Pathology of inflammatory disease

Question 1

acute pneumonia

Answer 1

usually pyogenic bacteria with neutrophils in alveoli

Question 2

pneumonitis

Answer 2

usually not pyogenic - atypical (viral or mycoplasmic)

Question 3

chronic pneumonias - causes

Answer 3

often TB, fungi, parasites, odd bacteria

Question 4

what are factors predisposing to pneumonia?

Answer 4

1. loss of cough reflex
2. injury to mucociliary apparatus
3. interference with phagocytic or bactericidal action of alveolar macrophages
4. pulmonary edema, congestion
5. accumulated secretions

Question 5

what are the two overlapping patterns of bacterial pneumonia? what does the pattern depend upon?

Answer 5

bronchopneumonia
lobar pneumonia

bacterial virulence and host resistance

Question 6

90-95% of lobar pneumonia cases are due to what organism?

Answer 6

strep pneumo

Question 7

what are the classic morphologies of lobar pneumonia?

Answer 7

congestion
red hepatization
gray hepatization
resolution

Question 8

what are the presenting features of primary atypical pneumonia?

Answer 8

lack of alveolar exudate
elevated WBCs
very little sputum
confined to alveolar septa and interstitium

Question 9

“walking pneumonia” is typically due to what organism? what are the most serious symptoms?

Answer 9

mycoplasma

bad persistent cough
V/Q mismatch

Question 10

what is the common pathogenic mechanism of atypical pneumonia?

Answer 10

attachment of organisms to respiratory epithelium - necrosis of cells and inflammatory response

if it extends to alveoli - interstitial inflammation

Question 11

what is possible if sputum changes from green to yellow?

Answer 11

superimposed bacterial infection

Question 12

what is the typical histopathology in atypical pneumonia?

Answer 12

interstitial pneumonia with mononuclear infiltrate, diffuse alveolar damage

Question 13

definition: sarcoidosis

Answer 13

systemic disease of unknown cause, noncaseating granulomas in many tissues and organs

diagnosis of exclusion

Question 14

how is the diagnosis of sarcoidosis made?

Answer 14

biopsy showing

noncaseating granulomas
special stains
cultures

Question 15

what are the immunologic factors involved in sarcoidosis?

Answer 15

cell mediated immunity type IV hypersensitivity

1. interstitial and intra-alveolar accumulation of CD4 Th1 cells
2. elevated levels of T cell derived Th1 cytokines - IL-2 and INFy
3. elevated IL-8, TNF

Question 16

what are the genetic factors associated with sarcoidosis?

Answer 16

HLA-A1

HLA-B8

Question 17

what are the “oddities” found inside sarcoid granulomas?

Answer 17

schaumann bodies - lamellated calcified structures usually in giant cells (aka berylliosis)

asteroid bodies - star shaped eosinophilic bodies made of compressed intermediate filaments; common in foreign body giant cells

Question 18

what is seen on CXR in sarcoidosis?

Answer 18

bilateral interstitial infiltrates and hilar lymphadenopathy

Question 19

hypersensitivity pneumonitis typically involves what lung structure?

Answer 19

alveoli (allergic alveolitis)

Question 20

what type of hypersensitivity is associated with hypersensitivity pneumonitis?

Answer 20

type III early (abs in serum)

type IV later (poorly formed granulomas)

Question 21

what cells are seen in acute hypersensitivity pneumonitis?

Answer 21

neutrophils

Question 22

what cells are seen in chronic hypersensitivity pneumonitis?

Answer 22

mononuclear interstitial infiltrate (lymphs, plasma cells, macrophages)

Question 23

what is silo fillers disease?

Answer 23

pulmonary edema due to widespread bronchiolotis obliterans with scar tissue forming in burned small airways

Question 24

what is the smoker related interstitial disease?

Answer 24

DIP

Question 25

what are the features of pulmonary alveolar proteinosis?

Answer 25

accumulation of acellular surfactant in intra-alveolar and bronchiolar spaces, PAS positive

minimal inflammatory response, normal alveolar walls

Question 26

what are the clinical features of pulmonary alveolar proteinosis?

Answer 26

insidious onset of cough
chunks of white gelatinous appearing sputum (jello)
progressive dyspnea, cyanosis

Question 27

how is pulmonary alveolar proteinosis treated?

Answer 27

bronchiolar lavage