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Respiratory Pathology > URT Diseases & Pleural Diseases, Collapse & ARDS > Flashcards

URT Diseases & Pleural Diseases, Collapse & ARDS Flashcards

1
Q

Allergic rhinitis is type …. hypersensitivity, repeated attacks can lead to …. .

A

1

Allergic nasal polypi

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2
Q

Mention microscopic features of nasal polypi, and the predominant cells.

A

Respiratory epithelium showing Hyperplasia, focal ulceration or focal squamous cell metaplasia.
Mixed with predominant eosinophils

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3
Q

Rhnioscleroma is caused by

A

Klebsiella rhinoscleromatis

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4
Q

Mention histological variants of nasopharyngeal carcinoma.

A
  1. Keratinising squamous cell carcinoma
  2. Non-keratinising squamous cell carcinoma
  3. Undifferentiated carcinoma
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5
Q

Mention histological features of undifferentiated carcinoma.

A

Sheets of large epithelial cells with indistinct cell borders (syncytial growth), prominent eosinophilic nucleoli surrounded by reactive T lymphocytes.

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6
Q

Undifferentiated carcinoma spreads to ….. & it is …. (treatment).

A

Cervical L.N.

Radiosensitive

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7
Q

Why does singer’s nodule occur?
What is its presentation?
Where does it occur?

A

Due to smoking or misuse of voice
Hoarseness of voice
On true vocal cords

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8
Q

Mention microscopic features of laryngeal nodule

A

Edemarous loose fibrous tissue may become hyalinized with presence of dilated thin blood vessels.

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9
Q

Compare laryngeal squamous cell papilloma in adults and children.

A

In adults, it is single while they are multiple in children (recurrent respiratory papillomatosis) and associated with HPV 6&11, they don’t become malignant and regress at puberty.

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10
Q

Describe the gross appearnace of squamous cell papilloma

A

Raspberry like mass (mammilated surface)

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11
Q

Most affected population by laryngeal carcinoma

A

Males above 50 yrs

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12
Q

Most common laryngeal carcinoma

A

Squamous cell carcinoma

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13
Q

C/P of laryngeal carcinoma

A

Persistent hoarseness of voice

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14
Q

Mention predisposing factors of laryngeal carcinoma

A

Excessive smoking, alcohol and asbestos exposure.

HPV (15% of tumours)

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15
Q

Give reason: glottic laryngeal carcinoma send late metastasis

A

Due to sparse lymphatics

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16
Q

GR: glottic laryngeal carcinoma symptomaizes early

A

Interferes with vocal cord mobility.

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17
Q

GR: supraglottic Laryngeal carcinoma metastasize early to cervical LN

A

Rich in lymphatics

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18
Q

Describe the prognosis of subglottic Laryngeal carcinoma

A

Clinically quiescent, presents with advanced disease

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19
Q

Mention complications of Cancer larynx

A
  1. Hemorrhage, ulceration, infection and obstruction.
  2. Lung abscess and bronchopneumonia due to aspiration of septic material.
  3. Effects of metastasis
  4. Cancer cachexia
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20
Q

……&….. effusions follow metastatic involvement, which contain desquamated neoplastic cells.

A

Serous/serrosanguinous

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21
Q

Mention forces that govern the pleural fluid formation

A
  1. Hydrostatic venous pressure
  2. Osmotic pressure
  3. Vascular permeability
  4. Lymphatic drainage
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22
Q

Enumerate non-iflammatory pleural effusion types

A

Hydrothorax, haemothorax & chylothorax

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23
Q

Causes if hydrothorax & properties of the fluid

A

Congestive heart failure, renal failure & liver cirrhosis or failure.
Protein less than 30 gm/L, it is straw coloured.
If less than 300 ml clinically silent, except radiopaque obliteration of costo-phrenic angles.

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24
Q

Enumerate causes and complications of haemothorax

A

Ruptured intrathoracic aortic aneurysm (usually fatal) ot trauma to chest wall and thoracic viscera.
Organization, fibrosis & pleural adhesions.

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25
Q

Mention causes of chylothorax.

A
  1. Malignancy within the thiracic cavity, lymphoma with obstruction of major duct.
  2. Distant cancers may metastasize via lymphatics and grow within the right lymphatic or thoracic duct leading to obstruction.
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26
Q

Enumerate causes & fate of serofibrinous pleuritis

A
  1. Underlying lung lesion, pnuemonia, lung infarction, lung abscess, bronchiectasis & tuberculosis.
  2. Collagen disease as, rheumatoid arthritis, SLE, metastatic involvement of pleura.
  3. Irradiation of lung tumours.
  4. Diffuse systemic infections as typhoid fever.
    Fate: resolution/organization
27
Q

Enumerate causes of suppurative pleuritis and its gross appearnce.

A
  1. Spread from pyogenic infection from the lung
  2. Direct extension from sub-diaohragmatic & liver abscess
  3. Spread may occur by haematogenous or by lymphatic route.
    Yellowish creamy
28
Q

Compare haemorrhagic pleuritis to haemothorax

A

Differs from haemothorax in having inflammatory cells or exfoliated tumour cells.

29
Q

Mention fate and complications of emypema of the pleura

A

If inadequately managed can lead to fibrous adhesions, obliteration of pleural cavity with impairment of lung expansion
C: Toxemia, lung collapse, bronchopleural fistula.

30
Q

Exposure to …. for a number of …… causes malignant mesothelioma.

A 
Asbestos
4 years (25-40 years)
31
Q

Mechanism by which asbestos causes mesothelioma

A

Its fibers gather near mesothelial cell layer where the generate reactive oxygen species causing DNA damage & mutation.

32
Q

Enumerate causes of pneumothorax

A

Spontaneous:
1. Idiopathic spontaneous, due to rupture of small peripheral subpleural blebs.
2. Idiopathic secondary, TB, lung abscess, carcinoma, emphysema& asthma.
Traumatic

33
Q

Sequelae of tension pneumothorax

A

Severe dyspnea & circulatory failure. Mediastinum is shifted to one side with lung collapse. If the leak is sealed amd lung is not expanded, hydropneumothorax & pyo-pneumothorax will follow.

34
Q

Cause of tension pneumothorax

A

A ball & valve leak that allows air to pass into the pleural cavity during inspiration and prevent it from escape during expiration.

35
Q

Causes of haemorrhagic pleuritis

A

Metastases & rickettsial infection

36
Q

Secondary tumours of pleura may arise from

A
  1. Primary neoplasm of lung
  2. Primary neoplasm of breast
  3. Ovarian carcinoma
37
Q

Spread of mesothelioma

A

Direct invasion

Lymphatic spread to hilar L.N. & pericardium

38
Q

Symptoms of mesothelioma

A

Chest pain, dyspnea, pleural effusion & infections.

39
Q

Mention immunohistochemical staining of malignant mesothelioma

A

Calretinin, WT1 & cytokeratin 5/6

40
Q

Mention microscopic patters and characters of mesothelioma

A
  1. Epithelial pattern, resembles adenocarcinoma, with microcystic spaces & micropapillary formation.
  2. Sarcomatous pattern, spindle cell sarcoma resembling fivrosarcoma, storiform pattern arrangement.
  3. Biphasic/mixed pattern, slit like spaces lined by neoplastic mesothelium seperated by spindle shaped tumour cells.
41
Q

Describe the gross stages & features of malignant mesothelioma

A

Starts by pleural fibrosis and plaque formation, followed by localized tumour that spreads forming diffuse thick yellowish white firm gelatinous tumour enshething the lung, can invade the chest wall/subpleural lung tissue.

42
Q

Mention the causes of primary atelectasis

A

Prematurity, cerebral birth injury or intrauterine hypoxia.

43
Q

Mention the types of secondary atelactasis

A

Compression, resorption & contraction

44
Q

Causes of compression collapse

A

Associted with accumulation of fluid, blood or air within the pleural cavity.

45
Q

The cause of basal atelactasis

A

Failure to breathe deeply in bedridden patients & in patients with ascites.

46
Q

Causes of resorption collapse

A

Obstruction prevents air from reaching distal airways e.g. postoperatively due to intrabronchial mucus, mucopurulent plugs, foreign body (children), or intrabronchial tumor. Air becomes absorbed and alveoli collapse.

47
Q

Define contraction collapse

A

Local or diffuse fibrosis affecting the lung or pleura that hinders lung expansion.

48
Q

Describe the prognosis amd management of compression & resorption collapse.

A

These types are potentially reversible, should be treated to prevent hypoxemia and superimposed infection of collapsed lung.

49
Q

Signs of ARDS

A

Life threatening respiratory insufficiency
Cyanosis
Severe areterial hypoxemia

50
Q

Mention the commonality between adult and neonatal RDS

A

Formation of hyaline membrane in the alveoli

51
Q

Causes of AARDS

A

Direct lung injury: diffuse pulmonary infections, aspiration of gastric contents, inhalation of toxins & irritants, near drowning, fat embolism & pulmonary contusion.
Indirect lung injury: sepsis, trauma, burns, acute pancreatitis, blood transfusion reactions.

52
Q

Describe the pathogenesis of adult ARDS

A
  1. Macrophages release pro-inflammatory mediators as IL-8, IL-1 & TNF
  2. Oxidants, proteases amd leukotrienes damage both alveolar epithelium and endothelium
  3. Vascular leakage, edema, alveolar collapse, formation of protein rich membrane like admixed with necrotic epithelial cells.
  4. Fibrogenic cytokines as TGF & PDGF, cause proliferation of fibroblasts, pneumocytes type 2 & collagen formation.
53
Q

Compare alveolar microscopic features in acute and organizing phases

A

A: Prsence of hyaline membrane composed of fibrin rich fluid admixed with remnants of necrotic epithelial cells. Capillary interstitial congestion and collection of neutrophils in capillaries.
O: proliferation of type 2 pneumocytes in an attempt to regenerate, intra-alveolar fibrosis by fibroblast proliferation and collagen deposition.

54
Q

Clinical consequences of adult ARDS

A
  • Supportive therapy decreases mortality from 60% to 40%
  • Most patients recover normal respiratory function after 6 to 12 months after bypassing and surviving acute attack, the rest develop chronic respiratory insufficiency.
55
Q

Mentions predictors of poor prognosis in adult ARDS

A

Advanced age, sepsis & multi-organ failure

56
Q

Causes of neonatal RDS

A
  1. Premature infant (less than 28 weeks)
  2. Excessive sedation of mother
  3. C-section
  4. Aspiration of blood/amniotic fluid
  5. Coiling of umbilical cord
57
Q

Describe pathogenesis of neonatal RDS

A

Inablitity to form surfactant normally synthesized by type 2 pneumocytes, alveoli tend to collapse, infant tires of breathing leading atelactasis. Hypoxia causes epithelial and endothelial damage and hyaline membrane is formed.

58
Q

Factors affecting prognosis of neonatal RDS

A

The maturity and birth weight of infant & promptness of treatment.

59
Q

Mention NRDS prophylaxis.

A

Delaying labor till lung maturity & antenatal corticosteroid therapy & prophylactic adiminstration of surfactant to premature infant.

60
Q

Mention the effects of hormones of surfactant production

A
  • Corticosteroid stimulate its formation (stressof labour, intrauterine stress & fetal growth restriction)
  • Insulin suppresses its formation where it is high in infants of diabetic mothers.
61
Q

Define obstructive lung diseases

A

Increased resistance to airflow due to partial or complete obstruction, there is diminished maximal air flow rates during forced expiration.

62
Q

Define restrictive lung disease

A

Reduced expansion of lung parenchyma with decreased total lung capacity

63
Q

Compare causes of obstructive & restrictive lung disease

A

O: emphysema, chronic bronchitis, bronchial asthma, bronchiectasis, bronchiolitis, cystic fibrosis.
R: Interstitial: ARDS/chronic interstitial lung diseses as pneumoconiosis, sarcoidosis & idiopathic pulmonary fibrosis.
Extrapulmonary: pleural diseases, obesity, poliomyelitis & kyphoscoliosis.

64
Q

The diseases comprising COPD

A

Emphysema & chronic bronchitis

Respiratory Pathology (3 decks)

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