Histopath - lung

Question 1

top 3 cancers in women

Answer 1

Breast, bowel, lung

Question 2

List 4 types of lung cancer in order of most to least common

Answer 2

Squamous cell
Adenocarcinoma
Small cell
Large cell

Question 3

SqCC

• Which part of the lung is affected?
• 2 Histological Fx?
• what electrolyte imbalance is often seen?

Answer 3

• Proximal bronchi affected
• Histo: Keratinisation + Intracellular prickles
• Hypercalcemia

Question 4

Lung adenocarcinoma

• Most common in whom?
• 2 histological Fx?
• Which part of the lung is affected?
• Molecular analysis results?

Answer 4

• Women and non-smokers
• Mucin production + gland formation
• Starts peripherally, early spread
• EGFR mutations seen in molecular analysis

Question 5

Small cell lung carcinoma

• what cells does it arise from?
• Prognosis? why?
• 2 common mutations seen?
• which weird neuro thing is it associated with?

Answer 5

• Arises from NEUROENDOCRINE cells
• POOR prognosis, due to early mets
• RB1 and p53 mutations
• Assoc with Lambert Eaton syndrome = autoimmune, muscle weakness which improves with testing

Question 6

What do the cells look like in large cell lung carcinoma/

Answer 6

Large nuclei, prominent nucleoli

Question 7

Wtf is carcinoid syndrome? Cause?

Answer 7

Flushing + diarrhoea + bronchoconstrictin

Serotonin excess in paraneoplastic syndrome

Question 8

Which molecular finding indicates a poorer response to cisplatin

Answer 8

ERCC1

Question 9

Which two molecular findings indicate a poor response to Tyrosine kinase inhibitors in lung cancer?

Answer 9

Kras mutation

EML4-ALK mutation

Question 10

staging of lung carcinoma?

Answer 10

TNM
T = 1-4, depends on size and invasion
N = 0-2
M = metastases, 0-1

Question 11

Pneumoconiosis includes 3 different disease.. which ones?

Answer 11

Coal worker’s lung
Asbestosis
Silicosis

Question 12

Which part of the lung is affected in Coalworker’s lung and asbestosis?

Answer 12

Upper lobe

Question 13

idiopathic pulmonary fibrosis

• who does it affect?
• what changes are seen in the lung?
• Sx?

Answer 13

• Tends to affect old men
• Fibrosis followed by cyst formation. aka honeycomb change. This starts at the periphery of the lobule, usually in lower lobes
• SOB and dry cough, progressively worsening

Question 14

What is extrinsic allergic alveolitis?

Answer 14

Immune mediated response to inhaled antigens –> alveolar inflammation

Question 15

Extrinsic allergic alveoli’s - legs of triggers?

Answer 15

Pigeons, hay, mould

Question 16

How does EAA present? Both acute and chronic presentation

Answer 16

Acutely - sudden SOB, fever, chills, cough after exposure to antigen

Chronic - only symptomatic at work, improves on the weekends

Question 17

Coal worker’s lung - which part of lung is affect?

Histology in mild and severe disease?

Answer 17

Upper lobes

Mild = macrophages containing pigment accumulate around airways
Severe = Large fibrotic nodules

Question 18

spirometry findings in restrictive lung disease

Answer 18

Decreased lung volume
Decreased compliance
Both FEV1 and FVC are reduced to same degree

Question 19

1 major sign on examination in interstitial lung disease

Answer 19

end inspiratory crackles

Question 20

Pathophysiology of bronchiectasis

Answer 20

Chronic mucus accumulation –> inflammation –> breakdown of elastin in bronchi –.> bronchus dilatation

Question 21

5 Causes of bronchiectasis

Answer 21

CF
Asthma
Aspiration
Obstruction - eg tumour
Secondary to fibrosis - sarcoidosis

Question 22

3 histological features of asthma

Answer 22

Whorls of shed epithelium

1. Curschmann spirals
2. Eosinophils
3. Leyden crystals

Question 23

Granulomatous lung infection

• 2 cells seen?
• 2 main causes?

Answer 23

Histiocytes + macrophages

1. TB
2. Fungal - cryptococcus, aspergillus

Question 24

4 stages of lobar pneumonia

Answer 24

1. Consolidation
2. Red hepatisation
3. Grey hepatisation
4. Resolution

Question 25

Lobar vs bronchial pneumonia

- affected people?

Answer 25

Lobar = younger
Bronchopneumonia = elderly

Question 26

3 causes of emphysema

Answer 26

Marfan’s
IVDU
a1 antitrypsin deficiency