110714 copd and cases

Question 1

acinus

Answer 1

distal to terminal bronchiole

Question 2

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

Answer 2

pseudostratified ciliated columnar epithelium

Question 3

definition of COPD

Answer 3

diseases that cause obstruction to airflow out of lungs

Question 4

types of obstructive lung disease

Answer 4

emphysema
chronic bronchitis
asthma
bronchiectasis

Question 5

obstructive disease is located where

Answer 5

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

Question 6

restrictive disease is located where

Answer 6

parenchymal disorder-respiratory bronchiole, alveoli and alveolar ducts

Question 7

obstructive lung disease

Answer 7

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

Question 8

restrictive lung disease

Answer 8

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

can have similar to normal or increased FEV1/FVC ratio

Question 9

emphysema

Answer 9

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

Question 10

causes of emphysema

Answer 10

smoking
air pollution
alpha1 antitrypsin deficiency

Question 11

types of emphysema

Answer 11

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

panacinar-associated with alpha1 antitrypsin deficiency

Question 12

pathogenesis of emphysema

Answer 12

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

Question 13

panacinar emphysema

Answer 13

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

Question 14

clinical findings of emphysema

Answer 14

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

Question 15

CXR of emphysema

Answer 15

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

Question 16

chronic bronchitis

Answer 16

productive cough for at least 3 months for 2 consecutive years

Question 17

causes of chronic bronchitis

Answer 17

smoking

cystic fibrosis

Question 18

pathogenesis of chronic bronchitis

Answer 18

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

Question 19

clinical findings of chronic bronchitis

Answer 19

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

blue bloaters
dyspnea
expiratory wheezing and rhonchi
cor pulmonale

Question 20

CXR of chronic bronchitis

Answer 20

enlarged heart, horizontally oriented

increased bronchial markings

Question 21

histology of chronic bronchitis

Answer 21

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

Question 22

reid index

Answer 22

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

Question 23

compare emphysema and chronic bronchitis

Answer 23

see slide 35

Question 24

bronchoectasis

Answer 24

permanent destruction and dilatation of bronchi and bronchioles

destruction involves cartilage and elastic tissue (entire wall)

Question 25

causes of bronchiectasis

Answer 25

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

Question 26

clinical findings of bronchiectasis

Answer 26

copious sputum
hemoptysis
digital clubbing
cor pulmonale

Question 27

CXR of bronchiectasis

Answer 27

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

Question 28

gross findings of bronchiectasis

Answer 28

bilateral lower lobes distal bronchi and bronchioles

dilated airways

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

Question 29

history of SOB as child

Answer 29

asthma

Question 30

what would productive cough mean?

Answer 30

chronic bronchitis

Question 31

what causes decreased FEV1 in chronic bronchitis?

Answer 31

mucous secretion

Question 32

what causes decreases FEV1 in emphysema

Answer 32

alveolar walls lost and elasticity lost

Question 33

would beta agonist help for emphysema?

Answer 33

no, because beta agonist only works for sm musc contraction

Question 34

clubbin is a sign of

Answer 34

chronic impaired air exchange, hypoxia

Question 35

COPD

Answer 35

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

Question 36

associated diseases of COPD

Answer 36

right heart failure

lung cancer

Question 37

asthma

Answer 37

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