XIII - The Lung Flashcards
Loss of lung volume cause by inadequate expansion of airspaces, resulting in shunting of inadequately oxygenated blood from pulmonary arteries into veins.
Atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 480
Atelectasis which occurs when an obstruction prevents air from reaching distal airways.
Resorption atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 480
Atelectasis usually associated with accumulation of fluid, blood, or air within the pleural cavity, which mechanically collapse the adjacent lung.
Compression atelectasis (aka passive or relaxation atelectasis)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 481
Atelectasis which occurs when either local or generalized fibrotic changes in the lung or pleura hamper expansion and increase elastic recoil during expiration.
Contraction or cicatricial atelectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 481
Lungs are dark red, firm, airless and heavy. There is capillary congestion, necrosis of alveolar epithelial cells, interstitial and intra-alveolar edema and hemorrhage and neutrophils in capillaries. Hyaline membrane is also characteristic, lining the alveolar ducts. SEE SLIDE 13.1
Acute Respiratory Distress Syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 482
Diffuse pulmonary disease characterized by limitation of airflow, usually resulting from an increase in resistance caused by partial or complete obstruction atvany level.
Obstructive pulmonary disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483
Diffuse pulmonary disease characterized by reduced expansion of lung parenchyma accompanied by decreased total lung capacity.
Restrictive lung disease(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483
Lung volumes in obstructive lung disease:FEV1FVCFEV1:FVC ratio
FEV1 - decreasedFVC - normal / increasedFEV1:FVC ratio - decreased. SEE SLIDE 13.2. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483
Lung volumes in restrictive lung diseaseFEV1FVCFEV1:FVC ratio
FEV1 - normal/decreasedFVC - decreasedFEV1:FVC ratio - near normal. SEE SLIDE 13.2. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 483
Characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls without obvious fibrosis. There is thinning of the alveolar walls and loss of elastic tissue. SEE SLIDE 13.3.
Emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485
Type of emphysema involving the central or proximal parts of the acini, formed by respiratory bronchioles, while distal parts are spared. Lungs deep pink and less voluminous, affecting the upper 2/3 of the lungs. Occurs in smokers.
Centriacinar (centrilobular) Emphysema. SEE SLIDE 13.4. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485
Type of emphysema wherein the acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal alveoli. Occurs more commonly in the lower lung zones. Occurs in a-antitrypsin deficiency.
Panacinar (panlobular) emphysema. SEE SLIDE 13.4. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485
Type of emphysema wherein only the distal part is primarily involved. Lesion is adjacent to the pleura along the lobular connective tissue septa and at the lobe margins. More severe at the upper half of the lungs, forming bullae.
Distal acinar (paraseptal) emphysema. SEE SLIDE 13.4. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 486
Barrel-chested, dyspneic, prolonged expiration, sits forward in a hunched-over position, adequate oxygenation of oxygen. “Pink puffers”.
COPD predominantly emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
History of recurrent infections with purulent sputum, less prominent dyspnea and respiratory drive, becomes hypoxic and are pften cyanotic and obese. “Blue bloaters”.
COPD predominantly chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Defined as persistent productive cough for at least 3 consecutive months in at least 2 consecutive years.
Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Mucosal lining of the larger airways is usually hyperemic and swollen with edema fluid, often covered by a layer of mucinous or mucopurulent secretions. Trachea and bronchi have enlarged mucus-secreting glands.
Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Characterized by goblet cell metaplasia, mucus plugging, inflammation and fibrosis, and sometimes complete obliteration of the lumen due to fibrosis.
Chronic bronchiolitis (small airway disease)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Most important underlying risk factor for chronic bronchitis.
Cigarette smoking(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Triad of 1.intermittent and reversible airway obstruction2.chronic bronchial inflammation with eosinophils3.bronchial smooth muscle cell hypertrophy and hyperreactivity SEE SLIDE 13.7
Asthma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Collections of crystalloids made up of eosinophil proteins.
Charcot-Leyden crystals. SEE SLIDE 13.5. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 492
Whorls of shed epithelium found in mucus plugs.
Curschmann spirals. SEE SLIDE 13.5. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 492
Thick, tenacious mucus plugs with Curshmann spirals and Charcot-Leyden crystals are found histologically in this disease. SEE SLIDE 13.5.
Asthma(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 470
Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue, resulting from chronic necrotizing infections. There is intense acute and chronic inflammatory exudate within the walls, with mixed flora often cultured. There is also peribronchiolar fibrosis in chronic cases. SEE SLIDE 13.6.
Bronchiectasis(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 471
An autosomal recessive disorder frequently associated with bronchiectasis and sterility in males.
Kartagener syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 493
Refers to a pulmonary disorder of unknown etiology characterizedby patchy interstitial fibrosis, honeycomb lung, and fibroblastic foci (usual interstitial pneumonia pattern). Grossly, pleural surfaces of the lung have the appearance of cobblestones because of retraction scars along the interlobular septa. SEE SLIDE 13.8.
Idiopathic Pulmonary Fibrosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 495
A thrombus that lodges astride a pulmonary artery bifurcation, which causes pulmonary hypertension, which can lead to hypoxia and cor pulmonale.
Saddle embolus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 505
Most common symptom of pulmonary embolism.
None, asymptomatic 60-80% of the time.(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506
Mean pulmonary pressures reach one-fourth or more of systemic pressures.
Pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506
Encountered in young persons, more commonly in women, marked by fatigue, syncope, dyspnea on exertion, and sometimes chest pain. Cause of increased pulmonary pressures is unknown.
Primary pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 506
Clinical features of this disease reflect the underlying disease, with accentuation of respiratory insufficiency and right-sided heart strain.
Secondary pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 507
Pneumonia with a patchy distribution of inflammation involving more than one lobe.
Bronchopneumonia(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 509
Four stages of pneumococcal pneumonia.
Congestion, red hepatization, gray hepatization, resolution(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 510
Inflammatory reaction is largely confined within the walls of the alveoli. Septa widened and edematous, with mononuclear infiltrates of lymphocytes, histiocytes and plasma cells. Alveolar spaces are free of cellular exudate.
Atypical pneumonia. SEE SLIDE 13.11. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 513
A localized area of suppurative necrosis within the pulmonary parenchyma, resulting in the formation of one or more large cavities.
Lung abscess(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 515
Pulmonary abscess resulting from aspiration of infective material are much more common on the left or right side?
Right side since it’s shorter and more vertical. Specifically, in the posterior segment of the right upper lobe. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 492
Form of tuberculosis that develops in a previously unexposed, unsensitized person.
Primary tuberculosis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518
Implantation of the inhaled M. tuberculosis bacilli in the distal airspaces of the lungs, causes the formation of this 1 - 1.5 cm area of gray-white inflammatory consolidation. SEE SLIDE 13.22.
Ghon focus(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518
Ghon focus + nodal involvement = ________
Ghon complex(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518
Radiographically detectable calcified Ghon complex.
Ranke complex(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 518
Pattern of disease that arises in previously sensitized host to M. tuberculosis.
Secondary or reactivation TB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 520
Occurs when TB bacilli drain through the lymphatics into lymphatic ducts, which eventually empty into the right side of the heart and into pulmonary circulation. Individual lesions are small, visible foci of yellow-white consolidation scattered through the parenchyma.
Miliary TB(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 520
The most frequent form of extrapulmonary TB.
TB Lymphadenitis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 521
TB lymphadenitis of the cervical LN.
Scrofula(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 521
Round to oval small yeast forms measuring 2-5 um in diameter. SEE SLIDE 13.9.
Histoplasma capsulatum(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523
Thick walled non-budding spherules 20-60 um diameter, often filled with small endospores.
Coccidiodomycosis immitis. SEE SLIDE 13.10. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523
Round to oval and larger fungi, which reproduce by broad-based budding.
Blastomycosis dermatitidis. SEE SLIDE 13.10. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 523
Cells infected by this virus exhibit gigantism of the cell and nucleus. An enlarged intranuclear inclusion surrounded by a clear halo “owl’s eye” is seen. It is the most common opportunistic viral pathogen in AIDS.
Cytomegalovirus (CMV)(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 524
Opportunistic infection of the lungs having a characteristic intra-alveolar foamy, pink-staining exudate “cotton candy exudate”, with thickened septa and mononuclear infiltrate. When silver stain is used, tissue reveals round to cup-shaped cysts. SEE SLIDE 13.12.
Pneumocystis carinii pneumonia(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 502
Most frequent disease-causing fungus.
Candida albicans(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 526
The fungus is a 5-10 um yeast, has a thick, gelatinous capsule and reproduces by budding. Most likely acquired through bird droppings. Visualized by India ink or Giemsa stain. SEE SLIDE 13.13.
Cryptococcus neoformans(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 527
Which type of lung cancer is treated by chemotherapy only? Why?
Small cell lung carcinomaIt is an aggressive tumor which usually have metastasized at the time of diagnosis.(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 529
Lung carcinoma best treated with surgery since they respond poorly to chemotherapy.
Non-small cell lung carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 529
Types of lung cancer with strongest association with tobacco exposure.
Squamous cell carcinoma and Small-cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 530
Lung cancer which are peripherally located, most common type of lung cancer in women and nonsmokers. Grows slowly and metastasize early. Assumes a variety of forms, incliding acinar, papillary and solid types.
Adenocarcinoma. SEE SLIDE 13.14. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 531
Lung carcinoma which typically have large, prominent nucleoli, and a moderate amount of cytoplasm, with minimal glandular or squamous differentiation.
Large-cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 531
Lung carcinoma which appear as pale gray, centrally located masses. Nests and cords of polygonal cells with scant cytoplasm, granular chromatin and inconspicuous nuclei. FNAB shows nuclear molding of adjacent cells. Associated with several paraneoplastic syndromes. SEE SLIDE 13.15.
Small cell lung carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532
Other name for small cell lung carcinoma.
Oat cell carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532
Paraneoplastic syndromes associated with oat cell carcinoma.
Cushing syndromeSIADH Lambert-Eaton myasthenic syndrome(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532
Hypercalcemia due to excessive production of PTH related protein is usually seen in patients with this type of lung carcinoma.
Squamous cell carcinoma. SEE SLIDE 13.14. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 532
Form of lung cancer that is thought to arise from neuroendocrine cells, called Kulchitsky cells, that line the bronchial mucosa and resemble intestinal carcinoids. Nests of small, rounded, uniform cells with “salt and pepper” chromatin. SEE SLIDE 13.16.
Bronchial carcinoids(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 534
Presence of fluid in the pleural space.
Pleural effusion(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535
Air or other gas in the pleural sac.
Pneumothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535
A collection of whole blood in the pleural cavity.
Hemothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535
A pleural collection of a milky lymphatic fluid containing microglobules of lipid.
Chylothorax(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 535
A rare cancer seen in patients who work in shipyards, miners and insulators. Presents as lung ensheathed by a yellow-white, firm or gelatinous layer of tumor the obliterates the pleural space. Lesion is preceeded by extensive pleural fibrosis and plaque formation. May be epithelial, sarcomatoid or biphasic in morphology.
Malignant mesothelioma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 536
Rare neoplasm with strong links to EBV and high frequency among the Chinese population. Characterized by large epithelial cells having indistinct borders (syncitial growth) and prominent eosinophilic nucleoli. SEE SLIDE 13.17.
Nasopharyngeal carcinoma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537
Smoothe, hemispherical protrusions located on the true vocal cords, composed of fibrous tissue and covered by stratified squamous mucosa.
Vocal cord nodules(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537
A benign neoplasm usually on the true vocal cords that forms a soft, raspberry-like excresence rarely more then 1 cm in diameter. Consists of multiple, slender, finger-like projections.
Laryngeal papilloma(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 537
Histologic manifestation of acute respiratory distress syndrome and acute lung injury.
Diffuse alveolar damage(TOPNOTCH)Robbins Pathologic Basis of Disease, 9th Ed. p. 672
A 70 y/o male presented to the ER with a 10 day history of fever followed by rapidly progressive dyspnea for 3 days prior to admission. Physical examination revealed tachypnea, central cyanosis, and extensive fine inspiratory crackles of the chest. Severe hypoxemia was noted on ABG. Chest radiograph revealed bilateral diffuse alveolar infiltrates with normal cardiac size. An extensive ground glassing was also. Diagnosis? Characteristic histologic picture expected for this condition?
ARDS. Hyaline membranes lining the alveolar walls. SEE SLIDE 13.1. (TOPNOTCH)
The key initiating events and the basis of lung damage in ARDS
Damage to endothelial and alveolar epithelial cells. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 674
Disease characterized by abnormally large alveoli separated by thin septa with only focal centriacinar fibrosis. SEE SLIDE 13.3
Emphysema (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 677
Mild chronic inflammation of the airways (predominantly lymphocytes) and enlargement of mucus-secreting glands of the trachea and bronchi are seen in:
Chronic bronchitis(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 679
A 55 y/o female presented with chronic cough, productive of thick, tenacious sputum, recurrent episodes of fever associated with pleuritic chest pain. Crackles were noted on auscultation. Chest radiograph showed presence of “tram tracks”. The most likely diagnosis:
Bronchiectasis(TOPNOTCH)
Dilation of bronchi and bronchioles, with acute and chronic inflammatory exudation, desquamation of the lining epithelium and extensive areas of ulceration, are characteristics of what disease?
Bronchiectasis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 683
Earliest feature of chronic bronchitis
Hypersecretion of mucus in the large airways. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 678
Subbasement membrane fibrosis, hyperplasia of bronchial wall muscle, hypertrophy of bronchial glands, and inflammatory infiltrate in the bronchial wall. SEE SLIDE 13.7. These are morphologic findings in:
Asthma(TOPNOTCH) Robbins Pathologic Basis of Disease, 9th ed., p. 682
Fundamental abnormality in atopic asthma
Exagerrated TH2 (Type 2 helper T cell) response. IL-4, IL-5, and IL-13 are important cytokines. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 470
Key inflammatory cells found in asthma
Eosinophils (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 683
Most common bacterial cause of acute exacerbation of COPD
Haemophilus influenzae. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703
A 3 y/o child was brought to ER due to sudden onset of high fever, labored breathing, and drooling. The most likely cause of this condition is:
Haemophilus influenzae (TOPNOTCH)
3 most common causes of otitis media in children
Streptococcus penumoniae, Haemophilus influenzae, Moraxella catarrhalis (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703
Most freqent cause of gram negative bacterial pneumonia.
Klebsiella pneumoniae (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703
A 45 y/o alcoholic male presented with fever, tachypnea, and cough with thick, mucoid, blood-tinged sputum. Chest radiograph showed right middle lobe opacification and bulging fissure sign. The most likely cause of pneumonia in this case is:
Klebsiella pneumoniae (TOPNOTCH)
An important cause of secondary bacterial pneumonia in children and adults following a viral respiratory illness (measles, influenza)
Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703
Cause of pneumonia associated with high incidence of lung abscess and empyema
Staphylococcus aureus (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 703
Most common cause of community acquired pneumonia
Streptococcus pneumoniae. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707
Distribution of pneumonia caused by Streptococcus pneumoniae, lobar or patchy consolidation?
Lobar (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707
Predominant histologic pattern in viral pneumonia
Interstitial inflammatory reaction of the walls of alveoli (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 707
Cause of pneumonia seen particularly in organ transplant recipients.
Pneumonia caused by Legionella pneumophila. (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708
Common cause of pneumonia in persons with cystic fibrosis, burn victims and in patients with neutropenia
Pneumonia caused by Pseudomonas aeruginosa (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708
Most frequent cause/mechanism of lung abscess
Aspiration of infective material (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 708
Cardinal histologic change in lung abscess
Suppurative destruction of lung parenchyma within the central area of cavitation (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 709
Major morphologic correlate of chronic rejection
Bronchiolitis obliterans (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 712
Type of emphysema in smoking
Centriacinar (centrilobular) Emphysema(TOPNOTCH)
Most common histologic pattern of bronchogenic carcinoma
Adenocarcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 715
Most common site of lung squamous cell carcinoma
Central/hilar region (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 715
Most common type of lung cancer in men
Squamous cell carcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 716
Histologic characteristics of this type of lung carcinoma is keratinization and/or intercellular bridges. SEE SLIDE 13.14.
Squamous cell carcinoma (TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 716
Pulmonary embolism could lead to this type of shock
Cardiogenic shock (TOPNOTCH)
Mechanism of pulmonary edema in left sided CHF.
Increased hydrostatic pressure(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 671
Associated with medial hypertrophy of the pulmonary muscular and elastic arteries, pulmonary arterial atherosclerosis, and right ventricular hypertrophy. SEE SLIDE 13.18.
Pulmonary hypertension(TOPNOTCH)Robbins Basic Pathology, 9th Ed. p. 700
An autoimmune disease characterized by rapidly progressive glomerulonephritis and necrotizing hemorrhagic interstitial pneumonitis. Lung histopathology can reveal diffuse alveolar hemorrhage and hemosiderin deposition.
Goodpasture syndrome(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 485
Presents with cough, fever, and copious foul-smelling sputum, usually with antecedent primary lung infection. Cardinal histologic change in this condition is suppurative destruction of lung parenchyma within the central area of cavitaion.
Lung abscess(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 709
Pneumonia acquired by inhalation of dust particles from soil contaminated with bird or bat droopings that contain micronidia. Symptoms resemble those of tuberculosis.
Histoplasmosis(TOPNOTCH)Robbins Basic Pathology, 9h Ed. p. 709
The most common site of metastatic neoplasm
Lung(TOPNOTCH)Robbins Basic Pathology, 9h Ed. p. 721
Sudden death in pulmonary embolism is caused by:
Blockage of blood flow through the lungs.(TOPNOTCH) Robbins Basic Pathology, 9th ed., p. 698
Inflammatory cell implicated in the pathogenesis of ARDS (A) type II pneumocyte (B) neutrophil (C) fibroblast (D) eosinophil
neutrophil (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 482
Of the types of emphysema that cause clinically significant airway obstruction, which one is the commonest? (A) centriacinar (B) panacinar (C) distal acinar (D) irregular
Centriacinar (centrilobular) Emphysema(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 485
In chronic bronchitis, a Reid index of more than 0.4 is diagnostic. The Reid index is the ratio of the thickness of the (A) metaplastic mucosa to the submucosal gland layer (B) submucosal gland layer to the bronchial wall (C) metaplastic mucos to the bronchial wall (D) cartilage to the submucosal gland layer
Submucosal gland layer to the mucosal wall (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 489
Gross examination of lungs that show airways that can be followed almost to the pleural surfaces is characteristic of (A) emphysema (B) bronchiectasis (C) pulmonary sequestration (D) chronic bronchitis
Bronchiectasis(TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 493
Usual interstitial pneumonia, or idiopathic pulmonary fibrosis, is differentiated from other fibrosing interstitial diseases by (A) the temporal heterogeneity of the fibrosing lesions (B) presence of a lymphocytic infiltrate (C) exuberant fibroblastic proliferation (D) association with a connective tissue disease such as SLE
the temporal heterogeneity of the fibrosing lesions (B is nonspecific and may occur in any; C may be seen in cryptogenic organizing pneumonia; D is wrong because by definition, “idiopathic” must not be associated with other conditions) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp. 495-496
Which cell is the key element in the initiation and perpetuation of lung injury and fibrosis in pneumoconioses? (A) alveolar macrophage (B) neutrophil (C) respiratory epithelium basal cell (D) type II pneumocyte
alveolar macrophage (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 497
Which pneomoconiosis is associated with an increased susceptibility to tuberculosis? (A) anthracosis (B) silicosis (C) asbestosis (D) sarcoidosis
silicosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 499
Concomitant cigarette smoking in patients who have been exposed to asbestos greatly increases the risk of (A) bronchogenic carcinoma (B) mesothelioma (C) carcinoid tumor (D) hamartoma
bronchogenic carcinoma (TOPNOTCH)Robbins Basic Pathology, 8th Ed. p. 500, 530
Which of the following is more prevalent in nonsmokers than smokers? (A) sarcoidosis (B) centriacinar emphysema (C) desquamative interstitial pneumonia (D) respiratory bronchiolitis
Sarcoidosis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P. 501
What is the histopathologic sine qua non of sarcoidosis? (A) noncaseating epithelioid granuloma (B) Schaumann bodies (C) asteroid bodies (D) caseation necrosis
Noncaseating epithelioid granuloma. Schaumann bodies and asteroid bodies may also be seen but not necessary for diagnosis. SEE SLIDES 13.19 and 13.20. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P479
A 33 year old woman with mitral stenosis from rheumatic heart disease develops hepatomegaly and bipedal edema. She eventually dies of heart failure. An autopsy is done. Which of the following lung findings supports pulmonary hypertension? (A) coagulative necrosis of alveoli with intraparenchymal hemorrhage (B) medial hypertrophy and reduplication of elastic membranes in small arteries (C) medium arteries with chronic inflammatory infiltrate and fibrinoid necrosis (D) vessels of varying caliber with endothelial proliferation
Medial hypertrophy and reduplication of elastic membranes in small arteries. SEE SLIDE 13.18. (TOPNOTCH)Robbins Basic Pathology, 8th Ed. P 507
A 40 year old lady develops progressive dyspnea and hemoptysis of 1 week. On further history, she reports tea-colored urine. Her condition worsens, and she dies. At autopsy, her lung alveoli have thickened fibrous septa, and the lumens diffusely filled with hemosiderin-laden macrophages. Immunofluorescence showed a linear pattern of immunoglobulin deposition along the alveolar septa. Kidney samples also showed the same pattern. Her dismal clinical picture is a consequence of antibodies against (A) fibrillin (B) elastin (C) collagen III (D) collagen IV
collagen IV (Goodpasture syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 507-508
Patients with sickle cell disease have an increased risk of streptococcal pneumonia because (A) macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (B) there is immunologic anergy to the streptococcal capsule which has structural similarity to hemoglobin S (C) the inherent resistance to malaria in sickle cell patients primes the cytotoxic T cells for protozoan, but not bacterial, infections (D) chronic hemolysis in sickle cell disease releases growth factors for the fastidious streptococcal bacteria
Macrophages that remove the encapsulated organims are significantly reduced due to a nonfunctioning spleen (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 428, 509
Which of the following patients with secondary tuberculosis have an increased likelihood of NEGATIVE sputum AFB smears? (A) 55 year old HIV-positive man with CD4+ counts 300 cells/mm3 (C) 43 year old HIV-negative man
55 year old HIV-positive man with CD4+ counts
A 55 year old man with a 50 pack year smoking history presents with a 5 cm right lung mass in the middle lobe. A CT-guided aspiration biopsy is performed, which shows round to polygonal cells twice the size of lymphocytes, with unappreciable cytoplasm, finely granular chromatin. Some of the cells demonstrate nuclear molding. What is the first line of treatment? (A) lobectomy (B) radiation therapy (C) chemotherapy (D) anti-Koch’s
chemotherapy (small cell carcinoma) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 531-534)
A 41 year old asymptomatic woman presents with a nodule on a routine xray. CT scan showed a 3-cm bronchial mucosal plaque penetrating the bronchial wall and fanning out into the peribrochial tissue, resembling a collar button. A bronchoscopy with core biopsy is done, which showed nests of uniform cells bearing regular round nuclei with salt-and-pepper chromatin, with little pleomorphism and mitosis. Which of the following is TRUE? (A) 70-80%% of patients with this tumor have hilar node metastasis at presentation (B) the tumor is thought to arise from the Kupffer cells that line the bronchial mucosa (C) Patients commonly present with the syndrome of diarrhea, flushing, and cyanosis (D) it can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms
It can be considered as a less aggressive cousin to small cell carcinoma, both belonging in a spectrum of pulmonary neuroendocrine neoplasms (A- 5-15% nodal metastasis; B - arises from Kulchitsky cells; C - rarely presents with the syndrome) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 534
A 28 year old man complains of epistaxis of one month duration. His otorhinolaryngologist finds an ill-defined erythematous mass in his nasopharynx, and performs a biopsy, which showed sheets and clusters of large epithelial cells having indistinct cell borders with eosinophilic nucleoli, with a background of lymphocytes. Which of the following is TRUE? (A) the mass is associated with EBV infection (B) the lymphocytes are neoplastic (C) the mass is usually resistant to radiotherapy (D) 5-year survival rates are less than 5%
the mass is associated with EBV infection (nasopharyngeal carcinoma) (B - the lymphocytes are not neoplastic; C - it is radiosensitive; D - 5-year survival rates 50% even for advanced cancers) (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 537
In laryngeal carcinoma, which tumor location has the best prognosis? (A) supraglottis (B) glottis (C) sublottis (D) epiglottis
glottis (TOPNOTCH)Robbins Basic Pathology, 8th Ed. Pp 538
Particles that are __ to __ um in diameter are the most dangerous to the lungs as they can get lodged at the bifurcation of distal airways,
1 to 5 (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 474
What disease is this? Nodules in the upper zones of the lungs made up of whorled hyalinized collagen fibers. Sometimes, LNs can have thin sheets of calcification, which on imaging looks like “egg shell” calcification
Silicosis (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 476
How does one differntiate asbestosis from usual interstitial pneumonia?
Presence of asbestos bodies (golden brown, fusiform or beaded rods with translucent center) (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 477
Most common manifestation of asbestos exposure
Pleural plaques, most frequently on the anterior and posterolateral aspects of the parietal pleura (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 477
What disease is this? Presents with granulomas in the lungs with hilar and paratracheal lymphadenopathy, erythema nodosum, and sometimes involves the eye, lacrimal glands, and parotid gland. SEE SLIDE 13.21.
Sarcoidosis. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 480
Eponym for combined uveoparotid involvement in sarcoidosis
Mikulicz syndrome. Eye and lacrimal gland involvement in sarcoidosis occurs in 1/5 to 1/2 of patients. Parotid involvement seen in 10%. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 480
Characteristic histologic picture of hypersensitivity pneumonitis
Peribronchiolar accentuation (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 480
Characteristic histologic picture seen in idiopathic pulmonary arterial hypertension, besides the usual thickening of arterial walls.
Plexiform lesions, in which endothelial proliferation forms multiple lumina within small arteries. SEE SLIDE 13.18. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 484
Hallmark diagnostic finding in renal biopsy specimens and alveolar septa of Goodpasture Syndrome
Linear pattern of immunoglobulin deposition (usually IgG) (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 485
Congestion, red hepatization, gray hepatization or resolution: Lobe is heavy, red, and boggy. There is proteinaceous fluid, neutrophils, and many bacteria in the alveoli.
Congestion (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 488
Congestion, red hepatization, gray hepatization or resolution: Lung lobe has a liver-like consistency. There are neutrophils, RED CELLS, and FIBRIN on the alveoli.
Red hepatization (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 488
Congestion, red hepatization, gray hepatization or resolution: Lung is dry and firm. Fibrinosuppurative exudate persists. Red cells are lysed.
Gray hepatization (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 488
Important diagnostic clue for C. albicans and represent budding yeast cells joined end to end at constrictions.
Pseudohyphae (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 502
Two key differences of zygomycetes (Rhizopus and Mucor) and Aspergillus
Zygomycetes: nonseptate hyphae, branch at right angles. Aspergilus: septate hyphae, branch at acute angles. (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 502
Squamous cell CA or Adenocarcinoma: Most common type of lung cancer in women and nonsmoker
Adenocarcinoma (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 506
Squamous cell CA or Adenocarcinoma: Tend to metastasize widely at an early stage
Adenocarcinoma (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 506
Key features of this lung cancer type include: Diameter of 3cm or less, grwoth along pre-existing structures in a “lepidic” pattern, preserved architecture structure
Adenocarcinoma in situ (AIS, formerly called brochioalveolar carcinoma) (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 509
Syndrome of ipsilateral enophthalmos, ptosis, miosis, and anhidrosis
Horner syndrome. Due to invasion of brachial or cervical sympathetic plexus caused by apical neoplasms (Pancoast tumors)(TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 509
Small cell or non-small cell lung carcinoma: Neuroendocrine and epithelial markers usually present. No mucin.
Small cell lung carcinoma (TOPNOTCH)Robbins Basic Pathology, 9th Ed. P. 509
