Path: Pulmonary Obstructive Disease

Question 1

What are examples of obstructive diseases vs. restrictive lung diseases?

Answer 1

Obstructive: asthma, chronic bronchitis, bronchiectasis, emphysema

Restrictive: obesity, kyphoscoliosis, polio, pulmonary fibrosis, ARDS, penumoconiosis

Question 2

Which obstructive diseases are considered in the COPD category?

Answer 2

Emphysema

Chronic Bronchitis

Question 3

General Etiology of Emphysema.

Answer 3

Protease/anti-protease imbalance caused by some stimulus (smoking, genetic)

Question 4

Cause and location of Centriacinar (centrilobular) emphysema.

Answer 4

Long-standing cigarette smoking

located in respiratory bronchioles in upper half of lungs (distal alveoli spared)

Question 5

Characteristic seen in emphysema patients.

Answer 5

Pink puffers

-pink colored blood and vasodilation in subcutaneous tissue

Question 6

Cause and location of Panacinar (Panlobular) emphysema.

Answer 6

Hereditary: homozygous alpha-1 antitrypsin def.

Destruction of entire alveolus in lower half of the lungs

Question 7

Location and features of Paraseptal (Distal Acinar) emphysema.

Answer 7

Distal airways (alveolar sacs and ducts)
Apical bullae are present.

Question 8

Common complication with paraseptal emphysema.

Answer 8

Compression atelectasis caused by pneumothorax (rupture of bullae)

Question 9

What is the criteria for diagnosis of chronic bronchitis?

Answer 9

Persistent cough with lots of sputum for at least 3 months in 2 consecutive years.

Question 10

What are the 3 general types of chronic bronchitis?

Answer 10

1. Simple: no evidence of obstruction
2. Asthmatic: hyperreactive airways
3. Obstructive: associated with emphysema

Question 11

What is the Reid Index?

Answer 11

Ratio of thickness of mucus gland layer to thickness of wall between epithelium and cartilage.
Normal: 0.4
-ratio increases in obstructive disease

Question 12

Major Complication of Chronic Bronchitis.

Answer 12

Recurrent Infection

malignancy also occurs but less frequent

Question 13

What are microscopic findings in early chronic bronchitis and then late chronic bronchitis?

Answer 13

Early: hypertrophy of submucosa glands
Late: goblet cell hyperplasia, squamous cell metaplasia

Question 14

What are the 4 types of asthma?

Answer 14

Atopic
Non-atopic
Occupational
Drug-Induced

Question 15

Describe Atopic Asthma.

Answer 15

Type I Hypersenstivity Rxn

-IgE mediated in response to allergen

Question 16

What is the difference between acute and late atopic asthma?

Answer 16

Acute: just a bronchoconstriction response
Late: airway constriction and epithelial damage

Question 17

What are the major causes of non-atopic, occupational, and drug-induced asthma?

Answer 17

Non-atopic: respiratory infection (IgE is normal)
Occupational: repeated exposure to dust, gas, fumes
Drug-Induced: ASA

Question 18

What is status asthmaticus?

Answer 18

Fatal asthma attack usually with complete airway obstruction. Doesn’t respond to any medications.

Question 19

What are Charcot-Leyden crystals?

Answer 19

Precipitated proteins derived from eosinophils in patients with asthma. Visible on microscopy.

Question 20

What are Curschmann Spirals?

Answer 20

Spiral shaped mucous plugs seen on microscopy in asthma patients. “yarn” appearance

Question 21

General definition of bronchiectasis.

Answer 21

Permanent dilation of airways resulting in “air trapping”.

Question 22

Common causes of acquired bronchiectasis.

Answer 22

Obstruction: tumor, foreign body, inspissated mucous

CF: mucous plugs

Question 23

Most common cause of inherited bronchiectasis.

Answer 23

Kartegener Syndrome

-immotile cilia, situs inversus, male infertility

Question 24

Primary microbe that can cause a hypersensitivity induced bronchiectasis.

Answer 24

Aspergillus fumigatus

• high serum IgE in response to fungus
• high Ab levels

Question 25

Characteristic finding of pleural membranes in lungs with bronchiectasis.

Answer 25

Fused Pleura