Pulmonary Pathology DSA I

Question 1

Resorptive, Compression, and Contraction atelectasis

Answer 1

Resorption - apex lowers.

Compression - base raises.

Contraction - entire long shrinks.

Question 2

Acute stage of Acute Respiratory Distress Syndrome (ARDS) morphology

Answer 2

Acutely, lungs are heavy, firm, red and boggy w/ intra-alveolar edema, inflammation and fibrin deposition w/ **diffuse alveolar damage.

Question 3

What is diffuse alveolar damage?

Answer 3

Alveolar walls become lined w/ waxy hyaline membranes that are morphologically similar to hyaline membrane DZ in neonates.

Question 4

What is ARDS?

Answer 4

Clinical syndrome of progressive respiratory insufficiency from diffuse alveolar damage in the settings of:

• sepsis
• severe trauma
• diffuse pulm infection

Question 5

What are the 2 key initiating events of lung disease?

Answer 5

Damage to endothelial and alveolar epithelial cells w/ inflammation.

Question 6

Smoking/pollution + genetic predisposition can lead to alveolar wall destruction via which 3 mechanisms?

Answer 6

1. Oxidative stress, increased apoptosis, senescence.
2. Inflammatory cells, release of mediators.
3. Protease-antiprotease imblance (a1 can come in here).

Question 7

Generally, which parts of the lungs are effect most in emphysema?

Answer 7

Upper 2/3.

Question 8

Microscopically, what do the alveoli look like in emphysema?

What causes the alveoli look like this from smoking?

Answer 8

Abnormally large and separated by thin septa w/ focal centriacinar fibrosis.

Ongoing accumulation of inflammatory cells, which releases elastases and oxidants which damage the alveolar walls.

Question 9

“Emphysema is…”

Answer 9

A chronic obstructive airway DZ characterized by permanent enlargement of air spaces distal to terminal bronchioles.

Question 10

4 subtypes of emphysema

Answer 10

Centriacinar - most common, smoking related.

Panacinar - seen in a1 antitrypsin def.

Distal acinar

Iregular

Question 11

What is the major gross change to the lung in a patient w/ chronic bronchitis?

Answer 11

Hyperplasia of mucous glands

Question 12

Reid index

Answer 12

Used to asses the amount of mucous gland hyperplasia by taking the ratio of thickness of the mucous gland layer to the thickness of the wall between the epithelium and cartilage. Usually 0.4, but increased in pts. w/ COPD.

Question 13

Bronchiolitis obliterans

Answer 13

Obliteration of the lumen of bronchioles from fibrosis seen in severe lung disease.

Question 14

Chronic bronchitis defined:

Answer 14

Persistent productive cough for 3 consecutive mo. in at least 2 consecutive years.

Question 15

2 dominant pathologic features of chronic bronchitis

Answer 15

Mucous hypersecretion and chronic inflammation

Question 16

Curshmann spirals

Answer 16

A finding in sputum or bronchoalveolar lavage specimens that likely result from extrusion of mucous plugs from subepithelial mucous glands or bronchioles in pts. *dying of acute severe asthma.

Question 17

Charcot-Leyden crystals

Answer 17

Another finding in a patent dying from acute severe asthma. They are composed of an eosinophil protein called galectin-10.

Question 18

What’s airway remodeling?

Answer 18

Occurs in asthma and includes:

• thickening of airways
• sub-BM fibrosis
• increased vascularity
• glandular hyperplasia and increased goblet cells
• enlargement of bronchial wall muscle

Question 19

Atopic asthma is caused by what immune reaction?

What 3 cytokines are most known to have a role?

What inflammatory cell is most commonly found in asthmatics?

Answer 19

Th2 and IgE-mediated rxn.

IL-4, IL-5, IL-13.

Eosinophils

Question 20

What part of lung is usually affected by bronchiectasis? What part of the respiratory tree is most serious?

What do the airways look like?

Answer 20

Lower lobes BL, and most severe in distal bronchi and bronchioles.

Dilated, sometimes up to 4x normal.

Question 21

Distal interstitial fibrosis of the lung gives rise to…

Answer 21

Restrictive lung DZ, characterized by reduced compliance and FVC. The ratio of FEV1/FVC is normal.

Question 22

What “characterizes” idiopathic PF?

Answer 22

Patchy interstital fibrosis fibroblastic foci and honeycombing.

Question 23

Coal macules and nodules

Answer 23

Macules are Mo found in pts. exposed to anthracosis and together form a nodule, along with some collagen fibers.

Question 24

Complicated coal workers’ pneumonia

Answer 24

Occurs in background of simple diseases and requires yrs to develop. It is characterized by blackened scares 1 cm or bigger (usually multiple) that consist of dense collagen and pigment. The center is usually necrotic from ischemia.

Question 25

What disease is associated w/ “hard, collaginous scars” in the hilar LNs and upper lung zones?

What is eggshell calcification?

Answer 25

Silicosis

The calcification of these nodes seen on CXR.

Question 26

What do asbestos bodies look like?

Answer 26

Golden brown, fusiform or beaded rods w/ a translucent center and consist of asbestos fibers coated in iron proteinaceous material, like ferringuous bodies.

Question 27

Most common manifestation of asbestos exposure:

Answer 27

Pleural plaques n the anterior and posterolateral parts of parietal pleura and over the domes of the diaphragm.

Question 28

Pneumoconioses

Most common type:

Answer 28

A group of chronic fibrosing DZs of lung resulting from exposure to organic and inorganic particulate, suually mineral dust.

Silicosis