Pathology: Obstructive Lung Disease 1

Question 1

Obstructive lung disease includes which 4 diseases?

Answer 1

1. Emphysema
2. Chronic bronchitis
3. Asthma
4. Bronchiectasis

Question 2

Obstructive disease patients have a _______ (increased/decreased) FEV₁/FVC, whereas Restrictive disease has _______ (increased/decreased) FEV₁/FVC.

Answer 2

• decreased
• increased

Question 3

FEV₁/FVC

Answer 3

Air exhaled forcibly after maximal inhalation/ total volume of air forcibly expelled after maximal inhalation

Question 4

Restrictive pulmonary disease is a reduced ___________

Answer 4

Expansion of lung parenchyma

(proportional decrease in both TLC & FEV₁)

Question 5

3 Causes of restrictive lung disease

Answer 5

1. NM disease (i.e. Kyphoscoliosis)
2. Pleural disease
3. Interstitial or infiltrative lung disease (i.e. sarcoidosis, pneumoconiosis)

Question 6

TLC = ______ + _____

Answer 6

FVC + RV

Question 7

Define emphysema

Answer 7

Irreversible enlargement of air spaces distal to the terminal bronchioles due to destruction of their walls

Question 8

Classification of emphysema

(2 most clinically relevant)

Answer 8

1. Centriacinar (~95% of cases)
2. Panacinar

(less common: Paraseptal, Irregular)

Question 9

Centriacinar (centrilobular emphysema) occurs predominantly in ________ and is often associated with _______.

Answer 9

• heavy smokers
• chronic bronchitis

Question 10

Panacinar (panlobular) emphysema is typically associated with _______

Answer 10

a₁ antitrypsin deficiency

Question 11

What is the anatomic location affected by centrilobular emphysema? panacinar (panlobular) emphysema?

Answer 11

• centriacinar: upper lobes (distal alveoli spared)
• panacinar: entire acinus; terminal blind alveoli

Question 12

Answer 12

centrilobular (centriacinar) emphysema

Question 13

Answer 13

Panacinar (panlobular): all are spaces throughout the acinus are enlarged

Question 14

Answer 14

emphysema

(note top: normal lung section)

Question 15

Answer 15

centriacinar emphysema

Question 16

Distal acinar paraseptal emphysema predominantly involves which portion of the acinus?

Answer 16

distal

(adjacent to atelectasis/alveoli collapse)

Question 17

Distal acinar paraseptal emphysema is it common cause of _______

Answer 17

spontaneous pneumothorax

Question 18

Irregular emphysema is associated with _______ (2).

(typically symptomatic and clinically insignificant)

Answer 18

Foci and fibrosis

Question 19

Describe the Proteolysis-antiproteolysis Theory

Answer 19

Question 20

Emphysema clinical findings (5)

Answer 20

1. Prolonged expiratory phase (decreased elastic recoil)
2. Tachypneic, Progressive dyspnea
3. “Pink puffers”
4. “Barrel chest”
5. Weight loss (increased energy to breath)

(no coughing or sputum)

Question 21

Answer 21

blebs or bullae in bullous emphysema

(this can rupture → pneumothorax)

Question 22

Define chronic bronchitis

Answer 22

Persistent cough with sputum production

(3 months in at least 2 consecutive years)

Question 23

Cause of chronic bronchitis in 90% of patients

Answer 23

Smoking

Question 24

Describe the development of chronic bronchitis with small Airway obstruction

Answer 24

Question 25

What are the key physiological findings of chronic bronchitis (3)?

Answer 25

1. Hyperplasia/hypertrophy of mucous glands 2. Inflammation: lymphocytes & MF 3. Squamous metaplasia (no cilia → impairs mucous removal) (similar to asthma, but asthma has hypertrophied smooth muscle)

Question 26

Reid index = \_\_\_\_\_\_\_

Answer 26

submucosa/thickness from epithelium to cartilage (abnormal \> 0.5)

Question 27

Reid index for chronic bronchitis

Answer 27

\>0.5

Question 28

Describe the clinical findings of chronic bronchitis (4)

Answer 28

1. Persistent cough w/sputum 2. pulmonary infection 3. SOB w/exertion 4. Hypercapnia/hypoxemia w/cyanosis ("blue bloater") (some develop emphysema, “bloater” due to development of cor pulmonale)