Pathology Flashcards
1
Q
Second name of neonatal respiratory distress syndrome
A
Hyaline membrane disease
2
Q
Neonatal respiratory distress syndrome
A
Respiratory distress
Refractory to oxygen therapy in newborn
Due to hyaline membranes formation in alveoli because of immaturity of lungs with surfactant deficiency
3
Q
First symptoms of neonatal respiratory distress syndrome
A
Resuscitation at birth within 30 minutes : dyspnea tachypnea expiratory grunts cyanosis crepitations in the lungs ground glass opacity over the lungs on x-rays Apneic spells
4
Q
Neonatal respiratory distress syndrome incidence
A
60% incidence when born before 28 weeks
30% incidents one born between week 28 and 34
Less than 5% chance is one born After week 34
5
Q
Risk factors of Neonatal respiratory distress syndrome
A
Prematurity (born before week 36)
Maternal diabetes
Planned c section
Male gender
6
Q
Neonatal respiratory distress syndrome pathogenesis
A
Prematurity Low surfactants High surface tension in alveoli Atelectasis Uneven Perfusion and hypoventilation Hypoxemia and CO2 retention Acidosis vicious cycle because acidosis decreases surfactant release
Pulmonary Hypoperfusion endothelial and epithelial cell damage exudation of plasma into alveoli Fibrosis necrosis and Hyaline membrane increased gradient rate hypoxemia and co2 retention vicious cycle
7
Q
Type of cell that produce surfactant
A
Type 2 pneumocyte
8
Q
Surfactant regulation
A
Corticosteroid induce production
Insulin repress production
9
Q
MacroMorphology of neonate respiratory distress syndrome
A
Lungs look airless, solid, reddish purple,sink in water
10
Q
Microscopic morphology of respiratory distress syndrome
A
Atelectatic Aleve alveoli alveoli
necrotic debris in alveolar duct in terminal bronchiole
Eosinophilic hyaline membrane ( in respiratory bronchiole, alveoli , alveolar ducts
11
Q
What are hyaline membranes
A
Fibrin with necrotic type 2 pneumocytes , RBC, rare neutrophils , macrophages
12
Q
Prevention of neonatal respiratory distress syndrome
A
Delay labor
antenatal steroids to mother
surfactants to very young fetuses
13
Q
Neonatal respiratory distress syndrome treatment
A
Oxygen
exogenous surfactants
14
Q
Neonatal respiratory distress syndrome complications
A
Retrolental fibroplasia broncopulmonary dysplasia due to oxygen toxicity patent ductus arteriosus intraventricular hemorrhage necrotizing enterocolitis
15
Q
Why are male neonate more prone to respiratory distress syndrome
A
Estrogen influence lung developments
Lower rates of alveolar sodium transport channels than in female => fluid accumulation and less gas exchange
Female develop surfactant earlier
16
Q
Why do diabetic mothers have higher chances of having a neonate with respiratory distress syndrome
A
Higher chances of pre-terms baby
Inadequate use of glycogen for surfactant Synthesis
17
Q
Coryza
A
Infectious rhinitis - common cold
18
Q
Coryza cause
A
Virus ( adeno, rhino, RSV, echo)
19
Q
Most common virus in coryza
A
Rhino virus
20
Q
Coryza characteristics
A
Acute inflammation
Catarrhal
Mucus hyper secretion
Loss of epithelial cells
Bacterial secondary inflammation
21
Q
Atopic rhinitis (hay fever / allergic rhinitis) causes
A
Sensitization to house dust mites proteins plants pollen fungi animal allergens
IGE mediated
22
Q
Atopic rhinitis pathogenesis
A
Mast cells release histamine: Mucosal edema nasal obstruction redness watery rinorhea goblet cells hyperplasia thickened basement membrane inflammatory exudate with many eosinophils
23
Q
Chronic rhinitis
A
Sequel to recurrent acute/allergic rhinitis
Superimposed bacterial infection
Mixed inflammatory exudate
Can extend into sinuses
24
Q
Nasal polyps cause
A
Chronic inflammation or type 1 hypersensitivity or asthma
25
Nasal polyps morphology
Soft
rounds or elongated masses
pale gray brown
0.5 to 2 cm
26
Nasal polyps site
Middle turbinate
27
Nasal polyp histology
Surface epithelium with meta plasia
| Allergic type have lot of eosinophils
28
Nasal polyp complications
Loss of smell
| Frequent infections
29
Acute sinusitis
Acute inflammation of sinuses
30
Cause of acute sinusitis
Acute /chronic rhinitis with edema and sinus Ostia blockage
31
Bacteria in secondary infection in acute sinusitis
Staph aureus
H influenza
Pneumococcus
Strep pyogenes
32
Acute sinusitis complications
Empyema
33
Chronic sinusitis
Failure to resolve acute sinusitis
34
Origin of severe form of chronic sinusitis
Fungal origin
35
Necrotizing nasal lesions
Acute fungal infection
36
Necrotizing nasal lesions Morphology
Granulomatosis - Polyangitis (wegeners granulomatosis)
giant cell granulomas of lungs
Polyarteritis
renal damage
Extranodal T cell then lymphoma in elderly
37
Pharyngitis and tonsillitis
Non-specific inflammation of needs a pharynx
38
Common causes of pharyngitis and tonsillitis
Mostly viral
| sometimes bacterial
39
Characteristics of pharyngitis and tonsillitis
Red
Oedematous mucosa
Enlarged tonsils and lymph node
40
Of what bacteria is pharyngitis and translate is an important sequelae
B haemolytic strep( pyogenes)
41
Benign tumors of nose Sinuses nasopharynx larynx
Hemangiomas
squamous papillomas
juvenile angiofibroma
42
Juvenile angiofibroma
Benign tumor of nasopharynx in childhood almost exclusive to male
Vascular and epistaxis
43
Malignant tumor of nose nasopharynx pharynx sinuses
```
Squamous cell carcinoma
Adenocarcinoma (common in wood workers)
lymphoma
sarcomas
Olfactory neuroblastoma
Nasopharyngeal carcinoma
```
44
Naso pharyngeal carcinoma incidence
Twice in males
Peak at 10-20 and 6th decade
45
Causes of nasal pharyngeal carcinoma
Hereditary
Age
EBV
diet
46
Acute epiglotitis causes
RSV
H influenza B
streptococcus
47
A cute epiglottis presentation
Respiratory obstruction by edema
| dyspnea worse in supine position
48
Managements of acute epiglottitis
Emergency so may require tracheostomy
49
Acute Laryngotracheo bronchitis
Gradual onset of cough
stridor
croupy cough
50
Benign tumors of larynx and trachea
```
Squamous papilloma (Single in adults and multiple in children)
polypoid mass on true vocal cord
```
51
Causes of benign tumors of larynx in trachea
Hpv6 /11
52
Presentation of benign tumors of larynx and trachea
Hoarse voice
| Bleeding
53
Laryngeal fibroma
Vocal cords polyp
| Covered by epithelium with a core of myxomatous connective or dense fibrocollagenous tissue
54
Causes of laryngeal fibroma
Common in singers smokers and in Myxedema
55
Malignant tumors of larynx and trachea
Squamous cell carcinoma of larynx ( commonest neoplasm of larynx)
56
Origin of squamous cell carcinoma of larynx
Squamous epithelium a vocal cords
57
cause of squamous cell carcinoma larynx
```
Smoking
excess alcohol
previous irradiation
zinc and vitamin a deficiency
asbestos
HPV infection
```
58
Squamous cell carcinoma of larynx incidence
Higher in male Chronic smokers
59
Morphology of squamous cell carcinoma of larynx
Severe dysplasia
carcinoma in situ
metastasis to cervical notes
Blood borne metastasis to lungs liver bones
keratinizing and non-keratinizing squamous carcinoma & spindle cell
60
Factors affecting local defense in respiratory tract
Suppression of cough reflex like in coma or anesthesia
Ciliary defects
Mucus disorders
acquired or congenital hypogammaglobulinemia ( low IgA)
Immunosuppression
depressed alveolar macrophage function
pulmonary edema with fluid accumulation in alveoli
61
Specific infections of LRT
Bronchitis
Bronchiolitis
Pneumonia
Lung abscess
62
Acute bronchitis
Acute inflammation of bronchi
63
Acute bronchitis causes
Viruses - RSV
Pollutants
SO2
Smoke
64
Acute bronchitis presentation
```
Cough
Dyspnoea
Tachypnoea
Sputum production
May have laryngotracheobronchitis and lungs issues
```
65
What disease superimposed with chronic obstructive airway disease
Acute bronchitis
66
Bronchiolitis
Inflammation of bronchioles
67
Cause of bronchiolitis
Viral disease in children (RSV)
68
Bronchiolitis presentation
Dyspnoea
Tachypnoea
Resolve in few days
Rarely bronchopneumonia
69
Pneumonia
Inflammation affecting lungs parenchyma
| Exudate formation leading to consolidation of lung tissue
70
Clinical classification of pneumonia
community acquired acute pneumonia
Health care associated pneumonia
Hospital acquired pneumonia
Aspiration pneumonia
Chronic pneumonia
Necrotizing pneumonia and lung abscess
Pneumonia in immunecompromised Host
71
Anatomic classification of pneumonia
Bronchopneumonia : patchy consolidation of lungs 3-4cm , common at autopsy
Lobar pneumonia : acute bacterial infection by droplets acquired by community , diffuse consolidation of one or more lobes or segments by fibrinosuppurative exudate , accompanied by pleural reaction with fibrin deposition
72
Causes of lobar pneumonia
90-95% : strep pneumonia type 1,3,7,2
Klebsiella pneumoniae
Staph aureus
H influenza
Pseudomonas
Proteus
73
Causes of bronchopneumonia
```
Staph
Strep
Pneumococci
H influenza
Pseudomonas
```
74
Pneumonia pathogenesis
Impaired defense mechanism by virulent organisms
Lobar pneumonia -> extensive exudate -> organism spread rapidly through pores of kohn too other alveoli
Bronchopneumonia involve bronchiole and spread to adjacent alveoli
75
Lobar pneumonia morphological stages
Congestion (lung heavy , red, Vascular engorgement intra-Alveolar fluid With few neutrophils and many bacteria
Red hepatization (the lung firm red, airless , liver like consistency, many RBC and neutrophils, breaks when firm gentle pressure instead of regaining shape )
Grey hepatization ( lung firm, gray brown, dry surface, progressive disintegration of RBC, fibrinosuppurative exudate )
Resolution ( consolidated exudate progressively digested by enzymes, resorted by macrophages or coughed up, inflammation resolution)
76
Pneumonia complications
```
Local:
Lung abscess
solid fibrotic lung
Pleural effusion
Empyema thoracis
```
```
Systemic:
Bacteraemic dissemination
Meningitis
Pericarditis
kidney or splenic abscess
septicemia
```
77
Symptoms of pneumonia
```
Fever (5days, and drops 2 days after antibiotics)
cough
sputum production
chest pain due to pleural reaction
dullness
bronchial breathing
```
78
X-ray findings of pneumonia
Opaque Well delineated lobe in lobar pneumonia
Focal opacities in bronchopneumonia
79
Community acquired viral pneumonia
Acute febrile respiratory disease with Patchy inflammatory changes in Lungs
confined to the alveolar septa and pulmonary interstitium
80
Causes of Community acquired viral pneumonia
```
Viruses
influenza
RSV
Varicella
adenovirus
rubeola
CMV
SARS
Coxiella burnetti
chlamydia
mycoplasma
```
81
Community acquired viral pneumonia morphology
Lung subcrepitant, patchy, unilateral or bilateral
no reaction at pleura
Septa widens by edema mononuclear cells and very few neutrophils
Alveoli mostly free of exudates
Few cases with exudate and hyaline membrane
82
Community acquired viral pneumonia symptoms
```
Severe cold
cough
fever
headache
muscle aches
leg pains
```
83
Pneumonia in the immunocompromised
Due to opportunistic infections In debilitating disease, therapy for organ transplants , tumors , irradiation
84
Pneumonia in the immunocompromised presentation
Fever
short breath
cough
85
Immunocompromised pneumonia x rays
```
Lung infiltrates
focal infiltrate ( with CMV, P Carinii, aspergillus, cryptococcus, tb, rubeola, drug run, malignancy )
```
Diffuse infiltrate ( gram neg bacilli, stap aureus, aspergillus, candida, cryptococcus, Nucor, p caring, legionella, malignancy )
86
Aspiration pneumonia
Inflammation and consolidation of the lung went fluids or foods is aspirated into lung
87
Risk factors of lung aspiration
```
Sedition
alcohol abuse
operations
Coma
stupor
laryngeal carcinoma
severe debilitation
```
88
What part of the lung will be affected if you aspirate something when laying on the back
Lower lobe
89
What part of the lung will be affected if you aspirate something when laying on the side
Upper lobe
90
Endogenous Lipid pneumonia
Airway obstruction by distal collection of foamy macrophages and giant cells
91
Exogenous lipid pneumonia
Aspiration of lipid rich material like paraffin oil in nasal drops, palm oil when given to children to Treats Toxicity, Vacuoles of lipids from foreign body giant cells in lung
92
Lung abscess
Local suppurative process in the lung with necrosis of lung tissue
93
Predisposition to lung abscess
```
Oral pharyngeal surgery or disease
sinobronchial infection
dental sepsis
bronchiectasis
complications of pneumonia
```
94
Causes of lung abscess
Potentially any organism usually Aero and anaerobic strep, staph aureus, gram neg organism
60% of cases => fusobacterium, peptococcus
95
Introduction of organisms to form lung abscess
Aspiration of infected material from mouth and pharynx
Primary bacterial or fungal infection of lung
Septic embolism
Neoplasia
Direct penetrating injuries
cryptogenic
96
Lung abscess morphology
Size goes from micro to macro
| Any parts of the lung can be affected
97
What side of the long is more affected by lung abscess
Right side because more aspiration
98
Lung abscess x ray
Air fluid level
99
In what case of lung abscess can you get gangrene of the lung
Super imposed saprophytic infection ( large fetid green black area)
100
Lung abscess clinical presentation
Fever
| cough with copious sputum (foul smelling and bloody or purulent)
101
Lung abscess complications
Metastatic abscesses in the brain ,kidney ,spleen , and finally pleura (risk of empyema)
malignancy in 15% of cases
102
2 groups of obstructive airway disease
Localised (mechanical factors like tumors, foreign body)
Diffuse (COPD)
103
Chronic obstructive pulmonary disease
Group of disease which presents with
dyspnea
increased resistance to air flow
reduce expiratory capacity
Diffuse reversible or irreversible abnormalities in bronchi or bronchioles
Respiratory improvements
chronic airflow limitation
Reduce vital capacity , FEV1/FVC ratio under 0.7
104
Types of COPD
```
Chronic bronchitis
emphysema
bronchiectasis
bronchial asthma
bronchiolitis
```
105
Chronic bronchitis
Defined clinically with persistent productive cough each day for at least three months of the year over 2 consecutive years
106
In which population do you see the most chronic bronchitis
Smokers
| Inhabitants of urban smug laden cities (so2, no2, dusts....)
107
Types of chronic bronchitis
Simple chronic bronchitis ( Early disease, cough, little sputum, no physiologic obstruction)
chronic asthmatic bronchitis ( Bronchospasm and intermittent wheezing)
chronic emphysematous bronchitis ( emphysema added)
108
Incidence of chronic bronchitis
Both sexes affected
most common in in the middle age
109
Risk factors of chronic bronchitis
```
Smoking (about 90% of patients )
air pollutants (about 20 to 40% of patients )
artificial fibers
coolant
occupational fumes like welding
```
110
Chronic bronchitis pathogenesis
Tissue damage by irritants
inflammation
large airways have hypersecretion due to enlarged mucus glands
Small airways like bronchi and bronchioles have goblet cell hyperplasia
Secondary infection of mucus
more damage and hypersecretion
airway obstruction
111
How does cigarette smoking predisposes to infection
Interfere with ciliary action
damage airway epithelium
Inhibit ability of bronchial and alveolar leukocytes to clear bacteria
112
Chronic bronchitis macro appearance
```
Hyperemia
swelling of mucous membranes
mucus cast in bronchi and bronchiole
mucus secretions in bronchi and bronchioles
Frank pus collection in bronchi
```
113
Histology of chronic bronchitis
Mucus glands enlargement
Mucus hypersecretion
increased diameter of acini of glands
increased proportion of mucus to serous cell
Goblets cell hyperplasia In bronchi and bronchioles
Bronchial narrowing and obstruction
Squamous metaplasia with dysplasia in bronchial epithelium
114
Reid index
Ratio Of the thickness of mucus glands layer to the thickness of bronchial wall
115
Normal reid index
0.36 to 0.41
116
Reid index in Chronic bronchitis
0.44 to 0.79
| Increases in proportion to severity and duration of disease
117
Bronchial mirroring and obstruction due to in chronic bronchitis :
```
Mucus secretion and plugging increased
goblet cell hyperplasia
Inflammation with exudate
accumulation of pigmented alveolar macrophages in clusters
fibrosis of the wall of the bronchioles
obliteration of bronchioles
```
118
Blue bloater
Classic patience with long-standing chronic bronchitis and obstructive features
Long history of chronic of recurrence airway insufficiency and recurrent chest infections
119
Blue bloater incidence
Male between 40 to 45-year-old
120
Symptoms of blue bloater
Progressive dyspnoea
| cyanosis
121
Blue bloater x ray
Increased lung markings
| large heart outline
122
Blue bloater pathogenesis
Failure of oxygenation in alveoli
Central Cyanosis with low alveolar oxygen pressure and increased alveolar co2
Ventilation perfusion imbalance
pulmonary hypertension with right heart changes
right heart failure which is a cause of death
recurrent infections
respiratory impairments
coma
death
123
Emphysema
Permanent abnormal enlargement of any part of the respiratory acinus ,destruction of the elastin in the wall, no obvious fibrosis
124
Where is emphysema common
Advanced countries
125
Population more at risk of emphysema
Female African-American
126
Most important risk factor of emphysema
Heavy cigarette smoking and urban dwelling
127
Four types of emphysema
Centriacinar ( 95%)
Panacinar
Distal acinar
Irregular
128
Centriacinar (centrilobular)
Respiratory bronchioles at center of lobules affected
Distal acinus and alveoli spared
Inflammation in terminal and respiratory bronchioles
Affects more upper part of lungs
Males heavy smoker and coal miners most affected
129
Panacinar emphysema
Entire acinus from respiratory bronchiole to alveolar sacs uniformly
Commoner in lower zones, anterior margins
70-80% idiopathic
Associated with alpha1 anti trypsin deficiency
130
Paraseptal
Affect distal acinus
Most striking Adjacent to pleura , along lobular connective tissue septa and margins of lobules
Adjacent to areas of fibrosis, scarring, atelectasis
More severe in upper half of lungs
May be responsible for pneumothorax
131
Irregular emphysema
```
Acinus irregularly involved
Invariably associated with scarring
Wall adjacent to scar is destroyed
Asymptomatic
Post inflammatory
Post tuberculosis
Pneumoconiosis
```
132
Pathogenesis of emphysema
Inflammation done by inflammatory mediators, oxidant antioxidants (mice studies on NRF2 gene inactivation ) protease anti protease(a1 deficiency homozygotes develop emphysema especially in smokers )
133
Emphysema morphology
```
Voluminous lungs
Cardiac shadow covered
Higher lung weight
Large blebs or bullae
Dilated alveoli
Abnormally large alveoli
Large pore of kohn
Floating alveolar sept
```
134
Clinical feature of emphysema
Classic => Pink puffer (patient is thin, tachypneoa, pink skim, prolonged expiration)
70-75yo male with no chronic bronchitis but pure emphysema
Early onset of dyspnoea - steadily progressive
Weight loss
Barrel Chest (trapping of air in lungs due to destruction of alveoli )
Hyperventilation
Late stage => reduced PAO2 , pulmonary hypertension, cor pulmonale, death
135
Causes of death in emphysema
Corpulmonale
Pneumothorax with lung collapse
Respiratory acidosis ->coma-> death
136
Other forms of emphysema
Compensatory emphysema
Obstructive overinflation
Bullous emphysema
Interstitial emphysema
137
Compensatory emphysema
Loss of lung substance leading to dilatation with no alveoli destruction (pneumomectomy)
138
Obstructive over inflation
Lung expand due to trapped air
Obstruction by tumor or FB
Collateral air passages - pore of kohn, bronchioalveolar canals of lambert supply air to distant parts. Can compress normal part of lung => emergency
139
Bullous emphysema
Large bleb or bullae distended with air ( usually near subpleural, apex, tb scars )
If rupture -> pneumothorax
140
Interstitial emphysema
Air into connective tissue strong of lung, mediastinum, or subcutaneous tissue
Air enter by alveolar tear from emphysema, congenital dx, chest wound, fractures , whooping cough, bronchitis,
Crackling sensation under hands
141
Bronchiectasis
Chronic necrotizing infections of bronchi and bronchioles
| Abnormal permanent dilatation of airways
142
Bronchiectasis presentation
Recurrent chest infections
Fever
Productive Cough of Foul smelling purulent sputum (sometimes bloody)
143
Bronchiectasis etiology
Bronchial obstruction
Necrotizing pneumonia
Congenital or hereditary conditions
Idiopathic
144
Type of bronchial obstruction leading to bronchiectasis
Focal : foreign body, tumor, lymphadenopathy, mucus impact ion,
Diffuse : obstructive airway disease, bronchial asthma, chronic bronchitis
145
Type of Necrotizing pneumonia leading to bronchiectasis
Tb
Staph
Mixed infections
Post whooping cough , measles, influenza
146
Types of congenital or hereditarily conditions leading to bronchiectasis
( defect in development of bronchi)
Cystic fibrosis
Immunodeficiency
Kartagener s syndrome : immobile cilia syndrome
147
Bronchiectasis pathogenesis
Obstruction
atelectasis
bronchial wall inflammation and secretion
reversible dilatation of bronchi
Persistence of obstruction / secondary infection
Inflammation
Destruction of wall
Permanent dilatation
Extensive bronchiolar damage
Endobrinchial obliteration
Atelectasis distal to obliterated area
Extensive bronchial damage
Bronchiectasis
148
Cystic fibrosis
Squamous metaplasia
Impaired mucociliary action
Infection and necrosis of walls
Bronchiectasis
149
Kartageners syndrome
Ciliary motility defect due to structural abnormalities
Poor bacterial clearance -> infection in sinus and bronchi
Bronchiectasis
Sinusitis and situs inversus ( poor cell motility in embryogenesis)
150
MacroMorphology of bronchiectasis
Lower lobes bilaterally
Unilateral in FB or tumors
Almost vertical air ways
Severe in distal bronchi and bronchioles => dilated 4x normal
Dilatation can be cylindroid, fusiform or saccukar
Gross examination -> dilated bronchi seen through pleural surface as cysts
151
Micro morphology of bronchiectasis
```
Acute or chronic inflammation
Ulceration of mucosa
Squamous metaplasia of epithelium
Abscess due to necrosis
Fibrosis in peribronchial and peribronchiolar tissue
```
152
Clinical presentation of bronchiectasis
```
Persistent cough
Foul smelling sputum sometimes bloody
F3ver
Dyspnoea
Cyanosis
```
153
Bronchiectasis complications
Cor pulmonale
Lung abscess
Metastatic micro abscesses in brain kidney
154
Bronchial asthma
Chronic relapsing inflammatory disease of conducting airways
Hyperreactive airways
Inflammation of bronchial walls
Increased mucus secretion
155
Bronchial asthma presentation
Wheezing ( due to acute reversible increase in resistance to airflow in small airways so more respiratory effort)
Dyspnoea
Chest tightness
Cough triggered by bronchospasm
156
Classification of bronchial asthma
Atopic asthma => extrinsic, allergic, IgE mediated, allergen sensitization
Non atopic asthma => intrinsic, no evidence of allergen sensitization
157
Stimuli of bronchial asthma
```
Respiratory infection
Cold air
Exercise
Exposure to irritants ( smoke, fumes, smog)
Stress , emotional state’s
DRugs like opiates, aspirin
Food allergens
```
158
Features of atopic asthma
```
Most common type
Classic igE Mediated hypersensitivity rxn
Begins in childhood
Triggers domestic environmental
Positive FHA OF ASTHMS
```
159
Features of non atooc asthma
No evidence of allergen sensitization
Less FH positive for asthma
Common triggers => respiratory infection and environmental pollutants
160
Classification asthma
Seasonal
Exercise induced
Drug induced
Occupational
Asthmatic bronchitis in smokers
161
Drug induced asthma (aspirin)
Not common
Recurrent rhinitis and nasal polyps
React excessively to nsaids
Inhibition of Cox so less prostaglandin E2 and more leukotrienes b4-e4
162
Occipqtional asthma
Triggered by fumes (epoxy resins, plastics) gases (toluene), organic and chemical dusts ( wood cotton platinum) other chemicals ( formaldehyde, penicillin)
163
Pathogenesis of asthma
Exaggerated TH2 and IGE respond to environment antigen
Sensitization ( 1st exposure allergen, th2 release IL4 &5, IL4 stimulates B cells which stimulates plasma cells for IgE which bind mast cells, IL5 recruits eosinophils for activation )
Reexposure - immediate or late ( immediate => allergenbinds IgE on mast cells , mast cell release granules, cytokines release too )
164
Immediate asthma phase response
Bronchoconstriction
Increased mucus production
Vasodilation
Increased vascular permeability
White cells recruitment
165
Late phase of asthma response
```
4-8h later
Mediated by white cells
Release cytokines , leucotrienes, PAF, eosinophils cationic protein,
Epithelial damage
Airway constriction
```
166
Action of leucotrienes
Prolonged bronchoconstriction
| Increase vascular permeability
167
Acetylcholine action
Bronchoconstriction
168
Histamine action
Bronchoconstriction
169
Prostaglandin D2 action
Bronchoconstriction
| Vasodilation
170
PAF action
Platelet aggregation
| Release histamine and serotonin
171
MacroMorphology of asthma
Over distended Lung
Small areas atelectasis
Occlusion of bronchioles by thick mucus plugs
172
Micro morphology of asthma
Thick tenacious layer of mucus to form plugs
Curschmann spiral
Numerous eosinophils
Collections of crystalloids with eosinophils membrane protein (Charcot leyden crystals )
Lot of goblet cells in epithelium
Basement membrane more thick
Edema and inflammation infiltrate in bronchial wall
Increased size of submucosal glands
Hypertrophy of bronchial wall
Emphysematous changes and bronchitis
173
Clinical features of asthma
Attack last several hours
Coughing
When severe -> impaired respiratory function -> cyanosis -> death
174
Cause of airway obstruction in asthma
Bronchial contraction
Bronchial mucosal increased thickness
Mucus and exudate retention in lumen
175
Asthma diagnosis
History
Examination-> resp difficulty, decreased air entry , wheezing
Test
Increased eosinophils in blood
Increased eosinophils, curschmann, spiral, Charcot Leyden crystals in sputum
176
Diagnosis of type of asthma
Increased IgE serum
| Positive skin allergen test , RAST TEST
177
Diffuse interstitial lung disease
Group of lung disease with chronic diffuse involvement of the connective tissue of the lungs Especially the most peripheral and delicate interstitium in alveolar walls
178
Interstitium in diffuse interstitial lung diseases
Basement membrane of endothelial and epithelial cells
Collagen
Elastic fibers
Proteoglycans
Fibroblasts
Mast cells
Histiocytes
Monocytes
179
Do we know most causes of diffuse interstitial lung diseases
No mostly idiopathic
180
Lung diseases with restrictive effect but non obstructive
Diffuse interstitial lung disease
181
Changes in the lung due to diffuse interstitial lung disea3e
Thick wall =< less o2 diffusion across wall
Decreased lung volume
Decreased lung compliance
182
Diffuse interstitial lung disease presentation
Dyspnoea
Tachypnoea
Cyanosis
No wheezing
183
Diffuse interstitial lung diseases x ray
Diffuse infiltration lay small granules , irregular lines, ground glass shadows
184
Complications of diffuse interstitial lung disease
Pulmonary hypertension
Right heart failure With cor pulmonale
Honey comb lung due to scarring and destruction
185
Classification of diffuse interstitial lung disease based on....
Known etiology
Not known etiology
186
Diffuse interstitial disease with known etiology
```
Pneumoconiosis
Ionizing radiation
Following ARDS
Drug busulfan
Bleomycin
Beryllosis
Hypersensitivity pneumonitis
```
187
Diffuse interstitial disease with unknown etiology
```
Collagen vascular disease
Goodpastures syndrome
Idiopathic pulmonary fibrosis
Idiopathic hemosiderosis
Sarcoidosis
Wegeners granulomatosis
```
188
Pneumoconiosis
Non neoplasticism lung reaction to inhalation of mineral dusts, organic dusts, chemical fumes, vapor
189
Types of pneumoconiosis based on mineral dusts involved
```
Coal - Anthracosis
Asbestos - abestosis
Silica- silicosis
Beryllium- beryllosis
Iron oxide - siderosis
Barium sulphate - baritosis
Tin oxide - stannosis
```
190
Types of pneumoconiosis based on organic dusts involved
Moldy hay: farmers lung
Bagase: bagassosis
Bird droppings: bird breeders lung
191
Types of pneumoconiosis based on fumes and vapors involved o
No2
So2.
Benzene
Insecticide
192
Type of reaction to dust and fumes
Inert ( simple, coal worker pneumoconiosis
Fibrosis ( progressive fibrosis , asbestosis, silicosis)
Allergy ( extrinsic allergy alveolitis
Neoplasm (=mesothelioma, bronchogenic
193
Pneumoconiosis pathogenesis
Dust retained in lung
Small dust (1-5mm) can get into alveoli
Large dust trapped early
Dust particles phagocytosed by alveolar macrophages and go to hilar lymph nodes
194
Particularity with asbestos fibers
Even tho long (8mm) , very thin so can get into alveoli
195
Coal workers pneumoconiosis
Inhalation of coal dust leading to
Asymptomatic anthracosis
Simple CWP => macular or nodular CWP
Complicated CWP=> progressive massive fibrosis
196
Macular CWP
Local aggregate of dust laden macrophages in and around
Bronchioles, arterioles, veins, lymphatic, hilar lymph nodes
No significant scarring
Mild emphysema due to smoking
197
Nodular CWP
Small nodules with more extensive macular lesions
No fibrosis
No functional difficulty
198
Complicated CWP
```
Extensive fibrosis
Large fibrotic nodules
Compromised lung function
Possible central liquefaction in nodules
Mid and upper zones of lungs
10% of simple CWP lead to complications
Pulmonary dysfunction
Pulmonary hypertension
Cor pulmonale
```
199
Silicosis
Inhalation of crystalline silicon dioxide
Slowly progressive nodular fibrosing pneumoconiosis
Particles phagocytized by macrophages in alveoli but not destroyed
Release of fibrogenic mediators(TNF, cytokines, IL-1, fibronectin, lipid mediators, free radicals )
Toxic injury due to SiOH denature membrane proteins and damage lipid membranes
200
Commonest occupational disease
Silicosis
201
Morphology of silicosis
At first => tiny dispersed nodules in upper zone
Nodules becomes hard fibrous scars , few cells, some with central cavitation
Eggshell calcification of lymph nodes
Progressive massive fibrosis occurs
202
Histology of silicosis
Nodular lesions with layers of collagen with dense collagenous capsule
Silica particles seen under polarized light
203
Can silicosis reactivate Tb
Yes
204
Association between silicosis and cancer
Increased risk of cancer by 2
205
Disease caused by asbestos
Crystalline Hydrated silicates that form fibers which can cause
- localized fibrous plaques
- pleural effusions
- parenchyma interstitial fibrosis (asbestosis )
- bronchogenic carcinoma
- mesothelioma
- laryngeal and extra pulmonary cancer
206
Type of asbestos
Serpentine - curly and flexible (chrysolite)
Amphibole - straight stiff brittle fibers ( crocidolite, amosite, tremsolite)
207
Most case of asbestosis due to what type of asbestos
Amphiboles
208
Asbestosis pathogenesis
```
React with lung macrophages and epithelial cells
Release of fibrogenic mediators
Diffuse interstitial lung disease
No nodules
Starts in lower lobes and extend
```
209
Asbestos morphology
Diffuse pulmonary interstitial fibrosis
Asbestos bodies - golden brown beaded rods with asbestos fibers coated with iron and proteinaceous material
Ferruginous bodies - inorganic particles coated with iron
Pleural plaques of dense collagen with calcium - most common manifestation
Pleural effusion - not common
Diffuse pleural fibrosis - rare
Bronchogenic carcinoma -5x
Mesothelioma - 1000x
210
Sarcoidosis
Systemic disease
Idiopathic
Non caseating
Naked granulomas
Bilateral hilar lymphadenopathy + lung involvement -90% cases
Eyes lesions ( iridocyclitis, corneal opacities, glaucoma, blindness)
Skin, salivary glands, spleen, liver
211
Incidence of sarcoidosis
Male more than females
| Blacks mostly
212
Sarcoidosis pathogenesis
```
Unknown antigen poorly degradable
type 4 reaction
Granuloma formation
High CD4 + lymphocytes in lung
High soluble IL2 receptors in serum and lung
```
213
Sarcoidosis morphology
Non caseating granulomas
Laminated concretions of calcium and shaumann bodies
Stellate inclusion bodies in giant cells cytoplasm => asteroid bodies
```
Activated alveolar macrophages , class II HLA expression , APC activity
Oligoclonal T cell proliferation in lung
```
214
Sarcoidosis presentation
```
Dyspnoea
Cough
Chest pain
Haemoptysis
Fatigue
Weight loss
Fever
Anorexia
Night sweats
```
215
Effective treatment of sarcoidosis
Steroids
216
Pulmonary vascular diseases
```
Pulmonary congestion and edema
Adult respiratory distress syndrome
Pulmonary embolism
Pulmonary Hemorrhage
Pulmonary Infarction
Pulmonary hypertension
Cor pulmonale
```
217
Adult respiratory distress syndrome (diffuse alveolar damage)
Rapid onset of severe life threatening respiratory insuffiency, cyanosis , severe arterial hypoxemia
Refractory to O2 therapy
Associated with severe pulmonary edema
218
X ray of adult respiratory distress syndrome
Diffuse alveolar infiltrate
| Hyaline membrane in alveoli
219
Pulmonary embolism hemorrhage infarction epidemiology
200,000 death per year in US
High incidence in autopsy
Common in Ghana
220
Etiology of pulmonary embolism hemorrhage infarction
Pulmonary arterial occlusion (generally thromboembolism, mostly coming from legs deep veins)
Large vessel thrombosis rare
Pulmonary hypertension
Pulmonary atherosclerosis
Congestive cardiac failure
221
Risk factor of pulmonary embolism hemorrhage infarction
```
Cardiac disease
Cancer
Immobilization over Long time
Hypercoagulable states
Indwelling central venous lines
Post op
Pregnancy
Post party’s
```
222
PAthogenesis of pulmonary embolism hemorrhage infarction
Fragmented thrombi of DVT
Carried through veins
Channels into right atrium
Gets into pulmonary arterial vascular use
Causes :
Respiratory compromise - non perfused segment
Hemodynamics compromise - increased pulmonary resistance due to obstruction
223
Severity of pulmonary embolism hemorrhage infarction depends on
Extent of arterial obstruction
Size of occluded vessel
Number of emboli
Status of CVS
224
Morphology of pulmonary embolism hemorrhage infarction
If large embolus => sudden death by blocking blood flow to lung and causing acute cor pulmonale
Small emboli => infarction if circulation inadequate , common in lower lobes, wedge shaped ( blocked artery tap apex, base at periphery with pleura with fibrinosuppurative exudate ) , red brown raised area, heals by fibrosis
=> if circulation adequate , pulmonary hemorrhage , no infarct
Tiny microembolism (shower emboli) => asymptomatic, over time may cause reduced cross sectional area, high vascular resistance , pulmonary hypertension
225
Pulmonary hypertension
Normal pulmonary pressure is 1/8 systemic blood pressure
| Pulmonary hypertension is 1/4 systemic blood pressure
226
Pulmonary hypertension causes
Cardio pulmonary disease with increased blood flow and/or pressure
Increased pulmonary vascular resistance
Left heart resistance to blood flow
Secondary pulmonary hypertension
Idiopathic
Chronic obstructive airway disease (emphysema)
Chronic interstitial Lung disease
Congenital or acquired heart disease (Mitral stenosis, increased left atrial pressure, pulmonary venous congestion, increased pulmonary artery pressure )
Recurrent shower embolism
Vasospam (bush tea, anti obesity appetite suppressor)
227
Pulmonary hypertension morphology
Vascular lesions
Atheromatous plaques in pul artery
Medial hypertrophy and intimate fibrosis with pinpoint channels in small arteries and arterioles
228
How is it determined if surgery of lung is required in pul HT
Biopsy
229
Wegener granulomas
Systemic vasculitis affecting upper respiratory tract, lung, kidneys, liver, and skin
230
Wegener granuloma morphology
Necrotizing granuloma of nose
Giant cell granuloma of lungs
Polyarteritis
Renal damage
231
Wegeners granuloma histology
Vasculitis affecting small arteries
Necrosis
Fibrinoid deposition in the wall
Thrombosis of vessel
Granuloma with central necrosis (caseated like)
Cellular infiltrate with macrophages eosinophils neutrophils
Kidney have segmental glomerulonephritis
232
More common type of primary tumors of the lungs
Malignant type more common than benign
233
Are all secondary tumors of lungs malignant..
Yes
234
Most commo type of lung tumor
Secondary
235
Types of malignant primary tumor of lungs
Bronchogenic (90-95%)
Neuroendocrine (carcinoid)
Mensenchymal tumors
Lymphomas
236
Major diagnosed cancer worldwide and most common cause of cancer mortality
Bronchogenic carcinoma
237
Population more affected by bronchogenic carcinoma
Male more than female
Smokers
Age 40-70 peak at 50-60
238
Bronchogenic carcinoma etiology
Tobacco smoking (80% of the cancer patients )
Rise with amount of smoking , especially tobacco smoking
Passive smoking
Smokeless tobacco (women more susceptible to carcinogen in tobacco )
Genetic susceptibility cytp450
Industrial hazard (asbestos, coal, nickel, hematite, arsenic, chronium, uranium, mustard gas, vinyl chloride)
Air pollutant (increase risk in susceptible people, chronic irritation, inflammation and repair ,
Genetics - cyt P450 polymorphism
239
Amount of carcinogens in smoke
1200 known
240
Impact of smoking on bronchial mucosa
Squamous metaplasia to dysplasia to squamous ca
241
Type of bronchiogenic carcinoma
Adenocarcinoma -40%, females
Squamous cell ca 20% male smokers
Small cell ca 14%
Large cell ca 3%
Other 25%
242
Common mixed cancer seen in bronchogenic carcinoma
Small cel ca with squamous cell ca
Squamous cell with adenocarcinoma
243
Bronchogenic cell ca morphology of ADC
In peripheral lung ADC
Central hilar region. SCC
Atypical adenomatous hyperplasia ADC if in Situ becomes invasive
ADC can grow like acinar, lepidic, papillary, solid
244
Bronchogenic cell ca morphology of SCC
Sq metaplasia leads to dysplasia leads to ca in situ leads to invasive SCC
Patterns:
Fungating mass in lumen
Infiltrative in peribronchial tissue and mediastinum
Cauliflower intraoarenchymal mass
```
Greg white color
Firm to hard
Focal hemorrhages
Necrosis
May have cavity
```
245
Bronchogenic carcinoma presentation
```
Cough
Weight loss
Chest pain
Dyspnoea
S
```
246
Bronchogenic carcinoma lab test
Sputum cytology tumor cells
Pleural effusion cytology
FNA fine needle aspiration cytology
247
Bronchogenic ca complication s
Emphysema - tumor partial obstruction;
Lobar colllapse
Pneumonia
Lung absces
Severe suppurative
Ulcerative bronchitis
Lipid pneumonia from obstruction
Cellular lipid accumulation
SVC syndrome - venous congestion that can lead to circulatory collapse
Malignant pericarditis , pleurisy, effusions , cardiac tamponadd
Bronchiectasis
Hornets syndrome ( sympathetic ganglia involved leading to enoohtalmos, ptosis, miosis, anhidrosis)
Pancoasts tumor ( apical tumor invading cervical neural plexus , pain in ulnar nerve causing horners syndrome )
Rib destruction
Diaphgram paralysis
Dysphasia
Hoarseness
Hypertrophic pulmonary osteodystrophy
248
Main site of spread of lung carcinoma
Lymph metastasis to trachea, bronchial m mediastinal lymph node
Blood borne metastasis to adrenal mostly and then liver and finally brain and bone
249
Metastatic lung tumors morphology
Discrete nodules over lungs mostly on periphery
Peribronchial and peribascular infiltrate in connective tissue septa
Subpleural lymph outlined in lymphangitis carcinomatosa
Diffuse in apparent intro lymphatic dissemination
250
Metastatic lung tumor treatment
Surgical excision
Radiation
Chemotherapy
251
Metastatic lung tumor prognosis
Poor
| E5YS - 5%/
