Respiratory- Phatology

Question 1

Rhinosinusitis

Answer 1

Obstruction of sinus drainage into nasal cavity Ž inflammation and pain

Most common acute cause is viral URI; may lead to superimposed bacterial infection, most commonly S pneumoniae, H influenzae, M catarrhalis.

Question 2

Epistaxis

Answer 2

Common causes include foreign body, trauma, allergic rhinitis, and nasal angiofibromas (common in adolescent males)

Question 3

Kiesselbach plexus

Answer 3

LEGS: superior Labial artery, anterior and posterior Ethmoidal arteries, Greater palatine artery, Sphenopalatine artery.

Question 4

Head and neck cancer

Answer 4

Mostly squamous cell carcinoma.

Risk factors include tobacco, alcohol, HPV-16 (oropharyngeal), EBV (nasopharyngeal).

Question 5

Deep venous thrombosis

Answer 5

Blood clot within a deep vein Ž swelling, redness, warmth, pain

d-dimer lab test used clinically to rule out DVT (high sensitivity, low specificity).

Imaging test of choice is compression ultrasound with Doppler

Question 6

Virchow triad (SHE)

Answer 6

ƒƒ Stasis
ƒƒHypercoagulability
ƒƒ Endothelial damage

Question 7

Pulmonary emboli

• O2 disturbance and clinical manifestations
• Types
• maging test of choice

Answer 7

V˙/Q˙ mismatch, hypoxemia, respiratory alkalosis. Sudden-onset dyspnea, pleuritic chest pain, tachypnea, tachycardia.

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor

CT pulmonary angiography

Question 8

Lines of Zahn

Answer 8

are interdigitating areas of pink (platelets, fibrin) and red (RBCs) found only in thrombi formed before death; help distinguish pre- and postmortem thromb

Question 9

Flow-volume loops

Answer 9

Pag. 655

Question 10

Obstructive lung diseases

- Chronic bronchitis (“blue bloater”)

Answer 10

Reid index > 50%. DLCO usually normal.

Diagnostic criteria: productive cough for > 3 months in a year for > 2 consecutive years

Question 11

Obstructive lung diseases

- Emphysema (“pink puffer”)

Answer 11

Centriacinar—associated with smoking . Frequently in
upper lobes (smoke rises up).
Panacinar—associated with α1-antitrypsin deficiency. Frequently in lower lobes.

Enlargement of air spaces low recoil, high compliance,
low DLCO from destruction of alveolar walls.

Question 12

síndrome de Widal, triada de Samter o tríada ASA

Answer 12

10% de los asmáticos

Asma, poliposis nasal e intolerancia a AINEs.

Question 13

Obstructive lung diseases

- Asthma

Answer 13

Smooth muscle hypertrophy and hyperplasia, Curschmann spirals (shed epithelium forms whorled mucous plugs), and Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum).

Diagnosis supported by spirometry and methacholine challenge.

Question 14

Obstructive lung diseases

- Bronchiectasis

Answer 14

Findings: purulent sputum, recurrent infections, hemoptysis, digital clubbing

Associated with bronchial obstruction, poor ciliary
motility, cystic fibrosis, allergic bronchopulmonary
aspergillosis.

Question 15

Restrictive lung diseases

- Types

Answer 15

ƒƒ Poor breathing mechanics (normal A-a gradient)
ƒƒ Interstitial lung diseases (pulmonary decrease diffusing capacity, high A-a gradient)

Pag. 657

Question 16

Hypersensitivity pneumonitis

Answer 16

III/IV hypersensitivity reaction to environmental
antigen.

Causes dyspnea, cough, chest tightness, headache.

Often seen in farmers and those exposed to birds

Question 17

Sarcoidosis

• Findings
• Imagen

Answer 17

immune-mediated, widespread noncaseating granulomas, elevated serum ACE levels, and elevated CD4+/CD8+ ratio in bronchoalveolar lavage fluid. More common in African-American females.

Findings on CXR of bilateral adenopathy and coarse reticular opacities; CT of the chest better demonstrates
the extensive hilar and mediastinal adenopathy

Question 18

Sarcoidosis

- Manifestations

Answer 18

Associated with Bell palsy, Uveitis, Granulomas (epithelioid, containing microscopic Schaumann and asteroid bodies), Lupus pernio (skin lesions on face resembling lupus), Interstitial fibrosis (restrictive lung disease), Erythema nodosum, Rheumatoid arthritis-like arthropathy, hypercalcemia (due to  1α-hydroxylase–mediated vitamin D activation in macrophages)

Question 19

Pneumoconioses

Answer 19

Asbestos is from the roof (was common in insulation), but affects the base (lower lobes).

Silica, Berylliosis, coal are from the base (earth), but affect the roof (upper lobes)

Question 20

Asbestosis

Answer 20

Associated with shipbuilding, roofing, plumbing. “Ivory white,” calcified, supradiaphragmatic and pleural plaques are pathognomonic of asbestosis.

Asbestos (ferruginous) bodies are golden-brown fusiform rods resembling dumbbells, found in alveolar sputum sample, visualized using Prussian blue stain

Risk of bronchogenic carcinoma > risk of mesothelioma.

Question 21

Berylliosis

Answer 21

in aerospace and manufacturing industries. Granulomatous (noncaseating) on histology.

risk of cancer and cor pulmonale.

Question 22

Coal workers’

pneumoconiosis (black lung disease)

Answer 22

coal dust exposure Ž macrophages laden with carbon Ž inflammation and fibrosis.

risk for Caplan syndrome (rheumatoid arthritis and pneumoconioses with intrapulmonary nodules).

Small, rounded nodular opacities seen on
imaging. Anthracosis

Question 23

Silicosis

Answer 23

Associated with sandblasting, foundries, mines. Fibrosis

increasing susceptibility to TB, of cancer, cor pulmonale, and Caplan syndrome.

“Eggshell” calcification of hilar lymph nodes on CXR.

Question 24

Mesothelioma

Answer 24

Malignancy of the pleura associated with asbestosis.

May result in hemorrhagic pleural effusion (exudative), pleural thickening

Psammoma bodies, Calretinin ⊕ in almost all mesotheliomas, ⊝ in most carcinomas.

Question 25

Acute respiratory distress syndrome

- Diagnosiis

Answer 25

ARDS:
ƒƒ Abnormal chest X-ray (bilateral lung opacities)
ƒƒ Respiratory failure within 1 week of alveolar insult
ƒƒDecreased Pao2/Fio2 (ratio < 300, hypoxemia)
ƒƒ Symptoms of respiratory failure are not due to HF/fluid overload

Question 26

Acute respiratory distress syndrome

- Phatophysiology

Answer 26

Alveolar insult Ž release of pro-inflammatory cytokines Ž neutrophil recruitment Ž capillary endothelial damage and vessel permeability Ž leakage of protein-rich fluid into alveoli Ž formation of intra-alveolar hyaline membrane and noncardiogenic pulmonary edema

Question 27

Acute respiratory distress syndrome

- Causes

Answer 27

Sepsis (most common), aspiration, pneumonia, trauma, pancreatitis