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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
clinical features of idiopathic pulmonary fibrosis
Progressive dyspnea and cough
26
Which organism are associated with pneumonia superimposed on COPD?
Legionella Moraxella cararrhalis H. Influenzae
27
Allegic bronchopulmonary aspergillosis is normally seen in patients with ______ or \_\_\_\_\_\_.
Asthma Cystic fibrosis
28
Mild exposure to carbon results in \_\_\_\_\_\_\_\_\_\_.
Anthracosis \*Collectin of carbon-laden macrophages; not clinically significant
29
Normal pulmonary artery pressure
10 mmHg
30
Complication of bronchiectasis
Hypoxemia with cor pulmonale Secondary amyloidosis
31
Which lung carcinomas are chromogranin positive?
Small cell carcinoma Carcinoid tumor **NOTE:** These are the tumors that are associated with neuroendocrine cells
32
Which lung carcinomas are associated with male smokers?
Small cell carcinoma Squamous cell carcinoma
33
Atypical pneumonia with posttransplant immunosuppression or chemotherapy
CMV
34
How does neonatal respiratory distress syndrome appear on x-ray
Diffuse granularity of lung (ground-glass appearance)
35
Clinical feautures of secondary TB
Fevers and night sweats Cough with hemoptysis Weight loss
36
berylliosis increases risk for \_\_\_\_\_\_\_\_.
Lung cancer
37
Pneumonia is an infection of the \_\_\_\_\_\_\_.
Lung parenchyma
38
Three patterns classically seen on chest x-ray of pneumonia
Lobar pneumonia Bronchopneumonia Interstitial pneumonia
39
Smoking leads to _______ emphysema that is most severe in the ________ lobes.
Centriacinar; upper \*Smoke goes up
40
\_\_\_\_\_\_\_\_\_\_ from injured pneumcytes induce fibrosis.
TGF-B
41
How does acute epiglottitis present?
High fever Sore throught Drooling with dysphagia Mufled voice Inspiratory stridor (narrowing of airway) \*Risk of airway of obstruction
42
How does berylliosis present?
Noncaseating granulomas in the lung, hilar lymph nodes and systemic organs
43
Productive cough, with spiral-shaped mucus plugs (Curshmann spirals) and eosinophil derived crystals (Charcot-Leyden crytals)
Asthma
44
Caplan syndrome
a combination of rheumatoid arthritis (RA) and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray.
45
Malignant tumor of nasopharyngeal epithelium
Nasopharyngeal carcinoma
46
A1AT deficiency results in _____ emphysema that is most severe in the ________ lobes.
Panacinar; lower
47
Gram - rod Silver stain Grows on charcoal yest extract
Legionella
48
Pathologic findings of histoplasmosis
Macrophage filled with Histoplasma
49
Benign tumor composed o lung tissue and cartilage; often calcified on imaging
Bronchial hamartoma
50
Abstestosis increases risk for ________ and \_\_\_\_\_\_\_\_\_\_\_.
Lung carcinoma Mesothelioma \*Lung carcinoma is more common
51
Decrease in FEV1/FVC
Obstructive
52
Allergic rhinitis is associated with which other conditions
Asthma Eczema
53
What is the likely cause of idiopathic pulmonary fibrosis?
Cyclical lung injury
54
What ratio indicates adequeate surfactant production?
\>2
55
Characteristics of secondary TB
Cavitary foci of caseous necrosis \*may also lead to pulmonary TB or tuberculous bronchopneumonia
56
Additional tissues involved in sarcoidosis
Uvea Skin Salivary and lacrimal glands (mimics Sjogren syndrome)
57
Treatment for legionella
Marolide Quinolone
58
Risk factors for laryngeal carcinoma
Alcohol and tobacco \*Can rarely arise from a laryngeal papilloma
59
Fibrotic nodules in the upper lobes of the lung
Silicosis
60
Imaging of lung carcinoma
Large spiculated mass A solitary nodule can also be seen
61
Demographic for berylliosis
Beryllium miners and workers in the aerospace industry
62
organisms that cause intersitital (atypical) pneumonia
Mycoplasma pneumonia Chlamydia pneumonia RSV CMV Influenza Coxiella
63
Protrusion of edematous, inlamed nasal mucosa
Nasal polp
64
\_\_\_\_\_\_\_\_\_\_\_\_ neutralizes proteases.
a1- antitrypsin
65
Demographic seen with coal workers' pneumonoconiosis
Coal miners
66
ARDS is secondary to which diseases?
Sepsis infection Shock Trauma Aspiration Pancreatitis DIC Hypersensivity reaactions Drugs
67
How does a laryngeal carcinoma present?
Hoarseness Cough Stridor
68
Gram + a-hemolytic Lancet-shaped Optochin sensitive
Strep pneumonia
69
Paraneoplastic syndrome associated with squamous cell carcinoma
May produce PTHrp
70
\_\_\_\_\_\_\_ deficiency is a rare cause of emphysema
A1AT
71
Chronic obstructive pulmonary diseases
Chronic bronchitis Emphysema Asthma Bronchiectasis
72
Benign papillary tumor of the vocal cord
Laryngeal papilloma
73
Major component of surfactant
Phosphatidylcholine (lecithin)
74
What other condition is present in A1AT deficiency emphysema and why?
Liver cirrhosis; mutant A1AT accumulates in the ER of hepatocytes, resulting in liver damage
75
Difuse damage to the alveoplar-capillar interface
ARDS
76
How does acute respiratory distress syndrome appear on x-ray?
White out
77
Restrictive lung diseases
Pulmonary fibrosis Pneumoconioses Sarcoidosis Hypersensitivity Pneumonitis
78
Pneumonia occurs when normal defenses are inpaired. Examples?
impaired cough reflex damage to mucociliary escalator Mucus plugging \*Also occurs when an organism is highly virulent
79
Most common lung tumor in nonsmokers and female smokers
Adenocarcinoma
80
Why does C-section lead to neonatal respiratory distress syndrome?
Due to lack of stress-induced steroids; steroids increase synthesis of surfactant
81
Demographic for silicosis
Sandblasters and silica miners
82
normal vs abnormal A1AT allele
Normal: M Abnormal: Z
83
\_\_\_\_\_\_\_\_\_ is the most common cause of emphysema.
Smoking
84
Which lung carcinomas are located only centrally?
Small cell carcinoma Squamous cell carcinoma
85
How is sarcoidosis treated?
Immunosuppression \*Often resolves spontaneously without treatment
86
Pneumoconioses
* Interstitial fibrosis due to occupational exposure; requires chronic exposure to **small** particles that are fibrogenic * Alveolar macrophages engulf foreign partcles and induce fibrosis
87
Characteristics of pulmonary hypertension
* Artherosclerosis of the pulmonary trunk * Smooth muscle hypertrophy of pulmonary arteries * Intimal fibrosis * Plexiform lesions are seen with severe, long-standing disease
88
Poorly differentiated small cells with neuroendocrine differentiation Chromagranin positive
Small cell carcinoma
89
\_\_\_\_\_\_\_\_\_\_\_\_\_ of pseudomonas may contribute to chronic pneumonia in cystic fibrosis patients due to high biofilm formation.
Mucoid polysaccharide capsule
90
Neonatal respiratory distress syndrome is associated wit..
* Prematurity * Caesarian section delivery * Maternal diabetes
91
ARDS treatment
Address underlying cause Ventilation with positive end-expiratory pressure (PEEP)
92
Most common tumor in male smokers
Squamous cell carcinoma
93
Stellate inclusions (asteroid bodies) Giant cells
Sarcodiosis
94
Chronic bronchitis is characterized by hypertrophy of the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Bronchial mucous glands
95
how does intersititial pneumonia present?
Mild upper respiratory symptoms * Minimal sputum * Low fever
96
causitive organisms of bronchopneumonia
S. aureus H. influenzae Psudonomas Moraxella Legionalla
97
TB that has spread to the kidneys results in\_\_\_\_\_\_\_\_.
Sterile pyuria \*persistent finding of white cells in the urine in the absence of bacteria
98
Secondary causes of interstitial fibrosis
Drugs Radiation therapy
99
How does a carcinoid tumor appear when located centrally?
Forms a polyp-like mass in the bronchus
100
Why does hypoxemia result from emphyesema?
Due to destruction of capillaries in the alveolar sac
101
Gram - rod Aerobic Catalase + Oxidase + Motile
pseudomonas
102
Demographic for angiofibroma
Adolescent males
103
What pathogen is associated with nasopharyngeal carcinoma?
EBV
104
What change is seen in FRC in obstructive lung diseases?
increase
105
What causes an increase in Reid index in chronic bronchitis?
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
TB that has spread the lumbar vertebrae is called \_\_\_\_\_\_\_\_.
Pott's disease
107
Where does secondary TB occur? Why?
Occurs at the apex of lungs due to relatively poor lymphatic drainage and high oxygen tension
108
Patients with chronic bronchitis are at an increased risk for ___________ and \_\_\_\_\_\_.
Inection and cor pulmonale \*Anytime a tube is blocked, there is a chance for infection behind that area
109
Treatment for mycoplasma pneumonia
Macrolides Doxycycline Fluoroquinolone
110
Demographic for nasophangeal carcinoma
African Children and chinese adults
111
* Black lung * Associated with rheumatoid arthritis
Coal workers' pneumoconiosis
112
Conditions caused by strep pneumonia
Meningitis Otitis media Pneumonia Sinusitis
113
Cough Dyspnea Foul-smelling sputum
Bronchiectasis
114
\_\_\_\_\_\_\_\_\_\_ levels increase as surfactant is produced.
phosphotidylcholine (lecithin)
115
Most common cause of rhinitis
Rhinovirus (ssRNA) \*Adenovirus (dsDNA) is also a common cause
116
\_\_\_\_\_\_\_\_\_\_\_ mutations is especially commonin Asian females who are nonsmokers. How is it treated?
EGFR; erlotinib
117
How does pulmonary hypertension presnt?
Exertional dyspnea Right sided heart failure
118
How does adenocarcinoma present on imaging?
Preumonia-like consolidation
119
Clinical feautures of pneumonia
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
Gram - rod Fast lactose fermenter Causes pneumonia
Klebsiella
121
Gross phases of lobar pneumonia
* Congestion * Rep hepatization * Gray hepatization * Resolution
122
Demographic for asbestosis
Construction workers Plumbers Shipyard workers
123
What is the cause of hypoxemia and cyanosis seen in acute respiratory distress syndrome?
Due to thickened diffusion barrier and collapse of air sacs (increased surface tension)
124
Two major carcinogens in cigarette smoke
Polycyclic aromatic hydrocarbons Arsenic
125
What causes cyanosis in chronic bronchitis?
Mucus plugs trap CO2, leading to an increase in CO2 and a decrease in O2
126
Lesions may contain long, golden-brown fibers with associated iron
Asbestosis
127
Increased TLC
Obstructive \*Due to increased air trapping
128
Late complications of emphysema
Hypoxemia Cor pulmonale
129
In emphysema, loss of ________ and _________ of airways during exhalation results in obstruction of air trapping.
Recoil; collapse
130
paraneoplastic syndromes associated with small cell carcinoma?
ADH ACTH Lambert-Eaton
131
Lack of surfactant leads to collaspe of air sacs and formation of ________ membranes.
Hyaline
132
Mechanism by which strep pneumonia acts
Encapsulated IgA protease
133
Cause of atypical pneumonia with high fever
Coxiella **REMEMER:** Signs in symptoms of most atypical pneumonias is a low fever
134
Characteristics of primary TB
* Focal, caseating necorsis in the lower lobe of the lung * Hilar lymph nodes that undergo fibrosis and calcification forming a Ghon complex
135
Very mucoid colonies caused by abundant polysaccharide capsules
Klebsiella
136
\_\_\_\_\_\_\_\_\_\_ drugs slow the disease progression of idiopathic pulmonary fibrosis.
Anti-fibrogenic \*Definitive treatment is lung transplantation
137
Well differentiated neuroendocrine cellls Chromogranin positive
Carcinoid tumor
138
Which cells are damaged in ARDS?
Type I and II pneumocytes \*Activation of neutrophils induce protease and free radical mediated damage
139
Poorly differentiated large cells No glands, mucin, TTF-1, keratin pearls, intercellular bridges, p40
Large cell neuroendocrine carcinoma
140
Dyspnea and cough with minimal sputum Prolonged expiration with pursed lips Weight loss Increased anterior-posterior diameter of chest (barrel chest)
Emphysema
141
Eosinophil derived crystals seen in asthma
Charcot-Leyden crystals
142
Where does mutant A1AT accumulate in hepatocytes?
ER
143
5 A's of Klebsiella
Apiration pneumonia Abscess in lungs and liver Alcoholics DiAbetics CurrAnt jelly sputum
144
Benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue
Angiofibroma
145
Biopsy: Pleomorphic keratin-positive eputhelial cells in a background of lymphocytes
Nasopharyngeal carcinoma
146
Increasing respiratory effort after birth, tachypnea with use of accessory muscles, ad grunting Hypoxemia with cyanosis Diffuse granularity of the lung
Neonatal respiratory stress syndrome
147
Destruction of alveolar air sacs
Emphysema
148
What leads to the hypercalcemia seen in sarcoidosis?
1-alpha hydroxylase activity of epithelioid histiocytes converts vitamin D to its active form
149
Productive cough due to exceissive mucus production Cyanosis
Chronic bronchitis
150
Key risk factors for lung cancer
Cigarette smoke Radon Asbestos
151
Treatment for Aspergillus fumigatus
Voriconazole Echinocandins (2nd line)
152
Biopsy of liver cirrhosis due to A1AT deficiency
Pink, PAS-positive globules in hepatocytes
153
Aspiration pneumonia is most often due to _____ bacteria in the oropharynx/
Anaerobic
154
Locations for histoplasmosis
Mississippi and Ohio River Valleys
155
Two broad categories of lung carcinoma
Small cell carcinoma (15%) Non-small cell carcinoma (85%)
156
Different types of pneumonconioses
Coal workers' pneumoconiosis Silicosis Berylloisis Asbestosis
157
Characterized by scattered pathy consolidation centered around bronchioles, often multifocal and bilateral
Bronchopneumonia
158
Chronic productive cough lasting at least 3 months over a minimum of 2 years
Chronic bronchitis
159
Enteric flora that is aspirated
Klebsiella
160
Bilateral fibrosis on lung CT Subpleural patches Extensive fibrosis with end-stage "honeycomb" lung
Idiopathic pulmonary fibrosis
161
Most common cause of laryngotracheobronchitis
parainfluenza virus
162
What conditions are caused by H. influenza?
Epiglottitis Meningitis Otitis media Pneumonia
163
Nasal polps occur in what two conditions
Cystic fibrosis Aspirin-intolerant asthma **NOTE:** Nasal polyps are usually secondary to repeated bouts of rhitinitis
164
How does mesothelioma present?
Recurrent pleural effusions Dyspnea Chest pain \*Tumor encases the lung
165
How does Coxiella differ from other rickettsial organisms?
* Causes pneumonia * Does not require arthropod vector for transmission * Does not produce a skin rash
166
Hoarse, "barking" cough and inspiratory stridor
Laryngotracheobronchitis
167
Aspiration pneumonia classically results in a _________ abscess.
Right lower lobe
168
Where does TB often spread?
Meninges Cervical lymph nodes Kindeys Lumbar vertebrae
169
Squamous cell carcinoma usually arising from the epithelial lining of the vocal cord
laryngeal carcinoma
170
Most common causes of restrictive diseases
Interstitial diseases of the lungs Chest wall abnomalities (i.e.massive obesity)
171
Sarcoidosis is likely due to _________ response to an unknown antigen.
CD4+ helper T-cell
172
What is unique site for distant metastasis from the the lung?
Adrenal gland
173
Which lung tumors are located both centrally and peripherally?
large cell neuroendocrine carcinoma carcinoid tumor
174
Superior vena cava syndrome
Obstruction of SVC leads to distended head and neck veins with edema and blue discoloration of arms and face
175
Increase in Reid Index
Chronic bronchitis **NOTE:** Reid index is increased to \>50% in chronic bronchitis. Normal is \<40%
176
TB that has spread to the meninges results in\_\_\_
Meningitis with granulomas at the base of the brain
177
Pint where outward pull of chest meets inward pull of the lungs
FRC
178
Which organism is associated with rusty sputum?
Strep pneumoniae
179
Silica impairs ___________ formation by macrophages.
Phagolysosome
180
* Keratin pearls * intercellular bridges * p40 expression
Squamous cell carcinoma
181
Spiral shaped mucus plugs seen in asthma
Curshmann spirals
182
Causes of secondary pulmonary hypertension
Hypoxemia Increased volume in the pulmonary circuit Recurrent pulmonary embolism
183
Cause of primary ciliary dyskinesia
Inherited defect of the dynein arm, whcih is necessary for ciliary movement
184
Intracellular organism Tranmitted from a water source best visualized by silver stain
legionella
185
Treatment for pseudomonas infection
**CAMPFIRE** * Carbapems * Aminoglycosides * Monobactams * Polymyxins * Fluroquinolones * Third and fouth generation cephalosporins (ceftazidine, cefepime) * Extended-spectum penicillins (pipercillins, ticarcillin)
186
Causitive agents for aspiration pneumonia
Bacteroides Fusobacterium Peptoccocus
187
What defends the bottom of the lungs?
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
Which lung tumors are located only peripherally?
Adenocarcinoma Bronchioalveolar carcinoma

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