PATHOLOGY EXAM 2 Flashcards
What happens to type I/II pneumocytes in idiopathic pulmonary fibrosis?
Type I’s damaged and Type II undergo hyperplasia
In what occupation is silicosis a problem? What is the causative agent?
Foundry, sandblasting, and stone cutting; Crystalline silicon dioxide
What are the 2 main forms of asbestos and which are removed from the lungs by mucociliary motion?
Chrysotile (serpentine) removed; Amphiboles (straight and stiff) not removed
Which lung disease is most likely to have Schaumann and Asteroid bodies?
Sarcoidosis
What is the Tx of the disease that leads to accumulation of surfactant and is associated with anti GM-CSF antibody?
Lung transplant; if not the kid is dead by 3-6 months of age
What are the 4 stages of the inflammatory response of lobar pneumonia?
Congestion, red hepatization, grey hepatization, and resolution
What is the current concept of pathogenesis in Idiopathic pulmonary fibrosis?
Repeated cycles of epithelial activation and injury by unidentified agent
Which pneumoconiosis has birefringent spicules with pointed ends in plane-polarized light?
Silcosis
What is the gram stain of S. pneumo? Why might a person have a false-positive for this as a cause of pneumonia?
Gram positive diplococci (lancet shaped); It is normal flora in 20% of adults
What is the most important pertinent negative for nonspecific interstitial pneumonia? What is the Tx?
There is NO TEMPORAL HETEROGENEITY also no honeycombing; steroids
What are 2 possible outcomes of inhalation of the bacteria that lives in amoebae in AC units and hot tubs?
This is L. pneumophila–can be either Legionnaire’s disease or Pontiac fever
What kind of “aspiration pneumonia” is a newborn at risk for?
Aspiration of amniotic fluid and epithelial cells (will look similar to amniotic fluid embolus b/c of the fetal squames)
Which 2 restrictive diseases are granulomatous?
Sarcoidosis and Hypersensitivity pneumonitis
What is the gram stain of the most common cause of CAP as an acute exacerbation of COPD?
Gram negative coccobacilli (pleomorphic)–this is Haemophilus influenzae
What are the risks of cancer in silicosis, asbestosis, and coal worker’s pneumoconiosis?
In CWP there is NO increased risk, in asbestosis there is definite risk, in silicosis the risk is unclear
Who is most likely to get desquamative interstitial pneumonia? What will you see? Tx?
Middle aged male smokers; intraalveolar macrophages w/ dusky pigment; smoking cessation and steroids
What is the histologic hallmark of pulmonary alveolar proteinosis?
Accumulation of surfactant in the alveoli
What are 2 ways to make a diagnosis of L. pneumophila?
Antigen detection in urine or grow on buffered charcoal yeast extract agar
Which bug looks like crushed ping pong balls or dented helmets? Below what CD4 count is an AIDS patient predisposed?
Pneumocystis jiroveci; below 200
What is an AIDS patient at risk for when his/her CD4 dips below 200 cells/mm3?
Pneumocystis jiroveci
What is cryptogenic organizing pneumonia often secondary to?
Viral and bacterial pneumonia and also generalized inflammatory insults to the lungs
A stroke patient is particularly at risk for what type of pneumonia?
Aspiration pneumonia if they have dysphagia. Also, they may lose the cough reflex which predisposes them to normal CAP and HAP pneumonia as well
Which pediatric emergency of unvaccinated children may descend to cause CAP?
Epiglottitis; most likely with Haemophilus influenza B in unvaccinated kids
What is Loeffler Syndrome?
Simple Pulmonary eosinophilia
Which disease causes ARDS-like Sx in a full-term infant? What is the best IMMEDIATE Tx, definitive?
Pulmonary Alveolar Proteinosis. WHOLE LUNG LAVAGE to get rid of the gelatinous stuff, lung transplant is definitive
Which type of pneumonia may look like it has cholesterol clefts like in atherosclerosis on biopsy?
Aspiration pneumonia, from the food that was aspirated
Which restrictive disease tends to have bilateral hilar lymphadenopathy?
Sarcoidosis
What is the second most common cause of acute exacerbation of COPD? Gram stain?
Moraxella catarrhalis (w/ H. flu being most common)–gram negative diplococci
What are the 4 fibrosing restrictive diseases?
Idiopathic pulmonary fibrosis, nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and the pneumoconioses
which type of asbestos is most likely to wind up in a pleural effusion and why?
Chrysotile (serpentine) because they are more SOLUBLE than amphiboles
What are 3 complications of pulmonary abscesses?
SEPTIC EMBOLI (brain abscess), hemorrhage, and pleuritis/effusion
What is the effect of coal workers P on PFT’s and cancer risk?
Most are not affected by this unless it progresses, and there is no increased CA risk
Micro tie-in: If a pulmonary abscess heals and leads to a cavity, what might colonize it?
Aspergillus fumigatus, FUNGAL BALL!
Where are disseminated infections from the dimorphic fungus endemic to the desert SW most likely to go?
To the skin (erythema nodosum and multiforme) and to the meninges, particularly in IC patients
What does a lobular pneumonia look like on CXR?
Patchy and frequently BILATERAL (lower lung fields), lobar pneumonias are more localized
What are the most likely causes of pulmonary abscess? What is a good way to differentiate this from a neoplasm on CXR?
Aspirated anaerobes and Staph aureus; A neoplasm (mass) will never have AIR FLUID LEVELS but an abscess will
Why does smoking worsen pneumoconioses?
It knocks out the cilia and thus worsens the clearing ability of the lungs
Which mediator seems to be driving aberrant epithelial repair in idiopathic pulmonary fibrosis?
TGF-B1
What does a Ziehl-Neelsen stain, stain for?
Acid fast Bacilli
In what way is hypersensitivity pneumonitis different from asthma?
HP affects alveoli vs. bronchioles and it is a granulmatous inflammation mediated by IgG rather than IgE (also, asthma is NOT granulomatous)
T/F: under normal conditions inhaled dust particulates remain in the alveoli, pneumoconiosis occurs when you inhale too much
False, normally the dust is phagocytosed by alveolar macrophages and pneumoconiosis occurs when the phagocytic ability of the macros is overpowered by the amount of dust inhaled
Why are smaller inhaled particles more likely to cause acute lung injury while large ones are more likely to induce fibrosis over time?
Because smaller ones are often inhaled in larger quantities and reach toxic levels quickly, whereas large ones tend to persist in the lung and evoke fibrosis
What is the best way to differentiate sarcoid from hypersensitivity pneumonitis?
Since both have non-caseating granulomas, the Hx of sarcoid DOESN?T MATTER whereas HP is usually from an occupation
What is the major complication of aspiration pneumonia? Why?
Lung abscess, really the cause is because they are caused by anaerobic bacteria. ASPIRATION PNEUMONIAS ARE VERY SERIOUS
How does Blastomyces dermatiditis replicate? Compare the size of the yeast cells to histoplasma:
Via broad-based budding; Blasto is much bigger than histo
An AIDS patient with a CD4 count below 50 cells/mm3 is most likely to have what as the cause of a pneumonia?
CMV or MAC
How long must someone have been hospitalized before you call it HAP? Most common types of organisms to cause HAP?
48 hours; Gram negative rods
What is the culprit of Coal Worker’s Pneumoconiosis? What are the 3 stages?
Carbon dust? Anthracosis, Simple Coal Worker’s pneumoconiosis, and Progressive Massive Coal Worker’s pneumoconiosis
Which pulmonary disease is associated with anti-granulocyte-monocyte colony stimulating factor (anti GM-CSF) antibody?
Pulmonary Alveolar Proteinosis
What do the pleural surfaces of a person with idiopathic pulmonary fibrosis look like? The parenchyma?
COBBLESTONED; Honey-combed
What happens when you cut the lung of a specimen with pulmonary alveolar proteinosis?
Exudation of turbid fluids
Where do CWP and silicosis affect the lungs? With which infectious agent are silicosis patients at risk for and why?
Both affect upper lungs; TB b/c the silica may inhibit the MO ability to phagocytose the TB
Which infection has a concentric (dystrophic) calcification that gives it an annular tree bark appearance?
Histoplasma capsulatum, this is a chronic infection and it can lead to granuloma formation
Who is at risk for Pseudomonas aeruginosa CAP?
Cystic fibrosis patients, particularly. Also neutropenic patients
Discuss the fibrosis seen in early and late lesions in IPF (i.e. the temporal heterogeneity) where do most lesions occur in IPF?
Early = myxoid lesions Late = dark pink (more mature collagen); mostly in the bases (bibasilar rales often heard)
Name the 2 smoking associated interstitial lung diseases
Desquamative Interstitial Pneumonia; Respiratory Bronchiolitis associated interstitial lung disease
Which infectious agent forms “Coin lesions” on CXR? What is a major concern in immunocompromised patients?
Histoplasma capsulatum; it may disseminate
What is the major difference between Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia?
IPF has temporal heterogeneity and NIP does not, also NIP lacks honeycombing and foci of fibroblasts
When alveoli are destroyed in IPF, what are the cystic spaces lined by?
Type II pneumocytes and/or bronchiolar epithelium
What form of silicon is most commonly implicated in silicosis? Why is that important?
Quartz, in the workplace it is rarely pure and the purer forms of silicon are the most fibrogenic
What is a hallmark finding on biopsy of an interstitial pneumonitis, pathologically?
Widened and edematous alveolar septa–b/c the infection is in the INTERSTICES not the alveoli
Why might a Hx of stroke predispose to a pneumonia? Just for the hell of it would the stroke most likely be in the vertebrobasilar circulation or the anterior circulation?
They may have lost the cough reflex; vertebrobasilar since coughing controlled by brainstem
Which bacteria is most likely to cause CAP in a debilitated alcoholic?
Klebsiella pneumoniae- gram negative bacillus produces a VISCID CAPSULAR POLYSACCHARIDE
What is the required histologic pattern for Idiopathic pulmonary fibrosis?
usual interstitial pneumonia
Why is it easier to identify the cause of a restrictive lung disease early as opposed to later?
Because they all end in the HONEYCOMB LUNG
Which is more acute, typical or atypical pneumonia?
Typical
What is the causal agent of tropical eosinophilia? Where does it reside?
Wucheria bancrofti, in pulmonary capillaries
What is the difference in Cancer association for silicosis, CWP, and asbestosis?
Definite increase in asbestosis, controversial in silicosis, and none in CWP
Why is desquamative interstitial pneumonia a misnomer?
They used to think it was sloughed off type II alveolar cells but really it is macrophages
What is Caplan Syndrome?
A person with an occupational pneumonconiosis and rheumatoid arthritis
Which fungus infects macrophages intracellularly? What is the likely Hx?
Histoplasma capsulatum; contaminated bird/bat droppings in Ohio/Mississippi river valley
What effect will quitting one’s job have on silicosis vs. hypersensitivity pneumonitis?
HP will get better b/c no longer exposed to the allergen; Silicosis will continue to progress but it would still be best to leave
What do you use a Gomori methenamine silver stain for?
Fungi. They show up black, the counterstain is green
Why is it more likely to have a pulmonary abscess on the right side?
Because most pulmonary abscesses are caused by anaerobic bacteria; anaerobic bacteria are often introduced by aspiration; when something is aspirated it is more likely to go into the right mainstem bronchus than left b/c the right is more steeply angled
What is the major complication of CAP caused by S. aureus? Sputum looks like what?
Empyema, looks salmon pink
What are 4 possible complications of pneumonia?
Abscess formation, Empyema, Sepsis, and Pleural scars & Pleural adhesions
What is an important pertinent negative in cryptogenic organizing pneumonia? What are causing the problems?
There is no interstitial fibrosis or honeycombing but there are MASSON BODIES plugging up the alveoli etc
What is the most common cause of of community acquired pneumonia? Removal of which organ predisposes to this?
Streptococcus pneumoniae; Splenectomized patients are at risk
How would you differentiate coccidiodes from paracoccidiodes on microscopy?
Coccidiodes forms a spherule while paracoccidiodes would have pilot-wheel budding yeast
What is the definitive Tx for IPF?
Lung transplant
What type of virus is SARS? What are the 2 most common bacterial causes of interstitial pneumonitis w/o consolidation?
Coronavirus; Mycoplasma pneumoniae and Chlamydophila pneumoniae
How to Dx pulmonary eosinophilia on bronchoalveolar lavage? Tx?
> than 25% eosinophils; respond well to cortiosteroids
What is a coal macule and nodule? In what stage of CWP are these first seen?
Coal macules are 1-2 mm collections of carbon-laden MO and Coal nodules are small areas of collagen fibers? Seen in simple coal workers pneumoconiosis first (NOT anthracosis)
Which fibrosing disease doesn?t result in honeycombing?
Cryptogenic organizing pneumonia (BOOP)
What does the pleura of IPF look like compared to asbestos?
IPF is cobblestoned and asbestos has plaques
Which general type of pneumonia often follows a viral URT infection?
Community Acquired pneumonia
What is another name for Cryptogenic Organizing Pneumonia?
Bronchiolitis obliterans organizing pneumonia
What is the name of the disease in which there is rheumatoid arthritis concurrent with occupational pneumoniosis?
Caplan Syndrome (positive Rheumatoid factor)
What are the 4 fibrosing diseases?
Idiopathic pulmonary fibrosis, Nonspecific interstitial pneumonia, Cryptogenic organizing pneumonia, and pneumoconioses
Which fibrosing disease has plugs of loose connective tissue in the alveoli and bronchioles? What is the name of the plugs?
Cryptogenic organizing pneumonia; Masson Bodies
What does the CXR of asbestosis look like?
Irregular linear densities–especially in the LOWER LOBES
An AIDS patient with a CD4 count above 200 is most likely to have what as the cause of pneumonia?
TB (or probably anything, really, but pick TB
What is the PATHOLOGICAL significance of the pores of Kohn?
They allow for the spread of infection among alveoli
Reye syndrome is a result of what?
Taking aspirin while having a viral illness (particularly in children) which leads to HEPATIC FAILURE and then encephalopathy
