path-pneumonia
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- give the three Pulmonary defense mechanisms and an example of each.
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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
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1)damage to any of the defense mechanisms (above)
2)congestion/edema
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
- bacterial
- 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
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⬢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?
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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
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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?
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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/
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PNEUMONIA-Immunocompromised Host
CMV - 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.
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PNEUMONIA of a Immunocompromised Host
aspirgillous - 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,
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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
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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.