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CPR Exam 2 > Pulmonary Pathology Part 4 > Flashcards

Pulmonary Pathology Part 4 Flashcards

1
Q

What are some facts about pneumonia?

A
  • Second most cause of hospital admissions
  • World’s leading cause of death in children <5 years old
  • Most common cause for sepsis and septic shock
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2
Q

How is pneumonia classified by clinical setting?

A
  • Community acquired (bacteria vs viral)
  • Health care associated pneumonia
  • Aspiration pneumonia
  • Chronic pneumonia
  • Pneumonia in the immunocompromised host
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3
Q

How is pneumonia classified by anatomic distribution?

A
  • Bronchopneumonia

- Lobar pneumonia

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4
Q

How is lobar pneumonia diagnosed?

A
  • Through characteristic radiographic appearance
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5
Q

What are the stages of lobar pneumonia?

A
  • Congestion (vascular engorgement)
  • Red hepatization (red cells and inflammation)
  • Grey hepatization (inflammation and debris)
  • Resolution (fibrosis and macrophage clean up)
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6
Q

What are some complications that can arise in lobar pneumonia?

A
  • Abscess
  • Empyema
  • Bacteremia
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7
Q

What are some community acquired bacteria that cause pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • K. pneumoniae
  • P. aeruginosa
  • L. pneumoniae
  • M. pneumoniae
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8
Q

Which bacteria is the most common cause of community acquired pneumonia?

A
  • Streptococcus pneumoniae
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9
Q

What are the vaccination requirements for strepococcus pneumoniae?

A
  • Recommended for infants and people >65

- Also in people that smoke or have respiratory disease

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10
Q

Where is H. influenzae caused pneumonia seen?

A
  • Virulent pneumonia in children
  • Recommended vaccination for type B for children >5
  • Patients will first have flu virus and then this will superimpose in host
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11
Q

Where is S. aureus pneumonia seen?

A
  • IV drug users

- Abscess formation

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12
Q

Where is K. pneumoniae pneumonia seen?

A
  • Alcoholics

- Will have a currant jelly sputum due to parenchymal bleeding

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13
Q

Where is P. aeruginosa pneumonia seen?

A
  • Seen often in cystic fibrosis patients
  • Can also been seen as opportunistic infection
  • May be hospital acquired
  • Look likes copper rust (green) when plated
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14
Q

What is the typical bacterial pneumonia presentation?

A
  • More abrupt onset
  • Respiratory symptoms predominate
  • Consolidation on CXR
  • Older adults or young children
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15
Q

What is the atypical (walking) pneumonia presentation?

A
  • Slower onset
  • Systemic symptoms predominate
  • Patchy infiltrates on CXR
  • In young adults/teens/older children
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16
Q

What bacteria causes typical pneumonia?

A
  • S. pneumoniae
  • H. influenzae
  • S. aureus
  • K. pneumoniae
  • P. aeruginosa
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17
Q

What bacteria causes atypical (walking) pneumonia?

A
  • Mycoplasma pneumoniae
  • Legionella pneumophila
  • Chlamydia pneumonia
  • Chlamydia psittaci
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18
Q

What is mycoplasma pneumoniae?

A
  • Smallest free-living, self replicating organism

- Has no cell wall

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19
Q

What is Legionella pneumophila?

A
  • Gram negative bacillis
  • Grows in warm freshwater
  • Airborne disease
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20
Q

Where can legionella pneumophila grow?

A
  • AC units
  • Misters
  • Hot tubs
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21
Q

What are some viral causes of community acquired pneumonia?

A
  • Influenze (H1N1)
  • SARS
  • COVID 19
  • Respiratory syncytial virus
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22
Q

What is the difference in spread between viruses and bacteria in pneumonia?

A
  • Bacteria spread in the alveolar spaces (wrecking ball)

- Viruses spread in the interstitium (through the walls)

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23
Q

How is the influenza virus classified?

A
  • By two proteins:
  • Hemagglutinin
  • Neuraminidase
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24
Q

What does hemagglutinin do?

A
  • Attaches to cells
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25
Q

What does neuraminidase do?

A
  • Allows release of replicated virus from cells
26
Q

What does tamiflu do to prevent the flu?

A
  • Prevents the action of neuraminidase which causes the viron to be stuck
27
Q

What is antigenic drift?

A
  • Minor changes to proteins on the virus, allowing increased spread
  • Similar enough to original virus to allow for some immunity in many individuals
  • Causes epidemics
28
Q

What is antigenic shift?

A
  • Genomic alterations with major resulting changes to protein structures
  • Naive immunity for almost all people
  • Picked up from animal gene products?
29
Q

What does COVID look like in regards to signaling molecules?

A
  • Looks like ARDS with the cytokine storm
30
Q

What is clinically seen in someone with COVID?

A
  • Congested lungs
  • Hyperemia on cut surfaces
  • Pleurisy
  • Lower extremity thrombus
  • Pulmonary embolus
31
Q

What is the cause of death in COVID?

A
  • Superimposed bacterial pneumonia
32
Q

What is elevated in COVID that could cause a serious issue?

A
  • Elevated D dimer correlates with the thrombotic complications
33
Q

What is COVID-19?

A
  • ssRNA virus
  • Spread via respiratory droplet
  • Induces “cytokine” storm
  • Coagulopathy
34
Q

What bacterial pneumonia is seen in neonates?

A
  • Group B strep
  • Gram negative bacilli
  • Listeria
35
Q

What viral pneumonia is seen in children <1 month?

A
  • Respiratory syncytial virus
  • Parainfluenza virus
  • Influenza A and B
  • Adenovirus
  • Rhinovirus
36
Q

What bacterial pneumonia is seen in children >1 month?

A
  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis
  • S. aureus
37
Q

What pneumonia is seen in older children/adolescents?

A
  • Same as younger children
  • M. pneumoniae
  • C. pneumoniae
38
Q

What is respiratory syncytial virus?

A
  • Paramyxovirus
39
Q

What are the symptoms of respiratory syncytial virus?

A
  • Symptoms of rhinorrhea and cough
  • Wheezing and dyspnea
  • Tachypnea
  • Cyanosis
40
Q

What are some specific paramyxoviridae viruses?

A
  • RSV
  • human Metapneumovirus
  • Parainfluenza
  • Measles
41
Q

What are some illnesses that have had a decline in vaccinations recently?

A
  • Measles
  • Pertussis
  • Diphtheria
42
Q

What is the general presentation for bacterial pneumonia?

A
  • Abrupt onset
  • Not associated with epidemics
  • May have associated bacteremia
  • High grade fever
  • Crackles on lung exam
  • Lobar or consolidated appearance
  • May involve pleura
  • Responds quickly to antibiotics
43
Q

What is the general presentation for viral pneumonia?

A
  • Gradual onset
  • Epidemics are common
  • Not typically associated with viremia
  • No fever or low grade fevers
  • Diffuse infiltrates on CXR
  • Will not typically involve pleura
  • Will not responsed to antibiotics but usually self limiting
44
Q

What can cause a lung abscess?

A
  • Complications of pneumonia

- Aspiration

45
Q

What bacterial pneumonia can cause a lung abscess?

A
  • S. aureus

- K. pneumoniae

46
Q

Who typically has lung abscesses due to aspiration?

A
  • Chronic alcoholics
  • Elderly patients
  • Anaerobic bacteria
47
Q

What side does aspirated material tend to go to? Why?

A
  • Tends to go to the right lung due to a steeper descent of the right main bronchus
48
Q

What happens in aspiration pneumonia?

A
  • Abscess formation in acute bacterial pneumonia

- Food particle in inflammatory exudate indicating aspiration

49
Q

What is the process of tuberculosis?

A
  • Primary infection causes a localized caseation

- Localized caseation can heal or progress to primary TB or become latent

50
Q

What can primary TB do?

A
  • Turn into miliary TB (massive hematogenous dissemination)

- Reinfection, turning into secondary TB

51
Q

What does secondary TB turn into?

A
  • Turns into progressive secondary TB
  • Then turns into miliary TB
  • OR could cause localized caseating destructive lesions
52
Q

What is specifically seen in TB?

A
  • Ghon complex
53
Q

What are some fungal sources of chronic pneumonia?

A
  • Histoplasma
  • Blastomycosis
  • Coccidioidomycosis
54
Q

What is histoplasma capsulatum?

A
  • Endemic in midwest and caribbean
  • Typically a subclinical infection with granulomatous response (coin lesions on CXR)
  • Can run aggressive course, especially in immunocompromised patients
55
Q

What is the characteristic form that is seen on morphology of histoplasma?

A
  • Pumpkin seed
56
Q

What is blastomyces dermatitides?

A
  • Endemic in central and SE US
  • In the lungs, infection yields a granulomatous response
  • Characteristic yeast forms show broad-based budding
  • Can also infect skin and rarely, disseminated infection
57
Q

What is coccidiodes immitis?

A
  • Endemic in southwestern US and Mexico
  • In the lungs, yields a granulomatous response with eosinophils
  • Often a subclinical, self-limited disease
  • Can produce disseminated infection (immunocompromised patients)
58
Q

What is pneumocystis jiroveci?

A
  • Opportunistic fungal infection
  • AIDS-defining illness
  • Characteristic cup shaped yeast forms
  • Can be diffuse or focal
59
Q

What is mycobacterium avium complex (MAC)?

A
  • Found in immunocompromised or elderly patients

- Thin mycobacteria seen as slender red forms on acid-fast staining

60
Q

What is needed to discriminate from rejection?

A
  • Biopsies which can produce infiltrates and fever
61
Q

What does rejection show in lung transplantation?

A
  • Mononuclear infiltrates around vessels

CPR Exam 2 (12 decks)

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