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Pathology II > Exam 1 Part 3 > Flashcards

Exam 1 Part 3 Flashcards

1
Q

how do you differentiate between pneumonia and pneumonitis?

A
  • pneumonia: infection or inflammation of only alveolar spaces
  • pneumonitis: inflammation of interstitial tissue
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2
Q

classifications of pneumonia? 6

A
  • community acquired
  • community-acquired atypical (non-bacterial)
  • nosocomial
  • aspiration
  • necrotizing/abscess
  • pneumonia in immunocompromised pts
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3
Q

predisposing factors to getting pneumonia? 5

A
  • loss of cough reflex
  • diminished mucin or cilia function
  • accumulation of secretions
  • decrease in phagocytic or bactericidal action of alveolar MOs
  • pulmonary congestion & edema
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4
Q

does pneumonia occur in healthy people spontaneously?

A

NO but it is one of the most common causes of death

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5
Q

how long does it take for sxs of pneu to develop?

A

several days

URI sxs may precede

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6
Q

what are the typical sxs of pneu?

A
  • cough
  • fever
  • fatigue
  • malaise
  • increased sputum production
  • pleuritic chest pain
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7
Q

what might you find on a PE?

A
  • fever, tachycardia, tachypnea, but sometimes can present with no cough of fever
  • may be signs of lung consolidation: dullness to percussion, crackles, absent breath sounds
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8
Q

pneumonia is the most common what kind of infection?

A

nosocomial; especially for those who have been intubated and on ventilator support

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9
Q

how does it affect developing countries and children?

A
  • 2nd major cause of death in developing countries

- leading cause of death worldwide for children

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10
Q

what is the main cause of community acquired pneumonia?

A

steptococcus pneumoniae

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11
Q

what other bugs can cause pneumonia? which one is considered atypical? which one is nosocomial?

A

h. influenza, m. catarrhalis, s.aureus, l.pneumophila (atypical), k.pneumoniae (nosocomial)

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12
Q

pneumonia leads to what two circumstances in the lungs? what is each?

A
  • congestion: leaky dilated capillaries leads to exudate in interstitium, numerous bacteria
  • consolidation: exudative rxn and solidification, maybe fibrosis
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13
Q

what are the 3 patterns of gross anatomic distribution of pneumonia? how can you distinguish b/w/

A

-lobar pneumonia (entire lobe)
-lobular pneumonia (part of a lobe)
-bronchopneumonia (patchy)
distinguish b/w by CXR

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14
Q

what are the 4 stages of the inflammatory response in lobar pneumonia? what does tx do?

A
  1. congestion
  2. red hepatization
  3. grey hepatization
  4. resolution
    - tx slows or halts progression through 4 stages
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15
Q

what are the 7 morphologies of pneumonia?

A
  • acute
  • organizing
  • chronic
  • fibrosis vs. full resolution
  • red vs. grey hepatization
  • consolidation
  • infiltrate vs. histopathology
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16
Q

would a classical pneumonia be more obstructive or restrictive

A

could be BOTH

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17
Q

what is red hepatization?

A
  • RBC exudate, neutrophils and fibrin fill alveolar spaces

- consistency resembles liver tissue

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18
Q

what is grey hepatization? what color is it?

A
  • RBCs disintegrate which leads to increased fibrinization
  • persistent neutrophils, fibrin & supprative exudate
  • alveoli consolidated
  • greyish brown drier surface
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19
Q

what kind of pneumonia does streptococcus cause? what is 100% curative and what is 100% preventative against?

A
  • classic lobar pneumonia
  • penicillin often 100% curative
  • vaccines often 100% preventative
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20
Q

who gets haemophilus pneumonia?

A
  • children <2 with otitis, URI, meningitis, cellulitis, osteomyelitis
  • most common from COPD in adults
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21
Q

moraxella catarrhalis ranks as what in the most common pneumonia?

A

-2nd most common after COPD pneumonia

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22
Q

what is the most common pneumonia following viral pneumonias?

A

-staph aureus

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23
Q

who gets klebsiella pneumonia?

A
  • debilitated malnourished people

- alcoholics with pneumonia thought to have k. pneumonia until proven otherwise

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24
Q

is pseudomonas aeruginosa community acquired? who gets pseudomonas aeruginosa?

A

NO it is nosocomial

-cystic fibrosis pts w/pneumonia presumed to have pseudomonas until proven otherwise

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25
Q

when does legionella happen? what classification? how is it spread and to who? is it typical or atypical?

A
  • often in outbreaks
  • often lobar
  • spread by water “droplets” to immunosuppressed pts
  • bridges typical & atypical classification: can inhale aerosolized organisms or aspiration of contaminated drinking water
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26
Q

in resolution what happens to the consolidated exudate?what happens to the debris? is there fibrosis?

A
  • consolidated exudate undergoes enzymatic digestion
  • granular semi-fluid debris is resorbed, eaten by MOs or coughed up
  • fibroblast reorganization of debris may lead to fibrous thickening or adhesions
  • lung tissue returns to baseline or there’s residual scarring
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27
Q

when do you hospitalize?

A
  • pts living in nursing home
  • elderly or infants, particularly <1 mo
  • cancer
  • heart failure
  • stroke
  • kidney failure
  • liver disease
28
Q

what kinds of PE findings would lead you to hospitalize?

A

-altered mental status, dehydration, fast breathing, heart rate >120 bmp, systolic BP 104

29
Q

what are laboratory findings that would lead you to hospitalize?

A
  • elevated blood sugar
  • fluid in sac around lung
  • low oxygen in blood
  • low sodium levels
  • poor kidney fxns
  • significant anemia
30
Q

what are the 4 characteristics of an atypical community acquired pneumonia?

A
  • mycoplasmal
  • not bacterial
  • viral
  • cultures not helpful
31
Q

community acquired atypical pneumonias are caused by what, lack what and are known as what?

A
  • caused by less typical pathogens
  • cell wall deficient bacteria
  • known as ‘walking pneumonia’
32
Q

what is the main bacteria which causes community acquired atypical? main viruses?

A
  • mycoplasma pneumoniae! also chlamydia, legionella

- viruses= RSV, parainfluenza virus, varicella, influenza A & B, adenovirus, SARS

33
Q

who does mycoplasma pneumoniae infect?

A

older children and young adults

34
Q

where do you see inflammation in community acquired atypical pneumonia?

A

-see interstitial inflammation and usually without alveolar involvement

35
Q

viral pneumonias are typically _____ not ______

A

typically interstitial not alveolar

36
Q

viruses are the _____ pathogen in ____ & _____. what is the most common?

A
  • primary pathogens in infants and young children

- respiratory syncytial virus most common; includes chicken pox, para-influenza virus& influenza A & B

37
Q

in adults what viruses cause pneumonia?

A

influenza A or varicella-zoster

38
Q

what does SARS stand for? bac or virus and what kind? how do you confirm?

A
  • SARS= severe acture respiratory syndrome
  • corona virus
  • confirmed by PCR
39
Q

what are hospital acquired pneumonias called? what causes them? (hospital practices and bugs) what is MRSA?

A
  • nosocomial
  • debilitation, catheters & ventilators
  • enterobacter, pseudomonas, staph
  • MRSA= methicillin resistant staph aureus
40
Q

who gets aspiration pneumonia? what part of the lobe is usually involved? what does it usually lead to?

A
  • unconcious pts
  • pts in prolonged bed rest
  • lack of ability to swallow or gag
  • usually aspirating gastric contents
  • usually in posterior lobes
  • leads to abscesses
41
Q

what bacteria usually cause aspiration pneumonia?

A
  • step
  • staph
  • haemophilus
42
Q

what are lung abscesses from? is this a type of pneumonia?

A
  • aspiration
  • septic embolization
  • neoplasia
  • from neighboring structures
  • any pneumonia which is severe, destructive and un-treated enough
  • NOT a type of pneumonia but a complication
43
Q

what is a pulmonary abscess?

A

localized infectious process characterized by necrosis

44
Q

what can cause a pulmonary abscess?

A
  • aspiration (most common)
  • preceding lung infection
  • septic embolism
  • trauma or extension of soft tissue infection
  • oral cavity flora, step, gram (-) organisms
45
Q

what increases risk of pulmonary abscess?

A
  • sinusitis
  • dental disease
  • bronchiectasis
  • fungal infxns
  • diminished gag reflex
46
Q

where does an abscess due to aspiration usually occur?

A

usually single in R lung (b/c more vertical)

47
Q

what are the sxs of a pulmonary abscess?

A
  • cough
  • fever
  • chest pain
  • weight loss
  • copious amounts of foul smelling purulent or sanguineous sputum
48
Q

txs for pulmonary abscess? complications?

A
  • antimicrobial therapy
  • surgical drainage
  • complications= empyema, spontaneous rupture, sepsis
49
Q

chronic pneumonia is often synonymous with what 4 things?

A

4 classic systemic fungal or granulomatous pulmonary infections: TB, histoplasmosis, blastomycosis, coccidiomycosis

50
Q

does chronic (in pneumonias) mean clinically or pathologically chronic?

A

CLINICALLY chronic

51
Q

risk factors for TB?

A
  • poverty
  • crowding
  • chronic debilitating illness
52
Q

what is the main bac which causes TB in non-compromised hosts? in immunocompromised hosts?

A

non-compromised: mycobacterium tuberculosis & m. bovis

immuno: m. avium & m. intracellularae

53
Q

what is the process of TB?

A

-inhalation of mycobacterium, engulfed by MO, transported to hilar lymph nodes, multiply, lyse MOs and travel, get ‘quarantined’= granulomas

54
Q

what kind of granuloma does TB produce and what does it look like?

A

caseous; cheesy

55
Q

what is the fxn of a granuloma?

A
  • prevent dissemination of mycobacteria

- local environment for communication of cells of immune system

56
Q

what is a ghon focus? ghon complex?

A

ghon focus: initial infxn location, 2-3 wks after develops undergoes caseous necrosis, TB bacilli drain out towards hilar lymph nodes
ghon complex: ghon focus w/hilar lymph node involvement, may caclify, latent TB here

57
Q

what is secondary TB?

A

reactivation TB

ghon complex breakdown and mycobacterium release due to poor nutrition or infections

58
Q

what is military TB?

A

infxn into circulatory sys, millet-like seeding of TB bacilli in lungs & other organs; 1-3% of TB cases

59
Q

what are sxs of TB infxn?

A
  • fever (night sweats)
  • cough (non-productive to sputum)
  • pleuritic chest pain
  • dyspnea
  • hemoptysis
  • weight loss
  • fatigue
60
Q

tx for TB?

A
  • long course Abx

- vaccinations used in high risk areas

61
Q

details of histoplasmosis?

A
  • spores in bird or bat droppings
  • mimics TB
  • calcified pulmonary granulomas
  • Ohio, Mississippi valley
  • primary infxn resembles viral URI
  • granulomas appear lamellar or onion-skin like
62
Q

details of blastomycosis?

A
  • spores in soil, yeast
  • mimics TB
  • calcified pulmonary granulomas
  • LARGE distinct spherules
  • Ohio, MS valley, great lakes, middle east, africa, canada, mexico
63
Q

details of coccidiomycosis?

A
  • spores in soil
  • mimics TB
  • calcified pulmonary granulomas
  • SMALL spherules (thick walled non-budding w/in MOs or giant cells, often cavitate)
  • american SOUTHWEST
  • dry cough, high fever, pleural effusion
64
Q

what do ppl who inhale coccidiomycosis spores develop?

A
  • anyone who inhales become infected and thereafter develops a delayed type hypersensitivity to the fungus
  • more than 80% of ppl in endemic area have + skin test
65
Q

details of aspergillus?

A
  • common mold
  • cause allergies in otherwise healthy ppl
  • invasive aspergillosis: opportunistic infxn seen in immunosuppressed & debilitated
  • aspergilloma= fungal growth w/in lung cavity

Pathology II (6 decks)

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