Respiratory Path 4 - Galbraith Flashcards
1
Q
5 things that could go wrong w/ the lungs and cause susceptibility to infection (w/ causes of each)
A
- Diminished cough reflex (coma, anesthesia, neuromuscular disorders)
- Impaired cilia (smoking, virus, genetics)
- Mucus stasis (CF, chronic bronchitis)
- Decreased MØ activity (smoking, ROS)
- Pulmonary edema (CHF)
2
Q
“Pneumonia” = ______
A
Infection of the lung parenchyma
3
Q
Most common cause of community-acquired pneumonia
A
Strep. pneumoniae (pneumococcus)
4
Q
Potential lab clues to bacterial rather than viral pneumonia (2)
A
- High CRP level
- High procalcitonin level
5
Q
Bacterial pneumonia may follow a _____
A
Viral URI
6
Q
Predisposing conditions to community-acquired pneumonia
A
- Young or old
- Chronic disease (COPD, CHF, DM)
- Absent spleen (ENCAPSULATED organisms)
7
Q
Gram (+), elongated diplococci
A
Strep. pneumoniae
8
Q
Gram (-), encapsulated organism in pneumonia of CHILDREN or COPD
A
H. influenzae
9
Q
Common cause of 2º bacterial pneumonia after viral infection
Significance?
A
Staph. aureus
More complications (abscesses, empyema)
10
Q
Most common GRAM (-) bacterial pneumonia
Seen in who? (2)
A
Klebsiella pneumoniae
Chronic alcoholics, malnourished
11
Q
CF or hospital + pneumonia - cause?
A
Pseudomonas
12
Q
Immunosuppressed or chronic disease + pneumonia + air conditioner or public water supply
A
Legionella
13
Q
COPD exacerbation with pneumonia - causes?
A
- H. influenzae
- Moraxella catarrhalis
14
Q
Consolidation in pneumonia - what is it?
A
Alveolar filling w/ inflammatory cells and exudate
15
Q
2 types of consolidation in pneumonia
A
- Bronchopneumonia
- Lobar pneumonia
16
Q
Bronchopneumonia - describe (4)
A
- Patchy involvement
- Coalescing areas
- Acute suppuration
- BASAL, multi-lobar
17
Q
Lobal pneumonia - describe stages (4)
A
- Congestion - vascular engorgement w/ fluid and bacteria
- Red hepatization - full of neutrophils, RBCs, fibrin
- Grey hepatization - fibrinosuppurative material, RBC breakdown, early org.
- Resolution - organizing fibrosis w/ macrophages
18
Q
Presentation of community-acquired bacterial pneumonia (general)
A
- Abrupt fever
- Shaking chills
- Productive cough
- Rust-colored sputum
19
Q
Common community viral pneumonias (5)
A
- Influenza (A, B, C)
- RSV
- Human metapneumo.
- Adenovirus
- Rhinoviruses
20
Q
Predisposing factors to community viral pneumonia
A
- Young, old
- Malnutrition, alcoholic
- Chronic disease
21
Q
Bacterial superinfection on a viral pneumonia is often due to what?
A
Viral damage (via inflamm.) to defense systems (cilia)
22
Q
2 crucial proteins in influenza virus (w/ functions)
A
Hemagglutinin - binds respiratory epithelium
Neuraminidase - allows new virion release
23
Q
Why are influenza epidemics so common?
A
No error detection on RNA polymerase –> common antigenic drift and recombination of multiple genomes –> NEW PATHOGENS
24
Q
Influenza viral infection generally also infects where?
Significance?
A
Upper respiratory tract
SPREAD!
25
Prominent findings in influenza pneumonia
- Vascular congestion
| - Inflammation (lymphocytes and macrophages) and edema of the alveolar wall
26
Factors that contribute to severity of viral pneumonia (3)
- Host immune system
- Virulence of the strain
- Other complicating conditions
27
Intra-macrophage fungal pathogen
| Inhaled bird/bat droppings
Histoplasma capsulatum
28
4 potential Histoplasmosis presentations
1. Self-limited
2. Chronic, progressive (apex, lung symptoms)
3. Extrapulmonary (liver, adrenals, mediastinum, meninges)
4. Wide dissemination
29
Caseating ranulomas, with coagulative necrosis that becomes fibrosis and calcification
Histoplasmosis
30
How to diagnose Histo?
3-5 µm yeast on SILVER STAIN
31
Clusters of macrophages filled with yeast w/in liver, adrenals, etc.
Disseminated histoplasmosis
32
5-15 µm dimorphic fungus with thick wall and broad-based budding
Blastomyces dermatidis
33
Potential symptoms of Blastomycosis
Productive cough, chest pain, headache, anorexia, weight loss, fever, chills, night sweats
34
In Blastomycosis, the granulomas are ______
Suppurative (pus-filled)
35
Prognosis of most Blasto cases?
Resolve spontaneously
36
Lung granulomas with giant cells w/ spherules of endospores
Coccidiomycosis (C. immitis)
37
Fever, cough, lung granulomas, pleuritic pain, erythema nodosum/multiforme
Coccidiomycosis (San Joaqin Valley fever)
38
MOST cases of Coccidiomycosis have what prognosis?
Subclinical, self-limiting
39
Nosocomial Pneumonia - common organisms (5)
- Klebsiella
- Serratia marcescens
- E. coli
- Pseudomonas
- MRSA
40
Aspiration pneumonia is partially ____ and partially _____
- Chemical (gastric acid)
| - Bacterial (oral flora)
41
Aspiration pneumonia is often _____ and has a common complication of _____
- Necrotizing
| - ABSCESSES
42
Bacterial causes of immunocompromised pneumonia (4)
- Pseudomonas
- Mycobacterium
- Legionella
- Listeria
43
Viral causes of immunocompromised pneumonia (2)
- CMV
| - Herpes
44
Fungal causes of immunocompromised pneumonia (3)
- Pneumocystis (PCP)
- Candida
- Aspergillus
45
HIV, CD4 > 200
Pneumonia
Organisms?
Normal bacteria, TB
46
HIV, CD4 50-200
Pneumonia
Organism?
Pneumocystis (PCP)
47
HIV CD4
CMV, MAC
48
Malignancies causing lung disease in HIV (3)
- Kaposi sarcoma
- Lymphoma
- Lung cancer
49
Lung abscess - define
Localized suppurative necrosis of lung tissue
50
Ways that abscess-forming bacteria can end up in the lungs (5)
- Aspiration
- Primary bacterial infection
- Septic emboli
- Obstructive tumors
- Traumatic punctures or spread from other organs
51
Lung transplants are generally used for what 4 things?
- Emphysema
- IPF
- CF
- Primary pulmonary HTN
52
3 complications of lung transplants
- Infections
- Acute rejection
- Chronic rejection
53
Lung transplant --> infections with which organisms?
Same as immunocompromised patients
54
Lung transplant --> vascular/airway mononuclear cell infiltrates
Acute rejection
55
Lung transplant --> fibrotic occlusion of small airways
Chronic rejection (bronchiolitis obliterans)
56
Vast majority of lung tumors are _____
Carcinoma
57
By the time a lung carcinoma is clinically apparent, how many mutations have accumulated?
10-20
58
4 things that contribute to lung carcinoma
- Smoking (MOST IMPORTANT)
- Environmental exposures
- Genetic mutations
- Precursor lesions
59
Environmental toxins that can contribute to lung carcinoma
- Radiation (uranium)
- Air pollution
- Inhaled metals
- Asbestos
- Vinyl chloride
60
Patients with what genetic mutation are more susceptible to tobacco smoke?
P450 mono-oxygenase
61
Squamous cell carcinoma - 4 characteristics
- Tobacco smoke
- p53 mutations
- Central/hilar region
- Preceded by bronchial squamous metaplasia/dysplasia/CIS
62
Lung adenocarcinoma - 3 characteristics
- Peripheral lung regions
- EGFR, ALK, ROS, MET, RET, KRAS mutations (GoF in growth factor receptor pathway)
- Precursor = atypical adenomatous hyperplasia and adenocarcinoma IS
63
Peripheral lung mass with microscopic glands, mucin productions, and desmoplastic tissue
Adenocarcinoma
64
Positive TTF-1 staining
Adenocarcinoma
65
Strongest lung carcinoma association with smoking
Small cell
66
Small cell lung carcinoma - 5 characteristics
- SMOKING
- TP53 and RB mutations
- Aggressive, high mortality
- Can arise anywhere
- From neuroendocrine cells in bronchial epithelium
67
Diagnosing small cell lung cancer
Immunostains for:
- Chromogranin
- Synaptophysin
- CD57+
68
Small tumor cells with little cytoplasm, closely-arranged nuclei with molding and no nucleoli
Small cell lung carcinoma
69
Favored metastatic sites for lung carcinoma (4)
- Adrenals
- Liver
- Brain
- Bone
70
Any type of lung cancer may spread to the _____
Pleural space
71
Routes of spread of lung cancer
Hematogenous or lymphatic
72
Lymph nodes to look for lung cancer (3)
- Mediastinal
- Bronchial
- Paratracheal
73
Secondary pathologies related to lung neoplasm
- Airway obstruction w/ emphysema or bronchiectasis or atelectasis
- SVC obstruction w/ impaired head/neck drainage
74
Neural symptom related to metastatic lung neoplasm ("pancoast tumors")
- Horner syndrome (invasion of cervical sympathetic plexus)
75
Carcinoid tumor
BRONCHIAL neuroendocrine proliferation lung tumor
76
Organoid nests of regular cells containing abundant cytoplasm and regular round nuclei
Carcinoid tumor
77
Symptoms of carcinoid tumor
- Bronchial obstruction (coughing, hemoptysis)
| - Vasoactive amines (flushing, diarrhea, cyanosis)
78
Typical vs. atypical carcinoid tumors
Atypical = more mitoses, more pleomorphism, more likely to invade lymphatics, worse prognosis
79
Multiple, scattered nodules of neoplastic cells
Metastatic cancer TO the lung
80
Common primary sites of metastatic cancer to the lung
- Breast
- Colon
- Kidney
- Prostate
- Bladder
81
Smoking + asbestos + pleural tumor = _____ (lung cancer)
Malignant mesothelioma
82
Homozygous deletion of p16
Malignant mesothelioma
83
Most likely location of malignant mesothelioma
Pleura (lung surface and fissures)
84
Eventually, malignant mesothelioma will ensheath and ___ the lung
Compress
85
Determining epithelioid malignant mesothelioma from adenocarcinoma
- WT-1, CK5/6, and calretinin positive
| - Long, slender microvilli
86
Chest pain, dyspnea, recurrent pleural effusions, interstitial fibrosis
What is the interstitial fibrosis from?
Malignant mesothelioma
Concurrent asbestos exposure
87
Survival time frame for malignant mesothelioma
1-2 years at best
88
2 types of malignant mesothelioma
- Epithelioid (epithelium, tubules, papillary projections that look like adenocarcinoma)
- Sarcomatoid (malignant spindle-shaped cells that look like fibrosarcoma)
