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Step One > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

What is rhinosinusitis? Symptoms? Causes? What can it lead to?

A

obstrution of sinus drainage into nasal cavity leading to inflammation and pain over affected area

Viral URI

May lead to superimposed bact infeciton such as S. pneumo, H. influenzae, M. catarrhalis

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2
Q

What is nasopharyngeal CA? Association? Epid? Biopsy? Presentation?

A

malignant tumor of nasopharyngeal epithelium

EBV: african children and chinese adults

Pleomorphic keratin-positive epithelial cells in backgrond of lymphocytes

Involvement of cervical nodes

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3
Q

What is epistaxis? Where does it most commonly occur (which vessels)? Where can life threatening hemorrhages occur? Which vessels?

A

Nose bleed

Anterior segment of nostril (kiessebach plexus)

Posterior segment (sphenopalatine artery of maxillary artery)

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4
Q

What is a vocal cord nodule? What causes it? Location? What is it composed of? Presentation? Treatment?

A

Singer’s nodule

Excessive use of vocal cords

Bilateral nodule on true vocal cords

Degenerative (myxoid) CT

Hoarseness

Resting of voice

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5
Q

What is a laryngeal papilloma? What causes it? Presentation?

A

Benign papillary tumor of the vocal cord

HPV 6 and 11; single in adults, multiple in children

hoarseness

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6
Q

What is laryngeal CA? What does it arise from? Risk factors? Presentation?

A

squam. cell CA arising from vocal cord epithelial lining

Alcohol and tobacco

hoarseness; also cough and stridor

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7
Q

What are the symptoms of a DVT? What puts people at risk? What do 95% of PE arise from? What is Homan sign? What is the treatment?

A

Swelling, redness, warmth, pain

Virchow triad

proximal deep veins of LE

Dorsiflexion of foot–>calf pain

Heparin or LMWH for acute management

Warfarin for treatment (long term)

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8
Q

What is the pathophys of pulmonary emboli? Symptoms? Diagnosis?

A

V/Q mismatch leasd to hypoxemia leads to respiratry alkalosis (incr. breathing).

Sudden onset dyspnea, chest pain, tachypnea, and tachycardia
Sudden death

CT pulmonary angiography

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9
Q

What is the pathophys of obstructive lung diseases? What happens to the PFTs? What happens to vasculature?

A

Obstruction of air flow resulting in air trapping in lungs. Airways close prematurely at high lung volumes.

Incr. RV and decr. FVC

Very Decr. FEV1

Decr. FEV1/FVC ratio (hallmark)

V/Q mismatch

Chronic hypoxic pulmonary vasoconstriction can lead to cor pulmonale

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10
Q

What is the pathology of chronic bronchitis? How is the diagnosis made? What are the findings?

A

Blue bloater

Hyperplasia of mucus secreting glands in bronchi leads to reid index (ratio of glands to wall thickness) >50%

Productive cough for >3 months per year for at least 2 yeras

Wheezing, crackles, cyanosis (early onset hypoxemia due to shunting), late onset dyspnea, CO2 retention, Secondary polycythemia

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11
Q

What is the pathology of emphysema? What are the two types are what are they associated with? Pathophys? CXR finding? How do they breath? Symptoms?

A

Enlargement of air spaces, decreased recoil, incr compliance, decr. diffusing capacity for CO resulting from destruction of alveolar walls.

Centriacinar: smoking
Panacinar: alpha 1 antitrypsin

Incr. elastase activity leads to loss of elastic fibers leading to incr. lung compliance

Pursed lip breathing

Barrel shaped Chest

Severe dyspnea

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12
Q

What is the pathology of asthma? What are some speficic histological findings and what causes them? What triggers it? Diagnosis? Findings?

A

Bronchial hyperresponsiveness cuases reversible bronchoconstriction.

Smooth muscle hypertrophy
Curschmann spirals (shed epithelium forms whorled mucus plugs)
Charcot-Leyden crystals (eosinophilic, hexagonal, double pointed, needle like crystals formed from breakdown of eosinophils in sputum)

Viral URIs, allergens, stress

Methacholine challenge

Cough, wheezing, tachypnea, dyspnea, hypoxemia, decr. insp/exp ratio, pulsus paradoxus, mucus plugging

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13
Q

What is the pathology of bronchiectasis? Symptoms? Associations/causes?

A

chronic necrotizing infection of bronchi leading to permanently dilated airways.

Purulent sputum, cough, dyspnea, recurrent infections, hemoptysis

Bronchial obstruction, poor ciliary function (smoking, kartageners), CF, allergic bronchopulmonary aspergillosis)

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14
Q

What is the pathology of restrictive lung disease? PFTs? What are the two main types/etiologies and how do their findings differ?

A

Restricted lung expansion causes decr. lung volumes.

Decr. FVC and TLC
FEV1/FVC ratio is greater than or equal to 80%

Poor breathing mechanics: extrapulmonary, peripheral hypoventilation, normal A-a gradient

Interstitial lung diseases: decr. pulm. diffusing capacity, incr. A-a gradient

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15
Q

What are some examples of poor breathing mechanics that lead to RLD? What are some interstitial lung diseases?

A

Poor muscular effort: Polio, myasthenia gravis
Poor structural apparatus: scoliosis, morbid obesity

ARDS, NRDS, Pneumoconioses (coal workers, silicosis, berylliosis, asbestosis), sarcoidosis, idiopathic pulmonary fibrosis, goodpasture syndrome, Wegener, eosinophilic granuloma, hypersensitivity pneumonitis, drug toxicity

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16
Q

What is the pathophys of idiopathic pulmonary fibrosis? Histology? Symptoms? Treatment?

A

Repeated cycles of lung injury leadin to TGF-beta release leading to fibrosis

Progressive dyspnea and cough

Honeycomb lung

Transplant

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17
Q

What is the pathophys of sarcoidosis? Epid? Affected organs? Findings/syptoms?

A

Noncaseating granulomas in multiple organs (CD4 helper t cells

African american males

bilateral hilar LAD
uveitis
cutaneous nodules or erythema nodosum
salivary and lacrimal glands (sjogren like)

Incr ACE in serum
hypercalcemia
dyspnea or cough

18
Q

What is pathophys of hypersensitivity pneumonitis? Symptoms? epid?

A

mixed type III/IV HSR to environmental antigen

Dyspnea, cough, chest tightness, headache

Farmers and those exposed to birds

19
Q

What are 4 examples of pneumoconioses? What do they increase risk for? What is caplan syndrome?

A

coal workers pneumoconioses, silicosis, berylliosis, asbestosis

Incr. risk of cor pulmonale and Caplan syndrome (RA with pneumocon. with intrapulmonary nodules)

20
Q

Epid. of asbestosis? Gross path? What does it increase risk for? What part of lung? Micro histo?

A

Shipbuilding, roofing and plumbing

Ivory white, calcified, supradiaphragmatic and pleural plaques

Incr. incidence of lung cancer (bronchogenic > mesothelioma)

asbestos (ferruginous) bodies are golden brown fusiforms rods resembling dumbells found in alveolar septum

21
Q

Epid. of berylliosis? What part of lungs? HIstology?

A

Aerospace and manufacturing

Granulomatous (Tb mimicker)

Upper lobes

22
Q

pathophys of coal workers pneumo? Location in lungs? What is anthracosis?

A

prolonged exposure to coal dust leads to macrophages laden with carbon leading to inflamm. and fibrosis

Black lung disease

Upper lobes

Asymptomatic coal dust in lungs (urban dwellers/sooty air)

23
Q

What is the epid. or silicosis? Pathophys? Incr susceptibility to what? How? Incr. risk of what? histology? Location in lung?

A

Foundries, sandblasting, mines

Macrophages respond to silica and release fibrogenic factors leading to fibrosis.

Disrupts phagolysosomes which may lead to Tb

Bronchogenic CA

Upper lobes

Eggshell calcification of hilar lymph nodes

24
Q

What is the pathophys of NRDS? What lab value is predictive of it? What are some complications? What are some complications due to supplemental O2? Risk factors for it? What is the treatment? Histology? CXR findings?

A

Surfactant defic leading to incr. surface tnesion leading to alveolar collapse

Lecithin:sphingo ratio

25
How is ARDS characterized? What may cause it? Pathophys/histology? What is the initial damage due to? How is it managed?
Acute onset respiratory failure Bilateral lung opacities Decr. PaO2/FiO2 No HF Trauma, sepsis, shock, gastric aspiration, uremia, acute pancr, amniotic fluid embolism. Release of neutrophilic substances toxic to alveolar wall, activation of coag cascade, and oxygen derived free radials This leads to diffuse alveolar damage leading to incr. alveolar capillary permeability leading to a protein rich leakage into alveoli and non cardiogenic pulmonary edema Intraalveolar hyaline membranes Mech. ventilatin with low tidal volumes (PEEP)
26
What is sleep apnea? What des it lead to? What does nocturnal hypoxia lead to? What is the cause of obstructive lseep apnea? ASsciations? Causes? Treatment? What is central sleep apnea? What does it lead to? What is obesity hypoventilation syndrome? How does it differ from obstructive sleep apnea?
Repeated cessation of breathing > 10 sec during sleep leads to disrupted sleep leading to daytime somnolence NOrmal PaO2 during the day Nocturnal hypoxia leads to systemic/pulmonary hypertension, arrhythmias (a fib/flutter), sudden death ``` Obstructive: resp. effor against airway obstruction Obesity, loud snoring Adults: excess parapharyngeal tissue Children: adenotonsillar hypertrophy Weight loss, CPAP, surgery ``` Central: no resp. effort (due to CNS injury/toxicity) Hypoxia leading to incr. EPO release leading to erythropoesis Obesity Hypoventilation: Obesity leads to hypoventilatin (decr. RR) leading to decr. PaO2 and incr. PaCO2 at night but PaCO2 continues throughout day.
27
What is a normal mean pumonary artery pressure? What is it in pulmonary hypertension? What does it lead to (histo)? What is the disease course (syptom progression)? What are the 5 classification groups?
NOrmal=10-14 mmHg PH >= 25 mmHg Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulm. arteries Severe resp. distress then cyanosis and RVH then death from decomp. cor pulmonale ``` Pulm. art. hypertension (idiopathic) Due to left heart disease due to lung diseases or hypoxia chronic thromboembolic PH Multifactorial ```
28
What is the cause of PAH? Mutation? Prognosis? Disease processes included in it? What are some causes of PH due to left heart disease? What are some causes of PH due to lung disease or hypoxia? Pathophys of PH due to chronic TE? Some causes of multifactorial?
Idiopathic Heritable: Inactivating mutaiton of BMPR2 Pulmonary venous occlusive disease persistent PH of newborn syst/diast dysfunction and valvular disease Lung parenchyma destruction (COPD) and hypoxemic conditions (altitude, obstructive sleep apnea) Recurrent microthrombi leads to a decr. cross sectional area of pulm. vascular bed Hematogic, systemic, and metabolic diseases
29
What are the breath sound, percussion, fremitus, and tracheal deviation findings in pleural effusion, atelectasis, simple pneumothorax, tension pneumothorax, and consolidation (lobar pneumo and pulm. edema)?
PLEURAL EFFUSION BS: Decr Perc: dull Frem: Decr Trach: none or away from side of lesion (if severe) ATELECTASIS BS: decr Perc: dull Frem: decr. Trach: toward side of lesion SIMPLE BS: decr. Perc: hyperresonant Frem: decr. Trach: none TENSION BS: decr. Perc: hyperresonant Frem: decr. Trach: away from lesion CONSOLIDATION BS: bronchial breath sounds, late insp. crackles Perc: dull Frem: incr. Trach: none
30
What is a pleural effusion? What does it lead to How can it be treated? What is a transudate? What causes it? What is an exudate like? What causes it? Treatment implications? What is a lymph pleural effusion like? Another name? Cause?
Excess accumulation of fluid between pleural layers Restricted lung expansion during inspiration Thoracentesis to remove fluid TRANSUDATE Decr. protein content Incr. hydro pressure or decr. oncotic EXUDATE incr. protein, cloudy malignancy, pneumonia, collagen vasc. disease, trauma (incr. vasc. permeability) Must be drained (incr. risk for infection) LYMPH Milky appearing fluid, incr. triglyc chylothorax Thoracic duct injury from trauma or malignancy
31
What is a pneumothorax? Symptoms? Findings? What happens in a primary spontaneous pneumo? Epid? What causes secondary spontaneous? What occurs in traumatic pneumothorax? What is a tension pneumothorax? Findings?
Accumulation of air in pleural space Unilateral chest pain and dyspnea, unilateral chest expansion Decr. tactile fremitus, hyperresonance, diminished breath sounds rupture of apical blebs or cysts: tall thin, young males diseased lung, mechanical ventilation with high pressures Blunt or penetrating trauma Air enters pleural space but cannot exit Trachea deviates away from effected lung.
32
What are some signs/symptoms of pneumonia?
``` Fever and chills Productive cough with yellow-green (pus) or rusty (bloody) sputum Tachypnea with pleuritic chest pain Decr. breath sounds Dullness to percussion Elevated WBC ```
33
What are the typical organisms that cause lobar pneumo? What are the characteristics? Location? Same questions for bronchopneumo? Same questions for interstitial (atypical) pneumo? What is the disease course like?
LOBAR S. pneumo, Klebsiella, Legionella Intra-alveolar exudate (consolidation) Entire lobe or lung BRONCHO S. pneumo, S. aureus, H. influenze, Klebsiella Acute inflammatory infiltrates from bronchioles into adjacent alveoli Patchy distribution of 1 or more lobes INTERSTITIAL Viruses (influenza, CMV, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia
34
What is a lung abscess? What causes it? In which patients does it occur in? What is the treatment? What is seen on CXR? What microbes is it usually due to?
Localized collection of pus within parenchyma Aspiration of oropharyngeal contents (alcoholics, epileptics) or bronchial obsruction (cancer) Clindamycin Air fluid levels Anaerobes (bacteroides, fusobacterium, peptostreptococcus) or S. aureus
35
What is mesothelioma? Assocations? Results? Histo? What is not a risk factor?
malignancy of pleura associated with asbestosis Hemorrhagic pleural effusion Pleural thickening Psammoma bodies Smoking is not a risk factor
36
What is a pancoast tumor? What is Pancoast syndrome and how does it occur? What is superior vena cava syndrome? What are some risks involved?
CA that occurs in apex of lung. Can invade cervical symp chain leading to: Horner syndrome (ipsilateral miosis, anhydrosis, ptosis) SVC syndrome (block off SVC-->impaired blood drainage from head (facial plethora), blanching after fingertip pressure, JVD, edema of upper extremities, dyspnea--->medical emergency (INcr. ICP=headaches, dizziness, risk of aneurysm/rupture) Sensorimotor deficits Hoarseness
37
What is the presentation of lung cancer? On CXR? CT? Where do they metastasize to? From? What are some complications? Risk factors? What are the 5 kinds? Where are they located? Subtype?
Cough, hemoptysis, bronchial obstruction, wheezing Pneumonic coin lesion on CXR Noncalcified nodule on CT Adrenals, bone (apth fracture), liver (jaundice, hepatomegaly) Breast, colon, prostate, bladder SPHERE of complications ``` SVC syndrome Pancoast tumor Horner syndrome Endocrine (PNP) Recurrent laryngeal nerve compression (hoarseness) Effusions (pleural or pericardial) ``` Smoking, secondhand smoke, radon, asbestos, FH Squamous and Small cell are sentral Small cell (central), adeno (periph)(bronchioloalveolar), squam (central), large cell (periph), bronchial carcinoid
38
What is the grade of small cell CA? What PNP syndromes will it cause? Mutations? Treatment? histology? Staining?
Undifferentiated=very aggressive Acth (Cushing syndrome) siAdh Lambert Eaton myasthenic syndrome (Antibodies against presynaptic Ca channels Paraneoplastic myelitis/encephalitis (Antibodies against neurons) Amplification of l-myc oncogenes common Inoperable; chemotherapy Neuroendocrine Kulchitsky cells=small dark blue cells Chromogranin positive
39
What is the significant epid. for adenoCA? Mutations? Assocations? Histo? staining? What is bronchioalveolar subtype like? What is seen on CXR? prognosis?
Most common lung cancer in non smokers Activating mutations of KRAS, EGFR, and SLK Hypertrophic osteoarthropathy (clubbing) Glandular pattern Mucin+ adenoCA in situ CXR=hazy infiltrates similar to pneumo (grow along alveolar subtype--->apparent thickening of alveolar walls) Excellent prognosis
40
Gross path of squamous? Assocations? PNP? Histo?
Hilar mass arising from bronchus; Cavitations Cigarettes hyperCalcemia (PTHrP) Keratin pearls and intercellular bridges
41
What is the grading of large cell CA? Prognosis? Treatment? Histo? serum marker?
Highly anaplastic undifferentiated tumor Poor prognosis Less responsive to chemo; surgery Pleomorphic giant cells Beta HCG (maybe)
42
What is the prognosis for bronchial carcinoid tumor? What causes symptoms usually? What are the symptoms of carcinoid syndrome? pathophys? Histo? Staining
Excellent prognosis; metastasis rare Mass effect 5-HT secretion leasd to flushing, diarrhea, wheezing Nests of neuroendocrine cells Chromogranin A +

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