MBBS Block 2: Pneumonia Classification and Pathogenesis
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Questions and Answers

What is a characteristic of early red hepatization?

  • Fibrin nets have formed
  • Fibroblasts are absent
  • Congested septal capillaries and numerous intra-alveolar neutrophils (correct)
  • The exudates have been converted to fibromyxoid masses

    • What type of bacteria may lead to tissue damage and fibrosis or abscess formation?

  • Pseudomonas aeruginosa
  • Streptococcus pneumoniae
  • Escherichia coli
  • Staphylococcus aureus (correct)

    • During which stage of pneumonia are fibrin nets formed?

  • Early organization of intra-alveolar exudate (correct)
  • Early red hepatization
  • Advanced organizing pneumonia
  • Acute pneumonia

    • What is the primary result of pneumonia in the lungs?

    <p>Solidification of lung part(s)</p> Signup and view all the answers

    Which of the following is an example of aetiological agent of pneumonia?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    What is formed in advanced organizing pneumonia?

    <p>Fibromyxoid masses</p> Signup and view all the answers

    What is the main difference between lobar pneumonia and bronchopneumonia?

    <p>Anatomical pattern</p> Signup and view all the answers

    What is characteristic of early organization of intra-alveolar exudate?

    <p>The exudate is seen streaming through the pores of Kohn</p> Signup and view all the answers

    What type of cell is present in fibromyxoid masses?

    <p>All of the above</p> Signup and view all the answers

    Which type of pneumonia is more likely to occur in an otherwise healthy person?

    <p>Primary pneumonia</p> Signup and view all the answers

    What is the term for the collection of inflammatory exudate in lung parenchyma?

    <p>Pneumonia</p> Signup and view all the answers

    What is a complication of pneumonia caused by some virulent bacteria?

    <p>Both A and B</p> Signup and view all the answers

    What is the name of the stage of pneumonia characterized by congested septal capillaries and numerous intra-alveolar neutrophils?

    <p>Early red hepatization</p> Signup and view all the answers

    Which of the following is an example of viral pneumonia?

    <p>Influenza</p> Signup and view all the answers

    What is the classification of pneumonia based on the anatomical pattern of involvement?

    <p>Lobar and bronchopneumonia</p> Signup and view all the answers

    What is the name of the bacterium that is an example of a bacterium that may lead to tissue damage and fibrosis or abscess formation?

    <p>Staphylococcus aureus</p> Signup and view all the answers

    Which of the following is NOT a type of pneumonia?

    <p>Meningitis</p> Signup and view all the answers

    What is the term for the solidification of lung tissue?

    <p>Consolidation</p> Signup and view all the answers

    What is the primary symptom of lobar pneumonia?

    <p>Fever</p> Signup and view all the answers

    What is the characteristic of the sputum in lobar pneumonia?

    <p>It is purulent and may contain flecks of blood</p> Signup and view all the answers

    What is the cause of acute pleuritic chest pain in lobar pneumonia?

    <p>Inflammation of the pleura</p> Signup and view all the answers

    What is the duration of the congestion stage in lobar pneumonia?

    <p>About 24 hours</p> Signup and view all the answers

    What is the characteristic of the lung during the red hepatisation stage?

    <p>It is red and airless</p> Signup and view all the answers

    What occurs during the grey hepatisation stage?

    <p>Destruction of white cells and red cells</p> Signup and view all the answers

    What is the characteristic of the lung during the resolution stage?

    <p>It is normal and functional</p> Signup and view all the answers

    What is the duration of the resolution stage in untreated cases?

    <p>About 8-10 days</p> Signup and view all the answers

    What is the chest sign that reflects inflammation of the pleura?

    <p>Pleural friction rub</p> Signup and view all the answers

    What is the term for the patches of consolidation shown in the image?

    <p>Patches of consolidation</p> Signup and view all the answers

    Which of the following is a complication of pneumonia?

    <p>Empyema</p> Signup and view all the answers

    What is the term for the formation of solid fibrous tissue in the lung?

    <p>Fibrosis</p> Signup and view all the answers

    Which type of bacterial infection is more likely to result in abscess formation?

    <p>Klebsiella</p> Signup and view all the answers

    What is the term for the dissemination of bacteria to other organs, leading to the formation of metastatic abscesses?

    <p>Bacterial dissemination</p> Signup and view all the answers

    Which of the following is a feature of bronchopneumonia on a chest X-ray?

    <p>Patchy bronchovascular thickening</p> Signup and view all the answers

    What is the term for the inflammation of the pleural cavity?

    <p>Empyema</p> Signup and view all the answers

    Which of the following is a complication of pneumonia that can lead to the formation of abscesses in various organs?

    <p>Bacterial dissemination</p> Signup and view all the answers

    Which of the following is a feature of bronchopneumonia?

    <p>Patches of consolidation</p> Signup and view all the answers

    What is the definition of atypical pneumonia?

    <p>An acute febrile respiratory disease that manifests with patchy inflammatory changes confined to alveolar space and pulmonary interstitium</p> Signup and view all the answers

    Which of the following viruses is a causative organism of atypical pneumonia?

    <p>Influenza virus type A and B</p> Signup and view all the answers

    What is the causative organism of lipid pneumonia that occurs due to aspiration of material containing a high concentration of lipid?

    <p>Exogenous lipid</p> Signup and view all the answers

    What is aspiration pneumonia caused by?

    <p>Aspirating fluid or food into the lung</p> Signup and view all the answers

    Which of the following is an example of non-infective pneumonia?

    <p>Aspiration pneumonia</p> Signup and view all the answers

    What is the location of the inflammatory changes in atypical pneumonia?

    <p>Alveolar space and pulmonary interstitium</p> Signup and view all the answers

    Which of the following is a causative organism of atypical pneumonia?

    <p>Mycoplasma pneumoniae</p> Signup and view all the answers

    What is the characteristic feature of lipid pneumonia that occurs due to airway obstruction?

    <p>Distal collections of foamy macrophages and giant cells</p> Signup and view all the answers

    Which of the following is an example of a non-infective pneumonia?

    <p>Cryptogenic organising pneumonia</p> Signup and view all the answers

    What is the characteristic distribution of bronchopneumonia?

    <p>Patchy distribution, centred on inflamed bronchioles and bronchi</p> Signup and view all the answers

    Which type of pneumonia is more likely to occur in patients with debilitating diseases?

    <p>Bronchopneumonia</p> Signup and view all the answers

    What is the typical radiographic appearance of lobar pneumonia?

    <p>Dense consolidation of one lobe</p> Signup and view all the answers

    What is the most common age group affected by bronchopneumonia?

    <p>Old age</p> Signup and view all the answers

    Which type of bacteria may cause bronchopneumonia?

    <p>All of the above</p> Signup and view all the answers

    What is the typical distribution of lobar pneumonia?

    <p>Uniform consolidation of one lobe</p> Signup and view all the answers

    Which type of pneumonia is characterized by a uniform consolidation of one lobe?

    <p>Lobar pneumonia</p> Signup and view all the answers

    What is the primary difference between bronchopneumonia and lobar pneumonia?

    <p>Distribution of lesions</p> Signup and view all the answers

    Which type of pneumonia is more likely to affect previously healthy individuals?

    <p>Lobar pneumonia</p> Signup and view all the answers

    What is the typical distribution of lesions in bronchopneumonia?

    <p>Basal area, due to secretions gravitating into lower lobe</p> Signup and view all the answers

    Which bacterium is commonly associated with lobar pneumonia?

    <p>Pneumococci</p> Signup and view all the answers

    What is the characteristic of bronchopneumonia?

    <p>Focal inflammation centred on the airways</p> Signup and view all the answers

    What is the characteristic of the sputum in bronchopneumonia?

    <p>Purulent, non-haemorrhagic</p> Signup and view all the answers

    What is the most common cause of acute pneumonia?

    <p>S.pneumoniae (the pneumococcus)</p> Signup and view all the answers

    Which type of pneumonia is more severe?

    <p>Lobar pneumonia</p> Signup and view all the answers

    What is the typical immune status of individuals affected by bronchopneumonia?

    <p>Immunosuppressed</p> Signup and view all the answers

    What is the characteristic of bacterial pneumonia?

    <p>Predominantly intra-alveolar neutrophilic inflammation</p> Signup and view all the answers

    What is the characteristic of lobar pneumonia?

    <p>Diffuse inflammation affecting the entire lobe</p> Signup and view all the answers

    What is the characteristic of viral pneumonia?

    <p>Interstitial lymphocytic inflammation</p> Signup and view all the answers

    Which of the following viruses is a causative organism of pneumonia?

    <p>Influenza virus</p> Signup and view all the answers

    What is the definition of pneumonia?

    <p>Collection of inflammatory exudate in lung parenchyma distal to terminal bronchioles</p> Signup and view all the answers

    What is a complication of pneumonia that results from tissue destruction?

    <p>Abscess formation</p> Signup and view all the answers

    What is seen on a chest X-ray in bronchopneumonia?

    <p>Patchy bronchovascular thickening</p> Signup and view all the answers

    What is the term for the formation of solid fibrous tissue in the lung?

    <p>Fibrosis</p> Signup and view all the answers

    What is the term for the dissemination of bacteria to other organs, leading to the formation of metastatic abscesses?

    <p>Bacterial dissemination</p> Signup and view all the answers

    What is the term for the inflammation of the pleural cavity?

    <p>Empyema</p> Signup and view all the answers

    What type of pneumonia is characterized by patchy consolidation on a chest X-ray?

    <p>Bronchopneumonia</p> Signup and view all the answers

    What is a complication of pneumonia that can lead to the formation of abscesses in various organs?

    <p>Bacterial dissemination</p> Signup and view all the answers

    What is the characteristic feature of atypical pneumonia?

    <p>Patchy inflammatory changes confined to the alveolar space and pulmonary interstitium</p> Signup and view all the answers

    Which of the following is a causative organism of atypical pneumonia?

    <p>Mycoplasma pneumoniae</p> Signup and view all the answers

    What is the definition of lipid pneumonia?

    <p>Pneumonia caused by aspiration of material containing a high concentration of lipid</p> Signup and view all the answers

    Which of the following is an example of non-infective pneumonia?

    <p>Cryptogenic organising pneumonia</p> Signup and view all the answers

    What is the location of the inflammatory changes in atypical pneumonia?

    <p>Alveolar space and pulmonary interstitium</p> Signup and view all the answers

    Which of the following viruses is a causative organism of atypical pneumonia?

    <p>Influenza virus type B</p> Signup and view all the answers

    What is aspiration pneumonia caused by?

    <p>Aspiration of food or fluid</p> Signup and view all the answers

    What percentage of lobar pneumonia cases are caused by Streptococcus pneumoniae?

    <p>90%</p> Signup and view all the answers

    Which type of pneumonia is more likely to occur in an otherwise healthy person?

    <p>Lobar pneumonia</p> Signup and view all the answers

    What is a common factor that can compromise pulmonary defense mechanisms?

    <p>All of the above</p> Signup and view all the answers

    Which type of pneumonia is more likely to occur in patients with debilitating diseases?

    <p>Bronchopneumonia</p> Signup and view all the answers

    What is the characteristic distribution of bronchopneumonia?

    <p>Patchy, diffuse, and scattered</p> Signup and view all the answers

    What is the typical age group affected by lobar pneumonia?

    <p>20-50 years</p> Signup and view all the answers

    Which type of pneumonia is more likely to occur in an elderly person?

    <p>Klebsiella pneumonia</p> Signup and view all the answers

    What is the common factor that can impair the host's immunity?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of lobar pneumonia in terms of affected segments?

    <p>Affects anatomically delineated segments or the entirety of a lobe</p> Signup and view all the answers

    Which type of pneumonia is caused by the aspiration of material containing a high concentration of lipid?

    <p>Lipid pneumonia</p> Signup and view all the answers

    Study Notes

    Definition and Classification of Pneumonia

    • Pneumonia is defined as a collection of inflammatory exudate in lung parenchyma distal to terminal bronchioles, resulting in consolidation (solidification) of lung part(s).
    • Classification of pneumonia can be based on anatomical pattern, clinical circumstances, and aetiological agents.
    • Anatomical pattern classification includes bronchopneumonia and lobar pneumonia.
    • Clinical circumstance classification includes primary and secondary pneumonia.
    • Aetiological agent classification includes bacterial, viral, and fungal pneumonia.

    Clinical Features of Pneumonia

    • Symptoms include cough, fever, production of sputum, and occasional hemoptysis.
    • Fever can be very high (over 40°C), with rigors (shaking chills).
    • Acute pleuritic chest pain on deep inspiration reflects inflammation of the pleura (pleurisy).
    • Signs include dullness to percussion, bronchial breathing, and pleural friction rub.

    Morphological Changes in Lobar Pneumonia

    • Congestion: the first stage, lasting about 24 hours, with protein-rich exudate and venous congestion.
    • Red hepatisation: the second stage, lasting a few days, with massive accumulation of polymorphs, lymphocytes, and macrophages in alveolar spaces.
    • Grey hepatisation: the third stage, lasting a few days, with further accumulation of fibrin, destruction of white cells and red cells.
    • Resolution: the fourth stage, occurring at about 8–10 days in untreated cases, with resorption of exudate and enzymatic digestion of inflammatory debris.

    Bronchopneumonia

    • Characterized by patches of consolidation.
    • Chest X-ray shows patchy bronchovascular thickening.

    Complications of Pneumonia

    • Abscess formation: results from tissue destruction, more common in Klebsiella or type III Pneumococcal infections.
    • Empyema: virulent bacterial strains induce suppuration in the pleural cavity.
    • Fibrosis: organization of intra-alveolar exudate may convert affected lung into solid fibrous tissue.
    • Bacterial dissemination: dissemination of bacteria may lead to endocarditis, pericarditis, meningitis, suppurative arthritis, and formation of metastatic abscesses in various organs.

    Atypical Pneumonia

    • Defined as an acute febrile respiratory disease with patchy inflammatory changes confined to alveolar space and pulmonary interstitium.
    • Causative organisms include Mycoplasma pneumoniae, influenza virus, respiratory syncytial viruses, adenovirus, rhinovirus, rubeola, varicella virus, Chlamydia, and Coxiella burnetii.

    Non-Infective Pneumonias

    • Cryptogenic organising pneumonia.
    • Aspiration pneumonia: when fluid or food is aspirated into the lung.
    • Lipid pneumonia: endogenous (associated with airway obstruction) and exogenous (due to aspiration of material containing a high concentration of lipid).

    Lobar Pneumonia

    • Affects anatomically delineated segment(s) or the entirety of a lobe or lung
    • Relatively uncommon in infancy and old age
    • Affects males more than females
    • 90% due to Streptococcus pneumoniae (pneumococcus)
    • Pneumococcal pneumonia typically affects otherwise healthy adults between 20 and 50 years of age
    • Lobar pneumonia caused by Klebsiella typically affects the elderly, diabetics, or alcoholics

    Bronchopneumonia

    • Patchy consolidation of multiple lobes (bilateral)
    • Often several lobes or bilateral
    • Characterized by focal inflammation centered on the airways
    • Typically occurs in old age, infancy, and patients with debilitating diseases
    • Common causes include staphylococci, streptococci, and Haemophilus influenzae
    • Pleural exudate is common

    Pathogenesis of Pneumonia

    • Occurs when defense mechanisms of the respiratory system are impaired or host immunity is low
    • Pulmonary defense mechanisms may be compromised by factors such as:
      • Loss or suppression of the cough reflex
      • Dysfunction of the mucociliary apparatus
      • Accumulation of secretions in conditions such as cystic fibrosis and bronchial obstruction
      • Interference with the phagocytic and bactericidal activities of alveolar macrophages
      • Pulmonary congestion and edema

    Complications of Pneumonia

    • Abscess formation
    • Empyema
    • Fibrosis
    • Bacterial dissemination leading to endocarditis, pericarditis, meningitis, suppurative arthritis, and formation of metastatic abscesses in various organs

    Atypical Pneumonia

    • Defined as an acute febrile respiratory disease with patchy inflammatory changes confined to the alveolar space and pulmonary interstitium
    • Caused by organisms such as Mycoplasma pneumoniae, influenza virus, respiratory syncytial viruses, adenovirus, rhinovirus, rubeola, and varicella virus, Chlamydia, and Coxiella burnetii

    Non-Infective Pneumonias

    • Cryptogenic organising pneumonia
    • Aspiration pneumonia
    • Lipid pneumonia
    • Pneumocystis jiroveci, Mycoplasma, Aspiration, lipid, eosinophilic

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    Identify and describe the different types of pneumonia, including lobar pneumonia and bronchopneumonia, and their clinicopathological features. Learn about the pathogenesis and morphology of pneumonia.

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