Respiratory Pathology Flashcards
What are common causes of nasal polyp?
repeated bouts of rhinitis, children with cystic fibrosis, and aspirin intolerant asthma
What is an angiofibroma? What population is it seen in?
benign tumor of nasal mucosa made of large blood vessels and fibrous tissue, seen in adolescent males with epistaxis
Histology of nasopharyngeal carcinoma?
pleomorphic keratin-positive poorly differentiated squamous cells in backround of lymphocytes
What is the common cause of Laryngeal Papilloma and what are the sxs?
benign papillary tumor of vocal cord due to HPV 6 and 11. Single nodules in adults and multiple nodules in children. Presents with hoarsness
What are the classic gross phases of lobar pneumonia?
Congestion: due to congested vessels and edema
Red hepatization: due to exudate, neutrophils and hemorrhage filling alveolar air spaces, giving the normally spong lung a solid consistency
Gray hepatization: due to degradation of red cells within the exudate
Resolution: type II pneumocytes regenerature normal tissue
What type of bacteria is seen in aspiration pneumonia?
anaerobic bacteria, bacteroides, fusobacterium, peptococcus
When do you usually see Klebsiella pneumoniae?
elderly in nursing homes, alcoholics, diabetics. current jelly sputum, often complicated by abscess
What are the 2 main causes of lobar pneumonia
S. pneumo and Klebsiella
What are the main causes of bronchopneumonia?
S. aureus, H. flu, Pseudomonas, moraxella catarrhalis, legionella
High yield facts about moraxella catarrhalis?
community-acquired pneumoni and pneumonia superimposed on COPD (leads to exacerbation)
What are the comon causes of interstitial (atypical) pneumonia?
Mycoplasma, chlamydia, RSV, CMV, influenza, voxiella burnettii
What lobe would you except to find consolidation in aspiration pneumonia?
right lower lobe! (R. mainstem bronchus branches at a less acute angle than the left, easier to fall down this path)
What happens to the FEV1/FVC ratio in COPD?
decreased ratio. FVC decreases but FEV1 decreases to a greater degree
Why are patients with chronic bronchitis called “blue bloaters”?
Hypoxia/cyanosis occurs early in the disease course. Mucous plugs the airway and leads to increased PaCO2 and decrease PaO2. Also they tend to be stocky
2 common consequences of chronic bronchitis?
infection and cor pulmonale. Remember if you plug anything, infection is more likely to occur behind the blockage. Also, if there is a blockage aka poor ventilation due to mucus, then blood will be shunted toward a more ventilated area of the lung and the arterioles near the poorly ventilated area will constrict, this increases the pressure that the R heart needs to pump against and can lead to right heart failure.
What is cor pulmonale?
abnormal enlargement of the right side of the heart in response to disease of pulmonary blood vessels
What is the role of A1AT (alpha1-antitrypsin)?
neutralizes protesases and protects the alveoli
What type of emphysema does smoking put you at risk for?
centriacinar emphysema in the upper lobes of the lung (smoke rises!)
What type of emphysema is seen in A1AT deficiency?
panacinar in the lower lobes
How does A1AT deficiency lead to cirrhosis?
A1AT is made in the liver, the issue is that it is a misfolded protein. Gets stuck in the hepatocyte ER and results in liver damage.
What is the clinically significant mutation seen in A1AT deficiency?
PiZ= super low levels of A1AT
PiZZ- homozygous for the mutant allele
PiMM is homozygous norm
Why is emphysema called pink puffer?
patients are not cyanotic until much later on in the disease and they breath out really slowly through pursed lips (creates a increased back pressure so the alveoli dont collapse). thin patients (lose weight due to increased work of breathing)
What happens to the FRC in emphysema?
increased
In asthma, which leukotrienes promoted bronchoconstriction, inflammation and edema?
LC4, LD4, LE4.
What are the histological findings of asthma?
spiral-shaped mucus plugs (Curschmann spirals) and eosinohpil-derived crystals (Charcot-Leyden crystals)
What causes bronchiectasis?
permanent dilatation of bronchioles and bronchi due to necrotizing inflammation with damage to airway walls.
Which patients get bronchiectasis?
Cystic fibrosis, Kartageners and ABPA
What are some complications of bronchiectasis?
hypoxemia with cor pulmonale and secondary AA amyloidosis (SAA is an acute phase protein, present in chronic inflammation and leads to increased AA deposition in tissues)
Is FEV1/FVC increased or decreased in restictive pulmonary disease?
increased. FVC decreases drastically (can’t get as much air in your lungs) and FEV1 only decreases a little.
What mediates fibrosis in idiopathic pulmonary fibrosis?
TGF-beta!!!
In IPF, where does the firbrosis begin?
Subpleural patches, then spreads to the whole lung causing a honeycomb appearance.
Tx: lung transplantation!
What is pneumoconiosis?
Type of restrictive lung disease due to chronic occupational exposure to small, fibrogenic particles.
High yield features of Coal Workers’ Pneumoconiosis?
CXR: nodules in upper lobes.
Due to exposure to carbon.
What is Caplan Syndrome?
Massive exposure to carbon can lead to black lung with rheumatoid arthritis (lung probs shrunken)
What is anthracosis?
mild exposure to carbon that is not clinically significant
High yield facts about silicosis?
CXR: fibrotic nodules in the upper lobes of the lung. Seen in silica miners and sandblasters. Increased risk for TB (silica impairs phagolysosome formation by macrophages)
High yield facts about berrylliosis?
Seen in workers in aerospace industry. Noncaseating granulomas in lung, hilar lymph nodea, and sysemic organs. Increased risk for lung cancer. similar to sarcoidosis
High yield facts about asbestosis?
Lower lobes, fibrosis of pleura, long golden brown fivers assocaited with iron (asbestos bodies-ferruginoius body; confirm dx) inc risk of bronchogenic carcinoma and mesothelioma. Bronchogenic more common!
Seen in construction, plumbers, and shipyard workers
Is mesothelioma or bronchogenic carcinoma more common after asbestosis exposure?
Bronchogenic more common!
High yield sarcoidosis facts?
noncaseating granulomas, AA females, asteroid bodies and shaumann bodies seen in granulomas. Mimics Sjogren (Sjogrens no granulomas). Increase ACE, hypercalcemia (in granulomas, 1 alpha-hydrozylase of epitheliod histiocytes converts vitamin D to active form). Tx: Steroids
What are the risk factors of laryngeal carcinoma?
Risk factors are alcohol and tobacco
If you see a nasal polyp in a child, what disease do they probably have?
cystic fibrosis
If you see a nasal polyp in an adult, what disease do they probably have?
aspirin-intolerant asthma
What is the triad of aspirin-intolerant asthma?
asthma, aspirin-induced bronchospasms, and nasal polyps
What is the classic epidemiology of nasopharyngeal carcinoma?
due to EBV and seen in African children and Chinese adults
How does nasopharyngeal carcinoma present?
cervical lymph node enlargement
What are the characteristics of vocal cord nodule?
bilateral nodules on true vocal cords composed of degenerative myxoid CT
What is the most common cause of community acquired pneumonia?
S. pneumo
What are the defining characterstics of Klebsiella pnemoniae?
enteric flora that is commonly aspirated. Has a thick mucoid capsule and often complicated by abscess
Most common cause of atypical pneumonia in infants?
RSV
What causes pneumonia in patients with posttransplant immunosuppressive therapy?
CMV
What is the most common cause of pnemonia in patients infected with Influenza virus?
S. aureus
Why is interstitial pnemonia referred to as atypical pneumonia?
presents with atypical sxs of relatively mild URI(minimal sputum and low fever). Cvaused by viruses
What are the most common sites of systemic spread of TB?
- meninges w/granuloma formation in the base of the brain
- kidneys causing sterile pyuria
- lumbar vertebrae (Pott disease)
Where are Ghon complexes classically seen?
subpleura, can also be seen in the hilar nodes
What type of stain is used to show acid fast bacilli?
AFB (literally stands for acid fast bacilli) or Ziehl-Neelsen stain
What should a patient with A1AT deficiency (PiMZ) not do?
Smoke! they already have low levels of A1AT, lets not make it any worse by adding an inflammatory stimulant into the picture
What will a liver biopsy reveal in someone with A1AT deficiency?
PAS-positive globules in hepatocytes
What is the pathophys of first exposure in asthma?
Exposure to allergen induces TH2 cells to secrete
IL-4, IL-5 (attracts eosinophils) and IL-10 (stimulates TH2 and inhibitos TH1)
What is the pathophys of early-phase reexposure to an allergen in asthma?
IgE-mediated activated of mast cells leading to release of preformed histamine granules and generation of leukotrienes C4, D4 and E4 to meiate bronchocontriction, inflammation and edema
What is the pathophys of late phase reaction in asthma?
MBP released from eosinophils causing damage and mediating more bronchoconstriction
What is the main mediator of healing?
TGF-beta
What are the 2 main features of hypersensitivity pneumonitis?
Granulomas w/eosinophils
What is the only respiratory situation with increased tactile fremitus?
Consolidation like lobar pneumonia or pulmonary edema
Who tends to get a small cell carcinoma?
male smokers
Who tends to get a squamous cell carcinoma??
male smokers
Who tends to get an adenocarcinoma?
femal smokers and nonsmokers
What is the most common cause of lung abscess?
aspiration of oropharynx contents (fusibacterium peptostreptococcus and bacteroides)
Why is the PO2 in the LA less than that found immediately after transport through the lungs?
Bronchial blood gets dumped in the LA (deoxygenated and performs the dual blood supply to the lung) and also the thesbian veins dump deoxygenated blood into the LA
What causes paraneoplastic cerebellar degeneration?
Autoimmune d/o associated with small cell lung carcinoma. Purkinje neurons are attacked, will see anti-Yo, anti-P/Q and anti-Hu.
