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Flashcards in Pathoma- COPD Deck (100):
1

DX? chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking

chronic bronchitis

2

What does the submucosa contain?

serous glands (produce serous fluid) and mucinous glands (to produce mucous)

2

What are chronic bronchitis pts at risk for?

Increased infections and cor pulmonale

2

What is panacinar emphysema? Where is it most severe?

emphysema across the whole acinus, usu associated with alpha-1-antitrypsin deficiency. most severe in the lower lobes

2

What is the pathogenesis of asthma?

genetically-susceptible pt is exposed to an allergen that induces TH2 phenotype in CD4+ cells

3

What syndrome is a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus, and lung infections?

Kartagener Syndrome

5

What will the spirometry findings be in obstructive diseases?

  • decreased FVC
  • very decreased FEV1
  • decreased FEV1:FVC ratio
  • increased TLC (air trapping)

5

Histamine-induced vasodilation occurs at?

the arterioles

6

What is a normal TLC?

7L

6

What is under the lamina propria?

the submucosa

6

  • DX?
  • dyspnea cough w/ minimal sputum
  • prolonged expriration, breathing thru pursed lips
  • weight loss
  • increased AP diameter of chest (barrel chested)

emphysema

7

How do bronchioles stay open without cartilage?

they have elastic recoil

7

_____ are a byproduct of inflammation; ______ proteins protect against this.

Proteases; antiproteases

8

What is below the submucosa?

cartilage

8

Nasal polyps are associated with?

1. chronic rhinitis 2. aspirin intolerant asthma 3. cystic fibrosis

9

What is the normal A1AT allele? What is the mutated allle?

PiM; PiZ

10

What cell protects the bottom of the lung?

the alveolar mac

10

What are the clinical features of bronchiectasis?

  • SOB
  • cough with foul-smelling sputum
  • complications: hypoxemia, cor pulmonale, 2a amyloidosis

11

What are the features of chronic bronchitis?

chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking increased thickness of mucus glands Reid index >50% cyanosis

11

What does IL5 do?

attracts eosinphils

12

What is an acinus?

the functional unit of the lung

13

What is the obstruction in emphysema?

collapsed bronchioles that have lost their elastic recoil

15

What is a normal FEV1?

4L

16

PAO2 creates a pressure that _____, which is then denoted PaO2.

pushes O2 into the BVs

16

What are 2 late complications of emphysema?

1. hypoxemia 2. cor pulmonale

17

What is allergic bronchopulmnary aspergilliosis?

a hypersensitivity rxn to aspergillis in asthmatics and CF pts

18

What causes the obstruction in chronic bronchitis?

mucous

20

What is a normal FEV1:FVC ratio?

80%

20

What are the features of chronic bronchitis?

  • chronic, productive cough lasting at least 3 months over a minimum of 2 years
  • highly assoc with smoking

20

What is the obstruction in bronchiectasis?

enlarged airways- can't force the air out

21

What is the average volume of air expired?

5L

23

A decreased FEV1:FVC ratio is indicative of _____.

obstructive lung disorders

24

What are the features of chronic bronchitis?

chronic, productive cough lasting at least 3 months over a minimum of 2 years highly assoc with smoking increased thickness of mucus glands Reid index >50%

24

What are the 2 major types of emphysema?

1. centriacinar emphysema 2. panacinar emphysema

25

What are the features of bronchiectasis?

permanent dilation of bronchioles and bronchi loss of airway tone --> air trapping

25

This is a hypersensitivity rxn to aspergillis in asthmatics and CF pts.

allergic bronchopulmnary aspergilliosis

27

How is lung volume and function measured?

spirometry

28

  • DX?
  • destruction of the alveolar air sacs
  • loss of elastic recoil
  • collapse of small airways
  • air trapping

emphysema

29

Obstructive disease means ____.

there's trouble getting air OUT of the lung

31

What is mucous in the lungs for?

it traps allergens and irritants, foreign material

31

Describe the histological findings of a liver with A1AT deficiency.

pink or purple, PAS positive, globules in hepatocytes

32

What also is often present with panacinar emphysema?

liver cirrhosis

34

Increased PaCO2 automatically means _____.

the PAO2 and PaO2 will go down

35

What are the 4 obstructive lung diseases?

  1. Chronic bronchitis
  2. emphysema
  3. asthma
  4. bronchiectasis

36

In asthma, IgE activates _____.

mast cells

37

What diseases are associated with bronchiectasis?

  • CF
  • Kartagener Syndrome
  • Tumor of Foreign Body
  • Necrotizing infection
  • Allergic bronchopulmonary aspergillosis

39

What is the difference between a bronchus and a bronchiole?

there's no cartilage in a bronchiole

40

What does TLC stand for? What is it?

total lung capacity; the maximum amount of air that can be w/I the lungs

40

What are the features of asthma?

reversible airway bronchoconstriction usu caused by type I hypersensitivity rxn assoc with rhinitis, eczema

41

What is serous fluid for?

to humidify the air to enter the alveoli

43

What is centriacinar emphysema?

destruction of the central part of the acinus due to smoking

44

Why is TLC increased in obstructive disease?

air is trapped

44

_____ with _____ causes bronchiectasis.

Necrotisin inflammation with damage to the airway wall

45

What is the functional residual capacity (FRC)?

the balance of the expanding chest wall vs the collapsing elastin in the lung

46

What is a severe, unrelenting asthma attack that can lead to death called?

status asthmaticus

48

What kind of cells make up the respiratory epithelium?

ciliated pseudostratified columnar cells

49

What is status asthmaticus?

a severe, unrelenting asthma attack that can lead to death

50

What kinds of emphysema do smokers get? Where is it worst?

centriacinar emphysema, usually most severe in the upper lobes

50

What is secondary amyloidosis? Which lung disease is associated with it?

SAA proteins depositing as AA; bronchiectasis

51

What is the obstruction in asthma?

bronchoconstriction

52

Which cytokine attracts eosinphils?

IL5

54

What is the most common cause of emphysema?

smoking

55

What is the Reid index?

a measure of the percent of mucous glands making up the wall thickness

56

In normal lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).

40% or less

57

Histamine-induced increased vascular permeability occurs at?

the post-capillary venules

57

What is the 2nd phase mast cells do to perpetuate inflammation?

produce leukotrienes (C4, D4, and E4)

58

  • DX?
  • permanent dilation of bronchioles and bronchi
  • loss of airway tone --> air trapping

bronchiectasis

59

In fibrosis of the lung, the FRC is ______.

decreased

60

Which cytokine stimulates TH2 production while inhibiting TH1s?

IL10

61

In normal lungs, the mucinous glands take up _____ of the wall thickness.

40% or less

61

What does IL10 do?

inhibits TH1 cell and increase TH2 cells

62

In a smoker's lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).

>50%

64

Smokers produce large amounts of ____ in their lungs.

mucous

66

What does FVC stand for and what does it mean?

forced vital capacity- the maximum amount of air expired after a maximal inspiration

68

Why is TLC increased in obstructive disease?

air is trapped in the lungs

69

What are Charcot-Leyden crystals? Where do they come from?

crystals coughed up in the sputum of asthmatics; made by eosinophils

71

What also is often present with panacinar emphysema?

liver cirrhosis

73

In emphysema, there is an imbalance between ____ and _____.

proteases and antiproteases

74

Alpha-1-antitrypsin deficiency is the cause of the rare ______ emphysema.

panacinar

75

Why does obstruction cause increased infections?

bc you are plugging up a tube, increasing infection propensity

76

Name 4 nonallergic causes of asthma.

1. exercise 2. viral infections 3. aspirin 4. occupational exposures

77

What is Kartagener Syndrome?

a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus

79

What does FEV1 stand for and what does it mean?

Forced expiratory volume 1; the max amount of air expired after 1 second after a maximal inspiration

80

What are the clinical features of asthma?

SOB, wheezing productive cough with Curshmann spirals mixed with Charcot-Leyden crystals

81

What underlies the BM under the epi of the lung?

the lamina propria

83

What is found in the lamina propria?

large BVs called venules

85

Which cytokine allows plasma cells to class switch to IgE?

IL4

86

What are antiproteases?

proteins, such as alpha-1-antitrypsin, that protect against proteases (inflammation)

87

In emphysema, the FRC is ______.

increased

89

Why are emphysemics called pink puffers?

slow breathing with pursed lips (increased back pressure)opens walls of the alveoli- pink bc they are oxygenating

90

Mast cells release their preformed ______ granules, causing ______ and _____.

histamine; vasodilation, increased vascular permeability

92

Where does mutated A1AT deficiency accumulate to cause problems in the liver? What does this cause?

in the ER of hepatocytes; cirrhosis

93

What do TH2 cells secrete?

IL4, IL5, IL10

94

What is the other cause of emphysema, behind smoking?

alpha-1-antitrypsin deficiency

95

What are the clinical features of emphysema?

  • dyspnea
  • breathing thru pursed lips
  • barrel chested

96

  • DX?
  • chronic, productive cough lasting at least 3 months over a minimum of 2 years
  • highly assoc with smoking
  • increased thickness of mucus glands
  • Reid index >50%

chronic bronchitis

97

What does IL4 do?

allows plasma cell to class switch to IgE

98

What is a normal FVC?

5L

99

What do leukotrienes do?

cause increased vasodilation, increased vascular permeability, and bronchoconstriction

100

The ____ will be decreased more than _____ in obstructive lung disease.

FEV1; FVC