7 - Injury, Obstructive Dz, Infections, Transplantation

Question 1

3 forms of acquired atelectasis

Answer 1

resorption (obstructive), compressive, contraction

Question 2

resorption atelectasis

Answer 2

airway obstruction, air resorption
lung vol diminished > mediastinum shifts towards collapsed lung
mucus plugs, foreign bodies, tumors

Question 3

compressive atelectasis

Answer 3

pleural cavity filled w/ air, fluid, blood, etc

mediastinum shifts away

Question 4

contraction atelectasis

Answer 4

fibrosis or tumor involving pleura or lung prevents expansion

Question 5

name of pathologic process behind ARDS

Answer 5

diffuse alveolar damage

Question 6

how does ARDS look on CT?

Answer 6

ground glass changes w/ consolidation

Question 7

pathogenesis of ARDS

Answer 7

damage centers on cap/alveolar junction
loss of integrity of microvasc endothelium and alveolar epithelium
inflammatory cascade
leakage of fluid and inflam cells
sloughing of epithelial cells

Question 8

2 phases of diffuse alveolar damage

Answer 8

exudative (acute) (<1wk)

proliferative (organizing)

Question 9

histologic hallmark of exudative phase of DAD

Answer 9

hyaline membranes

Question 10

histologic findings in proliferative phase of DAD

Answer 10

type 2 pneumocyte hyperplasia, intra alveolar granulation tissue, alveolar septal thickening, eventual resolution of organization - macrophages clear debris and granulation tissue becomes fibrosis

Question 11

obstructive lung disease

Answer 11

asthma
chronic bronchitis
bronchiectasis
emphysema

Question 12

asthma histologic changes

Answer 12

hyperinflated lungs
goblet cell metaplasia
submucosal gland hypertophy
Curschmann spiral - mucus plugs
thickened BM and muscle wall hypertrophy

Question 13

Curschmann spiral

Answer 13

mucus plugs in asthma

Question 14

Reid index

Answer 14

ratio of thickness of submucosal glands to lung wall

increased in chronic bronchitis

Question 15

chronic bronchitis histologic changes

Answer 15

inc Reid index
goblet cell metaplasia
chronic inflammation

Question 16

bronchiectasis lung changes

Answer 16

destruction of muscle/elastic tissue w/ inflammation and fibrosis due to repeated infxn/obstruction
permanent dilation of bronchi/bronchioles in lower lobes

Question 17

what chronic disease results in a lot of bronchiectasis?

Answer 17

CF

Question 18

centriacinar emphysema

Answer 18

95% cases, smokers
upper lobe dominant
both emphysematous and normal airspaces present in lobule

Question 19

panacinar emphysema

Answer 19

alpha 1 antitrypsin def
lower lobe
no normal airspaces

Question 20

4 pulm defense mechanisms to infxn

Answer 20

cough reflex
mucociliary elevator
alveolar macrophage
host resistance

Question 21

bronchoPNA begins in ___, lobar PNA begins in ___

Answer 21

airway, alveoli

Question 22

4 histologic patterns in PNA

Answer 22

congestion/edema
red hepatization - massive exudate of RBCs/WBCs/fibrin
gray hepatization - breakdown of RBCs, persistance of fibrin and neutrophils
resolution - granulation tissue

Question 23

3 complications of PNA

Answer 23

abscess, fibrinous pleuritis, empyema, hematogenous spread

Question 24

MC indications for lung transplantation

Answer 24

end stage emphysema
idiopathic pulm fibrosis
CF
primary pulm HTN