2.3 Lower Respiratory Tract Infections

Question 1

What are the distributions of pneumonia?

Answer 1

Lobar (entire lobe)

Bronchopneumonia (scattered in multiple lobes)

Question 2

What are the 2 infectious agents of pneumonia?

Answer 2

Typical - bacteria (more common in adults)

Atypical - virus, mycoplasma (more common in children)

Question 3

most common and known as “walking pneumonia”

Answer 3

mycoplasma pneumoniae

Question 4

The inflammation of alveoli and bronchioles

Answer 4

Pneumonia

Question 5

What is the most common cause of death from infectious disease in the US?

Answer 5

Pneumonia

More likely to occur in immunocompromised individuals

Question 6

How does pneumonia usually bein?

Answer 6

with an URI

Question 7

A region of normally compressible lung tissue that is filled with liquid instead of air

Answer 7

Pulmonary consolidation

Question 8

How does pulmonary consolidation occur?

Answer 8

Through accumulation of inflammatory cellular exudate in the alveoli and adjoining ducts

Question 9

List some symptoms of typical pneumonia

Answer 9

sudden onset of malaise, chills, fever, productive cough, fine crackles.

Later symptoms include: rust colored sputum, pleuritic pain

Question 10

What is a prevention for typical pneumonia?

Answer 10

Pneumococcal vaccine

Question 11

What are some treatments for typical penumonia?

Answer 11

Appropriate antibiotics

Question 12

What causes atypical pneumonia?

Answer 12

Influenza, RSV

Question 13

Describe the pathophysiology of atypical pneumonia

Answer 13

patchy involvement, confined to alveolar septum and pulmonary interstitium

Question 14

Describe manifestations of atypical pneumonia

Answer 14

chest cold, fever, headache, muscle ache, cough, dry, hacking non productive coughs

Question 15

Mycoplasma pneumonia, also known as ____

Answer 15

Atypical pneumonia

Question 16

What are some treatments of atypical pneumonia?

Answer 16

Treatment only recommended in complex cases. However if mycoplasma atypical pneumonia:
macrolides, fluoroquinolones, tetracyclines

for viral: targeted antivirals

Question 17

World’s foremost cause of death from a single infectious agent

Answer 17

Tuberculosis

It is also the cause of 26% of avoidable deaths in developing countries

Many drug resistant forms

Question 18

Describe Mycobacterium tuberculosis hominis

Answer 18

Aerobic, rod shaped bacterium

Protective waxy capsule

Can stay alive in “suspended animation” for years

Question 19

How is tuberculosis spread?

Answer 19

Airborne

Question 20

Describe the events of an initial TB infection

Answer 20

Macrophages begin a cell-mediated immune response

This leads to cell-mediated immunity

Results in granulomatous lesions (Ghon complex) containing:

• macrophages
• T cells
• Inactive TB bacteria

Lung damage is more a result of the immune response than bacteria

Question 21

Nodules in the lung tissue and lymph node as a result of TB

Answer 21

Ghon complex

Question 22

Where is primary TB usually isolated?

Answer 22

In Ghon foci

Question 23

When primary TB is in the ghon foci, bacteria is ____

Answer 23

in active and not contagious

Question 24

What happens if immune response fails and primary TB is not isolated in the Ghon foci?

Answer 24

If immune response is inadequate, bacteria multiply in the lungs. This leads to progressive primary TB.

Question 25

What happens in miliary TB?

Answer 25

Bacteria may erode blood vessels and spread through the body

Question 26

This TB occurs because of a reinfection from inhaled droplet nuclei

Answer 26

Secondary TB

Question 27

Describe what happens in Secondary TB

Answer 27

Reactivation of previously healed primary lesion

Immediate cell-mediated response walls off infection in airways

Bacteria damage tissues in the airways, creating cavities

Question 28

What is a sign of chronic pneumonia?

Answer 28

Gradual destruction of lung tissue ; “Consumption”

Question 29

How do they test for TB?

Answer 29

Screening - Mantoux tuberculin skin test

Often called PPD - purified protein derivative

Question 30

A precipitate of species-nonspecific molecules obtained from filtrates of sterilized, concentrated cultures

Answer 30

Tuberculin

Question 31

If exposed to TB, what type of reaction occurs?

Answer 31

type IV delayed hypersensitivity

Question 32

Describe some symptoms of primary active TB

Answer 32

fever, weight loss, night sweats, fatigue, productive cough

Question 33

Classification: Antimycobacterial treatment

Isoniazid

Describe the Action

Answer 33

Interferes with lipid and nucleic acid synthesis in actively growing tubercle bacilli

Often used with other antimycobacterials to reduce resistance

Question 34

Classification: Antimycobacterial treatment

Isoniazid

Describe the Adverse Effects

Answer 34

peripheral neuropathies, n/v, hepatitis, bone marrow suppression, fever, local irritation at injection sites, gynecomastia, lupus syndrome

Question 35

Classification: Antimycobacterial treatment

Rifampin & Rifapentine

Describe the Action

Answer 35

Inhibit RNA synthesis by blocking RNA transcription

Administered orally, rifampin can be given IV

Question 36

Classification: Antimycobacterial treatment

Rifampin & Rifapentine

Describe the Adverse Effects

Answer 36

Steven johnson syndrome, TEN, N/V, hepatitis

Will cause orange-red discoloration of ALL body fluids

Question 37

Common lower airway infections in children & infants

Answer 37

Acute bronchiolitis due to Respiratory syncytial virus (RSV)

Question 38

Describe acute bronchiolitis in children/infants

Answer 38

Inflammatory obstruction of small airways and necrosis of cells lining lower airway

Increased airway resistance with decreased airflow

Inability to fully expire with air trapping

Decreased gas exchange in affected areas

Question 39

Describe acute bronchiolitis manifestations in children/infants

Answer 39

Preceded by stuffy nose

Followed by wheezy cough, dyspnea, irritability

Breathlessness, rapid shallow breathing

Complication: respiratory failure