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Pulmonology > Lecture 9: Pathology of Pulmonary Infection > Flashcards

Lecture 9: Pathology of Pulmonary Infection Flashcards

1
Q

Five ways the defense mechanisms of the lung could be damaged (predisposing infection)

A

Decreased cough, injury to mucociliary apparatus, interference with macrophages, pulmonary congestion, secretion accumulation

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2
Q

Two patterns of bacterial pneumonia

A

Bronchopneumonia (patchy, neutrophils, surrounds airways) vs Lobar (less common)

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3
Q

T/F: Any organism that can cause broncho can cause lobar pneumonia

A

True

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4
Q

Two most common bacterial causes of pneumona

A

Step pneumoniae, staph aureus

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5
Q

Pseudomonas is associated with what disease? Where do we see this infection histologically?

A

Cystic fibrosis; tend to center around blood vessels

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6
Q

Primary characteristic of bacterial pneumonia

A

Neutrophils in alveolar spaces

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7
Q

Who is at risk for community-acquired acute pneumonia?

A

Extremes of age, chronic disease, immune def, splenic problems

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8
Q

Community acquired bacterial pneumonia pathogens (5)

A

Strep pneumoniae, staph aureus, haemophilus influenzae, klebsiella, legionalla

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9
Q

Four risk factors for acquiring a nosocomial pneumonia

A

Severe disease, immunosuppression, prolonged antibiotic therapy, invasive devices (catheter/ventilator)

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10
Q

Nosocomial bacterial pneumonia pathogens (4)

A

Pseudomonas, staph aureus (MRSA), e coli, enterobacter

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11
Q

Outcomes of pneumonia (6)

A

Resolution, pleural effusion, empyema (pus in pleural space), fibrosis, abscess, bacteremia

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12
Q

Where is aspiration induced abscesses more common?

A

Right lung

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13
Q

Symptoms of lung abscess (5)

A

Cough, fever, foul-smelling sputum, chest pain, weight loss

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14
Q

Treatment of abscess

A

Antibiotics, but may require surgery

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15
Q

Gross features of lung abscess

A

Thick fibrotic wall surrounding lung pus

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16
Q

Microscopic features of lung abscess

A

Sea of neutrophils

17
Q

What does atypical pneumonia mean?

A

Inflammation is alveolar septa and pulmonary interstitium (NOT in alveolar space)

18
Q

What are the most common two causes of atypical pneumonia? Where in the community do we find atypical pneumonias?

A

Mycoplasm or viruses; schools/military camps

19
Q

What is the atypical infiltrate?

A

Mononuclear inflammatory cells (lymphocytes)

20
Q

Common pulmonary viruses (4)

A

Cytomegalovirus, herpes, adenovirus, influenza

21
Q

CMV looks like…

A

Typically involves type 2 pneumocytes; intranuclear inclusions and cytoplasmic inclusions within megalocells

22
Q

Herpes looks like…

A

Multinucleated together with intranuclear inclusions

23
Q

Adenovirus looks like…

A

Slightly enlarged cells with a basophilic, large intranuclear inclusion

24
Q

Primary TB infection is characterized by

A

Necrotizing granulomas

25
Q

Define Gohn complex

A

Pulmonary granuloma + hilar lymph nodes

26
Q

Secondary TB (often) involves…

A

Lung apex

27
Q

Miliary TB involves…

A

Disseminated disease: granulomas all over the place (can be primary or secondary)

28
Q

Histological appearance of necrotizing granulomas

A

Giant cells/lymphocytes surround necrotizing center, neutrophils outside of this

29
Q

Mycobacteria (stain)

A

Acid-fast organisms –> stain red

30
Q

Mycobacterium avium occurs in which two situations

A
  1. HIV/Immunocompromised with granulomas or mycobacterial pseudotumor; 2. Right middle lobe syndrome in small, old ladies, bronchiectasis of right middle lobe secondary to poor clearance of secretions
31
Q

Describe histoplasma identification. What does histo look like grossly?

A

Small, unequal budding (bowling pins), silver stain; necrotizing granuloma similar to TB

32
Q

Coccidiodomycosis identification

A

Large organisms with thick walled spherules, silver/PAS/H&E staining

33
Q

Blastomycosis identification. Special clinical presentation? Special histological presentation?

A

Single based broad bud; presents w/ skin disease; large granulomas with necrosis that contains neutrophils

34
Q

Aspergillus identification

A

Hyphae, narrow angle branching, septate; large organism

35
Q

Invasive aspergillus looks like what?

A

Bulls-eye parttern (target lesion)

36
Q

T/F: Cryptococcus can occur in healthy people

A

True

37
Q

What other presentation do we worry about with crypto?

A

Meningitis

38
Q

Cryptococcus identification

A

Halo due to mucoid capsule: stain w/ mucoid stains (can also use silver stain), narrow-base buddings

39
Q

Pneumocystis identification (hint: what does it do to the alveolar spaces?)

A

Fills alvealor spaces with pink, foamy material and must use silver stain; dense rim w/ dot in middle and DO NOT BUD

Pulmonology (21 decks)

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