-
pneumonia that involves more than 1 lobe, more prevalent at extremes of age
bronchopneumonia
-
strep pneumonia is more common in what lobes?
lower and middle (cuz strep is in pharyngeal flora)
-
red hepatization in pneumonia occurs at days ____
1-3
-
gray hepatization in pneumonia occurs in days ____
4-8
-
resolution of pneumonia occurs in day ____
9 and beyond
-
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
-
pneumonia that occurs in those with chronic pulmonary diseases. most common cause of acute exacerbation of COPD
H influenza
-
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.)
Klebsella
-
pneumonia cause especially in elderly. 2d most common cause of acute exacerbation of COPD
Moraxella catarrhalis
-
Associated with infections in cystic fibrosis pts. Common in nosocomial settings
Common in neutropenic patients, chemotherapy, extensive burns, those requiring mechanical ventilation
pseudomonas
-
walking pneumonia
same as atypical pneumonias. Chlamidia, Legionella, Mycoplasma
-
Traced to water of the air-conditioning system. Abrupt onset, high mortality rate.
Assoc w/ abdominal pain
Legionella pneumonia
-
Assoc w/ pet birds, parrots most frequently. a type of chlamidia
Symptoms are severe: fever, headache, malaise, muscle aches
Psittacosis
-
pneumonia Caused by a spore-forming Gram + bacteria. (Not spread person to person)
Spores are very resistant to drying
anthrax pneumonia
-
Yersinia pestis, a Gram - rod. Occurs either in bubonic form (spread by fleas from infected rats) or as a hemorrhagic pneumonia
pneumonic plaque
-
TB causative agent
- mycobacteria TB. Aerobic, Non spore forming, Non motile bacilli
- Acid fast (retains the red dye)
-
Oro-pharyngeal
TB with draining fistulas is called
scrofula
-
Intestinal TB infection may occur by ingestion of unpasteurized milk contaminated w
mycobacterium bovis
-
Bone TB infection also occurs with deformation of the spine
Pott's dz
-
primary TB localized to
- lower
- part of upper lobes or upper part of lower lobes
-
-
miliary TB is part of ______ TB
2ndary
-
People undergoing adverse changes in their lives are more susceptible to ____
TB
-
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.)
-
pneumocystic pneumonia
- Caused by P. carinii
- Common in: pts w/ AIDS, severely malnourished infants , Immuno-suppression
-
Clinical features: fever, dry cough, and dyspnea
Diagnosis: bronchoalveolar lavage fluids, biopsy specimen
CXR: bilateral perihilar and basilar infiltrates
Pneumocystic pneumonia
-
alveoli are filled with a characteristic foamy "cotton candy" exudate
pneumocystic pneumonia
-
candida fungal infection
“thrush” in oropharynx. most common of all fungal infections. But rare in the lungs
-
lesion passes oblique fissure of lung. Granuloma has irregular, red margin, firm, tan-orange center
Aspergillosis (Aspergillus)
-
fungus ball
Fungus ball w/ hyphal elements of Aspergillus in bronchus.
-
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)
-
Coccidioides spherules contain ______
endospores
-
Fungal pneumonias
- Actinomycosis (Actinomyces)
- Nocardia
- Histoplasmosis (Histoplasma)
- Coccidiomycosis (Coccidioides)
- Cryptococosis (Cryptococcus)
- Blastomycosis (Blastomyces)
- Candida
- Aspergillosis (Aspergillus)
-
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
-
Nocardiosis
bacteria that acts as fungi, acid fast, gram + rod. Lung abscesses.
-
viral infections of the lung
- Cytomegalovirus (CMV)
- Measles
- Varicella
- Herpes
- Adenovirus
-
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--
-
Viral pneumonia w/ interstitial lymphatic infiltrates but no...
alveolar exudates, therefore no productive cough
-
CMV histo features
large cells w/ large violet intranuclear inclusions w/ small clear halo. Basophilic stippling can be seen in cytoplasm
-
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
-
exogenous lipid pneumonia
lipidvacuoles appear mainly along airways. Fatty materials aspirated into bronchial tree
-
95% of primary lung tumors arise from
bronchial epithelium
-
most common benign lung lesions are
hamartomas: "coin" lesions
-
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
-
peak incidence of lung cancer occurs at ages...
55-65
-
squamous cell carcinoma also called
called epidermoid carcinoma,as well as bronchogenic carcinoma. non small cell carcinoma
-
begin as central masses and grow into the peripheral parenchyma. It may undergo cavitary necrosis during intrapulmonary spread
squamous cell carcionmas
-
pink cytoplasm w/ distinct cell borders, intercellular bridges, resemble normal cells
well differentiated squamous cell carcinoma
-
poorly/less differentiated squamous cell carcinomas have what feature?
dark mitotic figures
-
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
adenocarcinoma
-
Involves peripheral parts of lung. Poor prognosis due to early metastasis
Undifferentiated neoplasms that lack cytologic differentiation
large cell carcinoma
-
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”)
-
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
-
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
-
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
-
Pancoast tumors, and combo of clinical findings is known as Pancoast syndrome
apical neoplasms
-
Pancoast tumor is often accompanied by destruction of
1st and 2nd ribs and sometimes thoracic vertebrae
-
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)
-
Cannonball look on lung
cancer metastasis to lung
-
arises in pleura. exposure to asbestos (shipyard workers, miners) . often 25 to 40 years after exposure
malignant mesothelioma
-
pleural fibrosis and hyaluronan deposition. thick, firm, white pleural tumor tissue. asbestos exposure only or combined w/ smoking
malignant mesothelioma
-
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
-
5-year Survival Rate for lung cancer (after therapy)
- Stage I 50%
- Stage II 20%
- Stage III 5%
-
encodes for a transcription factor that regulates expression of 15% of all genes. It recruits histone acetyltransferases (HATs)
Myc gene
-
tumor suppressor gene regulating the cell cycle (G1 DNA damage checkpt). Guardian of the genome
p53
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