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pulmonology > Obstructive Lung Disease- Bootcamp > Flashcards

Obstructive Lung Disease- Bootcamp Flashcards

1
Q

Obstructive lung disease occurs as a result of some kind of obstruction to airflow that causes an increase in airway resistance; this causes FEV1 to _ and FVC to _

A

Obstructive lung disease occurs as a result of some kind of obstruction to airflow that causes an increase in airway resistance; this causes FEV1 to dramatically decrease and FVC to decrease

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1
Q

Obstructive lung disease is associated with a _ FEV1/FVC ratio

A

Obstructive lung disease is associated with a decreased FEV1/FVC ratio
* Due to the dramatic decrease in FEV1

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2
Q

Three common examples of obstructive lung diseases are _ , _ , and _

A

Three common examples of obstructive lung diseases are COPD , asthma , and cystic fibrosis

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3
Q

The two “phenotypes” of COPD are _ and _

A

The two “phenotypes” of COPD are emphysema and chronic bronchitis

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4
Q

Emphysema causes airway obstruction via _ while chronic bronchitis causese airway obstruction via _

A

Emphysema causes airway obstruction via equal pressure point moving towards the alveoli while chronic bronchitis causese airway obstruction via mucus blocking the airways

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5
Q

Emphysema causes a “dynamic” obstruction; explain

A

Emphysema –> lung elastic tissue destroyed –> decreased elastance and increase compliance –> equal pressure point moves towards the alveoli –> dynamic airway collapse

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6
Q

Asthma causes obstruction via _

A

Asthma causes obstruction via bronchoconstriction
* Causing episodic airway obstruction

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7
Q

Cystic fibrosis causes obstruction via _

A

Cystic fibrosis causes obstruction via thick mucus plugging

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8
Q

Episodic, reversible bronchoconstriction describes _

A

Episodic, reversible bronchoconstriction describes asthma

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9
Q

Common symptoms of asthma

A

Asthma symptoms include:
* Wheezing
* Coughing
* Dyspnea
* Hypoxemia
* Asymptomatic between episodes

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10
Q

Asthma bronchoconstriction is caused by _

A

Asthma bronchoconstriction is caused by airway hyperresponsiveness

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11
Q

Three components of the “atopic triad”

A

“Atopic triad”
1. Atopic asthma
2. Atopic dermatitis
3. Allergic rhinitis

Common allergens are dust, pets, pollen

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12
Q

Atopic asthma is caused by _ and is mediated by _

A

Atopic asthma is caused by an identifiable allergen and is mediated by IgE
* It is a Type I Hypersensitivity reaction
* Classically triggered by pets, dust, pollen

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13
Q

Non-atopic asthma is _

A

Non-atopic asthma has no identifiable allergen
* It usually follows viral infection, stress or exercise

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14
Q

_ is severe asthma that has an acute onset and can be fatal

A

Status asthmaticus is severe asthma that has an acute onset and can be fatal

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15
Q

NSAIDs can also induce asthma by blocking the _ pathway and upregulating the production of _

A

NSAIDs can also induce asthma by blocking the COX pathway and upregulating the production of leukotrienes (via the LOX pathway)

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16
Q

Nasal polyps in adults are commonly associated with _

A

Nasal polyps in adults are commonly associated with NSAID induced asthma

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17
Q

Nasal polyps in children are commonly associated with _

A

Nasal polyps in children are commonly associated with cystic fibrosis

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18
Q

Atopic asthma pathophysiology

A
  1. Antigen enters
  2. Antigen is presented by APC to Th2 cell
  3. Th2 cell releases cytokines
  4. IL-5 recruits eosinophils
  5. IL-4 and IL-13 stimulates plasma cells to make IgE
  6. IgE primes the mast cells (IgE binds the mast cell)
  7. Mast cells are ready to degranulate
  8. On repeat exposure, the antigen binds IgE and mast cell degranulates
  9. Release of histamine and leukotrienes –> bronchoconstriction
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19
Q

The early phase of an asthma reaction involves bronchoconstriction caused by _ and _

A

The early phase of an asthma reaction involves bronchoconstriction caused by histamines and leukotrienes

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20
Q

In the late stage of an asthma reaction, _ cells are recruited to _

A

In the late stage of an asthma reaction, eosinophils are recruited to release major basic protein –> inflammation and mucus production

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21
Q

Asthma can be diagnosed with spirometry that shows a _ FEV1/FVC

A

Asthma can be diagnosed with spirometry that shows a decreased FEV1/FVC

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22
Q

In order to diagnose asthma using spirometry, we often have to induce an asthma episode with administration of _

A

In order to diagnose asthma using spirometry, we often have to induce an asthma episode with administration of methacholine
* Methacholine challenge causes bronchoconstriction

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23
Q

Healthy individuals spend about twice as long expiring as they do inspiring; asthmatic patients might spend _ time in expiration

A

Healthy individuals spend about twice as long expiring as they do inspiring; asthmatic patients might spend four times more time in expiration
* I/E goes from 1/2 –> 1/4

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24
Q

_ are eosinophil granules found in the sputum that can help to diagnose asthma

A

Charcot-Leyden crystals are eosinophil granules found in the sputum that can help to diagnose asthma

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25
Q

Curschmann spirals are _ and are also found in the sputum of patients with asthma

A

Curschmann spirals are whorled mucus plugs with epithelial casts and are also found in the sputum of patients with asthma

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26
Q

Cromolyn sodium treats asthma by _

A

Cromolyn sodium treats asthma by stabilizing mast cells

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27
Q

Meplizumab, Reslizumab, Benralizumab treat asthma via _ mechanism

A

Meplizumab, Reslizumab, Benralizumab are IL-5 and IL-5 receptor antagonists
* Decrease eosinophil activation and recruitment

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28
Q

Inhaled corticosteroids help asthma patients by _

A

Inhaled corticosteroids help asthma patients by suppressing cytokine production and also causing eosinophil apoptosis
* Fluticasone, Budesonide, Beclomethasone

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29
Q

Omalizumab is an asthma drug that is _

A

Omalizumab is an asthma drug that is an anti-IgE antibody

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30
Q

Lukast drugs are _ drugs

A

Lukast drugs are anti-leukotriene receptor drugs

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31
Q

Zileuton is a _ drug

A

Zileuton is an anti-lipoxyganase drug

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32
Q

Albuterol is a _ type drug

A

Albuterol is a short-acting B2 agonist (SABA) that induces bronchodilation

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33
Q

_ and _ are two long acting B2 agonists (LABAs)

A

Salmeterol and Formoterol are two long acting B2 agonists (LABAs) that cause bronchodilation

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34
Q

Ipratropium is a medication used in asthma that is _

A

Ipratropium is a medication used in asthma that is anti-muscarinic –> bronchodilation

35
Q

Theophylline is an asthma drug that is a _

A

Theophylline is an asthma drug that is a PDE inhibitor –> increases cAMP –> bronchodilation

36
Q

_ is a common medication choice for acute exacerbations of asthma

A

Albuterol is a common medication choice for acute exacerbations of asthma

37
Q

_ + _ is a common combination drug used for treatment of persistent asthma

A

Corticosteroid + LABA is a common combination drug used for treatment of persistent asthma

38
Q

Why can LABAs not be given as a monotherapy?

A

LABAs over time will cause downregulation of B2 receptors; therefore they must be combined with corticosteroids which upregulate B2 receptors

39
Q

In cases of resistant asthma in which patients have continued high IgE levels, _ can be given

A

In cases of resistant asthma in which patients have continued high IgE levels, Omalizumab can be given

40
Q

_ is an asthma medication that can cause oral candidiasis if not rinsed after use

A

Inhaled corticosteroids are an asthma medication that can cause oral candidiasis if not rinsed after use

41
Q

_ is an asthma drug that can have a caffeine-like effect due to adenosine blockade

A

Theophylline is an asthma drug that can have a caffeine-like effect due to adenosine blockade

42
Q

_ is an irreversible dilation and destruction of the airways; it is most commonly caused by cystic fibrosis

A

Bronchiectasis is an irreversible dilation and destruction of the airways; it is most commonly caused by cystic fibrosis

43
Q

Patients with obstructive disease like COPD take _ breaths

A

Patients with obstructive disease like COPD take slow, deep breaths
* They try to hold the airways open by taking deep breaths
* They decrease the turbulence and airway resistance by breathing slowly
* They also may purse their lips on expiration to create back-pressure

44
Q

Patients with restrictive lung disease will take _ breaths

A

Patients with restrictive lung disease will take rapid, shallow breaths
* They attempt to decrease the work of breathing by decreasing lung volume and decreasing elastic recoil force of the lungs

45
Q

(Emphysema/ Chronic bronchitis) causes patients to experience the chronic dyspnea; (Emphysema/ Chronic bronchitis) causes the persistent coughing

A

Emphysema causes patients to experience the chronic dyspnea; chronic bronchitis causes the persistent coughing

46
Q

COPD is a common disease that commonly presents in _ individuals

A

COPD is a common disease that commonly presents in smokers
* Other risk factors include air pollution exposure, occupational exposure, multiple chronic infections

47
Q

COPD in a young individual, who does not smoke may be due to _

A

COPD in a young individual, who does not smoke may be due to genetic cause like A1AT deficiency

48
Q

_ is an antiprotease that keeps elastase in check to prevent degradation of alveolar tissue

A

a1-antitrypsin is an antiprotease that keeps elastase in check to prevent degradation of alveolar tissue
* Some individuals have a genetic mutation that causes A1AT to misfold and never leave the hepatocyte ER

49
Q

Aside from affecting the lungs, A1AT deficiency can also affect the _

A

Aside from affecting the lungs, A1AT deficiency can also affect the liver
* Patients might present with liver failure due to accumulated A1AT in the hepatocyte ER

50
Q

A1AT deficiency tends to cause _ type emphysema

A

A1AT deficiency tends to cause panacinar emphysema
* Patients will normally be diagnosed in 40s-50s
* Effects will be more severe in patients who smoke

51
Q

Pathogenesis of COPD (specifically chronic bronchitis)

A

Airways become inflamed (ie cigarette smoke) –> neutrophils migrate to the area –> release cytokines + ROS –> ROS are intended to kill bacteria but when inflammation persists they can cause damage to the inflamed area –> increase mucus production (upregulate goblet cells) –> airway obstruction

52
Q

Two major histopathologic changes are seeen in chronic bronchitis _ and _

A

Two major histopathologic changes are seen in chronic bronchitis goblet cell hyperplasia and squamous metaplasia

53
Q

Constant bronchiolar injury induces ciliated pseudostratified columnar cells to be replaced with _

A

Constant bronchiolar injury induces ciliated pseudostratified columnar cells to be replaced with squamous epithelium

54
Q

The consequence of squamous metaplasia is that the loss of cilia causes _

A

The consequence of squamous metaplasia is that the loss of cilia causes increased infection risk

55
Q

Proteases are mostly made by _ cells

A

Proteases are mostly made by neutrophils and macrophages

56
Q

Antiproteases are secreted by _ cells to keep proteases in check

A

Antiproteases are secreted by resident epithelial cells to keep proteases in check

57
Q

The destruction of septae in emphysema can lead to enlarged areas of dilated lung sacs called _

A

The destruction of septae in emphysema can lead to enlarged areas of dilated lung sacs called blebs or bullae

58
Q

Centriacinar emphysema affects _

A

Centriacinar emphysema affects center of the acini (respiratory bronchi)
* Associated with smoking
* Most common type

59
Q

Panacinar emphysema affects _

A

Panacinar emphysema affects the entire acinus
* It is less common and associated with A1AT deficiency

60
Q

Paraseptal empysema affects _

A

Paraseptal empysema affects the periphery of the acinus
* Associated with pulmonary scarring

61
Q

_ emphysema is most likely to cause a spontaneous pneumothorax due to destruction just beneath the pleura

A

Paraseptal emphysema is most likely to cause a spontaneous pneumothorax due to destruction just beneath the pleura

62
Q

Three consequences of COPD

A
  1. Hypercapnia
  2. Bronchiectasis
  3. Pulmonary hypertension
63
Q

Long term hypoxia in COPD induces the production of _ and _

A

Long term hypoxia in COPD induces the production of 2,3-BPG and EPO
* EPO is a hormone made by the kidneys that stimulates the bone marrow to make more RBCs –> polycythemia

64
Q

The Reid index is the proportion of _ to _

A

The Reid index is the proportion of mucus glands/ mucosa + submucosa

65
Q

In chronic bronchitis, the Reid index will be greater than _

A

In chronic bronchitis, the Reid index will be greater than 50%

66
Q

What are the classic lab values expected in chronic bronchitis?
PaO2
PaCO2
pH
HCO3-

A

PaO2: decreased
PaCO2: increased
pH: decreased (< 7.35)
HCO3-: increased

67
Q

Why is oxygen therapy dangerous for COPD patients?

A

COPD patients (especially with chronic bronchitis) have hypercapnia –> over time their central/medullary chemoreceptors stop responding to the high CO2 levels –> they then rely entirely on their peripheral chemoreceptors to respond to low O2 –> if oxygen is delivered to COPD patient then hypoxic drive to breathe will be decreased –> can cause patient to be even more hypercapnic

68
Q

DLCO is decreased in (chronic bronchitis/ emphysema)

A

DLCO is decreased in emphysema
* Emphysema affects our diffusing capacity because it degrades our alevoli and decreases surface area
* Chronic bronchitis is a problem of the bronchi, it does not affect the alveoli

69
Q

Cyanosis is associated with (chronic bronchitis/ emphysema)

A

Cyanosis is associated with chronic bronchitis
* Emphysema is not usually associated with cyanosis- there is destruction of both alveoli and capillaries so there is not much of a V/Q mismatch

70
Q

Explain the pathogenesis of emphysema as a result of cigarette smoking

A

Smoke –> recruits neutrophils –> neutrophils release protease (elastase) –> elastase degrades around the area where smoke is inhaled which is central, in the respiratory bronchioles of the upper lobes

71
Q

Cigarette smoking tends to cause _ emphysema in the _ lobes

A

Cigarette smoking tends to cause centriacinar emphysema in the upper lobes

72
Q

A1AT deficiency tends to cause _ emphysema in the _ lobes

A

A1AT deficiency tends to cause panacinar emphysema in the lower lobes

73
Q

Cystic fibrosis has a _ inheritance pattern

A

Cystic fibrosis has an autosomal recessive inheritance pattern

74
Q

Cystic fibrosis is a mutation in the _ protein; it is caused by a _ deletion

A

Cystic fibrosis is a mutation in the CFTR protein; it is caused by a Phe508del
* CFTR encodes ATP-gated Cl- channel
* The mutated CFTR channel is misfolded and improperly trafficked to the cell membrane

75
Q

In the GI tract + lungs, Cl- should be (reabsorbed/ secreted) through the CFTR channel in normal individuals; in cystic fibrosis _ occurs

A

In the GI tract + lungs, Cl- should be secreted through the CFTR channel in normal individuals; in cystic fibrosis Cl- gets trapped inside the cells –> Na+ reabsorption –> H2O reabsorption
* We get thick and dehydrated mucus in the lumen

76
Q

In the skin, Cl- should be (reabsorbed/secreted) through the CFTR channel; however, in CF _ occurs

A

In the skin, Cl- should be reabsorbed through the CFTR channel; however, in CF the Cl- builds up in the sweat –> Na+ and H2O will also be lossed in the sweat

77
Q

What are the consequences of cystic fibrosis?

A

Thick mucus in the lungs –> mucus plugging –> hyperinflated lungs with productive cough + recurrent pulmonary infections

78
Q

The most common infection in young CF patients is _

A

The most common infection in young CF patients is S. aureus

79
Q

The most common infection in adults with CF is _

A

The most common infection in adults with CF is P. aeruginosa
* The thick mucus facilitates the formation of biofilms

80
Q

Bronchiectasis is most commonly caused by _

A

Bronchiectasis is most commonly caused by CF

81
Q

How does CF affect the pancreas and GI system?

A

Thick mucus in the pancreatic and bile ducts –> decreased pancreatic and biliary secretions –> decreased fat soluble absorption –> pancreatitis, steatorrhea, diabetes

82
Q

Thick mucus in the stool can cause _ in infants

A

Thick mucus in the stool can cause meconium ileus in infants
* Thick/sticky meconium –> inspissated mass –> bowel obstruction

83
Q

How does CF normally affect fertility?

A

Males often have an absent vas deferens –> sterile
Women may have thick cervical mucus making them subfertile

84
Q

_ CF drug improves protein misfolding and trafficking while _ drug enhances Cl- flux through the channel

A

Lumacaftor CF drug improves protein misfolding and trafficking while Ivacaftor drug enhances Cl- flux through the channel

pulmonology (16 decks)

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