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187 Cards in this Set

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Local effects of lung tumors
Airway obstruction --> pneumonia, abscess, lobar collapse
Hoarseness due to laryngeal nerve invasion
Dysphagia
Pleural effusion
Nerve entrapment syndromes (e.g. Horner's due to Pancoast's tumors in apex)
SVC syndrome
Histoplasmosis with granulomatous inflammation
Acute phase: Small (2-5 uM) ovoid budding yeast forms seen in macrophages
Identify the disease process and organism.
Candida. Pseudohyphae.
What organism is this?
What are the 4 characteristics of asthma?
a) Airway obstruction that is reversible either spontaneously or with treatment
b) Airway inflammation
c) Increased airway responsiveness
d) Airway remodeling
Pleural effusion on R.
What's going on?
Define pneumonia
Inflammation of the lower respiratory tractm involving the alveolar space.
Definition of asthma
Airway obstruction that is reversible either spontaneously or with treatment (may not be complete)
Airway inflammation
Increased airway responsiveness
Airway remodeling
Paraneoplastic syndromes
(specifically for small cell, squamous, carcinoid)
Lambert-Eaton syndrome (antibodies to neuronal calcium channels)
Small cell: Hyponatremia due to ADH production, Cushing's due to ACTH
Squamous: hypercalcemia due to PTH production
Carcinoid: serotonin
Adeno: DIC
Histoplasmosis:
clinical presentation
Granulomatous disease, interstitial disease, disseminated infection
What are the symptoms of Plummer-Vinson/Patterson-Kelly syndrome?
Anemia, glossitis, esophageal dysphagia

Very rare.
What cytokines are induced by the Th2 response in asthma?

What are the consequences?
IL-4, IL-13, Granulocyte-macrophage colony stimulating factor (GM-CSF)

B cells induced to synthesize IgE
Eosinophils recruited
Pulmonary causes of restriction (alveolar and interstitial)
Alveolar: filling (exudate, CHF), atelectasis/collapse (inadequate surfactant), airway obstruction

Interstitium: increased fluid (CHF), increased cellularity (leukocytes, (myo)fibroblasts), interstitial fibrosis
What is Kartagener's syndrome?
(a.k.a. ciliary dyskinesia)
Cilia do not beat, affecting respiratory epithelium and all other parts of body with cilia.
Predisposition to bacterial colonization and development of serious complications.
Definition of chronic bronchitis
Excessive mucus secretion in bronchial tree
Chronic or recurrent productive cough
Symptoms present most days for minimum of 3 months in year and not less than 2 successive years
Squamous cell carcinoma:
common location
Bronchial mucosa
Histoplasmosis:
Pathology
Granuloma or sheets of histiocytes containing fungus

Resembles leishmaniosis (a protozoan)
Irritation fibroma.
nodular mass of fibrous tissue occurring in the buccal mucosa along the bite line.
What is this?
What inflammatory cells are increased in asthma?
Mast cells, eosinophils, neutrophils (which release bronchospastic mediators like histamine and leukotriene, platelet activating factor)
Diffuse Interstitial Lung Disease
What is this?
What is the main inflammatory cell involved in bacterial pneumonia?
Neutrophil, filling bronchi, bronchioles, and alveolar space (only alveoli necessary to diagnose as pneumonia)
Definition of emphysema
Abnormal enlargement of airspaces distal to terminal nonrespiratory bronchiole, accompanied by destructive changes of alveolar wall.
Lobar pneumonia.
Edema, neutrophils
What's this?
Adenocarcinoma:
Location
Usually peripheral, subpleural nodules
Coccidiomycosis
Spherule with large (5-100 uM) endospores inside
When spherule ruptures, you get disseminated infection.
Identify disease process and organism
Irritation fibroma.
Squamous mucosa, fibrosis. Inflammatory cells sprinkled around stroma.
What is this?
UIP
Honeycombing, dilated spaces, surrounded by dense fibrosis. Some normal alveoli.
What disease?
What is the inflammation like in chronic bronchitis? (cell types)
Neutrophils in epithelium, mucous glands, and airways.
Eosinophils
Depressed ratio of helper/suppressor T cells
Subepithelial mononuclear cell infiltration of bronchial mucosa (macrophage CD8+ t cells)
3 types of anti-inflammatory agents
Corticosteroids
Cromolyn sodium, nedocromil sodium
Leukotriene modifiers
What characterizes emphysema?
Abnormal enlargement of airspaces distal to terminal non-respiratory bronchiole, accompanied by destructive changes of the alveolar wall
Lobar pneumonia, red hepatization stage.
Alveolar spaces filled with blood. Neutrohils present, RBCs dominate.
What disease? What stage?
Corticosteroids:
Mode of action
Bind to cytoplasmic glucocorticoid receptor, which alloows translocation into nucleus, where it modifies transcription of numerous genes involved in asthma
Down-regulates: cytokines (IL-4, IL-5, GM-CSF), chemokines (Rantes, IL-8)
Up-regulates: β-agonist receptor

Decreases airway edema, increases response to beta-agonists.
Coccidiomycosis:
Geography
Southwestern US
Bronchioalveolar Carcinoma (BAC):
Location
Characteristics
Cellular composition
Prognosis
Peripheral, in terminal bronchiolar cells or alveolar walls
Abundant mucus production
Well differentiated columnar cells containing mucin or cuboidal cells resembing Type II pneumocytes or Clara cells lining preserved septa
Better prognosis than regular adenos when they are solitary and < 2 cm
Pyogenic granuloma
highly vascular, pedunculated gingival lesion resembling an hemangioma. Occurs in children and pregnant women (“pregnancy tumor”).
Vessels with lobulated appearance. Edema, inflammation, vascular proliferation*.
What is this?
UIP. Fibroblast foci
What disease?
Pathological findings of UIP/IPF
Patchy, nonuniform, variable interstitial changes, normal lung, active fibrosis and end-stage fibrosis (honeycomb lung).

Fibroblast foci

Mild inflammation
Lobar pneumonia. Gray hepatization stage.
Accumulation of neutrophils, disintegrating RBCs and fibrin.
What disease? What stage?
What is the inflammation like in emphysema? (cells)
bronchiolitis w/plump, pigmented, activated alveolar macrophages in respiratory bronchioles
What is Wegener's granulomatosis?
Necrotizing vasculitis, with granulomas, areas of necrosis, collections of histiocytes, abundant chronic inflammation
Name corticosteroids:
Inhaled
Oral
IV
Inhaled: beclomethasone
Oral: prednisone, prednisolone
IV: methylprednisolone
Histoplasmosis:
Geography
Midwestern US (Ohio and Mississippi River valleys)
Types of neuroendocrine tumors in the lung
Benign tumorlets, carcinoids, atypical carcinoids, small cell carcinomas (increasing malignant potential)
UIP/IPF:
Clinical characteristics

(age, onset, symptoms, prognosis, therapy)
Most common IIP
Age: 50's, 60's
Onset: insidious
Symptoms: cough, dyspnea
Prognosis: poor
Therapy: none (except transplant)
What is the predominant inflammatory cell type in legionella pneumonia?
Macrophage, full of bacilli and nuclear dust.
Nasopharyngeal angiofibroma
Benign, rare. Admixture of mature vascular and fibrous tissue.
Some normal squamous epithelium with bland fibrous stroma witih myxoid areas and prominent vessels.
Occurs almost only in males in teens.
What neoplasm is this? What are its characteristics?
Asthma. the brown cells (bilobed) are eosinophils.
What inflammatory process is this?
Coccidiomycosis:
Clinical presentation
Necrotizing granuloma
Disseminated disease is rare
Corticosteroids:
Side effect
(All depend on dose, delivery, and duration)
Musc: myopathy, osteoporosis
GI: peptic ulcer
CNS: psychiatric
Ophal: post subcapsular cataracts
CV/renal: hypertension
Met: central obesity
Endo: growth failure, suppression of HPA system, exacerbation of hyperglycemia
Inhibition of fibroplasia (wound healing)
Impaired immune response
Bronchial carcinoid:
Location
Microscopic appearance
Malignancy and mortality
Main stem bronchi or peripheral
Ribbons of polygonal cells separated by vascular spaces, silver stains show argyrophilic granules
5% have lymph node metastasis, but 5-10 year survival is 50-95%
What is atypical about atypical carcinoid tumors in the lung?
More cytologic atypia, focal necrosis, mitoses
Desquamative Interstitial Pneumonia (DIP)
Increased macrophages in alveoli. Uniform appearance at low power. Moderate alveolar septal thickening due to collagen deposition.

If it were in respiratory bronchioles, it would be RB-Interstitial Lung Disease (RB-ILD)
What disease?
What is the antibiotic of choice for Legionellosis?
Erythromycin.
Sinonasal papilloma, fungiform/transitional cell type
Note the transitional epithelium
What neoplasm is this?
Asthma
What disease does this spirogram represent?
Blastomycosis:
Geography
Midwestern US (Mississippi and Ohio River Valleys)
Indications for inhaled corticosteroid
Controller/preventer
First-line anti-inflammatory in any pt with PERSISTENT asthma (requiring β-ag twice weekly)

Use in COPD is controversial
Desquamative Interstitial Pneumonia

Macrophages in alveolar space. Moderately thickened alveolar septae.
What disease?
Legionella.

Looks like necrosis.
Mononuclear cells look dirty (nuclear dust).
If stained with warthrin-starry, you'd see bacilli.
What pneumonia?
Sinonasal papilloma, inverted type.
See epithelial layer "growing in"
High rates of recurrence
What is this?
What are the effects of cigarette smoke?
Increased mucus secretion, alveolar wall thickening, smooth muscle contraction
Damages nerve endings --> substance P --> mucus
Recruits inflammatory cells
Destroys cilia to move mucus out
Small cell carcinoma:
Gross appearance
Microscopic appearance
bulky, white masses with necrotic areas

sheets and nests of small, hyperchromatic, round, oval, polygonal, or spindle cells with nuclear molding, crush artifact, DNA encrustation of BVs
Blastomycosis:
Clinical presentation
Similar to tuberculosis: pulmonary nodules and/or cavity
Indications for oral corticosteroids
Rescue therapy for acute exacerbation in out-patient asthma
DIP/RB-ILD:
Clinical characteristics
(Age, onset, symptoms, associations, prognosis, treatment)
40s
Insidious
Cough/dyspnea, clubbing in 50%
Smoking
30% mortality (RB-ILD not fatal)
60% respond to steroids, some improve spontaneously
What differentiates pseudomonas aeruginosa pneumonia?
Vascular haze, vasculitis with hemorrhage and pumonary infarcts. (bacteria need lots of O2, so it localizes near BVs --> hemorrhage and infarct)
Olfactory neuroblastoma.
What is this, if it also is immunopositive for S-100, neutron specific enolase, and chromogranin?
What are PFT findings of chronic bronchitis?
Decreased expiratory flow
Decreased FEV1
Normal FVC (lung volumes are normal)
Epithelial lung cancer types
Nonsmall cell types: Squamous cell carcinoma 25-40%, adenocarcinoma (including BAC) 25-40%, large cell carcinoma 10-15%
Prognosis better (resection possible)

Small cell carcinoma (20-25%)
Worse prognosis (chemo and radiation only)
Blastomycosis
Broad area of contact between dividing yeast
Large yeast form
Identify disease process and organism
Indications for IV corticosteroids in asthma
Acute exacerbation in hospital
Pseudomonas aeruginosa. Vascular haze and hemorrhage.
What pneumonia is this?
Acute Interstitial Pneumonia (AIP) or Hamman-Rich Disease

Diffuse alveolar damage, epithelial cell death, hyaline membranes, thombi, diffuse, active fibrosis with proliferating fibroblasts and myofibroblasts.
Temporarily uniform appearance, but rapid evolvement of honeycomb lung.
Looks like ARDS.
What disease?
Squamous cell carcinoma (could be nasopharyngeal carcinoma)
What neoplasm is this?
How does asthma differ from CB?
Type of inflammatory cell: TH2 and eos in asthma, macrophages, neutrophils, and CD8 T cells in CB
Location of inflammatory cells
How those cells lead to obstruction
Squamous cell carcinoma - making pearls
What is this?
Pneumocystis carinii pneumonia (PCP):
Clinical presentation
-Insidious, slow progressive atypical pneumonia.
-Fast progressive pneumonia.
-Typically presents as bilateral shadowing on a chest x-ray.
-Respiratory failure is the most common cause of death. PCP can cause diffuse alveolar damage.
Cromolyn sodium, nedocromil sodium:
Mechanism of action
Stabilizes mast cell membranes, interferes with signal transduction in mast cells
What organism is most associated with bacterial pulmonary abscess?
Staph aureus.
Acute interstitial pneumonia (Hamman-Rich)

Diffuse fibrosis
What disease?
What are the physical exam findings of emphysema?
Thin, pursed lips, decreased breath sounds, hyper-resonance, distant, faint heart sounds
What is the prognosis of nasopharyngeal carcinoma?
Poor. Grows slowly and unnoticed until unresectable size. Often spreads to lymph nodes and distally.
Adenocarcinoma - glandular
What is this?
PCP pneumonia:
Pathologic changes
Intraalveolar, pink, foamy, honeycomb exudate that contains the cysts and trophozoites of P. carinii.

Atypical presentations: granuloma, bullous pneumotorax, DAD, interstitial fibrosis.
Indications for neocromolyn sodium
Can be offered as first-line anti-inflammatory therapy, often in peds
Not as effective as CS, not effective in some pts at all.

No side effects.
Acute Interstitial Pneumonia (Hamman-Rich Disease):
Clinical presentation
(Common? onset, symptoms, associations, mortality, therapy)
Rare
Acute onset
Dyspnea, resp failure (like ARDS)
Viral prodome in most
60% mortality
Supportive therapy
Small cell carcinoma
Small, dark, like lymphocytes, scant cytoplasm
What is this?
What is a potential complication of eosinophilic pneumonia?
Churg-Strauss syndrome (eosinophilic vasculitis), which creates large areas of necrosis in any area of body.
Laryngeal polyp. Myxoid/gray appearance with fibrous stroma covered by squamous epithelium, some vascular proliferation in between.
What benign neoplasm is this?
How does emphysema lead to airway collapse?
Destruction of alveolar septae --> loss of elastic recoil --> collapse during expiration
PCP
Foamy exudate. Cyst does not stain with normal staining methods.
Identify process and organism
Actions of LTB4
Actions of LTC4, LTD4, LTE4
LTB4: chemoattractant
the rest: smooth muscle contraction, mucus secretion
Nonspecific Interstitial Pneumonia
varying amounts of inflammation (lymphocytes and plasma cells) and fibrosis in alveolar walls, but no specific findings of other ILDs.
Temporary uniform appearance
No fibroblast foci
What disease?
Large cell carcinoma - big, pleomorphic, undifferentiated
What is this?
Eosinophilic.
What type of pneumonia is this?
Laryngeal squamous papilloma.
Exophytic fronds of squamous epithelium with fibrovascular cores.

HPV 6 and 11
What is this? Imagine that it's growing in exophytic fronds.
What is it related to in children?
PCP cysts (w/silver stain)
Note cup shape of cysts
Identify organism
Zafirlukast, Montelukast:
Mechanism of action
Leukotriene receptor antagonist
Zileuton:
Mechanism of action
Blocks action of 5-lipoxygenase (which generates leukotrienes from arachidonic acid
Nonspecific Interstitial Pneumonia
What disease?
What is treatment for eosinophilic pneumonia?
Steroids (not an infection)
Which tumor is most associated with smoking?
Squamous cell carcinoma
Branchial cyst
Squamous or columnar lining with mural lymphoid infiltrate.
Florid lymphocytic proliferation in underlying stroma.
What the hell is this?
Blue: PCP (foamy, extracellular)
Black: CMV (owl's eye)
Identify organisms at blue and black arrows
Leukotriene modifiers:
Side effects
Hepatotoxicity
Churg-Strauss-like syndrome
Nonspecific Interstitial Pneumonia:
Clinical presentation
(age, onset, symptoms, mortality, associations)
mean age 50
Insidious onset
dyspnea, cough
10-20% mortality
Some have CVD (Collagen Vascular Disease), lung-toxic drugs or recent lung injury (e.g. pneumonia)
Interstitial (an atypical pneumonia, caused mostly by Mycoplasma pneumoniae)
What type of pneumonia is this?
Squamous cell carcinoma (pink cytoplasm with distinct cell borders and intercellular bridges)
What is this?
Paraganglioma.
nests of bluish cells with vesicular looking nuclei. bland, growing in nested pattern with fibrous stroma between them. Called Zell-Ballen pattern

Don't often see mitotic figures or necrosis
What neoplasm is this?
Cryptococcosis
(Pathological findings)
Interstitial pneumonia -- parenchymal granulomas, including cavitary lesions
Immunocompromised: interstitial or alveolar involvement w/o inflammation
Mucin capsule protects from immune system

Can cause meningitis in immunocompromised host
Leukotriene modifiers:
Indications
Controller/preventer
May be used as 1st line for mild asthma, but usually an add-on with CS. May not be active in all pts
Bronchiolitis Obliterans Organizing Pneumonia (BOOP):
Pathology
granulation tissue plugs within the lumens of small airways. extends into alveolar ducts and alveoli.
(1) proliferation of connective tissue that forms intramural polyps (proliferative bronchiolitis obliterans);
(2) fibrinous exudates;
(3) alveolar accumulation of foamy macrophages; (4) inflamed alveolar walls;
(5) evenly spaced, rounded balls of myxomatous connective tissue.
What type of pneumonia is especially associated with bone marrow transplants?
Adenovirus pneumonia.
Squamous cell carcinoma
at the upper left is a squamous eddy with a keratin pearl. At the right, the tumor is less differentiated and several dark mitotic figures are seen.
What is this?
BOOM! it's not a neoplasm.
This is normal salivary gland, with serous glands, ducts, and adipose tissue.
What neoplasm is this?
Cryptococcus neoformans
4-7 uM oval budding yeast
Capsule contains mucin
Unencapsulated forms are more often found in HIV (less pathogenic)
Identify organism
Short β-agonists:
2 examples
Albuterol sulfate
Pirbuterol
Bronchioltis Obliterans Organizing Pneumonia
(intraluminal buds of granulation tissue (bronchiolitis obliterans), involving distal airways more than alveoli)
What disease?
What is the pathology of adenovirus pneumonia?
ulceration of bronchi and bronchioli with shedding of the cilia from respiratory epithelium (ciliocytophthoria). May lead to interstitial pneumonia.
Sialadenitis.
Inflammatory cells have taken over gland, destroyed many ducts.
What is this?
Bronchioalveolar carcinoma.
Composed of columnar cells that proliferate along the framework of alveolar septae. The cells are well-differentiated.
What's this?
Cryptococcus neoformans
(long neck budding)
Use this if it's unencapsulated
Name organism
Small cell carcinoma
Arising centrally in this lung and spreading extensively is a small cell anaplastic (oat cell) carcinoma. The cut surface of this tumor has a soft, lobulated, white to tan appearance. The tumor seen here has caused obstruction of the main bronchus to left lung so that the distal lung is collapsed.
what is this?
BOOP:
Clinical features
(Onset, symptoms, associations, PFTs, treatment)
Subacute (faster onset - weeks)
Dyspnea, cough, weight loss
Heralded by flu-like illness, looks like community-acquired pneumonia
PFTs show restriction
Steroids
Short-acting β agonists:
Mechanism of action
Relaxation of smooth muscles with β2 receptors through activation of adenylate cyclase and increased cAMP levels
Adenovirus.
Look at the smudge cell (arrow) in alveolar space. Also, hyaline membrane and DAD.
What type of pneumonia is this?
Benign Lymphoepithelial Lesion - non-neoplastic enlargement of glands. Abnormal proliferation of lymphocytes in stroma and epithelium.

May be associated with Sjogren's syndrome
What is this? (it's in a salivary gland)
Association?
Cryptococcus neoformans
Name the organism (mucin stain)
Sarcoidosis
(granuloma of CD4+ T cells, epithelioid cells, macrophages, giant cells, fibroblasts, mast cells, may get fibrotic deposition if granuloma does not resolve)
What disease?
β-agonist side effects
Tremor, palpitations, hyperglycemia, hypokalemia.

May develop tolerance
What are the clinical characteristics of DAD/ARDS?
Rapid onset of severe resp insufficiency
Arterial hypoxemia
Refractory response to O2 (gets worse)
Small cell carcinoma
small dark blue cells with minimal cytoplasm are packed together in sheets.
What's this?
Name the benign salivary gland neoplasms.
i. Pleomorphic adenoma/benign mixed tumors (50%)
ii. Warthrin's tumor (5-10%)
iii. Oncocytoma (1%)
iv. Ductal papilloma (rare)
v. Monomorphic adenoma (5-10%)
a. Basal cell adenoma
b. Canalicular adenoma
Aspergillosis
(Clinical presentation)
Debilitated pts with neutropenia (not relevant in AIDS because mostly controlled by neutrophils)\

1) Allergic bronchopulmonary aspergillosis (ABPA)
2) Aspergilloma (fungus ball)
3) Invasive aspergillosis
Sarcoidosis:
Clinical features
(age, associations, treatment)
Earlier (10-40)
Multisystem disease, may be associated with Lofgren's syndrome: erythema nodosum, often on legs, caused by panniculitis, an inflammation of subcutaneous adipose tissue), hilar adenopathy, migratory polyarthralgias, fever
May spontaneously resolve, esp if symptoms were acute (Lorfgren's). Corticosteroids may give short term improvement, but long term effects are unknown.
What is the pathogenesis of DAD/ARDS?
Initial injury to alveolar capillary endothelium and epithelium --> leaky capillaries and intraalveolar edema, fibrosis and reorganization of parenchyma
Short-acting β-agonists:
Indications
All patients with bronchospasm, on PRN basis for fast relief. If needed more than twice weekly --> add anti-inflammatory agent
Is bronchial carcinoid associated with smoking?
No.
Name the malignant neoplasms of salivary glands.
i. Mucoepidermoid cancer (15%)
ii. Adenocarcinoma/NOS (10%)
iii. Acinic cell cancer
iv. Adenoid cystic cancer
v. Malignant mixed tumor
vi. Squamous cell
vii. Other
Allergic bronchopulmonary aspergillosis
(clinical presentation)
In certain asthmatic pts - unusual immunologic rxn to Asp.
Transient pulmonary infiltrates on CXR
Eosinophilia
Elevated IgE
Thickened bronchial walls w/mucus plugs on CXR
Proximal bronchiectasis w/plugs
Increased goblet cells, thickening of basment membrane
No invasion of bronchial wall

TREATMENT: steroids to get rid of inflammation
Diffuse Alveolar Damage (DAD).
Lots of edema, disorganized. Cells where alveoli should be. Thick walls, cells are separated.
What disease process is this?
Chronic eosinophilic pneumonia (left)
CHF (right)

negatives of each other
Name the two diseases
Long-acting β-agonists:
indications
Maintenance (preventative) therapy
NOT for acute exacerbation
NOT as anti-inflammatory
not to be used w/o anti-inflammatory agent
Bronchial carcinoid
note nests and chords of cells
?
BOOYAH. Not a neoplasm.

Normal salivary gland tissue.
What neoplasm is this?
Aspergilloma
(fungus ball)
May grow in preexisting cavities
No tissue invasion
Usually asymptomatic, but may result in massive hemoptysis --> emergency
Aspergillus spp
Name organism
DAD, later stage.
Hyaline membrane
What disease process?
Hypersensitivity pneumonia
Granulomas and/or mononuclear cells
Interstitial infiltrates, fibrosis in chronic
Disease?
Theophylline:
Mechanism of action
Unknown, but may increase cAMP by decreasing action of phosphodiesterase and/or inhibit adenosine actions.
What is the most common benign lesion in the lungs?
Hamartoma (mature cartilage)
Looks like a "coin lesion" on X-ray
Pleomorphic adenoma/benign mixed tumor

You can see all types of differentiation here
What neoplasm of the salivary glands is this?
Invasive aspergillosis
(Pathologic features)
Multiple patchy densities with target lesions (necrotic center w/ hemorrhagic periphery)
Tissue destruction w/vascular invasion with thrombosis
Only aspergillosis that invades -- wedge shaped lesion caused by fungus invading vessel walls
Main pathologic finding in BOOP.
Intraluminal organization characterized by airspace of bronchiolar plugs of fibroblasts and chronic inflammation. Organizing pneumonia --> fibrosis in alveolar space.
Hypersensitivity pneumonitis
granuloma, monocytes, fibrosis (looks like UIP)
disease?
Theophylline:
Delivery
Oral: slow-release, metabolized in liver that are rapidly excreted.
Lots of variation in response. May be altered by CHF, cigarettes, other meds (cimetidine, erythromycin, CCBs).
Monitor levels.
Also available IV
Hamartoma. Mature cartilage, well-circumscribed.

Contains admixture of fibrous tissue, fat, blood vessels.
Occasionally contains cysts lined w/respiratory epithelium
?
Warthrin's tumor
Oncotic epithelium (very eosinophilic with abundant cytoplasm) lining cystic spaces. Abundant lymphocyte proliferation surrounding.
What neoplasm is this?
Aspergillus (invasive)
(Branched hyphae shown w/silver stain)
Invading blood vessel and pulmonary parenchyma
Identify organism
BOOP.
Fibrous plug within bronchus and alveolar spaces.
What's this?
What process is ground-glass opacity indicative of?
Acute inflammation rather than fibrosis
Theophylline:
Side effects
GI, insomnia, headache, seizures, cardiac arrhythmias
Is a solitary fibrous (aka localized submesothelial fibroma or pleural fibroma) accompanied by pleural effusion?
No.
What is the origin of Warthrin's tumor?
lymphoid cells in salivary gland.
Aspergillus (invasive)
Septate, branched hyphae
Identify organism
Mucoepidermoid carcinoma
Mixture of squamous cells, mucin (goblet) cells, and transitional cell forms
What neoplasm is this?
What is the treatment for BOOP?
Corticosteroids.
Mesothelioma from asbestosis. Also see plaques on left side.
Disease?
Theophylline:
Indications
Controller/preventer
Maybe in pts who still have symptoms despite other treatments. Some use in COPD.
Sarcoidosis
(Clincal presentation)
Multisystem granulomatous disease
Interstitial pneumonia, enlarged hilar lymphadenopathy.
Mild dyspnea and cough, but may be asymptomatic
CXR: bilateral interstitial opacities with or without hilar LN enlargement
Anticholinergic agents:
Mechanism of action
Muscarinic (M3) receptors in lung respond to ACh and lead to contraction of SMCs.
Engagement of M2 --> inhibits release of ACh
Release is increased in asthma
Anti-ch agents block action of M receptors nonselectively
Blocking M3 --> block SMC contraction
Blocking M2 --> increase ACh release and counter relaxation
What are the diagnostic criteria for ARDS?
acute illness leading to hypoxemic respiratory failure, with diffuse pulmonary infiltrates that are not due to CHF.
What is the physiology of ARDS?
Initial damage and consequence?
What happens to membranes?
Alveoli?
Ultimate consequence
Diffuse alveolar damage --> leaky capillaries--> Fibrosis
fibrin deposition--> hyaline membranes and surfactant dysfunction
Thrombi form --> flooding and collapse of alveoli
Hypoxemia and increased dead space
Respiratory failure, need for mechanical ventilation
Sarcoidosis
(course and treatment)
2/3 resolve spontaneously
Others may get pulmonary insufficiency, CNS, or CV involvement

Tx: corticosteroids
Anticholinergics:
example
Ipratropium bromide
ARDS
L: acute exudative phase (hyaline membranes lining alveolar space)
R: proliferative phase (later) - fibroblast proliferation and collagen deposition
name processes and disease
Sarcoidosis
(Well-formed, non-necrotizing granuloma along lymphatic route)
Identify process
Epinephrine:
Indications
Relaxant effect on bronchial smooth muscle via stimulation of beta2-receptors. Beta2-stimulation also prevents mast cell secretion of histamine and other autocoids, thus antagonizing its effect on end organs and reversing bronchoconstriction and edema. Furthermore, alpha-stimulation may decrease secretions from the bronchial mucosa, attenuating the development of edema. There is some evidence that epinephrine's alpha properties make it more effective than pure beta-agonists for the treatment of some pulmonary conditions such as bronchiolitis in children.
Wegener's Granulomatosis
(Pathological findings)
Systemic granulomatous inflammatory process with accompanying vasculitis, which predominantly affects the upper and lower respiratory tract and kidney.
1) Vasculitis
2) Necrotic granuloma
3) Inflammation (around BVs)
Restrictive. Stiff lung. Smaller flow rates than normal, bowed out at top (increased recoil). Flow:volume ratio shows that it is very efficient.
What type of disease is this?
Anticholinergics:
Indications
Bronchodilator with slow onset of action (45 min).
Not a first line drug in asthma - more effective in COPD (first line)
Acute exacerbation of asthma
Wegener's granulomatosis
(treatment)
Steroid
Name 5 corticosteroids:
Low potency: Beclomethasone, triamcinolone, flunisolide

High potency: Budesonide, fluticasone
Long acting beta-agonist: names
Salmeterol
Formoterol
Wegener's granulomatosis

Necrotizing granulomatous inflammation centered around blood vessels (veins and arteries) with an inflammatory background.
Identify what's going on
Extrinsic allergic alveolitis
(What is it?)
Hypersensitivity pneumonitis caused by variety of agents (birds, etc)
Extrinsic allergic alveolitis
Ill-definied interstitial granulomas with lots of giant cells
NO EOSINOPHILIA
Granuloma is in alveolar septae
What's going on here?
Extrinsic allergic alveolitis
(clinical)
Cough, fever, dyspnea, pulmonary infilitrates