Lung Histo Qs Flashcards
(109 cards)
1
Q
What are the 5 main obstructive lung dseases?
A
Chronic Bronchitis, Bronchiectasis, Asthma, Emphysema, Small aiway disease/Bronchiolitis
2
Q
Describe the pathology of Chonic Bronchitis
A
Dilatation of the airways nd excess mucus production
3
Q
Describe the pathology of Bronchiectasis
A
Airway dilatation and scarring
4
Q
Describe the pathology of Asthma
A
SM cell hyperpplasia, excess mucus, inflammatioon
5
Q
Describe the pathology of Emphysema
A
Airspace nelargement, wall destruction
6
Q
Describe the pathology of Bronchiolitis
A
Inflammatory scarring/obliteration
7
Q
What is the aetiology of Chronic Bronchitis?
A
Tobacco smoke, air pollution
8
Q
What is the aetiology of Asthma?
A
Immunologic: allergens, drugs, cold air, exercise
9
Q
What is the aetiology of Emphysema?
A
Tobacco smoke, alpha1-AT deficiency
10
Q
What is the aetiology of Bronchiolitis?
A
Tobacco smoke, air pollutants
11
Q
What are the clinical features of Chronic Bronchitis?
A
Cough, sputum on most days for 3 months over 2 years
12
Q
What are the clinical features of Bronchiectasis
A
Cough, purulent sputum, fever
13
Q
What are the clinical features of Asthma
A
Episodic cough, wheezing, dyspnoea
14
Q
What are the clinical features of Emphysema?
A
Dyspnoea, cough
15
Q
What are the clinical features of Bronchiolitis?
A
Dyspnoea, cough
16
Q
What are the histological features of Chronic Bronchitis?
A
Dilatation of the airways, goblet cell hyperplasia, and hypertrophy of mucous glands
17
Q
What are the histological features of Bronchiectasis?
A
Permenent dilatation of the bronchi
18
Q
What are the histological features of Asthma?
A
Whorls of shed epithelium (Curschmann spirals), eosinophils, Charcot-Leyden crystals
19
Q
What are the histological features of Emphysema?
A
Loss of alveolar parrenchyma distal to the terminal bronchiole
20
Q
Complications of Chronic Bronchitis
A
Recurrent infections, chronic hypoxia, pulmonary hypertension
21
Q
Complications of Bronchiectasis
A
Recurrent infections, haemoptysis, pulmonary hypertension, amyloidosis
22
Q
complications of Asthma
A
Chronic asthma, death
23
Q
Complications of Emphysema
A
Pneumothorax, Respiratory falure, pulmonary hypertension
24
Q
What are the inflammatory causes of bronchiectasis?
A
Post-infectious, abnormal host defense (primary and secondary), ciliary dyskinesia (primary and secondary), post-inflammatory, secondary to bronchiolar disease and interstitial fibrosis, systemic disease, asthma
25
What are the congenital causes of bronchiectasis?
Cystic Fibrosis, Primary ciliary dyskinesia, Hypogammaglobulinema
26
What are interstitial lung diseases? (general characteristics)
Group of over 200 disease, characterised by inflammation and fibrosis of the pulmonary connective tissue, particularly the most peripheral and delicate interstitium of the alveolar wall
27
What are the 4 categories of interstitial lung disease?
Fibrosinf, Granulomatous, Eosinophilic, Smoking Related
28
How do Interstitial lung diseases present on spirometry?
Show features of RESTRICTIVE lung disease: decreased CO diffusion capacity, decreased lung volume, decreased compliance
29
How do interstitial lung diseases usually present?
SOB, end-inspiratory crackles, cyanosis, pulmonary hypertension, and cor pulmonale
30
What do all interstitial lung diseases have at end-stage?
Honey-comb lung
31
Main 6 types of Fibrosing Interstitial Lung Disease
Idiopathic pulmonary fibrosis, pneumoconiosis, cryptogenic organizing pneumonia, associated with CTD, drug-induced, radiation pneumonitis
32
3 subgroups of Granulomatous Interstitial Lung Disease
Sarcoid, Extrinsic Allergic Alveoplitis, Associated with vasculitides e.g. Wegener's, Churg-Strauss, microscopic polyangitis
33
Epidemiology and Aetiology of Cryptogenic Fibrosing Alveolitis/Idiopathic Pulmonary Fibrosis
M>F, 60years +, causative agent unknown
34
Histological Pattern of Diffuse Interstitial Fibrosis
Progressive patchy interstitial fibrosis with loss of normal lung architecture and honeycomb change, beginning at periphery of the lobule, usually sub-pleural. Hyperplasia of type II pneumocyts causing cyst formation - honeycomb fibrosis
35
Clinical presentation of Cryptogenic Fibrosing Alveolitis/Idiopathic Pulmonary Fibrosis
Increasing exertional dyspnoea and non productive cough. 40=70yo at presentation, with hypoxaemia leading to cyanosis and pulmonary HTN +/- cor pulmonale, and clubbing
36
Treatment of Cryptogenic Fibrosing Alveolitis/Idiopathic Pulmonary Fibrosis
Steroids, Cyclophosphomide, Azathioprine - but these have little impact on survival
37
What CTDs are associated with lung fibrosis? (3 main)
RA, systemic sclerosis, SLE
38
What is pneumoconiosis?
A non-neoplastic lung reaction to inhalation of mineral dusts or inorganic compounds - typically an occupational lung disease
39
What part of the lung do pneumoconioses typically affect? What is the exception?
Upper zones. Asbestosis = lower sone
40
Give 3 examples of pneumoconioses
Coal worker's pneumoconiosis, silicosis, asbestosis
41
What two types of lesions can be caused by Asbestosis?
Benign pleural lesions (plaques, fibrosis); Malignant ledions (adenocarcinoma, mesothelioma)
42
What is a granuloma?
Collection of histiocytes, macrophages +/- multi nucleate giant cells
43
Name some Fungal granulomatous infections
histoplasma, cryptococcus, coccidiodes, aspergillus, mucor
44
What are the causes of non-infectious granulomatous conditions?
Sarcoid, foreign body, drugs, occupational lung disease
45
What are the infectious causes of Granulomatous Lung Disease
TB, Parasites, Pneumocystis, fungal
46
What is seen on histology of Extrinsic Allergic Alveolitis and Cryptogenic organising pneumonia/BOOP?
prescence of polyploid plugs of loose connective tissue within alveoli/bronchioled - granuloma formation and organising pneumonia
47
Acute presentation of Extrinsic allergic alveolitis and Cryptogenic organising pneumonia (Immune-mediated granulomatous lung diseases)
inhalation of antigenicdust in sensitised indivisual --> systemic symptoms (fever, chills, chest pain, SOB, cough) within hours of exposure, usually settle by following day,
48
Chronic presentation of Extrinsic allergic alveolitis and Cryptogenic organising pneumonia (Immune-mediated granulomatous lung diseases)?
progressive persistent cough, SOB, finger clubbing, severe weight loss
49
What causes Farmer's lung?
Saccharopolyspora rectivirgula (mouldy hay, grain, silage)
50
What causes Pigeon's fancier's Lung?
proteins in excreta/feathers
51
What causes Malt-workers lung?
Aspergillus clavatus/fumigatus (Germinating barley)
52
What causes Humidifiers lung?
thermactinomyces spp. (heated water reservoirs)
53
What causes cheese washer's lung?
Aspergillus clavatus/penicillium casei (mouldy cheese)
54
What are Extrinsic allergic alveolitis and Cryptogenic organising pneumonia?
Immune mediated lung disorders cause by intense/prolonged exposure to inhaled organic antigens --> widespread alveolar inflammation
55
What is Extrinsic allergic alveolitis typically associated with?
Occupational lung disease (person will probably have a weird hobby or job on Q)
56
What is another name for extrinsic allergic alveolitis?
Hypersensitivity pneumonitis
57
What is another name for Cryptogenic organising pneumonia?
Bronchiolitis obliterans organising pneumonia (BOOP)
58
Give 5 examples of an Extrinsic Allergic Alveolitis
farmer's lung, Pigeon fancier's lung, Humidifier's Lung, Malt-workers Lung, Cheese washer's lung
59
What are the 4 stages of Lobar pneumonia?
1. Consolidation 2. Red Hepatisation (neutrophilia) 3. Grey Hepatisation (Fibrosis) 4. Resolution
60
What kind of consolidation is seen in Lobar pneumonia?
Fibrinosupparative consolidation
61
What is the most common cause of Lobar pneumonia?
Strep. Pneumonia
62
What kind of consolidation is seen in Bronchopneumonia?
Patchy bronchial/peri-bronchial distribution
63
What kind of organisms cause bronchopneumonia?
Low virulence organisms
64
What kind of consolidation/inflammation do you get in Atypical pneumonias?
Interstitial pneumonitis. No intra-alveolar inflammation.
65
What are your atypical causes of pneumonia? (there are 6)
Legionella pneumophilia; Mycoplasma pneumonia; Chlamydia pneumonia; Chlamydia psittaci; Boratella pertussis; TB
66
What is the most common tumour of the lung?
Squamous cell carcinoma
67
What lung tumour is most common in women and non-smokers?
Adenocarcinoma
68
Which lung cancer is associated with ectopic ACTH secretion and Lambert-Eaton?
Small Cel carcinoma
69
Which lung cancer has the highest rate of p53/c-myc mutations?
Squamous cell carcinoma
70
Where do squamous cell carcinomas typically occur? And how quickly do they metastasize?
Proximal bronchi - local spread with late metastasis
71
Where do adenocarcinomas typically occur? And how quickly do they metastasize?
Peripherally (alveoli). Metastasizes early
72
Where do small cell carcinomas typically occur? And how quickly do they metastasize?
Occur centrally, proximal bronchi. Highly malignant, metastasize early, usually by diagnosis they have spread to bone, adrenal, liver and brain.
73
Which lung cancer is the most chemosensitive? Which is the least chemosensitive?
Most sensitive = Small Cell carcinoma, but still has bad prognosis due to early metastasis. Least sensitive = Squamous Cell Carcinoma
74
What is seen on histology of a squamous cell carcinoma?
Keratinisation, intracellular prickles (desmosomes)
75
What is seen on cytology of Squamous Cell Carcinoma?
Squamous cells!!
76
How does Squamous Cell Carcinoma progress?
Epithelium --> Hyperplasia --> squamous metaplasia --> angiosquamous dysplasia --> carcinoma in situ --> invasive carcinoma
77
Which lung cancer is associate with cavitation and hypercalcaemia?
Squamous cell carcinoma
78
What is seen on histology of an Adenocarcinoma?
glandular differentiation (gland formation and mucin production)
79
What is seen on cytology of Lung Adenocarcinoma
Cells containing mucin vacoules
80
What mutations are seen in Adenocarcinoma?
EGFR mutations
81
What is the progression of Adenocarcinoma?
Atypical adenomatous hyperplasia --> non mucinous BAC --> mixed pattern adenocarcinoma
82
From what type of cell does Adenocarcinoma originate? What differentiation is seen?
Epithelial cell, glandular differentiation or mucin production
83
Where do Small Cell Carcinomas arise from?
Neuroendocrine cells
84
What mutations are commonly seen in Small cell carcinoma?
p53 and RB1
85
Which lung cancers have a strong correlation with Smoking?
Squamous cell carcinoma, Small cell carcinoma
86
What type of cell does a Large cell carcinoma evolve from?
Epithelial cell --> it is a poorly differentiated epithelial tumor
87
What is seen on histology of Large Cell Carcinoma?
No evidence of glandular or squamous differentiation. Large cells, large nuclei, prominent nucleoli.
88
Staging of lung cancer
TNM staging: T1-4 based on size and invasion of pleura, pericardium; N0-2 lymph node involvement; M0-1 whether there is distant metastasis
89
Which gene is associated with poorer response to Cisplatin?
ERCC1-NSCLC
90
Which gene provides a taregt for Anti-EGFR therapy, and what type of lung cancer is it normally seen in?
EGFR, usually in adenocarcinomas
91
Which genes have no response to TK inhibitors, and so a poor prognosis? What form of lung cancer are they each associated with?
Kras = Adenocarcinoma + Squamous; EML4-ALK = usually Adeno
92
Risk factors for PE?
Female, immobility, cardiac disease, cancer, OCP, pregnancy, primary and secondary hypercoaguable states
93
What is a saddle embolus?
An embolus occluding the pulmonary trunk
94
What happens in a PE (Pathologically)?
Large emboli impact in the main pulmonary arteries leading to acute cor pulmonale, cardiogenic shock and death if >60% of pulmonary bed occluded
95
How can small emboli present?
May be silent, or cause peripheral wedge infarction. Repeated infarctions can result in pulmonary HTN, and then RHF
96
Give some examples of non-thrombotic emboli
bone marrow, amniotic fluid, tumour, air, foreign body
97
What is the definition of Pulmonary HTN?
Mean pulmonary arterial pressure of over 25mmHg at rest
98
What are the causes of Pulmonary HTN?
Primary or Secondary (more common), due to chronic lung diseases, heart disease, recurrent thrombo-emboli and autoimmune disorders
99
Secondary causes of Pulmonary HTN can be split up by aetiology. List these, and give an example for each.
Pre-capillary: chronic hypoxia/embolus; Capillary: Pulmonary Fibrosis; Post-Capillary = Left Heart Disease/Veno-occlusive Disease
100
Who is most likely to present with a primary pulmonary HTN?
Women aged 20-40yrs.
101
What are the complications of Pulmonary HTN?
RHF - venous congestion of organs (nutmeg liver), peripheral oedema
102
What is pulmonary oedema?
INTRA ALVEOLAR fluid accumulation leads to poor gas exchange
103
What is the main cause of pulmonary oedema?
Left Heart Failure
104
In pulmonary oedema, what is seen on histology?
Intra-alveolar fluid and iron laden macrophages ('heart failure cells')
105
What is the name of Diffuse Alveolar damage in adults and neonates?
Adults = ARDS; Neonates = HMD (Hyaline Membrane Disease)
106
What is the cause of diffuse alveolar damage in Neonates?
Insufficient surfactant production in prems
107
What is the cause of diffuse alveolar damage in adults?
Infection, aspiration, trauma.
108
What is seen on histology in diffuse alveolar damage?
Lung expanded, firm, plum-coloured, airless.
109
How does Diffuse Alveolar damage present?
Rapid onset respiratory failure!
