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Year 2 clinical pathology > Week 5 RESPIRATORY PATHOLOGY > Flashcards

Week 5 RESPIRATORY PATHOLOGY Flashcards

1
Q

What is the histology of the conducting airways?

A

Pseudostratified cilliated columnar mucus secreting epithelium

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2
Q

What is the histology of the alveoli?

A

Mostly flat Type I pneumocytes (gas exchange) & some rounded Type II pneumocytes (surfactant production)

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3
Q

What is the partial pressure of oxygen during respiratory failure?

A

PaO2

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4
Q

What is the cause of respiratory failure?

A

Due to defective:

Ventilation
Perfusion
Gas exchange

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5
Q

What is Type I respiratory failure?

A

Type I (paCO2

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6
Q

What is Type 2 respiratory failure?

A

(paCO2>6.3kPa)

Hypercapnic respiratory drive

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7
Q

What are the general Respiratory signs & symptoms?
What does each one indicate?
There is 9

A

Sputum - Mucoid, purulent, haemoptysis
Cough - Reflex response to irritation
Stridor - Proximal airway obstruction
Wheeze - Distal airway obstruction
Pleuritic pain - Pleural irritation
Dyspnoea - Impaired alveolar gas exchange
Cyanosis - Decreased oxygenation of haemoglobin
Clubbing -
Weight loss - Catabolic state with chronic inflammation or tumours

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8
Q

What do the different auscultation of respiratory examination indicate?

A

Crackles – Resisted opening of small airways
Wheeze – narrowed small airways
Bronchial breathing – Sound conduction through solid lung
Pleural rub – Relative movement of inflamed visceral & parietal pleura

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9
Q

What do the different percussion of respiratory examination indicate?

A

Dull – Lung consolidation or pleural effusion

Hyperesonant – Pneumothorax or emphysema

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10
Q

How common are primary benign lung tumours?

Give a example

A

Rare

Example is adenochondroma

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11
Q

What percentage of primary lung cancer is carcinoma based?

A

90%

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12
Q

What is the biggest risk factor of lung carcinoma?

A

cigarettes (80%)

Secondary cigarette smoke - 10-30% increase

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13
Q

What are the risk factors of lung carcinoma?

A

asbestos, high level exposure, with or without asbestosis

lung fibrosis – including asbestosis and silicosis

radon

chromates, nickel, tar, hematite, arsenic, mustard gas

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14
Q

What does high doses of asbestoscause?

A

High level exposure produces pulmobary interstitial fibrosis –>asbestosis

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15
Q

What does asbestos look like under a ligh microscope?

A

Fibres coated with mucopolysacharide & ferric iron salts

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16
Q

What is the most dangerous type of asbestos?

A

Crocidolite –> blue asbestos

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17
Q

What is the least dangerous type of asbestos?

A

White asbestos (chrysotile)-

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18
Q

What is Mesothelioma?

A

A cancer of mesothelial tissue, associated especially with exposure to asbestos

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19
Q

What is high levels of asbestos linked to?

A

Higher incidence of all types of lung carcinoma

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20
Q

what is the problem in linking asbestos to lung carcinoma?

A

Effects of smoking – multiplicative risk
Diagnosing asbestosis
Quantification of asbestos exposure

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21
Q

What are the two types of lung carcinoma?

A

non-small cell carcinoma (85%)

small cell carcinoma (15%)

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22
Q

Give examples of non-small carcinoma?

A

squamous carcinoma 52%
adenocarcinoma 13%
large cell neuroendocrine carcinoma
undifferentiated large cell carcinoma

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23
Q

What type of cells are small cell carcinoma?

A

All are neuroendocrine

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24
Q

What are neuroendocrine cells?

A

Neuroendocrine cells are cells that receive neuronal input and, as a consequence of this input, release hormones to the blood.

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25
Q

Give example of a Carcinoid tumours?

A

Low grade neuroendocine epithelial tumours

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26
Q

What is more common secondary or primary lung tumors?

A

Secondary

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27
Q

What is the presentation of secondary lung tumours?

A

Typically multiple bilateral nodules but can be solitary

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28
Q

How do you tell the difference between primary or secondary tumor?

A

History

Morphology
some adenocarcinomas, but not squamous

Antigen expression
Immunocytochemistry is useful but not 100% reliable

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29
Q

When performing immunocytochemistry on a patient with Lung non-mucinous adenocarcinoma & small cell
what should you identify?

A

cytokeratin & thyroid transcription factor positive

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30
Q

When performing immunocytochemistry on a patient with Colorectal cancer what should you identify?

A

cytokeratin 7 negative & cytokeratin 20 positive

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31
Q

When performing immunocytochemistry on a patient with Upper gastrointestinal tract cancer what should you identify?

A

Cytokeratin 7 positive & cytokeratin 20 positive

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32
Q

When performing immunocytochemistry on a patient with breast cancer what should you identify?

A

May be oestrogen receptor positive

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33
Q

When performing immunocytochemistry on a patient with melanoma what should you identify?

A

S100, HMB45, MelanA positive & cytokeratin negative

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34
Q

Where is lung carcinoma often found?

A

Most central, main or upper lobe bronchus (bronchogenic

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35
Q

What is the structure of Squamous carcinoma?

A 
desmosomes link cells like epidermis 
\+/- keratinization
Occurs in ~90% in smokers
Central areas  > peripheral
hypercalcaemia due to parathyroid hormone related peptide
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36
Q

What is bronchial normally lined with?

A

Lined by pseudostratified columnar epithelium with ciliated and mucus-secreting cells

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37
Q

How does Squamous metaplasia occur on the bronchial epithelium?

A

Irritants such as smoke cause the epithelium to undergo a reversible metaplastic change from pseudostratified columnar to stratified squamous type which may keratinize (like skin)

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38
Q

How is the first neoplastic cell produced?

A

One metaplastic cell undergoes irreversible genetic changes producing the first neoplastic cell

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39
Q

How does dysplasia develop?

A

The neoplastic cell proliferates more sucessfully than the metaplastic cells

The neoplastic clone relaces the metaplastic cells producing dysplasia

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40
Q

How does Squamous cell lung cancer (carcinoma) metastases?

A

Neoplastic cells breach the basement membrane producing invasive squamous carcinoma

Invading neoplastic cells infiltrate lymphatic & blood vessels to produce metastases in lymph nodes & distant sites

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41
Q

Where Adenocarcinoma in the lung develop?

A

It develops from mucus making cells in the lining of the airways.

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42
Q

What is expressed in many non-mucinous lung adenocarcinomas ?

A

Thyroid transcription factor

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43
Q

What is Bronchioloalveolar carcinoma?

A

A type of adenocarcinoma that has a better outlook (prognosis) than those with other types of lung cancer

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44
Q

What is the structure of Bronchioloalveolar carcinoma?

A

Spread of well differentiated mucinous or non-mucinous neoplastic cells on alveolar walls

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45
Q

Is Bronchioloalveolar carcinoma invasive?

A

Not invasive - “adenocarcinoma in situ”

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46
Q

What disease does Bronchioloalveolar carcinoma mimic?

A

Mimics pneumonia

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47
Q

What neuroendocrine proteins in lungs are detected by immunocytochemistry?

A

Neural cell adhesion molecule (CD56)

Neurosecretory granule proteins :
chromogranin, synaptophysin

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48
Q

What neuroendocrine does electron microscope detect?

A

Neurosecretory granules

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49
Q

What is a carcinoid tumours?

A

A carcinoid tumour is a rare cancer of the neuroendocrine system – the body system that produces hormones.

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50
Q

Where does carcinoid tumours grow in the lungs?

A

Often grow into and occlude a bronchus

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51
Q

What cells is carcinoid tumours made of?

A

Organoid, bland cells, no necrosis

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52
Q

What syndrome is carcinoid tumours associated with?

A

Associated with multiple endocrine neoplasia syndrome type 1

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53
Q

Is carcinoid tumours associated with smoking?

A

NO

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54
Q

What is the survival rate of carcinoid tumours and how does it spread?

A

Not “benign” may invade lymphatic vessels and nodes but rare distant metastases 6-9% to hilar nodes, less to distant sites, 95% 5yr survival

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55
Q

What is the difference between typical and atypical carcinoid tumours?

A

Typical lung carcinoids grow slowly and rarely spread to other parts of the body

Atypical lung carcinoids are much rarer, tend to grow faster and are slightly more likely to spread to other parts of the body than typical lung carcinoids

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56
Q

What percentage of lung carcinoid are atypical?

A

11%

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57
Q

Structure of atypical carcinoid?

A

Less organoid, more atypia, nucleoli - may be focal atypia in an otherwise typical carcinoid

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58
Q

What percentage of atypical carcinoid tumors metastasise and what is the survival rate?

A

70% metastasise

60% 5yr survival

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59
Q

What is the structure of Large cell neuroendocrine carcinomas?

A

Neuroendocrine morphology
organoid architecture, eosinophilic granular cytoplasm
antigen expression

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60
Q

What is the prognosis of Large cell neuroendocrine carcinomas? What is it assoicated with?

A

Prognosis similar to or worse than other non-small cell lung carcinomas
Associated with smoking

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61
Q

What is a characteristic of Small cell carcinoma?

A

Rapidly progressive malignant tumours

Neurosecretory granules with peptide hormones such as ACTH

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62
Q

Is surgery possible with small cell carcinoma and why?

A

No because it expands very quickly

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63
Q

What is the structure of Large cell carcinomas?

A

No specific squamous or glandular morphology

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64
Q

What does Large cell carcinomas express?

A

50% express thyroid transcription factor

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65
Q

Large cell carcinomas can act as neuroendocrines, what do they express?

A

Express CD56 &/or neurosecretory granule proteins (synaptophysin, chromogranin)

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66
Q

What is the Paraneoplastic effects of lung carcinomas?

A 
Cachexia
Skin 
clubbing
Coagulopathies 
Encephalomyelitis, neuropathies & myopathies 
Endocrine effects
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67
Q

What are the endocrine effects from lung carcinomas?

A

Parathyroid hormone-related peptide from squamous cell carcinoma causing hypercalcaemia
ACTH and antidiuretic hormone from small cell carcinoma
5-hydroxytryptamine - carcinoid (uncommon)

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68
Q

What disease is caused by the Encephalomyelitis, neuropathies & myopathies side effects of lung carcinomas?

A

Lambert Eaton myasthenic syndrome due to anti-neuromuscular junction autoantibodies in small cell carcinoma

69
Q

What happens to people skin who have lung carcinomas?

A

acanthosis nigricans,

tylosis

70
Q

How many stages are there of lung malignancy?

A

T1-T4

71
Q

What stage of lung malignancy is nodules present?

A

T3 –> nodules present in same love

72
Q

What stage of lung malignancy is nodules present in the othe lobe?

A

T4

73
Q

At what stage does the lung malignancy invade the chest wall and diaphragm?

A

T3

74
Q

At what stage does the lung malignancy invade the Heart, great vessels, trachea, esophagus and spine?

A

T4

75
Q

What stage does atelectasis of whole lung occur?

A

T3

76
Q

How does epidermal growth factor receptor tyrosine kinase inhibitors work?

A

Inhibition of EGFR TK mediated protein phosphorylation and activation of the mitotic cycle
Not curative but stabilises progression until resistance mutations develop

77
Q

Give examples of epidermal growth factor receptor tyrosine kinase inhibitors work?

A

Gefitinib (Iressa) and erlotinib (Tarceva) are ATP analogues that inhibit EGFR-TK if activating mutations are present
Oral medication, less toxic than standard cytotoxic chemotherapy

78
Q

How common are Sensitising mutations to epidermal growth factor receptor tyrosine kinase inhibitors work?

A

Sensitising mutations present in 10% of non-small cell lung cancers and are commoner in adenocarcinomas in non-smoking Asian women

79
Q

How is ALK gene rearrangements detected?

How common is it?

A

Detect mRNA by FISH, CISH of RT-PCR
Low expression so ICC is difficult

Present in about 10% of lung adenocarcinomas
Non-smoking, Asian, women again

80
Q

What mutations is ALK gene rearrangements independent of?

A

Independent of EGFR or RAS mutations

81
Q

What is the mutation in ALK gene rearrangements?

A

Variable break point inversion on short arm of chromosome 2 fuses ALK and EML
genes activating ALK tyrosine kinase.

82
Q

What is the action of Crizotinib?

A

ATP analog inhibits ALK, ROS1, c-Met (Hepatocyte Growth Factor receptor /HGFR) tyrosine kinases

Temporary control – no progress or regress

83
Q

How effective is Crizotinib?

A

Effective in about 90% of tumours with ALK-EML fusion gene FDA approval

84
Q

What are the different damages to pleura?

A 
Pneumothorax -----------------air
tension pneumothorax
Pleural effusion (hydrothorax)
transudate or exudate
Haemothorax -------------------blood --> due to trauma
Chylothorax --------------------lymph
Empyema (pyothorax) --------pus
85
Q

What is pleura effusion?

A

Pleural effusion, is the build-up of excess fluid between the layers of the pleura outside the lungs.

86
Q

Causes of pleura effusion?

A 
Inflammatory:
	Serous/fibrinous –exudate
	Due to inflammation/infection in adjacent lung
Non inflammatory: 
	Congestive Cardiac Failure – transudate
87
Q

How is pleura effusion diagnosed?

A

LDH, pH, Glucose of fluid can be measured to suggest a diagnosis

Cytology used to assess the presence of malignant or inflammatory cells

88
Q

What diseases can cause pleuritis?

A

collagen vascular diseases
pneumonia, tuberculosis
lung infarct, usually secondary to pulmonary embolus
lung tumour

89
Q

What is the effect of asbestos on pleura?

A

Effusion, fibrous plaques, diffuse fibrosis

90
Q

Give example of benign Pleural tumours?

A

Benign - rare

fibroma

91
Q

What is the main cause of Malignant mesothelioma ? What is the latent period?

A

> 90% associated with asbestos exposure, blue (especially) or brown most hazardous

Occupational, paraoccupational or environmental contamination

Exposure may be low level

Long latent period of 15 to 60+ years from exposure before the mesothelioma develops

92
Q

What is the actions of malignant mesothelioma?

A

lung
Invades chest wall (pain) & lung
Nodal and distant and metastases less common than with carcinomas
Mixed spindle cell and epithelioid cells. May be very fibrous (desmoplastic)

93
Q

What are the difficulties in diagnosing malignant mesothelioma? How do you differentiate from adenocarcinoma ?

A

Differential diagnosis from reactive mesothelial cells in inflamed pleura can be very difficult

Differentiate from adenocarcinoma by cellular antigen expression (immunocytochemistry on cytology or biopsy)

94
Q

What is the prognosis and treatment of malignant mesothelioma?

A

Symptomatic treatment

Uniformly fatal in, usually

95
Q

What are the presenations of Early malignant mesothelioma?

A

Small plaques on the parietal pleura
Difficult to image & biopsy
May produce a significant pleural effusion

96
Q

What is Fibrous pleural plaques indication of?

A

Associated with low levels of exposure to asbestos

97
Q

How does Fibrous pleural plaques present itself?

A

On the lower thoracic wall & diaphragmatic parietal pleura

98
Q

What is the actions of Fibrous pleural plaques present and how is it diagnosed?

A

No physiological effect
Not premalignant
Seen on radiographs, a marker of possible asbestos exposure

99
Q

What are the two types of infection?

A

Primary - Previously healthy

Secondary - Weakened defence

100
Q

What is the cause of Acute bronchitis?

A

Viral (RSV), H. influenzae, Strep. pneumoniae
Croup
Exacerbations of COAD

101
Q

What is the profile of Bronchiolitis ?

A

Common in the young

Primary acute in infants, RSV, rare, resolve or develop bronchopneumonia

Follicular bronchiolitis
Bronchiolitis obliterans

102
Q

What is pneumonia?

A

Inflammatory exudate in alveoli & distal small airways - consolidation

103
Q

What are the different classifications of Pneumonia?

A

Clinical - primary or secondary
Aetiological - Bacterial, viral, fungal
Anatomical - lobar pneumonia or bronchopneumonia
Reaction - purulent, fibrinous

104
Q

What is the profile of Bronchopneumonia?

A 
Secondary - compromised defences
Often low virulence bacteria or occasionally fungi
Common
Patchy
Bronchocentric
Resolve or heal with scarring
105
Q

Who is at risk of Lobar pneumonia? What is its cause?

A

Primary - typically male 20 to 50 years
90% - virulent Strep pneumoniae
Uncommon

106
Q

What are the actions of Lobar pneumonia?

A

Confluent segments, whole lobe or lobes with overlying pleuritis
Congestion, red then grey hepatisation, resolution without scarring

107
Q

What are the Non-immunosuppressed causes of atypical pneumonia?

A

Viral - flu, varicella, RSV, rhino, adeno, measles
Mycoplasma pneumoniae - Mild, chronic, fibrosis
Chlamydia (psittacosis), Coxiella burnetti (Q-fever)
Legionella pneumophilla - Systemic, 10- 20% fatal

108
Q

What are the actions of Non-immunosuppressed causes of atypical pneumonia?

A

Severity mild to fatal
Intersitial lymphocytes, plasma cells, macrophges
Intra-alveolar fibrinous cell-poor exudate
Diffuse alveolar damage (DAD)

109
Q

What kind of people have immunosuppressed atypical pneumonia?

A

People who have Lymphomas, medication, AIDS

110
Q

What y low virulence or non-virulent organisms can cause atypical pneumonia in people who are immunocompromised?

A

Fungi - candida, aspergillus, Pnumocystis carinii

Viruses - CMV, HSV, measles

111
Q

Give examples of non infective pneumonias?

A

Aspiration pneumonia
Secondary infection often with mixed anaerobes produces abscesses

Lipid pneumonia
Endogenous – retention pneumonitis
Exogenous – aspiration

Cryptogenic organising pneumonia & bronchiolitis obliterans organising pneumonia (COP & BOOP)

112
Q

What is the cause of Pulmonary tuberculosis and where it is commonly found in the body?

A

Mycobacterium tuberculosis

Lung is the commonest site of infection

113
Q

What is the association of Pulmonary TB?

A

Socioeconomic deprivation

Immunosuppression - including AIDS and transplant patients

114
Q

What are the treatments of pulmonary TB?

A

Bacille Calmette-Guerin (BCG) vaccine

Antituberculous drugs & multidrug resistance

115
Q

What is the sequence of events in Pulmonary tuberculosis ?

A

Primary infection - Asymptomatic, Ghon complex in peripheral lung & hilar nodes, usually resolves

Reactivation - usually apical

Resolution or progression - empyema, pneumonia, miliary or more limited spread to other organs - bone, kidney

Scarring - fibrous calcified scar

116
Q

What are the diffrent types of emboli?

A

Thromboemboli
Fat emboli - fat & marrow from bone fracture
Air - due to medical error
Amniotic fluid
Tumour
Foreign bodies –> IV drug users and there needle snap off and get embolism

117
Q

Give example of a localised obstructive pulmonary diseases

A

Distal retention pneumonitis (endogenous lipid pneumonia) and bronchopneumonia

Distal bronchiectasis (bronchial dilatation

118
Q

What is the consequence of localised obstructive pulmonary diseases?

A

Tumour or foreign body

Distal alveolar collapse (total) or over expansion (valvular obstruction)

119
Q

What is Bronchiectasis?

A

Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue

120
Q

How common is Bronchiectasis?

A

Rare due to antibiotics

121
Q

What is the cause and site of Bronchiectasis?

A

Results from chronic necrotizing infection

Site: Bronchus/bronchioles

122
Q

Signs and symptoms of Bronchiectasis?

A

Cough, fever, copious amounts of foul smelling sputum

123
Q

What are predisposing conditions to Bronchiectasis?

A

Cystic fibrosis
Primary ciliary dyskinesia, Kartagener syndrome
Bronchial obstruction: tumour, foreign body
Lupus, rheumatoid arthritis, inflammatory bowel disease, GVHD

124
Q

What is the treatment and complications of Bronchiectasis?

A

Treatment –> retractable

Complications –> pneumonia, septicaemia, metastatic infection, amyloid

125
Q

Give two example of diffuse obstructive pulmonary disease?

A

Chronic obstructive pulmonary disease

Asthma

126
Q

What is COPD a combination of?

A

A combination of chronic bronchitis & emphysema

127
Q

What is site and cause of Chronic bronchitis?

A

Site: Bronchus
Cause : Chronic irritation
Smoking & air pollution
Middle aged & old

128
Q

What is chronic bronchitis?

A

cough & sputum for 3 months in each of 2 consecutive years

129
Q

What is the pathology of chronic bronchitis?

A

Mucus gland hyperplasia and hypersecretion, secondary infection by low virulence bacteria, chronic inflammation

130
Q

What is the result of chronic bronchitis?

A

Chronic inflammation of small airways of the lung causes wall weakness & destruction thus centrilobular emphysema

131
Q

What is emphysma?

A

Abnormal permanent dilation of airspaces distal to the terminal bronchiole, with destruction of airspace wall, without obvious fibrosis

132
Q

What are the different types of emphysma? Indicate the cause of each of them

A

Centrilobular (centiacinar) Coal dust, smoking

Panlobular (panacinar) - >80% a1 antitrypsin deficient (rare, autosomal dominant) , severest in lower lobe bases

Paraseptal (distal acinar) - Upper lobe subpleural bullae adjacent to fibrosis. Pneumothorax if rupture

133
Q

Site and symptoms of emphysma?

A

Acina is the site

Symptoms : Dyspnoea: progressive and worsening

134
Q

For the COPD to be predominantly bronchitis or emphysma what age would the COPD come?

A

40-50 then its predominantly bronchitis

50-75 then it’s predominantly emphysma

135
Q

What is the Stereotype of Predominant Emphysema and Predominant bronchitis?

A

Pink puffe and Blue bloater respectively

136
Q

What does chest xray show if COPD is Predominant Emphysema or Predominant bronchitis

A

Small heart, hyperinflated lungs

or Prominent vessels, large heart

137
Q

What is asthma?

A

Chronic inflammatory disorder of the airways

138
Q

What are the symptoms of asthma?

A

Paroxysmal bronchospasm

Wheeze
Cough
Variable bronchoconstriction that is at least partially reversible

139
Q

What is the consequence of asthma on the lungs?

A

Mucosal inflammation & oedema
Hypertrophic mucous glands & mucus plugs in bronchi
Hyperinflated lungs

140
Q

What are the Clinicopathological classification of asthma?

A

Atopic , non-atopic, aspirin-induced, allergic bronchpulmonary aspergillosis (ABPA)

141
Q

What is the patholopy of atopic asthma caused by Type I hypersensitivity reaction?

A

Allergen - dust, pollen, animal products

Cold, exercise, reparatory infections

Many different cell types and inflammatory mediators involved

Degranulation of IgE bearing mast cells
histamine initiated bronchoconstriction & mucus production obstructing air flow

eosinophil chemotaxis

142
Q

What are the Persistent or irreversible changes of atopic asthma?

A

bronchiolar wall smooth muscle hypertrophy
mucus gland hyperplasia
respiratory bronchiolitis leading to centrilobular emphysema

143
Q

What group of people most likely to get atopic asthma?

A

Kids and young adults

144
Q

What is Interstitial lung disease?

A 
Very heterogenous group 
Usually diffuse and chronic
Diseases of pulmonary connective tissue
Mainly alveolar walls
Restrictive rather than obstructive  lung disease
145
Q

What happens to the alveolar walls in interstitial lung disease?

A

Increased tissue in alveolar-capillary wall
Inflammation & fibrosis
Limited morpholgical patterns that differ with site and with time in any individual but with many causes & clinical associations

146
Q

What is the effect of interstitial lung disease on lung performance?

A

Decreased lung compliance

Increased gas diffusion distance

147
Q

What is Acute interstitial disease?

A

Diffuse alveolar damage – exudate & death of type I pneumocytes form hyaline membranes lining alveoli followed by type II pneumocyte hyperplasia. Histologically acute interstitial pneumonia

148
Q

What are the signs and symptoms of Chronic interstitial lung diseases?

A

Dyspnoea increasing for months to years
Clubbing, fine crackles, dry cough

Interstitial fibrosis and chronic inflammation with varying radiological and histological patterns
Common end-stage fibrosed “honeycomb lung”

149
Q

Examples of Chronic interstitial lung diseases?

A

idiopathic pulmonary fibrosis,
many pneumoconioses (dust diseases)
sarcoidosis,
collagen vascular diseases-associated lung diseases

150
Q

What is the profile of Sarcoidosis?

A

Non-caseating perilymphatic pulmonary granulomas, then fibrosis
Hilar nodes usually involved
Other organs may be affected- skin,heart, brain
Hypercalcaemia & elevated serum ACE
Typically young adult females, aetiology unknown

151
Q

What is Pneumoconioses?

A

The dust disease –> The non neoplastic lung diseases due to inhalation of mineral dusts, organic dusts, fumes and vaporation in work place
Occupational disease

152
Q

What are the different types of inhaled dust that can cuase Pneumoconioses?

A

inert
fibrogenic
allergenic

oncogenic
lung carcinoma & pleural mesothelioma

153
Q

What causes Silicosis?

A

Silica - sand & stone dust

154
Q

What is the pathology of Silicosis?

A

Kills phagocytosing macrophages
Fibrosis & fibrous silicotic nodules, also in nodes
Possible reactivation of tuberculosis

155
Q

What is silicosis?

A

Lung fibrosis caused by the inhalation of dust containing silica.

156
Q

What is Mixed dust pneumoconiosis?

A

Silica with other dusts

157
Q

What is the Asbestosis?

A

High level exposure of asbestos produces interstitial fibrosis, in a usual interstitial pneumonia pattern

158
Q

What is the histological difference beteen Asbestosis and idiopathic pulmonary fibrosis or collagen vascular disease associated pulmonary fibrosis ?

A

Asbestos bodies are identifiable in tissue sections of asbestosis

159
Q

What does Asbestosis increase the risk of?

A

Increased risk of lung cancer with asbestosis and with high asbestos exposure but no fibrosis

160
Q

What is Hypersensitivity pnumonitis?

A

aka extrinsic allergic alveolitis

161
Q

What type of hypersensitive reaction is Hypersensitivity pnumonitis?

A

Type III hypersensitivity reaction organic dusts
farmers’ lung - actinomycetes in hay
pigeon fanciers’ lung - pigeon antigens

Peribronchiolar inflammation with poorly formed non-caseating granulomas extends alveolar walls

Repeated episodes lead to interstitial fibrosis

162
Q

What is CF?

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

163
Q

Who does Cf most affect and what is the pathology of CF?

A

Mostly affects Caucasians

Incidence 0.4 per 1000 live births

Autosomal recessive inheritance

Mutation in CFTR gene
(Cystic fibrosis transmembrane conductance regulator gene on chromosome 7q31.2 )

Vast phenotypic variation due to variations in mutations, organs specific effects of the gene

Gene encodes a transmembrane chloride channel protein

164
Q

What are the general clinical presentation of CF?

A

Clinical presentation: Infancy (usually)

Abnormally viscous mucous secretions
Recurrent lung infections
Failure to thrive
Recurrent intestinal obstruction
Pancreatic insufficiency
165
Q

What is the affet of Cf on the lung?

A

Bronchioles distended with mucus
Hyperplasia mucus secreting glands
Multiple repeated infections
Severe chronic bronchitis and bronchiectasis

166
Q

What is the affet of Cf on the pancreas?

A

Exocrine gland ducts plugged by mucus
Atrophy and fibrosis of gland
Impaired fat absorption, enzyme secretion, vitamin deficiencies ( pancreatic insufficiency

167
Q

What is the affet of Cf on other organs?

A

Small bowel: mucus plugging - meconium ileus
Liver: plugging of bile cannaliculi – cirrhosis
Salivary glands: Similar to pancreas: artophy and fibrosis
95% of males are infertile

168
Q

How is CF diagnosed?

A

Part of Newborn screening in UK
Sweat test
Genetic testing

169
Q

What is the treatment for CF?

A

Median survival 41 years in the UK
Physiotherapy
Mucolytics
Heart/lung transplants

Year 2 clinical pathology (21 decks)

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