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66 Cards in this Set
- Front
- Back
What are the types of obstructive lung diseases?
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chronic bronchitis, emphysema, asthma, bronchiectasis
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What is obstructive lung disease?
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progressive development of airflow limitation that is not fully reversible due to physical or functional obstruction at any anatomic level
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What is COPD?
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chronic bronchitis and emphysema
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What are the two ways the pathology of COPD can develop?
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anatomic obstruction to airflow in large and small airways, resulting in chronic distal air entrapment
destruction of elastic alveolar tissue, loss of elastic recoil, functional obstruction |
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How do you diagnose COPD clinically?
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abnormal decrease in the rate of forced expiration in the absence of other disease
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How do you test for COPD?
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decrease in FEV1
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What are the risk factors for COPD?
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smoking, pollution, genetic predisposition
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What predicts poor mortality in COPD?
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low body mass index, high degree of airflow obstruction, severe dyspnea, significant impairment of exercise capacity
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How long does it take for FEV1 to return to normal after quitting smoking?
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3-5 years
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What causes mechanical obstruction?
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edema, increased mucus, impaired mucociliary transport, constriction of smooth muscle of bronchi/bronchioles
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What is the diagnostic criteria for chronic bronchitis?
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history of chronic cough or mucus production for at least three months in at least two successive years when other causes have been excluded
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What is the pathology of chronic bronchitis?
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hypertrophy of submucosal seromucinous glands in larger airways, goblet cell metaplasia of respiratory epithelium in large/small airways
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What is affected by the most severe forms of chronic bronchitis?
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smallest conducting airways, most easily obstructed by small amounts of mucus
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What causes chronic bronchitis?
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inhaled irritants, esp cigarette smoke
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What messes up the mucociliary escalator in chronic bronchitis?
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enlargement/hyperplasia of mucus secreting glands, more goblet cells, squamous metaplasia, thickening of airway wall, secondary infection
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What is emphysema?
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abnormal permanent enlargement of airspaces distal to the terminal bronchiole with destruction of walls and without obvious fibrosis
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What is the pathology of emphysema?
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chronic injury to terminal air passages and alveoli
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When does emphysema present?
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not right away, in some patients present without clinically apparent disease
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What is the most common form of emphysema?
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centrilobular
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What kind of emphysema is caused by environmental exposures?
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centrilobular
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What part of the lung is initially affected by centrilobular emphysema?
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respiratory bronchiole
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What is the pathology of centrilobular emphysema?
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patchy dilation of air spaces accompanied by some degree of anthracosis
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Where is anthracosis most prominent in centrilobular emphysema?
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upper part of lobes
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What does early panacinar emphysema look like?
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dilated alveolar ducts and alveoli, with more prominent involvement of the lower lobes
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What mutation is associated with panacinar emphysema?
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alpha-1-antitrypsin deficiency
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What happens in subpleural emphysema?
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dilated airspaces at lung periphery, apically and medially
air trapped can compromise function by compressing parenchyma or rupturing |
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Who gets bullae of air?
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patients with advanced centrilobular or panacinar emphysema, also developmental abnormality in young, nonsmoking adults
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What is irregular emphysema?
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localized dilation of airspaces from retraction secondary to scarring, with healing of TB or pneumoconiosis
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What happens in interstitial emphysema?
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dissection of air into interlobular septa, no actual destruction of alveolar parenchyma, so not true emphysema
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What causes interstitial emphysema?
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mechanical ventilation with high inspiratory pressures, esp in newborns, complication of emphysema
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What is asthma?
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disease of hyper-reactive airways, leading to episodic, reversible bronchoconstriction, owing to increased responsiveness of tracheobronchial tree to stimuli
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What are the symptoms of asthma?
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dyspnea, cough, chest tightness, wheezing
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What usually triggers asthma in kids?
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allergy to dust, pollen, antigens
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What causes adult onset asthma?
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abnormalities of autonomic regulation of bronchial musculature in response to physical/mechanical stimuli or psychogenic factors
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What is the pathology of asthma?
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bronchials are plugged with mucus, eosinophils, mucus gland hypertrophy, goblet cell metaplasia, hypertrophic basement membranes, bronchial smooth muscle
likely to be hyper-inflated |
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What causes morbidity with asthma?
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respiratory muscle exhaustion, airway infeciton, pneumothorax
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What causes mortality in asthma?
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cor pulmonale, "status asthmaticus"
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What is "status asthmaticus"?
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severe, prolonged asthma refractory to conventional therapy with acute irreversible respiratory failure
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What is the pathophysiology of asthma?
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smooth muscle constriction with airway narrowing, increased airway resistance during attacks
bronchoconstriction in all lobes, but not uniformly |
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Which airways are most affected by asthma?
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smallest caliber peripheral airways
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What is bronchiectasis?
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irreversible dilation of bronchi as a consequence of destruction of muscular and elastic elements of walls
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What are the histo features of bronchiectasis?
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intense bronchial inflammation, destruction of stromal support of bronchial walls, chronic bacterial infection of bronchus with intralumenal PMN response
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Why does bronchiectasis occur?
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result of chronic necrotizing infection or physical obstruction of bronchus followed by chronic secondary infection
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What are the symptoms of bronchiectasis?
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cough with production of abundant purulent foul smelling sputum
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What determines respiratory impairment in bronchiectasis?
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extent of parenchymal involvement and presence/absence of other bronchial/alveolar disease
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What causes obstruction in bronchiectasis?
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expiratory collapse of weakened bronchial walls, stasis of purulent secretions
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What causes death in bronchiectasis?
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infection, hemoptysis
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What are complications of bronchiectasis?
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pulmonary hypertension, cor pulmonale/right heart failure, amyloidosis
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What diseases can cause bronchiectasis?
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viral pneumonia, TB, lung injury, CF, immotile cilia syndromes, alpha-1-antitrypsin deficiency, congenital
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Which virus commonly causes bronchiectasis?
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adenovirus type 21
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What are the signs of CF?
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obstructive lung diseaes in childhood and early adulthood, excessively thick, sticky bronchial mucus iwth chronic bacterial bronchitis
later bronchiectasis |
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What is the most common CF mutation?
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mutation in CFTR
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What is the function of the abnormal CF channel?
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can't open in response to cAMP, results in abnormal viscid mucous
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What is the normal function of CFTR?
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when open, Cl moves out of cells, also influences other Cl/Na channels in nearby membrane
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Where are CFTR levels highest?
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in epithelial cells lining the internal surface of pancreas, sweat glands, salivary glands, intestine, reproductive organs, lungs
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Which parts of the lungs have the highest CFTR levels?
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submucosal glands of airways
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What is the result of the delta F508 CF mutation?
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CFTR can't be processed properly and doesn't assume functional location in the cell
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What are the presenting symptoms of CF?
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recurrent pneumonia, recurrent bronchiolitis, pansinusitis or nasal polyps, fatty stool, FTT, salty-tasting skin
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What is the most important finding of bronchiectasis?
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impaired clearance of secretions from bronchial tree, results in infections
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What is forced vital capacity?
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amount of gas forcefully expelled after max inspiration
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What is FEV1?
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volume expelled in first second of FVC
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What is PEFR?
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max airflow rate during FVC
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What is TLC?
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amount of gas in lungs after maximal inspiration
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What is RV?
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gas remaining after maximal expiration
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What is expiratory reserve volume?
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amount of gas representing difference between FVC and RV
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What is cor pulmonale?
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right ventricular disease secondary to lung disease
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