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Histopathology Path Year 5 > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

1
Q

How can non-neoplastic lung diseases be split?

A
  1. Airway disease
  • asthma
  • COPD
  • bronchiectasis
  1. Parenchymal disease
  2. Pulmonary vascular disease
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2
Q

How would you define asthma?

A

Chronic inflammatory airway disorder with recurrent episodes of widespread narrowing of the airways which change in severity over short periods of time

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3
Q

What are causes and associations of asthma?

A
  1. Allergens
  2. Pollution
  3. Drugs - NSAIDs
  4. Occupational (gases/fumes)
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4
Q

What are the phases of asthma?

A
  1. Sensitisation
    - > The allergen binds to the surface of the bronchial epithelial dendritic cells which present the antigen to the underlying T Cell. This triggers a cytokine reaction
  2. Immediate phase
    - > Mast Cells degranulate on contact leading to vascular permeability, eosinophil and mast cell recruitment and bronchospasm
  3. Late phase

Chronic antigenic stimulation results in

  • Tissue damage
  • Increased mucus production
  • Muscle Hypertrophy
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5
Q

What are the clinical features of a patient with asthma?

A
  • > SOB
  • > Wheeze
  • > Severe - Status Asthmaticus
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6
Q

Define COPD

A

Chronic cough productive of sputum

-> Most days for at least 3 months over 2 consecutive years

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7
Q

What are causes of COPD?

A
  • > Smoking (80%)
  • > Air Pollution
  • > Occupational Exposure

chronic injury elicits local inflammation and reactive changes which predispose to further damage

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8
Q

What are the complications of COPD?

A
  • > Repeated Infections
  • > Chronic Respiratory Failure
  • > Pulmonary Hypertension and RHF (as a result of chronic hypoxia)
  • > Increased risk of lung cancer
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9
Q

Define bronchiectasis

A

Permanent abnormal dilatation of bronchi with inflammation and fibrosis extending into the adjacent parenchyma

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10
Q

What are causes of bronchiectasis?

A
  • > Post Infectious (i.e. CF*)
  • > Ciliary Dyskinesia
  • > Obstruction
  • > Post-Inflammatory (i.e. Foreign Body)
  • > Systemic Disorders
  • > Asthma
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11
Q

What are complications of bronchiectasis?

A
  • > Recurrent Infections
  • > Haemoptysis
  • > Pulmonary Hypertension
  • > RHF
  • > Amyloidosis
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12
Q

What is cystic fibrosis?

A
  • > Abnormality which leads to defective ion transport and therefore excessive resorption of water from secretions.
  • > This leads to abnormally thick mucous secretions.
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13
Q

What are complications of CF?

A

Lung = airway bstruction, resp failure, infections
GI tract = meconium ileus, malabsorption
Pancreas = pancreatitis, secondary malabsorption
Liver = cirrhosis
Male reproductive system = Infertility

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14
Q

What is pulmonary oedema?

A

Accumulation of fluid in alveolar spaces as consequence of leaky capillaries / back pressure from failing LH.

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15
Q

What are causes of pulmonary oedema?

A
  • > LHF
  • > Alveolar Injury
  • > Neurogenic
  • > High altitude
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16
Q

What is Diffuse Alveolar Damage?

A
  • > A pattern of diffuse lung injury in which patients present with raid onset of respiratory failure, requiring ITU Ventilation.
  • > CXR shows “white out” of all lung fields
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17
Q

What causes Diffuse Alveolar Damage?

A

-> Acute damage to endothelium and/or alveolar epithelium leading to exudative inflammatory reaction

Adults = ARDS

Neonates = Hyaline Membrane Disease of the Newborn

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18
Q

What are common causes of lung infections?

A
  • > Bacterial* i.e. mycobacteria
  • > Viral
  • > Mycoplasma
  • > Fungal&PArasitic
19
Q

What is bronchopneumonia vs lobar pneumonia?

A
  1. broncho = Centered around bronchi and bronchioles, spotty pattern
  2. Lobar = alveolar spaces diffusely, massive consolidation
20
Q

What are the stages of lobar penumonia?

A
  1. Congestion
  2. Red hepatization
  3. Grey hepatization
  4. Resolution
21
Q

What are complications of pneumonia?

A
  • > Abscess formation
  • > Pleuritis and pleural effusion
  • > Infected pleural effusion o.e. EMPYEMA
  • > Fibrous scarring
  • > Septicaemia
22
Q

What is emphysema?

A

-> Emphysema is the permanent loss of alveolar parenchyma distal to the terminal bronchiole

23
Q

What are causes of emphysema?

A
  • > Smoking
  • > Alpha 1 Anti Trypsin
  • > Rare i.e. IVDU, Connective Tissue Disease
24
Q

How does smoking cause emphysema?

A
  1. Smoke activates neutrophils and macrophages
  2. They release proteases that cause tissue damage.
  3. Alpha 1 Antitrypsin (responsible for neutralising proteases) are also inhibited by smoke
25
Q

What are complications of emphysema?

A
  • > Formation of bullae
  • > Respiratory Failure (loss of area for gas exchange)
  • > Pulmonary Hypertension and thus RHF
26
Q

What are Granulomatous Diseases?

A
  • > Collection of histiocytes/macrophaes +/- multinucleate giants cells
  • > Can be both necrotising/non-necrotising.
27
Q

What are causes of granulomatous diseases?

A

Infectious

  • > TB
  • > Fungi
  • > Parasites

Non-Infectious

  • > Sarcoidosis
  • > Foreign Body (Aspiration/IVDU)
  • > Drugs
  • > Occupational
28
Q

What is Fibrosing ILD?

A

Chronic and progressive fibrosing diseases of lung

29
Q

What are causes of Fibrosing ILD?

A

i) Idiopathic Pulmonary Fibrosis

ii) Asbestosis

30
Q

What is Pulmonary Thromboembolism?

A

Embolization of peripheral thrombi to the lung, 95% of which form in the deep veins of the leg

31
Q

What are risk factors for Pulmonary Thromboembolism?

A
  • > Advanced age
  • > Female sex
  • > Obesity
  • > Immobility
  • > Cardiac Failure
  • > Malignancy
  • > Trauma
  • > Surgery
  • > Childbirth
  • > Haemoconcentration
  • > Polycythaemia
  • > DIC
  • > Contraceptive Pill
  • > Cannulation
  • > Antiphospholipid Syndrome
32
Q

What does the severity of the Pulmonary Thromboembolism depend on?

A

The size on the emboli

Small = pleuretic pain, SOB

Large = sudden death, RHF

33
Q

What are non thrombotic causes of Pulmonary embolism?

A
  • > Bone Marrow i.e. post fracture
  • > Amniotic Fluid
  • > Trophoblast
  • > Tumour
  • > Foreign Body
  • > Air
34
Q

Define pulmonary hypertension

A

Mean pulmonary arterial pressure >25mmHg at rest.

35
Q

What is the commonest cause of malignant lung tumours?

A

Non small cell Adenocarcinoma

36
Q

What is the main risk factor for epithelial lung cancers?

A

SMOKING

37
Q

How are Squamous Cell Carcinomas caused?

A
  1. Repeated injury from cigarette smoke changes normal epithelium to tougher squamous type.
  2. Continued smoking causes mutations in these squamous cells
38
Q

What is the commonest cause of cancer in non smokers?

A

adenocarcinoma

39
Q

Where are adenocarcinomas commonly found?

A

In the peripheries

40
Q

Define Large Cell Carcinoma

A

These are poorly differentiated tumours that show no histological evidence of glandular or squamous differentiation i.e. Adenocarcinoma or Squamous Cell Carcinoma.

-> Poor Prognosis

41
Q

Which type of lung cancer has the worst prognosis?

A

Small cell carcinoma

42
Q

Which hormone is associated with small cell carcinoma?

A

ASSOCIATED WITH ECTOPIC ACTH RELEASE

43
Q

Why is it important to sub type lung cancers?

A

Enables you to use targeted therapies depending on the mutations present

44
Q

How are lung cancers classified?

A
  1. Non small cell
    - Squamous cell
    - Adenocarcinoma
    - Large cell carcinoma
  2. Small cell carcinoma

Histopathology Path Year 5 (4 decks)

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