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Flashcards in Saroj 1 Deck (67):
1

which bronchi is more susceptible to aspiration

right main stem due to vertical orientation

2

What does bronchioles not have

cartilage
submucosal glands

3

what is pathway for air

bronchi
bronchioles
terminal bronchioles
acinus

4

What does Acinus contain

respiratory bronchioles --> alveolar ducts --> alveolar sacs

5

almost entire respiratory tree is lined by what? exceptions?

ciliated pseudostratified tall columnar epithelium
- vocal cord: stratified squamous epithelium

6

what are 2 types of alveolar epithelium

Type I pneumocytes: alveolar surface majority
Type II pneumocytes: surfactant and repair

7

what supplies the lung

pulmonary and bronchial arteries

8

nasal clearnce

sneezing or blowing

9

tracheobronchial clearance

epithelial mucociliary action

10

alveolar clearance

phagocytosis in alveolar macrophages

11

how can alcohol and smoking impact clearance mechanism

interfere with phagocytic action of alveolar macrophages

12

what is restrictive pulmonary disease

reduced expansion of lung parenchyma

13

what numbers are impacted for restrictive pulmonary disease

decreased total lung capacity
normal FEV1

14

what are 2 categories for restrictive disease

1. chest wall disorder with normal lungs
2. acute or chronic interstitial and infiltrative

15

define diffuse interstistial disease

inflammation and fibrosis of lung connective tissue or delicate alveolar septal interstitium

16

what is decreased in diffuse interstitial disease

diffusion capacity
lung volumes
compliance

17

clinical features of diffuse interstitial disease

dyspnea
tachypnea
cyanosis

18

what do advanced lesions on diffuse interstitial look like

honeycomb lung

19

name 2 granulomatous diseases

Sarcoidosis
Hypersensitivity pneumonitis

20

Idiopathic pulmonary fibrosis (IPF) is the same thing as

UIP
usual interstitial pneumonia

21

what is a probable cause for IPF UIP

- repeated cycles of epithelial activation/injury
- fibroblastic/myofibroblastic proliferation = FIBROBLASTIC FOCI

22

What is a probable genetic cause of IPF and UIP

TERT and TERC gene
telomerase

23

What is a second mechanism of pathogenesis for IPF UIP

- caveolin 1 inhibits TGF- beta1

decreased caveiolin-1 in IPF
- abnormal repair

24

idiopathic pulmonary fibrosis usually occurs where in the lung

subpleural regions in lower lobes

25

microscopically what do you see in Idiopathic pulmonary fibrosis (IPF

- fibroblastic foci initially
- later dense fibrosis and cystic spaces - HONEYCOMB

- abrupt transition between fibrosis and normal lung
- temporal heterogeneity

26

later clinical features of Idiopathic pulmonary fibrosis (IPF)

cyanosis and clubbing

27

microscopically what does nonspecific interstitial pneumonia look like

cellular - interstitial inflammation
fibrosing patterns without temporal heterogeneity if UIP
no fibroblastic foci or honeycomb lung

28

how is nonspecific interstitial pneumonia treated

steroids

29

another name for cryptogenic organizing pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP)

30

cryptogenic organizing pneumonia is associated with what

viral and bacterial pneumonias

31

what is the histo for cryptogenic organizing pneumonia

- polypoid plugs or loose organizing fibroconnective tissue ( MASSON BODIES)
- connective tissue plugs all the same age

32

what does X-ray show for cryptogenic organizing pneumonia

- Subplerual or peribronchial area of consolidation

33

how is cryptogenic organizing pneumonia treated

steroid therapy for greater than 6 months

34

What are 3 pneumoconioses

coal worker
silicosis
asbestos

35

what does cigarette smoke affect? amplies?

- affects mucociliary apparatus
- amplies effect of all inhaled dusts in obstructive and restrictive diseases

36

what size are the most dangerous cigarette particles

1-5 um

37

Is there cellular reaction in anthracosis of coal workers

no

38

morphology of simple CW coal workers

-coal macules: composed of carbon laden macrophages
- coal nodules, larger, collagen fibers

39

where does simple CW coal workers occur in the lung

upper lobes
upper zones of lower lobes

40

for simple CW coal workers macules and nodules are adjacent to

respiratory bronchioles

41

what can simple CW coal workers cause

centrilobular emphysema

42

clinical presentation for coal workers pneumonia

usually benign
- milder forms of complicated CWP exist without lung function abnormalities

43

what is Caplan syndrome coal workers

pneumoconiosis plus rheumatoid arthritis

44

what is the most prevalent chronic occupational disease worldwide

silicosis

45

what causes silicosis

inhalation of crystalline silicon dioxide

46

when does disease present for silicosis

decades after exposure

47

what forms in the lung for silicoisis

- crystalline ( more fibrosis, quartz most common) and amorphous forms

48

Silica causes activation and release of what

mediators within macrophages
-IL1, TNF, derived free radicals, fibrogenic cytokines

49

what does histo look like for silicosis

discrete pale to dark nodules
' eggshell calcifications'
- concentric layers of collagen

50

where does silicosis usually occur in lung

upper lung zones

51

Silicosis is associated with increased susceptibility to

tuberculosis

52

what are 2 forms of asbestos

serpentine
amphibole
both are fibrogenic

53

what is serpentine asbestos look like

soluble curly flexible fibers

54

compare serpentine and asmphibole

amphibole less prevalent but more pathogenic

55

describe amphibole

stiff brittle fibers

56

where does initial injury occur in asbetsosis

bifurcations of small airways and ducts

57

asbestosis can act as what? by what?

tumor promoter by free radical generation

58

what is seen in histo for asbestos

asbestos bodies: golden brown fusiform

59

what are asbestos fibers coated with

iron-containing proteinaceous material

60

where in the lung does asbestos occur

lower lobes

61

in asbestos what is a macro feature

honeycombing

62

what is the most common manifestation of asbestos ? what does it not have

pleural plaques
- does not contain asbestos bodies

63

when do symptoms occur for asbestois

20 years of more after exposure

64

asbestosis with lung or pleural cancer =

grim prognosis

65

Bleomycin

directly damage lung tissue

66

Amiodarone

causes penumonitis

67

radiation

pneumonitis occurs in 10-20% of patients 1-6 months after therapy