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Clinical Pathology > Lung Pathology > Flashcards

Lung Pathology Flashcards

1
Q

what is asthma

A

chronic inflammatory disorder of the airways

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2
Q

features of asthma

A

paroxysmal bronchospasm
wheeze
cough
variable bronchoconstriction - reversible

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3
Q

histology in asthma

A

mucosal inflammation and oedema

hypertrophic mucous glands and mucous plugs in brochi

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4
Q

what is atopic asthma?

A

type I hypersensitivity reaction

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5
Q

causes of atopic asthma

A

dust
pollen
animal products
cold, exercise, resp infections

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6
Q

persistent or irreversible changes in atopic asthma?

A

bronchiolar wall smooth muscle hypertrophy
mucus gland hyperplasia
respiratory brochiolitis leading to centrilobular emphysema

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7
Q

who gets atopic asthma

A

children and young adults

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8
Q

what is bronchiectasis

A

permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue

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9
Q

cause of bronchiectasis

A

infections

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10
Q

signs/symptoms of bronchiectasis

A

cough, fever, copious foul smelling sputum

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11
Q

predisposing conditions to bronchiectasis

A

CF
primary ciliary dyskinesia, Kartagener syndrome
bronchial obstruction - tumour, foreign body
lupus, RA, IBD, GVHD

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12
Q

complications of bronchiectasis

A

pneumonia
septicaemia
metastatic infection
amyloid

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13
Q

what is COPD

A

combination of chronic bronchitis and emphysema

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14
Q

cause of COPD

A

chronic irritation
smoking
air polution

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15
Q

what is the pathenogenesis of chronic bronchitis

A

mucous gland hyperplasia
seconday infection by low virulence bacteria
chronic inflammation - causes wall destruction and weakness = emphysema

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16
Q

most common emphysema

A

centrilobular

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17
Q

symptoms of COPD

A

dyspnoea - progressive and worsening

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18
Q

what is interstitial lung disease

A

diseases of pulmonary connective tissue

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19
Q

is interstitial lung disease restrictive or obstructive?

A

restrictive

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20
Q

what happens in interstitial lung disease

A

increased tissue in alveolar-capillary wall
inflammation and fibrosis
decreased lung compliance
increase diffusion distance

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21
Q

what is acute interstitial lung disease

A

diffuse alveolar damage - death of type 1 pneumocytes form hyaline membranes
adult respiratory distress syndrome: shock, trauma, infections, smoke, toxic gases

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22
Q

what is chronic interstitial lung diseases?

A

dyspnoea increasing for months to years

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23
Q

signs of chronic interstitial lung disease

A

clubbing, fine crackles, dry cough

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24
Q

examples of chronic interstitial lung diseases

A

idiopathic pulmonary fibrosis
many pnemoconioses
sarcoidosis
collagen vascular diseases

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25
Q

which lobes most severly affected in PF

A

lower lobes

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26
Q

what is sarcoidosis

A

non-caeseating perilymphatic pulmonary granulomas, then fibrosis

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27
Q

which nodes are usually involved in sarcoidosis

A

hilar nodes

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28
Q

which other organs may be affected by sarcoidosis

A

skin, heart, brain

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29
Q

who gets sarcoidosis

A

young adult females

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30
Q

what causes pneumoconioses

A

inhaled dusts

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31
Q

what size are the dust particles

A

<3 micrometres

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32
Q

what is silicosis

A

silica sand and stone dust kills phagocytosing macrophages
fibrosis and fibrous silicotic nodules
possible TB reactivation

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33
Q

what is hypersensitivity pneumonitis

A

extrinsic allergic alveolitis

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34
Q

what is the antigen in farmer’s lung

A

actinomycetes in hay

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35
Q

what is the antigen in pigeon fanciers lung

A

pigeon antigens

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36
Q

what is the effect of hypersensitivity pneumonitis

A

peribronchiolar inflammation with poorly formed non-caeseating granulomas extends alveolar walls
repeated episodes = interstitial fibrosis

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37
Q

what is cystic fibrosis

A

inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, GI and reproductive organs

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38
Q

characteristics of CF

A

broncioles distended with mucous
hyperplasia mucus secreting glands
repeated infections
bronchitis and bronchiectasis

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39
Q

effect of CF in exocrine gland

A

ducts plugged by mucus
atrophy and fibrosis of gland
impaired fat absorption, enzyme secretion, vit deficiencies

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40
Q

effect of CF in small bowel

A

mucus plugging

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41
Q

effect of CF in liver

A

plugging of bile cannaliculi - cirrhosis

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42
Q

effect of CF in salivary glands

A

similar to pancreas: atrophy and fibrosis

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43
Q

95% of males are …

A

infertile

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44
Q

diagnosis of CF

A

sweat test

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45
Q

treatment of CF

A

ivacaftor
mucolytics
heart/ lung transplants

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46
Q

most common type of primary lung cancer

A

carcinomas

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47
Q

most common lung carcinoma

A

adenocarcinoma

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48
Q

second most common lung carcinoma

A

squamous cell carcinoma

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49
Q

which kind of tumour is seen in HIV/AIDS patients

A

primary lung lymphomas

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50
Q

what are the most common secondary lung tumours

A

carcinomas from various sites e.g. breast, GI, kidney

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51
Q

epidemiology of lung cancer

A

most common cause of cancer death in UK

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52
Q

risk factors of lung cancer

A

smoking

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53
Q

5 year survival of lung cancer

A

5-10%

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54
Q

causes of lung cancer

A

smoking
occupational/ industrial hazards - asbestos
radiation - mines in which there is radon
lung fibrosis

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55
Q

genetic mutations in lung cancer

A

EGFR, KRAS, ALK

56
Q

where do lung mets go

A

brain
bone
pleura
liver

57
Q

local effects of lung tumours

A 
ulceration and bleeding - haemoptysis 
consolidation 
symptoms of pneumonia
pleural effusion 
chest wall/ rib pain 
recurrent laryngeal nerve - hoarseness 
horner's syndrome 
dysphagia
58
Q

what is lymphangitis carcinomatosa

A

lymphatics within lung are diffusely involved by tumour

59
Q

what makes up the visceral pleura

A

connective tissue

mesothelium

60
Q

what makes up the parietal pleura

A

mesothelium

connective tissue

61
Q

what should a normal mesothelium look like

A

single layer of cells

secrete hyaluronic acid - lubricates movement

62
Q

what is pleural effusion

A

excess fluid in the pleural cavity - serous fluid

63
Q

pus in pleural effusion

A

empyema or pyothorax

64
Q

blood in pleural cavity

A

haemothorax

65
Q

bile in pleural cavity

A

chylothorax

66
Q

air in pleural cavity

A

pneumothorax

67
Q

types of pleural effusions

A

transudates

exudates

68
Q

features of transudate pleural effusions

A

high vascular hydrostatic pressure

low capillary oncotic pressure - hypoalbuminaemia - hepatic cirrhosis, nephrotic syndrome

69
Q

features of exudate pleural effusions

A

inflammation with/without infection

neoplasms either primary or secondary

70
Q

symptoms of pleural effusions

A

breathlessness - effusion compresses the lung

little/no pleuritic pain - visceral and parietal pleura are not in contact

71
Q

signs of pleural effusion

A

dull percussion

reduced breath sounds

72
Q

investigations of pleural effusion

A

imaging - ultrasound, CXR, CT scan

73
Q

treatment of pleural effusion

A

aspiration with a needle and syringe - ultrasound

reaspirate if the fluid reaccumulates

74
Q

most common malignant pleural cancer

A

mesothelioma

75
Q

secondary malignant pleural cancers

A

carcinomas - breast, lung

76
Q

what is malignant mesothelioma

A

a neoplasm of the mesothelial cells that line serous cavities

77
Q

commoner in which gender?

A

men

78
Q

early malignant mesothelioma

A

a small tumour can produce a large pleural effusion

79
Q

how can mesothelial cells and epithelial cells be differentiated?

A

express different antigens

can be identified by immunostaining

80
Q

causes of malignant mesotheliomas

A

asbestos
thoracic irradiation
BAP1 mutations

81
Q

what is asbestos

A

fibrous metal silicates

82
Q

which form asbestos is the most oncogenic

A

amphiboles - particularly crocidolite

83
Q

what is asbestosis

A

interstitial pneumonia-like progressive pulmonary interstitial fibrosis caused by high level exposure to asbestos dust

84
Q

characteristics of asbestosis

A

fibrosis of alveolar walls impairs gas exhange and lung expansion

85
Q

pleural asbestos-related diseases

A

pleural effusion
parietal pleural fibrous plaques
diffuse pleural fibrosis
malignant mesothelioma

86
Q

lung asbestos related diseases

A

asbestosis

lung carcinoma

87
Q

skin asbestos related diseases

A

asbestos corns

88
Q

differential diagnoses for sore throat

A

pharygitis
acute tonsillar pharyngitis
infectious mononucleosis (EBV)
epiglottitis

89
Q

most common causes of pharyngitis and tonsillar pharyngitis

A 
viruses: 
rhinovirus
coronovirus 
parainfluenza
influenza (A and B) 
adenovirus

bacteria:
group A strep (strep pyogenes)
Rare: n. gonorrhoeae, HIV-1, c.diptheriae

90
Q

what are the centor criteria

A

tonsillar exudate
tender anterior cervical lymphadenopathy
>38
absence of cough

91
Q

cause of infectious mononucleosis

A

EBV

92
Q

who get infectious mononucleosis

A

teenagers

93
Q

triad of symptoms in infectious mononucleosis

A

fever
tonisillar pharyngitis
cervical lymphadenopathy

94
Q

what is epiglottitis

A

inflammation of structures above glottis

95
Q

most common cause of epiglottitis

A

H. Influenzae type b

96
Q

management of acute epiglottitis

A

significant mortality and morbidity

secure airway and oxygenation

97
Q

treatment for epiglottitis

A

IV antibiotics
analgesia
inform public health

98
Q

what is otitis externa

A

inflammation of the external ear canal presenting with otalgia, pruritus and non-mucoid ear discharge

99
Q

what is acute OE

A

range in severity - mild > necrotising

unilateral

100
Q

most common causative agent of acute OE

A

pseudomonas aeruginosa and s.aureus

101
Q

what is malignant OE

A

spreads to skull base

102
Q

who gets malignant OE

A

elderly diabetic or immunocompromised

103
Q

what is otitis media

A

middle ear inflammation

104
Q

what is uncomplicated acute OM

A

mild pain <72 hrs
no systemic symptoms
<39
no discharge

105
Q

complicated acute OM

A 
severe pain 
perforated ear drum 
purulent discharge 
bilateral infection 
mastoiditis
106
Q

organisms that cause OM

A

s. pneumoniae

h. influenzae

107
Q

what is mastoiditis

A

infection of mastoid bone and air cells

108
Q

what is pneumonia

A

infection affecting the most distal airways and alveoli

formation of inflammatory exudate

109
Q

what are the two anatomical patterns of pneumonia

A

bronchopneumonia - patchy distribution

lobar pneumonia - large part or entirety of lobe

110
Q

cause of lobar pneumonia

A

s. pneumoniae

111
Q

what is hospital acquired pneumonia

A

> 48hrs after hospital admission

112
Q

organism in Ventilation acquired pneumonia

A

pseudomonas

113
Q

organism in aspiration pneumonia

A

anaerobes

114
Q

typical causative organisms of CAP

A

s. pnemoniae
h. influenzae
m. catarrhalis
s. aureus
klebsiella

115
Q

atypical causative organisms of CAP

A

m. pneumoniae
legionella pneumophilia
chlamydophilia pneumoniae
chlamydophilia psittaci

116
Q

what is used to assess severity of CAP

A 
CURB score 
confusion 
urea - >7mmol/l 
resp rate - >30 
BP - systolic <90, diastolic <60 
age >65
117
Q

recommended tests for all moderate-severe CAP based on CURB65 score

A 
sputum culture 
blood culture 
pneumococcal urinary antigen
legionella urinary antigen 
PCR serology for viral pathogens, M. pneumoniae, Chlamydiophilia sp.
118
Q

complications of pneumonia

A

pleural effusion
empyema
lung abscess

119
Q

causes of viral pneumonia in adults

A

influenza A and B
Adenovirus
Varicella zoster virus

120
Q

causes of viral pneumonia in children

A

RSV

parainfluenza

121
Q

pnemonia in immunocompromised host

A 
measles 
HSV 
CMV
VZV
HHV-6
122
Q

presentation of primary viral pneumonia

A

cough
breathlessness
cyanosis

123
Q

causes of secondary bacterial pneumonia

A

s. pneumoniae
h. influenzae
s. aureus

124
Q

colonising organisms in CF

A

s. aureus
p. aeruginosa
burkholderia cepacia complex
non-tuberculous mycobacteria and fungi

125
Q

prevention of LRTIs

A

pneumococcal vaccination
influenza vaccination - 2-17 year olds
over 65s
chronic disease, multiple co-morbidities

126
Q

what is aspergillosis

A

infection caused by aspergillus

127
Q

who does allergic bronchopulmonary aspergillosis present in

A

people with atopy, asthma and CF

128
Q

how does ABPA present

A

worsening asthma and lung function

129
Q

diagnostic features of ABPA

A

high total IgE, specific IgE to aspergillosis, positive IgG to aspergillus

130
Q

treatment of ABPA

A

corticosteroids and antifungal therapy

131
Q

what is an aspergilloma

A

mobile mass of aspergillus within a pre-existing cavity

- old cavities left by TB and sarcoidosis

132
Q

symptoms of aspergilloma

A 
cough 
haemoptysis 
weight loss 
wheeze 
clubbing
133
Q

treatment of aspergilloma

A

surgical resection

antifungals

134
Q

how is TB transmitted

A

infection acquired by inhalation of respiratory droplets
bacilli lodge in alveoli and muliply
formation of Ghon focus
90% primary infection asymptomatic

135
Q

presentation of TB

A 
chronic productive cough 
haemoptysis 
weight loss 
fever 
night sweats 
can disseminate and affect other organisms
136
Q

detection of TB

A

detection of acid fast bacilli
culture of m. tuberculosis
interferon gamma release assays +/- tuberculin skin test

137
Q

treatment of TB

A

combined chemotherapy for several months

Clinical Pathology (8 decks)

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