Respiratory Pathology 1 (Non-Neoplastic) Flashcards by Srishti D

What is the radiographic appearance of a lung abscess?

Cavitating lesion

Air-fluid level

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What are the risk factors for developing a lung abscess?

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

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

Right main bronchus more vertical

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How do infections responsible for abscesses cause necrosis?

ROS
Proteases from inflammatory cells
Proteases from bacteria

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What is the natural environment of aspergillus?

Soil

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What patients are particularly susceptible to aspergillus infections?

Those with pre-existing lung condition

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What is secondary TB?

Reactivation of TB

Usually due to immunosuppression

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What are the symptoms of secondary TB?

Cough
Fever
Weight loss
Malaise

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What medication can predispose to secondary TB?

Corticosteroids

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What is primary TB?

First infection

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

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What are the symptoms of primary TB?

Usually asymptomatic and self-limiting

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

High oxygen concentration

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What are the histopathological features of TB?

Granuloma

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

Scar

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What is a Ranke complex?

Calcified Ghon lesion + ipsilateral calcified hilar lymph node

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What tests are available for diagnosing TB?

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

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

Isolation

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Is TB a notifiable disease?

Yes

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

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

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

Anaphylaxis
PE
Arrhythmias
Anxiety
Pneumothorax
Acute asthma
ARDS

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

Asthma
Pneumonia
Heart failure
Infective exacerbation of COPD
Pleural effusion

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

Chronic anaemia
COPD
Heart failure
Chronic bronchitis
Fibrosis

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

Exposure to irritants

What is DLCO in respiratory function tests?

Diffusing capacity of carbon monoxide

What is usual interstitial pneumonia?

Interstitial lung disease with no underlying cause - Idiopathic pulmonary fibrosis - Cryptogenic fibrosing alveolitis

What are the secondary causes of usual interstitial pneumonia?

Drug toxicity Collagen vascular diseases Environmental exposures

At what age is usual interstitial pneumonia common?

50-70 years

What are the radiographic features of usual interstitial pneumonia?

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

What is interstitial lung disease

Inflammation +/- fibrosis

What is the presentation of interstitial lung disease?

Progressive dyspnoea | Persistent, non-productive cough

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

Restrictive pattern Reduction of DLCO Variable hypoxaemia

What is the radiographic appearance of interstitial lung disease?

Reticular/nodular/mixed-patterns

What is the clinical classification of interstitial lung disease?

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

How is sarcoidosis diagnosed?

By exclusion - Radiology - Lung function test - Biopsy

What are the causes of bilateral hilar enlargement?

Sarcoidosis Infection Lymphoma Metastatic carcinoma

What is the clinical term for diffuse alveolar damage?

Acute respiratory distress syndrome (ARDS)

What is diffuse alveolar damage?

Acute injury to endothelium and/or alveolar epithelium > - Oedema - Cytokines - Inflammation

What are the causes of diffuse alveolar damage?

``` Infection Trauma Aspiration Inhalation Injury Drugs Radiation Acute pancreatitis ```

What is the time course of diffuse alveolar damage?

Rapid onset - within 24-48 hours of precipitating event

What are the clinical features of diffuse alveolar damage?

Respiratory failure | Pulmonary oedema

What are the three phases of diffuse alveolar damage?

Exudative - acute Organising Fibrotic - chronic

What are the macroscopic features of diffuse alveolar damage?

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

What are the microscopic features of diffuse alveolar damage?

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

What is honeycomb lung?

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

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

``` Silicosis Sarcoidosis Coal workers' pneumoconiosis Langerhans' cell histiocytosis Ankylosing spondylitis Allergic bronchopulmonary aspergillosis TB ```

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

``` Rheumatoid arthritis Asbestosis Scleroderma Idiopathic pulmonary fibrosis Radiation Drugs ```

What is the difference between transudate and exudate?

``` Transudate = changes in oncotic pressure > low protein Exudate = change in vascular integrity > high protein ```

What are the test findings in a transudate pleural effusion?

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

What are the test findings in an exudate pleural effussion?

High protein High specific gravity High LDH High cellular content

What are some causes of transudative pleural effusion?

``` Increased venous pressure - Cardiac failure - Cirrhosis Hypoproteinaemia - Nephrotic syndrome - Cirrhosis ```

What are some causes of exudative pleural effusion?

``` Implies local process Infection Inflammation - Infarction - Trauma - Radiation - Connective tissue disorders - Uraemia Neoplasia ```

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

Malignancy

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

Numbers of neoplastic cells in recurrent effusions often increase

What is the main differential diagnosis of mesothelioma?

Primary lung adenocarcinoma