Pulmonary Pathology Flashcards
What is the difference between transudate and exudate?
Transudate is an ultrafiltrate (like water, low in protein and cells)
Exudate is not an ultrafiltrate (serous, blood, pus, malignant, chyle)
Which disorders have pleural effusion with transudate?
CHF, Nephrotic syndrome, Cirrhosis
Which disorders have pleural effusion with exudate?
Inflammatory (SLE, RA)
Infectious (TB, pneumonia, empyema)
Reactive (embolus, diaphragm)
Malignant
What lab findings would indicate that pleural fluid is an exudate?
High fluid/serum protein
High fluid/serum LDH (lactate dehydrogenase)
High fluid cholesterol
What could cause a parietal pleura pneumothorax?
Trauma
Needle/catheter insertion
What could cause a visceral pleura pneumothorax?
Subpleural rupture
Subpleural lung necrosis
What is it called when a build up of connective tissue causes pressure on the lung? Air? Pus?
Connective tissue - Fibrothorax
Air - Pneumothorax
Pus - Empyema
What PFT finding is consistent with obstructive pulmonary disease?
FEV1/Total volume is markedly diminished
Are emphysema and chronic bronchitis small airway or large airway diseases?
Small airway
What causes restrictive diseases?
Scarring/Fibrosis
What causes permanent enlargement of lungs in emphysema patients?
Parenchymal damage (loss of alveolar structure), loss of elastic recoil Also decreases surface area for gas exchange
Are patients with emphysema or chronic bronchitis more likely to have infectious exacerbations?
Chronic bronchitis
What disease are the following complications associated with? Respiratory insufficiency, CO2 retention and respiratory acidosis, Secondary pulmonary hypertension, Right ventricular hypertrophy, Pneumothorax and lung collapse
Emphysema
Increased mucus secretions and mucopurulent exudates are common in emphysema or chronic bronchitis?
Chronic bronchitis
What are the differences b/t emphysema and chronic bronchitis?
Emphysema: Dyspnea > cough Few infections Cor pulmonale is rare Low elastic recoil
Chronic Bronchitis: Cough > dyspnea Infectious exacerbations Usual cor pulmonale Normal elastic recoil
What does the BODE index include?
B - BMI
O - Obstruction of airflow: FEV1
D - Dyspnea
E - Exercise capacity, 6 min walk test
Asthma is what type of hypersensitivity disorder?
Type I - IgE
Goblet cell metaplasia is seen in which disease?
Asthma
What is the pathogenesis of asthma?
Airway inflammation and bronchial hyperreactivity
Sensitization by envirmonmental antiget of Type I IgE mediated hypersensitivity
Sensitized CD4 T cells (Th-2) release IL-4, IL-5 cytokines which promote IgE production, mast cell activation, recruitment of eosinophils
Elaboration of histamine, prostaglandins and leukotrienes
What are the histopathological findings in the lungs of an asthma patient?
Mucus in lumen of bronchus
Inflammation and basement membrane thickening
Enlarged mucous glands
Smooth muscle hyperplasia
What is bronchiectasis?
Abnormally dilated airways toward pleural surface due to obstruction and infection
Can be in cystic fibrosis, bronchial obstruction, immunodeficiency diseases, necrotizing bronchopneumonias
What are the physical findings associated with bronchiectasis?
Persistent cough Purulent sputum Dyspnea Pleuritic chest pain Hemoptysis Fever, anorexia, weight loss
Alveolitis, intra-alveolar macrophages, interstitial inflammation and intersitital fibrosis is seen in what group of diseases?
Interstitial lung disease
What finding is expected on chest x-ray in interstitial lung disease?
Interstitial thickening
What is the pathogenesis of ILD?
Injury and inflammation at alveolus
Pneumocyte type I loss, type II proliferation
Interstitial inflammation - mediators and cytokines that damage alveolar epithelium
Angiogenesis, myofibroblast, fibroblast proliferation
Interstitial collagen deposition and reorganization
End stage pulmonary scarring
What is top of your DDx if CXR shows “honeycomb lung”?
Interstitial lung disease
What is a top priority for patients newly diagnosed with usual interstitial pneumonia?
Get pt on transplant list as soon as possible
Respiratory failure normally occurs over 2-5 yrs
RBILD and DIP are closely associated with what risk factor?
Smoking
What are the inflammatory foci in sarcoidosis called?
Non-caseating granulomas
What risk factor is most closely associated with pneumoconiosis?
Occupational exposure
Coal workers lung disease
Silicosis
Asbestosis
What type of WBC react to inhaled molecules in pneumoconiosis?
Macrophages
What is the difference b/t UID and asbestos lung disease?
Asbestos exposure
Pleural Plaques
What type of hypersensitivity is involved in hypersensitivity pneumonitis?
Type III (immune complex) and Type IV (cell mediated)
Bronchiolitis and interstitial giant cells are associated with what disease?
Hypersensitivity pneumonitis
What is a possible outcome of any disease which damages the alveolar-capillary structure via alveolar injury and/or endothelial cell injury?
ARDS
What happens when alveolar and endothelial cell injury occurs in ARDS?
Increased permeability and exudation of plasma proteins and inflammatory cells into the alveolus and interstitium
Exudative hyaline fibrinous membrane and cellular exudate
Why does ARDS not respond to oxygen therapy?
Vascular shunting
Ventilation-perfusion mismatch
Increased stiffness of lung
What finding on CXR is common in ARDS?
Bilateral interstitial edema
How can infectious agents get into the lungs?
Inhalation of aerosol particles
Aspiration of infected secretions from upper respiratory tract
Aspiration of regurgitated gastric contents
Hematogenous spread
What are common bacteria to blame for respiratory infections?
S. pneumonia, H. influenza, S. aureus, M. tuberculosis
What are common fungi involved in respiratory infection?
Aspergillus flavus, Candida albicans, Pneumocystis jiroveci
What are possible complications of pneumonia?
Pleural fibrosis Empyema Abscess Bronchiectasis Interstitial fibrosis Cysts
Patients with T cell dysfunction are most susceptible to what types of lung infection?
Bacterial
Fungal
Protozoan
Viral
In what disease are Ghon’s complexes seen?
Pulmonary Tuberculosis
What is primary disseminated TB?
Primary TB occurs in immunocompromised who develop cavitation and a military lung pattern
What is secondary TB?
reactivation of primary focus in individuals who develop immunodeficiency
What is primary localized TB?
granulomatous infection (Ghon lesion) which will drain to hilar lymph node with granulomatous caseous necrosis (Ghon complex)
What is the clinical presentation of lung cancer?
Local: Cough, Hemoptysis, Chest Pain, Wheeze, Dyspnea
Systemic: Effusion, Pancoast, SVC, Paraneoplastic, Metastases
TNM staging of lung cancer takes into account what characteristics of disease?
Tumor (histologic type and grade, size and distance from bronchial margin, invasion of pleura and adjacent structures, obstructive pneumonia) Lymph Node (bronchial, hilar, mediastinal) Metastases
Lung cancer is most frequently diagnosed in what stage? (per pathology lecture)
Stage IV: 45%
Stage III: 30%
Stage I/II: 25%
What is the overall survival rate of lung cancer? (per pathology lecture)
15%
Stage I 60%
Stage II 40%
Stage IIIa 20%
