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Year 2: Clinical Pathology > Respiratory Pathology > Flashcards

Respiratory Pathology Flashcards

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1
Q

Asthma - definition

Age affected

A

Chronic inflammatory disorder of the airways
Children in Young Adults
15% adult development due to occupation

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2
Q

Asthma
Signs - visible outside (4)
Pathology - whats happening inside

A

paroxysmal bronchospasm, wheeze, cough and variable bronchoconstriction

inflamed mucosa, oedema, hyperinflated lungs, hypertrophic mucosal glands = mucosal plugs

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3
Q

Types of Asthma (4)

A

Atopic - type one hypersensitivity reaction to allergen, cold weather, exercise of resp infections

Non atopic
aspirin induced
allergic bronchopulmonary aspergillosis (ABPA

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4
Q

Change to airways in atopic asthma
Reversible
Irreversible

A

Reversible = degranulation of IgE bearing mast cells = histamine = bronchoconstriction and mucous production
eosinophil chemotaxi

Irreversible = smooth muscle hypertrophy, mucus glands hyperplasia, respiratory bronchiolitis

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5
Q

COPD - chronic obstructive pulmonary disease.

Combination of what two conditions

A

chronic bronchitis and emphysema

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6
Q

Chronic Bronchitis - what?
Signs/ measurement
Age

A

chronic irritation of the bronchi due to smoking and air population
COUGH and sputum for 3 months of 2 concequative years. Recurrent resp infections
40-45

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7
Q

Emphysema - what?
Signs
Age

A

site of fibrosis in the acinar
DYSPONEA that progressive worsens. Cough develops late
50-75

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8
Q

Blue bloaters (cyanosis + increased residual volume and air trapping)

A

Chronic Bronchitis predominate COPD

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9
Q

Pink puffer (red in the face and Dysponea)

A

Emphysema predominate COPD

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10
Q

Chronic Bronchitis (blue) Vs Emphysema (pink)

A

BOTH = decreased expiratory flow rare BUT increase lung capacity and residual volume, decreased PO2

Bronchitis = increase Pco2, normal diffusing capacity, right side heart failure and sleep apnea

Emphysema = decreased diffuse capacity and elastic recoil, compensatory hyperventilation

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11
Q

Classification of Bronchitis (how much of lobe + what caused it)

A 
Centrilobular = coal dust and smoke
Panlobular = antitripsin deficiency
Paraseptal = upper lobe sub pleural bullae (air sacs in pleura) adjacent to fibrosis - burst = pneumonathorax
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12
Q

Interstitial lung disease - definition

A

Disease on connective tissue (alveoli walls)
Diffuse and chronic
Restrictive

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13
Q

Interstitial lung disease progression - consequences

A

Inflammation –> fibrosis (honey comb lung) of alveoli walls

Decreased lung compliance and diffusion distance

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14
Q

Acute Interstitial lung disease - pathology

A

Exudate
Death of type I pneumocytes from hyaline memebrane of alveloi
Type II pneumocytes hyperplasia
Looks like pneumonia

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15
Q

Presentation and causes (7) of Acute interstitial lung disease

A

Resp distress syndrome OR shock lung

Shock, Trauma, infections, toxic gas, narcotics, radiation and aspiration

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16
Q

Types of Chronic Interstitial lung disease (4)

A

Idiopathic
Sarcoidosis
Pneumoconioses - dust diseases
Silicosis

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17
Q

Idiopthic lung disease - lung appearance

A

Chronic inflammation and variable maturity fibrosis adjacent to normal tissue
Constriction of interstitial lung tissue = ‘cobble stone’

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18
Q

Idiopathic lung disease - prevalence, survival and location

A

older, rare 3-5 year survival, sub pleural and lower lobes

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19
Q

Sarcoidosis - what ?
Appearance of lung
Blood markers
those affected?

A

Systemic disease - brain, skin and heart
Non caseating perilymphatic pulmonary granulomas + Hilar node involvement of Xray
Hypercalceamia and elevated serum ACE
young women

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20
Q

Pneumoconioses or dust disease or non neoplastic lung disease - cause and types (4)

A

Inhalation of mineral dust <3 um in diameter

inert, fibrogenic, allergenic or oncogenic

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21
Q

Pneumoconioes - coal miners

A

Most common

>20 years underground = wide spread fibrosis and right side heart failure to deal with back pressure

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22
Q

Silicosis - what is it

A

silica in lungs –> attach to macrophages –> die –> accumulate in fibrosis silica nodules

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23
Q

Hypersensitivity Pneumonitis Or extrinsic allergic alveolitis - what type of allergic reaction to what time of dust

A

Type III hypersentivity reaction to organic dust

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24
Q

Types of Hypersensitivity Pneumonitis + causes

A

Farmers lung - actinomycetes in hay

Pigeon fanciers lung - pigeon antigens

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25
Pathology of Pneumonitits
Peribronchiolar inflammation - Non caseating granulomas spread into alveoli walls Repeated episodes of fibrosis and breathlessness
26
Bronchiectasis - What? causes?
Pernament dilation of bronchioles due to destruction of muscle and elastic tissue Due to chronic necrosis infection
27
Bronchiectasis - symptoms (3) and complications (3)
Cough, fever and large about of foul smelling sputum | Pneumonia, Septicemia, mets of infection
28
Resp impacts of Cystic Fibrosis (4)
bronchioles distended with mucous hyperplasia of mucous secreting glands repeated chest infections chronic bronchitis of bronchiectasis
29
Drug to relieve resp symptoms of CF
Orkambi - only for those with the F508 deletion mutation (VERY EXPENSIVE)
30
Lung tumours have abnormal characteristics that allow them to ...
Invade and metastasize
31
Most common primary lung tumour - what % of patients?
Carcinoma (from epithelial cells) in 90% of cases
32
Types of Primary lung carcinomas (appearance on light microscope)
Adenocarcinoma - most common 40% = musin (light colored) and glands Squamous cell = squamous 'pearl' Small cell carcinoma = dark nuclei Large cell undifferentiated carcinoma = most rare 10%
33
Other primary lung tumours (3)
Carcinoid = low grade + good survival Malignant mesenchymal = rare, most common as synovial sarcoma Primary lung lymphomas - HIV and AIDs patients
34
Secondary tumours - MORE COMMON Spread from? Main types? Present as?
kidney, liver, breast, brain and GI carcinoma - sarcomas - melanomas and lymphomas Multiple nodules or solid tumours
35
Lung cancers - risk factors (age/ gender) (5 + examples)
``` M>F but changing 40-70 years Tobacco smoke Occupational hazards - asbestos and heavy metals Radiation Lung fibrosis Genetic mutation - EGFR, KRAS and ALK ```
36
Lung cancer pathogenesis
Cigarette smoke irritate the squamous cells --> metaplasia --> gene mutation --> dysplasia --> carcinoma insitu
37
Localised effects of lung tumours
Obstructive pneumonia - distal collapse and consolidation = breathless Proximal airways = ulceration and bleeds
38
Effects of lung tumours infiltrating other tissues (5)
``` Pleura = effusion and breathlessness Chest wall = pain Laryngeal nerve = hoarse voice Sympathetic chain = horners syndrome Esophagus = dysphagia ```
39
Non specific effects o lung tumours
``` Clubbing Endocrine - ACTH, ADH and PTH increase = metabolism effects wight loss lathargy cachexia ```
40
Complication of lung tumours = mets
Mets: Brain = epilepsy Bone = increased Ca2+ = pain and fracture Lymphangitis carcinmatosa - lymphatics diffusely involved in the tumour
41
average 5 year survival for lung cancer
10-15%
42
Lung cancer treatment:
Surgery - 10-15% only in early diagnosis Palliative care - for those with advanced Mets + secondary disease (EXPENSIVE AND NOVIS) Targeted genome therapy - ECFR and ALK Immuno check point inhibitors eg. PD-L1 makes immune system fight the tumour
43
Mesothelial layer
A layer found in both parietal and visceral pleura that lines the pleural space
44
Hyaluronic acid
found in the pleural fluid
45
Pleural fibrosis + affect on lungs
Scarring secondary to inflammation Secondary to asbestos = fibrotic plaques and diffuse fibrosis Compress lungs = breathless. Partial and whole adhesion/ obliteration of pleural cavity
46
Fibrous plaques - causes + appearance
Low level asbestos exposure - visible of chest Xray
47
diffuse fibrosis - cause + appearance
high asbestos (occupational) - usually bilateral, collagen that doesn't extend in to fissures (benign)
48
Treatment for pleural fibrosis
pleural decortication - removal of fibrosis
49
Serous fluid in Pleural cavity
Pleural effusion
50
Two types of seroud fluid in a pleural effusion - what they contain
Transudates - low protein and low lactate dehydrogenase | Exudates (pathological) - high protein and high lactate dehydrogenase
51
Transudate pleural effusin - causes (2)
Due to semipermiability of capillaries 1) high capillary hydrostatic pressure - left ventricular failure, renal hypertension or water overload 2) Low capillary oncotic pressure - hypoalbumenia in hepatic syndrome or nephrotic syndrome
52
Exudate pleural effusion - causes (3)
Inflammation with/with out infection (effusion --> empyema) | Neoplasms
53
Signs of effusion
``` Breathlessness Pleuratic chest pain (on inspiration = stabbing) - infection Dull percussion Reduced breath sounds CT and Xray = cloudy ```
54
Treatment of effusion (4)
Aspirate under USS Recurrent? = chest drain Recurrent + idiopathic? pleurodesis (eradication of pleural cavity) Treat under lying cause
55
empyema or pyothorax
Pus - secondary to pneumonia
56
Blood in the pleura
Haemothora - due to traumata or ruptured aneruysm
57
Bile in pleura
Chylothorax
58
Pneumothroax
gas in pluera
59
Two types of pneumothorax - What?
Open = wound in chest wall - air enters in inspiration Closed - connection of lung air space to pleural space - lung into pleural cavity
60
Cause of Pneumothorax Open Closed
Open = EXTERNAL eg. trauma Closed = INTERNAL eg. ruptured emphysematous bullae, broken rib, punctured lung (latrogenic)
61
Tensions Pneumothorax - what? | Complications?
Open or closed Rupture = valve - lets air in on inspiration BUT not out again Pressure rises above atmospheric Pressure on mediastinum = back pressure and heart failure
62
Pneumothorax Signs symptoms
``` Breathless Pleuratic chest pain cyanosis Tachycardia Reduced breath sounds Hyper resonant on percussion ```
63
Pneumothorax treatment
EMERGENCY Syringe needle with ICS Dressed with specialized to way valve OR chest drain Recurrent = pleurodesis?
64
Primary Neoplasms of the pleura | Malignant
Mesothelioma
65
Mesothelioma also present in ?
Peritoneum, Pericardium
66
Early presentation of mesothelioma
Small tumour BUT large effusion Malignant cells shed into fluid = immunostaining (effusion cytology)
67
Advanced presentation of mesothelioma
Line whole pleural cavity and tubules = solid arrogates of mesothelial cells
68
Immunostaining 4 antibodies purpose
Cytokeratin 5, wilm's tumour antigen, calretinin To distinguish epithelial and mesothelial
69
Causes of mesothelioma
``` Asbestos dust (90%) - 15-60 years after exposure ``` Thoracic radiation BAP1 (BRACA 1 associated protein 1) mutation - germ line/ familial
70
5 years survival for mesothelioma
10%
71
Secondary Pleural tumours
breast, lung, lymphoma
72
Asbestos is?
Fibrous metal silicates found in rock
73
Types of asbestos (3)
Blue - crocidolite MOST oncogenic Brown - amosite White - chrysotile
74
Erionite (cappadocian carcinogen)
Similar to asbestos - zeolite Found in Cappadocia, Turkey.
75
Asbestos Bodies
Inhaled asbestos coated in mucopolysacharides and containing iron Seen on light microscopy Quantify the iron content
76
Asbestos causes (2)
interstitial pneumonia and progressive pulmonary fibrosis
77
Symptoms of Sore throat (4)
Rapid onset difficulty breathing, speaking swallowing and eating neck pain and swelling Fever symptoms?
78
Differential diagnosis for Sore throats (other symptoms + causes) (4)
Pharyngitis - + fever (viral) Acute tonsillar pharyngitis - symmetrical inflamed tonsils, fever and headache. Pus on tonsils Infectious mononucleosis (EBV) or Glandular fever - triad = symmetrical inflame tonsils, palate and cervical lymphadenopathy. Rash common in teenage - viral Epiglottis - SEVERE. Tonsils and oropharynx + systemic symptoms. Bacteria (strep pneumonia and group A) and Influenza type B. Vaccination.
79
Causes of Sore throats | Viral (5) and Bacterial (1)
Viral - rhinovirus, influenza, coronavirus, parinfluenza, adenovirus Bacterial - Group A Strep --> blood and cause a serious infection
80
Centor Criteria - is it viral or bacterial. Need 3/4 to get antiBs
Tonsil exudate Tender anter cervial lymphopathy Fever over 38 Absence of cough
81
Tests of EBV (glandular fever) (4)
Throat swabs and blood tests | Monospot or serology
82
Treatment for sore throats Viral Bacterial Epiglotitis - sever
Viral - oral analgesia Bacterial - antiBs Epiglotitis - secure airway, O2, IV anitbiotic, analgesia + warn public health
83
Otitis externa
Inflammation of the outer ear = pain, itching and non mucoidal discharge
84
Otitis externa acute vs chronic
Acute <3 weeks = unilateral. --> necorsing and spread the base of skull Chronic >3 weeks = bilateral. Thickened + narrowed canal (allergic aspect)
85
``` Causes of Otitis externa (7) Bacterial examples (2) ```
``` Swimmers ear (water exposure) Trauma Allergy Dermatological condition Bacterial - pseudomonas aeruginosa, Staph aureus fungal ```
86
Treatment for otitis Externa (5) Severe acute? Necorsing?
Remove cause Toileting or cleaning the ear (ear drops) Acute OE = flucloxillin Necrosing = 6 weeks with ceftazidime
87
Otitis Media - what? signs?
Inflammation of the middle ear = fluid Pain due to pressure on the tympanic membrane Erythema on otoscopy
88
Otitis Media uncomplicated (3) VS complicated (6) signs and symptoms
Un = mild pain <72 hours, non systemic symptoms no ear discharge Complicated = sever pain --> perforated ear drum = purulent discharge + bilateral mastoidosis (CT required), fever and oedema at the site
89
Causes of Otitis media (4)
Viral haemophilus influenza strep pneumoniae Moraxella Catarrhally
90
Treatment of otitis media (2)
Monitor | Amoxicillin
91
Pnuemonia - what?
BACTERIAL infection affecting the distal airways and alveoli | Formation of exudate or consolidation on CT
92
Anatomical patterns of pneumonia (2)
Broncho = pathcy around the bronchioles and surrounding alveoli Lobular = entire lobes affect = 90% of cases with Strep Pneumonia
93
4 types of Pneumonia (based on how/ where acquired)
Community acquired Hospital acquired Ventilator acquired Aspiration
94
Community acquired pneumonia - peak age, % hospital admins
MOST COMMON 40% hospital admissions 50-70 peak age
95
Causes of Pneumonia Typical (4) Atypical = Organism doesn't respond to penicillin (no cell wall) (3)
``` Typical = Strep pneumoniae Haemophilus influenza Staph aureus Klebsiealla pneumoniae ``` Atypical = Mycoplasm pneumoniae Legionella Chlamydophila pneumoniae
96
Hospital acquired pneumonia - what? cause?
>48 hours after hospital admission CAP organism + enterobacteriacea
97
Ventilator acquired pneumonia - what? cause?
> 48 hours ET ventilation Pseudomonas Spp
98
Aspiration pneumonia - what? cause?
abnormal entry of food into the LRT - impaired swallowing Upper GI bacteria and Anaerobes
99
Symptoms (6) and signs (6) of Penumonia
rapid onset, malaise, productive cough, anorexia, fever, pleuratic chest pain Tachypnoae, tachycardic, hypotension, reduced breath sounds, dull to percuss, bronchiole breathing
100
Investigation for Pneumonia (5) | CURB65 - severity
confusion, urea, resp rate, blood pressure and age >65 years CXR, sputum and blood cultures, Pneumococcal and legionella urine. PCR serology for viral causes?
101
Complications of Pneumonia (3)
Plueral effusion Emyema lung abscesses
102
Viral LRTI causes? Children (broncholitis <2 years) (2) Adults (4) Immuno suppressed (4)
Children = RSV and parainfluenza = Brochiolitis - inflame of small bronchioles) Adults = Influenza A or B, adenovirus, varicella coster Immunosupressed = as above + measles, herpes simplex and cytomegalovirus
103
Presentation Influenza (4) Primary viral pneumonia (usually those with preexhisting lung issues - inpatients) (4)
Influenza = uncomplicated, fever, headache, dry cough and sore throat for 2 - 3 weeks Viral pneumonia = cough, breathlessness, cyanosis and secondary bacterial infection
104
Cystic fibrosis - organism present and becomes more resistant over time. Children - Teen - adult
``` Child = Stap aureus Teen = psudoeomonas aeurginosa Adult = burkholderia cepacia complex ```
105
Management of CF resp infections (4)
Prolonged antB (3-4 weeks) Vaccinations Lungs transplants Postural draining
106
Fungal LRTI
Aspergillosis - in immunosupressed and lung patients
107
4 types of Aspergillosis
Space occupying or Aspergilloma - previous lung cavity (eg. TB or sarcoidosis) ABPA - allergic bronchopulmonary aspergillosis = linked to asthma Invasive/ infective = Pneumocystis - pneumonia and hypoxia in HIV patients Chronic pulmonary aspergillosis - COPD
108
TB or mycobacterium tuberculosis - symptoms (5)
``` chronic productive cough, weight loss NIGHT SWEATS haemoptysis fever ```
109
Progression of TB
inhalation of airborne disease --> bacilli lodge in alveoli and multiply = ghon formation 90% of primary infection asymptomatic - may reactivate later in life.
110
Tests for TB (4) 3 different names of the skin test
Detect acid fast bacilli OR Culture of M. tuberculosis in sputum culture OR PCR Tuberculin OR Mantoux OR Heaf skin test
111
What is placed under the skin during a mantoux skin test Results
PPD purified protein derivative or tuberculin Red bumps if the patient currently has or has every had TB
112
Treat and prevent TB
``` Treat = chemo (ionized for 6 months) Prevent = BCG vaccination ```

Year 2: Clinical Pathology (10 decks)

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