Respiratory Pathology Flashcards
Asthma - definition
Age affected
Chronic inflammatory disorder of the airways
Children in Young Adults
15% adult development due to occupation
Asthma
Signs - visible outside (4)
Pathology - whats happening inside
paroxysmal bronchospasm, wheeze, cough and variable bronchoconstriction
inflamed mucosa, oedema, hyperinflated lungs, hypertrophic mucosal glands = mucosal plugs
Types of Asthma (4)
Atopic - type one hypersensitivity reaction to allergen, cold weather, exercise of resp infections
Non atopic
aspirin induced
allergic bronchopulmonary aspergillosis (ABPA
Change to airways in atopic asthma
Reversible
Irreversible
Reversible = degranulation of IgE bearing mast cells = histamine = bronchoconstriction and mucous production
eosinophil chemotaxi
Irreversible = smooth muscle hypertrophy, mucus glands hyperplasia, respiratory bronchiolitis
COPD - chronic obstructive pulmonary disease.
Combination of what two conditions
chronic bronchitis and emphysema
Chronic Bronchitis - what?
Signs/ measurement
Age
chronic irritation of the bronchi due to smoking and air population
COUGH and sputum for 3 months of 2 concequative years. Recurrent resp infections
40-45
Emphysema - what?
Signs
Age
site of fibrosis in the acinar
DYSPONEA that progressive worsens. Cough develops late
50-75
Blue bloaters (cyanosis + increased residual volume and air trapping)
Chronic Bronchitis predominate COPD
Pink puffer (red in the face and Dysponea)
Emphysema predominate COPD
Chronic Bronchitis (blue) Vs Emphysema (pink)
BOTH = decreased expiratory flow rare BUT increase lung capacity and residual volume, decreased PO2
Bronchitis = increase Pco2, normal diffusing capacity, right side heart failure and sleep apnea
Emphysema = decreased diffuse capacity and elastic recoil, compensatory hyperventilation
Classification of Bronchitis (how much of lobe + what caused it)
Centrilobular = coal dust and smoke Panlobular = antitripsin deficiency Paraseptal = upper lobe sub pleural bullae (air sacs in pleura) adjacent to fibrosis - burst = pneumonathorax
Interstitial lung disease - definition
Disease on connective tissue (alveoli walls)
Diffuse and chronic
Restrictive
Interstitial lung disease progression - consequences
Inflammation –> fibrosis (honey comb lung) of alveoli walls
Decreased lung compliance and diffusion distance
Acute Interstitial lung disease - pathology
Exudate
Death of type I pneumocytes from hyaline memebrane of alveloi
Type II pneumocytes hyperplasia
Looks like pneumonia
Presentation and causes (7) of Acute interstitial lung disease
Resp distress syndrome OR shock lung
Shock, Trauma, infections, toxic gas, narcotics, radiation and aspiration
Types of Chronic Interstitial lung disease (4)
Idiopathic
Sarcoidosis
Pneumoconioses - dust diseases
Silicosis
Idiopthic lung disease - lung appearance
Chronic inflammation and variable maturity fibrosis adjacent to normal tissue
Constriction of interstitial lung tissue = ‘cobble stone’
Idiopathic lung disease - prevalence, survival and location
older, rare 3-5 year survival, sub pleural and lower lobes
Sarcoidosis - what ?
Appearance of lung
Blood markers
those affected?
Systemic disease - brain, skin and heart
Non caseating perilymphatic pulmonary granulomas + Hilar node involvement of Xray
Hypercalceamia and elevated serum ACE
young women
Pneumoconioses or dust disease or non neoplastic lung disease - cause and types (4)
Inhalation of mineral dust <3 um in diameter
inert, fibrogenic, allergenic or oncogenic
Pneumoconioes - coal miners
Most common
>20 years underground = wide spread fibrosis and right side heart failure to deal with back pressure
Silicosis - what is it
silica in lungs –> attach to macrophages –> die –> accumulate in fibrosis silica nodules
Hypersensitivity Pneumonitis Or extrinsic allergic alveolitis - what type of allergic reaction to what time of dust
Type III hypersentivity reaction to organic dust
Types of Hypersensitivity Pneumonitis + causes
Farmers lung - actinomycetes in hay
Pigeon fanciers lung - pigeon antigens
Pathology of Pneumonitits
Peribronchiolar inflammation - Non caseating granulomas spread into alveoli walls
Repeated episodes of fibrosis and breathlessness
Bronchiectasis - What? causes?
Pernament dilation of bronchioles due to destruction of muscle and elastic tissue
Due to chronic necrosis infection
Bronchiectasis - symptoms (3) and complications (3)
Cough, fever and large about of foul smelling sputum
Pneumonia, Septicemia, mets of infection
Resp impacts of Cystic Fibrosis (4)
bronchioles distended with mucous
hyperplasia of mucous secreting glands
repeated chest infections
chronic bronchitis of bronchiectasis
Drug to relieve resp symptoms of CF
Orkambi - only for those with the F508 deletion mutation (VERY EXPENSIVE)
Lung tumours have abnormal characteristics that allow them to …
Invade and metastasize
Most common primary lung tumour - what % of patients?
Carcinoma (from epithelial cells) in 90% of cases
Types of Primary lung carcinomas (appearance on light microscope)
Adenocarcinoma - most common 40% = musin (light colored) and glands
Squamous cell = squamous ‘pearl’
Small cell carcinoma = dark nuclei
Large cell undifferentiated carcinoma = most rare 10%
Other primary lung tumours (3)
Carcinoid = low grade + good survival
Malignant mesenchymal = rare, most common as synovial sarcoma
Primary lung lymphomas - HIV and AIDs patients
Secondary tumours - MORE COMMON
Spread from?
Main types?
Present as?
kidney, liver, breast, brain and GI
carcinoma - sarcomas - melanomas and lymphomas
Multiple nodules or solid tumours
Lung cancers - risk factors (age/ gender) (5 + examples)
M>F but changing 40-70 years Tobacco smoke Occupational hazards - asbestos and heavy metals Radiation Lung fibrosis Genetic mutation - EGFR, KRAS and ALK
Lung cancer pathogenesis
Cigarette smoke irritate the squamous cells –> metaplasia –> gene mutation –> dysplasia –> carcinoma insitu
Localised effects of lung tumours
Obstructive pneumonia - distal collapse and consolidation = breathless
Proximal airways = ulceration and bleeds
Effects of lung tumours infiltrating other tissues (5)
Pleura = effusion and breathlessness Chest wall = pain Laryngeal nerve = hoarse voice Sympathetic chain = horners syndrome Esophagus = dysphagia
Non specific effects o lung tumours
Clubbing Endocrine - ACTH, ADH and PTH increase = metabolism effects wight loss lathargy cachexia
Complication of lung tumours = mets
Mets:
Brain = epilepsy
Bone = increased Ca2+ = pain and fracture
Lymphangitis carcinmatosa - lymphatics diffusely involved in the tumour
average 5 year survival for lung cancer
10-15%
Lung cancer treatment:
Surgery - 10-15% only in early diagnosis
Palliative care - for those with advanced Mets + secondary disease
(EXPENSIVE AND NOVIS)
Targeted genome therapy - ECFR and ALK
Immuno check point inhibitors eg. PD-L1 makes immune system fight the tumour
Mesothelial layer
A layer found in both parietal and visceral pleura that lines the pleural space
Hyaluronic acid
found in the pleural fluid
Pleural fibrosis + affect on lungs
Scarring secondary to inflammation
Secondary to asbestos = fibrotic plaques and diffuse fibrosis
Compress lungs = breathless. Partial and whole adhesion/ obliteration of pleural cavity
Fibrous plaques - causes + appearance
Low level asbestos exposure - visible of chest Xray
diffuse fibrosis - cause + appearance
high asbestos (occupational) - usually bilateral, collagen that doesn’t extend in to fissures (benign)
Treatment for pleural fibrosis
pleural decortication - removal of fibrosis
Serous fluid in Pleural cavity
Pleural effusion
Two types of seroud fluid in a pleural effusion - what they contain
Transudates - low protein and low lactate dehydrogenase
Exudates (pathological) - high protein and high lactate dehydrogenase
Transudate pleural effusin - causes (2)
Due to semipermiability of capillaries
1) high capillary hydrostatic pressure - left ventricular failure, renal hypertension or water overload
2) Low capillary oncotic pressure - hypoalbumenia in hepatic syndrome or nephrotic syndrome
Exudate pleural effusion - causes (3)
Inflammation with/with out infection (effusion –> empyema)
Neoplasms
Signs of effusion
Breathlessness Pleuratic chest pain (on inspiration = stabbing) - infection Dull percussion Reduced breath sounds CT and Xray = cloudy
Treatment of effusion (4)
Aspirate under USS
Recurrent? = chest drain
Recurrent + idiopathic? pleurodesis (eradication of pleural cavity)
Treat under lying cause
empyema or pyothorax
Pus - secondary to pneumonia
Blood in the pleura
Haemothora - due to traumata or ruptured aneruysm
Bile in pleura
Chylothorax
Pneumothroax
gas in pluera
Two types of pneumothorax - What?
Open = wound in chest wall - air enters in inspiration
Closed - connection of lung air space to pleural space - lung into pleural cavity
Cause of Pneumothorax
Open
Closed
Open = EXTERNAL eg. trauma
Closed = INTERNAL eg. ruptured emphysematous bullae, broken rib, punctured lung (latrogenic)
Tensions Pneumothorax - what?
Complications?
Open or closed
Rupture = valve - lets air in on inspiration BUT not out again
Pressure rises above atmospheric
Pressure on mediastinum = back pressure and heart failure
Pneumothorax Signs symptoms
Breathless Pleuratic chest pain cyanosis Tachycardia Reduced breath sounds Hyper resonant on percussion
Pneumothorax treatment
EMERGENCY
Syringe needle with ICS
Dressed with specialized to way valve OR chest drain
Recurrent = pleurodesis?
Primary Neoplasms of the pleura
Malignant
Mesothelioma
Mesothelioma also present in ?
Peritoneum, Pericardium
Early presentation of mesothelioma
Small tumour BUT large effusion
Malignant cells shed into fluid = immunostaining (effusion cytology)
Advanced presentation of mesothelioma
Line whole pleural cavity and tubules = solid arrogates of mesothelial cells
Immunostaining
4 antibodies
purpose
Cytokeratin 5, wilm’s tumour antigen, calretinin
To distinguish epithelial and mesothelial
Causes of mesothelioma
Asbestos dust (90%) - 15-60 years after exposure
Thoracic radiation
BAP1 (BRACA 1 associated protein 1) mutation - germ line/ familial
5 years survival for mesothelioma
10%
Secondary Pleural tumours
breast, lung, lymphoma
Asbestos is?
Fibrous metal silicates found in rock
Types of asbestos (3)
Blue - crocidolite MOST oncogenic
Brown - amosite
White - chrysotile
Erionite (cappadocian carcinogen)
Similar to asbestos - zeolite
Found in Cappadocia, Turkey.
Asbestos Bodies
Inhaled asbestos coated in mucopolysacharides and containing iron
Seen on light microscopy
Quantify the iron content
Asbestos causes (2)
interstitial pneumonia and progressive pulmonary fibrosis
Symptoms of Sore throat (4)
Rapid onset
difficulty breathing, speaking swallowing and eating
neck pain and swelling
Fever symptoms?
Differential diagnosis for Sore throats (other symptoms + causes) (4)
Pharyngitis - + fever (viral)
Acute tonsillar pharyngitis - symmetrical inflamed tonsils, fever and headache. Pus on tonsils
Infectious mononucleosis (EBV) or Glandular fever - triad = symmetrical inflame tonsils, palate and cervical lymphadenopathy. Rash common in teenage - viral
Epiglottis - SEVERE. Tonsils and oropharynx + systemic symptoms. Bacteria (strep pneumonia and group A) and Influenza type B. Vaccination.
Causes of Sore throats
Viral (5) and Bacterial (1)
Viral - rhinovirus, influenza, coronavirus, parinfluenza, adenovirus
Bacterial - Group A Strep –> blood and cause a serious infection
Centor Criteria - is it viral or bacterial. Need 3/4 to get antiBs
Tonsil exudate
Tender anter cervial lymphopathy
Fever over 38
Absence of cough
Tests of EBV (glandular fever) (4)
Throat swabs and blood tests
Monospot or serology
Treatment for sore throats
Viral
Bacterial
Epiglotitis - sever
Viral - oral analgesia
Bacterial - antiBs
Epiglotitis - secure airway, O2, IV anitbiotic, analgesia + warn public health
Otitis externa
Inflammation of the outer ear = pain, itching and non mucoidal discharge
Otitis externa acute vs chronic
Acute <3 weeks = unilateral. –> necorsing and spread the base of skull
Chronic >3 weeks = bilateral. Thickened + narrowed canal (allergic aspect)
Causes of Otitis externa (7) Bacterial examples (2)
Swimmers ear (water exposure) Trauma Allergy Dermatological condition Bacterial - pseudomonas aeruginosa, Staph aureus fungal
Treatment for otitis Externa (5)
Severe acute?
Necorsing?
Remove cause
Toileting or cleaning the ear (ear drops)
Acute OE = flucloxillin
Necrosing = 6 weeks with ceftazidime
Otitis Media - what? signs?
Inflammation of the middle ear = fluid
Pain due to pressure on the tympanic membrane
Erythema on otoscopy
Otitis Media uncomplicated (3) VS complicated (6) signs and symptoms
Un = mild pain <72 hours, non systemic symptoms no ear discharge
Complicated = sever pain –> perforated ear drum = purulent discharge + bilateral mastoidosis (CT required), fever and oedema at the site
Causes of Otitis media (4)
Viral haemophilus influenza
strep pneumoniae
Moraxella Catarrhally
Treatment of otitis media (2)
Monitor
Amoxicillin
Pnuemonia - what?
BACTERIAL infection affecting the distal airways and alveoli
Formation of exudate or consolidation on CT
Anatomical patterns of pneumonia (2)
Broncho = pathcy around the bronchioles and surrounding alveoli
Lobular = entire lobes affect = 90% of cases with Strep Pneumonia
4 types of Pneumonia (based on how/ where acquired)
Community acquired
Hospital acquired
Ventilator acquired
Aspiration
Community acquired pneumonia - peak age, % hospital admins
MOST COMMON
40% hospital admissions
50-70 peak age
Causes of Pneumonia
Typical (4)
Atypical = Organism doesn’t respond to penicillin (no cell wall) (3)
Typical = Strep pneumoniae Haemophilus influenza Staph aureus Klebsiealla pneumoniae
Atypical =
Mycoplasm pneumoniae
Legionella
Chlamydophila pneumoniae
Hospital acquired pneumonia - what? cause?
> 48 hours after hospital admission
CAP organism + enterobacteriacea
Ventilator acquired pneumonia - what? cause?
> 48 hours ET ventilation
Pseudomonas Spp
Aspiration pneumonia - what? cause?
abnormal entry of food into the LRT - impaired swallowing
Upper GI bacteria and Anaerobes
Symptoms (6) and signs (6) of Penumonia
rapid onset, malaise, productive cough, anorexia, fever, pleuratic chest pain
Tachypnoae, tachycardic, hypotension, reduced breath sounds, dull to percuss, bronchiole breathing
Investigation for Pneumonia (5)
CURB65 - severity
confusion, urea, resp rate, blood pressure and age >65 years
CXR, sputum and blood cultures, Pneumococcal and legionella urine. PCR serology for viral causes?
Complications of Pneumonia (3)
Plueral effusion
Emyema
lung abscesses
Viral LRTI causes?
Children (broncholitis <2 years) (2)
Adults (4)
Immuno suppressed (4)
Children = RSV and parainfluenza = Brochiolitis - inflame of small bronchioles)
Adults = Influenza A or B, adenovirus, varicella coster
Immunosupressed = as above + measles, herpes simplex and cytomegalovirus
Presentation
Influenza (4)
Primary viral pneumonia (usually those with preexhisting lung issues - inpatients) (4)
Influenza = uncomplicated, fever, headache, dry cough and sore throat for 2 - 3 weeks
Viral pneumonia = cough, breathlessness, cyanosis and secondary bacterial infection
Cystic fibrosis - organism present and becomes more resistant over time.
Children - Teen - adult
Child = Stap aureus Teen = psudoeomonas aeurginosa Adult = burkholderia cepacia complex
Management of CF resp infections (4)
Prolonged antB (3-4 weeks)
Vaccinations
Lungs transplants
Postural draining
Fungal LRTI
Aspergillosis - in immunosupressed and lung patients
4 types of Aspergillosis
Space occupying or Aspergilloma - previous lung cavity (eg. TB or sarcoidosis)
ABPA - allergic bronchopulmonary aspergillosis = linked to asthma
Invasive/ infective = Pneumocystis - pneumonia and hypoxia in HIV patients
Chronic pulmonary aspergillosis - COPD
TB or mycobacterium tuberculosis - symptoms (5)
chronic productive cough, weight loss NIGHT SWEATS haemoptysis fever
Progression of TB
inhalation of airborne disease –> bacilli lodge in alveoli and multiply = ghon formation
90% of primary infection asymptomatic - may reactivate later in life.
Tests for TB (4)
3 different names of the skin test
Detect acid fast bacilli OR Culture of M. tuberculosis in sputum culture OR PCR
Tuberculin OR Mantoux OR Heaf skin test
What is placed under the skin during a mantoux skin test
Results
PPD purified protein derivative or tuberculin
Red bumps if the patient currently has or has every had TB
Treat and prevent TB
Treat = chemo (ionized for 6 months) Prevent = BCG vaccination
