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*meconium ileus: Obstruction of the intestine in a new-born baby with CYSTIC FIBROSIS due to failure of digestion of the…

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  1. 1ileus; a painful obstruction of the ileum or other part of the intestine. *Ileus: is a surgical emergency that may or may not require surgical intervention.meconium ileus:
    ileus in the newborn due to intestinal obstruction by thick meconium.
    -meconium;(صمغي
    mucilaginous)the dark green substance forming the first feces passed by the newborn.
  2. 2—*meconium ileus:
    Obstruction of the intestine in a new-born baby with CYSTIC FIBROSIS due to failure of digestion of the MECONIUM which becomes very firm and packs the lower ILEUM with a (المعجون )putty-like material. There is vomiting and distention. Surgery may be needed to remove the obstructed section of the bowel.    *meconium ileus: Obstruction of the intestine in a new-born baby with CYSTIC FIBROSIS due to failure of digestion of the MECONIUM which b...
  3. 3- Patients with cystic fibrosis usually have lung infections with bacteria such as Pseudomonas, not opportunistic agents. The immune system is intact with cystic fibrosis, it is just not getting help from lung function.-Pneumonias with cystic fibrosis are unlikely to produce pneumothorax. No bullae(a bubblelike cavity filled with air or fluid, in particular) form.
  4. 4-Pleural plaques are most frequently seen with pneumoconioses. -The incidence of lung cancer(e,g adenocarcinoma) is not increased with cystic fibrosis.*The chronic lung disease of cystic fibrosis often includes bronchiectasis(abnormal widening of the bronchi or their branches, causing a risk of infection).
  5. 5-bronchiectasis; a disease characterized by inflammation with obstruction and dilation and destruction of bronchi. This process is diffuse throughout the lungs. The loss of pulmonary vascular bed with progressive bronchiectasis can lead to pulmonary hypertension and cor pulmonale. The sweat chloride=screening test, and can be applied as well as immunoreactive trypsinogen, to select for additional genomic testing according to presence of cystic fibrosis.*CFTR;
    cystic fibrosis transmembrane regulator.
    -CFTR mutations cause cystic fibrosis and bilateral aplasia of the vas deferens.
    -functions as a chloride channel and controls the regulation of other transport pathways.
  6. 6-Legionella can produce a florid pneumonia, typically in all lobes, but it is not common. -S. aureus is more likely to be a nosocomial infection and more likely to produce a bronchopneumonia with patchy infiltrates.- having a lobar pneumonia, which is most often a community aquired pneumonia (the nursing home counts as a community venue), following a debilitating course of Alzheimer disease. The most common organism is Streptococcus pneumoniae (pneumococcus).
  7. 7-Viral pneumonias are common in the elderly but produce interstitial pneumonitis with non-productive cough. However, viral pneumonias are often complicated by bacterial pneumonia.-Tuberculosis produces a granulomatous pattern of infection. In an adult, reinfection or reactivation is the most likely pattern, with upper lobe involvement.
  8. 8-Cryptococcus neoformans; Cryptococcal infections typically occur more frequently in immunocompromised persons.-Listeria monocytogenes;
    Listeriosis is infrequent. Some cases occur in immune compromised persons. It can be a congenital infection. It can be a food or water contaminant.
  9. 9- Pneumocystis jiroveci (carinii) pneumonia is most often seen in immunocompromised patients and is typically bilateral and widespread in the lungs.-A hypersensitivity pneumonitis:
    occurs in response to an inhaled antigen and produces small areas of interstitial inflammation throughout the lungs. Lymph nodes are not enlarged.
  10. 10-Mycobacterium tuberculosis infection; asymptomatic and the infection goes unnoticed, This is a description of the typical 'Ghon complex' of an initial, or primary, TB infection. The peripheral granuloma does not produce symptoms, but the enlarged lymph nodes may impinge(cause a negative impact) upon airways.-A carcinoid tumor could produce focal obstruction with a pneumonia, but pulmonary neoplasms in children are rare. Most bronchial carcinoids act in a benign fashion without metastases.
  11. 11- In children, congenital heart disease is the most likely risk factor for infective endocarditis, and most of these lesions will involve the left heart, with systemic embolization. Even if right-sided vegetations embolize, there should be multiple abscesses present.-Goodpasture syndrome is rare at this age, and the pattern is that of diffuse pulmonary hemorrhage with hemoptysis(the coughing up of blood).
  12. 12nursing home: دار رعاية المسنين. diaphoretic;متعرق.-Pulmonary edema;
    does not have this sudden an onset. The edema could result in dyspnea and a cough with frothy sputum. Orthopnea would be a signficant finding with pulmonary edema. A thromboembolus may lead to right-sided heart failure with peripheral edema.
  13. 13-An effusion: would take days to weeks to form. There could be increasing dyspnea. A thromboembolus could lead to right-sided heart failure and peripheral edema with effusions, but the patient would have to survive the initial embolic event.- Post-operative changes(like Atelectasis) should have resolved after a week or so and would have a course of gradual improvement.
  14. 14-Thromboembolus; The activity of ambulation(التمشي) resulted in embolization of a thrombus that formed during his period of immobilization in leg or pelvic veins. The thrombus became an embolus and traveled up the vena cava, through the right heart, and to the pulmonary arterial tree of the lungs.-Diffuse alveolar damage(DAD):
    occurs following any severe lung injury. It does not have a sudden onset. It does not occur in patients who are up and about[Moving around, especially after a period of injury, illness, or inactivity].
  15. 15-hilar lymphadenopathy: enlargement of the tracheobronchial and pulmonary lymph nodes. -lymphadenopathy: An enlargement of the lymph nodes, usually associated with disease.Sarcoidosis:
    is typified by non-caseating granulomas. However, culture of the tissue and a careful search histologically should be made for organisms before beginning therapy with corticosteroids. Extensive granulomatous disease can produce a restrictive pattern of pulmonary disease.
  16. 16-Berylliosis:[poisoning by beryllium or beryllium compounds, especially by inhalation causing fibrosis of the lungs]. **Though chronic berylliosis can produce sarcoid-like granulomas, it is very rare. An environmental history of exposure would be helpful, and she does not have this history.-miliary(دخني):
    (of a disease) accompanied by a rash with lesions resembling millet seed.
    ** miliary Tuberculosis:
    A military pattern of tuberculosis could produce a diffuse reticulonodular pattern, but the granulomas of tuberculosis are typically caseating, especially with poor immune response that allows miliary spread.
  17. 17*Extrinsic allergic alveolitis: Persistent exposure to allergens may lead to 'farmer's lung' with small granulomas representing type IV hypersensitivity, but there is no good occupational history in this case.-Adenocarcinomas should yield malignant cells, not granulomas, on biopsy. The radiograph should show a focal area of involvement.
  18. 18-Histoplasmosis: is most common in the Mississippi and Ohio river valleys in the US. The dimorphic fungi tend to mimic tuberculosis and can have granulomas with central caseation.-Positive antinuclear antibody test:
    A positive ANA can be associated with autoimmune diseases such as SLE. There is often type III hypersensitivity with deposition of antigen-antibody complexes at basement membranes, producing serositis and effusions, such as pleural effusions.
  19. 19-serum ceruloplasmin test is related to Wilson disease, that affects the liver with chronic hepatitis/cirrhosis and the basal ganglia of the CNS (especially putamen), not the lungs.-sweat chloride test;[for cystic fibrosis].
    Though cystic fibrosis commonly affects the lungs, it leads to the obstructive lung disease known as bronchiectasis.
  20. 20urine nicotine test: *The nicotine would suggest smoking as a risk factor, but it would be unusual for emmphysema to develop by the 5th decade, and the distribution of centrilobular emphysema is primarily in upper lobes.-Decreased serum alpha-1-antitrypsin;
    AAT deficiency leads to lack of an anti-protease, which leads to the development of emphysema, typically a panlobular type affecting lower lobes more severely, and by the 5th decade.
  21. 21positive urine opiates; Intravenous drug users are at greater risk for infections and abscesses. The injected talc may form small foreign body granulomas in lung.*hyperchromatic nuclei and orange-pink cytoplasm are related to the presence of tumor cells.
  22. 22-Large hilar mass: Both squamous cell and small cell carcinomas, most common in smokers, tend to be central in location. Squamous cell carcinomas of the lung are associated with hypercalcemia, though overall the small cell carcinomas are best known for paraneoplastic syndromes.-This is more typical of adenocarcinoma-in-situ= Pneumonia-like consolidation.
    -Peripheral nodule; Such a peripheral mass would more likely be a granuloma, an adenocarcinoma or a hamartoma.
  23. 23-Carinal compression: The carina is an unusual site for a primary lung tumor, though involvement of lymph nodes may lead to lymphadenopathy in hilar or mediastinal regions.-Left pleural thickening related to mesothelioma.
    -
  24. 24-Bronchopulmonary sequestration; Sequestrations are masses of lung tissue without a normal connection to the airways. They act as space occupying lesions and can cause obstruction. They are congenital anomalies.-Lung abscess:
    A Lung abscesses can result from aspiration of oropharyngeal or nasopharyageal contents, where bacterial organisms as part of normal flora can be transported to the lungs. The straighter bronchus to the right lung is more likely to conduct aspirated material. With septicemia, multiple abscesses are more likely to be present. The infection is often polymicrobial and difficult to treat.
  25. 25-Chronic bronchitis: is a clinical diagnosis made when a patient has a chronic productive cough of copious mucoid sputum in more than 3 months in at least 2 consecutive years.-. Bronchiectasis:
    can occur from bronchial inflammation and destruction following obstruction and/or infection; cystic fibrosis is the best known disease to produce a widespread pattern of bronchiectasis. With obstruction, it depends upon the cause for the obstruction where the focus of bronchiectasis will be
  26. 26-diffuse bilateral pulmonary interstitial infiltrates in all lung fields, non-productive cough with malaise, sputum gram stain reveals normal flora and few neutrophils; Influenza A virus; The typical appearance of a viral lung infection is interstitial inflammation. The inflammatory response is primarily T lymphocytes.-Cryptococcus neoformans:
    is a fungus that leads to granulomatous disease. Though it may occur in immuncompetent hosts, it is best known as an opportunistic infection.
  27. 27-Streptococcus pneumoniae: Pneumococcus leads to alveolar filling with neutrophils, leading to a productive cough with purulent sputum.-TB most often produces a granulomatous pattern of inflammation with reticulonodular densities, particularly in the upper lobes. Clinically apparent disease tends to be chronic.
  28. 28-Mycobacterium avium-complex; MAC may produce poorly-formed granulomas and is more common in immunocompromised hosts.-. Smoking remains the most frequent cause of lung cancer. Lung cancer does, however, occur in nonsmokers. A small cell anaplastic carcinoma, as in this patient, is virtually always seen in smokers. Small cell cancers arise in the central portion of the lung but are aggressive neoplasms that spread quickly.
  29. 29-Silicosis increases the risk for lung cancer slightly by about 2 fold. -Radon gas exposure; is probably the second leading cause of lung cancer. However, most cases of lung cancer in which exposure to radon gas has been identified also occur in smokers. Passive smoking could probably be right behind radon exposure as the second leading cause for lung cancer.-asbestos exposure increases the risk for lung cancer in smokers even more.
    -Though chronic bronchitis is most likely to occur in smokers, it is not by itself a preneoplastic condition.
  30. 30-patchy infiltrates in both lungs, Cryptosporidium parvum organisms are found in a stool specimen, BAL(bronchoalveolar lavage) specimen yielding fluid that demonstrates pink, foamy exudate with little inflammation;*Lung disorders such as pneumonia, silicosis, asbestosis and cystic fibrosis often cause the air sacs or alveoli to fill with fluids comprised of white blood cells, cancer cells, pus, proteins or blood. These substances are called infiltrates. Depending on the severity of the condition, these infiltrates can involve a small area of the lung causing minor symptoms or completely fill an entire region of the lung causing a serious, life-threatening condition.
  31. 31-Branching septate hyphae is related to Aspergillus fungi, Aspergillus often produces a fungus ball, or a defined mass, rather than infiltrates. It does not produce an acellular exudate.-scant: barely sufficient or adequate.
    [scant cytoplasm].
  32. 32-Acid fast bacilli; Mycobacterial infection is unlikely in this setting, for there is still typically caseous necrosis and even poorly formed granulomas in an immunocompromised person with M. tuberculosis. M. avium-complex is less likely to produce florid pulmonary disease.-Multiple cysts with GMS stain; He is most likely to have Pneumocystis jiroveci pneumonia in association with the acquired immunodeficiency syndrome (AIDS). Note his lymphopenia from the very low CD4 count. PCP infection produces an exudate composed of the Pneumocystis cysts and trophozoites with little accompanying inflammation. The clinical findings in this case are typical as well.
  33. 33Hemosiderin-laden macrophages related to; Pulmonary hemorrhage in the setting of AIDS is not common. The clinical features suggest an acute infection.-Short gram positive rods suggest listeriosis, a disease that can sometimes be seen in immunocompromised persons, but it is not common, and it produces focal abscesses or small granulomas, not foamy exudate.
  34. 34* GMS stain; Grocott-Gomori methenamine-silver stain.episodes of pneumonia with Streptococcus pneumoniae and Klebsiella pneumoniae cultured, septicemia and brain abscess and he dies, mucus gland hypertrophy, 5 years smoking history, he has had a cough productive of copious amounts of mucoid sputum for over 3 months;
    Chronic bronchitis.
  35. 35-Centrilobular emphysema; As a smoker, he is at risk for development of emphysema, but this does not explain his sputum production. Sometimes, smokers have elements of both emphysema and chronic bronchitis.- Panlobular emphysema:
    Smoking can lead to severe bullous emphysema that can eventually involve a large amount of lung tissue, but a true panlobular pattern of emphysema is more typical for condtions such as alpha-1-antitrypsin deficiency.
  36. 36-Bronchiectasis is not a typically complication of smoking. -Bronchial asthma; Attacks of asthma are quite intermittent, and there is usually not a great amount of sputum production.-Chronic bronchitis:
    is defined clinically as persistent cough with sputum production for at least 3 months in at least 2 consecutive years. Air pollution and smoking are key causes for chronic bronchitis. The alteration of lung parenchyma predisposes to superimposed infection, typically with bacterial organisms.
  37. 37-congestive heart failure will produce pulmonary edema, if it is primarily left heart failure. If severe, there can be 'rusty' colored sputum.-Small cell carcinoma:
    Though lung cancers are more common in persons who smoke, his findings are not explained by a mass lesion, and his symptoms have persisted for years.
  38. 38-bilateral diaphragmatic pleural plaques with focal calcification as well as diffuse interstitial lung disease, sputum shows only ferruginous bodie, low FVC and a normal FEV1/FVC ratio; Asbestos crystals.- Fumes with iron particles;
    Increased iron in the lung is an uncommon form of pneumoconiosis. It is more likely to occur with hemochromatosis with iron overload.
  39. 39-Byssinosis: a lung disease caused by prolonged inhalation of textile fiber dust. *Byssinosis produces an asthma-like disease.Silica dust; Silicosis more typically produces a pattern of silicotic nodules in lung. Ferruginous bodies would not be present. Inorganic dusts often produce interstitial fibrosis.
  40. 40* exposure to asbestos. Pleural plaques are more frequent in this condition than in other pneumonconioses, particularly with calcification. Asbestosis is a rare form of pneumoconiosis that can lead to restrictive lung disease. The ferruginous bodies are asbestos fibers encrusted with iron. Building materials from older houses may contain asbestos, which was used for years because of its fire retardant properties.- Chronic berylliosis produces sarcoid-like granulomatous disease. An acute pneumonitis acutely occurs with fumes containing beryllium. This element is used in metalworking.
  41. 41-Black mold spores: Mold spores produce an extrinsic allergic alveolitis, which rarely is severe enough to produce chronic lung disease. It does not produce pleural plaques.Hgb A1C is 10%, smoker for 40 years, body mass index of 35, Auscultation of his chest reveals rales in lower lung fields bilaterally, A chest x-ray shows bilateral lower lobe infiltrates and a prominent left heart border;
    Edema.
  42. 42Though he is a smoker, emphysema would lead to alveolar loss and decreased in lung markings, not infiltrates. He would be at greater risk for right heart failure from emphysema.emphysema= no infiltrates,
    atelectasis= no infiltrates.
  43. 43-atelectasis should produce decreased breath sounds and lung collapse, not infiltrates.Fibrosis; He does not have findings of a restrictive lung disease which would produce a prominent right heart border on x-ray from pulmonary hypertension.
  44. 44Pneumonia: He does not have a fever or cough or other signs of infection.*He has multiple risk factors for ischemic heart disease leading to left heart failure and pulmonary edema.
  45. 45cough with hemoptysis along with pleuritic chest pain for the past 2 weeks, bilateral and predominantly upper lobe reticulonodular pattern of infiltrates with cavitation, sputum shows epithelioid cells with necrotic debris; Acid fast bacilli.-Pleomorphic cells with dark, angular nuclei;
    A squamous cell carcinoma is usually a central mass lesion. It is unlikely that epithelioid cells would appear on biopsy.
  46. 46Branching, septated hyphae; Aspergillus infection is not common. It is more likely to produce a fungus ball. Persons who are neutropenic are at greatest risk. The inflammatory reaction could vary from acute to mixed to granulomatous.-lusters of small RBC-sized cysts staining with GMS;
    PCP in rare cases has a granulomatous pattern, but the granulomas would be small and unlikely to lead to hemoptysis.
  47. 47-Large cells with intranuclear inclusions; Intranuclear inclusions suggest infection with a herpesvirus, and the largest cell enlargement occurs with cytomegalovirus. They are unlikely to be found along with epithelioid cells.inclusions:
    a body or particle recognizably distinct from the substance in which it is embedded.
  48. 48*The hemoptysis suggests that the granulomas have eroded enough parenchyma and involved a bronchus. A granulomatous reaction is typical for Mycobacterium tuberculosis infection.onc
  49. 49-Cryptosporidium parvum: infection is of particular concern in immunocompromised patients, where diarrhea can reach 10–15 l per day. - generally self-limiting in immunocompetent people. In immunocompromised patients,or those undergoing immunosuppressive therapy, infection may not be self-limiting, leading to dehydration and, in severe cases, death.*C. parvum:
    is considered to be the most important waterborne pathogen in developed countries.
  50. 50-GMS stain: Gomori-Grocott methenamine silver stain. A chromic acid, sodium bisulfite stain used in histology and cytology to identify fungi and Pneumocystis carinii.-Cryptosporidium parvum indicate having AIDS.
    **Pneumocystis jiroveci pneumonia:
  51. 51PCP: Pneumocystis carinii [now P. jiroveci] pneumonia. PCP infection produces an exudate composed of the Pneumocystis cysts and trophozoites with little accompanying inflammation.weight loss over the past 3 months, non-productive cough, and dyspnea for the past 3 days. His temperature is 38.2°C, diffuse rales in both lungs on auscultation,
    patchy infiltrates in both lungs.
    **CD4 lymphocyte count is 79/microliter= lymphopenia.
    = Multiple cysts with GMS stain.
  52. 52- 64-year, 90 pack year history of smoking, For past 5 years, had a cough productive of copious amounts of mucoid sputum for over 3 months at a time. episodes of pneumonia with Streptococcus pneumoniae and Klebsiella pneumoniae cultured. His last episode of pneumonia is complicated by septicemia and brain abscess and he dies.=Chronic bronchitis.
    is defined clinically as a persistent cough with sputum production for at least 3 months in at least 2 consecutive years. **Air pollution and smoking are key causes for chronic bronchitis.
    The alteration of lung parenchyma predisposes to superimposed infection, typically with bacterial organisms.
  53. 53-66-year, dyspnea for the past year, retired from the construction business, some rales auscultated in both lungs on physical examination, A chest radiograph reveals bilateral diaphragmatic pleural plaques with focal calcification as well as diffuse interstitial lung disease, A sputum cytology shows no atypical cells, only ferruginous bodies.=Asbestos crystals, Pleural plaques are more frequent in this condition than in other pneumonconioses, particularly with calcification. Asbestosis is a rare form of pneumoconiosis that can lead to restrictive lung disease. The ferruginous bodies are asbestos fibers encrusted with iron. Building materials from older houses may contain asbestos, which was used for years because of its fire retardant properties.
  54. 54- 58-year,smoker for 40 years, orthopnea over the past year, afebrile, A chest x-ray shows bilateral lower lobe infiltrates and a prominent left heart border, Hgb A1C is 10%. = multiple risk factors for ischemic heart disease leading to left heart failure and pulmonary edema.-hemoglobin A1c:
    hemoglobin A with a glucose group attached to the amino terminal of the beta chain. It accounts for 3-6% of the total hemoglobin in a normal person and up to12 % in persons with diabetes mellitus.
    Increased levels correlate with glucose intolerance in diabetics.
  55. 55--glycated hemoglobin (glycosylated hemoglobin): any of various hemoglobins with glucose attached nonenzymatically; the most common one is hemoglobin A1c. The percentage of hemoglobin that is glycosylated can be assessed over a long period of time as a gauge of blood sugar control; ** the normal range for a nondiabetic person is between 4-6%.-47-year, lost 6 kg in 5 month, had a cough with hemoptysis along with pleuritic chest pain for the past 2 weeks. his temperature is 37.5°C,
    A chest x-ray reveals a bilateral and predominantly upper lobe reticulonodular pattern of infiltrates with cavitation,
    A sputum sample shows epithelioid cells with necrotic debris.
    =Acid fast bacilli.
  56. 56-Intranuclear inclusions: suggest infection with a herpesvirus, and the largest cell enlargement occurs with cytomegalovirus. They are unlikely to be found along with epithelioid cells.-Branching, septated hyphae= fungus infection.
    Aspergillus infection is not common.
    It is more likely to produce a fungus ball. Persons who are neutropenic are at greatest risk. The inflammatory reaction could vary from acute to mixed to granulomatous.
  57. 57**Neutropenia: abnormally low level of neutrophils in the blood. sometimes called agranulocytosis or granulocytopenia because neutrophils make up about 60% of WBCs and have granules inside their cell walls. **Neutropenia is a serious disorder because it makes the body vulnerable to bacterial and fungal infections.granulomas would be small and unlikely to lead to hemoptysis.
    ** hemoptysis suggests that the granulomas have eroded enough parenchyma and involved a bronchus. A granulomatous reaction is typical for Mycobacterium tuberculosis infection.
  58. 58-Intrinsic asthma, usually seen in middle aged adults. *20-year, dyspneic with right-sided chest pain, breath sounds are absent over the right lung fields, mediastinum is shifted to the left, and there are no fractures, A thoracentesis on the right yields a rush of air.= Distal acinar emphysema:
    Distal acinar (paraseptal) emphysema is not common, but does account for a significant number of cases of spontaneous pneumothorax in young persons. It is not related to smoking. There are subpleural bullae that can burst, even with minimal trauma. They may be multiple, accounting for recurrent episodes. However, the total amount of lung involved is minimal, so pulmonary function tests will be normal between episodes.
    **He developed a tension pneumothorax in this case.
  59. 59-30-year, accident, placed on a mechanical ventilator, He has progressively decreasing oxygen saturations despite increasing PEEP and FIO2 content of 100%,He remains afebrile, He dies 3 days later. At autopsy, the distal lungs show pink hyaline membranes, thickened interstitium, and many macrophages but few neutrophils:= Diffuse alveolar damage.
    (or ARDS as it is known clinically) is the final event following severe lung injury from a variety of serious illnesses or accidents.
    In this case, it was probably initiated by the hypotension ('shock lung') and potentiated by the 100% oxygen generating free radical damage.
  60. 60- 51-year, slight cough he has had for a week, He is a non-smoker, On auscultation of the chest his lung fields are clear, A chest radiograph shows a subpleural 'coin lesion' 2 cm in diameter in the right upper lobe.=Granuloma.
    The differential diagnosis of a solitary peripheral coin lesion most often includes lung cancer (adenocarcinoma most likely), granuloma, or hamartoma. Many people have had a remote, subclinical tubercular or fungal infection leaving only a solitary granuloma. In this case the cough suggests possible active infection, but it may just be an incidental, unrelated finding.
  61. 61*subclinical infection: infection associated with no detectable symptoms but caused by microorganisms capable of producing easily recognizable diseases, such as poliomyelitis or mumps; this may occur in an early stage of the infection, with signs and symptoms appearing later during the course of the infection, or the symptoms and signs may never appear. **It is detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.**It is detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.
  62. 62-61-year, cough without production of much sputum for the past week, afebrile. decreased breath sounds at the right lung base, A chest x-ray reveals an area of consolidation in the right lower lobe. no response to antibiotic therapy, and his cough continues. A bronchoalveolar lavage yields atypical cells along with scattered alveolar macrophages.Adenocarcinoma-in-situ:
    can spread in a pneumonia-like pattern. The lack of a change over time and the absence of a response to antibiotics should suggest an underlying non-infectious process.
    Adenocarcinomas may occur in non-smokers.
  63. 63- atypical pneumonia with Mycoplasma pneumonia, e.g, would not yield atypical cells. It could respond to antibiotic therapy, such as erythromycin.- 25-year,receives a hematopoietic stem cell transplant for treatment of acute myelogenous leukemia, increasing dyspnea 3 weeks later, along with fever and cough. temperature is 37.8°C. A chest radiograph shows irregular interstitial infiltrates. A bronchoalveolar lavage shows cells that are enlarged and have prominent intranuclear inclusions.
  64. 64-CMV infection occurs most often with immune compromise, as in this case folowing transplantation before engraftement.-54-year, fever and dyspnea for a month along with a 2 kg weight loss. 37.7°C.
    A chest radiograph shows a reticulonodular pattern along with prominent hilar lymphadenopathy,
    microscopic examination shows no viral inclusions, no fungi, no acid fast bacilli, and no atypical cells.
    =Sarcoidosis.
  65. 65-symptoms and signs are classic for granulomatous disease. Sarcoidosis often involves the hilar lymph nodes as well. No organisms can be found.-UIP:
    is a form of restrictive lung disease with interstitial fibrosis, and without lymphadenopathy.
  66. 66-59-year,cigarette smoker for the past 42 years, blood-streaked sputum on coughing during the past week,back pain. A chest radiograph shows a small 3 cm right hilar mass with several 1 to 2 cm peripheral lung nodules. A bone scan reveals multiple areas of increased uptake in the vertebrae, ribs, and pelvis. A sputum cytology reveals the presence of clusters of small cells having hyperchromatic nuclei and almost no cytoplasm. -Serum sodium of 113 mmol/L.small cell anaplastic carcinoma with widespread metastases. The syndrome of inappropriate ADH.
    [hyponatremia is one form of paraneoplastic syndrome seen with this particular carcinoma].
    *ADH:antidiuretic hormone.
  67. 67-Thrombocytopenia is not a feature of a paraneoplastic syndrome.- 40-year, high fever for a week, accompanied by a cough productive of yellowish sputum. temperature is 38.2°C. diffuse rales in all lung fields. Her chest radiograph reveals patchy infiltrates in all lung fields, and there is a 4 cm rounded area of consolidation in the left upper lobe that has an air-fluid level. sputum Examination reveals numerous neutrophils.
    = Staphylococcus aureus.
  68. 68-Pulmonary abscesses typically have an air-fluid level from liquefactive necrosis caused by the collection of neutrophils. More virulent bacterial organisms such as Staphylococcus aureus are likely to cause such a complication of a bronchopneumonia.-consolidation in Imaging:
    ↑ in radiologic density of an air-filled space, due to accumulation of fluid and WBCs, as occurs in the lungs in acute pneumonia.
    **-solidification, said especially of the lung as it fills with fibrinous exudate in pneumonia.
  69. 69-Mycoplasma pneumoniae typically produces patchy infiltrates, but abscess formation is not likely to occur, and the process is more interstitial with mononuclear cells.-60-year, 7 cm area of golden-yellow consolidation on sectioning of the left lung. this area has alveoli filled with foamy macrophages:
    Squamous cell carcinoma.
  70. 70-Most squamous cell carcinomas: are located centrally and arise in bronchi, leading to obstruction of a large airway that can cause a distal lipid pneumonia. In this case, the breakdown of lung tissue distal to the mass yields an 'endogenous lipid pneumonia' with many macrophages. Some degree of atelectasis may also be present from air resorbtion distal to the obstruction.-lobar pneumonia:
    -acute bacterial pneumonia with edema, usually in one lung; the most common type is pneumococcal p.
    -endogenous-lipid pneumonia:
    focal alveolar accumulations of foamy, lipid-filled macrophages which may impede alveolar clearance.
  71. 71-2-year, acute onset of dyspnea and wheezing, coughs up a large, thick mucus plug, for the past 4 years, T: 37.1°C, P 109/minute, RR 40/minute, and BP 90/60 mm Hg. There are decreased breath sounds in all lung fields. A chest radiograph reveals hyperinflation but no infiltrates, WBC count of 8300/microliter 11 eosinophils. A sputum sample has increased numbers of eosinophils: Bronchial asthma.-In an acute asthmatic episode, there can be an outpouring of mucus which, along with some dehydration, can lead to the formation of mucus plugs.
    These atopic asthmatic episodes in children are usually initiated by a type I hypersensitivity reaction, typically with exposure to an allergen such as pollen from goldenrod or other flowering plant. Up to 10% of children may be affected to some degree by atopy.
  72. 72-Mycoplasma infection produces a primary atypical pneumonia which has a non-productive cough. -Hypersensitivity pneumonitis there is usually no eosinophila and the symptoms last longer than for asthma.-Gastric contents will be liquid to semiliquid material. Aspiration is most typical for persons with neurologic impairment, though it can occur as an accident.
  73. 7341-year, non-smoker, fever, non-productive cough, and dyspnea over the past 3 months. Her symptoms disappeared after a month's vacation, but reappeared when she returned home to take care of her canaries. no abnormal findings. A chest radiograph shows fine diffuse and nodular infiltrates in all lung fields.Antigen-antibody complex formation.
  74. 74-Birds make a lot of organic dust from their feathers. The result upon inhalation of the bird dust is an extrinsic allergic alveolitis. Getting away from the antigen (such as a vacation) will improve the situation. This is a form of type 3 hypersensitivity. It may progress to involve type 4 hypersensitivity if chronic.-63-year,increasing dyspnea for 5 years. lungs are hyper-resonant without dullness. Tactile vocal fremitus is slightly decreased over all lung fields. Scattered expiratory wheezes and inspiratory rhonchi are present without basal crackles. chest radiograph that reveals increased lung volumes and flattening of the diaphragmatic. Spirometry demonstrates an FEV1 that is decreased more than the FVC so that the FEV1/FVC ratio is less than 70% of normal:
    Nicotine.
  75. 75-She has findings of emphysema, and smoking is the most likely underlying cause. The nicotine in the cigarette smoke is chemotactic for neutrophils, and cigarette smoke activates the alternative complement pathway, releasing more mediators for neutrophil recruitment. Neutrophil elastase can damage the lung parenchyma. [Though neutrophils are not numerous in the lung with emphysema, the cumulative effect of even small numbers of neutrophils over many years leads to the tissue damage].-Exposure to toxic gases, such as Chlorine, produces an acute pneumonitis with injury to epithelium and edema.
    -Carbon dust:
    leads to anthracosis, which is a benign process that virtually everyone on earth now develops. Inhalation of large quantities of coal dust can produce progressive massive fibrosis, a restrictive lung disease.
  76. 76-Neutrophil elastase: a serine protease, Secreted by neutrophils and macrophages during inflammation, it destroys bacteria and host tissue. encoded by the ELANE gene,-its function:
    it hydrolyzes proteins within specialized neutrophil lysosomes, called azurophil granules, as well as proteins of the extracellular matrix following the protein's release from activated neutrophils. Neutrophil elastase may play a role in degenerative and inflammatory diseases by its proteolysis of collagen-IV and elastin of the extracellular matrix.
  77. 77- 53-year,increasing dyspnea for the past 6 years, but no cough. increased jugular venous distension. afebrile. A chest radiograph shows increased lucency in upper lung fields and increased lung volumes, with flattening of the diaphragmatic leaves. There are no infiltrates. The pulmonary arteries are enlarged and prominent bilaterally, and his right heart border is enlarged: Atherosclerosis. this case called: emphysema-induced destruction blood vessels.-Cor pulmonale:
    is the result of pulmonary hypertension, which is the major cause for pulmonary atherosclerosis. His emphysema has reduced the pulmonary vascular bed, promoting the hypertension. Note that the forces driving systemic atherosclerosis are not
    فعالoperative on the pulmonary arterial system.
  78. 78-Aneurysms may complicate atherosclerosis. -A dissection does not occur in pulmonary arteries, as in the aorta, because the pressures are not as high, even with pulmonary hypertension.-Pulmonary thromboembolism involving main pulmonary areries is an acute process.
    It is not related to emphysema. Chronic thromboembolism causing cor pulmonale is most likely to affect small peripheral pulmonary arteries.
  79. 79—-44-year, a non-smoker, had a fever and cough for the past 4 days. does not have hemoptysis. She has not experienced weight loss, malaise, nausea, or vomiting. temperature is 37.6°C. decreased breath sounds over the right upper lung. A chest radiograph reveals a 6 cm area of infiltrates in the right upper lobe. She is given a course of antibiotic therapy, but her cough persists. A month later her chest x-ray now reveals a 3 cm peripheral mass in the right upper lobe:
    Adenocarcinoma.    -44-year, a non-smoker, had a fever and cough for the past 4 days. does not have hemoptysis. She has not experienced weight loss, malaise...
  80. 80-Peripheral lung cancers (adenocarcinoma and large cell carcinoma) show less of an association with smoking than central lung cancers (small cell and squamous cell carcinoma). The focal obstruction from the mass predisposed to infection.-Squamous cell carcinoma: often associated with smoking. They are often bulky central masses.
  81. 81-70-year,bedridden for 5 weeks following a cerebrovascular accident (CVA). sudden onset of dyspnea, but has no further symptoms until two days later when she experiences left sided pleuritic chest pain. A radiologic imaging shows a wedge-shaped area consistent with hemorrhage based on the pleura of the left lower lobe: Thromboembolism.-An embolus to a medium-sized arterial branch may not be large enough to kill the patient, but large enough to cause an infarction. Her bedridden state predisposes her to deep venous thrombosis and thromboembolism--the CVAs are due to separate systemic arterial problems--or the systemic and pulmonary embolization can be tied together by a hypercoagulable state, or more remotely by a 'paradoxical' embolus through a patent foramen ovale once the right sided-pressures increased following the initial pulmonary thromboembolic event.
    **CVAs:cerebrovascular accidents
  82. 82-Clinical significance: Neutrophil elastase is an important protease enzyme that when expressed aberrantly can cause emphysema or emphysematous changes. This involves breakdown of the lung structure and increased airspaces. Mutations of the ELANE gene cause severe congenital neutropenia, which is a failure of neutrophils to mature.- Alpha 2-antiplasmin;
    one of Serpins (Serine Protease Inhibitors)which inhibit neutrophil elastase
    activity.
  83. 83-paradoxical embolus: An EMBOLUS arising in a vein which is able to reach the general (systemic) arterial circulation by passing through a defect in the inner wall of the heart, such as a PERSISTENT FORAMEN OVALE, to reach the left side.-38-year, non-productive cough for the past 4 days. temperature is 38.3°C. A chest radiograph shows patchy infiltrates and diffuse interstitial markings. Laboratory studies show a sputum gram stain with mixed flora. Hgb is 12.9 g/dL, platelet count 229,450/microliter, and WBC count 5815/microliter. cold agglutinin titer is elevated. Following a course of erythromycin therapy, she improves, with no complications:
    Mycoplasma pneumoniae.
  84. 84-Cold Agglutinin Titer: To identify and confirm the presence of viral infections such as found in atypical pneumonia. **Cold agglutinins are associated with Mycoplasma pneumoniae infection.-Mycoplasma infection predominantly affects the interstitium, and is not a widespread alveolar filling process. It is a cause for a 'primary atypical pneumonia' which is difficult to diagnose because this organism is not cultured by routine methods for bacterial organisms. The cold agglutinin titer is elevated in about half of cases and is a characteristic finding. Many cases respond to antibiotic therapy with erythromycin.
  85. 85-Mycoplasma infection: stimulates production of antibodies against specific RBC antigens in affected individuals.-Cold agglutinins are usually immunoglobulin M (IgM) antibodies and cause agglutination of cells (RBCs)at temperatures in the range of 0°C to 10°C. as temperature of circulating blood in the extremities much lower than in core body.
    RBCs of affected individuals may agglutinate and obstruct blood vessels in fingers, toes, and ears, or they may initiate the complement cascade. Affected cells may be lysed immediately within the capillaries and blood vessels as a result of the action of complement on the cell wall, or they may return to the circulatory system and be lysed in the spleen by macrophages.
  86. 86-23-year,old primigravida is found on prenatal testing to have an elevated hemoglobin A1C level. Her pregnancy is uncomplicated until the 33rd week of gestation, when she has the onset of premature labor and delivers a male infant 24 hours later. The infant initially has Apgar scores of 4 and 6 at 1 and 5 minutes, but within an hour is in severe respiratory distress and requires intubation with mechanical ventilation.-pharmacologic therapies administered to the mother prior to birth could have helped to prevent this infant's neonatal respiratory distress?
    Hydrocortisone.
  87. 87-She has diabetes, which inhibits fetal lung development. At 33 weeks, the baby's lungs may not make sufficient surfactant, though type II pneumomonocytes are present and increasing in number. [Corticosteroids administered to the mother help to speed up type II pneumonocyte production of surfactant in the baby]. At birth, exogenous surfactant can be given to the neonate. In addition, diabetes tends to impede fetal lung maturation.-Recurrent thromboembolism.
  88. 88-For the past 5 months, a 51-year, increased swelling of her lower legs as the day progresses.no fever and no cough. pitting edema to the knees. A chest radiograph reveals bilateral pleural effusions, and the right heart border is prominent. Laboratory studies show a serum AST of 238 U/L, ALT 263 U/L, LDH 710 U/L, and CK 127 U/L.Pulmonary hypertension and subsequent right heart failure can occur in the small number of cases in which recurrent thromboembolism takes place. The right heart failure that occurs then leads to hepatic passive congestion with centrilobular necrosis that is the cause for the increased transaminases and LDH (but normal CK, since the heart is enlarged, but not ischemic).
  89. 89-CK: creatine kinase an enzyme catalyzing the transfer of a phosphate group from phosphocreatine to ATP. It has three isoenzymes: CK1, found primarily in the brain; CK2, found in the myocardium; and CK3, found in both skeletal muscle and the myocardium. **The presence of CK2 in the blood is strongly indicative of a recent myocardial infarction; it is present until about 72 hours after the attack.-LDH: lactate dehydrogenase
    -an enzyme that catalyzes the interconversion of lactate and pyruvate. It is widespread in tissues and is particularly abundant in kidney, skeletal muscle, liver, and myocardium. It has five isoenzymes denoted LD1 to LD5. The “flipped” pattern in which the serum LD1 level is greater than the LD2 level is indicative of an acute myocardial infarction. This pattern occurs within 12 to 24 hours after the attack.
  90. 90-51-year, received an orthotopic cardiac transplant a month ago.fever with cough over the past 5 days. temperature is 37.5°C. A chest CT scan shows consolidation with abscess formation involving the left lower lobe. A sputum gram stain reveals normal upper respiratory tract flora. He does not respond to antibiotic therapy over the next 6 months. His mental status deteriorates and MR imaging of the brain shows multiple abscessesNocardia braziliensis:
    infection can persist and lead to chronic abscesses. It can complicate the course of immunocompromised patients. Though the lung is the portal of entry, dissemination to brain is common.
  91. 91-Pneumocystis pneumonia: is rarely disseminated and most often produces a diffuse pneumonic consolidation with minimal inflammatory cell infiltration and no abscess formation.-Mycoplasma pneumoniae produces a primary atypical pneumonia without abscess or alveolar filling.
  92. 92-Cytomegalovirus: does not produce abscesses. -Aspergillus fumigatus does not typically produce abscesses.-Mycobacterium avium-complex;
    MAI typically affects AIDS patients, and lung involvement is minimal.
  93. 93-A previously healthy 5-year,girl develops a fever along with dyspnea. her temperature is 37.9°C. Her lung fields are clear to auscultation but there are expiratory wheezes. A chest x-ray reveals clear lung fields. Laboratory studies show Hgb 13.6 g/dL, platelet count 183,600/microliter, and WBC count 14,480/microliter. Her dyspnea suddenly worsens, and emergent bronchoscopy reveals bronchi plugged by exudates.-Haemophilus influenzae:
    H. influenzae pneumonia can follow a descending laryngotracheobronchitis. The infection can cause airway obstruction from fibrin-rich exudates containing neutrophils, similar to pneumococcal pneumonia more common in adults.
    Pulmonary consolidation is usually bronchopneumonia and patchy but may involve the entire lung lobe. Vaccination is available for type b, but now non encapsulated and non-typeable forms are increasing in frequency.
  94. 94-RSV can produce childhood pneumonias, but they are typically interstitial pneumonias. -Mycobacterium tuberculosis; The pattern of lung involvement in the classical 'Ghon complex' of primary tuberculosis is seen more commonly in children, though only about 5% of cases are symptomatic. There are typically enlarged hilar nodes that can impinge upon central airways to produce obstruction.

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FlashCards sobre pathology website, criado por alice zoldiac em 26-04-2018.
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