Emphysema and Pneumonia Quiz

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Questions and Answers

Which type of emphysema involves the entire acinus?

Irregular emphysema

Centriacinar emphysema

Paraseptal emphysema

Panacinar emphysema (correct)

What is the most common type of emphysema?

Irregular emphysema

Paraseptal emphysema

Panacinar emphysema

Centriacinar emphysema (correct)

Which of the following is NOT a clinical manifestation of emphysema?

Weight gain (correct)

Dyspnea

Cough

Expiratory airflow limitation

What is the main cause of death in most patients with emphysema?

Respiratory acidosis and coma (C) Signup and view all the answers

Which type of emphysema is specifically associated with alpha 1 - antitrypsin deficiency?

Panacinar emphysema (C) Signup and view all the answers

What type of cells are increased in the lungs of individuals with emphysema?

Macrophages (B) Signup and view all the answers

What is the main mechanism thought to be responsible for centriacinar and panacinar emphysema?

Imbalance of oxidants and antioxidants (A) Signup and view all the answers

Which of the following is NOT a treatment option for emphysema?

Antibiotics (A) Signup and view all the answers

What is the most prevalent cause of community-acquired acute pneumonia?

Streptococcus pneumoniae (A) Signup and view all the answers

What is a predisposing condition that increases the risk of developing community-acquired acute pneumonia?

Individuals with congenital or acquired immune deficiencies (B) Signup and view all the answers

What is the hallmark of pneumococcal pneumonia?

Presence of numerous neutrophils containing gram-positive, lancet-shaped diplococci in sputum (B) Signup and view all the answers

What type of vaccine is used to protect high-risk individuals against pneumococcal pneumonia?

Vaccine containing capsular polysaccharides from common serotypes (C) Signup and view all the answers

Which of the following is a characteristic of Haemophilus influenzae?

Pleomorphic, gram-negative organism (B) Signup and view all the answers

What is a significant factor in the diagnosis of acute pneumonia?

Examination of Gram-stained sputum (D) Signup and view all the answers

What is a common consequence of bacterial invasion of the lung parenchyma in pneumonia?

Alveoli filled with inflammatory exudate (D) Signup and view all the answers

What does the term "pleomorphic" refer to in the context of Haemophilus influenzae?

The bacteria have variable shapes and sizes (B) Signup and view all the answers

What is the primary way that highly pathogenic coronaviruses, like SARS-CoV-2, affect the lungs?

They infect the lung tissue and damage the alveoli, preventing proper oxygen exchange. (B) Signup and view all the answers

What is the most significant factor in determining the severity of bacterial pneumonia?

The extent of lung involvement and the patient's ability to fight off the infection. (D) Signup and view all the answers

What is the key difference between bronchopneumonia and lobar pneumonia?

Bronchopneumonia affects the small bronchioles and alveoli, while lobar pneumonia involves one or more entire lobes of the lung. (C) Signup and view all the answers

What is a common complication that can arise from pneumonia?

The spread of the infection to the pleural cavity, causing empyema. (A) Signup and view all the answers

Which of the following is NOT a typical characteristic of acute bacterial pneumonia?

The presence of highly pathogenic coronaviruses like SARS-CoV-2. (C) Signup and view all the answers

What is the most likely outcome of severe, untreated bacterial pneumonia?

Fibrosis and scarring of the lung tissue. (B) Signup and view all the answers

Which of these is a true statement about the spread of infection in pneumonia?

Pneumonia can spread through the blood to other organs, leading to complications. (C) Signup and view all the answers

Why are older individuals with underlying health conditions more vulnerable to severe complications from viral pneumonia?

All of the above. (D) Signup and view all the answers

Which type of lung cancer is most commonly found in men with a history of smoking?

Squamous cell carcinoma (C) Signup and view all the answers

What is a histological characteristic of squamous cell carcinoma?

Keratinization and/or intercellular bridges (D) Signup and view all the answers

Which type of lung cancer is known to have a strong association with cigarette smoking and is highly malignant?

Small cell carcinoma (B) Signup and view all the answers

What is a notable characteristic of squamous cell carcinoma that may occur centrally in the tumor?

Cavitation (A) Signup and view all the answers

Which type of lung cancer is often peripherally located and can present as both well-differentiated and solid masses?

Adenocarcinoma (B) Signup and view all the answers

What is the most aggressive type of lung cancer that tends to metastasize widely?

Small cell carcinoma (C) Signup and view all the answers

What is a possible reason for central cavitation in a squamous cell carcinoma?

Rapid tumor growth exceeding blood supply (B) Signup and view all the answers

Which of the following is NOT a characteristic of adenocarcinoma?

Always well-differentiated (C) Signup and view all the answers

What is a characteristic finding in the histology of a caseating granuloma?

Presence of multinucleated giant cells with nuclei arranged in a horse-shoe shape (A) Signup and view all the answers

What stain is most commonly used to identify acid-fast bacilli in tissue sections?

Zeihl-Neelsen stain (D) Signup and view all the answers

Which fungal infection is associated with large, budding yeasts with thick walls and broad-based buds?

Blastomycosis (D) Signup and view all the answers

What is the most likely cause of aspiration pneumonia in a patient with a history of repeated vomiting?

Oral flora (A) Signup and view all the answers

Which of the following is NOT a predisposing factor for hospital-acquired pneumonia?

Healthy immune system (A) Signup and view all the answers

What is a defining characteristic of Mucormycosis?

Non-septate, broad, ribbon-like hyphae with wide angle branching (D) Signup and view all the answers

Which fungal infection is characterized by the formation of granulomas?

Histoplasmosis (D) Signup and view all the answers

What is a common characteristic of fungal infections like candidiasis, aspergillosis, and mucormycosis?

They are all positive for GMS and PAS stains (C) Signup and view all the answers

What is the primary cause of Idiopathic Pulmonary Fibrosis (IPF)?

Repeated cycles of epithelial activation/injury by an unknown agent (B) Signup and view all the answers

What is the significance of the inflammatory response observed in IPF?

It is a symptom of the disease but its role in the disease process is unknown. (A) Signup and view all the answers

Which of the following factors influence the development of Pneumoconiosis?

All of the above (D) Signup and view all the answers

What is the relationship between Pneumoconiosis and tobacco smoking?

Tobacco smoking can worsen the effects of Pneumoconiosis (D) Signup and view all the answers

What is the main difference between IPF and Pneumoconiosis?

IPF is caused by an unknown agent, while Pneumoconiosis is caused by exposure to known substances (B) Signup and view all the answers

What is the significance of studying Pneumoconiosis?

All of the above (D) Signup and view all the answers

What term best describes the process of excessive fibroblastic/myofibroblastic proliferation that occurs in IPF?

Fibrosis (C) Signup and view all the answers

What is the primary concern regarding the increased morbidity and mortality rates associated with high levels of ambient air particulate matter?

It negatively impacts public health in general (C) Signup and view all the answers

Study Notes

Respiratory Pathology

Respiratory pathology is a study of diseases and tumors affecting the lungs.
Students will learn about various types of lung diseases and tumors, and how to recognize common types microscopically.
Key objectives are identifying different diseases and tumors that develop in the lungs, and the microscopic recognition of the most common types.

The Lungs

The lungs' function is gaseous exchange, between inspired air and blood.
The right main stem bronchus runs more vertically and directly into the trachea.
Aspirated foreign materials, such as vomit, blood, and foreign bodies, tend to enter the right lung more frequently than the left.

Alveoli

Alveoli are the tiny air sacs in the lungs, vital for gas exchange.
Alveoli are surrounded by a network of capillaries, facilitating oxygen and carbon dioxide exchange.
Specialized cells, type I and type II pneumocytes, are present in the alveolar space.

Normal Lung Tissue

Except for the vocal cords, the entire respiratory tree—larynx, trachea, and bronchioles—is lined by pseudostratified, tall, columnar, ciliated epithelial cells.
Bronchial mucosa contains neuroendocrine cells that release hormones and peptides.
Goblet cells and submucosal glands secrete mucus throughout the trachea and bronchi (but not bronchioles).

Pulmonary Edema

Pulmonary edema is a buildup of fluid in the lungs.
Hemodynamic edema occurs due to elevated hydrostatic pressure.
Microvascular injury to pulmonary capillaries can cause edema.
Edema can result in fluid leaking into the interstitial space, and eventually into the alveoli.

Acute Lung Injury and Acute Respiratory Distress Syndrome (ARDS)

Acute lung injury (ALI) is characterized by the abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates, lacking cardiac failure.
ALI can exacerbate into ARDS.
ARDS and ALI increase in pulmonary vascular permeability, leading to epithelial and endothelial cell death.
The main feature of ARDS/ALI is diffuse alveolar damage (DAD).
Most conditions linked to ALI/ARDS involve an underlying cause like sepsis.

Acute Lung Injury Pathology

In the acute stage, the lungs appear heavy, firm, red, and boggy.
Alveolar walls become lined with waxy hyaline membranes that are similar to hyaline membrane disease in neonates.
Type II pneumocytes proliferate, creating granulation tissue in the alveolar walls and spaces.
Fatal cases often show superimposed bronchopneumonia.

Pathogenesis

Alveolar capillary membrane damage increases vascular permeability, leading to alveolar flooding and diffusion capacity loss.
Widespread surfactant abnormalities can result from injury to type II pneumocytes.
Microthrombi formation due to endothelial injury can worsen ischemic injury.
Hyaline membranes form when protein-rich edema fluid traps debris from deceased alveolar epithelial cells.

Clinical Course of Acute Lung Disease

Profound dyspnea, increasing cyanosis, and hypoxemia are common.
Lung stiffening due to surfactant loss occurs early.
Mortality rates from sepsis, multi-organ failure, and direct lung injury have decreased from roughly 60% to about 40%.

Obstructive vs Restrictive Pulmonary Diseases

Obstructive diseases increase airway resistance due to partial or complete obstruction.
Restrictive diseases reduce lung expansion and decrease total lung capacity.
Conditions such as neuromuscular diseases, severe obesity, pleural diseases, and kyphoscoliosis affect chest wall.
Chronic interstitial and infiltrative diseases like pneumoconioses and interstitial fibrosis of unknown etiology influence restrictive patterns.

Obstructive Pulmonary Diseases

Asthma: Reversible airway obstruction with bronchial hyperresponsiveness triggered by allergens, infection, etc.
Emphysema: Abnormal enlargement of air spaces distal to the terminal bronchioles, due to alveolar wall destruction (without fibrosis).
Chronic bronchitis: Persistent cough and sputum production for at least three months in two consecutive years.
Bronchiectasis: Irreversible dilation of the bronchi.
Bronchiolitis obliterans: Obliteration of the bronchioles.

Emphysema

Defined by abnormal, permanent enlargement of air spaces distal to the terminal bronchioles due to destruction of alveolar walls (without fibrosis).
COPD is a major public health problem, projecting to be the fourth leading cause of morbidity and mortality in US in 2020.
Cigarette smoking and increased susceptibility in women and African Americans are linked to emphysema.
Two common subtypes are centriacinar and panacinar.
Paraseptal emphysema involves the distal part of the lobule and is rarely extensively involved.
Emphysema is linked to inflammatory cell activation, releasing mediators that harm lung tissue and causing an imbalance of oxidants and antioxidants.

Clinical Manifestations of Emphysema/COPD

Early sign is dyspnea.
Weight loss is common, potentially mimicking a tumor.
The disease frequently progresses to cor pulmonale (right-sided heart failure) due secondary pulmonary vascular hypertension) and eventually congestive heart failure.
Death is often caused by exacerbations, respiratory acidosis, coma, right-sided heart failure, or severe lung collapse.
Treatment includes bronchodilators, steroids, bullectomy (removal of bullae), and, in selected patients, lung volume reduction surgery, or lung transplantation.

Chronic Bronchitis

Persistent cough producing sputum for at least three months in two consecutive years, common in smokers and smog-laden areas.
Long-term persistence can cause COPD, cor pulmonale (right-sided heart failure), and increased risk for cancerous transformation.

Asthma

Chronic inflammatory disorder causing recurrent episodes of wheezing, shortness of breath, chest tightness, and cough.
Characterized by genetic predisposition to type I hypersensitivity.
Cytological examination of sputum after an asthmatic attack may show eosinophils, Charcot-Leyden crystals, and Curschmann's spiral.
In severe cases of status asthmatics, the lungs are hyperinflated and mucoid secretion clogs small airways.
Common types include atopic (allergen-mediated) and non-atopic (infection or drug-induced) asthma.

Drug-Induced Asthma

Aspirin-sensitive asthma is an uncommon but notable type triggered by small doses of aspirin and other NSAIDs.
Occupational asthma is an allergic reaction to various chemicals and fumes encountered in the workplace.
Fumes and chemicals from epoxy resins, plastics, wood dust, etc. can provoke asthma in susceptible individuals.

Chronic Diffuse Interstitial (Restrictive) Diseases

Characterized by inflammation and fibrosis of pulmonary connective tissue.
Often of unknown cause, with overlapping histologic features.
Patients present with dyspnea, tachypnea, inspiratory crackles, and cyanosis.
Chest radiographs reveal infiltrative lesions.

Idiopathic Pulmonary Fibrosis (IPF)

Causative agents remain unknown but repeated cycles of epithelial activation and injury seem implicated.
T cell response, marked by eosinophils and mast cells is present.
Abnormal epithelial repair leads to exuberant fibroblastic/myofibroblastic proliferation.

Pneumoconiosis

Non-neoplastic lung reaction to inhaled mineral dusts in the workplace.
Severity and type of pneumoconiosis depend on dust amount retained, particle size, shape, and chemical properties of the dust, and potential interactions with other irritants like tobacco smoking.
Examples include silicosis from inhaling silica, asbestosis from asbestos exposure, coal workers' pneumoconiosis from coal dust.

Silicosis

A chronic occupational lung disease caused by inhaling crystalline silica.
Often a slowly progressing nodular, fibrosing pneumoconiosis in workers heavily exposed to silica, such as sandblasters and miners.
Potentially acute form, characterized by accumulation of lipoproteinaceous material in alveoli, occurs in heavy and prolonged exposure.

Asbestos is a family of crystalline hydrated silicates that form fibrous particles.
Occupational asbestos exposure is linked to pleural plaques, pleural fibrosis, parenchymal interstitial fibrosis, lung carcinoma, and mesothelioma.

Pathogenesis of Asbestos

– Two main forms: serpentine (chrysotile) and amphibole, with amphibole being more pathogenic, especially in relation to malignant pleural tumors.

Asbestos acts as a tumor initiator and promoter.
Asbestos fibrils cause reactive oxygen species (ROS), leading to lung carcinoma and mesothelioma (especially when combined with smoking).

– Histologically, asbestos bodies, consisting of asbestos fibers coated with iron-containing proteins, are typically present in the lung.

Development of pleura plaques and pulmonary fibrosis are common.
Asbestos exposure increases the risk of lung carcinoma and mesotheliomas.

Vascular Lung Diseases

Thromboembolism and infarction are common vascular diseases of the lung.
Thrombi originating from the deep veins of the leg are a primary source of emboli in 95% of cases.
Prolonged immobilization, trauma, severe burns, and fractures can increase the risk of venous thrombosis and pulmonary embolism.

Pulmonary Infarction

Occurs when pulmonary blood flow is compromised either through thromboembolism or other vascular obstructions.
Infarcts characteristically appear hemorrhagic initially, with discoloration changing to red-brown due to hemosiderin deposition with time.
Histological finding show hemorrhagic necrosis of the lung parenchyma.

Amyloidosis

Abnormal protein folding, leading to amyloid deposition in alveolar septa.
The lung shows deposition of amorphous eosinophilic proteinaceous material as well as diffuse or uniform interstitial nodules.
The vessels and pleura may also contain amyloid deposits.
Amyloid is characterized by apple-green birefringence in polarized light microscopy.

Community-Acquired Acute Pneumonias

Community-acquired pneumonias are typically caused by bacterial or viral infections, frequently following upper respiratory tract viral infections.
Predisposing factors include extremes of age, chronic diseases, immune deficiencies, and splenic dysfunction.
Diagnosis may involve Gram-stained sputum examination showing gram-positive diplococci for pneumococcal pneumonia.

Hospital-Acquired Pneumonia

Hospital-acquired pneumonias are pulmonary infections that occur during a hospital stay.
Predisposing factors include immunosuppression, prolonged antibiotic therapy, or invasive devices like catheters.
Gram-negative bacteria, including Enterobacteriaceae and pseudomonas species, and S. aureus are common isolates.

Tuberculosis

Tuberculosis is a bacterial lung infection.
Histologically characterized by caseating granulomas with Langhans' type giant cells.
Acid-fast bacilli (e.g., Mycobacterium tuberculosis) can be present in affected tissues.
Cultures are more sensitive than microscopy in diagnosing tuberculosis.

Fungal Infections

Fungal infections, notably candidiasis, aspergillosis, mucormycosis, histoplasmosis, blastomycosis, and coccidioidomycosis, may cause pulmonary inflammation and granulomas.
These infections often involve distinctive histologic features like pseudohyphae, acute angle branching of hyphae, or specific types of yeast cells.

Pneumocystis Pneumonia

Characterized by intraalveolar acellular, frothy material and minimal inflammation.
Diagnosis relies on silver stains (GMS) to visualize non-budding cysts in tissue.

Lung Transplantation

Indications include all non-neoplastic terminal lung diseases, most common being end-stage emphysema, idiopathic pulmonary fibrosis, cystic fibrosis, and idiopathic/familial pulmonary arterial hypertension.
Bilateral chronic lung infections (e.g., cystic fibrosis, bronchiectasis) necessitate replacing both lungs to address the infection reservoir.

Lung Cancer

Lung cancer is the most frequent cancer worldwide - a significant cause of cancer-related deaths.
The carcinogenic effects of cigarette smoking are a major risk factor, with a strong correlation between smoking and lung cancer.
The incidence is slightly lower in women than in men, and lung cancer usually arises in people aged 40 to 70, with a peak in 50s or 60s.

Tobacco Smoking

Associated with 80% of lung cancers, with a nearly linear relationship between smoking and the frequency of developing lung cancer.
Risk is significantly higher in heavy smokers compared to light smokers and nonsmokers.
Smoking cessation reduces lung cancer risk over time, but it may not return to baseline levels.

Industrial Hazards

High-dose ionizing radiation, (e.g., Hiroshima/Nagasaki bomb survivors), is carcinogenic.
Uranium exposure, although weakly radioactive, increases lung cancer risk amongst miners.
Exposure to asbestos, including a fivefold increased risk even in nonsmokers, causes asbestos-related diseases like mesothelioma, and lung carcinoma.
Atmospheric pollutants, particularly radon, contribute to indoor air pollution and increased lung cancer risk.
Genetic mutations, such as in c-MYC, KRAS, EGFR, c-MET, and other tumor suppressors, contribute to lung cancers, even in nonsmokers. – About 25% of lung cancers are in never-smokers, with possible precursor (pre-invasive) lesions, such as squamous dysplasia, atypical adenomatous hyperplasia, and others.

Malignant Mesothelioma

Arises from the pleura, peritoneal, pericardium, or tunica vaginalis.
Strongly linked to asbestos exposure, particularly with a high latency period.
Characterized by poor prognosis; the 5-year survival rate is generally under 16%.
Extrapleural pneumonectomy, a radical surgical procedure, can improve prognosis in certain subtypes.

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Description

Test your knowledge on emphysema and pneumonia with this quiz. Covering types of emphysema, their clinical manifestations, and treatment options, as well as details about pneumonia and its causes. Perfect for anyone studying respiratory diseases.