Robbins Ch 15 Part II Flashcards
Spectrum of immunologically-mediated interstitial disorders due to inhaled organic antigens is known as?
Hypersensitivity pneumonitis
Pigeon-breeder lung is a type of hypersensitivity pneumonitis from?
Farmer’s lung?
Hot tub lung?
1) Protein in bird feces
2) Actinomycetes spores in hay
3) Mycobacterium avium complex and Legionella
What does the Pulmonary Function Tests indicate for hypersensitivity pneumonitis?
Restrictive lung disease (FEV1:FVC ratio is normal)
What interleukin is increased with pulmonary eosinophilia?
IL-5
What improves the symptoms associated with respiratory bronchiolitis-associated Interstitial Lung Disease?
Smoking cessation
Pulmonary Langerhans Cell Histiocytosis is a rare disease of what population?
Most cases resolve with?
1) Young adult smokers
2) Smoking cessation
What condition is characterized by surfactant accumulation in alveoli and bronchioles?
The defects are related to?
What is it positive for?
How does it present clinically?
1) Pulmonary Alveolar Proteinosis
2) GM-CSF dysfunction
3) Periodic Acid-Schiff
4) Cough with abundant sputum containing chunks of gelatinous material
Hereditary Pulmonary Alveolar Proteinosis occurs in what population?
What is its prognosis?
1) Neonates
2) Rapidly fatal
What are characteristic of ante-mortem pulmonary embolism?
Lines of Zahn
DVTs are diagnosed by?
Duplex ultrasound
Bone Morphogenetic Protein Receptor Type 2 (BMPR2) mutation is associated with?
Familial Pulmonary HTN
Pulmonary HTN is defined by pulmonary artery pressure (PAP) greater than?
25 mmHg
What morphologic finding is highly associated with pulmonary HTN?
Plexiform lesions
Idiopathic pulmonary HTN is most common in what population?
Women 20-40 years old
Goodpasture syndrome has autoantibodies against?
It is most common in what population?
What does immunofluorescence show?
1) Basement Membrane
2) Male teens to late 20s
3) Linear Ig deposition along BM
What disease of children is similar to Goodpasture syndrome but there are no anti-basement membrane antibodies detected in serum?
Idiopathic Pulmonary Hemosiderosis
What is Polyangiitis with Granulomatosis (Wegner’s) positive for?
How does it compare to sarcoidosis?
1) PR3-ANCA/ c-ANCA
2) Scattered, poorly formed granulomas compared to the well defined granulomas of sarcoidosis
What is the most common cause of deaths in influenza epidemics?
Superimposed bacterial pneumonia
What is the most common cause of community acquired pneumonia?
What is its distribution of inflammation in the lung?
What is found on gram stained sputum?
1) Streptococcus pneumoniae
2) Lobar
3) Gram positive, lancet shaped diplococci that are encapsulated
What is the most common bacterial cause of acute exacerbation of COPD?
Which type was the vaccine made for?
What population does it have a high mortality rate with because it causes pneumonia?
1) Haemophilus influenzae
2) Type B
3) Children
What is the second most common bacterial cause of COPD exacerbation?
What does it cause in the elderly?
In children?
1) Moraxella catarrhalis
2) Pneumonia
3) Otitis media
What are the three most common causes of otitis media in children?
1) Streptococcus Pneumoniae
2) Haemophilus Influenzae
3) Moraxella Catarrhalis
What is the most frequent cause of gram (-) bacterial pneumonia?
What population is it most common in?
How is the sputum described?
1) Klebsiella pneumoniae
2) Chronic alcoholics
3) Currant jelly sputum
Legionella pneumophila pneumonia is seen particularly in?
How is it diagnosed?
1) Organ transplant recipients
2) Antigens in urine
What part of the influenza virus attaches to cells?
What part allows release of replicated virus from cells?
Which part does tamiflu act against?
1) Hemagglutinin
2) Neuraminidase
3) Neuraminidase
Human Metapneumovirus and human respiratory syncytial virus fall under what category?
Paramyxovirus
What infects the lower respiratory tree and spreads systemically causing Severe Acute Respiratory Syndrome (SARS)?
Coronavirus
What correlates with a poorer outcome in COVID patients due to the thrombotic complications?
D-dimer
What cell type may be identified in the circulation due to COVID?
Megakaryocytes
Hospital acquired pneumonia is most commonly caused by what gram positive cocci?
What gram negative rods?
Ventilator associated pneumonia is most commonly caused by?
1) Staphylococcus Aureus and Streptococcus Pneumonia
2) Enterobacteriaceae and Pseudomonas
3) Gram negative bacilli
What are very characteristic of lung abscess?
Air-fluid levels
Aspiration based abscesses are more common on the?
Pneumonia based abscesses are typically located?
1) Right main bronchus
2) Basally
What are intracellular pathogen of phagocytes, endemic to Ohio and Mississippi river valleys (midwest)?
What can it cause in immunocompromised patients?
The characteristic yeast form shows what morphology?
1) Histoplasma capsulatum
2) Fulminant disseminated histoplasmosis
3) Pumpkin seed
What are soil dwelling, dimorphic fungus that occurs in central and southeast USA (Florida)?
The characteristic yeast forms show what morphology?
1) Blastomyces dermatitidis
2) Broad Based Budding
What is endemic in southwestern U.S. and mexico and causes a granulomatous response with eosinophils in the lungs?
What characteristic morphology does it show?
1) Coccidioidomycosis
2) Non-budding spherules
What opportunistic fungal infection is an AIDS-defining illness?
The characteristic yeast forms show what morphology?
1) Pneumocystis jiroveci
2) Cup-shaped
Which sex has increased susceptibility to the associated carcinogens of tobacco smoking?
Females
What is characterized by loss of tumor suppressor genes due to tobacco smoke exposure such as CDKN2A and TP53?
Squamous cell carcinoma
Which carcinoma has the strongest association with smoking?
Which is the most common lung cancer associated with smoking?
1) Small cell carcinoma
2) Squamous cell carcinoma
Gain-of-function of GF receptor signaling pathways is characteristic of?
Adenocarcinoma
What is the most common form of lung cancer in the absence of smoking?
Where in the lung is it most common?
Majority express what transcription factor?
1) Adenocarcinoma
2) Peripheral lung
3) Thyroid transcription factor 1
What are composed entirely of dysplastic cells growing along preexisting alveolar septae?
Adenocarcinoma in situ
Orange cytoplasm and keratin pearls is diagnostic of?
Squamous cell carcinoma
What paraneoplastic syndrome does squamous carcinoma lead to?
Small cell carcinoma?
1) Hypercalcemia
2) SIADH and Cushing’s
What happens when carcinomas invades neural structures near trachea?
What tumors are associated with this?
1) Horner syndrome:
a) Partial Ptosis
b) Anhidrosis
c) Miosis
d) Arm weakness
2) Pancoast tumors
Lung cancer has a worse prognosis if there is what mutation?
KRAS mutation
What syndrome can carcinoid tumors cause?
Flushing, diarrhea, cyanosis
Radio-opacity ‘coin lesion’ on routine CXR is diagnostic of?
Lung hamartoma
What population does Lymphangioleiomyomatosis present in?
It is associated with loss of function of what tumor suppressor?
1) Young women
2) TSC2
Suppurative Pleuritis (Empyema) is more common on which side?
Right side
Exfoliated tumor cells is characteristic of?
Hemorrhagic Pleuritis
What is the most common cause of hydrothorax?
Cardiac failure
What occurs during tension pneumothorax?
Air enters during inspiration but is not released during expiration
Solitary fibrous tumors are positive for?
What fusion gene is virtually unique to solitary fibrous tumor?
1) CD34
2) NAB2-STAT6
90% of malignant mesothelioma cases are related to?
What is it positive for?
1) Asbestos exposure
2) Cytokeratin and calretinin
Small cell carcinoma causes what histological feature to be present?
Neuroendocrine differentiation
Large cells with intranuclear and cytoplasmic inclusions describes?
Hyphal forms without septations describes?
Caseating granulomata with acid fast organisms describes?
1) Cytomegalovirus
2) Mucormycosis
3) Mycobacteria
