Pathology - S2B1 - 1 Lungs 1 And 2

Front 1

Intra-alveolar accumulation of fluid

Back 1

Pulmonary edema

Front 2

2 general causes of Pulmonary Edema

Back 2

1. Hemodynamic derangements
-congestive heart failure
-decreased plasma oncotic pressure

2. Increased capillary permeability due to direct microvascular injury

Front 3

Most common cause of Pulmonary Edema

Back 3

Left-sided heart failure

Front 4

How much can Lymphatic drainage increase before appreciable pulmonary edema occurs?

Back 4

10-fold

Front 5

Type of edema associated with alteration in Starling's pressure
-Congestive Heart Failure

Back 5

Transudate = low protein content

Front 6

Type of edema associated with microvascular or alveolar damage?

Back 6

Exudate

Front 7

Edema with low protein content and low specific gravity

Back 7

Transudate

Front 8

What are 4 possible causes of increased Hydrostatic pressure resulting in Hemodynamic edema?

Back 8

1. Left heart failure
2. Mitral Stenosis
3. Volume overload
4. Pulmonary Vein obstruction

Front 9

What are 3 diseases that would result in Hypoalbuminemia and therefore Pulmonary Edema

Back 9

1. Nephrotic syndrome = losing protein in the urine

2. Liver disease/cirrhosis = not producing albumin

3. Protein-losing enteropathy = albumin is lost via the gut

Front 10

How could Lymphatics be involved in Pulmonary Edema?

Back 10

Lymphatic obstruction such as Metastatic Cancer could prevent fluid from being drained off

Front 11

Auscultation sound heard with Pulmonary Edema?

Treatment for Pulmonary Edema?

Back 11

Wet rales

Diuretic (Lasix = Furosemide)

Front 12

"Diffuse Alveolar Damage" is the same thing as...

Back 12

Acute Respiratory Distress Syndrome

Front 13

Increase in Alveolar capillary permeability causing leakage of protein-rich fluid into alveoli

Back 13

Acute Respiratory Distress Syndrome

Front 14

Drug that is used to treat testicular cancer that can cause ARDS

Back 14

Bleomycin

Front 15

Drug used to treat fungal infections that can cause ARDS

Back 15

Amphotericin B

Front 16

Drug used to treat Gout that can cause ARDS

Back 16

Colchicine

Front 17

What is the best way to treat ARDS?

Back 17

remove the inciting cause

Front 18

2 causes of Edema of Undetermined Origin

Back 18

High Altitude Pulmonary Edema

Neurogenic edema -> severe brain trauma

Front 19

Most common cause of ARDS

Back 19

sepsis

Front 20

Pathognomonic feature of ARDS (5)

Back 20

Hyaline Membranes

Front 21

Clinical findings of ARDS

Back 21

1. accelerated onset of respiratory insufficiency
2. progressive infiltrates on CXR
-CXR is normal initially
-progresses to diffuse bilateral infiltrates
3. Tachycardia
4. Cyanosis
5. Severe Arterial Hypoxemia which is refractory (unresponsive) to oxygen therapy

Front 22

Cells that line the alveoli

Back 22

Type I pneumocytes

Front 23

Cells that secrete Surfactant

Back 23

Type II Pneumocytes

Front 24

Loss of lung volume due to inadequate expansion of the airspaces = lung collapse

Back 24

Atelectasis

Front 25

When does Surfactant synthesis begin?

Back 25

at or after 28th week of gestation

Front 26

Major component of surfactant

Back 26

Phosphatidylcholine (lecithin)

Front 27

What is Surfactant stored in in Type II Pneumocytes

Back 27

Lamellar bodies

Front 28

Surfactant synthesis is increased by these 2 things

Back 28

Cortisol (Glucocorticoids)

Thyroxine

Front 29

What causes decreased synthesis of Surfactant?

Back 29

Insulin

Front 30

What are 3 possible causes of decreased surfactant in fetal lungs?

Back 30

1. Prematurity

2. Maternal diabetes = fetal hyperglycemia increases insulin release = insulin decreases surfactant synthesis

3. C-section = lack of stress-induced increase in Cortisol from a vaginal delivery = Cortisol increases Surfactant synthesis

Front 31

At what week is surfactant made most abundantly during gestation?

Back 31

35th week

Front 32

What are 4 complications of Hyaline Membrane Disease of the Newborn?

Back 32

1. Pulmonary Interstitial Edema

2. Pneumothorax = accumulation of gas/air in pleural cavity

3. Retrolental Fibroplasia = abnormal replacement of the sensory retian by fibrous tissue and blood vessels, mostly due to high-O2 treatment

4. Ventricular Brain Hemorrhage

Front 33

Parts of the Respiratory passages that Obstructive Lung Diseases can affect

Back 33

From the Trachea to the Respiratory Bronchioles

Front 34

3 Pulmonary Functional Tests decreased in COPD

Back 34

1. FEV1 = amount of air expelled from the lungs in 1 second after a maximal inspiration

2. FEV1/FVC = 4L / 5L in a normal person

3. Arterial pressure of O2 (PaO2)

*FVC is usually normal or slightly increased in COPD
**FVC = total amount of air expelled after a maximal inspiration (normal is 5L)

Front 35

What 2 Pulmonary Functional Tests are increased in Restrictive Lung Disease

Back 35

1. FEV1/FVC

2. A-a gradient = increase in the difference in O2 in the Alveoli compared to the Arteries = hypoxemia of pulmonary origin

Front 36

Prognosis of Neonatal Respiratory Distress Syndrome

Back 36

30-50% fatality rate

Front 37

Prognosis for Acute Respiratory Distress Syndrome

Back 37

60% fatality rate

Front 38

Enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls

Back 38

Emphysema

Front 39

Increase in resistance to air flow out of the lungs, resulting in air trapped in the lungs

Back 39

Obstructive Lung Disease

Front 40

What is the major cause of Emphysema?

Back 40

Smoking

*alpha1-antitrypsin is another cause

Front 41

Parts of the Respiratory passages that Obstructive Lung Diseases can affect

Back 41

From the Trachea to the Respiratory Bronchioles

Front 42

What is the most common type of Emphysema?

Back 42

Centriacinar (Centrilobular)

Front 43

What are 4 examples of Obstructive Lung Diseases

Back 43

1. Asthma
2. Chronic Bronchitis
3. Emphysema
4. Bronchiectasis

*BABE*

Front 44

Type of Emphysema caused by Smoking?

Back 44

Centriacinar

Front 45

Type of Emphysema caused by Alpha-1-antitrypsin deficiency

Back 45

Panacinar

Front 46

What is Restrictive Lung Disease?

Back 46

reduced expansion of the lung parenchyma and decreased total lung capacity

Front 47

What is the most common type of Emphysema?

Back 47

Centriacinar (Centrilobular)

Front 48

Part of the acini that Centriacinar emphysema affects

Back 48

central part, sparing the distal alveoli

Respiratory bronchioles are dilated

Front 49

Type of Emphysema with anthracotic pigment

Back 49

Centriacinar

Front 50

Type of Emphysema that primarily involves the apical segments of the upper lobe

Back 50

Centriacinar

Front 51

Gender that Centriacinar emphysema is most common in

Back 51

Male

Front 52

Type of Emphysema in which entire acinus is dilated

Back 52

Panacinar

Front 53

Emphysema associated with large subpleural bullae

Back 53

Paraseptal

Front 54

Emphysema associated with risk for spontaneous pneumothorax

Back 54

Paraseptal

Front 55

Emphysema that affects primarily the lower lobes

Back 55

Panacinar

Front 56

Emphysema with scarring (fibrosis) of the acinus within the walls of enlarged air spaces usually a complication of various inflammatory processes

Back 56

Irregular emphysema

Front 57

Enzyme that is at heightened activity in Emphysema

Back 57

Neutrophil Elastase

Front 58

Where is Alpha-1-antitrypsin synthesized?

What genotype interferes with AAT secretion?

Back 58

Liver

piZZ homozygous state
*pi = proteinase inhibitor

Front 59

Decent of people who primarily have AAT deficiency emphysema

Back 59

Northern European decent

Front 60

Explain the age differences in AAT deficiency emphysema and Smoking emphysema

Back 60

AAT = patients are classically around 25 yoa

Smoking = classically around 40 yoa

Front 61

Give 2 reasons why smoking causes emphysema

Back 61

1. attracts neutrophils and macrophage = sources of Elastase

2. inactivates AAT = usually neutralize Elastase

Front 62

How is diagnosis of AAT deficiency made?

Back 62

DNA-based cheek swab test

Front 63

Restrictive Lung Disease:
- increase or decrease in compliance?

- increase or decrease in elasticity?

Back 63

decrease = difficult to take air in

increase = easy to push air out

Front 64

chronic necrotizing infection of bronchi and bronchioles, resulting in abnormal dilation

Back 64

Bronchiectasis

Front 65

4 diseases that Bronchiectasis is associated with

Back 65

1. Bronchial obstruction
2. Cystic Fibrosis
3. Poor ciliary motility
4. Kartagener's syndrome

Front 66

Disease with sinusitis, bronchiectasis, and situs inversus, sometimes with hearing loss and male sterility

*ultimate cause is due to a defect in the motility of respiratory, auditory, and sperm cilia = absent DYNEIN arm in cilia

Back 66

Kartagener syndrome

Front 67

Most common cause of Bronchiectasis in US?

Worldwide?

Back 67

Cystic Fibrosis (P. aeruginosa)

Tuberculosis

Front 68

Bronchiectasis most commonly occurs in which lobes of the lungs?

Back 68

Lower lobes

Front 69

3 clinical findings with Bronchiectasis

Back 69

1. Purulent sputum
2. Recurrent infections
3. Hemoptysis

Front 70

At least 3 months of productive sputum for 2 or more consecutive years

Back 70

Chronic Bronchitis

Front 71

Hypertrophy of mucus-secreting glands in the bronchioles

Back 71

Chronic Bronchitis

Front 72

What is the Reid index?

Back 72

= gland depth / total thickness of bronchial wall

-used in measuring Chronic Bronchitis

Front 73

What is the Reid index greater than in Chronic Bronchitis?

Back 73

>50%

Front 74

Type of metaplasia in Chronic Bronchitis

Back 74

Squamous metaplasia

*loss of ciliated epithelia

Front 75

Describe Asthma

Back 75

Bronchial hyperresponsiveness causes reversible bronchoconstriction resulting in trapping of air in the lungs

Front 76

List 3 general causes of Asthma

Back 76

1. Extrinsic = allergens = Type I HS = IgE mediated
2. Intrinsic = viral URI's
3. Aspirin sensitive = clinical triad = nonsteroidal drugs, asthma, nasal polyps

Front 77

Mucus plugs containing denuded epithelium found in asthma

Back 77

Curschmann spirals

Front 78

Collection of crystalloid composed of eosinophil membrane protein in asthma patients

Back 78

Charcot-leyden crystals

Front 79

Type of hyperplasia found in Asthma

Back 79

Goblet cell hyperplasia

Front 80

COPD with Eosinophils

Back 80

Asthma

Front 81

Adult Respiratory Distress Syndrome
- Hyaline membranes
- Bilateral infiltrates

Back 81

A 60 year old man presented with Dyspnea, tachypnea, and cyanosis.

What is the diagnosis?

Front 82

What is the therapy for Hyaline Membrane Disease of the Newborn?

Back 82

- remove the initial insult

- Ventilator -> Positive end-expiratory Pressure

Front 83

What are 4 examples of Chronic Obstructive Lung Disease?

Back 83

1. Asthma
2. Chronic bronchitis
3. Emphysema
4. Bronchiectasis

Front 84

Pink Puffer = slowing of forced expiration through pursed lips

What disease?

Back 84

Emphysema

Front 85

What is the mechanism of obstruction in Emphysema?

Back 85

Loss of elastic recoil of the acini = air gets trapped in the acini

Front 86

What is the cause of Chronic Bronchitis in 90% of cases?

Back 86

Smoking

Front 87

Disease that affected are referred to as "Blue Bloaters"

Back 87

Chronic Bronchitis

Front 88

-Hypertrophy of Bronchial Smooth muscle
-Hyperplasia of bronchial submucosal glands
-Mucous plugs

Back 88

Asthma

Front 89

Asthma
-Bronchial cartilage at right
-Mucus plug at left
-Submucosa widened by Smooth Muscle Hypertrophy

Back 89

What lung pathology?

Explain what you see

Front 90

Hyperreactive airways, resulting in episodic bronchospasm when triggered by certain stimuli

Back 90

Asthma

Front 91

List some causes of Intrinsic Asthma

Back 91

1. Respiratory infections
2. Stress
3. Exercise
4. Cold
5. Aspirin -> Asthma, Nasal Polyps, Chronic pain syndrome

Front 92

Asthma b/c there are Eosinophils present

Back 92

What COPD would this be? Why?

Front 93

Bronchiectasis = permanent dilation of bronchi and bronchioles

Back 93

What COPD is this?

Front 94

Asthma

Back 94

What is this picture showing?

Front 95

Bronchiectasis
- dilated bronchi and bronchioles
- P. aeruginosa with

Back 95

What do these indicate?

Front 96

Bronchiectasis
- Dilated bronchioles with Signet-ring appearance
- Due to Cystic Fibrosis

Back 96

What is this?

Front 97

Panacinar Emphysema
AAT deficiency
Lower lobes (but all part can be affected)

Back 97

What is this?
What causes it?
What part of lung is primarily affects?

Front 98

Panacinar Emphysema

Back 98

What are these showing?

Front 99

Panacinar Emphysema

Back 99

What is this?

Front 100

Centriacinar Emphysema
-peripheral alveoli are normal

Back 100

What is this?

Front 101

Diffuse Alveolar Damage

Hyaline Membranes

Back 101

What is this?

Front 102

Centriacinar Emphysema
-holes are located around the terminal bronchioles

Rupture causing Pneumothorax

Back 102

What is this?

What is a potential complication?