COPD Flashcards

1
Q

COAD

Commonly used clinical term for a group of pathological conditions in which there is (acute or chronic?) partial or complete obstruction to air flow any level from _____ to ________ resulting in functional disability of the lungs

A

Chronic

trachea to smallest airways

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2
Q

COAD or COPD

⚫_________
⚫______________
⚫__________
⚫______________

A

Asthma

Chronic bronchitis

Emphysema

Bronchiectasis

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3
Q

ASTHMA

A chronic inflammatory disorder of the airways;
characterised by
⚫ widespread ________ of the airways, with
⚫ marked reduction in the __________________

⚫ Triggered by ________ stimuli.

⚫ Results in recurrent episodes of ________,________,__________ and __________.

⚫ May be ____________________, with or without
treatment

A

narrowing

inflow and outflow of air

a variety of

coughing, wheezing, breathlessness and chest tightness

reversed partly or completely

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4
Q

Classification of asthma Based on several factors including

A. Aetiology:

_________: ________ induced, Type 1 hypersensitivity

__________: induced by several ___________

A

Extrinsic; Allergen

Intrinsic; nonimmune factors

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5
Q

Classification of asthma Based on several factors including

Severity: _______,________, or ______

Frequency:_________ or _________

Clinical behaviour: i.e. brittle, difficult, ________ or ________

A

mild, moderate or severe

intermittent or persistent

steroid dependent or
resistant

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6
Q

Pollen concentrations are highest in the _______ or _________

A

Afternoon or midday

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7
Q

Pathophysiology

⚫ Asthma attacks are caused by airway
_________________

A

hyperresponsiveness

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8
Q

Pathophysiology
⚫ Asthma attacks are caused by airway
hyperresponsiveness—that is, an overreaction of the ________ and __________ to various environmental and
physiological stimuli, known as _______.

A

bronchi and bronchioles;

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9
Q

Pathophysiology

⚫ The most common causes of asthma attacks are extremely (small or large?) and (heavy or light?) weight particles transported through the ____ and inhaled into the lungs.

A

Small

Light ; air

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10
Q

Pathophysiology of asthma

⚫ When they enter the airways, these particles, known as
environmental triggers, cause ____________ in the airway walls, resulting in an asthma attack

A

An inflammatory response

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11
Q

Extrinsic/Environmental triggers
⚫ These are called __________.

A

allergens

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12
Q

ASTHMA: Extrinsic triggers

Allergens produce type ____ hypersensitivity reaction

A

1

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13
Q

Extrinsic triggers in asthma

⚫ They bind to _____ on the ____ cell in a previously sensitized individual

⚫______ cell _______ & releases inflammatory mediators & chemotactic
factors which cause

⚫ Increased ________ and ______

⚫ Broncho__________
⚫_______ hypersecretion

A

IgE; mast

Mast; degranulates

vascular permeability & oedema

constriction; Mucus

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14
Q

Asthma: Extrinsic triggers

These same allergens may cause little or no reaction in nonallergic people

T/F

A

T

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15
Q

10 Mediators

⚫ The _____ cells release ______ as a 10 mediator
⚫ ______ cells- secrete too much ______.

A

Mast; histamine

Goblet; mucus

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16
Q

10 Mediators

Histamine causes
⚫ increased ________ leading to ______ and ________

⚫ Broncho_____ - causing more _______

A

venular permeability

swelling and redness

spasms; narrowing

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17
Q

10 Mediators

Goblet cells- secrete too much mucus.

⚫ Mucus clogs the ________, resulting in _________ and ______

A

bronchioles

wheezing

Coughing

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18
Q

___________Triggers

These are refered to as intrinsic triggers.

A

Non-environmental

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19
Q

Non-environmental Triggers / intrinsic triggers. They include:

⚫_________ triggers
⚫ Physical exercise
⚫ Cold weather
⚫ Sometimes __________bring on attacks.
⚫ Chemicals found in _______ or _______
⚫ Intense ________

A

Physiological

substances in food or drink

food or medicine

emotion

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20
Q

Pathophysiology of asthma

⚫ Extrinsic triggers stimulate ______ nerves in ______ to discharge

⚫ These in turn stimulate the _____ nerve ( _______ nerve) to discharge

⚫ Cause release of inflammatory mediators & chemo tactic factors which
cause

⚫ Macrophage, eosinophil, basophil infiltration &________ activation
⚫ Broncho _______
⚫_______ hypersecretion

A

afferent

Tracheobronchial tree

vagal; efferent; mast cell

constriction

Mucus

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21
Q

Clinico-Pathologic correlation in asthma

⚫Bronchi and bronchioles become _______ resulting in _______ of airways

⚫_____eases work done to move air in and out of the lungs

⚫Mild chest _______ and _______ develop

⚫__________ starts and increases in pitch; dyspnoea sets in

A

oedematous; narrowing

Incr; pressure; dry cough

Wheezing

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22
Q

Clinico-Pathologic correlation in asthma

Cough _______ and becomes ______ of thick, stringy mucus.

Inflammation prevents ______________

Cells start to burn oxygen _________, increasing the body’s demand for oxygen.

________ develops. If untreated _____ occurs

A

intensifies; productive

insufficient oxygen-rich air from getting to the alveoli; at a higher rate

Hypoxaemia; cyanosis

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23
Q

Airway narrowing in asthma

⚫ Release of _______
⚫ Smooth muscle ______
⚫ Increased vascular _________/_______
⚫ Excessive mucous __________

A

chemical mediators

contraction

permeability/oedema

secretion

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24
Q

MORPHOLOGY of Asthma
Gross:
⚫ ________ lungs

⚫ (Thin or Thick?) , tenacious, adherent mucus in airway

A

Distended; thick

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25
MORPHOLOGY of asthma Microscopy: ⚫_________ crystals ⚫_________ spirals ⚫______ bodies ⚫ Hyperplastic bronchial _____________ & increase number of ______ cells ⚫_________ submucosa
Charcot-Leyden Curschmann Creola; mucosa and glands ; goblet Oedematous
26
MORPHOLOGY of ASTHMA Microscopy: ⚫ Charcot-Leyden crystals in _________,_______ , strips of _________ ⚫ Curschmann spirals- _________ of airway ⚫ Creola bodies- compact clusters of _______ in sputum
mucus plugs, eosinophils epithelium; mucus cast epithelial cells
27
Genetics of asthma ⚫ Research suggests that genetic factors increase the risk of developing the disorder. T/F
T
28
Genetics of asthma Children with a family history of asthma are more likely to develop asthma than other children. T/F
T
29
Emphysema Is the ________ of airspaces (proximal or distal?) to __________ With __________ Without _______
Enlargement Distal; terminal bronchioles destruction of their walls fibrosis
30
Emphysema occurs With fibrosis T/F
F Without fibrosis
31
Emphysema A progressive respiratory disease characterised by coughing, shortness of breath & wheezing T/F
T
32
Classification of Emphysema Based on morphology ⚫___________ ⚫_________ ⚫___________ ⚫__________ ⚫ Mixed (Unclassified)
Panacinar Centriacinar Paraseptal Irregular
33
Pathogenesis of emphysema ⚫ Cigerette smoking:__________ or _____ imbalance hypothesis ⚫_________ deficiency (genetic) ⚫ Air pollutants ⚫ Infection
Protease-Antiprotease or Proteolysis-Antiproteolysis Alpha-1-antitrypsin
34
Smokers’ Emphysema ⚫ Increased number of _______ ⚫ Contain __________ & other proteases ⚫ Reduced __________ activity due to _____________________ enzyme ⚫ Increased activity of _______ & other enzymes
neutrophils serine elastase; α1-antitrypsin oxidation of methionine trypsin
35
Smokers’ Emphysema Unopposed and increased ______ activity destruction of _______ leads to loss of ___________ permanent ________ of alveoli (Small or large?) volume of residual air trapped in the lungs
elastolytic; alveolar walls; elastic recoil dilatation Large
36
α1-antitrypsin Produced in the _______ Is a Circulating ________ Major _______ of _______
liver; glycoprotein Inhibitor ; proteases
37
α1-antitrypsin ⚫ In the lungs: inhibits _________ ⚫ In the blood:_____% of all antiproteinase activity
neutrophil elastase 90
38
Molecular genetics of α1-antitrypsin A1AT def caused by an abnormality of the ______ gene on chromosome ____ (14q32.1)
SERPINA1 14
39
Molecular genetics of α1-antitrypsin Amount produced determined by genotype ⚫ Alleles: ⚫_____ , non-mutated ⚫______, glutamate to lysine mutation at position 342 ⚫______ glutamate to valine mutation at position 264
PiM PiZ PiS
40
SERPINA1
(Serine Peptidase Inhibitor, Clade A, member 1)
41
Features of PANACINAR The acinus is ____________ Destruction of _________ Associated with ___________ Tends to occur in ______ lobes
uniformly affected alveolar septa α1-AT deficiency lower
42
Most frequently encountered pattern of emphysema is ???
Centrilobular
43
Centrilobular emphysema Destruction of cluster of ____________ in the ______ part of the pulmonary lobule Most severe in ______ zones Damaged RBs separated from each other by _____________
terminal respiratory bronchioles (RB) central; upper normal alveolar ducts
44
Centrilobular emphysema Proximal bronchioles are ______ and ———-
inflamed and narrow
45
___________ emphysema is Associated with smoking
Centrilobular
46
Localised Emphysema (________) destruction of ______ Usually found at the _____ of the _____ lobe but may be anywhere Usually ____pleural
paraseptal alveoli; apex; upper sub
47
Focal Dust Emphysema ⚫ Disease of __________ ⚫ Similar to ______- but enlarged spaces are (smaller or larger?) and (more or less?) regular
coal miners centrilobular Smaller More
48
_________ emphysema forms bullae which may rupture
Localized /paraseptal
49
Clinical features of emphysema Patients usually about _____yrs or older Symptoms usually start when _____ of lung tissue is damaged Dyspnoea initially ______, progressively worsens
60; ⅓ mild
50
Clinical features of emphysema Cough is (productive or non-productive?) , (minimal or maximal?) .
non-productive Minimal
51
Cough in emphysema is productive when it is associated with _________
chronic bronchitis
52
Clinical features of emphysema ⚫__________ may be the chief complaint ⚫ _______pnoea (↑RR), (shortened or prolonged?) expiratory phase, _____eased minute volume
Cough or wheezing Tachy; prolonged; incr
53
Clinical features of emphysema ⚫ Use of _______ muscles of respiration ⚫______ chest ⚫ _________ lungs on CXR
accessory; Barrel Overinflated
54
Emphysema is easily confused with asthma T/F
T
55
Emphysema patients are also called?? Chronic bronchitis patients are also called ???
Pink puffers Blue bloaters
56
Chronic Bronchitis Chronic (productive or non-productive ?) cough without a discernible cause for at least __________ of the year over a period of ________.
Productive 3 months 2yrs
57
Chronic Bronchitis _____% of cases occur in smokers Exposure to ETS & air pollution increases risk of CB in non-smokers
90
58
Morphology ⚫ Gross ⚫ Thick, hyperaemic & oedematous bronchial wall ⚫ Suppurative exudate in lumina of bronchi and bronchioles ⚫ + or – mucus plugs
59
Gross Morphology of CB ⚫ (Thin or Thick?) , hyperaemic & ________ bronchial wall ⚫_________ exudate in lumina of _______ and ______
Thick oedematous Suppurative bronchi and bronchioles
60
CB patients must have mucus plugs T/F
F ⚫ may or may not have mucus plugs
61
Morphology of CB ⚫ Hypertrophy of ________ & hyperplasia of ________ resulting in excess mucous in the airway ⚫ Thickened ______, _____ enlargement & oedema results in a narrower lumen ⚫___________ hyperplasia ⚫_____________ (in smokers)
submucous glands; goblet cells bronchial wall; glandular Smooth muscle Squamous metaplasia
62
Morphology of CB Ratio of wall thickness (distance between ____________ and ____________ ) to _________ = _____ index
epithelial basement membrane & the cartilage thickness of gland layer Reid
63
In CB, Reid index is > ____ Normal is ______
0.5 0.4
64
CB often accompanied by emphysema T/F
T
65
CB often accompanied by _______
emphysema
66
Clinical Features of CB ⚫________ cough for years ⚫ ________ on exertion ⚫________ (Blue bloaters) ⚫ Cor pulmonale ⚫ _______________ predisposes to infections
Productive Dyspnoea Cyanosis Retained mucous secretions
67
Cor pulmonale is frequent in emphysema T/F
F
68
Cor pulmonale is frequent in CB T/F
T
69
Bronchial infections is frequent in emphysema T/F
F
70
Bronchial infections is frequent in CB T/F
T
71
Age at diagnosis of CB Age at diagnosis of emphysema
50 60
72
Dyspnea is a late manifestation in CB T/F
T
73
Dyspnea is a late manifestation in emphysema T/F
F Early
74
Elastic recoil in CB is?? Elastic recoil in emphysema is ??
Normal Low
75
Bronchiectasis is Chronic inflammatory disorder of the lung caused by _________ With destruction of _______ and _______, Resulting in __________ of bronchi and bronchioles
necrotizing inflammation muscle and elastic permanent dilatation
76
Bronchiectasis This is clinically characterized by ⚫______ ⚫________ ⚫ Copious production of ______,_______ sputum
Fever Cough foul smelling, purulent
77
Asthma CB Emphysema Bronchectasis
Productive cough Productive cough Non- Productive cough Foul smelling sputum
78
Classification of bronchiectasis ⚫_________ bronchiectasis ⚫_________ bronchiectasis
Obstructive Non-obstructive
79
Obstructive bronchiectasis – may follow obstruction from ______ and is localised to _____________
any cause the region distal to the obstruction
80
Non-obstructive bronchiectasis – usually follows _________
infection
81
Predisposing factors of bronchiectasis Congenital ⚫ Immunodeficiency States ⚫________ ⚫_______ syndrome ⚫__________ sequestration of the lungs ⚫ Primary cilia dyskinesia Acquired ⚫___________ ⚫ Bronchial ______
Cystic fibrosis; Kartagener’s Intralobar Post-infectious; obstruction
82
Aetiopathogenesis of bronchiectasis Obstruction ⚫ Foreign bodies ⚫ _____ ⚫ Compression by enlarged ______ ⚫ Post-inflammatory _______ Infection ⚫________________ e.g _______ or ______
Tumors; hilar lymph nodes; scarring Necrotising pneumonia post TB or staph
83
Morphology of bronchiectasis ⚫ Diffuse or segmental involvement of the (proximal or distal?) bronchi and bronchioles ⚫ Bilateral involvement of _____ lobes ⚫ Thickened fibrotic pleura with adhesions to the chest wall
Distal lower
84
Morphology of bronchiectasis Dilated bronchi &bronchioles appear ⚫___________ ⚫________ ⚫________ ⚫__________
Cylindrical Saccular Varicose Fusiform
85
Morphology of bronchiectasis Dilated bronchi &bronchioles appear ⚫ Cylindrical –____ like dilatation ⚫ Saccular –_________-like distension ⚫ Varicose –________ enlargements ⚫ Fusiform –_____ shaped dilatation
tube rounded sac irregular spindle
86
Morphology of bronchiectasis Cut lung surface reveals ⚫ _______ appearance with fibrotic intervening stroma ⚫ (thin or thick?) (constricted or dilated?) bronchial walls with ________ filled lumina. ⚫ Bronchioles can be easily followed by dissection to the pleural surfaces
Honey comb Thick; dilated ; mucus/pus
87
Morphology of bronchiectasis: Microscopy reveals Bronchi & bronchioles ⚫ ___________________ epithelium ⚫ Acute & chronic inflammatory infiltrates ⚫ Tissue ________ and ______ Lung parenchyma ⚫ Fibrosis of _________ ⚫__________ pneumonia in surrounding lung tissue ⚫ Suppuration
Normal, ulcerated or metaplastic destruction and fibrosis intervening stroma Interstitial
88
In obstructive lung diseases Volume of air that can be forcefully expired is _____eased (), especially during the first second of expiration (_____);
decr; FVC FEV1
89
In obstructive lung diseases FEV1:FVC is _____eased
Decr
90
In obstructive lung diseases , Total lung capacity (TLC) is usually ______eased due to ________
incr air trapping
91
Emphysema is reversible T/F
F Emphysema is irreversible
92
Regions Centrilobular-______ lobes. Especially the ____ segments Panlobular-_______ lobes ; especially at the ———- Paraseptal-_______ lobes
upper; apical lower; bases upper
93
Irregular (______ or ______) emphysema Acinus is irregularly involved and may be asymptomatic.
scar or cicatricial
94
Irregular (scar or cicatricial) emphysema Association: Occurs near the _____ and is commonly found around ______________ like tuberculous scars.
scar old healed inflammatory process
95
In emphysema Usually, the __________ of the lungs are more severely involved ______ are found in irregular and distal acinar emphysema
upper two-thirds Bullae
96
Emphysema can easily be seen on the cut surface of formalin-inflated fixed lung. T/F
T
97
Weight gain is seen in (CB or emphysema?) Weight loss is seen in (CB or emphysema?)
CB Emphysema
98
Pursed lip breathing is a clinical feature in patients with __________
Emphysema
99
Acute asthmatic attack usually lasts up to _______
several hours.
100
_________ is the most severe form of asthma in which the severe paroxysm persists for days and even weeks.
Status asthmaticus
101
In Status asthmaticus, The bronchoconstriction responds to the drugs. It may cause severe airflow obstruction May lead to severe cyanosis and even death. T/F
F T T
102
Genetic Causes of bronchiectasis Kartagener or _______ syndrome (primary ______________) ________ syndrome
immotile cilia ; ciliary dyskinesia Young’s
103
Cystic Fibrosis Major respiratory diseases in cystic fibrosis (CF) are _________ and _________
sinusitis and bronchiectasis.