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Anatomy and Physiology
Pathology
Clinical
Assorted
100

How many lobes are in each lung?

Right - 3 lobes

Left - 2 lobes

100

What are risk factors for community acquired pneumonia?

  • age>50, <16
  • comorbidties: diabetes, CKD, recent resp infection 
  • underlying resp conditions: COPD, CF
  • lifestyle: smoking, alcoholism, IV drugs
  • immunosuppression: meds, diseases (cancer, rheumatoid arthritis)
100

What are examples of antimicrobials that inhibit protein synthesis?

  • tetracyclines - doxycycline
  • macrolides - erythomycin
  • chloramphenicol 
100

What are the four different types of beta lactams

  • penicillins
  • cephalosporins
  • carbapenems
  • monobactam
200

What are examples of mucosal antimicrobial molecules

  • alpha defensins - Paneth cells in SI
  • beta defensins - epithelial cells in oral mucosa, trachea, bronchi, mammary glands and salivary glands
200

Name two causes of type I and type II lung failurue

Type I:

  • pneumonia
  • pulmonary edema
  • asthma
  • pneumothorax
  • PE 
  • bronchiectasis


Type II

  • COPD
  • severe asthma
  • drug overdose
  • poisoning
  • primary muscle disorders
  • head/cervical cord injury
200

What microbiological investigations could you do to determine pathogen in pneumonia?

  • sputum MCNS (microscopy, culture, sensitivity)
  • blood cultures
  • swabs for viruses --> PCR 
  • COVID PCR/RAT
200

What are advantages and disadvantages of a simple mask?

  • ad: quick and easy to use, readily available
  • dis: not intended for long term use, nonspecific FiO2
300

Compare and contrast epithelium in conducting and respiratory tubes

  • conducting = respiratory epithelium: ciliated pseudostratified columnar epithelium with goblet cells 
  • respiratory tubes = simple cuboidal
  • alveoli = simple squamous epithelium 
300

Describe atypical pneumonia. What pathogens cause it?

  • milder lung infection 
  • inflammatory infiltration of alveolar walls only
  • caused by viruses (RSV, influenza, COVID, adenovirus) and atypical bacteria mycoplasma pneumoniae, legionella, chlamydophila pneuminoae
300

What are limitations of pulse oximetry and things that affect its accuracy?

  • doesn't monitor ventilation - ptx could be in RF/COPD/OD but not hypoxic
  • poor peripheral concentration 
  • physical barriers - nail polish or jaundice
300

What are infective organisms that cause CAP in Perth? 

What are infective organisms that cause CAP in Perth?

Perth

  • s pneumoniae, H influenzae, staph aureus, klebsiella
  • atypical: legionella, mycoplasma, chlamydia 
  • viruses: influenza, COVID, RSV
  • specific: mycobacterium tuberculosis, pneumocystis (HIV positive)

Kimberley

  • s pneumoniae, H influenzae, staph aureus, klebsiella
  • specific: burkholderia pseudomallei (esp during wet season), acinetobacter baumanii
400

 How do the blood supplies to the visceral and parietal pleura differ?

  • Visceral: from bronchial arteries (systemic supply to the lung tissue) 
  • Parietal: from arteries of the thoracic wall, diaphragm, and the bronchial and mediastinal arteries
400

What are the four stages in inflammatory response in lobar pneumonia? Describe each stage.

  1. congestion - first 24 hrs, alveolar capillaries dilate, exudate develops
  2. red hepatisation - 2-3 days, exudate consists of RBC, neutrophils and fibrin, alveoli become airless, thickening and stiffening of lobe
  3. grey hepatisation - 4-6 days, exudate mainly neutrophils and fibrin, RBCs and pathogens disintegrate
  4. resolution - 1 week, lobe recovers with little scarring, enzymes digest exudate, type II pneumocytes regenerate lung tissue
400

How does obesity relate to pneumonia risk?

  • fat in viscera and surrounding chest adds extra weight to chest 
  • reduces mucocillary clearance in lungs and makes it harder to aerate lungs
400

Outline special architecture of MALT

  • contain antigen sampling areas along mucosa
  • underneath these areas are T and B cell zones (follicles) which are arranged like lymph nodes but local 
  • then drain into thoracic duct --> bloodstream
500

What is the function of secretory IgA in mucosal immunity

  • binds to mucus and optimises viscosity 
  • resistant to protease degradation 
  • inhibits: bacterial adhesion, macromolecule absorption, inflammatory effect of other immunoglobulin classes/subclasses
  • Neutralisation of viruses and bacterial toxins 
  • Stimulation of non-specific defence mechanisms
500

Outline the pathophysiology of ARDS

  • triggered by lots of lung injuries (sepsis, viral, aspiration, drug OD, trauma, drowning)
  • injury leads to release of proinflammatory cytokines
  • cytokines attract neutrophils into lungs
  • neutrophils release toxic mediators - proteases, reactive O2 species
  • damages capillary endothelium and alveolar epithelium 
  • proteins escape from blood into alveoli 
  • creates graident for fluid to move into intersititum and space surrounding alveoli --> thickening of alveolar membrane --> hyaline membranes
500

What are clinical signs of pneumonia

- percussion: dull

- vocal resonance: increased 

- chest expansion: reduced on affected side

- auscultation: crackles, bronchial breath sounds

- perfusion: pallor, reduced cap refill

- vitals: tachycardia, tachypnea, low O2 sat, hypotension

500

What are ways in which microbes can evade pulmonary defences?

  • damage to mucocillary defence from smoking and CF 
  • can attach to epithelium, evading cillary clearance
  • impair ciliary activity e.g. H influenzae release toxins that paralyse cilia