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250 Cards in this Set
- Front
- Back
what are the heart failure cells?
|
hemosiderin macrophages- in lungs after hemodynamic edema
|
|
what disease is an example of localized edema due to microvascular injury?
|
pneumonia
|
|
what disease is an example of diffused edema due to microvascular injury?
|
adult respiratory distress syndrome
|
|
what disease causes pulmonary edema in the absence of cardiac failure with an abrupt onset of hypoxia and diffuse alveolar damage?
|
acute respiratory distress syndrome
|
|
what discriminates the fluids seen in hemodynamic versus DAD?
|
DAD shows exudate(protein) where hemodynamic shows transudate
|
|
what are the two stages of DAD seen in ARDS?
|
acute(exudative)edema, type II damage, HYALINE membranes
organizing(proliferative)- type II hyperplasia, fibrosis, squamous metaplasia |
|
what are hyaline membranes and what contributes to their formation?
|
made of plasma proteins and necrotic epithelial cells
decrease bronchioloalveolar urokinase plasminogen activator-mediated fibrinolysis |
|
what transcription factor tips the balance for pro-inflammatory state in ARDS?
|
nuclear factor kB which increases IL8
|
|
how are neutrophils involved in ARDS?
|
excessive generation of reactive O2 species and N2 species contribute to endothelial barrier dysfunction
|
|
which pneumocytes grow back first after ALI?
|
type II and they differentiate into type I
|
|
what is seen on a chest xray or CT in ALI?
|
diffuse bilateral lung infiltrates
|
|
how do the functional abnormalities of ALI present?
|
not evenly distributed, some areas are normal and others are ischemic or collapsed
|
|
what are the predisposing factors to neonatal respiratory distress syndrome?
|
pre-term
male maternal diabetes-insulin suppresses surfactant C-section |
|
what presents on the chest xray in NRDS?
|
uniform minute reticulonodular densities(ground glass)
|
|
when is surfactant produced?
|
after the 35th week
|
|
what increases surfactant production?
|
corticosteroids and thyroxine
|
|
big difference between ARDS and NRDS?
|
no neutrophils in NRDS
|
|
prognosis for NRDS?
|
excellent if they make it past 3 days
|
|
how is lung maturity tested in utero?
|
amniotic fluid phospholipids
|
|
what are some complications of prolonged oxygen therapy?
|
retrolental fibroplasia- increased VEGF due to hypoxia which causes angiogenesis and retinal vessel proliferation
bronchopulmonary dysplasia- decrease in alveolar septation and dysmorphic capillary architecture |
|
other pre-term complications accompanying NRDS?
|
patent ductus arteriosus
intraventricular brain hemorrhage necrotizing enterocolitis |
|
definition of emphysema?
|
abnormal IRREVERSIBLE enlargement of airspaces distal to terminal bronchiole with destruction of the their walls, no fibrosis
|
|
where is centriacinar emphesyma found?
|
apical segments in heavy smokers
|
|
where is panacinar emphysema found?
|
lower lobes, associated with alpa 1 antitrypsin deficiency, voluminous lungs
|
|
where is distal acinar emphysema found?
|
upper half of lungs, adjacent to pleura and areas of fibrosis, may cause spontaneous pneumothorax
|
|
clinical presentation of pink puffers?
|
emphysema- dyspnea, weight loss, barrel chest, prolonged expiration, small heart, use of accessory respiratory muscles
|
|
definition of chronic bronchitis?
|
persistent productive cough for at least three months in two consecutive years in the absence of any other cause
|
|
problem in chronic bronchitis?
|
increase in mucous gland size
airway inflammation and fibrosis infections |
|
what is the Reid index?
|
mucous layer/wall between epithelium and cartilage
>.5 is significant |
|
clinical presentation of blue bloaters?
|
persistent cough with sputum,dyspnea with exertion, hypercapnia,hypoxemia, cyanosis, large heart
|
|
inflammatory cells of chronic bronchitis?
|
CD4 TH 17
CD8, neutrophils and macros release LTB4, TNR and IL8 |
|
what is the most common alpha 1 antitrypsin deficient phenotype of chronic bronchitis?
|
PiZZ- 10% of normal level
|
|
what proteases causes the damage in chronic bronchitis?
|
elastase from neutrophils and metalloproteinases from macro's and neutro's
|
|
definition of asthma?
|
chronic inflammatory disorder of the airways that causes episodic, reversible bronchoconstriction due to increased responsiveness of the tracheobronchial tree to various stimuli
|
|
what is the genetic predisposition linked to asthma?
|
type I IgE hypersensitivity, atopic asthma
|
|
what is extrinsic asthma?
|
type I hypersensitivity reaction induced by exposure to extrinsic antigen
|
|
what is intrinsic asthma?
|
non-immune triggering mechanism(aspirin, virus, cold)
|
|
pathogenesis of acute atopic asthma?
|
presensitized IgE mast cells stimulate IgE cross-linking and release of chemical mediators
initial sensitization to allergen via TH2 cells |
|
pathogenesis of late phase atopic asthma?
|
mediated by leukocytes(neutro's,lympho's,eosino's,) and epithelial cells
|
|
what causes non atopic asthma?
|
usually respiratory tract infection with more viruses than bacteria
|
|
what patients develop aspirin sensitive asthma?
|
those with nasal polyps and recurrent rhinitis
|
|
what is the morphology of asthma?
|
overdistended lungs with atelectasis
mucus plugs eosinophil infiltrate Curschmann spirals(shed epithelium) Charcot-Leyden crystals(eosinophil membrane proteins) think BM of bronchiol epithelium |
|
what gene is involved in atopic asthma?
|
ADAM33 gene- increases bronchial smooth muscle and fibroblasts which increases hyperreactivity
|
|
big clinical feature of asthma fluids?
|
elevated eosinophils in peripheral blood
Curshmann spirals and Charcot-Leyden crystals in sputum |
|
definition of bronchiectasis?
|
chronic necrotizing infection associated with abnormal IRREVERSIBLE dilation of bronchi and bronchioles
|
|
what diseases is bronchiectasis associated with?
|
CF-universal over 6 months age
Kartagener syndrome Immunodef. states intralobular sequestration of lung primary ciliary dyskinesia pneumonia RA,SLE,IBD,transplant |
|
what is required for the development of bronchiectasis?
|
obstruction and infection, no order
|
|
what is primary ciliary dyskinesia?
|
linked to bronchiectasis
defect in ciliary motility by absence of dynein arms produces infertile males 50% develop Kartagener syndrome: bronchiectasis sinusitis situs inversus(organs in transverse plane) infertility |
|
morphology of bronchiectasis?
|
lower lobes
dilation of airways inflammatory exudation desquamation of lining and necrotizing ulceration of epithelium lung abscesses |
|
clinical features of bronchiectasis?
|
severe cough
large amounts of purulent, bloody sputum dyspnea paroxysmal orthopnea |
|
definition of pneumoconioses?
|
non-neoplastic lung reaction to inhaled particulates and vapors- usually mineral dust
similar risks to general and occupational exposure |
|
what are the most dangerous particles for pneumoconioses?
|
those between 1 to 5 micrometers-they reach the alveolar sacs- or fibers which are narrow
|
|
particle size in relation to presentation of pneumoconioses?
|
small-acute lung injury
large- interstitial fibrosis |
|
what is the morphology of coal workers' pneumoconiosis?
|
anthracosis-accumulation of carbon laden macro's in connective tissue septae along subpleural and parenchymal lymphatics and in lymphoid tissue- found in coal workers' pneumoconiosis
BENIGN |
|
difference between coal workers' pneumoconiosis and silicosis?
|
no evidence of susceptibility to TB or cancer in pneumoconiosis
|
|
what is the most prevalent chronic occupations disease worldwide?
|
silicosis
|
|
what type of silica is most associated with silicosis?
|
crystalline forms(quartz)
|
|
morphology of silicosis?
|
silica in alveolar macro's-release of TNF
black nodules in upper lungs with concentric hyaline layers |
|
what disease is silicosis associated with?
|
TB
|
|
what are the two forms of asbestos?
|
1 serpentine- most common industrial form but less pathogenic curly and flexible
2 amphibole- more pathogenic. straight and stiff |
|
which asbestos types is linked to mesothelioma?
|
amphibole, but no increased risk with smoking
|
|
how is asbestos different than other inorganic dusts?
|
may act as a tumor initiator and promotor-most likely due to toxic chemicals adsorbed to the fibers
|
|
morphology of asbestos diseases?
|
diffuse interstitial fibrosis
pleural plaques-no asbestos bodies lung carcinomas and mesotheliomas |
|
how are the ILD's grouped together?
|
by similar clinical,radiologic and pathologic features
|
|
what are the major signs and symptoms of the ILD's?
|
dyspnea
DRY cough crackles clubbing of fingers weakness and fatigue skin rash musculoskeletal pain |
|
what is the most important radiologic method for evaluating patients with ILD?
|
high resolution CT scan
|
|
definition of idiopathic pulmonary fibrosis?
|
histologic pattern seen in the clinical setting of insidious onset of diffuse bilateral interstitial lung disease with patchy,temporally heterogeneous fibrosis
|
|
gross findings of idiopathic pulmonary fibrosis?
|
small size
cobblestone appearance of pleural surface patchy white scarring of lower lobe |
|
what is the only definitive treatment for idiopathic pulmonary fibrosis?
|
transplantation
|
|
pathogenesis of idiopathic pulmonary fibrosis?
|
epithelium cell death- surfactant protein C and ABCA3 protein abnormalities
fibroblasts-increased proliferation,enhanced migration and invasion, independent growth TGF beta- induction of lung fibrosis |
|
what is the main induction of lung fibrosis?
|
amount and length of TGF beta cytokine signaling
|
|
distinguishing factor of non-specific interstitial pneumonia?
|
getter outcome than usual interstitial pneumonia
|
|
radiologic findings of idiopathic pulmonary fibrosis?
|
bilateral, symmetrical reticular pattern of lower lung with honeycombing
|
|
radiologic findings of non-specific interstitial pneumonia?
|
ground glass opacities in lower lung
|
|
what are the two patterns of non-specific interstitial pneumonia?
|
1 cellular- mild interstitial inflammation, type II hyperplasia, no dense fibrosis, younger patients
2 fibrosing- dense fibrosis throughout, mild inflammation, NO fibroblastic foci and honeycombing, less survival |
|
treatment of non-specific interstitial pneumonia?
|
corticosteroids
|
|
definition of organizing pneumonia?
|
histologic pattern of excessive proliferation of granulation tissue within small airways and alveolar ducts and mild chronic inflammation
|
|
radiographic findings of organizing pneumonia?
|
unilateral or bilateral areas of consolidation, patchy nodular areas without scarring or honeycombing
|
|
where are the plugs found in organizing pneumonia?
|
intraluminal
|
|
what are the pertinent negative findings in organizing pneumonia?
|
interstitial fibrosis,honeycombing,granulomas,
hyaline membranes,eosinophils,vasculitis |
|
treatment for organizing pneumonia?
|
corticosteroids
|
|
definition of respiratory bronchiolitis?
|
mild ILD with pigmented carbon macrophages in bronchioles and alveoli
|
|
definition of desquamative interstitial pneumonia?
|
intra-alveolar mononuclear cell infiltration WITHOUT fibrosis or honeycombing
|
|
what diseases are almost exclusively seen in current or recent heavy smokers?
|
respiratory bronchiolitis
desquamative interstitial pneumonia |
|
pertinent negative findings of DIP?
|
no fibrosis,lung remodeling,honeycombing,organizing pneumonia pattern,eosinophils
|
|
clinical course of respiratory bronchiolitis?
|
onset at 36- early for ILD
excellent prognosis with cessation of smoking |
|
clinical course of DIP?
|
present in 30s and 40s
men excellent prognosis with cessation of smoking corticosteroids |
|
definition of sarcoidosis?
|
systemic disease(lymph nodes, eyes, skin, spleen, heart, liver, marrow) of unknown etiology primarily involving lungs and is a diagnosis of exclusion, noncaseating granulomatous inflammation
|
|
radiographic findings of sarcoidosis?
|
bilateral symmetric hilar and mediastinal lymph node enlargement, nodules
|
|
histologic findings of sarcoidosis?
|
multiple, well-formed, tightly clustered noncaseating granulomas in the interstitium
|
|
pertinent negatives of sarcoidosis?
|
lack of microorganisms
no inflammation |
|
genetic component of sarcoidosis?
|
susceptibility genes different than clinical disease genes
familial and ethnic clustering HLA-DRB1 CD4,IL2,IFNgamma |
|
clinical course of sarcoidosis?
|
20 to 40 years
U.S.- AA,irish,scandinavians winter or spring corticosteroids some die due to lung, CNS or heart |
|
definition of hypersensitivity pneumonitis?
|
diffuse interstitial granulomatous inflammatory patterns due to immuno reaction to prolonged inhaled ORGANIC Ag's
type III and type IV reaction |
|
findings in acute hypersensitivity pneumonitis?
|
neutrophils in alveoli and respiratory bronchioles
uniform interstitial inflammation |
|
findings in chronic hypersensitivity pneumonitis?
|
noncaseating, POORLY formed granulomas
organizing pneumonia pattern fibrosis,honeycombing |
|
treatment of hypersensitivity pneumonitis?
|
removal of Ag
corticosteroids slow recovery, if fibrosis and honeycombing are present it is not reversible |
|
definition of eosinophilic pneumonia?
|
group of diseases, unknown etiology, accumulation of eosinophils in alveolar spaces or interstitium and peripheral blood eosinophilia
|
|
principles of eosinophilic pneumonia?
|
blood eosinophils do not correlate with inflammation or total IgE levels
not always asthma |
|
definition of pulmonary langerhans cell histiocytosis?
|
chronic,progressive, systemic disease with proliferation of langerhans cell infiltrates that form multiple bilateral interstitial nodules, association with smoking
|
|
radiographic findings in PLCH?
|
nodular pattern sparing the bases
|
|
histologic findings of PLCH?
|
nodules centered on bronchioles with stellate borders and central cavitation
mixed infiltrate-langerhans,macros,lymphos,eosinos |
|
what do langerhan cells show in PLCH?
|
prominent nuclear membrane grooves, S-100 protein and CD1, Birbeck granules
|
|
clinical course of PLCH?
|
rare disease
20 to 40, males, rarely AA universal smoking association |
|
definition of pulmonary alveolar proteinosis?
|
intra-alveolar accumulation of granular eosinophilic surfactant-derived lipid-rich material, little or no inflammation
|
|
radiographic findings of PAP?
|
crazy paving pattern-interlobular septal thickening
|
|
clinical course of PAP?
|
rare
30 to 50, males idiopathic most common(autoimmune) |
|
problem in acquired PAP?
|
autoimmune
deficiency in GMCSF- impaired clearing of surfactant by macro's GMCSF autoAb mutations in GMCSF receptor genes |
|
treatment of PAP?
|
GMCSF replacement therapy
NO role for corticosteroids of cytotoxic therapy |
|
which lung disease are most associated with collagen vascular diseases?
|
NSIP,UIP,OP,vasculitis,bronchiolitis
|
|
which collagen vascular disease involve the lung?
|
RA-chronic pleuritis,ILD without fibrosis,pulmonary HTN
Scleroderma- NSIP,UIP SLE-lupus pneumonitis, patchy infiltrates |
|
features of chronic radiation pneumonitis?
|
marked atypia of type II and fibroblasts
|
|
what is the most common preventable death in hospitalized patients?
|
pulmonary embolism
|
|
what are the signs of a large pulmonary embolus?
|
severe chest pain
dyspnea shock increase temp and lactic DH |
|
definition of pulmonary HTN?
|
when mean pulmonary P reaches 1/4 systemic P
|
|
pathogenesis of primary pulmonary HTN?
|
mutation in bone morphogenetic protein receptor type 2(BMPR2) signaling pathway-usually inhibits proliferation of vascular smooth muscle cells-occlusion
only one allele lost caused loss of signaling |
|
what causes secondary pulmonary HTN?
|
obstructive lung disease
left-right shunt, mitral stenosis thromboemboli autoimmune-sclerosis |
|
pathogenesis of secondary pulmonary HTN?
|
endothelial injury leads to:
vasoconstriction platelet adhesion and activation formation of fibrin vascular obstruction |
|
what is Goodpasture syndrome?
|
Ab mediated injury to glomerular and pulmonary BM's
rapidly progressive glomerular nephritis necrotizing interstitial pneumonia |
|
odd feature of Goodpasture's?
|
more common in males, abnormal for an autoimmune disease
|
|
genetic feature of Goodpasture's?
|
genetic predisposition with HLA-DRB1
Ab against non-collagenous domain of alpha 3 chain of collagen IV |
|
treatment of Goodpasture's?
|
plasma exchange to remove autoAb's and immunosuppressive therapy
|
|
triad of Wegener's granulomatosis?
|
1 acute necrotizing POORLY formed granulomas of upper and/or lower respiratory tract
2 necrotizing vasculitis of smaller vessels 3 focal necrotizing glomerulonephritis |
|
marker of disease activity in Wegener's?
|
c-ANCA( anti neutrophil cytoplasmic antibody
|
|
pathogenesis of Wegener's?
|
cell-mediated immune reaction
|
|
treatment of Wegener's?
|
immunosuppressive therapy-corticosteroids, cytotoxic agent, anti-TNF
|
|
features of idiopathic pulmonary hemosiderosis?
|
intermittent diffuse alveolar hemorrhage of unknown etiology
in children type II hyperplasia NO vasculitis,inflamm,infiltration responds to long-term immunosuppression |
|
what is in mucus?
|
antioxidants
antimicrobial agents IgA,IgG |
|
what infections do innate and humoral deficiencies lead to?
|
pyogenic bacterial infection
|
|
what infection do cell-mediated deficiencies lead to?
|
mycobacteria,herpes and P. carinii
|
|
what are common organisms causing nosocomial pneumonia?
|
gram negative rods and staph aureus
NOT s pneumoniae |
|
most common cause of community pneumonia?
|
S. pneumoniae
|
|
which type of H. influenza infects children?
|
type B(encapsulated) which secretes and Ab(haemocin) that kills the unencapsulated type
|
|
what is the most common cause of acute exacerbation of COPD?
|
H. influenzae
|
|
what does Klebsiella pneumoniae cause?
|
gram negative bacterial pneumonia in debilitated and malnourished patients-chronic alcoholics
|
|
where is Klebsiella found?
|
GI
|
|
where is Pseudomonas aeruginosa found?
|
moist hospital E
|
|
where does Pseudomonas aeruginosa infection occur?
|
CF patients
patients with neutropenia,COPD,cardiac disease,burns,steroid treatment |
|
what is pontiac fever?
|
self-limited upper respiratory tract infection due to Legionella
|
|
where is Legionella found and what are the predisposing conditions?
|
artificial aquatic E
organ transplant recipients, cardiac and renal disease |
|
definition of bronchopneumonia?
|
patchy consolidation that is multilobar,bilateral and basal with neutrophils
|
|
what are the four stages of lobar pneumonia?
|
1 congestion-heavy lung,bacteria
2 red hepatization-firm, airless lungs with RBCs,neutro's and fibrin 3 gray hepatization- gray,dry surface,macros and fibroblasts 4 resolution- fibro's |
|
what bacteria cause abscesses?
|
Klebsiella and S. aureus
|
|
clinical presentation of bacterial pneumonia?
|
high fever
chills cough with mucopurulent sputum pleuritic pain with rub |
|
what is atypical about atypical pneumonia?
|
moderate sputum
no consolidation moderate WBC elevation no alveolar exudate |
|
what is the common cause of atypical pneumonia?
|
mycoplasma pneumoniae
|
|
pathogenesis of atypical pneumonia?
|
attachment to upper epithelium with necrosis and inflammation localized to the alveolar walls
inhibition of clearance leading to secondary bacterial infection |
|
what is the most common cause of a lung abscess?
|
aspiration of infected material
|
|
what bugs cause lung abscesses?
|
strep
S. aureus gram negative oral cavity anaerobes-bacteroides,fusobacterium,peptococcus |
|
clinical features of lung abscess?
|
cough
fever FOUL smelling sputum chest pain weight loss clubbing of fingers and toes |
|
what are the complications of lung abscesses?
|
septic emboli
hemorrhage secondary amyloidosis pleural infection |
|
what causes chronic pneumonia?
|
bacteria-mycobacterium TB
fungi |
|
what is the second leading cause of infectious death worldwide?
|
TB
|
|
pathogenesis of TB?
|
type IV delayed hypersensitivity to MTb Ag
MTb enters and replicates in macros TH1 response against MTb-macros become bactericidal, formation of granulomas and caseous necrosis |
|
what is a PPD?
|
purified protein from MTb-positive test shows type IV reaction
DOES NOT distinguish between previous infection or active disease |
|
what genetic factor makes someone susceptible to TB?
|
polymorphisms in NRAMP1 gene
|
|
differences between primary and secondary TB?
|
primary- previously unexposed, exogenous source, lower and middle lobes
secondary- previously sensitized host, apex of upper lobes |
|
signs of TB?
|
malaise
anorexia fever night sweats |
|
what are the Ghon focus and complex?
|
focus of consolidation in distal airspace and regional nodal involvement of primary pulmonary TB
|
|
what is scrofula?
|
involvement of cervical region lymph nodes in pulmonary TB
|
|
things to look out for in HIV related TB?
|
sputum negative for AFB
false negative PPD lack of granulomas |
|
what causes histoplasmosis?
|
inhalation of dust particles from soil contaminated with bird or bat droppings with spores-no human to human transmission
|
|
what cells are the major targets of infection in histoplasmosis?
|
macrophages
|
|
what looks similar to TB?
|
histoplasmosis- lung apical involvement
fever,cough, night sweats |
|
where are the extrapulmonary lesions in histoplasmosis?
|
mediastinum,adrenals,liver,brain
|
|
which disease is characterized by tree bark granulomas and thin walled yeast forms with methenamine stain?
|
histoplasmosis
|
|
differences between histoplasmosis in healthy adults and fulminant disseminated histoplasmosis?
|
healthy- epithelioid granulomas
fulminant- NO epithelioid granulomas |
|
difference between histoplasmosis and blastomycosis?
|
histo- 3-5 micrometer THIN walled yeast forms with silver stain
blasto- 5-15 micrometer THICK walled yeast forms |
|
where does histoplasmosis occur?
|
ohio and mississippi river valleys
|
|
where does blastomycosis occur?
|
central and south eastern US, canada,mexico,middle east, africa and india
|
|
where does coccicioidomycosis occur?
|
southwest and western US
|
|
what causes the San Joaquin Valley river complex?
|
coccicioidomycosis
|
|
morphology of coccidioidomycosis?
|
granulomatous lesions
20-69 micrometer thick walled non budding spherules in macros |
|
what is the most common opportunistic viral pathogen in AIDS?
|
CMV
|
|
in what patient population is CMV most severe?
|
neonates and immunosuppressed patients
|
|
morphology of CMV?
|
interstitial pneumonitis
hemorrhages and alveolar epithelial cells with intracytoplasmic and intranuclear inclusions leukocytes are reservoir may progress to ARDS |
|
what is the leading cause of death in AIDS?
|
pneumocystis carinii infection
|
|
morphology of pneumocystis carinii?
|
intra-alveolar foamy eosinophilic exudate with cyst forms in silver stain
cysts look like CRUSHED PING PONG BALLS |
|
unique feature of pneumocystis carinii diagnosis?
|
cannot culture, use bronchoalveolar lavage
|
|
in what patients does allergic aspergillosis occur?
|
asthma and CF
|
|
where does aspergillosis tend to invade?
|
blood vessels- hemorrhage/infarction with necrotizing, inflammation
|
|
morphology of aspergillosis?
|
thin,parallel hyphae with 45 degree angle branching
|
|
which organisms cause pneumonia primarily in ummunoconpromised hosts?
|
CMV
pneumocystosis carinii aspergillus mucormycosis |
|
in what patients does mucormycosis infect?
|
DIABETICS
leukemia neutropenia malignancy |
|
what is the main clinical form of mucormycosis?
|
rhinocerebral in diabetic ketoacidosis
pulmonary involvement linked to rhinocerebral |
|
morphology of mucormycosis?
|
hemorrhagic pneumonia with necrosis and infarction
irregular,broad,twisted non-septate hyphae with 90 degree angle branching |
|
clinical course of mucormycosis?
|
poor prognosis
treatment with surgical debridement and antifungals |
|
what comprise most of the primary pulmonary neoplasms?
|
carcinomas
|
|
what statistical associations exist between smoking and lung cancer?
|
number of cigarettes/day
inhalation pack-years |
|
what is the clinical presentation of lung cancer?
|
cough
weight loss chest pain dyspnea |
|
mutations common in small cell carcinoma?
|
c-MYC and RB
p53 |
|
mutations common in non-small cell carcinoma?
|
RAS and p16
p53 |
|
what is the most common sight of NSCLC metastasis?
|
adrenal glands
|
|
what are the two growth patters of NSCLC?
|
1 endobronchial- in bronchial lumen with limited invasion to parenchyma
2 intraparenchymal- into and through bronchial wall with infiltrative borders in the lung parenchyma |
|
what is the most common type of lung cancer in the US?
|
adenocarcinoma
|
|
what is the most common type of lung cancer seen in non-smokers?
|
adenocarcinoma
|
|
what are the genetic changes associated with adenocarcinoma?
|
gain of chr. 5p
amplifications of proto-oncogenes- EGFR,KRAS and HER2 |
|
important morphologic feature of bronchioalveolar carcinoma?
|
non-invasive, it grows along alveolar septae
|
|
what are the two types of bronchioalveolar carcinoma?
|
1 non-mucinous- columnar or cuboidal cells, solitary nodule able to be resected
2 mucinous- tall, columnar cells with multiple nodules of pneumonia infiltrate |
|
what differentiates squamous cell from adenocarcinoma?
|
larger and located centrally, associated with necrosis and cavitation
|
|
what do the cells look like in squamous cell carcinoma?
|
planar,polygonal cells with keratinization and/or intercellular bridges
|
|
what is the genetic alteration in squamous carcinoma?
|
losses of 3p and 9p
loss of 3p increases progressively in the progression model from metaplasia and in situ proto-oncogenes- PIK3CA,BCL11A, MYC,KRAS |
|
what probably makes up the large cell carcinomas?
|
squamous and adenocarcinomas that can no longer be recognized
|
|
what do the cells look like in large cell carcinoma?
|
solid sheets, larger than adenocarcinoma or squamous
large nuclei,prominent nucleoli and abundant cytoplasm |
|
what percent of small cell carcinomas occur in non-smokers?
|
1
|
|
difference between typical and atypical carcinoids?
|
typical- NO p53 mutations or BCL2,BAX abnormalities, less than 2 mitoses and no necrosis
atypical- p53 mutations and some BCL2, BAX abnormalities, between 2 and 10 mitoses and foci of necrosis(more invasive) |
|
mutations in small cell carcinoma?
|
p53 and RB1
BCL2 overexpression BAX underexpression |
|
what are tumorlets?
|
microscopic,incidental hyperplastic proliferations of neuroendocrine cells in areas of scarring or chronic inflammation
|
|
what produces a collar-button lesion?
|
central carcinoid tumors
|
|
difference between large cell neuroendocrine carcinoma and carcinoids?
|
larger cells
more necrosis and mitoses highly aggressive |
|
morphology of small cell carcinoma?
|
cell size 3x lymphocytes
high mitotic count individual cell necrosis and zonal basophilic staining |
|
what happens in superior sulcus tumors?
|
invasion of cervical sympathetic plexus creating Horner's syndrom
|
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what cancer is Cushing's syndrome associated with?
|
small cell carcinoma
|
|
features of Cushings syndrome?
|
ACTH or POMC
POMC not found in Cushings disease(ACTH from periphery) |
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what paraneoplastic syndromes are associated with small cell carcinoma?
|
Cushing's syndrome
inappropriate ADH release Lamber-Eaton |
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what is the most common paraneoplastic syndrome?
|
hypercalcemia- PTHRP(same amino terminus as PTH and actions)
|
|
what produces PTHRP (parathyroid hormone-related protein)?
|
epithelial and mesenchymal cells
|
|
what cancer is associated with hypercalcemia?
|
squamous cell
|
|
what cancer is carcinoid syndrome seen most with?
|
small cell
|
|
what are the clinical features of carcinoid syndrome?
|
dry flushing
watery diarrhea wheezing |
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what causes the symptoms of carcinoid syndrome?
|
kallikrein from tumor cells which converts kininogen to bradykinin and serotonin
|
|
problem in Lamber-Eaton?
|
muscle weakness due to auto Ab against voltage gated Ca channels
|
|
what paraneoplastic syndromes are associated with NSCLC?
|
acanthosis nigricans
hypertrophic pulmonary osteoarthropathy |
|
problem in acanthosis nigricans?
|
TGF alpha from tumor cells
|
|
problem in hypertrophic pulmonary osteoarthropathy?
|
symmetrical new bone along the diaphyses of bones of appendicular skeleton
bone pain with/without clubbing |
|
what is the primary treatment for NSCLC?
|
surgical resection
|
|
what is a pulmonary hamartoma?
|
incidentally discovered tumor of mesenchymal elements like cartilage and epithelial components liked by ciliated columnar epithelium
round opacity on xray,well circumscribed,solitary |
|
what are two common cancers leading to lung metastasis?
|
esophageal carcinoma
mediastinal lymphoma |
|
which pleura has sensory innervation?
|
parietal
|
|
features of transudate?
|
low protein content and specific gravity
found in increased hydrostatic P,decreased oncotic P, increased negative P systemic derangements |
|
features of exudate?
|
high protein content, high specific gravity
local derangements: infections,neoplasms,infarcts, collagen vascular disease |
|
what causes hemorrhagic pleuritis?
|
tumors in pleural cavity
|
|
what causes serous pleuritis?
|
infarct,lupus,RA
|
|
what causes suppurative pleuritis?
|
pneumonia,abscess, TB,fungal infection
|
|
where is a chylothorax usually found?
|
left side
|
|
where is Meig's syndrome usually found?
|
right side
hydrothorax with ascites and pelvic tumor |
|
what causes a tension pneumothorax?
|
resuscitative efforts or mechanical ventilation
|
|
where do pleural tumors come from?
|
metastatic from lung and breast
|
|
features of benign mesothelioma of pleura?
|
attached to visceral pleura
subserosal nodule/mass no relationship to asbestos associated with hypoglycemia and pulmonary osteoarthropathy |
|
features of malignant mesothelioma of the pleura?
|
linked to amphibole asbestos fibers
visceral or parietal pleura NO increased risk with smoking surrounds and invades lung |
|
feature of mesenchymal type malignant mesothelioma?
|
resembles fibrosarcoma
spindle cell |
|
feature of epithelial type malignant mesothelioma?
|
resembles adenocarcinoma
columnar positive stain for calretnin |
|
difference in electron microscopy between adenocarcinoma and malignant mesothelioma?
|
short,plump microvilli in adeno
long,slender microvilli in meso |
|
which atelectasis is non-reversible?
|
contraction-fibrosis
|
|
what are tracheoesophageal fistula associated with?
|
esophageal atresia
|
|
what is the most common TE fistula?
|
type A
blind upper E segment and fistula between lower E and trachea |
|
what is a congenital cyst?
|
abnormal detachment of developing foregut, most are bronchogenic
|
|
where do extralobar segments get blood?
|
aorta
|
|
features of acute mediastinitis?
|
acute inflammation of posterior region due to esophageal perforation due to trauma,tumor, vomiting, instrumentation or neck infection
|
|
features of chronic mediastinitis?
|
fibrosing condition, may simulate superior vena cava syndrome,
|