Term
| Bacterial pneumonia is usually an ______ disease. what are two typical pathogens? |
|
Definition
airspace
strep pneumoniae, staph aureus |
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Term
| viral pneumonia is usually an ________ lung dz. what sign may be seen? name some pathogens |
|
Definition
interstitial
kerley B lines
influenza, varicella, rubella, SARS, herpes, Hanta |
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Term
| fungal pneumonia often presents as _______ or _______. what are some common causative agents? (esp in TN)? |
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Definition
cavities or nodules
histo (east Tn!), aspergillus, cocci |
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Term
| aspiration pneumonia is usually a ________ lung dz |
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Definition
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Term
| ___________ is a generic term that may be used for any non-discrete density change in the lung-- not just pneumonia. |
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Definition
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Term
| as with pulmonary edema, when the bronchi are filled with fluid, as in bronchopneumonia, there may not be an ______/_________ |
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Definition
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Term
| What produces an air bronchogram? |
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Definition
| anything of soft tissue or fluid density that surround, but does NOT collapse, the bronchi will produce an air bronchogram |
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Term
| what pattern of pneumonia is homogenous consolidation of affected lobe with air bronchograms centrally and produces silhouette sign? prototype pathogen? |
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Definition
lobar (alveolar)
pneumococcal pneumonia |
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|
Term
| what pattern of pneumonia is patchy airspace disease frequently involving several segments simultaneously; no air bronchogram; atelectasis may be associated. prototype pathogen? |
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Definition
segmental (bronchopneumonia)
staphylococcal pneumonia |
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Term
| what pattern of pneumonia is reticular interstitial disease usually diffusely spread throughout the lungs early in the disease process-- tends to involve airway walls and alveolar septa; frequently progresses to airspace disease. prototype pathogen? |
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Definition
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Term
| what type of pneumonia is spherically shaped pneumonia usually seen in the lower lobes of children that may resemble a mass? prototype pathogen? |
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Definition
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Term
| what pattern of pneumonia is produced by numerous microorganisms' chief among them being mycobacterium TB- has lucent cavities produced by lung necrosis as its hallmark. |
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Definition
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Term
| What is common with an H. flu pneumonia? |
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Definition
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Term
| pneumococcal and staph account for about ____% of typical and usual effusions in pneumonias |
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Definition
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Term
| what is the most common bacterial pathogen of pneumonia? |
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Definition
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Term
name the typical patient for the following pathogens:
-s. aureus
-k. pneumoniae
-p. aeruginosa |
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Definition
-hospitalized pt
-chronic alcoholics
-pt with bronchiectasis or cystic fibrosis |
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Term
| what pathogen is most likely responsible for an upper lobe pneumonia with bulging fissure? |
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Definition
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Term
| what pathogen is most likely responsible for airspace pneumonia with effusion |
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Definition
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Term
| what pathogen is most likely responsible for a solitary nodule pneumonia |
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Definition
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Term
| what pathogen is most likely responsible for a thin walled upper lobe cavity pneumonia |
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Definition
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Term
| what pathogen is most likely responsible for a lower lobe cavitary pneumonia? |
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Definition
| pseudomonas aeruginosa (or bacteroides) |
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Term
| what pathogen is most likely responsible for a spherical soft tissue mass in a thin walled upper lobe cavity? |
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Definition
| fungus ball (usually asperg) |
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Term
| what pathogen is most likely responsible for a thick wall upper lobe cavity with spread to the opposite lower lobe? |
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Definition
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Term
| what pathogen is most likely responsible for soft tissue, fingerlike shadows in the upper lobe |
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Definition
| ABPA (allergic bronchopulmonary aspergillosis) |
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Term
| A pneumonia that presents as diffuse interstitial disease, no air bronchograms, no effusions, no cardiac enlargement, no hilar adenopahty, and the pt has AIDS is most likely..... |
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Definition
PCP
pneumocystis carinii (jaroveci) pneumonia |
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Term
| except for the presence of air bronchograms, airspace pneumonia is usually ___________ in density |
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Definition
|
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Term
| in some types of pneumonia (i.e. bronchopneumonia), the bronchi, as well as the airspaces, contain inflammatory exudate. this can lead to.... |
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Definition
| atelectasis associated with the pneumonia |
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Term
| the prototypical bronchopneumonia is caused by ________/________. they are spread centrifugally via the tracheo-bronchial tree to many foci in the lung at the same time, therefore they frequently involve __________ segments of the lung simultaneously |
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Definition
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Term
| what is the most common clinically recognized infection in patents with AIDS? |
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Definition
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Term
| round pneumonias are almost always ___________ in the lungs and in the _________ lobes |
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Definition
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Term
| Primary TB: cavitation? which lobes effected? what else is seen? |
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Definition
cavitation is rare
upper lobes more often than lower (may see ipsilateral adenopathy)
sometimes large unilateral pleural effusions |
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|
Term
| post primary TB: cavitation? which lobes? |
|
Definition
-cavitation is common (thin walled, and has a smooth inner margin with NO air fluid level)
-apical or posterior segments of the ULs, or superior segments of the LLs |
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Term
| aspiration almost always occurs in the most ________ portions of the lungs. what part of the lung is this when the patient is upright? recumbent? |
|
Definition
-upright: lower lobes (R more often than L due to straighter R main bronchus)
-recumb: superior segments of the LLs or the posterior segments of the ULs |
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|
Term
| Pneumonia caused by aspiration of anaerobic organisms usually produces what type of pneumonia? |
|
Definition
| lower lobe airspace disease that frequently cavities. may take months to resolve |
|
|
Term
| what does aspiration of unneutralized stomach acid look like? |
|
Definition
| pulmonary edema, clearing may take days or longer and it is prone to becoming secondarily infected |
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Term
| if the ascending aorta is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
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Definition
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Term
| if the R heart border is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
|
Definition
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Term
| if the R hemidiaphragm is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
|
Definition
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Term
| if the descending aorta is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
|
Definition
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Term
| if the L heart border is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
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Definition
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|
Term
| if the L hemidiaphragm is no longer visible due to silhouetting from a pneumonia, the disease location is most likely..... |
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Definition
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Term
| most pneumonias typically resolve from within (vacuolization), gradually disappearing with a patchy fashion over a few weeks. if a pneumonia does not resolve in several weeks, consider the presence of an underlying __________ |
|
Definition
| obstruction (such as a neoplasm- preventing adequate drainage from that portion of the lung) |
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Term
| Post primary TB usually involves the ______ lobes. it can spread via a __________ route that can infect the _________ LL or another lobe in the same lung |
|
Definition
upper
transbronchial
opposite |
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Term
| one of the tell tale signs of a PTX is visible _______/________ line |
|
Definition
|
|
Term
| what are 4 things it could be confused with? |
|
Definition
-mach line
-medial border scapula
-clothing, skin, bedding
-bullous emphysema |
|
|
Term
| how do you tell the difference between skin and a PTX? |
|
Definition
| skin will be a uniform density while a PTX will be a thin white line |
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|
Term
| how can you differentiate a scapula from a PTX? |
|
Definition
| uniform density, curves in the opposite direction to the pleural line, |
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|
Term
| how do you tell an apical bulla from a PTX? what do you have to do with a bullae? |
|
Definition
the margin will be curved in the opposite direction of a PTX
bullae must be extirpated (NO CHEST TUBE!) |
|
|
Term
| what does the deep sulcus sign signal? |
|
Definition
|
|
Term
| in a tension PTX, will the mediastinum and heart be displaced? |
|
Definition
|
|
Term
|
Definition
| increased pressure air space IN the pleura itself. it is not associated with emphysema or smoking. it is a source of spontaneous PTX esp in 20-30's |
|
|
Term
| what is a trick in regards to lung markings and identifying a PTX? |
|
Definition
| absence of lung markings peripheral to the visceral pleural line |
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|
Term
| what sign is often seen on a supine radiograph of a PTX? |
|
Definition
|
|
Term
| what is surfactant? what does it do? |
|
Definition
| surface active agent , essentially detergent. reduces the surface tension of alveolar fluid and permits easier alveolar expansion. overcomes tendency of fluid molecular attraction to keep alveoli collapsed. (surface tension of pleural fluid helps keep lung expanded) |
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|
Term
| surfactant release into the alveoli commences at around _____ weeks gestation,. failure of surfactant release in infants born before 34 weeks (i.e. premature) causes what? |
|
Definition
34
hyaline membrane disease |
|
|
Term
| how is hyaline membrane disease (NRDS) characterized? |
|
Definition
| by collapsed alveoli alternating with hyper aerated alveoli vascular congestion and hyaline membranes |
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|
Term
| hyaline membrane disease has a ________/_________ appearace |
|
Definition
|
|
Term
| are air bronchograms seen in hyaline membrane dz? |
|
Definition
|
|
Term
| what else may be seen in a baby with hyaline membrane disease? |
|
Definition
| pulmonary interstitial emphysema , pneumopericardium |
|
|
Term
| what is the tell tale sign of a pneumomediastinum? |
|
Definition
|
|
Term
| what may keep part, but not all of the visceral pleura adherent to the parietal pleura even in the presence of PTX? |
|
Definition
|
|
Term
| what is the difference between primary and secondary PTX? |
|
Definition
primary- occurring in what appears to have been normal lung
secondary- those that occur in diseased lung |
|
|
Term
| what is the best imaging study for a PTX? what is commonly used in babies with suspected PTX? |
|
Definition
|
|
Term
| what is pulmonary interstitial emphysema? |
|
Definition
| if an alveolus ruptures and the air tracks backwards along the bronchovascular bundles in the lung to the mediastinum, then into the neck and out to the SUBq tissue of the chest and abd wall. |
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|
Term
| about 1 in 3 patients with pulmonary interstitial emphysema will develop __________. what is the tell tale sign? |
|
Definition
pneumomediastinum
continuous diaphragm sign |
|
|
Term
| what is the tell tale sign of pneumopericardium? what study is best? |
|
Definition
produces a continuous band of lucency that encircles the heart
CT |
|
|
Term
|
Definition
| air dissecting along muscle bundles producing characteristic comblike striated appearance that superimposes on the underlying lung. |
|
|
Term
| what view is a frontal radiograph of a neonate taken in? |
|
Definition
|
|
Term
| how many ribs are usually seen on a neonate film? |
|
Definition
8
>8= hyperinflated
<8= hypoinflated |
|
|
Term
| what is the major difference between the chest radiograph of an adult and a neonate/child? |
|
Definition
| the thymus is still large in the anterior mediastinum |
|
|
Term
| What can you use as a gross marker of a term infant? |
|
Definition
|
|
Term
| what are two other names for surfactant deficiency DO? |
|
Definition
hyaline membrane disease
respiratory distress syndrome |
|
|
Term
| what secretes surfactant? when is it released? |
|
Definition
type 2 pneumocytes
34 weeks gestational age |
|
|
Term
| What does the Law of Laplace say? |
|
Definition
basically means that if tension is kept constant, the tiny alveoli (tiny spheres) will require high pressures to keep open
-or since all alveoli are connected, the tiny ones will empty into larger ones |
|
|
Term
| FOr a given BP, the larger the radius of the vessel the (higher/lower) the tension will be. Large aneurysms are (less/more) likely to rupture |
|
Definition
|
|
Term
| what characterizes surfactant deficiency? |
|
Definition
| collapsed alveoli alternating with hyper aerated alveoli and vascular congestion and hyaline membranes |
|
|
Term
| what do hyaline membranes do? |
|
Definition
| cause soft tissue density to fill with otherwise air density alveoli |
|
|
Term
| how does surfactant deficiency DO look? low or large lung vols? effusions? |
|
Definition
-ground glass, ground coffee, diffuse granular opacities
-low lung vols
-effusions not common |
|
|
Term
| are air bronchograms seen on surfactant deficiency DO? |
|
Definition
|
|
Term
| what are two sequela of SDD? |
|
Definition
|
|
Term
| What is Pulm interstitial emphysema (PIE)? can lead to? appears? |
|
Definition
air dissects into the interstitial lymphatics
lead to PTX, pneumomediastinum
appears as tubular and cystic lucencies |
|
|
Term
| what is chronic lung disease (CLD) a result of? how does it appear? another name? |
|
Definition
barotrauma- high O2 with mechanical vent
appears as coarse linear and nodular opacities with "bubbly cysts"
bronchopulmonary dysplasia |
|
|
Term
| What is the sail sign? when is it seen? |
|
Definition
when air in the mediastinum lifts the thymus up from the rest of the mediastinal structures
PIE |
|
|
Term
| what is meconium aspiration syndrome? |
|
Definition
term or near term fetus has colic reflex stimulated during delivery
meconium stained fluid |
|
|
Term
|
Definition
similar to CLD
coarse bilateral linear and nodular densities
over inflation |
|
|
Term
| what is another name for transient tachypnea of the newborn? what is the theory behind it? |
|
Definition
retained fetal fluid
passage through the birth canal essentially helps to squeeze out fluid from the lungs
infants born via c section are the demographic for TTN |
|
|
Term
| what does TTN look like? effusions? how long does it last? |
|
Definition
streaky linear densities radiating out from the hill
small effusions may be present
quick to resolve |
|
|
Term
| what are two distinguishing factor of neonatal PNA? |
|
Definition
if there is an effusion- think PNA
luns wil be overinflated (under inflated in SDD) |
|
|
Term
| what are two distinguishing factor of neonatal PNA? |
|
Definition
if there is an effusion- think PNA
luns wil be overinflated (under inflated in SDD) |
|
|
Term
| does MAS happen to term or preterm babies usually? |
|
Definition
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