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Respiratory Medicine > Pathology slide set 4 > Flashcards

Pathology slide set 4 Flashcards

1
Q

What are the two types of malignant mesothelioma

A

epithelioid type and sarcomatoid type

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2
Q

What cancers are more often at peripheral lung

A

adenocarcinoma

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3
Q

location of carcinoid

A

either central or peripheral

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4
Q

This is related to heavy asbestos exposure and much more frequent in males

A

peritoneal mesothelioma

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5
Q

IV drugs users and S. aureus

A

endocarditis

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6
Q

complications of lung transplantation

A
  • accelerated pulmonary arteriosclerosis

- EBV-associated B cell lymphoma

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7
Q

immunostains for chromogranin, synaptophysin, and CD57+

A

Small cell carcinoma

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8
Q

Postpneumonic abscesses are usually associated with what organisms?

A
  • S. aureus
  • K. pneumonia
  • Type 3 pneumoncocci
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9
Q

IHC shows serotonin, neuron-specific enolase, bombesin, calcitonin,

A

Carcinoid tumor

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10
Q

TSC2 mutation for tuberin and negative regulator of mTOR

A

lymphangioleiomyomatosis

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11
Q

majority express thyroid transcription factor-1

A

adenocarcinoma

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12
Q

gender and age for inflammatory myofibroblastic tumor

A

M=F

more common in children

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13
Q

erythema nodosum and erythemia multiforme (the San Joaquin Valley fever complex

A

Cocci

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14
Q

What broad category of organism is more common in Aspiration pneumonia

A

Aerobes

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15
Q

HIV <50

A
  • CMV
  • fungal
  • mcyobacterium avium
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16
Q

hemaglutinin attaches the virus to its cellular target via what residues

A

sialic acid

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17
Q

What mutation is especially grim

A

KRAS in adenocarcinoma

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18
Q

5 year survival for Atypical carcinoids?

A

70%

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19
Q

what organ does lung cancer spread to most often?

A

adrenal glands

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20
Q

single, round well defined usually peripheral mass with cacium deposits. grayish white. spindle shaped fibroblasts and myofibroblasts, lymphocytes, plasma cells and peripheral fibrosis

A

inflammatory myofibroblastic tumor

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21
Q

morphology of chronic infection

A

bronchiolitis obliterans

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22
Q

EGFR, ALK, ROS, MET, RET

A

adenocarcinoma

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23
Q

Loss of RB

A

Small cell carcinoma

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24
Q

Most lung cancers spread early throughout the body EXCEPT this one which spreads outside the thorax late

A

Squamous cell carcinoma

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25
Q

4 cancers arising from bronchial neuroendocrine cells

A
  • Carcinoids
  • tumorlets
  • Small cell carcinoma
  • large cell carcinoma
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26
Q

whwhat is the diagnostic method for MPV

A

PCR for viral RNA and direct immunoflurescence

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27
Q

describe the reaction to inhales Cocci

A

delayed type hypersensitivity

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28
Q

What bacteria often secondarily infects with influenza viral pneumonia and can be life threatening?

A

S. aureus

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29
Q

which carcinoid is more likely to invade lymphatic vessels?

A

atypical

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30
Q

polymorphisms in this increases capacity to active procarcinogens leading to greater risk for lung cancer

A

P-450

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31
Q

Activating rearrangement in ALK gene on chromosome 2

A

inflammatory myofibroblastic tumor

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32
Q

What is the only definite treatment available for lymphangioleiomyomatosis

A

transplant

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33
Q

important cause of SECONDARY bacterial pneumonia in children and healthy adults following a viral respiratory illness (measles in children and influenza in both children and adults)

A

S. Aures

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34
Q

“salt and pepper pattern”

A

Small cell carcinoma

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35
Q

What do macrophages secrete in response to histo

A

TNF

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36
Q

shared genetic features of small cell carcinoma and squamous cell carcinoma

A

-loss of function mutations of TP53, RB, and deletion of 3p

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37
Q

Southwestern U.S.

A

cocci

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38
Q

Tree bark appearance

A

resolution of HISTO infection

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39
Q

Cause of bacterial pneumonia especially in ELDERLY and also second most common cause of bacterial exacerbation of COPD

A

Moraxella catarrhalis

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40
Q

multiple discrete nodules (CANNONBALL LESIONS) scattered throughout all lobes but more at PERIPHERY

A

metastasis

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41
Q

What is used for rapid diagnosis of legionella infection

A

Legionella antigens in urine

or positive fluorescent antibody test on sputum

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42
Q

if no cause can be found for an abscess what is it called

A

primary cryptogenic lung abscess

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43
Q

What predisposes someone with a viral pneumonia to getting a superimposed bacterial infection

A

impairment of mucociliary clearance

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44
Q

What tumors predominantly produce hypercalcemia

A

Squamous cell carcinoma

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45
Q

P63 and p40

A

squamous cell carcinoma

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46
Q

2 types of carcinoid tumor

A

Typical and Atypical (more agressive)

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47
Q

is the risk for malignant mesothelioma compounded by smoking?

A

NO

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48
Q

What biomarkers can be used to distinguish a bacterial from a viral pneumonia?

A

CRP and procalcitonin

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49
Q

4 stages of lobar pneumonia

A
  • congestion
  • red hepatization
  • grey hepatization
  • resolution
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50
Q

pulmonary disorder that primarily affects young woman of childbearing age characterized by proliferation of perivascular epithelioid cells taht express markers of both melanocytes and smooth muscle cells

A

Lymphangioleiomyomatosis

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51
Q

TTF-1 and napsin A

A

Adenocarcinoma

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52
Q

which cancer has strongest association with smoking

A

small cell carcinoma

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53
Q

HIV < 200

A

Pneumocystis pneumonia

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54
Q

intermittent attacks of diarrhea, flushing, and cyanosis

A

carcinoid syndrome

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55
Q

NAB2 and STAT6

A

solitary fibrous tumor

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56
Q

These tend to spread aerogenously, forming satellite tumors

A

mucinous adenocarcinoma

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57
Q

Gender preference for smoking carcinogens

A

females

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58
Q

What stain is used for fungi?

A

silver stain

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59
Q

What is the most common complication of a transplant in the first few weeks after

A

bacterial infection

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60
Q

Who is at high risk for disseminated Cocci disease

A
  • Filipinos
  • African American
  • immunosuppressed
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61
Q

The change that occurs in lymphangioleiomyomatosis is similar to what pulmonary disease

A

emphysema

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62
Q

secretion of parathormone related protein, a cause of paraneoplastic hypercalcemia

A

Small cell carcinoma

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63
Q

Collar-Button lesion

A

Carcinoid tumor

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64
Q

This type of pneumonia is often necrotizing, pursues a fulminant clinical course and is a frequent cause of death?

A

Aspiration pneumonia

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65
Q

whorls of reticulin and collagen fibers interspersed with spindle cells

A

solitary fibrous tumor

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66
Q

deletion of CDKN2A/INK4a

A

malignant mesothelioma

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67
Q

Most often a localized lesion in immunocompetent patient. Typically granulomatous and caused by M. tuberculosis or fungi (histoplasma capsulatum)

A

chronic pneumonia

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68
Q

The innate immune system induces release of what in response to influenza viral infection

A

alpha and beta interferon

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69
Q

What are the most commonly isolated organisms that cause lung Abscess

A
  • Aerobic and anaerobic strep
  • Staph. aureus
  • host of gram negatives
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70
Q

soft-tissue tumor attached to pleural surface by a pedicle

A

solitary fibrous tumors

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71
Q

1 year survival for malignant mesothelioma

A

approximately 50%. most die within 2 years

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72
Q

precursor to the development of multiple tumorlets and typical or atypical carcinoids

A

diffuse idiopathic pulmonary neuroendocrine cell hyperplasia

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73
Q

What do helper T cell secrete in response to Histo

A

IFN-gamma

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74
Q

IHC showed high levels of anti-apoptotic protein BCL2

A

Small cell carcinoma

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75
Q

This viral protein binds to respiratory epithelial cells, allowing cellular infection

A

Hemagglutinin

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76
Q

This viral protein allows release of newly-created virions

A

Neuraminidase

77
Q

Giant cells containing large sperules with endospores

A

Cocci

78
Q

KRAS

A

adenocarcinoma

79
Q

where do central carcinoid tumors protrude

A

into bronchial lumen

80
Q

Germline mutations in what gene that is an adaptor for TLRs and important for activation of NFkappaB are associated with destructive bacterial pneumococcal pneumonias

A

MyD88

81
Q

Most common Gram negative bacterial pneumonia

A

Klebsiella

82
Q

What 3 things does influenza virus infectiong the respiratory epithelium cause?

A
  • intraalveolar fluid accumulation
  • cell death
  • inflammation
83
Q

small, poorly formed nonnecrotizing granulomas with multinucleated foreign body giant cell reaction that iss inconsequential and especially in those with gastroesophageal reflux

A

microaspiration

84
Q

likely gender and cancer for NON smoker

A

women

adenocarcinoma

85
Q

important cause of PEDIATRIC bacterial pneumonia, and otitis media

A

H. influenzae (nonencapsulated)

86
Q

cryptic inversion of chromosome 12

A

solitary fibrous tumor

87
Q

CDKN2A and TP53 mutations

A

Squamous cell carcinoma

88
Q

What stage of lobar pnuemonia: robust exudate with neutrophils, erythrocytes, fibrin fill alveolar space

Red, firm, airless

A

red hepatization

89
Q

amplification of MYC

A

Small cell carcinoma

90
Q

What lobes are most frequently affected with blasto

A

upper

91
Q

relation of asbestos exposure with a solitary fibrous tumor

A

NONE

92
Q

Marked by gain of function mutations involving growth factor receptor pathways

A

adenocarcinoma

93
Q
  • little cytoplasm
  • closely arranged nuclei with “molding”
  • clusters
  • may have marked necrosis
A

small cell carcinoma

94
Q

Cough, fever, and copious amounts of foul-smelling purulent or sanguinous sputum. Fever, chest pain, and weight loss. clubbing of finger and toes may appear with a few weeks

A

lung abscess

95
Q

Factors that favor extension of a viral infection from upper respiratory tract to lower causing pneumonia?

A
  • extremes of age
  • malnutrition
  • alcoholism
  • underlying debilitating illnesses
96
Q

can be patchy or may involve whole lobe and bilateral or unilateral and the affected area is RED-BLUE and congested

A

Viral pnuemonia

97
Q

Abrupt onset of high fever, shaking chills, and cough producing mucopurulent (rust colored) sputum. occasional hemoptysis

A

community acquired pneumonia

98
Q

how does a Blast infection resolve

A

spontanously

99
Q

characterized by presence of keratinization and/or intercellular bridges.

A

Squamous cell carcinoma

100
Q

Pneudomonas most commonly causes what type of infection

A

hospital acquired

101
Q

What causes carcinoid syndrome?

A

tumor cells secreting vasoactive amines (serotonin)

102
Q

Thick, mucoid, (often blood-tinged) sputum is characteristic of this infection

A

klebsiella

103
Q

infection of what may follow a viral respiratory infection, and is a pediatric emergency and has high mortality rate

A

H. influenzae

104
Q

Cancers in nonsmokers are more likely to have what mutations and almost never have what mutation

A

EGFR

KRAS

105
Q

What are the most common organisms that cause health care associated pneumonia

A
  • methicillin-resistant Staph. Aureus

- P. aeruginosa

106
Q

muscle weakness caused by auto antibodies (possibly elicited by tumor ionic channels) directed to the neuronal calcium channel; peripheral sensory neuropathy; dermatologic abnormalities, including acanthosis nigricans; hematologic abnormalities such as leukemoid reactions; trousseau syndrome; and hypertrophic pulmonary osteoarthrophathy associated with clubbing of the fingers

A

Lambert-Eaton myasthenic syndrome

107
Q

What cells does histo target

A

macrophages

108
Q

losses in chromosome 3, 9, and 17

A

Squamous cell carcinoma

109
Q

-Enophthalmos
-ptosis
-miosis
-anhidrosis on same side of lesion
and pain in ulnar nerve distribution

A

Pancoast tumor

110
Q

Antigenic drift

A

EPIdemic . . spontaneous mutations

111
Q

may occur in patients with multiple endocrine neoplasia type 1

A

carcinoids

112
Q

What do bacterial infections often follow?

A

upper respiratory viral infection

113
Q

What virus is most commonly seen in young children, elderly, and immunocompromised

A

Human metapneumovirus (MPV)

114
Q

Peak incidence for lung carcinomas

A

50s-60s

115
Q

Gram positive, slightly elongated diplococci

A

Strep Pneumo

116
Q

deletion of 9p

A

malignant mesothelioma

117
Q

This infection occurs in Cystic fibrosis patients and immunocompromised and in neutropenic patients. Also invades blood vessels (hematogenous spread)

A

pseudomonas

118
Q

What stage of lobar pneumonia: organizing fibrosis admixed with macrophages

A

resolution

119
Q

CD34+ and keratin-negative

A

solitary fibrous tumor

120
Q

What stage of lobar pneumonia: vascular engorgement, cell-poor intra-alveolar fluid with numerous bacteria and few neutrophils

Heavy, boggy, red

A

congestion

121
Q

describe malignancy of carcinoid tumor

A

low grade

122
Q

progression of malignant mesothelioma

A

long latent period of 25-45 years

123
Q

when bilateral chronic infection is present from cystic fibrosis or bronchiectasis what do you do with the transplant?

A

both lungs must be replaces

124
Q

Most common cause of bacterial acute exacerbation of COPD?

A

Haemophilus influenzae

125
Q

most common causes are hospital acquired

A

Gram + cocci (mainly S. aureus and S. pneumo)

Gram - rods (enterobacteriacea and Pseudomonas)+

126
Q

p53 overexpression

A

Squamous cell carcinoma

127
Q

In those who survive Aspiration Pneumonia, What is a common complication?

A

Lung abscess

128
Q

Do granulomas occur in fulminant disseminated histoplasmosis which occurs in immunosuppressed

A

NO

129
Q

Well developed lesion are slightly elevated, dry, granular, gray-red to yellow and poorly delimited at their margins,

Histologically: neutrophil-rich exudate that fills bronchi, bronchioles, and adjacent alveolar spaces

A

Bronchopneumonia

130
Q

What indivivuals are at special risk for postpneumonic pneumonia?

A

immunosuppressed or post transplant

131
Q

Strong positivity for keratin proteins, calretinin, WT-1, cytokeratin 5/6, and D2-40

A

malignant mesothelioma

132
Q

how do you histologically differentiate Histo from TB, sarcoidosis, and Cocci

A

3-5 micrometer thin walled yeast forms

133
Q

Morphology of acute rejection

A

inflammatory infiltrates either around small vessels, in submucosa of airways or both

134
Q

What is the only chronic pneumonia causing fungi that gives headaches

A

Blasto

135
Q

What conditions predispose to legionella infection?

A
  • cardiac, renal, immunologic, or hematologic disease

- Organ transplant recipients are particularly susceptible

136
Q

most common form of lung cancer in women

A

adenocarcinoma

137
Q

Common viruses that cause community acquired pneumonia?

A
  • influenza type A and B
  • RSV
  • human metapneumovirus
  • adenovirus
  • rhinovirus
  • rubeola
  • varicella
138
Q

Where does legionella flourish

A

water tanks, pipes

139
Q

What are the 3 complications of pneumonia?

A
  • Abscess formation (type 3 pneumococci and klebsiella)
  • spread of infection to pleural cavity (empyema)
  • Bacteremic dessemination
140
Q

what enzyme system converts chemicals into carcinogens

A

P-450 monooxygenase

141
Q

epidemiology of squamous cell carcinoma

A

males

-strong association with smoking

142
Q
  • double wall
  • visible nucleus
  • 5-15micrometers
  • Granulomas with NEUTROPHILS
  • BROAD BASED BUDDING
A

Blasto

143
Q

When are antibodies against histo formed

A

2-6 weeks after infection

144
Q

p16 loss

A

Squamous cell carcinoma

145
Q

What causes pontiac fever, a self-limited URI

A

Legionella

146
Q
  • Intracellular Fungi
  • Midwest
  • Bird/bat dropping
A

Histoplasmosis

147
Q

hyperplasia of the lymphiod tissue within the Waldeyer ring frequently in children

A

virus-induced tonsillitis

148
Q

at periphery there is often lepidic pattern of spread in which the tumor cells “crawl” along normal appearing alveolar septa

A

Adenocarcinoma

149
Q

lobes for bronchopneumis?

bilateral?

A

lower lobes more often

bilateral

150
Q

S. aureus is associated with a high incidence of complication such as what?

A
  • Lung abscess

- empyema

151
Q

Shortly after an influenza virus enter into pneumocytes, it inhibits what channel?

A

sodium channelss

152
Q

central or southeaster U.S. SOIL dwelling

-Also Canada, mexico, middle east, Africa, and India

A

Blasto

153
Q

most virulent form of H. influenza

A

encapsulated type b

154
Q

predominant histologic pattern of viral pneumonia

A

interstitial inflammatory reaction involving the walls of the alveoli

155
Q

What are predisposing factors to CAP bacterial

A
  • Age: young or old
  • chronic disease: COPD, diabetes, CHF
  • Absent splenic function
156
Q

ORGANOID nests, trabecular, pallisading, ribbon, or rosette-like arrangements of cells separated by a delicate fibrovascular stroma

A

carcinoid tumor

157
Q

Where can histoplasmosis spread

A

liver, adrenals, mediastinum, meninges

158
Q

What are the two influenza viral proteins?

A

Hemagglutinin and neuraminidase

159
Q

What do apical lung cancers in the superior pulmonary sulcus tend to invade?

A

neural structure around the trachea

  • Cervical sympathetic plexus
  • Horner syndrome
  • Sever pain in distribution of ulnar nerve
160
Q

affected lung becomes ensheathed by thick layer of soft, gelatinous, grayish pink tumor tissue

A

malignant melothelioma

161
Q

What happens do histoplasmosis in an immunocompromised patient

A

wide dissemination

162
Q

edema to head and arm

A

superior vena cava syndrome

163
Q

What does an absent spleen predispose infection of?

A

encapsulated bacterial like pneumococcus

164
Q

commonly afflicts debilitate and malnourished people, particularly chronic alcoholics

A

klebsiella

165
Q

What patients are at particularly high risk of getting hospital-acquired pneumonia

A

patients on mechanical ventilation

166
Q

likely arise from neuroendocrine cells in the bronchial epithelium

A

small cell carcinoma

167
Q

Chronic, progressive, secondary lung disease which is localized to the lung apices and causes cough, fever, and night sweats

A

Histoplasmosis

168
Q

What is the most common cause of acute CAP?

A

Strep. Pneumo

169
Q

describe the progression of lymphangioleiomyomatosis

A

slowly progressive over a period of several decades

170
Q

complications of a lung abscess

A
  • extension of infection into pleural cavity
  • hemorrhage
  • development of brain abscesses or meningitis from septic emboli
  • Rarely secondary amyloidosis
171
Q

What tumors predominantly produce ACTH and ADH

A

Small cell carcinomas

172
Q

5 year survival for typical carcinoids?

A

95%

173
Q

if abscess is discovered in an older individual, you must rule out underlying what?

A

carcinoma

174
Q

What stage of lobar pneumonia: fibrinosuppurative material, erythrocyte disintegration, early organization

A

grey hepatization

175
Q

alpha and beta interferon upregulate what gene in response to influenza viral pneumonia

A

MX1 gene

176
Q
  • Coin lesion

- nodules of connective tissue (CARTILAGE) intersected by epithelial clefts

A

hamartoma

177
Q

CAP common among children and young adults.

local epidemics (schools, military camps, prisons)

Low level walking pneumo. persistent dry cough that won’t go away

A

Mycoplasma pneumo.

178
Q

highly malignant and agressive

A

Small cell carcinoma

179
Q

What anaerobic organisms that are normally found in the oral cavity can cause abscess

A
  • Bacteroides
  • Fusobacterium
  • Peptococcus
180
Q

3 most common causes of otitis media in children

A
  • S. pneumoniae
  • H. influenzae
  • M. catarrhalis
181
Q

worrisome epithelial changes with smoking

A

basal cell hyperplasia->squamous metaplasia –> squamous dysplasia –> carcinoma in situ

182
Q

Distant spread of lung carcinoma occur through what?

A

both lymphatic and hematogenous spread

183
Q

What is the only antiviral treatment available for human MPV

A

Ribavirin

184
Q

location of squamous cell carcinoma

A

central lung/hilar region

185
Q

Antigenic shift

A

PANdemic . . coinfection of different types of influenza virus

186
Q

Gender and age for carcinoid tumor

A

M=F

less than 40

187
Q

HIV >200

A

Tubercular infection

188
Q

Self limited and often latent primary pulmonary involvment which may result in COIN LESIONS on chest radiography

A

Histoplasmosis

Respiratory Medicine (37 decks)

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