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CPR Exam 2 > Pulmonary Pathology Part 4 > Flashcards

Pulmonary Pathology Part 4 Flashcards

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1
Q

What are some facts about pneumonia?

A
  • Second most cause of hospital admissions
  • World’s leading cause of death in children <5 years old
  • Most common cause for sepsis and septic shock
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2
Q

How is pneumonia classified by clinical setting?

A
  • Community acquired (bacteria vs viral)
  • Health care associated pneumonia
  • Aspiration pneumonia
  • Chronic pneumonia
  • Pneumonia in the immunocompromised host
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3
Q

How is pneumonia classified by anatomic distribution?

A
  • Bronchopneumonia

- Lobar pneumonia

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4
Q

How is lobar pneumonia diagnosed?

A
  • Through characteristic radiographic appearance
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5
Q

What are the stages of lobar pneumonia?

A
  • Congestion (vascular engorgement)
  • Red hepatization (red cells and inflammation)
  • Grey hepatization (inflammation and debris)
  • Resolution (fibrosis and macrophage clean up)
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6
Q

What are some complications that can arise in lobar pneumonia?

A
  • Abscess
  • Empyema
  • Bacteremia
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7
Q

What are some community acquired bacteria that cause pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • K. pneumoniae
  • P. aeruginosa
  • L. pneumoniae
  • M. pneumoniae
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8
Q

Which bacteria is the most common cause of community acquired pneumonia?

A
  • Streptococcus pneumoniae
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9
Q

What are the vaccination requirements for strepococcus pneumoniae?

A
  • Recommended for infants and people >65

- Also in people that smoke or have respiratory disease

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10
Q

Where is H. influenzae caused pneumonia seen?

A
  • Virulent pneumonia in children
  • Recommended vaccination for type B for children >5
  • Patients will first have flu virus and then this will superimpose in host
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11
Q

Where is S. aureus pneumonia seen?

A
  • IV drug users

- Abscess formation

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12
Q

Where is K. pneumoniae pneumonia seen?

A
  • Alcoholics

- Will have a currant jelly sputum due to parenchymal bleeding

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13
Q

Where is P. aeruginosa pneumonia seen?

A
  • Seen often in cystic fibrosis patients
  • Can also been seen as opportunistic infection
  • May be hospital acquired
  • Look likes copper rust (green) when plated
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14
Q

What is the typical bacterial pneumonia presentation?

A
  • More abrupt onset
  • Respiratory symptoms predominate
  • Consolidation on CXR
  • Older adults or young children
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15
Q

What is the atypical (walking) pneumonia presentation?

A
  • Slower onset
  • Systemic symptoms predominate
  • Patchy infiltrates on CXR
  • In young adults/teens/older children
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16
Q

What bacteria causes typical pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • K. pneumoniae
  • P. aeruginosa
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17
Q

What bacteria causes atypical (walking) pneumonia?

A
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydia pneumonia
  • Chlamydia psittaci
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18
Q

What is mycoplasma pneumoniae?

A
  • Smallest free-living, self replicating organism

- Has no cell wall

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19
Q

What is Legionella pneumophila?

A
  • Gram negative bacillis
  • Grows in warm freshwater
  • Airborne disease
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20
Q

Where can legionella pneumophila grow?

A
  • AC units
  • Misters
  • Hot tubs
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21
Q

What are some viral causes of community acquired pneumonia?

A
  • Influenze (H1N1)
  • SARS
  • COVID 19
  • Respiratory syncytial virus
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22
Q

What is the difference in spread between viruses and bacteria in pneumonia?

A
  • Bacteria spread in the alveolar spaces (wrecking ball)

- Viruses spread in the interstitium (through the walls)

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23
Q

How is the influenza virus classified?

A
  • By two proteins:
  • Hemagglutinin
  • Neuraminidase
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24
Q

What does hemagglutinin do?

A
  • Attaches to cells
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25
What does neuraminidase do?
- Allows release of replicated virus from cells
26
What does tamiflu do to prevent the flu?
- Prevents the action of neuraminidase which causes the viron to be stuck
27
What is antigenic drift?
- Minor changes to proteins on the virus, allowing increased spread - Similar enough to original virus to allow for some immunity in many individuals - Causes epidemics
28
What is antigenic shift?
- Genomic alterations with major resulting changes to protein structures - Naive immunity for almost all people - Picked up from animal gene products?
29
What does COVID look like in regards to signaling molecules?
- Looks like ARDS with the cytokine storm
30
What is clinically seen in someone with COVID?
- Congested lungs - Hyperemia on cut surfaces - Pleurisy - Lower extremity thrombus - Pulmonary embolus
31
What is the cause of death in COVID?
- Superimposed bacterial pneumonia
32
What is elevated in COVID that could cause a serious issue?
- Elevated D dimer correlates with the thrombotic complications
33
What is COVID-19?
- ssRNA virus - Spread via respiratory droplet - Induces "cytokine" storm - Coagulopathy
34
What bacterial pneumonia is seen in neonates?
- Group B strep - Gram negative bacilli - Listeria
35
What viral pneumonia is seen in children <1 month?
- Respiratory syncytial virus - Parainfluenza virus - Influenza A and B - Adenovirus - Rhinovirus
36
What bacterial pneumonia is seen in children >1 month?
- S. pneumoniae - H. influenzae - M. catarrhalis - S. aureus
37
What pneumonia is seen in older children/adolescents?
- Same as younger children - M. pneumoniae - C. pneumoniae
38
What is respiratory syncytial virus?
- Paramyxovirus
39
What are the symptoms of respiratory syncytial virus?
- Symptoms of rhinorrhea and cough - Wheezing and dyspnea - Tachypnea - Cyanosis
40
What are some specific paramyxoviridae viruses?
- RSV - human Metapneumovirus - Parainfluenza - Measles
41
What are some illnesses that have had a decline in vaccinations recently?
- Measles - Pertussis - Diphtheria
42
What is the general presentation for bacterial pneumonia?
- Abrupt onset - Not associated with epidemics - May have associated bacteremia - High grade fever - Crackles on lung exam - Lobar or consolidated appearance - May involve pleura - Responds quickly to antibiotics
43
What is the general presentation for viral pneumonia?
- Gradual onset - Epidemics are common - Not typically associated with viremia - No fever or low grade fevers - Diffuse infiltrates on CXR - Will not typically involve pleura - Will not responsed to antibiotics but usually self limiting
44
What can cause a lung abscess?
- Complications of pneumonia | - Aspiration
45
What bacterial pneumonia can cause a lung abscess?
- S. aureus | - K. pneumoniae
46
Who typically has lung abscesses due to aspiration?
- Chronic alcoholics - Elderly patients - Anaerobic bacteria
47
What side does aspirated material tend to go to? Why?
- Tends to go to the right lung due to a steeper descent of the right main bronchus
48
What happens in aspiration pneumonia?
- Abscess formation in acute bacterial pneumonia | - Food particle in inflammatory exudate indicating aspiration
49
What is the process of tuberculosis?
- Primary infection causes a localized caseation | - Localized caseation can heal or progress to primary TB or become latent
50
What can primary TB do?
- Turn into miliary TB (massive hematogenous dissemination) | - Reinfection, turning into secondary TB
51
What does secondary TB turn into?
- Turns into progressive secondary TB - Then turns into miliary TB - OR could cause localized caseating destructive lesions
52
What is specifically seen in TB?
- Ghon complex
53
What are some fungal sources of chronic pneumonia?
- Histoplasma - Blastomycosis - Coccidioidomycosis
54
What is histoplasma capsulatum?
- Endemic in midwest and caribbean - Typically a subclinical infection with granulomatous response (coin lesions on CXR) - Can run aggressive course, especially in immunocompromised patients
55
What is the characteristic form that is seen on morphology of histoplasma?
- Pumpkin seed
56
What is blastomyces dermatitides?
- Endemic in central and SE US - In the lungs, infection yields a granulomatous response - Characteristic yeast forms show broad-based budding - Can also infect skin and rarely, disseminated infection
57
What is coccidiodes immitis?
- Endemic in southwestern US and Mexico - In the lungs, yields a granulomatous response with eosinophils - Often a subclinical, self-limited disease - Can produce disseminated infection (immunocompromised patients)
58
What is pneumocystis jiroveci?
- Opportunistic fungal infection - AIDS-defining illness - Characteristic cup shaped yeast forms - Can be diffuse or focal
59
What is mycobacterium avium complex (MAC)?
- Found in immunocompromised or elderly patients | - Thin mycobacteria seen as slender red forms on acid-fast staining
60
What is needed to discriminate from rejection?
- Biopsies which can produce infiltrates and fever
61
What does rejection show in lung transplantation?
- Mononuclear infiltrates around vessels

CPR Exam 2 (12 decks)

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