Resp I Flashcards

Question

How do people usually aquire an H. influenza infection and what does it cause?

Answer 1

- from endogenous aspiration and reduced protective mechanisms - Often pre-existing COPD or viral infections * *Usually causes bronchopneumonia - May develop bronchiolitis or bronchiectasis as complications

Answer 2

- Uncommon in infancy and old age * Streptococcus pneumoniae most common - Affects otherwise healthy adults 20-50 yrs. - Except Klebsiella pneumoniae in elderly, diabetics, alcoholics - Diffuse consolidation - Uniformly affects anatomically delineated segment(s) or entire lobe(s)

Answer 3

cough, fever, rigors, pleuritic chest pain, difficulty breathing, purulent (green/yellow) sputum; may contain flecks of blood Demonstrated by dullness to percussion with bronchial breathing CXR: Well-defined, homogenous opacity observed in the right middle lobe (arrow)

Answer 4

- Strep. pneumoniae (pneumococcus) - Antibiotics decreased the mortality to 10%, but NO EFFECT on the incidence - Often a post-viral infection (i.e., host mechanisms impaired) - Route of infection: inhalation - Gram-positive diplococci

Answer 5

- pneumonia in right upper lobe - Common in elderly men, alcoholics, patients with diabetes mellitus, malignancies, and heart disease - Abscess formation common;25% develop empyemas - Mortality approaches 30% - Klebsiella is part of normal GI flora - Gram-negative rod

Answer 6

- Frequently from blood-borne dissemination to the lungs - Usually no preceding upper respiratory infection - High mortality rates - Associated with sepsis, diabetes mellitus, pyelonephritis, and heart disease - Gram-negative rods

Answer 7

- 5 – 10% of all pneumonias - High mortality rate - Classically FOLLOWS influenza infection - 20 – 40 % of normal adults carry the organism in the nares - Causes suppurative and ulcerative bronchiolitis with necrosis of bronchiolar wall - Septic infarction and abscess formation are complications (Patients with Staph. endocarditis can seed lungs with septic emboli --> pulmonary infarcts and abscess formation)

Answer 8

- hospital-acquired pneumonia - Burn patients, Patients on mechanical ventilation, Patients on antibiotics, Cystic fibrosis patients - Gram-negative rod

Answer 9

- Hospital-acquired and rare - Associated with instrumentation (intubation, bronchoscopy) and COPD - Gram-negative rod

Answer 10

- it is a classic acute inflammatory response 1. Edema and congestion: 12-14 hours - Vascular engorgement (congestion) - Intra-alveolar fluid (proteinaceous exudate) - Lung is heavy, edematous, red 2. Red hepatization: 1-3 days - Neutrophils accumulate in alveoli (and lymphocytes and macrophages) - Extravasation of red blood cells - Fibrinous exudate on pleura - Lung is red, solid and airless. Resembles fresh liver 3. Gray hepatization 3-4 days - more fibrin in alveoli - disintegrated inflammatory cells - Lung is grey-brown and solid 4. Resolution8-10 days (untreated) - Resorption of exudate - Enzymatic digestion of inflammatory debris with preservation of alveolar architecture

Answer 11

- Same as non-pulmonary abcesses - Thick fibrous wall with inflammatory cells - Core (center) has inflammatory debris - Radiology—cavitary mass may look like malignancy Arises from: - Pneumonia (Staphylococcus, coliforms, anaerobes) - Aspiration - Bronchial obstruction proximal to abscess - Infected pulmonary infarct - Septic embolus from another site

Answer 12

Lots of them -Respiratory and circulatory failure -Sepsis -Pleural effusion -Empyema (suppurative material in pleural space) -Lung abscess (Tissue destruction and necrosis; Common with S. pneumoniae, Klebsiella, S. aureus) Pleuritis, pericarditis, endocarditis, meningitis, arthritis (Dissemination of infection) Septic embolus into systemic artery Lung scar (Organization of exudate culminating in solid fibrous tissue) Bronchiectasis Antibiotic adverse effects

Answer 13

-Patients with symptoms that are not classic for bacterial pneumonia, i.e., minimal or nonproductive cough, headache; chest X-ray shows no consolidation Agents responsible: -Viruses: Parainfluenza, RSV, adenovirus, Epstein-Barr virus -Mycoplasma -Legionella pneumophila -Chlamydia (Follows contact with birds after inhalation of dried bird excretion and/or handling contaminated birds) -Rickettsia (Vector (usually tick) obligate intracellular bacteria; causes widespread vasculitis) -Histology shows interstitial inflammation and fibrinous exudate

Answer 14

- Alveolar wall inflammation - Lymphocytes, plasma cells, and macrophages - Alveoli free of cellular exudate, may have fibrinous exudate and hyaline membranes - Associated with viruses, Rickettsia or Mycoplasma - Diffuse alveolar injury is usually present (ARDS) - Not always bilateral and symmetrical – 50% are unilateral - interstitial pneumonia can also refer to a noninfectious pneumonia

Answer 15

-Diagnosis of exclusion -Common cause of pneumonia in children -Caused by influenza virus, respiratory syncytial virus (RSV), common cold viruses (parainfluenza, adenovirus), human metapneumovirus and herpes or varicella viruses -General histologic features: interstitial inflammation lymphocytic infiltrates nuclear and cytoplasmic inclusion bodies cell necrosis

Answer 16

-Significant cause of pneumonia in children and infants (Mortality Virus culture shows syncytia Necrotizing bronchiolitis and interstitial pneumonia, infrequent cytoplasmic inclusion bodies

Answer 17

- Immunocompromised people - Often associated with Pneumocystis jirovecii pneumonia - Leading cause of death in allogeneic bone marrow transplant recipients - Herpes-type virus - Diagnostic hallmark: cellular enlargement with intranuclear and intracytoplasmic inclusions - Diffuse interstitial pneumonia common feature

Answer 18

- Pneumonia occurs in approximately 5% of patients with chickenpox (mostly adults) - Greater severity in immunosuppressed - Herpes-type virus - Histology is typical interstitial pneumonia - Intranuclear inclusion may be found in alveolar lining cells

Answer 19

- common cause of community-acquired pneumonia - Prolonged gradual onset and resolution - Resolves without complications in almost all cases; may be severe in children - Small bacterium that lacks a cell wall - Free-living – doesn’t require host cell for replication - Doesn’t Gram stain and difficult to culture - High cold agglutinins, but not diagnostically useful; DNA probes available - Histology is typical interstitial pneumonia

Answer 20

-Community- or hospital- acquired -Aerosol of contaminated water Humidifiers, respiratory therapy equipment, whirlpool spas, showers, etc. 2 clinical syndromes: 1) Legionnaires’ disease: Severe pneumonia and multisystemic disease 2) Pontiac fever: acute febrile self-limited viral-like illness -High mortality in elderly and infants

Answer 21

Pathogenic: Superficial, Deep, Systemic Opportunistic: Reactivation of dormant systemic mycosis -Pulmonary entry of opportunistic pathogen (e.g., Aspergillus, zygomycetes) -GI or GU entry; hematogenous spread

Answer 22

-Histoplasmosis is a common pulmonary fungal infection -May disseminate (extrapulmonary) -Endemic in Ohio River and lower Mississippi River valleys -Inhalation of spores from soil near bird and bat guano -Most asymptomatic; Mimics a flu-like illness; self-limited -Chronic in some: cough, weight loss, fevers, cavitary lesions -Disseminated in immunocompromised Studies -Chest X-ray: coin lesions -Culture and serological testing Pathology; Granulomas plus caseation; heal with fibrosis and calcification -Narrow-necked budding yeasts (2-5 µm)

Answer 23

-Pulmonary fungal infection -May disseminate -Endemic in central and South Eastern U.S. -Inhalation of conidia from soil -50% asymptomatic, pulmonary symptoms vary -Resembles influenza, bacterial pneumonia, chronic TB, or ARDS Studies: Chest X-ray: infiltrates or mass-like nodules; Serologic testing Pathology: Granulomas with necrosis and variable neutrophilic response Heals with apparent fibrous scar without calcifications Large (8-15 µm) broad-based budding yeast; thick, refractile cell walls

Answer 24

-Coccidiomycosis in the southwest; Endemic to CA, AZ, NV, NM, TX, UT -San Joaquin Valley Fever I-nhalation of spores from soil -Usually mild, flu-like symptoms, rashes -May develop pneumonia, lung nodules, disseminated disease. May be fatal Studies: Chest X-ray: coin lesions Culture, serology, PCR, DNA probes Pathology similar to TB Necrotizing granulomas and neutrophils Heal by fibrosis with +/- calcifications Large spherules with small endospores

Answer 25

Immunocompromised host Most common fungemic/invasive fungus Bronchopneumonia (Hematogenous spread or aspiration, instrumentation) 0Chest X-ray non-specific -Culture interpretation difficult because of oral contamination -Normal oral and GI commensal -Histopathology is diagnostic -Invasive budding yeast, pseudohyphae; neutrophils Other Candida species too

Answer 26

-Aspiration of ubiquitous fungus -Aspergilloma, invasive aspergillosis in immunocompromised host -Allergic bronchopulmonary aspergillosis, --hypersensitivity pneumonia in asthma, cystic fibrosis -May cause colonization of lung abscess -Studies: chest X-ray, culture Histopathology: Septated hyphae branching at 45° Often invades vessels, may cause infarction, hemorrhage, necrosis

Answer 27

-Formerly Pneumocystis carinii (species in rats, not humans) -Causes PCP (pneumocystis pneumonia) -Opportunistic pathogen in immunosuppressed -Fever, non-productive cough, SOB, hypoxia, pneumothorax -Chest X-ray: diffuse pulmonary infiltrates Diagnose by BAL or biopsy Cup or boat-shaped cysts in alveoli with pink exudate (crushed ping pong balls)

Answer 28

- Approximately 1/3 of world infected with mycobacterium TB; 10% get disease - Approximately 30,000 cases per year in US with 2,000-3,000 fatalities - Resurgence of disease aided by immunocompromised state (HIV/AIDS) and drug-resistant strains - Most cases are Mycobacterium tuberculosis - Acid-fast bacilli (AFB) - Gram stain is unreliable for ID

Answer 29

- airborne droplets; implants in the lower lung fields - multiples slowly: one division/24 hours - After 3-10 weeks, may spread through lymphatic and hematogenous channels to nodes and organs/ tissues prior to cell-mediated immunity - Lymphohematogenous dissemination probably occurs in most cases, setting the stage for reactivation - Reactivation occurs commonly in the elderly and immunocompromised as the balance between host resistance and pathogenicity of bacteria tips in favor of the organism

Answer 30

1) Primary: small mid-zone lung lesion with hilar lymph node involvement 2) secondary: the lesions are usually apical and bilateral 3) miliary: the lungs and other organs contain numerous small granulomas

Answer 31

- Associated with a small inflammatory lesion and hilar lymphadenitis - Usually asymptomatic and becomes latent - Classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss

Answer 32

Focus of primary infection Granuloma with central caseous necrosis Organizes leaving a fibrocalcific nodule often with persisting viable tuberculosis

Answer 33

Diagnosed by chest X-ray, tuberculin skin test, sputum culture, histopathology

Answer 34

-reinfection (primary) or reactivation -Reactivation of dormant primary lesions many decades later ~10% of latent infections reactivate -Risk of reactivation increases with immunosuppression and age Apices of one or both upper lobes Histopathology: Granulomas with central caseous necrosis Most lesions converted to fibrocalcific scars Many complications can ensue, i.e., progressive pulmonary disease and/or dissemination to pleura and organs

Answer 35

Primary progressive Tuberculous pneumonia Non-reactive tuberculosis Hematogenous dissemination Tuberculous pleuritis; pericarditis Scrofula (tuberculosis affecting lymph nodes of the neck) Death due to: progressive pulmonary insufficiency, pulmonary hemorrhage due to erosion of major pulmonary artery, miliary tuberculosis, and tuberculous meningitis

Answer 36

-Permanent abnormal dilatation of the bronchi and bronchioles -Symptoms: chronic cough, dyspnea, hemoptysis, infected sputum production Pathogenesis: -Arises in various lung conditions -Chronic infection, cystic fibrosis, immotile cilia, radiotherapy, chronic aspiration, etc. -Results from pulmonary inflammation and scarring 2o infection, obstruction, lung fibrosis -Airways dilate when fibrosis contracts -Recurrent infection/inflammation damages airways -Can be idiopathic -Complications -Pneumonia, lung abscess, emphysema, remote abscesses, amyloid, pulmonary fibrosis, cor pulmonale

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