Lung Pathology Flashcards
(137 cards)
1
Q
what is asthma
A
chronic inflammatory disorder of the airways
2
Q
features of asthma
A
paroxysmal bronchospasm
wheeze
cough
variable bronchoconstriction - reversible
3
Q
histology in asthma
A
mucosal inflammation and oedema
hypertrophic mucous glands and mucous plugs in brochi
4
Q
what is atopic asthma?
A
type I hypersensitivity reaction
5
Q
causes of atopic asthma
A
dust
pollen
animal products
cold, exercise, resp infections
6
Q
persistent or irreversible changes in atopic asthma?
A
bronchiolar wall smooth muscle hypertrophy
mucus gland hyperplasia
respiratory brochiolitis leading to centrilobular emphysema
7
Q
who gets atopic asthma
A
children and young adults
8
Q
what is bronchiectasis
A
permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
9
Q
cause of bronchiectasis
A
infections
10
Q
signs/symptoms of bronchiectasis
A
cough, fever, copious foul smelling sputum
11
Q
predisposing conditions to bronchiectasis
A
CF
primary ciliary dyskinesia, Kartagener syndrome
bronchial obstruction - tumour, foreign body
lupus, RA, IBD, GVHD
12
Q
complications of bronchiectasis
A
pneumonia
septicaemia
metastatic infection
amyloid
13
Q
what is COPD
A
combination of chronic bronchitis and emphysema
14
Q
cause of COPD
A
chronic irritation
smoking
air polution
15
Q
what is the pathenogenesis of chronic bronchitis
A
mucous gland hyperplasia
seconday infection by low virulence bacteria
chronic inflammation - causes wall destruction and weakness = emphysema
16
Q
most common emphysema
A
centrilobular
17
Q
symptoms of COPD
A
dyspnoea - progressive and worsening
18
Q
what is interstitial lung disease
A
diseases of pulmonary connective tissue
19
Q
is interstitial lung disease restrictive or obstructive?
A
restrictive
20
Q
what happens in interstitial lung disease
A
increased tissue in alveolar-capillary wall
inflammation and fibrosis
decreased lung compliance
increase diffusion distance
21
Q
what is acute interstitial lung disease
A
diffuse alveolar damage - death of type 1 pneumocytes form hyaline membranes
adult respiratory distress syndrome: shock, trauma, infections, smoke, toxic gases
22
Q
what is chronic interstitial lung diseases?
A
dyspnoea increasing for months to years
23
Q
signs of chronic interstitial lung disease
A
clubbing, fine crackles, dry cough
24
Q
examples of chronic interstitial lung diseases
A
idiopathic pulmonary fibrosis
many pnemoconioses
sarcoidosis
collagen vascular diseases
25
which lobes most severly affected in PF
lower lobes
26
what is sarcoidosis
non-caeseating perilymphatic pulmonary granulomas, then fibrosis
27
which nodes are usually involved in sarcoidosis
hilar nodes
28
which other organs may be affected by sarcoidosis
skin, heart, brain
29
who gets sarcoidosis
young adult females
30
what causes pneumoconioses
inhaled dusts
31
what size are the dust particles
<3 micrometres
32
what is silicosis
silica sand and stone dust kills phagocytosing macrophages
fibrosis and fibrous silicotic nodules
possible TB reactivation
33
what is hypersensitivity pneumonitis
extrinsic allergic alveolitis
34
what is the antigen in farmer's lung
actinomycetes in hay
35
what is the antigen in pigeon fanciers lung
pigeon antigens
36
what is the effect of hypersensitivity pneumonitis
peribronchiolar inflammation with poorly formed non-caeseating granulomas extends alveolar walls
repeated episodes = interstitial fibrosis
37
what is cystic fibrosis
inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, GI and reproductive organs
38
characteristics of CF
broncioles distended with mucous
hyperplasia mucus secreting glands
repeated infections
bronchitis and bronchiectasis
39
effect of CF in exocrine gland
ducts plugged by mucus
atrophy and fibrosis of gland
impaired fat absorption, enzyme secretion, vit deficiencies
40
effect of CF in small bowel
mucus plugging
41
effect of CF in liver
plugging of bile cannaliculi - cirrhosis
42
effect of CF in salivary glands
similar to pancreas: atrophy and fibrosis
43
95% of males are ...
infertile
44
diagnosis of CF
sweat test
45
treatment of CF
ivacaftor
mucolytics
heart/ lung transplants
46
most common type of primary lung cancer
carcinomas
47
most common lung carcinoma
adenocarcinoma
48
second most common lung carcinoma
squamous cell carcinoma
49
which kind of tumour is seen in HIV/AIDS patients
primary lung lymphomas
50
what are the most common secondary lung tumours
carcinomas from various sites e.g. breast, GI, kidney
51
epidemiology of lung cancer
most common cause of cancer death in UK
52
risk factors of lung cancer
smoking
53
5 year survival of lung cancer
5-10%
54
causes of lung cancer
smoking
occupational/ industrial hazards - asbestos
radiation - mines in which there is radon
lung fibrosis
55
genetic mutations in lung cancer
EGFR, KRAS, ALK
56
where do lung mets go
brain
bone
pleura
liver
57
local effects of lung tumours
```
ulceration and bleeding - haemoptysis
consolidation
symptoms of pneumonia
pleural effusion
chest wall/ rib pain
recurrent laryngeal nerve - hoarseness
horner's syndrome
dysphagia
```
58
what is lymphangitis carcinomatosa
lymphatics within lung are diffusely involved by tumour
59
what makes up the visceral pleura
connective tissue
| mesothelium
60
what makes up the parietal pleura
mesothelium
| connective tissue
61
what should a normal mesothelium look like
single layer of cells
| secrete hyaluronic acid - lubricates movement
62
what is pleural effusion
excess fluid in the pleural cavity - serous fluid
63
pus in pleural effusion
empyema or pyothorax
64
blood in pleural cavity
haemothorax
65
bile in pleural cavity
chylothorax
66
air in pleural cavity
pneumothorax
67
types of pleural effusions
transudates
| exudates
68
features of transudate pleural effusions
high vascular hydrostatic pressure
| low capillary oncotic pressure - hypoalbuminaemia - hepatic cirrhosis, nephrotic syndrome
69
features of exudate pleural effusions
inflammation with/without infection
| neoplasms either primary or secondary
70
symptoms of pleural effusions
breathlessness - effusion compresses the lung
| little/no pleuritic pain - visceral and parietal pleura are not in contact
71
signs of pleural effusion
dull percussion
| reduced breath sounds
72
investigations of pleural effusion
imaging - ultrasound, CXR, CT scan
73
treatment of pleural effusion
aspiration with a needle and syringe - ultrasound
| reaspirate if the fluid reaccumulates
74
most common malignant pleural cancer
mesothelioma
75
secondary malignant pleural cancers
carcinomas - breast, lung
76
what is malignant mesothelioma
a neoplasm of the mesothelial cells that line serous cavities
77
commoner in which gender?
men
78
early malignant mesothelioma
a small tumour can produce a large pleural effusion
79
how can mesothelial cells and epithelial cells be differentiated?
express different antigens
| can be identified by immunostaining
80
causes of malignant mesotheliomas
asbestos
thoracic irradiation
BAP1 mutations
81
what is asbestos
fibrous metal silicates
82
which form asbestos is the most oncogenic
amphiboles - particularly crocidolite
83
what is asbestosis
interstitial pneumonia-like progressive pulmonary interstitial fibrosis caused by high level exposure to asbestos dust
84
characteristics of asbestosis
fibrosis of alveolar walls impairs gas exhange and lung expansion
85
pleural asbestos-related diseases
pleural effusion
parietal pleural fibrous plaques
diffuse pleural fibrosis
malignant mesothelioma
86
lung asbestos related diseases
asbestosis
| lung carcinoma
87
skin asbestos related diseases
asbestos corns
88
differential diagnoses for sore throat
pharygitis
acute tonsillar pharyngitis
infectious mononucleosis (EBV)
epiglottitis
89
most common causes of pharyngitis and tonsillar pharyngitis
```
viruses:
rhinovirus
coronovirus
parainfluenza
influenza (A and B)
adenovirus
```
bacteria:
group A strep (strep pyogenes)
Rare: n. gonorrhoeae, HIV-1, c.diptheriae
90
what are the centor criteria
tonsillar exudate
tender anterior cervical lymphadenopathy
>38
absence of cough
91
cause of infectious mononucleosis
EBV
92
who get infectious mononucleosis
teenagers
93
triad of symptoms in infectious mononucleosis
fever
tonisillar pharyngitis
cervical lymphadenopathy
94
what is epiglottitis
inflammation of structures above glottis
95
most common cause of epiglottitis
H. Influenzae type b
96
management of acute epiglottitis
significant mortality and morbidity
| secure airway and oxygenation
97
treatment for epiglottitis
IV antibiotics
analgesia
inform public health
98
what is otitis externa
inflammation of the external ear canal presenting with otalgia, pruritus and non-mucoid ear discharge
99
what is acute OE
range in severity - mild > necrotising
| unilateral
100
most common causative agent of acute OE
pseudomonas aeruginosa and s.aureus
101
what is malignant OE
spreads to skull base
102
who gets malignant OE
elderly diabetic or immunocompromised
103
what is otitis media
middle ear inflammation
104
what is uncomplicated acute OM
mild pain <72 hrs
no systemic symptoms
<39
no discharge
105
complicated acute OM
```
severe pain
perforated ear drum
purulent discharge
bilateral infection
mastoiditis
```
106
organisms that cause OM
s. pneumoniae
| h. influenzae
107
what is mastoiditis
infection of mastoid bone and air cells
108
what is pneumonia
infection affecting the most distal airways and alveoli
| formation of inflammatory exudate
109
what are the two anatomical patterns of pneumonia
bronchopneumonia - patchy distribution
| lobar pneumonia - large part or entirety of lobe
110
cause of lobar pneumonia
s. pneumoniae
111
what is hospital acquired pneumonia
>48hrs after hospital admission
112
organism in Ventilation acquired pneumonia
pseudomonas
113
organism in aspiration pneumonia
anaerobes
114
typical causative organisms of CAP
s. pnemoniae
h. influenzae
m. catarrhalis
s. aureus
klebsiella
115
atypical causative organisms of CAP
m. pneumoniae
legionella pneumophilia
chlamydophilia pneumoniae
chlamydophilia psittaci
116
what is used to assess severity of CAP
```
CURB score
confusion
urea - >7mmol/l
resp rate - >30
BP - systolic <90, diastolic <60
age >65
```
117
recommended tests for all moderate-severe CAP based on CURB65 score
```
sputum culture
blood culture
pneumococcal urinary antigen
legionella urinary antigen
PCR serology for viral pathogens, M. pneumoniae, Chlamydiophilia sp.
```
118
complications of pneumonia
pleural effusion
empyema
lung abscess
119
causes of viral pneumonia in adults
influenza A and B
Adenovirus
Varicella zoster virus
120
causes of viral pneumonia in children
RSV
| parainfluenza
121
pnemonia in immunocompromised host
```
measles
HSV
CMV
VZV
HHV-6
```
122
presentation of primary viral pneumonia
cough
breathlessness
cyanosis
123
causes of secondary bacterial pneumonia
s. pneumoniae
h. influenzae
s. aureus
124
colonising organisms in CF
s. aureus
p. aeruginosa
burkholderia cepacia complex
non-tuberculous mycobacteria and fungi
125
prevention of LRTIs
pneumococcal vaccination
influenza vaccination - 2-17 year olds
over 65s
chronic disease, multiple co-morbidities
126
what is aspergillosis
infection caused by aspergillus
127
who does allergic bronchopulmonary aspergillosis present in
people with atopy, asthma and CF
128
how does ABPA present
worsening asthma and lung function
129
diagnostic features of ABPA
high total IgE, specific IgE to aspergillosis, positive IgG to aspergillus
130
treatment of ABPA
corticosteroids and antifungal therapy
131
what is an aspergilloma
mobile mass of aspergillus within a pre-existing cavity
| - old cavities left by TB and sarcoidosis
132
symptoms of aspergilloma
```
cough
haemoptysis
weight loss
wheeze
clubbing
```
133
treatment of aspergilloma
surgical resection
| antifungals
134
how is TB transmitted
infection acquired by inhalation of respiratory droplets
bacilli lodge in alveoli and muliply
formation of Ghon focus
90% primary infection asymptomatic
135
presentation of TB
```
chronic productive cough
haemoptysis
weight loss
fever
night sweats
can disseminate and affect other organisms
```
136
detection of TB
detection of acid fast bacilli
culture of m. tuberculosis
interferon gamma release assays +/- tuberculin skin test
137
treatment of TB
combined chemotherapy for several months
