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Histopathology 12 - Respiratory pathology Flashcards

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1
Q

Main causes of pumonary oedema

A
  • Left heart failure
  • Alveolar injury i.e. in patients who have inhaled fire-smoke fumes
  • Neurogenic i.e. after a brain injury, can lead to systemic effects
  • High altitude
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2
Q

How does diffuse alveolar damage appear on CXR?

A

Firm and expanded lungs

Also “white out” of all lung fields

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3
Q

What are the acute features of the airway in asthma?

A

Acute bronchospasm
Acute mucosal oedema
Inflammation

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4
Q

What are the chronic features of the airway in asthma?

A

Muscular hypertrophy
Airway narrowing
Mucus plugging

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5
Q

What are the features of COPD?

A

Chronic bronchitis and emphysema

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6
Q

Describe the features of chronic bronchitis

A
  • Chronic cough productive of sputum
  • Most days for at least 3 months over at least 2 consecutive years
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7
Q

How does chronic hypoxia affect the heart?

A

Pulmonary hypertension —> right heart failure

COR PULMONALE

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8
Q

What is emphysema?

A

Permanent loss of the alveolar parenchyma distal to the terminal bronchiole

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9
Q

What is the genetic association of emphysema?

A

Alpha 1 anti-trypsin

Since a1 antitrypsin helps neutralise the activation of neutrophils and proteases and keep this system in balance, so deficiency increases R of emphysema due to damage from immune cells

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10
Q

Recall the pathophysiology of emphysema

A
  • Smoking causes inflammation
  • Neutrophil and macrophage involvement
  • Proteases recruited
  • Breakdown of epithelium
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11
Q

What does lung bullous rupture cause?

A

Pneumothorax

NB bullae form as complication of emphysema (bullae = large air spaces)

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12
Q

What is bronchiectasis?

A

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

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13
Q

Recall the complications of bronchiectasis

A
  • Haemoptysis
  • Pulmonary HTN
  • RHF
  • Amyloidosis secondary to chronic inflammation
  • Recurrent infections
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14
Q

Which condition has the strongest association with bronchiectasis?

A

Cystic fibrosis

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15
Q

What is bronchopneumonia?

A

Inflammation centred around airway (small bronchi and bronchioles)

Occurs in elderly pts

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16
Q

Where does bronchopneumonia often affect?

A

Lower lobes

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17
Q

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

A

Lobar pneumonia

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18
Q

What is empyema?

A

Infected pleural effusion

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19
Q

Which type of pneumonia is most likely to cause interstitial inflammation?

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A

Atypical pneumonias

20
Q

What are the most common lung tumours?

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A

Epithelial tumours - non small cell and small cell

21
Q

What are the 3 subtypes of non-small cell lung cancer?

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A

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

22
Q

Which 2 types of lung cancer are most associated with smoking?

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A 
Squamous cell (type of non-small cell)
Small cell carcinoma

NB 25% of lung cancers in non-smokers are attributed to passive smoking

23
Q

Where is squamous cell carcinoma most likely to develop in the lung?

24
Q

Where do adenocarcinomas typically develop?

25
Which mutations are smokers most likely to develop in adenocarcinomas?
K ras p53
26
Which mutations are non-smokers most likely to develop in adenocarcinomas?
EGFR This mutation occurs in around 25% lung adenocarcinomas
27
Which type of lung cancer is assoiated with the most paraneoplastic syndromes?
Small cell
28
Which mutations are most likely to develop in squamous cell carcinomas?
They're not - it's the adenocarcinomas that tend to get the mutations
29
Complication of chronic bronchitis (independent of smoking)
Lung cancer
30
Primary ciliary dyskinesia increases R of which lung disease?
**Bronchiectasis**
31
XRay sign of **Bronchiectasis**
tram-track opacities + signet ring sign
32
CXR finding in chronic LV failure
iron laden macrophages these are blue-stained cells which are full of iron pigment as there is chronic capillary leakage into the alveolar spaces
33
Another name for **Diffuse Alveolar Damage**
Acute Respiratory Distress Syndrome (shock lung)
34
Effect of Diffuse alveolar damage on lungs
* congested due to the exudate of fluid into alveolar spaces * alveoli become firm NB if condition resolved, then lung returns to normal
35
Complications of pneumonia
* abscess formation * Pleuritis and pleural effusion * Infected pleural effusion (empyema) * scarring
36
Pathophysiology of granulomatous lung disease, and 2 key causes
collection of histiocytes/ macrophages +/- multinucleate giant cells within the tissue Causes: * **Infection**- often TB in urban areas (CASEATING) - MUST EXCLUDE TB FIRST * Sarcoidosis- unusual immune reaction (NON-CASEATING) * Foreign body- Aspiration or IVDU * Drugs * Occupational lung disease
37
Possible enzyme effect of sarcoidosis
Elevated serum Angiotensin Converting Enzyme (ACE)
38
Best Ix for sarcoidosis
Biopsy
39
Which part of lung is effected in sarcoidosis
upper zones with a tendency to be peri-lymphatic or peri-bronchial
40
Cause of nutmeg liver
RH failure
41
Invasive Squamous Cell Carcinoma closely associated with which cause? Where in the lung do they occur?
smoking Centrally
42
What is a very aggresive lung carcinoma?
Small Cell Carcinoma - terrible prognosis since it recurs as soon as you stop chemo
43
44
Mutations in small cell carcinoma (2)
p53 and RB1 mutations
45
Where in lung is small cell caricnoma found?
central near bronchi
46
Why is surgery not that useful for small cell carcinoma?
Very aggressive, so has already metastasised by the time pt presents - therefore do chemoradiotherapy

HistoPath (21 decks)

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