Obstructive Disease

Question 1

Disease of Trachea (20

Answer 1

Upper Airway Obstruction

Cystic Fibrosis

Question 2

Disease of Bronchi (1)

Answer 2

Bronchitis

Question 3

Disease of Bronchioles (2)

Answer 3

Asthma

Brochiectasis

Question 4

Disease of Respiratory Bronchioles (1)

Answer 4

Bronchiolitis (viral pneumonia?)

Question 5

Disease of Alveoli (1)

Answer 5

Emphysema

Question 6

Spirometry Pattern

Answer 6

FEV1/FVC

Question 7

P-V Curve Pattern

Answer 7

Steeper and Shifted Up from increased compliance

Question 8

Airflow Pattern

Answer 8

Reduced flow at higher lung volumes with coving on end-expiration

Question 9

Effect on Diaphragm

Answer 9

Hyperinflation reduces diaphragm length, puts at mechanical disadvantage

Question 10

Asthma Pathology

Answer 10

Allergen induces Th2 cells which secrete IL-4 (IgE conversion); IL-5 (Eosinophil recruitment); and IL-10 (More Th2)
Second exposure causes IgE-activation of Mast cells, regrandulation. Early phase is histamine, leukotrienes, etc. Late phase is major basic protein bronchoconstriciton.

Question 11

Asthma cough: productive or non-productive?

Answer 11

Productive (mucus plugs, Charcot-Leyden crystals [MBP])

Question 12

Other causes of asthma?

Answer 12

Post-viral, chronic (cold air, exercise)

Question 13

Chronic Bronchitis Diagnosis

Answer 13

Productive Cough 3+ months for 2 years+

Question 14

Chronic Bronchitis Pathology

Answer 14

Mucus gland and goblet cell hyperplasia; smooth muscle hyperplasia

Question 15

Chronic Bronchitis Signs/Symptoms

Answer 15

Productive Cough
Cyanosis (mucus plugging)
Increased Cor Pulmonale

Question 16

Emphysema Pathology

Answer 16

Destruction of alveolar sacs from protease-anti-protease imablance (from chronic inflammation/PMNs or alpha-1 genetics)
Loss of elastic recoil, more dynamic airway collapse

Question 17

Smoking-related emphysema

Answer 17

Inflammation-mediated, centri-acinar, most severe in upper lobes

Question 18

Alpha-1-antitrypsin Emphysema

Answer 18

Enzyme-mediated, pan-acinar, more severe in lower lobes.

Might have associated cirrhosis from misfolded proteins

Question 19

Emphysema Signs/Symptoms

Answer 19

DOE, dry cough, pursed lip breathing, weight loss, increased chest diameter, hypoxemia