08.20 - Pathology of Pulmonary Infections (Nichols) - Questions Flashcards Preview

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Flashcards in 08.20 - Pathology of Pulmonary Infections (Nichols) - Questions Deck (148):
1

Cough productive of gelatinous blood sputum

Symptoms of Klebsiella Pneumonia

1

___ can frequently nail a specific dx of Cryptococcal Pneumonia

Serum Cryptococcal Antigen Test

2

CXR of TB

Patchy or nodular infiltrate in apical or subapical upper lobes

2

Gross Path of P Jirovecii Pneumonia

Heavy, diffusely consolidated, tan lungs

3

Tx of Pneumococcal Pneumonia

Almost any beta-lactam

3

Aspergillus Pneumonia needs to be distinguished from

Mere colonization (aspergilloma) and allergic bronchopulmonary aspergillosis

4

Gram Stain of P Aerug Pneumonia

Long thin Gram negative bacilli with pointed ends

4

Course of Histoplasmosis

Usually self-limited, but may disseminate in cell-mediated immunity deficient

5

When do macrophages replace neutrophils

Day 3

5

Any __ process will make the lung look like liver

Consolidating (alveolar filling)

5

With caseating necrosis, think __ first, then ___

TB, then Histo

6

Acute pneumonia with diarrhea, confusion, and hyponatremia suggests

Legionella

6

Tx of Histo

Itraconazole for mild-moderate; Amphotericin for severe

7

3 pathologic features of P Aeruginosa Pneumonia

Hemorrhagic, Necrotizing, Infarcting

8

Viral Pneumonia tends to be

Interstitial

8

Primary virulence factor of Cryptococcus

Anti-phagocytic capsule

9

Pathogenesis of S Aureus Pneumonia

Commonly follows viral respiratory infection (influenza)

10

Usual patient with pneumocystis pneumonia

HIV w/ CD4

11

Why does pneumococcal pneumonia stop at lobar septa

Non-necrotizing

11

Micro Path of Aspergillus Pneumonia

Necrosis, Hemm, Acute inflammation with regular septate hyphae with dichotomous branching

12

3 pathologic features of S Aureus Pneumonia

Hemorrhagic, Necrotizing, Abscessing

13

Prognosis of P Jiorvecii Pneumonia

Good

14

Why is pseudomonas aerug pneumonia so much worse than pneumococcal?

Hits people hospitalized with already bad disease

14

Dx of Legionella

Can't culture --> Urine antigen and bronchoscopy

15

The term aspiration pneumonia is used only for

Aspiration of gastroesophageal contents or food misrouted from the oropharynx -- large volumes

16

Gram positive cocci in clusters on sputum gram stain

S Aureus on sputum gram stain

17

Gross Path of Crypto Pneumonia

Soft, tan-grey nodules - Not hemmorrhage or calcified

17

Presentation of P Jirovecci Pneumonia in non-HIV

Fulminant respiratory failure

17

Viral and Mycoplasma pneumonia typically correlates with __ infiltrate on radiology

Ground-glass

18

Epidemiology of P. Jirovecii Pneumonia

Immunodeficient

18

Histo elicits a __ response

Caseating Granulomatous

18

Blasto vs Crypto

Blasto is bigger

19

Epidemiology of TB

HIV, Seasonal, Minorities

19

Mucicarmine Stain is red for

Capsule of Cryptococcus

20

Alveolar non-necrotizing acute bacterial pneumonia is commonly due to

Pneumococcus

20

Micro Path of Histoplasmosis

Oval basophilic yeast forms; Necrotizing granulomatous inflammation with epithelioid histiocytes and multinucleated giant cells

21

When you see caseating necrosis, order these two tests

1. Fungal staining with Methanamine Silver; 2. Acid Fast

22

Chronic phase of coccidioidomycosis

Granulomatous multinucleated giant cell response

25

What 3 things suggest Legionella Pneumonia

Diarrhea, Confusion, Hyponatremia

26

Alveolar necrotizing acute bacterial pneumonia is caused by

S Aureus, P Aeruginosa, Klebsiella

28

S aureus pneumonia is much worse than pneumococcal, probably b/c

it is necrotizing and abscessing

29

Gross Path of Aspergillus Pneumonia

Nodules, commonly with surrounding hemm (target lesions); Infarction

30

"walking pneumonia" - one of most common cause of atypical pneumonia

Mycoplasma Pneumonia

32

Definition of infiltrate

Radiologic manifestation of pneumonia, edema, or hemorrhage

33

Legionella: necrotizing?

No

33

4/5 Blastomycosis patients come from the ___

Jail

34

Fever, Hemoptysis, and Pleuritic chest pain in neutropenic patient

Aspergillosis Pneumonia

36

Tx of S Aureus Pneumonia

Oxacillin or Vancomycin

37

Micro Path of TB Pneumonia

Necrotizing Granulomas w/ epitheliod histiocytes and multinucleated giant cells; Very few organisms

37

Grey Hepatization Phase

Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils

38

Macrophages in lungs with finely granular brown pigment

Smoker's Macrophage

39

Signs of Pneumococcal Pneumonia

Low fever, Low tachycardia, Mild tachypnea, Crackles

39

Classic TB sputum has

few bugs

40

Tx of Aspergillus Pneumonia

Voriconazole

42

Tx of Mycoplasma Pneumonia

Azithromycin or Levofloxacin

42

Large encapsulated boxcar gram negative rods on sputum gram stain

Klebsiella

44

Foamy macrophages are characteristic of

Subacute bacterial pneumonia

44

Causes of interstitial chronic pneumonia

P Jirovecii, Sarcoidosis, Toxoplasmosis

46

Gram Stain of S Aureus Pnuemonia

Gram positive cocci in clusters

47

Signs of Histo

Fever

47

Acute phase of Coccidioidomycosis

Rupturing spherule releasing endospores

49

How does Legionella evade destruction

Inhibit phagosome-lysosome fusion

50

Aspergillosis pneumonia patient on step 1

Immunocompromised awaiting transplant

51

Presentation of Pneumococcal pneumonia in young people vs adults

Sudden severe onset of chils/fever vs gradually progressive fever/sputum production

52

How does Pneumococcus bind epithelial cells

Binds to Platelet Activating Factor Receptor

53

Stain for Cryptococcus

Mucicarmine Stain --> Capsule stains red

54

Micro Path of Crypto Pneumonia

Faintly basophilic yeast; Suppurative and granulomatous inflammation

54

Disseminated lesions resembling milit seeds

TB

55

Pseudomonas Vasculitis correlates with ___ features of Pseudomonas Pneumonia

Hemorrhagic, Necrotizing, and Infarcting

56

Staining of Legionella

Stain poorly with H&E and Gram stain --> Need to do silver stain

57

__ causes nodular pneumonia in immunocompromised patients

HSV

58

TB vs S Aureus

Both necrotizing, but TB is subacute/chronic, while S Aureus is actue

59

Urine Antigen Test for Pneumococcal Pneumonia

Rapid, 70-80 sensitive; 80-100 specific

60

Presentation of Pneumococcal Pneumonia in Elderly

Confused, Tired, and Cold; No fever or cough

61

Pulmonary TB starts as ___, then becomes __ when associated with enlarged lymph node

Gohn Focus --> Gohn Complex

62

Abscesses in P Aeruginosa Pneumonia

No

63

What symptoms and signs suggest Legionella pneumonia

Gastrointestinal; Neurologic

64

__ causes interstitial pneumonia in immunocompromised

CMV

66

Gross Path of S Aureus Pneumonia

Heavy plum-colored lungs; Numerous small abscesses

67

Broad-based budding and double contour walls

Blastomycosis

68

You see the term hepatization with ___

Pneumococcal Pneumonia

70

Signs of Mycoplasma Pneumonia

Erythematous Maculopapular Skin Rash

70

Day 4-7: Less congested capillaries, Foamy macrophages replace neutrophils

Grey Hepatization Phase

71

Large encapsulated rectangular (boxcar) Gram negative bacilli

Gram Stain of Klebsiella Pneumonia

72

Prognosis of Aspergillus Pneumonia

Poor

73

Helmets or teacups on silver stain

Pneumocystis Pneumonia

75

What does Histoplasmosis mimic

TB

76

Symptoms of Klebsiella

Cough productive of gelatinous blood sputum

77

Symptoms of Aspergillus Pneumonia

Fever, Pleuritic Chest Pain, Hemoptysis: In neutropenic patients

79

Gross path of P Aerug pneumonia

Firm red areas of hemorrhagic consolidation; Maybe yellow areas of consolidation with rim of hemm (target lesions); Infarction

80

Risk factors for P Aerug pneumonia

Intubation, Neutropenia

82

Micro Path of P Aerug pneumonia

Necrotizing; Long thin bacilli invading vessels from adventitia

83

Prognosis of S Aureus Pneumonia

Up to 50 % mortality, even if treated

83

Early infiltration by macrophages instead of neutrophils

Characteristic infiltration pattern of Legionella Pneumonia

85

Symptoms of Mycoplasma Pneumonia

Malaise, headache, Intractable Dry Cough

87

Galactomannan

Major constituent of Aspergillus cell walls

87

__ is the prototype Subacute/Chronic interstitial pneumonia in an immunocompromised patient

P Jirovecii

88

Necrotizing; Long thin bacilli invading vessels from adventitia

Micro Path of P Aerug pneumonia

89

Prognosis of Mycoplasma Pneumonia

Vast majority recover without sequelae

91

Micro path of P Jirovecci Pneumonia

Foamy eosinophilic; Centro-alveolar "honeycomb" exudate

93

Microscopic path of S Aureus Pneuminia

Acute necrotizing w/ abundant neutrophils, fibrin, and edema; Hemorrhage and abscesses

94

Pneumococcal Pneumonia on sputum gram stain

Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain

96

Lobar pneumonia is classically due to

Strep Pneumoniae

98

Chronic pneumonia tends to be anything but

bacterial

98

Micro path of Cryptococcus

Translucent/Lightly basophilic budding yeast surrounded by clear space (large anti-phagocytic capsule)

99

What color is mucus

Gray

99

__ invasion is classic in Aspergillosis, which is why patients have

Blood vessel invasion --> Infarcts

101

Symptoms of Histoplasmosis

75% none; Substernal chest pain

102

Abudant Fibring correlates with

Pneumococcus

104

Time frame of red hepatization phase

Day 2-3

105

Like ___, aspergillosis is very vaso-invasive

Pseudomonas

106

Symptoms of Crypto Pneumonia

Fever

108

Epidemiology of Cryptococcal Pneumonia

Immunodeficient

110

Acute interstitial pneumonia is commonly due to

Viruses (influenza)

110

All bacteria are __ in H&E

Blue

112

Red Hepatization Phase

Day 2-3: Congested capillaries, Alveolar filling with neutrophils and fibrin

113

Encapsulated lancet-shaped gram-positive diplococci on sputum gram stain

Pneumococcal Pneumonia on sputum gram stain

114

Dx of P Jirovecii Pneumonia

Elevated LDH; Decreased DLCO; Grocott stain

115

Signs for Legionella Pneumonia

Fever; Neurologic

116

Tx of Crypto Pneumonia

Fluconazole

117

Viral and Mycoplasma species typically produce a ___ pneumonia

Non-necrotizing, lymphocytic, interstitial

118

Prognosis of P Aerug Pneumonia

Up to 87% mortality, even if treated

119

Tx of P Jirovecci Pneumonia

Trimethoprim-Sulfamethoxazole

120

CXR of S Aureus Pneumonia

Bronchopneumonic infiltrates

121

Positive sputum smear in TB indicates

infectivity

122

Gross path of Klebsiella Pneumonia

Patchy or lobar consolidation; Necrotizing, Abscessing

123

Microscopy of Milit Seeds

Necrotic w/out granuloma formation --> Kill patient quickly

124

Gross path of Legionella pneumonia

Bulging firm rubbery areas of consolidation

126

Fungal and mycobacterial pneumonias tend to be

chronic and nodular

127

Epidemiology of Aspergillus Pneumonia

Neutropenia, Immunocompromised

128

Almost all acute bacterial pneumonias are due to

aspiration of saliva containing the pathogen

129

Most common causes of viral pneumonia

Influenza and Respiratory Syncitial Virus

130

Prognosis of TB

Usually Good

132

Pneumonia with hilar adenopathy should always suggest

TB

133

Micro path of Legionella pneumonia

Acute, non-necrotizing; Early macrophage infiltrate (unusual in acute pneumonia)

134

S Aureus on sputum gram stain

Gram positive cocci in clusters

135

Gross Path of Tuberculosis Pneumonia

Caseating Granulomas; Ghon focus or complex

137

Definiation of Consolidation

Alveoli filled with blood, pus, or water

138

Aspergillus invasion occurs with

Neutropenia, Immunosuppression, Corticosteroids

139

Gram Stain of Klebsiella Pneumonia

Large encapsulated rectangular (boxcar) Gram negative bacilli

140

Microscopic path of Klebsiella Pneumonia

Acute neutrophilic -> Subacute macrophage

141

Stain for histo

Methenamine Silver Stain

142

P Jirovecii is the prototype

Subacute/Chronic interstitial pneumonia in an immunocompromised patient

144

Characteristic infiltration pattern of Legionella Pneumonia

Early infiltration by macrophages instead of neutrophils

145

Protein A

S aureus: binds to TNFR1 and opens path for invasion b/t epithelial cells

146

Rupturing spherule releasing endospores

Coccidioidomycosis

147

Gross Path of Histoplasmosis

Tan nodules or areas of consoldiation that develop caseous necrosis

148

Classification of Strep Pneumoniae

Aerotolerant an-aerobic Gram Positive Diplococcus