L2- Pulmonary Pathology I

Question 1

Define the following:

• TV
• IRV
• ERV
• RV

Answer 1

Tidal Vol.: volume of air inhaled and exhaled with normal respiration

Inspiratory Reserve Vol.: volume of air that can be inhaled beyond normal inspiration

Expiratory Reserve Vol.: volume of air that can be exhaled beyond normal expiration

Residual Vol.: left over air volume after maximal exhalation

Question 2

Define the following:

• TLC
• VC
• IC
• FRC

Answer 2

Total Lung Capacity: maximal lung volume after maximal inhalation

Vital Capacity: maximal lung volume that can be inhaled/exhaled (TLC - RV = IRV + ERV + TV)

Inspiratory Capacity: maximal air volume that can be inhaled following normal expiration (TV + IRV)

Functional Residual Capacity: lung volume after normal expiration (ERV + RV)

Question 3

Define the following:

• FVC
• FVC1
• FEF

Answer 3

Forced Vital Capacity: volume of air exhaled with force following maximal inhalation

FVC-1: volume of air exhaled with force in first second following maximal inhalation

Forced Expiratory Flow (25%-75%): measure of airflow midway through expiration (middle half)

Question 4

Describe how the following change in Restrictive Lung Disease:

• FEV1/FVC
• FEV1
• FVC
• TLC

Answer 4

• FEV1/FVC: normal or inc (>80%)
• FEV1: normal or slightly dec
• FVC: dec
• TLC: dec

Question 5

Describe how the following change in Obstructive Lung Disease:

• FEV1/FVC
• FEV1
• FVC
• TLC

Answer 5

• FEV1/FVC: dec (<70%)
• FEV1: dec (significant)
• FVC: dec or normal
• TLC: inc or normal

Question 6

list the 4 types of laboratory tests conducted in the respiratory system

Answer 6

• Sputum analysis: cells, microbiology
• Arterial blood gases (pCO2, pO2)
• Pleural fluid
• Blood Culture

Question 7

describe the goal or types of tests conducted in sputum analysis

Answer 7

Cell analysis: WBCs, RBCs, malignant cells

Microbiological Studies:

• bacteria (staining, culture, AB resistant)
• fungal (KOH, culture)
• viral (PCR, DNA, culture)
• NAAT (nucleic acid amplification testing)

Question 8

what are the blood gas changes seen in lung diseases and why are they monitored

Answer 8

• pCO2: looking for INCreases
• pO2: looking for DECreases

-the quantity of changes determines the severity of the disease progression

Question 9

describe how pleural fluid is studied for lung diseases

Answer 9

-used as a therapeutic or diagnostic technique

i) Cell Count: HF (dec to normal) vs Infection (inc)
ii) Malignancy: primary vs secondary

Question 10

list the techniques or procedures used to acquire lung sample for cytology (hint- 9)

Answer 10

• bronchial washings (inject slime and aspirate it out)
• bronchial brushing (scraping lesion)
• TBNA, transbronchial needle aspiration
• TTNA, transthoracic needle aspiration
• EBUS-FNA, endobronchial ultrasound-guided fine needle aspiration

-navigational bronchoscopy

• bronchoscopic biopsy: transbronchial, endobronchial
• pleuroscopic biopsy

-Surgical biopsy / resection: VATS (video assisted transthoracic) biopsy or Open biopsy

Question 11

foreign objects that are accidentally inhaled will generally go into the (R/L) lung because of (2)

Answer 11

R lung- the R main bronchus is shorter and more vertical than the L

Question 12

Respiratory Zone function, (1)

Conducting Zone function, (2)

Answer 12

1- gas exchange

2- carry, warm, filter, humidify air

Question 13

list the components of the Bronchial Walls (histology)

Answer 13

[conducting zone only- no gas exchange]
(inside to outside)
1) Epithelium: ciliated columnar cells, goblet cells, basal cells, neuroendocrine cells
2) Basement Membrane
3) Smooth Muscle
4) Seromucinous Glands
5) Cartilage
6) Vasculature and Lymphatics

Question 14

list the components of the Bronchiolar Walls (histology)

Answer 14

[conducting zone until terminal bronchioles –> respiratory zone and respiratory bronchioles]
(inside to outside)
1) Epithelium: ciliated columnar cells, Clara cells
2) Basement Membrane
3) Smooth Muscle
4) Vasculature and Lymphatics

Question 15

compare the epithelium of Bronchi and Bronchioles

Answer 15

Bronchi: ciliated columnar cells, goblet cells, basal cells, neuroendocrine cells

Bronchioles: ciliated columnar cells, Clara cells

Question 16

describe the histology of alveoli

Answer 16

(inside to outside)

1) epithelium: type I/II pneumocytes
2) alveolar macrophages
3) interstitium
4) capillaries (endothelial cells)

Question 17

The alveolar epithelium is mostly type (I/II) pneumocytes.

• type I function, (2)
• type II function, (3)

Answer 17

1- type I, 95%
2- gas exchange
3- surfactant production, alveolar epithelium repair (generates type I and II pneumocytes)

Question 18

______ cells are responsible for gas exchange in alveoli

Answer 18

type I pneumocytes

Question 19

______ cells are responsible for surfactant production

Answer 19

type II pneumocytes

Question 20

______ cells are responsible for repairing alveolar epithelium

Answer 20

type II pneumocytes (generates type I and II pneumocytes)

Question 21

Atelectasis refers to either (1) or (2). The loss of (3) is secondary to (1)/(2) and has the following progression, (4).

Answer 21

(atelectasis = collapsed lung)
1- incomplete expansion of lungs (neonatal atelectasis)
2- collapse of previously inflated lung
3- lung volume
4- dec oxygenation –> ventilation perfusion imbalance

Question 22

list the three types of atelectasis

Answer 22

(based on cause and mechanism)

• resorption atelectasis (obstruction)
• compression atelectasis
• contraction atelectasis

Question 23

(1) atelectasis results do to some obstruction as a result of one of the following, (2)

Answer 23

Resorption Atelectasis

• mucus/mucopurulent plug post-surgery
• aspiration of foreign material
• bronchial asthma, chronic bronchitis, bronchiectasis
• bronchial neoplasms (if total obstruction)

Question 24

Resorption atelectasis results from (1) of the (2) part of respiratory tract. As a result, (3) is prevented and the (4) progression will occur to cause final (5) change to the lung.

Answer 24

1- complete obstruction
2- bronchi, subsegemental bronchi, bronchioles
3- airflow to alveoli
4- trapped air in distal spaces is resorbed thru Pores of Kohn (alveoli to alveoli) –> lack of air to distal airspaces –> (5)
5- lung collapse

Question 25

In resorption atelectasis, (1) is evident or presents 24-36 hrs post-lung collapse. - (2) and (3) are evident on imaging (X-Ray) - (4) is evident upon palpation and auscultation

Answer 25

1- fever, dyspnea 2- ipsilateral deviation of trachea / mediastinum 3- ipsilateral diaphragmatic elevation 4- absent breath sounds (no expansion upon inspiration --> dec air movement) + absent vocal vibratory sensation / tactile fremitus

Question 26

Compression atelectasis or lung collapse can occur due to accumulation of...... (include examples)

Answer 26

- air - fluid - tumor i.e. tension pneumothorax, pleural effusion

Question 27

_________ is the main clinical feature of compression atelectasis

Answer 27

(contralateral) trachea and mediastinum shift away from affected lung

Question 28

Contraction atelectasis, aka (1), occurs due to (2) affecting (3) or (4) which will prevent (5)

Answer 28

``` 1- cicatrization atelectasis 2- fibrosis (local or diffuse) 3- lung 4- pleura 5- lung expansion ```

Question 29

(T/F) atelectasis is a reversible process

Answer 29

T- Resorption and Compression atelectasis F- Contraction atelectasis

Question 30

atelectasis is treated promptly in order to prevent....

Answer 30

- hypoxemia | - superimposed infection of collapsed lung

Question 31

Surfactant is made out of....

Answer 31

(lipoprotein) Lipids: phosphatidylcholine (lecithin), phosphatidylglycerol Surfactant Proteins: SP- A, B, C, D

Question 32

surfactant production begins during (1) and is stored in (2)

Answer 32

1- week 28 of gestation | 2- lamellar bodies of type II pneumocytes

Question 33

- surfactant production is increased in response to (1) hormone(s) - surfactant production is decreased in response to (2) hormone(s)

Answer 33

1- (inc) cortisol, thyroxine 2- (dec) insulin

Question 34

describe the function of SP- A, B, C, D

Answer 34

(surfactant protein) B, C: reduces surface tension at air-liquid barrier in alveoli --> prevents collapse on expiration A, D: innate immunity

Question 35

SP-__ functions in the innate immune system

Answer 35

Surfactant Protein- A, D

Question 36

SP-__ functions to reduce air-liquid barrier surface tension to prevent lung collapse upon expiration

Answer 36

Surfactant Proteins- B, C

Question 37

Neonatal atelectasis causes (1) in newborns and occurs as a result from (2). Risk factors: (3), (4), (5)

Answer 37

1- RDS (respiratory distress syndrome) 2- dec surfactant production 3- premature birth: before 28 wks 4- maternal diabetes: fetal hyperglycemia => insulin release => dec production 5- C-section: b/c dec cortisol => dec production // labor/vaginal delivery inc stress => inc production

Question 38

how does maternal diabetes affect surfactant production

Answer 38

- fetal hyperglycemia => insulin release | - insulin dec surfactant production

Question 39

compare mechanism for increased surfactant production in vaginal delivery vs C-section

Answer 39

- vaginal birth => inc stress => inc cortisol => inc surfactant production - C-section has less cortisol in neonate, less surfactant production

Question 40

Neonatal atelectasis results in hypoxemia and CO2 retention in the body, which is mainly exhibited by (1) in the blood. As a result of (1), (2) occurs which causes (3) and (4), where (2), (3), (4) all compound the hypoxemia and CO2 retention. The biggest consequence of (3) and (4) is (5).

Answer 40

1- respiratory acidosis 2- pulmonary vasoconstriction / hypoperfusion 3- endothelial damage 4- epithelial damage 5- plasma leaks into alveoli --> hyaline membrane of fibrin and necrotic cells

Question 41

_____ is the main histological feature of neonatal atelectasis

Answer 41

hyaline membrane (fibrin and necrotic cells) as a result of plasma leak into alveoli

Question 42

Neonatal atelectasis is evident by (1) at birth, with (2) evident in blood work and (3) evident on imaging

Answer 42

1- RDS (respiratory distress syndrome) w/in few hrs of birth 2- hypoxemia, respiratory acidosis 3- 'ground glass appearance' (CXR)

Question 43

list the common complications of neonatal atelectasis - (1) in the brain - (2) in the GIT - (3) blood labs - (4) blood vessel structure - (5) as a result of Tx / therapy

Answer 43

1- intraventricular hemorrhage 2- necrotizing enterocolitis b/c intestinal ischemia 3- hypoglycemia b/c excessive insulin release 4- PDA b/c persistent hypoxemia 5- [via O2 therapy] lung damage (bronchopulmonary dysplasia) and cataracts/blindness