pt13 Flashcards
(50 cards)
What is the most common cause of community-acquired lobar pneumonia?
Streptococcus pneumoniae
Name two patient groups at risk for bronchopneumonia.
Infants, elderly, and patients with chronic debilitating disease or immunosuppression
What are the cardinal clinical features of bacterial pneumonia?
Cough with purulent or “rusty” sputum, dyspnoea, pyrexia; signs of consolidation and pleural rub
Which bedside tests help confirm consolidation in pneumonia?
Dullness to percussion over the affected area and bronchial breath sounds on auscultation
What immediate management is indicated for community-acquired pneumonia?
Empirical antibiotics without waiting for culture results; modify once sensitivities available
List two complications of untreated bacterial pneumonia.
Lung abscess formation and empyema (pleural effusion with infected exudate)
Describe the Ghon complex in primary tuberculosis.
A combination of a peripheral lung granuloma and ipsilateral hilar lymph node involvement, often healing with calcification
What changes characterize secondary (post-primary) pulmonary TB?
Reactivation in apical lung zones with caseating necrosis in larger granulomas and fibrous scarring
How is miliary tuberculosis distinguished pathologically?
Hematogenous dissemination forming numerous small granulomas (“millet seed” pattern) in multiple organs
What prophylaxis and treatment regimen is used for TB?
BCG vaccination for prevention; combination therapy of 3–4 anti-TB drugs for 6–9 months to prevent resistance
What four features characterise COPD?
Poorly reversible airflow limitation, progressive course, persistent inflammatory response, includes chronic bronchitis and emphysema
At what age and in which population is COPD most commonly symptomatic?
Rarely symptomatic before middle age; common in UK smokers (18% of male, 14% of female smokers)
What is the dominant causal agent in COPD and a notable rare genetic cause?
Cigarette smoking; α₁-antitrypsin deficiency causes early-onset emphysema
Describe the pathological changes in chronic bronchitis.
Chronic airway inflammation (predominantly lymphocytes), enlarged mucus-secreting glands, airway narrowing and mucus hypersecretion
Describe the pathological changes in emphysema.
Destruction and dilatation of lung tissue distal to terminal bronchioles, loss of elastic recoil, air trapping and bullae formation
What are the hallmark symptoms and signs of severe COPD?
Cough, sputum, breathlessness, wheeze; severe cases show tachypnoea, accessory muscle use, hyperinflation, poor expansion, cyanosis, cor pulmonale
Which lung function test abnormalities confirm COPD?
↓ FEV₁ and ↓ FEV₁/FVC ratio
What chest X-ray and blood gas findings support COPD?
Hyperinflated lungs on X-ray; arterial blood gases may show hypoxia and hypercapnia
What are the mainstays of COPD treatment?
Smoking cessation; bronchodilators (β₂-agonists, antimuscarinics), corticosteroids, antibiotics, management of respiratory failure and cor pulmonale
What is the 5-year prognosis for severe COPD with breathlessness?
Approximately 50% mortality within five years
What three characteristics define asthma?
Variable airflow limitation (often reversible), airway hyper-responsiveness, chronic bronchial inflammation
How does asthma epidemiology vary geographically?
Increasing prevalence overall; more common in developed countries, much rarer in Far Eastern countries
What are the two major aetiological categories in asthma?
Atopic/allergic (IgE-mediated) and non-atopic (intrinsic hyper-responsiveness to stimuli)
Which cells and processes drive asthma pathogenesis?
Eosinophils, T-lymphocytes, macrophages and mast cells release mediators causing bronchoconstriction, inflammation and airway remodelling
