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Robbins Pathology Respiratory(Chptr 15, 16) > Chapter 15/16 > Flashcards

Chapter 15/16 Flashcards

1
Q

Lung cancers in smokers tend to have which mutations

A

TP53

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2
Q

What tissue origin is sinonasal (schneiderian) papilloma

A

Respiratory mucosa lining the nasal cavity and paranasal sinuses

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3
Q

What are the main causes for lung infections

A
  • Loss of the cough reflex
  • Injury to the mucociliary function
  • Accumulation of secretions
  • Interference with phagocytosis of immune cells (due to smoking)
  • Pulmonary congestion and edema
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4
Q

What are the stages of lobar pneumonia

A

1-Congestion (vascular enlargement)
2- Red hepatization (Red cells and inflammation)
3-Grey hepatization (Inflammation and debris)
4- Resolution (fibrosis, macro clean up)

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5
Q

What conditions are associated with centralobular/acinar emphysema

A

COPD

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6
Q

What is the clinical presentation of diptheria

A
  • Pharyngeal or nasal infection, leading to grey pharyngeal membrane, damage to heart, nerves,
  • Can produce a toxin and necrosis
  • Formation of psuedomembranes from nonviable tissue
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7
Q

INfection with which agent is associated with an increased risk of developing asthma

A

Rhinovirus C have 10-30x increased risk

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8
Q

What are asteroid bodies in sarcoidosis composed of

A

Collagen

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9
Q

What are the complications as a result of chronic bronchitis

A
  • Cor pulmonale and heart failure
  • Atypical metaplasia, dysplasia and carcinoma
  • Bronchiectasis
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10
Q

What are the testing findings in a patient with allergic bronchoaspergillosis (ABPA)

A

Increased IgE
Positive skin test
Thick mucus in bronchi
-Fungal hyphi from Aspergillus spp

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11
Q

What are pleural empyemas and how do the form

A
  • Inflammatory process with the accumulation of pus in the pleural spaces, usually due to a bacterial infection
  • Create a loculation, which is a web like feature that traps fluid
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12
Q

What is the lesion that arises in chronic otitis media

A

Cholesteatoma

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13
Q

What is the difference in histology between bacterial and viral infections

A

-Bacterial infections are actually in the alveolar spaces while the viruses will be in the interstitial areas

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14
Q

What are the histological findings in the cause of granulomatosis with polyangiitis (GPA)

A

Aka Wegener granulomatosis

  • Granulomatous Inflammation/vasculitis
  • “necrobiotic” necrosis (very blue color)
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15
Q

What type of tumor is EBV related Extranodal NK/T cell lymphoma

A

Malignant

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16
Q

What is the most common emphysema

A

-Centracinar (95% if cases)

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17
Q

What is the prognosis of patients with sarcoidosis and progression to lung disease

A

65-70% recover normally
20% progress to lung disease

-Death from pulmonary, cardiac, or neurological involvement

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18
Q

What is a Ranke complex and what infection is it indicative of

A

When a TB infection’s Ghon complex undergoes fibrosis and produces a calcification that can be seen on radiographs

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19
Q

When are fat emboli commonly seen

A

Resulting from a trauma, whether a motor vehicle accident, or someone who has received CPR

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20
Q

What portion of the lung is affected by panacinar/lobular emphysema

A

The whole lung, most severely in the base of the Lung

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21
Q

What are the schaumann bodies seen in sarcoidosis composed of

A

Calcified concretions

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22
Q

What is the clinical prevention of primary tuberculosis.

A

Usually no different than a bacterial pneumonia and is generally not an issue for immunocompetent individuals.

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23
Q

IN the case of HIV patients, what is the likely pathogen causing pulmonary disease if the CD4 count is <200

A

-Pneumocystis jiroveci

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24
Q

What are the conditions that can commonly lead to Bronchiectasis

A

Obstruction and infection are the major conditions associated, which are included by these conditions:

  • Allergic bronchopulmonary aspergillosis
  • Cystic fibrosis
  • Primary ciliary dyskinesia (Kartegener syndrome)
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25
Q

In the cause of a hemothorax, how do you differentiate between trauma and other factors

A

Look at the hematocrit, with trauma being >50%, while the others are ,50%

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26
Q

What is the patients commonly seen to have langerhans cell histiocytosis (LCH)

A

Young smokers

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27
Q

What are the usual causes of sinusitis

A

Bacteria from the oral cavity

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28
Q

Which clinical presentation with patients with an increased risk for aspirin sensitive asthma

A

Samter’s triad which is:

  • Nasal polyps
  • Recurrent rhinitis
  • Aspirin sensitive asthma
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29
Q

Laryngeal carcinomas are which type of neoplasm

A

-Malignant squamous cell carcinoma

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30
Q

What is the histological findings of NUT carcinoma

A

Small round blue cell tumor with squamous nests (small blue cells, with very very large clear looking cells in the middle)

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31
Q

What is the clinical pattern seen in sarcoidosis

A

-Bilateral hilar lymphadopathy or lung involvment in 90% or cases

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32
Q

Nasopharyngeal carcinomas can be seen histologically with which markers

A

EBER 1 or LMP1

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33
Q

Which blood related genetic factor has an increased risk for lung cancer

A

-individuals who show more chromosomal breakages in blood lymphcytes have a 10x higher risk

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34
Q

What is the prognosis and treatment of cryptogenic organizing pneumonia (COP)

A

Good prognosis and responds to steroids

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35
Q

Which from of nasopharyngeal carcinoma has the worst prognosis

A

Keratinizing squamous cell because it is least radiosenstive

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36
Q

What is the prognosis of a patient with idiopathic pulmonary fibrosis

A

Most die from respiratory disease 3-5 years

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37
Q

What are the methods/pathways that are targeted by adenocarcinomas

A
  • EGFR
  • ALK-1
  • PD-1
  • CTLA-4
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38
Q

What other conditions are usually seen in a pt with asthma

A

-Rhinitis and eczema

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39
Q

What are the findings in a patient with hangerhans cell histiocytosis

A

Progressive scarring that leads to the formation of irregular cystic spaces

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40
Q

What are the characteristics of Haemophilus influenza

A

Gram negative organism

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41
Q

What are the characteristics of pulmonary adenocarcinoma

A
  • Shows malignant glands of different sizes.

- May even look like there are “spaces” due to the production of mucus

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42
Q

Idiopathic pulmonary fibrosis is most often causes by which condition

A

Environmental factors, especially smoking

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43
Q

Which tumor tends to spread aerogenously

A

Mucinous adenocarcinomas

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44
Q

Which form of asbestos is more dangerous

A

Amphibole

*tends to be more linear, so able to get deep into the lungs, as well as being more soluble

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45
Q

What is the characteristics of sarcoidosis

A

Non-caseating (nonnecrotizing) granulomatous disease

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46
Q

What would be the clinical presentation of measles

A
  • Koplic spots (ulcerated mucosal lesions in the oral cavity near the Stenson ducts
  • Warthin-Finkeldey cells (randomly distributed multinucleated giant cells)
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47
Q

What upper airway complication can be seen with Kartegener syndrome

A

Chronic severe sinusitis

*Kartegener syndome= Bronchiectasis and sinusitis due to defective cilia

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48
Q

What are the characteristics of adenocarcinoma in situ (AIS)

A
  • Large lesion (<3 cm)

- dysplasia pneumocytes growing along preexisting alveolar septum(Basically covers all of the edges)

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49
Q

What are the complications seen with cholesteatoma

A
  • Rupture leading to further inflammation

- Errosion into the ossicles or labyrinth

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50
Q

Which patients are seen to have talc embolism

A

IV drug users

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51
Q

What are the general conditions that lead to restrictive lung disease

A

Chest wall disorders (obesity, poliomyelitis, pleural diseases, kyphoscoliosis)

Interstitial and infiltrative diseases (pneumoconioses and interstitial fibrosis)

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52
Q

What is the prognosis of pulmonary hypoplasia

A

High mortality, with immediate death if lungs <40% normal lung weight

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53
Q

What is the histological finding in the cause of ARDS and ALI

A

Diffuse alveolar damage (DAD)

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54
Q

What type of tumor is sinonasal (schneiderian) papilloma

A

Benign

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55
Q

If a chyloud milky fluid is pulled from a pleural effusion, what is the underlying cause

A

Obstruction of the thoracic duct

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56
Q

What type of tumor is olfactory neuroblastoma

A

Malignant

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57
Q

Which patient population is commonly seen to have inflammatory myofioblastic tumors

A

Children, although it is a rare tumor

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58
Q

What are the findings that are going to be seen on a cellular level in the case of atopic asthma

A

-Increased mucus
Increased TH2 and eosinophils
-Increased gland proliferation

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59
Q

Renal angiomyolipoma and lymphangioleiomyomosis is associated with a mutation in which component

A

mTOR

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60
Q

What are the characteristics of mycobacterium

A

Slender, aerobic rods in straight or branching chains

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61
Q

What are the usual clinical presentations of patients with sarcoidosis that requires treatment

A

Onset of respiration abnormalities (SOB,cough, chest pain)

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62
Q

Which predisposing conditions lead to an increased risk of contracting legionnaires disease

A
  • Renal, cardiac, immunological, or hematologic disease

- Transplant Patients

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63
Q

What type of neoplasm is laryngeal squamous papilloma

A

Benign squamous neosplasm

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64
Q

What are the morphological findings in cystic fibrosis leading to Bronchiectasis

A

Thickening of the mucus allows pooling, leading to bronchi dilation with the smaller bronchioles being obliterated due to fibrosis

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65
Q

What is Potters sequence

A

When there is not enough amniotic fluid to support the development of the fetal lungs

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66
Q

What conditions are associated with panacinar emphysema

A

Alpha1-antitrypsin deficiency

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67
Q

What condition is nasopharyngeal angiofibroma associated with

A

Familial adenomatous polyposis (FAP)

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68
Q

Which bacterial infection is commonly seen causing secondary pneumonia following the influenza infection

A

Staph aureus

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69
Q

What are the three contributing factors to nasopharyngeal carcinoma

A
  • Hereditary
  • Age
  • EBV infection
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70
Q

What conditions are patients with silicosis at a higher risk for developing

A
  • Cancer (2 fold increase)

- TB

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71
Q

What are the characteristics of acute interstitial pneumoniae (AIP)

A

ARDS without a specific etiology

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72
Q

What are the morphological findings of the lung with a lymphangioleiomyomatosis

A
  • Cystic
  • emphysema-like dilation of terminal airspace’s
  • Thickening of the interstitium
  • obstruction of the lymphatic vessels
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73
Q

What is a complication of sinusitis

A

1) Obstruction of the outflow, leading to empyema

2) Accumulation of mucous leading to mucocele

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74
Q

Which complications are commonly seen to arise from mesothelioma

A

Extensive pleural effusions and invasion into thoracic structures

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75
Q

What are the common complications of the maxillary sinus

A

Osteomyelitis

Mucocele

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76
Q

What is the common finding with nasopharyngeal angiofibroma

A

Recurrent nose bleeds

*Can be the first sign of a patient with FAP

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77
Q

What are nasopharyngeal carcinomas associated with

A

EBV

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78
Q

What is the prognosis in the case of a patient with Mucor caused sinusitis

A

Not good if left untreated, and required emergent IV Amphotericin B

-Mucor will erode through the bone, causing necrosis and into the brain

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79
Q

What are the characteristic histological findings in sarcoidosis

A

Granuloma with tight well defined border, nonnecrotizing, with multi nucleated cells and lymphocytes

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80
Q

What size of particle seems to be most detrimental to the lungs

A

1-5 micrometers, since they are small enough to get into the alveoli

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81
Q

What is the location of a branchial (cervical lymphoepithelial cyst)

A

From the second branchial arch and forms along the SCM

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82
Q

Which bacteria is the cause of “current red jelly sputum” and which patient population is it commonly seen in

A

Alcoholics

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83
Q

What is the cell infiltrate in the cause of allergic rhinitis (hay fever)

A

Leukocytic, with eosinophils dominating

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84
Q

If bloody fluid is pulled from a pleural effusion, what is the underlying cause

A

Metastatic

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85
Q

What is antigenic drift

A

Cause of the epidemic of influenza every year, as it undergoes minor changes. Individuals carry some immunity year to year

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86
Q

What are the common causes of pneumonia in neonates

A
  • Group B strep
  • gram negative bacilli
  • Listeria (gram positive)
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87
Q

Olfactory neuroblastoma arises from which embryological tissue

A

Neuroectoderm

*member of the small round blue cell tumor, all of which are neuroectoderm

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88
Q

What is the patient seen to have Respiratory bronchiolitis- interstitial lung disease

A

30-40 year old smokers (virtually all who have the disease are smokers)

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89
Q

What is the cause of lung cancer Horner’s syndrome and what are the symptoms

A

Apical lung cancers in the superior pulmonary sulcus around the SNS cervical sympathetic plexus leading to:

  • Severe pain in the ulnar nerve
  • Enophthalmos (sunken eyeballs)
  • Ptosis (drooping of eyelid)
  • Miosis (persistent small pupil)
  • Anhydrosis (no sweating on that side of the face)

*basically the tumor will cause pinching of the nerve and lack of SNS innervation

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90
Q

What are the malignancies that can cause pulmonary disease in HIV patients

A
  • Kaposi sarcoma (purple skin lesions)
  • Non-Hodgkin lymphoma
  • lung cancer
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91
Q

Which conditions is characterized by infertility due to semen being retained in the epididymis and increased risk with Bronchiectasis

A

Young’s syndrome

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92
Q

Which tumor shows the highest association with smoking

A

Small cell carcinoma

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93
Q

What condition is present when there are a Velcro-like crackle on exam

A

Idiopathic pulmonary fibrosis

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94
Q

What is the difference between resolution and fibrosis following ARDS

A

Resolution results in normal cellular structure and function

Fibrosis results in distorted and changed shape, along with fibrosis and decreased function

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95
Q

What is occurring during resorption atelectasis

A

There is an obstruction in the airway that leads to gradual air resorption and lung collapse

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96
Q

What is occurring during acute Leung injury (ALI)

A

No cardiogenic Pulmonary edema that is characterized by abrupt hypoxemia and bilateral pulmonary infiltrates not caused by cardiac failure

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97
Q

What are the characteristics histological findings in Goodpasture syndrome

A

Linear deposits

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98
Q

What is the clinical presentation of pertussis

A

Whooping cough:

-Acute violent coughing with an inspiratory whooping

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99
Q

What are the characteristics of Bronchiectasis

A

Necrotizing inflammatory response leading to permanent dilation of bronchi and bronchioles

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100
Q

What are the histological findings of diffuse alveolar damage

A
  • Alveolar walls are lined with hyaline membranes
  • fibrin fish edema fluid
  • Cell debris
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101
Q

What is the histological findings on histoplasmosis

A

-Pumpkin seed morphology seen with a silver stain

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102
Q

What is the cause of the enlarged alveoli in emphysema

A

Small airway fibrosis results in airtrapping in the alveoli, resulting in the enlargement and wreaking of the walls

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103
Q

What is the presentation of cryptogenic organizing pneumonia (COP)

A

Pneumonia like presentation, not not induced by infection drugs or toxins. More a diagnosis by exclusion

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104
Q

What is the most common cause of death in a patients with influenza

A

Bacterial pneumonia

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105
Q

What is the prognosis and treatment of hypersensitivity pneumonitis

A

-Good prognosis as the treatment is removing the offending allergen

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106
Q

What is the location that thyroglossal duct cysts occur

A

IN the midline, along the path of the migration of the thyroid

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107
Q

Extranodal NK/T lymphomas are associated with which pathogen

A

EBV

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108
Q

What is the FEV1/FVC ratio in obstructive lung disease

A

Low, as the FVC does not change, but the FEV (forced expiration volume) decreases because the airways are obstructive, so the air can not be pushed out

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109
Q

What is the patients commonly seen to have desquamative interstitial pneumonia (DIP)

A

40-50 year old smokers (virtually all patients with this condition are smokers)

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110
Q

Small cell carcinoma has which histological features

A
  • Nuclear molding

- Tightly packed small blue cells (due to mostly nucleus and not cytoplasm)

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111
Q

What does carotid body tumors look like histologically

A

Zellballen, or nests of cells

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112
Q

Systemic sclerosis commonly shows which pattern of damage

A

Nonspecific interstitial pattern more often and usual

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113
Q

What are the immunological findings commonly seen in sarcoidosis

A
  • Higher CD4 to CD8 ratio (5-15:1)

- Increased TH1 activation and cytokines (TNF is a marker of disease activity)

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114
Q

If there is a trans usage fluid pulled from a pleural infusion, what is the normal underlying cause

A

Heart failure

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115
Q

What stain is used to visualize the carotid body tumors

A

S100 stain, which highlights the surrounding supporting cells

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116
Q

What is a gram positive rod that can cause illness in a neonate and what is the source

A

Listeria especially unpasteurized milk, deli meats, soft cheeses, refrigerated smoked fish

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117
Q

What are the characteristics of the cholesteatoma

A

Reactive process leading to Benign lesions lined with squamous epithelium with trapped keratin debris

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118
Q

What are the histological findings in grey hepatization in lung pneumonia

A
  • Firm and grey lung with Fibrous pleurisy
  • Macrophages
  • Dense fibril material
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119
Q

Which patients are seen to have mycobacterium avium complex and what is it

A

Immunocompromised or elderly patients and will show as slender red forms on acid fast staining

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120
Q

What is the common morphological/histological finding in patients with chronic lung rejection

A

Bronchiolitis obliterans, which is partial or complete occlusion of small airways with fibrosis, with or without inflammation

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121
Q

Lung cancers that are in non smokers tend to have which mutations

A

-EGFR mutations, with almost never having KRAS

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122
Q

What morphological finding is associated with all cases of pulmonary hypertension

A
  • Medial hypertrophy of the pulmonary muscular and elastic arteries
  • Right ventricular hypertrophy
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123
Q

What is antigenic shift

A

The cause of pandemic, where the change in antigens is across species, so there is little to no immunity agains the new strain

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124
Q

Small cell neuroendocrine carcinomas are almost always associated with which conditions

A

Smoking

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125
Q

What type of tumors are the majority of the lung tumors

A

Carcinomas (90-95%)

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126
Q

What are the characteristics of atypical adenomatous hyperplasia (AAH)

A
  • Small lesion (<5mm)

- dysplasia pneumocytes present along alveoli with some interstitial fibrosis

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127
Q

What is the characteristic of the human metapneumonovirus

A

Paramyxoviridae

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128
Q

What is the most common cause of death in a patient with goodpasture syndrome

A

Uremia

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129
Q

Which patient populations are at a higher risk for developing COPD

A

Smokers, women, African Americans

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130
Q

Extralobar pulmonary sequestrations are commonly associated with which other conditions

A

Tracheoesophageal fistulas or cardia abnormalities

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131
Q

What is the effect of coal workers pneumoconiosis

A

Benign with little changes to lung function, and very small amount progresses to massive fibrosis

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132
Q

What are Pulmonary sequestration’s characterized by

A
  • Lack of connection to the tracheobronchial tree

- Independent arterial supply from the aorta or its branches

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133
Q

When do most post-transplant infections occur

A

3-12 months following the transplantation

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134
Q

What is the increased levels of leukotriences C4, D4, E5 resulting in the case of asthma

A
  • Bronchoconstriction
  • Increased mucus secretion
  • Increased vascular permeability
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135
Q

Lobar pneumonia shows which disease pattern

A

Covers one whole lobe

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136
Q

What are the common gram negative bacteria causing nosocomial pneumonia

A

-Enterobacteria and pseudomonas

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137
Q

What is occurring during compression atelectasis

A

Accumulation of material, usually fluid or air, within the pleura that prevents the expansion of the lungs (pneumothorax, hemothorax)

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138
Q

What is laryngeal squamous papilloma associated with

A

HPV 6 and 11

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139
Q

What is the function of the type 2 pneumocytes

A

Produce surfactant

Replace damaged Type 1 cells

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140
Q

What is the complication seen with chronic rhinitis

A

Bacterial infection, producing results such as deviated septum or nasal polyps, with the ability to spread into the sinuses

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141
Q

What are the components of hyaline membranes

A

-Edema, fibrin, and cell debris

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142
Q

What are the histological findings in idiopathic pulmonary fibrosis

A

Shows the finding of usual interstitial pneumonia (UIP)
“Looks like a combination pizza”
- Normal and fibrotic areas
-Peripheral honeycombing

*There is the typical wave of damage, watch doing more and more damage

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143
Q

What is the function of the Type 1 pneumocytes

A

Facilitate gas exchange

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144
Q

IN the cases where there is a familial link to pulmonary hypertension, what is the common gene found mutated

A

Germline mutations in BMPR2 (bone morphogenetic protein receptor type 2) linked to TGF-beta leading to dysfunction in vascular smooth muscle proliferation

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145
Q

Which gender has a higher propensity to lung cancer

A

Women more than men

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146
Q

What is the mechanism of action for aspirin sensitive asthma

A
  • Blocks COX, leading do a Decreased production of Prostaglandin E2
  • Increased production due to shunting of other half of the pathway, resulting in increased production of C4,D4,E4
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147
Q

What are the histological findings in patients with respiratory bronchiolitis- interstitial lung disease

A
  • Stuffed “smokers” macrophages with brown pigmentation* in the 1st and second bronchioles
  • Peribronchiolar metaplasia (abnormally located ciliated cells) and fibrosis

*Very similar to desquamative interstitial pneumonia (DIP) but less macrophage involvement

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148
Q

In general, what are the general causes of restrictive lung disease

A

-Chronic interstital lung disease, where there is thickening of the alveolar wall affecting gas exchange

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149
Q

What is occurring during allergic fungal sinusitis

A

-Aspergillus will colonize the sinus tract (does not invade), leading to a hypersensitivity reaction

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150
Q

What can a congential pulmonary adenoma malformation cause in a neonate

A

Mass occupying lesion in the thoracic cavity that can restrict the development of the lungs

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151
Q

What are the main conditions classified as obstructive diseases

A
  • Asthma
  • Emphysema
  • Bronchiectasis
  • Bronchic bronchitis
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152
Q

What is the function of neuraminidase in the influenza virus

A

Allows the release of the replicated viruses from the host cell

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153
Q

What are the steps involved in ALI/ARDS

A

1) Endothelial damage (TNF involvement)
2) Adhesion and extravasation of neutrophils (MIF involvement)
3) Accumulation of intralveolar fluid and formation of hyaline membranes
4) Resolution of injury (TGF beta, PDGF involvement)

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154
Q

What are the conditions that result of leaking out fluid into the alveolar spaces during pulmonary edema

A
  • Hypoalbuminemia
  • Nephrotic syndrome
  • Liver disease

*All result in the decreased of proteins in the blood that keep the fluid from leaking out into the alveolar spaces

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155
Q

What are the findings in histology that can lead to the diagnosis of sarcoidosis

A

Asteroid body or Schaumann bodies as granuloma inclusions

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156
Q

What are the locations that can harbor legionella

A

Warm fresh water such as:

  • Hot tubs
  • Misters
  • Hot tubs
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157
Q

What is the pathogenesis of group 3 pulmonary hypertension

A

Secondary to chronic pulmonary parenchymal disease or hypoxia

*i.e obliterative alveolar capillaries or sleep apnea

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158
Q

Branchial cysts most commonly arise from where

A

Second branchial arch

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159
Q

ARDS and poorer prognosis is associated with which factors

A
  • Smokers

- Chronic alcoholics

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160
Q

What are the histological findings of a inflammatory myofibroblastic tumor

A

-Proliferation of spindle shaped fibroblasts/myofibroblasts, lymphocytes, plasma cells, and fibrosis

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161
Q

Which form of asthma is most common

A

Atopic (extrinsic)

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162
Q

What is the histology of nonspecific interstitial pneumonia (NSIP)

A

Uniform infiltrates and fibrosis and interstitial thickening

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163
Q

What are the characteristics of Strep pneumoniae

A

Gram positive lancet shaped diplococci

164
Q

What are the common causes of otitis media

A

Strep pneumoniae
Moraxella cararrhalis
Haemophilus influenza

165
Q

What are the morphological findings in asbestos exposure

A
  • Hyalinzed collagen (will appear very very pink)

- “Candlewax drippings” on the pleura

166
Q

What is congenital pulmonary adenomatoid malformation (CPAM)

A

Arrested development of pulmonary tissue with the formation of cystic masts. Can be at the stage of any portion of the respiratory tree

167
Q

What are the complications seen with congentical pulmonary adenomatoid malformations (CPAM)

A
  • Hydrops or pulmonary hypoplasia

- Can get infected

168
Q

Very generally, what are the histological findings of restrictive lung disease

A

Ground glass appearance due to the fibrosis of the interstitium

169
Q

Small cell tumors of the lung arise from which tissue origin

A

Neuroendocrine cells

170
Q

What are the characteristics of legionella pneumophila

A

Gram negative bacillus

171
Q

Which treatment in the hospital are increasing at risk from nosocomial infections

A

-Mechanical ventilation devices

172
Q

What are the common cause of diffuse infiltrates in immunocompromised hosts

A

CMV
Pneumocystis jiroveci
Drug reaction

173
Q

What is the patient group seen to have NUT carcinoma

A

Aka midline carcinoma

Any age, but median age is 22 years old

174
Q

What are the characteristics of pertussis

A

Gram negative coccobacilis

175
Q

What type of pathogens are commonly causing the post transplantation infection

A
  • Bacterial

- Some fungal, usually candida and Aspergillus (usually involved the bronchial anastomotic sites and lung

176
Q

What are the common causes of pneumonia in children older than one month

A
  • Strep pneumoniae
  • H influenza
  • M catarrhalis
  • Staph aureus
177
Q

What are the immunological factors involved in hypersensitivity pneumonia

A 
Proinflammtory chemokines (IL-8 and MIP)
Higher CD4 and CD8 cells
178
Q

What are the cell types typically seen in non-atopic asthma

A

Normal IgE levels

-Increased T lymphocytes and neutrophils

179
Q

What location of invasion is commonly seen with P. Aeruginosa

A

Blood vessels with speed to lead to bacteriemia

180
Q

What is the treatment for small cell carcinoma

A
  • Surgical excision if it has not reach the LN

- Responds very well to the specific chemotherapy, but there is a high rate of recurrence

181
Q

What is the prognosis and treatment for desquamative interstial pneumonia

A

Good prognosis (>95% at 5 years), and treatment is smoking cessation and corticosteroids

182
Q

What is the most common cause of communist acquired pneumoniae

A

Strep pneumonia

183
Q

What is the complication seen with the sphenoid sinus

A

Mucocele

184
Q

Carcinoid tumors histologically have which features

A

Uniform cells with visible nucleus

Organoid arrangement

185
Q

What is the common sinus that is the location of the mucocele

A

Frontal

186
Q

What are the age groups that olfactory neuroblastomas are seen

A
  • Adolescence
  • Middle age

*bimodal distribution

187
Q

What are the markers of an olfactory neuroblastoma

A
  • Neuron specific enolase, synaptophysin
  • CD56
  • chromogranin
188
Q

What will the fluid from an empyema contain

A

Thick, yellow fluid containing neutrophils and bacteria

189
Q

What marker can be used to see Extranodal NK/T cell lymphomas

A

EBER1 because it is associated with EBV

190
Q

Singer’s nodules are commonly due to which cause

A

Reactive swelling usually do to heavy use such as smoking or singers

191
Q

Lung smoking caused emphysema tends to involved which portion of the lung

A

Upper lobes

192
Q

What condition is associated with carotid body tumors

A

MEN 2

193
Q

What is the common clinical presentation of polyangiitis with granulomatosis, aka Wegener

A

Hemoptysis

194
Q

How does langerhans cell histiocytosis (LCH) patients normally first present with the disease

A

Unexplained Pneumothorax due to cyst rupture

195
Q

What are the common conditions that will lead to pulmonary hypoplasia What

A
  • Congential diaphragmatic hernia

- Oligohydramnios (secondary to renal agenesis)

196
Q

What is status asthmaticus

A

Unrelenting, potentially fatal asthma attack resulting in usual bronchial occlusion by thick mucus

197
Q

What is the inheritance pattern of otosclerosis

A

Autosomal dominant

198
Q

What the prognosis of mesothelioma

A

Grim, with most not living longer than 2 years

199
Q

What are the common gram positive bacteria causing nosocomial pneumonia

A

Staph aureus and strep pneumonia

200
Q

What is the cause of foregut cysts

A

Detachment of primitive foregut, usually in the hilum or middle mediastinum

201
Q

Arising of which syndrome would lead to thought of which type of tumor

A

Carcinoid Syndrome induced by serotonin

  • Flushing
  • Diarrhea
  • Cyanosis
202
Q

What are the morphological and radiographic findings in histoplasma capsulatum

A
  • Tree back appearance from granuloma formation from macrophages
  • Calcification or coin lesions on chest X ray
203
Q

What is the mechanism of damage in the case of chronic bronchitis

A
  • Damaged cilia do to the underlying cause
  • Mucus hypersecretion (earliest form) due to increased goblet cells proliferation (mucous gland hyperplasia)
  • Inflammation
  • Thickened smooth muscle decreases the size of the lumen
204
Q

What is the end stage of any fibrotic lung disease

A

Honeycomb fibrosis

205
Q

What are the histological findings in the red hepatization phase of lobar pneumonia

A
  • Red and firm lung with serofibrinous pleurisy

- Fibrin strands with numerous RBC and neutrophils

206
Q

How does smoking increase the chances for pneumoconiosis

A

Smoking decreases the function of the cilia, so it has a decreased ability to keep particles from getting into the lungs

207
Q

What is the end result of restrictive lung disease

A

Pulmonary hypertension and cor pulmonale

208
Q

What are some of the factors that can increase the chances of emphysema

A
  • Protease-antiprotease imbalance
  • Oxidative strees
  • Infection
  • Inflammatory mediators
209
Q

What are the locations that nasopharyngeal carcinomas are usually found

A

IN the nasopharynx, but more present in the neck because of the lymph node metastasis

210
Q

What are the histological findings in hypersensitivity pneumonitis

A
  • Noncaseating granulomas that are loosely formed

- contain lymphocytes

211
Q

What are the ways that autoimmune diseases can present

A 
Interstitial lung diseases such as:
1-usual interstitial pneumonia (UIP)
2- Nonspecific interstitial pneumonia (NSIP)
3- Organizing pneumonia 
4-Bronchiolitis
212
Q

IN the case of HIV patients, what is the likely pathogen causing pulmonary disease if the CD4 count is <50

A

CMV, fungal, Mycobacterium Avium

213
Q

What is the usual cause of nasopharyngeal carcinomas in patients with Chinese/southeast Asian adults

A

INgestion of smoked fish with nitrosamines or EBV

214
Q

Branchial cysts most commonly show which histological finding

A

Simple cyst lined by stratified squamous or respiratory epithelium surround fibrous tissue

215
Q

Which professions are associated with a higher risk of asbestos exposure

A
  • Insulation workers
  • Navy/shipyard workers
  • Paper mill workers
  • Oil or chemical refinery workers
216
Q

What is the most common cause of bacterial acute exacerbation of COPD

A

H influenza

217
Q

Indwelling central venous lines increase the risk for which complication

A

Right atrial thrombi formation

218
Q

What is the histological findings for cryptogenic organizing pneumonia (COP)

A

-Masson bodies (polyploid plugs of loose connective tissue) in the alveoli, alveolar ducts, and. Bronchioles

219
Q

What are Pulmonary sequestrations

A

Nonfunctioning lung tissue that forms from an accessory lung bud, typically in the left lower lobe

220
Q

Coal miner lungs can lead to what end stage condition

A

Centrilobular emphysema

221
Q

What is the prognosis of a patient with non-specific interstitial pneumonia (NSIP)

A

Much better prognosis that responds to steroids, because a uniform pattern of fibrosis.

-No heterogeneity, fibroblast foci, granulomatas

222
Q

What are the characteristics of the morphology in silicosis

A

Progressing, modular fibrosis

-Lipoproteinaceous material in the alveoli

223
Q

What are the complications that arise form emphysema

A
  • Respiratory failure
  • CAD
  • Right sided heart failure
  • Pneumothorax with lung collapse
224
Q

What are the common causes of focal inflitrates in immunocompromised hosts

A 
Malignancy 
Aspergillus
Candida
Staph aureus
Gram neg bacteria
225
Q

What is the prognosis of pulmonary harmatomas

A

Benign, usually found as a incidental finding

226
Q

What are the results of diffuse alveolar damage

A

-Hyaline membranes result in decreased surfactant, leading to stiff lungs, along with ventilation perfusion mismatch

227
Q

What is anthracosis

A

Coal induced pulmonary lesion in coal miners where there is pigmentation that is engulfed by alveolar macrophages

228
Q

What are the findings in status asthmaticus

A
  • Coiled mucus plugs known as “curschmann spirals”

- Charcot Leyden crystals as a result of the eosinophilic degranulation

229
Q

What is the gene involvement for mesothelioma

A

-CDKN2A/INK4

230
Q

What is the grade and rate of mitosis in carcinoids

A

Grade 1 (low rate of metastasis) as well as low levels of mitosis

231
Q

What is the mutations commonly associated with lymphangioleiomyomatosis

A

Loss of function in the tumor suppressor gene TSC2

-Affects the mTOR pathway

232
Q

What is the histological finding of olfactory neuroblastoma

A

Small blue cell carcinomas, with rosette looking areas intermixed

233
Q

What is the FEV1/FVC ratio in restrictive lung disease

A

Normal, as both the values drop, but at the same rate

234
Q

IN the case of HIV patients, what is the likely pathogen causing pulmonary disease if the CD4 count is >200

A

Bacterial or tubercular

235
Q

What are the common causes of serious pulmonary disorders in patients with HIV

A
  • S aureus
  • Strep pneumoniae
  • H influenza
  • gram negative rods

*These pulmonary offenders tend to be more common, more severe, and associated with bacteremia than in healthy individuals

236
Q

What is the most common location for metastatic neoplasms

A

THe lungs

237
Q

What is the clinical definition of chronic bronchitis

A

Persistent cough with sputum for at least 3 months in the last consecutive years

238
Q

Which factor tends to be expressed in pulmonary adenocarcinomas

A

-Thyroid transcription factor 1

239
Q

What type of virus is the influenza virus

A

RNA virus

240
Q

Panacinar emphysema tends to involved which portion of the lung

A

The basilar portion

241
Q

What portion of the lung is affected in idiopathic pulmonary fibrotic lung disease

A

-Affects the whole lung

242
Q

What are the characteristics of atopic asthma

A

-IgE mediated, TH2, typ1 hypersensitivity reaction to an environmental allergen

243
Q

What are the complications seen with pulmonary sequestrations

A

Infection and abscess formation

244
Q

What is a potential complication/ result from recurrent rhinitis

A

Nasal polyps, which are are edematous with a loose stroma. Is usually filled with a variety of inflammatory cells

245
Q

Which patient population seems to be more susceptible to sarcoidosis

A

African Americans (10 times) younger than 40

246
Q

What condition is being identified if it is positive for staining with S-100 and CD1a

A

Langerhans cell histiocytosis (LCH)

247
Q

What are the common complications of the ethmoid sinus

A
  • Mucoecele
  • Subperiosteal abcess
  • Preseptal cellulitis
  • orbital abscess
  • Orbital cellulitis

*Basically anything involving the orbit is related to the ethmoid sinus

248
Q

Which patients are at a higher risk for silicosis

A

African Americans

249
Q

What are the histological findings in the phase of lower pneumonia congestion

A
  • Enlarged and heavy lung and mild pleurisy
  • Widened septum
  • Neutrophils and RBCs with fluid
250
Q

What condition can be associated with larnyngeal squamous papilloma

A

Recurrent respiratory papillomatosis

251
Q

In general, obstructive lung diseases as classified as disease of which area

A

The airways

252
Q

What are the conditions that cause the pushing out of fluid into the alveolar spaces during pulmonary edema

A
  • Left sided heart failure (most common)
  • Volume overload
  • Pulmonary vein obstruction

*All result in blood/fluid to not leave the lungs, therefore the forces puss them out into the alveoli

253
Q

What is the most common origin of foregut cysts

A

Bronchogenic

254
Q

What are the organisms that make up the atypical pathogens

A

Aka do not stain or grow on typical culture media

  • Mycobacterium pneumoniae
  • Chlamydphila pneumoniae
  • Coxiella Burnetii
  • viruses
255
Q

What are the traits of atypical carcinoid tumors that differ from the typical from

A
  • Increased mitotic activity
  • Necrosis**
  • Disordered Growth
  • Increased rate of metastasis with lower rates of survival.
256
Q

Singer’s nodules are from which tissue origin

A

Expansion of the soft tissue underlying the vocal fold (Rienke’s space)

257
Q

Tuberous sclerosis complex can contain which components

A

-Hypomelanotic macules
-Facial angiofibromas
-cardiac rhabdo
Retinal hamartomas
-Shagreen Patch

258
Q

What is the prognosis of NUT carcinoma

A

Very bad, with most dying within a year due to this aggressive metastatic tumor

259
Q

What is the process and coloration of thelungs following a pulmonary infarct

A

1-Red infarct first and initially
2-White infarct as there is healing and scarring

*The lesions in the lungs following an infarct are wedge shaped

260
Q

How do the locations of pulmonary squamous cell carcinomas and adenocarcinomas differ

A

Squamous cells tend to be more central while adenocarcinomas tend to be towards the periphery

261
Q

What is the pathogenesis of group 2 pulmonary hypertension

A
  • Secondary to left heart failure

* i.e mitral stenosis

262
Q

What is the embryological origin of carotid body tumors

A

Aka PNA paraganglioma

-Neuroectoderm from NC cells

263
Q

Which environmental factor greatly increases the risk of lung carcinoma and mesothelioma

A

Smoking (55 fold increase)

264
Q

Idiopathic pulmonary hypertension is most common in which group

A

Women from 20-40 yrs old

265
Q

With regards to the the paraneoplasm condition of hypercalcemia (PTH related peptide), what is the underlying tumor

A

Squamous cell carcinoma

266
Q

What is the histological findings of thyroglossal duct cysts

A

Thyroid follicles with respiratory lining

267
Q

What type of tumor is NUT midline carcinomas

A

Malignant

268
Q

Which portion of the lung is most commonly involved in blastomycosis

A

Upper lung

269
Q

Which patient population is at high risk for infection with H influenza

A

-Causes virulent pneumonia in children

270
Q

What are the histological findings during allergic fungal sinusitis

A
  • Allergic mucin aka Charcot Leydig crystals, which are bright pink crystals from the eosinophilic degranulation
  • Fungal hyphae

+/- mycetoma (aka fungal ball)

271
Q

What are the histological and morphological findings in a harmatoma

A

Firm “coin like lesion or marble” with smooth edges composed of:

  • Fibrous connective tissue
  • Benign glandular respiratory epithelium around hyaline cartilage
272
Q

Polymorphisms in which gene has the strongest and most consistent association with asthma or allergic disease

A

IL13 gene

273
Q

What is the toxin of pseudomasa aeruginosa

A

-Exotoxins A inhibits protein synthesis and causes necrosis

274
Q

What are the three components to asthma

A
  • Recurrent airway obstructions that is reversible
  • Airways hyper responsiveness
  • Airway inflammation
275
Q

What conditions commonly make an individual more prone to TB infections

A 
HIV
DM
Hodgkin lymphoma
Chronic lung diseases (especially silicosis)
alcoholism
276
Q

What are the findings in chronic bronchitis

A

Elevated hemoglobin

Rhonchi and wheezing

277
Q

What is the histological finding in blastocysts dermatitides

A

Broad based budding (upon budding, the two buds have a lot of wall contact still)

278
Q

What are the 4 steps in the progression of adenocarcinomas of the lung

A

1-Normal tissue
2- Atypical adenomatous hyperplasia
3-Adenocarcinoma insitu
4-adenocarcinoma

279
Q

What conditions in children are caused by H influenza

A
  • acute purulent conjunctivitis

- pneumonia (emergency)

280
Q

Acute respiratory distress syndrome in neonates will have which neonate radiographic

A

Ground glass due to lack of surfactant

281
Q

What are the common bacteria that cause superimposed infection in the upper airways

A
  • Strep pneumoniae

- Haemophilus influenza

282
Q

What condition is present if there are “eggshell” findings on X-ray

A

Silicosis

283
Q

Where in the lungs does asbestosis begin

A

Lower lungs and pleura

284
Q

Which conditions is commonly seen in concurrence with a lymphangioleiomyomatosis

A

Angiolipomas of the kidney

285
Q

Inflammatory myofibroblastic tumors are associated with which gene rearrangement

A

ALK gene

286
Q

Which two factors are more commonly elevated in bacterial infections as opposed to viral infections

A

CRP and procalcitonin

287
Q

What is the method that M. tuberculosis is able to evade the host immunity

A

1) Enters the macrophages via CR3 and MBL

2) Replicates in the macrophage and able to prevent the formation of the phagolysosome by inhibiting calcium signaling

288
Q

What are the histological findings for pneumocystis jiroveci

A

Cup shaped fungus, usually in the diffuse form, but can be focal infiltrates

289
Q

What can be a common presentation of lymphangioleiomyomatosis

A

-Spontaneous pneumothorax

290
Q

What are the common products of the immune system that results in the affects seen during asthma

A

Leukotrience C4, D4,E4

291
Q

Where do mesotheliomas arise from

A

Visceral or parietal pleura

292
Q

Genetic defects in which portion of the innate immunity can lead to increased pulmonary infections

A

MyD88

293
Q

What is the underlying pathogenesis in neonatal respiratory distress syndrome

A

Hyaline membrane disease, with the lack of surfactant production

*All due to the immaturity if the fetal lungs

294
Q

Goodpasture sysndrome is caused by which factor

A

-Autoantibodies against the non collagenous domain of the alpha3 collagen 4

295
Q

What is the gene and its location for alpha1 antitrypsin deficiency

A

-Pi (protein inhibitor gene) coded on chromosome 14

296
Q

Patients with a pulmonary embolism are at an increased risk for developing which complication

A

A second PE

297
Q

With regards to the the paraneoplasm condition of SIADH, what is the underlying causing tumor

A

small cell carcinoma

298
Q

What are the complications of the frontal sinus

A
  • Osteomyelitis
  • Mucocele
  • Meningitis
  • Epidural and subdural abscess
  • Brain abcess

*Basically anything related to the brain

299
Q

Which patient population is commonly infected by P. Aeruginosa

A

-CF and immunocompromised individuals

300
Q

Expression of which gene tends to lead to mire severe disease, airway remodeling, and decreased pulmonary function

A

YKL-40

301
Q

What portion of the lung is affected in centriacinar/centrilobar emphysema

A

The proximal or central parts, with the distal portions being spared

302
Q

What is the patient population seen to have Granulomatosis with polyangiitis

A

Aka Wegener granulomatosis

-Middle aged adults

303
Q

What genetic polymorphism is commonly seen in patients with asthma

A

ADAM33, which is a metalloproteinase linked to increased proliferation of bronchial smooth muscle and fibroblasts

304
Q

What is the process of pulmonary edema

A

Interstitial Fluid enters the alveolar spaces in the lungs and prevents gas exchange

305
Q

What is the relation of lung cancer worldwide to diagnosis and deaths

A

Most frequently diagnosed and most come cause of cancer mortality

306
Q

What are the cell type markers expressed by a lymphangioleiomyomatosis

A
  • Smooth muscle cells

- Melanocytes (HMB45)

307
Q

What is the prognosis and treatment for respiratory bronchiolitis- Associated interstitial lung disease

A

Good prognosis if caught early, with treatment being smoking cessation

308
Q

What are the three types of atelectasis

A
  • Resorption
  • Compression
  • Contraction
309
Q

What are patients with a pulmonary embolism usually presenting with

A
  • Acute and instantaneous death
  • May have electromechanical dissociation, meaning the heart is beating, but there are not pulses felt due to no blood entering the pulmonary circulation
310
Q

How can honeycomb lung be diagnosed

A

Radiographic findings (CT)

311
Q

What is the progressing sequence of changes leading to lung cancer

A

1-Basal cell hyperplasia
2- squamous metaplasia
3- Squamous dysplasia
4- carcinoma in situ

312
Q

What is the type of sinonasal papillomas that can cause complications and what is the reason

A

Endophytic

*Although it is a benign tumor, it can be locally aggressive, growing down. It will grow into the stroma and of left excised, will invade the orbit or Cranial vault

313
Q

How will a inflammatory myofibroblastic tumor appear on radiographs

A

-Single lesion, well defined, round, calcium deposit

314
Q

WHat are the common causes of health care associated pneumonia

A
  • MRSA

- P aeruginosa

315
Q

What is used to diagnose DIPNECH

A

High resolution CT scan

316
Q

What are the histological findings of patients with deaquamative interstial pneumonia (DIP)

A

Stuffed “smokers” macrophages that contain large amounts of brown pigments

317
Q

What is the patient population seen to have nasopharyngeal angiofibromas

A

Young men, usually fair skinned and red headed

318
Q

ARDS is most commonly associated with which conditions

A
  • Sepsis
  • Diffuse Pulmonary Infections
  • Gastric aspiration
  • Mechanical or head trauma
319
Q

Chronic uncontrolled asthma can lead to which conditions

A

Irreversible changes due to airway remodeling, such as fibrosis, smooth muscle hyperplasia, and increased goblet cells and glands, all of which are unresponsive to therapeutic agents

320
Q

What is the usual cause of severe chronic sinusitis that is not of bacterial origin

A

Fungal, especially mucormycosis

321
Q

What is the morphological finding in coccidiodes immitis infection

A

Spherules full of intact coccidiodes

322
Q

Which patient population is highly susceptible to fungal caused sinusitis

A

Diabetic population and immunosuppressed patients (especially mucor invasion)

323
Q

What are the characteristics of polyangiitis with granulomatosis

A

Capillaries and scattered poorly formed granulomas (as opposed to the well formed ones of sarcoidosis)

324
Q

What is the function of hemagglutinin in influenza virus

A

Attaches to the cells

325
Q

What is the cause of hypersensitivity pneumonitis

A

-Overreaction to prolonged exposure to inhaled organic antigens (pigeon breeders lung, farmer’s lung, humidifier lung)

326
Q

Which form of silicon is the most detrimental

A

Crystalline from is more fibrogenic

*Includes quartz, tobalite, tridymite)

327
Q

Death as a result of ARDS is commonly due to which cause

A
  • Sepsis
  • Multiorgan failure
  • direct lung injury
328
Q

Which conditions are asbestos exposure linked to

A

Mesothelioma
Pleural effusions
Lung cancer

329
Q

What is the clinical presentation of a patient with idiopathic pulmonary hemosiderosis

A

Young children with symptoms similar to goodpasture, except there are no autoantibodies

330
Q

Which population is at a higher risk of pneumonia caused by E. Coli

A

IV drug users

331
Q

What is the common cause of chronic otitis media in diabetics

A

Pseudomonas aeuroginosa

332
Q

What is the characteristic histological finding in asbestos exposure and what is the cause

A

Asbestos body, which has a linear and rounded portion:

  • Linear portion is the asbestos
  • Rounded portion and color is due to the engulfing attempt by macrophages
333
Q

Emphysema and chronic bronchitis are normal grouped together as COPD because what reason

A

Most are caused by smoking and are commonly found together

334
Q

What are the interstitial conditions that are directly causes by smoking

A
  • Desquamative interstitial pneumonia (DIP)
  • Respiratory bronchiollitis-interstial lung disease (RB-ILD)
  • Langerhans cell histiocytosis (LCH)
335
Q

What are patients with coal workers pneumoconiosis at increased risk for

A

TB

*Does not affect cancer rate

336
Q

What is the common patient group to have sinonasal papillomas

A

-Middle aged man

337
Q

What is the pathogensis of pulmonary alveolar proteinosis (PAP)

A

Defective metabolism and breakdown of surfactant due to lack of granulocyte macrophage colony stimulating factor (GM-CSF)

338
Q

Which patient is commonly seen to have laryngeal carcinoma

A

Men >60 (because highest association with smoking and alcohol)

339
Q

What is the difference between diffuse interstitial pulmonary neuroendocrine cell hyperplasia and carcinoid tumor

A

They are just differentiated by size

  • DIPNECH (<5mm)
  • Carcinoid (>5mm)
340
Q

What is the patient group commonly seen to have lymphangioleiomyomatosis

A

Young women of childbearing age

341
Q

What are the clinical presentations of secondary tuberculosis

A

Generally is the more dangerous form, as it is the reactivation of a dormant infection. Usually involves the upper lobes of the lung, producing cavitations that causes sputum containing bacteria

342
Q

What are the complications of lobar pneumonia

A

Abscess
Empyema
Bacteremia

343
Q

Which directions does the mediastinum shift during compression atelectasis

A

Away from the atelectasis lung

344
Q

How does the influenza virus cause damage to the alveolar cells

A

Inhibits sodium channels and leads to electrolyte and water changes that cause fluid accumulation into the alveolar lumen

345
Q

What is the imaging finding in carotid body tumors

A

The carotid bifurcation is pushed out

346
Q

What is occurring during contraction atelectasis

A

Fibrotic or other restrictive processes restrict the lung expansion

347
Q

What is the usual cause of nasopharyngeal carcinomas in young patients with African descent

A

EBV related

348
Q

What is the treatment for idiopathic pulmonary hemosiderosis

A

Long term immunosuppression with prednisone and azathiprine

349
Q

With regards to the the paraneoplasm condition of cushing syndrome (secretion of ACTH) what is the underlying tumor

A

Small cell carcinoma

350
Q

Which lifestyle increases the chances for lung accesses

A

-alcoholism

351
Q

What is the entire respiratory tree lined by

A

Pseudostratified, tall, columnar, ciliated epithelial cells

352
Q

What type of tumor is EBV related nasopharyngeal carcinomas

A

Malignant

353
Q

How does RSV cause illness

A

1-RSV adheres to the epithelial cells of the airways
2-Cells are sloughed off, which allows the traveling further into the lower respiratory tract
3- INflmmation ensues and there is an increased amount of mucus production that leads to blockage of the airways

354
Q

Laryngeal carcinoma are strongly associated with which factors

A
  • Smoking
  • Alcohol
  • HPV infection
355
Q

What are the components and their cause in Kartegener syndrome

A

Ciliary dysfunction, leading to:

  • Sinus inverses (ciliary needed to rotate organs)
  • Infertility (nonmotile sperm)
  • Recurrent sinusitis
  • Bronchiectasis
356
Q

What is the finding of olfactory neuroblastomas on CT

A

Dumbbell shape, where there is one portion in the upper respiratory tract, and then the other have in the anterior cranial fossa as it penetrates the cribriform plate

357
Q

What is the characteristic lesion seen in pulmonary hypertension

A

-Plexiform lesion

358
Q

Bronchopneumonia usually has what type of disease pattern

A

Pathcy, covering multiple lung lobes/area

359
Q

Which patients tend to be prone allergic bronchopulmopnary aspergillosis

A

-Asthma and CF patients

360
Q

What are the interstitial granulomatous diseases

A
  • Sarcoidosis

- Hypersensitivity pneumonia

361
Q

What is the complication with otosclerosis

A

Conductive hearing loss due to the bony deposition at the stapedial endplate, leading to inabilty to transfer the sound wave

362
Q

What are the types of mesotheliomas

A
  • Epithelioid type (60%) being cuboidal, columnar or flattened cells resembling an adenocarcinoma
  • Sarcomatoid type (20%) being spindle cell sarcoma, resembling a fibrosarcoma
  • Mixed (20%)
363
Q

What are the major causes of rhinitis

A

Adenovirus
Echovirus
Rhinovirus *
Coronavirus *

*Most common

364
Q

What is the gene mutation involved with NUT carcinoma

A

NUT protein, which is a chromatin regulator protein, usually associated with BRD4

365
Q

What is the gene associated with an increased risk of oxidative stress leading to emphysema

A

-NFR2 lacking or decreased amounts more susceptible to smoke and other factors causing oxidative stress

366
Q

Which age population is commonly seen to have idiopathic pulmonary hemosiderosis

A

Young children

367
Q

What is the cause of non-atopic asthma

A

Cold, exercise, infection (usually viral)

368
Q

What is a spontaneous idiopathic pneumothorax

A

Rupture of a small apical subpleural bleb, usually in younger patients

369
Q

Which direction does the mediastinum shift during resorption atelectasis

A

Shifts towards the atelectic lung

370
Q

If there is a biopsy run on the neck, and it is found to be a squamous cell with squamous debris, how does the diagnosis differ by age

A

In infants and adolescents, it would be a branchial or thyroglossal cyst

In adults, it is a metastatic cystic carcinoma

371
Q

What are the characteristics of Respiratory syncytial virus (RSV)

A

Paramyxovirus

372
Q

What is the stain used to differentiate mesothelioma from other adenocarcinomas

A

Calretinin

*May even have ferruginous bodies present

373
Q

What is the pathogensis of group 1 pulmonary hypertension

A
  • Primary vascular disease leading to increased vascular resistance
  • most common is autoimmune in the form of systemic sclerosis
374
Q

Which pathogen can be found in patients with the endophytic or exophytic forms of sinonasal papillomas

A

DNA from HPV 6 and 11

*not found in the oncocytic/cylindrical form)

375
Q

What type of cell type of cancer is nasopharyngeal carcinoma

A

Squamous

376
Q

What is a characteristic of TB in patients with HIV

A

-Tend to be false negative- smear and PPD tests

377
Q

What are the histological findings that can lead to a diagnosis of squamous cell pulmonary carcinoma

A
  • Keratin pearls (very pink)

- Orange cytoplasm

378
Q

What are the factors/markers that are commonly seen in small cell carcinoma

A

-CD57, chromogranin, synaptophysin

379
Q

IN those with GERD, what lung issues may arise

A

-Aspiration pneumonia leading to small, poorly formed nonnecrotizing granulomas with multinucleated foreign body giant cell reactions

380
Q

What is the primary cause of the majority of pulmonary alveolar proteinosis

A

-Autoantibodies to GM-CSF (90% of cases)

381
Q

Carcinoids have an association to occur with which genetic conditions

A

MEN1

382
Q

What are the associations that lead to an increased risk for neonatal respiratory distress syndrome

A
  • Male
  • Maternal diabetes
  • Cesarean delivery
383
Q

What is the prognosis of Extranodal NK/T cell lymphomas

A

Not great, as very aggressive and commonly undergoes relapse and recurrence

384
Q

Elevated levels of Angiotensin converting enzyme (ACE) is characteristic of which condition

A

Sarcoidosis

385
Q

Which individuals have decreased alpha 1 antitrypsin

A

Z allele in the homozygous PiZZ individuals

386
Q

What is the prognosis and treatment for langerhans cell histiocytosis

A

Good prognosis and >95% getting better with smoking cessation

387
Q

What are the associations with recurrent respiratory papillomatosis

A
  • Mothers <20
  • Vaginal delivery
  • First born

*all usually due to the HPV being transferred to the newborn

388
Q

What is a gram positive rod that can cause disease of the upper respiratory tract

A

Diphtheria (club shaped)

389
Q

What is the treatment for idiopathic pulmonary fibrosis (IPF)

A
  • Tyrosine kinase inhibitors
  • TGF beta inhibitors

*Lung transplant is the only therapy

390
Q

What are the genetic factors involved in the case of idiopathic pulmonary fibrosis

A

Loss of function in:

  • TERT and TERC coding for telomerase,
  • MUC5B producing mucus

*These are making individuals more prone to toxins and factors

391
Q

How does the combination of obstruction and infection lead to Bronchiectasis

A
  • Obstruction or thickening mucus or ciliary dysfunction disrupts the normal clearing mechanism
  • Infection than can not be cleared/prevented
392
Q

What type of tumor is nasopharyngeal angiofibroma

A

Benign

393
Q

What are the characteristics of coal nodules

A

Larger coal caused areas where there are carbon-ladened macrophages

394
Q

What are the characteristics of coal macules

A

Small (1-2mm) ares of carbon-laden macrophages

395
Q

What is a Ghon complex and which infection is it indicative of

A

When the TB infection is creating caseous lesions located in the lung parenchyma, as well as moving to the regional LNs and causing caseous lesions

396
Q

What are the bacteria that can lead to lung abcess and necrotizing opneuomia

A

Staph aureus
Klebsiella
Strep pyogenes
Type 3 pneumococcus

-Anareobic bacteria

397
Q

What is the propensity for small cell carcinoma to metastasize

A

Very high rate with a poor prognosis

398
Q

What is the characteristic finding in emphysema

A

Irreversible enlargement of airspace distal to terminal bronchioles, along with damage such as fibrosis

399
Q

Which type of tumors will grow in a contiguous manner

A
  • Esophageal carcinomas

- Mediastinal lymphomas

400
Q

IN those with aspiration pneumoniae due to loss of gag reflex, what is the common complication

A

-Death due to necrotizing pneumonia, with Lung abscess formation in those few that survive

401
Q

What is the pathogenesis of group 4 pulmonary hypertension

A
  • Secondary to thromboembolitic pulmonary disease

* Recurrent pulmonary emboli can decreased the cross sectional area of the capillaries

402
Q

What condition will be positive for smooth muscle markers, as well as the melanoma markers (HMB45, Melan-A)

A

Renal cell tumors (lymphoangioleimyomatosis or angiomyolipoma)

403
Q

What are the characteristics of the measles virus

A

RNA paramyxovirus

404
Q

What is recurrent respiratory papillomatosis

A

Papillomas that not only affect the larynx, but are able to move down into the lungs

405
Q

Which patients are most commonly affected by human metapneumonovirus

A

Immunocompromised individuals, younger and older populations

406
Q

What are the histological findings of silicosis

A

Denise collagenous nodules

Robbins Pathology Respiratory(Chptr 15, 16) (3 decks)

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