Pulmonary Path 3/4

Question 1

Atypical adenomatous hyperplasia (AAH)

Answer 1

<5 mm

dysplastic pneumocytes present along alveoli with some interstitial fibrosis

Question 2

Adenocarcinoma in situ (AIS)

Answer 2

< 3 cm

dysplastic pneumocytes confluently growing along alveoli

Question 3

DIPNECH characteristics

Answer 3

precursor lesion
neuroendocrine tumor
very small, less than 5 mm (“tumorlets”)

Question 4

carcinoid tumor characteristics

Answer 4

5mm or larger
can metastasize
neuroendocrine carcinoma grade 1

Question 5

Neuroendocrine tumor grade 2

Answer 5

Atypical carcinoid tumor

• necrosis
• increased mitotic activity (increased rates of metastasis)
• disordered growth

Question 6

Neuroendocrine tumor grade 3

Answer 6

small cell carcinoma

Question 7

empyema

Answer 7

exudate with accumulation of pus in the pleural space (typically from a bacterial infection)

Question 8

What is empyema notorious for?

Answer 8

creating loculations or web like traps for fluid

Question 9

what does empyema look like?

Answer 9

fluid will be thick, yellow; smears show neutrophils and bacteria

Question 10

viral infectious rhinitis/sinusitis causes and appearance

Answer 10

• Rhinovirus, coronavirus, adenovirus, echovirus

- clear rhinorrhea

Question 11

bacterial rhinitis/sinusitis causes and appearance

Answer 11

• superimposed infection (strep pneumoniae, haemophilius influenzae)
• thick purulent nasal secretions

Question 12

allergic rhinitis/sinusitis cause/appearance

Answer 12

• can be from a variety of inhaled allergens (type 1 hypersensitivity)
• edema, rhinorrhea

Question 13

inflammatory sinonasal polyps clinical presentation/histo

Answer 13

presentation: large ball of mucus in sinuses
histo: edema in stroma with eosinophilic infiltrates

Question 14

What can cause obstructions with sinusitis?

Answer 14

• empyema

- mucocele

Question 15

Pathway of infection with sinusitis?

Answer 15

• enters maxillary sinus by tracking along periapical tissues (oral flora)
• advanced sinusitis can secondarily spread infection

Question 16

Where can ethmoidal sinusitis spread to?

Answer 16

pre-septum, orbit

Question 17

Where can frontal sinusitis spread to?

Answer 17

brain, meninges

Question 18

mycetoma

Answer 18

fungal ball seen with fungal sinusitis

Question 19

who gets acute invasive sinusitis?

Answer 19

diabetics, immunocompromised people

Question 20

What causes fungal sinusitis?

Answer 20

Zygomycosis species (mucor)

Question 21

Treatment of fungal sinusitis

Answer 21

emergent situation requiring IV antifungal therapy to prevent extension into the brain or sepsis

Question 22

clinical presentation Granulomatosis with polyangiitis

Answer 22

• middle aged adults

- nasal passages and sinuses have ulceration, necrosis and perforation of the septum

Question 23

histology Granulomatosis with polyangiitis

Answer 23

granulomatous inflammation/vasculitis

classic necrobiotic blue

Question 24

What agents are responsible for otitis media?

Answer 24

Streptococcus pneumoniae
Moraxella catarrhalis
Haemophilus influenzae

Question 25

What agent is responsible for chronic otitis media in diabetics?

Answer 25

Pseudomonas aeruginosa

Question 26

what is a cholesteatoma?

Answer 26

- cystic lesion that arises in chronic otitis media - lined by benign squamous epithelium with trapped keratin debris - Not neoplasm, can enlarge and erode adjacent bone

Question 27

otosclerosis

Answer 27

abnormal bony deposition, typically at the stapedial foot plate

Question 28

what does otosclerosis cause?

Answer 28

conductive hearing loss

Question 29

what is the inheritance of otosclerosis?

Answer 29

Autosomal dominant

Question 30

embryological origin of carotid body tumors

Answer 30

neural crest cells (from autonomic paraganglia)

Question 31

clinical presentation of carotid body tumors

Answer 31

May arise sporadically or be associated with MEN2

Question 32

radiographic features of carotid body tumors

Answer 32

lyre sign (bowing of vessels)

Question 33

Histologic findings for Dx of carotid body tumors

Answer 33

Nests of cells ("zellenballen") that are demonstrated with S-100 stain

Question 34

what radiological finding is ARDS associated with and why?

Answer 34

Diffuse whiteout due to permeative pulmonary edema

Question 35

What type of lesion is a hamartoma on radiology?

Answer 35

popcorn calcification or "coin"

Question 36

What causes resorption atelectatsis and what does it look like?

Answer 36

Airway blockage causes and it looks like a wedge shape Possible Blockages - tumor - foreign body - mucus

Question 37

pneumothorax on radiology

Answer 37

expiratory chest film shows shift of mediastinum