9.4 Obstructive Diseases

Question 1

What will happen to the FEV1/FVC ratio in obstructive diseases?

Answer 1

Decreases

Question 2

What will happen to the TLC in obstructive diseases?

Answer 2

Increases due to air trapping

Question 3

What is the clinical definition of chronic bronchitis?

Answer 3

Chronic productive cough lasting 3 months over 2 consecutive years

Question 4

What is the main symptom of chronic bronchitis?

Answer 4

Coughing up of massive amounts of mucus

Question 5

What is the Reid index?

Answer 5

The ratio of the thickness of the mucus gland layer to the overall thickness of the wall

Question 6

What happens to the Reid index in chronic bronchitis?

Answer 6

It will increase past 50% - bronchial mucus gland hypertrophy

Question 7

Will chronic bronchitis patients be cyanotic or not?

Answer 7

They will be cyanotic

Question 8

What does chronic bronchitis increase risk of?

Answer 8

Infection and for pulmonale

Question 9

How does obstruction occur in emphysema?

Answer 9

Elastic recoil on the air sacs is lost which will not be able to pull open the the air tubules - they will instead collapse, leading to air trapping

Question 10

Emphysema

Answer 10

Destruction of the alveolar air sacs

Question 11

Alpha-1 Antitrypsin

Answer 11

Anti-elastase enzyme

Question 12

What type of emphysema occurs with smoking?

Answer 12

Centriacinar Emphysema

Question 13

Centriacinar Emphysema

Answer 13

More severe in the upper lobes with centriacinar emphysema

Question 14

Panacinar Emphysema

Answer 14

More common in the lower lobes and is due to alpha-1 antitrypsin

Question 15

What may occur with panacinar emphysema?

Answer 15

Liver Cirrhosis

Question 16

What is the main mutation for alpha1-antitrypsin deficiency?

Answer 16

PiZ - leads to misfolding that causes accumulation in the ER of the cells

Question 17

How will a patient with emphysema be breathing?

Answer 17

Breathe with pursed lips

Question 18

What happens to the chest in emphysema patients?

Answer 18

Increased AP diameter of the chest - barrel chest

Question 19

What is the equilibrium point of the internal recoil of the lung and external recoil of the chest wall?

Answer 19

Functional Residual Capacity

Question 20

What are some complications of emphysema?

Answer 20

Hypoxemia

Cor pulmonale

Question 21

Asthma

Answer 21

Reversible airway bronchoconstriction - type I hypersensitivity reaction

Question 22

What is the pathogenesis of asthma?

Answer 22

Allergens induce Th2 in CD4+ T cells which will secrete IL-4, 5 and 10

Question 23

What is the function of IL-4?

Answer 23

Activates IgE

Question 24

What is the function of IL-5?

Answer 24

Calls in eosinophils

Question 25

What is the function of IL-10?

Answer 25

Inhibits Th1 cells and stimulates Th2 cells

Question 26

What is the clinical features of asthma patients?

Answer 26

Shortness of breath

Wheezing

Question 27

What will be seen in the sputum of asthma patients?

Answer 27

• Curschmann Spiral

- Charcot Leyden Crystals

Question 28

What drug can induce asthma?

Answer 28

Aspirin

Question 29

Bronchiectasis

Answer 29

Permanent dilation of bronchioles and bronchi and loss of the airway tone will result in air trapping

Question 30

What is the pathogenesis of bronchiectasis?

Answer 30

Chronic necrotizing inflammation with damage to the airways

Question 31

What conditions are associated with bronchiectasis?

Answer 31

• Cystic Fibrosis
• Kartagener Syndrome (no cilia to help clear mucus from the lung)
• Necrotizing Infections
• Allergic Bronchopulmonary Aspergillosis (ABPA)

Question 32

What are the clinical features of bronchiectasis?

Answer 32

Cough
Shortness of breath
Foul smelling sputum

Question 33

How does a secondary amyloidosis develop in bronchiectasis?

Answer 33

Overproduction of SAA which an acute phase reactant due to chronic inflammation and SAA will be converted into AA and this is what will deposit as amyloid