High Yield Pulmonary

Front 1

two patterns for acute lung injury

Back 1

Diffuse alveolar damage
• Organizing pneumonia

Front 2

what are hyaline membranes made from

Back 2

composed of dead cells
(nucleoplasm, cytoplasm,
fibrin)

Front 3

DAD organizing phase vs. pneumonia

Back 3

myofibroblasts and fibroblasts but no hyaline membranes in pneumonia

Front 4

dad review

Back 4

just for review

Front 5

when do hyaline membranes peak in DAD, when fibrosis start

Back 5

both day 2

Front 6

"strange' cause of DAD

Back 6

connective tissue dz

Front 7

boop vs. pneumonia

Back 7

pneumonia - note fibroblastic foci is branching, new and distal

Front 8

what, clinical term, pathology term, how much of lung, how treat

Back 8

UIP (idiopathic pulmonary fibrosis for clinicians), diffuse bilateral, temporal and geographic heterogeneity,
bad prognosis, NOT steroids, transplant in young patients

Front 9

where is UIP most often found

Back 9

Periphery of lung and lower lobes
-subpleural, paraseptal

Front 10

variation in fibrosis in UIP

Back 10

Dense fibrosis with remodeling and usually honeycombing
Fibroblastic foci at edge of fibrosis

Front 11

what

Back 11

UIP

Front 12

histologic fx of NSIP

Back 12

Uniform septal thickening
Usually no honey combing/architectural
distortion
Fibrotic and cellular patterns

Front 13

causes of NSIP

Back 13

CVD, drugs, infection, pneumoconiosis

Front 14

what

Back 14

cellular phase of NSIP - expansion by plasma cells and lymphocytes

Front 15

what

Back 15

fibrotic phase of NSIP

Front 16

how to think of DIP

Back 16

DIP (smoking!)
think of primarily alveolar filling (with smoker's macs) and secondary interstitial fibrosis (uniformly, thick)

Front 17

what

Back 17

DIP

Front 18

what is hamman-rich syndrome

Back 18

AIP (aka organizing DAD), complete white out by CXR

Front 19

cf LIP with cellular NSIP

Back 19

more dense inflammatory infiltrate

Front 20

what to associate with LIP

Back 20

Assoc with HIV, CVD (Sjögren’s syndrome) , EBV, Pneumocystis

Front 21

what are you at risk for developing with LIP

Back 21

small% extranodal marginal zone lymphoma

Front 22

what

Back 22

LIP

Front 23

new name for BOOP

Back 23

COP

Front 24

when get COP

Back 24

often 4-6 weeks post viral URI

Front 25

ground glass opacities think

Back 25

COP

Front 26

pathologic findings of COP

Back 26

Patchy airway centered fibrous polyps of organizing
pneumonia

Front 27

what

Back 27

COP

Front 28

for collagen vascular dz what histologic lung patterns of injury do you most see

Back 28

NSIP>UIP

Front 29

if see Follicular lymphoid hyperplasia – think

Back 29

Sjögren’s syndrome

Front 30

what

Back 30

think: sjogren's syndrome, follicular lymphoid hyperplasia

Front 31

acute hypersensitivity pneumonitis - what type of hypersensitivity

Back 31

type III

Front 32

chronic hypersensitivity pneumonitis

Back 32

type IV hypersensitivity

Front 33

histologic fx of hypersensitivity pneumonitis

Back 33

Bronchiolocentric interstitial lymphoplasmacytic infiltrates
– Poorly formed interstitial granulomas
– Organizing pneumonia
– Chronic bronchiolar inflammation with peribronchiolar metaplasia
(Lambertosis)

Front 34

causes of eosinophilic pneumonia

Back 34

1. loeffler's - allergic
2. Churg-strauss - if vasculitis, asthma
3. acute idiopathic if unknown (wiht DAD)

Front 35

two diffuse alveolar hemorrhage syndromes

Back 35

wegener's and goodpastures

Front 36

what is granulomatosis with polyangiitis

Back 36

wegener's

Front 37

triad for wegener's pathologically

Back 37

Vasculitis, granulomas and geographic necrosis

Front 38

what is the cANCA in wegener's against

Back 38

serine proteinase-3

Front 39

response of wegener's to steroids

Back 39

great response, fatal if untreated

Front 40

what

Back 40

diffuse alveolar hemorrhage syndrome (wegener's vs. goodpastures

Front 41

presentation of someone with goodpasture's

Back 41

young male, hemoptysis

Front 42

test for goodpasture's

Back 42

DIF alveolar septal basement
membranes with IgG and complement (anti alveolar BM antibodies; linear staining)

Front 43

pseudomonas - micro fx

Back 43

Gram-negative, motile (polar flagellum), strictly
aerobic, oxidase positive, respiratory
metabolism NOT fermentative

Front 44

three clinical settings for pseudomonas

Back 44

steroids,
– Cystic fibrosis
– Contaminated respiratory equipment

Front 45

good stain for nocardia

Back 45

Partial acid-fastness (Ziehl-Neelson+)

Front 46

atypical pneumonias: two

Back 46

mycoplasma, chylamydia

Front 47

how does mycoplasma attach to ciliated resp epithelium

Back 47

P1

Front 48

consequence of mycoplasma pneumonia

Back 48

development of cold agglutinins to I rbc antigen

Front 49

how does chylamydia get into to cells

Back 49

attaches through elementary body

Front 50

how acquire C. psittaci

Back 50

bird droppings (parakeet)

Front 51

CMV - dna, rna?

Back 51

ds DNA

Front 52

which HSV (1 or 2) is GU, which is respiratory

Back 52

HSV1 - respiratory
HSV2 - GU

Front 53

clinical findings for measles

Back 53

1-2 wk incubation, then fever, Koplik’s spot, giant cell pneumonia

Front 54

if see giant cell pneumonia think:

Back 54

RSV or measles

Front 55

what type of giant cells are seen with measles

Back 55

Warthin-Finkeldey cells

Front 56

adenovirus: DNA, RNA, ds or ss

Back 56

ds DNA virus (nonenveloped)

Front 57

pulmonary pattern for adenovirus

Back 57

bronchiolitis (can be severe, necrotizing)
pneumonitis

Front 58

what is in walls of mycobacterium TB

Back 58

mycolic acid

Front 59

what is Ranke’s complex

Back 59

calcified hilar nodes + GHon complex

Front 60

mechanism of entry of TB

Back 60

Alveolar bacilli are ingested by neutrophils and
macrophages - macrophages may go to regional
lymph nodes

Front 61

compare granulomas of Wegener's vs. TB

Back 61

those of TB tend to be more round, no vasculitis too

Front 62

use for auramine-rhodamine IF

Back 62

to identify TB

Front 63

where see MAI most commonly in lungs

Back 63

middle lobe (hard to get secretions out, lady windemere)

Front 64

association with MAI

Back 64

hot tubs

Front 65

where are granulomas found in MAI

Back 65

airway baesd granulomas

Front 66

findings in Allergic bronchopulmonary aspergillosis

Back 66

Tide mark lines
– Collections of eos
– Mucous
– Charcot-Leiden
crystals

Front 67

what

Back 67

since often too small to see on H&E, here's what to look for:
Intra alveolar macrophages and hob nailed pneumocytes
Intracellular (exist in macrophages)
may see round necrotizing granulomas

Front 68

clinical setting for cocciodiodes

Back 68

40% have flu-like illness for 1-3 wks
– 20% have erythema multiforme or erythema nodosum

Front 69

clinical setting for blastomyces

Back 69

likes to disseminate to skin and bone but can go to lung

Front 70

clinical setting for cryptococcus

Back 70

lung, hematogenous to cerebromeningeal

Front 71

new name for P carinii

Back 71

Pneumocystis jirovecki

Front 72

histol fx for pneumocystis

Back 72

Intra-alveolar frothy material with minimal inflammation
– GMS stains show 7-8 micron non-budding cysts
– Dented ping-pong balls
– Some with central black dot
– PAS negative

Front 73

what does Peudoallescheria boydii look like histologically

Back 73

like actinomyces

Front 74

what does Peudoallescheria boydii cause clinically

Back 74

Associated with allergic bronchopulmonary
disease

Front 75

three forms of toxo

Back 75

– Tachyzoite (invasion, proliferation)
– Tissue cyst (reservoir for tachyzoites) - cat is reservoir
– Oocyst (infectious after sporulation)

Front 76

what to think of

Back 76

acute necrotizing pneumonia - toxo

Front 77

what

Back 77

bag of jelly beans, toxo

Front 78

what

Back 78

filiform larva of strongyloides

Front 79

what

Back 79

Protoscolices containing teeth-like hooklets - ecchinococcus

Front 80

where find echinococcus

Back 80

liver in adults
lungs in kids

Front 81

what associated with Michaelis-Gutman bodies in lungs

Back 81

Rhodococcus equi
Aerobic Grampositive/ variable coccobacillus

Front 82

what stain can be used for michaelis-gutman bodies

Back 82

mineralization stain - von Kossa

Front 83

host and vector for Bartonella quintana or hensalae

Back 83

Cat is common host; transmission by flea,
Ctenocephalides felis

Front 84

useful stain for bartonella spp

Back 84

warthin-starry (gram neg rods)

Front 85

causes of secondary pulmonary hypertension

Back 85

Obstructive or interstitial lung disease
– Heart disease
– Recurrent thromboemboli

Front 86

in whom is PPH seen and what is the underlying problem

Back 86

young to middle age women, endothelial dysfunction

Front 87

specific fx in scope on PPH

Back 87

Plexiform lesion (anastomosing vessels)
– Angiomatoid lesion (plexiform+dilation)
– Necrotizing arteritis

applicable to both primary and secondary causes: smc proliferation in intima and media

Front 88

what is Capillary hemagiomatosis

Back 88

prominence of septal vessels

Front 89

what, in whom, syndromic association, family of tumors

Back 89

LAM
Cystic lung disease with numerous cysts lined by plump
smooth muscle cells
young women
TS, PEComa

Front 90

another name for eosinophilic granuloma

Back 90

langerhans cell histiocytosis X

Front 91

association for eosinophilic granuloma in adults

Back 91

smoking, DIP

Front 92

what

Back 92

eosinophilic granuloma (LCH)

*Stellate centrilobular scar with eosinophils
and Langerhans cells (coffee bean shape, grooves)

Front 93

causes of alveolar proteinosis

Back 93

-congenital (surfactant defect)
- inhale dusts
- problems with GM-CSF (where Macs can't consume surfactant and it accumulates)

Front 94

what, ddx (how distinguish)

Back 94

pulmonary alveolar proteinosis
No small dots as seen in pneumocystis
PAS+, unlike pneumocystis

Front 95

name, assoc/cause

Back 95

lipoid pneumonia, aspiration

Front 96

noncaseating granulomas: two prominent ddx

Back 96

sarcoid
berylliosis

Front 97

two findings in sarcoid

Back 97

asteroid bodies
schaumann bodies

note granulomas usu around bronchovascular bundle

Front 98

what is a type I hypersensitivity in lung

Back 98

asthma

Front 99

causes

Back 99

bronchiectasis;
causes CF, Kartagener's (lack dynein arms on cilia)

Front 100

which emphysema is found where

Back 100

centrilobular: bronchi-centered, upper lobes
panacinar: diffuse, lower lobe predominant

Front 101

when clinical sx worse than path, what to consider

Back 101

constrictive bronchiolitis (often just a little fibrosis or a little inflammation)
can get an obliterated bronchus

Front 102

what, location, ihc

Back 102

inflammatory myofibroblastic tumor
Bland spindle cells, inflammatory cells and
collagen
usu. endobronchial
sma, alk in 40%

Front 103

two additional names for sclerosing hemangioma

Back 103

pneumocytoma and sclerosing epithelioma

Front 104

cell of origin of a sclerosing hemangioma

Back 104

Tumor of primitive respiratory epithelium, not
vascular tumor (not hemangioma)

Front 105

what

Back 105

sclerosing hemangioma
Type 2 pneumocytes (hobnailing) line the surface of
papillary structures with underlying round cells

Front 106

staining pattern for cells of sclerosing hemangioma

Back 106

Surface epithelial cells (hobnailed cells)
keratin +, EMA+ TTF1+
– Round cells (bland cells): keratin -, EMA +, TTF1+

Front 107

molecular targets in lung ca

Back 107

EGFR, drug (cetuximab, gefitinib, erlotinib),
– Non smokers, women, asian
EML4-ALK (crizotinib), young non-smokers
VEGF, drug (avastin, ect)
HER2, drug herceptin
KRAS, smokers
BRAF

Front 108

what to test for molecularly in lung ca

Back 108

EGFR and ALK if adenoca component

Front 109

ihc for lung scca

Back 109

p63+, CK5/6+, 34βe12 +, CK7+, CK20-
TTF1-

Front 110

is lung scca a/w EGFR mutations

Back 110

no

Front 111

ihc for lung adenoca

Back 111

TTF1+, napsin+, mucin+ CK5/6 -

Front 112

if adenoca in lung and egfr mutation, think:

Back 112

women, nonsmoker, asian

Front 113

if adenoca lung with alk mutation, think:

Back 113

young, nonsmoker

Front 114

what does atypical adenomatous hyperplasia lead to (<5mm)

Back 114

adenoca precursor (call it a BAC if >5mm)

Front 115

does mucinous BAC have egfr mutations

Back 115

nope, and worse prognosis

Front 116

mits and necrosis for neuroendocrine tumors of lungs

Back 116

carcinoid <2 mits/10 hpf, no necrosis
atypical 2-10 mits, necrosis
small and large cell >10/10 mits, lots of necrosis, just cell size dependent at that point

Front 117

fx of acute rejection

Back 117

Changes in alveoli
– Intraparenchymal perivascular
mononuclear infiltrates
– More PMNs, eos and macrophages as
disease develops
– Endothelialitis

Front 118

fx of grade b rejection in lung

Back 118

Lymphcytic bronchiolitis
– Combined large and small airway inflammation

Front 119

fx of grade C rejection in lung

Back 119

chronic Chronic airway rejection
– Bronchiolitis obliterans

Front 120

fx of grade d rejection

Back 120

chronic vascular rejection
Fibrointimal thickening of arteries and
veins

Front 121

SFT ihc

Back 121

CD34, Bcl-2, CD99

Front 122

what

Back 122

SFT

Front 123

ihc for mesothelioma

Back 123

calretinin (cyto and nuclear),
CK 5/6, thrombomodulin, WT-1 (nuclear)
Sarcomatoid mesothelioma loss of these
antigens
– may only be calretinin +

Front 124

Types of asbestos

Back 124

– Serpentines – curly flexible fibers
1) Chrysotile – most U.S. asbestos
2) Less pathogenic
– Amphiboles – straight stiff fibers
1) More pathogenic
2) Amosite, crocidolite

Front 125

association aspergillus?

Back 125

adenoca

Front 126

fx of legionella pneumonia

Back 126

alveolar exudates of PMNs, macrophages
with fibrin +/- hyaline membranes.
Dieterle stain - small intra/extracellular coccobacillary organisms (Gram - )

Front 127

appearance: Pseudomonas pneumonia –

Back 127

acute necrotizing vasculitis

Front 128

Allergic pulmonary Aspergillosis histology

Back 128

bronchocentric granulomas

Front 129

see giant cell pneumonia, think

Back 129

measles

Front 130

two imp't facts about lung scca

Back 130

most associated with hypercalcemia
TTF1-

Front 131

lung ca most a/w paraneoplastic syndromes

Back 131

small cell ca

Front 132

know the gross fx of chondroid hamartoma

Back 132

see epithelial clefting

Front 133

fx and ihc of sft

Back 133

SFT, pleural pedunculated plaque, patternless pattern and staghorn
vessels CD34/CD99/BCL-2 +

Front 134

most common site of a plasmacytoma

Back 134

upper respiratory tract

Front 135

clear cell sarcoma a/w

Back 135

ts and lam

Front 136

ihc for mesothelioma

Back 136

+ for calretinin and CK5/6+,- for CEA/EMA/LeuM1

Front 137

Definition of Good Pastures

Back 137

antibodies
to antigens in basement membrane

Front 138

where find centrilobular emphysema

Back 138

upper lobes
and upper potions of lower lobes

Front 139

what

Back 139

anthrasilicosis - coal mine lung