Pathology Of Pneumonia

Front 1

What are the stages of lobar pneumonia

Back 1

1. Congestion
2. Red hepatization
3. Gray hepatization
4. Resolution

Front 2

What are the characteristics of congested stage of lobar pneumonia

Back 2

Red, wet lung with edema
vascular engorgement
few PMNs but many bacteria

Front 3

Describe red hepatization stage of lobar pneumonia

Back 3

Gross consolidation
Extravasation of red cells
Fibrin precipitation
Fibrinous pleuritis
More neutrophils in alveolar space

Front 4

Describe gray hepatization stage of lobar pneumonia

Back 4

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

Front 5

Describe resolution stage of lobar pneumonia

Back 5

8-10 days into illness
fibrin digested enzymatically
debris absorbed by macrophages or coughed up
pleuritis may resolve or organize

Front 6

What if the intra-alveolar exudate is not coughed up?

Back 6

You have intra-alveolar exudate with eventual fibrosis. It is then called organizing pneumonia

Front 7

Describe bronchiolitis obliterans organzing pneumonia

Back 7

Bronchioles are plugged wth granulation tissue. It is a lung disease characterized by fixed lung obstruction

Front 8

What are some key complications of lobar pneumonia?

Back 8

-Bacterial dissemination (meningitis or endocarditis)
-Abscess formation
-mucinous secretion
-Organization
-Bronchiolitis obliterans

Front 9

Describe bronchopneumonia (lobular)

Back 9

-patchy distribution all over lung
-causes disease in infants and elderly or the immune compromised
-it can be airborne or vascular

Front 10

Describe lobar pneumonia

Back 10

-Generally community acquired
-Usually airborne

Front 11

What agents often cause bronchopneumonia?

Back 11

1. staph
2. strep (usually pneumo)
3. H. influenza
4. Pseudomonas
5. Coliforms
6. Fungi
7. Mycobacteria

Front 12

Primary vs Secondary pneumonia

Back 12

Primary pneumonia means there are no contributing factors.

Secondary pneumonia occurs after being immune-compromised

Front 13

Describe bronchopneumonia more

Back 13

-patchy distribution
-each patch can be in any of 4 stages
-usually hospital acquired
-often follow an earlier viral infection

Front 14

What causes lobar pneumonia?

Back 14

Streptococcus pneumonia
-less common now because of antibiotics
-high mortality rate

Front 15

Describe abscesses

Back 15

-Often staph aureus
-Aspiration pneumonia often causes it in right posterior lung
-they can cause septicemia
-just a collection of PMNs

Front 16

Describe abscesses more

Back 16

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

Front 17

what could cause chronic abscessing

Back 17

nocardia could

Front 18

Pneumonia after viral infection

Back 18

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

Front 19

You pack vaseline into nose at night and get a pneumonia

Back 19

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

Front 20

You get an obstruction and then pneumonia

Back 20

Think endogenous lipid pneumonia. You have high cell turnover rate that can't go anywhere and macrophages breat down cell membrane and keep cholesterol

Front 21

What predisposes you to pneumococcal pneumonia

Back 21

-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

Front 22

Describe Klebsiella Pneumonia

Back 22

-If it is in sputum, they have it.
-Alcoholics and diabetics susceptible
-Very destructive with abscess formation
-Mucoid exudate

Front 23

Describe pseudomonas pneumonia

Back 23

-immune-compromised individuals
-acute, infectious vasculitis
-necrotizing (often with abscesses)
-hemorrhagic

Front 24

Describe staphlococcal pneumonia

Back 24

Multiple abscesses with extensive scarring

Front 25

Primary atypical pneumonia

Back 25

-Interstitial pneumonia
-caused by viral or mycoplasma
-VQ abnormalities
-also known as walking pneumonia

Front 26

Someone has nonproductive cough and cold agglutinates

Back 26

Mycoplasma

Front 27

Owls eye

Back 27

CMV

Front 28

What are the yeast forms that can cause pneumonia?

Back 28

Blastomyces, Cryptococcus, Histoplasma, Paracoccidioides

-BCHS Please

Front 29

Broad-based buds

Back 29

Blastomycosis

-See it in sputum with PMNs
-Can produce skin lesions
-get it via inhalation

Front 30

Capsule on India Ink

Back 30

Cryptococcosis
-absense of BBB
-pleomorphic
-immune compromised patients like lymphoma or leukemia

Front 31

Chicken farmer with a nodule that looks like TB

Back 31

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

Front 32

Pseudohyphae and pseudo yeast forms

Back 32

Candida
-Yeast forms have narrow pinched off bases

Front 33

Septate hyphae with vascular invasion and 45 degree branching

Back 33

Aspergillosis

Front 34

Non-septated hyphae with vascular invasion

Back 34

Mucormycosis

Front 35

Sphere that is big

Back 35

Coccidiomycosis
-Valley Fever
-Southwest

Front 36

AIDs patient with cough and alveolar-interstitial chest xray pattern. Frothy edema is present

Back 36

Pneumocystis

Front 37

Man with draining sinus in his neck with sulfur granules

Back 37

Actinomycosis
-Forms an abscess
-anaerobic
-susceptible to penecillin

Front 38

Someone has pneumonia with abscesses. You see a filamentous structure on gram stain

Back 38

Nocardia
-grows aerobically
-partially AFB positive and can see on GMS stain
-may occur in patients with pulmonary alveolar proteinosis