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Pathoma Bina > Respiratory: Chornic obstructive > Flashcards

Respiratory: Chornic obstructive Flashcards

1
Q

What characterizes chronic obstructive disease

A

lung does not empty

-air is trapped

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2
Q

what values are changed in spirometry for obstructive lung disease

A

decrease FEV and FEV1 ( FEV1 is decreased more)

Increase TLC

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3
Q

Define chronic bronchitis

A

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

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4
Q

chronic bronchitis is highly associated with what habit

A

smoking

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5
Q

what characterizes chronic bronchitis

A

hypertrophy of bronchial mucinous glands

  • increased thickness of mucus glands relative to bronchial wall thickness
  • Reid index increases to greater 50%
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6
Q

what are 3 clinical features of chronic bronchitis

A
  1. productive cough with excessive mucus production
  2. cyanosis ‘blue bloaters’
  3. increase risk for infection and cor pulmonale
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7
Q

why does cyanosis ‘blue bloaters’ occur in chronic bronchitis

A

mucus plugs trap carbon dioxide

increase PaCO2 and decrease PaO2

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8
Q

Define emphysema

A

destruction of alveolar air sacs

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9
Q

what happens during exhalation in emphysema

A

loss of elastic recoil and collapse of airways

- results in obstruction and air trapping

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10
Q

In emphysema why do the alveolar air sacs collapse

A

imbalance of proteases and antiproteases

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11
Q

who and what gets released during normal inflammation of the lung

A

neutrophils and macrophages release proteases

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12
Q

what neutralizes porteases

A

alpha1-antitrypsin

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13
Q

how is the protease and antiprotease imbalanced in emphysema

A

excessive inflammation - increase protease

lack of alpha1-antitrypsin

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14
Q

what is the most common cause of emphysema

A

smoking

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15
Q

how does smoking cause emphysema

A
  • excessive inflammation

- protease mediated damage

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16
Q

what does emphysema from smoking result in

A

centriacinar emphysema

upper lobe

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17
Q

what is a rare cause of emphysema

A

A1At deficiency

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18
Q

how does A1AT cause emphysema

A
  • lack of antiprotease
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19
Q

what results from A1At emphysema

A

panacinar emphysema

lower lobes

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20
Q

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

A

liver cirrhosis

  • A1AT deficiency due to misfolding of mutated protein
  • mutant A1At accumulates in endoplasmic reticulum of hepatocytes,
  • liver damage
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21
Q

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

A

reveals pink, PAS-positive globules in hepatocytes

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22
Q

what is the severity of A1AT based on

A

degree of A1AT deficiency

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23
Q

what is the normal allele for A1AT

A

PiM

24
Q

what is the most common clinically relevant mutation in A1AT

A

PiZ

25
Q

What alleles are usually asymptomatic with decreased circulating levels of A1AT

A

PiMZ heterozygotes

26
Q

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

A

smoke!

27
Q

what allele are at significant risk for panacinar emphysema and cirrhosis

A

PiZZ homozygotes

28
Q

what are 5 clinical features of emphysema

A
  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)
29
Q

why would hypoxemia occur in emphysema

A

destruction of capillaries in alveolar sac

30
Q

What asthma and is the most likely cause

A

reversible airway bronchoconstriction

- allergic stimuli ( atopic asthma)

31
Q

when does asthma usually present and what is asthma associated with

A
  • in childhood

- allergic rhinitis, eczema, family history of atopy

32
Q

Asthma is what type of hypersensitivity

A

type I hypersensitivity

33
Q

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

A

Th2 phenotype in CD4+ T cells

- genetically susceptible individuals

34
Q

in Asthma, Th2 cells secrete what

A

IL4
IL5
IL10

35
Q

role of IL4

A

mediates class switch to IgE

36
Q

role of IL5

A

attracts eosinophils

37
Q

role of IL10

A

stimulates Th2 cells and inhibits Th1

38
Q

in asthma, re-exposure to allergen leads to what

A

IgE-mediated activation of mast cells

39
Q

When mast cells are activated by IgE what do they release

A
  • preformed histamine granules

- generation of leukotrienes C4, D4, E4

40
Q

Leukotirienes C4, D4 and E4 causes what

A

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

41
Q

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

A

inflammation

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

42
Q

When do clinical features present for asthma

A

episodic,

related to allergen exposure

43
Q

what are clinical features of asthma

A

dyspnea
wheezing
productive cough
status asthmaticus

44
Q

describe the productive cough in asthma

A

spiral-shaped mucus plugs (Curschmann spirals)

eosinophil-derived crystals ( charcot-Leyden crystals)

45
Q

what is status asthmaticus and what can it lead to

A

severe, unrelenting attack

can lead to death

46
Q

what are some non-allergic causes of asthma

A

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

47
Q

What is bronchiectasis

A

permanent dilatation of bronchioles and bronchi

- loss of airway tone results in air trapping

48
Q

what is the common pathological cause for bronchiectasis

A

necrotizing inflammation with damage to airway

49
Q

what are specific causes of bronchiectasis

A 
cystic fibrosis
Kartagener syndrome 
tumor or foreign body
necrotizing infection
allergic bronchopulmonary aspergillosis
50
Q

what is Kartagener syndrome

A

inherited defect of dynein arm, necessary for cilliary movement

51
Q

Kartagener syndrome is associated with what other complications

A

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

52
Q

What is allergic bronchopulomary aspergillosis

A

hypersensitivity reaction to Aspergillus

53
Q

what does bronchopulmonary aspergillosis lead to

A

chronic inflammatory damage

54
Q

who is bronchopulomary aspergillosis usually seen in

A

asthma or cystic fibrosis

55
Q

what are clinical features of Bronchiectasis

A

cough
dyspnea
foul-smelling sputum

56
Q

what are complications of Bronchiectasis

A

hypoxemia with cor pulmonale

secondary amyloidosis

Pathoma Bina (38 decks)

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