Exam 3 Flashcards
(290 cards)
1
Q
Benign Breast Pathologies (4)
A
- Acute Mastitis
- Duct Ecstasia
- Fibroadenoma
- Fibrocystic Change
2
Q
Acute Mastitis: Epidemiology
A
- occurs almost exclusively in lactating women
- usually in first several months post partum
3
Q
Acute Mastitis: Pathogenesis
A
- Occurs in presence of milk stasis which happens with obstruction of a milk duct… this leads to engorgement and potentially the release of milk into the surrounding breast tissue which induces an inflammatory response
- may allow for infection (staph aureus or streptococcus)
- can also develop without milk stasis when bacteria enters through cracked/damaged nipples.
4
Q
Acute Mastitis: Clinical Presentation
A
- pain/tenderness, swelling, redness, and warmth of breast
- low grade fever and malaise
5
Q
Acute Mastitis: Treatment
A
- drainage of milk from the breast
- warm compress, rest, and antibiotics if necessary
6
Q
Is it safe for the baby to drink the milk of acute mastitis?
A
- yes, gastric juices of infant’s stomach kill infectious agents
7
Q
Duct Ecstasia: Pathogenesis
A
- large ducts near the nipple become dilated (ecstatic)
- at least some cases appear to be related to degenerative changes of the duct wall
8
Q
Duct Ecstasia: Epidemiology
A
- usually occurs in older, multiparous women
9
Q
Duct Ecstasia: Clinical Presentation
A
- nipple discharge (white), and sometimes nipple retraction
- fibrosis may develop around the dilated ducts and mimic carcinoma
10
Q
Duct Ecstasia: Microscopic Findings
A
- chronic inflammation and dilated ducts filled with macrophages and debris
11
Q
Duct Ecstasia: Treatment
A
- if no mass legion, no treatment is necessary
- is mass is present, excision may be done to exclude carcinoma.
12
Q
Fibroadenoma
A
- Benign tumors of the breast that are composed of proliferating stromal and epithelial cells
13
Q
Fibroadenoma: Epidemiology
A
- Usually occur in women in their 20s and 30s
- can be multiple and/or bilateral
- most common benign tumor in the breast
- ~10% of women
14
Q
Fibroadenoma: Pathogenesis
A
- thought to occur in response to estrogen stimulation of the tissue
- polyclonal proliferation of cells
15
Q
Fibroadenoma: Clinical Presentation
A
- mobile, round mass, ranging from 1cm to 4cm
16
Q
Fibroadenoma: Microscopic Findings
A
- well-circumscribed, round legions
17
Q
Fibroadenoma: Treatment
A
- some may not need treatment, others are removed
18
Q
Fibrocystic Change
A
- umbrella term
- encompasses numerous benign changes in the breast
19
Q
Fibrocystic Change: Epidemiology
A
- occurs most commonly in premenopausal women,but can occur in older women as well
20
Q
Fibrocystic Change: Clinical Presentation
A
- can mimic clinical signs of BC like mass formation, mammographic calcification, other mammogram abnormalities
21
Q
Fibrocystic Change: 3 histologic changes
A
- ranked according to severity
- Non-Proliferative
- Proliferative (ductal hyperplasia) (1.5-2x the risk of BC)
- Atypical Proliferative (4-5x the risk of BC)
22
Q
Fibrocystic Change: Treatment
A
- no treatment required, biopsy may be performed to rule out cancer
23
Q
Breast Cancer risk factors (5)
A
- Gender (F: 12% lifetime risk, M: 0.11% risk)
- Age (risk increases with age, average age 61)
- Genetic Factors (family history, BRCA1/2) (genetic is 3% of all BC)
- Estrogen Exposure (high levels of estrogen increase risk)
- Radiation Exposure (therapeutic doses)
24
Q
BC: Incidence and Mortality
A
- 2nd leading cause of cancer death in US
- incidence rose in early 80s (better screening), has leveled off
- mortality declining since 1990s
25
In Situ Carcinoma
- Ductal Carcinoma In Situ, or DCIS
- not invasive into surrounding tissue where lymph vessels are (not metastatic)
- often diagnosed with mammogram
- can be a precursor lesion to invasive carcinoma (8-12x higher risk)
26
Invasive Carcinoma
- cancerous cells spread beyond the ducts into the lymphatic channels where it can metastasize
- usually forms a mass legion
- can sometimes be considered a "chronic disease" instead of a "terminal disease" b/c women can live many years with it
27
Invasive Carcinoma: Clinical Presentations (6)
- palpable lump
- single mass
- hard
- immobile (advanced BC)
- irregular borders (vs. smooth)
- >2 cm
28
Invasive Carcinoma: Diagnosis
- biopsy, esp needle core biopsy
29
Invasive Carcinoma: Prognostic factor - Stage guidelines
- Tumor Size
- Lymphatic Spread (can still be cured)
- Distant Metastasis (generally incurable)
- higher stage worse prognosis (Stage 0: 92% survival, stage IV: 13% survival)
30
Invasive Carcinoma: Common sites of metastisis
- Axillary lymph nodes (almost always first, curable)
- Distant Metastasis
* Lungs
* Bones
* Liver
* Adrenals
* Brain, meninges, CSF
31
Invasive Carcinoma: Prognostic factor - Grade guidelines
- assigned according to how abnormal the cells look under the microscope
- not as powerful of a predictor of prognosis as stage
32
Invasive Carcinoma: Treatments (4)
- Surgery
- Radiation Therapy
- Hormonal Therapy
- Chemotherapy
33
Invasive Carcinoma: Surgery types (4)
- lumpectomy (only diseased tissue taken)
- mastectomy (can also have with reconstruction)
- Lymph node biopsy
- lymph node dissection
34
Invasive Carcinoma: Hormonal Therapy
- >50% of BC express estrogen and progesterone receptors
- often responsive to anti-estrogen agents (tamoxifen/aromatase inhibitors)
- fewer and less severe side effects
- sometimes used as preventive therapy
35
Invasive Carcinoma: Chemotherapy
- Traditional (attack all rapidly proliferating cells)
| - Targeted (antibody designed to attack cells that over-express HER2/neu
36
Common non-neoplastic gynecological conditions (4)
- STIs
- Dysfunctional Uterine Bleeding
- Endometriosis
- Obstetric Conditions
37
Dysfunctional Uterine Bleeding
- excessive menstruation or bleeding between periods
- abnormality in the hypothalamic/pituitary/ovarian hormone mechanism
- often peri-menopausal or right at menarche
38
Excessive Menstruation
- menorrhagia
39
Bleeding between periods
- metrorrhagia
40
Endometriosis
- "powder burn", "chocolate cyst," old blood
- presence of endometrial glands and stroma outside the uterus
- common (~10% women in 20s and 30s)
- frequently occurs in ovaries, fallopian tubes, pelvic peritoneum
- symptoms include pain, adhesions, and infertility
41
Endometriosis Theories of Pathogenesis
- retrograde menstruation (into fallopian tube)
- metaplasia
- vascular/lymphatic dissemination
42
Obstetric Conditions (3)
- Spontaneous Abortion
- Ectopic Pregnancy
- Toxemia of Pregnancy
43
Spontaneous Abortion
- miscarriage
- occurs in 10-15% of recognized pregnancies and 50% of all pregnancies
- most in first trimester are b/c of chromosomal abnormality
- later loss more commonly include hormonal insufficiency, infection, inflammation, trauma
- most of the time the miscarriage is not investigated unless a malformed fetus or 3+ spontaneous abortions
44
Ectopic Pregnancy
- implantation of the fetus somewhere other than the uterus
- 90% in fallopian tubes
- 1/150 pregnancies
- tubal obstruction: 1/3-1/2 patients have PID
- classic presentation of severe abdominal pain 8-10 weeks after last menstrual period
45
Toxemia of Pregnancy
- pre-eclampsia/eclampsia
- need hypertension, proteinuria, AND edema
- about 6% of all pregnant women
- usually in 3rd trimester
- some develop seizures and DIC (eclampsia)
46
Toxemia of Pregnancy: Treatments (4)
- bed rest
- dietary
- BP drugs
- delivery of infant
47
Common Gynecological Neoplastic Conditions (5)
- Vulvar and Vaginal Carcinoma
- Uterine Carcinoma
- Endometrial Carcinoma
- Myometrium
- Ovary and Uterine Tube tumors
48
Vulvar and Vaginal Carcinoma
- most squamous cell
- HPV related (younger women) or Non-HPV related (older women)
- Treatment is surgical, radiation & chemotherapy
49
Uterine Cervical Carcinoma
- common worldwide
- PAP smear screenings v effective at preventing invasive carcinoma
- mostly squamous cell carcinoma
- mortality usually associated from invasion, not metastasis
- HIGHLY associated with HPV (>95%)
- strains 16&18 highest risk, but most cases of HPV do not result in cervical cancer
- HPV vaccine at 11-26 yrs
- Treatment: surgical, radiation, chemo
50
Types of Surgery for Uterine Cervical Carcinoma
- Radical Hysterectomy: higher stage, removes uterus and upper vagina
- Radical Trachelectomy: removal of cervix but leave body of uterus intact (preserves fertility)
51
Endometrial Carcinoma
- "type I": 55-65 yrs, present with post-menopausal uterine bleeding
- risk factors: age, obesity, diabetes, hypertension, infertility, unopposed estrogen
- often cured by hysterectomy
- subgroup of patients more aggressive (looks like ovarian cancer)
- treatment: surgical, radiation, chemotherapy
52
Myometrium (2 types)
- leiomyoma (fibroid)
* benign, common
* symptoms include abnormal bleeding, compression of bladder, infertility, pain
- leiomyosarcoma
* malignant, rare
* does not arise from pre-existing leiomyoma
* treatment mainly surgical
53
Ovary and Uterine tube tumors
- most ovarian tumors in premenopausal women are benign
| - most ovarian tumors in postmenopausal women are malignant
54
Ovary and Uterine tube tumors: cells of origin
- epithelial tumors
- germ cell tumors
- sex cord-stromal tumors
55
Ovary and Uterine tube tumors: Benign Tumors
- 80%
- mature teratoma (dermoid cyst)
- very commonly hair and skin formation
- benign cystademona: of epithelial origin
56
Ovary and Uterine tube tumors: Malignant Tumors
- most are epithelial tumors
* serous carcinoma
* mucinous carcinoma
* endometriod carcinoma
- poor prognosis
- treatment: aggressive surgery, chemo, radiation
57
Non-Neoplastic Conditions of Male Repro (8)
- STIs
- Hypospadias
- Cryporchidism
- Testicular Torsion
- Epididymitis
- Granulomatous orchitis
- Prostatitis
- Benign prostatic hyperplasia
58
Hypospadias and epispadias
- congenital maldevelopment of the urethral groove that results in the urethral opening on either the ventral or dorsal aspect of the penis
- hypospadias is more common (1 in 300)
- complications: higher chance of urinary tract obstruction and infection
59
Cryptorchidism
- undescended testes
- 25% of cases of cryptochidism are bilateral
- arrested sperm development and scaring, infertility
- 5-10x increase risk of developing testicular cancer
- most descend on own by age 1
60
Surgery to place testis into scrotal sac
- orchiopexy
61
Testicular Torsion
- twisting of the testis which obstructs venous flow
- bell clapper deformity (fusion of scrotum and things that tether testis)
- occurs around puberty
- severe pain
- surgical de-torsion performed w/ fixation of the testis
62
De-torsion at 4-6 hrs vs 12 hours vs 24 hours viability
- 4-6: 100% viability
- 12: 20% of testes are still viable
- 24: no viability
63
Epididymitis
- inflammation of the epididymis as a result of infections that travel from the urinary tract down to the epididymis
- chlamydia most common cause in young adult men
- UTI most common cause in older adult men
64
Granulomatous orchitis
- granulomous inflammation of the testis
- rare
- can occur from tb or leprosy
- mostly idiopathic cause
- present clinically with tender testicular mass and fever or painless, enlarged testis
65
Prostatitis (3 types)
- Acute Prostatitis
- Chronic Prostatitis
- Granulomatous Prostatitis
66
Acute Prostatitis
- result of UTIs or after catheterization
| - present with fever, dysuria, and very tender prostate
67
Chronic Prostatitis
- may be from bacterial infection or not.
- presents with low back pain, dysuria, pubic and perineal pain
- usually independent of acute prostatitis
- treatment difficult
68
Why is treatment of chronic prostatitis difficult?
- most antibiotics penetrate the prostate poorly
69
Granulomatous prostatitis
- can be due to infectious agents (e.g. tb and fungi)
- also could be secondary to BGG
- possible to be non-specific also, from a rxn to ruptured ducts in the prostate
70
Benign Prostatic Hyperplasia (BPH)
- nodular hyperplasia
- increase in prostatic tissue
- can be considered normal b/c it occurs so often as one ages
- 20% of 40 yr old men, 90% of 80 yr old men
- clinical symptoms: nocturia, difficulty urinating, initiating and stopping urination, dysuria, UTI
71
What causes growth of the prostate? (2 hormones)
- testosterone
- dihydroxytestosterone
* more potent
72
Therapy for BHP
- 5-a reductase inhibitors
- a1- adrenergic receptor blockers
- transurethral resection of prostate (TURP)
73
Neoplastic Male Repro Conditions (3)
- Penile Cancer
- Testicular Cancer (germ cell tumors and lymphoma)
- Prostate Carcinoma
74
Penile Cancer
- carcinoma in-situ (no access to lymphatic channels) and invasive carcinoma
- less than 1% of male cancers in US
- associated with HPV, smoking, poor hygiene
- circumcision reduces risk, but US risk is also very low
75
Testicular Cancer: Germ Cell Tumors
- peak incidence 15-34 yrs of age
- two subtypes:
* seminoma (most common), good prognosis, usually caught early
* non-seminoma: higher stage of diagnosis, worse prognosis
- - one type is teratoma (usually malignant)
- risk factors: Race (white more common), Family History
- Often secrete hormones or enzymes
- common sites of metatstasis: retroperitoneal lymph nodes, other lymph nodes, lungs, liver, brain bones
76
Spermatocytic seminoma
- much older average age (>65) and very good prognosis
77
Testicular Cancer: Lymphoma
- systemic malignancy (present in many areas of body)
| - most common cancer in the testes in men over 60
78
Prostate Carcinoma: Clinical Presentation
- Nodule on rectal exam
- elevated PSA
- occasionally urinary symptoms
- symptoms from metastasis (bone pain)
79
Prostate Carcinoma: Etiology (Risk Factors) (5)
- Age: risk increases with age
- Race: common in blacks and whites, not asians
- Diet: dietary fat increase risk, lycopenes decrease risk
- Androgens
- Genetics: 8-10%
80
Prostate Carcinoma: Prognostic Factors
- Stage: most important
| - Grade: relatively more important in prostate cancer than some other cancers
81
Prostate Carcinoma: common sites of metastasis
- bone (most common)
- lung
- liver
- brain
82
Prostate Carcinoma: Treatments
- wait
- surgery
- radiation
- hormonal therapy (anti-androgens)
- chemo
83
Eunuch
- castrated male
| - will not get benign prostatic hypertrophy nor prostate cancer
84
Acute Kidney Injury refers to
- process that happens within hours to days that prevents clearance of waste products from the blood
- is potentially reversible
- increase in serum creatinine or reduction in urine output
85
azotemia
- buildup of nitrogenous waste products in the blood
- detected by blood urea nitrogen (BUN) levels
- preferred lab measurement is the serum creatinine test
86
urine output of
- oliguric
87
urine output of
- anuric
88
Uremia
- clinical syndrome of organ dysfunction that results from azotemia
- presents with fatigue, nausea, neuropathy, paricarditis, asterixis
89
asterixis
- flapping of the hands
| - symptom of uremia AKI
90
Serum Creatinine Test
- AKI measurement
| - creatinine is produced by all muscles and should be filtered by the kidneys
91
Etiology (Causes) of AKI
- pre-renal (low blood flow to kidney)
- post-renal (blockage so urine cannot flow)
- problem with glomeruli, tubules, or interstitum (intra-renal)
92
Pre-Renal AKI
- major issue is lack of blood flow from various insults
| - fixed by fixing insult (i.e. septic)
93
Post-Renal AKI
- not common
- usually "plumbing issue", something is blocking exit
- ex.) elderly man with enlarged prostate blocks the free flow of urine
- need renal ultrasound to see if hydronephrosis
94
hydronephrosis
- ureters and renal pelvis distended secondary to blockage of urine
- related to Post-Renal AKI
95
Intrinsic AKI (3) (what can be found in the urine?)
- casts (tubular proteins that trap RBC, WBC) commonly found in the urine
- Acute Interstitial Nephritis (AIN)
- Glomerulonephritis (GN)
- Acute tubular necrosis (ATN)
96
Acute Interstitial Nephritis
- AIN
- inflammation of the interstitium
- usually from medications that elicit a hypersensitivity rxn
- urine has WBCs
- mononuclear cells
97
Glomerulonephritis
- GN
- inflammation of the glomeruli
- presence of blood and protein in the urine
- can be immune-complex mediated (Wegener's granulomatosis) or non-immune complex mediated (post-streptococcal GN, traveled to kidneys)
98
Acute Tubular Necrosis
- ATN
- supply of oxygen and nutrients to the kidney tubules is insufficient to meet their metabolic demands
- can also occur when tubule cells exposed to a toxic agent
- extreme ATN has a loss of many tubules simultaneously, little or no urine output
- if tubular basement membrane remains intact, can heal itself over time.. if fibrosis, permanent damage
99
Two types of renal replacement therapy (dialysis)
- hemodialysis
| - peritoneal dialysis
100
Hemodialysis
- blood and clean fluid run countercurrent to each other through an artificial filter
- 3x/week, in a clinic
101
Peritoneal dialysis
- uses the peritoneum as a filter
- dialysate is placed directly into the abdominal cavity and overtime toxins diffuse from the capillaries into the abdominal cavity
- done daily, at home
102
why is an AKI transplant unique?
- do not remove 'old' kidney, just place new one beside it
103
Chronic Kidney Disease (CKD)
- kidney damage present for >3 months
- and that damage most commonly confirmed with a loss of GFR
- 5 stages (1 is essentially normal GFR and stage 5 needs RRT)
- irreversible
104
Pathology of CKD
- destruction of either glomeruli or renal tubules leads to functional loss of the nephron
- each remaining nephron takes on an additional workload (single-nephron GFR) but that causes them to become injured faster (super-nephron hypothesis)
- adaption can take place until less than 20% of the normal nephrons are left
- eventually, nonfunctioning nephrons are replaced by fibrosis tissue
105
Uremic Syndrome
- clinical syndrome of azotemia associated with organ dysfunction
- when the kidneys are no longer able to maintain a balance b/c the workload is too large
106
Typical Symptoms are Uremia
- fatigue
- increased irritability
- difficulty breathing
- nausea
- itching
- edema
107
Typical signs/altered lab values of uremia
- hypertension
- edema
- anemia
- acidosis
- low serum calcium
- high serum phosphate and/or potassium
- high levels of nitrogenous waste
108
Medications to help protect the kidneys over time
- ACE inhibitors (prevent angiotension 1 to angiotensin 2)
* keeps BP and aldosterone down to lessen salt retension
- Angiotension receptor blockers (ARBs)
109
Estimating GFR (general)
- inputs for creatinine level, age, if female, if african american
110
Most common causes of CKD in the US (4)
- diabetes, hypertension, glomerular disease, polycystic kidney disease
111
Patients with CKD are at high risk for what other disease?
- cardiovascular
112
Stages of CKD are determined by what two broad factors?
- Hypertension/Lab abnormalities
| - Clinical Symptoms
113
Risk factors for progression of CKD
- Hypertension
- Proteinuria
- Diabetes
- Smoking
- Hyperlipidemia
114
Who are kidney transplants usually given to?
stage 4 or 5 CKD, rare to get transplant if AKI
115
US stats on STIs
- 20 mil new STI cases/yr
| - 50% in 15-24 yr olds (reporting bias in minorities)
116
Types of Bacterial STIs (4) in order of prevalence
- Chlamydia
- Gonorrhea
- Syphilis
- Chancroid
117
Treponema Pallidum
- Syphilis, leus
- spirochete organism
- causes systemic disease in multiple forms
118
Treponema Pallidum: Clinical Features primary stage
- chancre 3 weeks after infection
119
Treponema Pallidum: Clinical Features secondary stage
- 2-10 weeks after chancre
- rash on palms and soles
- condyloma lata (lesions in genital area)
- lesions contain organisms
- sometimes fever, headache, arthritis
120
Treponema Pallidum: Clinical Features tertiary stage
- rare to develop in US
- inflammatory lesions, low amts of organism
- spread to aorta, CNS, gummas in skin, bones
- occurs years after primary infection
121
gumma
- tertiary stage of syphilis
| - granuloma like lesions
122
Congenital Sphyilis
- greatest risk when mother is in primary or secondary stage
- or late in pregnancy b/c easier to cross placenta s
- stillbirth in ~20-40% of untreated cases
123
syphilis pathogenesis
- chronic inflammation and scarring involving blood vessels
124
syphilis diagnosis & treatment
- cannot be cured
- use treponemal test against antibody (specific)
- non-treponemal test: (non specific) reflects disease activity
- treatment: penicillin
125
Neisseria Gonorrhoaea
- gonorrhea
| - facultative intracellular (can live in and outside cell)
126
Neisseria Gonorrhoaea: clinical features
- urethritis
- epididymitis
- PID
* endometrium usually spared from infection
- Pharyngitis
- proctitis (inflammation of rectum and anus)
- common to have co-infection w/ chlamydia
127
Neisseria Gonorrhoaea passed from mother to baby
- can cause blindness
- joint infection
- sepsis
128
Neisseria Gonorrhoaea Diagnosis
- gram stain of discharge
- culture
- DNA probe (most common)
129
Neisseria Gonorrhoaea Treatment
- generally treated for both gonorrhea and chlamydia at the same time (sometimes before test results back)
- antibiotic resistance is becoming a problem
130
Chlamydia trachomatis
- serotypes D-K commonly seen in the US
131
Chlamydia trachomatis: clinical features
- infects similar sites to gonorrhea
- often mild symptoms or asymptomatic but still does chronic damage (PID, infertility)
- associated with preterm delivery
132
Chlamydia trachomatis: Diagnosis
- DNA probe most commonly used
133
Chlamydia trachomatis: Treatment
- azithromycin, doxycycline
| - usually treated for gonorrhea as well b/c commonly co-infect
134
Haemophilis ducreyi
- chancroid
- gram negative coccobacillus
- common in the tropics
- associated with uncircumcised men and poor personal hygiene
- sores appear 4-7 days after exposure and open up to lesions
- associated with HIV spread
135
Haemophilis ducreyi diagnosis & treament
- culture or PCR
| - treatment: azithromycin, ceftriaxone, erthyromycin, ciprofloxacin
136
Viral STIs (3)
- HPV
- HSV (herpes simpex)
- HIV
137
HPV (capsulated/non-capsulated)(what type of cell it infects) (two general types)
- NON-ENCAPSULATED DNA virus
- infects basal epithelium of squamous mucosa
- 100+ types identified
- clinical features:
* asymptomatic
* low risk (6,11) genital warts
* high risk (16&18) may lead to dysplasia and carcinoma
138
Herpes Simplex Virus
- HSV
- ENCAPSULATED DNA virus
- two types: HSV-1 (infects mouth) & HSV-2 (infects genitals)
139
HSV clinical features
- infects epithelium of skin and mucous membranes
- enters the sensory neurons around the site of infection
- symptoms only occur in 1/3 infected
* blistering lesions that heal in 1-4 wks
- increased susceptibility to HIV
- subsequent outbreaks not a severe as the first
140
HSV and transmission
- can occur in both active and latent phases, but more likely in the active phase
141
HSV and pregnancy/birth
- can be passed from mom to baby in birth canal
| - may be fatal to the infant
142
HSV diagnosis & treatment
- serology: sensitive and specific
| - no cure; some antiviral agents prevent outbreaks and shorten duration/severity
143
HIV
- ENCAPSULATED RNA virus
- replicates by reverse transcription (retrovirus)
- infects cells that express CD4 on surface (T-cells)
144
Transmission of HIV
- via exchange of bodily fluids
- sexual
- parenteral inoculation (needle sharing)
- mother to infant (birth canal, breast milk, transplacental)
- NOT through casual contact
145
At risk groups in US adult population for HIV
- Homosexual & bisexual men
- intravenous drug abusers
- hemophiliacs or other who received blood or organs (before 1985)
- heteros who have had contact with any above group
146
HIV clinical course (3 stages)
- acute retroviral syndrome (flu-like)
- chronic asymptomatic phase (7-10 yrs)
* continuous HIV production, steady decline in CD4 T-Cells
- AIDS
* fever, fatigue, weight loss, severe opportunistic infections & neoplasms, neurological diseases
147
HIV diagnosis
- test for antibodies to HIV
| - test for viral nucleic acids in blood by PCR
148
HIV treatment
- Highly Active Antiretroviral Therapy (HAART)
149
Protozoal STI
- Trichomas Vaginalis
* adheres to mucosal surface, does not invade
* motile
150
Trichomas Vaginalis: Clinical Features
- asymptomatic
- itching
- discharge (vaginal or penile) fishy odor, yellow-green
- urinary frequency and/or dysuria
- dyspareunia (painful intercourse)
151
Trichomas Vaginalis: Diagnosis and Treatment
- small red ulcerations present on vaginal wall or cervix
| - treatment: metronidazole, tinadazole
152
General functions of the skin
- physical barrier
- immune organ
- provide pigment
- produce vitamin D
- absorptive ability
153
basal cells of skin
- like the "stem cells" of the skin
154
What cells produce melanin
- melanocytes
| - malignant melanoma from melanocytes
155
two most common neoplasms of the epidermis
- squamous cell carcinoma
- basal cell carcinoma
- both more common in older populations
- rarely lethal
- most common types of cancer in the US but easily treated so they are not included in statistics
156
Melanoma
- malignant neoplasm from melanocytes
- related to sun exposure
- arises in a younger population, spreads widely throughout the body
- affects unusual sites like acral skin, eyes, nail beds, internal organs
- incidence rising due to UV exposure from sunlight
157
Melanoma clinical manifestation
- naked eye best way to detect
| - use ABCDE criteria
158
Nevus
- mole, collection of cells present in an unusual location or excessive number
159
ABCDE criteria for melanoma identification
- A: asymmetry (two halves are not mirror images
- B: border irregularity (outlines are not rounded and smooth)
- C: color (not uniformly colored)
- D: diameter >6mm
- E: Evolution (does it change overtime)
160
Pathogenesis of Melanoma
- UV radiation in sunlight makes DNA damage
- formation of pyrimidine dimers
- accumulation of ROS
* melanin usually an antioxidant
- mutations in pro-growth factors, & telomerase
161
Diagnosis of Melanoma
- excision and examination of the specimen
- two most important prognosis factors are thickness and ulceration
- thin ones can be removed and person cured immediately
162
Melanoma next two most important prognosis factors
- lymph node metastasis and distant metastasis
163
what is rare about distant metastasis in melanoma?
- affects organs not usually involved (spleen and heart)
164
Acne Vulgaris
- caused by infection of plugged sebaceous glands
| - refined categorization by age group, etiologic agent, distribution, or severity
165
What plugs sebaceous glands?
| - what is it called when bacteria infect the plug
- mixture of keratin and sebum (oily product of gland)
| - when bacteria colonize the plug it forms a comedone
166
comedone below skin surface vs above
- below: whitehead
| - above: blackhead
167
What happens when sebaceous plug ruptures?
- releases pro-inflammatory factors
- WBC clean up debris and pustule forms
- fusion of pustules can lead to nodule and cyst formation
168
what is the most severe form of acne?
- nodule and cyst formation
169
Risk factors for acne vulgaris
- androgen production (male, puberty, steroids, stopping birth control pills, pregnancy..)
- stress (increases androgen production
- family history
- skin irritation
- some medications
170
Treatment for acne
- aimed at restructuring the follicles and eliminating the bacterial superinfection
- use retinoids to normalize epithelial cell maturation
- topical (benzoyl peroxide) and oral antibiotics most commonly used
171
Cellulitis
- infection of the skin caused by staphylococcal or streptoccocal bacteria
- can result in skin necrosis if not treated, bacteremia, and septic shock
172
Dermatitis
- inflammation of the skin; a reaction pattern
- red, itchy rash
- variety of causes such as autoimmune, hypersensitivity, genetic, toxins etc
- variety of environmental triggers: sunlight, drugs, chemicals, temperature, stress
- usually not infectious
173
Contact Dermatitis
- localized skin rxn to an irritant only @ site of contact with the skin
- two types:
* irritant contact derm
* allergic contact derm (auto-immune)
174
Irritant contact derm
- general improvement with time
- resolves relatively quickly after cessation of exposure
- ex. rubbing alcohol, cosmetic products, sawdust
175
Allergic Contact Derm
- initial exposure sensitizes T-cells to an antigen
- subsequent exposure elicits a T-cell mediated localized immune rxn
- common offenders: poison ivy, nickel, latex, UV light (photo-allergic contact dermatitis)
176
Treatments of Dermatitis
- avoid contact with irritant
- prescription steroid creams
- antihistamines for itching
177
Complications to Dermatitis
- secondary skin infection
| - chronic, itchy, scaly skin due to chronic itching
178
Atopic Dermatitis
- ex. eczema
| - patches of dry, itchy skin in a person with allergies, asthma, or hay fever
179
Seborrheic Dermatitis
- dandruff, cradle cap
| - red rash associated with waxy scaly plaques on scalp
180
Interstitial Lung Diseases
- characterized by lung injury
- pulmonary inflammation related to known or unknown causes
- variable degrees of fibrosis
181
Types of Interstitial Lung Disease (4)
- Idiopathic Pulmonary Fibrosis (IPF)
- Sarcoidosis
- Hypersensitivity Pneumonitis
- Pneumoconiosis
182
Idiopathic Pulmonary Fibrosis
- fibrotic interstitial lung disease
- unknown etiology
- seen as an end result to other lung diseases
- presents as progressive dyspnea and dry cough
- diagnosed by chest CT
- typically seen in males >55
- 50% of patients die within 5 years
- no effective treatments
- lung transplantation is the only cure
183
Lung Transplantation
- only for terminal lung diseases (COPD, cystic fibrosis, IPF)
- single lung (IPF, COPD) or double lung (CF)
- high risk surgery
- average survival after transplantation is only 5 yrs
- other limitations such as high cost, availability
184
Pathogenesis of IPF (two "stages")
Usual Interstitial Pneumonia (UIP)
- alveolar walls thickened with extensive fibrosis
- extreme abnormalities in alveolar architecture
Desquamative Interstitial Pneumonia (DIP)
- milder/earlier type of this disease
- minimal fibrosis, alveolar inflammation, and fulness of alveoli with macrophages
185
Two new drugs for IPF (general info)
- nintedonib and pirfendone
- slow down progression but do not cure
- $$$$$
186
What to do to "help" IPF?
- vaccinations for flu and pneumonia
- pulmonary rehab and oxygen therapy
- palliative care (live longer this way than with aggressive treatments)
- corticosteroids if they help
187
Sarcoidosis
- chronic granulomatous interstitial lung disease of idiopathic origin
- lungs most affected but can also be in eyes, skin, liver, spleen, bones, muscles, lymph nodes etc
- patients often present with dyspnea and cough
- most patients it resolves itself spontaneously
- in cases where it is not spontaneously resolved, treatment with corticosteroids
- the more severe it comes in, the more likely it will resolve itself
188
Pathogenesis of Sarcoidosis
- activation of T-Lymphocytes
- formation of granulomas
- minimal fibrosis
189
Stages of Sarcoidosis
- stage I: lymph nodes ("Idaho Potato")
- stage 2: lymph nodes and parenchyma
- stage 3: parenchyma disease
190
Ethnic Vulnerability of Sarcoidosis
- AA Women + +
- N Europeans +
- Asians - -
191
Hypersensitivity Pneumonitis
- Exterinsic Allergic Alveolitis
- pulmonary inflammation secondary to immune rxn to inhaled ORGANIC dusts
- most common are found in moldy hay (farmer's lung disease) and bird droppings (bird feeder's disease)
- two main syndromes
* acute: manifests rapidly after exposure to a fever, cough and dyspnea within a few hours of exposure and resolves in 24 to 48 hours
* chronic: low grade exposure over a long period of time, hard to connect to disease. cough and progressive dyspnea
- main treatment is avoidance of exposure to the offending agent and corticosteroids
192
Pneumoconioses: what it is and the two types
- caused by inhalation of INORGANIC dusts
- cause pulmonary inflammation associated with granulomas and a varying degree of fibrosis
- Silicosis
- Asbestosis
193
Silicosis
- caused by inhalation of silicon dioxide (silica)
- occurs in mining, sandblasting, and foundries
- causes pulmonary inflammation and fibrosis
- symptoms generally minimal in cases of simple silicosis
- x-ray findings and history sufficient for diagnosis
- do not require treatment generally, but at increased risk for developing TB
194
Asbestosis
- fibrotic pulmonary disease caused by inhalation of asbestos
- occurs in mining, insulation, tile production, and ship building
- inhaled asbestos fibers deposit in distal airways and alveoli and are ingested by macrophages
- asbestos bodies form (asbestos fibers surrounding with iron rich protein)
- clinically apparent 20-30 years post exposure
- progressive dyspnea and cough
195
Other conditions resulting from asbestosis
- pleural plaques
- pleural effusion
- mesothelioma
- increased risk for bronchogenic carcinoma esp in smokers
196
Mesothelioma
- can result from asbestosis
- cancer of the pleural surface
- need very low level to trigger
- very lethal cancer
197
What level risk from combination of asbestos exposure and smoking to get bronchogenic carcinoma
- 100 fold increase
198
Lung Cancer
- 1/4 of all cancer deaths
- more people die from lung cancer than from breast, colon, and prostate cancers combined)
- carcinoma of the lung is the most common cause of death of men and women in the US (160,000 deaths/yr)
- 225,000 new cases/yr
- most types present with persistent cough, sputum, weight loss, and hemoptysis
- diagnosis by chest x-ray and tissue examination
199
Small Cell carcinoma
- highly malignant cancer
- poor prognosis because usually caught late
- majority of patients have metastasized before diagnosis
- unpredictable
200
Non-small cell carcinoma
- more localized and metastasize slower
| - includes large cell carcinoma, squamous cell carcinoma, and adenocarcinoma
201
Treatment of Lung Cancers
- main therapy for small cell: chemo
- main therapy for non-small cell: surgery
- molecular marker targeted therapy now starting to be used
202
Pyelonephritis
- inflammation of the kidney
- usually due to bacterial infection
- viruses and fungi possible, but unlikely (mainly in immunocompromised patients)
203
Route of infection of Pyelonephritis
- Hematogenous
| - Ascending
204
Hematogenous Route of Pyelonephritis
- via the bloodstream
- less common
- usually occurs when sepsis or endocarditis
- more likely to be viruses and fungi if this way
205
Ascending Route of Pyelonephritis
- via lower urinary tract (urethra and bladder)
| - most common route of infection
206
Clinical presentation of acute pyelonephritis
- fever
- costovertebral angle tenderness (back where kidneys are is very tender)
- bladder/urethral symptoms (dysuria. frequency, urgency)
207
Risk factors for pyelonephritis (8)
- Gender and Age
- Partial Anatomical obstruction of urinary tract
- neurogenic bladder
- instrumentation of bladder (catheter)
- pregnancy
- diabetes
- immunosuppression
- vesicoureteral reflux
208
Pyelonephritis Gender and Age risk factor
- overall more women than men
| - very young and over age 40, more men than women
209
Neurogenic Bladder
- improper filling and emptying of bladder due to abnormality of its nerve function
210
Diabetes in Pyelonephritis
- immunosuppressed
- bacteria adhere more easily to their walls
- may develop neurogenic bladder
- glucosuria provides substrate for bacteria to grow
211
Vesicourteral Reflux
- urine flowing retrograde up the ureter due to "one way valve" not proper
212
Organisms associated with Pyelonephritis
- Escherichia Coli (85% of infections)
| - other organisms usually found in GI tract or skin organisms
213
Bacterial Virulence Factors with pyelonephritis
- fimbriae: filamentous proteins on surface of bacteria that allow the bacteria to adhere easier
- P fimbrae are expressed in some E. coli strains and are able to bind to galactose-galactose molecules on surface of epithelial cells lining the urinary tract
214
Pathologic findings of pyelonephritis: urinalysis
- cloudy urine b/c of pyuria, hematuria, proteinuria, and high pH
- find leukocyte casts as well (cylindrical shape)
215
pyuria
- WBC in urine
216
Acute pyelonephritis pathologic findings
- rarely seen b/c usually treated right away
- neutrophilic inflammation of renal tubules and interstitum
- rare cases form abscess (more severe)
217
Chronic pyelonephritis pathologic findings
- small, shrunken kidneys
- scarring on surface of kidney to calyx
- tubular dilation and chronic inflammation
218
Cystic Kidney Diseases (5)
- Simple Cyst
- Autosomal Dominant Polycystic Kidney Disease
- Autosomal Recessive Polycystic Kidney Disease
- Renal Cystic Dysplasia
- Acquired Renal Cystic Disease
219
Simple Cyst
- very common and may occur at any age
- usually one, maybe more thin-walled cysts on surface of kidney filled with clear or yellow fluid
- usually asymptomatic w/ no complications
- may rupture if too large
220
Autosomal Dominant Polycystic Kidney Disease
- AKA Adult Polycystic Kidney Disease
- fairly common
- always BILATERAL
- loss of renal function in 30s or 40s
- may have hematuria
- may have pain due to pressure from enlarged kidney or due to passage of blood clots
- both kidneys MASSIVELY ENLARGED
- hundreds of cysts
- about 10% of all renal failure patients are from APKD
- associated with intracranial aneurysms and mitral valve prolapse, asymptomatic cysts in other organs (liver)
221
Genes associated with Autosomal Dominant Polycystic Kidney Disease
- PKD1 and PKD2
- PKD1 = 85% of cases
- thought to play a role in adhesion between cells and adhesion of cells to surrounding matrix
- results in overactive proliferation of tube cells, overactive secretion of fluid, and fibrosis
222
Autosomal Recessive Polycystic Kidney Disease
- AKA childhood Polycystic Kidney Disease
- rare
- always BILATERAL
- renal failure in infancy/childhood
- enlarged kidneys with SMOOTH surface
- hundreds elongated cysts that run perpendicular to surface of the kidney
- mutations of the PKHD1 which encodes fibrocystin
- usually liver has cysts as well
- if child lives long enough, may develop liver fibrosis and failure (congenital hepatic fibrosis)
- best chance for survival is both a kidney and liver transplant
223
What is unique about transplants with Adult and Childhood Polycystic Kidney Disease?
- take the old kidneys out
| - too large for body
224
Renal Cystic Dysplasia
- Multicystic Dysplastic Kidney
- Dysplastic refers to abnormal development, not cancer
- may be unilateral or bilateral
- if unilateral --> flank mass in young child
- if bilateral --> may present with kidney failure in newborn
- slightly enlarged and irregular
- 20-50 cysts
- Islands of abnormal structures (cartilage, undifferentiated mesenchyme, immature collecting ducts)
- pathogenesis is abnormal metanephric differentiation
- outcome depends on whether it is unilateral or bilateral
225
Acquired Renal Cystic Disease
- affects men more than women
- occurs from long term dialysis treatment
- small "end-stage" kidneys
- multiple cysts inside
- complications: hematuria, renal cell carcinoma may develop
- non-functioning kidney anyways
226
Regulation of PaCO2
- 1:1 relationship between CO2 production and ventilation
- hyperventilation: reduced PaCO2
- hypoventilation: increased PaCO
227
Alveolar Hyperventilation associated disease states
- low PaCO2
- Fever, sepsis
- medications
- metabolic acidosis
- maximum exercise
- hypoxemia
- anxiety
228
Alveolar Hypoventilation assocated disease states
- CNS depression
- Airway Obstruction
- Chest wall restriction
- Advanced interstitial lung disease
- neuromuscular disorder
229
hypoxemia
- reduction of PaO2
230
5 mechanisms of hypoxemia
- Low inspired oxygen: airplanes, high altitude
- Impaired diffusion (thick membranes)
- Hypoventilation
- Low V/Q; ventilation/perfusion ratio low
- Right-to-left shunt
231
Right-to-left shunt: hypoxemia
- venous blood reaches systemic circulation w/o contacting alveolar oxygen
232
Residual Volume
- volume of air remaining at the end of forced exhalation
233
Functional Residual Capacity
- volume of gas remaining in lung after normal exhalation
234
Inspiratory Capacity
- volume inspired rom normal-end exhalation
| - dependent on inspiratory muscle strength
235
Vital Capacity
- volume of air inhaled or exhaled between maximum inspiratory and expiratory effect
236
Resistance vs Elastance
- Resistance: how difficult airflow is through airways
| - Elastance: how well the lung and thorax stretch
237
Elastic properties plotted on graph (axes)
- volume vs pressure
- highest TLC is emphysema (hyperinflation)
- lowest TLC is fibrosis (restriction)
238
Restrictive Lung Disease hallmark
- Reduced TLC
239
Two categories of restrictive lung disease
- restriction secondary to parenchymal abnormality (e.g. fibrosis)
* TLC reduced with rest of lung volumes
- restriction secondary to respiratory muscle weakness (eg. ALS)
* TLC is reduced along with IC (too weak to take a deep breath)
* RV is increased b/c patient is too weak to exhale maximally
240
Pathophys of Airflow obstruction (hallmark)
- FEV1/FVC reduced
241
Mechanisms of Airflow Obstruction (2)
- narrowing of airway lumen (increased thickness of airway wall & mucus and secretions that block airway)
- Dynamic airway narrowing (destruction of elastin fibers that decrease support and are prone to collapse when pressure in chest increases b/c of inhalation)
242
Spirometry
- tests lung forced vital capacity
- how much air in lung (-RV)
- test FEV1: how much air out in first second compared to total
* normal is 75-85% total capacity in first second
243
Pulmonary Hypertension
- increased pressure in the pulmonary vascular system
244
Two main patterns of Pulmonary Hypertension
- Acute (pulmonary embolism) and Chronic (result of chronic lung disease, recurrent thromboembolisms, congenital heart disease, and left heart failure
245
Primary Pulmonary Hypertension
- extreme fibrosis and very little blood flow
- leads to rapid death in most patients
- idiopathic cause
246
Pulmonary Embolism
- lodging of a preformed clot in pulmonary vasculature
- raises pulmonary pressure
- most clots originate in deep veins of legs and break off and travel to lungs
- symptoms: shortness of breath & chest pain, increased respiration, pulse rate, low PaO2 and PaCO2
- MOST clots fragment and lyse in a few days
247
Adult Respiratory Distress Syndrome (ARDS)
- clinical syndrome of rapidly progressing respiratory failure characterized by severe hypoxemia
- typically seen in previously healthy patient who sustained a severe injury or other catastrophic illness
- results from diffuse alveolar damage (DAD): non-specific pattern of pulmonary parenchymal reaction
248
Potential causes of ARDS
- Severe infection
- multiple trauma
- aspiration
- pancreatitis
- shock
249
Pathogenesis of ARDS
- main mechanism for DAD is sever lung injury resulting in endothelial and epithelial damage
- results in leakage of protein-rich fluid from capillaries into alveolar space and loss of type-1 pneumocytes
- inflammatory cells accumulate
- type 2 pneumocytes replace type 1
- fibrosis follows
250
Phases for DAD
- Exudative phase
- Organizing phase
- Resolution
251
Exudative Phase
- DAD
- first phase, develops over first week following the insult
- accumulation of inflammatory cells
- sloughing of type 1 cells
- can be edema as well
252
Organizing phase
- DAD
- second phase, second week following injury
- proliferation of type 2 pneumocytes
- varying degrees of fibrosis follow q
253
Resolution phase
- DAD
- third phase
- those who survive will gradually improve, most likely not to original function b/c of fibrosis that is left
254
Clinical Features of ARDS
- typically present a few hours post-insult with dyspnea, progressive hypoxemia, and diffuse infiltrate on chest x-ray
- most often will require mechanical ventilation and high levels of O2
- improvement in mortality rate from 70% 40 yrs ago to 40% recently
- no specific therapy, supportive care used, reverse underlying cause if possible
255
COPD
- chronic obstructive pulmonary disease
- patients with both chronic bronchitis or emphysema who show evidence of decreased expiratory flows
- irreversible
256
Chronic Bronchitis
- defined by symptoms
- presence of chronic productive cough for >3 months per year over 2 years
- leading cause is cigarette smoking (>90% of those with disease are smokers)
- pathology includes hyperplasia of mucus secreting cells
- thickening of bronchial wall
- excess mucus in airways
- chronic PRODUCTIVE cough and dyspnea
- treatment: flu and pneumonia vaccines, anitbiotics, bronchodilator & anti-imflammatory meds, supplemental oxygen
257
Emphysema
- defined by pathology
- enlargement of air spaces in alveolar sacs with destruction of bronchial walls
- no significant fibrosis
- major cause is cigarette smoking (increased number of neutrophils)
- damage to elastic tissues which leads to impaired elastic recoil and dilation of bronchioles
- little relationship between location of the emphysema and its clinical manifestation
258
1% of emphysema patients are deficient in what?
alpha-1 anti-trypsin
| - most of time emphysema from outside factors causing damage
259
Emphysema clinical features
- most greater than 60 yrs old
- progressive dyspnea upon exertion
- patients often have weight loss secondary to increased work of breathing
- chest hyperinflation
- no cure, treatment is to stop smoking, oxygen therapy, bronchodilators
- in end stage, patient can be considered for lung transplantation
260
Asthma
- reversible airway obstruction with increased airway resistance to a variety stimuli
- airway inflammation common
- 7% of US population
- allergy important risk factor
261
Pathogenesis & Pathology of Asthma
- stimuli lead to release of histamine, prostaglandins, leukotrienes from inflammatory cells in lungs
- these contribute to airway edema, increased mucus secretion, and smooth muscle contractions
- pathology: loss of bronchial epithelium, inflammation with eosinophils
262
Clinical features of asthma
- occasional or frequent attacks that manifest as cough, chest tightness, wheezing, and dyspnea
- viral upper respiratory infection most common cause of asthma exacerbations
- treatment includes bronchodilators, anti-inflammatory drugs
- 10% of patients do not respond to therapy
263
Pneumothorax
- accumulation of air in the pleural space
- spontaneous, secondary to trauma, or complication of lung disease or surgery
- decreased breath sounds
- larger or symptomatic needs draining via chest tube
264
Pleural Effusion
- accumulation of fluid in pleural space
- can be serous (simple effusion), bloody (hemorrhagic effusion), or pus-like (empyema)
- can be cause by elevated hydrostatic pressure in capillaries, low plasma protein, or pleural inflammation or trauma
- decreased breath sounds
- severe needs draining via chest tube
265
3 mechanical barriers of the respiratory system
- Nose (traps large particles)
- Mucociliary Blanket (traps midsized particles)
- cough (clears airways)
266
Non-specific and immune defense mechanisms respiratory system
- alveolar macrophages (protect from small particles 1-2 microns)
- neutrophils
- anti-oxidants
267
Congenital Abnormalities in respiratory systems
- incomplete or defective development of a part or entire lung
- can be asymptomatic and discovered later in life
- either a smaller or extra structure
- most common are bronchial atresia, pulmonary hypoplasia, bronchogenic cyst, pulmonary sequestration
268
diseases involving the bronchi and bronchioles include (3)
infection, obstruction, and bronchiectasis (destruction)
269
Infection of bronchi and bronchioles
- central airway: bronchitis
- peripheral airways: bronchiolitis
- bronchiolitis typically seen in children (croop)
- causes include viruses like flu and bacteria strep, and pneumonia
- main symptoms cough, sputum production or fever
270
Broncial Obstruction
- most commonly caused by aspiration of foreign bodies in children
- most commonly caused by lung disease or aspiration or thick mucus in adults
- affects more men
- pulmonary segment distal to the area of obstruction is susceptible to pneumonia, abscess formation, and bronchiolitis
- can lead to collapse of lung tissue distal to area of obstruction
271
collapse of lung tissue distal to area of obstruction
- atelectasis
272
Bronchiectasis
- destruction by permanent dilation of airway secondary to destruction of elastic and muscular elements
- can be secondary to obstruction, infections, or congenital abnormalities
- manifest by chronic cough with sputum production
- hemoptysis is common
- usually long-standing and recurrent infections
273
Pneumonia
infection of pulmonary parenchyma (lung tissue)
- can be caused by bacteria, viruses, fungi, and other organisms
- symptoms include fever, cough, chest pain, sputum production, and shortness of breath
274
3 categories of pneumonia
- community aquired pneumonia (outside the hospital)
- nosocomial pneumonia (already hospitalized, in hospital environment)
- opportunistic pneumonia (represents infection in patients with compromised immune status)
275
types of Community Acquired pneumonia (5)
- bacteria pneumonia
- mycoplasma pneumonia
- legionella pneumonia
- viral pneumonia
- fungal pneumonia
276
Community acquired bacterial pneumonia
- involves aspiration of organisms from the upper airway, prior viral infections, and immunosuppression
- early stages involve inflammation of parenchyma and outpouring of leukocytes
- affected segment of lung becomes firm ("red hepatatization")
- over next few days congestion decreases but lung remains firm ("gray hepatatitization")
- resolution stage follows
277
empyema
- pleural effusion that can become infected
| - complication of pneumonia
278
most community acquired pneumonias are caused by ____. what is treatment?
- streptococcus pneumoniae
| - antibiotics and supportive care
279
Mycoplasma Pneumonia
- community acquired
- gradual onset of respiratory systems and bronchopneumonia
- typically young adult
280
Legionella pneumonia
- community acquired or nosocomial
- caused by bacterium legionella pneumophila
- spreads through water environments
- multi-lobular involvement and bronchopneumonia
- symptoms similar to pneumococcal pneumonia
281
Viral Pneumonia
- community acquired
- measels, varicella rare causes for pneumonia
- rarely fatal except in immunocompromised hosts
- influenza can cause pneumonia in previously healthy people and could result in failure of multiple organs and death
282
Fungal Pneumonia
- community acquired
| - divided into two types: ones found outdoors and ones that afflict immunocompromised hosts
283
main example of fungal pneumonia that affects immunocompromised hosts
- aspergillosis
284
Blastomycosis
- fungal pneumonia that is community acquired
- found in the midwest
- causes infection of the parenchyma and lymph nodes of chest
- symptoms large range from mild to fatal respiratory failure
285
Nosocomial pneumonia
- hospital pneumonia
- caused by gram negative organisms or staphylococcus aureus which is gram positive
- highest risk in a patient a few days after hospitalization
- highest risk of those on ventillation and in ICU
286
Opportunistic pneumonias (3)
- occurs in immunocompromised hosts
- Pneumocystis carinii pneumonia/pneumocystis Jiroveci Pneumonia (PJP)
- Fungal
- Viral
287
Pneumocystis Jiroveci Pneumonia (PJP)
- occurs in immune-compromised hosts
- symptoms vary from minimal to severe progressive respiratory failure
- treatments include antibiotics, corticosteroids, and supportive care
288
Aspergilosis
- fungal opportunistic pneumonia
- seen in patients with severe neutropenia (low white count) and other immune compromised states
- manifests by diffuse nodular lesions which invade pulmonary blood vessels (can then spread to other organs)
- can lead to death, but antifungals to treat
289
Prevention of pneumonia
- vaccine very effective in preventing/reducing severity of pneumococcal pneumonia
- patients with chronic medical problems and those above 65 should get vaccine
- influenza vaccine also recommended
- two vaccines for pneumonia (repeat every 5-10 yrs)
290
Lung Abscess
- localized accumulation of pus in area of destroyed parenchyma
- most common cause for abscess is aspiration
- patients typically present with fever, productive cough, and chest pain
- can be complicated by hemoptysis, empyema, or other infections in the body
- most often the aspiration results from altered consciousness like alcohol.
