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9 Respiratory Pathology > 9.3 Pulmonary infections > Flashcards

9.3 Pulmonary infections Flashcards

1
Q

pneumonia:

3 main patterns seen on CXR

-which are due more to virus or bacteria

A
  1. lobar–entire lobe
  2. bronchopneumonia–circles
  3. interstitial–looks like lines

lobar and broncho: bacteria

interstitial (‘atypical’): virus

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1
Q

Legionella

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. broncho
  2. community acquired, superimposed on COPD, and immunosuppressed.
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2
Q

klebsiella pneumoniae

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. lobar
  2. aspiration of enteric flora, so assoc with debilitated populations: nursing homes, diabetics, alcoholics. Thick ‘currant jelly’ sputum
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2
Q

TB:

what are 4 common organ sites for spread?

A
  1. brain (classically meningitis at base of brain)
  2. cervical lymph nodes
  3. kidney (sterile pyuria)
  4. lumbar vertebrae (Pott’s disease)
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3
Q

Ghon complex

A

formed from primary TB.

-a focal, caseating necrosis in the lower lobe of lung and hilar lymph nodes. becomes fibrosed and calcified.

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4
Q

where in lung does 2ndary TB usu occur, and why

A
  • lung apex, b/c poor lymphatic draining and high O2 tension.
  • as opposed to lower lobe Ghon complexes
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4
Q

TB symptoms:

A
  • primary: asymptomatic
  • secondary: fevers, night sweats, hemoptysis, weight loss
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5
Q

interstitial pneumonia:

  • CXR
  • histology
A
  • lines on lungs on xray
  • air sacs are empty, but inflammatory cells are in the interstital spaces
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5
Q

Aspiration pneumonia

-3 common organisms

A

anaerobic bacteria in the oropharynx that are aspirated

  1. bacteroides
  2. fusobacterium
  3. peptococcus
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6
Q

Classic gross phases of lobar pneumonia (4)

A
  1. congestion–congested vessels, edema
  2. red hepatization–from exudate of neutrophils, RBCs into air sacs. lobe becomes solid
  3. grey hepatization–RBCs turn grey
  4. resolution–Type II pneumocytes are stem cells for regeneration
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6
Q

mycoplasma pneumoniae

  1. type of pneumonia
  2. important associations, populations, etc
  3. important organism properties
  4. important complications
A
  1. interstitial
  2. military recruits, college dorm students.

(most common cause of atypical in young adults)

  1. not visible on gram stain–no cell wall
  2. -autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia)
    - erythema multiforme
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8
Q

bronchopneumonia

-characterized by what on CXR and gross pathology

A

-patches of consolidation around bronchioles. often multifocal and bilateral

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9
Q

Aspiration pneumonia

-classic presentation

A
  • abscess in lower right lung lobe.
  • R side b/c of angle of bronchus
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10
Q

Pulm infections

-dx tests

A
  1. CXR
  2. sputum gram stain, culture
  3. blood culture
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11
Q

Pulm infections

-what are the lung’s main defenses against microbes

A
  1. cough
  2. mucociliary escalator
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11
Q

CMV

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. interstitial
  2. common cause in posttransplant, immunosuppressed.
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12
Q

TB spread to kidney

-how presents?

A

-presents as sterile pyuria (WBC in urine, but negative culture)

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13
Q

caseating granuloma in lung:

  • differential
  • how to differentiate
A
  • TB
  • fungal
  • do AFB stain (acid fast bacillus, for TB)
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14
Q

Elderly, immunocompromised pt with pneumonia:

think what?

A

influenza virus. (also, watch out for superimposed S Aureus or H influenzae pneumonia)

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15
Q

What 3 organisms typically cause pneumonia superimposed on COPD?

A
  1. haemophilus influenzae
  2. moraxella catarrhalis
  3. legionella
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16
Q

what are the #1 and #2 most common organisms that cause secondary pneumonia?

what kind of pneumonia do they present with?

A
  1. strep pneumo–lobar
  2. staph aureus-broncho
17
Q

Haemophilus influenzae

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. broncho
  2. common cause of 2ndary pneumonia, and pneumonia superimposed on COPD
17
Q

TB: primary vs secondary TB

A

primary: first exposure–focal, caseating necrosis in lower lobe of lung and hilar lymph nodes, undergoes fibrosis and calcification–Ghon complex. Asymtomatic
secondary: reactivation of TB

18
Q

Pt who just got a kidney transplant, gets pneumonia

think what?

A

CMV–for immunosuppressed

19
Q

When is TB typically reactivated?

A
  • Elderly age
  • AIDS
21
Q

How does interstitial pneumonia present differently from lobar or broncho?

A

It’s ‘atypical,’ usu viruses.

So, it’s mostly upper resp symptoms. (minimal sputum, cough, low fever)

22
Q

Comatose or alcoholic pts are increased risk of what lung problem?

A

Aspiration pneumonia

-usu anaerobic bacteria in the oropharynx

24
Q

empyema

A

pus in pleural space

25
Q

TB meningitis

-how usu present?

A

-usu at base of brain

27
Q

Pt with cystic fibrosis presents with pneumonia

think what?

A

Think Pseudomonas

28
Q

coxiella burnetii

  1. type of pneumonia
  2. important associations, populations, etc
  3. organism details
A
  1. interstitial
  2. farmers, veterinarians.
  3. Coxiella spores are deposited on cattle by ticks, or present in cattle placenta.
28
Q

coxiella burnetii

-how is it different from other Rickettsiae organisms (eg Rocky mountain, typhus)? (3 things)

A
  1. only one that causes pneumonia
  2. does not require arthropod vector (uses heat resistant spores that ticks can deposit on cattle)
  3. does not produce skin rash
29
Q

Legionella

-how to visualize it

A

-intracellular organism. visualize with silver stain.

30
Q

pseudomonas aeruginosa

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. broncho
  2. Cystic Fibrosis!
31
Q

bronchopneumonia

-list common organisms (5)

A

bacteria:

  1. staph A
  2. Haemophilus influenza
  3. Pseudomonas
  4. Moraxella catarrhalis
  5. Legionella
32
Q

Atypical pneumonia:

  1. # 1 and #2 most common causes in young adults
  2. most common cause in infants
  3. common in post transplant immunosuppressed
A
  1. mycoplasma pneumoniae, then chlamydia pneumoniae
  2. RSV
  3. CMV
34
Q

Moraxella catarrhalis

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. broncho
  2. community-acquired, also superimposed on COPD
36
Q

Q fever is caused by what?

what populations

A

Coxiella burnetii

  • farmers, veterinarians
  • Coxiella spores are on cattle or cattle placentas
37
Q

Strep pneumo

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. lobar
  2. most common causes of community-acquired pneumonia and 2ndary pneumonia. adults, elderly
38
Q

Staph aureus

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. broncho
  2. 2nd most common cause of 2ndary pneumonia. often has abcess or empyema
40
Q

Currant jelly sputum (bloody, thick, mucoid)

-think what

A

klebsiella pneumoniae

41
Q

Military recruit or dorm student with pneumonia:

think what?

A

mycoplasma pneumoniae

42
Q

TB: what to see on biopsy

A

caseating granulomas

-do AFB stain (acid fast bacillus) b/c caseating granuloma could also be fungus

43
Q

RSV

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. interstitial
  2. most common cause of atypical in infants
45
Q

Infant with pneumonia

think what?

A

RSV

46
Q

TB spread to bone

-how presents?

A

-lumbar vertebrae (Pott disease)

vertebral collapse.

47
Q

Influenza

  1. type of pneumonia
  2. important populations (3)
  3. pt has increased risk of what?
A
  1. interstitial
  2. common in elderly, immunocompromised, and those with interstitial lung disease

(increases risk for superimposed S Aureus and H influenza, which is more likely to kill pt)

48
Q

chlamydiae pneumoniae

  1. type of pneumonia
  2. important associations, populations, etc
A
  1. interstitial
  2. 2nd most common cause of atypical in young adults, after mycoplasma
49
Q

Organisms that cause interstitial pneumonia (6)

A
  1. mycoplasma pneumoniae
  2. chlamydia pneumoniae
  3. RSV
  4. CMV
  5. influenza
  6. coxiella burnetii
50
Q

Lobar pneumonia:

most common causes. how are they different in population

A
  1. strep pneumoniae (95%)
    - most common community-acquired and 2ndary pneumonia (on top of viral). adults and elderly.
  2. klebsiella pneumoniae (5%)
    - enteric flora that is aspired, so: debilitated individuals like nursing homes, alcoholics, diabetics. Thick ‘currant jelly’ sputum.
51
Q

Farmer/veterinarian with pneumonia

think what?

A

Coxiella burnetii (Q fever)

9 Respiratory Pathology (7 decks)

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