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Pulmonary - Pathology > Obstructive Lung Diseases > Flashcards

Obstructive Lung Diseases Flashcards

1
Q

*****What stereotype characterizes Chronic Bronchitis?

A

Blue Bloaters:
• Overweight and Cyanotic people with Elevated Hbg (because they’re hypoxic) peripheral edema and rhonchi and wheezing.

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2
Q

*****What disease is characterized by pink puffers?
• why do we call them pink puffers?

A

Emphysema = pink puffers
• Older and Thin (because they burn so much energy breathing) with severe dyspnea and quiet chest sounds

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3
Q

*****Differentiate the methods of Dx for chronic bronchitis and emphysema.

A

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

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4
Q

**Why would you seen an abundance of the cells pointed out by the black arrows?

A

Black arrows:
• Type II pneumocytes: these are hobnail shaped and are seen in abundance following destruction of type I pneumocytes

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5
Q

*****What are Clara Cells and what is their role in the lungs?
• where are they found?

A

Clara cells = CLUB CELLS - these are dome shaped cells with short microvilli found in small airways (BRONCHIOLES) of the lungs

ROLE: PROTECTION

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6
Q

**What is being pointed out by the back arrows in this electron microscopy image?

A

Surfactant - Lamellar Bodies - that are found in type II pneumocytes

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7
Q

**What most likely accounts for the changes seen in the cells on the left and on the right?
• what cells are being pointed out?

A

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

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8
Q

What are the 3 types of Atelectasis?
• differentiate their common causes.
• which way does the mediastinum shift in response?

A

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

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9
Q

**Which of these phenomena is irreversible?

A

Contraction - caused by fibrosis is irreversible

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10
Q

**What is happening here?

A

Resorption Atelectasis - a tumor affecting the right mainstem bronchus has resulted in markedly reduced right lung volume and rightward mediastinal shift

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11
Q

**what is happening here?

A

compression atelectasis - left pneumothorax from chest wall trauma is resulting in left lung collapse and right mediastinal shift

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12
Q

What is the only Obstructive lung disease that is caused by loss of elastic recoil of the lung?

A

Emphysema, all of the others (chronic bronchitis, asthma, and bronchietasis) result from airway obstruction and narrowing

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13
Q 
# Define Emphysema? 
• is fibrosis typically a feature of this disease?
A

Emphysema:
• Abnormal permanent enlargement of airspaces accompanied by destruction of their walls

• Fibrosis is not a significant feature of emphysema

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14
Q

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?

A

PARASEPTAL emphysema - causes pneumothorax in young adults

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15
Q

Differentiate locations and causes of centriacinar and panacinar emphysema.

A

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

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16
Q

*****What do you expect to see on the liver biopsy of a patient with A1AT deficiency?

  • what causes this appearance?
  • Genetics of this person?
A

Liver biopsy shows pink PAS positive hyaline globules that results from misfolded A1AT accumulating in the endoplasmic reticulum of hepatocytes - notice red blobs

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17
Q

What disease is a person with a PiMZ mutation at risk of developing?
• what factors would increase their risk of developing disease?

A

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

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18
Q

*****T or F: Centriacinar Emphysema affects alveolar ducts only.

A

False, Respiratory bronchioles are most affected - the smoke doesn’t make it to the alveolar ducts

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19
Q

**What is wrong in this CXR?

A

Nothing - this is a normal CXR

20
Q

**What are some important characteristics to notice in this CXR?
• dz?

A

Retrosternal Airspace - is not normal - heart should be close to the sterum

Flattening of the Diaphragm - also not good

21
Q

**What is the most likely etiology of the lung disease shown here?

A

Emphysema - this person was most likely a smoker

22
Q

**What disease is shown here and how do you know?

A

centriacinar emphysema - central portion of acinus (where arrows are pointing) has abnormally large airspaces with club-shaped alveolar septa that appear to be floating

23
Q

**What obstructive disease does this person most likely have/

A

Panacinar Emphysema caused by A1AT defieciency (PiZZ) causing LOWER LOBE tissue destruction

24
Q

**What do you suspect caused this obstructive disease?

A

A1AT - Panacinar - destruction of these alveoli is fairly uniform

25
Q

What part of the alveoli is affected in paraseptal emphysema?

A

Alveolar Ducts and Alveoli themselves

26
Q

**What did this person most likely die of?
• Predisposing factor?

A

• 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

27
Q

**What pathology is seen here?
• Cause?

A

Paraseptal Emphysema: DISTAL airspaces show marked dilation

28
Q

What 4 key histologic features should you look for to see if a patient’s lung biospy is consistent with Chronic Bronchitis?

A
  • Submucosal gland hypertrophy of large airways increased Reid Index
  • Increase goblet cells in smaller airways
  • Chronic LYMPHOCYTIC airway inflammation
  • Peribronchial fibrosis
29
Q

**What is the problem with this bronchiole?

A

Mucosal Gland hypertrophy - indicative, but NOT DIAGNOSTIC of chronic bronchitis

Reid Index definitely exceeds 0.4

30
Q

**What key feature of chonic bronchitis is the red arrow pointing to?
• Name the other 3 key features.

A

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

31
Q

What are the 2 different types of Asthma?
• differentiate between these.

A

Extrinsic:
• Type I (IgE) hypersensitivity reaction to inhaled allergen

Intrinsic:
• Non-immunologic reaction - precipitated by respiratory tract infection, stress, exercise, cold, drugs.

32
Q

**What key feature of chronic bronchitis is shown here?

A

• Increased goblet cells

33
Q

What gross features do you expect to see in a lung from a person suffering from Asthma?
• Microscopic features?

A

Asthma:

Gross:
• Overinflation and Mucous plugs

Microscopic:
• Thickened Basement Membrane
• Submucosal gland hypertrophy
• Bronchial wall smooth muscle hypertrophy
• Eosinophil-rich inflammatory infiltrate

34
Q

**The picture shown here is characteristic of what obstructive pulmonary disorder?
• Why?

A

Asthma - mucous plug in a bronchus

35
Q

**What 3 features should you notice in this bronchus?
• what obstructive disease is this indicative of?

A

3 Key Histologic Features:
• Bronchial Epithelium is desquamated
• Thickening of Basement membrane
• Eosinophilic Inflammation

36
Q

**This mucous sample shows a microscopic appearance characterisitic of what COPD?

A

• Charcot-Leyden crystals seen here are the result of eosinophil degradation and are seen in asthmatics

37
Q

**This microscopic finding is indicative of what COPD?

A

• Curschmann Spirals are indicative of Asthma

38
Q

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?

A

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

39
Q

What causes bronchiectasis?

A

• Repeated cycles of airway OBSTRUCTION AND INFLAMMATION

40
Q

What obstructive lung disease is associated with defective dyenin arms?

A

• Bronchietasis results from obstruction and inflammation that is repeated in Kartagener’s because these people have ineffective cilia and are also often infertile

41
Q

What 2 bugs often cause necrotizing pneumonia that can sometimes lead to bronchiectasis?

A

• Staph. Aureus

• Mycobacteria

42
Q

**What genetic mutation could lead to the disease shown here?

A
  • ∆F508 - Chromosome 7 - cystic fibrosis
  • or Dyeinin defect in Kartagener’s
43
Q

**What is the white stuff between the bronchioles in this patient that had bronchietasis?

A

FIbrosis

44
Q

**What is seen in this histiologic specimen?

A

Bronchietasis - alveoli appear relatively normal but there is pus (neutrophils) in the airway - other than the huge fibrotic airway, the alveoli appear pretty normal

45
Q

*****What causes tracheoesophageal fistula?

A

Failure of hte fetal respiratory tract to separate from the GI tract from which it derives.

46
Q

When is the saccular stage of lung development?
• why is this important?

A

26-32 weeks - fetal lungs develope type I and type II alveolar cells and begin making SURFACTANT

Pulmonary - Pathology (8 decks)

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