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172 Cards in this Set
- Front
- Back
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What are four reasons why lung pathology is important?
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-Primary respiratory infections are common
-Cigarette smoking, air pollution, and industrial exposures contribute to lung disease -Lung tumor malignancy = most common lethal malignancy in males AND females -Lung almost always involved in terminal disease |
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What do the lungs have double of?
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arterial supply: pulmonary and bronchial arteries (from aorta)
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What are the angles of the left and right bronchi?
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Left bronchus sits more horizontal
Right bronchus sits lower and more flat |
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By gravity, where are things more likely to go when standing?
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To the right (which explains why right bronchus sits lower and is more flat)
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Where do the lungs sit?
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In the thoracic cavity
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What are two characteristics of the pleural space?
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Nothing in space except for pleural fluid
Pressure is negative compared to outside pressure |
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What will you NOT hear upon auscultation of the lungs on an patient's back and why?
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The right middle lobe because it is located anteriorly
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What is dead air and where does it occupy?
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Dead air is 150mL of inspired air that never reaches alveoli and occupies the trachea and first generation of the bronchi
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What is one thing terminal bronchioles lack and two things they possess?
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lack cartilage (unlike bronchi which do have cartilage)
possess bronchioles and alveoli |
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What do you see in the white spaces of the alveoli and why?
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You see air because it is a negative space
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Is barrier between air and blood thick or thin?
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Thin
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How would you describe the volume of air exchange in the lungs?
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TREMENDOUS
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Name 3 characteristics of Type I pneumocytes:
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-thin and flat
-responsible for air exchange -covers 95% of alveolar surface |
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Name 4 characteristics of Type II pneumocytes:
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-plump and large
-can proliferate to help repair Type I pneumocytes -Can divide and take care of reactive problems -Produce and secrete surfactant |
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What is surfactant?
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lipid substance that decreases surface tension in the alveoli to prevent alveolar collapse
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What is each barrier between blood and air composed of?
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fused membrane, epithelial cell, endothelial cell
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What is atelectasis?
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incomplete expansion or collapse of the lung
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What are the four types of atelectasis?
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obstructive
compressive contraction patchy |
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What happens in obstructive atelectasis and what is it due to?
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complete obstruction of airway causing lung to lose O2 and collapse
due to: tumor, foreign body aspiration, mucous plug secretions in asthma |
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What happens in compressive atelectasis and what is it due to?
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external compression of the lung
due to pleural effusion, pneumothorax (brings air in pleural space to atmospheric pressure and lungs collapse) |
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What is contraction atelectasis due to?
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pleural effusion
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What is does patchy atelectasis lead to a loss of and what is it due to?
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loss of pulmonary surfactant
due to neonatal respiratory distress syndrome |
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What is pneumothorax?
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Air or gas in the pleural cavity causing partial or total collapse of the lung
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What are the three types of pneumothorax?
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traumatic pneumothorax, spontaneous pneumothorax, tension pneumothorax
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What is traumatic pneumothorax due to?
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rib fracture
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What is spontaneous pneumothorax due to?
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rupture of blebs (in pleural space)
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What is tension pneumothorax?
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air accumulates under pressure, lungs will be squashed, structures move (tracheal deviation)
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How would you trea tension pneumothorax?
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stick a needle in the affected site
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What is pulmonary edema?
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fluid accumulation in the lungs
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Where is pulmonary edema worse?
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in the base of the lungs
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Track an example of how pulmonary edema develops
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left sided heart failure leads to increase back pressure and therefore intravascular pressure which leads to fluid entering the interstitium and you lose gas exchange
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Describe 2 characteristics of the gross patholgy of pulmonary edema
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heavy and wet
begins at the base |
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Describe two characteristics of the micrscopic pathology of pulmonary edema
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engorged capillaries
intra-alveolar granular pink precipitate (congested with fluid) |
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What are two causes of pulmonary edema and which is more common?
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increase in hemodynamic pressure (more common) and microvascular injury (less common)
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What are two examples of how hemodynamic pressure can increase and causes pulmonary edema?
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mitral stenosis, left sided heart failure
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What are four examples of how microvascular injury can cause pulmonary edema?
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infections, drugs, inhaled gases, shock
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What is adult respiratory distress syndrome?
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diffuse alveolar capillary damage (DAD) with hypoxia and respiratory failure (loss of gas exchange surface)
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How would adult respiratory distress syndrome show up on an x-ray?
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one would see diffuse bilateral infiltrates on x-ray
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What kind of infections are frequent with adult respiratory distress syndrome?
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superimposed infections
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What is the mortality rate of adult respiratory distress syndrome?
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50-60%
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What are 5 causes of adult respiratory distress syndrome?
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Infections (viral, bacterial), drugs (inhaled gases), oxygen toxicity (oxygen produces free radical changes), shock, burns/surgery
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What are three symptoms of adult respiratory distress syndrome?
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profound dyspnea and tachypnea
cyanosis refractory to O2 therapy |
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What are three components of the pathogenesis of adult respiratory distress syndrome?
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aggregation of activated neutrophils in pulmonary vessels
activation of lung macrophages loss or damage to surfactant and a subsequent inflammatory response |
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What is the gross pathology of adult respiratory distress syndrome?
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diffusely firm, red, boggy, heavy
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What is the microscopic pathology of adult respiratory distress syndrome?
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acute stages: edema, hyaline membranes (fibrin deposits in alveoli), neutrophils
later stages: patchy interstitial fibrosis and type II pneumocyte proliferation |
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What does a clot occur?
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outside of the cardiovascular system
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What is an thrombus and where does it occur?
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clot in the cardiovascular system, can be mural or occlusive
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What is an embolus?
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clot that breaks off and travels to another place
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What is a pulmonary embolus?
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thromboembolus in a pulmonary artery
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What are the 5 types of emboli?
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thromboemboli
mycotic/septic emboli tumor emboli air emboli amniotic fluid emboli |
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What is the origin of most (95%) thromboemboli?
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leg veins (DVT)
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What is a thromboembolus?
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A piece of thrombus that breaks off and gets stuck somwhere else
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What increases your risk for a pulmonary embolus?
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anything that increases your risk for clotting such as venous stasis or being in a hypercoagulable state
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What is venous stasis and what can it be caused by?
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poor blood flow through veins
caused by: blood pooling due to prolonged immobility, bed rest (surgery, pregnancy), long trips or paralysis |
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What are 7 examples of how an individual could be in a hypercoaguable state?
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pregnancy (hormonal environment change), contraceptives, some AI diseases, OCT, some tumors, morbid obesity, smoking
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What are 3 things necessary for normal clotting and what could problems in any one of the 3 cause?
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normal blood flow
endothelial lining of vessels coagulation problems in any one of three result in increased clotting risk/pulmonary embolism risk |
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What is mycotic/septic emboli?
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infected piece of thrombus that gets stuck in kidneys
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What is an air emboli?
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bubble that can plug up circulation
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What is an amniotic fluid emboli?
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at birth, a big bolus of amniotic fluid finds its way into maternal circulation and results in emboli
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Where do venous thrombi usually end up?
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lungs/pulmonary circulation (as pulmonary embolus)
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Will left side vegetation end up in lungs?
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No
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Where do arterial thrombi usually end up?
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systemic circulation (as septic emboli)
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What do paradoxical emboli require?
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anatomic abnormalities
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What do emboli take the shape of?
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Where they came from (NOT where they end up)
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What's the percentage of small emboli and what are the clinical consequences?
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60-80% of emboli
clinically silent/minor symptoms transient chest pain hemoptysis secondary to pulmonary hemmorhage can result in small pulmonary infarcts |
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What's the percentage of medium emboli and what are the clinical consequences?
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20-30% of emboli
can result in larger pulmonary infarcts leads to less available gas exchange has clinical significance! |
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What is the percentage of large emboli and what are the clinical consequences?
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5% of emboli
saddle embolus lodge in the bifurcation of the main pulmonary artery can cause sudden death classic example of acute cor pulmonale |
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What are 4 general characteristics of pulmonary infarction?
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caused by occlusion of pulmonary artery
wedge shaped region firm, dark, red, bloody, necrotic classically hemmorhagic lesion - turns brown over time |
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What are two histologic characteristics of pulmonary infarction?
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ischemic necrosis of lung tissue
intra-alveolar hemorrhage |
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What is pulmonary hypertension?
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elevated pulmonary arterial pressure caused by increase in pulmonary vascular resistance
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What are four causes of pulmonary hypertension?
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primary-idiopathic, left heart failure, COPD or interstitial lung disease, recurrent pulmonary emboli
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Where is primary-idiopathic cause of pulmonary hypertension seen most often and is it common?
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In children and women 30-40 years old
not a common cause |
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What happens in COPD or interstitial lung disease to cause pulmonary hypertension?
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damage to vessels --> vessels get thicker/tighter --> pulmonary hypertension
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How do pulmonary emboli cause pulmonary hypertension?
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lead to increase in vascular resistance which leads to pulmonary hypertension
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What are consequences of pulmonary hypertension?
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respiratory distress
right heart hypertrophy/dilation/failure (cor pulmonale) |
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Where does pulmonary arterial atherosclerosis occur and what does it result in?
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occurs in systemic circulation, results in atherosclerotic plaques in venous circulation and increase in pressure
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What will vessels look like as a result of pulmonary hypertension?
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will see tons of tunica media, very small lumen, vessels become thicker and stenotic
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What are the 3 types of COPD?
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emphysema
chronic bronchitis bronchiectasis |
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What are the 5 types of pulmonary vascular disease?
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Pulmonary Edema
Adult Respiratory Distress Syndrome Pulmonary Embolism Pulmonary Infarction Pulmonary Hypertension |
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What is emphysema and what does it result in?
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abnormal enlargement of air spaces distal to terminal bronchioles with destruction of their walls, results in big dilated alveoli
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What is the protease-antiprotease hypothesis?
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-destruction of alveolar walls caused by imbalance between proteases (proteolytic enzymes) and protease inhibitors in the lung
-alpha-1-anti-trypsin is a major protease inhibitor. some people have a hereditary deficiency and can develop emphysema as a result (even as a young child) |
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In an experiment, if you add protease to the lungs, what happens?
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you will see emphysema development
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How does smoking relate to emphysema
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smoking recruits neutrophils to small bronchiole, inactivates alpha-1-anti-trypsin, stimulates elastase release, leads to emphysema
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What are the 6 types of emphysema?
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centriacinar emphysema
panacinar emphysema paraseptal emphysema irregular emphysema bullous emphysema interstitial emphysema |
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What are two characteristics of bullous emphysema?
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blebs (small) or bullae (bigger) are greater than 1 cm
can spontaneously rupture and cause a pneumothorax |
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What happens in interstitial emphysema?
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air into connective tissue of lung, mediastinum or subcutaneous tissue
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What are two characteristics of centriacinar emphysema?
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affects central/proximal parts of respiratory unit
most common in smokers |
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What are two characteristics of paracinar emphysema?
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affects proximal and distal respiratory unit
alpha-1-antitrypsin deficiency |
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What are two characteristics of paraseptal emphysema?
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near pleura
leads to spontaneous pneumothorax |
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What are three characteristics of irregular emphysema?
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irregular involvement of respiratory unit
scarring asymptomatic |
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Are types of emphysema usually clinically distinguishable or indistinguishable?
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usually indistinguishable
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Regardless of the type of emphysema, what is the ultimate consequence?
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alveolar tissue is destroyed, gas exchange surface decreases
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What can both centrilobar and panacinar emphysema cause?
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clinically significant air flow obstruction
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What are the different variants of emphysema likely due to?
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initiating event
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What is the gross pathology of emphysema?
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spongy look, great big holes
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What is the histopathology of emphysema?
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less alveolar wall
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What is chronic bronchitis typically seen with and what do they both present with?
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typically seen with emphysema, both present with shortness of breath (and their own symptoms)
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What the clinical manifestation of chronic bronchitis?
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persistent cough with sputum production for at least 3 months in at least 2 consecutive years
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What does chronic irritation/inflammation of airways lead to in chronic bronchitis?
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excessive mucus production
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What is the most common cause of chronic bronchitis?
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smoking
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What is the gross pathology of chronic bronchitis?
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mucosal hyperemia and edema
mucinous secretions or cases filling airways |
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What is the microscopic pathology of chronic bronchitis?
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mucous plugging, inflammation and fibrosis
squamous metaplasia of epithelium (changes from pseudostratified to stratified squamous non-keratinizing) mucous gland enlargement |
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What is bronchiectasis?
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chronic, necrotizing infection of bronchi and bronchioles associated with abnormal permanent airway dilation
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What is one way bronchiectasis differs from chronic bronchitis?
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chronic bronchitis does not have permanent airway dilation
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What are 3 clinical features of bronchiectasis?
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cough
purulent (foul smelling) sputum fever |
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What are 4 things that bronchiectasis is associated with?
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obstruction by tumor or foreign body
cystic fibrosis immotile cilia pathologic changes |
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What are 3 pathologic changes that are associated with bronchiectasis?
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dilation of distal airways mostly in lower lobes
necrotizing acute and chronic inflammation fibrosis |
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What are the 6 types of pulmonary disease?
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Pulmonary Vascular diseases
Chronic Obstructive Pulmonary Disease (COPD) Asthma Pulmonary Infections Tumors Interstitial Lung Disease |
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What is bronchial asthma (aka reactive airway disease)?
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disorder of increased responsiveness of the tracheobronchial tree to various stimuli, resulting in paroxysmal contraction of bronchial airways
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What are 3 common features of bronchial asthma?
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suddent onset
SOB wheezing |
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What are the two types of bronchial asthma?
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extrinsic (allergic bronchial asthma)
intrinsic (idiopathic) |
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What are 3 characteristics of extrinsic bronchial asthma?
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-allergic is most common type
-environmental antigens: dust, pollen, food -type I IgE immune mediated hypersensitivity reaction -eosinophils are recruited and dump granules here...you will see edema and mucus production, and reflex bronchial smooth muscle contraction |
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What are 3 characteristics of intrinsic bronchial asthma?
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-no IgE mediated hypersensitivity
-primary cause of airway reactivity is uknown -triggered by respiratory tract infections, chemicals or drugs |
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What is the gross pathology of bronchial asthma?
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overinflated lungs, patchy atelectasis, occlusion of airways by mucous plugs
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What is microscopic pathology of bronchial asthma?
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edema
inflammatory infiltrate of bronchial walls with numerous eosinophils hypertrophy or bronchial wall muscle whorled mucous plugs=Curshmann's spirals crystalloid debris of eosinophils membranes=Charcot-Leyden crystals |
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What are 2 protective barriers of respiratory system?
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mechanical
immunological (IgA, IgG, IgM etc). |
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What are 5 examples of the mechanical protective barrier of the respiratory system?
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sneezing or blowing, nasal hairs, mucus (trap), ciliated cells sweep to throat (spit/swallow), alveolar macrophages
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What are 5 ways defense mechanisms can be impaired?
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loss of cough
accumulation of secretions edema injury to cilia (loss of mucociliary escalator motion) decrease macrophage function |
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What are the 4 types of pulmonary infections?
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Bacterial pneumonia
Atypical pneumonia Tuberculosis Pneumonia in immunocompromised host |
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What are the two kinds of bacterial pneumonia?
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bronchopneumonia, lobarpneumonia
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What is bronchopneumonia and what is it caused by?
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bacterial infection with patchy consolidation of lung parenchyma
GPC: staphylococci, streptococci, pneumococci GNR: haemophilus influenza, pseudomonas aeruginosa |
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What is the gross pathology of bronchopneumonia?
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patchy areas of consolidation and suppuration, firm
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What is the microscopic pathology of bronchopneumonia and lobarpneumonia?
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neutrophils (and pus) filling airspaces and airways
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What are 4 complications of bronchopneumonia and lobarpneumonia?
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scarring, abscess formation, empyema (inflammation/accumulation of pus in the pleural space spilling out from the lungs)
bacteremia and sepsis (bloodborne infection) |
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What is lobarpneumonia?
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bacterial infection involving entire single anatomic lobe of the lung
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What is lobarpneumonia caused by?
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streptococcus pneumonia
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What is the gross pathology of lobarpneumonia?
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consolidation of single lobe
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What is the clinical course for bacterial pneumonia?
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abrupt onset
malaise, fever, chills, productive cough with sputum treat with ab <10% mortality airways are filled with bacteria and inflammatory cells |
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What is atypical pneumonia (aka walking pneumonia)?
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patchy or lobar congestion without consolidation (no alveolar exudate)
inflammation remains confined to interstitium walls, airways are fine |
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What are the 3 bacterial causes of atypical pneumonia?
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myoplasma pneumoniae, legionella pneumonophila, chlamydia pneumoniae
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What are the 6 viral causes of atypical pneumonia?
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influenza A and B, respiratory synctial virus (RSV), adenovirus, rhinovirus, herpes simplex, cytomegalovirus
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What is the microscopic pathology of atypical pneumonia?
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interstitial pneumonitis, lymphocytic (interstitium contains inflammatory cells), hyaline membranes, certain viruses have characteristic inclusion bodies
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What is the clinical course of atypical pneumonia?
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slower onset
low grade fever, headache, muscle ache |
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What contributes to atypical pneumonia?
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upper respiratory infection
more severe low respiratory infection |
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What is the mortality rate for the ordinary sporadic form of atypical pneumonia?
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<1%
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When happens when atypical pneumonia combined with superimposed bacterial infection?
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highly fatal
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What is tuberculosis and what are the two types?
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chronic infectious disease caused by mycobacterium tuberculosis
primary pulmonary tuberculosis secondary/cavitary pulmonary tuberculosis |
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How is tuberculosis transmitted?
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inhalation of infected droplets (person to person)
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What is the pathogenesis of tuberculosis?
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M. tuberculosis is an acid-fast organism and has a cell wall that interferes with phagolysosomal fusion
once exposed, delayed hypersensitivity reaction develops in 2-3 weeks (=positive PPD) classic inflammatory response=granulomatous with central caseous necrosis |
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What happens in primary pulmonary TB?
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no previous contact with organism
breathe it in and develop an acute response (lung lesion results near interlobar fissure=Ghon complex) most cases do not progress...scarring and calcification occurs...asymptomatic |
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If primary TB does progress, what happens?
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progressive pulmonary spread with cavitation (cavity formation) and organism may get blood borne and go somewhere else (miliary TB)
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What is a Ghon Complex?
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Single granulomatous lesion near interlobar fissure
enlarged caseous hilar lymph node draining the lesion |
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What is secondary/cavitary TB?
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active infection in a previously sensitized individual
may progress the same as primary TB large cavities form (cavitary) - involved in communication out of body so these pts need to wear masks or be isolated |
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What doe secondary/cavitary TB usually involve and why?
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apices of lungs b/c that's where most O2 is found and TB is aerobic
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What are the clinical features of secondary/cavitary TB?
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pts are chronically sick
insidious fever nigh sweats weight loss cough bright red blood streaked sputum |
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What are 5 causes of pneumonia in immunocompromised host?
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pneumocystis carinii (in sputum you will see silvery-black organisms)
CMV (cytomegalovirus, cells become enlarged with a large red inclusion) Aspergillus (inhaled fungus, long stringy hyphae in the lung), candida, bacterial pneumonia |
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What are the clinical features of lung tumors?
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seen later in life (60s)
present with cough, weight loss, chest pain, dyspnea (at this point, tumor is well advanced) 5 year survival: 9% Survival with successful resections: 30-40% |
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What are 4 features of primary (bronchogenic) carcinoma?
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tumors arise in bronchial epithelium
90-95% of primary lung tumors most common cause of cancer death in both women and men can cause atelctasis due to obstruction |
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What are 4 causes of primary (bronchogenic) carcinoma?
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smoking, asbestos exposure, radiation exposure, radon exposure
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What are the two histologic types of pulmonary tumors?
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small cell carcinoma, non-small cell carcinoma
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What are 6 characteristics of small cell carcinoma?
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20-25% of cases
central lesion well-linked to smoking most aggressive! (metastasize) treatment: chemo small, round oval cells, deeply basophilic |
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What are the five types of non-small cell carcinoma?
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squamous cell carcinoma, adenocarcinoma, large cell carcinoma, metastatic carcinoma, mesothelioma
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What are 6 features of squamous cell carcinoma?
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25-40% of cases
located in central region of lung central lesion (closer to hilum of lung) well-linked to smoking used to be more common in men (not anymore) squamous cells with or without keratinization |
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What are 6 features of adenocarcinoma?
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24-40% of cases
peripheral lesion (closer to pleura) linked to both smoking and not smoking more common in women and nonsmokers gland formation and mucin secretion subtype: bronchioalveolar carcinoma (lines alveoli...tumors palisade along alveolar septae) |
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What are 3 features of large cell carcinoma?
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10-15%
undifferentiated squamous and adenocarcinomas occasionally have giant cell patterns |
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How does metastatic carcinoma present?
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many lesions throughout the lung
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What are two features of mesothelioma?
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not bronchogenic, tumor surrounds lung, usually through exposure to asbestos
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What are 6 features of carcinoid tumor?
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1-5% of all lung tumors
no relationship to smoking neuroendocrine differentiation (neurosecretory granules) - come from Kulchitsky cell 90-95% curable by resection asymptomatic unless it causes obstruction nests, cords, masses of round uniform cells |
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What is the most common site for metastasis?
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the lung
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What is an example of a tumor of pleura?
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malignant mesothelioma
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What are 6 features of malignant mesothelioma?
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tumor of mesothelial cells
tumor spreads of lung surface asbestos exposure (90% of cases) highly malignant may involve peritoneal cavity few patients survive longer than 2 years |
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What are four features of interstitial lung disease?
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Diffuse and chronic involvement of pulmonary connective tissue
restrictive rather than obstructive dense infiltrates on chest radiographs begins as alveolitis, cause varied, often some pollutant |
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What does interstitial lung disease result in?
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diffusely scarred and fibrotic lungs
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The development and severity of interstitial lung disease is based on what 6 things?
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Amount of dust retained
Size, shape and buoyancy of particles Particle solubility Physiochemical reactivity Concurrent lung irritants (cigarettes) |
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Coal dust is associated with what disease/exposure?
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Coal mining
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SilicaAgen is associated with what disease/exposure?
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Sandblasting, stone work
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Iron oxide is associated with what disease/exposure?
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Welding
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Moldy hay is associated with what disease/exposure?
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farmer's lung
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Bird droppings are associated with what disease/exposure?
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bird-breeder's lung
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Cotton, flax and hemp are associated with what disease/exposure?
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textile manufacturing
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Nitrous oxide and benzene are associated with what disease/exposure?
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occupational exposure
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Inflammation leads to fibrosis and eventually to non-compliant lungs...is this an example of restrictive or obstructive illness?
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restrictive!
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