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USMLE Respiratory > Pathology > Flashcards

Pathology Flashcards

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USMLE® Step 1 flashcards
1
Q

What artery can cause a fatal bleed from trauma to the nose?

What is it a branch of?

A 
Sphenopalatine artery (branch of maxillary)
- Posterior segment of nostril
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2
Q

What type of cancers are head and neck cancer usually?

A

Squamous cell carcinoma

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3
Q

What are risk factors for Head and neck cancers?

A
  • Tobacco
  • Alcohol
  • HPV-16 (oropharyngeal)
  • EBV (nasopharyngeal)
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4
Q

What may nasopharyngeal carcinomas present with?

A
  • Unilateral nasal obstruction
  • Discharge
  • Epistaxis
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5
Q

What arteries are in the Kiesselbach plexus?

A

Kiesselbach’s LEGS

  • Labial artery
  • anterior and posterior Ethmoidal arteries
  • Greater palatine artery
  • Sphenopalatine artery
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6
Q

What does the superior meatus drain?

A

Sphenoid and posterior ethmoid sinuses

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7
Q

What does the middle meatus drain?

A
  • Frontal
  • Maxillary
  • Anterior ethmoid
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8
Q

What does the inferior meatus drain?

A

Nasolacrimal duct

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9
Q

What may paranasal sinus infections extend to?

A
  • Orbits - orbital cellulitis
  • Cavernous sinus - Cav sinus syndrome
  • Brain - meningitis
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10
Q

What are causes of epistaxis?

A
  • Foreign body
  • Trauma
  • Allergic rhinits
  • Nasal angiofibromas
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11
Q

What sinuses are most commonly affected by rhinosinusitis?

A

Maxillary sinuses

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12
Q

What are the causes of an anterior mediastinal mass?

A
  • Thyroid (substernal goiter)
  • Thymic neoplasm
  • Teratoma
  • Terrible Lymphoma
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13
Q

What are the causes of a middle mediastinal mass?

A
  • Esophageal carcinoma
  • Metastases
  • Hiatal hernia
  • Bronchiogenic cysts
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14
Q

What are causes of a posterior mediastinal mass?

A
  • Neurogenic tumour (neurofibroma)

- Multiple myeloma

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15
Q

What are causes of mediastinitis?

A
  • Post-op complications of cardio-thoracic procedures (< 14 days)
  • Esophageal perforation
  • Contigous spread of odontogenic/retropharyngeal infection
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16
Q

What organism may cause mediastinitis?

A

Histoplasma capsulatum

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17
Q

How does mediastinitis occur?

A

Increased proliferation of connective tissue in mediastinum (aka Fibrosing mediastinitis)

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18
Q

What are the clinical features of mediastinitis?

A
  • Fever
  • Tachycardia
  • Leukocytosis
  • Chest pain
  • Sternal wound drainage
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19
Q

What are the causes of pneumomediastinum?

A
  • Spontaneous rupture of pulmonary bleb

Secondary causes

  • Trauma
  • Iatrogenic
  • Boerhaave syndrome
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20
Q

What are complications of idiopathic pulmonary fibrosis?

A
  • PAH
  • Resp failure
  • Lung cancer
  • Arrhythmias
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21
Q

What are potential causes of idiopathic pulmonary fibrosis?

A
  • Smoking
  • Environmental pollutants
  • Genetic defects
22
Q

What type of hypersensitivity reaction is hypersensitivity pneumonitis?

A

III/IV

23
Q

What are the acute symptoms of hypersensitivity pneumonitis?

A
  • Dyspnea
  • Cough
  • Chest tightness
  • Fever
  • Headache
24
Q

What does chronic hypersensitivity pneumonitis lead to (what are its features)?

A
  • Irreversible fibrosis
  • Noncaseating granuloma
  • Alveolar septal thickening
  • Traction bronchiectasis
25
Q

What will serum and bronchioalveolar lavage fluid show specifically in Sarcoidosis, what will be elevated?

A
  • Serum - Elevated ACE levels

- Bronchioalveolar fluid - Elevated CD4/CD8 ratio

26
Q

What will CXR show in sarcoidosis?

A
  • Bilateral adenopathy

- Coarse reticular opacities

27
Q

What are possible signs / symptoms associated with sarcoidosis outside of the lungs?

A
  • Bell palsy
  • Uveitis
  • Lupus pernio
  • Erythema nodosum
  • Rheumatoid arthritis-like arthropathy
  • Hypercalcemia
28
Q

What are the features of the granulomas in sarcoidosis?

A
  • Noncaseating epitheloid

- Containing microscopic Schaumann and asteroid bodies

29
Q

How does sarcoidosis cause hypercalcemia?

A

Increased 1alpha-hydroxylasee-mediated vit D activation in macrophages

30
Q

What will bronchoscopy show in inhalation injury?

A

Edema, congestion of bronchus and possibly soot deposition

31
Q

What is pneumoconiosis?

A

Interstitial lung diseases where inhalation of dust has caused interstitial fibrosis

32
Q

Name 4 pneumoconioses

A
  • Asbestos-related disease
  • Berylliosis
  • Coal workers’ pneumoconiosis
  • Silicosis
33
Q

What types of pneumoconioses affect the upper lobes and what types affect the lower?

A

Asbestos-related disease - lower

Upper lobes

  • Berylliosis
  • Coal workers’ pneumoconiosis
  • Silicosis
34
Q

What are 3 main asbestos-related diseases?

A
  • Asbestosis - pulmonary fibrosis
  • Pleural disease
  • Malignancies - mesothelioma
35
Q

What cancers can be due to absestos exposure?

A
  • Bronchiogenic carcinoma

- Mesothelioma

36
Q

What is Caplan syndrome?

A
  • Rheumatoid arthritis
    • Pneumoconiosis
  • W. Intrapulmonary nodules
37
Q

What do asbestos bodies look like on histology from alveolar sputum sample (often obtained by bronchoalveolar lavage)?

What stain is used?

A
  • Golden-brown fusiform rods resembling dumbbells

- Visualized from Prussian-blue stain

38
Q

What is berylliosis?

A

Beryllium exposure in aerospace and manufacturing industries

39
Q

What will be seen on histology in berrylliosis?

A

Noncaseating granulomas

40
Q

What are those with berylliosis at increased risk of?

A
  • Cor pulmonare

- Cancer

41
Q

What diseases may increase the risk of Caplan syndrome?

A
  • Absestosis
  • Coal-workers pneumoconiosis
  • Silicosis
42
Q

What will be seen on histology in Coal-workers pneumoconiosis?

A

Macrophages laden with carbon

-> Inflammation and fibrosis

43
Q

What will be seen on imaging in Coal-workers pneumoconiosis?

A

Small, rounded nodular opacities seen

44
Q

What is anthracosis?

A

Basically asymptomatic coal-workers pneumoconiosis

- Many urban dwellers exposed to sooty air

45
Q

What is Silicosis associated with (what workers)/

A
  • Sandblasting
  • Foundries
  • Mines
46
Q

Describe the pathology of Silicosis?

A

Macrophages respond to silica and release fibrogenic factors, leading to fibrosis
- Silica may disrupt phagolysosomes and impair macrophages -> incr susceptibility to TB

47
Q

What are those with Silicosis at increased risk of?

A
  • Cancer
  • Cor pulmonale
  • Caplan syndrome
48
Q

What will ne seen on CXR in Silicosis?

A
  • Upper lobes affected

- Eggshell calcification of hilar lymph nodes

49
Q

What will histology show with mesothelioma?

A

Psammoma bodies

50
Q

What will EM show in mesothelioma?

A

Polygonal tumor cells with microvilli, desmosomes, tonofilaments
- Calretinin and cytokeratin 5/6 +ve in almost all and not in normal lung cancer

51
Q

What is the pneumonic to remeber silicosis?

A

The silly egg sandwich is mine

USMLE Respiratory (7 decks)

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