Pulm Path I

Question 1

What are type I pneumocytes for?

Answer 1

-gas exchange

Question 2

What are type II pneumocytes for?

Answer 2

• secrete surfactant

- stem cells

Question 3

What do alveolar macrophages do?

Answer 3

ingest foreign matter

Question 4

What are endothelial cells for?

Answer 4

-line blood vessels, gas exchange

Question 5

Mucociliary escalator

Answer 5

• Goblet cells secrete mucus

- Cilia and goblet cells exist till the end of the respiratory bronchioles

Question 6

Where does lung begin to grow?

Answer 6

From the foregut as a laryngotracheal tube during the 4th week. It undergoes dichotomous branching at that point.

Question 7

The Lung’s stages of development

Answer 7

• Embryonic
• Pseudoglandular
• Canalicular
• Saccular
• Alveolar

Question 8

Clinical presentation of lung agenesis or hypoplasia

Answer 8

• dec. intrathoracic space and breathing movements

- associated with prolonged oligohydramnios

Question 9

What are some trachea or bronchial anomalies?

Answer 9

• atresia
• stenosis
• fistulas

Question 10

What is bronchogenic cyst?

Answer 10

foregut buds that become separated and disconnected from the tracheobronchial tree
-enlarges progressively, forming a cystic mass

Question 11

What is congenital cystic adenomatoid Malformation?

Answer 11

-Also known as [Congenital Pulmonary Airway Malformation] (CPAM)
-Hamartomatous lesions = usually lower lobes
Type 1 - 5 (type 1 most common)
-Classification based on size and level of origin of cysts

Question 12

What is a hamartoma?

Answer 12

Benign, focal malformation composed of tissue elements normally found at that site, but which are growing in a disorganized mass

Question 13

Pulmonary sequestration

Answer 13

Discrete mass of lung tissue without connection to the airway system

Question 14

Resorption shifts the mediastinum [away or toward] the affected lung?

Answer 14

Towards

Question 15

Compression shifts the mediastinum [away or toward] the affected lung?

Answer 15

Away

Question 16

Where do items tend to lodge in the lung?

Answer 16

Right Lower lobe

Question 17

Signs/symptoms of Acute Lung Injury (ALI)

Answer 17

• Acute onset of dyspnea
• Hypoxemia
• Development of bilateral pulmonary infiltrates in absence of cardiac failure
• SEVERE ALI CAN PROGRESS TO ARDS

Question 18

Acute Respiratory Distress (ARDS) Signs/Symptoms

Answer 18

• rapid onset of resp. insufficiency
• cyanosis
• severe arterial hypoxemia (refractory to oxygen therapy)
• possible progression to multisystem organ damage

Question 19

ARDS Synonyms

Answer 19

• Adult resp. distress syndrome
• Acute lung injury?
• Traumatic wet lung
• Noncardiogenic pulmonary edema
• Adult hyaline membrane disease

Question 20

Etiology of ARDS

Answer 20

• sepsis
• diffuse pulmonary infections
• gastric aspiration
• mechanical trauma, head injuries

Question 21

Etiology of ARDS (with mnemonic)

Answer 21

A - aspiration, acute pancreatitis, air/amniotic fluid embolism
R - radiation
D - drug overdose, DIC, drowning
S - shock, sepsis, smoke inhalation

Question 22

ARDS Onset

Answer 22

24 - 72 hours after precipitating event

Question 23

Approach to ARDS Dx

Answer 23

clinical history, imaging studies (x-ray, CT), bronchoscopy

Question 24

Treatment for ARDS

Answer 24

treat underlying condition and supportive care

Question 25

ARDS on histology is known as:

Answer 25

Diffuse Alveolar Damage

Question 26

Histology of ARDS

Answer 26

- pneumoncyte and endothelial cell necrosis - edema - Hyaline membrane formation - Organizing interstitial fibrosis and type 2 pneumocyte proliferation

Question 27

Two possible outcomes of ARDS

Answer 27

- Restoratoin of normal lung architecture | - Progression to fibrosis (endstage honeycomb fibrosis)

Question 28

Phases of ARDS on pathology

Answer 28

- Early exudative phase (acute) - Subacute proliferative phase (organizing) - Fibrotic phase (late)

Question 29

Neonatal Respiratory Distress (NRD) Syndrome synonyms

Answer 29

- Infant Resp. Distress syndrome (IRDS) - Resp. Distress syndrome of newborn - Hyaline membrane disease

Question 30

Etiology of NRDS

Answer 30

- Fetal injury during delivery - aspiration of blood or amniotic fluid - cord compression - excessive sedation of mother - hyaline membrane disease (most common)

Question 31

Predisposing factors to NRDS

Answer 31

- prematurity - maternal diabetes - C-section

Question 32

Main problem in NRDS

Answer 32

Insufficient pulmonary surfactant production resulting in failure of lungs to inflate after birth

Question 33

Surfactant characteristics

Answer 33

- synthesized in type II pneumocyte - Composed of phosphatidylcholine (lecithin) - stabilizes lung by reducing surface tension - production starts as early as 20 weeks, but not enough till 34 weeks

Question 34

Treatment of NRDS

Answer 34

- Delay labor if possible to allow lung maturity - administer exogenous surfactant - assess fetal lung maturation (Lecithin:sphingomyelin ratio over 2:1

Question 35

Acute Interstitial Pneumonia is also known as:

Answer 35

Harman-Rich syndrome

Question 36

Acute Interstitial Pneumonia clinical presentation

Answer 36

- adults with influenza-like illness followed by SOB - clinically similar to ARDS but no known cause - death usually within 2 months - histologically: brisk interstitial fibroblastic proliferation