Exam 2 Path

Question 1

Stages of lobar pneumonia

Answer 1

congestion
red hepatization
gray hepatization
resolution

Question 2

Common causes of exacerbation of COPD (bugs)

Answer 2

haemophilus influenza

moraxella catarrhalis

Question 3

Sputum in klebsiella pneumonia and reason why

Answer 3

gelatinous sputum

viscid capsular polysaccharide

Question 4

Findings with atypical pneumonia

Answer 4

ulcerative bronchitis

viral infection with necrosis of epithelium

Question 5

Complications of atypical pneumonia

Answer 5

Reye syndrome (virus + aspirin)
hepatic failure
noninflammatory encephalitis

Question 6

Chronic pneumonia findings

Answer 6

granulomatous inflammation

immunocompetent pts

Question 7

Findings with histoplasma

Answer 7

epithelioid granulomas
caseation necrosis with coalescence
tree bark appearance after tx

Question 8

Findings with blastomyces dermatitidis

Answer 8

upper lungs

supparative granulomas

Question 9

FIndings with coccidioidis immitis

Answer 9

erythema nodosum/erythema multiforme
spherules
macrophages/giant cells with endospores

Question 10

Pulmonary diseases with HIV

Answer 10

below CD4 of 200- pneumocystic jirvocii

below CD4 of 50- CMV/MAC

Question 11

Characteristics of idiopathic pulmonary fibrosis

Answer 11

hyperplasia of type II pneumocytes
fibroblast proliferation
TGF-beta driven process
from repeated cycles of injury

Question 12

Tx of IPF

Answer 12

lung transplant

Question 13

Appearance of IPF

Answer 13

cobblestone pleural surface
lower lobe
fibrosis (blue is early, pink is late)

Question 14

Histo findings of IPF

Answer 14

smooth m. hyperplasia

squamous hyperplasia

Question 15

Cryptogenic organizing pneumonia

Answer 15

aka BOOP
polypoid plugs of CT (Masson bodies)
no interstitial fibrosis

Question 16

Anthracosis

Answer 16

coal macules/nodules
from pollution and carbon dust
asymptomatic
upper lungs

Question 17

Coal Worker’s Pneumoconioses

Answer 17

dilation of alveoli
over may years over 2cm black scars
adjacent to respiratory bronchioles
no increase in cancer risk

Question 18

Silicosis

Answer 18

foundries/sandblasters/stone cutters
decades of exposure
slow nodular fibrosis

Question 19

Silicosis pathogenesis

Answer 19

crystalline silicone cause macrophage mediator release

fibroblasts/TNF/IL/ROS/cytokines cause damage

Question 20

FIndings with silicosis

Answer 20

fine nodularity in upper lobes
progresses even with exposure removed
increased TB susceptibility
calcification of hilar LN’s

Question 21

Histo of silicosis

Answer 21

hyalinized collagen

polarized light with birefringent needle like spicules

Question 22

Types of abestos

Answer 22

serpentine- flexible, curly, soluble

amphiboles- straight, rigid, mesothelioma, more damaging

Question 23

Risk of abestosis

Answer 23

increased bronchogenic carcinoma and mesothelioma

Question 24

Pathogenesis of abestosis

Answer 24

macrophages ingest and release mediators

fibrosis distorts architecture (honeycombing)

Question 25

Findings with abestosis

Answer 25

lower lobes golden-brown, fusiform rods (coated with Fe) pleural plaques

Question 26

Caplan syndrome

Answer 26

``` Rheumatoid arthritis + pneumoconioses rheumatoid nodules (pallisading granulomatous inflammation) ```

Question 27

Sarcoidosis

Answer 27

noncaseating granulomas increased in females/blacks/Southeast immune disregulation

Question 28

Findings with sarcoidosis

Answer 28

``` hilar lymphadenopathy skin lesions uveitis phalangeal bone involvement lacrimal/salivary gland involvement ```

Question 29

Microscopic exam of sarcoidosis

Answer 29

noncaseating granulomas Schaumann bodies/Asteroid bodies granulomata of spleen and liver distribution along bronchi/lymphatics

Question 30

Hypersensitivity pneumonitis

Answer 30

``` removal of agent stops progression from prolonged exposure to organic dusts type III hypersensitivity (immune complexes) noncaseating granulomas (type IV HS) ```

Question 31

Simple pulmonary eosinophilia

Answer 31

Loeffler syndrome transient pulmonary lesions increased eosinophils in serum intrapulmonary densities on CT

Question 32

Tropical eosinophilia

Answer 32

infection of Wuchereria bancrofti only in tropical regions hypersenitivity reaction

Question 33

Desquamative interstitial pneumonia

Answer 33

assc with smoking 4th/5th decade dyspnea/dry cough

Question 34

Microscopy of DIP

Answer 34

intra-alveolar macrophage collections dusty brown pigment granular iron emphysema/thick septa

Question 35

Pulmonary alveolar proteinosis

Answer 35

asymmetric pulmonary opacifications accumulation of acellular surfactant anti-GM-CSF Ab in acquired causes

Question 36

Pulmonary alveolar proteinosis sx

Answer 36

abundant gelatinous sputum with cough increased risk of secondary infections increased wt/size of lungs granular precipitate in alveoli

Question 37

Genetics with lung carcinoma

Answer 37

p53-small and nonsmall cell lung ca cMYC/RB-small cell carcinoma p16/RAS-nonsmall cell carcinoma other genes-EGFR/HER-2neu

Question 38

Finding with squamous cell carcinoma of the lung

Answer 38

intracellular bridging keratinization hypercalcemia

Question 39

Adenocarcinoma characteristics

Answer 39

most common lung cancer peripheral location/pleural puckering no smoking assc signet ring lesions

Question 40

Bronchioloalveolar carcinoma findings

Answer 40

lepidic growth noninvasive/nondestructive pattern preserved architecture

Question 41

Small cell carcinoma characteristics

Answer 41

in central airways early metastasis/rapid growth assc with smoking paraneoplastic syndromes

Question 42

Findings with small cell carcinoma

Answer 42

salt and pepper chromatin round/oval cells extensive necrosis

Question 43

Large cell carcinoma characteristics

Answer 43

``` undifferentiated squamous or adenocarinomas aggressive peripheral lungs spherical tumor anaplastic cells ```

Question 44

Carcinoid tumors

Answer 44

``` function lesions secreting hormones (5HT) can be resected do not metastasize ```

Question 45

Hamartoma

Answer 45

normal tissue in an abnormal spot coin lesion on x-ray often hyaline/CT/bone

Question 46

Inflammatory myofibroblastic tumor

Answer 46

in children peripheral mass with calcium deposits anaplastic lymphoma kinase gene

Question 47

Metastatic tumors to the lung

Answer 47

most common type of lung cancer | cannonball lesions

Question 48

Solitary fibrous tumor

Answer 48

attached to pleura via pedicle Whorls of reticulin/collagen interspersed spindle cells confined to pleural surface

Question 49

Malignant mesothelioma

Answer 49

assc with abestos abestos bodies/plaques 20-50yrs after exposure low survival

Question 50

Other areas with mesothelioma

Answer 50

peritoneum pericardium tunica vaginalis genital tract

Question 51

Indication for bilateral lung transplant

Answer 51

cystic fibrosis bronchiectasis remove infectious reservoir

Question 52

Contraindication for lung transplant

Answer 52

maligancy

Question 53

Infections post lung transplant

Answer 53

first couple weeks-bacterial | 3-12mo post-candida/aspergillus