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Pulm > Pathoma Respiratory Part I > Flashcards

Pathoma Respiratory Part I Flashcards

1
Q

Inflammation of the nasal mucosa; presents with sneezing, runny nose, congestion

A

rhinitis

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2
Q

Most common cause of common cold

A

Rhinovirus

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3
Q

rhinitis due to type I HSR characterized by inflammatory infiltrate with eosinophils

A

Allergic rhinitis

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4
Q

Protrusion of edematous, inflamed nasal mucosa usually secondary to repeated bouts of rhinitis

A

Nasal polyp

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5
Q

Child with nasal polyp

A

CF

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6
Q

Adult with nasal polyp

A

could be ASA-intolerant asthma (triad: asthma, aspirin induced bronchospasm, nasal polyp - 10% of asthmatic adults)

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7
Q

Benign tumor nasal mucosa composed of large blood vessels and fibrous tissue, classically seen in adolescent males, presents with profuse epistaxis (nosebleed)

A

Angiofibroma

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8
Q

Malignant tumor of nasopharyngeal epithelium associated with EBV (enlarged cervical lymph nodes); classically seen in African children and Chinese young adult

A

Nasopharyngeal carcinoma

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9
Q

Pleomorphic keratin-positive epithelial cells in a background of lymphocytes

A

Nasopharyngeal carcinoma

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10
Q

How might you prove that cells are epithelial?

A

Keratin (intermediate filament in epithelial cells)

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11
Q

Child presents with high fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor.

A

Epiglottitis: Inflammation of the epiglottis caused by HiB (most common cause both in IMMUNIZED and non-immunized children; NB: RISK OF ACUTE AIRWAY OBSTRUCTION

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12
Q

Child presents with hoarse “barking” cough and inspiratory stridor

A

Croup = inflammation of the upper airway

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13
Q

What is the fancy name for croup? What is it?

A

Laryngotracheobronchitis; inflammation of the upper airway;

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14
Q

What is the most common cause of croup?

A

Parainfluenza virus

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15
Q

Singer presents with hoarseness

A

Vocal cord nodule

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16
Q

What are vocal cord nodule made of?

A

Degenerative myxoid connective tissue

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17
Q

Benign papillary tumor of vocal cord due to HPV 6 & 11; single tumor in adults but multiple in children

A

Laryngeal papilloma (can turn into laryngeal papilloma but rarely)

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18
Q

Risk facts of laryngeal carcinoma

A

alcohol and tobacco

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19
Q

Squamous cell carcinoma arising from epithelial lining of vocal cord; risk factors are alcohol and tobacco; presents with hoarseness, cough, stridor

A

Laryngeal carcinoma

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20
Q

Nosebleed in an adolescent male

A

Angiofibroma

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21
Q

Adult presents with hoarseness

A
  1. Vocal cord nodule
  2. Laryngeal papilloma
  3. Laryngeal carcinoma
  4. Reflux or infectious laryngitis
  5. Injury to vagus and/or recurrent laryngeal nerves (thyroid surgery)
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22
Q

Infection of the lung parenchyma

A

Pneumonia

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23
Q

Why might pneumonia occur?

A

Normal defenses impaired (cough reflex, damage to mucociliary escalator, mucus plugging,

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24
Q

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

A

pneumonia

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25
Q

How do you diagnose pneumonia?

A

Chest xray, sputum gram stain and culture, and blood culture

26
Q

What are the three patterns of pneumonia seen on CXR?

A
  1. Lobar pneumonia
  2. Bronchopneumonia
  3. Interstitial
27
Q

Lobar pneumonia is usually caused by?

A

Bacteria: Strep pneumo (95% - most common CAP) and rarely Klebsiella pneumo

28
Q

What are the four gross phases of lobar pneumonia (consolidation of a lobe)?

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution
29
Q

Histology of lobar pneumonia?

A

Air sacs full of lymphocytes and pink frothy material (exudate)

30
Q

Currant jelly sputum

A

Klebsiella pneumoniae (enteric flora) –> due to thick mucoid capsule; often w/ abscess

31
Q

Risk of aspiration pneumonia is increased in:

A 
elderly (nursing homes),
people who have seizures,
people w/ dementia, 
alcoholics
comatose
32
Q

What cell type regenerates lining of air sacs after pneumonia?

A

Type II pneumocytes

33
Q

Causes of bronchopneumonia

A
  1. Staph aureus
  2. HiB
  3. Pseudomonas aeruginosa
  4. Moraxella catarrhalis
  5. Legionella pneumophila
34
Q

Most common cause of secondary bronchopneumonia (bacterial on URI); often complicated by abscess or empyema (pus in pleural space)

A

Staph aureus

35
Q
  1. Common cause of secondary pneumonia and pneumonia superimposed on COPD
  2. Community-acquired pneumonia and pneumonia superimposed on COPD
A
  1. HiB

2. Morazella

36
Q

Pneumonia in CF patients

A

Pseudomonas

37
Q

Intracellular organism that is best visualized by silver stain and is transmitted from water source

A

Legionella

38
Q

CAP, pneumonia superimposed on COPD, pneumonia in immunocompromised

A

Legionella

39
Q

Diffuse interstitial infiltrates throughout lung; presents with mild upper respiratory symptoms (minimal sputum, cough, low fever)

A

Interstitial (ATYPICAL) pneumonia

40
Q

Most common cause of interstitial/atypical pneumonia

A

Mycoplasma pneumoniae

41
Q

Atypical pneumonia in young adult such as military recruit or college student

A

Mycoplasma

42
Q

Complications of mycoplasma pneumo

A

autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) and erythema multiforme

43
Q

What bacteria is not present on a gram stain?

A

Mycoplasma (NO CELL WALL)

Also anaplasma?

44
Q

Atypical pneumonia (second most likely after mycoplasma)

A

Chlamydia pneumoniae

45
Q

Most common cause of atypical pneumonia in infants

A

Respiratory synctial virus (RSV)

46
Q

Pneumonia in person on post transplant immunosuppressive therapy

A

Cytomegalovirus (CMV)

47
Q

Atypical pneumonia in elderly, immunocompromised, and those with preexisting lung disease; also increases risk for superimposed Staph aureus or HiB bacterial pneumonia)

A

Influenza virus

48
Q

Pneumonia caused by a virus is likely to have what pattern on X-ray?

A

Interstitial (lobar and bronchopneumonia are usually bacterial)

49
Q

Atypical pneumonia with high fever in farmers and vets

A

Coxiella burnetii (it’s called Q fever; spores are deposited on cattle by ticks or are present in cattle placentas)

50
Q

What distinguishes Coxiella from the other rickettsial organisms?

A
  1. causes pneumonia
  2. does not require arthropod vector for transmission (highly heat-resistant endospores)
  3. Does not produce a skin rash
51
Q

What are all the organisms that can cause atypical pneumonia?

A 
Mycoplasma
Chylamidia pneumo
RSV
CMV
Influenze
Coxiella
52
Q

Classic location for aspiration pneumonia

A

Right lower lobe (righ main stem broncus beaches at less acute angle

53
Q

Mouth anaerobes that can cause aspiration pneumonia

A

Bacteriodes, fusobacterium, and peptococcus (you can also aspirate Klebsiella, which comes from gut)

54
Q

Focal caseating necrosis in the lower lobe of lung and hilar lymph nodes that then undergo fibrosis and calcification to form a Ghon complex

A

PRIMARY TB (generally asymptomatic but gives positive PPD)

55
Q

Cavitary foci of caseous necrosis at apex of lung (may also lead to miliary pulmonary TB (lots of little spots everywhere) or TB bronchopneumonia)

A

Secondary TB arises with reactivation of TB - commonly due to AIDS or aging.

56
Q

Why does secondary TB occur at apex?

A

Relatively poor lymphatic drainage and high oxygen tension

57
Q

Patient presents w/ fever, night sweats, cough with hemoptysis, and weight loss

A

Secondary TB

58
Q

What do you see on biopsy with secondary TB?

A

Caseating granulomas

59
Q

Acid fast bacilli

A

TB (slender red)

60
Q

Systemic spread from secondary TB may go to (name 4 places)

A
  1. meninges (meningitis w/ granulomas at base of brain)
  2. cervical lymph nodes
  3. kidneys: (sterile pyuria)
  4. Lumbar vertebrae (Pott disease)
61
Q

Differential for caveating granuloma

A

TB or fungus (aspergillus…)

62
Q

An abnormal communication between the trachea and esophagus

A

Tracheoesophageal fistula caused by a malformation of the transesophageal septum; generally associated w/ esophageal atresia.

Pulm (5 decks)

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