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43 Cards in this Set
- Front
- Back
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Conditions that cause hemoptysis
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•TB
•Carcinoma •Left heart failure |
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Causes for atelectasis in adults
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•Obstruction (resorption): asthma, chronic bronchitis, aspiration
•Compression- pleural fluid, air (pneumothorax) •Contraction- fibrosis of lung •Microatelectasis (small collapse) |
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Pneumonia Symptoms
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•Fever
•Cough •Dyspnea •Chest pain |
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Difference between primary and secondary pneumonia
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Primary is in healthy people and involves a virulent organism (S. pneumonia, L. pneumophilia). Secondary involves the immunocompromised.
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Define Bronchiectasis in One Line!
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Permanent dilation of bronchi by destroying elastic muscle due to chronic necrotizing infections
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Features of atypical pneumonia?
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•Moderate sputum
•No consolidation •Lack of alveolar exudate Organisms: •Mycoplasma •Chlamydia •Viral (Influenza) •Rickettsiae •Herpes, CMV in the immunocompromised Affects alveolar wall (interstitial). Note that it is virus OR something thats obligate intracellular! |
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Organisms in Acute pneumonia?
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•S. pneumoniae
•H. influenzae •Moraxella catarrhalis •Legionella |
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Organisms in nosocomial pneumonia?
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•Klebsiella
•E. coli •Pseudomonas •Staph |
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Stages in Pneumonia
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Acute Congestion
• heavy red boggy lungs • Vascular congestion • bacteria multiply in alveoli, dilated alveolar capillaries, early fluid exudation • early PMNs + early red cells Red Hepatization • consistency liver like • lining alveolar cells lost • Alveoli packed with PMNs, fibrin, red cells ± Pleuritis • infection controlled Grey Hepatization • dry, gray, firm (red cells have been lysed) • exudation and hyperemia stop • Fibrino suppurative exudate persists in the alveoli Resolution • Removal of exudate by enzymatic degradation- granular semifluid debris- reabsorbed, engulfed by macrophages or coughed out • complete resolution can occur because structure of alveoli not damaged in lobar pneumonia • Bronchopneumonia has structural damage |
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Complications of Pneumonia
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•Abscess - local collection of pus. Think staph aureus, gram (-) bacteria or type 3 pneumococci. Would see foul smelling sputum
•Fibrosis - scar tissue •Empyema - collection of pus in pleural space •Bacteremia - bacteria in blood. Would see meningitis, arthritis, infective endocarditis |
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Clinical Features of Pneumonia
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• Abrupt high fever, cough, rusty
purulent sputum • Chest pain, pleural rub (if there is pleuritis) • ↓ air entry, consolidation, X- ray • Microbe - sputum, blood |
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Organisms in Community Acquired Pneumonia?
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•Strep pneumoniae
•Hemophilus influenzae •Moraxella Catarrhalis •Staph aureus •Klebsiella pneumoniae •Pseudomonas aerogenosa •Legionella pneumophila |
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H. influenzae causes...
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•Pneumonia in COPD
•Bronchiectasis •Infection in cystic fibrosis |
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Moxarella catarrhalis causes...
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•Pneumonia in elderly
•Second most common cause of pneumonia in elderly •Also causes otitis media in kids |
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Staph aureus pneumonia factoids...
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• After viral respiratory illness – secondary (measles in children, influenza in adults)
• Hospitalized patients – primary (nosocomial) • Abscess formation, empyema • I/V drug abusers- endocarditis right side • Penicillin resistance |
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Properties of Klebsiella pneumonia
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• Most frequent gram negative bacterial pneumonia
• Debilitated and malnourished • Chronic alcoholics • Thick gelatinous sputum ( viscid capsular material) • Extensive destruction |
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Properties of pseudomonas aeroginosa pneumonia?
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• Progressive necrotizing pneumonia
• Nosocomial, neutropenic patients, burns • Vasculitis and vascular spread • Extensive destruction, abscess formation • Empyema • Progressive necrotizing pneumonia • Nosocomial, neutropenic patients, burns • Can also cause disease in patients with cystic fibrosis- community acquired |
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Legionella pneumonia properties?
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• Sporadic, epidemic pneumonia
• Unlike Pontiac fever -> self limited URI without pneumonia • Artificial water pools- tubing, cooling towers • Inhalation of aerosolized organisms or aspiration of contaminated drinking water • In chronically ill patients, post transplant • High fatality |
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Clinical Features of Interstitial pneumonias?
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• Variable
• Mild illness usually • Fever, cough- nonproductive, dyspnea (sometimes out of proportion to chest signs and radiology) diffuse alveolar damage • Very few clinical signs • Reticular shadows on chest X- ray • Organisms difficult to demonstrate, check antibody titers |
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Types of people pneumonia of Mycoplasma pneumoniae tends to affect?
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• Children, young adults
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Causes of lung abscesses?
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1. Aspiration of infected material- caries from teeth, gastric contents
2. Sequela of acute suppurative pneumonia (Staph. Aureus, Klebsiella, Pseudomonas) 3. Bronchial obstruction - foreign body (inhalation, aspiration), tumor 4. Bronchiectasis 5. Secondary infection on tuberculous cavity 6. Septic embolus from infective endocarditis right heart |
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Clinical Features of Lung Abcesses
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• Cough with copious, foul sputum, hemoptysis, spiking fever, malaise
• Clubbing of fingers, weight loss, anemia • Complications – bronchopleural fistula, empyema, septicemia (meningitis, brain abscess), amyloidosis |
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CMV Pneumonia Morpholgoy and Demographics
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Morphology:
• Large cells-large nuclei, large amount of cytoplasm, large basophilic nuclear inclusion with halo around it- owl eye, smaller basophilic cytoplasmic inclusions Demographics: • Neonates, immune compromised, AIDS, BM transplant |
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Morphology and Etiology of Pneumocystis jiroveci Pneumonia
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•Reactivation in immune compromised (AIDS-CD4 < 200)
• Interstitial pneumonia • Intra alveolar foamy pink exudate-cotton candy • Alveolar septa thickened-edematous, minimal mononuclear infiltrate • Silver stain shows cup shaped cyst walls in alveolar exudate • Sputum if it can be induced or BAL- Giemsa or methylene blue- shows trophozoites • Can also do immunofluorescence or PCR |
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If Pneumonia is not responding to treatment it could be....
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•Brochiectasis
•Lung Abscess •Lung tumor causing hilar obstruction or bronchioalveolar carcinoma •Vasculitis |
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Morphology of ARDS
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Acute Stage:
•Lungs are dark red, firm, airless, heavy •Capillary congestion •Necrosis of alveolar epithelial cells •Hyaline membrane formation •Hemorrhage •Interstital and intraalveolar edema |
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Clinical Features of ARDS
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• Respiratory difficulty- acute
• Gasping for breath • Severe hypoxemia, cyanosis • Refractory to oxygen therapy • Bilateral infiltrates on chest X-ray • Absence of clinical features of left ventricular failure • Leads to multisystem organ failure • Predisposes to infections • High mortality |
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Clinical Features and Morphology of Pulmonary Infarct
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• Clinically resembles myocardial infarction: chest pain, dyspnea, shock
Gross: •Wedge shaped •hemorrhagic infarct •may be multiple •Occurs in lower lobes •apex of infarct towards hilum, •raised red blue area •pleura has fibrinous exudate • Micro: coagulation necrosis, hemorrhage. Later on may see hemosiderin, fibrosis |
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Morphology of Pulmonary Hypertension
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• Large elastic arteries - atheromas
• Medium sized muscular – proliferation of myointimal cells and smooth muscle cells -> medial and intimal thickening and narrowing of lumen • Smaller arteries and arterioles- marked thickening, medial hypertrophy, elastic reduplication • Capillaries burst, lead to necrosis • Plexogenic changes in severe varieties only (primary) • Necrosis of wall (fibrinoid) • Thrombosis • Rupture, bleed • Dilation lesions, angiomatoid lesions (tufts of thin walled capillaries) • Hemosiderin |
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Clinical Features of Primary Pulmonary Hypertension
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• Younger persons, more in females
• Symptoms appear late • Fatigue, dyspnea • Syncope on exercise (fainting) • Chest pain • Respiratory insufficiency, cyanosis • Cor pulmonale • Death in 2-5 years • Treat with vasodilators, antithrombotic agents and eventually lung transplantation |
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Clinical Features and Morphology of Goodpasture syndrome
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Clinical Features
•Hemoptysis •Hematuria •Oliguria •Hemorrhagic interstital pneumonia Morphology • Gross: lungs heavy, red brown, areas of consolidation • Micro: focal necrosis of alveolar walls, intra alveolar hemorrhages, fibrous thickening of alveolar septa, hemosiderin |
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Clinical Features and Morphology of Wegener's Granulomatosis
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Morphology:
• Pulmonary angiitis and granulomatosis • Necrotizing vasculitis (fibrinoid necrosis), parenchymal granulomas, vessels may also show necrotizing granulomas Clinical Features: • Upper respiratory tract- chronic sinusitis, epistaxis, nasal polyps, ulcers over the nose • Lower respiratory tract- cough, hemoptysis, chest pain • c-ANCA positivity- specific |
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Morphology of Idiopathic Pulmonary Fibrosis
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• Gross- Cobble stone appearance due to retraction by the scars in the septa, cut surface firm, rubbery, white (fibrosis), lower lobe more affected, patchy involvement, subpleural areas and interlobular septa
• Micro- Patchy interstitial fibrosis, mixture of early (fibroblastic) and late (fibrosis) lesions- temporal heterogeneity- (not seen in other cases of nonspecific interstitial pneumonia), collapse of alveolar walls, cystic spaces lined by proliferating pneumocytes or bronchiolar epithelium- honey comb fibrosis, patchy interstitial infiltrate- lymphocytes, plasma cells, mast cells, eosinophils, secondary pulmonary hypertension |
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Clinical Features of Idiopathic Pulmonary Fibrosis
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• Insiduous onset, nonproductive cough with dry crackles during inspiration
• Progressive dyspnea, hypoxia, cyanosis, pulmonary hypertension • Bilateral basal lesions • Diagnosis- Take proper social and occupational history • X-ray- small nodules, irregular lines, ground glass opacities • CT- early detection of IPF, exclude other causes of pulmonary fibrosis |
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Morphology of nonspecific interstital pneumonia
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• Either cellular pattern- Diffuse or patchy chronic interstitial inflammatory infiltrate- Lymphocytes, a few plasma cells
• Or fibrosing pattern- diffuse or patchy interstitial fibrosis (no temporal heterogeneity like in UIP) |
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Morphology of Sarcoidosis
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•Intraalveolar and interstitial accumulation of CD4 cells
•Anergy to Candida skin tests •Polyclonal hypergammaglobulinema •Noncaseating epitheliod granulomas •Asteroid bodies •Schaumann bodies CXR: •Linear shadows •Hilar lymph nodes |
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Hypersensitivity Pneumonitis
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•BAL - CD4 and CD8 cells
•Granulomas in alverolar walls • Patchy interstitial mononuclear infiltrate • Characteristic peribronchiolar accentuation • Lymphocytes, plasma cells, epithelioid cells • Noncaseating granulomas • Eventually may develop DIF •History shows exposure to things like farmer's hay, pigeon droppings, sugar cane |
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Clinical Features of Goodpasture's syndrome
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•Oliguria
•Hematuria •Hypertension •Right heart failure •Progressive dyspnea •Glomerulonephritis |
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Difference between panacinar and centriacinar emphysema
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Panacinar is symptomatic
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Morphology of Emphysema
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•Alveoli large
•Wall thin, destroyed •No fibrosis •Adjecent alveoli are confluent - large spaces |
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Clinical Features of Emphysema
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• Symptoms appear late (earleir if coexistent chronic bronchitis)
• Barrel chest, dyspnea, prolonged expiration (because it is active) • Sitting in a forward hunched position trying to squeeze air out of the lungs • X- ray flat domes of diaphragm • Hyperventilation → blood gases normal till late • “Pink Puffers” • Late stage - hypoxia, respiratory acidosis |
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Mediastinal Emphysema
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• Air escapes in to the connective tissue of lung stroma, mediastinum and subcutaneous tissue
• Spontaneously with sudden increase in intra alveolar pressure • violent cough, vomiting, whooping cough, trauma- perforating injury to the ribs • usually with some obstruction to the bronchial passage- eg mucus plug • tear in the interstitium • Patient bloats suddenly like a balloon including chest head and neck • Crackling crepitations over chest wall • Recovers spontaneously after the defect is sealed |
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Chronic bronchitis and bronchiolitis
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Bronchitis:
• hypertrophy and hyperplasia of mucous glands • (Reid Index > 0.5) • Goblet cells in the surface epithelium • Squamous metaplasia Bronchiolitis • Goblet cell metaplasia • Mucus plugging (obstruction) • Inflammation-mononuclear and some PMN • Peribronchiolar fibrosis (collapse in expiration) • smooth muscle hyperplasia • Coexistent emphysema • +/- secondary infection- inflammation exacerbates the symptoms • Rarely fibrous occlusion of bronchioles- bronchiolitis obliterans |
