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Pulmonology - OMS 2 > Pulmonary Infections - Pathology > Flashcards

Pulmonary Infections - Pathology Flashcards

(52 cards)

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1
Q

Systemic factors that predispose to pneumonia

A
  1. immune deficiency or supression
  2. leukopenia
  3. chronic illness
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2
Q

Local factors that predispose to pneumonia

A
  1. loss of cough reflex/impaired mucociliary apparatus
  2. interference w/phagocytic or bactericidal action of alveolar MF
  3. pulmonary congestion/edema
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3
Q

MC cause of community-acquired acute pneumonia

A

S. pneumoniae

(gram stain for dx; usually lobar)

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4
Q

Which type of pneumonia causes lobar pneumonia?

A

community-acquired (s. pneumoniae)

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5
Q

Difference between lobar and bronchopneumonia?

A

broncho: affects alveoli near bronchi
lobar: entire lobe

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6
Q
A

foci of consolidation (lung exudate) = bronchopneumonia

right: lobar pneumonia exhibits gray hepatization (firm like liver)
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7
Q

In lobar pneumonia, what are the four stages of the inflammatory response?

A
  1. congestion
  2. red hepatization
  3. gray hepatization
  4. resolution
gray hepatization
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8
Q

describe the congestion phase of lobar pneumonia

A

vascular engorgement, intra-alveolar fluid, neutrophils, bacteria present

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9
Q

Describe the red hepatization phase of lobar pneumonia

A
  1. massive exudation with neutrophils
  2. red cells
  3. fibrin filling alveolar spaces

lobe appears red, firm, and airless

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10
Q

Describe the gray hepatization phase of lobar pneumonia

A
  1. progressive disintegration of red cells
  2. persistence of a fibrinosuppurative exudate

appears grayish & dry

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11
Q

Describe the resolution phase of lobar pneumonia.

A

consolidated exudate undergoes enzymatic digestion –> produces granular, semifluid debris that is resorbed, ingested by MF or expectorated

pulmonary architecture restored. some –> organized pneumonia w/fibrous

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12
Q

Dx? Why?

A
  • acute bacterial pneumonia
  • large # neutrophils in alveoli
  • purulent exudate in alveoli
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13
Q

Difference in xray findings between broncho and lobar pneumonia

A
  • lobar: radiopaque
  • broncho: focal opacities
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14
Q

bacterial pneumonia vs. viral pneumonia presentation.

both have fever

A

bacterial: shaking chills, cough w/mucopurulent sputum
viral: myalgia, headache

(acute/community-acquired)

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15
Q

How long does it take a patient to recover from acute bacterial pneumonia once treated?

A

2-3 days

(10% of hospitalized pts die)

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16
Q

MC causes of viral pneumonia (5)

A
  1. Flu
  2. rhinoviruses
  3. RSV
  4. SARS-CoV-2
  5. Human metapneumovirus
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17
Q

How does SARS-CoV-2 enter epithelial cells

A

ACE2 receptor of alveolar epithelial cells

the reason its a lung disease

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18
Q

3 types (morphologies) of viral community-acquired pneumonia

A
  1. laryngotracheobronchitis
  2. bronchiolitis
  3. interstitial pneumonia

(location based)

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19
Q

Adult pneumonia is typically caused by which viruses?

A
  1. flu
  2. rhinovirus
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20
Q

Pediatric pneumonia is typically caused by which viruses?

A

RSV

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21
Q

In interstitial pneumonia, alveolar septa become thickened with _______ infiltrate.

22
Q

What is this? Why?

Study These Flashcards
A
  1. intersitital pneumonia
  2. lymphocytes
  3. exudate
  4. hyaline membranes (diffuse alveolar damage –> ARDS)

(this is the usual cause of death in COVID patients)

23
Q

2 common complications of aspiration pneumonia

Study These Flashcards
A

necrosis –> lung abscess

high mortality

24
Q

define lung abscess

Study These Flashcards
A
  1. neutrophils
  2. necrosis
25
5 Causes of lung abscess
1. aspiration 1. antecedent pneumonia (necrosis) 1. septic emboli (phlebits or endocarditis) 1. neoplasia 2. penetration injury
26
Which 3 pathogens are responsible for 60% of lung abscess?
1. bacteroides 1. fusobacterium 1. peptococcus | (usually from aspiration)
27
lung abscess | neutorphils + exudate
28
MC signs of lung abscess
copious amt of foul-smelling sputum | CP &. weight loss
29
4 complications of lung abscess
1. empyema 1. hemoptysis 1. meningitits 1. brain abscess
30
Chronic pneumonia inflammatory reaction involves _________.
granuloma
31
MC pathogen involved in chronic pneumonia (3)
1. M. tuberculosis 1. H. capsulatum 1. C. immitus
32
% of TB infection that progresses to primary TB
5
33
isolated tb
dissemination to one organ | ex: kidneys
34
What is happening during the 3 weeks of infection with Tb, before cell-mediated immunity begins?
MF take up TB but are not activated --> proliferation --> bacteremia & seeding
35
Describe the initiation of cell-mediated immunity in tuberculosis infection.
Alveolar MF presents to T-cell via IL-12 & MHC II --> differentiation to TH1 --> activated MF --> TNF, chemokines --> monocyte recruitement & casseous necrosis | very similair to histoplasmosis pathogenesis
36
ghon complex | yellow = hilar nodes blue = casseating granuloma in parenchyma
37
caseating granuloma | yellow = caseating necrosis blue = langhans giant cell
38
how are langhans giant cells formed
activation & fusion of activated MF | T-cell mediated response = langhans
39
What is this? why?
1. secondary tb 1. cavitation (cassceation coalesce)
40
acid-fast bacili smear = TB
41
miliary disseasae | spleen
42
What is predominate cell type in caseating granulomas?
activated MF | aka epitheliod MF due to increased cytosol which looks like epithelial c
43
What are the similairities between TB and histoplasmosis (2)?
1. primary & secondary disease 1. can disseminate to other organs
44
Dx? Why?
1. Histoplasmosis 1. "Tree bark" appearance due concentric layers of fibrosis and calcifications
45
Dx? Why?
* Histoplasmosis * pair shaped budding yeast w/narrow base
46
Histoplasmosis is very similair to TB pathogenesis, what is the difference?
mainly that histoplasmosis is a fungi, both are taken in by MF, multiply and lyse MF --> entry into blood --> T cells then activate and recruit MF via INF-g --> caseating granuloma
47
How is histoplasmosis dx (2)?
1. culture yeast 1. serologic testing (Ab & Ag)
48
only 10% of ppl w/San Joaquin Valley Fever develop symptoms. What are the sx (3)?
1. lung lesion 1. pleuritic pain 2. cutaneous lesions | (fever & cough)
49
Cutaneous involvment in coccidioidomycosis (2)
1. erythema nodosum 1. erythema multiforme | (only 1% will develop disseminated C. immitis )
50
Dx? Why?
* bronchopneumona * spheroles (C. immitus) | will develop caseating granuloma (below)
51
spheroles containing endospores
52
Histoplasmosis is endemic to which area?
ohio & mississippi river valleys

Pulmonology - OMS 2 (28 decks)

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