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Pathology > 13. Respiratory Pathology > Flashcards

13. Respiratory Pathology Flashcards

1
Q

What is atelectasis?

A

Area of collapsed or nonexpanded lung.

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2
Q

What are pores of Kohn?

A

Collaterla connections between air spaces through which infections can spread.

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3
Q

What are obstruction/resorption atelectasis and give and example.

A

Collapse of the lung due to resorption distal to an obstruction; aspiration of foreign body, chronic obstructive pulmonary disease (COPD), or postoperative.

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4
Q

What are compression atelectasis and give and example.

A

Atelectasis due to fluid, air, blood, or tumor in the pleural space.

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5
Q

What are contraction (scar) atelectasis and give and example.

A

Atelectasis due to fibrosis and scarring of the ling.

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6
Q

What is patchy atelectasis and give and example.

A

Atelectasis due to a lack of surfactants; Hyaline membrane disease of newborn or acute (adult) respiratory distress syndrome (ARDS).

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7
Q

What is a bacterial pneumonia?

A

Acute inflammation and consolidation (solidification) of the lung due to a bacterial agent.

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8
Q

What are the clinical symptoms of bacterial pneumonia?

A

I. Fever and chill. II. Productive cough with yellow-green (pus) or rusty (bloody) sputum. III. Tachypnea. IV. Pleuritic chest pain. V. Decreased breath sounds, rales, and dullness to percussion.

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9
Q

What do we see in the lab of someone with bacterial pneumonia?

A

Elevated WBC count with a left shift.

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10
Q

Which organism causes 95% of lobar pneumonia?

A

Streptococcus pneumoniae.

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11
Q

What are the classic four phasese of lobar pneumonia?

A

I. Congestion: active hyperemia and edema. II. Red hepatization: neutrophils and hemorrhage. III. Grey hepatization: degradation of red blood cells. IV. Resolution: healing.

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12
Q

What do we see microscopically in lobar pneumonia?

A

Intra-alveolar supporative inflammation (neutrophils) and edema.

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13
Q

What is bronchopneumonia?

A

Scattered patchy consolidtaion centered around bronchioles, tends to be bilateral, multilobar and basilar. Affects the young, old, and terminally ill.

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14
Q

What do we see microscopically in bronchopneumonia?

A

Acute inflammation of bronchioles and surrounding alveoli.

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15
Q

How is pneumonia diagnosed?

A

Sputum gram stain and culte and blood cultures.

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16
Q

What are lung abscess?

A

Localized collection of neutrophils (pus) and necrotic pulmonary parenchyma.

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17
Q

Which etiology is the most common for lung abscess?

A

Aspiration, tends to involve right lower lobe; mixed oral flora (anaerobic/aerobic).

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18
Q

What is atypical pneumonia?

A

Interstitial pneumonitis without consolidation.

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19
Q

What are three organisms that cause atypical pneumonia?

A

I. Mycoplasma pneumoniae. II. Influenza virus. III. Parainfluenza.

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20
Q

What are four clinicla presentations of tuberculosis?

A

I. Fever and night sweats. II. Weight loss. III. Cough. IV. Hemoptysis

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21
Q

What do we see microscopically in someone with tuberculosis?

A

Caseating granulomas with acid-fast bacilli.

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22
Q

What is Ghon focus?

A

Subpleural caseous granuloma above or below the interlobar fissure.

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23
Q

What is a Ghon complex?

A

Ghon focus plus hilar lymph node granuloma.

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24
Q

Where do we see Ghon focus?

A

Primary pulmonary tuberculosis.

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25
Q

What is a Simon focus?

A

Granulmoa at lung apex (high oxygen content). Seen in secondary pulmonary tuberculosis.

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26
Q

What is Pott’s disease?

A

Miliary spread to lumbar vertebrae bone marrow.

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27
Q

What are the clinical presentations of Sarcoidosis?

A

I. May be asymptomatic. II. Cough, SOB. III. Fatigue, malaise. IV. Skin lesion. V. Eye irritation or pain. VI. Fever/night sweats.

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28
Q

What is the defining presentation of sarcoidosis?

A

Noncaseating granulomas occur in any organ of the body.

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29
Q

What lab finding can we find in someone with sarcoidosis?

A

Elevated serum angiotensin converting enzyme (ACE).

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30
Q

What X-ray finding do we find in sarcoidosis?

A

Bilateral hilar lymphadenopathy.

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31
Q

What are Schaumann bodies?

A

Laminated calcifications seen in sarcoidosis.

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32
Q

What are Asteroid bodies?

A

Stellate giant-cell cytoplasmic inclusions seen sarcoidosis.

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33
Q

What is the definition of obstructive airway disease?

A

Increased resistance to airflow secondary to obstruction of airways.

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34
Q

What is the definition of restrictive lung disease?

A

Decreased lung volume and capacity.

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35
Q

What do we find in the pulmonary funtion test (spirometry) for obstructive airway disease?

A

FEV1/FVC ratio is decreased.

36
Q

What do we find in the pulmonary funtion test (spirometry) for restrictive lung disease?

A

Decreased TLC and VC.

37
Q

What are some chest wall disorders that can cause restrictive lung disease?

A

Obesity, kyphoscoliosis, polio.

38
Q

What are some interstitial/ infiltrative disease that can cause restrictive lung disease?

A

ARDS, pneumoconiosis, pulmonary fibrosis.

39
Q

What are some examples of chronic obstructive airway disease?

A

Asthma, Chronic bronchitis, emphysema, bronchiectasis.

40
Q

What is chronic bronchitis?

A

Persistent cough and copous sputum production for at least 3 months in 2 consecutive years.

41
Q

What is the Reid index?

A

RI: gland/wall. It is defined as ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cartilage that covers the bronchi.

42
Q

What is emphysema?

A

Destruction of alveolar septa resulting in enlarged air spaces and a loss of elastic recoil.

43
Q

What are three causes of emphysema?

A

I. Protease/antiprotease imbalance. II. Proteases (including elastase) are produced by neutrophils and macrophages, which are stimulated by smoke and pollution. III. Antiproteases include alpha-1-antitrypsin, alpha-1-macroglobulin, and secretory leukoprotease inhibitors.

44
Q

What is centriacinar emphysema?

A

Proximal respiratory bronchioles involved, distal alveoli spared. Worst in apical segments of upper lobes.

45
Q

What is Panacinar emphysema?

A

Entire acinus involved, entired lung as well; worse in bases of lower lobes.

46
Q

Which emphysema is caused by alpha-1-antitrypsin deficiency?

A

Panacinar.

47
Q

Which emphysema is related to smoking?

A

Centriacinar (centrilobar).

48
Q

Which type of emphysema is the most common?

A

Centriacinar (centrilobar).

49
Q

What are the clinical findings in emphysema?

A

Progressive dyspnea. Pursing of lips and use of accessory muscles to breathe. Barrel chest and weight loss.

50
Q

What is asthma?

A

Hyperreactive airways, resulting in episodic bronchospasm when triggered by certain stimuli.

51
Q

Which type of asthma is the most common type?

A

Allergic (atopic).

52
Q

A drug-induced asthma would be which type of asthma?

A

Intrinsic (unknown).

53
Q

What are Curschmann spirals?

A

Twisted mucous plugs admixed with sloughed epithelium, seen in sputum cytology of someone with asthma.

54
Q

What are Charcot-Leyden crystals?

A

Eosinophil membrane protein seen in sputum cytology of someone with asthma.

55
Q

What is Bronchiectasis?

A

Abnormal premanent airway dilation due to chronic necrotizing infection.

56
Q

What are four things that can cause bronchiectasis?

A

Bronchial obstruction, necrotizing pneumonias, cystic fibrosis, Kartagener syndrome.

57
Q

What is Adult respiratory distress syndrome (ARDS)?

A

Diffuse damage of alveolar epithelium and capillaries, resulting in progressive respiratory failure that is unresponsive to oxygen treatment.

58
Q

What do we seen in X-ray of someone with ARDS?

A

Bilateral lung opacity (white-out).

59
Q

What do we seen in X-ray of a patient with respiratory distress syndrome of the newborn?

A

“ground-glass” reticulogranular densities.

60
Q

What do we see in lab of a patient with respirtaory distress syndrome of the newborn?

A

Lecithin:Sphingomyelin ratio

61
Q

What pulmonary neoplasia is seen with the mutation of the L-myc oncogene?

A

Small cell carcinoma.

62
Q

What pulmonary neoplasia is seen with the mutation of the K-ras oncogene?

A

Adenocarcinoma

63
Q

What gross changes do we see in adenocarcinoma?

A

Peripheral gray-white mass with pleural puckering.

64
Q

What microscopic changes do we see in adenocarcinoma?

A

Tumor forms glands and may produce mucin.

65
Q

What gross changes do we see in bronchioloalveolar carcinoma?

A

Peripheral mucinous gray-white nodules.

66
Q

What microscopic changes do we see in bronchioloalveolar carcinoma?

A

Columnar tumor cells grow along the walls of pre-existing alveoli.

67
Q

What gross changes do we see in squamous cell carcinoma?

A

Usually centrally located, gray-white bronchial mass.

68
Q

What microscopic changes do we see in squamous cell carcinoma?

A

Invasive nest of squamous cells, intracellular brindges (desmosomes), Keratin production (“squamous pearls”).

69
Q

What gross changes do we see in small cell carcinoma?

A

Central, gray-white masses.

70
Q

What microscopic changes do we see in small cell carcinoma?

A

Small round or polygonal cells in clusters.

71
Q

What microscopic changes do we see in large cell carcinoma?

A

Large anaplastic cells without evidence of differentiation.

72
Q

What is a defining characteristic of small cell carcinoma?

A

AKA Oat cells, they are very aggressive; rapid growth and disseminate early.

73
Q

Which tumor causes Horner syndrome?

A

Pancoast tumor (apical).

74
Q

Which carcinomas involves the pleura?

A

Adenocarcinoma.

75
Q

What are the symtoms of Horner syndrome?

A

Ptosis, Miosis, Anhidrosis, Enopthalmos.

76
Q

Which carcinoma most likely would be releasing PTH and what does this cause?

A

Squamous cell carcinoma; causes hypercalcemia.

77
Q

What is the most frequecnt extrathoracic sites of metasis?

A

Adrenal (>50%), liver, brain and bone.

78
Q

What is the treatment for Nonsmall-cell lung cancer?

A

Surgery.

79
Q

What is the treatment for small-cell lung cancer?

A

Chemotherapy and radiation.

80
Q

In which age group do we see bronchial carcinoids?

A

Young people;

81
Q

What is the gross appearance of bronchial carcinoids

A

Polypoid intrabronchial mass.

82
Q

What is the most common malignant neoplasm in the lungs?

A

Matastatic carcinomas TO the lung.

83
Q

What are common primary sites of tumors that later metastatize to the lung?

A

Breast, stomach, pancreas, colon.

84
Q

What is tension pneumothorax?

A

Air in the pleural cavity that is causing a life threatning shift of thoracic organs across midline.

85
Q

What is empyema?

A

Pus in the pleural space.

86
Q

What is chylothorax?

A

Chylous fluid in pleural space secondary to obstruction of thoracic duct, usually a tumor.

87
Q

What microscopic changes do you see in mesothelioma?

A

Carcinomatous and sarcomatous elements.

Pathology (16 decks)

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