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Pulmonology - OMS 2 > Pulmonary Infections - Pathology > Flashcards

Pulmonary Infections - Pathology Flashcards

1
Q

Systemic factors that predispose to pneumonia

A
  1. immune deficiency or supression
  2. leukopenia
  3. chronic illness
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2
Q

Local factors that predispose to pneumonia

A
  1. loss of cough reflex/impaired mucociliary apparatus
  2. interference w/phagocytic or bactericidal action of alveolar MF
  3. pulmonary congestion/edema
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3
Q

MC cause of community-acquired acute pneumonia

A

S. pneumoniae

(gram stain for dx; usually lobar)

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4
Q

Which type of pneumonia causes lobar pneumonia?

A

community-acquired (s. pneumoniae)

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5
Q

Difference between lobar and bronchopneumonia?

A

broncho: affects alveoli near bronchi
lobar: entire lobe

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6
Q
A

foci of consolidation (lung exudate) = bronchopneumonia

right: lobar pneumonia exhibits gray hepatization (firm like liver)
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7
Q

In lobar pneumonia, what are the four stages of the inflammatory response?

A
  1. congestion
  2. red hepatization
  3. gray hepatization
  4. resolution
gray hepatization
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8
Q

describe the congestion phase of lobar pneumonia

A

vascular engorgement, intra-alveolar fluid, neutrophils, bacteria present

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9
Q

Describe the red hepatization phase of lobar pneumonia

A
  1. massive exudation with neutrophils
  2. red cells
  3. fibrin filling alveolar spaces

lobe appears red, firm, and airless

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10
Q

Describe the gray hepatization phase of lobar pneumonia

A
  1. progressive disintegration of red cells
  2. persistence of a fibrinosuppurative exudate

appears grayish & dry

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11
Q

Describe the resolution phase of lobar pneumonia.

A

consolidated exudate undergoes enzymatic digestion –> produces granular, semifluid debris that is resorbed, ingested by MF or expectorated

pulmonary architecture restored. some –> organized pneumonia w/fibrous

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12
Q

Dx? Why?

A
  • acute bacterial pneumonia
  • large # neutrophils in alveoli
  • purulent exudate in alveoli
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13
Q

Difference in xray findings between broncho and lobar pneumonia

A
  • lobar: radiopaque
  • broncho: focal opacities
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14
Q

bacterial pneumonia vs. viral pneumonia presentation.

both have fever

A

bacterial: shaking chills, cough w/mucopurulent sputum
viral: myalgia, headache

(acute/community-acquired)

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15
Q

How long does it take a patient to recover from acute bacterial pneumonia once treated?

A

2-3 days

(10% of hospitalized pts die)

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16
Q

MC causes of viral pneumonia (5)

A
  1. Flu
  2. rhinoviruses
  3. RSV
  4. SARS-CoV-2
  5. Human metapneumovirus
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17
Q

How does SARS-CoV-2 enter epithelial cells

A

ACE2 receptor of alveolar epithelial cells

the reason its a lung disease

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18
Q

3 types (morphologies) of viral community-acquired pneumonia

A
  1. laryngotracheobronchitis
  2. bronchiolitis
  3. interstitial pneumonia

(location based)

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19
Q

Adult pneumonia is typically caused by which viruses?

A
  1. flu
  2. rhinovirus
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20
Q

Pediatric pneumonia is typically caused by which viruses?

A

RSV

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21
Q

In interstitial pneumonia, alveolar septa become thickened with _______ infiltrate.

A

mononuclear

22
Q

What is this? Why?

A
  1. intersitital pneumonia
  2. lymphocytes
  3. exudate
  4. hyaline membranes (diffuse alveolar damage –> ARDS)

(this is the usual cause of death in COVID patients)

23
Q

2 common complications of aspiration pneumonia

A

necrosis –> lung abscess

high mortality

24
Q

define lung abscess

A
  1. neutrophils
  2. necrosis
25
Q

5 Causes of lung abscess

A
  1. aspiration
  2. antecedent pneumonia (necrosis)
  3. septic emboli (phlebits or endocarditis)
  4. neoplasia
  5. penetration injury
26
Q

Which 3 pathogens are responsible for 60% of lung abscess?

A
  1. bacteroides
  2. fusobacterium
  3. peptococcus

(usually from aspiration)

27
Q
A

lung abscess

neutorphils + exudate

28
Q

MC signs of lung abscess

A

copious amt of foul-smelling sputum

CP &. weight loss

29
Q

4 complications of lung abscess

A
  1. empyema
  2. hemoptysis
  3. meningitits
  4. brain abscess
30
Q

Chronic pneumonia inflammatory reaction involves _________.

A

granuloma

31
Q

MC pathogen involved in chronic pneumonia (3)

A
  1. M. tuberculosis
  2. H. capsulatum
  3. C. immitus
32
Q

% of TB infection that progresses to primary TB

A

5

33
Q

isolated tb

A

dissemination to one organ

ex: kidneys

34
Q

What is happening during the 3 weeks of infection with Tb, before cell-mediated immunity begins?

A

MF take up TB but are not activated –> proliferation –> bacteremia & seeding

35
Q

Describe the initiation of cell-mediated immunity in tuberculosis infection.

A

Alveolar MF presents to T-cell via IL-12 & MHC II –> differentiation to TH1 –> activated MF –> TNF, chemokines –> monocyte recruitement & casseous necrosis

very similair to histoplasmosis pathogenesis

36
Q
A

ghon complex

yellow = hilar nodes
blue = casseating granuloma in parenchyma

37
Q
A

caseating granuloma

yellow = caseating necrosis
blue = langhans giant cell

38
Q

how are langhans giant cells formed

A

activation & fusion of activated MF

T-cell mediated response = langhans

blue arrow
39
Q

What is this? why?

A
  1. secondary tb
  2. cavitation (cassceation coalesce)
40
Q
A

acid-fast bacili smear = TB

41
Q
A

miliary disseasae

spleen

42
Q

What is predominate cell type in caseating granulomas?

A

activated MF

aka epitheliod MF due to increased cytosol which looks like epithelial c

43
Q

What are the similairities between TB and histoplasmosis (2)?

A
  1. primary & secondary disease
  2. can disseminate to other organs
44
Q

Dx? Why?

A
  1. Histoplasmosis
  2. “Tree bark” appearance due concentric layers of fibrosis and calcifications
45
Q

Dx? Why?

A
  • Histoplasmosis
  • pair shaped budding yeast w/narrow base
46
Q

Histoplasmosis is very similair to TB pathogenesis, what is the difference?

A

mainly that histoplasmosis is a fungi, both are taken in by MF, multiply and lyse MF –> entry into blood –> T cells then activate and recruit MF via INF-g –> caseating granuloma

47
Q

How is histoplasmosis dx (2)?

A
  1. culture yeast
  2. serologic testing (Ab & Ag)
48
Q

only 10% of ppl w/San Joaquin Valley Fever develop symptoms. What are the sx (3)?

A
  1. lung lesion
  2. pleuritic pain
  3. cutaneous lesions

(fever & cough)

49
Q

Cutaneous involvment in coccidioidomycosis (2)

A
  1. erythema nodosum
  2. erythema multiforme

(only 1% will develop disseminated C. immitis )

50
Q

Dx? Why?

A
  • bronchopneumona
  • spheroles (C. immitus)

will develop caseating granuloma (below)

51
Q
A

spheroles containing endospores

52
Q

Histoplasmosis is endemic to which area?

A

ohio & mississippi river valleys

Pulmonology - OMS 2 (28 decks)

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