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IOD > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

1
Q

Define COPD

A

progressive airway obstruction which does not change markedly over several months. It is characterised by persistent airflow obstruction which is poorly reversible and usually progressive

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2
Q

define chronic bronchitis

A

cough productive of sputum for 3 consecutive months for 2 consecutive years which cannot be attributed to other cardiac or pulmonary disease

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3
Q

define emphysema

A

permanent dilatation of the airways distal to the terminal bronchioles due to the destruction of alveolar walls.

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4
Q

effects of smoking in the airways

A

bronchi: hyperplasia of mucus-producing glands in the submucosa and hyperplasia of the goblet cells on the surface epithelium causing increased sputum production

chronic inflammation, heals by fibrosis causing stenosis of airways

destruction of the walls of the respiratory bronchioles, with loss of elastic tissue but without significant fibrosis–> airway dilatation–> emphysema

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5
Q

what effect does the destruction of the respiratory bronchiole walls have?

A

loss of pulmonary surface area for gas exchange leading to hypoxia

loss of the elastic tissue of the terminal airways results in the loss of the natural recoil of the lungs –> airway obstruction

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6
Q

what is an acute exacerbation of COPD?

A

sudden, sustained worsening in a patient’s symptoms that is beyond their normal day to day variation

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7
Q

most common cause of acute exacerbation of COPD

A

infection

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8
Q

what are 3 complications of COPD

A

cor pulmonale

emphysema- loss of pulmonary arterioles and capillaries

chronic hypoxia causes pulmonary arterial vasoconstriction

chronic hypoxia also causes increased EPO leading to increased RBC production and blood viscosity

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9
Q

define pneumonia

A

inflammation of the lung parenchyma due to an infective agent

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10
Q

characteristics of bronchopneumonia

A

widespread patchy inflammation centred on the airways- often bilateral

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11
Q

characteristics of lobar pneumonia

A

diffuse inflammation affecting an entire lobe or lobes

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12
Q

4 types of pneumonia

A

hospital acquired
community acquired
aspiration
pneumonia in the immunocompromised

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13
Q

what is the main cause of hospital acquired pneumonia

A

60% gram negative bacteria e.g. E.coli and Pseudomonas

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14
Q

commonest cause of community acquired pneumonia

A

Strep pneumoniae

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15
Q

2 other important causes of community acquired pneumonia

A

Legionella

Staph aureus

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16
Q

what is the CURB-65 score?

A

severity score for community-acquired pneumonia

Confusion 
Urea >7mmol/L
Resp rate >30
BP <90/60
65 years or older
17
Q

causes of pneumonia in the immunocompromised

A 
pneumocystis
Candida
Aspergillus 
M. tuberculosis
CMV
HSV
18
Q

what are diffuse parenchymal lung diseases

A

large group of conditions characterised by inflammation centres on the interstitium of alveolar walls.

19
Q

pathology of diffuse parenchymal lung disease

A

lung interstitium becomes expanded by an anti-inflammatory cell infiltrate which impairs gas exchange and causes breathlessness

In some instances the inflammation is followed by repair by scarring; macrophages release fibrogenic cytokines and stimulate fibroblasts in the interstitium to secrete collagen. The thickened walls of the alveoli are ineffective at gas exchange which worsens SOB.

20
Q

define pneumonitis

A

inflammation of the lung parenchyma i.e. alveoli

21
Q

5 causes of diffuse parenchymal lung disease

A 
idiopathic 
inhaled inorganic/mineral dust
extrinsic allergic alveolitis
chest radiation 
drugs e.g bleomycin and amiodarone 
multisystem disease e.g. SLE, sjorgens
22
Q

long term consequences of diffuse parenchymal lung disease

A

pulmonary hypertension

cor pulmonale

23
Q

4 types of lung cancer

A

squamous cell carcinoma
adenocarcinoma
small cell carcinoma
large cell carcinoma

24
Q

RFs for lung cancer

A 
smoking
asbestos
radiation 
radon gas
genetic factors e.g. EGFR gene mutations
25
Q

clinical presentation of lung cancer

A 
cough 
haemoptysis 
stridor/wheeze
hoarse voice
SOB
chest wall pain 
non-resolving pneumonia
26
Q

common cause of SVC obstruction

A

right sided lung cancer

27
Q

clinical signs and symptoms of SVC obstruction

A 
increased venous pressure
interstitial oedema 
SOB
facial swelling
head fullness
cough
arm swelling
chest pain
dysphagia 
hoarseness
stridor

EMERGENCY

28
Q

4 characteristic symptoms of Horner syndrome

A

endophthalmos (eyeball depression).

ptosis (droop) of upper eyelid.

miosis (pupil constriction).

anhidrosis (absence of sweating).

29
Q

what is paraneoplastic syndrome

A

a syndrome caused by substances produced by the tumour cells which act remotely from the tumour or the metastases

may also be caused by antibodies produced by the body against the tumour but cross-react with normal tissues and damage them

30
Q

examples of paraneoplastic syndrome

A

hypercalcaemia
SIADH
ectopic ACTH secretion by tumour cells
Lambert Eaton myasthenic syndrome

31
Q

Pathogenesis of hypercalcaemia as a paraneoplastic syndrome

A

common with squamous cell carcinoma- release of PTH related peptide by tumour cells

32
Q

Pathogenesis of SIADH as a paraneoplastic syndrome

A

mainly seen with small cell carcinoma

inappropriate ADH secretion by the tumour cells

33
Q

Pathogenesis of ectopic ACTH secretion as a paraneoplastic syndrome

A

usually associated with small cell carcinoma

inappropriate secretion of ACTH by tumour cells leading to bilateral adrenal cortical hyperplasia and secretion of inappropriate amounts of cortisol

34
Q

Pathogenesis of Lambert Eaton myasthenic syndrome as a paraneoplastic syndrome

A

typically associated with small cell carcinoma

autoantibodies block VGCC in the presynaptic membrane thereby blocking ACh release.

35
Q

what is mesothelioma

A

malignant tumour of the pleura associated with asbestos exposure

36
Q

prognosis of mesothelioma

A

mean survival around 18months from diagnosis

37
Q

what is asbestosis

A

diffuse fibrosis of the lung parenchyma due to asbestos

IOD (54 decks)

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