Pathology Of Pneumonia

Front 1

Name three ways the pneumonia can be developed.

Back 1

1) Cough reflex is lowered (intoxication)
2) Hypoventilation
3) Aspiration of GI contents

Front 2

T/F: Inferior to the vocal cords is normally sterile.

Back 2

True

Front 3

What are three host defenses in the conductive zone?

Back 3

1) cough
2) mucocilliary apparatus
3) surface antibodies

Front 4

In the gas exchange zone, what is the first line of defense?

Back 4

alveolar macrophages, followed by PMNs, followed by antibodies

Front 5

Three types of pneumonia:

Back 5

1) lobar
2) lobular
3) interstitial

Front 6

Name the type: pneumonia is confined to a lobe and comes from an airborne source, which is spread from alveoli to alveoli.

Back 6

lobar

Front 7

Connections between alveoli are called ?

Back 7

Pores of Kohn

Front 8

Four stages of lobar pneumonia:

Back 8

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

Front 9

Name the stage: pronounced edema and vasular engorgement, presence of a few PMNs, numerous bacteria seen.

Back 9

Congestion

Front 10

Death during the congestion phase of lobar pneumonia is usually due to?

Back 10

septicemia and shock, but resp. failure and lack of oxygenation can happen

Front 11

Name stage: firm lung w/ lots of fibrin, extravasation of RBCs, presence of more PMNs, fibrinosuppurative pleuritis

Back 11

red hepatization

Front 12

What is the most important stage in determining if the lung will resolve?

Back 12

gray hepatization

Front 13

What is the determinant if the lung will resolve?

Back 13

keeping the alveolar wall intact

Front 14

Name stage: surface of lung is dry, fibrin present, disintegration of PMNs, and intense pleural rxn

Back 14

gray hepatization

Front 15

Name stage: debris in alveoli is either absorbed by macrophages or coughed up, fibrin enzymatically digested, pleuritis resolves or organizes.

Back 15

resolution

Front 16

Morphological finding of alveolar or lobar pneumonia.

Back 16

neutrophils in alveolus

Front 17

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

Back 17

organizing pneumonia leading to fibrosis

Front 18

Most important complication of lobar pneumonia.

Back 18

bacterial dissemination

Front 19

Complications of lobar pneumonia.

Back 19

bacterial dissemination, abscess formation, mucinous seretion, organization, and bronchiolitis obliterans

Front 20

True/False: Lobar pneumonia is usually seen in the hospital.

Back 20

False. it is community acquired

Front 21

Difference between lobar and lobular (bronchopneumonia).

Back 21

infection in bronchopneumonia has patch distribution and is seen often in infants and elderly

Front 22

Common etiologic agents of bronchopneumonia.

Back 22

staph, pneumococcus, H flu, pseudomonas, coliforms, fugni, mycobacteria

Front 23

Which etiologic agent is often the cause of bronchopneumonia after flu infection?

Back 23

staph

Front 24

Difference between primary and secondary pneumonia.

Back 24

primary has no other contributing factors, secondary is in the immune compromised

Front 25

The key on CXR in determining an alveolar process is?

Back 25

air bronchograms

Front 26

Typical radiological presentation for bronchopneumonia.

Back 26

patchy areas of pulmonary congestion, matching pattern of lung lobules

Front 27

Bronchopneumonia is classically ____ acquired after ______.

Back 27

hospital, viral pneumonia

Front 28

Collection of pus in pleural cavity.

Back 28

empyema

Front 29

Pneumonia may be complicated by _____, which is initially just an effusion.

Back 29

pleuritis

Front 30

Pleural effusion can become ____ or _____.

Back 30

fibrinous or purulent

Front 31

Many lung abscesses are caused by ?

Back 31

staph

Front 32

____ pneumonia is often complicated by abscesses, typically in _____ _____ lung.

Back 32

Aspiration, right posterior

Front 33

Abscesses can cause ____.

Back 33

septicemia

Front 34

What is a good sign for a patient with pneumonia?

Back 34

if alveolar walls are intact

Front 35

Aspiration pneumonia generally occurs in a ____ patient.

Back 35

unconscious,due to problem w/ cough reflex

Front 36

Common feature of inflammation caused by aspirated chemical irritants or gastric contents.

Back 36

Foreign body giant cells

Front 37

Infectious agent often found in chronic abscess forming inflammation

Back 37

Nocardia

Front 38

Histologic findings of Nocardia infection:

Back 38

stains red w/ acid fast stain
granulation tissue bordering necrotic tissue

Front 39

____ pneumonia causes interstitial lymphocytic infiltrates, w/ no alveolar exudate and no productive cough.

Back 39

Viral

Front 40

Common agents for viral pneumonia.

Back 40

influenza, parainfluenza, adenovirus, RSV, CMV

Front 41

Alveolar macrophages are packed w/ lipids.

Back 41

Lipid Pneumonia

Front 42

Due to packing lard or vaseline in nose at night. Microscopically lipid vacuoles appear accompanied by inf. and foreign body giant cells.

Back 42

Exogenous Lipid Pneumonia

Front 43

Clamp off a bronchus and cell turnover that can't go anywhere occurs. Cholesterol from CMs gets put in macrophages. Numerous foamy macrophages.

Back 43

Endogenous Lipid Pneumonia

Front 44

Risk factors for pneumococcal pneumonia:

Back 44

chronic heart, lung, or kidney disease; alcoholism; diabetes; asplenia

Front 45

In pneumococcal pneumonia mortality is related to:

Back 45

resp failure b/c of overwhelming growth of organism during first 5 days

Front 46

T/F: Antibiotics can help control the rapid growth of pneumococci in the first 5 days of infection.

Back 46

false, antibiotics only prevent septicemia, doesn't effect the pneumonia

Front 47

T/F: Klebsiella is not part of our normal flora.

Back 47

True

Front 48

Patient has cough, chest consolidation, and sputum positive for Klebsiella. How likely is that Klebsiella is causing his pneumonia?

Back 48

high likely 95%

Front 49

Susceptible to Klebsiella infection.

Back 49

alcoholics and diabetics

Front 50

Pathologic appearance of Klebsiella.

Back 50

very destructive w/ abscess formation and mucoid exudate

Front 51

Immune-compromised patients are susceptible to this infecion.

Back 51

Pseudomonas

Front 52

Pathologic appearance of pseudomonas.

Back 52

necrotizing w/ abscess formation and hemorrhage, vasculitis

Front 53

Pathologic appearance of staph.

Back 53

multiple abscesses w/ scarring

Front 54

___ or ___ usually cause an interstitial pneumonia.

Back 54

viral or mycoplasma

Front 55

"Walking pneumonia"

Back 55

mycoplasma

Front 56

Instead of saying ventilation-perfusion mismatch say ?

Back 56

VQ abnormalities

Front 57

Herpes pneumonia ID'd by ?

Back 57

intranuclear inclusions

Front 58

T/F: You should be able to see nuclei in a normal, healthy alveolar membrane.

Back 58

False, only ones that are reactive

Front 59

CMV pneumonia ID'd by?

Back 59

"owl's eye" cells

Front 60

TB typically presents w/ lobar or lobular pneumonia?

Back 60

trick question, either!

Front 61

Yeast forms of pneumonia:

Back 61

blastomycosis, cryptomycosis, histoplasmosis, and paracoccidiodes

Front 62

Blastomycosis is often seen in ____ patients.

Back 62

healthy

Front 63

Morphology of Blastomycosis.

Back 63

BBB - broad based buds, accompained by many PMNs, doubly refractive yeast form

Front 64

Blastmycosis can cause ___ lesions. It is acquired by ____.

Back 64

skin, inhalation

Front 65

Morphology of cryptococcosis:

Back 65

capsulated, no BBB, pleomorphism

Front 66

Cryptococcus has a tendency to disseminate to the ?

Back 66

brain

Front 67

____ will show halo around capsule of Cryptococcus.

Back 67

India Ink

Front 68

Cryptoccus is typically seen in _____ patients.

Back 68

immune-compromised, especially lymphoma or leukemia patients

Front 69

Smallest yeast form, can be intracellular.

Back 69

Histoplasmosis

Front 70

T/F: Only the immunecompromised acquie histoplasmosis.

Back 70

False, anyone can get it

Front 71

Histoplasmosis generally disseminates to ____.

Back 71

bone marrow

Front 72

Solitary granuloma from histoplasmosis can resemble ?

Back 72

cancer

Front 73

Candida on mucus membranes is often in patients taking ?

Back 73

antiobiotics

Front 74

Morophological key for Candida.

Back 74

pseudohyphae and pseudo yeast forms

Front 75

Fungus ball sequestered in a segmental bronchus as a nodule.

Back 75

Aspergilloma mold

Front 76

T/F: Mucormycosis is only seen in immunecompromised patients.

Back 76

true,

Front 77

Aspergillus morphology

Back 77

septate hyphae, 45 degree branching, vascular invasion

Front 78

Mucor morphology

Back 78

no septae in hypae

Front 79

"Valley Fever"

Back 79

coccidiomycosis

Front 80

Largest yeast form, largest fungus seen medically

Back 80

coccidiomycosis

Front 81

Coccidiomycosis is commonly found in ?

Back 81

San Joaquim Valley

Front 82

Pneumocystis is seen in ___ patients.

Back 82

AIDS

Front 83

Histology of pneumocystis.

Back 83

foamy alveolar processes

Front 84

Hangs out in oral cavity, when aspirated forms abscess, adheres to surface and invades like a cancer.

Back 84

Actinomycosis

Front 85

Classic finding for actinomycosis

Back 85

sulfur granules

Front 86

Nocardia is more prevalent in ?

Back 86

North Carolina (Go Tar Heels!)

Front 87

Microscopic appearance of Nocardia

Back 87

filamentous structure