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CVPR Pulmonary (Exam 3) > Pathoma- COPD > Flashcards

Pathoma- COPD Flashcards

1
Q

DX? chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking

A

chronic bronchitis

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2
Q

What does the submucosa contain?

A

serous glands (produce serous fluid) and mucinous glands (to produce mucous)

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2
Q

What are chronic bronchitis pts at risk for?

A

Increased infections and cor pulmonale

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2
Q

What is panacinar emphysema? Where is it most severe?

A

emphysema across the whole acinus, usu associated with alpha-1-antitrypsin deficiency. most severe in the lower lobes

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2
Q

What is the pathogenesis of asthma?

A

genetically-susceptible pt is exposed to an allergen that induces TH2 phenotype in CD4+ cells

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3
Q

What syndrome is a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus, and lung infections?

A

Kartagener Syndrome

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5
Q

What will the spirometry findings be in obstructive diseases?

A
  • decreased FVC
  • very decreased FEV1
  • decreased FEV1:FVC ratio
  • increased TLC (air trapping)
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5
Q

Histamine-induced vasodilation occurs at?

A

the arterioles

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6
Q

What is a normal TLC?

A

7L

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6
Q

What is under the lamina propria?

A

the submucosa

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6
Q
  • DX?
  • dyspnea cough w/ minimal sputum
  • prolonged expriration, breathing thru pursed lips
  • weight loss
  • increased AP diameter of chest (barrel chested)
A

emphysema

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7
Q

How do bronchioles stay open without cartilage?

A

they have elastic recoil

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7
Q

_____ are a byproduct of inflammation; ______ proteins protect against this.

A

Proteases; antiproteases

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8
Q

What is below the submucosa?

A

cartilage

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8
Q

Nasal polyps are associated with?

A
  1. chronic rhinitis 2. aspirin intolerant asthma 3. cystic fibrosis
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9
Q

What is the normal A1AT allele? What is the mutated allle?

A

PiM; PiZ

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10
Q

What cell protects the bottom of the lung?

A

the alveolar mac

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10
Q

What are the clinical features of bronchiectasis?

A
  • SOB
  • cough with foul-smelling sputum
  • complications: hypoxemia, cor pulmonale, 2a amyloidosis
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11
Q

What are the features of chronic bronchitis?

A

chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking increased thickness of mucus glands Reid index >50% cyanosis

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11
Q

What does IL5 do?

A

attracts eosinphils

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12
Q

What is an acinus?

A

the functional unit of the lung

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13
Q

What is the obstruction in emphysema?

A

collapsed bronchioles that have lost their elastic recoil

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15
Q

What is a normal FEV1?

A

4L

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16
Q

PAO2 creates a pressure that _____, which is then denoted PaO2.

A

pushes O2 into the BVs

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16
Q

What are 2 late complications of emphysema?

A
  1. hypoxemia 2. cor pulmonale
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17
Q

What is allergic bronchopulmnary aspergilliosis?

A

a hypersensitivity rxn to aspergillis in asthmatics and CF pts

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18
Q

What causes the obstruction in chronic bronchitis?

A

mucous

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20
Q

What is a normal FEV1:FVC ratio?

A

80%

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20
Q

What are the features of chronic bronchitis?

A
  • chronic, productive cough lasting at least 3 months over a minimum of 2 years
  • highly assoc with smoking
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20
Q

What is the obstruction in bronchiectasis?

A

enlarged airways- can’t force the air out

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21
Q

What is the average volume of air expired?

A

5L

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23
Q

A decreased FEV1:FVC ratio is indicative of _____.

A

obstructive lung disorders

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24
Q

What are the features of chronic bronchitis?

A

chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking increased thickness of mucus glands Reid index >50%

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24
Q

What are the 2 major types of emphysema?

A
  1. centriacinar emphysema 2. panacinar emphysema
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25
Q

What are the features of bronchiectasis?

A

permanent dilation of bronchioles and bronchi loss of airway tone –> air trapping

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25
Q

This is a hypersensitivity rxn to aspergillis in asthmatics and CF pts.

A

allergic bronchopulmnary aspergilliosis

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27
Q

How is lung volume and function measured?

A

spirometry

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28
Q
  • DX?
  • destruction of the alveolar air sacs
  • loss of elastic recoil
  • collapse of small airways
  • air trapping
A

emphysema

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29
Q

Obstructive disease means ____.

A

there’s trouble getting air OUT of the lung

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31
Q

What is mucous in the lungs for?

A

it traps allergens and irritants, foreign material

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31
Q

Describe the histological findings of a liver with A1AT deficiency.

A

pink or purple, PAS positive, globules in hepatocytes

32
Q

What also is often present with panacinar emphysema?

A

liver cirrhosis

34
Q

Increased PaCO2 automatically means _____.

A

the PAO2 and PaO2 will go down

35
Q

What are the 4 obstructive lung diseases?

A
  1. Chronic bronchitis
  2. emphysema
  3. asthma
  4. bronchiectasis
36
Q

In asthma, IgE activates _____.

A

mast cells

37
Q

What diseases are associated with bronchiectasis?

A
  • CF
  • Kartagener Syndrome
  • Tumor of Foreign Body
  • Necrotizing infection
  • Allergic bronchopulmonary aspergillosis
39
Q

What is the difference between a bronchus and a bronchiole?

A

there’s no cartilage in a bronchiole

40
Q

What does TLC stand for? What is it?

A

total lung capacity; the maximum amount of air that can be w/I the lungs

40
Q

What are the features of asthma?

A

reversible airway bronchoconstriction usu caused by type I hypersensitivity rxn assoc with rhinitis, eczema

41
Q

What is serous fluid for?

A

to humidify the air to enter the alveoli

43
Q

What is centriacinar emphysema?

A

destruction of the central part of the acinus due to smoking

44
Q

Why is TLC increased in obstructive disease?

A

air is trapped

44
Q

_____ with _____ causes bronchiectasis.

A

Necrotisin inflammation with damage to the airway wall

45
Q

What is the functional residual capacity (FRC)?

A

the balance of the expanding chest wall vs the collapsing elastin in the lung

46
Q

What is a severe, unrelenting asthma attack that can lead to death called?

A

status asthmaticus

48
Q

What kind of cells make up the respiratory epithelium?

A

ciliated pseudostratified columnar cells

49
Q

What is status asthmaticus?

A

a severe, unrelenting asthma attack that can lead to death

50
Q

What kinds of emphysema do smokers get? Where is it worst?

A

centriacinar emphysema, usually most severe in the upper lobes

50
Q

What is secondary amyloidosis? Which lung disease is associated with it?

A

SAA proteins depositing as AA; bronchiectasis

51
Q

What is the obstruction in asthma?

A

bronchoconstriction

52
Q

Which cytokine attracts eosinphils?

A

IL5

54
Q

What is the most common cause of emphysema?

A

smoking

55
Q

What is the Reid index?

A

a measure of the percent of mucous glands making up the wall thickness

56
Q

In normal lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).

A

40% or less

57
Q

Histamine-induced increased vascular permeability occurs at?

A

the post-capillary venules

57
Q

What is the 2nd phase mast cells do to perpetuate inflammation?

A

produce leukotrienes (C4, D4, and E4)

58
Q
  • DX?
  • permanent dilation of bronchioles and bronchi
  • loss of airway tone –> air trapping
A

bronchiectasis

59
Q

In fibrosis of the lung, the FRC is ______.

A

decreased

60
Q

Which cytokine stimulates TH2 production while inhibiting TH1s?

A

IL10

61
Q

In normal lungs, the mucinous glands take up _____ of the wall thickness.

A

40% or less

61
Q

What does IL10 do?

A

inhibits TH1 cell and increase TH2 cells

62
Q

In a smoker’s lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).

A

>50%

64
Q

Smokers produce large amounts of ____ in their lungs.

A

mucous

66
Q

What does FVC stand for and what does it mean?

A

forced vital capacity- the maximum amount of air expired after a maximal inspiration

68
Q

Why is TLC increased in obstructive disease?

A

air is trapped in the lungs

69
Q

What are Charcot-Leyden crystals? Where do they come from?

A

crystals coughed up in the sputum of asthmatics; made by eosinophils

71
Q

What also is often present with panacinar emphysema?

A

liver cirrhosis

73
Q

In emphysema, there is an imbalance between ____ and _____.

A

proteases and antiproteases

74
Q

Alpha-1-antitrypsin deficiency is the cause of the rare ______ emphysema.

A

panacinar

75
Q

Why does obstruction cause increased infections?

A

bc you are plugging up a tube, increasing infection propensity

76
Q

Name 4 nonallergic causes of asthma.

A
  1. exercise 2. viral infections 3. aspirin 4. occupational exposures
77
Q

What is Kartagener Syndrome?

A

a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus

79
Q

What does FEV1 stand for and what does it mean?

A

Forced expiratory volume 1; the max amount of air expired after 1 second after a maximal inspiration

80
Q

What are the clinical features of asthma?

A

SOB, wheezing productive cough with Curshmann spirals mixed with Charcot-Leyden crystals

81
Q

What underlies the BM under the epi of the lung?

A

the lamina propria

83
Q

What is found in the lamina propria?

A

large BVs called venules

85
Q

Which cytokine allows plasma cells to class switch to IgE?

A

IL4

86
Q

What are antiproteases?

A

proteins, such as alpha-1-antitrypsin, that protect against proteases (inflammation)

87
Q

In emphysema, the FRC is ______.

A

increased

89
Q

Why are emphysemics called pink puffers?

A

slow breathing with pursed lips (increased back pressure)opens walls of the alveoli- pink bc they are oxygenating

90
Q

Mast cells release their preformed ______ granules, causing ______ and _____.

A

histamine; vasodilation, increased vascular permeability

92
Q

Where does mutated A1AT deficiency accumulate to cause problems in the liver? What does this cause?

A

in the ER of hepatocytes; cirrhosis

93
Q

What do TH2 cells secrete?

A

IL4, IL5, IL10

94
Q

What is the other cause of emphysema, behind smoking?

A

alpha-1-antitrypsin deficiency

95
Q

What are the clinical features of emphysema?

A
  • dyspnea
  • breathing thru pursed lips
  • barrel chested
96
Q
  • DX?
  • chronic, productive cough lasting at least 3 months over a minimum of 2 years
  • highly assoc with smoking
  • increased thickness of mucus glands
  • Reid index >50%
A

chronic bronchitis

97
Q

What does IL4 do?

A

allows plasma cell to class switch to IgE

98
Q

What is a normal FVC?

A

5L

99
Q

What do leukotrienes do?

A

cause increased vasodilation, increased vascular permeability, and bronchoconstriction

100
Q

The ____ will be decreased more than _____ in obstructive lung disease.

A

FEV1; FVC

CVPR Pulmonary (Exam 3) (42 decks)

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