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150 Cards in this Set
- Front
- Back
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What causes the majority of URIs?
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viruses
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what is the broad definition of pneumonia?
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any infection of the lung parenchyma
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What pathogens cause community-acquired acute pneumonias?
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S. pneumoniae
H. influenzae M. catarrhalis S. aureus L. pneumophila K. pneumoniae Pseudomonas |
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What pathogens cause community-acquired atypical pneumonia?
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M. pneumoniae
Chlamydia pneumoniae/psittaci/trachomatis Coxiella burnetii RSV Parainfluenza virus Influenza A/B Adenovirus SARS virus |
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What pathogens cause hospital-acquired pneumonia?
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G- rods
Enterobacteria (Klebsiella, Serratia marcescens, E. coli) Pseudomonas S. aureus |
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what pathogens cause aspiration pneumonia?
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anaerobic oral flora
(Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus) mixed with aerobic bacteria (S. pneumoniae, S. aureus, H. influenzae, P. aeruginosa) |
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what pathogens cause chronic pneumonia?
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Nocardia
Actinomyces (Granulomatous): M. tuberculosis, atypical mycobacteria, Histoplasma, Coccidioides, Blastomyces |
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What pathogens cause necrotizing pneumonia and lung abscesses?
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anaerobic bacteria w/ or w/o mixed aerobic infection;
S. aureus, K. pneumoniae, S. pyogenes, type 3 pneumococcus (uncommon) |
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What pathogens cause pneumonia in the immunocompromised host?
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CMV
Pneumocystis jiroveci M. avium-intracellulare Invasive aspregillosis Invasis candidiasis "usual" bacterial, viral, and fungal organisms |
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Most common cause of community-acquired acute pneumonia; lancet-shaped, inside neutrophils?
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S. pneumoniae
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G- encapsulated or unencapsulated bacteria, cause severe LRIs and meningitis in children; common cause of pneumonia in adults, esp COPD?
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H. influenzae
(unencapsulated are nontypeable forms) |
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G- aerobic that causes penumonia esp in the elderly; exacerbates COPD; common cause of otitis media in children?
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Moraxella catarrhalis
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Two most common bacterial causes of acute exacerbation of COPD?
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1. H. influenzae
2. M. catarrhalis |
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Commonly causes secondary bacterial pneumonia following viral respiratory illnesses; infects IV drug abusers; infection causes abscess and empyema?
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S. aureus
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Most common cause of G- pneumonia; causes thick, gelatinous sputum d/t its viscid capsular polysaccharide; affects the debilitated and malnourished, esp alcoholics
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K. pneumoniae
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Most commonly causes hospital-acquired pneumonia, but also has high occurrence in CF pts and neutropenic pts?
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Pseudomonas aeruginosa
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Common cause of bacterial pneumonia in immunocompromised pts; G-, water-loving bacteria?
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Legionella pneumophila
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Pathogen that can cause epidemic and sporadic forms of pneumonia as well as Pontiac fever?
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L. pneumophila
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What disease is characterized by patchy exudative consolidation of lung parenchyma?
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Bronchopneumonia
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What disease is characterized by fibrinosuppurative consolidation of a large portion of a lobe of the lung?
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Lobar pneumonia
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what are the stages of inflammatory response in lobar pneumonia?
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congestion
red hepatization gray hepatization resolution |
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what are the most common causes of bronchopneumonia?
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staphylococci, pneumococci, H. influenzae, Pseudomonas, and Klebsiella
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what is the most common cause of lobar pneumonia?
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pneumococci
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what is seen in the red hepatization phase of lobar pneumonia?
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confluent exudates of neutrophils and RBCs
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what is seen in the gray hepatization phase of lobar pneumonia?
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RBCs disintegrate but remaining fibrinosuppurative exudate persists
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what is empyema?
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spread of infection in pneumonia to the pleual cavity
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what is an acute febrile disease characterized by patchy or lobar congestion without consolidation, moderate amounts of sputum, moderate elevation of WBC, no alveolar exudate, and predominant interstitial inflammation?
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Atypical (viral and mycoplasmal) pneumonia
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virulence factors of influenza A virus?
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surface proteins hemagglutinin and neuraminidase (determine the virus subtype)
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what are host mechanisms of clearance of primary influenza virus infection?
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1. CTLs kill virus-infected cells
2. intracellular anti-influenza protein is induced in macrophages by cytokines IFN-α and IFN-β |
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what disease is caused by a coronavirus, begins with flu-like sxs, and can progress to severe respiratory dz with SOB, tachypnea and pleurisy; lungs show diffuse alveolar damage and multinucleated giant cells?
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SARS
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Which type of abscess is more commonly single?
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Aspiration abscess
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Which type of abscess is more commonly multiple, basal, and diffusely scattered?
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Pneumonia or bronchiectasis-associated abscess
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Which type of abscess is often surrounded by a reactive fibrous wall?
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Chronic abscess
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Respiratory disease that is typically a localized granulomatous inflammation in healthy pts; may become disseminated in immunocompromised?
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Chronic pneumonia
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Infections with what dimorphic fungi cause granulomatous dz of the lungs that may resemble Tb and are geographically isolated?
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Histoplasmosis
Coccidioidomycosis Blastomycosis |
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This self-limited pulmonary infection produces granulomas with coagulative necrosis that undergo fibrosis and concentric calcification; endemic along Ohio and Mississippi Rivers and in the Caribbean?
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Histoplamosis
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Which pulmonary infection, which presents as an abrupt illness with productive cough and may have involvement of skin and larynx, is endemic in central and SE US?
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Blastomycosis
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A pt returning from a visit to Arizona has developed a pulmonary infection with lung lesions, fever, cough, pleuritic pains and erythema nodosum. What disease?
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Coccidioidomycosis
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Which bacteria commonly infect the lungs of immunocompromised pts?
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P. aeruginosa
mycobacterium L. pneumophila Listeria monocytogenes |
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Which viruses commonly cause pulmonary infection in immunocompromised pts?
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CMV
Herpes viruses |
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Which fungi commonly cause pulmonary infection in immunocompromised pts?
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P. jiroveci
Candida Aspergillus Phytomycetes Cryptococcus neoformans |
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What organisms/conditions cause diffuse pulmonary infiltrates in immunocompromised pts?
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CMV
P. jiroveci Drug reaction (uncommon: bacteria, Aspergillus, Cryptococcus, malignancy) |
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What organisms/conditions cause focal pulmonary infiltrates in immunocompromised pts?
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G- rods
S. aureus Aspergillus Candida Malignancy (uncommon: Cryptococcus, Mucor, P. jiroveci, L. pneumophila) |
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In HIV pts, at what cell count are bacterial and Tb infections more likely?
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CD4+ >200 cells/mm3
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In HIV pts, at what cell count is infection with Pneumocystis pneumonia more likely?
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CD4+ <200 cells/mm3
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C1 Inhibitor
Possible answers: a. C3 convertase Alternative Pathway b. C3 convertase Classic Pathway c. C5 convertase Alternative Pathway d. C5 convertase Classic Pathway e. MAC |
C3 Convertase Classical Pathway
(C1 INH blocks C1 and inturn C3 convertase...also blocks kallikrein) |
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Oncogenes involved in lung cancer?
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c-MYC
KRAS EGFR c-MET c-KIT |
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Commonly deleted or inactivated tumor-suppressor genes in lung cancer?
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p53
RB1 p16(INK4a) chromosome 3p |
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genetic alterations associated with small cell lung carcinoma?
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3p, p53, RB, BCL2, C-KIT, MYCN & MYCL
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genetic alterations associated with non-small cell lung carcinoma?
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p16 INK4a, p53, EGFR, KRAS
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most common form of lung cancer?
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adenocarcinoma
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precursor lesions to lung cancer?
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squamous dysplasia and carcinoma in situ
atypical adenomatous hyperplasia diffuse idiopathic pulmonary neuroendocrine cell hyperplasia |
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Which lung cancer presents as a hilar mass arising from bronchus, may have cavitation, is linked to smoking, and can produce PTH-related peptide?
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Squamous cell carcinoma
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Which lung cancer develops in sites of prior pulmonary inflammation or injury, and is the most common lung cancer in nonsmokers and females?
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Bronchial adenocarcinoma
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Which lung cancer grows along airways and can present like pneumonia and may lead to hypertrophic osteoarthropathy?
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Bronchioloalveolar adenocarcinoma
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Which lung cancer may be associated with ectopic production of ACTH or ADH?
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small cell carcinoma
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which lung cancers are almost always metastatic, is usually central or hilar, is strongly associated with smoking, and have a high initial response to chemo?
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Small cell carcinomas
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What is the most common site of metastasis of primary lung cancers?
What are the other common sites? |
Adrenal glands
Liver, brain, bone |
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which lung cancers are gland forming?
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adenocarcinoma
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which lung cancer is associated with KRAS mutations?
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adenocarcinoma
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What is the identifying feature of bronchioloalveolar adenocarcinomas?
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growth along preexisting structures w/o destruction of alveolar architecture
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which lung cancer is histologically characterized by keratinization and/or intercellular bridges?
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squamous cell carcinoma
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release of what substances can occur in paraneoplastic syndromes of lung carcinoma?
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ADH (SIADH)
corticotropin (cushings) PTH or PGE (hypercalcemia) calcitonin (hypocalcemia) gonadotropins (gynecomastia) serotonin (carcinoid syndrome) |
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which lung cancers show the highest frequency of p53 mutations?
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Squamous cell carcinoma
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what do the cells look like in small cell carcinoma?
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epithelial type, small, scant cytoplasm, ill-defined cell borders, salt and pepper nuclei, mitotic count is high.
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What do large cell carcinomas probably represent?
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squamous cell carcinomas and adenocarcinomas that are so undifferentiated that they can't be recognized by light microscopy
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what secondary complications are associated with lung carcinomas?
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(SPHERE)
Superior vena cava syndrome Pancoast tumor Horner's syndrome Endocrine Recurrent laryngeal sxs (hoarseness) Effusions (pericardial or pleural), Emphysema |
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differences in presentation of primary lung cancer vs. metastases to lung?
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Metastases present w/ dyspnea;
primary tumor presents w/ cough |
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which lung cancers occur most often in pts under 40, have neuroendocrine differentiation, and are intrabronchial, highly vascular, polypoid masses less than 3-4 cm?
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carcinoid tumors
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what is the difference between typical and atypical carcinoid tumors of the lung?
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typical are low-grade, atypical have more mitoses and necrosis and smaller survival rate
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which lung cancers can secrete serotonin and can cause a syndrome of flushing, diarrhea, wheezing and salivation?
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Carcinoid tumors
(carcinoid syndrome) |
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what is a malignancy of the pleura associated with asbestosis; results in hemorrhagic pleural effusions and pleural thickening?
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Mesothelioma
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what lung tumors are relatively common, benign, nodular neoplasms of cartilage and other mesenchymal tissues (fat, vessels, fibrous tissue)?
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Hamartomas
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what conditions cause pleural effusions?
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Increased hydrostatic pressure (HF)
Increased vascular permeability (pneumonia) Decreased oncotic pressure (nephrotic syndrome) Increased negative intrapleural pressure (atelectasis) Decreased lymphatic drainage (carcinomatosis) |
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what conditions cause serofibrinous pleuritis?
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Pulmonary inflammation (e.g. Tb, pneumonia, infarcts, abscesses, or systemic dzs [e.g. RA, uremia])
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what conditions cause suppurative pleuritis (empyema)
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pleural space infection leading to pus accumulation
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what conditions cause hemorrhagic pleuritis?
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bleeding disorders, neoplastic involvement, and certain rickettsial diseases
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What conditions can cause hydrothorax?
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CF (with pulmonary congestions and edema)
Renal failure Liver cirrhosis |
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What condition causes hemothorax?
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ruptured aortic aneurysm or vascular trauma
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What condition causes chylothorax?
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thoracic duct trauma or obstruction (usually neoplastic)
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what is tension pneumothorax?
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lung and mediastinal structures are compressed by collected air
serious, potentially fatal |
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what conditions are most commonly associated with pneumothorax?
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emphysema, asthma, tuberculosis
(spontaneous pneumothorax may complicate any pulmonary dz that causes rupture of an alveolus) |
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what is the most common cause of pleural tumors?
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metastases from lung, breast, ovaries or other organs
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what pleural tumor is noninvasive, fibrosing, rarely malignant, and composed of pleural fibroblasts?
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Solitary (localized) fibrous tumors
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where does mesothelioma occur most often?
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pleura
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what is the relationship between smoking, mesothelioma and lung carcinoma?
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asbestos workers who smoke have markedly higher risk of lung carcinoma, but no significant elevation in risk of mesothelioma
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what lung condition results in the formation of an encasing sheath over the lung surface and fissures, and may show epithelioid or sarcomatoid patterns of growth?
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Malignant mesothelioma
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what are lamellar bodies?
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surfactant inside type II pneumocytes
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what is the fxn of type II pneumocytes?
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synthesize surfactant and repair alveolar epithelium by giving rise to type I pneumocytes
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what are the common congenital pulmonary anomalies?
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Pulmonary hypoplasia
(causes: oligohydramnios, congenital diaphragmatic hernia, renal cystic dzs, anencephaly) Foregut cysts (bronchogenic are most common, found in mediastinum or hilum) Pulmonary sequestration (lung tissue w/o connection to airway but w/ vascular supply from AO or branches) |
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Identifying features of pulmonary sequestrations?
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Extralobar sequestration: found in infants as abnml mediastinal masses, assoc w/ other congenital anomalies
Intralobar: within lung substance in older children, assoc w/ recurrent localized infxn or bronchiectasis |
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Cause of resorption atelectasis?
Assocd w/ what conditions? |
follows complete airway obstruction within smaller bronchi
bronchial asthma, chronic bronchitis, bronchiectasis, post-op states, aspiration, and bronchial neoplasms |
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Cause of compressive atelectasis?
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pleural space is expanded by fluid exudate, blood, neoplasms or air (pneumothorax)
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Cause of contraction atelectasis?
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local or generalized fibrotic changes in lung or pleura prevent expansion.
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Which type of atelectasis is non-reversible?
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contraction atelectasis
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Causes of pulmonary edema?
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Hemodynamic disturbances (increased hydrostatic pressure, decreased oncotic pressure, lymphatic obstruction)
Injury to capillaries of alveolar septa (infections, inhaled gases, aspiration, drugs/chemicals, shock, trauma, radiation, transfusion) |
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What is seen in cases of long-standing pulmonary congestion?
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hemosiderin-laden macrophages are abundant; fibrosis and thickening of alveolar walls causes lungs to become firm and brown
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what are the consequences of localized and diffuse alveolar edema?
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Localized edema usually seen in pneumonia
Diffuse edema is a contributor to ARDS |
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syndrome characterized by abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates in the absence of cardiac failure?
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Acute lung injury (noncardiogenic pulmonary edema)
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what is acute interstitial pneumonia?
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widespread DAD assoc'd w/ rapidly progressive course with unknown etiology
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what characterizes acute phase ARDS?
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lungs are diffusely firm, red, boggy, and heavy with DAD (edema, hyaline membranes, acute inflammation)
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what characterizes proliferative stage ARDS?
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interstitial fibrosis and type II pneumocyte proliferation; often bacterial infections superimposed
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What are the main factors in the pathogenesis of ARDS?
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Imbalance of pro-inflammatory and anti-inflammatory mediators: NF-kB, IL-8, IL-1, TNF --> endothelial activation, pulmonary microvascular sequestration, activation of neutrophils --> release of ROS, lysosomal enzymes, proinflammatory cytokines
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abnormal premanent enlargement of airspaces distal to terminal bronchioles w/ alveolar wall destruction and minimal fibrosis?
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emphysema
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what is centriacinar emphysema?
with what is it associated? |
destruction of respiratory bronchioles w/ sparing of distal alveoli; usually upper lobes and apex
assoc'd w/ heavy smokers, many also have chronic bronchitis |
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what are the types of emphysema?
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centriacinar, panacinar, distal acinar (paraseptal), irregular
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which types of emphysema cause significant airflow obstruction?
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centriacinar and panacinar
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what is panacinar emphysema?
with what is it associated? |
uniform destruction/enlargement from respiratory bronchiole to alveloi; usually in lower basal zones
strong assoc w/ α1-antitrypsin deficiency |
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what is distal acinar or paraseptal emphysema?
with what is it associated? |
involves alveoli, typically near pleura and adjacent to fibrosis/scars
frequent cause of spontaneous pneumothorax |
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what is irregular emphysema?
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airspace enlargement with fibrosis; assoc w/ scarring; usually asxs
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how is a1 antitrypsin involved in the pathogenesis of COPD?
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it is a major inhibitor of proteases (esp elastase) secreted by neutrophils during inflammation; if decreased, neutrophilic protease secretions are unchecked
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Which forms of obstructive lung disease involve the bronchus?
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Chronic bronchitis
Bronchiectasis Asthma (Emphysema is in the acinus, small airway dz and bronchiolitis are in the bronchiole) |
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What is different about the presentation of emphysema compared to the other obstructive lung diseases?
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Usually presents with dyspnea rather than cough as the primary sx
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Difference in presentation of predominant bronchitis vs. predominant emphysema
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bronchitis = blue bloater, copious sputum, dyspnea is mild, normal elastic recoil, cor pulmonale is common
emphysema = pink puffer, scanty sputum, dyspnea is severe, low elastic recoil, cor pulmonale is rare and terminal |
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Difference btwn bronchitis and emphysema on CXR?
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bronchitis = prominent vessels, large heart
emphysema = hyperinflation, small heart |
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What is the pathogenesis behind the mucus production in bronchitis?
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Hyperplasia of submucosal glands in trachea and bronchi; Proteases released from neutrophils and matrix metalloproteinases stimulate mucus hypersecretion; Increase in goblet cells of small airways
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What is the most common form of asthma?
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atopic (allergic, reagin-mediated)
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What cellular process is skewed in atopic asthma?
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T-cell differentiation overproduces Th2 cells leading to IgE and eosinophil-dominated immune responses
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what is the mechanism of the acute phase reaction in atopic asthma?
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antigen binding to IgE-coated mast cells causes release of leukotrienes, cytokines and neuropeptides which causes bronchospasm, edema, mucus secretion and leukocyte recruitment
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What characterizes the airway remodeling of chronic asthma?
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Overall thickening of airway wall
Sub-basement membrane fibrosis Increased vascularity Increase in size of submucosal glands and mucous metaplasia of airway epithelial cells Hypertrophy and/or hyperplasia of bronchial wall muscle |
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What disease is characterized by permanent dilation of bronchi and bronchioles d/t destruction of muscle and elastic tissue from chronic necrotizing infxns?
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Bronchiectasis
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clinical presentation of bronchiectasis?
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cough, fever, abundant purulent sputum
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What part of the lung is affected in bronchiectasis?
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distal lower lobes bilaterally
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What characterizes chronic diffuse interstitial (restrictive) lung diseases?
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Inflammation and fibrosis of pulmonary CT, principally the most peripheral alveolar interstitium
Clinically: dyspnea, decreased lung volumes, decreased compliance Radiologically: diffuse infiltrates, ground-glass shadows |
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What are the classes of chronic diffuse interstitial lung diseases?
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Fibrosing diseases
Granulomatous diseases Eosinophilic diseases Smoking-related diseases Pulmonary alveolar proteinosis |
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What is the pathologic pattern of idiopathic pulmonary fibrosis called?
What is the hallmark of this pathology? |
Usual Interstitial Pneumonia (UIP)
Patchy interstitial fibrosis. Fibrosis has lower-lobe predominance in subpleural regions and along interlobular septa |
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What differentiates nonspecific interstitial pneumonia from idiopathic pulmonary fibrosis (UIP)?
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There may be patchy OR diffuse involvement; histologic pattherns may be fibrosing OR inflammatory
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What characterizes cryptogenic organizing pneumonia?
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loose fibrous tissue plugs within bronchioles, alveolar ducts, and alveoli; underlying lung is normal
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What connective tissue diseases can have lung involvement?
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SLE, RA, progressive systemic sclerosis, dematomyositis-polymyositis, mixed CT disease
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What are pneumoconioses?
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non-neoplastic lung reactions to inhalation of aerosolized mineral/organic dusts, fumes and vapors
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What are the manifestations of coal-workers pneumoconiosis?
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simple CWP = 1-5mm black coal macules diffusely throughout lobar upper zones
Complicated CWP = large blackened scars, esp in upper zones |
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what characterizes silicosis?
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chronic, nodular, dense pulmonary fibrosis
nodules may coalesce into hard, collagenous scars |
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Inhalation of what is associated with increased risk of tuberculosis?
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Silica
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What pulmonary abnormalities are linked to exposure to asbestos?
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Interstitial fibrosis (asbestosis)
Pleural reactions (effusions, fibrous pleural adhesions, dense fibrous plaques on pleura or diaphragm) Lung carcinoma and malignant mesothelioma |
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What helps differentiate asbestosis from other causes of diffuse interstitial fibrosis?
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Asbestos bodies (brown, fusiform or beaded rods w/ translucent center, coated with protein and iron)
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What is the most common manifestation of asbestosis?
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Pleural plaques (well circumscribed, made of dense collagen, most often on anterior and posterolateral aspects of parietal pleura)
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What is the link between smoking and development of lung neoplasms in asbestos exposed individuals?
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Increased risk for asbestos-related lung carcinoma
No change in risk for asbestos-related mesothelioma |
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what disease is characterized by noncaseating granulomas that can appear in any organ in the body; in lung involvement, CXR shows BL hilar adenopathy, lung tissue has diffuse scattered granulomas?
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sarcoidosis
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What must be done to definitively diagnose sarcoidosis?
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Biopsy (to show noncaseating granulomas)
Culture (to R/O tuberculosis, fungal infxn) |
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what are three common situational manifestations of hypersensitivity pneumonitis?
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Farmer's lung (spores of actinomycetes in hay)
Pigeon breeder's lung (proteins from bird feathers or excreta) Humidifier/AC lung (thermophilic bacteria) |
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Morphologic changes seen in hpersensitivity pneumonitis?
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interstitial pneumonitis/fibrosis of bronchioles, variable number of noncaseating, loosely formed granulomas
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What can cause pulmonary eosinophilia?
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Idiopathic acute eosinophilic pneumonia w/ resp flr
Simple pulmonary eosinophilia (transient pulm lesions, eosinophilia also in blood, idiopathic) Tropical eosinophilia (infxn w microfilariae) Secondary eosinophilia (infxns, allergic rxns, asthma, vasculitis) Idiopathic chronic eosinophilic pneumonia (focal consolidation w lymphocyte and eosinophil infiltration) |
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What is desquamative interstitial pneumonia?
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large intra-alveolar collections of dusty brown macrophages w/ mild interstitial inflammation. Almost always associated with smoking
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what rare pulmonary disease is characterized by accumulation of acellular surfactant in the intra-alveolar and bronchiolar spaces?
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Pulmonary alveolar proteinosis
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What disease can cause transient chest pain and sometimes hemoptysis; CXR may show peripheral, wedge-shaped hemorrhagic areas of necrosis?
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Small or medium sized pulmonary emboli
(CXR finding is d/t infarctions, usually found in pts w/ compromised pulmonary circulation) |
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what things can cause pulmonary hypertension?
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Chronic obstructive or interstitial lung dz
Congenital or acquired heart dz w/ LHF Recurrent pulm emboli Autoimmune disorders Obstructive sleep apnea Idiopathic pHTN Secondary to vascular disorders |
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what are the morphological changes seen in pHTN?
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hypertrophy of muscular and elastic arteries and atheromas in large arteries
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which pulmonary disease causes pulmonary necrosis, hemorrhagic interstitial pneumonitis, and is also associated with glomerulonephritis?
What is the cause? |
Goodpasture syndrome
autoantibodies against basement membrane in the lungs and kidneys |
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what rare lung disease of children causes intermittent diffuse alveolar hemorrhage and, after treatment with immunosuppression, leaves hemosiderin deposits and fibrosis?
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Idiopathic pulmonary hemosiderosis
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Which autoimmune lung disease most often presents with hemoptysis?
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Wegener granulomatosis
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