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38 Cards in this Set

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What are the stages of lobar pneumonia
1. Congestion
2. Red hepatization
3. Gray hepatization
4. Resolution
What are the characteristics of congested stage of lobar pneumonia
Red, wet lung with edema
vascular engorgement
few PMNs but many bacteria
Describe red hepatization stage of lobar pneumonia
Gross consolidation
Extravasation of red cells
Fibrin precipitation
Fibrinous pleuritis
More neutrophils in alveolar space
Describe gray hepatization stage of lobar pneumonia
Gray, dry cut surface
More fibrin
Disintegration of neutrophils
Pleural rxn more intense
preservation of alveolar septa is key to resolution

This stage is key to whether the lung will resolve
Describe resolution stage of lobar pneumonia
8-10 days into illness
fibrin digested enzymatically
debris absorbed by macrophages or coughed up
pleuritis may resolve or organize
What if the intra-alveolar exudate is not coughed up?
You have intra-alveolar exudate with eventual fibrosis. It is then called organizing pneumonia
Describe bronchiolitis obliterans organzing pneumonia
Bronchioles are plugged wth granulation tissue. It is a lung disease characterized by fixed lung obstruction
What are some key complications of lobar pneumonia?
-Bacterial dissemination (meningitis or endocarditis)
-Abscess formation
-mucinous secretion
-Organization
-Bronchiolitis obliterans
Describe bronchopneumonia (lobular)
-patchy distribution all over lung
-causes disease in infants and elderly or the immune compromised
-it can be airborne or vascular
Describe lobar pneumonia
-Generally community acquired
-Usually airborne
What agents often cause bronchopneumonia?
1. staph
2. strep (usually pneumo)
3. H. influenza
4. Pseudomonas
5. Coliforms
6. Fungi
7. Mycobacteria
Primary vs Secondary pneumonia
Primary pneumonia means there are no contributing factors.

Secondary pneumonia occurs after being immune-compromised
Describe bronchopneumonia more
-patchy distribution
-each patch can be in any of 4 stages
-usually hospital acquired
-often follow an earlier viral infection
What causes lobar pneumonia?
Streptococcus pneumonia
-less common now because of antibiotics
-high mortality rate
Describe abscesses
-Often staph aureus
-Aspiration pneumonia often causes it in right posterior lung
-they can cause septicemia
-just a collection of PMNs
Describe abscesses more
They can destroy the alveolar walls and cause hemorrhage. If pneumonia only causes neutrophils in alveoli and leaves walls intact then you might have resolution.

Abscesses should be drained before causing septicemia.

Unconscious people have problems with cough reflex and get abscesses. Foreign body giant cells are a feature of the inflammation caused by aspirated irritants
what could cause chronic abscessing
nocardia could
Pneumonia after viral infection
Causes interstitial pneumonia.

There will be lymphocytic infiltrates into the interstitium with no alveolar exudate and no productive cough.

Common causes are influenza, parainfluenza, adenovirus, respiratory syncytial virus, and CMV
You pack vaseline into nose at night and get a pneumonia
This is exogenous lipid pneumonia. Lipid vacuoles appear accompanied by inflammation with foreign body giant cells.

No problems except consolidation on xray. Don't treat as a baceterial pneumonia because of risk of resistant bacterial pneumonia
You get an obstruction and then pneumonia
Think endogenous lipid pneumonia. You have high cell turnover rate that can't go anywhere and macrophages breat down cell membrane and keep cholesterol
What predisposes you to pneumococcal pneumonia
-Chronic heart, kidney, lung disease
-Hemoglobinopathy
-Asplenia
-Alcoholism
-Diabetes

Mortality is related to overwhelming growth of organism. It does not destroy lung tissue. May be lobar or lobular
Describe Klebsiella Pneumonia
-If it is in sputum, they have it.
-Alcoholics and diabetics susceptible
-Very destructive with abscess formation
-Mucoid exudate
Describe pseudomonas pneumonia
-immune-compromised individuals
-acute, infectious vasculitis
-necrotizing (often with abscesses)
-hemorrhagic
Describe staphlococcal pneumonia
Multiple abscesses with extensive scarring
Primary atypical pneumonia
-Interstitial pneumonia
-caused by viral or mycoplasma
-VQ abnormalities
-also known as walking pneumonia
Someone has nonproductive cough and cold agglutinates
Mycoplasma
Owls eye
CMV
What are the yeast forms that can cause pneumonia?
Blastomyces, Cryptococcus, Histoplasma, Paracoccidioides

-BCHS Please
Broad-based buds
Blastomycosis

-See it in sputum with PMNs
-Can produce skin lesions
-get it via inhalation
Capsule on India Ink
Cryptococcosis
-absense of BBB
-pleomorphic
-immune compromised patients like lymphoma or leukemia
Chicken farmer with a nodule that looks like TB
Histoplasmosis
-Smallest yeast form (key)
-Can be intracellular
-Can act like TB and make granulomas
-Looks like pepper on GMS stain
-Disseminates to bone marrow
Pseudohyphae and pseudo yeast forms
Candida
-Yeast forms have narrow pinched off bases
Septate hyphae with vascular invasion and 45 degree branching
Aspergillosis
Non-septated hyphae with vascular invasion
Mucormycosis
Sphere that is big
Coccidiomycosis
-Valley Fever
-Southwest
AIDs patient with cough and alveolar-interstitial chest xray pattern. Frothy edema is present
Pneumocystis
Man with draining sinus in his neck with sulfur granules
Actinomycosis
-Forms an abscess
-anaerobic
-susceptible to penecillin
Someone has pneumonia with abscesses. You see a filamentous structure on gram stain
Nocardia
-grows aerobically
-partially AFB positive and can see on GMS stain
-may occur in patients with pulmonary alveolar proteinosis