COPD

Question 1

what happens in COPD with chronic inflammation

Answer 1

small airways narrowing and lung parechyma destruction

Question 2

abnormal permanent distal (respiratory bronchioles) airspace enlargement

Answer 2

emphysema

Question 3

genetic predisposition of COPD:

1. increased/decreased macrophage elastase
2. increased/decreased alv MMP* (matrix metalloproteinase, collagenase)
3. increased/decreased MMP inhibitor (TIMP)
4. increased/decreased predisposition to oxidative injury
5. increased/decreased anti-oxidant vitamins (C,E)

Answer 3

Increased macrophage elastase

Increased alv MMP* (matrix metalloproteinase, collagenase)

Decreased MMP inhibitor (TIMP)

Increased predisposition to oxidative injury

Decrease anti-oxidant vitamins (C,E)

Question 4

emphysema due to deficiency

Answer 4

alpha-1-antitrypsin- palnolubar(lower lobe)

Question 5

how do we treat panlolbular emphysema

Answer 5

replacement therapy

Question 6

panlobular found in

Answer 6

lower lobe

Question 7

mechanism of coPD dx,

Answer 7

1. chronic inflammation
2. imbalance btw elastase and anti-elastase
3. oxidant stress

Question 8

why is there airway collapse in expiration?

Answer 8

loss of radial traction

Question 9

loss of elastic recoil results in

Answer 9

decreased alveolar driving pressure

Question 10

hyperinflation on respiratory muscles

Answer 10

altered neuromechanical coupling and decreased neuromuscular capacity

Question 11

do we see V/Q mismatch in COPD

Answer 11

yasssssssssss

Question 12

treatment of COPD?

Answer 12

• pulmonary rehab
• improving nutrition to increase strength and immunocompetence
• SABD

Question 13

Acute exarcebation can lead to

Answer 13

increase in mortality and decrease in lung function

Question 14

what happens when elastic fibers are destroyed?

Answer 14

resistance increases due to the intra-dependence loss

Question 15

irreversible airspace enlargement without obvious fibrosis

Answer 15

emphysema

Question 16

subpleural involvement with formation of blebs and bullae

Answer 16

distal acinar emphysema

Question 17

irregular emphysema

Answer 17

emphysema adjacent to scars

Question 18

mucous gland hyperplasia

Answer 18

chronic bronchitis

Question 19

lymphocytes are a marker for

Answer 19

chronic inflammation

Question 20

complications of COPD (3)

Answer 20

• PH
• cor pulmonale
• pneumothorax

Question 21

Chronic inflammatory disorder of airways characterized by recurrent episodes of bronchoconstriction that are at least partially reversible

Answer 21

asthma

Question 22

asthma histologic changes

Answer 22

goblet cell hyperplasia, thickened basement membrane and submucosal eosinophil-rich inflammation

Question 23

permanent dilatation of bronchi resulting from or associated with chronic necrotizing infections

Answer 23

bronchiectasis

Question 24

_____ and _____ are major factors of bronchiectasis

Answer 24

obstruction and infection

Question 25

how is the cough in bronchiectasis

Answer 25

persistent, foul-smelling and may be bloody

Question 26

acute inflammation in bronchiectasis is shown with the presence of

Answer 26

neutrophils

Question 27

distal acinar emphysema has a increased risk fro

Answer 27

pneumothorax

Question 28

strongest risk factor for asthma

Answer 28

atopy--> increased levels of circulating IgE

Question 29

prevalence of asthma has what can account for this?

Answer 29

increased - hygiene hypothesis

Question 30

3 hallmarks of asthma

Answer 30

1. airway inflammation 2. airway hyperresponsiveness 3. airflow obstruction

Question 31

astham: early vs late response

Answer 31

early: bronchospams late: bronchospasm, edema and inflammation

Question 32

will asthma show increased resistance

Answer 32

yes

Question 33

history suggestive of asthma

Answer 33

- nocturnal cough and dyspnes | - cough or wheeze post-exercise

Question 34

wheezes= asthma

Answer 34

false, it can but there are a lot of other dx. that will also have wheezing

Question 35

what do we need to be aware of giving supplemental O2 to COPD patients

Answer 35

respiratory rate and minute ventilation to drop due to over-oxygenation

Question 36

what difference does chronic bronchitis and emphysema have early in its disease course?

Answer 36

chronic bronshitis causes respiratory acidosis and hypoxia

Question 37

mechanism of SABA

Answer 37

activates adenyl cyclase leading to increase in cAMP and thus smooth muscle relaxation

Question 38

causes of bronchiectasis

Answer 38

idiopathic or hereditary (CF, kartageners)

Question 39

most common mutation in CF

Answer 39

delta F508

Question 40

treatment in CF that can help clear mucous

Answer 40

nebulized DNase

Question 41

what does inhaled tobramycin do?

Answer 41

supress pseudomonas