obstructive lung disease: COPD + asthma

Question 1

easily collapsible airway (can be episodic or reversible)→ difficulty in removing air from lungs → ↑ lung volume

Answer 1

obstructive lung disease

Question 2

types of obstructive lung disease

Answer 2

asthma
copd
chronic bronchitis
emphysema
bronchiectasis

Question 3

↑ sensitivity of bronchioles → REVERSIBLE (with B2 agonist - FEV1/FVC ratio corrects) bronchoconstriction
bronchospasm → smooth muscle hypertrophy (↓ compliance of lung)

Answer 3

asthma

Question 4

curschmann spiral: spiral shaped mucous plugs + desquamated epithelium in sputum

Answer 4

seen in obstructive lung disease

Question 5

charcot-leyden crystal: associated with eosinophillic inflammation

Answer 5

asthma

Question 6

asthma can be induced by

Answer 6

viral URI
allergen
stress
exercise
ASPIRIN (asthma exacerbated)

Question 7

cough
wheezing
SOB
tachypnea
hypoxemia
↓ inspiratory: expiratory ratio
pulsus paradoxus
mucus plugging

Answer 7

asthma

Question 8

inspiration: ↓intrathoracic pressure →↑ blood flow into right ventricle → can cause IV septum to push over into left ventricle →↓ blood flow into LV →↓ LV output → small drop in systolic bp: if >10 mmHg during inspiration =

Answer 8

pulsus paradoxus

not paradoxical - just exaggerated form of normal physiologic response

Question 9

conditions with pulsus paradoxus

Answer 9

1) restrictive pericardial space - heart can't expand with RV full of blood → push IV septum into LV:
cardiac tamponade
pericarditis
2) lung conditions:
pulmonary embolism
asthma

Question 10

airflow limitation

chronic inflammation in airways + lungs

Answer 10

COPD

Question 11

primarily due to smoking
daily chronic productive cough for =>3 mo (not necessarily consecutive) for 2 consecutive years
other symptoms:
wheezing, crackles, cyanosis, late onset SOB
note: may proceed or follow the development of airflow limitation (like copd) but don’t need COPD for diagnosis

Answer 11

diagnosis of chronic bronchitis = clinical

Question 12

permanent enlargement of airspaces distal to terminal bronchioles

Answer 12

emphysema

Question 13

hyperplasia of goblet cells + submucosal glands

reid index >50%

Answer 13

chronic bronchitis

Question 14

reid index

Answer 14

thickness of submucosal glands/thickness of bronchial wall (epithelium to right before cartilage)

Question 15

“blue bloater”

Answer 15

chronic bronchitis

cyanosis + peripheral edema that can occur from poor oxygenation + pulmonary hypertension that can occur

Question 16

primarily due to smoking
dilated alveoli
damaged alveolar walls + septa
result: 
enlarged alveolar spaces
↓elastic recoil → air trapping

Answer 16

emphysema

Question 17

FEV1/FVC ratio in obstructive lung disease

Question 18

FEV1/FVC ratio in restrictive lung disease

Answer 18

equal or > 80%

Question 19

“barrel chested”

Answer 19

emphysema

↑AP diameter

Question 20

hyperinflated lungs
flattening of diaphgragm
blunting of costophrenic angle
↑AP diameter
prominent central pulmonary arteries

Answer 20

emphysema on CXR

Question 21

type of emphysema in which only central portion destroyed
associated with SMOKING
UPPER LOBES + SUPERIOR SEGMENTS OF LOWER LOBES
destruction of RESPIRATORY BRONCHIOLES in acinus ONLY

Answer 21

centriacinar emphysema

Question 22

“pink puffers”

Answer 22

centriacinar emphysema

severe SOB

Question 23

associated with pneumothorax (ACUTE SOB)

Answer 23

emphysema

Question 24

α1antitrypsin deficiency: emphysema at early age (20-30 yo) + early-onset cirrhosis
causes panacinar emphysema: overactive elastase degrades elastic fibers of lung
LOWER LOBES
destruction of ENTIRE ACINUS

Answer 24

panacinar emphysema

Question 25

permanent destruction + dilation of bronchial walls
COPIOUS PURULENT SPUTUM
recurrent infections → lung ABSCESSES
cause: chronic inflammation or infections of bronchi, CILIA disorders: CF, Kartagener syndrome

Answer 25

bronchiectasis

Question 26

associated with CF or Kartagener syndrome

Answer 26

bronchiectasis

Question 27

treatment of asthma

Answer 27

B2 agonist: smooth muscle relaxation in bronchi: albuterol, levalbuterol, salmeterol
methylaxthine
corticosteroids: ↓ inflammation: beclomethasone, fluticasone, budesonide
cromolyn
muscarinic antagonist: ipatriprium, tiotropium
antiluekotrienes: zilueton, zafirlukast, montelukast
theophylline

Question 28

expectorants

Answer 28

gauifenesin

N-acetylcysteine

Question 29

inhaled treatment of choice for chronic asthma

Answer 29

inhaled corticosteroid

Question 30

inhaled treatment of choice for acute asthma exacerbation

Answer 30

albuterol