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2 - CPR (pulmonary) > Respiratory Pathology - 2 > Flashcards

Respiratory Pathology - 2 Flashcards

1
Q

What is the primary description for Restrictive Lung Diseases?

A

DECREASED VOLUME

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2
Q

What is the primary description for Obstructive Lung Diseases?

A

AIR TRAPPING

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3
Q

FEV1/FVC ratio for Restrictive and Obstructive Lung Diseases

A

Restrictive - Normal

Obstructive - Decreased

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4
Q

FVC for Restrictive Lung Diseases is ____

A

Decreased

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5
Q

FEV1 for Obstructive Lung Diseases is ____

A

Decreased

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6
Q

What are 3 Obstructive Lung Diseases?

A

Chronic Bronchitis
Emphysema
Asthmas

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7
Q

Obstructive lung diseases are most often caused by?

A

Smoking

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8
Q

How is Chronic Bronchitis diagnosed?

A

Persistent cough with sputum production for 3 months out of 2 consecutive years

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9
Q

What is the pathophysiologic mechanism for Chronic Bronchitis?

A

Mucus gland hyperplasia –> Damaged epithelium

= Increased mucus and thickened muscle

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10
Q

What is the pathophysiologic mechanism for Chronic Bronchitis?

A

Mucus gland hyperplasia –> Damaged epithelium

= Increased mucus and thickened muscle

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11
Q

What is the term used to describe Chronic Bronchitis patients clinically?

A

Blue Bloaters

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12
Q

Blue Bloaters

A
  • Chronic Bronchitis

= Overweight and Cyanotic, increased hemoglobin and peripheral edema, rhonchi and wheezing

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13
Q

A patient presents as overweight, cyanotic, increased hemoglobin, peripheral edema and with rhonchi and wheezes. What is the likely diagnosis?

A

Chronic Bronchitis

– Blue Bloater

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14
Q

Why do Chronic Bronchitis patients have elevated hemoglobin?

A

Smoking induces carboxy hemoglobin which shifts the O2 dissociation curve to the LEFT and the compensation is to create more hemoglobin

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15
Q

What is Emphysema?

A

Irreversible air space enlargement DISTAL to terminal bronchiole

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16
Q

Air space enlargement distal to terminal bronchiole

A

Emphysema

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17
Q

What are the 2 most common types of Emphysema?

A

Centrilobar - enlargement of resp. bronchioles only

Panlobar/Panacinar - enlargement all distally

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18
Q

What type of emphysema usually presents with smokers that have chronic bronchitis and why?

A

Centrilobar

- chronic bronchitis constricts terminal bronchiole so dilation starts at respiratory bronchioles and moves distally

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19
Q

What is the term used to describe emphysema patients clinically?

A

Pink puffers

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20
Q

Pink Puffers

A
  • Emphysema

= Older, thin, severe dyspnea and quiet chest

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21
Q

A patient presents that is older and thinner with severe dyspnea and a quiet chest. What do you suspect the underlying disease is?

A

Emphysema

- Pink puffer

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22
Q

What will be seen on CXR and chest shape correlation with Emphysema?

A

Enlarged lungs with flattened diaphragm

- Barrel chest with increased AP diameter

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23
Q

What will be heard with auscultation of breath sounds with Emphysema?

A

Diminished breath sounds with prolonged expiratory wheezes

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24
Q

Normally, describe the function of Alpha1 Antitrypsin

A
  • Liver produces and secretes it
  • Coats the lungs to protect them
    = (-) Neutrophil Elastase that is produced by WBCs to breakdown bacteria because it is harmful to lungs
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25
What happens with Alpha1 Antitrypsin Deficiency?
- Alpha 1 AT is stuck in liver and damages it - Neutrophil Elastase is NOT (-) = Neutrophil Elastase damages the lungs!
26
What is the result of Alpha1 Antitrypsin Deficiency?
``` Basilar Panacinar (panlobular) Emphysema -- affects lower lungs and all air spaces distally are enlarged ```
27
What is the result of Alpha1 Antitrypsin Deficiency?
``` Basilar Panacinar (panlobular) Emphysema - affects lower lungs and all air spaces distally are enlarged ```
28
Alpha1 AT is encoded by what gene/allele on what chromosome?
Pi gene on chromosome 14 | -- Z allele has decreased Alpha1 AT
29
What gene is likely to manifest severe alpha1 AT deficiency?
Homozygous PiZZ
30
How do you test for Alpha1 AT deficiency?
Serum test for Alpha1 AT
31
What are the 3 components of Asthma?
1. Recurrent airway obstruction with a reversible component 2. Airway hyper-responsiveness 3. Airway Inflammation
32
What are the 3 components of Asthma?
1. Recurrent airway obstruction with a reversible component 2. Airway hyper-responsiveness 3. Airway inflammation
33
What are the 2 types of Asthma?
Atopic (extrinsic) | Non-Atopic (intrinsic)
34
Atopic Asthma is the most common type. When does it present, what are the IgE levels, main inflammatory cells and triggers?
- Presents in childhood - ELEVATED IgE levels - Eosinophils, mast cells, lymphocytes - Triggers = allergens
35
Non-Atopic Asthma is less common. When does it present, what are the IgE levels, main inflammatory cells and triggers?
- Presents in older adults - NORMAL IgE levels - T lymphocytes and Neutrophils - Triggers = cold, exercise, infection
36
Asthma is a combination of what 3 things?
Genetics Immunity Environment
37
Describe how Asthma is triggered
- Allergen (+) Th2 to secrete IL-4 - (+) IgE B cell to release IgE to Mast cells - Mast cells bind re-exposure to allergen and degranulate IL-5 - (+) Eosinophils
38
What are the main mediators of the Asthma inflammatory soup?
Leukotrienes C4, D4, E4
39
Bronchoconstriction, increased mucus, increased permeability and inflammation is seen with?
Asthma
40
With Asthma, what is a possible complication?
Airway Remodeling
41
What is involved in the Airway Remodeling if it occurs with Asthma?
- Fibrosis - Smooth muscle hyperplasia - Increased goblet cells and submucosal glands
42
If Airway Remodeling occurs with Asthma, what does that ultimately mean?
Irreversible | = DECREASED response to bronchodilators/corticosteroids!!
43
If an Asthma patient is not responding to bronchodilators/corticosteroids, what has likely occurred?
Airway remodeling | - Fibrosis, smooth muscle hyperplasia, increased goblet cells and submucosal glands
44
Status Asthmaticus
Unremitting, possible fatal asthma attack
45
What are the findings with Status Asthmaticus?
- Thick mucus plugs with coils = curschmann spirals | - Eosinophils and breakdown product = charcot leyden crystals
46
What are the findings with Status Asthmaticus?
- Thick mucus plugs with coils = curschmann spirals | - Eosinophils and breakdown product = charcot leyden crystals
47
What is the triad seen with Aspirin Sensitive Asthma and how does it occur?
Samters triad = asthma, nasal polyps, recurrent rhinitis | -- (-) cox so there is increased Leukotrienes C4,D4,E4
48
What is Bronchiectasis?
Permanent dilation of airways due to inflammatory destruction
49
Permanent dilation of airways due to inflammatory destruction
Bronchiectasis
50
Increased mucus, loss cilia and wall destruction in the airways?
Bronchiectasis
51
Bronchiectasis is an end stage process to many things. What are some things it can present with?
Infection, Obstruction Cystic Fibrosis Ciliary Dyskinesia ABPA
52
What will be seen on the lung with Bronchiectasis?
Dilated Bronchi extend to pleural surface
53
Mutation in Cl- channel causes Na+ and H2O to leave the mucus and cause it to be dehydrated
Cystic Fibrosis
54
What is Primary Ciliary Dyskinesia?
Dysfunction of dynein arm of microtubules | = Decreased motility of cilia/flagella
55
Primary Ciliary Dyskinesia is often seen with?
Kartagener's Syndrome
56
Kartagener's Syndrome
Sinusitis Bronchiectasis Situs Inversus Male Infertility
57
ABPA
Allergic Bronchopulmonary Aspergillosis
58
What is ABPA?
Hypersensitivity response to aspergillus infection overlying chronic lung disease
59
What will be signs of ABPA?
- Background of asthma/CF - (+) skin test - ELEVATED IgE - Thick and dark mucus
60
The thick and dark mucus with ABPA will show?
Fungal hyphae -- Aspergillus

2 - CPR (pulmonary) (26 decks)

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