Chapter 9: Respiratory Tract Pathology

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• Accumulation air pleural space pneumothorax
• Nasopharyngeal malignant tumor epithelium carcinoma
• Nasopharyngeal carcinomas epstein-barr virus are
• Inflammation nasal mucosa rhinitis of
• Common rhinitis rhinovirus specifically adenovirus
• Symptoms rhinitis sneezing congestion runny nose
• Rhinitis subtype due type i hypersensitivity reaction allergic
• Allergic rhinitis characterized inflammatory infiltrate eosinophils
• Allergic rhinitis asthma eczema is
• Nasal protrusion edematous inflamed mucosa polyp
• Nasal polyps secondary occur repeated bouts rhinitis cystic
• Triad symptoms characterizes aspirin-intolerant asthma aspirin-induced bronchospasms nasal
• Aspirin-induced asthma asthmatic adults is
• Benign tumor nasal mucosa composed large blood vessels
• Angiofibromas classically adolescent males are
• Angiofibromas present profuse epistaxis with
• Nasopharyngeal carcinomas classically african children chinese young adults
• Biopsy nasopharyngeal carcinoma reveals pleomorphic keratin-positive epithelial cells
• Nasopharyngeal carcinomas present involvement cervical lymph nodes
• Inflammation epiglottis acute epiglottitis of
• Common acute epiglottitis non-immunized children h influenzae  type
• Symptoms acute epiglottitis high fever sore throat drooling
• Acute epiglottitis poses increases risk airway obstruction
• Inflammation upper airway laryngotracheobronchitis croup
• Common laryngotracheobronchitis parainfluenza virus the
• Symptoms laryngotracheobronchitis hoarse barking cough inspiratory stridor
• Nodule vocal arises true cord singer's
• Vocal cord nodules arise due excessive
• Vocal cord nodules bilateral are
• Vocal cord nodules composed degenerative myxoid connective tissue
• Symptom vocal cord nodule hoarseness
• Vocal cord nodules resolve resting voice
• Benign papillary tumor vocal cord laryngeal papilloma
• Hpv laryngeal papillomas causes of
• Laryngeal papillomas adults children single multiple
• Laryngeal papillomas present hoarseness with
• Squamous cell carcinoma arising epithelial lining vocal cord
• Laryngeal risk factors carcinomas include rarely arise alcohol
• Laryngeal carcinomas present hoarseness cough stridor
• Infection lung parenchyma pneumonia of
• Pneumonia occurs normal defenses e.g cough reflex mucociliary
• Sputum clinical features pneumonia fever chills productive cough
• Diagnosis pneumonia made and/or chest x-ray sputum gram
• Pneumonia patterns classically chest x-ray lobar bronchopneumonia interstitial
• Pneumonia characterized consolidation entire lobe lung lobar
• Pneumoniae lobar pneumonia common bacterial streptococcus klebsiella
• Hepatization classic gross phases lobar pneumonia congestion red
• Gross phase lobar pneumonia caused congested vessels edema
• Gross phase lobar pneumonia caused exudate neutrophils hemorrhage
• Gross phase lobar pneumonia caused degradation red cells
• Gross phase lobar pneumonia type ii pneumocytes regenerate
• Common community-acquired pneumonia secondary middle-aged adults elderly streptococcus
• Bacterial pneumonia superimposed viral upper respiratory tract infection
• Enteric flora aspirated affects malnourished debilitated individuals elderly
• Pneumonia characterized scattered patchy consolidation centered bronchioles bronchopneumonia
• Bronchopneumonia multifocal bilateral is often
• Bronchopneumonia caused variety bacterial organisms
• Common bronchopneumonia staphylococcus aureus haemophilus influenzae pseudomonas aeruginosa
• Second-most common secondary pneumonia complicated abscess empyema staphylococcus
• Pneumonia common secondary superimposed copd leads exacerbation haemophilus
• Common pneumonia cystic fibrosis patients pseudomonas aeruginosa
• Pneumonia common community-acquired superimposed copd leads exacerbation moraxella
• Pneumonia common community-acquired superimposed copd immunocompromised states transmitted
• Interstitial pneumonia characterized diffuse infiltrates atypical
• Symptoms interstitial pneumonia mild upper respiratory e.g minimal
• Interstitial pneumonia caused viruses bacteria
• Common atypical pneumonia affects young adults classically military
• Hemolytic complications  mycoplasma pneumoniae  include autoimmune anemia igm
• Reason mycoplasma pneumoniae  is visible gram stain lack
• Second-most common atypical pneumonia young adults chlamydia pneumoniae
• Common atypical pneumonia infants respiratory syncytial virus rsv
• Common atypical pneumonia patients post-transplant immunosuppressive therapy cytomegalovirus
• Common atypical pneumonia elderly immunocompromised pre-existing lung disease
• Common atypical pneumonia high fever q farmers veterinarians
• Cattle coxiella  spores deposited present ticks placentas
• Coxiella  is distinct rickettsiae pneumonia require arthropod vector
• Coxiella burnetii  survives highly heat-resistant endospore
• Pneumoniae common atypical pneumonia mycoplasma chlamydia cytomegalovirus cmv
• Aspiration pneumonia patients risk e.g alcoholics comatose
• Aspiration pneumonia due anaerobic bacteria oropharynx
• Anaerobic bacteria oropharynx aspiration pneumonia bacteroides fusobacterium peptococcus
• Classic result aspiration pneumonia lower lobe abscess
• Lower lobe aspiration pneumonia result abscess left main
• Tuberculosis disease due inhalation mycobacterium tb
• Primary tb arises intial exposure mycobacterium tuberculosis
• Primary tb results forming focal caseating necrosis lower
• Primary tb generally leads positive asymptomatic ppd
• Secondary tb arises reactivation mycobacterium tuberculosis
• Reactivation mycobacterium tuberculosis  is caused aids aging
• Secondary tb occurs due apices lungs poor lymphatic
• Secondary tb forms cavitary foci caseous necrosis
• Secondary tb result miliary pulmonary tuberculous bronchopneumonia
• Clinical features secondary tb fevers night sweats cough
• Biopsy secondary tb reveal caseating granulomas
• Afb stain secondary tb reveals red acid fast
• Systemic spread secondary tb occurs involve tissue common
• Group diseases characterized airway obstruction i.e lungs empty
• Fev patients copd fvc ratio decreases greater extent
• Patients copd tlc due increased air trapping
• Clinically-defined condition patient productive cough months minimum years
• Chronic bronchitis highly smoking is
• Chronic bronchitis characterized hypertrophy hyperplasia bronchial mucinous glands
• Bronchial glands thickness hypertrophy hyperplasia mucinous cases chronic
• Clinical features chronic bronchitis productive cough due excessive
• Chronic bronchitis cyanosis mucus plugs trap carbon dioxide
• Air disease destruction alveolar sacs results obstruction trapping
• Inflammation lungs leads release proteases neutrophils macrophages
• Neutralizes proteases a1at
• And/or leads destruction alveolar air sacs emphysema excessive
• Common emphysema inhaled pollutants lead smoking excessive inflammation
• Smoking results emphysema severe centriacinar upper lobes
• Rare emphysema lack leaves air sacs vulnerable a1at
• A1at deficiency results emphysema severe panacinar lower lobes
• Liver a1at cirrhosis present patients deficiency mutant accumulates
• Liver biopsy patient a1at deficiency reveal pink pas-positive
• Normal allele a1at copies expressed pim
• Common clinically relevant mutation a1at piz
• Asymptomatic decreased circulating levels a1at significant risk emphysema
• Significant risk panacinar emphysema liver cirrhosis pizz homozygotes
• Clinical features emphysema dyspnea cough minimal sputum prolonged
• Alveolar air sacs capillaries hypoxemia pao2 mmhg complication
• Reversible airway bronchoconstriction due allergic stimulus asthma
• Asthma presents childhood allergic rhinitis eczema family history
• Pathogenesis asthma type i hypersensitivity reaction
• T individuals genetically susceptible developing asthma allergens induce
• T h cells secrete il-4 il-5 il-10 functions
• Asthmatic individuals reexposure allergen leads ige-mediated activation mast
• Asthmatic individuals reexposure allergen leads ige-mediated activation mast
• Clinical features asthma episodic related allergen exposure
• Clinical features asthma dyspnea wheezing productive cough curschmann
• Non-allergic asthma exercise viral infection aspirin occupational exposures
• Permanent dilatation bronchioles bronchi loss airway tone results
• Bronchiectasis caused necrotizing inflammation airway walls
• Specific bronchiectasis cystic fibrosis kartagener syndrome tumor foreign
• Inherited defect dynein arm ciliary movement kartagener syndrome
• Kartagener syndrome sinusitis infertility situs inversus
• Hypersensitivity reaction aspergillus  that leads chronic inflammatory damge
• Allergic bronchopulmonary aspergillosis individuals cystic fibrosis asthma
• Clinical features bronchiectasis cough dyspnea foul-smelling sputum complications
• Group diseases characterized restricted filling lungs restrictive
• Decreased restrictive lung diseases fev  is fvc tlc
• Restrictive lung diseases fev fvc ratio increased
• Lung diseases interstitial e.g restrictive commonly caused arise
• Fibrosis lung interstitium etiology unknown idiopathic pulmonary fibrosis
• Cyclical etiology unknown idiopathic pulmonary fibrosis thought related
• Secondary interstitial fibrosis induced drugs radiation therapy
• Drugs lead secondary interstitial fibrosis bleomycin amiodarone
• Lung clinical features idiopathic pulmonary fibrosis progressive dyspnea
• Fibrosis lung ct scan initially appears eventually results
• Interstitial fibrosis due occupational exposure pneumoconioses
• Pneumoconioses require small particles chronic exposure fibrogenic
• Pneumoconioses engulf foreign particles induce alveolar macrophages fibrosis
• Coal pneumoconiosis miners exposure carbon dust workers pneumoconiosis
• Pathologic findings coal workers pneumoconiosis include diffuse fibrosis
• Mild exposure carbon results clinically significant anthracosis collections
• Pneumoconiosis sand blasters silica miners exposure silicosis
• Pathologic findings lung afflicted silicosis fibrotic nodules upper
• Patients silicosis increased risk silica impairs macrophages tb
• Pneumoconiosis commonly beryllium miners workers aerospace industry presently
• Pathologic findings lung afflicted sarcoidosis non-caseating granulomas hilar
• Patients sarcoidosis increased risk lung cancer
• Pneumoconiosis commonly construction workers plumbers shipyard exposure asbestos
• Lung pathologic findings afflicted asbestosis fibrosis pleura plaques
• Common individuals exposed asbestos lung carcinoma mesothelioma
• Confirm exposure asbestos asbestosis lesions long golden-brown fibers
• Systemic disease characterized non-caseating granulomas multiple organs sarcoidosis
• Sarcoidosis commonly african-american females is
• Etiology sarcoidosis unknown caused cd4  helper t-cell response
• Sarcoidosis granulomas commonly involve leading hilar lymph nodes
• Sarcoidosis characteristic giant cells granulomas stellate inclusions asteroid
• Involved tissue sarcoidosis commonly include uvea uveitis skin
• Clinical features sarcoidosis dyspnea cough common presenting symptom
• Hypercalcemia clinical feature sarcoidosis 1-alpha hydroxylase activity epithelioid
• Sarcoidosis resolved spontaneously treatment is
• Granulomatous reaction eosinophils inhaled organic antigens hypersensitivity pneumonitis
• Hypersensitivity pneumonitis presents fever cough dyspnea
• Symptoms hypersensitivity pneumonitis present resolve hours exposure removal
• Chronic exposure allergen induces hypersensitivity pneumonitis lead interstitial
• Pulmonary high pressure circulation map mmhg normal hypertension
• Pulmonary hypertension characterized trunk arteries atherosclerosis smooth muscle
• Severe long-standing pulmonary hypertension plexiform lesions tufts capillaries
• Pulmonary hypertension leads eventual ventricular hypertrophy cor pulmonale
• Pulmonary hypertension presents exertional dyspnea right-sided heart failure
• Primary pulmonary hypertension classically young adult females
• Etiology primary pulmonary hypertension unknown familial forms related
• Pulmonary e.g secondary hypertension caused hypoxemia copd interstitial
• Pulmonary secondary hypertension arise recurrent embolism
• Alveolar diffuse damage alveolar-capillary interface acute respiratory distress
• Ards leakage leads edema combines necrotic epithelial cells
• Clinical features ards hypoxemia cyanosis respiratory distress white
• Hypoxemia cyanosis respiratory distress ards occur due thickened
• Ards secondary disease processes including sepsis infection shock
• Type ards activation induces protease free radical-mediated damage
• Treatment ards address underlying ventilation positive end-expiratory pressure
• Type ii pneumocytes damaged recovery ards complicated interstitial
• Respiratory distress due inadequate surfactant levels neonates neonatal
• Surfactant made major component type ii pneumocytes phosphatidylcholine
• Purpose surfactant decreases surface tension lungs preventing collapse
• Lack surfactant leads collapse air sacs formation hyalin
• Nrds prematurity caesarian section delivery maternal diabetes
• Surfactant begins production weeks adequate levels reached
• Screen lung maturity fetuses amniotic fluid lecithin-to-sphingomyelin l:s
• Levels increase surfactant produced remain constant phosphatidylcholine lecithin
• L:s ratio adequate surfactant production respiratory viablility womb
• Babies delivered c-section develop nrds stress-induced steroids increase
• Maternal elevated babies mother diabetes develop nrds normal
• Clinical features nrds increasing respiratory effort birth tachypnea
• Increases risk leads complications nrds hypoxemia persistence patent
• Spontaneous pneumothorax rupture emphysematous bleb
• Spontaneous pneumothoraces young adults are
• Collapse results spontaneous pneumothorax portion lung tracheal shift
• Arises penetrating chest wall injury tension pneumothorax
• Tension pneumothorax air enters pleural space exit trachea
• Tension pneumothoarx treated medical emergency insertion chest tube
• Malignant neoplasm mesothelial cells mesothelioma
• Mesothelioma highly occupational exposure asbestos
• Mesothelioma presents recurrent pleural effusions dyspnea chest pain
• Mesothelioma tumor encases lung the
• Common cancer mortality united states lung
• Average age presentation lung cancer years
• Key risk factors lung cancer cigarette smoke radon
• Cigarette smoke carcinogens lung cancer occurs smokers
• Carcinogens cigarette smoke mutagenic polycyclic aromatic hydrocarbons arsenic
• Cancer risk directly related smoking measured duration amount
• Radon formed radioactive decay present soil uranium
• Radon accumulates closed spaces basements
• Responsible public exposure ionizing radiation radon
• 2nd frequent lung carcinoma united states radon
• Addition smokers increased risk lung cancer exists uranium
• Presenting symptoms lung cancer include nonspecific cough hemoptysis
• Imaging lung cancer reveals solitary nodule coin-lesion
• Imaging diagnosis lung cancer biopsy
• Benign lesions produce coin-lesion younger patients
• Examples benign coin-lesions granuloma due tb fungus histoplasma
• Benign tumor composed lung tissue cartilage imaging bronchial
• Carcinoma cell lung classically divided categories small non-small
• Type lung carcinoma amenable surgical resection treated chemotherapy
• Type lung carcinoma amenable surgical resection non-small cell
• Cell carcinomas responsible lung small non-small
• Cell carcinoma subtypes non-small adenocarcinoma squamous large carcinoid
• Tnm staging tumors t stands size local extension
• Tumor lung obstructs svc result referred distended head
• Lung tumor involves hoarseness result recurrent laryngeal nerve
• Lung tumor involves diaphragmatic paralysis result phrenic nerve
• Location carcinoid tumors lungs central peripheral
• Tumors leading lung involvement sympathetic chain brachial plexus
• Symptoms horner syndrome ptosis miosis anhydrosis
• Apical tumors involving superior sulcus lung pancoast
• Tnm staging tumors n refers spread regional lymph
• Tnm staging tumors m refers sites distant metastasis
• Unique site distant metastasis lung tumors adrenal gland
• Lung 5-year survival rate carcinomas present late
• Screening lung cancer recommended patients low-dose ct long
• Testing guides systemic therapy advanced lung cancers driver
• Mutations translocation present adenocarcinoma egfr alk
• Egfr mutations common asian females non-smokers
• Chemotherapeutic drug lung cancer patients egfr mutation erlotinib
• Chemotherapeutic drug lung cancer patients alk translocation crizotinib
• Testing expression guides immunotherpay advanced lung cancers pd-l1
• Pd-l1 present non-small cell carcinoma
• Immunotherapeutic drug lung cancer patients pd-l1 expression pembrolizumab
• Small cells characteristic histology carcinomas lungs poorly differentiated
• Major association small cell carcinomas lungs male smokers
• Location small cell carcinomas lungs central
• E.g small cell carcinomas lungs produce paraneoplastic symptoms
• Small cell carcinomas lungs growth metastasis rapid early
• Characteristic histology squamous cell carcinomas lungs keratin pearls
• Squamous cell carcinomas common tumors male smokers
• Location squamous cell carcinomas lungs central
• Squamous cell carcinomas lungs produce leading pthrp hypercalcemia
• Characteristic histology adenocarcinoma lungs glands mucin
• Common tumor nonsmokers female smokers adenocarcinoma
• Location adenocarcinomas lungs peripheral involve pleura
• Adenocarcinoma lungs in-situ exhibits grow columnar cells pre-existing
• Adenocarcinoma lungs present imaging pneumonia-like consolidation
• Large characteristic histology cell carcinomas lungs poorly differentiated
• Major association large cell carcinomas lungs smoking
• Location large cell carcinomas lungs central peripheral
• Large cell carcinomas lungs prognosis poor
• Large cells carcinomas lungs immunohistochemistry specific classification ttf-1
• Characteristic histology carcinoid tumors lungs differentiated neuroendocrine cells
• Carcinoid tumors significantly related smoking
• Located central lung carcinoid tumor classically forms polyp-like
• Carcinoid tumors lungs malignancy rarely low-grade syndrome
• Common sources metastasis lungs breast colon carcinomas
• Carcinomas metastasized  the lung imaging multiple cannon-ball nodules
• Tumors metastasized lung primary common

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