Pathology of pulmonary infection

Question 1

what happened to the guy who had ravioli in his alveoli?

Answer 1

he pasta way

Question 2

what is a primary pathogenic microorganism?

Answer 2

very pathogenic and infects everyone regardless of health

Question 3

what is a opportunistic pathogenic microorganism?

Answer 3

uses immunosuppression to infect host (the organism is not normally capable of producing disease in patents with intact lung defences) (ex: low grade bacterial pathogens, CMV, pneumocystis jirovecii, other fungi and yeasts)

Question 4

is the respiratory tract sterile?

Answer 4

the upper one is not, the lower one is

Question 5

what is acute epiglottitis?

Answer 5

inflammation of the epiglottis, obstructing the respirator tract, is an upper respiratory tract infection

Question 6

what is a facultative microorganism?

Answer 6

may result to parasitic activity but does not rely on it’s host for the completion of its life cycle

Question 7

what does the capacity of a patient to resist an infection depend on?

Answer 7

state of host defence mechanisms, age of patients

Question 8

name 6 upper respiratory tract infections

Answer 8

• coryza (common cold)
• sore throat syndrome
• acute laryngotracheobronchitis
• laryngitis
• sinusitis
• acute epiglottis

Question 9

what bacteria can cause acute epiglottis?

Answer 9

groupe A beta-haemolytic streptococci
haemophilus influenza (type b- Hib)

Question 10

what virus can rarely cause acute epiglottis?

Answer 10

parainfluenza virus type 4, but not necessarily

Question 11

name 3 lower respiratory tract infections

Answer 11

bronchitis, bronchiolitis, pneumonia

Question 12

what is the respiratory tract defence mechanism composed of?

Answer 12

macrophage-mucocilliary escalator system, general immune system (humeral and cellular immunity), respiratory tract secretion

Question 13

how does the upper respiratory tract protect the lower one?

Answer 13

upper respiratory tract as a ‘filter’

Question 14

TRUE/FALSE patients will only get respiratory tract infection of all of the defence mechanisms fail

Answer 14

FALSE failure of any of these systems increases the risk of respiratory tract infection

Question 15

what are the components of the macrophage-mucocilliary escalator system?

Answer 15

it includes:

• alveolar macrophages
• mucociliary escalator
• cough reflex

Question 16

how does this system work in the ciliated airways?

Answer 16

clearance of particles via the muco-ciliary escalator (cilia push mucous-trapped particles up the airways)

Question 17

how does this system work in the smaller airways?

Answer 17

alveolar macrophages clear the particles by phagocytosis when these deposit on the terminal bronchioles/ proximal alveoli, then take the interstitial pathway via lymph to the lymph nodes

Question 18

what in the airways is lost with influenza?

Answer 18

bronchial epithelium lost

Question 19

what 3 ways are there of classifying pneumonia?

Answer 19

• anatomical (via radiology)
• aetiological (via circumstances, most useful)
• microbiological (most appropriate for treatment)

Question 20

what 6 different aetiological pneumonia are there?

Answer 20

• community acquired pneumonia
• hospital acquired (nocosomial) pneumonia
• pneumonia in the immunocompromised
• atypical pneumonia
• aspiration pneumonia
• recurrent pneumonia

Question 21

what is bronchopneumonia?

Answer 21

pneumonia in the middle? ‘often bilateral basal patch opacification relating to the focal nature of the consolidation’

Question 22

what is lobar pneumonia?

Answer 22

consolidation on one side only (one lung affected)

Question 23

what are the complications of pneumonia?

Answer 23

• pleurisy, pleural effusion, empyema
• lung abscess
• bronchiectasis
• mass lesion, constructive bronchiolitis, COP (cryptogenic organising pneumonia), all due to aspiration (inhaling food, liquids, or vomiting in lungs)
• death

Question 24

what happens to most pneumonias?

Answer 24

they just resolve

Question 25

what is a lung abscess?

Answer 25

obstructed bronchus because of tumour, aspiration of an object, particular organism (staph aureus, some pneumococci, Klebsiella), necrotic lung

Question 26

when can lung abscesses be metastatic?

Answer 26

in pyaemia (blood poisoning caused by the spread of pus-forming bacteria)

Question 27

what is bronchiectasis?

Answer 27

pathological dilatation of bronchi

Question 28

what causes bronchiectasis?

Answer 28

severe infective episode, recurrent infections, proximal bronchial obstruction, lung parenchymal destruction

Question 29

TRUE/FALSE most bronchiectasis start during adulthood

Answer 29

WRONG 75% start in childhood

Question 30

what are the symptoms of bronchiectasis?

Answer 30

cough, abundant purulent foul sputum, haemoptysis (coughing blood), signs of chronic infection, coarse crackles, clubbing

Question 31

how do you treat bronchiectasis?

Answer 31

thin section CT (previously bronchography), postural drainage, antibiotics, surgery

Question 32

what are the main causes of a local bronchial obstruction?

Answer 32

tumour, foreign body

Question 33

what are the main reasons for local pulmonary damage?

Answer 33

bronchiectasis

Question 34

what are the main reasons for a generalised lung disease?

Answer 34

cystic fibrosis, COPD

Question 35

what non-respiratory disease could eventually affect the respiratory tract?

Answer 35

anything which compromises the immune system (HIV…)

Question 36

what is aspiration pneumonia?

Answer 36

a lung infection developed after you aspirate food, liquid or vomit into your lungs

Question 37

how do you get aspiration pneumonia?

Answer 37

vomiting, oesophageal lesion, obstetric anaesthesia, neuromuscular disorders, sedation (basically anything that compromises the system that separates food from airways)

Question 38

is the airflow in airways laminar or turbulent?

Answer 38

depends on pressure difference, could be both

Question 39

where does diffusion in the airways happen?

Answer 39

beyond terminal bronchiole, in alveoli

Question 40

what is the minimum value of FIO2 to have 98% saturated Hb leave the capillary bed?

Answer 40

0,21

Question 41

why does CO2 rapidly equilibrate between blood and air?

Answer 41

because it is very soluble