Lec 13

Question 1

What is definition of asthma?

Answer 1

episodic obstruction characterized by reversible airway narrowing

Question 2

What is pathogenesis of asthma?

Answer 2

• development allergic phenotype in susceptibl individual characterized by TH2 lymphocyte IL 4/5/9/13 which orchestrate inflammatory response

Question 3

What are major effects cells of asthma?

Answer 3

eosinophils

Question 4

What is extrinsic asthma?

Answer 4

due to type 1 hypersensitivity

either atopic [allergic] or occupational

Question 5

What is intrinsic asthma?

Answer 5

due to non-immune cause

aspirin ingestion, pneumonia, cold, stress, exercis

Question 6

What is status asthmaticus?

Answer 6

unremitting attacks due to exposure to previously sensitized antigen

Question 7

What do you see grossly in asthma?

Answer 7

• overdistended lungs

- thick mucus plugs in proximal bronchi

Question 8

What do you on microscopy in asthma?

Answer 8

inflammation –> EOSINOPHILS
thickened basement membrane!!

also:

• mucus plugging
• increased goblet cells
• bronchial smooth muscle hypertrophy

Question 9

How do you diagnose asthma?

Answer 9

PFTs including methacholine provocation + bronchodilator response

Question 10

What is DLCO in emphysema? in pure chronic bronchitis?

Answer 10

emphysema = low DLCO

pure chronic bronchitis = normal

Question 11

What is emphysema?

Answer 11

• permanent enlargement of airpsoaces distal to terminal bronchole and destruction of their walls

results in diminished expiratory drive and loss of tethering of small airways

Question 12

What is centriacinar emphysema?

Answer 12

• central/proximal parts of acini affected; distal spared
• both emphysematous = normal airspaces exist within same acinus / lobule

usually upper lobe, heavy smokers

Question 13

What is panacinar emphysema?

Answer 13

enlarges uniformly acini from level of respiratory bronchiole to terminal bronchiole

pan = entire acinus but not entire lung

Question 14

What is paraseptal emphysema?

Answer 14

proximal portion of acinus is normal but distal involved

emphysema more striking adjacent to pleura

more severe in upper half of lungs

can cause spontaneous pneumothorax in young adult

Question 15

What type of emphysema can cause spontaneous pneumothorax in young adult?

Answer 15

paraseptal

Question 16

What are 2 subtypes of centriacinar emphysema?

Answer 16

• smoking related

- mineral dust [coal] associated

Question 17

What is clinical of alpha 1 antitrypsin deficiency?

Answer 17

• early onset emphysema [< 45 yo]

- unexplained liver disease + possible cirrhosis

Question 18

What is bullous emphysema?

Answer 18

any form that produces blebs/bulla = airspaces > 2cm

often subpleural near apex

can rupture –> pneumothorax, hemorrhage

Question 19

What is chronic bronchitis?

Answer 19

hypersecretory process = non-specific pathologic changes

changes in mucus glands and too much mucus secretion in airways

have more infections, purulent sputum, hypercapnia, hypoxia than emphysema

Question 20

How does tobacco lead to chronic bronchitis?

Answer 20

tobacco interferes with ciliary action

directly damages airway epitheilum and inhibits ability of WBCs to clear bacteria

Question 21

What is microscopic morphology of early + later chronic bronchitis?

Answer 21

early: hyper-secretion of mucus in large airways; hypertrophy of submucosal glands
later: increase goblet cells in small airways; excess mucus production + airway obstruction; increased Reid index

Question 22

What is definition of bronchiectasis?

Answer 22

pathologic irreversible dilatation of one or more proximal bronchi due to destruction of support structures of bronchial wall

can be localized but usually diffuse

Question 23

What causes localized bronchiectasis/

Answer 23

obstruction due to tumor, foreign body, mucus

Question 24

What causes diffuse bronchiectasis?

Answer 24

CF, immunodeficiency, kartageners

necrotizing pneumonia [staph or TB]

Question 25

What is pathogenesis of bronchiectasis?

Answer 25

• inflammation
• PMNS/cell products overwhelm the bronchial wall
• impaired clearance mechs

Question 26

What do you see on gross pathology in bronchiectasis?

Answer 26

• dilated tortuous easily collapsible airways often extending to visceral pleural surface

Question 27

How does bronchiectasis cause obstruction?

Answer 27

• collapse of dilated airways with expiration = floppy
• poor air movement –> air just spins around not in and out
• excess secretions

Question 28

What do you see in bronchiectasis on histology?

Answer 28

fibrosis, inflammation, loss of cartilage

increased vascularity

Question 29

What is bronchiolitis?

Answer 29

inflammatory response to injury of small airways

can have inflammation/fibrosis in diffuse or nodular fashion

Question 30

What kind of cells in small ariways?

Answer 30

simple columnar [ciliated and non-ciliated]

few neuroendocrine cells

Question 31

What diseases can small airway disease be associated wtih?

Answer 31

• bronchiectsasis
• asthma
• COPD
• hypersensitivity pneumonitis

Question 32

What do you see in small airway disease?

Answer 32

adjacent lung have have foamy macrophage accumulation + dilation of adajcent bornchioles

Question 33

What things cause acute small airway disease?

Answer 33

infection, fume exposure, aspiration, wegener’s

Question 34

What thigns cause chronic small airway disease?

Answer 34

bronchiectasis, collagen vascular disease, IBD, aspiration

Question 35

What is constrictive vs intralumenal bronchiolitis?

Answer 35

constrictive = in wall itself
intralumenal = within lumen

Question 36

WHat is constrictive bronchiolitis?

Answer 36

subepithelial collagen deposits –> airway narrowing + constriction

secondary to chronic airway damage with abnormal healing response

see w/ chronic transplant rejection

Question 37

WHat is bronchiolitis obliterans?

Answer 37

organization of luminal inflammatory exudates
polpoid plugs of fibroelastic tissue
rare as an isolated disease
more often associated with alveolar organizing pneumonia