Pulm Infectious Diseases (Handorf)

Question 1

Bacterial pneumonia and associated inflammation cause lung tissue to:

Answer 1

consolidate (firm to the touch)

Question 2

How does bronchopneumonia affect lung tissue? What does this suggest?

Answer 2

patchy consolidation

suggests distribution from terminal bronchioles

Question 3

Most common pathogen causing bronchopneumonia:

Answer 3

Streptococcus pneumoniae

Question 4

How does lobar pneumonia affect lung tissue? What are the stages of its progression?

Answer 4

consolidation of a whole lobe or a large part of a lobe

congestion, red hepatization, grey hepatization, resolution

Question 5

Under what conditions would you see lobar pneumonia?

Answer 5

virulent organism and/or compromised host

Question 6

Describe the histopathology of acute pneumonia.

Answer 6

congested septal capillaries

extensive neutrophil exudation into alveoli

Question 7

In early organizing pneumonia, what is seen microscopically?

Answer 7

intra-alveolar exudate streaming through pores of Kohn

Question 8

In advanced organizing pneumonia, what is seen microscopically?

Answer 8

exudate transformed to fibromyxoid masses

macrophages and fibroblasts present

Question 9

What stage does acute/early pneumonia correspond to? Advanced?

Answer 9

1. red hepatization

2. grey hepatization

Question 10

What is a classic sign of Klebsiella pneumonia in a patient?

Answer 10

Currant jelly sputum

blood and mucous

Question 11

How does Klebsiella pneumonia appear microscopically?

Answer 11

Large encapsulated “boxcar” Gram-negative rods

Question 12

Lung scarring after infection relates to:

Answer 12

severity

organism (viral more likely to scar than bac)

Question 13

In acute bacterial pneumonia, what causes hypoxia?

Answer 13

polys in alveoli

Question 14

Describe primary atypical pneumonia.

What organism is usually responsible?

Answer 14

acute febrile respiratory illness with patchy lung inflammation, primarily septal/interstitial

Mycoplasma pneumoniae

Question 15

When death occurs in viral pneumonia, it usually does so due to:

Answer 15

superimposed (bacterial) infection

Question 16

Pulmonary fungal infections are primarily caused by what 2 organisms?
How do these appear microscopically?

Answer 16

histoplasmosis (crowded into histiocytes)

blastomycosis (broad based budding yeast; “snowman”)

Question 17

Who is more at risk of TB infection?

Answer 17

males
economically disadvantaged
inner city residents
alcoholics
drug abusers 
recent immigrants

Question 18

Describe:
primary phase TB infections
secondary phase TB infections
progressive phase TB infections

Answer 18

Ghon complex; usually clinically inapparent

reactivation; apical consolidation and granuloma

associated with cavitary fibrocaseous TB, miliary TB or TB bronchopneumonia

Question 19

Where are TB infections typically localized?

Answer 19

apices (more O)

Question 20

How do TB infections spread within the lungs?

Answer 20

from periphery to hilum

Question 21

Miliary TB is associated with:

Answer 21

massive hematogenous dissemination (spleen, lung, brain, etc) and MOF

Question 22

TB is associated with what type of lesion?

Answer 22

caseating

Question 23

Describe a pulmonary abscess

Answer 23

A local suppurative process within the lung characterized by necrosis of lung tissue

Question 24

How do pulmonary abscesses present clinically?

Answer 24

Clinical “chronic pneumonia” with cough, fever, weight loss, copious foul smelling sputum

Question 25

Causes of pulmonary abscess?

Answer 25

Aspiration—alcoholism, anesthesia
Antecedent acute pneumonia
Septic embolism
Neoplasm—”postobstructive pneumonitis”
Miscellaneous—direct spread from adjacent organ

Question 26

Common immune suppression related pulmonary infections include:

Answer 26

pneumocystis, histoplasmosis, Aspergillus and tuberculosis

Question 27

Histopath associated with Pneumocystis:

Answer 27

fluffy looking intraalveolar exudate

organisms look like “deflated soccer balls”

Question 28

How does Aspergillus affect lung tissue?

Answer 28

angioinvasive: propensity to infarct surrounding tissues by growing into and occluding vessel lumens

may form “fungus ball”