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Pathology > Pulmonary, TBP > Flashcards

Pulmonary, TBP Flashcards

1
Q

2 types of acute respiratory failure

A

1) Hypoxic

2) Hypercapnic

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2
Q

Hypoxemic respiratory failure is characterized by pO2 levels of

A

Less than 60 mmHg

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3
Q

Hypercapnic respiratory failure is characterised by pCO2 level of

A

> 45mmHg

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4
Q

General mechanism of atelectasis

A

Airways and alveoli are unable to fill hence blood is shunted from arteries to veins without adequate oxygenation

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5
Q

Type of atelectasis: Lesion external to the lungs (pleural cavity)

A

Compressive

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6
Q

Type of atelectasis: Lesion in the airway

A

Obstructive/resorptive

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7
Q

Type of atelectasis: Loss of surfactant

A

Microatelectasis

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8
Q

Type of atelectasis: Localized or generalised fibrosis

A

Contraction

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9
Q

Disease of the lungs that impairs the ability of air to leave the alveoli during expiration

A

Obstructive lung disease

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10
Q

Obstructive lung diseases (4)

A

BACE

1) Bronchiectasis
2) Asthma
3) Chronic bronchitis
4) Emphysema

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11
Q

Disease process characterized by loss of pulmonary parenchyma (septae and walls) and dilation of terminal airways

A

Emphysema

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12
Q

Type of emphysema: Affects respiratory bronchioles

A

Centriacinar

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13
Q

Type of emphysema: Affects alveoli and alveolar acini and eventually respiratory bronchioles

A

Panacinar

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14
Q

Type of emphysema: Involves upper lobes

A

Centriacinar

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15
Q

Type of emphysema: Associated with smoking

A

Centriacinar

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16
Q

Type of emphysema: Involves lower lobes

A

Panacinar

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17
Q

Associated with α1-antitrypsin deficiency

A

Panacinar

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18
Q

Loss in emphysema: Pulmonary elastance vs pulmonary compliance

A

Pulmonary elastance

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19
Q

Mechanism of air-trapping in emphysema

A

When the patient breathes out, the airways collapse, trapping air because of reduced driving pressure

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20
Q

General mechanism of emphysema

A

Imbalance in protease-antiprotease and oxidant-antioxidant

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21
Q

Mechanisms of centriacinar emphysema by cigarette smoking (3)

A

1) Induction NFkβ that attracts neutrophils with resultant production of TNF and IL-8 that activate neutrophils causing them to release damaging proteases
2) Inactivation of antiproteases
3) Production of ROS

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22
Q

Complication of emphysema: Hypoxia-induced vasospasm and loss of vascular surface area

A

Pulmonary htn

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23
Q

Complication of emphysema: Right-sided heart failure secondary to pulmonary hypertension

A

Cor pulmonale

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24
Q

Complication of emphysema: Shunting of blood to areas of poor ventilation

A

VQ mismatch

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25
Q

Emphysema: Gross (2)

A

1) Spiderweb-like appearance

2) Bullae formation at pleural surface

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26
Q

Emphysema: Signs and symptoms

A

1) Pink puffers
2) Increased expiratory phase
3) ECG: Small amplitude QRS and right axis deviation

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27
Q

Classic type of tachycardia in COPD

A

Multifocal atrial tachycardia (MAT)

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28
Q

T/F Asthma is also associated with chronic inflammation

A

T

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29
Q

Type of asthma: A type I hypersensitivity

A

Atopic/allergic

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30
Q

Type of asthma: Strong familial tendencies

A

Atopic/allergic

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31
Q

Type of asthma: Viral infection

A

Non-atopic/non-allergic

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32
Q

Type of asthma: No family history

A

Non-atopic/non-allergic

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33
Q

Type of asthma: Normal IgE levels

A

Non-atopic/non-allergic

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34
Q

Type of asthma: Occurs more frequently in children

A

Atopic/allergic

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35
Q

Type of asthma: Occurs more frequently in adults

A

Non-atopic/non-allergic

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36
Q

Type of asthma: Exercise

A

Non-atopic/non-allergic

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37
Q

Type of asthma: Cold air

A

Non-atopic/non-allergic

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38
Q

Type of asthma: Hay fever and eczema

A

Atopic/allergic

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39
Q

Type of asthma: Pollen

A

Atopic/allergic

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40
Q

Type of asthma: Drugs

A

Non-atopic/allergic

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41
Q

Type of asthma: GERD

A

Non-atopic/allergic

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42
Q

Stage of asthma: Due to release of mediators from cells that promote bronchoconstriction

A

Early

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43
Q

Stage of asthma: Mast cell tryptase

A

Early

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44
Q

Stage of asthma: Enzymes from eosinophils and neutrophils

A

Late

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45
Q

Stage of asthma: Prostaglandins

A

Early

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46
Q

Stage of asthma: Responsible for morphologic changes

A

Late

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47
Q

Sloughed epithelial cells in mucous that cast in the shape of airways

A

Curschmann spirals

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48
Q

Composed of major basic protein from eosinophils

A

Charcot-Leyden crystals

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49
Q

Asthma, classic triad

A

1) Persistent wheezing
2) Chronic episodic dyspnea
3) Chronic nonproductive cough

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50
Q

Reason why asthma may be worse or only present at night time

A

Physiologic drop in cortisol secretion

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51
Q

Asthma symptom: Dark rings under eyes

A

Allergic shiners

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52
Q

Asthma symptom: Dark transverse crease on the nose

A

Allergic salute

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53
Q

Prolonged asthmatic attack that can be fatal

A

Status asthmaticus

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54
Q

CO2 in acute asthma exacerbation

A

Low due to hyperventilation

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55
Q

Often precedes respiratory failure in acute asthma exacerbation

A

Rising CO2 concentration

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56
Q

Basic description of chronic bronchitis

A

Productive cough for at least 3 MONTHS in 2 CONSECUTIVE YEARS

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57
Q

Chronic bronchitis: Pathogenesis

A

Chronic irritation of airway by cigarette smoke causing increased mucus production and hyperplasia of mucous-secreting glands

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58
Q

Measured in microscopic sections of chronic bronchitis

A

Reid index

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59
Q

Reid index

A

Thickness of mucous glands in relation to thickness of the wall

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60
Q

Reid index is a measure of

A

Submucosal gland hypertrophy

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61
Q

Reid index in chronic bronchitis

A

> 0.40

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62
Q

Signs and symptoms of chronic bronchitis

A

1) Blue bloaters

2) Hypercapnia

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63
Q

Refers to the abnormal permanent dilation of airways

A

Bronchiectasis

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64
Q

2 components required to bring about bronchiectasis

A

1) Infection

2) Obstruction

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65
Q

Bronchiectasis: Upper lobes vs lower lobes

A

Lower

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66
Q

Bronchiectasis: Right vs left lung

A

Right

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67
Q

Bronchiectasis: Characteristic cough

A

Large amounts of purulent sputum and hallitosis

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68
Q

Clubbing of fingers is aka

A

Pulmonary osteoarthropathy

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69
Q

Bronchiectasis: Chest radiograph

A

Parallel lines in peripheral lung fields representing non tapering thickened bronchial walls

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70
Q

Chronic bronchitis vs emphysema: Anatomic diagnosis

A

Emphysema

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71
Q

Chronic bronchitis vs emphysema: Clinical diagnosis

A

Chronic bronchitis

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72
Q

Cause of death in patients with COPD (2)

A

1) Respiratory acidosis

2) Cor pulmonale

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73
Q

COPD: Earliest symptom

A

Chronic productive cough

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74
Q

COPD: Characteristic PE

A

Barrel chest

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75
Q

COPD: 2 interventions demonstrated to influence natural history of disease

A

1) Smoking cessation

2) O2 therapy

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76
Q

Clinical term for acute restrictive lung disease

A

ARDS

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77
Q

Pathologic term for acute restrictive lung disease

A

Diffuse alveolar damage

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78
Q

Stages of diffuse alveolar damage (in order)

A

1) Exudative stage
2) Proliferative stage
3) Fibrosis

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79
Q

Stage of diffuse alveolar damage: Protein and necrotic cells layer out on the alveolar septa forming hyaline membranes

A

Exudative stage

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80
Q

Stage of diffuse alveolar damage: Type II pneumocytes undergo hyperplasia

A

Proliferative stage

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81
Q

4 main causes of diffuse alveolar damage

A

1) Severe pulmonary infection
2) Aspiration
3) Sepsis
4) Severe trauma with shock

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82
Q

Diffuse alveolar damage of undetermined etiology

A

Acute interstitial pneumonitis

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83
Q

Diffuse alveolar damage: Gross

A

Firm lungs

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84
Q

Diffuse alveolar damage: Microscopic

A

Depends on stage

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85
Q

Diffuse alveolar damage: Symptoms

A

Pink frothy sputum within 72h of exposure to inciting agent

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86
Q

4 categories of chronic restrictive lung disease

A

1) Autoimmune
2) Work-related
3) Drug-related
4) Idiopathic

87
Q

Autoimmune diseases that cause chronic restrictive lung disease (3)

A

1) SLE
2) Wegener’s
3) RA

88
Q

Work-related causes of chronic restrictive lung disease (3)

A

1) Asbestosis
2) Silica-induced lung disease
3) Coal-induced lung disease

89
Q

Drug-related causes of chronic restrictive lung disease

A

1) Bleomycin
2) Busulfan
3) Amiodarone
4) Methotrexate
5) O2 therapy

90
Q

Chronic restrictive lung disease: Gross

A

Honeycomb lung (end-stage ILD)

91
Q

Lung disease arising due to exposure to inorganic or organic dust or to chemical fumes or vapors

A

Pneumoconiosis

92
Q

Cancer associated with asbestosis

A

1) Bronchogenic

2) Mesothelioma

93
Q

T/F Asbestosis and smoking are synergistic for the development of bronchogenic CA

A

T

94
Q

Type of asbestos fibers: Straight and less soluble therefore penetrate deeper and more damaging

A

Amphibole

95
Q

Type of asbestos fibers: Curvy and more soluble, therefore do not penetrate as deeply as straight fibers and are cleared by mucociliary escalator

A

Chrysotile

96
Q

Complication of asbestosis brought about by exposure to amphibole fibers

A

Mesothelioma

97
Q

T/F Smoking increases the risk for development of mesothelioma in patients with asbestos exposure

A

F

98
Q

Refers to asbestos particles coated with iron by macrophages

A

Ferruginous bodies

99
Q

3 forms of coal-induced lung disease

A

1) Anthracosis
2) Simple coal workers’ pneumoconiosis
3) Complicated coal workers’ pneumoconiosis

100
Q

Form of coal-induced lung disease: Coalescence of pigment-laden macrophages into 1-2 mm macules and slightly larger nodules

A

Simple

101
Q

Form of coal-induced lung disease: Development of large scars (2-10cm) in the pulmonary parenchyma

A

Complicated

102
Q

Complicated coal workers’ pneumoconiosis is aka

A

Progressive massive fibrosis

103
Q

Acute vs chronic silicosis: Appears similar to pulmonary alveolar proteinosis

A

Acute

104
Q

Acute vs chronic silicosis: Nodular fibrosis, progressing to progressive massive fibrosis

A

Chronic

105
Q

Classic radiographic appearance of chronic silicosis (2)

A

1) Nodules on upper lobe

2) Eggshell-like calcification of hilar nodes

106
Q

T/F Silicosis predisposes to infection with mycobacteria

A

T

107
Q

Silicosis with infection to mycobacteria

A

Silicotuberculosis

108
Q

Pneumoconiosis characterised by the presence of granulomas in the alveolar septae

A

Chronic berylliosis

109
Q

Multisystem disease of probably immune etiology that produces noncaseating granulomas

A

Sarcoidosis

110
Q

Sarcoidosis: Most commonly affected organ

A

Lung

111
Q

Sarcoidosis: Second most commonly affected organ

A

LN

112
Q

Sarcoidosis: Smokers vs nonsmokers

A

Nonsmokers

113
Q

Sarcoidosis: Microscopic features

A

1) Noncaseating granulomas
2) Asteroid bodies
3) Schaumann bodies (concentrically calcified bodies)

114
Q

Sarcoidosis: Mechanism of hypercalcemia

A

Mononuclear cells produce the active form of vitamin D

115
Q

Sarcoidosis: Associated thymic abnormality

A

Pure thymic hyperplasia

116
Q

Disease occurring as a result of hypersensitivity to certain allergens that affects the alveolar septae

A

Allergic pneumonitis

117
Q

Disease-associaed cause of allergic pneumonitis: Pigeon breeder’s lung

A

Pigeon serum

118
Q

Disease-associaed cause of allergic pneumonitis: Humidifier lung

A

Thermophilic actinomyces

119
Q

Disease-associaed cause of allergic pneumonitis: Farmer’s lung

A

Mircopolyspora faeni (hay mold)

120
Q

2 causes of diffuse pulmonary hemorrhage

A

1) Goodpasture syndrome

2) Idiopathic pulmonary hemosiderosis

121
Q

Goodpasture syndrome is what type of hypersensitivity

A

Type II

122
Q

Antibodies in Goodpasture syndrome

A

Anti GBM specifically to a3 chain of Type IV collagen

123
Q

Goodpasture syndrome: Male vs female

A

Male

124
Q

Goodpasture syndrome: Type of glomerulonephritis

A

Crescentic

125
Q

Idiopathic pulmonary hemosiderosis: Children vs adults

A

Children

126
Q

Pulmonary htn: BP in pulmonary circulation

A

> 20 mmHg

127
Q

Pulmonary htn: More of primary vs secondary

A

Secondary

128
Q

Primary pulmonary htn: Male vs female

A

Female

129
Q

Primary pulmonary htn: Microscopy (4)

A

1) Medial hypertrpohy (Grade 1)
2) Intimal hypertrophy (Grade 2)
3) Pipestem fibrosis with near obliteration of lumen (Grade 3)
4) Plexiform pulmonary arteriopathy (Grade 4)

130
Q

Causative agent implicated in bacterial pneumonia in chronic alcoholics

A

Klebsiella pneumoniae

131
Q

Bronchopneumonia vs Lobar pneumonia: Patchy distribution of neutrophilic infiltrates and bacteria in 1 or many loves

A

Bronchopneumonia

132
Q

Bronchopneumonia vs Lobar pneumonia: Confined to 1 lobe of the lung

A

Lobar pneumonia

133
Q

Lobar pneumonia: Almost all cases due to

A

Streptococcus pneumoniae

134
Q

Bronchopneumonia vs Lobar pneumonia: Can occur in an otherwise healthy individual

A

Lobar pneumonia

135
Q

Lobar pneumonia: Morphologic stages

A

1) Edema and congestion
2) Red hepatization
3) Grey hepatization
4) Resolution

136
Q

Red vs grey hepatization: Neutrophils, fibrin, and RBCs

A

Red

137
Q

Red vs grey hepatization: Lysed RBCs, fibrin, macrophages

A

Grey

138
Q

Causative agent: Pneumonia with blood-tinged currant jelly sputum

A

Klebsiella pneumoniae

139
Q

Causative agent: Pneumonia often with extra pulmonary symptoms such as headache, hyponatremia, bradycardia, and diarrhea

A

Legionella pneumophila

140
Q

Typical vs atypical pneumonia: Follows a viral URTI

A

Typical

141
Q

Typical vs atypical pneumonia: Acute symptoms

A

Typical

142
Q

Typical vs atypical pneumonia: Moderate symptoms and PE findings

A

Atypical

143
Q

Typical vs atypical pneumonia: Viruses

A

Atypical

144
Q

Typical vs atypical pneumonia: Mycoplasma

A

Atypical

145
Q

Typical vs atypical pneumonia: Klebsiella

A

Typical

146
Q

Typical vs atypical pneumonia: Chlamydia

A

Typical

147
Q

Pneumonia-associated causative agent/s: Nosocomial (2)

A

1) G- bacilli

2) Pseudomonas

148
Q

Pneumonia-associated causative agent/s: Aspiration

A

Mixed aerobic and anaerobic flora

149
Q

Complication of aspiration pneumonia

A

Lung abscess

150
Q

Interstitial pneumonia: Microscopic

A

Lymphocytic infiltrate

151
Q

Interstitial pneumonia: Etiology

A

Viral or mycoplasmal

152
Q

Chronic pneumonia: Causative agents

A

1) M. tuberculosis

2) Dimorphic fungi

153
Q

Components of Ghon complex

A

1) Ghon focus

2) Enlarged hilar LN

154
Q

Refers to a granuloma at the periphery of the lung near the inter lobar grove

A

Ghon focus

155
Q

T/F Primary PTB lesions heal on their own

A

T

156
Q

T/F As the primary PTB lesion heals, the organism is eliminated by the body

A

F

157
Q

PTB that morphologically has the appearance of bronchopneumonia usually due to PTB in an immunocompromised patient

A

Primary progressive

158
Q

Hematogenous dissemination of M. tuberculosis to the lungs, liver, and spleen producing a millet seed appearance

A

Miliary tuberculosis

159
Q

PTB involvement of the vertebral column

A

Pott disease

160
Q

Dimorphic fungi that cause chronic pneumonia (3)

A

1) Histoplasma capsulatum
2) Blastomyces dermatitidis
3) Coccidioides immitis

161
Q

Dimorphic fungi-geographic distribution: Histoplasma capsulatum

A

Ohio and Mississippi River Valleys

162
Q

Dimorphic fungi-geographic distribution: Blastomyces dermatitidis

A

Overlap with H. capsulatum in central and southeastern US

163
Q

Dimorphic fungi-geographic distribution: Coccidioides immitis

A

San Joaquin Valley in California and Arizona

164
Q

CD4 count-likely associated organism: >200 cells/uL

A

Bacterial

165
Q

CD4 count-likely associated organism: Less than 200 cells/uL

A

Pneumocystis

166
Q

CD4 count-likely associated organism: Less than 50 cells/uL

A

CMV or M. avium-intracellulare

167
Q

Usual location of pulmonary abscesses

A

Lower lobes, more on the right

168
Q

Most common sites of metastases of pulmonary neoplasms in descending order

A

1) Liver
2) Brain
3) Bone

169
Q

3 types of non-small cell CA

A

1) SCC
2) AdenoCA
3) Large cell

170
Q

SCC of lung: Age

A

55-60

171
Q

SCC of lung: Gender

A

M

172
Q

SCC of lung: Location

A

Central

173
Q

SCC of lung: Risk factor

A

Cigarette smoking

174
Q

Lung CA with the highest rate of p53 mutations

A

SCC of lung

175
Q

SCC of lung: Associated condition

A

Hypercalcemia due to production of PTH-like protein

176
Q

SCC of lung: Gross

A

Cavitation

177
Q

SCC of lung: Microscopic

A

Keratin pearls

178
Q

AdenoCA of lung: Age

A

Less than 45

179
Q

AdenoCA of lung: Gender

A

F

180
Q

AdenoCA of lung: Location

A

Peripheral, perihilar

181
Q

AdenoCA of lung: Relation to smoking

A

Weak

182
Q

Growth of adenoma along alveolar septa is referred to as

A

Lepidic growth

183
Q

AdenoCA of lung: Classic symptom

A

Bronchorrhea

184
Q

Small cell lung CA: Gender/age

A

Older males

185
Q

Small cell lung CA: Location

A

Central, along bronchi

186
Q

Small cell lung CA: Risk factor

A

Smoking

187
Q

Small cell lung CA: Mutation

A

c-MYC and Rb

188
Q

Lung CA with associated paraneoplastic syndromes

A

Small cell lung CA

189
Q

Small cell lung CA: Associated paraneoplastic syndromes

A

1) ACTH, ADH, calcitonin

2) Lambert-Eaton syndrome

190
Q

Enlarged supraclavicular LN in pulmonary neoplasms

A

Virchow node

191
Q

External compression of SVC obstructing blood return to heart from upper body

A

SVC syndrome

192
Q

Erosion of lung tumor through apex of lung

A

Pancoast tumor

193
Q

Lung CA with no definitive squamoid or glandular differentiation

A

Large cell CA

194
Q

Source of pleural effusion, exudate: Elevated RBC count

A

1) Trauma

2) Malignancy

195
Q

Source of pleural effusion, exudate: Elevated WBC count

A

Empyema

196
Q

Source of pleural effusion, exudate: Elevated eosinophil

A

1) Collagen vascular disease
2) Pneumothorax
3) Hemothorac

197
Q

Source of pleural effusion, exudate: pH

A

1) Malignancy
2) RA
3) Infection

198
Q

Source of pleural effusion, exudate: Elevated amylase

A

1) Esophageal rupture

2) Acute pancreatitis

199
Q

Source of pleural effusion, exudate: TG > 100 mg/dL

A

Chylous effusion

200
Q

Sharp chest pain in pleural effusions is due to involvement of

A

Parietal pleura

201
Q

Defect in the pleura that acts as a one-way valve (ball-valve)

A

Tension pneumothorax

202
Q

T/F Most non tension pneumothorax spontaneously resolve

A

T

203
Q

Tension vs non tension pneumothorax

A

1) Mediastinal shift

2) Hemodynamic changes (hypotension and elevated JVP)

204
Q

Classic spontaneous pneumothorax exists in

A

Tall, thin, young male

205
Q

Malignant tumor of the pleural cavity derived from mesothelial cells

A

Mesothelioma

206
Q

Mesothelioma is almost always due to

A

Asbestos exposure

207
Q

Population where vocal cord nodules are seen

A

1) Singers

2) Smokers

208
Q

SCC of larynx: Present earlier due to earlier symptoms

A

Glottic

209
Q

SCC of larynx: Metastasize sooner

A

Supraglottic (rich in lymphatics)

210
Q

SCC of larynx: Less likely to metastasize

A

Glottic

211
Q

SCC of larynx: Most common location

A

Glottic

212
Q

SCC of larynx: Present late in the course of disease

A

Subglottic

213
Q

Refers to phenomena where development of CA in one area precede development in another or may by synchronous due to cigarette smoking

A

Field effect

Pathology (14 decks)

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