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SP16- Gen Path Exam 2 > Pulmonary Pathology > Flashcards

Pulmonary Pathology Flashcards

1
Q

How much do the lungs weigh?

A

200-250 grams each

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2
Q

Which lung is slightly larger?

A

right

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3
Q

True or False: The lungs have a dual blood supply.

A

True

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4
Q

What are the two sources of blood to the lungs?

A

pulmonary

bronchial

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5
Q

What is the major function of the lungs?

A

gas exchange

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6
Q

What is/are involved in the act of respiration?

A

upper respiratory tract
diaphragm
accessory muscles
neural regulation

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7
Q

Describe the pulmonary defenses of the upper and lower respiratory tract.

A 
upper = filtering function (hairs)
lower = mucociliary apparatus (clear debris through wavelike motions)
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8
Q

The vocal cords are lined by _______ epithelium.

A

stratified squamous

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9
Q

The large airways are lined by _______ epithelium. What are “large” airways?

A

pseudostratified, ciliated, columnar

larynx, trachea, and bronchi

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10
Q

What do the large airways contain within their walls?

A 
mucus glands (mucosal and submucosal)
neuroendocrine cells
cartilage
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11
Q

How many types of alveoli are lining the alveolar space? How prevalent are each of them?

A

Two types:
Type I Pneumocytes (flat) = 95%
Type II Pneumocytes (cuboidal, surfactant) = 5%

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12
Q

Other than hairs and mucociliary mechanisms, how does the pulmonary system protect itself?

A
  1. Lymphoid Tissues (in URT and LRT): provides cellular immunity and humoral immunity
  2. Alveolar Macrophages: collect particles of dust, infectious agents, etc.
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13
Q

What is the humoral immunity that lymphoid tissues provide?

A

mucosal IgA secretion

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14
Q

How far does cartilage extend through the pulmonary exchange vessels?

A

Trachea…Bronchi (c-shaped rings)…Small Bronchi (plaques of cartilage)….

(bronchioles contain no cartilage)

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15
Q

What is the difference between an immune and nonimmune lung?

A

immune: antibodies (IgA), Macrophages, Lymphocytes, PMN recruitment and opsonization

non-immune: mucus glands, complement proteins, neutrophils

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16
Q

What is hemoptysis?

A

coughing up blood

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17
Q

What is dyspnea?

A

difficulty breathing, perception of needing to breath deeper and faster (shortness of breath)

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18
Q

What is atelectasis?

A

collapse of lung volume; inadequate expansion of air spaces

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19
Q

What is a pneumothorax?

A

air in the pleural space OR CAVITY; leads to collapse of the lung

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20
Q

Describe pleural effusion.

A

fluid within the pleural space

-it can be either transudate or exudate

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21
Q

What is transudate?

A

low protein fluid, caused by increased VENOUS pressure (CHF for example)

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22
Q

What is exudate?

A

high protein fluid, with or without inflammatory cells, caused by increased vascular PERMEABILITY (damage), pneumonia is an example

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23
Q

________ is suppuration in the pleural cavity; often related to bacterial infection.

A

Empyema

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24
Q

Pulmonary edema is the accumulation of ________.

A

Fluid in the lungs

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25
Q

With pulmonary edema, where does fluid accumulate first?

A

in the interstitial tissues…then into the distal air spaces

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26
Q

What are the three causes of pulmonary edema?

A
  1. increased intravascular pressure (CHF)
  2. hypoproteinemia (low protein)- associated with liver/kidney diseases
  3. vascular damage (infections, autoimmune diseases)
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27
Q

What is the problem with pulmonary edema?

A
  • fluid inhibits normal oxygen exchange

- predisposes to infection (fluid become a food source for bacteria such as pneumonia)

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28
Q

Pulmonary thromboemboli usually originate in the _____.

A

deep veins of the legs or pelvis

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29
Q

What are the different effects of small, large, and very large emboli?

A

small: may only cause minimal damage
large: may causes hemorrhage or infarction

very large: may lodge at the bifurcation of pulmonary arteries and cause a saddle embolus= can causes sudden death

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30
Q

Name four predisposing factors to pulmonary thromboemboli.

A
  1. chronic illness
  2. prolonged bed rest (immobility)
  3. hypercoagulable state (factor V leiden)
  4. deep vein thrombophlebitis
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31
Q

There are four classes of _________ that result in airflow limitation or obstruction. What are the four?

A

Obstructive Pulmonary Diseases

  1. emphysema
  2. chronic bronchitis
  3. bronchiectasis
  4. asthma
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32
Q

True or False: Overlap among the obstructive pulmonary diseases is common.

A

True (emphysema + chronic bronchitis = COPD)

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33
Q

What is emphysema?

A

“alveolar wall destruction and overinflation”

  • permanent enlargement of the small air spaces due to destruction of alveolar septae (alveoli start as a bunch-of-grapes but as the walls breakdown, they form one large airspace which lowers the total surface area available for gas exchange = trouble exhaling and trapping of “old air”)
  • imbalance between PROTEASE and ANTI-PROTEASE enzymes
  • coughing, prolonged exhalation, shortness of breath
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34
Q

What is the major cause of the imbalance seen in emphysema? What is the imbalance?

A

Major cause = smoking (breakdown of alveoli parenchyma)

-imbalance between protease and anti-protease enzymes

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35
Q

What are the two types of emphysema?

A
  1. centriacinar
    (upper lobes effected, involves central portion of acini)
  2. panacinar
    (lower lobes usually effected, involves entire acinar unit from the respiratory bronchioles to terminal alveoli)
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36
Q

Panacinar emphysema is seen in patients with ______ deficiency.

A

alpha-1 Antitrypsin (alpha-1-AT)

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37
Q

Which type of emphysema is most closely related to smoking?

A

centriacinar (upper lobes!)

What happens: smaller “balloons/acini” of respiration no longer have elastic recoil and therefore the larger “balloons/acini” must work harder to squeeze enough air through

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38
Q

What are the two main clinical symptoms of chronic bronchitis?

A

cough AND sputum production

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39
Q

What causes chronic bronchitis?

A

chronic irritation (smoking) and infections

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40
Q

What are the criteria for becoming “chronic” bronchitis?

A

(cough + sputum) for 3 consecutive months…over 2 consecutive years

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41
Q

Patients with emphysema are called “______” and those with chronic bronchitis are called “______ .”

A

“pink puffers” -they look oxygenated

“blue bloaters” -hypoxic and cyanotic looking

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42
Q

What is the pathogenesis and pathology of chronic bronchitis?

A

pathogenesis: chronic irritation and infections (same as emphysema)
pathology: increased mucus gland layer, chronic inflammation, fibrosis and narrowing of the airways

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43
Q

True or False: The predisposing factors for emphysema and chronic bronchitis are the same.

A

True:

  1. cigarette smoking
  2. atmospheric pollutants
  3. infections
  4. genetic factors (CF, alpha-1-AT deficiency)
    * although a1AT is most closely related to emphysema*
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44
Q

Histologically, what are two signs of chronic bronchitis?

A

INCREASED mucus glands (2-3 times normal)

squamous metaplasia

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45
Q

Narrowing of the airways occurs in ________, but dilation of the airways occurs in ________.

A

bronchitis (narrowing)

bronchiectasis (dilation)

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46
Q

True or False: Bronchiectasis is not a disease.

A

True, it is the RESULT of disease (permanent dilation due to fibrosis is secondary to obstruction, infection, or both)

47
Q

How does bronchiectasis present clinically?

A

severe cough
bloody mucoid expectoration
dyspnea
fever

48
Q

What are the possible implications of bronchiectasis?

A

abscess, pneumonia, bronchopleural fistula, and empyema

49
Q

Lungs that suffer from bronchiectasis will show dilation of the distal airways. What will be grossly visible in these lungs?

A

fibrosis

mucus plugs

50
Q

What is asthma?

A

increased irritability and prominence of SMOOTH MUSCLE in bronchi and bronchioles
(results in episodes of contraction and constriction)
=wheezing, long exhalation, hyperinflation of lungs

51
Q

What are the common initiating factors for asthma?

A 
allergies
infection
exercise
drugs
emotions
52
Q

How common is asthma?

A

affects 5% of adults

affects 7 to 10% of children under 15

53
Q

True or False: Asthma is more common in inner city children.

A

True

54
Q

What are the types of asthma?

A
  1. Atopic

2. Non-atopic

55
Q

______ asthma is extrinsic/allergic and is associated with Type I hypersensitivity (mediated by IgE).

A

Atopic

56
Q

True or False: Atopic asthma commonly has a positive family history.

A

True

57
Q

What is non-atopic asthma?

A

intrinsic

-initiated by viruses, or air pollutants

58
Q

True or False: Either type of asthma can be triggered by emotional stress, exercise or cold temps

A

True

59
Q

Describe the pathology of asthma.

A

increased mucus glands
smooth muscle hypertrophy
inflammation

60
Q

What types of cells are associated with the asthma induced inflammation?

A

eosinophils

type 2 helper T cells

61
Q

How does asthma develop (pathogenesis)?

A
  • antigen binds to surface IgE on mast cells
  • release of mediators
  • mediators = histamine and leukotrienes
62
Q

How is asthma treated?

A
  • attacks may subside spontaneously
  • inhalation bronchodilators can provide immediate relief (albuterol)
  • control medications (corticosteroids)
63
Q

The airways in asthma patients will present with thicker layers of ______ and ______.

A

smooth muscle

eosinophils/mucus

64
Q

_______ is one of the leading causes of death (often complicates other debilitating diseases) and is caused by bacteria, virus, fungi, or parasites.

A

Pneumonia

65
Q

What are the predisposing factors to bacterial pneumonia?

A
  • loss of cough reflex
  • injury to cilia
  • immunocompromised condition
  • decreased phagocytosis
  • pulmonary edema (fluid = food for bacteria)
66
Q

Bacterial pneumonia is associated with “productive” coughing. What does this mean?

A

sputum production (blood or blue-green-gunk)

67
Q

What are the two major types of bacterial pneumonia?

A
  1. Bronchopneumonia = patchy, begins in small bronchi

2. Lobar pneumonia = entire lobe

68
Q

Bronchopneumonia (patchy) is common in ______ or _____.

A

very young

very old

69
Q

Lobar pneumonia occurs in healthy adults and is most commonly (90%) associated with _____ _____.

A

streptococcus pneumoniae

70
Q

What are the stages of pneumonia?

A
  1. Congestion (increased RBC and WBC)
  2. Red Hepatization (purulent exudate, RBCs)
  3. White Hepatization (exudate with fibrin /macrophages)
  4. Resolution (not normal, but functioning)
71
Q

If resolution and scarring does not occur, what are possible complications of bacterial pneumonia?

A
  1. abscess/empyema
  2. fibrinous pleuritis
  3. pericarditis
  4. bacteremia (vascularization, shock, and DIC)
72
Q

Atypical (interstitial) pneumonia is caused by viruses and __________.

A

mycoplasma pneumoniae

73
Q

How does atypical pneumonia differ clinically from bacterial pneumonia?

A

DRY cough***

other symptoms are variable, but include: headache, fever, myalgia

74
Q

What is the pathology associated with atypical pneumonia (also called interstitial or walking pneumonia)?

A

INTERSTITIAL inflammation
mononuclear cells
congestion
hyaline membranes (alveolar damage is variable)

75
Q

What are the “hyaline membranes” associated with interstitial pneumonia?

A
  • thickening of interstitium that can be seen histologically as thick bands around airspaces
  • also called “diffuse alveolar damage”
76
Q

True or False: ARDS has the same histologic features as interstitial pneumonia.

A

True, acute respiratory distress syndrome shows a thickened hyaline cartilage as is seen with interstitial pneumonia

77
Q

True or False: ARDS develops insidiously over the course of about 2 months.

A

False, very rapid…could cause death within 2-3 days

78
Q

What are the causes of ARDS?

A 
shock
infection
trauma
drug overdose
irritants
aspiration
fat embolism
many others
79
Q

ARDS presents with increased _______ ________ due to injury to the _______ and alveolar epithelium.

A 
endothelial permeability (leaky)
endothelium
80
Q

Aspiration is a common predisposing factor for _____ ______.

A

Pulmonary Abscess

81
Q

Describe the course (development) of a pulmonary abscess.

A

scar
cavitate
progressively enlarge

82
Q

True or False: there is purulent exudate associated with pulmonary abscess.

A

True

83
Q

How is tuberculosis spread?

A

inhalation

84
Q

Tuberculosis infects about ____ of the world population and accounts for approximately ______ deaths per year.

A

1/3
3 million
most common infectious cause of death in the world

85
Q

True or False: There is a higher rate of TB in immigrant and inner city populations.

A

True, crowing/poor living are predisposing factors

86
Q

__________ tuberculosis is a bacillus, ________ that is slow-growing and ________.

A

Mycobacterium
aerobe
non-motile

87
Q

How does M. tuberculosis resist acid destaining (making it an “acid fast bacillus”)?

A

its waxy coat is resistance

88
Q

What is the classic tissue reaction of M.tuberculosis?

A

CASEATING (cheesy) granulomatous inflammation

89
Q

A _____ lesion is seen at the site of early TB infection.

A

Ghon…. remember it’s cheesy!

90
Q

What is a Ghon Complex?

A

parenchymal lung lesion + hilar lymph nodes

91
Q

How often do primary cases of TB resolve?

A

90-95%

92
Q

What are three possible courses for TB infections?

A
  1. inactivates (may reactivate many years later if immunity wanes)
  2. disseminates (involves many other organs, ex: miliary TB)
  3. Reactivation and induction of type IV hypersensitivity (results in tissue necrosis)
93
Q

Cavitary TB is characteristic of “secondary” or “adult-type” tuberculosis and is associated with extensive ______ in the ______ of the lung.

A

necrosis/cavitation

apex or upper portion

94
Q

How can Cavitary TB produce a tuberculosis bronchopneumonia?

A
  • Cavities form when necrosis involves the wall of an airway
  • the semi-liquid necrotic material is discharged into the bronchial tree from where it is usually coughed up
  • This infected material may seed other parts of the lung via the airways to produce a tuberculous bronchopneumonia
95
Q

What is Miliary TB?

A
  • spread of TB through lymphatics or blood results in infection of other organs or systems (CNS, Kidneys, adrenals, bones, bone marrow, liver, spleen)
  • looks like “millet seeds”
96
Q

Granulomatous inflammation is found in processes other than TB. It is associated with _______ or fungal infections such as ______ (which is common in the Ohio River Valley)

A

sarcoidosis (growth of tiny collections of inflammatory cells in different parts of the body)

histoplasmosis

97
Q

What is the leading cause of cancer death in the US for both men and women?

A

Lung Cancer

98
Q

What are the risk factors for Lung Cancer?

A 
cigarette smoking*****
asbestos
radon gas
nickel/chromates
pollutants
lung scarring
99
Q

Why is there such a high rate of death associated with lung cancer?

A

late-stage detection

100
Q

True or False: Some lung tumors produce hormones.

A

True, or hormone-like substances (ADH, ACTH, PTH, etc.) = paraneoplastic syndromes

101
Q

What is a paraneoplastic syndrome?

A
  • a syndrome that is the consequence of cancer in the body that is not due to the local presence of cancer cells
  • These phenomena are mediated by humoral factors (by hormones or cytokines) excreted by tumor cells or by an immune response against the tumor.
102
Q

How does lung cancer present clinically?

A 
cough
weight loss
chest pain
hemotysis
dyspnea
103
Q

What are the two most common types of lung cancer?

A

Squamous Cell Carcinoma (25-30%)

Adenocarcinoma (30-35%)

104
Q

True or False: There is a “small cell” and a “large cell” lung cancer.

A

True,
small cell (oat cell) accounts for 20-25%
large cell is less common at 10-15%

105
Q

What is the prognosis for Lung Cancer?

A

5 year survival for all types= 16%

localize when found (however, it is hard to see it coming) = 45% survival

106
Q

______ is a group of lung disorders caused by inhalation of dust or particles.

A

Pneumoconioses

107
Q

What are important factors in pneumoconioses particles?

A

size
shape
concentration

108
Q

What size particles are most dangerous?

A

1 - 5 micrometers in diameter

go figure, cigarette smoke produces particles of ~1-5 micrometers

109
Q

What does pneumoconiosis do to the lungs?

A

inhaled particles induce fibrosis/scarring

110
Q

What is a common occupation that is associated with pneumoconioses?

A

Coal Workers’s

  • nodular or diffuse fibrosis with coal macules
  • “progressive massive fibrosis” = ongoing fibrosis and lung destruction
111
Q

What is the most prevalent form of occupational disease worldwide?

A

silicosis

112
Q

_______ disorders result in reduced lung capacities. Examples include: ARDS, interstitial lung disease, and others.

A

Restrictive Lung

113
Q

Asbestos bodies in the lungs are covered with which element?

A

iron

SP16- Gen Path Exam 2 (7 decks)

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