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House AMP > COPD > Flashcards

COPD Flashcards

1
Q

COAD

Commonly used clinical term for a group of pathological conditions in which there is (acute or chronic?) partial or complete obstruction to air flow any level from _____ to ________ resulting in functional disability of the lungs

A

Chronic

trachea to smallest airways

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2
Q

COAD or COPD

⚫_________
⚫______________
⚫__________
⚫______________

A

Asthma

Chronic bronchitis

Emphysema

Bronchiectasis

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3
Q

ASTHMA

A chronic inflammatory disorder of the airways;
characterised by
⚫ widespread ________ of the airways, with
⚫ marked reduction in the __________________

⚫ Triggered by ________ stimuli.

⚫ Results in recurrent episodes of ________,________,__________ and __________.

⚫ May be ____________________, with or without
treatment

A

narrowing

inflow and outflow of air

a variety of

coughing, wheezing, breathlessness and chest tightness

reversed partly or completely

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4
Q

Classification of asthma Based on several factors including

A. Aetiology:

_________: ________ induced, Type 1 hypersensitivity

__________: induced by several ___________

A

Extrinsic; Allergen

Intrinsic; nonimmune factors

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5
Q

Classification of asthma Based on several factors including

Severity: _______,________, or ______

Frequency:_________ or _________

Clinical behaviour: i.e. brittle, difficult, ________ or ________

A

mild, moderate or severe

intermittent or persistent

steroid dependent or
resistant

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6
Q

Pollen concentrations are highest in the _______ or _________

A

Afternoon or midday

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7
Q

Pathophysiology

⚫ Asthma attacks are caused by airway
_________________

A

hyperresponsiveness

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8
Q

Pathophysiology
⚫ Asthma attacks are caused by airway
hyperresponsiveness—that is, an overreaction of the ________ and __________ to various environmental and
physiological stimuli, known as _______.

A

bronchi and bronchioles;

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9
Q

Pathophysiology

⚫ The most common causes of asthma attacks are extremely (small or large?) and (heavy or light?) weight particles transported through the ____ and inhaled into the lungs.

A

Small

Light ; air

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10
Q

Pathophysiology of asthma

⚫ When they enter the airways, these particles, known as
environmental triggers, cause ____________ in the airway walls, resulting in an asthma attack

A

An inflammatory response

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11
Q

Extrinsic/Environmental triggers
⚫ These are called __________.

A

allergens

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12
Q

ASTHMA: Extrinsic triggers

Allergens produce type ____ hypersensitivity reaction

A

1

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13
Q

Extrinsic triggers in asthma

⚫ They bind to _____ on the ____ cell in a previously sensitized individual

⚫______ cell _______ & releases inflammatory mediators & chemotactic
factors which cause

⚫ Increased ________ and ______

⚫ Broncho__________
⚫_______ hypersecretion
⚫

A

IgE; mast

Mast; degranulates

vascular permeability & oedema

constriction; Mucus

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14
Q

Asthma: Extrinsic triggers

These same allergens may cause little or no reaction in nonallergic people

T/F

A

T

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15
Q

10 Mediators

⚫ The _____ cells release ______ as a 10 mediator
⚫ ______ cells- secrete too much ______.

A

Mast; histamine

Goblet; mucus

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16
Q

10 Mediators

Histamine causes
⚫ increased ________ leading to ______ and ________

⚫ Broncho_____ - causing more _______

A

venular permeability

swelling and redness

spasms; narrowing

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17
Q

10 Mediators

Goblet cells- secrete too much mucus.

⚫ Mucus clogs the ________, resulting in _________ and ______

A

bronchioles

wheezing

Coughing

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18
Q

___________Triggers

These are refered to as intrinsic triggers.

A

Non-environmental

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19
Q

Non-environmental Triggers / intrinsic triggers. They include:

⚫_________ triggers
⚫ Physical exercise
⚫ Cold weather
⚫ Sometimes __________bring on attacks.
⚫ Chemicals found in _______ or _______
⚫ Intense ________

A

Physiological

substances in food or drink

food or medicine

emotion

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20
Q

Pathophysiology of asthma

⚫ Extrinsic triggers stimulate ______ nerves in ______ to discharge

⚫ These in turn stimulate the _____ nerve ( _______ nerve) to discharge

⚫ Cause release of inflammatory mediators & chemo tactic factors which
cause

⚫ Macrophage, eosinophil, basophil infiltration &________ activation
⚫ Broncho _______
⚫_______ hypersecretion

A

afferent

Tracheobronchial tree

vagal; efferent; mast cell

constriction

Mucus

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21
Q

Clinico-Pathologic correlation in asthma

⚫Bronchi and bronchioles become _______ resulting in _______ of airways

⚫_____eases work done to move air in and out of the lungs

⚫Mild chest _______ and _______ develop

⚫__________ starts and increases in pitch; dyspnoea sets in

A

oedematous; narrowing

Incr; pressure; dry cough

Wheezing

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22
Q

Clinico-Pathologic correlation in asthma

Cough _______ and becomes ______ of thick, stringy mucus.

Inflammation prevents ______________

Cells start to burn oxygen _________, increasing the body’s demand for oxygen.

________ develops. If untreated _____ occurs

A

intensifies; productive

insufficient oxygen-rich air from getting to the alveoli; at a higher rate

Hypoxaemia; cyanosis

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23
Q

Airway narrowing in asthma

⚫ Release of _______
⚫ Smooth muscle ______
⚫ Increased vascular _________/_______
⚫ Excessive mucous __________

A

chemical mediators

contraction

permeability/oedema

secretion

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24
Q

MORPHOLOGY of Asthma
Gross:
⚫ ________ lungs

⚫ (Thin or Thick?) , tenacious, adherent mucus in airway

A

Distended; thick

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25
Q

MORPHOLOGY of asthma

Microscopy:

⚫_________ crystals

⚫_________ spirals

⚫______ bodies

⚫ Hyperplastic bronchial _____________ & increase number of ______ cells

⚫_________ submucosa

A

Charcot-Leyden

Curschmann

Creola; mucosa and glands ; goblet

Oedematous

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26
Q

MORPHOLOGY of ASTHMA

Microscopy:
⚫ Charcot-Leyden crystals in _________,_______ , strips of _________

⚫ Curschmann spirals- _________ of airway

⚫ Creola bodies- compact clusters of _______ in sputum

A

mucus plugs, eosinophils

epithelium; mucus cast

epithelial cells

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27
Q

Genetics of asthma

⚫ Research suggests that genetic factors increase the risk of developing the disorder.

T/F

A

T

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28
Q

Genetics of asthma

Children with a family history of asthma are more likely to develop asthma than other children.

T/F

A

T

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29
Q

Emphysema

Is the ________ of airspaces (proximal or distal?) to __________

With __________

Without _______

A

Enlargement

Distal; terminal bronchioles

destruction of their walls

fibrosis

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30
Q

Emphysema occurs With fibrosis

T/F

A

F

Without fibrosis

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31
Q

Emphysema

A progressive respiratory disease
characterised by coughing, shortness of
breath & wheezing

T/F

A

T

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32
Q

Classification of Emphysema

Based on morphology

⚫___________
⚫_________
⚫___________
⚫__________
⚫ Mixed (Unclassified)

A

Panacinar

Centriacinar

Paraseptal

Irregular

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33
Q

Pathogenesis of emphysema

⚫ Cigerette smoking:__________ or _____ imbalance hypothesis

⚫_________ deficiency (genetic)
⚫ Air pollutants
⚫ Infection

A

Protease-Antiprotease or Proteolysis-Antiproteolysis

Alpha-1-antitrypsin

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34
Q

Smokers’ Emphysema

⚫ Increased number of _______

⚫ Contain __________ & other proteases

⚫ Reduced __________ activity due to
_____________________ enzyme

⚫ Increased activity of _______ & other
enzymes

A

neutrophils

serine elastase; α1-antitrypsin

oxidation of methionine

trypsin

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35
Q

Smokers’ Emphysema

Unopposed and increased ______ activity

destruction of _______ leads to loss of
___________

permanent ________ of alveoli

(Small or large?) volume of residual air trapped in the lungs

A

elastolytic; alveolar walls; elastic recoil

dilatation

Large

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36
Q

α1-antitrypsin

Produced in the _______

Is a Circulating ________

Major _______ of _______

A

liver; glycoprotein

Inhibitor ; proteases

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37
Q

α1-antitrypsin

⚫ In the lungs: inhibits _________

⚫ In the blood:_____% of all antiproteinase activity

A

neutrophil elastase

90

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38
Q

Molecular genetics of α1-antitrypsin

A1AT def caused by an abnormality of the ______ gene on chromosome ____ (14q32.1)

A

SERPINA1

14

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39
Q

Molecular genetics of α1-antitrypsin

Amount produced determined by genotype
⚫ Alleles:

⚫_____ , non-mutated

⚫______, glutamate to lysine mutation at position 342

⚫______ glutamate to valine mutation at position 264

A

PiM

PiZ

PiS

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40
Q

SERPINA1

A

(Serine Peptidase Inhibitor, Clade A, member 1)

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41
Q

Features of PANACINAR

The acinus is ____________

Destruction of _________

Associated with ___________

Tends to occur in ______ lobes

A

uniformly affected

alveolar septa

α1-AT deficiency

lower

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42
Q

Most frequently encountered pattern of emphysema is ???

A

Centrilobular

43
Q

Centrilobular emphysema

Destruction of cluster of ____________ in the ______ part of the pulmonary lobule

Most severe in ______ zones

Damaged RBs separated from each other by _____________

A

terminal respiratory bronchioles (RB)

central; upper

normal alveolar ducts

44
Q

Centrilobular emphysema

Proximal bronchioles are ______ and ———-

A

inflamed and narrow

45
Q

___________ emphysema is Associated with smoking

A

Centrilobular

46
Q

Localised Emphysema (________)

destruction of ______

Usually found at the _____ of the _____ lobe but may be anywhere

Usually ____pleural

A

paraseptal

alveoli; apex; upper

sub

47
Q

Focal Dust Emphysema

⚫ Disease of __________

⚫ Similar to ______- but enlarged spaces are (smaller or larger?) and (more or less?) regular

A

coal miners

centrilobular

Smaller

More

48
Q

_________ emphysema forms bullae which may rupture

A

Localized /paraseptal

49
Q

Clinical features of emphysema

Patients usually about _____yrs or older

Symptoms usually start when _____ of lung tissue is damaged

Dyspnoea initially ______, progressively worsens

A

60; ⅓

mild

50
Q

Clinical features of emphysema

Cough is (productive or non-productive?) , (minimal or maximal?) .

A

non-productive

Minimal

51
Q

Cough in emphysema is productive when it is associated with _________

A

chronic bronchitis

52
Q

Clinical features of emphysema

⚫__________ may be the chief complaint

⚫ _______pnoea (↑RR), (shortened or prolonged?) expiratory phase, _____eased minute volume

A

Cough or wheezing

Tachy; prolonged; incr

53
Q

Clinical features of emphysema

⚫ Use of _______ muscles of respiration

⚫______ chest

⚫ _________ lungs on CXR

A

accessory; Barrel

Overinflated

54
Q

Emphysema is easily confused with asthma

T/F

A

T

55
Q

Emphysema patients are also called??

Chronic bronchitis patients are also called ???

A

Pink puffers

Blue bloaters

56
Q

Chronic Bronchitis

Chronic (productive or non-productive ?) cough without a discernible cause for at least __________ of the year over a period of ________.

A

Productive

3 months

2yrs

57
Q

Chronic Bronchitis

_____% of cases occur in smokers

Exposure to ETS & air pollution increases
risk of CB in non-smokers

A

90

58
Q

Morphology
⚫ Gross
⚫ Thick, hyperaemic & oedematous bronchial wall
⚫ Suppurative exudate in lumina of bronchi and
bronchioles
⚫ + or – mucus plugs

A
59
Q

Gross Morphology of CB

⚫ (Thin or Thick?) , hyperaemic & ________ bronchial wall

⚫_________ exudate in lumina of _______ and ______

A

Thick

oedematous

Suppurative

bronchi and bronchioles

60
Q

CB patients must have mucus plugs

T/F

A

F

⚫ may or may not have mucus plugs

61
Q

Morphology of CB

⚫ Hypertrophy of ________ & hyperplasia of ________ resulting in excess mucous in the airway

⚫ Thickened ______, _____ enlargement & oedema results in a narrower lumen

⚫___________ hyperplasia

⚫_____________ (in smokers)

A

submucous glands; goblet cells

bronchial wall; glandular

Smooth muscle

Squamous metaplasia

62
Q

Morphology of CB

Ratio of wall thickness (distance between ____________ and ____________ ) to _________ = _____ index

A

epithelial basement membrane & the cartilage

thickness of gland layer

Reid

63
Q

In CB, Reid index is > ____

Normal is ______

A

0.5

0.4

64
Q

CB often accompanied by emphysema

T/F

A

T

65
Q

CB often accompanied by _______

A

emphysema

66
Q

Clinical Features of CB

⚫________ cough for years
⚫ ________ on exertion
⚫________ (Blue bloaters)
⚫ Cor pulmonale
⚫ _______________ predisposes to infections

A

Productive

Dyspnoea

Cyanosis

Retained mucous secretions

67
Q

Cor pulmonale is frequent in emphysema

T/F

A

F

68
Q

Cor pulmonale is frequent in CB

T/F

A

T

69
Q

Bronchial infections is frequent in emphysema

T/F

A

F

70
Q

Bronchial infections is frequent in CB

T/F

A

T

71
Q

Age at diagnosis of CB

Age at diagnosis of emphysema

A

50

60

72
Q

Dyspnea is a late manifestation in CB

T/F

A

T

73
Q

Dyspnea is a late manifestation in emphysema

T/F

A

F

Early

74
Q

Elastic recoil in CB is??

Elastic recoil in emphysema is ??

A

Normal

Low

75
Q

Bronchiectasis is Chronic inflammatory disorder of the lung caused by _________ With destruction of _______ and _______, Resulting in __________ of bronchi and bronchioles

A

necrotizing inflammation

muscle and elastic

permanent dilatation

76
Q

Bronchiectasis

This is clinically characterized by
⚫______
⚫________
⚫ Copious production of ______,_______ sputum

A

Fever

Cough

foul smelling, purulent

77
Q

Asthma
CB
Emphysema
Bronchectasis

A

Productive cough

Productive cough

Non- Productive cough

Foul smelling sputum

78
Q

Classification of bronchiectasis

⚫_________ bronchiectasis
⚫_________ bronchiectasis

A

Obstructive

Non-obstructive

79
Q

Obstructive bronchiectasis

– may follow obstruction from ______ and is localised to _____________

A

any cause

the region distal to the obstruction

80
Q

Non-obstructive bronchiectasis
– usually follows _________

A

infection

81
Q

Predisposing factors of bronchiectasis

Congenital
⚫ Immunodeficiency States
⚫________
⚫_______ syndrome
⚫__________ sequestration of the lungs
⚫ Primary cilia dyskinesia

Acquired
⚫___________
⚫ Bronchial ______

A

Cystic fibrosis; Kartagener’s

Intralobar

Post-infectious; obstruction

82
Q

Aetiopathogenesis of bronchiectasis

Obstruction
⚫ Foreign bodies
⚫ _____
⚫ Compression by enlarged ______
⚫ Post-inflammatory _______

Infection
⚫________________ e.g _______ or ______

A

Tumors; hilar lymph nodes; scarring

Necrotising pneumonia

post TB or staph

83
Q

Morphology of bronchiectasis

⚫ Diffuse or segmental involvement of the (proximal or distal?) bronchi and bronchioles

⚫ Bilateral involvement of _____ lobes

⚫ Thickened fibrotic pleura with adhesions to the chest wall

A

Distal

lower

84
Q

Morphology of bronchiectasis

Dilated bronchi &bronchioles appear
⚫___________
⚫________
⚫________
⚫__________

A

Cylindrical

Saccular

Varicose

Fusiform

85
Q

Morphology of bronchiectasis

Dilated bronchi &bronchioles appear
⚫ Cylindrical –____ like dilatation
⚫ Saccular –_________-like distension
⚫ Varicose –________ enlargements
⚫ Fusiform –_____ shaped dilatation

A

tube

rounded sac

irregular

spindle

86
Q

Morphology of bronchiectasis

Cut lung surface reveals
⚫ _______ appearance with fibrotic
intervening stroma

⚫ (thin or thick?) (constricted or dilated?) bronchial walls with ________ filled lumina.
⚫ Bronchioles can be easily followed by
dissection to the pleural surfaces

A

Honey comb

Thick; dilated ; mucus/pus

87
Q

Morphology of bronchiectasis: Microscopy reveals

Bronchi & bronchioles
⚫ ___________________ epithelium

⚫ Acute & chronic inflammatory infiltrates

⚫ Tissue ________ and ______

Lung parenchyma
⚫ Fibrosis of _________
⚫__________ pneumonia in surrounding lung tissue
⚫ Suppuration

A

Normal, ulcerated or metaplastic

destruction and fibrosis

intervening stroma

Interstitial

88
Q

In obstructive lung diseases

Volume of air that can be forcefully expired is _____eased (), especially during the first second of expiration (_____);

A

decr; FVC

FEV1

89
Q

In obstructive lung diseases

FEV1:FVC is _____eased

A

Decr

90
Q

In obstructive lung diseases , Total lung capacity (TLC) is usually ______eased due to ________

A

incr
air trapping

91
Q

Emphysema is reversible

T/F

A

F

Emphysema is irreversible

92
Q

Regions

Centrilobular-______ lobes. Especially the ____ segments

Panlobular-_______ lobes ; especially at the ———-

Paraseptal-_______ lobes

A

upper; apical

lower; bases

upper

93
Q

Irregular (______ or ______) emphysema

Acinus is irregularly involved and may be asymptomatic.

A

scar or cicatricial

94
Q

Irregular (scar or cicatricial) emphysema

Association: Occurs near the _____ and is commonly found around ______________ like tuberculous scars.

A

scar

old healed inflammatory process

95
Q

In emphysema

Usually, the __________ of the lungs are more severely involved

______ are found in irregular and distal acinar emphysema

A

upper two-thirds

Bullae

96
Q

Emphysema can easily be seen on the cut surface of formalin-inflated fixed lung.

T/F

A

T

97
Q

Weight gain is seen in (CB or emphysema?)

Weight loss is seen in (CB or emphysema?)

A

CB

Emphysema

98
Q

Pursed lip breathing is a clinical feature in patients with __________

A

Emphysema

99
Q

Acute asthmatic attack usually lasts up to _______

A

several hours.

100
Q

_________ is the most severe form of asthma in which the severe paroxysm persists for days and even weeks.

A

Status asthmaticus

101
Q

In Status asthmaticus,

The bronchoconstriction responds to the drugs.

It may cause severe airflow obstruction

May lead to severe cyanosis and even death.

T/F

A

F

T

T

102
Q

Genetic Causes of bronchiectasis

Kartagener or _______ syndrome (primary ______________)

________ syndrome

A

immotile cilia ; ciliary dyskinesia

Young’s

103
Q

Cystic Fibrosis

Major respiratory diseases in cystic fibrosis (CF) are _________ and _________

A

sinusitis and bronchiectasis.

House AMP (64 decks)

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