2.3.1 Obstructive Pulmonary Disease

Question 1

What are each of the symbols and arrows demarcating?

Answer 1

Bronchus from an asthmatic patient showing goblet cell hyperplasia (green arrowhead), subbasement membrane fibrosis (black arrowhead), eosinophilic inflammation (yellow arrowhead),and muscle hypertrophy (blue arrowhead)

Question 2

What are some of the changes that occur when the airway gets remodeled in asthmatic patients?

Answer 2

Question 3

What are measure on a PFT is reduced in obstructive pulmonary disease?

Answer 3

FEV1, decreased maximal airflow during forced expiration

FEV1/FVC is < 0.7 (Normal is ~0.75)

Question 4

What type of emphysema are each of these slides?

Answer 4

Left: Centriacinar

Right: Panacinar

Question 5

What chromosome has been linked to asthma susceptibility?

Answer 5

5q

Question 6

What is the nickname for patients with chronic bronchitis? emphysema?

Answer 6

Chronic bronchitis: blue bloaters

Emphysema: pink puffers

Question 7

Compare chronic bronchitis and emphysema in the following categories

Answer 7

Question 8

Fill in this chart with the correct answers

Answer 8

Question 9

Where is alpha 1 anti-trypsin typically produced within the body? What genotype of someone with a deficiency in this protein?

Answer 9

Liver

PiZZ (~1% of the population)

Question 10

What are the two types of asthma?

Answer 10

Atopic - known allergen

Non-atopic - no evidence of allergen

Question 11

What is the term for continuous asthma attacks?

Answer 11

Status asthmaticus

Question 12

The loss of what force causes emphysema to be an obstructive pulmonary disease?

Answer 12

Loss of elastic recoil due to the rupture of the alveolar septae (like a paper bag rather than a balloon)

Question 13

What is the Reid Index?

Answer 13

The reid index measures the ratio of the thickness of the mucous gland layer to the thickness of the bronchial wall b/t epithelium and cartilage

(Normal is < 0.4)

Question 14

Name that condition: productive cough of unknown cause, occuring for 3 or more months in at least two successive years

Answer 14

Chronic bronchitis

Question 15

What is the most common type of asthma?

Answer 15

Atopic

Question 16

Asprin induced asthma has what defining characteristic?

Answer 16

Nasal polyps

Question 17

What are some of the clinical features of bronchiectasis?

Answer 17

cough, fever, copious of amounts of foul-smelling, purulent sputum, hemoptysis

Question 18

Name that condition

Answer 18

Bronchiectasis

Question 19

What type of metaplasia occurs in chronic bronchitis?

Answer 19

Goblet cell. Results in mucus hyperproduction

Question 20

What is obstructive pulmonary disease in its broadest sense?

Answer 20

An increase in resistance to airflow owing to partial or complete obstruction at any level

Question 21

Name that condition: Typified by permanent dilation of bronchi and bronchioles caused by the destruction of the muscle and elastic tissue by chronic necrotizing infections.

Answer 21

Bronchiectasis

Question 22

What is the pathogenesis of chronic bronchitis?

Answer 22

1. Inhalation of noxious substance (smoke or dust)
2. Mucus hypersecretion
3. Inflammation
4. Infection
5. Injury to epithelium -> chronic inflammation
6. Impaired ciliary action -> lack of mucus clearance -> infection

Question 23

What is the pathogenesis of bronchioectasis?

Answer 23

normal clearing mechanisms impaired -> pooling of secretions distal to the obstruction -> secondary infection and inflammation

Question 24

What is a unique complication of emphysema?

Answer 24

Pneumothorax (rupture of a bolus)

Question 25

COPD is a clinical combination of which two medical conditions? Which third condition may be present?

Answer 25

Chronic Bronchitis and Emphysema

Asthma may or may not be present

Question 26

What are some triggers for non-atopic asthma?

Answer 26

Viral infections, air pollutants, exercise, or cold

Question 27

Name the condition: abnormal permanent enlargement of the airspaces distal to the terminal bronchiole

Answer 27

Emphysema

Question 28

During an asthmatic episode, what are some of the symptoms? When are they most likely to occur?

Answer 28

Coughing, wheezing, breathlessness, chest tightness

Temporality: night or early morning

Question 29

What are four medical conditions that can be classified as obstructive pulmonary dz’s?

Answer 29

Emphysema, Chronic Bronchitis, Asthma, Bronchiestasis

Question 30

What are the two types of emphysema? What is generally the cause driving each type?

Answer 30

Centriacinar (smokers)

Panacinar (alpha 1 anti-trypsin deficiency)

Question 31

What is the pathogenesis of emphysema?

Answer 31

Question 32

Who typically get chronic bronchitis?

Answer 32

Men, age of 45(+)

Question 33

When do patients begin to notice the effects of the emphysema?

Answer 33

Manifestations begin after 1/3 of the functioning lung parenchyma is impaired

Question 34

What % of smokers develop COPD? What % of COPD is a result of smoking?

Answer 34

35-50% of smokers develop COPD

80% of COPD is due to smoking

Question 35

Atopic asthma is what type of hypersensitivity reaction?

Answer 35

Type I (IgE mediated)

Question 36

Asthma is most common in what patient population?

Answer 36

Children

Question 37

Name the condition: episodic bronchoconstriction due to increased airway sensitivity to a variety of stimuli

Answer 37

Asthma