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Respiratory > Path of Infectious and Non-infectious > Flashcards

Flashcards in Path of Infectious and Non-infectious Deck (107):
1

Pneumonia is responsible for what fraction of death in the US?

1/6

2

True or false: the lower airways are usually sterile

True

3

True or false: we all regularly aspirate

True--though it is minute

4

What is the technical definition of pneumonia?

Infection of the lung parenchyma

5

What are the two major lifestyle factors that predispose people to pneumonia?

EtOH
Smoking

6

What is the usual cause of acute pneumonia?

Pyogenic bacteria

7

What is pneumonitis?

Usually not pyogenic---often viral or d/t to mycoplasma

8

What are the common causes of chronic pneumonias?

TB
Fungi
Parasites

9

What are the five physiological changes that predispose to developing pneumonia?

-Loss of cough reflex
-Injury to mucociliary escalator
-LOF of macrophages
-Pulmonary edema and congestion
-Accumulated secretions

10

What are the two ways to classify pneumonia?

Etiological agent or clinical setting

11

True or false: you can get pneumonia from sepsis

True

12

CAP is usually caused by what infectious type of agent?

Bacterial

13

Atypical pneumonia is usually caused by what infectious agent?

Viruses

14

Aspiration pneumonia is usually caused by what?

Bacteria and chemicals

15

What are the usual causes of chronic pneumonias?

mycobacteria

16

True or false: Legionnaires disease is classified as a CAP

True

17

Which lobes of the lung are most often affected by aspiration?

Lower lobes or right middle

18

What are the two morphological patterns of bacterial pneumonia?

Bronchopneumonia and lobar pneumonia

19

What is lobar pneumonia?

Consolidation of an entire lobe or large portion of a lobe

20

What is bronchopneumonia?

Patchy consolidation in one or more lobes

21

What does the pneumonia pattern depend on?

Bacterial virulence and host resistance

22

What are the lung sounds with lobar pneumonia?

Rales

23

What are the gross findings of bronchopneumonia?

Dispersed, elevated 3-4 cm lesions of palpable consolidation

24

What are the histological findings of bronchopneumonia?

Acute PMN filled exudate filling airspaces and airways

25

90-95% of lobar pneumonia is caused by what pathogen?

Strep pneumoniae

26

What is the progression of lobar pneumonia?

Congestion
Red hepatization
Gray hepatization
Resolution

27

What causes the red hepatization in the lungs with pneumonia?

Confluent exudation with RBCs, fibrin in alveolar spaces

28

What causes the grey hepatization in the lungs with pneumonia?

RBCs break down, exudate remains

29

What is involved in the resolution phase of lobar pneumonia?

Exudate enzymatically digested

30

What happens if the pneumonia does not resolve? Why?

Scarring d/t degradation from enzymatic destruction

31

What are the four major indications that you should hospitalize a patient with pneumonia?

-severe dyspnea
-Empyema
-Underlying disease
-Severe systemic ssx

32

What are the pleural consequences of pneumonia? (3)

Pleuritis
Pleural effusion
Bronchopleural fistulas

33

What are the localized complications from pneumonia?

Abscesses
Empyema

34

What is type I respiratory failure?

Low O2, but CO2 not elevated

35

What are the heart sequelae of pneumonia? (3)

A-fib
Pericarditis
Myocarditis

36

What is atypical pneumonia?

Lack of alveolar exudate in most, with increased WBCs

37

Which WBC is increased markedly with atypical pneumonia (usually)?

Lymphocytes
Monocytes

38

What is the "proper" name for primary atypical pneumonia?

Interstitial pneumonitis

39

What are the CXR findings of atypical pneumonia?

Patchy Interstitial changes

40

What are the usual bacteria that cause atypical pneumonia?

Mycoplasma
Chlamydia

41

What are the ssx of atypical pneumonia?

Pharyngitis with URI like ssx

42

What are the classic ssx of mycoplasma pneumoniae?

Bad, persistent cough

43

What are the primary viral causes of atypical pneumonia?

Influenza A and B
RSV
Adenovirus

44

What is the common pathogenic mechanisms for viral pneumonia?

Attachment of organism to the respiratory epithelium, leading to necrosis of cells and an inflammatory response

45

If sputum changes from green to yellow, what should you suspect?

Bacterial pneumonia superimposed by a viral one

46

What is the usual clinical course of atypical pneumonia?

Usually resolves spontaneously

47

What are the severe sequelae of atypical pneumonia?

ARDS

48

What is the typical histopathology of atypical pneumonia?

Interstitial pneumonia with mononuclear infiltrates and diffuse alveolar damage

49

What are the two major granulomatous diseases that affect the lung?

Sarcoidosis
Hypersensitivity pneumonitis

50

What is the pulmonary eosinophilia?

a disease in which an eosinophil, a type of white blood cell, accumulates in the lung d/t some insult (meds, parasites, environmental triggers etc)

51

What is sarcoidosis?

Systemic disease of unknown etiology, but causes granulomas

52

What are the most frequent targets of sarcoidosis?

Lung and/or hilar lymph nodes

53

What is the classic patient to be affected by sarcoidosis?

Young, AA females

54

True or false: sarcoidosis is a disease of exclusion

True

55

What is the most common manifestation of sarcoidosis?

Asymptomatic

56

What are the usual ssx of pulmonary involvement with sarcoidosis?

Insidious onset of TB-like ssx

57

What is needed for a diagnosis of sarcoidosis? (3)

Biopsy showing:
-Non-caseating granulomas
-Special stains
-Culture

58

What are the lab findings of acute sarcoidosis? (3)

Increased IgG, Ca, and ACE

59

What are the cells that are involved with sarcoidosis? Where do they accumulate?

CD4+ T cells in the lung interstitium and alveoli

60

What are the cytokines release by the CD4+T cells in sarcoidosis? (4)

IL-2
IFN-gamma
IL-8
TNF

61

What do the IL-2 and IFN-gamma do in sarcoidosis?

Increase T cell expansion

62

What do IL-8 and TNF do in sarcoidosis?

Recruitment of additional T cells and monocytes

63

What causes the skin manifestations of sarcoidosis?

Peripheral anergy of CD4+ T cells

64

What type of antibody is upregulated with Sarcoidosis?

IgG

65

What are the HLA genotypes that are associated with sarcoidosis?

HLA A1 and B8

66

What is Mikulicz syndrome?

a type of benign enlargement of the parotid and/or lacrimal glands. 2/2 sarcoidosis

67

What is the defining characteristic of sarcoidosis?

Well formed noncaseating granulomas

68

What are the long term sequelae of sarcoidosis?

Fibrosis and honeycomb lung

69

Where does sarcoidosis granulomas forms in the long?

Along the lymphatic pathways

70

What is contained within granulomas in sarcoidosis?

Tight, clustered epithelioid histiocytes rimmed by outer zone of CD4+ T cells

71

What are the histological findings of sarcoidosis?

PMNs infiltrating the alveolar septa

72

What are the "potato" nodes in sarcoidosis?

Large granulomas

73

What are the schumann bodies that can be seen with sarcoidosis?

Little lamellated calcified structures in giant cells

74

What are the asteroid bodies that are found in sarcoidosis?

Star-shaped eosinophilic bodies made of compressed intermediate filaments

75

What is the clinical course of sarcoidosis?

very good with steroids

76

What type of sarcoidosis is more likely to become progressive?

Pulmonary disease without adenopathy

77

What percent of patients with sarcoidosis die? COD?

10-15%--pulmonary fibrosis or cor pulmonale

78

What is hypersensitivity pneumonitis?

usually an occupational disease resulting from an increased susceptibility to inhaled antigens

79

What type of pulmonary disease is hypersensitivity pneumonitis?

Interstitial, restrictive disease

80

What lung structure is primarily involved in hypersensitivity pneumonitis?

Alveoli

81

What usually causes hypersensitivity pneumonitis?

-Spores of thermophilic bacteria
-Fungi
-Animal proteins
-bacterial products

82

How do you avoid progression of hypersensitivity pneumonitis?

Remove the antigen early

83

What are the acute ssx of hypersensitivity pneumonitis?

Large exposure to antigen that causes SOB

84

What are the ssx of chronic hypersensitivity pneumonitis?

Insidious onset of SOB, cough, and fatigue

Respiratory failure eventually

85

What type of hypersensitivity reaction is hypersensitivity pneumonitis? (early and later)

Type III early
Type IV later

86

What are the BAL findings with hypersensitivity pneumonitis?

Increased T cells (both CD4 and CD8)

87

What are the serum findings with hypersensitivity pneumonitis?

Specific antibodies

88

What is the sequelae of type IV hypersensitivity prolonged hypersensitivity pneumonitis?

Non-caseating granuloma

89

What is Farmer's lung?

Hypersensitivity pneumonitis caused by spores of thermophilic actinomyces in hay

90

What is Pigeon breeder's lung?

Hypersensitivity pneumonitis caused by proteins from bird feathers

91

What is humidified or air conditioners lung?

Hypersensitivity pneumonitis caused by thermophilic bacteria

92

What type of cells are high with acute Hypersensitivity pneumonitis ?

PMNs in the interstitium

93

What are the primary cells types that are found with chronic Hypersensitivity pneumonitis?

Mononuclear cells

94

What are the characteristics of the granulomas formed from Hypersensitivity pneumonitis?

Noncaseating that are loose and poorly formed

95

What happens in the later stages of Hypersensitivity pneumonitis?

Interstitial fibrosis

96

What fraction of patients with Hypersensitivity pneumonitis will have intra-alveolar infiltrate?

Greater than 2/3 of pts

97

What are the CXR findings of Hypersensitivity pneumonitis?

Increased lung markings

98

What is silo filters disease?

AN occupational lung disease from NO/NO2 that is often sound in silos. This can lead to pulmonary edema in minutes, or chronic widespread bronchiolitis with scar tissue

99

What is the major cells that are upregulated with smoking?

Macrophages

100

What is desquamative interstitial pneumonia?

a form of idiopathic bronchitis featuring elevated levels of macrophages.
It is associated with patients with a history of smoking.

101

What is the survival rate of desquamative interstitial pneumonitis with steroid use?

100%

102

What is pulmonary alveolar proteinosis?

A rare lung disease in which abnormal accumulation of pulmonary surfactant occurs within the alveoli, interfering with gas exchange.

103

What is the stain that is used to highlight the acellular surfactant in pulmonary alveolar proteinosis?

PAS+

104

What are the ssx of pulmonary alveolar proteinosis?

Thick white sputum that is gelatinous
Progressive SOB cyanosis, respiratory insufficiency

105

What happens to the alveolar walls with pulmonary alveolar proteinosis?

Minimal inflammation

106

True or false: there is a high rate of progression to pulmonary fibrosis with pulmonary alveolar proteinosis?

False--very rare

107

What is the treatment for pulmonary alveolar proteinosis?

Lavage