Pathology Flashcards
1
Q
Obstruction of sinus drainage into nasal cavity leading to inflammation and pain over affected area
A
Rhinosinusitis
2
Q
Sinuses typically affected in rhinosinusitis
A
Maxillary sinuses
3
Q
Where do maxillary sinuses drain into
A
Middle meatus
4
Q
Most common cause of acute URI
A
Viral etiology
5
Q
What can occur after viral URI
A
Bacterial infection
6
Q
Bacterial URI organisms usually after viral URI
A
S pneumoniae, H influenzae, M catarrhalis
7
Q
Part of the nostril commonly affected by epistaxis
A
Anterior segment (Kiesselbach plexus)
8
Q
Artery involved in posterior nasal hemorrhage that can be life threatening
A
Sphenopalatine artery
9
Q
Sphenopalatine artery is a branch of what artery
A
Maxillary artery
10
Q
Most common type of cancer affecting head and neck
A
Squamous cell carcinoma
11
Q
Virus associated with oropharyngeal cancers
A
HPV-16
12
Q
Virus associated with nasopharyngeal cancers
A
EBV
13
Q
Risk factors for head and neck cancers
A
Tobacco, alcohol, HSV-16, EBV
14
Q
Blood clot within deep vein causing swelling, pain, redness and warmth and usually unilateral
A
DVT
15
Q
Conditions that predispose to DVT
A
Stasis, hypercoagulability, endothelial damage
16
Q
Lab test used to rule out DVT
A
D-dimer (high sensitivity, low specificity)
17
Q
What triggers clotting cascade
A
Exposed collagen
18
Q
Used for prophylaxis and acute management of DVTs
A
Unfractioned heparin or LMWH (enoxaparin)
19
Q
Anticoagulant used for long-term prevention of DVTs
A
Warfarin or rivaroxaban
20
Q
Imaging choice for DVTs
A
Compression ultrasound with Doppler
21
Q
Condition that presents with V/Q mismatch, hypoxemia, respiratory alkalosis, sudden onset dyspnea, pleuritic CP, tachypnea and tachycardia
A
Pulmonary emboli
22
Q
Emboli that may cause sudden death and blocks both left and right pulmonary arteries
A
Saddle embolus
23
Q
Types of emboli
A
Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (FAT BAT)
24
Q
Emboli associated with long bone fractures and liposuction
A
Fat emboli
25
Emboli that can present with DIC postpartum
Amniotic emboli
26
Emboli that presents with classic triad of hypoxemia, neurologic abnormalities, and petechial rash
Fat emboli
27
Emboli caused by nitrogen bubbles precipitating after ascending from a dive
Air emboli
28
Complication of diving with joint pain
Caisson disease
29
Treatment for decompression sickness
Hyperbaric O2
30
Imaging choice for pulmonary emboli
CT pulmonary angiography - looks for filling defects
31
FEV1/FVC value in normal lungs
FEV1/FVC = 0.8
32
FEV1/FVC value in obstructive disease
FEV1/FVC < 0.8
33
FEV1/FVC value in restrictive disease
FEV1/FV normal or > 0.8
34
What happens to flow volume loop in obstructive disease
Loop shifts left
35
What happens to flow volume loop in restrictive diseases
Loop shifts right
36
The hallmark of obstructive lung disease
Decreased FEV1/FVC ratio
37
What does obstruction of airflow lead to in obstructive lung disease
Air trapping in lungs
38
What are the obstructive lung diseases
Chronic bronchitis, Emphysema, Asthma, Bronchiectasis
39
Thickness of mucosal gland layer to thickness of wall between epithelium and cartilage
Reid index
40
Diagnostic criteria for Chronic bronchitis
Productive cough > 3 months in a year for 2 consecutive years
41
Reid index in chronic bronchitis
50% or > 0.5
42
Pathology of chronic bronchitis
Hypertrophy and hyperplasia of mucus-secreting glands in bronchi
43
Findings in bronchitis
Wheezing, crackles, cyanosis, dyspnea, CO2 retention, secondary polycythemia
44
CXR findings in emphysema
Increased AP diameter, flattened diaphragm, increased lung field lucency
45
Chronic obstructive pulmonary diseases include which diseases
Chronic bronchitis and emphysema
46
Smoking is associated with what findings in emphysema
Centriacinar damage in upper lobes
47
Alpha-1 antitrypsin is associated with what findings in emphysema
Panacinar damage in lower lobes
48
Mechanism of centriacinar damage
Smoking rises up affects upper lobes and destruction of alveoli
49
What happens to alveoli in emphysema on exhalation
Alveoli collapse due to loss of elastic recoil from increased elastase activity
50
What happens to diffusion capacity in emphysema
Decreased diffusion capacity due to loos of alveolar walls
51
How is breathing accomplished in emphysema
Breathing through pursed lips to increase airway pressure and prevent collapse
52
Symptoms of emphysema
Hyperventilation and weight loss
53
Age group of those with emphysema caused by alpha-1 antitrypsin deficiency
Younger patients < 40 years
54
Age group of those affected with emphysema caused by smoking
Older patients > 60 years
55
Diagnosis of asthma is supported by what lab findings
Spirometry and methacholine challenge test
56
Complication of asthma that may lead to death
Status asthmaticus
57
Triad of asthma
Asthma, nasal polyps, chronic rhinosinusitis
58
Mechanism of aspirin-induced asthma
COX inhibition increase leukotrienes causing airway constriction
59
Pathological findings in asthma
Smooth muscle hypertrophy and hyperplasia, Curschmann spirals, Charcot-Leyden crystals
60
Eosinophilic, hexagonal, double-pointed, needle-like crystals formed from breakdown of eosinophils in sputum
Charcot-Leyden crystals
61
Shed epithelium forming whorled mucous plugs commonly seen in asthma
Curschmann spirals
62
Asthma triggers
Viral URIs, allergens, stress
63
Asthma findings
Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased inspiratory/expiratory ratio, pulsus paradoxus, mucus plugging
64
Pulsus paradoxus
Large decrease in systolic blood pressure and pulse wave amplitude during inspiration of > 10 mmHg
65
Presents with purulent sputum, recurrent infections, hemoptysis, and digital clubbing with dilated airways
Bronchiectasis
66
Bronchiectasis is associated with what conditions
Bronchial obstruction, poor ciliary motility, CF, ABPA
67
Poor ciliary motility causes
Smoking and Kartagener syndrome
68
Increased sensitivity to Aspergillus commonly seen in immunocompromised, CF and asthma patients
Allergic bronchopulmonary aspergillosis
69
How is ABPA diagnosed
Skin test
70
Treatment for ABPA
Corticosteroids
71
Findings in ABPA
IgE antibody production, increased Th2 CD4+ cells, increased interleukin synthesis and eosinophilia
72
Types of Restrictive lung diseases
Poor breathing mechanics and Interstitial lung disease
73
Findings in restrictive lung disease caused by poor breathing mechanics
Extrapulmonary findings, peripheral hypoventilation, and normal A-a gradient
74
Causes of restrictive lung disease due to poor breathing mechanics
Poor muscular effort and structural apparatus
75
Causes of poor muscular effort seen in restrictive lung diseases
Polio, myasthenia gravis, Guillain-Barre syndrome, ALS
76
Causes of poor structural apparatus seen in restrictive lung diseases
Scoliosis and morbid obesity
77
Common findings in restrictive lung disease caused by interstitial lung disease
Pulmonary decreased diffusion capacity and increased A-a gradient
78
Interstitial lung disease presenting with bilateral hilar lymphadenopathy, non-caseating granulomas, increased ACE and calcium
Sarcoidosis
79
Interstitial lung disease caused by repeated cycles of lung injury and wound healing presenting with increased collagen deposition, "honeycomb" appearance and digital clubbing
Idiopathic pulmonary fibrosis
80
Farmer or bird handler with cough, dyspnea, and chest tightness with diffuse crackles on exam
Hypersensitivity pneumonitis
81
Presents with bilateral, diffuse pattern with small, irregular reticulonodular opacities and "honeycomb" lung appearance
Interstitial lung disease
82
What type of hypersensitivity reaction is seen in hypersensitivity pneumonitis
Mixed Type III/IV: immune-complex and cell-mediated reaction
83
Interstitial lung disease presenting with PR3-ANCA/c-ANCA and eosinophilic granulomas on CXR
Granulomatosis with polyangiitis
84
Interstitial lung disease caused by exposure to silica, asbestos, and coal
pneumoconioses
85
Common findings in Restrictive lung diseases overall
Decreased FVC, TLC with FEV1/FVC ratio greater than or equal to 80% with short, shallow breaths
86
Mechanism of lung injury in Idiopathic pulmonary fibrosis
TGF-beta from injured pneumocytes leads to fibrosis
87
Treatment for Idiopathic pulmonary fibrosis
Lung transplant
88
Treatment for Hypersensitivity pneumonitis
Remove exposure, steroids
89
Syndrome seen in pneumoconioses presenting with RA and pneumoconioses with intrapulmonary nodules
Caplan syndrome
90
Complications of pneumoconioses
Cor pulmonale, Caplan syndrome and cancer
91
Associated with shipbuilding, roofing and plumbing and affecting lower lobes
Asbestosis
92
Findings that are pathognomonic for asbestosis
Supradiaphragmatic and pleural plaques
93
Most common type of cancer associated with asbestosis
Bronchogenic carcinoma
94
Lung condition with fusiform rods resembling dumbbells, found in alveolar sputum and visualized on Prussian blue stain
Asbestosis
95
Lung condition associated with aerospace industry and non-caseating granulomas on histology affecting upper lobes
Berylliosis
96
Lung condition associated with prolonged coal dust exposure with macrophages laden with carbon causing inflammation and fibrosis affecting upper lobes
Coal worker's pneumoconiosis
97
Lung condition associated with foundries, sandblasting, and mines affecting upper lobes with "eggshell" calcification of hilar lymph nodes on CXR
Silicosis
98
What is complication of TB and mechanism
Silica disrupt phagolysosomes and impair macrophages, increasing risk of TB
99
Mechanism of lung injury in silicosis
Macrophages respond to silica and release fibrogenic factors leading to fibrosis
100
Malignancy of pleura associated with asbestosis
Mesothelioma
101
Common histologic findings in mesothelioma
Psammoma bodies
102
Common histologic stain findings in most mesotheliomas
Cytokeratin and calretinin positive
103
Complication of mesothelioma
Hemorrhagic pleural effusion and pleural thickening
104
Diagnosis of exclusion characterized by respiratory failure within 1 week of alveolar insult, bilateral opacities , decreased PaO2/FiO2 < 300 and no evidence of HF/fluid overload
Acute respiratory distress syndrome
105
Clinical features of acute respiratory distress syndrome
Hypoxemia and cyanosis from increased diffusion barrier and collapse of air sacs
106
Cause of acute respiratory distress syndrome
Formation of intra-alveolar hyaline membranes
107
Initial damage in ARDS
Neutrophils release toxic substances damaging alveolar wall and pulmonary capillary endothelial cells, activating coagulating cascade, on oxygen-derived free radicals
108
Management of ARDS
Mechanical ventilation with low tidal volumes (PEEP) and address underlying cause
109
Recovery complications
Damage to type II pneumocytes causes scarring and fibrosis
110
CXR findings in ARDS
"white-out"
111
Respiratory effort against airway obstruction associated with obesity and loud snoring
Obstructive sleep apnea (OSA)
112
Mechanism of OSA in adults
Excess pharyngeal tissue
113
Mechanism of OSA in children
Adenotonsillar hypertrophy
114
Treatment for OSA
Weight loss, CPAP, surgery
115
Disorder associated with CNS injury/toxicity, HF, opioids and Cheyne-Stokes respiration and no respiratory effort
Central sleep apnea
116
Treatment for Central sleep apnea
Positive airway pressure
117
Disorder associated with obesity and BMI > 30 kg/m2, increased PaCO2 during waking hours, decreased PaO2 and increased PaCO2 during sleep
Obesity hypoventilation syndrome
118
Normal mean pulmonary artery pressure
10-14 mmHg
119
What pressure is considered pulmonary HTN
> 25 mmHg at rest
120
Diagnosis of pulmonary HTN
Right heart catheterization
121
Course of pulmonary HTN
Respiratory distress causing cyanosis and RVH leading to death from decompensated cor pulmonale
122
Symptoms of pulmonary HTN
Loud or accentuated 2nd heart sound in LUSB
123
Vascular changes seen in pulmonary HTN
Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries and plexiform lesions
124
Type of pulmonary arterial hypertension classically seen in young adult females
Idiopathic PAH
125
Common cause of heritable PAH
Inactivating mutation in BMPR2 gene
126
Consequence of mutation in BMPR2 gene
Vascular smooth muscle proliferation
127
Heart disease caused by systolic/diastolic dysfunction and valvular disease
Left heart disease
128
Consequence of chronic or recurrent microthrombi
Pulmonary HTN
129
Common causes of pulmonary HTN
PAH, left heart disease, lung disease or hypoxia, chronic thromboemboli, and multifactorial
130
Decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation away from side of lesion
Pleural effusion
131
Decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation toward side of lesion
Atelectasis
132
Decreased breath sounds, hyperresonant to percussion and decreased fremitus - diagnosis?
Simple pneumothorax
133
Decreased breath sounds, hyperresonant to percussion, decreased fremitus and tracheal deviation away from side of lesion - diagnosis?
Tension pneumothorax
134
Bronchial breath sounds, late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy, dullness to percussion, increased fremitus - diagnosis?
Consolidation (lobar pneumonia or pulmonary edema)
135
Pulmonary HTN presents with...
exertional dyspnea and right-sided HF
136
Excess fluid between pleural layers causing restricted lung expansion
Pleural effusion
137
Treatment for pleural effusion
Thoracentesis
138
Pleural fluid with decreased protein content, due to increased hydrostatic pressure or decreased oncotic pressure
Transudate
139
Pleural fluid due to thoracic duct injury from trauma or malignancy with milky-white appearing fluid and increased triglycerides
Lymphatic
140
Pleural fluid with increased protein content, cloudy appearing due to malignancy, pneumonia, collagen vascular disease or trauma
Exudate
141
Treatment for pleural effusion with exudate
Must be drained - can cause infection
142
Accumulation of air in pleural space presenting with dyspnea, uneven chest expansion, CP, decreased tactile fremitus, hyperresonance, and diminished breath sounds on affected side
Pneumothorax
143
Pneumothorax due to rupture of apical sub-pleural bleb or cyst occurring in tall, thin, young males with trachea shifted toward affected lung
Primary spontaneous pneumothorax
144
Pneumothorax due to diseased lung or barotrauma from high mechanical ventilation pressures
Secondary spontaneous pneumothorax
145
Pneumothorax caused by blunt or penetrating trauma
Traumatic pneumothorax
146
Can be caused by any condition that causes air to enter pleural space, cannot exit increasing pressure with tracheal deviation away from affected lung
Tension pneumothorax
147
Treatment for tension pneumothorax
Immediate needle decompression and chest tube placement
148
Common organisms in lobar pneumonia
S pneumoniae most common, Legionella and Kliebsella
149
Cause of lobar pneumonia in alcoholics or elderly in nursing homes
Klebsiella
150
Findings of lobar pneumonia caused by Klebsiella
Currant-jelly sputum and lung abscess, intra-alveolar exudate involving entire lobe or lung
151
Type of inflammatory cells seen in lobar pneumonia
Neutrophils
152
Pneumonia with acute inflammatory infiltrates from bronchioles into adjacent alveoli and patchy distribution involving more than 1 lobe
Bronchopneumonia
153
Common organisms causing bronchopneumonia
S pneumoniae, S aureus, H influenzae, Klebsiella
154
Common causes of pneumonia in neonates
GBS and E coli
155
Common causes of pneumonia in children
(RMCCS: Runts May Cough Chunky Sputum)
| RSV, Mycoplasma, C trachomatis, C pneumoniae, S pneumoniae
156
Common causes of pneumonia in infants to 3 year-olds
C trachomatis
157
Common causes of pneumonia in school-aged children
C pneumoniae
158
Common cause of pneumonia in young adults
Mycoplasma, C pneumoniae, S pneumoniae, Viruses
159
Common causes of pneumonia in older adults
S pneumoniae, H influenzae, Anaerobes, Viruses, Mycoplasma
160
Common causes of pneumonia in elderly
S pneumoniae, Influenza virus, Anaerobes, H influenzae, Gram negative rods
161
Common causes of pneumonia in alcoholics
Klebsiella (also Peptostreptococcus, Fusobacterium, Prevotella, Bacteroides)
162
Common causes of pneumonia in IV drug users
S pneumoniae, S aureus
163
Common causes of pneumonia in aspiration
Anaerobes
164
Common causes of atypical pneumonia
Mycoplasma, Legionella, Chlamydia,
165
Common causes of pneumonia in CF
Pseudomonas, S aureus, S pneumoniae, Burkholderia cepacia
166
Common causes of pneumonia in immunocompromised
S aureus, enteric gram negative rods, fungi, viruses, P jirovecii
167
Common causes of nosocomial pneumonia
S aureus, Pseudomonas, other enteric gram negative rods
168
Common causes of post-viral pneumonia
S pneumoniae, S aureus, H influenzae
169
Common causes of interstitial pneumonia
Atypical organisms like Mycoplasma, Chlamydia, Legionella and viruses like RSV, CMV, influenza and adenovirus
170
Pneumonia presents with diffuse patchy infiltrate and distribution involving more than one lobe with indolent course
Interstitial pneumonia
171
Pneumonia with CXR findings more severe than presenting symptoms
Atypical pneumonia (interstitial)
172
Non-infectious pneumonia with inflammation of bronchioles and surrounding structure formerly known as BOOP
Cryptogenic organizing pneumonia
173
Findings in cryptogenic organizing pneumonia
Negative sputum and blood cultures and no response to antibiotics
174
Natural history of lobar pneumonia
Congestion, Red hepatization, Gray hepatization and Resolution
175
Stage of lobar pneumonia characterized by enzymes digesting components of exudate
Resolution
176
Stage of lobar pneumonia characterized by red-brown consolidate and exudate with fibrin, bacteria, RBCs and WBCs
Red hepatization
177
Stage of lobar pneumonia characterized by red-purple, partial consolidation of parenchyma and exudate with mostly bacteria
Congestion
178
Stage of lobar pneumonia characterized by uniform exudate full of WBCs and fibrin
Gray hepatization
179
Onset of red hepatization in lobar pneumonia
3-4 days
180
Onset of resolution in lobar pneumonia
8 or more days
181
Onset of gray hepatization in lobar pneumonia
5-7 days
182
Most common location of lung abscess secondary to aspiration
Right lung
183
Localized collection of pus within lung parenchyma with air-fluid levels on CXR
Lung abscess
184
Treatment for lung abscess
Clindamycin
185
Carcinoma that occurs in apex of lung that may invade cervical sympathetic chain
Pancoast tumor
186
Symptom caused by compression of laryngeal nerve
Hoarseness
187
Symptom caused by compression of stellate ganglion
Horner syndrome (ipsilateral ptosis, miosis, anhydrosis)
188
Symptom caused by compression of SVC
SVC syndrome
189
Symptom caused by compression of brachiocephalic vein
Brachiocephalic syndrome
190
Symptom caused by compression of brachial plexus
Sensorimotor deficits
191
Presents with blanching after fingertip pressure in neck and upper extremities, jugular venous distention and upper extremity edema, increased ICP with headaches, dizziness, and increased risk of aneurysm
SVC syndrome
192
Common causes of SVC syndrome
Mediastinal mass, Pancoast tumor, thrombosis from indwelling catheter
193
Leading cause of cancer death
Lung cancer
194
Most common sources of metastatic lung cancer
Breast, colon, prostate, bladder cancer
195
Site of metastases from lung cancer
Adrenals, brain, bone, and liver
196
Complications of lung cancer
```
SPHERE:
SVC syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression
Effusions
```
197
Risk factors for lung cancer
Smoking, secondhand smoke, radon, asbestos, family history
198
Common image findings of lung cancer
Coin lesion on CXR or non-calcified lung nodule on CT
199
Common presentation of lung cancer
Cough, hemoptysis, bronchial obstruction, wheezing
200
Lung cancer associated with Lambert-Eaton syndrome
Small cell carcinoma
201
Oncogene associated with small cell carcinoma
myc oncogene
202
Treatment for small cell carcinoma
Chemotherapy
203
Lung cancer with poorly differentiated, small, dark blue cells, chromogranin A positive and neuron-specific enolase positive
Small cell carcinoma
204
Endocrine hormones associated with small cell carcinoma
ADH (SIAD)
| ACTH (Cushing syndrome)
205
Patient with small cell carcinoma presenting with descending muscle weakness may have antibodies to what
Presynaptic calcium channels
206
Peripherally located lung cancer most common in nonsmokers that is not responsive to chemotherapy with mucus producing glands
Adenocarcinoma
207
Activating mutations associated with adenocarcinoma
KRAS, EGFR, and ALK
208
Centrally located lung cancer characterized by keratin pearls, intercellular bridges and hypercalcemia associated with smoking
Squamous cell carcinoma
209
Peripherally located, highly anaplastic undifferentiated tumor with pleomorphic giant cells and strong association with smoking that is removed surgically
Lung cell carcinoma
210
Hormone that causes hypercalcemia in squamous cell carcinoma of lung
PTHrP
211
Lung cancer associated with Kulchitsky cells on histology
Small cell carcinoma
212
Lung cancer associates with nests of neuroendocrine cells and chromogranin A positive on histology with well differentiated cells
Bronchial carcinoid tumor
213
Symptoms due to mass effect or carcinoid syndrome in bronchial carcinoid tumor
Flushing, diarrhea, wheezing
