Pulmonary Pathology

Question 1

What is the breakdown of the lung structures going from proximal to distal?

Answer 1

Trachea
Bronchi
Bronchioles
Terminal bronchioles
Acinus

Question 2

If a patient aspirates a crown, which lung is it more likely to end up in?

Answer 2

Right lung

Question 3

____ (structure in the lung)

cartilage and glands

Answer 3

Bronchus -

Question 4

____ (structure in the lung)

lack cartilage and glands, has smooth muscle

Answer 4

Bronchiole -

Question 5

Type ____ pneumocyte –
flattened alveolar
lining cell

Answer 5

Type 1

Question 6

Type _____ pneumocyte –

surfactant, repair

Answer 6

Type 2

Question 7

• Surface active agent –reduces surface 
tension
• Type II pneumocytes by 27-28th weeks of 
gestation
• Hyaline membrane disease

Answer 7

Surfactant

Question 8

Pain is not a part of lung disease until the _____ is involved

Answer 8

pleura

Question 9

_______ Atelectasis (collapsed lung)

– Obstruction prevents air
from reaching distal
airway

Answer 9

• Resorption

Question 10

_______ Atelectasis (collapsed lung)

– Fluid within pleural
cavity

Answer 10

• Compression

Question 11

_______ Atelectasis (collapsed lung)

– Local or generalized
fibrotic changes

Answer 11

• Contraction

Question 12

What are the 2 conditions that make up COPD?

Answer 12

Chronic bronchitis

Emphysema

Question 13

–
chronic inflammation of
bronchi

Answer 13

Chronic bronchitis

Question 14

–
destruction of elastic
tissue, loss of surface
area

Answer 14

Emphysema

Question 15

• 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

Answer 15

COPD

Question 16

Does chronic bronichitis occur in proximal or distal airways?

Answer 16

Proximal

Question 17

Does emphysema occur in proximal or distal airways?

Answer 17

Distal

Question 18

• Clinical definition –persistent productive cough for 3 consecutive months in 2 consecutive years

Answer 18

Chronic bronchitis

Question 19

With chronic bronchitis, is inspiration or expiration difficult?

Answer 19

Expiration

Question 20

• Abnormal permanent 
enlargement of the air 
spaces
• Destruction of alveolar 
walls without fibrosis
• Reduction in surface 
area for gas exchange

Answer 20

Emphysema

Question 21

______ Emphysema
• Typically seen in
cigarette smokers

Answer 21

Centrilobular

Question 22

\_\_\_\_\_\_ Emphysema
• Most commonly seen 
in Alpha-1 Anti-trypsin 
Deficiency
• Seen in people without 
risk factors (smoking)

Answer 22

Panacinar

Question 23

• Causes a rare form of emphysema –panacinar emphysema

Answer 23

Alpha-1 Antitrypsin Deficiency

Question 24

• 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

Answer 24

Bronchiectasis

Question 25

* 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

Answer 25

Bronchial asthma

Question 26

* Mucus accumulation * Goblet cell hyperplasia * Hypertrophy of submucosalmucous glands * Chronic inflammation * Basement membrane thickening * Smooth muscle cell hypertrophy and hyperplasia

Answer 26

Bronchial asthma

Question 27

* 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

Answer 27

Allergic asthma

Question 28

• Aspirin sensitivity –aspirin induces asthma attack • History of recurrent rhinitis, nasal polyps, urticaria and bronchospasm

Answer 28

Drug-Induced Asthma

Question 29

The most common lung tumor is ____ due to lymphatics?

Answer 29

Metastatic

Question 30

* Most often seen in cigarette smokers * Arises centrally from main bronchi close to the bifurcation * Squamous metaplasia precursor lesion * Prognosis depends on the stage

Answer 30

Squamous Cell Carcinoma

Question 31

• 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)

Answer 31

metaplasia

Question 32

* Arise centrally * Aggressive –metastasize early and widely * Chemotherapy * Neuroendocrine origin * Frequent association with smoking

Answer 32

Small Cell carcinoma

Question 33

______ is a form of lung cancer that arises peripherally

Answer 33

Adenocarcinoma

Question 34

``` • Undifferentiated epithelial tumors that lack the cytologic features of small cell carcinoma and glandular or squamous differentiation ```

Answer 34

Large cell carcinoma

Question 35

``` • 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 ```

Answer 35

Superior vena cava syndrome

Question 36

``` 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 ```

Answer 36

Horner syndrome

Question 37

What are the 4 signs of horner syndrome?

Answer 37

Enophthalmos Ptosis Miosis Anhidrosis

Question 38

``` • Compression of the lower cervical and upper thoracic nerves causing shoulder pain radiating down the arm ```

Answer 38

Pancoast Syndrome

Question 39

``` • Malignant neoplasm of pleura associated with environmental asbestos exposure • Asbestos also increases risk for squamous cell carcinoma as well as mesothelioma ```

Answer 39

Mesothelioma

Question 40

____ is the pneumonia associated with AIDS | -reclassified from a protozoan to a fungus

Answer 40

Pneumocystis jiroveci

Question 41

* 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

Answer 41

Tuberculosis

Question 42

• Lung scarring from inhaled particulate matter

Answer 42

Pneumoconioses

Question 43

____ lung cancer associatted with EBV | affects the upper airway

Answer 43

Nasopharyngeal Carcinoma

Question 44

What are the 4 conditions assocaited with EBV?

Answer 44

Burkitt's lymphoma Nasopharyngeal carcinoma Infectious Mononucleosis Oral Hairy Leukoplakia

Question 45

• 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

Answer 45

Larynx Cancer