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Respiratory

Pathology: Respiratory

QuestionAnswer
Dyspnea w/ decreased breath sounds, enlargement of air spaces on X-ray. Diagnosis Emphysema (Pink puffer) loss of elastic tissue → hyperinflation, barrel chest, ↑ A/P to lateral diameter
What is the main cause of hypoxia in brochiectasis? permanent dilation of the airways results in ineffective air acceleration out of the lungs
1. Hypertrophy of the mucus secreting glands in the brochioles. 2. Hypertrophy of airway smooth .muscle 1. chronic bronchitis 2. asthma
Obstructive disorders: 1. Elastance 2. Compliance 3. FVC 4. FEV1 5. FEV1/FVC 6. TLC 7. RV 1. ↓ 2. ↑ 3. ↓ 4. ↓↓ 5. ↓ 6. ↑ 7. ↑
Restrictive disorders: 1. Elastance 2. Compliance 3. FVC 4. FEV1 5. FEV1/FVC 6. TLC 7. RV 1. ↑ 2. ↓ 3. ↓ 4. ↓ 5. ↔ or ↑ 6. ↓ 7. ↓
1. What is the normal function of elastic fibers in the airway? 2. Which pathology is noted for a decrease in elastic fibers? 1. apply radial traction to help keep airways open 2. emphysema
Centriacinar emphysema 1. Site of elastic tissue destruction 2. What is the common cause? 3. Which lobes are usually effected? 1. distal terminal bronchioles and respiratory bronchioles 2. smoking 3. upper lobes
Panacinar emphysema 1. Site of elastic tissue destruction 2. What is the common cause? 3. What is seen on serum protein electrophoresis? 4. Which lobes are usually effected? 1. entire respiratory unit 2. α1-antitrypsin deficiency 3. absent α1-globulin peak 4. lower lobes
Which pathology presents with the following findings on CXR: 1. depressed diaphragm & vertically oriented heart 2. large horizontally oriented heart 1. emphysema -hyperinflated lungs pushed down diaphragm 2. chronic bronchitis
What is the different between the pathogenesis of extrinsic and intrinsic asthma? 1. extrinsic asthma is a type 1 hypersensitivity rxn caused by allergens 2. intrinsic is a rxn to external objects without IgE antibodies
What are the causes of intrinsic asthma (4)? 1. virus induced respiratory infections 2. aspirin 3. air pollutants, smoke 4. stress, exercise
Emphysema or chronic bronchitis 1. cyanosis present 2. ↓ PaCO2 1. chronic bronchitis 2. emphysema
What are the steps of the initial sensitization to allergens seen in extrinsic asthma? 1. allergen presented via MHC II to TH2 cells 2. TH2 releases IL-4 & IL-5 3. IL-4 → IgE production 4. IL-5 → eosinophil production
After the initial extrinsic asthmatic sensitization, how does a asthmatic reaction occur upon subsequent allergen exposure? 1. inhaled allergens cross-link IgE antibodies with mast cells 2. mast cells release histamine and leukotrienes
1. What causes Primary ciliary dyskinesia (PCD)? 2. What is the triad of findings frequently observed in PCD? 1. absent dynein arm on cilia 2. triad of bronchiectasis, sinusitus and situs inversus
1. Primary ciliary dyskinesia is also known as: 2. Why does it cause bronchiectasis? 1. Kartegener's syndrome 2. failure to clear mucus → chronic infections → bronchiectasis
What are the common causes of bronchiectasis? 1. cystic fibrosis 2. repeat infections 3. primary ciliary dyskinesia 4. allergic pulmonary aspergillosis
1. What is the genetic defect in cystic fibrosis? 2. What is the inheritance pattern? 3. Which ethnicity has the highest incidence? 1. 3 nucleotide deletion on chromosome 7 that normally codes for phenylalanine 2. autosomal recessive 3. whites
How does a defective CFTR affect secretions of sweat glands and lumenal epithelial cells? How does this lead to respiratory infection? 1. sweat glands unable reabsorb NaCl which is then lost in sweat 2. lumenal epithelial cells unable to secrete Cl- so Na and water retained → ↓secretions & ↓ mucus clearance
Primary pulmonary hypertension is due to: vascular smooth muscle proliferation (from mutation in BMPR2 which usually inhibits vascular smooth muscle proliferation)
What are the 3 classes of restrictive lung disorders? 1. neuromuscular disease (myasthenia gravis) 2. Chest wall disorders (kyphoscoliosis) 3. Interstitial lung disease
What 2 pulmonary conditions could cause a tracheal shift to the left? 1. ↓ volume of ipsilateral lung: spontaneous pneumothorax or atelectasis 2. ↑ contralateral pressure: pleural effusion or tension pneumothorax
1. Hemoptysis followed by renal failure. 2. Pathogenesis of Acute Respiratory Distress Syndrome? 3. Most common cause of ARDS 1. Goodpastures syndrome 2. inflammation → alveolar-capillary damage → exudation of fluid → pulmonary edema + hyaline membranes 3. Gram-negative sepsis
1. pneumoconiosis + rheumatoid arthritis 2. Which pneumoconiosis has an increased risk for tuberculosis? 1. Caplan syndrome 2. silicosis (impairs phagolysosome formation by macrophages)
1. Unexplained pleural effusion in young women is usually.. 2. Cyanosis of newborn when breast feeding 1. Systemic lupus erythematosus 2. choanal atresia; bony septum blocks passage from nose to pharynx
Sarcoidosis vs idiopathic pulmonary fibrosis 1. Which has a higher incidence in men? 2. Which has a higher incidence in women? 3. Which has higher incidence in African Americans? 1. Idiopathic pulmonary fibrosis 2. Sarcoidosis 3. Sarcoidosis
What type of hypersensitivity reaction is hypersensitive pneumonitis? type IV (forms granulomas)
1. What is the normal FEV1/FVC ratio? 2. What is the ratio in restritive lung diseases? 1. 0.80 2. 1.00
What is the pathogenesis of the pneumoconioses? small particles get phagocytosed by alveolar macrophages → release inflammatory mediators & initiate fibroblast proliferation w/collagen deposition
Silicosis vs Asbestosis 1. What is the fibrosing pattern? 2. What is the site of initial deposition? 1. Silicosis: nodular fibrosis; upper lobe 2. Diffuse interstitial; lower lobe
Pneumoconiosis with: 1. fibrotic opacities not in hilar nodes 2. calcified nodular in hilar nodes 3. diffuse interstitial w/ calcified plaques 4. diffuse interstitial w/ noncaseating granulomas 1. coal worker pneumoconiosis 2. silicosis 3. asbestosis 4. Berylliosis
1. Define Sarcoidosis 2. What type of granulomas are seen in sarcoidosis? multisystem granulomatous disease of unknown etiology 2. noncaseating
Pathogenesis of sarcoidosis uknown antigen → ↑CD4/CD8 ratio → cytokine release → granuloma formation
1. Obstructive lung disorder with honeycomb appearance on CXR. 2. Restrictive lung disorder with honeycomb appearance on CXR 1. bronchiectasis 2. idiopathic pulmonary fibrosis
How does Peak Expiratory Flow (PEF) change in restrictive and obstructive lung disease? both have decreased PEF
What is triad asthma? 1. asthma 2. aspirin sensitivity 3. nasal polyps
What causes resorption atelectasis? airway obstruction by mucus, aspiration of foreign material or centrally located bronchogenic carcimoa prevent air from reaching alveoli
What cause compression atelectasis? air or fluid in the pleural cavity causes small airways to collapse from increased pressure
1. Most common cause of atypical community acquired pneumonia? 2. What is seen on CXR in typical community acquired pneumonia that is not seen in atypical? 1. mycoplasma pneumoniae 2. consolidation; typical pneumonia has inflammatory infiltrate in the alveolar spaces while atypical has infiltrate in the interstitium
1. Where do the majority of pumonary thromboembolisms originate from? 2. Gold standard for pulmonary embolism diagnosis? 1. femoral vein 2. pulmonary angiogram
What conditions make hemorrhagic infarction more likely in a patient with a pulmonary embolism? 1. decreased bronchial artery blood flow (e.g. ↓ cardiac output) 2. previously underventilated lung (e.g. COPD)
1. How is pulmonary hypertension diagnosed? 2. What is Cor pulmonale 1. pulmonary artery pressure > 25 mmHg at rest or >30 mmHg with exercise 2. pulmonary hypertension + right ventricular hypertrophy leading to right sided heart failure
1. How does Goodpasture syndrome usually present? 2. What classification of lung disease is it? 3. What type of hypersensitivity is Goodpastures? 1. hemoptysis + renal failure 2. restrictive lung disease 3. Type II
What are the 5 main causes of secondary pulmonary hypertension 1. hypoxemia → pulmonary vasoconstriction 2. respiratory acidosis → vasoconstriction 3. loss of pulmonary vasculature → overload of remaining vessels 4. left-to-right cardiac shunt → volume overload 5. backward failure: mitral stenosis or LH failure
1. What is the definition of chronic bronchitis? 2. What is a solitary fibrous tumor? 1. cough with sputum production for at least 3 months in 2 consecutive years 2. rare tumor, originating in the pleura
1. Lung tumor with least favorable prognosis? 2. Lung tumor with hypercalcemia 1. small cell 2. squamous cell → paneoplastic syndrome by secretion of PTH
1. Emphysema associated with spontaneous pneumothoraxes 2. alveoli with hyaline membranes 1. paraseptal 2. acute respiratory diseases
Pleural effusion resulting from lymphatic fluid accumulating in pleura cavity. Likely cause Chylothorax; lymphatic obstruction from non-hodgkins lymphoma
Sudden death from a pulmonary embolism occurs from (2) 1. hypoxemia 2. acute cor pulmonale with right sided heart failure
1. Does atelectasis occur in a pulmonary embolism 2. When CHF or systemic lupus erythematosis produce a pleural effusion, is it an exudate or transudate? 1. no. airway are not obstructed and lungs to not collapse 2. CHF → transudate; SLE → exudate
What type of hypersensitivy reaction is Farmer's lung? (Hypersensitivity pneumonitis) type III hypersensitivity with immune complexes that deposit on lung tissue and can lead to type IV hypersensitivity with granulomatous inflammation
1. Curshmann spirals or Charcot-Leyden crystals 2. Most common lung cancer 1. Asthma 2. metastasis from other site
Lung tumor that secretes: 1. PTH 2. ADH or ACTH 3. serotonin 1. squamous cell 2. small cell 3. bronchial carcinoid
1. Coin lesion on CXR in a young patient is most likely 2 things: 2. Lung tumor associated with Eaton-Lambert Syndrome. 1. bronchial hamartoma or granuloma from fungus/TB 2. small cell carcinoma
Peripheral lung tumors 1. adenocarcinoma 2. some large cell carcinomas
Types of emboli FAT BAT 1. Fat 2. Air 3. Thrombus 4. Bacteria 5. Amniotic Fluid 6. Tumor
1. Most common type of lung cancer 2. Which obstructive lung disorder commonly has cor pulmonale 3. Most common cause of bronchiectasis in the US 1. adenocarcinoma 2. chronic bronchitis 3. cystic fibrosis
1. Usual cause of lobar pneumonia 2. Usual cause of interstitial pneumonia 1. Streptococcus pneumonia 2. Mycoplasma pneumonia
1. Non-productive cough: typical or atypical pneumonia? 2. Most common asbestos related tumor? 1. atypical - inflammation is outside the alveoli, in the interstitium, and can not be coughed up 2. bronchiogenic carcinoma (anywhere along the bronchiole tree)
1. Common gross cause of lung abscess 2. Most common patient with lung abscess 1. Aspiration of oropharyngeal material 2. alcoholic from loss of gag reflex
Restrictive lung disorder caused by smoking Desquamative interstitial pneumonia
Child with nasal polyp Cystic fibrosis
Most common cause of 1. acute epiglottitis 2. laryngotracheobronchitis 3. rhinitis 1. H influenza type B 2. (croup) parainfluenza virus 3. rhinovirus
Which cause of pneuomnia can lead to a cold hemolytic anemia? Mycoplasma pneumoniae
Which section of the lung is colonized: 1. primary tuberculosis 2. secondary tuberculosis 1. lower lobe and hilar lymph nodes 2. apex of lung
1. What is the normal A1AT allele? 2. Which is the abnormal allele? 1. PiM 2. PiZ
How does chronic bronchitis lead to cor pulmonale? mucus plugs trap CO2 with ↓O2, leads to global hypoxic vasoconstriction
Granuloma in hilar lymph nodes with restrictive lung disease. 1. multiple organ involvement, hypercalcemia 2. aerospace worker 1. Sarcoidosis 2. Berylliosis
What causes fibrosis in idiopathic pulmonary fibrosis? TGF-β from injured pneumocytes induces fibrosis
Plexiform lesion in pulmonary artery biopsy in patient with dyspnea. Pulmonary hypertension
Which two lung tumors stain positive for chromogranin? Neuroendocrine tumors 1. small cell carcinoma 2. carinoid tumor
Lung tumor for intercellular bridges on microscope? Squamous cell carcinoma ('bridges' are desmosomes between squamous cells seen when cells are pulled apart)
Which lung tumor arises from clara cells? Bronchioloalveolar carcinoma
In asthma, which cytokines lead to: 1. IgE production 2. eosinophil production 1. IL-4 2. IL-5
Which obstructive lung disorder has a decrease diffusion capacity? emphysema
Created by: amichael87