Histopathology 12 - Respiratory pathology

Question 1

What are the 2 types of causes of pulmonary oedema?

Answer 1

1. Leaky capillaries (drugs, inhalation of particles, pancreatitis)
2. Back pressure from a failing left ventricle (left heart failure)

Question 2

How does diffuse alveolar damage appear on CXR?

Answer 2

Firm and expanded lungs

whiteout appearance

Question 3

What are the acute features of the airway in asthma?

Answer 3

Acute bronchospasm
Acute mucosal oedema
Inflammation

Question 4

What are the chronic features of the airway in asthma?

Answer 4

Smooth muscle hypertrophy
Goblet cell hyperplasia
Eosinophil infiltration
Airway narrowing
Mucus plugging

Question 5

What are the features of COPD?

Answer 5

Chronic bronchitis and emphysema

Question 6

Describe the features of chronic bronchitis

Answer 6

Chronic cough productive of sputum

Most days for at least 3 months over at least 2 consecutive years

Question 7

How does chronic hypoxia affect the heart?

Answer 7

Pulmonary hypertension —> right heart failure

Question 8

What is emphysema?

Answer 8

Permanent loss of the alveolar parenchyma distal to the terminal bronchiole

Question 9

What is the genetic association of emphysema?

Answer 9

Alpha 1 anti-trypsin

Question 10

Recall the pathophysiology of emphysema

Answer 10

Smoking causes inflammation
Neutrophil and macrophage involvement
Proteases recruited
Breakdown of epithelium

Question 11

What does lung bullous rupture cause?

Answer 11

Pneumothorax

Question 12

What is bronchiectasis?

Answer 12

Permanent abnormal dilatation of bronchi with inflammation and fibrosis into adjacent parenchyma

Question 13

Recall the complications of bronchiectasis

Answer 13

Haemoptysis
Pulmonary HTN
RHF
Amyloidosis secondary to chronic inflammation

Question 14

Which condition has the strongest association with bronchiectasis?

Answer 14

Cystic fibrosis

Question 15

What is bronchopneumonia?

Answer 15

Inflammation centred around airway

More common in immunocompromised patients with low virulence pathogens

Question 16

Where does bronchopneumonia often affect?

Answer 16

Lower lobes

Question 17

Which type of pneumonia has become much rarer since ABx have been in use?

Answer 17

Lobar pneumonia

Question 18

What is empyema?

Answer 18

Infected pleural effusion

Question 19

Which type of pneumonia is most likely to cause interstitial inflammation?

Answer 19

Atypical pneumonias

Question 20

What are the most common lung tumours?

Answer 20

Epithelial tumours - non small cell and small cell

Question 21

What are the 3 subtypes of non-small cell lung cancer?

Answer 21

Adenocarcinoma (most common in non-smokers, KRAS, EGFR mutations)
Squamous cell carcinoma (PTHrp, p53 mutations)
Large cell carcinoma

Question 22

Which 2 types of lung cancer are most associated with smoking?

Answer 22

Squamous cell (strongest correlation to smoking)
Small cell (p53, RB1 mutations common, small "oat cells")

Question 23

Where is squamous cell carcinoma most likely to develop in the lung?

Answer 23

Centrally

Question 24

Where do adenocarcinomas typically develop?

Answer 24

Peripherally

Most common cancer in non-smokers

Question 25

Which mutations are smokers most likely to develop in adenocarcinomas?

Answer 25

K ras

p53

Question 26

Which mutations are non-smokers most likely to develop in adenocarcinomas?

Answer 26

EGFR

Question 27

Which type of lung cancer is assoiated with the most paraneoplastic syndromes?

Answer 27

Small cell

Question 28

Cystic fibrosis gene mutation?

35y/o non-smoker, liver and lung problems. Diagnosis?

small oat cells?

Answer 28

CFTR on chrm 7

alpha1 anti-trypsin

small cell lung cancer

Question 29

iron-laded macrophages?

Answer 29

heart-failure cells- seen in pulmonary oedema due to heart failure

Question 30

lung path: eosonophilic infiltrates vs neutrophilic infitrates

Answer 30

eos- asthma

neut- copd