أسئلة المحاضرة السادسة باثولوجي RESP (قبل التعديل)
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Questions and Answers

What characterizes the morphology of asbestos-related diseases?

  • Presence of asbestos bodies (correct)
  • Presence of hyalinized collagen fibers
  • Central necrosis in granulomas
  • Well-formed non-necrotizing granulomas

    • What is a common respiratory issue associated with the late presentation of asbestos-related diseases?

  • Chronic cough
  • Pneumonia
  • Pulmonary hypertension (correct)
  • Acute bronchitis

    • Which of these features is NOT typically involved in the granulomas of sarcoidosis?

  • Giant cells
  • Epithelioid macrophages
  • Schaumann bodies
  • Microorganisms (correct)

    • Which of the following is true regarding the presentation of sarcoidosis?

    <p>Schaumann bodies are common in 60% of granulomas</p> Signup and view all the answers

    What is a significant risk factor associated with crystalline silica exposure?

    <p>Risk of developing lung cancer</p> Signup and view all the answers

    What changes might occur in the granulomas of chronic sarcoidosis?

    <p>Encapsulation within fibrous rims</p> Signup and view all the answers

    As the disease progresses in patients with pulmonary fibrosis, which of these symptoms may become more apparent?

    <p>Shortness of breath</p> Signup and view all the answers

    What type of fibrosis is associated with asbestos exposure?

    <p>Diffuse pulmonary interstitial fibrosis</p> Signup and view all the answers

    What is characterized by the presence of polypoid plugs of loose organizing connective tissue?

    <p>Masson bodies</p> Signup and view all the answers

    Which mineral dust exposure is directly linked to causing silicosis?

    <p>Crystalline silicon dioxide</p> Signup and view all the answers

    What type of lung disease is characterized by coal macules and nodules?

    <p>Simple coal workers' pneumoconiosis</p> Signup and view all the answers

    Which condition is commonly associated with the inhalation of organic dust from moldy hay?

    <p>Farmer's lung</p> Signup and view all the answers

    In which stages of silicosis are discrete pale to blackened nodules observed?

    <p>Early stages</p> Signup and view all the answers

    What is a significant feature that distinguishes complicated coal workers' pneumoconiosis from simple coal workers' pneumoconiosis?

    <p>Development of progressive massive fibrosis</p> Signup and view all the answers

    Which of the following is NOT a characteristic of anthracosis?

    <p>Ingestion of crystalline silica</p> Signup and view all the answers

    Which air pollutant category is linked to inducing asthma?

    <p>Chemical fumes and vapors</p> Signup and view all the answers

    What characterizes the earliest lesions in interstitial fibrosis?

    <p>Exuberant proliferation of fibroblasts</p> Signup and view all the answers

    Which demographic is most commonly affected by idiopathic pulmonary fibrosis (IPF)?

    <p>Adults aged 55 to 75 years old</p> Signup and view all the answers

    What histological feature is typically absent in conditions associated with younger female patients who have interstitial lung disease?

    <p>Fibroblastic foci</p> Signup and view all the answers

    What is the primary cause of destruction of alveolar architecture in IPF?

    <p>Dense fibrosis</p> Signup and view all the answers

    Which combination of symptoms appears late in the course of idiopathic pulmonary fibrosis?

    <p>Cyanosis and hypoxemia</p> Signup and view all the answers

    In the pathological examination of lungs affected by IPF, what pattern is observed?

    <p>Honeycomb pattern with fibrous scarring</p> Signup and view all the answers

    What is a common clinical manifestation of Interstitial Lung Disease (ILD)?

    <p>Progressive interstitial pulmonary fibrosis</p> Signup and view all the answers

    Which of the following is classified as a fibrosing disease within ILD?

    <p>Usual interstitial pneumonia</p> Signup and view all the answers

    In acute exacerbations of interstitial lung disease, what condition may be superimposed?

    <p>Diffuse alveolar damage</p> Signup and view all the answers

    Which factor typically distinguishes the prognosis of conditions associated with interstitial lung disease from idiopathic pulmonary fibrosis?

    <p>Association with connective tissue diseases</p> Signup and view all the answers

    What is the primary characteristic of idiopathic pulmonary fibrosis?

    <p>It arises in genetically predisposed individuals.</p> Signup and view all the answers

    Which histological feature is typically seen in the pathology of idiopathic pulmonary fibrosis?

    <p>Cobblestoned pleural surfaces</p> Signup and view all the answers

    What type of interstitial lung disease is characterized by drug reactions?

    <p>Drug-induced pneumonitis</p> Signup and view all the answers

    Which disease is classified under granulomatous interstitial lung diseases?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the main cause of idiopathic pulmonary fibrosis as per the pathogenesis described?

    <p>Aberrant repair of recurrent epithelial cell injuries</p> Signup and view all the answers

    What distinctive feature is seen on the cut surface of lungs affected by idiopathic pulmonary fibrosis?

    <p>Firm, rubbery white areas of fibrosis</p> Signup and view all the answers

    Which condition is most specific for a CD4+/CD8+ ratio greater than 4?

    <p>Sarcoidosis</p> Signup and view all the answers

    What percentage of lymphocytes in BAL fluid is indicative of lymphocytic disorders?

    <blockquote> <p>15%</p> </blockquote> Signup and view all the answers

    Which condition is associated with >3% neutrophils in BAL fluid?

    <p>Asbestosis</p> Signup and view all the answers

    What is an important consequence of recurrent small-sized emboli in the lungs?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which type of pulmonary vascular disease corresponds to a mean pulmonary artery pressure of ≥25 mm Hg at rest?

    <p>Pulmonary arterial hypertension</p> Signup and view all the answers

    Which condition is characterized by an increased percentage of eosinophils?

    <p>Asthma</p> Signup and view all the answers

    What effect does a large embolus have on the pulmonary arteries?

    <p>Produces sudden death</p> Signup and view all the answers

    Which of the following is NOT a common source of pulmonary embolism?

    <p>Thrombi from the upper extremities</p> Signup and view all the answers

    What is observed during the acute phase of interstitial lung disease?

    <p>Acute alveolar damage</p> Signup and view all the answers

    Which cells are primarily involved in the interstitial pneumonitis associated with interstitial lung disease?

    <p>Cytotoxic T lymphocytes, plasma cells, and macrophages</p> Signup and view all the answers

    What type of defect is typically observed on pulmonary function tests in interstitial lung disease?

    <p>Restrictive defect with reduced diffusing capacity</p> Signup and view all the answers

    Which imaging finding is commonly associated with sarcoidosis?

    <p>Nodules in upper lung zone</p> Signup and view all the answers

    Which of the following conditions is characterized by cystic patterns in interstitial lung disease?

    <p>Langerhans cell histiocytosis</p> Signup and view all the answers

    What is a key feature of the bronchoscopy findings in patients under 60 years of age with interstitial lung disease?

    <p>Allows pathological classification</p> Signup and view all the answers

    What type of cellular pattern helps narrow the differential diagnosis of interstitial lung disease?

    <p>Predominantly inflammatory cellular pattern</p> Signup and view all the answers

    In the context of lung disease, what does BAL stand for?

    <p>Bronchial alveolar lavage</p> Signup and view all the answers

    What changes occur to fibroblastic foci in interstitial lung disease over time?

    <p>They become less cellular and more fibrotic.</p> Signup and view all the answers

    Which statement about the inflammation present in fibrotic areas is correct?

    <p>It is predominantly lymphocytes with fewer plasma cells and eosinophils.</p> Signup and view all the answers

    What is a typical clinical feature that occurs late in the course of idiopathic pulmonary fibrosis (IPF)?

    <p>Hypoxemia and clubbing.</p> Signup and view all the answers

    What typically characterizes the cut surface of lungs affected by idiopathic pulmonary fibrosis?

    <p>Patchy involvement with honeycomb patterns.</p> Signup and view all the answers

    Which demographic is most likely to present with interstitial lung disease associated with connective tissue disease or hypersensitivity pneumonitis?

    <p>Women, typically younger in age who have never smoked.</p> Signup and view all the answers

    What impact does the dense fibrosis have on alveolar architecture in interstitial lung diseases?

    <p>It leads to the formation of cystic spaces.</p> Signup and view all the answers

    In the context of interstitial lung disease, what is often required to establish a definitive diagnosis?

    <p>Lung biopsy.</p> Signup and view all the answers

    What is generally observed in acute exacerbations of interstitial lung disease?

    <p>Superimposed diffuse alveolar damage.</p> Signup and view all the answers

    What is a late complication associated with asbestos-related diseases?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    What morphological feature is specifically associated with granulomas in sarcoidosis?

    <p>Laminated concretions</p> Signup and view all the answers

    Which characteristic is NOT typically observed in pulmonary fibrosis associated with crystalline silica exposure?

    <p>Presence of mesothelioma</p> Signup and view all the answers

    What type of cells are primarily responsible for the formation of non-necrotizing granulomas in sarcoidosis?

    <p>Epithelioid macrophages</p> Signup and view all the answers

    Which finding is characteristic of the interstitial fibrosis observed in asbestos-related diseases?

    <p>Presence of asbestos bodies</p> Signup and view all the answers

    What significant change occurs in granulomas with chronicity in sarcoidosis?

    <p>Formation of fibrous scars</p> Signup and view all the answers

    What clinical sign might indicate advanced pulmonary involvement in asbestos-related diseases?

    <p>Cor pulmonale</p> Signup and view all the answers

    Which of the following is a recognizable feature of major pulmonary issues resulting from silicosis?

    <p>Pulmonary fibrosis</p> Signup and view all the answers

    Which type of lung disease is primarily caused by exposure to inorganic mineral dust?

    <p>Silicosis</p> Signup and view all the answers

    What is the primary histological feature observed in uncomplicated coal workers' pneumoconiosis?

    <p>Coal macules</p> Signup and view all the answers

    What environmental exposure is most commonly associated with inducing farmer's lung?

    <p>Moldy hay</p> Signup and view all the answers

    Which of the following is a distinguishing factor of complicated coal workers' pneumoconiosis compared to simple disease?

    <p>Presence of pulmonary fibrosis</p> Signup and view all the answers

    What histological structure is primarily associated with chronic organizing pneumonia?

    <p>Fibrous tissue plugs</p> Signup and view all the answers

    What common clinical symptom is associated with both viral and bacterial pneumonia?

    <p>Cough and dyspnea</p> Signup and view all the answers

    Which lung disease results from exposure to asbestos fibers?

    <p>Asbestosis</p> Signup and view all the answers

    What is a common radiographic finding in lung diseases associated with chronic inflammation and fibrosing processes?

    <p>Consolidation</p> Signup and view all the answers

    What histological changes are observed during the acute phase of interstitial lung disease?

    <p>Cytotoxic T lymphocytes predominating</p> Signup and view all the answers

    Which of the following conditions predominantly presents with restrictive defects on pulmonary function tests?

    <p>Interstitial lung disease</p> Signup and view all the answers

    What type of biopsy is considered standard for diagnosing interstitial lung disease in patients under 60 years of age?

    <p>Video-assisted thoracoscopic biopsy</p> Signup and view all the answers

    During which phase of interstitial lung disease are changes primarily centered on the bronchioles observed?

    <p>Subacute phase</p> Signup and view all the answers

    Which condition is associated with the presence of a predominantly nodular pattern in interstitial lung disease?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the expected pattern of distribution for interstitial lung disease in relation to lung zones?

    <p>Predominantly in the lower lung zones</p> Signup and view all the answers

    What clinical symptom is most commonly associated with hypersensitivity pneumonitis?

    <p>Wheezing</p> Signup and view all the answers

    Which category of chronic interstitial lung disease primarily involves disorders characterized by organized inflammatory responses?

    <p>Granulomatous diseases</p> Signup and view all the answers

    Which cellular profile in bronchoalveolar lavage (BAL) fluid is suggestive of a predominantly inflammatory pattern in interstitial lung disease?

    <p>Elevation of eosinophils or lymphocytes</p> Signup and view all the answers

    What feature is typically observed in the pathology of idiopathic pulmonary fibrosis (IPF)?

    <p>Progressive interstitial pulmonary fibrosis</p> Signup and view all the answers

    In which condition is the cut surface of the lung typically described as showing firm, rubbery white areas of fibrosis?

    <p>Idiopathic pulmonary fibrosis</p> Signup and view all the answers

    What is likely to be a triggering factor in the pathogenesis of idiopathic pulmonary fibrosis?

    <p>Repeated injury to alveolar epithelial cells</p> Signup and view all the answers

    Which of the following diseases is categorized as a fibrosing interstitial lung disease due to its histological features?

    <p>Cryptogenic organizing pneumonia</p> Signup and view all the answers

    What type of lung interstitial disease is characterized by patches of edema and eosinophilia in the interstitium?

    <p>Eosinophilic pulmonary eosinophilia</p> Signup and view all the answers

    Which feature is most indicative of progressive interstitial pulmonary fibrosis?

    <p>Cobblestoned pleural surfaces</p> Signup and view all the answers

    Which interstitial lung disease is associated with exposure to environmental agents leading to an aberrant repair response?

    <p>Idiopathic pulmonary fibrosis</p> Signup and view all the answers

    Which condition is primarily associated with an increase in BAL lymphocytes exceeding 15%?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the typical CD4+/CD8+ ratio that indicates a high specificity for sarcoidosis?

    <p>4:1</p> Signup and view all the answers

    What percentage of eosinophils in BAL fluid is commonly associated with eosinophilic disorders?

    <blockquote> <p>1%</p> </blockquote> Signup and view all the answers

    In the context of pulmonary embolism, what is a significant consequence of medium-sized emboli in a healthy lung?

    <p>No effect</p> Signup and view all the answers

    Which of the following conditions is most closely related to pulmonary hypertension due to left heart failure?

    <p>Cor pulmonale</p> Signup and view all the answers

    What is a common finding in patients with recurrent small-sized pulmonary emboli?

    <p>Pulmonary hypertension leading to right-sided heart failure</p> Signup and view all the answers

    In the classification of pulmonary hypertension, which mechanism is NOT typically considered?

    <p>Pulmonary arterial vasodilation</p> Signup and view all the answers

    What is the mean pulmonary artery pressure that defines pulmonary hypertension at rest?

    <p>25 mm Hg</p> Signup and view all the answers

    Study Notes

    Interstitial Lung Disease (ILD) & Diseases of Vascular Origin

    • ILD is a group of disorders characterized by generalized involvement of lung interstitium.
    • Over 200 different diseases comprise ILD, distinguished by common clinical, radiological, and histological features.
    • Fibrosing ILDs include usual interstitial pneumonia (UIP), non-specific interstitial pneumonia (NSIP), cryptogenic organizing pneumonia (COP), connective tissue disease-associated pneumonia, drug reactions, and radiation pneumonitis.
    • Granulomatous ILDs like sarcoidosis, hypersensitivity pneumonitis are also part of the categories of chronic ILDs.
    • Eosinophilic ILDs include pulmonary eosinophilia, smoking-related interstitial lung diseases like desquamative interstitial pneumonia (DIP) and respiratory bronchiolitis interstitial lung disease (RB-ILD), and Langerhans cell histiocytosis.
    • ILDs can be classified as idiopathic, iatrogenic, or related to systemic diseases based on the underlying cause.
    • Idiopathic pulmonary fibrosis (IPF) is a type of Usual Interstitial Pneumonia (UIP).
    • IPF is a progressive interstitial lung disease with reduced alveolar architecture and characteristic fibrosis.
    • IPF causes inflammation in the lungs, with fibrous tissue accumulation.
    • The cut surface of lungs with IPF shows white areas of fibrosis most common in lower lobes and subpleural regions.
    • Usual Interstitial Pneumonia (UIP) is characterised by progressive fibrosis.
    • The causes of IPF are still unknown but are believed to occur in genetically predisposed individuals with impaired alveolar repair.
    • IPF is often diagnosed in older adults.
    • Honeycomb fibrosis is caused by formation of cystic spaces lined by hyperplastic type II pneumocytes or bronchiolar epithelium in IPF.
    • Characteristic features of IPF include gradually increasing dyspnea on exertion and a dry cough.
    • Hypoxia, cyanosis, and clubbing are later stage manifestations, and the individual patient course is unpredictable.
    • Most patients diagnosed with IPF are between 55 and 75 years old at presentation.

    Non-Specific Interstitial Pneumonia (NSIP)

    • NSIP is similar to IPF but patients are often younger and have not smoked.
    • Characterized by a patchy interstitial involvement and is often associated with connective tissue diseases, hypersensitivity pneumonitis, and HIV infection.

    Cryptogenic Organizing Pneumonia

    • COP is an inflammatory condition commonly presenting as a response to infection in the lungs.
    • Often associated with viral or bacterial pneumonia.
    • It shows patchy airspace consolidation in radiographs and features polypoid plugs of loose organizing connective tissue (Masson bodies) in histological examination.

    Pneumoconiosis

    • Pneumoconioses are chronic fibrosing lung diseases resulting from exposure to mineral dusts (silicosis, asbestosis), organic dusts (farmers lung), and other chemical fumes and vapours.
    • Anthracosis is an example of simple coal workers' pneumoconiosis.
    • This is characterized by coal macules and nodules in lungs and upper lobes of the lung.
    • Complicated coal workers pneumoconiosis is marked by progressive massive fibrosis.

    Pulmonary Diseases of Vascular Origin

    • Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
    • It is mostly caused by thrombi in calf veins.
    • Large emboli can block the pulmonary trunk causing death, while medium sized emboli may not affect healthy lungs.
    • Recurrent small emboli can lead to pulmonary hypertension eventually leading to right-sided heart failure.

    Pulmonary Hypertension

    • Pulmonary hypertension involves high blood pressure in the pulmonary arteries.
    • The mean pulmonary artery pressure is 20-25 mmHg at rest.
    • The cause can be diverse and associated with left heart failure, lung diseases, hypoxia, chronic thromboembolic disease, and other multifactorial mechanisms.

    Diffuse Pulmonary Hemorrhage Syndromes

    • These syndromes are rare, potentially serious complications of interstitial lung diseases.
    • Goodpasture syndrome involves circulating autoantibodies against the non-collagenous domain of the a3 chain of collagen IV, affecting lungs and kidneys.
    • Idiopathic pulmonary hemosiderosis is characterized by intermittent, diffuse alveolar hemorrhage, mainly in children, with unknown cause.
    • Diffuse alveolar hemorrhage can be associated with vasculitis.

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