Resp

Question 1

dilatation of the airway and excess mucus production. caused by tobacco smoke, air pollution.
Histology shows goblet cell hyperplasia and hypertrophy of mucous glands.

Answer 1

Chronic bronchitis

Question 2

airway dilatation and scarring often occuring in children secondary to respiratory infections. present with cough, sputum, fever. histology shows permanent dilatation of the bronchi.

Answer 2

bronchiectasis

Question 3

complications of bronchiectasis

Answer 3

recurrent infections, haemoptysis, hypoxia, amyloidosis

Question 4

smooth muscle hyperplasia of the bronchus with excess mucus production and inflammation. histology shows eosinophils, Curshcmann spirals and Charcot leyden crystals.

Answer 4

Asthma

Question 5

acinar airspace enlargement and wall destruction. Histology shows loss of alveolar parenchyma distal to the terminal bronchiole.

Answer 5

Emphysema

Question 6

centrilobular pattern of alveolar parnechyma destruction

Answer 6

smoking

Question 7

Pan-acinar pattern of alveolar parenchymal destruction

Answer 7

a1-AT

Question 8

congenital causes of bronchiectasis

Answer 8

PCD, CF, hypogamaglobulinaemia, yellow nail syndrome, young syndrome (rhinosinusitis azoospermia and bronch)

Question 9

a group of >200 different lung pathologies characterised by inflammation and fibrosis of pulmonary connective tissue, particularly the peripheral and delicate alveolar wall tissue.
shows a RESTRICTIVE pattern on spirometry

Answer 9

Interstitial lung disease

Question 10

diffuse interstitial fibrosis/pneumonia with some cystic changes, leads to loss of normal lung architecture with honeycomb appearance. begins at the peripheries. Affects older patients, present with exertional SOB and non-productive cough.

Answer 10

Cryptogenic Fibrosing alveolitis (idiopathic pulm fibrosis)
presents with exertional SOB, cough, cyanosis, pulm HTN and clubbing.
may be associated with inflammatory disease i.e RA SLE
Progressive disease - over 50% die within 2-3years

Question 11

Rx of cryptogenic fibrosing alveolitis (IPF)

Answer 11

steroids
azathioprine
cyclophosphamide
(SAC - cus it forms little cyst sacs)

Question 12

an occupational lung disease that typically affects the upper lobe. often called dusty lung as its caused by inhalaation of mineral dusts or inorganic particles. Coal workers typically affected. leads to permanent alteration to the lungs structure.

Answer 12

Pneumoconioses

Question 13

can cause benign lesions such as plaques and fibrosis, or malignant lesions such as mesothelioma, adenocarcinoma. tends to affect the lower lobe.

Answer 13

Asbestosis

Question 14

Macrophages, pigment and fibrosis seen on lungs. fibrotic nodules. history of working in coal industry.

Answer 14

Coal workers pneumoconiosis

Question 15

a group of immune mediated lung disorders caused by prolonged or intense exposure to inhaled organic antigens, leading to widespread alveolar damage

Answer 15

Eosinophilic interstitial lung diseases (EAA)

Question 16

an occupational lung disease that can have a chronic or acute form.
histologically there is presence of polypoid plugs, loose connective tissue within alveoli and bronchioles, leading to granuoloma formation and organising pneumonia.

Answer 16

Extrinsic allergic alveolitis

Question 17

inhaled antigenic dust in a sensitised indivudial leading to systemic symptoms such as fever, chills, chest pain, sob and cough) within hours of exposure. usually settles by the following day.

Answer 17

Acute EEA - can progress to chronic

early recognition is vital in prevention of progression to fibrosis by removal of antigenic trigger

Question 18

Persistent productive cough, SOB, loss of weight and finger clubbing. symptomatic whenever they are at work.

Answer 18

Chronic EEA.

Question 19

EEA caused by mouldy grain, hay, silage - saccharopolyspora rectiv

Answer 19

Farmers lung

Question 20

pigeon exposure, protein in excreta/feathers

Answer 20

pigeon fanciers lung

Question 21

heated water reservoirs

Answer 21

humidfiers lung

Question 22

germinating barley - aspergillus clavatus/fumigatus

Answer 22

malt-workers lung

Question 23

mouldy cheese - aspergillus clavatus

Answer 23

cheese washers lung

Question 24

risk factors for lung cancer

Answer 24

asbestos, heavy metals, genetics, susceptibility genes, smoking

Question 25

makes up the majority of lung cancers, M>F, closely correlated with smoking.
p53 and c-myc mutations often present
usually found in the central/proximal bronchi with local spread and late mets.

Answer 25

squamous cell carcinoma
associated with p53, cmyc, p63 and CK5/6
histology shows keratinisation and intercellular prickles

Question 26

most common lung ca in women and nonsmokers. glandualr differentiation, mucus production. often occurs peripherally and mets early. EGFR mutations.

Answer 26

Adenocarcinoma —- e(G)fr - Glandular
mets early to the alveolar walls, leads to breakdown of elastin wall –> desmoplasia, ANGULAR glands
Rx - TARCEVA - anti-EGFR

Question 27

80% present with advanced disease. occurs centrally in the proximal bronchi. arises from neuroendocrine cells. associated with paraneoplastic syndromes.
highly malignaant, mets early - bone brain adrenal liver
strong association with smoking. p53 and RB1 mutations.

Answer 27

Small cell carcinoma
poor prognosis despite being very chemosensitive due to rapid mets.
poorly differentiated

Question 28

poorly differentiated malignant epithelial tumour. large cells with large nuclei and prominent nucleoli.

Answer 28

large cell carcinoma

poor prognosis

Question 29

EGFR mutations, non-smokers. Histology shows cells containing mucin vacuoles. poor prognosis.

Answer 29

adenocarcinoma

Question 30

lung cancer associated with ectopic ACTH secretion. Lambert Eaten and cerebellar degeneration. poor prognosis.

Answer 30

Small cell carcinoma

Question 31

assocaited with p53 and cmyc mutations, can secrete ectopic PTH. various subtypes - papillary, basaloid.

Answer 31

Squamous cell carcinoma

Question 32

paraneoplastic serotonin secretions leads to

Answer 32

Carcinoid syndrome - flushing, diarrhoea, bronchoconstriction

Question 33

ERCC1 mutation

Answer 33

poor response ot cisplation

Question 34

EGFR

Answer 34

adenocarcinoma. good target for TKI therapy - young patients non smokers

Question 35

K Ras

Answer 35

assocaited with adeno and squamous cell carcinoma. usually poor prognosis

Question 36

parietal or visceral pluera, spreads wiudely within the pleural space. associated with extensive pleural effusion, chest pain, and dyspnoea. Long latent period (25-45 years)

Answer 36

Mesothelioma.
<1% of lung ca, poor prognosis.
asbestos related. epitheloid or sarcomatoid.

Question 37

peripheral wedge infarctions

Answer 37

small pulmonary emboli

causes pleuritic chest pain

Question 38

acute cor pulmonale and cardiogenic shock

Answer 38

large emboli in the main pulm arteries

Question 39

mean pulmonary artery pressure at rest

Answer 39

25mmHg

Question 40

complications of pulmonary hypertension

Answer 40

right sided heart ailure, venous congestion of organs, nutmeg liver, plueral effusions, decreased lung perfusion

Question 41

intra-alveolar fluid accumulation leading to poor gas exchange. histology shows iron laden macrophages and intraalveolar fluid

Answer 41

pulmonary oedema

main aetiology LHF

Question 42

diffuse alveolar and endothelial damage. result in rapid onset resp failure. congested, expanded, firm plum coloured lungs on histology, airless, weigh >1kg. High mortality and morbidity.

Answer 42

ARDS