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Respiratory > Pathology of Lung Infection > Flashcards

Pathology of Lung Infection Flashcards

1
Q

What is pneumonia?

A

Inflammation of the lung - mostly due to infection but not always

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2
Q

What are the clinical features of pneumonia?

A

Fever and chills, unrelenting cough, sputum production (yellow or green), chest pain if pleura is inflamed, impaired gas exchange resulting in dyspnoea and tachypnoea

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3
Q

What are the three groups of pneumonia according to clinical setting?

A

Community acquired, hospital acquired or compromised immune host

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4
Q

What pathogen is most likely to cause community acquired pneumonia?

A

50% of cases are caused by streptococcus pneumoniae

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5
Q

What pathogen is most likely to cause hospital acquired pneumonia?

A

A gram negative bacteria

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6
Q

What pathogens are more likely in immune compromised hosts to cause pneumonia?

A

Fungi or protozoa (pneumocystis jirovecii)

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7
Q

What are the four ways which pathogens can reach the lung?

A

Inhalation of pathogens in air droplets, aspiration of infected secretions from the URT, aspirating infected particles like gastric contents or food or drink, from the blood

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8
Q

What are the three classes of pathogens causing pneumonia?

A

upper respiratory tract flora, enteric saprophytes, extraneous pathogens

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9
Q

What are the upper respiratory tract flora which can cause pneumonia?

A

Streptococcus pneumoniae, haemophilus influenzae, staphlococcus aureus

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10
Q

What are the enteric saprophytes which can cause pneumonia?

A

E. coli, pseudomonas

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11
Q

What are the extraneous pathogens which can cause pneumonia?

A

Legionella pneumophila, tuberculosis

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12
Q

What are the two patterns of infective pneumonia?

A

Alveolar inflammation or interstitial inflammation (atypical pneumonia)

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13
Q

What cells are involved in alveolar inflammation?

A

Neutrophils in the alveolar spaces (consolidation)

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14
Q

What pathogens cause alveolar inflammation?

A

bacterial pathogens such as streptococcus, staphylococcus, haemophilus, gram negatives

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15
Q

What are the two kinds of alveolar inflammation?

A

Bronchopneumonia and lobar pneumonia

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16
Q

What is the pattern of consolidation in bronchopneumonia?

A

Patchy and bilateral

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17
Q

What is the pattern of consolidation in lobar pneumonia?

A

Entirety of a single lobe

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18
Q

What does consolidation look like on a CXR?

A

White

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19
Q

What does consolidation look like macroscopically?

A

White and solid

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20
Q

What is the commonest cause of lobar pneumonia?

A

streptococcus pneumoniae

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21
Q

What is the commonest way to get strep pneumoniae lobar pneumonia?

A

community acquired

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22
Q

What are the symptoms of community acquired strep pneumoniae lobar pneumonia?

A

high fever with chills, raised white cell count, cough, pleuritic chest pain, blood stained sputum, gram positive diplococci present in sputum, often causes bacteraemia

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23
Q

What are the 4 stages of lobar pneumonia?

A

congestion, red hepatisation, grey hepatisation, resolution

24
Q

What happens in congestion?

A

Protinaceous exudate full of diplococci in the alveoli

25
Q

What happens in red hepatisation?

A

Consolidation with haemorrhage into airspaces

26
Q

What happens in grey hepatisation?

A

mesh work of fibrin in alveolar spaces with neutrophils and macrophages

27
Q

Which patients most commonly get bronchopneumonia?

A

Young and old patients or patients with chronic disease e.g. COPD, cardiac failure, malignancies or cystic fibrosis - hospitalised patients

28
Q

What pathogens most commonly cause bronchopneumonia?

A

gram negative bacteria - pseudomonas or staphylococcus

29
Q

What are the complications of pneumonia?

A

Pleurisy, pyothorax, empyema, abscess, bronchiecstasis, fibrosis, cysts

30
Q

What is a lung abscess?

A

A cavity containing puss

31
Q

What pathogen almost always causes lung abscess?

A

Staphylococcus aureus

32
Q

What are other causes of lung abscess?

A

aspiration of infected contents from the URT such as gastric contents, distal to bronchial obstruction by a tumor, septic emboli to the lung

33
Q

What cells are involved in atypical pneumonia?

A

Lymphocytes and macrophages in intra alveolar septa

34
Q

What pathogens cause atypical pneumonia?

A

Viruses, bacteria (mycoplasma pneumonia, coxiella burnetti, legionella, chlamydia pneumoniae)

35
Q

What is seen in the lung macroscopically in atypical pneumonia?

A

lung looks dark, wet and heavy - there is no consolidation

36
Q

What is the clinical presentation of atypical pneumonia?

A

systemic symptoms more than respiratory systems - malaise, aches, pains, headache, diarrhoea, non productive cough - ‘walking pneumonia’

37
Q

What does the CXR of atypical pneumonia look like?

A

Dots and dashes in both lung fields

38
Q

What is tuberculosis?

A

a chronic granulomatous pneumonia due to infection with mycobacterium tuberculosis

39
Q

What are the unique features of tuberculosis compared to other bacterial pneumonias?

A

the human body cannot eradicate it, and it can lie dormant after the initial infection before causing a secondary infection

40
Q

What are the clinical features of primary TB?

A

mild often asymptomatic

41
Q

What are the histological features of primary TB?

A

Ghon’s complex

42
Q

What is a Ghon’s complex?

A

Ghon focus + involved hilar lymph node

43
Q

What is a Ghon’s focus?

A

Granuloma (aggregate of epithelioid macrophages + multinucleate macrophages) around caseous necrosis

44
Q

What causes the granuloma?

A

A type IV hypersensitivity response where monocytes under the influence of IGNgamma become epithelioid macrophages

45
Q

How does primary TB resolve?

A

The immune response controls the infection and the Gohn complex heals by fibrosis, often with some calcification

46
Q

What is secondary TB?

A

The reactivation of a dormant infection or a reinfection

47
Q

What area of the lung does secondary TB effect?

A

Lobar pneumonia involving the upper lobe

48
Q

What macroscopic features are seen in secondary TB?

A

casseous necrosis, fibrosis, calcification, cavitation (where caseation erodes into a bronchus)

49
Q

What are the complications of secondary TB?

A

Spread into surrounding lung, erosion of blood vessels, erosion into bronchial tree causing spread, pleural inflammation and fibrosis, lung scarring

50
Q

How is TB spread from person to person?

A

infected aerosolised droplets

51
Q

What are the clinical features of secondary TB?

A

weight loss, malaise, fevers, night sweats, haemoptysis, dyspnoea and chronic cough

52
Q

What are the features of mycobacterium tuberculosis?

A

aerobic rods with an acid fast wall - detected by ZN stain

53
Q

How does TB spread around the body?

A

Via lymphatics to pleura or to the opposite lung, via the bronchial tree - can be coughed up into larynx and swallowed and become intestinal - or can spread via the blood stream to other organs

54
Q

What is miliary TB?

A

progressive tuberculosis caused by spread through the blood stream where multiple organs are involved - macroscopically you see numerous small white granulomas in the organs

55
Q

What is single organ TB?

A

Where a single organ is infected in primary TB but lies dormant and then when becomes activated has effect on only one organ e.g. Potts disease in the spine

Respiratory (31 decks)

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