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YEAR 2 S2 PATHOLOGY > Respiratory system and diseases I and II > Flashcards

Respiratory system and diseases I and II Flashcards

1
Q

what are the most frequent/common diseases in the respiratory tract

A

The most frequent diseases in respiratory tract are upper respiratory tract infections(bacterial, viral)

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2
Q

other than upper respiratory tract infections which othe rinfections are important

A

lobar pneumonia, tuberculosis & opportunistic infections

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3
Q

what are the common chronic lung diseases

A

asthma, chronic bronchitis, emphysema & pulmonary fibrosis

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4
Q

where in the resp system can Clinically important tumours form

A

from bronchial tree and lung are common; almost all malignant

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5
Q

in the resp system give an example of dysfunction secondary to diseases from other systems

A

pulmonary oedema due to heart failure

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6
Q

what does the trachea consist of

A
  • Cartilage plates & smooth muscle
  • Respiratory epithelium
  • Submucosal glands
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7
Q

what is the structure of the bronchi

A
  • Cartilage foci & smooth muscle
  • Respiratory epithelium
  • Submucosal glands
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8
Q

what is the structure of the bronchioles

A
  • No cartilage, thinner muscular layer
  • Simple ciliated epithelium
  • Clara cells
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9
Q

what do alveoli consist of

A

type I and type II pneumocytes

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10
Q

describe the structure of respiratory mucosa cells

A
  • pseudostratified, columnar, ciliated epithelium with mucus-secreting goblet cells
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11
Q

what is the main defence mechanism of the resp system

A

ciliated epithelium

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12
Q

where does the common cold infect

A

upper respiratory tract

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13
Q

describe the common cold

A
  • A catarrhal disorder of upper respiratory tract, very common
  • Mainly by rhinoviruses (picornavirus group, over 100 strains - vaccination impracticable)
  • Spread by close personal contact, droplets
  • Pathology: inflamed mucosal membrane of the nose
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14
Q

where does influenza infect

A

upper respiratory tract

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15
Q

describe influenza

A
  • Influenza virus (orthomyxovirus), main forms A, B
  • type A: cause for pandemics
  • ~10,000 deaths per year in UK
  • Haemagglutinin (H) – cell attachment
  • Neuraminidase (N) – cell penetration
  • H1-H3 and N1&N2 subtypes have established stable lineage in human population
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16
Q 
describe genetic variations of influenza
spread
incubation 
symptoms 
prophylaxis
A
  • Genetic variations of the virus:
    • Major antigenic shift can caus pandemics
    • Minor antigenic drift can cause less severe epidemics
  • Spread: By droplets and fomites
  • Incubation:−1-3 days
  • Symptoms:−Fever, shivering, generalised aching (limbs)−Severe headache, sore throat, persistent dry cough
  • Prophylaxis:
  • Influenza vaccines; recent advance: M2-protein based multi-strain vaccine; universal vaccine targeting core proteins on trial
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17
Q

what is pneuomonia

how is it classified

A

Inflammation of alveoli, usually caused by bacteria

Classifications:

  • Anatomical:Lobar pneumonia (whole of one lobe)
  • Bronchopneumonia (lobules and bronchi)

Aetiological:Bacterial, Viral, Other

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18
Q

what is a common cause of pneumonia

A

STREPTOCOCCUS PNEUMONIA

- causes acquired acute pneumonia

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19
Q

who does bronchopneumonia affect

A

Most commonly in old age, infancy andpatients with debilitating diseases

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20
Q

who does lobar pneumonia

A

Typically affects healthy adults between 20-50 yrs

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21
Q

what is the pathology of pneumonia

A
  • alveolar inflammtion
  • alveoli become filled with protein rich exudate
  • Bronchopneumonia:
    • Focal inflammation along the airways (patchy consolidation), often bilateral of the lung
  • Lobar pneumonia:
    • Diffuse inflammation affecting the entire lobe; pleural exudate common
22
Q

what are the clinical features, symptoms and signs of pneumonia

A

SYMPTOMS:
respiratory symptoms: cough, purulent or rusty sputum, dyspnoea (difficulty breathing)
systemic symptoms:
pyrexia (fever)

SIGNS:

  • consolidation (THE LUNG is normally full of air but in pneumonia the lungs are filled with fluid)
  • pleural rub (pleural cavity should be empty but in pneumonia it is filled with protein exudate)

but elderly patients often have fewer symptoms

23
Q

what investigations can we do for pneumonia

A
  • Chest X-ray (cheap, specific)
  • Blood cell count:
    • WBC count >15x10^9/L suggests bacterial infection

Sputum:
- Gram stain, culture & sensitivity tests

Other specific tests:
- Myoplasma, legionella (these are gram negative bacilli)

24
Q

how can we manage pneumonia

A

if COMMUNITY ACQUIRED:
- antibiotics immediately without waiting for microbial results

if HOSPITAL ACQUIRED:
- Often Gram-negative organisms; different antibiotics

  • treatment should be modified for depending on the bacterial culture and sensitivity results

Specific measures:
- Analgesia (pleuritic pain)−O2 therapy (hypoxaemia)−Intensive care (severe pneumonia)

25
Q

what complications of pneumonia can arise

A
  • lung abscess (liquefactive necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection)
  • empyma (collection of pus in the pleural cavity)
26
Q

what is tuberculosis (TB)

A
  • The world’s leading cause of death from a single infectious disease
  • Major cause of death/morbidity in developing countries
  • Prevalence on the increase in developed countries
  • Lung – the commonest site
27
Q

what is the cause, transmission and predisposing factors of TB

A

Caused mainly by:−Mycobacterium tuberculosis

Transmission:
- Through the air, or from direct contact

Predisposing factors: −Alcohol, diabetes, immunosuppression

28
Q

what is the pathogenesis of TB

A

1) First infection with mycobacteria (primary tuberculosis)
2) Initial reaction & macrophage ingestion
3) Interacting with T-cells & development of cellular immunity
4) DELAYED HYPERSENSITIVITY REACTION ADN TISSUE NECROSIS
5) Healing & calcification
6) REACTIVATION: (diabetes, malnutrition, immunosuppression)
7) Adult post-primary pulmonary tuberculosis

29
Q

what is the pathology of TB

A

Primary TB: small GRANULOMAS in lobes (Ghon complex) often resolves

Secondary TB: Reactivation; lesions in apices: caseous necrosis in granulomas, convert to fibrocalcific scars

Miliary tuberculosis:
disseminated GRANULOMAS in many

30
Q

what are the clinical features of TB

A

primary TB: usually asymptomatic
but if symptoms are experienced@ cough, chest pain, and fever
purulent sputum

Diagnosis:

  • chest x- ray (upper zone shadows, fibrosis)
  • sputum samples (stain and culture)
31
Q

how can TB be prevented and treated

A

Prevention: BCG (bacille Calmette-Guerin)vaccination

Treatment: 3 or 4 different antibiotics in combination over 6 to 9 months

32
Q

what is COPD Chronic obstructive pulmonary disease

A
  • Characterised by poorly reversible airflow limitation, usually progressive
  • Associated with a persistent inflammatory response of the lung
  • Predominantly caused by smoking in developed countries
  • A term for patients with airflow obstruction, including chronic bronchitis or emphysema

EPIDEMIOLOGY:

  • Develops over many years; rarely symptomatic before middle age
  • Common in UK, 18% of male smokers, 14% of female smokers; one of leading causes of lost working days
33
Q

what is the aetiology of COPD

A
  • SMOKING is the dominant causal agent
    1) smoking activates macrophages in the epithelial cell region
    2) causes release of CHEMOTACTIC factors
    3) this activates GRANULOCYTES
    4) causing the release of PROTEASES
    5) this damages cells
  • there is an imbalance of proteases/protease inhibitors in COPD
  • also ATMOSPHERIC POLLUTION: has a minor role in comparison with smoking
  • also alpha1- antitrypsin: a rare cause of early onset emphysema
34
Q

what is the pathology of COPD

A

CHRONIC BRONCHITIS:

  • chronic inflammation of airways (caused by predominantly lymphocytes)
  • enlargement of mucus secreting glands of trachea and bronchi
  • airway narrowing and O AIRFLOW LIMITATION

EMPHYSEMA:

  • dilation and destruction of the lung tissue distal to terminal bronchioles
  • loss of elastic recoil, expiratory airlow limitation and air trapping
35
Q

what are the characteristic symptoms and signs of COPD

A 
SYMPTOMS: 
- cough 
- sputum 
- breathlessness
- wheeze
SIGNS: 
- tachypnoea (abnormally rapid breathing) 
- use of accessory muscles in breathing 
- hyperinflation 
- poor expansion 
- others: cyanosis (blueish tinge to skin), cor pulmonale (enlargement of the right side of the heart)
36
Q

what are the investigations for COPD

A 
LUNG FUNCTION TESTS: 
- DECREASED FEV and DECREASED FEV1/FVC 
CHEST X RAY: 
- lungs hyperinflated 
ARTERIAL BLOOD GASES: 
- normal or hypoxia and hypercapnia ( elevated carbon dioxide levels in the blood) 
HAEMOGLOBIN and PCV may be high 
ECG and echocardiography : 
- assess cardiac status if clincal features of cor pulmonale
37
Q

what is cor pulmonale

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels

38
Q

how is COPD treated
complications
prognosis

A

TREATMENT:

  • smoking cessation
  • drug therapy (bronchodilators, corticosteroids, antibiotics)
  • treatment of respiratory failure
  • other measures - heart failure, secondary polycythaemia

COMPLICATIONS:

  • respiratory failure
  • Cor pulmonale (right heart failure secondary to lung disease)

PROGNOSIS:
- 50% of patients with severe breathlessness die within 5 years

39
Q

what is asthma

A
  • chronic inflammatory condition of the lungs
  • Hyper-reactivity of the bronchial tree with paroxysmal narrowing of the airways
  • 3 main characteristics: airflow limitation, airway hyperesponsiveness and inflammation of the bronchi
  • airflow limitation is often REVERSIBLE

epidemiology:
The prevalence is increasing; geographical variation: more common in developed countries; much rarer in Far Eastern countries

40
Q

what is the aetiolgy of asthma

A

2 major factors:

1) Atopy and allergy: Readily develop IgE against common environmental antigens; genetic and environmental factors affect IgE levels
2) Increased responsiveness of the airways ofthe lung (a fall in FEV1) to stimuli

41
Q

what is the pathogenesis of asthma

A

Primary abnormality:
- Narrowing of the airway
−Thickening of the airway wall
−Secretions within the airway lumen

Inflammation:
Cellular components: eosinophils, T lymphocytes, macrophages and mast cells which release inflammatory mediators

Remodelling:
structural changes in the airway

42
Q

what are precipitating factors in asthma

A

Occupational sensitizers:
- Over 200 materials encountered at workplace may giverise to wheezing, which typically improves on days off- (occupational asthma)

Non-specific factors that cause wheezing:
- viral infections, cold air, exercise, irritant dusts,vapours and fumes, emotion and drugs

Rare cause of asthma:
- airborne spores of Aspergillus fumagatus (soil mould)

43
Q

what are the clinical features of asthma

A
  • Wheezing attacks
  • Episodic shortness of breath
  • Some have one or two attacks a year;others have chronic symptoms
  • On examination, during attack:−reduced chest expansion, prolonged expiratory time and bilateral expiratory polyphonic wheezes
44
Q

what investigations can be done on asthmatic patients

A
  • Diagnosis often made on the history and response to bronchodilators. No single satisfactory diagnostic test for all

LUNG FUNCTION TESTS:
- Demonstration of variable airflow limitation ( PEFR or FEV1)

TESTS FOR ALLERGY/HYPERSENSITIVITY:
- Airway responsiveness (histamine or methacholine)−Test of allergy (skin-prick tests)−Blood and sputum for eosinophils & Aspergillus antibody

CHEST X RAY (at diagnosis and only repeated in the case of an acute severe attack)

TRIAL OF STEROIDS REVERSIBLY:
- to those with severe airflow limitation - reversibility (↑FEV1 > 15%)

EXERCISE TESTS (in children)

45
Q

how can asthma be treated

A
  • control extrinsic factors
  • drug treatment:
    Bronchodilators:
    ß2-adrenergic agonists
    Antimuscarinic bronchodilators
    Theophyllines
    Anti-inflammatory agents:
    steroids
    Chromones
    Leukotriene receptor antagonists
    Immunosuppressive agents
46
Q

what are the 2 types of lung tumour

A
  • primary

- secondary

47
Q

describe primary carcinoma of the lung (bronchial carcinoma)

A
  • Accounts for 95% of all primary tumours of the lung
  • Most common malignant tumour in the world
  • poor prognosis:
    • 5 year survival rate <10%
48
Q

what are the major risk factors/ aetiology in primary carcinoma of the lung

A
  • Directly related to smoking
  • Associated with occupational exposure to carcinogens
  • Pulmonary fibrosis
49
Q

what is the pathology of primary carcinoma of the lung

A
  • most arising form bronchi (hilum)
  • main histological types:
    • Squamous cell carcinoma
    • Small cell lung carcinoma
    • Adenocarcinoma
    • Large cell undifferentiated carcinoma
50
Q

what are the clinical features of primary carcinoma pf the lung

A
  • Cough
  • Chest pain
  • Haemoptysis
  • Weight loss
51
Q

how is primary carcinoma diagnosed

A
  • Chest X-ray
  • CT
  • Biopsy & cytology
52
Q

how is primary carcinoma treated

A
  • Surgical resection
    • Non small cell lung cancer
  • Chemotherapy
    • Small cell lung cancer
  • Radiotherapy
    • Localised tumours

overall poor prognosis

Recent advances:
specific targeted therapies: EGFR mutation –EGFR tyrosine kinase inhibitorALK fusion oncogene –ALK inhibitor

YEAR 2 S2 PATHOLOGY (22 decks)

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