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Respiratory Pathology and Immunology > Pulmonary Vascular Disease and Pleural Disease (PATHOLOGY) > Flashcards

Pulmonary Vascular Disease and Pleural Disease (PATHOLOGY) Flashcards

1
Q

Why is atherosclerosis not common in the pulmonary circulation?

A

because it is a Low pressure system

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2
Q

What is pulmonary oedema?

A

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

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3
Q

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

A

thicken

Restrictive

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4
Q

What are the causes of pulmonary oedema?

A

Increase in hydrostatic pressure

Cellular injury to alveolar lining or alveolar endothelium

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5
Q

What can cause ARDS?

A

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

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6
Q

What is the pathological cause of ARDS?

A

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

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7
Q

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

A

Fibrinous exudate lining of alveolar walls
Cellular regeneration
Inflammation

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8
Q

What are the 3 outcomes for ARDS?

A

Death
Resolution
Fibrosis

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9
Q

Why can low levels of surfactant in neonates cause RDS?

A

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

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10
Q

What is an embolus?

A

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

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11
Q

What is meant when saying that many PEs are subclinical?

A

Patient doesn’t really know that they are occurring

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12
Q

What is the most common site or origin for PEs?

A

DVT of lower limbs

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13
Q

Why are DVTs of the lower limbs common?

A

We stand a lot so there is a high hydrostatic pressure

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14
Q

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

A

Blood isn’t pumped properly

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15
Q

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

A

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)

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16
Q

What are the effects of PEs?

A 
Sudden death
Severe chest pain
Dyspnoea 
Pulmonary hypertension 
Pulmonary infarct (leading to...)
Haemoptysis
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17
Q

What do the effects of PEs depend on?

A

Size of embolus
Cardiac function
Respiratory function

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18
Q

What are the common features of small PEs?

A

more likely to cause chronic effects like pulmonary hypertension

Clinically silent

19
Q

What are the common features of large PEs?

A

Death
Pulmonary infarct
Severe symptoms

20
Q

What causes pulmonary infarct?

A

PE + Compromised bronchial artery supply

21
Q

What type of patient typically gets primary pulmonary hypertension?

A

Young women

22
Q

How common is primary pulmonary hypertension?

A

No, it is very rare?

23
Q

What causes primary pulmonary hypertension?

A

Idiopathic (unknown)

24
Q

What causes secondary pulmonary hypertension?

A

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

25
Q

What is the morphology of pulmonary hypertension?

A 
Medial hypertrophy of arteries
Intimal thickening (fibrosis) 
Atheroma
Right ventricular hypertrophy 
If extreme - plexogenic change/necrosis
26
Q

What is cor pulmonale?

A

Pulmonary hypertension complicating lung disease

Describes changes in the right ventricle = RV hypertrophy / RV dilation / right heart failure

27
Q

What is the pleura?

A

Mesothelial surface lining the lungs and mediastinum

28
Q

What are the mesothelial cells in the pleura designed for?

A

Fluid absorption

29
Q

What is the hallmark of disease in the pleura?

A

Effusion

30
Q

What are the two types of pleural effusions?

A

Transudate (low protein)

Exudate (high protein)

31
Q

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

A

Transudate - passive

Exudate - active

32
Q

Which diseases are associated with transudate pleural effusion?

A

Cardiac failure

Hypoproteinaemia

33
Q

Which diseases are associated with exudate pleural effusion?

A

Pneumonia
TB
Connective tissue disease
Malignancy

34
Q

What is a purulent effusion?

A

Full of acute inflammatory cells = pus = Empyema

Can become chronic

35
Q

Empyema usually occurs as a complication of ______

A

pneumonia

36
Q

What is a pneumothorax?

A

Air in the pleural sapce

37
Q

What can cause a pneumothorax?

A

Trauma

Rupture of bulla

38
Q

What is a malignant primary neoplasm in the pleural space?

A

Malignant mesothelioma

39
Q

What is the common secondary neoplasm in the pleural cavity?

A

Adenocarcinomas from the lung GI tract or ovary

40
Q

What chemical are mesotheliomas related to ?

A

Asbestos exposure

41
Q

What cell differentiation do malignant mesotheliomas have?

A

Mixed epithelial and mesenchymal differentiation

42
Q

How can malignant effusions be diagnosed

A

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

43
Q

How does immunohistochemistry work and what is it used for?

A

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

Respiratory Pathology and Immunology (7 decks)

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