Shared Flashcard Set

Details

Respiratory Tract Pathology
Pathoma: Path shelf study
40
Pathology
Graduate
04/03/2012

Additional Pathology Flashcards

 


 

Cards

Term
Rhinitis
Definition
  • Inflammation of the nasal mucosa
  • Adenovirus MCC
  • Presents with sneezing, congestion, and runny nose (common cold symptoms)
  • Allergic rhinitis is due to type 1 hypersensitivity due to pollen
    • Characterized by an inflammatory infiltrate with eosinophils
    • Associated with asthma and eczema

 

Term
Nasal Polyp
Definition
  • Protrusion of edematous inflamed nasal mucosa
  • Usually secondary to repealed bouts of rhinitis can also occur in CF and aspirin-intolerant asthma
    • Aspirin intolerant asthma is characterized by the triad of asthma, aspirin-induced bronchospasms, and nasal polyps
      • Seen in 10% of asthmatic adults
Term
Angiofibroma
Definition
  • Benign tumor of nasal mucosa composed of parge blood vessels and fibrous tissue
  • Classically seen in adolescent makes
  • Presents with profuse epistaxis (nose bleed) 
Term
Nasopharyngeal Carcinoma
Definition
  • Malignant tumor of nasopharyngeal epithelium
  • Associated wtih EBV
  • Classically seen in African children and Chinese adults
  • Biopsy usually reveals pleomorphic keratin-positive epithelial cells in a background of lymphocytes
    • Poorly differentiated squamous cell carcinoma
  • Involvement of cervical lymph nodes
Term
Acute Epiglottitis
Definition
  • Inflammation of the epiglottis
  • H. influenzae type B is MCC
  • Presents with high fever, sore throat, drooling with dysphagia, muffled voice, and inspiratory stridor
    • Risk of airway obstruction
Term

Laryngotracheobronchitis

Croup

Definition
  • Inflammation of the upper airway
  • Parainfluenza is MCC
  • Presents with a hoarse, "barking" cough and inspiratory stridor  
Term

Vocal Cord Nodule

Singers Nodule

Definition
  • Nodule that arises on the true vocal cord
  • Due to excessive use of vocal cords
  • Usually occurs bilaterally
  • Composed of degenerative (myxoid) connective tissue
  • Presents with hoarsness and resolves with resting of the voice  
Term
Laryngeal Papilloma
Definition
  • Benign papillary tumor of the vocal cord
  • Due to HPV 6 and 11
  • Papillomas are usually single in adults in multiple in children
  • Presents with hoarseness  
Term
Laryngeal Carcinoma
Definition
  • SCC usually arising from the epithial linnning of the vocal cords
  • Risk factors:
    • Alcohol
    • Tobacco
    • Rarely from laryngeal papilloma
  •  Presents with hoarsness, cough, stridor
Term
Pneumonia
Definition
  • Infection of lung parenchyma
  • Occurs when normal defenses are impaired
  • Clinical features:
    • Fever
    • Chills
    • Productive cough with yellow-green pus, or rusty (blood) sputum
    • Tachypnea
    • Pleuritic chest pain
    • Decreased breath sounds
    • Dullness to percussion
    • Elevated WBC
  •  Diagnosis is made by chest x-ray, sputum Gm stain and culture, and blood cultures
  • X-ray patterns:
    • Lobar pneumonia
    • Bronchopneumonia
    • Interstitial pneumonia
Term
Lobar Pneumonia
Definition
  • Characterized by consolidation of an entire lobe of the lung
  • Usually bacterial
  • MCC's S. pneumoniae and K. pneumoniae
  • Classic gross phases of lobar pneumoniae
    • Congestion: due to congested vessels and edema
    • Red Hepatization: Due to exudate, neutrophils, and hemorrhage filing the alveolar air spaces.  This gives the lung a solid consistency
    • Gray Hepatization: Due to degradation of red cells within the exudate
    • Resoluton   
Term
Bronchopneumonia
Definition
  • Characterized by scattered pathcy consolidation centered around the bronchioles
  • Often multifocal and bilateral
  • Caused by a variety of bacterial organisms 
Term
Interstitial (atypical) Pneumonia
Definition
  • Characterized by diffuse interstitial infiltrates
  • Presents with relatively mild upper respiratory symptoms
    • Minimal sputum
    • Low Fever
    • Atypical presentation
  • Caused by bacteria or virus 
Term
Aspiration Pneumonia
Definition
  • Seen in patients at risk for aspiration: alcoholics and comatose patients
  • Most often due to anaerobic bacteria in the oropharynx
    • Bacteroides
    • Fusobacterium
    • Peptococcus 
  • Classically results in a right lower abscess
    • The right main stem bronchus branches at a less acute angle than the left
Term
High Yield Associations of Lobar Pneumonia
Definition
  • S. pneumoniae: MCC of community acquired pneumonia. 
    • Middle aged adults
  • K. pneumoniae: Affects malnourished and debilitated individuals
    • Elderly in nursing home
    • Alcoholics
    • Diabetics
    • Thick mucoid capsule results in gelatinous sputum (Currant jelly)
    • Often complicated by abscess  
Term
High Yield associations of Bronchopneumonia
Definition
  • S. aureus: MC of seconday pneumonia (bacterial pneumonia superimposed on a viral URI
    • Complicated by abscess formation
  • H. influenzae: common cause of secondary pneumonia and pneumonia superimposed on COPD
  • P. aeruginosa: CF patients
  • Moraxella calarrhalis: Community acquired pneumonia and pneumonia super imposed on COPD
  • L. pneumonphila: Community acquired pneumonia superimposed on COPD or pneumonia in immunocompromised states
    • Transmitted from water sources
    • Intracellular organism that is best visualized by silver stain
Term
High Yield Associations with Interstitial Atypical Pneumonia
Definition
  • M. pneumoniae: MCC of atypical pneumonia
    • Young adults: clasically military recruits, college students living in dorm
    • Complications include autoimmune hemolytic anemia: IgM mediated
    • Erythema Multiforme
    • Not visible on Gm stain due to lack of cell wall
  • C. pneumoniae: Young adults
  •  RVS: MCC in infants
  • CMV: Atypical pneumonia with post transplant immunosupressive therapy
  • Influenza virus: Atypical pneumonia in the elderly, immunocompromised, and preexisting lung disease
    • Increases risk for superimposed S. aureus or H. influenza bacterial pneumonia
  • C. burnetti: Q fever
    • Atypical pneumonia with high fever
    • Seen in farmers and veterinarians
    • Rickettsial organism
    • Does not require arthropod vector for transmission
    • Does not produce skin rash
Term
TB
Definition
  • Due to inhalation of aerosolized M. tuberculosis
  • Primary TB arises with initial exposure
    • Results in focal caseating necrosis in the lower lobe of the lung and hilar lymph nodes that undergoes fibrosis and calcifications. Forms a Ghon complex
    • Asymptomatic
    • + PPD
  • Secondary TB arises with reactivation of M. tuberculosis
    • Immunocompromised individuals
    • Occurs at the apex of lung (high oxygen tension)
    • Forms a cavity of foci of caseous necrosis
    • Can lead to miliary pulmonary TB
    • Clinical Features: Weight loss, night sweats, cough with hemoptysis, and fevers
    • Biopsy reveals caseating granulomas
    • Acid-fast bacilli
    • Systemic spread often occurs and can involve any tissue
      • Meninges
      • Cervical lymph nodes
      • kidneys
      • Lumbar Vertebrae
Term

Chronic Obstructive Pulmonay Disease

Basic Principles

Definition
  • Group of disease cahracterized by airway obstruction
  • Lung does not empty, air is trapped
  • Volume of air that can forcefully expired is decreased (FVC) expecially during the first second (FEV1)
  • FEV:FVC ratio decreased
  • Total lung capacity (TLC) is increased due to air trapping
Term
Chronic Bronchitis
Definition
  • Chronic productive cough lasting at least 3 months over a minimum of 2 yrs
  • Highly assocaited with smoking
  • Characterized by hypertrophy of bronchial mucinous glands
    • Leads to increased thickness of mucous glands relative to overall bronchial wall thickness
    • Reid index increases >50% Normal is < 40%
  • Clinical Features:
    • Productive cough due to excess mucous production
    • Cyanosis "blue bloaters"
      • Mucus plugs trap carbon dioxide
    • Increased risk of infection and cor pulmonale  
Term
Emphysema
Definition
  • Destruction of alveolar air sacs
  • Loss of elastic recoil and collapse of airways during exhalation results in obstruction and air trapping
  •  Due to an imbalance of proteases (elastase) and antiproteases (antielastase)
    • Inflammation of the lung normally leads to release of proteases by neutrophils and macrophages
    • α1-antitrypsin (A1AT) neutralizes proteases
  • Imbalance between oxidants and antioxidants (glutathione)
  • Elastase and oxidants derive from neutrophils and macrophages
  • Cigarette smoke is a chemotactic to neutrophils and macrophages
    • Leads to excessive inflammation and protease-mediated damage
    • Free radicals in cig smoke inactivate A1AT and antioxidants
    • Produces functional A1AT deficiency
    • Results in centriacinar emphysema that is most severe in upper lobes
  • Excessive inflammation or lack of A1AT leads to destruction of the alveolar air sacs
  • True A1AT deficiency is a rare cause of emphysema
    • Lack of antiproteases leaves the air sac vunerable to protease mediated damage
    • Results in panacinar emphysema that is most severe in the lower lobes
    • Liver cirrhosis may also be present
      • A1AT deficiency is due to misfolding of the mutated protein
      • Mutatnt A1AT protein accumulates in the endoplasmic reticulum of hepatocytes resulting in liver damage
      • Biopsy reveals pink, PAS (+) globules in hepatocytes
    • Disease severity depends on the degree of A1AT defieicent
    • PiM is the normal allele to copies are usually expressed (PiMM)
    • PiZ is the most common clinically relevant mutation and results in significantly low levels of circulating A1AT
    • PiMZ heterozygotes are usually asymptomatic with decreased circulating levels of A1AT but are at a sig risk of developing emphysema with smoking
    • PiZZ homozygotes are at significant risk for panacinar emphysema and cirrohsis
  • Clinical Features of emphysema:
    • Dyspnea
    • Cough with minimal sputum
    • Prolonged expiration with pursed lips "pink puffer"
    • Wight loss
    • Increased anterior-posterior diameter of chest "barrel chest"
    • Hypoxemia due to destruction of capillaries in the alveolar sac and cor pulmonale are late complications
Term
Asthma
Definition
  • Reversible airway bronchoconstriction 
  • Type I hypersensitivity
  • Presents in childhood
  • Often associated with allergic rhinitis, eczema, allergies
  • Family history
  • Allergens induce Th2 phenotype in CD4 T cells of genetically susceptible  
  • Th2 cells secretes IL-4 which mediates class switching it IgE, IL-5 which attracts eosinophils, and IL-10 which stimulates Th2 and inhibits Th1
  • Reexposure to allergens leads to IgE mediated activation of mast cells
    • Release of preformed histamine granules and generation of leukotrienes C4, D4 and E4
    • Leads to bronchoconstriction, inflammation, and edema (early-phase reaction)
    • Inflammation, especially major basic protein released from eosinophils damages cells and perpetuates bronchoconstriction (late phase reaction)
  • Clinical Features are epidodic and realted to allergen exposure:
    • Dyspnea and wheezing
    • Productive cough, classically with spiral shaped mucus plugs (Curschmann spirals)
    • Eosinophil derived crystals (Charcot-Leyden crystals)
    • Severe, unrelenting attack can result in asthmaticus and death
  • Asthma may also result from non-allergic causes such as exercise, viral infection, aspirin, and occupational exposures
Term
Bronchiestasis
Definition
  • Permanent dialtion of bronchioles and bronchi
  • Loss of airway tone results in air trapping
  • Due to necrotizing inflammation with damage to airway cells
  • Causes:
    • CF
    • Kartagener Syndrome: Inherited defect of the dyenin arm which is necessary for ciliary movement.  Associated wtih sinusitis, infertility (poor motility of sperm) and situs inverus
    • Tumor or forgein body
    • Necrotizing infections
    • Allergic bronchopulmonary aspergillosis
      • Hypersensitivity reaction to Aspergillus
      • Leads to chronic inflammatory damage
      • Usually seen in individuals with asthma or CF
  • Clinical Features:
    • Cough
    • Dyspnea
    • Foul smelling sputum
  • Complications include hypoxemia with cor pumlomale and secondary amyloidosis
Term
Basic Principles of Restrictive Diseases
Definition
  • Characterized by restricted filling of the lung
  • Decreased FEV1
  • Decreased FVC- often the same value as FEV1
  •  FEV1/FVC is increased bc they are teh same value so 100% and normal is 80%
  • MC due to intersitial disease of the lung but can also arise with chest wall abnormalities that can be seen in massive obesity
Term
Idiopathic Pulmonary Fibrosis
Definition
  • Fibrosis of lung interstitium
  • M>F
  • 40-70 yrs old
  • Etiology is unknown thought to be due to:
    • Repeated cycles of alveolitis caused by an unknown agent
    • Releases cytokines which produces interstitial fibrosis
    • Alveolar fibrosis leads to proximal dilation of the small airways
  • Lung has a honeycomb appearance
  • Clinical Features:
    • Fever
    • Dyspnea
    • Cough
    • Inspiratory crackles
  • Fibrosis on lung CT: initially seen in subpleural patches but eventually results in diffuse fibrosis with endstage honeycomb lung
  • Treatment is lung transplant
Term
Pneumoconioses
Definition
  • Interstitial fibrosis due to occupational exposure
  • Requires chronic exposure to small particles taht are fibrogenic
  • Particles smaller than 0.5um reach the alveoli and are phagocytosed by macrophages which induces fibrosis
  • Coal Workers' Pneumoconiosis
    • Exposure to carbon dust seen in coal mines
    • Massive exposure leads to fibrosis "black lung"
    • Associated with Rheumatoid arthritis (Caplan syndrome)
    • Mild exposure to carbon (pollution) results in anthracosis
      • Collections of carbon-laden macrophages
      • Not clinically significant
  • Silicosis
    • Silica is seen in sand blasters and silica miners
    • Fibrotic nodules in upper lobe of the lung
    • Increased risk for TB
    • Silica impaires phagolysosome formation by macrophages
  • Berylliosis
    • Beryllium seen in beryllium miners and workres in the aerospace industry
    • Noncaseating granulomas in the lung, hilar lymph nodes, and systemic organs
    • Increased risk of lung cnacer
  • Asbestosis
    • Asbestos fibers in construction workers, plumbers, and shipyard workers
    • Fibrosis of lung and pleura (plaques) with increased risk for lung carcinoma and mesothelima
    • Lung carcinoma is more common than mesothelioma in exposed individuals
    • Lesions may contain long golden brown fibers with associated iron called asbestos bodies
      • Confirms exposure to asbestos  
Term
Sarcoidosis
Definition
  • Multisystem granulomatous diseae of unknown etiology
  • More common in blacks and non smokers
  • W > M
  • CD4 T cells interact with an unknown antigen which releases cytokines causing formation of noncaseating granulomas
  • Diagnosis of exclusion-must rule out other granulomatous diseases
  • Lung Disease
    • Primary target organ
    • Granulomas located in the interstitium and mediastinal and hilar nodes
    • Multinucleated giant cells
    • Schaumann bodies-laminated calcium concretions
    • Asteroid bodies- Stellate inclusion
  • Skin Lesions
    • Nodular lesions containing granulomas
    • Violaceous rash occurs on the nose and cheeks called lupus pernio
    • Erythema nodosum- painful nodules on lower extremities. Inflammation of subcutaneous fat
  • Eye lesions
  • Liver lesions
  • Enlarged salivary and lacrimal glands
  • Diabetes insipidus-hypothalmic and posterior pituitary disease
  • Granulomas in the bone marrow and spleen
  • Increased angiotensin-converting enzyme
  • Hypercalcemia (5%) via hypervitamin D b/c of increased synthesis 1-α-hydroxylase
  • Dyspnea or cough (MC presenting symtom)
  • Treatment is steroids
  • Often resolves spontaneously without treatment
Term
Hypersensitivity Pneumonitis
Definition
  • Granulomatous reacton to inhaled organic antigens
  • Presents with fever, cough, and dyspnea hours after exposure
  • Resolves with removal of the exposure
  • Chronic exposure leads to interstitial fibrosis
  • Does not involve IgE antibodies or have eosinophilia
  • Farmers Lung
    • Exposure to Saccharopolypora rectivirgula in moldy hay
    • First exposure: Patient develops precipitating IgG antibodies (present in serum)
    • Second exposure: Antibodies combine with inhaled allergens to form immune complexes
      • Type III hypersensitivity
      • Produces an inflammatory reaction in lung tissue
    • Chronic Exposure is type IV hypesensitivity
  • Silo Fillers Disease:
    • Inhalation of gases (NO) from plant material
    • Immediate hypersensitivity reaction associated with dyspnea
  • Byssinosis
    • Occurs in textil factories
    • Contact with cotton, linen, and hemp products
    • Exposure to bacterial endotoxin from Gm(-) bacteria growing on the cotton
    • Develop dyspnea on exposure to cotton, limen or hemp products
    • Workers feel better over the weekend bc they are no longer exposed to the antigen
    • Depression occurs when returning to work on Monday "Monday morning blues"
Term
Acute Respiratory Distress Syndrome
Definition
  • Diffuse damage to the alveolar capillary interface- diffuse alveolar damage
  • Leakage of protein rich fluid leads to edema and formation of hyaline membranes in alveoli
  • Hypoxemia and cyanosis with respiratory distress due to thickened diffusion barrier and collapse of air sacs
    • Increased surface tension
  • White out is seen on chest x-ray
  • Secondary to a variety of disease processes including sepsis, infection, shock, trauma, aspiration, pancreatitis, hypersensitivity reactions, and drugs
  • Activation of neutrophils induces protease-mediated and free radical damage of Type I and Type II pneumocytes
  • Treatment:
    • Address underlying cause
    • Ventilation with positive end expiratory pressure
  • Recovery may be complicated by interstitial fibrosis, damage and loss of type II pneumocytes which can lead to scarring and fibrosis  
Term
Neonatal Respiratory Distress Syndrome
Definition
  • Respiratory distress due to inadequate surfactant levels
  • Surfactant is made by type II pneumocytes, phosphatidylcholine (lecithin) is the major component
  • Surfactant decreases surface tension in the lung, preventing collapse of alveolar air sacs after expiration
  • Lack of surfactant leads to collapse of air sacs and formation of hyaline membranes
  • Prematurity: surfactant production begins at 28 weeks.  Adequate levels are reached until 34 weeks
    • Amniotic fluid lecithin to sphingomyelin ratio is used to screen for lung maturity
    • Lecithin levels increase as surfactant is produced; sphingomyelin remains constant
    • A ratio of > 2 indicates adequate surfactant production
  • Caesarin section delivery: Due to lack of stree induced steroids.  Steroids increase synthesis of surfactant
  • Maternal Diabetes: Insulin decreases surfactant production
  • Clinical Features:
    • Increasing respiratory effort after birth
    • Tachypnea with use of accessory muscles and grunting
    • Hypoxemia with cyanosis
    • Diffuse granularity of the lung (ground glass appearance) on x-ray
  • Hypoxemia increases the risk for persistence of patent ductus arteriosus and nectrozing enterocolitis
  • Supplemental oxygen increases the risk for free radical injury
  • Retinal injury leads to blindness
  • Lung damage leads to bronchopulmonary dysplasia
Term
Lung Cancer Basic Principles
Definition
  • MCC of cancer mortality in US
  • Avg age of presentation is 60
  • Risk factorse are cigarette smoke, radon, and asbestos
  • Presenting symptoms can be non-specific such as: wight loss hemoptysism and postobstructiv pneumonia
  • Imaging often reveals a solitary nodule (coin lesion)
  • Biopsy is necessary for a diagnosis of cancer
    • Benign lesions often occur in younger patients and can also produce coin lesions
      • Granuloma due to TB or fungus like Histoplasma
      • Bronchial hamartoma- benign tumor composed to lung tissue and cartilage olien calcified on imaging
  • 2 categories:
    • Small Cell Carcinoma: not amenable to surgery treated with chemotherapy
    • Non-small cell carcinoma- treated upfront with surgical resection. Does not respond well to chemotherapy. 
  • TNM staging
    • T: Tumor size and local extension
      • Pleural involvement is classically seen with adenocarcinoma
      • Obstruction of SVC leads to distended head and neck veins with edema and blue discoloration of arms and face (SVC syndrome)
      • Involvement of recurrent laryngeal (hoarseness) or phrenic (diaphragmatic paralysis) nerves
      • Compression of sympathetic chain leads Horner syndrome characterized by ptosis, miosis, and anhidrosis uaually due to a apical (Pancoast tumor)
    • N: spread to regional lymph nodes (hilar and mediastinal)
    • M: Unique site of distant metastasis is the adrenal gland
  • Overall 15% 5 year survival rate: often presents at a late stage due to absence of an effective screening method
Term
Small Cell Carcinoma
Definition
  • Poorly differentiated small cells
  • Arise from neuroendocrine (Kulchitsky) cells
  • MC in male smokers
  • Central Location
  • Rapid growth and early metastasis
  • May produce ADH or ACTH
  • Eaton-Lambert syndrome 
Term
Squamous Cell Carcinoma of Lung
Definition
  • Keratin pearls or intracellular bridges are seen on histology
  • MC  tummor in male smokers
  • Central location
  • May produce PTH-related  peptide (PTHrP)
Term
Adenocarcinoma of the Lung
Definition
  • Peripheral location
  • MC in W and non-smokers
  • NO RELATIONSHIP WITH SMOKING
  • Glands or mucin seen on histology
  • Scar Carcinomas: Develop in scars
  • Bronchioloalveolar carcinoma: Derives from Clara cells (nonciliated epithelium).  Malignant cells spread along alveolar walls (look like pegs).  Radiologically mimic lobar pneumonia.
Term
Large Cell Carcinoma of the Lung
Definition
  • Poorly differentiated large cells without keratin pearls, without intracellular bridges, without glands, without mucin
  • Association with smoking
  • Central or Peripheral location
  • Poor Prognosis 
Term
Bronchial alveoiar Carcinma
Definition
  • Columnar cells that grow along preexisting bronchioles and alveoli
  • Arise from Clara cells
  • Not related to smoking
  • Peripheral
  • May present with pneumonia like consolidation on imaging
  • Excellent prognosis 
Term
Carcinoid Tumor
Definition
  • Well differentiated neuroendocrine cells
  • No assocaition with smoking
  • Mean age of 55
  • MC primary lung tumor of children
  • Central or peripheral location
  • Forms a polyp-like mass in the bronchus
  • Low Grade malignancy
  • Rarely can cause carcinoid syndrome
  • Presents with hemoptysis, cough, and carcinoid syndrome  
Term
Metastasis to Lung
Definition
  • Most common sources are breast and colon carcinoma
  • Multiple cannon call nodules on imaging
  • More common than primary tumors  
Term
Pneumothorax
Definition
  • Accumulation of air in the pleural space
  • Spontaneous pneumothorax is due to rupture of an emphysematous bleb seen in young adults
    • Results in collapse of a portion of the lung
    • Trachea shifts to the side of collapse
  • Tension pneumothorax arise with penetrating chest wall injury
    • Air enters the pleural space but cannot exit
    • Trachea is pushed to the opposite side of injury
    • Medical emergency
    • Treated with insertion of a chest tube
Term
Mesothelioma
Definition
  • Malignant neoplasm of mesothelial cells
  • Highly associated with occupational exposure to asbestos
  • Presents with recurrent pleurl effusions, dyspnea, and chest pain
  • Tumor encases the lung  
Supporting users have an ad free experience!