Chapter 9 - Respiratory Flashcards
What causes nasal polyps?
Rhinitis, but also Cystic Fibrosis and aspirin intolerant asthma
What is aspirin intolerant asthma?
Asthma, aspirin induced bronchospasms, and nasal polyps
What is an angiofibroma, and when do you classically see it?
Benign tumor of nasal mucosa seen in adolescent males.
What is nasopharyngeal carcinoma associated with?
EBV
Pleomorphic keratin-positive epithelial cells in a background of lymphocytes = ???
Nasopharyngeal carcinoma
What causes laryngeal papillomas?
HPV 6 and 11.
Two most common causes of lobar pneumonia?
- Strep penumoniae
2. Klebsiella pneumoniae (diabetes, alcoholics)
How is tissue regenerated post-pneumoniae?
Type II pneumocytes!
Most common causes of aspiration pneumonia?
Anaerobic bacteria (bacteroides, fusobacterium, and peptococcus)
In chronic bronchitis, what histological finding is seen and what is the measure of this?
See increased thickness of mucus glands relative to overall bronchial wall thickness (Reid Index >50%)
how does emphysema develop?
Inflammation releases proteases, which are normally then neturalized by alpha1-antitrypsin. Excess inflammation overwhelms this.
What type of histologic emphysema is seen in smokes?>
Centriacinar (vs. panacinar)
In alpha1-antitrypsin deficiency, what histologic finding is seen in the liver?
pink, PAS-positive globules.
Most common causes of bronchopneumonia (5)?
- Staph aureus
- H influenzae
- Pseudonomas
- Moraxella catarrhalis
- Legionella pneumophila
Most common causes of atypical pneumonia? (6)
- Mycoplasma
- Legionella
- Chlamydia
- RSV
- CMV
- Influenzae
Common causes of pneumonia in the neonate (2)?
- Group B strep (Strep agalactiae)
2. E coli
Common causes of pneumonia in children (5)
- Viruses (RSV)
- Mycoplasma
- Chlamydia
- C. pneumoniae
- Strep pneumoniae
Common causes of pneumonia in adults (18-40) (3)
- Mycoplasma
- C. pneumoniae
- Strep pneumoniae
Common causes of pneumonia in adults (40-65) (5)
- Strep pneumoniae
- H influenzae
- Anearobes
- Viruses
- Mycoplasma
Common causes of pneumonia in the elderly (more than 65) (5)
- Strep pneumoniae
- Influenza
- Anaerobes
- H influenzae
- Gram - rods
Step by step pathogenesis of asthma?
- Allergens induce Th2 phenotype in CD4+ T cells
- Th2 cells secrete Il-4 (IgE), Il-5 (attracts eosinophils), and Il-10 (stimulates Th2 and inhibits Th1)
- Re-exposure to antigens leads to IgE activation of mast cells –> histamine release, leading to vasodilation and fluid leakage. Leukotrienes also produced (C4, D4, and E4), leading to bronchoconstriction, inflammation, and edema.
What are Curschmann spirals
Spiral shaped mucus plugs seen in asthma
What are charco-Leyden crystals?
Eosinophil-derived crystals seen in asthma.
Classic triad seen with aspirin induced asthma?
- Asthma
- Bronchospasm
- Nasal polyps
What respiratory disease can Kartagener’s syndrome cause?
Bronchiectasis (due to impaired ciliary clearance from defective dynein).
What is allergic bronchopulmonary aspergillosis?
Hypersensitivity reaction to aspergillosis leading to chronic inflammation and bronchiectasis. Classically seen in CF or asthmatic patients.
Complications of bronchiectasis?
- Hypoxemia –> cor pulmonale
2. Secondary amyloidosis (AA) from chronic inflammation. RESTRICTIVE DISEASE. Ouch.
What drugs can cause pulmonary fibrosis?
Bleomycin, busulfan, amiodarone, and methotrexate
“honeycomb” lung appearance on histo = ???
Idiopathic pulmonary fibrosis :(
Sarcoidosis general histologic appearance
Systemic disease causing noncaseating granulomas in multiple organs
Clinical features of sarcoidosis?
- Dyspnea/cough
- Elevated ACE
- Hypercalcemia (increased Vit. D activation by epithelioid histiocytes)
Caplan syndrome?
Coal workers pneumoconiosis (anthracosis) with RA
Silicosis is associated with what and puts you at increased risk for what disease?
Associated with sandblasting and silica mines. Causes pneumoconiosis. Increases your risk for TB!!! As impairs phagolysosome formation by Macrophages.
Berylliosis is associated with what and puts you at increased risk for what?
Associated with beryllium miners and workers in aerospace engineering. Causes pneumoconiosis. Increases risk for lung cancer.
Histological findings with berylliosis?
Noncaseating granulomas in lung, hilar lymph nodes, and systemic organs. NOTE THAT THIS SOUNDS JUST LIKE SARCOID…
What is hypersensitivity pneumonitis?
Granulomatous reaction to inhaled organic antigens. Chronic exposure leads to interstitial fibrosis with Eosinophils! Type 3 and 4 hypersensitivity reaction!
Histologic findings with Pulmonary Hypertension?
Atherosclerosis of pulmonary trunk, smooth muscle hypertrophy of the pulmonary arteries, and intimal fibrosis.
How does pulmonary hypertension present?
Exertional dyspnea or R sided heart failure.
Most common cause of primary pulmonary hypertension?
Inactivating mutations of BMPR2 –> proliferation of vascular smooth muscle
Common causes of secondary pulmonary hypertension?
Hypoxemia (COPD or interstitial lung disease), congenital heart disease backing up into pulm circuit, also recurrent PE’s…
Common complication of ARDS?
Pulmonary fibrosis due to damage and loss of type II pneumocytes leading to scarring and fibrosis.
What type of cells make surfactant and what is it primarily composed of?
From Type II pneumocytes. Made of phosphatidylcholine (lecithin!).
What tells you that you have adequate surfactant?
A lecithin (phosphatidylcholine) to sphingomyelin ratio >2 in the amniotic fluid.
What components of smoke are particularly mutagenic?
Polycyclic aromatic hydrocarbons AND arsenic.
Common causes of granuloma’s found on CXR?
TB or fungus (think histoplasma in midwest)
Causes of benign “coin-like” lesions of CXR that are not cancer?
- Granuloma’s
2. Bronchial hamartoma (benign tumor of lung tissue and cartilage).
Small cell carcinoma of the lung location and association?
Centrally located. Associated with male smokers
Small cell carcinoma of the lung often causes what paraneoplastic syndromes?
Produce ADH, ACTH, or causes Eaton-Lambert syndrome
Squamous cell carcinoma of the lung location and association
Central. Most common tumor in male smokers.
Keratin pearls or inercellular bridges seen in a lung biopsy?
Squamous cell carcinoma of the lung
What paraneoplastic syndrome is common with squamous cell carcinoma of the lung?
PTHrP
Adenocarcinoma of the lung location and association?
Peripheral. Most common tumor in nonsmokers and females (in lung)
Large cell carcinoma of the lung location and association
Central or Peripheral. Associated with smoking.
Bronchioloalveolar carcinoma of the lung location and association.
peripheral. Good prognosis, and not related to smoking.
Columnar cells that grow along preexisting bronchioles and alveoli that arise from Clara cells on lung biopsy = ???
Bronchioloalveolar carcinoma
What do carcinoid tumors of the lung stain with?
Chromogranin
Most common site of lung metastasis?
Adrenal glands!
