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Pathology > Chapter 9 ( Respiratory ) > Flashcards

Chapter 9 ( Respiratory ) Flashcards

1
Q

Most common cause of rhinitis ?

A

Rhinovirus

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2
Q

Nasal polyps is associated with ?

A

Repeated bouts of rhinitis
Cystic fibrosis
Aspirin intolerant asthma

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3
Q

Presentation of aspirin intolerant asthma ?

A 
Triad of :
Asthma 
Aspirin induced bronchospasm 
Nasal polyps 
Seen in 10% of asthmatic adults
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4
Q

Presentation of Angiofibroma of the nasopharynx ?

A

Profuse epistaxis in Adolescent males

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5
Q

Nasopharyngeal carcinoma is associated with what ? Presentation ? Microscopic findings ?

A 
EBV
Cervical lymphadenopathy in :
African children 
Chinese adults 
Microscopically : pleomorphic keratin - positive epithelial cells in a background of lymphocytes
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6
Q

Most common cause of acute epiglottitis ?

A

Hemophilus influenzae type b

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7
Q

Laryngotracheobronchitis most common cause ?

A

Parainfluenza virus

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8
Q

Vocal cord nodule composition ?

A

Degenerative ( myxoid ) connective tissue

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9
Q

Causes of laryngeal papilloma ?

A

HPV 6 , 11
Single in adults
Multiple in children

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10
Q

Laryngeal carcinoma arise from what ? Causes ?

A 
Squamous cell carcinoma usually arises from the epithelial lining of the vocal cords 
Risk factors :
Alcohol 
Smocking 
Laryngeal papilloma ( rare )
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11
Q

When does pneumonia occur ?

A

When normal defenses are impaired :
1- impaired cough reflex
2- damage mucociliary escalator
3- mucous plugging

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12
Q

Most common causes of lobar pneumonia ?

A

Streptococcus pneumoniae 95%

Klebsiella pneumoniae

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13
Q

Mechanism of grey hepatization in lobar pneumonia ?

A

Degradation of red cells within exudate

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14
Q

Who is affected by klebsiella pneumniae ? Characterized by what ?

A

Malnourished and debilitated individuals :
1-Elderly in nursing homes
2-Alcoholics
3-Diabetics

Characterized by thick mucoid capsule results in gelatinous sputum ( current jelly sputum )

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15
Q

Causes pf bronchopneumonia ?

A 
SIMPLe
1- Staphylococcus aureus 
2- hemophilus Influenza
3- Pseudomonas aeruginosa 
4- Moraxella Catarrhalis 
5- Legionella pneumophila
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16
Q

Causes of pneumonia superimposed on COPD ?

A

Staph aureus
Moraxella ctarrhalis
Legionella pneumophila

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17
Q

Cause of pneumonia in cystic fibrosis ?

A

Pseudomonas aeruginosa

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18
Q

Legionella pneumophila is transmitted by what ? Best visualized by ?

A

Transmitted from water source

Intracellular organism that is best visualized by Silver stain

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19
Q

Causes of interstitial (Atypical) pneumonia ?

A 
3CRIM
1- Chlamydia pneumoniae
2- Cytomegalovirus 
3- Coxiella burnetii 
4-Respiratory syncytial virus 
5- Influenza virus 
6- Mycoplasma pneumoniae
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20
Q

Most common cause of atypical pneumonia ?

A

Mycoplasma pneumoniae

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21
Q

Complications of Mycoplasma pneumonia ?

A

1- autoimmune hemolytic anemia ( IgM against I antigen on RBCs cause cold hemolytic anemia )
2- Erythema Multiform

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22
Q

Most common cause of atypical pneumonia in infants ?

A

Respiratory syncytial virus

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23
Q

Atypical pneumonia in post transplant immunosuppressive therapy ?

A

Cytomegalovirus

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24
Q

Why Coxiella burnetii is distinct from most rickettsiae ?

A

1- cause pneumonia
2- does not require arthropod vector for transmission ( survives as highly heat resistant endospores )
3- does not produce skin rash

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25
Q

Cause of atypical pneumonia in farmers and veterinarians that is transmitted by ticks on cattles or cattle placenta ?

A

Coxiella burnetti

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26
Q

Why mycoplasma pneumoniae not visible on gram stain ?

A

Due to lack of cell wall

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27
Q

Bacteria causing aspiration pneumonia ?

A

Anaerobic bacteria in the oropharynx :
1- Bacteroids
2- Fusobacterium
3- Peptococcus

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28
Q

Mechanism of idiopathic pulmonary fibrosis ?

A

Unknown

Likely related to cyclic lung injury , TGF-beta from injured pneumocytes induces fibrosis

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29
Q

Secondary causes of interstitial lung fibrosis ?

A

1- Drugs as Bleomycin and Amiodarone

2- radiation therapy

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30
Q

How is pulmonary fibrosis visualized on Lung CT ?

A

Intially seen in subpleural patches

Eventually results in diffuse fibrosis which is seen as honeycomb lung

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31
Q

Mechanism of pneumoconiosis ?

A

Alveolar macrophages engulf foreign particles and induces fibrosis

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32
Q

Exposure to what ? And pathological findings of Coal workers pneumoconiosis ?

A

To Carbon dust seen in coal miners

Massive exposure leads to diffuse fibrosis ( Black Lung )

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33
Q

Coal workers pneumoconiosis associated with rheumatoid arthritis ?

A

Caplan syndrome

34
Q

Anthracosis cause and pathology ?

A

Mild exposure to Carbon ( pollution )
Collection of carbon laden macrophages
Not clinically significant

35
Q

Exposure to what ? And pathological findings of Silicosis ?

A

To Silica seen in Sandblasters and Silica miners

Fibrotic nodules in the upper lobes of the lung

36
Q

Pneumoconiosis that increases risk for TB ?

A

Silicosis

37
Q

Mechanism of silicosis ?

A

Impairs phagolysosome formation by macrophages

38
Q

Exposure to what ? And pathological findings of Berylliosis ?

A

To Beryllium seen in beryllium miners and workers in the aerospace ( NASA )
Non caseating granuloma in the lung , cycle hilar LNs and systemic organs

39
Q

Pneumoconiosis that increases risk for lung cancer ?

A

Berylliosis

40
Q

Exposure to what ? And pathological findings of Asbestosis ?

A

To Asbestos fibers , sen in construction workers , plumbers and shipyard workers
Fibrosis of lung and pleura , lesions may contain asbestos bodies ( long golden brown fibers with associated iron )
with increased risk for lung carcinoma and mesothelioma

41
Q

Mechanism of sarcoidosis ?

A

Unknown

Likely due to CD4 T helper cells response to an unknown antigen

42
Q

Characteristic of silicosis ?

A

Stellate inclusions ( Asteroid bodies ) are often seen within giant cells of granulomas

43
Q

Commonly involved organs in sarcoidosis ?

A

1- lung and hilar LNs ( restrictive lun disease )
2- uvea ( uveitis )
3- skin ( cutaneous nodules and erythema nodosum )
4- salivary and lacrimal glands ( mimics Sjögren syndrome )

44
Q

Mechanism of hypercalcemia in sarcoidosis ?

A

1-alpha hydroxylase activity of epithelioid histiocytes converts vitamin D to its active form

45
Q

Clinical features of sarcoidosis ?

A

Dyspnea or cough ( most common )
Elevated serum ACE
Hypercalcemia

46
Q

Characteristics of pulmonary hypertension ?

A

1- MAP > 25 mmhg
2- atherosclerosis of the pulmonary trunk
3- smooth muscle hypertrophy of pulmonary arteries
4- intimal fibrosis
5- plexiform lesion are seen with severe long standing disease

47
Q

Mechanism of some familial forms of primary pulmonary hypertension ?

A

Inactivating mutations of BMPR2 leading to proliferation of vascular smooth muscle

48
Q

Mechanism of ARDS ?

A

Diffuse damage to the alveolar capillary interface leads to leakage of protein rich fluid ( activation of neutrophils induces protease- and free radicle-mediated damage of type I and ll pneumocytes ) —> edema that combines with necrotic epithelial cells —> formation of Hyaline membranes in alveoli

49
Q

Causes of secondary pulmonary hypertension ?

A

1- hypoxemia ( COPD , interstitial lung disease )
2- increase volume in the pulmonary circuit
3- recurrent pulmonary embolism

50
Q

Characteristic of ARDS on x ray ?

A

White out of the lung

51
Q

Why ARDS may be complicated by interstitial fibrosis ?

A

Due damage of type ll pneumocytes

52
Q

Mechanism of neonatal respiratory distress syndrome ?

A

Lack of surfactant leads to collapse of air sacs and formation of hyaline membranes

53
Q

Causes of neonatal respiratory distress syndrome ?

A

1- Prematurity
2- Cesarian section delivery ( due to lack of stress-induced steroids which increase synthesis of surfactant
3- Maternal Diabetes ( insulin decreases surfactant production )

54
Q

Characteristic of neonatal respiratory distress syndrome on x ray ?

A

Granularity of the lung ( Ground glass appearance )

55
Q

Complications of neonatal respiratory distress syndrome ?

A

1- hypoxemia increases the risk for :
PDA
Necrotizing enterocolitis

2- supplemental oxygen increases the risk for free radicle injury :
Retinal injury leads to Blindness
Lung damage leads to Bronchopulmonary Dysplasia

56
Q

Most contributing carcinogens in cigarette to increase risk of lung cancer ?

A

Polycyclic aromatic hydrocarbons

Arsenic

57
Q

2nd most common cause of lung carcinoma in usa ?

A

Radon which presents in soil

58
Q

Lung lesions that seen as solitary nodule ( coin lesion ) on imaging ?

A

1- Lung carcinoma
2- Granuloma ( TB or fungus especially Histoplasma in midwest )
3- Bronchial hamartoma

59
Q

Characteristic histology , association and location of small cell carcinoma of lung ?

A

Poorly differentiated small cells , arises from neuroendocrine cells ( Kulchitsky cells )

Male smokers

Central

60
Q

Paraneoplastic syndromes with small cell carcinoma of lung ?

A

⬆️ADH
⬆️ACTH
Eaton Lambert syndrome

61
Q

Characteristic histology , association and location of squamous cell carcinoma of lung ?

A

Keratin pearls or intracellular bridges

Male smokers ( most common tumor in male smokers )

Central

62
Q

Characteristic histology , association and location of adenocarcinoma of lung ?

A

Glands or mucin

Most common tumor in nonsmokers and female smokers

Peripheral

63
Q

Characteristic histology , association and location of large cell carcinoma of lung?

A

Poorly differentiated large cells ( no keratin pearls , intracellular bridges or mucin )

Smoking

Central or Peripheral

64
Q

Characteristic histology , association and location of Bronchioalveolar carcinoma ? Appearance on imaging ?

A

Columnar cells that grow along preexisting alveoli and bronchioles , arises from Clara cells

Not related to smoking !!!

Peripheral

Pneumonia like consolidation on imaging
Excellent prognosis

65
Q

Characteristic histology , association and location of carcinoid tumor pf lung ?

A

Well differentiated neuroendocrine cells , Chromogranin positive

Not related to smoking !!!

Central or Peripheral ( when central form polyp like mass in the bronchus )

Low grade , rarely produce carcinoid syndrome

66
Q

Pleural involvement is classically seen in which type of lung carcinoma ?

A

Adenocarcinoma of lung

67
Q

Unique site of metastasis of lung carcinoma ?

A

Adrenal gland

68
Q

Microscopical findings of chronic bronchitis ?

A

Hypertrophy of bronchial mucinous glands that leads to increased thickness of mucous glands relative to bronchial wall thickness ( Reid index increases to >50% , normally its <40% )

69
Q

Another name for chronic bronchitis patients ?

A

Blue bloaters

70
Q

Mechanism of emphysema ?

A

Destruction of alveolar air sacs due to imbalance between proteases and antiproteases ( excessive inflammation releasing too much proteases from neutrophils or Alpha-1 antitrypsin deficiency )that leads to loss of elastic recoil and collapse of airways during exhalation results in obstruction and air trapping

71
Q

Type and site of emphysema that results from smocking ?

A

Centriacinar emphysema

Most severe in the upper lobes

72
Q

Type and site of emphysema that results from Alpha-1 antitrypsin deficiency ?

A

Panacinar emphysema

Most severe in the lower lobes

73
Q

Cause of cirrhosis with Alpha-1 antitrypsin deficiency ?

A

Mutant misfolded Alpha-1 antitrypsin accumulates in the ER of hepatocytes resulting in liver damage

74
Q

Microscopic findings of hepatocytes in Alpha-1 antitrypsin deficiency ?

A

Pink, PAS-positive globules in hepatocytes

75
Q

Most common clinically relevant mutation in Alpha-1 antitrypsin deficiency ? Other mutations ?

A

Most common : PiZ ( significant low levels of the circulating enzyme )

Other types :
PiMZ ( heterozygous , usually asymptomatic , with significant risk of emphysema with smoking )
PiZZ ( homozygous , with significant risk for panacinar emphysema and cirrhosis )

76
Q

Other name for emphysema patients ?

A

Pink Puffers

77
Q

Pathogenesis of Asthma ?

A

Type l hypersensitivity :
Allergens induces TH2 phenotype in CD4 T cells which secrets IL4 , IL5 , IL10

Reexposure to allergen leads to IgE mediated activation of mast cells :
1- Early phase reaction : release of preformed histamine granules ( first ) , generation of Leukotrienes C4, D4, E4 ( later )
2- Late phase reaction : inflammation especially major basic protein derived from eosinophils damages cells and perpetuates bronchoconstriction

78
Q

Characteristics of the productive cough of Asthma ?

A

Associated with :
1- Spiral shaped mucous plugs ( Curschmann spirals)
2- Eosinophil derived crystals ( Charcot-Leyden crystals )

79
Q

Causes of bronchiectasis ?

A 
1- Cystic fibrosis 
2- Kartagener syndrome 
3- Tumor pf Foreign body 
4- Necrotizing infection 
5- Allergic bronchopulmonary aspergillosis
80
Q

Mechanism pf Kartagener syndrome ? Associations ?

A

Inherited defect of Dynein arm which is necessary for ciliary movement resulting in :
Sinusitis
Infertility
Situs inversus

81
Q

Allergic bronchopulmonary aspergillosis is seen in patients with ?

A

Asthma

Cystic fibrosis

Pathology (18 decks)

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