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CPR 2 Pulm Section > Respiratory Pathology Pt. 4 > Flashcards

Respiratory Pathology Pt. 4 Flashcards

1
Q

What is the top “morbid” cause of hospital admissions?

A

PNA

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2
Q

What is the most common cause of sepsis?

A

PNA

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3
Q

What is the most common cause of community-acquired PNA?

A

Strep pneumo

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4
Q

What are the stages of lobar PNA and their characteristics?

A

1) congestion: vascular engorgement, higher perfusion
2) red hepatization: RBC’s, inflammation, neutrophils
3) grey hepatization: inflammation and debris
4) resolution: fibrosis and macrophage clean-up

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5
Q

What are a few complications of lobar PNA?

A
  • abscesses
  • empyema (pus in pleural cavity)
  • bacteremia
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6
Q

How will Streptococcus pneumoniae appear on a gram stain?

A

gram-positive diplococci (lancet-shaped) in PAIRS AND CHAINS

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7
Q

For whom is the Strep pneumo vaccine recommended?

A
  • infants
  • elderly (>65yrs)
  • pts w/ respiratory disease
  • smokers
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8
Q

What are the characteristics of PNA d/t Haemophilus influenzae?

A
  • -virulent PNA in children
  • -recommended vaccine for Type B for kids <5yrs
  • -community-acquired
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9
Q

What are the characteristics of PNA d/t Staphylococcus aureus?

A
  • -abscess formation
  • -IV drug users
  • -community-acquired
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10
Q

What are the characteristics of PNA d/t Klebsiella pneumoniae?

A
  • -alcoholics
  • -chronic aspiration
  • -hemorrhagic PNA
  • -currant jelly sputum (d/t bleeding)
  • -community-acquired
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11
Q

What are the characteristics of PNA d/t Pseudomonas aeruginosa?

A
  • -seen often in CF pts
  • -may be seen as opportunistic or nosocomial
  • -foul-smelling (or fruity, grape-smelling) GREEN mucus
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12
Q

What are the characteristics of Typical PNA vs Atypical PNA?

A

Typical: abrupt onset, respiratory symptoms, consolidation, children, elderly

Atypical: slow onset, systemic symptoms, patchy infiltrates, teens, young adults

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13
Q

What are some bacteria that cause typical PNA?

A
  • Strep pneumo
  • Haemophilus influenza
  • Staph aureus
  • Klebsiella
  • Pseudomonas
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14
Q

What are some bacteria that cause atypical (“walking”) PNA?

A
  • Mycoplasma pneumoniae
  • Legionella
  • Chlamydia pneumonia
  • Chlamydia psittaci
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15
Q

What is the most common cause of atypical (“walking”) pneumonia?

A

Mycoplasma pneumoniae

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16
Q

What are the characteristics of Mycoplasma pneumoniae?

A
  • smallest, free-living, self-replicating microorganisms
  • smaller than the respiratory cilia
  • does NOT gram stain d/t lack of cell wall
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17
Q

What are the characteristics of Legionella pneumophila?

A
  • gram negative bacillus
  • grow in warm freshwater (A/C units, misters, hot tubs)
  • airborne disease
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18
Q

Where in the lungs does bacterial PNA localize versus where in the lungs does viral PNA localize?

A

Bacteria: in alveolar spaces

Viruses: in interstitium

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19
Q

What two proteins classify community-acquired PNA d/t the influenza virus and what are their roles in the disease?

A

Hemagglutinin: attaches virus to host cells

Neuraminidase: allows release of replicated virus from host cells

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20
Q

What is oseltamivir’s mechanism of action?

A

-neuraminidase inhibitor, prevents replicated virus from being released from the host cell

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21
Q

What are the clinical characteristics of the flu versus the common cold?

A

Flu: abrupt onset, fever, aches, chills, fatigue, HA

Cold: gradual onset, sneezing, stuffy nose, sore throat

22
Q

What is antigenic drift?

A
  • causes epidemics
  • minor changes to proteins on the virus allow spread
  • similar enough to original that some are immune
23
Q

What is antigenic shift?

A
  • causes pandemics
  • genomic alterations w/ major protein changes
  • naive immunity for almost all humans
  • possibly zoonotic in origin
24
Q

What viral class has the easiest time creating viral proteins and why?

A

single-stranded RNA, b/c it is the same format as mRNA and can go straight to the ribosome of the host cell and start translating proteins

25
Q

What viral class is SARS-CoV-2?

A

positive-sense ssRNA

26
Q

For what enzyme does SARS-Co-V-2 have a tropism?

A

ACE

27
Q

What are characteristic findings in the vasculature of COVID-19 patients?

A
  • -endothelial damage
  • -platelet activation
  • -D-dimer
  • -megakaryocytes
28
Q

What are causes of PNA in neonates?

A
  • Group B Strep
  • Listeria
  • gram negative rods (ex: E. coli)
29
Q

What are causes of viral PNA in infants and children?

A
  • RSV (seasonal peaks, mostly very young kids)
  • parainfluenza virus
  • influenza A/B
  • adenovirus
  • rhinovirus
30
Q

What are the causes of bacterial PNA in infants and children?

A
  • Strep pneumo
  • Haemophilus influenzae
  • Moraxella catarrhalis
  • Staph aureus

(Mycoplasma pneumoniae and Chlamydia pneumoniae should be additional considerations in older children and teens)

31
Q

What are the clinical symptoms of Respiratory Syncytial Virus (RSV)?

A
  • rhinorrhea
  • cough
  • wheezing
  • dyspnea, tachypnea
  • cyanosis
32
Q

What family of virus is Respiratory Syncytial Virus (RSV)?

A

paramyxovirus

33
Q

How did RSV get its name?

A

-on histology, a multinucleate cell forms a syncytium

34
Q

What are other paramyxoviridae besides RSV?

A
  • hMPV (human metapneumovirus
  • parainfluenza
  • measles
35
Q

What is the general presentation of a bacterial PNA?

A
  • abrupt onset
  • may have bacteremia
  • high fever
  • crackles
  • lobar/consolidated
  • may involved pleura
36
Q

What is the general presentation of a viral PNA?

A
  • gradual onset (exception: influenza)
  • epidemics are common
  • no fever (exception: influenza)
  • wheezes
  • diffuse infiltrates
  • doesn’t involve pleura
37
Q

Which two causes of bacterial PNA are associated w/ abscesses?

A
  • Staph aureus

- Klebsiella

38
Q

What are risk factors for an abscess formation during a PNA infection?

A
  • chronic alcoholism
  • elderly
  • stroke patients
  • infxn w/ an anaerobe
39
Q

Why are abscesses more common in the right middle and right lower lobes?

A

-aspirated material will tend to follow gravity into the R mainstem bronchus because it has the least sharp branching, making it the “path of least resistance”

40
Q

What is seen on histology of tuberculosis?

A
  • caseating granuloma (central necrosis)

- multinucleated giant cells

41
Q

What is a Ghon complex?

A

-caseation in the lung and caseation in the hilar LN’s

42
Q

What are three fungal causes of chronic PNA (lasting for months in an immunocompetent patient)?

A
  • Blastomycosis
  • Coccidomycosis
  • Histoplasmosis
43
Q

Where is Histoplasma capsulatum endemic?

A

Mississippi River Valley

44
Q

What is the presentation of histoplasmosis?

A
  • subclinical infxn w/ granulomatous response
  • calcifications and coin lesions on CXR

(can be aggressive in immunocompromised)

45
Q

What is seen on a silver stain of Histoplasma capsulatum?

A

–yeast form looks like “pumpkin seeds”

–narrow-based budding

46
Q

Where is Blastomyces dermatitides endemic?

A

Ohio and Mississippi River Valleys

47
Q

What is the presentation of blastomycosis?

A
  • subclinical infxn w/ granulomatous response
  • eosinophilia
  • can cause disseminated infxn in immunocompromised
48
Q

What is seen on a silver stain of Blastomyces dermatitides?

A

sphere w/ endospores

49
Q

What are the characteristics of Pneumocystis jiroveci?

A
  • -opportunistic fungal infxn
  • -AIDS-defining illness
  • -cup-shaped yeast
50
Q

What are the characteristics of Mycobacterium Avium Complex?

A
  • -immunocompromised or elderly

- -slender red forms on acid-fast stain

51
Q

Why is a lung biopsy needed to determine the difference b/w a lung infxn and a lung rejection in lung transplant patients?

A

–rejection also produces infiltrates and fever

–rejection will show mononuclear infiltrates around vessels on histology

–infxn will show opportunistic organisms on histology if the pt is on too high a dose of immunosuppressants

CPR 2 Pulm Section (9 decks)

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