Pulmonary: Pathology Part I - Nasopharynx thru Infections

Question 1

• Inflammation of the nasal mucosa
• Rhinovirus is the most common cause
• Sneezing, Congestion, and Runny nose
• Allergic reaction subtype is a
• *Type I Hypersensitivity** reaction
  
  • Inflammatory infiltrate w/ Eosinophils
  • A/w Asthma and Eczema

Answer 1

Rhinitis

Question 2

• Protrusion of Edematous, Inflamed nasal mucosa
• 2° to repeated bouts of Rhinitis
• A/w Cystic fibrosis and Aspirin-Intolerant Asthma
  
  • Asthma
  • Nasal polyps
  • Aspirin induced bronchospasms

Answer 2

Nasal Polyp

Question 3

• Benign tumor of Nasal mucosa
• Composed of Large blood vessels and Fibrous tissue
• Classically seen in adolescent males, rare in females
• Presents w/ Profuse Epitaxis (nosebleed)

Answer 3

Angiofibroma

Question 4

• Malignant tumor of nasopharyngeal epithelium
• Presents w/ enlarged Cervical lymphnodes
• A/w EBV; classically seen in African children and Chinese adults
• Biopsy → Pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a background of Lymphocytes

Answer 4

Nasopharyngeal carcinoma

Question 5

• Inflammation of the Epiglottis
• H Influenzae Type B is the most common cause, especially in Nonimmunized Children
• Presents w/ High Fever, Sore throat, Drooling with dysphagia, Muffled voice, and Inspiratory Stridor
• Risk of Airway Obstruction

Answer 5

Acute Epiglottis

Question 6

• Inflammation of the Upper Airway
• Parainfluenza Virus is the most common cause
• Presents w/ a hoarse, “Barking” Cough and Inspiratory Stridor (Cold Helps)

Answer 6

Laryngotracheobronchitis (Croup)

Question 7

• Nodule that arises on the true vocal cord
• Due to ‘wear and tear’, excessive use of vocal cords
• Usually Bilateral
• Compoased of Degenerative (Myxoid) Connective tissue
• Hoarseness; resolves w/ resting of voice

Answer 7

Vocal Cord Nodule (Singer’s nodule)

Question 8

• Benign papillary tumor of the vocal cord
• A/w HPV 6 and HPV 11
• Papillomas are usually Single lesions in adults and Multiple lesions in chilldren
• Presents w/ Hoarseness

Answer 8

Laryngeal papilloma

Question 9

• Squamous cell carcinoma, from Epithelial lining of the vocal cord
• A/w Alcohol, and Tobacco
• Arise from Laryngeal papilloma (rare)
• Hoarseness → advanced disease Cough, and Stridor

Answer 9

Laryngeal carcinoma

Question 10

• Infection of the Lung Parenchyma
• Normal defenses are impaired (Impaired cough reflex, Damage to mucociliary escalator, Mucus plugging) → Normally swallow mucus
• Fever and Chills, Productive cough w/ Yellow-green (pus) or Rusty (bloody) sputum
• Tachypnea w/ pleuritic chest pain, Decreased breath sounds, Dullness to percussion
• ↑ WBC
• Dx: CXR, Sputum gram stain, sputum and blood cultures
• (3) Patterns classically seen on CXR

Answer 10

Pneumonia

• (3) Patterns of Pneumonia
  
  1. Lobar pneumonia
  2. Bronchopneumonia
  3. Interstitial pneumonia

Question 11

• Consolidation of an Entire Lobe of Lung, intra-alveolar exudate → consolidation, may involve entire lung
• Bacterial; Streptococcus pneumonia (95%), Klebsiella pneumonia (alcoholics), Legionella
• (4) Classic gross phases:

1. Congestion – vessels and edema
2. Red hepatization – Exudate, Neutrophils, and Hemorrhage filling the Alveolar air spaces, a solid Liver-lung consistency
3. Gray hepatization – degradation of Red cells w/in exudate
4. Resolution of exudate → Type II neumocyte stem cell

Answer 11

Lobar Pneumonia

Question 12

• Scattered Patchy distribution w/ consolidation centered around Bronchioles (> 1 lobe)
• Acute inflammatory infiltrates from Bronchioles into adjacent alveoli
• Multifocal and Bilateral: **S. pneumoniae, S. aureus, H. influenzae, Klebsiella
• A/w a variety of Bacterial organisms

Answer 12

Bronchopneumonia

Question 13

• Diffuse Patchy **infiltrates **inflammation localized to **Interstitial **areas at Alveolar walls
• Distribution > 1 Lobe
• More indolent course (lazy)
• A/w both Bacteria and Viruses
• Bacteria (Mycoplasma, Legionella, Chlamydia)
• Viruses (influenza, RSV, Adenoviruses)
• Mild upper respiratory symptoms (Minimal Sputum and Low Fever)
• ‘Atypical’ presentation

Answer 13

Interstitial (Atypical) Pneumonia

Question 14

• Pts. at risk for Aspiration (alcoholics and comatose patients)
• Most often a/w Anaerobic bacteria in the Oropharynx in the Right-lower Lobe of the Lung
  
  • Bacteroids
  • Fusobacterium
  • Peptococcus
• Right Lower lobe Abscess – the Right Main stem bronchus branches at a less acute angle than the Left

Answer 14

Aspiration Pneumonia

Question 15

• Most common cause of Community-acquired pneumonia and 2° pneumonia
• Bacterial pneumonia superimposed on a Viral upper respiratory tract infection
• Usually seen in Middle-aged Adults and Elderly

Answer 15

Streptococcus pneumoniae

(Lobar Pneumonia)

Question 16

• Enteric flora that is Aspirated
• Affects Malnourished and Debilitated individuals (Elderly in homes, Alcoholics, and Diabetics)
• Thick Mucoid capsule results in Gelatinous sputum
• Complicated by Abscess

Answer 16

Klebsiella pneumoniae

(Lobar Pneumonia)

Question 17

• 2° most common cause of Secondary pneumonia
• Complicated by Abscess or Emphysema (pus in pleural space)

Answer 17

Staphylococcus aureus

(Bronchopneumonia)

Question 18

• Common cause of 2° pneumonia and pneumonia superimposed on COPD
• Leads to exacerbation of COPD

Answer 18

Haemophilus influenzae

(Bronchopneumonia)

Question 19

• Pneumonia in Cystic fibrosis pts.

Answer 19

Pseudomonas aeruginosa

(Bronchopneumonia)

Question 20

• Community-acquired pneumonia and pneumonia Superimposed on COPD
• Leads to exacerbation of COPD

Answer 20

Moraxella catarrhalis

(Bronchopneumonia)

Question 21

• Community-acquired pneumonia and pneumonia Superimposed on COPD, or pneumonia in Immunocompromised states
• Transmitted from Water source Intracellular organism
• Best visualized w/ Silver stain

Answer 21

Legionella pneumophila

(Bronchopneumonia)

Question 22

• Most common cause of Atypical pneumonia
• Affects Young adults (Military recruits, College dormitory kids)
• Complications include Autoimmune hemolytic anemia
  
  • IgM against I antigen on RBCs → Cold hemolytic anemia
• Erythema multiforme
• Does not produce purulent sputum unless there is a secondary bacterial infection
• Not visible on Gram stain due to lack of Cell Wall

Answer 22

Mycoplasma pneumoniae

(Interstitial (Atypical) Pneumonia)

Question 23

• Second most common cause of Atypical pneumonia in Young adults

Answer 23

Chlamydia pneumonia

(Interstitial (Atypical) Pneumonia)

Question 24

• Most common cause of Atypical pneumonia in Infants

Answer 24

Respiratory syncytial virus (RSV)

(Interstitial (Atypical) Pneumonia)

Question 26

• Pre-existing Lung disease
• ↑ Risk for Superimposed S aureus or H influenzae (2° pneumonia)

Answer 26

Influenza virus

(Interstitial (Atypical) Pneumonia)

Question 27

• Atypical pneumonia w/ Q fever (High fever)
• Farmers and Veterinarians
• Spores are deposited on cattle by Ticks or are present in cattle Placentas
• Rickettsial organism:
  
  • Causes pneumonia
  • Does not require Arthropod vector for Transmission (High-heat resistant endospores)
  • Does not produce a Skin rash

Answer 27

Coxiella burnetii

(Interstitial (Atypical) Pneumonia)

Question 28

• Inhalation of Aerosolized bacteria
• Primary w/ initial exposure
  
  • Focal, Caseating necrosis in the Lower Lobe of the lung and Hilar Lymph nodes → Fibrosis and Calcification → Ghon complex
  • Generally asymptomatic → Pos. PPD test
• Secondary w/ Reactivation
  
  • A/w AIDS and Aging
  • Apex of Lung (poor lymphatic drainage and High O­₂ tension - cavitary lesion
  • Foci of Caseous necrosis → Miliary Pulmonary TB or TB bronchopneumonia
  • Fever, Nocturnal hyperhidrosis, Cough w/ Hemoptysis, Weight Loss
  • Caseating Graunulomas, AFB stain → Acid-fast Bacilli
  • Meninges, Cervical lymph nodes, Kidneys (sterile pyuria) and Lumbar vertebrae (Pott disease)

Answer 28

Tuberculosis (TB)

Question 29

• Localized collection of pus w/in Parenchyma
• Caused by:
  
  • Bronchial obstruction (cancer)
  • Aspiration of Oropharyngeal contents (esp. pts. predisposed to LOC, alcoholics)
• Air-fluid levels often seen on CXR
• Bacterial:
  
  • S. aureus
  • Anaerobes (Bacteroides, Fusobacterium, Peptostreptococus)

Answer 29

Lung Abscess