Respiratory System Pathology Flashcards
What is the function of type 1 pneumocytes
Gas exchange
What is the function of type 2 pneumocytes
Surfactant production
Respiratory failure could be a result of defects in what 3 main areas?
Ventilation, perfusion and gas exchange
What blood o2 concentration classifies as respiratory failure
PaO2
What O2 and CO2 concentrations class as type 1 respiratory failure
PaO2
What O2 and CO2 concentrations class as type 2 respiratory failure?
PaO26.3kPa
Proximal airway obstruction
Stridor
Distal airway obstruction
Wheeze
What would you find on examination, if someone has restricted opening of their small airways?
Crackles
What would you find on examination, if someone has narrowed small airways
Wheeze
Sound conduction through solid lung
Cronchial breathing
Lung consolidation or pleural effusion- what would you see on examination?
Dull percussion
What would you see on examination if someone had a pneumothorax or emphysema?
Hyperesonant
Benign, primary lung neoplasm
Adenochondroma
What are the 4 main type of lung cancer?
Small cell carcinoma, squamous carcinoma, adenocarcinoma and undifferentiated large cell carcinoma
Non small cell carcinomas account for what proportion of lung diseases?
85%
How do secondary tumours usually present?
Multiple bilateral nodules
Which lung cancers are more peripherally sited?
Adenocarcinomas
What type of lung cancer is often seen with hypercalcaemia due to parathyroid related peptide in the neoplasm?
Squamous carcinoma
What is the usualy (90%) cause of squamous carcinoma?
Iriitants e.g. smoke, cause the normal pseudostratified columnar epithelium to undergo a reversible metastatic change to stratified squamous- may keratinise (like skin)
1st metastatic cell undergoes irreversible genetic changes
Dysplasia
In which lung cancer is thyroid transcription factor expressed?
Adenocarcinoma
What is a type of adenocarcinoma that is typically termed ‘adenocarcinoma in situ’ that is the spread of well differentiated mucinous or non mucinous neoplastic cells on alveolar walls. Not invasive and mimic pneumonia.
Bronchioalveolar carcinoma
Low grade, benign tumours not associated with smoking
Carcinoid tumours
‘Oat cell’ carcinomas- metastasise early, poorly differentiated. Secreted ACTH and almost all in smokers.
Small cell carcinoma
What skin condition is a paraneoplastic effect of lung carcinoma?
Acanthosis nigricans
Hypertrophic pulmonary osteroarthropathy
Clubbing
What coagulopathy is common paraneoplastic effect of lung cancer?
Thrombophelbitis migrans
Name a new drug used for lung cancers, that target epidermal growth factor receptors
Epidermal growth factor receptor tyrosine kinase inhibitors e.g. gefitinib and erlotinib
Lymph in pleural space
Chylothorax
Pus in pleural space
Empyema
Benign pleural tumour
Fibroma
Most common malignant secondary pleural tumour
Adenocarcinoma
Primary malignant pleural tumour
Malignant mesothelioma
What risk factor is commonly associated with malignant mesothelioma?
Aspestos exposure
How does early malignant mesothelioma typically present?
Small plaques on parietal pleura, may produce significant pleural effusion
These are found on the lower thoracic wall and diaphraymatic parietal pleura- marker of aspestos exposure .No physiological effect, not pre-malignant.
Fibrous pleural plaques
Causative organism of bronchiolitis
RSV
Inflammatory exudate in alveoli and distal small airways consolidations
Pneumonia
2 anatomical types of pneumonia
Bronchopneumonia and lobar pneumonia
Which type of pneumonia is most often primary (previously healthy)?
Lobar pneumonia
Which type of pneumonia is often caused by strep.pneumoniae?
Lobar pneumonia
Which type of pneumonia is most common
bronchopneumonia
Which type of pneumonia is often patchy and bronchocentric?
Bronchopneukonia
Describe the appearance of lobar pneumonia
congestion- red then grey
Which pneumonia typically heals with scarring?
Bronchopneumonia
What autoimmune sydrome can present as pulmonary vasculitis- intra-alveolar haemorrhage and glomerulonephritis
Goodpasture’s syndrome
Name 4 obstructive lung condiitons
Bronchiectasis, COPD (chronic bronchitis and emphysema), asthma and bronchiolitis
Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue. Results from chronic nectrotizing infection
Bronchiectasis
Which obstructive lung condition presents as copious amounts of foul smelling sputum?
Bronchiectasis
Predisposing conditions of bronchiectasis
CF, primary ciliary dyskinesia (kartagener’s syndrome), bronchial obstruction, rheumatoid arthritis, IBD
What is the histological presentation of COPD
Mucous gland hyperplasia and hypersecretion
Does emphysema occur with or without fibrosis?
Without
Differenct between emphysema and overinflation?
Both dilation of airspaces distal to terminal bronchioles, without obvious fibrosis. Emphysema- airspace wall destruction too.
3 classes of emphysema
Centrilobar (centriacinar)
Panlobar (panacinar)
Paraseptal (distal acinar)
Airspaces in the centre of lobules.
Centrilobar
Which type of emphysema is associated with smoking or coal dust?
Centrilobar
All airspaces distal to terminal bronchioles. Lower lobes mainly. Seen in 30-80% patients with alpha-1-antitrypsin deficiency
Panlobar
Airspaces at the periphery of lobules. Often adjacent scarring and fibrosis. Pneumothorax if ruptures.
Paraseptal
COPD with pred. bronchitis stereotype
Blue boater
COPD with pred. emphysema stereotype
Pink Puffer
Cor. pulmonale (dilated Right side of heart) seen in COPD patients with pred. bronchitis or pred. emphysema?
Pred. bronchitis
Conditions which presents as mucosal inflammation and oedema and hyperinflated lungs?
Asthma
What types of asthma are there?
Atopic, acute, aspirin induced, occupational
Which type of asthma is a type 1 hypersensitivity reaction in children/adults?
Atopic asthma
Is interstitial lung disease a restrictive or obstructive lung disease?
Restrictive
What are the 3 characteristics of interstitial lung disease?
Increase tissue in alveolar-capillary wall- ifnlammation and fibrosis
Reduced lung compliance
Increased gas diffusion distance
Diffuse alveolar wall damage caused by shock, trauma, infection etc. activated complement and results in a massive cytokine release, presenting as acute dyspnoea, tachypneoa and respiratory distress
Adult respiratory distress syndrome
honeycomb lung
Chronic interstitial lung disease
4 types of chronic interstitial lung diseases
Idiopathic pulmonary fibrosis
Pneumoconiosis
Sarcoidosis
Collagen vascular diseases- associated lung disease
Cobblestone pleural surface- contraction of interstitial fibrous tissue accenuates lobular architecture
Idiopathic pulmonary fibrosis
Multisystem inflammatory disorder, commonly involving mediastinal lymph nodes and lung.
Sarcoidosis
Discrete non-caseating granulomas with frequent lymph node involvement
Sarcoidosis
Inflammatory disorder presenting as chronic interstitial lung disease, commonly in young females
Sarcoidosis
‘The dust diseases’
Pneumoconioses
Give 1 example of fibrous pneumoconiosis
Asbestosis
