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Pulmonary - Matt > pathoma - pulm infections > Flashcards

pathoma - pulm infections Flashcards

1
Q

pneumonia

A

infection of lung parenchyma

occurs when normal defenses are impared (coughing, mucocilliary elevator

features: fever and chills, cough with yellow green or rusty sputum, tachypnea with pleuritic chest pain (when you breath in you streach pleura and pleura is infected so it hurts), decreased breath sounds with dullness to percussion (replaced air with exudate from infalamation), elevated WBC count

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2
Q

three patterns of pneumonia on CXR

A
  • lobar pneumonia - usually bacterial
  • bronchopneumonia - usually bacterial
    • runs along small airways - patchy pattern
  • interstitial pneumonia - viral normally
    • no consolidation but inflamation of interstitum of lung - increase in lung markings (the lines are more vissable)
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3
Q

lobar pneumonia

A

takes over entire lobe

most common cuase = strep pneumonia and Klebsiella (old person or a drunk) pneumoniae

four classic phases

  • congestion
  • red hepatization - develop exudate in lung - fills alveolar airsacs and gives spoungy look - red from RBCs
  • grey hepatization - RBCs are broken down
  • resolution - resolve exudate and regeneration of the lung tissue in airsacs (type 2 cells are the stem cells for this)
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4
Q

Bronchopneumonia

A
  • scattered patchy consolidation centered around bronchioles
  • often multifocal - can see multiple parts in CXR and is often bilateral
  • caused by a variety of bacteria
    • staphylococcus aureus
    • Haemophilus infuenzae
    • pseudomonas aeruginosa
    • moraxella catarrhalis
    • legionella pneumophilia
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5
Q

legionella pneumophilia

A

legionella pneumophilia - community aquired pneumonia, superimposed on COPD or pneumonia in immunocomped states

can also cause upper resp infection

transmitted by water sources

best visuallized by silver stain - if you suspect you have to tell the lab to use the stain

  • big in airconditioner workers
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6
Q

moraxella catarrhalis

A

moraxella catarrhalis - community acquired (bacterial) pneumonia and pneumonia superimposed by COPD

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7
Q

pseudomonas aeruginosa

A

pseudomonas aeruginosa - commonly seen in CF patients

most common cuase of hospital acquired infections

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8
Q

Haemophilus infuenzae

A

Haemophilus infuenzae - common cuase of secondary pneumonia and pneumonia superimposed by COPD

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9
Q

staphylococcus aureus

A

staphylococcus aureus - most common cuase of secondary pneumonia (superimposed by viral infection that knocks out the mucocilliary elevator and leads to further bacterial infections) - often complecated by abscesses or empyema (pus in alveolar space)

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10
Q

Interstitial (atypical) pneumonia

A
  • diffuse interstitial infiltrates (interstitum = connective tissue of the alveolar airsacs)
  • Atypical in that it doestn present how you would expect a pneumonia to present - relatively mild upper resp symptoms (min sputum, cough and low fever)
  • histologically = airsacs are empty (no exudate) but inflam cells in the interstitum
  • Caused by
    • Mycoplasma pneumoniae
    • chlamydia pneumoniae
    • respiratory syncytial virus (RSV)
    • cytomegalovirus (CMV)
    • influenza virus
    • coxiella burnetii
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11
Q

mycoplasma pneumoniae

A

most common cuase of atypical pneumonia

usually affects young adults (classically millitary recruits or college students living in dorm)

complications: autoimmune hemolytic anemia (IgM against I antigen on RBCs cuases cold hemolytic anemia) and erythema multiforme

not visible on gram stain due to lack of cell wall

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12
Q

Chlamydia pneumoniae

A

second most common cuase of atypical pneumonia in young adults

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13
Q

respiratory syncytial virus (RSV)

A

most common cuase of atypical pneumonia in infants

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14
Q

cytomegalovirus (CMV)

A

most common cuase of atypical pneumonia in posttransplant immunosuppressive therapy

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15
Q

influenza virus

A

atypical pneumonia in the elderly, immunocompromised, and those with preexisting lung disease

also increases risk for superimposed S aureusor H influenzae bacterial pneumonia (in flu patients the flu doesnt kill them it just weakens the defenses and a bacterial infection kills them)

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16
Q

coxiela burnetii

A

atypical pneumonia with high fever (Q fever) -> abnormal because atypical pneu usually have a low fever

seen in farmers and vets (the spores are deposited on cattle by ticks or present in cattel placentas)

it is a rickettsial organism but has unique characteristics

  • causes pneumonia (not normal for rickettsial)
  • doesnt require an arthropod vector (survives as a heat resistant spore)
  • doesnt produce a rash
17
Q

aspiration pneumonia

A

seen in patients at risk for aspiration (eg alcoholics and comatose patients)

due to anaerobic bacteria in the oropharynx (bacteroides, fusobacterium and peptococcus)

classically results in right lower lobe abscess - anatomically makes sense because things are more likely to go down the right bronchi

18
Q

tuberculosis

A

inhilation of aerosolized mycobacterium tuburculosis

  • when patient gets exposed they get primary TB
    • resulsts in focal caseating necrosis in the lower lobe of the lung and hilar lymph nodes
    • foci undergo fibrosis and calcification forming Ghon complex (shows that the person has been exposed to primary TB)
    • primary TB is generally asymptomatic but leads to positive PPD
  • secondary TB - reactivaton of the ghon complex
    • commonly seen with AIDS but may also be seen with aging
    • occurs at the apex of the lung
    • forms cavitary foci of caseaous necrosis; may also lead to miliary pulm TP or tuberculos bronchopneumonia
    • clinical features: fevers and night sweats, cough with hemoptysis, weight loss, biopsy reveals caseating granulomas, AFB stain reveals red acid fast bacilli
  • can spread to other places
    • can involve any tissue
    • meninges (meningitis) - granulomas at base of the brain
    • cervical lymph nodes
    • kidney (sterile pyuria) - most commonly found
    • lumbar vetebrae (pott disease)
19
Q

Lobar pneumonia: cause

A

-congestion: Active hyperemia, few Nphil-Red hep: nphils present and fibrin, lung feels liver like-grey hep: fibrin cell death-resolution

20
Q

Lobar pneumonia: Strep Pneumonia

A

-Strep pneumonia: most often the cause, especially in AA, penicillin treats it-gram positive lancet shaped rods-pneumovax and prevnar (for kids) are vaccines- fibrin pyrulent exudate

21
Q

Lobar pneumonia: Klebsiella

A

-most frequent cuase of gram neg-aspired in old people and drunks / malnourished-forms an abcess- thick blood tinged sputum

22
Q

Lobar: staph aureus

A

-microabscess/ empyema-IV drug user-Most common secondary infection- plays role in hospital acquired pneu

23
Q

Lobar: Haemophilus influenezae

A

-gram negative-common in kids, -Exacerbates COPD (second is Moraxells Catarrhalis)

24
Q

Lobar: Pseudomonas aerguinosa

A

gram -common in CF patients

25
Q

TB: histo

A

Ghon complex granuloma (complex of M*)-caseating granulomaPrimary progressive: in kidsSecondary: reactivated (miliary)

26
Q

Atypical pneumonia: cause

A

-Mycoplasm infection of alveolar-Moderate sputum, no consolidation-especially in college or in military-ground glass

27
Q

P. jirovecci

A

Replicated in human lung-goblet shaped cell-GMS stain for chain structures-Attacks immunocomp-Treat with bactrim

28
Q

Aspergillus

A

Allergic aspergillos: allergy in asthmaticsAaspergilloma: non invasive fungus ball occupies the sinusInvasive aspergillosis: wedge Infarcted lung. (Or PE)Can cause hemoptysis

29
Q

Legionella pneumophilia

A
  • found in aquatic envionrments (water cooling towers…) either aerosolized or inhaled while drinking- common in predisposed individuals (cardiac, renal, immunologic, hematologic diseas)- organ transplants are susceptable
30
Q

mycoplasma pneumoniae

A
  • common in children and young adults- occur in closed communities (schools, military camps, prisons)

Pulmonary - Matt (47 decks)

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