Pathoma - 9 (Respiratory)

arold001's version from 2015-12-30 19:28

Section 1

Question Answer
What can pts with repeated bouts of rhinitis develop?nasal polyps
male child presents with nasal polypthink CF!
What 2 conditions are associated with nasal polyps?CF and aspirin-intolerate asthma
what is an angiofibroma?benign tumor of nasal mucosa composed of large blood vessels and fibrous tissue
teen male presents with perfuse epistaxis....diagnosis?nasopharyngeal angiofibroma
whats another name for laryngotracheobronchitis?croup
what causes croup?parainfluenza virus
what are vocal cord nodules composed of?myxoid degenerative connective tissue
benign papillary tumor of the vocal cord?laryngeal papilloma = due to HPV 6, 11
koilocytic changeHPV
whats the difference btw laryngeal papilloma in adults vs. kids?adults: ONE single lesion. kids: multiple papillomas
what type of epithelium lines the vocal cords?squamous epithelium

Section 2

Question Answer
what are the 2 most common bacteria causing LOBAR pneumonia?strep pneumo and klebsiella pneumonia
what are the 4 stages of lobar pneumonia?1) congestion 2) red hepatization 3) grey hepatization 4) resolution
what type of pneumonia: scattered patchy consolidation centered around bronchiolesbronchopneumonia
name the 3 bacteria that causes aspiration pnuemonia?bacteroides, fusobacterium, peptpcoccus
where does aspiration pneumonia commonly like to infect?right lower lobe pneumonia
what bacteria causes lobar pneumonia is elderly pts in nursing homes, alcoholics and diabetics?klebsiella pneumonia
this bacteria has a thick mucoid capsule that results in gelatinous sputumklebsiella = has thick mucoid capsule
whats the most common cause of bacterial pneumonia post-viral infection?staph aureus
whats empyema?pus in pleura
what bacteria causes bronchopneumonia from a water source?legionella pneumonia
name 3 bacterias that cause pneumonia superimposed on COPD (leads to worsening of COPD)1) H. influenza
2) Moraxella
3) Legionella pneumophila
what are 2 complications of atypical pneumonia due to mycoplasma pneumonia?autoimmune hemolytic anemia (IgM against I antigen on RBCs and ERYTHEMA MULTIFORME
whats the most common cause of atypical pneumonia in infants?RSV
whats the 2nd most common cause of atypical pneumoia?chlamydia pneumonia
whats the most common cause of atypical pneumonia with post-transplant immunosuppressive therapy?CMV
whats causes atypical pneumonia with HIGH FEVER in farmers and veterinarians?coxiella burnetti
atypical pneumonia in a farmer or vet is due to what org?coxiella burnetti

Section 3

Question Answer
sign of primary TB?Gohn complex
caseating necrosis in LOWER LOBE and hilar LN that undergo fibrosis and calcificationprimary TB
which section of the lobe is involved in primary TB? secondary TB?primary TB: lower lobe and hilar LN
secondary TB: apex lung
what is chronic bronchitis?productive cough lasting at least 3 months over minimum of 2 years
what does Reid Index measure for chronic bronchitis?measures thickness of mucinous glands relative to bronchial wall
why is there alot of sputum in chronic bronchitis?hypertrophy and hyperplasia of bronchial mucinous glands
blue boaters?chronic bronchitis
what causes emphysema?destruction of alveolar air sacs --> loss of elastic recoil and collapse of airways during exhalation results in obstruction and air trapping
what type of emphysema does smoking cause? and what location?centriacinar emphysema in UPPER lobes
what type of emphysema does A1AT deficiency cause and what location?panacinar emphysema in LOWER lobes
how does A1AT deficiency cause cirrhosis?mutant A1AT accumulates in the ER of hepatocytes resulting in liver damage!!
PAS positive globules in hepatocytesmutated A1AT accumulated in hepatocytes
pink pufferemphysema
dilated air sacs are characteristic of which lung disease?emphysema = destruction of alveolar air sacs

Section 4

Question Answer
explain the pathogenesis of asthmareexposure to allergen leads to IgE-mediated activation of mast cells. 1) release of PREFORMED HISTAMINE GRANULES and generation of LTC3, LTD4, LTE4 (bronchoconstriction and inflammation) 2) inflammation derived from eosinophil major basic proteins damages cells and perpetuates bronchoconstriction
what causes late phase reaction of asthma = damages cell and perpetuates bronchoconstrictioneosinophil major basic protein
Curschmann spirals and Charcot leyden crystals are in what lung disease?asthma
what are charcot leyden crystals?crystal aggregates of eosinophil major basic protein
what is bronchiectasis?permanent dilation of bronchioles and bronchi due to necrotizing inflammation with damage to airway walls
name 3 disorders that cause dilated bronchioles/bronchi (bronchiectasis)CF
kartageners syndrome
allergic bronchopulmonary aspergillosis
pt presents with sinusitis, infertility due to poor motility, bronchiectasis?kartageners syndrome = defect in dynein arm needed for CILARY movement
CF pt presents with cough, dyspnea, and FOUL-SMELLING SPUTUMbronchiectasis
name 2 complications of bronchiectasis (due to necrotizing inflammation with damage to airway walls)?hypoexmia with cor pulmonale and SECONDARY AMYLOIDOSIS
how does allergic bronchopulmonary aspergillosis cause bronchiectasis?hypersensitivity reaction to aspergillous leads to chronic INFLAMMATORY damage to airway wall

Section 5

Question Answer
what causes fibrosis of lung interstitium in Idiopathic Pulmonary Fibrosis?TGF-beta from injured pneumocytes induces fibrosis
fibrosis with end stage honey comb lesion is a late complication of what?idiopathic pulmonary fibrosis
what autoimmune disease is a/w coal workers pneumoconiosis?rheumatoid arthritis = caplans syndrome
which pneumoconosis has an increased risk for TB?silicosis
what causes silocosis?silica impairs phagolysosome formation by macrophages
what type of HSN is beryllosis?Type IV HSN
berylliosis causes increased risk for which cancer?bronchogenic carcinoma
which pneumoconiosis causes fibrotic nodules in upper lobe of lung?silicosis
which disease do you see stellate inclusions "ASTEROID BODIES"sarcoidosis
asteroid bodiessarcoidosis
if you have noncaseating granulomas in salivary and lacrimal glands...think of?SARCOIDOSIS! mimics sjorgens
what are 2 weird labs seen in sarcoidosis?elevated ACE and hypercalcemia
why do pts with sarcoidosis show hypercalcemia?1-alpha hydroxylase activity of epitheloid histiocytes converts vitamin D to its active form
granulomas with eosinophils s/p playing with pigeonshypersensitivity pneumonitis = pigeons breeders lung

Section 6

Question Answer
what measurement defines pulmonary HTN?pulmonary HTN: > 25mmHg (normal: 10 mmHg)
what causes primary PULMONARY HTN?inactivating mutations of BMPR2 --> leads to proliferation of vascular smooth muscle
what causes secondary pulmonary HTN?hypoexmia (COPD or interstitial lung dz), increased volume in pulmonary circuit, or pulmonary embolism

Section 7

Question Answer
white out of CXRacute respiratory distress syndrome
What causes acute respiratory distress syndrome?activation of neutrophils induces protease-mediated and free radical damage of Type I and Type II pneumocytes
How do you tx acute respiratory distress syndrome?tx underlying cause (sepsis, aspiration, pancreatitis, DIC, hypersensitivity reactions) and ventilation with PEEP
Whats a good measure of surfactant production?phosphatidylcholine (lecithin): sphingomyelin >2
how come maternal diabetes is a risk factor of neonatal respiratory distress syndrome?insulin decreases surfactant production
name 3 risk factors for lung cancer?smoking, RADON and asbestos
what are the 2 categories of lung cancer?small cell carcinoma and NON-small cell carcinoma
what are the 4 subtypes of non-small cell carcinoma?1) adenocarcinoma
2) squamous cell lung carcinoma
3) large cell lung carcinoma
4) carcinoid tumor
small cell lung carcinoma is a paraneoplastic syndrome that can release what 3 things?ACTH, ADH and Lambert eaton syndrome
whats the most common lung tumor in male smokers?squamous cell carcinoma
whats the most common lung tumor in NONSMOKERS and female smokers?adenocarcinoma = see glands and mucin on histo
which lung cancer shows pleural involvements?adenocarcinoma and mesothelioma
what 2 lung cancers are derived from neuroendocrine?small cell lung carcinoma and carcinoid tumor
pt presents with polyp like mass in the bronchus. diagnosis?carcinoid tumor
Which 3 lung cancers are NOT related to smoking?1) adenocarcinoma
2) bronchoalveolar carcinoma
3) carcinoid tumor
Which 2 lung tumors are in the periphery?1) adenocarcinoma
2) bronchoalveolar carcinoma
multiple canon ball nodules on CXRmetastasis to lung by breast and colon carcinoma
what organ does LUNG cancer like to spread/metastasize to?ADRENAL GLAND!
trachea shifts TOWARD side of collapsed lungspontaneous pneumothorax
trachea shifts to OPPOSITE side of collapsed lungtension pneumothorax