Ch 15: Lung Flashcards
1.)
apical
2.)
posterior
3.)
anterior
4.)
medial
5.)
lateral
6.)
superior
7.)
posterior basal
8.)
lateral basal
9.)
anterior basal
10.)
right lung
11.)
left lung
12.)
anterior basal
13.)
posterior basal
14.)
lateral basal
15.)
superior
16.)
inferior lingual
17.)
superior lingual
18.)
anterior
19.)
apico-posterior
is this a left or right lung and how do you know
left
the artery is most superior
is this a left or right lung and how do you know
right
the artery is anterior
what do type 1 pneumocytes look like and what do they do
flattened
most common - cover 95% of aveolar surface
what do type 2 pneumocytes look like and what do they do
rounded
produce surfactant
help to repair aveolar epithelium if type 1 cell is destructed
what is the most common cause of pulmonary hypoplasia (incomplete development)
herniation of something like the bowl into that space which prevents the lung from growing to its full capability
what is the most common type of forgut cyst
bronchogenic
what is pulmonary sequestration
a congenital anomaly
non-functional mass of pulmonary tissue that is not connected to the main pulmonary branch
what is a resorption atelectasis
diminished lung volume because of some kind of obstruction
mediastinum shifts towards collapsed lung
what is compression atelectasis
compression of the lung due to fluid/air accumulation in the pleural cavity
what is contraction atelectasis
shriveling of lung
fibrosis prevents full lung expansion
what are the two main causes of pulmonary edema
hemodynamic disturbances (cardiac related)
microvascular injury (non-cardiac related)
what is the most common hemodynamic cause of pulmonary edema
left-sided congestive heart failure
how does microvascular injury lead to pulmonary edema
give two examples
damage produces inflammatory exudate that leaks into the interstital space
ex. COVID and acute respiratory distress syndrome (ARDS)
what are the four steps of noncardiogenic pulmonary edema (acute lung injury)
1.) endothelial activation - damaged endothelium stimulates an immune response
2.) adhesion of neutrophils - causes cycle of inflammation and damage
3.) accumulation of protein rich fluid - pulmonary capillaries are leaky
4.) resolution of injury - necrosis, fibrosis, and hyaline membranes
what is an obstrutive lung disease
cannot exhale properly due to increased resistance
what is a restrictive lung disease
cannot inhale poperly because of reduced expansion of lung parenchyma and reduced total lung capacity
what are the four types of chronic obstructive pulmonary disease (COPD)
emphysema
chronic bonchitis
asthma
bronchiectasis
what is emphysema
irreversible enlargement and destruction of the airspaces distal to the terminal bronchiole (acini)
what is centriacinar emphysema
most common type of emphysema
mostly seen in heavy smokers
starts in the center of the acinus and moves its way out
mostly affect upper (apical) lobes
what is panacinar emphysema
the second most common type of emphysema
affect all, but mostly lower, lobes
affects entire acinus equally
what is paraseptal emphysema
next to fibrosis
associated with spontaenous pneumothorax
what is the cause of panacinar emphysema
alpha1-antitrypsin deficiency
what is irregular emphysema
associated with scarring
what is an ephysematous bleb
distended areas of pleura
seen in any of the four types of emphysema
what must someone have to be diagnosed with chronic bronchitis
2 or more bouts of persistent cough with sputum production for at least three months
what causes 90% of chronic bronchitis cases
smoking
what are four factors of chronic bronchitis
mucus hypersecretion
CFTR dysfunction
inflammation
infection
what is bronchiolitis obliterans
obliteration of bronchiole lumen due fibrosis
what is cor pulmonale
a symptom of chronic bronchitis
heart tries to keep up, leading to pulmonary hypertension
what is asthma
chronic airway inflammation that causes overinflated lungs
symptoms such as weezing and shortness of breath
what causes atopic asthma
cause by IgE-mediated hypersensitivity reaction
what is non-atopic asthma and what is it casued by
respiratory infections caused by a virus being triggered
which medication causes drug-induced asthma
aspirin
what are three causes of occupational asthma
fumes
dusts
gases
what is the most striking gross finding in asthma
occlusion of bronchioles due to mucus plugs
what are the two characteristic features of asthma that helps it be diagnosed
curschmann spirals
charcot-ledyen crystals
what are curschmann spirals
seen in asthma patients
coiled, mucinous fibrils
what are charcot-leyden crystals
seen in asthma patients
bipyramidal hexagonal crystals
what is bronchiectasis
destruction of smooth muscle and elastic tissue due to severe infections
leads to permanent dilation of bronchioles and bronchi
what is idiopathtic pulmonary fibrosis
a type of restrictive pulmonary disease
dense fibrosis causes destruction of alveolar architecture
lungs appear cobblestoned due to scarring
occurs mostly in the subpleural regions and interlobular septa
honeycomb fibrosis is a characteristic of which disease
idiopathic pulmonary fibrosis
what is pneumoconiosis
lung reaction to inhalation of mineral dusts, chemical fumes, and vapors from the workplace
what is seen in the lungs of a coal worker
fibrosis
anthracosis (carbon deposits)
what is the most prevalent chronic occupational disease in the world
silicosis
what is the most common manifestation of asbestosis
pleural plaques
what causes mesothelioma
asbestos
what is simple coal workers’ pneumonconiosis (black lung disease)
earlier stage of coal workers’ pneumonconiosis
coal macules, 1-2 mm
what disease has eggshell calcification (thin sheets of calcification) within the lymph nodes
silicosis
this whorled aggregate of collagen fibers is seen in which disease
silicosis
what are the two geometric forms of asbestos
serpentine
amphibole
what is the most common geometric form of asbestos
serpentine
what are asbestos bodies
golden brown rods that have asbestos fibers coated with iron
form when a macrophage engulfs asbestos fibers
what are pleural plaques
well-circumscribed plaques of dense collagen that are often calcifed
seen in asbestos cases
what are the two most important findings of sarcoidosis
non-necrotizing granulomas
prominent hilar lymphadenopathy
what are three histologic patterns of sarcoidosis
langerhans giant cells
schaumann bodies
asteroid bodies
what are langhans giant cells
fusion of histiocytes forms a granuloma
characteristic of sarcoidosis
what are schaumann bodies
calcified inclusions
sometimes found in sarcoidosis
what are asteroid bodies
spider-like inclusions seen in cytoplasm of giant cells
sometimes seen in sarcoidosis
what is sarcoidosis
a restrictive disease
systemic granulomatous disease with unknown etiology
has non-necrotizing granulomas
what is desquamative interstitial pneumonia
type of restrictive lung disease caused by smoking
large collection of smoker’s macrophages
what is pulmonary langerhans cell histiocytosis
type of restrictive disease
collection of langerhans cells which cause scarring
what is the most common distant source of pulmonary emobli
DVTs
what is considered pulmonary hypertension
pulmonary artery pressure greater than 25 mm Hg at rest
all forms of pulmonary hypertension are associated with what
media hypertrophy of the pulmonary muscular and elastic arteries
right ventricular hypertrophy
Goodpasture is which type of hypersensitivity
antibody-mediated (type 2)
what is pneumonia
any infection of the lung parenchyma
what is the most common cause of community-aquired acute pneumonia
streptococcus pneumoniae
which bacteria causes pediatric H. influenzae pneumonia (a type of community acquired bacterial pneumonia)
haemophilus influenzae
which bacteria are intravenous drug users most at risk of aquiring
staphylococcus aureus
which bacteria is associated with lung abcesses
staphylococcus aureus
which bacteria causes pneumonia and commonly affects chronic alcoholics and those with nutrional deficiencies
klebsiella pneumoniae
which bacteria is most commonly acquired in a hospital and in patients with cystic fibrosis
pseudomonas aeruginosa
which type of bacteria flourishes in artificial aquatic environments like water-cooling towers
legionella pneumonphilia
which type of bacteria commonly affects adults and children and is acquired in places like schools and prisons
mycoplasma pneumoniae
which type of viruses infect farm animals and are the major cause of pandemic influenza infections
influenza viruses of type A
which virus is associated with upper and lower respiratory tract infections
human metapneumonovirus
what are 2 common morphologic changes in viral infections
laryngotracheobronchitis
bronchiolitis
what are the two most common community acquired viral pneumonias
S. aureus
P. aeruginosa
what are the two patterns of anatomic distribution of pneumonia
bronchopneumonia (most common)
lobar pneumonia
what does bronchopneumonia look like
patchy
what does lobar pneumonia look like
only includes one lobe
what are the four steps of lobar pneumonia
congestion
red hepatization
gray hepatization
resolution
explain the congestion phase of lobar pneumonia
occurs in first 1-2 days
lung is heavy, boggy, and red
lots of bacteria
explain the red hepatization step of lobar pneumonia
occurs in days 3-4
lots of neutrophils, red cells, and fibrin
lobe is firm and red
explain the grey hepatization step of lobar pneumonia
occurs days 4-8
red cells die leaving the lobe brown/grey
perstistanceof fibrinosuppurative exudate
explain the resolution step of lobar pneumonia
occurs between 1-3 weeks
fluid is broken down and debris is engulfed by macrophages
what are the three complications of lobar pneumonia
necrosis
empyema
bacteremic spreading to other areas
what is a soil-inhabiting dimorphic fungus that cause chronic pneumonia
blastomycosis
which fungi causes a delayed-type hypersensitivity leading to chronic pneumonia
coccidiodomycosis
which type of fungi is acquired by inhalation of dust particles from soil contamination with bird or bat droppings - leads to granulomas
histoplasmosis capsulatum
what is bronchiolitis obliterans characteristic of
a sign of lung transplant rejection
obliteration of bronchiole lumen due to inflammatory response
what is the most common type of lung tumor
carcinomas
what is the most common type of non-small cell lung cancer that is mostly associated with non-smokers
adenocarcinoma
what are the four subtypes of non-small cell lung cancer
adenocarcinoma
squamous cell carcinoma
large cell carcinoma
others
what is the main subtype of small cell lung cancers
small cell carcinoma
what percentage of lung cancers occur in smokers
80%
how is cytochrome P450 related to lung cancer
cytochrome P450 enzyme converts cigarrette chemicals into carcinogens
what are the four main gene mutations of squamous cell carcinoma
TP53
p53
CDKN2A
FGFR1
which three gene mutations are common in small cell carcinomas
TP53
RB
MYC
which gene mutation of adenocarcinoma has the worst prognosis
KRAS
what are the four classifications of adenocarcinoma
atypical adenomatous hyperplasia (AAH)
adenocarcinoma in sit (AIS)
minimally invasive adenocarcinoma (MIA)
invasive adenocarcinoma (IAC)
what is atypical adenomatous hyperplasia
small precursor lesion with dysplastic pneumocytes
what is adenocarcinoma in situ
<3 cm lesion made of cells growing along alveolar septa
what does in situ mean
lesion has not pentrated the basement membrane
where is adenocarcinoma most commonly seen in the lung
periphery, in the lung parenchyma
where is squamous cell carcinoma most commonly seen in the lung
around the bronchial tree
which type of lung tumor can produce a puckered/umbilicated area of the pleura
adenocarcinoma
what are the five growth patterns of adenocarcinoma
acinar
lepidic
papillary
micropapillary
solid with mucin formation
what is seen in the lepidic adenocarcinoma growth pattern
cells appear to be crawling
what is seen in the acinar adenocarcinoma growth pattern
glandular formation
what is seen in the papillary adenocarcinoma growth pattern
fibroelastic cores with lines coming off them
what is seen in the micropapillary adenocarcinoma growth pattern
similar to papillary but minus the fibroelastic cores
which stain is used to test for adenocarcinoma
TTF-1 (thyroid transcription factor 1)
who, men or women, are most susceptible to squamous cell carcinoma
men
what are the two types of squamous cell carcinoma
keratinizing
non-keratinizing
what are the three morphological features of keratinized SCC
abundant eosinophilic cytoplasm
keratin pearls
intercellular bridges
how is large cell carcinoma diagnosed
through exclusion since it really doesn’t match anything else
what are the four most common sites of lung tumor metastasis
adrenal glands
liver
brain
bone
what is the most common site of metastasis of lung cancer
adrenal glands
what are the four major complications of lung cancer
cough
weight loss
chest pain
dyspnea
what are the two most common routes of spread of a lung carcinoma
lymphatic and hematogenous
what is a pancoast tumor
tumor of pulmonary apex that causes horner syndrome
what is Horner syndrome
invasion of pancoast tumor to areas like the ribs and vertebrae
what is lung scar carcinoma (SC)
lung cancer that originates around peripheral scars in the lung
scar can oringinally be from infection or trauma
often found as subpleural adenocarcinoma that causes puckering
what are the two types of small cell carcinoma
neuroendocrine
carcinoids
what are the two types of carcinoid tumors
atypical
typical
what are kulchitsky cells
neuroendocrine cells of the lung that can turn into neuroendocrine tumors
what are the four types of neuroendocrine tumors
typical carcinoid
atypical carcinoid
small cell lung carcinoma
large cell neuroendocrine carcinoma
what are carcinoid tumors
type of small cell lung cancer
make up 1-5% of all lung tumors
found mostly in younger men and women
found within the bronchial tree
what are some features of a typical carcinoid tumor
type of neuroendocrine tumor
small, 3-4 cm
well circumscribed
mainstem bronchi
collar-button lesions
what are collar button lesions
typical carcinoid tumors
what do atypical carcinoid tumors look like
tan-yellow areas with focal necrosis
which type of lung cancer has a strong relationship to ciagarette smoking and is the most aggresive type
small cell carcinoma
what are two stains commonly used to identify carcinoid tumors
synaptophysin
chromogranins
what is a hamartoma
benign coin lesion made of connective tissue like cartilage
what is the most common site of metastatic neoplasms
lung
what condition shows up as bread and butter
fibrinous pleuritis of the lung
what is an empyema
intrapleural fibrinosuppurative reaction that usually develops from the spread of bacteria or fungal infections of the lung parenchyma
what does serosanguineous mean
thin and watery fluid from pleura with light red or pink hue
what does sanguineous mean
bright red fluid from the lungs that likely has fresh blood in it
what is a chylothorax
milky fluid in plerual cavity, usually of lymphatic origin
what happens in a tension pneumothorax
air can get in but can’t get out
what are the two types of primary pleural tumors
solitary fibrous tumors
mesothelioma
what is a solitary fibrous tumor
soft-tissue pleura tumor that is attached by a pedicle
what causes malignant mesothelioma
asbestos exposure
what are the three microscopic variants of malignant mesothelioma
epitheliod type
mesenchymal type
biphasic type
