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CP > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

What parts of the respiratory tract are included in the conducting airway?

A 
Trachea
L and R main bronchi
Segmental and smaller bronchi
Bronchioles
Terminal bronchioles
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2
Q

What parts of the respiratory tract are included in the gas exchange (lung acini)?

A

Respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

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3
Q

What is the respiratory tract split into?

A

Conducting airways

gas exchange

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4
Q

What types of cells are present in the conducting portion of the RT?

A

Pseudostratified cilliated columnar mucus secreting epithelium

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5
Q

What types of cells do alveoli mostly contain?

A

Type I pneumocytes = gas exchange

Type II pneumocytes = surfactant production

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6
Q

What is Type I respiratory failure classified as?

A

Low PaO2

Normal CO2

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7
Q

What is Type II respiratory failure classified as?

A

PaCO2>6.3kPa

Hypercapnic respiratory drive

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8
Q

What is the name of a benign primary lung tumour?

A

adenochrondroma

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9
Q

What are the risk factors for lung carcinomas?

A

cigarettes
asbestos exposure
lung fibrosis
radon etc

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10
Q

What specifically does asbestos cause to the body?

A

asbestosis - pulmonary interstitial fibrosis

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11
Q

What are the types of malignant primary cell tumours?

A

Carcinomas - small cell and non small cell
Carcinoid
Others - lymphomas, sarcomas, carcinosarcomas

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12
Q

What are the different types of non small cell carcinomas?

A

Squamous carcinomas
adenocarcinoma
large cell neuroendocrine carcinoma
undifferentiated large cell carcinoma

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13
Q

Which category of malignant primary lung tumours are all neuroendocrine?

A

small cell carcinomas

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14
Q

what are carcinoid tumours?

A

low grade neuroendocrine epithelial tumours

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15
Q

What factors can be tested for in lung non mucinous adenocarcinoma and small cell tumours?

A

cytokeratin factor

thyroid transcription factor

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16
Q

What are the features of squamous carcinomas?

A

desosomes linked cells like epidermis
with our without keratinisation
cental
hypercalcaemia due to parathyroid related peptide secreted by tumour cells

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17
Q

what cells are the bronchial epithelium lined with?

A

pseudostratified columnar epithelium with ciliated and mucus secreting cells

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18
Q

what is squamous metaplasia and why does it happen?

A

reversible change from pseudostatified columnar cells to (keratinised) stratified squamous cells
caused by irritants such as smoke

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19
Q

What are the features of adenocarcinomas?

A

glandular cells
serous or mucus vacuoles
in acinar, tubular, solid or papillary structures
central and peripheral
Thyroid transcription factor (TTF) expressed

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20
Q

What are the features of bronchioalveolar carcinomas?

A

spread of well differentiated mucinous/non mucinous neoplastic cells on alveolar wall
not invasive
mimics pneumonia

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21
Q

What are the cell proteins produced by neuroendocrine carcinomas?

A

neural cell adhesion molecule (CD56)
Chromogranin
synaptophysin

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22
Q

what are the features of typical carcinoid tumours?

A 
grow in and occlude a bronchus
bland cells, no necrosis
not associated with smoking
associated with multiple endocrine neoplasia syndrome type 1
not benign - may invade lymphatic nodes
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23
Q

what are the features of atypical carcinoid tumours?

A

more atypia nucleoli, otherwise typical
necrosis
more aggressive

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24
Q

What are the features of large cell neuroendocrine carcinomas?

A

eosinophilic granular cytoplasm
antigen expression
severe atypia nucleoli necrosis
associated with smoking

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25
Q

what are the features of small cell carcinomas?

A

rapidly progressive
malignant
neurosecretory granules with peptide hormones
mainly in smokers

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26
Q

What are the requirements for a mixed neuroendocrine carcinoma?

A

need 10% of a component for classification

adenosquamous

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27
Q

What are the requirements for a combined small cell carcinoma?

A

Any proportion of small cell carcinomas and NSCLC

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28
Q

What are the features of large cell carcinomas?

A

no specific squamous/glandular morphology
some express thyroid transcription factor
can be neuroendocrine

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29
Q

What is used for the staging of lung malignancies?

A

TNM

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30
Q

What is a pneumothorax?

A

air in the pleural cavity

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31
Q

What is a pleural effusion (hydrothorax)?

A

exudate in the pleural cavity

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32
Q

What is a haemothorax?

A

blood in the pleural cavity

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33
Q

What is a chylothorax?

A

lymph in the pleural cavity

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34
Q

What is a empyema (pyothorax)?

A

Pus in the pleural cavity

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35
Q

What are the causes of pleural effusion?

A

inflammatory - exudate, infection, inflammation

Non inflammatory - congestive cardiac failure

36
Q

What is malignant mesothelioma?

A

cancer in the pleura
over 90% associated with asbestos exposure
may produce pleural effusion
mixed spindal cells and epitheloid cells, may be fibrous
treat symptomatically
fatal in 1-3 years

37
Q

What are fibrous pleural plaques?

A

on lower thoracic wall and disphragmatic parietal pleura
associated with low level asbestos exposure
not premalignant

38
Q

What are primary infections?

A

obtaining an infection when previously healthy

39
Q

What are secondary infections?

A

obtaining an infection when immune system is already weakened

40
Q

What are examples of situations where you are more likely to get secondary infections?

A 
tumour, foreign
cough reflex doesnt work
kartageners syndrome
CF
hypogammaglobulinaemia
immunsupressive drugs
AIDS
smoking, hypoxia
pulomary oedema
41
Q

What are examples of acute bronchitis?

A

Viral (RSV), H. influenza, strep. pneumoniae
croup
exacerbations of COAD

42
Q

What are examples of bronchiolitis?

A

primary acute in infants, RSV

broncopneumonia - follicular/bronchiolitis obliterans

43
Q

What is pneumonia?

A

inflammatory exudate/consolidation in alveoli and distil small airways

44
Q

What are pneumonias classified into?

A

Clinical - primary/secondary
Aetiological - bacterial, viral, fungal
Antatomical - lobular/bronchopneumonia
Reaction - purulent/fibrinous

45
Q

What are the features of bronchopneumonia?

A 
secondary
often low virulence bacteria/fungi
common
patchy
bronchocentric - destructive, granulomatous lesion of the bronchi and bronchioles 
resolves/heals with scarring
46
Q

What are the features of lobular pneumonia?

A 
primary
typically males 20-50 years old
strep. pneumoniae
uncommon
congesstion
resolves without scarring
47
Q

What are the features of atypical pneumonias?

A

severity mild to fatal
interstitial lymphocytes, plasma cells, macrophages
poor exudate
diffuse alveolar damage

48
Q

What organisms cause atypical pneumonias?

A 
viral - flu, RSV, rhino, adeno, measles
Mycoplasma pneumoniae
chalmydia
coxiella burnetti
legionella pneumophilla
49
Q

What are examples of non infective pneumonias?

A

Aspiration pneumonias - produces abscesses
lipid pneumonias - endogenous and exogenous
cryptogenic organising pneumonia
bronchiolotis obliterans organising pneumonia

50
Q

What organism causes pulmonary tuberculosis

A

Mycobacterium tuberculosis

51
Q

What is the vaccine called to protect against TB?

A

Bacille Calmetta-Guerin (BCG)

52
Q

What are the symptoms of the primary infection in TB?

A

Asymtomatic

Ghon complex in lung and hilar nodes

53
Q

How does TB symptoms progress?

A

empyema
pneumonia
spread to other organs
scarring

54
Q

What are the features of pulmonary tuberculosis?

A

Granulomas with multinucelated Langhans’ giant cells
caseous necrosis
intense immune reaction
Type 4 hypersensitivity

55
Q

When are you likely to get pulmonary vasculitis?

A

necrotising granulomatous vasculitis’s e.g. Wegeners granulomatosis
goodpastures syndrome - rare autoimmune disease in which antibodies attack the basement membrane
Microvascular damage

56
Q

What causes localised obstruction of air flow in obstructive pulmonary disease?

A 
Tumour/forign body
distil alveolar collapse/over expansion
distil retention pneumonitis
brochoneumonia
distil bronchiesctasis
57
Q

What is bronchiectasis?

A

permanent dilatation of bronchi/bronchioles caused by destruction of the muscle and elastic tissue
results from chronic necrotising infection

58
Q

what are the symptoms of bronchiectasis?

A

cough
fever
foul smelling sputum

59
Q

What are predisposing conditions to bronchiectasis?

A

CF
Kartngners syndrome
Bronchial obstruction
lupus, RA, IBS, GVHD

60
Q

Name some examples of diffuse obstructive pulmonary disease.

A

COPD

Asthma

61
Q

What two conditions is COPD a combination of?

A

chronic bronchitis

emphysema

62
Q

What are the symptoms of chronic bronchitis?

A

cough and sputum for 3 months in each of 2 consecutive years

63
Q

What are the causes of chronic bronchitis?

A

chronic irritation
smoking
air pollution

64
Q

What is chronic bronchitis?

A

mucus gland hyperplasia/hypersecretion

chronic inflammation of small airways - wall weakness and destruction therefore emphysema

65
Q

What is emphysema?

A

abnormal permanent dilation of airspaces

destruction of airspace wall without obvious fibrosis

66
Q

What are the 3 classifications of emphysema?

A

Centrilobular (centiacinar)
panlobular (panacinar)
paraseptal

67
Q

What are the symptoms of emphysema?

A

Dysponea - progressive and worse

68
Q

What are the common features of predominantly bronchitis COPD?

A 
40-45 years old
mild dyspnea, late in disease
early cough
infections common
'blue bloater'
69
Q

What are the common features of predominantly emphysema COPD?

A 
50-75 years old
severe early dyspnea
late cough
infections rare
'pink puffer'
70
Q

What is asthma?

A

chronic inflammatory disorder of the airways

71
Q

What are the symptoms of asthma?

A

wheeze
cough
variable bronchoconstriction that is partially reversible

72
Q

What type of hypersensitivity reaction is atopic asthma?

A

type I

73
Q

What are the triggers for atopic asthma?

A

allergens

cold, exercise, respiratory infections

74
Q

What are the irriversible changes of atopic asthma?

A

bronchiolar wall smooth muscle hypertrophy
mucas gland hyperplasia
respiratory bronchiolitis
centrilobular emphysema

75
Q

What is interstitial lung disease?

A

disease of pulmonary connective tissue - increased tissue in alveolar capillary wall via inflammation and fibrosis
restrictive

76
Q

What is acute interstitial disease?

A

diffuse alveolar damage
death of type I pneumocytes - form hyaline membranes lining alveoli
type II pneumocyte hyperplasia
leads to adult respiratory distress syndrome

77
Q

What are the symptoms of chronic interstitial lung disease?

A 
dyspnoea
clubbing
fine crackles
dry cough
interstitial fibrosis&chronic inflammation
'honeycomb lung'
78
Q

What are example of chronic interstitial lung disease?

A

idiopathic pulmonary fibrosis
pneumoconiosis
sarcoidosis
collegen vascular disease-associated lung diseases

79
Q

What is idiopathic pulmonary fibrosis?

A

chronic inflammation and fibrous tissue
normal alveolar wall
‘cobblestone’

80
Q

What is sarcoidosis?

A 
perilymphatic pulmonary granulomas 
fibrosis
effects hilar nodes, other organs e.g. heart
hypercalcaemia
typically young females
81
Q

What is pneumoconioses?

A

non neoplastic lung disease due to inhalation of dusts, fumes and vapours

82
Q

What is hypersensitivity pneumonitis?

A

Type III hypersensitivity reaction to organic dusts
farmers lung
inflammation with non caseating granulomas
leads to fibrosis

83
Q

What is Cystic fibrosis?

A

inherited disorder
epithelial cells fluid secretion effected as well as linings of the respiratory, GI and reproductive tract
Autosomal recessive

84
Q

CF is a mutation in which gene?

A

CFTR - encodes for transmembrane proteins

85
Q

What are the clinical presentations of CF?

A

infancy
viscous mucous secretions
recurrent lung infections/intestinal obstruction
pancreatic insufficiency

CP (50 decks)

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