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87 Cards in this Set

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Name three ways the pneumonia can be developed.
1) Cough reflex is lowered (intoxication)
2) Hypoventilation
3) Aspiration of GI contents
T/F: Inferior to the vocal cords is normally sterile.
True
What are three host defenses in the conductive zone?
1) cough
2) mucocilliary apparatus
3) surface antibodies
In the gas exchange zone, what is the first line of defense?
alveolar macrophages, followed by PMNs, followed by antibodies
Three types of pneumonia:
1) lobar
2) lobular
3) interstitial
Name the type: pneumonia is confined to a lobe and comes from an airborne source, which is spread from alveoli to alveoli.
lobar
Connections between alveoli are called ?
Pores of Kohn
Four stages of lobar pneumonia:
1) congestion
2) red hepatization
3) gray hepatization
4) resolution
Name the stage: pronounced edema and vasular engorgement, presence of a few PMNs, numerous bacteria seen.
Congestion
Death during the congestion phase of lobar pneumonia is usually due to?
septicemia and shock, but resp. failure and lack of oxygenation can happen
Name stage: firm lung w/ lots of fibrin, extravasation of RBCs, presence of more PMNs, fibrinosuppurative pleuritis
red hepatization
What is the most important stage in determining if the lung will resolve?
gray hepatization
What is the determinant if the lung will resolve?
keeping the alveolar wall intact
Name stage: surface of lung is dry, fibrin present, disintegration of PMNs, and intense pleural rxn
gray hepatization
Name stage: debris in alveoli is either absorbed by macrophages or coughed up, fibrin enzymatically digested, pleuritis resolves or organizes.
resolution
Morphological finding of alveolar or lobar pneumonia.
neutrophils in alveolus
What happens if intra-alveolar exudate is not coughed up?
organizing pneumonia leading to fibrosis
Most important complication of lobar pneumonia.
bacterial dissemination
Complications of lobar pneumonia.
bacterial dissemination, abscess formation, mucinous seretion, organization, and bronchiolitis obliterans
True/False: Lobar pneumonia is usually seen in the hospital.
False. it is community acquired
Difference between lobar and lobular (bronchopneumonia).
infection in bronchopneumonia has patch distribution and is seen often in infants and elderly
Common etiologic agents of bronchopneumonia.
staph, pneumococcus, H flu, pseudomonas, coliforms, fugni, mycobacteria
Which etiologic agent is often the cause of bronchopneumonia after flu infection?
staph
Difference between primary and secondary pneumonia.
primary has no other contributing factors, secondary is in the immune compromised
The key on CXR in determining an alveolar process is?
air bronchograms
Typical radiological presentation for bronchopneumonia.
patchy areas of pulmonary congestion, matching pattern of lung lobules
Bronchopneumonia is classically ____ acquired after ______.
hospital, viral pneumonia
Collection of pus in pleural cavity.
empyema
Pneumonia may be complicated by _____, which is initially just an effusion.
pleuritis
Pleural effusion can become ____ or _____.
fibrinous or purulent
Many lung abscesses are caused by ?
staph
____ pneumonia is often complicated by abscesses, typically in _____ _____ lung.
Aspiration, right posterior
Abscesses can cause ____.
septicemia
What is a good sign for a patient with pneumonia?
if alveolar walls are intact
Aspiration pneumonia generally occurs in a ____ patient.
unconscious,due to problem w/ cough reflex
Common feature of inflammation caused by aspirated chemical irritants or gastric contents.
Foreign body giant cells
Infectious agent often found in chronic abscess forming inflammation
Nocardia
Histologic findings of Nocardia infection:
stains red w/ acid fast stain
granulation tissue bordering necrotic tissue
____ pneumonia causes interstitial lymphocytic infiltrates, w/ no alveolar exudate and no productive cough.
Viral
Common agents for viral pneumonia.
influenza, parainfluenza, adenovirus, RSV, CMV
Alveolar macrophages are packed w/ lipids.
Lipid Pneumonia
Due to packing lard or vaseline in nose at night. Microscopically lipid vacuoles appear accompanied by inf. and foreign body giant cells.
Exogenous Lipid Pneumonia
Clamp off a bronchus and cell turnover that can't go anywhere occurs. Cholesterol from CMs gets put in macrophages. Numerous foamy macrophages.
Endogenous Lipid Pneumonia
Risk factors for pneumococcal pneumonia:
chronic heart, lung, or kidney disease; alcoholism; diabetes; asplenia
In pneumococcal pneumonia mortality is related to:
resp failure b/c of overwhelming growth of organism during first 5 days
T/F: Antibiotics can help control the rapid growth of pneumococci in the first 5 days of infection.
false, antibiotics only prevent septicemia, doesn't effect the pneumonia
T/F: Klebsiella is not part of our normal flora.
True
Patient has cough, chest consolidation, and sputum positive for Klebsiella. How likely is that Klebsiella is causing his pneumonia?
high likely 95%
Susceptible to Klebsiella infection.
alcoholics and diabetics
Pathologic appearance of Klebsiella.
very destructive w/ abscess formation and mucoid exudate
Immune-compromised patients are susceptible to this infecion.
Pseudomonas
Pathologic appearance of pseudomonas.
necrotizing w/ abscess formation and hemorrhage, vasculitis
Pathologic appearance of staph.
multiple abscesses w/ scarring
___ or ___ usually cause an interstitial pneumonia.
viral or mycoplasma
"Walking pneumonia"
mycoplasma
Instead of saying ventilation-perfusion mismatch say ?
VQ abnormalities
Herpes pneumonia ID'd by ?
intranuclear inclusions
T/F: You should be able to see nuclei in a normal, healthy alveolar membrane.
False, only ones that are reactive
CMV pneumonia ID'd by?
"owl's eye" cells
TB typically presents w/ lobar or lobular pneumonia?
trick question, either!
Yeast forms of pneumonia:
blastomycosis, cryptomycosis, histoplasmosis, and paracoccidiodes
Blastomycosis is often seen in ____ patients.
healthy
Morphology of Blastomycosis.
BBB - broad based buds, accompained by many PMNs, doubly refractive yeast form
Blastmycosis can cause ___ lesions. It is acquired by ____.
skin, inhalation
Morphology of cryptococcosis:
capsulated, no BBB, pleomorphism
Cryptococcus has a tendency to disseminate to the ?
brain
____ will show halo around capsule of Cryptococcus.
India Ink
Cryptoccus is typically seen in _____ patients.
immune-compromised, especially lymphoma or leukemia patients
Smallest yeast form, can be intracellular.
Histoplasmosis
T/F: Only the immunecompromised acquie histoplasmosis.
False, anyone can get it
Histoplasmosis generally disseminates to ____.
bone marrow
Solitary granuloma from histoplasmosis can resemble ?
cancer
Candida on mucus membranes is often in patients taking ?
antiobiotics
Morophological key for Candida.
pseudohyphae and pseudo yeast forms
Fungus ball sequestered in a segmental bronchus as a nodule.
Aspergilloma mold
T/F: Mucormycosis is only seen in immunecompromised patients.
true,
Aspergillus morphology
septate hyphae, 45 degree branching, vascular invasion
Mucor morphology
no septae in hypae
"Valley Fever"
coccidiomycosis
Largest yeast form, largest fungus seen medically
coccidiomycosis
Coccidiomycosis is commonly found in ?
San Joaquim Valley
Pneumocystis is seen in ___ patients.
AIDS
Histology of pneumocystis.
foamy alveolar processes
Hangs out in oral cavity, when aspirated forms abscess, adheres to surface and invades like a cancer.
Actinomycosis
Classic finding for actinomycosis
sulfur granules
Nocardia is more prevalent in ?
North Carolina (Go Tar Heels!)
Microscopic appearance of Nocardia
filamentous structure