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Pulmonology Exam > Pulmonary Pathology 4 > Flashcards

Pulmonary Pathology 4 Flashcards

1
Q

What are 2 ways PNA can be classified?

A

by clinical setting and by anatomic distribution

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2
Q

what are the different types of PNA based on the classification by anatomic distribution?

A

bronchopneumonia and lobar pna

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3
Q

what is bronchopneumonia?

A

PNA where the infection is spreading along the airways

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4
Q

what are the pathologic stages of lobar PNA?

A

congestion (1-2 days), red hepatization (2-4 days), grey hepatization (4-8 days), and resolution (1-3 weeks)

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5
Q

what are the complications associated with lobar PNA?

A

abscess, empyema, and bacteremia (sepsis)

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6
Q

what are the 5 organisms that cause typical CAP?

A

s. pneumoniae, H. influenza, s. aureus, K. pneumoniae, P. aeruginosa

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7
Q

what is streptococcus pneumoniae?

A

lancet shaped gram positive diplococci (pairs and chains); most common cause of CAP- vaccination recommended for infants, patients> 65, and in respiratory disease/smoking

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8
Q

what is h. influenza?

A

gram negative, causes virulent PNA in children; recommended vaccination for type B for children 5 or younger

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9
Q

what is staphylococcus aureus?

A

abscess formation; iv drugs; gram positive

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10
Q

what is klebsiella pneumoniae?

A

alcoholics, currant jelly sputum, gram negative

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11
Q

what is pseudomonas aeruginosa?

A

gram negative, cystic fibrosis, diabetics, grapes

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12
Q

what are the major differences between typical and atypical bacterial CAP?

A

typical is more abrupt onset, respiratory symptoms predominate, consolidation on CXR, older adults or young children; atypical PNA is slower onset, systemic symptoms predominate, patchy infiltrates on CXR and young adults/teens

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13
Q

what are the 4 most likely organisms to cause atypical PNA?

A

myocoplasma PNA, legionella pneumophilia, chlamydia pneumonia, chlamydia psittaci

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14
Q

why is myocoplasm pneumoniae likely to cause atypical pna?

A

it is the smallest free living, self-replicating microorganism; no cell wall- it can just travel along the airways unchecked

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15
Q

what is legionalla pneumophila?

A

gram negative bacillus; grows in warm fresh water; AC units, hot tubs; airborne disease–> outbreaks

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16
Q

what 4 things cause community acquired viral PNA?

A

influenza (H1N1) 2) SARS 3) COVID-19 4) RSV

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17
Q

what are the 4 radiographic features of viral PNA?

A

more likely to be multilobar in distribution, follows an airway pattern- bronchocentric

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18
Q

how does the histology of bacterial PNA differ from the histology of viral PNA?

A

bacterial infiltrates in the alveolar spaces; viral PNA infiltrates in the interstitium

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19
Q

how is the influenza virus classified?

A

by 2 proteins–> hemagluttanin and neurominidase

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20
Q

difference between an antigenic shift and an antigenic drift?

A

antigenic drift: causes epidemics, minor changes to proteins; antigenic shift: causes pandemics, genomic alterations with major resulting changes to protein structures

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21
Q

what is normally the source of antigenic shifts?

A

animal reservoirs

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22
Q

what is the most direct route to viral proteins?

A

ss RNA (+)

23
Q

COVID-19 has a tropism for what?

A

ACE 2 receptors in the respiratory epithelium

24
Q

entry of sars-cov 2 initiates what?

A

a response that involves a cytokine storm, which leads to ARDS and DAD

25
Q

what is happening in the circulation of COVID-19 patients?

A

there’s coagulation–> megakaryocytes enter the circulation

26
Q

neonates are at risk of PNA due to what organisms?

A

1) group B strep 2) gram negative bacilli 3) listeria

27
Q

children greater than 1 month old are at risk of developing PNA from what viral thing?

A

respiratory syncytial virus, parainfluenza virus, influenza A and B, adenovirus, rhinovirus

28
Q

children greater than 1 month old are at risk of developing PNA from what bacterial organisms?

A

s. pneumoniae, H. influenza, M. catarrhalis, s. aureus

29
Q

older children/adolescents have additional concern for which bacterial PNAs?

A

M. pneumoniae and C. pneumoniae

30
Q

what is respiratory syncytial virus (RSV)?

A

paramyxovirus; the babies are having an accumulation of mucus in their bronchial airways and as the viral infection progresses it is inflamming their bronchial wall and thickening it

31
Q

besides RSV, what are 3 other examples of paramyxoviridae?

A

human metapneumovirus, parainfluenza, measles

32
Q

bacterial infections are not typically associated with epidemics; what is the exception to this?

A

legionella and pertussis

33
Q

how does bacterial pna sound on auscultation?

A

crackles on lung exam

34
Q

how does viral pna sound on auscultation?

A

wheezes

35
Q

which type of pna typically involves the pleura?

A

bacterial

36
Q

what is a complication of PNA specifically staph aureus and klebsiella?

A

lung abscess

37
Q

what type of pna is at risk for lung abscess?

A

aspiration

38
Q

which bacteria are more likely to cause aspiration pna?

A

anaerobic bacteria

39
Q

what is the ghon complex?

A

the parenchymal area that is caseating granulomatous infectious focus and a hilar lymph node

40
Q

what do you do if you see a granuloma?

A

you are going to put an acid fast stain on it–> tb shows tuberculosis

41
Q

what is the outcome of a primary complex of tb?

A

it can become a healed infection, it can become a latent lesion, which can then progress to secondary tb, or it can become progressive primary tb which leads to miliary tb

42
Q

what is chronic PNA?

A

pneumonia lasting for months in an immunocompetent patient

43
Q

what are the most common causes of fungal chronic PNA?

A

histoplasma, blastomycosis, and coccidiomycosis

44
Q

where is histoplasma endemic to?

A

midwest and caribbean

45
Q

how does histoplasma present?

A

subclinical infection with granulomatous response (calcifications or coin lesions on CXR)

46
Q

if you do a silver stain on histoplasma, what would it look like?

A

pumpkin seeds

47
Q

where is blastomyces endemic to?

A

central and SE US

48
Q

what are the histologic features of blastomyces?

A

broad-based budding

49
Q

where is coccidiodes endemic to?

A

endemic in southwestern US

50
Q

how does coccidiodes present?

A

infection yields a granulomatous response with eosinophils; often a subclinical self-limited disease; spherials containing the endospores

51
Q

what is pneumocystis jiroveci and how does it look?

A

opportunistic fungal infection; aids defining illness; cup-shaped yeast forms

52
Q

what is cytomegalovirus?

A

opportunistic viral infection; aids defining illness; big cell virus

53
Q

what is mycobacterium avium complex?

A

thin mycobacteria seen as slender red forms on acid-fast staining

54
Q

what does lung transplant rejection show?

A

mononuclear infiltrates around vessels

Pulmonology Exam (11 decks)

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