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DT3 Exam 2 > Path > Flashcards

Path Flashcards

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1
Q

histology of respiratory tree

A

ciliated pseudostratified columnar epithelium

cartilaginous airways with mucus secreting goblet cells and submucosal glands

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2
Q

alveolar histology

A 
capillary endothelium
basement membrane
intersititium
alveolar epithelium
alveolar macrophages
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3
Q

dual circulation

A

pulmonary and bronchial arteries

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4
Q

pulmonary tract defense mechanisms

A

nasal clearance
tracheobronchial clearance by cilia
alveolar clearance by macrophage

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5
Q

factors that affect pulmonary defense mechanisms

A

loss of cough reflex (coma, drugs, pain)
injury to mucociliary apparatus (ciliary dysfunction, smoking, viruses)
inerference with alveolar macrophages (alcohol, smoking)
pulmonary congestion and edema
accumulation of lung secretions (CF)

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6
Q

presentation of interstitial diseases

A

dyspnea, tachypnea, cyanosis without wheezing

reduced DLCO, reduced lung volume, reduced compliance

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7
Q

chest x-ray of interstitial diseases

A

small nodules, irregular lines or ground glass shadows

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8
Q

pathogenesis of idiopathic pulmonary fibrosis

A

inflammation causes abnormal epithelial repair leading to fibroblastic/myofibroblastic proliferation (fibroblastic foci)
TGF-beta1 released by type 1 alveolar epithelial cells-apoptosis
caveolin-1 which inhibits TGF-beta1 is decreased

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9
Q

morphology of IPF

A

cobblestone pleural surface
mostly lower lobes
temporal heterogeneity
later-dense fibrosis

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10
Q

clinical course of IPF

A

insidious onset of dyspnea on exertion and dry cough
hyoxemia, cyanosis, and clubbing
mean survival 3 years

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11
Q

morphology nonspecific interstitial pneumonia

A

cellular-uniform/patchy inflammation

fibrosing pattern-interstitial fibrosis without temporal heterogeneity, no fibroblastic foci, no honeycomb

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12
Q

clinical course of nonspecific interstitial pneumonia

A

dyspne and cough

better prognosis than UIP

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13
Q

etiology of cryptogeneic organizing pneumonia

A

response to various infections or inflammatory lung injury

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14
Q

morphology of cryptogenic organizing pneumonia

A

subpleural or peribronchial airspace consoidation
no temporal heterogeneity
no interstitial fibrosis or honeycomb lung

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15
Q

Masson bodies

A

intra-alveolar polypoid plugs of loose organizing connective tissue
seen in cryptogenic organizing pneumonia

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16
Q

clinical course of cryptogenic organizing pneumonia

A

acute onset of cough and dypsnea

steroids for >6 months

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17
Q

pulmonary involvement in connective tissue diseases

A

RA, sceroderma, and SLE

can occur in different patterns

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18
Q

pathogenesis pneumoconioses

A

depends on physical factors

most dangerous particles 1-5 um

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19
Q

asymptomatic anthracosis

A

accumulation of carbon pigment in macrophages in miners, tobacco smokers, and urban dwellers
does not produce a cellular reaction

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20
Q

simple coal workers pneumoconiosis

A

coal macules along the respiratory bronchioles
upper lobes and upper zones of lower lobes
leads to centrilobular emphysema

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21
Q

complicated coal workers pneumoconiosis

A

multiple blackened scars>2cm in lung parenchyma

dense collagen, carbon pigment and necrotic centers

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22
Q

clinical course of coal workers pneumoconiosis

A

mild forms of complicated can exist without loss of function

more advanced can lead to HTN or cor pulmonale

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23
Q

most prevalent chronic occupational disease worldwide

A

silicosis

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24
Q

pathogenesis of silicosis

A

silica in crystalline and amorphous forms
crystalline more fibrogenic
causes macrophage to release mediators

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25
morphology silicosis
early-nodules in upper lung zones later coalescing to from hard collagenous scars of concentric layers of hyalinized collagen with dense capsule involve hilar lymph nodes and pleura with thin calcifications (eggshell calcifications)
26
silicosis clinical course
x ray shows fine nodularity in upper lung areas dyspnea occurs after development of massive fibrosis associated with increased incidence of TB
27
pathogenesis asbestos
depends on concentration fibrogenic forms-serpentine and amphibole fibrous pleural plaques, pleural effusions, interstitial fibrosis, lung and laryngeal carcinoma, mesothelioma, colon carcinoma injury at bifurcations of small airways-penetrate macrophage
28
serpentine from
most prevalent curly and flexible removed by upper respiratory mucociliary apparatus
29
amphibole form
least prevalent stiff and brittle fibers penetrate deep into interstitium associated with mesothelioma
30
morphology of asbestos exposure
interstitial fibrosis similar to UIP interstitial fibrosis around respiratory bronchioles and alveolar ducts honeycomb pattern-begins in lower lobes pleural plaques
31
components of pleural plaques
dense collagen with calcium mostly on AP parietal pleura and diaphragm do not contain asbestos bodies
32
asbestos bodies
golden brown elongated asbstos fibers coated with iron-containing protein from macrophage
33
therapy induced lung disease
bleomycin amiodarone acute radiation pneumonitis chronic radiation pneumonitis
34
Caplan syndrome
coal worker pneumoconiosis and RA | nodules with possible central necrosis
35
epidemiology of sarcoidosis
higher prevalence in women, particularly AA and SE US | diagnosis of exclusion
36
pathogenesis of sarcoidosis
immunologic-increased CD4, IL2, IL8, TNF | anergy to certain skin test antigens (candida, PPD)
37
morphology of sarcoidosis
noncaseating granulomas with epithelioid cells, giant cells, Schaumann bodies, asteroid bodies
38
lung findings sarcoidosis
granulomas along lymphatics, bronchi, blood vessels
39
lymph nodes in sarcoidosis
hilar and mediastinal nodes
40
liver in sarcoidosis
granulomas in portal tracts
41
skin and mucous membranes in sarcoidosis
nodules, plaques, flat lesions
42
eyes and salivary glands in sarcoidosis
iritis with lacrimal gland infalmmation (dacroadenitis)
43
mikulicz syndrome
dacroadenitis+bilateral involvment of parotic/submax/sublingual
44
best prognosis sarcoidosis
hilar adenopathy alone
45
worst prognosis sarcoidosis
pulmonary involvement alonge
46
hypersensitivity pneumonitis
immunologically mediated due to increased reactivity to antigen can by type III or type IV hypersensitivity
47
farmers lung
spores of actinomycetes
48
pigeon breeders lung
proteins from feathers/excretions
49
humidifer lung
bacteria from heated water reservoir
50
morphology hypersensitivity
chronic interstitial inflammation noncaseating granulomas interstitial fibrosis and honeycombing
51
xray from hypersensitvity
diffuse and nodular infiltrates
52
time frame for acute attacks
sensitized patients with fever, dyspnea, cough, leukocytosis 4-6 hours after antigen exposure
53
chronic attacks of hypersensitivity
progressive respiratory failures and decreased lung capacity and compliance restrictive
54
acute eosinophilic pneumonia
rapid onset BAL>25% eosinophils good response to corticosteroids
55
simple pulmonary eosinophilia (Loeffler's syndrome)
transient lung lesions with blood eosinophilia CXR shows irregular lung densities thickened alveolar septa containing eosinophils and giant cells
56
secondary pulmonary eosinophilia
parasitic, bacterial, and fungal infections | associated with asthma, allergic bronchopulmonary aspergillosis and drug allergies
57
chronic eosinophilic pneumonia
areas of lung consolidation at the lung periphery eosinophils and lymphocytes in septal wall and alveolar spaces high fever, night sweats and dyspnea treated with steroid therapy
58
morphology of desquamative interstitial pneumonitis
large numbers of inta-alveolar macrophage containing brown pigment (smokers macrophages) thickened alveolar speta with sparse inflammation
59
clinical desquamative interstitial pneumonitis
more common in men around 40s-50s almost all smoke clubbing of digits response to steroid therapy and cessation of smoking
60
respiratory bronchiolitis associated interstitial lung disease morphology
large smokers macrophage numbers within respiratory bronchioles, alveolar ducts, peribronchiolar spaces patchy chronic submucosal and peribronchiolar inflammation mild peribronchiolar fibrosis with centrilobular emphysema
61
etiology of acquired pulmonary alveolar proteinosis
anti-GM-CSF antibodies | impaired clearance of surfactant
62
etiology of congenital PAP
mutations
63
secondary PAP etiology
secondary to silicosis, immunodeficiency and malignancies
64
morphology of PAP
heavy lungs dense intra-alveolar granular precipitate that is PAS positive and contains cholesterol clefts minimal inflammatory infiltrate
65
clinical PAP
mostly in adults with productive cough containing chunks of gelatinous material
66
most common cause of cancer mortality
lung cancer
67
genetics of squamous cell carcinoma
3p, 9p (CDKN2A), 17p (TP53) deletions loss of Rb amplification of FGFR1
68
genetics of small cell carcinoma
loss of TP3, RB 3p deletions MYC amplifications
69
genetics of adenocarcinoma
GoF in receptor tyrosine kinase | KRAS mutations
70
lung cancers in non-smokers
most have EGFR | women, adenocarcinoma
71
precursor lesions
squamous dysplasia atypical adenomatous hyperplasia adenocarcinoma in situ neuroendocrine cell hyperplasia
72
charactersistics of atypical adenomatous hyperplasia
less than 5mm, dysplasic pneumocytes lining alveoli
73
characteristics of adenocarcinoma in situ
less than 3cm | dysplastic cells lining alveolar septae with no invasion
74
characteristics of hamartoma
coin lesion on radiology solitary, well circumscribed epithelial and stromal component
75
characteristics of lymphangioleiomyomatosis
young child bearing age owmen | proliferation of perivascular epithelaioid cells, melanocytes, smooth muscle markers
76
genetics lymphangioleiomyomatosis
loss of function TSC2
77
treatment lymphangioleiomyomatosis
transplant
78
characteristics of inflammatory myofibroblastic tumor
children, single, well defined mass | fibroblasts, myofibroblasts, lymphs, plasma cells
79
genetics of myofibroblastic tumor
rearrangement of ALK
80
location of squamous cell carcinoma
centrally located
81
morphology squamous cell carcinoma
large mass, necrosis keratin pearls intercellular bridges p63 and p40 expression
82
carcinoid tumor histology
no necrosis | less than 2 mitoses/10HPF
83
atypical carcinoid tumor histology
2-10 mitoses/10HPT | may have focal necrosis
84
paraneoplastic syndromes
``` SIADH Cushing syndrome hypercalcemia/hypocalcemia gynecomastia carcinoid syndrome ```
85
benign pleural tumors
solitary fibrous tumor
86
kinds of malignant mesothelioma
epithelioid sarcomatoid mixed

DT3 Exam 2 (5 decks)

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