Exam 2 Flashcards

1
Q

1-why learn lung path

2-broad classification of lung disorders

3-disorders in the airways

4-obstructive pulmonary disease

A

1- many of diseases occur in patients

  • manage dental problems w/ special care
  • empower you to help patients avoid
  • some disease you can cause

2-disease affecting:
airways, interstitium, & pulm vascular system

3-atelectasis
acute lung injury (ARDS)
obstructive pulmonary diseases

4-emphysema
chronic bronchitis
asthma
bronchiectasis

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2
Q

1-Atelectasis

2-acute lung injury

3-acute respiratory distress syndrome ARDS

A

1-collapse
-loss of lung volume caused by inadequate expansion of airspaces
-shunting of inadequately O2 blood from
pulm arteries into veins

2-spectrum of pulm lesions
endothelial & epithelial
-acute dyspnea
-hypoxemia
-bilateral pulm infiltrates (radiographs)
-no evidence of primary l. sided heart failure
-non cardiogenic pulm edema

3-MEDICAL EMERGENCY

  • rapid onset of life threatening resp insufficiency, cyanosis, & severe arterial hypoxemia
  • 85% patients= clinical syndrome w/ 72 hrs of insult
  • prognosis= grim…mortality rate=100%
  • mortality now=60%
  • chronic sequalae= diffuse interstitial fibrosis
  • those who survive acute insult & dont develop chronic sequelae…norm function w/in 12 mo
  • –common cause pneumonia & gastric contents
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3
Q

1-obstructive disease

2-restrictive pulm disease

A

1-diffuse pulm disease

  • airway disease
  • limitation of airflow—emphysema, chronci bronchitis, bronchiectasis, asthma
  • FVC norm or slightly reduced
  • *-dec FEV1= much more than FVC reduction
  • FEV1/FVC = dec**

2-diffuse pulm disease

  • reduced expansion of lung parenchyma
  • *-chest wall disorders
  • acute or chronic interstitial lung diseases**
  • FVC reduced
  • FEV1 norm or reduced proportionately to FVC
  • FEV1/FVC = norm ratio
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4
Q

1-chronic bronchitis

2-bronchiectasis

3-asthma

4-emphysema

5-small airway disease, bronchioles

A

1-bronchus

  • mucous gland hypertrophy/hyperplasia/hypersecretion
  • tobacco, smoke, air pollutants
  • cough / sputum production

2-bronchus

  • airway dilation & scarring
  • severe infections
  • cough, prulent sputum, fever

3-bronchus

  • SM hypertrophy, hyperplasia, excessive mucus, inflam
  • immunologic
  • wheezing, cough, dyspnea

4-acinus

  • air space enlargememnt, wall destruction
  • tobacco smoke
  • dyspnea

5-bronchiole

  • inflam scarring, partial obliteration of bronchioles
  • tobacco smoke, air poluutants
  • cough, dyspnea
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5
Q

Small airway diseases

1-emphysema

2-chronic bronchitis

3-asthma

A

1-alveolar wall destruction overinflation

2-productive cough
airway inflam

3-reversible obstruction
-bronchial hyperresponsiveness triggered by allergens & infections

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6
Q

1-emphysema

2-centriacinar

3-panacinar

4-distal acinar—paraseptal

A

1-**abnormal perm englargement of airspaces

  • distal to term bronchioles
  • destruction of alveolar walls w/o obvious fibrosis**
  • enlargement when no destruction present= overinflation—opposite lung after unilateral pneumonectomy

2-in upper lobes of lung

  • cigarette smoking
  • no a1 antitrypsin

3-in lower lung
-a1 antitrypsin deficiency

4-adjacent to pleura, along lobular CT septa

  • upper half of lungs
  • *-cyst structures= bullae
  • underlies spontaneous pneumothorax in young adults**
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7
Q

Emphysema Clinical Features

A

1-dyspnea

  • weight loss over time
  • *-reduced FEV1/FVC**
  • pink puffers—pure emphysema & blue bloaters (chronic bronchitis)
  • secondary pulm hypertension
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8
Q

1-chronic bronchitis

A

1-common in cig smokers & city dwellers

  • 20-25% of men btween 45-60
  • persistant productive cough for at least 3 consecutive mo in 2 consecutive years

clinically= cough & sputum production w/ no ventilation disturbance—

  • chronic obstructive bronchitis/outflow obstruction
  • severe may have COPD w/ cyanosis blue bloaters
  • differntiated w/ emphysema- pink puffers

Complications= pulm hypertension & cardiac failure
-recurrent infections & resp failure

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9
Q

Asthma

A
  • MED EMERGENCY
  • recurrent episodes of wheezing, breathlessness & chest tightness
  • clinical triad= intermittent & reversible airway obstruction
  • chronic bronchial inflam & eosinophils
  • bronchial SM hypertrophy & hyperreactivity
  • extrinsic or atopic—70%, environental, IgE & TH2
  • intrinis or non-atopic= 30%—non immune stimuli, aspirin, infections, cold, exercise

-path===th2 inflam response & airway remodeling

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10
Q

1-atopic asthma

2-asthma morph

3-asthma clinical

A

1-in childhood, fam history

  • asthma attack by allergic rhinitis, urticaria, eczema
  • environmental antigens
  • skin test= wheal & flare type 1 hypersensitivity

2-gross= mucus plugs in bronchi & bronchioles
histo= curshmann spiral-whorls of shed epi
numerous eosinophils
charcot-layden crystals-crystalloids of eosinophilic proteins

-airway remodeling features in bronchial wall

3-dyspnea, wheezing, & difficulty expiration

  • 1-several hours
  • reduces spontaneously or after therapy
  • intervening times normal
  • paroxysm irrespnsive to therapy
  • status asthmaticus—days or weeks
  • hypercapnia, acidosis, hypoxia= fatal
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11
Q

Bronchiectasis

A

1-perm dilatation of bronchi & bronchioles= destruction of muscles & elastic tissues

  • obstruction
  • chronic infection= necrotizing/suppartive= s.aureus & k. pneumoniae
  • one leads to the other

morph= affects lower lung lobs, bilaterally, vertical air passage

  • dilated airways can be traced close to pleura
  • normal airways= only upto 2-3 cm away from pleura
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12
Q

Bronchiectasis Clinically

A

1-severe, persistent cough

  • mucopurulent, fetid sputum
  • specks of blood & frank hemoptysis
  • episodic, precipitated by infection
  • clubbing of fingers

severe=

  • widespread bronchiectasis
  • ventilatory defects
  • pulm hyperetnsion

-brain abscess & reactive amyloidosis

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13
Q

1-diffuse interstitial lung diseases

A
  • *-restrictive, infiltrative
  • reduced lung compliance, dyspnea, & hypoxia**
  • chest radiographs= small nodules, ground glass shadows

-progressive= resp failure, pulm hypertension,
cor pulmonale

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14
Q

Idiopathic Pulm Fibrosis IPF

A
  • cryptogenic fibrosing alveolitis
  • agent unknown
  • males > females over 60 yrs at presentation
  • *-histologic—usual interstitial pneumonia=diagnostic**
  • exclude other causes before calling idiopathic

Gross Morph= cobblestone of pleura & cut surface shows fibrosis (firm, rubbery white)
Histological= usual interstitial pneumonia—patchy interstitial fibrosis
-early & late lesions—temporal heterogeneity
-dense fibrosis—hoenycomb fibrosis

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15
Q

Idiopathic Pulm Fibrosis IPF Clinical

A
  • insidious onset= non productive cough= progress dyspnea
  • dry, velcro like—crackles during inspiration
  • late stages= cyanosis, cor pulmonale
  • surgical biposy—gold standard for diagnosis
  • mean survival= therapy 3 years
  • treatment= lung transplant
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16
Q

1-Pneumoconioses

2-sarcoidosis

A

1-inhaled mineral dusts & inorganic particulates

  • coal duse= anthracosis-coal macules & coal nodules
  • silica= silicosis—silicotic nodules & silica particles
  • asbestos= effusions & plaques, lung/laryngeal cancers—asbestos bodies

2-multisystem disease—non caseating granulomas

  • restictive lung disease
  • *-diagnosed= exlusion= mycobacterial& fungal infections, berryliosis—granulomatous lesions**
  • bilateral hilar lymphadenopathy
  • 25% cases- eye + skin—erythema nodosum
  • lung transplant needed
  • no etiology—adults <40, danish & swedish, blacks
  • interstitial & intra-alveolar—Th1 type CD4 T
  • oligoclonal expansion of T cells
  • Polyclonal hypergammaglobulinemia= B cells
  • association with HLA-A1 & HLA B8—CD8
17
Q

Disease of Vascular Origin

A
  • pulm embolism
  • hemorrhage
  • infarction
  • pulm hypertension
  • goodpasture syndrome
  • idiopathic pulm hemosiderosis
  • wegener granulomatosis
18
Q

1-Pulm Embolism

2-Pulm Hypertension

A

1-arise from deep vein thrombi in legs

  • prolonged bedrest, CHF, high estrogen birth control
  • inc in pulm artery pressure & ischemia of downstream lung parenchyma
  • diminished cardiac output= r. heart failure
  • hypoxemia develops

2-norm pulm BP= 1/8 systemic BP
pulm hypertension BP= 1/4 systemic BP
-secondary to other causes
-idiopathic pulm hypertension
-pulm endothelial cell or vascular SMC dysfunction
-reduced production of vasodilators—NO, prostacyclin
-migration & growth factors for SMC

19
Q

1-pulm infection

2-classification

A

1-infection of lung

  • bronchopneumonia= patchy, multilobar, bronchioles
  • lobar pneumonia= contiguous air spaces, consolidation
  • anatomic distinction —based on pathogen

2-community acquired acute pneumonias—S. pneumoniae

  • community acquired atypical pneumonia= mycoplasma
  • nosocomial
  • aspiration
  • chronic
  • necrotizing
  • pneumonias in immunocrompised host
20
Q

Community Acquired Acute Pneumonias

A
  • mostly bacterial= after viral
  • strep pneumoniae
  • lobar or bronchopneumonia=latter at age
  • aspiration of pharyngeal floras= lower & middle lobes

4 stages pre antibiotic= congestion, red hepatization, gray hepatization, & resolution
-early antibiotic treatment eliminates stages

  • bronchopneumonia= patchy inflam, confluence to consolidation
  • pleural involvement more in lobar
  • complications= lung abcess, empyema, fibrosis, & infection—meningitis & arthritis
21
Q

Community Acquired atypical Pneumonias

A
  • gram staining of sputum
  • blood cultures
  • hemophilus influenza, catarrhalis, staph aureus, pseudomonas, legionella, klebsiella
  • inflam reaction confined w/in walls of alveoli
  • mycoplasma pneumoniae, chlamydia, & coxiella burnetti
22
Q

1-nosocomial pneumonia

2-aspiration pneumoniae

A

1-hospital acquired

  • chronic immune depression, immunodeficiency, prolonged antibiotic therapy
  • mechanical ventilation= high risk
  • **gram neg rods (enterobacteria & pseudomonas)
  • staph aureus
  • typically not s. pneumoniae**

2-debilitated patients

  • *-unconscious anesthesia/repeated vomiting
  • **aspiration of gastric contents
  • partly chemicals (gastric)
  • partly bacterial
  • necrotizing/fulminant course, leading to death
23
Q

1-lung abcess

2-chronic pneumonia

3-tuberculosis

A

1-formation of 1 or more large cavities
2-aerobic & anaerobic bacteria—latter common in abcesses
-pleural cavity—pneumothorax or empyema
-embolization of septic material= meningitis or brain abcess
-symptoms= bronchiectasis

2-localized lesion in immunocompetent patient

  • bacteria= mycobacterium tuberculosis
  • fungi
  • HIV
  • mortality 6% from TB alone

3-communicable franulomatous disease= m. tuberculosis
-centers of granuloma= caseous necrosis

  • –parenchymal lesion & node= ghon complex
  • –calcified parenchymal lesion & nodals= Ranke complex
24
Q

1-secondary tuberculosis

2-fungal infections

3-pneumonia in immunocompromised

A

1-clinical= insidious & low grade fever in late afternoon, night sweat

  • cough, mucoid, purulent sputum, hemoptysis
  • pleuritic pain
  • diagnosis= consolidation/cavitation in upper lobes of lung
  • *-isolation of tubercle bacilii**
  • non tuberculous mycobacteria= m. avium in HIV patients

2-histoplama, immitis, blastomyces dermatidis= dimorphic fungi

  • *-isolated lesions= immunocompetent
  • disseminated when immunocompromised**
  • t cell mediated immunity
  • diagnosis= identification of fungi in tissue

3-cytomegalovirus
pneumocystitis jiroveci
candida albicans
mucormycosis
cryptococcus sporidium
HIV

25
1-lung tumors 2-carcinoma of lung
1-lung common site for metastasized tumors - benign= most common= hamartomas or coin lesions - malignant= common bronchial epithelial carcinoma---95 - Ca lung = common cancer in western world 2-85% of patients die w/in 5 yrs - localized disease 5 yr survival only 45% - incidence in male reducing, females inc - cig smoking= strong risk factor...casual relationship-peak incidence= 50s & 60s
26
Carcinoma of Lung
histo= squamous cell carcinoma adenocarcinoma small cell carcinoma large cell carcinoma - adenocarcinoma= greater than squamous cell carcinoma * *-adenocarcinomas= more common in women & lifetime nonsmokers**
27
1-Small Cell Lung Cancer SCLC 2-Non Small Cell Lung Cancer NSCLC 3-carcinoma of lung path
1-**metastasis at diagnosis not suitable for surgery** chemo & radiation---Rb gene mutations 2-**resistant to chemo & radiation -suitable for surgical resection** p16/CDKN21---gene mutations common -KRAS & EGFR= adenocarcinoma 3-genetic predisposition= P53, KRAS, EGFR - environmental factors= **cig smoking**---squamous & asbestos (inhaled) - not all people who smoke get cancer, nonsmokers can get it too - environmental factors may trigger Ca in genetically predisposed
28
Carcinoma of Lung 1-squamous cell carcinoma 2-adenocarcionma 3-small cell lung carcinoma 4-large cell lung carcinoma 5-clinical of carcinoma of lung
1-men\>women---stronger w/ smoking - arise in main bronchi, spread to hilar lymph nodes - slow distant spread - cavitation, hemorrhage - squamous metaplasia/dysplasia---\>carcinoma in situ---\>malig * *-cytobrushings, biposy have keratin pearls---well differentiated** 2-arise centrally but maybe peripheral * *grow slowly, but metastasize early** - precursor may be atypical adenomatous hyperplasia AAH - bronchioalveolar carcinoma= no destruction of alveolar structure 3-derived from neuroendocrine cells of lung 4-undifferentiated malig tumor - large nuclei, prom nucleoli, moderate cytoplasm - minimal squamous or glandular differntiation common 5-silent, insidious & spread fast - chronic cough, expectoration - hoarse voice, chest pain, superior vencaval syndrome, pericardial/effusion - segmental atelectasis, pneumonitis - metastatic
29
1-lesions of pleura 2-pleural effusion & pleuritis
1-secondary to parenchymal disease -primary lesions= primary intrapleural bacterial infection &&& malig mesothelioma---(in parietal or visceral pleura---50% bc of asbestos) 2-transudate= hydrothorax due to CHF - exudate= protein\>2.9 gm w/ inflam cells=pleuritis - transudates resorbed - exudates = fibrosis & calcification - principal cause of pleural exudate= suppurative pleuritis, cancer, pulm infarction, viral pleuritis
30
1-pneumothorax 2-hemothorax 3-chylothorax 4-malig mesothelioma
1-spontaneous & secondary 2-ruptured intrathoracic aorta aneurysm & blood clots w/in pleural cavity 3-lymph fluid & tumors 4-rare cancer of mesothelial cells parietal & visceral pleura **-50% cases in asbestos** -cig smoking & asbestos= inc risk for bronchogenic carcinoma but not for malig mesothelioma - preceded by pleural fibrosis & plaque formation - sheath of yellow-white, firm, gelatinous, layer around lung - histo= epithelial, sarcomatoid, biphasic - basis isnt clear
31
1-lesions of upper resp tract
1-acute infections - common cold - acute pharyngitis= mild pharyngitis= common - --accompanied by tonsilits, suppuration= b hemolytic strep - --coxsackie a virus= pharyngeal vesicles & ulcers - --EBV = infectious mono - acute bacterial epiglottis= h influenza - acute laryngitis= tuberculous & cornyebacterium diphth
32
1-nasopharyngeal carcinoma 2-laryngeal tumors
1-link to EBV & high incidence in chinese -invades locally, lymph nodes, metastaize to distant sites -radiosensitive 5 yr survival rate, 50% even for advanced cancer -histology= keratinizing squamous cell carcinoma non keratinizing squamous cell carcinoma undifferentiated carcinoma * *2-hoarseness of voice** - **non malig tumors=** vocal - --laryngeal papilloma/squamous papilloma - --multiple papilloma in kids= recurrent resp papillomatosis - --caused by **HPV 6 & 11** - --dont become malignant -carcinoma of larynx= 2% all tumors \>40 yrs age men to women= 7:1 60-75% glottic, 20-45% supraglottic, 5% subglottic **---environmental influences= all cases in smokers & alc & asbestos** ---**95% typical squamous cell lesions**= rarely adenocarcinomas -persistent hoarseness of voice -can be cured= 1/3rd die -infection of distal resp passages, metastasis, cachexia