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RAD 415 > pulmonary pathology > Flashcards

pulmonary pathology Flashcards

1
Q

what are 2 forms of lung cancer

A

non small cell lung cancer
small cell lung cancer

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2
Q

whats are the 5 types of cancer as a result of non small cell lung cancer

A
  • adenocarconoma (peripherally/eddges of lung)
  • squamous cell carcinoma (in airways)
  • large cell
  • mixe
  • carcinoid (tumor in gland of intestine, rare)
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3
Q

describe the features of lung cancer

A

less common
not amenable to surgery
often associated with paraneoplastic effects (immune system reaction due to tumor)

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4
Q

why might someone with lung cancer cough

A

tumor causes irritation of nerves

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5
Q

what is heamoptysis

A

coughing up blood from lungs or bronchial tubes

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6
Q

what is pneumonia

A

an infection that inflames the air sacs in one or both lungs.

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7
Q

what are 2 generalised signs of cancer

A
  • cachexia (weakness and wasting of body due to severe illness)
  • finger clubbing
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8
Q

what are 5 specific signs of lung cancer

A
  • palpable lymph nodes
  • signs of SVC obsturction
  • monophonic wheeze (single airway obstruction)
  • signs of nerve damage from mass effect
  • effusion
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9
Q

what is plural effusion

A

a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

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10
Q

what is thrombocytosis

A

a disorder in which your body produces too many platelets.

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11
Q

define grading in terms of lung cancer evaluation

A

a histological (microscopic characteristics of tumor) categorisation and needs biopsy
may need imaging to guide

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12
Q

what is a biopsy

A

a procedure to remove a piece of tissue or a sample of cells from your body so that it can be tested in a laboratory.

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13
Q

define staging in terms of lung cancer evaluation

A

anatomical categorisation often needing imaging
e.g size and location, presence and position of metastases

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14
Q

what form of classification fo most tumours follow + explain

A

TNM classification
- T refers to the size and extent of the main tumor.
( main tumor is usually called the primary tumor )
- N refers to the number of nearby lymph nodes that have cancer.
- M refers to whether the cancer has metastasized.

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15
Q

what imaging modality is often used during follow up during treatment of cancer and why

A

PET CT
- it can give indication of metabolic activity of tumour

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16
Q

what are the 4 forms of treatment for lung cancer

A
  • surgery
  • radiotherapy
  • chemotherapy
  • immunotherapy
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17
Q

when would surgery be a suitable treatment for cancer

A

if localised tumour has limited areas of spread

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18
Q

when would radiotherapy be suitable treatment for cancer and how is it done

A

if tumour region is localised but patient isnt suitable for surgery
- intense radiation beam kills cancer cells
- beam over tumour site allows high dose to tumour and low dose to surrounding tissue

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19
Q

when would chemotherapy be suitable treatment for cancer and how’s it done

A
  • if cancer has spread or there risk it will
  • affects rapidly dividing cells
  • drug/medicine (most often given as infusion) kills cancer cells
  • reduces patient immune system until recovered
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20
Q

when would immunotherapy be suitable treatment for cancer and how’s it done

A

more specific to tumour subtype and requires specific testing
- to treat advanced cancer, cancer that hasn’t respond to other treatments and cancer that’s come back

-immune cells are taken from your tumor. Those that are most active against your cancer are selected or changed in the lab to better attack your cancer cells, grown in large batches, and put back into your body through a needle in a vein.

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21
Q

what is targeted lung cancer screening

A

ppl at high risk of lung cancer are invited to screening

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22
Q

what does URTI and LRTI

A

upper respiratory tract infection
lower respiratory tract infection

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23
Q

where does URTI effect/ areas

A

larynx
pharynx
tonsils
nasal cavity
(less severe)w

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24
Q

where LRTI effect/area

A

below larynx
involving airways and alveoli
(most likely to be severe)

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25
Q

what is pneumonia and how does this affect the alveoli

A

infection of the lung parenchyma (tissue)
- alveoli walls are inflamed
- alveoli fills with fluid and pus which contains bacteria and blood cells

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26
Q

how might pneumonia show on xray

A

areas of white on lung

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27
Q

what is bronchopneumonia

A

a type of pneumonia that inflames the alveoli (tiny air sacs) inside the lungsw

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28
Q

what is interstitial pneumonia

A

a type of interstitial lung disease that causes inflammation between the air sacs of your lungs
(round alveoli and airways)

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29
Q

what is sepsis

A

life threatening reaction to an infection

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30
Q

what type of treatment is given to bacterial pneumonia

A

antibiotic treatment

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31
Q

what is bronchitis

A

inflammation of airway/bronchial mucosa in lungs (not a form of pneumonia)
- bronchial tube increased amount of mucus

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32
Q

what are symptoms of bronchitis

A

impaired mucocillary clearance
reduced immunity

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33
Q

what is epiglottitis

A

inflammation of upper airway tissues
- usually bacterial

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34
Q

what are symptoms of epiglottis

A
  • pyrexia (elevation of an individual’s core body temperature above a ‘set-point’ regulated by the body’s thermoregulatory center in the hypothalamus
  • painful swallowing
  • drooling
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35
Q

what does RSV stand for

A

Respiratory syncytial virus

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36
Q

what is often a cause of bronchiolitis

A

RSV virus

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37
Q

what is mycobacterium tuberculosis

A

slow growing but hardy mycobacterium

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38
Q

define slow growing and hardy characteristic of mycobacterium tubeculosis

A

slow growing = most antibiotics work on cell division so they are less effective and need to be taken for at least 6 months

hardy = enables spread from person to person

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39
Q

what 2 things make mycobacterium hard to analyse

A

difficult to isolate (multiple samples can be negative in active disease)

difficult to grow (bacteria can be gown on agar plates to help identification within days but TB takes weeks to grow delaying treatment process)

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40
Q

what is tuberculosis

A

a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person

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41
Q

how can you diagnose mycobacterium TB

A

amplification DNA

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42
Q

what is bronchiectasis

A

irreversibly dilated and thickened bronchi
- issues with drainage leading to recurrent infection and inflammation
(scarred and thickened airway wall, mucus, widened airway)

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43
Q

what are 3 causes of bronciectasis

A
  • previous infection
  • airway narrowing or obstruction
  • systemic disease e.g cystic fibrosis
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44
Q

what is tracheitis

A

inflammation of trachea

45
Q

what is empyema

A

a collection of pus in the pleural cavity

46
Q

what is a lung abcess

A

circumscribed collection of pus in the lung that leads to cavity formation.

47
Q

what is asthema

A

OBSTRUCTIVE ventilatory disorder characterised by hyperresponsiveness of bronchi leading to episodic spasm and inflammation

48
Q

explain the triggering of asthma

A
  • trigger e.g allergens
  • causes inflammation of mucose (soft tissue)
  • contraction of smooth muscle
  • airway mucous secretion
  • leading to airway obstruction
49
Q

what are some short term and long term complications of asthma

A

short:
secondary infection
pneumothorax

long:
loss of lung function
COPD

50
Q

what are 3 ways to diagnose asthma

A

FEV1/FVC
peak flow
fraction of exhaled nitric oxide

51
Q

what is peak flow

A

measure of how quickly you can blow air out of your lungs. If you have asthma, you may sometimes have narrow airways.

52
Q

what is FEV1/FVC

A

by testing patients FEV1/FVC (the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs)
(preferable to peak flow)

53
Q

what is fraction of exhaled nitric oxide

A

an endogenous gaseous molecule which can be measured in the human breath test because of airway inflammation

54
Q

what are 3 forms of treatment for asthma

A
  • beta 2 agonist e.g salbutamol/blue inhaler
  • corticosteroids (anti-inflammatory med)
  • leukotriene receptor antagonist tablet
55
Q

how do beta 2 agonists work

A

act directly on beta-2 receptors, causing smooth muscle relaxation and dilatation of the airways

56
Q

how do leukotriene receptor antagonist tablets work

A

blocking the effects of cysteinyl leukotrienes in the airways—these leukotrienes are released during asthma flare-ups and cause bronchoconstriction
(reduce allergy symptoms)

57
Q

what is the peak flow for a severe, moderate and life threatening asthma attack

A

moderate = greater than 50-75%
severe = 33-50%
life threatening = less 33%

58
Q

why would imaging be used for asthma

A

not to diagnose asthma but to assess for complications with asthma e.g pneumothorax or infection
CXR most likely

59
Q

asthma increases risk of contrast hypersensitivity reaction

A
60
Q

what does COPD stand for

A

chronic obstructive pulmonary disease

61
Q

what is COPD

A

air flow limitation associated with chronic inflammatory response in airway in lungs
- leads to destruction of lung tissue

62
Q

what 2 components are included in COPD

A

chronic bronchitis component :
inflammation of bronchi

emphysema component :
breakdown of alveolar walls

63
Q

what are the structural symptoms of copd

A
  • enlarged submucosal gland
  • inflammation of epithelium in mucous membrane
  • mucus accumulation
  • mucous plug
  • hyperinflation of alveoli
64
Q

what is emphysema

A

breakdown of alveoli walls reducing surface area of lungs for gaseous exchange
(upper lobes mainly affected as they are more aerated)

65
Q

what is alpha 1 anti trypsin deficiency

A
  • causes lung disease

A deficiency of A1AT allows substances that break down proteins (so-called proteolytic enzymes) to attack various tissues of the body

so ppl can get emphysema without smoking

66
Q

what do neutrophils (type of wbc) produce how does this correlate to alpha 1 anti trypsin

A

neutrophil elastase which breaks down elastic fibres
A1AT breaks down neutrophil elastase

67
Q

what is the difference between panacinar emphysema and centrilolobular emphysema

A

centrilobular emphysema = large airspaces are initially clustered around the terminal bronchiole.

Panacinar emphysema= large airspaces are distributed throughout the acinar unit (directly distal to the terminal bronchioles and which signals the beginning of the respiratory part)

68
Q

what is outflow obstruction

A

small airways collapse on EXPIRARTION

69
Q

how does outflow obstruction occur

A

air movement during inspiration as normal
then
during expiration, bronchial walls collapse and the airway is blocked by the mucous plug so expiration is hard

70
Q

what can be used to help outflow obstruction

A

beta 2 agonist to help relax smooth muscle and dilate airway

71
Q

what could you see on a AP and lateral x ray due to outflow obstruction

A

ap = hyper expanded lungs flattening the diaphragm which cause a barrel chest shown on lateral chest xray

72
Q

what is a secondary pulmonary lobule

A

supplied by single pulmonary artery and bronchiole

73
Q

where does the venous. and lymphatic drainage occurs in a secondary pulmonary lobule

A

in enclosing separations

74
Q

where do interstitial lung disease affect in the secondary pulmonary lobule

A

interstitial or interlobular septum

75
Q

what structure forms on a CXR if multiple septa are diseased

A

it can look like a mesh structure on CXR or reticular (too many lines on lungs)

76
Q

what are some things that can cause disease of multiple septa

A

autoimmune
occupational lung disease
radiation
post infectious

77
Q

what can the disease of multiple septa lead to

A

fibrosis (thickening or scarring of tissue)

78
Q

what can fibrosis lead to and why

A

lungs become still and struggle to expand causing a restrictive ventilatory defect

79
Q

what is the best imaging modality for abnormal lung pattern

A

high resolution CT

80
Q

what can fibrosis look like on a lung CT

A

honeycombing (small clusters of holes around edge of lungs)

81
Q

what treatment is available for fibrosis despite it being permanent

A

antifibrotic medication, slows progression

82
Q

what is pneumothorax

A

air in the pleural space
(spontaneous not due to trauma)

83
Q

what does primary and secondary pneumothorax mean

A

primary = no known lung disease
secondary = due to underlying lung disease

84
Q

what happens if pleura are damaged

A

negative pressure pf lungs cam equalise with air

85
Q

what can be the causes of puncture of visceral pleura

A
  • no underlying cause (primary)
  • due to underlying lung disease (secondary)
86
Q

hat can be the cause of puncture of parietal pleura

A

traumatic injury

87
Q

what are symptoms of pleural puncture

A

shortness of breath

88
Q

what is the hilum in lung anatomy

A

what connects your lungs to their supporting structures and where pulmonary vessels enter and exit your lungs

89
Q

how is pneumothorax treated

A
  • size of pneumothorax measured at hilum
  • treatment depends on size of pneumothorax and underlying lung disease
  • for large pneumothorax, chest drain using water seal to ensure air can escape plural space and not get back in
90
Q

what is tension pneumothorax

A
  • break in pleural creates a one way valve, each breath pushing air into pleural space that cant escape
  • pressure can get so high that the mediastinum can shift
  • veins can also be compressed cutting venous return to heart and causing circulatory to collapse
91
Q

what would a tension pneumothorax sound like if you were to tap the patients chest where it is locatedq

A

hollow

92
Q

how would you diagnose tension pneumothorac

A

clinically via history and examination
NO XRAY TO BE TAKEN

93
Q

what is a pleural effusion

A

excess fluid in pleural cavity

94
Q

what are the 2 types of causes of pleural effusion

A

exudate = changes to local area that lead to fluid formation/lac of absorption e.g cancer, infection

transudate = caused by changed in hydrostatic and oncotic pressure

95
Q

what 2 things are used to investigate whether a pleural effusion was caused by exudate or transudate

A

biochemical markers
LDH level

96
Q

what are symptoms of pleural effusion

A

progressive breathlessness as effusion progresses

97
Q

what are 3 treatments for pleural effusion

A
  • treat original cause if possible
  • aspirate fluid (needle and syringe)
  • chest drain insertion
98
Q

what can pleural fluid be

A
  • lymphatic fluid (rupture of thoracic duct)
  • blood (haemothorac caused by trauma)
99
Q

what is pulmonary embolism

A

blood clot blocks a blood vessel in the lungs

100
Q

what do you call a blood clot in the deep vein

A

deep vein thrombosis

101
Q

what is an embolus/ambolism

A

clot that can migrate

102
Q

what are some symptoms of pulmonary embolism

A
  • lower cardiac output (compensationary rise in heart rate)
  • hypotension
  • cardiac arrest
  • pleuritic chest pain
103
Q

CXR has no role in diagnosing pulmonary embolism, only when looking for things to explain the symptoms.
Decision to scan is based upon risk factors and blood tests

A
104
Q

what is the D-dimer

A

D-dimer test looks for D-dimer in blood. D-dimer is a protein fragment (small piece) that’s made when a blood clot dissolves in your body.

105
Q

how is the D-dimer test used for pulmonary embolism diagnosis

A

the lower the score the more likely we can safely rule out a PE
the higher the score, the more we need to scan

106
Q

what are 4 treatments for PE

A
  • anticoagulation (stops more clot forming while existing clot is broken down)
  • thrombolysis (into vein or pulmonary artery, medication to break up and prevent blood clots)
  • IVC filter (protects against further clot embolism from deep vein)
  • embolectomy ( surgical removal of clots)
107
Q

prednisolone is a type of corticalsteroid
ventolin is a brown inhaler

A
108
Q

what does SOB(OE) stand for

A

short ness of breath (on extertion)

RAD 415 (19 decks)

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