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Respiratory Pathology Flashcards

(85 cards)

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1
Q

What parts of the respiratory tract are included in the conducting airway?

A 
Trachea
L and R main bronchi
Segmental and smaller bronchi
Bronchioles
Terminal bronchioles
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2
Q

What parts of the respiratory tract are included in the gas exchange (lung acini)?

A

Respiratory bronchioles
alveolar ducts
alveolar sacs
alveoli

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3
Q

What is the respiratory tract split into?

A

Conducting airways

gas exchange

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4
Q

What types of cells are present in the conducting portion of the RT?

A

Pseudostratified cilliated columnar mucus secreting epithelium

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5
Q

What types of cells do alveoli mostly contain?

A

Type I pneumocytes = gas exchange

Type II pneumocytes = surfactant production

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6
Q

What is Type I respiratory failure classified as?

A

Low PaO2

Normal CO2

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7
Q

What is Type II respiratory failure classified as?

A

PaCO2>6.3kPa

Hypercapnic respiratory drive

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8
Q

What is the name of a benign primary lung tumour?

A

adenochrondroma

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9
Q

What are the risk factors for lung carcinomas?

A

cigarettes
asbestos exposure
lung fibrosis
radon etc

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10
Q

What specifically does asbestos cause to the body?

A

asbestosis - pulmonary interstitial fibrosis

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11
Q

What are the types of malignant primary cell tumours?

A

Carcinomas - small cell and non small cell
Carcinoid
Others - lymphomas, sarcomas, carcinosarcomas

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12
Q

What are the different types of non small cell carcinomas?

A

Squamous carcinomas
adenocarcinoma
large cell neuroendocrine carcinoma
undifferentiated large cell carcinoma

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13
Q

Which category of malignant primary lung tumours are all neuroendocrine?

A

small cell carcinomas

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14
Q

what are carcinoid tumours?

A

low grade neuroendocrine epithelial tumours

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15
Q

What factors can be tested for in lung non mucinous adenocarcinoma and small cell tumours?

A

cytokeratin factor

thyroid transcription factor

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16
Q

What are the features of squamous carcinomas?

A

desosomes linked cells like epidermis
with our without keratinisation
cental
hypercalcaemia due to parathyroid related peptide secreted by tumour cells

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17
Q

what cells are the bronchial epithelium lined with?

A

pseudostratified columnar epithelium with ciliated and mucus secreting cells

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18
Q

what is squamous metaplasia and why does it happen?

A

reversible change from pseudostatified columnar cells to (keratinised) stratified squamous cells
caused by irritants such as smoke

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19
Q

What are the features of adenocarcinomas?

A

glandular cells
serous or mucus vacuoles
in acinar, tubular, solid or papillary structures
central and peripheral
Thyroid transcription factor (TTF) expressed

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20
Q

What are the features of bronchioalveolar carcinomas?

A

spread of well differentiated mucinous/non mucinous neoplastic cells on alveolar wall
not invasive
mimics pneumonia

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21
Q

What are the cell proteins produced by neuroendocrine carcinomas?

A

neural cell adhesion molecule (CD56)
Chromogranin
synaptophysin

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22
Q

what are the features of typical carcinoid tumours?

A 
grow in and occlude a bronchus
bland cells, no necrosis
not associated with smoking
associated with multiple endocrine neoplasia syndrome type 1
not benign - may invade lymphatic nodes
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23
Q

what are the features of atypical carcinoid tumours?

A

more atypia nucleoli, otherwise typical
necrosis
more aggressive

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24
Q

What are the features of large cell neuroendocrine carcinomas?

A

eosinophilic granular cytoplasm
antigen expression
severe atypia nucleoli necrosis
associated with smoking

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25
what are the features of small cell carcinomas?
rapidly progressive malignant neurosecretory granules with peptide hormones mainly in smokers
26
What are the requirements for a mixed neuroendocrine carcinoma?
need 10% of a component for classification | adenosquamous
27
What are the requirements for a combined small cell carcinoma?
Any proportion of small cell carcinomas and NSCLC
28
What are the features of large cell carcinomas?
no specific squamous/glandular morphology some express thyroid transcription factor can be neuroendocrine
29
What is used for the staging of lung malignancies?
TNM
30
What is a pneumothorax?
air in the pleural cavity
31
What is a pleural effusion (hydrothorax)?
exudate in the pleural cavity
32
What is a haemothorax?
blood in the pleural cavity
33
What is a chylothorax?
lymph in the pleural cavity
34
What is a empyema (pyothorax)?
Pus in the pleural cavity
35
What are the causes of pleural effusion?
inflammatory - exudate, infection, inflammation | Non inflammatory - congestive cardiac failure
36
What is malignant mesothelioma?
cancer in the pleura over 90% associated with asbestos exposure may produce pleural effusion mixed spindal cells and epitheloid cells, may be fibrous treat symptomatically fatal in 1-3 years
37
What are fibrous pleural plaques?
on lower thoracic wall and disphragmatic parietal pleura associated with low level asbestos exposure not premalignant
38
What are primary infections?
obtaining an infection when previously healthy
39
What are secondary infections?
obtaining an infection when immune system is already weakened
40
What are examples of situations where you are more likely to get secondary infections?
``` tumour, foreign cough reflex doesnt work kartageners syndrome CF hypogammaglobulinaemia immunsupressive drugs AIDS smoking, hypoxia pulomary oedema ```
41
What are examples of acute bronchitis?
Viral (RSV), H. influenza, strep. pneumoniae croup exacerbations of COAD
42
What are examples of bronchiolitis?
primary acute in infants, RSV | broncopneumonia - follicular/bronchiolitis obliterans
43
What is pneumonia?
inflammatory exudate/consolidation in alveoli and distil small airways
44
What are pneumonias classified into?
Clinical - primary/secondary Aetiological - bacterial, viral, fungal Antatomical - lobular/bronchopneumonia Reaction - purulent/fibrinous
45
What are the features of bronchopneumonia?
``` secondary often low virulence bacteria/fungi common patchy bronchocentric - destructive, granulomatous lesion of the bronchi and bronchioles resolves/heals with scarring ```
46
What are the features of lobular pneumonia?
``` primary typically males 20-50 years old strep. pneumoniae uncommon congesstion resolves without scarring ```
47
What are the features of atypical pneumonias?
severity mild to fatal interstitial lymphocytes, plasma cells, macrophages poor exudate diffuse alveolar damage
48
What organisms cause atypical pneumonias?
``` viral - flu, RSV, rhino, adeno, measles Mycoplasma pneumoniae chalmydia coxiella burnetti legionella pneumophilla ```
49
What are examples of non infective pneumonias?
Aspiration pneumonias - produces abscesses lipid pneumonias - endogenous and exogenous cryptogenic organising pneumonia bronchiolotis obliterans organising pneumonia
50
What organism causes pulmonary tuberculosis
Mycobacterium tuberculosis
51
What is the vaccine called to protect against TB?
Bacille Calmetta-Guerin (BCG)
52
What are the symptoms of the primary infection in TB?
Asymtomatic | Ghon complex in lung and hilar nodes
53
How does TB symptoms progress?
empyema pneumonia spread to other organs scarring
54
What are the features of pulmonary tuberculosis?
Granulomas with multinucelated Langhans' giant cells caseous necrosis intense immune reaction Type 4 hypersensitivity
55
When are you likely to get pulmonary vasculitis?
necrotising granulomatous vasculitis's e.g. Wegeners granulomatosis goodpastures syndrome - rare autoimmune disease in which antibodies attack the basement membrane Microvascular damage
56
What causes localised obstruction of air flow in obstructive pulmonary disease?
``` Tumour/forign body distil alveolar collapse/over expansion distil retention pneumonitis brochoneumonia distil bronchiesctasis ```
57
What is bronchiectasis?
permanent dilatation of bronchi/bronchioles caused by destruction of the muscle and elastic tissue results from chronic necrotising infection
58
what are the symptoms of bronchiectasis?
cough fever foul smelling sputum
59
What are predisposing conditions to bronchiectasis?
CF Kartngners syndrome Bronchial obstruction lupus, RA, IBS, GVHD
60
Name some examples of diffuse obstructive pulmonary disease.
COPD | Asthma
61
What two conditions is COPD a combination of?
chronic bronchitis | emphysema
62
What are the symptoms of chronic bronchitis?
cough and sputum for 3 months in each of 2 consecutive years
63
What are the causes of chronic bronchitis?
chronic irritation smoking air pollution
64
What is chronic bronchitis?
mucus gland hyperplasia/hypersecretion | chronic inflammation of small airways - wall weakness and destruction therefore emphysema
65
What is emphysema?
abnormal permanent dilation of airspaces | destruction of airspace wall without obvious fibrosis
66
What are the 3 classifications of emphysema?
Centrilobular (centiacinar) panlobular (panacinar) paraseptal
67
What are the symptoms of emphysema?
Dysponea - progressive and worse
68
What are the common features of predominantly bronchitis COPD?
``` 40-45 years old mild dyspnea, late in disease early cough infections common 'blue bloater' ```
69
What are the common features of predominantly emphysema COPD?
``` 50-75 years old severe early dyspnea late cough infections rare 'pink puffer' ```
70
What is asthma?
chronic inflammatory disorder of the airways
71
What are the symptoms of asthma?
wheeze cough variable bronchoconstriction that is partially reversible
72
What type of hypersensitivity reaction is atopic asthma?
type I
73
What are the triggers for atopic asthma?
allergens | cold, exercise, respiratory infections
74
What are the irriversible changes of atopic asthma?
bronchiolar wall smooth muscle hypertrophy mucas gland hyperplasia respiratory bronchiolitis centrilobular emphysema
75
What is interstitial lung disease?
disease of pulmonary connective tissue - increased tissue in alveolar capillary wall via inflammation and fibrosis restrictive
76
What is acute interstitial disease?
diffuse alveolar damage death of type I pneumocytes - form hyaline membranes lining alveoli type II pneumocyte hyperplasia leads to adult respiratory distress syndrome
77
What are the symptoms of chronic interstitial lung disease?
``` dyspnoea clubbing fine crackles dry cough interstitial fibrosis&chronic inflammation 'honeycomb lung' ```
78
What are example of chronic interstitial lung disease?
idiopathic pulmonary fibrosis pneumoconiosis sarcoidosis collegen vascular disease-associated lung diseases
79
What is idiopathic pulmonary fibrosis?
chronic inflammation and fibrous tissue normal alveolar wall 'cobblestone'
80
What is sarcoidosis?
``` perilymphatic pulmonary granulomas fibrosis effects hilar nodes, other organs e.g. heart hypercalcaemia typically young females ```
81
What is pneumoconioses?
non neoplastic lung disease due to inhalation of dusts, fumes and vapours
82
What is hypersensitivity pneumonitis?
Type III hypersensitivity reaction to organic dusts farmers lung inflammation with non caseating granulomas leads to fibrosis
83
What is Cystic fibrosis?
inherited disorder epithelial cells fluid secretion effected as well as linings of the respiratory, GI and reproductive tract Autosomal recessive
84
CF is a mutation in which gene?
CFTR - encodes for transmembrane proteins
85
What are the clinical presentations of CF?
infancy viscous mucous secretions recurrent lung infections/intestinal obstruction pancreatic insufficiency

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