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Pulmonary - Pathology > Nichols Dumb Ass Document > Flashcards

Nichols Dumb Ass Document Flashcards

(105 cards)

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1
Q

What are almost all bacterial pneumonia due to?

A

aspiration of saliva containing the pathogen

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2
Q

What is an infiltrate?

A

radiologic manifestations of pneumonia or edema or hemoorhage

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3
Q

What is consolidation?

A

manifestations of alveoli filled with blood, pus, or water on PE or radiology

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4
Q

common causes of alveolar non-necrotizing acute bacterial pneumonia

A

Strep pneumonia
Legionella
Mycoplasma
etc

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5
Q

causes of alveolar necrotizing acute bacterial pneumonia

A

Staph Aureus
Pseudomonas aeruginosa
Klebsiella
etc

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6
Q

common cause of acute interstitial pneumonia

A

viruses

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7
Q

epidemiology of pneumococcal pneumonia

A

older adults, men

Risk factors: smoking, COPD, CHF, ICP, decreased or absent splenic function

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8
Q

How does one get infected w/ pneumococcal?

A

aerosol inhalation. bacteria attaches to respiratory epithelial cells and bind to PC and use PLANCH to infect and cause disease

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9
Q

What are the 4 phases for pneumococcal for gross pathology?

A
  1. congestion - day 1 - exudation of serous and frothy, blood tinged fluid into alveoli
  2. red hepatiziation - day 2-3: drier, granular, dark red consolidation resembling liver
  3. grey hepatiziation - day 4-7: continuing consolidation
  4. resolution w/out scarring
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10
Q

What are the 4 phases of microscopic pathology for pneumococcal?

A
  1. engorged septal capillaries, few RBCs, edema fluid, bacteria in alevoli
  2. continuing congestion, many PMNs and abundant fibrin in alveoli
  3. degenerating dead cells in alveoli, fibrin nets through pores of Kohn, foamy macrophages replace PMNs
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11
Q

Symptoms for pneumococcal pneumonia?

A

sudden single sever shaking rigor, sustained high fever, blood tinged sputum (rusty), pleuritic chest pain

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12
Q

What are signs of pneumococcal pneumonia?

A

low fever, low tachycardia, pulmonary crackles, bronchial/tubular breath sounds, dullness to percussion

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13
Q

What are two common complications for Staph Aureus pneumonia?

A

lung abscess and empyema

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14
Q

Who generally gets Staph Aureus pneumonia?

A

IV drug users, CF, and hospital acquired

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15
Q

What are the virulence factors Staph Aureus?

A

exotoxins and protein A

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16
Q

Gross path for staph aureus?

A

plum colored lungs, numerous small abcesses, pleuritis and empyema

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17
Q

Dx for staph aureus?

A

CXR- bronchopneumonic,

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18
Q

Rx for staph aureus?

A

oxacillin for methicillin sensitive, vancomycin for methicillin resistant

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19
Q

Risk factors for legionella?

A

smoking, COPD, transplant, not neutropenia, HIV

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20
Q

Pathogenesis for legionella?

A

water - once inhaled/aspirated attaches to cells and evades destruction by inhibiting phagosome-lyosome fusion

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21
Q

Gross path for legionella?

A

bulging firm rubbery areas of consolidation

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22
Q

Micro patho for legionella

A

early infiltration by macrophages

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23
Q

Symptoms for legionella?

A

dry cough, high fever, plus FLS, GI symptoms especially diarrhea

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24
Q

Dx for legionella?

A

Cxr - alveolar infiltrate w/ pleural effusion. Hyponatremia, urine Ag test, BCYE, blood tests have a lot of emias

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25
Rx for legionella?
macrolides or quinolones
26
Keys things for legionella?
diarrhea, confusion or hyponatremia
27
Pseudomonas
hospital acquired so most pts die. Risk factors = intubation and neutropenia
28
Pathogenesis of psuedomonas?
water, resistant to many Abx, forms biofilm, elastase
29
Gross path for pseudomonas?
firm red areas of hemorrhagic consolidation w/ rim of hemorrhage = target lesion
30
Microscopic path for pseudomonas?
acute necrotilizing alveolitis, long filamentous bacilli invading blood vessels
31
Symptoms for pseudomonas
think green purulent sputum
32
Pseudomonas Dx?
CXR - diffusely distributed bilateral bronchopneumonic. Stain shows long thin pointed end gram negative bacilli. Culture - sweet grape like odor, green pigment resembling bronze.
33
Pseudomonas rx?
antipseudomonal beta lactam and quinolone
34
Mycoplasmal pneumonia epidemiology
LRT infxn, fall and winter, kids and military recruits
35
Pathogenesis for mycoplasma?
small free living, filamentous bacilli lacking cell wall, invisible on gram stain. Transmitted via droplets
36
Micro path Mycoplasma
lymphoplasmacytic bronchiolitis then interstitial pneumonitis associated w/ type 2 hyperplasia
37
Mycoplasma Dx
Cxr - consolidation affects lower lobes more | Blood test- cold agglutins, WBC normal
38
TB epidemiology
HIV infxn, seasonal (spring and fall), old men
39
gross path for TB
caseating granuloma w/ central necrosis w/ hilar lymph nodal involvement
40
Micro path for TB
necrotizing granuloma w/ epithelioid histiocytes, Langhan cells, lymphocyte collar, dark red beaded bacilli on AFB stain
41
TB dx/
- patchy or nodular infiltrate in apex or superior segment of lower lobe - pneumonia associated w/ hilar adenopathy should always suggest primary TB
42
Pathogenesis for Histo
inhalation of airborne spores, infxn becomes latent in old granulomas in the lungs or lymph nodes
43
Gross path for Histo
tan areas of consolidation that develop caseous necrosis, may cavitate and eventually become white, fibrotic, and calcified
44
Mirco path for histo
small oval basophilic yeast w/ narrow-based budding
45
Histo symptoms
if you see runny nose and or sore throat then don't pick histo
46
Aspergillum micro path
fruiting body producing conidia
47
Aspergillum symptoms
Classic triad = fever, pleuritic chest pain and hemoptysis
48
Aspergillum Dx
CXR is insensitive, CT shows nodules. Galactomannan
49
Crytococcus epidemiology
opportunisitc, very uncommon in kids
50
Pathogenesis of Crypto
inhale airborne spores, pigeon feces, infxn becomes latent in old granulomas in lungs or lymph nodes
51
Gross path Crypto
soft, tan grey nodules/masses -- slimy cut surfaces and may cavitate
52
Micro path Crypto
narrow based budding surround by large clear space
53
Dx Crpto
Silver stain and mucicarmine stain. culture is fast and easy b/c grows in 48 hours.
54
PcP gross path
heavy, diffusely consolidated tan lungs
55
Micro PcP
foamy esoinophilic, centro-alveolar honey comb exduate
56
PcP dx
high resolution CT - patchy or nodular ground glass attenutation blood test - elevated LDH. PFT - decreased diffusing capacity. Cysts stain w/ grocott, trophozoite stain w/ Giema, immuno stain
57
What do the cysts look like in PcP
tea cup
58
causes of interstitial chronic pneumonia
Pcp, sarcoidosis, and toxo
59
most common causes of viral pneumonias
flu and RSV
60
interstitial pneumoina in ICPs
CMV
61
Risk factors for lung cancer
black males, smoker, asbesto workers, uranium miners
62
what lung cancer commonly cavitates?
squamous cell and causes post-obstructive pneumonia and high Ca
63
symptoms of lung cancer
cough, dyspnea, weight loss, hemoptysis, chest pain, hoarseness, etc
64
Adenocarcinoma definition
malignant epithelial tumor w/ glandular features such as making glands or mucin
65
pathogenesis for adenocarcinoma
77% due to smoking, increase due to filtered cigs
66
the common mutations in adenocarcinoma
p53, KRAS, EGFR, EML4-ALK, p40 and CK7 (immunostain positive)
67
the 5 patterns for adenocarcinoma
1. acinar - makes glands w/ desmoplasia (most common) 2. papillary 3. micropapillary (rare, bad prognosis) 4. solid 5. lepidic (in site, good prognosis)
68
What is unique about the symptoms for adenocarcinoma?
bone pain
69
Rx for adenocarcinoma
surgical resection for early stage, erlotinib
70
Definition of adenocarcinoma in situ
non-destructive growth along intact alveolar septa
71
Non-mucinous adenocarcinoma in situ
- terminal respiratory unit cells (type II and Clara cells) - smokers, EGFR - ground glass opacity TTF-1+ - commonly single nodules
72
Mucinos adenocarcinoma in situ
- metaplasia of bronchiolar epithelium - KRAS - CK20+
73
how will multifocal nodules spread w/ adenocarcinoma in situ
via airways
74
Adenocarcinoma in situ dx?
radiology (nodules may have ground glass character)
75
Important concept about adenocarcinoma
single small nodule curable by surgery or multiple nodules or a consolidation mimicking pneumonia
76
Squamous cell definitions
cancer w/ keratin pearls and intercellular bridges, PTHrP, smoking, more in AA less in Asians, cavitate
77
Gross path for squamous cell
central, 2/3 from main lobar segment or subsegmental bronchi, 1/3 from smaller peripheral bronchi
78
micro path for squamous cell
cohesive sheets, nest/cords of large cells w/ moderate smooth eosinophilic cytoplasm, intercellular bridge, and keratin pearls
79
Dx for squamous cell
immunostain: p63, ck 5/6
80
concept for squamous cell
central, endobronchial, cavitating and to bleed causing hemoptysis
81
Pathogenesis for small cell carcinoma of lung
cumulative mutations controlling gene proliferation b/c of smoking - RASSF1, RB1, telomerase, bcl2, FHIT, p53
82
Gross path for small cell
central, parabronchial, soft, off white mass w/ multifocal necrosis and metastasizes commonly to liver, bones, brain adrenals
83
Micro path for small cell
round to oval shape, scant cytoplasm, salt and pepper nuclear chromatin, absent nucleoli, molding, many mitoses
84
Signs of small cell
- facial, cervical and arm edema and venous engorment = SVC syndrome; - Pemberton's sign (facial flushing, distended neck and head veins, elevation of JVD
85
Dx of small cell
synaptophysin, chromogranin. paraneoplastic syndromes
86
Primary sites of lung metastases
breast, colon, stomach, pancreas, kidney, skin, prostate
87
Pulmonary metastases
smaller, rounder, contoured, peripheral,
88
Micro path for metastases
immunostains to rule out other cancers. 1st: CK7 and CK20 2nd: CDX2 and TTF-1 breast is combo of colon and lung (Ck20 and CK7 positive)
89
how do you distinguish btw fat embolus and air bubbles
oil red O stain
90
Rx for air embolus
left lateral decbuitus positioning, cardiac massage, hyperbaric oxygen, supportive care
91
ALI/DAD central pathophysiologic mechanism
increased permeability of microvascular barriers (normally maintained by VE-cadherin
92
What are the 3 phases of DAD?
1. exudative - alveolar hyaline membrane 2. proliferative - chronic interstitial inflammation 3. fibrotic -
93
Lipid-laden foamy macrophages w/ what?
amiodarone toxicity = DAD
94
Dx of DAD
PaO2/FiO2 = over 200 mmHg
95
Radiation Pneumonitis
after radiation. Atypical type 2 hyperplasia and blood vessel injury, residual hemosidern
96
epidmeiology of IPF
later middle aged, men, smokers
97
Pathogenesis of IPF
recurring ALI in small foci due to aspiration, imbalance of oxidative-antioxidant systems, autoimmune attack
98
gross path for IPF
fibrosis w/out large scars, worse in periphery and in lower lobes ---> honeycomb lung
99
Signs of IPF
Velcro (dry inspiratory) at bases and clubbing
100
COP
from necrotizing infection, late middle aged and non-smokers. STEROIDS
101
histologic hallmark of COP
plugs of fibrosing gransulation tissue in alveoli called Masson bodies
102
NSIP
more in women and never smokers, temporally homogeneous, less patchy the IPF, bilateral ground glass opacities. STEROIDS
103
Pneumothorax pathogenesis
rupture of subpleural bleb allowing air at positive pressure into pleural space which has negative pressure during inspiration
104
Signs of pneumothorax
diminished breath sounds, hyperresonant percussion, decreased chest excursion
105
Dx of pneumothorax
white visceral pleural line and hypoxemia

Pulmonary - Pathology (2 decks)

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