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RC Test 3 > B4.057 - Obstructive Pulmonary Disease > Flashcards

B4.057 - Obstructive Pulmonary Disease Flashcards

(72 cards)

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1
Q
A

pulmonary hypertension, a complication of COPD

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2
Q

histo of chronic bronchitis

A

thick walled bronchi, abundant mucous glants, goblet cell metaplasia, chronic inflammation

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3
Q

what is centriacinar emphysema

A

central/proximal portions of acini affected (resp bronchioles) but distal alveoli are spared if severe affects entire acinus worse in upper lobes smoking >95% of clinical cases

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4
Q

how does CF cause bronchiectasis

A

inherited ion transport defect leads to defective mucociliary action and airway obstruction by thick viscous secretions. predisposes to chronic infections causing airway damage and descruction of smooth muscle and elastic tissue

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5
Q

pathogenesis of atopic asthma

A

complex and mulitfactorial

Th2 and IgE response to environmental allergens in genetically prediosposed individuals

exaggerated Th2 response

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6
Q
A

left - normal

right - primary ciliary dyskinesia

loss of dynein arms in fibure b

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7
Q

what are the classes of triggers of asthma

A

seasonal

exercise induced

drug induced

occupational

asthmatic bronchitis in smokers

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8
Q

panacinar emphysema

A

acini are uniformly enlarged from respiratory bronchiole to alveoli entire acinus, not entire lung worst at bases Alpha1 antitrypsin deficiency

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9
Q

what is emphysema

A

abnormal permanent enlargement of the airspaces distal to the terminal bronchiole and destruction of their walls without obvious fibrosis, but may see fibrosis in small airways/bronchioles

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10
Q
A

bronchiectasis

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11
Q

epidemiology of chronic bronchitis

A

chronic irreversible obstruction of airflow

affects all people all ages

common in longtime smokers, polluted urban areas

more common over 45

more common in men

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12
Q

describe atopic asthma clinical scenario

A

most common type

begins in childhood

triggers: environmental antignes, dusts, pollens, animal dander, foods

positive family Hx of atopy

allergic rhinitis, urticaria, eczema

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13
Q

environmental factors predisposing to asthma

A

rhinovirus type C, respiratory syncytial virus

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14
Q
A

chracot leyden crystals

eosinophils

histo of asthma

represent breakdown products of eosinophils composed of an eosinophil protein called galectin 10

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15
Q

epidemiology of emphysema

A

men and women, men more common smoking major cause develops gradually clinically significant symptoms at any age, 40+ in smokers although ventilatory deficits seen earlier

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16
Q
A

sub pleural bullae seen in emphysema

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17
Q

pathogenesis of bronchiectasis

A

normal clearing mechanisms are impaired –> pooling of secretions distal to the obstruction –> secondary infection and inflammation

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18
Q
A

CF induced bronchiectasis

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19
Q

what percentage of smokers develop COPD

A

50%

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20
Q

chronic bronchitis

A

productive cough of unknown cause, ocurring for 3 or more months in at least 2 successive years

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21
Q

what is the mechanism of disease in emphysema

A

functional airflow obstruction

normally small airways are tethered open by elastic recoil in the walls of surrounding alveoli

loss of elastic tissue in aleolar walls allows th erespiratory bronchioles to collapse during expiration

inflammation also plays a role

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22
Q

types of emphysema

A

centriacinar panacinar distal acinar/paraseptal irregular

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23
Q
A

panacinar emphysema alpha 1 antitrypsin deficiency

ruptured alveolar septae (red arrow)

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24
Q

pathogenesis of emphysema

A

smoking

increased oxidative stress, inflammatory cells/mediators, protease/antiprotease imbalance

all lead to alveolar wall destruction

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25
bronchiectasis dilated bronchile wiht stasi of mucus secretions and inflamed walls surrounding fibrosis
26
epidemiology of asthma
ocurrs in 5% of pop any age most common in children, decreases with puberty, increases with age increasing incidence
27
pink puffer
emphysema barrel chested, dyspneic, prolonged expiration, hunched over position, breathes through pursed lips
28
centriacinar emphysema
29
what percentage of people with COPD smoke
80%
30
blue bloater
chronic bronchitis cough, DOE, hypercapnea, hypoxemia, mild cyanosis
31
asthma
chronic disorder of conducting airways, usually caused by an immunological reaction **episodic bronchodilation due to increased airway sensitivity to a variety of stimuli** inflammation of bronchial walls increased mucus secretion
32
atopic astham mediated by
IgE type 1 HS skin test using offentig antigen --\> immediate whela and flare reaction high serum IgE presence of RAST: detects presence of IgE Abs specific for individual allergens
33
compare and contrast chronic bronchitis and emphysema
34
chronic bronchitis anatomic compartment etiology pathogenesis
anatomic compartment - bronchus etiology - chronic irritation by inhaled substances like tobacco smoke pathogenesis - **hypersecretion of mucous**, metaplasia, hypertrophy and remodeling of small airways, **inflammation**
35
bronchiectasis
destruction of airway muscle and elastic tissue resulting in permanent dilation of bronchi and bronchioles, often by chronic necrotizing infections
36
occupational asthma causes
fumes, dusts, gases, other chemicals repeated exposure to chemicals results in minute quantity stricturing attakcs mechansism include: T1 reactions, direct reslease of bronchoconstrictors, unknown HS reponses
37
initiating factors of chronic bronchitis
exposure to noxious inhaled substances: tobacco smoke, dust mucus hypersecretion in airways (IL13) inflammation infection - maintains disease process and causes exacerbations
38
what is an alpha 1 antitrypsin deficiency and the genetics behind it
loss of an antiprotease that leads to emphysema PiMM - normal PiMZ - heterozygous PiZZ - homozygote - highest risk for emphysema
39
clinical features of bronchiectasis
cough, expectoration of copious amounts of foul smelling purulent sputum. hemoptysis recurrent acute infective exacerbations that can lead to sever lung function and impairment and respiratory failure dyspnea, wheezing
40
what is asthma characterized by
bronchial hyperresponsiveness triggered by allergens, infection etc.
41
distal acinar/paraseptal empysema
distal acinus is predominantly involved adjacent to the pleura, along the septa next to fibrosis, scarring or atelectasis worse in upper lung spontaneous pneumothorax
42
pts with bronchiectasis are at higher risk of what hypersensitivity
aspergillosis Th2 recruit eosinophils and other leukocytes high serum IgE and serum antibodies to aspergillus
43
goblet cell metaplasia of bronchial epithelium seen in chronic brochitis
44
what do bc and ad refer to
bc - thicknessof the mucous galnd layer ad - thickness of the bronchial wall between the epithelium and cartilage
45
irregular emphysema
acinus is irregularly involved scarring occurs in small foci, is clinically insignificant
46
symptoms of aspergillosis
inflammation and formation of mucus plugs, which play a primary role in pathogenesis
47
bronchiectasis dilated airways with inflamed walls
48
thickened basement membrane - bottom left smooth muscle hypertrophy - bottom right respiratory epithelium - top green arrowhead - goblet cell hyperplasia eosinophilic inflammation - yellow arrowhead seen in asthma
49
bullae seen in emphysema
50
susceptibility locus for asthma
chromosome 5q (codes interleukins IL13)
51
mucus plugs (left) chronic inflammation in bronchiolar wall (right) seen in chronic bronchitis
52
drug induced asthma causes
aspirin (+recurrent rhinitis, nasal polyps) NSAIDs - inhibit COX pathway decreasing PGE2 --\> release inhibition of enzymes that generate pro inflammatory mediators LTs
53
symptoms of asthma
recurrent episodes of wheezing, breathlessness, chest tightness, cough **particulary at night and early morning** at least partly **reversible** inflammation causes an increase in airway responsiveness to a variety of stimuli
54
airway remodeling
thickening of airway wall hypertrophy and hyperplasia of bronchial wall muslce
55
obstructive lung diseases cause what and what are some examples
increased resistance to airflow due to partial or complete obstruction at any level Decreased FEV1 emphysema, chronic bronchitis, asthma, bronchiectasis
56
50% of pts with primary ciliary dyskinesia have what
kartageners syndrome - situs inversus all organs are on flip side sinusitis bronchectasis
57
treatment of bronchiectasis
treat underlying cause chest physical therapy antibiotic therapy
58
panacinar emphysema
59
unique complication of emphysema
pneumothorax
60
types of asthma
atopic - evidence of allergen sensitization and immune activation, often with rhinitis and eczema non atopic - no evidence of allergen sensitization
61
bronchiectasis
62
complications of bronchiectasis
cor pulmonale amyloidosis metastatic brain abcesses
63
how do tobacco and infection contribute to chronic bronchitis
tobacco interferes with ciliary action, directly damages airway epithelium, inhibits ability of white blood cells to clear bacteria. Infections maintain but do not initiate chronic bronchitis
64
causes of bronchiectasis
idiopathic post infection congenital - CF, sequstration of lung, ciliary dyskinesia obstruction of bronchioles collagen vascular diseaes, inflammatory bowel disease, post transplant
65
what are bullae
large cystic dilated airspaces seen in emphyema
66
what is status asthmaticus
acute severe asthma, can be fatal, continuous symptoms
67
mucus plug - left surshmann spiral - right - coiled pragment of inspissated mucus gross
68
what is the reid index
the ratio and thickness of the mucous gland layer to the thickness of the bronchial wall between the epithelium and cartilage
69
non atopic asthma causes
triggered by respiratory tract (viral) infection rhinovirus, parainfluenza, respiratory syncytial viurus ihaled air pollutantts cold or exercies negative skin test
70
COPD complications
cor pulmonale, HF, pneumothorax (emphysema), superimposed acute infections (CB)
71
when do symptoms present in emphysema
1/3 of functioning lung parenchyma impaired
72
how does primary ciliary dyskinesia lead to bronchiectasis
autosoma recessive syndrome defect in ciliary motor protien dynein which inhibits bacterial clearance in sinuses and airways

RC Test 3 (15 decks)

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