The Lung - Chapter 15

Question 1

Name and differentiate the two principle cell types of alveolar epithelium.

Answer 1

Type I pneumocytes – flattened, platelike pavement, covering 95% of the alveolar surface.
Type II pneumocytes – rounded, synthesize pulmonary surfactant, main cell type involved in the repair of alveolar epithelium after destruction of type I cells. (p. 670)

Question 2

What phospholipid decreases surface tension within the alveoli, thus maintaining the stability of the alveoli?

Answer 2

Surfactant (p. 670)

Question 3

The most common hemodynamic mechanism of pulmonary edema is caused by __________ and most frequently occurs in _________.

Answer 3

Increased hydrostatic pressure
Left-sided congestive heart failure (p. 671)

Question 4

Describe the pathogenic mechanism of adult respiratory distress syndrome.

Answer 4

The alveolar capillary membrane is formed by two separate barriers: the microvascular endothelium and the alveolar endothelium. In ARDS, the integrity of this barrier is compromised by either endothelial or epithelial injury or both. (p. 672)

Question 5

The classic pathologic change seen in adult respiratory distress syndrome (ARDS) is____.

Answer 5

Hyaline membranes (p. 673)

Question 6

Describe the various stages of the process of ARDS.

Answer 6

The initial injury is to either capillary endothelium or alveolar epithelium, but eventually both are affected. Damage to these cells leads to increased capillary permeability, interstitial and then intra-alveolar edema, fibrin exudation, and formation of hyaline membranes. (p. 672)

Question 7

A larger embolus that occludes the main pulmonary artery and straddles the PA bifurcation or its branches is known as ____.

Answer 7

Saddle embolus (p. 698)

Question 8

Sudden death, right heart failure (cor pulmonale), or cardiovascular collapse occurs when ______.

Answer 8

Emboli obstruct 60% or more of the pulmonary circulation (p. 698)

Question 9

Define atelectasis.

Answer 9

Atelectasis refers either to incomplete expansion of the lungs or to the collapse of previously inflated lung, producing areas of relatively airless pulmonary parenchyma. (p. 670)

Question 10

Name two types of acquired atelectasis and give examples of a possible cause of each.

Answer 10

Obstruction (resorption) – consequence of complete obstruction of an airway leading to resorption of oxygen trapped in alveoli - found in bronchial asthma, chronic bronchitis, aspiration of foreign Compression – results whenever pleural cavity is partially or completely filled by fluid exudate, tumor, blood, or air - found in tension pneumothorax, pleural effusion (p. 671)

Question 11

Name five disorders that are in the spectrum of chronic obstructive pulmonary disease (COPD).

Answer 11

Chronic bronchitis, bronchiectasis, asthma, emphysema, small airway disease (bronchiolitis) (p. 674)

Question 12

Define emphysema.

Answer 12

Emphysema is characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole accompanied by destruction of their walls, and without obvious fibrosis. (p. 675)

Question 13

Name and differentiate the four types of emphysema.

Answer 13

1. Centriacinar
2. Panacinar
3. Paraseptal
4. Irregular

Question 14

Centriacinar

Answer 14

the central and proximal parts of the acini, formed by respiratory bronchioles, are affected, whereas distal alveoli are spared.

Question 15

Panacinar

Answer 15

acini are uniformly enlarged from the level of the respiratory bronchiole to the terminal blind alveoli.

Question 16

Paraseptal

Answer 16

proximal portion of the acinus is normal, but the distal part is dominantly involved.

Question 17

Irregular

Answer 17

the acinus is irregularly involved, almost invariably associated with scarring. (p. 675)

Question 18

Panacinar emphysema is frequently associated with a deficiency of what protein?

Answer 18

Alpha 1 antitrypsin (p. 675)

Question 19

Subpleural, dilated and confluent alveoli are known as______ or ________.

Answer 19

Blebs, bullae, or bullous emphysema (p. 678)

Question 20

Define interstitial emphysema and list one possible cause.

Answer 20

The entrance of air into the connective tissue stroma of the lung, mediastinum, or subcutaneous tissue is designated interstitial emphysema.
Possible cause – alveolar tears in pulmonary emphysema provide the avenue of entrance of air into the stroma of the lung, rarely a wound of the chest that allows air to the sucked in, or fractured rib that a punctures a lung. (p. 678)

Question 21

What is the name of the spiral-shaped mucus plugs in patients with asthma?

Answer 21

Curschmann spirals (p. 682)

Question 22

Define bronchiectasis and list one syndrome where this is particularly common.

Answer 22

Bronchiectasis is a disease characterized by permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue, resulting from or associated with chronic necrotizing infections.
Common in Kartagener syndrome (p. 683)

Question 23

Define lobar pneumonia and list the most common etiologic agent.

Answer 23

Lobar pneumonia is a fibrinosuppurative consolidation of a large portion of a lobe or of an entire lobe.
The most common etiologic agent is Streptococcus pneumoniae. (p. 704)

Question 24

ronchopneumonia is also known as________.

Answer 24

Lobular pneumonia (p.704)

Question 25

Name and differentiate the four stages of the inflammatory response in lobar pneumonia.

Answer 25

1. Congestion
2. Red Hepatization
3. Gray Hepatization
4. Resolution

Question 26

Congestion

Answer 26

lung is heavy, boggy and red. It is characterized by vascular engorgement, intra- alveolar fluid with few neutrophils, and often the presence of numerous bacteria.

Question 27

Red Hepatization

Answer 27

characterized by massive confluent exudation with red cells and neutrophils and fibrin filling the alveolar spaces.

Question 28

Gray Hepatization

Answer 28

progressive disintegration of red cells and the persistence of a fibrinosuppurative exudate giving the gross appearance of a grayish-brown, dry surface.

Question 29

Resolution

Answer 29

the consolidated exudate within the alveolar spaces undergoes progressive enzymatic digestion to produce a granular, semifluid debris that is resorbed, ingested by macrophages, coughed up or organized by fibroblasts growing into it. (p. 645)

Question 30

Primary atypical pneumonia is characterized by inflammatory changes primarily confined to the _______ and ________.

Answer 30

Alveolar septa and pulmonary interstitium

Question 31

The most common organism which causes interstitial pneumonitis is_____.

Answer 31

Mycoplasma pneumoniae

Question 32

Name several mechanisms responsible for the development of lung abscesses.

Answer 32

Aspiration of infective material
Antecedent primary lung infection Septic embolism
Neoplasia
Trauma (p. 708)

Question 33

A fungal infection by Coccidioides, prominent in the Southwest United States, characterized by lung lesions, fever, cough, pleuritic pain, and erythema nodosum or Erythema multiforme is also known as __________.

Answer 33

San Joaquin Valley fever (p. 710)

Question 34

Define hypersensitivity pneumonitis and give two examples.

Answer 34

Hypersensitivity pneumonitis describes a spectrum of immunologically mediated, predominantly interstitial lung disorders caused by intense, often prolonged exposure to inhaled organic dusts, and related occupational antigens.
Examples: Farmer’s lung, Pigeon breeder’s lung (p. 694)

Question 35

List the two characteristic findings associated with Goodpasture syndrome and describe their pathogenesis.

Answer 35

Rapidly progressive glomerulonephritis and a necrotizing hemorrhagic interstitial pneumonitis. Renal and pulmonary lesions are the consequence of antibodies evoked by antigens present in the glomerular and pulmonary alveolar basement membranes. (p.701)

Question 36

The major morphologic correlate of chronic lung transplant rejection is

Answer 36

Bronchiolitis obliterans (p. 712)

Question 37

List, in order of incidence, the four most common types of bronchogenic carcinoma.

Answer 37

1. squamous cell carcinoma Males 32%, females 25%
2. Adenocarcinoma Males 37%, females 47%
3. Small cell carcinoma Males 14%, females 18%
4. Large cell carcinoma Males 18%, females 10% (Not in Robbins)

Question 38

Name at least three etiologic agents associated with lung cancer.

Answer 38

Tobacco smoking, industrial hazards, air pollution, genetics (p. 713)

Question 39

Most “scar cancers” are_______.

Answer 39

Usually adenocarcinoma (Not in Robbins)

Question 40

Lung cancers most frequently disseminate by which pathways?

Answer 40

Lymphatic and hematogenous (p. 717)

Question 41

What is the term used for multiple discreet nodules scattered throughout all lobes in the setting of metastatic tumors?

Answer 41

Cannonball lesions (p. 721)

Question 42

Which lung carcinoma occurs in the pulmonary parenchyma in the terminal bronchioloalveolar regions at the peripheral portion of the lung?

Answer 42

Bronchioloalveolar carcinoma (p. 715)

Question 43

The tumor most commonly associated with a history of smoking is _______.

Answer 43

Squamous cell carcinoma (p. 716)

Question 44

Which tumors of the lung are thought to be derived from cells of the neuroendocrine system?

Answer 44

Tumorlets, carcinoid, and aggressive small cell carcinoma and large cell neuroendocrine carcinoma of the lung (p. 719)

Question 45

What pleural tumor is related to asbestos exposure?

Answer 45

Malignant mesothelioma (p. 723)

Question 46

At autopsy, the best way to identify a pneumothoraxis

Answer 46

Careful opening of the thoracic cavity under water to detect the escape of gas or air bubbles. (Not in Robbins)

Question 47

List three types of the entity described above.

Answer 47

Spontaneous, traumatic, tension (p. 722)

Question 48

Presence of air or gas in the pleural cavities is known as_______.

Answer 48

Pneumothorax (p. 722)

Question 49

Define chylothorax and describe the most common pathogenic mechanism

Answer 49

Chylothorax is an accumulation of milky fluid, usually of lymphatic origin, in the pleural cavity. It is most often caused by thoracic duct trauma or obstruction that secondarily causes rupture of major lymphatic ducts. Also encountered in malignant conditions arising within the thoracic cavity that cause obstruction of the major lymphatic ducts. (p. 722)

Question 50

Presence of air or gas in the pleural cavities is known as_______.

Answer 50

Pneumothorax (p. 722)

Question 51

Define empyema

Answer 51

Intrapleural fibrinosuppurative reaction (p. 722)

Question 52

The escape of blood into the pleural cavity is known as______.

Answer 52

Hemothorax (p. 722)

Question 53

A Noninflammatory collection of serous fluid within the pleural cavities is called______.

Answer 53

Hydrothorax (p. 722)

Question 54

Define and differentiate serous and fibrinous pleuritis.

Answer 54

Serous, serofibrinous, and fibrinous pleuritis are all caused by essentially the same processes. Fibrinous exudations generally reflect a later, more severe exudative reaction that, in an earlier developmental phase, might have presented as serous or serofibrinous exudates. (p. 722)

Question 55

What are the three classic clinical signs associated with the carcinoid syndrome?

Answer 55

Intermittent attacks of diarrhea, flushing, and cyanosis (p. 720)

Question 56

Carcinoids that produce little intraluminal mass but penetrate the bronchial wall to fan out in the peribronchial tissue, produce the

Answer 56

Collar button lesion (p. 719)

Question 57

What type of carcinoma resembles lobar pneumonia and is less likely to be cured by surgery?

Answer 57

Mucinous adenocarcinoma (p. 715)

Question 58

Apical lung cancers that invade the cervical sympathetic plexus giving rise to Horner syndrome on the same side as the tumor are also known as ________ tumors. What four entities comprise Horner syndrome?

Answer 58

Pancoast tumors

Horner syndrome – enophthalmos, ptosis, miosis, anhidrosis (p. 719)

Question 59

What are paraneoplastic syndromes and describe their relationship with lung carcinoma.

Answer 59

Symptom complexes in cancer-bearing individuals that cannot be readily explained, either by the local or distant spread of the tumor or by the elaboration of hormones indigenous to the tissue from which the tumor arose, are known as paraneoplastic syndromes.
Lung carcinoma can be associated with a number of paraneoplastic syndromes some of which may antedate the development of a gross pulmonary lesion. The hormones or hormone-like factors elaborated include: Antidiuretic hormone inducing hyponatremia due to inappropriate ADH secretion; ACTH leading to Cushing syndrome; Parathormone, parathyroid hormone-related peptide, prostaglandin E, and some cytokines, all implicated in the hypercalcemia often seen in lung cancer; Calcitonin causing hypocalcemia; Gonadotropins causing gynecomastia; Serotonin associated with carcinoid syndrome. (p. 719)