9. Respiratory Tract Patholog Flashcards by Jennifer Cromwell

most common cause of Rhinitis?

rhinovirus

aka common cold

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presentation of rhinitis?

sneezing, congestion, runny nose

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what is allergic rhinitis?

what is the body’s reaction?

subtype of rhinitis

due to Type I hypersens reaction (usually to pollen)

->inflammatory infiltrate, eosinophils (IgE mediated)

associated with asthma and eczema

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what is a nasal polyp?

what can cause it?

=protrusion of edematous, inflamed nasal mucosa

caused by repeated bouts of rhinitis

also caused by Cystic Fibrosis, Aspirin-intolerant Asthma

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Aspirin-intolerant asthma: triad?

asthma
aspirin induced bronchospasms
nasal polyps

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what is an angiofibroma?

who classicly has this?

benign tumor of nasal mucosa

composed of large blood vessels & fibrous tissue

seen most freq in adolescent males

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angiofibroma

classic patient? presentation?

(benign tumor of nasal mucosa)

adolescent males

profuse epistaxis

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nasophyaryngeal carcinoma: define

malignant tumor of nasopharyngeal epithelium

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nasopharyngeal carcinoma: associated with what?

classically seen in what patients?

EBV

seen in African children and Chinese young adults

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nasopharyngeal carcinoma: how to dx?

how might it present?

dx via biopsy. will have pleomorphic keratin-positive epithelial cells in background of lymphocytes (poorly differentiated squamous cell carcinoma)

(remember keratin is intermediate filament of epithelial cells)

often presents with involvement of cervical LNs.

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define acute epiglottitis

most common cause?

inflammation of the epiglottis

most common cause = H inf (esp with nonimmunized kids)

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acute epiglottitis: presentation?

high fever

sore throat

drooling/dysphagia (blocked airway)

muffled voice

inspiratory stridor

EMERGENCY due to risk to airway

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Laryngotracheobronchitis (Croup)

define? most common cause?

inflammation of upper airway

commonly caused by parainfluenza

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Laryngotracheobronchitis (Croup)

presentation?

hoarse “barking” cough

inspiratory stridor

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vocal cord nodule (aka singer’s nodule)

define. cause?

nodule on true vocal cord. bilateral.

due to excessive use of vocal cords

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vocal cord nodule (aka singer’s nodule)

composed of what tissue?

degenerative/myxoid connective tissue

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vocal cord nodule (aka singer’s nodule)

presentation? resolution?

hoarseness

resolves with resting of voice

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laryngeal papilloma

definition? cause?

benign papillary tumor of vocal cord

due to HPV 6 and 11

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laryngeal papilloma

presentation?

hoarseness

SINGLE in adults

MULTIPLE in children

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laryngeal carcinoma

define? cause?

squamous cell carcinoma (usually from epithelial lining of vocal cord)

risk factors: alcohol, tobacco.

May arise from laryngeal papilloma (HPV 6/11)

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laryngeal carcinoma

presentation?

hoarseness

possibly cough, stridor

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pneumonia

definition?

three patterns?

infection of lung parenchyma

Lobar

Broncho-

Interstitial

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pneumonia: clinical features?

fever/chills

productive cough (yellow-green or rusty sputum)

tachypnea

pleuritic chest pain

decr breath sounds

dullness to percussion

elevated WBC count

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pleuritic chest pain: what is it?

due to what mediators?

pain of the pleura, which are innervated

mediators: Bradykinin, Prostaglandin E2

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pneumonia: dx?

chest xray sputum gram stain blood cultures

type of pneumonia? most common causes? (2)

lobar typically bacterial: Strep pneumo (95%) Klebsiella (5% - usually 2' aspiration)

4 phases of lobar pneumonia (seen grossly)?

- Congestion. due to congested vessels, edema - Red hepatization. due to exudate, neutrophils, hemorrhage. lung goes from spongy to more solid. - Grey hepatization. due to degradation of RBCs in exudate - Resolution. tissue regenerates

Resolution of lobar pneumonia due to what type of cells?

Type II pneumocytes (stem cells of the lung) regenerate damaged tissue

what type of pneumonia? common causes? (5)

broncho-pneumonia due to variety of bacterial orgs: Staph aureus, H inf, Pseudomonas, Moraxella catarrhalis, Legionella

what type of pneumonia? causes? (6)

interstitial pneumonia caused by bacteria or viruses: Mycoplasma pneumoniae, Chlamydia pneumoniae, RSV, CMV, Influenza virus, Coxiella burnetii

Interstitial/Atypical pneumonia: presentation?

relatively mild upper resp symptoms minimal sputum, low fever "atypical" presentation

aspiration pneumo: seen in what patients? usually due to what cause? (3)

pts at risk for aspiration (alcoholics, comatose) usually due to anaerobic bacterial in oropharynx (Bacteriodes, Fusobacterium, Peptococcus)

aspiration pneumo: usually occurs in what part of lung?

right lower lobe due to anatomy: right main stem bronchus branches at a less acute angle than left.

secondary pneumonia: define

bacterial pneumonia that occurs after a viral upper resp tract infection virus has already knocked out the mucociliary escalator; easier for bacteria to infect

Organism that is the most common cause of comm-acquired pneumonia and Secondary pneumo? causes what type of pneumonia?

Strep pneumo. Lobar.

Enteric flora that is aspirated and causes Lobar pneumonia? who does it particularly affect?

Klebsiella. esp effects elderly in nursing homes, alcoholics, diabetics.

Klebsiella pneumonia: appearance of sputum? common complication?

sputum = gelatinous due to thick mucoid capsule. "red currant jelly" may be complicated by abscess.

second most common cause of Secondary pneumonia, causes bronchopneumonia?

Staph aureus.

stapy aureus pneumonia may be complicated by what?

abscess or empyema (pus in pleural space)

Pneumonia seen in cystic fibrosis patients? what type of pneumonia?

Pseudomonas aeruginosa. Broncho.

2 causes of secondary pneumonia, commonly superimposed on COPD? causes broncho-

- H inf - Moraxella catarrhalis

Community acquired pneumonia that is from an intracellular organism?

Legionella. causes broncho. transmitted from water source. may be pneumonia superimposed on COPD or in immunocompromosed patient.

what kind of pneumonia?

interstitial/atypical

what kind of pneumonia?

bronchopneumonia lumen of alveoli are filled with inflammatory infiltrate

most common cause of atypical pneumonia? seen in what patients?

Mycoplasma pneumonia seen in young adults: military recruits, college students in dorm.

Mycoplasma pneumonia: complications?

-autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) -erythema multiforme

Mycoplasma pneumonia: seen on gram stain?

NO due to lack of cell wall

second most common cause of atypical pneumonia in young adults?

Chlamydia pneumo

RSV: what type of pneumonia does it cause? typically in what patients?

atypical/interstitial infants.

CMV: what type of pneumonia? what patients?

atypical/interstitial immunocompromised due to posttransplant immunosuppressive therapy

Causes atypical pneumonia that occurs in elderly, immunocompromised, pts with pre-existing lung disease?

Influenza virus. Also increases risk for superimposed S aureus or H inf bacterial pneumonia. Major reason for the flu shot!

Coxiella burnetii what type of pneumonia? seen in what patients?

Atypical/interstitial but HIGH FEVER "Q fever" patients are farmers/vets who have come in contact with spores via ticks or placental tissue.

Coxiella burnetii what type of organism? how is it distinct from others in this category? (3)

Rickettsial organism distinct due to (1) causes pneumonia (2) does not require arthropod vector because it is a heat-resistant endospore (3) does not cause a skin rash

Tuberculosis: cause?

inhalation of aerosolized Mycobacterium tuberculosis

Primary TB: presentation?

focal, caseating necrosis in lower lung fields and hilar lymph nodes. -\> fibrosis, calcification -\> Ghon complex

Secondary TB: cause? clinical presentation?

re-activation of Mycobacterium tuberculosis (Ghon complex) Presents with fevers, night sweats, cough with hemoptysis, weight loss

Secondary TB: where in lung? what structures form in lung?

Apex of lung due to poor lymph drainage and high oxygen tension structures: cavitary foci of caseous necrosis.

Secondary TB: diagnosis?

Biopsy caseating granulomas distinguish from fungal infection via AFB stain (acid-fast bacilli are TB)

Secondary TB: common sites of systemic spread?

- kidneys (most common, -\> sterile pyuria) - meninges (meningitis at base of brain) - cervical LNs - lumbar vertebrae (Pott disease)

9. Respiratory Tract Patholog Flashcards

(60 cards)