Pulmonary Vascular Disease and Pleural Disease (PATHOLOGY)

Question 1

Why is atherosclerosis not common in the pulmonary circulation?

Answer 1

because it is a Low pressure system

Question 2

What is pulmonary oedema?

Answer 2

Accumulation of fluid in the lung interstitium and/or alveolar spaces

Question 3

Leaking of fluid into interstitium causes it to ______ resulting in which kind of spirometry pattern?

Answer 3

thicken

Restrictive

Question 4

What are the causes of pulmonary oedema?

Answer 4

Increase in hydrostatic pressure

Cellular injury to alveolar lining or alveolar endothelium

Question 5

What can cause ARDS?

Answer 5

Sepsis
Diffuse infection
Severe trauma
Oxygen (if at toxic levels)

Question 6

What is the pathological cause of ARDS?

Answer 6

Injury to alveolar lining or epithelium leading to infiltration of inflammatory cells, release of inflammatory cytokines, oxygen free radicals and injury to cell membranes

Question 7

What would you expect to find on autopsy of a patient that suffered from ARDS?

Answer 7

Fibrinous exudate lining of alveolar walls
Cellular regeneration
Inflammation

Question 8

What are the 3 outcomes for ARDS?

Answer 8

Death
Resolution
Fibrosis

Question 9

Why can low levels of surfactant in neonates cause RDS?

Answer 9

Increased effort to expand the lungs can lead to physical damage to the cells

Question 10

What is an embolus?

Answer 10

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

Question 11

What is meant when saying that many PEs are subclinical?

Answer 11

Patient doesn’t really know that they are occurring

Question 12

What is the most common site or origin for PEs?

Answer 12

DVT of lower limbs

Question 13

Why are DVTs of the lower limbs common?

Answer 13

We stand a lot so there is a high hydrostatic pressure

Question 14

Why are long-haul flights a risk factor for DVTs?

Answer 14

Blood isn’t pumped properly

Question 15

Virchow’s triad describes the risk factors for PEs. What are these?

Answer 15

Factors in endothelial wall (e.g. endothelial hypoxia)
Abnormal blood flow (venous stasis)
Hyper coagulate blood (e.g. cancer or post-MI patients due to high platelet levels)

Question 16

What are the effects of PEs?

Answer 16

Sudden death
Severe chest pain
Dyspnoea 
Pulmonary hypertension 
Pulmonary infarct (leading to...)
Haemoptysis

Question 17

What do the effects of PEs depend on?

Answer 17

Size of embolus
Cardiac function
Respiratory function

Question 18

What are the common features of small PEs?

Answer 18

more likely to cause chronic effects like pulmonary hypertension

Clinically silent

Question 19

What are the common features of large PEs?

Answer 19

Death
Pulmonary infarct
Severe symptoms

Question 20

What causes pulmonary infarct?

Answer 20

PE + Compromised bronchial artery supply

Question 21

What type of patient typically gets primary pulmonary hypertension?

Answer 21

Young women

Question 22

How common is primary pulmonary hypertension?

Answer 22

No, it is very rare?

Question 23

What causes primary pulmonary hypertension?

Answer 23

Idiopathic (unknown)

Question 24

What causes secondary pulmonary hypertension?

Answer 24

Hypoxia (vascular constriction leading to pressure increase)
Increased pulmonary blood flow (congenital heart disease)
PE
Emphysema Back pressure from left-sided heart failure

Question 25

What is the morphology of pulmonary hypertension?

Answer 25

``` Medial hypertrophy of arteries Intimal thickening (fibrosis) Atheroma Right ventricular hypertrophy If extreme - plexogenic change/necrosis ```

Question 26

What is cor pulmonale?

Answer 26

Pulmonary hypertension complicating lung disease | Describes changes in the right ventricle = RV hypertrophy / RV dilation / right heart failure

Question 27

What is the pleura?

Answer 27

Mesothelial surface lining the lungs and mediastinum

Question 28

What are the mesothelial cells in the pleura designed for?

Answer 28

Fluid absorption

Question 29

What is the hallmark of disease in the pleura?

Answer 29

Effusion

Question 30

What are the two types of pleural effusions?

Answer 30

Transudate (low protein) | Exudate (high protein)

Question 31

Between transudate and exudate pleural effusion - which one in active and which one is a passive process?

Answer 31

Transudate - passive | Exudate - active

Question 32

Which diseases are associated with transudate pleural effusion?

Answer 32

Cardiac failure | Hypoproteinaemia

Question 33

Which diseases are associated with exudate pleural effusion?

Answer 33

Pneumonia TB Connective tissue disease Malignancy

Question 34

What is a purulent effusion?

Answer 34

Full of acute inflammatory cells = pus = Empyema | Can become chronic

Question 35

Empyema usually occurs as a complication of ______

Answer 35

pneumonia

Question 36

What is a pneumothorax?

Answer 36

Air in the pleural sapce

Question 37

What can cause a pneumothorax?

Answer 37

Trauma | Rupture of bulla

Question 38

What is a malignant primary neoplasm in the pleural space?

Answer 38

Malignant mesothelioma

Question 39

What is the common secondary neoplasm in the pleural cavity?

Answer 39

Adenocarcinomas from the lung GI tract or ovary

Question 40

What chemical are mesotheliomas related to ?

Answer 40

Asbestos exposure

Question 41

What cell differentiation do malignant mesotheliomas have?

Answer 41

Mixed epithelial and mesenchymal differentiation

Question 42

How can malignant effusions be diagnosed

Answer 42

Fluid form effusion sent to pathology - examine cytology Sometimes requires bigger piece or biopsy Immunohistochemistry for lineage specific antigens Medicolegal important

Question 43

How does immunohistochemistry work and what is it used for?

Answer 43

Can identify primary/secondary and benign / malignant using different antibodies