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RC Test 3 > B4.057 - Obstructive Pulmonary Disease > Flashcards

B4.057 - Obstructive Pulmonary Disease Flashcards

1
Q
A

pulmonary hypertension, a complication of COPD

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2
Q

histo of chronic bronchitis

A

thick walled bronchi, abundant mucous glants, goblet cell metaplasia, chronic inflammation

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3
Q

what is centriacinar emphysema

A

central/proximal portions of acini affected (resp bronchioles) but distal alveoli are spared if severe affects entire acinus worse in upper lobes smoking >95% of clinical cases

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4
Q

how does CF cause bronchiectasis

A

inherited ion transport defect leads to defective mucociliary action and airway obstruction by thick viscous secretions. predisposes to chronic infections causing airway damage and descruction of smooth muscle and elastic tissue

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5
Q

pathogenesis of atopic asthma

A

complex and mulitfactorial

Th2 and IgE response to environmental allergens in genetically prediosposed individuals

exaggerated Th2 response

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6
Q
A

left - normal

right - primary ciliary dyskinesia

loss of dynein arms in fibure b

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7
Q

what are the classes of triggers of asthma

A

seasonal

exercise induced

drug induced

occupational

asthmatic bronchitis in smokers

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8
Q

panacinar emphysema

A

acini are uniformly enlarged from respiratory bronchiole to alveoli entire acinus, not entire lung worst at bases Alpha1 antitrypsin deficiency

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9
Q

what is emphysema

A

abnormal permanent enlargement of the airspaces distal to the terminal bronchiole and destruction of their walls without obvious fibrosis, but may see fibrosis in small airways/bronchioles

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10
Q
A

bronchiectasis

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11
Q

epidemiology of chronic bronchitis

A

chronic irreversible obstruction of airflow

affects all people all ages

common in longtime smokers, polluted urban areas

more common over 45

more common in men

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12
Q

describe atopic asthma clinical scenario

A

most common type

begins in childhood

triggers: environmental antignes, dusts, pollens, animal dander, foods

positive family Hx of atopy

allergic rhinitis, urticaria, eczema

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13
Q

environmental factors predisposing to asthma

A

rhinovirus type C, respiratory syncytial virus

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14
Q
A

chracot leyden crystals

eosinophils

histo of asthma

represent breakdown products of eosinophils composed of an eosinophil protein called galectin 10

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15
Q

epidemiology of emphysema

A

men and women, men more common smoking major cause develops gradually clinically significant symptoms at any age, 40+ in smokers although ventilatory deficits seen earlier

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16
Q
A

sub pleural bullae seen in emphysema

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17
Q

pathogenesis of bronchiectasis

A

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

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18
Q
A

CF induced bronchiectasis

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19
Q

what percentage of smokers develop COPD

A

50%

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20
Q

chronic bronchitis

A

productive cough of unknown cause, ocurring for 3 or more months in at least 2 successive years

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21
Q

what is the mechanism of disease in emphysema

A

functional airflow obstruction

normally small airways are tethered open by elastic recoil in the walls of surrounding alveoli

loss of elastic tissue in aleolar walls allows th erespiratory bronchioles to collapse during expiration

inflammation also plays a role

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22
Q

types of emphysema

A

centriacinar panacinar distal acinar/paraseptal irregular

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23
Q
A

panacinar emphysema alpha 1 antitrypsin deficiency

ruptured alveolar septae (red arrow)

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24
Q

pathogenesis of emphysema

A

smoking

increased oxidative stress, inflammatory cells/mediators, protease/antiprotease imbalance

all lead to alveolar wall destruction

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25
Q
A

bronchiectasis

dilated bronchile wiht stasi of mucus secretions and inflamed walls

surrounding fibrosis

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26
Q

epidemiology of asthma

A

ocurrs in 5% of pop

any age

most common in children, decreases with puberty, increases with age

increasing incidence

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27
Q

pink puffer

A

emphysema

barrel chested, dyspneic, prolonged expiration, hunched over position, breathes through pursed lips

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28
Q
A

centriacinar emphysema

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29
Q

what percentage of people with COPD smoke

A

80%

30
Q

blue bloater

A

chronic bronchitis

cough, DOE, hypercapnea, hypoxemia, mild cyanosis

31
Q

asthma

A

chronic disorder of conducting airways, usually caused by an immunological reaction

episodic bronchodilation due to increased airway sensitivity to a variety of stimuli

inflammation of bronchial walls

increased mucus secretion

32
Q

atopic astham mediated by

A

IgE type 1 HS

skin test using offentig antigen –> immediate whela and flare reaction

high serum IgE

presence of RAST: detects presence of IgE Abs specific for individual allergens

33
Q

compare and contrast chronic bronchitis and emphysema

A
34
Q

chronic bronchitis

anatomic compartment

etiology

pathogenesis

A

anatomic compartment - bronchus

etiology - chronic irritation by inhaled substances like tobacco smoke

pathogenesis - hypersecretion of mucous, metaplasia, hypertrophy and remodeling of small airways, inflammation

35
Q

bronchiectasis

A

destruction of airway muscle and elastic tissue resulting in permanent dilation of bronchi and bronchioles, often by chronic necrotizing infections

36
Q

occupational asthma causes

A

fumes, dusts, gases, other chemicals

repeated exposure to chemicals results in minute quantity stricturing attakcs

mechansism include: T1 reactions, direct reslease of bronchoconstrictors, unknown HS reponses

37
Q

initiating factors of chronic bronchitis

A

exposure to noxious inhaled substances: tobacco smoke, dust

mucus hypersecretion in airways (IL13)

inflammation

infection - maintains disease process and causes exacerbations

38
Q

what is an alpha 1 antitrypsin deficiency and the genetics behind it

A

loss of an antiprotease that leads to emphysema

PiMM - normal

PiMZ - heterozygous

PiZZ - homozygote - highest risk for emphysema

39
Q

clinical features of bronchiectasis

A

cough, expectoration of copious amounts of foul smelling purulent sputum.

hemoptysis

recurrent acute infective exacerbations that can lead to sever lung function and impairment and respiratory failure

dyspnea, wheezing

40
Q

what is asthma characterized by

A

bronchial hyperresponsiveness triggered by allergens, infection etc.

41
Q

distal acinar/paraseptal empysema

A

distal acinus is predominantly involved adjacent to the pleura, along the septa next to fibrosis, scarring or atelectasis worse in upper lung spontaneous pneumothorax

42
Q

pts with bronchiectasis are at higher risk of what hypersensitivity

A

aspergillosis

Th2 recruit eosinophils and other leukocytes

high serum IgE and serum antibodies to aspergillus

43
Q
A

goblet cell metaplasia of bronchial epithelium seen in chronic brochitis

44
Q

what do bc and ad refer to

A

bc - thicknessof the mucous galnd layer

ad - thickness of the bronchial wall between the epithelium and cartilage

45
Q

irregular emphysema

A

acinus is irregularly involved scarring occurs in small foci, is clinically insignificant

46
Q

symptoms of aspergillosis

A

inflammation and formation of mucus plugs, which play a primary role in pathogenesis

47
Q
A

bronchiectasis

dilated airways with inflamed walls

48
Q
A

thickened basement membrane - bottom left

smooth muscle hypertrophy - bottom right

respiratory epithelium - top

green arrowhead - goblet cell hyperplasia

eosinophilic inflammation - yellow arrowhead

seen in asthma

49
Q
A

bullae seen in emphysema

50
Q

susceptibility locus for asthma

A

chromosome 5q (codes interleukins IL13)

51
Q
A

mucus plugs (left)

chronic inflammation in bronchiolar wall (right)

seen in chronic bronchitis

52
Q

drug induced asthma causes

A

aspirin (+recurrent rhinitis, nasal polyps)

NSAIDs - inhibit COX pathway decreasing PGE2 –> release inhibition of enzymes that generate pro inflammatory mediators LTs

53
Q

symptoms of asthma

A

recurrent episodes of wheezing, breathlessness, chest tightness, cough particulary at night and early morning

at least partly reversible

inflammation causes an increase in airway responsiveness to a variety of stimuli

54
Q

airway remodeling

A

thickening of airway wall

hypertrophy and hyperplasia of bronchial wall muslce

55
Q

obstructive lung diseases cause what and what are some examples

A

increased resistance to airflow due to partial or complete obstruction at any level Decreased FEV1 emphysema, chronic bronchitis, asthma, bronchiectasis

56
Q

50% of pts with primary ciliary dyskinesia have what

A

kartageners syndrome - situs inversus all organs are on flip side

sinusitis

bronchectasis

57
Q

treatment of bronchiectasis

A

treat underlying cause

chest physical therapy

antibiotic therapy

58
Q
A

panacinar emphysema

59
Q

unique complication of emphysema

A

pneumothorax

60
Q

types of asthma

A

atopic - evidence of allergen sensitization and immune activation, often with rhinitis and eczema

non atopic - no evidence of allergen sensitization

61
Q
A

bronchiectasis

62
Q

complications of bronchiectasis

A

cor pulmonale

amyloidosis

metastatic brain abcesses

63
Q

how do tobacco and infection contribute to chronic bronchitis

A

tobacco interferes with ciliary action, directly damages airway epithelium, inhibits ability of white blood cells to clear bacteria. Infections maintain but do not initiate chronic bronchitis

64
Q

causes of bronchiectasis

A

idiopathic

post infection

congenital - CF, sequstration of lung, ciliary dyskinesia

obstruction of bronchioles

collagen vascular diseaes, inflammatory bowel disease, post transplant

65
Q

what are bullae

A

large cystic dilated airspaces seen in emphyema

66
Q

what is status asthmaticus

A

acute severe asthma, can be fatal, continuous symptoms

67
Q
A

mucus plug - left

surshmann spiral - right - coiled pragment of inspissated mucus

gross

68
Q

what is the reid index

A

the ratio and thickness of the mucous gland layer to the thickness of the bronchial wall between the epithelium and cartilage

69
Q

non atopic asthma causes

A

triggered by respiratory tract (viral) infection

rhinovirus, parainfluenza, respiratory syncytial viurus

ihaled air pollutantts

cold or exercies

negative skin test

70
Q

COPD complications

A

cor pulmonale, HF, pneumothorax (emphysema), superimposed acute infections (CB)

71
Q

when do symptoms present in emphysema

A

1/3 of functioning lung parenchyma impaired

72
Q

how does primary ciliary dyskinesia lead to bronchiectasis

A

autosoma recessive syndrome

defect in ciliary motor protien dynein which inhibits bacterial clearance in sinuses and airways

RC Test 3 (15 decks)

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