Obstructive Lung Diseases Flashcards by Gopu Premrajan

what genetic factors are associated with obstructive lung diseases?

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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obstructive diseases are a _______ disorder

airway: tracheal to terminal bronchiole

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atelectasis is linked to _____ emphysema

septa/distal acinar emphysema

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an ↑ in the Reid index is seen in _____

chronic bronchitis

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

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

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smoking is associated with ______ type of emphysema

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

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viral infections can cause ______ asthma by ________

NON ATOPIC asthma;

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

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septal emphysema is found next to ______

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

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what cytokine activates eosinophils?

IL-5

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_______ is a common cause of drug induced asthma

aspirin

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______ is a skin finding on atopic asthma

wheal and flare

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describe the cough in chronic bronchitis

PRODUCTIVE cough

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

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in bronchiectasis, the airways are _____

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

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virus induced mucosal damage lowers the threshold of _________

subepithelial vagal receptors to irritants in non atopic asthma

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is there fibrosis associated with emphysema?

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_______ is a distinctive feature of chronic bronchitis

hyper secretion of mucus

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

bronchiectasis;

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

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what is the Reid index?

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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define bronchiectasis

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

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what are some causes of bronchiectasis?

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

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_____ emphysema is associated with alpha 1 anti trypsin deficiency

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

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what are some differences between atopic and non atopic asthma

non atopic:

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

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

smokers;

langerhans cells

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Kartagener Syndrome is a AR disorder of ______

ciliary microtubules → persistent infection leadings to bronchiectasis

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

DISTAL; WITHOUT fibrosis

pneumothorax is a complication of ______ emphysema

septal/ distal acinar emphysema; | can form bullae that can rupture into the pleural cavity

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

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

______ is pathognomonic for eosinophilic granulomas

Birbeck granules on EM

what are some obstructive lung diseases?

- emPhysema (Pink Puffer) - chronic Bronchitis (Blue Bloater) - bronchiectasis - asthma (only one that is reversible)

what are some histological findings in someone with obstructive lung diseases

- 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

what are Curschmann spirals?

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

what are some similarities between atopic and non atopic asthma?

same treatment and same inflammatory mediators

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

IgE antibodies

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

restrictive lung disease | restrictive is due to a lung parenchymal disorder

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

hypertrophy of seromucinous glands and hyperplasia of the goblet cells

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

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

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

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

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

- smooth muscle hyperplasia | - peribronchiolar fibrosis

what are the types of emphysema?

- centrilobular (centriacinar) - panlobular (panacinar) - septal (distal acinar) - irregular (paracicatricial)

wheezing is very apparent in ________ because FEV1 <30%

asthma

the respiratory drive in chronic bronchitis is driven by ____

low pO2

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

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

chronic bronchitis is an example of a _____ lung disease

obstructive

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

asthma

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

squamous

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

bronchioles (they normally do not have goblet cells); | chronic bronchitis

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

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

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

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

what cytokine stimulates IgE production?

IL-4

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

- 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

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

- bronchoconstriction (due to direct vagal stimulation) - increased mucous production - vasodilation

polymorphism in TGFB signaling leads to ____

inadequate repair of elastin injury

airway disorder is _____ lung disease

obstructive

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

- hypertrophy of seromucinous glands | - ↑ goblet cells in surface epithelium

why is inspiration/expiration the issue in obstructive lung diseases

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

what is the pathogenesis of obstructive lung diseases such as emphysema

- imbalance of proteases and antiproteases coupled with inadequate repair mechanisms

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

restrictive

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

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

what is status asthmaticus?

asthma that does not respond to therapy such as from bronchodilators