COPD pathology Oct10 M1

Question 1

COPD def (2)

Answer 1

1) Any pulm disorder resulting from increased resistance or decreased lung or chest recoil
2) slowly progressive disorder resulting from emphysema or reduction in caliber of small airways (bronchioles)

Question 2

5 COPDs

Answer 2

emphysema, bronchiolitis (small airway disease), asthma, COPD, bronchiectasis

Question 3

2 COPDs that aren’t really obstructive

Answer 3

chronic bronchitis (even if considered true COPD)
bronchiectasis

Question 4

pulmonary acinus def

Answer 4

lung parenchyma distal to terminal bronchiole

Question 5

pulmonary lobule def

Answer 5

lung tissue surrounded by interlobular septae (group of acini)

Question 6

pulmonary interstitium def

Answer 6

CT in alveolar and interlobular septae and around vessels and airways

Question 7

bronchi vs bronchioles

Answer 7

bronchioles = no cartilage

Question 8

terminal bronchiole def

Answer 8

THE (1) last bronchiole with no alveoli associted with it

Question 9

major site of injury for many pulmonary diseases

Answer 9

proximal respiratory bronchioles

Question 10

secondary lobule def + width

Answer 10

region supplied by one terminal bronchiole. Usually 6 acini. surrounded by CT (interlobular septae). 1-2 cm in diameter

Question 11

secondary lobule (or lobule) blood sup

Answer 11

terminal bronchiole is paralleled by a centrilobular artery.

The veins and lymphatics run in the interlobular septa

Question 12

emphysema def

Answer 12

abnormal and permanent enlargement of airspaces with destruction of alveolar walls

Question 13

where elastic tissue found in lung + something important to note

Answer 13

in wall of airways and also in alveoli. Elastic tissue of these two regions is connected

Question 14

Function of elastic tissue

Answer 14

Stops airways from collapsing when we exhale.

Question 15

Protein other than elastin found in lung interstitium

Answer 15

some collagen too

Question 16

Equilibrium between __ and __ is important to maintain elastin and collagen in lung

Answer 16

Proteases (elastase and collagenase) and antiproteases

Question 17

What causes baseline protease release in the lung

Answer 17

Neutrophils and macrophages in circulation + in alveolar interstitium and septum, everyday, some die and release these enzymes

Question 18

Mechanisms (one major) to control baseline protease release in the lung (2)

Answer 18

alpha 1 antitrypsin present in the blood (major)

In situ antiproteases in the lung

Question 19

Cigarette smoke effects on neutrophils (4)

Answer 19

Increases their number
Delays their transit in lung (more chance they release enzymes)
Increase the amount of neutrophil elastase
Increase neutrophil elastase release

Question 20

Cigarette smoke effect on macrophages

Answer 20

Increases the number of alveolar macrophages

Question 21

2 antiproteases

Answer 21

1) epithelial cell antiproteases

2) serum alpha 1 antiprotease

Question 22

3 types of emphysema

Answer 22

centrilobular (proximal acinar)
panlobular (panacinar)
paraseptal (distal acinar)

Question 23

gross histology of centrilobular emphysema

Answer 23

patchy black holes (black due to cigarette’s carbon).. Foci of coalesced alveoli which can enlarge with time.

Question 24

centrilobular emphysema affects mostly which parts of the lung

Answer 24

upper zones

Question 25

location of disease of the lung: different words to characterize it

Answer 25

bilateral vs unilateral lower vs upper vs middle zones apexes

Question 26

what location of disease depends on (what characterizes it)

Answer 26

depends on PP gradient and blood flow

Question 27

why upper lobe that is affected in centrilobular emphysema (3)

Answer 27

1) underperfusion relative to ventilation (less blood antiprotease) 2) slower transit time of leukocytes (more time for leukocyte elastase release) 3) Less effective clearance of inhaled material from upper lobe

Question 28

95% of emphysema clinically is _______ (which type) and is related to ___

Answer 28

centrilobular | cigarette smoking

Question 29

panacinar emphysema affects which regions of the lung

Answer 29

lower zones

Question 30

cause of panacinar emphysema and when get it

Answer 30

alpha 1 antitrypsin deficiency (normally produced in liver) | get it a young age, can be 40-45 yr old if they smoke

Question 31

why panacinar emphysema has a predominance in lower zones of the lung

Answer 31

greater blood flow there so more neutrophils | proteases will digest the lung there more

Question 32

paraseptal (distal acinar) emphysema location

Answer 32

periphery of the lung next to intralobular septae, spaces often next to pleura

Question 33

physical feature seen in paraseptal emphysema

Answer 33

blebs that form in upper region of the lung

Question 34

danger of blebs in paraseptal emphysema (name of the disease)

Answer 34

spontaneous pneumothorax. can cause disease when they burst (bc pressure increased inside) bc then continous with pleural space.

Question 35

bullae def

Answer 35

spaces in the lung larger than a centimeter

Question 36

bronchiolitis (small airway disease) def

Answer 36

inflammation of the bronchioles

Question 37

small airway disease 3 characteristics + something in common between patients

Answer 37

mural chronic inflammation mural fibrosis epithelial goblet cell hyperplasia and luminal mucus accumulation Usually cigarette smokers

Question 38

small airway disease pathophysiology

Answer 38

inflammation, fibrosis and mucous decrease diameter of the lung

Question 39

goblet cells presence in SAD explanation

Answer 39

not normally in epithelial lining of bronchioles but epithelial cells changed to become goblet cells

Question 40

chronic bronchitis definition

Answer 40

expectoration (coughing up) of mucous on most days for at least 3 consecutive months for at least two years

Question 41

SAD: what cigarette smoking causes to bronchioles

Answer 41

irritates them and causes goblet cell metaplasia

Question 42

chronic bronchitis: what cigarette smoking causes to bronchi

Answer 42

irritates them and causes increase of mucous cells within bronchial glands

Question 43

chronic bronchitis severity and what it shows

Answer 43

not too bad: mucous won't obstruct airways and is coughed out It shows that airways are irritated

Question 44

chronic bronchitis often seen with ____

Answer 44

bronchiolitis

Question 45

bronchiectasis def

Answer 45

irreversible dilation of a portion of the bronchial tree

Question 46

3 adjectives to characterize bronchiectasis and their meaning

Answer 46

cylindrical varicose (worm like) saccular (sac like)

Question 47

3 classifications (location or other) of bronchiectasis

Answer 47

Intraluminal bronchial obstruction Inherited cellular or molecular defects Parenchymal fibrosis

Question 48

intraluminal bronchial obstruction in bronchiectasis caused by what

Answer 48

carcinoma, aspirated foreign body

Question 49

inherited cellular or molecular defects exemple in bronchiectasis

Answer 49

cystic fibrosis

Question 50

exemple of parenchymal fibrosis cause in bronchiectasis

Answer 50

sarcoidosis, tuberculosis