Robbin's 15: The Lung Flashcards
Pus in the pleural space is called _________, and typically complicates an existing pneumonia.
Pus in the pleural space is called empyema, and typically complicates an existing pneumonia.
A 26-year-old woman with postpartum sepsis is afebrile on antibiotic therapy, but she has had worsening oxygenation over the past 3 days. Her chest radiograph shows scattered bilateral pulmonary opacifications. A ventilation-perfusion scan shows areas of mismatch. What microscopic finding is most likely to be present in her lungs?
Alveolar hyaline membranes She has acute lung injury with noncardiogenic pulmonary edema and development of diffuse alveolar damage (DAD), clinically known as acute respiratory distress syndrome (ARDS). Inciting sepsis, trauma, or other forms of lung injury leads to a vicious cycle of inflammation with ongoing damage, mainly through the action of neutrophils. Though ARDS may eventually proceed to fibrosis, most patients do not survive that long.
Plexiform lesions of the lung are characteristic for _________
Plexiform lesions are characteristic for pulmonary hypertension.
Destruction of respiratory bronchioles is a feature of _________.
Destruction of respiratory bronchioles is a feature of centrilobular emphysema.
Dynein arms are absent or abnormal in what disease, which leads to bronchiectasis?
Dynein arms are absent or abnormal in Kartagener syndrome, which leads to bronchiectasis.
A 20-year-old, previously healthy man is jogging one morning when he trips and falls to the ground. He suddenly becomes markedly short of breath. On examination in the emergency room there are no breath sounds audible over the right side of the chest. A chest radiograph shows shift of the mediastinum from right to left. A chest tube is inserted on the right side, and air rushes out. What underlying disease is most likely to have produced this complication?
Distal acinar emphysema Distal acinar (paraseptal) emphysema is localized, beneath pleura typically in an upper lung lobe, and may occur in an area of fibrosis or scar formation. Although the lesions are usually less than 2 cm in diameter, they are prone to rupture spontaneously or with minor trauma, leading to pneumothorax. They can be a cause for spontaneous pneumothorax in young adults. A “ball valve” effect can lead to air trapping in pleura, producing tension pneumothorax, as in this case.
Centriacinar emphysema arises in respiratory bronchioles and is seen in what population?
Smokers
What kind of emphysema involves most of the lung lobule and can be seen in all lobes; α1-antitrypsin deficiency is the most likely antecedent?
Panacinar (panlobular) emphysema involves most of the lung lobule and can be seen in all lobes; α1-antitrypsin deficiency is the most likely antecedent.
What is the most likely complication of bronchiectasis?
Bronchiectasis results from inflammation with destruction of bronchi; hemoptysis is the most likely complication. Bronchiectasis results in airway dilation from destructive bronchial wall inflammation.
What is an expected complication of corpulmonale?
Pleural effusions
Centrilobular emphysema results from damage to the central part of the lung acinus, with dilation that primarily affects what part of the lung?
Centrilobular emphysema results from damage to the central part of the lung acinus, with dilation that primarily affects the respiratory bronchioles.
A 62-year-old man is a smoker with a 10-year history of cough productive of copious mucopurulent sputum. Over the past 6 months, he has developed progressive dyspnea. Physical examination shows bilateral pedal edema and a soft but enlarged liver. A chest radiograph shows bilateral pleural effusions and a prominent right heart border. Arterial blood gas values are Po2, 60 mm Hg; Pco2, 52 mm Hg; pH, 7.30; and HCO3−, 29 mEq/L. He is intubated and placed on a ventilator, and he requires increasing amounts of oxygen. What microscopic finding is most likely to be present in the affected lungs?
Hypertrophy of bronchial submucosal glands Chronic bronchitis can be complicated by pulmonary hypertension and cor pulmonale. There are few characteristic microscopic features of chronic bronchitis, so it is mainly defined clinically by the presence of a persistent cough with sputum production for at least 3 months in at least 2 consecutive years.
A 12-year-old girl has a 7-year history of coughing and wheezing and repeated attacks of difficulty breathing. The attacks are particularly common in the spring. During an episode of acute respiratory difficulty, a physical examination shows that she is afebrile. Her lungs are hyperresonant on percussion, and a chest radiograph shows increased lucency of all lung fields. Laboratory tests show an elevated serum IgE level and peripheral blood eosinophilia. A sputum sample examined microscopically also has increased numbers of eosinophils. What histologic feature is most likely to characterize the lung in her condition?
Remodeling of airways with smooth muscle hyperplasia Atopic asthma is a type I hypersensitivity reaction in which there are presensitized, IgE-coated mast cells in mucosal surfaces and submucosa of airways. Contact with an allergen results in degranulation of the mast cells, with both immediate release (minutes) of mediators such as histamine to promote bronchoconstriction, and delayed release (an hour or more) of leukotrienes and prostaglandins via the arachidonic acid pathway; these attract leukocytes, particularly eosinophils, and promote bronchoconstriction. The characteristic histologic changes in the bronchi, including remodeling of airways and smooth muscle hyperplasia, result from the episodes of inflammation.
Bronchial dilation with inflammatory destruction is a feature of _________.
Bronchial dilation with inflammatory destruction is a feature of bronchiectasis.
Charcot-Leyden crystals represent the breakdown products of ________.
The Charcot-Leyden crystals represent the breakdown products of eosinophil granules. Asthma, particularly extrinsic (atopic) asthma, is driven by a type I hypersensitivity response and is associated with an excessive TH2 and TH17 cell-mediated immune response. Genetic factors are important in the pathogenesis of atopic asthma and linkage to cytokine genes that map on 5q are strongly associated with development of asthma and other atopic allergies.
A 19-year-old man has a history of recurrent mucoid rhinorrhea with chronic sinusitis and otitis media since childhood. He has experienced multiple bouts of pneumonia. His temperature is 37.7° C. On examination of his chest, there is tactile fremitus, rhonchi, and rales in lower lung fields. Nasal polyps are noted. A chest radiograph shows bronchial dilation with bronchial wall thickening, focal atelectasis, and areas of hyperinflation; his heart shadow appears mainly on the right. What abnormality is he most likely to have?
Ciliary dyskinesia He has Kartagener syndrome (sinusitis, bronchiectasis, and situs inversus associated with ciliary dyskinesia). There is an abnormality of ciliary dynein arms that diminishes the mucociliary function of the respiratory epithelium, predisposing to recurrent and chronic infections of both upper and lower respiratory tract.
A 35-year-old woman has experienced multiple bouts of severe necrotizing pneumonia since childhood, with Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, and Serratia marcescens cultured from her sputum. She now has a cough productive of large amounts of purulent sputum. On physical examination, there is dullness to percussion with decreased breath sounds over the right mid to lower lung fields. A chest radiograph shows areas of right lower lobe consolidation. A bronchogram shows marked dilation of right lower lobe bronchi. What mechanism is the most likely cause of her disease?
Recurrent inflammation with bronchial wall destruction Bronchiectasis is a chronic obstructive airway disease from irreversible dilation of bronchi that results from inflammation and destruction of bronchial walls after prolonged infections or obstruction. Serious bouts of pneumonia can predispose to bronchiectasis.
BMPR2 is associated with development of what pathology?
BMPR2 is associated with development of primary pulmonary hypertension.
Mutations in ______ are related to development of pulmonary alveolar proteinosis.
Mutations in GM-CSF are related to development of pulmonary alveolar proteinosis.
A 54-year-old woman has had a mild fever with cough for a week. Her symptoms gradually improve over the next 10 days. She then begins to have increasing fever, cough, shortness of breath, and malaise. Now, on physical examination, her temperature is 37.9° C. There are inspiratory crackles on auscultation of the chest. A chest radiograph shows bilateral, patchy, small alveolar opacities. Chest CT scan shows small, scattered, ground-glass and nodular opacities. A transbronchial biopsy specimen shows polypoid plugs of loose fibrous tissue and granulation tissue filling bronchioles, along with a surrounding interstitial infiltrate of mononuclear cells. She receives a course of corticosteroid therapy, and her condition improves. What is the most likely diagnosis?
Cryptogenic organizing pneumonia Bronchiolitis obliterans is a feature of cryptogenic organizing pneumonia, an uncommon, nonspecific reaction to a lung injury, such as an infection or toxic exposure.
Desquamative interstitial pneumonitis is related to what predisposition?
Desquamative interstitial pneumonitis (DIP) is an uncommon smoking-related interstitial disease in which monocytes gather to form intra-alveolar macrophages.
What “pathogen” produces ferruginous bodies in the lungs?
Asbestos The ferruginous bodies are long, thin crystals of asbestos that have become encrusted with iron and calcium. The inflammatory reaction incited by these crystals promotes fibrogenesis and resultant pneumoconiosis.
What is commonly seen on CXR of a patient with asbestos?
Diaphragmatic pleural calcified plaques The inhaled asbestos fibers become encrusted with iron and appear as the characteristic ferruginous bodies with iron stain. The firm, tan mass encasing the pleura is most likely a malignant mesothelioma. Asbestosis more commonly gives rise to pleural fibrosis and interstitial lung disease, similar to other pneumoconioses. This is seen grossly as a dense pleural plaque, which often is calcified. Asbestosis can give rise to bronchogenic carcinoma, especially in smokers.
Upper lobe cavitation suggests what infection?
Upper lobe cavitation suggests secondary tuberculosis.