Ch 9 Pathoma Respiratory Tract Pathology (9.3-End)

Question 1

Pneumonia is a ___ of the ___. It occurs when normal defenses are impaired. Name 3 normal defenses

Answer 1

infection; lung parenchyma; 1) cough reflex; 2) mucociliary escalator; 3) mucus plugging

Question 2

Name 6 clinical features of pneumonia

Answer 2

1) fever and chills; 2) productive cough with yellow-green (pus) or rusty (bloody) sputum; 3) tachypnea w/pleuritic chest pain (bradykinin and PGE2); 4) decreased breath sounds; 5) dullness to percussion; 6) elevated WBC

Question 3

Diagnosis of pneumonia is made in these 3 ways

Answer 3

1) chest xray; 2) sputum gram stain and culture; 3) blood cultures

Question 4

Name the 3 patterns of pneumonia classically seen on chest X-ray (and what typically causes them)

Answer 4

1) lobar pneumonia; 2) bronchopneumonia; 3) interstitial pneumonia; (1 and 2 are usually bacterial, and 3 is usually viral)

Question 5

Lobar pneumonia is characterized by ___ of a ___. Usually bacterial/viral/fungal. Most common causes are ___ (95%) and ___.

Answer 5

consolidation; entire lobe of the lung; bacterial; strep pneumo; Klebsiella pneumoniae

Question 6

Name the 4 classic gross phases of lobar pneumonia (and what causes that)

Answer 6

1) congestion (due to congested vessels and edema); 2) red hepatization (due to exudate, neutrophils, and hemorrhage filling the alveolar air spaces, giving normally spongy lung a solid consistency; 3) gray hepatization (due to degradation of red cells in exudate); 4) resolution

Question 7

Bronchopneumonia is characterized by ___ centered around ___. Often focal/multifocal and unilateral/bilateral. Caused by a variety of bacterial/viral/fungal organisms

Answer 7

scattered patchy consolidation; bronchioles; multifocal; bilateral; bacterial

Question 8

Interstitial (___) pneumonia is characterized by ___. Presents with mild/moderate/severe ___ symptoms (minimal ___ and low __). “___” presentation. Caused by bacteria/virus/fungal infxn.

Answer 8

atypical; diffuse interstitial infiltrates (inflammation in wall of alveolar air sacs without consolidation); mild; upper respiratory; sputum; fever; atypical; bacteria and virus

Question 9

Aspiration pneumonia is seen in pts at risk for ___ (e.g. __ and __ pts). Most often due to ___ in the ___. Name 3 common organisms. Classically resents in a right/left upper/lower lobe __.

Answer 9

aspiration; alcoholics; comatose; anaerobic bacteria; oropharynx; 1) Bacteroides; 2) fusobacterium; 3) peptococcus; right lower; abscess (anatomically the right main stem bronchus branches at a less acute angle than the left)

Question 10

What is the most common cause of community-acquired pneumonia? In what patient age group is it seen in? What kind of pneumonia does it form?

Answer 10

Streptococcus pneumoniae (95%); middle-aged adults and elderly; lobar pneumonia

Question 11

What is the most common cause of secondary pneumonia? What is the 2nd most common cause of secondary pneumonia? What kind of pneumonia do they cause?

Answer 11

Strep pneumo (lobar); staph aureus (bronchopneumonia)

Question 12

Klebsiella pneumoniae is __ flora that is ___. It affects __ and ___ individuals, especially these 3 groups. It has a ___, which results in a ___ sputum (___). Often complicated by ___. It forms __ pneumonia

Answer 12

enteric; aspirated; malnourished; debilitated; elderly in nursing homes; alcoholics; diabetics; thick mucoid capsule; gelatinous; currant jelly; abscess; lobar

Question 13

Staph aureus forms ___ pneumonia. It is the 2nd most common cause of ___. Often complicated by __ or ___.

Answer 13

bronchopneumonia; secondary pneumonia; abscess; empyema (pus in pleural space)

Question 14

Name 5 organisms that cause bronchopneumonia

Answer 14

1) staph aureus; 2) haemophilus influenzae; 3) pseudomonas aeruginosa; 4) moraxella catarrhalis; 5) legionella pneumophila

Question 15

Haemophilus influenzae forms __ pneumonia. It is a common cause of ___ and ___.

Answer 15

bronchopneumonia; secondary pneumonia; pneumonia superimposed on COPD (leads to exacerbation of COPD)

Question 16

Pseudomonas aeruginosa forms __ pneumonia. It is seen in ___ patients.

Answer 16

bronchopneumonia; cystic fibrosis

Question 17

Moraxella catarrhalis forms __ pneumonia. It is a common cause of ___ pneumonia and ___.

Answer 17

bronchopneumonia; community-acquired; pneumonia superimposed on COPD (leads to COPD exacerbation)

Question 18

Legionella pneumophila forms ___ pneumonia. It is a common cause of ___ pneumonia, pneumonia ___, or pneumonia in ___. It is transmitted from ___. It is an extracellular/intracellular organism best visualized by ___.

Answer 18

bronchopneumonia; community acquired; superimposed on COPD; immunocompromised states; water source; intracellular; silver stain

Question 19

What is the most common cause of walking pneumonia? Who does it usually affect?

Answer 19

Mycoplasma pneumoniae; young adults

Question 20

Complications of mycoplasma pneumoniae atypical pneumoniae includes __ and __. How does it gram stain?

Answer 20

autoimmune hemolytic anemia (IgM against i antigen on RBCs causes cold hemolytic anemia); erythema multiforme; Not visible on gram stain due to lack of cell wall

Question 21

What is the second most cause of atypical pneumonia in young adults? What is the most common cause of atypical pneumonia in infants? What causes atypical pneumonia in post transplant immunosuppressive therapy?

Answer 21

chlamydia pneumoniae; respiratory syncytial virus (RSV); CMV

Question 22

Influenza virus causes ___ pneumonia in the __, __, and those with ___. It also increases risk for ____.

Answer 22

atypical pneumonia; elderly; immunocompromised; preexisting lung disease; superimposed S aureus or H influenzae bacterial pneumonia (thats what will kill you)

Question 23

___ causes atypical pneumonia with high fever (__ fever). Seen in __ and ___.

Answer 23

Coxiella burnetti; Q; farmers, veterinarians

Question 24

Coxiella is a ___ organism but it is distinct from most of those because of thee 3 reasons.

Answer 24

rickettsial; 1) causes pneumonia; 2) does not require arthropod vector transmission (survives as highly heat-resistant endospores); 3) does not produce a skin rash

Question 25

Name 6 causes of interstitial (atypical) pneumonia

Answer 25

1) mycoplasma pneumoniae; 2) chlamydia pneumoniae; 3) respiratory syncytial virus; 4) CMV; 5) influenza virus; 6) coxiella burnetti

Question 26

Tuberculosis is due to ____ of aerosolized ___. ___ TB arises with initial exposure.

Answer 26

inhalation; mycobacterium tuberculosis; primary

Question 27

Primary TB results in __, ___ in the upper/lower lobe of the __ and __ that undergoes __ and __, forming a __ complex. Primary TB is generally symptomatic/asymptomatic, and causes a positive/negative PPD

Answer 27

focal, caseating necrosis; lower; lung; hilar lymph nodes; fibrosis; calcification; Ghon; asymptomatic; positive

Question 28

Secondary TB arises with ___ of ___. Reactivation is commonly due to __, but may also be seen with __. Reactivation occurs at apex/base of lung. Forms cavitary foci of ___. May also lead to ___ or ___.

Answer 28

reactivation; Mycobacterium tuberculosis; AIDS; aging; apex (relatively poor lymphatic drainage and high oxygen tension); caseous necrosis; miliary pulmonary TB; tuberculous bronchopneumonia.

Question 29

Clinical features of secondary TB include these 4

Answer 29

1) fever; 2) night sweats; 3) cough with hemoptysis; 4) weight loss

Question 30

Biopsy of secondary TB reveals ___. When you see that on the differential is TB and ___. ___ stain reveals ___.

Answer 30

caseating granulomas; fungi; AFB; acid fast bacilli

Question 31

Systemic spread of secondary TB often occurs and can involve ___. Common sites include these 4.

Answer 31

any tissue; 1) meningies (meningitis - often at base of brain); 2) cervical lymph nodes; 3) kidneys (most common; causes sterile pyuria); 4) lumbar vertebrae (Pott disease)

Question 32

Chronic obstructive pulmonary disease is a group of diseases characterized by ____. The lung does not ___, and __ is trapped.

Answer 32

airway obstruction; empty; air

Question 33

In COPD the volume of air that can be forcefully expired (__) is increased/decreased, especially during the first second of expiration (___). The ___ ratio is increased/decreased. Total lung capacity (TLC) is usually increased/decreased due to ___.

Answer 33

FVC; decreased; FEV1; FEV1:FVC; decreased (FEV1 is decreased more than the FVC is decreased!); increased; air trapping

Question 34

Chronic bronchitis is a chronic ___ lasting at least __ over minimum of ___. Highly associated with ___. Characterized by ___ of ___, which leads to increased thickness of ___ relative to ___ (__ index increases to greater than __%; normal is less than __%).

Answer 34

productive cough; 3 months; 2 years; smoking; hypertrophy; bronchial mucinous glands; mucus glands; bronchial wall thickness; Reid; 50; 40

Question 35

Name 3 clinical features of chronic bronchitis

Answer 35

1) productive cough due to excessive mucus production; 2) cyanosis (‘blue bloaters’), mucus plug trap CO2, leading to inc PaCO2 and dec PaO2; 3) increased risk of infxn and cor pulmonale (hypoxemic vasoconstriction leads to inc pHTN - RV hypertrophy - R sided HF)

Question 36

Emphysema is the destruction of ___. There is a loss of ___ and there is ___ of airways during inhalation/exhalation, which results in __ and __.

Answer 36

alveolar air sacs; elastic recoil; collapse; exhalation; obstruction; air trapping

Question 37

Emphysema is due to an imbalance of __ and __. Inflammation in the lung normally leads to release of ___ by ___ and ___. ____ neutralizes ___ (what is released).

Answer 37

proteases; anti-proteases; proteases; neutrophils; macrophages; alpha1-antitrypsin (A1AT); proteases.

Question 38

What are the two pathways that result in emphysema and who gets which kind?

Answer 38

1) Excessive inflammation (smokers) 2) lack of A1AT (A1AT deficiency pts)

Question 39

In emphysema, pollutants in smoke lead to excessive ___ and ___-mediated damage. It results in ___ emphysema that is most severe in the ___.

Answer 39

inflammation; protease; centriacinar; upper lobes

Question 40

A1AT deficiency is a common/rare cause of emphysema. The lack of __ leaves the __ vulnerable to __-mediated damage. It results in __ emphysema that is most severe in the ___. ___ may also be present

Answer 40

rare; antiprotease; air sacs; protease; panacinar; lower lobes; liver cirrhosis

Question 41

A1AT deficiency is due to ___ of the mutated protein. Mutant A1AT accumulates in the ___ of ___, resulting in ___. Biopsy reveals ___, ___-positive globules in ___.

Answer 41

misfolding; endoplasmic reticulum; hepatocytes; liver damage; pink; PAS; hepatocytes

Question 42

___ is the normal allele for A1AT. Usually two copies are expressed (___). ___ is the most common clinically relevant mutation, which results in significantly low levels of circulating ___. ___ heterozygotes are usually ___, with decreased levels of __, but at risk for emphysema with __. __ homozygotes are at significant risk for ___ and ___.

Answer 42

PiM; PiMM; PiZ; A1AT; PiMZ; asymptomatic; smoking; PiZZ; panacinar emphysema; cirrhosis

Question 43

Name 5 clinical features of emphysema

Answer 43

1) dyspnea and cough with minimal sputum; 2) prolonged expiration with pursed lips (pink-puffer); 3) weight loss; 4) increased anterior-posterior diameter of chest (‘barrel chest’); 5) hypoxemia (due to destruction of capillaries in alveolar sac) and cor pulmonale are late complications

Question 44

Asthma is reversible/irreversible airway ___, most often due to ___ (___ asthma). Presents in ___, and is often associated with these 3 things.

Answer 44

reversible; bronchoconstriction; allergic stimuli; atopic; childhood; 1) allergic rhinitis; 2) eczema; 3) family hx of atopy

Question 45

In asthma (type__ hypersensitivity), allergens induce __ phenotype in CD_+ T cells of genetically susceptible individuals. __ cells secrete these 3 cytokines

Answer 45

I; Th2; 4; Th2; IL-4, IL-5, IL-10

Question 46

What does IL-4, 5, and 10 do?

Answer 46

IL-4: mediates class switch to IgE IL-5: attracts eosinophils IL-10: stimulates Th2 cells and inhibits

Question 47

In asthma, reexposure to allergen leads to __-mediated activation of __ cells. In the early phase reaction, there is release of preformed ___ granules and generation of these 3 leukotrienes, which lead to __, __ and ___

Answer 47

Ig-E; mast; histamine; C4, D4, E4; bronchoconstriction; inflammation; edema

Question 48

In asthma, the late phase reaction involves __, especially ___ derived from __, damages cells and perpetuates ___

Answer 48

inflammation; major basic protein; eosinophils; bronchoconstriction

Question 49

Name 3 clinical features of asthma (episodic)

Answer 49

1) dyspnea and wheezing; 2) productive cough; 3) severe, unrelenting attack can result in status asthmaticus and death

Question 50

In asthma, the productive cough classically has __-shaped __ (aka ___) and ___-derived crystals (___).

Answer 50

spiral; mucus plugs; Curschmann spirals; eosinophil; Charcot-Leyden crystals, which are aggregates of major basic protein

Question 51

Asthma may also arise from nonallergic causes. Name 4

Answer 51

1) exercise; 2) viral infxn; 3) aspirin (aspirin intolerant asthma - nasal polyps and bronchospasm); 4) occupational exposures

Question 52

Leukotrienes C4, E4, and D4 causes these 3 things

Answer 52

1) vasoconstriction; 2) increase vascular permeability; 3) bronchoconstriction

Question 53

Histamine induces ___ at ___ and increases ___ at __-

Answer 53

vasodilation; arterioles inc vascular permeability at post capillary venues

Question 54

Bronchiectasis is permanent ___ of ___ and ___. It is a loss of ___, which results in ___.

Answer 54

dilatation; bronchioles; bronchi; airway tone; air trapping

Question 55

Bronchiectasis is due to ___ with damage to ___. Name 5 causes.

Answer 55

necrotizing inflammation; 1) cystic fibrosis (thick secretions cause mucus plugging cause inc risk of infxn); 2) Kartagener syndrome (ciliary mvmt impaired causes inc risk of infxn); 3) Tumor/foreign body (block airway, inc risk of infxn); 4) Necrotizing infxn; 5) allergic bronchopulmonary aspergillosis

Question 56

Kartagener syndrome is a sporadic/inherited defect of the ___, which is necessary for ___. It is associated with these 3 things.

Answer 56

inherited; dynein arm; ciliary mvmt; 1) sinusitis; 2) infertility (poor motility of sperm); 3) situs inversus (position of major organs is reversed) pts with this can get bronchiectasis

Question 57

Allergic bronchopulmonary aspergillosis is a __ rxn to __, which leads to chronic inflammatory damage. Usually seen in individuals with __ or __.

Answer 57

hypersensitivity; aspergillus; asthma; cystic fibrosis *it is a cause of bronchiectasis

Question 58

Name 3 clinical features of bronchiectasis. Name 2 complications.

Answer 58

cough, dyspnea, foul-smelling sputum; 1) hypoxemia with cor pulmonale; 2) secondary amyloidosis

Question 59

In secondary amyloidosis, ___ leads to the production of an ___ (SAA), which is converted to ___, which is then deposited in tissues causing secondary amyloidosis.

Answer 59

chronic inflammation; acute phase reactant; AA

Question 60

Restrictive lung diseases are characterized by ____. What do you see with the TLC, FEV1, FVC, and FEV1:FVC ratio?

Answer 60

restricted filling of the lung; decreased TLC; decreased FEV1; very decreased FVC; increased FEV1:FVC ratio

Question 61

Restrictive lung disease is most commonly due to ___. May also arise with ___ (seen in pts with ___)

Answer 61

interstitial disease of the lung; chest wall abnormalities; massive obesity (force on chest wall makes it harder to expand, which makes it harder to open and fill the lungs)

Question 62

Idiopathic pulmonary fibrosis is fibrosis of ___. Etiology is ___. Likely related to ___. __ from injured pneumocytes induces fibrosis. Secondary causes of said fibrosis such as __ (name 2 examples) and ___ must be excluded.

Answer 62

lung interstitium; unknown; cyclical lung injury; TGF-B; drugs (bleomycin and amiodarone = anti-arryhthmic); radiation therapy

Question 63

Clinical features of idiopathic pulmonary fibrosis include progressive __ and __. __ is seen on lung CT. It is initially seen in ___ patches, but eventually results in diffuse ___ with end-stage ‘___’ lung. Tx is ___.

Answer 63

dyspnea; cough; fibrosis; subpleural; fibrosis; honeycomb; lung transplantation

Question 64

Pneumoconioses is ___ due to ___. It requires exposure to large/small particles that are ___. ____ engulf foreign particles and induce ___.

Answer 64

interstitial fibrosis; occupational exposure; small (large are easily filtered out); fibrogenic; alveolar macrophages; fibrosis

Question 65

Name 4 types of pneumoconiosis.

Answer 65

1) coal worker’s; 2) silicosis; 3) berylliosis; 4) asbestosis

Question 66

In coal worker’s pneumoconiosis, the exposure is __. Massive exposure leads to diffuse __ (‘___’). It is associated with ___ (___ syndrome).

Answer 66

carbon dust; fibrosis; black lung; rheumatoid arthritis; Caplan

Question 67

Mild exposure to carbon (from pollution) results in ___ (collection of carbon-laden ___). It is/is not clinically significant

Answer 67

anthracosis; macrophages; is not

Question 68

Silicosis is from exposure to ___, seen in ___ and ___. It causes __ nodules in ___ lobes of lung. It impairs ___ formation by macrophages. And you have an increased risk for ___.

Answer 68

silica; sandblasters; silica miners; fibrotic; upper; phagolysosome; TB

Question 69

Berylliosis is caused by exposure to ___. Seen in __ and ___. It causes ___ in the lung, hilar lymph nodes, and systemic organs (looks a lot like ___). There is an increased/decreased risk for lung cancer

Answer 69

beryllium; beryllium miners; workers in aerospace industry; noncaseating granulomas; sarcoidosis; increased

Question 70

Asbestosis is caused by ___ fibers. Seen in these 3 groups. It causes ___ and ___ of both the lung and pleura (which one is more common). Lesions may contain ___ (long, golden brown fibers with associated __).

Answer 70

asbestos; plumbers; construction workers; shipyard workers; fibrosis (plaques); increased risk for lung carcinoma and mesothelioma (lung cancer is more common); asbestos bodies; iron

Question 71

Sarcoidosis is a systemic/local disease characterized by ___ in multiple organs, most commonly these 2. It is classically seen in ___. Etiology is ___. Likely due to ___ response to an unknown antigen. Sarcoidosis leads to obstructive/restrictive lung disease.

Answer 71

systemic; noncaseating granulomas (means there is no necrosis in it); hilar lymph nodes; lung; African American females; unknown; CD4+ helper T cell; restrictive

Question 72

On histology, sarcoidosis causes characteristic ___ (‘___’), often seen within giant cells of the granulomas

Answer 72

stellate inclusions; asteroid bodies

Question 73

Besides from the lung and hilar lymph nodes, sarcoidosis commonly affects these 4 tissues.

Answer 73

1) uvea (uveitis); 2) skin (cutaneous nodules or erythema nodosum); 3) salivary; and 4) lacrimal glands (3 and 4 mimic Sjogren syndrome) Almost any tissue can be involved

Question 74

Name 3 clinical features of sarcoidosis (and which is most common), and treatment.

Answer 74

1) dyspnea or cough (most common); 2) elevated serum ACE; 3) hypercalcemia (1-alpha hydroxylase activity of epithelioid histiocytes converts vit D to its active form); tx is steroids, though it often resolves spontaneously w/o tx

Question 75

Hypersensitivity pneumonitis is a ___ reaction to inhaled ____ (eg ___). Presents with ___, ___, and ___ minutes/hours/days/weeks after exposure. Resolves with ___. Chronic exposure leads to ___.

Answer 75

granulomatous; organic antigens; pigeon breeder’s lung; fever, cough, dyspnea; hours; removal of the exposure; interstitial fibrosis

Question 76

Pulmonary hypertension is high pressure in the ___ circuit. Mean arterial pressure greater than __ mmHg; normal is __ mmHg. Can be sub classified as __ or __ based on etiology.

Answer 76

pulmonary; 25; 10; primary; secondary

Question 77

Pulmonary HTN is characterized by ___ of the pulmonary trunk, ___ hypertrophy of __ arteries, and ___. ___ are seen with severe, long standing disease. pHTN can lead to ___ with eventual ___. Presents with __ or __.

Answer 77

atherosclerosis (high pressure on vessel causes inc risk of atherosclerosis); smooth muscle; pulmonary; intimal fibrosis; Plexiform lesions; RV hypertrophy; cor pulmonale; exertional dyspnea; right-sided HF

Question 78

Primary pulmonary HTN is classically seen in ___. Etiology is ___. Some familial forms are related to activating/inactivating mutations of ___, leading to proliferation of ___.

Answer 78

young adult females; unknown; inactivating; BMPR2; vascular smooth muscle (thickens the vessel wall leading to HTN)

Question 79

Name 3 causes of secondary pulmonary HTN

Answer 79

1) hypoxemia (eg COPD and interstitial lung disease); 2) increased volume in pulmonary circuit (congenital heart disease - can then lead to Eisenmenger syndrome where shunt gets reversed from R to L due to high pHTN); 3) recurrent pulmonary embolism

Question 80

Name 2 respiratory distress syndromes

Answer 80

1) acute respiratory distress syndrome (ARDS); 2) neonatal respiratory distress syndrome

Question 81

Acute respiratory distress syndrome (ARDS) is diffuse damage to the ___. It leads to a leakage of ___-rich fluid, which leads to ___ that combines with necrotic ___ to form ___ in alveoli.

Answer 81

alveolar-capillary interface (diffuse alveolar damage); protein; edema; epithelial cells; hyaline membranes

Question 82

ARDS can cause __ and __ with respiratory ___, due to thickened ___ and ___ of air sacs (increased/decreased surface tension). ___ is seen on chest X-ray.

Answer 82

hypoxemia; cyanosis; distress; diffusion barrier; collapse; increased; white out

Question 83

ARDS is secondary to a variety of disease processes. Name 9. The common theme is activation of __ induces __ and __ mediated damage of type I/type II pneumoncytes.

Answer 83

sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, hypersensitivity rxns, drugs; neutrophil; protease and free radical; both

Question 84

Treatment of ARDS is to address ___. Also __ with ___. Recovery may be complicated by ___, since damage and loss of ___ leads to __ and __

Answer 84

underlying cause; ventilation with positive end expiratory pressure (PEEP - need PEEP to keep lungs open after expiration); fibrosis; type II pneumocytes (they are the stem cells); scarring; fibrosis

Question 85

Collapsing pressure (P) =

Answer 85

2(surface tension)/(radius); i.e. decreasing surface tension, by increasing surfactant production, decreases collapsing pressure

Question 86

Neonatal respiratory distress syndrome is respiratory distress due to ___. Surfactant is made by ___, and ___ is the major component. Surfactant increases/decreases surface tension in the lung, causing/preventing collapse of alveolar air sacs after expiration.

Answer 86

inadequate surfactant levels; type II pneumocytes; phosphatidylcholine (aka lecithin); decreases; preventing

Question 87

Lack of surfactant in the lungs leads to ___ of air sacs and formation of ___.

Answer 87

collapse; hyaline membranes

Question 88

Name 3 conditions associated with neonatal respiratory distress syndrome

Answer 88

1) prematurity; 2) c-section delivery (due to lack of stress induced steroids, which normally increase synthesis of surfactant); 3) maternal diabetes (insulin decreases surfactant production)

Question 89

Surfactant production begins at ___, and adequate levels are not reached until ___. Amniotic fluid lecithin:___ ratio is used to screen for lung maturity. ___ levels increase as surfactant is produces, and __ remains constant, so a ratio greater than __ indicates adequate surfactant production

Answer 89

28 wks; 34 wks; sphingomyelin; lecithin; sphingomyelin; 2 (L:S ratio)

Question 90

Name 4 clinical features of neonatal respiratory distress syndrome. ___ of the lung (‘___’ appearance) is seen on xray.

Answer 90

1) increasing respiratory effort after birth; 2) tachypnea with use of accessory muscles; 3) grunting; 4) hypoxemia with cyanosis; diffuse granularity; ground-glass

Question 91

Complications of neonatal respiratory distress syndrome include ___, increasing the risk for persistence of __. Also ___. ___ increases the risk for free radical injury. ___ injury leads to blindness. Lung damage leads to ____.

Answer 91

hypoxemia; patent ductus arteriosus; necrotizing enterocolitis (decreased oxygen going to gut); supplemental oxygen; retinal; bronchopulmonary dysplasia

Question 92

What is the most common cause of cancer mortality in the US and what is the average age at presentation? What is the most common cancer incidence in the US?

Answer 92

lung cancer; 60; breast/prostate (lung cancer has 2nd highest incidence)

Question 93

Name 3 key risk factors for lung cancer

Answer 93

1) cigarette smoke; 2) radon; 3) asbestos (which causes lung cancer more frequently than it causes mesothelioma)

Question 94

Cigarette smoke contains over __ carcinogens. __% of lung cancer occurs in smokers. ___ and __ are particularly mutagenic. Cancer risk is directly related to __ and __ of smoking (‘__’)

Answer 94

60; 85; polycyclic aromatic hydrocarbons; arsenic; duration; amount; pack years

Question 95

Radon is formed by ___ decay of __, which is present in the ___. It accumulates in closed spaces such as __. It is responsible for most of the public exposure to ___. It is the ___ most frequent cause of lung carcinoma in the US

Answer 95

radioactive; uranium; soil; basements; ionizing radiation; 2nd

Question 96

Lung cancer presenting symptoms are ___ (name 4).

Answer 96

nonspecific; cough, weight loss, hemoptysis, post obstructive pneumonia

Question 97

Imaging of lung cancer often reveals a ___ (‘___’). __ is necessary for diagnosis of cancer.

Answer 97

solitary nodule; coin-lesion; biopsy

Question 98

Benign lung lesions, which often occur in older/younger patients, can also produce a ‘coin-lesion.’ Name 2 examples

Answer 98

younger (less than 40); 1) granuloma (often due to TB or fungus (especially Histoplasma in the Midwest); 2) bronchial hamartoma (benign tumor composed of lung tissue and cartilage; often calcified on imaging)

Question 99

A granuloma in the lung is often due to __ or __ (especially ___ in the midwest). ___ is a benign tumor composed of lung tissue and cartilage. It is often ___ on imaging.

Answer 99

TB; fungus; histoplasma; bronchial hamartoma; calcified (a hamartoma is a benign mass comprised of tissue that normally belongs there, but is disorganized)

Question 100

Lung carcinoma is classically divided into these 2 categories. What are the tx differences

Answer 100

1) small cell carcinoma (15%) - usually not amenable to surgery, and tx with chemo; 2) non-small cell carcinoma (85%) - upfront surgical resection (does not respond well to chemo)

Question 101

Name the 4 subtypes of NSCLC and their percentages

Answer 101

1) adenocarcinoma (40%); 2) squamous cell carcinoma (30%); 3) large cell carcinoma (10%); 4) carcinoid tumor (5%)

Question 102

What is the most common lung cancer tumor in male smokers? female smokers? non-smokers?

Answer 102

squamous cell carcinoma; adenocarcinoma; adenocarcinoma

Question 103

Small cell carcinoma is well/poorly differentiated small cells that arises from ___. Associated with ___. Found centrally/peripherally. Rapid/slow growth and early/late mets. What is special about them?

Answer 103

poorly; neuroendocrine (Kulchitsky) cells; male smokers; centrally; rapid; early; causes paraneoplastic syndromes: may produce ADH or ACTH or cause Eaton-Lambert syndrome

Question 104

Name 2 histological features of squamous cell carcinoma. Associated with ___. Found centrally/peripherally. May produce ___, causing ___.

Answer 104

keratin pearls; intercellular bridges; male smokers; central; PTHrP (parathyroid hormone related peptide); hypercalcemia

Question 105

Name 2 histological features of adenocarcinoma. Associated with ___. Found centrally/peripherally.

Answer 105

glands or mucin; most common tumor in non-smokers and female smokers; peripheral

Question 106

Large cell carcinoma are well/poorly differentiated large cells. Associated with ___. Found centrally/peripherally. Excellent/poor prognosis.

Answer 106

poorly; smoking; central or peripheral; poor

Question 107

Bronchioloalveolar carcinoma are __ cells that grow along preexisting __ and ___. Arise from __ cells. Associated with ___. Found centrally/peripherally. May present with ___ on imaging. Excellent/poor prognosis

Answer 107

columnar; bronchioles; alveoli; Clara cells; not related to smoking!; peripheral; pneumonia-like consolidation; excellent

Question 108

Carcinoid tumor is well/poorly differentiated ___ cells, that are ___ positive. Associated with ___. Found centrally/peripherally (when __, classically forms a ___ mass in the ___). High/low grade malignancy. Rarely can cause ___ syndrome.

Answer 108

well; neuroendocrine; chromogranin (cells contain granules that stain chromogranin positive); not related to smoking!; both; central; polyp-like; bronchus; low; carcinoid

Question 109

Name the 2 most common sources of metastasis to the lung. They form multiple ‘___’ nodules on imaging. More/less common than primary lung tumors.

Answer 109

breast; colon; cannon-ball; more

Question 110

In lung cancer TNM staging, T is for __ and __. N is for ___ (especially __ and __) and M is for ___. The unique site of metastasis for lung cancer is the ___. Overall, __% 5-year survival. It often presents early/late due to presence/absence of effective screening method

Answer 110

tumor size; local extension; spread to regional LNs; hilar and mediastinal; distant metastases; adrenal gland; 15; late; absence

Question 111

Name 4 complications of lung cancer

Answer 111

1) pleural involvement; 2) SVC obstruction (SVC syndrome); 3) involvement of recurrent laryngeal nerve (hoarseness) or phrenic (diphragmatic paralysis) nerve; 4) Horner syndrome

Question 112

In lung cancer, pleural involvement is classically seen with ___. Obstruction of the SVC leads to distended __ and __ veins with __ and __ discoloration of __ and __.

Answer 112

adenocarcinoma; head and neck; edema; blue; arms; face

Question 113

In lung cancer, compression of the __ leads to Horner syndrome characterized by these 3. Usually due to an __ (___) tumor

Answer 113

sympathetic chain; ptosis, miosis, anhidrosis; apical; Pancoast

Question 114

Pneumothorax is an accumulation of __ in the __. Can be __ or __. Which one is a medical emergency?

Answer 114

air; pleural space; spontaneous; tension; tension

Question 115

Which type of lung cancers are central? peripheral? both

Answer 115

central: SCLC, SCC; peripheral: adenocarcinoma, bronchioloalveolar carcinoma; both: large cell carcinoma, carcinoid tumor

Question 116

Spontaneous pneumothorax is due to ___. Seen in old/young adults. Results in ___ of a portion of the lung. Trachea shifts to the side of/opposite side of collapse.

Answer 116

rupture of an emphysematous bleb; young; collapse; side of

Question 117

Tension pneumothorax is due to ___. Air enters the __, but cannot ___. Trace shifts to the side of/opposite side of injury. It is a medical emergency and is treated with ___.

Answer 117

penetrating chest wall injury; pleural space; exit; opposite side (pushed there by the entering air); insertion of a chest tube

Question 118

Mesothelioma is a benign/malignant neoplasm of ___ cells. Highly associated with occupational exposure to ___. Presents with recurrent ___, ___, and ___. Tumor encases the lung.

Answer 118

malignant; mesothelial; asbestos; pleural effusions; dyspnea; chest pain

Question 119

___ is a rare interestitial lung disease that occurs in women of childbearing age. It is characterized by widespread abnormal proliferation of smooth muscle in the lung, mediastinal and retroperiotneal lymph nodes and major lymphatic ducts. ___ therapy has shown some promise

Answer 119

lymphangioleiomyomatosis; hormonal ablation and antiestrogen and progesterone therapy