Pulmonary Disorders

Question 1

Obliterative bronchiolitis

Answer 1

• Caused by adenovirus

* Bronchiolitis —> healing by fibrosis

Question 2

RSV

Answer 2

• Nosocomial infection of children
• Usually self-limited
• May cause disorganized epithelium and severe distention (? displaced surfactant)

Question 3

Whooping cough

Answer 3

• Bordetella pertussis

* May cause bronchiectasis

Question 4

Candida albicans

Answer 4

•May produce mucosal ulceration

Question 5

Bronchocentric granulomatosis

Answer 5

• In asthmatic pts: allergic aspergillosis

* Non-asthmatic pts: TB or histoplasma; often coincides w/ autoimmune disease

Question 6

Right middle lobe syndrome

Answer 6

Collapse of R middle bronchus from hilar lymphadenopathy

Question 7

Strep pneumoniae

Answer 7

• Young to middle-aged adults
• Lobar PNA
• S/p aspiration of pneumococci or viral URI
• “Rusty” sputum, alveolar filling on CXR

Question 8

Klebsiella pneumoniae

Answer 8

• Lobar PNA

* Mucoid lung surfaces, bulging lobes, tissue necrosis/abscesses —> bronchopleural fistula

Question 9

Staph aureus

Answer 9

• Common in CF pts, nosocomial infection

* Many small abscesses; may create pneumatoceles (cystic spaces)

Question 10

Group B strep

Answer 10

Newborns; Sx look like respiratory distress syndrome; w/ severe toxemia, rapid death

Question 11

Legionella

Answer 11

• Hard to Cx
• Contaminated water
• Widespread bronchopneumonia w/ necrosis of inflammatory cells

Question 12

Pseudomonas aeruginosa

Answer 12

• Immunocompromised, burns, CF

* Occurs w/ vasculitis

Question 13

Mycobacterium

Answer 13

• Ghon lesion: granuloma at periphery of lung
• Miliary TB: multiple small granulomas in many organs
• M. avium-intracellulare: immunocompromised, extensive macrophage infiltrate w/ innumerable acid-fast orgs

Question 14

Actinomycosis

Answer 14

• Multiple small lung abscesses
• Gram + filamentous bacteria
• Sulfur granules

Question 15

Nocardia

Answer 15

• Beaded, thin filaments w/ R angle branching

* Pts w/ lymphomas, neutropenia, chronic granulomatous disease, alveolar proteinosis

Question 16

Histoplasmosis

Answer 16

• Midwest & South
• Inhalation of bird droppings
• Resembles TB
• Granulomas prone to calcification

Question 17

Aspergillosis

Answer 17

• AIDS pts or pts on cytotoxic therapy
• Invasive: blood vessel invasion —> thrombosis, lung infarcts
• Aspergilloma: fungus ball grows in pre-existing cavity
• Allergic bronchopulmonary aspergillosis: eosonophilia, increased serum IgE, proximal bronchiectasis

Question 18

Pneumocystitis jiroveci

Answer 18

• Fungus
• Interstitial infiltrates, type 2 pneumocyte hyperplasia
• Alveoli filled w/ foamy exudate

Question 19

CMV

Answer 19

• Interstitial infiltration

* Cytomegaly w/ nuclear inclusion

Question 20

Diffuse alveolar damage

Answer 20

• Causes ARDS
• Triggered by variety of insults
• Hyaline membranes and collagen deposition in alveolar walls
• Leakage of plasma proteins
• “Honeycomb lung”

Question 21

Goodpasture syndrome

Answer 21

Diffuse alveolar hemorrhage, glomerulonephritis, Ab to basement membrane

Question 22

Eosinophilic PNA

Answer 22

• Loeffler syndrome: Mild or asymptomatic PNA with eosinophilia
• Acute/chronic: allergy association
• Infectious: parasites

Question 23

Lipid PNA

Answer 23

• Endogenous: secondary to bronchial obstruction

* Exogenous: aspirated oils

Question 24

Alpha 1-antitrypsin deficiency

Answer 24

• A1AT is an inhibitor of proteinases including elastases
• Lack of inhibition leads to alveolar wall destruction
• Possible liver disease

Question 25

Silicosis

Answer 25

*  Simple nodular: progression of 10-40 yrs; "whorled" collagen nodules containing needle-shaped silicates; possible "eggshell calcification" of nodes *  Progressive massive: nodules 2-10 cm wide w/ central cavitation *  Acute: progression of a few yrs; no nodules; alveoli contain eosinophilic material

Question 26

Coal workers' pneumoconiosis

Answer 26

*  Anthracosis or anthracosilicosis *  Scattered 1-4 mm black foci *  Carbon-laden macrophages

Question 27

Asbestos

Answer 27

*  Diffuse interstitial fibrosis *  Asbestos bodies: long, thin fiber surrounded by iron-protein coat *  Plaque on parietal pleura *  Mesothelioma

Question 28

Berylliosis

Answer 28

*  Aerospace, industrial ceramics, or nuclear industries | *  Noncaseating granulomas

Question 29

Talcosis

Answer 29

*  Variable pathology *  FB granulomas w/ plate-like particles *  Associated w/ IV drug use

Question 30

Acute hypersensitivity pneumonitis

Answer 30

*  Acute or chronic interstitial inflammation | *  Chronic may have poorly formed granulomas, organizing PNA

Question 31

Sarcoidosis

Answer 31

*  Can also involve nodes, skin, eye *  More common in African-Americans *  CD4 helper cells form multiple noncaseating granulomas *  Along pleura, interlobular septa, around bronchovascular bundles, bronchial submucosa (diagnose via bronchoscopic biopsy) *  Can progress to onion-skin fibrosis around giant cells

Question 32

Idiopathic pulmonary fibrosis

Answer 32

*  Patchy interstitial fibrosis adjacent to normal lung *  Loose fibroblastic tissue adjacent to dense collagen *  Epithelium grows into dilated airspaces *  Gradual DOE and dry cough over 1-3 yrs

Question 33

Desquamative interstitial PNA

Answer 33

*  Smokers *  Alveolar architecture is preserved w/ minimal fibrosis *  Intra-alveolar macrophages contain golden-brown pigment

Question 34

Respiratory bronchiolitis

Answer 34

*  Smokers | *  Pigmented macrophages centered on bronchioles

Question 35

Langerhans cell histiocytosis

Answer 35

*  Smokers 20-40 *  Nodular infiltrates w/ stellate border *  Langerhans cells: eosinophilic cytoplasm, grooved nuclei *  Eosinophils

Question 36

Lymphangioleiomyomatosis

Answer 36

*  Women of childbearing age *  Abnormal proliferation of smooth muscle in lung (? hormonal control) *  Tuberous sclerosis gene complex mutation

Question 37

Pulmonary HTN

Answer 37

*  L to R shunt *  Recurrent PEs *  Hypoxemia *  LV failure

Question 38

Pulmonary hamartoma

Answer 38

*  Usu. at periphery *  Popcorn calcification *  Several types of tissue interspersed w/ respiratory epithelium-lined clefts

Question 39

Small cell carcinoma

Answer 39

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