RESPIRATORY: 604 - 605 Flashcards Preview

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Flashcards in RESPIRATORY: 604 - 605 Deck (53)
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1

What is the main problem in obstructive lung disease?

Obstruction of air flow - can't get air out of the lungs

2

What happens to the residual volume and forced vital capacity in obstructive lung disease?

RV increases and FVC decreases

3

What is forced vital capacity (FVC)?

Maximal expiration

4

What are the significant PFT's in obstructive lung disease?

Extremely decreased FEV1
Decreased FVC
Decreased FEV1/FVC ratio (hallmark)
V/Q mismatch

5

Name the major complication in obstructive lung disease.

Chronic, hypoxic pulmonary vasoconstriction can lead to cor pulmonale

6

What is cor pulmonale?

Enlargement and failure of the right ventricle of the heart as a response to pulmonary hypertension

7

What are the 4 types of obstructive lung disease?

1. Chronic bronchitis
2. Emphysema
3. Asthma
4. Bronchiectasis

8

Describe the pathophysiology of chronic bronchitis.

Hyperplasia of mucus-secreting glands in the bronchi leads to mucus plugs obstructing the airway

9

What is the classic description of a patient with chronic bronchitis?

Blue bloater

10

What clinical findings are associated with chronic bronchitis?

1. Productive cough
2. Wheezing
3. Crackles
4. Cyanosis
5. Late-onset dyspnea
6. CO2 retention

11

What type of cough is diagnostic for chronic bronchitis?

Productive cough for > 3 months per year (not necessarily consecutive) for > 2 years

12

Which airways are primarily affected in chronic bronchitis?

Small airways

13

What is the Reid index?

Thickness of gland layer/total thickness of bronchial wall

14

What complications are patients with chronic bronchitis at risk for?

Infection and cor pulmonale

15

What is the Reid index in patients with chronic bronchitis?

> 50%

16

Describe the pathologic changes in emphysema.

Destruction of alveolar walls leads to enlargement of air spaces, decreased recoil, and increased compliance

17

Why do emphysema patients exhale through pursed lips?

To increase airway pressure and prevent airway collapse during respiration

18

What are the two types of emphysema and what are they associated with?

1. Centriacinar - smoking
2. Panacinar - alpha1-antitrypsin deficiency

19

What is chronic bronchitis usually linked to?

Smoking

20

What are two mechanisms by which emphysema leads to air trapping?

1. Loss of elastic recoil and subsequent collapse of small airways
2. Imbalance of proteases and antiproteases

21

Is emphysema more a physical or physiologic obstruction?

Physiologic

22

What is the most important antiprotease in the lung?

Alpha1-antitrypsin

23

Why does the lung need antiproteases?

To protect the lung tissue from proteases from inflammation stimulated by alveolar macrophages

24

Why does smoking lead to emphysema?

Lots of toxic debris --> increased activity of alveolar macrophages --> increased inflammation --> increased protease activity

25

Is asthma reversible or irreversible?

Reversible

26

What is asthma?

Bronchial hyperresponsiveness causing reversible bronchoconstriction

27

Describe three histologic findings in asthma.

1. Smooth muscle hypertrophy
2. Curschmann spirals (shed epithelium forms mucus plugs)
3. Charcot-Leyden crystals (formed from breakdown of eosinophils in sputum)

28

List 5 causes of asthma.

1. Allergens
2. Viral URI's
3. Stress
4. Exercise
5. Aspirin

29

What type of hypersensitivity reaction is asthma?

Type 1

30

What sort of immune response does asthma induce?

Th2