Robbins Ch 15 Part II Flashcards by Billy Harrah

Spectrum of immunologically-mediated interstitial disorders due to inhaled organic antigens is known as?

Hypersensitivity pneumonitis

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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

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What does the Pulmonary Function Tests indicate for hypersensitivity pneumonitis?

Restrictive lung disease (FEV1:FVC ratio is normal)

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What interleukin is increased with pulmonary eosinophilia?

IL-5

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What improves the symptoms associated with respiratory bronchiolitis-associated Interstitial Lung Disease?

Smoking cessation

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Pulmonary Langerhans Cell Histiocytosis is a rare disease of what population?

Most cases resolve with?

1) Young adult smokers

2) Smoking cessation

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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

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Hereditary Pulmonary Alveolar Proteinosis occurs in what population?

What is its prognosis?

1) Neonates

2) Rapidly fatal

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What are characteristic of ante-mortem pulmonary embolism?

Lines of Zahn

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DVTs are diagnosed by?

Duplex ultrasound

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Bone Morphogenetic Protein Receptor Type 2 (BMPR2) mutation is associated with?

Familial Pulmonary HTN

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Pulmonary HTN is defined by pulmonary artery pressure (PAP) greater than?

25 mmHg

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What morphologic finding is highly associated with pulmonary HTN?

Plexiform lesions

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Idiopathic pulmonary HTN is most common in what population?

Women 20-40 years old

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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

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What disease of children is similar to Goodpasture syndrome but there are no anti-basement membrane antibodies detected in serum?

Idiopathic Pulmonary Hemosiderosis

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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

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What is the most common cause of deaths in influenza epidemics?

Superimposed bacterial pneumonia

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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

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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

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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

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What are the three most common causes of otitis media in children?

1) Streptococcus Pneumoniae
2) Haemophilus Influenzae
3) Moraxella Catarrhalis

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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