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Pathoma LAH > Pulmonary: 9.4: COPD > Flashcards

Pulmonary: 9.4: COPD Flashcards

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1
Q

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

A

chronic bronchitis

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2
Q

What does the submucosa contain?

A

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

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3
Q

What are chronic bronchitis pts at risk for?

A

Increased infections and cor pulmonale

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4
Q

What is panacinar emphysema? Where is it most severe?

A

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

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5
Q

What is the pathogenesis of asthma?

A

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

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6
Q

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

A

Kartagener Syndrome

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7
Q

What will the spirometry findings be in obstructive diseases?

A
  • decreased FVC
  • very decreased FEV1
  • decreased FEV1:FVC ratio
  • increased TLC (air trapping)
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8
Q

Histamine-induced vasodilation occurs at?

A

the arterioles

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9
Q

What is a normal TLC?

A

7L

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10
Q

What is under the lamina propria?

A

the submucosa

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11
Q
  • DX?
  • dyspnea cough w/ minimal sputum
  • prolonged expriration, breathing thru pursed lips
  • weight loss
  • increased AP diameter of chest (barrel chested)
A

emphysema

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12
Q

How do bronchioles stay open without cartilage?

A

they have elastic recoil

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13
Q

What is below the submucosa?

A

cartilage

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14
Q

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

A

PiM; PiZ

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15
Q

What cell protects the bottom of the lung?

A

the alveolar mac

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16
Q

What are the clinical features of bronchiectasis?

A
  • SOB
  • cough with foul-smelling sputum
  • complications: hypoxemia, cor pulmonale, 2a amyloidosis
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17
Q

What are the features of chronic bronchitis?

A

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

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18
Q

What does IL5 do?

A

attracts eosinphils

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19
Q

What is an acinus?

A

the functional unit of the lung

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20
Q

What is the obstruction in emphysema?

A

collapsed bronchioles that have lost their elastic recoil

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21
Q

What is a normal FEV1?

A

4L

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22
Q

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

A

pushes O2 into the BVs

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23
Q

What are 2 late complications of emphysema?

A
  1. hypoxemia2. cor pulmonale
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24
Q

What is allergic bronchopulmnary aspergilliosis?

A

a hypersensitivity rxn to aspergillis in asthmatics and CF pts

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25
What causes the obstruction in chronic bronchitis?
mucous
26
What is a normal FEV1:FVC ratio?
80%
27
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
28
What is the obstruction in bronchiectasis?
enlarged airways- can't force the air out
29
What is the average volume of air expired?
5L
30
A decreased FEV1:FVC ratio is indicative of \_\_\_\_\_.
obstructive lung disorders
31
What are the 2 major types of emphysema?
1. centriacinar emphysema2. panacinar emphysema
32
What are the features of bronchiectasis?
permanent dilation of bronchioles and bronchiloss of airway tone --\> air trapping
33
This is a hypersensitivity rxn to aspergillis in asthmatics and CF pts.
allergic bronchopulmnary aspergilliosis
34
How is lung volume and function measured?
spirometry
35
* DX? * destruction of the alveolar air sacs * loss of elastic recoil * collapse of small airways * air trapping
emphysema
36
Obstructive disease means \_\_\_\_.
there's trouble getting air OUT of the lung
37
What is mucous in the lungs for?
it traps allergens and irritants, foreign material
38
Describe the histological findings of a liver with A1AT deficiency.
pink or purple, PAS positive, globules in hepatocytes
39
What also is often present with panacinar emphysema?
liver cirrhosis
40
Increased PaCO2 automatically means \_\_\_\_\_.
the PAO2 and PaO2 will go down
41
What are the 4 obstructive lung diseases?
1. Chronic bronchitis 2. emphysema 3. asthma 4. bronchiectasis
42
In asthma, IgE activates \_\_\_\_\_.
mast cells
43
What diseases are associated with bronchiectasis?
* CF * Kartagener Syndrome * Tumor of Foreign Body * Necrotizing infection * Allergic bronchopulmonary aspergillosis
44
What is the difference between a bronchus and a bronchiole?
there's no cartilage in a bronchiole
45
What does TLC stand for? What is it?
total lung capacity; the maximum amount of air that can be w/I the lungs
46
What is serous fluid for?
to humidify the air to enter the alveoli
47
What is centriacinar emphysema?
destruction of the central part of the acinus due to smoking
48
\_\_\_\_\_ with _____ causes bronchiectasis.
Necrotisin inflammation with damage to the airway wall
49
What is the functional residual capacity (FRC)?
the balance of the expanding chest wall vs the collapsing elastin in the lung
50
What is a severe, unrelenting asthma attack that can lead to death called?
status asthmaticus
51
What kind of cells make up the respiratory epithelium?
ciliated pseudostratified columnar cells
52
What is status asthmaticus?
a severe, unrelenting asthma attack that can lead to death
53
What kinds of emphysema do smokers get? Where is it worst?
centriacinar emphysema, usually most severe in the upper lobes
54
What is secondary amyloidosis? Which lung disease is associated with it?
SAA proteins depositing as AA; bronchiectasis
55
What is the obstruction in asthma?
bronchoconstriction
56
Which cytokine attracts eosinphils?
IL5
57
What is the most common cause of emphysema?
smoking
58
What is the Reid index?
a measure of the percent of mucous glands making up the wall thickness
59
In normal lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).
40% or less
60
Histamine-induced increased vascular permeability occurs at?
the post-capillary venules
61
What is the 2nd phase mast cells do to perpetuate inflammation?
produce leukotrienes (C4, D4, and E4)
62
* DX? * permanent dilation of bronchioles and bronchi * loss of airway tone --\> air trapping
bronchiectasis
63
In fibrosis of the lung, the FRC is \_\_\_\_\_\_.
decreased
64
Which cytokine stimulates TH2 production while inhibiting TH1s?
IL10
65
In normal lungs, the mucinous glands take up _____ of the wall thickness.
40% or less
66
What does IL10 do?
inhibits TH1 cell and increase TH2 cells
67
In a smoker's lungs, the mucinous glands take up _____ of the wall thickness (the Reed index).
\>50%
68
Smokers produce large amounts of ____ in their lungs.
mucous
69
What does FVC stand for and what does it mean?
forced vital capacity- the maximum amount of air expired after a maximal inspiration
70
Why is TLC increased in obstructive disease?
air is trapped in the lungs
71
What are Charcot-Leyden crystals? Where do they come from?
crystals coughed up in the sputum of asthmatics; made by eosinophils
72
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. exercise2. viral infections3. aspirin4. occupational exposures
77
What is Kartagener Syndrome?
a defect of the dynein arm of all cilia, causing sinusitis, infertilitiy, situs inversus
78
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
79
What are the clinical features of asthma?
SOB, wheezingproductive cough with Curshmann spirals mixed with Charcot-Leyden crystals
80
What underlies the BM under the epi of the lung?
the lamina propria
81
What is found in the lamina propria?
large BVs called venules
82
Which cytokine allows plasma cells to class switch to IgE?
IL4
83
What are antiproteases?
proteins, such as alpha-1-antitrypsin, that protect against proteases (inflammation)
84
In emphysema, the FRC is \_\_\_\_\_\_.
increased
85
Why are emphysemics called pink puffers?
slow breathing with pursed lips (increased back pressure)opens walls of the alveoli- pink bc they are oxygenating
86
Mast cells release their preformed ______ granules, causing ______ and \_\_\_\_\_.
histamine; vasodilation, increased vascular permeability
87
Where does mutated A1AT deficiency accumulate to cause problems in the liver? What does this cause?
in the ER of hepatocytes; cirrhosis
88
What do TH2 cells secrete?
IL4, IL5, IL10
89
What is the other cause of emphysema, behind smoking?
alpha-1-antitrypsin deficiency
90
What are the clinical features of emphysema?
* dyspnea * breathing thru pursed lips * barrel chested
91
What does IL4 do?
allows plasma cell to class switch to IgE
92
What is a normal FVC?
5L
93
What do leukotrienes do?
cause increased vasodilation, increased vascular permeability, and bronchoconstriction
94
The ____ will be decreased more than _____ in obstructive lung disease.
FEV1; FVC

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