Diseases of Respiratory System - Pathology (16 & 17)

Question 1

Conducting airways

Answer 1

Trachea, main bronchi, segmental and smaller bronchi, bronchioles and terminal bronchioles

Question 2

Gas exchange - lung acini (3-5 make lobule)

Answer 2

Respiratory bronchioles, alveolar ducts, sacs and alveoli

Question 3

Histology - conduction airways

Answer 3

Pseudostratified ciliated columnar mucus secreting epithelium

Question 4

Histology - alveoli

Answer 4

Mostly flat type 1 pneumocytes (gas exchange) and some type 2 pneumocytes (surfactant production)

Question 5

Respiratory failure PaO2

Question 6

Type 1 respiratory failure

Answer 6

PaCO2

Question 7

Type 2 respiratory failure

Answer 7

PaCO2 >6.3 kPa (hypercapnia)

Question 8

Signs and symptoms

Answer 8

Sputum, cough, stridor, wheeze, pleuritic pain, dyspnoea, cyanosis, clubbing, weight loss

Question 9

Why weight loss?

Answer 9

Catabolic state with chronic inflammation/tumours

Question 10

Why cyanosis?

Answer 10

Decreased oxygenation of haemoglobin

Question 11

Why dyspnoea?

Answer 11

Impaired alveolar gas exchange

Question 12

Why pleuritic pain?

Answer 12

Pleural irritation

Question 13

Why wheeze?

Answer 13

Distal airway obstruction

Question 14

Why stridor?

Answer 14

Proximal airway obstruction

Question 15

Why cough?

Answer 15

Reflex response to irritation

Question 16

What kind of sputum?

Answer 16

Mucoid, purulent or haemoptysis

Question 17

Crackles

Answer 17

Resisted opening of small airways - fluid

Question 18

Wheeze

Answer 18

Narrowed small airways

Question 19

Bronchial breathing

Answer 19

Sound conduction through solid lung

Question 20

Pleural rub

Answer 20

Movement of inflamed visceral and parietal pleura

Question 21

Dull percussion

Answer 21

Lung consolidation or pleural effusion

Question 22

Hyperesonant percussion

Answer 22

Pneumothorax or emphysema

Question 23

Lungs diseases

Answer 23

• Neoplasms
• Infections
• Obstructive airways disease
• Interstitial lung diseases
• Vascular diseases
• Pleural diseases
• Occupational lung diseases
• Paediatric lung pathology

Question 24

Interstitial lung diseases

Answer 24

Adult respiratory distress syndrome, fibrosing alveolitis, sarcoidosis

Question 25

Vascular diseases

Answer 25

Pulmonary embolism, pulmonary hypertension

Question 26

Benign primary lung tumour

Answer 26

Rare, adenochondroma

Question 27

What are 90% malignant primary lung tumours?

Answer 27

Carcinoma

Question 28

Risk factors for lung carcinoma

Answer 28

Smoking (80%), asbestos, lung fibrosis (asbestosis/silicosis), radon, chromates, nickel, tar, hematite, arsenic, mustard gas

Question 29

Asbestos

Answer 29

• Fibrous metal silicates
• Amphiboles (blue/crocidolite and brown/amosite)
• Serpentines (white/chrysotile)
• Asbestos bodies seen by light microscopy (fibres coated with mucopolysaccharide and ferric iron salts)

Question 30

Which is most dangerous asbestos?

Answer 30

Amphiboles (blue/crocidolite)

Question 31

Which is least dangerous asbestos?

Answer 31

Serpentines (white/chrysotile)

Question 32

What do high levels of asbestos exposure lead to?

Answer 32

Pulmonary interstitial fibrosis/asbestosis

Question 33

Carcinoma (primary)

Answer 33

• Non-small cell carcinoma (squamous, adenocarcinoma, large cell neuroendocrine carcinoma, undifferentiated large cell carcinoma)
• Small cell carcinoma (neuroendocrine)

Question 34

Carcinoid tumours (primary)

Answer 34

Low grade neuroendocrine epithelial tumours

Question 35

Other primary malignant tumours

Answer 35

Lymphomas, sarcomas, carcinosarcomas

Question 36

Secondary lung tumours

Answer 36

Most common lung from known primary, multiple bilateral nodules/solitary