Pathoma TidBits

Question 0

Profuse epistaxis in a teen boy should make me think of…

Answer 0

Angiofibroma

Question 1

Nasal polyps are associated with which two conditions?

Answer 1

CF, aspirin-induced asthma

Question 2

What virus is associated with nasopharyngeal carcinoma? Biopsy?

Answer 2

EBV, pleomorphic keratin pos epithelial cells, background of lymphocytes

Question 3

Cause of laryngeal papilloma? # in kids vs adults?

Answer 3

HPV 6 and 11; single in adults. Multiple in kids.

Question 4

Risk factors for laryngeal carcinoma?

Answer 4

Squamous cell; alcohol and tobacco

Question 5

Four phases of lobar pneumonia?

Answer 5

Congestion; red hepatization (exudate, neutrophils, and hemorrhage into alveolar spaces); gray hepatization (RBC breakdown); resolution

Question 6

What are the two most common causes of lobar pneumonia?

Answer 6

Strep pneumo, klebsiella (can have currant jelly sputum, can be complicated by an abscess)

Question 7

What are 5 causes of bronchopneumonia? Which are seen post-influenza? In COPD?

Answer 7

Staph (most common secondary), H flu (secondary and COPD), Pseudomonas, Moraxella (COPD), legionella (water source, seen on silver stain since its intracellular)

Question 8

What are important features of Mycoplasma pneumo?

Answer 8

Autoimmune hemolytic anemia (cold agglutinin), erythema multiforme, not visible on gram stain

Question 9

How does coxiella differ from other rickettsial diseases?

Answer 9

Causes pneumonia, no skin rash, no vector

Question 10

How does primary TB present?

Answer 10

Lower lobe caseating necrosis with hilar lymph node fibrosis/calcification

Question 11

Whats the pathophys of chronic bronchitis? Presentation?

Answer 11

Hypertrophy of mucinous glands (Reid index > 50%); blue bloaters inc PaCO2 and low PaO2, productive cough, risk of infection and cor pulmonale

Question 12

Whats the pathophys of emphysema?

Answer 12

Destruction of alveolar air sacs from imbalance of proteases and antiproteases

Question 13

What area of the lung is fibrotic? What causes fibrosis? Where does the fibrosis start? End stage description?

Answer 13

Cyclical lung injury; TGF-Beta;

Starts in subpleural patches, honeycomb

Question 14

What pneumoconiosis causes diffuse fibrosis? What career? Whats the feature of mild exposure?

Answer 14

Carbon dust; coal miners

Anthracosis: carbon laden macrophagrs

Question 15

Which pneumoconiosis presents with fibrotic nodules in upper lobes? Profession? Important feature?

Answer 15

Silicosis, seen in sandblasters and silica miners; impairs phagolysosome formation by macrophages causing inc risk of TB

Question 16

Which pneumoconiosis causes noncaseating granulomas in the lung, hilar lymph nodes? What does it inc the risk of?

Answer 16

Beryllium in miners and aerospace; inc risk of lung cancer

Question 17

What pneumoconiosis presents with fibrosis of lung and pleura? Which professions? What does it inc the risk of? Biopsy?

Answer 17

Asbestosis; construction workers, plumbers, and shipyard workers; inc risk of lung carcinoma and mesothelioma; asbestos bodies

Question 18

What are the characteristic biopsy findings?

Answer 18

Asteroid bodies and noncaeating granulomas

Question 19

What are the clinical features of sarcoidosis?

Answer 19

Elevated ACE, hypercalcemia (1-alpha hydroxylase activity activates vit D)

Question 20

What are the characteristics of pHTN? Cause of primary?

Answer 20

Atherosclerosis of the pulm trunk; smooth muscle hypertrophy, and plexiform lesions (capillary tufts); BMPR2 inactivation causing smooth muscle proliferation

Question 21

Whats the hallmark of ARDS? Which cells are damaged?

Answer 21

Leakage of protein rich fluid causing hyaline membranes; type I and II

Question 22

How is lung maturity screened?

Answer 22

Phosphatidylcholine (lecithin: major component of surfactant) : sphingomyelin ratio > 2

Question 23

What is a calcified bronchial mass on imaging? Composition?

Answer 23

Hamartoma; cartilage and lung tissue

Question 24

Which lung cancer is only treated with chemo? What’s its histology?

Answer 24

Small cell, neuroendocrine cells

Question 25

Which paraneoplastic syndromes does it cause?

Answer 25

ADH, AcTH, or Eaton-Lambert

Question 26

Which type of lung cancer can lead to hypercalcemia? Histology?

Answer 26

Squamous cell, produces PTHrP; keratin pearls or intracellular bridges

Question 27

Which lung caner is most common in nonsmokers or women?

Answer 27

Adenocarcinoma (glands, mucin, peripheral)

Question 28

Which lung cancer presents as columnar cells along preexisting bronchioles and alveoli? What cells does it arise from? Presentation?

Answer 28

Bronchioalveolar carcinoma; Clara cells, pneumonia like consolidation

Question 29

Where do carcinoid lung tumors present? Stain?

Answer 29

Polyp-like mass in bronchus; chromogranin-positive