Pathology - S2B1 - 4 Vascular And Infectious

Front 1

What could cause a vasospasm in the lungs?

Back 1

amphetamines (cocaine)

Front 2

What are Pulmonary Infarcts most commonly the result of?

Back 2

Pulmonary Thromboembolism

Front 3

75% of pulmonary infarcts invlove which part of the lungs?

Back 3

Lower lobes b/c perfusion is greater than ventilation in the lower lobes

Front 4

What is the most common origin of Pulmonary Thromboembolisms?

Back 4

Femoral Vein = deep veins in legs

Front 5

Macroscopically, what is the classic appearance of Pulmonary Infarcts?

Back 5

Hemorrhagic infarct, which extends to the periphery of the lung as a wedge

Front 6

What can happen if the hemorrhagic infart extends to the pleural surface?

Back 6

can be covered by Fibrinous exudate and cause Pleural friction rub

Front 7

When an infarct is caused by a septic embolus, a septic infarct may occur and evolve into what?

Back 7

Abscess

Front 8

What is the classic triad associated with Pulmonary Embolism?

Back 8

1. Dyspnea (shortness of breath)
2. Pleuritic chest pain
3. Hemoptysis

**most patients are extremely dyspneic**

Front 9

List risk factors for pulmonary thromboembolism (6)

Back 9

1. Cancer (Trousseau syndrome = pancreatic carcinoma cancer cells release thromboplastin)
2. Cardiac disease
3. Obesity
4. Prolonged bed rest
5. Acute paraplegia
6. oral contraceptive use

Front 10

What is Homan's sign?

Back 10

Use to check for Deep vein thrombosis --> pain in the calf is produced by passive dorsiflexion of the foot

Front 11

What is the underlying principle of order of scanning in the V/Q scan?

Back 11

-1st scan using isotope with smallest dose or lowest energy to avoid down-scatter of higher energy isotope
-scan with highest energy isotope last

Front 12

When doing the V/Q scan, which imaging when done first can be cost effective?

Back 12

Perfusion because if it is normal, a ventilation study is not needed to assess for pulmonary emboli

Front 13

To determine the etiology of a perfusion defect, what 2 things are needed?

Back 13

1. ventilation study

2. CXR

Front 14

A V/Q mismatch suggest (V/Q is infinite)?

Back 14

Pulmonary embolism

Front 15

A V/Q match suggests?

Back 15

parenchymal disease

Front 16

What is the risk of performing an angiogram in trying to detect the presence of Pulmonary Thromboembolism?

Back 16

the radiographic contrast itself can cause thrombosis

Front 17

What are Interstitial Pneumonias usually caused by? (2)

Back 17

1. viral infections

2. Mycoplasma pneumonia

Front 18

Define Bronchopneumonia

Back 18

-patchy consolidation centered around small bronchi
-PMN reaction

Front 19

What is the cause of Bronchopneumonia?

Back 19

inhalation/aspiration, mostly bacteria, some fungi

Front 20

Define Lobar Pneumonia

Back 20

-homogenous
-identical involvement of alveoli, same time and same extent
-intra-alveolar exudate resulting in consolidation

Front 21

What is the most common cause of Lobar Pneumonia?

Back 21

Strep pneumo

*Klebsiella also

Front 22

List the 4 stages in Lobar Pneumonia

Back 22

1. congestion
2. red hepatization
3. gray hepatization
4. resolution

Front 23

Describe the Congestion phase of Lobar Pneumonia

Back 23

- heavy, boggy, red lung = active hyperemia

- histologically = vascular engorgement, intra-alveolar fluid with few NO and often the presence of numerous bacteria

Front 24

Describe the Red Hepatization phase of lobar pneumonia

Back 24

- lobe is distinctly red, firm, and airless, with a liver-like consistency

- Histo = alveolar spaces are filled with RBC's, PMN's, and fibrin

Front 25

Describe the Gray Hepatization phase of Lobar pneumonia

Back 25

-grayish,brown dry surface

- Histo = disintegration of RBC's and the persistence of fibrinopurulent (Fibrin + Neutrophils) exudate within air spaces

Front 26

Expected oropharyngeal flora in ~20% of adults

Back 26

Strep pneumo

Front 27

Normally sensitive to penicillin, but drug resistance is emerging

Back 27

Strep pneumo

Front 28

With this bacteria, African-Americans have a 3-5 fold higher incidence of bacteremia than whites and rates of invasive disease are also exceptionally high among Native Americans

Back 28

Strep pneumo

Front 29

What is the name of the vaccine available for adults against Strep pneumo?

What type of vaccine?

Back 29

Pneumovax

Polysaccharide vaccine that covers most of the bacteremic strains of pneumococcus

Front 30

Name of Strep pneumo vaccine given to children?

Vaccine properties?

Back 30

Prevenar

Heptavalent vaccine linked to Diphtheria toxin

Front 31

Classically "lancet-shaped" gram + diplococcus with a capsule

Back 31

Strep pneumo

Front 32

What are most Gram - pneumonias due to?

Back 32

Endogenous aspiration of oropharyngeal flora

Front 33

Eponymic name is Friedlander's pneumonia

Back 33

Klebsiella

Front 34

Encapsulated organism, 10% of all nosocomial pneumonias

Back 34

Klebsiella

Front 35

Gram -, fat rod surrounded by a mucoid capsule

Back 35

Klebsiella

Front 36

Most common gram - causing lobar pneumonia and typical pneumonia in elderly patients in nursing homes

Back 36

Klebsiella

Front 37

Common cause of Pneumonia in Alcoholics

Back 37

Klebsiella

Front 38

Pneumonia associated with blood-tinged, thick, mucoid sputum; lobar consolidation and abscess formation simulating TB

Back 38

Klebsiella

Front 39

Intracelluar organism that requires anti-microbial drugs with good cytoplasmic penetration, such as Macrolides

Back 39

Legionella

Front 40

Infection from inhalation of aerosol from contaminated stored water, most often in air-conditioning systems

Back 40

Legionella

Front 41

Detected by Immunofluorescence of sputum

Back 41

Legionella

Front 42

Inoculated on Charcoal Yeast extract plates

Back 42

Legionella

Front 43

Stained with Dieterle silver stain

Back 43

Legionella

Front 44

Gram - rod with green sputum (pyocyanin)

Back 44

P. aeruginosa

Front 45

Common colonizer of CF patients

Back 45

P. aeruginosa

Front 46

Pneumonia from this bacteria is often associated with infarction due to vessel invasion

Back 46

P. aeruginosa

Front 47

Mucoid colonies in chronically infected patients make eradication impossible

Back 47

P. aeruginosa

Front 48

Definition: a localized collection of pus in the lung resulting from liquefactive necrosis of lung tissue

Back 48

Lung Abscess

Front 49

List 4 bacteria that frequently cause abscesses

Back 49

1. S. aureus ***
2. Pseudomonas
3. Klebsiella
4. Proteus

Front 50

List 4 mechanisms that can lead to Lung Abscesses

Back 50

1. aspiration of infected material, especially Gram - and anaerobes in patients with dental caries
2. Antecedent primary bacterial infection
3. Septic embolism
4. obstruction secondary to neoplasm

Front 51

Definition: local aggregations of macrophages that become epithelioid cells

Back 51

Granulomatous inflammation = granuloma

Front 52

What are 3 causes of granulomatous inflammation in the lungs

Back 52

1. Mycobateria

2. Dimorphic fungi
-Histoplasma
-Coccidioides
-Blastomyces

3. Sarcoidosis

Front 53

What is the initial focus of Tuberculosis in primary infection?

Back 53

Ghon Complex

Front 54

What is a Ghon Complex?

Back 54

1. Parenchymal subpleural lesion

2. enlarged hilar lymph nodes

*both contain tuberculous granulomas

Front 55

Describe Miliary Tuberculosis

Back 55

Secondary TB with the presence of multiple, small tuberculous granulomas in many organs, which result from the hematogenous spread of bacteria

Front 56

Name 5 complications of TB

Back 56

1. cavitation
2. hemorrhage
3. bronchopleural fistulas
4. Bronchopneumonia
5. Aspergillomas

Front 57

With Tuberculosis, swallowed sputum may lead to ________

Back 57

GI TB

Front 58

This complication of TB is particularly a problem in children and the immunosuppressed

Back 58

TB meningitis

Front 59

List 3 common causes of diffuse infiltrate in IC'ed hosts

Back 59

CMV
PCP
Drug reaction

Front 60

List 3 common causes of focal infiltrates in IC'ed hosts

Back 60

Gram - rods
S. aureus
Aspergillus

Front 61

Fruiting body and narrow-angled, branching septate hyphae

Back 61

Aspergillus

Front 62

Non-invasive "fungus ball", occupies a previously existing anatomical space, such as a sinus cavity or abscess cavity

Back 62

Aspergilloma

Front 63

Most common opportunistic infection in AIDS patients

Back 63

Pneumocystis carinii

Front 64

Replicates in the human lung, with a complicated life cycle that includes formation of intra-alveolar CYSTS

Back 64

Pneumocystis carinii

Front 65

Most of the population is infected by age 5 with this organism

Back 65

PCP

Front 66

What is PCP probably acquired from?

Back 66

Aerosolized mouse or rat urine

Front 67

What drug is given prophylactically for PCP when CD4 counts drop below 200

Back 67

Trimethoprim-Sulfamethoxazole

Front 68

What do CXR's look like with PCP?

Back 68

Patchy, pneumonia, with a characteristic "ground-glass" appearance

Front 69

Budding yeast with narrow-based buds

Back 69

Cryptococcus neoformans

Front 70

Systemic fungi surrounded by a thick capsule

Back 70

Cryptococcus

Front 71

Is ubiquitous in the environment, preferring alkaline bird droppings as its habitat

Back 71

Cryptococcus neoformans

Front 72

Usually causes meningitis in IC'ed, but primary lung disease may occur

Back 72

Cryptococcus neoformans

Front 73

What test is useful in detecting Cryptococcus in normal hosts?

Back 73

Antigen testing of the CSF

Front 74

What test is adequate for detecting Cryptococcus in IC'ed host?

Back 74

India Ink prep

Front 75

Dimorphic large yeast with Broad-based budding

Back 75

Blastomyces dermitidis

Front 76

Saddle embolus originating from the deep veins of the leg
-straddles right and left pulmonary artery = sudden death

Back 76

What is this showing?

Front 77

Why are small Pulmonary Infarcts "Hemorrhagic" or "red" infarcts?

Back 77

The lung has a dual blood supply
-Pulmonary Artery
-Bronchial arteries

Front 78

Bronchopneumonia
-pathy areas where PMN's are within tiny bronchioles

Back 78

What is this picture showing?

Front 79

Strep pneumo

Back 79

What are these microbes?

Front 80

Lower Lobe consolidation

Pneumococcus

Back 80

What is this showing?

What is the most likely cause?

Front 81

Lobar Pneumonia
-if the bronchi were filled with pus = Bronchopneumonia, but since they are spared it is Lobar

Back 81

What is this showing?

Front 82

Klebsiella
-consolidation + abscesses

Back 82

What is the likely cause of this? How do you know?

Front 83

Legionella

Back 83

This person contracted 5-lobe consolidation by working in the produce section with water mist sprayers

Front 84

Legionella

Immunofluorescence
Dieterle Silver

Back 84

What microbe?
What are these 2 stains?

Front 85

Legionella

Immunofluorescence
Dieterle Silver

Back 85

What microbe?
What are these 2 stains?

Front 86

1. P. aeruginosa
2. Cystic Fibrosis
3. Bronchiectasis

Back 86

What are the 3 associations here?

Front 87

1. S. aureus
2. Klebsiella
3. Aerobic and anaerobic streptococci
4. Gram - organisms

Back 87

What organisms typically cause this?

Front 88

What is a Simon focus?

Back 88

Granuloma at the lung apex in Secondary Pulmonary TB
-occurs at apex due to high O2 tension

Front 89

Cytomegalovirus

Back 89

What is this microbe?

Front 90

When does Invasive (disseminated) Aspregillosis usually only occur?

Back 90

Immunocompromised

Front 91

Aspergilloma

Back 91

What is this?

Front 92

Aspergilloma

Back 92

What is shown here?

Front 93

Aspergillus

Acute (<45 degrees) branching Septate Hyphae

Back 93

What is this?
In culture, what do the hyphae look like?

Front 94

Invasive Aspergillosis

Back 94

This was from an Immunocompromised patient.
What pathogen?

Front 95

Invasive Aspergillosis

Acutely branching septate hyphae

Back 95

What pathogen?
How do you know?

Front 96

-Cryptococcus neoformans = narrow-based budding
-Meningitis in IC'ed
-Pigeon excreta

Back 96

What pathogen?
What does it usually cause?
How are you exposed to it?

Front 97

Pneumocystis carinii

IC'ed = AIDS

Back 97

What pathogen is this?
Who does it usually affect?

Front 98

Bronchopneumonia

Patchy areas of pulmonary consolidation

Back 98

What is this showing?

How do you know?