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Question 1

*****What stereotypecharacterizes Chronic Bronchitis?

Answer 1

Blue Bloaters:• Overweight and Cyanotic people with Elevated Hbg (because they’re hypoxic) peripheral edema and rhonchi and wheezing.

Question 2

*****What disease is characterized by pink puffers?• why do we call them pink puffers?

Answer 2

Emphysema = pink puffers• Older and Thin(because they burn so much energy breathing)with severe dyspnea and quiet chest sounds

Question 3

*****Differentiate the methods of Dx for chronic bronchitis and emphysema.

Answer 3

Chronic Bronchitis:• CLINICAL dx. characterized by 3 mo. of daily productivecough for 2 consecutive yearsEmphysema:• PATHOLOGIC dx. characterized by destruction of the airspace distal to the terminal bronchioles

Question 4

**Why would you seen an abundance of the cells pointed out by the black arrows?

Answer 4

Black arrows:•Type II pneumocytes:these are hobnail shaped and are seen in abundance following destruction oftype I pneumocytes

Question 5

*****What are Clara Cells and what is their role in the lungs?• where are they found?

Answer 5

Clara cells =CLUB CELLS- these are dome shaped cells withshort microvillifound insmall airways (BRONCHIOLES)of the lungsROLE:PROTECTION

Question 6

**What is being pointed out by the back arrows in this electron microscopy image?

Answer 6

Surfactant -Lamellar Bodies- that are found intype II pneumocytes

Question 7

**What most likely accounts for the changes seen in the cells on the left and on the right?• what cells are being pointed out?

Answer 7

Left side reprsentsalveolar macrophagesin someone who is a non-smoker while the right side shows acrack cocaine usernote theincreased number of particles in the macrophages*ANY PARTICLE this is 1-5µm in size have the potential to make it to an alveolus

Question 8

What are the 3 types of Atelectasis?• differentiate their common causes.• which way does the mediastinum shift in response?

Answer 8

3 types = Resorption, Compression, ContractionResorption:• Airway obstruciton bymucous plugsortumor,this acts as avalvethat allows air out but not back in leading to suction so the mediastium shiftstoward the affected sideCompression:•Filling of pleural cavity by tumor, blood, air,this acts tocompression of tissuepushing the mediastinumawayfrom the affected side.Contraction:•Fibrotic lung pleurathis is just a shrinking of the lung tissuethere is no mediastinal shift

Question 9

**Which of these phenomena isirreversible?

Answer 9

Contraction- caused by fibrosis isirreversible

Question 10

**What is happening here?

Answer 10

Resorption Atelectasis -a tumor affecting the right mainstem bronchus has resulted in markedly reduced right lung volume and rightward mediastinal shift

Question 11

**what is happening here?

Answer 11

compressionatelectasis - left pneumothorax from chest wall trauma is resulting in left lung collapse and right mediastinal shift

Question 12

What is the only Obstructive lung disease that is caused by loss of elastic recoil of the lung?

Answer 12

Emphysema, all of the others (chronic bronchitis, asthma, and bronchietasis) result from airway obstruction and narrowing

Question 13

Define Emphysema?• is fibrosis typically a feature of this disease?

Answer 13

Emphysema:• Abnormalpermanentenlargement of airspaces accompanied by destruction of their walls• Fibrosis isnot a significant feature of emphysema

Question 14

A previously healthy young adult man pressents with unknown respiratory disease developesspontaneous pneumothorax.Biopsy indicates a type of underlying obstructivedisease. What is this diseas?

Answer 14

PARASEPTALemphysema - causes pneumothorax in young adults

Question 15

Differentiate locations and causes of centriacinar and panacinar emphysema.

Answer 15

Centriacinar:• Typically found in heavy smokers => causes XS inflammation and overactivation of proteases• Predominates in the upper lobesPanacinar:• Associated the A1AT deficiency => is not present to prevent proteases from breaking down our own tissue• Found in the lower lobes

Question 16

*****What do you expect to see on the liver biopsy of a patient with A1AT deficiency?• what causes this appearance?• Genetics of this person?

Answer 16

Liver biopsy shows pinkPAS positive hyalineglobulesthat results from misfolded A1AT accumulating in theendoplasmic reticulum of hepatocytes - notice red blobs

Question 17

What disease is a person with a PiMZmutation at risk of developing?• what factors would increase their risk of developing disease?

Answer 17

This is a mutant heterozygote for A1AT deficiency.• these patients areasyptomatic unless they smoke**Remember Z indicates mutation - homozygote = PiZZ => theywill have disease

Question 18

*****T or F: Centriacinar Emphysema affects alveolar ducts only.

Answer 18

False, Respiratory bronchioles are most affected - the smoke doesn’t make it to the alveolar ducts

Question 19

**What is wrong in this CXR?

Answer 19

Nothing - this is a normal CXR

Question 20

**What are some important characteristics to notice in this CXR?• dz?

Answer 20

Retrosternal Airspace - is not normal - heart should be close to the sterumFlattening of the Diaphragm - also not good

Question 21

**What is the most likely etiology of the lung disease shown here?

Answer 21

Emphysema - this person was most likely a smoker

Question 22

**What disease is shown here and how do you know?

Answer 22

centriacinar emphysema- central portion of acinus (where arrows are pointing) has abnormally large airspaces with club-shaped alveolar septa that appear to be floating

Question 23

**What obstructivedisease does this person most likely have/

Answer 23

Panacinar Emphysemacaused by A1AT defieciency (PiZZ) causingLOWER LOBEtissue destruction

Question 24

**What do you suspect caused this obstructivedisease?

Answer 24

A1AT - Panacinar - destruction of these alveoli is fairly uniform

Question 25

What part of the alveoli is affected in paraseptal emphysema? 

Answer 25

Alveolar Ducts and Alveoli themselves 

Question 26

**What did this person most likely die of? • Predisposing factor? 

Answer 26

• Shown here is a ruptured bullae that is likely the result of a ruptured bled causing pneumothroax• Paraseptal emphysema is likely the cause - happens in young adults 

Question 27

**What pathology is seen here? • Cause? 

Answer 27

Paraseptal Emphysema: DISTAL airspaces show marked dilation 

Question 28

What 4 key histologic features should you look for to see if a patient's lung biospy is consistent with Chronic Bronchitis? 

Answer 28

• Submucosal gland hypertrophy of large airways increased Reid Index• Increase goblet cells in smaller airways • Chronic LYMPHOCYTIC airway inflammation • Peribronchial fibrosis 

Question 29

**What is the problem with this bronchiole? 

Answer 29

Mucosal Gland hypertrophy - indicative, but NOT DIAGNOSTIC of chronic bronchitisReid Index definitely exceeds 0.4 

Question 30

**What key feature of chonic bronchitis is the red arrow pointing to? • Name the other 3 key features. 

Answer 30

Lymphocytic infiltrate surrounding the bronchial epithelium - notice these are plasma cells as determined by the perinuclear hof Other Features:• Increased numbers of Goblet Cells• Mucous Gland Hyperplasia • Parabronchial Fibrosis 

Question 31

What are the 2 different types of Asthma? • differentiate between these. 

Answer 31

Extrinsic: • Type I (IgE) hypersensitivity reaction to inhaled allergen  Intrinsic: • Non-immunologic reaction - precipitated by respiratory tract infection, stress, exercise, cold, drugs. 

Question 32

**What key feature of chronic bronchitis is shown here? 

Answer 32

• Increased goblet cells 

Question 33

What gross features do you expect to see in a lung from a person suffering from Asthma? • Microscopic features? 

Answer 33

Asthma: Gross: • Overinflation and Mucous plugs  Microscopic: • Thickened Basement Membrane • Submucosal gland hypertrophy• Bronchial wall smooth muscle hypertrophy• Eosinophil-rich inflammatory infiltrate 

Question 34

**The picture shown here is characteristic of what obstructive pulmonary disorder? • Why? 

Answer 34

Asthma - mucous plug in a bronchus 

Question 35

**What 3 features should you notice in this bronchus? • what obstructive disease is this indicative of? 

Answer 35

3 Key Histologic Features: • Bronchial Epithelium is desquamated • Thickening of Basement membrane • Eosinophilic Inflammation 

Question 36

**This mucous sample shows a microscopic appearance characterisitic of what COPD? 

Answer 36

• Charcot-Leyden crystals seen here are the result of eosinophil degradation and are seen in asthmatics 

Question 37

**This microscopic finding is indicative of what COPD? 

Answer 37

• Curschmann Spirals are indicative of Asthma 

Question 38

Histologic finding in a patient look much like asthma including eosinophilic infiltrates, but the patient's physician and medical records never indicate any history of asthma. • what should be in your differential? • What causes this disease? 

Answer 38

Eosinophlic Bronchitis: • these patients do not have recurrent episodes of wheezing, shortness or breath, and coughing • DO NOT respond ot BRONCHODILATORS • Cause: ideopathic or secondary to infections, drug administration or immunologic diseases 

Question 39

What causes bronchiectasis? 

Answer 39

• Repeated cycles of airway OBSTRUCTION AND INFLAMMATION

Question 40

What obstructive lung disease is associated with defective dyenin arms? 

Answer 40

• Bronchietasis results from obstruction and inflammation that is repeated in Kartagener's because these people have ineffective cilia and are also often infertile 

Question 41

What 2 bugs often cause necrotizing pneumonia that can sometimes lead to bronchiectasis? 

Answer 41

• Staph. Aureus• Mycobacteria 

Question 42

**What genetic mutation could lead to the disease shown here? 

Answer 42

• ∆F508 - Chromosome 7 - cystic fibrosis• or Dyeinin defect in Kartagener's 

Question 43

**What is the white stuff between the bronchioles in this patient that had bronchietasis? 

Answer 43

FIbrosis 

Question 44

**What is seen in this histiologic specimen? 

Answer 44

Bronchietasis - alveoli appear relatively normal but there is pus (neutrophils) in the airway - other than the huge fibrotic airway, the alveoli appear pretty normal 

Question 45

*****What causes tracheoesophageal fistula? 

Answer 45

Failure of hte fetal respiratory tract to separate from the GI tract from which it derives. 

Question 46

When is the saccular stage of lung development? • why is this important? 

Answer 46

26-32 weeks - fetal lungs develope type I and type II alveolar cells and begin making SURFACTANT