Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulmonary > Pneumonia (Nichols) > Flashcards

Pneumonia (Nichols) Flashcards

(88 cards)

Start Studying
1
Q

Basic pneumonia definition:

A

inflammation of lung

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Almost all acute bacterial pneumonias are _______ before they become pneumonia, and may center around ____ early on

A

multifocal bronchitis

bronchi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Almost all acute bacterial pneumonias

are due to:

A

aspiration of saliva containing pathogen

note: term “apiration pneumonia” = gastroesoph contents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Infiltrate = radiologic manifestation of:

A

pneumonia, edema or hemorrhage –blood, pus or water

Not Specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Consolidation = radiologic or phys exam manifestation of:

A

alveoli filled with blood, pus or water

(Not Specific!!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Most types of pneumonia start with:

A

acute inflammation (neutrophilic infiltration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are characteristic of subacute bacterial pneumonia?

A 
foamy macrophages
(subacute = macrophages replacing neutrophils--garbage collectors replacing first responders-- starting about day 3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

ALVEOLAR NON-NECROTIZING

Acute Bacterial Pneumonia

A

Pneumococcus
Legionella
Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ALVEOLAR NECROTIZING

Acute Bacterial Pneumonia

A

Staph aureus
Pseudomonas
Klebsiella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

INTERSTITIAL NON-NECROTIZING

Acute Bacterial Pneumonia

A

Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Most commonly identified agent of community-acquired pneumonia:
Who is the typical patient?

A

Streptococcus pneumoniae (“pneumococcus”)

older adults with smoking, COPD, alcoholism, preceding viral infection, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pneumococcus stage 1
Gross?
Micro?

A

day 1:

G–congestion with exudation of serous and frothy, blood-tinged fluid into alveoli

M–engorged septal capillaries, with a few erythrocytes, edema fluid and bacteria in alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pneumococcus stage 2
Gross?
Micro?

A

days 2-3:

G–red hepatization with drier, granular, dark red consolidation (~ liver)

M–continuing congestion, extravasation of red cells and numerous neutrophils and abundant fibrin in alveoli, infection spreading through pores of Kohn into adjacent alveoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pneumococcus stage 3
Gross?
Micro?

A

days 4-7:

G–grey hepatization with continuing consolidation, but color change to grey

M–degenerating dead cells (neuts, RBC, sloughed pneumocytes and bacteria) in the alveoli; fibrin nets extending through pores of Kohn; foamy macrophages replace neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pneumococcus stage 4

Gross?

A

day 8 and following: slimy yellowish exudate, resolution without scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pneumococcus symptoms?

A

fever

cough productive of purulent, blood-tinged (“rusty”) sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pneumococcus signs?

A

fever, tachypnea, pulmonary rales and tubular breath sounds, dullness to percussion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pneumococcus CXR
Rare?
Common?

A

lobar alveolar consolidation with air bronchograms (rare)

segmental or subsegmental alveolar infiltrates without air bronchograms (common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pneumococcus diagnostic test results?

A

G+ sputum with lancet-shaped encapsulated diplococci

Urine antigen test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

STAPHYLOCOCCUS AUREUS PNEUMONIA

Gross pathology?

A

heavy plum-colored lungs
>exude bloody fluid on sectioning
>develop numerous small abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

STAPHYLOCOCCUS AUREUS PNEUMONIA

Micro pathology?

A
  • aggregates of bacteria
  • acute bronchitis (necrotizing)
  • alveolitis and bronchiolitis + abundant degenerating neutrophils, fibrin, edema fluid, hemorrhage and evolving abscesses

(“a b” x3)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

STAPHYLOCOCCUS AUREUS PNEUMONIA

CXR?

A

areas of alveolar consolidation in a bronchopneumonia pattern

more commonly than other acute pn: severe, bilateral, abscesses, pleural effusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Staph aureus pneumonia is characteristically:

A

abscessing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When is a lung abscess drained?

A

it isn’t, unless it becomes an empyema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do you isolate Staph aureus cultures?
primarily seen in stains of microbiology laboratory cultures | NOT clinical specimens of pus, sputum, etc.
26
Where would you find legionella?
hide inside amoebae in warm water | water heaters, shower heads, air conditioners...
27
LEGIONELLA PNEUMONIA | gross?
bulging firm red or tan areas of consolidation
28
LEGIONELLA PNEUMONIA | micro?
1. acute non-necrotizing alveolitis 2. early infiltration by numerous macrophages + neutrophils (once subacute > all macrophages)
29
LEGIONELLA PNEUMONIA | symptoms?
``` cough high fever, chills, rigors dyspnea headache diarrhea confusion myalgia CP ```
30
LEGIONELLA PNEUMONIA | signs?
pulmonary rales, relative bradycardia
31
LEGIONELLA PNEUMONIA | CXR?
initially unilateral bronchopneumonic (alveolar) infiltrate | progresses (in 50%) to pleural effusion
32
LEGIONELLA PNEUMONIA | high yield dx tests?
``` urine antigen CBC: leukocytosis, thrombocytopenia Urinalysis: hyponatremia, azotemia, liver dysfunction (must culture on special charcoal medium) ```
33
What are the 3 legionella tip-off?
diarrhea, confusion, hyponatremia
34
PSEUDOMONAS AERUGINOSA PNEUMONIA | gross?
firm red areas of hemorrhagic consolidation +/- yellow areas of consolidation with a rim of hemorrhage (target lesions)
35
PSEUDOMONAS AERUGINOSA PNEUMONIA | micro?
>acute necrotizing alveolitis | >Pseudomonas vasculitis (bac invading blood vessels from the adventitia) with associated infarction/hemorrhage
36
MYCOPLASMA PNEUMONIA usually affects?
children and young adults | 95% only have URI
37
MYCOPLASMA PNEUMONIA | micro?
-lymphoplasmacytic bronchiolitis with ulceration -neutrophils & fibrin in the lumen -lymphoplasmacytic interstitial pneumonitis extending out from the bronchiolitis
38
MYCOPLASMA PNEUMONIA | symptoms?
insidious onset of malaise headache low-grade fever and chills followed by **persistent intractable dry cough, pharyngitis, +/- coryza, +/- otitis
39
MYCOPLASMA PNEUMONIA | lab test?
cold agglutinins, titer >1:64
40
MYCOPLASMA PNEUMONIA | CXR?
patchy areas of consolidation or reticulonodular infiltrate | pl effusion in 20%
41
Classic mycoplasma pneumonia scenario?
“walking pneumonia”, outpatient young person with a persistent cough and a chest x-ray looking much worse than the patient
42
Primary TB | symptoms?
low-grade fever (occasionally) chest pain (rarely) dyspnea from lymph nodes pressing on airways
43
What controls primary TB?
type IV immune response
44
What are Ghon complexes?
1. caseating granuloma lesions, usually peripheral and mid lung (primary TB) 2. enlarged hilar lymph nodes
45
Describe typical reactivation of TB?
- UL | - frequently cavitating
46
Characteristic host response to TB?
caseating granuloma with Langhans type giant cells
47
TB diagnosis occurs via...
culture with PCR
48
TB gross?
tuber lesions + caseation
49
Histoplasmosis is normally from...
fecal-enriched soil in caves, chicken coops in | Mississippi (and Ohio) river valleys
50
Histoplasmosis looks like:
small yeast | many within phagocytes
51
Histoplasmosis host response?
caseating granulomatous (if immunocompetent)
52
Histoplasmosis has many similarities to:
TB
53
Histoplasmosis, radiologically?
nodules or masses | note: these resemble lung CA!
54
Histoplasmosis, gross pathologically?
nodules or masses | note: these resemble rheumatoid nodules or old TB granulomas!
55
How can you tell if a granuloma = Histo?
Methenamine silver stains | sometimes
56
Histoplasmosis, microscopically?
alveolar infiltrate of lymphocytes and macrophages, which contain histoplasmosis
57
ASPERGILLOSIS, transmission?
airborne transmission, not contagious
58
ASPERGILLOSIS | 3 forms of disease?
1. allergy 2. colonization 3. invasion (lung nodules or masses; occurs with corticosteroids, immunosuppression, etc)
59
ASPERGILLOSIS | symptoms?
fever hemoptysis pleuritic CP (cough, dyspnea)
60
ASPERGILLOSIS | microscopically?
regular septate hyphae with dichotomous acute angle branching -invades bronchus
61
What is particularly bad about the progression of ASPERGILLOSIS infection?
angioinvasive = causes hemorrhage and infarction
62
Diagnostic tests for Aspergillosis? | What would confirm the dx?
1. serum test for galactomannan (limited usefulness) 2. culture or biopsy (also not awesome) Aspergillus fruiting body
63
CRYPTOCOCCUS | Where do you find this?
yeast found in soil and pigeon poop
64
CRYPTOCOCCUS | transmission?
airborne transmission, not contagious
65
CRYPTOCOCCUS Most common form of infection? Second most common?
1. meningitis 2. lung nodules/masses (occ. interstitial pneumonia)
66
CRYPTOCOCCUS | Primary virulence factor?
anti-phagocytic capsule
67
CRYPTOCOCCUS | Primary host defense?
cell-mediated immunity | macrophage response, sometimes with discrete granulomas or giant cells
68
CRYPTOCOCCUS | microscopically?
faintly basophilic or translucent yeast with large surrounding clear space in H&E-stained tissue
69
CRYPTOCOCCUS | Diagnosis?
morphology antigen test culture
70
CRYPTOCOCCUS | Histologic confirmation?
mucicarmine stain | red = +
71
PNEUMOCYSTIS JIROVECII PNEUMONIA | 2 main characteristics?
1. fungus which behaves like a protozoan 2. opportunistic pathogen in patients with deficient cell-mediated immunity (AIDS, etc.)
72
PNEUMOCYSTIS JIROVECII PNEUMONIA | Symptoms?
insidious onset of dyspnea, fever, and non-productive cough
73
PNEUMOCYSTIS JIROVECII PNEUMONIA | Signs?
tachypnea with no rales or rhonchi
74
PNEUMOCYSTIS JIROVECII PNEUMONIA | CXR?
bilateral hazy interstitial infiltrates which become dense alveolar infiltrates
75
PNEUMOCYSTIS JIROVECII PNEUMONIA | Gross?
heavy, diffusely consolidated, tan lungs
76
PNEUMOCYSTIS JIROVECII PNEUMONIA | Micro?
foamy eosinophilic, sparsely cellular, centro-alveolar “honeycomb” exudate +/- lymphoplasmacytic interstitial pneumonia
77
PNEUMOCYSTIS JIROVECII PNEUMONIA Diagnosis? What would you NOT use?
Demonstration of helmet-shaped org in biopsy, smear, aspirate or lavage using: 1. cyst stains (e.g. Grocott, methenamine silver) 2. trophozoite 3. immunostains Cannot culture this--it doesn't grow!
78
Type 2 pneumocyte hyperplasia is seen in what 2 conditions?
interstitial pneumonias | acute lung injury
79
Chronic pneumonias tend to be (etiology):
fungal, mycobacterial, toxic, autoimmune or idiopathic
80
Chronic pneumonias tend to be (lung pattern):
interstitial nodular both
81
What two causes of chronic pneumonia are often chronic and nodular?
fungal | mycobacterial
82
INTERSTITIAL chronic pneumonias (3):
Pneumocystis Sarcoidosis Toxoplasmosis
83
NODULAR chronic pneumonias (6):
``` TB Histoplasmosis Aspergillosis Cryptococcosis Coccidioidomycosis Blastomycosis ``` "BITCHY Nodules = Blasto, asperg-i-llosis, Tb, Coccidio, Histo, crYpto
84
Most common causes of viral pneumonia?
influenza | RSV
85
What virus causes interstitial pneumonias in immunocompromised patients?
Cytomegalovirus (CMV)
86
What virus causes nodular pneumonias in immunocompromised patients?
Herpes simplex virus (HSV)
87
Viral pneumonias tend to be (interstitial/nodular)
interstitial
88
What are Ghon focuses?
grey/white caseating granulomas (necrotic centers) FYI: "complex" = this + hilar lymphadenopathy

Pulmonary (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions