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Flashcards in Lung Deck (452)
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150

Goodpasture's syndrome: Relevance of epidemiology to presentation (2).

Young white males: Pulmonary symptoms often precede renal symptoms.

Elderly women: Glomerulonephritis and renal failure precede pulmonary disease.

151

Goodpasture's syndrome: Pulmonary manifestation.

Hemoptysis, which may be mild or life-threatening.

152

Goodpasture's syndrome: Histology of pulmonary disease (3).

Intraalveolar hemorrhage with many hemosiderin-laden macrophages.

Fibrous thickening of alveolar septa.

Hyperplasia of pneumocytes.

153

Goodpasture's syndrome: Ancillary tests (2).

Immunofluorescence: Linear IgG, IgM, or IgA and complement along the alveolar basement membrane.

Serology: Circulating autoantibodies.

154

Goodpasture's syndrome: Electron microscopy.

Fragmented capillary basement membranes.

Widened gaps between endothelial cells.

155

Goodpasture's syndrome: Antibodies (2).

Anti-GBM against the non-collagenous domain of the α₃ chain of type IV collagen.

Concurrent c-ANCA or p-ANCA in one third of patients.

156

Goodpasture's syndrome: Associated HLA type.

DR2.

157

Pulmonary silicosis: Classification according to timing.

Acute: Symptoms within 3 years after exposure.

Accelerated: Within 3-10 years.

Chronic: At least 20 years.

158

Pulmonary silicosis: Classification according to gross pathology.

Simple: Nodules up to 1 cm.

Progressive massive: Nodules >1 cm.

159

Pulmonary silicosis, acute: Histology (3).

Pulmonary edema.

Interstitial inflammation.

PAS-positive granular substance fills alveoli.

160

Pulmonary silicosis, chronic: Histology.

Discrete fibrous nodules of variable size, mainly in the upper lobes and subpleural regions.

161

Pulmonary silicosis, chronic: Structure of nodules.

Center: Amorphous.

Middle zone: Layers of dense collagen with focal calcification and necrosis.

Periphery: Particle-laden macrophages, lymphocytes, fibroblasts.

162

Microbiological association of pulmonary silicosis:

A. Organism.
B. Histology.

A. Mycobacterium tuberculosis (silicotuberculosis).

B. Silicotic nodules with central necrosis and epithelioid granulomas.

163

Pulmonary silicosis vs. pulmonary alveolar proteinosis.

Pulmonary alveolar proteinosis:

− Little inflammation or fibrosis.
− Protein is reactive for antibodies to surfactant apoptotein.

164

Pulmonary alveolar proteinosis: Associations (3).

Inorganic dust.

Hematological malignancy.

Immunodeficiency.

165

Pulmonary alveolar proteinosis: Complication.

Secondary infection by

− Fungi.
− Viruses.
− Pneumocystis jiroveci.
− Nocardia.
− Mycobacteria.

166

Pneumoconiosis: Particles that induce fibrosis (5).

Silica.

Coal dust.

Asbestos.

Beryllium.

Talc.

167

Pneumoconiosis: Particles that induce little or no fibrosis (3).

Iron oxide.

Tin.

Barium.

168

Asbestosis:

A. Timing.
B. Clinical presentation (3).

A. Symptoms appear 15-20 years after exposure.

B. Dyspnea, clubbing, restrictive lung disease.

169

Asbestosis: Location of lesions.

Mostly in the lower lobes.

170

Asbestosis: How the inhaled fibers get to the pleura.

Through the lymphatic channels (carried in macrophages) or by direct penetration.

171

Asbestos: Chemical composition.

Hydrated magnesium silicates.

172

Asbestosis: Appearance of fibers in tissue (2).

Asbestos body: Brown (due to hemosiderin), beaded, two bulbous ends, clear core.

Ferruginous body: No clear core.

173

Asbestosis: Histology of tissue reaction (3).

Diffuse interstitial fibrosis with chronic inflammation.

Hyperplasia of type 2 pneumocytes.

Alveolar epithelial cells may contain a substance that resembles Mallory's hyaline.

174

Asbestosis: Preferred sample for recovery of asbestos bodies.

Bronchioloalveolar lavage.

175

Asbestosis: Related cancers.

Mesothelioma.

Lung cancer.

176

Radiation pneumonitis, acute:

A. Timing.
B. Clinical presentation.

A. Symptoms begin between 6 weeks and 6 months after exposure.

B. Cough, dyspnea on exertion.

177

Radiation pneumonitis: Exacerbating factors (3).

Chemotherapy.

Prior irradiation.

Infection.

178

Radiation pneumonitis, acute: Histology.

Hyaline membranes as in diffuse alveolar damage.

Interstitial proliferation of atypical fibroblasts within young fibrosis.

179

Radiation pneumonitis, fibrotic stage: Histology.

Resembles NSIP but with hyperplasia and cytologic atypia of type 2 pneumocytes.