Histopathology - Respiratory pathology Flashcards by Yasmin Kamara

main cause of pulmonary oedema?

left heart failure

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How does diffuse alveolar damage appear on CXR?

Firm and expanded lungs

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What are 3 acute features of the airway in asthma?

Acute bronchospasm
Acute mucosal oedema
Inflammation

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What are 3 chronic features of the airway in asthma?

Muscular hypertrophy
Airway narrowing
Mucus plugging

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What are the features of COPD?

Chronic bronchitis and emphysema

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Describe the features of chronic bronchitis

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

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How does chronic hypoxia affect the heart?

Pulmonary hypertension —> right heart failure

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What is emphysema?

Permanent loss of the alveolar parenchyma distal to the terminal bronchiole

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What is the genetic association of emphysema?

Alpha 1 anti-trypsin

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Recall the pathophysiology of emphysema

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

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What does lung bullous rupture cause?

Pneumothorax

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What is bronchiectasis?

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

signet ring sign on CT

tram track opacity on CXR

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Recall the complications of bronchiectasis

Haemoptysis
Pulmonary HTN
RHF
Amyloidosis secondary to chronic inflammation

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Which condition has the strongest association with bronchiectasis?

Cystic fibrosis (CFTR mutation on Chromsome 7)

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What is bronchopneumonia?

Inflammation centred around airway

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Where does bronchopneumonia often affect?

Lower lobes

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

Lobar pneumonia

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What is empyema?

a collection of pus in the pleural space

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

Atypical pneumonias

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What are the most common lung tumours?

small cell lung cancer (SCLC)

non small cell lung cancer (NSCLC) - most common

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What are the 4 subtypes of malignant lung tumours?

Squamous cell carcinoma

Adenocarcinoma

Large cell carcinoma (20%)

Small Cell Lung Carcinoma aka oat cell (20%)

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

2S’s
Squamous cell
Small cell

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

Centrally

Where do adenocarcinomas typically develop?

Peripherally

Which mutations are smokers most likely to develop in adenocarcinomas?

K ras p53

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

EGFR (epidermal growth factor receptor)

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

Small cell (SIADH)

What sign is the name of a palpable lymph node in the left supraclavicular fossa?

Troisier sign Troisier's sign is the finding of a palpable left supraclavicular lymph node; this is called Virchow's node. It may indicate gastrointestinal malignancy, commonly of the stomach, or less commonly, lung cancer.

give 3 histological findings of asthma

Curschmann spirals - spiral-shaped mucus plugs from subepithelial mucous gland Charcot- Leyden crystals Eosinophils

interstitial lung disease shows what on spirometry

RESTRICTIVE lung disease ● Decreased CO diffusion capacity ● Decreased lung volume ● Decreased compliance

triad presentation of ILD

Chronic shortness of breath End-inspiratory crackles Cyanosis, pulmonary HTN and cor pulmonale

CT finding of ILD

honeycomb appearance

what cancer are women & non smokers likely to develop

adenocarcinoma

outline large cells carcinoma

poorly differentiated malignant epithelial tumour – large cells, large nuclei, prominent nucleoli.

outline mesothelioma

malignant tumour of the pleura - very poor prognosis linked to asbestos exposure (long time lag) more common in men

outline the 6 paraneoplastic syndromes

ADH - SIADH, causing hyponatraemia ACTH - Cushings PTH/PTHrp - primary hyperparathyroidism, hypercalcaemia and bone pain calcitonin - bone pain serotonin - carcinoid syndrome (flushing, diarrhoea, bronchoconstriction) bradykinin - cough

which lung cancer is most likely to produce PTHrP

Squamous cell carcinoma is the most frequent type of PTHrP-producing lung cancer

does squamous or adenocarcinoma metastasise early or late

early mets - adenocarcinoma late mets - squamous cell

define pulmonary hypertension

Mean pulmonary arterial pressure of \>25mmHg at rest

2 consequences of pulmonary hypertension

RHF – venous congestion of organs (nutmeg liver), peripheral oedema.

2 histological findings of pulmonary oedema

intra-alveolar fluid, iron laden macrophages (“heart failure cells”).

where do the majority of PE's arise from

95% originate from DVT

occlusion of the pulmonary trunk with an embolus causes?

saddle embolus -a large blood clot gets stuck in the main pulmonary artery, where bifurcation happens

presentation of Extrinsic Allergic alveolitis (3)

progressive persistent productive cough and SOB, finger clubbing and severe weight loss identify early so can remove antigen

outline 5 types of EAA/hypersensitivity pneumonitis and the causative pathogens

1. Farmers lung (mouldy hay/grain/silage – Saccharopolyspora rectivirgula), tend to get better over weekend 2. Pigeon fancier’s lung (proteins in excreta/feathers), 3. Humidifier’s lung (heated water reservoirs – thermactinomyces spp.), 4. Malt-workers lung (germinating barley – Aspergillus clavatus/fumigatus), 5. Cheese washer’s lung (mouldy cheese – Aspergillus clavatus/penicillium casei).

what is EAA/HP

immune-mediated lung disorders caused by intense/prolonged exposure to inhaled ORGANIC antigens → widespread ALVEOLAR inflammation

clinical presentation of idiopathic pulmonary fibrosis

increasing exertional dyspnoea and NON-productive cough. 40-70y at presentation, with hypoxaemia, cyanosis and pulmonary HTN +/- cor pulmonale, and clubbing.

investigation & 3 drug options for IPF

HR-CT ± biopsy diagnosis steroids cyclophosphamide azathioprine

outline pneumoconiosis. most common in whom? what part of lung affected?

Occupational lung disease caused by inhlation of mineral dusts or inorganic particles. Classically seen in coal miners. The disease has a predilection for the upper lobes. note asbestosis - prefers lower lobes

compare spirometry results in obstructive vs restrictive diseases

obstructive ## Footnote Reduced FEV1 (\<80% of the predicted normal) Reduced FVC (but to a lesser extent than FEV1) FEV1/FVC ratio reduced (\<0.7) restrictive Reduced FEV1 (\<80% of the predicted normal) Reduced FVC (\<80% of the predicted normal) FEV1/FVC ratio normal (\>0.7)

what lung cancer accounts for most cases of sueperior vena cava syndrome. what signs

small cell shortnes of breath, swelling in face, venuous distension also large B NHL

most pancoast tumurs are what type of lung cancer? what signs do they cause

most are NON small cell cause horners - miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhidrosis (decreased sweating)