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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
when does HAP Tend to occur?
2 days after admission
26
what is responsible for HAP?
``` gram negative pneumonia klebsiella E coli pseudomonas S.aureus S.pneumoniae ```
27
what patients are at risk of aspiration pneumonia?
Stroke, impaired swallowing, septic with reduced consciousness
28
what fungis can cause pneumonia in the immunocompromised?
pneumocystitis Candida Aspergillus
29
what characterises diffuse parenchymal lung diseases?
inflammation is centred on the instertitium of the alveolour walls
30
in diffuse parenchymal lung diseases one outcome possibility is that the inflammation is followed by scarring how does this happen?
macrophages release fibrogenic cytokines that stimulate fibroblasts in the interstitium to secrete collagen
31
what is CXR finding of severe parenchymal lung diseases where scarring takes place?
honeycomb lungs
32
what is pneumonitis?
inflammation of the lung parenchyma
33
what is pneumonia?
inflammation of the lung parenchyma due to an infective agent
34
what are the categories for causes of diffuse parenchymal lung diseases?
1. unknown 2. pneummoconioses 3. extrinsic allergic alveolitis 4. side effects of a treatment 5. multisystem disese
35
what is pneumoconiosis?
A cause of diffuse parenchymal lung disease inhaled inorganic material such as mineral dust includes coal dust, silica and asbstososes
36
what is extrinsic allergic alveolitis?
A cause of DPLD | inhaled organic particles such as bird fancier lung and farmer lung
37
what spirometry result does DPLD show?
restrictive
38
what are possible long term complications of DPLD?
- can cause cor pulmonale - pulmonary hypertension - right ventricular hypertrophy
39
What are the four main groups of lung cancer?
1. adenocarcinoma 2. squamous cell carcinoma 3. small cell carcinoma 4. large cell carcinoma
40
where do squamous cell carcinomas arise?
In the larger airways near the hilum
41
what is the sequence of events leading to squamous cell carcinoma?
Metaplasia-dysplasia carcinoma
42
what is the most common type of lung cancer in non-smokers?
Adenocarcinoma
43
where does adenocarcinoma tend to arise?
Peripheral smaller airways
44
what is the precursor to adenocarcinoma?
atypical adenomatous hyperplasia
45
what lung cancer has the strongest association with smoking?
small cell carcinoma
46
where does small cell carcinoma normally arise?
A central location
47
what is the grading of small cell carcinoma?
Not graded. By definition is highly aggresive
48
what chromosome 2 mutation is associated with lung cancer?
inversion in the short arm of chromosome 2 causing fusion of EML4 gene with ALK gene.Responds to TKI crizotibin
49
why do some cancer cells express PD-L1?
PDL1 regulates T cell function. Expressing it stops T cells attacking them.
50
How do you obtain a biopsy for central lesions?
Bronchoscopy
51
how do you obtain a biopsy for peripheral lesions?
CT guided sampling
52
what imaging is good for the T part of staging in lung cancer?
CT
53
what imaging Is good for the N and M part of staging for lung cancer?
PET
54
what cancer tends to cause SVC obstruction?
right sided small cell carcinoma
55
what are signs of SVC obstruction?
SOB, facial swelling, head fullness, cough, arm swelling, chest pain, stridor
56
what is a pancoast tumour?
A cancer In the lung apex that involves the C8 nerve and T1 AND 2 nerves.
57
how can pancoasts tumour present?
1. pancoasts syndrome (shoulder pain radiating in an ulner distribution 2. horners syndrome
58
what is horners syndrome characterised by?
- endophthalmos (eyeball depression) - ptosis (droop of upper eyelid) - miosis (pupil constriction) - anhidrosis
59
what causes horners syndrome?
sympathetic nerve infiltration especially T1
60
what is a paraneoplastic syndrome?
A syndrome caused by substances produced from the tumour cells which act remotely from the tumour
61
what cancer is hypercalcaemia as a paraneoplastic syndrome more common with?
squamous cell carcinoma
62
what causes the paraneoplastic effect of hypercalcaemia?
The production of PTH related peptide by tumour cells causing calcium release from bone
63
what cancer is SIADH commonly seen with?
Small cell carcinoma
64
what are the effects of SIADH?
low sodium, low serum osmolality, overhydration
65
what cancer is ectopic ACTH secretion by tumour cells?
small cell carcinoma
66
what are the main manifestations of ectopic ACTH secretion?
thirst | polyuria
67
what are lambert eaton myasthenic syndrome associated with?
small cell carcinoma
68
what happens in lambert eaton myasthenic syndrome?
autoantibodies block VG ca channels blocking Ach release
69
how do you manage small cell lung carcinomas?
- often has mets so surgery is of no help | - initial chemo
70
how do you manage non small cell lung carcinoma?
surgery is possible at low stage or chemo
71
what is mesothelioma?
A malignant tumour of the pleura associated with abstesos exposure
72
what is the presentation of mesothelioma?
breathlessness chest pain pleural effusion
73
what is asbestosis?
A DPLD where there is diffuse fibrosis of the lung parenchyma

T IoD cellular pathology (10 decks)

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