Lung Pathology Flashcards
1
Q
pathogens of infectious rhinitis?
A
rhinovirus, adenovirus, echovirus
2
Q
infectious rhinitis is also known as?
A
the common cold
3
Q
symptoms of infectious rhinitis
A
sneezing, congestion, runny nose
4
Q
how is infectious rhinitis cured?
A
self-limiting
5
Q
infectious rhinitis treatment?
A
symptomatic with anti-histamines and decongestants
6
Q
allergic rhinitis is also known as
A
seasonal allergies
7
Q
allergic rhinitis is caused by what?
A
type 1 hypersensitivity rxn such as through IgE or pollen
8
Q
allergic rhinitis histology
A
inflammatory infiltrate and eosinophils
9
Q
symptoms of allergic rhinitis
A
mucosal edema, redness, secretion
10
Q
associations with allergic rhinitis
A
asthma, exzema
11
Q
treatment for allergic rhinitis
A
saline rinse
12
Q
what are nasal polyps
A
protrusion of edematous mucosa
13
Q
histology of nasal polyps
A
hyperplastic or cystic mucous glands
14
Q
nasal polyps caused by
A
recurrent rhinitis, CF, aspirin-induced asthma
15
Q
effects of nasal polyps
A
impair airway and drainage
16
Q
result of repeated attacks of infectious rhinitis
A
chronic rhinitis
17
Q
causes of chronic rhinitis
A
microbial or allergic
18
Q
symptoms of chronic rhinitis
A
desquamation, ulceration of mucosal epithelium, suppurative infections blocks air sinuses
19
Q
risk of chronic rhinitis
A
deviated nasal septum, nasal polyps, impaired drainage
20
Q
what is sinusitis
A
inflammation of paranasal sinusitis
21
Q
causes of sinusitis
A
Viral, bacterial, fungal, allergic (commonly oral cavity microbes, strep, staph, influenza)
22
Q
sinusitis symptoms
A
impaired drainage, suppurative exudate
Forms mucocele and empyema
Sx: pressure, pain, obstruction, productive cough at night
23
Q
sinusitis is associated with what syndromes?
A
kartagener syndrome: mutation of the dynein arm of the cilia
bronchiectasis and situs inversus
24
Q
pharyngitis tonsilitis is what?
A
acute inflammation
25
symptoms of pharyngitis tonsilitis
pain, anorexia, dysphagia, lymphadenopathy
26
pharyngitis tonsilitis treatment
antibiotics if culture is postiive
27
pharyngitis tonsilitis is caused by
strep A. viral infection (rhinovirus, echovirus, adenovirus)
28
nasopharyngeal angiofibroma is what?
a benign tumor of nasal mucosa
29
nasopharyngeal angiofibroma affects what?
large blood vessels
30
nasopharyngeal angiofibroma affects what population the most?
young males
31
nasopharyngeal angiofibroma has what symptoms?
epistaxis, hemorrhage
32
sinonasal papilloma
benign tumor of respiratory mucosa lining nasal cavity and sinuses
33
what is nasopharyngeal carcinoma
malignant tumor of nasalpharyngeal epithelium
34
nasopharyngeal carcinoma is associated with what virus?
herpes virus! EBV.
35
Nasopharyngeal carcinoma affects what populations?
African children and Chinese adults
36
Nasopharyngeal carcinoma histology:
pleomorphic keratin (+), epithelial cells (poorly differentiated squamous cell carcinoma)
37
nasopharyngeal carcinoma symptoms
enlarged cervical lymph nodes
38
laryngitis
inflammation of larynx
39
laryngitis symptoms
hoarseness, decreased volume of voice, pain, dysphagia
40
causes of laryngitis:
allergic, viral (URI), bacterial, chemical insults, overuse, persistant cough, GERD, smoking
41
treatment for laryngitis:
steam insulation and rest
42
epiglottitis
inflammation of epligottis
43
causes of epligottitis:
H. influenzae and bacteria (Strep/staph)
44
epligottitis symptoms:
fever, sore throat, drooling, dysphagia, muffled voice, inspiratory stridor, air obstruction
45
epiglottitis treatment
abx, protect airway
46
croup laryngotracheobronchitis
inflammaiton of upper airway
47
cause of Croup
parainfluenza virus
48
symptoms of Croup
hoarse, BARKING cough, inspiratory stridor, worse at night
49
xray of Croup
STEEPLE sign: narrowed trachea
50
Croup treatment
racemic (aerosol to inhale) epi, steroids, hydration, anti-pyretic
51
vocal cord nodules and polyps
reactive nodule on true vocal cord
52
histology of vocal cord nodules
myxoid degeneration
53
vocal cord nodules are caused by what and relieved with what?
over-use, resolves with rest
54
squamous papilloma is associated with what?
laryngeal papilloma
55
squamous papilloma is what?
benign epithelial tumor
56
causes of squamous papilloma?
HPV 6 AND 11
57
Symptoms of squamous papilloma
hoarse, breathy voice, dyspnea, aspiration, dysphagia, pain, otalgia, hemoptysis
58
treatment of squamous papilloma
visualization, CT, surgery for excision
59
papillomatosis
skin surface elevation caused by hyperplasia and enlargement of contiguous dermal papillae
60
papillomatosis looks like
papillary projections of the epidermis= undulating surface
61
laryngeal carcinoma
squamous cell carcinoma of epithelial lining of vocal cord
62
risk population for laryngeal carcinoma
male, over 60yrs, alcohol, smoking, low SES, laryngeal papilloma
63
symptoms of laryngeal carcinoma
hoarseness, cough, stridor
64
what happens in chronic obstructive lung disease?
airway flow obstruction. The lung does not empty and air is trapped
65
Flow values for COPD: FVC, FEV1, FEV1/FVC and TLC?
decreased FVC, decreased FEV1, decreased FEV1/FVC (7L)
66
Emphysema is
an obstructive lung disease that destroys the alveolar airsacs
67
pathology of emphysema
loss of elastic recoil leads to collapse in exhale
68
obstruction in the throat leads to
trapped air
69
causes of emphysema:
smoking (inflammation/proteases) or A1AT deficiency (antiprotease)
70
smoking causes what emphysema pattern in which lobes?
centriacinar in upper lobes
71
A1AT causes what emphysema pattern in which lobes?
panacinar in lower lobes and associated liver cirrhosis
72
emphysema symptoms
dyspnea, cough, long expiration, pursed lips, "pink puffer", weight loss, barrel-chest, hypoxemia, cor pulmonale
73
chronic bronchitis is defined as
cough for 3 months over 2 years
74
cause of chronic bronchitis?
smoking
75
histology of chronic bronchitis
hypertrophy of bronchial mucinous glands (Reid index >50%)
76
symptoms of chronic bronchitis
excessive mucous, productive cough, cyanosis, BLUE BLOATER, mucous plugs, increased CO2, decrease O2, increased infections, cor pulmonale
77
asthma is defined as
reversible bronchoconstriction
78
symptoms of asthma
dyspnea, wheezing, productive cough, status asthmaticus, death
79
histology of asthma
spiral shaped mucus plugs (Curschmann) and eosinophil-crystal (Charcot-Leyden)
80
causes of asthma:
allergic type 1 hypersensitivity IgE, nonallergic cause (exercise, viral infection, exposure)
81
allergic asthma is caused bye
TH2 CD4+ (makes IL4/5/10) and mast cells
| in early phase rxn: histamine, leukotrienes (leads to bronchoconstriction, inflammation, edema)
82
aspirin induced asthma triad:
asthma, bronchospasms, nasal polyps
83
bronchiectasis definition:
permanent dilation of bronchioles/bronchi
84
effect of bronchiectasis
loss of airway tone leads to trapped air
| necrotizing inflammation leads to damage to airway walls
85
causes of bronchiectasis
CF, kartagener syndrome (mutant dynein/cilia), tumor, FB, necrotizing infection, hypersensitivity rxn to aspergillus
86
symptoms of bronchiectasis:
cough, dyspnea, foul-rotting sputum, hypozemia, cor pulmonale, secondary amyloidosis
87
effects on FVC, FEV1, FEV1/FVC, TLC with restrictive lung diseases
decreased FVC, decreased FEV1, increased FEV1:FVC (>80%), decreased TLC (<7L)
88
effect of restrictive lung disease
restricted filling
89
causes of restrictive lung disease
interstitial lung disease (thick alveolar wall= decreased gas exchange) or chest wall abnormalities
90
idiopathic pulmonary fibrosis
fibrosing disease
| fibrosis of the lung interstitium
91
causes of idiopathic pulmonary fibrosis
idiopathic, lung injury (TGF-B induces fibrosis), drugs, radiation
92
symptoms of idiopathic pulmonary fibrosis
progressive dyspnea, cough
93
CT of idiopathic pulmonary fibrosis
fibrosis, honeycomb lung
94
treatment of idiopathic pulmonary fibrosis
lung transplant
95
pneumoconioses is
interstitial fibrosis due to chronic exposure to small particles = fibrosis
96
histology of pneumoconioses
macrophages wall off invaders
97
types of pneumoconioses
coal worker's lung, silica: sand blasters, beryllioses: aerospace workers, asbestos: mesothelioma and lung carcinoma
98
sarcoidosis affects what?
systemic, multiple organs
99
sarcoidosis is what
noncaseating granulomas and hilar lymph nodes
100
who is stereotypically risk for sarcoidosis
AA females
101
causes of sarcoidosis
idiopathic, CD4+ helper T cell
102
histology of sarcoidosis
epitheliod histocytes (giant cells), asteroid bodies (stellate bodies)
103
symptoms of sarcoidosis
dyspnea, cough, ACE increases, increased calcium/vitamin D (active 1-A hydroxylase
104
treatment of sarcoidosis
resolves in 3 years without treatment, steroids if treatment is necessary.
105
hypersensitivity pneumonitis
inhaled organic antigens = granulomas
106
symptoms of hypersensitivity pneumonitis
fever, cough, dyspnea
107
pulmonary HTN histology
atherosclerosis, SM hypertrophy, intimal fibrosis, plexiform lesions
108
symptoms of pulmonary HTN
RV hypertrophy, cor pulmonale, exertional dyspnea, heart fail
109
primary pulmonary HTN
young females, BMPR2 mutation (increases smooth muscle)
110
secondary pulmonary HTN
Hypoxemia, increased volume in pulmonary circuit, recurrent PE
111
epistaxis
bleeding from the upper airway/nose
112
symptoms of epistaxis
bright red blood, cough, inability to clear throar
113
the upper airway cough syndrome is associated most with what symptom?
post nasal drip
114
what is the most common cause of cough?
upper airway cough syndrome
115
pathophysiology for post nasal drip
allergies and infection -> nasal/sinus inflammation -> secretions down nasopharynx
116
upper airway cough syndrome xray results and treatment?
normal xray, treatment is nasal steroid, antihistamine, decongestants &/or saline rinse
117
What is GERD?
Gastroesophageal reflux disease: acidic gastric contents reflux into the esophagus
118
symptoms and xray of GERD?
cough, aspiration into lungs, heartburn/indigestion, vocal cord erythema; xray is normal
119
treatment for GERD
elevated head of bed, omeprazole, prevacid (proton pump inhibitor)
120
what is the acute version of sarcoidosis?
Loefgren's syndrome
121
what are the symptoms of Loefgren's syndrome?
triad: acute polyarthritis, erythema nodosum, hilar adenopathy; malaise, fever, joint disease, uveitis, parotitis
122
Who is at risk for Loefgren's syndrome?
scandinavian and irish women
123
treatment for Loefgren's
NSAIDs, self limited, rare elapse
124
what causes hypersensitivity pneumonitis
inhaled organic antigens -> grnaulomas
125
symptoms of hypersensitivity pneumonias
fever, cough, dyspnea
126
histology and treatment of hypersensitivity pneumonitis?
eosinophils; resolves on its own
127
effect of chronic hypersensitivity pneumonitis
interstitial fibrosis
128
Goodpasture syndrome is known as an
anti-GBM antibody disease (autoimmune); a type of pulmonary-renal syndrome and glomerulonephritis + alveolar hemorrhage
129
symptoms of goodpasture syndrome
dyspnea, cough, hemoptysis, fever, weight loss, hematuria, edema, fatigue
130
labs for goodpasture syndrome are positive for
anti-glomerular basement membrane antibodies, cANCA
131
who is at risk for goodpasture syndrome?
smoking, viral respiratory infection, men
132
xray and treatment for goodpasture syndrome
infiltrates; plasmapharesis, corticosteroids, immunosuppressants
133
what is pneumonia?
infection of the lung parenchyma
134
who is at risk for pneumonia? what are the symptoms?
people with impaired defenses; fever, chills, PRODUCTIVE cough, yellow/green sputum, tachypnea, decreased breath sounds, pleuritic CP, dullness to percussion, high WBC
135
xray, labs and treatment for pneumonia?
consolidation patterns on xray; sputum and blood culture show inflammation (neutrophils, macrophages) on labs, abx for tx
136
what is lobar pneumonia?
consolidation of the entire lobe
137
gross result of lobar pneumonia
intra-alveolar exudate
138
what causes lobar pneumonia?
bacterial strep pneumoniae, klebsiella pneumoniae, legionella
139
what are the gross stages of lobar pneumonia?
1- congestion, 2- red hepatization, 3- gray hepatization, 4- resolution
140
bronchopneumonia
scattered patchy distribution around bronchioles
141
histology of bronchopneumonia
acute inflammatory infiltrates from bronchioles into alveoli
142
causes of bronchopneumonia
bacterial staph aureus, haemophilus influenzae, pseudomonas aeruginose, moraxella catarrhalis, legionella pneumophila
143
(atypical) interstitial pneumonia
diffuse interstitial infiltrate (inflammatory cells in connective tissue wall of the alveolar air sac)
144
what is the common location of aspiration pneumonia
right lower lobe abscess
145
who is at risk for aspiration pneumonia?
alcoholics, comatose
146
causes of aspiration pneumonia
anaerobic oropharynx bacteria (bacteroides, fusobacterium, peptococcus)
147
what is a lung abscess?
collection of pus in the lung parenchyma
148
causes of a lung abscess?
bronchial obstruction, cancer, aspiration, staph aureus and anaerobes
149
xray, symptoms and treatment of lung asbcesses
air-fluid levels; cough, fever, sweats, eight loss; abx
150
organism that causes tuberculosis
mycobacterium tuberculosis
151
primary phase of tuberculosis
asymptomatic: positive PPD, Ghon complex forms, focally fibrosed, calcified hilar lymph nodes
152
secondary phase of tuberculosis
reactivated primary TB, caseating granulomas in APEX of lung, fever, night sweats, cough, hemoptysis, weight loss, systemic spread to many tissues (miliary TB in liver)
153
histology stain for secondary TB? what is seen on the slide?
acid fast bacilli (AFB stain); many white blood cells, many are lymphocytes, paucity of mesothelial cells
154
acute respiratory distress syndrome affects what? how?
diffuse damage to alveolar-capillary interface
155
ARDS histology
edema, cell debri, hyaline membranes
156
ARDS symptoms
hypoxemia, cyanosis, resp distress, disruption of surfactant, collapse of air sacs, pulmonary HTN, scarring, fibrosus
157
xray of ARDS
white out, diffuse bilateral infiltrates
158
causes of ARDS
sepsis, infection, shock, aspiration, drugs, hypersensitivity rxn
159
treatment of ARDS
PEEP: positive end expiratory pressure
160
neonatal respiratory distress syndrome is caused by
low surfactant levels (type 2 pneumocytes). increase in surface tension, leads to alveolar collapse and hyaline membranes
161
risk factor for neonatal RDS
Maternal diabetes, multi-fetal, prematurity (<34 wks), C-section
162
symptoms of neonatal RDS
increased respiratory effort, accessory muscles, grunting, hypoxemia, cyanosis, patent ductus arteriosus (right to left shunt), blindness (retinopathy), bronchopulmonary dysplasia
163
xray of neonatal RDS
hazy, granular
164
benign tumors
```
adenoma
hamartoma
myoblastoma
papilloma
fibroma
leiomyoma
lipoma
neurofibroma
schwannoma
sclerosing hemangioma
```
165
symptoms of carcinomas
nonspecific, cough, eight loss, hemoptysis, pna, airway obstruction, pleuritic, pleural effusion, metastasis to other tissues
166
local complications of carcinomas
local complication: SVC syndrome, recurrent larynmgheal or phrenic nerve palsy, pancoast tumor (shoulder/arm pain), horner syndrome (sympathetic chain compression)
167
small cell carcinoma
location: central, submucosa of airways, perihilar
histo: poorly differentiated small neuroendocrine cells
risk: male smoker, radon
a/w: paraneoplastic inc ADH, ACTH, Eaton-Lambert syndrome (muscle weakness)
tx: chemo
168
large cell carcinoma
location: peripheral
histo: poorly differentiated large cells
risk: smoking
poor prognosis
169
squamous cell carcinoma
location: central, endobronchial
histo: keratin pearls or intercellular bridges
risk: male smoker
a/w: inc PTHrP and Ca
170
adenocarcinoma
location: peripheral
hist: glands and mucin
risk: nonsmokers, females
171
bronchioloalveolar carcinoma
```
clara cells
location: peripheral
histo: columnar cells line bronchioles and alveoli
not related to smoking
xray: looks like pna consolidation
excellent prognosis
```
172
carcinoid tumor
```
neuroendocrine cells (bronchial mucosa)
location: polyp-like mass in bronchus
histo: chromogranin (+)
not related to smoking
rare, slow growing, low malignant
risk: 40’s-60’s
sx: asymptomatic, airway obstruction, pna, hemoptysis
a/w: Cushings, carcinoid syndrome (inflamm)
```
173
Metastatic Tumors
most common: breast and colon
| gross: multiple cannon-ball nodules
174
Inflammatory Pleural Effusions
exudate
labs: Light’s critera: (fluid:serum LDH>.6)(fluid:serum total protein>.5)(fluid LDH> 2/3serum LDH)
tx: thoracentesis
175
Noninflammatory Pleural Effusions
transudate
| tx: treat underlying cause
176
Pneumothorax
air in pleural space
spontaneous cause: bleb rupture in young men
tension pneumo: penetrating chest wall injury
sx: tracheal shift, sucking wound, dyspnea
tx: chest tube
177
Malignant Mesothelioma
malignant neoplasm of mesothelial cells
cause: asbestos
sx: pleural effusion, dyspnea, cp, tumor encases the lung, spread through lymph
