,mn,mn Flashcards
*****What stereotype characterizes Chronic Bronchitis?
Blue Bloaters:
• Overweight and Cyanotic people with Elevated Hbg (because they’re hypoxic) peripheral edema and rhonchi and wheezing.
*****What disease is characterized by pink puffers?
• why do we call them pink puffers?
Emphysema = pink puffers
• Older and Thin (because they burn so much energy breathing) with severe dyspnea and quiet chest sounds
*****Differentiate the methods of Dx for chronic bronchitis and emphysema.
Chronic Bronchitis:
• CLINICAL dx. characterized by 3 mo. of daily productive cough for 2 consecutive years
Emphysema:
• PATHOLOGIC dx. characterized by destruction of the airspace distal to the terminal bronchioles
**Why would you seen an abundance of the cells pointed out by the black arrows?
Black arrows:
• Type II pneumocytes: these are hobnail shaped and are seen in abundance following destruction of type I pneumocytes
*****What are Clara Cells and what is their role in the lungs?
• where are they found?
Clara cells = CLUB CELLS - these are dome shaped cells with short microvilli found in small airways (BRONCHIOLES) of the lungs
ROLE: PROTECTION
**What is being pointed out by the back arrows in this electron microscopy image?
Surfactant - Lamellar Bodies - that are found in type II pneumocytes
**What most likely accounts for the changes seen in the cells on the left and on the right?
• what cells are being pointed out?
Left side reprsents alveolar macrophages in someone who is a non-smoker while the right side shows a crack cocaine user note the increased number of particles in the macrophages
*ANY PARTICLE this is 1-5µm in size have the potential to make it to an alveolus
What are the 3 types of Atelectasis?
• differentiate their common causes.
• which way does the mediastinum shift in response?
3 types = Resorption, Compression, Contraction
Resorption:
• Airway obstruciton by mucous plugs or tumor, this acts as a valve that allows air out but not back in leading to suction so the mediastium shifts toward the affected side
Compression:
•Filling of pleural cavity bytumor, blood, air,this acts tocompression of tissuepushing the mediastinumaway from the affected side.
Contraction:
•Fibrotic lung pleura this is just a shrinking of the lung tissue there is no mediastinal shift
**Which of these phenomena is irreversible?
Contraction - caused by fibrosis is irreversible
**What is happening here?
Resorption Atelectasis - a tumor affecting the right mainstem bronchus has resulted in markedly reduced right lung volume and rightward mediastinal shift
**what is happening here?
compression atelectasis - left pneumothorax from chest wall trauma is resulting in left lung collapse and right mediastinal shift
What is the only Obstructive lung disease that is caused by loss of elastic recoil of the lung?
Emphysema, all of the others (chronic bronchitis, asthma, and bronchietasis) result from airway obstruction and narrowing
# Define Emphysema? • is fibrosis typically a feature of this disease?
Emphysema:
• Abnormal permanent enlargement of airspaces accompanied by destruction of their walls
• Fibrosis is not a significant feature of emphysema
A previously healthy young adult man pressents with unknown respiratory disease developes spontaneous pneumothorax. Biopsy indicates a type of underlying obstructive disease. What is this diseas?
PARASEPTAL emphysema - causes pneumothorax in young adults
Differentiate locations and causes of centriacinar and panacinar emphysema.
Centriacinar:
• Typically found in heavy smokers => causes XS inflammation and overactivation of proteases
• Predominates in the upper lobes
Panacinar:
• Associated the A1AT deficiency => is not present to prevent proteases from breaking down our own tissue
• Found in the lower lobes
*****What do you expect to see on the liver biopsy of a patient with A1AT deficiency?
- what causes this appearance?
- Genetics of this person?
Liver biopsy shows pink PAS positive hyaline globules that results from misfolded A1AT accumulating in the endoplasmic reticulum of hepatocytes - notice red blobs
What disease is a person with a PiMZ mutation at risk of developing?
• what factors would increase their risk of developing disease?
This is a mutant heterozygote for A1AT deficiency.
• these patients are asyptomatic unless they smoke
**Remember Z indicates mutation - homozygote = PiZZ => they will have disease
*****T or F: Centriacinar Emphysema affects alveolar ducts only.
False, Respiratory bronchioles are most affected - the smoke doesn’t make it to the alveolar ducts
**What is wrong in this CXR?
Nothing - this is a normal CXR
**What are some important characteristics to notice in this CXR?
• dz?
Retrosternal Airspace - is not normal - heart should be close to the sterum
Flattening of the Diaphragm - also not good
**What is the most likely etiology of the lung disease shown here?
Emphysema - this person was most likely a smoker
**What disease is shown here and how do you know?
centriacinar emphysema - central portion of acinus (where arrows are pointing) has abnormally large airspaces with club-shaped alveolar septa that appear to be floating
**What obstructive disease does this person most likely have/
Panacinar Emphysema caused by A1AT defieciency (PiZZ) causing LOWER LOBE tissue destruction
**What do you suspect caused this obstructive disease?
A1AT - Panacinar - destruction of these alveoli is fairly uniform
What part of the alveoli is affected in paraseptal emphysema?
Alveolar Ducts and Alveoli themselves
**What did this person most likely die of?
• Predisposing factor?
• Shown here is a ruptured bullae that is likely the result of a ruptured bled causing pneumothroax
• Paraseptal emphysema is likely the cause - happens in young adults
**What pathology is seen here?
• Cause?
Paraseptal Emphysema: DISTAL airspaces show marked dilation
What 4 key histologic features should you look for to see if a patient’s lung biospy is consistent with Chronic Bronchitis?
- Submucosal gland hypertrophy of large airways increased Reid Index
- Increase goblet cells in smaller airways
- Chronic LYMPHOCYTIC airway inflammation
- Peribronchial fibrosis
**What is the problem with this bronchiole?
Mucosal Gland hypertrophy - indicative, but NOT DIAGNOSTIC of chronic bronchitis
Reid Index definitely exceeds 0.4
**What key feature of chonic bronchitis is the red arrow pointing to?
• Name the other 3 key features.
Lymphocytic infiltrate surrounding the bronchial epithelium - notice these are plasma cells as determined by the perinuclear hof
Other Features:
• Increased numbers of Goblet Cells
• Mucous Gland Hyperplasia
• Parabronchial Fibrosis
What are the 2 different types of Asthma?
• differentiate between these.
Extrinsic:
• Type I (IgE) hypersensitivity reaction to inhaled allergen
Intrinsic:
• Non-immunologic reaction - precipitated by respiratory tract infection, stress, exercise, cold, drugs.
**What key feature of chronic bronchitis is shown here?
• Increased goblet cells
What gross features do you expect to see in a lung from a person suffering from Asthma?
• Microscopic features?
Asthma:
Gross:
• Overinflation and Mucous plugs
Microscopic:
• Thickened Basement Membrane
• Submucosal gland hypertrophy
• Bronchial wall smooth muscle hypertrophy
• Eosinophil-rich inflammatory infiltrate
**The picture shown here is characteristic of what obstructive pulmonary disorder?
• Why?
Asthma - mucous plug in a bronchus
**What 3 features should you notice in this bronchus?
• what obstructive disease is this indicative of?
3 Key Histologic Features:
• Bronchial Epithelium is desquamated
• Thickening of Basement membrane
• Eosinophilic Inflammation
**This mucous sample shows a microscopic appearance characterisitic of what COPD?
• Charcot-Leyden crystals seen here are the result of eosinophil degradation and are seen in asthmatics
**This microscopic finding is indicative of what COPD?
• Curschmann Spirals are indicative of Asthma
Histologic finding in a patient look much like asthma including eosinophilic infiltrates, but the patient’s physician and medical records never indicate any history of asthma.
• what should be in your differential?
• What causes this disease?
Eosinophlic Bronchitis:
• these patients do not have recurrent episodes of wheezing, shortness or breath, and coughing
• DO NOT respond ot BRONCHODILATORS
• Cause: ideopathic or secondary to infections, drug administration or immunologic diseases
What causes bronchiectasis?
• Repeated cycles of airway OBSTRUCTION AND INFLAMMATION
What obstructive lung disease is associated with defective dyenin arms?
• Bronchietasis results from obstruction and inflammation that is repeated in Kartagener’s because these people have ineffective cilia and are also often infertile
What 2 bugs often cause necrotizing pneumonia that can sometimes lead to bronchiectasis?
• Staph. Aureus
• Mycobacteria
**What genetic mutation could lead to the disease shown here?
- ∆F508 - Chromosome 7 - cystic fibrosis
- or Dyeinin defect in Kartagener’s
**What is the white stuff between the bronchioles in this patient that had bronchietasis?
FIbrosis
**What is seen in this histiologic specimen?
Bronchietasis - alveoli appear relatively normal but there is pus (neutrophils) in the airway - other than the huge fibrotic airway, the alveoli appear pretty normal
*****What causes tracheoesophageal fistula?
Failure of hte fetal respiratory tract to separate from the GI tract from which it derives.
When is the saccular stage of lung development?
• why is this important?
26-32 weeks - fetal lungs develope type I and type II alveolar cells and begin making SURFACTANT
