LUNG PATHOLOGY-1 Flashcards
Non Neoplastic lung conditions
3 asbestos exposure related conditions
Deborah Dalmeida MD

- Pleural plaques
- Adenocarcinoma
- Mesothelioma
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Ghon focus/ Ghon Complex?
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Ghon Complex
The image shows a combination of parenchymal lung lesion and regional nodal involvement
Refer Slide 98 of the Lung ppt
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1. Diagnosis?
Gross- Cobblestoned lung surface
C/F: Fine bibasilar crackles
2. What is the cause for the finding seen on radiology?
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- Idiopathic pulmonary fibrosis
- Retraction of interlobular septa due to scarring is responsible for the honeycomb fibrosis seen on radiology
Deborah Dalmeida MD
Identify the pneumoconioses based on description provided for each:
1. • increased susceptibility to tuberculosis, egg shell calcification on Xray, birefringent particles on polarizing microscopy
- multiple, intensely blackened scars larger than 2 cm, necrotic center, coal miner
- See the image. What stain has been used to identify this characteristic finding ? Which condition is this?
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- Silicosis (see slide 57 for microscopic image of silicotic nodule)
- Complicated coal worker’s pneumoconioses (CWP)
(See slide 56 for gross lung image)
- Perl’s Prussian Blue; asbestos body.
An asbestos body- golden brown, fusiform or beaded rods with a translucent center and consist of asbestos fibers coated with an iron-containing proteinaceous material
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- Miliary pulmonary disease- does spread occur thorugh venous /arterial blood?
- Systemic miliary tuberculosis - does spread occur through venous/ arterial blood?
Deborah Dalmeida MD
- occurs when organisms draining through lymphatics enter the venous blood and circulate back to the lung.
- Systemic miliary tuberculosis : occurs when bacteria disseminate through the systemic arterial system
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Primary/ reactivation Tuberculosis?
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Reactivation Tuberculosis
The key here is to observe the cavitation, typically assoc with reactivation
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List some fibrogenic cytokines produced by the activated alveolar epithelial cells in IPF?
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TNF-alpha, TGF-beta, PDGF
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What is the major source of the event represented in the image?
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The event shown is a saddle embolus; cause in 95% is DVT.
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Identify this condition using the clues and Xray given:
Local suppurative process
secondary to Aspiration of infective material
or an
Antecedent primary lung infection
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Lung abscess
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What is the echocardiogram finding associated with this condition?
See attached image
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Coronary sinus dilatation
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Diagnosis?
abrupt onset of high fever, chills, purulent sputum, chest pain that increases on inspiration
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Bronchopneumonia
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1. What type of atelectasis is this?
Resorption of oxygen trapped in dependent alveoli due to complete obstruction of the bronchial airway
Mediastinum shifts toward affected side
2. Name the other 2 types of atelectasis
Deborah Dalmeida MD

- Resorption atelectasis
2a. . Compression
2b. Contraction
(If you cannot remember these, study slide 11 of the Lung ppt)
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Identify the lesion represented in the image provided
- extends to the periphery of the lung substance as a wedge with the apex pointing toward the hilus of the lung
- hemorrhagic
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Pulmonary infarction
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1. Identify this condition
- greater prevalence in African-Americans
- noncaseating granulomas, Schaumann bodies & asteroid bodies
- hypercalcemia, elevated ACE, hypercalcemia
2. Describe the radiologic finding
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- Sarcoidosis
- Bilateral hilar lymphadenopathy
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PaO2 / FiO2 in ARDS
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Less than 200
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Identify this lesion that primarily involves the alveoli , immunologically mediated & is predominantly interstitial
- harvested humid, warm hay -
- proteins from serum, excreta, or feathers of birds
- thermophilic bacteria in heated water reservoirs
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Hypersensitivity pneumonitis
- Farmer’s lung
- Pigeon breeder’s lung
- Humidifier/air conditioner lung
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- What is the Reid Index?
- Which condition is this condition increased?
- In terms of the alphabets represented in the image, what represents the ratio?
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- ratio of the thickness of the mucous gland layer to the thickness of the wall between the epithelium and the cartilage .(normally 0.4)
- Chronic bronchitis
- bc/ad
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Pulmonary function test findings in restrictive airway diseases
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Decreased FVC and TLC
Increased FEV1/FVC ratio
Decreased lung volumes
Reductions in carbon monoxide diffusing capacity
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List 2 drugs causing pulmonary fibrosis
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Bleomycin
Busulfan
Amiodarone
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What is the cause for appearance of honeycomb fibrosis in IPF?
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Fibrosis destroys alveolar architecture and forms cystic spaces lined by hyperplastic type 2 pneumocytes / bronchiolar epithelium and fibrotic wall
Deborah Dalmeida MD
Identify the conditions from the microscopic descriptions below:
- loss of alveolar walls, Dilated airspaces, abnormally large alveoli separated by thin septa
- enlargement of the mucus-secreting glands of the trachea and bronchi, numbers of goblet cells increase slightly, mucous gland hyperplasia
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- Emphysema
- Chronic Bronchitis
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Identify industries/occupations associated with the following pneumoconioses
- Coal mining industry
- Foundry work, sandblasting, hard rock mining
- Shipbuilding yard, roofing, insulation
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- Coal worker’s pneumoconioses
- Silicosis
- Asbestosis
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Causes for pulmonary eosinophilia
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- D - Drugs
- N - Neoplasm
- A - Allergy, asthma
- A - Addison’s
- A - Acute interstitial nephritis
- C - Collagen vascular disease
- P - Parasites
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Which condition do you see this?
hyperinflation(> 6 ribs anterior above diaphragm, mid-clavicular line)
Flat hemidiaphragms
hyperlucency of the lungs
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Emphysema
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Histologic pattern associated with idiopathic pulmonary fibrosis
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Usual interstitial pneumonia (UIP)
Major findings consistent with UIP pattern:
- Dense fibrosis
- Patchy and peripheral / perilobular involvement
- Fibroblastic foci
- Honeycomb (Cystic spaces lined by bronchiolar epithelium and fibrotic wall)
Deborah Dalmeida MD
Identify the pattern of emphysema from the description
- Acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal blind alveoli
- The central or proximal parts of the acini are affected,distal alveoli are spared
- proximal portion of the acinus is normal, and the distal part is predominantly involved, tendency for spontaneous pneumothorax due to rupture of bullae (MEMORIZE THIS IMAGE)
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- Panacinar
- Centriacinar
- Paraseptal
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1. Identify the condition described
a. circulating neutralizing antibodies specific for GM-CSF
b. sputum that often contains chunks of gelatinous material.
2. What will you see on Light microscopy in this condition?
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- Pulmonary alveolar proteinosis
- Dense, homogeneous, granular precipitate containing surfactant proteins within the alveoli
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- Microscopic features of advanced Pulmonary hypertension
- List one important Complication of pulmonary hypertension
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1. Plexiform pulmonary arteriopathy
Characterized by:
a. medial hypertrophy
b. tuft of capillary formations is present, producing a network, or web, that spans the lumens of dilated thin-walled, small arteries
2. Cor Pulmonale
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Describe the microscopic findings in the 1st image and name the structures seen in the 2nd and 3rd
Deborah Dalmeida MD

1st image - bronchial cartilage at the right, bronchial lumen filled with mucus at the left , submucosa widened by smooth muscle hypertrophy, edema, and inflammation (mainly eosinophils).
- Curschmann’s Spirals
- Charcot-Leyden crystals
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autosomal recessive condition
immotile cilia due to a defect of dynein arms (primary ciliary dyskinesia)
bronchiectasis, chronic sinusitis, and situs inversus
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Kartagener syndrome
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- What is this condition?
abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates in the absence of cardiac failure
- What is the most severe form of this condition called?
Deborah Dalmeida MD
- Acute Lung Injury.
- The most severe form is ARDS.
Deborah Dalmeida MD
List some organisms that can cause necrotizing pneumonias and therefore lead to bronchiectasis
Deborah Dalmeida MD
Pseudomonas
Staphylococcus aureus
Hemophilus influenzae
Mycobacterium tuberculosis
Aspergillus
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Bronchopneumonia or lobar pneumonia?
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Lobar pneumonia
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Pulmonary function test findings in Obstructive airway diseases
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Increased FRC, Increased RV, Increased TLC.
Markedly decreased FEV1, Decreased FVC,
Decreased FEV1/FVC ratio
Increased lung volumes
Deborah Dalmeida MD
1. Diagnosis?
anti–basement membrane antibodies directed against α3 chain of collagen IV
rapidly progressive glomerulonephritis and a necrotizing hemorrhagic interstitial pneumonitis
Light microscopy- focal necrosis of alveolar walls +intra-alveolar hemorrhages. +hemosiderin-laden macrophages
2. Immunofluoresence finding?
Deborah Dalmeida MD
- GOODPASTURE SYNDROME
- Immunofluorescence - linear deposits of immunoglobulins along the basement membranes
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- Characteristic finding on bronchoalveolar lavage fluid in sarcoidosis
- Marker of disease activity of sarcoidosis
Deborah Dalmeida MD
- accumulation of CD4+ T cells (CD4:CD8 ratio 10:1)
- high TNF levels
Deborah Dalmeida MD
- Identify the clinical condition described.
Sudden onset dyspnea, pleuritic chest pain, petechial rash, confusion, tachypnea, tachycardia, V/Q scan shows V/Q mismatch
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Pulmonary embolism
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PaO2 / FiO2 in Acute lung injury
Deborah Dalmeida MD
Less than 300
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- What is the composition of the structure indicated by the black arrows in the image ?
- What is the Xray finding of this condition?
Deborah Dalmeida MD

- fibrin-rich edema fluid mixed with the cytoplasmic and lipid remnants of necrotic epithelial cells (hyaline membranes)
- diffuse bilateral infiltrates (ground glass opacifications)
(See slide 17 of the ppt)
Deborah Dalmeida MD
Red hepatization/ Gray hepatization?
- disintegration of red cells and the persistence of a fibrinosuppurative exudate ; grayish brown, dry surface
- massive confluent exudation with neutrophils, red cells, and fibrin filling the alveolar spaces ;affected lobe is distinctly red, firm, and airless, with a liver-like consistency
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- Gray hepatization
- Red hepatization
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1. Identify the condition described
permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections
2. Name one important complication of this condition
3. What are the classic clinical features?
Deborah Dalmeida MD

- Bronchiectasis
- Lung abscess
- Severe, persistent cough- particularly frequent when the patient rises in the morning; expectoration of foul-smelling, sometimes bloody sputum
Deborah Dalmeida MD
- What is this lesion?
- Describe it ?
- Causative organism
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- Granuloma
- granulomatous inflammatory reaction with caseation necrosis,enclosed within a fibroblastic rim punctuated by lymphocytes, Multinucleate Langhans giant cells
- Mycobacterium Tuberculosis
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1. What kind of pneumonia is this?
Scant amount of sputum, no consolidation, lack of alveolar exudate, confined to the alveolar septa and pulmonary interstitium
mononuclear inflammatory infiltrate
2. Name 2 causative organisms
Deborah Dalmeida MD

- Community acquired pneumonia (Atypical Pneumonia)
- Mycoplasma pneumoniae, influenza virus types A and B, Chlamydia pneumoniae
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Gene defect observed in 50% familial and 25% idiopathic pulmonary hypertension
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BMPR2 gene
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What are the components of airway remodeling in Asthma?
Deborah Dalmeida MD
- Overall thickening of airway wall
- Sub-basement membrane fibrosis
- An increase in size of the submucosal glands and mucous metaplasia of airway epithelial cells
- Hypertrophy and/or hyperplasia of the bronchial wall muscle
Deborah Dalmeida MD