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Respiratory - Pathology Flashcards

1
Q

A patient presents with sudden-onset dyspnea one hour after suffering a femur fracture. He is found to have a ventilation/perfusion mismatch. What is your diagnosis?

A

Fat emboli

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2
Q

Amniotic fluid emboli can lead to what dangerous hematologic condition in postpartum women?

A

Disseminated intravascular coagulation

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3
Q

A patient presents with sudden chest pain, tachypnea, and dyspnea. What is the most likely diagnosis?

A

Pulmonary embolus

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4
Q

Name the six most common causes of emboli to the lungs.

A

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (remember: An embolus moves like a FAT BAT)

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5
Q

What is the origin of the majority of emboli that become lodged in the lungs?

A

Deep leg veins

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6
Q

Which three factors that promote blood coagulation are known as Virchow’s triad?

A

Stasis, hypercoagulability, endothelial damage

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7
Q

Describe Homan’s sign.

A

In Homan’s sign, dorsiflexion of the foot causes a tender calf muscle because of the presence of deep venous thromboses

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8
Q

What medication is used to prevent deep venous thrombosis?

A

Heparin (or modified heparin molecules such as enoxaparin)

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9
Q

What is the hallmark pulmonary function test finding in patients with obstructive lung disease?

A

Decreased forced expiratory volume1/forced vital capacity ratio

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10
Q

List four types of obstructive lung disease.

A

Chronic bronchitis, emphysema, asthma, and bronchiectasis

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11
Q

In obstructive lung disease, there is a(n) _____ (decrease/increase) in residual volume and a(n) ____ (decrease/increase) in functional vital capacity.

A

Increase; decrease

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12
Q

What criteria must a patient meet to be considered to have chronic bronchitis?

A

A chronic productive cough at least three consecutive months in at least two years

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13
Q

What histologic changes would be seen on lung biopsy in a patient with chronic bronchitis?

A

Hypertrophy of the mucus-secreting glands in the bronchioles

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14
Q

The mucus gland hypertrophy seen in chronic bronchitis can be quantified using the _____ _____, which tends to be greater than what value in symptomatic patients?

A

Reid index; 50%

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15
Q

How is the Reid index calculated?

A

Reid index = gland depth / total thickness of bronchial walls

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16
Q

What clinical findings are auscultated in the lungs of patients with chronic bronchitis?

A

Usually wheezing and crackles

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17
Q

What visible skin finding may be noted in patients with chronic bronchitis?

A

Cyanosis

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18
Q

What pathologic changes are seen in the lungs of a patient with emphysema?

A

Enlargement of the air spaces; decrease in recoil resulting from the destruction of alveolar walls

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19
Q

Smoking is associated with _____ (centriacinar/panacinar) -type emphysema, whereas α1-antitrypsin deficiency is associated with _____ (centriacinar/panacinar) -type emphysema.

A

Centriacinar; panacinar

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20
Q

In addition to panacinar emphysema, α1-antitrypsin deficiency also causes what condition?

A

Liver cirrhosis

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21
Q

A deficiency of α1-antitrypsin results in the increased activity of what enzyme?

A

Elastase; the enzyme degrades elastic fibers in the lungs

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22
Q

What exam finding is often auscultated in the lungs of patients with emphysema?

A

Breath sounds are usually diminished with a decreased inspiratory/expiratory ratio

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23
Q

In emphysemic lungs, there is a(n) (decrease/increase) _____ in recoil and, subsequently, a(n) _____ (decrease/increase) in compliance.

A

Decrease; increase. As a result, the residual volume of the lungs increases as the disease progresses

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24
Q

In emphysema, the decrease in lung recoil is a result of destruction of alveolar walls by increased activity of which enzyme?

A

Elastase

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25
Q

Paraseptal emphysema is associated with bullae that can rupture and lead to _____ _____ in otherwise young healthy males.

A

Spontaneous pneumothorax

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26
Q

Individuals with emphysema tend to exhale through pursed lips to increase _____ _____ and prevent _____ _____ during expiration.

A

Airway pressure; airway collapse

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27
Q

The definitive feature of the bronchoconstriction of asthma is that it is fully _____.

A

Reversible

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28
Q

In patients with asthma, there is hyperresponsiveness of what lung segment?

A

The bronchi

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29
Q

While chronic bronchitis is a disease of the _____ (bronchi/bronchioles), asthma is a disease of _____ (bronchi/bronchioles).

A

Bronchioles; bronchi

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30
Q

Kartagener’s syndrome is associated with what types of lung disease?

A

Bronchiectasis and obstructive lung disease due to the failure of cilia to clear mucus from the lungs

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31
Q

Cough and wheezing are noted in patients with what two types of obstructive lung disease?

A

Asthma and chronic bronchitis

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32
Q

Tachypnea and pulsus paradoxus are noted in patients with what type of obstructive lung disease?

A

Asthma

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33
Q

A child presents with cough, wheezing, dyspnea, tachypnea, hypoxemia, and mucus plugging. On exam, the patient also has a pulsus paradoxus. From what disease is this patient likely suffering?

A

Asthma

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34
Q

What finding is commonly noted on pulmonary function testing of patients with asthma as well as those with emphysema?

A

Decreased inspiratory/expiratory ratio; generally, obstructive diseases lengthen the expiratory phase

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35
Q

What blood pressure/pulse finding is often observed in patients with asthma?

A

Pulsus paradoxus

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36
Q

What are Curschmann’s spirals?

A

Shed epithelium from mucous plugs associated with asthma

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37
Q

What two pathologic findings are associated with asthma?

A

Smooth muscle hypertrophy and mucous plugging

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38
Q

_____ is a chronic necrotizing infection of bronchi.

A

Bronchiectasis

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39
Q

In bronchiectasis, chronic necrotizing infection of the bronchi leads to what?

A

Permanent dilation of the airways

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40
Q

Patients with bronchiectasis often have a cough productive of what?

A

Blood and purulent sputum

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41
Q

Which two genetic diseases are associated with bronchiectasis?

A

Cystic fibrosis and Kartagener’s syndrome

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42
Q

Individuals with bronchiectasis are prone to develop which fungal pulmonary infection?

A

Aspergillosis

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43
Q

What are three common triggers of asthma attacks?

A

Viral upper respiratory infections, allergens, and stress

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44
Q

Compare the onset of dyspnea and hypoxia in emphysema vs chronic bronchitis.

A

In emphysema, there is early-onset dyspnea and late-onset hypoxemia; in chronic bronchitis, there is early-onset hypoxemia and late-onset dyspnea

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45
Q

What causes late-onset hypoxemia in emphysema?

A

The eventual loss of capillary beds, which occurs with the loss of alveolar walls

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46
Q

What causes early-onset hypoxemia in chronic bronchitis?

A

Shunting

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47
Q

What two lung volumes are typically decreased in patients with restrictive lung disease?

A

Functional vital capacity and total lung capacity

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48
Q

Patients with restrictive lung disease typically have an forced expiratory volume1/forced vital capacity ratio within what range?

A

> 80%; this differentiates restrictive from obstructive lung disease

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49
Q

What are the two general types of restrictive lung disease?

A

Poor breathing mechanics (caused by musculoskeletal or connective tissue disease) and interstitial lung diseases

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50
Q

Extrapulmonary causes of restrictive lung disease are generally the result of what?

A

Poor breathing mechanics, usually as a result of muscular dysfunction (eg, polio) or structural difficulty (eg, scoliosis, morbid obesity)

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51
Q

Pulmonary causes of restrictive lung disease are generally the result of what category of diseases?

A

Interstitial lung diseases

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52
Q

What infectious disease can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

A

Polio

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53
Q

What disease of the neuromuscular junction can cause poor muscular effort and thereby lead to extrapulmonary restrictive lung disease?

A

Myasthenia gravis

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54
Q

What is the mechanism of extrapulmonary restrictive lung disease in scoliosis?

A

The curvature of the spine distorts the breathing mechanics of the rib cage

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55
Q

Other than scoliosis and muscle diseases, what condition can lead to extrapulmonary restrictive lung disease?

A

Morbid obesity

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56
Q

What category of interstitial lung diseases has a clear association with an environmental exposure?

A

Pneumoconioses

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57
Q

What disease is associated with repeated cycles of lung injury and wound healing with increased collagen deposition?

A

Idiopathic pulmonary fibrosis

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58
Q

Name three pneumoconioses that can cause restrictive lung disease.

A

Coal miner’s disease, silicosis, asbestosis

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59
Q

What nongranulomatous disease that commonly affects the renal and pulmonary systems can cause interstitial lung disease?

A

Goodpasture’s syndrome

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60
Q

What disease can cause restrictive lung disease due to eosinophilic granulomas in the lungs?

A

Histiocytosis X

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61
Q

Name three drugs that can cause interstitial lung disease.

A

Bleomycin, busulfan, and amiodarone

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62
Q

What processes cause restrictive lung disease due to poor muscular effort?

A

Polio and myasthenia gravis

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63
Q

What processes cause restrictive lung disease due to poor structural breathing mechanics?

A

Scoliosis and morbid obesity

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64
Q

What processes cause restrictive lung disease due to interstitial lung pathology?

A

Acute respiratory distress syndrome, neonatal respiratory distress syndrome, pneumoconioses, sarcoidosis, idiopathic pulmonary fibrosis, Goodpasture’s syndrome, Wegener’s granulomatosis, histiocytosis X, and certain drug toxicities

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65
Q

Which lobe of the lung is most affected in coal miner’s disease?

A

Upper lobes

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66
Q

Coal miner’s disease can be associated with what two additional pathologic conditions?

A

Cor pulmonale or Caplan’s syndrome (the combination of pneumoconiosis and rheumatoid arthritis)

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67
Q

Patients with silicosis likely worked in what three fields?

A

Foundries, sandblasting, and mining

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68
Q

What cell type is responsible for the fibrosis induced by silica inhalation?

A

Macrophages

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69
Q

Silicosis increases the risk of what infectious disease?

A

Tuberculosis

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70
Q

What lobe of the lung is most affected by silicosis?

A

Upper lobes

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71
Q

The finding of eggshell calcification on chest x-ray would increase suspicion of what disease?

A

Silicosis

72
Q

What substance, used for such things as shipbuilding and insulation, can result in a diffuse pulmonary interstitial fibrosis?

A

Asbestos

73
Q

Patients with asbestosis are at increased risk of what two cancers?

A

Mesothelioma and bronchogenic carcinoma

74
Q

What gross pathologic finding can be found on the pleura of patients who have been exposed to asbestos?

A

Ivory white pleural plaques

75
Q

Asbestosis is most commonly seen in practitioners of what professions?

A

Shipbuilders, plumbers, and roofers

76
Q

Asbestosis mainly affects the ____ (lower/upper) lung lobes, while coal worker’s lung affects the _____ (lower/upper) lobes.

A

Lower; upper

77
Q

What are asbestos bodies and where are they located?

A

Golden-brown fusiform rods found in macrophages

78
Q

In neonatal respiratory distress syndrome, there is a deficiency of what chemical?

A

Surfactant

79
Q

How does the lack of surfactant in neonatal respiratory distress syndrome impair gas exchange in the lungs?

A

Surfactant deficiency leads to an increase in surface tension, resulting in collapse of the alveoli

80
Q

What cells make surfactant?

A

Type II pneumocytes

81
Q

Surfactant is made most abundantly during which period of neonatal gestation?

A

After the 35th week

82
Q

What ratio is used as a measure of lung maturity in neonates? How is it tested?

A

The lecithin/sphingomyelin ratio in the amniotic fluid

83
Q

In neonatal respiratory distress syndrome, the lecithin-to-sphingomyelin ratio is usually within what range?

A

<1.5

84
Q

Medical treatment for neonatal respiratory distress syndrome includes what treatment for the mother before birth?

A

Maternal steroids

85
Q

What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?

A

Patent ductus arteriosus; patent ductus arteriosus can cause pulmonary hypertension if not corrected medically or surgically

86
Q

What are three risk factors for neonatal respiratory distress syndrome?

A

Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)

87
Q

How can neonates be treated for respiratory distress syndrome after birth?

A

With artificial surfactant

88
Q

Use of supplemental oxygen in neonates can lead to what ocular pathology?

A

Retinopathy of prematurity

89
Q

In acute respiratory distress syndrome, acute alveolar damage leads to a(n) _____ (decrease/increase) in alveolar capillary permeability.

A

Increase

90
Q

Despite many etiologies, what pathophysiology is seen in all cases of acute respiratory distress syndrome?

A

Fluid leakage into alveoli causing hyaline membrane formation on the inside of the alveolus thus impeding gas exchange

91
Q

Name seven conditions known to cause acute respiratory distress syndrome.

A

Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, uremia

92
Q

What obstetric complication can result in adult respiratory distress syndrome?

A

Amniotic fluid embolism

93
Q

A chronic alcoholic suffering from acute pancreatitis is experiencing difficulty breathing and oxygen desaturation. From what pulmonary complication of acute pancreatitis may she be suffering?

A

Acute respiratory distress syndrome

94
Q

Name three molecular mechanisms that contribute to the initial damage to the alveoli in acute respiratory distress syndrome.

A

Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals

95
Q

The forced expiratory volume1:forced vital capacity is what percent in normal lungs; in obstructive lung disease; in and restrictive lung disease?

A

Approximately 80%; <80%; >80%

96
Q

Forced expiratory volume1 and forced vital capacity are reduced in both obstructive and restrictive pulmonary diseases; however, forced expiratory volume1 is more dramatically reduced in ____ (obstructive/restrictive) pulmonary disease.

A

Obstructive

97
Q

In ____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity <80% and lung volumes are increased.

A

Obstructive

98
Q

In _____ (obstructive/restrictive) pulmonary disease, forced expiratory volume1/forced vital capacity >80% and lung volumes are decreased.

A

Restrictive

99
Q

How do total lung volumes in obstructive lung disease compare with normal lung volumes?

A

Lung volumes in chronic obstructive pulmonary disease are greater than normal lung volumes

100
Q

Is residual volume decreased, increased, or normal in obstructive lung disease?

A

Increased

101
Q

How do total lung volumes in restrictive lung disease compare with normal lung volumes?

A

Lung volumes are less than normal in restrictive lung disease

102
Q

In which type of lung disease, obstructive or restrictive, is the forced expiratory volume1/forced vital capacity ratio more dramatically reduced?

A

Obstructive

103
Q

Define sleep apnea.

A

The condition that occurs when a person repeatedly stops breathing for at least 10 seconds during sleep

104
Q

Define central sleep apnea.

A

Sleep apnea due to a lack of respiratory effort

105
Q

Define obstructive sleep apnea.

A

Sleep apnea with which there is a drive to breathe but mechanical airway obstruction (usually obesity) prevents respiration

106
Q

An obese man complains of chronic fatigue. His wife says he is an especially loud snorer. What condition may be contributing to this patient’s fatigue?

A

Sleep apnea

107
Q

Name three treatments of sleep apnea.

A

Weight loss, continuous positive airway pressure, surgery

108
Q

Name five conditions potentially associated with sleep apnea.

A

Obesity, loud snoring, pulmonary hypertension, arrhythmias, and possible sudden death

109
Q

In the case of bronchial obstruction, what happens to the breath sounds over the affected area?

A

They are decreased or absent

110
Q

What are the physical exam findings in a patient with bronchial obstruction?

A

Hyporesonance to percussion, decreased fremitus, and if there is tracheal deviation, it is towards the side of the lesion

111
Q

What are the physical exam findings in a patient with pleural effusion?

A

Decreased breath sounds, dullness to percussion, decreased fremitus

112
Q

What are the physical exam findings in a patient with lobar pneumonia?

A

Bronchial breath sounds, dullness to percussion, increased fremitus, no tracheal deviation

113
Q

What are the physical exam findings in a patient with pneumothorax?

A

Decreased breath sounds, hyperresonance, absent fremitus, and tracheal deviation away from the lesion

114
Q

Pleural effusions cause a(n) _____ (decrease/increase) in fremitus, whereas pneumonia causes a(n) _____ (decrease/increase) in fremitus.

A

Decrease; increase

115
Q

Bronchial obstructions may cause tracheal deviation _____ (away from/toward) the lesion, whereas pneumothoraces result in deviation _____ (away from/toward) the lesion.

A

Toward; away from

116
Q

In what area of the lungs does squamous cell carcinomas typically arise?

A

Central

117
Q

In what area of the lungs does small cell carcinoma typically arise?

A

Central

118
Q

In what area of the lungs does adenocarcinoma typically arise?

A

Peripheral

119
Q

In what area of the lungs does large cell carcinoma typically arise?

A

Peripheral

120
Q

List the two lung cancers that have a link to smoking.

A

Squamous cell carcinoma and small cell carcinoma

121
Q

Squamous cell carcinoma of the lungs is known for the ectopic production of what substance?

A

Parathyroid hormone-related peptide, the release of which causes hypercalcemia

122
Q

List three forms of bronchogenic carcinoma that tend to arise peripherally in the lungs.

A

Adenocarcinoma, bronchioalveolar carcinoma, and large-cell carcinoma

123
Q

What is the most common type of lung cancer in non-smokers?

A

Adenocarcinoma

124
Q

What peripherally arising form of bronchogenic carcinoma is most anaplastic or undifferentiated?

A

Large-cell carcinoma

125
Q

What are the classic symptoms of carcinoid syndrome and what is the cause?

A

Flushing, diarrhea, wheezing, salivation; the symptoms are caused by serotonin secretion into the bloodstream

126
Q

Are metastases from primary lung cancers very rare, rare, common, or very common and to what three sites do they occur?

A

Very common; brain, bone, and liver

127
Q

In association with a primary lung cancer, what finding suggests brain metastases?

A

Seizures

128
Q

In association with a primary lung cancer, what finding suggests bone metastases?

A

Pathologic fractures

129
Q

In association with a primary lung cancer, what two findings suggest liver metastases?

A

Jaundice and hepatomegaly

130
Q

What type of cancer is the leading cause of cancer death?

A

Lung cancer

131
Q

Lung cancer can present with what incidental radiologic finding?

A

Pulmonary “coin” lesions

132
Q

How can the voice of a patient with lung cancer change?

A

Hoarseness; due to compression of the recurrent laryngeal nerve

133
Q

Which potential spaces can develop effusions as a result of lung cancer?

A

Pleural and pericardial effusions

134
Q

How does the mnemonic SPHERE help one to remember common complications associated with lung cancer?

A

SPHERE stands for Superior vena cava syndrome, Pancoast’s tumor, Horner’s syndrome, Endocrine (paraneoplastic) complications, Recurrent laryngeal symptoms, and Effusions

135
Q

A cavitary hilar mass arising from the bronchus of a long-time smoker may suggest which disease process?

A

Squamous cell carcinoma

136
Q

Histologically, which lung carcinoma forms keratin pearls and intercellular bridges?

A

Squamous cell carcinoma

137
Q

Which lung carcinoma may develop in sites of prior pulmonary inflammation or injury and is the most common lung cancer in nonsmokers and females?

A

Bronchial adenocarcinoma

138
Q

Which of the following is more common on x-ray of the chest in lung adenocarcinoma, a single lesion or multiple densities?

A

Multiple densities

139
Q

Clara cells differentiate into type II pneumocytes in which type of lung cancer?

A

Adenocarcinoma (bronchial and bronchioloalveolar)

140
Q

Which cells are the precursors to small-cell lung cancer?

A

Neuroendocrine Kulchitsky cells

141
Q

Name three possible paraneoplastic syndromes associated with small cell carcinoma of the lung.

A

Adrenocorticotropic hormone syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and Lambert-Eaton syndrome

142
Q

What is Lambert-Eaton syndrome?

A

A paraneoplastic syndrome associated with small cell carcinoma of the lung in which autoantibodies form against presynaptic calcium channels, leading to muscle weakness

143
Q

What is the usual approach to the treatment of large cell carcinoma of the lung?

A

Remove surgically (poorly responsive to chemotherapy)

144
Q

Histologically, which lung cancer is associated with pleomorphic giant cells with leukocyte fragments in the cytoplasm?

A

Large-cell carcinoma

145
Q

What is the approach to treatment of small-cell lung cancer?

A

This inoperable cancer is treated with chemotherapy

146
Q

Patients with metastases to the lung present with symptoms of _____ (cough/dyspnea) and patients with primary lung cancer present with symptoms of _____ (cough/dyspnea).

A

Dyspnea; cough

147
Q

Bronchioloalveolar adenocarcinoma can present similarly to which other non-cancer pathological lung disease?

A

Pneumonia

148
Q

A long-time shipbuilder presents with difficulty breathing. X-ray demonstrates an effusion. On tap, the fluid is bloody. A biopsy shows psammoma bodies. What is the disease process?

A

Mesothelioma secondary to asbestos exposure

149
Q

Small-cell carcinoma is associated with the production of what two hormones?

A

Adrenocorticotropic hormone or antidiuretic hormone

150
Q

In what region of the lung does Pancoast’s tumor occur?

A

The apex

151
Q

Because of its location, Pancoast’s tumor may affect what neurologic structure?

A

The cervical sympathetic plexus

152
Q

When Pancoast’s tumor disrupts the cervical sympathetic plexus, it can result in what condition?

A

Horner’s syndrome

153
Q

Horner’s syndrome includes what three findings?

A

Ptosis, miosis, and anhidrosis

154
Q

Lobar pneumonia is most frequently the result of infection with what organism?

A

Streptococcus pneumoniae

155
Q

Which type of pneumonia is most often caused by viruses?

A

Interstitial (atypical) pneumonia

156
Q

List two viruses that commonly cause interstitial pneumonia.

A

Respiratory syncytial virus and adenoviruses

157
Q

In which type of pneumonia does an intra-alveolar exudate lead to consolidation?

A

Lobar pneumonia

158
Q

Which type of pneumonia characteristically shows diffuse, patchy inflammation?

A

Interstitial (atypical) pneumonia

159
Q

Interstitial pneumonia characteristically shows diffuse, patchy inflammation that is localized to what areas of the lung?

A

Interstitial areas at the alveolar walls

160
Q

The distribution of interstitial pneumonia characteristically involves how many lobes?

A

At least one, usually more

161
Q

Which type of category of pneumonia typically has a less acute presentation?

A

Interstitial pneumonia

162
Q

List four bacterial etiologies of bronchopneumonia.

A

Staphylococcus aureus, Haemophilus influenzae, Klebsiella, Streptococcus pyogenes

163
Q

List three bacterial causes of interstitial pneumonia.

A

Mycoplasma, legionella, chlamydia

164
Q

What is a lung abscess?

A

A localized collection of pus in the lung parenchyma

165
Q

What two conditions can predispose a patient to lung abscesses?

A

Bronchial obstruction (usually by a tumor) or the aspiration of gastric contents (often after seizures or heavy alcohol use)

166
Q

What type of individuals are predisposed to developing lung abscesses, even in the absence of preexisting pulmonary disease?

A

Patients who are prone to loss of consciousness like alcoholics and epileptics; they are at increased risk of aspiration of gastric contents

167
Q

Name two organisms (or classes of organisms) most commonly implicated in the development of lung abscesses.

A

Staphylococcus aureus and anaerobes

168
Q

In terms of pleural effusions, transudates have _____ (less/more) protein than exudates.

A

Less

169
Q

In terms of pleural effusions, exudates have _____ (less/more) protein than transudates.

A

More

170
Q

What are three common causes of transudative pulmonary effusions?

A

Congestive heart failure, nephrotic syndrome, and hepatic cirrhosis

171
Q

Name four causes of exudative pulmonary effusions.

A

Malignancy, pneumonia, collagen vascular disease, trauma

172
Q

What makes an exudate cloudy?

A

Exudates are cloudy because of their higher protein content

173
Q

Name the three types of pleural effusions.

A

Transudative, exudative, and lymphatic

174
Q

Are pleural effusions that are secondary to trauma usually transudates or exudates?

A

Exudates, due to increased vascular permeability in the setting of trauma

175
Q

Which type of pleural effusion consists of high levels of triglycerides and has a milky appearance grossly?

A

Lymphatic

176
Q

For what reason does an exudative pleural effusion require drainage?

A

Exudates have a high infection risk; they can progress to empyema, which requires surgery

piggy (83 decks)

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