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MD2 Ambulatory Care and Emergency Medicine > Respiratory Pathology 1 (Non-Neoplastic) > Flashcards

Respiratory Pathology 1 (Non-Neoplastic) Flashcards

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1
Q

What is the radiographic appearance of a lung abscess?

A

Cavitating lesion

Air-fluid level

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2
Q

What are the risk factors for developing a lung abscess?

A 
Aspiration
Immunosuppression
Bronchial obstruction
Chronic lung damage
Bacteraemia
Staph and Gram negatives causing pneumonia
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3
Q

Why are lung abscesses most common in the right lower lobe?

A

Right main bronchus more vertical

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4
Q

How do infections responsible for abscesses cause necrosis?

A

ROS
Proteases from inflammatory cells
Proteases from bacteria

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5
Q

What is the natural environment of aspergillus?

A

Soil

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6
Q

What patients are particularly susceptible to aspergillus infections?

A

Those with pre-existing lung condition

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7
Q

What is secondary TB?

A

Reactivation of TB

Usually due to immunosuppression

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8
Q

What are the symptoms of secondary TB?

A

Cough
Fever
Weight loss
Malaise

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9
Q

What medication can predispose to secondary TB?

A

Corticosteroids

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10
Q

What is primary TB?

A

First infection

Forms Ghon complex, usually in upper half of right lower lobe

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11
Q

What are the symptoms of primary TB?

A

Usually asymptomatic and self-limiting

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12
Q

Why are lesions of secondary TB typically located in the apices of the lungs?

A

High oxygen concentration

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13
Q

What are the histopathological features of TB?

A

Granuloma

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14
Q

What histological changes take place with healing of TB in immunocompetent people?

A

Scar

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15
Q

What is a Ranke complex?

A

Calcified Ghon lesion + ipsilateral calcified hilar lymph node

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16
Q

What tests are available for diagnosing TB?

A 
Mantoux
Quatiferon gold
Interferon gamma release assay
Zeihl-Neelsen stain
PCR
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17
Q

How should you change the management if active TB is suspected?

A

Isolation

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18
Q

Is TB a notifiable disease?

A

Yes

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19
Q

What are some non-infectious causes of granulomatous inflammation in the lung?

A 
Sarcoidosis
Hypersensitivity pneumonitis
Granulomatosis with polyangiitis
Churg-Strauss syndrome
Aspiration pneumonia
Rheumatoid nodules
Bronchocentric granulomatosis
Foreign body
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20
Q

What are some differential diagnoses for shortness of breath developing in seconds to minutes?

A 
Anaphylaxis
PE
Arrhythmias
Anxiety
Pneumothorax
Acute asthma
ARDS
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21
Q

What are some differential diagnoses for shortness of breath developing in hours to days?

A 
Asthma
Pneumonia
Heart failure
Infective exacerbation of COPD
Pleural effusion
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22
Q

What are some differential diagnoses for shortness of breath developing in weeks or longer?

A 
Chronic anaemia
COPD
Heart failure
Chronic bronchitis
Fibrosis
23
Q

In lung disease, why is it important to take an occupational history?

A

Exposure to irritants

24
Q

What is DLCO in respiratory function tests?

A

Diffusing capacity of carbon monoxide

25
Q

What is usual interstitial pneumonia?

A

Interstitial lung disease with no underlying cause

  • Idiopathic pulmonary fibrosis
  • Cryptogenic fibrosing alveolitis
26
Q

What are the secondary causes of usual interstitial pneumonia?

A

Drug toxicity
Collagen vascular diseases
Environmental exposures

27
Q

At what age is usual interstitial pneumonia common?

A

50-70 years

28
Q

What are the radiographic features of usual interstitial pneumonia?

A

Bilateral, symmetrical, irregular linear opacities causing reticular pattern
Honeycombing sub-pleurally

29
Q

What is interstitial lung disease

A

Inflammation +/- fibrosis

30
Q

What is the presentation of interstitial lung disease?

A

Progressive dyspnoea

Persistent, non-productive cough

31
Q

What is the pattern in lung function tests of interstitial lung disease?

A

Restrictive pattern
Reduction of DLCO
Variable hypoxaemia

32
Q

What is the radiographic appearance of interstitial lung disease?

A

Reticular/nodular/mixed-patterns

33
Q

What is the clinical classification of interstitial lung disease?

A 
Drug-induced
Environmental and occupational exposure
Idiopathic interstitial pneumonias
Diffuse alveolar damage
Collagen vascular disease
IBD
Primary/unclassified
34
Q

How is sarcoidosis diagnosed?

A

By exclusion

  • Radiology
  • Lung function test
  • Biopsy
35
Q

What are the causes of bilateral hilar enlargement?

A

Sarcoidosis
Infection
Lymphoma
Metastatic carcinoma

36
Q

What is the clinical term for diffuse alveolar damage?

A

Acute respiratory distress syndrome (ARDS)

37
Q

What is diffuse alveolar damage?

A

Acute injury to endothelium and/or alveolar epithelium >

  • Oedema
  • Cytokines
  • Inflammation
38
Q

What are the causes of diffuse alveolar damage?

A 
Infection
Trauma
Aspiration
Inhalation
Injury
Drugs
Radiation
Acute pancreatitis
39
Q

What is the time course of diffuse alveolar damage?

A

Rapid onset - within 24-48 hours of precipitating event

40
Q

What are the clinical features of diffuse alveolar damage?

A

Respiratory failure

Pulmonary oedema

41
Q

What are the three phases of diffuse alveolar damage?

A

Exudative - acute
Organising
Fibrotic - chronic

42
Q

What are the macroscopic features of diffuse alveolar damage?

A 
Acute
- Lungs heavy
- Oedematous
- Dark red cut surface
Organising/chronic
- Rubbery firm
- Yellow-grey
- Fine cysts
43
Q

What are the microscopic features of diffuse alveolar damage?

A 
Acute
- Alveolar spaces show hyaline membranes
- Oedema
Organising
- Pneumocyte hyperplasia
- Inflamed interstitium
- Reactive fibrosis
Chronic
- Denser fibrosis
- Microscopic cysts
44
Q

What is honeycomb lung?

A

Irreversible end-stage manifestation of large number of interstitial, inflammatory, and proliferative lung diseases

45
Q

What are the causes of pulmonary fibrosis in the upper lobes?

A 
Silicosis
Sarcoidosis
Coal workers' pneumoconiosis
Langerhans' cell histiocytosis
Ankylosing spondylitis
Allergic bronchopulmonary aspergillosis
TB
46
Q

What are the causes of pulmonary fibrosis in the lower lobes?

A 
Rheumatoid arthritis
Asbestosis
Scleroderma
Idiopathic pulmonary fibrosis
Radiation
Drugs
47
Q

What is the difference between transudate and exudate?

A 
Transudate = changes in oncotic pressure > low protein
Exudate = change in vascular integrity > high protein
48
Q

What are the test findings in a transudate pleural effusion?

A

Low protein
Low specific gravity
Low LDH
Lower cellular and fibrin content

49
Q

What are the test findings in an exudate pleural effussion?

A

High protein
High specific gravity
High LDH
High cellular content

50
Q

What are some causes of transudative pleural effusion?

A 
Increased venous pressure
- Cardiac failure
- Cirrhosis
Hypoproteinaemia
- Nephrotic syndrome
- Cirrhosis
51
Q

What are some causes of exudative pleural effusion?

A 
Implies local process
Infection
Inflammation
- Infarction
- Trauma
- Radiation
- Connective tissue disorders
- Uraemia
Neoplasia
52
Q

What is a large unilateral pleural effusion (more than one litre) in the elderly highly suspicious of?

A

Malignancy

53
Q

Why should pleural effusions be re-tapped if the first tap shows no malignant cells or is inconclusive?

A

Numbers of neoplastic cells in recurrent effusions often increase

54
Q

What is the main differential diagnosis of mesothelioma?

A

Primary lung adenocarcinoma

MD2 Ambulatory Care and Emergency Medicine (29 decks)

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