Flashcards in 25. Obstructive lung diseases Deck (102):
Obstrcutive lung disease - types
1. chronic bronchitis
obstruction of air flow results in
air trapping in lungs
at hugh lung volumes, airways
Obstructive lung disease - volumes
1. increased RV
2. decreased FVC
3. Increased TLC
4. INcreased FRC
pulmonary function test
Obstructive lung disease - pulmonary function test
1. largely decreased FEV1
2. decreased FVC
3. decreased FEV1 /FVC ratio
4. V/Q mismatch
Obstructive lung disease - hallmark
decreased FEV1/ FVC Ratio
Obstructive lung disease - affect the heart ? (mechanism)
chronic , hypoxic pulmonary vasoconstriction can lead to cor pulmonale
chronic bronchitis- apperance
Obstructive lung disease - mechanism of increased RV and decreased FVC
airways close prematurely at high lung volumes
Obstructive lung disease - characteristics
1. airway obstruction
2. trapped air
chronic bronchitis - pathology
hyprplasia of mucus - secreting glands --> Reid index >50%
Reid index (pathology)
thickness of gland layer/ total thickness of bronchial wall
chronic bronchitis - definition
productive cough for >3 months PER YEAR ( not necessarilly consecutive for >2 years
chronic bronchitis - findings / symptoms
4. late onset dyspnea
6. secondary polycethemia
chronic bronchitis - polycethemia
secondary to hypoxi
chronic bronchitis - CYANOSIS ( MECHANISM
early onset due to shunting
chronic bronchitis - hypecapnia ( mechanism)
mucus plugs trap CO2
permanent dilation of bronchioles and bronchi loss of airway tone results in air trapping
bronchectasia is due to
chronic necrotizing infection
1. purulent sputum
2. recurrent infections
4. digital clubbing
bronchectasia is associated with ( like predisposition)
1. bronchial obstruction
2. poor ciliary motility ( SMOKING, kartegener syndrome)
3. cystic fibrosis
4. allergic bronchopulmonary aspergillosis
causes of poor ciliary motility
2. kartegener syndrome
bronchial hyperresponsiveness causes reversible bronchoconstriction
asthma can be triggered by
1. viral URI
test asthma with
asthma symptoms and clinical findings
6. decreased inspiratory / expiratory ratio
7. pulsus paradoxus
8. mucus plugging
pulsus paradoxus - seen in
1. cardiac tamponade
3. onstructive sleep apnea
pulsus paradoxus - definition
decreased in amplitude of systolic BP by >10 during inspiration
inspiratory / expiratory ratio in asthma and why
expiration is prolonged
normal inspiratoyr/ expiratory ratio
asthma - histology
1. smooth muscle hypertrophy
2. Curschmann spirals
3. Charcot-Leyden crystals
shed epithelium forms whorled mucus plugs ( IN ASTHMA)
Charcot Leyden crystals
eospinophilic , hexagonal, double- pointed, needle - like crystal drom breakdown of eosinophisl in sputum ( IN ASTHMA)
asthma bronchoconstriction is mediated by
1. inflammatory process
2. parasympathetic tone
1. β2 agonist ( albuterol, salmeterol, formoterol)
2. corticosteroids ( fluticAONW, BUdesonide)
3. Muscarinic antagonists (ipratropium)
4. Antileukotrienes ( montelukast, zafirlukast, zileuton)
6. methylxanthines (theophylline)
emphysema - patient apperance
emphysema - chest
barrel - shaped chest
emphysema - types
centriacinar emphysema -
associated with smoking - upper lobes
associated with α1- antitrypsin --> lower lobes
emphysema - diffusion capacity of CO test ( and mechanism
decreased diffusing capacity for CO resulting from destruction of alveolar walls
1. enlargement of air spaces
2. decreased recoil
3. increased compliance
emphysema - recoil
emphysema - compliance
a1 - antitrypsin role
emphysema - pathophysiology
increased elastase activity ( imbalance of protease anti protease) --> loss of elastic fibers --> increased lung compliance
emphysema - role of smoking
excessive inglammation and protease mediated damage
centriacinar emphysema is the most secere in ( area)
emphysema - pursued lips
expiration through pursed lips to increase airway pressure and prevent collapse during respiration
emphysema - sputum ?
diseases associated with a1 antitrypsin
1. panacinar emphysema
chronic bronchitis is highly associated with
chronic bronchitis - increased risk of
1. infenction (blocking(
2. cor pulmonale
obstructive lung disease with weight loss
emphysema - chest apperance ( and mechanism)
increased anterioposterio diameter
emphysema - late complication
nonallergic causes of asthma
bronchiectasis - complications
2. cor pulmonale
3. SECONDARY AMYLODOISIS
Obstructive lung disease with amyloidosis
Obstructive lung disease with polycethemia
Obstructive lung disease with hemoptysus
crackles are caused by ... ( and characteristics)
explosive opening of small airways and are discontinuous, nonmuscial and brief
asthma - cxr
periobronchial cuffing ( thickening)
emphysema - cxr
1. increased anteriorposterio diameter
2. flattened diaphragm
3. high lung field lucency
chronic bronchitis vs emphysema according to PCO2
chronic bronchitis --> hypecpania (retention)
emphysema --> normocapnia ( maintain alveolar ventilation)
chronic bronchitis vs emphysema according to PO2
chronic bronchitis --> severe hypoxemia (cyanosis)
emphysema --> mild hypoxemia
chronic bronchitis vs emphysema according to PO2 and PCO2
chronic bronchitis --> hypecpania (retention), severe hypoxemia (cyanosis)
emphysema --> normocapnia ( maintain alveolar ventilation), mild hypoxemia
• 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
• Does residual volume increase or decrease in obstructive lung disease? How about functional vital capacity?
RV increases; FVC decreases
• 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)
• A patient with chronic, hypoxic vasoconstriction can have what cardiac manifestation?
• List four types of obstructive lung disease.
Chronic bronchitis, emphysema, asthma, and bronchiectasis
• 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)
• 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)
• 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%
• How is the Reid index calculated?
Reid index = gland layer thickness/total bronchial wall thickness
• A patient with chronic bronchitis presents to clinic. What clinical findings are auscultated in the lungs of this patient?
Usually wheezing and crackles
• What visible skin finding may be noted in patients with chronic bronchitis?
Cyanosis (early-onset hypoxemia from shunting)
• What causes early-onset hypoxemia in chronic bronchitis?
• 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")
• In emphysemic lungs, there is a(n) ____ (decrease/increase) in recoil and a(n) ____ (decrease/increase) in compliance.
• Name the two types of emphysema.
Centriacinar and panacinar
• A patient is diagnosed with α1-antitrypsin deficiency. What pattern of alveolar damage is this associated with?
Panacinar (this is emphysema)
• In emphysema, the loss of elastic fibers and increased lung compliance result from increased activity of which enzyme?
• Individuals with emphysema tend to exhale through pursed lips to increase ____ and prevent ____ during expiration.
Airway pressure, airway collapse
• In patients with asthma, there is hyperresponsiveness of what lung segment?
• An important feature of the bronchoconstriction in asthma is that it is ____.
• 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)
• What are Charcot-Leyden crystals?
Formed after the breakdown of eosinophils in sputum, they are eosinophilic, hexagonal, double-pointed needle-shaped crystals in asthmatics
• Name some triggers for bronchial hyperresponsiveness in asthmatics.
Allergens, viral URIs, stress
• 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)
• What finding is commonly noted on pulmonary function tests of patients with asthma?
Decreased inspiratory:expiratory ratio
• You measure the blood pressure of a patient having a severe asthma attack. What phenomenon might you observe with repeat measurements?
• ____ is a chronic necrotizing infection of the bronchi.
• In bronchiectasis, chronic necrotizing infection of the bronchi leads to ____ (permanent/reversible) dilation of airways.
• A patient with bronchiectasis feels ill and has a productive cough. His sputum is most likely to consist of what?
Blood and purulence
• Recurrent infections, bronchial obstruction, and poor ciliary motility may lead to what lung manifestation?
• Which two genetic diseases are associated with bronchiectasis?
Cystic fibrosis and Kartagener syndrome