Pulm pathology prt 2

Question 1

Pleuritic pain is caused by an irritated ___ nerve

Answer 1

Phrenic

(C3-4-5) referred to shoulder

Question 2

Patients with ___ are at increased risk for lung abscess due to the aspiration of oral flora during periods of unconsciousness.

Answer 2

alcohol use disorder

Question 3

The main pathogens of aspiration induced lung abscess are ____ of the oral flora

Answer 3

strict and facultative anaerobic

(Bacteroides, Prevotella, Fusobacterium, Peptostreptococcus).

Question 4

Manifestations include subacute fever, cough, and foul-smelling sputum.

Answer 4

aspiration induced lung abscess

Question 5

Lobar pneumonia is marked by the cytokine-mediated accumulation of neutrophils and _____ material in the alveoli. Over several days, the material becomes fibrinous.
neutrophils are replaced by macrophages, and macrophages digest the fibrinous exudate,
thereby restoring normal lung histology.

Answer 5

proteinaceous

Question 6

bilateral "Velcro"-sounding crackles
Reticular nodular (bright, branching, lines) opacities

Answer 6

Pulmonary fibrosis

Question 7

Lung parenchyma inflammation

Aspiration of gastric acid with direct tissue injury

Answer 7

chemical pneumonitis

Question 8

Periods of altered consciousness (alcoholism, seizures, dementia)

Impaired swallowing (nasogastric tube, dysphagia)

Periodontal disease, particularly gingivitis

Increased risk for

Answer 8

Lung abscess from microaspiration

Question 9

fever, cough productive of copious sputum (often foul-smelling), and chest x-ray evidence of cavitation with air-fluid level.

Answer 9

Lung abscess
(microaspiration, untreated pneumonia)
NEUTROPHILS MEDIATE Liquifying necrosis

Question 10

has a propensity to affect older adults with chronic lung disease who smoke.

It causes high fever, diarrhea, headache, and confusion.

It is a non-staining gram-negative rod diagnosed by PCR

Answer 10

Legionella pneumophila

Question 11

triad of respiratory distress, neurologic dysfunction, and petechial rash that characterizes the condition

Answer 11

Fat Embolism

Recent trauma

Question 12

syndrome commonly presents with chronic fatigue, dyspnea, and difficulty concentrating.

Answer 12

Obesity hypoventilation

*OHS results from physical restriction of lung expansion by excessive thoracic tissue mass. Low TV

Question 13

Loss of intrapleural negative pressure (pneumothorax) causes the chest wall to spring outward & inspiratory compliance is

Answer 13

decreased

*Hemithorax increases in volume

Question 14

Age-related changes to the respiratory system include decreased chest wall compliance and ____ alveolar elastic recoil with resulting alveolar enlargement and air trapping.

Answer 14

decreased

Question 15

Malignancies like adenocarcinoma can cause Pleural effusion due to increased vascular permeability or ___

Answer 15

*Lymphatic obstruction

Thoracentesis yields fluid with a large number of red blood cells and numerous atypical cells staining positive for mucin

Question 16

Pleural fluid normally enters the pleural space via intercostal microvessels of the parietal pleura, and exits the pleural space via

Answer 16

parietal pleura lymphatics.

*Visceral pleural fluid comes from bronchial microvessels

Question 17

Autosomal dominant mutations impairing TGF-β signaling

Disrupted angiogenesis & loss of vascular integrity causing VASCULAR malformation

Answer 17

Hereditary Hemorrhagic Telangiectasia

Question 18

telangiectasia
Recurrent nose bleeds
Visceral organ Vascular Malformation:
gastrointestinal tract (bleeding), lung (hemoptysis), brain (hemorrhagic stroke), liver

Complications
High-output heart failure
Pulmonary hypertension
Paradoxic embolism
Iron deficiency anemia

Answer 18

Hereditary Hemorrhagic Telangiectasia

Question 19

In the lungs, the binding of O2 to hemoglobin drives the release of ____(2) from hemoglobin (Haldane effect).

Answer 19

H+ and CO2

Question 20

In the _____ tissues, high concentrations of CO2 and H+ facilitate O2 unloading from hemoglobin (Bohr effect).

Answer 20

peripheral

Question 21

Ciliated epithelium persists up to and ends at the respiratory

Answer 21

bronchioles

(Proximal bronchioles → Terminal → Respiratory bronchioles) PTR

Question 22

Terminal bronchiles have ciliated epithelium, serous glands, and

Answer 22

club cells

Question 23

After terminal bronchioles are RESPIRATORY bronchioles which have only ciliated cells, club cells and

Answer 23

Macrophages

*next comes alveoli which also have MQs

Question 24

Patients who are upright tend to aspirate into the ___ segments of the lower lobes.

Answer 24

basilar

Question 25

Supine patients typically aspirate into the ___ segments of the upper lobes and ____ segments of the lower lobes.

Answer 25

posterior

superior

Question 26

Ventilation is lowest in the ___ and highest in the ___ because gravity acts to stretch the lungs downward so that the alveoli at the apex are expanded more than those at the base

Answer 26

apex

base

Question 27

Perfusion is also lowest in the ___ and highest in the ___, as the increased hydrostatic pressure in the lower lung regions facilitates increased blood flow.

Answer 27

apex

base

Question 28

increased extraction of oxygen by skeletal muscle results in _____ mixed venous oxygen content

Answer 28

decreased

Question 29

IL-4 causes

Answer 29

IgE production

Question 30

IL-5 causes

Answer 30

Eosinophil recruitment

Question 31

bronchoconstriction is mediated by the ___ nervous system when the vagus nerve is stimulated (via an inhaled irritant)

Answer 31

parasympathetic

Question 32

Supplemental oxygen administration in patients with chronic obstructive pulmonary disease can lead to increased CO2 retention (oxygen-induced hypercapnia), resulting in confusion and depressed consciousness. The major cause is reversal of hypoxic pulmonary vasoconstriction, which increases physiologic dead space as blood is shunted away from well-ventilated alveoli.

Answer 32

Arterial partial pressure of carbon dioxide (PaCO2) is the major stimulator of respiration in healthy individuals; even a slight increase in PaCO2 stimulates central chemoreceptors and triggers increased ventilation. In patients with chronic obstructive pulmonary disease, the response to PaCO2 is blunted and hypoxemia can contribute to respiratory drive. Peripheral chemoreceptors are primarily responsible for sensing arterial partial pressure of oxygen (PaO2) and can be suppressed with oxygen administration causing hypoventilation

Question 33

Patients with severe emphysema typically have chronic ____ leading to chronic respiratory acidosis with metabolic compensation and hypoxemia

Answer 33

CO2 retention

Question 34

is the predominant substance contained within eosinophilic granules, and it acts as a potent toxin against helminths (parasitic worms).

Answer 34

Major basic protein

Question 35

Aspirin/NSAIDs
Nonselective beta blockers
Upper respiratory infection
Exercise & cold, dry air
Gastroesophageal reflux disease
can cause

Answer 35

Asthma exacerbation

eosinophilia

Question 36

is a major problem in lung transplant recipients; it affects small airways, causing bronchiolitis obliterans. It is characterized by lymphocytic inflammation, fibrosis, and, ultimately, destruction of the bronchioles.

Answer 36

Chronic rejection

Question 37

Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, and patchy squamous metaplasia of the bronchial mucosa are features of

Answer 37

chronic bronchitis

Question 38

Exposure to high temperature or exercise can lead to hyponatremia and hypochloremia due to excessive sodium chloride loss through sweat; therefore, salt supplementation is recommended.

Answer 38

Cystic Fibrosis

Question 39

Vitamin A maintains orderly differentiation of specialized epithelia, including the mucus-secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tracts, and pancreatic and other exocrine ducts. Avitaminosis A can cause squamous metaplasia of such epithelia to a keratinizing epithelium.

Answer 39

Cystic Fibrosis causing Pancreatic Problems

Question 40

This neonate has respiratory distress with asymmetric breath sounds and a scaphoid abdomen, findings concerning for congenital

Answer 40

diaphragmatic hernia (CDH)
*causes pulm HYPOplasia

Question 41

In cystic fibrosis, impairment of the cystic fibrosis transmembrane conductance regulator (CFTR) protein reduces chloride secretion and ___ sodium absorption by the respiratory epithelia, resulting in dehydrated mucus.

Answer 41

increases

*When saline is applied to the nasal mucosa, the increased sodium absorption in patients with CF causes a more negative nasal transepithelial potential difference

Question 42

This mutation causes impaired post-translational processing (eg, improper folding and glycosylation) of the receptor protein, which is detected by the endoplasmic reticulum. As a result, the abnormal protein is targeted for proteasomal degradation, preventing it from reaching the cell surface. Certain drugs (lumacaftor) can partially correct this folding defect, leading to expression of functional receptor protein on cell surface

Answer 42

CFTR

Cystic Fibrosis