Exam 1 Part 3 Flashcards
(65 cards)
1
Q
how do you differentiate between pneumonia and pneumonitis?
A
- pneumonia: infection or inflammation of only alveolar spaces
- pneumonitis: inflammation of interstitial tissue
2
Q
classifications of pneumonia? 6
A
- community acquired
- community-acquired atypical (non-bacterial)
- nosocomial
- aspiration
- necrotizing/abscess
- pneumonia in immunocompromised pts
3
Q
predisposing factors to getting pneumonia? 5
A
- loss of cough reflex
- diminished mucin or cilia function
- accumulation of secretions
- decrease in phagocytic or bactericidal action of alveolar MOs
- pulmonary congestion & edema
4
Q
does pneumonia occur in healthy people spontaneously?
A
NO but it is one of the most common causes of death
5
Q
how long does it take for sxs of pneu to develop?
A
several days
URI sxs may precede
6
Q
what are the typical sxs of pneu?
A
- cough
- fever
- fatigue
- malaise
- increased sputum production
- pleuritic chest pain
7
Q
what might you find on a PE?
A
- fever, tachycardia, tachypnea, but sometimes can present with no cough of fever
- may be signs of lung consolidation: dullness to percussion, crackles, absent breath sounds
8
Q
pneumonia is the most common what kind of infection?
A
nosocomial; especially for those who have been intubated and on ventilator support
9
Q
how does it affect developing countries and children?
A
- 2nd major cause of death in developing countries
- leading cause of death worldwide for children
10
Q
what is the main cause of community acquired pneumonia?
A
steptococcus pneumoniae
11
Q
what other bugs can cause pneumonia? which one is considered atypical? which one is nosocomial?
A
h. influenza, m. catarrhalis, s.aureus, l.pneumophila (atypical), k.pneumoniae (nosocomial)
12
Q
pneumonia leads to what two circumstances in the lungs? what is each?
A
- congestion: leaky dilated capillaries leads to exudate in interstitium, numerous bacteria
- consolidation: exudative rxn and solidification, maybe fibrosis
13
Q
what are the 3 patterns of gross anatomic distribution of pneumonia? how can you distinguish b/w/
A
-lobar pneumonia (entire lobe)
-lobular pneumonia (part of a lobe)
-bronchopneumonia (patchy)
distinguish b/w by CXR
14
Q
what are the 4 stages of the inflammatory response in lobar pneumonia? what does tx do?
A
- congestion
- red hepatization
- grey hepatization
- resolution
- tx slows or halts progression through 4 stages
15
Q
what are the 7 morphologies of pneumonia?
A
- acute
- organizing
- chronic
- fibrosis vs. full resolution
- red vs. grey hepatization
- consolidation
- infiltrate vs. histopathology
16
Q
would a classical pneumonia be more obstructive or restrictive
A
could be BOTH
17
Q
what is red hepatization?
A
- RBC exudate, neutrophils and fibrin fill alveolar spaces
- consistency resembles liver tissue
18
Q
what is grey hepatization? what color is it?
A
- RBCs disintegrate which leads to increased fibrinization
- persistent neutrophils, fibrin & supprative exudate
- alveoli consolidated
- greyish brown drier surface
19
Q
what kind of pneumonia does streptococcus cause? what is 100% curative and what is 100% preventative against?
A
- classic lobar pneumonia
- penicillin often 100% curative
- vaccines often 100% preventative
20
Q
who gets haemophilus pneumonia?
A
- children <2 with otitis, URI, meningitis, cellulitis, osteomyelitis
- most common from COPD in adults
21
Q
moraxella catarrhalis ranks as what in the most common pneumonia?
A
-2nd most common after COPD pneumonia
22
Q
what is the most common pneumonia following viral pneumonias?
A
-staph aureus
23
Q
who gets klebsiella pneumonia?
A
- debilitated malnourished people
- alcoholics with pneumonia thought to have k. pneumonia until proven otherwise
24
Q
is pseudomonas aeruginosa community acquired? who gets pseudomonas aeruginosa?
A
NO it is nosocomial
-cystic fibrosis pts w/pneumonia presumed to have pseudomonas until proven otherwise
25
when does legionella happen? what classification? how is it spread and to who? is it typical or atypical?
- often in outbreaks
- often lobar
- spread by water "droplets" to immunosuppressed pts
- bridges typical & atypical classification: can inhale aerosolized organisms or aspiration of contaminated drinking water
26
in resolution what happens to the consolidated exudate?what happens to the debris? is there fibrosis?
- consolidated exudate undergoes enzymatic digestion
- granular semi-fluid debris is resorbed, eaten by MOs or coughed up
- fibroblast reorganization of debris may lead to fibrous thickening or adhesions
- lung tissue returns to baseline or there's residual scarring
27
when do you hospitalize?
- pts living in nursing home
- elderly or infants, particularly <1 mo
- cancer
- heart failure
- stroke
- kidney failure
- liver disease
28
what kinds of PE findings would lead you to hospitalize?
-altered mental status, dehydration, fast breathing, heart rate >120 bmp, systolic BP 104
29
what are laboratory findings that would lead you to hospitalize?
- elevated blood sugar
- fluid in sac around lung
- low oxygen in blood
- low sodium levels
- poor kidney fxns
- significant anemia
30
what are the 4 characteristics of an atypical community acquired pneumonia?
- mycoplasmal
- not bacterial
- viral
- cultures not helpful
31
community acquired atypical pneumonias are caused by what, lack what and are known as what?
- caused by less typical pathogens
- cell wall deficient bacteria
- known as 'walking pneumonia'
32
what is the main bacteria which causes community acquired atypical? main viruses?
- mycoplasma pneumoniae! also chlamydia, legionella
| - viruses= RSV, parainfluenza virus, varicella, influenza A & B, adenovirus, SARS
33
who does mycoplasma pneumoniae infect?
older children and young adults
34
where do you see inflammation in community acquired atypical pneumonia?
-see interstitial inflammation and usually without alveolar involvement
35
viral pneumonias are typically _____ not ______
typically interstitial not alveolar
36
viruses are the _____ pathogen in ____ & _____. what is the most common?
- primary pathogens in infants and young children
| - respiratory syncytial virus most common; includes chicken pox, para-influenza virus& influenza A & B
37
in adults what viruses cause pneumonia?
influenza A or varicella-zoster
38
what does SARS stand for? bac or virus and what kind? how do you confirm?
- SARS= severe acture respiratory syndrome
- corona virus
- confirmed by PCR
39
what are hospital acquired pneumonias called? what causes them? (hospital practices and bugs) what is MRSA?
- nosocomial
- debilitation, catheters & ventilators
- enterobacter, pseudomonas, staph
- MRSA= methicillin resistant staph aureus
40
who gets aspiration pneumonia? what part of the lobe is usually involved? what does it usually lead to?
- unconcious pts
- pts in prolonged bed rest
- lack of ability to swallow or gag
- usually aspirating gastric contents
- usually in posterior lobes
- leads to abscesses
41
what bacteria usually cause aspiration pneumonia?
- step
- staph
- haemophilus
42
what are lung abscesses from? is this a type of pneumonia?
- aspiration
- septic embolization
- neoplasia
- from neighboring structures
- any pneumonia which is severe, destructive and un-treated enough
- NOT a type of pneumonia but a complication
43
what is a pulmonary abscess?
localized infectious process characterized by necrosis
44
what can cause a pulmonary abscess?
- aspiration (most common)
- preceding lung infection
- septic embolism
- trauma or extension of soft tissue infection
- oral cavity flora, step, gram (-) organisms
45
what increases risk of pulmonary abscess?
- sinusitis
- dental disease
- bronchiectasis
- fungal infxns
- diminished gag reflex
46
where does an abscess due to aspiration usually occur?
usually single in R lung (b/c more vertical)
47
what are the sxs of a pulmonary abscess?
- cough
- fever
- chest pain
- weight loss
- copious amounts of foul smelling purulent or sanguineous sputum
48
txs for pulmonary abscess? complications?
- antimicrobial therapy
- surgical drainage
- complications= empyema, spontaneous rupture, sepsis
49
chronic pneumonia is often synonymous with what 4 things?
4 classic systemic fungal or granulomatous pulmonary infections: TB, histoplasmosis, blastomycosis, coccidiomycosis
50
does chronic (in pneumonias) mean clinically or pathologically chronic?
CLINICALLY chronic
51
risk factors for TB?
- poverty
- crowding
- chronic debilitating illness
52
what is the main bac which causes TB in non-compromised hosts? in immunocompromised hosts?
non-compromised: mycobacterium tuberculosis & m. bovis
| immuno: m. avium & m. intracellularae
53
what is the process of TB?
-inhalation of mycobacterium, engulfed by MO, transported to hilar lymph nodes, multiply, lyse MOs and travel, get 'quarantined'= granulomas
54
what kind of granuloma does TB produce and what does it look like?
caseous; cheesy
55
what is the fxn of a granuloma?
- prevent dissemination of mycobacteria
| - local environment for communication of cells of immune system
56
what is a ghon focus? ghon complex?
ghon focus: initial infxn location, 2-3 wks after develops undergoes caseous necrosis, TB bacilli drain out towards hilar lymph nodes
ghon complex: ghon focus w/hilar lymph node involvement, may caclify, latent TB here
57
what is secondary TB?
reactivation TB
| ghon complex breakdown and mycobacterium release due to poor nutrition or infections
58
what is military TB?
infxn into circulatory sys, millet-like seeding of TB bacilli in lungs & other organs; 1-3% of TB cases
59
what are sxs of TB infxn?
- fever (night sweats)
- cough (non-productive to sputum)
- pleuritic chest pain
- dyspnea
- hemoptysis
- weight loss
- fatigue
60
tx for TB?
- long course Abx
| - vaccinations used in high risk areas
61
details of histoplasmosis?
- spores in bird or bat droppings
- mimics TB
- calcified pulmonary granulomas
- Ohio, Mississippi valley
- primary infxn resembles viral URI
- granulomas appear lamellar or onion-skin like
62
details of blastomycosis?
- spores in soil, yeast
- mimics TB
- calcified pulmonary granulomas
- LARGE distinct spherules
- Ohio, MS valley, great lakes, middle east, africa, canada, mexico
63
details of coccidiomycosis?
- spores in soil
- mimics TB
- calcified pulmonary granulomas
- SMALL spherules (thick walled non-budding w/in MOs or giant cells, often cavitate)
- american SOUTHWEST
- dry cough, high fever, pleural effusion
64
what do ppl who inhale coccidiomycosis spores develop?
- anyone who inhales become infected and thereafter develops a delayed type hypersensitivity to the fungus
- more than 80% of ppl in endemic area have + skin test
65
details of aspergillus?
- common mold
- cause allergies in otherwise healthy ppl
- invasive aspergillosis: opportunistic infxn seen in immunosuppressed & debilitated
- aspergilloma= fungal growth w/in lung cavity
