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Respiratory-First Aid 2017 > Pathology > Flashcards

Pathology Flashcards

1
Q

Obstruction of sinus drainage into nasal cavity leading to inflammation and pain over affected area

A

Rhinosinusitis

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2
Q

Sinuses typically affected in rhinosinusitis

A

Maxillary sinuses

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3
Q

Where do maxillary sinuses drain into

A

Middle meatus

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4
Q

Most common cause of acute URI

A

Viral etiology

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5
Q

What can occur after viral URI

A

Bacterial infection

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6
Q

Bacterial URI organisms usually after viral URI

A

S pneumoniae, H influenzae, M catarrhalis

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7
Q

Part of the nostril commonly affected by epistaxis

A

Anterior segment (Kiesselbach plexus)

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8
Q

Artery involved in posterior nasal hemorrhage that can be life threatening

A

Sphenopalatine artery

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9
Q

Sphenopalatine artery is a branch of what artery

A

Maxillary artery

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10
Q

Most common type of cancer affecting head and neck

A

Squamous cell carcinoma

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11
Q

Virus associated with oropharyngeal cancers

A

HPV-16

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12
Q

Virus associated with nasopharyngeal cancers

A

EBV

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13
Q

Risk factors for head and neck cancers

A

Tobacco, alcohol, HSV-16, EBV

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14
Q

Blood clot within deep vein causing swelling, pain, redness and warmth and usually unilateral

A

DVT

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15
Q

Conditions that predispose to DVT

A

Stasis, hypercoagulability, endothelial damage

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16
Q

Lab test used to rule out DVT

A

D-dimer (high sensitivity, low specificity)

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17
Q

What triggers clotting cascade

A

Exposed collagen

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18
Q

Used for prophylaxis and acute management of DVTs

A

Unfractioned heparin or LMWH (enoxaparin)

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19
Q

Anticoagulant used for long-term prevention of DVTs

A

Warfarin or rivaroxaban

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20
Q

Imaging choice for DVTs

A

Compression ultrasound with Doppler

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21
Q

Condition that presents with V/Q mismatch, hypoxemia, respiratory alkalosis, sudden onset dyspnea, pleuritic CP, tachypnea and tachycardia

A

Pulmonary emboli

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22
Q

Emboli that may cause sudden death and blocks both left and right pulmonary arteries

A

Saddle embolus

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23
Q

Types of emboli

A

Fat, Air, Thrombus, Bacteria, Amniotic fluid, Tumor (FAT BAT)

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24
Q

Emboli associated with long bone fractures and liposuction

A

Fat emboli

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25
Q

Emboli that can present with DIC postpartum

A

Amniotic emboli

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26
Q

Emboli that presents with classic triad of hypoxemia, neurologic abnormalities, and petechial rash

A

Fat emboli

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27
Q

Emboli caused by nitrogen bubbles precipitating after ascending from a dive

A

Air emboli

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28
Q

Complication of diving with joint pain

A

Caisson disease

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29
Q

Treatment for decompression sickness

A

Hyperbaric O2

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30
Q

Imaging choice for pulmonary emboli

A

CT pulmonary angiography - looks for filling defects

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31
Q

FEV1/FVC value in normal lungs

A

FEV1/FVC = 0.8

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32
Q

FEV1/FVC value in obstructive disease

A

FEV1/FVC < 0.8

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33
Q

FEV1/FVC value in restrictive disease

A

FEV1/FV normal or > 0.8

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34
Q

What happens to flow volume loop in obstructive disease

A

Loop shifts left

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35
Q

What happens to flow volume loop in restrictive diseases

A

Loop shifts right

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36
Q

The hallmark of obstructive lung disease

A

Decreased FEV1/FVC ratio

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37
Q

What does obstruction of airflow lead to in obstructive lung disease

A

Air trapping in lungs

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38
Q

What are the obstructive lung diseases

A

Chronic bronchitis, Emphysema, Asthma, Bronchiectasis

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39
Q

Thickness of mucosal gland layer to thickness of wall between epithelium and cartilage

A

Reid index

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40
Q

Diagnostic criteria for Chronic bronchitis

A

Productive cough > 3 months in a year for 2 consecutive years

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41
Q

Reid index in chronic bronchitis

A

50% or > 0.5

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42
Q

Pathology of chronic bronchitis

A

Hypertrophy and hyperplasia of mucus-secreting glands in bronchi

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43
Q

Findings in bronchitis

A

Wheezing, crackles, cyanosis, dyspnea, CO2 retention, secondary polycythemia

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44
Q

CXR findings in emphysema

A

Increased AP diameter, flattened diaphragm, increased lung field lucency

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45
Q

Chronic obstructive pulmonary diseases include which diseases

A

Chronic bronchitis and emphysema

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46
Q

Smoking is associated with what findings in emphysema

A

Centriacinar damage in upper lobes

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47
Q

Alpha-1 antitrypsin is associated with what findings in emphysema

A

Panacinar damage in lower lobes

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48
Q

Mechanism of centriacinar damage

A

Smoking rises up affects upper lobes and destruction of alveoli

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49
Q

What happens to alveoli in emphysema on exhalation

A

Alveoli collapse due to loss of elastic recoil from increased elastase activity

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50
Q

What happens to diffusion capacity in emphysema

A

Decreased diffusion capacity due to loos of alveolar walls

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51
Q

How is breathing accomplished in emphysema

A

Breathing through pursed lips to increase airway pressure and prevent collapse

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52
Q

Symptoms of emphysema

A

Hyperventilation and weight loss

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53
Q

Age group of those with emphysema caused by alpha-1 antitrypsin deficiency

A

Younger patients < 40 years

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54
Q

Age group of those affected with emphysema caused by smoking

A

Older patients > 60 years

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55
Q

Diagnosis of asthma is supported by what lab findings

A

Spirometry and methacholine challenge test

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56
Q

Complication of asthma that may lead to death

A

Status asthmaticus

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57
Q

Triad of asthma

A

Asthma, nasal polyps, chronic rhinosinusitis

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58
Q

Mechanism of aspirin-induced asthma

A

COX inhibition increase leukotrienes causing airway constriction

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59
Q

Pathological findings in asthma

A

Smooth muscle hypertrophy and hyperplasia, Curschmann spirals, Charcot-Leyden crystals

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60
Q

Eosinophilic, hexagonal, double-pointed, needle-like crystals formed from breakdown of eosinophils in sputum

A

Charcot-Leyden crystals

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61
Q

Shed epithelium forming whorled mucous plugs commonly seen in asthma

A

Curschmann spirals

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62
Q

Asthma triggers

A

Viral URIs, allergens, stress

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63
Q

Asthma findings

A

Cough, wheezing, tachypnea, dyspnea, hypoxemia, decreased inspiratory/expiratory ratio, pulsus paradoxus, mucus plugging

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64
Q

Pulsus paradoxus

A

Large decrease in systolic blood pressure and pulse wave amplitude during inspiration of > 10 mmHg

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65
Q

Presents with purulent sputum, recurrent infections, hemoptysis, and digital clubbing with dilated airways

A

Bronchiectasis

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66
Q

Bronchiectasis is associated with what conditions

A

Bronchial obstruction, poor ciliary motility, CF, ABPA

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67
Q

Poor ciliary motility causes

A

Smoking and Kartagener syndrome

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68
Q

Increased sensitivity to Aspergillus commonly seen in immunocompromised, CF and asthma patients

A

Allergic bronchopulmonary aspergillosis

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69
Q

How is ABPA diagnosed

A

Skin test

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70
Q

Treatment for ABPA

A

Corticosteroids

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71
Q

Findings in ABPA

A

IgE antibody production, increased Th2 CD4+ cells, increased interleukin synthesis and eosinophilia

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72
Q

Types of Restrictive lung diseases

A

Poor breathing mechanics and Interstitial lung disease

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73
Q

Findings in restrictive lung disease caused by poor breathing mechanics

A

Extrapulmonary findings, peripheral hypoventilation, and normal A-a gradient

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74
Q

Causes of restrictive lung disease due to poor breathing mechanics

A

Poor muscular effort and structural apparatus

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75
Q

Causes of poor muscular effort seen in restrictive lung diseases

A

Polio, myasthenia gravis, Guillain-Barre syndrome, ALS

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76
Q

Causes of poor structural apparatus seen in restrictive lung diseases

A

Scoliosis and morbid obesity

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77
Q

Common findings in restrictive lung disease caused by interstitial lung disease

A

Pulmonary decreased diffusion capacity and increased A-a gradient

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78
Q

Interstitial lung disease presenting with bilateral hilar lymphadenopathy, non-caseating granulomas, increased ACE and calcium

A

Sarcoidosis

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79
Q

Interstitial lung disease caused by repeated cycles of lung injury and wound healing presenting with increased collagen deposition, “honeycomb” appearance and digital clubbing

A

Idiopathic pulmonary fibrosis

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80
Q

Farmer or bird handler with cough, dyspnea, and chest tightness with diffuse crackles on exam

A

Hypersensitivity pneumonitis

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81
Q

Presents with bilateral, diffuse pattern with small, irregular reticulonodular opacities and “honeycomb” lung appearance

A

Interstitial lung disease

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82
Q

What type of hypersensitivity reaction is seen in hypersensitivity pneumonitis

A

Mixed Type III/IV: immune-complex and cell-mediated reaction

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83
Q

Interstitial lung disease presenting with PR3-ANCA/c-ANCA and eosinophilic granulomas on CXR

A

Granulomatosis with polyangiitis

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84
Q

Interstitial lung disease caused by exposure to silica, asbestos, and coal

A

pneumoconioses

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85
Q

Common findings in Restrictive lung diseases overall

A

Decreased FVC, TLC with FEV1/FVC ratio greater than or equal to 80% with short, shallow breaths

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86
Q

Mechanism of lung injury in Idiopathic pulmonary fibrosis

A

TGF-beta from injured pneumocytes leads to fibrosis

87
Q

Treatment for Idiopathic pulmonary fibrosis

A

Lung transplant

88
Q

Treatment for Hypersensitivity pneumonitis

A

Remove exposure, steroids

89
Q

Syndrome seen in pneumoconioses presenting with RA and pneumoconioses with intrapulmonary nodules

A

Caplan syndrome

90
Q

Complications of pneumoconioses

A

Cor pulmonale, Caplan syndrome and cancer

91
Q

Associated with shipbuilding, roofing and plumbing and affecting lower lobes

A

Asbestosis

92
Q

Findings that are pathognomonic for asbestosis

A

Supradiaphragmatic and pleural plaques

93
Q

Most common type of cancer associated with asbestosis

A

Bronchogenic carcinoma

94
Q

Lung condition with fusiform rods resembling dumbbells, found in alveolar sputum and visualized on Prussian blue stain

A

Asbestosis

95
Q

Lung condition associated with aerospace industry and non-caseating granulomas on histology affecting upper lobes

A

Berylliosis

96
Q

Lung condition associated with prolonged coal dust exposure with macrophages laden with carbon causing inflammation and fibrosis affecting upper lobes

A

Coal worker’s pneumoconiosis

97
Q

Lung condition associated with foundries, sandblasting, and mines affecting upper lobes with “eggshell” calcification of hilar lymph nodes on CXR

A

Silicosis

98
Q

What is complication of TB and mechanism

A

Silica disrupt phagolysosomes and impair macrophages, increasing risk of TB

99
Q

Mechanism of lung injury in silicosis

A

Macrophages respond to silica and release fibrogenic factors leading to fibrosis

100
Q

Malignancy of pleura associated with asbestosis

A

Mesothelioma

101
Q

Common histologic findings in mesothelioma

A

Psammoma bodies

102
Q

Common histologic stain findings in most mesotheliomas

A

Cytokeratin and calretinin positive

103
Q

Complication of mesothelioma

A

Hemorrhagic pleural effusion and pleural thickening

104
Q

Diagnosis of exclusion characterized by respiratory failure within 1 week of alveolar insult, bilateral opacities , decreased PaO2/FiO2 < 300 and no evidence of HF/fluid overload

A

Acute respiratory distress syndrome

105
Q

Clinical features of acute respiratory distress syndrome

A

Hypoxemia and cyanosis from increased diffusion barrier and collapse of air sacs

106
Q

Cause of acute respiratory distress syndrome

A

Formation of intra-alveolar hyaline membranes

107
Q

Initial damage in ARDS

A

Neutrophils release toxic substances damaging alveolar wall and pulmonary capillary endothelial cells, activating coagulating cascade, on oxygen-derived free radicals

108
Q

Management of ARDS

A

Mechanical ventilation with low tidal volumes (PEEP) and address underlying cause

109
Q

Recovery complications

A

Damage to type II pneumocytes causes scarring and fibrosis

110
Q

CXR findings in ARDS

A

“white-out”

111
Q

Respiratory effort against airway obstruction associated with obesity and loud snoring

A

Obstructive sleep apnea (OSA)

112
Q

Mechanism of OSA in adults

A

Excess pharyngeal tissue

113
Q

Mechanism of OSA in children

A

Adenotonsillar hypertrophy

114
Q

Treatment for OSA

A

Weight loss, CPAP, surgery

115
Q

Disorder associated with CNS injury/toxicity, HF, opioids and Cheyne-Stokes respiration and no respiratory effort

A

Central sleep apnea

116
Q

Treatment for Central sleep apnea

A

Positive airway pressure

117
Q

Disorder associated with obesity and BMI > 30 kg/m2, increased PaCO2 during waking hours, decreased PaO2 and increased PaCO2 during sleep

A

Obesity hypoventilation syndrome

118
Q

Normal mean pulmonary artery pressure

A

10-14 mmHg

119
Q

What pressure is considered pulmonary HTN

A

> 25 mmHg at rest

120
Q

Diagnosis of pulmonary HTN

A

Right heart catheterization

121
Q

Course of pulmonary HTN

A

Respiratory distress causing cyanosis and RVH leading to death from decompensated cor pulmonale

122
Q

Symptoms of pulmonary HTN

A

Loud or accentuated 2nd heart sound in LUSB

123
Q

Vascular changes seen in pulmonary HTN

A

Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulmonary arteries and plexiform lesions

124
Q

Type of pulmonary arterial hypertension classically seen in young adult females

A

Idiopathic PAH

125
Q

Common cause of heritable PAH

A

Inactivating mutation in BMPR2 gene

126
Q

Consequence of mutation in BMPR2 gene

A

Vascular smooth muscle proliferation

127
Q

Heart disease caused by systolic/diastolic dysfunction and valvular disease

A

Left heart disease

128
Q

Consequence of chronic or recurrent microthrombi

A

Pulmonary HTN

129
Q

Common causes of pulmonary HTN

A

PAH, left heart disease, lung disease or hypoxia, chronic thromboemboli, and multifactorial

130
Q

Decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation away from side of lesion

A

Pleural effusion

131
Q

Decreased breath sounds, dullness to percussion, decreased fremitus and tracheal deviation toward side of lesion

A

Atelectasis

132
Q

Decreased breath sounds, hyperresonant to percussion and decreased fremitus - diagnosis?

A

Simple pneumothorax

133
Q

Decreased breath sounds, hyperresonant to percussion, decreased fremitus and tracheal deviation away from side of lesion - diagnosis?

A

Tension pneumothorax

134
Q

Bronchial breath sounds, late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy, dullness to percussion, increased fremitus - diagnosis?

A

Consolidation (lobar pneumonia or pulmonary edema)

135
Q

Pulmonary HTN presents with…

A

exertional dyspnea and right-sided HF

136
Q

Excess fluid between pleural layers causing restricted lung expansion

A

Pleural effusion

137
Q

Treatment for pleural effusion

A

Thoracentesis

138
Q

Pleural fluid with decreased protein content, due to increased hydrostatic pressure or decreased oncotic pressure

A

Transudate

139
Q

Pleural fluid due to thoracic duct injury from trauma or malignancy with milky-white appearing fluid and increased triglycerides

A

Lymphatic

140
Q

Pleural fluid with increased protein content, cloudy appearing due to malignancy, pneumonia, collagen vascular disease or trauma

A

Exudate

141
Q

Treatment for pleural effusion with exudate

A

Must be drained - can cause infection

142
Q

Accumulation of air in pleural space presenting with dyspnea, uneven chest expansion, CP, decreased tactile fremitus, hyperresonance, and diminished breath sounds on affected side

A

Pneumothorax

143
Q

Pneumothorax due to rupture of apical sub-pleural bleb or cyst occurring in tall, thin, young males with trachea shifted toward affected lung

A

Primary spontaneous pneumothorax

144
Q

Pneumothorax due to diseased lung or barotrauma from high mechanical ventilation pressures

A

Secondary spontaneous pneumothorax

145
Q

Pneumothorax caused by blunt or penetrating trauma

A

Traumatic pneumothorax

146
Q

Can be caused by any condition that causes air to enter pleural space, cannot exit increasing pressure with tracheal deviation away from affected lung

A

Tension pneumothorax

147
Q

Treatment for tension pneumothorax

A

Immediate needle decompression and chest tube placement

148
Q

Common organisms in lobar pneumonia

A

S pneumoniae most common, Legionella and Kliebsella

149
Q

Cause of lobar pneumonia in alcoholics or elderly in nursing homes

A

Klebsiella

150
Q

Findings of lobar pneumonia caused by Klebsiella

A

Currant-jelly sputum and lung abscess, intra-alveolar exudate involving entire lobe or lung

151
Q

Type of inflammatory cells seen in lobar pneumonia

A

Neutrophils

152
Q

Pneumonia with acute inflammatory infiltrates from bronchioles into adjacent alveoli and patchy distribution involving more than 1 lobe

A

Bronchopneumonia

153
Q

Common organisms causing bronchopneumonia

A

S pneumoniae, S aureus, H influenzae, Klebsiella

154
Q

Common causes of pneumonia in neonates

A

GBS and E coli

155
Q

Common causes of pneumonia in children

A

(RMCCS: Runts May Cough Chunky Sputum)

RSV, Mycoplasma, C trachomatis, C pneumoniae, S pneumoniae

156
Q

Common causes of pneumonia in infants to 3 year-olds

A

C trachomatis

157
Q

Common causes of pneumonia in school-aged children

A

C pneumoniae

158
Q

Common cause of pneumonia in young adults

A

Mycoplasma, C pneumoniae, S pneumoniae, Viruses

159
Q

Common causes of pneumonia in older adults

A

S pneumoniae, H influenzae, Anaerobes, Viruses, Mycoplasma

160
Q

Common causes of pneumonia in elderly

A

S pneumoniae, Influenza virus, Anaerobes, H influenzae, Gram negative rods

161
Q

Common causes of pneumonia in alcoholics

A

Klebsiella (also Peptostreptococcus, Fusobacterium, Prevotella, Bacteroides)

162
Q

Common causes of pneumonia in IV drug users

A

S pneumoniae, S aureus

163
Q

Common causes of pneumonia in aspiration

A

Anaerobes

164
Q

Common causes of atypical pneumonia

A

Mycoplasma, Legionella, Chlamydia,

165
Q

Common causes of pneumonia in CF

A

Pseudomonas, S aureus, S pneumoniae, Burkholderia cepacia

166
Q

Common causes of pneumonia in immunocompromised

A

S aureus, enteric gram negative rods, fungi, viruses, P jirovecii

167
Q

Common causes of nosocomial pneumonia

A

S aureus, Pseudomonas, other enteric gram negative rods

168
Q

Common causes of post-viral pneumonia

A

S pneumoniae, S aureus, H influenzae

169
Q

Common causes of interstitial pneumonia

A

Atypical organisms like Mycoplasma, Chlamydia, Legionella and viruses like RSV, CMV, influenza and adenovirus

170
Q

Pneumonia presents with diffuse patchy infiltrate and distribution involving more than one lobe with indolent course

A

Interstitial pneumonia

171
Q

Pneumonia with CXR findings more severe than presenting symptoms

A

Atypical pneumonia (interstitial)

172
Q

Non-infectious pneumonia with inflammation of bronchioles and surrounding structure formerly known as BOOP

A

Cryptogenic organizing pneumonia

173
Q

Findings in cryptogenic organizing pneumonia

A

Negative sputum and blood cultures and no response to antibiotics

174
Q

Natural history of lobar pneumonia

A

Congestion, Red hepatization, Gray hepatization and Resolution

175
Q

Stage of lobar pneumonia characterized by enzymes digesting components of exudate

A

Resolution

176
Q

Stage of lobar pneumonia characterized by red-brown consolidate and exudate with fibrin, bacteria, RBCs and WBCs

A

Red hepatization

177
Q

Stage of lobar pneumonia characterized by red-purple, partial consolidation of parenchyma and exudate with mostly bacteria

A

Congestion

178
Q

Stage of lobar pneumonia characterized by uniform exudate full of WBCs and fibrin

A

Gray hepatization

179
Q

Onset of red hepatization in lobar pneumonia

A

3-4 days

180
Q

Onset of resolution in lobar pneumonia

A

8 or more days

181
Q

Onset of gray hepatization in lobar pneumonia

A

5-7 days

182
Q

Most common location of lung abscess secondary to aspiration

A

Right lung

183
Q

Localized collection of pus within lung parenchyma with air-fluid levels on CXR

A

Lung abscess

184
Q

Treatment for lung abscess

A

Clindamycin

185
Q

Carcinoma that occurs in apex of lung that may invade cervical sympathetic chain

A

Pancoast tumor

186
Q

Symptom caused by compression of laryngeal nerve

A

Hoarseness

187
Q

Symptom caused by compression of stellate ganglion

A

Horner syndrome (ipsilateral ptosis, miosis, anhydrosis)

188
Q

Symptom caused by compression of SVC

A

SVC syndrome

189
Q

Symptom caused by compression of brachiocephalic vein

A

Brachiocephalic syndrome

190
Q

Symptom caused by compression of brachial plexus

A

Sensorimotor deficits

191
Q

Presents with blanching after fingertip pressure in neck and upper extremities, jugular venous distention and upper extremity edema, increased ICP with headaches, dizziness, and increased risk of aneurysm

A

SVC syndrome

192
Q

Common causes of SVC syndrome

A

Mediastinal mass, Pancoast tumor, thrombosis from indwelling catheter

193
Q

Leading cause of cancer death

A

Lung cancer

194
Q

Most common sources of metastatic lung cancer

A

Breast, colon, prostate, bladder cancer

195
Q

Site of metastases from lung cancer

A

Adrenals, brain, bone, and liver

196
Q

Complications of lung cancer

A 
SPHERE:
SVC syndrome
Pancoast tumor
Horner syndrome
Endocrine (paraneoplastic)
Recurrent laryngeal nerve compression
Effusions
197
Q

Risk factors for lung cancer

A

Smoking, secondhand smoke, radon, asbestos, family history

198
Q

Common image findings of lung cancer

A

Coin lesion on CXR or non-calcified lung nodule on CT

199
Q

Common presentation of lung cancer

A

Cough, hemoptysis, bronchial obstruction, wheezing

200
Q

Lung cancer associated with Lambert-Eaton syndrome

A

Small cell carcinoma

201
Q

Oncogene associated with small cell carcinoma

A

myc oncogene

202
Q

Treatment for small cell carcinoma

A

Chemotherapy

203
Q

Lung cancer with poorly differentiated, small, dark blue cells, chromogranin A positive and neuron-specific enolase positive

A

Small cell carcinoma

204
Q

Endocrine hormones associated with small cell carcinoma

A

ADH (SIAD)

ACTH (Cushing syndrome)

205
Q

Patient with small cell carcinoma presenting with descending muscle weakness may have antibodies to what

A

Presynaptic calcium channels

206
Q

Peripherally located lung cancer most common in nonsmokers that is not responsive to chemotherapy with mucus producing glands

A

Adenocarcinoma

207
Q

Activating mutations associated with adenocarcinoma

A

KRAS, EGFR, and ALK

208
Q

Centrally located lung cancer characterized by keratin pearls, intercellular bridges and hypercalcemia associated with smoking

A

Squamous cell carcinoma

209
Q

Peripherally located, highly anaplastic undifferentiated tumor with pleomorphic giant cells and strong association with smoking that is removed surgically

A

Lung cell carcinoma

210
Q

Hormone that causes hypercalcemia in squamous cell carcinoma of lung

A

PTHrP

211
Q

Lung cancer associated with Kulchitsky cells on histology

A

Small cell carcinoma

212
Q

Lung cancer associates with nests of neuroendocrine cells and chromogranin A positive on histology with well differentiated cells

A

Bronchial carcinoid tumor

213
Q

Symptoms due to mass effect or carcinoid syndrome in bronchial carcinoid tumor

A

Flushing, diarrhea, wheezing

Respiratory-First Aid 2017 (5 decks)

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