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Resp II > Lung Path > Flashcards

Lung Path Flashcards

1
Q

which bronchi is straight

A

right

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2
Q

what size particles are most dangerous

A

.5-5um

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3
Q

lobule

A

cluster of terminal bronchioles w/attached acini

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4
Q

acinus

A

respiratory bronchiole and all attached alveolar ducts and sacs

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5
Q

pulmonary hypoplasia

A

common 10% neonatal autopsy

seen w/fetal compression and other anomalies

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6
Q

congenital foregut cysts

A 
detached section of maldeveloped foregut
presents as mass or incidental finding, possibly in adulthood
mediastinal and hilar locations
not connected to airway
usually bronchogenic w/respiratory epi
some esophageal, some enteric
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7
Q

cystic adenomatoid malformation

A

CPAM

Hamartomatous lesions w/abnormal bronchiolar tissue

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8
Q

types of CPAM

A

type I- large cysts good prognosis

type II- medium cysts, poorer prognosis since associated w/other congenital malformations

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9
Q

bronchopulmonary sequestrations

A

areas of lungs w/o normal connections to airways

blood supply is from systemic aa

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10
Q

extralobar bronchopulmonary sequesterations

A

external to lung

may have other congenital anomalies

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11
Q

intralobar bronchopulmonary sequestrations

A

w/in lung
associated w/recurrent local infection and/or bronchiectasis
most likely an acquired lesion

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12
Q

respiratory distress in newborn

A 
excessive maternal sedations
fetal head injury
blood or amniomtic fluid aspiration
intraunterine hypoxia from cord
hyaline membrane disese
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13
Q

hyaline membrane diease stats

A

most common

1000 deaths in 2002, but 25000/year in 60s

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14
Q

hyaline membrane disease

A

can occur in term infants, but usually preterm
rate inversely proportional to gestational age
associated w/males, materal DM, multiple gestations, and c-section before onset of labor
immature lungs
deficiency of surfactant

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15
Q

alveoli development

A

20wks- glandular
30wks- saccular
term- alveolar

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16
Q

bronchopulmonary dysplasia

A

> 28 days of O2 therapy in infant >36weeks post mentrual age
alveolar hypoplasia and thickened walls
dysmorphic capillaries and decreasesed VEGF
cytokines (TNF, IL8, etc)
increased and may have role

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17
Q

cystic fibrosis

A

widespread disorder in epi transport affecting fluid secretion in exocrine glands and epi of resp, GI, and repro tracts
viscid secretions
autosomal recessive
CFTR gene chrom 7
most common lethal genetic condition in Caucasians

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18
Q

Dx criteria for CF

A

one or more characteristic phenotypic features or a Hx or CF in sibling or positive newborn screening test
AND
an increased sweat chloride on 2+occasions or 2CFTR mutations or demonstration of abnomral epi nasal ion transport

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19
Q

Tx of CF- pancreas

A

oral pancrelipase

may progress to DM

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20
Q

Tx of CF- vit deficiency

A

oral fat soluble vitamins

parenteral nutrition

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21
Q

Tx of CF- pulomonary

A 
postural drainage and chest percussion
bronchcodilators
mucolytic agents
Antibiotics
hypertonic saline
high dose ibuprofen slows lung disease progression
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22
Q

apparent life threatening event (ALTE)

A

if survive at risk for future respiratory death
prolonged apnea, diminished responses to hypercarbia or hypoxia
often premature or have mechanical disorders leading to compromise
no longer considered true SIDs

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23
Q

atelectatsis

A

incomplete expansion- neonatal
acquired collapse- adults can be due to: resorption/obstruction, compression, or contraction
ALL AT RISK FOR INFECTION

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24
Q

resorption/obstruction atelectasis

A

airway obstruction, mucus, foreign body, tumor

mediastinal shift toward involved lung

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25
Q

compression atelectasis

A

external pressure including elecated diaphragm

mediastinal shift away from involved lung

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26
Q

contraction atelectasis

A

secondary to fibrosis

irreversible

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27
Q

types of pulmonary edema

A

hemodynamic

microvascular

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28
Q

hemodynamic pulmonary edema

A

most common
increased hydrostatic pressure due to left sided heart failure
basal lower lobes
heart failure cells
secondary infections
if chronic leads to alveolar fibrosis (brown lung)

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29
Q

microvascular (alveolar) injury pulmonary edema

A

increased permeability
caused by infection, toxic injry,
if diffuse leads to ARDS

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30
Q

non-cardiogenic pulmonary edema criteria

A

acute onset of dyspnea
hypoxemia
b/l infiltrates
absence of primary left heart failure

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31
Q

non-cardiogenic pulmonary edema etiology

A 
wide spread disorers
injuries 
may be related to mediators such as cytokine, oxidants, TNF, ILs, TGF beta,
susceptibility may be heritable
may progress to ARDS OR AIP
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32
Q

Adult ARDS

A 
shock
rapid onset, life threatening
occurs in patients w/severe disease
diffuse damage to alveolar capillary walls -> neutrophilic migration
secondary loss of surfactant
prothrombotic milieu
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33
Q

infectious conditions associated w/adult ARDS

A

Sepsis
diffuse pulmonary infections
gastric aspiration

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34
Q

physical injury ARDS

A 
mechanical trauma, including head injuries
pulmonary contusions
near-drowning
fractures w/fat emboli
burns
ionizing radiation
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35
Q

inhaled irritants ARDS

A

O2 toxicity
smoke
irritant gases and chemicals (paraquat)

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36
Q

other causes of ARDS

A

cardiac reperfusion injury

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37
Q

ARDS clinical

A 
patients are already ill when ARDS superimposed
rapid onset
profound dyspnea and tachypnea
cyanosis and respiratory failure
diffuse b/l inflitrates
up to 60% fatal
permanent damage
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38
Q

acute interstitial pneumonia (AIP)

A 
symptoms similar to ARDS
no associative causative disorder
59 yrs, M=F
acute respiratory failure following illness 
33-74% mortality rate w/in 2 months
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39
Q

obstructive lung disease

A

limit rate of flow
FEV1/FVC reduces
due to resistance at any level

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40
Q

obstructive lung disease examples

A

COPD, chronic bronchitis, asthma

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41
Q

restrictive lung disease

A

limit total lung capacity and residual volume

near normal flow rates

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42
Q

restrictive lung disease examples

A

chest wall disorders, obesity, ARDS, interstitial fibrosis, penumoconioses

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43
Q

COPD classifications

A

centriacinar/cantrilobular
panacinar/panlobular
distal acinar/paraseptal
irregular/paracicatrical

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44
Q

centriacinar/centrilobular

A

smoking, smoking, smoking

predominately upper lobes/apices

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45
Q

panacinar/panlobular

A

alpha-1 antitrpsin deficiency, smoking

predominately ant/lower lobes

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46
Q

distal acinat/paraseptal

A
  • subpleural and adjacent to septate
  • may be bullous and cause spontaneous penumothrorax in young adults
  • associated w/previous damaged lung
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47
Q

irregular/paracicatrical

A

common, but focal and usually asymptomatic associated w/scarring

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48
Q

proteolytic digrestion of alveolar walls in COPD

A

via neutrophil-secreted elastase

normally inhibited by alpha 1 antitrypsin

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49
Q

COPD clinical

A 
symptoms after 1/3 of lung damaged
barrel chest
low FEV1, high TLC, and RV
pink puffer
bullous emphysema
repsiratory acidosis 
cor pulmonale
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50
Q

COPD Tx

A 
quit smoking
bronchodilators
steroids
bullectomy
 transplant
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51
Q

other conditions w/increased air

A

compensatory hyperinflation
obstructive overinflation
interstitial emphysema

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52
Q

compensatory hyperinflation

A

due to loss of adjacent tissue

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53
Q

obstructive overinflation

A

trapped air
-ball valve obstruction by object
collaterals feeding around obstruction, life threatenting,
alveolar pores of kohn, bronchiloloalveolar canals of lambert
-congenital lobar overinflation from lack of bronchial cartilage

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54
Q

interstitial emphysema

A

any air in inetersitium

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55
Q

chronic bronchitis

A 
clinically defined as 3 mo productive cough/year for 2 consecutive years
smoking, smoking, smoking
hypersecretion of mucus 
increased reid index
brochiolitis obliterans in small airways
superimposed infection
dyspnea and cor pulmonale
blue bloaters
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56
Q

reid index

A

normal <.4
thickness of gland/thickness of walls
hypertrophy of bronchial submucosal glands

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57
Q

age bronchitis vs COPD

A

40-45 VS 50-75

58
Q

dyspnea bronchitis vs COPD

A

mild, late vs severe early

59
Q

cough/sputum bronchitis vs COPD

A

early copious vs late scant

60
Q

infections bronchitis vs COPD

A

common vs occasional

61
Q

resp insufficiency bronchitis vs COPD

A

repeated vs terminal

62
Q

cor pulmonale bronchitis vs COPD

A

common vs rare terminal

63
Q

airway resistance bronchitis vs COPD

A

increased vs normal slightly increased

64
Q

elastic recoil bronchitis vs COPD

A

normal vs low

65
Q

chest radiograph bronchitis vs COPD

A

prominant vessels, large heart vs hyperinflation, small heart

66
Q

appearance bronchitis vs COPD

A

blue bloater vs pink puffer

67
Q

asthma

A

chronic inflammatory disorder of airwyas

reactive airspace disease w/episodic partially reversible bronchoconstriction

68
Q

type I hypersensitivity asthma

A

atopy
begins in childhood
mucosal mast cells react
stimulation of sub epi vagal receptors

69
Q

non-atopic asthma

A

associated w/pulmonary infections and air pollutants
no allergic indicators
infection lowers threshold for vagal response

70
Q

drug induced asthma

A

uncommon form of disease
can also cause urticaria
aspirin classic cause ( inhibit cox 2, but not cox 1 so increases leukotrienes

71
Q

other types of asthma

A

exercise induced

occupational

72
Q

asthma morphology

A 
epi injury
subbasement membrane fibrosis
eos and inflam infiltrates
hypertophy/hyperplasia of submucosal glands and goblet cell metaplasia
hypertrophy/hyperplasia of smooth muscle
increased vascularity
73
Q

Histo markers of asthma

A

charcot-leyden crystals

curschmann spiral

74
Q

bronchiectasis

A

permanent dilation of bronchi and bronchioles

75
Q

causes of brochiectasis

A

tissue distruction secondary to infection

76
Q

symptoms of bronchiectasis

A

foul smelling +/- bloody sputum
dyspnea, orthopnea, rarely severe hemoptosis
may develop cor pulmonale, brain abscesses and amyloidosis

77
Q

brochiectasis associated w/

A 
genetic disorder 
obstruction 
many infections
chronic inflammatory conditions
pulmonary sequestration
allergic bronchopulmonary aspergillosis
autoimmune disorder and post transplant rejection of graft vs host ds
78
Q

genetic disorders and brochiesctasis

A

CF

primary ciliary dyskinesia- kartagener syndrome: male infertility, sinusitis, situs inversus,

79
Q

chronic diffuse interstitial lung diseases

A

restrictive
heterogenous group of disease
inflitrative x-ray changes (reticulonodular or ground glass)
most involve interstiutium and alveolar walls

80
Q

symptoms of chronic diffuse interstitial disease

A 
decreased TLC and RV
dyspnea
tachypnea
cyanosis
end-inspiratory crackles
end-stage- honey comb lung
81
Q

complications of restrictive disease

A

Cor pulmonale

pulmonary HTN

82
Q

fibrosing restrictive diseases

A 
unusual interstitial pneumonia
non-sepcific interstitial pneumonia
cyptogenic organizing pneumonia
CT disease
drug rxns
radation
83
Q

granulomatous restrictive diseases

A

sarcoidosis
hypersensativity pneumonitis
Eosinophillic

84
Q

smoking related restrictive disease

A
  • desquamative interstitial pneumonia

- respiratory broncholitis associated interstitial lung disease

85
Q

other causes of restrictive disease

A

pulmonary langerhands cell histocytosis
pulmonary alveolar proteinosis
lymphoid interstitial pneumonia

86
Q

idopathic pulmonary fibrosis (IPF) aka

A

unusual interstitial pneumonia (UIP)

cryptogenic fibrosing alveolitis

87
Q

IPF

A

unknown pathogenesis
repeated injury to alveolar wall
type I pneumocyte death, type II hyperplasia
inflammation via TH2, fibroblast proliferation, TBFbeta1 collagen deposisition

88
Q

environmental factors IPF

A

smoking
work related exposures
reflux esophagitis

89
Q

clinical IPF

A

insidious unpredictable disease in middle age >50
dyspnea, dry cough, hypoxemia w/cyanosis, digital clubbing
mean survival <3yrs

90
Q

pathology IPF

A

repeated cycles of alveolitis
healing/scarring -> patchy interstitial fibrosis
predominently subpleural/interlobular and lower lobe
end state: honey comb

91
Q

Tx IPF

A

lung transplant

92
Q

Non-specific interstitial penumonia (NSIP)

A

patients do not get as sick or progressive as IPF

better prognosis then IPF

93
Q

symptoms of NSIP

A

dyspnea and cough for months
middle ages w/milder sympotms
non-smoking females

94
Q

NSIP histo

A

all lesions at same stage

95
Q

cryptogenic organizing pneumonia (COP) aka

A

bronchiolitis obliterans organizing pneumonia (BOOP)

96
Q

COP

A

unknown by etiology
organizing penumonia in which all CT is of same age and no interstitial fibrosis
does not progress to honeycomb

97
Q

COP symptoms

A

cough

dyspnea

98
Q

COP Tx

A

oral steroid >6months

99
Q

collagen vascular disorder-related lung disease associated disorder

A 
RA
sclerederma
SLE
sjogren syndrome
polymyositis/dermatomyositis
mixed CT disorder
100
Q

caplan syndrome

A

RA and pneumoconiosis

101
Q

coal dust diseases

A

antrhacosis
macules
progressive massive fibrosis
caplan syndroe

102
Q

silica

A

silicosis

caplan syndrome

103
Q

asbestos

A 
asbestosis
pleural plaques
caplan syndrome
mesothelioma
carcinoma of lung, larynx, stomach, colon
104
Q

beryllium

A

acute berylliosis
berylium granulomatosis
lung carcinoma

105
Q

iron oxide

A

siderosis

106
Q

barium sulfate

A

baritosis

107
Q

tin oxide

A

stannosis

108
Q

coal workers pneumoconiosis (CWP)

A 
asymptomatic antracosis
simple CSP
complicated CWP
pathogenesis poorly understood
no increased risk of TB or CA
109
Q

simple CWP

A

coal macules and nodules +/- centirlobular emphysema

usually benign

110
Q

complicated CWP

A 
w/progressive massive fibrosis
scars >2cm
pulmonary dysfunction
pulmonary HTN
Cor pulmonale
111
Q

silicosis

A

currently most prevalent chronic occupational disease in the world
slowly progressive over decades
silica ingested by macros and it kills the macros
inflammation w/release of TNF -> activated fibroblasts
2x increased chance for CA
more susceptible to TB

112
Q

asbestos related disease

A 
pleural effusions
pleural plaques or diffuse pleural fibrosis
asbestosis 
lung cancer (5x increased chance)
mesothlioma
113
Q

asbestosis

A

fibrotic lung disease begins in lower lobes and subpleurally
dyspnea followed by productive cough

114
Q

asbestos on histo

A 
asbestos bodies (absent in pleural plaques)
stains prussian blue b/c of iron
115
Q

bleomycin

A

pneumonitis and fibrosis

116
Q

methotrexate

A

hypersensitivity pneumonitis

117
Q

amiodarone

A

pneumonitis and fibrosis

118
Q

nitrofurantoin

A

hypersensitivity penuomnitis

119
Q

aspirin

A

bronchospasm

120
Q

beta agonists

A

brochospams

121
Q

radiation pneumonitis

A

acute- 10-20% w/in 6 months of radiation

chronic- pulmonary fibrosis

122
Q

sarcoidosis

A

numerous non-caseating granumpomas
increased CD4, IL2, and cytokines
genetic factors
diagnosis of exclusion

123
Q

sarcoidosis location

A 
can occur anywhere including CNS
pulmonary >eye > skin
b.l pulmonary lymphadeopathy or lung disease
spleen and liver in 3/4
W>M
US black >>>whites, rare in chinese
124
Q

sarcoidosis recovery

A

65-70% full recovery
20% permanent loss of lung fnx
10-15% progress to pulmonary failure or death
hilar LN better prognosis then LN+lung infiltrates

125
Q

ACE converting enzyme

A 
elevated in:
sarcoidosis
leprosy
gaucher disease
primary biliary cirrhosis and amyloidosis
126
Q

sarcoidosis histo

A

noncaseating sub epi granulomas
multinucleated giant cells
asteroid body
schaumann body

127
Q

hypersensativity pneumonitis aka

A

extrinsic allergic alveolitis

128
Q

farmers lung

A

moldy hay

micropolyspora faeni

129
Q

bagassosis

A

moldy pressed sugar cane

thermophilic actinomycetes

130
Q

humidifier lung

A

cool-mist humidifier
thermophilic actinomycetes
aurobasidium pullulans

131
Q

pigeon breeers lung

A

pigeon serum proteins in droppings

132
Q

interstitial lung diseases

A

desquamative interstitial pneumonia
respiratory bronchiolitis-associated interstitial lung disease (RBILD)
eosinopilic granuloma

133
Q

DIP

A 
large collections of smokers macrophages in alveoli
minimal fibrosis
>50
M>>F
dyspnea
steroids and cessation of smoking
134
Q

RBILD

A 
common lesion in smokers (30+pack years)
pigmented macros in bronchiles
peribronchiolar fibrosis
usually mild may have dyspnea and cough
regresses w/cessation of smoking
135
Q

eosinophilic granuloma aka

A

pulmonary langerhans cell histocytosis

136
Q

eosinophilic granuloma

A

proliferation of dendritic cells in response to smoking
usually polyclonal and felt to be reactive hyperplasia
regresses w/cessation of smoking
expresses CD1z, S-100, CD207

137
Q

pulmonary alveolar proteinosis

A

uncommon

cough and sputum w/gelatinous chunks

138
Q

pulmonary alveolar proteinosis histo

A

accumulation of acellular surfactant in intra-alveolar and bronchiolar spaces

139
Q

pulmonary alveolar proteinosis classes

A

autoimmune/acquired
secondary
hereditary/congenital

140
Q

autoimmune pulmonary alveolar proteinosis

A

90%
20-50
Ab to GM-CSF
recurs after transplantation

141
Q

secondary pulmonary alveolar proteinosis

A

rare, many lung disorders, immunodeficiency syndromes, malignancy, and blood disorders

142
Q

hereditary pulmonary alveolar proteinosis

A

rare, genetic, fatal

Resp II (15 decks)

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