6. Respiratory Pathology Flashcards
Definition, epidemiology, aetiology, pathogenesis and key clinical features of:
Asthma
Chronic inflammatory disorder of the airways that is AT LEAST partially reversible (‘twitchy airways’)
Epidemiology: Common, children + young adults
Acute asthma is the commonest occupational lung disease
Aetiology: Dust mites, NSAIDs, cold, exercise, infections, emotions, Aspergillus (ABPA)
Pathogenesis: Type I hypersensitivity reaction involving IgE bearing mast cells and histamines
Clinical features:
Paroxysmal bronchospasm, wheeze, cough, bronchoconstriction, SOB, hyperinflation
Definition, epidemiology, aetiology, pathogenesis and key clinical features of:
Bronchiectasis
Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue as a result of chronic necrotizing infection.
Epidemiology: Rare
Aetiology: Predisposed to infections if you have cystic fibrosis, primary ciliary dyskinesia (Kartagener syndrome), lupus, rheumatoid arthiritis, IBD, GVHD (graft vs host disease)
Pathogenesis: destruction of muscle and elastic tissue by chronic necrotizing infection
Clinical features:
Cough, fever, a lot of foul smelling sputum
Definition, epidemiology, aetiology, pathogenesis and key clinical features of:
Chronic obstructive pulmonary disease (COPD)
COPD is the clinical grouping of ‘chronic bronchitis’ and ‘emphysema’.
Chronic bronchitis = coughing with sputum for 3 months in 2 consecutive years.
Emphysema = abnormal enlargement of the alveolar air spaces
Epidemiology: Smokers, middle + old age, 1 in 20 GP consultations of patients over 65
Aeitology: Cigarette smoke
Pathogenesis: Mucus gland hyperplasia + hypersecretion leading to infections. Chronic inflammation of small airways causes wall weakness and destruction.
Clinical features: Dyspnoea (progressive + worsening), SOB, cough, sputum, infection, right sided heart failure (fewer capillaries, therefore right side of heart has to work harder to compensate pulmonary circulation, eventually failing)
What type of emphysema is associated with a1 antitrypsin deficiency?
Panacinar/panlobular emphysema - (destruction of bronchioles AND alveoli)
severest in lower lobes
(a1 antitrypsin protects lung tissue from breakdown due to inflammatory enzymes, if your deficient in AAT then you are more susceptible to developing COPD when you smoke since you don’t have that extra layer of protection)
What type of emphysema is associated with coal dust and smoking?
Centriacinar/centrilobular emphysema - (destruction of bronchioles NOT alveoli)
In what conditions is bronchiectasis seen in?
- Cystic fibrosis
- Kartagener syndrome / primary ciliary dyskinesia
- Bronchial obstruction due to tumour or foreign body
- Rheumatoid arthritis
- Inflammatory bowel disease
What changes are seen in interstitial lung diseases?
Diseases of pulmonary connective tissue:
- Alveolar walls (mainly)
- Bronchioles
- Alveolar spaces
these are either thickened or lost which decreases gas exchange and lung compliance.
‘Diffuse alveolar damage’ and ‘adult respiratory distress syndrome’ are examples of what type of interstitial lung disease?
Acute
Diffuse alveolar damage = Type 1 pneumocytes which line the alveoli die and form a hyaline membrane that prevents gas exchange
Adult respiratory distress syndrome = fluid leaks into the alveoli and stops them functioning. Can results from shock, trauma, infection, smoke, toxic gases, paraquat, narcotics, radiation
Progressive dyspnoea, clubbing, fine crackles, dry cough and an end-stage ‘honey comb lung’ are seen in what disease?
Chronic interstitial lung disease
A lung disease with an unknown cause seen typically in young adult females that is characterised by non-caseating granulomas.
Sarcoidosis
A lung disease that is usually occupational, caused by the inhalation of dusts.
Pneumoconioses
the nature of the disease depends on the type of dust you inhaled e.g. coal worker’s pneumoconiosis
Lung disease associated with in the inhalation of silica - sand and stone dust.
Silicosis
What is a Type III hypersensitivity reaction to organic dusts?
Hypersensitivity pneumonitis
(inflammation of the alveoli due to organic dusts.
e.g. farmers’ lung + pigeon fanciers’ lung)
Definition, epidemiology, aetiology, pathogenesis and key clinical features of:
Cystic fibrosis
Inherited multiorgans disorder of the epithelial cells and their fluid secretion in the epithelial linings of the respiratory, GI and reproductive organs.
Epidemiology: Common (1 in 25 are carriers), mainly caucasians
Aetiology: Autosomal recessive inheritance, abnormality of chromosome 7, faulty CFTR (chloride channel protein) = thick mucus
Pathogenesis: Bronchioles filled with mucus, resulting in repeat infections > severe bronchitis + bronchiectasis.
Clinical features: Lung infections, bronchiectasis, meconium ileus (blockage in the ileum), cirrhosis of liver (due to mucus plugging of bile canaliculi), atrophy + fibrosis of salivary glands, 95% of males are infertile
What is the drug lumacaftor–ivacaftor used to treat?
Cystic fibrosis
controversially expensive drug
The most common type of primary malignant tumour.
Carcinoma (>90%)
What are the 3 differences between small cell and non-small cell carcinomas?
Small cell carcinoma =
- Less cytoplasm
- Nuclear chromatin is fine
- Less prominent/no nucleoli
Non small cell carcinoma =
- More cytoplasm
- Nuclei are usually clumped together
- More prominent nucleoli
Most common type of primary lung carcinoma.
Adenocarcinoma
What are the 4 major types of primary lung carcinoma?
- Adenocarcinoma - gland formation
- Squamous cell carcinoma - shows keratinization
- Small cell carcinoma - diagnosis based on nuclear characteristics
- Large cell undifferentiated carcinoma - doesn’t have the other features
Low grade malignant lung tumours with better survival chances.
Carcinoid tumours
Most common type of malignant lung tumour?
Secondary lung tumour
carcinomas from other sites e.g. breast, GI tract, kidneys
(sarcoma, lymphoma, myeloma)
Lung cancer is the most common cause of cancer death in the UK and world wide.
True or False?
TRUE
A gene mutation that predisposed you to lung cancer even if you have never smoked?
- EGFR
- KRAS
- ALK
(either of these)
What is lymphangitis carcinomatosa?
Diffuse spread of the tumour into the pulmonary lymphatics system
What is the latent period for asbestos exposure and the development of carcinoma?
20 years
Which lung cell carcinoma shows keratinisation?
Squamous cell carcinoma
What is the most common type of malignant mesenchymal lung tumour?
Synovial sarcoma
mesenchymal tumour = sarcoma
‘Blue bloaters’ refers to COPD patients with predominantly emphysema.
True or False?
FALSE
Blue bloaters = chronic bronchitis
Pink puffers = emphysema
The most common cause of sore throats i.e. pharyngitis or tonsillar pharyngitis.
Viruses
bacteria also cause it, but are not as common
Neisseria gonorrhoeae is a rare cause of pharyngitis.
True of False?
TRUE
HIV-1 is also a rare cause
The Centor Criteria predicts the likelihood of a sore throat being due to bacterial infection.
Which of the following are NOT part of the criteria?
- Absence of cough
- Temperature over 38°C
- Tonsillar exudate
- Tonsillar transudate
- Tender anterior cervical lymphadenopathy
- Inability to swallow
- Tonsillar transudate
6. Inability to swallow
What virus causes infectious mononucleosis?
What are the triad of symptoms?
Epstein-Barr virus
- Fever
- Tonsillar pharyngitis
- Cervical lymphadenopathy
(typically seen in teenagers, also called ‘glandular fever’)
Acute Otitis externa (AOE) is most commonly caused by bacteria.
What are the most common causative bacteria?
- Psedumonas aeruginosa
2. Staphylococcus aureus
What is a common cause of chronic otitis externa?
Allergic contact dermatitis (allergens that come in contact with skin e.g. chemicals in cosmetics or shampoo)
Inflammation of the middle ear with fluid build up behind the ear drum.
Otitis media (OM)
Mastoiditis is the infection of the mastoid bone and air cells.
Mastoiditis is the most common complication of what?
Otitis media
What are the common bacterial causes of perichondritis?
- Pseudomonas aeruginosa
- Staph aureus
(associated with piercings through cartilage)
https://www.studyblue.com/notes/note/n/respiratory-pathology/deck/12471413
Respiratory pathology flashcards given in lecture slides
What is pneumonia?
An infection of the most distal airways and alveoli.
This results in the formation of inflammatory exudate that fills these air sacs.
90% of lobar pneumonia is caused by S.pneumoniae and has a patchy distribution of inflammation.
True or False?
FALSE
yes, 90% of lobar pneumonia is caused by streptococcus pneumoniae HOWEVER bronchopneumonia is the one with a patchy distribution.
Lobar pneumonia is when a large part/entirety of a lobe is inflamed.
Atypical pneumonia is caused by bacteria which have atypical / lack a cell wall. Therefore, they have slightly different clinical presentation and treatment than typical pneumonia.
Which of these bacteria cause atypical pneumonia?
- Mycoplasma pneumoniae
- Streptococcus pneumoniae
- Legionella pneumophilia
- Klebsiella pneumoniae
- Chlamydophila pneumoniae
- Staphylococcus aureus
- Moraxella catarrhalis
- Chlamydophila psittaci
- Haemophilus influenzae
- Mycoplasma pneumoniae
- Legionella pneumoniae
- Chlamydophila pneumoniae
- Chlamydophila psittaci
(the rest are all ‘typical pneumonia’)
Responsible for most ‘common colds’.
Rhinovirus
Allergic bronchopulmonary aspergillosis (ABPA) presents with worsening asthma and lung function.
It occurs in people with a disease background of what?
Atopy (predisposition to developing rhinitis, asthma, eczema)
Asthma
Cystic fibrosis
Pneumocystis jiroveci pneumonia is caused by a fungus, however it is not susceptible to a number of antifungals.
Why?
It lacks ergosterol in its cell wall.
most fungi cannot survive without ergosterol, therefore it is one of the main drug targets
Pulmonary tuberculosis presents with chronic productive cough, haemoptysis, weight loss, fever, night sweats.
What is the cause?
What drugs are used to treat it?
Mycobacterium tuberculosis
Isoniazid + Rifampicin
What is pleural effusion?
Fluid build up in the pleural space around lungs
Which of these conditions is associated with high level asbestos dust exposure and prevent normal lung expansion + compression?
- Parietal pleura fibrous plaques
- Pleural effusion
- Pneumoconiosis
- Diffuse pleural fibrosis
- Diffuse pleural fibrosis
parietal pleura fibrous plaques = LOW level asbestos exposure, not given any occupational disability benefits from government.
asbestos related pneumoconiosis is pretty similar in fairness, but ‘pneumoconiosis’ on its own is too general.
What is ‘chlyothorax’?
Bile in the pleural cavity
usually caused by trauma
What is empyema or pyothorax?
Pus in the pleural cavity
usually secondary to pneumonia
What is pneumothorax?
Air in the pleural cavity
Left ventricle heart failure and renal failure are associated with exudate pleural effusion.
True or False
FALSE
Transudate - high hydrostatic pressure in the blood vessels causing fluid to leak out.
Exudate is associated with inflammation.
What are the signs and symptoms of a pleural effusion?
How is it treated?
Symptoms:
- Breathlessness - (effusion compresses the lung)
- Little/no pleuritic pain - (visceral + parietal pleura are not in contact)
Signs:
- Dull percussion
- Auscultation - reduced breath sounds
Diagnosis confirmed via ultrasound, chest radiograph, CT
Treatment:
- Aspiration - to remove fluid + treat breathlessness
- Identify underlying cause - e.g. biopsy, test pleural fluid in lab
What is a malignant mesothelioma?
A malignant tumour of the mesothelial cells that line serous cavities i.e. pleura, peritoneum, pericardium, tunica vaginalis.
Common
What is the main cause of malignant mesothelioma?
Asbestos
BAP1 mutation also predisposes you
What is the most oncogenic type of asbestos?
Crocidolite - blue asbestos
Disease of young women, often first diagnosed by the finding of hilar lymphadenopathy on a chest x-ray?
Sarcoidosis
An allergic reaction to which fungus that can present as asthma?
Aspergillus
The U in CURB score stands for?
Urea
What is CURB 65 and what does it stand for?
A clinical prediction rule for predicting mortality in community-acquired pneumonia and infection.
Confusion Urea Respiratory rate >30 Blood pressure (systolic <90) (diastolic <60) >65 years of age
This condition is caused by abnormal enlargement of the alveolar airspace?
Emphysema
A common “typical” organism that causes community acquired pneumonia.
Streptococcus pneumoniae
A Progressive build-up of air within the pleural space; allows air into the pleural space but not out of?
Tension pneumothorax
A malignant tumour of the pleura?
Mesothelioma
Condition characterised by a triad of symptoms: fever, tonsillar pharyngitis, and cervical lymphadenopathy with a positive monospot test?
Infectious mononucleosis
Disease of young women, often first diagnosed by the finding of hilar lymphadenopathy on a chest x-ray?
Sarcoidosis
A condition in which there is decreased pupil size, drooping of eyelid and decreased sweating on the affected side of the patient’s face - sometimes caused by a tumour in the lung?
Horner’s syndrome
Name of the diagnostic skin test used to determine if there has been exposure to mycobacterium tuberculosis?
Montoux test
Condition seen in infants that results in Inflammation and oedema of bronchioles and commonly caused by RSV?
Bronchiolitis
The following parameters : Tonsillar exudate, tender anterior cervical lymphadenopathy, fever over 38°C and absence of cough are part of the what criteria that gives an indication of the likelihood of a sore throat being due to bacterial infection?
Centor criteria
