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Respiratory 2 > Respiratory Path 4 - Galbraith > Flashcards

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)
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2
Q

“Pneumonia” = ______

A

Infection of the lung parenchyma

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3
Q

Most common cause of community-acquired pneumonia

A

Strep. pneumoniae (pneumococcus)

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4
Q

Potential lab clues to bacterial rather than viral pneumonia (2)

A
  • High CRP level

- High procalcitonin level

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5
Q

Bacterial pneumonia may follow a _____

A

Viral URI

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6
Q

Predisposing conditions to community-acquired pneumonia

A
  • Young or old
  • Chronic disease (COPD, CHF, DM)
  • Absent spleen (ENCAPSULATED organisms)
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7
Q

Gram (+), elongated diplococci

A

Strep. pneumoniae

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8
Q

Gram (-), encapsulated organism in pneumonia of CHILDREN or COPD

A

H. influenzae

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9
Q

Common cause of 2º bacterial pneumonia after viral infection

Significance?

A

Staph. aureus

More complications (abscesses, empyema)

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10
Q

Most common GRAM (-) bacterial pneumonia

Seen in who? (2)

A

Klebsiella pneumoniae

Chronic alcoholics, malnourished

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11
Q

CF or hospital + pneumonia - cause?

A

Pseudomonas

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12
Q

Immunosuppressed or chronic disease + pneumonia + air conditioner or public water supply

A

Legionella

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13
Q

COPD exacerbation with pneumonia - causes?

A
  • H. influenzae

- Moraxella catarrhalis

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14
Q

Consolidation in pneumonia - what is it?

A

Alveolar filling w/ inflammatory cells and exudate

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15
Q

2 types of consolidation in pneumonia

A
  • Bronchopneumonia

- Lobar pneumonia

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16
Q

Bronchopneumonia - describe (4)

A
  • Patchy involvement
  • Coalescing areas
  • Acute suppuration
  • BASAL, multi-lobar
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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
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18
Q

Presentation of community-acquired bacterial pneumonia (general)

A
  • Abrupt fever
  • Shaking chills
  • Productive cough
  • Rust-colored sputum
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19
Q

Common community viral pneumonias (5)

A
  • Influenza (A, B, C)
  • RSV
  • Human metapneumo.
  • Adenovirus
  • Rhinoviruses
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20
Q

Predisposing factors to community viral pneumonia

A
  • Young, old
  • Malnutrition, alcoholic
  • Chronic disease
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21
Q

Bacterial superinfection on a viral pneumonia is often due to what?

A

Viral damage (via inflamm.) to defense systems (cilia)

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22
Q

2 crucial proteins in influenza virus (w/ functions)

A

Hemagglutinin - binds respiratory epithelium

Neuraminidase - allows new virion release

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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

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24
Q

Influenza viral infection generally also infects where?

Significance?

A

Upper respiratory tract

SPREAD!

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25
Q

Prominent findings in influenza pneumonia

A
  • Vascular congestion

- Inflammation (lymphocytes and macrophages) and edema of the alveolar wall

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26
Q

Factors that contribute to severity of viral pneumonia (3)

A
  • Host immune system
  • Virulence of the strain
  • Other complicating conditions
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27
Q

Intra-macrophage fungal pathogen

Inhaled bird/bat droppings

A

Histoplasma capsulatum

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28
Q

4 potential Histoplasmosis presentations

A
  1. Self-limited
  2. Chronic, progressive (apex, lung symptoms)
  3. Extrapulmonary (liver, adrenals, mediastinum, meninges)
  4. Wide dissemination
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29
Q

Caseating ranulomas, with coagulative necrosis that becomes fibrosis and calcification

A

Histoplasmosis

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30
Q

How to diagnose Histo?

A

3-5 µm yeast on SILVER STAIN

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31
Q

Clusters of macrophages filled with yeast w/in liver, adrenals, etc.

A

Disseminated histoplasmosis

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32
Q

5-15 µm dimorphic fungus with thick wall and broad-based budding

A

Blastomyces dermatidis

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33
Q

Potential symptoms of Blastomycosis

A

Productive cough, chest pain, headache, anorexia, weight loss, fever, chills, night sweats

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34
Q

In Blastomycosis, the granulomas are ______

A

Suppurative (pus-filled)

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35
Q

Prognosis of most Blasto cases?

A

Resolve spontaneously

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36
Q

Lung granulomas with giant cells w/ spherules of endospores

A

Coccidiomycosis (C. immitis)

37
Q

Fever, cough, lung granulomas, pleuritic pain, erythema nodosum/multiforme

A

Coccidiomycosis (San Joaqin Valley fever)

38
Q

MOST cases of Coccidiomycosis have what prognosis?

A

Subclinical, self-limiting

39
Q

Nosocomial Pneumonia - common organisms (5)

A
  • Klebsiella
  • Serratia marcescens
  • E. coli
  • Pseudomonas
  • MRSA
40
Q

Aspiration pneumonia is partially ____ and partially _____

A
  • Chemical (gastric acid)

- Bacterial (oral flora)

41
Q

Aspiration pneumonia is often _____ and has a common complication of _____

A
  • Necrotizing

- ABSCESSES

42
Q

Bacterial causes of immunocompromised pneumonia (4)

A
  • Pseudomonas
  • Mycobacterium
  • Legionella
  • Listeria
43
Q

Viral causes of immunocompromised pneumonia (2)

A
  • CMV

- Herpes

44
Q

Fungal causes of immunocompromised pneumonia (3)

A
  • Pneumocystis (PCP)
  • Candida
  • Aspergillus
45
Q

HIV, CD4 > 200
Pneumonia

Organisms?

A

Normal bacteria, TB

46
Q

HIV, CD4 50-200
Pneumonia

Organism?

A

Pneumocystis (PCP)

47
Q

HIV CD4

A

CMV, MAC

48
Q

Malignancies causing lung disease in HIV (3)

A
  • Kaposi sarcoma
  • Lymphoma
  • Lung cancer
49
Q

Lung abscess - define

A

Localized suppurative necrosis of lung tissue

50
Q

Ways that abscess-forming bacteria can end up in the lungs (5)

A
  • Aspiration
  • Primary bacterial infection
  • Septic emboli
  • Obstructive tumors
  • Traumatic punctures or spread from other organs
51
Q

Lung transplants are generally used for what 4 things?

A
  • Emphysema
  • IPF
  • CF
  • Primary pulmonary HTN
52
Q

3 complications of lung transplants

A
  • Infections
  • Acute rejection
  • Chronic rejection
53
Q

Lung transplant –> infections with which organisms?

A

Same as immunocompromised patients

54
Q

Lung transplant –> vascular/airway mononuclear cell infiltrates

A

Acute rejection

55
Q

Lung transplant –> fibrotic occlusion of small airways

A

Chronic rejection (bronchiolitis obliterans)

56
Q

Vast majority of lung tumors are _____

A

Carcinoma

57
Q

By the time a lung carcinoma is clinically apparent, how many mutations have accumulated?

A

10-20

58
Q

4 things that contribute to lung carcinoma

A
  • Smoking (MOST IMPORTANT)
  • Environmental exposures
  • Genetic mutations
  • Precursor lesions
59
Q

Environmental toxins that can contribute to lung carcinoma

A
  • Radiation (uranium)
  • Air pollution
  • Inhaled metals
  • Asbestos
  • Vinyl chloride
60
Q

Patients with what genetic mutation are more susceptible to tobacco smoke?

A

P450 mono-oxygenase

61
Q

Squamous cell carcinoma - 4 characteristics

A
  • Tobacco smoke
  • p53 mutations
  • Central/hilar region
  • Preceded by bronchial squamous metaplasia/dysplasia/CIS
62
Q

Lung adenocarcinoma - 3 characteristics

A
  • Peripheral lung regions
  • EGFR, ALK, ROS, MET, RET, KRAS mutations (GoF in growth factor receptor pathway)
  • Precursor = atypical adenomatous hyperplasia and adenocarcinoma IS
63
Q

Peripheral lung mass with microscopic glands, mucin productions, and desmoplastic tissue

A

Adenocarcinoma

64
Q

Positive TTF-1 staining

A

Adenocarcinoma

65
Q

Strongest lung carcinoma association with smoking

A

Small cell

66
Q

Small cell lung carcinoma - 5 characteristics

A
  • SMOKING
  • TP53 and RB mutations
  • Aggressive, high mortality
  • Can arise anywhere
  • From neuroendocrine cells in bronchial epithelium
67
Q

Diagnosing small cell lung cancer

A

Immunostains for:

  • Chromogranin
  • Synaptophysin
  • CD57+
68
Q

Small tumor cells with little cytoplasm, closely-arranged nuclei with molding and no nucleoli

A

Small cell lung carcinoma

69
Q

Favored metastatic sites for lung carcinoma (4)

A
  • Adrenals
  • Liver
  • Brain
  • Bone
70
Q

Any type of lung cancer may spread to the _____

A

Pleural space

71
Q

Routes of spread of lung cancer

A

Hematogenous or lymphatic

72
Q

Lymph nodes to look for lung cancer (3)

A
  • Mediastinal
  • Bronchial
  • Paratracheal
73
Q

Secondary pathologies related to lung neoplasm

A
  • Airway obstruction w/ emphysema or bronchiectasis or atelectasis
  • SVC obstruction w/ impaired head/neck drainage
74
Q

Neural symptom related to metastatic lung neoplasm (“pancoast tumors”)

A
  • Horner syndrome (invasion of cervical sympathetic plexus)
75
Q

Carcinoid tumor

A

BRONCHIAL neuroendocrine proliferation lung tumor

76
Q

Organoid nests of regular cells containing abundant cytoplasm and regular round nuclei

A

Carcinoid tumor

77
Q

Symptoms of carcinoid tumor

A
  • Bronchial obstruction (coughing, hemoptysis)

- Vasoactive amines (flushing, diarrhea, cyanosis)

78
Q

Typical vs. atypical carcinoid tumors

A

Atypical = more mitoses, more pleomorphism, more likely to invade lymphatics, worse prognosis

79
Q

Multiple, scattered nodules of neoplastic cells

A

Metastatic cancer TO the lung

80
Q

Common primary sites of metastatic cancer to the lung

A
  • Breast
  • Colon
  • Kidney
  • Prostate
  • Bladder
81
Q

Smoking + asbestos + pleural tumor = _____ (lung cancer)

A

Malignant mesothelioma

82
Q

Homozygous deletion of p16

A

Malignant mesothelioma

83
Q

Most likely location of malignant mesothelioma

A

Pleura (lung surface and fissures)

84
Q

Eventually, malignant mesothelioma will ensheath and ___ the lung

A

Compress

85
Q

Determining epithelioid malignant mesothelioma from adenocarcinoma

A
  • WT-1, CK5/6, and calretinin positive

- Long, slender microvilli

86
Q

Chest pain, dyspnea, recurrent pleural effusions, interstitial fibrosis

What is the interstitial fibrosis from?

A

Malignant mesothelioma

Concurrent asbestos exposure

87
Q

Survival time frame for malignant mesothelioma

A

1-2 years at best

88
Q

2 types of malignant mesothelioma

A
  • Epithelioid (epithelium, tubules, papillary projections that look like adenocarcinoma)
  • Sarcomatoid (malignant spindle-shaped cells that look like fibrosarcoma)

Respiratory 2 (15 decks)

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