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Y2 Clinical Pathology > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

1
Q

What is asthma and how does it present

A

Chronic inflammatory disorder of the airways
Paroxysmal bronchospasm
Wheeze
Cough
Variable bronchoconstruction that is at least partially reversible
Mucosal inflammation and oedema
Hypertrophic mucous glands and mucus plugs in bronchi
Hyperinflated lungs
Clinicopathological classification

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2
Q

What are the types of asthma

A

Atopic
Non-atopic
Aspirin induced
Allergic bronchpulmonary aspergillosis (ABPA)

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3
Q

What is atopic asthma

A

Type 1 hypersensitivity reaction:

  • allergen (dust, pollen, animal products)
  • Cold, exercise, respiratory infections
  • Many cell types involved
  • Degranulation of IgE bearing mast cells:
  • -Histamine initiated bronchoconstriction and mucus production obstructing air flow
  • eosinophil chemotaxis

Persistent or irreversible changes:

  • Bronchiolar wall smooth muscle hypertrophy
  • mucus gland hyperplasia
  • respiratory bronchiolitis leading to centrilobular emphysema
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4
Q

What is obstructive pulmonary disease

A

Localised or diffuse obstruction of air flow

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5
Q

What is localised obstructive pulmonary disease

A 
Tumour or foreign body
Distal alveolar collapse (total) or over expansion (valvular obstruction)
Distal retention pneumonitis (endogenous lipid pneumonia) and bronchopneumonia
Distal bronchiectasis (bronchial dilation)
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6
Q

What is bronchiectasis

A

Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
Results form necrotising infection
Symptoms: cough, fever, copious amounts of foul smelling sputum

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7
Q

What infections can cause bronchiectasis

A

Cystic fibrosis
Primary ciliary dyskinesia, kartagener syndrome
Bronchial obstruction: tumour, foreign body
Lupus, rheumatoid arthritis, IBD and GVHD

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8
Q

What are complications of bronchiectasis

A

Pneumonia
Septicaemia
Metastatic infection

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9
Q

What is COPD

A

Chronic obstructive pulmonary disease

Combination of chronic bronchitis and emphysema

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10
Q

What is chronic bronchitis

A

Cough and sputum for 3 months in each of 2 consecutive years
Site: bronchus
Cause: chronic irritation, smoking, air pollution
Found in middle aged and elderly

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11
Q

What is the pathology of chronic bronchitis

A

Mucus gland hyperplasia and hyper secretion, secondary infection by low virulence bacteria, chronic inflammation
Chronic inflammation of small airways of the lung causes wall weakness and destruction thus centrilobular emphysema

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12
Q

What are the types of emphysema

A

Centrilobular
Panobular
Paraseptal

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13
Q

What is the symptom of emphysema

A

Progressive and worsening dyspnoea

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14
Q

What is interstitial lung disease

A

Disease of pulmonary connective tissue (mainly alveolar walls)
Restrictive rather than obstructive lung disease
Causes often unknown

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15
Q

What is acute interstitial lung disease

A

Diffuse alveolar damage: exudate and death of type 1 pneumocytes form hyaline membranes lining alveoli followed by type 11 pneumocyte hyperplasia
Adult respiratory distress syndrome

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16
Q

What is chronic interstitial lung disease

A

Dyspnoea increasing for months to years
Clubbing, fine crackles, dry cough
Interstital fibrosis and chronic inflammation with varying radiological and histological patterns
End stage fibroses honeycomb lung

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17
Q

What are examples of chronic interstitial lung diseases

A

Idiopathic pulmonary fibrosis
Many pneumoconiosis (dust diseases)
Sarcoidosis
Collagen vascular diseases-associated lung diseases

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18
Q

What is cystic fibrosis

A

An inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, gastrointestinal and reproductive organs
Autosomal recessive inheritance
Mostly affects caucasians

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19
Q

How does cystic fibrosis present

A

Bronchioles distended with mucus
Hyperplasia mucus secreting glands
Multiple repeated infections
Severe chronic bronchitis and bronchiectasis
Exocrine gland ducts plugged by mucus
Atrophy and fibrosis of gland
Impaired fat absorption, enzyme secretion, vitamin deficiencies, pancreatic insufficiency

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20
Q

How is cystic fibrosis tested for

A

Part of newborn screening in UK
Sweat test
Genetic testing

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21
Q

What is the definition of malignant lung pathology

A

Tumours within the lung that possess potential lethal abnormal characteristics that enable them to invade and metastasise/spread to other tissues

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22
Q

What are the categories of malignant lung tumours

A

Primary and secondary

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23
Q

What is the most common primary malignant lung tumour

A

Carcinomas

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24
Q

How are primary lung carcinomas classified

A

Based on light microscopy
Broadly classified as small cell carcinoma and non-small cell carcinoma

Small cell:

  • less cytoplasm
  • nuclear chromatin fine
  • less prominent/no nucleoli

Non-small cell:

  • Usually more cytoplasm
  • Usually clumped/ vesicular nuclei
  • Usually more prominent nucleoli
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25
Q

What are the 4 major types of primary lung carcinomas

A

Squamous cell carcinoma (20-30%) (show keratinisation)
Small cell carcinoma (15-20%) (diagnosis based on nuclear characteristics)
Adenocarcinoma (30-40%) (gland formation and or mucin production)
Large cell undifferentiated carcinoma (10-15%) (non-small cell carcinoma, lacking features of other two types)

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26
Q

What are the less common primary malignant lung tumours

A 
Carcinoid tumours (low grade malignant tumours, better survival)
Malignant mesenchymal tumours (very rare, most common type is synovial sarcoma)
Primary lung lymphomas (rare, can be seen in HIB/AIDS patients)
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27
Q

What are secondary lung tumours

A 
More common than primary
Usually multiple discrete nodules but can be solitary
Most common are carcinomas from:
-breast
-GI tract
-kidney
Sarcomas
Melanomas
Lymphomas
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28
Q

What is the most common cause of cancer death

A

Lung cancer

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29
Q

What is the prognosis

A

5 year survival between 5-10% so poor

30
Q

What is the aetiology of lung cancer

A

Tobacco smoking
Occupational/industrial hazards (asbestos, uranium, arsenic, nickel)
Radiation:
-Mines in which there is radon
-Survivors of the atomic bomb in Japan after 2nd world war had high incidence
Patients with lung fibrosis
Genetic mutations (EGFR, KRAS, ALK)

31
Q

What is one pack year

A

20 cigarettes per day for 1 year

32
Q

What other respiratory illnesses out with lung cancer is associated with asbestos

A

Lung fibrosis

Mesothelioma (malignant tumour of the pleura)

33
Q

What are the local effects of lung cancer

A

Central tumours arising in proximal airways can ulcerate and bleed (haemoptysis)
Tumour obstructing airways with distal collapse or consolidation - breathlessness or features of pneumonia
Tumour infiltrating into adjacent structures:
-Pleura -pleural effusion presenting as breathlessness
-Chest wall/ribs - pain
-Recurrent laryngeal nerve - hoarseness
-Horner’s syndrome - sympathetic chain
-Oesophagus - dysphagia

34
Q

What are the common sites of distant metastases in lung cancer

A 
Lymph nodes
Pleura
Liver
Bone
Adrenal
Brain
35
Q

How is lung cancer managed

A

Small % offered surgery or radical radiotherapy if diagnosed with early stage

Majority present with advanced disease and until recently option limited to chemo or palliative radiotherapy
New advances:
-targeted therapy
-based on tumour genomics
-immune checkpoint inhibitors
36
Q

What is normal mesothelium

A

A single layer of mesothelial cells that lines the pleural cavity and secretes hyaluronic acid rich mutinous pleural fluid that lubricated the movement of the visceral and parietal pleura against each other during respiration

37
Q

What causes pleural inflammation (pleurisy or pleuritis)

A 
Primary inflammatory diseases
Infections
Pulmonary infarction
Emphysema
Neoplasma
Therapeutic
Iatrogenic
38
Q

What are the effects of pleural fibrosis

A

Widespread thick fibrosis can prevent normal expansion and compression of the lung during respiration causing breathlessness
Fibrous adhesions can wholly or partly obliterate the pleural cavity

39
Q

What are parietal pleural fibrous plaques

A

Associated with low level asbestos dust exposure
Asymptomatic
May be visible on chest radiographs
Dense poorly cellular collagen

40
Q

What is diffuse pleural fibrosis

A

Associated with high level asbestos dust exposure
Usually bilateral
Dense cellular collagen not extending into interlobar fissures
Prevents normal expansion and compression of the lung during breathing causing breathlessness

41
Q

What do the pathological fluids found in the chest mean

A

Serous fluid: pleural effusion
Pus: empyema or pyothorax (usually secondary to pneumonia)
Blood: haemothorax (usually traumatic or a ruptured thoracic aortic aneurysm)
Bile: chylothorax (usually traumatic)
Air: pneumothorax

42
Q

What are the two types of pleural effusions

A

Transudates

Exudates

43
Q

What are the causes of transudate pleural effusions

A

High vascular hydrostatic pressure (left ventricular failure, renal failure)
Low capillary onctic (colloid osmotic) pressure (hypoalbumenaemia - hepatic cirrhosis, nephrotic syndrome)

44
Q

What are the causes of exudates pleural effusions

A

Inflammation with/without infection

Neoplasms either primary or secondary

45
Q

What are the signs and symptoms of pleural effusions

A

Breathlessness
Little/no pleuritic pain
Percussion dull
Auscultation reduced breath sounds

46
Q

What investigations are done to support the diagnosis

A

Imaging:

  • ultrasound
  • chest radiograph
  • CT
47
Q

How is pleural effusions treated

A

Treat the breathlessness by removing the fluid

  • Aspiration with a needle and syringe, ultrasound guided
  • Reaspirate if fluid reaccumulates
  • For recurrent effusions when the lung expands after drainage and the underlying cause remains consider pleurodesis to obliterate the pleural cavity

Identify and treat the underlying cause

  • local:
    • pleural fluid for cytology, microbiology and biochemistry
    • pleural biopsy
  • Systemic - investigate the systemic causes of pleural effusions
48
Q

What is a pneumothorax

A

Air in the pleural cavity

49
Q

What are the types of pneumothorax

A

Open:

  • chest wall perforation usually traumatic
  • external air is drawn into the pleural cavity during inspiration, reducing potential lung expansion

Closed:

  • lung perforation, usually not traumatic, connects the lung air spaces to the pleural cavity
  • lung air is drawn into the pleural cavity during inspiration, reducing potential lung expansion
50
Q

What are the signs and symptoms of pneumothorax

A 
Breathlessness
Pleuritic chest pain
Cyanosis
Tachycardia
Contralateral tracheal deviation in tension pneumothorax
Percussion hyperresonant
Auscultation reduced breath sounds
51
Q

What investigations support diagnosis of pneumothorax

A 
Imaging:
-ulrasound
-chest radiograph
-CT
Symptomatic ones often treated without further investigation
52
Q

How is a pneumothorax treated

A

May resolve spontaneously
Can be decompressed as an emergency using a needle inserted via an intercostal space
Chest drain tube can be inserted incorporating a valve to allow air out but not in while it resolves
For recurrent ones pleurodesis is considered

53
Q

What are the types of pleural neoplasms

A 
Primary:
-benign
-malignant
Secondary malignant:
-carcinomas (breast, lung etc)
-lymphoma, melanoma, etc
54
Q

What is malignant mesothelioma

A

A neoplasm of the mesothelial cells that line serous cavities - pleural, peritoneum, pericardium, tunica vaginalis
92% pleural, 8% peritoneal
Tend not to metastasise widely

55
Q

What are the causes of malignant mesothelioma

A

Asbestos
Thoracic irradiation
BAP1 (BRCA1 associated protein 1) mutations

56
Q

What is pharyngitis

A

Inflammation of the back of the throat (pharynx), resulting in a sore throat and fever

57
Q

What is acute tonsillar pharyngitis

A

Symmetrically inflamed tonsils and pharynx (± fever, ± headache) (sever infection: patient has marked systemic symptoms of infection and/or unable to swallow)

58
Q

What is infectious mononucleosis

A

Symmetrically inflamed tonsils/ soft palate inflammation and posterior cervical lymphadenopathy

59
Q

What is epiglottitis

A

Sudden onset of sever sore throat, no inflammation of the tonsils and/or oropharynx and systemic symptoms/signs of infection

60
Q

What is the Centor criteria

A

Gives an indication of the likelihood of a sore throat being due to bacterial infection
Criteria are:
-tonsillar exudate
-ander anterior cervical lymphadenopathy
-fever over 38 degrees C
-Absence of cough
If 3 or 4 of criteria are met the positive predictive value is 40%-60%. The absence of 3 or 4 of the criteria has a fairly high negative predictive value of 80%

61
Q

What is infectious mononucleosis

A 
AKA glandular fever, EBV (Epstein-Barr virus)
Teenagers often asymptomatic
Characterised by a triad of symptoms:
-fever
-tonsillar pharyngitis
-cervical lymphadenopathy
Complications (splenic rupture)
62
Q

How is epiglottitis investigated

A

Blood cultures and epiglottic swabs

63
Q

How is epiglottitis managed

A

Acute epiglottitis and associated upper airway obstruction has significant morbidity and mortality and may cause respiratory arrest and death within 24 hours. Securing the airway & oxygenation is a priority!
IV antibiotics (usually 3rd generation cephalosporin)
Analgesia
Hib epiglottitis - Inform public health

64
Q

What is Otitis media

A

Middle ear inflammation
Fluid present in middle ear
Very common in children

65
Q

What is mastoiditid

A 
Complication of otitis media
Infection of the mastoid bone and air cells
Clinical features:
-fever
-posterior ear pain and/or local erythema over the mastoid bone
-oedema of the pinna
-posteriorly and downward displaced auricle
CT scan always required
Treatment:
-Analgesia
-IV antibiotics
-Mastoidectomy
66
Q

What makes up the respiratory tract

A

Upper:

  • Nose
  • Sinuses
  • Mouth
  • Pharynx
  • Larynx

Lower:

  • Trachea
  • Bronchi
  • Bronchioles
  • Lungs
67
Q

What is pneumonia

A

Infection affecting the most distal airways and alveoli, forming an inflammatory exudate

68
Q

What are the two anatomical patterns of acute bacterial pneumonia

A

Bronchopneumonia:
Characteristic patchy distribution centred on inflamed bronchioles & bronchi then subsequent spread to surrounding alveoli

Lobar pneumonia:
Affects a large part, or the entirety of a lobe
90% due to S.pneumoniae

69
Q

What are the signs and symptoms of bacterial pneumonia

A

Symptoms:

  • rapid onset
  • fever/chills
  • productive cough
  • mucopurulent sputem
  • pleuritic chest pain
  • general malaise, fatigue, anorexia

Signs:

  • tachypnoea, tachycardia, hypotension
  • examination finding consistent with consolidation (dull to percuss, reduced air entry, bronchial breathing)
70
Q

What are the clinical features of influenza

A

Usually an uncomplicated disease:

  • fever
  • headache
  • myalgia
  • dry cough
  • sore throat
71
Q

How are lower respiratory tract infections prevented

A

Pneumococcal vaccination:

  • Patients with chronic heart, lung and kidney disease
  • Patients with splenectomy
  • Infant vaccination schedule
  • May repeat after 5 years in certain populations

Influenza vaccination for vulnerable groups (annually):

  • 2-17 year olds
  • Over 65s
  • Chronic disease, multiple co-morbidities

Y2 Clinical Pathology (11 decks)

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