Patho respiratory

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Questions and Answers

What is the main characteristic of chronic bronchitis?

Destruction of airspaces

Persistent, productive cough for ≥ 3 months in ≥ 2 consecutive years (correct)

Inflammation of the alveolar capillary membrane

Carcinoma of the lung

What is the prognosis for acute respiratory distress syndrome?

Good (20% mortality)

Bad (40% mortality) (correct)

Good (80% mortality)

Unknown

What is the main cause of centriacinar emphysema?

Alpha-1-antitrypsin deficiency

Smoking (correct)

Infection

Air pollution

What is the characteristic of asthma?

Chronic inflammation of the airways Signup and view all the answers

What is the main cause of panacinar emphysema?

Alpha-1-antitrypsin deficiency Signup and view all the answers

What is the morphology of acute respiratory distress syndrome?

Diffuse alveolar damage with hyaline membranes Signup and view all the answers

What is the trigger for asthma?

All of the above Signup and view all the answers

What is the definition of emphysema?

Destruction of airspaces Signup and view all the answers

What is the primary cause of death in medically/economically deprived areas?

Tuberculosis Signup and view all the answers

What is the name of the complex that forms in primary tuberculosis?

Ghon complex Signup and view all the answers

Which of the following is an opportunistic pneumonia that affects immunosuppressed patients?

Pneumocystis jiroveci Signup and view all the answers

What is the name of the type of branching seen in Aspergillus?

Acute-angle branching Signup and view all the answers

What is the main risk factor for lung cancer?

Smoking Signup and view all the answers

What is the term for the inflammatory response seen in tuberculosis?

Caseating granuloma Signup and view all the answers

Which of the following is a type of lung disease that can cause acute respiratory distress syndrome?

Carcinoma Signup and view all the answers

What is the name of the fungus that causes opportunistic pneumonias in immunosuppressed patients?

Aspergillus Signup and view all the answers

What is the primary cause of bronchiectasis?

Chronic inflammation Signup and view all the answers

What is the characteristic symptom of idiopathic pulmonary fibrosis?

Gradual onset of cough Signup and view all the answers

What is the most common source of pulmonary emboli?

Deep venous thromboses in leg veins Signup and view all the answers

What is the percentage of US deaths attributed to pneumonia?

2% Signup and view all the answers

What is the characteristic feature of idiopathic pulmonary fibrosis on radiologic examination?

Honeycomb lung Signup and view all the answers

What is the primary difference between bacterial and viral pneumonia?

Acute-onset shaking chills Signup and view all the answers

What is the term used to describe the radiologic pattern of idiopathic pulmonary fibrosis?

Usual interstitial pneumonia Signup and view all the answers

What is the primary risk factor for pneumonia?

All of the above Signup and view all the answers

Study Notes

Respiratory Pathology

Acute Respiratory Distress Syndrome

Symptoms: acute respiratory insufficiency that doesn’t respond to oxygen
Causes: pneumonia, aspiration of gastric contents, sepsis, severe trauma
Pathogenesis: damage to alveolar capillary membrane; neutrophils play a big role
Morphology: “diffuse alveolar damage” with hyaline membranes
Prognosis: bad (40% mortality)

Obstructive Lung Diseases

Emphysema

Destruction/enlargement of airspaces
Types:
- Centriacinar emphysema: destruction of proximal acinus, worse in upper lobes of lung, caused by smoking
- Panacinar emphysema: destruction of entire acinus, worse in lower lobes of lung, caused by alpha-1-antitrypsin deficiency

Chronic Bronchitis

Definition: persistent, productive cough for ≥ 3 months in ≥ 2 consecutive years
Pathogenesis: hypersecretion of mucous
Causes: smoking (mostly) and pollution

Asthma

Chronic inflammatory disease of airways leading to bronchial constriction
Symptoms: wheezing, breathlessness
Hallmarks: intermittent, reversible airway obstruction, chronic inflammation, increased mucus
Triggers: allergens, infection, smoke, cold, exercise

Bronchiectasis

Permanent dilation of bronchi and bronchioles due to chronic inflammation
Secondary to: obstruction (tumor), congenital conditions (cystic fibrosis), bad pneumonia

Restrictive Lung Diseases

Idiopathic Pulmonary Fibrosis

Patchy, progressive lung fibrosis
Symptoms: gradual onset cough, dyspnea, respiratory failure and cor pulmonale within about 3 years
Radiologic and histologic term: “usual interstitial pneumonia”

Vascular Diseases

Pulmonary Embolism

Most arise from deep venous thromboses in leg veins
Symptoms: shortness of breath, infarction, or asymptomatic
Morphology: “saddle” embolism filling left and right pulmonary arteries

Infections

Pneumonia

Infection of the lung parenchyma
Risk factors: increased age, chronic disease, immune problems, impaired mucous clearing
Causes: bacteria, viruses
Different anatomic patterns, clinical settings
Symptoms and prognosis:
- Bacterial: acute-onset, shaking chills, fever, productive cough
- Viral: much more variable, fever present, cough may be absent

Tuberculosis

Leading cause of death in medically/economically deprived areas (3 million deaths/year)
Cause: Mycobacterium tuberculosis
Chronic, granulomatous disease primarily of lungs
Spread by respiratory droplet
Primary (initial) TB: Ghon complex (lung+LN)
Secondary (reactivation) TB: Cavitating lung granulomas, “seeding” of other organs

Opportunistic Pneumonias

Affect immunosuppressed patients (patients with AIDS, cancer, post-transplant)
Unusual organisms:
- Pneumocystis jiroveci
- Aspergillus
- Cytomegalovirus

Carcinomas

Causes of lung cancer:
- 80% of cases occur in active smokers or those who have stopped recently
- Linear correlation between frequency of lung cancer and pack-years of cigarette smoking
- However: lung cancer develops in only 10-15% of smokers

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