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MED4 ACP > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

waiting for update (current stage: pneumonia)

1
Q

3 Pathological classifications of pneumonia

A

lobar pneumonia, bronchopneumonia, interstitial pneumonia

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2
Q

Inflammatory cells & pathogen types of broncho-/ lobar pneumonia

A

polymorphs, then macrophages. bacteria, fungi

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3
Q

Inflammatory cells & pathogen types of interstitial pneumonia

A

lymphocytes. virus, protozoa, mycoplasma

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4
Q

4 stages of gross pathology of lobar pneumonia (time)

A

congestion (24 hours) –> red hepatisation (2~4 days) –> grey hepatisation (4~8 days) –> fibrosis

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5
Q

2 phases of histological pathology of lobar pneumonia

A

acute phase –> organizing phase

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6
Q

Most common bacteria in acute exacerbation of COPD

A

Hemophilus influenzae

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7
Q

Most common bacteria in secondary infection to viral infection

A

S. aureus

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8
Q

Bacteria of atypical pneumonia

A

Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae

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9
Q

Which pneumonia shows interstitial inflammation and diffuse alveolar damage?

A

atypical pneumonia

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10
Q

Which atypical pneumonia shows multinucleated pneumocytes?

A

SARS

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11
Q

Which atypical pneumonia presents with hemophagocytic syndrome?

A

Avian flu (Influenza A H5N1)

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12
Q

Pathogenesis of Ghon focus (time)

A

type IV HSR (3 weeks)

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13
Q

Histology of Ghon focus

A
  • central caseous necrosis
  • surrounded by epithelioid histiocytes & Langhans giant cells
  • further rimmed by lymphocytes
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14
Q

How is Ghon complex different from Ghon focus?

A

Ghon complex = Ghon focus + hilar lymph nodes

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15
Q

How is Ranke complex different from Ghon complex?

A

Ranke complex = calcified Ghon complex

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16
Q

Pancoast syndrome (3)

A
  • small hand muscle wasting, numbness, weakness
  • Horner’s syndrome
  • hoarseness of voice
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17
Q

Paraneoplastic manifestations in lung cancer (3+3)

A
  • SIADH, Cushing, HHM [SQCC]
  • Lambert-Eaton myasthenic syndrome, dermatomyositis, hypertrophic pulmonary osteoarthropathy
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18
Q

Which lung cancer could present with HHM?

A

SQCC

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19
Q

Lung cancers (5)

A

ADC (MC), SQCC, LCLC, SCLC, carcinoid

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20
Q

Origin of lung carcinoma

A

bronchial epithelial cells

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21
Q

Genetic associations with lung carcinoma (4)

A
  • EGFR (MC), ALK, ROS1
  • KRAS (emerging)
    (HER2, BRAF, RET)
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22
Q

5 growth patterns of lung ADC (poorest prognosis?)

A

lepidic, acinar, papillary, micro-papillary (poorest), solid

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23
Q

Pathology of lung ADC (2)

A

intracellular mucin, desmoplastic reaction

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24
Q

Progression of lung ADC

A

atypical adenomatous hyperplasia (AAH) –> adenomatous in situ –> minimally invasive ADC –> invasive ADC

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25
minimally invasive adenocarcinoma in lungs definition (2) (what is the prognosis?)
<=3cm in diameter, invasion <5mm in depth ~100% survival
26
Lung cancer with the strongest association with smoking
SQCC
27
Pathology of lung SQCC (3)
- central in major bronchi - keratin - intercellular bridges
28
Progression of lung SQCC
squamous metaplasia --> squamous dysplasia --> SQCC in situ --> SQCC
29
lung cancer with the poorest survival
SCLC
30
Pathology of lung SCLC (6)
- centrally located - oat cell (nucleus: hyperchromatic, fine chromatin, inconspicuous nucleoli, high mitosis) - nuclear moulding - Azzopardi effect - NE markers +ve - electron-dense granules under electron microscopy
31
Diagnosis of lung LCLC
by exclusion
32
Lung carcinoid tumour: typical vs atypical
typical (more benign), atypical (more malignant)
33
Pathology of lung carcinoid tumour (2)
organoid architecture, NE markers +ve
34
Risk factor of mesothelioma
Asbestos
35
Precursor lesions of mesothelioma (2)
extensive pleural fibrosis, plaque
36
Patterns of mesothelioma (3)
epithelial, sarcomatoid, biphasic
37
How to differentiate between obstructive and restrictive lung diseases?
spirometry: FEV1/FVC
38
Complications of COPD
- acute exacerbation - pneumothorax - cor pulmonale - secondary polycythaemia - respiratory failure (type II)
39
What is chronic bronchitis?
persistent productive cough for >=3 months in >=2 consecutive years
40
Pathogenesis of chronic bronchitis
goblet cell metaplasia --> mucus hypersecretion --> inflammation, fibrosis
41
Pathological index for chronic bronchitis
Reid index >0.4 (Thickness of mucosal glands / thickness of bronchial wall)
42
What is emphysema?
abnormal permenant enlargment of airspaces distal to terminal bronchioles accompanied by destruction of their walls without obvious fibrosis
43
Which protein deficiency is related to emphysema? Explain. Also explain how it is related to tobacco
α1-antitrypsin AAT deficiency --> ↑ neutrophil elastase --> attack pulmonary elastic tissues ROS in tobacco --> deplete antioxidant mechanisms --> inactivate AAT
44
4 Types of emphysema. Compare the common two (5)
centriacinar, panacinar, distal acinar, irregular Centriacinar vs panacinar: - Aetiology: air-related; AAT deficiency - Distribution: respiratory bronchioles; acini - Lung regions: upper lobes; lower lobes - V/Q: ↓ ; ~ - ABG changes: severe; less
45
What is asthma?
recurrent episodes of wheezing, cough, dyspnoea, chest tightness
46
2 types of asthma
extrinsic / atopic v.s. intrinsic
47
Aetiology of bronchiectasis (6)
- Congenital - Infection (MC) - Bronchial obstruction - Fibrosis (traction bronchiectasis) - Autoimmune - Idiopathic
48
Aetiology of interstitial lung disease (6) (sites)
Idiopathic, autoimmune, inhaled agents, infiltrative, infection, iatrogenic - Idiopathic (basal) - Autoimmune (basal except AS, psoriasis) - Inhaled agents (apical except asbestos) - Infiltrative (apical) - Infection (apical) - Iatrogenic (radiation apical, drugs basal)
49
7 Pathological examples of interstital lung disease
Fibrosing: - UIP - BOOP - Pneumoconiosis - asbestosis Granulomatous: - sarcoidosis Other: - DIP - PAP
50
ILD with alveoli full of brown macrophages
Desquamative interstitial pneumonia
51
ILD with alveoli full of PAS+ protein
Pulmonary alveolar proteinosis
52
ILD associated with TGF-β1
Usual interstitial pneumonia
53
ILD associated with smoking
Desquamative interstitial pneumonia
54
ILD with spatial heterogenicity
Usual interstitial pneumonia
55
ILD with homogenic lesion
Cryptogenic organizing pneumonia / Bronchiolitis obliterans with organizing pneumonia
56
Targeted therapy to EGFR+ lung ADC (2)
Erlotinib 厄洛替尼, Gefitinib 吉非替尼
57
Tests for EGFR, ALK, ROS1, KRAS, PD-L1
PCR: EGFR, ALK, ROS1, KRAS IHC: PD-L1
58
3 phases of ARDS
Exudative ==> Proliferative ==> Fibrotic
59
Pathology of ARDS (3)
diffuse alveolar damage hyaline membrane formation in alveolar walls pulmonary oedema / exudate
60
Which IHC marker is used to differentiate between lung SQCC and ADC with solid pattern?
P40

MED4 ACP (13 decks)

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