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Respiratory System (CA) > 11. Pathology of Respiratory Tract Infection > Flashcards

11. Pathology of Respiratory Tract Infection Flashcards

1
Q

Which three factors make lung infections a multifactorial situation?

A

Microorganism Pathogenicity
Capacity to Resist Infection
Population at Risk

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2
Q

What are the three types of Microorganism Pathogenicity?

A

Primary
Facultative
Opportunistic

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3
Q

What are some examples of Upper Respiratory Tract infections?

A 
Coryza - Common Cold
Sore throat syndrome
Acute Laryngotracheobronchitis  (Croup)
Laryngitis
Sinusitis
Acute Epiglottitis
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4
Q

What causes Acute Epiglottitis?

A 
Group A beta-heamplytic Streptococci
Haemophilus influenza (Type B Hib)
(Rarely caused by Parainfluenza virus type 4 but other viruses may also be responsible)
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5
Q

What are some examples of Lower Respiratory Tract infections?

A 
Bronchitis
Bronchiolitis
Pneumonia
Consequences
Possible Complications
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6
Q

What are the Respiratory Tract’s defence mechanisms?

A 
Macrophage-mucociliary escalator system
General Immune system
- Humoral and Cellular Immunity
Respiratory Tract Secretions
Upper Respiratory Tract as a 'filter'
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7
Q

What increases the risk of respiratory tract infection?

A

Failure in any of the defence mechanisms

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8
Q

What is involved in the Macrophage-mucociliary escalator system?

A

Alveolar Macrophages
Mucociliary Escalator
Cough Reflex

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9
Q

What are the astrological classifications of Pneumonia?

A 
Community Acquired 
Hospital Acquired (Nosocomial)
Immunocompromised
Atypical 
Aspiration 
Reccurent
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10
Q

What are the patterns of Pneumonia?

A

Bronchopneumonia
Segmental
Lobar

Hypostatic
Aspiration
Obstructive, Retention, Endogenous Lipid

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11
Q

How can Bronchopneumonia be recognised?

A

Often bilateral basal patchy opacification, relating to the focal nature of the consolidation

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12
Q

What are the Outcomes/Complications of Pneumonia?

A

Most Resolve

If not, why?
Pleurisy, Pleural Effusion and Empyema
Organisation 
- Mass lesion
- COP (cryptogenic organsising pneumonia (BOOP))
- Constrictive Bronchiolitis 
Lung Abscess
Bronchiectasis

It is still a potentially fatal disease

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13
Q

What causes the Pathological dilation of Bronchi in Bronchiectasis?

A

Severe Infective Episode
Recurrent Infections - many causes
Proximal Bronchial Obstruction
Lung Parenchymal Destruction

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14
Q

What percentage of Bronchiectasis starts in childhood?

A

75%

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15
Q

What are the signs of chronic infection (Bronchiectasis)?

A

Cough
Adundant purulent foul sputum
Haemoptysis

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16
Q

What happens to the nails when a patient has Bronchiectasis?

A

Clubbing

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17
Q

What noise would be heard upon auscultation of lungs?

A

Coarse crackles

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18
Q

How would Bronchiectasis be identified?

A

Thin section CT

Previously Bronchography

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19
Q

How can Bronchiectasis be resolved?

A

Postural Drainage
Antibiotics
Surgery

20
Q

In recurrent lung infection, what would local bronchial obstruction indicate?

A

Tumour

Foreign Body

21
Q

In recurrent lung infection, what would local pulmonary damage indicate?

A

Bronchiectasis

22
Q

In recurrent lung infection, what would generalised lung disease indicate?

A

Cystic Fibrosis

COPD

23
Q

In recurrent lung infection, what would non-respiratory disease indicate?

A

Immunocompromised
(HIV, other)
Aspiration

24
Q

What are the causes of Aspiration Pneumonia?

A 
Vomiting
Oesophageal Lesion
Obstetric Anaesthesia
Neuromuscular Disorders
Sedation
25
What are opportunistic pathogens?
Organisms that cause infections that are not normally capable of producing disease in patients with intact lung defences
26
What are some examples of opportunistic pathogens?
Low grade bacterial pathogens CMV Pneumocystis Jirovecii Other fungi and yeasts
27
What are feature of Normal Pulmonary Gas Exchange?
Air flow in airways - Bulk flow – laminar or turbulent - Depends on pressure difference Beyond terminal bronchiole: Diffusion The Blood-Air barrier Hb affinity for oxygen means blood leaving capillary bed is 98% saturated for FIO2 of only 0.21 CO2 is VERY soluble and rapidly equilibrates between blood and air
28
In Abnormal Pulmonary Gas Exchange what are the normal PaO2 and PaCO2 levels?
PaO2 10.5-13.5 kPa | PaCO2 4.8-6.0 kPa
29
What are the statistics for PaO2 and PaCO2 in Type 1 Respiratory failure?
PaO2 <8 kPa | PaCO2 normal or low
30
What are the statistics for PaO2 and PaCO2 in Type 2 Respiratory Failure?
PaCO2 > 6.5 kPa | PaO2 usually low
31
What are the four abnormal states associated with Hypoxaemia?
Ventilation/Perfusion imbalance - V/Q Diffusion impairment Alveolar Hypoventilation Shunt
32
What are pulmonary vascular changes in Hypoxia?
Physiological pulmonary arteriolar vasoconstriction - When alveolar O2 tension falls - Localised effect - ALL VESSELS CONSTRICT IF THERE IS ARTERIAL HYPOXEMIA A protective mechanism - Do not send blood to alveoli short of O2
33
Pneumonia: Why hypoxaemia?
Ventilation/Perfusion abnormality (mismatch) - Bronchitis/Bronchopneumonia Shunt - Severe bronchopneumonia - Lobar pattern with large areas of consolidation
34
What Is normal breath, cardiac output and V/Q?
Breath ~4 l/min Cardiac output ~5 l/min V/Q 4/5 or 0.8
35
What is the commonest cause of Hypoxaemia that is encountered clinically?
Low V/Q
36
What causes low V/q in some alveoli?
Local alveolar hypoventilation due to some, focal disease
37
What does hypoxaemia due to low V/Q respond well to?
Small increase in FlO2
38
What does V/Q mismatch and Shunt mean for ventilation?
V/Q mismatch - Some ventilation of abnormal alveoli, just not enough Shunt - No ventilation of abnormal alveoli
39
What is shunt?
Blood passing from the right side of the heart to the left WITHOUT contacting ventilated alveoli
40
What is the normal Shunt percentage?
2-4%
41
Where is shunt prevalent?
AV malformations Congenital heart disease PULMONARY DISEASE
42
What do large shunts respond poorly to?
Increases in Fl O2
43
COPD: Why Hypoxaemia?
``` Ventilation / Perfusion abnormality (mismatch) - Airway Obstruction Alveolar Hypoventilation - Reduced Respiratory Drive Diffusion Impairment - Loss of Alveolar Surface Area Shunt - Only during acute exacerbation ```
44
What is alveolar hypoventilation?
Insufficient amount of air moved in and out of lungs
45
What happens during hypoventilation?
Hypoventilation increases PACO2, and thus increases PaCO2 Increase in PACO2 decreases PAO2, which causes PaO2 to fall Fall in PaO2 due to hypoventilation is corrected by raising FIO2 FlO2 = the fraction of Inspired air which is oxygen
46
What is Hypoxic Cor Pulmonale?
Hypertrophy of the Right Ventricle resulting from disease affecting the function and/or the structure of the lung

Respiratory System (CA) (32 decks)

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