Lec 2 pulmonary inf I

Question 1

Definition of pneumonia:

Answer 1

pathological:Infection of lung parenchyma distal to the terminal bronchioles

Clinically: at least one opacity on chest x-ray

Question 2

The histologic spectrum of pneumonia:

Answer 2

• fibrinopurulent alveolar exudate- acute bacterial pneumonia
• Mononuclear interstitial infiltrate- viral and atypical pneumonia
• Granulomas and cavitation: chronic pneumonia

Question 3

Lobar pneumonia:

Answer 3

-part or all of a lobe

-Streptococcus pneumonia responsible for more than 90%

Question 4

The best way to classify pneumonias:

Answer 4

1) identifying etiological agents
2)By tracking the clinical signs of the patient

Question 5

Pathogenic factors of pneumonia:
microbial

Answer 5

Capsule
IgA protease
ciliostatic factor

Question 6

important

Pathogenic factors of pneumonia: host factors

Answer 6

-hypogammaglobulinemia
-phagocytic or cilliary dysfunction
-neutropenia
-lymphopenia

in the exam he can put hypergamma to trick you!

Question 7

Impairment to defense mechanisms:

(ones that are likely to be mentioned)

Answer 7

1)Injury to mucocilliary blanket: due to smoking, alchohol etc
2)Decrease in macrophage function; due to smoking and alcohol
3)immune deficincies
4)Exisisting pulmonary disease

Question 8

important

Smoking and alcohol:

Answer 8

Smoking: impair cilliary blanket and defect macrophage activity

Alcoholl:Impairs cough and epiglottic reflexes increasing risk of aspiration
also interferes with neutrophil infiltration.

Question 9

Diagnosis of pneumonia:

3 main ways

Answer 9

Blood picture: CBC(leukocytosis) and acute phase reactants

-Isolation of microbe: sputum, blood culture, serology

Chest x ray- patchy or lobar?

Question 10

Community acquired Acute pneumonia:

typical and Atypical

Answer 10

Typical; Strep pneumonia
Hemophilus influenza
Staph aureus
enterobacteriacae

Atypical: Mycoplasma pneumonia
Chlamidiya, Parainfluenza, adenovirus

Question 11

Pneumococcal pneumonia: Consolidation

Answer 11

-hardening of lung parenchyma due to prescence of exudate in alveoli.

-acute onset of fever and rust colored sputum with chest pain especially with pleural involvment

-Usually lobar

Question 12

Pneumococcal pneumonia: 1)Congestional Evolution

Answer 12

Congestion phase:1-2 days
-Heavy red lungs
- severe vascular congestion
- intra alveolar exudate with neutrophil
- Wartery sputum
- Bacteria +++

Question 13

pneumococcal pneumonia:
3) Grey hepatization phase

Answer 13

Grey hepatization(4-8 days)

• -Dry grey brown cut surface
• -increased alveolar fibrin and macrophages
• -Disentegrating neutrophils, decreased RBC’s

Question 13

Pneumococcal pneumonia:
2)Red hepatization.

Answer 13

Red hepatization(2-4 days)
- firm airless liver like lung
- Fibrinopurulent pleuritis
- Intra alveolar exudate
- Cells: erythrocytes, neutrophils, fibrin, rusty color sputum

Question 14

pneumococcal pneumonia:
4) Resolution

Answer 14

Resolution (8-9days)

-enzymatic digestion of exudate
-Phagocytosis

Question 15

Bronchopneumonia:

Answer 15

-patchy consolidation

-Neutrophilic exudate spreading to adjacent alveoli

Question 16

Clinical manifestations of bronchopneumonia:

Answer 16

• fever cough
• chills and rigors
• pleuritic chest pain

Physical signs: TACHYPNEA, is a measure of severity

dullness to percussion

Question 17

Other causes of pneumonias in the community:

Answer 17

-H.influenza- COPD
-S.Aureus-secondary infection
-k.pneumonia- chronic alcoholics
-P.aeruginosa-seen in ppl eith neutropenia and cystic fibrosis
-L.pneumophilia-in organ transplant patients

Question 18

Community acquired Atypical pneumonia:

which is most common? and how often does it occur?

Answer 18

-Mycoplasma is most common
-Occurs sporadically or as local epidemics

Question 19

Pathology of community acquired pneumonia:

Answer 19

-Involves the interstitium
-May be patchy or diffuse
-alveolar septa contain infiltrate of lymphocytes
-Alveolar capillary block caused by exudate and edema

has little exudate

Question 20

Clinical picture of Community atypical pneumonia:

Answer 20

-insidous onset of minimal cough, minimal WBC, no Consolidation

-Radiological picture: Transient ill defined patches in lower lobes.
-viral inclusions can be seen in viral form
-In mycoplasma: cold agglutinin test positive.

Question 21

Hospital acquired (Nosocomial) pneumonia

Answer 21

occurs at within at least 48 hours after hospital admission

G-ve bacilli mostly: P.aeruginosa , K.pneumonia

G+ve : staph aureus in US

Question 22

Pathogenisis of Nosocomial pneumonia:

Answer 22

from prolonged use of antibiotics

-Endotracheal intubation

Question 23

Pseudomonas aeruginosa pneumonia:

bronchopneumonia with high mortality

Answer 23

-Patients: neutropenic cancer patient/ burn patients/ ventilator associated

-pathology: abcess formation and empyema with prominent vascular invasion—- vasculitis

-Necrosis

Question 24

Staphylococcal pneumonia:

Answer 24

Severe abcessing pneumonia

Risk: cystic fibrotic patients, COPD, IV Drug addicts

Question 25

Aspiration pneumonia:

Answer 25

Aspiration of oropharyngeal secretions or gastric contents

Patient:Weak sensation of hypopharynx, + consolidation

microaspiration does nottt lead to pneumonia

Question 26

Lung abcesses:

Answer 26

localized area of supparative necrosis within pulmonary parenchyma

In aspiration cases: more in right, single, upper area
In pneumonia cases: More basal and multiple

Question 27

Fate and complication of lung abcesses

Answer 27

1)healing by fibrosis leaving a sterile cavity
2)Rupture with partial drainage of material:
-Radiological- Air fluid level
-rupture into pleura:empyema
-rupture into bronchus:bronchopneumonia
3)Bronchopleural fistula; pneumothorax

Question 28

Complications of bacterial pneumonias:

Answer 28

1)Pleural effusion
2)fibrosis
3)abcess formation
4)bacterimic dissemenation
5)empyema
6)atelectasis

Question 29

note:

Answer 29

atypical pneumonias are characterized by resp distress