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Pathology ICSM COPY > Histopathology 12 - Respiratory pathology > Flashcards

Histopathology 12 - Respiratory pathology Flashcards

(54 cards)

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1
Q

What are the acute features of the airway in asthma?

A

Acute bronchospasm
Acute mucosal oedema
Inflammation

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2
Q

What are the chronic features of the airway in asthma?

A

Muscular hypertrophy
Airway narrowing
Mucus plugging

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3
Q

Define COPD

A

chronic cough productive of sputum

most days for ≥3 months over ≥2 consecutive years

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4
Q

What are the features of COPD?

A

Chronic bronchitis and emphysema

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5
Q

How does chronic hypoxia affect the heart?

A

Pulmonary hypertension —> right heart failure

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6
Q

What is emphysema?

A

Permanent loss of the alveolar parenchyma distal to the terminal bronchiole

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7
Q

What is the genetic association of emphysema?

A

Alpha 1 anti-trypsin

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8
Q

Recall the pathophysiology of emphysema

A

Smoking causes inflammation
Neutrophil and macrophage involvement
Proteases recruited
Breakdown of epithelium

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9
Q

How might histology differ in emphysema caused by smoking vs A1-AT deficiency?

A
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10
Q

What does lung bullous rupture cause?

A

Pneumothorax

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11
Q

What is bronchiectasis?

A

Permanent abnormal dilatation of bronchi with inflammation and fibrosis into adjacent parenchyma

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12
Q

Recall the complications of bronchiectasis

A

Haemoptysis
Pulmonary HTN
RHF
Amyloidosis secondary to chronic inflammation

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13
Q

What are some inflammatory causes of bronchiecstasis?

A
  • post infectious (children/ CF)
  • ciliary dyskinesia [i.e. Kartagener’s syndrome]
  • obstruction
  • post inflammatory (aspiration)
  • secondary to bronchiolar disease (OB) and interstitial fibrosis (CFA, sarcoidosis)
  • systemic disease (CTD)
  • asthma
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14
Q

Which condition has the strongest association with bronchiectasis?

A

Cystic fibrosis

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15
Q

What would you see on histology in bronchiectasis?

A

massively dilated airways

v little for normal parenchyma gas exchange

filled with mucus and blood

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16
Q

What are the 2 types of causes of pulmonary oedema?

A
  1. Leaky capillaries (drugs, inhalation of particles, pancreatitis)
  2. Back pressure from a failing left ventricle (left heart failure)
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17
Q

What is diffuse alvelolar damage?

A

acute diffuse lung injury - rapid onset resp failure

includes ARDS and HMD

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18
Q

How does diffuse alveolar damage appear on gross histopath?

A

Fluffy white infiltrates in all lung fields -“whiteout on all lung fields”

Lungs expanded/firm, plum coloured, airless, often weight >1kg

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19
Q

What is hyaline membrane disease?

A

Insufficient surfactant

Premature babies - HMD of newborn = RDS

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20
Q

What is bronchopneumonia?

A

Inflammation centred around airway

low virulence

  • stapylococcus
  • H influenzae
  • step
  • pneumococcus
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21
Q

Where does bronchopneumonia often affect?

A

Lower lobes

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22
Q

histopath of bronchopneumonia

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A

patchy bronchial and peribronchial distribution, often lower lobes

peribronchial distribution, acute inflammation surrounding airways and within alveoli

23
Q

Which type of pneumonia has become much rarer since ABx have been in use?

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A

Lobar pneumonia

High virulence - 90-95% pneumococci (i.e. strep)

24
Q

Outline the stage of lobar pneumonia

Study These Flashcards
A

Congestion - Hyperaemia, Intra-alveolar fluid

Red hepatization - Hyperaemia, Intra-alveolar neutrophils (non-atypical)

Grey hepatization - Intra-alveolar connective tissue

Resolution

25
What is empyema?
Infected pleural effusion
26
What does diagnosis of sarcoidosis involve?
non-caseating granuloma, elevated serum ACE, hypercalcaemia (1a-hydroxylase)
27
TB vs sarcoidosis histology
Sarcoid - non caesating granuloma TB - caesating granuloma
28
Which type of pneumonia is most likely to cause interstitial inflammation?
Atypical pneumonias
29
How is idiopathic pulmonary fibrosis diagnosed?
HR-CT ± biopsy diagnosis
30
What is extrinsic allergic alveolitis
farmer's lung - pt get better away from work/weekends
31
What is this image showing?
Small emboli: ## Footnote small peripheral pulmonary artery occlusion haemorrhagic infarct repeated emboli → ↑ occlusion of pulmonary vascular bed → pulmonary HTN
32
What is this image showing?
large emboli - occlude main pulmonary tract → saddle embolus
33
Definition of pulmonary HTN
PHBP \>25mmHg at rest
34
causes of pulm HTN
N.B. normal response of lungs to hypoxia is to reduce blood supply to hypoxic areas of lungs and divert it to aerated zones à chronic hypoxia results in chronic vasoconstriction to pulmonary arterioles (COPD, fibrosing lung disease)
35
What is nutmeg liver indicative of?
RHF → nutmeg liver as venous congestion
36
What are the most common lung tumours?
Epithelial tumours - non small cell and small cell
37
Which 2 types of lung cancer are most associated with smoking?
Squamous cell Small cell
38
what type of lungCa is most common in non-smokers?
Adenocarcinoma
39
Which mutations are non-smokers most likely to develop in adenocarcinomas?
EGFR
40
What are the 3 subtypes of non-small cell lung cancer?
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma
41
Where is squamous cell carcinoma most likely to develop in the lung?
Centrally
42
How does squamous cell carcinoma develop?
cig → normal ciliated → sqamous epithelium more resilient, but it does NOT have cilia → mucus build-up carcinogen accumulate within mucus spread locally - LATE mets
43
Where do adenocarcinomas typically develop?
Peripherally Mets early multi-centric pattern (many tumours at different stages of differentiation)
44
What would you see on adenocarcinoma histology?
evidence of glandular differentiation - mucin
45
What would you see on large cell carcinoma histolgy?
no evidence of glandular or squamous differentation central/peripheral poorer prognosis
46
Which mutations are smokers most likely to develop in small cell carcinoma?
RB1 p53
47
Which type of lung cancer is assoiated with the most paraneoplastic syndromes?
Small cell SIADH, ACTH, Lambert-Eaton Myasthenic Syndrome (LEMS)
48
Histhopathology of small cell carcinomas
Often CENTRAL and near the bronchi Small poorly differentiated cells - POOR PROGNOSIS
49
What molecular changes can be targeted in adenocarcinoma therapies?
EGFR (responder or resistance) ALK + Ros1 - responds to Crizotinib
50
what may happen in SCC if given biologics used to treat adenocarcinoma
fatal haemorrhage
51
What therapy does an EGFR mutated lung cancer respond to?
Tkl therapy
52
53
Which mutations are common in adenocarcinoma/NSCLC
EGFR Alk Ros1 PDL1
54
what marker do tumour cells usually express?
PDL1 - inhibits cytotoxic T cells PDL1 inhibitor can be used

Pathology ICSM COPY (90 decks)

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