Lung Pathology

Question 1

What composes the upper respiratory tract?

Answer 1

Nose
nasopharynx
larynx

Question 2

What comprises the lower respiratory tract?

Answer 2

trachea
bronchi
bronchioles
lungs

Question 3

How do we classify lung disease?

Answer 3

Neoplastic

Non - neoplastic

Question 4

Describe neoplastic lung disease?

Answer 4

95% tumours are malignant
Majority epithelial in origin
Most arise from bronchus
Lung is a common site fro metastasis

Question 5

Describe lung cancer presentation?

Answer 5

Usually late as symptoms take a while to show and are often ignored
Associated to smoking

Question 6

What types of lung cancer occur?

Answer 6

SCC 50%
small cell undifferentiated carcinoma 30%
adenocarcinoma 10%
large cell undifferentiated 10%

Question 7

How does lung cancer present orally?

Answer 7

epulus / polyp ( looks like gingival swelling)

Question 8

Describe non neoplastic lung disease?

Answer 8

Lungs have limited ability to respond to insult
Fibrosis dominant
Lugs normally sterile - continuous escalator of mucocilliary clearance

Question 9

Name 10 types of non neoplastic lung disease?

APPPPCATIW

Answer 9

Acute bronchitis
Pneumonia
Pulmonary embolus
Pulmonary vascular disease
Pulmonary oedema
COPD
Asthma
TB
Interstitial lung disease
Wegners Granulomatosis

Question 10

What is acute bronchitis?

Answer 10

Mostly cause by a virus - respiratory syncitial virus, H. influenzae and S. pneumoniae
May be associated with laryngitis
Inflammation with retention of secretions - predisposed to secondary infection

Question 11

What is pneumonia?

Answer 11

Inflammation of the lungs

Classified by causative organism or by anatomy

Question 12

Where can pneumonia affect the lungs?

Answer 12

LOBAR - limited to lobe
BRONCHOPNEUMONIA - starts in bronchioles and spreads
ASPIRATION - dental instruments

Question 13

What are the causative organisms for pneumonia?

Answer 13

ACUTE - S. pneumoniae, H. influenzae, S. aureus
OPPORTUNISTIC-gram -ve bacilli, aspergillus, cryptococcus
CHRONIC - TB

Question 14

What is a pulmonary embolus?

Answer 14

Embolus travel via IVC to right side of heart and into the pulmonary vein and lodges in the pulmonary arterial branch
Mostly caused by thrombotic origin (leg, pelvis)
Cause of sudden death
DVT is secondary to immoblisation

Question 15

What is pulmonary vascular disease (PVD)?

Answer 15

Disease affecting the blood vessels leading to or from the lungs.
Most common is pulmonary hypertension
PRIMARY - unknown cause: young females, right heart failure and pleural effusion
SECONDARY - hypoxia : COPD, high altitude, congenital heart disease

Question 16

What is pulmonary oedema?

Answer 16

two causes:
HAEMODYNAMIC (mitral stenosis, left hart failure, nephrotic syndrome) No lung abnormality, imbalance between forces pushing fluid to the alveolar space and forces pulling back into circulation
MICROVASCULAR - septic shock, trauma, burns, pancreatitis, injury to the lung

Question 17

What is COPD?

Answer 17

Irreversible airway obstruction due to 2 conditions:
BRONCHITIS - abnormal sputum production for 3+ months/yr for 3 yrs. Inflamed bronchioles
EMPHYSEMA - enlarged alveolar spaces distal to terminal bronchiole. Destruction of lunch tissue

Question 18

What is asthma?

Answer 18

Inflammation, reversible, variable, hyperactivity reaction
Increased airway irritability
Most common cause is allergies (atropy)
Type 1 hypersensitivity - IgE binds to mast cells which become sensitised to specific antigen and then when exposed, mast cells degranulate and release histamine and inflamatory mediators

Question 19

What is TB?

Answer 19

Most common infective disease in the world
Mycobacterium tuberculosis and bovis
Bacillis infects macrophages and get a cell mediated immune resonse

Question 20

What is the progression of TB?

Answer 20

Phagocytosis of bacilli by macrophages
TNF alpha release and autocrine stimulation
Cytokine and chemokine release.
Attraction and stimulation of CD4 and CD8 lymphocytes
Increased T cell adhesion
Activated T cells release interferon gamma
Further activation of macrophages
Increased antigen presentation
Intracellular killing of bacilli
Macrophage apoptosis
Granuloma formation

Question 21

What is interstitial lung disease?

Answer 21

Interstitium is tissue within the septa of the alveoli and tissues surrounding airways and blood vessels
Characterised by fibrosis with decreased lung compliance

Question 22

What is Wegners Granulomatosis?

Answer 22

Immunological disease affecting the lung and kidneys

Oral manifestations - gingival hyperplasia and URT infection