Lung Pathology Flashcards

Question

What are the differential diagnosis of emphysema?

Answer 1

Bronchiectasis Bronchitis Lymphangioleiomyomatosis

Answer 2

**Pulmonary/Lung Function tests** Spirometry is the best test to detect airflow limitation and obstruction. **Blood tests** Hb level increase secondary polycythaemia. **Chest x-ray** This helps to show hyperexpansion of the lungs. **ECG or Echocardiogram** Right heart failure (a complication of emphysema and COPD). **Blood gases** Normal, later stages of disease, low oxygen and high carbon dioxide levels. **High resolution CT** Best test for detecting emphysema and bullae (big dilated air spaces).

Answer 3

Stop smoking Physical activity **Vaccinations** Flu Pneumococcal Pertussis

Answer 4

Pneumothorax Cor pulmoale Acute exaccerbations Infection

Answer 5

An exacerbation can be defined as a sustained worsening of the patient's symptoms from his or her usual stable state that is beyond normal day-to-day variations, is acute in onset and requires additional therapy

Answer 6

S. pneumoniae, H. influenzae and Moraxella cartarrhalis

Answer 7

worsening of previous stable condition increased wheeze increased dyspnoea increased sputum volume increased sputum purulence chest tightness fluid retention reduced exercise tolerance increased fatigue

Answer 8

Chest X-ray Arterial Blood Gas Sputum Sample

Answer 9

**Increase bronchodilator use** - consider nebs **Antibitoics** Amoxicillin **Steroids** Prednisolone

Answer 10

Azithromycin 250mg 3 times a week

Answer 11

Irreversible dilation of the bronchioles

Answer 12

``` **_Congenital_** Cystic fibrosis (CF); ``` **_Post-infection_** TB HIV ``` **_Other_** Bronchial obstruction (tumour, foreign body) ```

Answer 13

Infection and imparied drainage Activates neutrophilic proteases and cytokines causing inflammation Increaed mucus and increased stagnent bacteria Cycle starts again

Answer 14

Chronic cough - foul smelling sputum Flecked with blood sometimes. Finger clubbing Coarse inspiratory crepitations. Wheeze

Answer 15

Alpha1-Antitrypsin Deficiency Aspiration Pneumonitis and Pneumonia Asthma Bronchitis Chronic Obstructive Pulmonary Disease (COPD) Cystic Fibrosis Emphysema Gastroesophageal Reflux Disease

Answer 16

**_Sputum culture_** **_Chest X-Ray_** Cystic shadows, thickened bronchial walls **_HRCT chest_** To assess extent and distribution of disease. **_Spirometry_** Obstructive.

Answer 17

Stop smoking Airway clearance exercises Bronchodilators Corticosteroids **Antibiotics - if infective cause** Amoxicillin

Answer 18

Pneumonia Emphysema Septicaemia Amyloid formation.

Answer 19

A deficiency in alpha-1 antitrypsin

Answer 20

Inactivates elastase (a protease) SERPINA1 Long arm of chromosome 14

Answer 21

Never smoked Young

Answer 22

Shortness of breath Wheezing Mucus production Chronic cough **_Cirrhosis_** Inability to make coagulation factors Build up of toxins

Answer 23

**Assaying protease inhibitor activity** **Typing proteins with isoelectric focusing** **_Bloods_** A1AT low **_Biopsy_** Liver - Periodic-acid shiff stain

Answer 24

**_Augmentation therapy_** IV infusion of normal protein Slow of halts progression Inhlaers Oxygen Liver transplant

Answer 25

Disease of the alveoli primarily Scarring Fibrosis

Answer 26

**Congenital** Neurofibromatosis Tuberous sclerosis **Chemical or dust inhalation** Organic dusts e.g. moulds, avian proteins Mineral dusts e.g. silica, coal dust, asbestos **Unknown causes:** Idiopathic haemosiderosis Sarcoidosis

Answer 27

Dry cough Digital clubing Diffuse inspiratory crackles Dysponea

Answer 28

Acute respiratory distress syndrome

Answer 29

Shock Trauma Infections Gas inhalation Narcotic abuse

Answer 30

Tachypnoea Dyspnoea Pulmonary oedema

Answer 31

Lung disease caused by inhaled dust Organic or inorganic dust (mineral)

Answer 32

Coal is ingested by alveolar macrophages (dust cells) They aggregate around bronchioles The consequences vary from trivial to lethal.

Answer 33

Rheumatoid arthritis interstitial lung disease (RA-ILD) is increasingly recognised and is clinically significant in up to 5% of patients with RA

Answer 34

1. Pulmonary function testing 2. High resolution CT

Answer 35

**High-dose corticosteroids** Prednisolone **Immunosuppresants** Azathioprine

Answer 36

The association between rheumatoid arthritis, pneumoconiosis, and pulmonary rheumatoid nodules.

Answer 37

Avoid exposure to coal dust Treat co-existing chronic bronchitis

Answer 38

Pneumoconiosis caused by inhalation of asbestos fibres, classically causing a chronic, diffuse, interstitial fibrosis of the lun

Answer 39

Inhaltion of asbestos.

Answer 40

Similar to other fibrotic lung diseases with progressive dyspnoea, clubbing, and fine end-inspiratory crackles. Also causes pleural plaques, increased risk of bronchial adenocarcinoma and mesothelioma.

Answer 41

**Chest X-ray** Diffuse bilateral shadowing, honeycomb lung. There may be pleural plaques which are an indicator of previous exposure to asbestos **Lung function tests** Restrictive

Answer 42

Symptomatic. Patients are often eligible for compensation through the UK Industrial Injuries Act.

Answer 43

Inflammation of the alveoli due to an extrinsic allergen of known type

Answer 44

**_Bird fancier’s lung_** Avian proteins in droppings Antigens **_Farmer’s lung_** Caused by fungus (poorly stored / mouldy hay)

Answer 45

Allergens comes in Irritates alveoli and activates neutrophils Releases inflammatory cytokines Cascade leads to B cell antibody prodction Complexes form TYPE 3

Answer 46

Acute (few hours after only inflammation) Chronic (fibrosis)

Answer 47

Granulomas Non-caseating Macrophages fuse with eachother making granulomas

Answer 48

**_Acute_** Fever Rigors Myalgia Dyspnoea Crackles (no wheeze). **_Chronic_** Increasing dyspnoea Weight decrease Exertional dyspnoea Type I respiratory failure Cor pulmonale.

Answer 49

**_CXR_** Upper-zone mottling/consolidation Honeycombing sometimes **_Blood_** FBC (neutrophilia); ESR increase; ABGS; positive serum precipitins (indicate exposure only). **_Lung function tests_** Restrictive defect; reduced gas transfer during acute attacks.

Answer 50

Remove allergen O2 Oral prednisolone

Answer 51

**_Asthma_** Obstructive Larger airways Type 1 allergic **_EAA_** Restrictive Smaller airways Type 3 and 4 allergic

Answer 52

Granulomatous disease affecting mainly the lungs, but also lymph nodes in a greater frequency.

Answer 53

Non-ceasiating granulomatous disease

Answer 54

African-americans Women more than men Under 40 years of age Non smokers

Answer 55

Unknown Disregulation of CD4 cells

Answer 56

4 D's! Dry cough Digital clubbing Dyspnoea Diffuse inspiatory crackles

Answer 57

1. Skin – erythema nodosum 2. Arthritis - esp. of feet, hands 3. Cardiac– heart block, VT, heart failure 4. Ocular– anterior uveitis, can lead to blindness 5. Intracranial (brain) – chronic meningitis, seizures, neuropathy 6. Derangement of liver and renal function – hepatic granuloma (70% patients), hypercalcaemia(

Answer 58

**_Tissue biopsy_** Diagnostic non-caseating granulomatas **_X-ray_** Enlarged lymph nodes **_24h urine_** Ca2+ increase. **_Blood_** Increased ESR, lymphopenia, LFT incerease, Serum ACE increase Increased Ca2+

Answer 59

Nothing usually **_Corticosteroids_** Prednisolone PO

Answer 60

Lofgren sydrome

Answer 61

Uknown excess amount of collagen in the lungs connective tissue and interstitial tissue after damage

Answer 62

1. Old age 2. Smoking 3. Male

Answer 63

Loss of alveoli and start pooling fluid Seen as honeycombing

Answer 64

4 D's! Dry cough Digital clubbing Dyspnoea Diffuse inspiatory crackles

Answer 65

**_CXR_** Thickening of alveoli walls Honeycomb lung _**Spirometry **_Restrictive; decrease transfer factor. **_Blood_** ABG decrease in oxygen, increase in CO2 CRP increase; immunoglobulins increase; ANA (30% +ve), rheumatoid factor (10% +ve). **_BAL (Bronchoalveolar lavage)_**

Answer 66

**_Supportive care_** Oxygen, pulmonary rehabilitation, opiates, palliative care input **_Antifibrotic medications_** Pirfenidone and nintedanib **_Lung transplant_**

Answer 67

Bronchial. Pleural.

Answer 68

**_Malignant (95%) = lung cancer_** 1. Non small cell cancer 2. Small cell cancer **_Benign_** 1. Hamartoma 2. Carcinoid 3. Lipoma

Answer 69

Smoking Asbestos Chromium Arsenic

Answer 70

**_Small cell lung cancer 15%_** **_Non small cell lung cancer 85%_** Squamous Adenocarcinoma (adenocarcinoma-in situe) Large cell 5% NOS

Answer 71

Cough (40%) Chest pain (20%) Haemoptysis (7%)

Answer 72

Weight loss Anaemia Clubbing Supraclavicular or axillary nodes

Answer 73

1. CXR 2. Constrast chest CT 3. Bronchoscopy 4. Needle or surgical biopsy

Answer 74

Bone Brain Adrenal glands Lymph glands Liver

Answer 75

**_Stage I/II_** surgical excision and radical deep x-ray therapy **_Stage III/IV_** Palliative chemotherapy, chemotherapy and radiotherapy, palliative care

Answer 76

Tumour of mesothelial cells in the pleura

Answer 77

Epithelioid (Activated macrophages resembling epithelial cells) Sarcomatoid (Sarcomatous, spindled or diffuse malignant fibrous mesothelioma) Inflammation DNA damage

Answer 78

1. FEVER 2. WEIGHT LOSS 3. FATIGUE 4. SOB 5. Persistent cough 6. Clubbed fingers

Answer 79

**_CXR_** Pleural thickening/effusion. Bloody pleural fluid **_CT scan_** **_Pleural aspiration_** **_Biopsy_**

Answer 80

Symptom control Palliative chemotherapy (Pemetrexed + cisplatin) Radical surgery/debulking surgery Palliative radiotherapy

Answer 81

Type 1: Low PaO2, normal (or low) paCO2, normal or high A-a gradient. Limited of ventilation, perfusion or diffusion.

Answer 82

Type 2: low paO2, high CO2, usually normal A-a gradient (acute or chronic). Alveolar hypoventilation. CO2 enters alveoli, but not removed.

Answer 83

An infection in the lungs by microbes Brings water into lung making it harder to breath

Answer 84

Infants and the elderly. COPD and certain other chronic lung diseases. Immunocompromised. Nursing home residents. Diabetes. Alcoholics and intravenous drug users.

Answer 85

**_Bronchopneumonia_** Throughout lung **_Atypical_** Interstatium **_Lobar_**

Answer 86

**_Viruses_** Influenza **_Bacteria_** Strep pneumoniae Staph aureus Legionella's (hot country, air conditioning) Jirovecci (HIV patients)

Answer 87

Fever Rigors Fatigue Pleuritic chest pain SOB Headache Cough with sputum (rusty green)

Answer 88

Pyrexia Cyanosis Tachypnoea Drop in BP SPUTUM Confusion(esp. elderly)

Answer 89

Listen to the chest Gold standard CXR Consolidation. **_Determine the causative organism_** Sputum sample and blood culture Urinary antigen test –Legionellas Thoracentesis

Answer 90

Antibiotics for CAP: Mild: oral amoxicillin Moderate: oral amxoicillin and clarithromycin Severe: IV co-amoxiclav and clarithromycin Antibiotics for Legionellas: Fluoroquinolone (ciprofloxacin) + clarithromycin

Answer 91

Confused Urea \>7 Resp rate \>30 Blood pressure 90/60 Over 65

Answer 92

REVERSIBLE chronic obstructive airway disease

Answer 93

Eosinophilic. Associated with allergy. Also non-allergic variant. Non-eosinophilic.

Answer 94

Overlaps with smoking and obesity.

Answer 95

**_Allergic_** Genetics, environmental stimuli, hygiene hypothesis **_Non-allergic_** Intrinsic e.g. stress, cold air, infection

Answer 96

Asthma Hayever Eczema

Answer 97

Type 1 as it involves IgE

Answer 98

Chest tightness Coughing Wheezing Dyspnea Sputum

Answer 99

**Spirometry** FEV1/FVC\<70% + Reversibility testing **Peak flow** (keep a diary –diurnal variation) **Bronchodilator reversability**

Answer 100

Bronchiectasis CF PE Bronchial obstruction - foreign body, tumour, etc Aspiration COPD

Answer 101

**_Step 1_** SABA (salbutamol) **_Step 2_** SABA + Beclametasone (ICS) **_Step 3_** SABA + ICS + LTRA (montoleukast) **_Step 4_** SABA + low-dose ICS + long-acting beta agonist (LABA) + LRTA **_Step 5_** SABA + LTRA + Low dose MART **_Step 6_** SABA + LTRA + medium dose MART **_Step 7_** SABA + LTRA + High dose ICS + Muscarnic receptor agonist

Answer 102

**O**xygen 15L O2 sats 94-98% **S**albutamol 5mg nebs **H**hydrocortisone 100mg IV **I**patropium bromide 0.5mg nebs **T**heophyilline IV **M**agnesium sulphate 2mg IV **E**scalate care

Answer 103

Mycobacterium Tuberculosis Which is an AEROBIC, NON-MOTILE SLIGHTLY CURVED ROD

Answer 104

Born in high prevalence area IVDU Homeless Alcoholic Prisons HIV+.

Answer 105

AIRBORNE DROPLETS

Answer 106

**_Healthy_** Person has never been infected with TB **_Active TB_** This is when the bacterium are multiplying in the lungs and people have symptoms **_Latent_** The TB bacteria are NOT dividing in the lungs. Individual asymptomatic.

Answer 107

Fever Night sweats Chills Chest pain Cough Sputum Haemoptysis Breathlessness

Answer 108

Coughing up BLOOD Individual will look unwell

Answer 109

**Sputum test (3x) - Ziehl–Neelsen stain** Used to detect acid fast organisms **Mantoux skin test** Latent TB **CXR** Enlarged lymph nodes GOHN COMPLEX **CT scan**

Answer 110

**_R_**ifampicin. 6 months **_I_**soniazid. 6 months **_P_**yrazinamide 2 months **_E_**thambutol. 2 months

Answer 111

**_Rifampicin_** Red urine, hepatitis, drug interactions. **_Isoniazid_** Hepatitis, neuropathy **_Pyranzidimide_** Hepatitis, arthralgia / gout, rash. **_Ethanbutol_** Optic neuritis

Answer 112

Build up of AIR in the pleural space

Answer 113

**_Primary_** No underlying lung disease, but risk factors include 1. Male 2. Smoking 3. Connective tissue disease (Marfans, Ehlers Danlos). **_Secondary_** Underlying lung pathology that has caused it. 1. Trauma 2. Fractured ribs 3. Stab wound 4. Gunshot 5. Catheter 6. Biopsy

Answer 114

**_Symptoms_** 1. SOB 2. Sharp 3. ONE SIDED chest pain 4. Altered consciousness **_Signs_** 1. Tachycardia 2. Tachypneoa

Answer 115

**_CXR_** BLACK

Answer 116

**_Primary pneumothorax_** 1. If the rim of air is \< 2cm and the patient is not short of breath then discharge should be considered 2. Otherwise, aspiration should be attempted 3. If this fails (defined as \> 2 cm or still short of breath) then a chest drain should be inserted **_Secondary pneumothorax_** 1. If the patient is \> 50 years old and the rim of air is \> 2cm and/or the patient is short of breath then a chest drain should be inserted. 2. Otherwise aspiration should be attempted if the rim of air is between 1-2cm. If fails then chest drain. All patients should be admitted for at least 24 hours 3. If the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours

Answer 117

Tension pneumothorax Thrachea deviation

Answer 118

Needle decompresion and chest drain 2nd intercostal space

Answer 119

Fluid in the pleural space Chyle, blood, serous, pus.

Answer 120

**_Transudates_** Excessive production of pleural fluid or resorption is reduced. E.g. heart failure, cirrhosis, nephrotic syndrome **_Exudates_** Result from damaged pleura. E.g. PE, bacterial pneumonia, cancer, viral infection, pancreatitis

Answer 121

Blood in the pleural space is a haemothorax, pus in the pleural space is an empyema, and chyle (lymph with fat) is a chylothorax. Both blood and air in the pleural space is called a haemopneumothorax.

Answer 122

SOB Cough Chest pain

Answer 123

Decreased chest movement Reduced breath sounds Dull to percussion

Answer 124

**_CXR_** white (fluid), **_Listen to the chest_** Dull to percussion Reduced breath sounds **_Thoracocentesis_**

Answer 125

Aspirate / chest drain Pleurodesis

Answer 126

Clot inside a pulmonary vessel a DVT

Answer 127

Immobility - \>3 days, surgery within last 4 weeks Previous DVT/ PE Pregnancy Thrombophilic syndromes Malignancy Hormone Therapy

Answer 128

Sudden onset dyspnoea Chest pain Red, swollen leg ? Haemoptysis Pre-syncope, syncope Tachycardia

Answer 129

Pyrecia Cyanosis Tachycardia Tachypnoea Hypertension Raised jvp

Answer 130

1. Active cancer, or cancer that’s been treated within last six months- 1 2. Paralyzed leg - 1 3. Recently bedridden for more than three days or had major surgery within last four weeks - 1 4. Tenderness near a deep vein - 1 5. Swollen leg - 1 6. Swollen calf with diameter that’s more than 3 centimeters larger than the other calf’s - 1 7. Pitting edema in one leg - 1 8. Large veins in your legs that aren’t varicose veins - 1 9. Previously diagnosed with DVT - 1 10. Other diagnosis more likely -2 \>3 High Risk of DVT 1 or 2 Moderate risk 0 or less Low risk of DVT

Answer 131

D-dimer – negative excludes PE but positive doe not prove it If positive, need to do CTPA

Answer 132

Oxygen Analgesia **_Anticoagulation_** – LMWH, Fondoparinux **_Start Warfarin_** – long term anticoagulation (Rivaroxaban is a suitable alternative) Embelecetomy if large PE

Answer 133

Vasculitis **Triad of:** 1. Glomerulonephritis 2. Pulmonary haemorrhage 3. Autoantibodies to GBM and alvelor basement membrane

Answer 134

Antibodies form against type IV collagen

Answer 135

Smoking Infection Oxidative stress

Answer 136

**_Haemoptysis_** SOB, chest pain, cough, **_Haematuria_** Proteinuria, oedema, uraemia, high bp

Answer 137

**_CXR_** Infiltrates due to pulmonary haemorrhage, often in lower zones. **_Kidney biopsy_** Crescentic glomerulonephritis.

Answer 138

**Immunosuppressive** Cyclophosphamide, prednisolone, rituximab ## Footnote **Plasmapheresis**

Answer 139

Small vessel vasculitis with caseating granulomas

Answer 140

1. Nasal passage 2. Respiratory tract 3. Kidneys

Answer 141

1. **_Kidneys_** RPGN with crescent cells, haematuria 2. **_Lung_** Migrating cavitatingcoin nodules, haemoptysis, pulmonary infiltrates 3. **_URT_** Saddle nose deformity, epistaxis 4. **_Eyes_** Iritis, scleritis, episcleritis 5. **Arthritis** 6. **Elbow nodules**

Answer 142

**_cANCA_** Positive **_Urinalysis_** Proteinuria or haematuria **_Biopsy of kidneys_** Granulomas **_CXR_** Nodules ± fluffy infiltrates of pulmonary haemorrhage Increased ESR/CRP

Answer 143

**Corticosteroids** **Cyclophosphamide** Inhibit immune system

Answer 144

Mean arterial blood pressure greater than 25 mmhg

Answer 145

**_Pre-capillary_** Multiple small PEs cause obliteration of vascular bed Left-to-right shunts cause increased pulmonary blood flow and pressure **_Capillary_** Disease of pulmonary vascular bed Eg emphysema, COPD **_Post-capillary_** Backlog of blood causes secondary pulmonary hypertension LV failure **_Chronic hypoxaemia_** Living at high altitude COPD

Answer 146

Fatigue, pre-syncope Tachycardia Raised JVP Altered heart sounds (louder S2) Peripheral oedema – sacral, ankle

Answer 147

**_Chest radiology_** May show right atrial dilatation and right ventricular enlargement **_ECG_** Increase pressure in pulmonary articles and right venticle, right axis deviation, R wave in V1, inverted T waves in right precordial lead **_Echocardiography_** Demonstrates a dilated right ventricle with impaired function and often provides the first evidence of pulmonary hypertension **_Spirometry_** Chronic lung disease sometimes

Answer 148

1. **Oxygen** 2. **Diuretics** Furosemide 3. **Anticoagulation** DOAC 4. **Prostacyclin analogue** Apoprostenol

Answer 149

Excessive mucus build up in lungs and pancreas

Answer 150

Autosomal recessive CF transmembrane conductance regulator (CFTR) gene Chromosome 7 DeltaF508

Answer 151

Defect in chlorine channel Chlorine can therefore not be transported into the lumen. Water does not move out by osmosis, making the mucus thick and sticky, clogging up the lumen. Na+ also moves into the cells via an electrochemical gradient (Cl- is negative, Na+ is positive), which also draws water in with it and makes the mucus even more thick and sticky.

Answer 152

Meconium - first stool Can get stuck in intestine Meconium ileus

Answer 153

Thick secretions block the duct No enzymes into intestine Protein and fat not absorbed Failure to thrive Steatorrhoea Pancreas damaged due to backup of enzymes Localised inflammation - pancreastitis

Answer 154

1. Neonatal period (around 20%): meconium ileus, less commonly prolonged jaundice 2. Recurrent chest infections (40%) 3. Malabsorption (30%): steatorrhoea, failure to thrive 4. Other features (10%): liver disease

Answer 155

Steatorrhea Children with a failure to thrive Finger clubbing Rectal prolapse

Answer 156

90% diagnosed before the age of 8. FAECAL ELASTASE **_Sweat (NaCl) test_** Parents taste salt when kissing baby **_Genetics testing_** DeltaF508

Answer 157

NO CURE, therefore symptom management **_Non-pharmalogical_** Physio for airway clearance **_Pharmalogical_** Antibiotics, anti-mucinolytics, bronchodilators, enzymes, insulin, bisphosphonates **_Surgery_** Lung transplant

Answer 158

INFERTILITY Pancreatitis RESP TRACT INFECTIONS Bronchiectasis

Lung Pathology Flashcards

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