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Respiratory Pathology Flashcards

1
Q

Rhinitis is inflammation of the nasal mucosa; the most common cause is ___________; presents with sneezing, congestion, and runny nose (common cold)

A

Adenovirus

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2
Q

Allergic rhinitis is due to a type ______ HSR (e.g., due to pollen), characterized by inflammatory infiltrate with _________; it is associated with asthma and eczema

A

Type I HSR; eosinophils

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3
Q

_____ _____ = protrusion of edematous, inflamed nasal mucosa, usually secondary to repeated bouts of rhinitis bu also occur in _____ _____ and ASA-intolerant asthma (asthma, aspirin-induced bronchospasm, and nasal polyps — seen in 10% of asthmatic adults)

A

Nasal polyps; cystic fibrosis

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4
Q

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue classically seen in adolescent males; presents with profuse epistaxis

A

Angiofibroma

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5
Q

Nasopharyngeal carcinoma is a malignant tumor of nasopharyngeal epithelium. It is associated with _______ (virus); classically seen in African children and Chinese adults who present with cervical LAD.

Biopsy shows pleomorphic _______-positive epithelial cells in a background of lymphocytes

A

EBV

Keratin

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6
Q

Acute epiglottitis = inflammation of the epiglottis, most commonly casued by __________, especially in non-immunized children.

Patients present with high fever, sore throat, drooling, dysphagia, muffled voice, and inspiratory ______. There is a risk of acute airway obstruction.

A

H influenza type b

Stridor

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7
Q

____________ = inflammation of the upper airway that presents with hoarse “barking” cough and inspiratory stridor; most common cause is ________ virus

A

Laryngotracheobronchitis (croup); Parainfluenza

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8
Q

Vocal cord nodules arise due to excessive use and are usually bilateral. They present with hoarseness and resolve with rest. What are these nodules composed of?

A

Degenerative (myxoid) connective tissue

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9
Q

Laryngeal papilloma = benign papillary tumor of vocal cord due to __________. Tend to present as single lesions in adults, and multiple in children. Presents with hoarseness

A

HPV 6 and 11

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10
Q

What type of cancer is laryngeal carcinoma?

A

Squamous cell

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11
Q

Laryngeal carcinoma is a squamous cell carcinoma arising from the epithelial lining of the vocal cord; Primary risk factors are _____ and ______. Presents with hoarseness, cough, and/or stridor

A

Alcohol; tobacco

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12
Q

Pneumonia is an infection of lung parenchyma arising when normal defenses are impaired (i.e., cough reflex, damage to mucociliary escalator, mucus plugs). Clinically patients present with fever and chills, cough with yellow-green or rusty sputum, tachypnea with pleuritic chest pain, decreased breath sounds with dullness to percussion, and elevated WBC count. Diagnosis is made by CXR, sputum gram stain and culture, and blood cultures. What are the 3 patterns classically seen on CXR and are they usually bacterial or viral?

A

Lobar pneumonia — bacterial

Bronchopneumonia — bacterial

Interstitial pneumonia — viral

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13
Q

Lobar PNA is a consolidation of an entire lobe and is usually bacterial. What are the 2 most common causes of lobar PNA?

A

S pneumoniae (95% of cases)

Klebsiella pneumoniae

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14
Q

_______ ______ affects malnourished and debilitated individuals, especially elderly in nursing homes, alcoholics, and diabetics (enteric flora that is aspirated). Thick mucoid capsule results in a gelatinous sputum (currant jelly); often complicated by abscess

A

Klebsiella pneumoniae

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15
Q

4 classic phases of lobar PNA

A

Congestion — congested vessels and edema

Red hepatization — exudate with neutrophils and blood

Grey hepatization — breakdown of exudate and blood

Resolution — mediated by type II pneumocyte

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16
Q

Bronchopneumonia is characterized by scattered patchy consolidation centered around bronchioles; often multifocal and bilateral, and is caused by a variety of bacteria. What are the 5 most common causes of bronchopneumonia?

A

S aureus

H influenzae

Pseudomonas aeruginosa

Morazella catarrhalis

Legionella pneumophila

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17
Q

Most common cause of secondary pneumonia (bacterial PNA superimposed on viral URI); often complicated by abscess or emphysema

A

Staphylococcus aureus

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18
Q

Common cause of secondary PNA and PNA superimposed on COPD (leads to COPD exacerbation)

A

Haemophilus influenzae

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19
Q

Cause of bronchopneumonia that should be associated with cystic fibrosis pts

A

Pseudomonas aeruginosa

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20
Q

Community-acquired PNA and PNA superimposed on COPD (leads to exacerbation of COPD)

A

Moraxella catarrhalis

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21
Q

Community-acquired PNA, PNA superimposed on COPD, or PNA in immunocompromised states; transmitted from water source. Intracellular organism best visualized by silver stain

A

Legionella pneumophila

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22
Q

Interstitial (atypical) PNA is characterized by diffuse interstitial infiltrates, presenting with relatively mild URI symptoms (minimal sputum, cough, and low fever). What are some of the organisms that can cause atypical PNA?

A

Mycoplasma pneumoniae

Chlamydia pneumoniae

Respiratory syncytial virus (RSV)

Cytomegalovirus (CMV)

Influenza virus

Coxiella burnetii

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23
Q

Most common cause of atypical PNA, usually affects young adults (classically military recruits or college students in dorms). Complications include autoimmune hemolytic anemia (IgM against I antigen on RBCs causes cold hemolytic anemia) and erythema multiforme. Not visible on gram stain due to lack of cell wall

A

Mycoplasma pneumoniae

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24
Q

Second most common cause of atypical PNA in young adults

A

Chlamydia pneumoniae

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25
Q

Most common cause of atypical PNA in infants

A

RSV

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26
Q

What etiology should you associate atypical PNA in the setting of posttransplant immunosuppressive therapy?

A

CMV

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27
Q

Cause of atypical PNA in the elderly, immunocompromised, and those with preexisting lung disease; also increases risk for superimposed S aureus or H influenzae bacterial PNA

A

Influenza virus

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28
Q

Rickettsial cause of atypical PNA with high fever seen in farmers and veterinarians (spores are deposited on cattle by ticks or are present in cow placentas); distinct from other rickettsial organisms because it causes PNA, does not require arthropod vector for transmission, and does not produce skin rash

A

Coxiella burnetii (Q fever)

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29
Q

Aspiration PNA is seen in pts at risk for aspiration (e.g., alcoholics, epileptics, comatose), due to anaerobic bacteria in oropharynx (e.g., bacteroides, fusobacterium, and peptococcus). It classically results in an abscess in what location?

A

Right lower lobe

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30
Q

Tuberculosis arises due to inhalation of aerosolized Mycobacterium tuberculosis. Primary TB arises with initial exposure, resulting in focal caseating necrosis in ______ lobe of lung and hilar LNs. Foci undergo fibrosis and calcification, forming _____ complex.

A

Lower; Ghon

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31
Q

T/F: Primary TB is generally asymptomatic, but leads to a positive PPD

A

True; TB does not typically become symptomatic until reactivated as secondary TB — clinical features may include fevers, night sweats, cough with hemoptysis, weight loss, and biopsy revealing caseating granulomas; AFB stain shows red acid-fast bacilli

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32
Q

Secondary TB arises with reactivation of TB, commonly due to ______ but may also be seen with aging. This occurs at the ______ of the lung, forming cavitary foci of caseous necrosis, and may also lead to miliary pulmonary TB or tuberculous bronchopneumonia

A

AIDS; apex

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33
Q

Systemic spread of TB often occurs and can involve any tissue. What are some locations that TB characteristically spreads?

A

Meninges —> meningitis (granulomas at the base of the brain)

Cervical LNs

Kidneys —> sterile pyuria

Lumbar vertebrae —> Pott disease

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34
Q

How do FVC, FEV1, FEV1:FVC ratio, and TLC change with obstructive pulmonary disease?

A

FVC decreases, FEV1 decreases more than FVC

FEV1:FVC ratio decreases

TLC increases (air trapping)

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35
Q

Chronic bronchitis is highly associated with smoking. What are the diagnostic criteria for chronic bronchitis?

A

Productive cough for >3 months in a year for >2 consecutive years

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36
Q

Pathophysiology of chronic bronchitis includes ______ of bronchial mucinous glands leading to increased thickeness of mucus glands relative to overall bronchial wall thickness, which results in a _____ index of ______

A

Hypertrophy; Reid index of >50%

[Normal Reid index should be <40%]

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37
Q

Clinical features of chronic bronchitis include productive cough, cyanosis, increased PaCO2 and decreased PaO2.

What 2 conditions does chronic bronchitis increase risk for?

A

Infection

Cor pulmonale

38
Q

______ = destruction of alveolar air sacs, loss of elastic recoil and collapse of small airways leading to air trapping due to imbalance of proteases and antiproteases

A

Emphysema

39
Q

Smoking is the most common cause of emphysema, resulting in a ________ emphysema that is more severe in ______ lobes

A

Centriacinar; upper

40
Q

Alpha-1 antitrypsin deficiency is a rare cause of emphysema, resulting in a _______ emphysema that is more severe in the ______ lobes. In terms of other organs affected, ______ ______ may also be present

A

Panacinar; lower

Liver cirrhosis

[Liver cirrhosis because the liver is still making alpha-1 antitrypsin, but it is misfolded and so it cannot leave the liver. It builds up in ER of hepatocytes and damages the cells leading to cirrhosis — presents with pink PAS+ globules on histology]

41
Q

With alpha-1 antitrypsin deficiency, disease severity is based on degree of deficiency. ______ is the normal allele for A1AT, while ______ is the most commonly clinically relevant mutation (causing A1AT to build up in _______ of hepatocytes)

A

PiM

PiZ; ER

42
Q

With alpha-1 antitrypsin deficiency, disease severity is based on degree of deficiency. PiM is the normal allele for A1AT, while PiZ is the most commonly clinically relevant mutation.

What is the significance of being a PiMZ heterozygote?

A

Usually asymptomatic with decreased circulating levels of A1AT

Significant risk for emphysema with smoking

43
Q

With alpha-1 antitrypsin deficiency, disease severity is based on degree of deficiency. PiM is the normal allele for A1AT, while PiZ is the most commonly clinically relevant mutation.

What is the significance of being a PiZZ homozygote?

A

Significant risk for panacinar emphysema and cirrhosis

44
Q

Clinical features of emphysema include dyspnea and cough with minimal sputum, prolonged expiration with pursed lips (‘pink puffer’), weight loss, and increased AP diameter of the chest (‘barrel chest’). Late complications include hypoxemia and cor pulmonale.

How does the functional residual capacity change in emphysema?

A

FRC increases

45
Q

Asthma is a condition characterized by reversible airway bronchoconstriction, most often due to allergic stimuli causing a type ______ HSR. Asthma typically presents in childhood, and is often associated with allergic rhinitis, eczema, and family history of atopy

A

Type 1 HSR

46
Q

The pathogenesis of asthma begins when allergens induce _____ phenotype in _____ T cells of genetically susceptible individuals.

These cells then secrete cytokines _____, _____, and _____.

On reexposure to allergen, there is ____-mediated activation of mast cells (early phase), and inflammation (e.g., major basic protein) perpetuates bronchoconstriction (late-phase)

A

Th2; CD4+

IL-4, IL-5, IL-10

IgE

__________________________________________
[IL-4 causes production of IgE. IL-5 recruits eosinophils. IL-10 stimulates development of Th2 subtype of CD4 T cells, and inhibits Th1 subtype]

47
Q

Clinical features of asthma are episodic, related to exposure to antigen, and include dyspnea, wheezing, and productive cough. The mucus from the productive cough contains _____ ______ admixed with _______ _______ (derived from eosinophils).

A severe, unrelenting attack can result in ______ ______ and death.

A

Curschmann spirals; Charcot-Leyden crystals

Status asthmaticus

48
Q

T/F: Asthma is always attributed to an allergic cause

A

False — nonallergic causes include exercise, viral infection, aspirin (e.g., aspirin-intolerant asthma), and occupational exposures

49
Q

______ = obstructive pulmonary disease characterized by permanent dilation of bronchioles and bronchi; loss of airway tone results in air trapping

A

Bronchiectasis

50
Q

Bronchiectasis occurs due to necrotizing inflammation with damage to airway walls. In what conditions is bronchiectasis seen?

A 
Cystic fibrosis
Kartagener syndrome
Tumor or foreign body
Necrotizing infection
Allergic bronchopulmonary aspergillosis
51
Q

Clinical features of bronchiectasis include cough, dyspnea, and foul-smelling sputum. Complications include hypoxemia with ____ _____ and _____ _____.

A

Cor pulmonale; secondary amyloidosis

[Chronic inflammation leads to overproduction of SAA which is converted to AA which is then deposited as amyloid]

52
Q

How do TLC, FVC, FEV1, and FEV1:FVC ratio change in restrictive lung disease?

A

TLC decreases

FVC decreases more than FEV1, FEV1 decreases

FEV1:FVC ratio is increased (>80%)

53
Q

Most commonly, restrictive lung disease is due to interstitial disease (resulting in fibrosis of interstitium), but may also arise with chest wall abnormalities (e.g., obesity, scoliosis, etc.).

_____ _____ _____ is an interstitial disease resulting in fibrosis of the lung interstitium caused by cyclical lung injury. ______ from injured pneumocytes induces fibrosis. Clinical features include progressive dyspnea and cough, fibrosis on lung CT (“honeycomb lung”), and treatment is lung transplant. Secondary causes such as drugs (e.g., bleomycin and amiodarone) and radiation therapy must be excluded

A

Idiopathic pulmonary fibrosis

TGF-beta

54
Q

Interstitial lung fibrosis due to occupational exposure; requires chronic exposure to small particles that are fibrogenic

A

Pneumoconiosis

55
Q

Coal worker’s pneumoconiosis may occur following exposure to carbon dust. Massive exposure leads to diffuse fibrosis (‘black lung’) associated with rheumatoid arthritis — a phenomenon known as _______ ________. Mild exposure to carbon (e.g., pollution) results in _______ (collections of carbon-laden macrophages) and is not clinically significant

A

Caplan syndrome; anthracosis

56
Q

________ is a type of pneumoconiosis seen in sandblasters and miners, manifesting as fibrotic nodules in upper lobes of the lung. These pts are at increased risk for ______, as this entity impairs phagolysosome formation by macrophages

A

Silicosis (silica); TB

57
Q

______ is a type of pneumoconiosis seen in miners and workers in the aerospace industry, manifesting as noncaseating granulomas in the lung, hilar LNs, and systemic organs. These pts are at increased risk for _______

A

Berylliosis; lung cancer

[beware — do not get this confused with sarcoidosis — look for context of exposure like aerospace industry, etc.]

58
Q

_______ is a type of pneumoconiosis seen in construction workers, plumbers, and shipyard workers leading to fibrosis of lung and pleura (plaques) with increased risk for lung carcinoma and mesothelioma (_______ is more common in exposed individuals).

Lesions may contain long, golden-brown fibers with associated _____, which confirm the exposure

A

Asbestosis; lung carcinoma

Iron

59
Q

What is the only pneumoconiosis that increases the risk for TB?

A

Silicosis — because it impairs phagolysosome formation by macrophages!

60
Q

Systemic disease characterized by noncaseating granulomas in multiple organs (most commonly lung and hilar LNs); classically seen in African American females. Etiology is unknown but most likely due to CD4+ helper T cell response to unknown antigen

A

Sarcoidosis

61
Q

Characteristic finding on biopsy of granuloma in the setting of sarcoidosis

A

Asteroid body

62
Q

While sarcoidosis most commonly involves the lung and hilar LNs, what are some other tissues commonly involved?

A

Uvea (uveitis)

Skin (cutaneous nodules or erythema nodosum)

Salivary and lacrimal glands (mimics Sjogren syndrome)

[note that almost any tissue can be involved!]

63
Q

Clinical features of sarcoidosis include dyspnea or cough, elevated serum _______, and _________ due to 1-alpha hydroxylase activity in granulomas that activate vitamin D.

Treatment is steroids; but it often resolves spontaneously without treatment

A

ACE; hypercalcemia

64
Q

Restrictive lung disease characterized as an eosinophilic granulomatous reaction to inhaled organic antigens (e.g., pigeon breeder’s lung); presents with fever, cough, and dyspnea hours after exposure; resolves with removal of the exposure, however chronic exposure can lead to interstitial fibrosis

A

Hypersensitivity pneumonitis

65
Q

Pulmonary HTN is defined as high pressure in the pulmonary circuit. What is the normal pressure in this circuit, and what is defined as pulmonary HTN?

A

Normal is 10 mm Hg

Pulmonary HTN is >25 mm Hg

66
Q

Pulmonary HTN is characterized by ______ of the pulmonary trunk, smooth muscle _______ of pulmonary arteries, intimal fibrosis, and _______ lesions with severe long-standing disease (refers to tuft of capillaries group together)

A

Atherosclerosis; hypertrophy, plexiform

67
Q

Pulmonary HTN leads to RVH and cor pulmonale, which presents with exertional dyspnea or right-sided heart failure. Pulmonary HTN can be divided into primary or secondary.

Primary pulmonary HTN is classically seen in young adult _______. The etiology is unknown, but familial forms are related to inactivating mutations of ________ which leads to proliferation of vascular smooth muscle

A

Females; BMPR2

68
Q

Pulmonary HTN can be divided into primary or secondary.

Secondary pulmonary HTN occurs due to _______ (e.g., COPD and interstitial lung disease) or increased volume in pulmonary circuit (e.g., congenital heart disease). It may also arise with recurrent _____ _____

A

Hypoxemia; pulmonary embolism

69
Q

Acute respiratory distress syndrome (ARDS) is characterized by diffuse damage to alveolar-capillary interface (diffuse alveolar damage) and leakage of protein-rich fluid leads to edema and formation of _______ membranes in alveoli.

Clinical features are hypoxemia and cyanosis with respiratory distress; presents with “white-out” appearance on CXR.

A

Hyaline

70
Q

Potential etiologies of ARDS include sepsis, infection, shock, trauma, aspiration, pancreatitis, DIC, hypersensitivity reactions, and drugs.

One of the underlying themes, regardless of etiology, is activation of _______, which induces ______-mediated and _______-mediated damage of type I and II pneumocytes

A

Neutrophils; protease-mediated; free radical-mediated

[NOTE that both type I and type II pneumocytes are damaged in this disorder!!]

71
Q

Treatment for ARDS involves addressing the underlying cause, as well as ventilation with _____________. Recovery may be complicated by interstitial fibrosis

A

Positive end-expiratory pressure (PEEP)

72
Q

Neonatal respiratory distress syndrome is due to inadequate _______ levels. Clinical features include increasing respiratory effort after birth, tachypnea with use of accessory muscles, and grunting. In addition, pts may present with hypoxemia with cyanosis, and diffuse granularity of lung on x-ray.

This condition is associated with _______ birth, which can be screened with ______ ratio (should be >2 to indicate adequate maturation); other associations include _______ delivery and maternal ______

A

Surfactant

Premature; Lecithin:Sphingomyelin (L:S) ratio; C-section; diabetes

73
Q

Major component of surfactant and the cells that produce it

A

Phosphatidylcholine (lecithin)

Produced by type II pneumocytes (which also serve as stem cells in the lung)

74
Q

Complications of neonatal respiratory distress syndrome, particularly due to hypoxemia, are _______________ and _____________.

Another complication, which may be caused by supplemental oxygen, is _________

A

Persistent PDA; necrotizing enterocolitis

Free radical injury

75
Q

Most common cause of cancer mortality in the US

A

Lung cancer

[Average age at presentation is 60 yrs; key risk factors are cigarette smoke (arsenic and polyaromatic hydrocarbons), radon (increased risk in uranium miners), and asbestos]

76
Q

Presentation of lung cancer typically involves nonspecific symptoms. Imaging often reveals a solitary nodule, or “coin lesion” — this must then be compared to prior imaging as benign lesions such as ______ (TB or fungus usually), and ______ ______ (often calcified on imaging) can also present with coin lesions on x-ray

____ is necessary for the official diagnosis of lung cancer

A

Granuloma; bronchial hamartoma

Biopsy

77
Q

The classic division of lung carcinoma is small cell carcinoma (15% of cases) and non-small cell carcinoma (85% of cases).

Which of these is more amenable to surgical resection, and which one is more amenable to chemotherapy?

A

Non-small cell carcinoma is more amenable to surgical resection, but is not usually as responsive to chemotherapy

Small-cell carcinoma is more amenable to chemotherapy, but is not typically able to be surgically excised

78
Q

Major subtypes of non-small cell carcinoma

A

Adenocarcinoma (40%)

Squamous cell carcinoma (30%)

Large cell carcinoma (10%)

Carcinoid tumor (5%)

79
Q

Small cell carcinoma of the lung is characterstically made up of poorly differentiated small cells arising from _________ cells. It is typically associated with male smokers and a _______ location.

This type of lung cancer exhibits ______ growth and ______ metastasis

A

Neuroendocrine (Kulchitsky); central

Rapid; early

80
Q

Production of ADH or ACTH, or Lambert-Eaton syndrome are paraneoplastic syndromes associated with which type of lung cancer?

A

Small cell carcinoma

81
Q

Squamous cell carcinoma is the most common tumor in male smokers and is associated with _______ location, as well as ______ and _______ on histology.

An associated paraneoplastic syndrome is the production of ______

A

Central; keratin pearls; intercellular bridges

PTHrP

82
Q

Most common lung tumor in nonsmokers and female smokers, associated with peripheral location and mucin on histology

A

Adenocarcinoma

83
Q

Large cell carcinoma consists of poorly differentiated large cells (no keratin pearls, intercellular bridges, glands, or mucin) and is associated with smoking. It may be of central or peripheral location, and has a ______ prognosis

A

Poor

84
Q

T/F: Bronchioalveolar carcinoma of the lung and carcinoid tumor of the lung are NOT related to smoking

A

True

85
Q

Type of lung cancer consisting of columnar cells that grow along preexisting bronchioles and alveoli; arises from Clara cells and typically affects peripheral location. May present with pneumonia-like consolidation on imaging and has excellent prognosis

A

Bronchioalveolar carcinoma

86
Q

Type of lung tumor consisting of well differentiated neuroendocrine cells that are chromogranin positive and may be affect central or peripheral location — classically forming a polyp-like mass in the bronchus. Considered a low-grade malignancy but rarely can cause associated syndrome

A

Carcinoid tumor

87
Q

In terms of metastasis to the lung, the most common sources are ____ and ____ carcinoma. Typically presents as multiple ‘cannon-ball’ nodules on imaging. Metastasis is ______ common than primary tumors

A

Breast; colon; more

88
Q

Describe TNM staging of lung carcinoma

A

T: based on size and local extension

N: based on spread to regional LNs (hilar and mediastinal)

M: unique site of distant spread is the adrenal gland

[Overall, 15% 5-year survival due to late presentation]

89
Q

Local complications of lung cancer

A

Pleural involvement

Obstruction of SVC (SVC syndrome)

Involvement of recurrent laryngeal (hoarseness) or phrenic nerve (diaphragmatic paralysis)

Compression of sympathetic chain (Pancoast tumor) — ptosis, miosis, anhidrosis (Horner’s syndrome)

90
Q

Pneumothorax = accumulation of air in the pleural space.

One type of pneumothorax is a spontaneous pneumothorax, which is caused by rupture of ______ _____ resulting in collapse of portion of lung; seen in young adults. In this case, the trachea shifts ______ the side of collapse

A

Emphysematous bleb; toward

91
Q

Tension pneumothorax arises with penetrating chest wall injury. In this case, the trachea is shifted ______ the side of injury. This is a medical emergency that requires insertion of a chest tube

A

Away from

92
Q

Mesothelioma is a malignant neoplasm of mesothelial cells highly associated with occupational exposure to ______. Presents with recurrent ______ _____, dyspnea, and chest pain. The tumor encases the lung.

A

Asbestos; pleural effusions

Boards Pathology SG (19 decks)

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