Systemic Patholgy - Resp. (Test #2)

Front 1

What is the order of Bronchi from largest to smallest?

Back 1

Mainstem bronchi
Lobar bronchi (2 Lt. 3 Rt.)
Segmental bronchi (9 Lt. 10 Rt.)
Subsegmental bronchi
Bronchioles
Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sacs

Front 2

What represents the functional gas exchange area of the lungs and is composed of a _____ and its branching segments?

Back 2

Acinus
Respiratory

Front 3

What is the smallest discrete portion of the lung bounded by fibrous septa and consists of a _____ bronchiole and its branching segments?

Back 3

Lobule
Terminal

Front 4

How many orders of branching airways are there?
What does this provide for the lungs?

Back 4

25
Increased cross sectional area

Front 5

The majority of the alveolar surface is lined with what?

Back 5

Type 1 pneumocytes (squamous/membranous)

Front 6

What cells are interspersed on the alveolar surface and are surfactant producing?

Back 6

Type 2 pneumocytes (cuboidal/granular)

Front 7

What type of alveolar surface cell proliferates due to tissue injury?

Back 7

Type 2 pneumocytes (cuboidal/granular)

Front 8

What is the movement and distrobution of air within the tracheobronchial system?

Back 8

Ventilation

Front 9

_____ is the movement of O2 and CO2 between the alveolar space and the capillary blood

Back 9

Diffusion

Front 10

_____refers to the flow and distribution of blood within the pulmonary vascular bed

Back 10

Perfusion

Front 11

Partial or total absence of the diaphragm may result in herniation of the abdominal contents into the thoracic cavity. Depending on the size of the defect, this may be asymptom¬atic or catastrophic.

Back 11

Diaphragmatic Hernia

Front 12

In utero, diaphragmatic defects will result in _____ _____ due to compression of the lungs by the herniated viscera. These infants will have respiratory difficulties at birth.

Back 12

Pulmonary hypoplasia

Front 13

What are the neoplastic diseases of the respiratory system?

Back 13

Squamous papilloma
Inverted papilloma
Nasopharyngeal Angiofibroma
Squamous cell carcinoma

Front 14

Usually occurring on the true vocal cords, they are a benign _____ neoplasm resulting from infection with _____ _____

Back 14

Squamous (sinonasal and laryngeal)

papillomas
exophytic
HPV types 6 and 11

Front 15

This lesion represents a benign but aggressive _____ proliferation of squamous cells that occurs in the _____ and _____ _____. Although malignant transformation is very rare, unless it is removed in its entirety, it has a tendency to recur and can grow into the _____ or _____ cavities.

Back 15

Inverted papilloma

endophytic
nose, paranasal sinuses
orbital, cranial

Front 16

This is a benign tumor of teenage boys that presents as a nasopharyngeal mass and consists of blood vessels admixed with fibrous tissue. Surgical removal is not infrequently complicated by extensive bleeding from the tumor.

Back 16

Nasopharyngeal angiofibroma

Front 17

What are the three subsets of Squamous cell carcinoma?

Back 17

Nasal (non-cutaneous)
Nasopharyngeal carcinoma
Laryngeal

Front 18

In children,squamous papillomas tend to be _____ (juvenile laryngeal papillomatosis) but may spontaneously regress at the time of puberty. In adults they are more likely to be _____. Histologically, they resemble cutaneous warts and have the same predilection for recurrence.

Back 18

Multiple
Solitary

Front 19

These malignancies arise from the nasal mucosa or maxillary sinus. There is a correlation between various environmental (_____ _____) and occupational (_____ _____ _____) hazards and the development of this tumor. Local destruction is common but distant metastases are rare.

Back 19

Squamous cell carcinoma
NASAL (NON-CUTANEOUS)

cigarette smoking
exposure nickel ore

Front 20

Difficult to diagnose because of their location and lack of early symptoms, these may either be _____ or _____ squamous cell carcinomas, or undifferentiated carcinoma. The latter two have a strong association with _____ infection.

Back 20

Squamous cell carcinoma
NASOPHARYNGEAL CARCINOMA

keratinizing, non-keratinizing
Epstein-Barr virus (EBV)

Front 21

These tumors are also associated with smoking as well as alcohol abuse and are usually preceded by steadily worsening _____ _____ of the epithelium over a prolonged period of time. When they originate within physical confines of the larynx, they tend to _____ _____ because of the surrounding cartilage.

Back 21

Squamous cell carcinoma
LARYNGEAL

dysplastic changes
remain localized

Front 22

What is characterized by tumor cells are characteristically surrounded by a heavy lymphocytic infiltrate.
.

Back 22

Squamous cell carcinoma
NASOPHARYNGEAL CARCINOM

Front 23

What is the mortality rate of Laryngeal squamous cell carcinoma?

Back 23

approximately 30%

Front 24

What disease results from the narrowing or obstruction of the tracheobronchial tree or from destruction of the pulmonary parenchyma.

Back 24

Obstructive Lung Disease

Front 25

Clinically Obstructive lung disease results in an increased _____ _____ and _____ _____ _____, but decreased _____ _____ _____.

Back 25

residual volume
total lung capacity
forced expiratory volumes

Front 26

This is a clinical disorder characterized by excessive _____ _____ within the bronchial tree than cannot be explained by either a specific infection or by infiltrative disease.

Back 26

Chronic bronchitis

mucous secretion

Front 27

What is clinically defined as a chronic cough with sputum production for at least three months of the year in at least two consecutive years?

Back 27

Chronic bronchitis

Front 28

What is the pathogenesis of Chronic bronchitis?

Back 28

Hypertrophy and hyperplasia of the submucosal mucous glands - leads to hypersecretion of mucus

Front 29

In chronic bronchitis what two lesser pathologic features aid in the proliferation of mucus?

Back 29

Goblet cell metaplasia
Decrease in ciliated cells

Front 30

What occurs on expiration in Chronic bronchitis?

Back 30

Bronchioles collapse around the mucous plugs

Front 31

What does the excess mucous in chronic bronchitis lead to?

Back 31

Bacterial infection resulting in injury and ultimate fibrosis

Front 32

Over time, chronic bronchitis will result in pulmonary _____ with ensuing _____ heart failure

Back 32

Hypertension
right

Front 33

- This is defined as an abnormal, permanent, destructive lesion of the pulmonary parenchyma which leads to an increase in the size and volume of the air spaces distal to the _____ bronchiole.

Back 33

Emphysema

terminal

Front 34

The major pathophysiologic disruption of Emphysema is distal airway tissue destruction with resultant loss of _____ _____ rather than large airway obstruction as is seen with chronic bronchitis, and a loss of the _____ _____ intact alveoli on the distal airways, they tend to collapse upon themselves during expiration trapping air behind

Back 34

elastic recoil
tethering effect

Front 35

What are the classifications of emphysema?

Back 35

Centriacinar (centrilobular)
Panacinar (panlobular)
Paraseptal
Irregular (scar) emphysema

Front 36

This pattern of emphysema is characterized by destructive changes primarily to the respiratory bronchioles. Most striking in the upper lobes, it is seen most frequently in cigarette smokers and for that reason is often also associated with chronic bronchitis.

Back 36

Centriacinar (centrilobular)

Front 37

Most frequently seen in the lower lobes, this pattern is characterized by uniform involvement of the _____ and is seen in patients with inherited or acquired alpha-1-antitrypsin deficiency, especially if they also smoke.

Back 37

Panacinar (panlobular)

acinus

Front 38

This pattern is characterized by destruction in the distal portion of the _____ directly underlying the pleura or fibrous septa and sparing the respiratory bronchiole. It tends to occur more frequently in the upper lobes, may form large subpleural (cyst-like) bullae or pleural blebs, and may be a cause of spontaneous pneumothorax in young adults.

Back 38

Paraseptal

acinus

Front 39

This refers to focal parenchymal loss found in almost all adult lungs, often in areas of old scars from tuberculosis, histoplasmosis, etc.

Back 39

Irregular (scar) emphysema

Front 40

What are two clinical aspects of Emphysema?

Back 40

(barrel chest) due to the increased lung volume
ventilation/perfusion mismatch is less than that of chronic bronchitis

Front 41

This common disorder is characterized by an increased sensitivity of the tracheobronchial tree to a variety of stimuli and is manifested by acute, widespread, narrowing of the small airways due to bronchoconstriction

Back 41

Bronchial asthma

Front 42

What disease is related to type 1 hypersensitivity?

Back 42

Bronchial asthma

Front 43

This is a permanent dilatation (cylindrical, fusiform, or saccular) of bronchi and bronchioles resulting from inflammatory damage to their walls. It may be due to bronchial obstruction (chronic bronchitis, asthma), necrotizing pneumonia, or a variety of congenital or inherited conditions (cystic fibrosis).

Back 43

Bronchiectasis

Front 44

This is an inherited autosomal (_____) recessive disorder of exocrine glands characterized by abnormally viscous secretions and, depending on the severity of the disease, clinically manifested by pancreatic insufficiency, chronic respiratory disease, electrolyte disturbances, infertility, and occasionally cirrhosis of the liver.

Back 44

Cystic Fibrosis

chromosome 7

Front 45

What disease is characterized by the submucosal glands in the bronchial tree secrete an atypical viscous mucus which is difficult to clear and which predisposes to obstruction and repeated infection.

Back 45

Cystic Fibrosis

Front 46

This group of disorders is characterized by decreased total lung capacity.

Back 46

Restrictive Lung disease

Front 47

What can restrictive lung disease be attributed too?

Back 47

Loss of lung tissue
Filling of alveolar space
Infiltration / thickening of the pulmonary interstitium

Front 48

This refers to a condition in which there is either collapse of alveoli or incomplete filling of alveoli. The pathophysiologic effect is to cause a decrease total lung volume and a restrictive pattern of pulmonary function.

Back 48

Atelectasis

Front 49

What results from the failure of lungs to ventilate at time of birth. This may be due to birth trauma, bronchial obstruction, drugs, immaturity, CNS disorders, etc. When placed in water, the lungs will sink since they have no air in the alveoli.

Back 49

Primary Atelectasis

Front 50

What may be due to deficiency of surfactant (neonatal respiratory distress syndrome), loss of negative intrapleural pressure (chest trauma, pneumothorax), complete obstruction of an airway (by secretions, exudates, neoplasms, or foreign bodies), direct pressure on lungs (usually by accumulation of material in the pleural cavities), or contraction (parenchymal fibrosis).

Back 50

Secondary (acquired) Atelectasis

Front 51

Since atelectatic lung is still perfused but ventilation is decreased, this creates what?

Back 51

Intrapulmonary right-to-left shunt

Front 52

What are the obstructive lung diseases?

Back 52

Chronic Bronchitis
Emphysema
Bronchial Asthma
Bronchiectasis (Includes cystic fibrosis)

Front 53

What are the restrictive lung diseases?

Back 53

Atelectasis
Respiratory Distress Syndromes
Chronic diffuse interstitial (restrictive) disease

Front 54

What are the two types of Respiratory distress syndromes?

Back 54

Type I (hyaline membrane disease, respiratory distress of the newborn)

Type II (adult respiratory distress syndrome (ARDS), diffuse alveolar damage, "shock" lung)

Front 55

What disease is characterized by decreased surfactant increases the surface tension of the alveoli allowing them to collapse during expiration, this causes blockage which creates exudation of fibrin rich fluid into the interstitium and alveolar space and the subsequent formation of hyaline membranes

Back 55

Respiratory distress syndrome
Type I (hyaline membrane disease, respiratory distress of the newborn)

Front 56

What disease has a wide variety of mechanisms but which has a common denominator of widespread diffuses alveolar epithelial cell and/or capillary endothelial cell injury? There is leakage of fibrin rich exudate into alveoli, and the resultant hyaline membrane formation (proteinaceous exudate admixed with necrotic epithelial cell debris) interferes with gas diffusion

Back 56

Respiratory distress syndrome
Type II (adult respiratory distress syndrome (ARDS), diffuse alveolar damage, "shock" lung)

Front 57

This disease results in activation of inflammatory and immunologic activity in the pulmonary _____. Chemotactic factors released from activated alveolar _____ act to attract additional inflammatory cells which infiltrate the alveolar walls. Complement and other mediators will activate the neutrophils to release _____ and _____ _____ into the interstitium, and other mediators will stimulate _____ proliferation and collagen deposition

Back 57

Chronic diffuse interstitial (restrictive) disease

interstitium
macrophages
proteases, free radicals
fibroblast

Front 58

What is the end result of chronic diffuse interstitial (restrictive) disease?

Back 58

"honeycomb" lung characterized by multiple cystic spaces separated by dense fibrous scars

Front 59

What are the subset diseases involved with Chronic diffuse interstitial (restrictive) disease?

Back 59

Pneumoconioses
Chronic interstitial (non-infectious) pneumonias
Pulmonary Alveolar Proteinosis
Sarcoidosis
Primary Pulmonary hypertension and vascular sclerosis

Front 60

These are primarily occupational diseases caused by the inhalation of inorganic mineral dusts

Back 60

Pneumoconioses

Front 61

Coal dust is deposited in small airways where it is ingested by _____ that then migrate into the interstitium and collect around the bronchioles. When macrophage activity is overwhelmed by excessive coal dust, the excess is deposited in the interstitium.

Back 61

Coal workers lung

macrophages
respiratory

Front 62

What do patients with coal worker's lung have an increased risk for?

Back 62

TB

Front 63

This is due to the inhalation primarily of crystalline silica (quartz dust) and is a major cause of chronic occupational disease worldwide. The silica particles are ingested by alveolar _____ which are destroyed by the toxic effects of the silica that are related to its surface chemical reactivity with membrane proteins and phospholipids.

Back 63

Silicosis

macrophages

Front 64

In silicosis, viable macrophages are activated and release chemical mediators that promote _____ until the silica becomes _____ _____by small fibrotic nodules of whorled collagen.

Back 64

Fibrosis
"walled off"

Front 65

What disease is often associated with Silicosis?

Back 65

TB

Front 66

This results from the inhalation of the long, thin asbestos fibers of the amphibole type (the serpentine type of asbestos fibers are not as pathogenic) which cause an alveolitis and interstitial fibrosis.

Back 66

Asbestosis

Front 67

What is the result of asbestosis?

Back 67

It cannot be completely engulfed by macrophages. They may become encrusted by protein and iron.

Front 68

What disease is associated with asbestosis?

Back 68

Malignant mesothelioma

Front 69

What are the chronic interstitial (non-infectious) pneumonias?

Back 69

Idiopathic pulmonary fibrosis
Desquamative interstitial pneumonitis
Lymphoid interstitial pneumonia
Hypersensitive pneumonitis
Bronchiolitis obliterans - organizing pneumonia

Front 70

Acute inflammatory lesions of bronchi and bronchioles may be caused by viruses or irritant gases, that may lead to fibrous obliteration of small airways.

Back 70

Acute Bronchitis/Bronchiolitis

Front 71

Caused by Mycoplasma pneumoniae and a wide variety of viruses but are morphologically and clinically similar. Deals with the interstitial or alveolar walls, and focal _____ membranes and _____ pneumocyte hyperplasia may be present reflecting alveolar epithelial damage.

Back 71

Mycoplasma/Viral (Interstitial) Pneumonias

hyaline
Type II

Front 72

Disease where fungi are weak antigens and can cause tissue damage primarily by virtue of the hypersensitivity reaction by the host against the fungal proteins. Can invade and obstruct vessels which can result in hemorrhagic _____.

Back 72

Mycotic Pneumonias

infarcts

Front 73

What is the primary response of Mycotic Pneumonias?

Back 73

chronic granulomatous inflammatory reaction

Front 74

What invokes both a chronic granulomatous response and a purulent exudation in Mycotic Pneumonias?

Back 74

Actinomycosis

Front 75

What is the primary route of infection in Primary TB?

Back 75

Inhalation of contaminated aerosol droplets from an infected individual

Front 76

Where are the lesions of Primary TB found?

Back 76

Subplural parenchyma

Front 77

The granulomatous lesion in primary TB is called the _____ _____ and typically has central caseous necrosis.

Back 77

Ghon focus

Front 78

What is considered to be the anatomic hallmark of secondary TB?

Back 78

Cavitation

Front 79

What is the most common cause of lung abscess?

Back 79

Aspiration

Front 80

Most bronchogenic carcinomas are felt to arise from the _____ _____of the bronchial epithelium and subsequently differentiate into a variety of recognizable patterns.

Back 80

Basal cells

Front 81

What are the different classifications of Bronchogenic carcinomas and their percentage of reverence?

Back 81

Squamous cell carcinoma (35%)
Adenocarcinoma (35%)
Small cell undifferentiated carcinoma (Oat cell) (20%)
Large Cell Undifferentiated carcinoma (10%)

Front 82

This is primarily a central lesion and is the cancer most closely associated with smoking, evolving from preceding dysplastic squamous metaplasia of the bronchial epithelium.

Back 82

Squamous cell carcinoma

Front 83

The histology of squamous cell carcinoma may vary from _____ _____ to _____ _____ and the tumors tend to infiltrate locally before _____.

Back 83

well-differentiated
poorly differentiated
metastasizing

Front 84

What can squamous cell carcinoma appear to be?
What can this disease also be associated with?

Back 84

TB
Hypercalcemia (due to parathyroid hormone-related protein)

Front 85

Although central lesions do occur, the majority of these are peripheral lesions that tend to spread through submucosal lymphatics to the hilar lymph nodes.

Back 85

Adenocarcinomas

Front 86

What do the tumors of adenocarcinomas contain cellularly?

Back 86

Mucus-secreting cells

Front 87

A relatively rare variant of adenocarcinoma, that apparently arises from bronchiolar epithelium (Type II pneumocytes, Clara cells) and characteristically grows as cuboidal or columnar cells spreading along alveolar septa.

Back 87

Bronchioloalveolar carcinoma,

Front 88

This carcinoma is always a central lesion with cells that are relatively small with little cytoplasm, and there is no distinctive architectural growth pattern. Thought to arise from the neuroendocrine Kulchitsky cells, these tumors are notorious for producing hormone-like substances (ADH, ACTH, gonadotropins, etc).

Back 88

Small cell undifferentiatied carcinoma (Oat cells)

Front 89

This tumor is comprised of large pleomorphic undifferentiated cells and may represent undifferentiated squamous cell carcinomas or adenocarcinomas.

Back 89

Large cell undifferentiated Carcinoma

Front 90

These tend to occur at a younger age than other malignant neoplasms of the lung and, like small cell undifferentiated carcinomas, arise from the neuroendocrine _____cells. They resemble intestinal carcinoid tumors and, like those tumors, can secrete _____.

Back 90

Bronchial Tumor

Kulchitsky
serotonin

Front 91

These lesions represent local overgrowth of normal tissue and are not considered true neoplasms.

Back 91

Hamartoma