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CPR II > (16.1) Pulmonary Pathology II (Singh) > Flashcards

(16.1) Pulmonary Pathology II (Singh) Flashcards

1
Q

Idiopathic pulmonary fibrosis

How does it damage pulmonary tissue?

A

IPF damages pulmonary tissue with waves of inflammatory injury leading to fibrosis

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2
Q

What would a CXR look like for a idiopathic pulmonary fibrosis pt?

A

Basilar infiltrates

“Honeycomb lung”

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3
Q

What do the lungs sound like on auscultation for idiopathic pulmonary fibrosis?

A

Crackles on exam

“Velcro-like”

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4
Q

What are the contributing factors to idiopathic pulmonary fibrosis?

A

Enviornmental factors (SMOKING)

Genetic factors

Increasing age

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5
Q

What is unique about the histology of idiopathic pulmonary fibrosis?

A

Very different patterns due to the “wave like” nature of the disease

Some patches are normal, some have inflammation, others have fibroblast foci and some have peripheral honeycombing

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6
Q

What do pathologists call idiopathic pulmonary fibrosis when found on pulmonary biopsy?

A

Usual Interstitial Pneumonia (UIP)

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7
Q

What do these images represent?

A

Honeycomb fibrosis

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8
Q

What is the prognosis for patients with idiopathic pulmonary fibrosis?

A

NOT GOOD

Most patients die from respiratory disease 3-5 years after diagnosis

Only truly effective treatment = lung transplant

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9
Q

What are some experimental medications being used to treat idiopathic pulmonary fibrosis?

A

These meds are used to arrest fibrosis

  • Tyrosine kinase inhibitors*
  • TGF-Beta inhibitors*
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10
Q

What is non-specific interstitial pneumonia (NSIP)?

A

VERY SIMILAR TO UIP

Idiopathic

Has UNIQUE HISTOLOGY = uniform infiltrates and fibrosis

Has better prognosis than UIP

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11
Q

What is this lung disorder?

A

Non-specific interstitial pneumonia (NSIP)

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12
Q

What is a cute way to remember what cryptogenic organizing pneumonia (COP) looks like histologically?

A

Looks like cotton candy… awwww

The “cotton candy” is fibroblast foci (Masson bodies)

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13
Q

Cryptogenic organizing pneumonia (COP)

Prognosis?

A

Very good!

Patient tend to have full recovery with oral steroids

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14
Q

How do you diagnose cryptogenic organizing pneumonia (COP)?

A

Diagnosis of exclusion

-Not an infection, drug- or toxin-induced, or related to connective tissue disorders

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15
Q

What is this?

A

Granulomatous inflammation

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16
Q

What is sarcoidosis?

A

Systemic disease manifesting non-caseating (non-necrotizing) granulomata

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17
Q

What is the clinical presentation of sarcoidosis?

A

Incidental abnormal radiograph

or

Dyspnea

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18
Q

What are some of the hallmark granuloma inclusions of sarcoidosis?

A

Granuloma inclusions:

Asteroid body (A)

Schaumann bodies (B-D)

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19
Q

What is the demographic of sarcoidosis?

A

<40 years of age

African americans

Commonly involve LUNGS

Elevated ACE levels

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20
Q

Sarcoidosis

Do the stages occur in order?

A

NO!

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21
Q

What is this?

A

Hypersensitivity Pneumonitis

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22
Q

What is hypersensitivity pneumonitis?

A

Immune reaction to inhaled antigen

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23
Q

What are three examples of specific types of hypersensitivity pneumonitis?

A

Pigeon-breeder’s lung — protein from bird feces

Farmer’s lung — Actinomycetic spores in hay

Hot tub lung — Reaction to mycobacterium avium complex (MAC)

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24
Q

What is one of the most imporant aspects of your clinical interaction w/ your patient that will allow you to diagnose hypersensitivity pneumonitis?

A

HISTORY

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25
Q

What is the pathology?

A

Desquamative Interstitial Pneumonia (DSIP)

*Notice that every alveolar space has macrophages inside. Also, a MISNOMER, these are NOT squamous cells lol.

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26
Q

What is the demographic of desquamative interstitial pneumonia (DSIP)?

A

Smokers in 40s/50s

Restrictive lung disease presentation

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27
Q

What is the prognosis for desquamative interstitial pneumonia (DSIP)?

A

Good prognosis only IF THE PATIENT CAN STOP SMOKING

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28
Q

What is the pathology?

A

Respiratory Bronchiolitis-Interstitial Lung Disease

(RB-ILD)

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29
Q

What is the demographic for respiratory bonchiolitis-interstitial lung disease?

A

Smokers

30s-40s

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30
Q

What is the pathology?

A

Langerhans cell histiocytosis (LCH)

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31
Q

What is a major characteristic of langerhans cells histologically?

A

Langerhans cells ALWAYS stain CD1a positive

32
Q

What are some dead giveaways that you are looking at a langerhans cell histiocytosis (LCH) biopsy?

A

Langerhans cells with a TON of eosinophils

33
Q

What is pulmonary alveolar proteinosis?

A

Impairment of surfactant metabolism due to defect in granulocyte-macrophage colony stimulating factor (GM-CSF)

34
Q

What is the histology of pulmonary alveolar proeinosis?

A

*Frequently confused with pulmonary edema

35
Q

How do you treat pulmonary alveolar proteinosis?

A

Treat with SubQ GM-CSF

36
Q

What is this?

A

Bone marrow embolism

37
Q

What is this?

A

Talc embolism

Seen in IV drug users

38
Q

What is this?

A

Septic emboli

39
Q

Where do septic emboli frequently originate from?

A

From the heart!

From endocarditis, valve vegetations break off and manifest in other sites…LIKE THE LUNGS

40
Q

What is the definition of pulmonary hypertension?

A

Pulmonary artery pressure (PAP) is greater than 25mmHg

41
Q

What are the two manifestations of pulmonary hyptertension?

A

Plexiform lesion (left)

Medial hypertrophy (right)

42
Q

What is the pathology?

A

Pulmonary hemorrhage syndromes

43
Q

What is the pathology?

A

Goodpasture syndrome

*Notice how you can see the RBCs within the lung parynchema

44
Q

What is goodpasture syndrome?

A

Antibody-mediated disease that damages basement membranes in the lung and kidney

*Targets Collagen IV

45
Q

What is the demographic of goodpasture syndrome?

A

YOUNG MEN

20s/30s

46
Q

What is the pathology?

A

GPA : Granulomatosis w/ polyangiitis

47
Q

__________ is the second most common cause of hospital admissions

A

Pulmonary infections

48
Q

What is the diagnosis?

A

Right upper lobar pneumonia

49
Q

What are the 4 stages of lobar pneumonia?

A
  1. Congestion (vascular engorgement)
  2. Red hapatization (red cells and inflammation)
  3. Grey hepatization (inflammation and debris)
  4. Resolution (fibrosis, macrophage clean-up)
50
Q

What is the most common cause of pneumonia?

A

Streptococcus pneumonia

(Lancet shaped gram positive diplococci)

51
Q

What is “atypical” (“walking”) pneumonia?

A

Slower onset than typical pneumonia

Systemic symptoms predominate

Patchy infiltrates on CXR

Young adults/teens/older children

52
Q

What is the major bacterium that causes “atypical walking pneumonia”?

A

Mycoplasma pneumoniae

53
Q

What is so special about mycoplasma pneumoniae?

A

Smallest free-living, self-replicating microorganisms

NO CELL WALL

54
Q

Where would you find legionella pneumophila?

A

Grows in warm freshwater

  • Air conditioning units
  • Misters
  • Hot tubs
55
Q

What are the three major causes of community acquired viral pneumonia?

A

Influenza (H1N1)

SARS

Respiratory Syncytial Virus

56
Q

How are influenza viruses classified?

A

Classified by 2 proteins

Hemagglutinin

Neuraminidase

57
Q

What is antigenic drift?

A

Epidemics

MINOR changes to proteins on the virus, allowing increased spread

Similar enough to the orignial virus to allow for some immunity in many individuals

58
Q

What is antigenic shift?

A

Pandemics

Genomic alterations with MAJOR resulting changes to protein structure

Naive immunity for almost all people

***Remember = Shift is close to “shit”. Antigenic shit. Antigenic shift is WAY worse than drift.

59
Q

What are the bacterial associations you should make with neonates?

A

Group B strep

Gram negative bacilli

Listeria

60
Q

What viral and bacterial associations should you make with children >1month old?

A

Viral = RESPIRATORY SYNCYTIAL VIRUS, parainfluenza virus, Influenza A&B, Adenovirus, Rhinovirus

Bacterial = S.pneumoniae, H. influenzae, M. catarrhalis, S.aureus

61
Q

What is the pathology?

A

Respiratory Syncytial Virus (RSV)

62
Q

What are the symptoms of respiratory syncytial virus?

A

Rhinorrhea/cough

Wheezing

Dyspnea

Tachypnea

Cyanosis

63
Q

Histologically, what is the difference b/w bacterial and viral pneumonia?

A

Bacterial usually stays in alveolar spaces

Viral stays in the interstitum

64
Q

What are the differences b/w bacterial and viral pneumonia in terms of clinical presentation?

65
Q

What pathology is HIGHLY associated with TB?

A

Caseating granulomata

66
Q

What is the pathology?

A

Histoplasma capsulatum

67
Q

Where is histoplasma capsulatum endemic?

A

Midwest and caribbean

68
Q

Histoplasma capsulatum has a characteristic…

A

Pumpkin seed morphology

69
Q

What is it!?

A

Blastomyces dermatitides

70
Q

What is this?

A

Coccidiodes immitis

*Remember: Coccidioodes has a lot of “O”s in it. The Cocciodes immitis biopsy shows “O” shaped specimens

71
Q

Where is coccidiodes immitis endemic?

A

Southwestern US and Mexico

72
Q

What is this?

A

Pneumocystis jiroveci

73
Q

What is pneumocystis jiroveci associated with?

74
Q

What is this?

A

Mycobacterium avium complex (MAC)

75
Q

Who typically gets mycobacterium avium complex?

A

Immunocompromised or elderly

76
Q

Why is it important to take a lung biopsy of a patient that you believe is undergoing transplant rejection?

A

Patient could have rejection, OR have an opportunistic infection

Determining which is occuring will determine the course of action

Tx for acute rejection = increase immunosuppression

Tx for opportunistic infection = target the organism

CPR II (30 decks)

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