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OS3 > Respiratory Tract Pathology > Flashcards

Respiratory Tract Pathology Flashcards

1
Q

What complicates recovery from ARDS?

A

Interstitial fibrosis;damage and loss of type II pneumocytes leads to scarring and fibrosis

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2
Q

Cause of emphysema

A

Imbalance of proteases and antiproteases

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3
Q

Causes o bronchiectasis

A
  • Cystic fibrosis
  • Primary ciliary dyskinesia
  • Tumor or foreign body
  • Necrotizing infection
  • Allergic brunchopulmonary aspergillosis
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4
Q

Pulmonary hypertension leads to…

A

Right ventricular hypertrophy with eventual cor pulmonale

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5
Q

Adenocarcinoma in-situ exhibits columnar cells that grow along preexisting __________ and __________.

A

Bronchioles;alveoli

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6
Q

Where granulomas often found in sarcoidosis?

A

Hilar lymph nodes and lung

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7
Q

Patients with silicosis have an increase risk for ____.

A

TB

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8
Q

Treatment for H, Influenza

A

Amoxicillin +/- clavulanate for mucosal infections

Ceftriaxone for meningitis

Rifampin prophylaxis for close contacts

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9
Q

Most common causes of lobar pneumonia

A

Strep pneumonia

Klebsiella pneumonia

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10
Q

Dyspnea or caush

Elevated serum ACE

Hypercalcemia

A

Sarcoidosis

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11
Q

Pneumonia in cystic fibrosis patients

A

Psudomonas

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12
Q

Cause of laryngeal papilloma

A

HPV 6 and 11

*papillomas are usually single in adults and multiple in children

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13
Q

What drugs can result in interstitial fibrosis?

A

Bleomycin

Amiodarone

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14
Q

What is the most common cause of acute epiglottitis?

A

H. Influenzae type B

*Especially in nonimmunized children

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15
Q
  • Immunohistochemistry for adenocarcinoma
A

Glands

Mucin

TTF-1

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16
Q

Symptoms of rhitinitis

A

Sneezing

Congestion

Runny nose

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17
Q

Complications of neonatal respiratory distress syndrome

A
  • Hypoxemia increases the risk for persistence of patent ductus arteriosus and necrotizing enterocolitis
  • Supplemental oxygen increases the risk for free radical injury. Retinal injury leads to blindness; lung damage leads to bronchopulmonary dysplasia
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18
Q

In ARDS, there is a leakage of protein rich fluid that leads to edema that combines with becrotic epithelial cells to form ___________ lining alveoli.

A

Hyaline membranes

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19
Q

Pancoast tumor

A
  • Apical tumors involving the superior sulcus
    • Sympathetic chain (ptosis, miosis, and anhidrosis)
    • Brachial plexus (shoulder pain and hand weakness)
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20
Q

Triad seen in aspirin intolerant asthma

A

Asthma

Aspirin-induced bronchospasms

Nasal polps

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21
Q

Most common sources of metastasis to lung

A

Breat and colon

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22
Q

Hypoxemia and cyanosis with respiratory distress

“White out” on chest x-ray

A

Acute respiratory distress syndrome

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23
Q

__________ regenrate lung tissue during resolution phase of lobar pneumonia.

A

Type II pneumocytes

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24
Q

How does angiofibroma present?

A

Profuse epistaxis

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25
Q

clinical features of idiopathic pulmonary fibrosis

A

Progressive dyspnea and cough

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26
Q

Which organism are associated with pneumonia superimposed on COPD?

A

Legionella

Moraxella cararrhalis

H. Influenzae

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27
Q

Allegic bronchopulmonary aspergillosis is normally seen in patients with ______ or ______.

A

Asthma

Cystic fibrosis

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28
Q

Mild exposure to carbon results in __________.

A

Anthracosis

*Collectin of carbon-laden macrophages; not clinically significant

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29
Q

Normal pulmonary artery pressure

A

10 mmHg

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30
Q

Complication of bronchiectasis

A

Hypoxemia with cor pulmonale

Secondary amyloidosis

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31
Q

Which lung carcinomas are chromogranin positive?

A

Small cell carcinoma

Carcinoid tumor

NOTE: These are the tumors that are associated with neuroendocrine cells

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32
Q

Which lung carcinomas are associated with male smokers?

A

Small cell carcinoma

Squamous cell carcinoma

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33
Q

Atypical pneumonia with posttransplant immunosuppression or chemotherapy

A

CMV

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34
Q

How does neonatal respiratory distress syndrome appear on x-ray

A

Diffuse granularity of lung (ground-glass appearance)

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35
Q

Clinical feautures of secondary TB

A

Fevers and night sweats

Cough with hemoptysis

Weight loss

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36
Q

berylliosis increases risk for ________.

A

Lung cancer

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37
Q

Pneumonia is an infection of the _______.

A

Lung parenchyma

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38
Q

Three patterns classically seen on chest x-ray of pneumonia

A

Lobar pneumonia

Bronchopneumonia

Interstitial pneumonia

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39
Q

Smoking leads to _______ emphysema that is most severe in the ________ lobes.

A

Centriacinar; upper

*Smoke goes up

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40
Q

__________ from injured pneumcytes induce fibrosis.

A

TGF-B

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41
Q

How does acute epiglottitis present?

A

High fever

Sore throught

Drooling with dysphagia

Mufled voice

Inspiratory stridor (narrowing of airway)

*Risk of airway of obstruction

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42
Q

How does berylliosis present?

A

Noncaseating granulomas in the lung, hilar lymph nodes and systemic organs

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43
Q

Productive cough, with spiral-shaped mucus plugs (Curshmann spirals) and eosinophil derived crystals (Charcot-Leyden crytals)

A

Asthma

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44
Q

Caplan syndrome

A

a combination of rheumatoid arthritis (RA) and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray.

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45
Q

Malignant tumor of nasopharyngeal epithelium

A

Nasopharyngeal carcinoma

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46
Q

A1AT deficiency results in _____ emphysema that is most severe in the ________ lobes.

A

Panacinar; lower

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47
Q

Gram - rod

Silver stain

Grows on charcoal yest extract

A

Legionella

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48
Q

Pathologic findings of histoplasmosis

A

Macrophage filled with Histoplasma

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49
Q

Benign tumor composed o lung tissue and cartilage; often calcified on imaging

A

Bronchial hamartoma

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50
Q

Abstestosis increases risk for ________ and ___________.

A

Lung carcinoma

Mesothelioma

*Lung carcinoma is more common

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51
Q

Decrease in FEV1/FVC

A

Obstructive

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52
Q

Allergic rhinitis is associated with which other conditions

A

Asthma

Eczema

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53
Q

What is the likely cause of idiopathic pulmonary fibrosis?

A

Cyclical lung injury

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54
Q

What ratio indicates adequeate surfactant production?

A

>2

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55
Q

Characteristics of secondary TB

A

Cavitary foci of caseous necrosis

*may also lead to pulmonary TB or tuberculous bronchopneumonia

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56
Q

Additional tissues involved in sarcoidosis

A

Uvea

Skin

Salivary and lacrimal glands (mimics Sjogren syndrome)

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57
Q

Treatment for legionella

A

Marolide

Quinolone

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58
Q

Risk factors for laryngeal carcinoma

A

Alcohol and tobacco

*Can rarely arise from a laryngeal papilloma

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59
Q

Fibrotic nodules in the upper lobes of the lung

A

Silicosis

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60
Q

Imaging of lung carcinoma

A

Large spiculated mass

A solitary nodule can also be seen

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61
Q

Demographic for berylliosis

A

Beryllium miners and workers in the aerospace industry

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62
Q

organisms that cause intersitital (atypical) pneumonia

A

Mycoplasma pneumonia

Chlamydia pneumonia

RSV

CMV

Influenza

Coxiella

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63
Q

Protrusion of edematous, inlamed nasal mucosa

A

Nasal polp

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64
Q

____________ neutralizes proteases.

A

a1- antitrypsin

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65
Q

Demographic seen with coal workers’ pneumonoconiosis

A

Coal miners

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66
Q

ARDS is secondary to which diseases?

A

Sepsis infection

Shock

Trauma

Aspiration

Pancreatitis

DIC

Hypersensivity reaactions

Drugs

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67
Q

How does a laryngeal carcinoma present?

A

Hoarseness

Cough

Stridor

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68
Q

Gram +

a-hemolytic

Lancet-shaped

Optochin sensitive

A

Strep pneumonia

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69
Q

Paraneoplastic syndrome associated with squamous cell carcinoma

A

May produce PTHrp

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70
Q

_______ deficiency is a rare cause of emphysema

A

A1AT

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71
Q

Chronic obstructive pulmonary diseases

A

Chronic bronchitis

Emphysema

Asthma

Bronchiectasis

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72
Q

Benign papillary tumor of the vocal cord

A

Laryngeal papilloma

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73
Q

Major component of surfactant

A

Phosphatidylcholine (lecithin)

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74
Q

What other condition is present in A1AT deficiency emphysema and why?

A

Liver cirrhosis; mutant A1AT accumulates in the ER of hepatocytes, resulting in liver damage

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75
Q

Difuse damage to the alveoplar-capillar interface

A

ARDS

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76
Q

How does acute respiratory distress syndrome appear on x-ray?

A

White out

77
Q

Restrictive lung diseases

A

Pulmonary fibrosis

Pneumoconioses

Sarcoidosis

Hypersensitivity Pneumonitis

78
Q

Pneumonia occurs when normal defenses are inpaired. Examples?

A

impaired cough reflex

damage to mucociliary escalator

Mucus plugging

*Also occurs when an organism is highly virulent

79
Q

Most common lung tumor in nonsmokers and female smokers

A

Adenocarcinoma

80
Q

Why does C-section lead to neonatal respiratory distress syndrome?

A

Due to lack of stress-induced steroids; steroids increase synthesis of surfactant

81
Q

Demographic for silicosis

A

Sandblasters and silica miners

82
Q

normal vs abnormal A1AT allele

A

Normal: M

Abnormal: Z

83
Q

_________ is the most common cause of emphysema.

A

Smoking

84
Q

Which lung carcinomas are located only centrally?

A

Small cell carcinoma

Squamous cell carcinoma

85
Q

How is sarcoidosis treated?

A

Immunosuppression

*Often resolves spontaneously without treatment

86
Q

Pneumoconioses

A
  • Interstitial fibrosis due to occupational exposure; requires chronic exposure to small particles that are fibrogenic
    • Alveolar macrophages engulf foreign partcles and induce fibrosis
87
Q

Characteristics of pulmonary hypertension

A
  • Artherosclerosis of the pulmonary trunk
  • Smooth muscle hypertrophy of pulmonary arteries
  • Intimal fibrosis
  • Plexiform lesions are seen with severe, long-standing disease
88
Q

Poorly differentiated small cells with neuroendocrine differentiation

Chromagranin positive

A

Small cell carcinoma

89
Q

_____________ of pseudomonas may contribute to chronic pneumonia in cystic fibrosis patients due to high biofilm formation.

A

Mucoid polysaccharide capsule

90
Q

Neonatal respiratory distress syndrome is associated wit..

A
  • Prematurity
  • Caesarian section delivery
  • Maternal diabetes
91
Q

ARDS treatment

A

Address underlying cause

Ventilation with positive end-expiratory pressure (PEEP)

92
Q

Most common tumor in male smokers

A

Squamous cell carcinoma

93
Q

Stellate inclusions (asteroid bodies)

Giant cells

A

Sarcodiosis

94
Q

Chronic bronchitis is characterized by hypertrophy of the _______________

A

Bronchial mucous glands

95
Q

how does intersititial pneumonia present?

A

Mild upper respiratory symptoms

  • Minimal sputum
  • Low fever
96
Q

causitive organisms of bronchopneumonia

A

S. aureus

H. influenzae

Psudonomas

Moraxella

Legionalla

97
Q

TB that has spread to the kidneys results in________.

A

Sterile pyuria

*persistent finding of white cells in the urine in the absence of bacteria

98
Q

Secondary causes of interstitial fibrosis

A

Drugs

Radiation therapy

99
Q

How does a carcinoid tumor appear when located centrally?

A

Forms a polyp-like mass in the bronchus

100
Q

Why does hypoxemia result from emphyesema?

A

Due to destruction of capillaries in the alveolar sac

101
Q

Gram - rod

Aerobic

Catalase +

Oxidase +

Motile

A

pseudomonas

102
Q

Demographic for angiofibroma

A

Adolescent males

103
Q

What pathogen is associated with nasopharyngeal carcinoma?

A

EBV

104
Q

What change is seen in FRC in obstructive lung diseases?

A

increase

105
Q

What causes an increase in Reid index in chronic bronchitis?

A

Increased thick ness of mucous glands relative to bronchial wall thickness, due to hypertrophy of mucous glands

*mucous glands secrete mucus to protect against pollutants. Smokers increase their # of pollutants and so the body increases mucuous gland production

106
Q

TB that has spread the lumbar vertebrae is called ________.

A

Pott’s disease

107
Q

Where does secondary TB occur? Why?

A

Occurs at the apex of lungs due to relatively poor lymphatic drainage and high oxygen tension

108
Q

Patients with chronic bronchitis are at an increased risk for ___________ and ______.

A

Inection and cor pulmonale

*Anytime a tube is blocked, there is a chance for infection behind that area

109
Q

Treatment for mycoplasma pneumonia

A

Macrolides

Doxycycline

Fluoroquinolone

110
Q

Demographic for nasophangeal carcinoma

A

African Children and chinese adults

111
Q
  • Black lung
  • Associated with rheumatoid arthritis
A

Coal workers’ pneumoconiosis

112
Q

Conditions caused by strep pneumonia

A

Meningitis

Otitis media

Pneumonia

Sinusitis

113
Q

Cough

Dyspnea

Foul-smelling sputum

A

Bronchiectasis

114
Q

__________ levels increase as surfactant is produced.

A

phosphotidylcholine (lecithin)

115
Q

Most common cause of rhinitis

A

Rhinovirus (ssRNA)

*Adenovirus (dsDNA) is also a common cause

116
Q

___________ mutations is especially commonin Asian females who are nonsmokers. How is it treated?

A

EGFR; erlotinib

117
Q

How does pulmonary hypertension presnt?

A

Exertional dyspnea

Right sided heart failure

118
Q

How does adenocarcinoma present on imaging?

A

Preumonia-like consolidation

119
Q

Clinical feautures of pneumonia

A

Fever and chills

Productive cough with yellow-green or rusty sputum

Tachypnea with pleuritic chest pain

Decreased breath sounds

Crackles

Dullness to percussion

Elevated WBC count

120
Q

Gram - rod

Fast lactose fermenter

Causes pneumonia

A

Klebsiella

121
Q

Gross phases of lobar pneumonia

A
  • Congestion
  • Rep hepatization
  • Gray hepatization
  • Resolution
122
Q

Demographic for asbestosis

A

Construction workers

Plumbers

Shipyard workers

123
Q

What is the cause of hypoxemia and cyanosis seen in acute respiratory distress syndrome?

A

Due to thickened diffusion barrier and collapse of air sacs (increased surface tension)

124
Q

Two major carcinogens in cigarette smoke

A

Polycyclic aromatic hydrocarbons

Arsenic

125
Q

What causes cyanosis in chronic bronchitis?

A

Mucus plugs trap CO2, leading to an increase in CO2 and a decrease in O2

126
Q

Lesions may contain long, golden-brown fibers with associated iron

A

Asbestosis

127
Q

Increased TLC

A

Obstructive

*Due to increased air trapping

128
Q

Late complications of emphysema

A

Hypoxemia

Cor pulmonale

129
Q

In emphysema, loss of ________ and _________ of airways during exhalation results in obstruction of air trapping.

A

Recoil; collapse

130
Q

paraneoplastic syndromes associated with small cell carcinoma?

A

ADH

ACTH

Lambert-Eaton

131
Q

Lack of surfactant leads to collaspe of air sacs and formation of ________ membranes.

A

Hyaline

132
Q

Mechanism by which strep pneumonia acts

A

Encapsulated IgA protease

133
Q

Cause of atypical pneumonia with high fever

A

Coxiella

REMEMER: Signs in symptoms of most atypical pneumonias is a low fever

134
Q

Characteristics of primary TB

A
  • Focal, caseating necorsis in the lower lobe of the lung
  • Hilar lymph nodes that undergo fibrosis and calcification forming a Ghon complex
135
Q

Very mucoid colonies caused by abundant polysaccharide capsules

A

Klebsiella

136
Q

__________ drugs slow the disease progression of idiopathic pulmonary fibrosis.

A

Anti-fibrogenic

*Definitive treatment is lung transplantation

137
Q

Well differentiated neuroendocrine cellls

Chromogranin positive

A

Carcinoid tumor

138
Q

Which cells are damaged in ARDS?

A

Type I and II pneumocytes

*Activation of neutrophils induce protease and free radical mediated damage

139
Q

Poorly differentiated large cells

No glands, mucin, TTF-1, keratin pearls, intercellular bridges, p40

A

Large cell neuroendocrine carcinoma

140
Q

Dyspnea and cough with minimal sputum

Prolonged expiration with pursed lips

Weight loss

Increased anterior-posterior diameter of chest (barrel chest)

A

Emphysema

141
Q

Eosinophil derived crystals seen in asthma

A

Charcot-Leyden crystals

142
Q

Where does mutant A1AT accumulate in hepatocytes?

A

ER

143
Q

5 A’s of Klebsiella

A

Apiration pneumonia

Abscess in lungs and liver

Alcoholics

DiAbetics

CurrAnt jelly sputum

144
Q

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

A

Angiofibroma

145
Q

Biopsy: Pleomorphic keratin-positive eputhelial cells in a background of lymphocytes

A

Nasopharyngeal carcinoma

146
Q

Increasing respiratory effort after birth, tachypnea with use of accessory muscles, ad grunting

Hypoxemia with cyanosis

Diffuse granularity of the lung

A

Neonatal respiratory stress syndrome

147
Q

Destruction of alveolar air sacs

A

Emphysema

148
Q

What leads to the hypercalcemia seen in sarcoidosis?

A

1-alpha hydroxylase activity of epithelioid histiocytes converts vitamin D to its active form

149
Q

Productive cough due to exceissive mucus production

Cyanosis

A

Chronic bronchitis

150
Q

Key risk factors for lung cancer

A

Cigarette smoke

Radon

Asbestos

151
Q

Treatment for Aspergillus fumigatus

A

Voriconazole

Echinocandins (2nd line)

152
Q

Biopsy of liver cirrhosis due to A1AT deficiency

A

Pink, PAS-positive globules in hepatocytes

153
Q

Aspiration pneumonia is most often due to _____ bacteria in the oropharynx/

A

Anaerobic

154
Q

Locations for histoplasmosis

A

Mississippi and Ohio River Valleys

155
Q

Two broad categories of lung carcinoma

A

Small cell carcinoma (15%)

Non-small cell carcinoma (85%)

156
Q

Different types of pneumonconioses

A

Coal workers’ pneumoconiosis

Silicosis

Berylloisis

Asbestosis

157
Q

Characterized by scattered pathy consolidation centered around bronchioles, often multifocal and bilateral

A

Bronchopneumonia

158
Q

Chronic productive cough lasting at least 3 months over a minimum of 2 years

A

Chronic bronchitis

159
Q

Enteric flora that is aspirated

A

Klebsiella

160
Q

Bilateral fibrosis on lung CT

Subpleural patches

Extensive fibrosis with end-stage “honeycomb” lung

A

Idiopathic pulmonary fibrosis

161
Q

Most common cause of laryngotracheobronchitis

A

parainfluenza virus

162
Q

What conditions are caused by H. influenza?

A

Epiglottitis

Meningitis

Otitis media

Pneumonia

163
Q

Nasal polps occur in what two conditions

A

Cystic fibrosis

Aspirin-intolerant asthma

NOTE: Nasal polyps are usually secondary to repeated bouts of rhitinitis

164
Q

How does mesothelioma present?

A

Recurrent pleural effusions

Dyspnea

Chest pain

*Tumor encases the lung

165
Q

How does Coxiella differ from other rickettsial organisms?

A
  • Causes pneumonia
  • Does not require arthropod vector for transmission
  • Does not produce a skin rash
166
Q

Hoarse, “barking” cough and inspiratory stridor

A

Laryngotracheobronchitis

167
Q

Aspiration pneumonia classically results in a _________ abscess.

A

Right lower lobe

168
Q

Where does TB often spread?

A

Meninges

Cervical lymph nodes

Kindeys

Lumbar vertebrae

169
Q

Squamous cell carcinoma usually arising from the epithelial lining of the vocal cord

A

laryngeal carcinoma

170
Q

Most common causes of restrictive diseases

A

Interstitial diseases of the lungs

Chest wall abnomalities (i.e.massive obesity)

171
Q

Sarcoidosis is likely due to _________ response to an unknown antigen.

A

CD4+ helper T-cell

172
Q

What is unique site for distant metastasis from the the lung?

A

Adrenal gland

173
Q

Which lung tumors are located both centrally and peripherally?

A

large cell neuroendocrine carcinoma

carcinoid tumor

174
Q

Superior vena cava syndrome

A

Obstruction of SVC leads to distended head and neck veins with edema and blue discoloration of arms and face

175
Q

Increase in Reid Index

A

Chronic bronchitis

NOTE: Reid index is increased to >50% in chronic bronchitis. Normal is <40%

176
Q

TB that has spread to the meninges results in___

A

Meningitis with granulomas at the base of the brain

177
Q

Pint where outward pull of chest meets inward pull of the lungs

A

FRC

178
Q

Which organism is associated with rusty sputum?

A

Strep pneumoniae

179
Q

Silica impairs ___________ formation by macrophages.

A

Phagolysosome

180
Q
  • Keratin pearls
  • intercellular bridges
  • p40 expression
A

Squamous cell carcinoma

181
Q

Spiral shaped mucus plugs seen in asthma

A

Curshmann spirals

182
Q

Causes of secondary pulmonary hypertension

A

Hypoxemia

Increased volume in the pulmonary circuit

Recurrent pulmonary embolism

183
Q

Cause of primary ciliary dyskinesia

A

Inherited defect of the dynein arm, whcih is necessary for ciliary movement

184
Q

Intracellular organism

Tranmitted from a water source

best visualized by silver stain

A

legionella

185
Q

Treatment for pseudomonas infection

A

CAMPFIRE

  • Carbapems
  • Aminoglycosides
  • Monobactams
  • Polymyxins
  • Fluroquinolones
  • Third and fouth generation cephalosporins (ceftazidine, cefepime)
  • Extended-spectum penicillins (pipercillins, ticarcillin)
186
Q

Causitive agents for aspiration pneumonia

A

Bacteroides

Fusobacterium

Peptoccocus

187
Q

What defends the bottom of the lungs?

A

Alveolar marchophages, which induce inflammation and leads to the production of proteases. Excessive inflammation leads to an imbalance of proteases and antiproteases, which leads to emphysema

188
Q

Which lung tumors are located only peripherally?

A

Adenocarcinoma

Bronchioalveolar carcinoma

OS3 (10 decks)

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