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Pulmonary Week 3 > Path in Class > Flashcards

Path in Class Flashcards

1
Q

A 65 yo woman receiving therapy for RA presented with a right lower lung mass. Never smoked or drank alcohol. A peripherally stapled wedge of lung parenchyma measuring 9x5x2cm was received and sectioned, showing a reasonably well circumscribed nodular mass 9x1.5 cm immediately beneath the pleura. Ddx?

A
  • neoplasm
  • infection
  • effect of drug therapy or R.A.
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2
Q

How does PCP present histologically?

A

lung parenchyma looks the same but you see foamy, pink exudate in the alveolar spaces

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3
Q

How do granulomas form?

A

macrophages cant digest inciting agent causing failure of acute inflammatory responses and persistence of injurious agent which results in recruitment of macrophages with epithelioid and giant cell formation

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4
Q

Asteroid body giant cells are seen in what disease?

A

Sarcoidosis

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5
Q

Tonton giant cells are seen in which disease?

A

lipid-laden lesions like fat necrosis

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6
Q

Langhans Type giant cells are seen in which disease?

A

TB but not specific

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7
Q

What do rheumatoid nodules look like?

A

central area of necrosis surrounded by palisading macrophages and lymphocytes

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8
Q

Fibroblasts in a rheumatoid nodule produce what?

A

large quantities of metalloproteases

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9
Q

The lymphocytes in a rheumatoid nodule produce what?

A

IgG and IgM rheumatoid factor

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10
Q

What finding suggests a pre-mortem clot?

A

lines of zahn

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11
Q

What is migratory thrombophlebitis?

A

aka Trousseau sign; in 10% due to tumor or tumor necrosis producing PAF and procoagulant

these patients respond better to heparin then warfarin

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12
Q

What is the most probably underlying basis for most forms of pulmonary HTN?

A

Pulmonary endothelial cell and/or vascular smooth muscle dysfunction

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13
Q

Wegener’s is associated with ___-ANCA

A

C (PR3)

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14
Q

Aspiration pneumonia is common in which patients?

A

debilitated patients with a history of recurrent pneumonia

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15
Q

How does aspiration pneumonia show histologically?

A
  • organizing pneumonia
  • often multinucleate giant cells
  • lipoid pneumonia
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16
Q

What is on the Ddx for aspiration pneumonia?

A

granulomatous inflammation

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17
Q

Neuroblastoma presentation on H&E

A
  • small round blue cell tumor

- rosettes around neuropils

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18
Q

What are some causes of acute eosinophilic pneumonia?

A
  • Aspergillus
  • Churg-Strauss syndrome
  • Asthma
  • tobacco
  • others
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19
Q

Describe SIMPLE eosinophilic pneumonia

A

(aka Loffler’s syndrome), self-limited disorder with no/minimal symptoms, and often transient

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20
Q

Describe ACUTE eosinophilic pneumonia

A

onset in 1-4 days and is accompanied by fever, cough, dyspnea, and chest pain. Prominent eosinophils in a BAL fluid

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21
Q

What is seen in a biopsy of acute eosinophilic pneumonia?

A

diffuse alveolar damage

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22
Q

Describe CHRONIC eosinophilic pneumonia

A

insidious onset, usually in months, and additional symptoms of weight loss and intense night sweats along with acute symptoms

23
Q

Chronic eosinophilic pneumonia is often associated with _____

A

asthma

24
Q

What does biopsy show in chronic eosinophilic pneumonia?

A

tissue eosinophilia and possible fibrin, but NO diffuse alveolar damage

25
Q

How are acute and chronic eosinophilic pneumonia treated?

A

corticosteroids

26
Q

What interleukin promotes eosinophil recruitment?

A

IL-5

27
Q

What causes hyaline membranes?

A

plasme proteins and necrosis

28
Q

Why do you see alveolar collapse in ARDS?

A

type II pneumocytes are necrotic and slough off into the alveolar space so surfactant production decreases

29
Q

What is Lambert Eaton syndrome?

A

a myasthenic syndrome caused by presynaptic disorder of neuromuscular transmission in which quantal of Ach is impaired, causing proximal muscle weakness, depressed tendon reflexes, post-tetanic potentiation, and autonomic changes (paraneoplastic syndrome)

presents like Myasthenia gravis

30
Q

SIADH and Lambert-Eaton are most often associated with _____

A

small cell carcinoma

31
Q

A nonsmoking woman of Far Eastern origin is diagnosed with pulmonary adenocarcinoma. What is the most likely mutation in this tumor?

A

EGFR

32
Q

Pancoast tumors are most often ____.

A

squamous cell NSCLC

33
Q

What are three major mechanisms by which hypercalcemia can occur with malignancy?

A

1) Osteolytic metastases with local release of cytokines
2) tumor secretion of PTHrP
3) tumor production og 1,25-dihydroxyvitamin D

34
Q

What are the effects of PTH?

A

increases bone resorption, distal tubular calcium reabsorption, and inhibition of proximal tubular phosphate transport

35
Q

Cushing syndrome is associated with what neoplasm? How?

A

lung small cell anapestic (oat cell) carcinoma via ACTH-like substance release

36
Q

Hypercalcemia is associated with what neoplasm? How?

A

Lung (squamous cell) carcinoma via PTHrH release

37
Q

How does acute hypercalcemia manifest?

A

chronically elevated calcium may be well-tolerated but acute (12-14 mg/dL) may give rise to polyuria, polydipsia, dehydration, anorexia, etc.

38
Q

Polycythemia is associated with what neoplasm? How?

A

renal cell carcinoma via EPO-like substance release

39
Q

Tadpol cells on cytology are indicative of what?

A

Squamous cell carcinoma

40
Q

What is the worst allele type for panaciar emphysema?

A

PiZZ
Z= very low levels of A1AT
S= some A1AT

41
Q

What gene has the alleles for A1AT?

A

SERPINA1

42
Q

DDx for a solitary pulmonary nodule?

A

Malignancy (primary lung carcinoma)

  • Infection (Granuloma/TB,pneumonia)
  • Vascular (resolving infarctions, rheumatoid nodules)
  • Hamartomas
43
Q

What are some things that cause an exudative pleural effusion?

A
  • malignancy
  • infection
  • CT disease (Churg-Strauss, lupus, RA, Wegener’s)
  • Dressler Syndrome
  • Pulmonary embolism
44
Q

What are some things that cause an transudative pleural effusion?

A
  • CHF
  • nephrotic syndrome
  • cirrhosis
  • atelectasis
45
Q

What are the most common types of malignant pleural effusions?

A

-metastasis from lung, GI, ovary, breast, lymphoid/leukemic

46
Q

TTF-1 is an immunization that is positive when?

A

thyroid and lung carcinomas

47
Q

Napsin-A is an immunization that is positive when?

A

lung adenocarcinomas

48
Q

Rule of thumb CK7= above the waist, CK20= below the waist

A

Rule of thumb CK7= above the waist, CK20= below the waist

49
Q

p40/p63 is an immunization that is positive when?

A

squamous cell carcinomas

50
Q

Chromogranin/synapthophysin is an immunization that is positive when?

A

neuroendocrine tumors

51
Q

How does lung abscess present?

A 
chills and rigors for 2+weeks
-fever
CBC show hemoglobin
-WBC elevated
-hypercellularity
52
Q

How do carcinomas spread?

A

typically via lymph (check sentinel lymph nodes)

53
Q

Diagnosing pulmonary fibrosis?

A
  • lack of ground glass
  • honeycombing
  • subpleural distribution lower lobe
  • traction bronchiolectasis (fibrosis pulls the bronchi open)

Pulmonary Week 3 (18 decks)

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