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77 Cards in this Set
- Front
- Back
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Pneumoconiosis
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lung disease cause by inhalation of dust or aerosols
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Is cigarette smoking an important health issue?
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Um, duh. It is the single most revalent cause of death in our society and the most important public health issue of our time.
Causes 300,000 deaths annually |
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Bulla
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big space caused by destruction of walls of alveoli; occurs, for example, in emphysema which causes destruction of alveoli walls
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What is the most common type of lung tumor produced by cigarette smoking?
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squamous cell carcinoma
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Can cigarette smoking cause adenocarcinomas?
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Yes.
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T/F Smoking more than 1 pack of cigarettes per day can increase the mortality from lung cancer by ten times.
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True
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T/F Smoking one pack of cigarettes per day does not affect the risk for chronic heart disease.
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False. It doubles the risk.
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T/F If mother smokes during pregnancy, it can cause increased fetal growth.
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False. Causes reduced fetal growth.
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What is passive smoking? Is it harmful?
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Second-hand smokers inhale the equivalent of 3 actively smoked cigarettes per day. Can increase the risk of lung cancer 1.5 fold. Increases respiratory illness in children under two whose mothers smoke.
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What are the two main carcinogens in cigarette smoke?
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Nitrosamines
Polycyclic aromatic hydrocarbons |
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What are the two main cell irritants contained in cigarette smoke?
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Nicotine
Carbon monoxide |
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What are the basic effects of nicotine and CO in the body?
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Increase in catecholamines and rise in heart rate.
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T/F Quitting smoking reduces the risk of MI after 1-2 years.
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True.
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T/F Mortality rate from COPD falls immediately after quitting smoking.
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False. Falls only after long delay.
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How many years does it take the risk from bronchiogenic carcinoma to approach normal levels after quitting smoking?
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14
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Development of pneumoconiosis depends on (4):
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1. Amount of dust retained in lung.
2. Size and shape of particle - most dangerous in range of 1-5 microns. Buoyancy is important. 3. Solubility and physiochemical reactivity. 4. Presence of other irritants. |
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What is the last stage of pneumoconiosis?
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Fibrosis
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T/F Anthracosis is asymptomatic and is found to at least some extent in all urban dwellers due to air pollution.
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True.
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What does complicated CWP cause?
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Extensive fibrosis with compromised lung functions.
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T/F Respiratory function is normal in simple coal worker's pneumoconiosis.
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True. There will be a slight cough, and blackish sputum, but respiratory function should be normal.
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Is lung parenchyma affected in simple CWP?
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No. This is the reason for the normal respiratory function.
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What do we see in the histology of CWP?
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Coal laden macrophages near respiratory bronchioles and alveolar ducts. Or, in more severe cases, a delicate network of reticulin and collagen fibers between the macules. Centrilobular emphysema (air gets trapped).
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What is "honeycomb" lung?
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Appearance of small holes surrounded by fibrosis. Looks like an end-stage lung disease. Can be result of complicated CWP.
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What causes the scarring seen in CWP?
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Coal dust enters lung and is taken up by macrophage. The activated macrophage releases cytokines and lysosomal enzymes. The lysosomal enzymes cause tissue damage, which needs to be repaired. This repair leads to scarring. The cytokines release FGFs (eg IL-1), which also leads to scarring.
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What is cor pulmonale?
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A change in structure and function of the right ventricle as a result of a respiratory disorder. Right ventricular hypertrophy is the predominant change in chronic cor pulmonale.
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Histology of complicated CWP?
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Scars: dense collagen with carbon pigment.
Thickening of the bronchiolar and alveoli walls and obliteration of the lumen. |
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What is Caplan's Syndrome?
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A combination of rheumatoid arthritis and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous and well-defined on chest X-ray.
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T/F Caplan's Syndrome only occurs in CWP, and not in silicosis or asbestosis.
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False. It can occur in all three.
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What is seen in an xray of a lung with simple CWP?
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diffuse nodularity - white dots
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T/F Rheumatoid arthritis can be caused by high levels of inflammatory agents in lungs.
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True.
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Does CWP cause increased risk for lung cancer?
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No. It is actually not carcinogenic.
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T/F Complicated CWP can cause an increased incidence of stomach cancer.
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True.
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Does silicosis cause a predisposition to any cancer?
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No.
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What is the difference in inflammatory reaction between silicosis and CWP?
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In silicosis, there is more of an adaptive immune response, so we see increased levels of b and t cells.
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What causes collagenous nodules?
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Chronic Silicosis
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T/F We will see honeycombing in chronic silicosis.
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True.
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If we see a lymph node with black in it, we know it must come from where?
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Area around lungs. Caused by air pollution.
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T/F With polariscope, we can see birefringent (bright spots) in histology of silicosis.
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True.
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T/F Air captured in alveoli with tearing of walls around it will lead to emphysema.
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True.
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Lung "snowstorm" appearance and lymph node "egg shell" calcifications occur in which disease?
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Silicosis.
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What are the possible complications of chronic silicosis (6)?
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1. Caplan's syndrome
2. Chronic bronchitis 3. Emphysema 4. Cor pulmonale 5. Autoimmune diseases 6. TB |
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What is the most harmful of the asbestos fibers?
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Amphiboles are straight and stiff, brittle fibers. The most carcinogenic of the amphiboles are the crocidolites.
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T/F Hemosiderin is collected on asbestos bodies.
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True.
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What are the possible complications of asbestos poisoning (4)?
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1. Emphysema
2. Secondary bronchiectasis 3. Caplan's syndrome 4. Pulmonary hypertension/ cor pulmonale |
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T/F Pleural reactions may appear in family members of those exposed, without having direct exposure themselves.
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True.
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T/F Pleural reactions never occur without evidence of asbestos.
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False.
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_____pleura is seen in asbestosis.
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Fibrotic
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Which type of cancer presents almost exclusively in people with asbestosis?
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Mesothelioma
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By histology, mesothelioma can look like adenocarcinoma. So, how can we differentiate?
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Antibodies
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T/F Asbestosis can be asymptomatic for many years.
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True.
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What is berelliosis?
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Inhalation of airborne dust or fumes of metallic beryllium, oxides, or salts. Heavy exposure causes acute pneumonitis. Low-dose exposure causes chronic pulmonary and systemic granulomatous lesions.
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Does berelliosis cause an increased risk of lung cancer?
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Yes.
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What are the clinical manifestations of berelliosis?
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Occurs many years after exposure. Dyspnea, cough, weight loss, arthralgia, nodular densities in xray.
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T/F When we find granulomatous disease, we need to consider berelliosis.
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True.
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Give four examples of radiation from human sources.
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1. Medical - diagnostic & therapeutic
2. Industry 3. Nuclear weapons 4. Power plants |
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Radiation occurs in two ways:
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1. Electromagnetic waves - x-ray and gamma rays.
2. Energetic charged particles - electrons, protons, neutrons, heavy ions. |
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The biologic effect of radiation on cells is largely by _____.
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ionization
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How does ionizing radiation transfer to biologic effects?
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1. Target theory - direct hit on target molecules within the cells --> DNA, leading to mutations.
2. Indirect theory - gamma and x-rays - free "hot" radicals within the cells |
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Which cells are more sensitive to radiation?
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Those that are more proliferative. The more differentiated the cell is, the less sensitive it is to radiation. More undifferentiated tumors will be treated by radiation because they are more sensitive.
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How does oxygen affect radiosensitivity?
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Tissues that are more oxygenated have more free radicals and are thus more radiosensitive. So, a poorly vascularized tumor will be less radiosensitive.
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Is the phase of the cell cycle important for radiosensitivity?
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Yes. G2 (pre-mitotic) and M (mitosis) are more vulnerable. Cells are less vulnerable in S and G1 (post mitotic).
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What do we see in the morphology of a cell damaged by radiation (6)?
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1. nuclear swelling
2. nuclear membrane breaks 3. condensation and clumping of chromatin 4. giant cells 5. pleomorphic nucleus 6. more than one nucleus |
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What effects of radiation can we see on the skin (5)?
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1. ulceration due to desquamation
2. telangiectasis - small blood vessel dilation 3. hypo/hyper-pigmentation 4. erythema 5. edema |
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Late effects of radiation:
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Squamous cell carcinoma
Basal cell carcinoma Melanoma |
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T/F Lymphopenia can be seen within hours after exposure to radiation.
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True.
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What happens to granulocyte levels after exposure to radiation?
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High levels at first, and decrease by end of fist week. After two weeks, they drop to zero, and by third week they are in recovery.
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Can anemia occur from radiation?
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Yes. It can occur in time from damage to bone marrow, but not immediately. Erythrocytes themselves are radio resistant.
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Are germ cells radiosensitive?
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Yuppers.
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T/F Uterus and cervix are radioresistant.
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True. But overies are radiosensitive.
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Why are the lungs radiosensitive?
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rich vasculature
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What do we see in the lungs in the acute phase after radiation exposure (5)?
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Endothelial cell changes
1. Congestion 2. Edema 3. Fibrin exudates 4. Adult respiratory distress syndrome 5. Hyaline membrane disorder |
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What do we see in the lungs in the late phase (3)?
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1. Fibrosis of alveolar walls
2. Thickening of vascular walls 3. Alveoli-capillary block |
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What parts of GI tract or radiosensitive? Resistant?
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Esophagus and rectum are resistant
Small intestine and stomach are radio sensitive |
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T/F Brain is high sensitive to radiation.
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False! It's actually resistant. Although, it can suffer damage if dose is high.
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T/F Exposure of large areas of the body even with small doses of radiation may cause damage.
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True.
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What are the three kinds of acute damage from irradiation?
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1. hematopoietic
2. GIT 3. CNS |
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T/F Acute damage is very common today in radiation used for cancer therapy.
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False. They used to be much more common, but machines are getting better. Now the radiation is very focused and specific.
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