Respiratory Exam 3 Flashcards
What are the three types of pneumonia?
Acute Pneumonia - usually pyogenic bacteria, neutrophils
Pneumoitis - “atypical pneumonia” non pyogenic (viral or mycoplasmal)
Chronic Pneumonia - Often TB, fungi, parasites, odd bacteria
What are the two top Community Acquired Pneumonia bacteria?
S. Pneumonia
Hemophilus Influenza
What are predisposing factors to CAP?
Age extremes, chronic disease, immuno deficiencies, decreased splenic function
When is a common time to get a bacterial pneumonia?
AFTER a viral infection. immune down
Where does pneumonia originate?
Lower lobes of right middle lobe
What are the two overlapping morphologic patterns of bacterial pneumonia?
Lobar and Bronchopneumonia
What are common manifestations of bacterial pneumonia?
Fever, chills, productive cough, Pleuritic chest pain, tachycardia, tachypnea
Describe Bronchopneumonia
Patchy, exudative consolidation of lung, specifically in airspaces and airways around bronchioles and bronchi
Describe Lobar Pneumonia
Large portion or entire lobe consolidated. 90-95% S. Pneumo
Describe progression of Lobar Pneumonia
Congestion: Heavy and congested lungs, vasc. engorged
Red Hepatization: Exudation of RBCs/fibrin
Gray Hepatization: RBCs break down, exudate remains
Resolution: Consolidation eaten up
What are indications for hospitalization for CAP?
Severe dyspnea, hypoxemia, empyema, extrapulmonary foci, signif. underlying disease, Mental problems
Describe Community Acquired Atypical Pneumonia
Lack of alveolar exudate, dry cough, cold like symptoms, interstitial pneumonitis, patchy inflammatory disease
What is the pathogenic mechanism of atypical pneumonia
Binds to epithelium, necrosis of cells, inflammatory response, predisposes to secondary bacterial infection, severe cases can progress to ARDS
What are two granulomatous diseases?
Sarcoidosis and Hypersensitivity Pneumonitis
Describe Sarcoidosis disease process
Increased CD4+ TH1 cells, increased IL-2 and IFN g, Increased macrophages, Increased IL-8 and TNF, which causes non caseating granulomas, leading to interstitial fibrosis and honeycomb lung. Black ladies
NON SMOKERS
Genetic component - HLA
What are some unique cells seen in sarcoidosis?
Asteroid bodies, and schauman bodies
What are some treatments for sarcoidosis?
Corticosteroids
Prognosis is favorable
Describe Hypersensitivity Pneumonitis
#1 Occupational pneumonia-allergic, Restrictive, attacks the alveoli/interstitim. 2/3 have RBC leak. Caused by thermophilic bacteria, fungi, bacterial stuff
Describe the two types of Hypersenstivity Pneumonitis
Acute- large antigen exposure, neutrophils, resolves on its own
Chronic - Prolonged exposure, gradual symptoms, mononuclear infiltration, fibrosis
What types of hypersensitivity is hypersensitivity pneumonitis?
Type III early - antibodies
Type 4 later- Form non caseating granulomas and fibrosis
How Diagnose Sarcoidosis?
Biopsy-Non-caseating granulomas, Special stain, Culture
BAL - CD4+ cells, macrophages
CXR - bilateral hilar lymphadenopathy
How Diagnose Hypersensitivity Pneumonitis?
BAL - CD4+ and CD8+ cells
Farmers lung, pidgeon breeders lung, humidifier
How do you treat Hypersensitiity Pneumonitis?
Remove from allergens
Describe Silo Fillers disease
NO NO2 exposure from silos, causes pulmonary edema and Bronchiolitis obliterans
