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PCM Exam 3 > Obstructive Lung Diseases > Flashcards

Obstructive Lung Diseases Flashcards

1
Q

what genetic factors are associated with obstructive lung diseases?

A
  • α1 antitrypsin deficiency
  • polymorphisms in TGFB (transforming growth factor B) gene which is important for immune cell activation
  • polymorphism in matrix metalloproteinases (MMP)
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2
Q

obstructive diseases are a _______ disorder

A

airway: tracheal to terminal bronchiole

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3
Q

atelectasis is linked to _____ emphysema

A

septa/distal acinar emphysema

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4
Q

an ↑ in the Reid index is seen in _____

A

chronic bronchitis

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5
Q

a patient’s sputum analysis comes back with presence of Charcot Leyden crystals. What is this a result of?

A

Charcot Leyden crystals are breakdown products of eosinophils (can be seen in asthmatic patients)

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6
Q

smoking is associated with ______ type of emphysema

A

centrilobular (centriacinar) which affects the upper lung zones and the respiratory bronchioles are affected

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7
Q

viral infections can cause ______ asthma by ________

A

NON ATOPIC asthma;

the mucosal damage caused by the virus lowers the threshold of subepithelial vagal receptors to irritants

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8
Q

septal emphysema is found next to ______

A

atelectasis, along septa, margins of lobes and subplueral zones;
more common in upper lobes

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9
Q

what cytokine activates eosinophils?

A

IL-5

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10
Q

_______ is a common cause of drug induced asthma

A

aspirin

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11
Q

______ is a skin finding on atopic asthma

A

wheal and flare

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12
Q

describe the cough in chronic bronchitis

A
  • PRODUCTIVE cough

- cough for at least 3 straight months for at least 2 years

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13
Q

in bronchiectasis, the airways are _____

A

dilated all the way to the pleura and filled with mucus and pus

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14
Q

virus induced mucosal damage lowers the threshold of _________

A

subepithelial vagal receptors to irritants in non atopic asthma

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15
Q

is there fibrosis associated with emphysema?

A

NO

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16
Q

_______ is a distinctive feature of chronic bronchitis

A

hyper secretion of mucus

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17
Q

patient has abnormal enlargement of the airspace proximal to the terminal bronchioles, what is this disease?

A

bronchiectasis;

if it was distal to the terminal bronchioles, it would be emphysema

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18
Q

what is the Reid index?

A

the ratio of the thickness of the mucous gland layer t the thickness of the entire bronchial wall (thickness of the all between the epithelium and cartilage)

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19
Q

define bronchiectasis

A

permanent dilation fo the bronchi/bronchioles PROXIMAL to the acinus secondary to destruction of supporting tissue

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20
Q

what are some causes of bronchiectasis?

A
  • obstruction and chronic infection (tumor, foreign body)
  • congenital/hereditary conditions (CF, immunodeficiency, Kartagener Syndrome)
  • necrotizing/suppurative pneumonia
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21
Q

_____ emphysema is associated with alpha 1 anti trypsin deficiency

A

panlobular (panacinar); entire acinus and the lower lung zones are involved

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22
Q

what are some differences between atopic and non atopic asthma

A

non atopic:

  • NO ↑ in serum IgE
  • no skin wheal and flare reaction
  • no family history (strong family history in atopic)
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23
Q

eosinophilic granuloma is a pulmonary disease almost exclusively in ______ and ______ is the culprit cell

A

smokers;

langerhans cells

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24
Q

Kartagener Syndrome is a AR disorder of ______

A

ciliary microtubules → persistent infection leadings to bronchiectasis

25
Q

emphysema is characterized by abnormal permanent airspace enlargement ____ to the terminal bronchioles accompanied by destruction for airspace walls with/without fibrosis

A

DISTAL; WITHOUT fibrosis

26
Q

pneumothorax is a complication of ______ emphysema

A

septal/ distal acinar emphysema;

can form bullae that can rupture into the pleural cavity

27
Q

obstructive lung diseases is characterized by _____ resistance to air flow and _________

A

↑ resistance to air flow and limited expiratory rates on forced expiration

28
Q

______ is pathognomonic for eosinophilic granulomas

A

Birbeck granules on EM

29
Q

what are some obstructive lung diseases?

A
  • emPhysema (Pink Puffer)
  • chronic Bronchitis (Blue Bloater)
  • bronchiectasis
  • asthma (only one that is reversible)
30
Q

what are some histological findings in someone with obstructive lung diseases

A
  • hyper inflated lungs with or without bullae
  • moth eaten appearance of lung parenchyma
  • destruction of alveolar septa WITHOUT fibrosis → enlarged airspaces
  • destruction of elastin in small airways
31
Q

what are Curschmann spirals?

A

found in patients with asthma. they are mucous that have shed epithelial cells in them

32
Q

what are some similarities between atopic and non atopic asthma?

A

same treatment and same inflammatory mediators

33
Q

binding of the inhaled antigen (on second exposure) to ______ on mast cells will cause degranulation of mast cells

A

IgE antibodies

34
Q

in ____ lung diseases the respiratory bronchiole, alveoli and alveolar ducts are affected

A

restrictive lung disease

restrictive is due to a lung parenchymal disorder

35
Q

_________ of the seromucinous glands and _______ of the goblet cells is seen in chronic bronchitis

A

hypertrophy of seromucinous glands and hyperplasia of the goblet cells

36
Q

bronchoconstriction in drug induced asthma (due to aspirin) is caused by _____

A

leukotrienes because aspirin inhibits COX pathway which then ↑ the activity of lipoxygenase pathway → ↑ leukotrienes

↓ production of prostaglandins
↑ production of leukotrienes

37
Q

what clinical presentation is required to diagnose someone with chronic bronchitis?

A

cough that occurs for at least 3 consecutive months in at least 2 consecutive years

38
Q

small airways disease, which causes the airflow obstruction in chronic bronchitis, is characterized by: goblet cell metaplasia, ______, and ________

A
  • smooth muscle hyperplasia

- peribronchiolar fibrosis

39
Q

what are the types of emphysema?

A
  • centrilobular (centriacinar)
  • panlobular (panacinar)
  • septal (distal acinar)
  • irregular (paracicatricial)
40
Q

wheezing is very apparent in ________ because FEV1 <30%

A

asthma

41
Q

the respiratory drive in chronic bronchitis is driven by ____

A

low pO2

42
Q

what is the TLC, FEV1, FVC, and the FEV1:FVC ratio of obstructive lung diseases?

A

TLC is ↑ (obstructive lung diseases have issue with expiration)
FEV1 is ↓
FVC: ↓ or normal
FEV1:FVC: reduced

43
Q

chronic bronchitis is an example of a _____ lung disease

A

obstructive

44
Q

basement membrane thickening, bronchiole smooth muscle hypertrophy, goblet cell hyperplasia, edema with patchy epithelial necrosis and Cruschmann spirals and Charcot Layden crystals are histological findings in what disease

A

asthma

45
Q

_______ metaplasia of the bronchial epithelium is a microscopic finding in bronchiectasis

A

squamous

46
Q

goblet cell metaplasia at the level of _____ is seen in _________

A

bronchioles (they normally do not have goblet cells);

chronic bronchitis

47
Q

____ zone of the lung and the _____ are affected in centrilobular emphysema

A

upper zone; respiratory bronchioles

acinus includes: respiratory bronchiole, alveolar duct and alveoli (all are distal to terminal bronchiole)

respiratory bronchiole is the most proximal/central part of the acinus

48
Q

In asthma, ____ cells are inappropriately activated by the inhaled antigens

A

TH2 cells; which release cytokines: IL-4, IL-5 and IL-13

49
Q

what cytokine stimulates IgE production?

A

IL-4

50
Q

describe the mutation and the chromosome involved in the alpha 1 antitrypsin deficiency; what is an AE of this disease?

A
  • gene point mutation on chromosome 14 that result in abnormal protein folding
  • can lead to chronic liver disease because the abnormal protein accumulates in the liver
51
Q

what do you see in the early phase of the mast cell degranulation in atopic asthma?

A
  • bronchoconstriction (due to direct vagal stimulation)
  • increased mucous production
  • vasodilation
52
Q

polymorphism in TGFB signaling leads to ____

A

inadequate repair of elastin injury

53
Q

airway disorder is _____ lung disease

A

obstructive

54
Q

what are some changes in the lungs in response to the inhaled irritants in chronic bronchitis

A
  • hypertrophy of seromucinous glands

- ↑ goblet cells in surface epithelium

55
Q

why is inspiration/expiration the issue in obstructive lung diseases

A

expiration;

inspiration is an active process so you can overcome the obstruction but expiration is passive you cannot overcome it

56
Q

what is the pathogenesis of obstructive lung diseases such as emphysema

A
  • imbalance of proteases and antiproteases coupled with inadequate repair mechanisms
57
Q

FEV1: FVC ratio is ↑ , what type of lung disease is this?

A

restrictive

58
Q

what inflammatory cells do you expect to see in the late phase of atopic asthma

A

activation of eosinophils, PMN’s and T cell and will get activation of epithelial cells which recruit more TH2 cells and eosinophils

59
Q

what is status asthmaticus?

A

asthma that does not respond to therapy such as from bronchodilators

PCM Exam 3 (32 decks)

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