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MQW U4 > Pathoma 7, 8, 9 > Flashcards

Pathoma 7, 8, 9 Flashcards

1
Q

What are the 3 layers of arterial walls and what are they made of?

A
  1. Intima – endothelium
  2. Media – smooth muscle
  3. Adventitia – connective tissue
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2
Q

50+ Female w/: headaches, visual disturbances, jaw claudication. Labs: elevated ESR. Biopsy: inflamed vessel walls.

What disease?

A

Giant Cell Arteritis (aka. GCA, Temporal arteritis) – Large-vessel

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3
Q

Presents: Giant Cell Arteritis symptoms + flu-like symptoms w/ joint and muscle pain

What disease that is often associated with GCA?

A

Polymyalgia Rheumatica

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4
Q

Biopsy of a branch of external carotid: inflamed vessel wall w/ giant cells and intimal fibrosis

What disease?

A

Giant Cell Arteritis (aka. GCA, Temporal arteritis) – Large-vessel vasculitis

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5
Q

Under 50 y/o Asian female w/: visual and neurologic symptoms, weak/absent pulse in upper extremities. Labs: elevated ESR.

What disease?

A

Takayasu Arteritis – Large-vessel vasculitis

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6
Q

Young adult w/: HTN, abdominal pain w/ melena (black tarry feces), neurologic disturbances, and skin lesions. Blood vessel histo: transmural inflammation w/ fibrinoid necrosis, ‘string-of-pearls’ appearance

What disease?

A

Polyarteritis Nodosa – Medium-vessel vasculitis

HTN= renal artery involvment
Abdn pain w/ melena= mesenteric artery involvement

  • -Necrotizing vasculitis of multiple organs; SPARES LUNGS
  • -Fatal if not treated
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7
Q

Which vasculitis’ treatment includes cyclophosphamide?

A 
Polyarteritis Nodosa
Wegener Granulomatosis (Granulomatosis w/ Polyangiitis)
Microscopic Polyangiitis
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8
Q

2 y/o Asian child w/: fever, conjunctivitis, erythematous rash of palms and soles, enlarged cervical lymph nodes.

What disease?
Treatment?

A

Kawasaki Disease – Medium-vessel vasculitis

–Treat w/ Aspirin, IVIG; self limited

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9
Q

Patient is a heavy smoker w/: Raynaud phenomenon, ulceration, gangrene and autoamputation of fingers and toes.

What disease?
Treatment?

A

Beurger Disease – Medium-vessel vasculitis

–Treatment: smoking cessation

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10
Q

Middle aged male w/: sinusitis, nasopharyngeal ulceration, saddle-nose, hemoptysis, hematuria. CXR: bilateral nodular lung infiltrates. Lab: c-ANCA. Biopsy: necrotizing granulomas, adjacent necrotizing vasculitis.

What disease?

A

Granulomatosis w/ Polyangiitis (Wegener) – Small-vessel vasculitis

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11
Q

Middle aged male w/: hemoptysis, hematuria. CXR: bilateral nodular lung infiltrates. Labs: p-ANCA. Biopsy: no granulomas.

What disease?

A

Microscopic Polyangiitis – Small-vessel vasculitis

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12
Q

Asthmatic patient w/: necrotizing granulomas in lungs. Labs: eosinophilia, p-ANCA.

What disease?

A

Churg-Strauss Syndrome – Small-vessel vasculitis

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13
Q

Pediatric patient w/: recent Hx of URI, GI pain and bleeding, hematuria, palpable purpura on buttocks and legs. Previous episode of symptoms resolved by itself.

What disease?

A

Henoch-Schönlein Purpura – Small-vessel vasculitis

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14
Q

What is the developmental defect of blood vessel wall that causes 2ndary HTN in young females?
What mechanism?
Where does it affect?

A
    • Fibromuscular dysplasia
    • Irregular thickening of large- and medium-sized arteries
    • Renal artery
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15
Q

Systemic HTN: over ___mm/Hg

Malignant HTN: over ___mm/Hg

A
    • 140/90

- - 180/120

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16
Q

It consists of a lipid core (mostly cholesterol) w/ a fibromuscular cap, and undergoes dystrophic calcification.

What is it?

A

Intimal plaque – Atherosclerosis

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17
Q

What are some common large- and medium-sized arteries affected by Atherosclerosis?

A
    • Abdominal aorta
    • Coronary artery
    • Popliteal artery
    • Internal carotid artery
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18
Q

Lipid oxidation and subsequent consumption by macrophages via scavenger receptors results in formation of ___

A

Foam cells

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19
Q

Which type of arteriolosclerosis is a consequence of:

  • -malignant HTN?
  • -Diabetes?
  • -benign HTN?
A

– Hyaline arteriolosclerosis – long-standing benign HTN, Diabetes

– Hyperplastic arteriolosclerosis – malignant HTN

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20
Q

Which type of arteriolosclerosis results in:

  • -Acute renal failure?
  • -Glomerular scarring (arteriolonephrosclerosis)?
  • -Chronic renal failure?
  • -End-organ ischemia?
A
  • -Acute renal failure – Hyperplastic
  • -Arteriolonephrosclerosis – Hyaline
  • -Chronic renal failure – Hyaline
  • -End-organ ischemia – Both
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21
Q

In Microscopy, which type of arteriolosclerosis has:

    • “flea-bitten appearance”
    • Pink proteins
    • “onion-skin appearance”
A
    • “flea-bitten appearance” – Hyperplastic
    • Pink proteins – Hyaline (pink hyaline proteins)
    • “onion-skin appearance” – Hyperplastic
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22
Q

What is calcification of the media of muscular (medium-sized) arteries?

A

Mönckeberg Medial Calcific Sclerosis

    • Not clinically significant
    • Incidental finding on x-ray or mammography
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23
Q

What 2 diseases commonly cause weakness of connective tissue in the media (called ___) in younger individuals that leads to Aortic Dissection?

A

– Marfan syndrome, Ehlers-Danlos syndrome

– Cystic medial necrosis = weakness of connective tissue in the media

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24
Q

Old patient w/ HTN has acute sharp, tearing chest pain radiating to the back.

What is it?

A

Aortic Dissection

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25
Q

What are the 3 most common complications of Aortic Dissection?

A
  1. Pericardial Tamponade (most common cause of death)
  2. Rupture w/ fatal hemorrhage
  3. Obstruction of branching arteries (coronary, renal) –> end-organ ischemia
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26
Q

Patient w/: Aortic valve insufficiency, and difficulty swallowing. Microscopy: ‘tree-bark’ appearance of aorta. Dark field microscopy: spirochetes.

What is it?

A

Thoracic Aortic Aneurysm

  • -Classically seen in Tertiary Syphilis
  • -Endarteritis of vasa vasorum –> luminal narrowing, decreased flow, atrophy of vessel wall
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27
Q

60+ y/o male smoker w/: HTN, enlarging midline pulsatile abdominal mass.

What is it?

A

Abdominal Aortic Aneurysm

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28
Q

60+ y/o male w/ 6cm dilation in abdominal aorta 1 hour ago now has triad of: Hypotension, Pulsatile abdominal mass, and flank pain.

What is it?

A

Ruptured Abdominal Aortic Aneurysm

    • Triad: Hypotension, Pulsatile abdominal mass, Flank pain
    • Major complication of aneurysm, esp. after 5+cm diameter
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29
Q

What is associated w/ exposure to polyvinyl chloride, arsenic, and Throtrast?

A

Liver angiosarcoma

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30
Q

Between what 2 locations does Abdominal Aortic Aneurysm usually arise?

A
    • Below renal arteries

- - Above aortic bifurcation

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31
Q

What vascular tumor is commonly present at birth, and regresses during childhood?
What does it usually involve?

A
    • Hemangioma = benign tumor of blood vessels

- - Skin and liver

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32
Q

What is highly aggressive malignant proliferation of blood vessel endothelia cells?
Common sites?

A
    • Angiosarcoma

- - Skin, breast, liver

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33
Q

A former Eastern European soldier w/ AIDS recently had a liver transplant and now presents w/ purple patches, plaques, and nodules on the skin. Labs: anti-HHV8 antibody.

What is it?

A

Kaposi Sarcoma

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34
Q

What’s more common? [Primary/Secondary] HTN.

A

Primary HTN = 95% of cases; unknown etiology

Secondary HTN = 5% of cases; identifiable etiology

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35
Q

What are 2 ways Angiotensin II raises BP?

A
  1. Contract arteriolar smooth muscle

2. Promote adrenal release of Aldosterone

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36
Q

EKG finding in Subendocardial vs. Transmural ischemia:

A
    • Subendocardial = ST-depression

- - Transmural = ST-elevation

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37
Q

EKG finding in:

  1. Stable Angina
  2. Unstable Angina
  3. Prinzmetal Angina
A
  1. Stable Angina = ST-depression (subendocardial)
  2. Unstable Angina = ST-depression (subendocardial)
  3. Prinzmetal Angina = ST-elevation (transmural)
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38
Q

Myocardial Infarction most common:

  • -Chamber involved?
  • -Vessel involved?
  • -2nd most common vessel?
A
  • -Left Ventricle
  • -Left Anterior Descending (LAD)
  • -Right Coronary Artery (RCA)
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39
Q

MI involving this vessel –> anterior wall, anterior septum of LV infarction

A

LAD

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40
Q

MI involving this vessel –> posterior wall, posterior septum, LV papillary muscle infarction

A

RCA

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41
Q

MI involving this vessel –> lateral wall of LV

A

Left Circumflex Artery

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42
Q

Troponin I vs. CK-MB

  1. Which rises earlier?
  2. Which peaks faster?
  3. Which normalizes faster?
A
  1. Troponin (2-4hrs) faster than CK-MB (4-6hrs)
  2. Same (24h) for both
  3. CK-MB (72h) faster than Troponin (7-10days)
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43
Q

Initial phase of MI has what EKG finding? Why?

A

ST-depression b/c subendocardial necrosis

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44
Q

Reperfusion of irreversibly-damaged cells resulting in calcium influx leads to what?

A

Hypercontraction of myofibrils –> contraction band necrosis

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45
Q

What is reperfusion injury?

A

Return of oxygen and inflammatory cells –> free radical generation –> further myocyte damage

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46
Q

What is the usual immediate cause of sudden cardiac death?

A

Fatal ventricular arrhythmia

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47
Q

Definition of Sudden Cardiac Death

A
  • -Unexpected death due to cardiac disease
  • -Occurs w/o symptoms
  • -Or less than 1hr after symptoms arise
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48
Q

What is Cor Pulmonale?

A

–Right ventricle enlargment and failure

–Due to increase pulm. vascular resistance or pulm. HTN

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49
Q

Microscopic finding of ‘Heart-failure’ cells:

A

Hemosiderin-laden macrophages

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50
Q

What is the most common cause of Right Heart Failure?

A

Left heart failure

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51
Q

What is it called when a left-to-right shunt increases right heart pressure to cause a reversal of flow creating a right-to-left shunt?

A

Eisenmenger Syndrome

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52
Q

What 4 common symptoms do you see in Eisenmenger syndrome?

A
  1. Late cyanosis (not as a baby)
  2. Right ventricular hypertrophy
  3. Polycythemia
  4. Nail clubbing
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53
Q

What direction of shunting presents as cyanosis shortly after birth?

A

Right-to-left shunt

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54
Q

What is the most common congenital heart defect that is also associated w/ fetal alcohol syndrome?

A

Ventricular Septal Defect (VSD)

–left-to-right shunt

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55
Q

What kind of congenital heart defect is associated w/ Down Syndrome?

A

Ostium primum type of Atrial Septal Defect (ASD)

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56
Q

What kind of congenital heart defect is associated w/ congenital Rubella?

A

Patent Ductus Arteriosus (PDA)

57
Q

What congenital heart defect has a split S2 on auscultation (increased blood in right heart that delays closure of pulmonary valve)

A

Atrial Septal Defect (ASD)

58
Q

What congenital heart defect has a ‘machine-like’ murmur?

A

Patent Ductus Arteriosus (PDA)

59
Q

How does Indomethacin treat Patent Ductus Ateriorsus (PDA)?

A
  • -Decreases Prostaglandin E1

- -Prostaglandin E1 maintains patency of ductus arteriosus

60
Q

What is Tetralogy of Fallot?

A
  1. Stenosis of right ventricular outflow tract
  2. Right ventricular hypertrophy
  3. Ventricular Septal Defect (VSD)
  4. Aorta that overrides VSD
61
Q

What congenital heart defect is associated with maternal diabetes?

A

Transposition of the Great Vessels

62
Q

What congenital heart defect has a ‘boot-shaped’ heart on X-ray?

A

Tetralogy of Fallot

63
Q

Infant patient w/ Turner syndrome has lower extremity cyanosis.
What congenital heart defect?
What is it associated with?

A

Coarctation of the Aortal (Infantile form)

  • -Associated w/ PDA
  • -Occurs distal to arch, but proximal to PDA
64
Q

What is it called when the tricuspid valve fails to develop and the right ventricle is hypoplastic?
What is often associated?

A

–Tricuspid atresia

–ASD –> right-to-left shunt –> early cyanosis

65
Q

Adult patient presents w/ upper extremity HTN, lower extremity Hypotension, and weak pulses. CXR: ‘notching’ of ribs due to engorged arteries.
What congenital heart defect?
What is it associated with?

A
  • -Coarctation of the Aorta (Adult form)

- -Associated w/ Bicuspid aortic valve

66
Q

What is bacterial M protein resembling human tissue protein called?

A

Molecular mimicry

67
Q

What are the 5 Major Jones criteria of Acute Rheumatic Fever?

A
  1. Migratory polyarthritis
  2. Pancarditis (endocarditis, myocarditis, pericarditis)
  3. Subcutaneous nodules
  4. Erythema marginatum
  5. Sydenham chorea
68
Q

What are reactive histiocytes w/ slender, wavy nuclei called?
When and where are they seen?

A

–Anitschkow cells

–In Aschoff bodies in myocardium in rheumatic heart disease

69
Q

This thing, found in the myocardium, is characterized by foci of chronic inflammation, reactive histiocytes w/ slender, wavy nuclei, giant cells, and fibrinoid material.

What is it?

A

Aschoff bodies found in myocardium of rheumatic heart disease

70
Q

Patient develops an annular, nonpruritic rash with erythematous borders involving the trunk and limbs after a recent URI.
What is it, specifically?
What condition is is a part of?

A
  • -Erythema marginatum

- -Acute Rheumatic Fever

71
Q

What prior infection causes Acute Rheumatic Fever?

A
  • -Pharyngitis
  • -Group A B-hemolytic streptococci (Strep. pyogenes)
  • -2-3wks after
  • -
72
Q

Patient develops swelling and pain that moves between wrists, knees, and ankles that resolves by itself after a recent URI.
What is it, specifically?
What condition is is a part of?

A
  • -Migratory polyarthritis

- -Acute Rheumatic Fever

73
Q

Patient develops infectious endocarditis and dies. Biopsy shows ‘fish-mouth’ appearance of mitral valve w/ thickening of chordae tendineae and valve cusps. Aortic valve commissures are fused.
What is it?

A

Chronic Rheumatic Heart Disease

  • -Almost always mitral valve
  • -Occasional aortic valve –> commissure fusion
74
Q

60+ y/o patient w/ bicuspid aortic valve has a systolic ejection click followed by a crescendo-decrescendo murmur on auscultation.
What is it?

A

Aortic Stenosis

75
Q

What are 3 complications of Aortic Stenosis?

A
  1. Concentric LVH
  2. Microangiopathic hemolytic anemia – calcified valve damages RBCs
  3. Angina and syncope w/ exercise – insufficient perfusion of myocardium and brain
76
Q

Patient has a bounding (water-hammer) pulse and head bobbing. Exam: pulsating nail bed (Quincke pulse), early, blowing diastolic murmur, BP 140/65. Echo: LV dilation, and eccentric cardiac hypertrophy.
What is it?

A

Aortic Regurgitation

–Characteristic: Increased pulse pressure, eccentric hypertrophy

77
Q

What is cardiac muscle mass in concentric vs. eccentric hypertrophy?

A
  • -Concentric = high muscle mass, normal volume

- -Eccentric = normal muscle mass, high volume

78
Q

Water-hammer pulse and Quincke pulse are seen in what disease?

A

Aortic regurgitation

  • -water-hammer = bounding pulse
  • -Quincke = pulsating nail bed
79
Q

What causes high Pulse Pressure in Aortic Regurgitation?

A
  • -Systolic pressure increase = increased stroke volume

- -Diastolic pressure decrease = regurgitation

80
Q

Patient with either Marfan or Ehlers-Danlos syndrome (who knows) has a mid-systolic click and a late systolic murmur. Click and murmur become softer when squatting. Somehow he dies and biopsy shows myxoid degeneration (accumulation of ground substance).
What is it?

A

Mitral Valve Prolapse

–Prolapse (click) –> regurgitation (murmur from mid systole)

81
Q

Patient has a holosystolic “blowing” murmur that gets louder w/ squatting and expiration.
What is it?

A

Mitral Regurgitation

  • -Squatting –> higher TPR –> more regurgitation
  • -Expiration –> more return to LA –>
82
Q

Patient with chronic rheumatic valve disease is found to have volume overload leading to dilation of LA. Exam: opening snap followed by diastolic rumble.
What is it?

A

Mitral Stenosis

  • -Mitral valve open after S2 –> diastolic opening snap (split S2)
  • -Turbulent flow from LA to LV –> low pitch diastolic rumble
83
Q

Endocarditis:

  • -Most common overall cause?
  • -Most common cause in IV drug users?
  • -Most common cause in colorectal carcinoma patients?
  • -Most common cause w/ negative blood cultures?
A
  • -Overall = Strep. viridians
  • -IV = Staph. aureus
  • -Cancer = Strep. bovis
    • (-) Cultures = HACEK (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella)
84
Q

Patient presents w/ anemia, fever, murmur, erythematous nontender lesions on palms and soles, tender lesions on fingers and toes, splinter hemorrhages in nail bed and retinal hemorrhages w/ pale centers
What is it?

A

Bacterial Endocarditis

  • -Janeway lesions = erythematous nontender lesion on palms and soles
  • -Osler nodes = tender lesions on fingres and toes
  • -Splinter hemorrhages = vertically running blood clots
  • -Roth spots = retinal hemorrhages w/ pale centers
85
Q

Afebrile patient w/ Hx of SLE and a holosystolic “blowing” murmur has an Echocardiogram showing a vegetation on the mitral valve
What is it?

A

Libman-Sacks endocarditis – sterile vegetations

–Holosystolic “blowing” murmur = mitral regurgitation

86
Q 
In Anemia of chronic disease:
Hb = \_\_\_
MCV = \_\_\_
Ferritin = \_\_\_
TIBC = \_\_\_
Serum iron = \_\_\_
% Saturation = \_\_\_
A 
Hb = low
MCV = low
Ferritin = high
TIBC = low
Serum iron = low
% Saturation = high
87
Q

What is it called when you get sterile vegetations that arise in association w/ SLE?
Where do the vegetations occur?

A
  • -Libman-Sacks endocarditis

- -surface and undersurface of mitral valve–>regurgitation

88
Q

What is the most common form of cardiomyopathy?

A

Dilated cardiomyopathy

89
Q

Most common cause of this heart disease is an autosomal dominant mutation in sarcomere proteins

A

Hypertrophic cardiomyopathy – massive hypertrophy of left ventricle

90
Q

A young athlete with known diastolic dysfunction (ventricle cannot fill) and has occasional syncope with exercise suddenly dies due to a ventricular arrhythmia. On biopsy, his heart shows myofiber disarray.
What does he have?

A

–Hypertrophic cardiomyopathy

91
Q

This syndrome is characterized by endomyocardial fibrosis with an eosinophilic infiltrate and eosinophilia.
What does it cause?

A

Loeffler Syndrome –> Restrictive cardiomyopathy

92
Q

Patient presents w/ CHF due to restrictive cardiomyopathy.

What are expected classic EKG findings?

A
  • -Low-voltage

- -diminished QRS amplitude

93
Q

Patient presents with an episode of syncope. Echo shows a pedunculated mass in the left atrium near the mitral valve.. Biopsy shows mesenchymal tumor with a gelatinous appearance and abundant ground substance in histology.
What is it?

A

–Myxoma – most common adult primary cardiac tumor

–Syncope b/c mitral valve obstruction

94
Q

A young child with tuberous sclerosis has a mass in his left ventricle.
What is it?

A

Rhabdomyoma – benign hamartoma of cardiac MUSCLE

–most common primary cardiac tumor in children

95
Q

Breast and lung carcinoma, melanoma and lymphoma commonly metastasize to the heart. Where do they usually affect and what does it result in?

A

Pericardium –> pericardial effusion

96
Q

Patient presents w/ fever, chills, productive cough w/ yellow-green, sometimes rusty, sputum. Exam: resp. rate 25, pleuritic chest pain, decreased breath sounds, dullness to percussion. Labs: elevated WBCs
What is it?
What 3 tests can make the diagnosis?

A

Pneumonia

  • -CXR
  • -Sputum gram stain and culture
  • -Blood cultures
97
Q

Aspiration pneumonia:

  • -What organisms usually cause it?
  • -In what patient population?
  • -What classical finding?
A
  • -Anaerobic bacterial in oropharynx
  • -Patients w/ risk of aspiration = alcoholics, comatose
  • -Right lower lobe abscess (b/c right main stem bronches branches at a less acute angle than left)
98
Q

What type of pneumonia is often multifocal and bilateral?

A

Bronchopneumonia

99
Q

Differentiate causes of Red vs. Gray hepatization in pneumonia

A

Red–due to exudate, neutrophils and hemorrhage filling alveolar spaces –> spongy lung into solid consistency
Gray–due to degradation of red cells within exudate

100
Q

What is another name for ‘atypical’ pneumonia?

What symptomatic differences make it ‘atypical’?

A
  • -Interstitial Pneumonia

- -Presents w/ relatively mild upper respiratory symptoms (minimal sputum, low fever)

101
Q

What 2 things make TB reactivation occur at apex of the lung?

A
  • -Relatively poor lymphatic drainage

- -High oxygen tension

102
Q

What is it called when TB spreads to affect the lumbar vertebrae?

A

Pott disease

103
Q

TB causes focal, caseating necrosis in the lower lobe and hilar lymph nodes that undergoes fibrosis and calcification.
What is this thing called?

A

Ghon complex

104
Q

4 Clinical features of TB:

A
  • -Fever
  • -Night sweats
  • -Cough w/ hemoptysis
  • -Weight loss
105
Q

How do the following change in in COPD:

  • -FVC? (forced vital capacity)
  • -FEV1?
  • -TLC? (total lung capacity)
A
  • -FVC decreases
  • -FEV1 decreases more than FVC
  • —so FEV1/FVC ratio decreases
  • -TLC increases
106
Q

Patient is a smoker presents with 3 months of productive cough (lots of mucus) for the past 2 years. Exam: high PaCO2, low PaO2 that causes cyanosis. He’s pissed another doctor called him a “blue bloater”.
What is it?
What pathophysiologic change?

A

–Chronic bronchitis

–Hypertrophy of bronchial mucinous glands ( over 50% Reid index)

107
Q

What causes:

  • -Panacinar emphysema that is most severe in lower lobes?
  • -Centriacinar emphysema that is most severe in upper lobes?
A

What causes:
Smoking–>Centriacinar emphysema that is most severe in upper lobes?
A1AT (a1-antidrypsin) deficiency –>Panacinar emphysema that is most severe in lower lobes?

108
Q

A1AT (a1-antitrypsin) deficiency is due to misfolding of the mutated protein. It can accumulate in the endoplasmic reticulum of what cell and lead to what condition (other than emphysema)?

A

Hepatocytes –> Liver damage –> Liver cirrhosis

109
Q

Patient has dyspnea, wheezing, a productive cough, spiral-shaped mucus plugs, and eosinophil-derived crystals
What is it?

A

Asthma

–classic Curschmann spirals and Charcot-Leyden crystals

110
Q

Is Asthma TH1 or TH2 mediated?

A

TH2! = antibody-mediated

111
Q

In asthma, TH2 cells secrete IL4, IL5, and IL10. What do they do?

A
  • -IL4 = mediate calss switch to IgE
  • -IL5 = attracts eosinophils
  • -IL10 = stimulate TH2, inhibit TH1
112
Q

A man with sinusitis, infertility, situs inversus, and Cystic Fibrosis presents with cough, dyspnea, and foul-smelling sputum. He might also have a type of aspergillosis, a tumor, or a necrotizing infection. It results in permanent dilation of brinchioles and bronchi b/c loss of airway tone results in air trapping.
What is it?

A

Bronchiectasis

–sinusitis + infertility + situs inversus = Kartagener syndrome = dynein arm defect affecting ciliary movement

113
Q

How do the following change in in Restrictive Respiratory Diseases:

  • -FVC? (forced vital capacity)
  • -FEV1?
  • -TLC? (total lung capacity)
A
  • -FVC decreases more than FEV1
  • -FEV1 decreases
  • —so FEV1/FVC ratio increases
  • -TLC decreases
114
Q

Patient w/ history of radiation therapy and taking bleomycin and amiodarone presents w/ progressive dyspnea and cough. CT: diffuse fibrosis described as ‘honeycomb’ lung
What is it?
What is the role of TGF-B here?

A

–Idiopathic Pulmonary Fibrosis

–TGF-B from injured pneumocytes induces fibrosis

115
Q

In Pneumoconiosis, chronic exposure to fibrogenic particles (carbon dust, silica, beryllium, or asbestos) leads to interestitial fibrosis.
What pathogenic process causes this?

A

Alveolar macrophages engulf foreign particles –> induces fibrosis

116
Q

Young African American female patient presents w/ dyspnea and cough. Labs: elevated serum ACE, hypercalcemia. Biopsy: noncaseating granulomas in hilar lymph nodes and lungs w/ stellate inclusions (‘asteroid bodies’) in giant cells.
What is it?

A

–Sarcoidosis – characteristic noncaseating granulomas in multiple organs

117
Q

Patient that is a pigeon breeder has fever, cough, and dyspnea a couple hours after he gets some new pigeons that resolves when he decides he doesn’t want to breed pigeons anymore.
Wha is it?

A

Hypersensitivity Pneumonitis –granulomatous reaction to inhaled organic antigens (Pigeon breeder’s lung)

118
Q

Criterion for pulmonary HTN:

A

Mean pulmonary arterial pressure greater than 25mmHg

119
Q

A young adult female has an inactivating mutation of BMPR2 leading to proliferation of vascular smooth muscle.
She has a familial form of what?

A

Primary pulmonary HTN

120
Q

Hypoxemia (COPD or interstitial lung disease), increased volume in pulmonary circuit (congenital heart disease), or recurrent embolism are all potential causes of this:

A

Secondary pulmonary HTN

121
Q

Patient with some kind of disease process develops hypoxemia and cyanosis w/ respiratory distress. CXR: ‘white out’. Microscopy: hyaline membranes in alveoli.
What is it?

A

Acute Respiratory Distress Syndrome (ARDS)

122
Q

A premature neonate delivered by c-section by a mother w/ diabetes develops tachypnea w/ use of accessory muscles, grunting, increasing respiratory effort after birth, and hypoxemia w/ cyanosis. CXR: diffuse granularity of lung, “ground-glass” appearance.
What is it?

A

Neonatal Respiratory Distress Syndrome

123
Q

Do Type 1 or 2 pneumocytes produce surfactant?

A

Type 2

124
Q

What are the 3 key risk factors for Lung Cancer?

A
  1. Cigarette smoke
  2. Radon
  3. Asbestos
125
Q

CXR reveals a solitary nodule (‘coin-lesion’) that suggests lung cancer. BUT

  • -What benign lesions could it be?
  • -What do you need to diagnose cancer?
A

–Could be: granuloma (TB or fungus like Histoplasma) or Bronchial hamartoma

–Biopsy necessary for cancer diagnosis

126
Q

Small cell carcinoma arises from what cells?

A

Neuroendocrine (Kulchitsky) cells

127
Q

What lung cancer has characteristic keratin pearls or intercellular bridges in histology?

A

Squamous Cell Carcinoma

128
Q

What is the most common lung tumor in nonsmokers and female smokers?

A

Adenocarcinoma

129
Q

What kind of lung cancer is likely if you see multiple ‘cannon-ball’ nodules on imaging?

A

2ndary Lung Cancer – metastasis to lung

130
Q

What category of lung cancer does not respond well to chemotherapy?

A

Non-small cell carcinoma – treated upfront w/ surgical resection

131
Q

Pleural involvement is classically seen with what kind of lung cancer?

A

Adenocarcinoma

132
Q

Lung cancer can cause distended head and neck veins w/ edema and blue discoloration of arms and face. What is it called when this happens?

A

Superior vena cava syndrome – obstruction of SVC

133
Q

Lung cancer can cause hoarsness and diaphragmatic paralysis when it involves what anatomic structures?

A
  • -Recurrent laryngeal nerve –> hoarsness

- -Phrenic nerve –> diaphragmatic paralysis

134
Q

What is a unique site of metastasis for lung cancer?

A

Adrenal gland

135
Q

What kind of lung cancer can cause Horner syndrome

A

Apical (Pancoast) tumor –> sympathetic chain compression

136
Q

A retired shipyard worker presents w/ recurrent pleural effusions, dyspnea, and chest pain.
What is it?

A

Mesothelioma

137
Q

A young adult has a rupture of an emphysematous bleb.

What is it?

A

Spontaneous pneumothorax – collapse of a portion of the lung

138
Q

Trachea displacement in spontaneous vs. tension pneumothorax:

A 
Spontaneous = shift to side of collapse
Tension = pushed opposite to side of injury

MQW U4 (9 decks)

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