Pathology of Respiratory Tract/Pulmonary Infection

Question 1

Healthy people are mainly infected by…

Answer 1

Viruses or aggressive organisms

Question 2

What are the types of mico-organism pathogenicity/ different types of pathogens?

Answer 2

Primary
Faculative
Opportunistic

Question 3

What does a patients capacity to resist infection rely on?

Answer 3

State of the hosts defence mechanisms

Age of patient

Question 4

What effect will being immunocompromised have on a patient’s likelihood to have an infection?

Answer 4

It increases the patient’s susceptibility (particularly from opportunistic pathogens)

Question 5

What are the most common URTIs?

Answer 5

Coryza -common cold
Sore throat syndrome
Acute 
Laryngotracheobronchitis (croup)
Laryngitis
Sinusitis
Acute epigottitis

Question 6

As a result of vaccination, what pathogen is increasingly responsible for acute epiglottitis?

Answer 6

Group A beta-haemolytic streptococci

Question 7

What are the most common lower respiratory tract infections?

Answer 7

Bronchitis
Bronchiolitis
Pneumonia

Question 8

What is the main respiratory tract defence mechanism?

Answer 8

The macrophage-mucociliary escalator system

Question 9

What are some other defences the respiratory tract uses against infection?

Answer 9

General immune system - Humoral and cellular immunity

Respiratory tract secretions
Upper respiratory tract as a filter

Question 10

What can failure in any of these systems lead to?

Answer 10

An increased risk of a respiratory tract infection

Question 11

In normal conditions, is the lower respiratory tract sterile or non-sterile?

Answer 11

Sterile

Question 12

What cells trap dirt allowing it to be removed from the lower respiratory tract?

Answer 12

Alveolar macrophages

Question 13

What is the function of the cillated cells in the respiratory tract?

Answer 13

To carry a layer of mucous upwards on the mucociliary escalator from the lower respiratory tract to the larynx

Question 14

What happens to the mucous layer with dirt or foreign particles once it is swept up via mucociliary escalatory into the larynx?

Answer 14

It’s swallowed or spat out

Question 15

What infection is fatal to people in a flu epidemic due to disruption of the mucociliary escalator?

Answer 15

Secondary bacterial infection

Question 16

What is a big danger of cellular bronchitis, especially in small children?

Answer 16

Inflammatory exudate produced during infection can close off the airway very rapidly

Question 17

What 3 categories can you class pneumonia into?

Answer 17

Anatomical
Aetiological
Microbiological

Question 18

Microbiological classification is useful because…

Answer 18

Allows you to confirm what organism is causing infection and can plan appropriate treatment

Question 19

Under what headings can pneumonia be classed, aetiologically?

Answer 19

Community Acquired Pneumonia

Hospital Acquired (Nosocomial) Pneumonia

Pneumonia in the Immunocompromised

Atypical Pneumonia
Aspiration Pneumonia
Recurrent Pneumonia

Question 20

What is the most common aetiological classification of pneumonia?

Answer 20

Community acquired pneumonia

Question 21

What two aetiological classes of pneumonia are generally caused by aggressive organisms?

Answer 21

Community and Hospital acquired

Question 22

What aetiological class of pneumonia is caused by abnormal organisms?

Answer 22

Atypical Pneumonia

Question 23

If a patient has a pneumonia infection alongside another condition (e.g. cardiac failure), what can it lead to?

Answer 23

Accumulation of secretions making it difficult to clear the infection

Question 24

What anatomical distributions/patterns of pneumonia are there?

Answer 24

Bronchopneumonia Segmental Pneumonia  Lobar Pneumonia
Hypostatic P
Aspiration P
Obstructive P
Retention P
Endogenous lipid P

Question 25

What does bronchopneumonia display as?

Answer 25

Displays acute inflammation at a pathological level Has spots of infection and formation of pus in the lungs

Question 26

What is seen on a chest x-ray of a patient with bronchopneumonia that relates to the focal nature of consolidation?

Answer 26

Bilateral basal patchy opacification

Question 27

What is consolidation

Answer 27

The replacement of air in the lungs by another substance

Question 28

What is seen in lobar pneumonia?

Answer 28

Consolidation/infection of an entire lobe

Question 29

ilateral basal patchy opacification

Answer 29

The aggresiveness

Question 30

What are some complications of pneumonia?

Answer 30

``` Pleurisy, Pleural Effusion and Empyema Organisation Constrictive bronchiolitis Lung Abscess Bronchiectasis ``` Pneumonia is still a potentially fatal disease

Question 31

What can organisation lead to?

Answer 31

Mass lesions Cryptogenic organizing pneumonia/ COP (BOOP) Constrictive bronchiolitis

Question 32

Cause of organising pneumonia?

Answer 32

Bronchopneumonia turning into fibrosis

Question 33

What does BOOP stand for?

Answer 33

Bronchioloitis Obliterans Organising Pneumonia

Question 34

10% of patients presenting with a lung abscess will have what?

Answer 34

An underlying tumour

Question 35

Lung abscess can result from the obstruction of what structure?

Answer 35

The bronchus

Question 36

What 3 pathogens cause lung abscesses?

Answer 36

Staph aureus | Some pneumococci Klebsiella

Question 37

What is Bronchiectasis?

Answer 37

A severe dilation of bronchi

Question 38

What causes Bronchiectasis?

Answer 38

Severe Infective Episode Recurrent Infections Proximal Bronchial Obstruction Lung Parenchymal Destruction

Question 39

When is bronchiectasis most common?

Answer 39

Childhood

Question 40

What are the symptoms of a chronic bronchiectasis infection?

Answer 40

Cough Haemoptysis Abundant, purulent, foul sputum

Question 41

What are the main treatments for bronchiectasis?

Answer 41

Postural drainage Antibiotics | Surgery

Question 42

What might cause local bronchial obstruction and lead to recurrent lung infection?

Answer 42

Tumours | Foreign Bodies

Question 43

What local pulmonary damage is a common cause of recurrent lung infections?

Answer 43

Bronchiectasis

Question 44

What generalised lung disease is a common cause of recurrent lung infection?

Answer 44

COPD | Cystic Fibrosis

Question 45

In what kind of patients might non-respiratory disease cause recurrent lung infection?

Answer 45

Immunocompromised

Question 46

What causes aspiration Pneumonia?

Answer 46

Vomit traveling down the trachea and into the lung

Question 47

What section of the lung is most common affected by aspiration pneumonia?

Answer 47

Apical segment of the right lower lobe

Question 48

What type of pneumonia might affect someone after excessive alcohol consumption?

Answer 48

Aspiration pneumonia

Question 49

What can oesophageal diseases/leasions lead to?

Answer 49

Aspiration pneumonia

Question 50

What is an opportunistic lung infection

Answer 50

An infection caused by organisms not normally capable of producing disease in patients with functioning lung defences

Question 51

Opportunistic infections are most common in what patients?

Answer 51

Immuno-compromised

Question 52

What two things can bulk flow in airways be?

Answer 52

Laminar or turbulent

Question 53

What does the air flow in airways depend on?

Answer 53

The pressure difference

Question 54

What does turbulent flow in the upper respiratory tract do to inhaled air?

Answer 54

Humidifies/warms it

Question 55

Pulmonary gas exchange occurs at what barrier?

Answer 55

Blood-air barrier

Question 56

Gas moves by diffusion beyond...

Answer 56

Terminal bronchiole

Question 57

What is Type I respiratory failure?

Answer 57

Failure to maintain arterial partial pressure of oxygen above 8 kPa PaCO2 is usally normal or low

Question 58

What is Type II respiratory failure?

Answer 58

Failure to remove CO2, so PaCO2 is above 6.5kPa PaO2 is usually low

Question 59

Four abnormal states are associated with Hypoxaemia are....

Answer 59

Ventilation / Perfusion imbalance - V/Q Diffusion impairment Alveolar Hypoventilation Shunt

Question 60

What pulmonary vascular change occurs in hypoxia?

Answer 60

Pulmonary arteriolar vasoconstriction

Question 61

Pulmonary arteriolar vasoconstriction occurs when...

Answer 61

When alveolar oxygen tension falls

Question 62

Alveolar oxygen tension falling can be a...

Answer 62

Localised effect

Question 63

Do all vessels constrict if there is arterial hypoxaemia?

Answer 63

Yes

Question 64

Why do vessels constrict?

Answer 64

As a protective mechanism - so blood is not sent to alveoli short of oxygen

Question 65

In Hypoxia, what changes will occur in the amount of blood going to the abnormal lung?

Answer 65

Blood going to abnormal lung will be reduced when compared to normal

Question 66

Outside lung disease - when might hypoxia occur?

Answer 66

At high altitudes with minimal O2

Question 67

Severe bronchopneumonia can cause what abnormal state associated with Hypoxaemia?

Answer 67

Shunt

Question 68

Bronchitis and Bronchopneumonia can cause what abnormal state associated with Hypoxaemia?

Answer 68

Ventilation/Perfusion abnormality (mismatch)

Question 69

What is hypoxaemia?

Answer 69

An abnormally low concentration of oxygen in the blood.

Question 70

To what abnormal state would treating with 100% oxygen make no difference due to no ventilation?

Answer 70

Shunt

Question 71

What is the most common cause of hypoxaemia encountered clinically?

Answer 71

Low Ventilation/Perfusion (V/Q) mismatch

Question 72

Hypoxaemia due to low V/Q responds well to small increases in what?

Answer 72

FlO2

Question 73

Shunt is...

Answer 73

Blood passing from the right to left side of the heart without contacting ventilated alveoli

Question 74

What are the common causes of Hypoxaemia in COPD?

Answer 74

Ventilation/Perfusion abnormality Alveolar hypoventilation Diffusion impairment Shunt

Question 75

When would a ventilation/perfusion mismatch occur?

Answer 75

Airway obstruction

Question 76

When could alveolar hypo-ventilation occur?

Answer 76

With a reduced respiratory drive

Question 77

When would diffusion impairment occur?

Answer 77

Loss of alveolar surface area

Question 78

When does a shunt occur?

Answer 78

Only during acute exacerbation

Question 79

What would the cause of hypoxaemia likely be in a patient with chronic COPD? Why?

Answer 79

Alveolar hypoventilation (as breaths per minute are decreased and CO2 retained)

Question 80

What is alveolar hypo-ventilation?

Answer 80

An insufficient amount of air moved in and out of the lungs

Question 81

What effect does hypoventilation have on PACO2, PaCO2, PAO2 and PaO2?

Answer 81

PACO2 - increases PaCO2 - increases PAO2 - decreases PaO2 - decreases

Question 82

Fall in PaO2 due to hypoventilation can be corrected by raising what?

Answer 82

FIO2

Question 83

What is FIO2

Answer 83

The fraction of inspired air which is O2

Question 84

Why can chronic hypoxia lead to pulmonary hypertension?

Answer 84

Causes bone marrow to produce more red blood cells which makes blood more viscous and difficult to move through blood vessels and lungs

Question 85

What is Chronic Cor Pulmonale?

Answer 85

Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of the lung