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Flashcards in 13. Respiratory Pathology Deck (87):
1

What is atelectasis?

Area of collapsed or nonexpanded lung.

2

What are pores of Kohn?

Collaterla connections between air spaces through which infections can spread.

3

What are obstruction/resorption atelectasis and give and example.

Collapse of the lung due to resorption distal to an obstruction; aspiration of foreign body, chronic obstructive pulmonary disease (COPD), or postoperative.

4

What are compression atelectasis and give and example.

Atelectasis due to fluid, air, blood, or tumor in the pleural space.

5

What are contraction (scar) atelectasis and give and example.

Atelectasis due to fibrosis and scarring of the ling.

6

What is patchy atelectasis and give and example.

Atelectasis due to a lack of surfactants; Hyaline membrane disease of newborn or acute (adult) respiratory distress syndrome (ARDS).

7

What is a bacterial pneumonia?

Acute inflammation and consolidation (solidification) of the lung due to a bacterial agent.

8

What are the clinical symptoms of bacterial pneumonia?

I. Fever and chill. II. Productive cough with yellow-green (pus) or rusty (bloody) sputum. III. Tachypnea. IV. Pleuritic chest pain. V. Decreased breath sounds, rales, and dullness to percussion.

9

What do we see in the lab of someone with bacterial pneumonia?

Elevated WBC count with a left shift.

10

Which organism causes 95% of lobar pneumonia?

Streptococcus pneumoniae.

11

What are the classic four phasese of lobar pneumonia?

I. Congestion: active hyperemia and edema. II. Red hepatization: neutrophils and hemorrhage. III. Grey hepatization: degradation of red blood cells. IV. Resolution: healing.

12

What do we see microscopically in lobar pneumonia?

Intra-alveolar supporative inflammation (neutrophils) and edema.

13

What is bronchopneumonia?

Scattered patchy consolidtaion centered around bronchioles, tends to be bilateral, multilobar and basilar. Affects the young, old, and terminally ill.

14

What do we see microscopically in bronchopneumonia?

Acute inflammation of bronchioles and surrounding alveoli.

15

How is pneumonia diagnosed?

Sputum gram stain and culte and blood cultures.

16

What are lung abscess?

Localized collection of neutrophils (pus) and necrotic pulmonary parenchyma.

17

Which etiology is the most common for lung abscess?

Aspiration, tends to involve right lower lobe; mixed oral flora (anaerobic/aerobic).

18

What is atypical pneumonia?

Interstitial pneumonitis without consolidation.

19

What are three organisms that cause atypical pneumonia?

I. Mycoplasma pneumoniae. II. Influenza virus. III. Parainfluenza.

20

What are four clinicla presentations of tuberculosis?

I. Fever and night sweats. II. Weight loss. III. Cough. IV. Hemoptysis

21

What do we see microscopically in someone with tuberculosis?

Caseating granulomas with acid-fast bacilli.

22

What is Ghon focus?

Subpleural caseous granuloma above or below the interlobar fissure.

23

What is a Ghon complex?

Ghon focus plus hilar lymph node granuloma.

24

Where do we see Ghon focus?

Primary pulmonary tuberculosis.

25

What is a Simon focus?

Granulmoa at lung apex (high oxygen content). Seen in secondary pulmonary tuberculosis.

26

What is Pott's disease?

Miliary spread to lumbar vertebrae bone marrow.

27

What are the clinical presentations of Sarcoidosis?

I. May be asymptomatic. II. Cough, SOB. III. Fatigue, malaise. IV. Skin lesion. V. Eye irritation or pain. VI. Fever/night sweats.

28

What is the defining presentation of sarcoidosis?

Noncaseating granulomas occur in any organ of the body.

29

What lab finding can we find in someone with sarcoidosis?

Elevated serum angiotensin converting enzyme (ACE).

30

What X-ray finding do we find in sarcoidosis?

Bilateral hilar lymphadenopathy.

31

What are Schaumann bodies?

Laminated calcifications seen in sarcoidosis.

32

What are Asteroid bodies?

Stellate giant-cell cytoplasmic inclusions seen sarcoidosis.

33

What is the definition of obstructive airway disease?

Increased resistance to airflow secondary to obstruction of airways.

34

What is the definition of restrictive lung disease?

Decreased lung volume and capacity.

35

What do we find in the pulmonary funtion test (spirometry) for obstructive airway disease?

FEV1/FVC ratio is decreased.

36

What do we find in the pulmonary funtion test (spirometry) for restrictive lung disease?

Decreased TLC and VC.

37

What are some chest wall disorders that can cause restrictive lung disease?

Obesity, kyphoscoliosis, polio.

38

What are some interstitial/ infiltrative disease that can cause restrictive lung disease?

ARDS, pneumoconiosis, pulmonary fibrosis.

39

What are some examples of chronic obstructive airway disease?

Asthma, Chronic bronchitis, emphysema, bronchiectasis.

40

What is chronic bronchitis?

Persistent cough and copous sputum production for at least 3 months in 2 consecutive years.

41

What is the Reid index?

RI: gland/wall. It is defined as ratio between the thickness of the submucosal mucus secreting glands and the thickness between the epithelium and cartilage that covers the bronchi.

42

What is emphysema?

Destruction of alveolar septa resulting in enlarged air spaces and a loss of elastic recoil.

43

What are three causes of emphysema?

I. Protease/antiprotease imbalance. II. Proteases (including elastase) are produced by neutrophils and macrophages, which are stimulated by smoke and pollution. III. Antiproteases include alpha-1-antitrypsin, alpha-1-macroglobulin, and secretory leukoprotease inhibitors.

44

What is centriacinar emphysema?

Proximal respiratory bronchioles involved, distal alveoli spared. Worst in apical segments of upper lobes.

45

What is Panacinar emphysema?

Entire acinus involved, entired lung as well; worse in bases of lower lobes.

46

Which emphysema is caused by alpha-1-antitrypsin deficiency?

Panacinar.

47

Which emphysema is related to smoking?

Centriacinar (centrilobar).

48

Which type of emphysema is the most common?

Centriacinar (centrilobar).

49

What are the clinical findings in emphysema?

Progressive dyspnea. Pursing of lips and use of accessory muscles to breathe. Barrel chest and weight loss.

50

What is asthma?

Hyperreactive airways, resulting in episodic bronchospasm when triggered by certain stimuli.

51

Which type of asthma is the most common type?

Allergic (atopic).

52

A drug-induced asthma would be which type of asthma?

Intrinsic (unknown).

53

What are Curschmann spirals?

Twisted mucous plugs admixed with sloughed epithelium, seen in sputum cytology of someone with asthma.

54

What are Charcot-Leyden crystals?

Eosinophil membrane protein seen in sputum cytology of someone with asthma.

55

What is Bronchiectasis?

Abnormal premanent airway dilation due to chronic necrotizing infection.

56

What are four things that can cause bronchiectasis?

Bronchial obstruction, necrotizing pneumonias, cystic fibrosis, Kartagener syndrome.

57

What is Adult respiratory distress syndrome (ARDS)?

Diffuse damage of alveolar epithelium and capillaries, resulting in progressive respiratory failure that is unresponsive to oxygen treatment.

58

What do we seen in X-ray of someone with ARDS?

Bilateral lung opacity (white-out).

59

What do we seen in X-ray of a patient with respiratory distress syndrome of the newborn?

"ground-glass" reticulogranular densities.

60

What do we see in lab of a patient with respirtaory distress syndrome of the newborn?

Lecithin:Sphingomyelin ratio

61

What pulmonary neoplasia is seen with the mutation of the L-myc oncogene?

Small cell carcinoma.

62

What pulmonary neoplasia is seen with the mutation of the K-ras oncogene?

Adenocarcinoma

63

What gross changes do we see in adenocarcinoma?

Peripheral gray-white mass with pleural puckering.

64

What microscopic changes do we see in adenocarcinoma?

Tumor forms glands and may produce mucin.

65

What gross changes do we see in bronchioloalveolar carcinoma?

Peripheral mucinous gray-white nodules.

66

What microscopic changes do we see in bronchioloalveolar carcinoma?

Columnar tumor cells grow along the walls of pre-existing alveoli.

67

What gross changes do we see in squamous cell carcinoma?

Usually centrally located, gray-white bronchial mass.

68

What microscopic changes do we see in squamous cell carcinoma?

Invasive nest of squamous cells, intracellular brindges (desmosomes), Keratin production ("squamous pearls").

69

What gross changes do we see in small cell carcinoma?

Central, gray-white masses.

70

What microscopic changes do we see in small cell carcinoma?

Small round or polygonal cells in clusters.

71

What microscopic changes do we see in large cell carcinoma?

Large anaplastic cells without evidence of differentiation.

72

What is a defining characteristic of small cell carcinoma?

AKA Oat cells, they are very aggressive; rapid growth and disseminate early.

73

Which tumor causes Horner syndrome?

Pancoast tumor (apical).

74

Which carcinomas involves the pleura?

Adenocarcinoma.

75

What are the symtoms of Horner syndrome?

Ptosis, Miosis, Anhidrosis, Enopthalmos.

76

Which carcinoma most likely would be releasing PTH and what does this cause?

Squamous cell carcinoma; causes hypercalcemia.

77

What is the most frequecnt extrathoracic sites of metasis?

Adrenal (>50%), liver, brain and bone.

78

What is the treatment for Nonsmall-cell lung cancer?

Surgery.

79

What is the treatment for small-cell lung cancer?

Chemotherapy and radiation.

80

In which age group do we see bronchial carcinoids?

Young people;

81

What is the gross appearance of bronchial carcinoids

Polypoid intrabronchial mass.

82

What is the most common malignant neoplasm in the lungs?

Matastatic carcinomas TO the lung.

83

What are common primary sites of tumors that later metastatize to the lung?

Breast, stomach, pancreas, colon.

84

What is tension pneumothorax?

Air in the pleural cavity that is causing a life threatning shift of thoracic organs across midline.

85

What is empyema?

Pus in the pleural space.

86

What is chylothorax?

Chylous fluid in pleural space secondary to obstruction of thoracic duct, usually a tumor.

87

What microscopic changes do you see in mesothelioma?

Carcinomatous and sarcomatous elements.