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MedEd + PathSoc + Laz's Qs + Romesh Path > Histopath 21: Resp Pathology > Flashcards

Histopath 21: Resp Pathology Flashcards

1
Q

What type of cells line the airways? the alveoli?

A

Airways = Ciliated respiratory epithelium

Alveoli = Type 1 Pneumocytes

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2
Q

Define pulmonary oedema + causes?

A

Accumulation of fluid in the alveolar spaces either due to leaky capillaries or back pressure from a failing left ventricle
This leads to poor gas exchange

Causes:
LH failure (MAIN for path), alveolar injury (drugs), neurogenic following head trauma, high altitude
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3
Q

Intra-alveolar fluid is the main histological feature of what condition?

A

Pulmonary oedema

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4
Q

Causes of ARDS in adults

A 
Infection 
Aspiration 
Trauma 
Inhaled irritant gases 
Shock 
DIC
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5
Q

What causes hyaline membrane disease in newborns?

A

Lack of surfactant (mainly in premature babies)

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6
Q

On a cellular level, what insult results in ARDS?

A

Acute damage to the endothelium and/or alveolar epithelium

The basic pathology is the same regardless of cause: diffuse alveolar damage

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7
Q

Lungs on post-partum examination was plum-coloured, heavy and airless

What was the cause of death?

A

ARDS

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8
Q

Outline the pathophysiology of ARDS.

A

Exudative phase – the lungs become congested and leaky

Hyaline membranes – form when serum protein that is leaked out of vessels end up lining the alveoli

Organising phase – organisation of the exudates to form granulation tissue sitting within the alveolar spaces

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9
Q

Define asthma

A

Chronic inflammatory airway disorder with recurrent reversible episodes of widespread narrowing of the airways

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10
Q

What is status asthmaticus ?

A

The term used to describe a severe attack of asthma where attacks occur one after the other

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11
Q

List some acute + chronic changes seen in asthma.

A 
Acute:
Bronchospasm 
Oedema 
Hyperaemia 
Inflammation

Chronic:
Muscular hypertrophy
Airway narrowing
Mucus plugging

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12
Q

Describe the main histological features of asthma

A

Lots of eosinophils and mast cells

Goblet cell hyperplasia

Mucus plugs within airways

Thickening of bronchial smooth muscle and dilatation of blood vessels

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13
Q

Define chronic bronchitis.

A

Chronic cough productive of sputum presents for most days for at least 3 months over 2 consecutive years

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14
Q

List some histological features of chronic bronchitis.

A

Dilated airways

Mucus gland hyperplasia

Goblet cell hyperplasia

Mild inflammation

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15
Q

List some complications of chronic bronchitis.

A

Recurrent infections

Chronic respiratory failure

Pulmonary hypertension and right heart failure (cor pulmonale)

Increased risk of lung cancer (independent of smoking)

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16
Q

Causes of emphysema (Type of COPD)

A

Smoking

Alpha-1 antitrypsin deficiency - may present as a young person w/ copd and liver issues and fhx

Rare: cadmium exposure, IVDU, connective tissue disorder

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17
Q

Define emphysema.

A

Permanent loss of alveolar parenchyma distal to the terminal bronchiole

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18
Q

Describe how the pattern of alveolar damage is different with smoking compared to alpha-1 antitrypsin deficiency

A

Smoking – centrilobular damage

Alpha-1 antitrypsin deficiency – panacinar (throughout the lungs)

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19
Q

List some complications of emphysema

A

Bullae (can rupture to cause pneumothorax)

Respiratory failure

Pulmonary hypertension and right heart failure (Cor Pulmonale)

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20
Q

Define bronchiectasis + what is a major RF and why + where is idiopathic bronchiectasis likley to affect

A

Pathalogical airway dilation secondary to recurrent infections

Major RF = CF - Permanent abnormal dilatation of the bronchi with inflammation and fibrosis extending into adjacent parenchyma

Lower lobe

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21
Q

Causes of bronchiectasis?

A

Infection (MOST COMMON):
Post-infectious (e.g. CF)
Abnormal host defence (e.g. chemotherapy, immunodeficiency)
Ciliary dyskinesia

Obstruction :
Post-inflammatory (aspiration)
Interstitial disease (e.g. sarcoidosis)
Asthma

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22
Q

List some complications of bronchiectasis.

A

Recurrent infections

Haemoptysis

Pulmonary hypertension and right heart failure (Cor Pulmonale)

Amyloidosis

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23
Q

Where is CFTR gene found and what is the most common mutation associated w/ CF?

A

7q3 - Delta F508

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24
Q

List some clinical manifestations of CF.

A 
GI – meconium ileus, malabsorption 
Pancreas – pancreatitis 
Liver – cirrhosis 
Male reproductive system – infertility 
Recurrent chest infections
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25
Q

Causes of CAP + HAP

A

CAP:

  • Strep pneumo
  • Haemophilus influenzae
  • Mycoplasma

HAP:
- Gram -ves (klebsiella, pseudomonas)

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26
Q

Bacteria involved in aspiration pneumonia

A

Mix of anaerobes + aerobes

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27
Q

What are the histopathological stages of lobar pneumonia?

A

Stage 1: congestion (hyperaemia and intra-alveolar fluid)
Stage 2: red hepatisation (hyperaemia, intra-alveolar neutrophils)
Stage 3: grey hepatisation (intra-alveolar connective tissue)
Stage 4: resolution (restoration of normal tissue architecture)

28
Q

What is lobar pneumonia?

A

Infection is focused in a lobe of the lung

90-95% caused by S. pneumoniae

Widespread fibrinosuppurative consolidation

29
Q

What is bronchopneumonia?

A

Infection is centred around the airways

Tends to be associated with compromised host defence (mainly the elderly) and is caused by low virulence organisms (e.g. Staphylococcus, Haemophilus, Pneumococcus)

It will show patchy bronchial and peribronchial distribution often involving the lower lobes

30
Q

What is a granuloma?

A

Collection of macrophages and multi-nucleate giant cells

31
Q

Describe the histological appearance of atypical pneumonia.

A

Interstitial inflammation (pneumonitis) without accumulation of intra-alveolar inflammatory cells

NOTE: causes include Mycoplasma, viruses, Coxiella and Chlamydia

32
Q

What is a long term consequence of repeated small pulmonary emboli?

A

Pulmonary hypertension

33
Q

What are the main types of lung cancer?

A

Non-small cell carcinoma:

  • Squamous cell carcinoma (30%)
  • Adenocarcinoma (30%)
  • Large cell carcinoma (20%)

Small cell carcinoma (20%)

34
Q

What components of cigarette smoke are responsible for its carcinogenicity?

A

Tumour initiators (polycyclic aromatic hydrocarbons)

Tumour promoters (nicotine)

Complete carcinogens (nickel, arsenic)

35
Q

Which types of lung cancer are most strongly associated with smoking?

Which type of lung cancer tends to occur in non-smokers?

A

Squamous cell carcinoma

Adenocarcinoma

36
Q

List some risk factors for lung cancer

A 
Smoking 
Asbestos 
Radiation 
Air pollution 
Heavy metals 
Susceptibility genes (e.g. nicotine addiction)
37
Q

Describe the sequence of histological changes that results in lung cancer

What feature of squamous epithelium makes it vulnerable to undergoing malignant changes?

A

Metaplasia 🡪 dysplasia 🡪 carcinoma in situ 🡪 invasive carcinoma

It does not have cilia leading to a build-up of mucus
Within the mucus carcinogens accumulate

38
Q

Where do SCCs tend to arise? Where do adenocarcinomas tend to arise?

A

SCCs:
Centrally – arising from the bronchial epithelium
NOTE: there is an increasing incidence of peripheral squamous cell carcinomas (possibly due to deeper inhalation of modern cigarette smoke)

Adenocarcinoma:
Peripherally – around the terminal airways
NOTE: it tends to be multi-centric and extra-thoracic metastases are common and occur early

39
Q

What is the precursor lesion for adenocarcinoma of the lung?

A

Atypical adenomatous hyperplasia (proliferation of atypical cells lining the alveolar walls)

40
Q

Which mutations are associated with adenocarcinoma in smokers? non-smokers?

A

Smokers:
Kras
Issues with DNA methylation
P53

Non-smokers:
EGFR

41
Q

What is large cell carcinoma of the lung?

A

Poorly differentiated tumour composed of large cells

There is no evidence of squamous or glandular differentiation - but probs from v poorly differentiated adeno or SCC

It has a poor prognosis

42
Q

Where does small cell lung cancer tend to arise + prognosis?

A

Central – around the bronchi

NOTE: 80% present with advanced disease and it carries a poor prognosis - common mets to brain ribs and spinal cord

43
Q

List some common mutations seen in small cell lung cancer

A

P53

RB1

44
Q

What is the difference in the chemosensitivity of small cell lung cancer and non-small cell lung cancer?

A

Small cell – sensitive

Non-small cell – not very chemosensitive

45
Q

Which molecular changes are important to test for in adenocarcinoma?

A

EGFR (responder or resistance)
ALK translocation
Ros1 translocation

46
Q

Why is it important to know the tumour type precisely?

A

Some treatments can be fatal if the cancer is misdiagnosed

E.g. bevacizumab can cause fatal haemorrhage if used for squamous cell carcinoma

47
Q

What is cancer of the pleura?

A

Mesothelioma

48
Q

Histopathology shows smooth muscle hypertrophy and eosinophilia

What is the ddx?

A

Asthma

49
Q

What is COPD?

A

COPD involves chronic bronchitis and emphysema

50
Q

Histopatholgy reveals neutrophilic infiltrations into airways, loss of alveoli elastive fibres and lung parenchyma?

A

COPD

Note - in severe cases you can find eosinophilia too

51
Q

Pathophysiology of CF?

A

Mutation leads to defective ion transport -> excessive resorption of water from secretions of exocrine glands -> abnormally thick mucous secretions -> affects all organ systems

52
Q

Histopathology reveal mucous clogged airways and inflammatory cell infiltration

What is the ddx?

A

CF

53
Q

Histopathology shows dilated fibrotic airways with mucous plugging - what is the ddx?

A

Bronchiectasis

54
Q

A patient presents acutely w/ some resp symptoms + histopathology reveals heavy watery lungs with intra-alveolar fluid

What is ddx?

A

Acute pulmonary oedema

55
Q

A patient presents acutely w/ some resp symptoms + histopathology reveals iron-laden macrophages and fibrosis

What is ddx?

A

Chronic pulmonary oedema

In this case IRON-LADEN MACROPHAGES are important - heart failure cells and pathogmnoic of pulmonary oedema

56
Q

CXR = white out all lung fields

what is the ddx?

A

Diffuse alveolar damage:

  • Adults = ARDS
  • Neonates = RDS (hyaline membrane disease of newborn)
57
Q

Histopathology shows pathcy bronchialand peribronchial distribution, acute inflammation of surrounding airways + w/in alveoli - what is ddx?

A

Bronchopneumonia

58
Q

What are the different types of fibrosing lung disease + their features?

A

Idiopathic pulmonary fibrosis / cryptogenic fibrosis alveolitis:

  • Chronic = SOB and cough
  • 50+y, male predominance
  • Diagnosis gold standard = High res CT +/- biopsy

Extrinsic allergic alveolitis / farmers lung
- organic allergens

Industrial lung disease / pneumoconiosis
- specific dusts in workspace (non-organic allergens)

59
Q

What type of lung disease are fibrosising lung diseases?

A

Restrictive lung disease - FEV1/FVC >0.8

60
Q

oat cells? ddx?

A

Small cell lung cancer

61
Q

Which paraneoplastic syndromes are associated w/ small cell lung cancer?

A

SIADH

Lambert-Eaton - myasthenic syndrome

Cushings

62
Q

1) A 35 year old non-smoker and non-drinker develops progressive shortness of breath, abdominal distension and spider naevi. What is the most likely underlying pathology?

A

Alpha-1 antitrypsin deficiency - Lung + Liver symptoms in a young non-smoker / drinker

63
Q

2) Which gene on which chromosome is mutated in cystic fibrosis?

A

CFTR gene on chromosome 7

64
Q

4) Which lung malignancy is the most common in non-smokers?

A

Adenocarcinoma

65
Q

5) Which lung malignancy is most commonly associated with PTHrp secretion?

A

Squamous cell lung cancer - This causes the paraneoplastic syndrome seen with this cancer = Hypercalcaemia of malignancy

MedEd + PathSoc + Laz's Qs + Romesh Path (99 decks)

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