chest Flashcards
(116 cards)
1
Q
What is thymus hyperplasia?
A
Can refer to B cell germinal center hyperplasia (thymic follicular hyperplasia) or true epithelial hyperplasia
Associated with myasthenia gravis, Graves’ disease, SLE, scleroderma, RA, and other autoimmune conditions.
2
Q
What is a thymoma?
A
Restricted to thymic epithelial cells and contains benign immature T cells.
3
Q
What are the types of thymic epithelial tumors in adults over 40?
A
Spectrum of disease: benign, benign with invasion, and malignant.
4
Q
How do benign and malignant thymic tumors differ histologically?
A
Benign generally have more medullary cells and less cortical cells, malignant have more cortical cells.
5
Q
What does thymic carcinoma resemble?
A
Resembles squamous cell carcinoma.
6
Q
What is the association of lymphoepithelioma-like carcinoma?
A
EBV associated.
7
Q
Are paraneoplastic syndromes common with thymic carcinoma?
A
Uncommon to develop paraneoplastic syndromes with carcinoma.
8
Q
What is sarcoidosis?
A
A condition of unknown etiology occurring in young people, HLA associated.
9
Q
What are the common manifestations of sarcoidosis?
A
Most commonly pulmonary, followed by eye and skin lesions.
10
Q
What are the key histological features of sarcoidosis?
A
Non-caseating granulomas, giant cells, Schaumann bodies, and asteroid bodies.
11
Q
What is the significance of serum ACE levels in sarcoidosis?
A
Serum ACE is raised.
12
Q
What is the prognosis of sarcoidosis?
A
65-70% recover +/- steroids; 20% have permanent loss of function.
13
Q
What is the definition of pneumonia?
A
Infection of lung parenchyma, resulting in consolidation.
14
Q
What is the difference between lobar pneumonia and bronchopneumonia?
A
Lobar: confluent consolidation affecting majority/entire lobe; Bronchopneumonia: patchy consolidation with endobronchial spread.
15
Q
What are the risk factors for community-acquired pneumonia?
A
Children and elderly.
16
Q
What factors predispose to hospital-acquired pneumonia?
A
Elderly or immunocompromised individuals.
17
Q
What are the common pathogens causing community-acquired pneumonia?
A
- Strep pneumonia (most common)
- Klebsiella
- H. influenzae
- Staph aureus
- P. aeruginosa
- Moraxella catarrhalis
- Legionella
18
Q
What are the 4 stages of lobar pneumonia?
A
- Congestion
- Red hepatisation
- Gray hepatisation
- Resolution
19
Q
What are the clinical features of pneumonia?
A
- Fevers and chills
- Pleuritic chest pain
- Cough with sputum (yellow or rusty)
- Increased white cell count
20
Q
What are common complications of pneumonia?
A
- Abscess
- Empyema
- Lung fibrosis
- Bacteraemia
21
Q
What is a lung abscess?
A
Localized suppurative process within lung parenchyma characterized by necrosis of lung tissue with resultant cavitation.
22
Q
What are the common pathogens causing lung abscesses?
A
- Strep
- Staph aureus
- GNB
- Klebsiella
- Anaerobes (oral cavity flora)
23
Q
What is SIRS?
A
Pathophysiological state caused by infectious and non-infectious entities characterized by two or more features: fever, tachycardia, tachypnea, and abnormal white cell count.
24
Q
What is pulmonary tuberculosis?
A
Chronic infective disease caused by Mycobacterium tuberculosis, characterized by caseating granulomatous inflammation.
25
What are the primary and secondary classifications of tuberculosis?
* Primary TB: infection in a non-sensitized individual
* Secondary TB: infection in a previously sensitized individual
26
What is bronchiectasis?
Irreversible dilatation of the bronchial tree, usually associated with bronchial wall inflammation.
27
What are the subtypes of bronchiectasis?
* Cylindrical
* Varicose
* Cystic
28
What are the common causes of bronchiectasis?
* Recurrent pneumonia
* TB
* Neoplasm
* Foreign body
* Cystic fibrosis
29
What is traction bronchiectasis?
A type of bronchiectasis caused by pulling on the bronchial walls from surrounding structures.
30
What are the three classifications of bronchiectasis?
* Cylindrical – least severe and most common
* Varicose – beaded appearance
* Cystic – severe, air fluid levels commonly
31
What are the acute changes associated with bronchiectasis?
* Acute inflammatory changes
* Mucous plugging
* Ulceration
* Abscess
32
What are the chronic changes associated with bronchiectasis?
Fibrotic changes.
33
What is a macroscopic description of bronchiectasis?
Dilated airways, up to 4 times normal size, can be followed up to pleural surfaces.
34
What are the clinical features of bronchiectasis?
* Recurrent chest infection
* Productive cough >8 weeks, often worse in the morning
* Hemoptysis
35
What are some complications of bronchiectasis?
* Mucoid impaction
* Recurrent infections
* Fibrosis
* Obstructive respiratory insufficiency
* Abscess formation
36
What is the first line of treatment for bronchiectasis?
Medical management including PT, sputum clearance, and prophylactic antibiotics.
37
What is pulmonary aspergillosis?
A disease caused by the mold Aspergillus, manifesting in five distinct categories of pulmonary disease.
38
What are the risk factors for pulmonary aspergillosis?
* Immunocompromised status
* Neutropaenia
* Pre-existing pulmonary disease (e.g., cavities)
* Associations with asthma and malnutrition.
39
What is ABPA?
Allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus fumigatus causing bronchial inflammation and destruction.
40
What are the microscopic features of pulmonary aspergillosis?
Sputum contains aspergillus hyphae, and forms fruiting bodies and septate filaments.
41
What are the common pulmonary infections associated with cystic fibrosis?
* Pseudomonas aeruginosa
* Staphylococcus aureus
* Haemophilus influenzae
* Burkholderia cepacia
42
What genetic mutation is most common in cystic fibrosis?
Homozygous defect of the CFTR gene, with ∂F508 being the most common mutation (66-70%).
43
What are the abdominal manifestations of cystic fibrosis?
* Exocrine and endocrine insufficiency
* Fatty replacement of pancreas
* Pancreatitis
* Hepatic steatosis
* Biliary issues
44
What is the prognosis for patients with cystic fibrosis?
Life expectancy now reaching 40 or more years due to multidisciplinary treatment; however, respiratory failure accounts for 95% of deaths.
45
What is primary ciliary dyskinesia?
A genetic condition affecting ciliary function, often associated with Kartagener’s syndrome.
46
What is the most important risk factor for squamous cell carcinoma of the skin?
DNA damage induced by exposure to UV light.
47
What is the definition of pulmonary embolism?
A blood clot within the pulmonary arteries, usually originating from deep vein thrombosis (DVT).
48
What are the clinical presentations of pulmonary embolism?
* Pleuritic chest pain
* Fever
* Tachycardia
* Shortness of breath
49
What are the two key components of chronic obstructive pulmonary disease (COPD)?
* Emphysema
* Chronic bronchitis
50
What defines emphysema?
Irreversible dilatation of the airspaces and destruction of walls distal to the terminal bronchiole without fibrosis.
51
What is chronic bronchitis defined as?
Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years.
52
What is the Reid index?
A pathological measurement of mucosal gland proliferation/thickness in chronic bronchitis, with a value >0.4 indicating chronic bronchitis.
53
What histologic examination findings are associated with chronic bronchitis?
Enlargement of mucous-secreting glands, goblet cell hyperplasia, chronic inflammation, bronchiolar wall fibrosis
## Footnote
Reid index >0.4 indicates pathological measurement of mucosal gland proliferation/thickness.
54
What is bronchiolitis obliterans?
Bronchiolar inflammation and submucosal fibrosis leading to obliteration of small airways
## Footnote
Causes include infection, cystic fibrosis, chronic rejection of lung transplant, and toxins.
55
What characterizes lymphangioleiomyomatosis?
Multiple pulmonary cysts and chylous pleural effusions in the setting of TSC
## Footnote
Neoplastic small muscle cells infiltrate bronchioles, alveolar walls, vessels, and lymphatics.
56
What is lipoid pneumonia?
Retained fatty content within bronchioles and influx of macrophages causing foam cells
## Footnote
Can be secondary to obstruction from tumor or foreign body, or due to ingestion/aspiration of oils.
57
What are the types of pulmonary alveolar proteinosis (PAP)?
Autoimmune, secondary, hereditary
## Footnote
Autoimmune PAP accounts for 90% and is against GM-CSF.
58
What is a key diagnostic criterion for acute eosinophilia syndromes?
Need more than 25% eosinophils in bronchoalveolar lavage
## Footnote
Secondary causes include Churg Strauss and other atopy diseases.
59
What conditions are associated with diffuse pulmonary hemorrhage syndromes?
Vasculitis, Goodpasture syndrome, idiopathic pulmonary hemosiderosis
## Footnote
Goodpasture syndrome affects both kidneys and lungs.
60
What is pulmonary veno-occlusive disease?
Intimal fibrosis of small venules in the lungs, leading to pulmonary hypertension
## Footnote
Related to chemotherapy, bone marrow transplant, and connective tissue disorders.
61
What is the Bochdalek hernia?
Failure of closure of the pleuropulmonary canal on the left side
## Footnote
May be associated with pulmonary hypoplasia.
62
What is the definition of diffuse interstitial lung disease (ILD)?
Heterogeneous group of disorders characterized predominantly by inflammation and fibrosis of the pulmonary interstitium.
63
What are common causes of interstitial pneumonia?
Idiopathic, connective tissue diseases, drugs, occupational exposure, smoking
## Footnote
Common responses to injury include recruiting lymphocytes/macrophages and initiating fibrotic reaction.
64
What is the UIP pattern in interstitial pneumonia?
Fibrosing interstitial pneumonia with poor prognosis if idiopathic
## Footnote
Characterized by lower lobes reticular opacities, honeycombing, and traction bronchiectasis.
65
What distinguishes NSIP from UIP?
NSIP has a better prognosis and lacks diagnostic features of other interstitial diseases
## Footnote
Two types: cellular vs fibrosing patterns.
66
What is respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)?
Characterized by smoker's macrophages in bronchioles
## Footnote
Found in individuals aged 40-50s with upper lobe involvement.
67
What is desquamative interstitial pneumonia (DIP)?
Macrophages in alveoli with ill-defined ground glass disease
## Footnote
Often associated with smoking and can progress to fibrosis.
68
What is cryptogenic organizing pneumonia (COP)?
Response to infections or inflammation characterized by polypoid plugs of organizing connective tissue
## Footnote
Normal underlying architecture with no fibrosis or honeycombing.
69
What is acute interstitial pneumonia (AIP)?
Only interstitial pneumonia with acute onset and worst prognosis
## Footnote
Pathologically synonymous with diffuse alveolar damage.
70
What are the clinical features of interstitial lung disease?
Insidious onset of dyspnea, dry cough, clubbing
## Footnote
Complications include restrictive lung disease and secondary pulmonary hypertension.
71
What is inhalation lung disease?
Heterogeneous group of pulmonary disorders due to inhalational exposure
## Footnote
Predominantly affects upper lobes.
72
What is asbestosis?
Lung disease with a 20-year latent period due to asbestos exposure
## Footnote
Increased risk of lung cancer and mesothelioma.
73
What is hypersensitivity pneumonitis?
Hypersensitivity reaction to inhaled organic antigens
## Footnote
Classified into acute/non-fibrotic and chronic/fibrotic forms.
74
What type of pneumonia tends to affect the upper zones more often?
Inhalational pneumonia
75
What is anthracosis?
Seen in coal workers' pneumoconiosis (CWP) and smokers; carbon pigment engulfed by macrophages and accumulated in connective tissue along lymphatics
76
What are the clinical features of inhalational pneumonia?
* Insidious onset of dyspnea
* Dry cough
* Constitutional symptoms
* Asymptomatic
77
What are the complications of inhalational pneumonia?
* Restrictive lung disease with eventual respiratory failure
* Reduced lung volumes and compliance
* Secondary pulmonary hypertension and cor pulmonale
78
What treatment may be required for histological diagnosis in inhalational pneumonia?
Lung biopsies may be required if imaging is equivocal
79
What is the definition of asbestos-related diseases?
Disease processes, primarily pulmonary in nature, that occur as a result of exposure to asbestos
80
What are the two forms of asbestos?
* Amphiboles (10%)
* Serpentine (90%)
81
What characterizes amphibole asbestos?
Straight and stiff, reaches deep lung more easily, less soluble
82
What are the clinical manifestations of asbestos exposure?
* Focal pleural plaques
* Benign pleural effusions
* Asbestosis
* Bronchogenic cancer
* Malignant mesothelioma
83
What is asbestosis?
Parenchymal interstitial fibrosis due to prolonged and heavy exposure to asbestos
84
What is the latency period for malignant mesothelioma?
25-40 years
85
True or False: Smoking is a significant risk factor for malignant mesothelioma.
False
86
What percentage of mesotheliomas are due to asbestos exposure?
80%
87
What is the most common type of cancer among asbestos workers?
Bronchogenic cancer
88
What are the microscopic features of malignant mesothelioma?
* Asbestos bodies
* Pleural plaques
89
What is the average prognosis for mesothelioma?
Overall poor prognosis (12 months average)
90
What is the most common cause of cancer mortality worldwide?
Lung cancer
91
What is the relationship between smoking and lung cancer risk?
10x increased risk, 60x in habitual smokers
92
What are the main types of lung cancer?
* Small cell carcinoma
* Non-small cell carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
- Large cell carcinoma
93
What is the classification of small cell lung cancer?
Almost always metastatic, most aggressive, exquisitely chemoradiosensitive
94
What genetic mutations are associated with lung cancer?
* EGFR
* ALK
* KRAS
* TP53
* Rb
95
What is the typical latency period for lung cancer due to asbestos exposure?
10-30 years
96
What are the clinical features of lung tumors?
* Hemoptysis
* Weight loss
* Hoarseness
* Dysphagia
97
What type of lung cancer is associated with paraneoplastic syndromes?
Small cell lung cancer
98
What is the treatment for lung cancer?
* Surgery
* Chemotherapy
* Radiotherapy
* Tyrosine kinase inhibitors for EGFR mutations
99
What is the significance of programmed death ligand (PD-L1) in lung cancer?
It helps decide if immunomodulation therapies can be used on certain types of cancers
100
What is a pulmonary carcinoid?
Low grade malignant epithelial neoplasms classified as well-defined, small masses
101
What is a major immune checkpoint protein that mediates anti-tumour suppression and response?
PD-1
## Footnote
PD-1 is involved in the regulation of immune responses.
102
List some complications associated with immune checkpoint therapy.
* Pneumonitis
* Endocrinopathies
* Sarcoid-like lymphadenopathy
* Colitis
* Hepatitis
* Hyperprogression
## Footnote
These complications can arise from the activation of the immune system.
103
What is the macroscopic description of a pulmonary carcinoid tumor?
* Well defined
* Small (< 4 cm)
* Peripheral or central mass
* Polypoid: projects into bronchial lumen covered by intact mucosa
* Collar-button lesion: penetrates bronchial wall into peribronchial tissue
## Footnote
These tumors can vary in appearance based on their location and growth pattern.
104
Define pulmonary carcinoid.
Low grade malignant epithelial neoplasms classified as typical or atypical
## Footnote
These tumors are neuroendocrine in origin.
105
What is the WHO classification for lung cancer neuroendocrine tumors?
* Small cell (14%)
* Combined small cell
* Large cell neuroendocrine
* Combined large cell
* Carcinoid (Typical and Atypical)
* Large cell (3%)
* Sarcomatoid (e.g., pleomorphic, spindle cell)
* Preinvasive
## Footnote
This classification helps in the diagnosis and treatment of lung cancers.
106
What is the epidemiology of pulmonary carcinoid tumors?
* < 5% of all primary lung tumors
* Usually < 40 years old
* No gender predilection
* 20-40% are non-smokers
## Footnote
These tumors are relatively rare and can occur in younger individuals.
107
What condition is associated with pulmonary carcinoids?
MEN1
## Footnote
Multiple Endocrine Neoplasia type 1 can predispose individuals to neuroendocrine tumors.
108
What is the precursor condition to pulmonary carcinoid tumors?
DIPNECH: diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
## Footnote
This condition is characterized by the proliferation of neuroendocrine cells.
109
What are the microscopic features of typical carcinoid tumors?
* Organoid, trabecular, palisading, ribbon or rosette-like arrangements
* Small round, uniform cells with moderate neoplasms
* < 2 mitoses / 10 HPF
## Footnote
HPF stands for high-power fields, used in microscopy.
110
What are the microscopic features of atypical carcinoid tumors?
* Higher mitotic rates (2-10 mitoses/10 HPF)
* Focal necrosis
* Increased pleomorphism
* Lymphatic invasion
## Footnote
These features indicate a more aggressive tumor compared to typical carcinoids.
111
What are common clinical presentations of pulmonary carcinoids?
* Hemoptysis
* Cough
* Bronchiectasis
* Atelectasis
* Infection
* Carcinoid syndrome (diarrhea, flushing, cyanosis in 10%)
## Footnote
Symptoms may vary based on tumor size and location.
112
What is the 5-year survival rate for typical carcinoid tumors?
95%
## Footnote
This high survival rate reflects the generally indolent nature of typical carcinoids.
113
What is the 5-year survival rate for small cell neuroendocrine tumors?
5%
## Footnote
Small cell tumors are aggressive with poor prognosis.
114
What imaging technique is used to detect neuroendocrine tumors?
PET with gallium-68 labeled somatostatin analogue (SSA)
## Footnote
This imaging technique is sensitive to the overexpression of somatostatin receptors in neuroendocrine tumors.
115
Fill in the blank: Well differentiated tumors (i.e., typical carcinoids) are _______ and FDG positive.
concordant
## Footnote
This indicates that both imaging modalities yield similar results.
116
True or False: Higher grade tumors tend to lose SSTR and move to glycolytic metabolism (FDG).
True
## Footnote
This metabolic shift is indicative of tumor progression.
