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Pathoma > Respiratory tract Pathology > Flashcards

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
Q

Aspiration pneumonia seen in

A

Alcoholics and comatose patients

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26
Q

****Aspiration pneumonia caused by

A

Bacteroides , Fusobacterium and peptococcus

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27
Q

Aspiration pneumonia classically results in

A

Right Lower lobe abscess

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28
Q

TB systemic spread often occurs to

A

Meninges (meningitis)usually involve **the base of the brain
Cervical lymph node
Kidney (sterile pyuria)
Lumbar vertebrae (pott disease)

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29
Q

In COPD parameters changes include

A

Decreased Forced volume capacity FVC
Decreased more Forced expiratory volume FEV1
So ****FEV1:FVC ratio is decreased
TLC is increased (bc of air trapping)

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30
Q

Chronic bronchitis

A

Chronic productive cough lasting at least 3 months over a minimum of 2years
Highly associated with smoking

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31
Q

Chronic bronchitis pathogenesis

A

Hypertrophy of mucous glands

Reid index >50% (normally less than 0.4)

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32
Q

Chronic bronchitis clinical features

A

Productive cough
Cyanosis ; high PaCO2 , low PaO2
Increase risk of infection and corpulmonale

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33
Q

Emphysema

A

Destruction of alveolar spaces

Loss of elastic recoil and collapse of small airways leads to air trapping

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34
Q

Emphysema occurs due to

A

Imbalance between proteases and antiproteases

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35
Q

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

A

Smoking

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36
Q

Smoking results in ………………… emphysema while alpha 1 antitrypsin deficiency results in…………………emphysema

A

Centriacinar emphysema more severe in the upper lobe

Panacinar emphysema more severe in the lower lobe

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37
Q

Alpha 1 antitrypsin deficiency May also be present with

A

Liver cirrhosis

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38
Q

The mutated alpha 1 antitrypsin will be accumulated in

A

The endoplasmic reticulum

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39
Q

Emphysema clinical features

A

Dyspnea and cough with minimal sputum
**Prolonged expiration with pursed lips (pink puffer)
Weight loss
**Increased AP diameter of chest (barrel chest)

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40
Q

Late complications of emphysema

A

Hypoxemia

Corpulmonale

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41
Q

Asthma

A

Reversible airway bronchoconstriction

Most often due to allergic stimuli (type 1 HSR)

42
Q

Asthma present in childhood often associated with

A

Allergic rhinitis , eczema and family history of atopy

43
Q

Asthma pathogenesis

A

Allergens induce Th2 which secrete IL4 , IL5 and IL10

44
Q

IL4 , IL5 and IL10 function involved in asthma

A

IL4 allows the production of IgE
IL5 calls eosinophils
IL10 inhibits the TH1

45
Q

Asthma clinical features (episodic)

A

Dyspnea and wheezing

Productive cough ; curschmann spirals admixed with Charcot-Leyden crystals

46
Q

Non allergic causes of asthma

A

Exercise
Viral infection
**Aspirin (ex: aspirin intolerant asthma “
Occupational exposure

47
Q

COPD include

A

Chronic bronchitis
Emphysema
Asthma
Brochiectasis

48
Q

Brochiectasis

A

Permanent dilation of bronchioles and brochi

49
Q

Brochieactasis occurs due to

A

Necrotizing inflammation with damage to airway walls

50
Q

Examples associated with Brochieactasis

A

Cys

51
Q

Brochiectasis clinical features

A

Cough , dyspnea and foul-smelling sputum

52
Q

Brochiectasis complications include

A

Hypoxemia with corpulmonale and **secondary amyloidosis

53
Q

Parameters changes in restrictive lung disease

A

TLC decreased
FVC decreased more , FEV1 decreased
So FEV1:FVC ratio is increased (>80%)

54
Q

Restrictive lung disease most commonly occur due to

A

Interstitial disease

55
Q

Idiopathic pulmonary fibrosis definition

A

Fibrosis of lung interstitium

56
Q

Idiopathic pulmonary fibrosis etiology

A

Is related to cyclical lung injury (TGF-beta from injured pneumocytes )

57
Q

Secondary causes of pulmonary fibrosis

A

Drugs **( bleomycin and amiodarone ) and radiation therapy

58
Q

Pneumoconiosis

A

Interstitial fibrosis due to occupational exposure

Require chronic exposure

59
Q

Coal workers pneumoconiosis associated with rheumatoid arthritis known as

A

Caplan syndrome

60
Q

Collection of carbon laden macrophages known as

A

Anthracosis

61
Q

The only pneumoconiosis that increased risk for TB

A

Silicosis (impair phagolysosome formation)

62
Q

Berylliosis pathologic finding similar to *****sarcoidosis that cause

A

Non-caseating granuloma in the lung , hilar lymph nodes and systemic organs

63
Q

Asbestosis increased risk for

A

Lung carcinoma **more common that mesothelioma

64
Q

Sarcoidosis is

A

Systemic disease characterized by non-caseating granuloma in multiple organs

65
Q

Sarcoidosis classically seen in

A

African-American females

66
Q

Organs affected by sarcoidosis

A

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
Q

Sarcoidosis clinical features

A

Dyspnea or cough
Elevated serum ACE(angiotensin converting enzyme )
Hypercalcemia

68
Q

Pulmonary HTN

A

When mean arterial pressure >25mmHg (normal 10mmHg)

69
Q

Pulmonary HTN characterized by

A

Atherosclerosis of pulmonary trunk
Smooth muscle hypertrophy of pulmonary arteries
Intimal fibrosis
**Plexiform lesions are seen with severe long standing disease

70
Q

Pulmonary HTN leads to right ventricular hypertrophy and corpulmonale which present with

A

**Exertional dyspnea

71
Q

Primary Pulmonary HTN classically seen in

A

Young adult females

72
Q

Primary Pulmonary HTN familial form related to

A

Inactivating mutation of **BMPR2 which lead to proliferation of vascular smooth muscle

73
Q

Secondary pulmonary HTN due to

A

Hypoxemia ( COPD and interstitial lung disease) or increased volume in pulmonary circuit (congenital heart disease)
**may also arise with recurrent pulmonary embolism

74
Q

Acute respiratory distress syndrome ARDS

A
  • Diffuse damage to alveolar capillary interface

- leakage of protein rich fluid leads to edema and formation of hyaline membrane in alveoli

75
Q

ARDS etiology

A

Sepsis ,infection ,trauma ,aspiration ,pancreatitis ,DIC

76
Q

ARDS pathogenesis

A

Activation of neutrophils induce protease mediated and free radical damage of type 1 and 2 pneumocytes

77
Q

ARDS recovery may be complicated by

A

**Interstitial fibrosis

78
Q

Neonatal RDS due to

A

Inadequate surfactant levels that produced by **type 2 pneumocytes

79
Q

Neonatal RDS clinical features

A

Hypoxemia and cyanosis

Diffuse Granularity on X-ray

80
Q

Neonatal RDS associated with

A

Prematurity ; screen with **lecithin : sphingomyelin ratio
C-section delivery
Maternal diabetes

81
Q

Neonatal RDS complications

A

Hypoxemia increases risk for persistence ductus arteriosus and necrotizing enterocolitis

82
Q

Supplemental O2 increase risk for

A

Free radical injury (may lead to blindness)

83
Q

Neonatal RDS complications

A

Hypoxemia increases risk for persistence ductus arteriosus and necrotizing enterocolitis

84
Q

Supplemental O2 increase risk for

A

Free radical injury (may lead to blindness)

85
Q

Most common cause of cancer mortality in the US

A

Lung cancer

86
Q

Lung cancer average age presentation

A

60yrs

87
Q

Lung cancer key risk factors

A

Cigarette smoke , radon and asbestos

88
Q

Imaging of lung cancer often reveals

A

Solitary nodule

89
Q

Benign coin lesions of lung include

A
  • ***Granuloma ( TB or histoplasmosis)

* ***Bronchial hamartoma (lung tissue + cartilage) ;often calcified on imaging

90
Q

Classic division of lung carcinoma

A

Small cell carcinoma (15%) (it responds to chemotherapy )

Non small cell carcinoma (85%)

91
Q

Major subtypes of Non-small cell lung carcinoma

A

Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Carcinoid tumor

92
Q

Small cell carcinoma

A

Poorly differentiated cells arise from neuroendocrine(kulchitsky) cells
Associated with smokers
Location :Central
May cause Eaton lambert syndrome (paraneoplastic syndrome )

93
Q

Squamous cell carcinoma

A

Keratin pearls or intercellular bridges seen
Most common tumor in male smokers
Location Central
May produce PTH( leads to hypercalcemia)

94
Q

Adenocarcinoma

A

Glands or mucin seen
Most common tumor in **non smokers and female smokers
Location Peripheral

95
Q

No keratin pearls or cellular bridges , No glands or mucin

Suggest ………………carcinoma

A

Large cell carcinoma

96
Q

Brochioloalveolar carcinoma

A

-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
Q

Carcinoid tumor

A
  • Well differentiated neuroendocrine cells (**chromoagranin positive )
  • not related to smoking
  • classically form a **polyp-like mass in the bronchus
98
Q

Most common sources of lung metastasis

A

Breast and colon carcinoma

99
Q

Lung metastasis appear as …………………on imaging

A

Multiple cannon ball nodules

100
Q

Unique site of distant lung metastasis is

A

Adrenal glands

101
Q

Lung cancer local complications

A

Pleural involvement
Obstruction of SVC
Involvement recurrent laryngeal nerve or phrenic nerve
Compression of sympathetic chain (ptosis , pin point pupil and anhidrosis)

Pathoma (4 decks)

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