Pulmonary: Atelectasis + Obstructive Flashcards Preview

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Flashcards in Pulmonary: Atelectasis + Obstructive Deck (58):
1

What is atelectasis

Collapse of airway spaces

2

What is resorption atelectasis

Occlusion of a bronchus

3

What is compression atelectasis

Due to a mass or bleeding

4

What is contraction atelectasis due to

Scarring in the lung like silicosis

5

What is obstructive lung disease?

Limitation of airflow due to partial or complete obstruction

6

Lung volumes in obstructive?
What is the problem?

Normal

Hard to get air out (FEV1 done)

7

What forms of obstructive are reversible?

Just asthma

8

What is asthma?

Episodic reversible bonrchospasm from stimuli with underlying chronic inflammatory state

9

Asthma on histo?

Inflammatory cells
Eosinophils

10

Symptoms of asthma?

1. Episodic dyspena
2. Chest tightnesss
3. Cough

11

Extrinsic asthma initiated by what?
Timing in life

Type 1 hypersenstivity
Early in life (kids)

12

Asthma Ig?
Cells (2)

IgE

Mast and Eosinophils

13

Atopic asthma?

Kids with red rash from hay fever

14

Occupational asthma?

Something from work place

15

Allergic bronchopulmonary asthma is due to what?

Aspergillus growing in airways

16

Intrinsic asthma is triggered by what?
When in life?

Non-immune triggers like asthma, cold exposure, exercise

Later in life

17

Main cells in all asthmas? 2

1. Eosinophils
2. Th2 lymphocytes

18

Substances involved in early phase of asthma? (5)

1. Leukotrienes
2. Prostglandings
3. Platelet-activating factor
4. Histamine
5. Mast cell tryptase

19

Substances involved in late phase of asthma? (5)

1. WBC chemotactic factors
2. Leukotreine B
3. IL-4 and IL-5
4. Platelet activating factor
5. Tumor necrosis factor

20

Morpho changes

1. Mucus plugs (obstructive
2. Edema
3. Hyperemia
4. Goblet cells increase
5. Hypertrophy of bronchial muscle

21

What is hyperemia

Dilated vessels that give tissues a red color

22

COPD affects what % of US population

Reversible or irreversible?

10%

Irreversible

23

Two forms of COPD
Which is more common?

Emphysema
Chronic bronchitis

Combination of the two

24

Mechanism of emphysema

Alveolar sacs dilate and lose elastic recoil

25

What is the change in the lung in emphysema?

The walls are destroyed

26

How are chronic bronchitis and emphysema

1. Emphysema is defined by morphologic changes
2. Emphysema Restricted to the acini

27

Emphysema is more common in which sex?
Which form especially?

Men

Centriacinar

28

Emphysema has a clear association with what two factors?

1. Smoking
2. Alpha-1-antitrypsin deficiency

29

Two imbalances in emphysema and their effect

1. Protease-antiprotease imbalance: ( Destruction of elastic fibers --> Permanent dilation of air sacs (Smoking & alpha-1-AT deficiency)

2. Oxidant-antioxidant imbalance: Oxidative damage --> Tissue destruction (Smoking)

30

First symptom of emphysema
Speed of disease

Dyspena
Slow

31

PFT's of emphysema show what?
FEV1?
FVC?
FEV1-FVC ratio
O2 levels

FEV1 down
FVC normal
FEV1/FVC down
O2 normal

32

Pure emphysema individuals are described how?
Why?

Pink puffers

Barrel chest
Exhale against pursed lips (Back pressure against)
Thin

33

Chronic bronchitis patients are described how?
Why?

Blue bloaters

Overweight
Hypoxic/Cyanosis

34

What do emphysema patients gradually acquire? (End-Stage)
Why?

Pulmonary hypertension

Loss of capillary surface --> Increases resistance --> Pulmonary HTN

35

Centroacinar emphysema
Locations spared?
Upper or lower lobes
Associated with what?

Distal parts of acini
Upper lobes
Cigarette smoke

36

Panacinar
Location
Upper or lower
Associated with what?

All of the acini
Lower lung
Alpha-1-antitrypsin

37

Normal alpha-1-AT genotype?
Bad one?
What else happens with bad one?

MM
ZZ
Liver disease/Cirrhosis

38

Distal/paraceptal
Location
Location in lungs (2)
Type of patient:

Distal portions of acini
Pleural surface AND upper half
Spontaneous pneumothorax in young adults

39

False emphysemas

1. Compensatory emphysema
2. Senile emphysema
3. Obstructive overinflation
4. Mediastinal emphysema

40

Compensatory emphysema cause

Dilatation due to loss of lung substance elsewhere

41

Senile emphysema definition

Overdistended lungs in elderly due to change in lung geometry (NO tissue destruction)

42

Obstructive overinflation definition?
Problem?

Lung expansion due to obstruction with air trapping
Serious lifethreatening if too much lung is compressed

43

Mediastinal emhysema definition
What is it secondary to?

Entrance of air into soft tissues of the lung, mediastinum and subcutis.

High intra-alveolar pressures, ventilators, and chest wall trauma

44

Chronic bronchitis is diagnosed how?

Clinically: persistent productive cough for at least 3 consecutive months in at least 2 consecutive yeras

45

Define chronic bronchitis

Bronchial mucus hypersecretion secondary to inflammation, fibrosis, and narrowing of bronchioles

46

Simple chronic bronchitis is defined how?

Cough with mucoid sputum (no obstruction)

47

Chronic mucopurulent bronchitis is defined how?

Production of purulent sputum secondary to associated infections

48

Chronic asthmatic bronchitis is defined how?
Best treatment?

Hyperresponsive airways giving episodes of asthma

Bronchodilator

49

Single most important cause of chronic bronchitis?

Cigarette smoke

50

Inflammation cells in chronic bronchitis?

1. CD8 T cells
2. Neutrophils
3. Macrophages

51

What is a secondary problem with chronic bronchitis?

Microbial infections

52

CB patients are described how?
Why?

Blue bloaters

1. Overweight
2. Cyanotic

53

Progression of chronic bronchitis (2)

1. Pulm HTN
2. Cardiac failure

54

Bronchiectasis definition

Inflammatory destruction of bronchi walls --> Dilated and floppy with purulent secretions

55

Predisposing bronchiectasis hereditary conditions

1. Cystic fibrosis (pseudomonas)
2. Kartagener syndrome (ciliary dysfunction)

56

Nonhereditary predisposing bronchiectasis conditions? 2

1. Necrotizing pneumoniae (Klebsiella, S. aureus)
2. Suppurative pneumonias

57

How do cultures of bronchiectasis present?

Mixed: lots of bugs

58

Symptom of bronchiectasis

1. Persistent cough with sputum
2. Episodic and worsened by URI's
3. Clubbing of finger tips
4. Metastatic brain abscesses
5. Reactive amyloidosis