First Aid Pathology

Question 1

What is the most common cause of rhinitis (common cold)?

Answer 1

Rhinovirus

Question 2

What bugs most commonly superimpose on viral URI?

Answer 2

S. pneumo H. influenzae M. catarrhalis

Question 3

Allergic rhinitis is what type of hypersensitivity? What is it characterized by?

Answer 3

Type 1 hypersensitivity

Inflammatory infiltrate w/ eosinophils

Question 4

What is the Virchow triad for deep venous thrombosis?

Answer 4

1. Stasis
2. Hypercoagulability
3. Endothelial damage

Question 5

Where do most pulmonary emboli arise from?

Answer 5

Deep leg veins

Question 6

Repeated bouts of rhinitis can cause what?

Answer 6

Nasal polyp

Question 7

Nasal polyps in children….

Nasal polyps in adults….

Answer 7

Children = CF

Adults = Aspirin-intolerant asthma

Question 8

Aspirin-intolerant asthma

Answer 8

Asthma, aspirin-induced bronchospasm, nasal polyp

Question 9

Who are angiofibromas (nasal mucosa) commonly seen in? How does it present?

Answer 9

Adolescent males

Profuse epistaxis

Question 10

Nasopharyngeal carcinoma is a malignant tumor of the nasopharyngeal epithelim - what is it associated with? What will a biopsy show?

Answer 10

EBV - African Children and Chinese Adults

1. Pleomorphic, keratin⊕ epithelial cells -poorly diff SCC
2. In background of lymphocytes

Cervical LN involvement

Question 11

What bug causes acute epiglottitis? What are the symptoms?

Answer 11

H. influenzae type B

High fever, sore throat, drooling w/ dysphagia, muffled voice, stridor

**risk of airway obstruction**

Question 12

What bug causes croup?

Answer 12

Parainfluenza virus

Hoarse, barking cough, stridor

Question 13

Vocal cord nodule that arises due to excessive use occurs where and is composed of what?

Answer 13

True vocal cords

Myxoid (degenerative) CT

Question 14

What bug causes laryngeal papilloma?

Answer 14

HPV 6 & 11

Single in adults, multiple in children

Question 15

What are risk factors for ** laryngeal carcinoma (SCC)**? How does it present

Answer 15

Alcohol and tobacco - rarely from papilloma (6 & 11)

Hoarsenss, cough, stridor

Question 16

What are fat emboli associated with?

Answer 16

Long bone fractures and liposuction

Question 17

Wht is the classic triad of presenting symptoms w/ a Fat Emboli?

Answer 17

1. Hypoxemia
2. Neurologic abnormalities
3. Petechial rash

Question 18

What can an amniotic fluid emobli lead to?

Answer 18

DIC - postpartum

Question 19

How do you treat gas emboli in a diver?

Answer 19

Hyperbaric oxygen

Question 20

What is the test of choice to look for a PE?

Answer 20

CT

Question 21

V/Q mismatch → hypoxemia → ________________

Answer 21

Respiratory alkalosis

Question 22

Lines of Zahn are only found in thrombi formed ________ death.

Answer 22

Before

Question 23

How might this present?

Answer 23

Sudden onset dyspnea, chest pain, tachypnea

Question 24

What are the 4 types of obstructive lung disease - what is the hallmark finding?

Answer 24

↓ FEV₁/FVC

1. Chronic bronchitis
2. Emphysema
3. Asthma
4. Bronchiectasis

Question 25

What disease do these symptoms belong to: "A productive cough for \> 3 months/year, for \> 2 years" What other findings might there be?

Answer 25

**Chronic Bronchitis** Wheezing, crackles, cyanosis (shunting), late-onset dyspnea, CO₂ retention

Question 26

What causes the productive cough in chronic bronchitis?

Answer 26

Hyperplasia of mucus glands in the bronchi Reid index \>50%

Question 27

What is the most common cause of emphysema?

Answer 27

Smoking

Question 28

What is the main defense at the bottom of the lung (i.e. alveolar air sacs)?

Answer 28

**Alveolar Mφ** - release proteases \*\*_α1-antitrypsin_ breaks down proteases\*\*

Question 29

What are the two causes of emphysema?

Answer 29

**Smoking**: ↑ inflammation, ↑Mφ, ↑proteases **α1-antitrypsin deficiency**: can't deal w/ normal amounts of proteases

Question 30

What type of emphysema does smoking result in? A1AT deficiency?

Answer 30

Centriacinar - upper lobes Panacinar - lower lobes

Question 31

Which type of emphysema also leads to liver cirrhosis? What would a liver biopsy show?

Answer 31

A1AT deficiency is due to a **misfolding** of mutated protein mt. A1AT accumalates in the **ER** of hepatocytes → liver damage BX: pink, PAS-⊕ globules in hepatocytes

Question 32

What is the most common clinically relevant mutation causing emphysema?

Answer 32

**PiZ** PiZZ - ↑↑ risk of panacinar emphysema & cirrhosis PiMZ - asymptomatic w/ ↓circulating A1AT - ↑ risk w/ smoking

Question 33

What leads to air trapping in emphysema? How do pts attempt to correct it?

Answer 33

Loss of elastic recoil and collapse of airways during exhalation Breathing out thru pursed lips - ↑ back pressure

Question 34

What type of hypersenstivity causes asthma? What is the stimuli?

Answer 34

Type 1 hypersensitivity Allergic - associated w/ allergic rhinitis, eczema, family hx

Question 35

What results from the _first exposure_ to an allergen in a genetically susceptible individual?

Answer 35

**T_H2 cells secrete** IL-4: IgE switch IL-5: attract eosinophils IL-10: ↑T_H2 ↓T_H1

Question 36

What results from re-exposure to allergens?

Answer 36

IgE medated activation of **mast cells**

Question 37

What is involved in the early phase reaction of mast cell degranulation?

Answer 37

Release of histamine and LT C4, D4, and E4 Bronchoconstriction, inflammation, edema

Question 38

What is involved in the late phase reaction of mast cell degranulation?

Answer 38

Major basic protein from eosinophils Cell damage & Bronchoconstriction

Question 39

What does the productive cough from asthma produce?

Answer 39

1. Spiral shaped mucus plugs - Curschmann spirals 2. Eosinophil derived crystals - Charcot-Leyden crystals

Question 40

Asthma can also arise from what nonallergic causes?

Answer 40

Exercise, viral infection, aspirin, and occupational exposure

Question 41

What is bronchiectasis?

Answer 41

Permament dilatation of bronchioles and bronchi due to necrotizing inflammation

Question 42

What causes bronchiectasis?

Answer 42

1. CF 2. Kartagener syndrome 3. Tumor/foreign body 4. Necrotizing infection 5. Allergic bronchopulmonary aspergillosis

Question 43

Besides hypoxemia and cor pulmonale, what other complication can bronchiectasis cause?

Answer 43

2˚ amyloidosis Chronic inflammation → ↑ SAA → ↑AA

Question 44

What is characterisitic of restrictive lung disease?

Answer 44

FEV₁/FVC ratio ≥ 80%

Question 45

What are structural causes of restrictive lung disease?

Answer 45

Polio, myasthenia gravis Scoliosis, morbid obesity

Question 46

What drugs can cause restrictive lung disease?

Answer 46

Belomycin Busulfan Amiodarone Methotrexate

Question 47

Caplan syndroe

Answer 47

RA + pneumoconioses w/ intrapulmonary nodule

Question 48

What are the causes of restricitive lung disease from intertittial problems?

Answer 48

1. Idiopathic pulmonary fibrosis 2. Pneumoconioses 3. Sarcoidosis 4. Hypersenstivity Pneumonitis

Question 49

What is thought to cause **idiopathic pulmonary fiboriss**?

Answer 49

**Cyclic injury:** TGF-β from injured pneumocytes → fibrosis

Question 50

How do the pneumoconioses cause fibrosis?

Answer 50

Occupational exposure → chronic exposure to small particles that are fibrogenic (Alveolar Mφ)

Question 51

What does carbon dust cause?

Answer 51

Coal Workers' Pneumoconiosis Massive exposure = "black lung" Mild i.e. pollution = anthracosis

Question 52

What does silica cause? Who is it seen in?

Answer 52

Fibrotic nodules in upper lobes ↑ risk for TB - impairs phagolysosome formation (Mφ) Sandblasters and silica miners

Question 53

What does berylliosis cause? What occupations could yield this?

Answer 53

Noncaseating granulomas in lung, hilar LN, and systemic organs ↑ risk for lung CA Miners and aerospace industry

Question 54

What does asbestos exposure cause? Who is at risk for exposure?

Answer 54

Fibrosis of lung and pleura → CA of lung and pleura (mesothelioma) \*\*Lung CA \>\> mesothelioma\*\* Construction workers, plumbers, and shipyard workers

Question 55

What is characteristic of asbestos lesions?

Answer 55

long, golden brown fibers, w/ associated iron (asbestos bodies) Lower lobes

Question 56

What is the charcteristic lesion of silicosis?

Answer 56

Eggshell calcification of hilar LN

Question 57

Sarcoidosis

Answer 57

Systemic disease characterized by **noncaseating granulomas** in _multiple organs_ - AA females, **CD4+** response to unknown antigen

Question 58

Stellate inclusions or "asteroid bodies" in giant cells of granulomas in lung indicate whwat?

Answer 58

Sarcoidosis

Question 59

Besides the lung, what other organs does sarcoidosis affect?

Answer 59

**Uvea** - uveitis **Skin** - nodules or erythema nodosum **Salivary/lacrimal glands **

Question 60

What are clnical features of sarcoidosis?

Answer 60

1. Cough or dyspnea - most common 2. ↑ serum ACE 1. Hypercalcemia

Question 61

Why is hypercalcemia seen in sarcoidosis?

Answer 61

1-α hydroxylase of epithelioid histiocytes converts vitamin D to its active form

Question 62

What type is **Hypersensitivity Pneumonitis**? How does it present

Answer 62

Mixed type 3/4 to inhaled organic antigens (farmers/bird exposure) Fever, cough, dyspnea hours post exposure - resolves w/ removal

Question 63

What forms hyaline membranes in an alveoli?

Answer 63

Leakage of protein rich fluid Necrotic epithelial cells

Question 64

What causes damage in acute RDS?

Answer 64

Activation of neutrophils induce protease and free radical mediated damage of type I and type II pneumocyes

Question 65

How do you treat acute RDS?

Answer 65

Treat _underlying_ cause Ventilation w/ PEEP

Question 66

When does surfactant production begin, when is it typically adequate? How can you tell

Answer 66

Week 28 Week 34 Lecithin : sphingomyelin \> 2

Question 67

What cells make surfactant?

Answer 67

Type II Pneumocytes - Phosphatidylcholine (lecithin)

Question 68

Neonatal RDS can cause hypoxemia and lead to the use of supplemental oxygen - what are complications of both?

Answer 68

**Hypoxemia**: PDA & necrotizing enterocolitis **Supplemental O₂**: retinopathy of prematurity & bronchopulmonary dysplasia

Question 69

What 3 things can lead to neonatal RDS?

Answer 69

Prematurity, maternal diabetes, and C-section

Question 70

What is this?

Answer 70

Acute RDS

Question 71

Pulmonary HTN?

Answer 71

≥ 25 mmHg (nl=10-14)

Question 72

What does pulmonary HTN lead to?

Answer 72

Atherosclerosis of pulmonary trunk SM hypertrophy of pulmonary arteries Intimal fiborsis Plexiform lesions RVH Cor pulmonale

Question 73

What causes primary HTN?

Answer 73

BMPR2 mutation → Proliferation of vascular SM Young adult females

Question 74

What causes 2˚ pulmonary HTN?

Answer 74

**Hypoxemia** from COPD, interstitial lung disease **↑ volume in pulmonary circuit** **Recurrent PE** **Mitral stenosis** **Sleep apnea** **High altitude** **Systemic sclerosis**

Question 75

Obesity hypoventilation syndrome

Answer 75

BMI ≥ 30 Hypoventilate → ↓Pa_O2 → ↑Pa_CO2 (while awake)

Question 76

Sleep apnea is the repeated cessation of breathing for \> 10 seconds during sleep causing daytime somnolence and nocturnal hypoxia. What is the Pa_O2 in the day?

Answer 76

Normal

Question 77

What complications can nocturnal hypoxia cause?

Answer 77

Systemic/Pulmonary HTN Arrhythmias Sudden death

Question 78

What 2 things result in _hyperressonant_ lungs to percussion?

Answer 78

**Pneumothorax - **tension or spontaneous

Question 79

What will result in increased tactile fremitis?

Answer 79

Consolidation - lobar pneumonia, pulmonary edema

Question 80

What are common symptoms of lung cancer?

Answer 80

Cough, hemoptysis, bronchial obstruction, wheezing, pneumonic "coin" lesion on x-ray, or noncalcifided nodule on CT

Question 81

What is the most common tumor in the lung?

Answer 81

Mets Breast, colon, prostate, bladder

Question 82

Where does lung cancer like to travel to?

Answer 82

Adrenal, brain, bone (path fx), liver (jaundice, hmegaly)

Question 83

What are the key risk factors for lung cancer?

Answer 83

Cigarette smoke, radon, and asbestos

Question 84

Where does radon come from?

Answer 84

Radioactive decay of uranium - closed spaces i.e. basements

Question 85

What other things can produce a "coin" lesion?

Answer 85

Granuloma - TB/fungus Bronchial hamartoma - calcified

Question 86

Small cell carcinoma is a neoplasm of ______________ cells that shows \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. It is treated with _______ It may produce \_\_\_\_\_, \_\_\_\_\_\_, or Eaton Lambert Syndrome (antibodies against presynatptic Ca channels)

Answer 86

**Neuroendocrine** (Kulchitsky) cells, poorly diff **Rapid growth**/early mets **Chemo - **not surgically resectable **ADH** or **ACTH**

Question 87

What is the most common lung tumor in male smokers?

Answer 87

Squamous Cell CA

Question 88

Squamous cell carcinoma (lung)

Answer 88

Central - keratin perals or intercellular bridges PTHrP (hypercalcemia)

Question 89

What is the most common lung tumor in female smokers and non-smokers?

Answer 89

Adenocarcinoma - peripheral - glands/mucin

Question 90

What mutations are associated w/ adenocarcinoma?

Answer 90

k-ras, EGFR, and ALK Associated w/ hypertrophic osteoarthropathy - clubbing

Question 91

**Bronchioloalveolar** is a subtype of adenoCA that arises from \_\_\_\_\_\_\_\_\_, and grows along _preexisting bronchioles_. CXR shows hazy infiltrates similar to \_\_\_\_\_\_\_\_\_\_\_.

Answer 91

Clara cells Pneumonia \*\*excellent prognosis\*\*

Question 92

Large cell CA is a highly anaplastic undifferentiated tumor of _________________ and it occurs \_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 92

Pleomorphic giant cells Peripherally

Question 93

Bronchial carcinoid tumor is a low grade malignancy composed of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, it is located \_\_\_\_\_\_\_\_\_\_\_\_\_\_, and has a ______ prognosis.

Answer 93

Nests of neuroendocrine cells Central or peripheral Good

Question 94

Mesothelioma

Answer 94

Malignancy of the **pleura** - associated w/ **asbestosis** _Hemorrhagic pleural effusions_ and _pleural thickening_

Question 95

Pancoast tumor

Answer 95

Tumor occuring in the **apex** of the lung - may affect _cervical sympathetic plexus_ → Horner , SVC syndrome, sensorimotor deficits, hoarsness

Question 96

SVC syndrome

Answer 96

Obstruction that impairs SVC drainage from: * Head: facial plethora * Neck: JVD * Upper extremities: edema Due to malignancy or thrombosis from indwelling catheter Severe: headeache, dizziness, ↑risk of aneurysm/rupture

Question 97

Pneumonia is an infection of the lung __________ that occurs when \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 97

Parenchyma Normal defenses are impaired - cough reflex, mucociliary escalator, mucus plugging

Question 98

Diagnosis of pneumonia is made by what three things?

Answer 98

CXR Sputum gram stain and culture Blood culture

Question 99

Lobar pneumonia is usually \_\_\_\_\_\_\_\_\_, and the most common causes are \_\_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_\_\_\_\_\_, and \_\_\_\_\_\_\_\_\_\_\_\_. (3)

Answer 99

Bacterial S. pneumo, Legionella, Klebsiella

Question 100

What are the 4 classic gross phases of lobar pneumonia?

Answer 100

1. **Congestion** - congested vessels and edema 2. **Red Hepatization**: exudate, **neutrophils**, and hemorrhage - spongy 3. Grey hepatization: **degreadation of red cells in exudate** 4. **Resolution**

Question 101

What cell regenerates the lung?

Answer 101

Type II pneumocytes

Question 102

What bugs are the most common cause of bronchopneumonia?

Answer 102

S. pneumo, S. aureus, H. flu, Klebsiella

Question 103

What type of pneumonia is characterized by "scattered patchy consolidation, centered around bronchioles, often multifocal and bilateral"?

Answer 103

Bronchopneumonia

Question 104

**Bacteroides**, **Fusobacterium**, and **Peptococcus** are common causes of what?

Answer 104

**Aspiration Pneumonia** Alcoholics and comatose patients

Question 105

What bugs commonly cause interstitial (atypical) pneumonia?

Answer 105

Viruses: Influenza, RSV, adenovirus Mycoplasma Legionella Chlamydia

Question 106

What type of pneumonia is characterized as "diffuse patchy inflammation localized to interstitial areas at alveolar walls, ≥1 lobe involved"

Answer 106

Interstitial/Atypical pneumonia

Question 107

**Lung abscesses** are caused by _bronchial obstruction_ or \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Answer 107

Aspiration of oropharyngeal contents - alcoholics/epileptics

Question 108

What are the 3 types of pleural effusions?

Answer 108

Transudate Exudate Lymphatic

Question 109

True or false: **Transudate pleural effusion** has ↓ protein content and is due to CHF, nephrotic syndrome, or cirrhosis.

Answer 109

True

Question 110

What are the causes of exudate pleural effusion?

Answer 110

Malignancy Pneumonia Collagen vascular disease Trauma

Question 111

What causes spontaneous pneumothorax?

Answer 111

Rupture of apical blebs — tall, thin, young males