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Clinical Pathology > 15+16 Respiratory pathology > Flashcards

15+16 Respiratory pathology Flashcards

1
Q

Differentiate between Type 1 and Type 2 respiratory failure.

A

Both PaO2 6.3
T1: hypoxic drive (CO2 less than 6.3).
T2: hypercapnic drive (CO2 more than 6.3)

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2
Q

What causes bronchial breathing?

Pleural rub?

A

BB: sound conduction through solid lung
PR: relative mvmt of inflamed pleura

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3
Q

What are the risk factors for lung carcinoma? (4).

A

Cigarettes.
Asbestos (±asbestosis).
Lung fibrosis (inc asbestosis + silicosis).
Radon.

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4
Q

What are the different types of asbestos? (3).

A

Amphiboles: blue (most dangerous), brown.
Serpentines: white (least dangerous).

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5
Q

What does high level exposure to asbestos cause?

A

Pulmonary interstitial fibrosis.

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6
Q

Which type of lung cancer are prescribed occupational diseases? (4).

A

Asbestosis.
Asbestos related pleural fibrosis.
Silicosis.
Lung CA in absence of asbestosis if Hx of 5years high exposure work.

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7
Q

What types of primary lung carcinomas are there?

A

Non-small cell carcinoma (85%): squamous, adenocarcinoma, large cell neuroendocrine, undifferentiated large cell.

Small cell carcinoma (15%): all neuroendocrine.

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8
Q

Immunocytochemistry is used to differentiate between secondary lung tumours. Which common mets show which molecules? (4types)

A

Colorectal: cytokeratin 7+20 +ve
Upper GI: cytokeratin 7+20 +ve
Breast: oestrogen +ve
Melanoma: S100, HMB45, MelanA +ve, cytokeratin -ve

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9
Q

What is the pathology of squamous carcinoma of the lung? (5).
Cells, smoking, location, paraneoplastic.

A

Epidermoid (desmosome linked) ± keratinisation
90% smokers
Central > peripheral
Hypercalcaemia due to parathyroid hormone related peptide.

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10
Q

What is the pathology of adenocarcinoma of the lung? (4).

Cells, location, smoking, expression.

A

Glandular cells, serous vacuoles in acinar/tubular/papillary structures.
Central=peripheral.
80% smokers.
Thyroid transcription factor (TTF) expressed.

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11
Q

What is the pathology of bronchioalveolar carcinoma? (3).

Cells, invasion, mimic.

A

Spread of well differentiated mucinous/non-mucinous neoplastic cells on alveolar walls.
Non invasive.
Mimic pneumonia.

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12
Q

Which proteins do neuroendocrine cells of the lung produce? (3).
What is the other name for these cells?

A

Neural cell adhesion molecule (CD56).
Chemogranin.
Synaptophysin.
Kulchitsky cells.

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13
Q

What are the different types of neuroendocrine tumours? (4).

A

Carcinoid.
Atypical carcinoid.
Large cell neuroendocrine carcinoma.
Small cell carcinoma.

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14
Q

What is the pathology of a typical carcinoid tumour of the lung?
Behaviour, histology, associations, severity.

A 
Often occlude bronchi.
Oganioid, bland cells, no necrosis.
Associated with MEN1.
Not smoking associated.
Not benign.
95% 5 year survival.
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15
Q

What is the pathology of atypical carcinoid tumours of the lung?
Histology, behaviour.

A

11% of lung carcinoids.
Less organoid, more atypic and nucleoli. Necrosis present.
More aggressive - 70% metastasise and 60% 5 year survival.

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16
Q

What is the pathology of large cell neuroendocrine carcinomas of the lung?
Cells, histology, smoking.

A

Organoid, eosinophilic granular cytoplasm.
Severe atypia, nucleoli and necrosis.
Associated with smoking.

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17
Q

What is the pathology of small cell carcinomas?

Behaviour, secretion, smoking, presentation.

A

Rapidly progressive and malignant.
Neurosectory granules with ACTH.
99% in smokers.
Will present with mets.

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18
Q

How common are lung carcinomas with multiple differentiation?
Define mixed vs combined SCC.

A

50% of cancers.
Mixed: >10% of component.
Combined: ant % SCC + NSCLC.

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19
Q

What is the pathology of large cell carcinomas? (3).

A

No specific morphology.
50% express thyroid transcription factor.
May be neuroendocrine.

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20
Q

What are the paraneoplastic effects of lung carcinomas? (6).

A 
Cachexia.
Acanthosis nigricans (darkened skin).
Clubbing.
Thrombophlebitis migrans.
Hypercalcaemia (squamous cell)
SCC: Lambert Eaton myasthenia syndrome, ACTH, ADH.
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21
Q

How are lung malignancies staged?

A

T1: 7cm. Lung structure invasion, nodules in same lobe.
T4: Tumour in carina, invades out of lung, nodules in other lobe.

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22
Q

Which drugs are epidermal growth factor receptor tyrosine kinase inhibitors. (2).
How do they work?
Who?

A

Gefitinib. Erlotinib.
ATP analogues that inhibit EGFR-TK (if mutation present). Inhibits mitosis. Not curative but stabilising.
In 10% of NSCLC. More common in Asian women.

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23
Q

What are ALK rearrangements in lung cancer?
Who are they most common in?
Which drug targets this?

A 
Anaplastic lymphoma kinase.
inv(2)(p21;p23). ALK + EML fusion.
Activates ALK tyrosine kinase.
Non smoking Asian women.
Crizotinib.
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24
Q

What is a chylothorax?

Empyema/pyothorax?

A

Chylo: lymph in pleural cavity
Pyro: pus in pleaural cavity

25
Q

What are the causes of a pleural effusion? (2).

A

Serous/fibrinous exudate due to inflammation in adjacent lung.
Congestive cardiac failure - transudate.

26
Q

What types of pleural tumours are there?

A

Benign: fibroma. Rare.
Malignant: secondary adenocarcinoma (lung/breast). Primary malignant mesothelioma (rarer).

27
Q

What is the pathology of a malignant mesothelioma?

Cause. Cells.

A

> 90% asbestos related, may be low level exposure. 15-60yr latent period.
Mixed spindle and epithelioid cells.

28
Q

How does a malignant mesothelioma spread?

A

Initial nodule and effusion, later obliterating pleural cavity, invading chest wall.
Mets uncommon due to fatality .

29
Q

What is a fibrous pleural plaque?
Related to?
Prognosis?

A

On lower thoracic wall and diaphragmatic parietal pleura.
Low level asbestos exposure.
No physiological effect. Not premalignant.

30
Q

What types of illness are lung infections commonly secondary to?

A

Mucociliary escalator - physical obstruction, poor cough reflex, Kartagener’s syndrome, cystic fibrosis.
Immunity - obvious, smoking, hypoxia (macrophage).
Pulmonary oedema.

31
Q

What is pneumonia?

A

Inflammatory exudate in alveoli and distal small airways with consolidation.

32
Q

What causes bronchopneumonia and how is it distributed?

A

Low virulence bacteria, fungi.

Common, patchy and bronchocentric.

33
Q

What causes lobar pneumonia, and how does it affect the lungs?

A

90% Strep pneumoniae.
Klebsiella pneumoniae -elderly, diabetic, alcoholic.
Uncommon.
Lobes with overlying pleuritis. congestion, hepatisation, and resolution without scarring.

34
Q

What causes atypical pneumonia’s in non-immunosuppressed patients? (5)

A 
Viral.
Mycoplasma pneumoniae.
Chlamydia.
Coxiella burnetti (Q-fever).
Legionella pneumophilla.
35
Q

What causes atypical pneumonia’s in immunosuppressed patients? (6)

A 
Candida
Aspergillus
Pneumocystis carinii.
CMV
HSV
Measles
36
Q

What are the non-infective pneumonias? (4).

A

Aspiration pneumonia.
Lipid (retention pneumonitis).
Cryptogenic organising pneumonia.
Bronchiolitis obliterans organising pneumonia.

37
Q

How does pulmonary tuberculosis usually resolve or progress? (4)

A

Empyema.
Pneumonia.
Miliary.
Limited spread to bone, kidney.

38
Q

Name three causes of pulmonary vasculitis:

A

Wegener’s granulomatosis.
Churg-Strauss syndrome.
Goodpasture’s syndrome.

39
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.

40
Q

What is chronic obstructive pulmonary disease?

A

A combination of chronic bronchitis and emphysema.

41
Q

Define chronic bronchitis.

Pathology?

A

Cough and sputum for 3 months in each of 2 consecutive years.
Mucus gland hyperplasia with 2o infection + chronic inflamm -> wall weakness + destruction.

42
Q

What is emphysema?

A

Abnormal permanent dilation of airspaces distal to terminal bronchiole with destruction of the wall and without obvious fibrosis.

43
Q

Describe the three classifications of emphysema:

A

Centrilobular: smoking/coal.
Panlobular: >80% α1 antitrypsin deficient, lower lobes.
Paraseptal: upper lobe bulllae + fibrosis.

44
Q

What are the two stereotypes for COPD?

A

Bronchitis - blue bloater, large heart, younger.

Emphysema - pink puffer, small heart, hyper inflated lungs, older.

45
Q

What is asthma?

A

Paroxysmal bronchospasm with wheeze, cough, and partially reversible bronchorestriction.

46
Q

Describe atopic asthma and common stimuli:

A

Type 1 hypersensitivity reaction. Smooth muscle hypertrophy, mucus gland hyperplasia.
Dust, pollen, animals, cold, exercise.

47
Q

What is interstitial lung disease?

4 examples:

A

Increased tissue in alveolar-capillary wall.
Decreases lung compliance, increases gas diffusion distance.

Idiopathic pulmonary fibrosis,
Pneumoconioses
Sarcoidosis,
Collagen vascular diseases

48
Q

What is acute interstitial lung disease?

A

Exudate and death of type 1 pneumocytes. Type 2 pneumocyte hyperplasia.
= Adult respiratory distress syndrome.

49
Q

What is chronic interstitial lung disease?

A

Increasing dyspnoea, clubbing, crackles, fine cough.

Interstitial fibrosis and chronic inflammation.

50
Q

What is idiopathic pulmonary fibrosis?
Histology?
Macro appearance?

A

Cryptogenic fibrosing alveloitis.
Sub-pleural, lower lobes affected most.
Interstitial pneumonia.
Bosselated pleural surface due to interstitial fibrous tissue contraction.

51
Q

What is sarcoidosis?
Clinical effects?
Who?

A

Non-caseating perilymphatic pulmonary granulomas, then fibrosis.
May affect other organs. Hypercalcaemia and elevated ACE.
Young adult females.

52
Q

What are pneumoconiosis?

A

Non neoplastic lung diseases due to inhalation of mineral dusts in the workplace.

53
Q

How does silicosis produce a disease state?

Risk? (2)

A

Silica kills macrophages, causing fibrosis and fibrous silicotic nodules.
Increased risk of lung carcinoma. TB reactivation.

54
Q

What is asbestosis?

Risk?

A

Interstitial fibrosis with visible asbestos bodies. Increased risk of lung cancer.

55
Q

What is hypersensitive pneumonitis?
Who gets it?
Histology?

A

Type III hypersensitivity reaction to organic dusts.
Farmers (actinomycetes), pigeon fanciers.
Inflammation and non caseating granulomas.

56
Q

What is cystic fibrosis?

Genetics?

A

Inherited multiorgan disorder of epithelial cells affecting fluid secretions.
Caucasians, autosomal recessive.
CFTR gene on 7q31.2.

57
Q

What does cystic fibrosis cause? (6).

A 
Hyperplasia of mucus glands.
Mucus distended bronchioles.
Atrophy of pancreas with impaired fat absorption, enzyme secretion and vitamin deficiencies. 
Meconium ileum. 
Cirrhosis. 
Male infertility.
58
Q

Differentiate between type 1 and type 2 pneumocytes:

A

Type 1 : gas exchange.

Type 2: surfactant production.

Clinical Pathology (66 decks)

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