EXAM #2: INFECTIOUS AND NON-INFECTIOUS DISEASE

Question 1

What is required for the development of pneumonia?

Answer 1

Impairment of normal host defenses

Question 2

What is the definition of “pneumonia?”

Answer 2

Any infection of the lung parenchyma

Question 3

What are the major factors that diminish host resistance to infection/pneumonia?

Answer 3

1) Chronic disease
2) Immunodefiency
3) Immunosuppression/Luekopenia
4) Lifestyle i.e. smoking

Question 4

What typically causes acute pneumonia?

Answer 4

Pyogenic bacteria

Question 5

What typically causes pneumonitis?

Answer 5

• Viruses

- Fungi

Question 6

What typically causes chronic pneumonias?

Answer 6

1) TB
2) Fungi
3) Parasites
4) Atypical bacteria

Question 7

What factors general predispose one to pneumonia?

Answer 7

1) Impaired cough reflex
2) Damage to mucociliary escalator
3) Mucus plugging

Question 8

What is a lobar pneumonia?

Answer 8

Consolidation involving an entire lobe of the lung

Question 9

What is a bronchopneumonia?

Answer 9

Consolidation characterized by scattered/ patchy consolidation around bronchioles

Question 10

What are the clinical signs and symptoms of pneumonia?

Answer 10

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

Question 11

What causes the majority of cases of lobar pneumonia?

Answer 11

Streptococcus pneumoniae

Question 12

What are the classic gross phases of lobar pneumonia?

Answer 12

1) Congestion
2) Red hepatiziation
3) Gray hepatiziation
4) Resolution (or scar)

Question 13

What is red hepatiziation?

Answer 13

Exudate, neutrophils, and hemorrhage filling the alveoli

*Gives the lung a solid consistency, like the liver–hence “hepatiziation”

Question 14

What is gray hepatiziation?

Answer 14

Degradation of RBCs lead to a gray color within exudate

Question 15

What are the indications for hospitalization in CAP?

Answer 15

1) Severe dyspnea or hypoxemia
2) Empyema
3) Significant underlying disease
4) Systemic manifestation of infection e.g. delirium

Question 16

In atypical pneumonia, what type of cells predominate?

Answer 16

Lymphocytes NOT neutrophils as in lobar/bronchopneumonia

Question 17

What location of the lung is most involved in atypical pneumonia?

Answer 17

Interstitium

Question 18

What is the most common cause of atypical pneumonia?

Answer 18

Mycoplasma

Next is Chlamydia

Question 19

What is the treatment of mycoplasma or chlamydia pneumonia?

Answer 19

Erythromycin

Question 20

What is Sarcoidosis?

Answer 20

Systemic disease characterized by noncaseating (no necrosis) granulomas in multiple organs

Diagnosis of exclusion

Question 21

What are the most frequent targets for Sarcoidosis?

Answer 21

Lung and hilar lymph nodes

*“Potato nodes”

Question 22

What patient population is Sarcoidosis most common in?

Answer 22

African American females

Question 23

What is the clinical presentation of Sarcoidosis?

Answer 23

Typically asymptomatic but dyspnea and dry cough are most common

Question 24

What labs are associated with Sarcoidosis?

Answer 24

1) Hypercalcemia

2) Elevated serum ACE

Question 25

What cells mediate the pathogenesis of Sarcoidosis?

Answer 25

CD4+ T-cells (Th1)

Question 26

What HLA genotype is associated with Sarcoidosis?

Answer 26

HLA- A1 and B8

Question 27

In addition to the lungs and hilar lymphnodes, what other organs/ systems are affected by Sarcoidois?

Answer 27

1) Uvea
2) Skin
3) Salivery and lacrimal glands
4) Heart

Question 28

Microscopically, how does Sarcoidosis appear?

Answer 28

Stellate inclusions within multi-nuclear giant cells

Question 29

What are Schaumann bodies?

Answer 29

Calcifications usually seen in giant cells associated with Sarcoidosis

Question 30

What are Asteroid bodies?

Answer 30

Star-shaped eosinophilic bodies composed of intermediate filaments in the multi-nuclear giant cells seen in Sarcoidosis

Question 31

What is hypersensitivity pneumonitis?

Answer 31

Granulomatous reaction to inhaled organic antigens

Question 32

What type of hypersensitivity reactions are seen in Hypersensivity Pneumonitis?

Answer 32

1) Type III

2) Type IV

Question 33

What causes the Farmer’s Lung variant ofr Hypersensitivity Pneumonitis?

Answer 33

Spores of thermophilic actinomyces in moldy hay

Question 34

What is Silo fillers disease?

Answer 34

Breathing toxic gas from silo leading to pulmonary edema and bronchiolitis obliterans

This basically causes a chemical burn to the airway

Question 35

What causes Desquamative Interstitial Pneumonia (DIP)?

Answer 35

Macrophage response to smoking

Question 36

What clinical sign is pathogonominic for Pulmonary Alveolar Proteinosis (PAP)?

Answer 36

Smoker coughing up white jello-like chunks of sputum

*This is an accumulation of acellular surfactant

Question 37

How is PAP treated?

Answer 37

Bronchiolar lavage