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MHD VI: Pulm > 11.20: Pulm II > Flashcards

11.20: Pulm II Flashcards

1
Q

What is the issue in obstructive pulmonary disease?

A
  • **PROBLEM WITH EXHALATION
  • Increase in resistance to airflow from partial/complete obstruction at any level
  • Decreased FEV1
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2
Q

What is problem in restrictive pulmonary disease?

A
  • **Problem with ability of chest wall
  • Expansion or compliance
  • Can be problem with chest wall, parenchyma, or fibrotic lung
  • Decreased TLC
  • Normal FEV1
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3
Q

What is reduced FEV1 indicative of? Normal?

A

Reduced: Obstructive airway disease
Normal: Restrictive airway disease

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4
Q

What is FEV1?

A

How much of a forced inspiration is expired in 1st second of exhalation

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5
Q

What are examples of obstructive lung diseases?

A
  1. Emphysema
  2. Chronic bronchitis
  3. Asthma
  4. Bronchiectasis
  5. Tumor / foreign body
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6
Q

What are examples of restrictive lung diseases?

A 
Chest wall disorders
1. Polio
2. Obesity
3. Pleural disease 
4. Kyphoscoliosis
Interstitial/Infiltrative disease:
1. ARDS
2. Dust diseases
3. Interstitial fibrosis
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7
Q

What is FVC?

A

“Forced vital capacity”

  • Total amount inhaled during forced inspiration
  • How much expired in first second is FEV1
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8
Q

What is included in vital capacity (VC)?

A

VC = TV + IRV + ERV

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9
Q

What is included in total lung capacity (TLC)?

A

TLC = TV + IRV + ERV + RV

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10
Q

What is included in functional residual capacity (FRC)?

A

FRC = RV + ERV

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11
Q

What is spirometry?

A
  • Clinical measure of inspiratory / expiratory volume and rate
  • Inspiration on bottom of graph
  • Expiration on top of graph
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12
Q

What are the COPDs?

A

“Chronic obstructive pulmonary disorders”

  1. Chronic Bronchitis
  2. Emphysema
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13
Q

Key characteristic of asthma?

A
  • INTERMITTENT and REVERSIBLE airway obstruction
  • Muscle layer has become hypersensitive to a stimulus
  • Bronchial inflammation with eosinophils
  • Increased mucus production
  • Bronchial smooth muscle hypertrophy
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14
Q

What is bronchial inflammation with eosinophils characteristic of?

A
  • Asthma
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15
Q

Symptoms of asthma?

A
  1. Wheezing
  2. Chest tightness
  3. Breathlessness
  4. Cough
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16
Q

Stimuli of asthma?

A
  1. Infections
  2. Cold Air
  3. Exercise
  4. Environmental irritants
  5. Stress
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17
Q

What is a main mechanism for increased asthma in Western world?

A
  • Body shifts to making more IgE than IgG/M due to limited exposure to environmental infections / toxins
  • IgE is key factor in development of asthma and other hypersensitivity disorders
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18
Q

What is atopic asthma?

A
  • Immune mediated Type I hypersensitivity rxn involving IgE bound to mast cells
  • Begins in childhood and triggered by allergens
  • General predisposition to this response
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19
Q

How can atopic asthma be detected?

A
  • Skin test for allergen rxn
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20
Q

What is non atopic asthma?

A
  • Triggered by non-immune mechanisms
  • Viral inflammation of mucosa increasing sensitivity of subepithelial vagal receptors or irritants
  • Skin an serum tests are NEGATIVE
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21
Q

During which type of asthmatic process are skin tests positive?

A

Atopic

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22
Q

Important causes of drug induced asthma?

A

Aspirin

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23
Q

Pathogenesis of asthma?

A
  • Toxin initially enters body and APC presents to T cell
  • T cell produces IL 3/5 recruiting EOSs
  • T cell produces IL 4 causing B cell to produce IgE
  • Next time antigen enters body it is primed for brisk, stronger response via vagal receptors causing constriction
  • Mucus cells degranulate and produce more mucus
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24
Q

What do IL3/5 cause?

A
  • Chemotaxis of EOSs

- Released by T cells in interaction with irritant causing atopic asthma

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25
What does IL4 cause?
- B cell to release IgE | - IL4 Released by T cell in atopic asthma
26
What is status asthmaticus?
- Prolonged bout of asthma responding poorly to treatment - Persistent hyperinflation of the lungs on autopsy - Bronchial mucus casts from degranulation of mucus glands can also be seen
27
What are Curschmann spirals?
- Dying epithelial cells coated by mucin giving spiral appearance on microscopy - Characteristic of status asthmaticus
28
What are Charcot leyden crystals?
- Seen in status asthmaticus | - Caused by degranulation EOSs leading to granule precipitate
29
What are Curschmann spirals and Charcot leyden crystals indicative of?
- Status asthmaticus
30
What changes occur in chronic asthma?
1. Smooth muscle proliferation beyond usual thin layer 2. Sub mucosa becomes layers with EOSs 3. Thickening of basement membrane
31
What is thermoplasty?
- Clinical procedure in which smooth muscle from chronic asthma is burned off to decrease hyperplasia in bronchial tree - Once it has burned it will no longer be able to constrict
32
How can asthma cause cor pulmonale?
- Vasoconstriction of lungs leading to right heart failure
33
What is chronic bronchitis?
- Disease of large airways: trachea / bronchi | -
34
Difference between bronchi and bronchiole?
- Bronchi have cartilage, bronchioles do not | - Bronchi have mucus glands, bronchioles do not
35
What is emphysema a disease of?
- Destruction and loss of recoil in (acinus) area is distal to bronchioles resulting in abnormal enlargement of spaces - Acinus: respiratory bronchiole, alveolar ducts, alveoli
36
What constitutes the acinus?
1. Respiratory bronchiole 2. Alveolar ducts 3. Alveoli
37
Clinical definition of chronic bronchitis?
- Persistent productive cough for at least 3 consecutive months in at least 2 consecutive years - Biopsy is not needed
38
Who is at risk for chronic bronchitis?
1. Smokers 2. Urban dwellers, smog 3. Middle aged men
39
What is the REID index?
- Measurement of gland to wall ratio from epithelial basement membrane to cartilage - 40% - Leads to obstruction of airway and productive cough
40
Complications seen in chronic bronchitis?
1. Cor pulmonale with CHF 2. Infections: low flow 3. Bronchogenic carcinoma: squamous metaplasia as cells adapt that can become carcinogenic
41
What is emphysema a destruction of?
- Alveolar septa between alveolar sacks - Leads to destruction of capillaries - Leads to destruction of individual sack units into larger sacks
42
What are the 4 types of emphysema?
1. Centriacinar - Smokers, upper lobes 2. Panacinar 3. Distal acinar 4. Irregular
43
Characteristics of centriacinar emphysema?
- Seen in smokers - Upper lobes of respiratory bronchioles - Upper lobes because smoke rises to upper lobes * **Coal workers pneumoconiosis does similar thing
44
Characteristics of panacinar emphysema?
- Lower lobe involvement - Alpha1 antitrypsin deficiency is classic disease - Whole acinus involved
45
Characteristics of distal acinar emphysema?
- Distal acinus along pleura and lobular septa - Occurs adjacent to areas of fibrosis or scarring - Can form VERY LARGE air space that can become cysts/bullae - Can lead to spontaneous pneumothorax
46
What is compensatory emphysema?
- One portion of lung that is agenic with otherside overcompensating by inflating
47
What is bullous emphysema?
- VERY large are cavities in lung | - Danger is that they will rupture
48
When is interstitial emphysema seen?
Trauma
49
Pathogenesis of emphysema?
"Protease/antiprotease theory" - Mild chronic inflammation from macs, CD8 T cells, and neuts - Toxin (Tobacco) activates neuts to produce elastase - Elastase digests elastin in lung - Body products anti elastase: alpha1 antitrypsin
50
What is alpha1 antitrypsin?
- Body produces this to combat elastase produced in development of emphysema from neutrophil elastin production - A1AT is trying to stop damage from smoking but eventually can lose - In deficiency, any injury will cause emphysema
51
What is hyperinflated lung with bullae characteristic of?
Emphysema, not status asthmaticus because of the bullae
52
What are PiMM / PiZZ?
PiMM: normal phenotype of alpha 1 antitrypsin PiZZ: abnormal phenotype of alpha 1 antitrypsin of which 80% develop emphysema
53
Age difference in emphysema vs. bronchitis?
Emphysema seen in older patients usually > 50yo
54
Dyspnea difference in emphysema vs. bronchitis?
- Severe and early onset in emphysema
55
Cough difference in emphysema vs. bronchitis?
Bronchitis: Early, lots of sputum Emphysema: Late onset, scant sputum: fewer mucus glands in acinar area
56
Infections more common in bronchitis or emphysema?
Bronchitis demonstrates repeated infections
57
What is a blue bloater?
Patient with bronchitis
58
What is a Pink puffer?
- Patient with emphysema | - Because of way they purse way in breathing allowing to push out air
59
What is bronchiectasis?
PERMANENT dilation of bronchi and bronchioles caused by destruction of muscle and elastic tissue - This is usually caused by necrotizing inflammation
60
What can lead to bronchiectasis?
1. TB: #1 cause 2. Tumor 3. CF 4. Kartagener Syndrome
61
Pathogenesis of bronchiectasis?
- OBSTRUCTION leading to impaired clearing mechanisms - POOLING of secretions distal to obstruction - Leads to INFLAMMATION with necrosis, fibrosis, and eventual dilatation
62
Primary defect in CF?
- Defect in chloride transport channel causing accumulation of viscous secretions obstructing the airways - This pulls NaCl into cells with water following - Mucus becomes very dry and cement like - Leads to airway damage and high susceptibility to infections
63
Genetics of CF?
- CFTR protein product found on chromosome 7 | - Autosomal recessive transmission
64
What is kartagener syndrome?
- Defective cilia preventing from removal and escalation of mucus - Dynein arms are missing from cilia
65
Various diseases associated with kartagener?
1. Sinusitis from lack of cilia in nose 2. Bronchiectasis 3. Infertility 4. Situs inversus
66
What is situs inversus?
Heart and other organs are transposed through sagittal plane to opposite from normal
67
Complications of bronchiectasis?
 Respiratory insufficiency  Cor pulmonale  Brain abscesses  Amyloidosis
68
Summary of emphysema?
 Destruction and dilatation of acini  Centriacinar: smoking  Panacinar: alpha 1 antitrypsin deficiency  “Pink Puffers”
69
Key facts of chronic bronchitis?
```  Cough  Hypersecretion of mucus  Smoking, pollutants  Small airway disease  “Blue bloaters” ```
70
Key issues with Bronchiectasis?
 Damage to and dilatation of bronchial wall  Permanent  Infections, purulent mucus
71
Key facts of bronchial asthma?
```  Episodes of bronchospasm  Atopic or allergic  Nonatopic (viruses and pollutants)  Eosinophils, mucus plugs (Charcot-Leyden crystals and Curschmann’s spirals) ```

MHD VI: Pulm (20 decks)

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