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Y2 CARDIORESP > Pneumonia and respiratory infection > Flashcards

Pneumonia and respiratory infection Flashcards

1
Q

What are the three different types of pneumonia?

A

community acquired, hospital acquired and ventilator acquired

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2
Q

Define pneumonia

A

Infection of the lung parenchyma

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3
Q

Define bronchitis

A

inflammation and swelling of the bronchi

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4
Q

Define bronchiolitis

A

inflammation and swelling of the bronchioles

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5
Q

What happens to the alveoli during pneumonia and what are the consequences of this?

A

inflammation and swelling, impairment of gas exchange process due to cellular infiltration or leakage into the airspace over a substantial area of the respiratory tract

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6
Q

During acute bacterial pneumonia what is the first immune cell to be recruited?

A

neutrophils however alveoli also have their own alveolar macrophages

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7
Q

What is the main cause of bacterial pneumonia?

A

streptococcus pneumoniae

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8
Q

What happens in the first step of the immune response to bacterial pneumonia?

A

Rapid release of neutrophil chemokines such as IL-8 casing rapid recruitment in inflammatory cytokines

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9
Q

What are the demographic and lifestyle risk factors associated with pneumonia?

A

age <2 or >65. Cigarette smoking. Excess alcohol consumption

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10
Q

What are the social risk factors associated with pneumonia?

A

Contact with children aged <15. Poverty. Overcrowding

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11
Q

What medications put someone at an increased risk of pneumonia?

A

inhaled corticosteroids, immunosuppressants, proton pump inhibitors

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12
Q

What medical conditions put someone at an increased risk of pneumonia?

A

COPD, asthma, heart disease, liver disease, diabetes mellitus, HIV, malignancy, hyposplenism, previous pneumonia

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13
Q

Outline the signs and symptoms of pneumonia

A

fever, lethargy, productive cough, respiratory changes with sudden onset, dyspnoea, tachypnea, confusion, crepitations

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14
Q

What is a CRB-65 test?

A

test to judge the urgency of treatment in someone with community acquired pneumonia

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15
Q

Describe how pneumonia usually presents on an X-ray

A

airspace opacity with a consolidation (air replaced with another medium) pattern. Bilateral blurring of the constophrenic recesses in the pleural cavity consistent with effusion. This indicates fluid and potentially cellular infiltration into the alveolar space

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16
Q

What are the treatment options for bacterial pneumonia, (streptococcus pneumoniae)?

A

is a gram-positive bacterium
> use penicillinse.g amoxicillin
> susceptible to beta lactams that bind proteins in the bacterial cell wall to prevent transpeptidation and bacterial replication
> additional macrolide can be added to ensure successful treatment

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17
Q

What are the treatment options for bacterial pneumonia (chlamydia pneumoniae)?

A

is gram negative
> penicillin resistant
> macrolide, eg. clarithromycin, which inhibits the 50S ribosomal subunit limiting protein synthesis is used

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18
Q

What is the difference in treatment between bacterial and viral pneumonia?

A

bacterial treated with antibiotics vs viral usually gets better on its own or gets really bad

19
Q

What treatment is given for late stage pneumonia?

A

invasive mechanical ventilation, continuous positive airway pressure (CPAP), veno-arterial-venous extracorporeal membrane oxygenation (VAM-ECMO)

20
Q

What is measured in a CRB-65 score?

A

confusion, respiratory rate (>30 breaths per minute), blood pressure (<90 systolic and/or <60 diastolic) , 65+

21
Q

How does a CRB-65 score change in hospital?

A

add urea, becomes a CURB-65

22
Q

What supportive therapy is given for bacterial pneumonia?

A

oxygen, fluids, analgesia

23
Q

How do penicillins work against bacterial pneumonia?

A

are beta-lactams that bind proteins in the bacterial cell wall to prevent transpeptidation

24
Q

How do macrolides such as clarythromycin work to treat bacterial pneumonia?

A

bind to bacterial ribosome to prevent protein synthesis

25
Q

What is the key to increasing the success of antibiotics?

A

Time of administration (sooner limit bacterial replication the better) and giving right antibiotic for right bacteria (give penicillins and macrolides together as results can take time)

26
Q

What is an opportunistic pathogen?

A

Opportunistic Pathogen: A microbe that takes advantage of a change in conditions (often immuno -suppression).

27
Q

What is a pathobiont

A

A microbe that is normally commensal, but if found in the wrong environment (e.g. anatomical site) can cause pathology.

28
Q

Why do respiratory viruses cause disease? (CDM)

A

Cause cellular inflammation leading to modulator release. Result in local immune memory. Damage the epithelium resulting in loss of chemoreceptors, loss of barrier, bacterial growth and a loss of cilia preventing oxygen transfer and causing microedema in the respiratory tract

29
Q

What three factors cause severe disease?

A

Highly pathogenic strains
Absence of prior immunity
Predisposing illness

30
Q

What is the role of tight junctions in defence against infection?

A

Prevents systemic infection

31
Q

What is the role of the mucous lining and cilia in preventing infection?

A

Prevent attachment and clear particulates

32
Q

What is the role of antimicrobials in the respiratory epithelium in protection against infection?

A

Recognise, neutralise and/or degrade microbes and their products

33
Q

What is the function of pathogen recognition receptors in the respiratory epithelium in protecting against infection?

A

Recognise pathogens either outside or inside a cell

34
Q

What is the function of interferon pathways of the respiratory epithelium in defending against infection?

A

Activated by viral infection, promote upregulation of anti-viral proteins and apoptosis

35
Q

What components of the respiratory epithelium play a direct role in the first line of defence against infection?

A

Tight junctions
Mucous lining and cilial clearance
Antimicrobials
Pathogen recognition receptors
Interferon pathways

36
Q

What are serotypes?

A

Pathogens which cannot be recognised by serum (antibodies in serum) that recognise another pathogen

37
Q

Antibody mediated immunity / Humoral immunity is adaptive, so is dependent on what?

A

Prior exposure

38
Q

The nasal cavity is enriched for which type of antibody class and how?

A

Enriched for IgA
High frequency of IgA plasma cells, poly IgA receptor allows export of IgA to mucosal surface

39
Q

The bronchi are enriched for which type of antibody class and how?

A

IgGs
Thin-walled alveolar space allows transfer of plasma IgGs into the alveolar space

40
Q

What is the leading cause of infant hospitalisation in the developed world?

A

RSV

41
Q

What are the risk factors for RSV?

A

Premature birth
Congenital heart and lung disease

42
Q

what are the signs and symptoms of RSV bronchiolitis in infants?

A

Chest wall retractions, nasal flaring, hypoxemia and cyanosis, croupy cough, exploratory wheezing, tachypnea with apneic episodes

43
Q

Viral bronchiolotis is associated with the development of what disease?

A

Asthma

44
Q

Rhinoviruses are the most common cause of ______

A

Asthma and COPD exacerbations

Y2 CARDIORESP (15 decks)

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