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Flashcards in Pathology of Obstructive Diseases Deck (96):
1

What is atelectasis?

Incomplete expansion of the lung of collapse of previously inflated lung

2

What is the major issue with atelectasis?

Predisposes to infx

3

What is the resorptive type of atelectasis? What happens to the mediastinum with this?

Atelectasis that follows complete airway obstruction

Mediastinum will shift toward the affected side

4

What is compressive atelectasis? What happens to the mediastinum with this?

Excessive air, fluid, blood etc in pleural space causing compression

Mediastinum will shift away from the affected lung

5

What is patchy atelectasis? What usually causes this?

Loss of surfactant, usually post surgical complication

6

What is contraction atelectasis?

FIbrosis around the lung causing collapse

7

Which way does the trachea/mediastinum shift with a tension pneumothorax?

Away from the affected lung

8

What are the two primary causes of pulmonary congestion and edema?

-Hemodynamic disturbances
-Microvascular injury

9

What happens in ARDS?

Breakdown of capillary cell walls and lung interstitium usually due to sepsis

10

What are the hemodynamic disturbances that can cause pulmonary edema?

Increased hydrostatic pressure from heart failure

11

What are the gross characteristics of pulmonary edema?

Heavy, wet lungs

12

What are the histological characteristics of hemodynamic pulmonary edema? (3)

-Engorgement of alveolar capillaries
-Intraalveolar HF cells
-Fibrosis

13

What is transudate?

extravascular fluid with low protein content and a low specific gravity (

14

What is exudate?

any fluid that filters from the circulatory system into lesions or areas of inflammation.

15

What is the microvascular injury type of pulmonary edema?

Capillaries of alveolar septa. Either the endothelial cells, or the alveolar epithelial cells

16

What are the localized forms of microvascular injury type forms of pulmonary edema?

Pneumonia and ALI

17

What is the systemic form of microvascular injury type forms of pulmonary edema?

ARDS

18

What are the four major obstructive diseases?

-Emphysema
-chronic bronchitis
-asthma
-bronchiectasis

19

What is COPD?

Emphysema + chronic bronchitis

20

What is the main feature of obstructive pulmonary disease?

Air cannot get out of the lung efficiently

21

What is the main feature of restrictive pulmonary disease?

Air cannot get in the lung efficiently

22

Which of the obstructive diseases is/are reversible?

Asthma

23

What is the pathophysiology behind emphysema?

Breakdown of the elastin in alveoli, causing overexpansion

24

Which airways are primarily affected with emphysema?

Small airways--acinus and respiratory bronchioles

25

Which airways are primarily affected with chronic bronchitis?

Large airways--trachea and bronchi

26

What is the pathophysiology with chronic bronchitis?

Airway inflammation, causing mucus plugging

27

What is the pathophysiology behind asthma?

Bronchial hyperresponsiveness

28

What part of the airways are primarily affected with bronchiolitis? What happens here?

Bronchioles--fibrosis causes airway obstruction

29

What is the anatomic site affected with asthma?

Bronchi

30

What is the anatomic site affected with bronchiectasis? What happens here? Cause?

bronchus--breakdown of the airways due to an excessive inflammatory response. Involved bronchi become enlarged and thus less able to clear secretions

31

What are the ssx of bronchiectasis?

Productive, purulent cough, fever

32

In which obstructive lung diseases does tobacco play a major role?

Emphysema
Chronic bronchitis
Bronchiolitis

33

Which of the obstructive disorders primarily present(s) with wheezing?

asthma

34

Which of the lung volumes increase in obstructive diseases? What causes this?

Residual volume due to obstruction or loss of recoil (as in COPD)

35

What happens to the FVC1 with obstructive airway disease?

Decreases

36

What happens to FVC1/FVC with obstructive lung diseases?

Decreases

37

What happens to TLC and FVC with obstructive diseases?

Normal to increased

38

What happens to TLC with restrictive diseases?

Decreases

39

What happens to FVC with restrictive diseases?

Decreases

40

What happens to FEV1/FVC in restrictive lung diseases? Why?

Normal--both FEV1 and FVC decrease since there is not a problem with getting air out, just how much that can be held

41

Ssx of emphysema are not apparent until what fraction of the pulmonary parenchyma are incapacitated?

1/3

42

What is the definition of emphysema?

Irreversible enlargement of airspaces distal to the terminal bronchioles *without* fibrosis

43

What are the two major causes of emphysema?

Smoking and environmental pollutants

44

What is the pathogenesis of COPD?

Smoking causes PMNs to increase in the lungs, which release elastase.

45

What is notable about macrophages specifically in the role of COPD?

Macrophage elastase is not inhibited by alpha-1-antitrypsin.

Also release metalloproteases

46

What is the oxidant model of COPD?

Oxidants in cigarette smoke and free radical formation inhibit antiprotease and cause damage

47

What is the role of alpha-1-antitrypsin?

Inhibits elastase

48

What are the cytokines that increase PMNs in the alveoli? (3)

IL-8
LTB4
TNF

49

What causes the cirrhosis with alpha-1-antitrypsin deficiency?

Buildup of protein in the liver

50

What is the gene that is mutated in alpha-1-antitrypsin?

PiMM goes to PiZZ

51

What is the major functional difference between smoking induced COPD and alpha-1-antitrypsin induced?

Smoking merely inhibits antitrypsin, while alpha-1-antitrypsin causes a decrease in antitrypsin

52

What is the stain that highlights antitrypsin in the liver?

PAS

53

What is the anatomic site of smoking induced emphysema? How about for alpha-1-antitrypsin?

smoking = centriacinar
alpha-1-antitrypsin = panacinar

54

What are the four anatomic locations of emphysema? Which is clinically insignificant?

Centriacinar
Panacinar
Paraseptal
Irregular*-insignificant

55

What is paraseptal emphysema?

lesion in the distal acinar, adjacent to areas of fibrosis, scarring, or atelectasis

56

What is irregular emphysema?

Airspace enlargement with fibrosis

57

What is centriacinar emphysema?

Respiratory bronchioles are fragmented with loss of septal tissue, creating enlarged areas

58

Where in the lungs is the greatest damage with centriacinar emphysema?

Apical lungs

59

What is panacinar emphysema?

Acini are uniformly enlarged from respiratory bronchioles to terminal blind alveoli

60

Where is the lungs is panacinar emphysema most common?

Basilar portions

61

Which two types of emphysema commonly occur together?

Panacinar and centriacinar

62

What is distal acinar (paraseptal) emphysema? Where in the lung is this usually found?

Enlargement with destruction of the distal portion of the acinus, worst in the upper lung zones, adjacent to the pleura

63

What is distal acinar (paraseptal) emphysema usually associated with? Why?

Spontaneous pneumothorax

d/t cyst like structure that form rupturing

64

What are the histological characteristics of distal acinar (paraseptal) emphysema?

Scarring, fibrosis, or atelectasis

Cyst like structures

65

What is irregular emphysema?

Acini are irregularly involved, but are scarred and inflamed

66

What is bullous emphysema? What is the major complication associated with this?

Subpleural emphysematous spaces that are greater than 1-2 cm in diameter

Can give rise to a pneumothorax

67

What are the three major causes of death from emphysema?

-respiratory acidosis/coma
-Right heart failure
-Massive pneumothorax

68

What is the treatment for emphysema?

Bronchodilators
Steroids

69

What is pink puffer?

Pt with severe emphysema, who overventilation but achieves adequate respiration

70

What are blue bloaters?

Chronic bronchitis leads to hypercapnia and abundant sputum production

71

What is the clinical definition of chronic bronchitis?

Persistent cough with production of sputum for at least 3 months of year, for 2 consecutive years

72

What is the most common cause of chronic bronchitis?

cigarette smoking

73

What is chronic bronchitis? What is it characterized by?

Chronic inflammation of the airways, characterized by hypertrophy of submucosal glands, and goblet cell metaplasia

74

What is bronchiolitis obliterans?

obliteration of the lumen of bronchioles secondary to fibrosis from chronic bronchitis

75

What is the Reid index?

Fraction of the submucosa (from BM to the cartilage) that is taken up by glands.

76

What are the ssx of chronic bronchitis?

Persistent cough and sputum production, leading to outflow obstruction

77

What are the non-neoplastic complications of chronic bronchitis?

Pulmonary HTN and HF

78

What are the neoplastic complications of chronic bronchitis?

Squamous metaplasia and dysplasia of bronchial epithelium

79

What are the two common infectious bacteria that cause chronic bronchitis?

H. Influenza
Strep Pneumonia

80

What are the two common infectious viruses that cause chronic bronchitis?

Adenovirus
RSV

81

How does cigarette smoking predispose patients to chronic bronchitis? (2)

Interfere with mucociliary escalator, and directly damaging the epithelium

82

What is the elastic recoil like in emphysema? Chronic bronchitis?

Emphysema = low
Bronchitis = normal

83

When does a cough usually present with chronic bronchitis? Emphysema? How does this compare to the SOB with each?

Early with bronchitis
Late with emphysema

Flipped for dyspnea

84

Which can lead to pulmonary HTN: chronic bronchitis or emphysema?

Bronchitis

85

What are the CXR findings for chronic bronchitis? Emphysema?

Bronchitis = prominents vessels

COPD= hyperinflation

86

What are the histological changes with chronic bronchiolitis? (3)

Goblet cell metaplasia with fibrous thickening of the wall and increased smooth muscle

87

What are the long term complications of asthma?

chronic bronchitis or cor pulmonale

88

What is status asthmaticus?

Unremitting asthma attack

89

What are the two important questions to ask patients with asthma Why?

Have you been hospitalized or intubated for it

Increased probability of mortality

90

What is atopic asthma? Non-atopic?

Atopic = Type I hypersensitivity

Non-atopic = idiopathic

91

What are the cytokines released by Th2 cells in allergic asthma? (2)

IL-4
IL-5

92

What is the major immune cell response to asthma?

Th2

93

What is the early phase of allergic asthma?

antigen exposure causes asthmatic attack within 30 minutes

94

What is the late phase of allergic asthma?

4-8 hours after initial attack, with new cells binding to left-over IgE triggering another attack

95

Why is the vagal nerve stimulated to cause contraction in asthma?

Destruction of epithelial cells

96

What are the two findings of asthma with alveolar lavage? What are each of these?

Curschmann spirals = whorls of shed epithelium

Charcot-Leyden crystals = crystalloids of eosinophilic proteins