Pathology

Question 1

Rhinitis (common cold). Most common pathogens. Presentation. Tx.

Answer 1

Inflammation of nasal mucosa
-Adenovirus (Rhinovirus according to Diebel), or Coronovirus is most common cause
Sneezing, congestion, and runny nose
Usually winter months, more common in children
Secondary infections due to ciliary epithelial cells being destroyed (sinusitis, otitis media, bronchitis)
Tx is supportive

Question 2

Allergic Rhinitis

Answer 2

Inflammation of nasal mucosa due to TYPE I Hypersensitivity (pollen)
-Inflammatory infiltrate with eosinophils
Associated with asthma and eczema

Question 3

Nasal Polyp

Answer 3

Complication of rhinitis*
-Protrusion of edematous inflamed nasal mucosa
Child with nasal polyps - think about CYSTIC FIBROSIS*
Adults with nasal polyps - think about Aspirin induced asthma*

Question 4

Nasal Angiofibroma

Answer 4

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue
- Adolescent males*
Presents with profuse epistaxis

Question 5

Nasopharyngeal Carcinoma

Answer 5

Malignant tumor of nasopharyngeal epithelium
-EBV associated** (African children or Chinese adults)
Presents with cervical lymphadenopathy, biopsy shows pleomorphic keratin-positive* epithelial cells in a background of lymphocytes

Question 6

Acute Epiglottitis

Answer 6

Inflammation of epiglottis
-H. influenza type B* is most common cause in immunized and non-immunized children*
Presents with high fever, sore throat, drooling with dysphagia, muffled voice, inspiratory stridor
RISK of AIRWAY obstruction**

Question 7

Laryngotracheobronchitis (CROUP)

Answer 7

Inflammation of upper airway
-Parainfluenza virus** is most common cause
-Influenza virus and RSV tend to occur during winter and early spring
Presents as hoarse “barking” cough and inspiratory stridor (usually following a URI with general cold symptoms)
-Sx usually peak at 3-5 days and resolve within 4-7
Tx is symptomatic or corticosteroids if breathing is very bad.
A cool air humidifier may help resolve symptoms

Question 8

Vocal Cord Nodule

Answer 8

Nodule arises on vocal cord due to excessive use
-Bilateral, composed of degenerative mixoid* connective tissue
Presents with hoarseness, resolves with rest

Question 9

Laryngeal Papilloma

Answer 9

Bengin papillary tumor of vocal cord
-Due to HPV 6 and 11**
Single papilloma in adults* and multiple in children*
Presents with hoarseness

Question 10

Laryngeal Carcinoma

Answer 10

Squamous cell carcinoma arising form epithelial lining of vocal cord
-Alcohol and tobacco are most common risks** also laryngeal papilloma
Presents with hoarseness, cough, stridor

Question 11

Pneumonia

Answer 11

Infection of lung parenchyma
-Occurs when normal defenses are impaired (cilia are paralyzed (mucociliary escalator) - viral pneumonia, smoking, mucus plug.

Question 12

Pneumonia. Sx and Dx

Answer 12

Present with fever and chills, productive couph (yellow-green or rusty), tachypnea, pleuritic chest pain (when lung expand) PGE2 and bradykinin mediate the pain**, Decreases breath sounds with dullness to percussion, Elevated WBC count
Dx with chest X-ray, sputum gram stain and culture, blood cultures

Question 13

Lobar Pneumonia

Answer 13

Entire lobe consolidation
-Usually bacterial
Most common are Strep pneumoniae* (most common cause of community acquired) and Klebsiella* pneumonia (enteric flora that is aspirated - elderly, alcoholics. CURRANT jelly sputum (thick capsule of Klebsiella), often complicated by abscess**)
-Alveoli will be full of neutrophils and exudate

Question 14

Bronchopneumonia

Answer 14

Patchy areas along small airways, often multifocal and bilateral
-Usually bacterial
Staphylococcus Aureus (most common cause of secondary** pneumonia, after viral infection), often accompanied by empyema or abscess
Haemophilus influenza - in patients with COPD
Pseudomonas in cystic fibrosis patients
Moraxella in COPD or community acquired
Legionella - immunocompramized or COPD patients. Arises from water source. Intracellular - need silver stain

Question 15

Interstitial Pneumonia

Answer 15

Consolidation with in interstitial of lung - increased in the lung markings
-Atypical pneumonia (viral)
Presents with relatively mild URI sx (minimal sputum, cough, and low fever
- in biopsy the alveoli would be empty - but thick interstitium
Mycoplasma Pneumoniae (young adults in close quarters, can produce IgM autoimmune hemolytic anemia, not visible on gram stain*)
Chlamydia pneumonia (young adults)
RSV (most common in infants)
CMV (post transplant immunosuppressive therapy pts)
Influenza virus (elderly, immunocompramized and those with lung disease, increased risk for secondary bacterial pneumonia - S. Aureus** - what usually kills the patient)
Coxiella Brunetii - Atypical pneumonia with HIGH fever (Q fever) in farmers and veterinarians (spores on cattle or ticks) it is a rickettsiae

Question 16

Four Phases of Lobar Pneumonia in pathology

Answer 16

Congestion - increasing blood in lungs and edema
Red Hepatization - exudate within lung, exudate contains blood and neutrophils - makes lung solid
Grey Hepatization - RBCs are broken down turning it grey
Resolution - resolving the exudate

Type II pneumocyte helps to regenerate lining of alveoli**

Question 17

Aspiration Pneumonia

Answer 17

Alcoholics or comatos patients
- Due to anaerobic bacteria in oropharynx (bacteroides, fusobacterium, and peptococcus)
Classically RIGHT LOWER Lobe abscess (right has steeper angle for aspirates to go down)

Question 18

Primary TB

Answer 18

Arises with initial exposure*
Focal caseating necrosis in the lower lobe of lung and hilar lymph nodes
-Goci udergo fibrosis and calcification forming Ghon complex** (subpleural)
Primarily Asymptomatic

Question 19

Secondary TB

Answer 19

Reactivation of TB in Ghon complex
-Due to AIDS (HIV) or with aging
-occurs in APEX of lung
Forms cavitary foci of caseous necrosis, lead to military pulmonary TB or tuberculous bronchopneumonia
Presents with fever, night sweats, cough, hemoptysis, weight loss
Biopsy reveals caveating granulomas
AFB stain reveals red ACID FAST bacilli
Can involve any tissue if it spreads - Meninges (meningitis at base of brain**), Cervical, most common is KIDNEY - sterile pyuria, lumbar vertebrae (Pott disease)

Question 20

Pneumothorax

Answer 20

Accumulation of air in pleural space

Question 21

Spontaneous Pneumothorax

Answer 21

Rupture of emphysematous bleb - seen in young adults

Portion of lung collapses, trachea shifts to side of collapse

Question 22

Tension Pneumothorax

Answer 22

With puncture injury - medical emergency
-one way valve (breath in air enters pleural space, air does not exit on exhalation)
Trachea deviates to opposite side
Can compress heart, need to needle decompress

Question 23

Mesothelioma

Answer 23

Malignant neoplasm of mesothelial cells
- Highly associated with occupation exposure to asbestos
Presents with recurrent pleural effusions dyspnea, and chest pain
Tumor encases the lung

Question 24

Sinusitis (Rhinosinusitis). Presentation. Tx. Organisms.

Answer 24

Inflammation/infection of mucosa of nasal passages and at least one paranasal sinus (no longer than 4 weeks)
Presents with sneezing, rhinorrhea, nasal congestion with postnasal drip, aural fullness (pressure in the ear), facial pressure and headache, sore throat, cough and fever, and muscle aches.
Commonly VIRAL (tx supportive) but that predisposes pt for secondary bacterial infection (usually if it persists more than 7 days or if severe symptoms like tooth pain or facial swelling)
-Strep pneumoniae
-H. influenzae
Tx: Amoxicillin or Azythromycin
If treated and doesn’t resolve could be fungal
-Aspergillus fumigatus
tx is then mechanical removal

Question 25

Pharyngitis. Presentation. Tx. Organisms.

Answer 25

Sore throat. Inflammation of nasopharynx. Main cause is VIRAL if not viral and SUDDEN than Strep Pyogenes** Presents with Fever, sore throat, edema, and hyperemia of the tonsils and pharyngeal walls, red tonsils with or without exudate and enlarged, tender cervical lymph nodes -If conjunctivitis or cough is is MOST LIKELY VIRAL* (ADENOVIRUS) If suspect bacterial must do rapid strep test (antigen testing) Tx is supportive if viral, if Strep Pyogenes must use penicillin or erythromycin (if allergic to penicillin)

Question 26

Scarlet Fever.

Answer 26

Uncontrolled Strep Pyogenes infection. Lysogenized bacteriophage infected strep can secrete superantigens (exotoxins) Children at highest risk* "Strawberry Tongue"

Question 27

Diptheria

Answer 27

Pharyngitis caused by Corynebacterium Diphtheriae Usually in unvaccinated pts (DTAP vaccine prevents it) Can create a white/grey pseudomembrane on back of throat (DO NOT disrupt it - can cause bacterial to get into blood and cause myocarditis) Tx is Abx AND anti-toxin

Question 28

Bronchitis

Answer 28

Infection of bronchi and bronchioles. Presents with cough, fever, chest pain and usually follows a viral URI (common cold). Hacking cough with some sputum production (difficult to differentiate from pneumonic without CXR) Tx is symptomatic unless it lasts longer than 14 days (2 weeks), then Abx are necessary (erythromycin or azythromycin) Pathogens: Same as Rhinitis: Rinovirus, adenovirus, parainfluenza virus if a child**, RSV

Question 29

Bronchiolitis

Answer 29

Inflammation of bronchial tree as low as the bronchioles - NO alveolar involvement. Usually in infants less than 1 year of age*** and is preceded by minor viral URI Must get CXR to rule out pneumonia Most common pathogen is RSV*** (also parainfluenza or adenovirus) Passive immunization will work only if it is RSV - high risk patients include premature births or those with congenital pulmonary defects

Question 30

Pertussis

Answer 30

Lower respiratory tract infection by Bordetella Pertussis Two symptom phases: 1 - incubation, 3-21 days (Catarrhal stage), common cold symptoms, mainly with a runny nose. 2 - Paroxysmal stage. Uncontrollable coughing***, bursted blood vessels in eyes or vomiting, possible seizure from small hemorrhages in brain Then a recovery stage (convalescent) - RISK FOR secondary infection (the Ciliary escalator has been damaged by pertussis AB toxin)

Question 31

Pneumonia

Answer 31

Inflammatory condition of lung where fluid fills the alveoli. Can be a secondary infection of the flu. Most common cause of pneumonia is Streptococcus pneumonae

Question 32

Child with pharyngitis, fever, conjunctivitis? What could be secondary infections?

Answer 32

Viral pharyngitis - Adenovirus If bacterial S. Pyogenes Gastroenteritis, myocarditis, hemorrhagic cystitis, ARDS

Question 33

Infant with staccato cough a few weeks after birth?

Answer 33

Chalmidae Trachomonis

Question 34

Findings of pneumothorax

Answer 34

Physical exam findings of a pneumothorax include hyperresonance to percussion, decreased breath sounds, & decreased tactile fremitus. Egophony is seen with consolidation, such as lobar pneumonia. Whispered pectoriloquy refers to louder, clearer breath sounds than normal and is associated with consolidation. A person with a pneumothorax would have decreased or absent transmission of whispered breath sounds.