Pulmonary Pathology 1

Question 1

How many grams is each lobe?

Answer 1

200-250 grams each (right lung is slightly heavier)

Question 2

T/F. The lungs have a dual blood supply from the pulmonary and bronchial vasculature.

Answer 2

True

Question 3

What does breathing require?

Answer 3

muscles (diaphragm, chest wall and accessory) plus neural control

Question 4

What type of epithelium lines the vocal cords?

Answer 4

stratified squamous epithelium

Question 5

The large airways (larynx, trachea, bronchi) are lined by ___, ___, ___ epithelium with mucus glands (mucosal and submucosal), neuroendocrine cells and cartilage.

Answer 5

pseudostratified, ciliated, columnar;

Question 6

Describe the two cell types in the alveoli?

Answer 6

1. flat, type I pneumocytes (95%)

2. cuboidal, type II pneumocytes (produce surfactant)

Question 7

What are the defense mechanisms important in protection against foreign materials and infections?

Answer 7

i. upper airway – filtering function
ii. lower airway – mucociliary apparatus
iii. lymphoid tissues – cellular & humoral immunity (mucosal IgA)
iv. alveolar macrophages

Question 8

Define the following terms:

1. hemoptysis
2. dyspnea
3. atelectasis
4. pneumothorax
5. pleural effusion
6. empyema

Answer 8

1. Hemoptysis - coughing up blood
2. Dyspnea - difficulty breathing, perception of needing to breathe deeper and faster (aka; shortness of breath)
3. Atelectasis – collapse or loss of lung volume – inadequate expansion of airspaces
4. Pneumothorax - air in the pleural space, leads to collapse of the lung
5. Pleural effusion - fluid in the pleural space
6. Empyema – suppuration (purulence) in pleural cavity, often related to bacterial infection

Question 9

Explain the differences between transudate and exudate.

Answer 9

a. Transudate - low protein fluid, caused by increased venous pressure (CHF)
b. Exudate - high protein fluid, with or without inflammatory cells, caused by increased vascular permeability (damage), pneumonia is an example

Question 10

Pulmonary ___ is accumulation of ___ in the lungs, first in the ___ tissues, then filling the ___ air spaces. What are some causes?

Answer 10

fluid; interstitial; distal

a. increased intravascular pressure (CHF)
b. hypoproteinemia (low protein)
c. vascular damage (infections, autoimmune diseases)

Question 11

What is the problem with pulmonary edema?

Answer 11

1. inhibits normal oxygen exchange

2. predisposes to infection

Question 12

Pulmonary ___ are usually from the ___ veins of the legs or pelvis. Very large emboli lodge at the ___ of the pulmonary arteries (“___” embolus) and can cause sudden death.

Answer 12

thromboemboli; deep; bifurcation; saddle

Question 13

Name 4 predisposing factors to pulmonary thromboemboli.

Answer 13

1. chronic illness
2. prolonged bed rest (immobility)
3. hypercoagulable state
4. deep vein thrombophlebitis

Question 14

___ pulmonary diseases are a group of diseases that result in airflow ___ or ___. List the 4 classic disorders.

Answer 14

Obstructive; limitations; obstruction

1. Emphysema
2. Chronic bronchitis
3. Bronchiectasis
4. Asthma

Question 15

What two conditions are known as COPD?

Answer 15

emphysema and chronic bronchitis

Question 16

T/F. Overall, chronic pulmonary diseases are #4 behind heart disease, cancer and pneumonia.

Answer 16

False, Overall, chronic pulmonary diseases are #3 behind heart disease and cancer.

Question 17

___ is a permanent enlargement of the ___ air spaces due to destruction of the alveolar ___ walls.

Answer 17

Emphysema; small; septal

Question 18

What is the clinical and pathological presentation of emphysema?

Answer 18

clinical - dyspnea, cough, prolonged exhalation (“pink puffers” - air gets in but hard to push out)

path - imbalance between protease and anti-protease enzymes

Question 19

T/F. Smoking is a minor cause of the imbalance seen in emphysema.

Answer 19

False, Smoking is a MAJOR cause of the imbalance seen in emphysema.

Question 20

___ emphysema involves the central portion of the lobule, may progress to bullae, usually affects ___ lobes, typically associated with ___.

Answer 20

Centriacinar; upper; smoking

Question 21

___ emphysema involves the entire respiratory lobule and usually involves the ___ lobes, associated with ___ deficiency

Answer 21

Panacinar; lower; alpha-1-AT

Question 22

What symptoms must be present for a diagnosis of chronic bronchitis?

Answer 22

cough with sputum production at least 3 consecutive months for 2 consecutive years

May have hypoxemia, cyanosis (“blue bloaters” - lots of stuff in airway so hard to get air in)

Question 23

In chronic bronchitis, chronic irritation (smoking) and infections lead to increased ___ glands, chronic ___, fibrosis and ___ of the airways.

Answer 23

mucus; inflammation; narrowing

Question 24

What does cigarette smoking do in chronic bronchitis?

Answer 24

causes mucus gland hyperplasia, increases smooth ms tone, inhibits cilia, inhibits phagocytosis, and squamous metaplasia

Question 25

List the 4 predisposing factors to chronic bronchitis and emphysema.

Answer 25

1. cigarette smoking 2. atmosphere pollutants 3. infection(s) 4. genetic factors - CF(cystic fibrosis), a-1-AT deficiency (esp. emphysema)

Question 26

What condition has a chronic infection with permanent (large) airway dilation?

Answer 26

Bronchiectasis

Question 27

How do patients clinically present with bronchiectasis? What are some complications?

Answer 27

clinically - cough, fever, expectoration, dyspnea complications - abscess, pneumonia, bronchopleural fistula, empyema

Question 28

What predisposing factors can lead to bronchiectasis?

Answer 28

obstructive tumors, foreign bodies, cystic fibrosis (mucus plugs), other COPD, suppurative or necrotizing pneumonia

Question 29

T/F. The pathology of bronchiectasis is narrowed distal bronchi and bronchioles, chronic infection with inflammation and no purulence

Answer 29

False, the pathology of bronchiectasis is DILATED distal bronchi and bronchioles, chronic infection with inflammation and VARIABLE purulence (bloody mucoid sputum).

Question 30

___ is increased irritability of smooth muscle in ___ and ___ that leads to ___ airway contraction/constriction.

Answer 30

Asthma; bronchi; bronchioles; reversible

Question 31

T/F. Asthma affecs ~ 5% of adults and 7-10% of kids, esp. inner city children.

Answer 31

True.

Question 32

What is the clinical presentation of asthma?

Answer 32

wheezing, long exhalation, hyperinflation of lungs

Question 33

Which of the following is true for atropic asthma? 1. its allergic, extrinsic 2. Type I hypersensitivity (IgE mediated) 3. environmental antigen 4. positive family history

Answer 33

All are characteristic of atopic asthma

Question 34

Which type of of asthma is intrinsic and may be initiated by viruses or air pollutants?

Answer 34

non-atopic

Question 35

The pathology of asthma is increased ___ glands, smooth muscle ___, inflammation with ___ and type ___ helper T cells.

Answer 35

mucus; hypertrophy; eosinophils; 2

Question 36

What is the pathogenesis of asthma?

Answer 36

antigen binds to surface IgE on mast cells releasing a large number of mediators, including histamine and leukotrienes

Question 37

How is asthma treated?

Answer 37

1. Attack may subside spontaneously 2. Inhalation bronchodilators for immediate relief (albuterol) 3. Controller medications (corticosteroids)