Chapter 15: The Lung - Restrictive through Diseases of Vascular Origin Flashcards
1
Q
What are the sign/sx’s of chronic interstitial pulmonary diseases?
A
- Dyspnea and Tachypnea
- End-respiratory crackles
- Cyanosis (late)
- NO wheezing
2
Q
What is characteristically seen on CXR of someone w/ chronic interstitial pulmonary diseases?
A
- Bilateral lesions that take form of small nodules, irregular lines, or
- Ground-glass shadows
3
Q
Grossly, what is the end-stage lung seen in chronic interstitial pulmonary diseases referred to as?
A
Honeycomb lung
4
Q
Which 2 chronic interstitial lung diseases are categorized as granulomatous?
A
- Sarcoidosis
- Hypersensitivity pneumonitis
5
Q
What are some of the enviornmental and occupational factors which may be associated with Idiopathic Pulmonary Fibrosis?
A
- Cigarette smoking
- Expsoure to metal fumes and wood dust
- Occupations such as: farming, hair-dressing, and stone-polishing
- GERD has also been implicated
6
Q
Loss-of-function mutations in which 2 genes has been implicated in Idiopathic Pulmonary Fibrosis?
A
- TERT
- TERC
*Encode components of telomerase
7
Q
Some cases of Idiopathic Pulmonary Fibrosis are associated with a genetic variant leading to ↑ secretion of which mucin?
A
MUC5B
8
Q
Idiopathic pulmonary fibrosis is a disease most common in which age group?
A
>50 yo
9
Q
The histologic pattern of fibrosis seen in Idiopathic Pulmonary Fibrosis is referred to as what; can be diagnosed based on its characteristic appearance via what imaging modality?
A
- Usual interstitial pneumonia (UIP)
- On CT
10
Q
Microscopically, what is the hallmark of Idiopathic Pulmonary Fibrosis; there is coexistence of what?
A
- Patchy interstitial fibrosis***, which varies in intensity and age
- Coexistence of early (fibroblastic foci) and late (collagenous) lesions
11
Q
In Idiopathic Pulmonary Fibrosis the formation of cystic spaces lined by hyperplastic type II pneumocytes or bronchiolar epithelium is known as what?
A
Honeycomb fibrosis
12
Q
The earliest lesions in Idiopathic Pulmonary Fibrosis contain exuberant what?
A
Fibroblastic proliferation (fibroblastic foci)
13
Q
Diagnosis of Idiopathic Pulmonary Fibrosis requires what?
A
Classic findings on high-resolution CT or pulmonary biopsy
14
Q
What are the initial sx’s of Idiopathic Pulmonary Fibrosis and the later sx’s with progression?
A
- Early —> ↑ dyspnea on exertion and dry cough
- Later –> hypoxemia, cyanosis and clubbing
15
Q
What is the prognosis and only definitive therapy for Idiopathic Pulmonary Fibrosis?
A
- Median survival = 3 years after Dx
- Lung transplantation
16
Q
Why is it important to recognize pt’s with Nonspecific Interstitial Pneumonia?
A
Have much better prognosis than those w/ UIP
17
Q
What is the morphology of both the cellular and fibrosing patterns of Nonspecific Interstitial Pneumonia?
A
- Cellular = mild to moderate chronic interstitial inflammation; in UNIFORM or patchy distribution
- Fibrosing = diffuse or patchy fibrotic lesions of roughly the SAME age
18
Q
What is a major morphological difference between the lesions of Nonspecific Interstitial Pneumonia and Idiopathic Pulmonary Fibrosis?
A
In NSIP the lesions are at roughly SAME stage of development
19
Q
What 4 morphologial findings are absent in Nonspecific Interstitial Pneumonia?
A
- NO fibroblastic foci
- NO honeycombing
- NO hyaline membranes
- NO granulomas
20
Q
Which population is most likely to be affected by Nonspecific Interstitial Pneumonia?
A
Female NON-smokers in their 6th decade of life
21
Q
What are the key features of Nonspecific Interstitial Pneumonia seen on high-resolution CT?
A
Bilateral, SYMMETRIC, predominantly lower lobe reticular opacities
22
Q
How do patients with Cryprogenic Organizing Pneumonia present and what is seen radiographically?
A
- Cough and dyspnea
- Patchy SUBpleural or peribronchial areas of airspace consolidation
23
Q
What is the hallmark histology seen with Cryprogenic Organizing Pneumonia?
A
- Polypoid plugs of loose organizing CT (Masson bodies) within alveolar ducts, alveoli, and often bronchioles
- “Balls of Fibroblasts”
24
Q
Prognosis and Tx of Cryprogenic Organizing Pneumonia?
A
- Some recover spontaneously
- Most need oral steroids x 6 months + for complete recovery
25
Cryprogenic Organizing Pneumonia is most often caused by what?
As a **response** to **infection** or **inflammatory injury** to the lungs
26
Which 3 autoimmune/CT disease can manifest as interstital lung disease?
- Rheumatoid arthritis
- Systmic sclerosis (scleroderma)
- SLE
27
Inhalation of particles, pneumoconiosis, stimulate what inside the lung which lead to progression of disease?
**Resident INNATE** immune cells
28
Inhalation of coal dust may be a part of what 4 diseases?
- **Anthracosis**
- Coal **macules/nodules**
- **Progressive massive fibrosis --\> "Black lung"**
- **Caplan syndrome**
29
What occurs to the inhaled carbon pigment from coal, leading to Anthracosis?
Engulfed by alveolar or interstitial **macrophages**, which then accumulate in the CT along lymphatics in lungs or in hilus
30
Where are lesions (macules and nodules) of simple coal workers' pneumoconiosis most often seen in the lungs?
**Upper lobes** and **upper zones** of lower lobes
31
Indoor use of **smoky coal (bituminous)** for cooking and heating is associated with what complication?↑
↑ risk of **lung cancer**
32
What is the **most prevalent** occupational disease worldwide?
Silicosis
33
Which race has a higher risk for Silicosis?
African American
34
Which form of silica (crystalline/amorphous) is the most **fibrogenic**?
Crystalline (i.e., quartz, cristobalite, and tridymite)
35
What occurs after inhalation of silica particles; what is activated and what is released?
- Particles **phagocytosed** by **macrophages**
- **Activate** the **inflammasome**
- Leads to release of inflammtory mediators, **IL-1** and **IL-18**
36
Where in the lungs and in which LN's are the nodules of silicosis seen?
- **Hilar LN's**
- **Upper zones** of lungs
37
Histologically, what is the **hallmark** lesion seen with silicosis?
**Central** area of **WHORLED COLLAGEN** fibers w/ a **peripheral** zone of dust-laden **macrophages**
38
Thin sheets of calcification may occur in the LN's of pt with silicosis and are seen radiographically as what?
**Eggshell calcification**
39
Silicosis is associated with an increased susceptibility to what infection; why?
**TB**; impaired ability of pulm. macrophages to kill phagocytosed mycobacteria
40
The onset of Silicosis may occur in what 3 ways (classification/duration)?
- **Slow and insidious** = 10-30 yrs after exposure
- **Accelerated** = within 10 yrs
- **Rapid** = week to months after intense exposure to fine dust high in silica
41
Pt's with Silicosis have double the risk for developing?
Lung cancer
42
Which asbestos fiber (serpentine or amphibole) is the **most** dangerous and pathogenic?
**Amphibole** = more aerodynamic and **less soluble**
43
Which property of asbestos fibers accounts for the remarkable synergy btw tobacco smoking and development of lung carcinoma in asbestos workers?
Toxic chemicals ca be **adsorbed** onto the fibers
44
Asbestosis is marked by diffuse pulmonary interstital fibrosis, indistinguishable from other causes, except for the presence of?
**Asbestos bodies** --\> **Golden-brown**, **fusiform** or **beaded rods**
45
In asbestosis, inorganic particulates may become coated with **iron-protein** complexes and are called what?
**Ferruginous bodies**
46
Most common manifestation of asbestos exposure seen on the anterior and posterolateral aspects of the **parietal pleura** and over the dome of the diaphragm?
Known as?
- **Well-circumscribed plaques** of dense **collagen**, often **calcified**
- **"Candlewax drippings**"
47
In contrast to other types of pneumoconiosis, where is the lungs does asbestosis typically begin?
**Lower lobes** and **subpleurally**
48
Which cytotoxic drug used in cancer therapy may lead to pulmonary damage and fibrosis?
Bleomycin
49
What is the most common clinical pattern/organs of involvement seen with Sarcoidosis?
- **Bilateral HILAR lymphadenopathy** and **Lung** involvement
- **Eye** and **skin** lesions are 2nd in frequency
50
What is the CD4/CD8 T-cell like in pt's with Sarcoidosis?
- **CD4/CD8 T-cell ratios** range from **5:1** to **15:1**
- Suggests **pathogenic** involvement of **CD4+ helper T cells**
51
Which cytokine found in the bronchoalveolar fluid of pt with Sarcoidosis is a marker of disease activity?
TNF
52
Pt's with Sarcoidosis have abnormal immune responses including **anergy** to what?
Common **skin test** Ags such as *Candida* or tuberculosis PPD
53
Which 2 HLA genotypes are associated with Sarcoidosis?
- **HLA-A1**
- **HLA-B8**
54
What is the characterisic finding in the tissues of pt with Sarcoidosis?
**Non-caseating (Non-necrotizing) granulomas** composed of clustered **epitheloid macrophages**, often w/ **giant cells**
55
What are 2 characteristic morphological findings within giant cells of pt with Sarcoidosis?
- Laminated concentrations of Ca2+ and proteins = **Schaumann bodies**
- **Stellate** inclusions known as **asteroid bodies**
56
Why is there a high diagnostic yield of bronchoscopic biopsies for Sarcoidosis?
Relatively **high frequency** of granulomas in the **bronchial submucosa**
57
Which LN's are most frequently affected by Sarcoidosis?
**Hilar** and **mediastinal**
58
Which 3 sites other than lungs and LN's are also commonly affected by Sarcoidosis and what is seen in each?
- **Spleen** - may be enlarged; granulomas often form **small nodules**
- **Liver** - may be enlarged; scattered granulomas often in **portal triad**
- **Bone marrow** - lesions w/ tendency for phalangal bones of hands and feet; small areas of bone resorption within marrow cavity w/ widening of the bony shafts
59
What 3 types of skin lesions may be encountered in Sarcoidosis?
- **Subcutaneous nodules**
- **Erythema nodosum**
- Flat, slightly red and scaling, resembling those of **SLE**
60
Scattered granulomas associated with Sarcoidosis may be found in the liver, most often where?
**Portal triads**
61
What is the ocular involvement in some cases of Sarcoidosis?
- **Iritis** or **uveitis**, either **uni-** or **bilaterally**
- **Corneal opacities, glaucoma**, and **total vision loss** may occur
- Often accompanied by **inflammation** of the **lacrimal** glands w/ **suppression** of **lacrimation**
62
Bilateral sarcoidosis of the parotid, submaxillary, and sublingual glands constitutes a combined uveoparotid involvement designated as what?
**Mikulicz syndrome**
63
Muscle involvement in Sarcoidosis may be asymptomatic, but weakness, tenderness, aches, and fatigue should prompt consideration of what?
Occult Sarcoid Myositis
64
Majority of pt's with Sarcoidosis will present due to what signs/sx's?
- Insidious onset of **respiratory abnormalities** (i.e., SOB, cough, chest pain, hemoptysis)
- Constitutional sx's --\> **fever, fatigue, weight loss, night sweats**
65
Elevated serum levels of what enzyme and ion may be seen in Sarcoidosis?
- **↑↑↑ ACE**
- ↑ 1ᾳ-hydroxylase --\> **hyper**calcemia
66
What is the prognosis of Sarcoidosis; how does death most often occur?
- 60-70% **recover** w/ minimal or no residual manifestations
- 20% have permanent loss of lung function or vision
- 10-15% die of **cardiac** or **CNS damage**
67
Hypersensitivity pneumonitis primarily involves what structures in the lungs in constrast to asthma?
- **Alveolar walls; granulomatous rxn** to inhaled Ags
- Asthma = **conducting airways**
68
Why is history so important in the diagnosis of Hypersensitivity Pneumonitis?
- Disorders such as ***Pigeon breeder's lung*** and ***Humidifier*** or ***air-conditioner lung*** are in this class
- Pet birds and moldy basements are **easily missed** unless asked about specifically
69
Presence of noncaseating granulomas in 2/3's of pt's with hypersensitivity pneumonitis suggests what type of hypersensitivity rxn?
**T-cell** mediated (**type IV**)
70
Farmers lung is due to exposure to dusts generated from humid, warm, newly harvested hay that permits rapid proliferation of which spores?
**Thermophilic actinomycetes**
71
The histologic changes of hypersensitivity pneumonitis are characteristically centered around which lung structures?
Bronchioles
72
What are 3 histomorphological changes seen with hypersensitivity pneumonitis?
1. **Interstitial** pneumonitis w/ **lymphocytes**, **plasma cells**, and **macrophages**
2. **Noncaseating granulomas**
3. **Interstital fibrosis** w/ **fibroblastic foci**, **honeycombing**, and **obliterative bronchiolitis** (late stages)
73
How soon after exposure to antigenic dust do sx's of hypersensitivity pneumonitis appear; last how long; what are the sign's/sx's?
- Appear **4-6 hours** after exposure; lasting **12 hours** to **days**
- Sx's = **recurring fever, dyspnea, cough,** and **leukocytosis**
74
What is seen on CXR of pt with hypersensitivity pneumonitis and what will PFT's show?
- **CXR** = micronodular interstitial infiltrates
- **PFT's** = acute **restrictive disorder**
75
Why is it important to recognize the diseases of hypersensitivity pneumonitis as far as prognosis goes?
- If unresolved ---\> **chronic fibrotic lung disease**, respiratory failure w/ **dyspnea** and **cyanosis** and a ↓ TLC and compliance
- If exposure **removed** = sx's and disease **resolve**
76
What is the most striking morphological finding in Desquamative Interstitial Pneumonia?
Large # of **macrophages** w/ **abundant cytoplasm** containing **dusty brown pigment** (**smoker's macrophages**) in the airspaces
77
Some of the macrophages in desquamative interstitial pneumonia contain lamellar bodies which are what?
**Vacuoles** of **surfactant** from **necrotic type II pneumocytes**
78
What is the morphology of the alveolar septa in desquamative interstitial pneumonia and they are lined by what?
**Thickened** septa lined by **plump, cuboidal pneumocytes**
79
Desquamative interstitial pneumonia most often presents in which age group associated w/ what risk factor; what are the sign's/sx's?
- **Men** or **women** in the **4th** or **5th decade**; virtually all of whom **smoke**
- Insidious onset of **dyspnea** + **dry cough** over **weeks to months**, often with **clubbing** of digits = **restrictive lung disease** presentation
80
Patients with desquamative interstitial pneumonia often have an excellent response to what; what is the prognosis like?
- **Steroids** and **cessation of smoking**
- **Excellent prognosis**
81
Respiratory bronchiolitis-interstitial lung disease is part of a spectrum with desquamative interstitial pneumonia, except when does it present and what are the sx's like?
- **Earlier presentation** (3rd-4th decades)
- **Less symptomatic**; still has restrictive pattern w/ similar sx's
82
Hallmark of respiratory bronchiolitis-interstitial lung disease is presence of pigmented intraluminal macrophages where?
**First-** and **second-order respiratory bronchioles**
83
Patchy submucosal and peribronchiolar infiltrate of lymphocytes and histiocytes in a smoker is characteristic of what disease?
Respiratory bronchiolitis-interstitial lung disease
84
Pulmonary Langerhans Cell Histiocytosis is most commonly seen in whom?
**Young smokers**; who improve after **smoking cessation**
85
Imaging of the chest in pt w/ Pulmonary Langerhans Cell Histiocytosis will show what?
**Cystic** and **nodular** abnormalities
86
Peripheral cysts of Pulmonary Langerhans Cell Histiocytosis may rupture and cause what?
Pneumothorax
87
The langerhans cells of Pulmonary Langerhans Cell Histiocytosis will stain positive for what and negative for?
- **Positive** for **S100**, **CD1a** and **CD207** (**langerin**)
- **Negative** for **CD68**
88
In some cases of Pulmonary Langerhans Cell Histiocytosis, the Langerhans cells show neoplastic change due to activating mutation in what?
Serine/threonine kinase **BRAF**
89
Major histology and cell types of Pulmonary Langerhans Cell Histiocytosis?
- **Eosinophils**
- **Langerhans cells** (immature dendritic cells)
- Varying **fibrosis** and **cysts**
90
Pulmonary Alveolar Proteinosis (PAP) is a rare disorder related to which defects?
- Defects in **granulocyte-macrophage CSF** (**GM-CSF**)
or
- **Pulmonary macrophage dysfunction** = **accumulation** of **surfactant** in the **intra-alveolar** and **bronchiolar spaces**
91
Pulmonary Alveolar Proteinosis (PAP) is characterized by what radiologic findings?
**Bilateral** PATCHY **asymmetric** pulmonary **opacifications**
92
Autoimmune Pulmonary Alveolar Proteinosis (PAP) occurs primarily in whom and is due to antibodies against what?
- **Primarily** adults; represents **90%** of PAP cases
- Antibodies against **GM-CSF**
93
Loss of GM-CSF signaling seen in Pulmonary Alveolar Proteinosis (PAP) causes what?
Blocks terminal differentiation of alveolar macrophages **impairing** their ability to **catabolize surfactant**
94
Pulmonary Alveolar Proteinosis (PAP) can be treated how if autoimmune vs. secondary?
- **Autoimmune** = SQ injections of **GM-CSF**
- **Secondary** = Tx the underlying disorder
95
Secondary Pulmonary Alveolar Proteinosis (PAP) is uncommon and associated with what other disorders?
- Hematopoietic disorders
- Malignancies
- Immunodeficiency disorders
- Lysinuric protein intolerance (inborn error of metabolism)
- Acute silicosis
96
Hereditary Pulmonary Alveolar Proteinosis (PAP) is extremely rare and occurs in whom?
**Neonates**
97
Pulmonary Alveolar Proteinosis (PAP) is characterized by what morphological changes within the alveoli?
- Homogenous, granular precipitate containing **surfactant** proteins
- Causing **focal-to-confluent consolidation** of large areas of the lungs w/ **minimal inflammation**
98
What is found in the alveolar precipitate of Pulmonary Alveolar Proteinosis (PAP) and what does it stain positive for?
- **Cholesterol clefts** and **surfactant proteins**
- Stains **(+)** for **PAS**
99
What is the standard of care and provides underlying benefit for pt's with Pulmonary Alveolar Proteinosis (PAP) regardless of cause?
**Whole-lung lavage**
100
How do adult pt's with Pulmonary Alveolar Proteinosis (PAP) present (signs/sx's)?
**Cough** + **andundant sputum** w/ chunks of **gelatinous material**
101
What is the most frequently mutated gene in surfactant disorders and via what inheritance pattern?
**Autosomal recessive** disorder assoc. w/ ***ABCA3***
102
Small lamellar bodies with electron dense cores are diagnostic for which mutation causing a surfactant dysfunction disorder?
***ABCA3* mutation**
103
Fractures of which bone cause a particularly high risk for PE?
Hip fractures
104
What are some primary and secondary hypercoagulable states that are risk factors for PE?
- **Primary** = factor V Leiden, prothrombin mutations, and antiphospholipid syndrome
- **Secondary** = obesity, recent surgery, cancer, OC use, and pregnancy
105
Which type of emboli are often seen in pt's who die after chest compressions performed during CPR?
Small **bone marrow** emboli
106
Indwelling central venous lines can act as a nidus for formation of what type of thrombi, with what complication?
**Right atrial thrombi**, which can **embolize** to **lungs**
107
PE have what 2 deleterious pathophysiologic consequences?
- **Respiratory compromise** due to the non-perfused, although ventilated, segment
- **Hemodynamic compromise** due to ↑ resistance to pulmonary blood flow caused by the embolic obstruction
108
In pt's w/ adequate CV function, which arterial supply sustains the lung parenchyma following PE; what is seen (hemorrhage/infarction)?
- **Bronchial** arterial supply
- **Hemorrhage** may occur WITHOUT **infarction**
109
Majority of infarcts associated w/ PE affect which lobes and occur as (single/multiple) lesions?
- **Lower lobes**
- **Multiple** lesions
110
How can a PE be distinguished from a postmortem clot?
Presence of the **lines of Zahn** in the thrombus
111
Infarction associated with PE is most often seen in whom?
Pt's w/ inadequate CV function
112
How does pulmonary infarction appear morphologically in the early stages and what is seen on the apposed pleural surface?
- **Hemorrhagic** as **raised**, **red-blue** area
- Pleural surface covered by **fibrinous exudate**
113
What occurs 48 hours after pulmonary infarct and what are the morphological changes as time progresses?
- Red cells begin to **lyse** --\> infarct becomes **paler** and eventually **red-brown** as **hemosiderin** is produced
- Over time, **fibrous replacement** begins at margins as a **gray-white peripheral zone** ---\> **contracted scar**
114
If a pulmonary infarct is caused by an infected embolus, there may be intense neutrophilic inflammatory rxn, and these lesions are knowna as what?
**Septic infarcts**
115
What is electromechanical dissociation in regards to the clinical presentation of a large pulmonary embolus?
**ECG has a rhythm**, but **no** **pulses are palpated** due to no blood entering pulmonary aterial circulation
116
If pt survives after a sizable pulmonary embolus the clinical syndrome may mimic what other condition, with what associated signs/sx's?
- May mimic **MI**
- Severe chest pain + dyspnea + shock
117
What are the associated signs/sx's of a pulmonary infarct?
- Dyspnea
- **Tachypnea**
- Fever
- Chest pain
- Cough + **hemoptysis**
118
Fibrinous pleuritis associated with pulmonary infarcts may produce what PE finding?
Pleural friction rub
119
How soon can pulmonary infarct be seen on CXR and what is seen?
- **12-36 hours**
- **Wedge-shaped** infiltrate
120
Via which imaging modality is the diagosis of PE usually made?
**Spiral CT angiography**
121
What are complications which may develop due to small pulmonary which are unresolved; greater risk for developing what?
- **Pulmonary HTN**
- Chronic **cor pulmonale**
- Pt's have 30% chance of suffering **2nd** embolus
122
Talc embolisms are common in whom?
IV drug users
123
Pulmonary HTN is defined as mean pulmonary artery pressure ≥\_\_\_\_\_\_mmHg at rest
**≥25 mmHg** at rest
124
What are the 5 classification of pulmonary HTN as classified by the WHO?
1. **Pulmonary arterial HTN** - primarily vascular disease
2. **2'** to **left-heart failure**
3. **2'** to **chronic pulmonary parenchymal** disease or **hypoxemia**
4. **2'** to **thromboembolic pulmonary HTN**
5. **Multifactorial**
125
List 5 common causes of pulmonary HTN
1. **Chronic obstructive** or **interstitial lung disease** (**group 3**)
2. **Congenital** or **acquired** heart disease (**group 2**)
3. **Recurrent thromboemboli** (**group 4**)
4. **Autoimmune disease** (**group 1**)
5. **Obstructive sleep apnea** (also **group 3**)
126
Idiopathic pulmonary HTN has what type of inheritance pattern?
**Autosomal Dominant** w/ **incomplete penetrance**
127
Inactivating germline mutations in which gene has been implicated in familial pulmonary HTN?
**BMPR2 gene**
128
Haploinsufficiency for BMPR2 leads to what pathologic changes causing pulmonary vascular thickening and occlusion?
**Proliferation** of **endothelial** cells AND **vascular smooth m.** cells
129
What are the hallmark morphological changes of pulmonary muscular and elastic arteries and right ventricle seen with all forms of pulmonary HTN (list 3)?
- **MEDIAL** **hypertrophy** of the **pulmonary** and **elastic arteries**
- **Pulmonary arterial ATHEROSCLEROSIS**
- **RV hypertrophy**
130
Which vessels are most prominently affected by pulmonary HTN and what's seen morphologically?
**Arterioles** and **small arteries** = **striking MEDIAL** hypertrophy and **INTIMAL** fibrosis
131
What type of lesions are **small**, vascular channels (**tufts of capillary**) that may be seen with **severe**, long standing pulmonary HTN?
**Plexiform** lesions
132
Idiopathic pulmonary HTN is most commonly seen in whom?
- **Women** who are **20-40 yo**
- Occasionally **young children**
133
What is the usual cause of death that ensues within 2-5 years of symptomatic idiopathic pulmonary HTN?
**Decompensated** cor pulmonale often w/ **superimposed thromboembolism** and **pneumonia**
134
In Goodpasture Syndrome autoantibodies destroy the glomerular BM in renal glomeruli and pulmonary alveoli giving rise to what disease in each system?
- **Rapidly progressive glomerulonephritis (RPGN)**
- **Necrotizing hemorrhagic interstitial pneumonitis**
135
Which sex and age group is most often affected by Goodpasture Syndrome?
**Males** in the **teens** or **20's**; majority are **active smokers**
136
Which 2 HLA subtypes are associated with Goopasture Syndrome?
**HLA-DRB1\*1501** and **\*1502**
137
What is the histology of the damage to alveolar walls in Goodpasture Syndrome?
**Focal necrosis** w/ **hemosiderin-laden macrophages**
138
What is the most common cause of death in pt with Goodpasture Syndrome?
Uremia
139
Most cases of Idiopathic Pulmonary Hemosiderosis occur in whom and how does it present?
- Most often **young children**; but some cases in **adults**
- Insidious onset of **productive cough, hemoptysis**, and **anemia** assoc. w/ diffuse pulmonary infiltrations
140
Tx for Idiopathic Pulmonary Hemosiderosis?
**Long-term** immunosuppression w/ **prednison** or **azathioprine**
141
What are the diagnostically important features of Polyangiitis w/ Granulomatosis (Wegener), especially in contrast to Sarcoidosis?
- **Capillaritis** and **scattered**, **POORLY** formed **granulomas**
- Granulomas of **sarcoidosis** are **rounded** and **well-defined**
142
Which biopsy technique may provide the only tissue necessary for diagnosis of Polyangiitis w/ Granulomatosis (Wegener)?
**Transbronchial** biopsy
