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Flashcards in Respiratory Pathology Deck (129):
1

What 3 M's define respiratory pathology

morbidity, mortality, money.

2

What 2 parts make up the lungs and respiratory system

conducting portion- trachea to terminal bronchioles.
Respiratory portion- respiratory bronchioles, alveolar ducts, sacs and alveoli

3

What type os epithelium lines the conducting part of the reparatory system

Pseudo stratified ciliated columnar (mucus secreting)

4

What types of cells line the alveoli

Flat type 1 pneumocytes (gas exchange) and type 2 pneumocytes (surfactant production)

5

Problems in what 3 functions can lead to respiratory failure

ventilation
perfusion
gasexchange

6

define type 1 respiratory failure

low oxygen but co2 is normal (

7

define typ 2 respiratory failure

low oxygen and high co2 (>6.3kPa)
hypercapnic drive

8

signs and symptoms which indicated a respiratory problems

sputum
cough
stridor-proximal airway obstruction.
wheeze- distal airway obstruction.
pleuritic pain
dysponea
cyanosis
clubbing
weight loss.

9

signs on respiratory examination

Auscultation-crackles, wheeze, bronchial breathing, pleural rub
Percussion
dull (consolidation or effusion), hyperresonanat (pneumothorax or emphysema)

10

Are most primary lung tumours benign or malignant

90% are malignant.

11

what are the risk factors of primary lung tumours.

smoking, secondary cigarette smoke, asbestos, lung fibrosis, nickel, hematite, arsenic and mustard gas

12

define asbestosis

pulmonary interstitial fibrosis cause by asbestos.

13

Is asbestos related disease occupational

yes if proven to have a history of over 5 years in a high absestos exposure job.

14

what are benign primary lung tumours called

adenochondroma

15

what is the most common type of malignant primary tumour

non-small cell carcinoma.

16

what type of tumours are carcinoid tumours

malignant primary tumours
low grade, neuroendocrine epithelial tumours.

17

what type of lung tumour is the commonest

secondary lung tumour (usually from a primary source)

18

How do you distinguish between a primary and a secondary lung tumour.

histology, morphology, antigen expression

19

what antigens are expressed in lung non-mucinous adenocarcinoma and small cell.

cytokeratin and thyroid transcription factor postivie.

20

most common sites of lung carcinoma

central, main or upper lobe bronchus (bronchogenic).

21

are adenocarcinomas found centrally or peripherally.

peripherally.

22

what type of epithelium does respiratory epithelium become after metaplastic change.

pseudostratified columnar epithelium -- stratified squamous type which may keratinize.

23

what irritant causes metaplastic change to occur in the epithelium

smoke

24

define dysplasia.

One metaplastic cell undergoes irreversible genetic changes (a series of sequential somatic mutations of oncogenes & anti-oncogenes) producing the first neoplastic cell

25

define neoplasm

An abnormal tissue that grows by cellular proliferation more rapidly than normal and continues to grow after the stimuli that initiated the new growth cease

26

define metaplastic

change from 1 cell type to another.

27

Why does squamous cell carcinoma cause hypercalcaemia

parathyroid hormone related peptide.

28

how does sqaumous cell carcinoma metasize

nfiltrate lymphatic and blood vessel

29

what common respiratory condition does bronchioalveolar carcinoma mimic

pneumonia

30

Is bronchioalveolar carcinoma invasive.

No.

31

How are neuroendocrine cells detected in lung tumours

immunochemistry
neural cell adhesion molecule
neurosecretory granule protein.

32

What cells are associated with typical carcinoid tumours

bland cells

33

what syndrome is typical carcninoid tumour associated with

multiple endocrine neoplasia syndrome type 1

34

which is more aggressive atypical or typical carcinoid tumours

atypical

35

What is a common peptide hormone secreted by small cell carcinoma.

Neurosecretory granules with peptide hormones such as ACTH

36

can carcinomas have multiple differentiation

NSCLC, small cell carcinoma.

37

What common factor do large cell carcinomas express

thyroid transcription factor

38

common paraneoplastic effects of lung carcinomas

• Cachexia
• Skin
• Hypertrophic pulmonary osteoarthropathy.
• Coagulopathies.
• Encephalomyelitis, neuropathies & myopathies
• Endocrine effects

39

what is acanthosis nigricans

hyperpigmentation of the skin- thick dark patches
thickening of palms and soles

40

New drug which has been introduced to treat lung cancer.

epidermal growth factor receptor tyrosine kinase inhibitors

41

How does this drug work

– Inhibition of EGFR TK mediated protein phosphorylation and activation of the mitotic cycle

42

What does ALK gene stand for

anaplastic lymphoma kinase-
Important gene in cell maturation and differentiation
rearrangements in this gene can lead to tumours.

43

what drug inhibits ALK

crizotinib

44

Types of pleural diseases

Pneumothorax
Pleural effucison
Haemothorax
Chylothorax-lymph
empyema-pus

45

what is a common fusion gene which results in respiratory cancer

ALK-EML

46

what are the inflammatory causes of pleural effusion

serous/fibrinous exudate

47

what causes non inflammatory pleural effusion

congestive cardiac failure
(transduate)

48

what conditions can affect the pleura

– inflammation (pleurisy, pleuritis)
• collagen vascular diseases
• pneumonia, tuberculosis
• lung infarct, usually secondary to pulmonary embolus
• lung tumour
– asbestos
• effusion, fibrous plaques, diffuse fibrosis

49

Are pleural tumours likely to be benign or malignant

malignant
benign e.g. fibroma is rare.

50

common pleural tumour

malignant mesothelioma.

51

what chemical is malignant mesothelioma associated with

asbestos

52

how long is the latency period for malignant mesothelioma

15-60 years

53

How does malignant mesothelioma progress

1-nodule and effusion
2-invades chest wall and lung.
3-nodal and distal metastases less common than with carcinomas.

54

which pleura does early malignant mesothelioma effect

parietal pleura

55

where are fibrous pleural plaques typically found and what chemical are they associated with

lower thoracic wall & diaphragmatic parietal pleura and asbestos

56

What condition is PE secondary to

DVT

57

Risk factors of PE

virchow's triad (stasis, hypercoagubale blood, endothelial wall injury), recent surgery, low flow, reduced mobility

58

what syndrome is a result of cillary dysmotility

Kartageners syndrome

59

what causes acute bronchitis

– Viral (RSV), H. influenzae, Strep. pneumoniae

60

2 clinical signs associated with cute bronchiolits

– Croup- viral infection which causes swelling of the windpipe
– Exacerbations of COAD-chronic obstructive airway disease.

61

define bronchiolitis obliterans

bronchioles compressed and narrowed.

62

what 2 main factors lead to respiratory infections

mucocillary escalator problem
immunity problem e.g. hypogammaglobulinaemia

63

what is pneumonia

• Inflammatory exudate (seeped out of blood or organ) in alveoli & distal small airways - consolidation

64

what are the 4 main classifications for pneumonia

clinical
Aetiology
Anatomical
reaction

65

what are 2 main types of respiratory infections.

primary
secondary- compromised defences

66

is bronchopneumonia caused by a primary or secondary infection

secondary infection

67

what causes bronchopnemonia

low virulence bacteria or occasionally fungi

68

is lobarpneumoniae primary or secondary

primary

69

which type of pneumonia affect full lobes and which type has a pathcy distribution

full lobes-lobarpneumoniae
pathcy-bronchopneumoniae

70

most common atypical pneumonia's in the non-immunosuppressed.

• Viral - flu, varicella, RSV, rhino, adeno, measles
• Mycoplasma pneumoniae - Mild, chronic, fibrosis
• Chlamydia (psittacosis), Coxiella burnetti (Q-fever)
• Legionella pneumophilla - Systemic, 10- 20% fatal

71

clinical signs and symptoms of atypical pneumonia

– Intersitial lymphocytes, plasma cells, macrophges
– Intra-alveolar fibrinous cell-poor exudate
– Diffuse alveolar damage (DAD)

72

most common atypical pneumonia in the immunsuppressed patient

• Opportunistic infections by low virulence or non-virulent organisms
– Fungi - candida, aspergillus, Pnumocystis carinii
– Viruses - CMV, HSV, measles

73

3 types of non-infective pneumonias

aspiration pneumonia
lipid pneumonia
Cryptogenic organising pneumonia and bronchiolotis obliterans organising pneumonia

74

what causes pulmonary TB

Mycobacterium tuberculosis

75

what vaccine is used to prevent TB

BCG

76

primary Tb reaction symotomatic or asymtomatic

aymptomatic

77

where does reactivation of TB typically occur

apically.

78

effects of TB on the lungs

Primary infection: Asymptomatic, Ghon complex in peripheral lung & hilar nodes, usually resolves
Scarring - fibrous calcified scar.
Granulomas with multinucleated Langhans’ giant cells & caseous necrosis

79

3 conditions which cause pulmonary vasculitis.

• Necrotising granulomatous vasculitis - Wegener’s granulomatosis (kidneys & nose, elevated serum ANCA) Churg-Strauss syndrome (eosinophilia & asthma)
• Goodpasture’s syndrome - Anti-glomerular basement membrane antibody, Intra-alveolar haemorrhage & glomerulonephritis
• Microvascular damage - ARDS & DAD, SLE

80

common causes for emboli to forms

DVT, fat, air amniotic fluid, tumour, foreign bodies.

81

define obstructive pulmonary disease.

localised of diffuse obstruction of air flow.

82

causes of obstructive pulmonary disease

tumour or foreign body
distal alveolar collapse
distal retention pnemonitis
distal bronchiectasis

83

define bronchiectaisis

• Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue

84

cause of brochiectasis

• Results from chronic necrotizing infection

85

signs and symptoms of bronchiectais

Cough, fever, copious amounts of foul smelling sputum

86

Chronic Obstructive Pulmonary Disease is a combination of what 2 conditions

chronic bronchitis & emphysema

87

pathology of chronic bronchitis

Mucus gland hyperplasia and hypersecretion, secondary infection by low virulence bacteria, chronic inflammation

88

define emphysema

Abnormal permanent dilation of airspaces distal to the terminal bronchiole, with destruction of airspace wall, without obvious fibrosis

89

how do we classify emphysema

– Centrilobular (centiacinar) Coal dust, smoking
– Panlobular (panacinar) - >80% a1 antitrypsin deficient (rare, autosomal dominant) , severest in lower lobe bases
– Paraseptal (distal acinar) - Upper lobe subpleural bullae adjacent to fibrosis. Pneumothorax if rupture

90

pink puffer and blue bloater describe which 2 conditions

emphysema-pink puffer
brochioloits- blue bloater

91

is asthma reversible

yes

92

which hyper of hypersensitivity reaction is asthma

type 1 -caused by an allergen

93

what chemical initiates bronchoconstriciton and mucus production is asthma

histamine initiated bronchoconstriction and mucus production obstructing the airways.

94

what are the main changes to the airways in asthma.

– bronchiolar wall smooth muscle hypertrophy
– mucus gland hyperplasia
– respiratory bronchiolitis leading to centrilobular emphysema

95

Is intersitial lung disease more commonly restrictive or obstructive

restrictive.

96

signs of chronic interstitial disease

• Dyspnoea increasing for months to years
• Clubbing, fine crackles, dry cough

97

what does the lung look like in chronic interstitial disease

honeycomb

98

example of chronic interstitial disease

– idiopathic pulmonary fibrosis,
– many pneumoconioses (dust diseases)
– sarcoidosis,
– collagen vascular diseases-associated lung diseases

99

Idiopathic pulmonary fibrosis
is also known as

cryptogenic fibrosing alveolitis

100

what lobes of the lungs are effected more in Idiopathic pulmonary fibrosis

lower

101

what do the lungs look like in idiopathic pulmonary fibrosis

– Interstitial chronic inflammation & variably mature fibrous tissue
– Adjacent normal alveolar walls
– Similar pattern of fibrosis in collagen vascular disease associated interstitial lung disease and in asbestosis
• Bosselated (“cobblestone”) pleural surface due to contraction of interstitial fibrous tissue accentuates lobular architecture

102

what structure is typically involved in sarcoidosis

• Hilar nodes

103

what other organs are typically affected in Sarcoidosis

skin, heart, and brain.

104

are the granulomas caseating or non-caseating in Sarcoidosis

non-caseating

105

what chemical in the body is elevated in sarcodoisis

calcium (hypercalcaemia)

106

Pneumonconises are also known as

the dust diseases

107

what causes pneumoconioses

inhalation of mineral dusts

108

common 3 Pneumonconises

coal-workers
silicosis
asbestosis

109

what condition that silicosis reactivate

tuberculosis

110

what is the pathology of silicosis

Kills phagocytosing macrophages

111

which pneumonconises increase the occurrence of lung cancer

Asbestosis, Silicosis

112

what is hypersensitivity pnemonitis also known as

extrinsic allergic alveolitis

113

what type of hypersensitivity reaction is pnemonitis

Type 3

114

what condition are
– farmers’ lung - actinomycetes in hay
– pigeon fanciers’ lung - pigeon antigens
associated with

hypersensitivity pneumonitis

115

define CF

• An inherited multiorgan disorder of epithelial cells affecting fluid secretion in exocrine glands and the epithelial lining of the respiratory, gastrointestinal and reproductive organs

116

What cause CF

• Mutation in CFTR gene

117

Is CF recessive or dominant condition

recessive

118

what are the main organs which CF affects

lungs, pancreas and bowel

119

treatments for CF

• Mucolytics
• Heart/lung transplants
• Not genre therapy currently.
• Physiotherapy

120

diagnosis test for CF

• Part of Newborn screening in UK
• Sweat test
• Genetic testing

121

How does CF affect the lungs

• Bronchioles distended with mucus
• Hyperplasia mucus secreting glands
• Multiple repeated infections
• Severe chronic bronchitis and bronchiectasis

122

How does CF affect the pancrease

• Exocrine gland ducts plugged by mucus
• Atrophy and fibrosis of gland
• Impaired fat absorption, enzyme secretion, vitamin deficiencies ( pancreatic insufficiency)

123

common symptoms of CF

reccurent chest infections

124

are hypersensitive pneumonitis granuolomas caveating or non caveating

poorly formed non-caseating granulomas extends alveolar walls

125

what type of inflammation occurs in hypersensitivity pneumonitis

• Peribronchiolar inflammation

126

coal workers's pneumoconiosis is also known as

• Anthracosis

127

Coal workers’ pneumoconiosis is associated with causing which respiratory condition

COPD
via ling fibrosis

128

2 main types of Coal workers’ pneumoconiosis

• Simple (macular) CWP
• Nodular CWP

129

4 main types of inhaled dust are

• inert
• fibrogenic
• allergenic
• oncogenic