Pathoma Respiratory Part I Flashcards
Inflammation of the nasal mucosa; presents with sneezing, runny nose, congestion
rhinitis
Most common cause of common cold
Rhinovirus
rhinitis due to type I HSR characterized by inflammatory infiltrate with eosinophils
Allergic rhinitis
Protrusion of edematous, inflamed nasal mucosa usually secondary to repeated bouts of rhinitis
Nasal polyp
Child with nasal polyp
CF
Adult with nasal polyp
could be ASA-intolerant asthma (triad: asthma, aspirin induced bronchospasm, nasal polyp - 10% of asthmatic adults)
Benign tumor nasal mucosa composed of large blood vessels and fibrous tissue, classically seen in adolescent males, presents with profuse epistaxis (nosebleed)
Angiofibroma
Malignant tumor of nasopharyngeal epithelium associated with EBV (enlarged cervical lymph nodes); classically seen in African children and Chinese young adult
Nasopharyngeal carcinoma
Pleomorphic keratin-positive epithelial cells in a background of lymphocytes
Nasopharyngeal carcinoma
How might you prove that cells are epithelial?
Keratin (intermediate filament in epithelial cells)
Child presents with high fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor.
Epiglottitis: Inflammation of the epiglottis caused by HiB (most common cause both in IMMUNIZED and non-immunized children; NB: RISK OF ACUTE AIRWAY OBSTRUCTION
Child presents with hoarse “barking” cough and inspiratory stridor
Croup = inflammation of the upper airway
What is the fancy name for croup? What is it?
Laryngotracheobronchitis; inflammation of the upper airway;
What is the most common cause of croup?
Parainfluenza virus
Singer presents with hoarseness
Vocal cord nodule
What are vocal cord nodule made of?
Degenerative myxoid connective tissue
Benign papillary tumor of vocal cord due to HPV 6 & 11; single tumor in adults but multiple in children
Laryngeal papilloma (can turn into laryngeal papilloma but rarely)
Risk facts of laryngeal carcinoma
alcohol and tobacco
Squamous cell carcinoma arising from epithelial lining of vocal cord; risk factors are alcohol and tobacco; presents with hoarseness, cough, stridor
Laryngeal carcinoma
Nosebleed in an adolescent male
Angiofibroma
Adult presents with hoarseness
- Vocal cord nodule
- Laryngeal papilloma
- Laryngeal carcinoma
- Reflux or infectious laryngitis
- Injury to vagus and/or recurrent laryngeal nerves (thyroid surgery)
Infection of the lung parenchyma
Pneumonia
Why might pneumonia occur?
Normal defenses impaired (cough reflex, damage to mucociliary escalator, mucus plugging,
Patient w/ fever, chills, cough with yellow-green or rusty sputum, tachypnea with pleuritic chest pain (pain on inspiration caused by bradykinin and prostaglandin E2), decreased breath sounds w/ dullness to percussion, elevated WBC count
pneumonia
How do you diagnose pneumonia?
Chest xray, sputum gram stain and culture, and blood culture
What are the three patterns of pneumonia seen on CXR?
- Lobar pneumonia
- Bronchopneumonia
- Interstitial
Lobar pneumonia is usually caused by?
Bacteria: Strep pneumo (95% - most common CAP) and rarely Klebsiella pneumo
What are the four gross phases of lobar pneumonia (consolidation of a lobe)?
- Congestion
- Red hepatization
- Gray hepatization
- Resolution
Histology of lobar pneumonia?
Air sacs full of lymphocytes and pink frothy material (exudate)
Currant jelly sputum
Klebsiella pneumoniae (enteric flora) –> due to thick mucoid capsule; often w/ abscess
Risk of aspiration pneumonia is increased in:
elderly (nursing homes), people who have seizures, people w/ dementia, alcoholics comatose
What cell type regenerates lining of air sacs after pneumonia?
Type II pneumocytes
Causes of bronchopneumonia
- Staph aureus
- HiB
- Pseudomonas aeruginosa
- Moraxella catarrhalis
- Legionella pneumophila
Most common cause of secondary bronchopneumonia (bacterial on URI); often complicated by abscess or empyema (pus in pleural space)
Staph aureus
- Common cause of secondary pneumonia and pneumonia superimposed on COPD
- Community-acquired pneumonia and pneumonia superimposed on COPD
- HiB
2. Morazella
Pneumonia in CF patients
Pseudomonas
Intracellular organism that is best visualized by silver stain and is transmitted from water source
Legionella
CAP, pneumonia superimposed on COPD, pneumonia in immunocompromised
Legionella
Diffuse interstitial infiltrates throughout lung; presents with mild upper respiratory symptoms (minimal sputum, cough, low fever)
Interstitial (ATYPICAL) pneumonia
Most common cause of interstitial/atypical pneumonia
Mycoplasma pneumoniae
Atypical pneumonia in young adult such as military recruit or college student
Mycoplasma
Complications of mycoplasma pneumo
autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) and erythema multiforme
What bacteria is not present on a gram stain?
Mycoplasma (NO CELL WALL)
Also anaplasma?
Atypical pneumonia (second most likely after mycoplasma)
Chlamydia pneumoniae
Most common cause of atypical pneumonia in infants
Respiratory synctial virus (RSV)
Pneumonia in person on post transplant immunosuppressive therapy
Cytomegalovirus (CMV)
Atypical pneumonia in elderly, immunocompromised, and those with preexisting lung disease; also increases risk for superimposed Staph aureus or HiB bacterial pneumonia)
Influenza virus
Pneumonia caused by a virus is likely to have what pattern on X-ray?
Interstitial (lobar and bronchopneumonia are usually bacterial)
Atypical pneumonia with high fever in farmers and vets
Coxiella burnetii (it’s called Q fever; spores are deposited on cattle by ticks or are present in cattle placentas)
What distinguishes Coxiella from the other rickettsial organisms?
- causes pneumonia
- does not require arthropod vector for transmission (highly heat-resistant endospores)
- Does not produce a skin rash
What are all the organisms that can cause atypical pneumonia?
Mycoplasma Chylamidia pneumo RSV CMV Influenze Coxiella
Classic location for aspiration pneumonia
Right lower lobe (righ main stem broncus beaches at less acute angle
Mouth anaerobes that can cause aspiration pneumonia
Bacteriodes, fusobacterium, and peptococcus (you can also aspirate Klebsiella, which comes from gut)
Focal caseating necrosis in the lower lobe of lung and hilar lymph nodes that then undergo fibrosis and calcification to form a Ghon complex
PRIMARY TB (generally asymptomatic but gives positive PPD)
Cavitary foci of caseous necrosis at apex of lung (may also lead to miliary pulmonary TB (lots of little spots everywhere) or TB bronchopneumonia)
Secondary TB arises with reactivation of TB - commonly due to AIDS or aging.
Why does secondary TB occur at apex?
Relatively poor lymphatic drainage and high oxygen tension
Patient presents w/ fever, night sweats, cough with hemoptysis, and weight loss
Secondary TB
What do you see on biopsy with secondary TB?
Caseating granulomas
Acid fast bacilli
TB (slender red)
Systemic spread from secondary TB may go to (name 4 places)
- meninges (meningitis w/ granulomas at base of brain)
- cervical lymph nodes
- kidneys: (sterile pyuria)
- Lumbar vertebrae (Pott disease)
Differential for caveating granuloma
TB or fungus (aspergillus…)
An abnormal communication between the trachea and esophagus
Tracheoesophageal fistula caused by a malformation of the transesophageal septum; generally associated w/ esophageal atresia.
