Respiratory Flashcards
What is a Pulmonary Abscess composed of? What is its most common cause?
Pus accompanied by the destruction of pulmonary parenchyma (alveli, airways, and blood vessels)
It is most commonly caused by aspiration as in the setting of depressed consciousness.
It is also a common complication of lung cancer, lobar pneumonia, and bronchopneumonia
What additional finding is expected to see in a CXR of a Pulmonary abscess?
Air Fluid Level (as a result of the abscess cavity being partially filled with pus and air)
Inflammation can be seen in the surrounding pulmonary parenchyma
With what is foul smelling sputum associated?
- A pulmonary abscess that is connected to a bronchus
- Bronchiectasis
Where is bronchiectasis localized to?
Segment of the lung distal to mechanical obstruction of a bronchus by a bariety of lesions, including tumors, inahled foreign bodies, mucous plugs and compressive lymphadenopathy
Empyema
collectiono f pus with fibrous walls that follows the spread of bacterial infection to the pleural space
What are the complications of bacterial pneumonia?
Pleuritis (extension of inflammation to the pleural space)
Pleural Effusion
Pyothorax (infection of pleural effusion)
Pulmonary Abscess
Pulmonary Fibrosis
What often accompanies a Ghon complex?
A pleural effusion
Describe the pattern expected in the histological studies in the lungs of a 3 day newborn girl who is infected by CMV
ALVEOLAR macrophages/ pneumocytes CELLS ARE VERY LARGE AND DISPLAY BASOPHILIC NUCLEAR INCLUSIONS, WITH A PERIPHERAL HALO and Multiple Cytoplasmic basophilic inclusions
What is the consequence of viral infection of lung parenchyma?
DAD (Diffuse alveolar damage) and Interstitial Pneumonia
What organism is typically seen in pigeon droppings? What would this organism stain positively for in a mucicarmin stain ?
Cryptococcus Neoformans
Positive for Capsular Polysaccharides
The most frequent cause of infectious Pneumonia in AIDS
The fungus, Pneumocytis jiroveci formerly Pneumocystis carinii
What would be microscopic finidngs in a patient with Pneumocystis jiroveci?
Lesion: Interstitial Infiltrate of plasma cells and lymphocytes, diffuse alveolar damage, and hyperplasia of Type II Pneumocytes. The alveoli are filled with a characteristic foamy exudate. The organisms appear as small bubbles in a background of proteinaceous exudates.
Bronchoalveolar lavage specimens: impregnated with silver shows a cluster of cysts - crescent moon bodies (round and indented)- approximately 5 micrometers in diameter.
What subset of patients often get Mycobacterium avium-intracellulare (MAI) complex?
Describe the syndrome.
1/3 of all patients with AIDS (because low helper T cells -cd4pos- cripples the immune response.
Pneumonia with Infiltrate of macrophages
Proliferation of MAI and the recruitment of macrophages produce expanding lesions, ranging from epithelioid granulomas containing few organisms to loose aggregates of foamy macrophages.
Symptoms resemble TB
When is Traumatic Pneumothorax often seen?
After aspiration f=of fluid from the pleura (Thoracentesis)
Pleural or Lung Biopisies
Transbronchial Biopsies
Positive Pressure-Assisted Ventilation
What are some causes of Atelectasis?
- Pneumothorax
- Surfactant Deficiency
- Compression of the Lungs
- Bronchial Obstruction
What are some causes of Diffuse Alveolar Damage?
- Respiratory Infections
- sepsis
- Shock
- Aspiration of gastric contents
- Inhalation of toxic gases
- Near- Drowning
- Radiation Pneumonitis
- Drugs and other chemicals
Desqumative Interstitial Pneumonia
Chronic. fibrosing, interstitial pneumonitis of unknown etiology
Describe the filling seen in alveolar proteinosis
Granular, Proteinacous, Eosinophilic, PAS + , Diastase Resistant, and Lipid Rich Material
What states are associated with Alveolar Proteinosis?
Disease states: Lymphoma , Leukemia, Respiratory Infections
Other states: Exposure to environmental inorganic dusts, compromised immunity
How would you expect the lungs of a patient suffering from hypersensitivity pneumonitis to be?
The lung contains poorly formed granulomas
What is the most important action of alpha1 antitrypsin in the lung?
Inhibition of Neutrophil Elastase, an enzyme that digests elastin and other structural components of the alveolar septa
What are some complications of chronic bronchitis
COPD, exertional dyspnea , cyanosis, cor pulmonale (cyanosis and edema= BLUE BLOATER)
Increased risk of infection
A histologic exam of a lungs of a patient with status asthmaticus would reveal:
A bronchus containing a luminal mucous plug Submucosal gland hyperplasia Smooth muscle hyperplasia Basement Membrane Thickening Increased Number of Eosinophils
Describe Lymphocytic Interstitial Pneumonia and what conditions it is asscoiated with
Lymphoid infiltrates are distributed diffusely in the interstitial spaces of the lung.
LIP occurs in clinical settings such as Sjogren syndrome and HIV infection. It can lead to end stage lung disease and respiratory failure
What characterizes Lymphangioleiomyomatosis?
It’s an Interstitial Lung Disease with:
Abnormal proliferation of smooth muscle in the lung
Mediastinal and Retroperitoneal Lymph Nodes
Major Lymphatic Ducts
B/L Diffuse enlargement, with extensive cystic changes resembling those of emphysema
What are some promising treatments of Lymphangioleiomyomatosis?
Hormonal ablation through oophorectomy
Antiestrogen and antiprogesterone therapy
Describe Goodpasture syndrome
It’s an autoimmune disease in which autoantibodies bind to the noncollagenous domain of type IV collagen (a structural component of both pulmonary and glomerular basement membranes of capillaries)
Type II Hypersensitivity:
Local complement activation results in the recruitment of neutrophils, tissue injury, pulmonary hemorrhage, and glomerulonephritis
What can be found in the alveolar septa and spaces of eosinophilic pneumonia?
Alveolar spaces: eosinophils and macrophages Alveolar septa (thickened): eosinophils and hyaline membranes
What is the treatment for Eosinophilic pneumonia?
Corticosteroids
What is a hamartoma composed of?
Cartilage Fibromyxoid connective tissue Fat Bone Smooth Muscle occasionally
What are some characteristic findings of hamartomas on chest radiographs?
“coin” lesions (10% of coin lesions are hamartomas)
“popcorn” pattenrn of calcification is see by x-ray
Well differentiatied squamos cell carcinomas display waht features?
Keratin “pearls” - small round nest of brightly eosinophilic aggregates of keratin surrounded by concentric layers of squamous cells (onion skin)
Adenocarcinoma usually presents as ______.
A peripheral subpleural mass composed of neoplastic gland-like structures .
Peripheral lung cancers are most commonly diagnosed as adenocarcinomas. (Central/hilar cancers of the lungs can be of any of the following: Large cell carcinoma, small cell carcima, squamous cell carcinoma)
Which part of the lung is associated with Mesothelioma?
Pleura most often (tend to spread locally and extensively within the chest cavity, but do not typically invade the pulmonary parenchyma- widespread metastases can occur)
It also occurs in the Peritoneum, Pericardium and the Tunica Vaginalis of the testis.
Describe the neoplastic cells seen in large cell carcinoma
atypical and don’t resemble any normal cells in the lungs
Where do the cells of bronchioloalveolar carcinoma originate from ? Where do they grow?
Originate from stem cells in the terminal bronchioles
They grow along the alveolar septa
What are the histologic characteristics of bronchioloalveolar carcinoma cells?
They may be columnar and mucus producing OR
They may be cuboidal
They are similar to Type II Pneumocytes
What are the histological and clinical characteristics that distinguish Small Cell Carcinoma from Carcinoid Tumors
Both contain Nueoroendocrine granules BUT in carcinoid tumors, the tumor cells are arranged in a distinctive pattern
(Carcinoid tumors have Organoid growth pattern and Uniform Cytologic Features/ carcinoid tumors exhibit a nueroendrocrine differentiation similar to that of resident Kulchitsky cells )
Cushing Syndrome is often encountered in patients with small cell carcinoma and is NOT seen in carcinoid tumor
(carcinoid tumor is indolent and half of the patients are asymptomatic at the time of presentation, but regional lymph node metastases occur in 20% of patients/atypical carcinoids are more aggressive)
What microscopic and clinical features are seen in Mesothelioma?
Pleural Effusions
Pleural Mass
Chest Pain
Non specific symptoms (weight loss and malaise)
Biphasic pattern (Epithelial and sarcomatous elements)
What occupational exposure is associated with mesotheloma?
asbestos
Chlyothorax
lymph in pleural space
Lymphatic obstruction leads to a mily, lipid-rich fluid in the pleural cavity.
It is a rare complication of malignant tumors in the mediastinum, such as lymphoma
