Pulmonary Pathology Flashcards
What is the breakdown of the lung structures going from proximal to distal?
Trachea Bronchi Bronchioles Terminal bronchioles Acinus
If a patient aspirates a crown, which lung is it more likely to end up in?
Right lung
____ (structure in the lung)
cartilage and glands
Bronchus -
____ (structure in the lung)
lack cartilage and glands, has smooth muscle
Bronchiole -
Type ____ pneumocyte –
flattened alveolar
lining cell
Type 1
Type _____ pneumocyte –
surfactant, repair
Type 2
• Surface active agent –reduces surface tension • Type II pneumocytes by 27-28th weeks of gestation • Hyaline membrane disease
Surfactant
Pain is not a part of lung disease until the _____ is involved
pleura
_______ Atelectasis (collapsed lung)
– Obstruction prevents air
from reaching distal
airway
• Resorption
_______ Atelectasis (collapsed lung)
– Fluid within pleural
cavity
• Compression
_______ Atelectasis (collapsed lung)
– Local or generalized
fibrotic changes
• Contraction
What are the 2 conditions that make up COPD?
Chronic bronchitis
Emphysema
–
chronic inflammation of
bronchi
Chronic bronchitis
–
destruction of elastic
tissue, loss of surface
area
Emphysema
• Chronic bronchitis –increases resistance to the
outflow of air
• Emphysema –reduces the elastic recoil of the lung
and surface area
• Common in cigarette smokers
• Rare in non-smokers
• Frequently occur together
COPD
Does chronic bronichitis occur in proximal or distal airways?
Proximal
Does emphysema occur in proximal or distal airways?
Distal
• Clinical definition –persistent productive cough for 3 consecutive months in 2 consecutive years
Chronic bronchitis
With chronic bronchitis, is inspiration or expiration difficult?
Expiration
• Abnormal permanent enlargement of the air spaces • Destruction of alveolar walls without fibrosis • Reduction in surface area for gas exchange
Emphysema
______ Emphysema
• Typically seen in
cigarette smokers
Centrilobular
\_\_\_\_\_\_ Emphysema • Most commonly seen in Alpha-1 Anti-trypsin Deficiency • Seen in people without risk factors (smoking)
Panacinar
• Causes a rare form of emphysema –panacinar emphysema
Alpha-1 Antitrypsin Deficiency
- A secondary disease; not a primary disease
- Permanent dilation of bronchi and bronchioles caused by destruction of muscle and supporting tissue resulting from chronic necrotizing infections
- Cough and expectoration of copious amounts of purulent sputum
Bronchiectasis
- Severe dyspnea with wheezing
- Difficulty with expiration
- Bronchi constricted and filled with mucin and debris
- Attacks last from one to several hours
- Subside spontaneously or with therapy –usually bronchodilators and corticosteroids
- Status asthmaticus –a severe paroxysm that does not respond to therapy and persists
Bronchial asthma
- Mucus accumulation
- Goblet cell hyperplasia
- Hypertrophy of submucosalmucous glands
- Chronic inflammation
- Basement membrane thickening
- Smooth muscle cell hypertrophy and hyperplasia
Bronchial asthma
- Allergic disease - repeated immediate hypersensitivity and late phase reactions
- Intermittent and reversible airway obstruction
- Chronic bronchial inflammation with eosinophils
- Bronchial smooth muscle hypertrophy and hyper-reactivity
Allergic asthma
• Aspirin sensitivity –aspirin induces asthma
attack
• History of recurrent rhinitis, nasal polyps,
urticaria and bronchospasm
Drug-Induced Asthma
The most common lung tumor is ____ due to lymphatics?
Metastatic
- Most often seen in cigarette smokers
- Arises centrally from main bronchi close to the bifurcation
- Squamous metaplasia precursor lesion
- Prognosis depends on the stage
Squamous Cell Carcinoma
• Smoking causes squamous ______ of
respiratory epithelium
• Creates “dead spots” in mucociliary escalator
• Creates “fertile soil” for development of
epithelial dysplasia leading to squamous cell
carcinoma (most common type of
bronchogenic carcinoma in smokers)
metaplasia
- Arise centrally
- Aggressive –metastasize early and widely
- Chemotherapy
- Neuroendocrine origin
- Frequent association with smoking
Small Cell carcinoma
______ is a form of lung cancer that arises peripherally
Adenocarcinoma
• Undifferentiated epithelial tumors that lack the cytologic features of small cell carcinoma and glandular or squamous differentiation
Large cell carcinoma
• Obstruction of superior vena cava • Impaired venous return from the head and neck • Edema and congestion of face, neck and upper chest • Upper extremity veins fail to empty on elevation
Superior vena cava syndrome
Compression of the sympathetic nerves to head and neck causing: • Enophthalmos –retraction of globe • Ptosis of the upper eyelid • Miosis - Pupillary constriction • Anhidrosis –lack of sweating
Horner syndrome
What are the 4 signs of horner syndrome?
Enophthalmos
Ptosis
Miosis
Anhidrosis
• Compression of the lower cervical and upper thoracic nerves causing shoulder pain radiating down the arm
Pancoast Syndrome
• Malignant neoplasm of pleura associated with environmental asbestos exposure • Asbestos also increases risk for squamous cell carcinoma as well as mesothelioma
Mesothelioma
____ is the pneumonia associated with AIDS
-reclassified from a protozoan to a fungus
Pneumocystis jiroveci
- Caused by Mycobacterium tuberculosis hominis or bovis
- In AIDS patients, Mycobacterium avium-intracellulare is a common pathogen
- Transmitted from person-to-person by aerosolized droplets during coughing, sneezing and talking
- Initial lesion in lung (Gohn focus/complex)
- Following exposure the course of events is variable - may disseminate and cause systemic involvement
- Before anti-tubercular drugs, nature took its course
Tuberculosis
• Lung scarring from inhaled particulate matter
Pneumoconioses
____ lung cancer associatted with EBV
affects the upper airway
Nasopharyngeal Carcinoma
What are the 4 conditions assocaited with EBV?
Burkitt’s lymphoma
Nasopharyngeal carcinoma
Infectious Mononucleosis
Oral Hairy Leukoplakia
• Most common presenting symptom of is hoarseness
• Vocal cord nodules (singer’s nodes, polyps) –chronic irritation
• papillomas –squamous papilloma - HPV
– Solitary in adults
– Multiple in children
• Recurrent respiratory papillomatosis (RRP)
• HPV types 6 and 11 (vaccination) –vertical transmission from infected mother
• Spontaneously regress at puberty
Larynx Cancer
