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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

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

A

Small cell

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22
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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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
Q

CFs of emphysema?

A

Pink puffer w/pursed lips
Weight loss –> very thin
Dyspnea and cough w/minimal sputum

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28
Q

Where does the trachea shift in a spontaneous pneumothorax?

Occurs how?

A

Towards collapse

Spontaneous rupture of emphysematous bleb –> young athlete

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30
Q

When does a Ghon complex form in Tb infection?

Where is the caseating necrosis?

A

Primary infection

Lower lobe of lung and Hilar LNs

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31
Q

What causes foul-smelling sputum w/cough and dyspnea?

A

Bronchiectasis

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32
Q

What are the MC primary tumors that metastasize to the lung?

Imaging shows what?

A

Breast and Colon

Multiple cannon ball nodules

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33
Q

MC cause of emphysema?

Results in what?

A

Smoking –> excessive inflammation

centriacinar emphysema more severe in upper lobes

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34
Q

MC cause of interstitial pneumonia?

A

M.pneumoniae –> cause hemolytic anemia (IgM - cold agglutinin)
Chlamydia pneumoniae

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35
Q

What are the 3 main causes of neonatal respiratory distress syndrome?

A

Prematurity - Lecithin comp of surfactant is too low
C section
Maternal diabetes - insulin decreases surfactant production

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36
Q

Nasal polyps in a child think what?

A

Cystic fibrosis

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37
Q

Pts w/asthma induce what Th phenotype?

What does this phenotype secrete?

A

Th2

IL-4 (IgE), IL-5 (eosinophils), IL-10 (makes Th2)

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38
Q

Aspiration pneumonia is most commonly caused by what organisms?

What location?

A

Bacteroides, Fusobacterium, and Peptococcus –> anaerobic bacteria

Right lower lobe abscess

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39
Q

Classic CFs of Tb?

A

Hemoptysis, fever, night sweats, cough, weight loss

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40
Q

What is pneumoconiosis?

Mediated by what?

A

Interstitial fibrosis due to occupational exposure

Macrophages

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41
Q

What is the MOA behind emphysema (big picture)?

A

Imbalance of proteases (via neuts and macrophages) and antiproteases (A1AT)

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42
Q

A tumor in the apex of the lung is what?

Causes what?

A

Pancoast tumor

Horner’s

43
Q

People with Asbestos exposure like shipyard workers and plumbers are most likely to get what?

A

Lung cancer, THEN mesothelioma

44
Q

MC cause of atypical pneumoniae in pre-existing lung disease?

A

Influenzae virus

45
Q

A1AT accumulation in hepatocytes stains how?

A

Pink PAS(+)

46
Q

What are the 2 MC causes of lobar pneumonia?

A 
S. Pneumoniae
Klbesiella pneumoniae (enteric flora that is aspirate) --> alcoholics and elderly
47
Q

What are the MC causes of bronchopneumonia?

A 
S.aureus
H.influenzae
P.aeruginosa
Moraxella
Legionella
48
Q

What is an unique site of distant metastases from the lung?

49
Q

What has a ground-grass appearance of the lung on xray?

A

Neonatal respiratory distress syndrome

50
Q

What is a long-standing complication of pulmonary HTN?

A

Plexiform lesion

51
Q

What is carbon-laden macrophages due to mild exposure to carbon pollution?

A

Anthracosis

52
Q

Where are the MC sites of spread of Tb?

A

Meninges - base of brain
Cervical LNs
Kidneys - sterile pyuria
Lumbar vertebrae - Pott’s disease

53
Q

Biopsy showing pleomorphic keratin(+) epithelial cells in a background of of lymphocytes is what?

A

Nasopharyngeal carcinoma

54
Q

Misfolded PiZ protein accumulates where?

55
Q

MC cause of atypical pneumoniae in post transplant immunosuppressive therapy?

56
Q

What is pathologic lesion seen in mesothelioma that is long, golden-brown w/iron?

Aka what?

A

Asbestos body

Ferruginous body

57
Q

What is activated in ARDS?

A

Neutrophils producing protease and free radical damage by type I and II pneumocytes

58
Q

What lung cancer has activating mutations in KRAS, EGFR, ALK?

What common sign?

A

Adenocarcinoma

clubbing

59
Q 
COPD has what levels of the following?
FVC
FEV1
FEV1/FVC ratio
TLC
A

Dec
Dec MORE
Dec
Inc (air trapping)

60
Q

Berylliosis occurs in what exposure?

Mimics what?

Increased risk for what?

A

Miners, NASA workers

Sarcoidosis - noncaseating granulomas, hilar LNs

lung cancer

61
Q

What is Caplan syndrome?

A

Coal Worker’s Pneumoconiosis + R.A.

62
Q

What causes bronchiectasis?

A 
Cystic fibrosis 
Kartagener syndrome 
Tumor of foreign body
Necrotizing infection 
Allergic bronchopulmonary Aspergillus
63
Q

Where does IPF begin?

Progresses to what?

A

Subpleura

honeycomb lung

64
Q

Tx of ARDS?

What complicates recovery?

A

PEEP

Interstitial fibrosis

65
Q

Familial form of pulmonary HTN has what mutation?

Leads to what?

A

Inactivating mutations BMPR2

Proliferation of vascular smooth muscle

66
Q

MC location of epistaxis?

Life-threatening location?

A

Kiesselbach plexus

Post. Segment –> sphenopalantine artery –> branch of maxillary a.

67
Q

What is the major component of surfactant?

A

phosphatidylcholine (lecithin)

68
Q

Mesothelioma has what positivity on microscopy?

Histology?

Is smoking a RF?

A

Cytokeratin and calretinin

PSAMMOMA Bodies

Nope

69
Q

Nasopharyngeal carcinoma occurs in what pt populations?

presents how?

Assoc w/what?

A

African kids, Asian adults

Cervical LAD

EBV

70
Q

What can cause interstitial fibrosis due to a hypersensitivity reaction?

A

Pneumonitis - granulomatous reaction (pigeon breeder’s lung) w/eosinophils

71
Q

What can cause pulmonary HTN?

A

Hypoxemia
Congenital heart disease
Recurrent PE

72
Q

What is Lambert-Eaton syndrome?

What causes it?

A

Antibodies against pre-synaptic Ca channels –> muscle weakness

Small cell carcinoma

73
Q

What does silicosis do once it gets in the lung?

At risk for what?

A

Impairs phagolysosome

TB –> upper lung

74
Q

The 2nd phase of mast cells perpetuating inflammation is characterized by what?

A

LTC4, D4, E4

75
Q

What defines chronic bronchitis?

Associated w/what?

Characterized by what?

A

Chronic productive cough lasting at least 3 months over a minimum of 2 years

Smoking

Hypertrophy of bronchial mucinous glands

76
Q 
Describe the following in Restrictive Lung Disease:
FVC
FEV1
FEV1/FVC ration
TLC
A

Dec MORE
Dec
Inc
Dec

77
Q

Adenocarcinoma associated w/what?

Location?

Characterized by what?

A

MC in nonsmokers and FEMALE smokers

Peripheral

Glands or mucin

78
Q

What are the 4 phases of lobar pneumonia?

A
  1. Congestion
  2. Red hepatization
  3. Gray hepatization
  4. Resolution of the exudate
79
Q

Laryngeal Papilloma is due to what?

U/l or B/l in adults? Children?

Presents how?

A

HPV 6 and 11 - low risk

U/l in adults
b/l in kids

Hoarseness

80
Q

What is the stem cell of the lung that helps to regenerate the lining of the air sacs?

A

Type II pneumocyte

81
Q

Tension pneumothorax causes shift of trachea to which side?

Tx how?

A

Opposite

Chest tube - 5th ICS midaxillary line

82
Q

What type of A1AT mutation causes panacinar emphysema and cirrhosis?

A

PiZZ homozygotes

83
Q

What forms a polyp-like mass in the bronchus?

85
Q

Chronic bronchitis has increased risk of what?

CFs are what?

A

Infection, cor pulmonale

Cyanosis - Blue bloater –> Inc PaCO2 and Dec PaO2

86
Q

Late phase inflammation of mast cells is due to what?

A

Major basic protein

89
Q

What lung cancer has pleural involvement?

A

Adenocarcinoma bc it is peripheral

90
Q

Pt coughing up buckets of mucus think what?

A

Chronic bronchitis

91
Q

What is a b9 tumor that presents w/profuse epistaxis in adolescent males?

A

Angiofibroma

92
Q

What is distended head and neck veins w/edema and blue discoloration of arms and face?

A

SVC syndrome

93
Q

What type of cancer is laryngeal carcinoma?

Rfs?

A

SCC

Smoking and alcohol, rarely laryngeal papilloma

94
Q

Emphysema causes what?

A

Destruction of alveolar air sacs

Loss of elastic recoil and collapse of airways during exhalation leads to air trapping

95
Q

What is the most mutagenic components of cigarette smoke?

A

polycyclic aromatic hydrocarbons

Arsenic

96
Q

What other tissue symptoms does Sarcoidosis cause?

Most common sx?

A

Uveitis, skin - erythema nodosum, salivary and lacrimal glands

Cough

97
Q

What lung cancer may produce PTHrP?

103
Q

What lung tumors are chromogranin positive?

What kind of cells?

A

Small cell and Carcinoid

Neuroendocrine

104
Q

Small cell carcinoma associated w/what?

Location?

Characterized by what?

A

Male Smokers

Central

Arises from neuroendocrine (Kulchitsky) cells

107
Q

What lung cancer has a poor prognosis?

Excellent?

A

Large cell carcinoma

Bronchioalveolar

110
Q

SCC associated w/what?

Location?

Characterized by what?

A

MC in male smokers

Peripheral

Keratin pearls or intercellular bridges

111
Q

How is small cell carcinoma treated?

A

Chemotherapy

CANNOT treat w/surgery - cells too small

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