Chapter 9 ( Respiratory ) Flashcards
1
Q
Most common cause of rhinitis ?
A
Rhinovirus
2
Q
Nasal polyps is associated with ?
A
Repeated bouts of rhinitis
Cystic fibrosis
Aspirin intolerant asthma
3
Q
Presentation of aspirin intolerant asthma ?
A
Triad of : Asthma Aspirin induced bronchospasm Nasal polyps Seen in 10% of asthmatic adults
4
Q
Presentation of Angiofibroma of the nasopharynx ?
A
Profuse epistaxis in Adolescent males
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
6
Q
Most common cause of acute epiglottitis ?
A
Hemophilus influenzae type b
7
Q
Laryngotracheobronchitis most common cause ?
A
Parainfluenza virus
8
Q
Vocal cord nodule composition ?
A
Degenerative ( myxoid ) connective tissue
9
Q
Causes of laryngeal papilloma ?
A
HPV 6 , 11
Single in adults
Multiple in children
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 )
11
Q
When does pneumonia occur ?
A
When normal defenses are impaired :
1- impaired cough reflex
2- damage mucociliary escalator
3- mucous plugging
12
Q
Most common causes of lobar pneumonia ?
A
Streptococcus pneumoniae 95%
Klebsiella pneumoniae
13
Q
Mechanism of grey hepatization in lobar pneumonia ?
A
Degradation of red cells within exudate
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 )
15
Q
Causes pf bronchopneumonia ?
A
SIMPLe 1- Staphylococcus aureus 2- hemophilus Influenza 3- Pseudomonas aeruginosa 4- Moraxella Catarrhalis 5- Legionella pneumophila
16
Q
Causes of pneumonia superimposed on COPD ?
A
Staph aureus
Moraxella ctarrhalis
Legionella pneumophila
17
Q
Cause of pneumonia in cystic fibrosis ?
A
Pseudomonas aeruginosa
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
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
20
Q
Most common cause of atypical pneumonia ?
A
Mycoplasma pneumoniae
21
Q
Complications of Mycoplasma pneumonia ?
A
1- autoimmune hemolytic anemia ( IgM against I antigen on RBCs cause cold hemolytic anemia )
2- Erythema Multiform
22
Q
Most common cause of atypical pneumonia in infants ?
A
Respiratory syncytial virus
23
Q
Atypical pneumonia in post transplant immunosuppressive therapy ?
A
Cytomegalovirus
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
25
Cause of atypical pneumonia in farmers and veterinarians that is transmitted by ticks on cattles or cattle placenta ?
Coxiella burnetti
26
Why mycoplasma pneumoniae not visible on gram stain ?
Due to lack of cell wall
27
Bacteria causing aspiration pneumonia ?
Anaerobic bacteria in the oropharynx :
1- Bacteroids
2- Fusobacterium
3- Peptococcus
28
Mechanism of idiopathic pulmonary fibrosis ?
Unknown
| Likely related to cyclic lung injury , TGF-beta from injured pneumocytes induces fibrosis
29
Secondary causes of interstitial lung fibrosis ?
1- Drugs as Bleomycin and Amiodarone
| 2- radiation therapy
30
How is pulmonary fibrosis visualized on Lung CT ?
Intially seen in subpleural patches
| Eventually results in diffuse fibrosis which is seen as honeycomb lung
31
Mechanism of pneumoconiosis ?
Alveolar macrophages engulf foreign particles and induces fibrosis
32
Exposure to what ? And pathological findings of Coal workers pneumoconiosis ?
To Carbon dust seen in coal miners
| Massive exposure leads to diffuse fibrosis ( Black Lung )
33
Coal workers pneumoconiosis associated with rheumatoid arthritis ?
Caplan syndrome
34
Anthracosis cause and pathology ?
Mild exposure to Carbon ( pollution )
Collection of carbon laden macrophages
Not clinically significant
35
Exposure to what ? And pathological findings of Silicosis ?
To Silica seen in Sandblasters and Silica miners
| Fibrotic nodules in the upper lobes of the lung
36
Pneumoconiosis that increases risk for TB ?
Silicosis
37
Mechanism of silicosis ?
Impairs phagolysosome formation by macrophages
38
Exposure to what ? And pathological findings of Berylliosis ?
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
Pneumoconiosis that increases risk for lung cancer ?
Berylliosis
40
Exposure to what ? And pathological findings of Asbestosis ?
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
Mechanism of sarcoidosis ?
Unknown
| Likely due to CD4 T helper cells response to an unknown antigen
42
Characteristic of silicosis ?
Stellate inclusions ( Asteroid bodies ) are often seen within giant cells of granulomas
43
Commonly involved organs in sarcoidosis ?
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
Mechanism of hypercalcemia in sarcoidosis ?
1-alpha hydroxylase activity of epithelioid histiocytes converts vitamin D to its active form
45
Clinical features of sarcoidosis ?
Dyspnea or cough ( most common )
Elevated serum ACE
Hypercalcemia
46
Characteristics of pulmonary hypertension ?
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
Mechanism of some familial forms of primary pulmonary hypertension ?
Inactivating mutations of BMPR2 leading to proliferation of vascular smooth muscle
48
Mechanism of ARDS ?
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
Causes of secondary pulmonary hypertension ?
1- hypoxemia ( COPD , interstitial lung disease )
2- increase volume in the pulmonary circuit
3- recurrent pulmonary embolism
50
Characteristic of ARDS on x ray ?
White out of the lung
51
Why ARDS may be complicated by interstitial fibrosis ?
Due damage of type ll pneumocytes
52
Mechanism of neonatal respiratory distress syndrome ?
Lack of surfactant leads to collapse of air sacs and formation of hyaline membranes
53
Causes of neonatal respiratory distress syndrome ?
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
Characteristic of neonatal respiratory distress syndrome on x ray ?
Granularity of the lung ( Ground glass appearance )
55
Complications of neonatal respiratory distress syndrome ?
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
Most contributing carcinogens in cigarette to increase risk of lung cancer ?
Polycyclic aromatic hydrocarbons
| Arsenic
57
2nd most common cause of lung carcinoma in usa ?
Radon which presents in soil
58
Lung lesions that seen as solitary nodule ( coin lesion ) on imaging ?
1- Lung carcinoma
2- Granuloma ( TB or fungus especially Histoplasma in midwest )
3- Bronchial hamartoma
59
Characteristic histology , association and location of small cell carcinoma of lung ?
Poorly differentiated small cells , arises from neuroendocrine cells ( Kulchitsky cells )
Male smokers
Central
60
Paraneoplastic syndromes with small cell carcinoma of lung ?
⬆️ADH
⬆️ACTH
Eaton Lambert syndrome
61
Characteristic histology , association and location of squamous cell carcinoma of lung ?
Keratin pearls or intracellular bridges
Male smokers ( most common tumor in male smokers )
Central
62
Characteristic histology , association and location of adenocarcinoma of lung ?
Glands or mucin
Most common tumor in nonsmokers and female smokers
Peripheral
63
Characteristic histology , association and location of large cell carcinoma of lung?
Poorly differentiated large cells ( no keratin pearls , intracellular bridges or mucin )
Smoking
Central or Peripheral
64
Characteristic histology , association and location of Bronchioalveolar carcinoma ? Appearance on imaging ?
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
Characteristic histology , association and location of carcinoid tumor pf lung ?
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
Pleural involvement is classically seen in which type of lung carcinoma ?
Adenocarcinoma of lung
67
Unique site of metastasis of lung carcinoma ?
Adrenal gland
68
Microscopical findings of chronic bronchitis ?
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
Another name for chronic bronchitis patients ?
Blue bloaters
70
Mechanism of emphysema ?
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
Type and site of emphysema that results from smocking ?
Centriacinar emphysema
| Most severe in the upper lobes
72
Type and site of emphysema that results from Alpha-1 antitrypsin deficiency ?
Panacinar emphysema
| Most severe in the lower lobes
73
Cause of cirrhosis with Alpha-1 antitrypsin deficiency ?
Mutant misfolded Alpha-1 antitrypsin accumulates in the ER of hepatocytes resulting in liver damage
74
Microscopic findings of hepatocytes in Alpha-1 antitrypsin deficiency ?
Pink, PAS-positive globules in hepatocytes
75
Most common clinically relevant mutation in Alpha-1 antitrypsin deficiency ? Other mutations ?
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
Other name for emphysema patients ?
Pink Puffers
77
Pathogenesis of Asthma ?
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
Characteristics of the productive cough of Asthma ?
Associated with :
1- Spiral shaped mucous plugs ( Curschmann spirals)
2- Eosinophil derived crystals ( Charcot-Leyden crystals )
79
Causes of bronchiectasis ?
```
1- Cystic fibrosis
2- Kartagener syndrome
3- Tumor pf Foreign body
4- Necrotizing infection
5- Allergic bronchopulmonary aspergillosis
```
80
Mechanism pf Kartagener syndrome ? Associations ?
Inherited defect of Dynein arm which is necessary for ciliary movement resulting in :
Sinusitis
Infertility
Situs inversus
81
Allergic bronchopulmonary aspergillosis is seen in patients with ?
Asthma
| Cystic fibrosis
