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Pulmonary - Pathology > Nichols Dumb Ass Document > Flashcards

Nichols Dumb Ass Document Flashcards

1
Q

What are almost all bacterial pneumonia due to?

A

aspiration of saliva containing the pathogen

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2
Q

What is an infiltrate?

A

radiologic manifestations of pneumonia or edema or hemoorhage

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3
Q

What is consolidation?

A

manifestations of alveoli filled with blood, pus, or water on PE or radiology

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4
Q

common causes of alveolar non-necrotizing acute bacterial pneumonia

A

Strep pneumonia
Legionella
Mycoplasma
etc

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5
Q

causes of alveolar necrotizing acute bacterial pneumonia

A

Staph Aureus
Pseudomonas aeruginosa
Klebsiella
etc

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6
Q

common cause of acute interstitial pneumonia

A

viruses

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7
Q

epidemiology of pneumococcal pneumonia

A

older adults, men

Risk factors: smoking, COPD, CHF, ICP, decreased or absent splenic function

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8
Q

How does one get infected w/ pneumococcal?

A

aerosol inhalation. bacteria attaches to respiratory epithelial cells and bind to PC and use PLANCH to infect and cause disease

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9
Q

What are the 4 phases for pneumococcal for gross pathology?

A
  1. congestion - day 1 - exudation of serous and frothy, blood tinged fluid into alveoli
  2. red hepatiziation - day 2-3: drier, granular, dark red consolidation resembling liver
  3. grey hepatiziation - day 4-7: continuing consolidation
  4. resolution w/out scarring
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10
Q

What are the 4 phases of microscopic pathology for pneumococcal?

A
  1. engorged septal capillaries, few RBCs, edema fluid, bacteria in alevoli
  2. continuing congestion, many PMNs and abundant fibrin in alveoli
  3. degenerating dead cells in alveoli, fibrin nets through pores of Kohn, foamy macrophages replace PMNs
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11
Q

Symptoms for pneumococcal pneumonia?

A

sudden single sever shaking rigor, sustained high fever, blood tinged sputum (rusty), pleuritic chest pain

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12
Q

What are signs of pneumococcal pneumonia?

A

low fever, low tachycardia, pulmonary crackles, bronchial/tubular breath sounds, dullness to percussion

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13
Q

What are two common complications for Staph Aureus pneumonia?

A

lung abscess and empyema

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14
Q

Who generally gets Staph Aureus pneumonia?

A

IV drug users, CF, and hospital acquired

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15
Q

What are the virulence factors Staph Aureus?

A

exotoxins and protein A

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16
Q

Gross path for staph aureus?

A

plum colored lungs, numerous small abcesses, pleuritis and empyema

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17
Q

Dx for staph aureus?

A

CXR- bronchopneumonic,

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18
Q

Rx for staph aureus?

A

oxacillin for methicillin sensitive, vancomycin for methicillin resistant

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19
Q

Risk factors for legionella?

A

smoking, COPD, transplant, not neutropenia, HIV

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20
Q

Pathogenesis for legionella?

A

water - once inhaled/aspirated attaches to cells and evades destruction by inhibiting phagosome-lyosome fusion

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21
Q

Gross path for legionella?

A

bulging firm rubbery areas of consolidation

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22
Q

Micro patho for legionella

A

early infiltration by macrophages

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23
Q

Symptoms for legionella?

A

dry cough, high fever, plus FLS, GI symptoms especially diarrhea

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24
Q

Dx for legionella?

A

Cxr - alveolar infiltrate w/ pleural effusion. Hyponatremia, urine Ag test, BCYE, blood tests have a lot of emias

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25
Q

Rx for legionella?

A

macrolides or quinolones

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26
Q

Keys things for legionella?

A

diarrhea, confusion or hyponatremia

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27
Q

Pseudomonas

A

hospital acquired so most pts die. Risk factors = intubation and neutropenia

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28
Q

Pathogenesis of psuedomonas?

A

water, resistant to many Abx, forms biofilm, elastase

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29
Q

Gross path for pseudomonas?

A

firm red areas of hemorrhagic consolidation w/ rim of hemorrhage = target lesion

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30
Q

Microscopic path for pseudomonas?

A

acute necrotilizing alveolitis, long filamentous bacilli invading blood vessels

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31
Q

Symptoms for pseudomonas

A

think green purulent sputum

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32
Q

Pseudomonas Dx?

A

CXR - diffusely distributed bilateral bronchopneumonic. Stain shows long thin pointed end gram negative bacilli. Culture - sweet grape like odor, green pigment resembling bronze.

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33
Q

Pseudomonas rx?

A

antipseudomonal beta lactam and quinolone

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34
Q

Mycoplasmal pneumonia epidemiology

A

LRT infxn, fall and winter, kids and military recruits

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35
Q

Pathogenesis for mycoplasma?

A

small free living, filamentous bacilli lacking cell wall, invisible on gram stain. Transmitted via droplets

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36
Q

Micro path Mycoplasma

A

lymphoplasmacytic bronchiolitis then interstitial pneumonitis associated w/ type 2 hyperplasia

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37
Q

Mycoplasma Dx

A

Cxr - consolidation affects lower lobes more

Blood test- cold agglutins, WBC normal

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38
Q

TB epidemiology

A

HIV infxn, seasonal (spring and fall), old men

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39
Q

gross path for TB

A

caseating granuloma w/ central necrosis w/ hilar lymph nodal involvement

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40
Q

Micro path for TB

A

necrotizing granuloma w/ epithelioid histiocytes, Langhan cells, lymphocyte collar, dark red beaded bacilli on AFB stain

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41
Q

TB dx/

A
  • patchy or nodular infiltrate in apex or superior segment of lower lobe
  • pneumonia associated w/ hilar adenopathy should always suggest primary TB
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42
Q

Pathogenesis for Histo

A

inhalation of airborne spores, infxn becomes latent in old granulomas in the lungs or lymph nodes

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43
Q

Gross path for Histo

A

tan areas of consolidation that develop caseous necrosis, may cavitate and eventually become white, fibrotic, and calcified

44
Q

Mirco path for histo

A

small oval basophilic yeast w/ narrow-based budding

45
Q

Histo symptoms

A

if you see runny nose and or sore throat then don’t pick histo

46
Q

Aspergillum micro path

A

fruiting body producing conidia

47
Q

Aspergillum symptoms

A

Classic triad = fever, pleuritic chest pain and hemoptysis

48
Q

Aspergillum Dx

A

CXR is insensitive, CT shows nodules. Galactomannan

49
Q

Crytococcus epidemiology

A

opportunisitc, very uncommon in kids

50
Q

Pathogenesis of Crypto

A

inhale airborne spores, pigeon feces, infxn becomes latent in old granulomas in lungs or lymph nodes

51
Q

Gross path Crypto

A

soft, tan grey nodules/masses – slimy cut surfaces and may cavitate

52
Q

Micro path Crypto

A

narrow based budding surround by large clear space

53
Q

Dx Crpto

A

Silver stain and mucicarmine stain. culture is fast and easy b/c grows in 48 hours.

54
Q

PcP gross path

A

heavy, diffusely consolidated tan lungs

55
Q

Micro PcP

A

foamy esoinophilic, centro-alveolar honey comb exduate

56
Q

PcP dx

A

high resolution CT - patchy or nodular ground glass attenutation
blood test - elevated LDH. PFT - decreased diffusing capacity. Cysts stain w/ grocott, trophozoite stain w/ Giema, immuno stain

57
Q

What do the cysts look like in PcP

A

tea cup

58
Q

causes of interstitial chronic pneumonia

A

Pcp, sarcoidosis, and toxo

59
Q

most common causes of viral pneumonias

A

flu and RSV

60
Q

interstitial pneumoina in ICPs

A

CMV

61
Q

Risk factors for lung cancer

A

black males, smoker, asbesto workers, uranium miners

62
Q

what lung cancer commonly cavitates?

A

squamous cell and causes post-obstructive pneumonia and high Ca

63
Q

symptoms of lung cancer

A

cough, dyspnea, weight loss, hemoptysis, chest pain, hoarseness, etc

64
Q

Adenocarcinoma definition

A

malignant epithelial tumor w/ glandular features such as making glands or mucin

65
Q

pathogenesis for adenocarcinoma

A

77% due to smoking, increase due to filtered cigs

66
Q

the common mutations in adenocarcinoma

A

p53, KRAS, EGFR, EML4-ALK, p40 and CK7 (immunostain positive)

67
Q

the 5 patterns for adenocarcinoma

A
  1. acinar - makes glands w/ desmoplasia (most common)
  2. papillary
  3. micropapillary (rare, bad prognosis)
  4. solid
  5. lepidic (in site, good prognosis)
68
Q

What is unique about the symptoms for adenocarcinoma?

A

bone pain

69
Q

Rx for adenocarcinoma

A

surgical resection for early stage, erlotinib

70
Q

Definition of adenocarcinoma in situ

A

non-destructive growth along intact alveolar septa

71
Q

Non-mucinous adenocarcinoma in situ

A
  • terminal respiratory unit cells (type II and Clara cells)
  • smokers, EGFR
  • ground glass opacity
    TTF-1+
  • commonly single nodules
72
Q

Mucinos adenocarcinoma in situ

A
  • metaplasia of bronchiolar epithelium
  • KRAS
  • CK20+
73
Q

how will multifocal nodules spread w/ adenocarcinoma in situ

A

via airways

74
Q

Adenocarcinoma in situ dx?

A

radiology (nodules may have ground glass character)

75
Q

Important concept about adenocarcinoma

A

single small nodule curable by surgery or multiple nodules or a consolidation mimicking pneumonia

76
Q

Squamous cell definitions

A

cancer w/ keratin pearls and intercellular bridges, PTHrP, smoking, more in AA less in Asians, cavitate

77
Q

Gross path for squamous cell

A

central, 2/3 from main lobar segment or subsegmental bronchi, 1/3 from smaller peripheral bronchi

78
Q

micro path for squamous cell

A

cohesive sheets, nest/cords of large cells w/ moderate smooth eosinophilic cytoplasm, intercellular bridge, and keratin pearls

79
Q

Dx for squamous cell

A

immunostain: p63, ck 5/6

80
Q

concept for squamous cell

A

central, endobronchial, cavitating and to bleed causing hemoptysis

81
Q

Pathogenesis for small cell carcinoma of lung

A

cumulative mutations controlling gene proliferation b/c of smoking - RASSF1, RB1, telomerase, bcl2, FHIT, p53

82
Q

Gross path for small cell

A

central, parabronchial, soft, off white mass w/ multifocal necrosis and metastasizes commonly to liver, bones, brain adrenals

83
Q

Micro path for small cell

A

round to oval shape, scant cytoplasm, salt and pepper nuclear chromatin, absent nucleoli, molding, many mitoses

84
Q

Signs of small cell

A
  • facial, cervical and arm edema and venous engorment = SVC syndrome;
  • Pemberton’s sign (facial flushing, distended neck and head veins, elevation of JVD
85
Q

Dx of small cell

A

synaptophysin, chromogranin. paraneoplastic syndromes

86
Q

Primary sites of lung metastases

A

breast, colon, stomach, pancreas, kidney, skin, prostate

87
Q

Pulmonary metastases

A

smaller, rounder, contoured, peripheral,

88
Q

Micro path for metastases

A

immunostains to rule out other cancers.

1st: CK7 and CK20
2nd: CDX2 and TTF-1

breast is combo of colon and lung (Ck20 and CK7 positive)

89
Q

how do you distinguish btw fat embolus and air bubbles

A

oil red O stain

90
Q

Rx for air embolus

A

left lateral decbuitus positioning, cardiac massage, hyperbaric oxygen, supportive care

91
Q

ALI/DAD central pathophysiologic mechanism

A

increased permeability of microvascular barriers (normally maintained by VE-cadherin

92
Q

What are the 3 phases of DAD?

A
  1. exudative - alveolar hyaline membrane
  2. proliferative - chronic interstitial inflammation
  3. fibrotic -
93
Q

Lipid-laden foamy macrophages w/ what?

A

amiodarone toxicity = DAD

94
Q

Dx of DAD

A

PaO2/FiO2 = over 200 mmHg

95
Q

Radiation Pneumonitis

A

after radiation. Atypical type 2 hyperplasia and blood vessel injury, residual hemosidern

96
Q

epidmeiology of IPF

A

later middle aged, men, smokers

97
Q

Pathogenesis of IPF

A

recurring ALI in small foci due to aspiration, imbalance of oxidative-antioxidant systems, autoimmune attack

98
Q

gross path for IPF

A

fibrosis w/out large scars, worse in periphery and in lower lobes —> honeycomb lung

99
Q

Signs of IPF

A

Velcro (dry inspiratory) at bases and clubbing

100
Q

COP

A

from necrotizing infection, late middle aged and non-smokers. STEROIDS

101
Q

histologic hallmark of COP

A

plugs of fibrosing gransulation tissue in alveoli called Masson bodies

102
Q

NSIP

A

more in women and never smokers, temporally homogeneous, less patchy the IPF, bilateral ground glass opacities. STEROIDS

103
Q

Pneumothorax pathogenesis

A

rupture of subpleural bleb allowing air at positive pressure into pleural space which has negative pressure during inspiration

104
Q

Signs of pneumothorax

A

diminished breath sounds, hyperresonant percussion, decreased chest excursion

105
Q

Dx of pneumothorax

A

white visceral pleural line and hypoxemia

Pulmonary - Pathology (2 decks)

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