Lung histology and COPD

Question 1

what is the cut off between the upper and lower respiratory tract?

Answer 1

At the larynx

Question 2

What is the important of the cricoid cartilage?

Answer 2

It’s the only complete cartilagenous ring, can apply pressure during inspiration to try and prevent aspiration of gastric contents.

Question 3

What is a tumour if it’s within 2cm of the carina?

Answer 3

T3

Question 4

When standing where are foreign objects likely to impact?

Answer 4

The right bronchus

Question 5

What is the innervation of the parietal pleura?

Answer 5

intercostal and phrenic nerves

Question 6

what is the innervation of the visceral pleura?

Answer 6

the vagus nerve and sympathetic nerves

Question 7

what is the lining of the upper airways?

Answer 7

ciliated pseudostratified columnar epitheilal cells

Question 8

What are type 1 pneumocytes?

Answer 8

thin flat squamoid cells

Question 9

what are type 2 pneumocytes?

Answer 9

cuboidal cells that produce surfactant.

Question 10

where does the lymphatic drainage of the subpleural space go?

Answer 10

to the hilar lymph nodes

Question 11

what is emphysema?

Answer 11

permanent enlargement of the distal airspaces
destruction of walls
no fibrosis

Question 12

what is bronchitis?

Answer 12

Presence of a chronic productive cough on most days for 3 months in each of 2 consecutive years

Question 13

what inflammation is seen in COPD?

Answer 13

CD8>CD4

increase in neutrophils and macrophages

Question 14

what poteases do neutrophils produce?

Answer 14

elastase, cathepsin G and protease 3

Question 15

what proteases for macrophages produce?

Answer 15

cysteinine proteases, cathepsin

Question 16

what is the consequence of more proteases than anti-proteases?

Answer 16

increase mucous release

alveolour wall destruction

Question 17

what are the main three processes in the pathogenesis of COPD?

Answer 17

1. inflammation
2. more proteases than anti proteases
3. inbalance between oxidants and anti oxidants

Question 18

what causes mucous hypersecretion in COPD?

Answer 18

squamous metaplasia, increase in the number of goblet cells, increased proteases, increase in size of bronchial submucosal glands

Question 19

what are the two types of emphysema?

Answer 19

1. centreacinar

2. panacinar

Question 20

what is centriacinar emphysema?

Answer 20

affects the proximal acini are more seen in smokers

Question 21

what is panacinar emphysema?

Answer 21

uniform enlargement at the lower lobes. there is build up of neutrophils and often AAT deficiency

Question 22

why can some patients with COPD get liver cirrhosis?

Answer 22

AAT 1 deficiency as it may change shape so can no longer fit through vessels and builds up in the liver

Question 23

what conditions cause finger clubbing?

Answer 23

Lung cancer
Bronchiectasis
idiopathic pulmonary fibrosis.

Question 24

what are featurse of cor pulmonale?

Answer 24

raised JVP, loud P2 heart sounds, pulmonary HT, tricuspid regurgitation, pitting peripheral oedema, hepatiomegaly

Question 25

what MMP proteases are involved in COPD?

Answer 25

8,9,12

Question 26

why does pulmonary hypertension develop in COPD?

Answer 26

hypoxia causes pulmonary constriction, endothelial dysfunction and remodelling of pulmonary arteries and destruction of the capillary bed.

Question 27

what are systemic features of COPD?

Answer 27

cachexia, skeletal muscle wasting, increased risk of CVS disease due to increased CRP, normochromic normocytic anaemmia, secondary polycythamiia, osteoporosis, depression