Obstructive lung diseases Flashcards
Which type of emphysema is associated with alpha-1 antitrypsin deficiency?
Panacinar emphysema
What medical term refers to the permanent dilatation of the bronchi and bronchioles?
Bronchiectasis
A persistent cough with sputum production for at least 3 months in 2 consecutive years, without another identifiable cause
Bronchitis
Which index is used to assess the enlargement of mucus-secreting glands in chronic bronchitis?
Reid Index
What crystal, composed of eosinophil lysophospholipase binding protein, is found in asthmatic airways?
Charcot-Leyden crystal
Which term describes the structural changes that occur in the airways of people with asthma due to chronic inflammation?
Airway remodeling
Atopic asthma is often associated with which type of hypersensitivity reaction?
Type I IgE-mediated hypersensitivity reaction
Name one of the three cytokines secreted by TH2 cells that contribute to asthma pathogenesis.
IL-4
What term describes the whorls of shed epithelium found in mucus plugs in asthmatic airways?
Curschmann spirals
What medical term refers to large subpleural blebs or bullae often seen in emphysema?
Bullae
Which type of emphysema primarily affects the respiratory bronchioles and is linked to smoking?
Centriacinar emphysema
What appearance is characteristic of patients with severe emphysema due to over-ventilation?
Pink puffer
What appearance is often seen in patients with chronic bronchitis due to hypoxemia and cyanosis?
Blue bloater
What type of emphysema is associated with scarring and irregular acinar involvement?
Irregular emphysema
Name one of the two major conditions associated with bronchiectasis.
Obstruction or Infection
Which enzyme, released by neutrophils, plays a key role in the destruction of alveolar walls in emphysema?
Elastase
Which antiprotease, when deficient, predisposes individuals to developing panacinar emphysema?
Alpha-1 antitrypsin
What group of inflammatory mediators contributes to bronchoconstriction in the early phase of asthma?
Leukotrienes
Which term describes the dilation of alveoli without destruction
often as a compensatory mechanism?
Which condition involves air entering the connective tissue stroma of the lung?
Interstitial emphysema
This type of emphysema is more common in the lower lobes of the lung and is associated with a deficiency in a certain protease inhibitor. What is the specific protease inhibitor? What is the name of this type of emphysema?
Alpha-1 antitrypsin; Panacinar emphysema. Panacinar emphysema is associated with a deficiency in the protease inhibitor alpha-1 antitrypsin
A 65-year-old man with a 40-pack-year smoking history presents with chronic cough, dyspnea, and wheezing. A chest X-ray reveals hyperinflation of the lungs and a flattened diaphragm. Upon examination, the patient is thin with a barrel chest and appears to be using his accessory respiratory muscles to breathe. What is the most likely diagnosis? What physical exam finding would you expect to observe in this patient due to loss of elastic recoil in the airway?
Emphysema; Pursed-lip breathing.
The patient’s history, symptoms, and radiographic findings are highly suggestive of emphysema. Pursed-lip breathing is a common compensatory mechanism used by patients with emphysema to help maintain airway patency during exhalation by increasing airway pressure and preventing premature airway collapse.
A lung biopsy from a patient with emphysema shows abnormally large alveoli separated by thin septa. What is the key histological feature that differentiates emphysema from restrictive lung diseases?
Absence of fibrosis. Unlike restrictive lung diseases
True or False: Obstructive overinflation, a condition mimicking emphysema, is characterized by the destruction of alveolar walls.
False.
In emphysema, there is destruction of alveolar walls, leading to a permanent loss of elastic recoil and decreased surface area for gas exchange.
In obstructive overinflation, the alveolar structure remains intact, and the condition is potentially reversible if the underlying obstruction is removed.
A 25-year-old, previously healthy woman presents with sudden onset of shortness of breath and chest pain. She has no history of smoking or respiratory illness. A chest X-ray reveals a pneumothorax. Which type of emphysema is associated with an increased risk of spontaneous pneumothorax in young adults? What structural feature of this type of emphysema makes it prone to rupture?
Distal acinar (paraseptal) emphysema;
Multiple, continuous, enlarged airspaces (blebs or bullae) that are thin-walled.
This type of emphysema occurs near the pleura and its large, thin-walled airspaces are prone to rupture, leading to pneumothorax.
Chronic bronchitis is clinically defined by persistent cough with sputum production for at least 3 months in at least 2 consecutive years. What is the primary factor that contributes to the development of chronic bronchitis?
Exposure to noxious or irritating substances. The primary factor in chronic bronchitis is exposure to irritants like tobacco smoke or dust
A 50-year-old man with a long history of chronic bronchitis presents with worsening dyspnea
cyanosis
A lung biopsy from a patient with chronic bronchitis reveals an increased Reid Index. What does the Reid index measure? What histological changes would contribute to an elevated Reid index?
The ratio of the thickness of the mucous gland layer to the thickness of the bronchial wall. An elevated Reid Index indicates enlargement of the mucus-secreting glands in the bronchi
True or False: Squamous metaplasia and dysplasia of the respiratory epithelium in chronic bronchitis increase the risk of lung carcinoma.
True. Squamous metaplasia and dysplasia are premalignant changes that increase the risk of developing lung cancer
Which type of asthma is triggered by an IgE-mediated hypersensitivity reaction? Name two common environmental allergens that can trigger this type of asthma.
Atopic asthma; Dust mites and pollen. Atopic asthma is a type I IgE-mediated hypersensitivity reaction to environmental allergens.
A 10-year-old boy with a history of atopic asthma presents with acute wheezing, shortness of breath, and coughing. Which inflammatory mediators, derived from the lipoxygenase pathway of arachidonic acid metabolism, are responsible for bronchoconstriction in the early-phase asthmatic response?
Leukotrienes C4, D4, and E4.
These inflammatory mediators, particularly leukotrienes C4, D4, and E4, cause potent bronchoconstriction and contribute to the early phase of the asthmatic response.
of breath
A sputum sample from a patient with asthma reveals mucus plugs containing whorls of shed epithelium. What is the specific term used to describe these whorls of shed epithelium? What other microscopic finding in the sputum would support a diagnosis of asthma?
Curschmann spirals; Charcot-Leyden crystals. Curschmann spirals are whorls of shed epithelium found in mucus plugs in asthmatic airways
Airway remodeling is a hallmark of chronic asthma. Describe three structural changes that contribute to airway remodeling in asthma.
Hypertrophy and/or hyperplasia of bronchial smooth muscle
True or False: Occupational asthma is stimulated by exposure to inhaled allergens like dust mites and pollen.
False. Occupational asthma is triggered by workplace exposures to fumes
A chest X-ray of a 30-year-old woman reveals permanent dilation of the bronchi and bronchioles,especially in the lower lobes. What is this condition called? What are the two major etiological factors associated with this condition?
Broncheiectasis
The entrance of air into the connective tissue stroma of the lung often caused by alveolar tears or chest trauma
pulmonary interstitial emphysema (PIE).
A patient presents with dyspnea, cough, and copious amounts of foul-smelling sputum. Imaging studies reveal dilated airways filled with mucopurulent secretions. What is the most likely diagnosis?
Bronchiectasis.
The clinical presentation and imaging findings are consistent with bronchiectasis.
What is the name of the triad consisting of bronchiectasis
bronchiectasis, chronic sinusitis, and situs inversus is known as Kartagener’s syndrome
A patient with cystic fibrosis develops recurrent respiratory infections and progressive airway damage. Which obstructive lung disease is this patient highly susceptible to developing?
Bronchiectasis. Cystic fibrosis patients are highly susceptible to developing bronchiectasis due to impaired mucociliary clearance and recurrent respiratory infections.
True or False: Emphysema is characterized by reversible enlargement of the airspaces distal to the terminal bronchiole with destruction of alveolar walls.
False. Emphysema is characterized by irreversible enlargement of airspaces distal to the terminal bronchiole with destruction of alveolar walls.
This type of emphysema is characterized by the presence of large subpleural blebs or bullae but without the destruction of alveolar walls or the protease/antiprotease imbalance seen in other forms of emphysema. What is it?
Bullous emphysema. This form of emphysema is distinguished from the others by the absence of alveolar wall destruction and the typical protease/antiprotease imbalance.
Aspirin and other NSAIDs can trigger asthma in some individuals. Explain the mechanism by which aspirin can induce an asthmatic attack.
Aspirin inhibits the cyclooxygenase pathway. Aspirin inhibits the cyclooxygenase (COX) pathway
