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General Pathology > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What is the major function of the lungs?

A

to replenish oxygen (O2) and remove carbon dioxide (CO2) from blood

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2
Q

What is pulmonary ventilation?

A

(commonly referred to as breathing) the process of air flowing into the lungs during inspiration (inhalation) and out of the lungs during expiration (exhalation)

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3
Q

Where does gas exchange occur? What properties do the alveoli require for this to happen?

A
  • occurs in the lungs between alveolar air and the blood of the pulmonary capillaries.
  • alveoli must be ventilated and perfused
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4
Q

What is ventilation (V) referring to in gas exchange?

A

refers to the flow of air into and out of the alveoli

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5
Q

What is perfusion (Q) referring to in gas exchange?

A

the flow of blood to alveolar capillaries

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6
Q

What zone of the lung does gas exchange occur?

A

occurs in the respiratory zone of the lung, where alveoli are present

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7
Q

What does the respiratory zone of the lung include?

A
  • alveolar septa
  • alveolar septum
  • capillary endothelial cells
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8
Q

What does the alveolar septum contain?

A
  • type I pneumocytes cover ~ 95% of the internal surface (lining)
  • type II pneumocytes that secrete surfactant
  • alveolar macrophages (also known as dust cells)
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9
Q

Lung function is physiologically divided into _____ volumes

A

four

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10
Q

What are the four volumes of the lung?

A

(1) expiratory reserve volume
(2) inspiratory reserve volume
(3) residual volume
(4) tidal volume.

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11
Q

What is the total of the four lung volumes equal to?

A

total lung capacity (TLC)

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12
Q

What is Pulmonary function testing (spirometry)

A

measures the rate at which the lung changes volume during forced breathing maneuvers

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13
Q

What are the lung capacities?

A
  • Inspiratory capacity (IC)
  • Total lung capacity (TLC)
  • Vital capacity (VC)
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14
Q

What are the different lung volume measurements?

A
  • Expiratory reserve volume (ERV)
  • Inspiratory reserve volume (IRV)
  • Residual volume (RV)
  • Tidal volume (VT )
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15
Q

What are the frequently used Spirometric values of the lung?

A
  • Forced vital capacity (FVC)
  • Forced expiratory volume in one second (FEV1 )
  • FEV1/ FVC ratio
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16
Q

What is forced vital capacity?

A

the total volume of air that can be exhaled during a maximal forced expiration effort.

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17
Q

What is forced expiratory volume in one second?

A

the volume of air exhaled in the first second under force after a maximal inhalation

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18
Q

What is the FEV1/ FVC ratio

A

the percentage of the FVC expired in one second

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19
Q

What are the airflow measurements of the lung?

A

Peak expiratory flow (PEF) (or peak expiratory flow rate [PEFR])

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20
Q

What is obstructive pulmonary disease?

A

any disease which causes a decrease in ventilatory function (airflow) due to (usually irreversible) obstruction of bronchi or bronchioles

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21
Q

What is Restrictive Pulmonary Disease?

A

any disease which causes a decrease in ventilatory function due to a decrease in the elasticity of the lungs themselves or caused by a problem related to the impaired expansion of the chest wall during inhalation

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22
Q

What is atelectasis?

A

(also known as collapse) is loss of lung volume caused by inadequate expansion of air spaces

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23
Q

What are the two major etiologic types of atelectasis?

A
  • Obstructive atelectasis (resorption atelectasis)
  • Nonobstructive atelectasis
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24
Q

What does obstructive atelectasis result from?

A

results from a blocked airway

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25
Q

What does nonobstructive atelectasis result from?

A
  • Compression atelectasis (pleural effusion)
  • Contraction atelectasis
  • Abnormalities in surfactant
  • Decreased ventilation of a portion of the lung
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26
Q

What is a pneumothorax?

A

Air in the pleural space, resulting in collapsing (atelectasis) of the lung

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27
Q

What are the classifications of pneumothorax?

A
  • Primary pneumothorax
  • Secondary pneumothorax
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28
Q

What causes Primary pneumothorax and Secondary pneumothorax

A
  • Primary: idiopathic pneumothorax
  • Secondary: emphysema or chronic bronchitis
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29
Q

What are clinical signs of a pneumothorax

A
  • Sudden onset of pleuritic chest pain
  • dyspnea
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30
Q

What is a hydrothorax?

A

A noninflammatory collection of serous fluid within the pleural cavities

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31
Q

What is the most common cause of a hydrothorax?

A

congestive heart failure

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32
Q

What do hydrothorax cause?

A

causes compression atelectasis

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33
Q

What is bacterial pneumonia?

A

Inflammation of the pulmonary parenchyma caused by an infectious agent (in this case, bacteria

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34
Q

What is etiology of bacterial pneumonia?

A

Bacteria cause acute, pyrogenic inflammation with exudates (fibrin, edema, neutrophils and macrophages) filling alveoli

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35
Q

What are the classifications of bacterial pneumonia?

A
  1. Lobar pneumonia
  2. Bronchopneumonia
  3. Interstitial (atypical) pneumonia
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36
Q

What is lobar pneumonia characterized by

A

consolidation (normal air filled space is filled with disease) of an entire lobe of the lung

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37
Q

What is Bronchopneumonia characterized by

A

scattered patchy consolidation centered around the bronchioles

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38
Q

What is Interstitial (atypical) pneumonia characterized by

A
  • diffuse interstitial infiltrates
  • Inflammatory cells and exudates are confined to alveolar walls only
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39
Q

What is the clinical presentation of bacterial pneumonia?

A

Varies with the cause of pneumonia, the patient’s age, and the clinical situation, but often includes:
- fever and chills
- productive cough with purulent yellow-green (pus) or rusty (bloody) sputum
- tachypnea with pleuritic chest pain
- decreased breath sounds
- elevated WBC coun

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40
Q

What is aspiration pneumonia?

A

sub-type of bacterial pneumonia resulting from entry (aspiration) of bacterial-colonized oropharyngeal or upper gastrointestinal contents

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41
Q

Aspiration pneumonia classically presents as what?

A

right lower lobe infection / pneumonia

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42
Q

What is viral pneumonia, and what are the most common causes?

A
  • lung infection caused by any of a large number of viral pathogens
  • influenza types A and B, the respiratory syncytial viruses (RSV), & coronavirus
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43
Q

What are lung abscess?

A

localized area of suppurative liquefaction necrosis within the pulmonary parenchyma

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44
Q

What causes lung abscess?

A

Aspiration of infective material from carious teeth or infected sinuses or tonsils are the most common cause of lung abscess, with periodontal disease being a major predisposing factor

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45
Q

What is the clinical presentation of lung abscess?

A
  • Prominent cough that usually yields copious amounts of foul-smelling, purulent, or sanguineous sputum
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46
Q

Where are lung abscess most common

A

more common in the right lower lobe of the lung

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47
Q

What is pulmonary tuberculosis?

A

an infection of the lung and, occasionally, surrounding structures, caused by the bacterium Mycobacterium tuberculosis (MTB)

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48
Q

What are the two major forms of tuberculosis infections and the characteristics?

A
  • Primary (acute) tuberculosis: develops in a previously unexposed and therefore unsensitized patient
  • Secondary (reactivation) tuberculosis: reactivation of dormant primary lesions many decades after initial infection, particularly when host resistance is weakened.
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49
Q

What is the main cause of tuberculosis?

A

Mycobacterium tuberculosis (MTB), strict aerobe bacilli that are slow-growing and acid-fast

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50
Q

What are different classifications of tuberculosis?

A
  • Pulmonary TB (most common form)
  • Miliary (disseminated) pulmonary TB
  • Systemic miliary TB
  • Endobronchial, endotracheal, and laryngeal TB
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51
Q

When does miliary pulmonary TB occur?

A

when MTB bacilli reach the bloodstream through lymphatic vessels and then recirculate to the lung via the pulmonary arteries

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52
Q

When does systemic miliary TB occur?

A

when the MTB bacilli spread hematogenously throughout the body

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53
Q

How do the MTB organisms enter the body in Primary (Pulmonary) Tuberculosis?

A
  • enter the body by inhalation, then commonly deposited in alveoli
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54
Q

In Primary (Pulmonary) Tuberculosis, sensitized _____ cells are lacking. The MTB organisms _____ freely and enter the bloodstream and lymphatics and disseminate to other parts of the body during the first few ______ after infection

A
  • CD4+ T
  • multiply
  • weeks
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55
Q

What type of immunity is important in primary tuberculosis?

A

cell mediated immunity

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56
Q

What is a ghon focus?

A

an area (tubercle) of gray-white granulomatous inflammation with consolidation develops in the lung as the immune response develops to MTB

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57
Q

In most cases, the center of the Ghon focus tubercle undergoes _____ necrosis

A

caseous

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58
Q

Tubercle MTB bacilli, either free or within phagocytes, drain to the ____ lymph nodes, which also often caseate

A

regional hilar

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59
Q

What is the ghon complex?

A

The combination of Ghon focus parenchymal lung lesion and regional hilar lymph node involvement

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60
Q

T/F In about 95% of normal adults development of cell-mediated immunity does not control the MTB infection, and it follows a self-limited course

A

FALSE

In about 95% of normal adults development of cell-mediated immunity controls (but does not eliminate) the MTB infection, and it follows a self-limited course

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61
Q

What happens to the lesions in the lung and lymph nodes of the ghon complex as cell mediated immunity develops?

A

undergoing shrinkage, fibrous scarring, followed by radiologically detectable calcification (called the “Ranke complex”), and despite seeding of other organs, with MTB no lesions (granulomas) develop

62
Q

Regardless of the organs involved, all ______ granulomas have similar features and follow the same progression

A

tuberculous

63
Q

Histologically, what do sites of active MTB infection undergo?

A

characteristic inflammatory reaction marked by the presence of caseating (and noncaseating) granulomas, which consist mainly of epithelioid histiocytes (macrophages) and multinucleate (Langhans’ giant cells), that eventually undergo fibrosis and calcification

64
Q

What happens if a patient with MTB infection develops a decrease in their immune function

A

the dormant MTB organisms may break out of the fibrosed and calcified TB granuloma and cause serious (reactivation) tuberculous infection

65
Q

Is progressive primary tuberculosis common?

A
  • TB infection takes this course in less than 10% of normal adults, but it is common in children under 5 years of age.
  • In adults, progressive primary tuberculosis most commonly occurs in patients with suppressed or defective immunity
66
Q

What does secondary (reactivation) tuberculosis usually result from?

A

reactivation of dormant, endogenous tubercle bacilli in a sensitized patient who has had previous contact with the tubercle bacillus

67
Q

How long after primary infection does secondary tuberculosis develop?

A

Secondary tuberculosis may develop any time after primary infection, even decades later

68
Q

What are responsible for a significant number of cases of secondary tuberculosis?

A

immunosuppressive disease (e.g., HIV/AIDS) or immunosuppressive drug therapy

69
Q

Classic symptoms of TB include what?

A
  • Cough is nearly universal (purulent secretions, appearance of blood streaking or gross hemoptysis)
  • Sweating / drenching night sweats
  • malaise, fatigue, weight loss, non-pleuritic chest pain and dyspnea
70
Q

What are common signs of tuberculosis?

A
  • Fever
  • Rales (small irregular clicking, bubbling, or rattling breath sounds)
  • rhonchi (low pitched continuous breathing sounds that resemble snoring or gurgling)
  • wheezing
71
Q

In the past, progressive tuberculosis could lead to a cachectic-like wasting termed “_______”

A

consumption

72
Q

Fungal infections evoke what type of hypersensitivity reaction? What do they result in?

A
  • type IV (T cell-mediated) hypersensitivity reaction
  • typically result in granulomas in the lung, with little or no caseation
73
Q

What causes Histoplasmosis?
What causes Coccidioidomycosis?
What causes Cryptococcosis?

A
  • Caused by Histoplasma capsulatum
  • Caused by Coccidioides
  • Caused Cryptococcus neoformans
74
Q

What causes North American Blastomycosis?
What causes aspergillosis?

A
  • Caused by Blastomyces dermatitidis
  • Caused Aspergillus species mold
75
Q

What is Sarcoidosis (Boeck’s disease)?

A

A chronic multisystem granulomatous disease, with noncaseating granulomas

76
Q

What do tissues involved in sarcoidosis contain?

A
  • well-formed noncaseating (non-necrotizing) granulomas
  • multinucleated Langhans’ giant cells
77
Q

What are clinical manifestations of sarcoidosis?

A
  • Lung involvement occurs in more than 90% of patient
  • Uveoparotid fever
  • bilateral enlargement of the parotid or salivary glands, facial nerve paralysis and anterior uveitis
78
Q

What is Chronic obstructive pulmonary disease (COPD)?

A

an umbrella term, usually refers to a mixture of chronic bronchitis and emphysema

79
Q

What is chronic bronchitis characterized by?

A
  • excessive secretion of bronchial mucus resulting in obstruction of small airways
  • manifested by productive cough for 3 months or more in at least 2 consecutive years
80
Q

What is emphysema characterized by?

A

loss of lung elasticity and destruction of lung parenchyma

81
Q

What is the biggest risk factor for COPD?

A

Cigarette smoking (and age) account for more than 85% of the risk of developing COPD in the USA

82
Q

What are other risk factors for COPD

A
  • Air pollution and occupational exposure
  • Hyper-responsive airways
  • Alpha1 -protease inhibitor (API) or alpha1 -antitrypsin [ATT]) deficiency
  • Homozygous API (ATT) deficiency
83
Q

How does air pollution and occupational exposures increase your risk of COPD?

A
  • indoor air pollution
  • airborne chemical vapors / fumes or biologically inactive dusts (e.g., dusts from cotton, cadmium, coal, silica)
84
Q

How does a Homozygous API (ATT) deficiency increase your risk of COPD?

A

results in premature development of severe emphysema

85
Q

What is emphysema characterized by pathologically?

A
  • dilatation of the acinar air spaces due to destruction of the interalveolar septa
  • proteolytic enzymes
86
Q

In emphysema, what are consequences of septal destruction?

A
  1. Elasticity of lung tissue is reduced causing airways to collapse during expiration
  2. surface area and amount of capillaries available for gas exchange is greatly reduced
  3. progressive dyspnea and hypoxemia and hypoxia
87
Q

In advanced emphysema, there is increased ______ pressure (_____ hypertension) and eventual cor pulmonale

A
  • pulmonary artery
  • pulmonary
88
Q

Two major forms of emphysema are?

A
  • Centriacinar (centrilobular) emphysema: most common form
  • Panacinar (panlobular) emphysema
89
Q

Where are lesions the worst in Centriacinar (centrilobular) emphysema

A

lesions are more common and severe in the upper lung lobes

90
Q

What is the distinctive feature of centriacinar emphysema?

A
  • central or proximal parts of the acini, formed by respiratory bronchioles, are affected, while distal alveoli are spared
  • associated with cigarette smoking
91
Q

What does Panacinar (panlobular) emphysema most often affect?

A

more commonly in the lower lung zones

92
Q

What are distinctive features of Panacinar (panlobular) emphysema

A
  • acini are uniformly enlarged, from the level of the respiratory bronchiole to the terminal blind alveoli
  • associated with alpha1 -antitrypsin deficiency
93
Q

Chronic bronchitis is primarily attributed to long-standing irritation of the airways from what?

A

airway irritants, especially cigarette smoke

94
Q

The distinctive feature of chronic bronchitis is what?

A

hypersecretion of mucus, beginning in the large airways

95
Q

Other pathologic changes of chronic bronchitis include? (5)

A
  1. Hypertrophy of mucous glands and increase in mucin-secreting goblet cells
  2. increased mucus viscosity and volume → impairment of pulmonary defense mechanisms
  3. airway wall inflammatory cell populations
  4. Retained mucus secretions plus inflammation
  5. Impairment of pulmonary defense mechanisms
96
Q

What does retained mucus secretions plus inflammation in chronic bronchitis account for?

A

reduction in small airway function (significant airflow obstruction)

97
Q

What does impairment of pulmonary defense mechanisms account for in chronic bronchitis?

A

increase in the frequency of lower respiratory bacterial and viral infections

98
Q

Most patients with COPD have pathologic evidence of what?

A

both disorders (i.e., concomitant chronic bronchitis and emphysema)

99
Q

How old are most patients with COPD? What are some of the symptoms?

A

present in the fifth or sixth decade of life complaining of excessive cough, sputum production, and shortness of breath (dyspnea)

100
Q

What are signs and symptoms of COPD?

A
  • Cyanosis with chronic (usually productive) cough, tachypnea, tachycardia, and fatigue.
  • Dyspnea (that is persistent and progressive).
  • Pursed-lip breathing with use of accessory muscles for respiration, decreased breath sounds, and wheezing
  • Chronic sputum production.
  • Chest wall abnormalities
101
Q

What are some chest wall abnormalities of COPD?

A

hyperinflation, increased anteroposterior diameter of the chest, [i.e., “barrel chest”], and a protruding abdomen

102
Q

COPD has a ______ progressive course with frequent _____ exacerbations

A
  • chronic
  • acute
103
Q

What characterize the late stage of COPD?

A

Pneumonia, pulmonary hypertension, cor pulmonale, and chronic respiratory failure

104
Q

What is the reference standard for measuring the severity of COPD

A

Spirometry

105
Q

What happens to FEV1 and FVC when doing a spirometry measurement of a COPD patient?

A

abnormally decreased FEV1 and FVC is required to confirm diagnosis

106
Q

Besides spirometry, what are other diagnostic features of COPD?

A
  • Oximetry (blood oxygen saturation): hypoxemia
  • Arterial blood gases: hypercapnia
  • Chest radiograph: hyperinflation of the lungs with flattening of the diaphragm
107
Q

What is bronchiectasis?

A

not a specific disease, but consequence of another disease (most often an infection) that results in dilatation of the bronchi or bronchioles

108
Q

What are some of the common causes of bronchiectasis?

A
  • previous infections
  • cystic fibrosis
  • COPD
109
Q

What is the clinical presentation of bronchiectasis

A
  • Chronic cough, typically with expectoration of purulent sputum
  • frequent bronchitis or pneumonias
110
Q

What is asthma?

A

an inflammatory disease of the airways

111
Q

Asthma is characterized by what?

A

recurrent episodes of airway obstruction due to bronchospasm

112
Q

In asthma, the airflow obstruction is usually ______, either spontaneously, or through pharmacologic therapy

A

reversible

113
Q

Asthma can be classified by etiology into two general categories. What are they?

A
  • extrinsic (allergic, atopic) asthma
  • intrinsic asthma
114
Q

What is the most common form of asthma? Whay type of hypersensitivity is it?

A
  • Allergic or extrinsic asthma
  • type I hypersensitivity
115
Q

What does binding of the allergens to sensitized IgE attached to the surface of mast cells trigger in asthma?

A

degranulation and the release of histamines, bradykinins, leukotrienes (LTC4, D4, and E4), and prostaglandin D2.

116
Q

What does the release of histamines, bradykinins, leukotrienes (LTC4, D4, and E4), and prostaglandin D2 lead to in asthma?

A
  • intense inflammatory reaction
  • spasm (contraction) of the airways smooth muscle (bronchospasm)
  • increased mucus secretion with plugging of small airways
117
Q

What are the subtypes of intrinsic asthma?

A
  • Exercise-induced asthma
  • Occupational or environmental asthma
  • Drug-induced asthma (or triad asthma)
118
Q

What are some things that can make exercise induced asthma worse?

A
  • Hyperventilation of cold, dry air
  • emotional stress
119
Q

What is drug induced asthma caused by?

A

a combination of bronchospasm, aspirin (and some nonsteroidal anti-inflammatory drugs [NSAIDs], sulfites, sensitivity, and rhinitis, nasal polyps, and urticaria

120
Q

What is considered a characteristic feature of asthma (regardless of overall asthma severity)

A

Persistent (chronic) airway inflammation

121
Q

What does persistent (chronic) airway inflammation consist of?

A

infiltration of the airways by inflammatory cells, hypertrophy of the airway smooth muscle, and thickening of the lamina reticularis

122
Q

What are the most striking findings in individuals experiencing an severe asthmatic episode (“asthma attack”)?

A
  • Lungs that are distended due to air trapping
  • Occlusion of bronchi and bronchioles by thick, tenacious mucous plugs
  • Numerous eosinophils and Charcot-Leyden crystals
123
Q

What do the mucous plugs found in asthma attacks (severe asthmatic episodes) contain?

A

mucus, serum proteins, inflammatory cells, and cellular debris, which includes desquamated epithelial cells often arranged in a spiral pattern (Curschmann spirals)

124
Q

Signs and symptoms of an asthmatic episode are generally characterized by what?

A

wheezing, dyspnea, coughing, and a feeling of tightness in the chest

125
Q

What are common signs of more severe asthma attacks?

A

sitting upright and leaning forward (“tripoding”), and use of accessory muscles of respiration

126
Q

T/F The frequency of asthma symptoms is highly variable

A

True

127
Q

T/F Asthma symptoms are frequently worse during the day

A

FALSE

Asthma symptoms are frequently worse at night

128
Q

What is Status asthmaticus

A
  • A medical emergency
  • It is an extreme form of acute asthma exacerbation characterized by hypoxemia, hypercarbia, and secondary respiratory failure
129
Q

Patients with extrinsic (allergic) asthma will usually show elevated levels of _____ and ____ skin tests to various allergens

A
  • serum IgE
  • positive
130
Q

During an asthmatic episode (“asthma attack”), what will spirometry show?

A
  • Decreased FEV1 , FVC, FEV1 /FVC ratio, and peak expiratory flow (PEF)
  • Reversibility of airway obstruction is usually seen after the patient inhales a short-acting bronchodilator drug
131
Q

What is Asthma-COPD Overlap (ACO) (or Asthma-COPD overlap syndrome [ACOS])

A

It identifies a subgroup of smokers with COPD that share some pathogenic and inflammatory characteristics with asthma and that tend to have a more severe disease manifestations than just COPD alone

132
Q

What is the most common cause of cancer mortality in the U.S.

A

lung cancer

133
Q

What are key risk factors for lung cancer?

A

cigarette smoke, radon, and asbestos

134
Q

______% of lung cancer occurs in smokers.

Cancer risk is directly related to the _____ and _____ of smoking

A
  • 85%
  • duration
  • amount
135
Q

What are the major histologic types of carcinomas of the lung?

A
  1. Non-small cell lung carcinomas (NSCLC)
  2. Small cell lung carcinoma (SCLC)
136
Q

What are examples of Non-small cell lung carcinomas (NSCLC)?

A
  • adenocarcinoma (~ 50%)
  • squamous cell carcinoma (~ 30%)
  • large cell neuroendocrine carcinoma (~ 5%)
137
Q

What type of carcinoma has the strongest association with smoking?

A

small cell lung cancer carcinoma (SCLC)

138
Q

What does the term bronchogenic carcinoma describe?

A
  • Once used to describe only certain lung cancers arising from the epithelium of the bronchus or bronchiole.
  • However, today it can refer to any type of SCLC and NSCLC
139
Q

What are some clinical presentations of lung cancer?

A

symptoms are nonspecific:

typically include cough, hemoptysis, dyspnea, unintentional weight loss and post-obstructive pneumonia

140
Q

What are Pneumoconioses: Silicosis, Anthracosis, Asbestosis, Berylliosis

A

Chronic fibrotic lung diseases caused by the inhalation of inert inorganic dusts

141
Q

What is the exposure for anthracosis?

A

carbon dust

142
Q

What is the exposure for silicosis

A

silica

143
Q

what is the exposure for berylliosis

A

beryllium

144
Q

what is the exposure for asbestosis

A

asbestos fibers

145
Q

What are the pathological findings of Anthracosis

A
  • Mild exposure = anthracosis
  • Major exposure diffuse fibrosis (‘black lung disease’)=
146
Q

What are the pathological findings of Silicosis

A

Fibrotic nodules in upper lobes of the lung

147
Q

What are the pathological findings of Berylliosis

A

Non-caseating granulomas in the lung

148
Q

What are the pathological findings of Asbestosis

A

Fibrocalcific lesions (plaques) of lung and pleura with increased risk for lung carcinoma and mesothelioma

149
Q

What are asbestos bodies?

A
  • also called ferruginous bodies
  • long, golden-brown fibers with associated iron coating
150
Q

What does silicosis increase the risk for

A

TB

151
Q

What does berylliosis increase the risk for?

A

lung cancer

General Pathology (32 decks)

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