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Respiratory tract Pathology Flashcards

1
Q

………….. is the most common cause of rhinitis

A

Adenovirus

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2
Q

Rhinitis present with

A

Sneezing , congestion and runny nose

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3
Q

Allergic rhinitis associated with

A

Asthma and eczema

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4
Q

Nasal polyp usually secondary to

A

Repeated bouts of rhinitis

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5
Q

Nasal polyp also occur in

A

**cystic fibrosis and ***Aspirin intolerant asthma

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6
Q

Angiofibroma definition

A

Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue

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7
Q

Angiofibroma classically seen only in

A

Adolescent males

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8
Q

Angiofibroma present with

A

Profuse epistaxis

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9
Q

Nasopharyngeal carcinoma associated with

A

**EBV

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10
Q

Nasopharyngeal carcinoma classically seen in

A

African children and Chinese adults

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11
Q

Nasopharyngeal carcinoma Biopsy shows

A

Pleomorphic *keratin-positive epithelial cells in a background of lymphocytes

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12
Q

…………….. is the most common cause of acute epiglottitis

A

H-influenza type B

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13
Q

……………… is the most common cause of larygotracheobronchitis (croup)

A

Parainfluenza virus

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14
Q

Vocal cord nodule arises due to

A

Excessive use , usually bilateral

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15
Q

Vocal cord nodule composed of

A

Degenerative myxoid connective tissue

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16
Q

Laryngeal papilloma due to

A

HPV 6 and 11

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17
Q

**Laryngeal papilloma …………….. in adults and ……………….. in children

A

Single , multiple

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18
Q

Risk factors for laryngeal carcinoma

A

Alcohol and tobacco

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19
Q

Pneumonia clinical features

A

Fever and chills
Cough with yellow green or rusty sputum
Tachypnea with *pleuritic chest pain
Decreased breath sound and *dullness with percussion

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20
Q

Three patterns of pneumonia

A 
Lobar pneumonia( usually bacterial )
Bronchopneumonia (usually bacterial) 
Interstitial pneumonia (usually viral)
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21
Q

Most common causes of Lobar pneumonia

A

S.pneumonia (95%) and klebsiella pneumonia

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22
Q

Four classes of lobar pneumonia

A

Congestion
Red hepatization
Grey hepatization
Resolution

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23
Q

Causes of bronchopneumonia

A

S.aureus (most common cause of secondary pneumonia )
H.influenza
Pseudomonas aeruginosa (in CF patients )
Moraxella catarrhalis
Legionella pneumophila (transmitted from water source)

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24
Q

Causes of interstitial (atypical) pneumonia

A

Mycoplasma pneumonia (complicated by autoimmune hemolytic anemia)
Chlamydia pneumonia
RSV , CMV , influenza virus
Coxiella burnetii

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25
Aspiration pneumonia seen in
Alcoholics and comatose patients
26
******Aspiration pneumonia caused by
Bacteroides , Fusobacterium and peptococcus
27
Aspiration pneumonia classically results in
Right Lower lobe abscess
28
TB systemic spread often occurs to
Meninges (meningitis)usually involve ****the base of the brain Cervical lymph node Kidney (sterile pyuria) Lumbar vertebrae (pott disease)
29
In COPD parameters changes include
Decreased Forced volume capacity FVC Decreased more Forced expiratory volume FEV1 So ******FEV1:FVC ratio is decreased TLC is increased (bc of air trapping)
30
Chronic bronchitis
Chronic productive cough lasting at least 3 months over a minimum of 2years Highly associated with smoking
31
Chronic bronchitis pathogenesis
Hypertrophy of mucous glands | Reid index >50% (normally less than 0.4)
32
Chronic bronchitis clinical features
Productive cough Cyanosis ; high PaCO2 , low PaO2 Increase risk of infection and corpulmonale
33
Emphysema
Destruction of alveolar spaces | Loss of elastic recoil and collapse of small airways leads to air trapping
34
Emphysema occurs due to
Imbalance between proteases and antiproteases
35
.................... is the most common cause of emphysema
Smoking
36
Smoking results in ..................... emphysema while alpha 1 antitrypsin deficiency results in.....................emphysema
Centriacinar emphysema more severe in the upper lobe | Panacinar emphysema more severe in the lower lobe
37
Alpha 1 antitrypsin deficiency May also be present with
Liver cirrhosis
38
The mutated alpha 1 antitrypsin will be accumulated in
The endoplasmic reticulum
39
Emphysema clinical features
Dyspnea and cough with minimal sputum *******Prolonged expiration with pursed lips (pink puffer) Weight loss *******Increased AP diameter of chest (barrel chest)
40
Late complications of emphysema
Hypoxemia | Corpulmonale
41
Asthma
Reversible airway bronchoconstriction | Most often due to allergic stimuli (type 1 HSR)
42
Asthma present in childhood often associated with
Allergic rhinitis , eczema and family history of atopy
43
Asthma pathogenesis
Allergens induce Th2 which secrete IL4 , IL5 and IL10
44
IL4 , IL5 and IL10 function involved in asthma
IL4 allows the production of IgE IL5 calls eosinophils IL10 inhibits the TH1
45
Asthma clinical features (episodic)
Dyspnea and wheezing | Productive cough ; curschmann spirals admixed with Charcot-Leyden crystals
46
Non allergic causes of asthma
Exercise Viral infection ********Aspirin (ex: aspirin intolerant asthma “ Occupational exposure
47
COPD include
Chronic bronchitis Emphysema Asthma Brochiectasis
48
Brochiectasis
Permanent dilation of bronchioles and brochi
49
Brochieactasis occurs due to
Necrotizing inflammation with damage to airway walls
50
Examples associated with Brochieactasis
Cys
51
Brochiectasis clinical features
Cough , dyspnea and foul-smelling sputum
52
Brochiectasis complications include
Hypoxemia with corpulmonale and ********secondary amyloidosis
53
Parameters changes in restrictive lung disease
TLC decreased FVC decreased more , FEV1 decreased So FEV1:FVC ratio is increased (>80%)
54
Restrictive lung disease most commonly occur due to
Interstitial disease
55
Idiopathic pulmonary fibrosis definition
Fibrosis of lung interstitium
56
Idiopathic pulmonary fibrosis etiology
Is related to cyclical lung injury (TGF-beta from injured pneumocytes )
57
Secondary causes of pulmonary fibrosis
Drugs ****( bleomycin and amiodarone ) and radiation therapy
58
Pneumoconiosis
Interstitial fibrosis due to occupational exposure | Require chronic exposure
59
Coal workers pneumoconiosis associated with rheumatoid arthritis known as
Caplan syndrome
60
Collection of carbon laden macrophages known as
Anthracosis
61
The only pneumoconiosis that increased risk for TB
Silicosis (impair phagolysosome formation)
62
Berylliosis pathologic finding similar to *****sarcoidosis that cause
Non-caseating granuloma in the lung , hilar lymph nodes and systemic organs
63
Asbestosis increased risk for
Lung carcinoma ****more common that mesothelioma
64
Sarcoidosis is
Systemic disease characterized by non-caseating granuloma in multiple organs
65
Sarcoidosis classically seen in
African-American females
66
Organs affected by sarcoidosis
Lung and hilar lymph nodes (most commonly) Uvea ( uveitis) Skin ( cutaneous nodules or erythema nodosum) ******Salivary and lacrimal glands ( mimics sjögren syndrome ) Almost any tissue can be involved
67
Sarcoidosis clinical features
Dyspnea or cough Elevated serum ACE(angiotensin converting enzyme ) Hypercalcemia
68
Pulmonary HTN
When mean arterial pressure >25mmHg (normal 10mmHg)
69
Pulmonary HTN characterized by
Atherosclerosis of pulmonary trunk Smooth muscle hypertrophy of pulmonary arteries Intimal fibrosis ****Plexiform lesions are seen with severe long standing disease
70
Pulmonary HTN leads to right ventricular hypertrophy and corpulmonale which present with
****Exertional dyspnea
71
Primary Pulmonary HTN classically seen in
Young adult females
72
Primary Pulmonary HTN familial form related to
Inactivating mutation of ****BMPR2 which lead to proliferation of vascular smooth muscle
73
Secondary pulmonary HTN due to
Hypoxemia ( COPD and interstitial lung disease) or increased volume in pulmonary circuit (congenital heart disease) ****may also arise with recurrent pulmonary embolism
74
Acute respiratory distress syndrome ARDS
- Diffuse damage to alveolar capillary interface | - leakage of protein rich fluid leads to edema and formation of hyaline membrane in alveoli
75
ARDS etiology
Sepsis ,infection ,trauma ,aspiration ,pancreatitis ,DIC
76
ARDS pathogenesis
Activation of neutrophils induce protease mediated and free radical damage of type 1 and 2 pneumocytes
77
ARDS recovery may be complicated by
****Interstitial fibrosis
78
Neonatal RDS due to
Inadequate surfactant levels that produced by ****type 2 pneumocytes
79
Neonatal RDS clinical features
Hypoxemia and cyanosis | Diffuse Granularity on X-ray
80
Neonatal RDS associated with
Prematurity ; screen with ****lecithin : sphingomyelin ratio C-section delivery Maternal diabetes
81
Neonatal RDS complications
Hypoxemia increases risk for persistence ductus arteriosus and necrotizing enterocolitis
82
Supplemental O2 increase risk for
Free radical injury (may lead to blindness)
83
Neonatal RDS complications
Hypoxemia increases risk for persistence ductus arteriosus and necrotizing enterocolitis
84
Supplemental O2 increase risk for
Free radical injury (may lead to blindness)
85
Most common cause of cancer mortality in the US
Lung cancer
86
Lung cancer average age presentation
60yrs
87
Lung cancer key risk factors
Cigarette smoke , radon and asbestos
88
Imaging of lung cancer often reveals
Solitary nodule
89
Benign coin lesions of lung include
* ***Granuloma ( TB or histoplasmosis) | * ***Bronchial hamartoma (lung tissue + cartilage) ;often calcified on imaging
90
Classic division of lung carcinoma
Small cell carcinoma (15%) (it responds to chemotherapy ) | Non small cell carcinoma (85%)
91
Major subtypes of Non-small cell lung carcinoma
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma Carcinoid tumor
92
Small cell carcinoma
Poorly differentiated cells arise from neuroendocrine(kulchitsky) cells Associated with smokers Location :Central May cause Eaton lambert syndrome (paraneoplastic syndrome )
93
Squamous cell carcinoma
Keratin pearls or intercellular bridges seen Most common tumor in male smokers Location Central May produce PTH( leads to hypercalcemia)
94
Adenocarcinoma
Glands or mucin seen Most common tumor in ****non smokers and female smokers Location Peripheral
95
No keratin pearls or cellular bridges , No glands or mucin | Suggest ..................carcinoma
Large cell carcinoma
96
Brochioloalveolar carcinoma
-Columnar cells that grow along preexisting bronchioles and alveoli Arises from Clara cells -Not related to smoking -peripheral -may present with *****pneumonia-like consolidation on imaging -excellent prognosis
97
Carcinoid tumor
- Well differentiated neuroendocrine cells (****chromoagranin positive ) - not related to smoking - classically form a ****polyp-like mass in the bronchus
98
Most common sources of lung metastasis
Breast and colon carcinoma
99
Lung metastasis appear as .....................on imaging
Multiple cannon ball nodules
100
Unique site of distant lung metastasis is
Adrenal glands
101
Lung cancer local complications
Pleural involvement Obstruction of SVC Involvement recurrent laryngeal nerve or phrenic nerve Compression of sympathetic chain (ptosis , pin point pupil and anhidrosis)

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