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Pathology I > Respiratory Pathology > Flashcards

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
Q

Extensively drug resistant tuberculosis (XDR-TB)

A
  • Resistant to three or more of the six classes of second-line drugs
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26
Q

TB drugs that XDR-TB can be resistant to

A
  • Rifampin
  • Isoniazide
  • Pyrazinamide
  • Ethambutol
  • Strreptomycin
  • Aminoglycosides
  • Polypeptides
  • Flouroquinolones
  • Thioamides
  • Cycloserine
  • PAS
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27
Q

Pathophysiological basis of COPD

A
  • Airflow obstruction and/or resistance to flow
  • Luminal obstruction
  • Narrowing of bronchi
  • Alveolar wall thickening
  • Loss of supporting structures
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28
Q

Types of COPD

A
  • Emphysema
  • Chronic bronchitis
  • Bronchial asthma
  • Bronchiectasis
  • Cystic fibrosis
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29
Q

Features of emphysema

A
  • Acini destruction
  • Loss of elastic recoil
  • Alveolar wall destruction
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30
Q

Types of emphysema

A
  • Centrilobular/Centriacinar (smokers)

- Panacinar (alpha-1 antitrypsin deficiency)

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31
Q

Emphysema gross morphology

A
  • Large
  • Voluminous lungs
  • Air space enlargement
  • Compressed capillaries
  • Blebs and bullae
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32
Q

Clinical findings of emphysema

A
  • Pink puffer
  • Barrel chest
  • Clubbing of hands
  • Blue boater
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33
Q

Benefits of triflow used in atelectasis

A
  • Strengthens diaphragm
  • Encourages patients to take deep breaths
  • Expand small air sacs in their lungs
  • Help clear the air passage of mucus
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34
Q

Complications associated with emphysema

A
  • Cor pulmonae
  • Pneumothorax
  • Polycythemia
  • Acidosis
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35
Q

Cor pulmonae

A
  • Right ventricular hypertrophy due to increased pulmonary pressures
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36
Q

Pneumothorax

A
  • Collapsed lobe of the lung
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37
Q

Plycythemia

A
  • Increase in RBCs
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38
Q

Acidosis

A
  • Blood pH becomes acidic secondary to retention of CO2
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39
Q

COPD may involve vasculature or parenchymal disease in the alveolar sacs

A
  • Stretched flattened capillaries impedes blood flow

- Increases pulmonary pressure/resistance

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40
Q

Chronic bronchitis (definition)

A
  • Cough with sputum for 3 months or more per year for 2 or more consecutive years
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41
Q

1 cause of bronchitis and emphysema

A
  • Smoking
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42
Q

Clinical signs and symptoms of bronchitis

A
  • Excessive coughing
  • Expectoration of thick sputum
  • Dyspnea
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43
Q

Bronchitis prognosis

A
  • Bronchial spastic episodes
  • Progression to emphysema

Worsened:

  • Cor pulmonale CHF
  • Marked disability
  • Shortened lifespan
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44
Q

Asthma

A
  • Chronic inflammatory disorder

- Bronchoconstriction and Airflow Limitation

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45
Q

Hallmarks of asthma

A
  • Increased airway responsiveness to stimuli
  • Episodic bronchoconstriction
  • Inflammation of the bronchial walls
  • Increased mucus secretion
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46
Q

Classifications of asthma

A
  • Atopic (evidence of allergen sensitization)
  • Non-atopic (without evidence of allergen sensitization)
  • Drug-Induced Asthma
  • Occupational Asthma
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47
Q

Asthma triggers (bronchospasm)

A
  • Respiratory infections (viral infections)
  • Environmental exposure (e.g., smoke, fumes)
  • Cold air
  • Stress
  • Exercise
48
Q

Atopic asthma

A
  • Genetic predisposition

- Type I hypersensitivity (Atopy)

49
Q

Pathogenesis of asthma

A
  • Allergen stimulated TH2 Response
  • TH2 cells secrete cytokines
  • B cell stimulation
  • IgE coats submucosal mast cells
  • Allergen triggers the mast cell degranulation
50
Q

TH2 cells secretion of cytokines in asthma

A
  • IL-4 stimulates IgE production
  • IL-5 activates eosinophils
  • IL-13 stimulates mucus secretion
51
Q

B cell stimulation in asthma leads to

A
  • IgE production
52
Q

Pathogenesis of atopic asthma: early phase (immediate hypersensitivity)

A
  • Leukotrienes C4, D4, and E4 (from Mast cells)
  • Acetylcholine (from intrapulmonary motor nerves)
  • Bronchoconstriction
53
Q

Acetylcholine release from intrapulmonary motor nerves (atopic asthma early phase) causes

A
  • Smooth muscle constriction via muscarinic receptors
54
Q

Bronchospasm in the early phase of atopic asthma pathogenesis is a result of

A
  • Stimulation of subepithelial vagal (parasympathetic) receptors
55
Q

Bronchospasm in the early phase of atopic asthma pathogenesis causes

A
  • Increased mucus production
  • Vasodilation
  • Increased vascular permeability
56
Q

Atopic asthma late phase mediators

A
  • Histamine (Bronchoconstrictor)
  • Prostaglandin D2 (Bronchoconstriction and vasodilatation)
  • Chemokines (Eotaxin)
  • IL-1, TNF, IL-6
57
Q

Chemokines (Eotaxin) in the late phase of atopic asthma result in

A
  • Recruitment of mediator-releasing cells

- Neutrophils, eosinophils, and basophils; lymphocytes and monocytes)

58
Q

Late phase of atopic asthma perpetuates

A
  • Clinical symptoms
59
Q

Status asthmaticus

A
  • Severe acute paroxysm

- Severe cyanosis/death

60
Q

Severe cyanosis/death associates with status asthmaticus results from

A
  • Overdistension/overinflation of lungs
  • Atelectasis
  • Mucus Plugs
  • Curschmann spirals
  • Numerous eosinophils
  • Charcot-Leyden crystals
61
Q

Curschmann spirals

A
  • Whorls of shed epithelium
62
Q

Charcot-Leyden crystals

A
  • Eosinophil Crystalloid
63
Q

Clinical course of status asthmaticus

A
  • Chest tightness
  • Dyspnea
  • Wheezing
  • Cough (+/- sputum production)
  • Increase in airflow obstruction (from baseline levels)
  • Less difficulty with exhalation
64
Q

Pulmonary function test normal values

A
  • TV = 500
  • IRC = 3000
  • IC = 3500
  • ERV = 1000
  • RV = 1200
  • FRC = 2200
  • VC = 4500
  • TLC = 5700
65
Q

Pulmonary function test values decreased below normal in asthmatics

A
  • ERV
  • VC
  • FEV/FVC
66
Q

Pulmonary function test values increased above normal in asthmatics

A
  • RV

- FRC

67
Q

Types of restrictive lung disease

A
  • Beryllium disease
  • Congestive heart failure
  • Idiopathic pulmonary fibrosis
  • Infectious inflammation (e.g., histoplasmosis, mycobacterium infection)
  • Interstitial pneumonitis
  • Neuromuscular diseases
  • Sarcoidosis
  • Thoracic deformities
68
Q

Idiopathic pulmonary fibrosis (IPF)

A
  • Causative agent(s) unknown
  • Current concept: repeated cycles of epithelial activation/injury
  • Inflammation/induction of TH2 type T cell (leads to cell recruitment)
69
Q

Cells recruited in idiopathic pulmonary fibrosis

A
  • Eosinophils

- Mast cells

70
Q

Mediators of idiopathic pulmonary fibrosis

A
  • IL-4
  • IL-13
  • Both from TH2 type T cell
71
Q

_____ is responsible for repair mechanisms in idiopathic pulmonary fibrosis

A
  • TGF-β1
72
Q

Properties of TGF-β1 in abnormal epithelial repair

A
  • Fibrogenic (released from injured type I alveolar epithelial cells)
  • Transformation of fibroblasts into myofibroblasts
  • Deposition of collagen and other extracellular matrix molecules
73
Q

Process of abnormal epithelial repair in idiopathic pulmonary fibrosis

A
  • TGF-β1 responsible for Repair Mechanisms
  • Exuberant fibroblastic / myofibroblastic proliferation
  • Fibroblastic foci are produced
74
Q

Pathogenesis of idiopathic pulmonary fibrosis

A
  • Mutations that Shorten Telomeres
  • TGF-β1
  • Caveolin-1
75
Q

Mutations that shorten telomeres in idiopathic pulmonary fibrosis results in

A
  • Alveolar epithelial cells undergo rapid senescence and apoptosis
76
Q

TGF-β1

A
  • Negatively regulates telomerase activity

- Facilitates epithelial cell apoptosis

77
Q

Caveolin-1

A
  • Endogenous inhibitor of pulmonary fibrosis
  • Limits TGF-β1 activity
  • Decreased in IPF patients
78
Q

Pathology of IPF

A
  • Fibrotic lungs
  • Scattered fibroblast foci
  • Subpleural fibrosis
79
Q

Clinical findings on IPF chest x-rays

A
  • Bilateral lower lobe opacities

- Decrease lung volumes

80
Q

Clinical findings on IPF high-resolution CT scan (HRCT)

A
  • Reticular opacities

- Honey combing

81
Q

Clinical course of restrictive lung disease

A
  • Insidious
  • Increasing dyspnea on exertion
  • Dry cough
  • Presentation: 4th-7th Decade
  • Disease course unpredictable
82
Q

Late findings of restrictive lung disease

A
  • Hypoxemia
  • Cyanosis
  • Clubbing
83
Q

Disease course of restrictive lung disease

A
  • Gradual deterioration
  • Mean survival of 3 years or less
  • Lung transplantation is the only definitive therapy available
84
Q

Bronchiestasis

A
  • A chronic necrotizing infection of the bronchi and bronchioles leading to or associated with abnormal dilation of these airways
85
Q

Conditions associated with the development of bronchiectasis

A
  • Bronchial obstruction
  • Congenital or hereditary
  • Necrotizing pneumoniae
86
Q

Bronchial obstructive diseases associated with the development of bronchiectasis

A
  • Tumor
  • Foreign bodies
  • Mucous impaction
87
Q

Congenital or hereditary diseases associated with the development of bronchiectasis

A
  • Cystic fibrosis

- Immotile cilia syndrome

88
Q

Necrotizing pneumoniae associated with the development of bronchiectasis

A
  • Caused by MTB, S. aureus, mixed infections
89
Q

Etiology and pathogenesis of bronchiectasis

A
  • Obstruction/infection
  • Atelectasis
  • Airway wall dilation
90
Q

Morphology of brionchiectasis

A
  • Dilated airways containing purulent exudate

- Adjacent fibrotic lung tissue

91
Q

Microscopic findings of bronchiectasis

A
  • Chronic inflammation

- Fibrosis of bronchial wall

92
Q

Bronchiectasis complications

A
  • Repeated infections
  • Pneumoniae with abscess formation
  • Metastatic brain abscesses
  • Pulmonary fibrosis –> Cor pulmonale
93
Q

Malignant Bronchogenic CA (histological classification)

A
  • Squamous cell CA
  • Adenocarcinoma
  • Small cell CA
  • Large cell CA
94
Q

Bening lung tumors

A
  • Hamartoma
95
Q

Etiology of bronchogenic CA

A
  • Cigarette smoking
  • Industrial pollutants
  • Asbestos
  • Pulmonary scars
96
Q

Genetic aberrations of squamous cell lung CA

A
  • Chromosome deletions involving tumor suppressor loci
  • CDKN2A gene
  • TP53 gene
97
Q

Squamous cell lung CA is more common with

A
  • Cigarette smoking

- Men

98
Q

Lung carcinoma histological findings

A
  • Gray-white tumor infiltrates the lung parenchyma

- Well-differentiated squamous cell carcinoma showing keratinization

99
Q

Adenocarcinomas of the lung arise from

A
  • Oncogenic gain-of-function mutations

- Growth factor receptor signaling pathways

100
Q

Genes encoding receptor tyrosine kinases

A
  • EGFR
  • ALK
  • ROS
  • MET
  • RET
  • Also must have mutations with the KRAS gene
  • Influence growth factor signaling pathways
101
Q

Adenocarcinoma is commonly associated with

A
  • Women

- Scarring

102
Q

Gross findings of lung adenocarcinoma

A
  • Bronchioloalveolar CA

- Develop at periphery

103
Q

Microscopic findings of lung adenocarcinoma

A
  • Slow growth, gland forming
  • Well to poorly differentiated
    mucin production
104
Q

Adenocarcinoma histological findings

A
  • Tumor with tan-gray appearance growing near periphery of lung
  • Gland-forming
105
Q

Small cell CA strongest association with

A
  • Smoking
106
Q

Small cell CA shares many molecular features with SCCA

A
  • 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
Q

Small cell CA characteristics

A
  • Aggressive

- Ectopic hormone production

108
Q

Small cell CA gros findings

A
  • Hilar/central growth
109
Q

Small cell CA microscopic findings

A
  • Small oval cells that grow in clusters
110
Q

Small cell carcinoma histological findings

A
  • Islands of small deeply basophilic cells and areas of necrosis
111
Q

Large cell CA

A
  • Undifferentiated malignant epithelial tumor

- Lacks the cytologic features and markers of other lung tumors

112
Q

Large cell CA morphology

A
  • Large nuclei
  • Prominent nucleoli
  • Moderate amounts of cytoplasm
  • Diagnosis of exclusion
113
Q

Large cell carcinoma histological findings

A
  • Tumor cells are pleomorphic and show no evidence of squamous or glandular differentiation
114
Q

Systemic manifestations of large cell CA

A
  • Weight loss

- Hemoptysis

115
Q

Paraneoplastic syndromes associated with large cell CA

A
  • Small Cell CA

- SCCA (ADH, serotonin, parathormone)

116
Q

Diagnosis of large cell CA

A
  • CXR
  • Sputum
  • Bronchial bx
  • Pleural fluid examination
  • Lymph node bx
  • R/O metastasis

Pathology I (9 decks)

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