Rubin's respiratory

Question 1

1. Lung abscess a

Answer 1

localized accumulation of pus accompanized by destruction of pulmonary parenchyma, including alveoli, airways, and bv’s;
can complicate aspiration, lung cancer;
abscess cavities often partially filled with pus and air, accounting for X-ray finding of an “air/fluid level,” and can get foul-smelling sputum if abscess connected to bronchus

Question 2

5. Bronchiectasis often localized to

Answer 2

segment of the lung distal to mech obstruction of a bronchus by a variety of lesions, like tumors, inhaled foreign bodies, mucous plugs, and compressive LAD; look for mucopurulent sputum!!

Question 3

6. Complications of bacterial pneumonia include

Answer 3

1. pleuritis (extension of inflamm to pleural space)
2. pleural effusion
3. pyothorax (infection of pleural effusion)
4. pulmonary abscess
5. pulmonary fibrosis;
   look out for empyema!!

Question 4

7. Though uncommon in terms of comm-acquired disease, think of S aureus and pulm infection in context of

Answer 4

influenza, vital respiratory tract infections, nosocomial staph pneumonia (if prone to aspiration and intubated)

Question 5

10. CMV produces a

Answer 5

characteristic intersitital pneumonia; think immuno comp and children getting it transplacentally;
look for enlargement of infected cells, containing typical intranuclear and cytoplasmic inclusions!!

Question 6

12. INterstitial pneumonia characterized by

Answer 6

hyaline membranes and interstitial inflamm (look for diffuse alveolar damage)

Question 7

13. Cryptococcosis results from

Answer 7

inhalation of spores of C neoformans, encountered in pigeon droppings; think immunocomp;
STAINS POSITIVE with mucicarmine stain for capsular polysaccharides

Question 8

14. P jiroveci can appear as

Answer 8

small bubbles in a background of proteinaceous exudates; in this case, centrifuged bronchoalveolar lavage specimen impregnanted with silver shows a cluster of cysts; cysts appear as round or indented (crescent moon) bodies, approx 5 micrometers in diameter

Question 9

17. Traumatic pneumothorax can occur after

Answer 9

1. aspiration of fluid from pleura
2. pleural or lung biopsies
3. transbronchial biopsies
4. positive pressure-assisted ventilation

Question 10

20. Alveolar proteinosis is a condition in which

Answer 10

alveoli are filled with a granular, proteinaceous, eosinophilic material, which is PAS-positive, diastase resistant, and rich in lipids; maybe associated with compromised immunity, leukemia, and lymphoma, respiratory infections, and exposure to environ inorganic dust

Question 11

24. alpha1-antitrypsin deficiency leads to emphysema that is

Answer 11

diffuse and classified as panacinar; normally, alpha1-antitrypsin inhibits neutrophil elastase, enzyme digesting elastin and other components of the alveolar septa

Question 12

28. Status asthmaticus shows on histology

Answer 12

a bronchus containing a luminal mucous plug, submucosal gland hyperplasia, smooth muscle hyperplasia, BM thickening, and increased numbers of eosinophils

Question 13

29. Silicosis marked by

Answer 13

insidious development of fibrotic pulmonary nodules containing quartz crystals; disease can be asymp for prolonged periods of time or cause only mild to moderate dyspnea

Question 14

30. Anthracosilicosis is

Answer 14

highly fibrogenic thanks to the silica;
coal-workers’ pneumoconiosis known as black lung disease because of carbon particle deposition; in complicated cases, think palpable coal-dust nodules throughout lung as black foci (macrophages around with fibrotic stroma)

Question 15

32. In this patient, pulmonary thromboembolism

Answer 15

associated with pulmonary infarction, pleuritic chest pain, hemoptysis, and pleural effusion

Question 16

34. Lymphocytic interstitial pneumonia is a

Answer 16

rare pneumonitis where lymphoid infiltrates are distributed diffusely in the interstitial spaces of the lung; you have chronic inflamm cells and see LIP occur in context of Sjogren and HIV

Question 17

36. Langerhans cell histiocytosis is

Answer 17

eosinophilic granuloma (think of the pulmonary form associated with CIG SMOKERS!!); see Langerhans cells with lymphocytes, eosinophils, macrophages

Question 18

37. Lymphangioleiomyomatosis characterized by

Answer 18

women of childbearing age; widespread abnormal prolif of smooth muscle in lung, mediastinal and retroperitoneal lymph nodes, major lymphatic ducts;
look for bilateral, diffuse enlargement of lungs with cystic changes resembling emphysema;
could respond to antiestrogen and progesterone therapy!!!

Question 19

39. Eosinophilic pneumonia has

Answer 19

inflamm exudate composed of eosinophils and macrophages in the alveolar spaces; look for hyaline membranes;
people respond to corticosteroids!!

Question 20

40. Usual interstitial pneumonia demonstrates histologically

Answer 20

patchy, subpleural fibrosis and microscopic “honeycomb” cystic change; look for DIFFUSE FIBROSIS!!

Question 21

41. Cryptogenic organizing pneumonia:

Answer 21

1. originally bronchiolitis obliterans-organizing pneumonia
2. look for respiratory tract infections, inhalation of toxic materials, and collagen vascular diseases
3. look for loose fibrous tissue in the alveoli and bronchioles

Question 22

48. Broncioalveolar carcinoma is a

Answer 22

primary pulmonary adenocarcinoma originating from stem cells in terminal bronchioles;
cells might be columnar and mucus producing, or cuboidal and similar to type II pneumocytes;
grow along ALVEOLAR SEPTA!!

Question 23

50. Carcinoid tumors occur most often in

Answer 23

the wall of the major bronchus and could protrude into its lumen; look for neuroendocrine differentiation

Question 24

Hydrothorax is

Answer 24

elevation of hydrostatic pressure in those with CHF causing transudation of edema fluid into pleural cavity

Question 25

Empyema is

Answer 25

variant of pyothorax (turbid effusion with many neutrophils); here, thick pus accumulates within the pleural cavity, often with loculation and fibrosis

Question 26

Chylothorax is defined as

Answer 26

the accumulation in the pleural cavity of a milky, lipid-rich fluid as a result of lymphatic obstruction; usually a rare complication of malignant tumors in the mediastinum, like lymphoma