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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
What is the pathogenesis of ILD?
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
What is top of your DDx if CXR shows "honeycomb lung"?
Interstitial lung disease
27
What is a top priority for patients newly diagnosed with usual interstitial pneumonia?
Get pt on transplant list as soon as possible | Respiratory failure normally occurs over 2-5 yrs
28
RBILD and DIP are closely associated with what risk factor?
Smoking
29
What are the inflammatory foci in sarcoidosis called?
Non-caseating granulomas
30
What risk factor is most closely associated with pneumoconiosis?
Occupational exposure Coal workers lung disease Silicosis Asbestosis
31
What type of WBC react to inhaled molecules in pneumoconiosis?
Macrophages
32
What is the difference b/t UID and asbestos lung disease?
Asbestos exposure | Pleural Plaques
33
What type of hypersensitivity is involved in hypersensitivity pneumonitis?
Type III (immune complex) and Type IV (cell mediated)
34
Bronchiolitis and interstitial giant cells are associated with what disease?
Hypersensitivity pneumonitis
35
What is a possible outcome of any disease which damages the alveolar-capillary structure via alveolar injury and/or endothelial cell injury?
ARDS
36
What happens when alveolar and endothelial cell injury occurs in ARDS?
Increased permeability and exudation of plasma proteins and inflammatory cells into the alveolus and interstitium Exudative hyaline fibrinous membrane and cellular exudate
37
Why does ARDS not respond to oxygen therapy?
Vascular shunting Ventilation-perfusion mismatch Increased stiffness of lung
38
What finding on CXR is common in ARDS?
Bilateral interstitial edema
39
How can infectious agents get into the lungs?
Inhalation of aerosol particles Aspiration of infected secretions from upper respiratory tract Aspiration of regurgitated gastric contents Hematogenous spread
40
What are common bacteria to blame for respiratory infections?
S. pneumonia, H. influenza, S. aureus, M. tuberculosis
41
What are common fungi involved in respiratory infection?
Aspergillus flavus, Candida albicans, Pneumocystis jiroveci
42
What are possible complications of pneumonia?
``` Pleural fibrosis Empyema Abscess Bronchiectasis Interstitial fibrosis Cysts ```
43
Patients with T cell dysfunction are most susceptible to what types of lung infection?
Bacterial Fungal Protozoan Viral
44
In what disease are Ghon's complexes seen?
Pulmonary Tuberculosis
45
What is primary disseminated TB?
Primary TB occurs in immunocompromised who develop cavitation and a military lung pattern
46
What is secondary TB?
reactivation of primary focus in individuals who develop immunodeficiency
47
What is primary localized TB?
granulomatous infection (Ghon lesion) which will drain to hilar lymph node with granulomatous caseous necrosis (Ghon complex)
48
What is the clinical presentation of lung cancer?
Local: Cough, Hemoptysis, Chest Pain, Wheeze, Dyspnea Systemic: Effusion, Pancoast, SVC, Paraneoplastic, Metastases
49
TNM staging of lung cancer takes into account what characteristics of disease?
``` 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
Lung cancer is most frequently diagnosed in what stage? (per pathology lecture)
Stage IV: 45% Stage III: 30% Stage I/II: 25%
51
What is the overall survival rate of lung cancer? (per pathology lecture)
15% Stage I 60% Stage II 40% Stage IIIa 20%

Clin Med - Pulmonary (13 decks)

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