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What is laryngeal carcinoma? Correct Ans-Squamous cell carcinoma arising from epithelial
lining of vocal cord
Risk factors = alcohol and tobacco
Presents with hoarseness; other signs include cough and stridor
Rarely arises from laryngeal papilloma
What is pneumonia? Correct Ans-Infection of the lung parenchyma
Occurs when normal defenses are impaired (ex = cough reflex, damage to mucociliary
elevator (cilia on resp epithelium) due to virus, mucus plugging)
Present with: fever and chills, cough with yellow-green (pus) or rusty sputum (blood),
tachypnea with pleuritic chest pain (d/t bradykinin and prostaglandin E2), decreased breath
sounds with dullness to percussion, elevated WBC count
How is pneumonia diagnosed? Correct Ans--CXR
-sputum gram stain and culture
-blood culture
-3 patterns seen on CXR:
-lobar pneumonia = pneumonia in one lobe
-bronchopneumonia = patchy along small airways
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-interstitial pneumonia = inflammation in interstitium (CT of alveolar air sac) = inc in lung
markings
-lobar + broncho = bacterial
-interstitial = usually not bacterial; viral
What is bronchopneumonia? Correct Ans-Scattered patchy consolidation centered around
bronchioles (multifocal and bilateral)
Caused by bacterial organisms
What is lobar pneumonia? Correct Ans-Consolidation of entire lobe
Most common cause = S. pneumoniae (95%) and Klebsiella pneumoniae**
Gross Phases: 1) Congestion 2) Red Hepatization 3) Gray Hepatization 4) Resolution
What is interstitial pneumonia (aytpical)? Correct Ans-Diffuse interstitial infiltrates
Presents with relatively mild upper respiratory symptoms (min. sputum, low fever)
Causes by bacteria or viruses
What is lobar penumonia? Correct Ans-Consolidation of entire lobe
Usually bacterial (most common cause = S. pneumoniae (95%) and Klebsiella pneumoniae**
Histology = airsacs filled with neutrophils + pink fluffy material
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Four gross phases:
1) Congestion - due to congested blood vessels and edema
2) Red Hepatization - due to exudate, neutrophils, hemorrhage filling the alveolar air spaces,
giving the normally spongy lung a solid consistency
3) Gray Hepatization - due to degredation of red cells within exudate
4) resolution of exudate - lung heals by regenerating (type 2 pneumocytes)
What is bronchopneumonia? Correct Ans-Scattered patchy consolidation centered around
bronchioles
Often multifocal and bilateral
Caused by variety of bacteria
Most common cause - S. aureus
What is interstitial pneumonia (aytpical)? Correct Ans-Diffuse interstitial infiltrates
Presents with relatively mild upper respiratory symptoms (min. sputum, low fever)
Causes by bacteria or viruses
What is aspiration pneumonia? Correct Ans-Seen in pts at risk for aspiration (ex =
alcoholics and comatose pts)
Due to anaerobic bacteria in oropharynx (ex = Bacteroides, Fusobacterium, and
Peptococcus)**
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Classically results in right lower lobe abscess** (right main stem bronchus branches at a less
acute angle than the left)
What is primary tuberculosis? Correct Ans-Inhalation of aerosolized Mycobacterium
tuberculosis
Arises with initial exposure
Results in focal caseating necrosis in the lower lobe of lung and hilar lymph nodes that
undergo fibrosis and calcification, forming Ghon complex
Generally asymptomatic, but leads to + PPD
Histology of Secondary Tuberculosis Correct Ans-Caseating granuloas
AFB stain reveals acid fast bacili
Discuss the systemic spread of secondary tuberculosis Correct Ans-Often occurs
Can involve any tissue
Most common sites -
1. Meninges - base of brain (meningitis)
2. cervical lymph nodes
3. kidney (sterile pyuria)
4. lumbar vertebrae (Pott disease)