LUNG pathology

Question 1

Respiratory system is an outgrowth from the____

Answer 1

Ventral wall of the foregut

Question 2

Midline trachea develops two lateral outpocketings

Answer 2

Lung buds

Question 3

How many branches arise from the Right lung bud?

Answer 3

3 (lobar bronchi)

Question 4

How many branches arise from the left lung bud?

Answer 4

2 ( lobar bronchi)

Question 5

Respiratory bronchioles + alveolar ducts + alveolar sacs

Answer 5

Acinus

Question 6

3-5 terminal bronchioles + respective acinus

Answer 6

Pulmonary lobule

Question 7

Histology of bronchial mucosa

Answer 7

pseudostratified, tall, columnar, ciliated epithelial cells

Question 8

Alveolar epithelium

Answer 8

Flattened, plate-like Type 1 pneumocytes covering 95% of the alveolar surface

Rounded Type II pneumocytes; synthesize surfactant; contained in osmiophilic lamellar bodies

Question 9

Entire lung and bronchial tree may be absent on one side

Answer 9

Pulmonary agenesis

Question 10

Incomplete development of the lungs (Presence of rudimentary bronchi but no lung tissue)

Answer 10

Pulmonary Aplasia

Question 11

Defective development of distal lung tissue of both lungs (can be bilateral but usually one may be more affected than the other)

Answer 11

Pulmonary hypoplasia

Question 12

Decreased weight, volume, and acini disproportional to the body weight and gestational age

Answer 12

Pulmonary hypoplasia

Question 13

Causes Pulmonary hypoplasia

Answer 13

abnormalities that compress the lungs or impede normal lung expansion in utero

(CDH and oligohydramnios)

Question 14

Bowels enter the thoracic cavity and impede proper growth and development of the lung

Answer 14

Congenital diaphragmatic hernia

Question 15

Abnormal communication between the trachea and the esophagus, Depending on the type, this can lead to severe and fatal pulmonary complications and aspirations

Answer 15

Tracheoesophageal Fistula

Question 16

Most common type of Tracheoesophageal Fistula

Answer 16

H type variation

Question 17

Suspected in a newborn baby who frequently coughs or regurgitate milk after bleeding

Answer 17

TEF

Question 18

Vascular abnormalities

Answer 18

Pulmonary Arteriovenous malformations
Alveolar capillary dysplasia
Pulmonary Lymphagiectasia

Question 19

Massive overinflation of one or more lung lobes occuring postnatally (compared to adult type emphysema wherin you have actual wall loss)

Answer 19

Congenital Lobar Emphysema

Question 20

What lobe is mostly common in the congenital lobar emphysema

Answer 20

Upper lobes

Question 21

Causes of vongenital lobar emphysema

Answer 21

Intrinsic absence or abnormality (bronchomalacia) of cartilaginous ring

External compression by a large pulmonary artery

Question 22

Compression by a large pulmonary artery ..(Congenital Lobar emphysema)

Answer 22

Bronchi at the involved site may be devoid of cartilahe

Cardiac anomalies may be present

Question 23

Abnormal detachment of the primitive foregut

Answer 23

Foregut cyst

Question 24

Most often location of foregut cyst

Answer 24

hilum or the middle mediastinum

Question 25

Classification of foregut cyst

Answer 25

Bronchogenic (most common) Esophageal Enteric

Question 26

Foregut cyst

Answer 26

lined by ciliated pseudostratified columnar epithelium with squamous metaplasia. Wall contains bronchial glands, cartilage and smooth muscle

Question 27

Curative for Foregut cyst

Answer 27

Surgical Resection

Question 28

Also called Congenital Adenomatoid Malformation (CCAM)

Answer 28

Congenital airway malformation

Question 29

Defect in the development of the terminal bronchioles

Answer 29

Congenital pulmonary airway malformation

Question 30

Histologic categories of congenital pulmonary airway malformation

Answer 30

Macrocytic (13%) Microcystic (73%) Solid Cystic Adenomatoid Malformation (13%)

Question 31

Macrocystic CPAM

Answer 31

Best prognosis | One or more large (>5mm on prenatal ultrasound) cysts are lined with normal pseudostratified ciliated epithelium)

Question 32

Microcystic CPAM

Answer 32

Small cysts lined with ciliated columnar or cuboidal epithelium (similar to lining of more distal and terminal airways)

Question 33

Solid cystic Adenomatoid Malformation

Answer 33

Worst prognosis | Airless Tissue mass composed of cuboidal epithelium lined bronchioles

Question 34

Presence of a discrete mass of lung tissue without normal connection to the airway system

Answer 34

Pulmonary sequestration

Question 35

Blood supply of the pulmonary sequestration arise from??

Answer 35

aorta and its branches

Question 36

External to the lung, and may be located anywhere in the thorax or mediastinum, Obvious separate mass from the main lung lobe, Abnormal mass lesion in infants, associated with other congenital anomalies

Answer 36

Extralobar sequestration

Question 37

Within the lung substance, Usually in older children, often associated with recurrent localized infection or bronchiectasis

Answer 37

Intralobar sequestration

Question 38

Mucus gland hyperplasia, Hypersecretion, redi index of >0.4

Answer 38

Chronic Bronchitis

Question 39

Airway dilation and scarring, necrotizing inflammation of airway

Answer 39

Bronchiectasis

Question 40

Smooth muscle hyperplasia, excessive mucus inflammation, reversible narrowing/ obstruction of airway

Answer 40

Asthma

Question 41

Airspace enlargement; wall destruction

Answer 41

Emphysema

Question 42

Inflammatory scarring, obliteration of bronchioles

Answer 42

Small-airway disease/ Bronchiolitis

Question 43

Predominant Bronchitis

Answer 43

``` Age: 40-45 Dyspnea: Mild; late Cough: Early; copious sputum Infections: Common Respiratory Insufficiency: Repeated Cor pulmonale : common Airway Resitance: Increased Elatic Recoil: Normal Chest Radiograph: Prominent vessels;large heart Appearance: blue Bloater ```

Question 44

Predominant Emphysema

Answer 44

``` Age: 50-75 Dyspnea: Severel earlyl classic characteristic for emphysema Cough: Late; scabty sputum Infections: Occasional Respiratory insufficiency: terminal Cor pulmonale: Rare Airway Resistance: Normal Elastic Recoil: Low Chest Radiograph: Hyperinflation; small heart Appearance: Pink puffer ```

Question 45

Abnormal permanent enlargement of the airspaces distal to the terminal bronchioles

Answer 45

Emphysema Destruction of their walls without obvious fibrosis in contrast to overinflation

Question 46

Overinflation

Answer 46

Enlargement of airspaces not accompanied by destruction

Question 47

Emphysema types according to its anatomic distribution within the lobule:

Answer 47

Centriacinar Panacinar Distal acinar Irregular

Question 48

Centriacinar

Answer 48

Clinically significant 20x more common than panacinar Distal acinar are usually spared

Question 49

Panacinar

Answer 49

Clinically significant

Question 50

Distal acinar and irregular types

Answer 50

not clinically significant but are pprone to develop pleural blebs, causing pneumothorax in younger people

Question 51

Tobacco

Answer 51

causes production of ROS, induce inflammation, increase neutrophils that secrete elastases; ROS also inactivate anti-proteases, activating tissue disruption

Question 52

Reversible bronchoconstriction, Airway hyperresponsiveness

Answer 52

ASTHMA

Question 53

Th2 and immunologic reaction to environmental allergens. Has acute phase and late phase

Answer 53

Atopic asthma

Question 54

Th2 cytokines in atopic asthma

Answer 54

IL-4, IL-5, IL-13

Question 55

Whorls of shed epithelium

Answer 55

Curschmann spirals

Question 56

Collections of crystalloids made up of eosinophil proteins

Answer 56

Charcot Leyden crystals

Question 57

Irreversible component of asthma, Sub basement membrane thickening, hypertrophy of bronchial glands and smooth muscle

Answer 57

Airway Remodeling

Question 58

Persistent productive cough for at least 3 consecutive months in at least 2 consecutive year

Answer 58

Chronic bronchitis

Question 59

Hypersecretion of mucus. Airflow obstruction due to (small airway disease and coexistent emphysema)

Answer 59

Hyersecretion of mucus

Question 60

Morphology of large airway in chronic Bronchitis

Answer 60

``` Hyperemic and swollen mucosal lining Mucinous or mucopurulent secretions Enlargement of mucus secreting glands Reid index of >0.4 THickness of submucosal gland layer to bronchial wall Chronic and acute inflammation of mucosa Eosinophils not a prominent feature ```

Question 61

Morphology of chronic bronchiolitis

Answer 61

Goblet cell metaplasia Mucus plugging Inflammation Fibrosis

Question 62

Permament dilation of bronchi and bronchioles due to ulcerating inflammation. Caused by destruction of the muscle and elastic tissue

Answer 62

Bronchiectasis

Question 63

Primary ciliary dyskinesia

Answer 63

Kartegener syndrome