Pulmonary infections Flashcards by Ali Q8

What is the pathological definition of pneumonia?

A3: Infection of the lung tissue distal to the terminal bronchioles.

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What is the clinical definition of pneumonia?

A4: Signs and symptoms of lung infection with at least one opacity on chest X-ray.

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What are the histological types of pneumonia?

➔ Fibrinopurulent alveolar exudate: acute bacterial
➔ Mononuclear interstitial infiltrate: viral & atypical
➔ Granulomas & cavitation: many of the chronic pneumonias

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Name 4 complications of bacterial pneumonia.
A9:

• Necrotizing pneumonia
• Empyema
• Meningitis
• Sepsis and multi-organ failure

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How is typical pneumonia diagnosed in the lab?
A11:

• MOs grow on standard culture media
• Identified by Gram stain

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What are the characteristics of atypical pneumonia?

▪ MOs can’t be cultured on standard media
▪ MOs can’t be identified through Gram stain

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What are MO of atypical pneumonia?

✓ Legionella species

✓ Mycoplasma

✓ Chlamydia

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What are the microorganisms that cause opportunistic pneumonia?
A:

• Mycobacterium tuberculosis
• Nocardia species

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What are Community-Acquired Pneumonia (CAP), Hospital-Acquired Pneumonia (HAP), and Ventilator-Associated Pneumonia (VAP)?

➔ Community-acquired pneumonia (CAP): patient acquired it
from the community or within 48 h of hospital admission
➔ Hospital-acquired pneumonia (HAP): in a non-intubated
patient that develops after 48 h of hospitalization
➔ Ventilator-acquired pneumonia (VAP): type of nosocomial
pneumonia that develops 48 h or longer after intubation
for mechanical ventilation

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What is atypical pneumonia?

A: Pneumonia caused by pathogens that are not detectable by traditional Gram stain or standard culture methods.

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The most common case of CAP?

The second most coordinated case of CAP?

Streptococcus pneumonia

Sec= Hemophilus influenzae

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What are the common pathogens causing Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP)?

• Klebsiella pneumoniae
• Escherichia coli
• Pseudomonas aeruginosa
• Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA)

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the primary drivers of
the clinical manifestations in bacterial pneumonia

➔ Host inflammatory responses

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Cytokines cause constitutional symptoms are?

▪ IL-1 and TNF: fever
▪ IL-8 (chemokine): chemotaxis & neutrophil maturation
▪ G-CSF: chemotaxis & neutrophil maturation
▪ IL-9 & IL-13: mucin production,

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What causes pleuritic chest pain in pneumonia?

➔ Pleural inflammation triggers somatic receptors of phrenic
nerve within the parietal pleura → pleuritic chest pain

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How does hemoptysis occur in bacterial pneumonia?

➔ Localized necrosis from damage to the lung parenchyma
and tissue extravasation can result in hemoptysis

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What are the Impairment of defense mechanisms leading to infections?

➔ Loss or suppression of cough reflex

➔ Injury to mucociliary blanket

➔ Decrease in macrophage function

➔ Impaired immune system

➔ Existing pulmonary disease

➔ Unusually virulent infecting organism

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What are the features of the congestion stage in lobar pneumonia?

➔ Pulmonary parenchyma is not fully consolidated
➔ Microscopically, the alveoli contain serous exudates
(pathogens, some neutrophils, and macrophages)

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What characterizes the red hepatization stage of lobar pneumonia?

➔ The affected lobe consolidates with firm & liver-like texture
➔ Capillaries are congested and alveolar walls are thickened
➔ Microscopically: fibrin, serous exudate, pathogens,
neutrophils, and macrophages

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What happens during the resolution stage of lobar pneumonia?

➔ Clearing of exudate: lymphatic drainage or cough

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What are the characteristic sputum colors in pneumonia caused by different bacteria?

• Pseudomonas, Haemophilus: Green sputum
• Klebsiella pneumoniae: Red currant jelly sputum (thick, dark red)
• Anaerobic bacteria: Foul-smelling, bad-tasting sputum
• Streptococcus pneumoniae: Rust-colored sputum (brownish)

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What is a key clinical feature of Legionella pneumonia?

altered mentation (encephalitis, meningitis,
and peripheral neuropathy), myocarditis, panniculitis,
myositis, and cutaneous symptoms

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What are common exposures linked to Legionella infection?

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A: Smoking, contaminated air-conditioning and water systems, such as in cruise ships and hotels.

Which birds are commonly associated with Psittacosis and Tularemia and Q fever also P. aeruginosa?

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1-birds
2-rabbit
3-cats, sheep, and cattle
4-immunocompromised

What does increase risk of aspiration?

➔ Altered mentation

Which gastrointestinal conditions increase aspiration risk?

A: GERD (acid reflux), gastric outlet obstruction, and persistent vomiting.

Which lung infections are common in patients with asthma, COPD, smoking, or decreased immunity?

A: Haemophilus influenzae infections.

What infections are common in advanced HIV patients with CD4 count less than 100?

A: Tuberculosis (TB) and cryptococcosis.

Why are IV drug users at increased risk for bacterial pneumonia?

A: Because they are prone to infections by Staphylococcus aureus.

Why should doctors have a low threshold for ordering chest X-rays in children suspected of pneumonia?

A: Because children may not always show typical physical exam signs of pneumonia, so chest X-rays help confirm the diagnosis.

Which type of pneumonia is associated with : ➔ Relative bradycardia…? ➔ Dental illnesses……? ➔ Impaired gag reflex and dysphagia…? ➔ Cutaneous nodules……? ➔ Osteomyelitis and lower lobe pneumonia……?

➔ Relative bradycardia: Legionella species ➔ Dental illnesses: Anaerobes ➔ Impaired gag reflex and dysphagia: Aspiration pneumonia ➔ Cutaneous nodules: Nocardiosis ➔ Osteomyelitis and lower lobe pneumonia: Actinomycosis

Scrofula (cervical lymphadenitis) and spinal deformities are commonly associated with what disease?

A: Tuberculosis (TB).

What is the CURB-65 scoring system used for, and what does each letter stand for? A:

The CURB-65 score helps assess the severity of pneumonia and guides decisions about hospitalization. Each letter stands for: • C = Confusion (new disorientation to person, place, or time) • U = Urea > 7 mmol/L (or BUN > 20 mg/dL) • R = Respiratory rate ≥ 30 breaths/min • B = Blood pressure (Systolic < 90 mmHg or Diastolic ≤ 60 mmHg) • 65 = Age ≥ 65 years

What are the key laboratory evaluations in pneumonia diagnosis and severity assessment?

- CBC - Inflammatory biomarkers like ESR and CRP (↑ = severe) - Blood cultures, sputum analysis or Gram staining - PCR - Arterial blood gas analysis: hypoxia and respiratory acidosis - Severe hypoxia: if O2 saturation < 92% by pulse oximetry

What is the first imaging test used in pneumonia diagnosis?

A: Chest X-ray (CXR) is the initial and most common imaging test.

What radiological pattern is typical for Staphylococcus aureus pneumonia?

A: Multi-lobar patchy opacities with cavitary lesions.

What is the radiological appearance of Pseudomonas aeruginosa pneumonia?

A: Patchy opacities with lung abscess formation.

What is the “bulging fissure sign” and which organism is classically associated with it?

A: It’s when an abscess pushes the lung fissure outward, commonly caused by Klebsiella pneumoniae.

The most common cause of viral pneumonia in small children and infants

RSV(rna)

The most common cause of URTI across all age groups

Rhinovirus (RNA)

Which type of Influenza is most fatal ?

Influenza A is the greatest cause of mortality and morbidity among the viral pneumonia

Most commonly associated with pneumonia-like illness in young children seasonally

Parainfluenza 1, 2, 3, and 4 (RNA)

Pneumonia in immune-compromised patients,

HSV I and II (DNA) Adenovirus (DNA)

may cause severe pneumonia in non-immune pregnant women.

VZV (DNA) Chickenpox and shingles

A subset of the coronavirus associated with severe pneumonia.

MERS (RNA)

What are the common chest X-ray (CXR) features of bacterial pneumonia?

Alveolar infiltrates Lobar consolidation Nodular densities Pleural effusion

It is not routinely cultured and have no cell wall ?

Mycoplasma pneumonia

What are key features of Mycoplasma pneumoniae infection?

- Excreted from the RT after many weeks of acute infection - Isolation of the organism is not specific to acute infection - A common cause of community-acquired pneumonia

Characters of Mycoplasma pneumonia?

asymptomatic ➔ Disease onset is gradual, mild and self-limited

What are key evaluation findings in Mycoplasma pneumoniae infection?

➔ No specific clinical or radiological findings ➔ Hemolysis that causes a positive Coombs test ➔ White blood cell count is normal CXR= unilateral or bilateral and are more prominent in the lower lobes

What are key points about aspiration pneumonia?

• Common in advanced age - Aerobic gram-negative bacilli: the predominant pathogens

What are the key radiological findings in aspiration pneumonia?

➔ The right lung is more frequently affected than the left ➔ Upright patients: basal segments of the lower lobes & RML ➔ Bedridden patients: superior segments of the lower lobes or posterior parts of the upper lobes

What are key features of Pneumocystis jirovecii pneumonia (PCP)?

- Fungal infection most commonly affects immunocompromised - Pneumocystis was once considered an AIDS-defining illness

What are key pathological and clinical features of primary lung tuberculosis? A:

• Main pathology: necrotizing granulomatous inflammation (with central caseation) • Granuloma formation is the hallmark feature • Lungs are the main organs affected • Most cases are asymptomatic in early/primary infection

What are common systemic symptoms of pulmonary tuberculosis?

➔ Prolonged fever is the most commonly reported symptom ➔ Fever has a diurnal pattern weight loss

What is a hallmark radiological finding in primary pulmonary tuberculosis? A:

• Hilar lymphadenopathy

Pulmonary infections Flashcards

(56 cards)