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Lung - Path Flashcards

1
Q

What are the 2 key mediators of pain?

A

Bradykinin

PGE2

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2
Q

What is idiopathic pulmonary fibrosis?

What induces fibrosis?

A

Fibrosis of lung interstitium

TGF-Beta

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3
Q

Nasal polyps in an asthmatic adult indicates what?

A

ASA-intolerant asthma

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4
Q

What is bronchiectasis?

A

Dilation of bronchioles (large airway) and bronchi, loss of airway tone resulting in air trapping

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5
Q

What special finding is seen on sarcoidosis microscopy?

A

Stellate inclusions (asteroid bodies) –> seen w/giant cells of granulomas

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6
Q

Complications of bronchiectasis?

A

Hypoxemia –> Cor pulmonale

Secondary AA

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7
Q

MC cause of atypical pneumonia in infants?

A

RSV

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8
Q

What is normal pulmonary pressure?

Pulmonary HTN?

A

10 mmHg

> 25 mmHg

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9
Q

Bronchioalveolar carcinoma associated w/what?

Location?

Characterized by what?

A

Columnar and Clara cells

Peripheral

NO relation to smoking

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10
Q

A1AT deficiency causes what type of emphysema?

What may also be present?

A

Panacinar, more severe in lower lobes

Liver cirrhosis due to UPR in ER which accumulates and causes liver disease

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11
Q

Mast cells cause vasodilation, where does this occur?

What about leakage?

A

Arterioles

Post-capillary venules

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12
Q

Hoarse barking cough w/inspiratory stridor occurs in what?

Due to what?

A

Laryngotracheobronchitis (croup)

Parainfluenza virus

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14
Q

What does the Reid index measure?

Increases to what in chronic bronchitis?

A

Thickness of mucus glands relative to bronchial wall thickness

> 50%, normally 40%

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15
Q

Diffuse white out of the lung on xray seen in what?

A

ARDS

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16
Q

Sarcoidosis has what abnormal lab value? Why?

Tx?

A

Hypercalcemia
Epithelioid histiocytes has 1-alpha hydroxylase activity, converts Vit D to active form

Steroids, self-resolving

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17
Q

Large cell carcinoma associated w/what?

Location?

Characterized by what?

A

Smoking

Central or peripheral

Poorly differentiated

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18
Q

Complications of neonatal respiratory distress syndrome?

A

Hypoxemia –> PDA and necrotizing enterocolitis
Supp O2 causes free radicals leading to retinal injury and blindness and lung damage leading to bronchopulmonary dysplasia

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20
Q

Interstitial pneumonia is commonly associated w/what?

Xray shows what?

A

Virus

Increase in lung MARKINGS

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21
Q

Is vocal cord’s nodule u/l or b/l?

Composed of what tissue?

A

B/l

Degenerative myxoid CT

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21
Q

What lung cancer is chromogranin A (+) and enolase (+)?

A

Small cell

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23
Q

Charcot-Leyden crystals are derived from what?

Composed of what?

What else is assoc w/asthma?

A

Eosinophils

Major basic protein

Curschmann spirals

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24
Q

How is the FRC affected in COPD?

Interstitial lung disease?

A

Increased

Dec

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25
Q

What shows eggshell calcifications of hilar LNs on CXR?

A

Silicosis

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26
Q

Berylliosis affects what part of lung?

Tx?

A

Upper lobes

Steroids

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27
CFs of emphysema?
Pink puffer w/pursed lips Weight loss --> very thin Dyspnea and cough w/minimal sputum
28
Where does the trachea shift in a spontaneous pneumothorax? Occurs how?
Towards collapse Spontaneous rupture of emphysematous bleb --> young athlete
30
MC cause of interstitial pneumonia?
M.pneumoniae --> cause hemolytic anemia (IgM - cold agglutinin) Chlamydia pneumoniae
30
When does a Ghon complex form in Tb infection? Where is the caseating necrosis?
Primary infection Lower lobe of lung and Hilar LNs
31
What causes foul-smelling sputum w/cough and dyspnea?
Bronchiectasis
32
What are the MC primary tumors that metastasize to the lung? Imaging shows what?
Breast and Colon Multiple cannon ball nodules
33
MC cause of emphysema? Results in what?
Smoking --> excessive inflammation centriacinar emphysema more severe in upper lobes
35
What are the 3 main causes of neonatal respiratory distress syndrome?
Prematurity - Lecithin comp of surfactant is too low C section Maternal diabetes - insulin decreases surfactant production
36
Nasal polyps in a child think what?
Cystic fibrosis
37
Pts w/asthma induce what Th phenotype? What does this phenotype secrete?
Th2 IL-4 (IgE), IL-5 (eosinophils), IL-10 (makes Th2)
38
Aspiration pneumonia is most commonly caused by what organisms? What location?
Bacteroides, Fusobacterium, and Peptococcus --> anaerobic bacteria Right lower lobe abscess
39
MC cause of atypical pneumoniae in post transplant immunosuppressive therapy?
CMV
39
Classic CFs of Tb?
Hemoptysis, fever, night sweats, cough, weight loss
40
What is pneumoconiosis? Mediated by what?
Interstitial fibrosis due to occupational exposure Macrophages
41
What is the MOA behind emphysema (big picture)?
Imbalance of proteases (via neuts and macrophages) and antiproteases (A1AT)
42
What is an unique site of distant metastases from the lung?
Adrenals
42
A tumor in the apex of the lung is what? Causes what?
Pancoast tumor Horner's
43
People with Asbestos exposure like shipyard workers and plumbers are most likely to get what?
Lung cancer, THEN mesothelioma
44
What are the MC causes of bronchopneumonia?
``` S.aureus H.influenzae P.aeruginosa Moraxella Legionella ```
44
MC cause of atypical pneumoniae in pre-existing lung disease?
Influenzae virus
45
A1AT accumulation in hepatocytes stains how?
Pink PAS(+)
46
What are the 2 MC causes of lobar pneumonia?
``` S. Pneumoniae Klbesiella pneumoniae (enteric flora that is aspirate) --> alcoholics and elderly ```
49
What has a ground-grass appearance of the lung on xray?
Neonatal respiratory distress syndrome
50
What is a long-standing complication of pulmonary HTN?
Plexiform lesion
51
What is carbon-laden macrophages due to mild exposure to carbon pollution?
Anthracosis
52
Biopsy showing pleomorphic keratin(+) epithelial cells in a background of of lymphocytes is what?
Nasopharyngeal carcinoma
52
Where are the MC sites of spread of Tb?
Meninges - base of brain Cervical LNs Kidneys - sterile pyuria Lumbar vertebrae - Pott's disease
54
Misfolded PiZ protein accumulates where?
ER
56
What is pathologic lesion seen in mesothelioma that is long, golden-brown w/iron? Aka what?
Asbestos body Ferruginous body
57
What is activated in ARDS?
Neutrophils producing protease and free radical damage by type I and II pneumocytes
58
What is the stem cell of the lung that helps to regenerate the lining of the air sacs?
Type II pneumocyte
58
What lung cancer has activating mutations in KRAS, EGFR, ALK? What common sign?
Adenocarcinoma clubbing
59
``` COPD has what levels of the following? FVC FEV1 FEV1/FVC ratio TLC ```
Dec Dec MORE Dec Inc (air trapping)
60
Berylliosis occurs in what exposure? Mimics what? Increased risk for what?
Miners, NASA workers Sarcoidosis - noncaseating granulomas, hilar LNs lung cancer
61
Laryngeal Papilloma is due to what? U/l or B/l in adults? Children? Presents how?
HPV 6 and 11 - low risk U/l in adults b/l in kids Hoarseness
61
What causes bronchiectasis?
``` Cystic fibrosis Kartagener syndrome Tumor of foreign body Necrotizing infection Allergic bronchopulmonary Aspergillus ```
61
What is Caplan syndrome?
Coal Worker's Pneumoconiosis + R.A.
63
What defines chronic bronchitis? Associated w/what? Characterized by what?
Chronic productive cough lasting at least 3 months over a minimum of 2 years Smoking Hypertrophy of bronchial mucinous glands
63
Where does IPF begin? Progresses to what?
Subpleura honeycomb lung
64
Tx of ARDS? What complicates recovery?
PEEP Interstitial fibrosis
65
Familial form of pulmonary HTN has what mutation? Leads to what?
Inactivating mutations BMPR2 Proliferation of vascular smooth muscle
66
MC location of epistaxis? Life-threatening location?
Kiesselbach plexus Post. Segment --> sphenopalantine artery --> branch of maxillary a.
67
What is the major component of surfactant?
phosphatidylcholine (lecithin)
68
Nasopharyngeal carcinoma occurs in what pt populations? presents how? Assoc w/what?
African kids, Asian adults Cervical LAD EBV
68
Mesothelioma has what positivity on microscopy? Histology? Is smoking a RF?
Cytokeratin and calretinin PSAMMOMA Bodies Nope
70
What can cause interstitial fibrosis due to a hypersensitivity reaction?
Pneumonitis - granulomatous reaction (pigeon breeder's lung) w/eosinophils
71
What does silicosis do once it gets in the lung? At risk for what?
Impairs phagolysosome TB --> upper lung
71
What can cause pulmonary HTN?
Hypoxemia Congenital heart disease Recurrent PE
72
What is Lambert-Eaton syndrome? What causes it?
Antibodies against pre-synaptic Ca channels --> muscle weakness Small cell carcinoma
74
The 2nd phase of mast cells perpetuating inflammation is characterized by what?
LTC4, D4, E4
76
``` Describe the following in Restrictive Lung Disease: FVC FEV1 FEV1/FVC ration TLC ```
Dec MORE Dec Inc Dec
77
Adenocarcinoma associated w/what? Location? Characterized by what?
MC in nonsmokers and FEMALE smokers Peripheral Glands or mucin
78
What are the 4 phases of lobar pneumonia?
1. Congestion 2. Red hepatization 3. Gray hepatization 4. Resolution of the exudate
81
Tension pneumothorax causes shift of trachea to which side? Tx how?
Opposite Chest tube - 5th ICS midaxillary line
82
What type of A1AT mutation causes panacinar emphysema and cirrhosis?
PiZZ homozygotes
83
What forms a polyp-like mass in the bronchus?
Carcinoid
85
Chronic bronchitis has increased risk of what? CFs are what?
Infection, cor pulmonale Cyanosis - Blue bloater --> Inc PaCO2 and Dec PaO2
86
Late phase inflammation of mast cells is due to what?
Major basic protein
89
What lung cancer has pleural involvement?
Adenocarcinoma bc it is peripheral
90
Pt coughing up buckets of mucus think what?
Chronic bronchitis
91
What is a b9 tumor that presents w/profuse epistaxis in adolescent males?
Angiofibroma
92
What is distended head and neck veins w/edema and blue discoloration of arms and face?
SVC syndrome
93
What type of cancer is laryngeal carcinoma? Rfs?
SCC Smoking and alcohol, rarely laryngeal papilloma
94
Emphysema causes what?
Destruction of alveolar air sacs | Loss of elastic recoil and collapse of airways during exhalation leads to air trapping
95
What is the most mutagenic components of cigarette smoke?
polycyclic aromatic hydrocarbons | Arsenic
96
What other tissue symptoms does Sarcoidosis cause? Most common sx?
Uveitis, skin - erythema nodosum, salivary and lacrimal glands Cough
97
What lung cancer may produce PTHrP?
SCC
103
What lung tumors are chromogranin positive? What kind of cells?
Small cell and Carcinoid Neuroendocrine
104
Small cell carcinoma associated w/what? Location? Characterized by what?
Male Smokers Central Arises from neuroendocrine (Kulchitsky) cells
107
What lung cancer has a poor prognosis? Excellent?
Large cell carcinoma Bronchioalveolar
110
SCC associated w/what? Location? Characterized by what?
MC in male smokers Peripheral Keratin pearls or intercellular bridges
111
How is small cell carcinoma treated?
Chemotherapy | CANNOT treat w/surgery - cells too small

Board Prep (19 decks)

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