Respiratory

Question 1

1. Define asthma.

Answer 1

Chronic inflammatory airway disorder with recurrent reversible episodes of widespread narrowing of the airways

Question 2

3. List some non-atopic triggers of asthma.

Answer 2

Air pollution
Occupational
Exercise

Question 3

4. Describe the pathogenesis of asthma?

Answer 3

Immediate phase – mast cells degranulate when they come into contact with antigen. Inflammatory mediators are released which causes increased vascular permeability= recruitment of eosinophils and mast cells and bronchospasm
Late phase – tissue damage = increase mucus production and muscle hypertrophy

Question 4

5. List some acute changes seen in asthma.

Answer 4

Bronchospasm
Oedema
Hyperaemia
Inflammation

Question 5

6. List some chronic changes seen in asthma.

Answer 5

Muscular hypertrophy
Airway narrowing
Mucus plugging

Question 6

7. Describe the main histological features of asthma.

Answer 6

Lots of eosinophils and mast cells
Goblet cell hyperplasia
Mucus plugs within airways
Thickening of bronchial smooth muscle and dilatation of blood vessels

Question 7

8. Define chronic bronchitis.

Answer 7

Chronic cough productive of sputum presents for most days for at least 3 months over 2 consecutive years

Question 8

9. List some histological features of chronic bronchitis.

Answer 8

Dilated airways
Mucus gland hyperplasia
Goblet cell hyperplasia
Mild inflammation

Question 9

10. List some complications of chronic bronchitis.

Answer 9

Recurrent infections
Chronic respiratory failure
Pulmonary hypertension and right heart failure (cor pulmonale)
Increased risk of lung cancer (independent of smoking)

Question 10

11. Define bronchiectasis.

Answer 10

Permanent abnormal dilatation of the bronchi with inflammation and fibrosis extending into adjacent parenchyma

Question 11

12. Which part of the lungs tends to be affected most frequently in idiopathic bronchiectasis?

Answer 11

Lower lobe

Question 12

13. List some causes of bronchiectasis.

Answer 12

Infection (MOST COMMON)
•	Post-infectious (e.g. CF)
•	Abnormal host defence (e.g. chemotherapy, immunodeficiency)
•	Ciliary dyskinesia
Obstruction 
Post-inflammatory (aspiration)
Interstitial disease (e.g. sarcoidosis)
Asthma

Question 13

14. List some complications of bronchiectasis.

Answer 13

Recurrent infections
Haemoptysis
Pulmonary hypertension and right heart failure
Amyloidosis

Question 14

15. Where is the CFTR gene found?

Answer 14

7q3

Question 15

16. What is the most common mutation associated with CF?

Answer 15

Delta F508

Question 16

17. List some clinical manifestations of CF.

Answer 16

GI – meconium ileus, malabsorption 
Pancreas – pancreatitis 
Liver – cirrhosis 
Male reproductive system – infertility 
Recurrent chest infections

Question 17

18. What is pulmonary oedema?

Answer 17

Accumulation of fluid in the alveolar spaces either due to leaky capillaries or back pressure from a failing left ventricle
This leads to poor gas exchange

Question 18

19. List some causes of pulmonary oedema.

Answer 18

Left heart failure
Alveolar injury (e.g. drugs)
Neurogenic following head trauma
High altitude

Question 19

21. What is diffuse alveolar disease?

Answer 19

Acute damage to alveolar epithelium/endothelium leading to exudative inflammatory rection

Question 20

23. Describe the appearance of the lungs on post-mortem examination in a patient who died from ARDS.

Answer 20

Plum-coloured
Heavy
Airless

Question 21

24. Outline the pathophysiology of ARDS.

Answer 21

Capillary congestion
Exudative phase – the lungs become congested and leaky
Hyaline membranes – form when serum protein that is leaked out of vessels end up lining the alveoli
Organising phase – organisation of the exudates to form granulation tissue sitting within the alveolar spaces

Question 22

27. List some causes of hospital-acquired bacterial pneumonia.

Answer 22

Gram-negatives (Klebsiella, Pseudomonas)

Question 23

28. Which types of bacteria tend to be implicated in aspiration pneumonia?

Answer 23

Mixture of aerobic and anaerobic

Question 24

29. What is bronchopneumonia?

Answer 24

Infection is centred around the airways
Tends to be associated with compromised host defence (mainly the elderly) and is caused by low virulence organisms (e.g. Staphylococcus, Haemophilus, Pneumococcus)
It will show patchy bronchial and peribronchial distribution often involving the lower lobes

Question 25

30. What is lobar pneumonia?

Answer 25

Infection is focused in a lobe of the lung 90-95% caused by S. pneumoniae Widespread fibrinosuppurative consolidation

Question 26

31. What are the histopathological stages of lobar pneumonia?

Answer 26

Stage 1: congestion (hyperaemia and intra-alveolar fluid) Stage 2: red hepatisation (hyperaemia, intra-alveolar neutrophils) Stage 3: grey hepatisation (intra-alveolar connective tissue) Stage 4: resolution (restoration of normal tissue architecture)

Question 27

32. List some complications of pneumonia.

Answer 27

``` Abscess formation Pleural effusion Empyema Fibrous scarring Septicaemia ```

Question 28

33. What is a granuloma?

Answer 28

Collection of macrophages and multi-nucleate giant cells

Question 29

35. Define emphysema.

Answer 29

Permanent loss of alveolar parenchyma distal to the terminal bronchiole due to protease activation

Question 30

36. List some causes of alveolar damage that can lead to emphysema.

Answer 30

Smoking Alpha-1 antitrypsin deficiency Rare: cadmium exposure, IVDU, connective tissue disorder

Question 31

37. Describe how the pattern of alveolar damage is different with smoking compared to alpha-1 antitrypsin deficiency.

Answer 31

Smoking – centrilobular damage – loss centred around bronchioles Alpha-1 antitrypsin deficiency – panacinar (throughout the lungs)

Question 32

38. List some complications of emphysema.

Answer 32

Bullae (can rupture to cause pneumothorax) Respiratory failure Pulmonary hypertension and right heart failure

Question 33

39. What is a long term consequence of repeated small pulmonary emboli?

Answer 33

Increase occlusion of pulmonary vascular bed = Pulmonary hypertension

Question 34

40. List some types of non-thrombotic emboli.

Answer 34

``` Bone marrow Amniotic fluid Trophoblast Tumour Foreign body Air Fat ```

Question 35

41. What are some causes of pulmonary hypertension?

Answer 35

``` Pre-capillary Vasoconstrictive - chronic hypoxia Embolic – thromboelmbolism Capillary Widespread pulmonary fibrosis Post capillary Veno-occlusive disease Left sided heart failure ```

Question 36

42. What are the main types of lung cancer?

Answer 36

``` Non-small cell carcinoma • Squamous cell carcinoma (30%) • Adenocarcinoma (30%) • Large cell carcinoma (20%) Small cell carcinoma (20%) ```

Question 37

44. Which types of lung cancer are most strongly associated with smoking?

Answer 37

Squamous cell carcinoma | Small cell carcinoma

Question 38

45. Which type of lung cancer tends to occur in non-smokers?

Answer 38

Adenocarcinoma

Question 39

47. Describe the sequence of histological changes that results in lung cancer.

Answer 39

Metaplasia  dysplasia  carcinoma in situ  invasive carcinoma

Question 40

48. What feature of squamous epithelium makes it vulnerable to undergoing malignant changes?

Answer 40

It does not have cilia leading to a build-up of mucus | Within the mucus carcinogens accumulate

Question 41

49. Where do squamous cell carcinomas and adenocarcinomas tend to arise?

Answer 41

Squamous cell Centrally – arising from the bronchial epithelium Adeno - Peripherally – around the terminal airways

Question 42

52. Which mutations are associated with adenocarcinoma in smokers AND non smokers?

Answer 42

SMOKERS Kras Issues with DNA methylation P53 NON SMOKERS EGFR

Question 43

55. Where does small cell lung cancer tend to arise?

Answer 43

Central – around the bronchi

Question 44

54. What is large cell carcinoma of the lung?

Answer 44

Poorly differentiated tumour composed of large cells There is no evidence of squamous or glandular differentiation It has a poor prognosis

Question 45

56. List some common mutations seen in small cell lung cancer.

Answer 45

P53 | RB1

Question 46

57. What is the difference in the chemosensitivity of small cell lung cancer and non-small cell lung cancer?

Answer 46

Small cell – sensitive | Non-small cell – not very chemosensitive

Question 47

58. Which molecular changes are important to test for in adenocarcinoma?

Answer 47

EGFR (responder or resistance) ALK translocation Ros1 translocation

Question 48

60. What is cancer of the pleura?

Answer 48

Mesothelioma