Path 3 - Obstructive Pulmonary Disease

Front 1

Definition of obstructive lung disease

Back 1

inc resistance to airflow due to obstruction at any level
ie. emphysema, chronic bronchitis, bronchiectasis, asthma

Front 2

Definitio of restrictive lung disease

Back 2

reduced expansion of lung parenchyma
dec tot lung capacity
ie. chest wall disorders, acute or chronic intertitnal & inflitrative disease

Front 3

Forced vital capacity

Back 3

lungs are forcibly emptied at maximal speed from pt of full inspiration
measures flow as well as vital capacity

Front 4

FEV1

Back 4

foreced expiratory volume in 1 sec

Front 5

FEV1/FVC ratio is useful for

Back 5

detecting obstruction

Front 6

decreased FEV1/FVC

Back 6

obstructive disease

Front 7

in restrictive disease

Back 7

VC is dec
TLC is dec
normal FEV1/FVC

Front 8

emphysema defintition

Back 8

abnormal permanent enlargement of alveolar airspaces accompained by wall distruction without fibrosis

Front 9

4 types of emphysema

Back 9

1. centriacina
2. panaciar
3. paraseptal
4. irregular

Front 10

centroacinar emphysema

Back 10

most common
proximal respiratory brochials affected, distal spared
upper lobes more affected
heavy smokers

Front 11

panacinar emphysema

Back 11

acini uniformly enlarged
most severe at lung bases
a-antitrypsin deficiency

Front 12

pathogenesis of emphysema

Back 12

mild chronic inflam w inc MP, CD8 & neutrophils
relase leukotriene B4, IL8, TNF
hypoth: protease antiprotease mech and antiox imbalance

Front 13

protease-antiprotease mech

Back 13

imbalance btwn elastase & anti
homo a1anti-trypsin deficiency = emphysema
80% ppl w PiZZ get emphysema

Front 14

Where do you find proteases? anti?

Back 14

prot: neutrophils & MP
anti: serum

Front 15

Status of proteases in smokers? anti?

Back 15

prot: inc
anti: dec

Front 16

a1-anti-trypsin & emphysema
what type?
where?

Back 16

panacina emphysema
lower lungs

Front 17

smoking & emphysema
what type?
where?

Back 17

centriacinar emphysema
bifurcations

Front 18

gross findings of emphysema?

Back 18

large pale lungs
blebs or bullae
large alveoli

Front 19

microscopic findings of emphysema?

Back 19

large alveloi
thin septa w/out fibrosis that protrude blindly inot alveolar space & have a club shaped end

Front 20

Symptoms of emphysema

Back 20

progressive dyspnea, cough, wheezing, weight loss

Front 21

clinical signs of emphysema

Back 21

barrel chest
prolonged expiration
sits forward/hunched
pursed lips

Front 22

Causes of death in emphysema

Back 22

respiratory acidosis & coma
R- heart failure
collapse of lungs
pneumothorax

Front 23

treatment of emphysema

Back 23

bronchodialators
steroids
bullectomy
lung vol reduction surgery

Front 24

Clinical definition of chronic bronchitis

Back 24

persistent cough w sputum for 3 mo for 2 yrs in the abscence of any identifiable cause

Front 25

pathogenesis of chronic bronchitis

Back 25

chronic irritation
hypersecretionof mucus
bronchiolitis
infection

Front 26

what does hypersecretion of mucus cause? what is it caused by?

Back 26

hypertrophy of submucosal gland
inc # of goblet cells
caused by stimulated proteases

Front 27

How does smoking predispose you to chronic bronchitis?

Back 27

interference w cilliary action
direct damage of epithelium

Front 28

Gross findings in chronic bronchitis

Back 28

hyperemia- swelling & edema of mucus membranes
mucinous & mucopurulent secretions

Front 29

microscopic findings in chronic bronchitis

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chronic inflam
hypertrophy of mucus cells
inc Reid index
squamous metaplasia
narrowing of bronchiolar lumen

Front 30

Reid Index

Back 30

ratio of hte thickness of the mucus gland layer to the thickness of the wall btwn the epithelium & cartilage

Front 31

clinical course of chronic bronchitis

Back 31

persitent cough w sputum
SOB on exertion
Hyercapnia, hypoxemia, cyanosis
cor pulmonale

Front 32

pink puffer?

Back 32

emphysema

Front 33

blue bloater?

Back 33

chronic bronchitis

Front 34

Definition of asthma

Back 34

chronic inflam of airways w partially reversible bronchioconstriction

Front 35

3 key factors to the pathogenesis of asthma

Back 35

1. genetic predisposition to type I hypersenstivity
2. acute & chronic airway inflam
3. bronchial hyperresponsiveness

Front 36

Airway remodeling in asthma

Back 36

hypertrophy of bronchial SM
deposition of subepithelial collagen
linkage to ADAM33 gene

Front 37

Atopic Asthma

Back 37

type I IgE mediated hypersens.
skin test w wheal & flare rxn

Front 38

Acute Mast Cell Mediator Release

Back 38

bronchoconstriction
edema
mucus secretion
influx of PMN, monocytes, basophils, lymphocytes & eosinophils

Front 39

Late phase mast cell mediator release

Back 39

eosinophils
epithelial damage
airway constriction

Front 40

Nonatopic asthma

Back 40

resp tract infections
no family history
normal IgE levels
hyperirritability

Front 41

Drug induced asthma

Back 41

*asprin
uncommon
recurrent rhinitis & nasal polyps
inhib of COX w/out affecting lipozygenase -> constriction

Front 42

occupational asthma

Back 42

after repeated exposure
various mech: IgE, Direct constriction, unknown

Front 43

Gross findings in asthma

Back 43

overdistention of lungs
atelectasis
thich mucus plugs

Front 44

microscopic findings in asthma

Back 44

thichening of BM
edema & inflam
inc size of submucosal glands
hypertrophy of wall muscle

Front 45

Clinical presentation of asthma

Back 45

episodic attacks of dyspnea, coughing & wheezing
triggered by exercise, cold, allergens

Front 46

atopic asthma one more time

Back 46

most common, begins in childhood, + FH, associated w/ allergic rhinitis, urticaria & eczema

Front 47

status asthmaticus

Back 47

severe acute asthma that can persist for days to weeks and cause death

Front 48

sputum findings in asthma

Back 48

eosinophils
curschmann spirals
charcot-leyden crystals

Front 49

definition of bronchiectasis

Back 49

permanent dilatation of bronchi caused by distruction of muscle & elastic tissue

Front 50

What is bronchiectasis associated with?

Back 50

congenital or hereditary
postinfectous
bronchial obstruction
other

Front 51

Congenital causes of bronchiectasis?

Back 51

CF
immunodeficiency
primary cillary dyskinesia

Front 52

Postinfectious causes of broncietcasis?

Back 52

necrotizing pnumonias caused by bacteria, viruses & fungi

Front 53

bronchial obstruction causes of bronchiectasis?

Back 53

tumor
forgein body

Front 54

other causes of bronchiectasis?

Back 54

RA
SLE
IBD
post transplant

Front 55

Cystic fibrosis

Back 55

thick secretions
airway obstruction
repeated infection
destruction

Front 56

primary ciliary dyskinesia

Back 56

poorly fxning cilia
secretion retention
recurrent infection

Front 57

allergenic bronchiopulmonary aspergillosis?

Back 57

hypersensitivey to colonizing fungus, inflam, mucus plugs
fungus doesnt cause disease but allergy to it does

Front 58

Kartagener Syndrome

Back 58

problems w dyneind arms in cilia
infections, situs invertus, males are infertile

Front 59

gross findings in bronchiectasis?

Back 59

bilateral lower lobes & distal bronchi
dialated airways followed out to pleural surface
cutsy w/ mucopurulent secretions

Front 60

Microscopic findings in bronchiecatsis?

Back 60

inflam exudate in bronchial walls
necrotizing ulceration
squamous metaplasia
lung abscesses
fibrosis of bronchial walls leading to bronchial obliternas
+ cultures

Front 61

clinical course of bronchiectasis

Back 61

severe persistent cough
foul smelling sputum
dyspnea & othopnea
episodic induced by URI
paroxysmal coughing

Front 62

complications of bronchiectais?

Back 62

cor pulonale
metastatic brain abscess
amyloidosis

Front 63

definition of interstitial lung disease

Back 63

lung parenychemal disorder that involves the interstitium

Front 64

parenchymal disorder

Back 64

interstitial tissue
dec expansion w dec TLC, O2 diffusing capacity, LVs & complinance

Front 65

obstruction

Back 65

trachea to resp bronchioles
inc resistance to air flow & limited expiratory rts on forced expiration

Front 66

primary intersitital widening

Back 66

activation & proliferation of fibroblasts within interstitum w production of collagen

Front 67

examples of diseases with primary interstitial widening

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interstital edema
sarcoidosis

Front 68

accretion

Back 68

fibrous tissues w/in air spaces is incorporated w/in interstitum

Front 69

example of diseases with accretion

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organizing pneumonia

Front 70

what is the most commong presenting symptom of ILD

Back 70

dyspnea

Front 71

what are other symptoms of ILD

Back 71

fever, weight loss, finger clubbing, bronchiovesicular breath sounds w bibasilar rales

Front 72

what are some complications of ILD

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RVH/ cor pulmonale
infection
PE
pneumothorax

Front 73

pneumoconiosis definition

Back 73

non-neoplastic lung disease in response to inhalation of mineral dust, organic/inorganic, fumes/vapors from the workplace

Front 74

fibrogenic pneumoconiosis

Back 74

coal worker
silicosis
asbestosis

Front 75

non-neoplastic asbestos-related diseases

Back 75

pleural plaques
diffuse pleural fibrosis
asbestosis

Front 76

2 different compositions of asbestos

Back 76

serpentine
amphibole

Front 77

characteristics of serpentine asbestos

Back 77

long, curved, flexible, so dont get destroyed less clinically significant

Front 78

characteristics of amphibole asbestos

Back 78

short brittle, can get in more easily, clincally significant

Front 79

leibow ILD

Back 79

unusual interstital pneumonitis/ idiopathic pulmonary fibrosis

Front 80

Hamman & rich

Back 80

acute fulminant respiratory disorder

Front 81

how can you visualize asbestos?

Back 81

iron stain
asbestos bodies
golden brown hemosiderin

Front 82

idiopathic pulmonary fibrosis

Back 82

dyspnea & nonspecific sx
subpleural accentuation
unpredictable progressive disease

Front 83

what do you see in advanced ILD

Back 83

honeycomb lung

Front 84

sarcoidosis

Back 84

multisys asymptomatic disorder
**raised ACE levels
resolution

Front 85

distinct features of sarcoidosis

Back 85

granulomas that lack necrosis!