OBSTRUCTIVE lung disease

Question 1

2 major causes of airflow obstruction

Answer 1

1) intrinsic airway narrowing (bronchospasm, plugging, inflame/edema)
2) “floppy airways- decr radial tethering or decr airway integrity

Question 2

relationship of Airways resistance with airway radius

Answer 2

airway resistance = 1 / airway radius ^ 4

Question 3

Work of breathing is combination of 2 things

Answer 3

Work against elastic recoil work against airflow resistance

Question 4

Elastic work and resistive work graph

Answer 4

Question 5

In obstructive disease are you

incr/decr O2 consumption

incr/decr CO2 conusmption

easier/harder to move air in and out

Answer 5

incr O2 consumption

incr CO2 consumption

harder to move air in and out

Question 6

How does airflow obstruction incr lung volume

Answer 6

Incomplete emptying of alveoli

incr TLC (breath stacking, gas trapping)

Question 7

How does diaphragm change in obstructive disease

Answer 7

diaphragm gets flattened because pressure builds up and pushes down

Question 8

How does hyperinflation and obstructive disease affect

RV

ERV

IC

Answer 8

incr RV

incr ERV

incr FRC

decr IC

Question 9

How does flattening of diaphragm in obstructive disease affect inspiration?

why?

Answer 9

less inspiratory pressure because incr radius of curvaure

so diaphragm must generate more tension

Question 10

Lung disease assoc with

Trachea

Bronchi

Bronchioles

Respiratory bronchioles

Alveolar sacs

Answer 10

Trachea = upper airway obstruction

Bronchi = bronchitis

Bronchioles = asthma, bronchiectasis

Respiratory bronchioles = bronchiolitis

Alveolar sacs = emphysema

Question 11

Asthma

1) describe
2) symptoms
3) assoc with ?
4) physical exam

Answer 11

1) chronic inflamm of airways; reversible
2) airway hyperresponsive

wheezing

breathlessness

chest tightness

dyspnea

cough at night/morning

3) exercise, cold air, allergens, infection
4) maybe normal in stable

incr RR, accessory muscle use

expiratory wheezing

Question 12

Two types of asthma

Answer 12

1) extrinsic = allergic

IgE

2) Intrinsic = nonseasonal, non allergic

chronic and persistent

= Post viral (epithelail injury causing bronchial narrowing)

• incr leukotrienes, decr porstaglandins

Question 13

Factors that influence development of asthma

Answer 13

1) genetic predisposition
2) enviornmental (allergens, animals, infection, occupation, smoke)

Question 14

Molecular underlying causes of asthma1

Answer 14

1) airway hypertrophy of smooth muscle cells
2) mucous plugging
3) incr Th2 pathway so incr mast cells, eosinophils

Question 15

Th2 process of asthma

Answer 15

1) allergen picked up by macrophage/dendritic cell
2) Th2 cell
3) eosinophil and mast cell release histamine
4) mucous plugging and smooth muscle hypertrophy

Question 16

PFTs of asthma

Answer 16

normal if no symptoms

normal to incr DLCO

bronchoprovocation with methacholine (airway irritant) shows hyperreactivity

Question 17

3 Different courses of asthma

Answer 17

1) chronic inflamm = mild persistent
2) incr airway obstruction = moderate persistent
3) irrev airway obstruction = severe

Question 18

Signs of acute asthma

Answer 18

Hyperinflation

Unable to exhale fully before next breath = incr TLC

Decr tension by shortened diaphragm

Accessory muscle use

incr work of breathing

Question 19

Molecular changes in acute asthma

Answer 19

1) inflammation, cellular infiltrates
2) epithelial desquamation
3) smooth muscle hypertrophy
4) mucous plugging

Question 20

P-V curve of asthma

Answer 20

Same shape just raised up

Question 21

Vocal cord dysfunction

1) describe
2) airflow vs. volume curve
3) symptoms
4) coexists with?

Answer 21

1) inappropriate vocal cord motion –> airflow obstruction
2) variable extrathoracic pattern from closing up of vocal cords with inspiration
3) symptoms same as asthma EXCEPT INSPIRATORY STRIDOR
4) asthma

Question 23

How do you use bronchoprovocation studies in VCD?

How do you treat?

Answer 23

VCD may worsen with bronchoprovocation BUT NO CHANGES IN FEV1 OR PC20 BECAUSE NOT EXPIRATORY

acute treatment = anxiolytics, H2-O2 mix

long term = speech therapy

Question 24

COPD

1) Define
2) PFT
3) major cause

Answer 24

1) fixed airflow obstruction
2) FEV1/FVC < 0.7
3) tobacco smoke

Question 26

Distinguish between blue bloater and pink puffer

Answer 26

Blue bloater = hypoventilator, hypoxic, hypercapnic

Assoc with cor pulmonale

= chronic bronchitis

Pink puffer = hyperventilator, less hypoxia/hypercapnia=

= emphysema

Question 27

Define chronic bronchitis

Answer 27

1) productive cough at least 3 months over past 2 yrs
2) incr airway resistance due to edema, mucous fibrosisi
3) decr ventilation

Question 28

P-V curve of chronic bronchitis

Answer 28

compliance normal but hyperinflated

Question 29

emphysema pathogenesis

Answer 29

1) loss of alveolar space and enlarged distal airspace
2) incr compliance (decr elastic tissue, apoptosis of alveolar ccells)
3) loss elasticity around alveoli = alveoli collapse
4) decr DLCO

Question 30

Define alpha1 antitrypsin deficiency

Answer 30

loss of balance btwn proteases and anti-proteases in lung

Question 31

how does emphysema affect distal airspaces (acini)

distinguish between pan-acinar and centri-acinar

Answer 31

permanent enlargement of acini

pan-acinar = entire acinus; older patients; alpha 1 antitrypsin

central acinar = smoking, respiratory bronchioles

Question 32

P-V curve in emphysema

Answer 32

Question 33

Physical exam in

Chronic bronchitis vs. Emphysema

Answer 33

Chronic bronchitis = cough, rhonchi, wheezing

Emphysema = decr breath sounds, hyper-resonant

Common = prolonged expiratory phase, pursed lip breathing, tripodding

Question 34

GOLD COPD Classification

Answer 34

Mild = > 80% FEV1

Moderate = 50-80% FEV1

Severe = 30-50% FEV1

Very severe = < 30%

Question 35

What are symptoms of COPD exacerbations

What are changes on PFTs and CXR?

What precipitates?

Treatment

Answer 35

1) cough, sputum with purulence, wheezing
2) worsened obstruction on PFT

unchanged CXR

3) infection, pollution, PE
4) bronchodilators, steroids, antibiotics

Question 36

Causes of death from COPD

Answer 36

1) REspiratory failure
2) RV failure
3) pneumonia
4) spontaneous pneumo
5) pulm embolism

Question 37

Distinguish reversibility and DLCO in asthma, chronic bronchitis, emphysema

Answer 37

Asthma = reversible, normal to incr DLCO

Chronic bronchitis = minimal reversibility, normal to slight incr DLCO

Emphysema = no reversibility to bronchodilators, decr DLCO, change in PV slope

Question 38

Bronchiectasis

1) define/pathophys
2) symptoms
3) causes
4) what worsens?

Answer 38

1) abnormal dilation of prox bronchi

infectious + inflamm insult, decr drainage with obstruction

loss of airway wall integrity due to dilation

2) cough with purulence, sputum, wheezing, hemoptysis
3) recurrent infections- CF, PCD, immunodeficiency (localized or diffuse like lobar pneumonia vs. CF)
4) Airway clearance, antibiotics, bronchodilators, corticosteroids

Question 39

Bronchiolitis

1) exam
2) kids
3) adults

Answer 39

1) inspiratory squeaks
2) infection (RSV) in kids
3) infection (mycoplasma but less than kids)

toxins, collagen vascular disease, smoking, lung transplant rejection, HP

Question 40

Define CF

1) mutation
2) symptoms

Answer 40

1) heterogeneous recessive in CFTR; incr salt build up in all organs except kidney
2) sinusitis, pancreatic exocrine insufficiency, chronic bacterial infection of airways, abnormal sweat chloride too high