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Tri 4 - Pathology II > Respiratory > Flashcards

Respiratory Flashcards

1
Q

what is the epithelial lining of the larynx, trachea, bronchi, and bronchioles

A

pseudostratified columnar epithelium (true vocal folds - stratified squamous epithelium)

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2
Q

what are the secretions from the bronchial mucosa

A

neuroendocrine cells that secrete serotonin (vasodilation), gastrin (HCL acid secretion), and calcitonin (reduces plasma Ca++)

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3
Q

what are the characteristics of type 1 and 2 pneumocytes

A

type 1 - flat, thin, large surface area, facilitates gas exchange, vulnerable to injury type 2 - cuboidal, produce surfactant

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4
Q

how are particles deposited in the respiratory tract based on their size

A

large - trapped in nose medium - deposit on bronchi and bronchioles, moved by mucociliary action small - deposit on alveoli, removed by macrophages very small - behave as a gas and are breathed out

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5
Q

what are the characteristics of bronchial atresia

A
  • involves apico-posterior BPS of L upper lobe - results in a compensatory expansion of the other lobes, eventually leading to emphysema - bronchial mucus accumulation appears as a mass on x-rays
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6
Q

what are the characteristics of hypoplasia on the lung (agenesis)

A
  • lung is smaller than normal due to fever or small acini - 90% cases present with other congenital anomalies - seen in trisomies 13,18,21 - another cause is oligohydroamnios (inadequate amniotic fluid)
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7
Q

what are the characteristics of bronchogenic cysts

A
  • fluid filled mass lined by respiratory epithelium - usually common, asymptomatic, and only affect one lobe - mostly seen in ages 0-2, and may compress a major airway, causing respiratory distress - secondary infection may cause hemorrhage and perforation
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8
Q

what are the classifications of bronchogenic cysts

A

type 1 - large cysts, ciliated epithelium, 50% of cases type 2 - multiple small and relatively uniform cysts, ciliated epithelium, 40% of cases type 3 - solid and bulky lesions causing mediastinal shift, cuboidal epithelium, 10% of cases

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9
Q

what is bronchopulmonary sequestration

A
  • pulmonary tissue is situated outside the lung parenchyma - blood supply is directly from aorta or via its branches - often associated with diaphragmatic hernias/defects, cardiopulmonary anomalies, or abnormal communication with foregut
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10
Q

what are the characteristics of an intralobar sequestration

A
  • within lung substance (base)
  • usually in older children
  • associated with recurrent infection
  • 90% cases on L side
  • more common in males (4:1)
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11
Q

what are the characteristics of extralobar sequestration

A
  • external to lung, anyhwere in the thorax/mediastinum
  • pyramidal/round masses covered by pleura
  • more common in males
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12
Q

what are the macro- and microscopic presentation of a bronchopulmonary sequestration

A
  • macroscopic: fibrosis and honeycomb cystic changes resulting from recurrent infection
  • microscopic: cystic spaces lined by columnar or cuboidal epithelium, lumen contains foamy macrophages and esoinophilic material
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13
Q

what are the clinical presentations of a patient with a bronchopulmonary sequestration

A
  • cough, sputum, recurrent infection
  • dyspnea and cyanosis in 90% of extralobar cases, esp: children
  • increased vascular markings on x-ray
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14
Q

what is neonatal respiratory distress syndrome

A
  • aka hyaline membrane disease
  • most common cause of respiratory failure in newborns
  • due to surfactant deficiency or immature lung development
  • indicator of fetal pulmonary maturity is a lecithin:sphingomyelin ratio of 2:1 in amniotic fluid
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15
Q

what are some indicators of disease you might find on inspection of a patient’s breathing

A
  • pursed lips breathing: slow air expiration associated with chronic obstructive pulmonary disease
  • kussmal breathing: deep gasping breath associated with severe diabetic acidosis
  • barrel chested: increased A-P chest diameter due to increased functional residual capacity associated with chronic bronchitis and emphysema
  • pink puffers: noncyanotic, severe emphysema
  • blue bloaters: cyanotic, chronic bronchitis
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16
Q

what are pleural rubs

A
  • scratching sounds due to roughened pleura
  • can be amplified by compressing the stethoscope further against the lung field and asking the patient to take deeper breaths
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17
Q

what are rhonchi

A
  • long continuous sounds due to obstructed airways
  • diffuse sounds are associated with generalized airway obstruction (ex: COPD, asthma)
  • localized sounds are associated with specific airway obstruction (ex: tumor, mucus)
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18
Q

what are the classifications of rhonchi

A
  • stridor: loud, audible inspiratory
  • sibilant: high-pitched
  • sonorous: low-pitched
  • crackle: adventitious when heard at end of inspiration or start of expiration
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19
Q

what is acute respiratory distress syndrome (ARDS)

A
  • a group of disorders with endo- or epithelial injuries characterized by rapid onset of severe respiratory insufficiency
  • idiopathic form: diffuse alveolar damage (DAD)
  • neonatal form: newborn respiratory distress syndrome (NRDS)
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20
Q

what are the causes of ARDS

A
  • infection
  • physical injury
  • inhale irritants
  • drugs
  • hematological conditions
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21
Q

what is the pathophysiology of ARDS

A
  • injury results in pro-inflammatory cytokine release (IL-1, IL-8, TNF)
  • neutrophils adhere to pulmonary capillaries and release factors that contribute to the local damage
  • result: fluid accumulation in airspaces, surfactant inactivation, hyaline membrane formation
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22
Q

what is hyaline membrane formation

A

eosinophilic glassy membranes consisting of precipitated plasma proteins as well as cytoplasmic and nuclear debris from sloughed epithelial cells

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23
Q

what are the clinical presentations of a patient with ARDS

A
  • tachypnea, dyspnea, cyanosis, hypoexemia
  • respiratory acidiosis (blood gas)
  • diffuse bilateral infiltrate on x-rays
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24
Q

what are the pathological mechanisms of pulmonary edema

A
  • increased hydrostatic pressure: caused by L-sided heart failure, mitral stenosis, volume overload
  • decreased oncotic pressure: caused by hypoalbuminuria due to nephrotic syndrome, liver disease, protein-losing enteropathies
  • microvascular injury: caused by infection, inhaled gases, aspiration, drugs, radation
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25
Q

what are the symptoms of pulmonary edema

A
  • history of coughing up blood (hemoptysis)
  • difficulty breathing when lying down (orthopnea)
  • wheezing with breathing
  • inability to speak in full sentences due to shortness of breath
  • crackles in the lungs
  • abnormal heart sounds
  • increased HR and RR
  • pallor or cyanosis
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26
Q

what is localized emphysema

A
  • involves destruction of alveoli
  • occurs in only one or just a few locations
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27
Q

what is compensatory emphysema (hyperinflation)

A

emphysema that follows surgical removal of a diseased lung or lobe

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28
Q

what are the different types of emphysema based on anatomical distribution

A
  • centriacinar: upper lobes (smokers)
  • panacinar: loss of acinus (a-1-antitrypsin deficiency)
  • paraseptal: involves ducts (underlies spontaneous pneumothorax in young adults)
  • irregular: involves bullae/blebs (most common form)
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29
Q

what is interstitial emphysema

A

entrance of air into the connective tissue stroma of the lung, mediastinum, or subcutaneous tissue

30
Q

what are the signs of a patient with emphysema

A
  • destruction of septal walls
  • bronchiole deformations
  • compression of vasculature
31
Q

what are the characteristics of chronic bronchitis

A
  • definition: excessive cough and sputum production on most days for at least 3 months per year for at least 2 years
  • primary factors: chronic irritants, smoking
  • more common in urban areas with substantial air pollution
  • interferes with ciliary action and inhibits ability of leukocytes to clear bacteria
32
Q

what are the clinical presentations of a patient with chronic bronchitis

A
  • mucopurulent secretion and cast
  • clustering of macrophages
  • infiltration of leukocytes
  • increase in goblet cells
  • bronchiolar wall fibrosis
  • bronchiolitis: small airway disease
33
Q

what is the difference between obstruction and restriction regarding lung pathology

A

obstruction: airway obstruction results in decreased forced expiratory volume and presents with wheezing
restriction: reduced compliance due to infiltrative lesions results in decreased total lung capacity and presents with dyspnea and cyanosis

34
Q

what are the common obstructive pulmonary diseases

A
  • asthma
  • COPD
  • emphysema
  • chronic bronchitis
  • bronchiectasis
  • bronchiolitis obliterans
35
Q

what are the common restrictive pulmonary diseases

A
  • intrinsic: sarcoidosis, pneumocomiosis, tuberculosis
  • extrinsic: kyphoscoliosis, obesity
  • neuromuscular: diaphragmatic paralysis, myasthenia gravis, muscular dystrophy
36
Q

CASE: 69-yr-old male smoker presents with shortness of breath following several bouts of lower respiratory tract infection over the last two years. Dx?

A

chronic bronchitis (large airway obstruction) and emphysema (small airway obstruction)

37
Q

CASE: 69-yr-old male smoker…
- pO2 = 73 mmHg (normal = 80-100)
- pCO2 = 50 (normal = 35-45)
- pH = 7.32 (normal = 7.3-7.5)
Why are value increased?

A

increased pCO2 and pH due to difficulty of exhalation of CO2 at a sufficient rate

38
Q

CASE: 69-yr-old male smoker… Why would giving this patient O2 be dangerous for him?

A
  • probably has had chronically elevated CO2 levels, which is the primary stimulus for breathing rate in the brainstem
  • patients CO2 receptors have been elevated for so long that they are probably desensitized, thus his primary stimulus is probably his low O2 levels
  • if given 100% O2, levels would rise too much and remove stimulus, thus he could go into respiratory failure
39
Q

CASE: 69-yr-old male smoker…. Why is he susceptible to lower respiratory tract infection?

A
  • chronic irritation of bronchial epithelium by cigarette smoke causes inflammation that results in excessive mucus production
  • mucus pools in the bronchial tree causing the “smokers cough” and providing medium for bacteria
40
Q

what are the clinical presentations of a patient with bronchial asthma

A
  • macroscopic: lungs distended with air, airways filled with mucus plugs
  • microscopic: Charcot-Leyden crystals, Curschmann spirals (cast of mucoid exudate)
41
Q

what are the 4 classic histological findings in bronchial asthma? what is the 5th finding is etiology is allergy

A
  • inflammation
  • bronchial narrowing
  • increased mucus
  • smooth mm. hyperplasia

* - eosinophils

42
Q

what are the characteristics of atelectasis

A
  • aka collapsed lung
  • incomplete expansion of neonatal lung or collapse or previously inflated lung
  • obstructive: airway obstruction, mediastinum shifts to affected lung
  • compressive: pleural cavity filled by fluid exudate, blood, air, or tumor, mediastinum shifts away from affected lung
  • contractive: fibrotic changes in lung or pleura
43
Q

what are the characterisitics of bronchiectasis

A
  • consequence of another disease process that destroys airways
  • permanent dilation and destruction of bronchioles
44
Q

what are the characteristics of Kartagener syndrome

A
  • immotile cilia syndrome, aka ciliary dyskeneis
  • triad: dextrocardia, bronchiectasis, sinusitis
  • also sterile b/c of immobility of vas deferens/fallopian tube
45
Q

what are the types of bronchiectasis

A
  • saccular: involves proximal bronchial branches, bronchi, and sacs are dialted
  • varicose: bronchi resemble varicose veins on imaging
46
Q

what are th clincal presentations of patients with bronchiectasis

A
  • severe presistent cough with sputum (bloody)
  • dysnpnea, orthopnea, hemoptysis
  • episodic fever
47
Q

CASE: 28-yr-old female with cystic fibrosis presents with shortness of breath with abundant foul-smelling sputum. Dx?

A

bronchiectasis

48
Q

the following characteristics of sputum present with which condition

A
  • clear, white: viral respiratory tract infection
  • white, yellow: acute bronchitis, acute pneumonia, asthma (thick)
  • yellow, green: chronic bronchitis, chronic pneumonia
  • frothy white, pink: pulmonary edema
  • reddish brown: penumococcal pneumonia, tuberculosis, lung cancer
  • brown, black: coal worker’s penumoconiosis
49
Q

what are the stages of acute inflammation

A
  • early: vasodilation, congestion
  • exudation: polymorphs, proteins
  • late: fibrin deposition, macrophage cleaning
  • repair: replacement with normal tissue if minimal damage, fibrosis if extensive damage
50
Q

what are the stages of chronic inflammation

A
  • persistance of irritant
  • activation of macrophages
  • activation of fibroblasts and vascular endothelial cells
  • repair via fibrosis
  • loss of function with longer duration
51
Q

what are the characteristics of bronchopneumonia

A
  • scattered foci in same or several lobes
  • typically of terminally ill patients
  • due to strep. pneumonia, h. influenza, or staph. aureus
52
Q

what are the characteristics of lobar pneumonia

A
  • consolidation of entire lobe
  • due mostly to strep. penumoniae or klebsiella
  • associated with alcoholism, diabetes, chronic lung diseases
53
Q

what are the characteristics of segmental pneumonia

A
  • common feature is idiopathic fibrosis
  • due mostly to strep. pneumoniae
54
Q

what is the cause of interstitial pneumonia

A

due mostly to h. influenza or mycoplasma pneumoniae

55
Q

compare community-acquired, nosocomial, and opportunistic pneumonia

A

community - acquired: arises outside hospital in patient with no primary disorder of the immune system

nosocomial: develops in hospital
opportunisitc: involves patients with deficient immunity, caused by p. carinii, aspergillus, or cytomegalovirus

56
Q

what are the causes of bacterial pneumonia

A
  • most common: strep. pneumonia
  • also: h. influenza, s. aureus, k. pneumoniae, m. catarrhalis, p. aeruginosa, l. pneumophila (aquatic organism associated with contaminated water)
57
Q

what are the causes of viral/mycoplasmal pneumonia

A
  • influenza A and B
  • adenovirus and rhinovirus
  • measles and varicella
  • severe acute respiratory syndrome (SARS)
58
Q

what are the stages of acute lobar pneumonia

A
  • congestion: vascular enlargement, lungs become heavy and boggy, fluid exudate with few neutrophils, numerous bacteria present
  • red hepatization: massive exudation with red cells and neutrophils
  • grey hepatization: appearance of macrophages, compression of alveolar capillaries
  • resolution: exudate coughed up or pushed up by cilia, the rest is phagocytosed
59
Q

CASE: 64-yr-old male presents with fever, chills, shortness of breath, pleuritic chest pain, crackles and decreased breath sounds, tachypnea, flaring nares, rusty-yellow sputum. Cause of infection?

A

strep. pneumoniae

60
Q

CASE: 62-yr-old male with small cell carcinoma begins chemotherapy. During treatment, he presents with 103 fever, productive cough with foul-smelling sputum, increased respirations, leukocytosis, and x-ray shows air/fluid level distal to tumor. Dx?

A

pulmonary abscess

61
Q

what are the causes of pulmonary hypertension

A
  • primary: idiopathic
  • secondary (more common): COPD, chronic interstitial pulmonary disorders, CHF, recurrent pulmonary emboli
62
Q

what is the pathogenesis of pneumonconiosis

A
  • dust/irritant inhalation
  • impairment of mucociliary apparatus
  • reactivity of the particles
  • oxidant and protease release causes inflammation
  • macrophage and neutrophil recruitment and activation
  • fibroblast stimulation
  • granuloma formation
63
Q

what are the characteristics of silicosis

A
  • inhalation of silicon dioxide (quartz, silica)
  • early phase: black nodules
  • late phase: hard collagenous scars
  • egg-shell calcification
64
Q

what are the types of asbestosis

A
  • chrysotile: caused by a white curly asbestos fiber that contain magnesium
  • amosite: brown/gray straight fibers that contain magnesium and iron
  • crocidolite (riebeckite): blue straight fibers that contain magnesium, iron, and sodium
65
Q

what is the pathophysiology of asbestosis

A
  • can lead to diffuse pulmonary interstitial fibrosis
  • presence of “asbestos bodies”
66
Q

CASE: 60-yr-old male presents with dyspnea and nonproductive cough. Non-smoker but worked at ship-builder with known asbestos exposure. What is this patient predisposed to?

A

malignant mesothelioma of the pleura

67
Q

what are the charactersistics of sarcoidosis

A
  • systemic dz of unknown cause characterized by noncaseating granumolas
  • more common in females and africans
  • more commonly affecting lungs and lymph nodes
  • presence of asteroid bodies (star shaped) or Schaumann bodies (lamellar structures composed of calcium and proteins)
68
Q

CASE: 25-yr-old African-American non-smoking female presents with fatigue, dyspnea, nonproductive cough, and chest pain. Lab work shows bilateral hilar lymphadenopathy and hypercalcemia. Dx?

A

sarcoidosis

69
Q

what are the characteristics of primary tuberculosis

A
  • caused by m. tuberculosis via droplet inhalation
  • starts as Gohn lesion which becomes fibrotic
  • if spread to lymphatics, called Ghon complex
70
Q

what are the characteristics of secondary tuberculosis

A
  • reactivation of primary TB or new infection in previously sensitized host
  • typical features: apical/upper parts of lung affected, caseous granuloma, local or systemic/miliary
71
Q

what are the features of tuberculous/case ating granuloma

A
  • round outlines
  • central caseous necrosis that appears irregular, amorphous, pink
  • macrophages -> epitheloid cells
  • fibroblasts and Langhans giant cells
72
Q
A

Tri 4 - Pathology II (21 decks)

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