Pulmonary Path 2

Question 1

Pulmonary infections

Answer 1

pneumonia, acute resp distress syndrome, pulmonary abscess and TB

Question 2

Pneumonia

Answer 2

one of the leading causes of death, often complicates other chronic debilitating diseases
-any organism can cause pneumonia (bac common, viral, fungal (immunocomp pts.), parasites)

Question 3

bacterial pneumonia predisposing factors

Answer 3

loss of cough reflex, injury to cilia and decreased phagocytosis (all 3 above from smoking) pulmonary edema, immunocomp condition (ex. pregnancy complication)

Question 4

clinical presentation

Answer 4

cough, dyspena, fever, chills, sputum production (blue/green from myloperoxase and neutrophils but also bloody from destruction)

Question 5

bronchopneumonia

Answer 5

patchy, begins around the small bronchi

-common in the very young and very old

Question 6

lobar pneumonia

Answer 6

involves the entire lobe

• happens in healthy adults
• strep pneumonia is the cause in 90% of cases

Question 7

2 forms of bacterial pneumonia

Answer 7

bronchopneumonia and lobar pneumonia

Question 8

2 stages of the infammatory process in LOBAR pneumonia

Answer 8

1. congestion - increased red blood cells with (WBC) neutrophils that start to fill the air spaces
2. red hepatization - purulent exudate with many RBC (looks like the liver)
3. gray hepatization - rbc lyse and get taken out and replaced with exudate with fibrin and macrophages
4. resolution - doesn’t completely repair - the air spaces will open and the scaring will be in the interstitium

Question 9

complicaitons of pneumonia

Answer 9

abcess, pleuritis, pericarditits (lung wrapped around teh heart) and bacteremia (because there is so much vascularization

Question 10

interstitial/atypical/walking pneumonia

Answer 10

seen with mycoplasma pneumonia and viruses

Question 11

clinical interstitial pneumonia

Answer 11

highly variable - fever, DRY cough (b/c no PMNs), myalgia (mm. cramps) to life threatening

Question 12

pathologay of interstitial pneumonia

Answer 12

intersitital inflammation (in the walls), mononuclear cells (macrophages), congestion and hyaline membrane (diffuse alveolar damage)
-pneumocytes (type 1 ) can be injured by macros and neutrophils and cause hyaline membrane formation

Question 13

Acute Respiratory Distress Syndrome (ARDS)

Answer 13

rapidly developing serious condition with same histologic features as interstitial pneumonia

• serious complication of that has many triggers
• *can cause death in a few days
• 30% mortality

Question 14

what causes ARDS?

Answer 14

many triggers

shock (ex. prego complications), infections, trauma (ex. vehicle accident), drug overdoses, irritants etc..

Question 15

pathology ARDS

Answer 15

injury to endothelium and alveolar epithelium and increased endothelial permeability

• cytokines activate “ases” and macrophages so shit is ripped up like bronchial epithelium and hyaline membranes form
• alveolar spaces are there, but all the type 1 pneumocytes are damaged and the type 2 are trying to regenerate and fill in the spaces

Question 16

clinical pulm abscess

Answer 16

cough, fever, purulent sputum (PMN, possibly blood)

** pulm abcess have air-fluid lines on a radiograph dileniating where the pus is vs. air

Question 17

predisposing factors pulm abcess

Answer 17

bronchiectasis, aspiration, septic emboli, airway ob, dental sepsis (aspiration form procedures)
**harder to cause an abcess in the lung than in the mouth from say an extraction

Question 18

course of a pulm abcess

Answer 18

scar, cavitate, progressively enlarge

-cavities will only heal through scarring, tissue not coming back

Question 19

TB frequency

Answer 19

myobacterium tuberculosis

• 1/3 of the world infected - most infectious cause of death in the world (3 million deaths/yr)
• in 80s (with HIV) the US cases rose, but since 1992, have been declining

Question 20

exceptions to TB decline in frequency in the US

Answer 20

HIV infections (immunocomp), overcrowding, poor living conditions, patches of immigrant populations

Question 21

myobacterium tuberculosis

Answer 21

acid fast bacillus (rod), aerobe, non-motile, slow groeht

• waxy coat that is resistant to acid destaining (but we have a special stain to find it in the tissues
• caseating (cheesy) granulomatous inflammation - tissue reaction

Question 22

pathology TB

Answer 22

casseating granuloma (multinuc giant cells)

Question 23

TB pathogenesis

Answer 23

• almost always airborne (inhalation) b/c bacillus 3-4 micros in size
• Ghon lesion (site of early infec) - inflammation trying to wall off the infection in the lung
• Ghon complex (lung lesion + hilar lymph nodes) - nodes are the secondary area of infection from spread of bacteria

Question 24

cavitary TB

Answer 24

• apex of the lung
• when destruction out weighs the isolation of the granulmoa
• significant scarring (can only heal through scarring, will not regen)
• this much destruction may seed the large airways, lymph nodes or blood (bacteremia)
• -> sputum from the airways may lead to TB infection in the mouth
• direct extension to the pleura (thickening) - effusion

Question 25

TB course

Answer 25

• may become inactive or progress (90-95% of primary cases (single foci) resolve)
• may reactivate if immunity wanes
• -> reactivation leads to type IV hypersens and tissue necrosis (cavities may form)
• -> may widely disseminate (Mililary TB has multi organ involvement)

Question 26

Miliary TB

Answer 26

• from spread via the lymphatics or blood (lymphohematogenous)
• “millet seeds” are like small granulomas that take over the organ
• other lung, CNS, kidney, adrenals, bones, bone marrow, liver and spleen

Question 27

Granulomatous lung disease

Answer 27

• TB is classic
• fungal infections (esp. histoplasmosis in ohio) –> not necrotizing, not a caseous look
• sarcoidosis

Question 28

Lung cancer facts

Answer 28

• leading cause of cancer deaths
• risk factors: smoking***** (prevalent for our parents age, asbestos, radon gas, nickel, chromates, pollutants, lung scar)

Question 29

why is lung cancer the leading cause of cancer death?

Answer 29

late stage detection

5 year survival for all types is 16%, if its localized then 45% survival rate

Question 30

cancer death rates vs. smoking

Answer 30

1990 - peak for men, 2000 - peak for women in deaths, which correlates with smoking “fad” and decline
** women later because of the thought, “if men can do it, we can do it”

Question 31

lung cancer clinical

Answer 31

cough, weight loss, chest pain, hemoptysis, dyspnea

• tumors can produce hormones (or hormone-like susbtances) –> paraneoplastic syndrome, ADH, ACTH, PTH and others
  ex. PTH will produce hypercalcemia to lead to seizures or bone resorption

Question 32

lung cancer pathology

Answer 32

squamous cell carcinoma and adenocarcinoma (make up half of lung cancers) are the leading causes, but also small cell and large cell and mesothelioma pleural malignancy (abestos assoc)

Question 33

pneumoconioses

Answer 33

group of lung disorders caused by inhalation of dusts/particles
-size, shape and concentration of the particles is important
(1-5 micron diameter are the most dangerous, smoke particles are this size)
-induce fibrosis, esp if particles inhaled in large amount and macrophages can’t keep up (scarring)

Question 34

pneumoconoses pathology

Answer 34

usually from occupational and environmental causes

• coal workers pneumoconiosis –> nodular or diffuse fibrosis with coal macules, progressive massive fibrosis
• abestos and some drugs (drugs are not inhaled, but the fibrosis is the same)

Question 35

silicosis

Answer 35

worldwide, most prevalent form of occupational disease

minning etc..

Question 36

abestos bodies

Answer 36

inhaled abestos particles covered in iron, found on a radiograph on people with mesothelioma