Respiratory-Pathology Flashcards
1
Q
What is rhinosinusitis?
A
Obstruction of sinus drainage into the nasal cavity leading to inflammation and pain over the affected (most commonly the maxillary sinuses which drain to the middle meatus)
2
Q
What is the most common cause of rhinosinusitis?
A
viral UTI (can be superimposed on a bacterial infection)
3
Q
Most common bacterial infection causing rhinosinusitis?
A
S. pneumo, H. influenzae, and M catarrhalis
4
Q
What is epitaxis?
A
Nose bleed
5
Q
Where does epitaxis most commonly occur?
A
in the anterior segment of the nostril (Kiesselbach plexus)
6
Q
Potentially life-threatening nose bleeds occur where?
A
The posterior segemnt (sphenopalatine artery, a branch of the maxillary a.)
7
Q
What are the most common causes of head and neck cancer?
A
tobacco and alcohol
HPV-16 (oropharyngeal)
EBV (nasopharyngeal)
8
Q
What is the Virchow triad?
A
These are a triad of symptoms related to increased risk of thromboembolism, including:
SHE
Stasis
Hypercoagulability
Endothelial damage
9
Q
What test can be used to rule out a DVT?
A
D-dimer test
10
Q
How should a DVT be treated prophylatically?
A
Unfractionated heparin or LMW heparin (e.g. enoxaparin) for prophylaxis and acute management
11
Q
How should a DVT be treated?
A
oral anticoagulatns (e..g warfarin, rivaroxaban) for treatment or long-term prevention
12
Q
What is the best imaging test for a DVT?
A
compression ultrasound
13
Q
What is the imaging test of choice for a pulmonary embolism?
A
CT pulmonary angiography
14
Q
What histologic finding is indicative of an embolis?
A
Lines of Zahn - interdigitating areas of pink (platelets, fibrin), and red (RBCs)
15
Q
T or F. Lines of Zahn are only found in thrombi formed before death
A
T.
16
Q
What are the main types of emboli?
A
FAT BAT
Fat
Air
Thrombus
Bacteria
Amniotic fluid
Tumor
17
Q
Describe fat emboli and their CLASSIC presentation
A
These commonly form after fracture of long bones (in older people usually) and present with the classic triad of:
hypoxemia
neurologic confusion
petechial rash
18
Q
An amniotic fluid embolus most commonly leads to what?
A
DIC, especially in post-partum
19
Q
What are obstructive lung diseases?
A
these are diseases that result in air flow obstruction leading to air being trapped in the lungs
20
Q
What is FVC? FEV1?
A
Forced vital capacity, or FVC, is the amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible. FVC is used to help determine both the presence and severity of lung diseases.
FEV1 is this volume expelled in 1 second
21
Q
What is the hallmark of an obstructive lung disease on a PFT?
A
decreased FEV1/FVC ratio (both decrease but FVC decreases more)
22
Q
What are some types of obstructive lung disease?
A
- chronic brinchitis
- emphysema
- asthma
- bronchiectasis
23
Q
What is chronic bronchitis?
A
defined as a productive cough for 3+ months per year (doesnt have to be consecutive) for 2+ consecutive yrs
24
Q
What causes chronic bronchitis?
A
There is marked hyperplasia of mucus-secreting glands in the bronchi, as defined as greater than 50% via the Reid Index
25
What are the findings of chronic bronchitis?
wheezing, crackles, cyanosis (early-onset hypoxemia due to shunting), and late-onset dyspnea and Co2 trapping
26
What is emphysema?
loss of alveolar walls leading to enlargement of air spaces and thus, less surface area for gas exchange
27
How do compliance and recoil change in emphysema?
compliance increases (this is due to increased elastase activity due to less a1-antitrypsin) and recoil decreases
28
What are the main types of emphysema?
- centriacinar
- panacinar
29
Describe centriacinar emphysema
this is most commonly found in the upper lobe and is associated with smoking (**smoke rises),**
30
Describe panacinar emphysema
this is more common in the lower lobes and is associated with a1-antitrypsin deficiency
31
What are the classic findings of emphysema on CXR?
barrel-chest, increased AP diameter, and a flattened diaphragm
32
How might a person with emphysema breath?
**exhalation through pursed lips** to increase airway pressure and prevent airway collapse during respiration
33
What is asthma?
An obstructive lung disease caused by bronchial hyperresponsiveness that results in **reversible** bronchoconstriction
34
What are some classic histological findings of asthma?
- smooth muscle hypertrophy
- Curschmann spirals (below)- shed epithelium that forms whorled mucus plugs
- Charcot-Leyden crystals
35
What are Charcot Leyden crystals?
eosinophilic, hexogonal, needle-like crystals that form from **breakdown of eosinophils in suptum**
36
What is bronchiectasis?
a chronic necrotizing infecvtion of bronchi that results in permanent dilation
37
What are some common causes of bronchiectasis?
- bronchial obstruction
- cystic fibrosis
- smoking
Kartagener syndrome
-allergic aspergillosis
38
What are restrictive lung diseases?
diseases that are marked by restricted lung expansion causing decreased lung volume (FEV1:FVC ratio is still above 80%)
39
What are the main categories of types of restrictive lung disease?
- poor breathing mechanics
- interstitial lung disease
40
What are some causes of poor breathing mechanics?
- poor muscular effort- polio, myasthenia gravia, Guillian-Barre syndrome
- poor structural apparatus- scoliosis, morbid obesity
41
What are some causes of ILD?
- ARDS and NRDS (hyaline membrane)
- Pneumoconiosis
- Sarcoidosis
- IPF
- Goodpasture syndrome
- Wegener Polyangiitis
- Langerhan Cell Histiocytosis
- Hypersensitivity Pneumonitis
- Drug toxicity (bleomycin, busalfan, amiodarone, methotrextae)
42
Once you diagnosis restrictive lung disease via a PFT, how can you determine whether the cause is mechanical or interstitial lung disease?
Check the A-a gradient
Normal in mechanical issues and elevated in ILD
43
What is the most common cause of ARDS?
premature birth before surfactant is fully developed (surfactant is mature at 35 weeks)
44
What are some common types of pneumoconioses?
- anthracosis/coal miners pneumoconiosis
- silicosis
- abestosis
- berylliosis
45
What causes coal miners pneumoconiosis (aka black lung disease?
typically prolonged coal dust exposure
46
What is this?
Coal miners pneumoconiosis marked by carbon laden macrophages that can significant interstital inflammation and fibrosis
47
What lung lobes are most commonly affected by coal miners pneumoconiosis?
upper
48
Asbestosis is most common in what types of jobs?
shipbuilding, roofing, and plumbing
49
What is this?
Pleural plaques which are pathgnomonic to asbestosis
50
What lung lobes are most commonly affected by asbestosis?
lower
51
What are these?
Asbestos (ferruginous) bodies- golden-brown fusiform rodes resembling dumbbells found in alveolar suptum samples
52
How can asbestos bodies be best seen?
Prussion blue stain
53
Describe berylliosis
This is common in aerospace and manufacturing industries and commonly affected the ***upper*** lobes
54
Where is siliocosis most common?
foundries, sandblasting, and mines
55
Pts with silicosis are at an increased risk of what?
TB- silica interrupts phagolysosomes and impairs macrophages
56
What lung lobe in silicosis most common in?
upper
57
What is hypersensitivity pneumonitis?
mixed type III/IV hypersensitivity reaction to an environmental antigen leading to dyspnea, cough, chest tightness, and HA
Often seen in farmers and those exposed to birds
58
What are some common causes of ARDS?
SPARTAS
**S**epsis
**P**ancreatitis
Pneumonia
**A**spiration
u**R**emia
**T**rauma
**A**mniotic Fluid Embolism
**S**hock
59
What is a classic finding of ARDS (and NRDS) and what causes it?
hyaline membranes (below)- endothelial damage caused increased capillary permaebility leading to leakage of protein-rich exudate into the alveoli and the formation of noncardiogenic pulmonary edema (normal PCWP)
60
How should ARDS be managed?
Go to deck
61
What is a common cause of increased EPO in the blood?
Sleep apnea, which results in hypoxia induced synthesis of EPO
62
What is the normal pulmonary a. pressure?
10-14 mm Hg
63
How is pulmonary HTN defined?
25+ mm Hg at rest
64
What are the most common causes of pulmonary HTN?
- Idiopathic PAH
- Left heart disease
- chronic TE
65
What is the genetic cause of hereditary PAH?
inactivating mutation in BMPR2 gene (which normally inhibits vascular smooth muscle proliferation)- poor prognosis
66
Keep in mind that anything that induces pulmonary hypoxemia will result in vasoconstriction and potential formation of PAH
I.e. High altitude
67
How would a pleural effusion look on a CXR?
68
How does a pleural effusion affect breath sounds? percussion? Fremitus?
breath sounds are decreased and percussion is dull
Fremitus also decreases
69
Does the trachea deviate in a pleural effusion?
Typically no but may deviate away from the effusion if its large enough
70
How does atelectasis (bronchial obstruction causing lung collapse) affect breath sounds? percussion? Fremitus?
breath sounds are decreased and percussion is dull
Fremitus also decreases
71
How would the treachea deviate in atelectiasis?
toward the side of the lesion
72
73
How does spimple pneumothorax affect breath sounds? percussion? Fremitus?
breath sounds and fremitus are decreased and percussion is hyperresonant (same in tension)
74
What is this?
Tension pneumothorax.. notice how the trachea deviates to the **opposite** side
75
Does the trachea deivate in simple pneumothorax?
NO
76
What is a pleural effusion?
Accumulation of fluid between the pleural alyers lining the lungs leading to restricted lung expansion during inspiration
77
What are the main categories of 'materials' found in pleural effusions?
transudate,
exudate,
lymphatic
78
What causes transudate?
This kind of fluid is low in protein content and is typically driven by increased hydrostatic pressure in the inter-ventricular capillaries of the lung
79
What are the main causes of a transudative pleural effusion?
HF
nephrotic syndrome
hepatic cirrhosis
80
What are the main causes of a exudate in a pleural effusion, which is marked by increased protein content?
typically things that increase vascular permeability such as malignancy, pneumonia, collagen vascular disease, or trauma
81
What pt. population is typical for a spontaneous pneumothorax?
tall, thin, young males
82
What are the main categories of pneumonia?
- lobar
- bronchopneumonia
- interstitial (atypical)
83
What are the most common causes of lobar pneumonia?
- S pneumo (most common)
- Legionella, Klebsiella
84
S. pneumo is \_\_\_\_\_-hemolytic
alpha
85
What is 'alpha' hemolysis?
partial hemolysis in which the surrounding zone if hemolysis has a green hue from oxidation of hemoglobin
86
What is the major virulence factor of strep pneumo?
a polysaccharide capsule
87
Is Strep pneumo Optochin resistant or sensitive?
sensitive
88
How does strep pneumo appear?
lancet-shaped gram-positive diplococci
89
How does strep pneumo lobar pneumonia present?
production of a **rust-colored** sputum
90
What else does strep pneumo very commonly cause besides pneumonia?
MOPS
Meningitis
Otitis Media
Pneumonia
Sinusitis
91
What other virulence determinant does Strep pneumo use?
IgA protease
92
Who has a particularly increased risk of infection with strep pneumo?
those with no spleen (SCD, trauma, etc.)
93
How should Strep pneumo be treated?
Azithromycin, a macrolide
Ceftriaxone, or other 3rd-gen cephalosporin
94
What are the main causes of bronchopneumonia?
S. pneumo
S. aureus
H. influenzae
Klebsiella
95
What are the most common causes of Interstitial (atypical) pneumonia?
viruses (influenza, CMV, RSV, adenovirus),
Mycoplasma
Legionella
Chlamydia
96
What is a pancoast tumor?
a carcinoma that occurs in the apex of the lung
NOTE: Most Pancoast tumors are squamous cell carcinomas (SCCs) or adenocarcinomas; only 3-5% are small cell carcinomas.
97
How might a pancoast tumor?
may cause dyspnea, nonproductive cough, etc.
- voice hoarseness
- Pancoast syndrome
- Horner Syndrome
- SVC syndrome
98
Why would a pancoast tumor cause voice hoarseness?
The tumour can also compress the recurrent laryngeal nerve and from this a hoarsevoice and bovine cough may occur
99
What is Pancoast syndrome?
Pancoast syndrome is characterized by a malignant neoplasm of the superior sulcus of the lung with destructive lesions of the thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (stellate ganglion). This is accompanied by the following:
Severe pain in the shoulder region radiating toward the axilla and scapula along the ulnar aspect of the muscles of the hand
Atrophy of hand and arm muscles
Horner syndrome ( ptosis, miosis, hemianhidrosis, enophthalmos)
Compression of the blood vessels with edema
100
Pancoast tumor presentation
-**referred pain over the scapula to the shoulder** as the result of damage to the afferent pain fibers of the sympathetic trunk.
Initially, localized pain occurs in the shoulder and vertebral border of the scapula. **Pain may later extend along an ulnar nerve distribution** of the arm to the elbow and, ultimately, to the ulnar surface of the forearm and to the small and ring fingers of the hand (**C8**).
If the tumor extends to the sympathetic chain and stellate ganglion, **Horner syndrome and anhidrosis develop on the ipsilateral side of the face and upper extremity.**
**The pain is frequently relentless and unremitting**, and adequate relief often requires administration of narcotics. The patient usually supports the elbow of the affected arm in the hand of the opposite upper extremity to ease the tension on the shoulder and upper arm.
**The hand muscles may become weak and atrophic, and the triceps reflex may be absent**.
101
What is Horner syndrome?
It is characterized by miosis (a constricted pupil), ptosis (a weak, droopy eyelid), apparent anhidrosis **(decreased sweating)**, with or without enophthalmos (inset eyeball).
102
What is SVC syndrome?
Compression of the SVC, typically due to malignancy, that blocks drainage from the head leading to:
edema (swelling due to excess fluid) of the face and arms and development of swollen collateral veins on the front of the chest wall.
**blanching of skin after fingertip pressure**
Shortness of breath and coughing are quite common symptoms.
103
What is this?
Psamomma body
104
What are some diseases associated with psamomma bodies?
Papillary thyroid carcinoma
Papillary renal cell carcinoma
Micropapillary subtype of lung adenocarcinoma
Ovarian papillary serous cystadenoma and cystadenocarcinoma
Endometrial adenocarcinomas (Papillary serous carcinoma ~3%-4%)
Meningiomas, in the central nervous system
Peritoneal and Pleural Mesothelioma
Somatostatinoma (pancreas)
Prolactinoma of the pituitary
105
Where does lung cancer like to MET to?
**BAB**e**L**
Brain
Adrenals
Bone (can lead to pathological fracture)
Liver
106
What cancers like to MET to the lungs?
Everywhere fluid comes out of:
Breast
Colon
Prostate
Bladder
107
What are the five main types of lung cancer?
- small cell (oat cell) carcinoma
- adenocarcinoma
- squamous cell carcinoma
- large cell carcinoma
- bronchial carcinoid tumor
108
What lung cancers can consistently be found centrally in the lungs?
small cell and squamous cell
109
Describe small cell carcinomas
these are undifferentiated and very aggressive.
110
What are some associations of small cell carcinomas?
- may produce ACTH (Cushing Syndrome)
- SIADH
- Lambert-Eaton Syndrome
- paraneoplastic myelitis/encephalitis
111
How might SIADH present?
hyponatremia leading to brain swelling and
concentrated urine
112
What is Lambert-Eaton Syndrome?
A rare **pre**synaptic disorder of neuromuscular transmission in which quantal release of acetylcholine (ACh) is impaired due to binding of Abs to Ca2+ channels
113
How does Lambert-Eaton syndrome present?
Symptoms of Lambert-Eaton myasthenic syndrome (LEMS) **usually begin insidiously and progress slowly**. Many patients have symptoms for months or years before the diagnosis is made. **Weakness is the major symptom**. Weak muscles may ache and are occasionally tender. **Proximal muscles are more affected than distal muscles; lower extremity muscles are affected predominantly.**
**Patients typically have difficulty rising from a chair, climbing stairs, and walking.**
114
Amplification of the ____ proto-oncogene is commonly seen in a small cell carcinoma
MYC
115
How does a small cell carcinoma look histologically?
Kulchitsky cells (small dark blue cells) common
116
What stains can be used to diagnose small cell carcinoma?
chromogranin A
117
Histologically, squamous cell carcinomas of the lung are marked by what?
keratin swirls and intercellular bridges
118
SSC of the lung typically is seen at bronchi bifurcations
119
What is one common manifestation of SCC of the lung?
**hypercalcemia** due to **secretion of PTHrP**
120
What cancers of the lung are commonly found in the periphery?
adenocarcinoma and large cell carcinoma
121
What mutations are common in adenocarcinomas?
activating mutations in KRAS, EGFR, and ALK
122
What is the main paraneoplastic syndrome of adenocarcinoma?
hypertrophic osteoarthropathy (clubbing)
