Obstructive Lung Diseases

Question 1

deficiency in what disease is responsible for the genetic cause of COPD (emphysema)?

Answer 1

alpha-1 antitrypsin (inhibits elastase from degrading elastin)

Question 2

What immune responses are involved in the pathogenesis of COPD?

Answer 2

Both innate and adaptive immunity

Question 3

Histopathologic lesions of emphysema are characterized by

Answer 3

dilation and merging of alveolar spaces

Question 4

FEV1/FVC naturally decreases with

Answer 4

age

Question 5

Predicted % values of FEV1, FVC, and FEV1/FVC are based on

Answer 5

1. age
2. height
3. sex
4. race at times

Question 6

The point where chest wall forces is equal to the lung elastic recoil forces is called

Answer 6

FRC (functional residual capacity)

Question 7

What three lung volume measurements can’t be measured by spirometry?

Answer 7

RV
FRC
TLC

Question 8

What is the best way to measure lung volumes?

Answer 8

Body Box

Question 9

What test is used if patient is claustrophobic and can’t use body box?

Answer 9

Helium dilution

Question 10

Why is helium dilution bad for COPD?

Answer 10

It underestimates the degree of abnormality of COPD

Question 11

Hyperinflation and air trapping develop over many years. ______ hyperinflation refers to the findings of COPD at rest.

Answer 11

static

Question 12

______ hyperinflation is and when air trapping and hyperinflation become more profound as respiratory rate increase with exercise

Answer 12

dynamic

Question 13

Dyspnea in COPD patients is due to reduced

Answer 13

IC (inspiratory capacity)

Question 14

people with pure chronic bronchitis; LE edema, and tends to retain CO2 making them appear blue

Answer 14

blue bloater

Question 15

people with pure emphysema; decreased O2 level makes them tachypneic and pink

Answer 15

pink puffer

Question 16

True or False: Quit smoking at any age increases longevity

Answer 16

true

Question 17

Acute inflammation of the airways; sudden onset cough greater than 5 days; NO fever, tachycardia or tachypnea; number one cause of antibiotic abuse

Answer 17

Acute bronchitis

Question 18

Why is acute bronchitis the number one cause of antibiotic abuse in US?

Answer 18

90% is caused by virus

Question 19

What is required to distinguish acute bronchitis from pneumonia, chronic bronchitis, asthma, GERD, etc.?

Answer 19

a good HISTORY

Question 20

Why might asthmatic lungs become hyperinflated?

Answer 20

Mucous plugs prevent air from escaping

Question 21

Asthma is more prevalent in

Answer 21

developed countries

Question 22

Asthma “phenotypes” are divided into what 2 large categories?

Answer 22

1. T2 high (secrete type 2 cytokines –> IL-4, IL-5 and IL-13)
2. Non-Th2 or T2 low (not driven by T2 cytokines)

Question 23

Eosinophils cause mild, moderate, and severe asthma and is recruited by Th2 cells or ILCs. Eosinophils are steroid

Answer 23

responsive

Question 24

Neutrophils cause severe asthma and is recruited by Th17 cells. Neutrophils are steroid

Answer 24

resistant

Question 25

Why do asthmatics have a "scooped out appearance" on flow-volume curves and a a low FEV-1 value?

Answer 25

reduced airway luminal diameter, flow through asthmatic airways is slower than normal resulting in less air being exhaled per second

Question 26

Test that can be used to clinically differentiate between asthma from COPD

Answer 26

DLCO (Diffusion of Lung Carbon Monoxide)

Question 27

airway contrition after exposure to various stimuli (cold air, perfume, smoke) that do not affect the caliber of airways in normal individuals

Answer 27

Airway hyperresponsiveness

Question 28

test that is used clinically to diagnose asthma in patients suspected of having mild-asthma hyperresponsiveness whose baseline spirometry is normal

Answer 28

Methacholine challenge test

Question 29

Why might intubation of an asthmatic patient with a high RR (to blow off CO2) be detrimental?

Answer 29

Appropriate for a patient WITHOUT airflow obstruction Can lead to hypotension in a patient with obstructive asthma (or COPD) because air SLOWLY leaves the lungs, so a high RR can prevent complete expiration and lead to gradual hyperinflation and compression of thoracic vasculature

Question 30

How might you set the ventilation settings on an intubated asthmatic patient with possible airway obstruction to avoid hyperinflation and cardiac arrest

Answer 30

Low RR and slightly low tidal volume (~400) (allow for complete expiration with each breath) AVOID AUTO-PEEP (will compress pulmonary veins and decrease overall CO)

Question 31

breath stacking caused by mechanical ventillation which results in a progressive increase in lung volume

Answer 31

dynamic hyperinflation

Question 32

Auto-peep can cause

Answer 32

cariogenic shock

Question 33

when you have a cardiac rhythm that is not V tach or V fib but have no pulse or blood pressure indicating that blood is not circulating

Answer 33

Pulseless Electrical Activity

Question 34

The layer that lines the inside of the thoracic cavity, ribcage, diaphragmatic surface

Answer 34

parietal pleura

Question 35

The layer that lines the lungs and separates the different lobes of the lung from each other; thicker than parietal pleura;

Answer 35

visceral pleura

Question 36

Both parietal and visceral pleura are lines by

Answer 36

mesothelial cells

Question 37

Which pleura has stoma (openings) between mesothelial cells that lead to lymphatic channels (drains pleural fluid)?

Answer 37

Parietal pleura only

Question 38

Which pleura has sensory (pain) nerves and can possibly cause pleuritic chest pain?

Answer 38

Parietal pleura only * there is no pain nerves in parenchyma

Question 39

Which pleura is supplied by intercostal arteries and drains into venous system?

Answer 39

Parietal

Question 40

Which pleura is supplied by bronchial arteries and drains into pulmonary venous system?

Answer 40

Visceral

Question 41

______ is generated in the pleural space by the opposing elastic forces of the chest wall (outward pull) and lung (inward pull) at FRC

Answer 41

negative pressure

Question 42

How much fluid is normally present in the pleural space?

Answer 42

10 ml

Question 43

Hydrostatic pressure gradient favors net

Answer 43

influx of fluid into pleural space

Question 44

Oncotic pressure gradient favors net

Answer 44

efflux of fluid out of pleural space and into capillaries

Question 45

Normally, hydrostatic pressure is ______ than the oncotic pressure gradient, creating a net influx of fluid into the pleural space

Answer 45

greater

Question 46

Normally, there is no effusion (abnormal collection of fluid) in the pleural space because lymphatic clearance is ___ times higher than the normal rate of pleural fluid formation

Answer 46

28

Question 47

(True vs. False) Normal pleural fluid has about 75% macrophages and 25% lymphocytes and 2% mesothelial cells/neutrophils/eosinophils

Answer 47

True

Question 48

(True vs. False) Normal pleural fluid has pH >7.5 and is low in protein

Answer 48

True