Pathoma (HIGH YIELD)

Question 1

Possible consequences of rhinitis

Answer 1

Nasal polyps (most important), angiofibroma, nasopharyngeal carcinoma

Question 2

What are nasal polyps associated with in children?

Answer 2

Cystic fibrosis

Question 3

What are nasal polyps associated with in adults?

Answer 3

ASA-intolerant asthma

Question 4

Angiofibroma classic demographic

Answer 4

Adolescent males

Question 5

Pathogen(s) associated with nasopharyngeal carcinoma

Answer 5

EBV

Question 6

Patient demographics associated with nasopharyngeal carcinoma

Answer 6

African children, Chinese adults

Question 7

Histopathologic features of nasopharyngeal carcinoma

Answer 7

Pleiomorphic keratin-positive epithelial cells in a background of lymphocytes

Question 8

Pathogen(s) associated with laryngeal papilloma

Answer 8

HPV 6 & 11

Question 9

Laryngeal papilloma typical presentation by demographic

Answer 9

Single lesion in adults, multiple in children

Question 10

Most important cytokine mediators of pain

Answer 10

Bradykinin, PGE2

Question 11

Klebsiella pneumoniae typical mechanism of host entry

Answer 11

Aspiration (e.g. in the elderly, alcoholics)

Question 12

What is responsible for the resolution phase of pneumonia

Answer 12

Type II pneumocyte (stem cell of the lung)

Question 13

Most common cause of secondary pneumonia

Answer 13

Staph aureus

Question 14

Common complications of S aureus secondary pneumonia

Answer 14

Abscess, empyema

Question 15

Which causes of secondary pneumonia can lead to COPD exacerbation

Answer 15

Haemophilus influenzae, Moraxella cattarhalis

Question 16

Bronchopneumonia pathogen associated with cystic fibrosis patients

Answer 16

Pseudomonas aeruginosa

Question 17

Bronchopneumonia pathogen often arising from water source? Lab stain to visualize?

Answer 17

Legionella pneumophila; silver stain

Question 18

Which pneumonia pathogen is associated with autoimmune hemolytic anemia? Describe pathogenesis

Answer 18

Mycoplasma pneumoniae (interstitial pneumonia); IgM against RBC antigen leads to cold HA

Question 19

Mycoplasma pneumoniae gram stain characteristics

Answer 19

Not visible on gram stain (b/c no cell wall)

Question 20

Which viral pathogen increases risk for superimposed bacterial pneumonia?

Answer 20

Influenza (Staph aureus, Haemophilus influenzae most common pathogens)

Question 21

Pathogens associated with aspiration pneumonia

Answer 21

Bacterioides, fusobacterium, peptococcus

Question 22

Sites of systemic spread of secondary TB

Answer 22

• Meninges (meningitis) – with granulomas at base of brain, particularly HIGH YIELD
• Cervical LN
• Kidney (sterile pyuria)
• Lumbar vertebrae (Pott disease)

Question 23

Effect of COPD on FEV1/FVC ratio?

Answer 23

Decreased

Question 24

What heart pathology does chronic bronchitis predispose, and how?

Answer 24

Cor pulmonale; in chronic bronchitis, there is widespread poor oxygenation, thus excessive “clamping down” (blood gets shunted away from areas of poor oxygenation) increases pulmonary pressure, leading to RVH

Question 25

Describe pathophysiology of "air trapping" in emphysema

Answer 25

In emphysema, alveolar "air sacs" get destroyed, which leads to loss of elastic recoil, which under normal conditions keeps the alevoli from collapsing when air is being expired (the wall gets "dragged" along with the expired air; remember for conducting portion cartilage prevents this)

Question 26

How can an A1AT deficiency lead to liver cirrhosis?

Answer 26

Protein is absent from blood, but may still be produced in the liver, in which case it builds up in ER (important) of hepatocytes, damaging the cell

Question 27

What does "pink puffer" refer to?

Answer 27

Prolonged expiration with pursed lips; seen in emphysema ("pink" b/c oxygenated, but with "puffer" appearance)

Question 28

Important clinical features of emphysema

Answer 28

 Prolonged expiration with pursed lips ('pink puffers')  Incr. AP diameter of chest (‘barrel-chest’)  Dyspnea + cough with minimal sputum  Weight loss (incr. work of breathing)

Question 29

1st (most important) consequence of Mast cell activation

Answer 29

Histamine release (2 effects: vasodilation and incr. vascular permeability)

Question 30

Important components of asthmatic mucus

Answer 30

Curschmann spirals with Charcot-Leyden crystals (derived from eosinophils)

Question 31

Possible complications of bronchiectasis

Answer 31

Secondary amyloidosis (most important), hypoxemia (CO2 trapping) with cor pulmonale

Question 32

Drugs that can cause idiopathic pulmonary fibrosis

Answer 32

Bleomycin, amiodarone

Question 33

What is anthracosis? What is it associated with?

Answer 33

Collections of carbon-laden macrophages in the lung; "black lung" and Caplan syndrome (rheumatoid arthritis + Coal miners' pneumoconiosis)

Question 34

Which pneumoconiosis increases risk for TB? Why?

Answer 34

Silicosis; silica impairs phagolysosome formation by macrophages

Question 35

Pathologic findings in Berylliosis? What disease shares similar features?

Answer 35

Noncaseating granulomas in lung, hilar LN and systemic organs; sarcoidosis

Question 36

Classic demographic of primary pulm HTN? Presentation?

Answer 36

Young women; exertional dyspnea

Question 37

Familial pulmonary HTN gene

Answer 37

BMPR2

Question 38

Possible causes of secondary pulm HTN

Answer 38

Recurrent PE (most important), hypoxemia (e.g. COPD and interstitial lung disease) or incr. volume in pulmonary circuit (e.g. congenital heart disease)

Question 39

What can complicate recovery from Acute Respiratory Distress Syndrome, and why?

Answer 39

Interstitial fibrosis; type II pneumocytes are "knocked out"

Question 40

Screening for neonatal RDS?

Answer 40

L:S ratio (>2 means adequate surfactant)

Question 41

Prominent carcinogen in cigarette smoke

Answer 41

PAH

Question 42

Benign lung lesions

Answer 42

Granuloma (midwest, histoplasma connections), bronchial hamartoma (often calcified on imaging)

Question 43

Common components of lung hamartoma

Answer 43

Lung tissue + cartilage

Question 44

Adenocarcinoma typical demographics

Answer 44

Most common in nonsmokers and female smokers

Question 45

Carcinoid tumor characteristic histology

Answer 45

Chromogranin positive (neuroendocrine cell tumor)

Question 46

Unique site of distant metastasis for lung ca

Answer 46

Adrenal gland