Zaman: Lung 5

Question 1

What are the main etiologic agents for atypical pneumonia?

Answer 1

Mycoplasma pneumonia (MCC), Chlamidia pneumonia, Legionella pneumonia.

Question 2

What will be the XR and histology findings of an atypical pneumonia?

Answer 2

Patchy infiltrates, scant sputum, mild WBC elevation

Question 3

What are the common etiologic agents for chronic pneumonia?

Answer 3

Norcrdia, Actinomyces, Mycobacteria, histoplasma, coccidiodes, blastomyces.

Question 4

What will be the XR and histological findings of chronic pneumonia?

Answer 4

Localized pneumonia with granulomata associated with regional exposure to pathogens.

Question 5

Identify.

Answer 5

Mycoplasma.

Question 6

Patchy foci of consolidation (pus in many alveoli adn adjacent air passages) scattered in one or more lobes in one or both lungs.

Answer 6

Bronchopneumonia. The interstitial markings are very obvious.

Question 7

Identify. Filled with neutrophils.

Answer 7

bronchopneumonia.

Question 8

Identify. What is the treatment?

Answer 8

COP: Cryptogenic Organizing Pneumonia. (used to be aclled BOOP: bronchiolitis obliterans organizing pneumonia). Treat with steroids, not antibiotics. (COP is chronic)

Question 9

Identify. What is the MCC?

Answer 9

Lobar pneumonia. Streptococcus pneumoniae. (there is also an xray image Zaman had in his PPT but we should know that from Katz).

Question 10

What are the 4 stages of inflammation in lobar pneumonia?

Answer 10

1. Congestion (24h; heavy, red, boggy lung; micro: vascular engorgement, intra-alveolar fluid with few PMNs and bacteria)
2. red hepatization (d3-4; red, frm, airless; micro: PMNs, fibrin precipitate in alveoli, extravasation of RBC, alveola septa preserved)
3. gray hepatization (d5-7; empymea; extension of bacterial infection into pleural cavity with fibrinosuppritive reaction; micro: accumulation of fibrin, disintigration of PMNs adn RBC)
4. resolution or fibrosis (d8-3w; exudate within the alveolar spaces will be drained through lymphatics and airways (“productive” cough) with gradual aeration of the affected segment; FIBROSIS in complicated cases)

Question 11

What are common characteristics of primary atypical pneumonia?

Answer 11

1. no response to sulfonamides nor penicillin
2. patchy inflammatory changes in lungs
3. Inflammation is in alveolar septa and pulmonary interstitium only
4. Typically follows a URI

Question 12

What is the clinical presentation of primary atypical pneumonia?

Answer 12

fever, HA, myalgias.

Cough with scanty and mucoid sputum.

Question 13

Identify. What are 2 possible bugs your patient may have had prior to this occurring?

Answer 13

Primary Atypical Pneumonia (PAP).

Staph aureus; Strep spp.

Question 14

What are some clinical features of legionella that will not likely be present in infections wtih mycoplasma or chalmydia?

Answer 14

abdominal pain, confusion, diarrhea

Question 15

What are two main etiologies of pneumonia of immunocompromised hosts?

Answer 15

Fungal pneumonias and TB

Question 16

Identify. What type of cells surround the infection?

Answer 16

TB; multinucleated giant cells

Question 17

Identlfy. Most commonly seen in?

Answer 17

**Pneumocystis jiroveci pneumonia (aka PCP). AIDS patients.

Question 18

Techniques used to diagnosed pulmonary parenchymal infections?

Answer 18

• Sputum: gram stain and cultures
• Blood cultures are not very sensitive but if bacteremia occurs, the etiologic agent is presumed to be the same as that causing the pneumonia, so very specific.
• Nasotracheal/Tracheal aspirate examination and cultures.
• Bronchoscopy with brush and washes examination and cultures..
• **Bronchoalveolar lavage (BAL) examination and cultures is the best method for sampling alveolar material.
• Transthoracic aspiration examination and cultures is good for sampling peripheral focal lesions
• Lung biopsy is a definitive procedure for diagnosis of pneumonia in immunocompromised patients and carcinoma.
• Pleural fluid aspiration is for those specimens that can be cultured anaerobically
• Viral cultures