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Pathology > Infective Lung Disorders > Flashcards

Infective Lung Disorders Flashcards

1
Q

Causative agent of Pulmonary Tuberculosis

A

Mycobacteria tuberculosis hominis

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2
Q

Mode of transmission of Pulmonary Tuberculosis infection

A

Droplet infection

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3
Q

Primary pulmonary Tb

A

Infection in lung on 1st time entry of mycobacteria

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4
Q

Cells first infected in Primary pulmonary Tb

A

Alveolar Macrophages

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5
Q

Subpleural lesion seen in Primary pulmonary Tb

A

Ghon’s Focus

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6
Q

Ghon’s Complex

A

Ghon’s Focus + lymphatics + LN enlargement

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7
Q

After 3 weeks of Tb exposure

A

Macrophages works as APC - carry mycobacteria antigen to LN - contact with TH1 cells - activation of TH1 cell - secrets Cytokines - IFN-alpha (required for macrophages activation) - Macrophages activation - leads to Granuloma formation - Mycobacteria inactivates

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8
Q

Ghon’s focus

A

Subpleural lesion along with hilar lymph nodes enlargement

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9
Q

Raenke’s Complex

A

Fibrous ghon’s focus + calcium deposition

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10
Q

Simon’s focus

A

If immunity low in Primary pulmonary Tb - lesion forms in apical centre

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11
Q

Secondary pulmonary Tb can be due to

A

Reactivation - of prexisting mycobacteria
Reinfection - common in endemic areas

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12
Q

Most common cause of secondary pulmonary Tb

A

Reactivation

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13
Q

Reactivation in case of Tb is mostly seen in which condition

A

Occurs when immunity decreases
Elderly patients
Immunosuppressive disorders

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14
Q

Why apical lesion most commonly seen in secondary pulmonary Tb

A

Because there is maximum ventilation perfusion ratio in apical region

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15
Q

In case of Reactivation, individuals already sensitized for mycobacteria

A

Immune system rapidly recognizes mycobacteria antigen - leads to delayed type hypersensitivity

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16
Q

Types of hypersensitivity seen due to reactivation in case of secondary pulmonary Tb

A

Delayed type hypersensitivity

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17
Q

Delayed type hypersensitivity in secondary pulmonary Tb can leads to

A

Caseous necrosis
Cavitation ++
Hemoptysis - due to damage of Bronchial artery branches

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18
Q

If low immunity in individuals in case of secondary pulmonary Tb

A

No delayed type hypersensitivity - bacteria spreads through lymphatics, hematogenous and aerogenous routes

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19
Q

Type of Tb when bacteria spreads through Lymph nodes

A

Miliary Tb

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20
Q

Type of Tb when bacteria spreads through Lymph nodes

A

Miliary Tb

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21
Q

Mycobacteria in case of secondary Pulmonary Tb can affect which systemic organs through lymphatics or hematogenous spread

A

Spleen
Liver
LN
Genital organs

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22
Q

Type of Tb seen when bacteria spreads through aerogenous route

A

Endotracheal Tb
Laryngeal Tb

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23
Q

Clinical features of Secondary pulmonary Tb

A

Cough
Unexplained weight loss
Fever (evening rise of fever)
Night sweats
Hemoptysis
Anorexia

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24
Q

Most common source of Hemoptysis in Tuberculosis

A

Bronchial artery
Sometimes may be Pulmonary artery

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25
Q

Effect of Tuberculosis infection on Lymph nodes

A

2nd most common involved
Size increases
Caseous necrosis
Mating of LN (fusion)

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26
Q

Rich’s focus

A

Present in brain in case of tubercular infection

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27
Q

Appearance seen on CSF exam in case of tubercular meningitis

A

Cobweb appearance

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28
Q

Cardiac manifestations in case of Tuberculosis

A

Chronic constrictive pericarditis

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29
Q

Most common cause of Chronic constrictive pericarditis in India

A

Tuberculosis

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30
Q

Which bones are most commonly involved in Tuberculosis infection

A

Vertebral column - Spinal tuberculosis or Pott’s spine

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31
Q

Kidney related manifestations in Tuberculosis infection

A

Tubercular pyelonephritis
Pus cell in urine (Pyuria)

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32
Q

Adrenal gland manifestations in case of Tuberculosis

A

Can lead to Chronic adrenal insufficiency

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33
Q

Most common cause of Chronic adrenal insufficiency in india

A

Tubercular adrenalitis

Autoimmune adrenalitis

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34
Q

Male Genital tract involvement in Tb

A

Involves 1st epididymis and then involves testicular tissue

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35
Q

Female genital tract involvement in Tb

A

Involvement of fallopian tube - Decreases fertility

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36
Q

Focus seen in liver in case of Tb

A

Simmond’s focus

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37
Q

Focus seen in Pulmonary vein in case of Tb

A

Weigart focus

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38
Q

Involvement of ear in Tb

A

Tubercular otitis media - multiple perforations in tympanic membrane

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39
Q

Eye involvement in Tb

A

Phlectenular conjunctivitis (Type 4 HR) - associated with delayed type HR

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40
Q

Diagnostic methods of Tuberculosis

A

ESR
Lymphocytosis
Sputum examination - Stain, Culture, PCR - CBNAAT
Chest X ray
CT scan

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41
Q

Sputum sample in case of Tb is usually taken at which time

A

Early morning

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42
Q

Findings on staining method in Tb

A

Mycolic acid - acid fast appearance - Pink colored mycobacteria in Bluish background can be seen

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43
Q

Gold standard diagnostic method for Tb

A

Bacterial culture

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44
Q

Bacterial culture can be done on which media in Tb

A

Lobstein Jenson media
Takes time
Bactec media - needs>10,000 bac.

45
Q

Decontamination method used for sputum in case of Tb

A

Petroff’s method
NALC method

46
Q

Full form of CBNAAT

A

Cartridge based nucleic acid amplification test

47
Q

X ray findings in case of Tb

A

Tubercular focus+
Pleural effusion - On pleural tap - Straw colored fluid, increased adenosine deaminase

48
Q

MDR-TB full form

A

Multidrug resistance Tb

49
Q

MDR-TB therapy given to patients who are resistant to

A

Isoniazid/Rifampicin resistant

50
Q

XDR-TB full form

A

Extensively drug resistant Tb

51
Q

XDR -TB therapy is resistant to

A

Resistance to 1st line drugs
Aminoglycosides
Injectable fluoroquinolones

52
Q

Pneumonia

A

Inflammation and infection of lung parenchyma

53
Q

Classification of pneumonia

A

Typical Pneumonia (Air space Pneumonia)
Atypical Pneumonia (Interstitial Pneumonia)

54
Q

Most common cause of Typical Pneumonia

A

Bacterial infection

55
Q

Characteristics findings of Typical Pneumonia

A

Presence of alveolar exudates (M.I)
Neutrophilic infiltration

56
Q

Most common causes of Atypical Pneumonia

A

Mostly non bacterial in nature

57
Q

Infiltration seen in Atypical Pneumonia

A

Involvement of Interstitial spaces
Macrophages/lymphocytes infiltration

58
Q

Laennec stages of Typical Pneumonia

A

Congestion
Red hepatization
Gray hepatization
Resolution

59
Q

Congestion stage of Typical Pneumonia

A

1-2 days
Blood vessels dilatation
Fluid in alveoli (bacteria +, WBC +++)

60
Q

Red hepatization stage of Typical Pneumonia

A

3-4 days
Fluid in alveoli - WBC + , RBC +++
Lungs consistency decreases - Liver like consistency (hepatization)
Fibrin +

61
Q

Gray hepatization stage of Typical Pneumonia

A

5-8 days
RBC breakdown
Fibrin deposition +++ - color changes to gray

62
Q

Resolution stage of Typical Pneumonia

A

More than 8 days
Phagocytosis of causative organism by WBC

63
Q

Lobar pneumonia

A

S. Pneumoniae
Whole lobe involvement

64
Q

Bronchopneumonia

A

Smaller airways
Patchy involvement
Seen in childrens and adzlts
Basal/bilateral

65
Q

Clinical features of Typical Pneumonia

A

Fever with chills
Cough with sputum
Dyspnea
Pain on deep inspiration

66
Q

Clinical features of Atypical Pneumonia

A

Also termed as Walking pneumonia
Fever
Cough - dry cough
Mild dyspnea

67
Q

Organisms associated with Typical Pneumonia

A

Streptococcus pneumoniae
Staphylococcus aureus
Klebsiella
H. Influenza
Pseudomonas aeruginosa

68
Q

Most common cause of community acquired pneumonia

A

S. Pneumoniae

69
Q

Staph aureus in Pneumonia

A

Associated with secondary pneumonia
Abscess formation

70
Q

Sputum in case of pneumonia caused by Klebsiella

A

Red currant jelly sputum

71
Q

Bacteria most commonly responsible for pneumonia on aspiration

A

Klebsiella

72
Q

Most common bacterial cause of COPD exacerbations

A

H. Influenza - capsulated organism

73
Q

Vaccine for Type ‘b’ H influenza

A

Hib Vaccine

74
Q

Which organism most commonly causes pneumonia in immunocompromised individuals

A

Pseudomonas aeruginosa

75
Q

Most common cause in Nosocomial and ventilator associated pneumonia

A

Pseudomonas aeruginosa

76
Q

Organisms associated with Atypical Pneumonia

A

Mycoplasma pneumoniae
Chlamydia
Pneumocystis jiroveci
Coxiella brunetti
Legionella

77
Q

Most common cause of Atypical Pneumonia

A

Mycoplasma pneumoniae

78
Q

2nd most common cause of Atypical Pneumonia

A

Chlamydia

79
Q

Fungus responsible for Atypical Pneumonia

A

Pneumocystis jiroveci
Affects immunocompromised individuals (AIDS)

80
Q

Cause of Q fever

A

Coxiella brunetti

81
Q

Legionella

A

Air loving organismd
ICU admitted patient + immunocompromised
History of post transplant

82
Q

Pontiac fever is caused by

A

Legionella

83
Q

Viruses responsible for Atypical Pneumonia

A

Influenza type A
Respiratory syncytial virus(RSV)
Measles
CMV

84
Q

Adult respiratory syndrome can also be termed as

A

Shock lung
Stiff lung
Hyelin membrane disease (HMD)
Non cardiac Pulmonary edema

85
Q

Findings of Adult respiratory distress syndrome

A

Acute respiratory failure within 1 week
+ Radiographically bilateral pulmonary opacities

86
Q

Direct risk factors of ARDS

A

Direct injury to lungs
Pneumonia
Gastric aspiration
Inhaled gas

87
Q

Overall most common cause of ARDS

A

Pneumonia

88
Q

Initiation point in pathogenesis of ARDS

A

Endothelial cell injury - release Cytokines - IL-8 - neutrophils accumulation - damages alveolar epithelial cells - surfactants decreases - surface tension increases - leads to alveolar collapse
Also release of Cytokines - leads to increase in permeability - leak out of protein rich fluid - protein rich fluid makes barrier - formation of hyelin membrane - decreased elasticity of lung - stiff lung

88
Q

Clinical features of ARDS

A

Respiratory distress - Hypoxemia - Multiple organ dysfunction syndrome - Death

89
Q

Diagnosis of ARDS

A

Chest X ray
Pulmonary capillary wedge pressure (PCWP)

90
Q

Finding of chest x ray in ARDS

A

Bilateral Pulmonary opacities (Whitish appearance) - “White-out lung”

91
Q

Treatment of ARDS

A

O2 - Refractory
Targets primary cause - If pneumonia treat it
PEEP Ventilation (Positive End expiratory pressure ventilation)
Steroids

92
Q

Cause of Neonatal respiratory distress syndrome

A

Surfactants deficiency

93
Q

Stimulatory effect of which hormones on surfactants production

A

Cortisol
Thyroxine

94
Q

Inhibitory effect of which hormone on Surfactants production

A

Insulin

95
Q

Surfactants are secreted from

A

Type 2 Pneumocytes

96
Q

Surfactants secretion starts from which week of gestation

A

From 28th week of gestation

97
Q

Secretion of Surfactants peaks in which week of gestation

A

33-34th week

98
Q

Chemical composition of Surfactants

A

Lecithin - Dilpalmityl phosphatidyl choline (DPPC)

99
Q

Function of Surfactants

A

Decreases surface tension - increased alveolar collapse tendency
Surfactants reduces alveolar collapse tendency

100
Q

Etiology of Neonatal respiratory distress Syndrome

A

Premature baby (M.C cause)
C-section
Maternal diabetes - maternal hyperglycemia - fetal Hyperglycemia - fetal pancreas stimulation - insulin secretion increases - Surfactants inhibition

101
Q

Clinical features of Neonatal respiratory distress Syndrome

A

Onset of respiratory distress within few hours of birth
Tachypnea
Hypoxemia

102
Q

Diagnosis of NRDS

A

Lecithin : Singomyelin ratio - L:S ratio in amniotic fluid
Chest X ray

103
Q

Normal L:S ratio

A

> 2:1

104
Q

If L:S ratio <2:1

A

High chances of NRDS

105
Q

X ray finding in NRDS

A

White -out lung
Ground glass opacity

106
Q

Complications of NRDS

A

Decreased O2 in blood - Patent ductus arteriosus
Intestine - gut mucosa injury - Necrotizing enterocolitis

107
Q

Treatment of NRDS

A

Surfactants for lung maturity - Intratracheal administration of Surfactants
O2 therapy - Endotracheal tube
Steroids to mother if risk of premature baby - increases no. Of Surfactants in baby

108
Q

Indirect risk factors of ARDS

A

Sepsis
Mechanical Trauma
TRALI(Transfusion related acute lung injury)
DIC
Fat embolism
Drugs - Barbiturates
Pancreatitis
Burns

Pathology (14 decks)

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