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Year 2: Clinical Pathology > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

Asthma - definition

Age affected

A

Chronic inflammatory disorder of the airways
Children in Young Adults
15% adult development due to occupation

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2
Q

Asthma
Signs - visible outside (4)
Pathology - whats happening inside

A

paroxysmal bronchospasm, wheeze, cough and variable bronchoconstriction

inflamed mucosa, oedema, hyperinflated lungs, hypertrophic mucosal glands = mucosal plugs

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3
Q

Types of Asthma (4)

A

Atopic - type one hypersensitivity reaction to allergen, cold weather, exercise of resp infections

Non atopic
aspirin induced
allergic bronchopulmonary aspergillosis (ABPA

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4
Q

Change to airways in atopic asthma
Reversible
Irreversible

A

Reversible = degranulation of IgE bearing mast cells = histamine = bronchoconstriction and mucous production
eosinophil chemotaxi

Irreversible = smooth muscle hypertrophy, mucus glands hyperplasia, respiratory bronchiolitis

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5
Q

COPD - chronic obstructive pulmonary disease.

Combination of what two conditions

A

chronic bronchitis and emphysema

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6
Q

Chronic Bronchitis - what?
Signs/ measurement
Age

A

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

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7
Q

Emphysema - what?
Signs
Age

A

site of fibrosis in the acinar
DYSPONEA that progressive worsens. Cough develops late
50-75

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8
Q

Blue bloaters (cyanosis + increased residual volume and air trapping)

A

Chronic Bronchitis predominate COPD

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9
Q

Pink puffer (red in the face and Dysponea)

A

Emphysema predominate COPD

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10
Q

Chronic Bronchitis (blue) Vs Emphysema (pink)

A

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

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11
Q

Classification of Bronchitis (how much of lobe + what caused it)

A 
Centrilobular = coal dust and smoke
Panlobular = antitripsin deficiency
Paraseptal = upper lobe sub pleural bullae (air sacs in pleura) adjacent to fibrosis - burst = pneumonathorax
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12
Q

Interstitial lung disease - definition

A

Disease on connective tissue (alveoli walls)
Diffuse and chronic
Restrictive

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13
Q

Interstitial lung disease progression - consequences

A

Inflammation –> fibrosis (honey comb lung) of alveoli walls

Decreased lung compliance and diffusion distance

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14
Q

Acute Interstitial lung disease - pathology

A

Exudate
Death of type I pneumocytes from hyaline memebrane of alveloi
Type II pneumocytes hyperplasia
Looks like pneumonia

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15
Q

Presentation and causes (7) of Acute interstitial lung disease

A

Resp distress syndrome OR shock lung

Shock, Trauma, infections, toxic gas, narcotics, radiation and aspiration

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16
Q

Types of Chronic Interstitial lung disease (4)

A

Idiopathic
Sarcoidosis
Pneumoconioses - dust diseases
Silicosis

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17
Q

Idiopthic lung disease - lung appearance

A

Chronic inflammation and variable maturity fibrosis adjacent to normal tissue
Constriction of interstitial lung tissue = ‘cobble stone’

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18
Q

Idiopathic lung disease - prevalence, survival and location

A

older, rare 3-5 year survival, sub pleural and lower lobes

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19
Q

Sarcoidosis - what ?
Appearance of lung
Blood markers
those affected?

A

Systemic disease - brain, skin and heart
Non caseating perilymphatic pulmonary granulomas + Hilar node involvement of Xray
Hypercalceamia and elevated serum ACE
young women

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20
Q

Pneumoconioses or dust disease or non neoplastic lung disease - cause and types (4)

A

Inhalation of mineral dust <3 um in diameter

inert, fibrogenic, allergenic or oncogenic

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21
Q

Pneumoconioes - coal miners

A

Most common

>20 years underground = wide spread fibrosis and right side heart failure to deal with back pressure

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22
Q

Silicosis - what is it

A

silica in lungs –> attach to macrophages –> die –> accumulate in fibrosis silica nodules

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23
Q

Hypersensitivity Pneumonitis Or extrinsic allergic alveolitis - what type of allergic reaction to what time of dust

A

Type III hypersentivity reaction to organic dust

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24
Q

Types of Hypersensitivity Pneumonitis + causes

A

Farmers lung - actinomycetes in hay

Pigeon fanciers lung - pigeon antigens

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25
Q

Pathology of Pneumonitits

A

Peribronchiolar inflammation - Non caseating granulomas spread into alveoli walls
Repeated episodes of fibrosis and breathlessness

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26
Q

Bronchiectasis - What? causes?

A

Pernament dilation of bronchioles due to destruction of muscle and elastic tissue
Due to chronic necrosis infection

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27
Q

Bronchiectasis - symptoms (3) and complications (3)

A

Cough, fever and large about of foul smelling sputum

Pneumonia, Septicemia, mets of infection

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28
Q

Resp impacts of Cystic Fibrosis (4)

A

bronchioles distended with mucous
hyperplasia of mucous secreting glands
repeated chest infections
chronic bronchitis of bronchiectasis

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29
Q

Drug to relieve resp symptoms of CF

A

Orkambi - only for those with the F508 deletion mutation (VERY EXPENSIVE)

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30
Q

Lung tumours have abnormal characteristics that allow them to …

A

Invade and metastasize

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31
Q

Most common primary lung tumour - what % of patients?

A

Carcinoma (from epithelial cells) in 90% of cases

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32
Q

Types of Primary lung carcinomas (appearance on light microscope)

A

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%

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33
Q

Other primary lung tumours (3)

A

Carcinoid = low grade + good survival
Malignant mesenchymal = rare, most common as synovial sarcoma
Primary lung lymphomas - HIV and AIDs patients

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34
Q

Secondary tumours - MORE COMMON
Spread from?
Main types?
Present as?

A

kidney, liver, breast, brain and GI
carcinoma - sarcomas - melanomas and lymphomas
Multiple nodules or solid tumours

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35
Q

Lung cancers - risk factors (age/ gender) (5 + examples)

A 
M>F but changing
40-70 years
Tobacco smoke 
Occupational hazards - asbestos and heavy metals
Radiation
Lung fibrosis 
Genetic mutation - EGFR, KRAS and ALK
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36
Q

Lung cancer pathogenesis

A

Cigarette smoke irritate the squamous cells –> metaplasia –> gene mutation –> dysplasia –> carcinoma insitu

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37
Q

Localised effects of lung tumours

A

Obstructive pneumonia - distal collapse and consolidation = breathless
Proximal airways = ulceration and bleeds

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38
Q

Effects of lung tumours infiltrating other tissues (5)

A 
Pleura = effusion and breathlessness
Chest wall = pain
Laryngeal nerve = hoarse voice
Sympathetic chain = horners syndrome
Esophagus = dysphagia
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39
Q

Non specific effects o lung tumours

A 
Clubbing
Endocrine - ACTH, ADH and PTH increase = metabolism effects
wight loss
lathargy
cachexia
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40
Q

Complication of lung tumours = mets

A

Mets:
Brain = epilepsy
Bone = increased Ca2+ = pain and fracture
Lymphangitis carcinmatosa - lymphatics diffusely involved in the tumour

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41
Q

average 5 year survival for lung cancer

A

10-15%

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42
Q

Lung cancer treatment:

A

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

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43
Q

Mesothelial layer

A

A layer found in both parietal and visceral pleura that lines the pleural space

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44
Q

Hyaluronic acid

A

found in the pleural fluid

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45
Q

Pleural fibrosis + affect on lungs

A

Scarring secondary to inflammation
Secondary to asbestos = fibrotic plaques and diffuse fibrosis

Compress lungs = breathless. Partial and whole adhesion/ obliteration of pleural cavity

46
Q

Fibrous plaques - causes + appearance

A

Low level asbestos exposure - visible of chest Xray

47
Q

diffuse fibrosis - cause + appearance

A

high asbestos (occupational) - usually bilateral, collagen that doesn’t extend in to fissures (benign)

48
Q

Treatment for pleural fibrosis

A

pleural decortication - removal of fibrosis

49
Q

Serous fluid in Pleural cavity

A

Pleural effusion

50
Q

Two types of seroud fluid in a pleural effusion - what they contain

A

Transudates - low protein and low lactate dehydrogenase

Exudates (pathological) - high protein and high lactate dehydrogenase

51
Q

Transudate pleural effusin - causes (2)

A

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

52
Q

Exudate pleural effusion - causes (3)

A

Inflammation with/with out infection (effusion –> empyema)

Neoplasms

53
Q

Signs of effusion

A 
Breathlessness
Pleuratic chest pain (on inspiration = stabbing) - infection
Dull percussion
Reduced breath sounds
CT and Xray = cloudy
54
Q

Treatment of effusion (4)

A

Aspirate under USS
Recurrent? = chest drain
Recurrent + idiopathic? pleurodesis (eradication of pleural cavity)
Treat under lying cause

55
Q

empyema or pyothorax

A

Pus - secondary to pneumonia

56
Q

Blood in the pleura

A

Haemothora - due to traumata or ruptured aneruysm

57
Q

Bile in pleura

A

Chylothorax

58
Q

Pneumothroax

A

gas in pluera

59
Q

Two types of pneumothorax - What?

A

Open = wound in chest wall - air enters in inspiration

Closed - connection of lung air space to pleural space - lung into pleural cavity

60
Q

Cause of Pneumothorax
Open
Closed

A

Open = EXTERNAL eg. trauma

Closed = INTERNAL eg. ruptured emphysematous bullae, broken rib, punctured lung (latrogenic)

61
Q

Tensions Pneumothorax - what?

Complications?

A

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

62
Q

Pneumothorax Signs symptoms

A 
Breathless
Pleuratic chest pain
cyanosis
Tachycardia
Reduced breath sounds
Hyper resonant on percussion
63
Q

Pneumothorax treatment

A

EMERGENCY

Syringe needle with ICS
Dressed with specialized to way valve OR chest drain

Recurrent = pleurodesis?

64
Q

Primary Neoplasms of the pleura

Malignant

A

Mesothelioma

65
Q

Mesothelioma also present in ?

A

Peritoneum, Pericardium

66
Q

Early presentation of mesothelioma

A

Small tumour BUT large effusion

Malignant cells shed into fluid = immunostaining (effusion cytology)

67
Q

Advanced presentation of mesothelioma

A

Line whole pleural cavity and tubules = solid arrogates of mesothelial cells

68
Q

Immunostaining
4 antibodies
purpose

A

Cytokeratin 5, wilm’s tumour antigen, calretinin

To distinguish epithelial and mesothelial

69
Q

Causes of mesothelioma

A 
Asbestos dust (90%)
- 15-60 years after exposure

Thoracic radiation

BAP1 (BRACA 1 associated protein 1) mutation - germ line/ familial

70
Q

5 years survival for mesothelioma

A

10%

71
Q

Secondary Pleural tumours

A

breast, lung, lymphoma

72
Q

Asbestos is?

A

Fibrous metal silicates found in rock

73
Q

Types of asbestos (3)

A

Blue - crocidolite MOST oncogenic

Brown - amosite

White - chrysotile

74
Q

Erionite (cappadocian carcinogen)

A

Similar to asbestos - zeolite

Found in Cappadocia, Turkey.

75
Q

Asbestos Bodies

A

Inhaled asbestos coated in mucopolysacharides and containing iron

Seen on light microscopy
Quantify the iron content

76
Q

Asbestos causes (2)

A

interstitial pneumonia and progressive pulmonary fibrosis

77
Q

Symptoms of Sore throat (4)

A

Rapid onset
difficulty breathing, speaking swallowing and eating
neck pain and swelling
Fever symptoms?

78
Q

Differential diagnosis for Sore throats (other symptoms + causes) (4)

A

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.

79
Q

Causes of Sore throats

Viral (5) and Bacterial (1)

A

Viral - rhinovirus, influenza, coronavirus, parinfluenza, adenovirus

Bacterial - Group A Strep –> blood and cause a serious infection

80
Q

Centor Criteria - is it viral or bacterial. Need 3/4 to get antiBs

A

Tonsil exudate
Tender anter cervial lymphopathy
Fever over 38
Absence of cough

81
Q

Tests of EBV (glandular fever) (4)

A

Throat swabs and blood tests

Monospot or serology

82
Q

Treatment for sore throats
Viral
Bacterial
Epiglotitis - sever

A

Viral - oral analgesia
Bacterial - antiBs
Epiglotitis - secure airway, O2, IV anitbiotic, analgesia + warn public health

83
Q

Otitis externa

A

Inflammation of the outer ear = pain, itching and non mucoidal discharge

84
Q

Otitis externa acute vs chronic

A

Acute <3 weeks = unilateral. –> necorsing and spread the base of skull
Chronic >3 weeks = bilateral. Thickened + narrowed canal (allergic aspect)

85
Q 
Causes of Otitis externa (7)
Bacterial examples (2)
A 
Swimmers ear (water exposure)
Trauma
Allergy 
Dermatological condition
Bacterial - pseudomonas aeruginosa, Staph aureus 
fungal
86
Q

Treatment for otitis Externa (5)
Severe acute?
Necorsing?

A

Remove cause
Toileting or cleaning the ear (ear drops)
Acute OE = flucloxillin
Necrosing = 6 weeks with ceftazidime

87
Q

Otitis Media - what? signs?

A

Inflammation of the middle ear = fluid
Pain due to pressure on the tympanic membrane
Erythema on otoscopy

88
Q

Otitis Media uncomplicated (3) VS complicated (6) signs and symptoms

A

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

89
Q

Causes of Otitis media (4)

A

Viral haemophilus influenza
strep pneumoniae
Moraxella Catarrhally

90
Q

Treatment of otitis media (2)

A

Monitor

Amoxicillin

91
Q

Pnuemonia - what?

A

BACTERIAL infection affecting the distal airways and alveoli

Formation of exudate or consolidation on CT

92
Q

Anatomical patterns of pneumonia (2)

A

Broncho = pathcy around the bronchioles and surrounding alveoli

Lobular = entire lobes affect = 90% of cases with Strep Pneumonia

93
Q

4 types of Pneumonia (based on how/ where acquired)

A

Community acquired
Hospital acquired
Ventilator acquired
Aspiration

94
Q

Community acquired pneumonia - peak age, % hospital admins

A

MOST COMMON
40% hospital admissions
50-70 peak age

95
Q

Causes of Pneumonia
Typical (4)
Atypical = Organism doesn’t respond to penicillin (no cell wall) (3)

A 
Typical =
Strep pneumoniae
Haemophilus influenza
Staph aureus
Klebsiealla pneumoniae

Atypical =
Mycoplasm pneumoniae
Legionella
Chlamydophila pneumoniae

96
Q

Hospital acquired pneumonia - what? cause?

A

> 48 hours after hospital admission

CAP organism + enterobacteriacea

97
Q

Ventilator acquired pneumonia - what? cause?

A

> 48 hours ET ventilation

Pseudomonas Spp

98
Q

Aspiration pneumonia - what? cause?

A

abnormal entry of food into the LRT - impaired swallowing

Upper GI bacteria and Anaerobes

99
Q

Symptoms (6) and signs (6) of Penumonia

A

rapid onset, malaise, productive cough, anorexia, fever, pleuratic chest pain

Tachypnoae, tachycardic, hypotension, reduced breath sounds, dull to percuss, bronchiole breathing

100
Q

Investigation for Pneumonia (5)

CURB65 - severity

A

confusion, urea, resp rate, blood pressure and age >65 years

CXR, sputum and blood cultures, Pneumococcal and legionella urine. PCR serology for viral causes?

101
Q

Complications of Pneumonia (3)

A

Plueral effusion
Emyema
lung abscesses

102
Q

Viral LRTI causes?
Children (broncholitis <2 years) (2)
Adults (4)
Immuno suppressed (4)

A

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

103
Q

Presentation
Influenza (4)
Primary viral pneumonia (usually those with preexhisting lung issues - inpatients) (4)

A

Influenza = uncomplicated, fever, headache, dry cough and sore throat for 2 - 3 weeks

Viral pneumonia = cough, breathlessness, cyanosis and secondary bacterial infection

104
Q

Cystic fibrosis - organism present and becomes more resistant over time.
Children - Teen - adult

A 
Child = Stap aureus
Teen = psudoeomonas aeurginosa
Adult = burkholderia cepacia complex
105
Q

Management of CF resp infections (4)

A

Prolonged antB (3-4 weeks)
Vaccinations
Lungs transplants
Postural draining

106
Q

Fungal LRTI

A

Aspergillosis - in immunosupressed and lung patients

107
Q

4 types of Aspergillosis

A

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

108
Q

TB or mycobacterium tuberculosis - symptoms (5)

A 
chronic productive cough,
weight loss
NIGHT SWEATS
haemoptysis
fever
109
Q

Progression of TB

A

inhalation of airborne disease –> bacilli lodge in alveoli and multiply = ghon formation

90% of primary infection asymptomatic - may reactivate later in life.

110
Q

Tests for TB (4)

3 different names of the skin test

A

Detect acid fast bacilli OR Culture of M. tuberculosis in sputum culture OR PCR

Tuberculin OR Mantoux OR Heaf skin test

111
Q

What is placed under the skin during a mantoux skin test

Results

A

PPD purified protein derivative or tuberculin

Red bumps if the patient currently has or has every had TB

112
Q

Treat and prevent TB

A 
Treat = chemo (ionized for 6 months)
Prevent = BCG vaccination

Year 2: Clinical Pathology (10 decks)

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