Lung Pathology

Question 1

In what percentage of patients does progressive TB occur?

Answer 1

Less than 10% of all TB patients, usually immunosuppressed

Question 2

What are some DDx of bilateral hilar enlargement?

Answer 2

Sarcoidosis

Lymphoma

TB

Metastasis

Other infections - fungal

Question 3

What is honeycomb lung?

Answer 3

Irreversible end-stage manifestation of a large number of interstitial inflammatory and proliferative lung diseases

Poor prognosis

Question 4

What is the pathogenesis of an exudate?

Answer 4

Altered permeability of or damage to the capillaries surrounding space

Question 5

What are some non-infectious causes of pleuritis?

Answer 5

Trauma

Infarction

Connective tissue disorders: eg RA or lupus

Uraemia

Tumour

Radiation effect

Question 6

What is a common cause of mesothelioma?

Answer 6

Asbestos

Question 7

What is sarcoidosis?

Answer 7

It is a multisystem inflammatory disease of unknown etiology that manifests as noncaseating granulomas, predominantly in the lungs and intrathoracic lymph nodes

Question 8

What is a common first presentation of mesothelioma?

Answer 8

Pleural effusion

Question 9

What type of TB typically occurs at the apex of the lung?

Answer 9

Secondary TB

Question 10

What are common causes of interstitual lung disease?

Answer 10

Idiopathic

Occupational/environmental exposure

Drugs

Question 11

What is secondary TB?

Answer 11

Reactivation of a dormant focus of primary TB

or a new infection

Question 12

What is the pathophysiology of mesothelioma?

Answer 12

Small fibres in the alveolar causes chronic stimulation > tumour develops

Question 13

What is granulomatous inflammation?

Answer 13

Nodular clusters of macrophages +/- giant cells

Question 14

What is the commonest cause of non-necrotising granulomas?

Answer 14

Sarcoidosis

Question 15

What are differentials for granulomatous inflammation?

Answer 15

TB

Sarcoid

Lymphoma

Question 16

What is Gohn’s complex?

Answer 16

Gohn focus - TB lesion in the lung parenchyma

TB Lesion in a draining LN

Question 17

What must you do before treating sarcoidosis?

Answer 17

Exclude infective causes as steroids will likely exacerbate the infection

Question 18

What is the prognosis of mesothelioma?

Answer 18

Average survival from onset of symptoms is 12-15 months

Mortality is 100%

Question 19

What causes a chylous effusion?

Answer 19

High lymphocyte count - TB, lymphoma

Question 20

How much fluid accumulation consitutes a pleural effusion?

Answer 20

>15mL

Question 21

Typical presentation of interstitial lung disease?

Answer 21

Slow, increasing SOB

Dry cough

Question 22

How do you differentiate adenocarcinoma with mesothelioma?

Answer 22

IHC staining

Question 23

What is the difference between a transudate and exudate?

Answer 23

Transudate is lower in protein

Question 24

What is the pattern of location of sarcoidosis?

Answer 24

Enlarged lymphadenopathy at the hilum

Bilateral granulomatous inflammation of lungs

Question 25

What is the main differential for mesothelioma?

Answer 25

Adenocarcinoma

Question 26

What are the three stages of ARDS and how do they appear microscopically?

Answer 26

Acute - Alveolar spaces with hyaline membranes and oedema Organising - Pneumocyte hyperplasia and interstitium inflammation and reactive fibrosis Chronic - Denser fibrosis and microscopic cysts

Question 27

How does mesothelioma appear macroscopically?

Answer 27

Numerous small nodules covering the serosa, fuse and form diffuse thickening. Massive encase of viscera often causing obliteration of pleura or peritoneal cavity

Question 28

How does mesothelioma appear microscopically?

Answer 28

Epithelioid type with tubulopapillary structures Sarcamatoid type with spindle cells Tumour cells have enlarged nuclei, prominent nucleoli and hyperchromasia

Question 29

What is the cell surface marker for mesothelioma?

Answer 29

Calretin