Respiratory Pathology Quiz

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Questions and Answers

What is the hallmark characteristic of secondary TB, distinguishing it from primary TB, in terms of patient presentation?

  • Presence of cavitary lesions in the lungs
  • Upper lobe involvement with minimal lower lobe involvement (correct)
  • Absence of hilar lymphadenopathy
  • Development of extrapulmonary manifestations

Based on the text, what is the primary mechanism of secondary TB, particularly when it arises decades after initial infection?

  • Reactivation of dormant primary lesions due to waning host resistance (correct)
  • Reactivation of dormant primary lesions due to a new primary infection
  • Reactivation of dormant primary lesions due to reinfection with a large inoculum of bacteria
  • Reactivation of dormant primary lesions due to the development of new immunodeficiency

What is the typical size of the initial consolidative lesion associated with secondary TB?

  • Larger than the size of the initial lesion in primary TB
  • Less than 2 cm in diameter (correct)
  • Between 2 and 5 cm in diameter
  • Greater than 5 cm in diameter

How does the degree of immunodeficiency impact the likelihood of extrapulmonary involvement in secondary TB?

<p>Extrapulmonary involvement is more common in severely immunocompromised individuals (D)</p> Signup and view all the answers

According to the passage, how does secondary TB relate to primary TB in terms of the time of occurrence?

<p>Secondary TB can occur shortly after primary TB or many years later (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of typical carcinoids?

<p>High mitotic rate (A)</p> Signup and view all the answers

What is the most likely cause of pleural exudate formation?

<p>Bacterial infection (A)</p> Signup and view all the answers

Which of the following is a characteristic of atypical carcinoid tumors?

<p>Higher incidence of lymph node and distant metastasis than typical carcinoids (A)</p> Signup and view all the answers

What is the Azzopardi effect?

<p>Basophilic staining of vascular walls due to encrustation by DNA from necrotic tumor cells (A)</p> Signup and view all the answers

Which of the following is a characteristic of small cell carcinoma?

<p>Areas of necrosis (D)</p> Signup and view all the answers

What is the percentage of carcinoids that metastasize to hilar nodes at presentation?

<p>5-15% (B)</p> Signup and view all the answers

Which of the following conditions is LEAST likely to cause a malignant pleural effusion?

<p>Pulmonary infarction (B)</p> Signup and view all the answers

Which of the following is NOT a histological characteristic of large cell carcinoma?

<p>Squamous differentiation (B), Gland formation (C)</p> Signup and view all the answers

In primary tuberculosis, what is the initial site of infection?

<p>Alveolar macrophages (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of the Ghon complex?

<p>Cavitation in the lung (C)</p> Signup and view all the answers

What is the significance of the Ghon complex undergoing progressive fibrosis and calcification?

<p>It indicates a successful immune response to the infection (C)</p> Signup and view all the answers

How does secondary tuberculosis differ from primary tuberculosis in terms of dissemination?

<p>Secondary TB mainly spreads through the airways, while primary TB spreads through the bloodstream (C)</p> Signup and view all the answers

What is the primary reason for the increased risk of tuberculosis in individuals with HIV?

<p>HIV weakens the immune system, decreasing the ability to control Mycobacterium tuberculosis infection (C)</p> Signup and view all the answers

Which of the following histological features is characteristic of progressive primary tuberculosis in immunocompromised individuals?

<p>Sheets of macrophages with numerous bacilli (A)</p> Signup and view all the answers

Which of the following statements accurately describes the difference in clinical presentation of tuberculosis in HIV-positive individuals with varying degrees of immunocompromise?

<p>Less severely immunocompromised individuals exhibit apical cavitation, while severely immunocompromised individuals present with disseminated disease (C)</p> Signup and view all the answers

What is the significance of the fact that secondary tuberculosis often involves erosion of infected tissues into the airways?

<p>This is a major source of infectivity, allowing the spread of tuberculosis through sputum (B)</p> Signup and view all the answers

Which of the following statements regarding the treatment of symptomatic pneumonia in the context of COVID-19 is accurate?

<p>Immunosuppressive steroids are often prescribed to dampen the exaggerated immune response associated with severe COVID-19 pneumonia. (C)</p> Signup and view all the answers

Which of the following statements accurately describes the mechanism by which low-dose anticoagulants are beneficial in treating COVID-19?

<p>They counter the procoagulant state induced by COVID-19, reducing the risk of blood clots. (C)</p> Signup and view all the answers

Which of the following factors contributes to the persistent nature of SARS-CoV-2, making it likely to become an endemic seasonal respiratory infection?

<p>The emergence of new, more easily transmissible strains like the Omicron variant. (B)</p> Signup and view all the answers

What distinguishes 'hospital-acquired pneumonias' (nosocomial pneumonias) from other types of pneumonia?

<p>They are infections that develop in a patient during their hospital stay, rather than being present upon admission. (D)</p> Signup and view all the answers

Lung abscesses can develop due to a variety of causes. Which of the following is NOT a common cause of lung abscess formation?

<p>Viral infection leading to localized tissue necrosis. (D)</p> Signup and view all the answers

What is the significance of the statement "Low-dose anticoagulants improve outcomes, presumably by countering the procoagulant state that is induced by COVID-19"?

<p>It suggests that COVID-19 can cause blood clots, which can be prevented by low-dose anticoagulants. (B)</p> Signup and view all the answers

In what way does the emergence of new SARS-CoV-2 strains like Omicron impact the potential for the virus to become endemic?

<p>New strains with increased transmissibility make it more likely that the virus will persist and become endemic. (A)</p> Signup and view all the answers

What is the most common consequence of primary TB infection in otherwise healthy individuals?

<p>Pulmonary scarring (D)</p> Signup and view all the answers

What is the clinical significance of tuberculin negativity in an M.tuberculosis-infected patient?

<p>A marker of weakened immunity and impending severe disease (A)</p> Signup and view all the answers

What is the primary reason for the increased risk of TB reactivation in patients treated with TNF antagonists?

<p>Suppression of the inflammatory response (D)</p> Signup and view all the answers

What characteristically distinguishes progressive primary tuberculosis from the more common outcome of primary infection?

<p>Lack of a robust CD4+ T-cell response (D)</p> Signup and view all the answers

Which of the following individuals is most likely to develop progressive primary TB?

<p>A patient with a CD4+ T-cell count below 200 cells/mL (C)</p> Signup and view all the answers

What is the significance of the Ghon focus?

<p>The site of the initial bacterial infection in primary tuberculosis (B)</p> Signup and view all the answers

What is the typical anatomical location for the development of a Ghon focus in primary tuberculosis?

<p>The upper lobe bronchioles (C)</p> Signup and view all the answers

What is the key factor that determines whether primary tuberculosis will progress to a more severe form?

<p>The individual's immune response to the infection (A)</p> Signup and view all the answers

What characterizes a hemothorax?

<p>It is specifically a collection of whole blood in the pleural cavity. (D)</p> Signup and view all the answers

In which condition is the right lung hyperlucent and the heart shifted to the left side of the thoracic cavity?

<p>Tension pneumothorax. (A)</p> Signup and view all the answers

Which of the following is true regarding malignant mesothelioma?

<p>It is predominantly associated with exposure to airborne asbestos. (D)</p> Signup and view all the answers

What is a distinguishing feature of chylothorax?

<p>It involves a pleural collection of milky lymphatic fluid. (D)</p> Signup and view all the answers

What kind of tumor is malignant mesothelioma considered?

<p>A neoplasm originating from mesothelial cells. (B)</p> Signup and view all the answers

What is a common risk factor for developing malignant mesothelioma?

<p>Occupational exposure to asbestos. (A)</p> Signup and view all the answers

Which histological feature is characteristic of carcinoid tumors?

<p>Small, rounded, uniform nuclei with moderate cytoplasm. (A)</p> Signup and view all the answers

What is a significant clinical implication of chylothorax?

<p>It implies potential malignancy, usually related to intrathoracic cancer. (A)</p> Signup and view all the answers

Flashcards

Secondary Tuberculosis

Pattern of TB disease in an already sensitized host, often reactivating from dormant lesions or reinfection.

Immunocompromised

A state where the immune system is weakened, increasing susceptibility to diseases like TB.

Extrapulmonary Involvement

Spread of TB disease beyond the lungs, more common in those with severe immune deficiency.

Morphology of Secondary TB

Typically begins as a small consolidation focus near the apical pleura, under 2 cm.

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Primary vs Secondary TB

Primary TB occurs on first exposure; Secondary TB arises from reactivation or reinfection later.

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SARS-CoV-2

A coronavirus that causes COVID-19 disease.

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Lung abscess

A localized collection of pus in the lungs.

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Septic embolism

Obstruction of a blood vessel by a blood clot containing bacteria.

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Immunosuppressive steroids

Medications that lower the immune response.

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Anticoagulants

Medications that prevent blood clotting.

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Nosocomial pneumonia

Pneumonia acquired during a hospital stay.

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Bacteremia

Presence of bacteria in the bloodstream.

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Endemic seasonal infection

Infections that persist and regularly occur in a population.

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TNF Antagonists

Medications that inhibit tumor necrosis factor, increasing risk of TB reactivation.

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Tuberculosis Reactivation

Re-emergence of TB infection in previously sensitized individuals, often due to immunosuppression.

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Primary Tuberculosis

The initial TB infection in a previously unsensitized host, often asymptomatic.

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Symptoms of Primary TB

Can lead to pulmonary scarring; significant disease develops in about 5% of cases.

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Progressive Primary TB

Severe form of TB that arises in patients with weakened immune systems.

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CD4+ T Cells

A type of immune cell crucial for fighting TB; their count below 200 indicates severe immunosuppression.

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Ghon Focus

A gray-white area of consolidation in the lungs that appears during primary TB infection.

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Caseous Necrosis

A type of tissue death that occurs at the center of a Ghon focus during TB infection.

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Ghon Complex

A combination of parenchymal and nodal lesions seen in primary tuberculosis.

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Caseation

The necrotic tissue death that occurs in granulomas, characteristic of tuberculosis.

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Cell-Mediated Immunity

The immune response that typically controls tuberculosis infection in 95% of cases.

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HIV and TB

Patients with HIV are at increased risk for developing tuberculosis, particularly secondary TB.

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Granulomas

Aggregates of macrophages and giant cells formed in response to TB infection.

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Squamous cell carcinoma

A lung cancer that appears as a central mass invading surrounding lung tissue.

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Cavitation

The formation of air-filled cavities in lung tissue due to severe tuberculosis infection.

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Large cell carcinoma

Lung cancer characterized by large cells that do not form glands or squamous structures.

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Small cell carcinoma

A type of lung cancer with small, basophilic cells, often showing necrosis.

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Azzopardi effect

Basophilic staining of vascular walls due to DNA from necrotic tumor cells.

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Typical carcinoid tumor

A neuroendocrine tumor with uniform cells and 'salt-and-pepper' chromatin.

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Atypical carcinoid tumor

A carcinoid with a higher mitotic rate and necrosis, indicating worse prognosis.

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TP53 mutations

Genetic mutations seen in 20-40% of atypical carcinoid tumors linked to cancer progression.

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Pleural exudate formation

Fluid accumulation in the pleura due to various causes like infections or cancers.

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Carcinoid Tumor

A type of neuroendocrine tumor that can grow in the lungs, often presenting as a pale mass in the bronchus.

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Tension Pneumothorax

A life-threatening condition where air builds up in the pleural cavity, causing lung collapse and heart displacement.

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Hemothorax

The accumulation of whole blood in the pleural cavity, often from injuries or ruptures.

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Chylothorax

A collection of lymphatic fluid in the pleural cavity, which indicates major lymph duct obstruction.

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Malignant Mesothelioma

A rare cancer linked to asbestos exposure, primarily affecting the pleura around the lungs.

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Asbestos Exposure

Inhalation or contact with asbestos fibers, a major risk factor for developing malignant mesothelioma.

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Latency Period

The duration from initial exposure to asbestos to the development of malignant mesothelioma, often 25 years or more.

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Intrathoracic Aortic Aneurysm

A bulge in the aorta located in the chest cavity that can lead to complications like hemothorax.

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