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Pathology > Pulmo Part 2 > Flashcards

Pulmo Part 2 Flashcards

1
Q

Hallmark of CILD (restrictive, infiltrative)

A

Reduced compliance (more pressure required to expand lungs bec they are stiff) necessitating effort in breathing (dyspnea)

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2
Q

Unknown etiology
Patchy progressive bilateral interstitial fibrosis resulting in hypoxemia and cyanosis

Histology: usual intersitial pneumonia

A

Idiopathic pulmonary fibrosis

Cryptogenic fibrosing alveolitis

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3
Q

Endogenous inhibitor of pulmonary fibrosis

A

Caveolin-1

Downregulated by TGFB1

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4
Q

Cobblestones of pleural surface bec of retraction scars along interlobular septa
Patchy interstitial fibrosis
Fibroblastic foci
Temporal homogeneity (early and late lesion)
Honeycomb fibrosis

A

Idiopathic pulmonary fibrosis

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5
Q

Dense fibrosis causing collapse of alveolar wall and cystic spaces lined by hyperplastic type II pneumocytes or bronchiolar epithelium

A

Honeycomb fibrosis

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6
Q

Dry velcro like crackles on inspiration
Cyanosis, cor pulmonale
Peripheral edema
Lung biopsy for diagnosis

Mean survival 3 years

Tx: lung transplant

A

Idiopathic pulmonary fibrosis

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7
Q

Mild to mod chronic interstitial inflamm in uniform or patchy distribution

A

Nonspecific interstitial pneumonia cellular

Best prognosis

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8
Q

Diffuse patchy intersitial fibrosis without temporal homogeneity of UIP

A

Nonspecific intersitial pneumonia fibrosing

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9
Q

BOOP Bronchiolitis obliterans organizing pneumonia
subpleural or perobronchial patchy areas of air space consolidation
Polypoid plugs of loose CT
Lung architecture normal
Tx: steroid 6 mos

A

Cryptogenic organizing pneumonia

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10
Q

Cryptogenic organizing pneumonia histologic hallmark

Balls of fibroblast in alveolar space

A

Masson body

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11
Q

Restrictive lung diseases with reduced lung compliance and reduced FVC

Ratio of FEV/FVC = normal

A

Diffuse interstitial fibrosis

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12
Q

Unifying pathogenic factor of DIF

A

mac activation and TGFB release (fibrogenic)

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13
Q

Patchy intersitial fibrosis, fibroblastic foci, cystic space formation honeycomb lung and Usual Interstitial Pneumonia

A

Idiopathic pulmonary fibrosis

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14
Q

Non neoplastic lung reaction to mineral dust

A

Pneumoconiosis

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15
Q

Particles 5-10 um are

Particles 0.5 less are

A

unable to reach distal airway

move into and out of alveoli without deposition

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16
Q

Most dangerous bec they get lodged at the bifurcation of distal airway

A

1–5 um

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17
Q

Key cellular element in initiation and perpetuation of lung injury and fibrosis

A

alveolar macrophage

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18
Q

Smoking worsens effects of inhaled mineral dusts especially

A

asbestos

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19
Q

Most common mineral dust pneumoconioses

A

coal
dust
silica

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20
Q

Coal worker’s pneumoconiosis:

A

Macule and nodule

Coal mining

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21
Q

Complicated coal worker’s pneumoconiosis

A

PMF

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22
Q

Sandblast quarrying mining stone cutting foundry work, ceramics

A

Silicosis

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23
Q

Pleural effusion, pleural plaque, diffuse fibrosis, mesothelioma, carcinoma of lung and larynx

Mining, milling, fabrication of ores and materials, installation and removal of insulation

A

Asbestos

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24
Q

Pigment accum without perceptible cellular reaction

A

Anthracosis

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25
Q

Most inoccuous coal induced pulmo lesion in coal miner and smoker
Carbon engulfed mac accumulating in CT along lymphatics

A

Pulmonary anthracosis

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26
Q

Dust laden mac

small amounts of collagen fibers arrayed in delicate network
Frequent in upper lobes
Centrilobular emphysema

A

Coal macule

Coal nodule
Simple CWP

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27
Q

Coalescence of coal nodule
Multiple intense blackened scar larger than 2cm

Dense collagen and pigment

A

Complicated CWP

Progressive massive fibrosis

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28
Q

Pulmonary dysfunction
Pulmonary hypertension
Cor pulmonale

A

Progressive massive fibrosis

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29
Q

Most prevalent chronic occupational disease worldwide

A

Silicosis

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30
Q

Most implicated in silicosis

Less fibrosis if mixed with other minerals

A

quartz

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31
Q

Tiny barely palpable discrete pale-to-blackened nodules in upper zones of lungs

Concentrically arranged hyalinized collagen fibers surrounding amorphous center

Whorled appearance, weakly birefringent silica at the center sometimes with egg shell calcification in LN

A

Silicotic nodule

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32
Q

Silicosis is associated with inc susceptibility to

A

tuberculosis and
lung cancer

inhibited ability of mac to kill phagocystosed bacteria

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33
Q

Asbestos fiber is curly and flexible

Most common and impacted at upper respiratory passage

A

Serpentine

Chrysotile

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34
Q

Asbestos fiber is straight, stiff and brittle

More pathogenic bec can lodge deep to interstitium

A

Amphibole

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35
Q

asbestos can produce

A

asbestosis
lung ca
mesothelioma

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36
Q

Important to synergy between smoking and lung ca in asbestos

A

adsorption of carcinogen in tobacco smoke onto asbestos

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37
Q

Golden brown fusiform rod with transluscent center

Asbestos fiber coated with iron material

A

Asbestos bodies

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38
Q

Most common manif of asbestos exposure

Well circumscribed plaque of dense collagen containing calcium on parietal pleura

A

Pleural plaque

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39
Q

Asbestosis begins

A

in lower lobes and subpleura

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40
Q

Asbestos exposure is linked with

A 
1 parenchymal intersitial fibrosis
2 plaques/diffuse pleural fibrosis
3 pleural effusion
4 lung cancer
5 malignant pleural mesothelioma
6 laryngeal cancer
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41
Q

Causes pneumonitis and interstitial fibrosis

A

Bleomycin

42
Q

Causes pneumonitis and fibrosis

A

Amiodarone

43
Q

1 month post radiotherapy
Fever, dyspnea, pleural effusion, pulmo infiltrates

Resolve with corticosteroid therapy progressing to chronic radiation pneumonitis

A

Radiation pneumonitis

44
Q

Multisystem disease of unknown etiology characterized by noncaseating granuloma in organs

Diagnosis of exclusion in young less than 40, nonsmoker

Mc manifestation

A

Sarcoidosis

Bilateral hilar lymphadenopathy or lung involvement

45
Q

Sarcoidosis pathogenesis

A

Disordered immune regulation in genetically predisposed persons

46
Q

Diagnostic histopath feature in sarcoidosis

A

Noncaseating epitheloid granuloma irrespective of organ involved

47
Q

Laminated concretion of calcium and protein

A

Schaumann body

48
Q

Stellate inclusion enclosed within giant cell

A

Asteroid bodies

49
Q

Uveoparotid involvement in sarcoidosis

A

Mikulicz syndrome

50
Q

CD4 cells secreting THI Independent cytokines
IFN y
IL2
LN enlargement, sicca syndrome, erythema nodosum, visceral invovlement
Lung 90% with granuloma formation and intersitial fibrosis

A

Sarcoidosis

51
Q

Immunologically mediated and delayed type hypersensitivity inflammatory lung disease primarily affecting alveoli

Type III and IV (caseating granuloma) hypersensitivity

A

Hypersensitivity pneumonitis

52
Q

Mold’s hay exposure

Micropolyspora faeni

A

Farmer’s lung

53
Q

Moldy sugar cane
Bagasse
Thermophilic actinomycetes

A

Bagossis

54
Q

Moldy maple bark

Cryptostroma corticale

A

Maple bark disease

55
Q

Cool mist humidifier
Actinomycetes
Aureobasidium pullulans

A

Humidifier lung

56
Q

Mold barley

Apergillus clavatus

A

Malt worker’s lung

57
Q

Moldy cheese

Penicillium casei

A

Cheesewasher’s lung

58
Q 
Dust contaminated grain
Sitophilus granarius (wheat weevil)
A

Miller’s lung

59
Q

Pigeon dropping

Pigeon serum protein in dropping

A

Pigeon breeder’s lung

60
Q

Chemical industry

Trimellitic anhydride isocyanate

A

Chemical worker’s lung

61
Q

Fever, dyspnea, hypoxia and diffuse pulmo infiltrate
BAL 25% eosinophil
Prompt response to corticosteroid

A

Acute eosinophilic pneumonia with respiratory failure

62
Q

Transient pulmonary lesions
eosinophilia
Thickened alveolar septa with eo and giant cell

A

Simple pulmonary eosinophilia

Loeffler

63
Q

Clinically silent emboli percentage

Recurrence rate of PE

A

60-80%

30%

64
Q

Hemoptysis
Anemia
Diffuse pulmonary infiltrate

A

Diffuse alveolar hemorrhage syndrome

65
Q

Proliferative rapidly progressive glomerulonephritis
Hemorrhagic interstitial pneumonitis
Antibody against alpha3 of collagen IV

A

Goodpasture syndrome

66
Q

diffuse alveolar hemorrhage
hemosiderin
linear immuneglobulin deposition in renal biopsy

A

Diffuse alveolar hemorrhage syndrome

67
Q

Pulmo manifestation like Goodpasture but no renal disease or antibasement membrane antibody

A

Idiopathic pulmonary hemosiderosis

68
Q

Upper respiratory or pulmonary manifestation
Necrotizing vasculitis
Parenchymal necrotizing granulomatous inflammation
sinusitis, epistaxis, nasal perforation
cough, hemoptysis, chest pain
PR3 ANCA +

A

Wegener’s granulomatosis

69
Q

Pneumococcal infections occur with inc frequency in

A

1 chronic disease (DM, COPD, CHF)
2 congenital or acquired IgG defect (AIDS)
3 sickle cell or splenectomy bec harbors phagocyte and produces antibody

70
Q

Pneumococcal pneumonia is acquired by

with lobes more involved

A

aspiration of pharyngeal flora 20%

lower lobes and right middle lobe

71
Q

4 stages of pneumonia

A

Congestion
Red hepatization
Gray hepatization
Resolution

72
Q

Heavy, boggy red, vascular congested lobe

Proteinacious fluid, scattered neutrophil and bacteria in alveoli

A

Congestion

73
Q

Liver like consistency and alveolar spaces are packed with neutrophil, red cell, and fibrin

A

Red hepatization

74
Q

Dry, gray firm

Lysed red cell with fibrinosuppurative exudate persists within alveoli

A

Gray hepatization

75
Q

Uncomplicated case

Digestion of exudate to produce granular semifluid debris resorbed ingested by mac coughed up by fibroblast

A

Resolution

76
Q

Complications of pneumonia esp sero type 3

A

1 abscess
2 empyema
3 organization of intraalveolar exudate converting lung to solid fibrous tissue
4 meningitis, arthritis, infective endocarditis

77
Q

Gram + lancet shaped diplococci

Most common cause of CAP and a lobar inflammation

A

S pneumoniae

78
Q

Most common bacterial cause of acute exacerbation of COPD

A

H influenzae

79
Q

Causes epiglottitis and suppurative meningitis in children

A

H influenzae type B

Encapsulated

80
Q

Inc cause of bacteria in elderly
2nd most common cause of acute exac of COPD in adult
Causes otitis media along with H influenzae and S pneumoniae

A

M catarrhalis

81
Q

Important cause of secondary bacterial pneumoniae in children and healthy adults after viral respi illness (measles, influenza)

Assoc with abscess and empyema

Also a cause of nosocomial p

A

Staphylococcus aureus

82
Q

Staph pneumoniae with r sided staph endocarditis is a serious complication of

A

iv drug abuse

83
Q

Most freq cause of gram neg bacterial pneumonia

A

Klebsiella pneumoniae

84
Q

Pneumonia affecting alcoholics, debilitated and malnourished

A

Klebsiella

85
Q

Thick gelatinous sputum is characteristic of Kleb bec

A

viscid capsular polysaccharide preventing coughing up

86
Q

Nosocomial and cystic fibrosis related pneumonia

Neutropenic, burns, mech vent

Propensity to invade bv with extrapulmo spread

Fulminant, death with coag necrosis of pulmo parenchyma invading walls of necrotic blood vessel

A

Pseudomonas aeruginosa

Pseudomonas vasculitis

87
Q

Pontiac fever(URTI)
Water cooling towers, tubing system
Inhaled aerosolized organism or aspiration of contaminated water
Common in cardiac, renal, hema and organ transplant patient

A

Legionella pneumophila

88
Q

L pneumonia may be dx by

A

L antigen in urine or
+ fluorescent antibody on sputum

Standard: culture

89
Q

Mosy common atypical pneumonia occuring in closed community

A

Mycoplasma pneumoniae

90
Q

Red blue congested subcrepitant area
Inflammatory reaction largely confined within walls of alveoli
Widened edematous septa
Alveolar space free of cellular exudate

A

Atypical pneumoniae

91
Q 
Moderate amount of sputum
Absence of consolidation
Moderate elevation of white cell 
Lack of alveolar exudate
Respi distress out of proportion to clinical and radio signs
A

Atypical pneumoniae

92
Q

Influenza subtypes are determined by

A

Hemagglutinin

Neuraminidase

93
Q

Epidemics

Mutations of HA and NA antigen allowing them to escape most host antibodies

A

Antigenic drift

94
Q

Pandemics
HA and NA replaced through RNA recombination with that of animal viruses making all animals susceptible to new influenza virus

A

antigenic shift

95
Q

Pulmo abscess resulting from aspiration of infective material are more common on

A

the right side with more vertical airway

posterior segment of upper lobe
apical segment of lower lobe

96
Q

Lung abscess may rupture into

A

Pneumothorax

Empyema

97
Q

Most common cause of death from single infectious agent

A

TB

98
Q

Single most important risk factor for development of TB

A

HIV

99
Q

Polymorphism of this gene predisposes diseasr progression without development of effective immune TB response

A

NRAMPI

100
Q

Immunity to TB is mediated by

A

THI cells stimulating mac to kill bacteria

comes at cost of hypersensitivity

101
Q

Most common opportunistic viral pathogen in AIDS

A

CMV

Pathology (24 decks)

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