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CPR II > (16.1) Pulmonary Pathology II (Singh) > Flashcards

(16.1) Pulmonary Pathology II (Singh) Flashcards

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1
Q

Idiopathic pulmonary fibrosis

How does it damage pulmonary tissue?

A

IPF damages pulmonary tissue with waves of inflammatory injury leading to fibrosis

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2
Q

What would a CXR look like for a idiopathic pulmonary fibrosis pt?

A

Basilar infiltrates

“Honeycomb lung”

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3
Q

What do the lungs sound like on auscultation for idiopathic pulmonary fibrosis?

A

Crackles on exam

“Velcro-like”

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4
Q

What are the contributing factors to idiopathic pulmonary fibrosis?

A

Enviornmental factors (SMOKING)

Genetic factors

Increasing age

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5
Q

What is unique about the histology of idiopathic pulmonary fibrosis?

A

Very different patterns due to the “wave like” nature of the disease

Some patches are normal, some have inflammation, others have fibroblast foci and some have peripheral honeycombing

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6
Q

What do pathologists call idiopathic pulmonary fibrosis when found on pulmonary biopsy?

A

Usual Interstitial Pneumonia (UIP)

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7
Q

What do these images represent?

A

Honeycomb fibrosis

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8
Q

What is the prognosis for patients with idiopathic pulmonary fibrosis?

A

NOT GOOD

Most patients die from respiratory disease 3-5 years after diagnosis

Only truly effective treatment = lung transplant

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9
Q

What are some experimental medications being used to treat idiopathic pulmonary fibrosis?

A

These meds are used to arrest fibrosis

  • Tyrosine kinase inhibitors*
  • TGF-Beta inhibitors*
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10
Q

What is non-specific interstitial pneumonia (NSIP)?

A

VERY SIMILAR TO UIP

Idiopathic

Has UNIQUE HISTOLOGY = uniform infiltrates and fibrosis

Has better prognosis than UIP

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11
Q

What is this lung disorder?

A

Non-specific interstitial pneumonia (NSIP)

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12
Q

What is a cute way to remember what cryptogenic organizing pneumonia (COP) looks like histologically?

A

Looks like cotton candy… awwww

The “cotton candy” is fibroblast foci (Masson bodies)

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13
Q

Cryptogenic organizing pneumonia (COP)

Prognosis?

A

Very good!

Patient tend to have full recovery with oral steroids

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14
Q

How do you diagnose cryptogenic organizing pneumonia (COP)?

A

Diagnosis of exclusion

-Not an infection, drug- or toxin-induced, or related to connective tissue disorders

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15
Q

What is this?

A

Granulomatous inflammation

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16
Q

What is sarcoidosis?

A

Systemic disease manifesting non-caseating (non-necrotizing) granulomata

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17
Q

What is the clinical presentation of sarcoidosis?

A

Incidental abnormal radiograph

or

Dyspnea

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18
Q

What are some of the hallmark granuloma inclusions of sarcoidosis?

A

Granuloma inclusions:

Asteroid body (A)

Schaumann bodies (B-D)

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19
Q

What is the demographic of sarcoidosis?

A

<40 years of age

African americans

Commonly involve LUNGS

Elevated ACE levels

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20
Q

Sarcoidosis

Do the stages occur in order?

A

NO!

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21
Q

What is this?

A

Hypersensitivity Pneumonitis

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22
Q

What is hypersensitivity pneumonitis?

A

Immune reaction to inhaled antigen

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23
Q

What are three examples of specific types of hypersensitivity pneumonitis?

A

Pigeon-breeder’s lung — protein from bird feces

Farmer’s lung — Actinomycetic spores in hay

Hot tub lung — Reaction to mycobacterium avium complex (MAC)

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24
Q

What is one of the most imporant aspects of your clinical interaction w/ your patient that will allow you to diagnose hypersensitivity pneumonitis?

A

HISTORY

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25
What is the pathology?
Desquamative Interstitial Pneumonia (DSIP) \*Notice that every alveolar space has macrophages inside. Also, a MISNOMER, these are NOT squamous cells lol.
26
What is the demographic of **desquamative interstitial pneumonia (DSIP)?**
**Smokers** in 40s/50s Restrictive lung disease presentation
27
What is the prognosis for **desquamative interstitial pneumonia (DSIP)?**
Good prognosis only IF THE PATIENT CAN STOP SMOKING
28
What is the pathology?
Respiratory Bronchiolitis-Interstitial Lung Disease (RB-ILD)
29
What is the demographic for **respiratory bonchiolitis-interstitial lung disease?**
Smokers 30s-40s
30
What is the pathology?
Langerhans cell histiocytosis (LCH)
31
What is a **major characteristic** of **langerhans cells** histologically?
Langerhans cells ALWAYS stain **CD1a positive**
32
What are some dead giveaways that you are looking at a **langerhans cell histiocytosis (LCH)** biopsy?
Langerhans cells with a TON of **eosinophils**
33
What is **pulmonary alveolar proteinosis?**
Impairment of **surfactant metabolism** due to defect in **granulocyte-macrophage colony stimulating factor (GM-CSF)**
34
What is the histology of **pulmonary alveolar proeinosis?**
\*Frequently confused with pulmonary edema
35
How do you treat **pulmonary alveolar proteinosis?**
Treat with SubQ GM-CSF
36
What is this?
Bone marrow embolism
37
What is this?
Talc embolism Seen in IV drug users
38
What is this?
Septic emboli
39
Where do **septic emboli** frequently originate from?
From the heart! From endocarditis, valve vegetations break off and manifest in other sites...LIKE THE LUNGS
40
What is the definition of **pulmonary hypertension?**
Pulmonary artery pressure (PAP) is greater than 25mmHg
41
What are the two manifestations of **pulmonary hyptertension?**
Plexiform lesion (left) Medial hypertrophy (right)
42
What is the pathology?
Pulmonary hemorrhage syndromes
43
What is the pathology?
Goodpasture syndrome \*Notice how you can see the RBCs within the lung parynchema
44
What is **goodpasture syndrome?**
Antibody-mediated disease that damages **basement membranes** in the **lung** and **kidney** \*Targets **Collagen IV**
45
What is the demographic of **goodpasture syndrome?**
YOUNG MEN 20s/30s
46
What is the pathology?
GPA : Granulomatosis w/ polyangiitis
47
\_\_\_\_\_\_\_\_\_\_ is the second most common cause of hospital admissions
Pulmonary infections
48
What is the diagnosis?
Right upper lobar pneumonia
49
What are the 4 stages of **lobar pneumonia?**
1. Congestion (vascular engorgement) 2. Red hapatization (red cells and inflammation) 3. Grey hepatization (inflammation and debris) 4. Resolution (fibrosis, macrophage clean-up)
50
What is the most common cause of **pneumonia?**
Streptococcus pneumonia (Lancet shaped gram positive diplococci)
51
What is **"atypical" ("walking") pneumonia?**
Slower onset than typical pneumonia **Systemic** symptoms predominate **Patchy infiltrates** on CXR Young adults/teens/older children
52
What is the major bacterium that causes "atypical walking pneumonia"?
Mycoplasma pneumoniae
53
What is so special about **mycoplasma pneumoniae?**
Smallest free-living, self-replicating microorganisms NO CELL WALL
54
Where would you find **legionella pneumophila?**
Grows in **warm freshwater** - Air conditioning units - Misters - Hot tubs
55
What are the three major causes of **community acquired viral pneumonia**?
Influenza (H1N1) SARS Respiratory Syncytial Virus
56
How are influenza viruses classified?
Classified by 2 proteins **Hemagglutinin** **Neuraminidase**
57
What is **antigenic drift?**
Epidemics **MINOR** changes to proteins on the virus, allowing increased spread Similar enough to the **orignial virus** to allow for some immunity in many individuals
58
What is **antigenic shift?**
Pandemics Genomic alterations with **MAJOR** resulting changes to protein structure **Naive immunity** for almost all people \*\*\*Remember = Shift is close to "shit". Antigenic shit. Antigenic shift is WAY worse than drift.
59
What are the bacterial associations you should make with **neonates?**
Group B strep Gram negative bacilli Listeria
60
What viral and bacterial associations should you make with **children \>1month old?**
Viral = **RESPIRATORY SYNCYTIAL VIRUS**, parainfluenza virus, Influenza A&B, Adenovirus, Rhinovirus Bacterial = S.pneumoniae, H. influenzae, M. catarrhalis, S.aureus
61
What is the pathology?
Respiratory Syncytial Virus (RSV)
62
What are the symptoms of **respiratory syncytial virus?**
Rhinorrhea/cough Wheezing Dyspnea Tachypnea Cyanosis
63
Histologically, what is the difference b/w **bacterial** and **viral pneumonia?**
Bacterial usually stays in alveolar spaces Viral stays in the interstitum
64
What are the differences b/w **bacterial** and **viral pneumonia** in terms of clinical presentation?
65
What pathology is HIGHLY associated with TB?
Caseating granulomata
66
What is the pathology?
Histoplasma capsulatum
67
Where is **histoplasma capsulatum** endemic?
Midwest and caribbean
68
Histoplasma capsulatum has a characteristic...
Pumpkin seed morphology
69
What is it!?
Blastomyces dermatitides
70
What is this?
Coccidiodes immitis \*Remember: C**o**ccidio**o**des has a lot of "**O**"s in it. The Cocciodes immitis biopsy shows "O" shaped specimens
71
Where is coccidiodes immitis endemic?
Southwestern US and Mexico
72
What is this?
Pneumocystis jiroveci
73
What is **pneumocystis jiroveci** associated with?
AIDS
74
What is this?
Mycobacterium avium complex (MAC)
75
Who typically gets **mycobacterium avium complex?**
Immunocompromised or elderly
76
Why is it important to take a lung biopsy of a patient that you believe is undergoing transplant rejection?
Patient could have rejection, OR have an opportunistic infection Determining which is occuring will determine the course of action Tx for acute rejection = increase immunosuppression Tx for opportunistic infection = target the organism
77

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