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Anat 1082 Multiple Choice Revision > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

5 Relevance of Pneumonia?

A

1- Pregnancy puts mums at risk of developing pneumonia this is part attributed to natural immune suppression due to pregnancy and reduced lung capacity.

2- Is a leading cause of death in maternity settings.

3- In the UK 0.5 -1% of adults each year are affected by pneumonia.

4- It is the most common cause of sepsis and septic shock causing 50% of all episodes

5- There are 120 million episodes of pneumonia per year in children under five. Over 10% of which 14 million progress to severe episodes.

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2
Q

Classification of Pneumonia …. GO

A
  • Can be classified according to the area of the lung 🫁 that is affected. E.G lobar or bronchioles pneumonia
  • Can be classified according to the organism causing the condition E.G bacterial, fungal or viral
  • Can be classified by geographical location E.G community acquired or hospital acquired.
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3
Q

What is mycoplasma pneumonia?

A
  • Mild pneumonia only causes mild symptoms
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4
Q

What us Aspiration pneumonia?

A
  • Caused by injecting stomach contents and allowing the contents of the stomach acid to travel up ⬆️ to the oesophagus and down the trachea.
  • People laying down for lug periods of time can develop this. So can unconscious people who are vomiting 🤮 and cant protect their airway
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5
Q

What is Atypical pneumonia?

A
  • Caused by more uncommon bacteria 🦠 E.G Streptococcus pneumonia
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6
Q

What is Hospital 🏥 acquired pneumonia

A
  • This develops in the Hospital 🏥
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7
Q

What is Community acquired pneumonia?

A
  • This is acquired in the community
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8
Q

What is viral pneumonia

A
  • Caused by a virus
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9
Q

What is lobar pneumonia?

A

Affects one or more sections of the lungs 🫁

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10
Q

Pneumonia is caused by a number of infectious agents including viruses, bacteria 🦠 and fungi.
What are the 3 most common?

A

1- Streptococcus pneumonia - most common cause of bacterial pneumonia in children 👶

2- Haemophilus influenza type B (HiB)- 2nd most common cause of bacterial pneumonia (Particularly affects children 👶 under 5)

3- Respiratory syncytial virus - most common cause of viral pneumonia

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11
Q

Characteristics of pneumonia?

A
  • Pneumonia is the inflammation and infection of the terminal bronchioles and alveoli leading to the engorgement of the capillaries and subsequently stasis of blood leading to consolidation
  • This occurs when the alveolar sacs and small airways are filled with fluids instead of air
  • This shows up as shadowing on a chest x-ray and can be detected upon auscultation.
  • As the alveolar capillary membrane breaks down the alveoli fill with blood 🩸 and inflammation exudate resulting in atelectasis (Collapse or closure of a lung 🫁)
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12
Q

How do you diagnose Pneumonia?

A
  • Based on the presence of clinical symptoms including malaise, lethargy, dyspnoea, fever 🥵, persistent cough 😷 and pleurytic pain
  • Cough may or may not be present
  • Symptoms may be accompanied by a chest x- ray changes. And raised white blood 🩸 cell count
  • Sample of sputum can be sent to diagnose pneumonia. If the bacteria streptococcus is found then a diagnosis can be made.
  • ABCDE assessment can be done
  • High temperature 🤒
  • Low or falling BP
  • Cyanosis
  • Increasing heart rate
  • Fast resp rate due to acidosis
  • Green / yellow sputum.
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13
Q

What are TH2 cells?

AKA Helper type 2 cells

A
  • TH2 cells are simply white cells involved in the inflammatory response.
  • These cells are required for immunity and play an important role in coordinating the immune response to large extra cellular pathogens 🦠
  • TH2 cells are a distinct type of T cells that secrete IL-4, IL-5, IL-9, IL-13, IL-17.
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14
Q

Explain the difference between the inflammation and activation of the TH2 cells in Pneumonia and Asthma.

A
  • We don’t know what causes the activation of the TH2 response in Asthma but we know that in Pneumonia the activation of the TH2 cells is caused by bacteria or virus or fungus.
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15
Q

Explain the inflammatory response in Pneumonia.

4 steps

A

1- Vasodilation and increased permeability of blood 🩸 vessels
2- Emigration on phagocytes ( white cells that engulf the pathogen) from the blood to the area of injury.
3- Tissue repair
4- With pneumonia in the lungs 🫁 inflammation presents ad consolidation.

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16
Q

How does pneumonia cause acidosis?

A
  • If you cant breath O2 then you wont deliver O2 to your cells.
  • If you cant deliver O2 to your cells then then they have respire using anaerobic respiration
  • This causes lactic acid production
  • Causing the Ph to fall = Acidosis
  • When your Ph falls the medulla oblongata causing resp rate to increase
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17
Q

Will pneumonia cause cyanosis?

A
  • YES

- Cant breath in O2 due to fluid build up in the lungs 🫁 causing cyanosis

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18
Q

Explain what pyrexia is and what it does.

A
  • Pyrexia is the posh word for temperature 🤒
  • It inhibits bacterial growth and ,metabolises immune defences damaging the membranes of both the bodies and bacterial cells
  • At the cellular level pyrexia is generated when ineffective agents such as bacteria or viruses invade the body cells
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19
Q

What does the body do fight pyrexia following the invasion of bacteria cells.

A
  • The invasion triggers a release of a variety of proteins from the host cell.
  • These proteins (referred to as pyrogens) are also released when a cell is damaged through trauma. The bigger the damage the more pyrogens are released.
  • Pyrogens travel 🧳 in the blood 🩸 to the hypothalamus where they act either directly via the generation of prostaglandins ( a hormone) to alter the hypothalamus temperature set point.
  • Once the set point in the hypothalamus is reset to a higher point, the blood 🩸 flowing through the hypothalamus is perceived as being below the correct temperature 🤒 and heat conversion, and heat generation mechanisms are initiated.
  • This makes the temperature 🤒 rise further.
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20
Q

2 examples of a pyrogen.

All pyrogens belong to the cytokine family meaning they are proteins

A

Interleukin 1 - Acts directly on the hypothalamus.

Tumour necrosis factor- TNF

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21
Q

What is Tumour Necrosis Factor (TNF)

A
  • It is the principle cytokine that mediates acute inflammation.
  • It stimulates a coagulation (clotting) pathway
  • Activates neutrophils (white blood cells)
  • Promotes extra cellular killing by neutrophils
  • Stimulates production of other cytokines such as interleukin 6 and 8
  • Upgrades the leukocyte adhesion molecules
  • Alters vascular tone.
  • Acts directly on the hypothalamus causing a fever 🤒
22
Q

What does Interleukin 6 do?

A
  • It is a pro inflammatory secreted by T helper cells and macrophages.
  • It stimulates the liver to produce acute phase proteins
  • Increases the production of neutrophils
23
Q

What does interleukin 8 do?

A
  • It is cytokine produced by macrophages (white blood 🩸 cell)
  • it is produced by macrophages in the alveoli and attracts neutrophils to the site of inflammation.
24
Q

Why does infection cause a high temperature 🤒?

A
  • Infection causes damaged cells
  • Damaged cells release pyrogens
  • Example of these pyrogens are Interleukin 1 and tumour necrosis factor (TNF)
  • Interleukin 1 and TNF act directly on the hypothalamus
  • They change the set point of the hypothalamus
  • The nervous system perceives the the person top be colder then normal.
  • Causing shivering
  • Temperature 🤒 increases
  • High temperature 🤒 is a classic symptom of Pneumonia
25
Q

Pyrexia/ High temperature can cause cellular damage by?

A
  • Damaging the Golgi Apparatus
  • Swelling the mitochondria
  • Changing the cellular permeability
  • Disrupting the nucleus and aggregation of chromatin which is a combination of DNA and proteins in the nucleus.
  • elevating protein synthesis.
  • High temps reduce the ATP (energy) production and you need ATP (energy) for normal electrical activity
26
Q

MEGA PRINCIPLE 4

Why does your heart rate increase when your blood pressure falls.

A
  • Drop in BP
  • Baroreceptors (in the neck) constantly assess BP
  • Medulla oblongata is connected to the baroreceptors (visa versa )
  • The medulla oblongata sends impulses to the Venus nerve in the heart ♥️ and so to speak releases the break
  • Heart rate increases
27
Q

What can cause BP to increase?

A

The stress response..

  • Releases adrenaline
  • Adrenaline acts on receptors in the heart ♥️
  • Causing BP to increase
28
Q

What makes sputum green?

A
  • Neutrophils have something in them called a respiratory burst.
  • That means they have enzymes which produce free radicals of O2, and these free eradicate of O2 destroy the bacteria 🦠
  • This process can also kill the whole neutrophils (white blood 🩸 cell),
  • The enzymes that Make the respiratory burst 💥 contain iron as a cofactor.
  • It is the combination of the iron and with the mucous that makes it bright green.
29
Q

What makes sputum yellow?

A
  • Due to the presence of white blood cells particularly neutrophils and eosinophils
  • Chronic inflammation, allergic reactions and infections cause yellow sputum.
30
Q

What does clear a snot indicate?

A
  • Normal unless excess amount this is a sign of allergies.
  • Mucous moisturises the nasal membrane lining and protects from air prune particles.
  • Contains water 💧, proteins, andtibodies and salt 🧂
31
Q

What does yellow snot indicate?

A
  • May be starting to fight an infection

- Yellow colour comes from white blood cells

32
Q

What does green snot indicate?

A
  • Immune system is working hard

- May be dead 💀 white blood 🩸 cells and other cellular debris in the mucous

33
Q

What does brown snot indicate?

A
  • This could be dried blood 🩸
  • Perhaps the person has inhaled something
  • can be a sign of bronchitis
34
Q

What is leukocytosis?

A
  • It is defines as a raised white blood cell count
  • Neutrophils increase if there is a bacterial infection
  • Lymphocytes increase of you have a viral infection
  • Monocytes increase when you have a form of cancer
  • Basophils are associated with anaphylaxis
  • Eosinophils may be associated with a parasitic infection
35
Q

How does pneumonia interrupt the O2 journey?

A
  • Pneumonia fills the alveoli with fluid
  • This stops✋ the movement of O2 out of the respiratory system and into the cardiovascular 🫀 system
  • Pneumonia and Asthma can result in the inability or reduction of the available O2 being delivered to the cells
36
Q

What is hypoxia and what are the potential issues of hypoxia?

A
  • Hypoxia is the starvation of O2 to cells/ reduced O2 in the arterial blood 🩸
  • It results in the reduction of the available O2 for cells, tissues and organs
  • Hypoxia can lead to cell death ☠️ tissues will become narcotic
37
Q

There are five causes of Hypoxia ….. Name them….Go

A
  • Anaemic hypoxia
  • Hypoxic hypoxia
  • Ischaemic hypoxia
  • Oxygen affinity hypoxia
  • Stagnant hypoxia
38
Q

What is anaemic hypoxia?

A
  • Hypoxia dues to the decreased concentration of functional haemoglobin or a reduced number of red blood cells
  • A cause of this would be anaemia or a haemorrhage
39
Q

What is hypoxia hypoxia?

A
  • Hypoxia resulting from a defective mechanism of O2 in the lungs.
  • Caused by low tension of O2 , abnormal pulmonary function or airway obstruction
40
Q

What is ischaemic hypoxia?

A
  • Tissue hypoxia caused by arteriolar obstruction or vasoconstriction
41
Q

What is oxygen affinity hypoxia?

A
  • Hypoxia due to the reduced ability of the haemoglobin to release O2
  • Cause = Carbon monoxide poisoning
42
Q

What is stagnant hypoxia ?

A
  • Tissue Hypoxia characterised by intravascular stasis due to the impairment of venous outflow or decreased arterial inflow
  • A cause of this is low BP
43
Q

What happens to a cell when it is deprived of O2 for significant periods?

A
  • In principle there is a switch from Aerobic respiration to Anaerobic respiration.
44
Q

There are 3 steps in aerobic respiration what are they?

A

1- Glycolysis - where you make a small amount of ATP (energy)

2- Krebb cycle - A lot of ATP is made here. 36 ATP’s are made during the Krebb Cycle

3- Production of CO2 and heat

45
Q

Step of anaerobic respiration?

A
  • Glycolysis - resulting in formation of 2 pyruvic acid
  • Small amount of ATP and water produced ( 2 ATP)
  • No available O2
  • Production of Lactic acid and ethanol.
46
Q

What are the products of Aerobic respiration?

A
  • 38 ATP
  • No real lactic acid
  • No real lactate
47
Q

What are the products of anaerobic respiration?

A
  • 2 ATP
  • Lactic acid production
  • Lactate production
48
Q

What will eventually happen when cells switch from aerobic to anaerobic respiration?

A
  • Reduction in ATP production and disruption of the sodium (NA) potassium (k) pump.
  • A decrease in cellular Ph
  • Increase in lactate production
  • A compromised cell membrane and cell organelle activity
  • The end point is cell death or hypoxic cell death ☠️
49
Q

What happens when the cell membrane pathway is disrupted?

A
  • The ATP dependent sodium potassium pump relies on the ionic gradient
  • Sodium accumulation in the cell causes water to be drawn into the cell. This causes causes cellular oedema
  • Calcium also then builds up in the cell
  • Potassium leaks out of the cell
  • This leads to an increase in cellular fluid and and electrolyte imbalance
  • Potassium always leaks out of an acidotic cell
50
Q

What happens to lysosomes when there is a lack of O2 and ATP?

A
  • The lysosome is an important cell structure containing enzymes that break down cell waste.
  • The lack of O2 and ATP the lysosomal membrane starts to use its structural phospholipids as a nutrient source
  • Combined with the increase in sodium, calcium and H2O in the cell, the lysosomal membrane becomes increasingly permeable, ruptures and releases digestive enzymes resulting in cell self ingestion, compromised integrity.
  • Causing cell death
51
Q

What are the 2 main causes of cell death?

A
  • Water movement + electrolyte disturbance
  • Lysosomal enzyme activation

Both of these cause a lack of O2 failure of the sodium potassium pump and change in the cell Ph

52
Q

The British Thorac society suggest using the CURB assessment on someone over 65, to assess degree of illness.
Scoring above one indicates an admission to hospital.
What do you assess when you make a CURB assessment?

A 
C= new mental CONFUSION 
U= UREA greater then 7mmol/litre 
R= RAISED RESP RATE above 30 per min
B= lower BP systolic less then 90 diastolic less then 60

Anat 1082 Multiple Choice Revision (20 decks)

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