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Pathoma > Chapter 9 - Respiratory > Flashcards

Chapter 9 - Respiratory Flashcards

1
Q

What causes nasal polyps?

A

Rhinitis, but also Cystic Fibrosis and aspirin intolerant asthma

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2
Q

What is aspirin intolerant asthma?

A

Asthma, aspirin induced bronchospasms, and nasal polyps

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3
Q

What is an angiofibroma, and when do you classically see it?

A

Benign tumor of nasal mucosa seen in adolescent males.

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4
Q

What is nasopharyngeal carcinoma associated with?

A

EBV

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5
Q

Pleomorphic keratin-positive epithelial cells in a background of lymphocytes = ???

A

Nasopharyngeal carcinoma

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6
Q

What causes laryngeal papillomas?

A

HPV 6 and 11.

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7
Q

Two most common causes of lobar pneumonia?

A
  1. Strep penumoniae

2. Klebsiella pneumoniae (diabetes, alcoholics)

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8
Q

How is tissue regenerated post-pneumoniae?

A

Type II pneumocytes!

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9
Q

Most common causes of aspiration pneumonia?

A

Anaerobic bacteria (bacteroides, fusobacterium, and peptococcus)

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10
Q

In chronic bronchitis, what histological finding is seen and what is the measure of this?

A

See increased thickness of mucus glands relative to overall bronchial wall thickness (Reid Index >50%)

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11
Q

how does emphysema develop?

A

Inflammation releases proteases, which are normally then neturalized by alpha1-antitrypsin. Excess inflammation overwhelms this.

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12
Q

What type of histologic emphysema is seen in smokes?>

A

Centriacinar (vs. panacinar)

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13
Q

In alpha1-antitrypsin deficiency, what histologic finding is seen in the liver?

A

pink, PAS-positive globules.

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14
Q

Most common causes of bronchopneumonia (5)?

A
  1. Staph aureus
  2. H influenzae
  3. Pseudonomas
  4. Moraxella catarrhalis
  5. Legionella pneumophila
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15
Q

Most common causes of atypical pneumonia? (6)

A
  1. Mycoplasma
  2. Legionella
  3. Chlamydia
  4. RSV
  5. CMV
  6. Influenzae
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16
Q

Common causes of pneumonia in the neonate (2)?

A
  1. Group B strep (Strep agalactiae)

2. E coli

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17
Q

Common causes of pneumonia in children (5)

A
  1. Viruses (RSV)
  2. Mycoplasma
  3. Chlamydia
  4. C. pneumoniae
  5. Strep pneumoniae
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18
Q

Common causes of pneumonia in adults (18-40) (3)

A
  1. Mycoplasma
  2. C. pneumoniae
  3. Strep pneumoniae
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19
Q

Common causes of pneumonia in adults (40-65) (5)

A
  1. Strep pneumoniae
  2. H influenzae
  3. Anearobes
  4. Viruses
  5. Mycoplasma
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20
Q

Common causes of pneumonia in the elderly (more than 65) (5)

A
  1. Strep pneumoniae
  2. Influenza
  3. Anaerobes
  4. H influenzae
  5. Gram - rods
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21
Q

Step by step pathogenesis of asthma?

A
  • 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.
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22
Q

What are Curschmann spirals

A

Spiral shaped mucus plugs seen in asthma

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23
Q

What are charco-Leyden crystals?

A

Eosinophil-derived crystals seen in asthma.

24
Q

Classic triad seen with aspirin induced asthma?

A
  1. Asthma
  2. Bronchospasm
  3. Nasal polyps
25
Q

What respiratory disease can Kartagener’s syndrome cause?

A

Bronchiectasis (due to impaired ciliary clearance from defective dynein).

26
Q

What is allergic bronchopulmonary aspergillosis?

A

Hypersensitivity reaction to aspergillosis leading to chronic inflammation and bronchiectasis. Classically seen in CF or asthmatic patients.

27
Q

Complications of bronchiectasis?

A
  1. Hypoxemia –> cor pulmonale

2. Secondary amyloidosis (AA) from chronic inflammation. RESTRICTIVE DISEASE. Ouch.

28
Q

What drugs can cause pulmonary fibrosis?

A

Bleomycin, busulfan, amiodarone, and methotrexate

29
Q

“honeycomb” lung appearance on histo = ???

A

Idiopathic pulmonary fibrosis :(

30
Q

Sarcoidosis general histologic appearance

A

Systemic disease causing noncaseating granulomas in multiple organs

31
Q

Clinical features of sarcoidosis?

A
  1. Dyspnea/cough
  2. Elevated ACE
  3. Hypercalcemia (increased Vit. D activation by epithelioid histiocytes)
32
Q

Caplan syndrome?

A

Coal workers pneumoconiosis (anthracosis) with RA

33
Q

Silicosis is associated with what and puts you at increased risk for what disease?

A

Associated with sandblasting and silica mines. Causes pneumoconiosis. Increases your risk for TB!!! As impairs phagolysosome formation by Macrophages.

34
Q

Berylliosis is associated with what and puts you at increased risk for what?

A

Associated with beryllium miners and workers in aerospace engineering. Causes pneumoconiosis. Increases risk for lung cancer.

35
Q

Histological findings with berylliosis?

A

Noncaseating granulomas in lung, hilar lymph nodes, and systemic organs. NOTE THAT THIS SOUNDS JUST LIKE SARCOID…

36
Q

What is hypersensitivity pneumonitis?

A

Granulomatous reaction to inhaled organic antigens. Chronic exposure leads to interstitial fibrosis with Eosinophils! Type 3 and 4 hypersensitivity reaction!

37
Q

Histologic findings with Pulmonary Hypertension?

A

Atherosclerosis of pulmonary trunk, smooth muscle hypertrophy of the pulmonary arteries, and intimal fibrosis.

38
Q

How does pulmonary hypertension present?

A

Exertional dyspnea or R sided heart failure.

39
Q

Most common cause of primary pulmonary hypertension?

A

Inactivating mutations of BMPR2 –> proliferation of vascular smooth muscle

40
Q

Common causes of secondary pulmonary hypertension?

A

Hypoxemia (COPD or interstitial lung disease), congenital heart disease backing up into pulm circuit, also recurrent PE’s…

41
Q

Common complication of ARDS?

A

Pulmonary fibrosis due to damage and loss of type II pneumocytes leading to scarring and fibrosis.

42
Q

What type of cells make surfactant and what is it primarily composed of?

A

From Type II pneumocytes. Made of phosphatidylcholine (lecithin!).

43
Q

What tells you that you have adequate surfactant?

A

A lecithin (phosphatidylcholine) to sphingomyelin ratio >2 in the amniotic fluid.

44
Q

What components of smoke are particularly mutagenic?

A

Polycyclic aromatic hydrocarbons AND arsenic.

45
Q

Common causes of granuloma’s found on CXR?

A

TB or fungus (think histoplasma in midwest)

46
Q

Causes of benign “coin-like” lesions of CXR that are not cancer?

A
  1. Granuloma’s

2. Bronchial hamartoma (benign tumor of lung tissue and cartilage).

47
Q

Small cell carcinoma of the lung location and association?

A

Centrally located. Associated with male smokers

48
Q

Small cell carcinoma of the lung often causes what paraneoplastic syndromes?

A

Produce ADH, ACTH, or causes Eaton-Lambert syndrome

49
Q

Squamous cell carcinoma of the lung location and association

A

Central. Most common tumor in male smokers.

50
Q

Keratin pearls or inercellular bridges seen in a lung biopsy?

A

Squamous cell carcinoma of the lung

51
Q

What paraneoplastic syndrome is common with squamous cell carcinoma of the lung?

A

PTHrP

52
Q

Adenocarcinoma of the lung location and association?

A

Peripheral. Most common tumor in nonsmokers and females (in lung)

53
Q

Large cell carcinoma of the lung location and association

A

Central or Peripheral. Associated with smoking.

54
Q

Bronchioloalveolar carcinoma of the lung location and association.

A

peripheral. Good prognosis, and not related to smoking.

55
Q

Columnar cells that grow along preexisting bronchioles and alveoli that arise from Clara cells on lung biopsy = ???

A

Bronchioloalveolar carcinoma

56
Q

What do carcinoid tumors of the lung stain with?

A

Chromogranin

57
Q

Most common site of lung metastasis?

A

Adrenal glands!

Pathoma (15 decks)

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