13. Respiratory Pathology

Question 1

What is atelectasis?

Answer 1

Area of collapsed or nonexpanded lung.

Question 2

What are pores of Kohn?

Answer 2

Collaterla connections between air spaces through which infections can spread.

Question 3

What are obstruction/resorption atelectasis and give and example.

Answer 3

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

Question 4

What are compression atelectasis and give and example.

Answer 4

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

Question 5

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

Answer 5

Atelectasis due to fibrosis and scarring of the ling.

Question 6

What is patchy atelectasis and give and example.

Answer 6

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

Question 7

What is a bacterial pneumonia?

Answer 7

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

Question 8

What are the clinical symptoms of bacterial pneumonia?

Answer 8

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.

Question 9

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

Answer 9

Elevated WBC count with a left shift.

Question 10

Which organism causes 95% of lobar pneumonia?

Answer 10

Streptococcus pneumoniae.

Question 11

What are the classic four phasese of lobar pneumonia?

Answer 11

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

Question 12

What do we see microscopically in lobar pneumonia?

Answer 12

Intra-alveolar supporative inflammation (neutrophils) and edema.

Question 13

What is bronchopneumonia?

Answer 13

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

Question 14

What do we see microscopically in bronchopneumonia?

Answer 14

Acute inflammation of bronchioles and surrounding alveoli.

Question 15

How is pneumonia diagnosed?

Answer 15

Sputum gram stain and culte and blood cultures.

Question 16

What are lung abscess?

Answer 16

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

Question 17

Which etiology is the most common for lung abscess?

Answer 17

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

Question 18

What is atypical pneumonia?

Answer 18

Interstitial pneumonitis without consolidation.

Question 19

What are three organisms that cause atypical pneumonia?

Answer 19

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

Question 20

What are four clinicla presentations of tuberculosis?

Answer 20

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

Question 21

What do we see microscopically in someone with tuberculosis?

Answer 21

Caseating granulomas with acid-fast bacilli.

Question 22

What is Ghon focus?

Answer 22

Subpleural caseous granuloma above or below the interlobar fissure.

Question 23

What is a Ghon complex?

Answer 23

Ghon focus plus hilar lymph node granuloma.

Question 24

Where do we see Ghon focus?

Answer 24

Primary pulmonary tuberculosis.

Question 25

What is a Simon focus?

Answer 25

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

Question 26

What is Pott's disease?

Answer 26

Miliary spread to lumbar vertebrae bone marrow.

Question 27

What are the clinical presentations of Sarcoidosis?

Answer 27

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

Question 28

What is the defining presentation of sarcoidosis?

Answer 28

Noncaseating granulomas occur in any organ of the body.

Question 29

What lab finding can we find in someone with sarcoidosis?

Answer 29

Elevated serum angiotensin converting enzyme (ACE).

Question 30

What X-ray finding do we find in sarcoidosis?

Answer 30

Bilateral hilar lymphadenopathy.

Question 31

What are Schaumann bodies?

Answer 31

Laminated calcifications seen in sarcoidosis.

Question 32

What are Asteroid bodies?

Answer 32

Stellate giant-cell cytoplasmic inclusions seen sarcoidosis.

Question 33

What is the definition of obstructive airway disease?

Answer 33

Increased resistance to airflow secondary to obstruction of airways.

Question 34

What is the definition of restrictive lung disease?

Answer 34

Decreased lung volume and capacity.

Question 35

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

Answer 35

FEV1/FVC ratio is decreased.

Question 36

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

Answer 36

Decreased TLC and VC.

Question 37

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

Answer 37

Obesity, kyphoscoliosis, polio.

Question 38

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

Answer 38

ARDS, pneumoconiosis, pulmonary fibrosis.

Question 39

What are some examples of chronic obstructive airway disease?

Answer 39

Asthma, Chronic bronchitis, emphysema, bronchiectasis.

Question 40

What is chronic bronchitis?

Answer 40

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

Question 41

What is the Reid index?

Answer 41

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.

Question 42

What is emphysema?

Answer 42

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

Question 43

What are three causes of emphysema?

Answer 43

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.

Question 44

What is centriacinar emphysema?

Answer 44

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

Question 45

What is Panacinar emphysema?

Answer 45

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

Question 46

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

Answer 46

Panacinar.

Question 47

Which emphysema is related to smoking?

Answer 47

Centriacinar (centrilobar).

Question 48

Which type of emphysema is the most common?

Answer 48

Centriacinar (centrilobar).

Question 49

What are the clinical findings in emphysema?

Answer 49

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

Question 50

What is asthma?

Answer 50

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

Question 51

Which type of asthma is the most common type?

Answer 51

Allergic (atopic).

Question 52

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

Answer 52

Intrinsic (unknown).

Question 53

What are Curschmann spirals?

Answer 53

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

Question 54

What are Charcot-Leyden crystals?

Answer 54

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

Question 55

What is Bronchiectasis?

Answer 55

Abnormal premanent airway dilation due to chronic necrotizing infection.

Question 56

What are four things that can cause bronchiectasis?

Answer 56

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

Question 57

What is Adult respiratory distress syndrome (ARDS)?

Answer 57

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

Question 58

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

Answer 58

Bilateral lung opacity (white-out).

Question 59

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

Answer 59

"ground-glass" reticulogranular densities.

Question 60

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

Answer 60

Lecithin:Sphingomyelin ratio

Question 61

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

Answer 61

Small cell carcinoma.

Question 62

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

Answer 62

Adenocarcinoma

Question 63

What gross changes do we see in adenocarcinoma?

Answer 63

Peripheral gray-white mass with pleural puckering.

Question 64

What microscopic changes do we see in adenocarcinoma?

Answer 64

Tumor forms glands and may produce mucin.

Question 65

What gross changes do we see in bronchioloalveolar carcinoma?

Answer 65

Peripheral mucinous gray-white nodules.

Question 66

What microscopic changes do we see in bronchioloalveolar carcinoma?

Answer 66

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

Question 67

What gross changes do we see in squamous cell carcinoma?

Answer 67

Usually centrally located, gray-white bronchial mass.

Question 68

What microscopic changes do we see in squamous cell carcinoma?

Answer 68

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

Question 69

What gross changes do we see in small cell carcinoma?

Answer 69

Central, gray-white masses.

Question 70

What microscopic changes do we see in small cell carcinoma?

Answer 70

Small round or polygonal cells in clusters.

Question 71

What microscopic changes do we see in large cell carcinoma?

Answer 71

Large anaplastic cells without evidence of differentiation.

Question 72

What is a defining characteristic of small cell carcinoma?

Answer 72

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

Question 73

Which tumor causes Horner syndrome?

Answer 73

Pancoast tumor (apical).

Question 74

Which carcinomas involves the pleura?

Answer 74

Adenocarcinoma.

Question 75

What are the symtoms of Horner syndrome?

Answer 75

Ptosis, Miosis, Anhidrosis, Enopthalmos.

Question 76

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

Answer 76

Squamous cell carcinoma; causes hypercalcemia.

Question 77

What is the most frequecnt extrathoracic sites of metasis?

Answer 77

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

Question 78

What is the treatment for Nonsmall-cell lung cancer?

Answer 78

Surgery.

Question 79

What is the treatment for small-cell lung cancer?

Answer 79

Chemotherapy and radiation.

Question 80

In which age group do we see bronchial carcinoids?

Answer 80

Young people;

Question 81

What is the gross appearance of bronchial carcinoids

Answer 81

Polypoid intrabronchial mass.

Question 82

What is the most common malignant neoplasm in the lungs?

Answer 82

Matastatic carcinomas TO the lung.

Question 83

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

Answer 83

Breast, stomach, pancreas, colon.

Question 84

What is tension pneumothorax?

Answer 84

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

Question 85

What is empyema?

Answer 85

Pus in the pleural space.

Question 86

What is chylothorax?

Answer 86

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

Question 87

What microscopic changes do you see in mesothelioma?

Answer 87

Carcinomatous and sarcomatous elements.