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Path Y > Histopathology - Respiratory pathology > Flashcards

Histopathology - Respiratory pathology Flashcards

1
Q

main cause of pulmonary oedema?

A

left heart failure

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2
Q

How does diffuse alveolar damage appear on CXR?

A

Firm and expanded lungs

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3
Q

What are 3 acute features of the airway in asthma?

A

Acute bronchospasm
Acute mucosal oedema
Inflammation

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4
Q

What are 3 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

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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

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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

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12
Q

What is bronchiectasis?

A

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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13
Q

Recall the complications of bronchiectasis

A

Haemoptysis
Pulmonary HTN
RHF
Amyloidosis secondary to chronic inflammation

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14
Q

Which condition has the strongest association with bronchiectasis?

A

Cystic fibrosis (CFTR mutation on Chromsome 7)

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15
Q

What is bronchopneumonia?

A

Inflammation centred around airway

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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

a collection of pus in the pleural space

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19
Q

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

A

Atypical pneumonias

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20
Q

What are the most common lung tumours?

A

small cell lung cancer (SCLC)

non small cell lung cancer (NSCLC) - most common

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21
Q

What are the 4 subtypes of malignant lung tumours?

A

Squamous cell carcinoma

Adenocarcinoma

Large cell carcinoma (20%)

Small Cell Lung Carcinoma aka oat cell (20%)

22
Q

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

A

2S’s
Squamous cell
Small cell

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

(epidermal growth factor receptor)

27
Q

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

A

Small cell (SIADH)

28
Q

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

A

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.

29
Q

give 3 histological findings of asthma

A

Curschmann spirals - spiral-shaped mucus plugs from subepithelial mucous gland

Charcot- Leyden crystals

Eosinophils

30
Q

interstitial lung disease shows what on spirometry

A

RESTRICTIVE lung disease

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

31
Q

triad presentation of ILD

A

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

32
Q

CT finding of ILD

A

honeycomb appearance

33
Q

what cancer are women & non smokers likely to develop

A

adenocarcinoma

34
Q

outline large cells carcinoma

A

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

35
Q

outline mesothelioma

A

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

36
Q

outline the 6 paraneoplastic syndromes

A

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

37
Q

which lung cancer is most likely to produce PTHrP

A

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

38
Q

does squamous or adenocarcinoma metastasise early or late

A

early mets - adenocarcinoma
late mets - squamous cell

39
Q

define pulmonary hypertension

A

Mean pulmonary arterial pressure of >25mmHg at rest

40
Q

2 consequences of pulmonary hypertension

A

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

41
Q

2 histological findings of pulmonary oedema

A

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

42
Q

where do the majority of PE’s arise from

A

95% originate from DVT

43
Q

occlusion of the pulmonary trunk with an embolus causes?

A

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

44
Q

presentation of Extrinsic Allergic alveolitis (3)

A

progressive persistent productive cough and SOB, finger clubbing and severe weight loss

identify early so can remove antigen

45
Q

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

A
  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).
46
Q

what is EAA/HP

A

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

47
Q

clinical presentation of idiopathic pulmonary fibrosis

A

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

48
Q

investigation & 3 drug options for IPF

A

HR-CT ± biopsy diagnosis

steroids
cyclophosphamide
azathioprine

49
Q

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

A

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

50
Q

compare spirometry results in obstructive vs restrictive diseases

A

obstructive

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)

51
Q

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

A

small cell

shortnes of breath, swelling in face, venuous distension

also large B NHL

52
Q

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

A

most are NON small cell

cause horners - miosis (a constricted pupil), partial ptosis (a weak, droopy eyelid), apparent anhidrosis (decreased sweating)

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