Pathoma Respiratory High Yield Flashcards
What do you think about an adult with asthma, nasal polyps, and bronchospasm?
Likely aspirin-induced asthma - seen in 10% of adults
What causes nasal polyps and what is a typical cause in children?
Caused by repeated bouts of edema / inflammation due to rhinitis
-> classically seen in children with Cystic fibrosis
A patient comes in with a locally aggressive and destructive benign neoplasm of the nasopharynx causing epistaxis. Name and describe his condition, and what demographics he most likely is?
Nasopharyngeal angiofibroma (it is aggressive despite being benign)
Highly vascular neoplasm which causes profuse bleeding and has a high recurrence rate
Almost exclusively in adolescent males, especially with fair skin and red hair
What typically causes nasopharyngeal carcinoma and who is it seen in?
Seen in African children and Chinese adults
Associated with EBV infection classically, also nitrosamines and tobacco / fumes
What does nasopharyngeal carcinoma look like microscopically?
Poorly differentiated squamous cell carcinoma (pleomorphic, keratin-positive), surrounded by lymphocytes (mostly T cells to fight EBV infection)
What radiologic sign is descriptive of epiglottitis and what is your major worry? What organism causes this?
Thumbprint sign -> inflamed epiglottis shows up on X-ray
Risk of airway obstruction is the major worry
-> caused by hemophilus influenzae b
Where do Singer’s nodules arise and what do they look like histologically?
Arise on the true vocal cord, usually bilateral due to excessive use
Appear as degenerative (myxoid) connective tissue -> resolves with rest
What causes laryngeal papilloma and how does the presentation differ between kids and adults?
HPV 6/11
Adults - only one papilloma (wart)
Children - usually multiple
-> presents with hoarseness
What is the usual cause of laryngeal vs pharyngeal/oropharynx squamous cell carcinoma?
Laryngeal - usually due to alcohol / tobacco
Oropharynx - usually due to HPV 16
-> includes tonsils, soft palate, base of tongue, pharynx
How do patients typically get Klebsiella pneumoniae? How does this relate to who is most susceptible?
It is enteric flora which has been aspirated
-> people most susceptible to aspiration include elderly, diabetics, and alcoholics
Who gets Moraxella catarrhalis?
Second most cause of exacerbation of COPD, behind Haemophilus influenzae
What is the most common cause of atypical pneumonia in infants? Prophylaxis?
Respiratory syncytial virus
Prophylaxis with palivizumab
What type of disease does Coxiella burnetii cause and why can it be thought of as an atypical atypical?
Causes atypical (interstitial) pneumonia, but also causes high fever
Also does not require arthropod vector for transmission like most Rickettsial organisms, and does not produce a skin rash.
What happens when TB involves the kidneys?
Causes a sterile pyuria
Dr. Sattar says it’s common
What is the clinical diagnostic criteria for chronic bronchitis?
Productive cough for >3 months in a year for >=2 consecutive years.
What is the classic pathologic finding in Chronic Bronchitis?
Increase in thickness of the mucinous glands >50% - from the epithelium to the cartilage
Normal is <40%
The % occupied is the Reid Index
Why do patients with Chronic Bronchitis turn blue?
Mucus plugs trap carbon dioxide in alveoli -> increases PACO2 -> automatically drops PAO2 -> drop in PaO2 -> cyanosis
What is the consequence of chronic hypoxia in the alveoli in chronic bronchitis?
Generalized pulmonary vasoconstriction -> cor pulmonale
Where does protein accumulate in A1AT deficiency?
In the endoplasmic reticulum of hepatocytes -> PAS positive
Why does the AP diameter increase in emphysema?
Because there is a loss of elastic recoil of the lung to pull the chest wall inward -> FRC equilibrates further outward, more towards chest wall’s desired point.
Are hypoxemia and cor pulmonale more common in emphysema or chronic bronchitis?
More common in chronic bronchitis, where air trapping behind mucus plugs is more likely to lead to hypercapnia -> hypoxia -> vasoconstriction. This leads to early cor pulmonale.
Hypoxemia is a LATE complication of emphysema due to elastase destroying blood vessels in the interstitium -> reduction in gas exchange -> pulmonary hypertension and subsequent cor pulmonale.
What airway remodeling occurs in asthma in the bronchi / bronchioles?
From top to bottom:
- Globlet cell metaplasia / mucous gland hyperplasia
- Sub-basement membrane fibrosis
- Edema of submucosa with inflammatory cell infiltrate with eosinophils, increased vascularity
- Smooth muscle hyperplasia / hypertrophy (chronic bronchoconstriction)
What diagnostic things of asthma are contained in the mucous plugs?
Curschmann spirals - mucoid swirls of epithelial cells
Charcot-Leyden crystals - needle-like structures formed by extruded and coalesced granules of eosinophils, next to eosinophils
What is the cause of airway obstruction in bronchiectasis?
Dilation of the airways -> airflow becomes more easily turbulent in the large airways -> air just begins to swirl around in the open tube when attempted to exhale and never leaves
What obstructive lung disease is associated with allergic bronchopulmonary aspergillosis? Who gets it?
Bronchiectasis
Occurs in asthmatics and patients with cystic fibrosis
What is thought to be the underlying pathogenesis of idiopathic pulmonary fibrosis (IPF / UIP)?
Cyclical lung injury -> wound healing with fibrosis
-> increased collagen deposition in the interstitium via TGFbeta
What is the common pathology of UIP?
subPLEURAL and bibasilar accentuation of tissue damage (extensive fibrosis)
->heterogeneity of tissue damage with “fibroblastic foci” - extensive fibroblast proliferation with ECM