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DT3 Exam 2 > Path > Flashcards

Path Flashcards

1
Q

histology of respiratory tree

A

ciliated pseudostratified columnar epithelium

cartilaginous airways with mucus secreting goblet cells and submucosal glands

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2
Q

alveolar histology

A 
capillary endothelium
basement membrane
intersititium
alveolar epithelium
alveolar macrophages
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3
Q

dual circulation

A

pulmonary and bronchial arteries

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4
Q

pulmonary tract defense mechanisms

A

nasal clearance
tracheobronchial clearance by cilia
alveolar clearance by macrophage

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5
Q

factors that affect pulmonary defense mechanisms

A

loss of cough reflex (coma, drugs, pain)
injury to mucociliary apparatus (ciliary dysfunction, smoking, viruses)
inerference with alveolar macrophages (alcohol, smoking)
pulmonary congestion and edema
accumulation of lung secretions (CF)

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6
Q

presentation of interstitial diseases

A

dyspnea, tachypnea, cyanosis without wheezing

reduced DLCO, reduced lung volume, reduced compliance

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7
Q

chest x-ray of interstitial diseases

A

small nodules, irregular lines or ground glass shadows

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8
Q

pathogenesis of idiopathic pulmonary fibrosis

A

inflammation causes abnormal epithelial repair leading to fibroblastic/myofibroblastic proliferation (fibroblastic foci)
TGF-beta1 released by type 1 alveolar epithelial cells-apoptosis
caveolin-1 which inhibits TGF-beta1 is decreased

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9
Q

morphology of IPF

A

cobblestone pleural surface
mostly lower lobes
temporal heterogeneity
later-dense fibrosis

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10
Q

clinical course of IPF

A

insidious onset of dyspnea on exertion and dry cough
hyoxemia, cyanosis, and clubbing
mean survival 3 years

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11
Q

morphology nonspecific interstitial pneumonia

A

cellular-uniform/patchy inflammation

fibrosing pattern-interstitial fibrosis without temporal heterogeneity, no fibroblastic foci, no honeycomb

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12
Q

clinical course of nonspecific interstitial pneumonia

A

dyspne and cough

better prognosis than UIP

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13
Q

etiology of cryptogeneic organizing pneumonia

A

response to various infections or inflammatory lung injury

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14
Q

morphology of cryptogenic organizing pneumonia

A

subpleural or peribronchial airspace consoidation
no temporal heterogeneity
no interstitial fibrosis or honeycomb lung

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15
Q

Masson bodies

A

intra-alveolar polypoid plugs of loose organizing connective tissue
seen in cryptogenic organizing pneumonia

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16
Q

clinical course of cryptogenic organizing pneumonia

A

acute onset of cough and dypsnea

steroids for >6 months

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17
Q

pulmonary involvement in connective tissue diseases

A

RA, sceroderma, and SLE

can occur in different patterns

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18
Q

pathogenesis pneumoconioses

A

depends on physical factors

most dangerous particles 1-5 um

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19
Q

asymptomatic anthracosis

A

accumulation of carbon pigment in macrophages in miners, tobacco smokers, and urban dwellers
does not produce a cellular reaction

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20
Q

simple coal workers pneumoconiosis

A

coal macules along the respiratory bronchioles
upper lobes and upper zones of lower lobes
leads to centrilobular emphysema

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21
Q

complicated coal workers pneumoconiosis

A

multiple blackened scars>2cm in lung parenchyma

dense collagen, carbon pigment and necrotic centers

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22
Q

clinical course of coal workers pneumoconiosis

A

mild forms of complicated can exist without loss of function

more advanced can lead to HTN or cor pulmonale

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23
Q

most prevalent chronic occupational disease worldwide

A

silicosis

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24
Q

pathogenesis of silicosis

A

silica in crystalline and amorphous forms
crystalline more fibrogenic
causes macrophage to release mediators

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25
Q

morphology silicosis

A

early-nodules in upper lung zones
later coalescing to from hard collagenous scars of concentric layers of hyalinized collagen with dense capsule
involve hilar lymph nodes and pleura with thin calcifications (eggshell calcifications)

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26
Q

silicosis clinical course

A

x ray shows fine nodularity in upper lung areas
dyspnea occurs after development of massive fibrosis
associated with increased incidence of TB

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27
Q

pathogenesis asbestos

A

depends on concentration
fibrogenic forms-serpentine and amphibole
fibrous pleural plaques, pleural effusions, interstitial fibrosis, lung and laryngeal carcinoma, mesothelioma, colon carcinoma
injury at bifurcations of small airways-penetrate macrophage

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28
Q

serpentine from

A

most prevalent
curly and flexible
removed by upper respiratory mucociliary apparatus

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29
Q

amphibole form

A

least prevalent
stiff and brittle fibers
penetrate deep into interstitium
associated with mesothelioma

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30
Q

morphology of asbestos exposure

A

interstitial fibrosis similar to UIP
interstitial fibrosis around respiratory bronchioles and alveolar ducts
honeycomb pattern-begins in lower lobes
pleural plaques

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31
Q

components of pleural plaques

A

dense collagen with calcium mostly on AP parietal pleura and diaphragm
do not contain asbestos bodies

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32
Q

asbestos bodies

A

golden brown elongated asbstos fibers coated with iron-containing protein from macrophage

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33
Q

therapy induced lung disease

A

bleomycin
amiodarone
acute radiation pneumonitis
chronic radiation pneumonitis

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34
Q

Caplan syndrome

A

coal worker pneumoconiosis and RA

nodules with possible central necrosis

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35
Q

epidemiology of sarcoidosis

A

higher prevalence in women, particularly AA and SE US

diagnosis of exclusion

36
Q

pathogenesis of sarcoidosis

A

immunologic-increased CD4, IL2, IL8, TNF

anergy to certain skin test antigens (candida, PPD)

37
Q

morphology of sarcoidosis

A

noncaseating granulomas with epithelioid cells, giant cells, Schaumann bodies, asteroid bodies

38
Q

lung findings sarcoidosis

A

granulomas along lymphatics, bronchi, blood vessels

39
Q

lymph nodes in sarcoidosis

A

hilar and mediastinal nodes

40
Q

liver in sarcoidosis

A

granulomas in portal tracts

41
Q

skin and mucous membranes in sarcoidosis

A

nodules, plaques, flat lesions

42
Q

eyes and salivary glands in sarcoidosis

A

iritis with lacrimal gland infalmmation (dacroadenitis)

43
Q

mikulicz syndrome

A

dacroadenitis+bilateral involvment of parotic/submax/sublingual

44
Q

best prognosis sarcoidosis

A

hilar adenopathy alone

45
Q

worst prognosis sarcoidosis

A

pulmonary involvement alonge

46
Q

hypersensitivity pneumonitis

A

immunologically mediated
due to increased reactivity to antigen
can by type III or type IV hypersensitivity

47
Q

farmers lung

A

spores of actinomycetes

48
Q

pigeon breeders lung

A

proteins from feathers/excretions

49
Q

humidifer lung

A

bacteria from heated water reservoir

50
Q

morphology hypersensitivity

A

chronic interstitial inflammation
noncaseating granulomas
interstitial fibrosis and honeycombing

51
Q

xray from hypersensitvity

A

diffuse and nodular infiltrates

52
Q

time frame for acute attacks

A

sensitized patients with fever, dyspnea, cough, leukocytosis
4-6 hours after antigen exposure

53
Q

chronic attacks of hypersensitivity

A

progressive respiratory failures and decreased lung capacity and compliance
restrictive

54
Q

acute eosinophilic pneumonia

A

rapid onset
BAL>25% eosinophils
good response to corticosteroids

55
Q

simple pulmonary eosinophilia (Loeffler’s syndrome)

A

transient lung lesions with blood eosinophilia
CXR shows irregular lung densities
thickened alveolar septa containing eosinophils and giant cells

56
Q

secondary pulmonary eosinophilia

A

parasitic, bacterial, and fungal infections

associated with asthma, allergic bronchopulmonary aspergillosis and drug allergies

57
Q

chronic eosinophilic pneumonia

A

areas of lung consolidation at the lung periphery
eosinophils and lymphocytes in septal wall and alveolar spaces
high fever, night sweats and dyspnea
treated with steroid therapy

58
Q

morphology of desquamative interstitial pneumonitis

A

large numbers of inta-alveolar macrophage containing brown pigment (smokers macrophages)
thickened alveolar speta with sparse inflammation

59
Q

clinical desquamative interstitial pneumonitis

A

more common in men around 40s-50s
almost all smoke
clubbing of digits
response to steroid therapy and cessation of smoking

60
Q

respiratory bronchiolitis associated interstitial lung disease morphology

A

large smokers macrophage numbers within respiratory bronchioles, alveolar ducts, peribronchiolar spaces
patchy chronic submucosal and peribronchiolar inflammation
mild peribronchiolar fibrosis with centrilobular emphysema

61
Q

etiology of acquired pulmonary alveolar proteinosis

A

anti-GM-CSF antibodies

impaired clearance of surfactant

62
Q

etiology of congenital PAP

A

mutations

63
Q

secondary PAP etiology

A

secondary to silicosis, immunodeficiency and malignancies

64
Q

morphology of PAP

A

heavy lungs
dense intra-alveolar granular precipitate that is PAS positive and contains cholesterol clefts
minimal inflammatory infiltrate

65
Q

clinical PAP

A

mostly in adults with productive cough containing chunks of gelatinous material

66
Q

most common cause of cancer mortality

A

lung cancer

67
Q

genetics of squamous cell carcinoma

A

3p, 9p (CDKN2A), 17p (TP53) deletions
loss of Rb
amplification of FGFR1

68
Q

genetics of small cell carcinoma

A

loss of TP3, RB
3p deletions
MYC amplifications

69
Q

genetics of adenocarcinoma

A

GoF in receptor tyrosine kinase

KRAS mutations

70
Q

lung cancers in non-smokers

A

most have EGFR

women, adenocarcinoma

71
Q

precursor lesions

A

squamous dysplasia
atypical adenomatous hyperplasia
adenocarcinoma in situ
neuroendocrine cell hyperplasia

72
Q

charactersistics of atypical adenomatous hyperplasia

A

less than 5mm, dysplasic pneumocytes lining alveoli

73
Q

characteristics of adenocarcinoma in situ

A

less than 3cm

dysplastic cells lining alveolar septae with no invasion

74
Q

characteristics of hamartoma

A

coin lesion on radiology
solitary, well circumscribed
epithelial and stromal component

75
Q

characteristics of lymphangioleiomyomatosis

A

young child bearing age owmen

proliferation of perivascular epithelaioid cells, melanocytes, smooth muscle markers

76
Q

genetics lymphangioleiomyomatosis

A

loss of function TSC2

77
Q

treatment lymphangioleiomyomatosis

A

transplant

78
Q

characteristics of inflammatory myofibroblastic tumor

A

children, single, well defined mass

fibroblasts, myofibroblasts, lymphs, plasma cells

79
Q

genetics of myofibroblastic tumor

A

rearrangement of ALK

80
Q

location of squamous cell carcinoma

A

centrally located

81
Q

morphology squamous cell carcinoma

A

large mass, necrosis
keratin pearls
intercellular bridges
p63 and p40 expression

82
Q

carcinoid tumor histology

A

no necrosis

less than 2 mitoses/10HPF

83
Q

atypical carcinoid tumor histology

A

2-10 mitoses/10HPT

may have focal necrosis

84
Q

paraneoplastic syndromes

A 
SIADH
Cushing syndrome
hypercalcemia/hypocalcemia
gynecomastia
carcinoid syndrome
85
Q

benign pleural tumors

A

solitary fibrous tumor

86
Q

kinds of malignant mesothelioma

A

epithelioid
sarcomatoid
mixed

DT3 Exam 2 (5 decks)

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