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411 > Week 6: Pneumonia > Flashcards

Week 6: Pneumonia Flashcards

1
Q

4 major categories of microbes that cause disease

A

bacteria
fungi
parasites
viruses

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2
Q

99% of cultureable bacteria are

A

anaerobes

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3
Q

Minute ventilation definition

A

Amount of air inhaled or exhaled per minute

TV x RR

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4
Q

Alveolar ventilation definition

A

Amount of air reaching alveolus per minute

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5
Q

Dead space ventilation definition

A

Volume of air inhaled that does not take part in gas exchange

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6
Q

Anatomic deadspace definition

A

Total volume of conducting airways: mouth/nose to terminal bronchioles
~150 mL average

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7
Q

Alveolar deadspace definition

A

Volume of air in the alveolus that doesn’t participate in gas exchange

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8
Q

Physiologic deadspace definition

A

Sum of anatomic and alveolar deadspace

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9
Q

What 4 factors affect the diffusion transport of a gas from alveolar air to pulmonary capillary blood ?

A

Membrane thickness
Membrane surface area
Pressure difference across the membrane
Diffusion coefficient of gas

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10
Q

What are the 5 etiologies of hypoxemia ?

A 
Hypoventilation 
Ventilation perfusion mismatch (low VQ ratio)
Right to left shunt
Low FiO2
Diffusion impairment
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11
Q

Causes of hypoventilation

A

Impaired central drive
Spinal cord problems
Problems with nerve supplying resp muscle
Problems at neuromuscular junction
Problems with respiratory muscles (myopathy)
Defects in chest wall

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12
Q

Characteristics of hypoventilation

A

Good response to O2 therapy
P(A-a)O2 is usually normal
PaCO2 high

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13
Q

Most common cause of hypoxemia

A

VQ mismatch

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14
Q

What causes VQ mismatch ?

A

All lung diseases

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15
Q

What is the goal of hypoxia pulmonary vasoconstriction

A

Maintain matching between ventilation and perfusion by reducing perfusion to areas with reduced ventilation

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16
Q

Characteristics of right to left shunt

A

Poor response to O2 therapy
PCO2 normal
P(A-a)O2 is elevated

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17
Q

What can cause extremely short capillary transit time (a cause of diffusion impairment) ?

A

High cardiac output

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18
Q

Key anatomic components of the ventilatory pump

A

Respiratory muscles
Rib cage and abdomen
Cortical and brain stem that control ventilation
Neural connections

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19
Q

Describe airway branching

A

Trachea —> primary bronchi —> smaller bronchi —> bronchioles —> respiratory bronchioles —> alveolar ducts —> alveolar sacs

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20
Q

Type I vs Type II alveolar cells functions

A

Main site of gas exchange

Secrete surfactant

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21
Q

What 3 pressures is ventilation dependent on ?

A

Atmpspheric, alveolar, intrapleural

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22
Q

What happens during inspiration ?

A

Muscles contract —> increase thoracic volume —> decrease alveolar pressure —> air moves into the lungs

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23
Q

What 3 factors affect ventilation ?

A

Surface tension of alveolar fluid
Compliance of lungs
Airway resistance

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24
Q

What affect does surfactant have on surface tension ?

A

Increase surfactant —> decrease surface tension

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25
Q

What is lung compliance ?

A

How much effort is required to stretch the lungs and chest wall

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26
Q

Tidal volume definition

A

Amount of air inhaled or exhaled with each breath under resting conditions

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27
Q

inspiratory reserve volume definition

A

Amount of air that can be forcefully inhaled after a normal tidal volume inhalation

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28
Q

Expiratory reserve volume definition

A

Amount of air that can be forcefully exhaled after a Normal tidal volume exhalation

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29
Q

Residual volume definition

A

Amount of air remaining in the lungs after a forced expiration

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30
Q

Total lung capacity definition

A

Maximum amount of air contained in the lungs after a maximum inspiratory effort
TLC= TV+IRV+ERV+RV

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31
Q

Vital capacity definition

A

Maximum amount of air that can be expired after a maximum inspiratory effort
VC= TV + IRV + ERV

32
Q

Inspiratory capacity definition

A

IC = TV + IRV

33
Q

Functional residual capacity definition

A

FRC = ERV + RV

34
Q

Dalton’s Law

A

Partial pressures

35
Q

Henry’s Law

A

Quantity of gas that will dissolve in a liquid is proportional to the partial pressure of the gas and its solubility

36
Q

Two types of gas exchange and where they take place

A

Pulmonary
- occurs in alveoli
Systemic
- occurs between systemic capillaries and tissue cells

37
Q

Conducting structures of the respiratory system

A 
Nasal cavities 
Nasopharynx, oropharynx, larynx 
Trachea 
Bronchi 
Bronchioles
38
Q

Respiratory structures of the respiratory system

A 
Respiratory bronchioles 
Pulmonary alveoli 
- alveolar ducts 
-alveolar sacs 
-alveolus
39
Q

3 components of conducting airways

A

Mucosa
-epithelium, basement membrane, lamina propria
Submucosa
-loose connective tissue containing seromucous glands
Adventitia
- outer connective tissue layer
-binds airway to adjacent structures

40
Q

4 definable layers of the trachea

A 
Mucosa 
- respiratory epithelium 
Submucosa 
- seromucous glands 
Cartilaginous layer 
Adventitia 
- loose connective tissue
41
Q

Histological differences when bronchi enter the lungs

A

Rings of cartilage —> irregular cartilage plates

Circular of smooth muscle appears

42
Q

3 important functions of mucus

A

Traps bacteria, viruses and foreign material
Antimicrobial properties
Lubricates and protects

43
Q

Ways that pathogens can evade the immune system

A 
Intracellular invasion 
Capsule 
Antigenic variation 
Immune modulation 
Immune privileged sites
44
Q

Common signs and symptoms of infection

A

Fever (>38C)
Chills, rigours, sweats
Signs of inflammation: pain, erythema, swelling, pus
Lymphadenopathy
Weight loss, fatigue, poor energy and appetite
Typical skin changes or rash

45
Q

What are the “big 3” that have dramatically improved life expectancy over the past 100 years ?

A

Improved hygiene
Vaccines
Antibiotics

46
Q

4 main barriers to infection

A

Microbial
Chemical
Physical
Immunological

47
Q

What 3 factors should you consider when you are making a differential diagnosis

A

Host
Local epidemiology
Exposures

48
Q

Causes of pneumonia (mechanisms)

A

Aspiration
Droplet transmission
Hematogenous spread

49
Q

Top 3 typical causes of CAP

A

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

50
Q

Top 2 atypical causes of CAP

A

Mycoplasma pneumoniae

Chlamydophila pneumoniae

51
Q

Most common cause of CAP in infants and young children

A

Viral (RSV)

52
Q

5 common causes of HAP

A 
Strep p. 
H. Influenzae
Staph A. 
Pseudomonas 
Eneterobacteraciae
53
Q

Clinical presentation of pneumonia

A

Cough
Fever
Dyspnea
Abnormal lung exam: rales, rhonchi, dullness to percussion

54
Q

Laboratory data for pneumonia diagnosis

A

Elevated WBC
Abnormal CXR
Maybe respiratory sample

55
Q

Treatment for healthy outpatient with CAP

A

Amoxicillin or doxycycline

56
Q

Treatment for CAP outpatient with co-morbidities

A

Amoxicillin-clavulanate + azithromycin

57
Q

Treatment for CAP inpatient

A

Ceftriaxone + azithromycin

58
Q

Common Treatment for HAP or VAP

A

Pipercillin-Tazobactam +/- vancomycin

59
Q

Drugs for treatment of pseudomonas

A

PO: Ciprofloxin
IV: pip-taco, ceftazidime, cefepime, meropenem, imipenem

60
Q

What is the difference between gram positive bacilli and mycobacteria ?

A

Thicker cell wall
Waxy
Hydrophobic

61
Q

How long is pulmonary TB treatment ?

A

Minimum 6 months

62
Q

Steps to TB infection

A
  1. Droplet nuclei containing tubercle bacilli enter lungs and travel to alveoli
  2. Tubercle bacilli multiply in alveoli
  3. Small # of tubercle bacilli enter bloodstream —> spread through body
  4. Macrophages surround tubercle bacilli
  5. If immune system can’t contain —> rapid multiplication —> TB disease
63
Q

Basic viral structure

A

DNA or RNA genes
Capsid
Envelope (sometimes)
Protein molecules

64
Q

General viral lifecycle

A
  1. Attachment
  2. Entry
  3. Replication and gene expression
  4. Assembly
  5. Release
65
Q

Characteristics of Influenza

A 
Enveloped 
Single stranded (-) sense RNA
66
Q

Proteins on influenza

A

Hemagglutinin

Neuraminidase

67
Q

What affect do neuraminidase inhibitors have on viruses ?

A

Block replication

68
Q

3 main clinical presentations of adenovirus

A

Respiratory tract infection
Gastroenteritis
Conjunctivitis

69
Q

Pneumonia definition

A

Inflammation of the pulmonary parenchyma

70
Q

3 anatomical classifications of pneumonia

A

Lobar
Broncho
Interstitial

71
Q

Pneumonia predisposing factors (6)

A 
Suppression of cough 
Impaired systemic immunity 
Impaired mucociliary apparatus 
Impaired alveolar macrophage function 
Pulmonary edema 
General debility
72
Q

Pathological stages of lobar pneumonia

A

Congestion
Red hepatization
Grey hepatization
Resolution

73
Q

Characteristics of bronchopneumonia

A

Patchy infective consolidation of the lung in a predominantly lobular distribution
Usually bilateral

74
Q

Complications of bacterial pneumonia

A

Bacterial dissemination
Lung abscess formation
Empyema
Death

75
Q

Pathology of tuberculosis

A

Macroscopic appearance of cassation necrosis

Microscopic appearance of necrotizing granulomatous inflammation

76
Q

Pathology of fungal infection in immunocompromised host

A

Necrotizing pneumonia
Angioinvasion
Consequent tissue infarction
Systemic dissemination

411 (16 decks)

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