path pulmonary 2

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path pulmonary 2
2010-09-28 10:55:32
path pulnonary

path pulmonary 2
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  1. pneumonia that involves more than 1 lobe, more prevalent at extremes of age
  2. strep pneumonia is more common in what lobes?
    lower and middle (cuz strep is in pharyngeal flora)
  3. red hepatization in pneumonia occurs at days ____
  4. gray hepatization in pneumonia occurs in days ____
  5. resolution of pneumonia occurs in day ____
    9 and beyond
  6. Important cause of 2ndary bacterial pneumonia following viral respiratory illnesses. High incidence of complications.
    Associated with right-sided endocarditis
    An important cause of nosocomial pneumonia
    staph aureus
  7. pneumonia that occurs in those with chronic pulmonary diseases. most common cause of acute exacerbation of COPD
    H influenza
  8. Most frequent cause of gram - bacterial pneumonia. Mainly in malnourished persons e.g. chronic alcoholics. Thick and gelatinous sputum is characteristic
    Causes lobar pneumonia with some frequency. (Urge your patients to keep the humidifier water clean.)
  9. pneumonia cause especially in elderly. 2d most common cause of acute exacerbation of COPD
    Moraxella catarrhalis
  10. Associated with infections in cystic fibrosis pts. Common in nosocomial settings
    Common in neutropenic patients, chemotherapy, extensive burns, those requiring mechanical ventilation
  11. walking pneumonia
    same as atypical pneumonias. Chlamidia, Legionella, Mycoplasma
  12. Traced to water of the air-conditioning system. Abrupt onset, high mortality rate.
    Assoc w/ abdominal pain
    Legionella pneumonia
  13. Assoc w/ pet birds, parrots most frequently. a type of chlamidia
    Symptoms are severe: fever, headache, malaise, muscle aches
  14. pneumonia Caused by a spore-forming Gram + bacteria. (Not spread person to person)
    Spores are very resistant to drying
    anthrax pneumonia
  15. Yersinia pestis, a Gram - rod. Occurs either in bubonic form (spread by fleas from infected rats) or as a hemorrhagic pneumonia
    pneumonic plaque
  16. TB causative agent
    • mycobacteria TB. Aerobic, Non spore forming, Non motile bacilli
    • Acid fast (retains the red dye)
  17. Oro-pharyngeal
    TB with draining fistulas is called
  18. Intestinal TB infection may occur by ingestion of unpasteurized milk contaminated w
    mycobacterium bovis
  19. Bone TB infection also occurs with deformation of the spine
    Pott's dz
  20. primary TB localized to
    • lower
    • part of upper lobes or upper part of lower lobes
  21. 2ndary TB localized to
    • apices
    • of upper lobes
  22. miliary TB is part of ______ TB
  23. People undergoing adverse changes in their lives are more susceptible to ____
  24. treatmt for TB
    • Once you start, you have to finish the course of treatment. (9 mos.)
    • huge horse pills, and hard to swallow. No alcohol while you are on INH.
    • Rifampicin turns your secretions pink, including tears. (cannot wear contact lenses.)
  25. pneumocystic pneumonia
    • Caused by P. carinii
    • Common in: pts w/ AIDS, severely malnourished infants , Immuno-suppression
  26. Clinical features: fever, dry cough, and dyspnea
    Diagnosis: bronchoalveolar lavage fluids, biopsy specimen
    CXR: bilateral perihilar and basilar infiltrates
    Pneumocystic pneumonia
  27. alveoli are filled with a characteristic foamy "cotton candy" exudate
    pneumocystic pneumonia
  28. candida fungal infection
    “thrush” in oropharynx. most common of all fungal infections. But rare in the lungs
  29. lesion passes oblique fissure of lung. Granuloma has irregular, red margin, firm, tan-orange center
    Aspergillosis (Aspergillus)
  30. fungus ball
    Fungus ball w/ hyphal elements of Aspergillus in bronchus.
  31. valley fever. Central valley of Cali. Well formed granuloma w/ Langhans giant cell in center. Spherules of fungal cells seen in giant cells.
    Coccidiomycosis (Coccidioides)
  32. Coccidioides spherules contain ______
  33. Fungal pneumonias
    • Actinomycosis (Actinomyces)
    • Nocardia
    • Histoplasmosis (Histoplasma)
    • Coccidiomycosis (Coccidioides)
    • Cryptococosis (Cryptococcus)
    • Blastomycosis (Blastomyces)
    • Candida
    • Aspergillosis (Aspergillus)
  34. fungal infections in normal AND immunosuppressed pts
    • Histoplasmosis (Histoplasma capsulatum): Produces a dz similar to TB. Budding intracellular yeast Coccidioidomycosis (Coccidioides immitis). asymptomatic (60%), progressive pulmon dz or miliary dz
    • Blastomycosis (Blastomyces dermatitidis): progressive pulmonary disease, or rarely, disseminated disease Cryptococcus (Cryptococcus neoformans): rare in normal people. Dissemination to meninges. Pigeon droppings. Budding yeast
  35. Nocardiosis
    bacteria that acts as fungi, acid fast, gram + rod. Lung abscesses.
  36. viral infections of the lung
    • Cytomegalovirus (CMV)
    • Measles
    • Varicella
    • Herpes
    • Adenovirus
  37. common pathogens of respiratory tract
    • Orthomyxovirus--influenza
    • Paramyxovirus--measles, parainfluenza, respiratory syncytial virus
    • Picornavirus--rhinovirus,enterovirus, Coxsackie B, echovirus
    • Coronavirus
    • Adenovirus (encephalitis, insect-spread)
    • Herpes type viruses--
  38. Viral pneumonia w/ interstitial lymphatic infiltrates but no...
    alveolar exudates, therefore no productive cough
  39. CMV histo features
    large cells w/ large violet intranuclear inclusions w/ small clear halo. Basophilic stippling can be seen in cytoplasm
  40. lipid pneumonia
    endogenous, foamy lipid laden macrophages in alveolar spaces. Lipid from breakdown of blood and lung from distal site of obstructive process. golden pneumonia
  41. exogenous lipid pneumonia
    lipidvacuoles appear mainly along airways. Fatty materials aspirated into bronchial tree
  42. 95% of primary lung tumors arise from
    bronchial epithelium
  43. most common benign lung lesions are
    hamartomas: "coin" lesions
  44. hamartoma features
    • consist mainly of mature cartilage admixed with fat, fibrous tissue, and blood vessels
    • most are smaller than 2cm. some calcification --> picked up by radiography
    • sharply circumscribed lesions, lobulated nodules
    • nodules of hyaline cartilage separated by connective tissue lined by respiratory epithelium
  45. peak incidence of lung cancer occurs at ages...
  46. squamous cell carcinoma also called
    called epidermoid carcinoma,as well as bronchogenic carcinoma. non small cell carcinoma
  47. begin as central masses and grow into the peripheral parenchyma. It may undergo cavitary necrosis during intrapulmonary spread
    squamous cell carcionmas
  48. pink cytoplasm w/ distinct cell borders, intercellular bridges, resemble normal cells
    well differentiated squamous cell carcinoma
  49. poorly/less differentiated squamous cell carcinomas have what feature?
    dark mitotic figures
  50. most common in patients < 45 years, weakest association with smoking
    more peripherally located, many arising in relation to lung scars “scar carcinomas”
    grow slowly and form smaller masses, tend to metastasize widely at an early stage
    irregular border, tan or grey cut surface, causes puckering of overlying pleura
  51. Involves peripheral parts of lung. Poor prognosis due to early metastasis
    Undifferentiated neoplasms that lack cytologic differentiation
    large cell carcinoma
  52. histo features of large cell carcinoma
    • cells are large and anaplastic: multinucleated “giant cell carcinoma”, “spindle cell carcinoma”
    • a mixture of both (“spindle and giant cell carcinoma”)
  53. usually metastasized by the time of diagnosis, treated by chemotherapy
    Formerly called “oat cell carcinoma”.
    highest association with smoking and are the really wicked lung malignancies
    small cell carcinoma
  54. features of small cell carcinoma
    • Centrally located w/ extension into lung parenchyma
    • tumor cells are markedly fragile and often show fragmentation and “crush artifact” in biopsy
    • Nuclear molding resulting from close apposition of tumor cells that have scant cytoplasm
    • derived from neuroendocrine cells of the lung
    • dark blue cells w/ minimal cytoplasm, packed in sheets. Finely granular nuclear chromatin
  55. invade brachial or cervical sympathetic plexus to cause severe pain in the distribution of the ulnar nerve or to produce Horner syndrome (ipsilateral enophthalmos, ptosis, meiosis, and anhidrosis)
    apical neoplasms
  56. Pancoast tumors, and combo of clinical findings is known as Pancoast syndrome
    apical neoplasms
  57. Pancoast tumor is often accompanied by destruction of
    1st and 2nd ribs and sometimes thoracic vertebrae
  58. paraneoplastic syndromes
    • 1. hypercalcemia caused by secretion of a parathyroid hormone-related peptide
    • 2. Cushing syndrome (from increased production of adrenocorticotropic hormone)
    • 3. syndrome of inappropriate secretion of antidiuretic hormone (SIADH)
    • 4. neuromuscular syndromes, including a myasthenic syndrome, peripheral neuropathy, and polymyositis
    • 5. finger clubbing (hypertrophic osteoarthropathy)
    • 6. hematologic manifestations: migratory thrombophlebitis, nonbacterial endocarditis, and DIC (disseminated intravascular coagulation)
  59. Cannonball look on lung
    cancer metastasis to lung
  60. arises in pleura. exposure to asbestos (shipyard workers, miners) . often 25 to 40 years after exposure
    malignant mesothelioma
  61. pleural fibrosis and hyaluronan deposition. thick, firm, white pleural tumor tissue. asbestos exposure only or combined w/ smoking
    malignant mesothelioma
  62. lung tumor staging
    • Stage I: tumor without metastasis; or tumor less than 3 cm with metastasis to local hilar lymph nodes only.
    • Stage II: tumor larger than 3 cm with local hilar lymph node metastases only.
    • Stage III: tumor w/in 2 cm of the carina or invading adjacent structures outside the lung; tumor of any size with metastasis to mediastinal lymph nodes or distant metastases
  63. 5-year Survival Rate for lung cancer (after therapy)
    • Stage I 50%
    • Stage II 20%
    • Stage III 5%
  64. encodes for a transcription factor that regulates expression of 15% of all genes. It recruits histone acetyltransferases (HATs)
    Myc gene
  65. tumor suppressor gene regulating the cell cycle (G1 DNA damage checkpt). Guardian of the genome