Respiratory: Pulomanry infection

Question 1

what is pneumonia

Answer 1

infection of lung parenchyma

Question 2

when does pneumonia occur? examples?

Answer 2

when normal defenses are impaired

1. impaired cough reflex
2. damage to mucociliary escalator
3. mucus plug

Question 3

what are clinical features of pneumonia

Answer 3

• fever and chills
• productive cough with yellow-green (pus) or rusty (bloody sputum
• tachypnea
• pleuritic chest pain
• decreased breath sounds
• dullness to percussion
• elevated WBC count

Question 4

how is the diagnosis for pneumonia made

Answer 4

• chest X-ray
• sputum gram stain and culture
• blood cultures

Question 5

what are the 3 classical patterns seen on chest x-ray for pneumonia

Answer 5

1. lobar pneumonia
2. bronchopneumonia
3. interstitial pneumonia

Question 6

what characterizes lobar pneumonia

Answer 6

consolidation of an entire lobe of the lung

Question 7

what is the most common cause of lobar pneumonia

Answer 7

usually bacteria

• Streptococcus pneumoniae
• Klebsiella pneumoniae

Question 8

What are 4 phases of loar pneumonia

Answer 8

1. congestion
2. red hepatization
3. gray hepatization
4. resolution

Question 9

why is there congestion in lobar pneumonia

Answer 9

due to congested vessels and edema

Question 10

what causes red hepatization

Answer 10

due to exudate, neutrophils, and hemorrhage filling the alveolar air spaces, giving the normal spongy lung a solid consistency

Question 11

what causes gray hepatization

Answer 11

due to degradation of red cells within the exudate

Question 12

what is the most common cause of community-acquired pneumonia and secondary pneumonia and who usually gets it

Answer 12

Streptococcus Pneumonia

- middled-aged adults and elderly

Question 13

what is secondary pneumonia

Answer 13

bacterial pneumonia superimposed on a viral upper respiratory tract infection

Question 14

klebsiella pneumoniae impacts who

Answer 14

• malnourished and debilitated individuals

- elderly in nursing homes, alcoholics, and diabetics

Question 15

what is clinical presentation for klebsiella pneumoniae

Answer 15

• enteric flora that is aspirated

- thick mucoid capsule results in gelatinous sputum ( currant jelly)

Question 16

what complicates Klebsiella pneumoniae

Answer 16

abscess

Question 17

what characterizes bronchopneumonia

Answer 17

scattered patchy consolidation centered around bronchioles

- multifocal and bilateral

Question 18

what causes bronchopneumonia

Answer 18

Staphylococcus aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis 
Legionella Pneumophila

Question 19

what is the 2nd most common cause of secondary pneumonia

Answer 19

Staphylococcus aureus

Question 20

Staphylococcus aureus bronchopneumonia is complicated with what

Answer 20

abscess and empyema

Question 21

empyema

Answer 21

pus in pleural space

Question 22

what is a common cause of secondary pneumonia and pneumonia superimposed of COPD, leading to exacerbation of COPD

Answer 22

haemophilus influenzae

Question 23

Pneumonia in cystic fibrosis patients

Answer 23

Pseudomonas aeruginosa

Question 24

causes community-acquired pneumonia and pneumonia superimposed on COPD, leads to exacerbation of COPD

Answer 24

Moraxella Catarrhalis

Question 25

what type of pneumonia does Legionella cause

Answer 25

1. community acquired pneumonia 2. pneumonia superimposed on COPD 3. pneumonia in immunocompromised states

Question 26

how is legionella pneumophila transmitted

Answer 26

from water source

Question 27

how is Legionella best visualized

Answer 27

intracellular organism best visualized by silver stain

Question 28

what characterizes interstitial atypical pneumonia

Answer 28

diffuse interstitial infiltrates

Question 29

what symptoms presents with interstitial atypical pneumonia

Answer 29

mild upper respiratory symptoms - minimal sputum - low fever 'atypical' presentation

Question 30

what causes interstitial (atypical pneumonia)

Answer 30

``` Mycoplasma pneumoniae chlamydia pneumoniae respiratory syncytial virus (RSV) Cytomegalovirus (CMV) Influenza virus Coxiella burnetii ```

Question 31

what is the most common cause of atypical pneumonia

Answer 31

mycoplasma pneumoniae

Question 32

who does mycoplasma pneumoniae impact

Answer 32

- young adults - military recruits - college students living in dormitory

Question 33

what are complications with mycoplasma pneumoniae

Answer 33

- autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) - erythema multiforme

Question 34

why is mycoplasma pneumoniae not visible on gram stain

Answer 34

lack of cell wall

Question 35

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

Answer 35

Chlamydia pneumoniae

Question 36

what is the most common cause of atypical pneumonia in infants

Answer 36

Respiratory syncytial virus (RSV)

Question 37

what causes atypical pneumonia with post-transplant immunosuppressive therapy

Answer 37

Cytomegalovirus (CMV)

Question 38

who is influenza virus usually seen in for atypical pneumonia

Answer 38

elderly immunocompromised preexisting lung disease

Question 39

influenza virus atypical pneumonia increases the risk of what

Answer 39

superimposed S aureus or H. influenzae bacterial pneumonia

Question 40

how does Coxiella Burnettii present atypical pneumonia?

Answer 40

- high fever ( Q fever)

Question 41

who usually gets Coxiella Burnetti? how do they get it?

Answer 41

farmers and veterinarians | - coxiella spores are deposited on cattle by ticks or are present in cattle placentas

Question 42

Coxiella is what type of oragnism

Answer 42

Rickettsial organism

Question 43

how distinguishes Coxiella from the other Rickettsial species

Answer 43

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

Question 44

aspiration pneumonia is seen in patients at risk for what

Answer 44

aspiration | eg, alcoholics, and comatose patients

Question 45

what causes aspiration pneumonia

Answer 45

anaerobic bacteria in oropharynx | eg. bacteroides, Fusobacterium, Paptococcus

Question 46

how does aspiration pneumonia present in lungs? why?

Answer 46

right lower lobe abscess | - right main stem bronchus branches at a less acute angle than the left

Question 47

what causes Tuberculosis

Answer 47

inhalation of aerosolized mycobacterium tuberculosis

Question 48

what results in primary TB

Answer 48

- focal, caseating necrosis in lower lobe of lung | - hilar lymph nodes that undergo fibrosis and calcification, forming Ghon complex

Question 49

what are the symptoms of primary TB? what about tests?

Answer 49

- usually asymptomatic | - positive PPD test

Question 50

when does secondary TB occur

Answer 50

reactivation of mycobacterium tuberculosis - commonly due to AIDS - can be seen with aging

Question 51

where in the lung does secondary TB usually occur?

Answer 51

apex of lung ( relatively poor lymphatic drainage and high O2 tension)

Question 52

clinical features of secondary TB

Answer 52

fevers night sweats cough with hemoptysis weight loss

Question 53

what does biopsy reveal about secondary TB

Answer 53

caseating granulomas

Question 54

how does TB stain

Answer 54

AFB stain reveals acid-fast bacilli

Question 55

how and what does secondary TB lead to

Answer 55

forms cavitary foci of caseous necrosis | - may lead to miliary pulmonary TB or Tuberculous bronchopneumonia

Question 56

Systemic spread often occurs in secondary TB and involve what common tissues

Answer 56

1. meninges ( meningitis) 2. cervical lymph nodes 3. kidneys ( produces sterile pyuria) 4. lumbar vertebrae ( Potts disease)