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Flashcards in Lung Histopath Deck (69):
1

What is the pathology of chronic bronchitis?

Dilatation of bronchi & excess mucus production

2

Aetiology of chronic bronchitis (2)

Tobacco smoke
pollution

3

Clinical features of chronic bronchitis

Productive cough for 3 months over 2 years

4

Histological features chronic bronchitis (3)

Airway dilatation
Goblet cell hyperplasia
Hypertrophy of mucous glands

5

Complications of chronic bronchitis (3)

Recurrent infections
chronic hypoxia
pulmonary HTN

6

Pathology of bronchiectasis

Airway dilatation & scarring

7

Clinical features of bronchiectasis (3)

Purulent sputum
cough
fever

8

Histological features of bronchiectasis

Permanent dilatation of bronchi

9

Complications of bronchiectasis (4)

recurrent infections
haemoptysis
amyloidosis
pulmonary HTN

10

Pathology of asthma

SM cell hyperplasia
excess mucus
inflammation

11

Aetiology of asthma

Immunogenic: allergens, drugs, cold air, exercise

12

Clinical features of asthma (3)

Episodic cough
Wheezing
SOB

13

Histological features of asthma (2)

Curschmann spirals - whorls of shed epithelium
Charcot Leyden crystals - eosinophils degraded in mucous plugs

14

Complications of asthma (2)

Death, chronic asthma

15

Pathology of emphysema

Affects acinus (distal to terminal bronchioles), wall destruction, airspace enlargement

16

Aetiology of emphysema (2)

Smoking
A1AT deficiency

17

Clinical features of emphysema (2)

cough
SOB

18

Histological feature of emphysema

Loss of alveolar parenchyma (distal to terminal bronchiole)

19

Complications of emphysema (3)

Pneumothorax
Resp failure
Pulmonary HTN

20

Causes of bronchiectasis (6)

Post-infectious
Abnormal host defence - hypogammaglobulinaemia
Ciliary dyskinesia (primary = Kartagener's)
Asthma
CF
Secondary to bronchiolar disease

21

What is the characteristics of all interstitial lung diseases?

Inflammation & fibrosis of the pulmonary connective tissue (particulary the interstitium of the alveolar wall)

End stage all have HONEYCOMB LUNG

22

Interstitial lung disease shows features of RESTRICTIVE lung disease on spirometry, name 3:

Decreased CO diffusion capacity
reduced lung compliance
reduced lung volume

23

Interstitial lung disease presents with: (3)

SOB
cyanosis, pulmonary HTN & corpulmonale
End-inspiratory crackles

24

Causes of fibrosing interstitial lung disease: (6)

IPF
Pneumoconiosis
Radiation induced pneumonitis
Drug induced
Cryptogenic organizing pneumonia
associated with connective tissue disease

25

Causes of granulomatous interstitial lung disease (3)

Sarcoid
EAA
Associated with vasculitides e.g. Wegener's, Churg-Strauss, microscopic polyangitis

26

2 other categories of interstitial lung disease

eosinophillic
Smoking related

27

Is IPF more common in males or females?

Males

28

Histology of IPF (3)

Pattern of fibrosis = USUAL INTERSTITIAL PNEUMONIA - progressive patchy interstitial fibrosis
Hyperplasia of type 2 pneumocytes, causing HONEYCOMB FIBROSIS (beginning at peripery of lobule)

29

Clinical presentation of IPF (4)

SOB
Non-productive cough
Hypoxaemia - whcih causes pulmonary HTN +/- Cor pulmonale
clubbing

30

Treatment of IPF (3) & impact on survival

Steroids
cyclophosphamide
Azathioprine
little impact on survival

31

What is pneumoconiosis?

An occupational lung disease, whereby inhalation of mineral dusts/ inorganic particles leads to a non-neoplastic lung rxn

32

In pneumoconiosis which lobe of lung is most commonly affected?

Upper lobe e.g. Coal workers, Silicosis

33

In Asbestosis which lobe is affected?

Usually lower lobe, and it can cause malignant as well as benign lesions e.g. adenocarcinoma, mesothelioma

34

What is a granuloma?

A collection of histiocytes + macrophages +/- multi-nucleate giant cells (cells of macrophage lineages fused together)

35

EAA/ Hypersensitvity pneumonitis/ Cryptogenic organising pneumonia/ Bronchiolitis obliterans organising pneumonia (BOOP). What are these conditions?

Group of IMMUNE MEDIATED lung disorders, caused by prolonged exposure to inhaled ORGANIC ags, which results in widespread ALVEOLAR INFLAMMATION (contrast with asthma - bronchi)
EAA is typically an occupational health disease

36

What is seen in histology of EAA etc? (2)

GRANULOMA formation and organising pneumonia - polypoid plugs of loose connective tissue within alveoli/ bronchioles

37

What is the acute presentation of EAA & how doews it present? (5)

Inhalation of antigenic dust in sensitized individual
Systemic sympoms - fevers, chills, cough, SOB, chest pain (within hours of exposure) Settles by next day

38

Presentation of chronic EAA? (4)

Persistent PRODUCTIVE cough
SOB
Clubbing
severe weight loss

39

Farmer's lung
Pigeon fancier's lung
Humidifier's lung
Malt-workers lung
Cheese washer's lung

mouldy hay/grain/silage
proteins in excreta/ feathers
Heated water reservoirs
Germinating barley - aspergillus clavatus/fumigatus
Mouldy cheese - aspergillus clavatus/ penicillium casei

Early recognition > removal of ag > prevents progression to fibrosis

40

Bronchopneumonia

Patchy bronchial distribution
low virulence organisms

41

Lobar pneumonia, 4 stages

Fibrinosuppurative consolidation
1) Consolidation
2) Red hepatisation (neutrophilia)
3) Grey hepatisation (fibrosis)
4) resolution

42

Atypical Pneumonia

Interstitial pneumonitis
No alveolar inflammation

43

Risk factors for SCC (3)

Smoking
Male
Highest rate of p53/ c-myc mutations

44

Histology of SCC (2)

Keratinisation
intercellular pricks (desmosomes)

45

Cytology of SCC (1)

squamous cells

46

Progression of SCC (6)

Epithelium > hyperplasia > metaplasia > dysplasia > angiosquamous dysplasia > carcinoma in situ > invasive carcinoma

47

In which group is adenocarcinoma of lungs most common?

Women & non-smokers

(a malignant epithelial tumour with glandular differentiation or mucin production) usually occurs peripherally

48

Histology of adenocarcinoma of lungs (1)

Glandular differentiation (and mucin production)

49

Cytology of adenocarcinoma of lungs (1)

Cells containing mucin vacuoles

50

What molecular mutation is sometimes seen in adenocarcinoma of lungs

EGFR mutations (treated with TK inhibitors)

51

Small cell carcinoma common location? Arises from which cells?

Centrally from proximal bronchi
neuroendocrine cells

52

Small cell carcinoma is associated with: (3)

ectopic ACTH
Lambert-Eaton
cerebellar degeneration

53

Small cell carcinoma has strong relationship to smoking, what mutations are common? (2)

p53 & RB1

54

Large cell carcinoma - what is it?

poorly differentiated epithelial tumour - large cells, large & prominent nuclei (poor prognosis)

55

Histology of large cell carcinoma?

no evidence of glandular or squamous differentiation

56

Paraneoplastic syndromes occur due to large cell carcinoma, give 5 examples:

ADH
ACTH
PTH
PTHrP
Calcitonin

57

ERCC1 mutation associated with which cancer?

NSCLC - pooer response to cisplatin

58

EGFR mutation associated with which cancer?

Adeno - treat with anti-EGFR (TK inhibitors)

59

Kras mutations associated with which cancer?

Adeno/squamous, poor prognosis (does not respond to TKI)

60

EML4-ALK mutation associated with which cancer?

Adeno usually - no benefit from TKI

61

Clinical presentation of mesothelioma (3)

Chest pain
SOB
Pleural effusion (extensive)

62

Risk factors for PE (4) & Virchows triad

Female
Immobile
Cardiac disease
Cancer
Virchow's = blood stasis + damage to endothelium + increased coagulation

63

Complications of large PE (3)

Acute cor pulmonale
cardiogenic shock
death

64

Complications of small PE (2)

Can be silent
can cause peripheral wedge infarctions

65

What is defined as pulmonary HTN?

pressure > 25 mmHg at rest

66

Causes of secondary pulmonary HTN? Pre-cap (2), cap (1), post-cap (1)

Pre-capillary: Hypoxia/ embolus
Capillary: Pulmonary fibrosis
Post capillary: Left heart disease

67

Pulmonary HTN is most common in which group?

Females 20-40

68

Complications of pulmonary HTN (3)

RHF > venous congestion of organs, nutmeg liver, peripheral oedema

69

Main histology of pulmonary oedema

Iron laden macrophages (aka heart failure cells)