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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
What is lung compliance ?
How much effort is required to stretch the lungs and chest wall
26
Tidal volume definition
Amount of air inhaled or exhaled with each breath under resting conditions
27
inspiratory reserve volume definition
Amount of air that can be forcefully inhaled after a normal tidal volume inhalation
28
Expiratory reserve volume definition
Amount of air that can be forcefully exhaled after a Normal tidal volume exhalation
29
Residual volume definition
Amount of air remaining in the lungs after a forced expiration
30
Total lung capacity definition
Maximum amount of air contained in the lungs after a maximum inspiratory effort TLC= TV+IRV+ERV+RV
31
Vital capacity definition
Maximum amount of air that can be expired after a maximum inspiratory effort VC= TV + IRV + ERV
32
Inspiratory capacity definition
IC = TV + IRV
33
Functional residual capacity definition
FRC = ERV + RV
34
Dalton’s Law
Partial pressures
35
Henry’s Law
Quantity of gas that will dissolve in a liquid is proportional to the partial pressure of the gas and its solubility
36
Two types of gas exchange and where they take place
Pulmonary - occurs in alveoli Systemic - occurs between systemic capillaries and tissue cells
37
Conducting structures of the respiratory system
``` Nasal cavities Nasopharynx, oropharynx, larynx Trachea Bronchi Bronchioles ```
38
Respiratory structures of the respiratory system
``` Respiratory bronchioles Pulmonary alveoli - alveolar ducts -alveolar sacs -alveolus ```
39
3 components of conducting airways
Mucosa -epithelium, basement membrane, lamina propria Submucosa -loose connective tissue containing seromucous glands Adventitia - outer connective tissue layer -binds airway to adjacent structures
40
4 definable layers of the trachea
``` Mucosa - respiratory epithelium Submucosa - seromucous glands Cartilaginous layer Adventitia - loose connective tissue ```
41
Histological differences when bronchi enter the lungs
Rings of cartilage —> irregular cartilage plates | Circular of smooth muscle appears
42
3 important functions of mucus
Traps bacteria, viruses and foreign material Antimicrobial properties Lubricates and protects
43
Ways that pathogens can evade the immune system
``` Intracellular invasion Capsule Antigenic variation Immune modulation Immune privileged sites ```
44
Common signs and symptoms of infection
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
What are the “big 3” that have dramatically improved life expectancy over the past 100 years ?
Improved hygiene Vaccines Antibiotics
46
4 main barriers to infection
Microbial Chemical Physical Immunological
47
What 3 factors should you consider when you are making a differential diagnosis
Host Local epidemiology Exposures
48
Causes of pneumonia (mechanisms)
Aspiration Droplet transmission Hematogenous spread
49
Top 3 typical causes of CAP
Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis
50
Top 2 atypical causes of CAP
Mycoplasma pneumoniae | Chlamydophila pneumoniae
51
Most common cause of CAP in infants and young children
Viral (RSV)
52
5 common causes of HAP
``` Strep p. H. Influenzae Staph A. Pseudomonas Eneterobacteraciae ```
53
Clinical presentation of pneumonia
Cough Fever Dyspnea Abnormal lung exam: rales, rhonchi, dullness to percussion
54
Laboratory data for pneumonia diagnosis
Elevated WBC Abnormal CXR Maybe respiratory sample
55
Treatment for healthy outpatient with CAP
Amoxicillin or doxycycline
56
Treatment for CAP outpatient with co-morbidities
Amoxicillin-clavulanate + azithromycin
57
Treatment for CAP inpatient
Ceftriaxone + azithromycin
58
Common Treatment for HAP or VAP
Pipercillin-Tazobactam +/- vancomycin
59
Drugs for treatment of pseudomonas
PO: Ciprofloxin IV: pip-taco, ceftazidime, cefepime, meropenem, imipenem
60
What is the difference between gram positive bacilli and mycobacteria ?
Thicker cell wall Waxy Hydrophobic
61
How long is pulmonary TB treatment ?
Minimum 6 months
62
Steps to TB infection
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
Basic viral structure
DNA or RNA genes Capsid Envelope (sometimes) Protein molecules
64
General viral lifecycle
1. Attachment 2. Entry 3. Replication and gene expression 4. Assembly 5. Release
65
Characteristics of Influenza
``` Enveloped Single stranded (-) sense RNA ```
66
Proteins on influenza
Hemagglutinin | Neuraminidase
67
What affect do neuraminidase inhibitors have on viruses ?
Block replication
68
3 main clinical presentations of adenovirus
Respiratory tract infection Gastroenteritis Conjunctivitis
69
Pneumonia definition
Inflammation of the pulmonary parenchyma
70
3 anatomical classifications of pneumonia
Lobar Broncho Interstitial
71
Pneumonia predisposing factors (6)
``` Suppression of cough Impaired systemic immunity Impaired mucociliary apparatus Impaired alveolar macrophage function Pulmonary edema General debility ```
72
Pathological stages of lobar pneumonia
Congestion Red hepatization Grey hepatization Resolution
73
Characteristics of bronchopneumonia
Patchy infective consolidation of the lung in a predominantly lobular distribution Usually bilateral
74
Complications of bacterial pneumonia
Bacterial dissemination Lung abscess formation Empyema Death
75
Pathology of tuberculosis
Macroscopic appearance of cassation necrosis | Microscopic appearance of necrotizing granulomatous inflammation
76
Pathology of fungal infection in immunocompromised host
Necrotizing pneumonia Angioinvasion Consequent tissue infarction Systemic dissemination

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