25. Obstructive lung diseases Flashcards Preview

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Flashcards in 25. Obstructive lung diseases Deck (102):
1

Obstrcutive lung disease - types

1. chronic bronchitis
2. EMphysema
3. Asthma
4. Bronchiectasis

2

obstruction of air flow results in

air trapping in lungs

3

at hugh lung volumes, airways

close prematurely

4

Obstructive lung disease - volumes

1. increased RV
2. decreased FVC
3. Increased TLC
4. INcreased FRC

5

PFT

pulmonary function test

6

Obstructive lung disease - pulmonary function test

1. largely decreased FEV1
2. decreased FVC
3. decreased FEV1 /FVC ratio
4. V/Q mismatch

7

Obstructive lung disease - hallmark

decreased FEV1/ FVC Ratio

8

Obstructive lung disease - affect the heart ? (mechanism)

chronic , hypoxic pulmonary vasoconstriction can lead to cor pulmonale

9

chronic bronchitis- apperance

blue bloaters

10

Obstructive lung disease - mechanism of increased RV and decreased FVC

airways close prematurely at high lung volumes

11

Obstructive lung disease - characteristics

1. airway obstruction
2. trapped air

12

chronic bronchitis - pathology

hyprplasia of mucus - secreting glands --> Reid index >50%

13

Reid index (pathology)

thickness of gland layer/ total thickness of bronchial wall

14

chronic bronchitis - definition

productive cough for >3 months PER YEAR ( not necessarilly consecutive for >2 years

15

chronic bronchitis - findings / symptoms

1. wheezing
2. crackles
3. cyanosis
4. late onset dyspnea
5. hypecapnia
6. secondary polycethemia

16

chronic bronchitis - polycethemia

secondary to hypoxi

17

chronic bronchitis - CYANOSIS ( MECHANISM

early onset due to shunting

18

chronic bronchitis - hypecapnia ( mechanism)

mucus plugs trap CO2

19

bronchectasia

permanent dilation of bronchioles and bronchi loss of airway tone results in air trapping

20

bronchectasia is due to

chronic necrotizing infection

21

bronchectasia symptoms

1. purulent sputum
2. recurrent infections
3. hemoptysis
4. digital clubbing

22

bronchectasia is associated with ( like predisposition)

1. bronchial obstruction
2. poor ciliary motility ( SMOKING, kartegener syndrome)
3. cystic fibrosis
4. allergic bronchopulmonary aspergillosis

23

causes of poor ciliary motility

1. smoking
2. kartegener syndrome

24

asthma mechanism

bronchial hyperresponsiveness causes reversible bronchoconstriction

25

asthma can be triggered by

1. viral URI
2. allergens
3. stress

26

test asthma with

metacholine challenge

27

asthma symptoms and clinical findings

1. cough
2. wheezing
3. tachypnea
4. dyspnea
5. hypoxemia
6. decreased inspiratory / expiratory ratio
7. pulsus paradoxus
8. mucus plugging

28

pulsus paradoxus - seen in

1. cardiac tamponade
2. asthma
3. onstructive sleep apnea
4. pericarditis
5. croup

29

pulsus paradoxus - definition

decreased in amplitude of systolic BP by >10 during inspiration

30

inspiratory / expiratory ratio in asthma and why

decreased
expiration is prolonged

31

normal inspiratoyr/ expiratory ratio

1:2
1:3
or :4

32

asthma - histology

1. smooth muscle hypertrophy
2. Curschmann spirals
3. Charcot-Leyden crystals

33

Cruschman spirals

shed epithelium forms whorled mucus plugs ( IN ASTHMA)

34

Charcot Leyden crystals

eospinophilic , hexagonal, double- pointed, needle - like crystal drom breakdown of eosinophisl in sputum ( IN ASTHMA)

35

asthma bronchoconstriction is mediated by

1. inflammatory process
2. parasympathetic tone

36

asthma drugs

1. β2 agonist ( albuterol, salmeterol, formoterol)
2. corticosteroids ( fluticAONW, BUdesonide)
3. Muscarinic antagonists (ipratropium)
4. Antileukotrienes ( montelukast, zafirlukast, zileuton)
5. omalizumab
6. methylxanthines (theophylline)
7. Metacholine

37

emphysema - patient apperance

pink puffer

38

emphysema - chest

barrel - shaped chest

39

emphysema - types

1. centriacinar
2. panacinar

40

centriacinar emphysema -

associated with smoking - upper lobes

41

panacinar emphysema

associated with α1- antitrypsin --> lower lobes

42

emphysema - diffusion capacity of CO test ( and mechanism

decreased diffusing capacity for CO resulting from destruction of alveolar walls

43

emphysema properties

1. enlargement of air spaces
2. decreased recoil
3. increased compliance

44

emphysema - recoil

decreased

45

emphysema - compliance

increased

46

a1 - antitrypsin role

neutralizes proteases

47

emphysema - pathophysiology

increased elastase activity ( imbalance of protease anti protease) --> loss of elastic fibers --> increased lung compliance

48

emphysema - role of smoking

excessive inglammation and protease mediated damage

49

centriacinar emphysema is the most secere in ( area)

upper lobes

50

emphysema - pursued lips

expiration through pursed lips to increase airway pressure and prevent collapse during respiration

51

emphysema - sputum ?

minimal

52

blue bloaters

chronic bronchitis

53

pink puffer

emphysema

54

diseases associated with a1 antitrypsin

1. panacinar emphysema
2. cirrhosis

55

chronic bronchitis is highly associated with

smoking

56

chronic bronchitis - increased risk of

1. infenction (blocking(
2. cor pulmonale

57

obstructive lung disease with weight loss

emphysema

58

emphysema - chest apperance ( and mechanism)

Barrel shaped
increased anterioposterio diameter

59

emphysema - late complication

cor pulmonale
hypoxemia

60

nonallergic causes of asthma

1. aspirin
2. exercise
3. occupational
4. viral

61

bronchiectasis - complications

1. hypoxemia
2. cor pulmonale
3. SECONDARY AMYLODOISIS

62

Obstructive lung disease with amyloidosis

bronchiectasis

63

Obstructive lung disease with polycethemia

chronic bronchitis

64

Obstructive lung disease with hemoptysus

bronchiectasis

65

crackles are caused by ... ( and characteristics)

explosive opening of small airways and are discontinuous, nonmuscial and brief

66

asthma - cxr

periobronchial cuffing ( thickening)

67

emphysema - cxr

1. increased anteriorposterio diameter
2. flattened diaphragm
3. high lung field lucency

68

chronic bronchitis vs emphysema according to PCO2

chronic bronchitis --> hypecpania (retention)
emphysema --> normocapnia ( maintain alveolar ventilation)

69

chronic bronchitis vs emphysema according to PO2

chronic bronchitis --> severe hypoxemia (cyanosis)
emphysema --> mild hypoxemia

70

chronic bronchitis vs emphysema according to PO2 and PCO2

chronic bronchitis --> hypecpania (retention), severe hypoxemia (cyanosis)
emphysema --> normocapnia ( maintain alveolar ventilation), mild hypoxemia

71

• What is the definition of obstructive lung disease? How does it affect lung volumes?

Obstruction to flow leading to air trapping & the collapse of airways at high volumes; RV increases due to air trapping, & FVC decreases

72

• Does residual volume increase or decrease in obstructive lung disease? How about functional vital capacity?

RV increases; FVC decreases

73

• What is the hallmark pulmonary function test finding in patients with obstructive lung disease?

Decreased ratio of FEV1 to FVC (the decrease in FEV1 > FVC)

74

• A patient with chronic, hypoxic vasoconstriction can have what cardiac manifestation?

Cor pulmonale

75

• List four types of obstructive lung disease.


Chronic bronchitis, emphysema, asthma, and bronchiectasis

76

• A patient has a productive cough for 5 months over the course of 3 years. What findings do you expect on pulmonary function tests?

PFTs show a decreased ratio of FEV1 to FVC (the patient has classic chronic bronchitis)

77

• A man has a productive cough for 5 months over 2 years with wheezing, crackles, cyanosis. What histologic changes are seen on lung biopsy?

Hyperplasia of the mucus-secreting glands in the bronchi (the patient has chronic bronchitis)

78

• The mucus gland hyperplasia seen in chronic bronchitis can be quantified using the ____, which tends to be greater than what value (in %)?

Reid index (thickness of gland layer/total thickness of bronchial wall); >50%

79

• How is the Reid index calculated?

Reid index = gland layer thickness/total bronchial wall thickness

80

• A patient with chronic bronchitis presents to clinic. What clinical findings are auscultated in the lungs of this patient?

Usually wheezing and crackles

81

• What visible skin finding may be noted in patients with chronic bronchitis?


Cyanosis (early-onset hypoxemia from shunting)

82

• What causes early-onset hypoxemia in chronic bronchitis?

Shunting

83

• A woman has 6 months of productive cough in 3 years, wheezing, crackles, and cyanosis. What other findings would you expect in this patient?

Expect late-onset dyspnea, secondary polycythemia, and hypercapnia (this patient has chronic bronchitis, as she is a "blue bloater")

84

• In emphysemic lungs, there is a(n) ____ (decrease/increase) in recoil and a(n) ____ (decrease/increase) in compliance.

Decrease, increase

85

• Name the two types of emphysema.

Centriacinar and panacinar

86


• A patient is diagnosed with α1-antitrypsin deficiency. What pattern of alveolar damage is this associated with?

Panacinar (this is emphysema)

87


• In emphysema, the loss of elastic fibers and increased lung compliance result from increased activity of which enzyme?

Elastase

88

• Individuals with emphysema tend to exhale through pursed lips to increase ____ and prevent ____ during expiration.



Airway pressure, airway collapse

89

• In patients with asthma, there is hyperresponsiveness of what lung segment?

The bronchi

90

• An important feature of the bronchoconstriction in asthma is that it is ____.

Reversible

91

• A man with cough, tachypnea, and wheezing has a drop in BP >10 mmHg on inspiration. What pathologic lung findings do you expect on biopsy?

Curschmann spirals, smooth muscle hypertrophy, Charcot-Leyden crystals (this is asthma, which can exhibit pulsus paradoxus when severe)

92

• What are Charcot-Leyden crystals?

Formed after the breakdown of eosinophils in sputum, they are eosinophilic, hexagonal, double-pointed needle-shaped crystals in asthmatics

93

• Name some triggers for bronchial hyperresponsiveness in asthmatics.

Allergens, viral URIs, stress

94


• A child with cough, wheezing, dyspnea, and tachypnea has pulsus paradoxus on exam. What is a test for his condition?


Test with methacholine challenge (the patient has asthma)

95

• What finding is commonly noted on pulmonary function tests of patients with asthma?

Decreased inspiratory:expiratory ratio

96

• You measure the blood pressure of a patient having a severe asthma attack. What phenomenon might you observe with repeat measurements?

Pulsus paradoxus

97

• ____ is a chronic necrotizing infection of the bronchi.



Bronchiectasis

98

• In bronchiectasis, chronic necrotizing infection of the bronchi leads to ____ (permanent/reversible) dilation of airways.

Permanent

99

• A patient with bronchiectasis feels ill and has a productive cough. His sputum is most likely to consist of what?

Blood and purulence

100

• Recurrent infections, bronchial obstruction, and poor ciliary motility may lead to what lung manifestation?


Bronchiectasis

101

• Which two genetic diseases are associated with bronchiectasis?

Cystic fibrosis and Kartagener syndrome

102

• A patient has Kartagener syndrome leading to permanently dilated airways. Which fungal pulmonary infection is he prone to developing?

Allergic bronchopulmonary aspergillosis (he likely has bronchiectasis)