Obstructive Pathology

Question 1

common features of obstructive lung disease

Answer 1

generally increased lung volumes

generalyl decreased elastic recoil

decreased flow in the airways

do not generally progress to “honeycomb lung”

Question 2

general features of restrictive lung disease

Answer 2

most involve parenchyma

decreased lung capacity

reduced expansion of lung parenchyma

may progress to end stage “honeycomb lung”

Question 3

obstructive lung diseases

Answer 3

COPD - emphysema and chronic bronchitis

asthma

bronchiectasis

Question 4

pathology of emphysema

Answer 4

large, overinflated lungs

enlarged alveolar spaces with “floating sepae”

Question 5

variants of emphysema

Answer 5

centriacinar, panacinar, and distal acinar emphysema

Question 6

centriacinar emphysema

Answer 6

most common (95%)

affects respiratory bronchioles more than alveolar ducts

smoking related

Question 7

panacinar emphysema

Answer 7

affects the alveolar ducts predominantly

usually related to A1AT

Question 8

distal acinar emphysema

Answer 8

usually seen in sporadic cases related to pre-existing lung scarring unrelated to A1AT deficiency or smoking

Question 9

chronic bronchitis definition

Answer 9

productive cough for most days in 3 consecutive months in 2 consecutive years

disease of larger airways and smoking related

Question 10

complications of chronic bronchitis

Answer 10

chornic airway inflammation

mucus gland hypertrophy

predisposes to superimposed infection

Question 11

Reid index

Answer 11

a ratio between the thickness of the submucosal glands and the distance between the bronchial cartilage and the surface of the epithelium

an index of greater than 0.4 suggests chornic bronchitis

Question 12

causes of bronchiectasis

Answer 12

cystic fibrosis

Kartagener’s syndrome

repeated infections

Question 13

Kartagener’s syndrome

Answer 13

cilliary dyskenesis, prevents mucus clearance, resulting in obstruction

Question 14

pathology of bronchiectasis

Answer 14

wall destruction and irreversible airway dilatation

Question 15

common characteristics of asthma

Answer 15

reversible episodic obstruction - smooth muscle contraction, mucosal edema, mucus secretion

airway hyperreactivity

chronic inflammation - cytoking secreting Th2 lymphosites, eosinophils, and leukotrienes are central

Question 16

atopic asthma

Answer 16

related to Type 1 IgE hypersensitivity reaction

Question 17

nonatopic asthma

Answer 17

triggered by environmental irritants and infection

Question 18

aspirin related asthma

Answer 18

Samter’s triad:

asthma

aspirin allergy

nasal polyps

Question 19

early reaction in asthma

Answer 19

airway constriction

vascular permeability

edema

mediated by leukotrienes, prostaglandings, histamine, etc.

Question 20

late asthma reaction

Answer 20

recruitement of inflammatory cells

eosinophils, lymphocytes, etc.

Question 21

changes in long-term asthma

Answer 21

airway remodeling:

epithelial damage

smooth muscle hyperplasia

mucus gland hypertrophy

Question 22

pathologic findings of asthma

Answer 22

basement membrane thickening

mucus casts that take the shape of the bronchial tree, spiral structures called Churchman’s spirals

Charcot Leyden crystals - a florid eosinophilic infiltrate, crystalline structures formed from the products of eosinophil degranulation