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Respiratory > Path of Infectious and Non-infectious > Flashcards

Path of Infectious and Non-infectious Flashcards

1
Q

Pneumonia is responsible for what fraction of death in the US?

A

1/6

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2
Q

True or false: the lower airways are usually sterile

A

True

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3
Q

True or false: we all regularly aspirate

A

True–though it is minute

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4
Q

What is the technical definition of pneumonia?

A

Infection of the lung parenchyma

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5
Q

What are the two major lifestyle factors that predispose people to pneumonia?

A

EtOH

Smoking

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6
Q

What is the usual cause of acute pneumonia?

A

Pyogenic bacteria

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7
Q

What is pneumonitis?

A

Usually not pyogenic—often viral or d/t to mycoplasma

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8
Q

What are the common causes of chronic pneumonias?

A

TB
Fungi
Parasites

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9
Q

What are the five physiological changes that predispose to developing pneumonia?

A
  • Loss of cough reflex
  • Injury to mucociliary escalator
  • LOF of macrophages
  • Pulmonary edema and congestion
  • Accumulated secretions
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10
Q

What are the two ways to classify pneumonia?

A

Etiological agent or clinical setting

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11
Q

True or false: you can get pneumonia from sepsis

A

True

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12
Q

CAP is usually caused by what infectious type of agent?

A

Bacterial

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13
Q

Atypical pneumonia is usually caused by what infectious agent?

A

Viruses

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14
Q

Aspiration pneumonia is usually caused by what?

A

Bacteria and chemicals

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15
Q

What are the usual causes of chronic pneumonias?

A

mycobacteria

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16
Q

True or false: Legionnaires disease is classified as a CAP

A

True

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17
Q

Which lobes of the lung are most often affected by aspiration?

A

Lower lobes or right middle

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18
Q

What are the two morphological patterns of bacterial pneumonia?

A

Bronchopneumonia and lobar pneumonia

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19
Q

What is lobar pneumonia?

A

Consolidation of an entire lobe or large portion of a lobe

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20
Q

What is bronchopneumonia?

A

Patchy consolidation in one or more lobes

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21
Q

What does the pneumonia pattern depend on?

A

Bacterial virulence and host resistance

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22
Q

What are the lung sounds with lobar pneumonia?

A

Rales

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23
Q

What are the gross findings of bronchopneumonia?

A

Dispersed, elevated 3-4 cm lesions of palpable consolidation

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24
Q

What are the histological findings of bronchopneumonia?

A

Acute PMN filled exudate filling airspaces and airways

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25
Q

90-95% of lobar pneumonia is caused by what pathogen?

A

Strep pneumoniae

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26
Q

What is the progression of lobar pneumonia?

A

Congestion
Red hepatization
Gray hepatization
Resolution

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27
Q

What causes the red hepatization in the lungs with pneumonia?

A

Confluent exudation with RBCs, fibrin in alveolar spaces

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28
Q

What causes the grey hepatization in the lungs with pneumonia?

A

RBCs break down, exudate remains

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29
Q

What is involved in the resolution phase of lobar pneumonia?

A

Exudate enzymatically digested

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30
Q

What happens if the pneumonia does not resolve? Why?

A

Scarring d/t degradation from enzymatic destruction

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31
Q

What are the four major indications that you should hospitalize a patient with pneumonia?

A
  • severe dyspnea
  • Empyema
  • Underlying disease
  • Severe systemic ssx
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32
Q

What are the pleural consequences of pneumonia? (3)

A

Pleuritis
Pleural effusion
Bronchopleural fistulas

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33
Q

What are the localized complications from pneumonia?

A

Abscesses

Empyema

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34
Q

What is type I respiratory failure?

A

Low O2, but CO2 not elevated

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35
Q

What are the heart sequelae of pneumonia? (3)

A

A-fib
Pericarditis
Myocarditis

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36
Q

What is atypical pneumonia?

A

Lack of alveolar exudate in most, with increased WBCs

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37
Q

Which WBC is increased markedly with atypical pneumonia (usually)?

A

Lymphocytes

Monocytes

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38
Q

What is the “proper” name for primary atypical pneumonia?

A

Interstitial pneumonitis

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39
Q

What are the CXR findings of atypical pneumonia?

A

Patchy Interstitial changes

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40
Q

What are the usual bacteria that cause atypical pneumonia?

A

Mycoplasma

Chlamydia

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41
Q

What are the ssx of atypical pneumonia?

A

Pharyngitis with URI like ssx

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42
Q

What are the classic ssx of mycoplasma pneumoniae?

A

Bad, persistent cough

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43
Q

What are the primary viral causes of atypical pneumonia?

A

Influenza A and B
RSV
Adenovirus

44
Q

What is the common pathogenic mechanisms for viral pneumonia?

A

Attachment of organism to the respiratory epithelium, leading to necrosis of cells and an inflammatory response

45
Q

If sputum changes from green to yellow, what should you suspect?

A

Bacterial pneumonia superimposed by a viral one

46
Q

What is the usual clinical course of atypical pneumonia?

A

Usually resolves spontaneously

47
Q

What are the severe sequelae of atypical pneumonia?

A

ARDS

48
Q

What is the typical histopathology of atypical pneumonia?

A

Interstitial pneumonia with mononuclear infiltrates and diffuse alveolar damage

49
Q

What are the two major granulomatous diseases that affect the lung?

A

Sarcoidosis

Hypersensitivity pneumonitis

50
Q

What is the pulmonary eosinophilia?

A

a disease in which an eosinophil, a type of white blood cell, accumulates in the lung d/t some insult (meds, parasites, environmental triggers etc)

51
Q

What is sarcoidosis?

A

Systemic disease of unknown etiology, but causes granulomas

52
Q

What are the most frequent targets of sarcoidosis?

A

Lung and/or hilar lymph nodes

53
Q

What is the classic patient to be affected by sarcoidosis?

A

Young, AA females

54
Q

True or false: sarcoidosis is a disease of exclusion

A

True

55
Q

What is the most common manifestation of sarcoidosis?

A

Asymptomatic

56
Q

What are the usual ssx of pulmonary involvement with sarcoidosis?

A

Insidious onset of TB-like ssx

57
Q

What is needed for a diagnosis of sarcoidosis? (3)

A

Biopsy showing:

  • Non-caseating granulomas
  • Special stains
  • Culture
58
Q

What are the lab findings of acute sarcoidosis? (3)

A

Increased IgG, Ca, and ACE

59
Q

What are the cells that are involved with sarcoidosis? Where do they accumulate?

A

CD4+ T cells in the lung interstitium and alveoli

60
Q

What are the cytokines release by the CD4+T cells in sarcoidosis? (4)

A

IL-2
IFN-gamma
IL-8
TNF

61
Q

What do the IL-2 and IFN-gamma do in sarcoidosis?

A

Increase T cell expansion

62
Q

What do IL-8 and TNF do in sarcoidosis?

A

Recruitment of additional T cells and monocytes

63
Q

What causes the skin manifestations of sarcoidosis?

A

Peripheral anergy of CD4+ T cells

64
Q

What type of antibody is upregulated with Sarcoidosis?

A

IgG

65
Q

What are the HLA genotypes that are associated with sarcoidosis?

A

HLA A1 and B8

66
Q

What is Mikulicz syndrome?

A

a type of benign enlargement of the parotid and/or lacrimal glands. 2/2 sarcoidosis

67
Q

What is the defining characteristic of sarcoidosis?

A

Well formed noncaseating granulomas

68
Q

What are the long term sequelae of sarcoidosis?

A

Fibrosis and honeycomb lung

69
Q

Where does sarcoidosis granulomas forms in the long?

A

Along the lymphatic pathways

70
Q

What is contained within granulomas in sarcoidosis?

A

Tight, clustered epithelioid histiocytes rimmed by outer zone of CD4+ T cells

71
Q

What are the histological findings of sarcoidosis?

A

PMNs infiltrating the alveolar septa

72
Q

What are the “potato” nodes in sarcoidosis?

A

Large granulomas

73
Q

What are the schumann bodies that can be seen with sarcoidosis?

A

Little lamellated calcified structures in giant cells

74
Q

What are the asteroid bodies that are found in sarcoidosis?

A

Star-shaped eosinophilic bodies made of compressed intermediate filaments

75
Q

What is the clinical course of sarcoidosis?

A

very good with steroids

76
Q

What type of sarcoidosis is more likely to become progressive?

A

Pulmonary disease without adenopathy

77
Q

What percent of patients with sarcoidosis die? COD?

A

10-15%–pulmonary fibrosis or cor pulmonale

78
Q

What is hypersensitivity pneumonitis?

A

usually an occupational disease resulting from an increased susceptibility to inhaled antigens

79
Q

What type of pulmonary disease is hypersensitivity pneumonitis?

A

Interstitial, restrictive disease

80
Q

What lung structure is primarily involved in hypersensitivity pneumonitis?

A

Alveoli

81
Q

What usually causes hypersensitivity pneumonitis?

A
  • Spores of thermophilic bacteria
  • Fungi
  • Animal proteins
  • bacterial products
82
Q

How do you avoid progression of hypersensitivity pneumonitis?

A

Remove the antigen early

83
Q

What are the acute ssx of hypersensitivity pneumonitis?

A

Large exposure to antigen that causes SOB

84
Q

What are the ssx of chronic hypersensitivity pneumonitis?

A

Insidious onset of SOB, cough, and fatigue

Respiratory failure eventually

85
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis? (early and later)

A

Type III early

Type IV later

86
Q

What are the BAL findings with hypersensitivity pneumonitis?

A

Increased T cells (both CD4 and CD8)

87
Q

What are the serum findings with hypersensitivity pneumonitis?

A

Specific antibodies

88
Q

What is the sequelae of type IV hypersensitivity prolonged hypersensitivity pneumonitis?

A

Non-caseating granuloma

89
Q

What is Farmer’s lung?

A

Hypersensitivity pneumonitis caused by spores of thermophilic actinomyces in hay

90
Q

What is Pigeon breeder’s lung?

A

Hypersensitivity pneumonitis caused by proteins from bird feathers

91
Q

What is humidified or air conditioners lung?

A

Hypersensitivity pneumonitis caused by thermophilic bacteria

92
Q

What type of cells are high with acute Hypersensitivity pneumonitis ?

A

PMNs in the interstitium

93
Q

What are the primary cells types that are found with chronic Hypersensitivity pneumonitis?

A

Mononuclear cells

94
Q

What are the characteristics of the granulomas formed from Hypersensitivity pneumonitis?

A

Noncaseating that are loose and poorly formed

95
Q

What happens in the later stages of Hypersensitivity pneumonitis?

A

Interstitial fibrosis

96
Q

What fraction of patients with Hypersensitivity pneumonitis will have intra-alveolar infiltrate?

A

Greater than 2/3 of pts

97
Q

What are the CXR findings of Hypersensitivity pneumonitis?

A

Increased lung markings

98
Q

What is silo filters disease?

A

AN occupational lung disease from NO/NO2 that is often sound in silos. This can lead to pulmonary edema in minutes, or chronic widespread bronchiolitis with scar tissue

99
Q

What is the major cells that are upregulated with smoking?

A

Macrophages

100
Q

What is desquamative interstitial pneumonia?

A

a form of idiopathic bronchitis featuring elevated levels of macrophages.
It is associated with patients with a history of smoking.

101
Q

What is the survival rate of desquamative interstitial pneumonitis with steroid use?

A

100%

102
Q

What is pulmonary alveolar proteinosis?

A

A rare lung disease in which abnormal accumulation of pulmonary surfactant occurs within the alveoli, interfering with gas exchange.

103
Q

What is the stain that is used to highlight the acellular surfactant in pulmonary alveolar proteinosis?

A

PAS+

104
Q

What are the ssx of pulmonary alveolar proteinosis?

A

Thick white sputum that is gelatinous

Progressive SOB cyanosis, respiratory insufficiency

105
Q

What happens to the alveolar walls with pulmonary alveolar proteinosis?

A

Minimal inflammation

106
Q

True or false: there is a high rate of progression to pulmonary fibrosis with pulmonary alveolar proteinosis?

A

False–very rare

107
Q

What is the treatment for pulmonary alveolar proteinosis?

A

Lavage

Respiratory (34 decks)

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