Exam 1 path Flashcards
Premortum exam of pulmonary embolism
lines of Zahn
Pulmonary embolism on gross exam
lower lobe
triangle shaped pointing toward hilum
Microscopic exam of pulmonary embolism
plexiform lesions (adjacent to vessel) concentric laminar intimal fibrosis (above both are irreversible)
Goodpasture syndrome
type II cytotoxic hypersensitivity triad of sx 1. diffuse pulmonary hemorrhage 2. glomerulonephritis 3. anti-GBM Abs men b/t 15-30 y/o
Goodpastures dx tool
IgG Abs against alveoli and glomeruli in serum
Goodpastures microscopic exam
lungs: linear deposits of IgG, thickening of alveolar septa
kidney: focal proliferative to crescentic glomerulonephritis, linear deposits of IgG
Idiopathic pulmonary hemosiderosis
intermittant hemoptysis
refractory anemia
in children/teens
no serum Abs
Microscopic exam of idiopathic pulmonary hemosiderosis
hemosiderin laden macrophages
alveolar capillary congestion
no necrosis/vasculitis/granulomas
interstitial fibrosis
Wegener granulomatosis
necrotizing granuolmatous inflammation (kidney and lungs)
necrotizing vasculitis (sm/med vessels)
c-ANCA against neutrophil proteinase 3 (PR3)
neutrophils activated and damage endothelium
Pulmonary HTN presentation
exertional dyspnea
in women 20-40 y/o
Familial pulmonary HTN gene
BMPR2 mutation (when inactivated)
Most common cause of secondary pulmonary HTN
recurrent pulmonary embolism
Acute Respiratory Distress syndrome
hyaline membrane at capillary/alveolar interface,
neutrophil damage to type I and II pneumocytes,
inhibited recovery due to damage to type II pneumocytes
Causes of pulmonary hypoplasia
oligohydramnios
decreased intrathoracic space
Most common tracheoesophageal fistula type
blind esophagus with lower esophagus connected to trachea
Extralobar sequestration
mostly on L side
polyhydramnios and edema can cause
external to lung w/ separate pleural lining
Intralobar sequestration
assc with fibrosis/infections/bronchiectasis
usually lower lobe
aortic branch supplied
not in pleura
Atelectasis
incomplete expansion of the lungs
collapse of previously inflated lung
Resorption atelectasis
complete airway obstruction mediastinal shift toward obstruction excess secretions/asthma/foreign body retraction of lung in airless state (cells filled with secretions) most common type
Compression atelectasis
mediastinal shift away from affected lung
pleural cavity filled (with fluid/air)
Contraction atelectasis
fibrotic changes in lung/pleura
prevents full expansion
irreversible
Pulmonary edema histology
engorged capillaries
hemosiderin laden macrophages
granular pink precipitate
Acute respiratory distress syndrome (acute lung injury)
diffuse alveolar damage with hyaline deposition lining capillary/alveoli interface
Acute interstitial pneumonia
Hamman-Rich syndrome
rapidly progressive in young aduts
flu like illness w/ SOB
brisk interstitial fibroblastic proliferation
Impact of obstructive lung disease on airflow rate
decreases (FEV1/FEV)
Impact of restrictive lung disease on airflow rate
normal or increased (FEV1/FEV)
Cause of emphysema
imbalance of protease/antiproteases
Centriacinar emphysema
upper half of lungs
respiratory bronchioles
from long standing smoking
Panacinar emphysema
uniform destruction of entire alveolus
lower half of lungs
A1AT deficiency
assc with liver cirrhosis (PAS + stain)
Paraseptal emphysema
distal airway structures
apical/giant bullae with spontaneous pneumothorax
around septa or pleura
Symptoms/findings of emphysema
pursed lips/pink skin/Tx barrel chest
functional capacity loss
decreased FEV1/FEV
Dx for chronic bronchitis
persistent cough/copious sputum production for 3 months (2x) within 2 years
Symptoms/findings of chronic bronchitis
hypercapnea (cyanotic)
wt gain
aka blue bloaters
elevated Reid index (over 0.4) due to thickened mucus layer
Atopic asthma
in children
type 1 hypersensitivity (IgE mediated)
Occupational asthma
from repeated exposure to chemicals/irritants
Drug induced asthma
commonly aspirin (assc with nasal polyps)
Non-atopic asthma
respiratory infections with normal serum IgE
Status asthmaticus
unrelenting asthma attack
refractory to bronchodilators
Findings with asthmatic lungs
Curschmann spirals
Charcot-Leyden crystals (from eosinophils)
over distended lungs
goblet cell hyperplasia
What is bronchiectasis?
permanent dilation of the airways
Sx of bronchiectasis
SOB
cough
hemoptysis
Cause of congenital bronchiectasis
developmental arrest of bronchial tree
Acquired bronchiectasis
in adults
infectious insult/obstruction/drainage impairment can cause
Causes of bronchiectasis
bronchial obstruction
cystic fibrosis
Kartagener syndrome (immotile cilia/sinusitis/situs inversus)
allergic bronchopulmonary aspergillosis
Pts with allergic bronchopulmonary aspergillosis
asthmatics
cystic fibrosis
Who are pink puffers?
pts with emphysema
thin/barrel chest/pursed lips
Who are blue bloaters?
pts with chronic bronchitis
heavy/cyanotic
Kartagener’s syndrome
dynein arms mutation (immotile cilia)
situs inversus
bronchiectasis
sinusitis
