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Block 9 Week 4 > Baker/Parks: Infectious Diseases of the Lung > Flashcards

Baker/Parks: Infectious Diseases of the Lung Flashcards

1
Q

Self-limited inflammation of the large* airways of the lung that is characterized by cough without pneumonia
Usually no fever
“Chest cold”
VERY common

A

Acute bronchitis

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2
Q

What usually causes acute bronchitis?

A 
viruses
infleunza A and B
parainfluenza virus
RSV
coronavirus
adenovirus
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3
Q

How long must the cough last for it to be acute bronchitis?

A

more than 5 days

**typically lasts 10-20 days, and sometimes longer than 4 weeks

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4
Q

What will you find on pulmonary exam with a patient with acute bronchitis? What will you find on CXR?

A

usually normal pulmonary exam, maybe some wheezing

CXR usually normal - not indicated, may see some non-specific bronchial wall thickening

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5
Q

Acute bronchitis is made worse by (blank)

A

smoking

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6
Q

Should antibiotics be used for acute bronchitis?

A

NO!!!

**usually viral

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7
Q

T/F: Pneumonia can be caused by bacteria, viruses, and fungus
It causes significant morbidity and mortality

A

True

**9th leading cause of death in the US

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8
Q

What causes community acquired pneumonia?

A

bacteria or viruses or both!!

**Think Strep pneumo, H flu, Moraxella catarrhalis, Staph aureus

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9
Q

Predisposing conditions for community acquired pneumonia?

A

extremes of age
presence of chronic conditions
immune deficiencies

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10
Q

Compare lobar pneumonia to bronchopneumonia in terms of degree and pattern of consolidation

A

lobar pneumonia - large portion or whole lobe consolidation

bronchopneumonia - patchy consolidation

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11
Q

Four stages of community acquired lobar pneumonia?

A
  1. congestion
  2. red hepatization
  3. gray hepatization
  4. resolution
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12
Q

Reaction to inflammation if consolidation extends to the pleura

A

pleuritis

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13
Q

While there may be complete clearance of infection from the pleura, fibrin may organize and leave (blank)

A

permanent scarring

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14
Q 
Patchy
Often mutilobar
Sometimes bilateral
Lower lobe predominance
Similar mechanism
Suppurative, neutrophil rich exudate in bronchi, bronchioles and alveolar spaces
A

bronchopneumonia

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15
Q

Clinical features of community acquired pneumonia

A

abrupt onset with fever and chills
cough with mucopurulent sputum
may be some pleuritic chest pain
crackles on auscultation, dullness to percussion

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16
Q

Complications of community acquired pneumonia?

A

pulmonary abscess
infected pleural effusion –> empyema
bacterial dissemination

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17
Q

How to treat community acquired pneumonia?

A

antibiotics!!!
vaccinate!
thoracentesis for pleural effusion/empyema

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18
Q

Acute, febrile respiratory condition with patchy inflammatory changes in the lungs.
Generally confined to the alveolar septa and pulmonary interstitium
Moderate amount of sputum
No physical findings of consolidation
Only moderately elevated WBC
Lack of alveolar exudate

A

Atypical pneumonia

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19
Q

What usually causes atypical pneumonia

A

**most commonly Mycoplasma pneumoniae
also Chlamydia pneumoniae
Influenza A/B, RSV, etc

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20
Q

What distinguishes atypical pneumonia from acute bronchitis?

A

site of infection!

bronchitis: bronchial wall
atypical pneumonia: alveolar septum and interstititum

21
Q

In atypical pneumonia, where will you see infiltration of lymphocytes and monocytes?

A

in the interstitial space!

**around the edges of alveoli

22
Q 
Common in patients with
Severe underlying disease
Immunosuppression
Prolonged antibiotic therapy (resistance)
Invasive intravascular access
Mechanical ventilation – VERY high risk
Potentially life threatening
A

Hospital acquired pneumonia

23
Q

What bugs cause hospital acquired pneumonia?

A

gram negative rods!
pseudomonas aeruginosa, enterobacteriaceae, Klebsiella
Also staph aureus

24
Q

Inhalation of gastric contents
Debilitated patients
Stroke, intoxication or other causes of altered mental status
Occurs while unconscious or during vomiting
Common in alcoholics

A

Aspiration pneumonia

25
Q

How is aspiration pneumonia different from aspiration (chemical) pneumonitis?

A

multiple organisms are aspirated
these pts get very sick very quickly
possible lung abscess and ARDS as complications

26
Q

Suppurative destruction of the lung parenchyma within a central area of cavitation, liquefactive necrosis

A

lung abscess

27
Q

How do lung abscesses get to the lung?

A 
aspiration
post-pneumonic
septic emboli from distant infections
obstructive (neoplastic conditions)
trauma, infected adjacent organs, hematogenous seeding (bacteremia)
28
Q

How will people with lung abscesses present?

A

cough
fever
copious foul-smelling purulent sputum
clubbing

29
Q

Typically localized lesion

Granulomatous inflammatory reaction

A

Chronic pneumonia

30
Q

What usually causes chronic pneumonia?

A

mycobacterium TB

fungi: histoplasma, blastomyces, coccidioides

31
Q

Clinical presentation and morphology are very similar to TB
Intracelluar parasite of macrophages
Self-limited and latent 1o infection
Chronic progressive 2o disease
Fever, night sweats, cough
Localized extrapulmonary involvement
Wide dissemination in immunocompromised patients

A

Histoplasmosis

32
Q

This disease presents like TB, with granuloma formation with caseation necrosis. Granulomas can become fibrotic and calcify.

A

Histoplasmosis

33
Q

How do you distinguish histoplasmosis from TB?

A

yeast on tissue exam
culture
antibody testing

34
Q

Macrophages have limited ability to ingest and kill this dimorphic fungus
Calls in neutrophils, which leads to suppurative granulomas
Causes pulmonary, disseminated, and primary cutaneous infections

A

Blastomycosis

35
Q

How does blastomycosis infect the skin?

A

when the fungus is directly innoculated to the skin

**can be mistaken for squamous cell cancer due to epithelial hyperplasia

36
Q 
San Joaquin Valley Fever
Most in endemic areas have been infected
Most primary infections are asymptomatic
10% have lung lesions
Fever, cough, pleuritic chest pain
Erythema nodosum or Erythema multiformae
Granulomatous or pyogenic (suppurative) or both
Depends on if spherules remain intact
Rupture and release of endospores results in a pyogenic reaction
Rarely (
A

Coccidioidomycosis

37
Q

Ubiquitous mold that can cause allergies*, invasive lung disease in immunocompromised host, and pulmonary lesions

A

Aspergillus fumigatus

38
Q

Risk factors for Mycobacterium TB infection?

A

poverty
crowding
chronic disease

39
Q

If you are infected with Mycobacterium TB, do you have disease manifestations?

A

not always

Primary TB is typically asymptomatic, but it can remain dormant and reactivate when immunity is down

40
Q

What type of cell-mediated reaction does Mycobacterium TB cause? What do you look for when administering the PPD skin test?

A

type 4 delayed sensitivity reaction;

look for palpable induration

41
Q

A lesion seen in the lung that is caused by tuberculosis

The lesions consist of a calcified focus of infection and an associated lymph node.

A

Ghon complex

**Ghon focus is the calcified region of infection

42
Q

What will be seen in both the lung and lymph node in a Gohn complex in a patient with TB?

A

caseous necrosis

43
Q

For granulomas to develop in TB, what factor is necessary? This explains why Crohn’s disease and RA can cause reactivation of TB

A

TNF is key!!

44
Q

This factor activates macrophages and can be used in an assay to test for latent TB

A

IFN gamma

45
Q

Secondary (mostly) Reactivation TB
Usually years after Primary Infection when host resistance is down
Can be from an exogenous source
Classic location of lesions is at the apex of the lung
Pre-existing hypersensitivity activates and walls off the infection –> caseous necrosis
Erosion into airways leads to coughing up TB laced sputum
Erosion into blood vessels leads to hemoptysis

A

Secondary (reactivation) TB

46
Q

How will patients with reactivation TB present?

A

malaise, anorexia, weight loss –> CONSUMPTION
fever that is remittant
night sweats
hemoptysis and pleuritic chest pain may be present

47
Q

What can be done to diagnose TB? What MUST be done?

A 
clinical picture
culture
acid fast stain of sputum or BAL fluid
PCR (nucleic acid testing) for Tb DNA
TNF assay

**must identify tubercle bacilli

48
Q

TB mixed with this immunodeficiency is a bad bad thing

A

HIV

  • *with HIV, you may get false negative sputum or PPD test
  • *you have higher bacterial loads, but decreased T cell activity, so you get cavitation and erosion :(

Block 9 Week 4 (8 decks)

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