Ch 9 Pathoma Respiratory Tract Pathology (9.3-End) Flashcards
1
Q
Pneumonia is a ___ of the ___. It occurs when normal defenses are impaired. Name 3 normal defenses
A
infection; lung parenchyma; 1) cough reflex; 2) mucociliary escalator; 3) mucus plugging
2
Q
Name 6 clinical features of pneumonia
A
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
3
Q
Diagnosis of pneumonia is made in these 3 ways
A
1) chest xray; 2) sputum gram stain and culture; 3) blood cultures
4
Q
Name the 3 patterns of pneumonia classically seen on chest X-ray (and what typically causes them)
A
1) lobar pneumonia; 2) bronchopneumonia; 3) interstitial pneumonia; (1 and 2 are usually bacterial, and 3 is usually viral)
5
Q
Lobar pneumonia is characterized by ___ of a ___. Usually bacterial/viral/fungal. Most common causes are ___ (95%) and ___.
A
consolidation; entire lobe of the lung; bacterial; strep pneumo; Klebsiella pneumoniae
6
Q
Name the 4 classic gross phases of lobar pneumonia (and what causes that)
A
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
7
Q
Bronchopneumonia is characterized by ___ centered around ___. Often focal/multifocal and unilateral/bilateral. Caused by a variety of bacterial/viral/fungal organisms
A
scattered patchy consolidation; bronchioles; multifocal; bilateral; bacterial
8
Q
Interstitial (___) pneumonia is characterized by ___. Presents with mild/moderate/severe ___ symptoms (minimal ___ and low __). “___” presentation. Caused by bacteria/virus/fungal infxn.
A
atypical; diffuse interstitial infiltrates (inflammation in wall of alveolar air sacs without consolidation); mild; upper respiratory; sputum; fever; atypical; bacteria and virus
9
Q
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 __.
A
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)
10
Q
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?
A
Streptococcus pneumoniae (95%); middle-aged adults and elderly; lobar pneumonia
11
Q
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?
A
Strep pneumo (lobar); staph aureus (bronchopneumonia)
12
Q
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
A
enteric; aspirated; malnourished; debilitated; elderly in nursing homes; alcoholics; diabetics; thick mucoid capsule; gelatinous; currant jelly; abscess; lobar
13
Q
Staph aureus forms ___ pneumonia. It is the 2nd most common cause of ___. Often complicated by __ or ___.
A
bronchopneumonia; secondary pneumonia; abscess; empyema (pus in pleural space)
14
Q
Name 5 organisms that cause bronchopneumonia
A
1) staph aureus; 2) haemophilus influenzae; 3) pseudomonas aeruginosa; 4) moraxella catarrhalis; 5) legionella pneumophila
15
Q
Haemophilus influenzae forms __ pneumonia. It is a common cause of ___ and ___.
A
bronchopneumonia; secondary pneumonia; pneumonia superimposed on COPD (leads to exacerbation of COPD)
16
Q
Pseudomonas aeruginosa forms __ pneumonia. It is seen in ___ patients.
A
bronchopneumonia; cystic fibrosis
17
Q
Moraxella catarrhalis forms __ pneumonia. It is a common cause of ___ pneumonia and ___.
A
bronchopneumonia; community-acquired; pneumonia superimposed on COPD (leads to COPD exacerbation)
18
Q
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 ___.
A
bronchopneumonia; community acquired; superimposed on COPD; immunocompromised states; water source; intracellular; silver stain
19
Q
What is the most common cause of walking pneumonia? Who does it usually affect?
A
Mycoplasma pneumoniae; young adults
20
Q
Complications of mycoplasma pneumoniae atypical pneumoniae includes __ and __. How does it gram stain?
A
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
21
Q
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?
A
chlamydia pneumoniae; respiratory syncytial virus (RSV); CMV
22
Q
Influenza virus causes ___ pneumonia in the __, __, and those with ___. It also increases risk for ____.
A
atypical pneumonia; elderly; immunocompromised; preexisting lung disease; superimposed S aureus or H influenzae bacterial pneumonia (thats what will kill you)
23
Q
___ causes atypical pneumonia with high fever (__ fever). Seen in __ and ___.
A
Coxiella burnetti; Q; farmers, veterinarians
24
Q
Coxiella is a ___ organism but it is distinct from most of those because of thee 3 reasons.
A
rickettsial; 1) causes pneumonia; 2) does not require arthropod vector transmission (survives as highly heat-resistant endospores); 3) does not produce a skin rash
25
Name 6 causes of interstitial (atypical) pneumonia
1) mycoplasma pneumoniae; 2) chlamydia pneumoniae; 3) respiratory syncytial virus; 4) CMV; 5) influenza virus; 6) coxiella burnetti
26
Tuberculosis is due to ____ of aerosolized \_\_\_. ___ TB arises with initial exposure.
inhalation; mycobacterium tuberculosis; primary
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
focal, caseating necrosis; lower; lung; hilar lymph nodes; fibrosis; calcification; Ghon; asymptomatic; positive
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 \_\_\_.
reactivation; Mycobacterium tuberculosis; AIDS; aging; apex (relatively poor lymphatic drainage and high oxygen tension); caseous necrosis; miliary pulmonary TB; tuberculous bronchopneumonia.
29
Clinical features of secondary TB include these 4
1) fever; 2) night sweats; 3) cough with hemoptysis; 4) weight loss
30
Biopsy of secondary TB reveals \_\_\_. When you see that on the differential is TB and \_\_\_. ___ stain reveals \_\_\_.
caseating granulomas; fungi; AFB; acid fast bacilli
31
Systemic spread of secondary TB often occurs and can involve \_\_\_. Common sites include these 4.
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)
32
Chronic obstructive pulmonary disease is a group of diseases characterized by \_\_\_\_. The lung does not \_\_\_, and __ is trapped.
airway obstruction; empty; air
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 \_\_\_.
FVC; decreased; FEV1; FEV1:FVC; decreased (FEV1 is decreased more than the FVC is decreased!); increased; air trapping
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 \_\_%).
productive cough; 3 months; 2 years; smoking; hypertrophy; bronchial mucinous glands; mucus glands; bronchial wall thickness; Reid; 50; 40
35
Name 3 clinical features of chronic bronchitis
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)
36
Emphysema is the destruction of \_\_\_. There is a loss of ___ and there is ___ of airways during inhalation/exhalation, which results in __ and \_\_.
alveolar air sacs; elastic recoil; collapse; exhalation; obstruction; air trapping
37
Emphysema is due to an imbalance of __ and \_\_. Inflammation in the lung normally leads to release of ___ by ___ and \_\_\_. ____ neutralizes ___ (what is released).
proteases; anti-proteases; proteases; neutrophils; macrophages; alpha1-antitrypsin (A1AT); proteases.
38
What are the two pathways that result in emphysema and who gets which kind?
1) Excessive inflammation (smokers) 2) lack of A1AT (A1AT deficiency pts)
39
In emphysema, pollutants in smoke lead to excessive ___ and \_\_\_-mediated damage. It results in ___ emphysema that is most severe in the \_\_\_.
inflammation; protease; centriacinar; upper lobes
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
rare; antiprotease; air sacs; protease; panacinar; lower lobes; liver cirrhosis
41
A1AT deficiency is due to ___ of the mutated protein. Mutant A1AT accumulates in the ___ of \_\_\_, resulting in \_\_\_. Biopsy reveals \_\_\_, \_\_\_-positive globules in \_\_\_.
misfolding; endoplasmic reticulum; hepatocytes; liver damage; pink; PAS; hepatocytes
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 \_\_\_.
PiM; PiMM; PiZ; A1AT; PiMZ; asymptomatic; smoking; PiZZ; panacinar emphysema; cirrhosis
43
Name 5 clinical features of emphysema
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
44
Asthma is reversible/irreversible airway \_\_\_, most often due to ___ (\_\_\_ asthma). Presents in \_\_\_, and is often associated with these 3 things.
reversible; bronchoconstriction; allergic stimuli; atopic; childhood; 1) allergic rhinitis; 2) eczema; 3) family hx of atopy
45
In asthma (type\_\_ hypersensitivity), allergens induce __ phenotype in CD\_+ T cells of genetically susceptible individuals. __ cells secrete these 3 cytokines
I; Th2; 4; Th2; IL-4, IL-5, IL-10
46
What does IL-4, 5, and 10 do?
IL-4: mediates class switch to IgE IL-5: attracts eosinophils IL-10: stimulates Th2 cells and inhibits
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 \_\_\_
Ig-E; mast; histamine; C4, D4, E4; bronchoconstriction; inflammation; edema
48
In asthma, the late phase reaction involves \_\_, especially ___ derived from \_\_, damages cells and perpetuates \_\_\_
inflammation; major basic protein; eosinophils; bronchoconstriction
49
Name 3 clinical features of asthma (episodic)
1) dyspnea and wheezing; 2) productive cough; 3) severe, unrelenting attack can result in status asthmaticus and death
50
In asthma, the productive cough classically has \_\_-shaped __ (aka \_\_\_) and \_\_\_-derived crystals (\_\_\_).
spiral; mucus plugs; Curschmann spirals; eosinophil; Charcot-Leyden crystals, which are aggregates of major basic protein
51
Asthma may also arise from nonallergic causes. Name 4
1) exercise; 2) viral infxn; 3) aspirin (aspirin intolerant asthma - nasal polyps and bronchospasm); 4) occupational exposures
52
Leukotrienes C4, E4, and D4 causes these 3 things
1) vasoconstriction; 2) increase vascular permeability; 3) bronchoconstriction
53
Histamine induces ___ at ___ and increases ___ at \_\_-
vasodilation; arterioles inc vascular permeability at post capillary venues
54
Bronchiectasis is permanent ___ of ___ and \_\_\_. It is a loss of \_\_\_, which results in \_\_\_.
dilatation; bronchioles; bronchi; airway tone; air trapping
55
Bronchiectasis is due to ___ with damage to \_\_\_. Name 5 causes.
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
56
Kartagener syndrome is a sporadic/inherited defect of the \_\_\_, which is necessary for \_\_\_. It is associated with these 3 things.
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
57
Allergic bronchopulmonary aspergillosis is a __ rxn to \_\_, which leads to chronic inflammatory damage. Usually seen in individuals with __ or \_\_.
hypersensitivity; aspergillus; asthma; cystic fibrosis \*it is a cause of bronchiectasis
58
Name 3 clinical features of bronchiectasis. Name 2 complications.
cough, dyspnea, foul-smelling sputum; 1) hypoxemia with cor pulmonale; 2) secondary amyloidosis
59
In secondary amyloidosis, ___ leads to the production of an ___ (SAA), which is converted to \_\_\_, which is then deposited in tissues causing secondary amyloidosis.
chronic inflammation; acute phase reactant; AA
60
Restrictive lung diseases are characterized by \_\_\_\_. What do you see with the TLC, FEV1, FVC, and FEV1:FVC ratio?
restricted filling of the lung; decreased TLC; decreased FEV1; very decreased FVC; increased FEV1:FVC ratio
61
Restrictive lung disease is most commonly due to \_\_\_. May also arise with ___ (seen in pts with \_\_\_)
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)
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.
lung interstitium; unknown; cyclical lung injury; TGF-B; drugs (bleomycin and amiodarone = anti-arryhthmic); radiation therapy
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 \_\_\_.
dyspnea; cough; fibrosis; subpleural; fibrosis; honeycomb; lung transplantation
64
Pneumoconioses is ___ due to \_\_\_. It requires exposure to large/small particles that are \_\_\_. ____ engulf foreign particles and induce \_\_\_.
interstitial fibrosis; occupational exposure; small (large are easily filtered out); fibrogenic; alveolar macrophages; fibrosis
65
Name 4 types of pneumoconiosis.
1) coal worker's; 2) silicosis; 3) berylliosis; 4) asbestosis
66
In coal worker's pneumoconiosis, the exposure is \_\_. Massive exposure leads to diffuse __ ('\_\_\_'). It is associated with ___ (\_\_\_ syndrome).
carbon dust; fibrosis; black lung; rheumatoid arthritis; Caplan
67
Mild exposure to carbon (from pollution) results in ___ (collection of carbon-laden \_\_\_). It is/is not clinically significant
anthracosis; macrophages; is not
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 \_\_\_.
silica; sandblasters; silica miners; fibrotic; upper; phagolysosome; TB
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
beryllium; beryllium miners; workers in aerospace industry; noncaseating granulomas; sarcoidosis; increased
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 \_\_).
asbestos; plumbers; construction workers; shipyard workers; fibrosis (plaques); increased risk for lung carcinoma and mesothelioma (lung cancer is more common); asbestos bodies; iron
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.
systemic; noncaseating granulomas (means there is no necrosis in it); hilar lymph nodes; lung; African American females; unknown; CD4+ helper T cell; restrictive
72
On histology, sarcoidosis causes characteristic ___ ('\_\_\_'), often seen within giant cells of the granulomas
stellate inclusions; asteroid bodies
73
Besides from the lung and hilar lymph nodes, sarcoidosis commonly affects these 4 tissues.
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
74
Name 3 clinical features of sarcoidosis (and which is most common), and treatment.
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
75
Hypersensitivity pneumonitis is a ___ reaction to inhaled ____ (eg \_\_\_). Presents with \_\_\_, \_\_\_, and ___ minutes/hours/days/weeks after exposure. Resolves with \_\_\_. Chronic exposure leads to \_\_\_.
granulomatous; organic antigens; pigeon breeder's lung; fever, cough, dyspnea; hours; removal of the exposure; interstitial fibrosis
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.
pulmonary; 25; 10; primary; secondary
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 \_\_.
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
78
Primary pulmonary HTN is classically seen in \_\_\_. Etiology is \_\_\_. Some familial forms are related to activating/inactivating mutations of \_\_\_, leading to proliferation of \_\_\_.
young adult females; unknown; inactivating; BMPR2; vascular smooth muscle (thickens the vessel wall leading to HTN)
79
Name 3 causes of secondary pulmonary HTN
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
80
Name 2 respiratory distress syndromes
1) acute respiratory distress syndrome (ARDS); 2) neonatal respiratory distress syndrome
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.
alveolar-capillary interface (diffuse alveolar damage); protein; edema; epithelial cells; hyaline membranes
82
ARDS can cause __ and __ with respiratory \_\_\_, due to thickened ___ and ___ of air sacs (increased/decreased surface tension). ___ is seen on chest X-ray.
hypoxemia; cyanosis; distress; diffusion barrier; collapse; increased; white out
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.
sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, hypersensitivity rxns, drugs; neutrophil; protease and free radical; both
84
Treatment of ARDS is to address \_\_\_. Also __ with \_\_\_. Recovery may be complicated by \_\_\_, since damage and loss of ___ leads to __ and \_\_
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
85
Collapsing pressure (P) =
2(surface tension)/(radius); i.e. decreasing surface tension, by increasing surfactant production, decreases collapsing pressure
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.
inadequate surfactant levels; type II pneumocytes; phosphatidylcholine (aka lecithin); decreases; preventing
87
Lack of surfactant in the lungs leads to ___ of air sacs and formation of \_\_\_.
collapse; hyaline membranes
88
Name 3 conditions associated with neonatal respiratory distress syndrome
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)
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
28 wks; 34 wks; sphingomyelin; lecithin; sphingomyelin; 2 (L:S ratio)
90
Name 4 clinical features of neonatal respiratory distress syndrome. ___ of the lung ('\_\_\_' appearance) is seen on xray.
1) increasing respiratory effort after birth; 2) tachypnea with use of accessory muscles; 3) grunting; 4) hypoxemia with cyanosis; diffuse granularity; ground-glass
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 \_\_\_\_.
hypoxemia; patent ductus arteriosus; necrotizing enterocolitis (decreased oxygen going to gut); supplemental oxygen; retinal; bronchopulmonary dysplasia
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?
lung cancer; 60; breast/prostate (lung cancer has 2nd highest incidence)
93
Name 3 key risk factors for lung cancer
1) cigarette smoke; 2) radon; 3) asbestos (which causes lung cancer more frequently than it causes mesothelioma)
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 ('\_\_')
60; 85; polycyclic aromatic hydrocarbons; arsenic; duration; amount; pack years
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
radioactive; uranium; soil; basements; ionizing radiation; 2nd
96
Lung cancer presenting symptoms are ___ (name 4).
nonspecific; cough, weight loss, hemoptysis, post obstructive pneumonia
97
Imaging of lung cancer often reveals a ___ ('\_\_\_'). __ is necessary for diagnosis of cancer.
solitary nodule; coin-lesion; biopsy
98
Benign lung lesions, which often occur in older/younger patients, can also produce a 'coin-lesion.' Name 2 examples
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)
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.
TB; fungus; histoplasma; bronchial hamartoma; calcified (a hamartoma is a benign mass comprised of tissue that normally belongs there, but is disorganized)
100
Lung carcinoma is classically divided into these 2 categories. What are the tx differences
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)
101
Name the 4 subtypes of NSCLC and their percentages
1) adenocarcinoma (40%); 2) squamous cell carcinoma (30%); 3) large cell carcinoma (10%); 4) carcinoid tumor (5%)
102
What is the most common lung cancer tumor in male smokers? female smokers? non-smokers?
squamous cell carcinoma; adenocarcinoma; adenocarcinoma
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?
poorly; neuroendocrine (Kulchitsky) cells; male smokers; centrally; rapid; early; causes paraneoplastic syndromes: may produce ADH or ACTH or cause Eaton-Lambert syndrome
104
Name 2 histological features of squamous cell carcinoma. Associated with \_\_\_. Found centrally/peripherally. May produce \_\_\_, causing \_\_\_.
keratin pearls; intercellular bridges; male smokers; central; PTHrP (parathyroid hormone related peptide); hypercalcemia
105
Name 2 histological features of adenocarcinoma. Associated with \_\_\_. Found centrally/peripherally.
glands or mucin; most common tumor in non-smokers and female smokers; peripheral
106
Large cell carcinoma are well/poorly differentiated large cells. Associated with \_\_\_. Found centrally/peripherally. Excellent/poor prognosis.
poorly; smoking; central or peripheral; poor
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
columnar; bronchioles; alveoli; Clara cells; not related to smoking!; peripheral; pneumonia-like consolidation; excellent
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.
well; neuroendocrine; chromogranin (cells contain granules that stain chromogranin positive); not related to smoking!; both; central; polyp-like; bronchus; low; carcinoid
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.
breast; colon; cannon-ball; more
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
tumor size; local extension; spread to regional LNs; hilar and mediastinal; distant metastases; adrenal gland; 15; late; absence
111
Name 4 complications of lung cancer
1) pleural involvement; 2) SVC obstruction (SVC syndrome); 3) involvement of recurrent laryngeal nerve (hoarseness) or phrenic (diphragmatic paralysis) nerve; 4) Horner syndrome
112
In lung cancer, pleural involvement is classically seen with \_\_\_. Obstruction of the SVC leads to distended __ and __ veins with __ and __ discoloration of __ and \_\_.
adenocarcinoma; head and neck; edema; blue; arms; face
113
In lung cancer, compression of the __ leads to Horner syndrome characterized by these 3. Usually due to an __ (\_\_\_) tumor
sympathetic chain; ptosis, miosis, anhidrosis; apical; Pancoast
114
Pneumothorax is an accumulation of __ in the \_\_. Can be __ or \_\_. Which one is a medical emergency?
air; pleural space; spontaneous; tension; tension
115
Which type of lung cancers are central? peripheral? both
central: SCLC, SCC; peripheral: adenocarcinoma, bronchioloalveolar carcinoma; both: large cell carcinoma, carcinoid tumor
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.
rupture of an emphysematous bleb; young; collapse; side of
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 \_\_\_.
penetrating chest wall injury; pleural space; exit; opposite side (pushed there by the entering air); insertion of a chest tube
118
Mesothelioma is a benign/malignant neoplasm of ___ cells. Highly associated with occupational exposure to \_\_\_. Presents with recurrent \_\_\_, \_\_\_, and \_\_\_. Tumor encases the lung.
malignant; mesothelial; asbestos; pleural effusions; dyspnea; chest pain
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
lymphangioleiomyomatosis; hormonal ablation and antiestrogen and progesterone therapy
