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Respiratory Flashcards

1
Q

What defines respiratory failure?

A

PaO2

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2
Q

What defines Type I respiratory failure?

A

PaO2

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3
Q

What defines Type II respiratory failure?

A

PaO2 6.3kPa

Hypercapnic respiratory drive

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4
Q

Immunocytochemistry of a lung tumour which is cytokeratin & thyroid transcription factor positive may indicate what origin?

A

Primary Lung non-mucinous adenocarcinoma & small cell

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5
Q

Immunocytochemistry of a lung tumour which is cytokeratin 7 negative & cytokeratin 20 positive
may indicate what origin?

A

Colorectal

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6
Q

Immunocytochemistry of a lung tumour which is cytokeratin 7 positive & cytokeratin 20 positive
may indicate what origin?

A

Upper gastrointestinal tract

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7
Q

Immunocytochemistry of a lung tumour which is oestrogen receptor positive may indicate what origin?

A

Breast

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8
Q

Immunocytochemistry of a lung tumour which is S100, HMB45, MelanA positive & cytokeratin negative may indicate what origin?

A

Melanoma

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9
Q

Which lung tumour is characterised by:
desmosomes link cells like epidermis (‘epidermoid’)
+/- keratinization
~90% in smokers
central > peripheral
hypercalcaemia due to parathyroid hormone related peptide

A

Squamous carcinoma

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10
Q

What is the normal bronchial epithelium?

A

pseudostratified columnar epithelium with ciliated and mucus-secreting cells

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11
Q

What can irritants such as smoke do to the epithelium?

A

cause the epithelium to undergo a reversible metaplastic change
from pseudostratified columnar to stratified squamous type which may keratinize

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12
Q

What can carcinoma obstructing a bronchus cause?

A

distal retention pneumonitis

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13
Q

Which lung tumour is characterised by:
central = peripheral
~80% in smokers
Thyroid transcription factor (TTF) is expressed in many

A

Adenocarcinoma

glandular cells, serous or +/- mucus vacuoles, in acinar, tubular, solid or papillary structures

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14
Q

What is the spectrum of malignancy of neuroendocrine tumours of the lung?

A

carcinoid,
atypical carcinoid,
large cell neuroendocrine carcinoma
small cell carcinoma

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15
Q

Which lung tumour is characterised by:

Organoid, bland cells, no necrosis,

A

Typical carcinoid tumour

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16
Q

What differentiates an atypical lung carcinoid tumour from a lung carcinoid tumour?

A

Less organoid, more atypia, nucleoli - may be focal atypia in an otherwise typical carcinoid

Necrosis, 2-10 mitotic figure per 2sqmm

More aggressive than typical carcinoids
70% metastasise
60% 5yr survival

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17
Q

What differentiates a Large cell neuroendocrine carcinomas from an atypical lung carcinoid tumour?

A

organoid architecture, eosinophilic granular cytoplasm + antigen expression

Severe atypia, nucleoli, necrosis, >11 mitotic figures per 2sqmm

Prognosis similar to or worse than other non-small cell lung carcinomas
Associated with smoking

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18
Q

What are the defining features of Large cell carcinomas of the lung?

A

No specific squamous or glandular morphology

~50% express thyroid transcription factor

Can be neuroendocrine

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19
Q

What are the defining features of small cell carcinoma of the lung?

A

Rapidly progressive malignant tumours - small primary metastasises early before presentation

Neurosecretory granules with peptide hormones such as ACTH

~99% in smokers

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20
Q

What is Cachexia?

A

Wasting syndrome - loss of weight, muscle atrophy, fatigue, weakness, and significant loss of appetite in someone who is not actively trying to lose weight.

Cannot be reversed nutritionally: Even if the affected patient eats more calories, lean body mass will be lost, indicating a primary pathology is in place

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21
Q

What are the paraneoplastic effects of small cell lung cancer?

A

ACTH and antidiuretic hormone

Lambert Eaton myasthenic syndrome due to anti-neuromuscular junction autoantibodies

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22
Q

What are the paraneoplastic effects of squamous cell carcinoma of the lung?

A

Parathyroid hormone-related peptide from squamous cell carcinoma causing hypercalcaemia

Cachexia
acanthosis nigricans,
Hypertrophic pulmonary osteoarthropathy (clubbing)
Coagulopathies - thrombophebitis migrans

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23
Q

What is found in the pleural cavity in a Chylothorax?

A

lymph

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24
Q

What is found in the pleural cavity in a Empyema (pyothorax)?

A

pus

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25
What is found in the pleural cavity in a Pleural effusion (hydrothorax)?
Transudate - Low protein non-inflammatory eg. Congestive cardiac failure Exudate - High protein Inflammatory eg, Infection in adjacent lung
26
What is the aetiology of malignant mesothelioma?
Blue asbestos – the most dangerous Brown asbestos White asbestos
27
What is the pathogenesis of malignant mesothelioma?
Initial nodule and effusion. Later obliterates pleural cavity growing around the lung Invades chest wall (pain) & lung Nodal and distant and metastases less common than with carcinomas Mixed spindle cell and epithelioid cells. May be very fibrous (desmoplastic)
28
What is Chylothorax?
Lymph in the pleural cavity
29
What is Empyema (pyothorax)?
Pus in the pleural cavity
30
What is Bronchiectasis?
Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue Results from chronic necrotizing infection
31
What is copious amounts of foul smelling sputum | a sign of?
Bronchiectasis
32
What is Chronic Obstructive Pulmonary Disease?
A combination of chronic bronchitis & emphysema
33
What is emphysema?
Abnormal permanent dilation of airspaces distal to the terminal bronchiole, with destruction of airspace wall, without obvious fibrosis
34
What are the classifications of Emphysema?
Centrilobular (centiacinar) - In the respiratory bronchioles only Panlobular (panacinar) - Respiratory bronchioles and alveoli Paraseptal (distal acinar) - Alveoli only
35
What is the main cause of centrilobular emphysema?
Smoking | Coal dust
36
What is the main cause of panlobular emphysema?
Patients with homozygous alpha-1-antitrypsin deficiency
37
What would the chest x-ray of a COPD patient with predominant bronchitis show?
Prominent vessels with large heart Blue Bloater
38
What would the chest x-ray of a COPD patient with predominant emphysema show?
Small heart with Hyperinflated lungs Pink Puffer
39
Which chronic inflammatory disorder of the airway is characterised by paroxysmal bronchospasm?
Asthma
40
What is the pathogenesis of Atopic asthma?
Type I hypersensitivity reaction Degranulation of IgE bearing mast cells Histamine initiated bronchoconstriction & mucus production obstructing air flow eosinophil chemotaxis
41
What is the general pathology of Interstitial lung disease?
Increased tissue in alveolar-capillary wall due to inflammation and fibrosis Decreased lung compliance - restrictive lung disease Increased gas diffusion distance
42
Give an example of Acute interstitial lung disease
Adult respiratory distress syndrome (shock lung) Diffuse alveolar damage – exudate & death of type I pneumocytes formation of hyaline membranes lining alveoli, followed by type II pneumocyte hyperplasia
43
Give an example of Chronic interstitial lung disease
Idiopathic pulmonary fibrosis Interstitial chronic inflammation & variably mature fibrous tissue - Adjacent normal alveolar walls Common end-stage fibrosed “honeycomb lung”
44
What disease presents with non-caseating perilymphatic pulmonary granulomas, then fibrosis. Usually with hilar node involvement and hypercalcaemia
Sarcoidosis
45
What is pneumoconiosis?
non neoplastic lung diseases due to inhalation of dusts, fumes and vapours
46
What is seen on macroscopically in coal workers pneumoconiosis?
Anthracosis | Progressive massive fibrosis
47
How does inhalation of silica (sand and stone dust) cause lung disease?
Silica kills phagocytosing macrophages Collagen is layed down around, forming fibrous silicotic nodules Increases risk of lung carcinoma
48
What is seen in Asbestosis?
High level asbestos exposure produces interstitial fibrosis, in a usual interstitial pneumonia pattern Histologically like idiopathic pulmonary fibrosis but asbestos bodies are identifiable in tissue sections
49
What kind of disease is farmers lung?
Hypersensitivity pneumonitis Type III hypersensitivity reaction to actinomycetes in hay
50
What is seen in Hypersensitivity pneumonitis?
poorly formed noncaseating interstitial granulomas and mononuclear cell infiltration in a peribronchial distribution with prominent giant cells
51
What is cystic fibrosis caused by?
Mutation in the Cystic Fibrosis Transmembrane conductance Regulator gene (CFTR) on chromosome 7q31.2 encodes a transmembrane chloride channel protein
52
What are the possible severe complications of chronic Rhino-sinusitis?
Osteomyelitis, meningitis, cerebral abscess
53
What are the common causes of Pharyngitis/Tonsillitis?
Viral eg. RSV, Influenza, Adeno, EBV, HSV1 Bacterial eg. Strep. pyogenes, Rarely - Neisseria gonorrhoeae, Corynebacterium diphtheriae
54
Ampicillin will cause a mas-pap rash when given in the presence of what pathogen?
Epstein-Barr virus (EBV)
55
Child (2-4 yrs), fever, irritable, difficulty speaking (“hot potato”) and swallowing. Leans forward, drools. Stridor, hoarse. What is the cause?
Epiglottitis - Medical emergency
56
What is the Rx for Epiglottitis?
maintain airway cefotaxime (Cephalosporin)
57
What is Croup and what causes it?
Acute laryngotracheobronchitis Inflammation of larynx and trachea after infection of upper airways, usually by parainfluenza type 2
58
What are the main organisms that cause acute otitis externa?
S. aureus (likely if pustular) and Pseudomonas spp.(esp. after swimming)
59
What antibiotics are to be avoided in chronic otitis externa?
Avoid aminoglycosides (gentamicin etc.) if perforation. Resistance may form and sensitisation occurs with prolonged courses
60
What usually causes malignant otitis externa and how is it treated?
Pseudomonas aeruginosa In the Elderly, diabetics, immunosuppressed Rx IV ceftazidime, then ciprofloxacin
61
What is the first line treatment for mastoiditis?
co-amoxiclav | amoxicillin-clavulanate
62
When is Erythromycin used in URTIs?
Whooping Cough Diptheria Also best alternative if penicillin allergy
63
What defines chronic bronchitis?
Cough productive of sputum on most days during at least 3 months of 2 successive years (which cannot be attributed to an alternative cause)
64
What is the most common cause of bronchiolitis and who gets it?
RSV (75%) Peaks in winter and early spring, in infants 2-10 months
65
What are the who anatomical patterns of pneumonia?
Bronchopneumonia - Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli Lobar pneumonia- Affects a large part, or the entirety of a lobe 90% due to S.pneumoniae
66
When is a pneumonia classified as hospital acquired?
Pneumonia developing >48hrs after hospital admission
67
What are considered the typical causative organisms of pneumonia?
``` Streptococcus pneumoniae Haemophilus influenzae Moraxella catarrhalis Staphylococcus aureus Klebsiella pneumoniae ```
68
What are considered the atypical causative organisms of pneumonia?
``` Mycoplasma pneumoniae Legionella pneumophilia Chlamydophila pneumoniae Chlamydophila psittaci Coxiella burnetii ```
69
What can influenza cause in patients with pre-existing cardiac & lung disorders?
Primary viral pneumonia can lead to Secondary bacterial pneumonia after initial period of improvement.
70
What is score used to assess severity of community acquired pneumonia ?
CURB65 Confusion Urea >7mmol/l Respiratory rate >30 BP - sys
71
What is a Ghon focus?
mycobacterium bacilli collecting in the hilar lymph nodes
72
What is the bodys response mycobacterium bacilli?
Tubercle formation - Granuloma caused by cell mediated response. Central area of epithelioid cells, giant cells. Surrounding lymphocytic cell infiltration. Progresses to central area of caseous necrosis, With fibrosis and calcification of the lesions
73
What is military tuberculosis?
When the infection is disseminated, usually only in the very young/old or immunocompromised.
74
What do you look for in microscopy of sputum when suspecting TB?
Acid Fast Bacilli poor uptake of Gram stains, Ziehl Neelsen better
75
What is the Mantoux test?
Tuberculin skin test | Type IV hypersensitivity reaction
76
What is the BCG vaccine?
Attenuated strain Mycobacterium bovis provides TB immunity
77
Mycobacterium avium can cause what?
HIV infected = Disseminated disease non HIV = pulmonary TB
78
What is the treatment for standard pulmonary TB?
Isoniazid and rifampicin
79
What is Hansen's disease and what causes it?
Leprosy Mycobacterium leprae
80
What are the two extreme clinical presentations of leprosy?
Tuberculoid (paucibacillary) - Macules and peripheral nerve damage Lepromatous (multibacillary) - Due to failure of Th1 cell mediated response - Subcutaneous tissue accumulation, spongy plaques
81
What is the treatment for Leprosy?
Dapsone, rifampicin, clofazimine | for 6-12months

Clinical pathology (14 decks)

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