Pulmonary Pathology I Flashcards Preview

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Flashcards in Pulmonary Pathology I Deck (43):
1

What are the histological layers of the trachea?

- Respiratory Epithelium
- Lamina Propria
- Submucosa
- Tracheal Cartilage

2

What cells is the primary bronchus mainly made of?

Pseudostratified columnar epithelium

3

Type I cells

Squamous pneumocytes - gas exchange

4

Type II cells

Granular pneumocytes -secrete surfactant

5

What pneumocyte can regenerate?

Type II

6

What cell type makes up most of the alveolus?

Type I

7

What is the function of respiratory units?

Respiratory units are responsible for the transport of oxygen from the airspace into the blood, and transport of carbon dioxide from the blood to the airspace.

8

Where does the mudcillary escalator end?

Below the respiratory bronchioles, there is no mucociliary escalator

9

Bronchogenic Cyst

Foregut buds that become separated and disconnected from the tracheobronchial tree, progressively enlarging, and forming a cystic mass.

10

Congenital Cystic Adenomatoid Malformation (CCAM) AKA Congenital Pulmonary Airway Malformation (CPAM)

“Hamartomatous lesions” - Benign, focal malformation composed of tissue elements normally found at that site, but which are growing in a disorganized mass. Usually in the lower lobes.

11

What is seen on histology as a result of CCAM?

Large dilated spaces caused by cysts

12

Pulmonary Sequestration

Discrete mass of lung tissue without connection to the
airway system.

13

Atelectasis

Collapse or closure of the lung

14

What are the 3 types of atelectasis?

􏰄Resorption or obstruction
Compression
􏰄Contraction

15

When is resorption/obstruction atelectasis seen?

Asthma, COPD, bronchiectasis, aspiration, postop patients

16

When is compression atelectasis seen?

Effusions, air, tumors, CHF

17

When is contraction atelectasis seen?

Fibrosis of lung/pleura

18

Where does the mediastinum shift in resorption/obstruction atelectasis?

Towards the affected lung

19

Where does the mediastinum shift in compression atelectasis?

Away from the affected lung

20

What is a pneumothorax most commonly seen with?

Emphysema, asthma , TB

21

Pneumothorax

Causes compression, collapse, and atelectasis, leading to respiratory distress

22

What is the most common place for the lodging of foreign objects in the respiratory tract?

Lodged in the R lower lobe - through the R main bronchus

23

What are some causes of pulmonary edema?

- 􏰅 Hemodynamic or cardiogenic edema
- 􏰅 Edema due to microvascular injury
- 􏰅 Edema of undetermined origin

24

What is seen on histology of an edematous lung?

Pink will be seen filling the alveolar sacs

25

What are the manifestations of acute lung injury?

a) Acute onset dyspnea
b) Hypoxemia
c) Development of bilateral pulmonary infiltrates in the absence of cardiac failure

26

What can acute lung injury progress to if it is severe?

Acute Respiratory Distress Syndrome (ARDS)

27

Acute Respiratory Distress Syndrome (ARDS)

-􏰄 Rapid onset of life-threatening respiratory insufficiency
􏰄- Cyanosis
􏰄- Severe arterial hypoxemia –refractory to oxygen therapy

28

What are some of the possible causes of ARDS?

􏰄A – Aspiration, acute pancreatitis, air/amniotic fluid embolism
􏰄R – Radiation
􏰄D –Drug overdose, DIC, drowning 􏰄
S – Shock, sepsis, smoke inhalation

29

What is the pathological term associated with ARDS?

Diffuse Alveolar Damage

30

Diffuse Alveolar Damage

Pneumocyte and endothelial cell necrosis with hyalin membrane formation causing type 2 pneumocyte proliferation

31

What is seen on histology with DAD?

Hyaline membrane is thick and seen as dark pink

32

What are the causes of Neonatal Respiratory Distress Syndrome (NRDS)?

- Due to a deficiency of surfactant - Hyaline Membrane Disease
- Fetal injury during delivery
- Aspiration of blood and amniotic fluid,
- Cord compression
- Excessive sedation of the mother

33

What is the pathological term associated with NRDS?

Hyaline Membrane Disease

34

What are some risk factors for NRDS?

- prematurity
􏰄- maternal diabetes
􏰄- C-section

35

What is the composition of surfactant?

Dipalmitoyl phosphatidylcholine/ lecithin (DPPC), unsaturated phosphatidyl cholines (PC) and phosphatidylglycerol (PG) and surfactant specific proteins SP-A, SP-B, SP-C and SP-D.

36

What are the functions of surfactant?

-􏰄 Stabilizing the lung by reducing surface
tension
􏰄- Host defense mechanism as a barrier for inhaled particles

37

When are sufficient amounts of surfactant produced in the fetus?

At 34 weeks

38

Glucocorticoid effect on surfactant synthesis...

Increases

39

Insulin effect on surfactant synthesis...

Decreases - this is why diabetic mothers put infant at a greater risk

40

A 30-year-old woman develops multiple organ failure, bleeding diathesis post-partum. Sputum and blood cultures are negative. Nevertheless, she requires intubation with mechanical ventilation, but it becomes progressively more difficult to maintain her oxygen saturations. Ventilatory pressures must be increased. A portable chest radiograph shows increasing opacification of all lung fields. Capillary wedge pressure is normal. Which of the following pathologic processes is most likely now to be present in her lungs?

􏰄A Emphysema
􏰄B Diffuse alveolar damage
􏰄C Extensive neutrophilic alveolar exudates (i.e. Pneumonia) 􏰄
D Extensive intra-alveolar fluid (i.e. pulmonary edema)
􏰄E Normal lung

􏰄B Diffuse alveolar damage

41

Acute Interstitial Pneumonia

Rapidly progressive disease clinically similar to ARDS with no identifiable cause; death usually within 2 months
􏰄
Adults with influenza-like illness followed by shortness of breath

42

Pathogenesis of ARDS

Imbalance of pro- inflammatory and anti-inflammatory mediators

43

Pathogenesis of NRDS

Surfactant deficiency

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