Path Exam II

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Anonymous
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265044
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Path Exam II
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2014-03-05 12:07:42
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Shea PathoII
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Patho II shea
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  1. Influenza
    • —Most common Upper respiratory Infection(URI)
    • —Transmission is by aerosol by droplet nuclei
    • —Three types of Infection:
    • —-Upper respiratory infection (rhinotracheitis)—
    • -—Viral pneumonia (orthomyxoviridae family) —
    • -Respiratory viral infection followed by a bacterial infection —
  2. Influenza Three types of Infection:
    • —-Upper respiratory infection (rhinotracheitis)—
    • -—Viral pneumonia (orthomyxoviridae family) 
    • —-Respiratory viral infection followed by a bacterial infection —
  3. —Influenza Incubation:
    1-4 days
  4. —Influenza —CM:(8)
    • similar other upper resp. viruses,
    • chills,
    • malaise,
    • fever,
    • headache (HA),
    • muscle aches,
    • non-productive cough(NPC),
    • sore throat(ST),
    • profuse nasal drainage—
  5. —Influenza Complications:
    • Viral pneumonia,
    • sinusitis,
    • Otitis media,
    • bronchitis,
    • bacterial pneumonia—
  6. —Influenza DX: (3)
    • Usually by s/s,
    • labs,
    • xray for pneumonia—
  7. —Influenza TX:
    • No absolute treatment- no antibiotics,
    • Early Tx to manage side effects and minimize spread (keep to UR tract),
    • Anti-viral drugs
    • ***FLU Vaccine****— —
  8. Pneumonia
    Acute inflammation of lung caused by microbial organism
  9. Leading cause of death in the United States from infectious disease
    Pneumonia
  10. —Discovery of____ ____ and ____ decreased morbidity and mortality rates from Pneumonia
    sulfa drugs and penicillin
  11. —Typical Pneumonia
    bacteria in the alveoli
  12. —Typical Pneumonia Lobar:
    affect an entire lobe of the lung
  13. Typical Pneumonia —Bronchopneumonia:
    patchy distribution over more than one lobe
  14. Pneumonia- Atypical
    Viral and mycoplasmainfections of alveolar septum or interstitium
  15. Pneumonia —Etiology (4)
    • —Likely to result when defense mechanisms become incompetent or overwhelmed
    • —↓ Cough and epiglottal reflexes may allow aspiration—
    • Mucociliary mechanism impaired —
    • —Alteration of leukocytes from malnutrition— Increased frequency of gram-negative bacilli from leukemia, alcoholism, and diabetes mellitus—
  16. Pneumonia —Etiology:Mucociliary mechanism impaired by (5)
    • —Pollution
    • —Cigarette smoking
    • —Upper respiratory infections—
    • Tracheal intubation 
    • —Aging
  17. Pneumonia —Etiology:
    Three ways organisms reach lungs—
    • Aspiration from nasopharynx or oropharynx
    • Inhalation of microbes such as Mycoplasma pneumoniae —
    • Hematogenous spread from primary infection elsewhere in body— —
  18. Pathophysiologic Course of Pneumococcal Pneumonia
    (PIC)
  19. Types of Pneumonia: —Community-acquired pneumonia (CAP) (5)
    • —Lower respiratory infection of lung 
    • —Onset in community or during first 2 days of hospitalization—
    • 4 million U.S. adults diagnosed yearly
    • —Highest incidence in midwinter—
    • Smoking important risk factor— —
  20. CAP Pneumonia:Organisms implicated (4)
    • **Streptococcus pneumoniae,most common
    • —Haemophilus influenzae
    • Legionella—
    • Mycoplasma
    • —Chlamydia —
    • Can be viral:
  21. CAP Pneumonia viral causes:
    • influenza
    • RSV
    • adenovirus
    • parainfluenza virus
  22. CAP Pneumonia —Three-step approach to treatment (ppt)
    • Assess ability to treat at home
    • Calculate PORT (Pneumonia Patient Outcomes Research Team)
    • Clinician decision for inpatient or outpatient
  23. CAP Pneumonia (book): (2)
    • Antibiotics- empiric antibiotic therapy (home)
    • Hospitalization for more severe cases
  24. Hospital-acquired pneumonia 
     (2)
    —Occurring 48 hours or longer after admission and not incubating at time of hospitalization— Second most common nosocomial infection
  25. Risk factors for HAP
    • —Immunosuppressive therapy—
    • General debility —
    • Endotracheal intubation
  26. resp. disorders involving inflammation of the lung structures, such as the alveoli and bronchioles
    Pneumonia
  27. Causes of opportunistic pneumonia: (4)
    • Bacterial and viral causative agents—
    • Pneumocystis jiroveci pneumonia (PCP)—
    • Cytomegalovirus—
    • Fungi
  28. —Opportunistic pneumonia: —Patients at risk :— (4)
    • Severe protein-calorie malnutrition—
    • Immune deficiencies—
    • Chemotherapy/radiation recipients—
    • Transplant recipients
  29. Pneumonia:—Clinical manifestations of (opportunistic) PCP: —
    • Fever—
    • Tachypnea —
    • Tachycardia—
    • Dyspnea—Nonproductive cough
    • —Hypoxemia —
  30. —Pneumonia Pathophysiology —4 Stages
    • Stage 1: Congestion from outpouring of fluid to alveoli—
    • —Stage 2: Red hepatization
    • Stage 3: Gray hepatization
    • Resolution—
  31. —Pneumonia Pathophysiology ——Stage 1: Congestion from outpouring of fluid to alveoli (3) (what happens)
    • Organisms multiply —
    • Infection spreads
    • —Interferes with lung function
  32. —Pneumonia Pathophysiology Stage 2: Red hepatization (3)
    • Massive dilation of capillaries —
    • Alveoli fill with organisms, neutrophils, RBCs, and fibrin—
    • - Causes lungs to appear red and granular, similar toliver
  33. —Pneumonia Pathophysiology 
    (Stage3) Gray hepatization (2)
    • —↓ Bloodflow 
    • —Leukocyte and fibrin consolidate in affected part of lung
  34. —Pneumonia Pathophysiology: —Resolution (3)
    • —Resolution and healing if no complications
    • —Exudate lysed and processed by macrophages—
    • Tissue restored
  35. Tuberculosis (3)
    • —World’s foremost cause of death from asingle infectious agent — 
    • —Drug-resistant forms 
    • —Mycobacterium tuberculosis hominis —Aerobic—Protective waxy capsule—Can stay alive in “suspended animation” for years—
  36. Mycobacterium tuberculosis hominis (3)
    • —Aerobic—
    • Protective waxy capsule
    • —Can stay alive in “suspended animation” for years—
  37. TB: Etiology and Pathophysiology (5)
    • Spread via airborne droplets 
    • Inhaled bacilli pass down bronchial system and implant themselves on bronchioles or alveoli
    • Multiply with no initial resistance
    • —Replicates slowly and spreads via the lymphatic system
    • If cellular immune system is activated-Tissue granuloma forms
  38. TB —Brief exposure ___ causes infection—
    rarely
  39. TB Transmission requires ____, ____ or ____ exposure —
    close, frequent, or prolonged
  40. Tb spread by: (5)
    • —via airborne droplets when infected person:
    • Coughs—,
    • Speaks—,
    • Sneezes—,
    • Sings—,
    • Spread
  41. TB not spread by
    Not by hands or objects
  42. TB —Favorable environments for growth:
    • —Upper lobes of lungs 
    • —Kidneys 
    • —Epiphyses of bone
    • —Cerebral cortex
    • —Adrenal glands
  43. TB ________ and _______ patients are at higher risk for disease
    —Immunosuppressed and diabetic
  44. TB- Classes 0-4

    —
    • 0 = No TB exposure—
    • 1 = Exposure, noinfection—
    • 2 = Latent TB, nodisease—
    • 3 = TB, not clinically active
    • —4 = TB suspected
  45. TB Clinical Manifestations: Early stages are
    usually free of symptoms
  46. TB —Clinical Manifestations:
    • —Fatigue—
    • Malaise—
    • Anorexia— —
    • Weight loss—
    • Low-grade fevers—
    • Night sweats— —
    • —Cough becomes frequent-—Produces white, frothy sputum
    • Cough-—Hemoptysis is not common and is usually associated with advanced disease—
  47. TB Clinical Manifestations Acute symptoms
    • (generalized flu symptoms)—
    • High fever—
    • Chills
    • —Pleuritic pain—
    • Productive cough—
  48. Initial TB Infection
    • —Macrophages begin a cell-mediated immune response —
    • Takes 3–6 weeks to develop positive TB test—
    • Results in a granulomatous lesion or Ghon complex
  49. Ghon complex
    • —Nodules in lung tissue and lymph nodes—
    • Caseous necrosis inside nodules
    • —Calcium may deposit in the fatty area of necrosis
    • —Visible on x-rays—
  50. Primary TB
  51. Miliary TB
    • —Miliary TB lesions look like grains of millet in the tissues—
    • Meat inspection was introduced to keep them out of the food supply—
    • Pasteurization of milk was introduced to keep TB out of the milk supply—
  52. Secondary TB
    • —Reinfection from inhaled droplet nuclei
    • Reactivation of a previously healed primary lesion —
    • Immediate cell-mediated response walls off infection inairways
    • —Bacteria damage tissues in the airways, creating cavities—
    • Signs of chronic pneumonia: gradual destruction of lungtissue—
    • “Consumption”: eventually fatal ifuntreated—

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