FMS Week 9: Pathology of Asthma

Question 1

What is Asthma?

Answer 1

basically a reduction of airflow through a variety of processes that is

bronchoconstriction

airflow limitation

airway hyperreactivity

least partly reversible (in order to be asthma must be partly reversible)

Question 2

Hallmarks of Asthma

Answer 2

*

Question 3

Airway remodeling is?

Answer 3

Changes in the proportions of histologic constituents that make up the airways

Question 4

Atopy classification

Answer 4

genetic predisposition towards IgE-mediated hypersensitivity reaction (eczema, allergic rhinitis, etc.)

Question 5

Most common type of asthma

Answer 5

• Atopic Asthma

Question 6

Classic example of Type I IgE-mediated hypersensitivity reaction

Answer 6

Atopic Asthma

Question 7

Atopic Asthma begins when?

Answer 7

Typically in childhood

Question 8

Atopic Asthma is triggered by?

4 Listed

Answer 8

environmental allergens

• pollen
• dust
• foods
• animal dander

Question 9

Does Atopic Asthma have a family history component?

Answer 9

Yes, often see a family history of asthma

Question 10

Tests for atopic asthma

2 Listed

Answer 10

Weal and flare

RAST (Radioallergosorbent test)

Question 11

RAST description and name

Answer 11

Identifies serum IgE specific for a panel of allergens

Radioallergosorbent test

Question 12

Non-Atopic Asthma test

Answer 12

No evidence of allergen sensitization (negative RAST, skin test)

Question 13

Non-Atopic Asthma family history component?

Answer 13

Less common than in atopic asthma

Question 14

Non-Atopic Asthma underlying cause?

Answer 14

• increased airway hyperirritability
• viral respiratory infections are a common cause

Question 15

Aspirin-sensitive asthma

Answer 15

• seen in conjunction with recurrent rhinitis and nasal polyps
• special type of non-atopic asthma

Question 16

Occupational Asthma

Answer 16

• A special type of non-atopic asthma
• caused by dusts (wood, platinum), fumes, gases; generally occurs after repeated exposure

Question 17

Asthma Pathogenesis

Answer 17

Pollen meets tissue dendritic cell to Th2 cell

Th2 cell activates B cell with IL-4

B cell produces IgE

IgE coats mast cells

IgE cross-linking on mast cells

degranulation recruits eosinophils

Question 18

histopathologic changes in asthma

Answer 18

• Type I hypersensitivity
• A genetic predisposition + environmental triggers
• thickening of the basement membrane
• smooth muscle cells thickening
• lamina propria macrophages, eosinophils, mast cells, neutrophils
• goblet cell hyperplasia
• eosinophils in the mucus

Question 19

Atopic Asthma Early phase or immediate phase:

4 Listed

Answer 19

• vagus nerve stimulated
• vagus nerve parasympathetic nervous system
• get bronchoconstriction
• increased vascular permeability

Question 20

Atopic Asthma: Late Phase

Answer 20

• Increased inflammation
• causes epithelial damage (raggedness and cell dropout of epithelial layer)

Question 21

T cell environmental differentiation factors: Th1

5 Listed

Answer 21

• Presence of older siblings
• early exposure to daycare
• viral infection
• farm environment
• Tuberculosis

Question 22

T cell environmental differentiation factors: Th2

5 Listed

Answer 22

• Widespread use of antibiotics
• Western Lifestyle
• Urban Environment
• Diet
• Aeroallergens

Question 23

Early Phase responses

4 Listed

Answer 23

• Bronchial smooth muscle contraction
• mucus secretion
• vascular leakage
• mucosal edema

Question 24

Late Phase response

3 Listed

Answer 24

• Infiltration with eosinophils and neutrophils
• increase inflammation
• bronchial hyperreactivity

Question 25

Early and LAte Phase response effects 4 Listed

Answer 25

* Obstruction of large and small airways * air trapping * respiratory acidosis * hypoxemia

Question 26

Genetics of Asthma 3 Listed

Answer 26

* Multifactorial with environmental factors with multiple susceptibility genes * gene expression and the combination of various polymorphisms varies from patient to patient * more than 100 genes have a reported association in various mechanisms (immune response, tissue remodeling, disease severity, response to therapy)

Question 27

Specific examples of Genetics of Asthma 3 Listed

Answer 27

Question 28

Tissue/Pathology?

Answer 28

normal airway wall

Question 29

Tissue/Pathology?

Answer 29

Normal respiratory bronchiole

Question 30

Tissue remodeling in chronic asthma At least 8

Answer 30

* luminal mucous plugging * Epithelial goblet hyperplasia * Epithelial injury * Basement membrane thickening/fibrosis (AKA subepithelial fibrosis/subepithelial collagen deposition) * Increased airway vascularity * Smooth muscle hypertrophy * Mucous gland hypertrophy

Question 31

Airway remodeling summary

Answer 31

Question 32

Epithelial-mesenchymal trophic unit

Answer 32

Question 33

Answer 33

Question 34

Answer 34

Question 35

Question 36

Additional characteristic findings in asthma 3 Listed

Answer 36

* Creola Bodies * Curschmann spirals * Charcot-Leyden crystals

Question 37

Creola bodies Description 5 Listed

Answer 37

Question 38

Curschmann Spirals 5 Listed

Answer 38

Question 39

Charcot-Leyden Crystals Description 5 Listed

Answer 39

Question 40

What is this?

Answer 40

Creola Bodies

Question 41

What is this?

Answer 41

Curschmann Spirals

Question 42

What is this?

Answer 42

Creola Bodies

Question 43

What's This?

Answer 43

Charcot-Leyden Crystals

Question 44

What's this?

Answer 44

Charcot-Leyden Crystals

Question 45

What's This?

Answer 45

Charcot-Leyden Crystals

Question 46

What's This?

Answer 46

Charcot-Leyden Crystals

Question 47

Clinical features of Asthma

Answer 47

Question 48

Asthma Treatment

Answer 48

Question 49

Status Asthmaticus

Answer 49

Question 50

Status asthmaticus autopsy findings?

Answer 50

Obstructive: Difficulty expelling air

Question 51

Asthma summary 1

Answer 51

Question 52

Asthma Summary 2

Answer 52

Question 53

Asthma Summary 3

Answer 53

Question 54

Subepithelial fibrosis AKA

Answer 54

Basement membrane thickening