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Pathology 2 - Block 2 - Part 6

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davidwurbel7's version from 2016-07-01 17:24

Respiratory Infections 1

Question Answer
Infection and Inflammation of the lung parenchyma with accumulation of exudate, inflammatory cells and fibrin within the alveolar spaces or within alveolar septaPneumonia
Replacement of airspaces by inflammatory exudates giving the affected area a firm (solid) consistencyConsolidation
Organisms of high varilance will cause this type of pneumoniaTypical Pneumonia
Organisms of low varilance will cause this type of pneumoniaAtypical Pneumonia
involvement of the whole lobeLobar Pneumonia
Begins as acute bronchitis and spreads locally into the alveoli. Lung has patchy areas of consolidation in same or several lobes. Also called patchy pneumoniaBronchopneumonia
affects the interstitium and does NOT lead to consolidation Interstitial Pneumonia
Majority caused by bacterial pathogens. Most often due to Streptococcus pneumoniae. People at risk include patients with splenic dysfunction (Sickle cell disease or splenectomy patients)Typical Community Acquired Pneumonia
This pneumonia can have two gross patterns of anatomic distribution - Lobar pneumonia and BronchopneumoniaTypical Community Acquired Pneumonia
Consolidation of entire lobe or large portion of a lobe. Associated with predominantly intra-alveolar exudate and spreads through pores of KohnLobar Pneumonia
Patchy areas of consolidation. Usually bilateral. More common in Lower lobes (gravity). Neutrophil-rich exudate fills the bronchi, bronchioles, and adjacent alveolar spacesBronchopneumonia
Sudden onset of High fever, chills, Cough productive of sputum [yellow-green (pus) or rusty (bloody- hemoptysis)]. If pleuritis presents with pleuritic pain + pleral friction rub. Signs of consolidation in lungs on PE and X-ray. Dullness to percussion. Increased vocal tactile fremitus. Chest X ray - Radio-opaque lobeLobar pneumonia
Sudden onset of High fever, chills, Cough productive of sputum [yellow-green (pus) or rusty (bloody- hemoptysis)]. If pleuritis presents with pleuritic pain + pleral friction rub. Signs of consolidation in lungs on PE and X-ray. Dullness to percussion. Increased vocal tactile fremitus. Chest X ray - Focal opacitiesBronchopneumonia
Blood labs neutrophilic leukocytosis with left shift and toxic granulation. Extremely high levels of C-reactive protein and procalcitonin. Blood culture:+veBacterial Pneumonia
Blood labs lymphocytic leukocytosis with left shift. Elevated levels of C-reactive protein and procalcitonin. Blood culture:-veViral Pneumonia
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Question Answer
Stage of lobar pneumonia in the first 24 hoursStage of Congestion
Stage of lobar pneumonia in days 2-3Stage of Red Hepatozation
Stage of lobar pneumonia in days 4-6Stage of Gray Hepatozation
Stage of lobar pneumonia in days 8-10Stage of Resolution
Macroscopic appearance - The affected lobe is red, boggy and heavy. Microscopic appearance - Alveolar exudate mostly contains bacteria and a few neutrophils. Vessel dilatation and congestionStage of Congestion
Macroscopic appearance - Brick Red , airless and firm liver like consistency of lung. Microscopic appearance - Vascular congestion. Massive alveolar exudate containing neutrophils, fibrin and RBCsStage of Red Hepatization
Macroscopic appearance - Gray brown and firm appearance of lung. Microscopic appearance - Disintegration of red cells. Less vascular congestion and persistence of fibrino-suppurative exudateStage of Gray Hepatization
Characterized by degradation and clearance of consolidated exudate by macrophages. Restoration of Normal structureStage of Resolution
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Typical Pneumonia
Question Answer
Strep pneumoniae, Staph aureus, H. influenzae, Pseudomonas aeruginosa, Klebsiella pneumonia, Legionella pneumophiliaCommunity Acquired Pneumonia - Typical
Pseudomonas aeruginosa, E. coli, Staph aureusHospital Acquired (Nosocomial) Pneumonia
Anaerobes - Bacteroides, Fusobacterium, Peptostreptococcus spp. and Aerobes - Strep pneumoniae and Staph aureusAspiration Pneumonia
Aspiration pneumonia can lead to this necrotizing inflammation with fulminant course which may cause deathNecrotizing Pneumonia
Pneumocystis carniii, Pseudomonas aeruginosaPneumonia in Immunocompromised Hosts
Bacteria - Mycobacterium tuberculosis; Fungi - Blastomyces, Histoplasma, CoccidioidesChronic Pneumonia
The most common cause of Community Acquired Pneumonia - Typical is thisStrep pneumoniae
The most common cause of Community Acquired Pneumonia - Atypical is thisMycoplasma pneumonia
The most common pathogen causing pneumonia following influenza infectionStaph aureus
The most common cause of pneumonia in IV drug abusersStaph aureus
The most common cause of acute exacerbation of COPDH. influenza
H. influenza will cause this in childAcute Epiglottitis
The most common cause of nosocomial pneumoniaPseudomonas aeruginosa
The most common cause of pneumonia in CF patientsPseudomonas aeruginosa
The most common cause of pneumonia in ICU/CCU due to being on respiratorsPseudomonas aeruginosa
Pneumonia with green color sputum suggests this organismPseudomonas aeruginosa
Causes pneumonia in alcoholicsKlebsiella pneumonia
The most common pneumonia in nursing homesKlebsiella pneumonia
Pneumonia with sputum that is thick, gelatinous, mucoid and blood tinged suggests this organismKlebsiella pneumonia
Pneumonia with dry cough, malaise, myalgia, headache, delirium +flu like symptoms and striking fever. Other findings include arthralgias, renal and CNS findings and can produce hyponatremia due to interstitial nephritis suggests this organismLegionella pneumophilia
Organ transplant recipients, COPD, DM patients are at risk for pneumonia cause by this organismLegionella pneumophilia
Hyponatremia produced by Legionella pneumophilia is due this the destruction of this which leads to the inability to produce aldosterone resulting in the loss of sodium in the urineJuxtaglomerular Apparatus
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Atypical Pneumonia
Question Answer
Mycoplasma pneumoniae, Chlamydia trachomatis, Chlamydia pneumoniaCommunity Acquired Pneumonia - Atypical
IgM antibodies targeted against the I antigen on the RBCs in the cold parts of the bodyCold Autoimmune Hemolytic Anemia
Cold Autoimmune Hemolytic Anemia is a complication of thisMycoplasma pneumoniae Pneumonia
Clinical findings include acute nonspecific febrile illness, Low grade fever, Non to mildly productive cough (dry cough), No signs of consolidation (interstitial pneumonia), Headache, myalgias, pharyngitis, laryngitis. Chest X ray: minimal signsAtypical Pneumonia
The most common cause of interstitial pneumonia and bronchiolitis in infantsRespiratory Syncytial Virus (RSV)
Newborn pneumonia. Presents with staccato cough (choppy cough), conjunctivitis, tachypnea and wheezing. Afebrile and eosinophiliaChlamydia trachomatis
Interstitial pneumonia due to inhalation of this organism found in dropping and feathers of birds such as parrots and parakeetsChlamydia psittaci
Only rickettsia transmitted without a vector. Inhalation of the organism spore. People at risk for this are dairy farmers and veterinariansCoxiella burnetii
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Respiratory Infections 2

Question Answer
Pseudomonas aeruginosa, E.coli and Staph aureus are the most common cause of thisNosocomial Pneumonia
The most common cause of nosocomial pneumonia is due to this interventionRespirator
Aspiration pneumonia can lead to this necrotizing inflammation with fulminant course which may cause deathNecrotizing Pneumonia
Anaerobes - Bacteroides, Fusobacterium, Peptostreptococcus spp. and Aerobes - Strep pneumoniae and Staph aureusAspiration Pneumonia
A frequent complication of aspiration pneumonia is the development of this in surviving patientsLung Abscess
Alcoholic intoxication, Seizures, Unconscious state, Repeated vomiting, Anesthesia predispose a patient for thisAspiration
Usually occurs as a complication of aspiration pneumonia and is characterized by microbial infection resulting in necrosis of lung tissue with formation of cavities containing necrotic debris (pus)Lung Abscess
A localized collection of pus often accompanied by liquefactive necrosisAbscess
Clinical features include spiking fever, Cough with sputum production, night sweats and weight loss. Expectorated sputum characteristically is foul smelling and bad tasting. Clubbing, Leukocytosis and in chronic cases anemiaLung Abscess
Lung abscess due to aspiration will most likely involve this lungRight Lung, Single
Lung abscess due to aspiration while standing will most likely involve this part of the lungRight Lower Lobe - Post Segment
Lung abscess due to aspiration while supine will most likely involve this part of the lungRight Lower Lobe - Superior Segment
Lung abscess due to aspiration while right sided position will most likely involve this part of the lungRight Medial Lobe - Posterior Segment of the Right Upper Lobe
Lung abscess due to pneumonia will most likely involve this part of the lungBasal, Multiple
Abscess cavity will show this on X-rayAir Fluid Level
Diagnosis by clinical suspicion, amphoric breath sounds, Chest radiograph - Iregularly shaped cavity with an air – fluid level insideLung Abscess
Differential diagnosis include cancer of lung (squamous cell carcinoma) and cavitary tuberculosisLung Abscess
Treatment of lung abscess is this antibioticClindamycin
The type of pneumonia caused by bacteria - Mycobacterium tuberculosis and fungi - Blastomyces, Histoplasma, CoccidioidesChronic Pneumonias
A granuloma in the lung with a tree bark appearanceHistoplasma
Acquired by inhalation of spores found in bird and bat dropping usually in cavesHistoplasma
Histoplasmosis is also called thisSpelunker's Disease
Clincally presents most infections are asymptomatic. If symptomatic, lung infections are characterized by self limiting fever, chills and a non-productive coughHistoplasma
Has narrow based buddingHistoplasma
This organism is endemic to the Ohio and Mississippi River ValleysHistoplasma
Acquired by inhalation of spores found in moist soil with decomposing woodBlastomyces
Cutaneous blastomycosis can be confused with this conditionSquamous Cell Carcinoma of the Skin
Has broad-based buddingBlastomyces
Can cause lesions in the lung, skin and boneBlastomyces
This organism is endemic to the Ohio and Mississippi River Valleys and WisconsinBlastomyces
Presents with flu like symptoms - cough, fever, arthralgia and rashCoccidioides
Tissue form is called this and is filled with small endosporesSpherule
Coccidioides infection is also called thisSan Joaquin Valley Fever
This organism is endemic to the southwest of the US and dry areas in the westCoccidioides
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Respiratory Infections 3

Question Answer
A communicable, chronic granulomatous disease usually involves the lungs but may affect any organ or tissue in the body (multisystem disease). Typically, the centers of tubercular granulomas undergo caseous necrosisTuberculosis
Purified Protein Derivative (PPD) test is a test for thisT-Cell Immunity to Mycobacteria
A 1-1.5 cm gray white area of granolomatous inflmmation with caseous necrosis in subpleural locationGhon Focus
The combination of Ghon focus and lymphnode involvementGhon Complex
Usually asymptomatic. Usually resolves. Produces a calcified granuloma or area of scar tissue . May be a nidus for reactivation or Secondary TBPrimary TB
The state of the patient's immune system that develops primary TBImmunocompetent
The state of the patient's immune system that develops Progressive primary TBImmunoincompetent
Involves one or both apices in upper lobes. There is more tissue destruction with cavitation and increased signs and symptomsSecondary TB
Clinical finding include cough, fever, drenching night sweats, weight loss and hemoptysisSecondary TB
Granuloma zone containing caseous necrosisInner Zone
Granuloma zone containing epithelioid cells & multinucleated giant cells of Langhans typeMiddle Zone
Granuloma zone containing lymphocytes & plasma cellsOuter Zone
Granuloma zone containing fibrous tissue (if healing has begun)Fourth Zone
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Question Answer
Pneumonia caused by usual bacterial pathogens or M. tuberculosis hominis CD4+ count>200/mm3
Pneumonia caused by P. jiroveci (carinii) CD4+ count<200/mm3
Pneumonia caused by MAI complex and CMV CD4+ count<50/mm3
Clinical findings include low grade fever, dyspnea ,tachypnea and hypoxemiaPneumocystis jiroveci (carinii)
Frothy (“cotton candy”) exudate seen within alveoli composed of cyst and trophozoitesPneumocystis jiroveci (carinii)
Pneumocystis jiroveci (carinii) can be seen on microscope slide using this stainGiemsa Silver Stain
Most common TB in AIDS. Occurs when CD 4 count falls below 50 cells/mm3Mycobacterium avium intracellulare
Enlarged alveolar macrophages, pneumocytes and endothelial cells contain basophilic intranuclear inclusions surrounded by a haloCytomegalovirus
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