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Pulmo Part 3 Flashcards

1
Q

Most common opportunistic CMV disease

A

retinitis

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2
Q

Fungi causing pneumonia in AIDS <200 CD4 count

Foamy acellular exudate
Cup-shaped round cyst within exudate

A

P jiroveci

P carinii

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3
Q

Intraalveolar foamy pink staining exudate with h & e (cotton candy)
Round to cup shaped cyst 4-10um dm with intracystic body without budding

A

P jiroveci

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4
Q

P jiroveci dx

A

Sputum or BAL immunofluorescence

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5
Q

Most common disease causing fungus

A

Candida albicans

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6
Q

Yeast like form (blastoconidia)
pseudohyphae, true hyphae

Budding yeast joined end to end at constrictions simulating true fungal hyphae

Stain:

A

C albicans

Pseudohyphae

Gomori methenaminesilver
Periodic acid Schiff

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7
Q

Gray white
Dirty looking pseudomembrane
Matted organism and inflammatory debris
Mucosal hyperemia, inflammation

A

Oral thrush

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8
Q

Candidal infection on nail fold

A

Paronychia

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9
Q

Candida assoc disease

A

Hypoparathyroidism
Addison disease
Autoantibodies

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10
Q

Mutation affecting TH17 Rendering px highly susceptible to severe mucocutaneous candidiasis

A

Job syndrome

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11
Q

5-10 um yeast with thick gelatinous capsule, buds
No pseudohyphae true hyphae
Capsule is invaluable to diagnosis
Halo seen in india ink and periodic acid Schiff staining
Capsular polysaccharide antigen substrate for latex agglutination assay

A

C neoformans

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12
Q

C neoformans grow in meninges and perivascular Virchow Robin spaces producing

A

soap bubble lesion

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13
Q

Zygomycetes
Nonseptate hyphae branching at right angle
Common to hematolymphoid malig, neutropenia and corticosteroid therapy allogeneic stem cell

A

Mucormycosis

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14
Q

Septate and branched hyphae at acute angles

A

Aspergillus

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15
Q

Nondistinctive suppurative granulomatous reaction with predilection for invading blood vessel wall causing necrosis and infarction (3)

A

Rhizopus
Mucormycosis
Aspergillus

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16
Q

Colonizes nasal cavity and sinuses spreading into brain, orbit
DKA
localized pulmonary disease with diffuse miliary involvement

A

Rhinocerebral mucormycosis

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17
Q

Immunosupressed

Localizing in lung manifesting as necrotizing pneumoniae

A

Invasive aspergillosis

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18
Q

Asthma caused by type I hypersensitivity against fungus growing in bronchi

A

Allergic bronchopulmo aspergillosis

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19
Q

Fungus ball
Colonization of preexisting pulmo cavity
Act as ball valves

A

Aspergilloma

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20
Q

Most common benign lung lesion 3-4cn
Coin lesion
mature cartilage admixed with fat, fibrous tissue and blood vessel

A

hamartoma

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21
Q

Carcinoma with strongest association with smoking

A

Squamous cell

Small cell

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22
Q

Most common primary lung tumor

esp in women
never smokers
less than 45
metastasize at early stage

A

Adenocarcinoma

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23
Q

Two broad lung ca

bec

A

1 small cell
2 non small cell (adeno, squamous and large)

all small cell have metastasized by time of diagnosis, not curable by surgery

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24
Q

Small cell lung ca best tx

A

chemotherapy

with or without radiation

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25
Q

Lung CA pathogenesis

A

inactivating TSG on short arm of ch 3p
TP53 mutation
activation of KRAS oncogene

“field effect” seen even in lungs of smokers without lung cancer

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26
Q

Adenocarcinoma in nonsmoking women is due to mutation of

A

EGFR epidermal growth factor receptor
KRAS
EML4-ALK
cMET

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27
Q

Heavy smokers exposed to asbestos inc risk of lung cancer

A

55 times greater

28
Q

SCCs are common in smoking men and arise in

A

central major bronchi

large lesions undergo central necrosis giving rise to cavitation

29
Q

SCCs are preceded by

A

squamous metaplasia or dysplasia in bronchial epithelium -> carcinoma in situ

30
Q

SCCs histologically are seen as

A

Keratin pearls and

intercellular bridged

31
Q

Adenocarcinomas are located

A

peripherally with central scar

32
Q

Adenocarcinoma on histology

A

Acinar gland forming
Papillary
Mucinous
Solid with intracellular mucin

33
Q

Putative precursor for adenocarcinoma

A

atypical adenomatous hyperplasia

cuboidal -> low columnar with atypia

34
Q

Peripheral part of lung occuring as single nodule

diameter of 3cm or less, growth along preexisting structure and preservation of alveolar architecture

A

Adenocarcinoma in situ

Bronchioalveolar carcinoma

35
Q

Undifferentiated malignant epithelial tumor lacking cytologic features of small cell carcinoma without glandular or squamous differentiation

A

Large cell carcinoma

36
Q

Pale gray
centrally located masses with extension into lung parenchyma and involvement of hilar mediastinal nodes
Round fusiform shape, scant cytoplasm and finely granular chromatin
“Crush artifact” in small biopsy
Neuroendrocine expression

A

Small cell lung carcinoma

37
Q

Left supraclavicular node involvement in lung ca

A

Virchow node

38
Q

Destruction of first and second rib
Invasion of brachial or cervical sympathetic plexus causing severe pain in ulnar nerve or Horner’s (ipsi enopthalmos, ptosis, miosis abd anhidrosis)

A

Pancoast tumor

39
Q

Basophilic staining of vascular wall due to encrustation of DNA from necrotic tumor cell in small cell carcinoma

A

Azzopardi effect

40
Q 
Scant cytoplasm
Small hyperchromatic nuclei with fine chromatin
Indistinct nucleoli 
Diffuse sheet of cell 
Neuroendocrine marker + (chromogranin, enolase, synaptophysin)
Absent Mucin
ACTH, ADH, Gastrin and calcitonin
3p deletion, rb mutation and p54 mut
Complete response to chemo and radio
A

Small cell lung carcinoma

41
Q 
Abundant cytoplasm
Pleomorphic nuclei with coarse chromatin
Prominent nucleoli
Glandular or squamous architecture
Absent neuroendocrine
Present epithelial marker (CEA, cytokeratin)
Mucin in adenoCa
PTh-rp in SCC
3p deletion 
KRAS mut in adenoCa
EGFR in adeno, nonsmoker, women
ALK rearrangement in adeno, non, signet ring
A

Non small cell lung carcinoma

42
Q

Lung CA common mets

A

brain
liver
bone

43
Q

Better prognosis

44
Q

Paraneoplastic syndromes

A

1 hypercalcemia from PTH
2 Cushing syndrome
3 SIADH
4 neuromusc MG
5 clubbing and hypertrophic pulmonary osteoarthropathy
6 coagulation abno (migratory thrombo), nonbacterial endo

45
Q

Hypercalcemia is associated with

A

Squamous cell

46
Q

Hematologic syndromes are assoc with

A

adenocarcinoma

47
Q

Tumors 3cm or less charac by pure growth along preexisting structures (lepidic pattern) without stromal invasion are called

A

adenocarcinoma

48
Q

Paraneoplastic syndromes are caused by

49
Q

Carcinoid patterns

A

1 obstructing polypoid, spherical, intraluminal mass

2 mucosal plaque penetrating bronchial wall to fan out in peribronchial tissue (collar-button)

50
Q

Nests of uniform cell with regular round nuclei
Salt and pepper chromatin
Absent or rare mitosis

A

Typical carcinoid

51
Q

Higher mitotic rate
Focal necrosis
High incidence of lymph node and distant metastasis
TP53 mutation

A

Atypical carcinoid

52
Q

Represent continuum of inc histologic aggressiveness and malignant potential withib spectrum of pulmo neuroendocrine neoplasm

A

Typical, atypical, small cell

53
Q

Attacks of diarrhea
Flushing
Cyanosis

A

Carcinoid syndrome

54
Q

Transudate

A

hydrothorax

55
Q

Protein content greater than 2.9gm/dl

Inflammatory cell

56
Q

Cause of pleural exudate

A

1 microbe invasion(suppurative pleuritis, empyema)
2 cancer
3 pulmonary infarct
4 viral pleuritis

57
Q

Rare cancer of mesothelial cell in parietal and visceral pleura, peritoneum, pericardium

Related to asbestos exposure

A

Malignant mesothelioma

58
Q

Extensive pleural fibrosis and plaque formation
Ensheathed by yellow-white, firm, gelatinous layer of tumor
Distant metastasis rare

3 patterns:

A

Mesothelioma

Epithelial (most common), Sarcomatous (spindled, fibroblastic)
Biphasic (sarcomatous and epithelial)

59
Q

Mesotheliomas are associated with mutations in

A

p16/CDKN2A at ch9p21

NF2 at ch22q12

60
Q

Smooth, hemispherical protrusion less than 0.5cm on true vocal cords
Singer’s nodule, heavy smoker

A

Vocal cord nodule

61
Q

Benign neoplasm on true vocal cord
Soft raspberrylike excrescence more than 1cm
Multiple slender fingerlike projection by central fibrovascular cores

A

Laryngeal papilloma

Squamous papilloma

62
Q

Recur after excision
Multiple in children
Recurrent respiratory papillomatosis are caused by

A

HPV 6 and 11

regress after puberty from vertical transmission

63
Q

2% of all ca
40 yrs, M
Smokers, alcoholics and asbestos
HPV
SCC on vocal cord (glottic 60-75%), above and below
Pearly gray plaques on mucosa ulcerating, fungating
Hoarseness

A

Carcinoma of larynx

Location has bearing on prognosia since 90% located on larnyx without dense lymphatic supply vs supraglottic which metastasize into cervical LN

64
Q

Cause of death in laryngeal ca

A

Infection of distal respi passages

Metastases, cachexia

65
Q

Acute bacterial epiglottitis is causes by

A

H influenzae

66
Q

Diptheritic laryngitis is caused by

A

Corynebacterium diptheriae

dirty gray pseudomembrane

67
Q

Most common cause of laryngotracheobronchitis or croup

A

Parainfluenza

stridor

Pathology (24 decks)

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