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Flashcards in Pulmonary Deck (57)
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Explain the pathogenesis of coal-workers' lung disease.

Particles are taken up by macrophages in alveoli. Particles are deposited in centrolobular zones and may be associated with fibrosis or centroacinar emphysema.


What is silicosis, and how does it present pathologically?

Inhalation of silica (sand-blasting, mining, stone cutting)

causes fibronodular lesions in the lung parenchyma. Particles taken up by macrophages, which release silica crystals and stimulate fibroblasts to produce collagen

**TB is a common complycation b/c silica-laden macrophages cannot effectively combat mycobacterial infections


Which lung diseases are related to exposure to asbestos?

  1. pulmonary fibrosis
  2. pleural fibrosis and pleural plaques
  3. lung cancer
  4. mesothelioma


Explain the pathogenesis of dyspnea caused by various mechanisms.

large airway obstruction . . . laryngospasm

small airway obstruction . . . bronciolitis, asthma

intra-alveolar obstruction . . . pneumonia, edema

alveolar septal lesions

destruction . . . emphysema

increase in thickness . . . intersitital fibrosis

collapse . . . atelectasis

CNS causes . . . apoplexy of respiratory centers


Compare the pathologic findings in wet drowning and dry drowning.

wet drowning: water prevents entry of air, death occurs within minutes


dry drowning: reflex laryngospasm closes glottis and prevents air/fluid


List four main pathogenetic mechanisms of ventilatory failure and explain how they affect respiration. 

  1. Neural control
    depends on CO2 content
    e.g. apoplexy
  2. Respiratory muscles
    striated muscles dependent on cranial/spinal nerves
    e.g. polio, tetanus, MG, MD
  3. Chest wall
    can restrict expansion
    e.g. kyphoscoliosis
  4. Airways
    alveolar hypoxia
    cystic fibrosis, laryngospasm


List common causes of acute respiratory distress syndrome.


  • trauma
  • burns
  • acute cardiac failure


  • bacterial
  • viral

Toxic lung injury

  • toxic fumes
  • cytotoxic drugs
  • bacterial endotoxins

Aspiration of fluids


Describe the pathology of acute respiratory distress syndrome and explain its pathogenesis.

alveolar injury = initiating event in viral pneumonia or fumes

endothelial injury = initiating event in sepsis
regardless of initial injury, lesions are comprised of hyaline membranes, ruptured alveolar walls, and intra-alveolar edema

see pg. 185 in book


What are the possible outcomes of acute respiratory distress syndrome?

1/3 die within days
1/3 die of pneumonia and heart failure within weeks
1/3 recover


What is atelectasis, and what are its possible causes?

atelectasis is the incomplete expansion or collapse of alveoli.

  1. deficiency of surfactant
  2. compression of the lungs from outside
  3. resorption of air distal to bronchial obstruction


What are the most important neoplasms of the respiratory tract?

lung cancer + carcinoma of the larynx


Correlate the pathology of carcinomas of the larynx with clinical findings and prognosis of the disease.

* all are squamous cell

- linked with smoking and chronic alcohol

- rare <40 yrs

- can originate in any part of the larynx

- present as nodules and ulcerations of the mucosa
patients present relatively early with hoarseness, stridor. 75% 5yr survival. 


How common is lung cancer?

Most common malignant disease of internal organs and leading cause of cancer death in the US


How is tobacco smoking related to lung carcinoma?

90% of patients with lung cancer are smokers!


Tobacco smoke has polycyclic hydrocarbons that initiate and promote malignant transformation of cells. Also contains procarcinogens.


Explain the histogenesis of various histologic types of lung carcinoma.

Columnar epithelium undergoes squamous metaplasia, which can progress to carcinoma in situ and invasive squamous cell carcinoma. 

adenocarcinomas = mucous/ciliated cells

small-cell = neuroendocrine cells

large-cell = anaplastic stem cells


Compare hilar (central) and peripheral lung carcinoma.

Central = squamous, large-cell, small-cell

peripheral = adenocarcinomas


Where do lung carcinomas metastasize?

- Liver
- Brain
- Bone
- Adrenals


What are the clinical signs of lung cancer?

- bronchial irritation/obstruction
wheezing, dyspnea, hemoptysis

- local extension into the mediastinum or pleural cavity
atelectasis, dysphagia

- distant mets
HSM, neurologic symptoms, Addisons

- systemic effects
weight loss, anorexia, malaise


What are the common paraneoplastic syndromes caused by lung carcinoma?

PTH >> hypercalcemia
ACTH >> Cushing's

ADH >> hyponatremia


Compare pneumothorax and hydrothorax.

pneumothorax = air in the pleural cavity

hydrothorax = fluid in pleural cavity


Explain the pathogenesis of pleuritis.

Hallmark = exudate

bacterial pneumo >> fibrinous/purulent
viral >> serous
TB >> serous or fibrinous, NO PMNs
heart failure/edema >> transudate


What is mesothelioma?

rare malignant tumor of the pleura

*often r/t asbestos


What makes interstitial pneumonia unique?

Interstitial . . . inflammation affects the alveolar septa and does not result in exudation of PMNs into the alveolar lumen. Also viruses that cause interstitial pneumonia attach to respiratory epithelial cells >> cell necrosis = "reticular pattern" on x-ray


How is pneumonia diagnosed?

- x-ray

- sputum studies

- peripheral blood studies


What are some unique features of TB?

- acid-fast bacillus (Ziehl-Neelsen)

- TB does NOT attract PMNs, but forms granulomas

- Ghon complex = parenchymal focus and hilar lymph node lesion 

- Ghon complex = central caseous necrosis surrounded by epithelioid cells, multinucleated giant cells, lymphocytes


What is the defnition of chronic bronchitis?

excessive production of tracheobronchial mucus causing cough and expectoration for at least 3 months during 2 consecutive years.