Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pulmonology > Nichols Doc > Flashcards

Nichols Doc Flashcards

1
Q

Infiltrate

A

The term for a radiologic manifestation of pneumonia or edema or hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Consolidation refers to

A

manifestations of alveoli filled with with water, blood, pus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most types of pneumonia start how?

A

acute inflammation due to neutrophil prescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most types of pneumonia go on to the subacute phase around the 3 day mark when…

A

macrophages replace neutrophils….Think of Macrophages as the garbage clean-up of the cell.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Alveolar non-necrotizing pneumonia is most commonly due to what>

A

Strep Pneumo, Legionella, or Mycoplasma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alveolar necrotizing pneumonia is often due to>

A

Staph aureus, Klebsiella, Pseudomonas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Strep Pneumo stains what and look like what

A

Gram positive (purple) Lancet shaped diplococci

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pneumolysin is a virulence factor for which bug and what does it do>

A

Strep Pneumo, It binds to cholesterol in cell membranes and forms pores at that area. The cells it binds to are erythrocytes and leukocytes.
ALSO…It is the reason that sputum in Strep Pneumo is rusty, the pneumolysin lyses red blood cells and the iron is absorbed into the sputum and coughed up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Four phases of Pneumococcal Lobar Pneumonia: Gross Path

A

Congestion: Serous, frothy, blood tinged fluid in alveoli
Red Hepatization: Days two and 3
Grey Hepatization: Day 4-7
Resolution- Day 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Microscopic Pathology of Pneumococcal Pneumonia

A

Phase 1- Engorged Septal capillaries, edema fluid, bacteria,
Phase 2- Continuing Congestion, extravasation of red cells, infection spreading through pores of kohn
Phase 3- degenerating dead cells, fibrin nets through pores of kohn, foamy macros

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Symptoms of strep pneumo in younger ppl

A

single severe shaking chill (rigor), fever, cough with RUSTY SPUTUM, pleuritic chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of pneumococcal strep pneumo in older ppl

A

confused, tired, cold, may not have cough or fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Signs of strep pneumo

A

Fever, Tachypnea, pulmonary Rales, dullness to percussion, chest x-ray shows lobar consolidation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In what % of strep pneumo cases is a blood culture positive

A

Less than 25%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Urine test for strep pneumo

A

Pretty good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment for strep pneumo

A

Any beta lactam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Microbiology of Legionella

A

gram neg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Pathogenesis of LEgionella

A

Live in warm water. Can hide inside amoeba. Once they are inhaled or aspirated they attach to respiratory epithelium by pili or flagella. After they are phagocytosed they prevent phagosome lysosome fusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Gross pathology of Legionella

A

Bulging Firm rubbery area of consolidation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is unique about the microscopic pathology of Legionella

A

Tons of macrophages early on.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SYmptoms of Legionella

A

Chills, rigor, high fever, dyspnea, headache, DIARRHEA, myalgia, chest pain. GI symptoms suggest Legionella

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Neurologic signs that suggest Legionella

A

confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Blood test results that suggest Legionella

A

hyponatremia (sodium less than 130)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Best way to test for legionella

A

Urine test….they wont grow on gram stain, you can sometimes see them on Dieterle stain but its hard to differentiate them from debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Treatment of Legionella
Newer macrolides (azithromycin) or quinilones (levlofloxacin)
26
When is Mycoplasma most common
Fall and winter
27
If a bunch of high school kids or college kids get a walking pneumonia, it is most likely
Mycoplasma
28
What do Mycoplasma Pneumoniae look like on Gram stain
Invisible
29
Microscopic pathology to note for mycoplasma
Alveolar type 2 hyperplasia
30
Symptoms of mycoplasma to note
headache, anorexia, malaise, dry cough!!!
31
Signs to note for mycoplasma
maculopapular skin rash
32
Treatment
Azithromycin or levofloxacin
33
Staph Aureus risk factors
staph skin infection, nursig home residence, recent hospitalization, endotracheal intubation
34
Virulence factors for staph aureus
exotoxins, protein A which binds to TNF receptor and opens up a path for invasion, drug resistance
35
Gross path for staph aureus
PLUM COLORED LUNGS, BLOODY FLUID COMES OUT ON SECTIONING< MANY SMALL ABCESSES, some pleuritis and effuision
36
Symptoms of staph
cough comes on late, dyspne, fever, chills
37
Diagnosis
Gram stain, look for leukocytosis on CBC
38
Treat staph with
oxacillin for meth sensitive or vancomycin for mrsa
39
Pseudomonas mostly always affects patients who are where?
Hospital
40
Pathogenesis of Pseudomonas
once ingested it attaches to resp epithelium. Resistant to many common ABs
41
Virulence of Pseudomonas
Resistant to many abs, forms a biofilm,
42
Gross pathology of pseudomonas to note
firm red areas of hemorrhagic consolidation +/- yellow areas of consolidation with hemorrhage
43
Microscopic path to note for pseudomonas
acute necrotizing alveolitis, with long thin bacili invading blood vessels.
44
Symptoms for pseudomonas
Productive cough, confusion, dyspnea, fever chills,
45
Helpful hints for Dx of pseudomonas
Look for long thin gram negative bacilli with pointed ends. Culture should have a sweet grape like odor
46
Treat pseudomonas with
a beta lactam that works and a quinilone
47
Major risk factor for TB
HIV
48
other TB risk factors
Man, poor, black, Spring time, Elderly
49
What are the four possible outcomes after inhalation
1) Clearance 2) Primary Infection 3) Latent infection 4) Reactivated infection
50
Gross Pathology
Caseating granuloma, Gray-white, central necrosis
51
What is a ghon foci
1.5 cm gray white caseating granuloma with central necrosis
52
What is a ghon complex
A ghon foci with hilar lymph node involvement
53
Microscopic pathology of TB
Multinucleated giant cells with a lymphocyte collar, few dark red beaded bacili on acid fast stain. Sometimes neutrophilic necrotizing pneumonia
54
Symptoms to note for TB
night sweats, anorexia, wt. loss, fever, VERY FEW RESPIRAOTRY Symptoms. May have mild cough with hemoptysis
55
Diagnosis of TB
chest x ray showing consolidation of upper lobes. Chest x-ray and acid fast culture should get you where you need to go.
56
What is one giveaway for TB
Pneumonia associated with hilar lymphadenopathy
57
Treat for TB
RIPE for 8 weeks, RI for 18
58
TB wanna-be
Histoplasmosis
59
Most Histoplasmosis infections are mild, but some can be severe under what circumstances
AIDS, immunosuppresion therapy for transplants
60
Pathogenesis of histo
Inhalation, bat crap and chicken crap. Much like TB, the spores get into the alveoli, are phagocytosed but not killed nless they are activated by T cells which have had antigen presented to them. Granulomas form.
61
Symptoms of histoplasmosis
Fever, chills cough, anorexia, SUBSTERNAL CHEST PAIN THAT IS WORSE ON INHALATION
62
Diagnosis of histo
biopsy, culture, antigen test. Biopsy can yield definite diagnosis, culture takes up to 6 weeks
63
Treatment of histo
itraconazole for mild-moderate, amphotericin for severe
64
Aspergillus pneumonia
remember 45 degree branching septate hyphae
65
Classic triad of aspergillous symptoms
fever, pleuritic chest pain, hemoptysis
66
Diagnosis of aspergillous
Biopsy, culture, serum test for galactomannan
67
Be sure to differentiate aspergilous pneumonia from aspergillous colonization and allergic bronchopulmonary aspergillosis
ok
68
Cryptococcal pneumonia comes from
Cryptococcus fungi
69
Is cryptococal pneumonia common?
No way....seen rarely in AIDS pts, or other immunosuppresed pts. Never in children. More common in blacks
70
DX of cryptococcus
Culture is fast and easy on standard media. takes less than 48 hours. Serum antigen test is pretty easy in folks with immunodeficiency
71
What percentage of lung cancers develop in active or recently active smokers
85%
72
The three major types of lung cancer
small cell 15%, squamous cell 20%, adenocarcinoma 40%
73
adenocarcinoma
malignant epithelial tumor with glandular features
74
Most common mutation in adenocarcinoma
KRAS
75
5 Patterns of adenocarcinoma
Acinar (making glands), papillary, micropapillary (bad prognosis), solid (also bad), lepidic (spreading within alveoli better prognosis).
76
Treatment of adenocarcioma
surgery ir early stage, erlotinib (for EGFR mutation)
77
Adenocarcinoma is the most likely cancer to be responsive to targeted therapy
truth
78
bronchioalveolar carcinoma is now called
adenocarcinoma in Situ
79
Adenocarcinoma in situ is cahracterized by what?
non-destructive growth along intact alveoloar septa
80
Two types of adenocarcinoma in situ
mucinous and non-mucinous
81
Non-mucinous found predominantly in who and characterized by what
smokers, ground glass, EGFR mutation, evolves from terminal respiratory unit (type II pneumocytes and Clara Cells)
82
Mucinous
Evolves from broonchiolar epithelium, commonly presesnts as pneumonia type infiltrate on x-ray, KRAS mutation
83
Symptoms of adenocarcinoma in situ
Most have none. If they do have symptoms though, they often mimic pneumonia with productive cough
84
How is adenocarcinoma in situ diagnosed?
Discovered on radiology (nodules frequently have ground glass appearance) but a biopsy or cytology needed for actual diagnosis.
85
Treatment of Adeno in situ
surgical resection, if inoperable: Erlotinib for EGFR positive tumors, Paclitaxel for EGFR negative
86
What paraneoplastic syndrome might squamous cell carcinoma cause
Hypercalcemia due to production of a parathyroid hormone like substance
87
Where does sqquamous cell carcinoma arise>
2/3 aris from main, lobar, segmental, or subsegmental bronchi....centrally
88
What type of lung cancer is most likely to cavitate
squamous
89
Squamous is also associated with these other complications
post-obstructive pneumonia, mucous lugging, abcess, bronchiectasis.
90
Symptoms of squamous cell carcinoma
cough with hemoptysis, dyspnea, weight loss, anorexia
91
Major mode of diagnosis for squamous cell
H&E stain of biopsy,
92
Most common gene mutation in squamous cell
k63,, nearly 100%
93
What is the most aggressive lung cancer type
Small cell carcinoma
94
Where is small cell carcinoma typically located
Central, parabronchial, multifocal necrosis and metastatic tumor in lymph nodes and liver, bones, brain, adrenal
95
Signs of small cell carcinoma
facial, cervical, arm edema. Venous engorgement, Pemberton's sign= development of facial flushing
96
Diagnosis
H&E stain biopsy
97
Primary sites of lung metastases
breast, colon, stomach
98
Gross path of metastatic lung cancer
small, numerous (generally smaller than primary neoplasms), rounder, more evenly contoured, generally peripheral and not endobronchial
99
Larger cannonball metastases most commonly from
breast
100
What is lymphangitic carcinomatosis
When metastatic disease fills lymphatics and infiltrates interstitium without creating masses
101
Diagnosis
radiology detects them but biopsy is required because fungal, mycobacterial and autoimmune diseases have similar appearances
102
What are some risk factors for pulmonary embolism that you are likely to forget
oral contrceptives, ptregnancy
103
Do small emboli usually cause infarction>
generally not because of dual blood supply
104
What about intermediate emboli
Can cause infarction if bronchial circulation is poor
105
Large emboli
Can cause saddle embolus where the block the pulmonary trunk. may cause cor pulmonale and immediate death
106
Pneumocystis jirovecii is what type of microorganism
fungus
107
Pneumocystis jirovecci most commonly infects what type of pts
AIDS...its an opportunistic bacteria. The prototype pneumonia in immunocompromised pts
108
Characteristics of pneumocystis infection?
Heavy consolidation
109
Symptoms of pneumocystis
insidious onset of progressive dyspnea, cough, fever
110
Signs of pneumocystis
Elevated LDH. decreased diffusion capacity
111
DX of pneumocystis
detection of bug in sputum stains, immunostains (regular method)cyst stains such as methenamine silver
112
Treatment of Pneumocystis
Trimethorphim
113
Prognosis
93% survival in AIDS pts
114
Most common presentation of pulmonary embolism
Dyspnea
115
Fat embolism is what?
globules of fat travelling in the vascular circulation
116
Fat embolism syndrome features
hypoxemia, neurological impairment and petechial rash (1-3 days after trauma)
117
fat embolism most commonly follows
single long bone fractures and bilateral femoral fractures
118
Symptoms of fat embolism
dyspnea, confusion
119
DX:
Be sure there is arterial hypoxemia, cerebral dysfunction, skin rash.
120
Air embolism
gas present in circulation
121
How does it happen
most common is the disconnection or breakage of vascular catheterization, keeping the pt upright when inserting catheter, deep inspiration during inertion or removal, surgery with an opening higher than the heart, traumatic blod vessel rupture,
122
Symptoms of air embolism
dyspnea, sense of impending doom, lightheadedness or dizzines
123
signs of air embolism
gasp or cough when air enters pulmonary circulation, mill wheel heart murmur, tachypnea, tachycardia,
124
Acute lung injury
non-cardiogenic pulmonary damage manifested by edema with an inflammatory or fibrosing response
125
Characteristics of acute lung injury
starts as interstitial edema which moves into alveolus. It is due to dysregulated inflammation. Increased permeability of microvascular barriers leads to extravascular accumulation of protein rich fluid.
126
Histologic hallmark of the exudative phase of acute lung injury
alveolar hyaline membranes
127
Histologic hallmark of proliferative phase
chronic interstitial inflammation
128
PaO2/FiO2 over 200
needs to be presesnt
129
What is radiation pneumonitis
acute lung injury occuring 1-2 mths after radiation
130
micropathology of radiation pneumonitis
atypical type 2 pneumocyte hyperplasia and blood vessel injury
131
Viral pneumonia tends to be interstitial
true
132
Influenza and RSV are the most common viral pneumonias
true
133
Cytomegalovirus causes interstitial pneumonia in immunocompromised pts.
true
134
Foamy Macrophages are characteristic of which time frame of bacterial pneumonia
subacture (day 3 and after)
135
Pneumococcal Pneumonia typically causes an alveolar exudate that is rich in what?
FIbrin
136
For Legionella think ADAM....
He is in a warm pool, in an amoeba brand swimsuit, firm, bulging, rubbery mass, confused, shitting himself, with low sodium (salt rings around lips) AT THE SPORTSPLEX
137
Staph Chest x-ray findings
Alveolar consolidation in a bronchopneumonic pattern, rapidly progressive- bilateral- multilobar abscesses and pleural effusions

Pulmonology (41 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions