Pathology - Lung (Vascular Disease To Pulm Infections)

Front 1

What two arterial supplies go to lung?

Back 1

pulmonary arteries which pump out CO; bronchiole arteries that stem from aorta and intercostal arteries

Front 2

What are most emboli from?

Back 2

thrombi

Front 3

What cause most pulmonary embolisms?

Back 3

DVTs

Front 4

What is compromised in pulmonary embolism

Back 4

respiratory compromise and hemodynamic compromise (increase BF resistance)

Front 5

What are the outcomes of large emboli

Back 5

death or cor pulmonale

Front 6

outcomes of small pulmonary emboli?

Back 6

infarct or hemorrhage

Front 7

What might fibrinous pleuritis be caused by?

Back 7

small emboli with infarction

Front 8

Tests for pulm emboli?

Back 8

CXR, d-dimer testing, spiral CT, angiography

Front 9

Most common clinical presentation of pulmonary embolism?

Back 9

none (60-80% asymptomatic)

Front 10

Clinical outcomes of pulm embolism?

Back 10

none, acute (hemorrhage, infarct, death)

and chronic (pulmHTN, RHF)

Front 11

Cause of primary pulm HTN

Back 11

mutation in BMPR2 which allows smooth muscle proliferation and vascular thickening

Front 12

Causes of secondary pulmonary hypertension?

Back 12

OLD, ILD, congential shunt, mitral valve stenosis, recurrent pulm thromboemboli, autoimmune disease to cause intimal fibrosis.

Front 13

drugs that cause pulmonary hypertension:

Back 13

aminorex, antiobesity drugs that effect serotonin transporter activity

Front 14

What is seen in pulmonary htn?

Back 14

atheromatous plaques, capillary tufts in severe cases.

Front 15

Definition of PTH

Back 15

2x normal pulmonary pressure or 1/4 of systemic circulation.

Front 16

treatment for pulmonary hypertension?

Back 16

vasodilators and antithrombotic medications, none curative.

Front 17

HLA-DRB1

Back 17

gene implicated in having a predisposition for Goodpasture's and sarcoidosis

Front 18

People who usually get goodpasture's

Back 18

male, 20's

Front 19

What causes onset of goodpasture's

Back 19

a trigger: viral, smoking

Front 20

Dx of goodpasture's:

Back 20

lung/kidney biopsy and presence of circulating AB's

Front 21

Goodpasture syndrome:

Back 21

autoAb's to the goodpasture antigen

Front 22

What is the goodpasture antigen?

Back 22

non-collagenous domain of alpha3 chain of collagen IV in glomeruli and alveoli basement membrane

Front 23

Tx of goodpastures

Back 23

plasma exchange and immunosuppression

Front 24

What is wegener's granulmatosis?

Back 24

Necrotizing vasculitis with:
1)upper resp granulomas,
2)necrotizing vasculitis,
3)renal disease

Front 25

Typical presentation of Wegener's Granulomatosis?

Back 25

hemoptysis or respiratory tract infection/ulcers becasue this si NECROTIZING!! and renal disease

Front 26

Serum indicator for Wegener's Granulomatosis?

Back 26

c-ANCA; antineutrophil cytoplasmic antibody

Front 27

TReatment for Wegener's?

Back 27

immunosuppressive therapy

Front 28

What is idiopathic pulmonary hemosiderosis?

Back 28

random alveolar hemorrhage, casuses red-brown consolidation

Front 29

treatment for idiopathic pulmonary hemosiderosis?

Back 29

long-term immunosuppression

Front 30

likely to present with idiopathic bulmonary hemosiderosis?

Back 30

children

Front 31

primary defense mechanisms to pulmonary infection?

Back 31

cough relex,
mucociliary clearance, surfactant
pulmonary macrophages,

Front 32

Contents of mucus

Back 32

IgA, IgG, antioxidants, antimicrobial (lysozymes)

Front 33

What is pnemonia?

Back 33

infection of lung parenchyma resulting in exudation and consolidation

Front 34

Classification of pneumonia?

Back 34

etiology:bacterial, viral, fungal, parasitic

clinical: community, nosocomial, aspiration -- this classification used if no pathogen is isolated

Front 35

Most common cause of nosocomial pneumonia?

Back 35

Enterobacteriacea, pseudomonas, S. aureus

Front 36

Most common cause of community-acquired pneumonia?

Back 36

Streptococcus pneumonia?

Front 37

morphology of s pneumococcus?

Back 37

gram + diplococcus (lancet-shaped) that live in neutrophils

Front 38

Treatment for s. pneumonia?

Back 38

penicillin

Front 39

Diseases caused by S. pneumonia?

Back 39

lobar pneumonia

Front 40

Most common cause of acute exacerbation of COPD?

Back 40

Hemophilus influenza

Front 41

Susceptible to inspiratory stridor?

Back 41

young children with H. influenzae and acute epiglottis.

Front 42

Morphology of H. influenzae

Back 42

gram neg pleomorphic (coccobacilli)

Front 43

Virulence factors of H influenzae

Back 43

IgA protease
Pili for adhesion

Front 44

type of pneumonia caused by H Influenza?

Back 44

lobar or lobular

Front 45

Secondary bacterial pneumonia following viral respiratory illness

Back 45

S. aureus

Front 46

Mophology of s. aureus?

Back 46

gram positive cocci in clusters

Front 47

Typical presentation of S. aureus in drug users

Back 47

Pneumonia with endocarditis

Front 48

Most frequent cause of gram neg bacterial pneumonia?

Back 48

Klebsiella (FAT ROD)

Front 49

Pts most susceptible to Klebsiella?

Back 49

debilitated and malnourished people

Front 50

How does one self-acquire klebsiella?

Back 50

aspiration because its normal GI floura

Front 51

Lung showing mucoid yellow consolidation

Back 51

Klebsiella pneumoniae because it is gram - and produces viscid capsule that causes thick sputum

Front 52

Nosocomial pneumonia that occurs in cystic fibosis pts?

Back 52

pseudomonas aeruginosa

Front 53

morphology of pseudomonas aeruginosa

Back 53

gram - bacilli

Front 54

P aeruginosa virulence factor:

Back 54

elastase to destroy blood vessel walls
mucoid for adherance

Front 55

What does P aeruginosa virculence factor elastase allow?

Back 55

extrapulmonary spread and fulminat spticemia because elastase can dissolve blood vessels

Front 56

Pontiac fever:

Back 56

self-limited upper resp tract infection due to Legionella

Front 57

Where the f does Legionella come from?

Back 57

where little mermaid is from: legion

(arficifial aquatic environments)

Front 58

Diagnosis for Legionnaire's disease:

Back 58

Ag in urine or Ab in sputum; CULTURE is gold standard

Front 59

morphology of legionnaire's?

Back 59

gram negative coccobacillus

Front 60

The two patterns of bacterial pneumonia:

Back 60

bronchopneumonia and lobar pneumonia

Front 61

Difference between bronchopneumonia and lobar pneumonia?

Back 61

bronchopneumonia is patchy and migrate towards adjacent alveoli;
lobar pneumonia is fibrinosuppurative in the entire lobe or lung (spreads interstitially)

Front 62

4 stages of inflammatory response in lobar pneumonia?

Back 62

Congestion, Red hepatization, Gray hepatization, Resolution

Front 63

Congestive phase of lobar pneumonia inflammation? Red hep? Gray hep? resolution?

Back 63

Congestive: bacteria partying in alveolar and the red police are clogging up vessels around the party.

red hep: the red police invade with neutrophils and fibrin into the party space

Gray: the fibrin start to get out of control and macrophages appear to police them

resolutoin: debris is left from the party and the fibroblasts proliferate

Front 64

goal of pneumonia therapy?

Back 64

ID the organism asap and determine antibiotic sensitivity! before it spreads or destroys more!

Front 65

Primary atypical pneumonia

Back 65

caused by mycoplasama or virusus and confined to interstitium and interstitial areas of alveolar walls.

Front 66

signs of community acquired atypical

Back 66

moderate sputum, but no consolidation or alveolar exudate! mild white count elveation

Front 67

What causes Q fever?

Back 67

coxiella burnetti


Q, Coxiella burnetti for queer cocks burn

Front 68

Who is at risk for atpyical pneumonia?

Back 68

children and young adults in closed communities with malnutrition, alcoholism, and debilitating illnesses

Front 69

How does the little creeper cause primary atypical pneumonia?

Back 69

mycoplasma/chlamydia pneumonia or viruses... they attach to the upper tract epitheliu, kill the cell, and prevent mucociliary clearance

Front 70

causes of lung ABScess?

Back 70

Aspirated material
bacterial infection
Septic embolism

Front 71

acute lung sepsis microscopically:

Back 71

neutrophils and necrotic lung parenchyma

Front 72

chronic lung sepsis microscopically:

Back 72

fibroblastic wall

Front 73

Symptoms in lung sepsis sufferer?

Back 73

smelly sputum, cough, fever, weight loss, clubbing of fingers and toes

Front 74

Causes of chronic pneumonia?

Back 74

things that live in your lung: bacteria and fungi

Front 75

Acid fast bacilli

Back 75

mycobacteria

Front 76

How can one contract oropharyngeal and intestinal tuberculosis?

Back 76

drinking unpasturized milk with M. bovis

Front 77

epidemiology of tuberculosis

Back 77

2nd leading cause of infectious death worldwide

Front 78

percent of world population infected with TB

Back 78

1/3

Front 79

types of people in the US that get TB

Back 79

elderly, poor people with AIDS that are citydwellers

Front 80

Pathogenesis of MTb?

Back 80

1) DTH to MTb antigens
2) MTb enters macrophages and repicates
3) TH1 attacks MTb and macrophages become bactericidal
4)caseating granulomas occur from TH1 response
5) Activated macrophages produce THF which cause more granulomas via recruitment of monocytes

Front 81

In what types of people would false negative PPD tests occur in?

Back 81

immunosuppressed such as sarcoidosis or even OVERWHELMING active TB

Front 82

What might cause false positive PPD test?

Back 82

atypical mycobacterial infection

Front 83

Describe primary tuberculosis

Back 83

Ghon focus develops with DTH in lower part of upper lobe or upper part of lower lobe, 95% develop latent disease where bacteria hides in a calcified nodule

Front 84

Where does seconday tuberculosis unleash?

Back 84

apex of upper lobes, highly aerobic!

Front 85

What is progressive pulmonary TB?

Back 85

advancement of either primary or secondary TB into full force disease; left untreated will spread everywhere (systemic miliary TB)

Front 86

What is scrofula?

Back 86

TB of the neck

Front 87

in a less severly immunocompromised HIV patient, what TB might develop? Severly immunocompromised?

Back 87

secondary TB and mayhaps some extrapulm involvement.

Severely compromised will have progressive pulm TB with for sure extrapulm involvement

Front 88

similar to TB but caused by fungi

Back 88

fungal pneumonia

Front 89

morphology of fungi at environmental temps

Back 89

hypahe with spores

Front 90

morphology of fungi at body temps

Back 90

yeasts

Front 91

What might you get if you sniff bird or bat poop down by the missippi?

Back 91

Histoplasmosis; fungal pneumonia

Front 92

Major target of histoplasmosis

Back 92

Macrophages

Front 93

What is tree bark appearance referring to?

Back 93

concentric calcifications of histoplasmotic lesions

Front 94

What extent of histoplasmosis is seen in immunosuppressed individuals?

Back 94

fulminant disseminated histoplasmosis:
no epitheliod granulmas but phagocytes fill w fungal yeasts throughout WHOLE BODY! eeeek!

Front 95

Dx for histoplasmosis?

Back 95

culture, ID in tissue, serologic tests for Ag/Ab

Front 96

Forms of blastomycosis?

Back 96

pulmonary, disseminated, cutaneous

Front 97

Presentation of blastomycosis?

Back 97

abrupt illness with productive cough, weight loss, fever, night sweats

Front 98

types of granulomas seen in blastomycosis?

Back 98

suppurative

Front 99

Clinical course of blastomycosis?

Back 99

either spontaneous resolution or prgoression to chronic lesion

Front 100

What is endemic in CALI, with primary infections being asymptomatic?

Back 100

Coccidiodomycosis in CALI

Front 101

San Joaquin Valley fever complex?

Back 101

lung, fever, cough, pleuritic pain with skin lesions (seen in 10% of coccidiodomycosis

Front 102

Most common opportunistic viral pathogen in AIDS?

Back 102

cytomegalovirus

Front 103

What is CMV and how prevalent is it?

Back 103

50% of adults are serologically positive for this member of herpes; it hids in WBCs

Front 104

most susceptible to CMV:

Back 104

neonates and immunosuppressed (AIDS)

Front 105

What respiratory condition might CMV lead to?

Back 105

ARDS

Front 106

What develops in 80% of AIDS patients and is the leading cause of their deaths?

Back 106

pneumoncystis carinii

Front 107

Who is at risk for pneumocystis carinii?

Back 107

malnutritioned kiddies and immunocompromised

Front 108

Most frequent sidekick for pneumocystis carinii?

Back 108

CMV, both occur simultaneously

Front 109

How does CMV present?

Back 109

like interstitial pneumonitis with hemorrhaging

Front 110

How does pneumocystis carinii pathologically present?

Back 110

eosinophilic exudate, CYSTS everywhere in lung loooking like "crushed ping pong balls"

anywhere from mild interstitian infl. to DAD

Front 111

Diagnosis of pneumocystis carinii

Back 111

bronchoalveolar lavage; cannot culture!

Front 112

most common species to cause aspergillus?

Back 112

A. fumigatus (fumes, inhaled by lung)

Front 113

What is likely to happen in immunocompromized pts when aspergillus is inhaled?

Back 113

invasion in blood vessels and hematogenous spread to heart valves, brain, and kidneys

Front 114

Morphology of aspergillus?

Back 114

Aspergillus in the Army:
parallel septate hyphae with 45 degree branching

Front 115

What is bread mold fungi?

Back 115

mucormycosis

Front 116

What patients may be affected by mucormycosis?

Back 116

diabetics, immunodeficient, those taking Ab's...

Front 117

What are the clinical diseases that murcomycosis can cuase?

Back 117

rhinocerebral ( in diabetic ketoacidosis)
pulmonary (primary or secondary to rhinocerebral disease)
GI

Front 118

Morphology of mucormycosis?

Back 118

irregular, broad, twisted, non-septate hypae with wide-angle branching

Front 119

Clinical course of mucormycosis?

Back 119

poor prognosis but treatment is surgical debridement and antifungals