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Flashcards in 110714 copd and cases Deck (37)
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1
Q

acinus

A

distal to terminal bronchiole

2
Q

airways prxoimal to respiratory bronchioles are lined by what kind of epithelium

A

pseudostratified ciliated columnar epithelium

3
Q

definition of COPD

A

diseases that cause obstruction to airflow out of lungs

4
Q

types of obstructive lung disease

A

emphysema
chronic bronchitis
asthma
bronchiectasis

5
Q

obstructive disease is located where

A

airway disorder–trachea to terminal bronchiole (although in emphysema you see changes with alveoli)

6
Q

restrictive disease is located where

A

parenchymal disorder-respiratory bronchiole, alveoli and alveolar ducts

7
Q

obstructive lung disease

A

increased resistance to air flow and limited expiratory rates on forced expiartion

8
Q

restrictive lung disease

A

decreased expansion with reduced total lung capacity, O2 diffusing capacity, lung volumes and compliance

can have similar to normal or increased FEV1/FVC ratio

9
Q

emphysema

A

permanent enlargement of all or part of the respiratory unit (respiratory bronchioles, alveolar ducts, alveoli) accompanied by wall destruction WITHOUT obvious fibrosis

10
Q

causes of emphysema

A

smoking
air pollution
alpha1 antitrypsin deficiency

11
Q

types of emphysema

A

centriacinar (centrilobular)-95% of cases–associated with smoking

panacinar-associated with alpha1 antitrypsin deficiency

12
Q

pathogenesis of emphysema

A

increased numbers of macrophages, CD8 T cells and neutrophils

neutrophils and macrophages are activated by tissue damage from cigarette smoke

neutrophils make elastase
macrophages make free radicals

destruction of elastic tissue
increased compliance and decreased elasticity

elastic tissue normally keeps airway lumens open by applying traction. destruction of elastic tissue causes COLLAPSE of airways on expiration and prevention of air exit, causing trapped air distending repiratory unit and destruction of alveoli and alveolar ducts

13
Q

panacinar emphysema

A

alpha1 antitrypsin deficiency that’s genetic or acquired (acquired from things like cigarette smoke)

lower lobes (as opposed to upper for centriacinar emphysema)

all parts of respiratory unit are affected by elastic tissue destruc

14
Q

clinical findings of emphysema

A

severe and early onset of dyspnea
pink puffers
coexistence w chronic bronchitis (smokers’ emphysema)
cor pulmonale (less common)
diminished breath sounds due to hyperinflation

15
Q

CXR of emphysema

A

increased AP diameter (barrel chest)
hyperlucent lung fields
vertical heart
depressed diaphragm

16
Q

chronic bronchitis

A

productive cough for at least 3 months for 2 consecutive years

17
Q

causes of chronic bronchitis

A

smoking

cystic fibrosis

18
Q

pathogenesis of chronic bronchitis

A

inhaled smoke causes mucous hypersecretion in bronchi, leading to airflow osbruction in terminal bronchioles. in long standing cases, leads to irreversible fibrosis of terminal bronchioles

exacerbated by infection

another contributing factor is bronchospasm resulting in narrowed airway

19
Q

clinical findings of chronic bronchitis

A
PRODUCTIVE COUGH (due to mucus secretion)
cyanosis (due to decreased O2 saturation from hypoxemia)

blue bloaters
dyspnea
expiratory wheezing and rhonchi
cor pulmonale

20
Q

CXR of chronic bronchitis

A

enlarged heart, horizontally oriented

increased bronchial markings

21
Q

histology of chronic bronchitis

A

chronic inflam cells in airway wall
increased mucous glands-hyperplasia
thickening of walls (narrowing of bronchiolar lumen)

22
Q

reid index

A

ratio of thickness of mucous gland layer to thickness of wall btwn epithelium and cartilage

23
Q

compare emphysema and chronic bronchitis

A

see slide 35

24
Q

bronchoectasis

A

permanent destruction and dilatation of bronchi and bronchioles

destruction involves cartilage and elastic tissue (entire wall)

25
Q

causes of bronchiectasis

A
cystic fibrosis
infections 
bronchial obstruction (tumor)
primary ciliary dyskinesia
allergic bronchopumonary aspergillosis
26
Q

clinical findings of bronchiectasis

A

copious sputum
hemoptysis
digital clubbing
cor pulmonale

27
Q

CXR of bronchiectasis

A

bronchial markings (from dilatation) extending to the periphery of lungs

28
Q

gross findings of bronchiectasis

A

bilateral lower lobes distal bronchi and bronchioles

dilated airways

on cut surface dilated bronchi appear as cysts filled with mucopurulent secretions

29
Q

history of SOB as child

A

asthma

30
Q

what would productive cough mean?

A

chronic bronchitis

31
Q

what causes decreased FEV1 in chronic bronchitis?

A

mucous secretion

32
Q

what causes decreases FEV1 in emphysema

A

alveolar walls lost and elasticity lost

33
Q

would beta agonist help for emphysema?

A

no, because beta agonist only works for sm musc contraction

34
Q

clubbin is a sign of

A

chronic impaired air exchange, hypoxia

35
Q

COPD

A

usually related to smoking
obstruction not reversible with beta agonist
reduced gas exchange

36
Q

associated diseases of COPD

A

right heart failure

lung cancer

37
Q

asthma

A

usually develops early in life (exacerbated by smoke but not caused by it)

associated with allergies

obstruction reversible with beta agonist

no defect in gas exchange