Lab 3+4 Respiratory Flashcards
Repetitive phonatory damage is an etiology of ___ which appear ___ in on the vocal folds of the larynx
Singer’s nodules
Bilateral, symmetrical
What are some potential etiologies of a laryngeal Polyp?
- single episode of neck/vocal abuse
- gastroesophageal reflux
- chronic laryngeal allergic rxns
- chronic smoking
- alcohol use
- viral infection
- cysts
How do Polyps appear different from Singer’s nodules?
Unilateral
What are some potential etiologies of laryngeal carcinoma?
- cig smoking
- alcohol use
- HPV
- asbestos exposure
How does Laryngeal carcinoma appear different from a polyp or singer’s nodule?
- nodular (unilateral in lab photo)
- sm. Grey lesions of squamous epithelium
Histologically, laryngeal carcinoma’s sm. Grey lesions appear as ___
Keratin pearls
Describe a Keratin Pearl. what do they always indicate?
- squamous cell whirls deposit keratin in center
- indicate squamous cell carcinoma
What SSx may present with any of the 3 laryngeal conditions
- Changes in voice (hoarseness, scratchy/raspy, breathiness, harsh-sounding)
- neck pain
- “lump in throat” feeling
inability of a neonate lung to inflate after premature birth may be due to ___. Name the condition.
insufficient surfactant production
Neonatal Respiratory Distress Syndrome (NRDS)
another name for NRDS?
Hyaline Membrane Disease
w/ NRDS, birth may be ___, shortly followed by symptoms leading to respiratory distress which present with what SSx?
unremarkable
nostril flaring, use of accessory respiratory Mm.
Histologically, NRDS displays dark pink staining material w/in collapsed alveoli termed ___ which have fused w/ ___ into an amorphous mass, making gas exchange difficult/impossible
Hemolyzed RBCs fused w/ platelets + fibrin
define Red Hepatization
ample RBCs w/in alveoli, resembling Liver
what pattern of consolidation occurs in early stage presentation of Lobar Pneumonia
Red Hepatization
what does a later presentation of Lobar Pneumonia involve? how does the pattern of consolidation change?
healing process:
- macrophages clear out RBCs from alveoli
- Grey Hepatization (more pale)
What are the 2 gross patterns of anatomic distributions of bacterial pneumonia?
- Lobar pneumonia (consolidates in entire lobe)
- (Lobular) Bronchopneumonia (patchy consolidation)
another name for Bronchopneumonia?
Lobular pneumonia
what pattern of inflammation is involved in viral pneumonia? what name is given to its radiographic presentation?
- interstitial pattern of inflammation
- “Batwing sign”
what pattern of consolidation occurs in Lobular pneumonia? how does this type of consolidation appear grossly? histologically?
- Patchy consolidation
- areas of consolidation surround bronchioles = “Bronchopneumonia”
- consolidation focus around bronchi w/ peripheral alveoli largely spared
what substance is w/in alveoli of a patient w/ Lobar pneumonia? what WBC predominates?
- Purulent exudate
- PMNs
describe Interstitial pattern of inflammation. What type of pneumonia is this found in?
Viral pneumonia
- dilated alveolar septal walls
- inflammatory cells = largely lymphocytes
- spared alveoli (comparatively less edema)
Refer to image 13 of respiratory. What type of pneumonia is demonstrated?
Lobar pneumonia
Refer to image 14 of respiratory. What type of pneumonia is demonstrated?
Bronchopneumonia
A radiograph resembling bronchopneumonia along with what symptoms would yield a different differential diagnosis?
chronic cough for months + long history of smoking
Refer to image 15 of respiratory. What type of pneumonia is demonstrated? This perihilar shadowing pattern is termed ___ and displays what pattern of inflammation?
- Viral pneumonia
- Bat-wing sign = interstitial pattern of inflammation
define Atelectasis
incomplete expansion of the lungs or collapse of previously inflated lungs
name the 3 types of atelectasis
Resorption, Compression, Contraction
Resorption atelectasis results in a mediastinal shift in what direction?
TOWARD affected lung
Compression atelectasis results in a mediastinal shift in what direction?
AWAY FROM affected lung
Contraction atelectasis results in a mediastinal shift in what direction?
NO shift
What atelectasis types are considered reversible?
Resorption and Compression
refer to image 16 in respiratory.
A) what is causing this atelectasis? propose a mechanism of injury.
B) describe the lung collapse. How is this unlike a classic example of this type of atelectasis?
A) air rushing into pleural cavity
- knife wound, near drowning, shock, infection, sepsis, aspiration
B) elastic recoil of lung = collapse toward mediastinum
- unlike classic compression atelectasis b/c NO mediastinal shift present (equal pressure in + out of thorax = collapse w/o mediastinal shift)
Refer to image 17 in respiratory.
A) Identify the arrows.
B) What distinctive pattern of inflammation is seen?
C) What is the causative organism?
A) left -involved hilar lymph node
right -Ghon/initial lesion (subpleural nodule)
B) granulomatous inflammation (caseous necrosis)
C) Mycobacterium TB
What are the clinical features of pulmonary TB?
- cough lasting 3+ weeks
- chest pain
- hemoptysis or coughing up sputum
- weakness/fatigue
- weight loss
- no appetite
- fever, chills, night sweats
A patient with posterior leg pain begins complaining of difficulty breathing. What is occurring? What are some risk factors in this patient?
Deep V. thrombosis resulting in pulmonary embolus (thromboembolism)
- Acute Cor Pulmonale -> R. ventricular hypertrophy + dilation due to pulmonary hypertension (causes acute RHF = emergency)
describe Virchow’s triad, what’s the most important aspect?
- endothelial cell damage
- increased coagulability of blood
- alterations in blood flow
A diagnosis of pre-eclampsia prompts caesarean section at 31-weeks gestation. Prior to delivery, the expecting mother was given an injection of betamethasone. The child was delivered successfully. Immediate Apgar score was high (8/10). approximately 20 minutes later, the respiration rate as well as pulse begin to increase. Flaring of the nostrils was observed as well as use of accessory respiratory muscles. the child was rushed to the NICU.
A) what is your diagnosis?
B) what is the cause of your diagnosis?
A) NRDS
B) insufficient surfactant production
Spirometry results are used to differentiate between ___ and ___
COPD and CRPD
Draw + label a spirogram
I know you didn’t draw it >:(
How are spirometric results different in COPD vs CRPD?
COPD
- FEV1 decrease
- VC normal
- FEV1/VC decrease
CRPD
- FEV1 normal
- VC decrease
- FEV1/VC increase
What asthma is the most common? When does it usually begin?
- Extrinsic
- Childhood
how is Extrinsic asthma initiated?
type I hypersensitivity rxn from extrinsic antigen (usually environmental antigens: dust, pollen, animal dander, foods)
what HX is common in a patient w/ extrinsic asthma? what often precedes extrinsic asthmatic attacks?
- family Hx of atopy (allergies)
- allergic rhinitis, urticaria (hives), or eczema
how is Intrinsic asthma initiated?
diverse, nonimmune mechanism including:
- aspirin
- pulmonary infections (especially viral)
- cold (extreme weather/temperature)
- inhaled irritants
- stress
- exercise
What is an Expiratory wheeze? How is it produced?
High pitched exhalation
Partially obstructed airways
what are Rhonchi? how is it produced? is it produced during expiration or inspiration?
low-pitched, coarse sounds (described as snoring/gurgling)
- obstruction or ^secretion in airways
- expiration, or inspiration + expiration (never inspiration alone) not sure how important this point is lol
what condition is typically associated with expiratory wheezes?
Asthma (which is an example of a COPD!)
refer to image 19 of respiratory. what normal attributes of a bronchus are seen?
- sm. amount of mucus
- single layer of PSCCE w/ G
- Smooth M.
- Hyaline cartilage
- alveoli
refer to image 20 of respiratory. what changes are seen in the asthmatic bronchus? which of these is a hallmark of COPD? what spirometry values would you expect in this patient?
- ample mucus production + hypertrophy of mucus-secreting cells
- Smooth M. hypertrophy
- Submucosal fibrosis of CT
- decreased luminal diameter COPD hallmark
what are two indicators of Extrinsic asthma that would be found in a sputum sample?
- Curschmans spirals
- Charcot-Leyden Crystals
What are Curschmans spirals? Describe their appearance. (image 21)
- extruded mucous plugs from mucus-secreting cells in bronchi
- deep colored spirals
What are Charcot-Leyden crystals? Describe their appearance. (image 22)
- eosinophil-derived proteins found in allergic rxns (asthma, bronchitis, allergic rhinitis) and parasitic infections
- translucent linear masses
(images 23 + 24) What condition is characterized by a loss of inter-alveolar septal walls
Emphysema
What is the importance of alpha1-antitrypsin? What pathology is it implicated in and how?
- prevents WBCs from complete digestion of own lungs
- deactivation/deficiency of alpha1-antitrypsin acquired thru inheritance or smoking = Emphysema
what is meant by “Pink-Puffer”? what is the associated pathology?
Associated with Emphysema
- overinflated lungs, depressed diaphragms: “barrel chested” (Puffer)
- increased respiratory rates w/ minute volumes
- maintain arterial hemoglobin saturation (Pink)
what is meant by “Blue-Bloater”? what is the associated pathology?
Associated with Chronic Bronchitis
- hypoxic blood = Cyanosis (Blue)
- Cor pulmonale -> RSHF = Pitting Edema (Bloater)
A) What presentation of the heart does COPD lead to?
B) What is this called?
C) What are the consequences?
(refer to the image on page 40 of the lab manual)
A) Chronic Cor Pulmonale
B) RV hypertrophy + dilation = loses crescenteric shape due to IVS bowing in the opposite direction.
C) RSHF
Describe how COPD leads to cardiac hypertrophy. What is the pattern of hypertrophy?
- initial pulm. hypertension (creates pressure overload) -> pulm. valve incompetence -> pulm. trunk dilation resulting in regurgitation (creates volume overload)
- Eccentric AND Concentric hypertrophy
What is the 1st MC cause of RSHF? What is the 2nd?
MC: LSHF due to ischemic heart disease
2nd MC: COPD
What is the defining feature of pneumoconiosis?
lung rxn to inhalation of mineral dusts
pneumoconiosis is a major etiologic factor in what pathology?
CRPD
what are the subtypes of pneumoconiosis?
- Anthracosis
- Silicosis
- Asbestosis
- Berylliosis
what particle is inhaled in Anthracosis? what name is often given for this condition?
Coal/Carbon (anthracyte)
“Coal Miner’s Lung”
what particle is inhaled in Silicosis?
Silica sand/quartz dust
what particle is inhaled in Asbestosis? why might the size of these particles be important?
Asbestos
- macrophages are unable to digest the large particle = chronic inflammation w/in lung
what particle is inhaled in Berylliosis?
Beryllium compounds
Pneumoconiosis due to exposure to which particle is a major etiology in Mesothelioma?
Asbestos bodies
refer to image 27 of respiratory. what are the areas of brightness bilaterally termed? what condition does this present in? what is the chief presenting complaint?
- “Potato nodes”
- Sarcoidosis (a CRPD)
- cough + dyspnea
radiographically, how can you differentiate Sarcoidosis from cancer?
- potato nodes: bilateral, somewhat symmetrical
- cancer: random, non-uniform
what is the characteristic pattern of inflammation in Sarcoidosis?
non-caseating granulomas
what are the general clinical features of lung neoplasias?
- local effects
- paraneoplastic syndromes
- metastases
describe Alveolar Cell Carcinoma in terms of:
A) preferential location
B) histologic appearance
C) cells derived from
D) para-neoplasia?
A) periphery
B) “fern leaf” glandular pattern
C) type II pneumocytes
D) no
describe Squamous Cell Carcinoma in terms of:
A) preferential location
B) histologic appearance
C) cells derived from
D) para-neoplasia?
A) Bronchus (arise + grow here, then later found in hilum)
B) Keratin Pearl
C) type I pneumocytes (squamous cells)
D) no
describe Small Cell Carcinoma in terms of:
A) preferential location
B) histologic appearance
C) cells derived from
D) para-neoplasia?
A) Peri-hilar
B) Conspicuous mitoses (diffusely infiltrating sm. compact cells)
C) Neuroendocrine
D) yes
Where do lung cancers prefer to metastasize to?
regional lymph nodes (hilar, mediastinal), brain, bone, liver
whats another name for Adenocarcinoma in the lung?
Alveolar cell carcinoma
whats another (uncommon) name for Small cell carcinoma?
“oat cell” carcinoma
which cell derivative in lung neoplasias is most aggressive, leading to the highest likelihood of paraneoplastic syndromes?
Neuroendocrine (small cell carcinoma)
what type of cell are type II pneumocytes?
glandular cells secreting surfactant
refer to image 28 of respiratory to view the “fern-leaf” pattern.
What neoplasia is this associated with?
Adenocarcinoma
what term describes the hypercoagulable state of alveolar cell carcinoma which creates recurrent thrombi (clotting disorder)?
Trousseau sign of malignancy
describe how the gross image 29 (of respiratory) is consistent with the presentation of Adenocarcinoma. How is this seen radiographically?
- peripheral lesion = “puckering” of overlying pleura
- radiographic Ground-glass appearance
refer to image 30 of respiratory. name the structures found in the center of pane “B”. what neoplasia is this associated with?
Keratin pearl
-Bronchogenic carcinoma (tumor mass at root of bronchiole produces keratin pearl)
what is another name for Squamous cell Carcinoma?
Bronchogenic Carcinoma
what is required for Squamous cell carcinoma to become symptomatic?
when it protrudes into bronchus - Endobronchial
refer to image 31 of respiratory
A) describe the histological appearance
B) What telltale sign of carcinoma is present
C) What are the consequences of this sign?
A) large, deeply eosinophilic Keratin pearls, also carbon accumulations
B) Hypercalcemia of Malignancy
C) extreme exhaustion, prone to patho Fx
How can Bronchogenic Carcinoma result in Hypercalcemia of Malignancy?
neoplastic cells produce PTH
refer to image 32 of respiratory showing a highly aggressive lung cancer.
A) from what cells are these derived?
B) what are the possible products of these cells and what conditions result?
A) Neuroendocrine
B) - ACTH = Cushing’s Syndrome
- Ab towards presynaptic neurons = Myasthenic/Eaton-Lambert Syndrome
- SIADH
define Paraneoplastic syndrome. what are some examples?
syndromes of which symptoms mask the underlying neoplasm
- Cushing’s Syndrome
- Clubbing
- Myasthenic Syndromes
- SIADH
- Secretion of PTH-like substance
What are the clinical features of patients presenting with Cushing’s Syndrome?
- ^ACTH
- buffalo hump
- moon face
- central obesity
- stretch marks
A) What is Eaton-Lambert Syndrome?
B) What carcinoma is it associated with?
C) What are the clinical features?
A) a type of Myasthenic syndrome - Ab against presynaptic neurons prevents Ach release
B) Sm. Cell Lung Carcinoma
C) hyporeflexia, weakness
What are the clinical features of patients presenting with Horner Syndrome?
- enophthalmos
- ptosis
- miosis
- anhidrosis
define enophthalmos
depression of eyeball
define ptosis
drooping upper eyelid
define miosis
pupil constriction
define anhidrosis
lack of sweating
refer to image 33 of respiratory.
A) What is meant by “Cannon-ball metastasis”?
B) Does it suggest a primary tumor or otherwise and why?
C) From where might this neoplasia arise?
D) What is required to confirm a cancer diagnosis in this case?
A) multi-focal pattern of metastases
B) secondary tumor -> lung is MC location for metastatic cancer
C) from liver, bone, skin
D) biopsy required
what is Mesothelioma?
neoplasm of pleura.
(mesothelium = serous membrane lining of closed cavity)
(Refer to image 35 an be able to identify Mesothelioma)
what is the cell of origin in Mesothelioma?
varies based on layer affected:
- epithelial layer “Epithelioid”
- CT layer “Sarcomatoid”
- both “Mixed”
what is the primary etiology of Mesothelioma?
Asbestos exposure
refer to image 35 of respiratory. what should be appreciated about this neoplasm?
thickened pleura = constriction of lung tissue (Mesothelioma)
refer to image 36 of respiratory.
Describe what has happened to cause the area of brightness over the right hemi diaphragm.
What sign is present?
- Costodiaphragmatic recess obliterated by pleural effusion
- meniscus sign
what is Pleural effusion?
fluid accumulation between visceral + parietal layers of pleura
what Inflammatory substances may accumulate to produce Pleural effusion?
- Serofibrinous exudate
- Pus
- Bloody exudate
what Noninflammatory substances may accumulate to produce Pleural effusion?
- Transudate
- Blood
- Chyle (lymph)
what substance accumulates in Serofibrinous Pleuritis? what are the common associations?
Serofibrinous exudate
- inflammation in adjacent lung
- collagen vascular disease
what substance accumulates in Empyema? what is another name for this condition? what is the common association?
Pus
- Suppurative Pleuritis
- suppurative infection in adjacent lung
what substance accumulates in Hemorrhagic Pleuritis? what is the common association?
- Bloody exudate
- tumor
what substance accumulates in Hydrothorax? what are the common associations?
Transudate
- congestive heart failure
- (also nephrotic syndrome, liver failure, starvation)
decreased albumin
what substance accumulates in Hemothorax? what are the common associations?
Blood
- ruptured aortic aneurysm
- trauma
what substance accumulates in Chylothorax? what is the common association?
Lymph (Chyle)
- tumor obstruction of normal lymphatics
increased glucose
68 year old retired plumber has been coughin for 4 months at least. he schedules a doctor’s appointment after coughing up a small amount of blood. he has smoked since he was in the Navy at 18 years of age. the doctor notes that he has lost 8 pounds in the last 8 months. a pulmonary function test finds diminished vital capacity (VC) and only a slight decreased forced expiratory volume (FEV1). chest radiographs reveal a 3cm mass in the area of the left primary bronchus.
A) what do you suspect?
B) what do you think the cause is?
A) Neoplasia
B) Bronchogenic carcinoma
Define Cor Pulmonale
RV hypertrophy and dilation due to pulmonary hypertension
