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Flashcards in Pulmonary Pathology 1 Deck (37)
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1
Q

How many grams is each lobe?

A

200-250 grams each (right lung is slightly heavier)

2
Q

T/F. The lungs have a dual blood supply from the pulmonary and bronchial vasculature.

A

True

3
Q

What does breathing require?

A

muscles (diaphragm, chest wall and accessory) plus neural control

4
Q

What type of epithelium lines the vocal cords?

A

stratified squamous epithelium

5
Q

The large airways (larynx, trachea, bronchi) are lined by ___, ___, ___ epithelium with mucus glands (mucosal and submucosal), neuroendocrine cells and cartilage.

A

pseudostratified, ciliated, columnar;

6
Q

Describe the two cell types in the alveoli?

A
  1. flat, type I pneumocytes (95%)

2. cuboidal, type II pneumocytes (produce surfactant)

7
Q

What are the defense mechanisms important in protection against foreign materials and infections?

A

i. upper airway – filtering function
ii. lower airway – mucociliary apparatus
iii. lymphoid tissues – cellular & humoral immunity (mucosal IgA)
iv. alveolar macrophages

8
Q

Define the following terms:

  1. hemoptysis
  2. dyspnea
  3. atelectasis
  4. pneumothorax
  5. pleural effusion
  6. empyema
A
  1. Hemoptysis - coughing up blood
  2. Dyspnea - difficulty breathing, perception of needing to breathe deeper and faster (aka; shortness of breath)
  3. Atelectasis – collapse or loss of lung volume – inadequate expansion of airspaces
  4. Pneumothorax - air in the pleural space, leads to collapse of the lung
  5. Pleural effusion - fluid in the pleural space
  6. Empyema – suppuration (purulence) in pleural cavity, often related to bacterial infection
9
Q

Explain the differences between transudate and exudate.

A

a. Transudate - low protein fluid, caused by increased venous pressure (CHF)
b. Exudate - high protein fluid, with or without inflammatory cells, caused by increased vascular permeability (damage), pneumonia is an example

10
Q

Pulmonary ___ is accumulation of ___ in the lungs, first in the ___ tissues, then filling the ___ air spaces. What are some causes?

A

fluid; interstitial; distal

a. increased intravascular pressure (CHF)
b. hypoproteinemia (low protein)
c. vascular damage (infections, autoimmune diseases)

11
Q

What is the problem with pulmonary edema?

A
  1. inhibits normal oxygen exchange

2. predisposes to infection

12
Q

Pulmonary ___ are usually from the ___ veins of the legs or pelvis. Very large emboli lodge at the ___ of the pulmonary arteries (“___” embolus) and can cause sudden death.

A

thromboemboli; deep; bifurcation; saddle

13
Q

Name 4 predisposing factors to pulmonary thromboemboli.

A
  1. chronic illness
  2. prolonged bed rest (immobility)
  3. hypercoagulable state
  4. deep vein thrombophlebitis
14
Q

___ pulmonary diseases are a group of diseases that result in airflow ___ or ___. List the 4 classic disorders.

A

Obstructive; limitations; obstruction

  1. Emphysema
  2. Chronic bronchitis
  3. Bronchiectasis
  4. Asthma
15
Q

What two conditions are known as COPD?

A

emphysema and chronic bronchitis

16
Q

T/F. Overall, chronic pulmonary diseases are #4 behind heart disease, cancer and pneumonia.

A

False, Overall, chronic pulmonary diseases are #3 behind heart disease and cancer.

17
Q

___ is a permanent enlargement of the ___ air spaces due to destruction of the alveolar ___ walls.

A

Emphysema; small; septal

18
Q

What is the clinical and pathological presentation of emphysema?

A

clinical - dyspnea, cough, prolonged exhalation (“pink puffers” - air gets in but hard to push out)

path - imbalance between protease and anti-protease enzymes

19
Q

T/F. Smoking is a minor cause of the imbalance seen in emphysema.

A

False, Smoking is a MAJOR cause of the imbalance seen in emphysema.

20
Q

___ emphysema involves the central portion of the lobule, may progress to bullae, usually affects ___ lobes, typically associated with ___.

A

Centriacinar; upper; smoking

21
Q

___ emphysema involves the entire respiratory lobule and usually involves the ___ lobes, associated with ___ deficiency

A

Panacinar; lower; alpha-1-AT

22
Q

What symptoms must be present for a diagnosis of chronic bronchitis?

A

cough with sputum production at least 3 consecutive months for 2 consecutive years

May have hypoxemia, cyanosis (“blue bloaters” - lots of stuff in airway so hard to get air in)

23
Q

In chronic bronchitis, chronic irritation (smoking) and infections lead to increased ___ glands, chronic ___, fibrosis and ___ of the airways.

A

mucus; inflammation; narrowing

24
Q

What does cigarette smoking do in chronic bronchitis?

A

causes mucus gland hyperplasia, increases smooth ms tone, inhibits cilia, inhibits phagocytosis, and squamous metaplasia

25
Q

List the 4 predisposing factors to chronic bronchitis and emphysema.

A
  1. cigarette smoking
  2. atmosphere pollutants
  3. infection(s)
  4. genetic factors - CF(cystic fibrosis), a-1-AT deficiency (esp. emphysema)
26
Q

What condition has a chronic infection with permanent (large) airway dilation?

A

Bronchiectasis

27
Q

How do patients clinically present with bronchiectasis? What are some complications?

A

clinically - cough, fever, expectoration, dyspnea

complications - abscess, pneumonia, bronchopleural fistula, empyema

28
Q

What predisposing factors can lead to bronchiectasis?

A

obstructive tumors, foreign bodies, cystic fibrosis (mucus plugs), other COPD, suppurative or necrotizing pneumonia

29
Q

T/F. The pathology of bronchiectasis is narrowed distal bronchi and bronchioles, chronic infection with inflammation and no purulence

A

False, the pathology of bronchiectasis is DILATED distal bronchi and bronchioles, chronic infection with inflammation and VARIABLE purulence (bloody mucoid sputum).

30
Q

___ is increased irritability of smooth muscle in ___ and ___ that leads to ___ airway contraction/constriction.

A

Asthma; bronchi; bronchioles; reversible

31
Q

T/F. Asthma affecs ~ 5% of adults and 7-10% of kids, esp. inner city children.

A

True.

32
Q

What is the clinical presentation of asthma?

A

wheezing, long exhalation, hyperinflation of lungs

33
Q

Which of the following is true for atropic asthma?

  1. its allergic, extrinsic
  2. Type I hypersensitivity (IgE mediated)
  3. environmental antigen
  4. positive family history
A

All are characteristic of atopic asthma

34
Q

Which type of of asthma is intrinsic and may be initiated by viruses or air pollutants?

A

non-atopic

35
Q

The pathology of asthma is increased ___ glands, smooth muscle ___, inflammation with ___ and type ___ helper T cells.

A

mucus; hypertrophy; eosinophils; 2

36
Q

What is the pathogenesis of asthma?

A

antigen binds to surface IgE on mast cells releasing a large number of mediators, including histamine and leukotrienes

37
Q

How is asthma treated?

A
  1. Attack may subside spontaneously
  2. Inhalation bronchodilators for immediate relief (albuterol)
  3. Controller medications (corticosteroids)