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Pathology bs > Respiratory tract neoplastic & non-neoplastic disease > Flashcards

Respiratory tract neoplastic & non-neoplastic disease Flashcards

1
Q

Viral infection can go anywhere in the respiratory system. What causes congestion?

A

virus cause inflammation of the mucosal layer

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2
Q

What is the definition of pneumonia?

A

inflammation of the lung parenchyma

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3
Q

What are the causes of pneumonia?

A

infectious agents
inhalation of chemicals
chest wall trauma

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4
Q

What are the two stages of pneumonia?

A
  • CONSOLIDATION of the affected part

- EXUDATE with inflammatory cells and fibrin in the alveolar spaces

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5
Q

Most pneumonias are caused by bacteria, what is the most common bacterial cause in community acquired pneumonia?

A

Streptococcus pneumoniae

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6
Q

What are the clinical features of pneumonia?

A 
- fever 
rigours 
SOB 
pleuritic chest pain (pain on breathing)
purulent sputum (green)
cough 
chest x-ray or cough  changes 
increase WCC
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7
Q

Pneumonia can be split in to categories on where it affects. The main ones are lobar and multifocal (bronchopneumonia). What do each one affect?

A
  • lobar just one lobe

- multifocal - multiple places

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8
Q

hospital acquired pneumonia is also known as nosocomial pneumonia. How long does a person have to be in hospital before it is classed as hospital acquired?

A

48-72 hours after admission

  • normally gram negative and staph aureus
  • most common cause of death in ICU
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9
Q

aspiration pneumonia develops after inhalation of foreign material. Who is this common in?

A
  • elderly, stroke, dementia, anaesthetic

- the symptoms can often be silent

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10
Q

Where does aspirated pneumonia normally occur?

A
  • usually right middle and right lower lobe
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11
Q

An obstructive disease is characterised by partial or complete obstruction at any level from trachea to respiratory bronchioles. What are examples of obstructive diseases?

A
  • asthma
  • COPD
  • broncectisis
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12
Q

In COPD emphysema what happens to the alveolar wall?

A

become bigger holes in them which reduces surface area

large aplical bullae or blebs

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13
Q

What are the symptoms of COPD emphysema ?

A
  • dyspnoea (SOB)
  • cough
  • wheezing
  • weight loss due to using accessary muscles to breathe)
  • cor pulmonale (right sided heart failure)
  • can develop congestive heart failure and pneumothorax
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14
Q

What should you be careful giving people with COPD if they are short of breath

A

oxygen! could stop respiratory drive

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15
Q

What is the definition of (in copd) chronic bronchitis?

A
  • persistent cough with sputum production
  • for at least 3 months in at least two consecutive years
  • without any other identifiable cause
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16
Q

What are the 2 main causes of chronic bronchitis?

A
  • smoking
  • inhalation of dust, grain, cotton
  • chronic irritation
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17
Q

what changes in the anatomy in chronic bronchitis?

A
  • hypertrophy of submucousal glands in trachea and bronchi, increase in goblet cells
  • narrowing of the bronchioles causing mucus plugging
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18
Q

Asthma is a chronic inflammatory disorder of the airways. they have a recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly at night and in the early morning. What are the hallmarks of asthma?

A
  • increased airway responsiveness
  • episodic bronchoconstriction,
  • inflammation of bronchial walls
  • increased mucus production
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19
Q

What are the clinical signs of asthma?

A
  • chest tightness
  • wheezing
  • dyspnea (SOB)
  • status asthmatics ( does not respond to treatments)
  • increase in airflow obstruction (difficulty with exhalation)
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20
Q

What is bronchiectasis?

A
  • permentant destruction and dilation of the airways
  • associated with servere infections or obstructions
  • leads to narrowing of the lumen
  • can occur with COPD
21
Q

What are the clinical signs for bronchiectasis?

A
  • persistent cough
  • Purulent sputum ++
  • haemoptysis (coughing up blood )
22
Q

Restrictive disease are characterised by inflammation and fibrosis of the pulmonary connective tissue. Where do restrictive disease tend to occur in the lung?

A
  • interstitium of the alveolar walls
  • this becomes a problem because this increases the alveolar space and therefore increase the distances from the blood vessels so resicrits gas exchange
23
Q

What are the main causes of restrictive diseases?

A
  • Sarcoidosis

- occupational / environmental (asbestosis exposure)

24
Q

What is the morphology of restrictive lung disease?

A
  • bilateral infultrative lesions
  • on Xray shows small nodules, irregular lines, ground glass shawdows
  • scarring and gross destruction of the lung
  • end stage = honeycomb lung
25
Q

What are the clinical features of restrictive lung disease?

A
  • dyspnea (SOB)
    -tachypnea (increased resp rate)
  • eventually cyanosis
    reduction in gas diffusing capacity, lung volume and compliance
  • may lead to secondary pulmonary hypertension and right sided heart failure with car pulmonale
  • increased risk of developing pneumonia
26
Q

Pulmonary embolism (PE) is the main vascular disorder. What is

A

Blockage of a main or branch pulmonary artery by an embolus

  • usual source of emboli are deep venous thrombi of the leg.
  • respiratory compromise and haemodynamic compromise
  • associated with people that are bed bound for a long time (why stockings and stuff are used)
  • also associated with pregnancy, long operations and long flights
27
Q

What are the clinical appearances of pulmonary embolism?

A
  • abrupt onset pleuritic chest pain
  • SOB
  • hypoxia
  • increased pulmonary vascular pulmonary vascular resistance - right ventricular failure
28
Q

What is pulmonary oedema and its causes?

A
  • Accumulation of fluid in the air spaces and parenchyma of the lungs
    Causes:
  • increased venous pressure (eg. ventricular failure)
  • haemodynamic (heart failure)
  • secondary to kidney problems (eg. nephrotic syndrome )
  • oedema due to alveolar injury/ infection
29
Q

initially pulmonary oedema happens at the bottom of the lungs and then makes its way up. What are the clinical feature of pulmonary oedema?

A
  • SOB
  • pink frothy sputum
  • x-ray shows hasieness
  • heavy wet lungs
  • granular pink
30
Q

What is a Pneumothorax? And what diseases is it associated with?

A
  • air in the throric/ pleural cavity
  • causes lungs to collapse
  • it is reversible
    its associated with emphysema, asthma, TB, trauma, idiopathic
31
Q

What is a tension pneumothorax?

A
  • normally in pneumothorax can get chest drain to get air out and lung with expand
  • in tension pneumothorax every time patient takes a breath in the air in pleural space expands. medical emergency and causes cardiac arrest
32
Q

What is atelectasis?

A
  • incomplete expansion of lungs
  • reduces oxygenation and predisposes to infection.
  • this is revisable
33
Q

In type 1 hypoxia with a normal or low PCO2 what is type 2?

A

hypoxia with high co2. normally in obstructive disease.

34
Q

There is a linear correlation between smoking and epithelial changes what are these?

A
  • metaplasia
  • then dyslasia,
  • carcinoma in situ leading to
  • invasive carcinoma
35
Q

What are the most common clinical complaints of lung cancer ?

A
  • cough
  • weight loss
    chest pain
  • SOB
36
Q

Some lung cancers will have metastasis what are the most common places fro these to go?

A

adrenal
liver
brain
bone

37
Q

Paraneoplastic syndrome is ectopic hormone secretion by tumours. What are the most common hormones and effects?

A

ACTH( adrenocorticotrophic hormone) - causing cushing syndrome
ADH (antidiuretic hormone) causing hyponatraemia
Calcitonin - causing hypercalcaemia

38
Q

small cell carcinoma has a strong relationship to smoking. they grow and metasises very early and so not generally curable to with surgery. they are most responsive to _____

A

most responsive to chemotherapy. but worst prognosis as relapses early.

39
Q

For diagnostic purposes when staining small cell carcinomas what does it show?

A
  • chromogranin
  • CD56
  • TTF1
  • synaptophysin
40
Q

Squamous cell cancer mostly effect men, with high correlation with smoking. Where do they normally arise?

A

arise close to HILUM (centrally located), usually in area of squamous metaplasia.

41
Q

What is a common marker for squamous cell carcinomas?

A

keratinisation and or intercellular bridges

42
Q

adenocarcinomas are most common in women and tend to be peripherally located. How do they grow in comparison to squamous cell carcinomas?

A
  • grow more slowly but

- metastasize early and widely

43
Q

What are adenocarcinomas sometimes associated with?

A

scarring e.g healed TB. people that have had old TB might get adenocarcinoma occurring

44
Q

What is a large cell carcinoma?

A
  • undifferentiated malignant epithelial tumour
  • undifferentiated SCC and adenocarcinoma with no discernible features
  • associated with neuroendocrine variant (highly malignant tumour, granular cytoplasm, central necrosis, peripheral palisading)
45
Q

When finding lung metastases (these are the most common) where are the primary tumours most likely to be?

A

bowel
prostate
breast
kidney

46
Q

In a lung cancer normally positive for CK7 and negative for CK20. What is different in metastatic colorectal adenocarcinoma?

A

negative for CK7

positive for CK20.

47
Q

Which cancer normally causes cancer after asbestos exposure?

A

malignant mesothelioma
it is a pleural tumour
- associated with extensive pleural effusion and direct invasion of thoracic structures.

48
Q

Patients with mesothelioma present with chest pain, SOB, pleral effusion (abnormal amount of fluid around lungs) and it can alsoarise in peritoneum, pericardium and genital tract. What is the treatments?

A

extra-pleural pneumonectomy, chemo, radiotherapy

- doesn’t often improve prognosis

Pathology bs (21 decks)

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