37: Pathology of the Lung Part 1 and 2- Carnevale

Question 1

incomplete expansion of lungs (neonatal) or collapse of previously inflated lungs

Answer 1

atelectasis

Question 2

what type of atelectasis: follows complete airway obstruction, excessive secretions, mediastinal shift toward the atelectatic lung

Answer 2

resorption atelectasis

Question 3

what is the most common form of atelectasis?

Answer 3

compression

excessie air, fluid, blood, or tumor in pleural space. t

Question 4

where does the mediastinum shift with compression atelectasis?

Answer 4

away from the affected lung

Question 5

what type of atelectasis occurs with loss of surfactant, RDS or post-surgically?

Answer 5

patchy atelectasis

Question 6

fibrosis around the lung –> ______ atelectasis

Answer 6

contraction

Question 7

2 primary causes of pulmonary congestion and edema

Answer 7

• hemodynamic disturbances

- microvascular injury

Question 8

most common cause of hemodynamic pulmonary edema

Answer 8

increased hydrostatic pressure from things such as L CHF

Question 9

heart-failure cells may indicate ….

Answer 9

hemodynamic pulmonary edema

Question 10

injury to capillaries of alveolar septa –>

Answer 10

hemodynamic pulmonary edema caused by micorvascular injury

Question 11

group of diseases with common symptoms of dyspnea and recurrent airway obstruction

Answer 11

obstructive pulmonary disease

ex: emphysema, chronic bronchitis, asthma, bronchiectasis

Question 12

emphysema and chronic bronchitis =

Answer 12

COPD

Question 13

mucus hypersecretion and inflammation in large airways =

Answer 13

chronic bronchitis

Question 14

loss of elastic recoil in respiratory bronchioles and alveolar ducts (small airways) =

Answer 14

emphysema

Question 15

irreversible airway obstruction in contrast to asthma

Answer 15

COPD

Question 16

limitation of airflow due to increased resistance caused by partial or complete obstruction from trachea to respiratory bronchioles

Answer 16

obstructive airway disease

Question 17

decreased FEV1 and decreased FEV1/FVC ratio

TLC and FVC normal

Answer 17

obstructive airway disease

Question 18

decreased expansion of the lung

Answer 18

restrictive lung disease

Question 19

decreased TLC and FVC

normal FEV/FVC ratio

Answer 19

restrictive lung disease

Question 20

emphysema is more common and severe in ____

Answer 20

males

generally not disabling until 5-8th decades

Question 21

symptoms of emphysema are generally not apparent until _ of pulmonary parenchyma incapacitated

Answer 21

1/3

Question 22

irreversible enlargement of airspaces distal to terminal bronchiole accompanied by non-fibrotic destruction of airway walls

Answer 22

emphysema

Question 23

smoking stimulates release of ________ from both neutrophils and macrophages

Answer 23

elastase

macrophage elastase is not inhibited by alpha1-AT

ALSO free radicals inhibit the antiprotease leading to even more damage

Question 24

proposed mechanism for emphsema

Answer 24

protease-antiprotease mechanism

Question 25

a person develops emphysema at an earlier age... what might they have?

Answer 25

alpha1-AT deficiency

Question 26

do you have too little or too much protease/elastase in emphysema?

Answer 26

too much ---> collagen and elastin destruction

Question 27

PiZZ phenotype =

Answer 27

80% develop symptomatic panacinar emphysema this genotype leads to misfolded prtns which can not get out of the liver

Question 28

acinus =

Answer 28

lung distal to terminal bronchiole

Question 29

emphysema adjacent to areas of fibrosis, scarring or atelectasis

Answer 29

paraseptal emphysema

Question 30

airspace enlargement with fibroiss associated with scarring

Answer 30

irregular emphysema

Question 31

most common type of emphysema

Answer 31

centriacinar emphysema

Question 32

emphysema with respiratory bronchioles affected and distal alveoli spared

Answer 32

centriacinar emphysema greatest severity in apical segments of upper lobes

Question 33

emphysema with acini uniformly enlarged from respiratory bronchioles to terminal blind alveoli

Answer 33

panacinar emphysema most common in basilar portions of lung can occur together with centriacinar emphysema

Question 34

emphysema enlargement with destructiono of distal portion of acinus

Answer 34

distal acinar/ paraseptal emphysea usually adjacent to pleura, septae, lobule margins and areas of scarring

Question 35

what type of emphysema is associated with sponstaneous pneumothorax and bullous disease of lung in young adults NOT smoking

Answer 35

paraseptal emphysema

Question 36

what causes death from emphysema?

Answer 36

- respiratory acidosis and coma - R HF - massive collapse of lungs secondary to pneumothorax

Question 37

"pink puffers"

Answer 37

severe emphysema - barrel chest, DOE, pursed-lip breathing, weight loss

Question 38

"blue bloaters"

Answer 38

chronic bronchitis --> cor pulmonale and CF purulent sputumm hypoxia

Question 39

chronic bronchitis = persistent cough with production of sputum for at least _____ months of a year for at least ___ consecutive years; may have airflow decrease (FEV1)

Answer 39

3 | 2

Question 40

morphologic correlates of chronic bronchitis

Answer 40

- chronic inflammation of airways - hypertrophy of submucosal glands - goblet cell metaplasia - plugging from mucus - epithlium metaplasia and dysplasia

Question 41

what is bronchiolitis obliterans?

Answer 41

obliterationof lumen secondary to fibrosis leads to narrowing of bronchioles morphologic correlate of chronic bronchitis

Question 42

normal v. chrnic bronchitis reid index

Answer 42

normal = less than 0.4 chronic is more than 0.4

Question 43

pulomonary HTN and HF caused by chronic bronchitis occur ________ than from severe emphysema

Answer 43

earlier and more severe

Question 44

why does chronic bronchitis provide ground for cancer development?

Answer 44

causes squamous metaplasia and dysplasia of bronchial epithelium

Question 45

how does cigarette smoke predispose to infection with chronic bronchits?

Answer 45

- interfering with ciliary action - directly damaging the epithelium - inhibitng the ability of bronchial and alveolar leukocytes to clear bacteria

Question 46

younger, late dyspnea, copious sputum, infections, episodic, HF, airway resistance, large heart, "blue bloater"

Answer 46

bronchitis

Question 47

older, early dyspnea, little sputum, progressively worse, low elastic recoil, "pink puffer"

Answer 47

emphysema

Question 48

observe: lumen filled with mucus, tall epitheliu, with goblet cell metaplasia, fibrous thickening of wall, and increased prominence of smooth muscle

Answer 48

chronic bronchitis

Question 49

chronic inflammatory disorder of airways; causes recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night or early morning

Answer 49

asthma

Question 50

inflammation --> _______ --> episodes of reversible bronchoconstriction

Answer 50

hyperreactive airways = asthma

Question 51

unremitting and fatal asthma =

Answer 51

status ashtmaticus

Question 52

initiated by a type I hypersensitivity rxn after exposure to an extrinisc allergen; triggered by environmental allergens

Answer 52

atopic (extrinisc) asthma nonatopic would be initiated by a diverse nonimmune mechanism such as ingestion of aspirin, pulmonary infection, inhalants and exercise

Question 53

Describe the hypersensitivity rxn of asthma

Answer 53

- initial sensitization to inhaled antigens stimulates induction of CD4+ cells of TH2 type - TH2 releases cytokines IL4 and IL5 - IG-E mediated eosinophilic reaction can make this early and a later response

Question 54

what response is fundamental for allergic asthma?

Answer 54

TH2 response

Question 55

early v. late phase asthma

Answer 55

early: antigen exposure, 30 min, asthmatic attack, goes away by itself in hours late: 4-8 hrs later recruited cells arrive in bronchus, binding to left over IgE triggers another attack bronchoconstriction is vagal a direct effect of mediators on smooth muscle

Question 56

how do autonomic nerves play a role in asthma?

Answer 56

the discharge of eosinophilic granules further impairs mucociliary function and damages epithelial cells; stimulating n. endings in the mucosa, thereby initiating an autonomic discharge that contributes to airway narrowing and mucous secretion

Question 57

what are curshmann spirals?

Answer 57

asthma indication whorls of shed epithelium

Question 58

what are charcot-leyden crystals?

Answer 58

asthma indication crystalloids made of eosinophilic prtns

Question 59

permanent dilation of bronchi and bronchioles caused by destruction of muscle and elastic supporting tissue, resulting from or assoc. with chronic necrotizing infections

Answer 59

bronchiectasis -- IRREVERSIBLE

Question 60

two requisite conditions for bronchiectasis

Answer 60

obstruction and chronic persistent infection

Question 61

what is kartagener syndrome?

Answer 61

genetic disorder causing abnormal cilia and loss of radial spokes

Question 62

complications of bronchiectasis?

Answer 62

pulmonary HPT brain abscesses rarely cor pulmonale amyloidosis

Question 63

``` chronic productive cough hemoptysis foul smelling sputum dyspnea pneumonia lung abscess fever weight loss weakness ```

Answer 63

bronchiectasis

Question 64

mechanism of bronchiectasis

Answer 64

obstruction --> airway damaged, dilates and distorts infection --> causes fibrosis around distorted airway and locks it in that position IRREVERSIBLE