Patterns of Lung Injury (Path)

Question 1

Describe the normal morphology of reparatory epiethlium

Answer 1

psuedostratifed epithelium with cilia

Question 2

Contrast acute v. chronic patterns of lung injury.

Answer 2

acute: inflammation (neutrophils), edema/pleural effusion,, acute lung injury (ARDS/DAD) pulmonary hemorrhage (due to infarct or vasculitis)
chronic: inflammation (lymphocytes/macrophages) and fibrosis, emphysema

Question 3

Describe the associated pathogen with acute, chronic, granulamatous, or eosinophillic inflammation

Answer 3

acute (neutrophils) associated with bacterial infection or infarct
chronic (lymphs) due to viral or chronic infection
granulomatous: TB, fungal, sarcoid, foreign body, HP
eosinophillic: parasitic infection

Question 4

Describe how an abscess is histologically different from pneumonia infiltrate?

Answer 4

abscess is walled of, there is loss of parenchymal structures, localized infection

Question 5

Describe granulomatous inflammation and its causes?

Answer 5

granolas are sub-acute or chronic accompanied by giant cells and lymphocytes

can be cause by foreign body and immune reaction, note that sarcoidosis (bland and ‘naked’) and TB (caveating granulmas) have slightly different morphology

Question 6

What are the crystalline foreign bodies likely caused by if found in the lung?

Answer 6

talc, visible under polarized light; usually associated with injection drug use

Question 7

Define sarcoidosis.

Answer 7

multi organ granlomatous disease of unknown etiology, which frequently affects the lungs but also commonly involves lymph nodes, liver, spleen, skin heart, eye and other organs
granulomas are non-caseating

Question 8

Give the top 3 fungal- yeast causes of pneumonia and what are their distinguishing factors?

Answer 8

Histoplasma capsulatum: small yeast with narrow based budding
Blastomyces dermatitis: big yeast with broad based budding
Coccidioides immunities: spherules with endospores (CA)

note all fungi lead to necrotizing granulomatous inflammation

Question 9

Describe the two types of fungi hyphea that can most commonly cause lung disease.

Answer 9

aspergillis: branches at 45 degree angles (think of A) septated hyphea
mucor: branches at 90 degrees, non-septated hyphae (folded ribbon appearance)

Question 10

What type of disease might include caseous necrosis.

Answer 10

caseous necrosis of TB

Question 11

What stains would you use to identify TB and fungals.

Answer 11

Acid fast- nocardia and TB

GMS (silver based) stain used to see fungals

Question 12

Hypersensitivity pneumonitis is an immune response to inhaled antigen, analogous to asthma that occurs in interstitial area, only this disease is in the airways. Name three common types and their source of infection.

Answer 12

Farmer’s lung- thermophilic actinomyces
Pigeon Breeders lung- avian proteins in poop
Humidifier (or air-conditioner) lung- bacteria

Question 13

Granuloma formation is consistent with which type of hypersensitivity reaction.

Answer 13

type IV

Question 14

Name the three major obstructive lung diseases.

Answer 14

COPD: emphysema and chronic bronchitis
Asthma
Bronchiectasis

Question 15

Emphysema results in irreversible enlargement of airspaces distal to the _____ _____ and destruction of alveoarl walls without obvious _______ .

Answer 15

distal to the terminal bronchioles
without obvious fibrosis

remember smoking damage occurs in a central pattern and the resulting inflammation can cause an increase in protease activity

Question 16

Contrast the location of emphysema due to smoking v. alpha-antitrypsin deficiency.

Answer 16

smoking is centriacinar while alpha-1 antitrypsin deficiency is panacinar.

Question 17

What is bullous emphysema and what are some of its possible complications?

Answer 17

emphysema that results in large distended air sacs which can rupture and cause pneumothorax