9. Respiratory Tract Patholog Flashcards
most common cause of Rhinitis?
rhinovirus
aka common cold
presentation of rhinitis?
sneezing, congestion, runny nose
what is allergic rhinitis?
what is the body’s reaction?
subtype of rhinitis
due to Type I hypersens reaction (usually to pollen)
->inflammatory infiltrate, eosinophils (IgE mediated)
associated with asthma and eczema
what is a nasal polyp?
what can cause it?
=protrusion of edematous, inflamed nasal mucosa
caused by repeated bouts of rhinitis
also caused by Cystic Fibrosis, Aspirin-intolerant Asthma
Aspirin-intolerant asthma: triad?
- asthma
- aspirin induced bronchospasms
- nasal polyps
what is an angiofibroma?
who classicly has this?
benign tumor of nasal mucosa
composed of large blood vessels & fibrous tissue
seen most freq in adolescent males
angiofibroma
classic patient? presentation?
(benign tumor of nasal mucosa)
adolescent males
profuse epistaxis
nasophyaryngeal carcinoma: define
malignant tumor of nasopharyngeal epithelium
nasopharyngeal carcinoma: associated with what?
classically seen in what patients?
EBV
seen in African children and Chinese young adults
nasopharyngeal carcinoma: how to dx?
how might it present?
dx via biopsy. will have pleomorphic keratin-positive epithelial cells in background of lymphocytes (poorly differentiated squamous cell carcinoma)
(remember keratin is intermediate filament of epithelial cells)
often presents with involvement of cervical LNs.
define acute epiglottitis
most common cause?
inflammation of the epiglottis
most common cause = H inf (esp with nonimmunized kids)
acute epiglottitis: presentation?
high fever
sore throat
drooling/dysphagia (blocked airway)
muffled voice
inspiratory stridor
EMERGENCY due to risk to airway
Laryngotracheobronchitis (Croup)
define? most common cause?
inflammation of upper airway
commonly caused by parainfluenza
Laryngotracheobronchitis (Croup)
presentation?
hoarse “barking” cough
inspiratory stridor
vocal cord nodule (aka singer’s nodule)
define. cause?
nodule on true vocal cord. bilateral.
due to excessive use of vocal cords
vocal cord nodule (aka singer’s nodule)
composed of what tissue?
degenerative/myxoid connective tissue
vocal cord nodule (aka singer’s nodule)
presentation? resolution?
hoarseness
resolves with resting of voice
laryngeal papilloma
definition? cause?
benign papillary tumor of vocal cord
due to HPV 6 and 11
laryngeal papilloma
presentation?
hoarseness
SINGLE in adults
MULTIPLE in children
laryngeal carcinoma
define? cause?
squamous cell carcinoma (usually from epithelial lining of vocal cord)
risk factors: alcohol, tobacco.
May arise from laryngeal papilloma (HPV 6/11)
laryngeal carcinoma
presentation?
hoarseness
possibly cough, stridor
pneumonia
definition?
three patterns?
infection of lung parenchyma
Lobar
Broncho-
Interstitial
pneumonia: clinical features?
fever/chills
productive cough (yellow-green or rusty sputum)
tachypnea
pleuritic chest pain
decr breath sounds
dullness to percussion
elevated WBC count
pleuritic chest pain: what is it?
due to what mediators?
pain of the pleura, which are innervated
mediators: Bradykinin, Prostaglandin E2
pneumonia: dx?
chest xray
sputum gram stain
blood cultures
type of pneumonia?
most common causes? (2)
lobar
typically bacterial: Strep pneumo (95%)
Klebsiella (5% - usually 2’ aspiration)
4 phases of lobar pneumonia (seen grossly)?
- Congestion. due to congested vessels, edema
- Red hepatization. due to exudate, neutrophils, hemorrhage. lung goes from spongy to more solid.
- Grey hepatization. due to degradation of RBCs in exudate
- Resolution. tissue regenerates
Resolution of lobar pneumonia due to what type of cells?
Type II pneumocytes
(stem cells of the lung)
regenerate damaged tissue
what type of pneumonia?
common causes? (5)
broncho-pneumonia
due to variety of bacterial orgs:
Staph aureus, H inf, Pseudomonas, Moraxella catarrhalis, Legionella
what type of pneumonia?
causes? (6)
interstitial pneumonia
caused by bacteria or viruses: Mycoplasma pneumoniae, Chlamydia pneumoniae, RSV, CMV, Influenza virus, Coxiella burnetii
Interstitial/Atypical pneumonia: presentation?
relatively mild upper resp symptoms
minimal sputum, low fever
“atypical” presentation
aspiration pneumo: seen in what patients?
usually due to what cause? (3)
pts at risk for aspiration (alcoholics, comatose)
usually due to anaerobic bacterial in oropharynx (Bacteriodes, Fusobacterium, Peptococcus)
aspiration pneumo: usually occurs in what part of lung?
right lower lobe
due to anatomy: right main stem bronchus branches at a less acute angle than left.
secondary pneumonia: define
bacterial pneumonia that occurs after a viral upper resp tract infection
virus has already knocked out the mucociliary escalator; easier for bacteria to infect
Organism that is the most common cause of comm-acquired pneumonia and Secondary pneumo?
causes what type of pneumonia?
Strep pneumo.
Lobar.
Enteric flora that is aspirated and causes Lobar pneumonia?
who does it particularly affect?
Klebsiella.
esp effects elderly in nursing homes, alcoholics, diabetics.
Klebsiella pneumonia: appearance of sputum?
common complication?
sputum = gelatinous due to thick mucoid capsule.
“red currant jelly”
may be complicated by abscess.
second most common cause of Secondary pneumonia, causes bronchopneumonia?
Staph aureus.
stapy aureus pneumonia may be complicated by what?
abscess or empyema (pus in pleural space)
Pneumonia seen in cystic fibrosis patients? what type of pneumonia?
Pseudomonas aeruginosa.
Broncho.
2 causes of secondary pneumonia, commonly superimposed on COPD?
causes broncho-
- H inf
- Moraxella catarrhalis
Community acquired pneumonia that is from an intracellular organism?
Legionella.
causes broncho.
transmitted from water source.
may be pneumonia superimposed on COPD or in immunocompromosed patient.
what kind of pneumonia?
interstitial/atypical
what kind of pneumonia?
bronchopneumonia
lumen of alveoli are filled with inflammatory infiltrate
most common cause of atypical pneumonia?
seen in what patients?
Mycoplasma pneumonia
seen in young adults: military recruits, college students in dorm.
Mycoplasma pneumonia: complications?
-autoimmune hemolytic anemia
(IgM against I antigen on RBCs causes cold hemolytic anemia)
-erythema multiforme
Mycoplasma pneumonia: seen on gram stain?
NO due to lack of cell wall
second most common cause of atypical pneumonia in young adults?
Chlamydia pneumo
RSV: what type of pneumonia does it cause? typically in what patients?
atypical/interstitial
infants.
CMV: what type of pneumonia?
what patients?
atypical/interstitial
immunocompromised due to posttransplant immunosuppressive therapy
Causes atypical pneumonia that occurs in elderly, immunocompromised, pts with pre-existing lung disease?
Influenza virus.
Also increases risk for superimposed S aureus or H inf bacterial pneumonia.
Major reason for the flu shot!
Coxiella burnetii
what type of pneumonia?
seen in what patients?
Atypical/interstitial but HIGH FEVER
“Q fever”
patients are farmers/vets who have come in contact with spores via ticks or placental tissue.
Coxiella burnetii
what type of organism? how is it distinct from others in this category? (3)
Rickettsial organism
distinct due to (1) causes pneumonia (2) does not require arthropod vector because it is a heat-resistant endospore (3) does not cause a skin rash
Tuberculosis: cause?
inhalation of aerosolized Mycobacterium tuberculosis
Primary TB: presentation?
focal, caseating necrosis in lower lung fields and hilar lymph nodes.
-> fibrosis, calcification -> Ghon complex
Secondary TB: cause?
clinical presentation?
re-activation of Mycobacterium tuberculosis (Ghon complex)
Presents with fevers, night sweats, cough with hemoptysis, weight loss
Secondary TB: where in lung?
what structures form in lung?
Apex of lung due to poor lymph drainage and high oxygen tension
structures: cavitary foci of caseous necrosis.
Secondary TB: diagnosis?
Biopsy
caseating granulomas
distinguish from fungal infection via AFB stain (acid-fast bacilli are TB)
Secondary TB: common sites of systemic spread?
- kidneys (most common, -> sterile pyuria)
- meninges (meningitis at base of brain)
- cervical LNs
- lumbar vertebrae (Pott disease)
