Pneumonia

Question 1

The infection of lung parenchyma

Answer 1

Pneumonia

Question 2

Pneumonia is the infection of what?

Answer 2

Lung parenchyma

Question 3

The pathogenesis of pneumonia

Answer 3

Microbial organisms overwhelm antimicrobial defence mechanisms

Question 4

how does the impaired local defence mechanisms leads to pneumonia

Answer 4

Impaired local defence mechanisms:
*
Loss/suppression of cough reflex predisposing to aspiration of gastric contents;
*
Dysfunctional mucociliary apparatus e.G. Due to smoking; accumulation of secretions e.G. Bronchiectasis.
*
Interference with phagocytic and bactericidal activities of alveolar macrophages e.G. Due to alcohol, tobacco smoke;
*
Pulmonary congestion and oedema

Question 5

How does the lowered systemic host resistance lead to pneumonia

Answer 5

Lowered systemic host resistance:
Chronic diseases, immunologic deficiencies,
immunosuppressive agents, leukopenia
* Classification: according to aetiologic agent or clinical setting if no pathogen is isolated (which
provides a guide for empiric antimicrobial therapy)

Question 6

How is pneumonia classified?

Answer 6

Accordingto aetiology agent or clinical setting if no pathogen is isolated (which provide a guide for empiric antimicrobial therapy)

Question 7

name the organisms that causes CAP

Answer 7

Streptococcus pneumonia (most common)
Haemophilus influenzae (children, also acute exacerbation of copd)
Mycoplasma pneumoniae (children, young adults)
Viruses, influenza, respiratory syncytial virus

Question 8

list the microorganisms that causes the HCAP

Answer 8

Staphylococcus aereus (methicillin sensitive (MSSA), methicillin resistance (MRSA)
Pseudomonas aeruginosa
Streptococcus pneumoniae

Question 9

List organisms that causes HAP

Answer 9

GRAM NEGATIVE RODS: enterobacteriacease (e.g klebsiella spp), pseudomonas spp
Gram positive rods:
Staphylococcus aureus (usually MRSA)

Question 10

Acquired during a hospital stay
Name that pneumonia

Answer 10

HAP

Question 11

what are the risk factors of HAP

Answer 11

severe underlying disease, immunosuppression, prolonged antibiotic therapy, invasive access device, mechanical ventilation
Often serios and life threatning

Question 12

List the risk factors of HCAP

Answer 12

Hospitalization of at least 2 days within the recent past, nursing home/long term care resident, recent attendance of a hospital.hemodialysis clinic, recent IV antibiotics, chemotherapy or wound care, higher mortality than CAP

Question 13

Mild but can have complications that lead to morbidity and mortality
Name that pneumonia under CAP

Answer 13

Viral pneumonia

Question 14

The bacterial infection is seen by what in CAP

Answer 14

Often follows upper respiratory tract viral infection, often presents with high fever, chills and productive cough

Question 15

Lung infection in otherwise healthy individuals acquired from the normal environment
name that type of pneumonia

Answer 15

CAP

Question 16

name the organisms causing aspiration pneumonia

Answer 16

Anaerbic oral flora admixed with aerobic bacteria

Question 17

List the risk factors of aspiration pneumonia

Answer 17

Abnormal gag and swallowing reflex, e.g in debilated patients or those who aspirate gastric contents while unconscious or during repeated vomiting

Question 18

aspiration pneumonia is caused by what?

Answer 18

Combination of chemical (gastric acid) and bacterial pneumonia with high mortality or resulting lung asbcess

Question 19

List organisms that causes chronic pneumonia

Answer 19

Nocardia, actinomyces graunlomaous: mycobacterium tuberculosis, atypical mycobacyeria, histoplasma capsulatum

Question 20

the chronic pneumonia usually affect which group of people

Answer 20

Usually in immunocompetent patients, with the organism ofte resulting in a granulomatous rection

Question 21

List organisms that causes necrotizing pneumonia and lung abscess

Answer 21

Anaerobic bacteria staphylcoccus aureus, klebsiella pneumonia

Question 22

List organisms that are associted with causation of pneumonia in immunicomoprised host

Answer 22

cytomegalovirus
Pneumocystic jirovecii
Mycobacterium avium
Intracellulare complex (MAC)
Invasive aspergillosis/candiadis

Question 23

List the compications of pneumonia

Answer 23

Abscess formation (especially in pneumococcal or klebsiella infections),

Empyema

Systemic bacteraemic dissemination (e.g. to heart valves, brain, joints causing septic endocarditis, meningitis, arthritis etc.)

Question 24

differentiate between viral and bacterial pneumonia

Answer 24

o Viral pneumonia:Predominantly interstitial inflammation (usually lymphocytic – sometimes
referred to as “atypical pneumonia”) and interstitial oedema; when complicated by ARDS,
may also show changes of diffuse alveolar damage
o Bacterial pneumonia: usually has 2 patterns based on anatomic distributiono Bronchopneumonia and lobar pneumonia, but often overlap. The same organisms can produce either pattern, depending on host factors

Question 25

Looking under bacterial pneumonia microscopy
The alveolar exudates composed of what?

Answer 25

Neutrophils

Question 26

Under bacterial pneumonia microscopic appearance, the surrounding alveolar walls appearance

Answer 26

The surrounding alveolar walls (decreased) have congested capillaries (dilated and filled with red blood cells)

Question 27

The exudates process is typical for whihc infection

Answer 27

bacterial infection

Question 28

The exudate usually gives rise to what?

Answer 28

The exudate gives rise to a productive cough of purulent yellow sputum often seen with bacterial pneumonias.

Question 29

explain on alveolar archictecture

Answer 29

The alveolar architecture is still maintained, so even an extensive pneumonia often resolves with minimal residual destruction or damage to the pulmonary parenchyma

Question 30

explain the Bronchopneumonia

Answer 30

Patchy lung consolidation that is frequently bilateral and often basal.
Consolidated areas of acute suppurative inflammation that fills the bronchi, bronchioles and adjacent alveolar spaces

Question 31

explain the bronchopneumonia microscopic appearance

Answer 31

the alveoli are filled with a neutrophilic exudate that corresponds to the areas of grossly apparent consolidation with bronchopneumonia.

Question 32

Consolidation of a large portion / entire lobe. The consolidated areas may match the distribution pattern of lung lobules— Give the name

Answer 32

Lobar pneumonia

Question 33

List 4 classic stages of inflammatory response for lobar pneumonia
Do not explain

Answer 33

1. Congestion
2. Red hepatizarion
3. Gray hepatization
4. Resolution

Question 34

Heavy boggy red lung. Due to engorged vessels and intra-alveolar oedema containing few neutrophils; can have numerous bacteria
Sate whihc stage is this

Answer 34

Congestion

Question 35

Red, firm lung (resembles texture of liver). Extensive exudate (neutrophils, red cells, fibrin) in alveolar spaces
state which stage is this?

Answer 35

Red hepatization

Question 36

Gray-brown colour. Disintegration of red cells but persistence of fibrinopurulent exudate
Which stage is this?

Answer 36

Gray hepatization

Question 37

Breaking down of intra-alveolar exudate that is resorbed, ingested by macrophages, expectorated or organized by fibroblasts
which stage is this?

Answer 37

Resolution

Question 38

any associated fibrinous pleuritis also?

Answer 38

resolves or leaves fribrous thickening/adhesion