Resp Final - Dr. Trif: Respiratory Infections

Front 1

protective mechanisms of URT

Back 1

- nasal hair
- cilia of trach/bronch mucosa
- lymphoid tissue of oro/nasopharynx
- **alveolar macrophages

Front 2

sinus mucosa cover

Back 2

- secreted by goblet cells in sinus epithelium, consisting of 2 layers

Front 3

2 layers of sinus mucosa cover

Back 3

superficial - traps inhaled particles, covers cilia
deep - lubricates cilia

Front 4

ciliary movement

Back 4

- moves superficial layer with entrapped debris
- keep sinus epi free of pathogens

Front 5

mucous contains 2 types of defenses that aid in protecting sinuses from pathogens

Back 5

specific and non-specific

-> maintain healthy lung sterility despite direct contact w/ ext air***

Front 6

URTIs common:
adults
children

Back 6

adults: 2-3 viral URTIs/yr
children: 3-8 viral URTIs/yr

Front 7

common cold

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- mild, self limiting infection
- caused by many groups of viruses (adeno-,rhino-,flu-,parainflu-)

Front 8

common cold:
mechanism

Back 8

- inflammation of nasal mucous memb w/ excessive production of mucous AND loss of superficial ciliated cells

Front 9

rhino-sinusitis

Back 9

- group of disorders characterized by inflamm of:
- nasal mucosa
- paranasal sinuses (frontal, maxillary, sphenoid, ethmoid)

Front 10

rhino-sinusitis:
1. MC
2. acute
3. chronic

Back 10

1. one of MC type of URTI (1 bill cases viral/bacT sinusitis/yr US)
2. inflamm predom caused by **viral or bacT microorganisms
3. inflamm d/t a **number of other causes

Front 11

rhino-sinusitis:
pathogenesis

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viral URTI -> dysfnxn of epi cells -> disturbance of sinus hometostasis -> accum and stag of secretions and bacT in sinuses -> bacT superinfxn -> **acute bacT rhinosinusitis (ABRS)

Front 12

ABRS:
inc risk

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- immunosuppressed (cortisone & AIDS pts)
- presence of asthma, allergy, CF
- 2*/environmental smoke exposure or snort coke
--> last 2 both damage nasal mucosa -> pt prone to infxn

Front 13

ABRS:
etiology

Back 13

s. pneumonia, h. flu (m. catarrhais, s. pyogenes, s. auereus, anaerobes)

Front 14

the same bugs (streps, h-flu, m-cat, anaerobes) are also a/w:

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- community acquired PNA (CAP)
- acute exacerb of chronic bronch
- acute otitis media

Front 15

ABRS:
micro

Back 15

- acutely inflamed mucosa shows congestion, edema and hyperactive mucosal glands

Front 16

why is it imp to use right abx therapy w/ tx of ABRS?

Back 16

- resistance (esp S. pna, H. flu)

Front 17

acute laryngo-tracheitis

Back 17

- URTI including phonation, mainly children
- bugs: strep, H-flu, paraflu, RSV
-clinical: hoarse, high pitch cough and stridor
-MC complication: trach obstruction
- loss cilated epi inflamm mucosa

Front 18

acute bronchitis

Back 18

- inflamm of large bronchi
- bugs: flu, bacT, cold, chemicals
- micro: vasc congestion & infiltration of mononuc (virus), PMNs (bacT), fibrin & occasionally ulceration of bronchial mucosa

Front 19

why is acute bronchitis a problem esp w/ babies?

Back 19

- abundant mucus secretion can block bronchioles (can't open if infected)

Front 20

PNA

Back 20

- inflamm of lung parenchyma, characterized by presence of inflamm exudate w/in alveoli and or/interstitium

- cause infectious or non-infectious

Front 21

PNA:
classifications

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anatomical: distribution of lesions (lobar, broncho, interstitial)
etiological: bacT, viral, mycoplasma PNA
clinical setting: where infxn occurs --> PNA syndromes

Front 22

PNA syndromes

Back 22

1. CAP
--> acute PNA
--> atypical PNA
2. nosocomial PNA
3. aspiration PNA
4. chronic PNA (granulomatous)
5. necrotizing PNA & lung abscess
6. PNA in immunocomp host

Front 23

CAP:
1. cause
2. mechanism

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1. bacT (may follow URT infxn) or atypical (viral or mycoplasma)
2. bacT invades lung parenchyma & causes alveoli to be filled w/ inflamm exudates -> causes consolidation of pulm tissue

Front 24

CAP:
predisposing condidtions

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1. age
2. chronic ds (COPD,CHF,DM)
3. congen or acquired immune deficiencies
4. dec or absent splenic fnxn causes inc risk of encapsulated bacT (ie pneumococcus)

Front 25

bacT PNA:
1. cause
2. who

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1. G+/-
2. age group 10-40

Front 26

bacT PNA:
highest risk group

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1. immunosupp/AIDS/elderly
2. asplenic pts
3. SCA pts
4. mult myeloma
5. cirrhosis/ alcoholics
6. renal failure
7. influenza
8. COPD
9. diabetics

Front 27

bacT PNA:
high risk group should...

Back 27

get vaccinated, highly recommended***

Front 28

classifications of bacT PNA

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1. bronchoPNA: inflamm involves bronchi and corresponding lobule
2. lobar PNA: involve alveoli of entire love w/o involvement of bronchi

Front 29

bronchoPNA
1. definition
2. histo

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1. patchy consolid. centered around inflamed bronchi, usually multifocal and bilat
2. suppurative bronchitis and bronchiolitis w/ acute inflamm exudates containg polymorphs, fibrin and organisms

Front 30

bronchoPNA
1. bugs
2. high risk pts

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1. staph, strep, pneumo, H-flu, coriform bacT
2.
- very young/old
-pre-existing trachea-bronchitis
- cardio/renal failure
- ca or stroke pt

Front 31

bronchoPNA:
1. mechanism
2. where

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1. bilat involv of several lobular bronchi and their corresponding lobules w/ multiple firm areas of consolid. around bronchi --> filled w/ mucopurulent material

Front 32

bronchoPNA
1. complications
2. s/sx

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1. prog of ds may cause confluence of consolidated areas
2.
- fever
- cough w/ expectoration of purulent sputum
- hx of being bedridden
- underlying serious condtn
- URT infxn

Front 33

broncho PNA
outcome and complications

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1. resolution
2. oganization of suppurative exudates
3. lung abscess
4. empyema, pericarditis
5. distant effects of bacTemia
6. death -*very common terminal manifestation for many pts (due to mult organ failure)

Front 34

describe resolution in bronchoPNA

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only occurs if tx is started early before structural damage was done

Front 35

describe organization in bronchoPNA

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- organization of suppurative exudates leads to fibrous scarring which can lead to fibrosis

Front 36

lobar PNA

Back 36

acute bacT infxn w/ large areas of consolidation in one or more lobes

Front 37

lobar PNA:
1. etiology
2. sites

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1. 90-95% caused by pneumococci which is esp dangerous infxn in children
- types 1,2,3,7 w/ 3 most virulent
- occasionally caused by klebsiella p, stap, strep and h-flu
2. sharply confined to a love, rarely more than one lobe affected

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lobar PNA:
4 stages

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1. congestion
2. red hepatization
3. gray hepatization
4. resolution

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congestion

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boggy, engorged, congestive alveolar vessels
--deep red firm lobe

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red hepatization

Back 40

- lobe filled w/ intra-alveolar PMNs and RBCs; resembles liver tissue
- red and firm, makes it airless and sink in water
- alveoli fills w/ inflamm exudates, fibrin, PMNs, bacT, etc

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gray hepatization

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- looks pale as PMNs destroy and inject RBCs and debris
- lobe appears gray and dry w/ no more congestion and lung is preserved

Front 42

resolution

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- return to nL or near-nL state
- exudate is digested & absorbed by macrophages
- lung fibroblasts help return alveoli to nL

Front 43

lobar PNA:
1. s/sx
2. outcomes

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1. typical infxous symp: fev/chills/malaise
- others: inspiratory chest pain & blood-stained sputum
- sudden improvement of symps during resolution stage
2. typically completely resolved in most tx'd cases

Front 44

lobar PNA:
complications

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- most likely in cases by Klebsiella or S. aureus
1. hemorrhagic pleuritis, esp in rickettsias or typhus
2. lung abscesses
3. suppurateive pleuritis leads to empyema
4. pulm fibrosis
5. poss bacTemia leading to meningitis or endocarditis

Front 45

lobar PNA:
CXR

Back 45

homogenous opacification w/ vol of lobe unchanged, not reduced like atelectasis

Front 46

aspiration PNA

Back 46

- aspiration of gastric content while unconscious
- high risk: ppl who fall asleep while eating or vom in sleep
--debiliated pt
--alcoholics
--impaired esophageal fnxn (scleroderma, diverticula, achalasia)
- impaired cough/gag reflex

Front 47

aspiration PNA
bugs

Back 47

anaerobic oral flora mixed w/ aerobic common pathogens (H-flu, strep, staph, etc)

Front 48

lung abscess

Back 48

localized destruction (liquificative necrosis) of lung parenchyma containing pus-surrounded by fibrous tissue

Front 49

lung abscess:
1. bug
2. patho

Back 49

1. staph, strep, G- bacT and anaerobes
2. aspiration of infx'd material (fb like teeth)
--following pulm infxn
--a/w ds from other site - may cause sepsis in steroid abuser or IV drug use

Front 50

lung abscess:
complications

Back 50

1. communication w/ bronchus and expectoration of copious sputum
2. comm w/ pleural cavity leadint to empyema or fistulas
3. metastatic abscess, particularly brain - sym inc erratic behavior & h/a