Lecture 9: Pathology of Pulmonary Infection Flashcards Preview

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Flashcards in Lecture 9: Pathology of Pulmonary Infection Deck (39):
1

Five ways the defense mechanisms of the lung could be damaged (predisposing infection)

Decreased cough, injury to mucociliary apparatus, interference with macrophages, pulmonary congestion, secretion accumulation

2

Two patterns of bacterial pneumonia

Bronchopneumonia (patchy, neutrophils, surrounds airways) vs Lobar (less common)

3

T/F: Any organism that can cause broncho can cause lobar pneumonia

True

4

Two most common bacterial causes of pneumona

Step pneumoniae, staph aureus

5

Pseudomonas is associated with what disease? Where do we see this infection histologically?

Cystic fibrosis; tend to center around blood vessels

6

Primary characteristic of bacterial pneumonia

Neutrophils in alveolar spaces

7

Who is at risk for community-acquired acute pneumonia?

Extremes of age, chronic disease, immune def, splenic problems

8

Community acquired bacterial pneumonia pathogens (5)

Strep pneumoniae, staph aureus, haemophilus influenzae, klebsiella, legionalla

9

Four risk factors for acquiring a nosocomial pneumonia

Severe disease, immunosuppression, prolonged antibiotic therapy, invasive devices (catheter/ventilator)

10

Nosocomial bacterial pneumonia pathogens (4)

Pseudomonas, staph aureus (MRSA), e coli, enterobacter

11

Outcomes of pneumonia (6)

Resolution, pleural effusion, empyema (pus in pleural space), fibrosis, abscess, bacteremia

12

Where is aspiration induced abscesses more common?

Right lung

13

Symptoms of lung abscess (5)

Cough, fever, foul-smelling sputum, chest pain, weight loss

14

Treatment of abscess

Antibiotics, but may require surgery

15

Gross features of lung abscess

Thick fibrotic wall surrounding lung pus

16

Microscopic features of lung abscess

Sea of neutrophils

17

What does atypical pneumonia mean?

Inflammation is alveolar septa and pulmonary interstitium (NOT in alveolar space)

18

What are the most common two causes of atypical pneumonia? Where in the community do we find atypical pneumonias?

Mycoplasm or viruses; schools/military camps

19

What is the atypical infiltrate?

Mononuclear inflammatory cells (lymphocytes)

20

Common pulmonary viruses (4)

Cytomegalovirus, herpes, adenovirus, influenza

21

CMV looks like...

Typically involves type 2 pneumocytes; intranuclear inclusions and cytoplasmic inclusions within megalocells

22

Herpes looks like...

Multinucleated together with intranuclear inclusions

23

Adenovirus looks like...

Slightly enlarged cells with a basophilic, large intranuclear inclusion

24

Primary TB infection is characterized by

Necrotizing granulomas

25

Define Gohn complex

Pulmonary granuloma + hilar lymph nodes

26

Secondary TB (often) involves...

Lung apex

27

Miliary TB involves...

Disseminated disease: granulomas all over the place (can be primary or secondary)

28

Histological appearance of necrotizing granulomas

Giant cells/lymphocytes surround necrotizing center, neutrophils outside of this

29

Mycobacteria (stain)

Acid-fast organisms --> stain red

30

Mycobacterium avium occurs in which two situations

1. HIV/Immunocompromised with granulomas or mycobacterial pseudotumor; 2. Right middle lobe syndrome in small, old ladies, bronchiectasis of right middle lobe secondary to poor clearance of secretions

31

Describe histoplasma identification. What does histo look like grossly?

Small, unequal budding (bowling pins), silver stain; necrotizing granuloma similar to TB

32

Coccidiodomycosis identification

Large organisms with thick walled spherules, silver/PAS/H&E staining

33

Blastomycosis identification. Special clinical presentation? Special histological presentation?

Single based broad bud; presents w/ skin disease; large granulomas with necrosis that contains neutrophils

34

Aspergillus identification

Hyphae, narrow angle branching, septate; large organism

35

Invasive aspergillus looks like what?

Bulls-eye parttern (target lesion)

36

T/F: Cryptococcus can occur in healthy people

True

37

What other presentation do we worry about with crypto?

Meningitis

38

Cryptococcus identification

Halo due to mucoid capsule: stain w/ mucoid stains (can also use silver stain), narrow-base buddings

39

Pneumocystis identification (hint: what does it do to the alveolar spaces?)

Fills alvealor spaces with pink, foamy material and must use silver stain; dense rim w/ dot in middle and DO NOT BUD