Respiratory Pathology Flashcards
1
Q
What type of epithelium does the conducting airways of the lung have?
A
Pseudostratified ciliated columnar epithelium.
2
Q
What type of epithelium is present in the alveoli?
A
Type 1 and 2 Pneumocytes
3
Q
What is the function of Type 1 Pneumocytes?
A
Mucus production.
4
Q
What is the function of Type 2 Pneumocytes?
A
Surfactant production
5
Q
Under what partial pressure of oxygen are you in respiratory failure?
A
8.0kPa
6
Q
What is Type 1 respiratory failure?
A
PaCO2
7
Q
What is Type 2 respiratory failure?
A
PaCO2 >6.3kPa
Hypercapnic resp drive
8
Q
What is a stridor?
A
Proximal airway obstruction
9
Q
What is a wheeze?
A
Distal airway obstruction
10
Q
Why are crackles heard on resp auscultation?
A
Resisted small airways opening
11
Q
Why are wheezes heard on resp auscultation?
A
Narrowed small airways
12
Q
What is a pleural rub?
A
Relative movement of inflamed viscera and parietal pleura.
13
Q
Why would a dull percussion be felt ?
A
Lung consolidation/pleural effusion.
14
Q
Why would a hyper resonant percussion be felt?
A
Pneumothorax/emphysema.
15
Q
What malignant lung tumours are common?
A
Carcinoma (90%)
16
Q
What is the biggest risk factor for lung carcinoma?
A
Cigarettes
17
Q
What type of material is asbestos?
A
Fibrous metal silicate
18
Q
Which asbestos is the most dangerous?
A
Blue asbestos
19
Q
Which asbestos is the least dangerous?
A
White asbestos
20
Q
What disease can high level exposure to Asbestos cause?
A
Pulmonary interstitial fibrosis asbestosis
21
Q
How can asbestos bodies be viewed?
A
Light microscopy
22
Q
What are asbestos fibres coated with?
A
Mucopolysaccharide and ferric iron salts.
23
Q
What type of carcinoma is in 85% of cases?
A
Non-small cell carcinoma
24
Q
What type of carcinoma is in 15% of cases?
A
Small cell carcinoma
25
What is the most common type of non-small cell carcinoma?
Squamous carcinoma
26
What type of carcinomas are small cell carcinomas?
All neuroendocrine
27
In what type of carcinoma is multiple differentiation common?
Small cell carcinoma
28
What can be detected in lung non-mucinous adenocarcinomas and small cell carcinomas?
> Thyroid transcription factor
| > Cytokeratin
29
Where is the most common lung carcinoma site?
Central, upper lobe, main bronchus.
30
Where is adenocarcinoma mostly?
More peripheral
31
What is present in squamous carcinoma?
> Keratin
| > Desmosomes
32
Where is squamous carcinoma more present?
Central > peripheral
33
Why can squamous carcinoma cause hypercalcaemia?
Parathyroid hormone related peptide
34
What change occurs in a squamous metaplasia?
Pseudostratified columnar epithelium --> Stratified squamous.
35
How is a neoplastic cell made?
Irreversible genetic changes to a metaplastic cell
36
What occurs in dysplasia?
> Neoplastic cell made
> Neoplastic cell proliferate more than metaplastic cell
> Neoplastic clone replaces metaplastic cell.
37
What is an adenocarcinoma?
Malignant tumour of glandular structures of epithelial tissue.
38
Where are adenocarcinomas most likely found?
Central as much as peripheral.
39
In non-mucinous lung adenocarcinomas what may be expressed?
Thyroid transcription factor.
40
What is a bronchioalveolar carcinoma ?
When well-differentiated non/mucinous neoplastic cells spread to alveolar walls.
41
What does bronchioalveolar carcinoma mimic?
Pneumonia
42
Where do typical carcinoid tumours occlude?
Bronchi
43
What are typical carcinoid tumours associated with?
Multiple endocrine neoplasia syndrome type 1.
44
Where do approx. 10% of typical carcinoid tumours metastasize to?
Hilar nodes
45
How are atypical carcinoid tumours different from typical?
> Necrotic
> Less organoid, more atypical
> More aggressive
46
What are the features of large cell neuroendocrine carcinomas?
> Severe atypia
| > Necrosis
47
What are large cell neuroendocrine tumours assc with?
Smoking
48
What are the features of small cell carcinoma?
> Rapidly progresses + malignant.
> Have neurosecretory granules w/ peptide hormones.
> ~99% in smokers
49
What do 50% of Large cell carcinoma express?
Thyroid transcription factor
50
What do large cell carcinomas express that can make them neuroendocrine?
> Express CD56
| > Neurosecretory granule proteins (synaptophysin, chromogranin)
51
What are some of the paraneoplastic effects of lung carcinoma?
```
> Cachexia
> Skin - tylosis, acanthosis, nigricans
> Clubbing
> Thrombophlebitis migrans
> Lambert- Eaten syndrome
> Hypercalcaemia
```
52
What are Getifinib and Erlotinib examples of?
Epidermal growth factor receptor tyrosine kinase inhibitors
53
How do EGFR-TR inhibitors work?
> Inhibit EGFR-TK mediated protein phosphorylation
| > Activate mitotic cycle
54
EGFR-TK sensitising mutations are present in what cancer?
Non-small cell lung cancers
55
ALK gene rearrangements are found in what cancer?
Lung adenocarcinomas
56
What is Crizotinib?
An ATP analog that inhibits tyrosine kinases.
57
What is Crizotinib effective in?
90% of tumours w/ ALK-EML fusion gene.
58
What are the two causes (broad) of Pleural diseases?
Inflammatory and non-inflammatory.
59
What are the inflammatory causes of pleural diseases?
> Serous/fibrinous exudate
| > Inflammation/ infection in adjacent lung.
60
What are the non-inflammatory causes of pleural disease?
Congestive heart failure forms a transudate.
61
How are pleural diseases diagnosed?
> Lactase dehydrogenase
> pH
> Glucose of fluid
62
What conditions can cause Pleuritis?
```
> Collagen vascular diseases
> TB
> Lung infarct, secondary to PE
> Lung Tumour
> Asbestos
```
63
Is malignant or benign pleurisy more common?
Malignant
64
What is pleurisy usually secondary to?
Adenocarcinoma
65
What exposure is malignant mesothelioma associated with?
Asbestos (low level)
66
What is the latent period for malignant mesothelioma?
15-60 year latent period
67
What is the pathway of malignant mesothelioma?
> Initial nodule and effusion
> Obliterates pleural cavity
> Invades chest wall and lung
68
What is malignant mesothelioma hard to differentiate from?
Reactive mesothelial cells in inflamed pleura.
69
How do you differentiate malignant mesothelioma from adenocarcinoma?
Cellular antigen expression
70
What may early malignant mesothelioma present as?
Small plaques on the parietal pleura
71
Where are fibrous pleural plaques found?
Lower thoracic wall and diaphragmatic parietal pleura.
72
What are fibrous pleural plaques assc with?
Low level asbestos exposure
73
Define: Pneumonia
An inflammatory exudate in the alveoli & distal small airways.
74
What different classes does Pneumonia have?
> Clinical
> Aetiological
> Anatomical
> Reaction
75
What is bronchopneumonia secondary to?
Compromised defences
76
What is the cause of bronchopneumonia?
Low virulence bacteria / occ fungi.
77
What is the consolidation of bronchopneumonia like?
Patchy and common
78
What is the cause of 90% of lobar pneumonia?
Streptococcus Pneumoniae
79
Is consolidation common in Lobar Pneumonia?
No
80
Which pneumoniae leaves scarring?
Lobar pneumonia
81
What causes lobar pneumonia in the elderly, diabetic and alcoholic?
Klebsiella pneumoniae
82
What virus can cause pneumonia in the non-immunosuppressed?
```
> Varicella
> Respiratory Syncytial Virus
> Adenovirus
> Measles
> Flu
```
83
What are the characteristics of pneumonia caused by Mycoplasma penumoniae?
Mild, chronic fibrosis.
84
What is the severity of Legionella pneumophilia?
Mild to fatal
85
What type of pneumonia is intra-alveolar fibrinous cell-poor exudate assc with?
Legionella pneumoniae
86
What are aspiration, lipid, COP and BOOP examples of?
Non-infective pneumonias
87
What does aspiration pneumonia result in?
Abscesses
88
What are the two sources of lipid pneumonia?
> Exogenous
| > Endogenous
89
What is an example of endogenous lipid pneumonia?
Retention pneumonitis
90
What does COP stand for?
Cryptogenic organising pneumonia
91
What does BOOP stand for?
Bronchiolitis Obliterans Organising Pneumonia
92
What is the cause of Pulmonary TB?
Mycobacterium Tuberculosis
93
What is the most common site of Pulmonary TB?
The lungs
94
What is the fatality rate of Pulm. TB?
50% if left untreated
95
How is pulm. TB prevented?
BCG vaccine
96
What is primary presentation of pulmonary TB?
Ghon complex (lesion) in peripheral lung and hilar nodes.
97
Where does pulm. TB usually reactivate?
Apex
98
What can pulm. TB progress into?
> Empeyma
> Pneumonia
> Miliary TB
99
What is the scarring of pulm. TB?
FIBROUS CALCIFIED SCAR
> Granuloma with multi-nucleated Langhan's giant cells
> Caseous necrosis
100
The Heaf and Mantoux test what?
Type IV hypersensitivity to tuberculin.
101
What are Wegner's granulomatosis and Churg-Strauss syndrome examples of?
Necrotising granulomatous vasculitis
102
What is the mechanism of Goodpasture's syndrome?
Anti-glomerular basement membrane antibody attack basement membrane of lung/kidney.
103
What is the result of Goodpasture's syndrome?
> Intra-alveolar haemorrhage
| > Glomerulonephritis
104
What do Acute resp disress syndrome, diffuse alveolar damage and SLE do?
Microvascular pulmonary damage.
105
How can fat emboli occur?
Fat and marrow from bone fractures
106
What are examples of localised obstructive pulmonary diseases?
> Distal alveolar collapse (total)
> Over expansion (valvular obstruction)
> Distal retention pneumonitis
> Distal bronchiecstasis
107
What is bronchiectasis?
Elastic/tissue damage causing permanent dilation of bronchioles.
108
What causes bronchiectasis?
Chronic necrotising infections.
109
What are the signs/symptoms of bronchiectasis?
Cough, fever, lots of foul smelling sputum.
110
What are the complications of bronchiectasis?
> Pneumonia
> Septicaemia
> Metastatic infection
111
What are examples of diffuse obstructive pulmonary diseases?
> COPD
| > Asthma
112
Define: Chronic Bronchitis
Cough/sputum in 3 months of each of two consecutive years.
113
What is the cause of chronic bronchitis? (Hint: long term)
Long term smoking/air pollution.
114
What is the pathology of chronic bronchitis?
> Mucus gland hyper secretion/hyperplasia
> Low virulence bacteria = secondary infection
> Chronic inflammation of small airways
> Wall weakness & destruction --> centrilobar emphysema.
115
Define: Emphysema
Abnormal permanent dilation of areas distal to terminal bronchioles (alveoli).
116
What are the different types of emphysema?
> Centrilobular
> Panlobular
> Paraseptal
117
What causes centrilobular emphysema?
Coal dust and smoking
118
What causes panlobular emphysema?
>80% = a1 anti-trypsin deficient
119
What causes paraseptal emphysema?
Upper lobe subplural bullae. If rupture --> pneumothorax
120
What are the symptoms of Emphysema?
Dyspnoea - progressive and worsening.
121
What is Asthma?
Chronic inflammatory disorder of the airways
122
What are the symptoms of Asthma?
Wheeze, cough, variable bronchoconstriction
123
What are the clinical features of asthma?
```
> Mucosal inflammation
> Mucosal oedema
> Mucosal plugs
> Hypertrophic mucous glands
> Hyperinflated lungs
```
124
What are the classifications of Asthma?
> Atopic
> Non-atopic
> Aspirin-induced
> Allergic bronchopulmonary aspergillosis (ABPA).
125
What are the causes of Type 1 hypersensitivity reaction?
> Allergen, cold, exercise, resp infections
| > Degranulation of IgE mast cells --> histamine mediated mucus production and bronchoconstriction --> obstruct airway.
126
What are the irreversible changes of asthma?
> Bronchiole wall smooth muscle hypertrophy
> Mucus gland hyperplasia
> Respiratory bronchiolitis centrilobular emphysema
127
What are interstitial lung diseases?
Diseases affecting lung interstitium (tissue and space around lung air sacs)
128
Are interstitial lung diseases restrictive or obstructive?
Restrictive
129
Interstitial lung diseases have abnormal what tissue?
Pulmonary connective tissue
130
What are the two phases of diffuse alveolar damage (DAD)?
1. Exudative phase - Alveoli flooded with transudate
| 2. Hyaline membrane production, stop O2 being absorbed by damaged alveoli.
131
What is the appearance of a chronically fibrosed lung?
Honeycomb
132
What are the causes of Chronic interstitial lung disease?
> Interstitial fibrosis
> Chronic inflammation
> Pneumoconiosis (dust diseases)
> Sarcoidosis
133
What are the symptoms of chronic interstitial lung disease?
> Dyspnoea (for years)
> Clubbing
> Fine crackles
> Dry cough
134
What are affected first in idiopathic pulmonary fibrosis?
Lower lobes, and most severely.
135
What histology characterizes idiopathic pulmonary fibrosis ?
Usual Interstitial Pneumonia
136
What are the features of UIP?
> Normal alveolar walls
> Interstitial chronic inflammation
> Mature fibrous tissue
137
Why is the pleura cobblestoned in idiopathic pulmonary fibrosis?
Contraction of fibrous tissue accentuates lobular architecture.
138
What is Sarcoidosis? (HARD)
Non-caseating perilymphatic pulmonary granulomas, then fibrosis.
139
What is involved usually in Sarcoidosis?
> Hilar nodes
| > Skin, heart and brain ~affected.
140
What do clinical tests for Sarcoidosis show?
> Hypercalcaemia
| > Elevated serum angiotensin converting enzyme.
141
What is Pneumoconiosis?
A non-neoplastic lung disease due to dust inhalation.
142
What diameter do things need to be to reach the alveoli?
143
What does coal worker's pneumoconiosis begin as?
Anthracosis = milder, asymptomatic
144
What forms does coal worker's pneumoconiosis have?
Simple and nodular --> progress to massive fibrosis.
145
What does >20 years of mining underground increase the risk of?
COPD
146
What does Silicosis kill?
Kills phagocytosing macrophages.
147
What does Silicosis reactivate?
TB
148
What is the result of high level asbestos exposure?
Interstitial fibrosis
149
What type of hypersensitivity reaction is Hypersensitivity pneumonitis?
Type 3
150
What is CF?
A multiorgan epithelial disorder affecting exocrine gland secretion.
151
On what chromosome is the CTFR gene?
Chromosome 7
152
What is the presentation of CF in the lungs?
> Mucus secreting glands hyperplasia.
> Bronchioles distended with mucus
> Chronic bronchitis and bronchiectasis.
153
What is the presentation of CF in the pancreas?
> Pancreatic insufficiency
> Mucus plugged glands
> Glands atrophy/fibrosis
154
What is meconium ileus?
Mucus plug in small bowel.
155
What are the other organ defects of CF (liver, salivary glands)
> Liver - plugging of bile cannaliculi
| > Salivary glands - atrophy and fibrosis.
