w6 histology

Question 1

where does the elastin lie

Answer 1

lamina propria

Question 2

PT presents with crushing’s like symptoms from ectopic ACTH secrection. Where is the likely source?

Answer 2

Tumor can cause crushing’s like symptoms, ACTH secrection in the respiratory epithelium

Question 3

there is a mutation in the serous secretions of the submucousal glands. What layer is most likely disturbed?

if the patient was not able to create glycoproteins what layer would be distrubed

Answer 3

Sol layer

gel layer

• Gel layer: Mucous layer derived from goblet cells and mucous portion of submucosal glands; Viscous, lubricating properties due to mucins(hydrophilic glycoproteins that are hydrated to form mucus)
• Sol layer: Watery, periciliarylayer derived from serous portion of submucosalglands

Question 4

a male patient presents to the infertility clinic with infertility issues and has a long history of chronic respiratory infections. what is likely the source of his problem?

Answer 4

Primary ciliary dyskinesia (or Immotile Cilia Syndrome) from a dyein mutation

if the patient also presented with: (1) dextrocardia with or without situsinversus, (2) chronic sinusitis, and (3) bronchiectasis = •Kartagener’ssyndrome:

situs invertus is only some times because the beating of the cillia determines the orientation in embryology

Question 5

compare and contrast COPD from metaplasia

Answer 5

metaplasia

Goblet cell hyperplasia increased cell number; increased mucous secretions protect surface from physical stress & mucosal irritants

Basal cell hyperplasia indicates stem cell proliferation and differentiation to replace cells that are damaged

Squamous cell metaplasia offers better protection against increased airflow that may be associated with “smoker’s cough”, bronchiectasis

COPD

hypertrophy of glands in trachea and bronchi

goblet cell hyperplasia extending into small bronhioles

Question 6

where are the stem cells within the lung

Answer 6

basal cells

type II pneumocytes (can diff into type 1 so more plastic)

Question 7

patient presents with edema contained to the superficial lamina propria, what is this called?

Answer 7

a Cyst or Reinke’s edema

Question 8

what area of the submucousa is subject to changes with age

Answer 8

the hyaline cartilage in the anterior and lateral edges can essify with age

Posterior wall contains trachealissmooth muscle, fibroelastic ligamentconnecting ends of rings

Question 9

what is the smooth muscle called in the trachea and in the bronchus

Answer 9

trachealis and muscularis

Question 10

is this an extrapulmonary or intrapulmonary artery and how do you know

Answer 10

extrapulmonary because it has complete rings of cartilage while intrapulmonary cartilage has discontinous rings

Question 11

a baby is born with a lung that is not working, what is likely the problem

Answer 11

Congenital neonatal emphysema

Congenital absence of bronchial cartilage formation

air can enter but cannot exit

cartilage rings help prevent collapsing of bronchi during exhalation

Question 12

differentiate between restrictive and obstructive lung diseases

Answer 12

obstructive–> cant get air out (dysnea and wheezing)

restrictive–> cant get air in

Restrictive lung diseases decrease the lung volume and the compliance

Obstructive lung diseases increase the lung volume and the compliance

Question 13

patient presents with signs of COPD how can we quickly estimate the pathology

Answer 13

Reid Index to analyze the gland hypertrophy

Ratio of seromucous gland acini to wall from epithelial basement membrane to inner surface the cartilage (A/B);normal value is 0.4; measurements of > 0.55 seen in many patients with chronic bronchitis

Question 14

what conditions present with wheezing

Answer 14

Asthma, emphysema, and chronic bronchitis (COPD)

Question 15

where do goblet cells stop

Answer 15

brionchiole, none in terminal bronchiole

Question 16

what is the source of problems in asthma

Answer 16

bronchioles

Parasympatheticstimulation of muscarinic receptors causes bronchiolar smooth muscle contraction and stimulates submucosal gland secretion

Sympatheticstimulation of β-2 receptors causes bronchiolar smooth muscle relaxation(e.g., during exercise)

Question 17

patient presents with pneumonia, what was the likely source through which this spread

Answer 17

pores of kohn

These openings serve to equalize pressure and increase collateral ventilation of air. If obstructive disease blocks normal airflow to distal regions, undamaged alveoli aerated by the blockage airway can still communicate, to a limited extent, with the airways of an adjacent lobule or acinus.

A disadvantage is that these small openings can also serve as avenues of dissemination of infections.

Question 18

what does an oxygen molecule have to diffuse through to get to the blood vessel

Answer 18

Type 1 pneumocyte (occluden junctions- tight junctions), BM (type 4 collagen) and endothelial

Question 19

what occurs in pulmonary edema

Answer 19

Increase in capillary, hydrostatic pressure or inflammation increases fluid exiting capillaries, exceeds lymphatic drainage capacity tight junctions between pneumocytes initially confine fluid to interstitium, if not resolved fluid eventually seeps into alveolar lumen

Question 20

what makes up the interalvelar septa

Answer 20

Contained within thick segment connective tissue are reticular fibers (type III collagen) that supports the connective tissue and elastic fibers prividing recoil properties to the interalvelarsepta.

Question 21

differentiate Centriacinar Emphysema and Panacinar Emphysema

Answer 21

Centriacinar Emphysema is usually confined to an area and is the result of smoking wherare panacinar is usually entire area arising from a1 antitrypsin deficiency. Both have excess elastase degredation

Question 22

what is an acini

Answer 22

portions of lung consisting of a terminal bronchiole and the respiratory airways it aerates.

Question 23

outline what happens in emphysema

Answer 23

macrophages –> neurophils –> elastase –> overwhelms the protective effect of a1 antitrypsin and neutralize the basal cells

LOSS OF RECOIL

ØIrreversible distention of respiratory airways (i.e., loss of recoil, elasticity, elastance)

–

Question 24

what cells produce surfactant

how do you measure it in amnotic fluid

what is the pathogenesis of neonatal respiratory distress syndrome

Answer 24

type II cells and club cells non-ciliated bronchiolar cells

type II cells –> Dipalmitoylphosphotidylcholineaccounts for almost all surface-tension reducing properties of surfactant

a phosphotidylcholine: sphingomyelin ratio lower than 2:1 and the absenceof phosphatidyl glycerol = not developed

•Pathogenesis: lack of surfactant production by type II pneumocytes→ increased surface tension→ collapse of smaller alveoli and dilation of alveolar ducts and respiratory bronchioles → stretch damages the epithelium and vasculature→ deposition of intraluminal fibrin and platelet aggregation (eosinophilic staining = “hyaline membrane”)

Question 25

you detect high CC16 what is it an indicator of

Answer 25

Damaged terminal bronchioles

CC16 is a Clara cell protein of 16 kilodaltons. Damaged terminal bronchioles, and therefore damaged Clara cells, would decrease the concentration of CC16 in bronchial lavage fluid. Conversely, leakage of CC16 across the air-blood barrier would increase CC16 in serum and indicate the integrity of the airway walls are damaged.

Question 26

22-year-old man with a two-year history of cigarette smoking presents to the otolaryngologist after developing a change in his voice. Laryngoscopy shows edema of the true vocal fold (see picture). A biopsy would show edematous fluid has collected in Reinke’s space, which is a thin strip of connective tissue between the stratified squamous epithelium and the vocal ligament. Which of the following best identifies Reinke’s space in the attached photomicrograph of a true vocal cord?

Answer 26

B

•True vocal cord: stratified squamous epithelium (protective), Reinke’sspace, elastic cone, skeletal muscle (vocalis)