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51 Cards in this Set
- Front
- Back
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How are the bronchi unlike the bronchioles?
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They have cartilage and submucosal glands
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What are the components of the acinus?
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respiratory bronchiole, alveolar duct/sac
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What are the structures included in the upper respiratory tract?
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nose, pharynx, larynx
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Nasal polyps
What do they consist of? |
Benign outgrowth of nasal mucosa following recurrent rhinitis
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Nasal polyps
Risk factors? (5) |
Recurrent rhinitis, asthma, allergies, CF, aspirin
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Nasal polyps
Microscopic appearance? |
Hyperplastic mucosa overlying edematous and inflamed stroma
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What is a sinonasal papilloma?
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Benign neoplasm arising in the squamous or columnar epithelium of the sinonasal tract
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What is the most important type of sinonasal papilloma? What does it do?
What viruses is it associated with? |
Inverted
Grows backwards into the mucosa, can be locally aggressive and recur HPV 6 and 11 |
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Nasopharyngeal angiofibroma
what is it? How does it present? |
Benign vascular tumor IN BOYS
Presents as epistaxis, can be locally aggressive |
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What would you expect to find on a sluture with allergic fungal sinusitis?
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High mucin --> amorphous, pink
High eosinophils |
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Nasopharyngeal carcinoma
a. what is it? b. populations? c. viral association? |
a. malignant tumor of nasopharynx
b. adult, male, chinese, pediatric african c. EBV |
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What are 3 histological types of Nasopharyngeal angiofibroma
How do you treat |
1. keratinizing squamous cell carcinoma
2. non-keratinizing 3. Undifferentiated (lots of lymphocytes, syncytium of epithelial cells) Radiosensitive |
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What are vocal polyps?
How gets it mostly |
Reactive nodules on true vocal cord due to irritation
smokers and singers |
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What do vocal polyps look like histologically?
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Squamous epithelium overlying fibrous tissue
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Laryngeal/squamous papilloma
a. where is it? b. what does it look like? c. Viral association? |
a. benign, on true vocal cords
b. raspberry like mass, fibrovascular core c. HPV 6 and 11 |
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Juvenile laryngeal papillomatosis
viral association? transmission? characteristics? |
HPV 6 and 11
vertical transmission of HPV in delivery Multiple nodules, recurs |
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Carcinoma of the larynx
a. whom does it affect most b. predominant type c. predominant area d. Field effect? |
a. men>40, smokers, drinkers, asbestos-exposed, radiation-exposed
b. squamous cell c. glottic area (vocal cords) --> hoarse d. cigarettes expose multiple areas --> can get multiple sq. cell carcinomas |
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Conditions associated with HPV?
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HPV -
sinonasal papillomas laryngeal papilloma squamous carcinomas and precursor lesions |
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Conditions associated with EBV?
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Nasopharyngeal carcinoma
Hairy leukoplakia - white tongue in HIV |
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What happens in neonatal atelectasis?
Acquired atelectasis? What does this result in? |
Neonatal - inadequate expansion of the lungs
Acquired - collapse of lung Results in collapse of alveoli, hypoxia, superimposed infections |
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Acquired atelectasis
3 methods of acquiring? |
1. Resorption/obstruction
2. Compression 3. Contraction |
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Acquired atelectasis
What happens in reabsorption/obstruction? What can cause this? |
Obstruction in distal airway, air resorbed distally, mediastinum pulled in, alveolar collapse
mucous, asthma, COPD, bronchiectasis, foreign body |
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Acquired atelectasis
How do you acquire from compression? What causes it? |
accumulated fluid or air in pleural cavity causes collapsed lung, mediastinal shift away
pleural effusion, pneumothorax, hemothorax |
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Acquired atelectasis
What happens in contraction? What causes this? |
Irreversible fibrosis prevents expansion, mediastinum shifts towards
pulmonary fibrosis |
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What is the definition of bronchial asthma?
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recurrent episodic, reversible bronchoconstriction of hyperreactive airways in response to various stimuli
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What is the difference between atopic and non-atopic asthma?
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Atopic: Type I hypersenstivity to environmental antigens, IgE, family hx positive, childhood
Non-atopic: Non-IgE mediated rxn to viral/cold/stress/etc., family hx neg, adults |
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What are the two phases that account for the pathogenesis of atopic asthma?
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1. Sensitization
allergen --> TH2 resonse --> IgE (IL4) binds to mast cells, eosinophils recruited (IL5), and mucus produced (IL13) 2. Re-exposure --> antigen cross links IgE --> mast cells release mediators --> bronchoconstriction, mucus production, vascular congestion, edema |
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What are the mast cell mediators that lead to atopic asthma?
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Histamine
Heparin Leukotrienes Proteases Bronchconstrict, mucus production, vascular congestion, edema |
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What happens in the late phase of an atopic asthmatic response?
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Recruitment of leukocytes --> more mediators released --> epithelial damage and bronchoconstriction
Leads to airway remodling |
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What is the pathogenesis of non-atopic asthma?
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Virus-induced inflammation of respiratory mucosa lowers the threshold of subepithelial vagal receptors to irritants
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Asthma
gross appearance? |
over inflation of lungs, areas of atelectasis, mucus plugs
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Asthma
histology? |
mucus lugs contain curschmann's spirals (whorls of shed epithelium), entrapped eosinophils, and Charcot-leyden crystals
Airway remodling |
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What are the 4 processes that occur in airway remodling?
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1. hypertrophy/hyperplasia of bronchiolar wall
2. overgrowth of submucosal glands 3. basement membrane thickening 4. increased vascularity |
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What is a typical presentation of acute asthma?
What is status asmaticus? |
Severe dyspnea, wheezing, non-productive nighttime cough, difficulty in expiration
Severe asthma that persists for days, does not respond to meds |
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What is emphysema?
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Permanent enlargement of airspaces of the acinus accompanies with destruction of walls (no fibrosis)
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What are 3 types of emhysema?
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1. centriacinar - respiratory bronchioles, upper lobes, smoking-related
2. panacinar - all of acini, lower lobe, a1 antitrypsin deficiency 3. distal - distal acini, subpleural upper lung near fibrosis or atelectasis, forms bullae |
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How does smoking lead to emphysema?
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Nicotine activates macrophages --> mediators --> neutrophils --> secretes proteases (elastase), also inactivates a1-antitrypsin (antiprotease)
also create free oxygen radicals, deplete antioxidants |
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What is the gross appearnace of emphysema?
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hyperinflated lungs
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What is the microscopic appearance of emphysema?
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enlarged alveoli with free-floating septa, thin walled, no fibrosis
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What is the clinical presentation of emphysema?
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"Pink puffers"
progressive dyspnea, shallow breathing, breath through pursed lips, barrel chest, weight loss No cough |
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What are 3 complications of emphysema?
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1. Pulm Ht, cor pulomonale
2. respiratory failure 3. tension pneumo |
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What is chronic bronchitis?
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persistnet productive cough for 3 months for at least 2 years in a row
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What are the 3 types of chronic bronchitis?
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Simple chronic - productive cough, no obstruction
chronic asthmatic - hyper-responsive airways with bronchospasm and wheezing chronic obstructive - chronic obstruction (coexists w/emphysmea) |
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What is the pathogeneis of chronic bronchitis?
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smoking/pollution --> inflammation of the bronchioles, hypersecretion of mucus --> obstruction
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What characterizes the morpholgy of chronic bronchitis?
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Hyperplasia/hypertrophy of submucosal mucus glands
Reid index >0.4 (thickness of mucous gland/thickness of bronchial wall) |
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What is the clinical presentation of chronic bronchitis?
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Blue bloater
history of cough and sputum with frequent exacerbations chronic hypoxemia pulm HT, cor pulmonale |
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What is bronchiectasis?
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Permanent dilation of bronchi and bronchioles caused by destruction of smooth muscle and supporting elastic tissue associated with chronic necrotizing infections
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What are some pathogens that can cause bronchiectasis?
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s. aureaus, klebsiela, aspergillus, mycobact. TB
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What are 3 congenital causes of bronchiectasis?
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CF, immunodeficiencies, kartagener syndrome
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How does bronchiectasis look
a. grossly b. histologically |
a. lower lobes, abnormal dilation of airways can be followed to pleural surface
b. enlarged airway, giant cells with necrotizing inflammation |
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What is the clinical course of bronchiectasis?
Complications (4) |
Foul-smelling sputum
Hemoptysis 1. Lung abscess --> embolize 2. pulm HT 3. metastatic brain abscess 4. reactive amyloidosis |
