Baker/Parks > Infectious Lung Diseases Flashcards
1
Q
define acute bronchitis
A
self-limited inflammation of the LARGE airways of the lung, characterized by cough W/O PNEUMONIA
2
Q
T/F: acute upper respiratory infections are v common
A
TRUE
4th leading reason for office visits
3
Q
T/F: acute bronchitis is typically bacterial
A
FALSE
it’s typically VIRAL
4
Q
which viruses cause acute bronchitis?
A
influenza A & B parainfluenza RSV coronavirus adenovirus rhinovirus
5
Q
what do viruses infect in acute bronchitis?
A
bronchial epithelium
6
Q
what gets inflamed in acute bronchitis?
A
large airways
7
Q
what causes sputum in acute bronchitis?
A
desquamation & denudation of the airway
8
Q
what is acute bronchitis indistinguishable from for the first few days?
A
mild URI
9
Q
how long do you need a cough to have acute bronchitis?
A
> 5 days
10
Q
how long does the cough usually last in acute bronchitis?
A
10-20 days, but sometimes >4 wks
11
Q
what do you usually NOT have in acute bronchitis?
A
NO fever
NO constitutional sx
+/- sputum
12
Q
what does the pulmonary exam of acute bronchitis look like?
A
usu normal, sometimes wheezing d/t bronchospasm
13
Q
T/F: acute bronchitis can exacerbate chronic lung conditions
A
TRUE
COPD & asthma
14
Q
should you do an x-ray if you suspect acute bronchitis?
A
usu no
bc CXR is usu normal in these pts
possibly some non-specific bronchial wall thickening
15
Q
what is the treatment for acute bronchitis?
A
STOP SMOKING
DON’T FUCKING GIVE ABX BC IT’S NOT FUCKING BACTERIAL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
16
Q
what are the 4 general types of infection that can cause pneumonia?
A
bacterial
viral
mycoplasmal
fungal
17
Q
T/F: various types of pneumonia can “gang up”
A
true viral syndrome (influenza) can lead to secondary bacterial infxn
18
Q
what are the 7 main types of pneumonia?
A
- community-acquired acute
- community-acquired atypical
- hospital acquired
- chronic
- aspiration
- necrotizing + lung abscess
- in immunocompromised host
19
Q
what is the etiology of CAP?
A
bacterial or viral or BOTH
20
Q
what is the pathophysiology of CAP?
A
invasion of lung parenchyma > inflammatory exudates in alveoli > lung consolidation
21
Q
T/F: the presentation, clinical course, and pathology of pneumonia are always the same in every pt
A
FALSE
variable depending on organism, host rxn, & extent of infxn
22
Q
what are the 3 predisposing conditions for CAP?
A
- age extremes
- chronic conditions
- immune deficiencies
23
Q
where in the lung is the inflammatory infiltrate in CAP?
A
in the ALVEOLI
24
Q
what are the 2 types of CAP?
A
lobar & bronchopneumonia
25
how are lobar & broncho CAP different?
degree & pattern of consolidation
26
how are lobar & broncho CAP the same?
morphology & microbiology
27
what are the 4 stages of lobar CAP?
1. congestion
2. red hepatization
3. gray hepatization
4. resolution
28
what can happen if the consolidation of CAP extends to the pleura?
pleuritis (rxn to inflammation)
29
what happens in the "resolution" phase of lobar CAP?
complete clearance, but there may be organized fibrin which leaves permanent scarring
30
what parts of the lung does broncho CAP affect?
PATCHY, multilobar, sometimes bilateral
| LOWER LOBE PREDOMINANCE
31
what is the exudate in broncho CAP & where does it go?
suppurative, neutrophil-rich exudate
| in bronchi, bronchioles, & alveolar SPACES
32
what are the clinical sx of CAP?
1. abrupt onset of high fever & chills
2. cough w/ mucopurulent sputum
3. crackles on ausc, dullness to percussion
4. maybe pleuritic chest pain, maybe not
33
what are 3 possible complications of CAP?
1. pulmonary abscess
2. empyema
3. bacteremic dissemination
34
what is the treatment for CAP?
1. ABX
2. thoracentesis
3. VAX!!
35
how does atypical pneumonia present?
acute, febrile condition w/ patchy inflammatory changes in lungs
36
where is atypical pneumonia confined to in the lung?
alveolar SEPTA & pulmonary INTERSTITIUM
37
what are the 2 possible (generally) etiologies of atypical pneumonia?
bacterial & viral
38
what is the most common cause of atypical pneumonia?
mycoplasma pneumoniae
39
who gets atypical pneumonia typically?
children & young adults in closed communities sporadically
40
what is the other bacterial cause of atypical pneumonia?
chlamydia pneumoniae
41
what viruses can cause atypical pneumonia?
```
influenza A & B
RSV
human metapneumovirus
adenovirus
rhinovirus
rubeola
varicella
```
42
what are the 4 "atypical" things about atypical pneumonia?
1. moderate sputum
2. no consolidation on physical
3. moderately high WBC
4. no alveolar exudate
43
how can you distinguish atypical pneumonia from acute bronchitis?
SITE OF INFXN
| alveolar septum & interstitium (atypical pneumonia) vs. bronchial wall (bronchitis)
44
what is the main clinical feature of atypical pneumonia?
sx out of proportion to minimal physical exam findings
45
T/F: the clinical course of atypical pneumonia is variable
TRUE
46
what is the range of sx for atypical pneumonia?
bad "chest cold" to severe illness w/ secondary infxn
fever, HA, myalgias
maybe cough, maybe not
47
how does atypical pneumonia look on CXR?
patchy d/t interstitial lymphocyte/monocyte infiltrate
48
what cells are involved in atypical pneumonia vs CAP?
```
CAP = neutrophils
atypical = lymphs & monos
```
49
what pts are at risk for getting HAP?
pts w/...
1. severe underlying dz
2. immunosuppression
3. prolonged abx tx (resistance)
4. invasive intravascular access
5. MECHANICAL VENTILATION
50
what pt population is at the HIGHEST risk for HAP?
pts on MECHANICAL VENTILATION!!! (that's what Kuhls' whole lecture was about)
51
T/F: HAP is potentially life-threatening
TRUE
52
what types of organisms cause HAP?
gram negative rods (Pseudomonas & Enterobacter)
&
S. aureus (MRSA)
53
how do you get aspiration pneumonia?
inhalation of gastric contents
54
what pts get aspiration pneumonia?
debilitated pts
| d/t stroke, intoxication, or other AMS cause
55
when does the aspiration of aspiration pneumonia occur?
while unconscious or during vomiting
56
how can you tell the diff btwn aspiration pneumonia vs. aspiration/chemical pneumonitis?
aspiration pneumonia has...
1. multiple organisms (oral flora)
2. fulminant course (v sick v fast)
3. possibly lung abscess & ARDS
57
what is a lung abscess?
suppurative process in the lung w/ tissue necrosis
58
what are 5 possible ways you can get
1. aspiration
2. post-pneumonic
3. septic emboli d/t distant infection
4. obstructive (cancer)
5. bacteremia (hematogenous seeding)
59
what 2 organisms can cause a post-pneumonic lung abscess?
s. aureus
| k. pneumoniae
60
what does a lung abscess look like?
suppurative destruction of lung PARENCHYMA w/ central area of CAVITATION
61
what is another name for "suppurative destruction"?
liquefactive necrosis
62
what are the clinical sx of lung abscess?
cough
fever
COPIOUS foul-smelling purulent sputum (yuck)
clubbing
63
how do you dx lung abscess?
radiology
64
what do you have to rule out in old people if you suspect lung abscess?
cancer
65
what are the 2 etiologies of chronic pneumonia?
mycobacterium TB
| fungi
66
T/F: chronic pneumonia typically presents as a localized lesion
TRUE
67
what fungi can cause chronic pneumonia?
1. histoplasma capsulatum
2. blastomyces dermatidis
3. coccidioides immitis
68
what type of rxn is involved in chronic pneumonia?
granulomatous inflammatory rxn
69
which 2 etiologies of chronic pneumonia are very similar?
histoplasmosis & TB
| similar clinical presentation & morphology
70
which cells does histoplasmosis infect?
MACROPHAGES
| intracellular parasite
71
T/F: you can have primary or secondary histoplasmosis
TRUE
72
what is primary histoplasmosis?
self-limited & latent
73
what is secondary histoplasmosis?
chronic progressive
74
what are the sx of secondary histoplasmosis?
fever
night sweats
cough
75
T/F: you can have localized extrapulmonary involvement w/ histoplasmosis
TRUE
76
what happens to immunocompromised pts if they get histoplasmosis?
wide dissemination
77
what forms in the lung w/ histoplasmosis?
granuloma w/ caseation necrosis (just like TB)
78
how does a histoplasmosis granuloma resolve?
spontaneously or w/ antifungals
fibrosis of the granuloma
concentric calcification
79
how can you distinguish histoplasma from TB?
1. yeast on tissue exam
2. culture
3. ab testing
80
what is the MAIN way that blastomycosis is different from histoplasmosis?
macrophages have limited ability to ingest & kill blastomycosis!
81
what types of cells are recruited in blastomycosis?
neutrophils
82
what do neutrophils lead to in blastomycosis?
main gross morphology of suppurative granulomas
83
what are the 3 types of blastomycosis?
pulmonary
disseminated
primary cutaneous
84
how can you get primary cutaneous blastomycosis?
direct inoculation of fungus to the skin
85
what can be hard to distinguish from cutaneous blastomycosis?
squamous cell cancer
| d/t epithelial hyperplasia
86
what is another name for coccidioidomycosis?
San Joaquin Valley Fever (Joaquin Phoenix's cocc [SORRY])
87
T/F: most people in endemic areas are not infected w/ coccidioidomycosis
FALSE
| they HAVE BEEN infected
88
how do primary coccidioidomycosis infections present?
asymptomatic
89
10% of coccidioidomycosis pts have WHAT?
lung lesions
90
what are the sx of San Joaquin Valley Fever?
fever
cough
pleuritic chest pain
erythema nodosum or multiformae
91
what are the 3 main types of coccidioidomycosis?
1. granulomatous
2. pyogenic (suppurative)
3. disseminated (RARE)
(can be 1 & 2 simultaneously)
92
what is the main diff btwn granulomatous & pyogenic coccidioidomycosis?
it depends on if the spherules remain intact
intact = granulomatous
ruptured (endospores released) = pyogenic
93
what organs can be affected d/t disseminated coccidioidomycosis?
```
meninges
skin
bones
adrenals
lymph nodes
spleen
liver
```
94
is disseminated coccidioidomycosis more like granulomatous or pyogenic?
more purulent/pyogenic
95
where is the San Joaquin Valley?
Cali
96
how does aspergillus affect healthy people vs immunosuppressed ppl?
healthy ppl get allergies (acute bronchopulmonary aspergillosis)
immunosuppressed ppl get invasive aspergillosis
97
what is affected in invasive aspergillosis in immunocompromised hosts?
lungs + hematogenous dissemination is common
98
what do the pulmonary lesions of aspergillosis look like?
necrotizing pneumonia w/ sharply delineated round lesions w/ HEMORRHAGIC BORDERS
99
what are the risk factors of mycobacterium TB infection?
1. poverty
2. crowding
3. chronic dz (DM, lymphoma, chronic lung dz, immunosuppression, HIV/AIDS)
100
T/F: mycobacterium TB infection equates to dz
FALSE
| infection does NOT equal disease!!!!!
101
how is mycobacterium TB spread?
person-to-person
| airborne
102
how does primary TB present?
asymptomatic
103
what does the mycobacterium TB do in your body?
remains dormant
| reactivates when your immunity is down
104
what type of immunity is activated in mycobacterium TB infection?
cell-mediated
105
what type of allergic rxn is involved w/ mycobacterium TB infection?
delayed (type IV) sensitivity rxn
106
WHEN does the allergic rxn to mycobacterium TB occur?
2-4 weeks after exposure
107
how does the PPD test work?
inject PPD subQ
type IV rxn peaks 48-72 hours later
PALPABLE INDURATION is noted
108
what are Ghon foci & complexes assoc w/?
TB
109
what % of TB pts progress from primary complex to progressive primary TB?
5%
110
what is a Ghon complex?
focal CASEATING necrosis in the lower lobe
AND
hilar lymph nodes undergo fibrosis & calcification
111
what is a Ghon FOCUS?
the "focus" of infection, i.e. the caseating necrosis
112
what is very important in order for a granuloma to develop?
TNF
113
what pts are susceptible to reactivation of latent TB infxn?
Crohn's dz & RA pts bc they are on anti-TNF agents (infliximab)
114
what can be used to detect latent TB infxn?
IGRAs (interferon gamma releasing assays)
115
what activates macrophages?
IFN gamma
116
generally, how do you get primary TB?
exogenous source
117
what % of primary TB pts develop a clinically significant response?
5%
118
cell-mediated immunity wanes over time, so what is possible w/ TB?
a 2nd primary TB infxn
119
what can primary progressive TB result in?
TB meningitis
| miliary TB
120
primary progressive TB is less likely to develop WHAT?
cavitary lesions
121
when does secondary reactivation TB usu occur?
years after primary infxn when host resistance is down
122
where are lesions of secondary reactivation TB classically located?
apex of lung
123
how do you get caseous necrosis in secondary reactivation TB?
pre-existing hypersensitivity activates & walls off the infection
124
why do secondary TB pts have TB-laced sputum?
erosion in airways
125
why do secondary TB pts have hemoptysis?
erosion into BVs
126
what are the sx of secondary TB?
1. CONSUMPTION (malaise, anorexia, weight loss)
2. fever > low grade & remittant
3. night sweats
4. maybe hemoptysis
5. maybe pleuritic chest pain
127
how do you diagnose secondary TB?
IDENTIFICATION OF TUBERCLE BACILLI via ACID FAST STAIN of sputum or PCR
128
TB + ? = bad news
HIV
129
how do CD4 counts affect TB presentation?
CD4 > 300 = secondary TB presentation
| CD4 <200 = primary progressive TB presentation
130
how does HIV + TB cause false negative sputum?
higher bacterial loads, but LOWER T CELL ACTIVITY > less cavitation > less erosion
131
what 2 things can be false negative w/ HIV + TB?
sputum
| PPD
