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Flashcards in Lung Deck (452)
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180

Radiation pneumonitis: Typical cells (2).

Foam cells: Lipid-rich cells with features of macrophages and smooth-muscle cells.

Radiation fibroblasts: Stromal cells with atypical nuclei and much blue cytoplasm.

181

Radiation pneumonitis: Prognosis (2).

Acute pneumonitis usually responds to corticosteroids.

Carcinoma may arise after >10 years.

182

Bleomycin toxicity:

A. Incidence.
B. Mechanism.

A. Less than 5%.

B. The lungs are relatively deficient in hydrolase, which detoxifies bleomycin.

183

Bleomycin toxicity: Exacerbating factors (3).

Oxygen.

Cyclophosphamide and other drugs.

Radiation.

184

Bleomycin toxicity: Radio-recall phenomenon

Bleomycin can unmask damage to lungs caused by previous irradiation.

185

Bleomycin toxicity: Histology.

Diffuse alveolar damage.

Atypia of pneumocytes.

Progression to nonuniform fibrosis in some patients.

186

Amiodarone toxicity: Histology.

Diffuse alveolar damage.

Hyperplasia of type 2 pneumocytes.

Foamy histiocytes in airspaces.

187

Amiodarone toxicity: Electron microscopy.

Lamellar inclusions in alveolar macrophages.

188

Methotrexate toxicity: Histology.

Poorly formed granulomas.

Interstitial inflammation that includes eosinophils.

189

Wegener's granulomatosis: Clinical triad.

Disease of upper airways (e.g. sinusitis).

Disease of lower airways.

Glomerulonephritis.

190

Wegener's granulomatosis: Affected sites (3).

Head and neck.

Lungs.

Kidneys.

191

Wegener's granulomatosis: Autoantibody.

c-ANCA in most: Usually against proteinase 3.

192

Wegener's granulomatosis in the lungs: Distribution of lesions.

Mostly in the lower lobes.

193

Wegener's granulomatosis in the lungs: Gross pathology.

Many nodules of variable size.

Cavitation in half of cases.

194

Wegener's granulomatosis in the lungs: Histology (5).

Geographic necrosis.

Granulomatous inflammation.

Palisades of histiocytes.

Microabscesses.

Vasculitis of small vessels.

195

Wegener's granulomatosis in the lungs: Special stain.

Elastic stain: Destruction of elastic lamina.

196

Wegener's granulomatosis vs. Churg-Strauss syndrome (5).

Churg-Strauss syndrome:

− Eosinophilia in blood and tissues is typical.
− Asthma is typical.
− Cardiac disease is common.
− Renal disease is mild.
− Sinus disease is mild.

197

Churg-Strauss syndrome: Clinical tetrad.

Asthma.

Rhinitis.

Peripheral eosinophilia.

Systemic vasculitis.

198

Churg-Strauss syndrome: Autoantibody.

p-ANCA in some: Usually against myeloperoxidase.

199

Churg-Strauss syndrome in the lungs: Gross pathology (4).

Multifocal consolidation.

Eosinophilic pleural effusion.

Stellate peripheral pulmonary arteries.

Cavitation is rare.

200

Churg-Strauss syndrome in the lungs: Histology (4).

Eosinophilic pneumonia.

Diffuse hemorrhage.

Vasculitis.

Extravascular granulomas with central necrosis.

201

Churg-Strauss syndrome in the lungs: Pharmacological differential diagnosis.

Carbamazepine-induced vasculitis.

202

Churg-Strauss syndrome in the lungs: Microbiological differential diagnoses.

Parasitic infection.

Fungal infection.

203

Pulmonary arterial hypertension: Associations with systemic diseases (4).

Scleroderma.

Sickle-cell disease.

Rheumatoid arthritis.

Systemic lupus erythematosus.

204

Pulmonary hypertension: Symptoms (5).

Dyspnea.

Chest pain.

Syncope.

Cough.

Hemoptysis is rare.

205

Pulmonary hypertension: Leading cause.

Left-sided heart failure.

206

Pulmonary hypertension:

A. Definition.
B. Gross pathology.

A. Pulmonary systolic pressure >25 mmHg.

B. Pulmonary atherosclerosis.

207

Grading scheme for pulmonary hypertension: Use.

Applies only to idiopathic pulmonary hypertension and to certain types of secondary pulmonary hypertension ("APAH").

208

Grading scheme for pulmonary hypertension: Histology of Grade I (2).

Medial hypertrophy of pulmonary arteries.

Extension of muscle into walls of pulmonary arterioles.

209

Grading scheme for pulmonary hypertension: Histology of Grade II.

Grade I plus proliferation of intimal cells.