COPD Flashcards
What four pathologies encompass COPD?
Chronic bronchitis
Emphysema
Asthma
Bronchiectasis
What is the primary cause of chronic bronchitis and emphysema?
Smoking
How is COPD diagnosed?
Spirometry
What spirometric reading is present in a patient with COPD?
Decreased forced expiratory volume (FEV1)
What population is chronic bronchitis most frequent in?
Middle-aged men
What is the earliest feature of chronic bronchitis?
Hypersecretion of mucus and hypertrophy of the submucosal glands in the trachea and bronchi
As chronic bronchitis persists what occurs?
Goblet cells increase in small airways (bronchi and bronchioles) leading to excessive mucus production
Patient has been complaining of a cough for three years now that has been getting progressively worse as of late. The patient is getting more and more tired working out. He has tried multiple times to quit smoking in the past 15 years but has failed continuously. The patient presents with edema in the lower extremities and is a tint of blue around the face. What is this describing?
Chronic bronchitis
45 year old male smoker in the construction industry presents to your office today with a chronic cough lasting for “years” and is getting worse. You observe the patient coughing into a napkin and the cough is wet and mucousy. Spirometry shows a decreased FEV to 74% of normal values. Biopsy of tissue in the bronchi shows hypertrophy of glands and smooth muscle cells. The patient has a history of smoking since his early 20s. What is the likely diagnosis?
Chronic bronchitis
What is the formula for calculating vital capacity?
TV+ IRV + ERV
What is the formula for calculating total lung capacity?
TV + IRV + ERV + RV
What is emphysema?
A condition of the lung characterized by abnormal permanent enlargement of the airspaces distal to the terminal bronchiole in the alveoli
What mechanism is a plausible hypothesis for the destruction of alveolar walls in a patient with emphysema?
Protease-antiprotease mechanism
(Alpha1-anti-trypsin deficiency)
What enzyme is made by the lungs to protect itself from inflammatory conditions?
Alpha 1 - Antitrypsin
What enzyme is deficient in patients with emphysema?
Alpha 1 - Antitrypsin
A patient with emphysema under the age of 40 likely has a(n)____ alpha 1 - AT deficiency?
Congenital
(Over 40 likely acquired due to smoking)
Centrilobular emphysema is caused by ____?
Smoking
Panacinar emphysema is due to a ____ defect?
Congenital
What is usually the first symptom of emphysema?
Dyspnea
A patient with emphysema will have a heightened respiratory rate (TRUE/FALSE)?
TRUE
A barrel-chested patient may have what chronic lung pathology?
Emphysema
50 year old male patient with a history of smoking presents with dyspnea. His respiratory rate is heightened and his FEV is decreased to 80% of normal values. The patient has no peripheral edema. Radiograph shows lungs that are enlarged with a depressed diaphragm. The patients face is a tint of pink and they have a prominent barrel chest. What is the diagnosis?
Centrilobular emphysema
A 25 year old male patient presents to your office with dyspnea and a pinkish face. The patient has no history of smoking. The patient has no edema, but reports exertional dyspnea during exercise that has onset in the last few months. What type of lung pathology does this patient have?
Panacinar emphysema
What is bronchiectasis?
Permanent dilation of bronchi and bronchioles caused by destruction of the muscle and elastic tissue
What is the etiology of bronchiectasis?
Obstruction and infection (choking on vomit)
What lung pathology can be seen secondary to cystic fibrosis?
Bronchiectasis
Cystic fibrosis involves a defect in what system?
Chloride transport
Cystic fibrosis is commonly seen in (Children/Adults)?
Children
Patient presents with a chronic cough occasionally tinted with red. He has been battling pneumonia for a few months now. At this moment, he is producing 300 milliliter of mucopurulent sputum a day that is foul smelling. What is this patient suffering from besides pneumonia?
Bronchiectasis
What is asthma?
A pulmonary disease characterized by reversible airway obstruction, airway inflammation, and increased airway responsiveness to a variety of stimuli
A patient with a high frequency wheeze upon expiration likely has what general diagnosis?
Asthma
What is extrinsic asthma?
Asthma initiated by a type I hypersensitivity reaction induced by exposure to an extrinsic antigen
When does extrinsic asthma normally begin?
Childhood
What triggers extrinsic asthma?
Dust, pollen, dander, foods
A 9 year old girl begins having severely labored breathing, wheezing upon expiration and bronchospasms. It is high pollen season and a CBC shows high levels of IgE and eosinophils. What is the diagnosis?
Extrinsic asthma
What antibody will be heightened in a patient having an extrinsic asthma attack?
IgE
What cells release histamine in a type one hypersensitivity reaction such as extrinsic asthma?
Mast cells and basophils
What is intrinsic asthma?
Asthma initiated by diverse non immune mechanisms
What can trigger intrinsic asthma?
Ingestion of aspirin, viral pulmonary infections, cold weather, stress, and exercise
A 40 year old male who works at a milling plant inhales the coolant used on the machines. By the end of the day he is found wheezing upon expiration and coughing uncontrollably. What is the diagnosis?
Intrinsic asthma
What pathway of arachidonic acid metabolism is inhibited by NSAIDs such as aspirin?
COX
What pathway of arachidonic acid metabolism triggers allergic reactions causing vasodilation and bronchoconstriction?
LOX
What is the most common lethal autosomal recessive disorder in the Caucasian population?
Cystic fibrosis
What causes cystic fibrosis?
CFTR gene mutation leading to defective chloride channels
Defective chloride channels are indicative of what pathology?
Cystic fibrosis
Acute pancreatitis is commonly seen in what lung condition?
Cystic fibrosis
What are the clinical features of a child with cystic fibrosis?
Salty sweat and viscous secretions
Productive cough with large amounts of purulent sputum
Repeated bouts of bronchitis and bronchopneumonia
What can cystic fibrosis cause in the heart later on?
Cor Pulmonale and right heart failure
What is an expiratory wheeze indicative of?
Asthma
What is a rhonchi?
Low-pitched wheeze on inspiration and expiration
