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
2
Q
What does the submucosa contain?
A
serous glands (produce serous fluid) and mucinous glands (to produce mucous)
2
Q
What are chronic bronchitis pts at risk for?
A
Increased infections and cor pulmonale
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
2
Q
What is the pathogenesis of asthma?
A
genetically-susceptible pt is exposed to an allergen that induces TH2 phenotype in CD4+ cells
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
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)
5
Q
Histamine-induced vasodilation occurs at?
A
the arterioles
6
Q
What is a normal TLC?
A
7L
6
Q
What is under the lamina propria?
A
the submucosa
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
7
Q
How do bronchioles stay open without cartilage?
A
they have elastic recoil
7
Q
_____ are a byproduct of inflammation; ______ proteins protect against this.
A
Proteases; antiproteases
8
Q
What is below the submucosa?
A
cartilage
8
Q
Nasal polyps are associated with?
A
- chronic rhinitis 2. aspirin intolerant asthma 3. cystic fibrosis
9
Q
What is the normal A1AT allele? What is the mutated allle?
A
PiM; PiZ
10
Q
What cell protects the bottom of the lung?
A
the alveolar mac
10
Q
What are the clinical features of bronchiectasis?
A
- SOB
- cough with foul-smelling sputum
- complications: hypoxemia, cor pulmonale, 2a amyloidosis
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
11
Q
What does IL5 do?
A
attracts eosinphils
12
Q
What is an acinus?
A
the functional unit of the lung
13
Q
What is the obstruction in emphysema?
A
collapsed bronchioles that have lost their elastic recoil
15
Q
What is a normal FEV1?
A
4L
16
Q
PAO2 creates a pressure that _____, which is then denoted PaO2.
A
pushes O2 into the BVs
16
What are 2 late complications of emphysema?
1. hypoxemia 2. cor pulmonale
17
What is allergic bronchopulmnary aspergilliosis?
a hypersensitivity rxn to aspergillis in asthmatics and CF pts
18
What causes the obstruction in chronic bronchitis?
mucous
20
What is a normal FEV1:FVC ratio?
80%
20
What are the features of chronic bronchitis?
* chronic, productive cough lasting at least 3 months over a minimum of 2 years
* highly assoc with smoking
20
What is the obstruction in bronchiectasis?
enlarged airways- can't force the air out
21
What is the average volume of air expired?
5L
23
A decreased FEV1:FVC ratio is indicative of \_\_\_\_\_.
obstructive lung disorders
24
What are the features of chronic bronchitis?
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%
24
What are the 2 major types of emphysema?
1. centriacinar emphysema 2. panacinar emphysema
25
What are the features of bronchiectasis?
permanent dilation of bronchioles and bronchi loss of airway tone --\> air trapping
25
This is a hypersensitivity rxn to aspergillis in asthmatics and CF pts.
allergic bronchopulmnary aspergilliosis
27
How is lung volume and function measured?
spirometry
28
* DX?
* destruction of the alveolar air sacs
* loss of elastic recoil
* collapse of small airways
* air trapping
emphysema
29
Obstructive disease means \_\_\_\_.
there's trouble getting air OUT of the lung
31
What is mucous in the lungs for?
it traps allergens and irritants, foreign material
31
Describe the histological findings of a liver with A1AT deficiency.
pink or purple, PAS positive, globules in hepatocytes
32
What also is often present with panacinar emphysema?
liver cirrhosis
34
Increased PaCO2 automatically means \_\_\_\_\_.
the PAO2 and PaO2 will go down
35
What are the 4 obstructive lung diseases?
1. Chronic bronchitis
2. emphysema
3. asthma
4. bronchiectasis
36
In asthma, IgE activates \_\_\_\_\_.
mast cells
37
What diseases are associated with bronchiectasis?
* CF
* Kartagener Syndrome
* Tumor of Foreign Body
* Necrotizing infection
* Allergic bronchopulmonary aspergillosis
39
What is the difference between a bronchus and a bronchiole?
there's no cartilage in a bronchiole
40
What does TLC stand for? What is it?
total lung capacity; the maximum amount of air that can be w/I the lungs
40
What are the features of asthma?
reversible airway bronchoconstriction usu caused by type I hypersensitivity rxn assoc with rhinitis, eczema
41
What is serous fluid for?
to humidify the air to enter the alveoli
43
What is centriacinar emphysema?
destruction of the central part of the acinus due to smoking
44
Why is TLC increased in obstructive disease?
air is trapped
44
\_\_\_\_\_ with _____ causes bronchiectasis.
Necrotisin inflammation with damage to the airway wall
45
What is the functional residual capacity (FRC)?
the balance of the expanding chest wall vs the collapsing elastin in the lung
46
What is a severe, unrelenting asthma attack that can lead to death called?
status asthmaticus
48
What kind of cells make up the respiratory epithelium?
ciliated pseudostratified columnar cells
49
What is status asthmaticus?
a severe, unrelenting asthma attack that can lead to death
50
What kinds of emphysema do smokers get? Where is it worst?
centriacinar emphysema, usually most severe in the upper lobes
50
What is secondary amyloidosis? Which lung disease is associated with it?
SAA proteins depositing as AA; bronchiectasis
51
What is the obstruction in asthma?
bronchoconstriction
52
Which cytokine attracts eosinphils?
IL5
54
What is the most common cause of emphysema?
smoking
55
What is the Reid index?
a measure of the percent of mucous glands making up the wall thickness
56
In normal lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).
40% or less
57
Histamine-induced increased vascular permeability occurs at?
the post-capillary venules
57
What is the 2nd phase mast cells do to perpetuate inflammation?
produce leukotrienes (C4, D4, and E4)
58
* DX?
* permanent dilation of bronchioles and bronchi
* loss of airway tone --\> air trapping
bronchiectasis
59
In fibrosis of the lung, the FRC is \_\_\_\_\_\_.
decreased
60
Which cytokine stimulates TH2 production while inhibiting TH1s?
IL10
61
In normal lungs, the mucinous glands take up _____ of the wall thickness.
40% or less
61
What does IL10 do?
inhibits TH1 cell and increase TH2 cells
62
In a smoker's lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).
\>50%
64
Smokers produce large amounts of ____ in their lungs.
mucous
66
What does FVC stand for and what does it mean?
forced vital capacity- the maximum amount of air expired after a maximal inspiration
68
Why is TLC increased in obstructive disease?
air is trapped in the lungs
69
What are Charcot-Leyden crystals? Where do they come from?
crystals coughed up in the sputum of asthmatics; made by eosinophils
71
What also is often present with panacinar emphysema?
liver cirrhosis
73
In emphysema, there is an imbalance between ____ and \_\_\_\_\_.
proteases and antiproteases
74
Alpha-1-antitrypsin deficiency is the cause of the rare ______ emphysema.
panacinar
75
Why does obstruction cause increased infections?
bc you are plugging up a tube, increasing infection propensity
76
Name 4 nonallergic causes of asthma.
1. exercise 2. viral infections 3. aspirin 4. occupational exposures
77
What is Kartagener Syndrome?
a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus
79
What does FEV1 stand for and what does it mean?
Forced expiratory volume 1; the max amount of air expired after 1 second after a maximal inspiration
80
What are the clinical features of asthma?
SOB, wheezing productive cough with Curshmann spirals mixed with Charcot-Leyden crystals
81
What underlies the BM under the epi of the lung?
the lamina propria
83
What is found in the lamina propria?
large BVs called venules
85
Which cytokine allows plasma cells to class switch to IgE?
IL4
86
What are antiproteases?
proteins, such as alpha-1-antitrypsin, that protect against proteases (inflammation)
87
In emphysema, the FRC is \_\_\_\_\_\_.
increased
89
Why are emphysemics called pink puffers?
slow breathing with pursed lips (increased back pressure)opens walls of the alveoli- pink bc they are oxygenating
90
Mast cells release their preformed ______ granules, causing ______ and \_\_\_\_\_.
histamine; vasodilation, increased vascular permeability
92
Where does mutated A1AT deficiency accumulate to cause problems in the liver? What does this cause?
in the ER of hepatocytes; cirrhosis
93
What do TH2 cells secrete?
IL4, IL5, IL10
94
What is the other cause of emphysema, behind smoking?
alpha-1-antitrypsin deficiency
95
What are the clinical features of emphysema?
* dyspnea
* breathing thru pursed lips
* barrel chested
96
* 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%
chronic bronchitis
97
What does IL4 do?
allows plasma cell to class switch to IgE
98
What is a normal FVC?
5L
99
What do leukotrienes do?
cause increased vasodilation, increased vascular permeability, and bronchoconstriction
100
The ____ will be decreased more than _____ in obstructive lung disease.
FEV1; FVC
