6. Respiratory Pathology

Question 1

Definition, epidemiology, aetiology, pathogenesis and key clinical features of:

Asthma

Answer 1

Chronic inflammatory disorder of the airways that is AT LEAST partially reversible (‘twitchy airways’)

Epidemiology: Common, children + young adults
Acute asthma is the commonest occupational lung disease

Aetiology: Dust mites, NSAIDs, cold, exercise, infections, emotions, Aspergillus (ABPA)

Pathogenesis: Type I hypersensitivity reaction involving IgE bearing mast cells and histamines

Clinical features:
Paroxysmal bronchospasm, wheeze, cough, bronchoconstriction, SOB, hyperinflation

Question 2

Definition, epidemiology, aetiology, pathogenesis and key clinical features of:

Bronchiectasis

Answer 2

Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue as a result of chronic necrotizing infection.

Epidemiology: Rare

Aetiology: Predisposed to infections if you have cystic fibrosis, primary ciliary dyskinesia (Kartagener syndrome), lupus, rheumatoid arthiritis, IBD, GVHD (graft vs host disease)

Pathogenesis: destruction of muscle and elastic tissue by chronic necrotizing infection

Clinical features:
Cough, fever, a lot of foul smelling sputum

Question 3

Definition, epidemiology, aetiology, pathogenesis and key clinical features of:

Chronic obstructive pulmonary disease (COPD)

Answer 3

COPD is the clinical grouping of ‘chronic bronchitis’ and ‘emphysema’.
Chronic bronchitis = coughing with sputum for 3 months in 2 consecutive years.
Emphysema = abnormal enlargement of the alveolar air spaces

Epidemiology: Smokers, middle + old age, 1 in 20 GP consultations of patients over 65

Aeitology: Cigarette smoke

Pathogenesis: Mucus gland hyperplasia + hypersecretion leading to infections. Chronic inflammation of small airways causes wall weakness and destruction.

Clinical features: Dyspnoea (progressive + worsening), SOB, cough, sputum, infection, right sided heart failure (fewer capillaries, therefore right side of heart has to work harder to compensate pulmonary circulation, eventually failing)

Question 4

What type of emphysema is associated with a1 antitrypsin deficiency?

Answer 4

Panacinar/panlobular emphysema - (destruction of bronchioles AND alveoli)

severest in lower lobes

(a1 antitrypsin protects lung tissue from breakdown due to inflammatory enzymes, if your deficient in AAT then you are more susceptible to developing COPD when you smoke since you don’t have that extra layer of protection)

Question 5

What type of emphysema is associated with coal dust and smoking?

Answer 5

Centriacinar/centrilobular emphysema - (destruction of bronchioles NOT alveoli)

Question 6

In what conditions is bronchiectasis seen in?

Answer 6

1. Cystic fibrosis
2. Kartagener syndrome / primary ciliary dyskinesia
3. Bronchial obstruction due to tumour or foreign body
4. Rheumatoid arthritis
5. Inflammatory bowel disease

Question 7

What changes are seen in interstitial lung diseases?

Answer 7

Diseases of pulmonary connective tissue:

1. Alveolar walls (mainly)
2. Bronchioles
3. Alveolar spaces

these are either thickened or lost which decreases gas exchange and lung compliance.

Question 8

‘Diffuse alveolar damage’ and ‘adult respiratory distress syndrome’ are examples of what type of interstitial lung disease?

Answer 8

Acute

Diffuse alveolar damage = Type 1 pneumocytes which line the alveoli die and form a hyaline membrane that prevents gas exchange

Adult respiratory distress syndrome = fluid leaks into the alveoli and stops them functioning. Can results from shock, trauma, infection, smoke, toxic gases, paraquat, narcotics, radiation

Question 9

Progressive dyspnoea, clubbing, fine crackles, dry cough and an end-stage ‘honey comb lung’ are seen in what disease?

Answer 9

Chronic interstitial lung disease

Question 10

A lung disease with an unknown cause seen typically in young adult females that is characterised by non-caseating granulomas.

Answer 10

Sarcoidosis

Question 11

A lung disease that is usually occupational, caused by the inhalation of dusts.

Answer 11

Pneumoconioses

the nature of the disease depends on the type of dust you inhaled e.g. coal worker’s pneumoconiosis

Question 12

Lung disease associated with in the inhalation of silica - sand and stone dust.

Answer 12

Silicosis

Question 13

What is a Type III hypersensitivity reaction to organic dusts?

Answer 13

Hypersensitivity pneumonitis

(inflammation of the alveoli due to organic dusts.
e.g. farmers’ lung + pigeon fanciers’ lung)

Question 14

Definition, epidemiology, aetiology, pathogenesis and key clinical features of:

Cystic fibrosis

Answer 14

Inherited multiorgans disorder of the epithelial cells and their fluid secretion in the epithelial linings of the respiratory, GI and reproductive organs.

Epidemiology: Common (1 in 25 are carriers), mainly caucasians

Aetiology: Autosomal recessive inheritance, abnormality of chromosome 7, faulty CFTR (chloride channel protein) = thick mucus

Pathogenesis: Bronchioles filled with mucus, resulting in repeat infections > severe bronchitis + bronchiectasis.

Clinical features: Lung infections, bronchiectasis, meconium ileus (blockage in the ileum), cirrhosis of liver (due to mucus plugging of bile canaliculi), atrophy + fibrosis of salivary glands, 95% of males are infertile

Question 15

What is the drug lumacaftor–ivacaftor used to treat?

Answer 15

Cystic fibrosis

controversially expensive drug

Question 16

The most common type of primary malignant tumour.

Answer 16

Carcinoma (>90%)

Question 17

What are the 3 differences between small cell and non-small cell carcinomas?

Answer 17

Small cell carcinoma =

1. Less cytoplasm
2. Nuclear chromatin is fine
3. Less prominent/no nucleoli

Non small cell carcinoma =

1. More cytoplasm
2. Nuclei are usually clumped together
3. More prominent nucleoli

Question 18

Most common type of primary lung carcinoma.

Answer 18

Adenocarcinoma

Question 19

What are the 4 major types of primary lung carcinoma?

Answer 19

1. Adenocarcinoma - gland formation
2. Squamous cell carcinoma - shows keratinization
3. Small cell carcinoma - diagnosis based on nuclear characteristics
4. Large cell undifferentiated carcinoma - doesn’t have the other features

Question 20

Low grade malignant lung tumours with better survival chances.

Answer 20

Carcinoid tumours

Question 21

Most common type of malignant lung tumour?

Answer 21

Secondary lung tumour

carcinomas from other sites e.g. breast, GI tract, kidneys
(sarcoma, lymphoma, myeloma)

Question 22

Lung cancer is the most common cause of cancer death in the UK and world wide.
True or False?

Answer 22

TRUE

Question 23

A gene mutation that predisposed you to lung cancer even if you have never smoked?

Answer 23

1. EGFR
2. KRAS
3. ALK

(either of these)

Question 24

What is lymphangitis carcinomatosa?

Answer 24

Diffuse spread of the tumour into the pulmonary lymphatics system

Question 25

What is the latent period for asbestos exposure and the development of carcinoma?

Answer 25

20 years

Question 26

Which lung cell carcinoma shows keratinisation?

Answer 26

Squamous cell carcinoma

Question 27

What is the most common type of malignant mesenchymal lung tumour?

Answer 27

Synovial sarcoma | mesenchymal tumour = sarcoma

Question 28

'Blue bloaters' refers to COPD patients with predominantly emphysema. True or False?

Answer 28

FALSE Blue bloaters = chronic bronchitis Pink puffers = emphysema

Question 29

The most common cause of sore throats i.e. pharyngitis or tonsillar pharyngitis.

Answer 29

Viruses | bacteria also cause it, but are not as common

Question 30

Neisseria gonorrhoeae is a rare cause of pharyngitis. | True of False?

Answer 30

TRUE | HIV-1 is also a rare cause

Question 31

The Centor Criteria predicts the likelihood of a sore throat being due to bacterial infection. Which of the following are NOT part of the criteria? 1. Absence of cough 2. Temperature over 38°C 3. Tonsillar exudate 4. Tonsillar transudate 5. Tender anterior cervical lymphadenopathy 6. Inability to swallow

Answer 31

4. Tonsillar transudate | 6. Inability to swallow

Question 32

What virus causes infectious mononucleosis? What are the triad of symptoms?

Answer 32

Epstein-Barr virus 1. Fever 2. Tonsillar pharyngitis 3. Cervical lymphadenopathy (typically seen in teenagers, also called 'glandular fever')

Question 33

Acute Otitis externa (AOE) is most commonly caused by bacteria. What are the most common causative bacteria?

Answer 33

1. Psedumonas aeruginosa | 2. Staphylococcus aureus

Question 34

What is a common cause of chronic otitis externa?

Answer 34

Allergic contact dermatitis (allergens that come in contact with skin e.g. chemicals in cosmetics or shampoo)

Question 35

Inflammation of the middle ear with fluid build up behind the ear drum.

Answer 35

Otitis media (OM)

Question 36

Mastoiditis is the infection of the mastoid bone and air cells. Mastoiditis is the most common complication of what?

Answer 36

Otitis media

Question 37

What are the common bacterial causes of perichondritis?

Answer 37

1. Pseudomonas aeruginosa 2. Staph aureus (associated with piercings through cartilage)

Question 38

https://www.studyblue.com/notes/note/n/respiratory-pathology/deck/12471413

Answer 38

Respiratory pathology flashcards given in lecture slides

Question 39

What is pneumonia?

Answer 39

An infection of the most distal airways and alveoli. | This results in the formation of inflammatory exudate that fills these air sacs.

Question 40

90% of lobar pneumonia is caused by S.pneumoniae and has a patchy distribution of inflammation. True or False?

Answer 40

FALSE yes, 90% of lobar pneumonia is caused by streptococcus pneumoniae HOWEVER bronchopneumonia is the one with a patchy distribution. Lobar pneumonia is when a large part/entirety of a lobe is inflamed.

Question 41

Atypical pneumonia is caused by bacteria which have atypical / lack a cell wall. Therefore, they have slightly different clinical presentation and treatment than typical pneumonia. Which of these bacteria cause atypical pneumonia? 1. Mycoplasma pneumoniae 2. Streptococcus pneumoniae 3. Legionella pneumophilia 4. Klebsiella pneumoniae 5. Chlamydophila pneumoniae 6. Staphylococcus aureus 7. Moraxella catarrhalis 8. Chlamydophila psittaci 9. Haemophilus influenzae

Answer 41

1. Mycoplasma pneumoniae 3. Legionella pneumoniae 5. Chlamydophila pneumoniae 8. Chlamydophila psittaci (the rest are all 'typical pneumonia')

Question 42

Responsible for most 'common colds'.

Answer 42

Rhinovirus

Question 43

Allergic bronchopulmonary aspergillosis (ABPA) presents with worsening asthma and lung function. It occurs in people with a disease background of what?

Answer 43

Atopy (predisposition to developing rhinitis, asthma, eczema) Asthma Cystic fibrosis

Question 44

Pneumocystis jiroveci pneumonia is caused by a fungus, however it is not susceptible to a number of antifungals. Why?

Answer 44

It lacks ergosterol in its cell wall. | most fungi cannot survive without ergosterol, therefore it is one of the main drug targets

Question 45

Pulmonary tuberculosis presents with chronic productive cough, haemoptysis, weight loss, fever, night sweats. What is the cause? What drugs are used to treat it?

Answer 45

Mycobacterium tuberculosis Isoniazid + Rifampicin

Question 46

What is pleural effusion?

Answer 46

Fluid build up in the pleural space around lungs

Question 47

Which of these conditions is associated with high level asbestos dust exposure and prevent normal lung expansion + compression? 1. Parietal pleura fibrous plaques 2. Pleural effusion 3. Pneumoconiosis 4. Diffuse pleural fibrosis

Answer 47

4. Diffuse pleural fibrosis parietal pleura fibrous plaques = LOW level asbestos exposure, not given any occupational disability benefits from government. asbestos related pneumoconiosis is pretty similar in fairness, but 'pneumoconiosis' on its own is too general.

Question 48

What is 'chlyothorax'?

Answer 48

Bile in the pleural cavity | usually caused by trauma

Question 49

What is empyema or pyothorax?

Answer 49

Pus in the pleural cavity | usually secondary to pneumonia

Question 50

What is pneumothorax?

Answer 50

Air in the pleural cavity

Question 51

Left ventricle heart failure and renal failure are associated with exudate pleural effusion. True or False

Answer 51

FALSE Transudate - high hydrostatic pressure in the blood vessels causing fluid to leak out. Exudate is associated with inflammation.

Question 52

What are the signs and symptoms of a pleural effusion? How is it treated?

Answer 52

Symptoms: 1. Breathlessness - (effusion compresses the lung) 2. Little/no pleuritic pain - (visceral + parietal pleura are not in contact) Signs: 1. Dull percussion 2. Auscultation - reduced breath sounds Diagnosis confirmed via ultrasound, chest radiograph, CT Treatment: 1. Aspiration - to remove fluid + treat breathlessness 2. Identify underlying cause - e.g. biopsy, test pleural fluid in lab

Question 53

What is a malignant mesothelioma?

Answer 53

A malignant tumour of the mesothelial cells that line serous cavities i.e. pleura, peritoneum, pericardium, tunica vaginalis. Common

Question 54

What is the main cause of malignant mesothelioma?

Answer 54

Asbestos | BAP1 mutation also predisposes you

Question 55

What is the most oncogenic type of asbestos?

Answer 55

Crocidolite - blue asbestos

Question 56

Disease of young women, often first diagnosed by the finding of hilar lymphadenopathy on a chest x-ray?

Answer 56

Sarcoidosis

Question 57

An allergic reaction to which fungus that can present as asthma?

Answer 57

Aspergillus

Question 58

The U in CURB score stands for?

Answer 58

Urea

Question 59

What is CURB 65 and what does it stand for?

Answer 59

A clinical prediction rule for predicting mortality in community-acquired pneumonia and infection. ``` Confusion Urea Respiratory rate >30 Blood pressure (systolic <90) (diastolic <60) >65 years of age ```

Question 60

This condition is caused by abnormal enlargement of the alveolar airspace?

Answer 60

Emphysema

Question 61

A common “typical” organism that causes community acquired pneumonia.

Answer 61

Streptococcus pneumoniae

Question 62

A Progressive build-up of air within the pleural space; allows air into the pleural space but not out of?

Answer 62

Tension pneumothorax

Question 63

A malignant tumour of the pleura?

Answer 63

Mesothelioma

Question 64

Condition characterised by a triad of symptoms: fever, tonsillar pharyngitis, and cervical lymphadenopathy with a positive monospot test?

Answer 64

Infectious mononucleosis

Question 65

Disease of young women, often first diagnosed by the finding of hilar lymphadenopathy on a chest x-ray?

Answer 65

Sarcoidosis

Question 66

A condition in which there is decreased pupil size, drooping of eyelid and decreased sweating on the affected side of the patient’s face - sometimes caused by a tumour in the lung?

Answer 66

Horner's syndrome

Question 67

Name of the diagnostic skin test used to determine if there has been exposure to mycobacterium tuberculosis?

Answer 67

Montoux test

Question 68

Condition seen in infants that results in Inflammation and oedema of bronchioles and commonly caused by RSV?

Answer 68

Bronchiolitis

Question 69

The following parameters : Tonsillar exudate, tender anterior cervical lymphadenopathy, fever over 38°C and absence of cough are part of the what criteria that gives an indication of the likelihood of a sore throat being due to bacterial infection?

Answer 69

Centor criteria