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Pathology (Melicia) > Pulmonary > Flashcards

Pulmonary Flashcards

1
Q

What is COPD?

A

clinical term for lung disease characterized by chronic airway obstruction w/ increased resistance to air flow

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2
Q

What diseases are included in COPD?

A

chronic bronchitis, emphysema, bronchial asthma, bronchiectasis

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3
Q

What is the main cause of chronic bronchitis

A

smoking

cessation of smoking is associated with improvement of clinical sxs

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4
Q

What are the 2 types of pna?

A

alveolar pna

interstitial pna

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5
Q

Describe alveolar pna

A

intraavleolar inflammation, either as a bronchopna or lobar pna

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6
Q

Describe interstitial pna

A

primarily involves the alveolar septae, which includes viral pna

thickening of the alveolar sac

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7
Q

Which type of pna is caused by a bacterial infection?

A

alveolar

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8
Q

Alveolar pna may be…

A

focal or diffuse

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9
Q

Who is most likely to get alveolar pna?

A

debilitated elderly pts who are confined to be

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10
Q

What is bronchopneumonia?

A

pna limited to the segmental bronchi and surrounding parenchyma

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11
Q

What is known as “white out” of the lung

A

complete lobar pna, lobe is completely filled with pus

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12
Q

What is characteristic about lobar pna?

A

widespread or diffuse alveolar pna

causes total whiteout of an entire lobe/lobes on c xray

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13
Q

most common cause of community acquired pna?

A

strep pneumoniae

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14
Q

What is characteristic about interstitial pnas?

A

usually diffuse and often bilateral

usually caused by viruses

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15
Q

What happens if acute bacteria/viral pna are untreated or incompletely treated?

A

can become organizing pna (chronic pna)

resulting in interstitial fibrosis

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16
Q

What causes pna?

A

bacterial (75%), viral

less common: fungi, protozoa, parasites, aspiration

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17
Q

What is aspiration pna?

A

some ppl can loose gag reflex: alcoholics, higher neuro dysfunction (dementia), stroke pts, meningitis pts, trauma pts, high opiates

anything that is in the stomach can come up and go into the lungs, will see food surrounded by bacterial colonies in lungs

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18
Q

Most important bacteria causing pna?

A

Streptococcus

Staphylococcus

H. Infleunza

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19
Q

Where do the gram neg bacteria that cause pna come from?

A

bacteria are part of the enteric flora and can cause pna by contamination of the blood to the lungs

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20
Q

How do pathogens reach the lungs for infection?

A
  1. inhalation in air droplets (TB)
  2. aspiration of infected secretions from UR tract (strep/staph)
  3. Aspiration of infected particles in gastric contents
  4. hematogenous spread- via blood
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21
Q

pna is common in sepsis and may develop secondary to…

A

UTIs or GI tract infections

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22
Q

2 types of clinical pnas?

A

primary/community acquired: affects healthy ppl

secondary pna/hospital acquired (nosocomial): arise in ppl with preexisting illnesses

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23
Q

Sxs of pna?

A

fever, chills and prostration along with signs related to bronchial inflammation: cough and expectoration, SOB, dyspnea and tachypnea

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24
Q

What does the sputum look like in pna?

A

mucopurulent blood-tinged “rust-colored sputum”

strep pneumoniae

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25
Q

How is pna dx?

A

presumed dx clinically but need

  1. CXR
  2. bacteriologic studies of the sputum
  3. peripheral blood smears
    - -bacterial: leukocytosis (neutrophilia)
    - –viral: +/- lymphocytosis
  4. blood gas analysis: may detect hypoxia or respiratory acidosis
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26
Q

Treatment for bacterial pna?

A

abx

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27
Q

Treatment for viral pna

A

supportive care

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28
Q

Who is the pneumococcus vaccine best for?

A

80-90% effect against most serotypes

high risk pts: sickle cell, multiple myeloma, DM, cancer, alcoholics, splenectomy pts, eldrly

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29
Q

What are feautres of atypical pna?

A

do not present with classic features, best ex. diffuse pna cause by mycoplasma pneumoniae

sxs are milderly

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30
Q

What are feautres of atypical pna?

A

do not present with classic features, best ex. diffuse pna cause by mycoplasma pneumoniae

sxs are milder

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31
Q

What is coccidioidomycosis?

A

a chronic necrotizing infx. that resembles TB

“valley fever”

in soil it forms hyphae with arthrospores that are very light and can be carried by the wind and be inhaled

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32
Q

How does coccidioidomycosis cause disease in the lungs?

A

arthrospores form spherules that are large vacuoles with a thick wall that are filled with endospores, upon rupture of walls endospores are released and spread via blood or by extension forming caseating granulomas

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33
Q

How pts with coccidioidomycosis present clinically?

A

begins as focal asxs pneumonitis limited to lungs/regional lymph nodes… in immunocompromised granulomatous lesions can spread to virtually any organ

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34
Q

How pts with coccidioidomycosis present clinically?

A

begins as focal asxs pneumonitis limited to lungs/regional lymph nodes… in immunocompromised granulomatous lesions can spread to virtually any organ

some develop flu like sxs

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35
Q

What is pneumocystis carinii?

A

important cause of diffuse interstitial pna in immunocompromised pts

has characterisitics of both fungus and protozoan parasite

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36
Q

How is pneumocystis carinii transmitted?

A

via inhalation

  • no disease in healthy pts
  • pna in aids pts, leading cause of death
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37
Q

What is TB?

A

A chronic, bacterial infectious disease caused by Mycobacterium tuberculosis

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38
Q

What do we stain TB with? What does it look like?

A

AFB stain

magenta beaded rods

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39
Q

What does M. tuberculosis look like?

A

rod shaped bacterium with a waxy capsule. Acid fast.

it is an obligate aerobe whose cell wall contains mycolic acid, a complex lipid

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40
Q

What is reactivation/secondary TB? findings?

A

a reactivation of a dormant primary infection.

bacteria spreads to apex of lungs -> granulomatous pna -> confluent granulomas produce cavities -> hemoptysis

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41
Q

What is the spread of TB called?

A

miliary spread- GI tract if swallowed or spread to kidneys, brain or bones

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42
Q

What is the main complication of secondary TB?

A

Miliary spread

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43
Q

What type of lung carcinoma do non-smokers usually develop?

A

adenocarcinoma

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44
Q

Peak age in carincoma of lung? Gender difference?

A

60-70 yrs

male predominance but starting to even out due to increased smoking in women

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45
Q

How many ppl will die of lung cancer in US each year?

A

150,000

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46
Q

What is the only type of lung cancer that is receptive to chemo/radiation?

A

small cell carcinoma

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47
Q

Lung ca tumor may also extend into the esophagus causing…

A

dysphagia

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48
Q

What is chronic bronchitis?

A

chronic cough and production of sputum for a minimum of 3 months/yr for at least 2 consecutive years

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49
Q

Pathology of chronic bronchitis?

A

fibrous thickening of the walls of the bronchi and bronchiole with their lumens completely filled with thickened mucus

  • due to hypertrophy of bronchial mucous and increase in # of goblet cells
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50
Q

What happens to the surface epithelium in chronic bronchitis?

A

may show focal ulcerations or metaplasia of columnar epithelium into stratified squamous epithelium

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51
Q

Sxs of chronic bronchitis due to increased mucus production?

A

prolonged coughing, thick tenacious/purulent sputum and dyspnea

52
Q

Who are blue bloaters?

A

those with chronic bronchitis

hypoxia can be so bad during coughing that it causes cyanosis

53
Q

How is the pulmonary vasculature affected by chronic bronchitis?

A

by peribronchial fibrosis, results in pulmonary HTN and chronic Cor Pulmonale (R HF)

54
Q

Chronic bronchitis CXR?

A

increased bronchovascular markings and an enlarged heart

55
Q

What is emphysema?

A

enlargement of the airspaces distal to the terminal bronchioles with destruction of the alveolar walls

rare in non-smokers, except in pts with genetic deficiency of Alpha-1 antitrypsin

56
Q

Pathogenesis of emphysema

A

hypothesis: irritants in smoke cause influx of inflammatory cells into the alveoli-> proteolytic enzymes from the leukocytes destroy the alveolar walls causing enlargement of alveolar spaces

57
Q

Gross pathology in emphysema>

A

lungs are enlarged, remain filled with air and do not collapse. Whiter than normal, billowy and touch in the chest midline

58
Q

What are blebs?

A

sub pleural air-filled spaces formed by rupture alveoli which can rupture into the pleural cavity, causing a pneumothorax

59
Q

What are bullae?

A

parenchymal air-filled spaces greater than 1 cm in diameter

60
Q

blebs and bullae are seen in…

A

emphysema

61
Q

Clinical features of emphysema

A

reduced respiratory surface so…compensatory tachypnea, barrel shaped chest. Often hunch forward to engage respiratory muscles

62
Q

Who are pink puffers?

A

pts with emphysema, hyperventilate and are able to oxygenate blood adequately

63
Q

Emphysema CXR?

A

clr lung fields with overinflation

64
Q

What is bronchial asthma?

A

increased responsiveness of the bronchial tree to a variety of stimuli

attacks: expiratory wheeze, cough, dyspnea

65
Q

What are the 2 major forms of asthma?

A

extrinsic asthma, intrinsic asthma

66
Q

Describe extrinsic asthma

A

mediated by exposure to exogenous allergens (pollen, dander, mold)

typically affects children, often associated with all.

67
Q

Describe intrinsic asthma

A

precipitated by non-immune mechanisms: heat/cold, exercise, psychological stress

increased bronchi reactivity may be related to persistent inflammation of the bronchial mucosa

68
Q

Pathology of bronchial asthma

A

bronchi show chronic inflammation and overabundance of mucus in lumen

nonspecific inflammatory cells, + several eosinophils

+/- whorls of shed epithelial cells (Curschmann spirals)

69
Q

Histologic features of asthma

A

bronchial wall- bronchial gland hyperplasia with overproduction of mucus

increased # of smooth muscle cells and appear to be enlarged (freq. spasm)

70
Q

Gross features of asthma

A

lungs are large, pink and touch in the midline (similar to emphysema)

overabundance of mucus plugs in lumen -> form casts

71
Q

What is bronchiectasis?

A

permanent dilation of the bronchi (most common comp of chronic bronchitis)

recurrent pna common

adhesions btwn lobes may occur

72
Q

What is pna?

A

inflammation of the lung

73
Q

Etiology of an legionella infection?

A

can occur following inhalation of bacteria from humidifiers/AC units

74
Q

What does pna sound like on auscultation?

A

rales, rhonchi and other signs of pulmonary consolidation

75
Q

Clinical features of pneumococcus pna?

A

sudden onset chills, fever, pleuritic CP, cough and rust-colored sputum

76
Q

What is characteristic about staph pna?

A

tends to produce multiple abscesses

77
Q

What is characteristic about gram - pseudomonas pna?

A

most common hospital acquired pna, characterized by vascular lesions that cause infarcts/necrosis of the lung parenchyma

common source: contaminated ventilatory equipment.

mortality rate > 70%

78
Q

What is characteristic about gram - klebsiella pneumoniae infx?

A

occurs in middle aged alcoholic males

thick currant red jelly sputum

79
Q

What does Cryptococcus neoformans cause?

A

fungus which causes cryptococcosis, a systemic opportunistic mycosis which affects the meninges and lungs

80
Q

Cryptococcus neoformans usually occurs only in which pt populations?

A

immunocompromised: AIDS, leukemia, lymphoma pts

81
Q

Clinical presentation for P. carinii infx.

A

sudden onset fever, cough, dyspnea and tachypnea

bi rales/rhonchi

CXR: diffuse interstitial pna

82
Q

How does P. carinii cause disease?

A

presence of cup/boat shaped cysts in the alveoli induce inflammatory response, resulting in a frothy, eosinophilic edema that blocks O2 exchange

83
Q

How is TB transmitted?

A

person-person via respiratory aerosols, the initial site of infx is in the lungs

84
Q

Where/what is the initial lung lesion in TB?

A

usually occurs in lower lobes, consists of a Ghon complex: peripheral parenchymal granuloma and prominent infected draining mediastinal (hilar) lymph node

85
Q

What does the Ghon nodule look like grossly?

A

well circumscribed with central necrosis

in later stages: fibrotic and calcified

86
Q

How do pts presents with primary TB?

A

90-95% asxs, lesion remains localized and heal with calcification than can be seen on CXR

87
Q

What is progressive primary TB?

A

uncommonly, TB spreads to other parts of the lungs. Usually occurs in children/immunosuppressed.

initial lesion rapidly enlarges and there is an erosion of bronchi/bronchioles by the necrotic central liquefaction

88
Q

What is Scrofula?

A

miliary spread of TB to neck supraclavicular lymph nodes

89
Q

Complications of miliary spread?

A

contralateral pna, pleurtitis, intestinal TB, hemoptysis (erosion of small pulmonary aa)

90
Q

Clinical features of TB?

A

begins with nonspecific sxs: fever, fatigue, night sweats, weight loss

secondary TB: nonproductive dry cough, low grade fever, loss of appetite, minor hemoptysis

91
Q

Most common cause of cancer deaths worldwide

A

lung CA

92
Q

How are carcinomas of the lungs classified?

A

according to histologic types of carcinoma: small cell v. non-small cell carcinoma

PATHOLOGIST makes this distinction

93
Q

Etiology of lung CA?

A

chemicals in tobacco smoke- Polycyclic Hydrocarbons

genetics also involved

94
Q

Mutated oncogenes in lung CA?

A

K-ras

Myc

95
Q

mutation in tumor suppressor genes in lung CA

A

p53

Rb (retinoblastoma gene)

96
Q

chromosomal abnormality associated with lung cancer?

A

deletion in the short arm of chromosome 3 (3p)

97
Q

cellular adaptions before lung CA

A

metaplasia of bronchial epithelium from pseudostratified columnar epithelium into stratified squamous epithelium

(can be restored to normal if smoker quits)

98
Q

What is “undifferentiated large cell carcinoma”

A

malignant transformation of the stem cells of the bronchial epithelium- become anaplastic before differentiation

99
Q

What are tumors of neuroendocrine cells called

A

small or oat cell carcinoma

100
Q

What are tumors of mucous producing cells of the bronchioles called?

A

adenocarcinomas, form irregular glands

101
Q

What is the only lung CA that will produce hormones?

A

small cell carcinoma

102
Q

Where is small cell carcinoma located?

A

centrally

103
Q

only lung CA highly response to chemo/radiation

A

small cell carcinoma (if caught early)

104
Q

What is the only lung CA that is 95% peripherally located?

A

adenocarcinoma of the lung

105
Q

Which lung cancer is also known as scar carcinoma?

A

adenocarcinoma

106
Q

What is characteristic about squamous cell carcinomas?

A

30% all lung CA

always associated with smoking

most centrally located

107
Q

How do squamous cell carcinomas appear grossly?

A

firm, gray-white ulcerative masses which extent through bronchial wall into the adjacent parenchyma

108
Q

Are most squamous cell carcinomas usually invasive at dx?

A

2/3 are.

But this is the lung CA with the best prognosis out of the 4 due to slower metastasis

109
Q

Squamous cell carcinoma presentation?

A

cough, dyspnea, hemoptysis, CP, +/- pna with pleural effusion

110
Q

How do adenocarcinomas of the lung appear grossly?

A

irregular masses, gray-white, soft and glistening

111
Q

What is bronchioalveolar carcinoma?

A

distinctive subtype of adenocarcinoma that grows along preexisting alveolar walls

copious mucin in sputum

CXR: single peripheral nodule OR multiple nodules OR diffuse infiltrate indistinguishable from lobar pna

112
Q

Histology of bronchioalveolar carcinoma?

A

2/3 nonmucinous

1/3 mucinous tumors feat. increased goblet cells

113
Q

Which of the 4 types of lung CAs grows and metastasizes the fastest?

A

small cell carcinoma (aka oat cell carcinoma)

114
Q

What is unique to small cell carcinomas?

A

it produces a variety of paraneoplastic syndromes which are distinctive: diabetes insipidus due to ADH production, ectopic ACTH or parathorome production

115
Q

How does small cell carcinoma appear grossly?

A

as a perihilar (central) mass, freq. with extensive lymph node metastases. Soft and white but with extensive hemorrhage and necrosis

116
Q

How does small cell carcinoma look histologically?

A

sheets of small, round, oval or spindle-shaped cells

scant cytoplasm with finely granular nuclear chromatin (large nucleus, dark purple)

117
Q

What is characteristic of large cell carcinoma? how do they look histologically?

A

dx of exclusion in poorly undifferentiated non-small cell carcinoma

cells are large and irregular, ample cytoplasm. nuclei freq. show prominent nucleoli and vesicular chromatin

118
Q

Where do all lung CAs typically metastasize to?

A

to regional lymph nodes, particularly the mediastinal and hilar lymph nodes

Most common extranodal site: adrenal gland. then brain, bone, liver.

119
Q

Clinical presentation for most lung CAs

A

10-15% asxs, discover incidentally on CXR

30%: local effects (bronchial obstruction, atelectasis, sxs of lung infx)

30% sxs pertaining to distant metastasis (liver=hepatomegaly, brain= seizures, bone= fractures, etc.)

30% nonspecific (weight loss, night sweats, malaise)

120
Q

Most successful technique in dx of squamous cell carcinoma?

A

bronchoscopy with biopsy (if centrally located)

FNA and cytology can also be useful

121
Q

5 year survival rate for most lung CAs

A

10-15%

122
Q

What is malignant mesothelioma?

A

neoplasm of mesothelial cells, most common in the pleura

80% of pts have exposure to asbestos, latency period 20-30yrs

pleural mesotheliomas encases and compresses the lung

123
Q

Mesothelioma is also called…

A

rind tumor

124
Q

Presentation of malignant mesothelioma

A

age ~60yrs

pleural effusion/pleural mass, CP, weight loss, malaise

spreads locally first then mets to liver, bones, peritoneum and adrenals

125
Q

Tx for malignant mesothelioma

A

ineffective, prognosis poor

Pathology (Melicia) (6 decks)

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