08.20 - Pathology of Pulmonary Infections (Nichols) - Questions Flashcards
1
Q
Cough productive of gelatinous blood sputum
A
Symptoms of Klebsiella Pneumonia
1
Q
___ can frequently nail a specific dx of Cryptococcal Pneumonia
A
Serum Cryptococcal Antigen Test
2
Q
CXR of TB
A
Patchy or nodular infiltrate in apical or subapical upper lobes
2
Q
Gross Path of P Jirovecii Pneumonia
A
Heavy, diffusely consolidated, tan lungs
3
Q
Tx of Pneumococcal Pneumonia
A
Almost any beta-lactam
3
Q
Aspergillus Pneumonia needs to be distinguished from
A
Mere colonization (aspergilloma) and allergic bronchopulmonary aspergillosis
4
Q
Gram Stain of P Aerug Pneumonia
A
Long thin Gram negative bacilli with pointed ends
4
Q
Course of Histoplasmosis
A
Usually self-limited, but may disseminate in cell-mediated immunity deficient
5
Q
When do macrophages replace neutrophils
A
Day 3
5
Q
Any __ process will make the lung look like liver
A
Consolidating (alveolar filling)
5
Q
With caseating necrosis, think __ first, then ___
A
TB, then Histo
6
Q
Acute pneumonia with diarrhea, confusion, and hyponatremia suggests
A
Legionella
6
Q
Tx of Histo
A
Itraconazole for mild-moderate; Amphotericin for severe
7
Q
3 pathologic features of P Aeruginosa Pneumonia
A
Hemorrhagic, Necrotizing, Infarcting
8
Q
Viral Pneumonia tends to be
A
Interstitial
8
Q
Primary virulence factor of Cryptococcus
A
Anti-phagocytic capsule
9
Q
Pathogenesis of S Aureus Pneumonia
A
Commonly follows viral respiratory infection (influenza)
10
Q
Usual patient with pneumocystis pneumonia
A
HIV w/ CD4
11
Q
Why does pneumococcal pneumonia stop at lobar septa
A
Non-necrotizing
11
Q
Micro Path of Aspergillus Pneumonia
A
Necrosis, Hemm, Acute inflammation with regular septate hyphae with dichotomous branching
12
Q
3 pathologic features of S Aureus Pneumonia
A
Hemorrhagic, Necrotizing, Abscessing
13
Q
Prognosis of P Jiorvecii Pneumonia
A
Good
14
Q
Why is pseudomonas aerug pneumonia so much worse than pneumococcal?
A
Hits people hospitalized with already bad disease
14
Q
Dx of Legionella
A
Can’t culture –> Urine antigen and bronchoscopy
15
The term aspiration pneumonia is used only for
Aspiration of gastroesophageal contents or food misrouted from the oropharynx -- large volumes
16
Gram positive cocci in clusters on sputum gram stain
S Aureus on sputum gram stain
17
Gross Path of Crypto Pneumonia
Soft, tan-grey nodules - Not hemmorrhage or calcified
17
Presentation of P Jirovecci Pneumonia in non-HIV
Fulminant respiratory failure
17
Viral and Mycoplasma pneumonia typically correlates with __ infiltrate on radiology
Ground-glass
18
Epidemiology of P. Jirovecii Pneumonia
Immunodeficient
18
Histo elicits a __ response
Caseating Granulomatous
18
Blasto vs Crypto
Blasto is bigger
19
Epidemiology of TB
HIV, Seasonal, Minorities
19
Mucicarmine Stain is red for
Capsule of Cryptococcus
20
Alveolar non-necrotizing acute bacterial pneumonia is commonly due to
Pneumococcus
20
Micro Path of Histoplasmosis
Oval basophilic yeast forms; Necrotizing granulomatous inflammation with epithelioid histiocytes and multinucleated giant cells
21
When you see caseating necrosis, order these two tests
1. Fungal staining with Methanamine Silver; 2. Acid Fast
22
Chronic phase of coccidioidomycosis
Granulomatous multinucleated giant cell response
25
What 3 things suggest Legionella Pneumonia
Diarrhea, Confusion, Hyponatremia
26
Alveolar necrotizing acute bacterial pneumonia is caused by
S Aureus, P Aeruginosa, Klebsiella
28
S aureus pneumonia is much worse than pneumococcal, probably b/c
it is necrotizing and abscessing
29
Gross Path of Aspergillus Pneumonia
Nodules, commonly with surrounding hemm (target lesions); Infarction
30
"walking pneumonia" - one of most common cause of atypical pneumonia
Mycoplasma Pneumonia
32
Definition of infiltrate
Radiologic manifestation of pneumonia, edema, or hemorrhage
33
Legionella: necrotizing?
No
33
4/5 Blastomycosis patients come from the \_\_\_
Jail
34
Fever, Hemoptysis, and Pleuritic chest pain in neutropenic patient
Aspergillosis Pneumonia
36
Tx of S Aureus Pneumonia
Oxacillin or Vancomycin
37
Micro Path of TB Pneumonia
Necrotizing Granulomas w/ epitheliod histiocytes and multinucleated giant cells; Very few organisms
37
Grey Hepatization Phase
Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils
38
Macrophages in lungs with finely granular brown pigment
Smoker's Macrophage
39
Signs of Pneumococcal Pneumonia
Low fever, Low tachycardia, Mild tachypnea, Crackles
39
Classic TB sputum has
few bugs
40
Tx of Aspergillus Pneumonia
Voriconazole
42
Tx of Mycoplasma Pneumonia
Azithromycin or Levofloxacin
42
Large encapsulated boxcar gram negative rods on sputum gram stain
Klebsiella
44
Foamy macrophages are characteristic of
Subacute bacterial pneumonia
44
Causes of interstitial chronic pneumonia
P Jirovecii, Sarcoidosis, Toxoplasmosis
46
Gram Stain of S Aureus Pnuemonia
Gram positive cocci in clusters
47
Signs of Histo
Fever
47
Acute phase of Coccidioidomycosis
Rupturing spherule releasing endospores
49
How does Legionella evade destruction
Inhibit phagosome-lysosome fusion
50
Aspergillosis pneumonia patient on step 1
Immunocompromised awaiting transplant
51
Presentation of Pneumococcal pneumonia in young people vs adults
Sudden severe onset of chils/fever vs gradually progressive fever/sputum production
52
How does Pneumococcus bind epithelial cells
Binds to Platelet Activating Factor Receptor
53
Stain for Cryptococcus
Mucicarmine Stain --\> Capsule stains red
54
Micro Path of Crypto Pneumonia
Faintly basophilic yeast; Suppurative and granulomatous inflammation
54
Disseminated lesions resembling milit seeds
TB
55
Pseudomonas Vasculitis correlates with ___ features of Pseudomonas Pneumonia
Hemorrhagic, Necrotizing, and Infarcting
56
Staining of Legionella
Stain poorly with H&E and Gram stain --\> Need to do silver stain
57
\_\_ causes nodular pneumonia in immunocompromised patients
HSV
58
TB vs S Aureus
Both necrotizing, but TB is subacute/chronic, while S Aureus is actue
59
Urine Antigen Test for Pneumococcal Pneumonia
Rapid, 70-80 sensitive; 80-100 specific
60
Presentation of Pneumococcal Pneumonia in Elderly
Confused, Tired, and Cold; No fever or cough
61
Pulmonary TB starts as \_\_\_, then becomes __ when associated with enlarged lymph node
Gohn Focus --\> Gohn Complex
62
Abscesses in P Aeruginosa Pneumonia
No
63
What symptoms and signs suggest Legionella pneumonia
Gastrointestinal; Neurologic
64
\_\_ causes interstitial pneumonia in immunocompromised
CMV
66
Gross Path of S Aureus Pneumonia
Heavy plum-colored lungs; Numerous small abscesses
67
Broad-based budding and double contour walls
Blastomycosis
68
You see the term hepatization with \_\_\_
Pneumococcal Pneumonia
70
Signs of Mycoplasma Pneumonia
Erythematous Maculopapular Skin Rash
70
Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils
Grey Hepatization Phase
71
Large encapsulated rectangular (boxcar) Gram negative bacilli
Gram Stain of Klebsiella Pneumonia
72
Prognosis of Aspergillus Pneumonia
Poor
73
Helmets or teacups on silver stain
Pneumocystis Pneumonia
75
What does Histoplasmosis mimic
TB
76
Symptoms of Klebsiella
Cough productive of gelatinous blood sputum
77
Symptoms of Aspergillus Pneumonia
Fever, Pleuritic Chest Pain, Hemoptysis: In neutropenic patients
79
Gross path of P Aerug pneumonia
Firm red areas of hemorrhagic consolidation; Maybe yellow areas of consolidation with rim of hemm (target lesions); Infarction
80
Risk factors for P Aerug pneumonia
Intubation, Neutropenia
82
Micro Path of P Aerug pneumonia
Necrotizing; Long thin bacilli invading vessels from adventitia
83
Prognosis of S Aureus Pneumonia
Up to 50 % mortality, even if treated
83
Early infiltration by macrophages instead of neutrophils
Characteristic infiltration pattern of Legionella Pneumonia
85
Symptoms of Mycoplasma Pneumonia
Malaise, headache, Intractable Dry Cough
87
Galactomannan
Major constituent of Aspergillus cell walls
87
\_\_ is the prototype Subacute/Chronic interstitial pneumonia in an immunocompromised patient
P Jirovecii
88
Necrotizing; Long thin bacilli invading vessels from adventitia
Micro Path of P Aerug pneumonia
89
Prognosis of Mycoplasma Pneumonia
Vast majority recover without sequelae
91
Micro path of P Jirovecci Pneumonia
Foamy eosinophilic; Centro-alveolar "honeycomb" exudate
93
Microscopic path of S Aureus Pneuminia
Acute necrotizing w/ abundant neutrophils, fibrin, and edema; Hemorrhage and abscesses
94
Pneumococcal Pneumonia on sputum gram stain
Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain
96
Lobar pneumonia is classically due to
Strep Pneumoniae
98
Chronic pneumonia tends to be anything but
bacterial
98
Micro path of Cryptococcus
Translucent/Lightly basophilic budding yeast surrounded by clear space (large anti-phagocytic capsule)
99
What color is mucus
Gray
99
\_\_ invasion is classic in Aspergillosis, which is why patients have
Blood vessel invasion --\> Infarcts
101
Symptoms of Histoplasmosis
75% none; Substernal chest pain
102
Abudant Fibring correlates with
Pneumococcus
104
Time frame of red hepatization phase
Day 2-3
105
Like \_\_\_, aspergillosis is very vaso-invasive
Pseudomonas
106
Symptoms of Crypto Pneumonia
Fever
108
Epidemiology of Cryptococcal Pneumonia
Immunodeficient
110
Acute interstitial pneumonia is commonly due to
Viruses (influenza)
110
All bacteria are __ in H&E
Blue
112
Red Hepatization Phase
Day 2-3: Congested capillaries, Alveolar filling with neutrophils and fibrin
113
Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain
Pneumococcal Pneumonia on sputum gram stain
114
Dx of P Jirovecii Pneumonia
Elevated LDH; Decreased DLCO; Grocott stain
115
Signs for Legionella Pneumonia
Fever; Neurologic
116
Tx of Crypto Pneumonia
Fluconazole
117
Viral and Mycoplasma species typically produce a ___ pneumonia
Non-necrotizing, lymphocytic, interstitial
118
Prognosis of P Aerug Pneumonia
Up to 87% mortality, even if treated
119
Tx of P Jirovecci Pneumonia
Trimethoprim-Sulfamethoxazole
120
CXR of S Aureus Pneumonia
Bronchopneumonic infiltrates
121
Positive sputum smear in TB indicates
infectivity
122
Gross path of Klebsiella Pneumonia
Patchy or lobar consolidation; Necrotizing, Abscessing
123
Microscopy of Milit Seeds
Necrotic w/out granuloma formation --\> Kill patient quickly
124
Gross path of Legionella pneumonia
Bulging firm rubbery areas of consolidation
126
Fungal and mycobacterial pneumonias tend to be
chronic and nodular
127
Epidemiology of Aspergillus Pneumonia
Neutropenia, Immunocompromised
128
Almost all acute bacterial pneumonias are due to
aspiration of saliva containing the pathogen
129
Most common causes of viral pneumonia
Influenza and Respiratory Syncitial Virus
130
Prognosis of TB
Usually Good
132
Pneumonia with hilar adenopathy should always suggest
TB
133
Micro path of Legionella pneumonia
Acute, non-necrotizing; Early macrophage infiltrate (unusual in acute pneumonia)
134
S Aureus on sputum gram stain
Gram positive cocci in clusters
135
Gross Path of Tuberculosis Pneumonia
Caseating Granulomas; Ghon focus or complex
137
Definiation of Consolidation
Alveoli filled with blood, pus, or water
138
Aspergillus invasion occurs with
Neutropenia, Immunosuppression, Corticosteroids
139
Gram Stain of Klebsiella Pneumonia
Large encapsulated rectangular (boxcar) Gram negative bacilli
140
Microscopic path of Klebsiella Pneumonia
Acute neutrophilic -\> Subacute macrophage
141
Stain for histo
Methenamine Silver Stain
142
P Jirovecii is the prototype
Subacute/Chronic interstitial pneumonia in an immunocompromised patient
144
Characteristic infiltration pattern of Legionella Pneumonia
Early infiltration by macrophages instead of neutrophils
145
Protein A
S aureus: binds to TNFR1 and opens path for invasion b/t epithelial cells
146
Rupturing spherule releasing endospores
Coccidioidomycosis
147
Gross Path of Histoplasmosis
Tan nodules or areas of consoldiation that develop caseous necrosis
148
Classification of Strep Pneumoniae
Aerotolerant an-aerobic Gram Positive Diplococcus
