Obstructive lung diseases

Question 1

Which type of emphysema is associated with alpha-1 antitrypsin deficiency?

Answer 1

Panacinar emphysema

Question 2

What medical term refers to the permanent dilatation of the bronchi and bronchioles?

Answer 2

Bronchiectasis

Question 3

A persistent cough with sputum production for at least 3 months in 2 consecutive years, without another identifiable cause

Answer 3

Bronchitis

Question 4

Which index is used to assess the enlargement of mucus-secreting glands in chronic bronchitis?

Answer 4

Reid Index

Question 5

What crystal, composed of eosinophil lysophospholipase binding protein, is found in asthmatic airways?

Answer 5

Charcot-Leyden crystal

Question 6

Which term describes the structural changes that occur in the airways of people with asthma due to chronic inflammation?

Answer 6

Airway remodeling

Question 7

Atopic asthma is often associated with which type of hypersensitivity reaction?

Answer 7

Type I IgE-mediated hypersensitivity reaction

Question 8

Name one of the three cytokines secreted by TH2 cells that contribute to asthma pathogenesis.

Answer 8

IL-4

Question 9

What term describes the whorls of shed epithelium found in mucus plugs in asthmatic airways?

Answer 9

Curschmann spirals

Question 10

What medical term refers to large subpleural blebs or bullae often seen in emphysema?

Answer 10

Bullae

Question 11

Which type of emphysema primarily affects the respiratory bronchioles and is linked to smoking?

Answer 11

Centriacinar emphysema

Question 12

What appearance is characteristic of patients with severe emphysema due to over-ventilation?

Answer 12

Pink puffer

Question 13

What appearance is often seen in patients with chronic bronchitis due to hypoxemia and cyanosis?

Answer 13

Blue bloater

Question 14

What type of emphysema is associated with scarring and irregular acinar involvement?

Answer 14

Irregular emphysema

Question 15

Name one of the two major conditions associated with bronchiectasis.

Answer 15

Obstruction or Infection

Question 16

Which enzyme, released by neutrophils, plays a key role in the destruction of alveolar walls in emphysema?

Answer 16

Elastase

Question 17

Which antiprotease, when deficient, predisposes individuals to developing panacinar emphysema?

Answer 17

Alpha-1 antitrypsin

Question 18

What group of inflammatory mediators contributes to bronchoconstriction in the early phase of asthma?

Answer 18

Leukotrienes

Question 19

Which term describes the dilation of alveoli without destruction

Answer 19

often as a compensatory mechanism?

Question 20

Which condition involves air entering the connective tissue stroma of the lung?

Answer 20

Interstitial emphysema

Question 21

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?

Answer 21

Alpha-1 antitrypsin; Panacinar emphysema. Panacinar emphysema is associated with a deficiency in the protease inhibitor alpha-1 antitrypsin

Question 22

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?

Answer 22

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.

Question 23

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?

Answer 23

Absence of fibrosis. Unlike restrictive lung diseases

Question 24

True or False: Obstructive overinflation, a condition mimicking emphysema, is characterized by the destruction of alveolar walls.

Answer 24

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.

Question 25

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?

Answer 25

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.

Question 26

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?

Answer 26

Exposure to noxious or irritating substances. The primary factor in chronic bronchitis is exposure to irritants like tobacco smoke or dust

Question 27

A 50-year-old man with a long history of chronic bronchitis presents with worsening dyspnea

Answer 27

cyanosis

Question 28

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?

Answer 28

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

Question 29

True or False: Squamous metaplasia and dysplasia of the respiratory epithelium in chronic bronchitis increase the risk of lung carcinoma.

Answer 29

True. Squamous metaplasia and dysplasia are premalignant changes that increase the risk of developing lung cancer

Question 30

Which type of asthma is triggered by an IgE-mediated hypersensitivity reaction? Name two common environmental allergens that can trigger this type of asthma.

Answer 30

Atopic asthma; Dust mites and pollen. Atopic asthma is a type I IgE-mediated hypersensitivity reaction to environmental allergens.

Question 31

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?

Answer 31

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

Question 32

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?

Answer 32

Curschmann spirals; Charcot-Leyden crystals. Curschmann spirals are whorls of shed epithelium found in mucus plugs in asthmatic airways

Question 33

Airway remodeling is a hallmark of chronic asthma. Describe three structural changes that contribute to airway remodeling in asthma.

Answer 33

Hypertrophy and/or hyperplasia of bronchial smooth muscle

Question 34

True or False: Occupational asthma is stimulated by exposure to inhaled allergens like dust mites and pollen.

Answer 34

False. Occupational asthma is triggered by workplace exposures to fumes

Question 35

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?

Answer 35

Broncheiectasis

Question 36

The entrance of air into the connective tissue stroma of the lung often caused by alveolar tears or chest trauma

Answer 36

pulmonary interstitial emphysema (PIE).

Question 37

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?

Answer 37

Bronchiectasis.

The clinical presentation and imaging findings are consistent with bronchiectasis.

Question 38

What is the name of the triad consisting of bronchiectasis

Answer 38

bronchiectasis, chronic sinusitis, and situs inversus is known as Kartagener’s syndrome

Question 39

A patient with cystic fibrosis develops recurrent respiratory infections and progressive airway damage. Which obstructive lung disease is this patient highly susceptible to developing?

Answer 39

Bronchiectasis. Cystic fibrosis patients are highly susceptible to developing bronchiectasis due to impaired mucociliary clearance and recurrent respiratory infections.

Question 40

True or False: Emphysema is characterized by reversible enlargement of the airspaces distal to the terminal bronchiole with destruction of alveolar walls.

Answer 40

False. Emphysema is characterized by irreversible enlargement of airspaces distal to the terminal bronchiole with destruction of alveolar walls.

Question 41

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?

Answer 41

Bullous emphysema. This form of emphysema is distinguished from the others by the absence of alveolar wall destruction and the typical protease/antiprotease imbalance.

Question 42

Aspirin and other NSAIDs can trigger asthma in some individuals. Explain the mechanism by which aspirin can induce an asthmatic attack.

Answer 42

Aspirin inhibits the cyclooxygenase pathway. Aspirin inhibits the cyclooxygenase (COX) pathway