Pathology of Respiratory System: Lungs

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Questions and Answers

What is the primary cause of hemodynamic pulmonary edema?

Congenital diaphragmatic hernia

Increased capillary permeability

Abnormalities in lung expansion

Increased hydrostatic pressure (correct)

Where are foregut cysts most often located?

In the pleural cavity

In the hilum or middle mediastinum (correct)

In the lower lobes of the lungs

In the upper lobes of the lungs

What is characteristic of pulmonary sequestration?

Abnormal connection to the airway system

Normal blood supply from the pulmonary artery

Compression of nearby structures

Lack of any connection to the airway system (correct)

What type of pulmonary edema is caused by microvascular injury?

Pulmonary edema due to increased capillary permeability Signup and view all the answers

What is a common association of pulmonary sequestration?

Other congenital anomalies Signup and view all the answers

What is the characteristic feature of alveolar microhemorrhages and hemosiderin-laden macrophages?

They are a result of long-standing pulmonary congestion Signup and view all the answers

Where does fluid initially accumulate in hemodynamic pulmonary edema?

In the basal regions of the lower lobes Signup and view all the answers

What is the cause of noncardiogenic pulmonary edema?

Primary injury to the vascular endothelium or damage to alveolar epithelial cells Signup and view all the answers

What is a characteristic of extralobar sequestrations?

Location external to the lung Signup and view all the answers

What is the outcome of severe cases of noncardiogenic pulmonary edema?

Leakage of fluid into the alveoli Signup and view all the answers

What is a complication of pulmonary edema in the early neonatal period?

Fatal outcome Signup and view all the answers

What is the characteristic feature of intralobar sequestrations?

They occur within the lung Signup and view all the answers

What is the outcome of long-standing pulmonary congestion?

Fibrosis and thickening of the alveolar walls Signup and view all the answers

What is the characteristic feature of pneumonia?

Edema remains localized and is overshadowed by the manifestations of infection Signup and view all the answers

Which of the following is a risk factor associated with a worse prognosis in Acute Respiratory Distress Syndrome (ARDS)?

Chronic alcoholism Signup and view all the answers

What is the characteristic histologic manifestation of Acute Lung Injury (ALI) and ARDS?

Diffuse Alveolar Damage (DAD) Signup and view all the answers

Which of the following is NOT a common cause of Acute Lung Injury (ALI)?

Pulmonary embolism Signup and view all the answers

What is the effect of activated endothelium on microvascular permeability in the pathogenesis of Acute Lung Injury (ALI)?

It increases microvascular permeability Signup and view all the answers

What is the characteristic clinical manifestation of Acute Respiratory Distress Syndrome (ARDS)?

Profound dyspnea and tachypnea Signup and view all the answers

What is the effect of Type II pneumocyte necrosis on surfactant production in Acute Lung Injury (ALI)?

It decreases surfactant production Signup and view all the answers

Which of the following is a feature of Restrictive Lung Disease?

Decreased total lung capacity (TLC) Signup and view all the answers

What is the effect of Obstructive Lung Disease on FEV1?

It decreases FEV1 Signup and view all the answers

Which of the following is an example of Restrictive Lung Disease?

Pulmonary fibrosis Signup and view all the answers

What is the effect of Acute Lung Injury (ALI) on lung function?

It impairs lung function Signup and view all the answers

What is the primary characteristic of Pulmonary Hypoplasia?

Defective development of both lungs Signup and view all the answers

What is the main complication of Atelectasis?

Inadequate oxygenation Signup and view all the answers

What is the cause of Atelectasis due to Resorption?

Air or fluid in the alveoli Signup and view all the answers

What is the characteristic of Contraction Atelectasis?

Tracheal deviation to the affected side Signup and view all the answers

What is the primary difference between Compression and Resorption Atelectasis?

Cause of lung collapse Signup and view all the answers

What is the impact of long-standing Contraction Atelectasis on tracheal deviation?

Tracheal deviation to the opposite side Signup and view all the answers

What is the characteristic of Pulmonary Edema?

Generally reversible Signup and view all the answers

What is the primary complication of Atelectasis?

Inadequate oxygenation and increased risk of infection Signup and view all the answers

Study Notes

Congenital Anomalies

Pulmonary Hypoplasia: defective development of both lungs, resulting in decreased weight, volume, and acini for body weight and gestational age
Foregut Cysts: arise from abnormal detachments of primitive foregut, located in the hilum or middle mediastinum, classified as bronchogenic, esophageal, or enteric
Pulmonary Sequestration: discrete area of lung tissue that lacks connection to the airway system, with abnormal blood supply arising from the aorta or its branches
- Types: extralobar (external to the lung, commonly found in infants) and intralobar (occur within the lung, present in older children)

Atelectasis

Collapsed lung, generally reversible except for contraction
Complications: inadequate oxygenation and increased risk of infection

Pulmonary Edema

Leakage of excessive interstitial fluid that accumulates in alveolar spaces
Causes: hemodynamic disturbances (cardiogenic pulmonary edema) or increase in capillary permeability due to microvascular injury
Types:
- Hemodynamic Pulmonary Edema:
  - Caused by increased hydrostatic pressure, commonly seen in left-sided congestive heart failure
  - Fluid accumulates initially in the basal regions of the lower lobes (dependent edema)
  - May be associated with alveolar microhemorrhages and hemosiderin-laden macrophages (“heart failure” cells)
- Edema Caused by Microvascular (Alveolar) Injury:
  - Noncardiogenic pulmonary edema due to injury to the alveolar septa
  - Primary injury to the vascular endothelium or damage to alveolar epithelial cells
  - Inflammatory exudate leaks into the interstitial space and alveoli

Acute Lung Injury and ARDS

Abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure
Acute respiratory distress syndrome (ARDS) - severe ALI
Histologic manifestation: diffuse alveolar damage (DAD)
Most common causes: sepsis, diffuse pulmonary infections, gastric aspiration, and mechanical trauma (head injuries)
Pathogenesis:
- Endothelial activation and leukocyte adhesion
- Inflammation and tissue injury
- Pneumocyte necrosis and decreased surfactant production
- Diffusion defect and hypoxemia

Obstructive and Restrictive Lung Diseases

Features:
- Obstructive: ↑ airway resistance due to obstruction, ↓ expansion of the lung parenchyma
- Restrictive: ↓ expansion of the lung parenchyma, ↓ TLC
Examples:
- Obstructive: bronchial asthma, emphysema, chronic bronchitis, bronchiectasis
- Restrictive: pulmonary fibrosing diseases, chest wall disorders
Lung Volumes:
- Obstructive: ↑ lung volumes, ↓ FEV1
- Restrictive: ↓ lung volumes, ↓ FVC
FEV1/FVC:
- Obstructive: ↓
- Restrictive: ↓ (but not as low as obstructive)

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Description

This quiz covers diseases of the respiratory system, including atelectasis, pulmonary edema, and acute lung injury. It's designed for BSOT 1-1 students.