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CRRAB II Week 7 - WLB > Pulmonary Infections - Pathoma > Flashcards

Pulmonary Infections - Pathoma Flashcards

1
Q

What is the definition of pneumonia?

A

Infection of the lung parenchyma

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2
Q

When does pneumonia occur?

A

The normal defenses are impaired (e.g. cough reflex, damage to the mucociliary elevator)

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3
Q

What are the clinical features of pneumonia?

A
  • Fever & chills
  • Cough with yellow-green (pus) or rusty sputum (blood)
  • Tachypnea with pleuritic chest pain (bradykinin and PGE2)
  • Decreased breath sounds with dullness to percussion
  • Elevated WBC count
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4
Q

What diagnostic tests help diagnose pneumonia?

A
  • chest x-ray
  • sputum gram stain and culture
  • blood culture
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5
Q

What are the three patterns classically seen on chest x-ray in pneumonia?

A

1) Lobar pneumonia
2) Bronchopneumonia
3) Interstitial pneumonia (atypical pneumonia)

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6
Q

What is lobar pneumonia?

A
  • Consolidation of entire lobe
  • Usually bacterial
  • Most common causes are: S pneumoniae (95%) and Klebsiella pneumoniae
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7
Q

What pathogen causes the majority of cases of community acquired pneumonia usually seen in middle-age and elderly adults?

A

Streptococcus pneumoniae

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8
Q

What organism affects malnourished and debilitated individuals, especially elderly nursing homes, alcoholics, diabetics, and people at increased risk for aspiration?

A

Klebsiella pneumoniae

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9
Q

What pneumonia-causing pathogen has a thick mucoid capsule that results in gelatinous sputum (currant jelly) and is often complicated by abscess?

A

Klebsiella pneumoniae

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10
Q

What are the four classic phases of lobar pneumonia?

A
  1. Congestion
  2. Red hepatization (exudate in the lungs containing PMNs & blood)
  3. Gray hepatization
  4. Resolution (regenerate tissue by type II pneumocyte)
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11
Q

What is bronchopneumonia?

A

Scattered, patchy consolidation centered around bronchioles; often multifocal and bilateral

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12
Q

What organism is the most common cause of secondary pneumonia (bacterial pneumonia superimposed on a viral upper respiratory tract infection)?

A

Staphylococcus aureus

often complicated by abscess or empyema

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13
Q

What is empyema

A

Pus in the pleural space

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14
Q

What organism is a common cause of secondary pneumonia and pneumonia superimposed on COPD (leads to exacerbation of COPD)?

A

Haemophilus influenzae

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15
Q

What pathogen commonly causes pneumonia in cystic fibrosis patients?

A

Pseudomonas aeruginosa

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16
Q

What organism is a common cause of community-acquired pneumonia and pneumonia superimposed on COPD (leads to exacerbation of COPD)?

A

Moraxella catarrhalis

17
Q

What organism is a common cause of community-acquired pneumonia, pneumonia superimposed on COPD, or pneumonia in immunocompromised states, and is transmitted from water sources?

A 
Legionella pneumophila
(intracellular organsims that is best visualized by silver stain)
18
Q

What is interstitial (atypical) pneumonia? How does it present?

A
  • Diffuse interstitial infiltrates

- Presents with relatively mild upper respiratory symptoms (minimal cough, minimal sputum, and low fever)

19
Q

What pathogen is the most common cause of atypical pneumonia, usually affects young adults (classically military recruits or college students living in a dormitory)?

A

Mycoplasma pneumoniae

20
Q

What pathogen is not visible on gram stain due to lack of cell wall and often causes complications including autoimmune hemolytic anemia (Igm against I antigen on RBCs causing cold hemolytic anemia) and erythema multiforme?

A

Mycoplasma pneumoniae

21
Q

What pathogen is the second most common cause of atypical pneumonia in young adults?

A

Chlamydia pneumoniae

22
Q

What pathogen is the most common cause of atypical pneumonia in infants?

A

Respiratory Syncitial Virus

23
Q

What pathogen causes atypical pneumonia in patients with post-transplant immunosuppressive therapy?

A

Cytomegalovirus (CMV)

24
Q

What pathogen causes atypical pneumonia in the elderly, immunocompromised, and those with preexisting lung disease?

A

Influenza virus

also increases the risk for superimposed S. aureus or H. influenzae bacterial pneumonia

25
Q

What pathogen causes atypical pneumonia with HIGH fever (Q fever) that is seen in farmers and veterinarians?

A

Coxiella burneti

Coxiella spores are deposited on cattle by ticks or are present in cattle placentas.

26
Q

How is Coxiella different from Rickettsia?

A

Coxiella is a rickettsial organism, but it is distinct from most rickettsiae because it:

1) causes pneumonia
2) does not require arthropod vector for transmission (survives as highly heat-resistant endospores)
3) does not produce a skin rash

27
Q

What type of patients get aspiration pneumonia?

A

Alcoholics, comatose patients

28
Q

What type of bateria causes aspiration pneumonia?

A

Anaerobic bacteria in the oropharynx

e.g. Bacteroides, Fusobacterium, and Peptococcus

29
Q

What does aspiration pneumonia classically result in?

A

right lower lobe abscess

30
Q

What occurs pathologically after initial exposure of aerosolized Mycobacterium tuberculosis?

A
  • Focal caseating necrosis in the lower lobe of lung and hilar lymph nodes
  • Foci undergo fibrosis and calcification forming Ghon complex (subpleural fibrosed/calcified lung nodule)
31
Q

What are the symptoms of Primary TB?

A

Primary TB is generally asymptomatic!

-but will still lead to postive PPD test

32
Q

What occurs pathologically in Secondary TB?

A

Reactivation of TB:

  • forms cavitary foci of caseous necrosis at apex of lung
  • may also lead to miliary pulmonary TB or tuberculous bronchopneumonia
33
Q

What are the clinical features of TB?

A
  • Fevers and night sweats
  • Cough and hemoptysis
  • Weight loss
34
Q

What does biopsy reveal in TB?

A

-Caseating granulomas

35
Q

Where does TB have the potential to spread to?

A
  • Can involve any tissue!
  • Meninges (meningitis at base of brain)
  • Cervical lymph nodes
  • Kidney (sterile pyuria)
  • Lumbar vertebrae (Pott disease)

CRRAB II Week 7 - WLB (12 decks)

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