Path-Pneumonia

Front 1

give the three Pulmonary defense mechanisms and an example of each.

Back 1

1) nasal clearance e.g., sneezing
2)tracheobronchial clearance e.g., mucociliary elevator
3)alveolar clearance e.g.,phagocytic action

Front 2

What conditions predispose you to pneumonia

Back 2

1)damage to any of the defense mechanisms (above)
2)congestion/edema
3)accumulation of secretions
4)sepsis: hematogenous portal of entry
5)hospital setting
6)extreme age
7)chronic disease (COPD, CHF, DM
8) immunodeficiency

Front 3

community aquired pneumonia is usually of ______ origen

Back 3

bacterial

Front 4

nososomial pneumonia is usually caused by _______ organisms

Back 4

antibiotic resistant

Front 5

necrotizing pneumonia often involves an aspiration & abcess. The organism most often found is ________

Back 5

staph aureous

Front 6

describe the clinical features of pneumonia

Back 6

•fever, chills, chest pain, dyspnea, productive cough (rusty sputum)
•breath sounds; crackling or crepitant rales
•marked leukocytosis (high neutrophilia & bandemia)
•infiltrates on chest x-ray

Front 7

86 year old male comes down with pneumonia. X-ray shows patchy consolidations. If microscopic analysis could be done it would show PMNs filling alveolar spaces & bronchi. What type of pneumonia does he have?

Back 7

bacterial bronchopneumonia
(AKA lobUlar)

Front 8

• 86 (elderly) year old man (3x male) comes in with pneumonia mid-winter(seasonal). Sputum culture grows Streptococcal pneumoniae (95%). He dies (mortality =10%) and neutrofilic distribution is confluent throughout the entire L. lower lobe. Alveolar walls are congested and Intralveolar exudates consists of neutrophilic infiltration. What type of pneumonia does he have?

Back 8

Lobar Pneumonia

Front 9

On examination, his longs appear red, firm and airless. There is massive confluent exudation consisting of RBCs & PMNs. Knowing the evolving stages of lobar pneumonia what stage was he in when he died and how long had he had pneumonia?

Descibe the other stages in the evolution of lobar pneumonia

Back 9

Red hepatization (1-3 days)

1st stage is the first 24 hours--congestion stage--lungs are heavy, boggy, & red. vasculature is engorged and intraalveolar spaces are filled with fluid, there are few PMNs but many bacteria.

After the congestion stage hepatization occurs- as described in the clinical scenerio.

On days 4-8 grey hepatization occurs. Lung becomes grey and dry. RBCs disintegrate and macrophages move in.

Front 10

30 year old kidney transplant patient on immunosupressents presents with symptoms of pneumonia, pneumocystis, & signs of systemic infection. X-ray shows a diffuse infiltrate. B- group herpes virus is isolated. Histologic stain shows enlarged cells w/ prominent nuclear inclusions. What is the diagnosis? What is the virs?

Back 10

PNEUMONIA-Immunocompromised Host
CMV

Front 11

Cancer patient on chemotherapy presents with serious pneumona & sinusitis. X-ray shows a focal infiltrate. On autopsy examination of organism shows a mold with filimants branching at acute angles. What is the diagnosis? What is the organism.

Back 11

PNEUMONIA of a Immunocompromised Host
aspirgillous

Front 12

34 year old Aids patient w/ CD4 count <200 presents with pneumonia symptoms. X-ray shows a bilateral fluffy infiltrate. Therapy with pentamidine & folic acid is started. Pt dies and on autopsy, gross examination, the lungs appear atelectatic, red, & firm. They are frothy/fluffy with a proteinaceous edema. Microscopic exam shows an alveolar space filled with “steel wool” exudates which reveals what organism when stained with a silver stain?
What was the diagnosis? What type of organism is this?

Back 12

PNEUMONIA of a Immunocompromised Host
Pneumocystis carinii

probably a fungus

Front 13

60 year old comes in with “chest cold” like symptoms. He has no cough and moderate sputum. He has fever, headache, muscle aches, and pains. Labs show moderate leucoytosis & elevated cold agglutinin titers. Micro & Macroscopically his lungs would show no obvious consolidation or alveolar exudation. However he would have interstitial edema and mononuclear infiltration of the alveolar walls causing membrane damage and hyalin deposition. What is the organism?

Back 13

Primary Atypical Pneumonia-interstitial pneumonitis
Caused by Mycoplasma pneumoniae

Front 14

Another older person comes in with the same “chest cold” symptoms & mild leucocytosis. Microscopically examination shows presence of multinucleated giant cells. What is the differential

Back 14

Primary Atypical Pneumonia-interstitial pneumonitis of viral origin. Possibly SARS or Measles.