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92 Cards in this Set

  • Front
  • Back
Bronchi; note cartilagenous plates

Bronchioles do not have them and trachea have cartilage rings
T= terminal bronchioles
R= respiratory bronchioles
A= alveoli
AD= alveolar ducts
AS= alveolar sacs
Tertiary bronchus; note cartilage plates
Bronchiole; note lack of cartilage plates or C rings; smooth muscle ring
Alveolar Walls

A= alveoli C= capillaries I= type I alveolar cells II= type II alveolar cells M= alveolar macrophages
Community Acquired Pneumonia
Community acquired (outside of hospital)

Acute fever, cough with mucopurlulent sputum; leukocytosis with a left shift
Good sputum sample
A “good” sputum sample will have polymorphonuclear leukocytes but a low to absent number of squamous epithelial cells on gram stain

Left picture has too many squamous epithelial cells; right = gram positive diplococci consistenw tih streptococcus pneumoniae
Klebsiella Pneumoniae
Commonly affects debilitated and malnourished individuals (alcoholics);

Can cause tissue necrosis (hemoptysis, dense lobar consolidation, abscess formation)

Causes a thick gelatinous sputum ("CURRANT JELLY)" since the orgainsm produces a viscid capsular polysaccharide
Pseudomonas Aerguinosa
Cystic fibrosis patients whoa re immunocompromisedl tendency to invade blood vessels with subsequent extrapulmonary spread
Alcoholic with a red jelly like sputum
Klebsiella pneumoniae
Cystic fibrosis pt with HIV
Pseudomonas aerguinosa
Legionalle Pneumophilia
Survives well in water; aerosilized organisms or aspiration of contaminated drinking water; organ transplant pts and smokers; immunocompromised pts can have mortality rates up to 50%
Organ transplant pt with a history of smoking and also somehow an olympic swimmer (phelps)!
Legionella Pneumophilia
Haemophilus Influenzae
Pleomorphic, gram negative organism

Common cause of meningitis in children up to 5 years of age prior to development of its vaccine; acute conjunctivitis in children

Secretes a protease that degrades IgA
4 year old with meningitis; his mother does not believe in vaccines
Haemophilus Influenzae
Lobar Pneumoniae; gray hepatization; lwoer lobe is uniformly consolidated
Lobar Pneumonia; This PA chest radiograph shows diffuse right upper lobe consolidation. This particular patient had lobar pneumonia due to S. pneumoniae
Bronchopneumonia; arrows indicate patches of consolidation
Bronchopneumonia; patchy sonsolidation in the left upper and lower lobes
Stages of Lobar Pneumonia
Congestion (red, boggy heavy) -> red hepatization (liver like consistency, red, firm, airless) -> gray hepatization (gray/brown and dry, fibrinosuppurative exudate) -> resolution
Empyema
Spread of infection to the pleural capillary; collection of pus in space between the lung and inside of chest wall
Abscess Formation
Associated with Klebsiella infection
Most common cause of community acquired artpical pneumonia
Mycoplasma Pneumoniae

Thickened alveolar walls are infiltrated with mononuclear leukocytes
Influenza (community acquired atypical) pneumonia is associated with what in children
Reye's syndrome (acute encephalopathy and fatty liver in children who have ingested asprin)
Pneumonia Symptoms
Worsening cough, purulent or bloody sputum, dyspnea and rales
Severe Acute Respiratory Syndrome
Coronovirus; infects lower respiratory tract and spreads throughout the body

10% mortality
hospital Acquired Pneumonia
48 hours after admission; pts on mechanical ventilators at highest risk; same s/s as community acquired

most commonly gram negative rods and staph aureus
Aspiration Pneumonia
seizures, anesthesia, CS disease, decreased consciousness, NG tubes

usually more than one organism is seen; sputum can be malodorous; lung abscess is a common complication
With foul smelling sputum
Lung Abscess; note focus of parenchymal lung destruction

Complications: extension into pleural cavity, hemorrhage, brain abscess or meningitis
Lung Abscess
Note the large cavity with air fluid level in the right upper lobe
Fungal infection in midwestern states located in the Ohio and Mississippi River valleys
Histoplasmosis (bird/bat droppings, targets macrophages)
Histoplasmosis
Bird/bat droppings; targets macrophages; bad in immunocompromised patients
Histoplasmosis; note yeast forms filling phagocytes in a lympho node of a person with disseminated histoplasmosis
Blastomysis location
Soil inhabiting, dimorphic fungus
Blastomycosis; yeast cell that divides by broad based budding; thick walls
Coccidiomycosis
Exists as a mold in soil and spherule in tissue
Coccidiomycosis
Exists as a mold in soil and spherule in tissue
Thick walled nonbudding spherules; often filled with endospores
Coccidiomycosis arthrospore
Coccidiomycosis spherule; Endospores form within spherules in tissue; when the spherules rupture the endospores disseminate and form new spherules
Obstructive Diseases
Resistance to outflow due to obstruction
COPD
COPD
Applied to pts who have emphysema, chronic bronchitis, or a combo of the two

A. Chronic bronchitis (excessive secretions)
B. Thickened airway by edema or muscle hypertrophy
C. Emphysema;; destruction of lung parenchyma = loss of radial traction
Emphysema
Irreversible enlargement of airspaces; macrophages suck up smoke; damage airspace
Emphysema Classification

A = alveolus
RB = respiratory bronchiole
TB = terminal bronchiole
Centriacinar: heavy smokers
Paracinar: alpha-1 antitrypsin deficiency
Distal acinar (paraseptal): distal portoin of acinus predominantly involved
Irregular: acinus irregularly involved, associated with scarring
Normal lung
Emphysema; loss of alveolar walls and dilated airspaces
Subpleural bullae which can occur in emphysema
Left: centriacinar emphysema; E = damage surrounded by spared alveolar spaces
right is Paracinar emphysema which is involving the entire pulmonary lobole
Emphysema morphology

a. normal
b. centriacinar
c. centriacinar
d. paracinar
e. paracinar
Pink Puffers
emphysema;

these pts experience dyspnea, minimal, nonproductive cough (cuz its not bacterial, barrel chested and pursed lips

Bc of their higher respiratory rate and increased minute volume they maintain arterial hemoglobin sats and are called pink puffers
Emphysema; flattening diaphragm
Chronic Bronchitis Pathogenesis
Tobacco smoke irritation -> hypersecretion of mucous and hypertrophy of submucosal glands (goblet cell hyperplasia)

Can be obstructive to the airway
Reid Index
Measure of the size of mucous glands

ratio of thickness of mucous gland layer to thickness of the wall between the epithelium and cartilage; normally 0.4 or less; in chronic bronchitis it is more than 0.5
Pulmonary Edema; intraalveolar fluid, engorged capillaries, hemosiderin laden macrophages (heart failure cells)
Pulmonary Edema; intraalveolar fluid, engorged capillaries, hemosiderin laden macrophages (heart failure cells)
Pulmonary Edema
Fluid accumulation in lungs bc of starling forces (hydrostatic pressure from LSHF, stenosis)) or endothelial injury or increased capillary permeability (infection, drugs, shock);

Gross: wet, heavy lungs usually worse in lower lobes
Congestive Heart Failure
Insufficient cardiac output to meet the metabolic demand of the body's tissues and organs

Forward failure = decreased organ perfusion
Backward failure = passive congestion of organs
Left Sided Heart Failure
Causes pulmonary congestion/edema

Sx: SOB, exertoinal dyspnea which progresses to orthopnea, paroxysmal nocturnal dyspnea, dyspnea at rest
Cor Pulmonale
pulmonary heart disease is enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs.
Nutmeg Liver
Passive congestion of the portal system from right sided CHF; passive congestion around central veins = darker red/brown lobular center with pale peripheral zone
Nutmeg Liver; seen in chronic passive congestion due to RCHF; dark areas = accumulated red blood cells in centrilobular area
Nutmeg liver; congestion around central vein with pale peripherals
Primary Cardiomyopathies
Disorders confiend to heart muscle; cardiac enlargement with dilation of all four chambers resulting in progressive CHF

Associated with dystrophin mutations
Secondary Cardiomyopathies
myocardium is involved as part of a systemic or multiorgan disorder; cardiac enlargement with dilation in all four chambers resulting in progressive CHF

Associated with dystrophin mutations
Doxarubicin
Chemotherapeutic drug; causes dose dependent cardiotoxicity = dilated cardiomyopathy
Dilated Cardiomyopathy

Arrow shows mural thrombus

Note variable myocyte hypertrophy and intestitial fibrosis
Restrictive Cardiomyopathy
Caused by dz that produce restriction of cardiac filling during diastole (decrease in ventricular compliance) (amyloidosis, sarcoidosis, endomyocardial fibroelastosis, Loeffler endomyocarditis)
Endocardial Fibroelastosis
Endomyocadial fibrosis; cause of restrictive cardiomyopathy
Cardiac Sarcoidosis; cause of restrictive cardiomyopathy
Hypertrohic Cardiomyopathy; note septum bulging into left ventricular outflow tract

note disarray and branching of myocytes; also there is intestitial fibrosis
Hypertrophic Cardiomyopathy Pathophysiology
HCM due to mutations in genes that encode sarcomeric proteins

Most common = B-MHC (beta myosin heavy chain)
Dz that causes sudden cardiac death in athletes
Hypertrophic Cardiomyopathy

There may be a harsh systolic ejection murmur caused by ventricular outflow obstruction
PUlmonary Hypertension
Mutation in BMPR2 signaling inhibits proliferation and favors apoptosis; mutation = smooth muscle survival and proliferation

Caused by recurrent PEs = increased pulmonary resistance = may lead to cor pulmonale (pulmonary heart dz/RCHF)
Pulmonary htn; medial hypertrophy of muscular and elastic arteries
Pulmonary Embolism; infarcts extend to periphery of lung in shape of a wedge

955 arise from DVT;
saddle emboli can = sudden death
w sudden onset of dyspnea, hypoxemia and hypotension
Pulmonary Embolism in both main pulmonary arteries
How can multiple PE result in pulmonary hypertension?
Emboli often resolve by contraction and fibrinolysis; unresolved emboli can = pulm htn, vascular sclerosis and chronic cor pulmonale

a small emolus may harbinger a larger one
Acute Respiratory Distress Syndrome/Acute Lung Injury
Diffuse damage of alveolar epithelium and capillaries, resulting in progressive respiratory failure that is unresponsive to oxygen tx; likely due to uncontrolled neutrophil activation

CXR: Bilateral lung opacity ("white out")
ARDS
Lungs are hevy and firm
Note alveolar hyaline membranes are composed of fibrin rich fluid mixed with necrotic epithelial cell debris

Note that many of the alveoli are lined by hyaline membranes
ARDS; bilateral lung opacity (white out)
Pneumothorax; air in pleural cavities
Spontaneous Pneumothorax
Young adults with rupture of emphysematous blebs; air in pleural cavity
Tension Pnemothorax
Life threatening shift of thoracic organs across midline; rupture acts as one way valve and air enters pleural cavity but does not exit
most common cause of epiglottitis
bacterial infection of epiglottis/surrounding tissues; respiratory obstruction;

H. influenzae
Child with fever, sore throat, dysphagia and drooling; child sits upright, leans forward and hyperextends the neck
Epiglottitis

Laryngoscopy visualizes "cherry red" epiglottis
Epiglottitis; thumb sign
most common pathogenic cause of croup
Parainfluenza viruses (esp type 1)
Croup; Steeple sign; narrowing of the airway
Croup

Steeple's sign
Pts 6 months - 3 yrs of age; inflammation of the larynx, trachea, bronchi, bronciholes, and lung parenchyma

Obstruction due to inflammation and swelling becomes pronounced in the subglottic region

Most commonly caused by parainfluenza virus

Often preceded by URI; barking cough/hoarseness, worse at night

Inspiratory stridor