Pulmonary Pathology Flashcards
(97 cards)
1
Q
Structure Of The Lung
(5)
A
Trachea
Bronchi Bronchi
Bronchioles Bronchioles
Terminal Bronchioles Terminal Bronchioles
Acinus Acinus
2
Q
Bronchus -
A
cartilage
and glands
3
Q
Bronchiole -
A
lack
cartilage and glands,
has smooth muscle
4
Q
Type I pneumocyte –
A
flattened alveolar
lining cell
5
Q
Type II pneumocyte –
A
surfactant, repair
6
Q
Microscopic Structure:
Alveolar Wall
(3)
A
- Type I pneumocyte
- Type II pneumocyte
- Pores of Kohn
7
Q
Surfactant
(3)
A
- Surface active agent –reduces surface
tension - Type II pneumocytes by 27-28th weeks of
gestation - Hyaline membrane disease
8
Q
Pleura
(6)
A
- Visceral pleura
- Parietal pleura
- Mesothelial lining
- Pleural space –a potential space
- Pleura –pain receptors
- Lung –few pain receptors
9
Q
- Pain is not a part of lung disease until the — is involved
A
pleura
10
Q
Atelectasis –Collapsed Lung
* Resorption
A
– Obstruction prevents air
from reaching distal
airway
11
Q
Atelectasis –Collapsed Lung
* Compression
A
– Fluid within pleural
cavity
12
Q
Atelectasis –Collapsed Lung
* Contraction
A
– Local or generalized
fibrotic changes
13
Q
- COPD –
A
a combination of
two diseases
14
Q
- Chronic bronchitis –
A
chronic inflammation of
bronchi
increases resistance to the
outflow of air
15
Q
- Emphysema –
A
destruction of elastic
tissue, loss of surface
area
reduces the elastic recoil of the lung
and surface area
16
Q
Chronic Obstructive
Pulmonary Disease
common in
rare in
A
- Common in cigarette smokers
- Rare in non-smokers
17
Q
Frequently occur together (companion diseases)
A
chronic bronchitis
emphysema
18
Q
Chronic Bronchitis
Clinical definition –
A
persistent productive cough for 3 consecutive months in 2 consecutive years
19
Q
- Simple chronic bronchitis
A
airflow not obstructed
20
Q
Chronic asthmatic bronchitis –
A
hyperreactive airways with bronchospasm and wheezing
21
Q
Chronic obstructive bronchitis –
A
chronic outflow obstruction
22
Q
Chronic Bronchitis
* Inspiration –
* Expiration -
A
easy
difficult
23
Q
Emphysema
(3)
A
- Abnormal permanent
enlargement of the air
spaces - Destruction of alveolar
walls without fibrosis - Reduction in surface
area for gas exchange
24
Q
Centrilobular Emphysema
* Typically seen in
A
cigarette smokers
25
Panacinar Emphysema
(2)
* Most commonly seen
in Alpha-1 Anti-trypsin
Deficiency
* Seen in people without
risk factors (smoking)
26
Alpha-1 Antitrypsin Deficiency
(5)
* Causes a rare form of emphysema –panacinaremphysema
* Protease-antiprotease imbalance
* Oxidant-antioxidant imbalance
* A1AT is anti-protease synthesized in the liver
* A1AT scavenges proteases released by inflammatory cells (polys and macrophages)
27
Bronchiectasis
(3)
* A secondary disease; not a primary disease
* Permanent dilation of bronchi and bronchioles caused by destruction of muscle and supporting tissue resulting from chronic necrotizing infections
* Cough and expectoration of copious amounts of purulent sputum
28
Brochial Asthma
(6)
* Severe dyspnea with wheezing
* Difficulty with expiration
* Bronchi constricted and filled with mucin and debris
* Attacks last from one to several hours
* Subside spontaneously or with therapy –usually bronchodilators and corticosteroids
* Status asthmaticus
29
* Status asthmaticus –
a severe paroxysm that does not respond to therapy and persists
30
Bronchial Asthma
(6)
* Mucus accumulation
* Goblet cell hyperplasia
* Hypertrophy of submucosalmucous glands
* Chronic inflammation
* Basement membrane thickening
* Smooth muscle cell hypertrophy and hyperplasia
31
Allergic Asthma
(4)
* Allergic disease - repeated immediate hypersensitivity and late phase reactions
* Intermittent and reversible airway obstruction
* Chronic bronchial inflammation with eosinophils
* Bronchial smooth muscle hypertrophy and hyper-reactivity
32
Drug-Induced Asthma
(2)
* Aspirin sensitivity –aspirin induces asthma
attack
* History of recurrent rhinitis, nasal polyps,
urticaria and bronchospasm
33
The lungs are a frequent site of -- disease
metastatic
34
The most common lung tumor is ---
metastatic
35
Lung metastases are present in about --- of all cancer deaths
1/3
36
Metastases to the lungs are more common even than primary lung neoplasms simply because
so many other primary tumors can metastasize to the lungs
37
Carcinomas usually metastasize via the ---
lymphatics
38
Sarcomas frequently metastasize via the
hematogenous route
39
Therapeutic Classification of
Bronchogenic Carcinoma
(2)
* Small cell carcinoma
* Non-small cell carcinoma
40
Pathologic Classification of
Bronchogenic Carcinoma
(4)
* Squamous cell carcinoma
* Adenocarcinoma
* Small cell carcinoma (oat cell carcinoma)
* Large cell undifferentiated carcinoma
41
Squamous Cell Carcinoma
(4)
* Most often seen in cigarette smokers
* Arises centrally from main bronchi close to the bifurcation
* Squamous metaplasia precursor lesion
* Prognosis depends on the stage
42
Squamous Metaplasia of Columnar,
Ciliated Respiratory Epithelium
* Smoking causes
* Creates (2)
squamous metaplasia of
respiratory epithelium
* Creates “dead spots” in mucociliary escalator
* Creates “fertile soil” for development of
epithelial dysplasia leading to squamous cell
carcinoma (most common type of
bronchogenic carcinoma in smokers)
43
Small Cell Carcinoma
(Oat Cell Carcinoma)
(5)
* Arise centrally
* Aggressive –metastasize early and widely
* Chemotherapy
* Neuroendocrine origin
* Frequent association with smoking
44
Adenocarcinoma
* Arises --- in lung
peripherally
45
Large Cell Carcinoma
* Undifferentiated
epithelial tumors that
lack the cytologic
features of small cell
carcinoma and
glandular or squamous
differentiation
46
Bronchial Carcinoid
(2)
* Neuroendocrine cell
origin
* Often resectable and
curable
47
Mass Effects of Lung Cancer
(4)
* Obstruction
* Superior vena cava syndrome
* Pancoast syndrome
* Horner syndrome
48
* Obstruction -
atelectasis
49
* Superior vena cava syndrome –
compression of superior vena cava
50
* Pancoast syndrome –
compression of lower cervical and upper thoracic nerves
51
* Horner syndrome –
compression of sympathetic nerves
52
Superior Vena Cava Syndrome
(4)
* Obstruction of superior
vena cava
* Impaired venous return
from the head and neck
* Edema and congestion of
face, neck and upper chest
* Upper extremity veins fail
to empty on elevation
53
Horner Syndrome
Compression of the sympathetic
nerves to head and neck causing:
(4)
* Enophthalmos –retraction of
globe
* Ptosis of the upper eyelid
* Miosis - Pupillary constriction
* Anhidrosis –lack of sweating
54
Pancoast Syndrome
* Compression of the
lower cervical and
upper thoracic nerves
causing shoulder pain
radiating down the arm
55
Lung Cancers - Well Known for
Causing Paraneoplastic Syndromes
(3)
* Small cell carcinoma
* Cushing syndrome
* Hyperparathyroidism
56
* Small cell carcinoma –
frequent ectopic hormone production
57
* Cushing syndrome -
ectopic secretion of an ACTH-like hormone
– Patients present with Cushing syndrome
58
* Hyperparathyroidism -
ectopic secretion of a parathyroid-like hormone
– Patients present with symptoms of hyperparathyroidism –parathyroids normal
59
Effects of Bronchogenic Carcinoma
Summation
(5)
* Local mass effects by blockage of airway
* Metastasis
* Paraneoplastic syndromes
* Superior vena syndrome
* Horner syndrome
60
Mesothelioma
(2)
* Malignant neoplasm of
pleura associated with
environmental
asbestos exposure
* Asbestos also increases
risk for squamous cell
carcinoma as well as
mesothelioma
61
Traditional Classification of
Pneumonia by Anatomic Distribution
(4)
* Pneumonia =
pneumonitis
* Pattern of lung
involvement
* Bronchopneumonia –
patchy involvement
* Lobar pneumonia –
entire lobe involved
62
Classification of Pneumonia by
Etiologic Agent or Clinical Setting
(2)
* Specific etiologic agent –e.g. Streptococcus pneumoniae
* Clinical setting
63
Clinical setting
(5)
– Community-acquired pneumonia
– Nosocomial pneumonia
– Aspiration pneumonia
– Chronic pneumonia
– Pneumonia in the immunocompromised host
64
Pneumonia in Immunocompromised
Individuals
* Pneumocystis jiroveci
(older name: Pneumocystis carinii)
– Fungal organism of very low virulence in
immunocompetent individials
65
Pneumonia in Immunocompromised
Individuals
* Mycobacterium avium intracellulare (MAI)
– Rarely pathogenic in immunocompetent individuals
66
Pneumonia –Pneumonitis
* Bacterial
(5)
– Streptococcus pneumoniae
– Klebsiella pneumoniae
– Staphylococcus aureus
– Streptococcus pyogenes
– Legionella pneumophilia
67
Pneumonia –Pneumonitis
* Viral
(3)
– Cytomegalovirus
– Roseola (measles)
– Varicella (chickenpox)
68
Pneumonia –Pneumonitis
* Other
(2)
– Mycoplasma
– Chlamydia psittaci (psittacosis –
parrot fever)
69
Pneumonia in AIDS
(2)
* AIDS patients are susceptible to all forms of pneumonia
* Pneumocystis carinii pneumonia (PCP)
70
* Pneumocystis carinii pneumonia (PCP)
(3)
– AIDS patients especially vulnerable to Pneumocystis carinii pneumonia (PCP)
– Reclassified from a protozoan to a fungus
– Name changed to Pneumocystis jiroveci
71
Tuberculosis
* Caused by
Mycobacterium tuberculosis hominis or bovis
72
Tuberculosis
* In AIDS patients, --- is a common pathogen
Mycobacterium avium-intracellulare
73
Tuberculosis
* Transmitted from person-to-person by
aerosolized droplets during coughing, sneezing and talking
74
Tuberculosis
* Initial lesion in
lung (Gohn focus/complex)
75
Tuberculosis
* Following exposure the course of events is variable -
may disseminate and cause systemic involvement
76
Tuberculosis
* Before anti-tubercular drugs,
nature took its course
77
Primary Tuberculosis
(2)
* Granulomas form in the
periphery of the lung
(Gohn focus) followed by
Gohn complex
* The classic lesion is a
caseating granuloma
78
Primary Tuberculosis
* The classic lesion is a
caseating granuloma –
a
collection of activated
macrophages (epitheliod
histiocytes), sensitized
lymphocytes,
multinucleated giant cells
and a collar of fibroblasts
79
Secondary Tuberculosis
(3)
* Lesions classically appear at the apices of the lungs and are cavitary
* This form of tuberculosis usually is the result of reactivation of dormant organisms in old, silent lesions of primary tuberculosis
* Reactivation is usually triggered by immunosuppression
80
Pneumoconioses
* Lung scarring from inhaled particulate matter
81
Pneumoconioses
* Silicosis –
* Asbestosis –
* Berylliosis –
* Anthracosis –
silica
asbestos
Beryllium
coal dust
– Coal worker’s pneumoconiosis, Black lung disease
82
Silicosis
(2)
* Increased risk for
tuberculosis
* Silico-tuberculosis
83
Asbestosis
(2)
* Environmental hazard
* Risk for mesothelioma
84
Coal Worker’s Pneumoconiosis
(3)
* Coal worker’s
pneumoconiosis
* Black lung disease
* Progressive massive
fibrosis
85
Nasopharyngeal Carcinoma
(5)
* Strong epidemiologic link to Epstein Barr
virus
* High frequency in Chinese
* Three histologic variants:
* Undifferentiated carcinoma variant most
common
* Radiosensitive–50% 5-year survival rate
86
Nasopharyngeal Carcinoma
Three histologic variants:
(3)
– Keratinizing SCCa
– Non-keratinizing SCCa
– Undifferentiated carcinoma
87
Nasopharyngeal Carcinoma
Undifferentiated carcinoma variant most
common
– “Lymphoepithelioma” (a misnomer) due
to the influx of mature lymphocytes
88
Association of Epstein-Barr Virus
(HHV-4 ) with Human Disease
(4)
1. Infectious Mononucleosis
2. Lymphomas –NHL and HL
e.g. Burkitt lymphoma (NHL)
3. Nasopharyngeal Carcinoma
4. Oral Hairy Leukoplakia
89
Most common presenting symptom of laryngeal lesions is
hoarseness
90
Vocal cord nodules (singer’s nodes, polyps) -
chronic irritation
91
Laryngeal papillomas –
squamous papilloma - HPV
92
* Laryngeal papillomas –squamous papilloma - HPV
(5)
– Solitary in adults
– Multiple in children
* Recurrent respiratory papillomatosis (RRP)
* HPV types 6 and 11 (vaccination) –vertical transmission from infected mother
* Spontaneously regress at puberty
93
Laryngeal Squamous Cell Carcinoma
(6)
* Adult males (7:1)
* Strong association with cigarette smoking
* Persistent hoarseness is most common symptom
* Glottic tumors (directly on vocal cords) most common
* Supraglottic tumors (above the vocal cords)
* Subglottic tumors (below the vocal cords) least common
94
Glottic tumors (directly on vocal cords) most common
(3)
– Most confined to larynx at diagnosis
– Cause symptoms early in course of disease
– Best prognosis –sparse lymphatics
95
Supraglottic tumors (above the vocal cords)
(1)
– Rich in lymphatics –likely to metastasize to regional (cervical) lymph nodes
96
Subglottic tumors (below the vocal cords) least common
(1)
– Remain subclinical and present with advanced disease
97
Toxic Pulmonary Effects of
Chemotherapy (Pulmonary Fibrosis)
(5)
* 67M with non-Hodgkin lymphoma undergoing chemotherapy (Bleomycin)
* Pulmonary function tests (PFTs) normal at start of chemotherapy
* One year later PFTs, 19% of lung function remaining
* Continuous 100% oxygen therapy
* Confined to wheel chair
