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Lung Path Flashcards

1
Q

which bronchi is straight

A

right

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2
Q

what size particles are most dangerous

A

.5-5um

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3
Q

lobule

A

cluster of terminal bronchioles w/attached acini

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4
Q

acinus

A

respiratory bronchiole and all attached alveolar ducts and sacs

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5
Q

pulmonary hypoplasia

A

common 10% neonatal autopsy

seen w/fetal compression and other anomalies

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6
Q

congenital foregut cysts

A 
detached section of maldeveloped foregut
presents as mass or incidental finding, possibly in adulthood
mediastinal and hilar locations
not connected to airway
usually bronchogenic w/respiratory epi
some esophageal, some enteric
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7
Q

cystic adenomatoid malformation

A

CPAM

Hamartomatous lesions w/abnormal bronchiolar tissue

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8
Q

types of CPAM

A

type I- large cysts good prognosis

type II- medium cysts, poorer prognosis since associated w/other congenital malformations

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9
Q

bronchopulmonary sequestrations

A

areas of lungs w/o normal connections to airways

blood supply is from systemic aa

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10
Q

extralobar bronchopulmonary sequesterations

A

external to lung

may have other congenital anomalies

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11
Q

intralobar bronchopulmonary sequestrations

A

w/in lung
associated w/recurrent local infection and/or bronchiectasis
most likely an acquired lesion

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12
Q

respiratory distress in newborn

A 
excessive maternal sedations
fetal head injury
blood or amniomtic fluid aspiration
intraunterine hypoxia from cord
hyaline membrane disese
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13
Q

hyaline membrane diease stats

A

most common

1000 deaths in 2002, but 25000/year in 60s

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14
Q

hyaline membrane disease

A

can occur in term infants, but usually preterm
rate inversely proportional to gestational age
associated w/males, materal DM, multiple gestations, and c-section before onset of labor
immature lungs
deficiency of surfactant

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15
Q

alveoli development

A

20wks- glandular
30wks- saccular
term- alveolar

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16
Q

bronchopulmonary dysplasia

A

> 28 days of O2 therapy in infant >36weeks post mentrual age
alveolar hypoplasia and thickened walls
dysmorphic capillaries and decreasesed VEGF
cytokines (TNF, IL8, etc)
increased and may have role

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17
Q

cystic fibrosis

A

widespread disorder in epi transport affecting fluid secretion in exocrine glands and epi of resp, GI, and repro tracts
viscid secretions
autosomal recessive
CFTR gene chrom 7
most common lethal genetic condition in Caucasians

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18
Q

Dx criteria for CF

A

one or more characteristic phenotypic features or a Hx or CF in sibling or positive newborn screening test
AND
an increased sweat chloride on 2+occasions or 2CFTR mutations or demonstration of abnomral epi nasal ion transport

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19
Q

Tx of CF- pancreas

A

oral pancrelipase

may progress to DM

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20
Q

Tx of CF- vit deficiency

A

oral fat soluble vitamins

parenteral nutrition

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21
Q

Tx of CF- pulomonary

A 
postural drainage and chest percussion
bronchcodilators
mucolytic agents
Antibiotics
hypertonic saline
high dose ibuprofen slows lung disease progression
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22
Q

apparent life threatening event (ALTE)

A

if survive at risk for future respiratory death
prolonged apnea, diminished responses to hypercarbia or hypoxia
often premature or have mechanical disorders leading to compromise
no longer considered true SIDs

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23
Q

atelectatsis

A

incomplete expansion- neonatal
acquired collapse- adults can be due to: resorption/obstruction, compression, or contraction
ALL AT RISK FOR INFECTION

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24
Q

resorption/obstruction atelectasis

A

airway obstruction, mucus, foreign body, tumor

mediastinal shift toward involved lung

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25
compression atelectasis
external pressure including elecated diaphragm | mediastinal shift away from involved lung
26
contraction atelectasis
secondary to fibrosis | irreversible
27
types of pulmonary edema
hemodynamic | microvascular
28
hemodynamic pulmonary edema
most common increased hydrostatic pressure due to left sided heart failure basal lower lobes heart failure cells secondary infections if chronic leads to alveolar fibrosis (brown lung)
29
microvascular (alveolar) injury pulmonary edema
increased permeability caused by infection, toxic injry, if diffuse leads to ARDS
30
non-cardiogenic pulmonary edema criteria
acute onset of dyspnea hypoxemia b/l infiltrates absence of primary left heart failure
31
non-cardiogenic pulmonary edema etiology
``` wide spread disorers injuries may be related to mediators such as cytokine, oxidants, TNF, ILs, TGF beta, susceptibility may be heritable may progress to ARDS OR AIP ```
32
Adult ARDS
``` shock rapid onset, life threatening occurs in patients w/severe disease diffuse damage to alveolar capillary walls -> neutrophilic migration secondary loss of surfactant prothrombotic milieu ```
33
infectious conditions associated w/adult ARDS
Sepsis diffuse pulmonary infections gastric aspiration
34
physical injury ARDS
``` mechanical trauma, including head injuries pulmonary contusions near-drowning fractures w/fat emboli burns ionizing radiation ```
35
inhaled irritants ARDS
O2 toxicity smoke irritant gases and chemicals (paraquat)
36
other causes of ARDS
cardiac reperfusion injury
37
ARDS clinical
``` patients are already ill when ARDS superimposed rapid onset profound dyspnea and tachypnea cyanosis and respiratory failure diffuse b/l inflitrates up to 60% fatal permanent damage ```
38
acute interstitial pneumonia (AIP)
``` symptoms similar to ARDS no associative causative disorder 59 yrs, M=F acute respiratory failure following illness 33-74% mortality rate w/in 2 months ```
39
obstructive lung disease
limit rate of flow FEV1/FVC reduces due to resistance at any level
40
obstructive lung disease examples
COPD, chronic bronchitis, asthma
41
restrictive lung disease
limit total lung capacity and residual volume | near normal flow rates
42
restrictive lung disease examples
chest wall disorders, obesity, ARDS, interstitial fibrosis, penumoconioses
43
COPD classifications
centriacinar/cantrilobular panacinar/panlobular distal acinar/paraseptal irregular/paracicatrical
44
centriacinar/centrilobular
smoking, smoking, smoking | predominately upper lobes/apices
45
panacinar/panlobular
alpha-1 antitrpsin deficiency, smoking | predominately ant/lower lobes
46
distal acinat/paraseptal
- subpleural and adjacent to septate - may be bullous and cause spontaneous penumothrorax in young adults - associated w/previous damaged lung
47
irregular/paracicatrical
common, but focal and usually asymptomatic associated w/scarring
48
proteolytic digrestion of alveolar walls in COPD
via neutrophil-secreted elastase | normally inhibited by alpha 1 antitrypsin
49
COPD clinical
``` symptoms after 1/3 of lung damaged barrel chest low FEV1, high TLC, and RV pink puffer bullous emphysema repsiratory acidosis cor pulmonale ```
50
COPD Tx
``` quit smoking bronchodilators steroids bullectomy transplant ```
51
other conditions w/increased air
compensatory hyperinflation obstructive overinflation interstitial emphysema
52
compensatory hyperinflation
due to loss of adjacent tissue
53
obstructive overinflation
trapped air -ball valve obstruction by object collaterals feeding around obstruction, life threatenting, alveolar pores of kohn, bronchiloloalveolar canals of lambert -congenital lobar overinflation from lack of bronchial cartilage
54
interstitial emphysema
any air in inetersitium
55
chronic bronchitis
``` clinically defined as 3 mo productive cough/year for 2 consecutive years smoking, smoking, smoking hypersecretion of mucus increased reid index brochiolitis obliterans in small airways superimposed infection dyspnea and cor pulmonale blue bloaters ```
56
reid index
normal <.4 thickness of gland/thickness of walls hypertrophy of bronchial submucosal glands
57
age bronchitis vs COPD
40-45 VS 50-75
58
dyspnea bronchitis vs COPD
mild, late vs severe early
59
cough/sputum bronchitis vs COPD
early copious vs late scant
60
infections bronchitis vs COPD
common vs occasional
61
resp insufficiency bronchitis vs COPD
repeated vs terminal
62
cor pulmonale bronchitis vs COPD
common vs rare terminal
63
airway resistance bronchitis vs COPD
increased vs normal slightly increased
64
elastic recoil bronchitis vs COPD
normal vs low
65
chest radiograph bronchitis vs COPD
prominant vessels, large heart vs hyperinflation, small heart
66
appearance bronchitis vs COPD
blue bloater vs pink puffer
67
asthma
chronic inflammatory disorder of airwyas | reactive airspace disease w/episodic partially reversible bronchoconstriction
68
type I hypersensitivity asthma
atopy begins in childhood mucosal mast cells react stimulation of sub epi vagal receptors
69
non-atopic asthma
associated w/pulmonary infections and air pollutants no allergic indicators infection lowers threshold for vagal response
70
drug induced asthma
uncommon form of disease can also cause urticaria aspirin classic cause ( inhibit cox 2, but not cox 1 so increases leukotrienes
71
other types of asthma
exercise induced | occupational
72
asthma morphology
``` epi injury subbasement membrane fibrosis eos and inflam infiltrates hypertophy/hyperplasia of submucosal glands and goblet cell metaplasia hypertrophy/hyperplasia of smooth muscle increased vascularity ```
73
Histo markers of asthma
charcot-leyden crystals | curschmann spiral
74
bronchiectasis
permanent dilation of bronchi and bronchioles
75
causes of brochiectasis
tissue distruction secondary to infection
76
symptoms of bronchiectasis
foul smelling +/- bloody sputum dyspnea, orthopnea, rarely severe hemoptosis may develop cor pulmonale, brain abscesses and amyloidosis
77
brochiectasis associated w/
``` genetic disorder obstruction many infections chronic inflammatory conditions pulmonary sequestration allergic bronchopulmonary aspergillosis autoimmune disorder and post transplant rejection of graft vs host ds ```
78
genetic disorders and brochiesctasis
CF | primary ciliary dyskinesia- kartagener syndrome: male infertility, sinusitis, situs inversus,
79
chronic diffuse interstitial lung diseases
restrictive heterogenous group of disease inflitrative x-ray changes (reticulonodular or ground glass) most involve interstiutium and alveolar walls
80
symptoms of chronic diffuse interstitial disease
``` decreased TLC and RV dyspnea tachypnea cyanosis end-inspiratory crackles end-stage- honey comb lung ```
81
complications of restrictive disease
Cor pulmonale | pulmonary HTN
82
fibrosing restrictive diseases
``` unusual interstitial pneumonia non-sepcific interstitial pneumonia cyptogenic organizing pneumonia CT disease drug rxns radation ```
83
granulomatous restrictive diseases
sarcoidosis hypersensativity pneumonitis Eosinophillic
84
smoking related restrictive disease
- desquamative interstitial pneumonia | - respiratory broncholitis associated interstitial lung disease
85
other causes of restrictive disease
pulmonary langerhands cell histocytosis pulmonary alveolar proteinosis lymphoid interstitial pneumonia
86
idopathic pulmonary fibrosis (IPF) aka
unusual interstitial pneumonia (UIP) | cryptogenic fibrosing alveolitis
87
IPF
unknown pathogenesis repeated injury to alveolar wall type I pneumocyte death, type II hyperplasia inflammation via TH2, fibroblast proliferation, TBFbeta1 collagen deposisition
88
environmental factors IPF
smoking work related exposures reflux esophagitis
89
clinical IPF
insidious unpredictable disease in middle age >50 dyspnea, dry cough, hypoxemia w/cyanosis, digital clubbing mean survival <3yrs
90
pathology IPF
repeated cycles of alveolitis healing/scarring -> patchy interstitial fibrosis predominently subpleural/interlobular and lower lobe end state: honey comb
91
Tx IPF
lung transplant
92
Non-specific interstitial penumonia (NSIP)
patients do not get as sick or progressive as IPF | better prognosis then IPF
93
symptoms of NSIP
dyspnea and cough for months middle ages w/milder sympotms non-smoking females
94
NSIP histo
all lesions at same stage
95
cryptogenic organizing pneumonia (COP) aka
bronchiolitis obliterans organizing pneumonia (BOOP)
96
COP
unknown by etiology organizing penumonia in which all CT is of same age and no interstitial fibrosis does not progress to honeycomb
97
COP symptoms
cough | dyspnea
98
COP Tx
oral steroid >6months
99
collagen vascular disorder-related lung disease associated disorder
``` RA sclerederma SLE sjogren syndrome polymyositis/dermatomyositis mixed CT disorder ```
100
caplan syndrome
RA and pneumoconiosis
101
coal dust diseases
antrhacosis macules progressive massive fibrosis caplan syndroe
102
silica
silicosis | caplan syndrome
103
asbestos
``` asbestosis pleural plaques caplan syndrome mesothelioma carcinoma of lung, larynx, stomach, colon ```
104
beryllium
acute berylliosis berylium granulomatosis lung carcinoma
105
iron oxide
siderosis
106
barium sulfate
baritosis
107
tin oxide
stannosis
108
coal workers pneumoconiosis (CWP)
``` asymptomatic antracosis simple CSP complicated CWP pathogenesis poorly understood no increased risk of TB or CA ```
109
simple CWP
coal macules and nodules +/- centirlobular emphysema | usually benign
110
complicated CWP
``` w/progressive massive fibrosis scars >2cm pulmonary dysfunction pulmonary HTN Cor pulmonale ```
111
silicosis
currently most prevalent chronic occupational disease in the world slowly progressive over decades silica ingested by macros and it kills the macros inflammation w/release of TNF -> activated fibroblasts 2x increased chance for CA more susceptible to TB
112
asbestos related disease
``` pleural effusions pleural plaques or diffuse pleural fibrosis asbestosis lung cancer (5x increased chance) mesothlioma ```
113
asbestosis
fibrotic lung disease begins in lower lobes and subpleurally dyspnea followed by productive cough
114
asbestos on histo
``` asbestos bodies (absent in pleural plaques) stains prussian blue b/c of iron ```
115
bleomycin
pneumonitis and fibrosis
116
methotrexate
hypersensitivity pneumonitis
117
amiodarone
pneumonitis and fibrosis
118
nitrofurantoin
hypersensitivity penuomnitis
119
aspirin
bronchospasm
120
beta agonists
brochospams
121
radiation pneumonitis
acute- 10-20% w/in 6 months of radiation | chronic- pulmonary fibrosis
122
sarcoidosis
numerous non-caseating granumpomas increased CD4, IL2, and cytokines genetic factors diagnosis of exclusion
123
sarcoidosis location
``` can occur anywhere including CNS pulmonary >eye > skin b.l pulmonary lymphadeopathy or lung disease spleen and liver in 3/4 W>M US black >>>whites, rare in chinese ```
124
sarcoidosis recovery
65-70% full recovery 20% permanent loss of lung fnx 10-15% progress to pulmonary failure or death hilar LN better prognosis then LN+lung infiltrates
125
ACE converting enzyme
``` elevated in: sarcoidosis leprosy gaucher disease primary biliary cirrhosis and amyloidosis ```
126
sarcoidosis histo
noncaseating sub epi granulomas multinucleated giant cells asteroid body schaumann body
127
hypersensativity pneumonitis aka
extrinsic allergic alveolitis
128
farmers lung
moldy hay | micropolyspora faeni
129
bagassosis
moldy pressed sugar cane | thermophilic actinomycetes
130
humidifier lung
cool-mist humidifier thermophilic actinomycetes aurobasidium pullulans
131
pigeon breeers lung
pigeon serum proteins in droppings
132
interstitial lung diseases
desquamative interstitial pneumonia respiratory bronchiolitis-associated interstitial lung disease (RBILD) eosinopilic granuloma
133
DIP
``` large collections of smokers macrophages in alveoli minimal fibrosis >50 M>>F dyspnea steroids and cessation of smoking ```
134
RBILD
``` common lesion in smokers (30+pack years) pigmented macros in bronchiles peribronchiolar fibrosis usually mild may have dyspnea and cough regresses w/cessation of smoking ```
135
eosinophilic granuloma aka
pulmonary langerhans cell histocytosis
136
eosinophilic granuloma
proliferation of dendritic cells in response to smoking usually polyclonal and felt to be reactive hyperplasia regresses w/cessation of smoking expresses CD1z, S-100, CD207
137
pulmonary alveolar proteinosis
uncommon | cough and sputum w/gelatinous chunks
138
pulmonary alveolar proteinosis histo
accumulation of acellular surfactant in intra-alveolar and bronchiolar spaces
139
pulmonary alveolar proteinosis classes
autoimmune/acquired secondary hereditary/congenital
140
autoimmune pulmonary alveolar proteinosis
90% 20-50 Ab to GM-CSF recurs after transplantation
141
secondary pulmonary alveolar proteinosis
rare, many lung disorders, immunodeficiency syndromes, malignancy, and blood disorders
142
hereditary pulmonary alveolar proteinosis
rare, genetic, fatal

Resp II (15 decks)

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