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PBLs > Week 8 - Pneumonia > Flashcards

Week 8 - Pneumonia Flashcards

1
Q

what happens to sympathetic innervation in high core body temperatures?

A

Sympathetic innervation is decreased, reducing the vasomotor tone in the AVAs.

More blood flows through the AVAs and reaches the superficial venous plexus (near the skin’s surface). This increases heat loss and reduces core temperature.

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2
Q

what happens to sympathrtic innervation in low core body temperatures?

A

Sympathetic innervation is increased, increasing the vasomotor tone in the AVAs.

Less blood flows to the apical skin (of nose, lips, ears, hands and feet). This reduces heat loss and increases the core temperature.

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3
Q

what medications can be used to manage pyrexia?

A

paracetamol
NSAIDs

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4
Q

what adverse effects does paracetamol have?

A

few
in overdose it can cause liver failure so dose should be reduced if patient has liver toxicity

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5
Q

what is the action of paracetamol?

A

weak COX inhibitor
COX is involved in prostaglandin metabolism

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6
Q

what is the action of NSAIDs?

A

inhibits prostaglandin synthesis from arachidonic acid by inhibiting COX

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7
Q

what are the adverse of effects of NSAIDs?

A

GI toxicity
renal impairment
increased risk of CV events
high BP
headaches + dizziness

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8
Q

when should NSAIDs be avoided?

A

severe renal impairement
heart failure
liver failure

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9
Q

what are the types of polymorphonuclear leukocytes?

A

AKA granulocytes

Neutrophils
Eosinophils
Basophils
Mast cells

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10
Q

what is the innate immune system?

A

the cells don’t need to learn to recognise the invaders, they attack anything that the body considers foreign

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11
Q

what is the acquired immune response?

A

specialised immune cells learn to recognise specific invaders

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12
Q

what is the function of neutrophils?

A
  • First-line defence against bacteria, viruses and fungal infections
    Tissue injury → body release chemotactic factors to attract neutrophils
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13
Q

what is the function of eosinophils?

A
  • Involved in allergic reactions & also fight parasitic infections
    • High levels of eosinophils can result from other conditions → including drug reactions or immune system disorders like eosinophilic esophagitis
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14
Q

what is the function of basophils?

A
  • Involved in allergic reactions
    • Also secrete histamine and other compounds that cause inflammation
    • Basophils → the bloodborne equivalent of mast cells
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15
Q

what is the function of mast cells?

A
  • Live in tissues and play an important role in respiratory and digestive conditions
    • Two major subtypes:
      ○ Connective tissue mast cells → trigger inflammation
      ○ Mucosal mast cells → keep the gut in balance
    • Histmaine and other substances within these PMNs (such as heparin) help regulate the immune response
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16
Q

what is the difference between M1 and M2 macrophages?

A
  • M1 → aka classically-activate macrophages. Activate by pathogen invasion and play a large role in the immune response to foreign pathogens e.g. bacteria
    detect, engulf and destroy bacteria. They do this through phagocytosis.
    ○ Phagocytosis → process by which cells ingest or engulf other cells or particles
    ○ M1 macrophrages promote inflammation, extracellular matrix destruction, apoptosis of invading cells by releasing various cytokines and nitric oxide to aid in cellular destruction, as well as antigen presentation
    • M2 → aka alternatively-activated macrophages. Play a role in wound healing, tissue repair, and have an anti-inflammatory role
      needed for regeneration of connective tissue during wound healing.
      ○ Produce vascular endothelial growth factor (VEGF) and transforming growth factor (TGF)-Β1 which allows for vascular stability and wound repair
      ○ Also function to phagocytose bacteria and damaged tissue around the wound
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17
Q

what are the 5 clinical signs of inflammation?

A

pain
heat
redness
swelling
loss of fucntion

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18
Q

what factors can stimulate an acute inflammatory response?

A
  1. Microorganisms (viruses and bacteria)
  2. Physical agents
  3. Chemicals
  4. Inappropriate immunological responses (autoimmune responses)
    Tissue death
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19
Q

what causes heat in inflammation?

A
  1. Immune system releases inflammatory mediators such as bradykinin and histamine.
  2. Blood vessels in the injured tissue vasodilate.
    More blood flow leads to the area becoming inflamed (swelling), red, and hot.
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20
Q

what is the cause of pain in inflammation?

A
  1. Increased blood flow to injured area results in inflammation
  2. Release of both histamines and bradykinin triggers neurons to send pain signals to the brain
  3. Injured area feels painful
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21
Q

what is tissue repair?

A

restoration of tissue architecture and function after an injury. This is a process that involves both of the below two processes, and the predominance of one over the other depends on the site of injury, extent of damage, and the tissue that needs to be repaired.

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22
Q

what is tissue regeneration?

A

where new growth completely restores portions of damaged tissue to their normal state. replacing damaged cells functioning identical copies

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23
Q

what is labile tissue? give examples

A

continuously dividing tissue
e.g. bone marrow cells, skin, hair, GIT epithelium

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24
Q

what is stable tissue? give examples?

A

quiescent tissue
non-dividing but are capable of entering the cell cycle and replicating again

e.g. parenchymal liver, kidney, pancreas cells, lymphocytes

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25
Q

what are permanent tissues? give examples

A

consist of cells that dont proliferate anymore

e.g. RBC, cardiac muscle, skeletal muscle, neurones

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26
Q

what does gram -ve bacteria stain like?

A

pink

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27
Q

what does gram +ve bacteria stain like?

A

purple

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28
Q

which bacteria type has a thicker peptidoglycan wall?

A

gram +ve

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29
Q

what is the action of penicillins and what bacteria do they target?

A

prevent cell wall formation (inhibit peptidoglycan production)
gram positive

30
Q

what is the action of cephlasporins and what bacteria do they target?

A

interfere with cell wall formation
gram positive

31
Q

what is the action of tetracyclines and what bacteria do they target?

A

inhibit 30s ribosomal subunit .: prevent replication/growing
gram +ve, gram -ve and atypical

32
Q

what is the action of aminoglycosides and what bacteria do they target?

A

bind to 30s ribosomal subunit .: inhibit translocation of genetic code
gram -ve and +ve
particulary enterobacteria

33
Q

what is the action of macrolides and what bacteria do they target?

A

inhibit protien synthesis
gram-positive (excluding enterococci) and some gram-negative bacteria

34
Q

what is the action of clyndomycins and what bacteria do they target?

A

bind to 50s ribosomal subunit and disrupt protein synthesis
gram +ve

35
Q

what is the action of sulfonamides?

A

inhibitor of dihydrofolate synthesis

36
Q

what is the action of trimethoprim?

A

inhibits the enzyme dihydrofolate reductase

37
Q

what is the action of quinolones and what bacteria do they target?

A

fragment the bacterial chromosome
gram -ve and +ve and atypical

38
Q

give examples of penicillins

A

phenoxymethylpenicillin, flucloxacillin and amoxicillin.

39
Q

give examples of cephlasporins

A

cefaclor, cefadroxil and cefalexin.

40
Q

give examples of tetracyclines

A

tetracycline, doxycycline and lymecycline

41
Q

give examples of aminoglycosides

A

gentamicin and tobramycin.

42
Q

give examples of macrolides?

A

erythromycin, azithromycin and clarithromycin.

43
Q

what is co-trimoxazole?

A

combination of sulfonamide and trimethoprim

44
Q

give examples of quinolones

A

ciprofloxacin, levofloxacin and norfloxacin.

45
Q

what is the clinical presentation of pneumonia?

A

· Shortness of breath
· Cough productive of sputum (rusty coloured)
· Fever
· Haemoptysis
· Pleuritic chest pain (sharp chest pain worse on inspiration)
· Delirium (acute confusion associated with infection)

46
Q

what is heard on auscultation in pneumonia?

A

Bronchial breath sounds – harsh breath sounds
 Focal coarse crackles – air passing through sputum (similar to using a straw to blow into a drink)
 Dullness to percussion – lung tissue collapse/consolidation

47
Q

what are the most common organims responsible for pneumonia?

A

· Streptococcus pneumoniae (50%)
* Common in elderly, almost always a preceding viral infection
· Haemophilus influenzae (20%)
Frequent causes of exacerbation of chronic bronchitis in COPD

48
Q

patient has come back from holiday with pneumonia. what is the likely organism?

A

Legionella pneuomiphila (viral pneumonia)

49
Q

patient is a teen from a boarding school with pneumonia. what is the likely organism? what other clinical features would they display?

A

Mycoplasma pneumoniae (viral pneumonia)

Can cause rash called ‘erythema multiforme’ characterised by ‘target lesions’ formed by pink rings and pale centres

50
Q

patient is a school-aged child with pneumonia. what is the likely organism?

A

Chlamydophila pneumoniae

51
Q

patient is a farmer with pneumonia. what is the likely organism?

A

Coxiella burnetii aka Q Fever

Linked to exposure to animals and their bodily fluids

52
Q

patient has a parrot and gets pneumonia. what is the likely organism?

A

Chlamydia psittaci

pt has had contact with birds

53
Q

when is pnuemonia often caused by Klebsiella pneumoniae?

A

Rare, occurs in elderly, diabetics and alcoholics, severe pneumonia leading to lung abscess

54
Q

patient is alcoholic with pneumonia. what is the likely organism?

A

Klebsiella pneumoniae

55
Q

when is pnuemonia often caused by Legionella pneuomiphila?

A

Infected water supplies or air conditioning units, cause hyponatraemia (usually pt. has come back from holiday)

56
Q

when is pneumonia often caused by Mycoplasma pneumoniae?

A

Can cause rash called ‘erythema multiforme’ characterised by ‘target lesions’ formed by pink rings and pale centres. Occurs in teens, boarding institutions

57
Q

when is pneumonia often caused by Chlamydophila pneumoniae?

A

school aged children

58
Q

when is pneumonia often caused by Coxiella burnetii?

A

Linked to exposure to animals and their bodily fluids (usually farmer pt.)

59
Q

when is pneumonia often caused by Chlamydia psittaci?

A

Pt. has had contact with birds

60
Q

what treatment is given to CAP with CURB65 of 1?

A

oral amoxacillin (5day course)

61
Q

what treatment is given to CAP with curb65 of 2?

A

Oral Amoxicillin + Clarithromycin (7-10 days)

62
Q

what treatment is given to CAP with curb 65 of 3-5?

A

IV Co-Amoxiclav + Clarithromycin (7-10 days)

63
Q

what treatment is given in HAP?

A

Co-Amoxiclav, IV Cephalosporin if severe

64
Q

what treatment is given in aspiration pneumonia?

A

co-amoxiclav

65
Q

what anatomical barriers are part of the innate immune systme?

A
  • Skin
    • Epithelial and mucous membranes
    • Mucous
    • Tears
    • Stomach acid
      Ear wax
66
Q

what physiological barriers are part of the innate immune system?

A
  • Temperature
    • Low pH
    • Chemical mediators (lysosomes and interferons)
67
Q

what is curb65 score for? what is it?

A

pneumonia
* C – Confusion (new disorientation in person, place or time)
* U – Urea > 7
* R – Respiratory rate ≥ 30
* B – Blood pressure < 90 systolic or ≤ 60 diastolic.
65 – Age ≥ 65

dont do urea in hospital

Score 0/1: Consider treatment at home
Score ≥ 2: Consider hospital admission
Score ≥ 3: Consider intensive care assessment

68
Q

what minimum tests should someone with suspected pneumonia get?

A
  • Chest xray
    • FBC (raised white cells)
    • U&Es (for urea)
      CRP (raised in inflammation and infection)
69
Q

what tests should pts with moderate or severe pneumonia get?

A
  • Sputum cultures
    • Blood cultures
      Legionella and pneumococcal urinary antigens (send a urine sample for antigen testing)
70
Q

what are the complications of pneumonia?

A
  • Sepsis
    • Pleural effusion
    • Empyema
    • Lung abscess
      Death
71
Q

which high risk groups usually get the pneumonia vaccine?

A
  • babies
    • adults aged over 65
    • people with heart, lung, liver, kidney or neurological conditions with a risk of aspiration
    • people with diabetes
      people with a weakened immune system, for example, you have a condition that stops your immune system working properly, or you are having treatment to suppress your immune system

PBLs (19 decks)

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