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Respiratory Pathology Flashcards

1
Q

Air passages (conducting portion)

A
  • Trachea ( Middle Respiratory tract )
  • Primary bronchi
  • Secondary bronchi
  • Bronchioles
  • Terminal Bronchioles
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2
Q

Lower respiratory tract (respiratory portion)

A
  • Respiratory bronchioles
  • Alveolar ducts
  • Alveolar sacs
  • Elastic fibers
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3
Q

3 concepts involved in gas exchange

A
  • Ventilation
  • Perfusion
  • Diffusion
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4
Q

Assessment of pulmonary function

A
  • Arterial Blood Gas
  • Pulse Oximetry
  • Spirometry
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5
Q

Normal arterial blood gas (ABG)

A
  • pH = 7.38 - 7.44
  • pCO2 = 35 - 40mmHg
  • pO2 = 95 - 100mmHg
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6
Q

Respiratory failure values

A
  • pO2 < 60

- pCO2 > 50

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7
Q

Pulse oximeter

A
  • Noninvasive
  • CO and circulation
  • Not accurate in respiratory failure
  • ( % Saturation, i.e. 95% )
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8
Q

Spirometry measures

A
  • Volumes of air during ventilation
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9
Q

Spirometry acronyms

A
  • VT = Tidal volume
  • VC = Vital capacity
  • RV = Residual volume
  • IC = Inspiratory capacity
  • TLC = Total lung capacity
  • FVC = Forced vital capacity
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10
Q

Requirements for normal respiration

A
  • Patent airways
  • Intact alveolar membranes
  • Coordination between lungs and central nervous system
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11
Q

Aberrations in defense mechanisms (mechanical)

A
  • Major diseases affecting the lungs

- Tumors

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12
Q

Major categories of diseases affecting the lungs

A
  • Infectious diseases
  • Immune diseases
  • Environmental induced diseases
  • Circulatory diseases
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13
Q

Types of pneumonia

A
  • Bacterial pneumoniae (bronchopneumonia and lobar pneumonia)
  • Viral pneumonia
  • Immuno-compromisation
  • Tuberculosis
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14
Q

Pathogenesis and spread of pneumonia

A
  • Inhalation of pathogens in air droplets
  • Aspiration of infected secretions from the upper respiratory tract
  • Aspiration of infected particles in gastric contents
  • Hematogenous spread (sepsis)
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15
Q

Broncopneumonia vulnerable populations

A
  • Very young
  • Very old
  • Immunocompromised
  • Community Acquired
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16
Q

Potential microbial agents involved with causing bronchopneumonia

A
  • Streptococcus pneumoniae
  • Legionella pneumophilia
  • Hemophilus influenzae
  • Any pathogen
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17
Q

Bronchopneumonia gross findings

A
  • Patchy consolidation

- Mucopurulent material

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18
Q

Bronchopneumonia clinical findings

A
  • Fever, chills
  • Productive Cough
  • Expectoration
  • Infiltrates on CXR
  • Hemoptysis
  • Patchy x-ray (infiltrates)
  • Blood cultures +
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19
Q

Bronchopneumonia microscopic findings

A
  • Acute inflammatory exudate
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20
Q

Viral pathogens that cause pneumonia

A
  • Influenza A and B
  • RSV
  • Adenovirus
  • Rhinovirus
  • Mycoplasma pneumonia
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21
Q

Tuberculosis etiology

A
  • M. tuberculosis
  • M. avium intracellulare
  • M. hominis
  • M. bovis
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22
Q

Caseating granulomas in TB

A
  • Giant cells

- Langerhan type

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23
Q

Clinical features of primary TB

A
  • Low-grade fever

- Other non-specific symptoms

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24
Q

Clinical features of secondary TB

A
  • Dry cough
  • Low-grade fever
  • Night sweats, weight loss
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25
Extensively drug resistant tuberculosis (XDR-TB)
- Resistant to three or more of the six classes of second-line drugs
26
TB drugs that XDR-TB can be resistant to
- Rifampin - Isoniazide - Pyrazinamide - Ethambutol - Strreptomycin - Aminoglycosides - Polypeptides - Flouroquinolones - Thioamides - Cycloserine - PAS
27
Pathophysiological basis of COPD
- Airflow obstruction and/or resistance to flow - Luminal obstruction - Narrowing of bronchi - Alveolar wall thickening - Loss of supporting structures
28
Types of COPD
- Emphysema - Chronic bronchitis - Bronchial asthma - Bronchiectasis - Cystic fibrosis
29
Features of emphysema
- Acini destruction - Loss of elastic recoil - Alveolar wall destruction
30
Types of emphysema
- Centrilobular/Centriacinar (smokers) | - Panacinar (alpha-1 antitrypsin deficiency)
31
Emphysema gross morphology
- Large - Voluminous lungs - Air space enlargement - Compressed capillaries - Blebs and bullae
32
Clinical findings of emphysema
- Pink puffer - Barrel chest - Clubbing of hands - Blue boater
33
Benefits of triflow used in atelectasis
- Strengthens diaphragm - Encourages patients to take deep breaths - Expand small air sacs in their lungs - Help clear the air passage of mucus
34
Complications associated with emphysema
- Cor pulmonae - Pneumothorax - Polycythemia - Acidosis
35
Cor pulmonae
- Right ventricular hypertrophy due to increased pulmonary pressures
36
Pneumothorax
- Collapsed lobe of the lung
37
Plycythemia
- Increase in RBCs
38
Acidosis
- Blood pH becomes acidic secondary to retention of CO2
39
COPD may involve vasculature or parenchymal disease in the alveolar sacs
- Stretched flattened capillaries impedes blood flow | - Increases pulmonary pressure/resistance
40
Chronic bronchitis (definition)
- Cough with sputum for 3 months or more per year for 2 or more consecutive years
41
#1 cause of bronchitis and emphysema
- Smoking
42
Clinical signs and symptoms of bronchitis
- Excessive coughing - Expectoration of thick sputum - Dyspnea
43
Bronchitis prognosis
- Bronchial spastic episodes - Progression to emphysema Worsened: - Cor pulmonale CHF - Marked disability - Shortened lifespan
44
Asthma
- Chronic inflammatory disorder | - Bronchoconstriction and Airflow Limitation
45
Hallmarks of asthma
- Increased airway responsiveness to stimuli - Episodic bronchoconstriction - Inflammation of the bronchial walls - Increased mucus secretion
46
Classifications of asthma
- Atopic (evidence of allergen sensitization) - Non-atopic (without evidence of allergen sensitization) - Drug-Induced Asthma - Occupational Asthma
47
Asthma triggers (bronchospasm)
- Respiratory infections (viral infections) - Environmental exposure (e.g., smoke, fumes) - Cold air - Stress - Exercise
48
Atopic asthma
- Genetic predisposition | - Type I hypersensitivity (Atopy)
49
Pathogenesis of asthma
- Allergen stimulated TH2 Response - TH2 cells secrete cytokines - B cell stimulation - IgE coats submucosal mast cells - Allergen triggers the mast cell degranulation
50
TH2 cells secretion of cytokines in asthma
- IL-4 stimulates IgE production - IL-5 activates eosinophils - IL-13 stimulates mucus secretion
51
B cell stimulation in asthma leads to
- IgE production
52
Pathogenesis of atopic asthma: early phase (immediate hypersensitivity)
- Leukotrienes C4, D4, and E4 (from Mast cells) - Acetylcholine (from intrapulmonary motor nerves) - Bronchoconstriction
53
Acetylcholine release from intrapulmonary motor nerves (atopic asthma early phase) causes
- Smooth muscle constriction via muscarinic receptors
54
Bronchospasm in the early phase of atopic asthma pathogenesis is a result of
- Stimulation of subepithelial vagal (parasympathetic) receptors
55
Bronchospasm in the early phase of atopic asthma pathogenesis causes
- Increased mucus production - Vasodilation - Increased vascular permeability
56
Atopic asthma late phase mediators
- Histamine (Bronchoconstrictor) - Prostaglandin D2 (Bronchoconstriction and vasodilatation) - Chemokines (Eotaxin) - IL-1, TNF, IL-6
57
Chemokines (Eotaxin) in the late phase of atopic asthma result in
- Recruitment of mediator-releasing cells | - Neutrophils, eosinophils, and basophils; lymphocytes and monocytes)
58
Late phase of atopic asthma perpetuates
- Clinical symptoms
59
Status asthmaticus
- Severe acute paroxysm | - Severe cyanosis/death
60
Severe cyanosis/death associates with status asthmaticus results from
- Overdistension/overinflation of lungs - Atelectasis - Mucus Plugs - Curschmann spirals - Numerous eosinophils - Charcot-Leyden crystals
61
Curschmann spirals
- Whorls of shed epithelium
62
Charcot-Leyden crystals
- Eosinophil Crystalloid
63
Clinical course of status asthmaticus
- Chest tightness - Dyspnea - Wheezing - Cough (+/- sputum production) - Increase in airflow obstruction (from baseline levels) - Less difficulty with exhalation
64
Pulmonary function test normal values
- TV = 500 - IRC = 3000 - IC = 3500 - ERV = 1000 - RV = 1200 - FRC = 2200 - VC = 4500 - TLC = 5700
65
Pulmonary function test values decreased below normal in asthmatics
- ERV - VC - FEV/FVC
66
Pulmonary function test values increased above normal in asthmatics
- RV | - FRC
67
Types of restrictive lung disease
- Beryllium disease - Congestive heart failure - Idiopathic pulmonary fibrosis - Infectious inflammation (e.g., histoplasmosis, mycobacterium infection) - Interstitial pneumonitis - Neuromuscular diseases - Sarcoidosis - Thoracic deformities
68
Idiopathic pulmonary fibrosis (IPF)
- Causative agent(s) unknown - Current concept: repeated cycles of epithelial activation/injury - Inflammation/induction of TH2 type T cell (leads to cell recruitment)
69
Cells recruited in idiopathic pulmonary fibrosis
- Eosinophils | - Mast cells
70
Mediators of idiopathic pulmonary fibrosis
- IL-4 - IL-13 - Both from TH2 type T cell
71
_____ is responsible for repair mechanisms in idiopathic pulmonary fibrosis
- TGF-β1
72
Properties of TGF-β1 in abnormal epithelial repair
- Fibrogenic (released from injured type I alveolar epithelial cells) - Transformation of fibroblasts into myofibroblasts - Deposition of collagen and other extracellular matrix molecules
73
Process of abnormal epithelial repair in idiopathic pulmonary fibrosis
- TGF-β1 responsible for Repair Mechanisms - Exuberant fibroblastic / myofibroblastic proliferation - Fibroblastic foci are produced
74
Pathogenesis of idiopathic pulmonary fibrosis
- Mutations that Shorten Telomeres - TGF-β1 - Caveolin-1
75
Mutations that shorten telomeres in idiopathic pulmonary fibrosis results in
- Alveolar epithelial cells undergo rapid senescence and apoptosis
76
TGF-β1
- Negatively regulates telomerase activity | - Facilitates epithelial cell apoptosis
77
Caveolin-1
- Endogenous inhibitor of pulmonary fibrosis - Limits TGF-β1 activity - Decreased in IPF patients
78
Pathology of IPF
- Fibrotic lungs - Scattered fibroblast foci - Subpleural fibrosis
79
Clinical findings on IPF chest x-rays
- Bilateral lower lobe opacities | - Decrease lung volumes
80
Clinical findings on IPF high-resolution CT scan (HRCT)
- Reticular opacities | - Honey combing
81
Clinical course of restrictive lung disease
- Insidious - Increasing dyspnea on exertion - Dry cough - Presentation: 4th-7th Decade - Disease course unpredictable
82
Late findings of restrictive lung disease
- Hypoxemia - Cyanosis - Clubbing
83
Disease course of restrictive lung disease
- Gradual deterioration - Mean survival of 3 years or less - Lung transplantation is the only definitive therapy available
84
Bronchiestasis
- A chronic necrotizing infection of the bronchi and bronchioles leading to or associated with abnormal dilation of these airways
85
Conditions associated with the development of bronchiectasis
- Bronchial obstruction - Congenital or hereditary - Necrotizing pneumoniae
86
Bronchial obstructive diseases associated with the development of bronchiectasis
- Tumor - Foreign bodies - Mucous impaction
87
Congenital or hereditary diseases associated with the development of bronchiectasis
- Cystic fibrosis | - Immotile cilia syndrome
88
Necrotizing pneumoniae associated with the development of bronchiectasis
- Caused by MTB, S. aureus, mixed infections
89
Etiology and pathogenesis of bronchiectasis
- Obstruction/infection - Atelectasis - Airway wall dilation
90
Morphology of brionchiectasis
- Dilated airways containing purulent exudate | - Adjacent fibrotic lung tissue
91
Microscopic findings of bronchiectasis
- Chronic inflammation | - Fibrosis of bronchial wall
92
Bronchiectasis complications
- Repeated infections - Pneumoniae with abscess formation - Metastatic brain abscesses - Pulmonary fibrosis --> Cor pulmonale
93
Malignant Bronchogenic CA (histological classification)
- Squamous cell CA - Adenocarcinoma - Small cell CA - Large cell CA
94
Bening lung tumors
- Hamartoma
95
Etiology of bronchogenic CA
- Cigarette smoking - Industrial pollutants - Asbestos - Pulmonary scars
96
Genetic aberrations of squamous cell lung CA
- Chromosome deletions involving tumor suppressor loci - CDKN2A gene - TP53 gene
97
Squamous cell lung CA is more common with
- Cigarette smoking | - Men
98
Lung carcinoma histological findings
- Gray-white tumor infiltrates the lung parenchyma | - Well-differentiated squamous cell carcinoma showing keratinization
99
Adenocarcinomas of the lung arise from
- Oncogenic gain-of-function mutations | - Growth factor receptor signaling pathways
100
Genes encoding receptor tyrosine kinases
- EGFR - ALK - ROS - MET - RET - Also must have mutations with the KRAS gene - Influence growth factor signaling pathways
101
Adenocarcinoma is commonly associated with
- Women | - Scarring
102
Gross findings of lung adenocarcinoma
- Bronchioloalveolar CA | - Develop at periphery
103
Microscopic findings of lung adenocarcinoma
- Slow growth, gland forming - Well to poorly differentiated mucin production
104
Adenocarcinoma histological findings
- Tumor with tan-gray appearance growing near periphery of lung - Gland-forming
105
Small cell CA strongest association with
- Smoking
106
Small cell CA shares many molecular features with SCCA
- Loss-of-function (LOF) aberrations - TP53 (75% to 90% of tumors) - RB (close to 100% of tumors) - Chromosome 3p deletions - Amplification of genes of the MYC family
107
Small cell CA characteristics
- Aggressive | - Ectopic hormone production
108
Small cell CA gros findings
- Hilar/central growth
109
Small cell CA microscopic findings
- Small oval cells that grow in clusters
110
Small cell carcinoma histological findings
- Islands of small deeply basophilic cells and areas of necrosis
111
Large cell CA
- Undifferentiated malignant epithelial tumor | - Lacks the cytologic features and markers of other lung tumors
112
Large cell CA morphology
- Large nuclei - Prominent nucleoli - Moderate amounts of cytoplasm - Diagnosis of exclusion
113
Large cell carcinoma histological findings
- Tumor cells are pleomorphic and show no evidence of squamous or glandular differentiation
114
Systemic manifestations of large cell CA
- Weight loss | - Hemoptysis
115
Paraneoplastic syndromes associated with large cell CA
- Small Cell CA | - SCCA (ADH, serotonin, parathormone)
116
Diagnosis of large cell CA
- CXR - Sputum - Bronchial bx - Pleural fluid examination - Lymph node bx - R/O metastasis

Pathology I (9 decks)

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