Clinical Airways Diseases

Question 1

Asthma
Emphysema

Hallmark and dx

Answer 1

Airway inflammation with variable sx…demonstrate reversbility of obstruction and exclude others

Chest hyperexpansion…anatomic/radiographic findings

Question 2

Chronic bronchitis
Bronchiectasis
Bronchiolitis

CLinical hallmarks and dx

Answer 2

Chronic sputum…hx

Chronic sputum…radiographic demonstration of enlarged airways

Dyspnea and cough…often clinical dx or maybe lung biopsy

Question 3

COPD in general

Answer 3

Emphysema and chronic bronchitis

Question 4

Cough

Sputum production

Answer 4

Due to irritation of airway epithelium

Inflammation, increased mucous production, airway infection

Question 5

Hemoptysis
Wheezing
Dyspnea

Answer 5

Airway and/or lung injury

Narrowed small airway

Due to altered MECHANICS

Question 6

Smoking effects and pack years

Answer 6

packs a day* years smoked

Emphysema, chronic bronchitis and lung cancer

Question 7

Airflow of obstruction

Answer 7

SHows disproportionate expiratory phase involvement

Question 8

Emphysema diaphragmatic

Answer 8

Hover’s sign - inward retraction

Minimal excursion

Impaired diaphragmatic excursion

Question 9

Diffusion and emphysema

Answer 9

Diffusion impairment ID’s with exercise because losing surface area of the membrane

Question 10

Astham in general

Answer 10

Inflammatory

Reversible onstruction

Sx - cough, wheeze, dyspnea worse at night

Question 11

COPD

Answer 11

Airflow obstruciton irreversible to some extent

Usually smoking related

Pink puffer (pure emphysema) vs. blue bloater (chronic bronchitis)

Question 12

Asthma pathology

Answer 12

Inflammation with eosinophilic infiltrates

Atopy/allergic

Demonstrably reversible

Bronchial hyper-reactivity

Normally present in childhood, remit in teens, recur in adulthood

Question 13

Emphysema

Answer 13

Dx by CT imaging

Tobacco smoke produces imbalance in lung protease-anti-protease system

Centriacinar - smoking

Panacinar - alpha 1 antitrypsin def

Paraseptal - around margins

Airflow obstruction NOT mandatory for dx

Question 14

Centriacinar emphysema

Answer 14

With chest hyperextension

Smokers

Will see more ribs

Question 15

Alpha 1 AT def

Answer 15

Sx at 32-41 years if a smokes

Predominant in the lower lobes vs. centriacinar that is apical predominant

Question 16

Chronic bronchitis dx

Answer 16

SPutum production on most days

More than 3 mos a year

Over 2 years

Most common is smoking

Associated iwth ob struction but not mandatory

Question 17

Bronchiectasis

Answer 17

Enlarged and distorted bronchi that drain poorly, chronically infected and produce airflow obstruction

Signet ring sign

Sx usually chronic and similar to chornic brochitis…recurrent pneumonia and mayeb qwheezing

Question 18

Etiologies of bronchiectasis

Answer 18

CF

IMmotile cilia syndrome…bronchiectasis, sinusitis, situs inversus, and infertility…missing dynein arms on ultrastructure

Question 19

CT bronchiectasis

Answer 19

Bronchi larger than companion artery (ring sign)

Seen in lung periphery

Don’t taper as they should

Question 20

Bronchiolitis syndromes

Answer 20

Dz where bronchioles are the primary locus of pathoogy

More involved in children

Peds infections like RSV