Y2S1B2 - Path - Pathoma Respiratory

Front 1

What are the clinical features of pneumonia?

Back 1

Fever and chills
Productive cough w/ yellow-green (pus) OR rusty (bloody) sputum
Tachypnea w/ pleuritic chest pain
Decreased breath sounds and dullness to percussion (d/t consolidation)
Elevated WBC count

Front 2

How is the diagnosis of pneumonia made?

Back 2

chest x-ray
sputum gram stain and culture
blood cultures

Front 3

What are the 2 most common causative organisms of lobar pneumonia?

Back 3

Streptococcus pneumoniae (95%)
Klebsiella pneumoniae

Front 4

What are the 4 classic gross phases of lobar pneumonia?

Back 4

1. Congestion (congested vessels & edema)
2. Red hepatization (exudate, neutrophils, hemorrhage filling alveoli; lung has solid consistency)
3. Gray hepatization (degradation of RBCs w/in exudate)
4. Resolution (type II pneumocytes are the stem cells!!)

Front 5

Bronchopneumonia is characterized by scattered patchy consolidation centered around __________.

Back 5

Bronchioles

Front 6

Which pneumonia pattern is often bilateral and multifocal?

Back 6

Bronchopneumonia

Front 7

What organisms can cause bronchopneumonia?

Back 7

Staph aureus
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis
Legionella pneumophila

Front 8

What is the MC cause of secondary pneumonia?

Back 8

Staph aureus

*often complicated by abscess or empyema

Front 9

What is a common cause of secondary pneumonia and pneumonia superimpose on COPD?

Back 9

Haemophilus influenzae

Front 10

Bacterial pneumonia superimposed on a viral upper respiratory tract infection is also called a what?

Back 10

secondary pneumonia

Front 11

What bacteria is known for pneumonia in CF patients?

Back 11

pseudomonas aeruginosa

Front 12

What bacteria can cause community-acquired pneumonia and pneumonia superimposed on COPD?

Back 12

Moraxella catarrhalis

Front 13

Legionella pneumophila is an (extra/intra)cellular organism best visualized by _____ stain.

Back 13

Intracellular; silver stain

Front 14

What pneumonias are most a/w Legionella pneumophila?

Back 14

Community-acquired
Superimposed on COPD
Immunocompromised states

Front 15

What pneumonia pattern typically presents w/ mild upper respiratory symptoms (minimal sputum and low fever)?

Back 15

Interstitial "atypical" pneumonia

Front 16

What organisms are a/w interstitial (atypical) pneumonia?

Back 16

Mycoplasma pneumoniae
Chlamydia pneumoniae
Respiratory syncytial virus (RSV)
Cytomegalovirus (CMV)
Influenza virus
Coxiella burnetti

Front 17

What is the MC causative organism of atypical pneumonia?

Back 17

Mycoplasma pneumoniae

usually in young adults (military or college dorms)

Front 18

Which organism lacks a cell wall and therefore is not visible on gram stain?

Back 18

Mycoplasma pneumoniae

Front 19

Autoimmune hemolytic anemia (IgM against I Ag on RBCs causes cold hemolytic anemia) and erythema multiforme are complications of what type or organism?

Back 19

Mycoplasma pneumoniae

Front 20

What is the 2nd MC causative organism of atypical pneumonia in young adults?

Back 20

Chlamydia pneumoniae

Front 21

MC cause of atypical pneumonia in infants?

Back 21

RSV

Front 22

Causative organism of atypical pneumonia a/w post-transplant immunosuppressive therapy?

Back 22

CMV

Front 23

Atypical pneumonia caused by influenza virus is a/w which populations?

Back 23

Elderly
Immunocompromised
Preexisting lung dz

Front 24

Which type of atypical pneumonia increases the risk for superimposed S aureus or H influenzae bacterial pneumonia?

Back 24

Influenza virus

It's this secondary bacterial pneumonia that can actually kill the patient.

Front 25

If a patient who is a farmer (or vet) presents with high fever (Q fever) but chest x-ray shows interstitial (atypical) pneumonia, what is the likely cause?

Back 25

Coxiella burnetti

(spores are deposited on cattle by ticks or are in cattle placentas)

Front 26

Coxiella burnetti is a rickettsial organism, but why is it distinct from most rickettsiae? (3 reasons)

Back 26

1. causes pneumonia
2. doesn't require arthropod vector for transmission (survives as highly heat-resistant endospores)
3. does NOT produce skin rash

Front 27

Aspiration pneumonia is commonly d/t anaerobic bacteria in the oropharynx, such as...

Back 27

Bacteroides
Fusobacterium
Peptococcus

(classically seen in alcoholics and comatose patients, resulting in a right lower lobe abscess)

Front 28

T/F

Primary TB is generally asymptomatic.

Back 28

True!

and leads to a positive PPD

Front 29

Ghon complex is a/w what?

Back 29

Primary TB

Front 30

Primary TB results in focal, caseating necrosis in _____ lobe of the lung and _______ that undergoes _____ and ______, forming a Ghon complex.

Back 30

Lower lobe; hilar lymph nodes

fibrosis and calcification

Front 31

Reactivation of m. TB is commonly d/t what?

Back 31

AIDS

may also be seen with aging

Front 32

Secondary TB occurs where in the lung?

Back 32

Apex of lung (d/t high O2 tension)

Front 33

Secondary TB forms ______ foci of caseous necrosis. It may also lead to ______ pulm TB or TB ___________.

Back 33

cavitary; miliary; bronchopneumonia

Front 34

An AIDS patient presents with fevers and night sweats, cough with hemoptysis, and weight loss. What should be high on your differential? What would you expect on biopsy and AFB stain?

Back 34

Secondary TB

biopsy - caseating granulomas
AFB stain - red, slender, acid-fast bacilli

Front 35

Systemic spread of secondary TB commonly affects what tissues?

Back 35

Meninges -> meningitis (usually base of brain)
Cervical lymph nodes
Kidneys -> sterile pyuria
Lumbar vertebrae -> Pott disease

Front 36

In COPDs, the FEV1:FVC ratio is (decreased/normal/increased) and the TLC is usually (decreased/normal/increased).

Back 36

Decreased (normal is 80%); increased

(FEV1 is decreased more than FVC; normal FEV1 is 4 L and FVC is 5 L)

Front 37

Chronic bronchitis is a chronic (nonproductive/productive) cough lasting at least __ months over a minimum of __ years.

Back 37

productive; 3 months; 2 years

Front 38

Chronic bronchitis is highly a/w what?

Back 38

Smoking

Front 39

Very generally, what is the pathophys of chronic bronchitis?

Back 39

Hypertrophy of bronchial mucinous glands (in submucosal layer)
Reid index >50% of the wall (normal is <40%)

Excess mucus production!!

Front 40

"Blue bloaters" a/w what?

Back 40

Chronic bronchitis

cyanosis b/c the mucus plugs trap CO2, leading to an increase in arterial CO2 (and alveolar) and decrease in arterial O2 (and alveolar)

Front 41

Chronic bronchitis pts have an increased risk of what 2 things?

Back 41

Infection
Cor Pulmonale

Front 42

What is the analogy for understanding the symptoms of Emphysema?

Back 42

destruction of alveolar air sacs

-> alveolar balloons become 1 big shopping bag! air doesn't come out as easily
-> balloons normally hold small airways open with outward air movement, but can't when their walls are destroyed, leading to airway collapse

Front 43

"Pink puffers" a/w what?

Back 43

Emphysema

by pursing their lips and increasing the backward pressure in the airways, they are able to maintain oxygenation!

Front 44

What is the MC cause of emphysema?

Back 44

Smoking

pollutants -> excess inflammation -> increase in proteases

Front 45

Emphysema d/t smoking results in (panacinar/centriacinar) emphysema that is most severe in the (upper/lower) lobes.

Back 45

Centriacinar (smoke will go to the center of the acinus)
Upper (smoke goes up!)

Front 46

What is an important anti-protease that helps keep the balance between proteases and anti-proteases during normal inflammation in the lung?

Back 46

Alpha 1 antitrypsin (A1AT)

Front 47

A patient presents with dyspnea, cough w/ minimal sputum, weight-loss, and a barrel chest. They have no history of smoking. Chest xray reveals panacinar emphysema mostly in the LOWER lobes of the lung.
What do you suspect to be the cause?

Back 47

A1AT deficiency (homozygous PiZZ)

a rare hereditary cause that occurs when there is a lack of A1AT in the blood due

Front 48

If a patient with PiMZ (heterozygous) mutation of the allele for A1AT develops emphysema, what type of findings would you suspect in your tests?

What would be the trigger for them?

Back 48

Centriacinar emphysema in the upper lobes
Low circulating A1AT

However, heterozygotes are usually asymptomatic... so they likely smoke! Heterozygotes have a significant risk for emphysema w/ smoking

Front 49

a) What other organ may be damaged with emphysema d/t A1AT deficiency?

b) What would biopsy of this organ reveal?

Back 49

a) Liver

Liver cirrhosis d/t accumulation of mutant A1AT in the ER of hepatocytes

b) pink, PAS-positive globules in hepatocytes

Front 50

In A1AT deficiency, where does the mutant A1AT accumulate?

Back 50

The ENDOPLASMIC RETICULUM of hepatocytes

Front 51

What are the clinical features of emphysema?

Back 51

Dyspnea and cough w/ minimal sputum
Prolonged expiration w/ pursed lips (pink puffer d/t increased back-pressure)
Weight loss (d/t pink puffer efforts)
Inc AP diameter of chest "barrel chest"

Front 52

What are late complications of emphysema?

Back 52

Hypoxemia (paO2 <60 d/t destruction of capillaries in the alveolar sac)
Cor pulmonale

Front 53

"Barrel chest" is a/w what disease?

The FRC is (decreased/normal/increased)

Back 53

Emphysema

normally, the collapsing-in desire of the lung is in balance with the chest wall's desire to expand. here - the chest wall wins.

FRC - increased, d/t resetting of the FRC

Front 54

What do Th2 cells secrete?

Back 54

IL4 (IgE), 5 (eosinophils) and 10 (stimulates Th2 and inhibits Th1)

(important for asthma)

Front 55

What are the 2 phases following reexposure to an allergen?

Back 55

IgE-mediated activation of mast cells:
1. release preformed histamine granules
2. generate LTC4, D4, E4 (bronchoconst, inflamm, edema - early phase rxn)
late phase - inflammation (especially MBP from eosinophils) damage cells and perpetuate bronchoconstriction

Front 56

Curshmann spirals and Charcot-Leyden crystals:
a) What disease are they a/w?
b) What are they?

Back 56

a) Asthma (in the sputum)

b) Curshmann spirals are spiral-shaped mucus plugs. Charcot-Leyden crystals are eosinophil-derived crystals (crystalline aggregates of MBP).

Front 57

When might asthma lead to death?

Back 57

When there is a severe, unrelenting attack, leading to status asthmaticus

Front 58

What are some nonallergic causes of asthma?

Back 58

Exercise
Viral infections
Aspirin (aspirin intolerant asthma - 10-15% of adults w/ asthma: bronchospasm + nasal polyps)
Occupational exposures (dusts at work)

Front 59

Loss of airway tone w/ air trapping of the larger airways (bronchioles and bronchi) is called what?

Back 59

Bronchiectasis

Front 60

What are some causes of bronchiectasis?

Back 60

d/t Necrotizing inflammation, therefore:

Cystic fibrosis (thick secretions -> mucus plug -> inc infection -> damage airway)
Kartagener syndrome
Tumor or foreign body
Necrotizing infection
ABPA - Allergic bronchopulmonary aspergillosis (seen in pts w/ asthma or CF)

Front 61

Kartagener syndrome is caused by an inherited defect in what?

Back 61

dynein arm, which is necessary for ciliary movement

Front 62

What causative disease of bronchiectasis is a/w sinusitis, infertility, and situs inversus?

Back 62

Kartagener syndrome

infertility d/t poor motility of sperm

Front 63

What are the clinical features of bronchiectasis?

Back 63

Cough
Dyspnea
Foul-smelling sputum (loaded with inflammatory junk)

Front 64

What are the complications of bronchiectasis?

Back 64

Hypoxemia w/ cor pulmonale

Secondary (AA) amyloidosis (SAA increases with chronic inflammation and deposits as AA; a systemic amyloidosis)

Front 65

Restrictive lung diseases are characterized by a (decreased/normal/increased) FEV1/FVC ratio and by a (decreased/normal/increased) TLC.

Back 65

Increased (FVC is decreased more than FEV1)
Decreased

Front 66

Restrictive lung diseases most commonly are caused by what?

Back 66

Interstitial diseases

(may also arise w/ chest wall abnormalities, such as massive obesity)

Front 67

Which restrictive lung disease is likely related to cyclical lung injury?

Which cytokine is released from injured pneumocytes to induce fibrosis?

Back 67

Idiopathic Pulmonary Fibrosis

TGF-beta

Front 68

Secondary causes of interstitial fibrosis must be excluded before making the diagnosis of Idiopathic Pulmonary Fibrosis. What are some of these secondary causes?

Back 68

Drugs (bleomycin and amiodarone)
Radiation therapy

Front 69

A patient presents with dyspnea and cough that has been progressively worsening over a long time. You do a chest xray that comes back with normal findings. You send in for a lung CT, and the results show a "honeycomb" lung. Your patient denies taking any medications or treatment with radiation.

What is high on your differential?
What would you need to do to treat this patient?

Back 69

Idiopathic Pulmonary Fibrosis

Lung transplant

Front 70

Pneumoconioses are d/t (acute/chronic) ______ exposures to (small/large) particles that are fibrogenic.

Back 70

chronic; occupational; small

need to be small enough to get all the way down in the lung to the intersitium

Front 71

In pneumoconioses, what cells engulf the foreign particles and induce fibrosis?

Back 71

Alveolar macrophages

they freak out! cause they don't know what the heck it is

Front 72

"black lung" is a/w what disease?

Back 72

Coal Workers' Pneumoconioses

this is massive fibrosis throughout the lung, also resulting in a shrunken lung

Front 73

What is anthracosis?

Back 73

Collections of carbon-laden macrophages in the lungs d/t mild exposure to carbon (pollution). Not clinically significant and is common

Front 74

What is Caplan syndrome?

Back 74

RA w/ Coal Workers' Pneumoconioses

Front 75

A 53 yo man who has worked as a sandblaster for the past 30 years presents to your office with respiratory complaints. A chest xray shows fibrotic nodules in the upper lobes of the lungs.

What do you suspect?
What disease will he also have an increased risk for?

Back 75

Silicosis

TB (this is the only pneumoconiosis that increases the risk for TB)

Front 76

What does silica impair in the lungs, therefore leading to fibrosis?

Back 76

Phagolysosome formation by macrophages

Front 77

A 50 yo patient presents with respiratory complaints. She works for NASA. A chest xray reveals noncaseating granulomas in the lung, hilar lymph nodes, and further examinations shows others in systemic organs.

a) What do you suspect first?
b) What other disease does this look like?
c) What do they have an increased risk for?

Back 77

a) Berylliosis (a pneumoconiosis)
b) sounds like Sarcoidosis, but giveaway is that she works in the aerospace industry. also seen in beryllium miners
c) increased risk for Lung Cancer

Front 78

What pneumoconiosis is a/w construction workers, plumbers, and shipyard workers?

Back 78

Asbestosis

Causes fibrosis of lung and pleura (plaques) w/ increased risk for lung carcinoma and mesothelioma (lung MC)

Front 79

Lesions in the lung or pleura that have long, golden-brown fibers w/ associated iron (looks like brown beads) confirms exposure to what?

Back 79

Asbestos
(asbestos bodies)

Front 80

A 30 yo African American female presents w/ respiratory complaints and painful nodules on her shins. You find noncaseating granulomas in multiple organs, including the hilar lymph nodes, lung, skin (cutaneous nodules or erythema nodosum). What does she have?

Back 80

Sarcoidosis

Front 81

What are the clinical features of sarcoidosis?

Back 81

Dyspnea or cough (MC)
Elevated serum ACE
Hypercalcemia (1-alpha hydroxylase activity of epitheliod histiocytes converts Vitamin D to its active form)

Front 82

A 32 yo African American female patient presents with complaints of dry eyes and mouth. She says she can't chew a cracker and she has dirt in her eyes. Biopsy of the salivary and lacrimal glands reveals noncaseating granulomas. What is her diagnosis?

Back 82

Sarcoidosis (not sjogren!!!)

Sarcoidosis can affect many organs, including salivary and lacrimal glands

Front 83

How do you treat sarcoidosis?

Back 83

with steroids, although it often resolves spontaneously w/o treatment

Front 84

"Asteroid bodies" are a/w what disease?

What are they?

Back 84

Sarcoidosis

characteristic stellate inclusions often seen w/in giant cells of the granulomas

Front 85

Pigeon breeder's lung is also called what?

Back 85

Hypersensitivity pneumonitis

Front 86

A granulomatous reaction (w/ eosinophils) to inhaled organic antigens that presents w/ fever, cough, and dyspnea hours after exposure is called what?

It resolves with removal of exposure. However, what happens with chronic exposure?

Back 86

Hypersensitivity Pneumonitis

chronic -> interstitial fibrosis

Front 87

Why does hypercalcemia occur in diseases with non-caseating granulomas (Sarcoidosis or Berylliosis)?

Back 87

because the 1-alpha hydroxylase activity of epithelioid histiocytes converts vitamin D to its active form.

Front 88

What is the normal pressure in the pulmonary circuit?
When is it considered HTN?

Back 88

normal: 10 mm Hg

pulm HTN: >25 mm Hg

Front 89

Pulmonary HTN is characterized by _________ of the pulmonary trunk, __________ hypertrophy, and ______ fibrosis.

Back 89

atherosclerosis
smooth muscle
intimal

Front 90

Pulmonary HTN leads to right ventricular hypertrophy with eventual _________.

Back 90

cor pulmonale

Front 91

Pulmonary HTN presents with either _______ or _______.

Back 91

Exertional dyspnea
right-sided heart failure

Front 92

A 24 yo female presents with exertional dyspnea. What should you immediately think?

Back 92

Primary Pulmonary HTN

Front 93

Innactivating mutations of BMPR2 are a/w what? What does it lead to?

Back 93

Primary pulmonary HTN

the mutation leads to proliferation of vascular SM

Front 94

What are some possible causes of secondary pulmonary HTN?

Back 94

Hypoxemia (COPD and ILD)
Increased volume in pulm circuit (congenital heart dz, especially Eisenmenger)

Recurrent PE

(PE can either lead to: 1 - asymptomatics. 2 - pulm infarction. 3. sudden death from saddle embolus. 4. chronic PE that gets reorganized -> thickened vascular wall -> pulm HTN)

Front 95

a) Acute respiratory distress syndrome is diffuse damage to the _______ interface (diffuse _____ damage).

b) Leakage of ____-rich fluid leads to edema and formation of _________

Back 95

a) alveolar-capillary; alveolar

b) protein-rich; hyaline membranes in alveoli

Front 96

How do hyaline membranes in ARDS cause hypoxemia and cyanosis?

Back 96

Thickened diffusion barrier
Collapse of air sacs (d/t increased surface tension)

When alveoli collapse, it requires a lot of effort to open them back up again when inhaling!

Front 97

ARDS occurs secondary to a variety of different disease processes. What do they all have in common?

List some examples.

Back 97

They activate neutrophils -> inducing protease-mediated and free radical damage of type I AND II pneumocytes!

Sepsis
Infection
Shock
Trauma
Aspiration
Pancreatitis
DIC
HS rxns
Drugs

Front 98

Surfactant is made by type (I/II) pneumocytes.

Back 98

II

Surfactant decreases surface tension in lung, preventing alveolar collapse after expiration.

Front 99

What is the major component of surfactant?

Back 99

Phosphatidylcholine (lecithin)

Front 100

Surfactant production begins at ____ wks and adequate levels are reached at ____ wks.

Back 100

28 wks; 24 wks

Front 101

How can you screen for lung maturity in neonates?

Back 101

L:S ratio should be >2! (lecithin:sphingomyelin... S remains constant as L increases along w/ surfactant)

Front 102

How are C sections a/w neonatal respiratory distress syndrome?

Back 102

Because normal vaginal deliveries stimulate stress-induced steroids -> steroids increase surfactant synthesis.

C-sections result in a lack of stress-induced steroids

Front 103

How is maternal diabetes a/w neonatal respiratory distress syndrome?

Back 103

because the high blood glucose in the mother is transferred to the baby, and the baby has a normal pancreas that will release high insulin in response. *Insulin decreases surfactant production.

Front 104

A woman gives birth to a baby at 32 weeks gestation. The baby exhibits tachypnea with use of accessory muscles and grunting. The baby also becomes hypoxemic and cyanotic. Chest x-ray shows diffuse granularity of the lung ("ground glass" appearance).

What's the problem?

Back 104

Neonatal Respiratory Distress Syndrome - not enough surfactant yet (adequate is about 34 weeks)

Front 105

Hypoxemia, d/t neonatal respiratory distress syndrome, can result in risk of what 2 conditions?

Back 105

Persistence of PDA (PDA closes with good oxygenation)
Necrotizing Enterocolitis (decreased O2 to gut)

Front 106

Supplemental oxygen given to newbowns suffering from neonatal respiratory distress syndrome can have serious consequences.
a) What are 2 possible consequences?
b) How does this injure the tissue?

Back 106

a) Blindness (d/t retinal injury) or Bronchopulmonary Dysplasia (d/t lung damage)

b) free radical damage!

Front 107

"ground-glass" appearance in chest xray of newborn is a/w what?

Back 107

Neonatal respiratory distress syndrome

Front 108

What is the average age at presentation of lung cancer?

Back 108

60 years

Front 109

What are the 3 key risk factors for lung cancer?

Back 109

#1 - Cigarette smoke (polycyclic aromatic hydrocarbons and arsenic especially)
#2 - Radon (formed by radioactive decary of uranium)
#3 - Asbestos

Front 110

Lung cancer presents w/ nonspecific symptoms, such as:

Back 110

cough
weight loss
hemoptysis
postobstructive pneumonia

Front 111

"coin-lesion" on chest xray is a/w what?

Back 111

It's a solitary nodule and could be benign or cancerous

Front 112

What are some examples of benign "coin-lesions?"

Back 112

Usually in younger patients.

- Granuloma (often d/t TB or fungus, especially Histo in midwest)
- Bronchial hemartoma - benign tumor of lung tissue and cartilage, often calcified

Front 113

Which is more common - small or non-small cell carcinoma of the lung?

Back 113

non-small cell carcinoma

Front 114

Small cell carcinoma of the lung is treated with _______, while non-small cell carcinoma is treated with ________.

Back 114

small - chemotherapy (usually not amenable to surgical resection)
non-small - upfront w/ surgical resection! (usually doesn't respond well to chemo)

Front 115

Which lung cancers are a/w male smokers, centrally located, and are known to cause paraneoplastic syndromes?

Back 115

S's! smokers, c(s)entral, syndromes

Squamous cell carcinoma
and
Small cell carcinoma

Front 116

Which two types of lung cancer would be chromogranin positive?

This means they arise from what type of cell?

Back 116

Small cell carcinoma and Carcinoid tumors

from neuroendocrine cells

Front 117

Small cell carcinoma of the lung and large cell carcinoma of the lung are (poorly/well)-differentiated.

Back 117

Poorly differentiated

Front 118

Carcinoid tumors of the lung are (poorly/well) differentiated.

Back 118

Well differentiated neuroendocrine cells

Front 119

a) Which lung cancers can show up centrally in the lung?

b) peripherally?

Back 119

a) small cell carcinoma, squamous cell carcinoma, large cell carcinoma, carcinoid tumor

b) adenocarcinoma, large cell carcinoma, carcinoid tumor

note that large cell and carcinoid can be either one!

Front 120

What paraneoplastic syndromes are a/w small cell carcinoma of the lung?

Back 120

may produce ADH or ACTH (Cushing's)
Eaton-Lambert syndrome (antibodies against pre-synaptic Ca2+ channels can lead to muscle weakness)

Front 121

Kulchitsky cells are a/w what?

Back 121

Small cell carcinoma of the lung arises from neuroendocrine (Kulchitsky) cells

Front 122

Small cell carcinoma has (slow/rapid) growth and (early/late) metastasis.

Back 122

Rapid; early

Front 123

What is the MC tumor in male smokers?

Back 123

Squamous cell carcinoma

Front 124

What paraneoplastic syndrome is a/w a small subset of squamous cell carcinoma of the lung?

Back 124

may produuce PTHrP (parathryoid hormone related protein)

Front 125

The following findings point to which type of lung cancer?

a) keratin pearls
b) glands
c) intercellular bridges
d) mucin
e) none of the above?

Back 125

a) squamous cell carcinoma
b) adenocarcinoma
c) squamous cell carcinoma (desmosomal cnxns b/w the desmosomes)
d) adenocarcinoma
e) large cell carcinoma

Front 126

Large cell carcinoma is a/w ______ and has a (good/poor) prognosis.

Back 126

smoking; poor

Front 127

What is the MC tumor in nonsmokers and in female smokers?

Back 127

Adenocarcinoma

Front 128

Which lung cancers are not related to smoking?

Back 128

Bronchioalveolar carcinoma
Carcinoid tumor

Front 129

A lung cancer where columnar cells grow along preexisting bronchioles and alveoli is what?

What does it arise from?

Back 129

Bronchioalveolar carcinoma

arise from Clara cells

Front 130

Which lung cancer may present w/ pneumonia-like consolidation on imaging and has an excellent prognosis?

Back 130

Bronchioalveolar carcinoma

Front 131

Which lung cancer classically forms a polyp-like mass in the bronchus?

It is a (low/high)-grade malignancy.

Back 131

Carcinoid tumor

low-grade malignancy

Carcinoid tumors can (rarely) cause carcinoid syndrome.

Front 132

If you spot multiple "cannon-ball" nodules in the lung imaging, what should you expect?

Back 132

a) metastatic cancer, MC from breast or colon carcinoma

Front 133

T/F

Primary tumors of the lung are more common than metastasis to the lung.

Back 133

False!

The opposite is true. The lungs are a common site for metastases.

Front 134

Pleural involvement is classically seen with which lung cancer?

Back 134

Adenocarcinoma (d/t location on periphery)

Front 135

There are several different structures that can be obstructed by tumors in the lung. What are some of them and what do they cause?

Back 135

SVC - distended head and neck veins w/ edema and blue discoloration of arms and face (superior vena cava syndrome)

Recurrent laryngeal nerve - hoarseness

Phrenic nerve - diaphragmatic paralysis

Sympathetic chain - Horner syndrome (ptosis, miosis, and anhidrosis in forehead especially). Usually d/t an apical (Pancoast) tumor

Front 136

Lung cancers can spread to regional lymph nodes, such as which ones?

What is a unique site of distant metastasis?

Back 136

Hilar and mediastinal

Adrenal gland

Front 137

Overall 5-yr survival of lung cancer is what?

Back 137

15%

(d/t late presentation)

Front 138

A pneumothorax is accumulation of air in the __________.

Back 138

Pleural space

Front 139

A young adult patient presents w/ difficulty breathing. Chest x-ray shows a pneumothorax of part of the right lung, and the trachea is shifted to the right (same side as collapse).

What type of pneumothorax is this?
What causes this?

Back 139

Spontaneous pneumothorax
d/t rupture of an emphysematous bleb (seen in young adults)

Front 140

a) What causes a tension pneumothorax?
b) The trachea will deviate to the (same/opposite) side of the injury.
c) This is a medical emergency and is treated how?

Back 140

a) Penetrating chest wall injury (air enters the pleural space with each inhalation, but it isn't able to exit)
b) Opposite side of injury
c) Insertion of a chest tube (allows air to drain out)

Front 141

Mesothelioma is a (benign/malignant) neoplasm of mesothelial cells and is highly a/w what?

Back 141

Malignant; occupational exposure to asbestos

Front 142

A 54 yo construction worker presents w/ recurrent pleural effusions, dyspnea, and chest pain. You find that they have a large mass that is encasing their lung.

Back 142

Mesothelioma

Asbestos exposure is seen in construction workers, shipyard workers, and plumbers. Although lung cancer is more common, this patient is presenting with signs of mesothelioma (particularly the recurrent pleural effusions and the mass encasing the lung).