Respiratory Pathology Flashcards
1
Q
What 3 M’s define respiratory pathology
A
morbidity, mortality, money.
2
Q
What 2 parts make up the lungs and respiratory system
A
conducting portion- trachea to terminal bronchioles.
Respiratory portion- respiratory bronchioles, alveolar ducts, sacs and alveoli
3
Q
What type os epithelium lines the conducting part of the reparatory system
A
Pseudo stratified ciliated columnar (mucus secreting)
4
Q
What types of cells line the alveoli
A
Flat type 1 pneumocytes (gas exchange) and type 2 pneumocytes (surfactant production)
5
Q
Problems in what 3 functions can lead to respiratory failure
A
ventilation
perfusion
gasexchange
6
Q
define type 1 respiratory failure
A
low oxygen but co2 is normal (
7
Q
define typ 2 respiratory failure
A
low oxygen and high co2 (>6.3kPa)
hypercapnic drive
8
Q
signs and symptoms which indicated a respiratory problems
A
sputum cough stridor-proximal airway obstruction. wheeze- distal airway obstruction. pleuritic pain dysponea cyanosis clubbing weight loss.
9
Q
signs on respiratory examination
A
Auscultation-crackles, wheeze, bronchial breathing, pleural rub
Percussion
dull (consolidation or effusion), hyperresonanat (pneumothorax or emphysema)
10
Q
Are most primary lung tumours benign or malignant
A
90% are malignant.
11
Q
what are the risk factors of primary lung tumours.
A
smoking, secondary cigarette smoke, asbestos, lung fibrosis, nickel, hematite, arsenic and mustard gas
12
Q
define asbestosis
A
pulmonary interstitial fibrosis cause by asbestos.
13
Q
Is asbestos related disease occupational
A
yes if proven to have a history of over 5 years in a high absestos exposure job.
14
Q
what are benign primary lung tumours called
A
adenochondroma
15
Q
what is the most common type of malignant primary tumour
A
non-small cell carcinoma.
16
Q
what type of tumours are carcinoid tumours
A
malignant primary tumours
low grade, neuroendocrine epithelial tumours.
17
Q
what type of lung tumour is the commonest
A
secondary lung tumour (usually from a primary source)
18
Q
How do you distinguish between a primary and a secondary lung tumour.
A
histology, morphology, antigen expression
19
Q
what antigens are expressed in lung non-mucinous adenocarcinoma and small cell.
A
cytokeratin and thyroid transcription factor postivie.
20
Q
most common sites of lung carcinoma
A
central, main or upper lobe bronchus (bronchogenic).
21
Q
are adenocarcinomas found centrally or peripherally.
A
peripherally.
22
Q
what type of epithelium does respiratory epithelium become after metaplastic change.
A
pseudostratified columnar epithelium – stratified squamous type which may keratinize.
23
Q
what irritant causes metaplastic change to occur in the epithelium
A
smoke
24
Q
define dysplasia.
A
One metaplastic cell undergoes irreversible genetic changes (a series of sequential somatic mutations of oncogenes & anti-oncogenes) producing the first neoplastic cell
25
define neoplasm
An abnormal tissue that grows by cellular proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease
26
define metaplastic
change from 1 cell type to another.
27
Why does squamous cell carcinoma cause hypercalcaemia
parathyroid hormone related peptide.
28
how does sqaumous cell carcinoma metasize
nfiltrate lymphatic and blood vessel
29
what common respiratory condition does bronchioalveolar carcinoma mimic
pneumonia
30
Is bronchioalveolar carcinoma invasive.
No.
31
How are neuroendocrine cells detected in lung tumours
immunochemistry
neural cell adhesion molecule
neurosecretory granule protein.
32
What cells are associated with typical carcinoid tumours
bland cells
33
what syndrome is typical carcninoid tumour associated with
multiple endocrine neoplasia syndrome type 1
34
which is more aggressive atypical or typical carcinoid tumours
atypical
35
What is a common peptide hormone secreted by small cell carcinoma.
Neurosecretory granules with peptide hormones such as ACTH
36
can carcinomas have multiple differentiation
NSCLC, small cell carcinoma.
37
What common factor do large cell carcinomas express
thyroid transcription factor
38
common paraneoplastic effects of lung carcinomas
* Cachexia
* Skin
* Hypertrophic pulmonary osteoarthropathy.
* Coagulopathies.
* Encephalomyelitis, neuropathies & myopathies
* Endocrine effects
39
what is acanthosis nigricans
hyperpigmentation of the skin- thick dark patches
| thickening of palms and soles
40
New drug which has been introduced to treat lung cancer.
epidermal growth factor receptor tyrosine kinase inhibitors
41
How does this drug work
– Inhibition of EGFR TK mediated protein phosphorylation and activation of the mitotic cycle
42
What does ALK gene stand for
anaplastic lymphoma kinase-
Important gene in cell maturation and differentiation
rearrangements in this gene can lead to tumours.
43
what drug inhibits ALK
crizotinib
44
Types of pleural diseases
```
Pneumothorax
Pleural effucison
Haemothorax
Chylothorax-lymph
empyema-pus
```
45
what is a common fusion gene which results in respiratory cancer
ALK-EML
46
what are the inflammatory causes of pleural effusion
serous/fibrinous exudate
47
what causes non inflammatory pleural effusion
congestive cardiac failure
| transduate
48
what conditions can affect the pleura
– inflammation (pleurisy, pleuritis)
• collagen vascular diseases
• pneumonia, tuberculosis
• lung infarct, usually secondary to pulmonary embolus
• lung tumour
– asbestos
• effusion, fibrous plaques, diffuse fibrosis
49
Are pleural tumours likely to be benign or malignant
malignant
| benign e.g. fibroma is rare.
50
common pleural tumour
malignant mesothelioma.
51
what chemical is malignant mesothelioma associated with
asbestos
52
how long is the latency period for malignant mesothelioma
15-60 years
53
How does malignant mesothelioma progress
1-nodule and effusion
2-invades chest wall and lung.
3-nodal and distal metastases less common than with carcinomas.
54
which pleura does early malignant mesothelioma effect
parietal pleura
55
where are fibrous pleural plaques typically found and what chemical are they associated with
lower thoracic wall & diaphragmatic parietal pleura and asbestos
56
What condition is PE secondary to
DVT
57
Risk factors of PE
virchow's triad (stasis, hypercoagubale blood, endothelial wall injury), recent surgery, low flow, reduced mobility
58
what syndrome is a result of cillary dysmotility
Kartageners syndrome
59
what causes acute bronchitis
– Viral (RSV), H. influenzae, Strep. pneumoniae
60
2 clinical signs associated with cute bronchiolits
– Croup- viral infection which causes swelling of the windpipe
– Exacerbations of COAD-chronic obstructive airway disease.
61
define bronchiolitis obliterans
bronchioles compressed and narrowed.
62
what 2 main factors lead to respiratory infections
mucocillary escalator problem
| immunity problem e.g. hypogammaglobulinaemia
63
what is pneumonia
• Inflammatory exudate (seeped out of blood or organ) in alveoli & distal small airways - consolidation
64
what are the 4 main classifications for pneumonia
clinical
Aetiology
Anatomical
reaction
65
what are 2 main types of respiratory infections.
primary
| secondary- compromised defences
66
is bronchopneumonia caused by a primary or secondary infection
secondary infection
67
what causes bronchopnemonia
low virulence bacteria or occasionally fungi
68
is lobarpneumoniae primary or secondary
primary
69
which type of pneumonia affect full lobes and which type has a pathcy distribution
full lobes-lobarpneumoniae
| pathcy-bronchopneumoniae
70
most common atypical pneumonia's in the non-immunosuppressed.
* Viral - flu, varicella, RSV, rhino, adeno, measles
* Mycoplasma pneumoniae - Mild, chronic, fibrosis
* Chlamydia (psittacosis), Coxiella burnetti (Q-fever)
* Legionella pneumophilla - Systemic, 10- 20% fatal
71
clinical signs and symptoms of atypical pneumonia
– Intersitial lymphocytes, plasma cells, macrophges
– Intra-alveolar fibrinous cell-poor exudate
– Diffuse alveolar damage (DAD)
72
most common atypical pneumonia in the immunsuppressed patient
• Opportunistic infections by low virulence or non-virulent organisms
– Fungi - candida, aspergillus, Pnumocystis carinii
– Viruses - CMV, HSV, measles
73
3 types of non-infective pneumonias
aspiration pneumonia
lipid pneumonia
Cryptogenic organising pneumonia and bronchiolotis obliterans organising pneumonia
74
what causes pulmonary TB
Mycobacterium tuberculosis
75
what vaccine is used to prevent TB
BCG
76
primary Tb reaction symotomatic or asymtomatic
aymptomatic
77
where does reactivation of TB typically occur
apically.
78
effects of TB on the lungs
Primary infection: Asymptomatic, Ghon complex in peripheral lung & hilar nodes, usually resolves
Scarring - fibrous calcified scar.
Granulomas with multinucleated Langhans’ giant cells & caseous necrosis
79
3 conditions which cause pulmonary vasculitis.
* Necrotising granulomatous vasculitis - Wegener’s granulomatosis (kidneys & nose, elevated serum ANCA) Churg-Strauss syndrome (eosinophilia & asthma)
* Goodpasture’s syndrome - Anti-glomerular basement membrane antibody, Intra-alveolar haemorrhage & glomerulonephritis
* Microvascular damage - ARDS & DAD, SLE
80
common causes for emboli to forms
DVT, fat, air amniotic fluid, tumour, foreign bodies.
81
define obstructive pulmonary disease.
localised of diffuse obstruction of air flow.
82
causes of obstructive pulmonary disease
tumour or foreign body
distal alveolar collapse
distal retention pnemonitis
distal bronchiectasis
83
define bronchiectaisis
• Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
84
cause of brochiectasis
• Results from chronic necrotizing infection
85
signs and symptoms of bronchiectais
Cough, fever, copious amounts of foul smelling sputum
86
Chronic Obstructive Pulmonary Disease is a combination of what 2 conditions
chronic bronchitis & emphysema
87
pathology of chronic bronchitis
Mucus gland hyperplasia and hypersecretion, secondary infection by low virulence bacteria, chronic inflammation
88
define emphysema
Abnormal permanent dilation of airspaces distal to the terminal bronchiole, with destruction of airspace wall, without obvious fibrosis
89
how do we classify emphysema
– Centrilobular (centiacinar) Coal dust, smoking
– Panlobular (panacinar) - >80% a1 antitrypsin deficient (rare, autosomal dominant) , severest in lower lobe bases
– Paraseptal (distal acinar) - Upper lobe subpleural bullae adjacent to fibrosis. Pneumothorax if rupture
90
pink puffer and blue bloater describe which 2 conditions
emphysema-pink puffer
| brochioloits- blue bloater
91
is asthma reversible
yes
92
which hyper of hypersensitivity reaction is asthma
type 1 -caused by an allergen
93
what chemical initiates bronchoconstriciton and mucus production is asthma
histamine initiated bronchoconstriction and mucus production obstructing the airways.
94
what are the main changes to the airways in asthma.
– bronchiolar wall smooth muscle hypertrophy
– mucus gland hyperplasia
– respiratory bronchiolitis leading to centrilobular emphysema
95
Is intersitial lung disease more commonly restrictive or obstructive
restrictive.
96
signs of chronic interstitial disease
* Dyspnoea increasing for months to years
| * Clubbing, fine crackles, dry cough
97
what does the lung look like in chronic interstitial disease
honeycomb
98
example of chronic interstitial disease
– idiopathic pulmonary fibrosis,
– many pneumoconioses (dust diseases)
– sarcoidosis,
– collagen vascular diseases-associated lung diseases
99
Idiopathic pulmonary fibrosis
| is also known as
cryptogenic fibrosing alveolitis
100
what lobes of the lungs are effected more in Idiopathic pulmonary fibrosis
lower
101
what do the lungs look like in idiopathic pulmonary fibrosis
– Interstitial chronic inflammation & variably mature fibrous tissue
– Adjacent normal alveolar walls
– Similar pattern of fibrosis in collagen vascular disease associated interstitial lung disease and in asbestosis
• Bosselated (“cobblestone”) pleural surface due to contraction of interstitial fibrous tissue accentuates lobular architecture
102
what structure is typically involved in sarcoidosis
• Hilar nodes
103
what other organs are typically affected in Sarcoidosis
skin, heart, and brain.
104
are the granulomas caseating or non-caseating in Sarcoidosis
non-caseating
105
what chemical in the body is elevated in sarcodoisis
calcium (hypercalcaemia)
106
Pneumonconises are also known as
the dust diseases
107
what causes pneumoconioses
inhalation of mineral dusts
108
common 3 Pneumonconises
coal-workers
silicosis
asbestosis
109
what condition that silicosis reactivate
tuberculosis
110
what is the pathology of silicosis
Kills phagocytosing macrophages
111
which pneumonconises increase the occurrence of lung cancer
Asbestosis, Silicosis
112
what is hypersensitivity pnemonitis also known as
extrinsic allergic alveolitis
113
what type of hypersensitivity reaction is pnemonitis
Type 3
114
what condition are
– farmers’ lung - actinomycetes in hay
– pigeon fanciers’ lung - pigeon antigens
associated with
hypersensitivity pneumonitis
115
define CF
• An inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, gastrointestinal and reproductive organs
116
What cause CF
• Mutation in CFTR gene
117
Is CF recessive or dominant condition
recessive
118
what are the main organs which CF affects
lungs, pancreas and bowel
119
treatments for CF
* Mucolytics
* Heart/lung transplants
* Not genre therapy currently.
* Physiotherapy
120
diagnosis test for CF
* Part of Newborn screening in UK
* Sweat test
* Genetic testing
121
How does CF affect the lungs
* Bronchioles distended with mucus
* Hyperplasia mucus secreting glands
* Multiple repeated infections
* Severe chronic bronchitis and bronchiectasis
122
How does CF affect the pancrease
* Exocrine gland ducts plugged by mucus
* Atrophy and fibrosis of gland
* Impaired fat absorption, enzyme secretion, vitamin deficiencies ( pancreatic insufficiency)
123
common symptoms of CF
reccurent chest infections
124
are hypersensitive pneumonitis granuolomas caveating or non caveating
poorly formed non-caseating granulomas extends alveolar walls
125
what type of inflammation occurs in hypersensitivity pneumonitis
• Peribronchiolar inflammation
126
coal workers's pneumoconiosis is also known as
• Anthracosis
127
Coal workers’ pneumoconiosis is associated with causing which respiratory condition
COPD
| via ling fibrosis
128
2 main types of Coal workers’ pneumoconiosis
* Simple (macular) CWP
| * Nodular CWP
129
4 main types of inhaled dust are
* inert
* fibrogenic
* allergenic
* oncogenic
