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MED4 ACP > Respiratory pathology > Flashcards

Respiratory pathology Flashcards

waiting for update (current stage: pneumonia)

1
Q

3 Pathological classifications of pneumonia

A

lobar pneumonia, bronchopneumonia, interstitial pneumonia

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2
Q

Inflammatory cells & pathogen types of broncho-/ lobar pneumonia

A

polymorphs, then macrophages. bacteria, fungi

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3
Q

Inflammatory cells & pathogen types of interstitial pneumonia

A

lymphocytes. virus, protozoa, mycoplasma

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4
Q

4 stages of gross pathology of lobar pneumonia (time)

A

congestion (24 hours) –> red hepatisation (2~4 days) –> grey hepatisation (4~8 days) –> fibrosis

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5
Q

2 phases of histological pathology of lobar pneumonia

A

acute phase –> organizing phase

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6
Q

Most common bacteria in acute exacerbation of COPD

A

Hemophilus influenzae

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7
Q

Most common bacteria in secondary infection to viral infection

A

S. aureus

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8
Q

Bacteria of atypical pneumonia

A

Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae

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9
Q

Which pneumonia shows interstitial inflammation and diffuse alveolar damage?

A

atypical pneumonia

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10
Q

Which atypical pneumonia shows multinucleated pneumocytes?

A

SARS

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11
Q

Which atypical pneumonia presents with hemophagocytic syndrome?

A

Avian flu (Influenza A H5N1)

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12
Q

Pathogenesis of Ghon focus (time)

A

type IV HSR (3 weeks)

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13
Q

Histology of Ghon focus

A
  • central caseous necrosis
  • surrounded by epithelioid histiocytes & Langhans giant cells
  • further rimmed by lymphocytes
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14
Q

How is Ghon complex different from Ghon focus?

A

Ghon complex = Ghon focus + hilar lymph nodes

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15
Q

How is Ranke complex different from Ghon complex?

A

Ranke complex = calcified Ghon complex

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16
Q

Pancoast syndrome (3)

A
  • small hand muscle wasting, numbness, weakness
  • Horner’s syndrome
  • hoarseness of voice
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17
Q

Paraneoplastic manifestations in lung cancer (3+3)

A
  • SIADH, Cushing, HHM [SQCC]
  • Lambert-Eaton myasthenic syndrome, dermatomyositis, hypertrophic pulmonary osteoarthropathy
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18
Q

Which lung cancer could present with HHM?

A

SQCC

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19
Q

Lung cancers (5)

A

ADC (MC), SQCC, LCLC, SCLC, carcinoid

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20
Q

Origin of lung carcinoma

A

bronchial epithelial cells

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21
Q

Genetic associations with lung carcinoma (4)

A
  • EGFR (MC), ALK, ROS1
  • KRAS (emerging)
    (HER2, BRAF, RET)
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22
Q

5 growth patterns of lung ADC (poorest prognosis?)

A

lepidic, acinar, papillary, micro-papillary (poorest), solid

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23
Q

Pathology of lung ADC (2)

A

intracellular mucin, desmoplastic reaction

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24
Q

Progression of lung ADC

A

atypical adenomatous hyperplasia (AAH) –> adenomatous in situ –> minimally invasive ADC –> invasive ADC

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25
Q

minimally invasive adenocarcinoma in lungs definition (2) (what is the prognosis?)

A

<=3cm in diameter, invasion <5mm in depth
~100% survival

26
Q

Lung cancer with the strongest association with smoking

A

SQCC

27
Q

Pathology of lung SQCC (3)

A
  • central in major bronchi
  • keratin
  • intercellular bridges
28
Q

Progression of lung SQCC

A

squamous metaplasia –> squamous dysplasia –> SQCC in situ –> SQCC

29
Q

lung cancer with the poorest survival

A

SCLC

30
Q

Pathology of lung SCLC (6)

A
  • centrally located
  • oat cell (nucleus: hyperchromatic, fine chromatin, inconspicuous nucleoli, high mitosis)
  • nuclear moulding
  • Azzopardi effect
  • NE markers +ve
  • electron-dense granules under electron microscopy
31
Q

Diagnosis of lung LCLC

A

by exclusion

32
Q

Lung carcinoid tumour: typical vs atypical

A

typical (more benign), atypical (more malignant)

33
Q

Pathology of lung carcinoid tumour (2)

A

organoid architecture, NE markers +ve

34
Q

Risk factor of mesothelioma

A

Asbestos

35
Q

Precursor lesions of mesothelioma (2)

A

extensive pleural fibrosis, plaque

36
Q

Patterns of mesothelioma (3)

A

epithelial, sarcomatoid, biphasic

37
Q

How to differentiate between obstructive and restrictive lung diseases?

A

spirometry: FEV1/FVC

38
Q

Complications of COPD

A
  • acute exacerbation
  • pneumothorax
  • cor pulmonale
  • secondary polycythaemia
  • respiratory failure (type II)
39
Q

What is chronic bronchitis?

A

persistent productive cough for >=3 months in >=2 consecutive years

40
Q

Pathogenesis of chronic bronchitis

A

goblet cell metaplasia –> mucus hypersecretion –> inflammation, fibrosis

41
Q

Pathological index for chronic bronchitis

A

Reid index >0.4

(Thickness of mucosal glands / thickness of bronchial wall)

42
Q

What is emphysema?

A

abnormal permenant enlargment of airspaces distal to terminal bronchioles accompanied by destruction of their walls without obvious fibrosis

43
Q

Which protein deficiency is related to emphysema? Explain. Also explain how it is related to tobacco

A

α1-antitrypsin
AAT deficiency –> ↑ neutrophil elastase –> attack pulmonary elastic tissues

ROS in tobacco –> deplete antioxidant mechanisms –> inactivate AAT

44
Q

4 Types of emphysema. Compare the common two (5)

A

centriacinar, panacinar, distal acinar, irregular

Centriacinar vs panacinar:
- Aetiology: air-related; AAT deficiency
- Distribution: respiratory bronchioles; acini
- Lung regions: upper lobes; lower lobes
- V/Q: ↓ ; ~
- ABG changes: severe; less

45
Q

What is asthma?

A

recurrent episodes of wheezing, cough, dyspnoea, chest tightness

46
Q

2 types of asthma

A

extrinsic / atopic v.s. intrinsic

47
Q

Aetiology of bronchiectasis (6)

A
  • Congenital
  • Infection (MC)
  • Bronchial obstruction
  • Fibrosis (traction bronchiectasis)
  • Autoimmune
  • Idiopathic
48
Q

Aetiology of interstitial lung disease (6) (sites)

A

Idiopathic, autoimmune, inhaled agents, infiltrative, infection, iatrogenic

  • Idiopathic (basal)
  • Autoimmune (basal except AS, psoriasis)
  • Inhaled agents (apical except asbestos)
  • Infiltrative (apical)
  • Infection (apical)
  • Iatrogenic (radiation apical, drugs basal)
49
Q

7 Pathological examples of interstital lung disease

A

Fibrosing:
- UIP
- BOOP
- Pneumoconiosis
- asbestosis
Granulomatous:
- sarcoidosis
Other:
- DIP
- PAP

50
Q

ILD with alveoli full of brown macrophages

A

Desquamative interstitial pneumonia

51
Q

ILD with alveoli full of PAS+ protein

A

Pulmonary alveolar proteinosis

52
Q

ILD associated with TGF-β1

A

Usual interstitial pneumonia

53
Q

ILD associated with smoking

A

Desquamative interstitial pneumonia

54
Q

ILD with spatial heterogenicity

A

Usual interstitial pneumonia

55
Q

ILD with homogenic lesion

A

Cryptogenic organizing pneumonia / Bronchiolitis obliterans with organizing pneumonia

56
Q

Targeted therapy to EGFR+ lung ADC (2)

A

Erlotinib 厄洛替尼, Gefitinib 吉非替尼

57
Q

Tests for EGFR, ALK, ROS1, KRAS, PD-L1

A

PCR: EGFR, ALK, ROS1, KRAS
IHC: PD-L1

58
Q

3 phases of ARDS

A

Exudative ==> Proliferative ==> Fibrotic

59
Q

Pathology of ARDS (3)

A

diffuse alveolar damage
hyaline membrane formation in alveolar walls
pulmonary oedema / exudate

60
Q

Which IHC marker is used to differentiate between lung SQCC and ADC with solid pattern?

A

P40

MED4 ACP (13 decks)

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