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Yr3 Respiratory > 3. Lung Pathology > Flashcards

3. Lung Pathology Flashcards

1
Q

The ____ have C-shaped rings of cartilage with ____ glands

A

Trachea

Mucous Glands

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2
Q

The ____ have discontinuous cartilage plates and ____ glands

A

Bronchi

Mucous Glands

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3
Q

The ____ have NO Cartilage or Mucous Glands

A

Bronchioles

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4
Q

What are the two main types of Bronchioles and describe them

A

Terminal: <2 mm in diameter

Respiratory: Where Gas exchange takes place

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5
Q

The ___________ have a Flat Epithelium
No Glands
No Cilia

A

Alveolar Ducts

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6
Q

The __________ have
No Glands
No Cilia

A

Alveolar Sacs

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7
Q

What are the main Lung Diseases of Vascular Origin?

A
  1. Pulmonary Oedema
  2. Diffuse Alveolar Damage (Acute ARDS)
  3. Emboli/Infarction
  4. Pulmonary Hypertension
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8
Q

What can usually be seen in Pulmonary Oedema?

A
  1. Heavy Wet Lungs
  2. Alveolar Pink Granular Fluid with Haemosiderin-Laden Macrophages
  3. Brown induration
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9
Q

What can usually be seen in DAD (Diffuse Alveolar Damage)?

A
  1. Oedema fluid and Fibrinous Membranes lining alveoli
    - –Oedema is caused by injury to Alveolar Capillary Endothelium
    - –Also by Shock, Sepsis, Trauma
  2. Can proceed to severe scarring
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10
Q

How are Emboli/Infarction caused and where can you find them?

A
  1. Pulmonary Artery Occlusion due to clots from Lower Deep Veins (Bedridden)
  2. Large Saddle Emboli are fatal
    - Lodged at Bifurcation of Pulmonary Trunk
  3. Smaller Emboli
    - Lodged peripherally
    - Wedge-shaped infarcts
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11
Q

For Emboli, where are Large saddle emboli usually lodged?

A

Bifurcation of Pulmonary Trunk

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12
Q

For Emboli, where are Small saddle emboli lodged?

A

Peripherally

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13
Q

How is Pulmonary Hypertension caused?

A
  1. When there is low Pulmonary circulatory resistance
  2. Increased Pulmonary Pressure is SECONDARY TO:
    - COPD
    - Left Valvular Heart Disease (Most common)
    - Thromboemboli
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14
Q

What fatal conditions can Pulmonary Hypertension develop into?

A

Right Ventricular Hypertrophy and Failure or Chronic Cor Pulmonale?

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15
Q

What is Cor Pulmonale?

A

Condition causing the Right side of the heart to fail

  • High BP of the Pulmonary Arteries
  • High BP of the Right side of the heart
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16
Q

What can be observed in an Obstructive Pulmonary Disease?

A
  1. Low FEV1
  2. No decrease in TLC
  3. Narrowed Airway/Loss of Recoil
  4. Airway resistance
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17
Q

What can be observed in a Restrictive Pulmonary Disease?

A
  1. Low TLC and FEV1
  2. Decreased TLC
  3. Chest Wall/Interstitial Disorders/Infiltrative (Dust)
  4. Reduced Lung Parenchyma expansion
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18
Q

What are COPDs?

A

Group of diseases characterised by:

  1. Obstructed Air flow (Intermittent/Reversible/Irreversible)
  2. ANY level of the Respiratory Tract
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19
Q

Give FOUR examples of COPDs

A
  1. Bronchial Asthma
  2. Bronchiectasis (Airways widen and fill with mucus)
  3. Chronic Bronchitis
  4. Emphysema
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20
Q

What usually links both Chronic Bronchitis and Emphysema?

A

Both usually co-existent and usually via Smoking

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21
Q

What is the Clinical Definition of Chronic Bronchitis?

A

Productive cough for 3+ months in 2 consecutive years

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22
Q

What symptoms can you usually see in Chronic Bronchitis?

A
  1. Mucous Gland Hypertrophy
  2. Mucus Hypersecretion
  3. Hypoxia
  4. Hypercapnia

BLUE BLOATER

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23
Q

What is the Pathological Definition of Emphysema?

A

Permanent dilatation of the airways DISTAL to the Terminal Bronchiole

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24
Q

What symptoms can you usually see in Emphysema?

A
  1. Hyperventilation
  2. Normal Blood Gases
  3. Elastin is DESTROYED and there is less recoil

PINK PUFFERS

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25
Q

What types of Emphysema are there?

A

Centri-Acinar

Pan-Acinar

Distal Acinar (Paraseptal)

Irregular

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26
Q

What is Centriacinar Emphysema?

A

Affected Central/Proximal Parts of Respiratory Bronchioles

SMOKERS

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27
Q

What is Panacinar Emphysema?

A

Uniform dilation of Acini from Respiratory Bronchiole to the Alveoli

A1AT DEFICIENCY

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28
Q

What is Paraseptal Emphysema?

A

Peripheral along the Lung Margins
Adjacent to SCARRING/FIBROSIS/COLLAPSE

Predisposition to Spontaneous Pneumothorax in Young Adults

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29
Q

Which type of Emphysema predisposes to Spontaneous Pneumothorax in Young Adults?

A

Paraseptal

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30
Q

What is Irregular Emphysema?

A

Irregular involvement of Acini

SCARRING Patients

31
Q

What is the pathogenesis of Emphysema?

A

Protease-Antiprotease Hypothesis:

- Imbalance of these two will DESTROY ELASTIN

32
Q

What can lead to A1AT destruction?

A
  1. Congenital A1AT deficiency
  2. Smoking -> Free Radicals
  3. Smoking -> Elastase/PMN
33
Q

What is Bronchial Asthma?

A
  1. Increased irritability of Bronchial Tree

2. Paroxysms (sudden attack) of Reversible Bronchospasm

34
Q

What is the commonest cause of Bronchial Asthma?

A

Atopic
Caused by Type 1 HS to common allergens:
1. Pollen
2. House dust

35
Q

What are the less common causes of Bronchial Asthma?

A
  1. Aspirin-induced
  2. Occupational Infection (Allergic Bronchopulmonary Aspergillosis)

Aspergillus fumigatus

36
Q

What is Bronchiectasis?

A
  1. Perma dilation of the Bronchi/ioles with Wall Necrosis

2. Follows Obstruction/Viral Pneumonia

37
Q

What symptoms usually come with Bronchiectasis?

A
  1. Saclike airways
  2. Foul pus/sputum
  3. Chronic Paroxysmal Cough due to posture change
38
Q

What complications can Bronchiectasis lead to?

A
  1. Respiratory Failure (Insufficient O2 from Lungs to Blood)
  2. Atelectasis (Improper inflation of some segments)
  3. Cor Pulmonale
  4. Abscess (Pus)
  5. Fibrosis
  6. Clubbing
39
Q

What are Restrictive Lung Diseases characterised by?

A
  1. Diffuse/Chronic Damage to:
    - Pulmonary Interstitium
    - Basement membranes
    - Collagen
    - Elastic Tissue
    - Fibroblasts
    - Leukocytes
40
Q

What changes can be seen in RLDs?

A
  1. Physio: Less Oxygen diffusing capacity/volume/compliance in lungs
  2. Chest X-Ray: Diffuse infiltration by
    - Small nodules
    - Irregular lines
    - Ground-Glass Shadows
41
Q

What are the main causes of RLDs?

A
  1. Environmental Diseases (Occupational too): 25%
  2. Sarcoidosis: 20%
  3. Collagen Vascular Diseases: 10%
  4. Idiopathic Pulmonary Fibrosis: 15%
  5. Miscel
42
Q

What is Occupational Lung Disease?

A

Diseases caused by inhaling dust/small particles

43
Q

What are the Two Broad Mechanisms of Injury to the Lung?

A
  1. Scarring from Chronic Irritation (Inert substances/Pneumoconiosis from coal workers)
  2. Hypersensitivity (Dusts)
44
Q

Give some examples for Occupational Lung Diseases

A
  1. Coal Workers:
    Pneumoconiosis
    Anthracosis
    Progressive Massive Fibrosis
  2. Silicon: Caplan’s Syndrome
  3. Asbestos: Lungs/Stomach/Colon
  4. Farmer’s Lung
    Bagassosis (Bagasse Dust)
    Byssinosis (Cotton/Hemp)
45
Q

What is Sarcoidosis characterised by?

A
  1. Non-Caseating Granulomatous reaction in MANY tissues (Lungs 90% of the time)
  2. Found incidentally/present with respiratory symptoms
46
Q

Can you treat Sarcoidosis?

A

Steroid therapy can be unpredictable

47
Q

What type of cancers can be caused by Smoking?

A
  1. Lip
  2. Tongue
  3. Floor of Mouth
  4. Larynx
  5. Oesophagus
  6. Urinary Bladder
  7. Kidney
  8. Pancreas
48
Q

What is the progression of cellular change in Smoking/Lung Cancer?

A
  1. Ciliated, Mucus-secreting, Pseudostratified, Columnar)
  2. Stratified Squamous
  3. Squamous DYSPLASIA
  4. Carcinoma
49
Q

What are the different types of Lung Cancer?

A
  1. Squamous Cell Carcinoma
  2. Adenocarcinoma
  3. Small Cell Carcinoma
  4. Large Cell Carcinoma
  5. ETC
50
Q

What is the relative percentage of individuals with Squamous Cell Carcinoma?

A

25-40%

51
Q

What is the relative percentage of individuals with Adenocarcinoma?

A

25-40%

52
Q

What is the relative percentage of individuals with Small Cell Carcinoma?

A

20-25%

53
Q

What is the relative percentage of individuals with Large Cell Carcinoma?

A

10-15%

54
Q

Which type of Carcinoma is known to be treated surgically?

A

NSCLC

55
Q

Why is SCLC not treated surgically?

A

Widely disseminated at time of diagnosis

56
Q

What do we use to treat SCLC then?

A

Chemotherapy

57
Q

What are the mechanisms of Targeted therapy for NSCLCs?

A
  1. Block receptors with antibodies
  2. Block cell pathways with inhibitors
    (Since Tumour cells express GFRs, we can block them to stop dividing)
  3. Stop Angiogenesis by the tumour
  4. Encourage immune response to fight against the tumour cells
58
Q

What are the main targeted receptors for NSCLCs?

A

EGFR
VEGR

MET
BRAF

59
Q

What is EGFR?

A

Receptor usually detected by PCR or NGS

60
Q

What is PD-1/PD-L1 interaction?

A

PD-1 Receptor on T cells
PD-L1 on Tumour Cells

This interaction can protect the cancer cell from immune destruction

If we block it, the T cells can destroy the tumour

PEMBROLIZUMAB

61
Q

What are the Local clinical features of Lung Cancer?

A

Locally: Coughing/Haemoptysis/Pain

62
Q

What are the General clinical features of Lung Cancer?

A

Weight Loss
Clubbing
Hypertrophic Pulmonary Osteoarthropathy

63
Q

Why can Lung Cancer lead to PNS?

A

Paraneoplastic Syndromes are due to Ectopic Hormone production by tumour cells

  • Hypercalcemia
  • SIADH
64
Q

What is the prognosis of Lung Cancer

A

Determined by Staging

5 Year survival usually

65
Q

What is the clinical Definition of Asthma?

A

More than 1 of:

  1. Wheeze
  2. Breathlessness
  3. Chest tightness
  4. Cough
  5. EPISODIC

A. Variable Airflow Obstruction
B. Airway Hyper-responsiveness
C. Airway Inflammation

66
Q

When considering Asthma, what should you consider?

A
  1. Episodic Symptoms
  2. Wheezing in Auscultation
  3. Diurnal Variability
  4. Atopy
  5. Absence of other symptoms
67
Q

What drugs are given to treat Asthma as required?

A

Short Acting Bronchodilators

  • Salbutamol
  • Terbutaline

NOT RECOMMENDED ALONE

68
Q

What drugs are considered 1st line regular maintenance for Asthma?

A

ICS

  • Beclamethasone
  • Budesonide
  • Mometasone
  • Fluticasone
69
Q

What drugs are considered 2nd line regular maintenance for Asthma?

A

Long Acting Beta2 Agonists

  • Salmeterol
  • Formoterol
  • Indacterol
  • Vilanterol
70
Q

What drugs are considered 3rd line regular maintenance for Asthma?

A

LTRA: Montelukast

Anticholinergics: Tiotropium

Theophyllines (Nasty side effects)

71
Q

What drugs are considered 4th line regular maintenance for Asthma?

A

Anti-IgE therapy
Anti-IL5 Therapy
Other biological products

72
Q

What drugs are considered 5th line regular maintenance for Asthma?

A

Oral Steroids

73
Q

What is 33-92-CHEST?

A

Life-Threatening Asthma

  • PEF < 33%
  • Sats <92%
  • Cyanosis
  • Hypotension
  • Exhaustion
  • Silent Chest
  • Tachy/Bradycardia

Yr3 Respiratory (5 decks)

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