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Flashcards in Respiratory Pathology Deck (42):
1

What is rhinosinusitis? Symptoms? Causes? What can it lead to?

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

Viral URI

May lead to superimposed bact infeciton such as S. pneumo, H. influenzae, M. catarrhalis

2

What is nasopharyngeal CA? Association? Epid? Biopsy? Presentation?

malignant tumor of nasopharyngeal epithelium

EBV: african children and chinese adults

Pleomorphic keratin-positive epithelial cells in backgrond of lymphocytes

Involvement of cervical nodes

3

What is epistaxis? Where does it most commonly occur (which vessels)? Where can life threatening hemorrhages occur? Which vessels?

Nose bleed

Anterior segment of nostril (kiessebach plexus)

Posterior segment (sphenopalatine artery of maxillary artery)

4

What is a vocal cord nodule? What causes it? Location? What is it composed of? Presentation? Treatment?

Singer's nodule

Excessive use of vocal cords

Bilateral nodule on true vocal cords

Degenerative (myxoid) CT

Hoarseness

Resting of voice

5

What is a laryngeal papilloma? What causes it? Presentation?

Benign papillary tumor of the vocal cord

HPV 6 and 11; single in adults, multiple in children

hoarseness

6

What is laryngeal CA? What does it arise from? Risk factors? Presentation?

squam. cell CA arising from vocal cord epithelial lining

Alcohol and tobacco

hoarseness; also cough and stridor

7

What are the symptoms of a DVT? What puts people at risk? What do 95% of PE arise from? What is Homan sign? What is the treatment?

Swelling, redness, warmth, pain

Virchow triad

proximal deep veins of LE

Dorsiflexion of foot-->calf pain

Heparin or LMWH for acute management

Warfarin for treatment (long term)

8

What is the pathophys of pulmonary emboli? Symptoms? Diagnosis?

V/Q mismatch leasd to hypoxemia leads to respiratry alkalosis (incr. breathing).

Sudden onset dyspnea, chest pain, tachypnea, and tachycardia
Sudden death

CT pulmonary angiography

9

What is the pathophys of obstructive lung diseases? What happens to the PFTs? What happens to vasculature?

Obstruction of air flow resulting in air trapping in lungs. Airways close prematurely at high lung volumes.

Incr. RV and decr. FVC

Very Decr. FEV1

Decr. FEV1/FVC ratio (hallmark)

V/Q mismatch

Chronic hypoxic pulmonary vasoconstriction can lead to cor pulmonale

10

What is the pathology of chronic bronchitis? How is the diagnosis made? What are the findings?

Blue bloater

Hyperplasia of mucus secreting glands in bronchi leads to reid index (ratio of glands to wall thickness) >50%

Productive cough for >3 months per year for at least 2 yeras

Wheezing, crackles, cyanosis (early onset hypoxemia due to shunting), late onset dyspnea, CO2 retention, Secondary polycythemia

11

What is the pathology of emphysema? What are the two types are what are they associated with? Pathophys? CXR finding? How do they breath? Symptoms?

Enlargement of air spaces, decreased recoil, incr compliance, decr. diffusing capacity for CO resulting from destruction of alveolar walls.

Centriacinar: smoking
Panacinar: alpha 1 antitrypsin

Incr. elastase activity leads to loss of elastic fibers leading to incr. lung compliance

Pursed lip breathing

Barrel shaped Chest

Severe dyspnea

12

What is the pathology of asthma? What are some speficic histological findings and what causes them? What triggers it? Diagnosis? Findings?

Bronchial hyperresponsiveness cuases reversible bronchoconstriction.

Smooth muscle hypertrophy
Curschmann spirals (shed epithelium forms whorled mucus plugs)
Charcot-Leyden crystals (eosinophilic, hexagonal, double pointed, needle like crystals formed from breakdown of eosinophils in sputum)

Viral URIs, allergens, stress

Methacholine challenge

Cough, wheezing, tachypnea, dyspnea, hypoxemia, decr. insp/exp ratio, pulsus paradoxus, mucus plugging

13

What is the pathology of bronchiectasis? Symptoms? Associations/causes?

chronic necrotizing infection of bronchi leading to permanently dilated airways.

Purulent sputum, cough, dyspnea, recurrent infections, hemoptysis

Bronchial obstruction, poor ciliary function (smoking, kartageners), CF, allergic bronchopulmonary aspergillosis)

14

What is the pathology of restrictive lung disease? PFTs? What are the two main types/etiologies and how do their findings differ?

Restricted lung expansion causes decr. lung volumes.

Decr. FVC and TLC
FEV1/FVC ratio is greater than or equal to 80%

Poor breathing mechanics: extrapulmonary, peripheral hypoventilation, normal A-a gradient

Interstitial lung diseases: decr. pulm. diffusing capacity, incr. A-a gradient

15

What are some examples of poor breathing mechanics that lead to RLD? What are some interstitial lung diseases?

Poor muscular effort: Polio, myasthenia gravis
Poor structural apparatus: scoliosis, morbid obesity

ARDS, NRDS, Pneumoconioses (coal workers, silicosis, berylliosis, asbestosis), sarcoidosis, idiopathic pulmonary fibrosis, goodpasture syndrome, Wegener, eosinophilic granuloma, hypersensitivity pneumonitis, drug toxicity

16

What is the pathophys of idiopathic pulmonary fibrosis? Histology? Symptoms? Treatment?

Repeated cycles of lung injury leadin to TGF-beta release leading to fibrosis

Progressive dyspnea and cough

Honeycomb lung

Transplant

17

What is the pathophys of sarcoidosis? Epid? Affected organs? Findings/syptoms?

Noncaseating granulomas in multiple organs (CD4 helper t cells

African american males

bilateral hilar LAD
uveitis
cutaneous nodules or erythema nodosum
salivary and lacrimal glands (sjogren like)

Incr ACE in serum
hypercalcemia
dyspnea or cough

18

What is pathophys of hypersensitivity pneumonitis? Symptoms? epid?

mixed type III/IV HSR to environmental antigen

Dyspnea, cough, chest tightness, headache

Farmers and those exposed to birds

19

What are 4 examples of pneumoconioses? What do they increase risk for? What is caplan syndrome?

coal workers pneumoconioses, silicosis, berylliosis, asbestosis

Incr. risk of cor pulmonale and Caplan syndrome (RA with pneumocon. with intrapulmonary nodules)

20

Epid. of asbestosis? Gross path? What does it increase risk for? What part of lung? Micro histo?

Shipbuilding, roofing and plumbing

Ivory white, calcified, supradiaphragmatic and pleural plaques

Incr. incidence of lung cancer (bronchogenic > mesothelioma)

asbestos (ferruginous) bodies are golden brown fusiforms rods resembling dumbells found in alveolar septum

21

Epid. of berylliosis? What part of lungs? HIstology?

Aerospace and manufacturing

Granulomatous (Tb mimicker)

Upper lobes

22

pathophys of coal workers pneumo? Location in lungs? What is anthracosis?

prolonged exposure to coal dust leads to macrophages laden with carbon leading to inflamm. and fibrosis

Black lung disease

Upper lobes

Asymptomatic coal dust in lungs (urban dwellers/sooty air)

23

What is the epid. or silicosis? Pathophys? Incr susceptibility to what? How? Incr. risk of what? histology? Location in lung?

Foundries, sandblasting, mines

Macrophages respond to silica and release fibrogenic factors leading to fibrosis.

Disrupts phagolysosomes which may lead to Tb

Bronchogenic CA

Upper lobes

Eggshell calcification of hilar lymph nodes

24

What is the pathophys of NRDS? What lab value is predictive of it? What are some complications? What are some complications due to supplemental O2? Risk factors for it? What is the treatment? Histology? CXR findings?

Surfactant defic leading to incr. surface tnesion leading to alveolar collapse

Lecithin:sphingo ratio

25

How is ARDS characterized? What may cause it? Pathophys/histology? What is the initial damage due to? How is it managed?

Acute onset respiratory failure
Bilateral lung opacities
Decr. PaO2/FiO2
No HF

Trauma, sepsis, shock, gastric aspiration, uremia, acute pancr, amniotic fluid embolism.

Release of neutrophilic substances toxic to alveolar wall, activation of coag cascade, and oxygen derived free radials

This leads to diffuse alveolar damage leading to incr. alveolar capillary permeability leading to a protein rich leakage into alveoli and non cardiogenic pulmonary edema

Intraalveolar hyaline membranes

Mech. ventilatin with low tidal volumes (PEEP)

26

What is sleep apnea? What des it lead to? What does nocturnal hypoxia lead to? What is the cause of obstructive lseep apnea? ASsciations? Causes? Treatment? What is central sleep apnea? What does it lead to? What is obesity hypoventilation syndrome? How does it differ from obstructive sleep apnea?

Repeated cessation of breathing > 10 sec during sleep leads to disrupted sleep leading to daytime somnolence
NOrmal PaO2 during the day
Nocturnal hypoxia leads to systemic/pulmonary hypertension, arrhythmias (a fib/flutter), sudden death

Obstructive: resp. effor against airway obstruction
Obesity, loud snoring
Adults: excess parapharyngeal tissue
Children: adenotonsillar hypertrophy
Weight loss, CPAP, surgery

Central: no resp. effort (due to CNS injury/toxicity)
Hypoxia leading to incr. EPO release leading to erythropoesis

Obesity Hypoventilation: Obesity leads to hypoventilatin (decr. RR) leading to decr. PaO2 and incr. PaCO2 at night but PaCO2 continues throughout day.

27

What is a normal mean pumonary artery pressure? What is it in pulmonary hypertension? What does it lead to (histo)? What is the disease course (syptom progression)? What are the 5 classification groups?

NOrmal=10-14 mmHg
PH >= 25 mmHg

Arteriosclerosis, medial hypertrophy, intimal fibrosis of pulm. arteries

Severe resp. distress then cyanosis and RVH then death from decomp. cor pulmonale

Pulm. art. hypertension (idiopathic)
Due to left heart disease
due to lung diseases or hypoxia
chronic thromboembolic PH
Multifactorial

28

What is the cause of PAH? Mutation? Prognosis? Disease processes included in it? What are some causes of PH due to left heart disease? What are some causes of PH due to lung disease or hypoxia? Pathophys of PH due to chronic TE? Some causes of multifactorial?

Idiopathic
Heritable: Inactivating mutaiton of BMPR2
Pulmonary venous occlusive disease
persistent PH of newborn

syst/diast dysfunction and valvular disease

Lung parenchyma destruction (COPD) and hypoxemic conditions (altitude, obstructive sleep apnea)

Recurrent microthrombi leads to a decr. cross sectional area of pulm. vascular bed

Hematogic, systemic, and metabolic diseases

29

What are the breath sound, percussion, fremitus, and tracheal deviation findings in pleural effusion, atelectasis, simple pneumothorax, tension pneumothorax, and consolidation (lobar pneumo and pulm. edema)?

PLEURAL EFFUSION

BS: Decr
Perc: dull
Frem: Decr
Trach: none or away from side of lesion (if severe)

ATELECTASIS

BS: decr
Perc: dull
Frem: decr.
Trach: toward side of lesion

SIMPLE

BS: decr.
Perc: hyperresonant
Frem: decr.
Trach: none

TENSION

BS: decr.
Perc: hyperresonant
Frem: decr.
Trach: away from lesion

CONSOLIDATION

BS: bronchial breath sounds, late insp. crackles
Perc: dull
Frem: incr.
Trach: none

30

What is a pleural effusion? What does it lead to How can it be treated? What is a transudate? What causes it? What is an exudate like? What causes it? Treatment implications? What is a lymph pleural effusion like? Another name? Cause?

Excess accumulation of fluid between pleural layers
Restricted lung expansion during inspiration
Thoracentesis to remove fluid

TRANSUDATE

Decr. protein content
Incr. hydro pressure or decr. oncotic

EXUDATE

incr. protein, cloudy
malignancy, pneumonia, collagen vasc. disease, trauma (incr. vasc. permeability)
Must be drained (incr. risk for infection)

LYMPH

Milky appearing fluid, incr. triglyc
chylothorax
Thoracic duct injury from trauma or malignancy

31

What is a pneumothorax? Symptoms? Findings? What happens in a primary spontaneous pneumo? Epid? What causes secondary spontaneous? What occurs in traumatic pneumothorax? What is a tension pneumothorax? Findings?

Accumulation of air in pleural space
Unilateral chest pain and dyspnea, unilateral chest expansion
Decr. tactile fremitus, hyperresonance, diminished breath sounds

rupture of apical blebs or cysts: tall thin, young males

diseased lung, mechanical ventilation with high pressures

Blunt or penetrating trauma

Air enters pleural space but cannot exit
Trachea deviates away from effected lung.

32

What are some signs/symptoms of pneumonia?

Fever and chills
Productive cough with yellow-green (pus) or rusty (bloody) sputum
Tachypnea with pleuritic chest pain
Decr. breath sounds
Dullness to percussion
Elevated WBC

33

What are the typical organisms that cause lobar pneumo? What are the characteristics? Location? Same questions for bronchopneumo? Same questions for interstitial (atypical) pneumo? What is the disease course like?

LOBAR

S. pneumo, Klebsiella, Legionella
Intra-alveolar exudate (consolidation)
Entire lobe or lung

BRONCHO

S. pneumo, S. aureus, H. influenze, Klebsiella
Acute inflammatory infiltrates from bronchioles into adjacent alveoli
Patchy distribution of 1 or more lobes

INTERSTITIAL

Viruses (influenza, CMV, RSV, adenoviruses), Mycoplasma, Legionella, Chlamydia

34

What is a lung abscess? What causes it? In which patients does it occur in? What is the treatment? What is seen on CXR? What microbes is it usually due to?

Localized collection of pus within parenchyma

Aspiration of oropharyngeal contents (alcoholics, epileptics) or bronchial obsruction (cancer)

Clindamycin

Air fluid levels

Anaerobes (bacteroides, fusobacterium, peptostreptococcus) or S. aureus

35

What is mesothelioma? Assocations? Results? Histo? What is not a risk factor?

malignancy of pleura associated with asbestosis

Hemorrhagic pleural effusion
Pleural thickening

Psammoma bodies

Smoking is not a risk factor

36

What is a pancoast tumor? What is Pancoast syndrome and how does it occur? What is superior vena cava syndrome? What are some risks involved?

CA that occurs in apex of lung.

Can invade cervical symp chain leading to:

Horner syndrome (ipsilateral miosis, anhydrosis, ptosis)

SVC syndrome (block off SVC-->impaired blood drainage from head (facial plethora), blanching after fingertip pressure, JVD, edema of upper extremities, dyspnea--->medical emergency (INcr. ICP=headaches, dizziness, risk of aneurysm/rupture)

Sensorimotor deficits

Hoarseness

37

What is the presentation of lung cancer? On CXR? CT? Where do they metastasize to? From? What are some complications? Risk factors? What are the 5 kinds? Where are they located? Subtype?

Cough, hemoptysis, bronchial obstruction, wheezing
Pneumonic coin lesion on CXR
Noncalcified nodule on CT

Adrenals, bone (apth fracture), liver (jaundice, hepatomegaly)

Breast, colon, prostate, bladder

SPHERE of complications

SVC syndrome
Pancoast tumor
Horner syndrome
Endocrine (PNP)
Recurrent laryngeal nerve compression (hoarseness)
Effusions (pleural or pericardial)

Smoking, secondhand smoke, radon, asbestos, FH

Squamous and Small cell are sentral

Small cell (central), adeno (periph)(bronchioloalveolar), squam (central), large cell (periph), bronchial carcinoid

38

What is the grade of small cell CA? What PNP syndromes will it cause? Mutations? Treatment? histology? Staining?

Undifferentiated=very aggressive

Acth (Cushing syndrome)
siAdh
Lambert Eaton myasthenic syndrome (Antibodies against presynaptic Ca channels
Paraneoplastic myelitis/encephalitis (Antibodies against neurons)

Amplification of l-myc oncogenes common

Inoperable; chemotherapy

Neuroendocrine Kulchitsky cells=small dark blue cells

Chromogranin positive

39

What is the significant epid. for adenoCA? Mutations? Assocations? Histo? staining? What is bronchioalveolar subtype like? What is seen on CXR? prognosis?

Most common lung cancer in non smokers

Activating mutations of KRAS, EGFR, and SLK

Hypertrophic osteoarthropathy (clubbing)

Glandular pattern

Mucin+


adenoCA in situ
CXR=hazy infiltrates similar to pneumo (grow along alveolar subtype--->apparent thickening of alveolar walls)
Excellent prognosis

40

Gross path of squamous? Assocations? PNP? Histo?

Hilar mass arising from bronchus; Cavitations

Cigarettes

hyperCalcemia (PTHrP)

Keratin pearls and intercellular bridges

41

What is the grading of large cell CA? Prognosis? Treatment? Histo? serum marker?

Highly anaplastic undifferentiated tumor

Poor prognosis

Less responsive to chemo; surgery

Pleomorphic giant cells

Beta HCG (maybe)

42

What is the prognosis for bronchial carcinoid tumor? What causes symptoms usually? What are the symptoms of carcinoid syndrome? pathophys? Histo? Staining

Excellent prognosis; metastasis rare

Mass effect

5-HT secretion leasd to flushing, diarrhea, wheezing

Nests of neuroendocrine cells

Chromogranin A +