Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MED234 Respiratory > Resp Path 4 - Pulmonary Infection and Neoplasia - Galbraith > Flashcards

Resp Path 4 - Pulmonary Infection and Neoplasia - Galbraith Flashcards

1
Q

Five things that if compromised, can allow pulmonary infections to occur.

A
  1. Cough reflex - decreased = aspiration
  2. Ciliary function - impaired = 3. mucus-stasis
  3. Decreased phagocytic function of pulmonary macrophages
  4. Pulmonary edema/congestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Definition of pneumonia.

A

Any infection of the lung parenchyma.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What 2 lab testing characteristics help differentiate between bacterial pneumonia and viral pneumonia?

A

In bacterial pneumo:
Higher CRP
Higher procalcitonin levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Absent splenic function predisposes toward what type of infection?

A

Encapsulated bacterial infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Seven bacterial causes of Community-Acquired Acute Pneumonias

A 
**Strep pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staph aureus
Klebsiella pneumoniae
Pseudomonas aeruginosa
Legionella pneumophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • G+, lancet shape diplo
  • Elongated DIPLOCOCCI in SPUTUM
  • Most common cause of CA-pneumonia
A

Strep pneumoniae characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • Gram (-)
  • ENCAPSULATED type B most virulent
  • Kids and COPD
A

Haemophilus influenzae characteristics

Pediatrics - bacterial pneumonia (meningitis and LRIs)

  • Adults - Most common cause of bacterial acute EXACERBATION OF COPD.
  • Virulence factors like adhesive pili and IgA degredation by protease.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • G- cocci
  • Elderly - exacerbation of COPD
  • Pediatric - OTITIS MEDIA
A

Moraxella catarrhalis characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • G+ cocci
  • Imp cause of SECONDARY BACTERIAL PNEUMONIA, after a viral infection
  • High risk of complications (abscess, empyema)
  • Think: IV drug abusers and endocarditis
A

Staph aureus characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • Most common G- bacterial pneumonia (rod)

- CHRONIC ALCOHOLICS, MALNOURISHED, DM

A

Klebsiella pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • Imp cause of pneumo in CF and neutropenic pts
  • Hematogenous spread!
  • **Nosocomial infection
A

Pseudomonas aeruginosa characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • Water tanks&raquo_space; aerolization
  • Pontiac fever and Leginnaires’ disease
  • Immunosuppressed, chronic disease
  • URINE LEGIONELLA ANTIGEN for diagnosis
A

Legionella pneumophila characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • in children and YA

- a dry cough that won’t go away

A

Mycoplasma pneumonia characteristics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main morphologic change in lung tissue due to bacterial invasion?

A

CONSOLIDATION, as alveoli fill with inflammatory cells and exudate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Two main patterns of consolidation in the lungs.

A
  1. Bronchopneumonia

2. Lobar pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What type of consolidation pattern is this?
- PATCHY exudative consolidation of lung parenchyma.

What else is characteristic of this?

A

Bronchopneumonia

  • Focal, consolidated areas that may coalesce
  • BASAL, MULTIlobar and frequently BILATERAL.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What type of consolidation pattern is this?

- Consolidation occupies an ENTIRE LOBE

A

Lobar pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List the four stages of lobar pneumonia

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

1/4 Stage of Lobar Pneumonia and characteristics

A
  1. CONGESTION due to vascular engorgement and with fluid and bacteria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

2/4 Stage of Lobar Pneumonia and characteristics

A
  1. RED HEPATIZATION - full of neutrophils, RBCs, fibrin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3/4 Stage of Lobar Pneumonia and characteristics

A
  1. GREY HEPATIZATION - fibrinosuppurative material, RBC breakdown, early org.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

4/4 Stage of Lobar Pneumonia and characteristics

A
  1. Resolution - organizing fibrosis admixed with macrophages resorption of debri and enzymatic digestion of exudates.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What does resolution normally result in ?

A

Restoration of normal lung structure and function. But organization with fibrous scarring can occur.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is empyema?

A

Fibrinopurulent material.

Expansion of infection into pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

s/s of CA-acute pneumonia

A
  • Abrupt fever
  • Shaking chills
  • Productive cough
  • Rust-colored sputum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Look for what in PE to suggest pleural involvement in CA-acute pneumonia.

A

Friction rub and pleuritic chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Potential complications of CA-acute pneumonia.

A

Systemic dissemination causing: endocarditis, meningitis, suppurative arthritis, metastatic abscesses.
Galbr: abscess, empyema (pleural involvement), bacteremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Difference in CXR between lobar and bronchpneumonia.

A

Lobar - obque lobe

Bronch - focal opacities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the common pathogenic mechanism between CA-Atypical (Viral and Mycoplasmal) Pneumonias?

A

Attachment of organisms to epithelial cells, followed by necrosis and inflammation.

  • In alveoli, causes fluid transudation.
  • In upper airways - loss of mucociliary clearance of resp epithelium=secondary bacterial (super) infection predisposition.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Morphology of CA-Atypical pneumonias (differing characteristics from bacterial)

A
  • Patchy or lobar congestion WITHOUT CONSOLIDATION
  • Widened, EDEMATOUS alveolar walls with LYMPHOCYTES AND MACROPHAGES
  • HYALINE MEMBRANES reflex DAD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Five common causes of CA-Viral Pneumonia

A
  1. INFLUENZA A (B and C)
  2. RSV
  3. Human metapneumovirus
  4. Adenovirus
  5. Rhinovirus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Cause of major influenza epidemics (antigenic drift - “drift away form host antibodies”) and pandemics (antigenic SHIFT “recombo of viral RNA during replication”).

A

Influenza A infecting humans, pigs, birds, horses.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the two important viral proteins that determine the influenza A virus subtype?

A
  • Hemagglutinin (H1-H3) - binds to respiratory epithelial cells, allowing cellular infection
  • Neuraminidase (N1-N2) - allows new virion release
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What part of respiratory tract does influenza involve? And once it infects the epithelium, what does it cause?

A
  • URT = facilitation of spread from person to person.

- After infection occurs, it causes: intraalveolar fluid accumulation, cell death, inflammation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Human metapnumovirus characteristics.

A

Cause bronchiolitis and pneumonia in very young and very old.
- Causes 20% of outpatient visits for pediatric acuteRTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

SARS characteristics

A

Coronavirus. Different because it infects upperRT AND LOWER RESPIRATORY TREE&raquo_space; systemic spread.
Fatal cases = lungs show DAD with multinucleated giant cells.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

3 common causes of Chronic Pneumonia.

- General characteristics

A

Localized granilomatous inflammation in inmmunocompromised pts.

  1. Histoplasmosis
  2. Blastomycosis
  3. Coccidioidomycosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Intra-macrophage fungal pathogen

Inhaled bird/bat droppings

A

histoplasma capsulatum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

MS/OH rivers, think…

A

Histoplasmosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

4 clinical presentations of histoplasmosis.

A
  1. Self limited pulm infection!
  2. Chronic, prgressive lung infeciton (apical, night sweats, Fever, cough)
  3. Extrapulmonary involvement (liver, adrenals, mediastinum, meninges)
  4. Wide dissemination
41
Q

Morphologic findings in histoplasmosis.

What stain used for dx?

A
  • Caseating granulomas
  • Coagulative necrosis that may resolve by fibrosis and concentric calcification
  • SILVER STAIN shows 3-5micro-m yeast.
42
Q

If histoplasmosis is disseminated, what two morphologic things are seen?

A
  1. Organisms found within clusters of macrophages (liver, adrenals, etc)
  2. NO CASEATING GRANULOMAS
43
Q

General characteristics of blastomycosis.

A
  • Caused by Blastomyces dermatidis.
44
Q

Central/SW USA soil think…

Canada, Mexico, ME, Africa, India

A

Blastomycosis

45
Q

Three forms of blastomycosis

A

Pulmonary
Disseminated
Primary cutaneous (erythema nodosum, erythema multiforme)

46
Q

Morphology of blastomycosis

Granulomas are___

A
  • 5-15micro-m thick
  • DOUBLE-WALLED YEAST WITH VISIBLE NUCLEUS

-… suppurative

47
Q

Broad Based Budding, think…

A

Blastomycosis

48
Q

General characteristics of coccidiomycosis

A
  • Caused by Coccidioides immitis
49
Q

SW/W US and Mexico, think…

A

Coccidiomycosis

50
Q

Spherules are what.

think what disease…

A

Contain endospores. Are in lung granulomas

Coccidiomycosis

51
Q

Morphology of Coccidiomycosis

A
  • 20-60micro-m
  • Taken up by macrophages&raquo_space; resist killing
  • SPHERULES
52
Q

fever, cough, detectable lung granuloma, pleuritic pain, skin lesions = what specific manifestation of
coccidiomycosis

A

San Joaquin Valley Fever

53
Q

Defining characteristics of Hospital Acquired Pneumonia - high risk situation, most common G+ and G-

A
  • Very high risk with mechanical ventilation
  • G-positive cocci: Staph aureus and Strep pneumonia
  • G-negative rods: enterobacteriaceae and Pseudomonas
54
Q

Defining characteristics of Aspiration Pneumonia

A
  • People with abnormal gag and swallowing reflexes
  • Pneumonia dt chemical (gastric acid) and bacterial (oral flora)
  • Often aerobic, NECROTIZING, fulminant
  • Complication: Lung ABSCESS
55
Q

Difference between Aspiration Pneumonia and Microaspiration

A
  • Aspiration - frequent cause of death.
  • Microaspiration - frequent in ppl with GERD. See NON-NECROTIZING granulomas with multinucleated giant cell rxn. Can exacerbate asthma, interstital fibrosis, lung rejection.
56
Q

Main opportunistic infections that cause life-threatening pneumonias in immunocompromised hosts (3 for diffuse infiltrates; 5 for focal infiltrates)

A

Diffuse - CMV, Pneumocystis jiroveci, drug rxn

Focal - G- bacteria, Staph aureus, Aspergillus, Candida, Malignancy

57
Q

HIV related Pulmonary disease: most common bugs at CD4 counts (200+, 50-200, less than 50)

A

200+ = bacterial and TB
50-200 = Pneumocystis
Less than 50 = CMV and MAC
Also: all the “normal” pneumonia bugs (strep pneumo, staph aureaus, H. flu)

58
Q

Lung abscess defintion

A

Local suppurative process that produces necrosis of lung tissue

59
Q

Etiology of lung abscess

A
  • Oropharyngeal surgery, dental, sinobronchial infection, bronchiectasis, etc.
  • Nugs: Staph aureaus, G-, anaerobic (Bacteroides, Fusobac, peptococcus)
60
Q

Five ways causative organisms are introduced to the lungs to cause abscesses.

A
  1. Aspiration of infective material (most frequent)
  2. Antecedent primary lung infectino (s aureus, K pneumoniae) **Post-transplant
  3. Septic embolism from infected thrombo or R-sided endocarditis
  4. Obstructive neoplasia - postobstructive pneumonia
  5. Direct traumatic punctures or spread of infection from adjacent organs
61
Q

What do lung abscesses contain?

A

Pus and air.

62
Q

Complications of lung abscesses

A
  • *Development of BRAIN ABSCESSES or MENINGITIS from septic emboli.
  • Secondary amyloidosis, hemorrhage, infection into pleural cavity
63
Q

When are lung transplants performed?

A

Emphysema, idiopathic pulmonary fibrosis, CF, primary pulmonary HTN

64
Q

3 potential complications of lung transplant

A
  • Infection in first few weeks posttransplant (Aspergillus, Candida at bronchial anastomotic site)
  • Acute rejection
  • Chronic rejection 3-5years posttransplant. Fibrosis (broncholitis obliterans)
65
Q

What genetic polymorphisms result in increased susceptibility to tobacco smoke?

A

Polymorphisms of p-450 mono-oxygenase

66
Q

Environmental exposures that cause lung cancer.

A
  • ASBESTOS esp + smoking
  • Radiation: uranium/radon
  • Occupational: Vinyl chloride
67
Q

Three precursor lesions that may progress to malignancy

A
  1. Squamous dysplasia and carcinoma in situ
  2. Atypical adenomatous hyperplasia
  3. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia.
68
Q

What carcinoma has the strongest association with smoking?

Other characteristics?

A

Squamous Cell Carcinoma

  • p53 mutations/overexpression
  • Begins in CENTRAL lung/hilar region from segmental bronchi
69
Q

Morphologic progression of squamous cell carcinoma.

A
  • Shows intrabronchial **PRECURSOR LESION (squamous metaplasia, dysplasia, and CARCINOMA IN SITU)
70
Q

Keratin Pearls, think what?

PTH-rp, causing hypocalcemia without feedback… think what?

A

Squamous Cell Carcinoma

71
Q

Smoking with in situ component, think what neoplasm?

A

Squamous Cell Carcinoma

72
Q

No smoking, no in situ component, think what neoplasm?

A

Adencocarcinoma (met)

73
Q

3 P’s of adenocarcinoma

A

Pleural surface
Peripheral (differentiates this from carcinoid)
Pucker Pleural surface

74
Q

Mutations in adenocarcinoma

A

Gain of function mutations involving GF receptor pathways:

  • EGFR, ALK (ROS, MET, RET)
  • KRAS (resistant to therapy)
75
Q

Adenocarcinoma precursor lesions (2)

A
  1. Atypical adenomatous hyperplasia (less than 5mm)

2. Adenocarcinoma in situ (less than 3cm) PRODUCING MUCIN

76
Q

What positive staining test helps determine if adenocarcinoma is from the lung?

A

TTF-1

77
Q

“Oat Cell”

SMOKING!!! withOUT in situ

A

small cell carcinoma

78
Q

Characteristics of small cell carcinoma - genetics, aggressiveness, size

A
  • TP53 and RB mutations

- Aggressive and high fatality

79
Q

What area of the lung do small cell carcinomas generally arise from? And what type of cells?

A
  • Central OR peripheral

- From neuroendocrine cells in bronchial epithelium

80
Q

Describe morphology of small cell carcinoma

A
  • Small cells with little cytoplasm
  • Huge nuclei with MOLDING and ABSENT NUCLEOLI
  • Marked necrosis
81
Q

Paraneoplastic syndrome assoc with small cell carcinoma

A

ADH or ACTH (SIADH and Cushings)

82
Q

Metastasis of lung cancer

A

ADRENALS, kidney, brain, bone

- Hematogenous spread within lymphatics

83
Q

Name of tumor that arises from BRONCHIAL neuroendocrine cells.
Is this malignant or benign?

A

Carcinoid tumor - low grade malignant. Classified typical (p53 mutation) or atypical (BCL2 and MAX abnormal expression)

84
Q

What are Pancoast tumors?

A

Lung tumors than invade neural structures around trachea&raquo_space; cervical sympathetic plexus = HORNER SYNDROME

85
Q

What are tumorlets?

A

Small, benign hyperplastic nests of neuroendocrine cells seen adjacent to chronic inflammation or scarring.

86
Q

Morphology of carcinoids

A
  • Intrabronchial, highly vascular, polyploid masses less than 3-4cm.
  • Neurosecratory granules seen. with immunostaining.
  • Propensity for LYMPHATIC INVASION
87
Q

What is carcinoid syndrome?

Results in what s/s?

A
  • Tumor makes SEROTONIN, look for 5-HIAA in urine

- FLUSHING, DIARRHEA, CYANOSIS

88
Q

Organoid nests, think what?

A

Well organized appearance of carcinoids.

89
Q

What are symptoms of carcinoids related to?

A

Centrally located/Bronchial obstruction - cough, hemoptysis, impaired drainage.

90
Q

Prognosis for carcinoid.

A

Typical - Relatively benign with 95% 5 year survival

Atypical - 70% 5 year survival

91
Q

Tumors met to the lung

A

Breast, colon, kidney, prostate, bladder.

92
Q

2 types of Pleural Tumors

A
  1. Solitary Fibrous Tumor (nonivasive, fibrosing, rarely malignant.)
  2. Malignant mesothelioma
93
Q

Malignant mesothelioma is highly associated with exposure to what?

A

ASBESTOS, compounded by smoking

94
Q

Morphology of Malignant mesothelioma

A

Spreads diffusely over entire lung surface - forms a compressive sheath

  1. Epithelioid Pattern
  2. Sarcomatoid Pattern
95
Q

Epithelioid pattern of Malignant mesothelioma

A

Epithelium like cells forming tubules and papillary projections. Distinctive from adenocarcinoma bc of WT-1, CK5/6, and calretinin and long, selder microvilli.

96
Q

Sarcomatoid pattern of Malignant mesothelioma

A

Malignant, SPINDLE shaped cells resembling fibrosarcoma

97
Q

s/s of Malignant mesothelioma

A

chest pain, dyspnea, recurrent plerual effusion.

98
Q

Most common mutation in Malignant mesothelioma.

A

homozygous deletion of p16, seem in 80%

99
Q

Survival rate of Malignant mesothelioma

A

few survive longer than 2 years.

MED234 Respiratory (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions