Pulm

Question 1

Hemorrhage and Infection

Question 2

What is the antibody in goodpasture syndrome? Organ targets?

Answer 2

Anti-collagen IV antibody

Kidney (if only kidney Anti-GBM disease)

Lungs (necrotizing hemorrhage)

Question 3

Although initiationof Goodpastures is unknown, what is it genetically associated with?

Answer 3

HLA-DRB1

Question 4

Initial pathology of goodpastures?

Late pathology?

Answer 4

• Initial
  
  • red brown consolidation
  • focal necrosis and intra-alveolar hemorrhage
  • Macrophages loaded with hemosiderin
  • Linear deposits of Ig along BM in septal wall (similar to kidney)
• Later
  
  • Fibrosis
  • Hypertrophic TII pneumocytes

Question 5

Presentation of Goodpastures? Death caused by?

Answer 5

• Hemoptysis
• Focal consolidation
• Death mostly by uremia (so not resp. insufficiency)

Question 6

Differences between Goodpasture syndrome and Idiopathic pulmonary hemosiderosis?

Answer 6

• Goodpastures = lung and kidney
• IPH = lung only (no anti-BM abs!)
  
  • Young children mostly

Question 7

What is Polyangiitis with Granulomatosis?

Answer 7

• Previouslycalled Wegener granulomatosis
• Autoimmune to URT and/or lungs
• Hemoptysis = main clinical symptom

Question 8

Diagnosis of polyangiitis with granulomatosis?

Answer 8

• Transbronchial biopsy
  
  • capillaritis
  • Scattered poorly formed granulomas
    
    • **different from the rounded ones found in sarcoidosis

Question 9

Defects ininnateor humoral ID lead to increased incidence of what infections?

Answer 9

Pyogenic bacterial infections

Question 10

What is MyD88? Germline mutations are associated with what?

Answer 10

• MyD88 = adaptor for TLRs important in NFkB activation
• Associated with destructive pneumococcal pneumonias

Question 11

What do defects in Cell-mediated immunity lead to?

Answer 11

• Infections with intracellular microbes
  
  • mycobacteria
  • hsv
  • pneumocystis

Question 12

Most common bacteria associated with CAP?

What else is associated with CAP?

Answer 12

• S. pneumoniae
• H. influenzae
• Pseudomonas
• VIRUSES!
  
  • RSV, parainfluenza, metapneumovirus, flu A and B, and adenovirus

Question 13

What bacteria is most common for Health care associated pneumonia?

Answer 13

• MRSA/MSSA
• Pseudomonas
• S. pneumoniae

Question 14

What bacteria is associated with Nosocomial pneumonia?

Answer 14

• G- rods
  
  • Enterobacteriaceae (klebsiella, Serratia, E. coli)
  • Pseudomonas
• MRSA