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Guided Lecture Notes, Chapter 36, Respiratory Tract Infections, Neoplasms, and
Childhood Disorders
Learning Objective 1. Characterize community-acquired pneumonia, hospital-acquired
pneumonia, and pneumonia in immunocompromised people in terms of pathogens,
manifestations, and prognosis.

Describe how pneumonia is so harmful due to its virulence and involvement in the entire
respiratory tract. Differentiate from the community-type and hospital-acquired–type
pneumonia. The community type is found in individuals who develop the condition
outside the hospital. Community type can be viral or bacterial. Hospital-type pneumonia
is lower respiratory tract infection that develops after you have been in the hospital.
Usually it involves those who have been “trached” or have a complicating lung condition.
Then, explain that immunocompromised host usually is applied to persons with a variety
of underlying defects in host defenses. In all types, the parenchymal tissue is infected as
well as are alveoli and bronchioles. (Refer to PowerPoint slides 16 to 18.)
Learning Objective 2. Describe the immunologic properties of the tubercle bacillus, and
differentiate between primary tuberculosis and reactivated tuberculosis on the basis of their
pathophysiology.

Explain that essentially progression of the disease is the same. The complicating factor is
the waxy covering that protects the mycobacterium from degradation by macrophages.
Describe to the students that the process of inflammatory compensation results in an
increased activity in macrophages that results in the significant lung damage. (Refer to
PowerPoint slides 19 to 21.)
Learning Objective 3. Compare small cell lung cancer (SCLC) and non–small cell lung cancer
(NSCLC) in terms of histopathology, prognosis, and treatment methods.

Explain to the students the differences in appearance and metastatic tendencies for each
type of cancer. Describe how the greater derangement will reflect the more aggressive
cancer. Have them think about order versus disorder. (Refer to PowerPoint slides 25 to
27.)
Learning Objective 4. Define the term paraneoplastic and cite three paraneoplastic
manifestations of lung cancer.

Describe to the students that paraneoplastic disorders result from tissue derangement
secondary to the cancer. Explain that the tumor is pushing on the nerve, for example, and
that results in an impediment of neural function. For an analogy, have them picture a
kinked hose. (Refer to PowerPoint slide 28.)
Learning Objective 5. Describe the role of surfactant in lung function in the neonate.

Describe how during the saccular period of development the production of surfactant via
type II cells. The importance is in keeping alveoli from collapsing. Have the students
remember the law of Laplace and its relation to surface tension. Explain that this is
critical for survival outside of the womb. (Refer to PowerPoint slide 31.)
Learning Objective 6. Describe the possible cause and manifestations of RDS and
bronchopulmonary dysplasia.

Describe how lung immaturity and lack of functioning type II cells are the most common
causes of RDS in infants. Treatment of RDS via mechanical ventilation may then cause
BPD due to the interruption of normal lung development. (Refer to PowerPoint slide
32.)
Learning Objective 7. List the signs of impending respiratory failure in small children.

Describe how the differences are based on anatomical size of the airways and reflect the
increase in workload. Have the students picture the small size and increased flexibility of
infants’ and children’s bone structure. (Refer to PowerPoint slides 33 and 34.)