zwinthrop's version from 2015-04-23 00:03


Question Answer
CAPStrep pneumo, H. flu, Moraxella, Legionella, chlamydia, influnza A, RSV, ADenovirus, rhinovirus, H1 NA
HCAPStaph aureus, Pseudomonas, Enterococcus, Klebsiella
TypicalStrep pneumo, H. flu, Klebsiella
Atypical Staph aurues, Psedomonas, Moraxella, Legionalla
Aspiration pneumoniamicroaspiration of gm (-) enterics/anaerobes (S. aureus), ACUTE BRONCHOPNEUMONIA/LIPOID PNEUMONIA--> use 3rd gen cephalosporin (ceftriaxone), or Fluroquinolone
Aspiration pneumonitisaspiration of gastric contents, TNF aplha, IL-8, atelectasis (3 min) , PMN/fibrin (4 hrs), hyalin (48 hrs)
Strep pneumoniaCAP, Gm (+) cocci, yellow/green sputum (or rusty colored)
H. influenzaeCAP, Gm (-) rod, COPD/Elderly, otitis, sinusitis, meningitis
LegionellaCAP, Gm (-) rod, Silver stain, legionaires (cool, damp, via water source), sick fast (diarrhea/hypernitremia) healthy fast
Staph aureusHCAP, Gm (+) cocci, SUPER infection, MRSA/Cystic FIbrosis/IV drugs, TOXIC SHOCK SYNDROME
PseudomonasHCAP, Gm (-) rod, cystic fibrosis/bronchiectasis, green sputum
KlebsiellaHCAP, Gm (-) rod, CURRANT JELLY SPUTUM, aspiration; poor dentition, alcoholics, diabetics, COPD, elderly
Respiratory syncytial virus (RSV)Bronchiolitis (winter, in children), lower resp tract, multinucleated giant cells w/ eosinophils.
Influenza ARNA virus, viral shedding prior to illness, fever/headaches/myalgias, NON-productive cough, SUPER infection w/ staph aureus
AdenovirusDNA virus, Smudge Cells, Halos, fecal oral, Upper Resp symptoms: pharyngitis, bronchitis, etc (ITIS)
Herpes simplex (HSV)GIANT CELL EROSION (BLUE DOTS) lower resp tract infections
Varicella Pneumoniaaccompanied by chicken pox, HEMORRHAGIC PARENCHYMAL NODULES< EMERGENCY in immunocomprimised, 20% mortaliity in adults
Cytomegalo (CMV) PneumoniaHIV/neonates, intracytoplasmic inclusions, antibodies IgM/IgG
Mycoplasma PneumoniaCOLLEGE STUDENTS/ARMY RECRUITS/SCHOOOL AGED CHILDREN, +Coombs/increased ESR = hemolytic, Cold agglutinins, lymphocytic pleocytosis, "tree in bud", Macrolides used to treat.
Cryptococcal pneumoniaNW, HIV/AIDS, helathy ppl w/ BIRDS, granulomatous, macrophage infiltrates, narrow budding/THICK CAPSULE.
CoccidiodomycosisSan Juaquin Valley (AZ, TX), erythema nodosum/multiforme unilateral hillar adenopathy (big balls)
HistoplasmosisOhio/Miss River Valley, Bird/bat/soil, resembles TB, CALCIFICATIONS/SPLEEN NODULES, COPD, Disseminated-HIV patients, Chronic -- COPD, Acute -- callcification
BlastomycosisNE, Upper lobe, "tree in bud" , cough, skin lesions, GREY/VIOLET
MucurmycosisDIABETICS< EATS FACE OFF< 80-100% mortaltiy, MASSIVE hemoptysis, Halo sign/reverse halo sign.
Aspergillus(1) Invasive-netropenic, halo/reverse halo sign (2) chronic pulmonary-COPD/sarcoidosis, IgG, CRP/ESR (3) ABPA-TH2, ASthma, CF, IgE, Bronchiectasis
Pneumocystis Jirovecii (PCP)HIV, CD4<200, SILVER STAIN, foamy eaosinophilic material. Cysts rupture. Attack Type I pneumocytes. use BACTRIM + Corticosteroids, Spontaneous Pneumothorax, A-a > 35 = MILD (IV bactrim), A-a >45 = severe (IV bactrim +corticosteroids). LDH levels and CMV dictate severity.
Tuberculosisaerobic, acid fast, elderly/immune comprimised/diabetics/AIDS, hemoptysis/fevers/chills/nightsweats. Primary, Seconday, Latent, use INH/Rifampin. Secondary progresses to bronchopneumonia in progressive pulm.


Question Answer
Small Cell carcinoma(S) SMOKING (MALE), CENTRALLY located, SYNDROMES (ADH, ACH). Poor prognosis (aggressive). Chemo/Radiation. NO SURGERY. Lots of metastasis, HISTO: small nuclei, fine chromatin, absent nucleoli. (dark blue nuclei fill entire space-very little cytoplasm. More common in men. ACH (Cushing syndrome), ADH (hypoatremia).
Squamous Cell Carcinoma(S) SMOKING (MALE), CENTRALLY LOCATED, SYNDROME (Hypercalcemia due to PTHrP). KERATIN PEARLS, INTRACELLULAR BRIDGES (DESMOSOMES). Originates in Epithelial/Bronchial wall.. Histo: (balls) cavities w/ areas of necrosis, keratinzation (KERATIN PEARLS). Spreads locally and metastasizes later then others.
AdenocarcinomaMOST COMMON type in non-smokers/FEMALE smokers, PERIPHERAL distribution.GLANDS/MUCOUS PRODUCTION.
KRAS--> most common mutation in smokers
EGFR -->15% of all NSCLC, can treat w/ Tyrosine kinase inhbitor
Histo: Glands, glandular gormations-mucin/nuclei large, open chromatin, prominent nuclei. Desmoplastic reaction.
Metastatic disease: liver, bone brain, adrenals.
Gross: lepidic growth pattern (along alveolar lining-invasive) = Adenocarcinome now: IN-SITU-bronchioloalveolar carcinoma.
Large CellRare. Defined by "lack of other features"- no glands, mucin, keratin, or bridges. Smoking. Acts similarly to adenocarcinoma BUT larger. Associated local phenomena: bronchial obstructio--> atelectasis, pneumonia, bronchiectasis, abcess. Extnesion through pleura/pericardium --> pericarditis, effusions, etc. Depends on presence of lymphocytes.
Carcinoid4 C's: CENTRAL LOCATION, CORDS/NESTS, CHROMAGRANIN + (NEUROENDOCRINE), CLASSIFICATION (typical vs. atypical- necrosis/mitosis). NOT smoking related. Polyp-like masses in bronchus. NEUROENDOCRINE--chromogranin+. Atypical = necrosis, mitotis rate 2+/10HPF, associate with a more aggresive course. Grow intraluminally in bronchi. Histo: nests/cords of cells, neuroendocrine differentiation, chromogranin+ and synaptophysin +.
HemartomaBENIGN, POPCORN< most ommon benign tuor of lung. Central/peripheral location, well-circumscribed/lobulated.
MetastaticVERY common (more common then primary tumor). BREAST/COLON. Spread through lymph, blood, mediastinum, espohogus. CANNONBALL/SNOWSTORM patterns.
Pancoast Tumor"Superior Sulcus Tumor". Lung tumor in Apical region of lung. Compression of sympatheti chain/brachoplexus. HORNER'S Syndrome (invasion of tumor into cervical sympathetic chain--> Ptosis, miosis (pinpoint puples), anhidrosis (lack of sweat)).
Paraneoplastic Syndromesvariable, most common in small/squamous cell lung cancers. Small cell --> ACTH (cushing-like syndrome), or ADH (hypoatremia (SIADH syndrome). Squamous Cell --> hypercalcemia.
Pleural EffusionCHF MOST COMMON, with parapneumonic and malignant next most common.
TRANSUDATE: (CHF, PE, cirrhosis) = ratio of pleural: serum (1) Protein<0.5 (2) LHD<0.6 (3) Pleural LDH <2/3 upper limit of normal serum LDH.
EXUDATE: 1 of the 3 being >0.5,0.6, or 2/3--> an exudate is disease of pleura (pneumonia, malignancy, PE, Gi disease).
Malignant pleural effusion1 of the 3 light cirteria must be met. Almost always METASTATIC disease. Median survival: 3-6 months. Might do pleurodesis (talc).
Pleural MassMost common = metastatic disease w/ associated effusion. Primary tumors rare but include: Mesothelioma, Solitary Fibrous Tumor. Malignant Mesothelioma.
Malignant MesotheliomaASBESTOS EXPOSURE (7-10% risk w/ exposure). Chest pain, dyspnea, recurrent exudative pleural effusion. 50% mortaltiy.
Solitary Fibrous TumorRare. Originates in pleural surface. Bening in ?80%, malignant in 10-20%.

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