Pathoma - Respiratory Pathology

Question 1

allergic rhinitis

Answer 1

type I hypersensitivity reaction
inflammatory infiltrate with eosinophil
associated with asthma and eczema

Question 2

consequence of allergic rhinitis

Answer 2

• nasal polyps occur in response to repeated bouts of rhinitis.

polyp is edematous inflamed nasal mucosa

Question 3

child with nasal polyps consider…

Answer 3

cystic fibrosis

Question 4

aspirin intolerant asthma

Answer 4

nasal polyps
aspirin induced bronchospasm
asthma

– triad, seen in 10 percent of asthamtic adults

Question 5

angiofibroma
pathology
presentation
epidemiology

Answer 5

benign tumor of the nasal mucosa, consists of large vessels and fibrous tissue.
seen in adolescent males
presents with profuse epistaxis

Question 6

Nasopharyngeal carcinoma

• associated virus
• epidemiology
• histology

Answer 6

• malignant tumor of nasopharyngeal epithelium
• associated with EBV.
• classically seen in african children and asian young adults.
• will often present with involvement of the cervical lymph nodes. biopsy will show pleomorphic epithelial cells in the background of lymphocytes.
• -> stain for keratin to determine presence of epithelial cells.

Question 7

Acute epiglottitis

- most common cause

Answer 7

H. Flu type B

Question 8

Acute epiglottitis - presentation

Answer 8

high fever 
sore throat 
drooling 
dysphagia 
muffled voice 
inspiratory stridor

Question 9

Laryngotracheobronchitis - AKA

Answer 9

Croup

Question 10

Laryngotracheobronchitis - most common cause

Answer 10

para influenza virus
hoarse barking cough
inspiratory stridor

Question 11

vocal cord nodules due to…

Answer 11

excessive use

myxoid degeneration of connective tissue

Question 12

laryngeal papilloma

• associated virus
• presentation adult vs child

Answer 12

due to HPV 6 and 11
- benign tumor.

presents usually as single lesion in adult but multiple lesions in child.

Question 13

laryngeal carcinoma

• origin
• presentation
• risk factors

Answer 13

squamous cell carcinoma arising from lining of vocal cord.

• presents with hoarseness, sometimes cough and stridor.
• risk factors are alcohol and tobacco use

Question 14

pneumonia physical exam -
breath sounds?
percussion?

Answer 14

decreased breath sounds

dullness to percussion

Question 15

Chemical mediators of pleuritic chest pain in pneumonia

Answer 15

bradykinin

prostaglandin E2

Question 16

Reid index

Answer 16

thickness of mucus glands relative to bronchial wall thickness. > 50 percent Reid index in chronic bronchitis, < 40 percent is normal.

Question 17

PiZ mutation

Answer 17

most common clinically relevant mutation of alpha-1- antitrypsin deficiency. results in significantly low levels of circulating A1AT.

Question 18

PiMZ mutation

Answer 18

heterozygotes, usually asymptomatic. decreased circulating levels of A1AT. BUT there is a significant risk of emphysema with smoking.

Question 19

Pathophysiology of A1AT

Answer 19

accumulation of misfolded, mutated AIAT protein in ENDOPLASMIC RETICULUM of hapatocytes. stains pink, PAS +.

Question 20

PiZZ

Answer 20

significant risk for panacinar emphysema and cirrhosis. Homozygous for mutant protein.

Question 21

FRC in emphysema

Answer 21

• FRC is increased as recoil of the lung is lost. Increased AP diameter.

Question 22

Pathogenesis of asthma

Answer 22

In genetically susceptible individuals, Th2 cells are activated and release
IL-4 - induces class switching of plasma cell to IgE
IL-5 - recruits eosinophils
Il-10 - ability to inhibit the production of Th1 helper T-cells, and stimulates Th2 (promotes this overall reaction)

• upon rexposure to the allergen there is cross linking of mast cell (IgE) stimulating dumping of preformed histamine granules. This leads to histamine induced vasodilation and histamine induced vascular permeability. This is the early phase.

The second phase by which inflammation is perpetuated is by leukotriene C4, D4, E4 (arachdonic acid metabolite). This causes vasoconstriction, increased vascular permeability by constricting pericytes, and broncho constriction by constricting smooth muscle of the bronchus. –> take away point is that there is bronchoconstriction.

Question 23

Charcot-Leyden crystals

Answer 23

• derived from eosinophils. can be seen in microscopy of the sputum.

Question 24

Patients at risk for bronchiectasis

Answer 24

cystic fibrosis 
kartagener syndrome 
tumor or foreign body
necrotizing infection 
allergic bronchopulmonary aspergillosis

Question 25

bronchiectasis

Answer 25

• permanent dilation of the bronchioles and the bronchi. Due to necrotizing inflammation with damage to airway walls. As a result loss of airway tone results in air trapping.

Question 26

Pathophysiology of idiopathic pulmonary fibrosis

Answer 26

TGF-beta released from cyclical injury of pneumocytes that induces fibrosis.

interstitial pulmonary fibrosis can be caused by medications (classically bleomycin or amiodarone) or radiation. rule these out as causes first.

• but we dont know what causes the cyclical damage, idiopathic.

Question 27

pneumoconioses

Answer 27

interstitial fibrosis due to occupational exposure to small particles that are fibrogenic.

• induced by macrophage engulfing a very small particle.

Question 28

pneumoconioses examples

Answer 28

• Coal workers pneumoconiosis from carbon dust
• silicosis seen in sand blasters and silica miners. –> fibrotic nodules in the upper lobe of the lung. resides in macrophages preventing phagolysosome formation. increases risk for TB.
• asbestosis from asbestos fibers seen in construction workers, plumbers, and shipyard workers. Increased risk of lung cancer. Pts with mesothelioma are more likely to get lung cancer than mesothelioma.
• -> look for asbestos bodies long brown rods in the sample.
• berylliosis beryllium seen in beryllium miners and workers in the aerospace industry –> forms non-caseating granulomas of the lung, hilar lymph nodes and other organs (do not confuse with sarcoidosis).

Question 29

Sarcoidosis pathophysiology

Answer 29

Non-caseating granulomas of multiple organs.

- grnaulomas most commonly involve the hilar lymph node and the lung leading to restricitve lung disease.

Question 30

Sarcoidosis other organs involved

Answer 30

• uvea (uveitis)
• skin (erythema nodosum)
• salivary and lacrimal glands mimicking sjogrens syndrome

Question 31

Sarcoidosis clinical features

Answer 31

• dyspnea or cough
• elevated serum ACE
• hypercalcemia (1-alpha hydroxylase activity of the epithelioid histiocytes converts Vitamin D to its active form)

Question 32

Hypersensitivity pneumonitis

Answer 32

pigeon breeders lung

• presents with fever, cough, dyspnea hours after the exposure.
• -> will see eosinophils since this is a hypersensitivity reaction.
• symptoms resolve when the antigen is removed
• with chronic exposure can get interstitial fibrosis leading to restrictive pattern.

Question 33

Primary pulmonary hypertension

Answer 33

• etiology is unknown mostly
• SOME FAMILIAL forms are related to a mutations of BMPR2 leading to proliferation of vascular smooth muscle and pulmonary hypertension.

Question 34

Plexiform lesions

Answer 34

are seen with severe long standing pulmonary hypertension. They are bundles of capillaries.

Question 35

ARDS Pathophysiology

Answer 35

damage to alveolar capillary interface leads to leakage of protein and formation of hyaline membrane around the air sac.

• -> thickened diffusion barrier
• -> increased surface tension of alveolar air sac leading to collapse of the lung.
• recovery can be complicated by interstitial fibrosis due to loss of type pneumocytes (the stem cell of the alveoli).

Question 36

Cancers of the lung chart on page 96

Answer 36

see page 96 pathoma