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STEP 9: Pulm PATHOMA > Associations > Flashcards

Associations Flashcards

1
Q

Child with chronic rhonchitis and nasal polyps. What pathology do I immediately think of?

A

CYSTIC FIBROSIS

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2
Q

Adult with nasal polyps. What triad do I think of?

A

ASA-intolerance -> Bronchospasm
Asthma -> Bronchoconstriction
Nasal poyps

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3
Q

PINK PAS+ globules (pulm pathology)

A

PANACINAR EMPHYSEMA - lack of antitrypsin emphysema (LOWER LOBES), INCREASED NEUTROPHIL ELASTASE

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4
Q

INCREASED FRC, DECREASED FRC are associated with which pathologies?

A

INCREASED FRC = obstructive

DECREASED FRC = restrictive

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5
Q

CURSCHMANN SPIRAL PLUTS + CHARCOT LEYDEN CRYSTALS = ?

What are the charcot leyden crystals made of?

A

ASTHMA

Charcot-leyden = eosinophilic basic protein - derived from eosinophils (IL-5)

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6
Q

What is BRONCHIECTASIS? What are the 5 associated causes? [Think 1 inherited, 1 syndrome, 1 HSR infectious, 2 generalized systemic]

A

BRONCHIECTASIS = dilation of bronchioles and bronchi (loss of airway tone) resulting in airway trapping - usually due to CHRONIC INFLAMMATION -> Damage to airway wall -> Dilation

CAUSE 1: CF
CAUSE 2: KARTAGENER SYNDROME -SISB: sinusitis, infertility, situs inversus, bronchiectasis
CAUSE 3: Necrotizing infection
CAUSE 4: Tumor/Foreign body
CAUES 5: HYPERSENSITIVE BRONCHOPULMONARY ASPERGILLOSIS

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7
Q

What two pt populations is HYPERSENSITIVITY BRONCHOPULMONARY ASPERGILLOSIS most prevalent in?

A

ASTHMA

CYSTIC FIBROSIS

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8
Q

What are the two complications of BRONCHIECTASIS? (Think 1 physiologic, 1 chronic inflammation-related)

A
  1. HYPOXEMIA with cor pulmonale

2. SECONDARY SYSTEMIC AMYLOIDOSIS

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9
Q

What is the driving factor of FIBROSIS (cyclical healing and lung injury) in IDIOPATHIC PULMONARY FIBROSIS?

A

TGF-beta release from INJURED PNEUMOCYTES

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10
Q

Which other secondary causes of pulmonary fibrosis must be excluded before diagnosing pt with IDIOPATHIC PULMONARY FIBROSIS? [HINT: Think 2 drugs, 1 iatrogenic]

A

DRUGS - BLEOMYCIN + AMIODARONE

RADIATION THERAPY

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11
Q

Which region of the lung is first affected with IDIOPATHIC PULMONARY FIBROSIS? Which region of the lung is affected thereafter? What is the treatment?

A

FIRST affects the SUBPLEURAL regions (sub pleural patches)
THEN affects diffusely with END-STAGE HONEYCOMB lung
Tx = LUNG TRANSPLANT

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12
Q

What exactly does SILICA do in SILICOSIS (Restrictive lung disease)?

A

Silica enters alveolar macrophages -> IMPAIRS PHAGOLYSOSOME FORMATION

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13
Q

What is the ONLY PNEMONOCONIOSIS that increases TB risk?

A

SILICOSIS: Bec it impairs phagolysosome formation (Remember CORD FACTOR of Mycobacterium tuberculosis does this as well)

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14
Q

What portion of the lung is predominantly affected in SILICOSIS?

A

SILICOSIS, THINK TB REACTIVATION due to increased risk of TB
Fibrotic nodules in the UPPER LOBE of lung

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15
Q

Pt works at NASA or recently designed some type of “stealth fire equipment”, what restrictive lung disease do you think of?

A

BERYLLIOSIS due to AEROSPACE INDUSTRY

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16
Q

When SARCOIDOSIS is considered, what should automatically always be included in the DDx? why?

A

BERYLLIOSIS - Bec both have NON-CASEATING granulomas in the lungs, hilar lymph nodes, and systemic organs

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17
Q

Which pneumoconiosis(es) has an INCREASED RISK of LUNG CANCER?

A

Cancer, Think systemic, Think sarcoidosis - most similar =

1) BERYLLIOSIS
2) ASBESTOSIS - Causes fibrosis of lung/pleura + cancer of lung/pleura (i.e. mesothelioma)

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18
Q

Pt is a construction worker, used to be a plumber, or works at a shipyard. Which restrictive lung disease do I think of?

A

ASBESTOSIS

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19
Q

ASBESTOS BODIES (long-golden brown fibers) are used to diagnose ASBESTOSIS. What is the metal associated with these ASBESTOS BODIES?

A

IRON

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20
Q

Does ASBESTOSIS infer a greater INCREASED RISK OF MESOTHELIOMA (pleura cancer) or LUNG CANCER?

A

LUNG CANCER

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21
Q

ASTEROID BODIES are found in what pathology? What are they actually made of?

A

ASTEROID BODIES - STELLATE INCLUSIONS found in non-caseating granulomas of SARCOIDOSIS [Made of inclusions from giant cells]

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22
Q

Pt comes in with an inability to chew on food, see dirt in his eyes, and has recurrent cavities. While this may sound like one pathology, which other one also has to always be on the Ddx?

A

Sounds like SJOGREN
But also must always consider SARCOIDOSIS - Involving uvea (uveitis), lacrimal gland, salivary glands (can’t chew food), cutaneous nodules/erythema nodosum

23
Q

NON-CASEATING GRANULOMAS + EOSINOPHILS in lung biopsy after exposure to pigeon feces = ?

A

HYPERSENSITIVITY PNEUMONITIS

24
Q

PLEXIFORM LESIONS are characteristic of what pathology? What are they made of?

A

SEVERE, LONG-STANDING PULMONARY HTN

= Tufts of new capillaries that form as collaterals around a fibrotic lesion from inflammation

25
Q

What gene familial mutation is associated with PRIMARY PULMONARY HTN?

A

BMPR2 inactivating mutation

26
Q

BMPR2 INACTIVATING MUTATIONS, PLEXIFORM LESIONS, ATHEROSCLEROSIS OF PULMONARY ARTERY = ?

A

PRIMARY PULMONARY HTN

27
Q

DIFFUSE WHITE OUT OF LUNG on CXR = ?

What is the pathophysiology? Which cells are damaged?

A

ACUTE RESPIRATORY DISTRESS SYNDROME

Underlying etiology (e.g. sepsis, shock, infection, pancreatitis, HSR, drugs, trauma, aspiration) -> Activation of neutrophils + free-radical mediated damage of BOTH TYPE 1 AND TYPE 2 PNEUMOCYTES -> Diffuse alveolar damage -> Leakage of protein-rich fluid (fibrinogen containing edema) -> HYALINE MEMBRANE FORMATION

28
Q

TYPE 1 PNEUMOCYTE FUNCTION = ?

TYPE 2 PNEUMOCYTE FUNCTION = ?

A

TYPE 1 = Cells that make up the alveolar-capillary interface
TYPE 2 = Produce surfactant + Stem cells of the alveoli

29
Q

Why is the recovery process of ARDS complicated by INTERSTITIAL FIBROSIS?

A

ARDS: Damage of BOTH type I and Type II pneumocytes
TYPE 2 PNEUMOCYTES = stem cell
NO TYPE 2 pneumocytes = NO REGENERATION -> instead get FIBROBLAST SCARRING/FIBROTIC REPAIR

30
Q

DIFFUSE GRANULARITY (GROUND GLASS APPEARANCE) on CXR = ?

A

NEONATAL RESPIRATORY DISTRESS SYNDROME

31
Q

What is the most common cause of NEONATAL RESPIRATORY DISTRESS SYNDROME? What is the appropriate screening test?

A

PREMATURITY - Surfactant production begins at 28wks and adequate production is not until 34wks. INADEQUATE SURFACTANT -> Collapse of air sacs due to inability to reduce surface tension

SCREENING TEST: Nl adequate surfactant production - LECITHIN:SPHINGOMYELIN > 2 [lecithin = phosphatidylcholine]
Both lecithin, sphingomyelin components of surfactant [sphingo = constant, lecithin = increases with adequate production]

32
Q

What are the causes of NEONATAL RESPIRATORY DISTRESS SYNDROME? [HINT: 2 pregnancy-related, 1 maternal endocrine]

A
  1. PREMATURE BABIES
  2. C-SECTION DELIVERY: No vaginal stress from nl delivery -> NO STEROID RELEASE = No increase in surfactant prodn + No induction of release from surfactant already present within type II pneumocytes (2 actions of steroids)
  3. MATERNAL DIABETES = High Glc -> Enters baby’s pancreas -> INSULIN PRODUCTION -> Inhibits surfactant
33
Q

What are two possible complications that can result from treating NEONATAL RESPIRATORY DISTRESS with supplemental Oxygen?

A

Supplemental Oxygen -> Induces free radical damage ->

  1. BRONCHOPULMONARY DYSPLASIA - free radical damage of lung dvlm
  2. RETINAL BLINDNESS - free radical damage of retina
34
Q

What are two possible complications of NEONATAL RESPIRATORY DISTRESS SYNDROME due to the HYPOXEMIA [HINT: Think 1cardio related, 1dvlm]

A
  1. PERSISTENCE OF PDA (Normally oxygenation will close the PDA)
  2. NECROTIZING ENTEROCOLITIS
35
Q

SOLITARY COIN LIKE LESION on CXR. What is the next step after seeing this finding on CXR?

A

LUNG CANCER
NEXT STEP = Compare against previous CXR to determine if it is BENIGN (stable coin lesion) OR MALIGNANT (new or growing coin lesion)

36
Q

What is absolutely necessary to diagnose lung cancer?

A

BIOPSY

Usually obtained after determining that the coin-like lesion is MALIGNANT on CXR

37
Q

If a coin-like lesion on CXR is determined to be benign (stable, unchanged from previous CXR), then what are three possible causes of the benign nodule? [Hint: Think 2 infectious, 1 proliferation]

A

Think Ddx of caseating granuloma

  1. TB GRANULOMA
  2. HISTOPLASMOSIS FUNGAL GRANULOMA
  3. BRONCHIAL HAMARTOMA
38
Q

What is a BRONCHIAL HAMARTOMA made of?

A

LUNG TISSUE + CARTILAGE (Normal tissue = hamartoma)

39
Q

What is the difference in Tx protocol for SMALL CELL vs NON-SMALL CELL CARCINOMAS?

A
  1. SMALL CELL - Cells are so small, that surgeon can NOT resect
    YES responsive to chemotherapy
    NO surgical resection
  2. NON-SMALL CELL -
    NO, not responsive to chemo
    YES, surgical resection
40
Q

NON-SMALL CELL CARCINOMA: Which one has GLANDS or EXCESS MUCIN PRODUCTION?

A

ADENOCARCINOMA

41
Q

NON-SMALL CELL CARCINOMA: Which one has KERATIN PEARLS and INTERCELLULAR BRIDGES
What are INTERCELLULAR BRIDGES?

A

SQUAMOUS CELL CARCINOMA

INTERCELLULAR BRIDGES = desmosomal connections btw squamous cells

42
Q

NON-SMALL CELL CARCINOMA: Which one is the disease of exclusion (no keratin pearls, no intercellular bridges, no glands, no mucus)?

A

LARGE CELL CARCINOMA

43
Q

CHROMOGRANIN + of LUNG CARCINOMAS

A

CHROMOGRANIN = Neuroendocrine cell marker
MOST POORLY DIFFERENTIATED = SMALL CELL CARCINOMA
BEST DIFFERENTIATED = CARCINOID TUMOR (low-grade malignancy)

44
Q

Which lung carcinoma is most common in FEMALE smokers and MALE NON-smokers?

A

ADENOCARCINOMA

45
Q

Which lung carcinoma(S) are most commonly located in the PERIPHERAL EDGES of the lung (PLEURAL INVOLVEMENT)? Which are located in the CENTRAL portion of the lung?

A

PERIPHERAL = ADENOCARCINOMA (mostly metastatic at presentation), LARGE CELL (BRONCHIOLOALVEOLAR or CARCINOID)

CENTRAL = “S” - SMALL CELL, SQUAMOUS CELL CARCINOMAS, LARGE CELL CARCINOMA (CARCINOID TUMOR)

46
Q

Which lung carcinoma presents with PNEUMONIA-LIKE CONSOLIDATION on imaging but has EXCELLENT PROGNOSIS? What type of cells grow and where do they arise from?

A 
BRONCHIOLOALVEOLAR CARCINOMA (LARGE CELL CARCINOMA TYPE 1) 
- COLUMNAR cells grow along pre-existing bronchioles and alveoli
Arise from CLARA CELLS
47
Q

Which lung carcinoma presents with a POLYP-LIKE MASS in the BRONCHUS in the CENTER of the lung?

A

CARCINOID TUMOR

Rarely progresses to CARCINOID SYNDROME

48
Q

MULTIPLE CANNON BALL NODULES of LUNG on CXR = ?

A

METASTATIC LUNG DISEASE

49
Q

In M of TNM staging of lung cancer, which organ is the UNIQUE SITE OF DISTANT SPREAD?

A

ADRENAL GLAND

50
Q

In T of TNM staging of lung cancer, which structure is compromised with PANCOAST TUMOR (malignant squamous cell carcinoma of lung apex)

A

CERVICAL SYMPATHETIC CHAIN (STELLATE GANGLION) -> Results in HORNER SYNDROME (PTOSIS, MIOSIS, ANHIDROSIS)

51
Q

In T of TNM staging of lung cancer, which 3 distinct structures can be compromised and what are the associated results?

A
  1. RECURRENT LARYNGEAL NERVE - Hoarseness
  2. PHRENIC NERVE - diaphragm paralysis
  3. SUPERIOR VENA CAVA - Distended head and neck veins + edema + blue discoloration of arms and face
52
Q

Which pneumothorax results in a TRACHEAL SHIFT AWAY from collapse? Which pneumothorax results in TRACHEAL SHIFT TOWARD the collapse?

A

TENSION pneumothorax due to TRAUMA -> Air enters pleural cavity -> Compresses on the lung -> Pushes the trachea AWAY -> Compress the heart -> Shock

SPONTANEOUS pneumothorax due to rupture of emphysematous bleb -> Collapse of portion of lung -> Trachea shifts TOWARD collapse

53
Q

Pathology: Massive tumor is encasing the lung tissue. What am I? Why are recurrent pleural effusions common with this pathology? What restrictive lung disease increases the risk of this disease?

A

MESOTHELIOMA
Mesothelioma - Tumor of mesothelial cells that line both the visceral and parietal pleura -> Increase fluid secretions to facilitate movement of lung against chest cavity

ABSESTOSIS increases risk of mesothelioma

STEP 9: Pulm PATHOMA (1 decks)

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