Respiratory pathology Flashcards by Alana Copeland

The majority of common, transmissible viruses that circulate every year, have what genetic material?

Ss-RNA

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What is an antigenic subtype?

Slight differences in the same virus that mean they can keep evading the immune system

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What is the most common cause of viral URTIs?

Rhinovirus

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What virus causes infectious mononucleosis?

EBV

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What is meant by a non-aetiological diagnosis?

Unknown cause, diagnosed from signs and symptoms

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What would the blood smear of Glandular fever look like and what cells does it infect?

Activated CD8+ (Tc) cells which are larger and have larger amount of cytoplasm to nucleus. Mono infects B Cells.

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What is the leading cause of death among infectious diseases in the human population?

LRTIs

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What is the typical size for most inspired, common respiratory viruses?

90-120nm

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What are haemagglutinin and neuraminidase?

Viral spike proteins of influenza

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What does monocistronic mean?

Encode for a single protein

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What function does Heamagglutinin have?

Attachment to host cell

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What common receptor lies on the surface of most animals respiratory cells and is the reason for the easily transmissible and zoonotic nature of influenza?

Sialic acid

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What proteins are important in transcription of negative strand RNA to positive strand, ready for translation?

Polymerase complexes

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What allows for the transport of viral genetic material across the cytoplasm to the nucleus?

NSL (nuclear localisation sequences)

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What can happen with a positive strand of viral RNA?

Can be directly translated in the ribosomes to form viral proteins

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What is viral load?

The amount of virus in the blood

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What was the viral cause of 1918 Spanish flu?

Influenza A

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What is the term for a virus that infects cells of the respiratory tract?

Pneumotropic

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What is a cytolytic infection?

Kills the cells that are infected

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What two innate defence mechanisms are destroyed from the cytolytic nature of pneumotropic viruses?

Mucous secretion and ciliary clearance

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Interleukins have what systemic effect?

Pro-inflammatory. Cause fever, malaise, headache etc (coryzal symptoms)

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What do interferons do?

Signal neighbouring cells (that are currently unaffected) to slow protein synthesis and trigger apoptosis.

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What are the two types of pneumonia occurring from a viral illness?

Primary and secondary (bacterial)

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What affect could viral infections have on the heart?

Viral induced myocarditis

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What is the difference between an epidemic and pandemic?

While an epidemic is large, it is also generally contained or expected in its spread, while a pandemic is international and out of control.

Influenza viruses have a designation that describes its subtype. Decode this one : A/duck/Alberta/35/76 (H1N1)

Influenza A, first discovered in ducks, first discovered in Alberta, Canada, strain number, year of isolation 1976, (subtypes of haemagglutinin and neurominadase)

What mechanism is responsible for a sudden, dramatic change resulting in a new subtype of virus?

Antigenic shift

What are the three major types of vaccine?

Recombinant, inactivated and live-attenuated

What is the incubation period of RsV?

4-5 days

What is the attachment protein called on the surface of RSV virus?

Attachment protein G

What is the target receptor for SARS COV 2?

Angiotensin converting enzyme (ACE) receptor 2

Surfactants in the respiratory tract help kill inhaled pathogens, there are two types, what are their functions?

SP-A directly kills pathogens through lysis. SP-D assists in the phagocytosis process.

What are the afferent nerves involved in the cough reflex?

Rapidly adapting stretch receptors (RARs), slowly adapting stretch receptors (SARs) and C-fibres

What are the three phases of the cough reflex?

Inspiratory, Compression, Expiratory

What complication can arise, mainly in children, from a Group A strep infection?

Scarlet fever

Name the most common bacterial causes of sinusitis

Strep pneumoniae, Haemophilus influenza, Staph aureus, Strep pyogenes (A)

What is the most common cause of pharyngitis, tonsilitis and laryngitis?

Strep pyogenes (Group A Strep)

Bronchitis is usually caused by what pathogen?

Viral pathogens

Bronchiolitis is most commonly caused by what virus?

RSV

What pathogen is the most common cause of CAP?

Strep pneumoniae

What is a common pathogen associated with HAP?

Klebsiella pneumoniae

True or False: Anatomical dead space is increased in disease

False. Physiological dead space is INCREASED in disease due to the alveoli that is not perfused. Anatomical dead space is based on anatomy, size, posture and tidal volume.

What measure could you use to estimate someone's anatomical dead space?

Weight in lbs

Name the two types of irreversible COPD

Chronic bronchitis and emphysema

What is an obstructive pulmonary disease?

Limitation of airflow resulting from increased resistance in the bronchial passages

True or False: Obstructive pulmonary diseases mainly affect exhalation.

True, restrictive mainly affect inhalation

Pulmonary fibrosis, ankylosing spondylitis and pleural effusion are all what type of pulmonary disease?

Restrictive

What is the distal respiratory tree?

The respiratory portion of the airways (respiratory bronchioles and alveoli)

What might you find on a histological sample of a patient with emphysema?

Enlarged air spaces, destruction of alveolar walls, loss of alveolar attachment and accumulation of inflammatory cells

What is the main aetiology of irreversible COPD?

Smoking

Describe the pathogenesis of emphysema

A toxin/pollutant causes irritation and stimulates an increase in macrophages. Chemoattractants released by macrophages stimulate neutrophils. Neutrophils secrete elastase. Alpha-1 antitrypsin neutralises elastase. Persistent exposure to the stimulant continues the production of elastase and alpha-1 antitrypsin levels decrease. Elastase destroys elastin in the elastic fibres surrounding the alveoli.

Name some differential diagnoses of COPD

Lung ca, pulmonary fibrosis, heart failure

True or False: it is unusual for COPD to cause haemoptysis

True

What scale is NICE recommended scale to assess the impact of the breathing difficulty in COPD patients?

Medical Research Council's 5 point dyspnea scale

What does an obstructive disease show in spirometry?

FEV1/FVC < 0.7. The patient's overall lung capacity is not as bad as their ability to blow air out of their lungs.

For a COPD patient: if a beta-2-agonist is given for inhalation, and a spirometry test is run again, will the result show a dramatic improvement?

No, it is irreversible so shouldn't show dramatic improvement on the chronic condition. Beta 2 agonists can improve symptoms of acute exacerbations of COPD though.

What are the common symptoms of asthma?

Bilateral, polyphonic, expiratory wheeze. Dry cough. Symptoms are episodic, diurnal and/or triggered by external factors.

What are the main tests that can be performed to diagnose asthma?

Fractional exhaled NO, Spirometry and bronchodilator reversibility, Peak flow expiratory rate

Between exacerbations of asthma, what might you find on respiratory examination?

There might be no abnormalities

What's Hoover's sign?

During assessment of chest expansion, thumbs move towards each other at the costal margins instead of away, this happens during COPD due to overexpansion of the lungs.

How would you describe TB under a microscope?

Acid-fast bacilli that are stained red under Ziehl-Neelson stain.

Secondary pulmonary TB usually localises to what segments of the lungs?

Apical and posterior segments of the upper lobes

Name some tests for TB

Sputum smear microscopy Mantoux test Interferon-Gamma release assay PCR Nucleic acid amplification test (only for very at risk)

What is a granuloma?

Compact collection of immune cells formed in response to an infection like TB

When the centre of a granuloma starts to die, what happens?

A caseous necrotic core develops. Surrounding immune cells and fibroblasts form scar tissue to encapsulate the necrotic tissue.

What is the Ghon complex?

The initial site of infection of pulmonary TB and the spread to the hilar lymph nodes.

Spread of TB to the spine is called what?

Pott's disease

What is miliary TB characterised by?

Millet seed sized tubercles spread all over the lung fields, it is rare and has a poor prognosis.