Pathoma Pulmonary Infections

Question 1

Pneumonia

Answer 1

Infection of the lung parenchyma

Question 2

Normal cause of Pneumonia

Answer 2

Occurs when normal defenses are impaired

Question 3

Clinical features of PNA

Answer 3

Fever and chills, cough with yellow green or rusty sputum, tachypnea with pleuritic chest pain, decreased breath sounds with dullness to percussion

Question 4

Labs for PNA

Answer 4

Elevated WBC count

Question 5

3 chest x ray patterns involving Penumonia

Answer 5

Lobar PNA - Whole lobe consolidated

Bronchopneumonia - Consolidation in patchy pattern on airways

Interstitial pneumonia - N oconsolidation, just inflammation in the interstitium. Increased in lung markings

Question 6

CXR for bacterial PNA

Answer 6

Lobar and broncho PNA

Question 7

CXR for viral PNA

Answer 7

Interstitial PNA

Question 8

Most common causes of lobar PNA

Answer 8

Strep Pneumonia in 95%

Klebsiella pneumonia in 5% or less

Question 9

Which PNA is associated with community-acquired?

Answer 9

Streptococcus Pneumoniae

Question 10

Which PNA is associated with malnourished or debilitated individuals like in nursing homes?

Answer 10

Klebsiella Pneumoniae?

Question 11

Regarding Klebsiella PNA, we typically see this PNA etiology and complication:

Answer 11

Thick mucoid capsule results in gelatinous sputum (currant) jelly.

Often complicated by abscess

Question 12

4 phases of lobar pneumonia

Answer 12

1. Congestion - congested vessels and edema
2. Red Hepatization - Develop exudate in the lung with blood and neutrophils, making a thick, tougher lung over spongy normal one
3. Grey Hepatization - RBCs break down
4. Resolution - Resolve exudate and heal

Question 13

Discuss lung healing and the most important cell involved

Answer 13

Type II pneumocyte which a stem cell of the lung that regenerates the lung.

Question 14

How does bronchiopneumonia look?

Answer 14

Scattered, often bilateral. Centered around bronchioles

Question 15

There are 5 bacteria associated with bronchopneumonia:

Answer 15

1. Staph Aureus
2. H Influenza
3. Pseudomonas aeruginosa
4. Moraxella Catarrhalis
5. Legionella Pneumophila

Question 16

This bacteria is seen in cystic fibrosis patients who have bronchopneumonia

Answer 16

Pseudomonas Aeruginosa

Question 17

This bacteria is seen in community acquired pneumonia patients who have bronchopneumonia

Answer 17

H. Influenza
M. Catarrhalis
L. Pneumophila

Question 18

This bacteria is seen superimposed on COPD patients patients who have bronchopneumonia

Answer 18

H. Influenza
M. Catarrhalis
L. Pneumophila

Question 19

This bacteria is seen in patients who have bronchopneumonia and is often associated with an abscess and empyema, which is pus

Answer 19

S. Aureus

Question 20

This bacteria is seen in patients who have bronchopneumonia and are immune compromised

Answer 20

L. Pneumophila

Question 21

This bacteria is associated with bronchopneumonia and is superimposed on a viral upper respiratory infection

Answer 21

S. Aureus

Question 22

This bacteria is best visualized on a silver stainm and is associated with bronchopneumonia

Answer 22

L. Pneumophila

Question 23

This bacteria is associated with bronchopneumonia and is the most common cause of secondary pneumonia

Answer 23

S. Aureus

Question 24

Presentation of interstitial pneumonia, also called atypical PNA

Answer 24

Diffuse infiltrates

Presents with relatively mild upper respiratory symptoms like minimal sputum, cough, and low fever

Question 25

Most common cause of atypical PNA in infants

Answer 25

RSV - Respiratory Syncytial virus

Question 26

This atypical pneumonia is associated with post transplant immunosuppressive therapy

Answer 26

Cytomegalovirus (CMV)

Question 27

Most common cause of atypical PNA, usually in young adults

Answer 27

Mycoplasma pneumoniae

Question 28

Complications of atypical pneumoniae caused by Mycoplasma pneumoniae

Answer 28

1. Autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) 2. Erythema multiforme

Question 29

Why can't we visualize Mycoplasma pneumoniae on a gram stain?

Answer 29

No cell wall

Question 30

Second msot common cause of atypical pneumonia

Answer 30

Chlamydia pneumoniae

Question 31

This causes an atypical pneumonia of the elderly or immune compromised or those with preexisting lung disease

Answer 31

Influenza virus

Question 32

Typically atypical pneumonia does not present with a high fever, but with this organism, it does:

Answer 32

Coxiella Burnetti

Question 33

What is special about Coxiella Burnetti?

Answer 33

It is rickettsial, but it distinct because 1. Causes pneumonia 2. Does not require arthropod vector for transmission (survives as highly heat-resistant endospores) 3. Does not produce a skin rash

Question 34

This organism increases the risk for superimposed S. Aureus or H. Influenza bacterial pneumonia

Answer 34

Influenza virus

Question 35

This organism puts farmers and vets at risk for developing atypical pneumonia

Answer 35

Coxiella burnetti

Question 36

Who gets Aspiration Pneumonia?

Answer 36

Those at risk for aspiration...idiot Like alcoholics and comatose patients, and Nick

Question 37

What causes aspiration pneumonia? Give top 3 examples

Answer 37

Anaerobic bacteria in the oropharynx like: 1. Bacteroides 2. Fusobacterium 3. Peptococcus

Question 38

spiration Pneumonia classically results in what?

Answer 38

Right lower lobe abscess

Question 39

What causes tuberculosis?

Answer 39

Inhalation of aerosolized Mycobacterium tuberculosis

Question 40

What is primary TB?

Answer 40

Results from initial exposure of M. Tuberculosis

Question 41

Symptoms of primary TB

Answer 41

Usually asymptomatic

Question 42

Describe what is happening biologically with primary TB

Answer 42

Results in focal caseating necrosis in the lower lobe of the lung and hilar lymph nodes. The foci undergo fibrosis and calcification, forming a Ghon complex.

Question 43

What is secondary TB and who gets it the most?

Answer 43

Its when you have a reactivation of your TB, usually seen in AIDS and sometimes with aging

Question 44

Where does Secondary TB hit and what does it lead to

Answer 44

Occurs at the apex of the lung Forms a cavitary foci of caseous necrosis, may also lead to miliary pulmonary TB or tuberculosis bronchopneumonia

Question 45

Presentation of Secondary TB

Answer 45

1. Fever and night sweats 2. Cough with hemoptysis 3. Weight loss

Question 46

Biopsy/staining of secondary TB shows what?

Answer 46

Biopsy reveals caseating granulomas AFB stain reveals red acid-fast bacilli

Question 47

Secondary TB can spread to any tissue. What are the top three and what do they cause?

Answer 47

1. Meninges leading to meningitis 2. Kidney which can lead to sterile pyuria 3. Lumbar vertebrae leading to Pott Disease Can also go to cervical lymph nodes but everything does.

Question 48

What is the most common organ affected by secondary TB?

Answer 48

Kidney

Question 49

With Meningitis caused by Secondary TB, which ones are most affected and how do we know?

Answer 49

The base of the brain, you'll see granulomas there