EXAM #2: INFECTIOUS AND NON-INFECTIOUS DISEASE Flashcards
What is required for the development of pneumonia?
Impairment of normal host defenses
What is the definition of “pneumonia?”
Any infection of the lung parenchyma
What are the major factors that diminish host resistance to infection/pneumonia?
1) Chronic disease
2) Immunodefiency
3) Immunosuppression/Luekopenia
4) Lifestyle i.e. smoking
What typically causes acute pneumonia?
Pyogenic bacteria
What typically causes pneumonitis?
- Viruses
- Fungi
What typically causes chronic pneumonias?
1) TB
2) Fungi
3) Parasites
4) Atypical bacteria
What factors general predispose one to pneumonia?
1) Impaired cough reflex
2) Damage to mucociliary escalator
3) Mucus plugging
What is a lobar pneumonia?
Consolidation involving an entire lobe of the lung
What is a bronchopneumonia?
Consolidation characterized by scattered/ patchy consolidation around bronchioles
What are the clinical signs and symptoms of pneumonia?
1) Fever
2) Chills
3) Productive cough (yellow-green or rusty sputum)
4) Tachypnea
5) Pleuritic chest pain
6) Decreased breath sounds
7) Dullness to percussion
8) Elevated WBC
What causes the majority of cases of lobar pneumonia?
Streptococcus pneumoniae
What are the classic gross phases of lobar pneumonia?
1) Congestion
2) Red hepatiziation
3) Gray hepatiziation
4) Resolution (or scar)
What is red hepatiziation?
Exudate, neutrophils, and hemorrhage filling the alveoli
*Gives the lung a solid consistency, like the liver–hence “hepatiziation”
What is gray hepatiziation?
Degradation of RBCs lead to a gray color within exudate
What are the indications for hospitalization in CAP?
1) Severe dyspnea or hypoxemia
2) Empyema
3) Significant underlying disease
4) Systemic manifestation of infection e.g. delirium
In atypical pneumonia, what type of cells predominate?
Lymphocytes NOT neutrophils as in lobar/bronchopneumonia
What location of the lung is most involved in atypical pneumonia?
Interstitium
What is the most common cause of atypical pneumonia?
Mycoplasma
Next is Chlamydia
What is the treatment of mycoplasma or chlamydia pneumonia?
Erythromycin
What is Sarcoidosis?
Systemic disease characterized by noncaseating (no necrosis) granulomas in multiple organs
Diagnosis of exclusion
What are the most frequent targets for Sarcoidosis?
Lung and hilar lymph nodes
*“Potato nodes”
What patient population is Sarcoidosis most common in?
African American females
What is the clinical presentation of Sarcoidosis?
Typically asymptomatic but dyspnea and dry cough are most common
What labs are associated with Sarcoidosis?
1) Hypercalcemia
2) Elevated serum ACE
What cells mediate the pathogenesis of Sarcoidosis?
CD4+ T-cells (Th1)
What HLA genotype is associated with Sarcoidosis?
HLA- A1 and B8
In addition to the lungs and hilar lymphnodes, what other organs/ systems are affected by Sarcoidois?
1) Uvea
2) Skin
3) Salivery and lacrimal glands
4) Heart
Microscopically, how does Sarcoidosis appear?
Stellate inclusions within multi-nuclear giant cells
What are Schaumann bodies?
Calcifications usually seen in giant cells associated with Sarcoidosis
What are Asteroid bodies?
Star-shaped eosinophilic bodies composed of intermediate filaments in the multi-nuclear giant cells seen in Sarcoidosis
What is hypersensitivity pneumonitis?
Granulomatous reaction to inhaled organic antigens
What type of hypersensitivity reactions are seen in Hypersensivity Pneumonitis?
1) Type III
2) Type IV
What causes the Farmer’s Lung variant ofr Hypersensitivity Pneumonitis?
Spores of thermophilic actinomyces in moldy hay
What is Silo fillers disease?
Breathing toxic gas from silo leading to pulmonary edema and bronchiolitis obliterans
This basically causes a chemical burn to the airway
What causes Desquamative Interstitial Pneumonia (DIP)?
Macrophage response to smoking
What clinical sign is pathogonominic for Pulmonary Alveolar Proteinosis (PAP)?
Smoker coughing up white jello-like chunks of sputum
*This is an accumulation of acellular surfactant
How is PAP treated?
Bronchiolar lavage
