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The Respiratory System > Pathology and Histology > Flashcards

Pathology and Histology Flashcards

1
Q

What is pneumonia?

A

Infection involving the distal aspects of the respiratory tree including localised oedema

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2
Q

What is lobar pneumonia?

A

Pneumonia involving a complete lung lobe

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3
Q

What are the different types of pneumonia (based on where infection was acquired)?

A
  1. Community acquired
  2. Hospital aquired
  3. Aspiration
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4
Q

During a classical acute inflammatory response what are the main stages in a pneumonia?

A
  1. Exudation - emission of fibrin-rich fluid through pores or wounds
  2. Infiltration by neutrophils
  3. Infiltration by macrophages
  4. Resolution
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5
Q

Why is pneumonia potentially able to cause long term damage? (3 what would it lead to)

A

Organisation of tissues during healing can cause fibrous scarring

Abcesses can form

Bronchiestasis can occur - abnormal dilation of bronchi

Empyema - collection of pus in body cavity most commonly the pleura

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6
Q

What is bronchopneumonia?

A

This is when infection causing pneumonia starts in the airways and proceeds to infect the alveolar lung

This is common when the patient has pre-existing disease

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7
Q

Which pathogens can cause bronchpneumonia?

A

Strep. pneumoniae, Haemophilius influenza, S. aureus, anaerobes and coliforms

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8
Q

What is an abscess?

A

A local collection of pus

Can cause chronic malaise and fever

Caused by aspiration of pathogens

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9
Q

What is bronchiestasis?

A

Fixed dilatation of bronchi

This is due to fibrous scarring after infection, or chronic obstruction

Irreversible and abnormal dilation of the bronchial tree that is generally caused by cycles of bronchial inflammation in addition to mucus plugging and progressive airway destruction

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10
Q

Which pathogen is most likely to cause Tb? and ?

A

Mycobacterium tuberculosis

(M.bovis can also cause Tb)

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11
Q

What is a key sign of Tb?

A

Granuloma formation

Caseating “cheesy” necrosis

This is due to a delayed hypersensitivity (type IV) reaction

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12
Q

What is primary Tb?

A

The first exposure to Tb

The pathogen is phagocytosed and taken to hilar lymph nodes which provokes an immune reaction leading to a granulomatous response

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13
Q

What is secondary Tb?

A

This is a secondary encounter with Tb and involves reinfection and reactivation

A degree of immunity will be present

Generally the disease will still remain localised to the lung apices

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14
Q

Describe the tissue changes in primary Tb

A

Small focuses (Ghon focuses) occur which are small lesions caused by the mycobacterium

Large hilar nodes will develop due to the granulomas forming

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15
Q

Describe the tissue changes in secondary Tb

A

Fibrosis and cavitating of apical lesions will occur

This worsens the damage already present

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16
Q

Why may reactivation with Tb occur?

A

Decrease in T cell function due to:

  • Age
  • Immunosuppression due to disease (HIV)
  • Immunosuppression due to therapy - steroids, chemo
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17
Q

How may a patient be diagnosed with Tb?

A
    • 3 separate sputum samples in pulmonary TB (including one early morning sample)
    • Can do broncoscopy and lavage or gastric washings (rarely required)
    • Ziehl-Neelson stain - tests for AFB, rapid (24h)
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18
Q

What is the pulmonary interstitium and
what does it contain ?

A

This is where gas exchange occurs

Contains alveolar type I and II cells as well as thin connective tissue high in elastin

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19
Q

How does ILD commence?

A

Any form of injury that leads to alveolitis - inflammation of the alveoli

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20
Q

What are the two umbrella causes for ILD?

A
  1. Environmental - minerals (asbestos), drugs, radiation
  2. Idiopathic
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21
Q

How can ILD be diagnosed?

A
  • Transbronchial biopsy
  • Thoracoscopic biopsy - more invasive - thoracoscope enters through an incision between ribs allowing for visual inspection of the lungs
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22
Q

What are some forms of ILD?

A
  • Fibrosing alveolitis
  • Sarcoidosis
  • Extrinsic allergic alveolitis (hypersensitivity pneumonitis)
  • Pneumoconiosis - A group of lung diseases caused by inhaling dust or other particles, such as coal dust (coal worker’s pneumoconiosis) or silica dust (silicosis).disease
  • Connective tissue disease
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23
Q

What is fibrosing alveolitis?

A

A type of idiopathic pulmonary fibrosis

Inflammation is usually associated with the condition

Finger clubbing is a common symptom

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24
Q

What is the pathology of fibrosing alveolitis?

A

A sub-pleural and basal fibrosis occurs due to inflammation

In the terminal stages the lung structure becomes composed of large dilated spaces surrounded by fibrous walls - this is honeycombing

These thick walla and dilated spaces hinder gas exchange

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25
Q

What is extrinsic allergic alveolitis?

A

Chronic inflammation due to a type III and type IV hypersensitivity reaction

Airways become small and granulomas can be formed from collections of activated macrophages

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26
Q

What are some causes/forms of extrinsic allergic alveolitis? (3people lungs)

A
  1. Thermophilic bacteria - Farmer’s lung
  2. Avian proteins - Pigeon fancier’s lung
  3. Fungi - Malt worker’s lung
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27
Q

How can extrinsic allergic alveolitis diagnosed? (what blood test and lab test can be done )

A

The presence of antibodies called precipitins can be detectable in the blood serum which indicate hypersensitivity reactions

Biopsies can be utilised to diagnose more difficult conditions

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28
Q

What is sarcidosis?

A

A multisystem granulomatous disorder commonly affecting the pulmonary system

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29
Q

In what ways can sarcoidosis manifest itself? (4)

A
  • Uveitis - inflammation of iris
  • Erythema nodosum - inflammation of fat cells under the skin causing red patches
  • Lympthadenopathy
  • Hypercalcaemia
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30
Q

What effects can connective tissue diseases have on the pulmonary system?

A
  • Interstitial fibrosis
  • Pleural effusions
  • Rheumatoid nodules - local swelling or lumps most often associated with rheumatoid arthritis
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31
Q

What is pneumoconiosis?

A

An umbrella term for “dust diseases”

Characterised by inalation of “dust”, inflammation and fibrosis

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32
Q

What are three types of pneumoconiosis? (lead to mesothelium )

A
  1. Asbestosis
  2. Coal worker’s lung
  3. Silicosis
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33
Q

What does the severity of pneumoconiosis depend on?

A
  • Particle size (1-5microns) - larger get trapped, smaller can be breathed in and out
  • Reactivity of particle
  • Clearance of particle
  • Host response
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34
Q

Asbestosis is a ________ and can have _________ (curved) or _________ (straight) fibres. Of the two, _________ fibres are far more dangerous

A

Silicate

Serpentine

Amphibole

Serpentine

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35
Q

What are consequences of asbestosis exposure?

A
  • Parietial pleural plaques
  • Interstitial fibrosis (asbestosis)
  • Bronchial carcinoma
  • Mesothelioma
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36
Q

What is pulmonary oedema?

A

Fluid build up in the lung interstitium

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37
Q

Pulmonary oedema is a type of __________ lung disease

A

Restrictive

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38
Q

What is the most common cause of pulmonary oedema?

A

Left ventricular heart failure and backflow pressure which causes the release of tissue fluid into the lungs

The heart cannot pump blood out of the lungs fast enough so pressure builds and fluid is deposited.

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39
Q

Why is pulmonary oedema bad for gas transfer?

A

By occupying space in the alveoli, the fluid increases the distance oxygen must diffuse to enter the blood stream so less oxygen will diffuse

This is not a problem for carbon dioxide to exit since it is 20 times more soluble than oxygen

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40
Q

What is ARDS?

A

Adult respiratory distress syndrome

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41
Q

What is the pathology of ARDS?

A
  • Inflammatory cells enter a region of injury in the lungs due to bacterial endotoxin
  • Cytokines are released
  • Oxygen free radicals are released
  • Collateral damage occurs to cell membranes due to the inflammatory response
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42
Q

ARDS can cause?

A
  • Sepsis
  • Severe trauma
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43
Q

How is ARDS characterised?

A
  • Fibrous exudate lining alveolar walls
  • Evidence of cell regeneration
  • Inflammation
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44
Q

Why does neonatal RDS occur?

A

Premature infants produce inadequate surfactant between pleura

There is reduced surface tension and breathing is difficult and may cause damage to cells

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45
Q

What is an embolus?

A

A detached intravascular mass carried by the blood to a site in the body far from its origin

Emboli can be thrombi, gas, fat, foreign bodies or tumour

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46
Q

What is the source of most pulmonary emboli?

A

Deep venous thrombosis of the lower limbs

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47
Q

Virchow’s triad describes the risk factors for developing a thrombus as with DVT for example, what is this triad?

A
  1. Stagnant blood flow
  2. Hypercoaguable blood
  3. Endothelial injury/abnormality
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48
Q

What is primary pulmonary hypertension?

A

This is hypertension due to abnormalities within the lungs

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49
Q

What is secondary pulmonary hypertension?

A

Hypertension associated with another condition such as emphysema, COPD, lupus etc

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50
Q

Primary pulmonary hypertension is most common in ________ ________

A

Young women

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51
Q

What is cor pulmonale?

A

This the alteration in the structure and or functio of the right ventricle due to a primary disorder of the respiratory system

Often this is due to primary hypertension

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52
Q

The pleural is lined with that type of epithelium?

A

Squamous

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53
Q

What are the two types of pleural effusion?

A
  1. Transudate - cardiac failure, low protein levels
  2. Exudate - high protein levels, Tb, pneumonia, malignancy, connective tissue disease
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54
Q

What is a purulent effusion?

A

An empyema

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55
Q

Tumours in the lungs can be of which two categories?

A

Primary - malignant mesothelioma, benign

Secondary - adenocarcinomas, undergone metastasis

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56
Q

Mesothelioma is characterised by AFFECTING THE ——– which surround the lungs

A

the pleura which is the lining surrounding the lungs

57
Q

The differentiation of both __________ and ___________ cells are involved in mesothelioma

A

Epithelial

Mesenchymal
During Mesothelioma the Epithelia cells will constantly metaplasia to Mesenchymal leading to cancer

58
Q

What is present under the ethmoid bone that is specialised for the sense of smell?

A

An area of olfactory epithelium

59
Q

The vestibule of the nasal cavity is lined with what for protection?

A

Keratinised stratified squamous epithelium

60
Q

Further into the nasal cavity, how does the epithelium change

A

It becomes respiratory epithelium

(pseudostratified ciliated columnar epithelium with goblet cells)

61
Q

Where are basal cells located and what do they function to do?

A

Located at basal lamina and will replace epithelium - they are a type of stem cell

62
Q

What is the lamina propria?

A

A thin layer of connective tissue below the epithelium to which it connects collectively becoming the mucosa

It contains seromucous glands

63
Q

The oropharynx and epiglottis have which type of epithelium?

A

Respiratory epithelium without goblet cells

(Non-keritinised stratified squamous epithelium)

64
Q

What epithelium coats the larynx?

A

The cartilage ad muscle is coated with respiratory epithelium

The vocal folds are coated in stratified squamous epithelium for strength due to vocal cord collisions during sound production

65
Q

What is the carina?

A

The point of bifurcation of the trachea

66
Q

What are seromucous glands?

A

Glands in which serous and mucous secretory cells are present

67
Q

The walls of the trachea have what lining?

A

Respiratory epithelium

(with basal lamina and lamina propria - contains elastic fibres)

There is also a layer of submucosa containing seromucous glands

68
Q

What is present within the bronchi that allows for the mucociliary rejection current?

A

Cilia

69
Q

How does the cartilage in bronchi differ from that in the trachea?

A

Bronchi - irregularly shaped in plates

Trachea - “C” shaped

70
Q

When is the transition from bronchi to bronchioles defined?

A

When there are no longer cartilage plates

71
Q

The lamina propria in bronchioles is composed of what 3 main consititutes?

A
  1. Smooth muscle
  2. Elastic fibres
  3. Collageous fibres
72
Q

What are terminal bronchioles?

A

The smallest bronchioles that still lack respiratory function

73
Q

What is present down the bronchial tree after terminal bronchioles?

A

Respiratory bronchioles

74
Q

What innervates the smooth muscle of bronchioles?

A

The parasympthetic nervous system

This can inititiate contraction

75
Q

Terminal bronchial epithelia are lined with what types of cell?

A

Cuboidal ciliated epithelium and non-ciliated club cells (Clara cells)

76
Q

Non-ciliated club cells have which roles?

A
  • Stem cells
  • Detoxification
  • Immune modulation
  • Surfactant production
77
Q

Describe respiratory bronchiole walls

A

It is discountinous squamous epithelium with type 1 aveoli within their walls - as opposed to low cuboidal epithelium

78
Q

What are pneumocytes?

A

Alveolar cells

79
Q

Type 2 alveoli are covered in what?

A

Microvilli

80
Q

The cytoplasm of type II alveoli contains what?

A

Lamellar bodies

(release surfactant by exocytosis)

81
Q

What are dust cells?

A

Macrophages found in alveloli which remove pathogens and foreign material that bypasses the mucociliary escalator

82
Q
A
83
Q

Is palpable within the** jugular notch**

A

Trachea

84
Q

The level at which the lower respiratory tract begins.

A

C6 vertbra C6 vertebra

85
Q

The anatomical landmark for cardiopulmonary resuscitation (CPR)

A

Xiphoid process
at level of T10

86
Q

Contains hyaline cartilage, and is surrounded by the** arch of the azygous vein.**

A

Right bronchia

87
Q

Carry oxygenated blood, and are sited inferoposteriorly within the lung root.

A

Pulmonary vein

88
Q

Carry deoxygenated blood, and are sited superomedially within the lung root.

A

Pulmonary Artery

89
Q

A vein running up the right side of the thoracic vertebral column draining itself towards the superior vena cava and arches round the right lung root.

A

Azygous vein

90
Q

Arise from the anterior surface of the descending aorta.

A

Bronchial artery

91
Q

Surrounded by vessels, and may appear black on dissection.

A

Pulmonary lymph nodes

92
Q

Where the middle lobe is auscultated.

A

in the intercostal spaces between the right 4 rib to the 6 rib

93
Q

Where the lung base is auscultated.

A

vertbrate T 11

94
Q

The site of the horizontal fissure.

A

right 4th rib

95
Q

The level of the carina.

A

2nd RIB
(T4/5)

96
Q

The level of the oblique fissure posteriorly.

The site of the oblique fissure anteriorly.

A

T 3 vertbrate

Rib 6

97
Q

The site used in decompressing a tension pneumothorax.

A

2nd intercostal space

98
Q

An accessory muscle of respiration in the neck

A

Sternocleidomastoid

99
Q

A major inspiratory muscle in a sheet, containing crura.

A

Diaphragm

100
Q

Thoracic muscles involved in active expiration.

A

Abdominal wall muscles
o External oblique
o Internal oblique
o Transverse abdominus
o Rectus abdominus
b. ((((((Internal intercostals))))) Pull

101
Q

contain both Cuboidal ciliated epithelium and non-ciliated Clara cells

A

terminal bronchioles

102
Q

Contain Pseudostratified ciliated columnar epithelium and goblet cells with hyaline cartilage rings and cartilage plates.

A

Main Bronchi

103
Q

Pseudostratified ciliated columnar epithelium with very few goblet cells. No cartilage.
Lamina propria of smooth muscle and elastic and collagenous fibres.

A

Bronchioles

104
Q

Non-keratinised stratified squamous epithelium.

A

oropharnx

105
Q

Keratinised stratified squamous epithelium

A

nasal cavity

106
Q

A mucus-producing cell found within respiratory epithelium.

A

Goblet cell

107
Q

A non-ciliated cell found in terminal bronchioles. Acts as an immune modulator and stem cell and is able to produce surfactant.

A

Clara cells

108
Q

The majority cell type lining the terminal bronchioles.

A

cuboidal epithelum cells

109
Q

Squamous epithelial cells found in the alveolar sac.

A

type I pneumcyte

110
Q

The cells of the pulmonary capillaries which contribute to the blood-air barrier.

A

Endothelial cell

111
Q

Rib 1to 7

A

are true
* Each have a costal cartilage which attaches them to sternum

112
Q

Rib 8-10

A

are false
* Connected to rib 7 by cartilage instead of to sternum

113
Q

Ribs 11 & 12

A

are floating
* Not attached by cartilage at all
* Can puncture organs when fractured

114
Q

Characteristics of thoracic vertebrae:

A
  • Superior & inferior facets articulate with the heads of the ribs
  • Costal facets on transverse processes articulate with the tubercles of the ribs – present on T1-T10
  • Spinous processes are long and slant inferiorly
115
Q

*Vertebral foramen
* Pedicles:
* Laminae:

A

*(through which the spinal cord runs)
* bony connection to intervertebral disc
* bony connection to spinous process

116
Q

At what level does the Larynx become trachea

A

C6

117
Q

different between
* Cervical pleura ,
* costal pleura ,
* diaphragmatic pleura and
* mediastinal pleura

A

https://pbs.twimg.com/media/E2pdEveWQAcqlKl.jpg

118
Q

Lung root (hilum) contains

A

1 bronchus, 1 pulmonary artery, 2 pulmonary veins and bronchial
vessels, nerves and lymphatics

119
Q

What is the costodiaphragmatic recess?
A:

A

The costodiaphragmatic recess is a small space or cavity located at the bottom of the thoracic cavity where the diaphragm meets the ribs.

120
Q

What is the costophrenic angle?

A

A: The costophrenic angle is the point where the diaphragm and the chest wall meet at the bottom of the thoracic cavity. It is formed by the costodiaphragmatic recess.

121
Q

What is the costophrenic angle?

A

A: The costophrenic angle is the point where the diaphragm and the chest wall meet at the bottom of the thoracic cavity. It is formed by the costodiaphragmatic recess.

122
Q

where do Bronchial veins – drainage to

A
  • azygous veins (R)
  • accessory hemiazygous vein (L)
123
Q

what muscles involve in ‘bucket handle mechanism’

A

External, internal and innermost intercostal muscles alter thoracic
dimensions

124
Q

What runs in the costal groove of each rib between the internal and innermost intercostal muscles?

A

A: The intercostal vein, artery, and nerve run in the costal groove of each rib between the internal and innermost intercostal muscles.

125
Q

which cervical nerves connect to the diaphram

A

‘C3, 4, 5 keeps the diaphragm alive’

126
Q

In which space is pleural effusion first identifiable on a posteroanterior chest film?

A

Costodiaphragmatic recess

127
Q

Which structure forms a barrier between the laryngopharynx and larynx to prevent aspiration?

A

Epiglottis

128
Q

A patient with a known lung tumour develops a left-sided Horner’s syndrome. Where is the causative lesion likely to be found?

A

Left Upper lobe

129
Q

A patient on the stroke unit has a compromised swallow. They later develop aspiration pneumonia. Where is the aspirated bolus most likely to be found?

A

Right Lower lobe

130
Q

A patient is treated in the accident and emergency department following a motorcycle accident. They are acutely breathless. Chest films reveal a left-sided rib fracture. Damage to which structure MUST be excluded during the diagnostic work-up?

A

Spleen

131
Q

Pa

A

partial pressure in the arteries

P; partial pressure in the alveoli (respration)

132
Q

Provides motor innervation to the diaphragm

A

Phernic nerve

133
Q

Innervate the abdominal wall with somatic sensory, somatic motor and sympathetic nerve supply

A

Thoracoabdominal nerves

134
Q

Provides sensory innervation to the nasal mucosa and motor innervation to the soft palate

A

Trigeminal nerve (CN V)

135
Q

Stimulation triggers a reflex sneeze response

A

Glossopharyngeal nerve (CN IX) and trigeminal nerve (CN V)

136
Q

Stimulation triggers a reflex cough response

A

Glossopharyngeal nerve (CN XI) and vagus nerve (CN X) 9 +10

137
Q

Insert a small bore cannula into the 2nd intercostal space, mid-clavicular line on the right side. True / False.

A

False LARGE
Insert a large bore cannula into the 2nd intercostal space, mid clavicular line on the right side

138
Q

what is te next stage in treating large large bore cannula into the 2nd intercostal space?

A

Insert a chest drain into the 4th or 5th intercostal space in the mid axillary line.

to allow air to escape and the lung to re-expand.

The Respiratory System (19 decks)

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