Pulmonary: Pathology Part I - Nasopharynx thru Infections Flashcards Preview

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Flashcards in Pulmonary: Pathology Part I - Nasopharynx thru Infections Deck (29):
1

  • Inflammation of the nasal mucosa
  • Rhinovirus is the most common cause
  • Sneezing, Congestion, and Runny nose 
  • Allergic reaction subtype is a
    Type I Hypersensitivity reaction
    • Inflammatory infiltrate w/ Eosinophils
    • A/w Asthma and Eczema

Rhinitis

2

  • Protrusion of Edematous, Inflamed nasal mucosa
  • 2° to repeated bouts of Rhinitis
  • A/w Cystic fibrosis and Aspirin-Intolerant Asthma
    • Asthma
    • Nasal polyps
    • Aspirin induced bronchospasms

Nasal Polyp

3

  • Benign tumor of Nasal mucosa
  • Composed of Large blood vessels and Fibrous tissue
  • Classically seen in adolescent males, rare in females
  • Presents w/ Profuse Epitaxis (nosebleed)

Angiofibroma

4

  • Malignant tumor of nasopharyngeal epithelium
  • Presents w/ enlarged Cervical lymphnodes
  • A/w EBV; classically seen in African children and Chinese adults
  • Biopsy → Pleomorphic keratin-positive epithelial cells (poorly differentiated squamous cell carcinoma) in a background of Lymphocytes

Nasopharyngeal carcinoma

5

  • Inflammation of the Epiglottis
  • H Influenzae Type B is the most common cause, especially in Nonimmunized Children
  • Presents w/ High Fever, Sore throat, Drooling with dysphagia, Muffled voice, and Inspiratory Stridor
  • Risk of Airway Obstruction

Acute Epiglottis

6

  • Inflammation of the Upper Airway
  • Parainfluenza Virus is the most common cause
  • Presents w/ a hoarse, "Barking" Cough and Inspiratory Stridor (Cold Helps)

Laryngotracheobronchitis (Croup)

7

  • Nodule that arises on the true vocal cord
  • Due to ‘wear and tear’, excessive use of vocal cords
  • Usually Bilateral
  • Compoased of Degenerative (Myxoid) Connective tissue
  • Hoarseness; resolves w/ resting of voice

Vocal Cord Nodule (Singer’s nodule)

8

  • Benign papillary tumor of the vocal cord
  • A/w HPV 6 and HPV 11
  • Papillomas are usually Single lesions in adults and Multiple lesions in chilldren
  • Presents w/ Hoarseness

Laryngeal papilloma

9

  • Squamous cell carcinoma, from Epithelial lining of the vocal cord
  • A/w Alcohol, and Tobacco
  • Arise from Laryngeal papilloma (rare)
  • Hoarseness → advanced disease Cough, and Stridor

Laryngeal carcinoma

10

  • Infection of the Lung Parenchyma
  • Normal defenses are impaired (Impaired cough reflex, Damage to mucociliary escalator, Mucus plugging) → Normally swallow mucus
  • Fever and Chills, Productive cough w/ Yellow-green (pus) or Rusty (bloody) sputum
  • Tachypnea w/ pleuritic chest pain, Decreased breath sounds, Dullness to percussion
  • ↑ WBC
  • Dx: CXR, Sputum gram stain, sputum and blood cultures
  • (3) Patterns classically seen on CXR

Pneumonia

  • (3) Patterns of Pneumonia
    1. Lobar pneumonia
    2. Bronchopneumonia
    3. Interstitial pneumonia

11

  • Consolidation of an Entire Lobe of Lung, intra-alveolar exudate → consolidation, may involve entire lung
  • Bacterial; Streptococcus pneumonia (95%),  Klebsiella pneumonia (alcoholics), Legionella
  • (4) Classic gross phases:
  1. Congestion – vessels and edema
  2. Red hepatization – Exudate, Neutrophils, and Hemorrhage filling the Alveolar air spaces, a solid Liver-lung consistency
  3. Gray hepatization – degradation of Red cells w/in exudate
  4. Resolution of exudate → Type II neumocyte stem cell

Lobar Pneumonia

12

  • Scattered Patchy distribution w/ consolidation centered around Bronchioles (> 1 lobe)
  • Acute inflammatory infiltrates from Bronchioles into adjacent alveoli
  • Multifocal and Bilateral: S. pneumoniae, S. aureus, H. influenzae, Klebsiella
  • A/w a variety of Bacterial organisms

Bronchopneumonia

13

  • Diffuse Patchy infiltrates inflammation localized to  Interstitial areas at Alveolar walls
  • Distribution > 1 Lobe
  • More indolent course (lazy)
  • A/w both Bacteria and Viruses
  • Bacteria (Mycoplasma, Legionella, Chlamydia)
  • Viruses (influenza, RSV, Adenoviruses)
  • Mild upper respiratory symptoms (Minimal Sputum and Low Fever)
  • ‘Atypical’ presentation

Interstitial (Atypical) Pneumonia

14

  • Pts. at risk for Aspiration (alcoholics and comatose patients)
  • Most often a/w Anaerobic bacteria in the Oropharynx in the Right-lower Lobe of the Lung
    • Bacteroids
    • Fusobacterium
    • Peptococcus
  • Right Lower lobe Abscess – the Right Main stem bronchus branches at a less acute angle than the Left

Aspiration Pneumonia

15

  • Most common cause of Community-acquired pneumonia and 2° pneumonia
  • Bacterial pneumonia superimposed on a Viral upper respiratory tract infection
  • Usually seen in Middle-aged Adults and Elderly

Streptococcus pneumoniae

(Lobar Pneumonia)

16

  • Enteric flora that is Aspirated
  • Affects Malnourished and Debilitated individuals (Elderly in homes, Alcoholics, and Diabetics)
  • Thick Mucoid capsule results in Gelatinous sputum
  • Complicated by Abscess

Klebsiella pneumoniae

(Lobar Pneumonia)

17

  • 2° most common cause of Secondary pneumonia
  • Complicated by Abscess or Emphysema (pus in pleural space)

Staphylococcus aureus

(Bronchopneumonia)

18

  • Common cause of 2° pneumonia and pneumonia superimposed on COPD
  • Leads to exacerbation of COPD

Haemophilus influenzae

(Bronchopneumonia)

19

  • Pneumonia in Cystic fibrosis pts.

Pseudomonas aeruginosa

(Bronchopneumonia)

20

  • Community-acquired pneumonia and pneumonia Superimposed on COPD
  • Leads to exacerbation of COPD

Moraxella catarrhalis

(Bronchopneumonia)

21

  • Community-acquired pneumonia and pneumonia Superimposed on COPD, or pneumonia in Immunocompromised states
  • Transmitted from Water source Intracellular organism
  • Best visualized w/ Silver stain

Legionella pneumophila

(Bronchopneumonia)

22

  • Most common cause of Atypical pneumonia
  • Affects Young adults (Military recruits, College dormitory kids)
  • Complications include Autoimmune hemolytic anemia
    • IgM against I antigen on RBCs → Cold hemolytic anemia
  • Erythema multiforme
  • Does not produce purulent sputum unless  there is a secondary bacterial infection
  • Not visible on Gram stain due to lack of Cell Wall

Mycoplasma pneumoniae

(Interstitial (Atypical) Pneumonia)

23

  • Second most common cause of Atypical pneumonia in Young adults

Chlamydia pneumonia

(Interstitial (Atypical) Pneumonia)

24

  • Most common cause of Atypical pneumonia in Infants

Respiratory syncytial virus (RSV)

(Interstitial (Atypical) Pneumonia)

25

26

  • Pre-existing Lung disease
  • Risk for Superimposed S aureus or H influenzae (2° pneumonia)

Influenza virus

(Interstitial (Atypical) Pneumonia)

27

  • Atypical pneumonia w/ Q fever (High fever)
  • Farmers and Veterinarians
  • Spores are deposited on cattle by Ticks or are present in cattle Placentas
  • Rickettsial organism:
    • Causes pneumonia
    • Does not require Arthropod vector for Transmission (High-heat resistant endospores)
    • Does not produce a Skin rash

Coxiella burnetii

(Interstitial (Atypical) Pneumonia)

28

  • Inhalation of Aerosolized bacteria
  • Primary w/ initial exposure
    • Focal, Caseating necrosis in the Lower Lobe of the lung and Hilar Lymph nodes → Fibrosis and Calcification → Ghon complex
    • Generally asymptomatic → Pos. PPD test
  • Secondary w/ Reactivation
    • A/w AIDS and Aging
    • Apex of Lung (poor lymphatic drainage and High O­2 tension - cavitary lesion
    • Foci of Caseous necrosis → Miliary Pulmonary TB or TB bronchopneumonia
    • Fever, Nocturnal hyperhidrosis, Cough w/ Hemoptysis, Weight Loss
    • Caseating Graunulomas, AFB stain → Acid-fast Bacilli
    • Meninges, Cervical lymph nodes, Kidneys (sterile pyuria) and Lumbar vertebrae (Pott disease) 

Tuberculosis (TB)

29

  • Localized collection of pus w/in Parenchyma
  • Caused by:
    • Bronchial obstruction (cancer)
    • Aspiration of Oropharyngeal contents (esp. pts. predisposed to LOC, alcoholics)
  • Air-fluid levels often seen on CXR
  • Bacterial:
    • S. aureus
    • Anaerobes (Bacteroides, Fusobacterium, Peptostreptococus)

Lung Abscess