The Lung and Pleura Flashcards

1
Q

Loss of lung volume cause by inadequate expansion of airspaces, resulting in shunting of inadequately oxygenated blood from pulmonary arteries into veins; can be resorption (obstruction that prevents air reaching distal air spaces), compression (pleural fluid or mass compressing the lung), and contraction (pleural fibrosis impeding expansion of lungs).

A

Atelectasis

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2
Q

Abrupt onset of significant hypoxemia and bilateral infiltrates WITHOUT heart failure.

A

Acute lung injury (ALI)

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3
Q

Severe manifestation of ALI; lungs are dark red, firm, airless and heavy; there is capillary congestion, necrosis of alveolar epithelial cells, interstitial and intra-alveolar edema and hemorrhage and neutrophils in capillaries; hyaline membrane is also characteristic, lining the alveolar ducts.

A

Acute respiratory distress syndrome (ARDS)

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4
Q

Most common causes of ARDS.

A

Sepsis, diffuse pulmonary infections, Gastric aspiration

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5
Q

Class A recommendation for management of ARDS.

A

Low Tidal Volume ventilation: 6cc/Kg PREDICTED Body weight Early neuromuscular blockade: Cisatracurium besylate for 48 hours

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6
Q

Diffuse pulmonary disease characterized by limitation of airflow, usually resulting from an increase in resistance caused by partial or complete obstruction at any level; spirometry findings: markedly decreased FEV1, decreased FVC, decreased FEV1/FVC; examples: Bronchial asthma, Emphysema, Chronic bronchitis and Bronchiectasis

A

Obstructive lung diseases

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7
Q

Characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of their walls without obvious fibrosis; there is thinning of the alveolar walls and loss of elastic tissue; can be centriacinar (respiratory bronchioles only; associated with smoking), panacinar (associated with a-1-antitrypsin deficiency, distal acinar (most commonly seen in adults with spontaneous pneumothorax), and irregular (most common).

A

Emphysema (Pink puffers)

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8
Q

Defined as persistent productive cough for at least 3 consecutive months in at least 2 consecutive years; morphologically, mucosal lining of the larger airways is usually hyperemic and swollen with edema fluid, often covered by a layer of mucinous or mucopurulent secretions; trachea and bronchi have enlarged mucus-secreting glands.

A

Chronic bronchitis (Blue bloaters)

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9
Q

Triad of: 1. Intermittent and reversible airway obstruction; 2. Chronic bronchial inflammation with eosinophils; and 3. Bronchial smooth muscle cell hypertrophy and hyperreactivity; morphologically characterized by thick, tenacious mucus plugs with Curschmann spirals (whorls of shed epithelium found in mucus plugs) and Charcot-Leyden crystals (collections of crystalloids made up of eosinophil protein).

A

Bronchial asthma

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10
Q

Criteria for reversibility of airway obstruction diagnostic of bronchial asthma.

A

FEV1 increase of >12% or 200 mL post bronchodilator

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11
Q

Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic supporting tissue, resulting from chronic necrotizing infections; morphologically, there is intense acute and chronic inflammatory exudate within the walls, with mixed flora often cultured; there is also peribronchiolar fibrosis in chronic cases.

A

Bronchiectasis

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12
Q

Thickening of airway wall; sub-basement membrane fibrosis; increased vascularity in submucosa; increase in size of the submucosal glands and goblet cell metaplasia of the airway epithelium; hypertrophy and/or hyperplasia of the bronchial muscle; are collectively called:

A

Airway remodeling

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13
Q

Diffuse pulmonary disease characterized by reduced expansion of lung parenchyma accompanied by decreased total lung capacity; spirometry findings: decreased FEV1, markedly decreased FVC, normal or increased FEV1/FVC; examples: Chronic interstitial lung diseases

A

Restrictive lung diseases

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14
Q

Heterogeneous group of disorders characterized predominantly by inflammation and fibrosis of the pulmonary interstitium; follows restrictive lung disease pattern; complications include cor pulmonale and honeycomb lung; examples: Usual interstitial pneumonia (Idiopathic pulmonary fibrosis), Pneumoconiosis, and Sarcoidosis.

A

Chronic interstitial lung diseases

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15
Q

Pneumonia with a patchy distribution of inflammation involving more than one lobe.

A

Bronchopneumonia

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16
Q

Pattern of pneumonia observed in pneumococcal pneumonia; has four phases of evolution, from congestion, red hepatization, gray hepatization and resolution.

A

Lobar pneumonia

17
Q

Inflammatory reaction is largely confined within the walls of the alveoli; septa widened and edematous, with mononuclear infiltrates of lymphocytes, histiocytes and plasma cells; alveolar spaces are free of cellular exudate. This morphology points more to:

A

Atypical pneumonia

18
Q

A localized area of suppurative necrosis within the pulmonary parenchyma, resulting in the formation of one or more large cavities; most commonly occurs in the right side, particularly in the posterior segment of the upper lobe and apical segments of the lower lobe; most common isolates are anaerobic bacteria.

A

Lung abscess

19
Q

Form of tuberculosis that develops in a previously unexposed, unsensitized person.

A

Primary tuberculosis

20
Q

Implantation of the inhaled M. tuberculosis bacilli in the distal airspaces of the lungs, causes the formation of this 1-1.5 cm area of gray-white inflammatory consolidation.

A

Ghon focus

21
Q

Ghon focus with involvement of the hilar lymph nodes is called:

A

Ghon complex

22
Q

Radiographically detectable calcified Ghon complex is called:

A

Ranke complex

23
Q

Pattern of disease that arises in previously sensitized host to M. tuberculosis.

A

Secondary or reactivation TB

24
Q

Occurs when TB bacilli drain through the lymphatics into lymphatic ducts, which eventually empty into the right side of the heart and into pulmonary circulation; individual lesions are small, visible foci of yellow-white consolidation scattered through the parenchyma.

A

Miliary tuberculosis

25
Q

Type of necrosis seen in tuberculosis.

A

Caseous

26
Q

Type of inflammation seen in tuberculosis.

A

Chronic granulomatous

27
Q

Type of hypersensitivity reaction in tuberculosis (including TST).

A

Type IV (Cell-mediated/Delayed)

28
Q

Cytokine responsible for formation of granulomas in tuberculosis.

A

IFN-g

29
Q

Histologic appearance of tuberculosis infection in the absence of an intact cell-mediated immunity.

A

Macrophages filled with bacilli

30
Q

Most common form of extrapulmonary TB.

A

Tuberculous lymphadenitis (scrofula)

31
Q

Most common affected segment in gastrointestinal TB (Note: GITB is rare, due to decrease in consumption of infected milk).

A

Ileum

32
Q

One of the two most common histologic types of lung cancer associated with smoking; centrally located in major bronchi; may range from poorly differentiated to well-differentiated with keratin pearl formation; associated in general with hypercalcemia, due to production of PTH related peptide (PTHrp). Immunostains: p63, p40.

A

Squamous cell carcinoma

33
Q

The most common histologic type of lung cancer; most commonly seen in nonsmokers; peripherally located; histologically, may show acinar (glandular), papillary, mucinous, and solid types. Immunostains: TTF-1 and napsin A.

A

Adenocarcinoma

34
Q

Most common histologic type of lung cancer associated with smoking; centrally located; with early nodal involvement; histologically, small, round to fusiform cells with scant cytoplasm and finely granular chromatin with numerous mitotic figures are present; most associated with paraneoplastic syndromes, such as Cushing syndrome (ectopic ACTH), Lambert-Eaton myasthenic syndrome, and SIADH, among others; only type not amenable to surgery; Immunostains: chromogranin, synaptophysin, CD57 and BCL2.

A

Small cell (Oat cell) carcinoma

35
Q

Lung carcinoma that typically has large, prominent nucleoli, and a moderate amount of cytoplasm, with minimal glandular or squamous differentiation. Diagnosed when immunostains for known histologic types of lung cancer are negative.

A

Large cell carcinoma

36
Q

A rare cancer seen in patients who work in shipyards, miners and insulators; presents as lung ensheathed by a yellow-white, firm or gelatinous layer of tumor that obliterates the pleural space; lesion is preceeded by extensive pleural fibrosis and plaque formation; may be epithelial, sarcomatoid or biphasic in morphology.

A

Malignant mesothelioma

37
Q

Immunostains: Epithelioid and Sarcomatoid

A

Immunostains: Epithelioid: Keratin, calretinin, WT-1, CK5,6, D2-40; Sarcomatoid: usually Keratin(+) only.