Obstructive Lung Disease- Bootcamp Flashcards

(85 cards)

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
_ are eosinophil granules found in the sputum that can help to diagnose asthma
**Charcot-Leyden crystals** are *eosinophil granules* found in the sputum that can help to diagnose asthma
25
Curschmann spirals are _ and are also found in the sputum of patients with asthma
Curschmann spirals are **whorled mucus plugs with epithelial casts** and are also found in the sputum of patients with asthma
26
Cromolyn sodium treats asthma by _
Cromolyn sodium treats asthma by **stabilizing mast cells**
27
Meplizumab, Reslizumab, Benralizumab treat asthma via _ mechanism
Meplizumab, Reslizumab, Benralizumab are **IL-5 and IL-5 receptor antagonists** * Decrease eosinophil activation and recruitment
28
Inhaled corticosteroids help asthma patients by _
Inhaled corticosteroids help asthma patients by **suppressing cytokine production** and also causing eosinophil apoptosis * Fluticasone, Budesonide, Beclomethasone
29
Omalizumab is an asthma drug that is _
Omalizumab is an asthma drug that is an **anti-IgE** antibody
30
Lukast drugs are _ drugs
Lukast drugs are **anti-leukotriene receptor** drugs
31
Zileuton is a _ drug
Zileuton is an **anti-lipoxyganase drug**
32
Albuterol is a _ type drug
Albuterol is a **short-acting B2 agonist (SABA)** that induces bronchodilation
33
_ and _ are two long acting B2 agonists (LABAs)
**Salmeterol** and **Formoterol** are two long acting B2 agonists (LABAs) that cause bronchodilation
34
Ipratropium is a medication used in asthma that is _
Ipratropium is a medication used in asthma that is **anti-muscarinic** --> bronchodilation
35
Theophylline is an asthma drug that is a _
Theophylline is an asthma drug that is a **PDE inhibitor** --> increases cAMP --> bronchodilation
36
_ is a common medication choice for acute exacerbations of asthma
**Albuterol** is a common medication choice for acute exacerbations of asthma
37
_ + _ is a common combination drug used for treatment of persistent asthma
**Corticosteroid** + **LABA** is a common combination drug used for treatment of persistent asthma
38
Why can LABAs not be given as a monotherapy?
LABAs over time will cause **downregulation of B2 receptors**; therefore they must be combined with corticosteroids which upregulate B2 receptors
39
In cases of resistant asthma in which patients have continued high IgE levels, _ can be given
In cases of resistant asthma in which patients have continued high IgE levels, **Omalizumab** can be given
40
_ is an asthma medication that can cause oral candidiasis if not rinsed after use
**Inhaled corticosteroids** are an asthma medication that can cause oral candidiasis if not rinsed after use
41
_ is an asthma drug that can have a caffeine-like effect due to adenosine blockade
**Theophylline** is an asthma drug that can have a caffeine-like effect due to adenosine blockade
42
_ is an irreversible dilation and destruction of the airways; it is most commonly caused by cystic fibrosis
**Bronchiectasis** is an irreversible dilation and destruction of the airways; it is most commonly caused by cystic fibrosis
43
Patients with obstructive disease like COPD take _ breaths
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
Patients with restrictive lung disease will take _ breaths
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
(Emphysema/ Chronic bronchitis) causes patients to experience the chronic dyspnea; (Emphysema/ Chronic bronchitis) causes the persistent coughing
**Emphysema** causes patients to experience the chronic dyspnea; **chronic bronchitis** causes the persistent coughing
46
COPD is a common disease that commonly presents in _ individuals
COPD is a common disease that commonly presents in **smokers** * Other risk factors include air pollution exposure, occupational exposure, multiple chronic infections
47
COPD in a young individual, who does not smoke may be due to _
COPD in a young individual, who does not smoke may be due to **genetic cause like A1AT deficiency**
48
_ is an antiprotease that keeps elastase in check to prevent degradation of alveolar tissue
**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
Aside from affecting the lungs, A1AT deficiency can also affect the _
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
A1AT deficiency tends to cause _ type emphysema
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
Pathogenesis of COPD (specifically chronic bronchitis)
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
Two major histopathologic changes are seeen in chronic bronchitis _ and _
Two major histopathologic changes are seen in chronic bronchitis **goblet cell hyperplasia** and **squamous metaplasia**
53
Constant bronchiolar injury induces ciliated pseudostratified columnar cells to be replaced with _
Constant bronchiolar injury induces ciliated pseudostratified columnar cells to be replaced with **squamous epithelium**
54
The consequence of squamous metaplasia is that the loss of cilia causes _
The consequence of squamous metaplasia is that the loss of cilia causes **increased infection risk**
55
Proteases are mostly made by _ cells
Proteases are mostly made by **neutrophils and macrophages**
56
Antiproteases are secreted by _ cells to keep proteases in check
Antiproteases are secreted by **resident epithelial cells** to keep proteases in check
57
The destruction of septae in emphysema can lead to enlarged areas of dilated lung sacs called _
The destruction of septae in emphysema can lead to enlarged areas of dilated lung sacs called **blebs or bullae**
58
Centriacinar emphysema affects _
Centriacinar emphysema affects **center of the acini** (respiratory bronchi) * Associated with smoking * Most common type
59
Panacinar emphysema affects _
Panacinar emphysema affects the **entire acinus** * It is less common and associated with A1AT deficiency
60
Paraseptal empysema affects _
Paraseptal empysema affects the **periphery of the acinus** * Associated with pulmonary scarring
61
_ emphysema is most likely to cause a spontaneous pneumothorax due to destruction just beneath the pleura
**Paraseptal** emphysema is most likely to cause a spontaneous pneumothorax due to destruction just beneath the pleura
62
Three consequences of COPD
1. Hypercapnia 2. Bronchiectasis 3. Pulmonary hypertension
63
Long term hypoxia in COPD induces the production of _ and _
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
The Reid index is the proportion of _ to _
The Reid index is the proportion of **mucus glands/ mucosa + submucosa**
65
In chronic bronchitis, the Reid index will be greater than _
In chronic bronchitis, the Reid index will be greater than **50%**
66
What are the classic lab values expected in chronic bronchitis? PaO2 PaCO2 pH HCO3-
PaO2: **decreased** PaCO2: **increased** pH: **decreased (< 7.35)** HCO3-: **increased**
67
Why is oxygen therapy dangerous for COPD patients?
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
DLCO is decreased in (chronic bronchitis/ emphysema)
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
Cyanosis is associated with (chronic bronchitis/ emphysema)
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
Explain the pathogenesis of emphysema as a result of cigarette smoking
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
Cigarette smoking tends to cause _ emphysema in the _ lobes
Cigarette smoking tends to cause **centriacinar** emphysema in the **upper** lobes
72
A1AT deficiency tends to cause _ emphysema in the _ lobes
A1AT deficiency tends to cause **panacinar** emphysema in the **lower** lobes
73
Cystic fibrosis has a _ inheritance pattern
Cystic fibrosis has an **autosomal recessive** inheritance pattern
74
Cystic fibrosis is a mutation in the _ protein; it is caused by a _ deletion
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
In the GI tract + lungs, Cl- should be (reabsorbed/ secreted) through the CFTR channel in normal individuals; in cystic fibrosis _ occurs
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
In the skin, Cl- should be (reabsorbed/secreted) through the CFTR channel; however, in CF _ occurs
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
What are the consequences of cystic fibrosis?
Thick mucus in the lungs --> mucus plugging --> hyperinflated lungs with productive cough + recurrent pulmonary infections
78
The most common infection in young CF patients is _
The most common infection in young CF patients is *S. aureus*
79
The most common infection in adults with CF is _
The most common infection in adults with CF is *P. aeruginosa* * The thick mucus facilitates the formation of biofilms
80
Bronchiectasis is most commonly caused by _
Bronchiectasis is most commonly caused by **CF**
81
How does CF affect the pancreas and GI system?
Thick mucus in the pancreatic and bile ducts --> decreased pancreatic and biliary secretions --> decreased fat soluble absorption --> pancreatitis, steatorrhea, diabetes
82
Thick mucus in the stool can cause _ in infants
Thick mucus in the stool can cause **meconium ileus** in infants * Thick/sticky meconium --> inspissated mass --> bowel obstruction
83
How does CF normally affect fertility?
Males often have an **absent vas deferens** --> sterile Women may have thick cervical mucus making them subfertile
84
_ CF drug improves protein misfolding and trafficking while _ drug enhances Cl- flux through the channel
**Lumacaftor** CF drug improves protein misfolding and trafficking while **Ivacaftor** drug enhances Cl- flux through the channel