Pulmonary 1016 Obstructive Lung Diseases

Front 1

What are the types of obstructive lung diseases?

Back 1

chronic bronchitis, emphysema, asthma, bronchiectasis

Front 2

What is obstructive lung disease?

Back 2

progressive development of airflow limitation that is not fully reversible due to physical or functional obstruction at any anatomic level

Front 3

What is COPD?

Back 3

chronic bronchitis and emphysema

Front 4

What are the two ways the pathology of COPD can develop?

Back 4

anatomic obstruction to airflow in large and small airways, resulting in chronic distal air entrapment
destruction of elastic alveolar tissue, loss of elastic recoil, functional obstruction

Front 5

How do you diagnose COPD clinically?

Back 5

abnormal decrease in the rate of forced expiration in the absence of other disease

Front 6

How do you test for COPD?

Back 6

decrease in FEV1

Front 7

What are the risk factors for COPD?

Back 7

smoking, pollution, genetic predisposition

Front 8

What predicts poor mortality in COPD?

Back 8

low body mass index, high degree of airflow obstruction, severe dyspnea, significant impairment of exercise capacity

Front 9

How long does it take for FEV1 to return to normal after quitting smoking?

Back 9

3-5 years

Front 10

What causes mechanical obstruction?

Back 10

edema, increased mucus, impaired mucociliary transport, constriction of smooth muscle of bronchi/bronchioles

Front 11

What is the diagnostic criteria for chronic bronchitis?

Back 11

history of chronic cough or mucus production for at least three months in at least two successive years when other causes have been excluded

Front 12

What is the pathology of chronic bronchitis?

Back 12

hypertrophy of submucosal seromucinous glands in larger airways, goblet cell metaplasia of respiratory epithelium in large/small airways

Front 13

What is affected by the most severe forms of chronic bronchitis?

Back 13

smallest conducting airways, most easily obstructed by small amounts of mucus

Front 14

What causes chronic bronchitis?

Back 14

inhaled irritants, esp cigarette smoke

Front 15

What messes up the mucociliary escalator in chronic bronchitis?

Back 15

enlargement/hyperplasia of mucus secreting glands, more goblet cells, squamous metaplasia, thickening of airway wall, secondary infection

Front 16

What is emphysema?

Back 16

abnormal permanent enlargement of airspaces distal to the terminal bronchiole with destruction of walls and without obvious fibrosis

Front 17

What is the pathology of emphysema?

Back 17

chronic injury to terminal air passages and alveoli

Front 18

When does emphysema present?

Back 18

not right away, in some patients present without clinically apparent disease

Front 19

What is the most common form of emphysema?

Back 19

centrilobular

Front 20

What kind of emphysema is caused by environmental exposures?

Back 20

centrilobular

Front 21

What part of the lung is initially affected by centrilobular emphysema?

Back 21

respiratory bronchiole

Front 22

What is the pathology of centrilobular emphysema?

Back 22

patchy dilation of air spaces accompanied by some degree of anthracosis

Front 23

Where is anthracosis most prominent in centrilobular emphysema?

Back 23

upper part of lobes

Front 24

What does early panacinar emphysema look like?

Back 24

dilated alveolar ducts and alveoli, with more prominent involvement of the lower lobes

Front 25

What mutation is associated with panacinar emphysema?

Back 25

alpha-1-antitrypsin deficiency

Front 26

What happens in subpleural emphysema?

Back 26

dilated airspaces at lung periphery, apically and medially
air trapped can compromise function by compressing parenchyma or rupturing

Front 27

Who gets bullae of air?

Back 27

patients with advanced centrilobular or panacinar emphysema, also developmental abnormality in young, nonsmoking adults

Front 28

What is irregular emphysema?

Back 28

localized dilation of airspaces from retraction secondary to scarring, with healing of TB or pneumoconiosis

Front 29

What happens in interstitial emphysema?

Back 29

dissection of air into interlobular septa, no actual destruction of alveolar parenchyma, so not true emphysema

Front 30

What causes interstitial emphysema?

Back 30

mechanical ventilation with high inspiratory pressures, esp in newborns, complication of emphysema

Front 31

What is asthma?

Back 31

disease of hyper-reactive airways, leading to episodic, reversible bronchoconstriction, owing to increased responsiveness of tracheobronchial tree to stimuli

Front 32

What are the symptoms of asthma?

Back 32

dyspnea, cough, chest tightness, wheezing

Front 33

What usually triggers asthma in kids?

Back 33

allergy to dust, pollen, antigens

Front 34

What causes adult onset asthma?

Back 34

abnormalities of autonomic regulation of bronchial musculature in response to physical/mechanical stimuli or psychogenic factors

Front 35

What is the pathology of asthma?

Back 35

bronchials are plugged with mucus, eosinophils, mucus gland hypertrophy, goblet cell metaplasia, hypertrophic basement membranes, bronchial smooth muscle
likely to be hyper-inflated

Front 36

What causes morbidity with asthma?

Back 36

respiratory muscle exhaustion, airway infeciton, pneumothorax

Front 37

What causes mortality in asthma?

Back 37

cor pulmonale, "status asthmaticus"

Front 38

What is "status asthmaticus"?

Back 38

severe, prolonged asthma refractory to conventional therapy with acute irreversible respiratory failure

Front 39

What is the pathophysiology of asthma?

Back 39

smooth muscle constriction with airway narrowing, increased airway resistance during attacks
bronchoconstriction in all lobes, but not uniformly

Front 40

Which airways are most affected by asthma?

Back 40

smallest caliber peripheral airways

Front 41

What is bronchiectasis?

Back 41

irreversible dilation of bronchi as a consequence of destruction of muscular and elastic elements of walls

Front 42

What are the histo features of bronchiectasis?

Back 42

intense bronchial inflammation, destruction of stromal support of bronchial walls, chronic bacterial infection of bronchus with intralumenal PMN response

Front 43

Why does bronchiectasis occur?

Back 43

result of chronic necrotizing infection or physical obstruction of bronchus followed by chronic secondary infection

Front 44

What are the symptoms of bronchiectasis?

Back 44

cough with production of abundant purulent foul smelling sputum

Front 45

What determines respiratory impairment in bronchiectasis?

Back 45

extent of parenchymal involvement and presence/absence of other bronchial/alveolar disease

Front 46

What causes obstruction in bronchiectasis?

Back 46

expiratory collapse of weakened bronchial walls, stasis of purulent secretions

Front 47

What causes death in bronchiectasis?

Back 47

infection, hemoptysis

Front 48

What are complications of bronchiectasis?

Back 48

pulmonary hypertension, cor pulmonale/right heart failure, amyloidosis

Front 49

What diseases can cause bronchiectasis?

Back 49

viral pneumonia, TB, lung injury, CF, immotile cilia syndromes, alpha-1-antitrypsin deficiency, congenital

Front 50

Which virus commonly causes bronchiectasis?

Back 50

adenovirus type 21

Front 51

What are the signs of CF?

Back 51

obstructive lung diseaes in childhood and early adulthood, excessively thick, sticky bronchial mucus iwth chronic bacterial bronchitis
later bronchiectasis

Front 52

What is the most common CF mutation?

Back 52

mutation in CFTR

Front 53

What is the function of the abnormal CF channel?

Back 53

can't open in response to cAMP, results in abnormal viscid mucous

Front 54

What is the normal function of CFTR?

Back 54

when open, Cl moves out of cells, also influences other Cl/Na channels in nearby membrane

Front 55

Where are CFTR levels highest?

Back 55

in epithelial cells lining the internal surface of pancreas, sweat glands, salivary glands, intestine, reproductive organs, lungs

Front 56

Which parts of the lungs have the highest CFTR levels?

Back 56

submucosal glands of airways

Front 57

What is the result of the delta F508 CF mutation?

Back 57

CFTR can't be processed properly and doesn't assume functional location in the cell

Front 58

What are the presenting symptoms of CF?

Back 58

recurrent pneumonia, recurrent bronchiolitis, pansinusitis or nasal polyps, fatty stool, FTT, salty-tasting skin

Front 59

What is the most important finding of bronchiectasis?

Back 59

impaired clearance of secretions from bronchial tree, results in infections

Front 60

What is forced vital capacity?

Back 60

amount of gas forcefully expelled after max inspiration

Front 61

What is FEV1?

Back 61

volume expelled in first second of FVC

Front 62

What is PEFR?

Back 62

max airflow rate during FVC

Front 63

What is TLC?

Back 63

amount of gas in lungs after maximal inspiration

Front 64

What is RV?

Back 64

gas remaining after maximal expiration

Front 65

What is expiratory reserve volume?

Back 65

amount of gas representing difference between FVC and RV

Front 66

What is cor pulmonale?

Back 66

right ventricular disease secondary to lung disease