Pathology, principles, resp, cardio, GI.

Question 1

What are local effects of lung cancer?

Answer 1

Airway obstruction - pneumonia.
Chest wall invasion - pain.
Ulceration - haemoptysis.

Question 2

What does PTH suggest in regards to lung cancer?

Answer 2

Squamous cell lung cancer.

Question 3

What does ACHT suggest in regards to lung cancer?

Answer 3

Small cell lung cancer.

Question 4

What are the 4 common smoking-associated types of lung tumour?

Answer 4

1. Adenocarcinoma.
2. Squamous cell carcinoma.
3. Small cell carcinoma.
4. Large cell carcinoma.

Question 5

How may histological diagnosis of lung cancer be made?

Answer 5

Bronchoscopy and biopsy of tumour.

Biopsy or needle aspiration of metastases.

Question 6

Feature of squamous cell lung carcinoma?

Answer 6

Keratinising.

Question 7

Feature of lung adenocarcinoma?

Answer 7

Gland forming, mucin production

Question 8

Which type of lung cancer has the worst prognosis?

Answer 8

Small cell, almost all diagnosed are dead at one year.

Question 9

Main treatment for small cell lung cancer?

Answer 9

Chemotherapy, but has shown rapidly emerging resistance.

Question 10

What is the treatment of choice in non-small cell lung cancers?

Answer 10

Surgery.

Question 11

Which oncogene do small cell and non-small cell lung cancer share?

Answer 11

myc.

Question 12

what are typical bronchial (large airway tumours)?

Answer 12

Squamous cell carcinoma. Often dysplastic, or carcinoma in situ, eventually displaying invasive malignancy.

Question 13

Describe peripheral adenocarcinomas.

Answer 13

Display atypical adenomatous hyperplasia, and spread of neoplastic cells along alveolar walls. They are true invasive adenocarcinomas, becoming more common.

Question 14

What are prognostic indicators in lung cancer?

Answer 14

Tumour staging and histological subtype.

Question 15

What are carcinoid lung neoplasms?

Answer 15

Neuroendocrine neoplasms of low-grade malignancy.

Question 16

Define neoplasm.

Answer 16

New and abnormal growth. commonly referred to as a tumour.

Question 17

What is a lung abscess?

Answer 17

A localized collection of pus, tumour-like. Causes chronic malaise and fever. May result from aspiration.

Question 18

Pathogenesis of ARDS?

Answer 18

Injury (e.g. by bacterial endotoxin), causing infiltration of inflammatory cells, cytokines, oxygen free radicals and injury to cell membranes.
This results in a fibrinous exudate lining alveolar walls (hyaline membrane), cellular regeneration and inflammation.

Question 19

Define embolus.

Answer 19

Embolus is a mass (typically thrombus, but may be fat, foreign bodies, gas, tumour clumps), carried by the blood to a site in the body, distant of its origin.

Question 20

Virchow’s triad.

Answer 20

1. Endothelial injury
2. Hypercoagulability (cancer, post MI)
3. Stasis of blood flow

Question 21

Pathology of pulmonary hypertension.

Answer 21

Hypoxia, increased flow through pulmonary circulation (congenital heart disease), blockage or loss of pulmonary vascular bed, back pressure from left-sided heart failure.

Question 22

Morphology of pulmonary hypertension.

Answer 22

Medial hypertrophy of arteries, intimal thickening (fibrosis), atheroma, RV hypertrophy, extreme cases (congenital heart disease, primary pulmonary hypertension).

Question 23

Purulent effusion.

Answer 23

Effusion filled with acute inflammatory cells, aka empyema. It may become chronic.

Question 24

Define pneumothorax.

Answer 24

Air in the pleural space, may occur due to trauma or rupture of bulla.

Question 25

Primary pleural neoplasia.

Answer 25

Most likely malignant mesothelioma, rarely benign.

Question 26

Secondary pleural neoplasia.

Answer 26

Common, e.g. adenocarcinomas of the lung.

Question 27

Mesothelioma.

Answer 27

Related to asbestos exposure, results in mixed epithelial/mesenchymal differentiation. Dismal prognosis.

Question 28

Acute anaphylaxis.

Answer 28

Type 1 hypersensitivity (IgE) reaction. Causes flushing, pruritis, urticarial, angioneurotic oedema, abdo. pain, vomiting, hypotension, shock, stridor, wheeze, respiratory failure.