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Pulmonology > 08.20 - Pathology of Pulmonary Infections (Nichols) - Questions > Flashcards

08.20 - Pathology of Pulmonary Infections (Nichols) - Questions Flashcards

1
Q

Cough productive of gelatinous blood sputum

A

Symptoms of Klebsiella Pneumonia

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1
Q

___ can frequently nail a specific dx of Cryptococcal Pneumonia

A

Serum Cryptococcal Antigen Test

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2
Q

CXR of TB

A

Patchy or nodular infiltrate in apical or subapical upper lobes

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2
Q

Gross Path of P Jirovecii Pneumonia

A

Heavy, diffusely consolidated, tan lungs

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3
Q

Tx of Pneumococcal Pneumonia

A

Almost any beta-lactam

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3
Q

Aspergillus Pneumonia needs to be distinguished from

A

Mere colonization (aspergilloma) and allergic bronchopulmonary aspergillosis

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4
Q

Gram Stain of P Aerug Pneumonia

A

Long thin Gram negative bacilli with pointed ends

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4
Q

Course of Histoplasmosis

A

Usually self-limited, but may disseminate in cell-mediated immunity deficient

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5
Q

When do macrophages replace neutrophils

A

Day 3

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5
Q

Any __ process will make the lung look like liver

A

Consolidating (alveolar filling)

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5
Q

With caseating necrosis, think __ first, then ___

A

TB, then Histo

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6
Q

Acute pneumonia with diarrhea, confusion, and hyponatremia suggests

A

Legionella

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6
Q

Tx of Histo

A

Itraconazole for mild-moderate; Amphotericin for severe

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7
Q

3 pathologic features of P Aeruginosa Pneumonia

A

Hemorrhagic, Necrotizing, Infarcting

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8
Q

Viral Pneumonia tends to be

A

Interstitial

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8
Q

Primary virulence factor of Cryptococcus

A

Anti-phagocytic capsule

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9
Q

Pathogenesis of S Aureus Pneumonia

A

Commonly follows viral respiratory infection (influenza)

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10
Q

Usual patient with pneumocystis pneumonia

A

HIV w/ CD4

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11
Q

Why does pneumococcal pneumonia stop at lobar septa

A

Non-necrotizing

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11
Q

Micro Path of Aspergillus Pneumonia

A

Necrosis, Hemm, Acute inflammation with regular septate hyphae with dichotomous branching

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12
Q

3 pathologic features of S Aureus Pneumonia

A

Hemorrhagic, Necrotizing, Abscessing

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13
Q

Prognosis of P Jiorvecii Pneumonia

A

Good

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14
Q

Why is pseudomonas aerug pneumonia so much worse than pneumococcal?

A

Hits people hospitalized with already bad disease

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14
Q

Dx of Legionella

A

Can’t culture –> Urine antigen and bronchoscopy

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15
Q

The term aspiration pneumonia is used only for

A

Aspiration of gastroesophageal contents or food misrouted from the oropharynx – large volumes

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16
Q

Gram positive cocci in clusters on sputum gram stain

A

S Aureus on sputum gram stain

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17
Q

Gross Path of Crypto Pneumonia

A

Soft, tan-grey nodules - Not hemmorrhage or calcified

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17
Q

Presentation of P Jirovecci Pneumonia in non-HIV

A

Fulminant respiratory failure

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17
Q

Viral and Mycoplasma pneumonia typically correlates with __ infiltrate on radiology

A

Ground-glass

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18
Q

Epidemiology of P. Jirovecii Pneumonia

A

Immunodeficient

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18
Q

Histo elicits a __ response

A

Caseating Granulomatous

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18
Q

Blasto vs Crypto

A

Blasto is bigger

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19
Q

Epidemiology of TB

A

HIV, Seasonal, Minorities

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19
Q

Mucicarmine Stain is red for

A

Capsule of Cryptococcus

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20
Q

Alveolar non-necrotizing acute bacterial pneumonia is commonly due to

A

Pneumococcus

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20
Q

Micro Path of Histoplasmosis

A

Oval basophilic yeast forms; Necrotizing granulomatous inflammation with epithelioid histiocytes and multinucleated giant cells

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21
Q

When you see caseating necrosis, order these two tests

A
  1. Fungal staining with Methanamine Silver; 2. Acid Fast
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22
Q

Chronic phase of coccidioidomycosis

A

Granulomatous multinucleated giant cell response

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25
Q

What 3 things suggest Legionella Pneumonia

A

Diarrhea, Confusion, Hyponatremia

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26
Q

Alveolar necrotizing acute bacterial pneumonia is caused by

A

S Aureus, P Aeruginosa, Klebsiella

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28
Q

S aureus pneumonia is much worse than pneumococcal, probably b/c

A

it is necrotizing and abscessing

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29
Q

Gross Path of Aspergillus Pneumonia

A

Nodules, commonly with surrounding hemm (target lesions); Infarction

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30
Q

“walking pneumonia” - one of most common cause of atypical pneumonia

A

Mycoplasma Pneumonia

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32
Q

Definition of infiltrate

A

Radiologic manifestation of pneumonia, edema, or hemorrhage

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33
Q

Legionella: necrotizing?

A

No

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33
Q

4/5 Blastomycosis patients come from the ___

A

Jail

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34
Q

Fever, Hemoptysis, and Pleuritic chest pain in neutropenic patient

A

Aspergillosis Pneumonia

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36
Q

Tx of S Aureus Pneumonia

A

Oxacillin or Vancomycin

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37
Q

Micro Path of TB Pneumonia

A

Necrotizing Granulomas w/ epitheliod histiocytes and multinucleated giant cells; Very few organisms

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37
Q

Grey Hepatization Phase

A

Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils

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38
Q

Macrophages in lungs with finely granular brown pigment

A

Smoker’s Macrophage

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39
Q

Signs of Pneumococcal Pneumonia

A

Low fever, Low tachycardia, Mild tachypnea, Crackles

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39
Q

Classic TB sputum has

A

few bugs

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40
Q

Tx of Aspergillus Pneumonia

A

Voriconazole

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42
Q

Tx of Mycoplasma Pneumonia

A

Azithromycin or Levofloxacin

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42
Q

Large encapsulated boxcar gram negative rods on sputum gram stain

A

Klebsiella

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44
Q

Foamy macrophages are characteristic of

A

Subacute bacterial pneumonia

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44
Q

Causes of interstitial chronic pneumonia

A

P Jirovecii, Sarcoidosis, Toxoplasmosis

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46
Q

Gram Stain of S Aureus Pnuemonia

A

Gram positive cocci in clusters

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47
Q

Signs of Histo

A

Fever

47
Q

Acute phase of Coccidioidomycosis

A

Rupturing spherule releasing endospores

49
Q

How does Legionella evade destruction

A

Inhibit phagosome-lysosome fusion

50
Q

Aspergillosis pneumonia patient on step 1

A

Immunocompromised awaiting transplant

51
Q

Presentation of Pneumococcal pneumonia in young people vs adults

A

Sudden severe onset of chils/fever vs gradually progressive fever/sputum production

52
Q

How does Pneumococcus bind epithelial cells

A

Binds to Platelet Activating Factor Receptor

53
Q

Stain for Cryptococcus

A

Mucicarmine Stain –> Capsule stains red

54
Q

Micro Path of Crypto Pneumonia

A

Faintly basophilic yeast; Suppurative and granulomatous inflammation

54
Q

Disseminated lesions resembling milit seeds

A

TB

55
Q

Pseudomonas Vasculitis correlates with ___ features of Pseudomonas Pneumonia

A

Hemorrhagic, Necrotizing, and Infarcting

56
Q

Staining of Legionella

A

Stain poorly with H&E and Gram stain –> Need to do silver stain

57
Q

__ causes nodular pneumonia in immunocompromised patients

A

HSV

58
Q

TB vs S Aureus

A

Both necrotizing, but TB is subacute/chronic, while S Aureus is actue

59
Q

Urine Antigen Test for Pneumococcal Pneumonia

A

Rapid, 70-80 sensitive; 80-100 specific

60
Q

Presentation of Pneumococcal Pneumonia in Elderly

A

Confused, Tired, and Cold; No fever or cough

61
Q

Pulmonary TB starts as ___, then becomes __ when associated with enlarged lymph node

A

Gohn Focus –> Gohn Complex

62
Q

Abscesses in P Aeruginosa Pneumonia

A

No

63
Q

What symptoms and signs suggest Legionella pneumonia

A

Gastrointestinal; Neurologic

64
Q

__ causes interstitial pneumonia in immunocompromised

A

CMV

66
Q

Gross Path of S Aureus Pneumonia

A

Heavy plum-colored lungs; Numerous small abscesses

67
Q

Broad-based budding and double contour walls

A

Blastomycosis

68
Q

You see the term hepatization with ___

A

Pneumococcal Pneumonia

70
Q

Signs of Mycoplasma Pneumonia

A

Erythematous Maculopapular Skin Rash

70
Q

Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils

A

Grey Hepatization Phase

71
Q

Large encapsulated rectangular (boxcar) Gram negative bacilli

A

Gram Stain of Klebsiella Pneumonia

72
Q

Prognosis of Aspergillus Pneumonia

A

Poor

73
Q

Helmets or teacups on silver stain

A

Pneumocystis Pneumonia

75
Q

What does Histoplasmosis mimic

A

TB

76
Q

Symptoms of Klebsiella

A

Cough productive of gelatinous blood sputum

77
Q

Symptoms of Aspergillus Pneumonia

A

Fever, Pleuritic Chest Pain, Hemoptysis: In neutropenic patients

79
Q

Gross path of P Aerug pneumonia

A

Firm red areas of hemorrhagic consolidation; Maybe yellow areas of consolidation with rim of hemm (target lesions); Infarction

80
Q

Risk factors for P Aerug pneumonia

A

Intubation, Neutropenia

82
Q

Micro Path of P Aerug pneumonia

A

Necrotizing; Long thin bacilli invading vessels from adventitia

83
Q

Prognosis of S Aureus Pneumonia

A

Up to 50 % mortality, even if treated

83
Q

Early infiltration by macrophages instead of neutrophils

A

Characteristic infiltration pattern of Legionella Pneumonia

85
Q

Symptoms of Mycoplasma Pneumonia

A

Malaise, headache, Intractable Dry Cough

87
Q

Galactomannan

A

Major constituent of Aspergillus cell walls

87
Q

__ is the prototype Subacute/Chronic interstitial pneumonia in an immunocompromised patient

A

P Jirovecii

88
Q

Necrotizing; Long thin bacilli invading vessels from adventitia

A

Micro Path of P Aerug pneumonia

89
Q

Prognosis of Mycoplasma Pneumonia

A

Vast majority recover without sequelae

91
Q

Micro path of P Jirovecci Pneumonia

A

Foamy eosinophilic; Centro-alveolar “honeycomb” exudate

93
Q

Microscopic path of S Aureus Pneuminia

A

Acute necrotizing w/ abundant neutrophils, fibrin, and edema; Hemorrhage and abscesses

94
Q

Pneumococcal Pneumonia on sputum gram stain

A

Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain

96
Q

Lobar pneumonia is classically due to

A

Strep Pneumoniae

98
Q

Chronic pneumonia tends to be anything but

A

bacterial

98
Q

Micro path of Cryptococcus

A

Translucent/Lightly basophilic budding yeast surrounded by clear space (large anti-phagocytic capsule)

99
Q

What color is mucus

A

Gray

99
Q

__ invasion is classic in Aspergillosis, which is why patients have

A

Blood vessel invasion –> Infarcts

101
Q

Symptoms of Histoplasmosis

A

75% none; Substernal chest pain

102
Q

Abudant Fibring correlates with

A

Pneumococcus

104
Q

Time frame of red hepatization phase

A

Day 2-3

105
Q

Like ___, aspergillosis is very vaso-invasive

A

Pseudomonas

106
Q

Symptoms of Crypto Pneumonia

A

Fever

108
Q

Epidemiology of Cryptococcal Pneumonia

A

Immunodeficient

110
Q

Acute interstitial pneumonia is commonly due to

A

Viruses (influenza)

110
Q

All bacteria are __ in H&E

A

Blue

112
Q

Red Hepatization Phase

A

Day 2-3: Congested capillaries, Alveolar filling with neutrophils and fibrin

113
Q

Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain

A

Pneumococcal Pneumonia on sputum gram stain

114
Q

Dx of P Jirovecii Pneumonia

A

Elevated LDH; Decreased DLCO; Grocott stain

115
Q

Signs for Legionella Pneumonia

A

Fever; Neurologic

116
Q

Tx of Crypto Pneumonia

A

Fluconazole

117
Q

Viral and Mycoplasma species typically produce a ___ pneumonia

A

Non-necrotizing, lymphocytic, interstitial

118
Q

Prognosis of P Aerug Pneumonia

A

Up to 87% mortality, even if treated

119
Q

Tx of P Jirovecci Pneumonia

A

Trimethoprim-Sulfamethoxazole

120
Q

CXR of S Aureus Pneumonia

A

Bronchopneumonic infiltrates

121
Q

Positive sputum smear in TB indicates

A

infectivity

122
Q

Gross path of Klebsiella Pneumonia

A

Patchy or lobar consolidation; Necrotizing, Abscessing

123
Q

Microscopy of Milit Seeds

A

Necrotic w/out granuloma formation –> Kill patient quickly

124
Q

Gross path of Legionella pneumonia

A

Bulging firm rubbery areas of consolidation

126
Q

Fungal and mycobacterial pneumonias tend to be

A

chronic and nodular

127
Q

Epidemiology of Aspergillus Pneumonia

A

Neutropenia, Immunocompromised

128
Q

Almost all acute bacterial pneumonias are due to

A

aspiration of saliva containing the pathogen

129
Q

Most common causes of viral pneumonia

A

Influenza and Respiratory Syncitial Virus

130
Q

Prognosis of TB

A

Usually Good

132
Q

Pneumonia with hilar adenopathy should always suggest

A

TB

133
Q

Micro path of Legionella pneumonia

A

Acute, non-necrotizing; Early macrophage infiltrate (unusual in acute pneumonia)

134
Q

S Aureus on sputum gram stain

A

Gram positive cocci in clusters

135
Q

Gross Path of Tuberculosis Pneumonia

A

Caseating Granulomas; Ghon focus or complex

137
Q

Definiation of Consolidation

A

Alveoli filled with blood, pus, or water

138
Q

Aspergillus invasion occurs with

A

Neutropenia, Immunosuppression, Corticosteroids

139
Q

Gram Stain of Klebsiella Pneumonia

A

Large encapsulated rectangular (boxcar) Gram negative bacilli

140
Q

Microscopic path of Klebsiella Pneumonia

A

Acute neutrophilic -> Subacute macrophage

141
Q

Stain for histo

A

Methenamine Silver Stain

142
Q

P Jirovecii is the prototype

A

Subacute/Chronic interstitial pneumonia in an immunocompromised patient

144
Q

Characteristic infiltration pattern of Legionella Pneumonia

A

Early infiltration by macrophages instead of neutrophils

145
Q

Protein A

A

S aureus: binds to TNFR1 and opens path for invasion b/t epithelial cells

146
Q

Rupturing spherule releasing endospores

A

Coccidioidomycosis

147
Q

Gross Path of Histoplasmosis

A

Tan nodules or areas of consoldiation that develop caseous necrosis

148
Q

Classification of Strep Pneumoniae

A

Aerotolerant an-aerobic Gram Positive Diplococcus

Pulmonology (31 decks)

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