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ACP Cardi and Respi system > ACP L18 Pathology of Lung infections > Flashcards

ACP L18 Pathology of Lung infections Flashcards

1
Q

State the differences between broncho-/lobar pneumonia interstitial pneumonia. (3)

A
  1. Site
    Bronchopneumonia: alveoli
    Interstitial pneumonia: interstitium
  2. Causative agents
    Bronchopneumonia: Bacteria, fungi
    Interstitial pneumonia: Virus, protozoa, Mycoplasma
  3. Inflammatory cells
    Bronchopneumonia: Neutrophils, then macrophages
    Interstitial pneumonia: Lymphocytes, eosinophils, macrophages
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2
Q

What is the difference in site between bronchopneumonia and lobar pneumonia?

A

Bronchopneumonia:

  • starts at bronchi/bronchioles, then alveoli
  • focal and patchy consolidation affecting more than one lobes

Lobar pneumonia
- complete consolidation of one lobe

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3
Q

What happens in the following timeslots in the natural course in pneumonia?
Briefly describe what happens in the event.

  1. 24h
A
  1. Congestion

- vascular response

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4
Q

What happens in the following timeslots in the natural course in pneumonia?
Briefly describe what happens in the event.
2. 2-4 days

A
  1. 2-4 days: Red hepatisation
    - alveolar cells filled with RBC, fibrin, neutrophils
    - acute inflammation
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5
Q

What happens in the following timeslots in the natural course in pneumonia?
Briefly describe what happens in the event.
3. 4-8 days

A
  1. 4-8 days: Grey hepatisation
    - Red cells lysed by macrophages
    - fibrinosuppurative exudate persists
    - chronic inflammation
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6
Q

What happens in the following timeslots in the natural course in pneumonia?
Briefly describe what happens in the event.

  1. > 8 days
A

> 8 days

  1. Resolution
    - Exudate is digested to debris > ingested by mmacrophages or organised by fibroblasts
    - repair by fibrosis
  2. Complications (if any)
    - abscess: collection of pus in a newly formed cavity
    - empyema: collection of pus in pleura
    - sepsis
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7
Q

What is the important negative: nodular lesion in pneumonia?

A

Tumor

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8
Q

Important negative: cystic lesion in pneumonia?

A

Usual interstitial pneumonia (honeycombing)

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9
Q

important negative: pleural lesion in pneumonia?

A

occupation: asbestosis

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10
Q

What are the 4 clinically classified pneumonia?

A
  1. Community-acquired acute
  2. Community-acquired atypical
  3. Nosocomial
  4. Aspiration
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11
Q

Give examples of causative agents in community-acquired acute pneumonia. (5)

A
  1. Streptococcus pneumoniae (MC)
  2. Haemophilus influenzae
    - MC in acute exacerbation in COPD
  3. Moraxella catarrhalis
  4. Staph. Aureus
    - secondary infection to viral infection, IVDA (IV drug abuse) , high incidence of complications (abscess, empyemia)
  5. Klebsiella pneumoniae
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12
Q
  • High grade fever
  • Productive cough, purulent (pus containing) sputum
  • WBC increased
  • Consolidation in CXR

D(x)?
Any other clinical manesfistations ?

A

Community acquired acute pneumonia

  • Abrupt onset
  • CXR consolidation due to alveolar exudate
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13
Q
  • Non-productive cough, non-purulent sputum
  • Patchy infiltrates, no consolidation in CXR
  • Low grade fever

D(x)?
Any other clinical manesfistations ?

A

Community acquired atypical pneumonia

  • WBC normal
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14
Q

Causative agents of community-acquired atypical pneumonia? (4)

A
  1. Mycoplasma pneumoniae (MC)
  2. Chlamydophila pneumoniae
  3. Legionella pneumophilia
    - artificial aquatic environment, organ transplant
  4. Virus: SARS, H5N1
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15
Q

Causative agents of nosocomia pneumonia? (4)

A
  1. Pseudomonas aeruginosa
    - immunocompromised
    - e.g. neutropenia, burns, mechanical ventilation
  2. Enterobacteriaceae
  3. S. aureus
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16
Q

Anaerobic oral flora, stroke, unconsciousness and repeated vomiting, necrotising pneumonia and abscess - related to which type of pneumonia?

A

Aspiration pnuemonia

17
Q

Which side of the lung is more usually involved in aspiration pneumonia? why?

A

Right: shorter and straighter RMB

18
Q

State the pathology of SARS - coronavirus.

infection of the lung epithelial cells

A
  1. Interstitial inflammation - diffuse alveolar damage (DAD) (pink hyaline membranes line the alveolar walls)
  2. Cytopathic effect - Multinucleated giant cells formed by pneumocytes and macrophages
  3. Organization - fibrosis and macrophages
19
Q

Which of the following about Avian flu (H5N1) is correct?
A. Most fatal cases seen in young children and physically fit adults
B. it is airborne rather than by droplets
C. associated with hemophagocytic syndrome, an overeactive immun respone

A

All of the above

20
Q

Which of the following about pulmonary tuberculosis is incorrect?

A. it is caused by mycobacterium tuberculosis
B. fever
C. diarrhea
D. drenching night sweat
E. weight gain
A

C, not mentioned

21
Q

What kind of response granulomatous inflammation in TB belongs to?

A

T cell mediated hypersensitivity response

22
Q

What are the 3 important microscopic features of granulomatous inflammation in TB?

A
  1. Collection of epitheloid histiocytes surrounding
  2. Caseous necrotic center
  3. Langhan’s giant cells
  4. lymphocytes (outer rim of epitheloid histiocytes)

> > > cavity

23
Q

What is primary TB?

A

subpleral lesion with Ghon focus and Ghon complex (Ghon focus + ipsilateral hilar lymph nodes)

24
Q

State the 3 fates of primary TB.

A
  1. Resolve - healed scar
  2. Progress to hematogenous dissemination (miliary TB)
  3. Latent - reactivate as secondary TB
25
Q

Secondary TB characteristics?

= reactivation of a previous primary TB site when immunocompromised

A
  • lung- localised, caseating, cavitatory lesions
  • upper zone due to highest ventilation (M tuberculosis is a strict aerobe)
  • may progress to miliary TB
26
Q

State all the fungal causative agents of pneumonia in immunocompromised hosts.

A
  1. Candidia
  2. Aspergillus
  3. Cryptococcus
  4. Pneumocystis jirovecii
27
Q

Candidia albicans resembles pneumocystis pneumonia, with?

A

bilateral nodular infiltrates

28
Q

Pneumocytis jiroveci infects mostly immunocompromised patients, e.g. ?

A

HIV patients

29
Q

Which are the 3 types of aspergillus fungal infections? briefly describe.

A
  1. Aspergilloma
    - growth of aspergillus in pre-existing pulmonary cavities
  2. Invasive aspergillosis
    - necrotizing pneumonia, fungal hyphae: invasion of blood vessels, systemic dissemination
  3. Allergic bronchopulmonary aspergillosis
    - hypersensitivity reaction against aspergillus in the bronchi, increase IgE and eosinophil
30
Q

What is the viral causative agents in pneumonia?

Results in patients?

A

Cytomegalovirus (CMV)
- CMV mononucleosis > fever, lymphadenopathy in immunocompetent patients

  • in immunocompromised patients: disseminated diseases, life-threatening, nuclear and cytoplasmic inclusions in lungs
31
Q

List 4 mechanisms of entry of lung abscesses.

A

ABCS

Aspiration: anaerobes, more common on right lung
Bronchiol obstruction: bronchiectasis, CA lung
Complication of bacterial pneumonia/mycotic infection
Septic embolism: IE

ACP Cardi and Respi system (5 decks)

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