Respiratory Path 2 - Galbraith

Question 1

Obstructive disease

Answer 1

Increased resistance to airflow anywhere in the tract

Question 2

Restrictive disease

Answer 2

Reduced expansion of lung parenchyma with decreased lung capacity

Question 3

PFTs for obstructive disease

Answer 3

Decreased FEV1

Question 4

4 obstructive diseases

Answer 4

• Emphysema
• Chronic bronchitis
• Asthma
• Bronchiectasis

Question 5

COPD is a combo of what obstructive diseases? Why is this a common combo?

Answer 5

Emphysema + chronic bronchitis

BOTH are caused by SMOKING

Question 6

Emphysema description

Answer 6

Irreversible enlargement of airspaces DISTAL TO terminal bronchioles (ACINUS)

Question 7

Centriacinar emphysema…

• Occurs in who?
• Lung involvement?
• Seen in which lung part?

Answer 7

• Smokers (COPD)
• Respiratory bronchioles (more proximal)
• Upper lobes/apical parts

Question 8

Panacinar emphysema…

• Occurs in who?
• Lung involvement?
• Seen in which lung part?

Answer 8

• Alpha-1 antitrypsin deficiency
• Distal alveoli
• Lung bases

Question 9

Roles of tobacco smoke in emphysema pathogenesis (4)

Answer 9

• Recruit/activate neut’s and macrophages
• Induce protease release from neutrophils (elastase)
• Reducing antioxidants via abundant ROS’s
• Inactivate antitrypsin-1

ALL cause alveolar wall destruction

Question 10

PiZZ chromosome 14 homozygote

Most will develop what?

Answer 10

Alpha-1 antitrypsin deficiency

–> Panacinar emphysema that’s accelerated by smoking

Question 11

Why and when is emphysema obstructive?

Answer 11

Destruction of elastic alveolar walls around bronchioles –> collapse of bronchioles during EXPIRATION

Question 12

Dyspnea, cough, wheezing, weight loss, barrel chest, prolonged expiration

Answer 12

Emphysema

Question 13

Progression/complication of emphysema

Answer 13

Pulmonary HTN –> R heart failure

Question 14

4 causes of death in emphysema

Answer 14

• CAD
• Respiratory failure
• RHF
• Pneumothorax/collapse

Question 15

• Smoker or inhabitant of polluted environment
• Chronic, persistent, productive cough
• Dyspnea on exertion

Answer 15

Chronic bronchitis

Question 16

Changes seen in chronic bronchitis

Answer 16

• Mucus gland hyperplasia and hypersecretion
• Bronchiolar fibrosis and thickening
• Mucus stasis
• Respiratory squamous metaplasia
• Increased goblet cells
• Small airway mucous plugging

Question 17

Pink puffer vs. blue bloater

Answer 17

PP = over-respiration of normal parenchyma in emphysema

BB = cyanosis in bronchitis

Question 18

• Recurrent episodic wheezing, shortness of breath, chest tightness, cough
• Common in morning and night

Answer 18

Asthma

Question 19

3 changes in asthma

Answer 19

• Recurrent bronchoconstriction
• Inflammation of bronchial walls
• Increased mucus secretion

Question 20

Atopic asthma

Answer 20

• Type 1 (IgE) hypersensitivity to allergen(s)

Question 21

Atopic asthma 2-part pathogenesis

Answer 21

1. Th2 cells stimulate IgE production, eosinophil recruitment, and mucus production in response to allergen
2. IgE binds to mast cells (Fc), then cross linked by allergen re-exposure –> hypersensitivity reaction

Question 22

Immediate phase of asthma attack (3)

Answer 22

• Bronchoconstriction
• Mucus secretion
• Vascular permeability

Question 23

Late phase of asthma attack (2)

Answer 23

• Inflammatory recruitment

- Mucosal tissue damage

Question 24

Non-atopic asthma

Answer 24

Non-allergen stimulation of bronchoconstriction (viruses, irritants/smoke, cold air, exercise)

Question 25

Morphologic changes over time due to recurrent asthma attacks

Answer 25

- SM hypertrophy/hyperplasia - Subepithelial fibrosis - Mucosal gland hyperplasia - Increased airway vascularity - Increased airway thickness

Question 26

Curschmann spirals

Answer 26

ASTHMA - Mucus plugs from occluded bronchi and bronchioles that are expelled in sputum/lavage

Question 27

Charcot-Leyden crystals

Answer 27

ASTHMA - Eosinophil granule debris deposited in airways and expelled in sputum/lavage

Question 28

Status asthmaticus | - Danger?

Answer 28

- Acute asthma symptoms lasting for days | - Can cause cyanosis and death

Question 29

Bronchiectasis pathogenesis

Answer 29

Airway obstruction -->/or chronic destructive necrotizing infections of airway --> SM and elastic destruction --> permanent dilation of airways

Question 30

Predisposing conditions for bronchiectasis

Answer 30

- Conditions affecting mucus clearing - 1º ciliary diskinesia - Cystic fibrosis - Bronchial obstruction - Immunodeficiency

Question 31

Bronchiolitis obliterans

Answer 31

Bronchiectasis --> repeated attempts to resolve inflammatory process --> fibrosis --> small bronchiolar obliteration

Question 32

Cystic fibrosis - cause

Answer 32

Defect or lack of epithelial chloride channel (CFTR)

Question 33

CFTR functions (3)

Answer 33

- Sweat glands - chloride on surface --> cell (w/ Na+) - Epithelia - chloride in cell --> lumen - Inhibits epithelial ENaC channel

Question 34

A deficient/missing CFTR leads to what? (2)

Answer 34

- Over-active ENaC --> sodium uptake into cells --> water uptake --> thicker respiratory mucus - Under-active sweat gland Na+ channels --> excess Na+ in sweat --> salty sweat

Question 35

Why do CF patients get recurrent infections?

Answer 35

Thick mucus + defective ciliary activity --> can't clear microbes in the mucus --> INFECTIONS

Question 36

Eventually, CF recurrent infections leads to _____

Answer 36

Bronchiectasis

Question 37

4 common infection species in CF

Answer 37

- S. aureus - H. influenzae - Burkholderia cepacia - Pseudomonas aeruginosa

Question 38

Special thing about Pseudomonas in CF?

Answer 38

Produces mucoid capsule --> biofilm --> protection from immune system