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PATHOphys Exam 2 > Pulm 3 Shea > Flashcards

Pulm 3 Shea Flashcards

1
Q
  • Diffuse interstitial PNA in immunocompromised patients
  • Characteristics of both fungus and protozoan parasite
  • Transmission?
  • # 1 cause of PNA in AIDS patients, leading cause of death in these patients
A
  • Pneumocystis jiroveci
  • Inhalation, does not cause disease in healthy patients
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2
Q
A
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3
Q
  • Cup or boat shaped cysts in alveoli induces inflammatory response –> results in frothy, eosinophilic, edema fluid which blocks O2 exchange.
A

Pneumocystic jiroveci

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4
Q
  • Sudden onset fever, cough, dyspnea, tachypnea
  • Bilateral rales/rhonchi
  • Chest x-ray reveals diffuse interstitial PNA
  • Isolates to lungs only
A

Pneumocystic jiroveci

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5
Q

What type of stain is used to see the boat/ cup like appearance of pneumocystis jiroveci?

A

Silver Stain (GMS) for Cyst Organsims

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6
Q

A chronic, bacterial infectious disease caused by Mycobacterium

A

Tuberculosis

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7
Q
  • TB is more common in which patients and which population?
  • How is it treated?
A
  • AIDS patiens
  • Homeless population (crowding in small areas in the cold)
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8
Q
  • Rod shaped bacterium w/ waxy capsule
  • Acid fast
  • Neither gram neg or gram pos
  • DOES NOT stain w/ gram stain dyes
  • Obligate aerobe
A

M. tuberculosis

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9
Q

M. tuberculosis has a cell wall which contains what?

A

Mycolic acid (a complex lipid) which is antiphagocytic

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10
Q
  • Which organism stains “magenta?”
  • What is the shape?
A
  • TB on an acid fast stain
  • Beaded rod
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11
Q

How is TB transmitted?

A

Person to person w/ respiratory aerosols

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12
Q

Where is the initial site of infection of TB?

A

Lungs

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13
Q
  • Bacterial infection which is not acute
  • Does not attract PMNs
  • Not marked by acute purulent lesions
  • Encapsulated bacteria form granulomas which contain stimulated macrophages, which transform into –> multi-nucleated giant cells w/ central caseous necrosis
A

TB

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14
Q

Why do we need to use 3 drugs to kill TB?

A

Because just one drug would not be enough to penetrate the necrosis

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15
Q

Where does the TB organism multiply in the lungs after being inhaled? Why?

A

In the alveoli, bc/ alveolar macrophages can’t kill it

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16
Q

Where does the initial infection of TB usually occur within the lungs?

A

Lower lobes

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17
Q

Consists of:

  • peripheral parenchymal granuloma
  • prominent infected draining mediastinal (hilar) lymph node w/ *caseous necrosis - looks like mozarella chz*
A

Ghon Complex associated w/ initial infection of TB

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18
Q

What part of the lungs is there higher oxygen levels?

A

Lower lobes

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19
Q

Grossly, is well circumscribed w/ central necrosis and later on the lesion is fibrotic and calcified

A

Healed, subpleural Ghon nodule

20
Q
  • How do patients w/ primary TB infection present clinically?
  • Where is the organism?
A
  • 90-95% (majority) are asymptomatic, lesion remains localized, heals w/ calcification that can be seen on CXR. (coin lesion)
  • Calcified primary lesion within the caseous necrosis (organism visualized on AFB stain
21
Q

The initial lesion enlarges rapidly and there is erosion of bronchi or bronchioles by the necrotic central liquefaction. Which 2 groups does this most often occur in?

(Primary TB typically does not remain limited and heal, it usually spreads to other parts of lungs)

A

Progressive Primary TB

  • Children
  • Immunosuppressed
22
Q

Represents a reactivation of dormant primary infection

A

Secondary Infection of TB

(Reactivation)

23
Q
  • Bacteria spreads to apex of lungs
  • Causes granulomatous PNAs
  • Hemoptysis from erosion into pulmonary blood vessels
A

Secondary TB / Reactivation

24
Q

What is the main complication of the Secondary Stage of TB?

A

Miliary Spread which is a result of tissue destruction and erosions

25
Q

Multiple, small tuberculous granulomas in many organs which have well oxygenated sites

A

Miliary Spread

26
Q

Where are the 4 oxygenated sites of miliary spread?

A
  • If swallowed: GI tract (small intestines)
  • Via eroded bloodstream: kidneys, brain, or bones
27
Q

What are complications of miliary spread?

A
  • contralateral PNA
  • pleuritis w/ effusion
  • pleural granulomas
  • TB laryngitis
  • intestinal TB (from swallowing)
  • hemoptysis (from erosion of small pulm arteries in wall of cavity)
  • Scrofula
  • TB meningitis
  • Osteoarthritis
28
Q
  • Lymphatic spread to the hilar lymph nodes w/ infection to the neck area causing enlarged supraclavicular lymph nodes
  • Unilateral cervical adenitis (swollen non-tender nodes)
A

Scrofula (complication of Miliary Spread of TB)

29
Q

Where does TB tend to go in the CNS?

A

Meninges (base of brainstem/pons)

30
Q
  • TB eroding the body of vertebrae, can involve the disc as well as the bone.
  • A miliary form of TB
A

Pott’s disease

(vertebral osteoarthritis)

31
Q

Expectorated acid-fast bacilli (TB) may cause infection of what?

A

Larynx, causing laryngitis

32
Q

What is the initial diagnostic test for TB?

A

Acid-Fast Staining of sputum or other specimens

33
Q

Slowest growing organism

A

Acid-fast bacilli (TB)

34
Q

Where is a tuberculoma located?

A

Brainstem

35
Q

What is the #1 cancer in men and #1 cause of death from cancer in the U.S.?

A

Carcinoma of the Lung

36
Q
  • Subtype of adenocarcinoma that grows along preexisting alveolar walls.
  • Accounts for 1-5 % of all invasive lung tumors.
  • Copious mucin in the sputum
  • Grossly, may appear as a single peripheral nodule or coin lesion (over 50% of cases), multiplenodules or a diffuse infiltrate indisting-uishible from a lobar pneumonia.
A

Bronchioloalveolar Carcinoma

37
Q

Which 3 cancers to 90% are centrally located?

A
  • Squamous Cell Carcinoma
  • Small Cell Carcinoma
38
Q
  • **Which cancer to 90% is peripherally located?
  • often associated with scars which can result in puckering of the pleural.
  • Slight association with smoking.
  • Appear as irregular masses, which on cut section appear gray-white in color, soft and glistening, depending on the amount of mucus.
A

Adenocarcinoma

39
Q
  • Previously called “oat cell carcinoma”.
  • A highly malignant epithelial tumor that exhibits neuroendocrine features.
  • Accounts for 20% of all lung cancers and is strongly associated with cigarette smoking.
A

Small Cell Carcinoma

40
Q
  • Produces a variety of Paraneoplastic Syndromes, including Diabetes Insipidus, due to ADH production, ectopic ACTH (corticotropin) or Parathormone production.
A

Small Cell Carcinoma

41
Q
  • Usually appears as a perihilar (central) mass
  • Extensive lymph node metastases.
  • On cut section, it is soft and white, but with extensive hemorrhage and necrosis.
A

Small Cell Carcinoma

42
Q

This type of lung cancer is the only tumor that is sensitive to radiotherapy.***

A

Small Cell Carcinoma

43
Q
  • Histologically, they consist of sheets of small, round, oval or spindle-shaped cells.
  • The tumor cells display scant cytoplasm with finely granular nuclear chromatin.
  • By EM (electron microscopy) many of the cells contain secretory neuroendocrine granules
A

Small Cell Carcinoma

44
Q
  • Diagnosis of exclusion in a poorly undifferentiated non-small cell carcinoma
  • Does not show features of squamous or glandular differentiation.
  • Cells are large and irregular and exhibit ample cytoplasm. The nuclei frequently show prominent nucleoli and vesicular chromatin.
A

Large Cell Carcinoma

45
Q
  • Where is the most common extranodal site/extranodal metastasis?
  • 3 most common sites of metastatic disease
A
  • Adrenal gland
  • Brain, bone, liver

PATHOphys Exam 2 (22 decks)

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