Pathology Flashcards
Rhinitis (common cold). Most common pathogens. Presentation. Tx.
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
Allergic Rhinitis
Inflammation of nasal mucosa due to TYPE I Hypersensitivity (pollen)
-Inflammatory infiltrate with eosinophils
Associated with asthma and eczema
Nasal Polyp
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*
Nasal Angiofibroma
Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue
- Adolescent males*
Presents with profuse epistaxis
Nasopharyngeal Carcinoma
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
Acute Epiglottitis
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**
Laryngotracheobronchitis (CROUP)
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
Vocal Cord Nodule
Nodule arises on vocal cord due to excessive use
-Bilateral, composed of degenerative mixoid* connective tissue
Presents with hoarseness, resolves with rest
Laryngeal Papilloma
Bengin papillary tumor of vocal cord
-Due to HPV 6 and 11**
Single papilloma in adults* and multiple in children*
Presents with hoarseness
Laryngeal Carcinoma
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
Pneumonia
Infection of lung parenchyma
-Occurs when normal defenses are impaired (cilia are paralyzed (mucociliary escalator) - viral pneumonia, smoking, mucus plug.
Pneumonia. Sx and Dx
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
Lobar Pneumonia
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
Bronchopneumonia
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
Interstitial Pneumonia
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
Four Phases of Lobar Pneumonia in pathology
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**
Aspiration Pneumonia
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)
Primary TB
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
Secondary TB
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)
Pneumothorax
Accumulation of air in pleural space
Spontaneous Pneumothorax
Rupture of emphysematous bleb - seen in young adults
Portion of lung collapses, trachea shifts to side of collapse
Tension Pneumothorax
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
Mesothelioma
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
Sinusitis (Rhinosinusitis). Presentation. Tx. Organisms.
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
Pharyngitis. Presentation. Tx. Organisms.
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)
Scarlet Fever.
Uncontrolled Strep Pyogenes infection. Lysogenized bacteriophage infected strep can secrete superantigens (exotoxins)
Children at highest risk* “Strawberry Tongue”
Diptheria
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
Bronchitis
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
Bronchiolitis
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
Pertussis
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)
Pneumonia
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
Child with pharyngitis, fever, conjunctivitis?
What could be secondary infections?
Viral pharyngitis - Adenovirus
If bacterial S. Pyogenes
Gastroenteritis, myocarditis, hemorrhagic cystitis, ARDS
Infant with staccato cough a few weeks after birth?
Chalmidae Trachomonis
Findings of pneumothorax
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.
