CPCs

Question 1

Answer 1

Chronic inflammation in asthma
IgE mediated

Question 2

Answer 2

Airways infiltrated with mast cells (A) and CD4 T lymphocytes (B)

Chronic asthma

Question 3

Answer 3

Creola bodies → found in sputum, ciliated columnar cells from bronchial mucosa
Asthma

Question 4

Answer 4

Charcot-Leyden crystals → lysophospholipase, liberated from eosinophil breakdown
Asthma

Question 5

Answer 5

Asthma - mucus plugging, eosinophilic infiltration, thickened basement membrane, epithelial denudation, goblet cell hyperplasia

Question 6

Answer 6

Air spaces filled with fluid and inflammatory infiltrate – lobar pneumonia

Question 7

Answer 7

BAL: acute inflammatory cells
Probably VIRAL - lymphocyte

Question 8

Answer 8

lymphoid follicles and germinal centres in the lung! Usual interstitial pneumonia (UIP) pattern

Question 9

Answer 9

Gross pathology – fibrotic changes in lower lobes, elastic hard consistency, diffuse destruction of lung mesenchyme, multiple air cysts with honeycomb change
Usual interstitial pneumonia (UIP) pattern

Question 10

Answer 10

Microscopically, dense fibrosis and destruction of alveolar architecture.
Active fibrotic lesions composed of myofibroblasts
Aggregation of spindle cells with gray to pale purple matrix adjacent to dense fibrosis

Usual interstitial pneumonia (UIP) pattern

Question 11

Answer 11

An asbestos body

Question 12

Answer 12

Emphysema

Question 13

Answer 13

Streptococcus pneumoniae
Gram positive diplococci
Can aid identification through use of capsule stain

Question 14

Answer 14

Aspergillus in Lungs

Question 15

Answer 15

Klebsiella pneumoniae
Gram negative bacilli

Question 16

Answer 16

Granuloma

Question 17

Answer 17

Peripheral blood monocyte

Question 18

Answer 18

Granuloma = aggregate of ‘epithelioid’ histiocytes

Question 19

Answer 19

Lung TB

Question 20

Answer 20

Sarcoid granuloma

Question 21

Answer 21

TB – caseating granuloma with central necrosis.

Question 22

Answer 22

TB – caseating granuloma with central necrosis.

Question 23

Answer 23

Ziehl-Neelson (ZN) stain → shows acid fast bacilli

Question 24

Answer 24

Grocott stain shows fungi

Question 25

Answer 25

Vasculitis - Triad pf inflammatory infiltrate - Thrombotic vascular occlusion - Fibrinoid necrosis

Question 26

Answer 26

presence of necrosis, lymphocytes, multinucleated giant cells that do not form well defined granulomas. Neutrophils and lymphocytes are invading the walls of the blood vessels. From the lung - Greanulomatosis with polyangitis - Wegner's vasculitis

Question 27

Answer 27

Granulomatosis with polyangiitis – Wegener’s vasculitis

Question 28

Answer 28

Granulomatosis with polyangiitis – Wegener’s vasculitis

Question 29

Answer 29

Eosinophilic granulomatosis with polyangiitis – Churg-Strauss Lots of eosinophils

Question 30

Answer 30

Aneuysmal dilatation - due to vessel wall damage

Question 31

Answer 31

Tuberculosis

Question 32

Answer 32

Ziehl–Neelsen (ZN) stain → used to identify acid-fast organisms such as members of the genus Mycobacterium. Definitive diagnosis is with sputum culture not microscopy

Question 33

Answer 33

Pleural fluid - acure inflammation (Adjacent pneumonia or empyema)

Question 34

Answer 34

Pleural fluid - eosinophilic effusion (drug reactions, pulmonary infection, Churg-strauss)

Question 35

Answer 35

Pleural effusion - lymphocytic effusion (infection inc TB, Malignancy, post cardiac surgery, lymphoproliferative disorder)

Question 36

Answer 36

Malignant effusion - Cohesive clusters of cells - High Nuclear: Cytoplasmic ratio - Nuclear hyeprchromia - Abnormal chromatin pattern - Irregular nuclear contours - Prominent nucleoli

Question 37

Answer 37

Pleural thickening Fibrin (acellular pink material) on the surface, shows ongoing inflammation Thickening due to organised granulation tissue Non-neoplastic pleural thickening caused by inflammation – fibrinous pleuritis

Question 38

Answer 38

Metastatic adenocarcinoma – looks very similar to mesothelioma on histology. Need IHC to differentiate.

Question 39

Answer 39

Pleural plaque

Question 40

Answer 40

Mesothelioma

Question 41

Answer 41

Epitheliod on left and sarcomatoid on left - types of mesothelioma Epitheliod: Polygonal cells with moderate eosinophilic cytoplasm Sarcomatoid: Atypical spindle cells with eosinophilic cytoplasm

Question 42

Answer 42

Harmatoma - benign lung malignancy

Question 43

Answer 43

Malignant lung cancer More marked cytological atypia High mitotic index – atypical mitotic figures may be seen Necrosis may be present

Question 44

Answer 44

Metastatic lung cancer

Question 45

Answer 45

Carcinoid tumours Low grade malignant endocrine carcinoma Excision usually curative

Question 46

Answer 46

Squamous metaplasia on left and squamous dysplasia on right Predisposing for squamous cell carcinoma

Question 47

Answer 47

Squamous metaplasia is caused by smoking. This leads to dysplasia and eventually malignancy.

Question 48

Answer 48

Atypical adenomatous hyperplasia Adenomatous hyperplasia – alveolar walls lined by atypical pneumocytes with high N:C ratio (hobnail appearance), hyperchromatic nuclei and prominent nucleoli.

Question 49

Answer 49

Adenocarcinoma in situ Adenocarcinoma in situ – alveolar walls are thickened and lined by larger, atypical cells

Question 50

Answer 50

Invasive adenocarcinoma

Question 51

Answer 51

Adenocarcinoma Solid tumours are more aggressive – the areas around the invasive component could be described as pre-cancerous – can progress to solid tumour or regress.

Question 52

Answer 52

Lung tumour - Large cell neuroendocrine subtype

Question 53

Answer 53

Small cell lung cancer

Question 54

Answer 54

Myocardial infarction

Question 55

Answer 55

Pericardial tamponade

Question 56

Answer 56

Fatty streaks → may or may not progress Contains lipid laden ‘foam cells’, derived from smooth muscle cells and macrophages

Question 57

Answer 57

(linear staining for IgG/C3) Their nephrotic syndrome is due to membranous GN

Question 58

Answer 58

Diabetic nephropathy - capillaries are distorted or compressed by nodular sclerosis

Question 59

Answer 59

Coxsackie virus on EM

Question 60

Answer 60

Myocarditis

Question 61

Answer 61

Eosinophilic myocarditis

Question 62

Answer 62

Granulomatous myocarditis

Question 63

Answer 63

Giant cell myocarditis - Associated with thymoma, lymphoma, SLE, thyroidisits, dermatomysotis

Question 64

Answer 64

Fat emboli

Question 65

Answer 65

Amniotic fluid embolism

Question 66

Answer 66

E.coli

Question 67

Answer 67

Strep. pneumoniae

Question 68

Answer 68

Neisseria meningitidis

Question 69

Answer 69

Strep. pyogenes

Question 70

Answer 70

Staph. aureus

Question 71

Answer 71

Candida albicans

Question 72

Answer 72

ARDS

Question 73

Answer 73

ARDS

Question 74

Answer 74

Yellow - white cortical abscesses Surrounding hyperaemia Acute pyelonephritis

Question 75

Answer 75

Acute pyelonephritis Neutrophils seen in renal tubules and interstitium Glomerular involvement suggests severe disease Tubular necrosis leads to scarring

Question 76

Answer 76

Renal papillary necrosis

Question 77

Answer 77

Acute cholecystitis Fibrinous exudate on external surface; Subserosal haemorrhage Gallbladder wall thickened (oedematous) and hyperaemic Neutrophilic inflammation

Question 78

Answer 78

Chronic cholecystitis Thickened wall Chronic inflamm (plasma cells, lymphocytes, macros) Sub-epithelial/-serosal fibrosis Outpouchings of epithelium through wall