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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
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)
what paraneoplastic syndromes are associated with small cell carcinoma?
Cushing's syndrome
inappropriate ADH release
Lamber-Eaton
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
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,