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Clinical Pathology > 15, 16 - Pathology of Respiratory System > Flashcards

15, 16 - Pathology of Respiratory System Flashcards

1
Q

Conducting airways have what type of epithelium

A

Pseudostratified ciliated columnar mucus secreting epithelium

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2
Q

Type I pneumocytes involved in…

A

Gas exchange

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3
Q

Type II pneumocytes involved in…

A

Surfactant

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4
Q

When is respiratory failure diagnosed?

A

PaO2

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5
Q

Causes of respiratory failure inc. defects in

A

Ventilation
Perfusion
Gas exchange

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6
Q

Type I respiratory failure

A

paCO2

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7
Q

Type II respiratory failure

A

paCO2 >6.3kPa

Hypercapnic respiratory drive

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8
Q

Wheeze vs stridor

A

Proximal vs distal airway obstruction

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9
Q

Crackles on auscultation indicate:

A

Resisted opening of small airways

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10
Q

Wheeze on auscultation indicate:

A

Narrowed small airways

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11
Q

Bronchial breathing on auscultation indicate:

A

Sound conduction through solid lung

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12
Q

Pleural rub on auscultation indicates:

A

Relative movement of inflamed visceral and parietal pleura

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13
Q

Dull percussion indicates:

A

lung consolidation or pleural effusion

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14
Q

Hyper resonance indicates:

A

Pneumothorax or emphysema

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15
Q

VITAMIN D

A 
Vascular
Inflammation
Trauma
Autoimmune
Metabolic
Infectious
Neoplastic
Degenerative
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16
Q

What is a benign primary lung tumour called

A

Adenochondroma

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17
Q

Rough survival rate of lung tumours

A

5%

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18
Q

Risk factors of lung carcinoma

A

Cigarettes
Asbestos
Lung fibrosis - inc. asbestosis, silicosis
Radon
Chromates, nickel, tar, hematite, arsenic, mustard gas

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19
Q

Types of asbestos

A

Amphiboles - blue + brown

Serpentines - white

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20
Q

Most dangerous asbestos

A

Blue (crocidolite)

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21
Q

Pneumoconiosis is?

A

Dust related pneumonia

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22
Q

What jobs are related to asbestos?

A

Insulation work
Ship building & repair
Asbestos textile work
Manufacture of gas masks

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23
Q

Types of malignant primary lung tumours

A

Non-small cell carcinoma (85%) of which 52% are squamous

Small cell carcinoma (neuroendocrine) (15%)

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24
Q

Secondary tumours are more common but the presenting feature is different…

A

Multiple nodules generally

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25
Q

Primary vs secondary tumours how to distinguish

A

History
Morphology
Antigen expression

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26
Q

Lung non-mucinous adenocarcinoma and small cell immunocytochemistry

A

Cytokeratin & thyroid transcription factor positive

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27
Q

Colorectal immunocytochemistry

A

Cytokeratin 7 negative & cytokeratin 20 positive

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28
Q

Upper GI tract immunocytochemistry

A

Cytokeratin 7 positive & cytokeratin positive

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29
Q

Breast immunocytochemistry

A

May be oestrogen receptor positive

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30
Q

Melanoma immunocytochemistry

A

S100, HMB45, MelanA positive, cytokeratin negative

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31
Q

Common lung carcinoma sites

A

Most central, main or upper lobe bronchus

Adenocarcinoma is more peripheral

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32
Q

Squamous carcinoma features

A

+/- keratinisation
Roughly 90% in smokers
Central > peripheral
Hypercalcaemia due to parathyroid related peptide

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33
Q

What is the epithelium of bronchi?

A

Pseudostratified columnar epithelium with ciliated and mucus-secreting cells

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34
Q

What is squamous metaplasia?

A
  1. irritants cause epithelium to reversibly change from pseudostratified columnar to stratified squamous which can keratinise
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35
Q

What is dysplasia?

A

One metaplastic cell undergoes irreversible changes producing the first neoplastic cell

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36
Q

Adenocarcinoma features

A

Glandular cells, serous +/- mucus vacuoles
Central equivalent to peripheral
80% in smokers
Thyroid transcription factor is expressed in many non-mucinous lung adenocarinomas

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37
Q

Bronchioloalveolar carcinoma features

A

Spread of well differentiated mucinous or non-mucinous neoplastic cells on alveolar walls
Not invasive i.e. adenocarcinoma in situ
Mimics pneumonia
Uncommon nodal & distant mets

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38
Q

Neuroendocrine cell proteins

A

Neural cell adhesion molecule (CD56)

Neurosecretory granule proteins - chromogranin, synaptophysin

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39
Q

Neuroendocrine cell in normal mucosa is called…

A

Kulchitsky cells

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40
Q

Typical carcinoid tumour features

A

Grow into and occlude a bronchus

Organoid, bland cells, no necrosis,

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41
Q

Atypical carcinoid tumour features

A 
11% of lung carcinoids
Less organoid, more atypia, nucleoli
Necrosis, 2-10 mitotic figure per 2sqmm
70% meta
60% 5yr survival
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42
Q

Large cell neuroendocrine carcinomas morphology

A

Organoid architecture, eosinophilic granular cytoplasm

Antigen expression

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43
Q

Large cell neuroendocrine features

A

Severe atypia, nucleoli, necrosis, >11 mitotic figures per 2spmm
Prognosis similar/worse than non-small cell lung carcinomas
Associated with smoking

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44
Q

Small cell carcinoma features

A

Rapidly progressive malignant tumours
Neurosecretory granules with peptide hormones such as ACTH
Could have small primary w/ met at presentation
99% are smokers

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45
Q

Large cell carcinoma features

A

No specific squamous/glandular morphology
50% express thyroid transcription factor
Can be neuroendocrine

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46
Q

Staging on lung malignancy uses what system?

A

TNM

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47
Q

TNM T1

A

Diam:
T1a:

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48
Q

TNM T2

A 
Diam: 
T2a: 3-5cm
T2a: 5-7cm
Scopy: >2cm to carina
Atelectasis: lobar atelectasis or obstructive pneumonia to hilus
49
Q

TNM T3

A

Diam: >7cm
Scopy:

50
Q

TNM T4

A

Scopy: tumour in carina
Invasion: heart great vessels, trachea, eoso, spine
Nodules: nodules in other ipsilateral lobes

51
Q

Epidermal growth factor receptor tyrosine kinase inhibitors

A

Oral
Less toxic vs standard cytotoxic chemo
Inhibits mitotic cycle
Not curative but stabilises progression until resistance mutations develop

52
Q

ALK gene short for?

A

Anaplastic lymphoma kinase gene

53
Q

ALK gene features

A

Detect mRNA by FISH, CISH of RT-PCR
Present in 10% of lung adenocarcinomas
Non-smoking, Asian, women

54
Q

Crizotinib

A

ATP analog inhibits ALK, ROS1, c-MET tyrosine kinases
Temporary control
Effective in 90% of tumours
$100,000 per patient per year

55
Q

Causes of pleural effusion

A

Inflammatory: serous/fibrinous - exudate

Non-inflammatory: congestive heart failure

LDH, pH, glucose of fluid can be measured for diagnosis
Cytology used to assess presence of malignant or inflammatory cells

56
Q

Pleural tumour types

A

Benign - rare
Malignant - common
Usually secondary adenocarcinoma
Primary malignant mesothelioma is rarer

57
Q

Malignant mesothelioma

A

> 90% associated with asbestos exposure, blue or brown most hazardous
Exposure may be low level
Long latent period of 15 to 60 years

58
Q

Malignant mesothelioma establishment steps

A
  1. Initial nodule and effusion
  2. Obliterates pleural cavity growing around the lung
  3. Invades chest wall (pain) and lung
  4. Nodal and distant and metastases less common than with carcinomas
  5. Mixed spindle cell and epithelioid cells. May be very fibrous (desmoplastic)
59
Q

How to differentiate adenocarcinoma from malignant mesothelioma

A

Cellular antigen expression (immunocytochemistry on cytology or biopsy)
Symptomatic treatment
Uniformly fatal in usually

60
Q

Virchow’s triad reminder

A

Endothelial injury
Stasis of blood flow
Hypercoagubulity

61
Q

Secondary infection due to problems with:

A

Mucocilliary escalator: physical obstruction, cough reflex, ciliary dysmotility (kartagener’s syndrome), mucus viscosity

Immunity: hypogammaglobulinaemia, lymphomas, immunosuppressive drugs, AIDS; macrophage function: smoking, hypoxia

Pulmonary oedema

62
Q

Common infections of respiratory system

A 
Acute brochitis
Bronchiolitis
Pneumonia
Bronchopneumonia
Lobar pneumonia
Atypical pneumonias
Non-infected pneumonias
Pulmonary TB
63
Q

Acute bronchitis which virus causes it

A

Respiratory Syncytial Virus (RSV)
H.influenzae
Strep. pneumoniae

64
Q

Bronchiolitis what is it?

A

Primary acute infection that occurs in infants.
Caused by RSV
Rare

65
Q

What is pneumonia?

A

Inflammatory exudate in alveoli & distal small airways - consolidation

66
Q

Classifications of pneumonia

A

Clinical - primary of secondary
Aetiological - bacterial, viral, fungal
Anatomical - lobar pneumonia or bronchopneumonia
Reaction - purulent, fibrinous

67
Q

Bronchopneumonia features

A 
Secondary - compromised defences
Low virulence bacteria or occasionally fungi 
Common
Patchy
Bronchocentric
Resolve or heal w/ scarring
68
Q

Lobar pneumonia features

A 
Primary - mainly male 20-50 yo
90% virulent Strep pneumoniae
Uncommon
Confluent segments - whole lobe or lobes with overlying pleuritis
Red to grey hepatisation
Klebsiella pneumonia
69
Q

What is red to grey hepatisation?

A

A state where the lungs is engorged with matter, so no longer pervious to air.

Red is when there are RBCs, neutro, fibrin in pulm. alveolus.

Precedes, grey. Where RBCs have been broken down to fibrinosuppurative exudate.

70
Q

What is Klebsiella pneumoniae?

A

Anaerobic, gram–ve, rod-shaped bacteria that causes pneumonia.

Mainly found in soil.
Affects elderly, diabetic and alcoholic people the most.

71
Q

Atypical pneumonias in non-immunosuppressed - causative agents

A

Viral - flu, varicella, RSV, rhino, measles
Mycoplasma pneumonias - chronic fibrosis
Chlamydia, Coxiella burnetti (Q-fever)
Legionella pneumophilla - systemic, 10-20% fatal

72
Q

Atypical pneumonias in non-immunosuppressed - features

A

Severity mild to fatal
Interstitial lymphocytes, plasma cells, macrophages
Intra-alveolar fibrinous cell-poor exudate
Diffuse alveolar damage

73
Q

Atypical pneumonias in immunosuppressed - causative agents

A

Fungi - candida, aspergillus, pneumocystis carinii

Viruses - CMV (cytomegaly virus), (herpes simplex) HSV, measles

74
Q

Non-infected pneumonias

A

Aspiration - 2* infection often with mixed anaerobes producing abscesses
Lipid - endogenous (retention pneumonitis), exogenous (aspiration)
Cryptogenic organising pneumonia (COP)
Bronchiolitis obliterans organising pneumonia (BOOP)

75
Q

Pulmonary TB - causative agent

A

Mycobacterium TBosis

76
Q

Pulm TB vaccine name

A

Bacille Calmette-Guerin (BCG)

77
Q

Pulm TB - features

A

Asymptomatic, Ghon complex in peripheral lung & hilar nodes which usually resolves
Atypically reactivates

78
Q

Pulm TB - disease progression

A

Empyema
Pneumonia
Miliary or more limited spread to other organs - bone, kidney
Scarring - fibrous calcified scar

79
Q

Pulm TB - what we see

A

Granulomas with multinucleated Langhan’s giants cells & caseous necrosis
Few bacilli but intense immune rxn causing tissue damage
Type IV hypersensitivity to tuberculin - Heaf & Mantoux tests

80
Q

Pulmonary vascular diseases

A

Pulm. vasculitis
Emboli
Obstructive
Bronchiectasis

81
Q

Pulm vascular diseases - what are they?

A

Vessel wall inflammation (vasculitis)
Obstruction of flow
Haemodynamic disturbances

82
Q

Pulmonary vasculitis

A

Necrotising granulomatous vasculitis - Wegener’s granulomatosis; Churg-strauss syndrome
Goodpasture’s syndrome - anti-glomerular basement membrane antibody, intra-alveolar haemorrhage & glomerulonephritis
Microvascular damage - ARDS & DAD, SLE

83
Q

Obstruction via emboli - type of emboli

A 
Thromboemboli - common, DVTs, size determines symptoms
Fat emboli
Air
Amniotic fluid 
Tumour
Foreign bodies
84
Q

What is bronchiectasis?

A

Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
Results from chronic necrotising infection
Rare

85
Q

Predisposing conditions for bronchiectasis

A 
CF
Primary ciliary dyskinesia
Kartagener syndrome
Bronchial obstruction
Lupus, rheumatoid, IBD, GVHD (graft-versus-host-disease)
86
Q

Types of COPD

A

Chronic bronchitis and emphysema

87
Q

What is chronic bronchitis?

A

Cough and sputum for 3 months in each of 2 consecutive years
At bronchi
Caused by chronic irritation
Middle aged and old

88
Q

Pathology of chronic bronchitis

A

Mucus gland hyperplasia and hypersecretion
Secondary infection by low virulence bacteria
Chronic inflammation

89
Q

What is emphysema?

A

Abnormal permanent dilation of airspaces distal to the terminal bronchiole with destruction of airspace wall, w/o fibrosis

90
Q

Why does emphysema occur?

A

Overinflation

91
Q

Classification of emphysema

A

Centrilobular
Panlobular
Paraseptal

92
Q

Centrilobular emphysema

A

Centiacinar

Coal dust, smoking

93
Q

Panlobular emphysema

A

Panacinar
>80% a1 antitrypsin deficient
Rare, AD
Severe in lower lobe bases

94
Q

Paraseptal emphysema

A

Distal acinar
Upper lobe subpleural bullae adjacent to fibrosis
Will cause PT if ruptured

95
Q

Stereotype for predominant bronchitis

A

Blue bloated

96
Q

Stereotype for predominant emphysema

A

Pink puffer

97
Q

What is asthma?

A

Chronic inflammatory disorder of the airways

Paroxysmal bronchospasm

98
Q

What problems does asthma cause?

A

Mucosal inflammation & oedema
Hypertrophic mucous glands & mucous plugs in bronchi
Hyperinflated lungs

99
Q

Clinicopathological classification

A

Atopic
Non-atopic
Aspirin-induced
Allergic bronchpulmonary aspergillosis (ABPA)

100
Q

Atopic asthma - pathology

A

Allergen - dust, pollen, animal products
Cold, exercise, resp infection
Degranulation of IgE bearing mast cells

101
Q

Interstitial lung disease features

A

Diffuse and chronic
Disease of pulm connective tissue
Restrictive disease
Unknown cause

102
Q

What interstitial lung disease does to lungs

A

Increased tissue in alveolar-capillary wall
Decreased lung compliance
Increased gas diffusion distance

103
Q

Acute interstitial disease

A

Diffuse alveolar damage - exudate & death of type I pneumocytes -> form hyaline membranes lining alveoli followed by type II pneumocyte hyperplasia.

Histologically acute interstitial pneumonia.

Adult resp distress syndrome

104
Q

Chronic interstitial lungs disease presentation

A

Dyspnoea increasing for months to years
Clubbing, fine crackles, dry cough
Interstitial fibrosis & chronic inflammation
‘Honeycomb lung’

105
Q

Chronic interstitial lung disease e.g.s

A

Idiopathic pulm fibrosis
Pneumoconioses
Sarcoidosis
Collagen vascular disease-associated lung disease

106
Q

Idiopathic pulm. fibrosis features

A

Aka cryptogenic fibrosing alveolitis
5000 new cases pa
3&5 year mortality (43%, 57%)
Sub-pleural, lower lobes affected first & most severely.

107
Q

Idiopathic pulm. fibrosis histology

A

Usual Interstitial pneumonia
Interstitial chronic inflammation & variably mature fibrous tissue
Adjacent normal alveolar walls
Similar pattern of fibrosis in collagen vascular disease - cobblestone

108
Q

Sarcoidosis features

A

Non-caseating perilymphatic pulmonary granulomas, then fibrosis
Hilar nodes usually involved
Other organs may be affected - skin, heart, brain
Hypercalcaemia & elevated serum ACE
Typically young adult females

109
Q

What are pneumoconiosis?

A

Dust diseases

Non-neoplastic lung diseases due to inhalation of dusts, fume, vapours

110
Q

What size diameter does dust need to be to reach alveoli?

A
111
Q

Coal workers’ pneumoconiosis

A

Anthracosis
Simple macular or could be nodular
Progressive massive fibrosis
COPD if >20 yrs underground mining

112
Q

Silicosis

A 
Silica - sand and stone dust
Kills phagocytosing macrophages
Fibrosis & fibrous silicotic nodules 
Possible reactivation of TB
Increased risk of lung carcinoma
113
Q

Asbestosis

A

High level exposure produces interstitial fibrosis

Histologically like idiopathic pulm. fibrosis but asbestos bodies are identifiable in tissue sections

114
Q

Hypersensitivity pneumonitis

A

Aka extrinsic allergic alveolitis
Type III hypersensitivity reaction to organic dusts
E.g. farmers’ lung (actinomycetes in hay); pigeon fanciers’ lung (pigeon antigens)
Peribronchiolar inflammation w/ poorly formed non-caseating granulomas extends alveolar walls.
Repeated episodes lead to interstitial fibrosis

115
Q

CF

A

Inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the resp, GI and repro organs.
Mainly Caucasians
0.4 per 1000 live births
AR
CTFR gene - transmembrane chloride channel protein

116
Q

CF - clinical presentation

A 
Infancy
Abnormally viscous mucous secretions
Recurrent lung infections
Failure to thrive
Recurrent intestinal obstruction
Pancreatic insufficiency
117
Q

CF - affects on lung

A

Bronchioles distended with mucus
Hyperplasia mucus secreting glands
Multiple repeated infections
Severe chronic bronchitis and bronchiectasis

118
Q

CF - affects on pancreas

A

Exocrine gland ducts plugged by mucus
Atrophy and fibrosis of gland
Impaired fat absorption, enzyme secretion, vitamin deficiencies

119
Q

CF - other organs

A

Small bowel - mucus plugging (meconium ileus)
Liver - plugging of bile cannaliculi - cirrhosis
Salivary glands - similar to pancreas: atrophy & fibrosis
95% of males are infertile

Clinical Pathology (65 decks)

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