Histopath - Resp

Question 1

Asthma MACRO & MICROscopic features

Answer 1

MACRO:

• mucous plug
• overinflated lungs

MICRO:

• hyperaemia
• eosinophilic inflammation
• goblet cell hyperplasia
• hypertrophic constricted muscle
• mucus plugging

Question 2

COPD - Chronic Bronchitis - MACRO & MICRO scopic features

Answer 2

MACRO:
- airway dilation

MICRO:

• mucous gland hypertrophy
• goblet cell hyperplasia

Question 3

Smoking related emphysema - pattern

Answer 3

• centered around airways

- centrilobular

Question 4

Alpha 1 anti trypsin related emphysema - pattern

Answer 4

• diffuse loss of alveolae

- panacinar

Question 5

CT evidence of bronchiectasis

Answer 5

Bronchial wall thickening

Positive signet ring sign

Question 6

Most common causative organism of Bronchiectasis

Answer 6

Staph aureus

Question 7

Organism associated with longstanding bronchiectasis

Answer 7

Pseudomonas

Question 8

Pulmonary Oedema Progression of MACRO & MICRO scopic changes

Answer 8

Acute:

• MACRO = heavy watery lungs
• MICRO = intra-alveolar fluid

Chronic:
- MICRO = iron laden macrophages, fibrosis

Question 9

Diffuse alveolar damage - types?

Answer 9

Adults = acute respiratory distress syndrome

Neonates = hyaline membrane disease of newborn / surfactant deficiency / respiratory distress syndrome

Question 10

ARDS - MACRO & MICRO scopic features

Answer 10

MACRO:

• firm, plum coloured expanded lungs
• airless
• often >1kg

MICRO

• capillary congestion
• fluid leakage (in exudative phase)
• dead cells + proteinaceous debris
• thick bands of protein deposited on alveolar epithelium ‘hyaline membranes’
• exudates organise into scar/granulation tissue

Question 11

ARDS on CXR

Answer 11

White out of all lung fields

Question 12

Bronchopneumonia - features

Answer 12

• low virulence organisms in compromised host
• Staph, Haemophilus, Strep, Pneumococcus
• patchy bronchial + peribronchial distribution
• often lower lobes
• neutrophils + inflammatory exudate
• mainly around airways then spreads into alveolar spaces

Question 13

Lobar pneumonia - features

Answer 13

• high virulence organisms
• 90-95% Pneumococci e.g. S. pneumoniae
• congestion –> red hepatisation –> grey hepatisation –> resolution

Question 14

Stages of of red hepatisation process

Answer 14

Acute inflammation
Capillary leakage
Contents leaks into alveoli

Appearance:

• Hyperaemia
• Intra-alveolar neutrophils

Question 15

Causative organism of abscess formation (pneumonia)

Answer 15

Klebsiella

in EtOH dependent patients

Question 16

Idiopathic pulmonary fibrosis macroscopic features

Answer 16

Basal + peripheral fibrosis

Cyst formation

Question 17

Presentation of small emboli

Answer 17

Pleuritic chest pain

Acute SOB +/- chronic progressive SOB

Question 18

Presentation of large emboli

Answer 18

Sudden death

Acute R heart failure

CVS shock

If patient survives, 30% develop more

Question 19

Risk of Bevacizumab in lung ca.?

Answer 19

Some patients develop fatal lung haemorrhage

Invasive squamous cell carcinoma type

Question 20

Most common type of ca. seen in non-smokers?

Answer 20

Adenocarcinoma

Question 21

Rank lung ca. by prognosis

Answer 21

Terrible = small cell carcinoma

Poor = large cell carcinoma

Extrathoracic mets common + early = Adenocarcinoma

Local spread, late mets = Invasive squamous cell carcinoma

Question 22

Type of cancer associated with paraneoplastic syndromes

Answer 22

Small cell carcinoma