Pathology II

Question 1

What type of inflammation accompanies chronic bronchitis?

Answer 1

lymphocytic inflammation, along with the cardinal symptom of excessive mucus production (as opposed to eosinophillic infiltrate in asthma

Question 2

Describe the type of collagen that is laid down in basement membrane thickening during asthma.

Answer 2

type I and III are deposited instead of the normal type IV

Question 3

What are Curschmann spirals and Charcot-Leyden crystals? What disease are they characteristic of?

Answer 3

whorls of shed epithelium in mucus plugs

Question 4

Classify and describe Loffler Syndrome.

Answer 4

simple pulmonary eosinophilia with transient pulmonary lesions, peripheral (blood) eosinophilia, benign course

Question 5

Describe the symptoms and clinical data associated with acute eosinphilic pneumonia with respiratory failure.

Answer 5

rapid onset of illness of unknown cause presenting with fever, dyspnea and hypoxemic reparatory failure which responds to corticosteriods

BAL >25% eosinophils, CXR shows diffuse infiltrates

Question 6

Define bronchiectasis by describing the symptoms and mechanism(s) of disease. What are some possible causes?

Answer 6

permanent dilation of bronchi/bronchioles caused by destruction of muscle and elastic tissue due to repeated bouts of inflammation, associated with chronic necrotizing infection (TB, Staph, Aspergillus)

Causes: obstruction by tumor or foreign body, hereditary dysfunction of mucus (CF) or kartageners (cilia).

Question 7

What defect causes primary cilia dyskinesia?

Answer 7

AR defect in dyne in arms of cilia (present in ½ patients with Kartageners syndrome: bronchiectasis, sinusitis, situs inversus)

Question 8

CRTR is a ______ channel but regulates multiple ion channels including facilitating the movement of ____ ions.

Answer 8

chloride, Na+

Question 9

What are the 3 striking pathological features of CF lung?

Answer 9

mucus plugging, bronchiectasis, consolidation (due to infection), pseudomonas is a common infection and causes green color from metabolite

Question 10

Name 4 common causes of pulmonary fibrosis.

Answer 10

chronic injury or recurrent acute injury

interstitial lung disease

Question 11

What is the key mediator that is released from injured type I alveolar epithelial cells in IPF?

Answer 11

TGF B1

it is an important inhibitor of caveolin (natural inhibitor of collagen deposition) AND acts to reduce telomerase

Question 12

Name two pathologic characteristics of a section of IPF lung.

Answer 12

temporal heterogeneity (key feature of UIP) consists of both:
new (active) fibrosis called fibroblastic foci
old (collagenized) dense fibrosis

Question 13

Discuss the two geometric forms of asbestosis and how their characteristics modulate disease risk.

Answer 13

amphibole: more pathogenetic because it is more aerodynamic (penetrates deeper in lung) and is less soluble
serpentine: less pathogenic because of curly shape (less penetrant) and is more soluble (able to be removed from lung)

Question 14

Asbestos fibers become coated with iron and calcium which is why it is often referred to as a ______ ______.

Answer 14

ferrugeinous body

Question 15

What two qualities of a mesothelioma can be used to confirm by lab test that the growth is mesothelioma?

Answer 15

mesothelioma does not produce TTF-1 thyroid transcription factor like lung tissue does

mesothelioma will be Cal-retnin positive

Question 16

What is egg-shell calcification on x-ray a classic symptom of?

Answer 16

silicosis (affects the upper lobe primarily), can increase susceptibility to TB

Question 17

What are lines of Zahn?

Answer 17

created by the layering effect of thrombus forming in a vessel with blood flow (an alternating pattern of platelets, fibrin and RBC)

is important in identifying ante-morem thrombosis v. post mortem clot

Question 18

Discuss possible causes of pulmonary HTN.

Answer 18

COPD/ILD causing hypoxia and loss of capillaries
congenital (shunts) or acquired heart disease (MS)
recurrent tromboemboli (obstruction causes increase in PVR)
connective tissue disease (systemic sclerosis)
obstructive sleep apnea (with obesity_
idiopathic PAH

Question 19

What gene is connected to familial pulmonary arterial hypertension? What is its inheritance pattern?

Answer 19

BMPR 2: bone morphogenic protein receptor type 2, lack of signaling by this receptor causes an increase in proliferation and a decrease in apoptosis of endothelial cells (“gate keeper” of # endothelial cells)

AD with 10-20% entrance, follows two-hit hypothesis

Question 20

What morphological changes occur in response to pulmonary hypertension?

Answer 20

increase atherosclerotic plaques, and medial hypertrophy (smooth muscle proliferation causing onion like pattern)

plexiform lesions: proliferation of SM form multiple channels within the capillary

Question 21

Pulmonary edema can be divided into types based on their etiology, what are those two types?

Answer 21

Hemodyanmic (increased hydrostatic pressure-CHF; decreased oncotic pressure- protein loss)

microvascular injury (increased vascular permeability due to injury, infection, sepsis, trauma, shock and drugs)

Question 22

What is pulmonary alveolar proteinosis? What causes it?

Answer 22

granular precipitate of surfactant that can fill alveoli; it is most often caused by a anti GM-CSF antibody (autoimmune) and secondarily by hemopoietic disease or malignancy

Question 23

How are ALI, ARDS and DAD related?

Answer 23

acute lung injury: hypoxemia and infiltrates without heart failure

acute respiratory distress syndrome: severe hypoxema and infiltrates without heart failure

diffuse alveolar damage: histologic manifestations of ALI and ARDS characterized by hyaline membranes that impair gas exchange and consist of fibrin rich edema and cytoplasmic and lipid remnants of necrotic cells

Question 24

What are the reproducible phases of DAD?

Answer 24

exudative, transition, proliferative, fibrotic

Question 25

Goodpasture syndrome is an autoimmunity disease that occurs against type ____ collagen in the basement membrane which is damaged in a type ___ reaction.

Answer 25

antibody against type IV collagen in the basement membrane, damage due to type II reaction

note death commonly mediated by uremia in renal failure and tx. includes plasmapheresis to remove antibody (linear pattern of antibody deposition)

Question 26

What systems does Wegener Granulomatosis effect?

Answer 26

necrotizing granulomatous vascultitis involves the airways (upper and lower) and the kidneys and is mediated by cANCA (anti protenase-3) in 95% of patients causing granulomas and vasculitis