Lung Pathology #1 10/2/06 Dr.zaman

Front 1

1.All of the follow are true except:
a. V and Q are greater in the lower lung
b. V and Q are lesser in the upper lung
c. The V/Q ratio os higher in the upper lung
d. The V/Q ratio is lower in the lower lungs
e. the upper lungs are more efficient

Back 1

e. is not correct. the lower lungs are more efficient

 However, the V/Q ratio is higher in upper lung than lower (relative ventilation is greater and hence 02, concentrations are greater in upper lung). Upper lobes - more ventilation and less profusion.

Front 2

2. Which is true of the lower lungs?

a. they are never fully deflate
b. there is constant stress on the alveolil
c. there is not re inflation necessary
the lower lung is more subject to collapse
d. there is greater o2 concentration in the lower lung
e. there is more TB in the lower lung

Back 2

c. By contrast the lower lung deflates with each breath and requires reinflation. The lower lung is more subject to collapse (atelectasis).

all of the others are true for the upper lung

Front 3

3. what 2 diseases are common in the upper lobe?

b. how can you iatrogenically kill patients with O2?

Back 3

Emphysema and TB

b.  In some patients with lung disease and coexisting C02 retention lose the respiratory response to elevated pCO2. This can lead to iatrogenically caused deaths in patients administered 02.
You remove c02 drive that keeps them alive, and that kills them

Front 4

4. What are the three zones of respiration?

Where are you most likely to aspirate a swallowed object?

Back 4

The respiratory system is divided into:
1. Conducting zone -Zone of air conduction, the site of dead volume.
2. Transition zone -Zone of both air conduction (distal bronchiles) and gas exchange (into acinar system – TB here!)
3. Respiratory zone -Zone of gas exchange. (proximal alveolus)

3b. Right middle lobe

Front 5

5. What is a lobule?

b. What keeps the lung intact in atelectasis?

Back 5

The lobule -the lung made up of multiple acini and demarcated by fibrous septae. –impt → keeps lung intact in atelectasis!
and they serve as a partial barrrier to localized patholocical processes.

Front 6

6. You know that atalectasis is the collapse of a airspace. What are the 4 types?

Back 6

1. Resportion - blockage (plug) of the bronchial system
2. Compression - passive collapse secondary to accululated fluid in another area
3. mocroctelectasis: nonobstructive, due to loss of surfactant
4. cicatrix-fibrotic changes hampering expansion and increasing recoil

Front 7

7. Where are sectetory cells found?

b .What is their fucntion

cwhere is serous vs. Muscos secretion?

Back 7

In the conducting zone - found on the surface epithellium and submucosal glands.

b. to lubricate the airway

c. more fluid distally with serous, and more proximal mucus (that traps and dilutes bad substances)

Front 8

8. What are the ciliated cells?

Where are they found?

what do they beat?

Back 8

a. Pseudostratified ciliated epithelium (still the conduction Zone)

b.  These cells line the airway and provide the means by which mucus is transported into the larynx where the mucus and entrapped material may be expectorated.

c. the cilia beat in a serous fluid layer and the movement of this layer moves the upper thick layer of mucus.

Front 9

9. What are the 2 cells in the respiratory epithelium?

what is their fuction?

which can you ID histologically?

Back 9

Squamous pneumocyte or Tvpe I -specialized in shape.
 Extensive thin areas for gas exchange.
 Penetrate pores of Kohn to cover adjacent alveolar surfaces. (gaps in the alveolar walls, allow air to circulate through the alveoli)
 Because of extensive surface, they are very susceptible to inhaled agents.

b. Granular pneumocvte or Tvpe II -the surfactant secreting alveolar epithelial cell.
Have lamellar inclusions (surfactant lipid). Histo ID with EM
They are the predominant cell type lining alveoli following injury (replaces the type I cell).
They are the stem cells.
Cannot differentiate with light microscope, but you can tell with electron!

Front 10

10. What fills the histiocytes (the pulmonary macs) that are the principle cells of inflammation?

Back 10

10 - filled with carbon articles. they trigger fibrotic responce, and scavage.

Front 11

11. How do duct cells respond to tissue injury?

b. what accounts for the largest source of pollutant?

Back 11

They send out IL-8 to attract neutrophils, and the release TNF and they release IL-1 to try to fight off the acute inflammation.

b. Cars --> CO!, the Sulfur oxides

Front 12

12. Deposition of particles in the lung

a. What is nasal clearance, and what kind of particles does it remove?

b. What is trachael bronchial clearance, and what sized particles to they remove?

where is flow rate zero?

Back 12

Nasal Clearance (Impaction) -removes most large particles (5-15 um).These travel in a straight line and impact on the posterior wall of the nasopharynx.
 2. Tracheobronchial Clearance (Sedimentation) -removes medium-sized particles (0.2-5 um). The particles settle because of their weight. This occurs primarily in the small airways because of low flow (flow rates approximate zero because of the marked and rapid increase in cross-sectional areas of the bronchial tree – in the bronchioles not bronchi. ).
 Many aerosol drugs are deposited by sedimentation. Ex – albuterol!

Front 13

13. What percentage of inhaled small particles are removed?

Back 13

80% removed and 20 % deposited.