Pathology and Histology Flashcards
1
Q
What is pneumonia?
A
Infection involving the distal aspects of the respiratory tree including localised oedema
2
Q
What is lobar pneumonia?
A
Pneumonia involving a complete lung lobe
3
Q
What are the different types of pneumonia (based on where infection was acquired)?
A
- Community acquired
- Hospital aquired
- Aspiration
4
Q
During a classical acute inflammatory response what are the main stages in a pneumonia?
A
- Exudation - emission of fibrin-rich fluid through pores or wounds
- Infiltration by neutrophils
- Infiltration by macrophages
- Resolution
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
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
7
Q
Which pathogens can cause bronchpneumonia?
A
Strep. pneumoniae, Haemophilius influenza, S. aureus, anaerobes and coliforms
8
Q
What is an abscess?
A
A local collection of pus
Can cause chronic malaise and fever
Caused by aspiration of pathogens
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
10
Q
Which pathogen is most likely to cause Tb? and ?
A
Mycobacterium tuberculosis
(M.bovis can also cause Tb)
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
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
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
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
15
Q
Describe the tissue changes in secondary Tb
A
Fibrosis and cavitating of apical lesions will occur
This worsens the damage already present
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
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)
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
19
Q
How does ILD commence?
A
Any form of injury that leads to alveolitis - inflammation of the alveoli
20
Q
What are the two umbrella causes for ILD?
A
- Environmental - minerals (asbestos), drugs, radiation
- Idiopathic
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
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
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
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
25
What is extrinsic allergic alveolitis?
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
26
What are some causes/forms of extrinsic allergic alveolitis? (3people lungs)
1. Thermophilic bacteria - Farmer's lung
2. Avian proteins - Pigeon fancier's lung
3. Fungi - Malt worker's lung
27
How can extrinsic allergic alveolitis diagnosed? (what blood test and lab test can be done )
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
28
What is sarcidosis?
A multisystem granulomatous disorder commonly affecting the pulmonary system
29
In what ways can sarcoidosis manifest itself? (4)
* Uveitis - inflammation of iris
* Erythema nodosum - inflammation of fat cells under the skin causing red patches
* Lympthadenopathy
* Hypercalcaemia
30
What effects can connective tissue diseases have on the pulmonary system?
* Interstitial fibrosis
* Pleural effusions
* Rheumatoid nodules - local swelling or lumps most often associated with rheumatoid arthritis
31
What is pneumoconiosis?
An umbrella term for "dust diseases"
Characterised by inalation of "dust", inflammation and fibrosis
32
What are three types of pneumoconiosis? (lead to mesothelium )
1. Asbestosis
2. Coal worker's lung
3. Silicosis
33
What does the severity of pneumoconiosis depend on?
* Particle size (1-5microns) - larger get trapped, smaller can be breathed in and out
* Reactivity of particle
* Clearance of particle
* Host response
34
Asbestosis is a ________ and can have _________ (curved) or _________ (straight) fibres. Of the two, _________ fibres are far more dangerous
Silicate
Serpentine
Amphibole
Serpentine
35
What are consequences of asbestosis exposure?
* Parietial pleural plaques
* Interstitial fibrosis (asbestosis)
* Bronchial carcinoma
* Mesothelioma
36
What is pulmonary oedema?
Fluid build up in the lung interstitium
37
Pulmonary oedema is a type of __________ lung disease
Restrictive
38
What is the most common cause of pulmonary oedema?
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.
39
Why is pulmonary oedema bad for gas transfer?
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
40
What is ARDS?
Adult respiratory distress syndrome
41
What is the pathology of ARDS?
* 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
42
ARDS can cause?
* Sepsis
* Severe trauma
43
How is ARDS characterised?
* Fibrous exudate lining alveolar walls
* Evidence of cell regeneration
* Inflammation
44
Why does neonatal RDS occur?
Premature infants produce inadequate surfactant between pleura
There is reduced surface tension and breathing is difficult and may cause damage to cells
45
What is an embolus?
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
46
What is the source of most pulmonary emboli?
Deep venous thrombosis of the lower limbs
47
Virchow's triad describes the risk factors for developing a thrombus as with DVT for example, what is this triad?
1. Stagnant blood flow
2. Hypercoaguable blood
3. Endothelial injury/abnormality
48
What is primary pulmonary hypertension?
This is hypertension due to abnormalities within the lungs
49
What is secondary pulmonary hypertension?
Hypertension associated with another condition such as emphysema, COPD, lupus etc
50
Primary pulmonary hypertension is most common in ________ \_\_\_\_\_\_\_\_
Young women
51
What is cor pulmonale?
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
52
The pleural is lined with that type of epithelium?
Squamous
53
What are the two types of pleural effusion?
1. Transudate - cardiac failure, low protein levels
2. Exudate - high protein levels, Tb, pneumonia, malignancy, connective tissue disease
54
What is a purulent effusion?
An empyema
55
Tumours in the lungs can be of which two categories?
Primary - malignant mesothelioma, benign
Secondary - adenocarcinomas, undergone metastasis
56
Mesothelioma is characterised by AFFECTING THE -------- which surround the lungs
the pleura which is the lining surrounding the lungs
57
The differentiation of both __________ and ___________ cells are involved in mesothelioma
Epithelial
Mesenchymal
During Mesothelioma the Epithelia cells will constantly metaplasia to Mesenchymal leading to cancer
58
What is present under the ethmoid bone that is specialised for the sense of smell?
An area of olfactory epithelium
59
The vestibule of the nasal cavity is lined with what for protection?
Keratinised stratified squamous epithelium
60
Further into the nasal cavity, how does the epithelium change
It becomes respiratory epithelium
(pseudostratified ciliated columnar epithelium with goblet cells)
61
Where are basal cells located and what do they function to do?
Located at basal lamina and will replace epithelium - they are a type of stem cell
62
What is the lamina propria?
A thin layer of connective tissue below the epithelium to which it connects collectively becoming the mucosa
It contains seromucous glands
63
The oropharynx and epiglottis have which type of epithelium?
Respiratory epithelium without goblet cells
(Non-keritinised stratified squamous epithelium)
64
What epithelium coats the larynx?
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
What is the carina?
The point of bifurcation of the trachea
66
What are seromucous glands?
Glands in which serous and mucous secretory cells are present
67
The walls of the trachea have what lining?
Respiratory epithelium
(with basal lamina and lamina propria - contains elastic fibres)
There is also a layer of submucosa containing seromucous glands
68
What is present within the bronchi that allows for the mucociliary rejection current?
Cilia
69
How does the cartilage in bronchi differ from that in the trachea?
Bronchi - irregularly shaped in plates
Trachea - "C" shaped
70
When is the transition from bronchi to bronchioles defined?
When there are no longer cartilage plates
71
The lamina propria in bronchioles is composed of what 3 main consititutes?
1. Smooth muscle
2. Elastic fibres
3. Collageous fibres
72
What are terminal bronchioles?
The smallest bronchioles that still lack respiratory function
73
What is present down the bronchial tree after terminal bronchioles?
Respiratory bronchioles
74
What innervates the smooth muscle of bronchioles?
The parasympthetic nervous system
This can inititiate contraction
75
Terminal bronchial epithelia are lined with what types of cell?
Cuboidal ciliated epithelium and non-ciliated club cells (Clara cells)
76
Non-ciliated club cells have which roles?
* Stem cells
* Detoxification
* Immune modulation
* Surfactant production
77
Describe respiratory bronchiole walls
It is discountinous squamous epithelium with type 1 aveoli within their walls - as opposed to low cuboidal epithelium
78
What are pneumocytes?
Alveolar cells
79
Type 2 alveoli are covered in what?
Microvilli
80
The cytoplasm of type II alveoli contains what?
Lamellar bodies
| (release surfactant by exocytosis)
81
What are dust cells?
Macrophages found in alveloli which remove pathogens and foreign material that bypasses the mucociliary escalator
82
83
Is palpable within the** jugular notch**
Trachea
84
The level at which the lower respiratory tract begins.
C6 vertbra C6 vertebra
85
The anatomical landmark for cardiopulmonary resuscitation (CPR)
Xiphoid process
at level of T10
86
Contains hyaline cartilage, and is surrounded by the** arch of the azygous vein.**
Right bronchia
87
Carry oxygenated blood, and are sited inferoposteriorly within the lung root.
Pulmonary vein
88
Carry deoxygenated blood, and are sited superomedially within the lung root.
Pulmonary Artery
89
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.**
Azygous vein
90
Arise from the anterior surface of the descending aorta.
Bronchial artery
91
Surrounded by vessels, and may appear black on dissection.
Pulmonary lymph nodes
92
Where the middle lobe is auscultated.
in the intercostal spaces between the right 4 rib to the 6 rib
93
Where the lung base is auscultated.
vertbrate T 11
94
The site of the horizontal fissure.
right 4th rib
95
The level of the carina.
2nd RIB
(T4/5)
96
The level of the oblique fissure posteriorly.
The site of the oblique fissure anteriorly.
T 3 vertbrate
Rib 6
97
The site used in decompressing a tension pneumothorax.
2nd intercostal space
98
An accessory muscle of respiration in the neck
Sternocleidomastoid
99
A major inspiratory muscle in a sheet, containing crura.
Diaphragm
100
Thoracic muscles involved in active expiration.
Abdominal wall muscles
o External oblique
o Internal oblique
o Transverse abdominus
o Rectus abdominus
b. ((((((Internal intercostals))))) Pull
101
contain both Cuboidal ciliated epithelium and non-ciliated Clara cells
terminal bronchioles
102
Contain Pseudostratified ciliated columnar epithelium and goblet cells with hyaline cartilage rings and cartilage plates.
Main Bronchi
103
Pseudostratified ciliated columnar epithelium with very few goblet cells. No cartilage.
Lamina propria of smooth muscle and elastic and collagenous fibres.
Bronchioles
104
Non-keratinised stratified squamous epithelium.
oropharnx
105
Keratinised stratified squamous epithelium
nasal cavity
106
A mucus-producing cell found within respiratory epithelium.
Goblet cell
107
A non-ciliated cell found in terminal bronchioles. Acts as an immune modulator and stem cell and is able to produce surfactant.
Clara cells
108
The majority cell type lining the terminal bronchioles.
cuboidal epithelum cells
109
Squamous epithelial cells found in the alveolar sac.
type I pneumcyte
110
The cells of the pulmonary capillaries which contribute to the blood-air barrier.
Endothelial cell
111
Rib 1to 7
are true
* Each have a costal cartilage which attaches them to sternum
112
Rib 8-10
are false
* Connected to rib 7 by cartilage instead of to sternum
113
Ribs 11 & 12
are floating
* Not attached by cartilage at all
* Can puncture organs when fractured
114
Characteristics of thoracic vertebrae:
* 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
*Vertebral foramen
* Pedicles:
* Laminae:
*(through which the spinal cord runs)
* bony connection to intervertebral disc
* bony connection to spinous process
116
At what level does the Larynx become trachea
C6
117
different between
* Cervical pleura ,
* costal pleura ,
* diaphragmatic pleura and
* mediastinal pleura
https://pbs.twimg.com/media/E2pdEveWQAcqlKl.jpg
118
Lung root (hilum) contains
1 bronchus, 1 pulmonary artery, 2 pulmonary veins and bronchial
vessels, nerves and lymphatics
119
What is the costodiaphragmatic recess?
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
What is the costophrenic angle?
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
What is the costophrenic angle?
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
where do Bronchial veins – drainage to
* azygous veins (R)
* accessory hemiazygous vein (L)
123
what muscles involve in 'bucket handle mechanism'
External, internal and innermost intercostal muscles alter thoracic
dimensions
124
What runs in the costal groove of each rib between the internal and innermost intercostal muscles?
A: The intercostal vein, artery, and nerve run in the costal groove of each rib between the internal and innermost intercostal muscles.
125
which cervical nerves connect to the diaphram
‘C3, 4, 5 keeps the diaphragm alive’
126
In which space is pleural effusion first identifiable on a posteroanterior chest film?
Costodiaphragmatic recess
127
Which structure forms a barrier between the laryngopharynx and larynx to prevent aspiration?
Epiglottis
128
A patient with a known lung tumour develops a left-sided Horner’s syndrome. Where is the causative lesion likely to be found?
Left Upper lobe
129
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?
Right Lower lobe
130
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?
Spleen
131
Pa
partial pressure in the arteries
P; partial pressure in the alveoli (respration)
132
Provides motor innervation to the diaphragm
Phernic nerve
133
Innervate the abdominal wall with somatic sensory, somatic motor and sympathetic nerve supply
Thoracoabdominal nerves
134
Provides sensory innervation to the nasal mucosa and motor innervation to the soft palate
Trigeminal nerve (CN V)
135
Stimulation triggers a reflex sneeze response
Glossopharyngeal nerve (CN IX) and trigeminal nerve (CN V)
136
Stimulation triggers a reflex cough response
Glossopharyngeal nerve (CN XI) and vagus nerve (CN X) 9 +10
137
Insert a small bore cannula into the 2nd intercostal space, mid-clavicular line on the right side. True / False.
False LARGE
Insert a large bore cannula into the 2nd intercostal space, mid clavicular line on the right side
138
what is te next stage in treating large large bore cannula into the 2nd intercostal space?
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.
