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Clin Med - Pulmonary > Pulmonary Pathology > Flashcards

Pulmonary Pathology Flashcards

1
Q

What is the difference between transudate and exudate?

A

Transudate is an ultrafiltrate (like water, low in protein and cells)
Exudate is not an ultrafiltrate (serous, blood, pus, malignant, chyle)

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2
Q

Which disorders have pleural effusion with transudate?

A

CHF, Nephrotic syndrome, Cirrhosis

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3
Q

Which disorders have pleural effusion with exudate?

A

Inflammatory (SLE, RA)
Infectious (TB, pneumonia, empyema)
Reactive (embolus, diaphragm)
Malignant

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4
Q

What lab findings would indicate that pleural fluid is an exudate?

A

High fluid/serum protein
High fluid/serum LDH (lactate dehydrogenase)
High fluid cholesterol

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5
Q

What could cause a parietal pleura pneumothorax?

A

Trauma

Needle/catheter insertion

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6
Q

What could cause a visceral pleura pneumothorax?

A

Subpleural rupture

Subpleural lung necrosis

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7
Q

What is it called when a build up of connective tissue causes pressure on the lung? Air? Pus?

A

Connective tissue - Fibrothorax
Air - Pneumothorax
Pus - Empyema

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8
Q

What PFT finding is consistent with obstructive pulmonary disease?

A

FEV1/Total volume is markedly diminished

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9
Q

Are emphysema and chronic bronchitis small airway or large airway diseases?

A

Small airway

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10
Q

What causes restrictive diseases?

A

Scarring/Fibrosis

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11
Q

What causes permanent enlargement of lungs in emphysema patients?

A 
Parenchymal damage (loss of alveolar structure), loss of elastic recoil
Also decreases surface area for gas exchange
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12
Q

Are patients with emphysema or chronic bronchitis more likely to have infectious exacerbations?

A

Chronic bronchitis

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13
Q

What disease are the following complications associated with? Respiratory insufficiency, CO2 retention and respiratory acidosis, Secondary pulmonary hypertension, Right ventricular hypertrophy, Pneumothorax and lung collapse

A

Emphysema

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14
Q

Increased mucus secretions and mucopurulent exudates are common in emphysema or chronic bronchitis?

A

Chronic bronchitis

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15
Q

What are the differences b/t emphysema and chronic bronchitis?

A 
Emphysema:
Dyspnea > cough
Few infections
Cor pulmonale is rare
Low elastic recoil
Chronic Bronchitis:
Cough > dyspnea
Infectious exacerbations
Usual cor pulmonale
Normal elastic recoil
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16
Q

What does the BODE index include?

A

B - BMI
O - Obstruction of airflow: FEV1
D - Dyspnea
E - Exercise capacity, 6 min walk test

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17
Q

Asthma is what type of hypersensitivity disorder?

A

Type I - IgE

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18
Q

Goblet cell metaplasia is seen in which disease?

A

Asthma

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19
Q

What is the pathogenesis of asthma?

A

Airway inflammation and bronchial hyperreactivity
Sensitization by envirmonmental antiget of Type I IgE mediated hypersensitivity
Sensitized CD4 T cells (Th-2) release IL-4, IL-5 cytokines which promote IgE production, mast cell activation, recruitment of eosinophils
Elaboration of histamine, prostaglandins and leukotrienes

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20
Q

What are the histopathological findings in the lungs of an asthma patient?

A

Mucus in lumen of bronchus
Inflammation and basement membrane thickening
Enlarged mucous glands
Smooth muscle hyperplasia

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21
Q

What is bronchiectasis?

A

Abnormally dilated airways toward pleural surface due to obstruction and infection
Can be in cystic fibrosis, bronchial obstruction, immunodeficiency diseases, necrotizing bronchopneumonias

22
Q

What are the physical findings associated with bronchiectasis?

A 
Persistent cough
Purulent sputum
Dyspnea
Pleuritic chest pain
Hemoptysis
Fever, anorexia, weight loss
23
Q

Alveolitis, intra-alveolar macrophages, interstitial inflammation and intersitital fibrosis is seen in what group of diseases?

A

Interstitial lung disease

24
Q

What finding is expected on chest x-ray in interstitial lung disease?

A

Interstitial thickening

25
Q

What is the pathogenesis of ILD?

A

Injury and inflammation at alveolus
Pneumocyte type I loss, type II proliferation
Interstitial inflammation - mediators and cytokines that damage alveolar epithelium
Angiogenesis, myofibroblast, fibroblast proliferation
Interstitial collagen deposition and reorganization
End stage pulmonary scarring

26
Q

What is top of your DDx if CXR shows “honeycomb lung”?

A

Interstitial lung disease

27
Q

What is a top priority for patients newly diagnosed with usual interstitial pneumonia?

A

Get pt on transplant list as soon as possible

Respiratory failure normally occurs over 2-5 yrs

28
Q

RBILD and DIP are closely associated with what risk factor?

A

Smoking

29
Q

What are the inflammatory foci in sarcoidosis called?

A

Non-caseating granulomas

30
Q

What risk factor is most closely associated with pneumoconiosis?

A

Occupational exposure
Coal workers lung disease
Silicosis
Asbestosis

31
Q

What type of WBC react to inhaled molecules in pneumoconiosis?

A

Macrophages

32
Q

What is the difference b/t UID and asbestos lung disease?

A

Asbestos exposure

Pleural Plaques

33
Q

What type of hypersensitivity is involved in hypersensitivity pneumonitis?

A

Type III (immune complex) and Type IV (cell mediated)

34
Q

Bronchiolitis and interstitial giant cells are associated with what disease?

A

Hypersensitivity pneumonitis

35
Q

What is a possible outcome of any disease which damages the alveolar-capillary structure via alveolar injury and/or endothelial cell injury?

A

ARDS

36
Q

What happens when alveolar and endothelial cell injury occurs in ARDS?

A

Increased permeability and exudation of plasma proteins and inflammatory cells into the alveolus and interstitium
Exudative hyaline fibrinous membrane and cellular exudate

37
Q

Why does ARDS not respond to oxygen therapy?

A

Vascular shunting
Ventilation-perfusion mismatch
Increased stiffness of lung

38
Q

What finding on CXR is common in ARDS?

A

Bilateral interstitial edema

39
Q

How can infectious agents get into the lungs?

A

Inhalation of aerosol particles
Aspiration of infected secretions from upper respiratory tract
Aspiration of regurgitated gastric contents
Hematogenous spread

40
Q

What are common bacteria to blame for respiratory infections?

A

S. pneumonia, H. influenza, S. aureus, M. tuberculosis

41
Q

What are common fungi involved in respiratory infection?

A

Aspergillus flavus, Candida albicans, Pneumocystis jiroveci

42
Q

What are possible complications of pneumonia?

A 
Pleural fibrosis
Empyema
Abscess
Bronchiectasis
Interstitial fibrosis
Cysts
43
Q

Patients with T cell dysfunction are most susceptible to what types of lung infection?

A

Bacterial
Fungal
Protozoan
Viral

44
Q

In what disease are Ghon’s complexes seen?

A

Pulmonary Tuberculosis

45
Q

What is primary disseminated TB?

A

Primary TB occurs in immunocompromised who develop cavitation and a military lung pattern

46
Q

What is secondary TB?

A

reactivation of primary focus in individuals who develop immunodeficiency

47
Q

What is primary localized TB?

A

granulomatous infection (Ghon lesion) which will drain to hilar lymph node with granulomatous caseous necrosis (Ghon complex)

48
Q

What is the clinical presentation of lung cancer?

A

Local: Cough, Hemoptysis, Chest Pain, Wheeze, Dyspnea
Systemic: Effusion, Pancoast, SVC, Paraneoplastic, Metastases

49
Q

TNM staging of lung cancer takes into account what characteristics of disease?

A 
Tumor (histologic type and grade, size and distance from bronchial margin, invasion of pleura and adjacent structures, obstructive pneumonia)
Lymph Node (bronchial, hilar, mediastinal)
Metastases
50
Q

Lung cancer is most frequently diagnosed in what stage? (per pathology lecture)

A

Stage IV: 45%
Stage III: 30%
Stage I/II: 25%

51
Q

What is the overall survival rate of lung cancer? (per pathology lecture)

A

15%
Stage I 60%
Stage II 40%
Stage IIIa 20%

Clin Med - Pulmonary (13 decks)

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