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T IoD cellular pathology > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

1
Q

what are the three factors that make up the COPD definition?

A
  • persistant airflow obstruction
  • poorly reversible
  • progressive
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2
Q

what is the clinically definition of chronic bronchitis?

A

Cough productive of sputum for 3 consecutive months for 2 consecutive years which has no other cardiac or pulmonary cause

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3
Q

what is the pathological definition of emphysema?

A

permanent dilatation of the airways distal to the terminal bronchiole due to destruction of alveolour walls

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4
Q

why do COPD patients get increased sputum production?

A

There is hyperplasia of the mucus producing glands in the submucosa and hyperplasia of the goblet cells on the surface epithelium

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5
Q

In COPD there is destruction of the respiratory bronchiole walls, what is the consequence

A
  1. less pulmonary surface area for gas exchange leading to hypoxia
  2. loss of elastic tissue in terminal airways meaning less natural recoil leading to obstruction
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6
Q

what is the spirometry result in COPD?

A

obstructive

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7
Q

What are causes of IECOPD?

A
  • infection
  • pneumothorax
  • PE
  • LVF
  • lung carcinoma
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8
Q

where is the infection site in IECOPD compared to pneumonia?

A

Pneumonia- alveoli

COPD- airways

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9
Q

what are the most common causes of IECOPD?

A

H.influenzae
M.catarrhalis
S.pneumonia
virus

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10
Q

what are the most common causes of pneumonia?

A

S.pneumoniae
H.influenzae
Viruses
atypicals

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11
Q

what is the most common cause of cor pulmonale?

A

COPD

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12
Q

what is pulmonary hypertension?

A

Increase in blood pressure in the pulmonary vasculature as resting pulmonary artery pressure above 25

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13
Q

what leads to pulmonary hypertension in COPD?

A

Chronic hypoxia leading to increased EPO leading to polycythaemia
Chronic hypoxia leading to pulmonary arterial vasoconstriction

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14
Q

what is pneumonia?

A

Inflammation of the lung parenchyma due to an infective agent

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15
Q

Pneumonia affects the parenchyma, what is this?

A

the alveolour spaces

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16
Q

What is the pathological classification of pneumonia?

A

Bronchopneumonia vs lobar

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17
Q

what are the characteristics of bronchopneumonia?

A
  • normally bilateral
  • ## widespread patchy inflammation
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18
Q

what are the characteristics of lobar pneumonia?

A

diffuse inflammation affecting the entire lobe or lobes

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19
Q

what is consolidation?

A

replacement of air by fluid or other material

in pneumonia this is exudate

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20
Q

what is the single most common cause of community acquired pneumonia?

A

Strep pneumonia (pneumococcus)

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21
Q

Other than the most common (strep pneumoniae) what are other causes of community acquired pneumonia?

A

Influenza, chlamydia pneumonia, mycoplasma pneumoniae, legionella pneumoniae, haemophilus influena

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22
Q

what are the three causes of more severe CAP?

A

S.Pneumoniae, legionella, S.aureus

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23
Q

what is used to assess severity of CAP?

A

curb 65

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24
Q

what does CURB 65 stand for?

A 
confusion- AMT above 8
Urea above 7
Resp rate above 30
Blood pressure (90/60)
65 yrs or older
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25
Q

when does HAP Tend to occur?

A

2 days after admission

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26
Q

what is responsible for HAP?

A 
gram negative pneumonia
klebsiella
E coli
pseudomonas
S.aureus
S.pneumoniae
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27
Q

what patients are at risk of aspiration pneumonia?

A

Stroke, impaired swallowing, septic with reduced consciousness

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28
Q

what fungis can cause pneumonia in the immunocompromised?

A

pneumocystitis
Candida
Aspergillus

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29
Q

what characterises diffuse parenchymal lung diseases?

A

inflammation is centred on the instertitium of the alveolour walls

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30
Q

in diffuse parenchymal lung diseases one outcome possibility is that the inflammation is followed by scarring how does this happen?

A

macrophages release fibrogenic cytokines that stimulate fibroblasts in the interstitium to secrete collagen

31
Q

what is CXR finding of severe parenchymal lung diseases where scarring takes place?

A

honeycomb lungs

32
Q

what is pneumonitis?

A

inflammation of the lung parenchyma

33
Q

what is pneumonia?

A

inflammation of the lung parenchyma due to an infective agent

34
Q

what are the categories for causes of diffuse parenchymal lung diseases?

A
  1. unknown
  2. pneummoconioses
  3. extrinsic allergic alveolitis
  4. side effects of a treatment
  5. multisystem disese
35
Q

what is pneumoconiosis?

A

A cause of diffuse parenchymal lung disease
inhaled inorganic material such as mineral dust
includes coal dust, silica and asbstososes

36
Q

what is extrinsic allergic alveolitis?

A

A cause of DPLD

inhaled organic particles such as bird fancier lung and farmer lung

37
Q

what spirometry result does DPLD show?

A

restrictive

38
Q

what are possible long term complications of DPLD?

A
  • can cause cor pulmonale
  • pulmonary hypertension
  • right ventricular hypertrophy
39
Q

What are the four main groups of lung cancer?

A
  1. adenocarcinoma
  2. squamous cell carcinoma
  3. small cell carcinoma
  4. large cell carcinoma
40
Q

where do squamous cell carcinomas arise?

A

In the larger airways near the hilum

41
Q

what is the sequence of events leading to squamous cell carcinoma?

A

Metaplasia-dysplasia carcinoma

42
Q

what is the most common type of lung cancer in non-smokers?

A

Adenocarcinoma

43
Q

where does adenocarcinoma tend to arise?

A

Peripheral smaller airways

44
Q

what is the precursor to adenocarcinoma?

A

atypical adenomatous hyperplasia

45
Q

what lung cancer has the strongest association with smoking?

A

small cell carcinoma

46
Q

where does small cell carcinoma normally arise?

A

A central location

47
Q

what is the grading of small cell carcinoma?

A

Not graded. By definition is highly aggresive

48
Q

what chromosome 2 mutation is associated with lung cancer?

A

inversion in the short arm of chromosome 2 causing fusion of EML4 gene with ALK gene.Responds to TKI crizotibin

49
Q

why do some cancer cells express PD-L1?

A

PDL1 regulates T cell function. Expressing it stops T cells attacking them.

50
Q

How do you obtain a biopsy for central lesions?

A

Bronchoscopy

51
Q

how do you obtain a biopsy for peripheral lesions?

A

CT guided sampling

52
Q

what imaging is good for the T part of staging in lung cancer?

A

CT

53
Q

what imaging Is good for the N and M part of staging for lung cancer?

A

PET

54
Q

what cancer tends to cause SVC obstruction?

A

right sided small cell carcinoma

55
Q

what are signs of SVC obstruction?

A

SOB, facial swelling, head fullness, cough, arm swelling, chest pain, stridor

56
Q

what is a pancoast tumour?

A

A cancer In the lung apex that involves the C8 nerve and T1 AND 2 nerves.

57
Q

how can pancoasts tumour present?

A
  1. pancoasts syndrome (shoulder pain radiating in an ulner distribution
  2. horners syndrome
58
Q

what is horners syndrome characterised by?

A
  • endophthalmos (eyeball depression)
  • ptosis (droop of upper eyelid)
  • miosis (pupil constriction)
  • anhidrosis
59
Q

what causes horners syndrome?

A

sympathetic nerve infiltration especially T1

60
Q

what is a paraneoplastic syndrome?

A

A syndrome caused by substances produced from the tumour cells which act remotely from the tumour

61
Q

what cancer is hypercalcaemia as a paraneoplastic syndrome more common with?

A

squamous cell carcinoma

62
Q

what causes the paraneoplastic effect of hypercalcaemia?

A

The production of PTH related peptide by tumour cells causing calcium release from bone

63
Q

what cancer is SIADH commonly seen with?

A

Small cell carcinoma

64
Q

what are the effects of SIADH?

A

low sodium, low serum osmolality, overhydration

65
Q

what cancer is ectopic ACTH secretion by tumour cells?

A

small cell carcinoma

66
Q

what are the main manifestations of ectopic ACTH secretion?

A

thirst

polyuria

67
Q

what are lambert eaton myasthenic syndrome associated with?

A

small cell carcinoma

68
Q

what happens in lambert eaton myasthenic syndrome?

A

autoantibodies block VG ca channels blocking Ach release

69
Q

how do you manage small cell lung carcinomas?

A
  • often has mets so surgery is of no help

- initial chemo

70
Q

how do you manage non small cell lung carcinoma?

A

surgery is possible at low stage or chemo

71
Q

what is mesothelioma?

A

A malignant tumour of the pleura associated with abstesos exposure

72
Q

what is the presentation of mesothelioma?

A

breathlessness
chest pain
pleural effusion

73
Q

what is asbestosis?

A

A DPLD where there is diffuse fibrosis of the lung parenchyma

T IoD cellular pathology (10 decks)

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