COPD Flashcards by Iseoluwa Ojo

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

Chronic

trachea to smallest airways

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COAD or COPD

⚫_________
⚫______________
⚫__________
⚫______________

Asthma

Chronic bronchitis

Emphysema

Bronchiectasis

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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

narrowing

inflow and outflow of air

a variety of

coughing, wheezing, breathlessness and chest tightness

reversed partly or completely

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Classification of asthma Based on several factors including

A. Aetiology:

_________: ________ induced, Type 1 hypersensitivity

__________: induced by several ___________

Extrinsic; Allergen

Intrinsic; nonimmune factors

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Classification of asthma Based on several factors including

Severity: _______,________, or ______

Frequency:_________ or _________

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

mild, moderate or severe

intermittent or persistent

steroid dependent or
resistant

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Pollen concentrations are highest in the _______ or _________

Afternoon or midday

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Pathophysiology

⚫ Asthma attacks are caused by airway
_________________

hyperresponsiveness

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

bronchi and bronchioles;

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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.

Small

Light ; air

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Pathophysiology of asthma

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

An inflammatory response

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Extrinsic/Environmental triggers
⚫ These are called __________.

allergens

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ASTHMA: Extrinsic triggers

Allergens produce type ____ hypersensitivity reaction

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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
⚫

IgE; mast

Mast; degranulates

vascular permeability & oedema

constriction; Mucus

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Asthma: Extrinsic triggers

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

T/F

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10 Mediators

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

Mast; histamine

Goblet; mucus

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10 Mediators

Histamine causes
⚫ increased ________ leading to ______ and ________

⚫ Broncho_____ - causing more _______

venular permeability

swelling and redness

spasms; narrowing

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10 Mediators

Goblet cells- secrete too much mucus.

⚫ Mucus clogs the ________, resulting in _________ and ______

bronchioles

wheezing

Coughing

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___________Triggers

These are refered to as intrinsic triggers.

Non-environmental

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Non-environmental Triggers / intrinsic triggers. They include:

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

Physiological

substances in food or drink

food or medicine

emotion

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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

afferent

Tracheobronchial tree

vagal; efferent; mast cell

constriction

Mucus

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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

oedematous; narrowing

Incr; pressure; dry cough

Wheezing

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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

intensifies; productive

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

Hypoxaemia; cyanosis

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Airway narrowing in asthma

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

chemical mediators

contraction

permeability/oedema

secretion

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MORPHOLOGY of Asthma
Gross:
⚫ ________ lungs

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

Distended; thick

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MORPHOLOGY of asthma Microscopy: ⚫_________ crystals ⚫_________ spirals ⚫______ bodies ⚫ Hyperplastic bronchial _____________ & increase number of ______ cells ⚫_________ submucosa

Charcot-Leyden Curschmann Creola; mucosa and glands ; goblet Oedematous

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

Genetics of asthma ⚫ Research suggests that genetic factors increase the risk of developing the disorder. T/F

Genetics of asthma Children with a family history of asthma are more likely to develop asthma than other children. T/F

Emphysema Is the ________ of airspaces (proximal or distal?) to __________ With __________ Without _______

Enlargement Distal; terminal bronchioles destruction of their walls fibrosis

Emphysema occurs With fibrosis T/F

F Without fibrosis

Emphysema A progressive respiratory disease characterised by coughing, shortness of breath & wheezing T/F

Classification of Emphysema Based on morphology ⚫___________ ⚫_________ ⚫___________ ⚫__________ ⚫ Mixed (Unclassified)

Panacinar Centriacinar Paraseptal Irregular

Pathogenesis of emphysema ⚫ Cigerette smoking:__________ or _____ imbalance hypothesis ⚫_________ deficiency (genetic) ⚫ Air pollutants ⚫ Infection

Protease-Antiprotease or Proteolysis-Antiproteolysis Alpha-1-antitrypsin

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

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

α1-antitrypsin Produced in the _______ Is a Circulating ________ Major _______ of _______

liver; glycoprotein Inhibitor ; proteases

α1-antitrypsin ⚫ In the lungs: inhibits _________ ⚫ In the blood:_____% of all antiproteinase activity

neutrophil elastase 90

Molecular genetics of α1-antitrypsin A1AT def caused by an abnormality of the ______ gene on chromosome ____ (14q32.1)

SERPINA1 14

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

SERPINA1

(Serine Peptidase Inhibitor, Clade A, member 1)

Features of PANACINAR The acinus is ____________ Destruction of _________ Associated with ___________ Tends to occur in ______ lobes

uniformly affected alveolar septa α1-AT deficiency lower

Most frequently encountered pattern of emphysema is ???

Centrilobular

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

Centrilobular emphysema Proximal bronchioles are ______ and ———-

inflamed and narrow

___________ emphysema is Associated with smoking

Centrilobular

Localised Emphysema (________) destruction of ______ Usually found at the _____ of the _____ lobe but may be anywhere Usually ____pleural

paraseptal alveoli; apex; upper sub

Focal Dust Emphysema ⚫ Disease of __________ ⚫ Similar to ______- but enlarged spaces are (smaller or larger?) and (more or less?) regular

coal miners centrilobular Smaller More

_________ emphysema forms bullae which may rupture

Localized /paraseptal

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

Clinical features of emphysema Cough is (productive or non-productive?) , (minimal or maximal?) .

non-productive Minimal

Cough in emphysema is productive when it is associated with _________

chronic bronchitis

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

Clinical features of emphysema ⚫ Use of _______ muscles of respiration ⚫______ chest ⚫ _________ lungs on CXR

accessory; Barrel Overinflated

Emphysema is easily confused with asthma T/F

Emphysema patients are also called?? Chronic bronchitis patients are also called ???

Pink puffers Blue bloaters

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

Chronic Bronchitis _____% of cases occur in smokers Exposure to ETS & air pollution increases risk of CB in non-smokers

Morphology ⚫ Gross ⚫ Thick, hyperaemic & oedematous bronchial wall ⚫ Suppurative exudate in lumina of bronchi and bronchioles ⚫ + or – mucus plugs

Gross Morphology of CB ⚫ (Thin or Thick?) , hyperaemic & ________ bronchial wall ⚫_________ exudate in lumina of _______ and ______

Thick oedematous Suppurative bronchi and bronchioles

CB patients must have mucus plugs T/F

F ⚫ may or may not have mucus plugs

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

Morphology of CB Ratio of wall thickness (distance between ____________ and ____________ ) to _________ = _____ index

epithelial basement membrane & the cartilage thickness of gland layer Reid

In CB, Reid index is > ____ Normal is ______

0.5 0.4

CB often accompanied by emphysema T/F

CB often accompanied by _______

emphysema

Clinical Features of CB ⚫________ cough for years ⚫ ________ on exertion ⚫________ (Blue bloaters) ⚫ Cor pulmonale ⚫ _______________ predisposes to infections

Productive Dyspnoea Cyanosis Retained mucous secretions

Cor pulmonale is frequent in emphysema T/F

Cor pulmonale is frequent in CB T/F

Bronchial infections is frequent in emphysema T/F

Bronchial infections is frequent in CB T/F

Age at diagnosis of CB Age at diagnosis of emphysema

50 60

Dyspnea is a late manifestation in CB T/F

Dyspnea is a late manifestation in emphysema T/F

F Early

Elastic recoil in CB is?? Elastic recoil in emphysema is ??

Normal Low

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

Bronchiectasis This is clinically characterized by ⚫______ ⚫________ ⚫ Copious production of ______,_______ sputum

Fever Cough foul smelling, purulent

Asthma CB Emphysema Bronchectasis

Productive cough Productive cough Non- Productive cough Foul smelling sputum

Classification of bronchiectasis ⚫_________ bronchiectasis ⚫_________ bronchiectasis

Obstructive Non-obstructive

Obstructive bronchiectasis – may follow obstruction from ______ and is localised to _____________

any cause the region distal to the obstruction

Non-obstructive bronchiectasis – usually follows _________

infection

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

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

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

Morphology of bronchiectasis Dilated bronchi &bronchioles appear ⚫___________ ⚫________ ⚫________ ⚫__________

Cylindrical Saccular Varicose Fusiform

Morphology of bronchiectasis Dilated bronchi &bronchioles appear ⚫ Cylindrical –____ like dilatation ⚫ Saccular –_________-like distension ⚫ Varicose –________ enlargements ⚫ Fusiform –_____ shaped dilatation

tube rounded sac irregular spindle

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

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

In obstructive lung diseases Volume of air that can be forcefully expired is _____eased (), especially during the first second of expiration (_____);

decr; FVC FEV1

In obstructive lung diseases FEV1:FVC is _____eased

Decr

In obstructive lung diseases , Total lung capacity (TLC) is usually ______eased due to ________

incr air trapping

Emphysema is reversible T/F

F Emphysema is irreversible

Regions Centrilobular-______ lobes. Especially the ____ segments Panlobular-_______ lobes ; especially at the ———- Paraseptal-_______ lobes

upper; apical lower; bases upper

Irregular (______ or ______) emphysema Acinus is irregularly involved and may be asymptomatic.

scar or cicatricial

Irregular (scar or cicatricial) emphysema Association: Occurs near the _____ and is commonly found around ______________ like tuberculous scars.

scar old healed inflammatory process

In emphysema Usually, the __________ of the lungs are more severely involved ______ are found in irregular and distal acinar emphysema

upper two-thirds Bullae

Emphysema can easily be seen on the cut surface of formalin-inflated fixed lung. T/F

Weight gain is seen in (CB or emphysema?) Weight loss is seen in (CB or emphysema?)

CB Emphysema

Pursed lip breathing is a clinical feature in patients with __________

Emphysema

Acute asthmatic attack usually lasts up to _______

several hours.

_________ is the most severe form of asthma in which the severe paroxysm persists for days and even weeks.

Status asthmaticus

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

Genetic Causes of bronchiectasis Kartagener or _______ syndrome (primary ______________) ________ syndrome

immotile cilia ; ciliary dyskinesia Young’s

Cystic Fibrosis Major respiratory diseases in cystic fibrosis (CF) are _________ and _________

sinusitis and bronchiectasis.

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COPD Flashcards

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