Chapter 15 - The Lung Flashcards
0
Q
Type of pneumocyte that makes surfactant
A
Type II
1
Q
Causes of pulmonary hypoplasia
A
- Compression
- impede normal expansion
1. oligohydramnios-not enough fluid to go in lungs and expand
2. diaphragmatic hernia
2
Q
Pneumocyte covering 95% of alveolar surface
A
Type I
3
Q
Epithelium for most of respiratory tree & where is it not this?
A
Pseudostratified, tall, columnar, ciliated epithelial cells except for vocal cords (stratified squamous)
4
Q
- RESORPTION ATELECTASIS caused by? <– And what can cause this?
- Reversible/irreversible?
- Which way will mediastinum shift?
- Why do alveoli collapse?
A
- Complete obstruction of airway by mucous plugs post op, aspiration, neoplasms
- shift towards affected lung
- alveoli collapse because a lack of distal air and resorption of pre-existing trapped O2
5
Q
- COMPRESSION ATELECTASIS caused by?
- why do alveoli collapse?
- which way does the mediastinum shift?
- reversible/irreversible?
A
- pleural cavity is partially or completely filled by exudate, tumor, blood, air
- pressure collapses small airways under the pleura
- shifts away from affected lung
- reversible
6
Q
- CONTRACTION ATELECTASIS caused by?
- reversible/ irreversible?
A
- fibrotic changes cause prevent expansion
- irreversible :(
7
Q
What are the 2 types of pulmonary edema?
A
- Hemodynamic pulmonary edema
2. Micro vascular injury
9
Q
Hemodynamic pulmonary edema caused by and an example
A
Increased hydrostatic pressure, like left sided CHF
10
Q
- What do the lungs look like in hemodynamic edema grossly?
- histology?
A
- heavy wet lungs
- heart failure cells
- alveolar capillaries engorged
- intra-alveolar pink precipitate
- eventually brown induration
11
Q
Pathophysiology behind edema caused by microvascular injury
A
Primary injury to vascular endothelium/epithelial cells –> leakage of fluids and fluids into interstitial space –> leaks to alveoli –> can cause acute respiratory distress syndrome
12
Q
Examples of edema caused by micro vascular injury
A
Infections (pneumonia, sepsis), aspiration, drugs
13
Q
What is acute lung injury & and what’s it’s most severe form
A
- Abrupt onset of hypoxemia and pulmonary lung infiltrates w/o cardiac failure
- acute respiratory distress syndrome (ARDS)
14
Q
Histology of ARDS
A
Diffuse alveolar damage, waxy hyaline membranes on alveoli
15
Q
Pathophysiology of ARDS
A
Injury to endothelial/epithelial cells –> shift to pro-inflammatory state –> cytokine release –> neutrophil chemotaxis –> neutrophils damage alveolar epithelium –> dysregulation of coag system
16
Q
Resolution and late findings in ARDS
A
Type II pneumocytes make surfactant and make more type I pneumocytes
17
Q
Predisposing conditions to ARDS (10)
A
*Gram negative sepsis, *gastric aspiration, *trauma with shock, *pulmonary infections like SARS, heroin, smoke inhalation, acute pancreatitis, cardiopulmonary bypass, DIC, fat embolism
18
Q
Physical findings for ARDS
A
Dyspnea, tachypnea, inspiratory infiltrates b/l, respiratory acidosis, unresponsive to O2, V/Q mismatch
19
Q
Obstructive Lung Diseases (4) can’t get air in/out?
A
Can’t get air out:
- Bronchitis
- Bronchi ecstasies
- Asthma
- Emphysema
20
Q
Types of emphysema (4)
A
- Centriacinar
- Panacinar
- Paraseptal
- Irregular
21
Q
CENTIACINAR
- What part does this affect
- associated with what
- what lobe
A
- central/proximal acini
- associated with smokers
- upper lobes
22
Q
PANACINAR
- what part of alveoli?
- associated with?
- what part of lung
A
- whole acinus from bronchioles to terminal alveoli
- associated with alpha 1-anti trypsin deficiency
- lower lung
23
Q
Pathophysiology of emphysema
A
Cigarette smoke –> chemotactic for neutrophils and creates free radicals –> inactivates antiproteases (functional alpha1 antitrypsin deficiency) –> increase in neutrophil elastase <– congenital alpha1 antitrypsin deficiency
24
Q
Genes involved in alpha1 antitrypsin deficiency!?!
A
Normal M allele and homozygous ZZ allele which has an 80% chance of getting Panacinar emphysema
25
What are some symptoms of emphysema and when do they begin?
- Dyspnea, coughing, wheezing, weight loss, barrel-chested, hunched over, breathing through pursed lips
- clinical manifestations begin when at least 1/3 of pulmonary parenchyma is damaged
26
Where does para septal emphysema occur? Does it produce COPD? What is there an increase risk of?
- distal acini
- no COPD
- increased risk of spontaneous pneumothorax with rupture of us pleural blebs
27
IRREGULAR EMPHYSEMA:
- associated with?
- COPD?
- associated with scar tissue
| - no COPD
28
CHRONIC BRONCHITIS definition?
Productive cough for at least 3 months for 2 years
29
Pathophysiology of chronic bronchitis
Irritation --> hypersecretion of mucous--> alterations in small airways of the lung, fibrosis
30
Histology of chronic bronchitis
Mucous gland hyperplasia in trachea + bronchi, Reid index of wall thickness to mucous gland layer (normal 0.4), goblet cell metaplasia
31
Long term Chronic bronchitis can lead to: (3)
1. COPD
2. Cor pulmonale and heart failure
3. Atypical metaplasia/dysplasia (pre-cancerous)
32
Pink puffers
Emphysema
33
Blue bloaters
Chronic bronchitis
34
Symptoms of chronic bronchitis
Other than chronic sputum, dyspnea on exertion
35
Most common respiratory disease in kids
Asthma
36
Asthma with IgE mediated hypersensitivity, what will be a positive test
Atopic asthma, allergen sensitization, skin reaction positive
37
Asthma with no allergen sensitization and negative skin test result. What is its common trigger
Non-atopic asthma, viral respiratory infection
38
Pathophysiology of atopic asthma:
Initial sensitization --> IL-4 (switch to IgE) and IL-5 ( eosinophil chemotaxis) --> release mediators--> bronchoconstriction, mucous, leukocytes --> late phase 4-8 hours --> eotaxin (for eosinophils) --> eosinophils release mbp and damage epithelial cells and constrict airway
39
Status astmaticus
Unremitting attacks that result in fatality
40
Histology of asthma: (4)
Mucous plugs (curschmann spirals), eosinophils, Charcot Leyden crystals, airway remodeling
41
What is bronchiectasis? What does it destroy
Permanent dilatation of bronchi and bronchioles, destruction of cartilage and elastic tissue
42
What causes bronchiectasis? (4)
Cystic fibrosis, infections (TB is most common), bronchial obstruction (like a carcinoma), primary ciliary dyskinesia, aspergillosis
43
What is primary ciliary dyskinesia?
Absent dynein (ATPase for movement) arm in cilia, often have kartagener syndrome with it
44
What part of lungs does bronchiectasis affect
Lower lobes
45
Histology of bronchiectasis
Very dilated airways
46
Symptoms of bronchiectasis:
So much foul smelling sputum!, hemoptysis, dyspnea, orthopnea
47
Complication of bronchiectasis
Cor pulmonale
48
Causes of restrictive lung disorders (2)
Chest wall disorders, interstitial and infiltration diseases
49
Clinical and pulmonary symptoms of restrictive disease (5)
Dyspnea, tachypnea, end inspiratory crackles, b/l infiltrative lesions (nodules, irregular lines, ground-glass shadows), honeycomb lung (fibrosis in advanced stage)
50
What age group has interstitial pulmonary fibrosis?
40-70
51
Pathogensis of idiopathic pulmonary fibrosis
Unknown agent --> repeated cycles of epithelial injury/activation --> cytokine release --> alveolar interstitial fibrosis --> proximal dilation of small airways
52
Histology and gross morphology of lung in idiopathic pulmonary fibrosis
Usual interstitial pneumonia (patchy interstitial fibrosis), honeycomb fibrosis , grossly cobblestoned lung
53
What part of lung is affected in idiopathic pulmonary fibrosis
Lower lobes
54
what are heart failure cells?
Hemosiderin laden macrophages
55
Symptoms of idiopathic pulmonary fibrosis (3)
Dyspnea on exertion, dry cough, cyanosis/clubbing (late)
56
What are Masson bodies and in what disease can you find them?
Polyploid plugs of loose connective tissue in cryptogemic organizing pneumonia
57
Connective tissue diseases with pulmonary involvement (3)
1. Rheumatoid arthritis
2. Systemic sclerosis
3. Lupus erythematosus
58
Characteristics of the lung in rheumatoid arthritis
Interstitial fibrosis with or without rheumatoid nodules, chronic pleuritic with or without effusion
59
4 main causes of pneumoconiosis
1. Coal dust
2. Silica
3. Asbestos
4. Beryllium
60
Most dangerous particle size in pneumonconiosis
1-5 micrometers --> reach terminal airways and sacs. If they are smaller than this they can reach the alveoli and be phagocytosis by the macrophages
61
Which is the mildest form of coal workers pneumoconiosis
Anthracosis
62
What size buildup in simple coal workers pneumoconiosis and what part of lung does it affect
1-2mm coal macules and larger coal nodules in upper lobes and upper portions of lower lobes
63
What can simple coal workers pneumoconiosis lead to
Centriacinar emphysema if coal deposits adjacent to respiratory bronchioles
64
Size of coal deposits in complicated coal workers pneumoconiosis, and what may happen in the middle of these deposits
Blackened scars greater than 2 cm, usually have a necrotic center
65
What can complicated coal workers pneumoconiosis lead to: (2)
Pulmonary HTN and cor pulmonale
66
What is the most common occupational disease in the world
Silicosis
67
What deposits in silicosis and where in lung
Crystalline silicone dioxide (Quartz), upper lung
68
Pathophysiology of silicosis
Macrophages eat the quartz and it causes them to release cytokines which stimulate fibrosis
69
What 2 things do you see on radiography in advanced silicosis
Nodular opacities that progress to hard collagenous scars and eggshell calcifications in hilar nodes
70
What disease is associated with silicosis
Increased susceptibility to tuberculosis
71
What 2 geometric forms of asbestos are there and what do they look like
Serpentine (curly and flexible) and amphibole (straight and rigid)
72
Serpentine and Amphibole forms of asbestosis is associated with what diseases
Interstitial fibrosis (both), lung cancer (both), and mesothelioma (only amphibole form)
73
What histology is associated with asbestosis (3)
Ferruginous bodies and asbestos bodies pleural plaques (most common)
74
What are asbestos bodies
Golden brown beaded rods with a translucent center that consist of asbestos fibers coated with iron
75
Asbestos related diseases (4)
Pleural plaques, diffuse interstitial fibrosis, bronchogenic carcinoma (risk lowers with smoking cessation), mesothelioma (not associated with smoking)
76
What is berylliosis associated with
Nuclear aerospace industry
77
Risks with berylliosis
Lung cancer, interstitial fibrosis with noncaseating granulomas
78
Drugs associated with pulmonary disease (4)
Bleomycin, amiodarone, methotrexate, nitrofurantoin
79
When can you get radiation induced lung disease and what can it turn into
1-6 months after radiation therapy --> chronic radiation pneumonitis
80
Sarcoidosis etiology and is the pathologic finding
Unknown and non cascading grannnnnnuloooommaaaaas
81
Pathophysiology of sarcoidosis
Cd4 th T cells interact with unknown Ag --> cytokine release --> non-case acting granulomas
82
How do you diagnose sarcoidosis
Exclusion
83
What are found in the granulomas of sarcoidosis and where are the granulomas in the lung located
Giant cells with Schaumann bodies (lamellar end calcium) and stellar inclusions (asteroid bodies), you find them in the interstitial and mediastinal and hilar nodes
84
Other than the lung, what other organs does sarcoidosis mainly effect
Skin, eye (uveitis), liver, pituitary, salivary/lacrimal glands, bone, spleen
85
How does sarcoidosis resolve, and really serious cases can lead to
On its own, cor pulmonale and death
86
Types of hypersensitivity pneumonitis and what are their pathogens
1. Farmers lung (humid warm hay - thermophilic actinoycetes)
2. Pigeon breeders lung (proteins from bird feathers and feces)
3. Air conditioner lung (thermophilic bacteria in heated water reservoirs)
87
What histology do you find in hypersensitivity pneumonitis
Noncaseating granulomas
88
Most common cause of pulmonary embolism
Thrombosis of deep leg veins
89
Risk factors for thromboembolism
Blood flow stasis (bed rest), hypercoaguable state
90
Clinical consequences of pulmonary embolism
Saddle embolus (large embolus), pulmonary infarction
91
What does the embolism look like
Wedge shaped infarct, apex towards lung
92
How can you distinguish a pulmonary embolus from a post mortem clot
Lines of Zahn in the thrombus
93
You try CPR with pulmonary embolism and what happens
EKG will show activity but no pulses because no blood in pulmonary circulation
94
Pulmonary embolism can lead to...
Cor pulmonale, pulmonary HTN, increased risk of another infarct (30%)
95
Definition of pulmonary HTN
Pulmonary pressure reaches 1/4 of systolic levels
96
Types of pulmonary HTN
Primary (mutation in BMPR-2,TGF-beta) or secondary (endothelial cell dysfunction)
97
Diseases associated with pulmonary hypertension
COPD, heart disease (mitral stenosis), thromboemboli, connective tissue disease, obstructive sleep apnea
98
Histology with pulmonary HTN
Medial hypertrophy of muscular and elastic arteries, plexiform lesions (tuft of capillaries)
99
Good pasture syndrome etiology
Autoantibodies against collagen IV (basement membrane)
100
What part of organs does good pasture syndromes affect
Basement membranes --> glomerulonephritis and pneumonitis
101
Histology of good pasture syndrome 1.kidney 2. Lung
1. Heavy lungs with red brown consolidation and hemosiderin laden macrophages
2. Crescents, immunoglobulin deposits
102
Most common cause of death with good pasture syndrome
Uremia
103
Wagner granulomagosis has what kind of granulomas
Scattered and poorly formed unlike in sarcoidosis
104
Most common cause of typical community acquired pneumonia
Streptococcus pneumoniae
105
Most common bacterial cause of acute exacerbation of COPD
Hemophilus influenzae
106
Common cause of typical pneumonia in elderly
Moraxella catarrhalis
107
Most common gram negative cause of lobar pneumonia
Klebsiella
108
Pneumonia in alcoholics
Klebsiella
109
Is strep pneum part of indigenous flora?
Yes nasopharynx
110
Major cause of meningitis in kids
Hemophilus
111
Three most common causes of otitis media in kids
1. H. Influenzae, M. cattarrhalis, S. pneumoniae
112
Pneumonia in drug users
Staphylococcus aureus
113
Characteristic sputum of klebsiella
Thick gelatinous currant jelly sputum
114
Pneumonia in cystic fibrosis
Pseudomonas aeruginosa
115
Organ transplant recipients are susceptible to pneumonia by what
Legionella
116
Where does legionella thrive
Aquatic environments, ie water cooling towers
117
What type of pneumonia?
1. Patchy consolidation
2. Consolidated areas of acute suppurative inflammation
Bronchopneumonia
118
What type of pneumonia?
| 1. Fibrinosuppurative consolidation of large portion of lobe
Lobar pneumonia
119
Stages of inflammation in lobar pneumonia (4)
1. Congestion (heavy boggy lung)
2. Red hepatization (neutrophils and RBCs)
3. Gray hepatization (fibrinosuppurative exudate)
4. Resolution (digestion --> granular debris)
120
Atypical pneumonia caused by
Viruses and mycoplasma and Chlamydia
121
Some types of atypical pneumonia
Mycoplasma, influenzae, MPV (kids elderly immuno compromised), SARS (civet cats in china)
122
Where is the inflammation in atypical pneumonias
Within walls of alveoli interstitially
123
Common causes of hospital acquired pneumonia
Gram negative rods like pseudomonas and also staph aureus
124
Who gets aspiration pneumonia
Alcoholics, comatose
125
Histologic change in lung abscess
Suppurative destruction of lung parenchyma within the central area of cavitation
126
3 causes of chronic pneumonia
Histoplasmosis, blastomycosis, coccidiodomycosis
127
Geographical Location of histoplasmosis,
What part of lung does it attach to,
Histological appearance,
Vector
Ohio, MS, Caribbean
Intra cellular parasite of macrophages
Tree bark calcium yeast forms
Bird or bat droppings
128
Where is blastomycosis found?
What part geographically?
Features of this bug
In soil in central nd southeast us
| Suppurative granulomas, a yeast with thick double cell wall with lots of nuclei
129
Where is coccidiodomycosis found, pathophysiology, vector,
Delayed type hypersensitivity, southwestern and western us, arthroconidia
130
Most common cause of cancer mortality in the world
Lung cancer
131
Most common cause of lung cancer
Cigarette smoking
132
Other potential causes of lung cancer: (5)
Uranium, indoor air pollution (radon), asbestos, high dose ionizing radiation, second hand smoke
133
Primary lung cancers in decreasing incidence (5)
Adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma, bronchial carcinoid
134
Lung cancers with the greatest relation to smoking
Squamous and small cell lung carcinomas
135
Lung cancer with the weakest association to smoking
Adenocarcinoma
136
Which lung cancers are most responsive to initial chemotherapy
Small cell carcinomas, as opposed to non small cell
137
Which lung cancers are more likely to metastasize
Small cell carcinomas as opposed to non small cell carcinomas
138
Most common type of lung cancer in women. This is also the most common in what other category of people
Adenocarcinoma, also most common lung cancer in non-smokers
139
Where is an Adenocarcinoma located in the lung. Are they larger or smaller lesions?
Peripherally, smaller lesions (cigarette filters take away the larger carcinogens slowing the smaller ones to get into the periphery -rapid review)
140
What Histologic characteristic do you see in adenocarcinoma
Glands/mucin
141
Where does the carbon pigment end up in anthracosis
Interstitial tissue and hilar nodes
142
What is a subtype of adenocarcinoma
Bronchioloalveolar carcinoma
143
What cell type is found in bronchioloalveolar carcinoma and what are they composed of
Clara cells, mucin secreting
144
What might bronchioloalveolar carcinoma on chest radiograph
Can look like lobar pneumonia
145
What part of the lung does squamous cell carcinoma usually infect?
Central parts
146
What does histology show for squamous cell carcinoma
Keratin pearls and intercellular bridges
147
What lung carcinoma is most associated with the p53 mutation
Squamous cell carcinoma
148
What can squamous cell carcinoma secrete? And what may it lead to?
PTH, hypercalcemia
149
What type of cells are associated with small cell carcinoma
Kulchitsky cells (neuro endocrine)
150
What part of the lung does small cell carcinoma affect
Central
151
What may small cell carcinoma secrete
ADH or ACTH
152
Why is small cell carcinoma so dangerous (2)
It's rapidly growing and it metastasizes early
153
What part of the lung does large cell carcinoma typically affect
Central or peripheral
154
What do you see histologically with large cell carcinomas, what types of cells are associated
Nothing much because it is poorly differentiated, large nuclei in cells
155
Symptoms associated with lung cancer (4)
Cough, weight loss, chest pain, dyspnea
156
Common sites for lung metastasis in decreasing incidence
Hilar lymph nodes, adrenal gland, liver, brain, bone
157
Is metastatic or primary lung tumor more common?
Metastatic
158
Cancers most likely to metastasize to the lung
Breast, colon cancer, renal cell carcinoma
159
What is a pancoast tumor
Cancer goes to extreme apex of the lung, destroys superior cervical ganglion resulting in ptosis, miosis, and anhydrosis
160
What secondary pathology is possible from lung cancer
Pancoast tumor (sympathetic effects), superior vena cava syndrome, emphysema, Atelectasis, pleuritis, paraneoplastic syndromes
161
What is lambert eaton syndrome
Antibodies against calcium channel in muscle that result in muscle weakness
162
Which lung cancers have the better prognosis?
Adenocarcinoma and squamous cell
163
What part of he lunch does a bronchial carcinoid tumor affect
Central or peripheral
164
Where does a bronchial carcinoid originate from?
Neuroendocrine
165
What kind of mass does a bronchial carcinoid form
Polyp like mass by the bronchus
166
Collar button lesion associated with:
Carcinoid tumor of lung if it goes peripherally
167
What is carcinoid syndrome
Intermittent attacks of diarrhea, flushing, and cyanosis
168
Carcinoid tumor of lung is benign or malignant?
Benign
169
Where is a bronchial harmatoma most likely located in
Peripheral 90% and central the rest of the time
170
Why does spontaneous pneumothorax occur?
Rupture of a emphysematous bleb
171
What kind of people does a spontaneous pneumothorax occur in, what will happen to the trachea
Young tall people, trachea shifts toward the affected lung
172
What causes a tension pneumothorax
Penetrating injury
173
Pathophysiology of tension pneumothorax, how do you treat it
A flap forms that allows air to enter during inhalation but does not let the air out --> need a chest tube
174
Asbestos workers that also smoke are most likely to die from
Lung carcinoma, not mesothelioma
175
Mesothelioma has the most correlation with
Asbestos exposure
176
Cancer will arise in patients with asbestos exposure approximately how many years after exposure
20/25(lung carcinoma/mesothelioma) - 40 (for mesothelioma)
177
Histology of bronchioloalveolar carcinoma, growth pattern
No invasion, grows along pre-existing structures without destruction of alveolar architecture --> Lepidic like butterflies on a fence (what?)
