COPD

Question 1

COPD defined

Answer 1

Chronic airway obstruction + Increased flow resistance

Question 2

4 diseases of COPD

Answer 2

1. Chronic bronchitis
2. Emphysema
3. Bronchial asthma
4. Bronchiectasis

Question 3

Bronchitis definition

Answer 3

Chronic cough + sputum

> 3 mo, >2 years consecutively

Question 4

Bronchitis etiology

Answer 4

1. Smoking (>90%)
   Cessation improves, related to pack/year
2. Other: air pollution, toxic fumes, pneumonias

Question 5

Bronchitis pathology

Answer 5

1. Increased goblet cells & hypertrophy of mucus glands
2. Thickening of walls + lumen filled with mucus
3. Mucosa infiltrated with lymphocytes, macrophages & plasma cells

Question 6

Bronchitis over time patho

Answer 6

Ulcer/Metaplasia of epithelium

Pulmonary vasculature compressed by peribronchial fibrosis–Pulm HTN–Cor pulmonale

Question 7

Bronchitis symptoms

Answer 7

1. Prolonged coughing + thick tenacious/purulent sputum
2. Dyspnea
3. Hypoxia
4. Cor pulmonale leads to peripheral venous stagnation
   BLUE BLOATER

Question 8

Bronchitis CXR findings

Answer 8

1. Increased bronchovascular markings

2. Enlarged heart

Question 9

Emphysema Definition

Answer 9

Enlarged airpace distal to terminal bronchioles

& Alveolar wall destruction

Question 10

Emphysema etiology

Answer 10

1. Smoking

2. Non-smokers rare, except Alpha-1-Antitrypsin deficiency

Question 11

Emphysema pathology

Answer 11

1. Smoke irritant increase inflammatory cells in alveoli
2. WBC release proteolytic enzymes (elastases)
3. Alveolar wall damage, decreased elastin fibers
4. Alveolar space enlarges

Question 12

Emphysema gross pathology

Answer 12

1. Enlarged, billowy, white lungs (don’t collapse)
2. Touch at midline
3. Blebs: subpleural, pneumothorax if rupture into pleural cavity
4. Bullae: parenchymal, >1 cm

Question 13

Emphysema Symptoms

Answer 13

1. NO cough/sputum
2. Tachypnea (compensate for decreased resp surface)
3. Chest over-expanded= “barrel shaped”
4. Leaning forward to use auxiliary muscles
5. Hyperventilate–
   PINK PUFFERS

Question 14

Emphysema CXR

Answer 14

1. Clear lung fields
2. Barrel-shaped/over inflation
   A lot of space between ribs, low diaphragm, increased
   AP diameter

Question 15

Asthma definition

Answer 15

Stimuli increases responsiveness of bronchial tree

Question 16

Asthma epidemiology/age

Answer 16

1. 10% of children, 5% of adults
2. M 2X F
3. 50% in childhood, 30% after 40, 20% old age

Question 17

Asthma forms

Answer 17

1. Extrinsic: Exogenous allergen, children with hay fever
2. Intrinsic: non-immune mechanisms, due to persistent inflammation of bronchial mucosa
   Ex: Heat/cold, stress, exercise, pollution, infection

Question 18

Asthma pathophysiology

Answer 18

1. Allergen binds to IgE on Mast cell
2. Mast cell degranulates, releases histamine
3. Macrophages, lymphocytes, basophils, eosinophils, plasma cell release mediators:
   Histamine, bradykinin, PG
4. Effects: Vasodilate, Bronchoconstrict, Mucus secretion

Question 19

Asthma histologic findings

Answer 19

1. Bronchi: chronic inflammation
2. Gland hyperplasia & increased mucus
3. Eosinophil/Inflammatory cell infiltrate in mucosa
4. Curschmann spirals: whorls of epithelial cells
5. Smooth muscle cell increase in size & number (due to frequent spasm)

Question 20

Asthma gross features

Answer 20

1. Lungs: large, pink, touch in midline

2. Mucus plugs–turn into casts

Question 21

Bronchiectasis definition

Answer 21

Permanent bronchi dilation

Question 22

Bronchiectasis etiology

Answer 22

MC complication of chronic bronchitis

Also caused by lobar pneumonia

Question 23

Bronchiectasis pathophysiology

Answer 23

1. Dilated bronchi/bronchioles
2. Fill with mucopurulent material
3. Material stagnates, can’t clear with cough–Halitosis
4. Infection results
5. Adhesions may occur between lobes

Question 24

Bronchiectasis infection characteristics

Answer 24

1. Spreads to alveoli
2. Recurren pneumonia
3. Hematogenic spread to other organs

Question 25

Bronchiectasis CXR

Answer 25

Increased vascular markings (due to dilation)