Respiratory Pathology

Question 1

What is being described:

• Hoarseness from recurrent laryngeal nerve compression
• Horner Syndrome
• SVC Syndrome
• Brachiocephalic Syndrome
• Brachial Plexus atrophy
• Phrenic nerve damage (hemidiaphragm paralysis)

Answer 1

Presence of a Pancoast Tumor

Question 2

What is being described: medical emergency. Obstruction of the SVC that impairs drainage from the head (facial plethora) that causes skin blanching, JVD, and UE edema. May raise intracranial pressure if severe.

Answer 2

Superior Vena Cava Syndrome

Raised Intracranial pressure results in headache, dizziness, and increased risk of aneurysm or rupture

Question 3

What are possible causes of SVC Syndrome?

Answer 3

• Malignancy (mediastinal mass, Pancoast tumor)

- Thrombus from indwelling catheters

Question 4

What may cause the Oxygen-hemoglobin dissociation curve to shift left?

Answer 4

Decreased H+
Decreased PCO2
Decreased 2,3-BPG
Decreased temperature 
————————————-
Increased CO (CO poisoning)
Increased methemoglobin (MetHg)
Increased HbF

Question 5

What may cause the Oxygen-hemoglobin dissociation curve to shift right?

Answer 5

Increased H+
Increased PCO2
Exercise 
Increased 2,3-BPG
High Altitude
Increased Temperature

Question 6

A 35yo Px presents with CO poisoning. What classic findings are associated with MRI imaging?

Answer 6

Globus pallidus lesions (bilateral)

Question 7

What will Cyanide toxicity do (in terms of shift) to Hb dissociation curve?

Answer 7

Nothing because O2 supply is ample at first, but it oxygen cannot be used due to ineffective oxidative phosphorylation.

Question 8

What disease is pathognomonic for: Ivory-white calcified, supradiaphragmatic and pleural plaques.

Answer 8

Asbestos related disease

Question 9

What is the most common head and neck neoplasms?

Answer 9

Squamous cell carcinoma, as it arises from different types of epithelial cells

Question 10

What are the different etiologies of a PE?

Answer 10

Fat, Air, Thrombus, Bacteria, Amniotic fluid, and tumor.

Air- nitrogen bubbles precipitate in divers (Caisson disease) or due to central line placement
Amniotic- due to uterine trauma, rare but high mortality

Question 11

This type of emphysema is characterized by smoking and affects the respiratory bronchioles while sparing distal alveoli.

Answer 11

Centriacinar emphysema

Question 12

This type of emphysema affects respiratory bronchioles and alveoli, associated with alpha1-antitrypsin deficiency. Frequently seen in lower lobes.

Answer 12

Panacinar emphysema

Question 13

This pathology is characterized by enlargement of air spaces, decreased recoil, increased compliance (imbalance of proteases, and antiproteases, causing increases elasticity, loss of elastic fibers, and increased Lung compliance), and decreased blood volume in pulmonary capillaries.

Answer 13

Emphysema
CRX: increased AP diameter, flattened diaphragm, increased Lung lucency. Chronic inflammation mediated by CD8+ cells, neutrophils, and macrophages

Question 14

Patient presents with a chronic necrotizing infection of the bronchi or obstruction that causes permanent dilated airways. This causes purulent sputum, recurrent infections, hemoptysis, and digital clubbing. What pathology is at hand and what could be the causative agent?

Answer 14

Bronchiectasis - associated with poor ciliary motility
Causes:
—> P. aeruginosa
- Kartagener Sd.
- Cystic fibrosis
- Allergic bronchopulmonary aspergillosis
- Tobacco smoking

Question 15

What is the diagnostic criteria for Chronic bronchitis?

Answer 15

Productive cough for >_ 3 months in a year, for >2 consecutive years

Question 16

Patient presents with wheezing, crackles, cyanosis, dyspnea, CO2 retention, and secondary polycythemia. What disease is at hand?

Answer 16

Bronchitis —> you see hypertrophy and hyperplasia of mucus-secreting glands in bronchi. Reid index (thickness of mucosal gland layer to thickness of epithelium and cartilage) is >50%.

Question 17

Patient presents lung disease that affect the upper lobes. Granulomatous appearing (noncaseating) on histology and there for occasionally unresponsive to steroids. Increased risk of cancer and Cor pulmonale. Affects upper lobes. What pathology is at hand? Associated with aerospace and manufacturing.

Answer 17

Berylliosis

Question 18

What pneumoconial infections affect the upper lobes, and which affect the lower lobes?

Answer 18

Upper: berylosis, Coal workers’ pneumoconiosis, and silicosis.

Lower: Asbestos

Question 19

Patient presents: intra-alveolar exudate —> consolidation; may involve entire lobe or whole lung.

Causative agents include: S. pneumoniae, Legionella, Klebsiella.

What is being described?

Answer 19

Lobar pneumonia

Question 20

Patient presents:
Acute inflammatory infiltrates from bronchioles into adjacent alveoli. Patchy distribution involving >_ 1 lobe.

Causative agents include: S. pneumoniae, S aureus, H influenzae, Klebsiella.

What is being described?

Answer 20

Bronchopneumonia

Question 21

Patient presents: Diffuse patchy inflammation localized to interstitial areas at alveolar walls; CXR shows bilateral multifocal opacities. Generally follows a more indolent course. (Walking pneumonia)

Causative agents include: Mycoplasma, Chlamydophilia pneumoniae, psittaci, Coxiella burnetti, Legionella, viruses (RSV, CMV, influenza, adenovirus).

What is being described?

Answer 21

Interstitial (atypical) pneumonia

Question 22

Patient presents: formally known as bronchiolitis obliterans organizing pneumonia (BOOP). Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure.

Etiology unknown. (-) sputum and blood cultures, often responds to steroids but not to antibiotics.

What is being described?

Answer 22

Cryptogenic organizing pneumonia

Question 23

Whatbare the types of Non-small cell carcinoma?

Answer 23

Adenocarcinoma
Squamous cell carcinoma
Large-cell lung carcinoma