Obstructive Lung Dz

Question 1

Asthma

Answer 1

Bronchoconstriction – reversible w/ b2 agonist

Sm.m. hypertrophy
Curshman cpirals in sputum – mucus spirals, purple
Charcot laden crystals – eosinophic inflammation

Triggers:
Viral URIs, allergens, stress, exercise, aspirin

Sx: coughing wheezing
Dyspnea
Tachypnea
Hypoxemia
Decreased respiratory/expiratory ratio
Pulsus paradoxus – decreased flow into LV, decreased SBP greater than 10 mmHg during inspiration
Mucus plugging

Question 2

COPD

Answer 2

Airflow limitation

Chornic inflammation

Question 3

Chronic bronchitis

Answer 3

Productive cough >= 3 mo
Hyperplasia of goblet cells and submucosal glands

Reid index >50%
Thickness of glands/total thickness of wall (not including cartilage)

Dx: clinical
Daily productive cough >= 3 mo for at least two consecutive years

Small airway dz
Wheezing, crackles
Cyanosis
Late-onset dyspnea

“blue bloater”
-cyanosis and peripheral edema

Question 4

Emphysema

Answer 4

Permanent enlargement of airspaces distal to terminal bronchioles

Dilated alveoli
Damaged alveolar walls/septae
Enlarged alveolar airspaces
Decreased elastic recoil -> air trapping
Barrel chested

CXR: flattening diaphragm, blunting costophrenic angles

Question 5

Obstructive dz

Answer 5

Difficulty moving air out

Asthma
COPD
Chornic bronchitis
Emphysema
Bronchiectasis

Question 6

Panacinar emphysema

Answer 6

Alpha1 antitrypsin deficiency
Entire acinus damaged – respiratory bronchiole to alveoli

Emphysema at early age
Early onset cirrhosis

Elastase degrades elastic tissue of lung

More severe lower lungs

Question 7

Centriacinar emphysema

Answer 7

Smoking
Upper lobes and superior segments of lower lobes
Can be focal

Respiratory bronchioles enlarged, alveolar ducts and alveoli spared

“pink puffers”

risk spontaneous pneumothorax

Question 8

Bronchiectasis

Answer 8

Destruction and dilation of bronchial walls
Large bronchioles

Copious purulent sputum

Recurrent infection -> lung abscesses

Assoc w/ cilia disorder

CF, Kartageners Sn 50%

Question 9

Obstructive vs Restrictive vs normal lung functioning tests

Answer 9

Normal FEV1/FVC = 80%

Obstructive: FEV1/FVC less than 80%
-more air in lung

Restrictive: FEV1/FVC >= 80%
Proprortionate drop
Can’t fill lungs well, less air to start and end