Pulmo Part 3 Flashcards
Most common opportunistic CMV disease
retinitis
Fungi causing pneumonia in AIDS <200 CD4 count
Foamy acellular exudate
Cup-shaped round cyst within exudate
P jiroveci
P carinii
Intraalveolar foamy pink staining exudate with h & e (cotton candy)
Round to cup shaped cyst 4-10um dm with intracystic body without budding
P jiroveci
P jiroveci dx
Sputum or BAL immunofluorescence
Most common disease causing fungus
Candida albicans
Yeast like form (blastoconidia)
pseudohyphae, true hyphae
Budding yeast joined end to end at constrictions simulating true fungal hyphae
Stain:
C albicans
Pseudohyphae
Gomori methenaminesilver
Periodic acid Schiff
Gray white
Dirty looking pseudomembrane
Matted organism and inflammatory debris
Mucosal hyperemia, inflammation
Oral thrush
Candidal infection on nail fold
Paronychia
Candida assoc disease
Hypoparathyroidism
Addison disease
Autoantibodies
Mutation affecting TH17 Rendering px highly susceptible to severe mucocutaneous candidiasis
Job syndrome
5-10 um yeast with thick gelatinous capsule, buds
No pseudohyphae true hyphae
Capsule is invaluable to diagnosis
Halo seen in india ink and periodic acid Schiff staining
Capsular polysaccharide antigen substrate for latex agglutination assay
C neoformans
C neoformans grow in meninges and perivascular Virchow Robin spaces producing
soap bubble lesion
Zygomycetes
Nonseptate hyphae branching at right angle
Common to hematolymphoid malig, neutropenia and corticosteroid therapy allogeneic stem cell
Mucormycosis
Septate and branched hyphae at acute angles
Aspergillus
Nondistinctive suppurative granulomatous reaction with predilection for invading blood vessel wall causing necrosis and infarction (3)
Rhizopus
Mucormycosis
Aspergillus
Colonizes nasal cavity and sinuses spreading into brain, orbit
DKA
localized pulmonary disease with diffuse miliary involvement
Rhinocerebral mucormycosis
Immunosupressed
Localizing in lung manifesting as necrotizing pneumoniae
Invasive aspergillosis
Asthma caused by type I hypersensitivity against fungus growing in bronchi
Allergic bronchopulmo aspergillosis
Fungus ball
Colonization of preexisting pulmo cavity
Act as ball valves
Aspergilloma
Most common benign lung lesion 3-4cn
Coin lesion
mature cartilage admixed with fat, fibrous tissue and blood vessel
hamartoma
Carcinoma with strongest association with smoking
Squamous cell
Small cell
Most common primary lung tumor
esp in women
never smokers
less than 45
metastasize at early stage
Adenocarcinoma
Two broad lung ca
bec
1 small cell
2 non small cell (adeno, squamous and large)
all small cell have metastasized by time of diagnosis, not curable by surgery
Small cell lung ca best tx
chemotherapy
with or without radiation
Lung CA pathogenesis
inactivating TSG on short arm of ch 3p
TP53 mutation
activation of KRAS oncogene
“field effect” seen even in lungs of smokers without lung cancer
Adenocarcinoma in nonsmoking women is due to mutation of
EGFR epidermal growth factor receptor
KRAS
EML4-ALK
cMET