Respiratory: Chornic obstructive

Question 1

What characterizes chronic obstructive disease

Answer 1

lung does not empty

-air is trapped

Question 2

what values are changed in spirometry for obstructive lung disease

Answer 2

decrease FEV and FEV1 ( FEV1 is decreased more)

Increase TLC

Question 3

Define chronic bronchitis

Answer 3

productive cough lasting at least 3 months over a minimum of 2 years

Question 4

chronic bronchitis is highly associated with what habit

Answer 4

smoking

Question 5

what characterizes chronic bronchitis

Answer 5

hypertrophy of bronchial mucinous glands

• increased thickness of mucus glands relative to bronchial wall thickness
• Reid index increases to greater 50%

Question 6

what are 3 clinical features of chronic bronchitis

Answer 6

1. productive cough with excessive mucus production
2. cyanosis ‘blue bloaters’
3. increase risk for infection and cor pulmonale

Question 7

why does cyanosis ‘blue bloaters’ occur in chronic bronchitis

Answer 7

mucus plugs trap carbon dioxide

increase PaCO2 and decrease PaO2

Question 8

Define emphysema

Answer 8

destruction of alveolar air sacs

Question 9

what happens during exhalation in emphysema

Answer 9

loss of elastic recoil and collapse of airways

- results in obstruction and air trapping

Question 10

In emphysema why do the alveolar air sacs collapse

Answer 10

imbalance of proteases and antiproteases

Question 11

who and what gets released during normal inflammation of the lung

Answer 11

neutrophils and macrophages release proteases

Question 12

what neutralizes porteases

Answer 12

alpha1-antitrypsin

Question 13

how is the protease and antiprotease imbalanced in emphysema

Answer 13

excessive inflammation - increase protease

lack of alpha1-antitrypsin

Question 14

what is the most common cause of emphysema

Answer 14

smoking

Question 15

how does smoking cause emphysema

Answer 15

• excessive inflammation

- protease mediated damage

Question 16

what does emphysema from smoking result in

Answer 16

centriacinar emphysema

upper lobe

Question 17

what is a rare cause of emphysema

Answer 17

A1At deficiency

Question 18

how does A1AT cause emphysema

Answer 18

• lack of antiprotease

Question 19

what results from A1At emphysema

Answer 19

panacinar emphysema

lower lobes

Question 20

what other clinical findings would you find for someone who has A1AT emphysema? why?

Answer 20

liver cirrhosis

• A1AT deficiency due to misfolding of mutated protein
• mutant A1At accumulates in endoplasmic reticulum of hepatocytes,
• liver damage

Question 21

what does biopsy of liver cirrhosis show in an A1AT deficient person

Answer 21

reveals pink, PAS-positive globules in hepatocytes

Question 22

what is the severity of A1AT based on

Answer 22

degree of A1AT deficiency

Question 23

what is the normal allele for A1AT

Answer 23

PiM

Question 24

what is the most common clinically relevant mutation in A1AT

Answer 24

PiZ

Question 25

What alleles are usually asymptomatic with decreased circulating levels of A1AT

Answer 25

PiMZ heterozygotes

Question 26

PiMZ heterozygotes have a significant risk for emphysema if they do what

Answer 26

smoke!

Question 27

what allele are at significant risk for panacinar emphysema and cirrhosis

Answer 27

PiZZ homozygotes

Question 28

what are 5 clinical features of emphysema

Answer 28

1. dyspnea and cough with minimal sputum 2. prolonged expiration and pursed lips 3. weight loss 4. increase A/P diameter of chest ( 'barrel-chest') 5. hypoxemia and cor pulmonale ( both late complications)

Question 29

why would hypoxemia occur in emphysema

Answer 29

destruction of capillaries in alveolar sac

Question 30

What asthma and is the most likely cause

Answer 30

reversible airway bronchoconstriction | - allergic stimuli ( atopic asthma)

Question 31

when does asthma usually present and what is asthma associated with

Answer 31

- in childhood | - allergic rhinitis, eczema, family history of atopy

Question 32

Asthma is what type of hypersensitivity

Answer 32

type I hypersensitivity

Question 33

In asthma, allergens induces what response and in what type of individuals

Answer 33

Th2 phenotype in CD4+ T cells | - genetically susceptible individuals

Question 34

in Asthma, Th2 cells secrete what

Answer 34

IL4 IL5 IL10

Question 35

role of IL4

Answer 35

mediates class switch to IgE

Question 36

role of IL5

Answer 36

attracts eosinophils

Question 37

role of IL10

Answer 37

stimulates Th2 cells and inhibits Th1

Question 38

in asthma, re-exposure to allergen leads to what

Answer 38

IgE-mediated activation of mast cells

Question 39

When mast cells are activated by IgE what do they release

Answer 39

- preformed histamine granules | - generation of leukotrienes C4, D4, E4

Question 40

Leukotirienes C4, D4 and E4 causes what

Answer 40

bronchocontriction, inflammation, and edema ( early-phase reaction)

Question 41

What is the late-phase reaction to mast cells that are activated by IgE in asthma

Answer 41

inflammation | -especially major basic protein derived from eosinophils, damaged cells and perpetuates bornchocontraction

Question 42

When do clinical features present for asthma

Answer 42

episodic, | related to allergen exposure

Question 43

what are clinical features of asthma

Answer 43

dyspnea wheezing productive cough status asthmaticus

Question 44

describe the productive cough in asthma

Answer 44

spiral-shaped mucus plugs (Curschmann spirals) | eosinophil-derived crystals ( charcot-Leyden crystals)

Question 45

what is status asthmaticus and what can it lead to

Answer 45

severe, unrelenting attack | can lead to death

Question 46

what are some non-allergic causes of asthma

Answer 46

exercise viral infection aspirin (aspirin-intolerant asthma) occupational exposures

Question 47

What is bronchiectasis

Answer 47

permanent dilatation of bronchioles and bronchi | - loss of airway tone results in air trapping

Question 48

what is the common pathological cause for bronchiectasis

Answer 48

necrotizing inflammation with damage to airway

Question 49

what are specific causes of bronchiectasis

Answer 49

``` cystic fibrosis Kartagener syndrome tumor or foreign body necrotizing infection allergic bronchopulmonary aspergillosis ```

Question 50

what is Kartagener syndrome

Answer 50

inherited defect of dynein arm, necessary for cilliary movement

Question 51

Kartagener syndrome is associated with what other complications

Answer 51

sinusitis infertility (poor motility of sperm) situs inversus (position of major organs is reversed ex. heart is on right side of thorax)

Question 52

What is allergic bronchopulomary aspergillosis

Answer 52

hypersensitivity reaction to Aspergillus

Question 53

what does bronchopulmonary aspergillosis lead to

Answer 53

chronic inflammatory damage

Question 54

who is bronchopulomary aspergillosis usually seen in

Answer 54

asthma or cystic fibrosis

Question 55

what are clinical features of Bronchiectasis

Answer 55

cough dyspnea foul-smelling sputum

Question 56

what are complications of Bronchiectasis

Answer 56

hypoxemia with cor pulmonale | secondary amyloidosis