Quiz 1 Flashcards
Because Steve is probably going to ask and you haven’t thought about the dyspnea pyramid since December because fuck that thing, what are the parts that make up the base of the pyramid?
Lungs
Vasculature
Airways
Alveoli
Parenchyma
Pleura
Diaphragm
What constitutes the middle of the dyspnea pyramid and what are its components?
Heart
Valves
Plumbing
Pump
Wiring
What constitutes the top of the dyspnea pyramid and what are its components?
Anemia
Anxiety
Acidosis
Neuromuscular weakness
What is a significant distinction between CAP and NAP?
CAP is commonly caused by a set of pathogens that respond to certain drug combinations. Pathogens that are associated with NAP tend to be more difficult to treat as they were acquired in a hospital setting and are therefore more likely to have drug-resistance
What is the story with Health care associated PNA and why do we give a shit?
Category introduced in 2005 with the goal of producing guidelines on nosocomial PNA that would produce criteria which could be utilized to identify patients at risk for developing NAP and treat them accordingly
Didnt fucking work, is no longer a thing. Some people dont know this. Educate them.
A disease process that causes inflammation and affects the gas exchange areas of the lungs which is most commonly caused by infection is called what?
Pneumonia (PNA)
Describe pneumonia
An inflammatory process that primarily affects gas exchange areas of the lungs and is most frequently caused by infection
PNA comes in a lot of flavors. What are some of the most common categories of PNA?
Community acquired PNA (CAP)
Nosocomial PNA (NAP?)
Hospital Acquired PNA (HAP)
Ventilator associated PNA (VAP)
Describe prevalence in regards to epidemiology
The term for the number of people in a given population with the disease
Describe incidence in relation to epidemiology
The rate at which a disease appears
Number of cases per given time period in a given population in a given area
Describe the mortality rates associated with CAP
7% of hospitalized patients
12% of hospitalized patients over the age of 65
Why do we care so much about preventing patients from getting pneumonia in a hospital setting?
Contracting PNA in the hospital particularly post-op significantly increases mortality rates particularly in geriatric populations and we already have enough issues with stupid people not believing medicine works
T/F: the worldwide leading cause of mortality in infants and children is dark wizards with grudges
False. PNA is the worldwide leading cause of mortality in children and infants
Which populations are most at risk for dying from PNA or PNA related complications?
Infants or young children
Geriatric patients
T/F: Lung diseases such as COPD, bronchiectasis and asthma do not increase the risk of CAP
False. Lung diseases such as COPD bronchiectasis and asthma significantly increase the risk of CAP
What non-respiratory comorbidities increase the risk of CAP
Congestive heart failure
Stroke
Diabetes mellitus
Malnutrition
Immunocompromise
T/F: PNA can result from viral respiratory tract infections
True.
Can result in viral pneumonia and secondary bacterial pneumonia
How does impaired airway protection increase CAP risk?
Impaired airway protection can result in micro/macroaspirations which can lead to infection resulting in PNA
Macroaspiration refers to what?
Aspiration of stomach contents
Yummy yummy
Microaspiration refers to what?
Aspiration of upper airway secretions
What can cause impaired airway protection?
Stroke
Seizure
Anesthesia
Drug use
Alcohol use
Medication for sleep
What is dysphagia?
Medical condition characterized by difficulty swallowing
What can cause dysphagia?
Stroke
Esophageal lesions
Dysmotility
What is dysmotility?
Dysmotility is a condition where the muscles and nerves of the digestive system do not work as they should
Why do we care about whether or not a patient has dysphagia?
Difficulty swallowing could result in accidental aspirations increasing the risk for PNA
How is gastroesophageal reflux disease (GERD) related to PNA?
GERD affects the sphincter that separates the the esophagus from the stomach which can result in stomach contents leaking back up into the esophagus where they can potentially be aspirated
What are examples of modifiable risk factors that could increase your chances on contracting PNA?
Drug use (Smoking, alcohol, opioids)
Living conditions (prisons, homeless shelters)
Low income residences
Environmental toxins (solvents, paints, gasoline smoke, fumes)
T/F: combinations of risk factors regarding CAP result in exponential increases in risk of contracting PNA
False. Combinations of risk factors are additive
What is etiology?
The study or theory of the factors that cause disease and the method of their introduction to the host
AKA what causes the disease and how poor saps get it
Describe the first model for pathogenesis of PNA in the alveoli
Pathogens arrive in alveolar space
Pathogens multiply
Alveolar macrophages produce cytokines
Cytokines result in recruitment of neutrophils into alveolar space and cytokines into systemic circulation
Lungs fill up with crap as capillary permeability increases to allow WBCs in to fight infection
Describe the second model for pathogenesis of PNA in the alveoli
The balance between microbial elimination and microbial immigration is tipped in the favor of immigration resulting in infections
What are the defensive “forces” that prevent microbial immigration?
Nostrils filtering crap out
Coughing crap up
Mucociliary escalator moving crap out
Commensal microbes inhibiting pathogen growth
Innate and adaptive host defenses
How do commensal microbes inhibit pathogen growth?
Commensal microbes crowd out the pathogen and take up resources that the pathogen would require to multiple
What are “offensive forces” that aid in microbial immigration
Inhalation
Aspiration
Direct inoculation
Hematogenous spread (spread in the blood)
Activation of dormant infection
Loss of commensal microbes
What are the leukocytes that primarily respond to a bacterial infection in the alveoli?
Neutrophils - kill invaders
Macrophages - remove cellular debris (and kill)
What does the inflammation associated with PNA result in?
Pulmonary capillaries become leaky allowing serum and cells into the alveoli resulting in infiltrates
What is the fancy name for the leukocytes that enter the alveoli as a result of PNA?
Polymorphonuclear leukocytes
Neutrophils, eosinophils and basophils are all examples of what kind of leukocyte?
Polymorphonuclear leukocytes
What do the alveoli fill with during a PNA?
Fluid
RBCs
Polymorphonuclear leukocytes
Macrophages
Alveoli that have been filled with fluid, RBCs, polymorphonuclear leukocytes and macrophages are described as what?
Consolidated
What is the main effect of alveolar consolidation?
Compromised gas exchange
Why is the location of pneumonia an important factor?
Location can be a clue as to the type of pneumonia
A PNA that is limited to the segmental bronchi and surrounding lung parenchyma?
Bronchopneumonia
Describe bronchopneumonia
A PNA that is limited to the segmental bronchi and surrounding lung parenchyma
What happens to the AC membrane with PNA?
The thickness increases which decreases gas exchange
Think ficks law
T/F: Pneumonia does not cause atelectasis
False, consolidation within the alveoli can cause atelectasis