Pneumonia

Front 1

Define pneumonia.

Back 1

an inflammatory dz of the distal portions of the lung (terminal airways, alverolar spaces, and interstitium) characterized by the exudate. Exudative inflammation in the distal portions of the lung.

Front 2

What are the four possible routes of bacteiral inoculation of the otherwise sterile lower respiratory tract?

Back 2

MOST COMMONLY
- ASPIRATION of contaminated oropharyngeal secretions
- INHALATION of airborne bacteria or viruses

and less commonly,
- hematogenous
- direct extension into the lungs

Front 3

The host of normal defenses that keep the alveoli sterile include respiratory filtering, laryngeal competence, cough, and mucociliary transport. Describe how each help keep alveoli sterile.

Back 3

- respiratory filtering: airborne particles are filtered from inspired air according to size
- laryngeal competence: larynx is able to prevent significant tracheal contamination under most circumstances of micro or small macro aspirations
- cough: defense by initiating physical removal. ineffective cough can occur in stroke, quadriplegia, weakness)
- mucociliary transport: pushes the mucus layer towards the mouth, helps with mucosal turnover

Front 4

Give some examples of the clinical situation for each.

Back 4

Front 5

True or False:
Pneumonia is uncommon when defenses are normal.

Back 5

True

80% or more of pneumonia cases will occur in patients over the age of 60 or with co-morbid conditions (diabetes, chronic obstructive lung dz, congestive heart failure, renal insufficiency, chronic liver dz) that impair defense mechanisms

defense can be augmented by making sure the individuals at risk recieve the appropriate vaccinations (pertussis, pneumovax, influenza vaccine, Hemophilus B vaccine

Front 6

Review of some agents that cause pneumonia:
What is the classic presentation symptoms for pneumonia due to Streptococcus pneumoniae? (~4)

Back 6

fever, chills, productive cough, hemoptysis (rusty sputum)

Front 7

Review of some agents that cause pneumonia:
What is the organism responsible for ~75-85% of pneumococcal pneumonia?
A. Streptococcus pneumoniae
B. Hemophilus influenzae,
C. Staphylococcus aureus
D. Mycoplasma pneumoniae
E. Moraxella catarrhalis
F. Pneumocystis jirovecii

Back 7

A. Streptococcus pneumoniae

Front 8

Review of some agents that cause pneumonia:
This is the typical cause of "atypical pneumonia". Major symptoms are insidious onset of dry non-productive cough and headache. Xray is often far worse than symptoms or signs.

A. Streptococcus pneumoniae
B. Hemophilus influenzae,
C. Staphylococcus aureus
D. Mycoplasma pneumoniae
E. Moraxella catarrhalis
F. Pneumocystis jirovecii

Back 8

D. Mycoplasma pneumoniae

Front 9

Review of some agents that cause pneumonia:
This is the most common cause of pneumonia in HIV and other immunosuppressed individuals.

A. Streptococcus pneumoniae
B. Hemophilus influenzae,
C. Staphylococcus aureus
D. Mycoplasma pneumoniae
E. Moraxella catarrhalis
F. Pneumocystis jirovecii

Back 9

F. Pneumocystis jirovecii

Front 10

The major pathophysiologic alteration in patients with pneumonia is to ________.

Back 10

gas exchange

variable degrees of alveolar flooding prevent air entry

Front 11

What is hypoxic vasoconstriction and what does it have to do with pneumonia?

Back 11

In pneumonia, inflammatory exudate fills the alveoli and ventilation is poor in the area with pneumonia. Arterial blood flow is NOT maintained in areas of poor ventilation in an attempt to match perfusion to the decreased ventilation. That adjustment is called hypoxic vasoconstriction.

Front 12

Contrast "typical" pneumonia with "atypical" pneumonia with regards to:
A. onset
B. presence of chills
C. cough
D. sputum quality
E. pain
F. crackles distribution
G. wheezing present
H. CXR appearance
I. most common organism

Back 12

Front 13

True or False:
Regarding pneumonia presenting symptoms, elderly patients are less likely to develop fever, leukocytosis or cough and commonly present with mental status changes.

Back 13

TRUE

Front 14

Upon chest xray, alveolar filling (air space) pattern suggests [ bacterial / pneumococcal or Klebsiella pneumonia / viral ] etiology whereas an interstitial pattern suggest [ bacterial / pneumococcal or Klebsiella pneumonia / viral ] etiology.

Back 14

alveolar filling suggests BACTERIAL etiology; interstitial suggests VIRAL etiology.

Lobar distribution suggests pneumococcal or Klebsiella pneumonia.

Front 15

What are some common complications of pneumonia? (2)

Back 15

Lung abscess - a localized collection of pus with necrosis of lung tissue, creating a fluid filled cavity.

Empyema - infected pleural effusion

Front 16

Bacterial pneumonia is characterized by an exudate of what 4 things?

Back 16

- edema fluid
- red cells
- leukocytes
- fibrin

This exudate is present in alveolar spaces and distal bronchioles

Front 17

Lobar pneumonia (usually bacterial, specifically Strep pneumoniae), consists of four stages of evolution: congestion, red hepatization, grey hepatization and resolution. Describe each stage.

Back 17

CONGESTION: First changes you’ll see is an edema of fluid present within alveolar spaces. This would be an early stage. The fluid comes from alveolar capillaries. Lots of bacteria would be in the fluid if you took a smear.
RED HEPATIZATION: due to the outpouring of fluid from capillaries, you end up with sludging of the red cells and congestion of the alveolar septal capillary.Simultaneously, in the alveolar spaces you have the edema fluid and some extravasatation of the red cells there too. “red hepatization” due to liver like appearance.
GREY HEPATIZATION: Over time, RBCs lyse, break down and neutrophils and fibrin increase in amount. You lose the red, wet consistency of the lung -> “grey hepatizitation”.
RESOLUTION: Exudate is cleared from alveolar spaces by coughing and macrophage activity. Lung returns to normal appearance. may be delayed or incomplete because of superimposed complications (lung abcess or empyema)

Front 18

True or False:
Bronchopneumonia appears as a multifocal patchy distribution upon CXR.

Back 18

True

Can be caused by many types of bacteria. Severe cases may become large and confluent and merge with lobar pneumonia so keep in mind when you say lobar or bronchopneumonia, you are just talking about distribution, not cause.

Front 19

True or False:
Whereas the bacterial pneumonia had to do with alveolar spaces, viral pneumonia is predominantly in the interstitium itself – in the alveolar septa itself.

Back 19

True

Acute interstitial pneumonia
Necrotizing bronchopneumonia
Focal parenchymal necrosis

Front 20

Because viruses often affect and damage the ciliated cells of the airways, a severe viral pneumonia can predispose the person to a ____________.

Back 20

secondary bacterial pneumonia.