Pathology of Obstructive Lung Disease

Question 1

Which three conditions are obstructive airway diseases?

Answer 1

Chronic bronchitis
Emphysema
Asthma

Question 2

Which two conditions together are called COPD?

Answer 2

Chronic bronchitis

Emphysema

Question 3

What is FEV1?

Answer 3

Forced expiratory volume of air exiting the lung in the first second

Question 4

What is FVC?

Answer 4

Final total amount of air expired

Question 5

What percentage of FVC is FEV1 normally?

Answer 5

70-80%

Question 6

What volume is usually expired in FEV1?

Answer 6

3.5-4L

Question 7

What volume is FVC usually?

Answer 7

5L

Question 8

What is the normal ratio of FEV1/FVC?

Answer 8

0.7-0.8

Question 9

What is predicted FVC based on?

Answer 9

Age
Sex
Height

Question 10

What is a marked fall in PEFR?

Answer 10

<50% of best

Question 11

What is the normal range in PEFR?

Answer 11

80-100% of best

Question 12

In obstructive lung disease what happens to PEFR, FEV1 and FVC?

Answer 12

Reduced (FVC might be reduced)

Question 13

What is FEV compared to FVC in obstructive lung disease?

Answer 13

< 70%

Question 14

What is causing narrowing of the airway in bronchial asthma?

Answer 14

Smooth muscle contraction/twitching

Inflammation

Question 15

What are causes of bronchi bronchitis and emphysema?

Answer 15

Smoking
Atmospheric pollution
Occupation: dust
Alpha-1-antitrypisin deficiency (emphysema)

Question 16

How can an individual be susceptible to developing COPD?

Answer 16

How your metabolism handles the chemicals in cigarettes or pollution

Question 17

What is the clinical definition of chronic bronchitis

Answer 17

Cough productive of sputum in 3 consecutive months for 2 or more consecutive years

Question 18

What are some causes which induces mast cells to release chemotactic factors and spasmogens?

Answer 18

Specific IgE
Drugs
Chemicals
Stress
Cold

Question 19

What are the morphological changes that occur in the large airways of chronic bronchitis?

Answer 19

Mucous gland hyperplasia
Goblet cell hyperplasia

Inflammation and fibrosis is a minor component

Question 20

What morphological changes that occur in small airways?

Answer 20

Goblet cells appear

Inflammation and fibrosis in long standing disease

Question 21

What is emphysema?

Answer 21

Increased in the size of the airspaces distal to the terminal bronchiole arising either from dilatation or from destruction of their walls

And without obvious fibrosis

Question 22

What is the terminal bronchiole?

Answer 22

The last conducting airway which is lined by resp. epithelium

Question 23

What is the acinus?

Answer 23

The structure beyond the terminal bronchiole

Question 24

What is centri-acinar emphysema?

Answer 24

Loss of alveolar tissue around the middle of the acinus (around the bronchioles)

Question 25

What is panacinar emphysema?

Answer 25

Destruction of the air spaces (alveoli) distal to respiratory bronchioles

Question 26

What is a bulla?

Answer 26

Emphysematous space > 1cm

Question 27

What causes emphysema?

Answer 27

Smoking
Protease-antiprotease imblance
Ageing
Alpha-1-antitrypsin deficiency

Question 28

What is the effect of alpha-1-antitrypsin deficiency?

Answer 28

Less inhibition of elastase which causes tissue destruction leading to emphysema

Question 29

What is the effect of smoking that leads to emphysema?

Answer 29

Decrease in anti-elastase, therefore increase in elastase
Increase in neutrophils and macrophages which increases elastase
Decrease in repair mechanisms to resynthesis elastin

Question 30

What is the reversible component of COPD?

Answer 30

Smooth muscle tone and inflammation in the small airways respond to pharmacological intervention

Question 31

Why does hypoxaemia arise in COPD?

Answer 31

Airway obstruction
Reduced respiratory drive
Loss of alveolar surface area
Only during acute infective exacerbation

Question 32

What does hypoxaemia due to low V/Q respond well to?

Answer 32

Small increase in FlO2