obstructive pulmonary disease

Question 1

increased secretions and increased spasms

Answer 1

asthma

Question 2

increased secretions

Answer 2

bronchitis

Question 3

loss of surrounding supporting tissue

Answer 3

emphysema

Question 4

chronic inflammation of the airway and variable airflow obstruction; presence of intermittent symptoms

Answer 4

asthma

Question 5

what is the cause of asthma?

Answer 5

immune-mediated airway inflammation caused by exposure to an allergen or an irritant

Question 6

what are some symptoms of asthma

Answer 6

-sob
-wheezing
-coughing
-chest tightness
-feeling of breathlessness

Question 7

what are some signs of a severe asthma episode

Answer 7

-wheezing
-orothpnea
-tachypnea
-tachycardia
-use of accessory muscles
=qgitation
-intercostal retractions

Question 8

what are some common allergens

Answer 8

-dust mites
-smoke
-foods
-animal dander
-excersie
-pollution

Question 9

true/false: type 2 inflammation involves innate and adaptive immune systems

Answer 9

true

Question 10

type 2 inflammation: _____ induces B-cell isotope (antibody) switching to production of IgE

Answer 10

IL-4

Question 11

type 2 inflammation: IgE, through its binding to _______ and ______ results in environmental sensitivity to allergens

Answer 11

basophils and mast cells

Question 12

type 2 inflammation: what are the products from the cross linkage of IgE on the surface of basophils and mast cells

Answer 12

type II cytokines and direct activators of smooth muscle contraction and edema

Question 13

type 2 inflammation: ____ has a critical role in regulating eosinophils. it controls formation, recruitment and survival of these cells

Answer 13

IL-5

Question 14

type 2 inflammation: _____ induces airway hyperresponsivemess, mucus hyper secretion, and goblet cell metaplasia.

Answer 14

IL-13

Question 15

type 2 inflammation: ____ can produce IL-5 and IL-13. they can be activated by epithelial cytokines known as alarming, which are produced in response to “nonallergic” epithelial exposures such as irritants, pollutants, oxidative agents, fungi or viruses.

Answer 15

type 2 innate lymphoid cells (ILC2)

Question 16

non-type 2 inflammation: true/false: non-type 2 processes can exist either in combination which type 2 inflammation or without type 2 inflammation

Answer 16

true

Question 17

non-type 2 inflammation: which type of inflammation is more commonly seen in severe asthma, that has not responded to the common anti-inflammatory therapies such as corticosteroids, that usually suppress type 2 inflammation

Answer 17

neutrophilic inflammation

Question 18

these 3 cytokines are the major cytokines associated with type 2 inflammation, and have been targeted successfully in asthma therapies

Answer 18

Il-4,5, and 13

Question 19

true/false: thymic stromal lymphopoetin (TSLP), IL-25 and IL-33 also play a role in the signalling cascade and have been targeted successfully in asthma therapies

Answer 19

false - actively being studied as targets for tx of asthma

Question 20

these cytokines have been implicated in non-type 2 inflammation

Answer 20

IL-6, IL-17, TNF alpha, IL-1beta and IL-8

Question 21

what are pre-disposing (risk) factors of asthma

Answer 21

• genetics *mutation on chromosome 17q21
• family history of asthma
• positive skin test to an allergen
• tobacco (second hand and maternal smoke)
• air pollution
• diets (vitamin D deficiency)
• obesity
• medications
• occupational exposures

Question 22

this type of inflammation is eosinophilic predominant and an IgE response is common.
clinical manifestations include: elevated IgE levels, eczema, allergic rhinitis, positive fam history of allergen and attacks associated with seasonal, environmental or occupational exposure

Answer 22

type 2 inflammation

Question 23

know the IgaE dependant pathway of the pathogenesis of asthma

Answer 23

an allergen is present -> mast cells and eosinophils are activated -> prostaglandins, leukotrines, interleukins and cytokines are released -> there is acute/chronic inflammation -> bronchoconstriciton, mucus and edema production, airway hyperresponsiveness

Question 24

know the IgE independent pathway of the pathogenesis of asthma

Answer 24

cold/exercise, osmotic stimuli, irritant exposure -> mast cells and eosinophils activated -> prostaglandins, leukotrienes, interleukins and cytokines released -> acute/chronic inflammation -> bronchoconstriction, mucus & edema production and airway hyperresponsiveness

Question 25

know the epithelial cell activation pathway of the pathogenesis of asthma

Answer 25

cyokines and chemokine are released -> mast cells and eosinophils growth, influx and proliferation of T lymphocytes, differentiation of B lymphocytes (IgE/A) and TH2 differentiations - IL production -> acute/chronic inflammation -> bronchoconstriciton, mucus and edema production and airway hyperresponsiveness

Question 26

what does the activation of local inflammatory cells produce?

Answer 26

- acute bronchospasm - mucosal edema - mucus plug formation - airway wall remodelling

Question 27

what are some immunohistopathologic features of asthma

Answer 27

- denudation of airway epithelium ' - collagen deposition beneath basement membrane - edema - mast cell activation - infiltration by neutrophils, eosinophils and lymphocytes

Question 28

what medical conditions/findings may be associated with obstructive lung disease?

Answer 28

- sensitive - GERD - allergic rhinitis - cough - wheezing - hyper inflated chest

Question 29

know the mechanism of bronchial smooth muscle relaxation

Answer 29

- epinephrine binds to adrenergic receptors - adenyl cyclase is stimulated - increased cAMP production - increased Ca2+ pump activity = Ca2+ returned to sarcoplasmic reticulum in muscle - decreased activity of myosin light chain kinase - dephospho rylation of myosin-P and changes to shape and binding site - actin-myosin cross bridges are broken - decrease in contraction of bronchial smooth muscle = smooth muscle relaxation

Question 30

a term used to represent a process characterized by presence of chronic bronchitis or emphysema (usually both).

Answer 30

COPD

Question 31

type B COPD "blue bloater" - resting hypoxemia - chronic or recurrent cough > 3 months > 2+ successive years - persistent, but sometimes reversible airway obstruction - commonly caused by: cigarette smoking, repeated airway infections, genetic predisposition and inhalation of chemical irritants

Answer 31

chronic bronchitis

Question 32

in chronic bronchitis, elevated _____ levels recruit neutrophil activation

Answer 32

IL-8

Question 33

in chronic bronchitis, ciliated epithelium are replaced by _____- type

Answer 33

squamous

Question 34

what are some clinical manifestations of chronic bronchitis

Answer 34

- sob on exertion - cyanosis - excessive sputum - chronic cough - evidence of excess body fluids

Question 35

how do you know someone has bronchitis based on their pulmonary function tests (e.g. TLC, RV and FEV)

Answer 35

- normal total lung capacity (TLC) - increased residual volume (RV) - decreased FEV (forced expiratory volume) and FEV/FVC (forced expiratory volume/forced vital capacity)

Question 36

how do you know someone has bronchitis based on their arterial blood gases (e.g. pCO2 and pO2)

Answer 36

- elevated pCO2 -decreased pO2

Question 37

type A COPD "pink puffer" - develops overtime usually > 50 years of age - usually caused by smoking and air pollution, as well with certain occupations e.g. mining, welding, working withs asbestos

Answer 37

emphysema

Question 38

what cells are effected in emphysema

Answer 38

- macrophages - neutrophils - epithelial cells - lymphocytes

Question 39

know the pathogenesis of emphysema

Answer 39

- reduction in pulmonary capillary bed: exchange of O2 and CO2 between capillary and alveoli is impaired - loss of elastic tissue: results in a decrease in size of smaller bronchioles and results in loss of radial traction (hold airway open)

Question 40

this type of emphysema is associated with chronic bronchitis and it destroys the respiratory bronchioles

Answer 40

centraicinar (centrilobular)

Question 41

this type of emphysema destroys the alveoli and is mostly seen in smokers

Answer 41

panacinar (panlobular)

Question 42

this type of emphysema affects the peripheral lobules

Answer 42

paraseptal

Question 43

what are some clinical manifestations of emphysema

Answer 43

- pursed lip breathing - use of accessory muscles - thin - cough is minimal or absent - increased SOB for past 3-4 years

Question 43

what are some clinical manifestations of emphysema

Answer 43

- pursed lip breathing - use of accessory muscles - thin - cough is minimal or absent - increased SOB for past 3-4 years - barrel chest - digital clubbing - decrease3d breath sounds