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give the three Pulmonary defense mechanisms and an example of each.
1) nasal clearance e.g., sneezing
2)tracheobronchial clearance e.g., mucociliary elevator
3)alveolar clearance e.g.,phagocytic action
What conditions predispose you to pneumonia
1)damage to any of the defense mechanisms (above)
3)accumulation of secretions
4)sepsis: hematogenous portal of entry
5)hospital setting
6)extreme age
7)chronic disease (COPD, CHF, DM
8) immunodeficiency
community aquired pneumonia is usually of ______ origen
nososomial pneumonia is usually caused by _______ organisms
antibiotic resistant
necrotizing pneumonia often involves an aspiration & abcess. The organism most often found is ________
staph aureous
describe the clinical features of pneumonia
⬢fever, chills, chest pain, dyspnea, productive cough (rusty sputum)
⬢breath sounds; crackling or crepitant rales
⬢marked leukocytosis (high neutrophilia & bandemia)
⬢infiltrates on chest x-ray
86 year old male comes down with pneumonia. X-ray shows patchy consolidations. If microscopic analysis could be done it would show PMNs filling alveolar spaces & bronchi. What type of pneumonia does he have?
bacterial bronchopneumonia
(AKA lobUlar)
⬢ 86 (elderly) year old man (3x male) comes in with pneumonia mid-winter(seasonal). Sputum culture grows Streptococcal pneumoniae (95%). He dies (mortality =10%) and neutrofilic distribution is confluent throughout the entire L. lower lobe. Alveolar wa
Lobar Pneumonia
On examination, his longs appear red, firm and airless. There is massive confluent exudation consisting of RBCs & PMNs. Knowing the evolving stages of lobar pneumonia what stage was he in when he died and how long had he had pneumonia?

Red hepatization (1-3 days)

1st stage is the first 24 hours--congestion stage--lungs are heavy, boggy, & red. vasculature is engorged and intraalveolar spaces are filled with fluid, there are few PMNs but many bacteria.

After the congestion stage hepatization occurs- as described in the clinical scenerio.

On days 4-8 grey hepatization occurs. Lung becomes grey and dry. RBCs disintegrate and macrophages move in.
30 year old kidney transplant patient on immunosupressents presents with symptoms of pneumonia, pneumocystis, & signs of systemic infection. X-ray shows a diffuse infiltrate. B- group herpes virus is isolated. Histologic stain shows enlarged cells w/
PNEUMONIA-Immunocompromised Host
Cancer patient on chemotherapy presents with serious pneumona & sinusitis. X-ray shows a focal infiltrate. On autopsy examination of organism shows a mold with filimants branching at acute angles. What is the diagnosis? What is the organism.
PNEUMONIA of a Immunocompromised Host
34 year old Aids patient w/ CD4 count <200 presents with pneumonia symptoms. X-ray shows a bilateral fluffy infiltrate. Therapy with pentamidine & folic acid is started. Pt dies and on autopsy, gross examination, the lungs appear atelectatic, red,
PNEUMONIA of a Immunocompromised Host
Pneumocystis carinii

probably a fungus
60 year old comes in with “chest cold” like symptoms. He has no cough and moderate sputum. He has fever, headache, muscle aches, and pains. Labs show moderate leucoytosis & elevated cold agglutinin titers. Micro & Macroscopically his lungs wo
Primary Atypical Pneumonia-interstitial pneumonitis
Caused by Mycoplasma pneumoniae
Another older person comes in with the same “chest cold” symptoms & mild leucocytosis. Microscopically examination shows presence of multinucleated giant cells. What is the differential
Primary Atypical Pneumonia-interstitial pneumonitis of viral origin. Possibly SARS or Measles.

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