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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
What is the most common form of community-acquired acute pneumonia?
strep. pneumoniae (bacterial)
26
What are the acute symptoms assoicated with community-acquired acute pneumonia?
fever, cough, chills, pleuritis, mucopurulent sputum (yellow-green), occasional hemoptysis
27
What is hemoptysis?
coughing up blood
28
Who is the most at risk for community-acquired acute pneumonia?
people with diabetes, congestive heart failure, COPD, AIDS patients, children, elderly, people who have decreased or absent splenic function
29
Why would people who have decreased splenic function be at risk for community-acquired acute pneumonia?
because the spleen removes pneumococccal bacteria
30
How do you get CAAP normally?
aspiration of strep. pneumonia while sleeping
31
What is the typical pattern for CAAP?
lobar or bronchopneumonia
32
What are some other bacteria that can cause CAAP?
staph. aureus, kleibsella pneumoniae, pseudomonas aeruginosa, legionella pneumophila
33
Who gets CAAP from staph. aureus?
children (MC), people who have had a viral URTI
34
Who gets CAAP from Kleibsella pneumoniae?
alcoholics or the debilitated
35
How does one contract CAAP from pseudomonas aeruginosa?
people who have been burned, chemotherapy or have cystic fibrosis can be caught from the community or nosocomial
36
Which form of CAAP can be angioinvasive and lead to sepsis?
pseudomonas aeruginosa
37
How does one acquire CAAP from leigonella pneumophila?
inhalation or aspiration of water
38
What are the different diseases you can acquire from legionella pneumophila?
Legionnaire disease, pontiac fever
39
What is Legionnaire disease?
an aggressive disease that can lead to hospitalization
40
Who is at risk for Legionnaire disease?
organ transplant recipients, immunocompromised (30-50% lethal), it is often co-morbid
41
What is Pontiac fever?
mild, limited to URTI, no alveolar involvement and spontaneously resolves
42
What makes community-acquired atypical pneumonia different than CAAP?
subjective distress that doesn't correlate with objective findings moderate sputum, modestly increased WBC count, no lung consolidation on X ray
43
What kind of epithelial inflammtion is seen in CAaP?
the alveoli are generally clear of exudates, prominent features as edema collects within the alveolar septa
44
What are the signs and symptoms of community acquired atypical pneumonia?
fever, dyspnea, cough, alveolar edema (decreased gas exchange)
45
What microbes cause CAaP?
mycoplasma pneumonia (MC), influenza A&B, respiratory syncytial virus (RSV), rhinovirus
46
How does one contract CAaP?
respiratory droplets from schools, military, camps, prisons
47
What are the diverse features of CAaP?
mild "chest cold" or life threatening fever, headache, malaise, non-productive cough generally self-limiting
48
When is CAaP severe or lethal?
if infants, elderly, alcoholics, malnourished, immunocompromised contract it also if there is epithelial necrosis
49
What happens if there is epithelial necrosis in the upper respiratory tract?
decreased mucociliary clearance that can lead to a secondary infection
50
What happens if there is epithelial necrosis in the lower respiratory tract?
interstitial inflammation
51
What viruses cause influenza?
RNA viruses (influenza A, B, or C)
52
Who can get influenza from influenza A?
humans, pigs, horses, birds
53
When there is a pandemic of the influenza, who is the most at risk?
children and elderly
54
What are the signs and symptoms of influenza?
chills, fever, pharyngitis, bronchitis, headache, cough, fatigue, malaise, myalgia, nausea, vomiting, gastroenteritis
55
What allows the influenza virus to escape host antibodies?
antigenic shift
56
What is the avian flu?
H5N1, in SE Asia, came from poultry | poor interspecies transmission
57
Describe the H1N1 pandemic.
occured in 2009, most commonly limited to moderate URTI, 1/2 million people were affected, led to 6,200 deaths
58
What were the signs for H1N1 virus?
acute tracheobronchitis, self-limited, occasional diffuse alveolar damage
59
Who were at risk for H1N1?
obese individuals, people with cardiomyopathy or congestive heart failure
60
Who were notably spared during the H1N1 pandemic?
the elderly
61
What kind of infection is hospital-acquired pneumonia?
nosocomial, usually around 2 days after hospitalization, could be lethal
62
Patients with what co-morbidities were at risk for hospital acquired pneumonia?
immunodeficient people, people on prolonged antibiotics, people on mechanical ventilation
63
Is hospital-acquired pneumonia viral or bacterial?
MC bacterial
64
What kind of bacterial causes hospital acquired pneumonia?
staph aureus, e. coli
65
What is the treatment for hospital acquired pneumonia?
I.V. antibiotics
66
What is aspiration pneumonia?
pneumonia acquired after inhaling a foreign material, usually vomit
67
Who gets aspiration pneumonia?
the severely debilitated | dysfunctional gag reflex, post-stroke, stupor, physical disabilities
68
Where does the inflammation come from in aspiration pneumonia?
chemical and the infection
69
What bacteria cause aspiration pneumonia?
strep. pneumoniae, staph aureus, H. influenzae
70
Describe the infection associated with aspiration pneumonia.
acute, severe, necrotizing, possibly lethal
71
How do people survive aspiration pneumonia
abscess formation
72
What is a lung abscess?
localized suppurative necrosis that causes a cavitation, MC on the right side
73
What are the signs and symptoms of a lung abscess?
foul and purulent sputum from anaerobic bacteria, fever, malaise, cough, hemoptysis
74
What are the 3 different mechanisms for a lung abscess?
aspiration, bronchial obstruction, hematogenous spread
75
How does one get a lung abscess through aspiration?
URTIs, sinus infections, oral surgery, vomit, decreased gag reflex, coma, anesthesia
76
How does one get a lung abscess through bronchial obstruction?
15% of bronchogenic carcinoma patients, atelectasis
77
How does one get a lung abscess through hematogenous spread?
septic embolism, right sided endocarditis
78
What is chronic pneumonia?
a localized lesion in an immunocompetent person, with or without regional involement
79
What kind of inflammation do people with chronic pneumonia have?
granulomatous information, can be bacterial or fungal
80
What fungus is seen in people with chronic pneumonia have?
histoplasma disease
81
What bacteria is seen in people with chronic pneumonia have?
mycobacterium tuberculosis
82
Which chronic pneumonia disease is the most common cause of infectious death?
tuberculosis (6% of deaths worldwide)
83
Who normally contracts tuberculosis in the US?
impoverished (medically or economically), elderly, urban poor, AIDS
84
How does one contract tuberculosis?
direct transmission via respiratory droplets
85
What is seen in people with tuberculosis?
small caseous granulomas, can be dormant for decades/life
86
What percentage of people with small caseous granulomas get infected with tuberculosis?
3-15%
87
What kind of hypersensitivity is tuberculosis?
type IV hypersensitivity
88
The first 3 weeks of being infected with tuberculosis are what?
noncontagious
89
How does one test for tuberculosis?
a tuberculin test
90
If someone gets re-infected with tuberculosis, what happens?
there is tissue destruction
91
What percent of the Asian/African population tests positive for tuberculosis?
80%
92
Primary tuberculosis are seen in what kind of people?
previously unexposed people (therefore unsensitized)
93
What are the symptoms of primary TB?
asymptomatic or mild-flu like symptoms, Gohn focus, lymphatic spread
94
What is Gohn focus?
gray-white (subpleural + lymph node) with granulomatous inflammation
95
What are the consequences of primary tuberculosis?
induces hypersensitivity and increased resistance foci of scarring may harbor viable bacilli for years (for reactivation may lead to progressive primary tuberculosis
96
What is Ranke complex?
further calcification and fibrosis of hilar lymph nodes (radiologically detectable)
97
What is the single most important risk factor for the development of tuberculosis?
HIV
98
Secondary tuberculosis occurs in what kind of patients?
previously sensitized hotst
99
When does secondary tuberculosis typically show up?
typically decades after infection from reactivation of dormant primary lesions
100
Where is secondary tuberculosis typically located?
one or both of the upper lobes
101
When cavitation occurs in secondary tuberculosis, what results?
erosion into and dissemination along airways
102
What are the symptoms of secondary tuberculosisif it is isolated to the lungs?
asymtpomatic
103
What are the symptoms of secondary tuberculosis if there is an insidious onset?
malaise, anorexia, low grade afternoon fever, headache, pleuritis, night sweats, contaminated sputum, 1/2 of the time hemoptysis
104
Who has a poor prognosis when diagnosed with secondary tuberculosis?
people with the miliary form, elderly, debilitated, immunosuppressed, multi-drug resistant strains
105
What is miliary TB?
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
Miliary TB is common among what types of people?
immunosuppressed
107
Miliary TB can move into what organs?
liver, marrow, spleen, adrenals, meninges, kidneys, fallopian tubes, vertebrae
108
How can miliary TB get into the intestines?
milk, M. bovis or sputum
109
What is the name of the type of TB that is within the vertebrae?
Pott disease
110
What are features of Pott disease?
back pain, paresthesia, LE weakness
111
Community acquired atypical pneumonia is also known as what?
Walking pneumonia

Systems Pathology Final (5 decks)

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