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Respiratory Pathology Flashcards

1
Q

What are common causes of nasal polyp?

A

repeated bouts of rhinitis, children with cystic fibrosis, and aspirin intolerant asthma

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2
Q

What is an angiofibroma? What population is it seen in?

A

benign tumor of nasal mucosa made of large blood vessels and fibrous tissue, seen in adolescent males with epistaxis

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3
Q

Histology of nasopharyngeal carcinoma?

A

pleomorphic keratin-positive poorly differentiated squamous cells in backround of lymphocytes

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4
Q

What is the common cause of Laryngeal Papilloma and what are the sxs?

A

benign papillary tumor of vocal cord due to HPV 6 and 11. Single nodules in adults and multiple nodules in children. Presents with hoarsness

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5
Q

What are the classic gross phases of lobar pneumonia?

A

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

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6
Q

What type of bacteria is seen in aspiration pneumonia?

A

anaerobic bacteria, bacteroides, fusobacterium, peptococcus

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7
Q

When do you usually see Klebsiella pneumoniae?

A

elderly in nursing homes, alcoholics, diabetics. current jelly sputum, often complicated by abscess

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8
Q

What are the 2 main causes of lobar pneumonia

A

S. pneumo and Klebsiella

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9
Q

What are the main causes of bronchopneumonia?

A

S. aureus, H. flu, Pseudomonas, moraxella catarrhalis, legionella

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10
Q

High yield facts about moraxella catarrhalis?

A

community-acquired pneumoni and pneumonia superimposed on COPD (leads to exacerbation)

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11
Q

What are the comon causes of interstitial (atypical) pneumonia?

A

Mycoplasma, chlamydia, RSV, CMV, influenza, voxiella burnettii

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12
Q

What lobe would you except to find consolidation in aspiration pneumonia?

A

right lower lobe! (R. mainstem bronchus branches at a less acute angle than the left, easier to fall down this path)

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13
Q

What happens to the FEV1/FVC ratio in COPD?

A

decreased ratio. FVC decreases but FEV1 decreases to a greater degree

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14
Q

Why are patients with chronic bronchitis called “blue bloaters”?

A

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

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15
Q

2 common consequences of chronic bronchitis?

A

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.

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16
Q

What is cor pulmonale?

A

abnormal enlargement of the right side of the heart in response to disease of pulmonary blood vessels

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17
Q

What is the role of A1AT (alpha1-antitrypsin)?

A

neutralizes protesases and protects the alveoli

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18
Q

What type of emphysema does smoking put you at risk for?

A

centriacinar emphysema in the upper lobes of the lung (smoke rises!)

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19
Q

What type of emphysema is seen in A1AT deficiency?

A

panacinar in the lower lobes

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20
Q

How does A1AT deficiency lead to cirrhosis?

A

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.

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21
Q

What is the clinically significant mutation seen in A1AT deficiency?

A

PiZ= super low levels of A1AT

PiZZ- homozygous for the mutant allele

PiMM is homozygous norm

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22
Q

Why is emphysema called pink puffer?

A

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)

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23
Q

What happens to the FRC in emphysema?

A

increased

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24
Q

In asthma, which leukotrienes promoted bronchoconstriction, inflammation and edema?

A

LC4, LD4, LE4.

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25
Q

What are the histological findings of asthma?

A

spiral-shaped mucus plugs (Curschmann spirals) and eosinohpil-derived crystals (Charcot-Leyden crystals)

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26
Q

What causes bronchiectasis?

A

permanent dilatation of bronchioles and bronchi due to necrotizing inflammation with damage to airway walls.

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27
Q

Which patients get bronchiectasis?

A

Cystic fibrosis, Kartageners and ABPA

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28
Q

What are some complications of bronchiectasis?

A

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)

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29
Q

Is FEV1/FVC increased or decreased in restictive pulmonary disease?

A

increased. FVC decreases drastically (can’t get as much air in your lungs) and FEV1 only decreases a little.

30
Q

What mediates fibrosis in idiopathic pulmonary fibrosis?

A

TGF-beta!!!

31
Q

In IPF, where does the firbrosis begin?

A

Subpleural patches, then spreads to the whole lung causing a honeycomb appearance.

Tx: lung transplantation!

32
Q

What is pneumoconiosis?

A

Type of restrictive lung disease due to chronic occupational exposure to small, fibrogenic particles.

33
Q

High yield features of Coal Workers’ Pneumoconiosis?

A

CXR: nodules in upper lobes.

Due to exposure to carbon.

34
Q

What is Caplan Syndrome?

A

Massive exposure to carbon can lead to black lung with rheumatoid arthritis (lung probs shrunken)

35
Q

What is anthracosis?

A

mild exposure to carbon that is not clinically significant

36
Q

High yield facts about silicosis?

A

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)

37
Q

High yield facts about berrylliosis?

A

Seen in workers in aerospace industry. Noncaseating granulomas in lung, hilar lymph nodea, and sysemic organs. Increased risk for lung cancer. similar to sarcoidosis

38
Q

High yield facts about asbestosis?

A

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

39
Q

Is mesothelioma or bronchogenic carcinoma more common after asbestosis exposure?

A

Bronchogenic more common!

40
Q

High yield sarcoidosis facts?

A

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

41
Q

What are the risk factors of laryngeal carcinoma?

A

Risk factors are alcohol and tobacco

42
Q

If you see a nasal polyp in a child, what disease do they probably have?

A

cystic fibrosis

43
Q

If you see a nasal polyp in an adult, what disease do they probably have?

A

aspirin-intolerant asthma

44
Q

What is the triad of aspirin-intolerant asthma?

A

asthma, aspirin-induced bronchospasms, and nasal polyps

45
Q

What is the classic epidemiology of nasopharyngeal carcinoma?

A

due to EBV and seen in African children and Chinese adults

46
Q

How does nasopharyngeal carcinoma present?

A

cervical lymph node enlargement

47
Q
A
48
Q

What are the characteristics of vocal cord nodule?

A

bilateral nodules on true vocal cords composed of degenerative myxoid CT

49
Q

What is the most common cause of community acquired pneumonia?

A

S. pneumo

50
Q

What are the defining characterstics of Klebsiella pnemoniae?

A

enteric flora that is commonly aspirated. Has a thick mucoid capsule and often complicated by abscess

51
Q

Most common cause of atypical pneumonia in infants?

A

RSV

52
Q

What causes pneumonia in patients with posttransplant immunosuppressive therapy?

A

CMV

53
Q

What is the most common cause of pnemonia in patients infected with Influenza virus?

A

S. aureus

54
Q

Why is interstitial pnemonia referred to as atypical pneumonia?

A

presents with atypical sxs of relatively mild URI(minimal sputum and low fever). Cvaused by viruses

55
Q

What are the most common sites of systemic spread of TB?

A
  1. meninges w/granuloma formation in the base of the brain
  2. kidneys causing sterile pyuria
  3. lumbar vertebrae (Pott disease)
56
Q

Where are Ghon complexes classically seen?

A

subpleura, can also be seen in the hilar nodes

57
Q

What type of stain is used to show acid fast bacilli?

A

AFB (literally stands for acid fast bacilli) or Ziehl-Neelsen stain

58
Q

What should a patient with A1AT deficiency (PiMZ) not do?

A

Smoke! they already have low levels of A1AT, lets not make it any worse by adding an inflammatory stimulant into the picture

59
Q

What will a liver biopsy reveal in someone with A1AT deficiency?

A

PAS-positive globules in hepatocytes

60
Q

What is the pathophys of first exposure in asthma?

A

Exposure to allergen induces TH2 cells to secrete

IL-4, IL-5 (attracts eosinophils) and IL-10 (stimulates TH2 and inhibitos TH1)

61
Q

What is the pathophys of early-phase reexposure to an allergen in asthma?

A

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

62
Q

What is the pathophys of late phase reaction in asthma?

A

MBP released from eosinophils causing damage and mediating more bronchoconstriction

63
Q

What is the main mediator of healing?

A

TGF-beta

64
Q

What are the 2 main features of hypersensitivity pneumonitis?

A

Granulomas w/eosinophils

65
Q

What is the only respiratory situation with increased tactile fremitus?

A

Consolidation like lobar pneumonia or pulmonary edema

66
Q

Who tends to get a small cell carcinoma?

A

male smokers

67
Q

Who tends to get a squamous cell carcinoma??

A

male smokers

68
Q

Who tends to get an adenocarcinoma?

A

femal smokers and nonsmokers

69
Q

What is the most common cause of lung abscess?

A

aspiration of oropharynx contents (fusibacterium peptostreptococcus and bacteroides)

70
Q

Why is the PO2 in the LA less than that found immediately after transport through the lungs?

A

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

71
Q

What causes paraneoplastic cerebellar degeneration?

A

Autoimmune d/o associated with small cell lung carcinoma. Purkinje neurons are attacked, will see anti-Yo, anti-P/Q and anti-Hu.

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