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histopath > Histopathology 12 - Respiratory pathology > Flashcards

Histopathology 12 - Respiratory pathology Flashcards

1
Q

Main causes of pumonary oedema

A
  • Left heart failure
  • Alveolar injury i.e. in patients who have inhaled fire-smoke fumes
  • Neurogenic i.e. after a brain injury, can lead to systemic effects
  • High altitude
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2
Q

How does diffuse alveolar damage appear on CXR?

A

Firm and expanded lungs

Also “white out” of all lung fields

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3
Q

What are the acute features of the airway in asthma?

A

Acute bronchospasm
Acute mucosal oedema
Inflammation

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4
Q

What are the chronic features of the airway in asthma?

A

Muscular hypertrophy
Airway narrowing
Mucus plugging

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5
Q

What are the features of COPD?

A

Chronic bronchitis and emphysema

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6
Q

Describe the features of chronic bronchitis

A
  • Chronic cough productive of sputum
  • Most days for at least 3 months over at least 2 consecutive years
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7
Q

How does chronic hypoxia affect the heart?

A

Pulmonary hypertension —> right heart failure

COR PULMONALE

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8
Q

What is emphysema?

A

Permanent loss of the alveolar parenchyma distal to the terminal bronchiole

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9
Q

What is the genetic association of emphysema?

A

Alpha 1 anti-trypsin

Since a1 antitrypsin helps neutralise the activation of neutrophils and proteases and keep this system in balance, so deficiency increases R of emphysema due to damage from immune cells

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10
Q

Recall the pathophysiology of emphysema

A
  • Smoking causes inflammation
  • Neutrophil and macrophage involvement
  • Proteases recruited
  • Breakdown of epithelium
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11
Q

What does lung bullous rupture cause?

A

Pneumothorax

NB bullae form as complication of emphysema (bullae = large air spaces)

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12
Q

What is bronchiectasis?

A

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

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13
Q

Recall the complications of bronchiectasis

A
  • Haemoptysis
  • Pulmonary HTN
  • RHF
  • Amyloidosis secondary to chronic inflammation
  • Recurrent infections
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14
Q

Which condition has the strongest association with bronchiectasis?

A

Cystic fibrosis

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15
Q

What is bronchopneumonia?

A

Inflammation centred around airway (small bronchi and bronchioles)

Occurs in elderly pts

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16
Q

Where does bronchopneumonia often affect?

A

Lower lobes

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17
Q

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

A

Lobar pneumonia

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18
Q

What is empyema?

A

Infected pleural effusion

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19
Q

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

A

Atypical pneumonias

20
Q

What are the most common lung tumours?

A

Epithelial tumours - non small cell and small cell

21
Q

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

A

Adenocarcinoma (30%)
Squamous cell carcinoma (30%)
Large cell carcinoma (20%)

22
Q

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

A 
Squamous cell (type of non-small cell)
Small cell carcinoma

NB 25% of lung cancers in non-smokers are attributed to passive smoking

23
Q

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

A

Centrally

24
Q

Where do adenocarcinomas typically develop?

A

Peripherally

25
Q

Which mutations are smokers most likely to develop in adenocarcinomas?

A

K ras
p53

26
Q

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

A

EGFR

This mutation occurs in around 25% lung adenocarcinomas

27
Q

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

A

Small cell

28
Q

Which mutations are most likely to develop in squamous cell carcinomas?

A

They’re not - it’s the adenocarcinomas that tend to get the mutations

29
Q

Complication of chronic bronchitis (independent of smoking)

A

Lung cancer

30
Q

Primary ciliary dyskinesia increases R of which lung disease?

A

Bronchiectasis

31
Q

XRay sign of Bronchiectasis

A

tram-track opacities + signet ring sign

32
Q

CXR finding in chronic LV failure

A

iron laden macrophages

these are blue-stained cells which are full of iron pigment as there is chronic capillary leakage into the alveolar spaces

33
Q

Another name for Diffuse Alveolar Damage

A

Acute Respiratory Distress Syndrome (shock lung)

34
Q

Effect of Diffuse alveolar damage on lungs

A
  • congested due to the exudate of fluid into alveolar spaces
  • alveoli become firm

NB if condition resolved, then lung returns to normal

35
Q

Complications of pneumonia

A
  • abscess formation
  • Pleuritis and pleural effusion
  • Infected pleural effusion (empyema)
  • scarring
36
Q

Pathophysiology of granulomatous lung disease, and 2 key causes

A

collection of histiocytes/ macrophages +/- multinucleate giant cells within the tissue

Causes:

  • Infection- often TB in urban areas (CASEATING) - MUST EXCLUDE TB FIRST
  • Sarcoidosis- unusual immune reaction (NON-CASEATING)
  • Foreign body- Aspiration or IVDU
  • Drugs
  • Occupational lung disease
37
Q

Possible enzyme effect of sarcoidosis

A

Elevated serum Angiotensin Converting Enzyme (ACE)

38
Q

Best Ix for sarcoidosis

A

Biopsy

39
Q

Which part of lung is effected in sarcoidosis

A

upper zones with a tendency to be peri-lymphatic or peri-bronchial

40
Q

Cause of nutmeg liver

A

RH failure

41
Q

Invasive Squamous Cell Carcinoma closely associated with which cause?

Where in the lung do they occur?

A

smoking

Centrally

42
Q

What is a very aggresive lung carcinoma?

A

Small Cell Carcinoma - terrible prognosis since it recurs as soon as you stop chemo

43
Q
A
44
Q

Mutations in small cell carcinoma (2)

A

p53 and RB1 mutations

45
Q

Where in lung is small cell caricnoma found?

A

central near bronchi

46
Q

Why is surgery not that useful for small cell carcinoma?

A

Very aggressive, so has already metastasised by the time pt presents - therefore do chemoradiotherapy

histopath (21 decks)

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