Pulmonary Pathology II

Question 1

Idiopathic Pulmonary Fibrosis
Risk Factors (3), Presentation (3) and Diagnosis (4)

Answer 1

Urban Living
Smoking
Older age

SOB
Velcro-like lung crackles
Honeycomb basilar infiltrates
Bad prognosis

Biopsy shows:
Normal areas, inflammation, fibroblast foci, Peripheral honeycombing fibrosis

Question 2

Non-Specific Interstitial Pneumonia

Associated Group, Histology (2)

Answer 2

Older non-smoking females

Bilateral, symmetrical infiltrates and fibrosis

Question 3

Cryptogenic Organizing Pneumonia

Presentation, Histology, Prognosis

Answer 3

Pneumonia-like consolidation in 50s and 60s

Fibroblast foci called Masson Bodies

Very good when treated with corticosteroids

Question 4

Sarcoidosis
Histology (3), Diagnosis, Presentation (4)

Answer 4

Non caseating granuloma
Asteroid Body
Schaumann Body

Diagnosed with incidental radiograph

Lymphadenopathy
Dyspnea
Fibrosis
Increased serum ACE**

Question 5

Hypersensitivity Pneumonitis

Types with Exposures (3) and Diagnosis

Answer 5

Pigeon Breeder’s Lung: protein in feces
Farmer’s Lung: actinomyces in hay
Hot Tub Lung: mycobacterium avium complex

Diagnosed with detailed history

Question 6

Desquamative Interstitial Pneumonia

Population, Histology, Prognosis

Answer 6

Smokers in 40s/50s

Alveoli stuffed with Macrophages**

Good with corticosteroids and smoking cessation

Question 7

Respiratory Bronchiolitis-Interstitial Lung Disease

Population, Diagnosis (3)

Answer 7

Smokers in their 30s/40s

Peribronchiolar metaplasia**
Macrophages in alveoli
Fibrosis

Question 8

Langerhans Cell Histocytosis

Population, Pathogenesis (3) and Histology (2)

Answer 8

Young smokers

Stellate shaped lesions scar
Cysts form that rupture
Hemorrhage causes pneumothorax

CD1A+ histiocytes
Abundant eosinophils

Question 9

Pulmonary Alveolar Proteinosis

Pathogenesis (2) and Diagnosis

Answer 9

Impaired GM-CSF production (mostly autoimmune)
Surfactant accumulates in alveoli

Bronchioalveolar lavage yields copious milky fluid

Question 10

Pulmonary Embolism
Risk Factors (3), Complications (2)

Answer 10

Immobilization (DVT)
IV Drug Use (Talc embolus, Septic embolus)
Trauma (Marrow/Fat embolus)

Pulmonary infarct: wedge shaped necrosis
Cor pulmonale (saddle embolus)
No pulmonary infarct with saddle embolus

Question 11

Pulmonary Hypertension

Pressure, Causes (3) and Lesion

Answer 11

> 25 mmHg

Mostly secondary to CHF or Chronic Pulmonary Dz
Can see Primary Pulmonary HTN

Plexiform lesion (knot of blood vessels)

Question 12

Pulmonary Hemorrhage Syndromes

Types (3)

Answer 12

Goodpasture Syndrome
Type II hypersensitivity - Ab to collagen subunit in lung/kidney basement membrane

Granulomatosis with Polyangitis

Idiopathic Pulmonary Hemosiderosis

Question 13

Lobar Pneumonia

Complications (3) and Stages (4)

Answer 13

Abscess
Empyema
Bacteremia (sepsis)

Congestion: vessels enlarge

Red Hepatization: RBCs and inflammation

Gray Hepatization: Inflammation and Debris

Resolution: Fibrosis and Macrophages

Question 14

Typical Bacterial Pneumonia

Bacteria with Descriptions (6)

Answer 14

Streptococcus pneumoniae
Lancet shaped diplococci, most common cause

Haemophilus influenzae
Highly virulent in kids, vaccine to Protein B

Staphylococcus aureus
mostly in IVDU, forms abscesses

Klebsiella pneumoniae
mostly alcoholics, red currant jelly sputum

Pseudomonas aeruginosa
mostly cystic fibrosis patients

Moraxella catarrhalis
Mostly elderly patients

Question 15

Atypical Bacterial Pneumonia

Bacteria with Descriptions (2)

Answer 15

Mycoplasma pneumoniae
smallest organism, no cell wall

Legionella pneumophila
Grows in warm fresh water and is airborne
(AC units, hot tubs)

Question 16

Pneumonia Presentation

Typical (3) vs Atypical (4)

Answer 16

Typical: Abrupt onset, Pulmonary sx, Consolidation on CXR

Atypical: Slow onset, Systemic Sx, Patchy infiltrates on CXR, Younger population

Question 17

Antigenic Shift (2) vs Drift (3)

Answer 17

Drift: minor changes that increase spread, people maintain immunity so only epidemics

Shift: major genomic alterations that cause pandemics, associated with animal gene products

Question 18

Viral Pneumonia Causes (4)

Answer 18

Influenza virus Type A
Respiratory syncytial virus
Human Metapneumovirus
Corona Virus (severe acute respiratory syndrome)

Question 19

Respiratory Syncytial Virus

Presentation (3) and Complications (2)

Answer 19

Wheezing, grunting cough
Dyspnea
Cyanosis

Bronchiole inflammation and mucus occludes airway

Question 20

Influenza A Symptoms (6)

Answer 20

Abrupt onset
3-4 day Fever
Severe aches
Chills
Fatigue
Headache

Question 21

Bacterial vs Viral Pneumonia

Histology (2) and Presentations (3/4)

Answer 21

Bacteria in alveoli
Virus in interstitium

Bacteria: high fever, crackles, lobar distribution
Virus: Epidemics, no fever, wheezes, diffuse infiltrate

Question 22

Lung Abscess

Description and Causes (3)

Answer 22

Suppurative destruction of the lung parenchyma within the central area of cavitation

Aspiration pneumonia (elderly and alcoholics)

Staphylococcus aureus or Klebsiella pneumoniae infections

Question 23

Pulmonary Tuberculosis

Primary and Secondary

Answer 23

Initial infection forms primary complex (Ghon complex)
Good immune system scars over and heals
Bad immune system makes it go latent

Latent Tb can progress to secondary Tb
Caseating granulomatous inflammation
Disseminated Miliary Tb

Question 24

Chronic Pneumonia Fungal Infections

Fungus (3), Locations, Morphology and Presentation

Answer 24

Histoplasma capsulatum
Endemic to midwest, Pumpkin seed appearance
Calcified coin lesion granuloma

Blastomyces dermatitides
Endemic to Ohio and Mississippi river valleys
Broad-Based-Budding
Self limiting granuloma

Coccidiodes immitis
Endemic to SW US
Eosinophilic granulomatous response

Question 25

Immunocompromised Pneumonia Infections

Bacteria with Descriptions (2)

Answer 25

Pneumocystis jiroveci
AIDS defining illness with non-specific radiography

Mycobacterium avium complex
slender rod shaped bacteria on acid fast stain

Question 26

Lung Death

Transplant vs Infection

Answer 26

Rejection shows perivascular mononuclear infiltrates

Infection often caused by candida, pneumocystis, aspergillus