pulmonary pathology Flashcards
1
Q
what are 2 forms of lung cancer
A
non small cell lung cancer
small cell lung cancer
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)
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)
4
Q
why might someone with lung cancer cough
A
tumor causes irritation of nerves
5
Q
what is heamoptysis
A
coughing up blood from lungs or bronchial tubes
6
Q
what is pneumonia
A
an infection that inflames the air sacs in one or both lungs.
7
Q
what are 2 generalised signs of cancer
A
- cachexia (weakness and wasting of body due to severe illness)
- finger clubbing
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
9
Q
what is plural effusion
A
a buildup of fluid between the layers of tissue that line the lungs and chest cavity.
10
Q
what is thrombocytosis
A
a disorder in which your body produces too many platelets.
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
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.
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
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.
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
16
Q
what are the 4 forms of treatment for lung cancer
A
- surgery
- radiotherapy
- chemotherapy
- immunotherapy
17
Q
when would surgery be a suitable treatment for cancer
A
if localised tumour has limited areas of spread
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
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
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.
21
Q
what is targeted lung cancer screening
A
ppl at high risk of lung cancer are invited to screening
22
Q
what does URTI and LRTI
A
upper respiratory tract infection
lower respiratory tract infection
23
Q
where does URTI effect/ areas
A
larynx
pharynx
tonsils
nasal cavity
(less severe)w
24
Q
where LRTI effect/area
A
below larynx
involving airways and alveoli
(most likely to be severe)
25
what is pneumonia and how does this affect the alveoli
infection of the lung parenchyma (tissue)
- alveoli walls are inflamed
- alveoli fills with fluid and pus which contains bacteria and blood cells
26
how might pneumonia show on xray
areas of white on lung
27
what is bronchopneumonia
a type of pneumonia that inflames the alveoli (tiny air sacs) inside the lungsw
28
what is interstitial pneumonia
a type of interstitial lung disease that causes inflammation between the air sacs of your lungs
(round alveoli and airways)
29
what is sepsis
life threatening reaction to an infection
30
what type of treatment is given to bacterial pneumonia
antibiotic treatment
31
what is bronchitis
inflammation of airway/bronchial mucosa in lungs (not a form of pneumonia)
- bronchial tube increased amount of mucus
32
what are symptoms of bronchitis
impaired mucocillary clearance
reduced immunity
33
what is epiglottitis
inflammation of upper airway tissues
- usually bacterial
34
what are symptoms of epiglottis
- 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
35
what does RSV stand for
Respiratory syncytial virus
36
what is often a cause of bronchiolitis
RSV virus
37
what is mycobacterium tuberculosis
slow growing but hardy mycobacterium
38
define slow growing and hardy characteristic of mycobacterium tubeculosis
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
39
what 2 things make mycobacterium hard to analyse
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)
40
what is tuberculosis
a bacterial infection spread through inhaling tiny droplets from the coughs or sneezes of an infected person
41
how can you diagnose mycobacterium TB
amplification DNA
42
what is bronchiectasis
irreversibly dilated and thickened bronchi
- issues with drainage leading to recurrent infection and inflammation
(scarred and thickened airway wall, mucus, widened airway)
43
what are 3 causes of bronciectasis
- previous infection
- airway narrowing or obstruction
- systemic disease e.g cystic fibrosis
44
what is tracheitis
inflammation of trachea
45
what is empyema
a collection of pus in the pleural cavity
46
what is a lung abcess
circumscribed collection of pus in the lung that leads to cavity formation.
47
what is asthema
OBSTRUCTIVE ventilatory disorder characterised by hyperresponsiveness of bronchi leading to episodic spasm and inflammation
48
explain the triggering of asthma
- trigger e.g allergens
- causes inflammation of mucose (soft tissue)
- contraction of smooth muscle
- airway mucous secretion
- leading to airway obstruction
49
what are some short term and long term complications of asthma
short:
secondary infection
pneumothorax
long:
loss of lung function
COPD
50
what are 3 ways to diagnose asthma
FEV1/FVC
peak flow
fraction of exhaled nitric oxide
51
what is peak flow
measure of how quickly you can blow air out of your lungs. If you have asthma, you may sometimes have narrow airways.
52
what is FEV1/FVC
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
what is fraction of exhaled nitric oxide
an endogenous gaseous molecule which can be measured in the human breath test because of airway inflammation
54
what are 3 forms of treatment for asthma
- beta 2 agonist e.g salbutamol/blue inhaler
- corticosteroids (anti-inflammatory med)
- leukotriene receptor antagonist tablet
55
how do beta 2 agonists work
act directly on beta-2 receptors, causing smooth muscle relaxation and dilatation of the airways
56
how do leukotriene receptor antagonist tablets work
blocking the effects of cysteinyl leukotrienes in the airways—these leukotrienes are released during asthma flare-ups and cause bronchoconstriction
(reduce allergy symptoms)
57
what is the peak flow for a severe, moderate and life threatening asthma attack
moderate = greater than 50-75%
severe = 33-50%
life threatening = less 33%
58
why would imaging be used for asthma
not to diagnose asthma but to assess for complications with asthma e.g pneumothorax or infection
CXR most likely
59
asthma increases risk of contrast hypersensitivity reaction
60
what does COPD stand for
chronic obstructive pulmonary disease
61
what is COPD
air flow limitation associated with chronic inflammatory response in airway in lungs
- leads to destruction of lung tissue
62
what 2 components are included in COPD
chronic bronchitis component :
inflammation of bronchi
emphysema component :
breakdown of alveolar walls
63
what are the structural symptoms of copd
- enlarged submucosal gland
- inflammation of epithelium in mucous membrane
- mucus accumulation
- mucous plug
- hyperinflation of alveoli
64
what is emphysema
breakdown of alveoli walls reducing surface area of lungs for gaseous exchange
(upper lobes mainly affected as they are more aerated)
65
what is alpha 1 anti trypsin deficiency
- 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
what do neutrophils (type of wbc) produce how does this correlate to alpha 1 anti trypsin
neutrophil elastase which breaks down elastic fibres
A1AT breaks down neutrophil elastase
67
what is the difference between panacinar emphysema and centrilolobular emphysema
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
what is outflow obstruction
small airways collapse on EXPIRARTION
69
how does outflow obstruction occur
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
what can be used to help outflow obstruction
beta 2 agonist to help relax smooth muscle and dilate airway
71
what could you see on a AP and lateral x ray due to outflow obstruction
ap = hyper expanded lungs flattening the diaphragm which cause a barrel chest shown on lateral chest xray
72
what is a secondary pulmonary lobule
supplied by single pulmonary artery and bronchiole
73
where does the venous. and lymphatic drainage occurs in a secondary pulmonary lobule
in enclosing separations
74
where do interstitial lung disease affect in the secondary pulmonary lobule
interstitial or interlobular septum
75
what structure forms on a CXR if multiple septa are diseased
it can look like a mesh structure on CXR or reticular (too many lines on lungs)
76
what are some things that can cause disease of multiple septa
autoimmune
occupational lung disease
radiation
post infectious
77
what can the disease of multiple septa lead to
fibrosis (thickening or scarring of tissue)
78
what can fibrosis lead to and why
lungs become still and struggle to expand causing a restrictive ventilatory defect
79
what is the best imaging modality for abnormal lung pattern
high resolution CT
80
what can fibrosis look like on a lung CT
honeycombing (small clusters of holes around edge of lungs)
81
what treatment is available for fibrosis despite it being permanent
antifibrotic medication, slows progression
82
what is pneumothorax
air in the pleural space
(spontaneous not due to trauma)
83
what does primary and secondary pneumothorax mean
primary = no known lung disease
secondary = due to underlying lung disease
84
what happens if pleura are damaged
negative pressure pf lungs cam equalise with air
85
what can be the causes of puncture of visceral pleura
- no underlying cause (primary)
- due to underlying lung disease (secondary)
86
hat can be the cause of puncture of parietal pleura
traumatic injury
87
what are symptoms of pleural puncture
shortness of breath
88
what is the hilum in lung anatomy
what connects your lungs to their supporting structures and where pulmonary vessels enter and exit your lungs
89
how is pneumothorax treated
- 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
what is tension pneumothorax
- 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
what would a tension pneumothorax sound like if you were to tap the patients chest where it is locatedq
hollow
92
how would you diagnose tension pneumothorac
clinically via history and examination
NO XRAY TO BE TAKEN
93
what is a pleural effusion
excess fluid in pleural cavity
94
what are the 2 types of causes of pleural effusion
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
what 2 things are used to investigate whether a pleural effusion was caused by exudate or transudate
biochemical markers
LDH level
96
what are symptoms of pleural effusion
progressive breathlessness as effusion progresses
97
what are 3 treatments for pleural effusion
- treat original cause if possible
- aspirate fluid (needle and syringe)
- chest drain insertion
98
what can pleural fluid be
- lymphatic fluid (rupture of thoracic duct)
- blood (haemothorac caused by trauma)
99
what is pulmonary embolism
blood clot blocks a blood vessel in the lungs
100
what do you call a blood clot in the deep vein
deep vein thrombosis
101
what is an embolus/ambolism
clot that can migrate
102
what are some symptoms of pulmonary embolism
- lower cardiac output (compensationary rise in heart rate)
- hypotension
- cardiac arrest
- pleuritic chest pain
103
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
104
what is the D-dimer
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
how is the D-dimer test used for pulmonary embolism diagnosis
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
what are 4 treatments for PE
- 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
prednisolone is a type of corticalsteroid
ventolin is a brown inhaler
108
what does SOB(OE) stand for
short ness of breath (on extertion)
