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Pulmonary Pathology Flashcards

1
Q

Structure Of The Lung
(5)

A

Trachea
Bronchi Bronchi
Bronchioles Bronchioles
Terminal Bronchioles Terminal Bronchioles
Acinus Acinus

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2
Q

Bronchus -

A

cartilage
and glands

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3
Q

Bronchiole -

A

lack
cartilage and glands,
has smooth muscle

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4
Q

Type I pneumocyte –

A

flattened alveolar
lining cell

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5
Q

Type II pneumocyte –

A

surfactant, repair

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6
Q

Microscopic Structure:
Alveolar Wall
(3)

A
  • Type I pneumocyte
  • Type II pneumocyte
  • Pores of Kohn
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7
Q

Surfactant
(3)

A
  • Surface active agent –reduces surface
    tension
  • Type II pneumocytes by 27-28th weeks of
    gestation
  • Hyaline membrane disease
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8
Q

Pleura
(6)

A
  • Visceral pleura
  • Parietal pleura
  • Mesothelial lining
  • Pleural space –a potential space
  • Pleura –pain receptors
  • Lung –few pain receptors
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9
Q
  • Pain is not a part of lung disease until the — is involved
A

pleura

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10
Q

Atelectasis –Collapsed Lung
* Resorption

A

– Obstruction prevents air
from reaching distal
airway

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11
Q

Atelectasis –Collapsed Lung
* Compression

A

– Fluid within pleural
cavity

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12
Q

Atelectasis –Collapsed Lung
* Contraction

A

– Local or generalized
fibrotic changes

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13
Q
  • COPD –
A

a combination of
two diseases

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14
Q
  • Chronic bronchitis –
A

chronic inflammation of
bronchi
increases resistance to the
outflow of air

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15
Q
  • Emphysema –
A

destruction of elastic
tissue, loss of surface
area
reduces the elastic recoil of the lung
and surface area

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16
Q

Chronic Obstructive
Pulmonary Disease
common in
rare in

A
  • Common in cigarette smokers
  • Rare in non-smokers
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17
Q

Frequently occur together (companion diseases)

A

chronic bronchitis
emphysema

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18
Q

Chronic Bronchitis
Clinical definition –

A

persistent productive cough for 3 consecutive months in 2 consecutive years

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19
Q
  • Simple chronic bronchitis
A

airflow not obstructed

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20
Q

Chronic asthmatic bronchitis –

A

hyperreactive airways with bronchospasm and wheezing

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21
Q

Chronic obstructive bronchitis –

A

chronic outflow obstruction

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22
Q

Chronic Bronchitis
* Inspiration –
* Expiration -

A

easy
difficult

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23
Q

Emphysema
(3)

A
  • Abnormal permanent
    enlargement of the air
    spaces
  • Destruction of alveolar
    walls without fibrosis
  • Reduction in surface
    area for gas exchange
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24
Q

Centrilobular Emphysema
* Typically seen in

A

cigarette smokers

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25
Q

Panacinar Emphysema
(2)

A
  • Most commonly seen
    in Alpha-1 Anti-trypsin
    Deficiency
  • Seen in people without
    risk factors (smoking)
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26
Q

Alpha-1 Antitrypsin Deficiency
(5)

A
  • Causes a rare form of emphysema –panacinaremphysema
  • Protease-antiprotease imbalance
  • Oxidant-antioxidant imbalance
  • A1AT is anti-protease synthesized in the liver
  • A1AT scavenges proteases released by inflammatory cells (polys and macrophages)
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27
Q

Bronchiectasis
(3)

A
  • 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
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28
Q

Brochial Asthma
(6)

A
  • 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
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29
Q
  • Status asthmaticus –
A

a severe paroxysm that does not respond to therapy and persists

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30
Q

Bronchial Asthma
(6)

A
  • Mucus accumulation
  • Goblet cell hyperplasia
  • Hypertrophy of submucosalmucous glands
  • Chronic inflammation
  • Basement membrane thickening
  • Smooth muscle cell hypertrophy and hyperplasia
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31
Q

Allergic Asthma
(4)

A
  • 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
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32
Q

Drug-Induced Asthma
(2)

A
  • Aspirin sensitivity –aspirin induces asthma
    attack
  • History of recurrent rhinitis, nasal polyps,
    urticaria and bronchospasm
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33
Q

The lungs are a frequent site of – disease

A

metastatic

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34
Q

The most common lung tumor is —

A

metastatic

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35
Q

Lung metastases are present in about — of all cancer deaths

A

1/3

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36
Q

Metastases to the lungs are more common even than primary lung neoplasms simply because

A

so many other primary tumors can metastasize to the lungs

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37
Q

Carcinomas usually metastasize via the —

A

lymphatics

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38
Q

Sarcomas frequently metastasize via the

A

hematogenous route

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39
Q

Therapeutic Classification of
Bronchogenic Carcinoma
(2)

A
  • Small cell carcinoma
  • Non-small cell carcinoma
40
Q

Pathologic Classification of
Bronchogenic Carcinoma
(4)

A
  • Squamous cell carcinoma
  • Adenocarcinoma
  • Small cell carcinoma (oat cell carcinoma)
  • Large cell undifferentiated carcinoma
41
Q

Squamous Cell Carcinoma
(4)

A
  • Most often seen in cigarette smokers
  • Arises centrally from main bronchi close to the bifurcation
  • Squamous metaplasia precursor lesion
  • Prognosis depends on the stage
42
Q

Squamous Metaplasia of Columnar,
Ciliated Respiratory Epithelium
* Smoking causes
* Creates (2)

A

squamous metaplasia 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)

43
Q

Small Cell Carcinoma
(Oat Cell Carcinoma)
(5)

A
  • Arise centrally
  • Aggressive –metastasize early and widely
  • Chemotherapy
  • Neuroendocrine origin
  • Frequent association with smoking
44
Q

Adenocarcinoma
* Arises — in lung

A

peripherally

45
Q

Large Cell Carcinoma

A
  • Undifferentiated
    epithelial tumors that
    lack the cytologic
    features of small cell
    carcinoma and
    glandular or squamous
    differentiation
46
Q

Bronchial Carcinoid
(2)

A
  • Neuroendocrine cell
    origin
  • Often resectable and
    curable
47
Q

Mass Effects of Lung Cancer
(4)

A
  • Obstruction
  • Superior vena cava syndrome
  • Pancoast syndrome
  • Horner syndrome
48
Q
  • Obstruction -
A

atelectasis

49
Q
  • Superior vena cava syndrome –
A

compression of superior vena cava

50
Q
  • Pancoast syndrome –
A

compression of lower cervical and upper thoracic nerves

51
Q
  • Horner syndrome –
A

compression of sympathetic nerves

52
Q

Superior Vena Cava Syndrome
(4)

A
  • 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
53
Q

Horner Syndrome
Compression of the sympathetic
nerves to head and neck causing:
(4)

A
  • Enophthalmos –retraction of
    globe
  • Ptosis of the upper eyelid
  • Miosis - Pupillary constriction
  • Anhidrosis –lack of sweating
54
Q

Pancoast Syndrome

A
  • Compression of the
    lower cervical and
    upper thoracic nerves
    causing shoulder pain
    radiating down the arm
55
Q

Lung Cancers - Well Known for
Causing Paraneoplastic Syndromes
(3)

A
  • Small cell carcinoma
  • Cushing syndrome
  • Hyperparathyroidism
56
Q
  • Small cell carcinoma –
A

frequent ectopic hormone production

57
Q
  • Cushing syndrome -
A

ectopic secretion of an ACTH-like hormone
– Patients present with Cushing syndrome

58
Q
  • Hyperparathyroidism -
A

ectopic secretion of a parathyroid-like hormone
– Patients present with symptoms of hyperparathyroidism –parathyroids normal

59
Q

Effects of Bronchogenic Carcinoma
Summation
(5)

A
  • Local mass effects by blockage of airway
  • Metastasis
  • Paraneoplastic syndromes
  • Superior vena syndrome
  • Horner syndrome
60
Q

Mesothelioma
(2)

A
  • Malignant neoplasm of
    pleura associated with
    environmental
    asbestos exposure
  • Asbestos also increases
    risk for squamous cell
    carcinoma as well as
    mesothelioma
61
Q

Traditional Classification of
Pneumonia by Anatomic Distribution
(4)

A
  • Pneumonia =
    pneumonitis
  • Pattern of lung
    involvement
  • Bronchopneumonia –
    patchy involvement
  • Lobar pneumonia –
    entire lobe involved
62
Q

Classification of Pneumonia by
Etiologic Agent or Clinical Setting
(2)

A
  • Specific etiologic agent –e.g. Streptococcus pneumoniae
  • Clinical setting
63
Q

Clinical setting
(5)

A

– Community-acquired pneumonia
– Nosocomial pneumonia
– Aspiration pneumonia
– Chronic pneumonia
– Pneumonia in the immunocompromised host

64
Q

Pneumonia in Immunocompromised
Individuals
* Pneumocystis jiroveci
(older name: Pneumocystis carinii)

A

– Fungal organism of very low virulence in
immunocompetent individials

65
Q

Pneumonia in Immunocompromised
Individuals
* Mycobacterium avium intracellulare (MAI)

A

– Rarely pathogenic in immunocompetent individuals

66
Q

Pneumonia –Pneumonitis
* Bacterial
(5)

A

– Streptococcus pneumoniae
– Klebsiella pneumoniae
– Staphylococcus aureus
– Streptococcus pyogenes
– Legionella pneumophilia

67
Q

Pneumonia –Pneumonitis
* Viral
(3)

A

– Cytomegalovirus
– Roseola (measles)
– Varicella (chickenpox)

68
Q

Pneumonia –Pneumonitis
* Other
(2)

A

– Mycoplasma
– Chlamydia psittaci (psittacosis –
parrot fever)

69
Q

Pneumonia in AIDS
(2)

A
  • AIDS patients are susceptible to all forms of pneumonia
  • Pneumocystis carinii pneumonia (PCP)
70
Q
  • Pneumocystis carinii pneumonia (PCP)
    (3)
A

– AIDS patients especially vulnerable to Pneumocystis carinii pneumonia (PCP)
– Reclassified from a protozoan to a fungus
– Name changed to Pneumocystis jiroveci

71
Q

Tuberculosis
* Caused by

A

Mycobacterium tuberculosis hominis or bovis

72
Q

Tuberculosis
* In AIDS patients, — is a common pathogen

A

Mycobacterium avium-intracellulare

73
Q

Tuberculosis
* Transmitted from person-to-person by

A

aerosolized droplets during coughing, sneezing and talking

74
Q

Tuberculosis
* Initial lesion in

A

lung (Gohn focus/complex)

75
Q

Tuberculosis
* Following exposure the course of events is variable -

A

may disseminate and cause systemic involvement

76
Q

Tuberculosis
* Before anti-tubercular drugs,

A

nature took its course

77
Q

Primary Tuberculosis
(2)

A
  • Granulomas form in the
    periphery of the lung
    (Gohn focus) followed by
    Gohn complex
  • The classic lesion is a
    caseating granuloma
78
Q

Primary Tuberculosis
* The classic lesion is a
caseating granuloma –

A

a
collection of activated
macrophages (epitheliod
histiocytes), sensitized
lymphocytes,
multinucleated giant cells
and a collar of fibroblasts

79
Q

Secondary Tuberculosis
(3)

A
  • Lesions classically appear at the apices of the lungs and are cavitary
  • This form of tuberculosis usually is the result of reactivation of dormant organisms in old, silent lesions of primary tuberculosis
  • Reactivation is usually triggered by immunosuppression
80
Q

Pneumoconioses

A
  • Lung scarring from inhaled particulate matter
81
Q

Pneumoconioses
* Silicosis –
* Asbestosis –
* Berylliosis –
* Anthracosis –

A

silica
asbestos
Beryllium
coal dust
– Coal worker’s pneumoconiosis, Black lung disease

82
Q

Silicosis
(2)

A
  • Increased risk for
    tuberculosis
  • Silico-tuberculosis
83
Q

Asbestosis
(2)

A
  • Environmental hazard
  • Risk for mesothelioma
84
Q

Coal Worker’s Pneumoconiosis
(3)

A
  • Coal worker’s
    pneumoconiosis
  • Black lung disease
  • Progressive massive
    fibrosis
85
Q

Nasopharyngeal Carcinoma
(5)

A
  • Strong epidemiologic link to Epstein Barr
    virus
  • High frequency in Chinese
  • Three histologic variants:
  • Undifferentiated carcinoma variant most
    common
  • Radiosensitive–50% 5-year survival rate
86
Q

Nasopharyngeal Carcinoma
Three histologic variants:
(3)

A

– Keratinizing SCCa
– Non-keratinizing SCCa
– Undifferentiated carcinoma

87
Q

Nasopharyngeal Carcinoma
Undifferentiated carcinoma variant most
common

A

– “Lymphoepithelioma” (a misnomer) due
to the influx of mature lymphocytes

88
Q

Association of Epstein-Barr Virus
(HHV-4 ) with Human Disease
(4)

A
  1. Infectious Mononucleosis
  2. Lymphomas –NHL and HL
    e.g. Burkitt lymphoma (NHL)
  3. Nasopharyngeal Carcinoma
  4. Oral Hairy Leukoplakia
89
Q

Most common presenting symptom of laryngeal lesions is

A

hoarseness

90
Q

Vocal cord nodules (singer’s nodes, polyps) -

A

chronic irritation

91
Q

Laryngeal papillomas –

A

squamous papilloma - HPV

92
Q
  • Laryngeal papillomas –squamous papilloma - HPV
    (5)
A

– 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

93
Q

Laryngeal Squamous Cell Carcinoma
(6)

A
  • Adult males (7:1)
  • Strong association with cigarette smoking
  • Persistent hoarseness is most common symptom
  • Glottic tumors (directly on vocal cords) most common
  • Supraglottic tumors (above the vocal cords)
  • Subglottic tumors (below the vocal cords) least common
94
Q

Glottic tumors (directly on vocal cords) most common
(3)

A

– Most confined to larynx at diagnosis
– Cause symptoms early in course of disease
– Best prognosis –sparse lymphatics

95
Q

Supraglottic tumors (above the vocal cords)
(1)

A

– Rich in lymphatics –likely to metastasize to regional (cervical) lymph nodes

96
Q

Subglottic tumors (below the vocal cords) least common
(1)

A

– Remain subclinical and present with advanced disease

97
Q

Toxic Pulmonary Effects of
Chemotherapy (Pulmonary Fibrosis)
(5)

A
  • 67M with non-Hodgkin lymphoma undergoing chemotherapy (Bleomycin)
  • Pulmonary function tests (PFTs) normal at start of chemotherapy
  • One year later PFTs, 19% of lung function remaining
  • Continuous 100% oxygen therapy
  • Confined to wheel chair

Pathology (23 decks)

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