immunologic lung diseases

Question 1

th2 cytokines

Answer 1

il-4,5,10,13

Question 2

th1 cytokines

Answer 2

il-2, ifn-y

Question 3

th1 role

Answer 3

killing microbes, autoimmunity, activate macrophages

Question 4

th2 role

Answer 4

antibodies, extracellular parasites, allergy

Question 5

th17 role

Answer 5

induction of inflammatory response, autoimmunity

Question 6

treg role

Answer 6

dampening immune activation, tolerance

Question 7

innate immunity immunologic lung diseases

Answer 7

pneumonia, ards

Question 8

granulomatous immunologic lung disease

Answer 8

tb
sarcoid
egpa (esosinophilic granulomatosis with polyangitis)

Question 9

autoimmune and vasculitis lung disease

Answer 9

gpa (granulomatosis with polyangitis)
sle
rheumatoid lung
anti-gbm disease

Question 10

th-1 related lung diseases

Answer 10

hypersensitivity pneumonitis, copd

Question 11

th-2 related lung diseases

Answer 11

allergic asthma, abpa (allergic bronchopulmonary aspergillosis)

Question 12

extrinsic allergic alevolitis= ?

Answer 12

hypersensitivity pneumonitis

Question 13

signs of hypersensitive pneumonitis?

Answer 13

cough, dyspnea, fever

Question 14

most common causes of HP?

Answer 14

thermophilic actinomycetes, fungi, bird proteins

Question 15

how do you diagnose hp?

Answer 15

ouchterlony test for igG directed against allergen

Question 16

pathology of hp?

Answer 16

in a genetically susceptible host, antigen exposure activates the immune system, causing alveolitis, granulomatous inflammation, and fibrosis

Question 17

cells involved in hp?

Answer 17

b cell (igG antibodies) and t cell mediated (th1, IFN-gamma)

Question 18

clinical features of acute HP?

Answer 18

4-48 hrs: fever, chills, cough, hypoxemia, aches, tachypnea, fine rales

Question 19

clinical features of subacute HP?

Answer 19

weeks-4 mo: dyspnea, cough, episodic flares, tachypnea, diffuse rales

Question 20

clinical features of chronic HP?

Answer 20

4 mo-years: dyspnea, cough, fatigue, weight loss, +/- clubbing

Question 21

hrct on acute hp?

Answer 21

ground glass infilatrates

Question 22

hrct in subacute hp?

Answer 22

micronodules, air-trapping

Question 23

hrct in chronic hp?

Answer 23

fibrosis, honeycombing, emphysema

Question 24

prognosis in HP?

Answer 24

good for acute and subacute, chronic is poor

Question 25

immunopathology of acute hp?

Answer 25

macrophage, lymphocyte response (th1) to antigen, immune complexes

Question 26

immunopathology of subacute hp?

Answer 26

formation of GRANULOMAS and lymphoid follicles containing plasma cells, activated b cells

Question 27

immunopathology of chronic hp?

Answer 27

lymphocytic infiltration, collagen formation, FIBROSIS, neutrophil-mediated air space destruction

Question 28

bronchoalveolar lavage in HP?

Answer 28

inc. total cell count, increased T lymphocytes (more CD8/CD4)

Question 29

diagnostic criteria for hypersensitivity penumonitis

Answer 29

1. exposure to known antigen 2. precipitating antibodies to antigen 3. recurrent episodes 4. inspiratory crackles on PE 5. symptoms occur 4-8 hours after exposure 6. weight loss

Question 30

spirometry of HP?

Answer 30

restrictive patterns and reduced diffusion

Question 31

management of hp?

Answer 31

trial of corticosteroids in acute phase; longer course at higher doses often necessary for subacute phase--efficacy not established

Question 32

immunology of abpa?

Answer 32

th2 and eosinophils

Question 33

what is allergic bronchopulmonary aspergillosis?

Answer 33

allergic inflammatory response to colonization by aspergillus and other fungi; characterized by asthma, pulmonary infiltrates, mucus plugging, proximal bronchiectasis

Question 34

what is aspergillus?

Answer 34

ubiquitous fungus that grows in organic debris; hyphae branch at 45 degree angles, macrophages ingest and kill spores

Question 35

normal response to aspergillus

Answer 35

macrophages ingest and kill spores, neutrophils bind to hyphae and damage cell walls with an oxidative burst

Question 36

what happens in abpa?

Answer 36

virulence factors/mycotoxins cause th2 mediated inflammation generation of eosinophil-rich mucoid impaction activation of cd20 b cells which generate igE antibodies

Question 37

criteria for diagnosis of abpa?

Answer 37

1. asthma 2. central bronchiectasis (inner 2/3 of chest CT) 3. immediate cutaneous reactivity to aspergillus species 4. total igE > 417 5. elevated igE and or igG to A. fumigatus non essential but supportive: infiltrtes on Cxr/ct; serum precipitating antibodies to Af, eosinophilia

Question 38

lobe predominance in abpa?

Answer 38

upper lobe

Question 39

spirometry in abpa?

Answer 39

obstructive; bd response in fewer than 1/2, air trapping, deification is reduced in minority (bronchiectasis)

Question 40

drugs for abpa?

Answer 40

itraconazole (anti-fungal) | omalizumba (anti-igE--> use in CF patients where you can't use steroids)

Question 41

GPA stands for?

Answer 41

granulomatosis with polyangitis

Question 42

what is vasculitis?

Answer 42

leukocytes in vessel wall with reactive damage to rural structures; loss of wall integrity leads to bleeding; compromise of lumen leads to ischemia and necrosis

Question 43

gpa is an example of what kind of vasculitis?

Answer 43

small vessel that most commonly affects the upper airways, lower airways, and kidneys

Question 44

upper airway disease in GPA:

Answer 44

sinus disease, epistaxis, septal perforation, subglottic stenosis

Question 45

how do you diagnose gpa?

Answer 45

at least 2 of the following: 1) nasal or oral inflammation (painful or painless oral ulcers or purulent or bloody nasal discharge) 2) abnormal chest CT showing nodules, fixed infiltrates, or cavities 3) abnormal urinary sediment (microscopic hematuria with or without rbc casts) 4) granulomatous inflammation on biopsy of an artery or perivascular area AND positive c-anca

Question 46

what else is anca associated vasculitis?

Answer 46

gpa, mpa (microscopic polyangiitis), egpa (eosinophilic...), renal limited vasculatis

Question 47

egpa is ____=anca?

Answer 47

perinuclear (p-anca)--> antibodies to strong cations (myeloperoxidase)

Question 48

what is c-anca?

Answer 48

antibodies to neutral proteins or weak cations (proteinase 3)

Question 49

immunopathogenesis of gpa?

Answer 49

activated Cd4 T cells; B cells, neutrophils

Question 50

spirometry in gpa?

Answer 50

restrictive with reduced diffusion