Pathology - Obstructive Lung Diseases

Question 1

What’s up wit it?

Is this an example of a fixed, or a functional obstruction?

Answer 1

Carcinoid tumor - fixed obstruction

Question 2

What is this and what disease is it associated with?

Answer 2

Curschmann spiral - seen in the sputum of an asthma patient

Question 3

What type of inflammatory cell is the predominant inflammatory cell seen in histologic sections of conducting airways in an asthma patient?

Answer 3

Eosinophils

Question 4

What is the major histologic finding seen in a cross-section of a bronchiole of a patient with asthma?

Answer 4

Smooth muscle hypertrophy and hyperplasia

Question 5

What is your Dx?

Answer 5

Asthma

Question 6

What’s your Dx?

Answer 6

Asthma

Question 7

What is your Dx?

Answer 7

Chronic bronchitis

Question 8

What is the role of neutrophils in the pathogenesis of emphysema and how does smoking contribute to the development of the disease?

Answer 8

They make elastase, which destroys elastic fibers in the lungs. This protease is normally inhibited by alpha-1-antitrypsin, but smoking inactivates antitrypsin.

Question 9

What is your Dx?

Answer 9

Emphysema

Question 10

Aside from inactivating alpha-1–antitrypsin, smoking can damage tissues in the lungs through what other mechanism?

Answer 10

Reactive oxygen species

Question 11

What are the two types of emphysema? What causes each?

Answer 11

Centrilobular - caused by smoking

Panacinar - caused by a genetic mutation (or genetic mutation + smoking)

Question 12

In which region of the lungs would one find alveolar destruction in a patient with centrilobular emphysema, and in a patient with panacinar emphysema, respectively?

Answer 12

Centrilobular emphysema typically affects the upper lobes

Panacinar either affects the bases or the entire lung uniformly

Question 13

Which section of the airways (bronchi, terminal bronchiole, respiratory bronchiole, etc.) is affected by centrilobular and panacinar emphysema, respectively?

Answer 13

Centrilobular destroys and dilates the respiratory bronchioles

Panacinar destroys and dilates the alveolar ducts and alveoli

Question 14

What is your Dx?

Answer 14

Centrilobular emphysema

Question 15

Name the structure at the tip of the arrow. What disease is this?

Answer 15

Terminal bronchiole (it’s spared) - centrilobular emphysema

Question 16

What is your Dx?

Answer 16

Centrilobular emphysema

Question 17

What is the etiology of this disease?

Answer 17

Panlobular emphysema - genetic etiology (alpha-1-antitrypsin deficiency)

Question 18

What genotype causes most forms of alpha-1-antitrypsin deficiency? Which genotype makes a smoker susceptible to panacinar emphysema?

Answer 18

PiZZ causes most forms (very little A1-AT)

PiMZ smokers can get panacinar emphysema

Question 19

The loss of ________ ________ is the primary reason why the conducting airways collapse upon exhalation in patients with emphysema.

Answer 19

loss of radial traction

Question 20

What is bronchiectasis and what causes it?

Answer 20

Permanent dilation of the bronchi from chronic infection or inflammation leading to necrosis of the bronchial wall.

Question 21

Name five conditions that can make a person susceptible to bronchiectasis.

Answer 21

1. Bronchial obstruction (like a tumor, foreign body)
2. Chronic sinusitis
3. Post nasal drip
4. Infection
5. Genetic diseases: CF, Kartagener’s

Question 22

What is your Dx? A picture of a normal lung is on the left.

Answer 22

Bronchiectasis

Question 23

What is your Dx?

Answer 23

Bronchiectasis

Question 24

Bronchiectasis usually occurs in which portion of the lung (upper, middle, lower) in patients with CF?

Answer 24

Upper

Question 25

The main factor in the development of bronchiectasis is abnormal…?

Answer 25

abnormal airway clearance