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Systems Pathology Final > Lungs Part 3 > Flashcards

Lungs Part 3 Flashcards

1
Q

What is the classic triad of diffuse alveolar hemorrhage syndromes?

A

hemoptysis, anemia, diffuse pulmonary edema

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2
Q

What are diffuse alveolar hemorrhage syndromes?

A

a group of immune-mediated diseases, considered a primary cause of pulmonary hemorrhage

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3
Q

What is Goodpasture syndrome?

A

antibodies against lung and kidney collagen, causes hemoptysis and hematuria

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4
Q

What is Goodpasture syndrome characterized by?

A

proliferative, usually rapidly progressive, glomerulonephritis and hemorrhagic interstitial pneumonitis

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5
Q

What symptoms do Wegener’s granulomatosis and Goodpasture syndrome have in common?

A

hemoptysis, hematuria

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6
Q

What are the symptoms and characteristics of Wegener’s granulomatosis?

A

type IV hypersensitivities, hemoptysis, hematuria, rash, myalgia, arthritis, granulomas, ~40 years of age in males

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7
Q

What are the symptoms and characteristics of Goodpasture syndrome?

A

type II hypersensitivity, hemoptysis, hematuria, pulmonary infiltrates, diffuse alveolar hemorrhage syndrome, 20-30 in males, 60-70 in females

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8
Q

What are our protections against pulmonary infections?

A

alveolar macrophages (phagocytosis), neutrophils, mucociliary clearance, complement (amplified phagocytosis), lymphatic drainage, IgA (upper airways, decrease microbial attachment), IgG, IgA (protect alveoli), T cells (decrease viral infections

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9
Q

What is pneumonia?

A

a lung infection that leads to pulmonary inflammation

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10
Q

What is the morbidity of pneumonia in the US?

A

1/6 of all deaths in US

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11
Q

Are lung parenchyma normally sterile or have some germs?

A

normally sterile

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12
Q

What are the sources of pulmonary infections?

A

contaminated air, aspiration of nasopharyngeal flora, various pulmonary or NMS pathologies

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13
Q

Who normally gets pneumonia via aspiration of nasopharyngeal flora?

A

when people are sleeping or alcoholics (kleibsella pneumoniae)

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14
Q

What are some extrinsic factors for pulmonary infections?

A

smoking and alcohol

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15
Q

How is smoking an extrinsic factor for pulmonary infections?

A

it decreases mucociliary clearance and decreases immune cell mobilization

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16
Q

How is alcohol an extrinsic factor for pulmonary infections?

A

decreases epiglottic reflexes

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17
Q

What are some intrinsic factors for pulmonary infections?

A

defects in cell-mediated immunity (lymphocytes) and defects in humoral immunity (antibodies)

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18
Q

What are the signs and symptoms of pneumonia?

A

inflammation primarily with the alveoli, fever, lung consolidation/edema (seen on chest X ray)

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19
Q

What are the two types of acute bacterial pneumonia?

A

bronchopneumonia and lobar pneumonia

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20
Q

What is bronchopneumonia?

A

infection is in different parts of the lung (patchy) and there are well developed lesions (3-4 cm)

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21
Q

What is lobar pneumonia?

A

infection is isolated to 1 lobe, is homogenously filled with exudate, abrupt lines of radiopacity

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22
Q

90% of lobar pneumonia result from what bacterial infection?

A

streptococcus pneumoniae

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23
Q

Why is the way we separated lobar from bronchopneumonia not the best?

A

because many organisms can manifest as either distribution, whether lobar or bronchi…
many won’t have a distinct pattern

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24
Q

Who gets community-acquired acute pneumonia?

A

people who were not recently hospitalized who have had a recent upper respiratory tract infection

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25
Q

What is the most common form of community-acquired acute pneumonia?

A

strep. pneumoniae (bacterial)

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26
Q

What are the acute symptoms assoicated with community-acquired acute pneumonia?

A

fever, cough, chills, pleuritis, mucopurulent sputum (yellow-green), occasional hemoptysis

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27
Q

What is hemoptysis?

A

coughing up blood

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28
Q

Who is the most at risk for community-acquired acute pneumonia?

A

people with diabetes, congestive heart failure, COPD, AIDS patients, children, elderly, people who have decreased or absent splenic function

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29
Q

Why would people who have decreased splenic function be at risk for community-acquired acute pneumonia?

A

because the spleen removes pneumococccal bacteria

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30
Q

How do you get CAAP normally?

A

aspiration of strep. pneumonia while sleeping

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31
Q

What is the typical pattern for CAAP?

A

lobar or bronchopneumonia

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32
Q

What are some other bacteria that can cause CAAP?

A

staph. aureus, kleibsella pneumoniae, pseudomonas aeruginosa, legionella pneumophila

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33
Q

Who gets CAAP from staph. aureus?

A

children (MC), people who have had a viral URTI

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34
Q

Who gets CAAP from Kleibsella pneumoniae?

A

alcoholics or the debilitated

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35
Q

How does one contract CAAP from pseudomonas aeruginosa?

A

people who have been burned, chemotherapy or have cystic fibrosis
can be caught from the community or nosocomial

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36
Q

Which form of CAAP can be angioinvasive and lead to sepsis?

A

pseudomonas aeruginosa

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37
Q

How does one acquire CAAP from leigonella pneumophila?

A

inhalation or aspiration of water

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38
Q

What are the different diseases you can acquire from legionella pneumophila?

A

Legionnaire disease, pontiac fever

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39
Q

What is Legionnaire disease?

A

an aggressive disease that can lead to hospitalization

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40
Q

Who is at risk for Legionnaire disease?

A

organ transplant recipients, immunocompromised (30-50% lethal), it is often co-morbid

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41
Q

What is Pontiac fever?

A

mild, limited to URTI, no alveolar involvement and spontaneously resolves

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42
Q

What makes community-acquired atypical pneumonia different than CAAP?

A

subjective distress that doesn’t correlate with objective findings
moderate sputum, modestly increased WBC count, no lung consolidation on X ray

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43
Q

What kind of epithelial inflammtion is seen in CAaP?

A

the alveoli are generally clear of exudates, prominent features as edema collects within the alveolar septa

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44
Q

What are the signs and symptoms of community acquired atypical pneumonia?

A

fever, dyspnea, cough, alveolar edema (decreased gas exchange)

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45
Q

What microbes cause CAaP?

A

mycoplasma pneumonia (MC), influenza A&B, respiratory syncytial virus (RSV), rhinovirus

46
Q

How does one contract CAaP?

A

respiratory droplets from schools, military, camps, prisons

47
Q

What are the diverse features of CAaP?

A

mild “chest cold” or life threatening
fever, headache, malaise, non-productive cough
generally self-limiting

48
Q

When is CAaP severe or lethal?

A

if infants, elderly, alcoholics, malnourished, immunocompromised contract it
also if there is epithelial necrosis

49
Q

What happens if there is epithelial necrosis in the upper respiratory tract?

A

decreased mucociliary clearance that can lead to a secondary infection

50
Q

What happens if there is epithelial necrosis in the lower respiratory tract?

A

interstitial inflammation

51
Q

What viruses cause influenza?

A

RNA viruses (influenza A, B, or C)

52
Q

Who can get influenza from influenza A?

A

humans, pigs, horses, birds

53
Q

When there is a pandemic of the influenza, who is the most at risk?

A

children and elderly

54
Q

What are the signs and symptoms of influenza?

A

chills, fever, pharyngitis, bronchitis, headache, cough, fatigue, malaise, myalgia, nausea, vomiting, gastroenteritis

55
Q

What allows the influenza virus to escape host antibodies?

A

antigenic shift

56
Q

What is the avian flu?

A

H5N1, in SE Asia, came from poultry

poor interspecies transmission

57
Q

Describe the H1N1 pandemic.

A

occured in 2009, most commonly limited to moderate URTI, 1/2 million people were affected, led to 6,200 deaths

58
Q

What were the signs for H1N1 virus?

A

acute tracheobronchitis, self-limited, occasional diffuse alveolar damage

59
Q

Who were at risk for H1N1?

A

obese individuals, people with cardiomyopathy or congestive heart failure

60
Q

Who were notably spared during the H1N1 pandemic?

A

the elderly

61
Q

What kind of infection is hospital-acquired pneumonia?

A

nosocomial, usually around 2 days after hospitalization, could be lethal

62
Q

Patients with what co-morbidities were at risk for hospital acquired pneumonia?

A

immunodeficient people, people on prolonged antibiotics, people on mechanical ventilation

63
Q

Is hospital-acquired pneumonia viral or bacterial?

A

MC bacterial

64
Q

What kind of bacterial causes hospital acquired pneumonia?

A

staph aureus, e. coli

65
Q

What is the treatment for hospital acquired pneumonia?

A

I.V. antibiotics

66
Q

What is aspiration pneumonia?

A

pneumonia acquired after inhaling a foreign material, usually vomit

67
Q

Who gets aspiration pneumonia?

A

the severely debilitated

dysfunctional gag reflex, post-stroke, stupor, physical disabilities

68
Q

Where does the inflammation come from in aspiration pneumonia?

A

chemical and the infection

69
Q

What bacteria cause aspiration pneumonia?

A

strep. pneumoniae, staph aureus, H. influenzae

70
Q

Describe the infection associated with aspiration pneumonia.

A

acute, severe, necrotizing, possibly lethal

71
Q

How do people survive aspiration pneumonia

A

abscess formation

72
Q

What is a lung abscess?

A

localized suppurative necrosis that causes a cavitation, MC on the right side

73
Q

What are the signs and symptoms of a lung abscess?

A

foul and purulent sputum from anaerobic bacteria, fever, malaise, cough, hemoptysis

74
Q

What are the 3 different mechanisms for a lung abscess?

A

aspiration, bronchial obstruction, hematogenous spread

75
Q

How does one get a lung abscess through aspiration?

A

URTIs, sinus infections, oral surgery, vomit, decreased gag reflex, coma, anesthesia

76
Q

How does one get a lung abscess through bronchial obstruction?

A

15% of bronchogenic carcinoma patients, atelectasis

77
Q

How does one get a lung abscess through hematogenous spread?

A

septic embolism, right sided endocarditis

78
Q

What is chronic pneumonia?

A

a localized lesion in an immunocompetent person, with or without regional involement

79
Q

What kind of inflammation do people with chronic pneumonia have?

A

granulomatous information, can be bacterial or fungal

80
Q

What fungus is seen in people with chronic pneumonia have?

A

histoplasma disease

81
Q

What bacteria is seen in people with chronic pneumonia have?

A

mycobacterium tuberculosis

82
Q

Which chronic pneumonia disease is the most common cause of infectious death?

A

tuberculosis (6% of deaths worldwide)

83
Q

Who normally contracts tuberculosis in the US?

A

impoverished (medically or economically), elderly, urban poor, AIDS

84
Q

How does one contract tuberculosis?

A

direct transmission via respiratory droplets

85
Q

What is seen in people with tuberculosis?

A

small caseous granulomas, can be dormant for decades/life

86
Q

What percentage of people with small caseous granulomas get infected with tuberculosis?

A

3-15%

87
Q

What kind of hypersensitivity is tuberculosis?

A

type IV hypersensitivity

88
Q

The first 3 weeks of being infected with tuberculosis are what?

A

noncontagious

89
Q

How does one test for tuberculosis?

A

a tuberculin test

90
Q

If someone gets re-infected with tuberculosis, what happens?

A

there is tissue destruction

91
Q

What percent of the Asian/African population tests positive for tuberculosis?

A

80%

92
Q

Primary tuberculosis are seen in what kind of people?

A

previously unexposed people (therefore unsensitized)

93
Q

What are the symptoms of primary TB?

A

asymptomatic or mild-flu like symptoms, Gohn focus, lymphatic spread

94
Q

What is Gohn focus?

A

gray-white (subpleural + lymph node) with granulomatous inflammation

95
Q

What are the consequences of primary tuberculosis?

A

induces hypersensitivity and increased resistance
foci of scarring may harbor viable bacilli for years (for reactivation
may lead to progressive primary tuberculosis

96
Q

What is Ranke complex?

A

further calcification and fibrosis of hilar lymph nodes (radiologically detectable)

97
Q

What is the single most important risk factor for the development of tuberculosis?

A

HIV

98
Q

Secondary tuberculosis occurs in what kind of patients?

A

previously sensitized hotst

99
Q

When does secondary tuberculosis typically show up?

A

typically decades after infection from reactivation of dormant primary lesions

100
Q

Where is secondary tuberculosis typically located?

A

one or both of the upper lobes

101
Q

When cavitation occurs in secondary tuberculosis, what results?

A

erosion into and dissemination along airways

102
Q

What are the symptoms of secondary tuberculosisif it is isolated to the lungs?

A

asymtpomatic

103
Q

What are the symptoms of secondary tuberculosis if there is an insidious onset?

A

malaise, anorexia, low grade afternoon fever, headache, pleuritis, night sweats, contaminated sputum, 1/2 of the time hemoptysis

104
Q

Who has a poor prognosis when diagnosed with secondary tuberculosis?

A

people with the miliary form, elderly, debilitated, immunosuppressed, multi-drug resistant strains

105
Q

What is miliary TB?

A

a type of tuberculosis that occurs when organisms drain into the lymphatic ducts, which then empty into the venous return, to the right side of the heart and then to the pulmonary arteries

106
Q

Miliary TB is common among what types of people?

A

immunosuppressed

107
Q

Miliary TB can move into what organs?

A

liver, marrow, spleen, adrenals, meninges, kidneys, fallopian tubes, vertebrae

108
Q

How can miliary TB get into the intestines?

A

milk, M. bovis or sputum

109
Q

What is the name of the type of TB that is within the vertebrae?

A

Pott disease

110
Q

What are features of Pott disease?

A

back pain, paresthesia, LE weakness

111
Q

Community acquired atypical pneumonia is also known as what?

A

Walking pneumonia

Systems Pathology Final (5 decks)

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