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Pulmonology > Obstructive/Restrictive Disease- Lecture > Flashcards

Obstructive/Restrictive Disease- Lecture Flashcards

1
Q

Draw the volume-flow loop in obstructive lung disease

A
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2
Q

Draw the volume-flow loop in restrictive lung disease

A
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3
Q

_ is characterized by airway inflammation, hyperresponsiveness, and reversible airflow obstruction

A

Asthma is characterized by airway inflammation, hyperresponsiveness, and reversible airflow obstruction

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4
Q

What happens during an asthma exacerbation?

A
  • Bronchoconstriction
  • Mucosal inflammation
  • Increased mucus production
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5
Q

Patient has a decreased FEV1/FVC which is normalized after bronchodilation

A

This is characteristic of asthma- it is reversible whereas COPD is not

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6
Q

The asthma phenotypes that are associated with high Th2 include:

A

High Th2:
* Allergic asthma
* Eosinophilic asthma
* Exercise-induced asthma
* Aspirin induced asthma

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7
Q

The asthma phenotypes that are not associated with Th2 (non-Th2) include:

A

Non-Th2:
* Neutrophilic asthma
* Obesity associated
* Infection-induced asthma

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8
Q

IL-4 is a type 2 cytokine that causes _

A

IL-4 is a type 2 cytokine that causes production of IgE

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9
Q

IL-5 is a type 2 cytokine that causes

A

IL-5 is a type 2 cytokine that attracts eosinophils to the bronchial wall

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10
Q

IL-9 is a type 2 cytokine that

A

IL- 9 is a type 2 cytokine that heightens the Th2 response

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11
Q

IL-13 is a type 2 cytokine that causes

A

IL-13 is a type 2 cytokine that promotes mucus production

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12
Q

Two short acting beta agonists used for asthma include _ and _

A

Two short acting beta agonists used for asthma include albuterol and epinephrine

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13
Q

Three long acting beta agonists used for asthma:

A
  1. Salmeterol
  2. Formoterol
  3. Indacaterol
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14
Q

_ is a short acting muscarinic antagonist

A

Ipratropium is a short acting muscarinic antagonist

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15
Q

Three long acting muscarinic antagonists include:

A
  1. Tiotropium
  2. Aclidinium
  3. Umeclidinium
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16
Q

Theophylline is another drug that can be used as a bronchodilator that has _ mechanism

A

Theophylline is another drug that can be used as a bronchodilator that is a phoshodiesterase4 inhibitor

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17
Q

The muscarinic receptor in the lungs that can be antagonized to treat asthma is specifically the _ receptor, which is a _ g protein

A

The muscarinic receptor in the lungs that can be antagonized to treat asthma is specifically the M3 receptor, which is Gq coupled receptor

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18
Q

Both beta receptors (beta1 and beta2) are _ G protein coupled

A

Both beta receptors (beta1 and beta2) are Gs –> adenylyl cyclase –> cAMP

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19
Q

The a2 and M2 receptors are coupled to _ G proteins

A

The a2 and M2 receptors are coupled to Gi –> inhibits adenylyl cyclase

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20
Q

a1, M1, M3 are _ G protein coupled

A

a1, M1, M3 are Gq coupled –> PLC –> Ca2+

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21
Q

cAMP in the bronchiole smooth muscle cell leads to (bronchodilation/ bronchoconstriction)

A

cAMP in the bronchiole smooth muscle cell leads to bronchodilation

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22
Q

Adenosine binds to bronchiole smooth muscle cell and induces _

A

Adenosine binds to bronchiole smooth muscle cell and induces bronchoconstriction

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23
Q

Theophylline is a _ inhibitor (although with poor sensitivity) and it works by _ and _

A

Theophylline is a phophodiesterase4 inhibitor (although with poor sensitivity) and it works by blocking adenosine binding and breaking down PDE4 to increase cAMP levels

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24
Q

PDE4 normally _ cAMP

A

PDE4 normally breaks down cAMP
* Giving a drug that inhibits this therefore rises cAMP levels
* Can induce bronchodilation this way

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25
Q

Name four corticosteroids used in the treatment of asthma

A
  1. Beclomethasone
  2. Budesonide
  3. Fluticasone
  4. Mometasone
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26
Q

_ and _ are two biologics that work against IL-5 to treat asthma

A

Mepolizumab and Reslizumab are two biologics that work against IL-5 to treat asthma

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27
Q

_ is a biologic that blocks the IL-5 receptor

A

Benralizumab is a biologic that blocks the IL-5 receptor

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28
Q

`

Corticosteroids are used in the treatment of asthma because they _ and _

A

Corticosteroids are used in the treatment of asthma because they promote anti-inflammatory mediators and inhibit inflammatory mediators

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29
Q

Corticosteroids bind hormones and cause changes in _

A

Corticosteroids bind hormones and cause changes in transcription and translation
* Increase transcription of anti-inflammatory mRNA
* Decrease transcription of inflammatory mediators

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30
Q

Corticosteroids (inhibit/ upregulate) NF-kappaB

A

Corticosteroids inhibit NF-kappaB
* NFkB mediates the induction of various pro-inflammatory genes

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31
Q

Inflammation or tissue injury triggers _ enzyme to convert phospholipids in the cell membrane into arachidonic acid

A

Inflammation or tissue injury triggers phospholipase A2 enzyme to convert phospholipids in the cell membrane into arachidonic acid

32
Q

Arachidonic acid can then be converted by _ into leukotrienes or converted by cyclooxygenases into _

A

Arachidonic acid can then be converted by lipoxygenase into leukotrienes or converted by cyclooxygenases into prostaglandins

33
Q

Corticosteroids can inhibit the production of arachidonic acid by upregulating the production of _

A

Corticosteroids can inhibit the production of arachidonic acid by upregulating the production of annexin 1
* Annexin 1 blocks phospholipase A2

34
Q

Montelukast and zafirlukast work via _

A

Montelukast and zafirlukast work via binding to the leukotriene receptor

35
Q

Montelukast and zafirlukast have a target that is located on _ cells

A

Montelukast and zafirlukast have a target that is located on bronchial smooth muscle cells

36
Q

Zilueton has a target found in _ cells

A

Zilueton’s target is found in mast cells and eosinophils

37
Q

What is the progression of asthma medications for increasing severity?

A
  1. SABA
  2. Add daily corticosteroid
  3. Daily CS/ LABA
  4. Add LAMA
  5. Add oral corticosteroid
38
Q

Dilation of the distal airspaces with septal destruction describes _

A

Dilation of the distal airspaces with septal destruction describes emphysema

39
Q

Hereditary emphysema is caused by a gene mutation that causes A1AT to misfold and remain stuck in the _

A

Hereditary emphysema is caused by a gene mutation that causes A1AT to misfold and remain stuck in the hepatocyte ER

40
Q

Explain how smoking, even in the absense of A1AT def can lead to emphysema

A

Smoking causes damage to the resident epithelial cells that normally release A1AT and also causes recruitment of neutrophils and macrophages which are responsible for secreting elastase

41
Q

This pattern of emphysema is most likely associated with _

A

This pattern of emphysema is most likely associated with smoking; this is centrilobular emphysema

42
Q

This is a gross view of a lung with _

A

This is a gross view of a lung with centrilobular emphysema

43
Q

An increase in the _ diameter is common in COPD; this is sometimes called a _ chest

A

An increase in the AP diameter is common in COPD; this is sometimes called a barrel chest

44
Q

The most important “treatment” for COPD patients is _

A

The most important “treatment” for COPD patients is smoking cessation

45
Q

Our oxygen saturation goal for COPD patients is _

A

Our oxygen saturation goal for COPD patients is 88-92%

46
Q

What are the possible complications that this patient may experience?

A

This patient has bronchiectasis- a pathologic dilation of the airways that leads to impaired mucus clearance, obstructive lung disease, and cough, dyspnea, sputum

Complications include:
* Infection
* Hemoptysis
* Cor pulmonale
* Hypercapnia/hypoxemia

47
Q

Hemoptysis is usually a sign that the _ arteries are being affected

A

Hemoptysis is usually a sign that the bronchial arteries are being affected

48
Q
A

Sarcoidosis

49
Q

Sarcoidosis is associated with _ electrolyte abnormality

A

Sarcoidosis is associated with hypercalcemia
* Granulomas produce calcitrol –> stimulates bone release of calcium

50
Q

Sarcoidosis is a multiorgan inflammatory disease that is associated with _

A

Sarcoidosis is a multiorgan inflammatory disease that is associated with thick, well-formed non-necrotizing granulomas

51
Q

Sarcoidosis granulomas have a focal accumulation of _

A

Sarcoidosis granulomas have a focal accumulation of epithelioid histiocytes (lymphocytes)
* Recall that these are non-caseating granulomas
* TB, fungi have amorphorous pink debris in the center (necrotizing)

52
Q

Identify the giant cells, macrophages, and T cells

A
53
Q
A

Sarcoidosis

54
Q

Pneumoconiosis is caused by an (organic/ inorganic) cause while hypersensitivity pneumonia is caused by an (organic/inorganic) cause

A

Pneumoconiosis is caused by an inorganic cause while hypersensitivity pneumonia is caused by an organic cause

55
Q

Explain the pathogenesis of hypersensitivity pneumonia

A

Inhaled antigen derived from plant/animal protein or microorganism –> lymphocytic inflammation (T cells) –> activation of macrophages –> granulomatous inflammation

56
Q

Hypersensitivity pneumonia can be diagnosed via the presence of _ antibodies or _ cells on bronchoalveolar lavage

A

Hypersensitivity pneumonia can be diagnosed via the presence of IgG antibodies against specific antigens or lymphocytosis on bronchoalveolar lavage

57
Q

Treatment of hypersensitivity pneumonia includes _ and _

A

Treatment of hypersensitivity pneumonia includes avoidance and steroids

58
Q

Hypersensitivity pneumonitis histology is characterized by _ and _

A

Hypersensitivity pneumonitis histology is characterized by pathy peri-bronchiolar and interstitial inflammation and loosely formed granulomas

59
Q

Subpleural fibrosis and pleural plaques are associated with _

A

Subpleural fibrosis and pleural plaques are associated with asbestosis

60
Q

_ is not fibrogenic, but rather inert; it just settles and sits in the lungs

A

Coal is not fibrogenic, but rather inert; it just settles and sits in the lungs

61
Q

Idiopathic pulmonary fibrosis is a fibrosis of the _ of unknown etiology

A

Idiopathic pulmonary fibrosis is a fibrosis of the lung parenchyma of unknown etiology

62
Q

Usual interstitial pneumonia (UIP) is _

A

Usual interstitial pneumonia (UIP) is a pattern of histologic findings that often is synonymous with IPF
* Shows honeycombing on CT scan
* We see a dilation of the parenchyma surrounded by fibrosis

63
Q

In usual interstitial pneumonia we may see fibroblastic or fibrotic foci with temporal heterogeneity which means _

A

In usual interstitial pneumonia we may see fibroblastic or fibrotic foci with temporal heterogeneity which means various timepoints of fibrosis
* Some young fibrosis (fibroblastic foci)
* Some mature fibrosis (fibrotic foci)

64
Q

mean pulmonary artery pressure equation

A

mPAP = LAP + (CO x PVR)

65
Q

Compared to the systemic arterial vasculature, the pulmonary arterial vasculature is _ pressure and _ resistance

A

Compared to the systemic arterial vasculature, the pulmonary arterial vasculature is lower pressure and lower resistance
* This is important for the right ventricle which can’t handle high pressures

66
Q

WHO group 1 of PH includes _

A

WHO group 1 of PH includes PAH

67
Q

WHO group 2 of PH includes

A

WHO group 2 of PH includes left heart disease

68
Q

WHO group 3 of PH includes

A

WHO group 3 of PH includes lung disease
* Hypoxic vasoconstriction
* Sleep apnea
* Destruction of blood vessels (emphysema, fibrosis)

69
Q

WHO group 4 of PH includes

A

WHO group 4 of PH includes chronic thromboembolism

70
Q

“Plexiform lesion” is associated with _

A

“Plexiform lesion” is associated with pulmonary arterial hypertension (Group 1)
* Narrowing of the arterial lumen –> increased PVR

71
Q

Pulmonary arterial hypertension is often idiopathic; heritable PAH is often caused by a mutation of the _ gene

A

Pulmonary arterial hypertension is often idiopathic; heritable PAH is often caused by a mutation of the BMPR2 gene

72
Q

Secondary causes of PAH

A

Secondary causes of PAH
* Schistosomiasis
* HIV
* Scleroderma and other connective tissue diseases
* Drug/ toxins

73
Q

Pulmonary hypertension patients will often present with _ symptoms

A

Pulmonary hypertension patients will often present with exertional dyspnea, lightheadedness, fatigue, peripheral edema, weight gain, sometimes angina and syncope

74
Q

Exam findings of PH might include:

A

Loud P2, TR murmur, parasternal heave & sometimes signs of RV failure

75
Q

Right heart catheterization is necessary for PAH diagnosis to determine that mPAP > _

A

Right heart catheterization is necessary for PAH diagnosis to determine that mPAP > 20 mm Hg

Pulmonology (16 decks)

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