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CR3 > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

What kind of infections is the respiratory tract prone to?

A

Air borne infections

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2
Q

Terms for an infection of the lung

A

Pneumonia or Pneumonitis

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3
Q

How many L of air inhaled each day?

A

10,000L

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4
Q

Where and how many bacterial microns are held in the respiratory tract?

A
  • > 10 in upper airways
  • 3-10 trapped in tracheobronchial mucus
  • 1-5 deposited in terminal airways and alveoli
  • <1 in suspended alveolar air as exhaled
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5
Q

Defence mechanisms of the respiratory tract

A
  • nasal clearance
  • mucociliary action in tracheobronchials
  • alveolar macrophages
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6
Q

What can suppress the cough reflex?

A
  • coma
  • anaesthesia
  • drugs
  • chest pain
  • neuromuscular disease
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7
Q

What can injure the mucociliary apparatus?

A
  • smoking
  • inhalation of hot/corrosive gases
  • congenital
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8
Q

What can disturb macrophage function?

A
  • smoking
  • alcohol
  • anoxia
  • O2 toxicity
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9
Q

What other things can disturb normal lung defence?

A
  • pulmonary congestion
  • pulmonary oedema
  • accumulation of secretions
  • general immune suppression
  • unusually virulent organisms
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10
Q

Define pneumonia

A

Alveolar inflammation due to lung infection

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11
Q

3 types of pneumonia

A
  • lobar
  • bronchopneumonia
  • atypical pneumonia
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12
Q

Lobar pneumonia features

A
  • affects large part of lobe or entire
  • previously healthy males age 20-50
  • 90% strep penumonie cause
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13
Q

Clinical features of lobar pneumonia

A
  • high grade fever with rigors
  • productive cough
  • rusty sputum
  • pleuritic chest pain
  • signs of consolidation
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14
Q

4 stages of lobar pneumonia

A
  • congestion
  • red hepatisation
  • grey hepatisation
  • resolution
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15
Q

Congestion stage of lobar pneumonia

A
  • first
  • 24 hours
  • vessels engorged
  • alveolar oedema
  • heavy red lung
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16
Q

Red hepatisation in lobar pneumonia

A
  • 2-4 days
  • outpouring neutrophils and RBCs into alveoli
  • red, solid, airless, liver like lung
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17
Q

Grey hepatisation in lobar pneumonia

A
  • 4-8 days
  • fibrin and macrophages replace neutrophils and RBCs
  • grey, solid, airless lung
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18
Q

Resolution stage in lobar pneumonia

A
  • last
  • 8-10 days
  • gradual return to normal
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19
Q

Complications of lobar pneumonia

A
  • lung abscess
  • empyema
    (rare but more likely with Klebsiella or Staph infections)
20
Q

What is the commonest type of pneumonia?

A
  • bronchopenumonia
21
Q

What does bronchopneumonia begin as?

A
  • bronchitis and bronchiolitis

- then spreads to alveoli

22
Q

Bacteria causing bronchiolitis

A
  • staph
  • strepto viridans
  • H influenzae
  • pseudomonas
  • coliforms
23
Q

4 typical clinical settings of bronchopneumonia

A
  • infancy
  • old age
  • secondary to viral infection
  • chronic debilitating illness
24
Q

Pathology of bronchopneumonia

A
  • bilateral
  • basal
  • patchy
  • grey/grey-red spots of consolidation
  • microscopic = acute inflammatory infiltrate in bronchioles and alveoli
25
Q

Complications of bronchopneumonia

A
  • death (as usually old age or debilitating illness)
  • resolution
  • scarring
  • abscess/empyema (rare)
26
Q

Differences between lobar and bronchopneumonia

A

lobar = Afflicts large portion or entire lobe vs.
Patchy, usually bilateral basal distribution
Previously healthy individuals vs. Pre-existing suppressed immune defense
90-95% Streptococcus pneumoniae vs. Any pathogen (staph, strept, pneumo, hamophilus, pseudomonas, coliforms) Xray and clinical signs: Complete lobar opacity vs. Xray: Focal opacities; clinical signs less pronounced
Generally complete resolution vs.
Variable; often fatal; determined by preexisting illness

27
Q

Most important distinctions between lobar and bronchopneumonia?

A
  • identifying causative agent

- extent of disease

28
Q

Features of interstitial pneumonia

A
  • patchy or extensive

- congested/subcrepitant lungs

29
Q

Site of inflammation in interstitial pneumonia

A
  • alveolar septa and interstitial tissues
30
Q

Why is interstitial pneumonia atypical?

A
  • no/minimal alveolar exudate
31
Q

Causative agents of interstitial pneumonia

A
  • mycoplasma pneumoniae
  • influenza A and B
  • rhino
  • rubeola
  • varicella
  • chlamydia
  • coxiella
  • undetermined often
32
Q

Predisposing conditions to interstitial pneumonia

A
  • malnutrition
  • alcoholism
  • debilitating illnesses
33
Q

Clinical presentation of interstitial pneumonia

A
  • variable
  • general symptoms
  • sporadic change from mild to self limiting
  • secondary bacterial infections common
34
Q

Cause of pulmonary TB

A
  • Mycobacterium tuberculosis or M bovis infecting the lungs
35
Q

Commonest site of TB

A

Lungs

36
Q

Why is there a UK rise in pulmonary TB cases

A

HIV rise
immunosuppression
low socioeconomic status
drug resistance

37
Q

What does clinical pulmonary TB represent?

A
  • reinfection or reactivation

- rarely progressive primary TB

38
Q

Pathogenesis of TB

A

See video/last year

39
Q

Primary TB

A
  • response to first contact with tubercle bacilli
  • asymptomatic
  • Ghon complex = 1cm focus in midzone with draining lymph node
  • fibrosis and calcification heals
40
Q

Secondary TB

A
  • reinfection or reactivation
  • sometimes progressive primary TB
  • bacteria relocate to oxygen rich areas
  • usually apical about 3cm
41
Q

Microscopic pathology of TB

A
  • Type 4 hypersensitivity
  • granulomas with caseous necrosis, langhan’s giant cells, epithelioid macrophages
  • acid fast bacilli with Ziehl-Neelsen
42
Q

What provides definitive diagnosis of TB

A

sputum culture

43
Q

Complications of pulmonary TB

A
  • progressive fibrocavitary = destroying lungs through necrosis, cavitation and fibrosis
  • military TB = bloodborne dissemination within lung or throughout body, throughout body = meninges, bone marrow, liver
44
Q

Fungal infections

A
  • in immunocompromised
  • HIV = pneumocystis carinii
  • histoplasma, coccidio, candida, aspergillus, mucor, cryptococcus
45
Q

Aspiration pneumonia

A
  • route of infection via aspiration or blood borne

CR3 (30 decks)

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