Pathoma Chapter 9

Front 1

Most common cause of Rhinitis...

Back 1

Adenovirus

Front 2

Repeated bouts of Rhinitis is A/w

Back 2

Nasal polyps

Front 3

Nasal polyps A/w

Back 3

Cystic Fibrosis(child), Aspirin intolerant asthma(adult)

Front 4

Aspirin intolerant asthma clinical triad

Back 4

Asthma
Aspirin Induced Bronchospasm
Nasal Polyps

Front 5

adolescent males with profuse bleeding of the nose...

Back 5

Angiofibroma

Front 6

Nasopharyngeal carcinoma A/w?
Classic presentation?

Back 6

A/w EBV and classically seen in African children, chinese adults

Classically presents with enlarged cervical lymph nodes.

Front 7

Pleiomorphic keratin positive epithelial cells in the background of lymphocytes

Back 7

Nasopharyngeal Carcinoma

Keratin = epithelial cells IMF, thus it must be carcinoma

Front 8

Most common cause of epiglottitis

Back 8

H. Flu type B in BOTH immunized and non-immunized children

Front 9

hoarse, barking cough and inspiratory stridor

Back 9

Laryngotracheobronchitis(croup)
commonly caused by Parainfluenza virus(paramyxovirus)

Front 10

Vocal cord nodules

Back 10

nodules that arise due to excessive use.

Front 11

Laryngeal Papilloma is caused by?

Back 11

HPV 6 and 11.
Generally single in adults and multiple in children.

Front 12

Second most common cause of lobar pneumonia?

Back 12

Klebsiella(First is strep. pneumo)

Klebsiella hits malnourished and debilitated. Currant jelly sputum often complicated by abscess

Front 13

Four classic phases of lobar pneumonia

Back 13

1.) congestion
2.) red hepatization
3.) gray hepatization
4.) Resolution
Resolution occurs via Type II pneumocyte.

Front 14

COPD superimposed pneumonia caused by?

Back 14

H. Flu or Moraxella Catarrhalis

Front 15

empyema

Back 15

pus in the pleural space
caused by?

Hint 15

Staph Aureus

Front 16

Most common cause of secondary pneumonia after viral infection

Back 16

Staph. Aureus.
Often will cause abscess/empyema

Virus will disrupt mucociliary elevator which allows other organisms to superinfect.

Front 17

Pneumonia in CF

Back 17

Pseudomonas

Front 18

Aspiration is most common to cause infection in the...

Back 18

Right lower lobe

Front 19

Atypical pneumonia presentation

Back 19

Classic pneumonia presents with high fever, chills, productive cough, elevated white count, etc.

Atypical pneumonia usually presents with low fever and minimal symptoms.

Front 20

Mycoplasma pneumonia a/w

Back 20

autoimmune hemolytic anemia - cold agluttinins(IgM)

Front 21

Military recruit or college student with pneumonia

Back 21

Mycoplasma Pneumonia

Front 22

Atypical pneumonia in infants...

Back 22

RSV

Front 23

Second most common cause of atypica pneumonia

Back 23

Chlamydia pneumonia

Front 24

Atypical pneumonia post-transplant

Back 24

CMV

Front 25

Atypical pneumonia in elderly, immunocompromised, those with pre-existing lung disease

Back 25

Influenza.

Patients are then susceptible to bacterial superinfection by Staph. Aureus or H.flu

Front 26

seen in farmers and veterinarians with high fever and atypical pneumonia

Back 26

Coxiella Burnetti
Atypical pneumonia with high fever(Q fever)

--rickettsial organism. Coxiella spores deposited on cattle by ticks or present on cattle placentas.

Front 27

How Coxiella varies from normal Rickettsial organisms

Back 27

1.) causes pneumonia
2.) doesn't cause skin rash
3.) does not require arthropod vector(surives as heat resistant endospore)

Front 28

Aspiration pneumonia a/w what organisms...

Back 28

anaerobic bacteria in oropharynx -
Bacteroides, Fusobacterium and peptococcus

Front 29

Sterile pyuria

Back 29

Mycobacterium Tuberculosis that spread to kidney

Front 30

Where does Myc. TB affect meninges?

Back 30

At the base of the brain...

Front 31

Describe primary Myc. TB infection...

Back 31

Primary TB is generally ASYMPTOMATIC aside from the formation of the ghon complex

Focal caseating necrosis in the subpleural lower lobe of lung and hilar lymph nodes. These foci undergo fibrosis and calcification forming a Ghon Complex.

Front 32

Secondary reactivation of TB manifests as...

Back 32

1.) cavitary foci of caseous necrosis
2.) miliary pulmonary TB
3.) Tuberculous bronchopnuemonia

Fever/night sweats, cough with weight loss, biopsy of caseating granulomas, AFB reveals acid fast bacilli

Front 33

Histology of respiratory tract

Back 33

Pseudostratified Ciliated Columnar Epithelium

Lamina Propria contains large blood vessels(venules) to warm the air.
Submucosa contains serous and mucinous glands. Serous to humidify the air, and mucinous to protect against irritants.

Front 34

Spirometry of COPD

Back 34

FEV1 goes down A LOT
FVC goes down

FEV1/FVC goes DOWN. This DEFINES COPD.

FVC is the total air you can breathe out after taking a deep breath.
FVC1 is the air you breathe out in one second.

Front 35

What does the Reed index measure?

Back 35

It measures the thickness of the mucinous glands relative to the thickness of the bronchial wall.
>50% indicates COPD.
<40% normal

Front 36

Cor pulmonale

Back 36

Global lung arteriole vasoconstriction in an attempt to shunt blood to a more oxygenated portion of the lung(that doesn't exist). This causes pulmonary hypertension leading to right ventricular hypertrophy and eventually failure.

Front 37

Smoking causes

Back 37

centriacinar emphysema that tends to affect the upper lobes most

Front 38

alpha-1-antitrypsin deficiency causes

Back 38

panacinar emphysema that tends to affect the lower lobes most

A1AT is misfolded and accumulated within the ER of hepatocytes causing liver cirrhosis.

Front 39

Pink, PAS-positive globules in hepatocytes

Back 39

these are the accumulation of A1AT in the ER of hepatocytes

Front 40

Genotyping of A1AT Deficiency

Back 40

PiMM -- normal
PiMZ --- heterozygote, usually asymptomatic but have less circulating A1AT
PiZZ --- disease state, panacinar emphysema and liver cirrhosis

Front 41

"prolongued expiration with pursed lips"

Back 41

improves expiration of emphysema patients.

Front 42

discuss FRC. How fibrosis changes it. How emphysema changes it.

Back 42

fibrosis decreases FRC.
Emphysema increases FRC(increase A-P diameter)

Front 43

the elastic recoil forces of the lungs and chest wall are equal but opposite at this spirometrical measure...

Back 43

Functional Residual Capacity

Front 44

Phases of Eosinophil mediated Asthma attack

Back 44

1.) Histamine release due to cross linking of IgE receptors
2.) Leukotriene C4,D4,E4 release causing vasoconstriction, vascular permeability and bronchiolar smooth muscle constriction
3.) Inflammatory mediators like major basic protein perpetuate bronchoconstriction

Front 45

Curschmann spirals

Back 45

found within mucus of asthmatics

Front 46

Charcot-Leyden crystals

Back 46

crystalline aggregates of eosinophils with major basic protein that show up in the mucus of asthmatics

Front 47

Bronchiectasis

Back 47

Permanent dilatation of bronchioles and bronchi; loss of airway tone results in air trapping

Front 48

Kartagener Syndrome

A/w?

Back 48

inherited defect of the DYNEIN arm, which is necessary for ciliary movement. Can cause bronchiectasis

A/w Situs Inversitus

Front 49

Allergic Bronchopulmonary Aspergillosus

Back 49

Bronchopulmonary - "larger airways"

hypersensitivity to Aspergillus causing chronic inflammatory damage and bronchiectasis

classically seen in?

Hint 49

Seen in asthmatics and CF patients

Front 50

Bronchiectasis can have what important complication?

Back 50

Secondary Amyloidosis

Primary amyloidosis is when light chain is overproduced remember? But SECONDARY amyloidosis arises from chronic inflammatory process creating excess "SAA" protein which then causes AA amyloid crap to be deposited in tissues.

Front 51

What chemokine induces fibrosis in the lungs from injured pneumocytes?

Back 51

TGF-Beta

Front 52

Common drugs that cause pulmonary fibrosis

Back 52

Bleomycin and Amiodarone
Radiation therapy

Front 53

Fibrosis begins in which part of the lung in idiopathic pulmonary fibrosis?

Back 53

Initially it begins in subpleural patches

Front 54

Coal Worker's Pneumoconiosis

Back 54

Carbon dust, seen in coal miners. Massive exposure leads to diffuse fibrosis('black lung')

A/w?

Hint 54

Rheumatoid Arthritis(Caplan syndrome)

Front 55

Caplan Syndrome

Back 55

Rheumatoid Arthritis A/w Coal Worker's Pneumoconiosis

Front 56

Anthracosis

Back 56

carbon laden macrophages - not clinically significant

Front 57

fibrotic nodules in upper lobes of lung

Back 57

Silicosis

Increased risk for TB due to impairment of phagolysosome formation by macrophages

Front 58

Non-caseating granulomas in the lung, hilar lymph nodes and systemic organs

increases risk for?

Back 58

SOUNDS LIKE sarcoidosis but is driven by Beryllium. Seen in beryllium miners and workers in the aerospace industry.

INCREASES risk for lung cancer

Front 59

Works in aerospace industry

Back 59

Berylliosis

Front 60

Asbestosis

Back 60

fibrosis in the lung, fibrosis in the pleura, cancer in the lung, cancer it the pleura

Cancer of the pleura = mesothelioma

Front 61

Ferruginous body

Back 61

Asbestos related

Front 62

African American female with noncaseating granulomas in multiple organs(lung, hilar lymph nodes)

Back 62

Sarcoidosis

Front 63

Dry eyes, dry mouth with non-caseating granulomas

Back 63

Sarcoidosis

Front 64

Clinical features of Sarcoidosis

Back 64

Elevated Serum ACE

NOTABLY
Hypercalcemia - due to 1 alpha hydroxylase activity of epithelioid histiocytes of granulomas convert vitamin D to active form)

Front 65

Presents with fever, cough, dyspnea hours after going to the zoo.

Back 65

(Pigeon breeder's lung)
Hypersensitivity Pneumonitis a/w
granulomatous reaction to inhaled organic particles/antigens. Causes granulomatous reaction that resolves with removal of exposure but can progress to interstitial fibrosis in chronic exposure.

Front 66

Severe long standing pulmonary hypertension can lead to...

Back 66

Plexiform lesions, group of capillaries that travel together.

Front 67

young woman with exertional dyspnea

Back 67

pulmonary hypertension

Front 68

causes excess proliferation of smooth muscle leading to pulmonary hypertension. A/w young adult women

Back 68

BMPR2 inactivating.
Think plexiform lesions.

Front 69

BMPR2 inactivating mutation

Back 69

causes excess proliferation of smooth muscle leading to pulmonary hypertension. A/w young adult women

Think plexiform lesions.

Front 70

Secondary Pulmonary HTN

Back 70

Due to hypoxemia(COPD, interstitial lung diseasea)
or
increased volume in pulmonary circuit(congenital heart disease leading to Eisenmenger Syndrome)

Front 71

Acute Respiratory Distress Syndrome

Back 71

formation of hyaline membrane due to leakage of protein rich fluid into alveoli

Diffuse damage to the alveolar-capillary interface(diffuse alveolar damage)

Activation of neutrophils induces protease-mediated and free radical damage to type I and type II pneumocytes

Front 72

What does the hyaline membranization of alveoli cause?

Back 72

This causes inability to exchange gas and an increase in alveolar surface tension

use PEEP to keep alveoli open despite the increased surface tension of alveoli

Front 73

Notable complication of ARDS

Back 73

Interstitial fibrosis due to the destruction of type II pneumocytes by neutrophils leading to inability to regenerate.

Front 74

indicates lung maturity

Back 74

lecithin(phosphatidylcholine):sphingomyelin ratio greater than 2

Front 75

C-section a/w

Back 75

Neonatal RDS due to lack of stress induced steroids. Steroids increase surfactant production.

Front 76

Maternal Diabetes a/w

Back 76

Neonatal RDS due to increased insulin production. Insulin inhibits surfactant production

Front 77

Neonatal ARDS risks

Back 77

Patent PDA, and necrotizing enterocolitis

Front 78

Bronchopulmonary dysplasia

Back 78

free radical damage to lung early in life before lungs are mature enough to handle pure oxygen

Front 79

Supplemental oxygen complication in neonate

Back 79

Free radical damage to retina causing blindness. Bronchopulmonary dysplasia.

Front 80

Imaging reveals 'coin-lesion'. What do you do BIATCH!?

Back 80

Check for past x-rays to see if it has been stable. if it has, it's likely benign. If it's new, CUT THAT SHIT UP AND BIOPSY IT.

Front 81

Most likely coin lesions in younger gentlepeoplez?

Back 81

Granuloma -- often due to TB or fungus(especially Histoplasma in the midwest)

Bronchial Hamartoma - benign tumor composed of lung tissue AND cartilage often calcified on imaging

Front 82

Mode of treatment for lung cancer

Back 82

Small cell -- chemo
Non-Small Cell -- surgical resection(doesn't respond well to chemo)

Front 83

Non-Small Cell Subtypes

Back 83

Adenocarcinoma(40%)
Squamous Cell Carcinoma(30%)
Large Cell Carcinoma(10%)
Carcinoid Tumor(5%) - neuroendocrine origin

Front 84

Male Smokers

Back 84

Small Cell Carcinoma

Front 85

Small Cell Carcinoma associations

Back 85

Smokers, Central, Paraneoplastic Syndromes(ADH, ACTH or Eaton-Lambert Syndrome)

Front 86

Eaton-Lambert Syndrome

Back 86

Antibodies formed against presynaptic calcium channels STRONGLY associated with Small Cell Carcinoma and Smokers

Front 87

Squamous Cell Carcinoma

Back 87

Keratin pearls or intercellular bridges(desmosomal connections).
Associated with male smokers.

May produce PTHrP

Front 88

PTHrP

Back 88

Squamous Cell Carcinoma

Front 89

What unique site does lung cancer like to metastasize to?

Back 89

Adrenal glands

Front 90

Metastasis to lung

Back 90

Most common sources are breast and colon carcinoma. Presents with multiple 'cannon-ball' nodules on imaging. More common than primary tumors.

Front 91

Central Tumors

Back 91

Small Cell, Squamous Cell, Large Cell(central or periphery), Carcinoid Tumor(central or periphery)

Front 92

female smoker lung cancer

Back 92

Adenocarcinoma
Presents peripherally

Front 93

non-smoker lung cancer

Back 93

adenocarcinoma
Presents peripherally

Front 94

Large Cell Carcinoma

Back 94

Poorly differentiated large cells that lack karatin pearls, intercellulary bridges, glands or mucin.
Associated with smoking

Front 95

Associated with smoking

Back 95

Small Cell Carcinoma(male), Squamous Cell Carcinoma(male), Large Cell Carcinoma, Adenocarcinoma(female)

Front 96

Bronchioloalveolar Carcinoma arises from what cell?

Back 96

Clara Cells - main function is to protect bronchiolar epithelium, perhaps by secreting GAGS

Front 97

Neuroendocrine Tumors

Back 97

Chromogranin POSITIVE

Small Cell Carcinoma(poorly differentiated, arises from Kulchitsky Cells)
Carcinoid Tumor(Well differentiated)

Front 98

What cell line does Small Cell Carcinoma arise from?

Back 98

Kulchitsky cells(AKA enterochromaffin cells) which derive from the neural crest

Front 99

polyp like mass in the bronchus

Back 99

Carcinoid Tumor

Front 100

Lung cancers not related to smoking

Back 100

Bronchioalveolar Carcinoma
Carcinoid Tumor

Front 101

asteroid body

Back 101

sarcoidosis

Front 102

granulomas with eosinophils in lungs

Back 102

hypersensitivity pneumonitis

presents acutely with fever, cough and dyspnea

Front 103

fever, cough, dyspnea hours after exposure

Back 103

hypersensitivity pneumonitis

Front 104

pigeon breeder's lung

Back 104

HYPERSENSITIVITY pneumonitis

a/w granulomas and eosinophils.