Pathology of Obstructive Lung Disease

Question 1

Obstructive airway diseases

Answer 1

Chronic bronchitis
Emphysema
Asthma

Question 2

Chronic bronchitis and emphysema are better known as

Answer 2

Chronic obstructive pulmonary disease (COPD)

Question 3

Normal FEV1

Answer 3

3.5-4 litres

Question 4

Normal FVC

Answer 4

5 litres

Question 5

Investigations for obstructive lung disease

Answer 5

Spirometry

Peak expiratory flow rate (PEFR)

Question 6

Normal range of peak flow

Answer 6

80-100%

Question 7

Moderate fall range of peak flow

Answer 7

50-80%

Question 8

Marked fall range of peak flow

Answer 8

<50%

Question 9

PEFR in obstructive lung disease

Answer 9

Reduced

Question 10

FEV1 in obstructive ling disease

Answer 10

Reduced

Question 11

FEV in obstructive lung disease

Answer 11

May be reduced

Question 12

FEV1/FVC ratio in obstructive lung disease

Answer 12

<70%

Question 13

Bronchial asthma is a reflection of

Answer 13

Type 1 hypersensitivity

Question 14

Bronchial asthma

Answer 14

Bronchial smooth muscle contraction and inflammation

Question 15

Bronchial asthma is generally considered to be

Answer 15

Reversible airway obstruction

Question 16

Causes of chronic bronchitis and emphysema

Answer 16

Smoking
Atmospheric pollution
Occupation - dust
Age 
Susceptibility

Question 17

Prevalence of chronic bronchitis and emphysema

Answer 17

Men>women

Increasing in developing countries

Question 18

Why are chronic bronchitis and emphysema more common in men than women

Answer 18

Men tend to smoke more and are occupied in jobs that are more likely to have them around atmospheric pollution

Question 19

Clinical presentation of chronic bronchitis

Answer 19

Cough with sputum most days in at least 3 consecutive months for 2 or more consecutive years

Question 20

Complicated chronic bronchitis when

Answer 20

Mucopurulent

Question 21

Mucopurulent

Answer 21

Excess production of mucous in the respiratory tract - result in coughing it out

Question 22

Morphological changes in large airways in chronic bronchitis

Answer 22

Mucous gland hyperplasia
Goblet cell hyperplasia
Inflammation and fibrosis - minor

Question 23

Morphological changes in small airways in chronic bronchitis

Answer 23

Goblet cells appear

Inflammation and fibrosis in long standing disease

Question 24

Emphysema

Answer 24

Increase in the size or airspace’s distal to the terminal bronchiole arising either from dilation or from destruction of their walls and without obvious fibrosis

Question 25

Acinus

Answer 25

Area of lung where gas exchange takes place

Question 26

Forms of emphysema

Answer 26

``` Centriacinar Panacinar Periacinar Scar 'irregular' Bullous emphysema ```

Question 27

Centriacinar emphysema

Answer 27

Emphysema in the centre of the acinus, begins with bronchiolar dilation then alveolar tissue is lost

Question 28

Panacinar emphysema

Answer 28

Emphysema in entire acinus, from bronchiole to alveoli expanded, more common in lower lobes

Question 29

Periacinar emphysema

Answer 29

Emphysema adjacent to pleura and septal lines, distributed within secondary pulmonary lobule, subpleaural

Question 30

Bulla

Answer 30

Emphysematous space greater than 1cm

Question 31

Bleb

Answer 31

Bulla just underneath the pleura

Question 32

Pathogenesis of emphysema

Answer 32

Smoking Protease-antiprotease imbalance Ageing Alpha-1-antitrypsin deficiency

Question 33

Apha-1-antitrypsin deficiency caused emphysema

Answer 33

Prevents production of anti-elastase (anti-protease) so too much elastase (protease) present leading to tissue destruction

Question 34

Smoking caused emphysema

Answer 34

Increases the production of inflammatory cells (macrophages and neutrophils) which produce elastase (protease) production and lead to more tissue destruction. Repair mechanisms and anti-elastase proaction are inhibited.

Question 35

Most of airflow limitation in COPD is

Answer 35

Irreversible

Question 36

Mechanisms of airway obstruction in COPD in small airways

Answer 36

Smooth muscle tone, inflammation. fibrosis, partial collapse on expiration

Question 37

Mechanisms of airway obstruction in COPD in large airways

Answer 37

Little contribution by glands and mucous

Question 38

Mechanisms of airway obstruction that respond to pharmacological intervention

Answer 38

Smooth muscle tone and inflammation (like asthma)

Question 39

Function of alveolar attachments

Answer 39

Stop alveoli from collapsing at expiration and so keep airways open

Question 40

Effect of emphysema on alveolar attachments

Answer 40

Attachments are cut resulting in loss of pull and so flopping airways and airflow limitation

Question 41

Why COPD results in hypoxaemia

Answer 41

Airway obstruction Reduced respiratory drive Loss of al velour surface are Only during acute infective exacerbation

Question 42

Chronic (hypoxic) cor pulmonale

Answer 42

Hypertrophy of the right ventricle resulting from disease affecting the function and/or structure of the lung

Question 43

Why does chronic (hypoxic) cor pulmonate result sin pulmonary hypertension

Answer 43

Pulmonary vasoconsriction Loss of capillary bed Muscle hypertrophy and intimal fibrosis of pulmonary arterioles Secondary polychthemia