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Pathology > LUNG 2 > Flashcards

LUNG 2 Flashcards

1
Q
  • a sudden blockage in a pulmonary
    artery that is most often caused by an embolism
    of a thrombus usually located in the deep vein of
    the leg (MC) or other distant site.
A

Pulmonary embolism (PE) or thromboembolism

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2
Q

3

rd main cause of CV death

A

Pulmonary embolism (PE) or thromboembolism

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3
Q

Virchow’s triad

A

hypercoagulability, vessel injury and

stasis

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4
Q

Respiratory compromise due to

A

lack of

perfusion

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5
Q

Hemodynamic compromise due to

A

pulmonary-arterial resistance that is

called cor pulmonale

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6
Q 
o Clinically silent (60 to 80%)
o Pulmonary hemorrhage or infarction 
(dyspnea, tachypnea, pleuritic pain, 
friction rub, signs of effusion, cough and 
wheezing)
A

Small vessel emboli:

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7
Q

Main manifestation of medium-sized artery embolus

A

Medium sized artery embolus

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8
Q

Large vessel obstruction (pulmonary artery):

A

o Sudden death, cor pulmonale or CV

collapse

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9
Q

ACUTE HEMORRHAGIC PULMONARY INFARCT is located in

A

Located in lower lobes because perfusion is

greater in the lower lobe

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10
Q

Raised, red-blue (early)→red-brown wedge
shaped

Also called “septic infarcts”

A

ACUTE HEMORRHAGIC PULMONARY INFARCT

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11
Q

▪ Cause CV collapse, and right sided heart failure

▪ If untreated, it can cause sudden cardia death

A

SADDLE EMBOLUS

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12
Q

Diagnosis of saddle embolus

A

o Chest radiography (nonspecific signs-effusion, etc.)
o Perfusion radionuclide scan (V/Q scan)
o Computed tomography pulmonary
angiogram (CTPA- spiral CT)
o Pulmonary angiogram
o D-dimer
o Cardiac panel is also used by some institution (cardiac enzymes)

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13
Q 
▪ Most commonly employed imaging 
because of non-invasiveness
▪ look for “cut-off” sign (abrupt hypo 
vascularity) sign
▪ after the dye has been seen in the 
main pulmonary artery there is loss 
of trachea-bronchial supply
A

Computed tomography pulmonary

angiogram (CTPA- spiral CT)

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14
Q

▪ Gold standard
▪ Direct visualization of pulmonary
artery

A

Pulmonary angiogram

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15
Q

▪ Highly sensitive, used for screening

A

D-dimer

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16
Q

Prognosis of ACUTE HEMORRHAGIC PULMONARY INFARCT

A

Prognosis:
o Case fatality 1 month after diagnosis is
12%
o Recurrence rate is 1-6% during the first 6 months

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17
Q

In pulmonary hypertension, the mean pulmonary artery pressure is

A

≥25 mmHg at

rest

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18
Q

Pulmonary HTN pathophysiology

A

▪ Bone morphogenetic protein receptor type 2
(BMPR2) signaling pathway
o Mutations -> SMC Hyperplasia
o Seen in 75% of familial cases
▪ Activin receptor-like kinase 1 (ALK1) and
endoglein
▪ Drugs & Toxins (“Phen-Phen”)

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19
Q

Pulmonary HTN morphology

A 
▪ Right ventricular hypertrophy
▪ Medial hypertrophy of the pulmonary 
muscular and elastic arteries
o More characteristic of pulmonary 
hypertension.
o Causes complete obliteration of the 
lumen that leads to hypertension
▪ Atherosclerosis
▪ Plexiform lesions
o Tuffs of capillary formation that have 
developed secondary to pulmonary 
hypertension.
▪ Atheromatous lesions
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20
Q

Pulmonary HTN is more common in ________ aged ___

A

women; 20-40 yrs of age

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21
Q

Most common presenting symptom of Pulmonary HTN

A

Exertional dyspnea

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22
Q

Clinical features of Pulmonary HTN

A 
▪ Exertional dyspnea
▪ Chest pain
▪ Severe respiratory distress
▪ Cyanosis
▪ Right ventricular hypertrophy
▪ Cor Pulmonale (Right-sided heart failure)
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23
Q

Diagnosis for pulmonary HTN

A

▪ Right heart catheterization
▪ Transthoracic echocardiogram
▪ ECG

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24
Q

Gold standard in diagnosing Pulmonary HTN

o Invasive

A

Right heart catheterization

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25
Q

Diagnosing technique wherein it shows resistance to airflow

A

Transthoracic echocardiogram

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26
Q

Treatment for mild cases (Pulmonary HTN)

A

Vasodilators

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27
Q

Treatment for severe cases (Pulmonary HTN)

A

Lung transplant

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28
Q

Is a dramatic complication of some interstitial lung

disorders

A

Diffuse Pulmonary Hemorrhage

Syndromes

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29
Q

▪ Rare disease of children characterized by
Intermittent diffuse alveolar hemorrhage
▪ Cough & hemoptysis

A

Idiopathic pulmonary hemosiderosis

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30
Q

Diffuse Pulmonary hemorrhage syndromes

A

Idiopathic Pulmonary Hemosiderosis
Goodpasture Syndrome
Polyangiitis with Granulomatosis

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31
Q

▪ Anti-GBM Ab Disease with Pulmonary
Involvement
▪ Antibodies against a3 chain of collagen IV
▪ Renal disease + Pulmonary hemorrhage
▪ Rapid and progressive pulmonary hemorrhage

A

Goodpasture syndrome

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32
Q

▪ “Wegener Granulomatosis”

▪ Immune disease typically presenting with hemoptysis

A

Polyangiitis with Granulomatosis

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33
Q

Important features of Polyangiitis with granulomatosis

A

Capillaritis and scattered,

poorly formed granulomata

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34
Q

▪ Portal of Entry

pulmonary infection

A

o Inhalation
o Aspiration
o Hematogenous spread
o Direct spread

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35
Q

▪ Compromised local pulmonary defense

A

o Loss or suppression of the cough reflex
o Dysfunction of the mucociliary apparatus
o Accumulation of secretions
o Interference with the phagocytic and
bactericidal activities of alveolar
macrophages
o Pulmonary Congestion and Edema

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36
Q

can be very broadly defined as any

infection of the lung parenchyma

A

Pneumonia

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37
Q

It causes alveoli to be filled with inflammatory
exudates, and can usually result into
consolidation (sort of solidification within the lung)
of lung.

A

Pneumonia

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38
Q

Pneumonia can be assessed using

A

X-Rays, using
sethescope on auscultation (decrease breath
sounds) or even in PE when doing tactile fremitus
test (Vibrations are increased over areas of
consolidation).

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39
Q

Pneumonia clinical features

A 
fever and chills,
productive cough with yellow-green (pus) or rusty 
(bloody) sputum, 
tachypnea with pleuritic chest 
pain, 
decreased breath sounds, 
dullness to 
percussion, and 
elevated WBC count
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40
Q

Pneumonia Accdg to anatomic region

A

o Lobar pneumonia
o Bronchopneumonia ( or Lobular
pneumonia )
o Interstitial pneumonia

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41
Q

Pneumonia Accdg to clinical settings

A

o Community - acquire pneumonia
o Health care - associated pneumonia (
HCAP )
o Ventilator - associated pneumonia ( VAP)

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42
Q

PRIMARY ATYPICAL

PNEUMONIA

A

VIRAL AND MYCOPLASMAL

PNEUMONIA

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43
Q

NON INFECTIVE PNEUMONIAS

A

I. Aspiration (inhalation)
pneumonia .
II. Hypostatic pneumonia
III. Lipid pneumonia

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44
Q

Bacterial lung infection in otherwise

healthy individuals that is acquired from the normal environment

A

COMMUNITY ACQUIRED BACTERIAL

PNEUMONIA

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45
Q

Most common cause of CAP

A

Streptococcus
pneumoniae or
Pneumococcus

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46
Q 
Most common 
bacterial cause in 
COPD. It causes life 
threatening infections 
and meningitis in 
children.
A

Haemophilus

influenza

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47
Q 
Secondary bacterial 
pneumonia following 
viral respiratory 
illnesses. It has high 
risk of development 
of abscess.
A

S. aureus

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48
Q 
In debilitated and 
malnourished people. 
Including alcoholics. 
Thick mucoid sputum 
tinged blood or rusty 
sputum.
A

Enterobacteriace
ae (Klebsiella
pneumoniae )

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49
Q

Common in patients

with neutropenia.

A

Pseudomonas

aeruginosa

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50
Q

Organ transplant

recipients.

A

Legionella

pneumophila

51
Q

Patchy consolidation

A

bronchopneumonia

52
Q

Usually bilateral basal in location due to gravitation of secretions

A

Bronchopneumonia

53
Q

Diffuse inflammation

A

Lobar pneumonia

54
Q

Acute (neutrophilic)

suppurative exudation

A

Bronchopneumonia

55
Q

Lobar pneumonia 4 stages

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution
56
Q

Affects extremes of age

infants or old

A

Bronchopneumonia

57
Q

o The lung is heavy, boggy, and
red.
o Vascular engorgement, intra-alveolar edema fluid with few neutrophils, and the presence of
bacteria, which may be numerous.

A

Congestion

58
Q

e initial phase that represents
acute inflammation response to bacterial
infection and it can last for 1-2 days.

A

Congestion

59
Q

Congestion (microscopically)

A

microscopy you can see that there
is dilatation and congestion of capillary
walls and edema in air spaces

60
Q

o The lobe is red, firm, and airless.

o Massive confluent exudation, neutrophils, red cells, fibrin fill the alveolar spaces.

A

Red hepatization

61
Q

Red hepatization lasts for around

A

2 days

62
Q

In this
stage RBCS began to lyse and start to
give paler color or grey color on gross
and cut section

A

Gray hepatization

63
Q

Gray hepatization (Microscopically)

A 
e fibrous that 
are denser and more numerous 
compared to the previous stage, so 
cellular exudates of neutrophils also start  to disintegrate with bacterial organism 
and other pathogens.
64
Q 
o Progressive disintegration of red 
cells and the persistence of a 
fibrinosuppurative exudate,
resulting in a color change to 
grayish-brown
A

Grey hepatization

65
Q

Advanced
organizing pneumonia.The exudates have been
converted to fibromyxoid masses rich in
macrophages and fibroblasts

A

Resolution

66
Q

the exudate within
the alveolar spaces is broken down by enzymatic
digestion to produce granular, semifluid debris that is resorbed, ingested by macrophages,
expectorated, or organized by fibroblasts growing
into it

A

Resolution

67
Q

Clinical features of pneumonia

A

▪ High fever, rigors and productive cough,
occasionally with hemoptysis;
▪ A friction rub and pleuritic chest pain herald pleural involvement

68
Q

The whole lobe is ______ in lobar pneumonia

A

radiopaque

69
Q

presence of focal opacities in ________

A

bronchopneumonia

70
Q

Appropriately treated patients may become
afebrile with few clinical signs ______ hours after
the initiation of antibiotics

A

48 to 72

71
Q

Pneumonia diagnosis

A

▪ CXR
▪ CBC
▪ Sputum Gm stain
▪ Blood culture (in severe cases)

72
Q

Pneumonia caused by viruses and
intracellular organisms characterized by patchy
inflammatory changes, largely confined to
interstitial tissue of the lungs, usually without any
alveolar exudate and consolidation

A

COMMUNITY-ACQUIRED VIRAL (ATYPICAL)

PNEUMONIA

73
Q

the most common
cause of common cold and this common cold can
extend and reach the lower respiratory tract
causing viral pneumonia.

A

Rhinovirus

74
Q

Other viruses that can

cause pneumonia are

A

adenovirus and coxsakie virus

75
Q

influenza viruses of type A infect

A

humans, pigs,
horses, and birds and are the major cause of
pandemic and epidemic influenza infections.

76
Q

Influenza virus is a ___-stranded RNA virus

A

single

77
Q

minor mutation. Does not require

a new vaccine.

A

Antigen drift

78
Q

major mutation. A new vaccine is

required

A

Antigen shift

79
Q

▪ Paramyxovirus
▪ Bronchiolitis and pneumonia in extreme ages and
immunocompromised

A

METAPNEUMOVIRUS

80
Q

Such infections are clinically indistinguishable
from those caused by human respiratory syncytial
virus and are often mistaken for influenza

A

METAPNEUMOVIRUS

81
Q

Gross morphology of interstitial type pneumonia

A

Patchy or diffuse

Red-blue and congested

82
Q

In microscopic morphology of Interstitial type pneumonia, Inflammatory cells are present in the _______ rather than the alveoli and without consolidation

A

interstitium

83
Q

predominant feature of Interstitial type pneumonia

A

Interstitial inflammatory reaction

84
Q

T or F

In interstitial type pneumonia, Mononuclear infiltrate is present, rather than
neutrophils

A

T

85
Q

T or F

In interstitial type pneumonia, Alveolar spaces are usually free of exudate (pus)

A

T

86
Q

Clinical features of Interstitial type pneumonia (viral)

A

▪ Mild to severe upper respiratory tract infections
and continue down to your LRT infection
▪ Myalgias and fever
▪ Dyspnea
▪ Dry cough > productive
▪ Most viral illnesses are mild and spontaneously
resolve

87
Q

Diagnosis (viral)

A

▪ CXR
▪ CBC
▪ PCR (To identify etiologic agent

88
Q

Pneumonia occurring ≤48 hours of
hospital admission in patients with at least 1 risk
factor for MDR bacteria

A

HEALTHCARE- ASSOCIATED PNEUMONIA (HCAP)

89
Q

) Pneumonia occurring
≥48 hours of hospital admission. (Prolonged
hospital stay)

A

HAP

90
Q

Pneumonia occurring >48 hours after

endotracheal intubation

A

VAP

91
Q

Gram positive cocci (HCAP)

A

S. aureus

92
Q

Gram negative rods

A

Enterobacteriaceae and Pseudomonas spp

93
Q

▪ Non infective in nature
▪ Aspiration of different agents into the lungs
▪ When it becomes infected - Polymicrobial:
aerobes» anaerobes

A

Aspiration pneumonia

94
Q

able to aspirate gastric
contents which can present as hemoptysis and
dyspnea secondary to pulmonary hemorrhage
and edema

A

Chemical pneumonitis

95
Q

aspirate infective material
coming from oropharynx or nasopharynx and can
present as pulmonary necrosis and suppuration.

A

Bronchopneumonia

96
Q

Histology: Biopsy lung secondary to aspiration

pneumonia

A

foreign body type
granulomatous inflammation because of the
foreign materials that had been aspirated

97
Q

Local suppurative process that produces necrosis

of lung tissue.

A

Chronic pneumonia

Lung abscess

98
Q

most common cause of primary lung abscess

A

Aspiration of infected material

99
Q

develops as a
complication of some other disease of the lung or
from another site.

A

Secondary lung abscess

100
Q

most common

microbes introduced in the lung

A

aerobic and anaerobic streptococci, S. aureus,

and a host of gram-negative organisms

101
Q

anaerobic organisms normally found in what part of pharynx

A

Oropharynx

102
Q

common causes of Lung abscess

A

o Aspiration of infective material
o Antecedent primary bacterial infection
o Septic emboli from infected thrombi or
right sided endocarditis
o Obstructive tumors
o Direct traumatic punctures or spread of
infection from adjacent organs

103
Q

anaerobes

A

(Bacteroide,

Fusobacterium, and Peptococcus)

104
Q

primary abscess

A

single

105
Q

secondary lung abscess

A

multiple

106
Q

size (lung abscess)

A

5-6cm

107
Q

Lung abscess microscopic appearance

A

Suppurative necrosis of the lung parenchyma

within the central area of cavitation

108
Q

Clinical features of lung abscess

A

much like those of bronchiectasis and
characteristically include cough, fever,
and copious amounts of foul-smelling
purulent or sanguineous sputum

clubbing due to hypoxemia

109
Q

Complications (lung abscess)

A 
o Extension of the infection into the pleural 
cavity
o Hemorrhage 
o Septic emboli
o Secondary amyloidosis
110
Q

causative agent of Histoplasmosis

A

Histoplasma capsulatum

111
Q 
▪ Microconidia in bird/bat dropping
▪ Macrophages ingest but cannot kill the 
organism without T-cell help
▪ Granulomas with coagulative necrosis
- clinically mimics tuberculosis
A

Histoplasmosis

112
Q

Histoplasmosis

3-5 um, thin-walled cyst

A

silver stain

113
Q

Blastomycosis C.A.

A

▪ Blastomyces dermatitidis

▪ Inhalation of spores in the ground

114
Q

types of blastomycosis

A

▪ Pulmonary, disseminated, and cutaneous

blastomycosis

115
Q

type granuloma in blastomycosis

A

suppurative

116
Q

size and morphology of blastomycosis

A

▪ 5-15 um, thick-walled yeast with broad-based
budding
▪ Clinically mimics tuberculosis

117
Q

delayed-type of hypersensitivity reaction to the fungus, most remain asymptomatic

A

coccidiomycosis

118
Q

T or F

Infectivity of C. immitis is that infective
arthroconidia, when ingested by alveolar
macrophages, block fusion of the phagosome
and lysosome and so resist intracellular killing

A

T

119
Q

Micro morphology of coccidiomycosis

A

Macrophages or giant cells, thick walled, often

filled with small endospores

120
Q

Opportunistic infection agents

A 
o P. aeruginosa, Mycobacterium species, 
L. pneumophila, and Listeria 
monocytogenes
o CMV and herpesviruses
o Pneumocystis, Candida, Aspergillus and
Cryptococcus neoformans
121
Q

common causes of pneumonia in HIV

A

o S. pneumoniae, S. aureus, H, infuenza

and gram-negative rods

122
Q

> 200/uL CD-4 T-cell count

A

Bacteria, including

tuberculosis

123
Q

50 to 200/uL CD4 T cell count

A

Pneumocystis

124
Q

<50/uL CD4 Tcell count

A

CMV and Mycobacterium avium

comple

Pathology (31 decks)

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