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OS 213 Respiratory EXAM 1 > LUNG DEFENSE MECHANISM > Flashcards

LUNG DEFENSE MECHANISM Flashcards

1
Q

Most common entry of microorganism into the lower RT?

A

Aspiration

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2
Q

Increase in aspirated volume

A

loss of control of the upper airway which should be patent in order to protect us from aspiration

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3
Q

2nd most common mode of infection

A

Inhalation

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4
Q

Infection that has spread to the lungs

A

Hematogenous spread

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5
Q

Non-pulmonary infection that spreads to the lungs

A

contiguous Extension

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6
Q

Mechanical components in lung defense

A
  1. Turbinates and nares -
  2. Branching architecture of tracheobronchial tree
  3. particle deposition in the RT
  4. Expulsive mechanism
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7
Q

Most important mechanism involved in protection of the respiratory tract

A

Mucociliary escalatory

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8
Q

Transport rate of Mucociliary escalator

A

3mm/min, becoming more rapid proximally

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9
Q

Conditions that can cause clearance impairment

A
  1. Advanced age
  2. Smoking
  3. Viral infections
  4. Pulmonary dysfunctions
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10
Q

Double layer of Mucus

A

External Gel Layer

Internal Sol layer

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11
Q

External Gel Layer

A

Viscous, elastic
traps and transport deposited particles
Loss of elasticity can impair clearance

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12
Q

Internal sol layer

A

Thin liquid where cilia can move easily

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13
Q

Mucus is more abundant where? proximally or distally?

A

proximally

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14
Q

Cilia

A

biphasic, periodic motion and strikes the gel with their tips

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15
Q

Presence of Normal Bacterial flora

A

adhere to the mucosal oropharynx and serve as protective organisms

Prevent the binding of pathogenic bacteria to mucosal areas

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16
Q

Most important defense mechanism in the alveolar level

A

Alveolar macrophages

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17
Q

Defenses at the alveolar level

A
  1. Alveolar macrophages
  2. lymphoid nodule
  3. lymphokines
  4. surfactants
  5. Immunoglobulins
  6. COmplement
  7. Chemotactic factors
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18
Q

Surfactant proteins

A

SP A and D
antiviral and antibacterial
capable of opsonization

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19
Q

Functions of alveolar macrophages

A
  1. phagocytosis
  2. possess immunologic form (T-lymphocytes)
  3. release cytokines to trigger inflammatory response
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20
Q

Enables macrophages to recruit and activate other inflammatory cells

A

Cytokines (LT B4 and IL 8)

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21
Q

Events that follow capillary leak

A

Hemoptysis
Radiographic infiltrates
Rales on physical examination

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22
Q

Factors Affecting Host Defense

A
  1. Medical Illness
  2. Immunosupression
  3. Cortocosteroids
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23
Q

Drugs that cause immunosupression

A 
ATG/ALG
OKT3
Corticosteroids
Cyclosporine
Azathioprine
Tacrolimus, Sirolimus
Mycophenolate Mofetil
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24
Q

Side effects of immunosuppression

A

Granulocytopenia
Bone marrow depression
Subtle changes on macrophages

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25
Q

Infections caused by chronic steroid intake

A 
TB
Legionella
Nocardia
Streptococci
Aspergillus, Candida
CMV, HSV, RSV
Pneumocystis
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26
Q

First line of defese against infection

A

innate immunity

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27
Q

Does not confer long lasting immunity

A

innate immunity

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28
Q

Initial response of innate immunity

A

limit infection, initiate specific or adaptive immune response

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29
Q

Found on the surface and within endosome of host cells

A

TLR

30
Q

LPS in g(-) are detected by

A

TLR4

31
Q

types of adaptive immune response

A

Cellular and humoral

32
Q

consists of T lymphocytes, macrophages, NK cells

A

Cellular immunity

33
Q

Recognizes and combats pathogens that proliferate intracellularly

A

Cellular immunity

34
Q

Components of the adaptive immune response

A

dendritic cells, macrophages, B lymphocytes

35
Q

CD8 (+)

A

cytotoxic T cells

36
Q

CD4 (+)

A

Helper T cells

37
Q

Stimulate inflammatory response

A

Cytokines

38
Q

RES

A

Monocyte-derived phagocytic cells

39
Q

Produced by B lymphocytes

A

Antibodies

40
Q

Immunoglobulin that predominates in the circulation

A

IgG

41
Q

Earliest specific antibody to appear in infetion

A

IgM

42
Q

Important in allergic and Parasitic disease

A

IgE

43
Q

monomeric IgA

A

Serum

44
Q

Have receptors for both antibody and C3b which aid in the clearance of infectious agents

A

PMN

45
Q

group of serum proteins that adhere to and in some cases disruot the surface of the invading organisms

A

Complement system

46
Q

Complement that acts as opsonin

A

C3b

47
Q

Complements that directly kill some bacterial invaders thru bacteriolysis

A

C7.8,9

48
Q

complement that acts as chemoattractants

A

C5a

49
Q

Pathways for complement activation

A

Classical, Alternative, Mannose binding

50
Q

IV drug USe

A

S aureus

51
Q

Risk of aspiration

A

Anaerobes

52
Q

HIV

A

Pneumocystis, CMV

53
Q

Alcoholic

A

Lung abscess

54
Q

HIV

A

Interstitial pneumonia

55
Q

Respiratory symptoms

A 
cough 90%
Expectoration 66%
Dyspnea 66%
Pleuritic Pain 50%
Hemoptysis 15%
56
Q

Community acquired pneumonia is present in 20 to 50% of those who have

A 
cough
fever
tachypnea
tachycardia
pulmonary crackles
57
Q

Typical CAP

A

Acute, chills, productive cough, purulent or bloody expectoration, pleuritic pain, consolidation by X-ray, crackles by PE, ELevated WBCs (neutrophils)

58
Q

Atypical CAP

A 
Legionella, mycoplasma, chlamydia
Gradual onset
Fever
Nonproductive cough
Systemic complaints more prominent than respiratory ones
Normal white count
59
Q

Elderly and immunocompromised

A

changes in sensorium, loss of appetite, electrolyte imbalance, history of falls, sleepiness, increased sleeping time, incontinence

60
Q

Specificity of Gram stain for pneumococcal pneumonia

A

> 80%

61
Q

Good sputum mechanism

A

EC <10/LPfF

PMN >25/LPF

62
Q

Blood cultures

A

at least 2

Overall yield : 20%

63
Q

Endotracheal aspirate

A

quantitative cultures

>105 CFU/ml = pneumonia

64
Q

CXR : whole Lobe

A

LOBAR

65
Q

CXR: bulging fissure sign

CUrrant jelly sputum

A

Lobar: Klebsiella

66
Q

CXR: Diffuse pattern

A

Bronchopneumonia

S. aureus, P aeruginosa, E. colu

67
Q

CXR: Blateral or symmetrical, lung abscess, and pneumatocoeles

A

Bronchial: Staphylococcal

68
Q

CXR: Reticular pattern

A

Interstitial

Mycoplasma and Viruses

69
Q

CXR: lung fluid level

A

Lung abscess

70
Q

CXR:apical

A

TB

OS 213 Respiratory EXAM 1 (19 decks)

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