Obstructive Pulmonary Diseases

Question 1

This is when elastin fibers are destroyed, leading to more compliance and an increase in FRC.

Answer 1

Emphysema

Question 2

This is when there is decreased compliance, increased elasticity, and decrease in FRC.

Answer 2

Pulmonary fibrosis

Question 3

This a slow waxing and waning respiration occuring about every 40-60s.

Answer 3

Cheyne-Stokes breathing

Question 4

Which 2 types of patients get Cheyne-Stokes breathing?

Answer 4

1. Cardiac failure- b/c blood flow is slow.

2. Brain dmg- cuz resp drive is slow.

Question 5

This is the absence of spontaneous breathing during normal sleep.

Answer 5

Sleep apnea

Question 6

This is when there is blockage of the upper airway which causes an absence of spontaneous breathing during sleep.

Answer 6

Obstructive sleep apnea

Question 7

Besides your significant other trying to kill you, what causes obstructive sleep apnea?

Answer 7

be fat –> too much relaxation of pharyngeal muscles –> snoring gasps

Question 8

This is the type of sleep apnea where the CNS drive to the ventilator muscles transiently ceases.

Answer 8

Central sleep apnea

Question 9

What causes central sleep apnea?

Answer 9

Damage to the central respiratory centers or abnormalities of the respiratory neuromuscular apparatus (like from strokes)

Question 10

Emphysema destroys capillaries –> ↑ pulmonary resistance –> pulmonary HTN –> ____ _______ _______

Answer 10

Right heart failure

Question 11

What is the cause of asthma is 70% of the cases?

Answer 11

Allergic hypersensitivity (plants and smog)

Question 12

What is the main chemical to cause bronchoconstriction in asthma?

Answer 12

Slow-reacting substance of anaphylaxis

Question 13

What happens to inspiration an expiration problems in asthma?

Answer 13

pt can inspire normally but cannot expire

Question 14

What are the 2 main diseases for COPD?

Answer 14

Emphysema

Chronic bronchitis

Question 15

What makes asthma different than emphysema and chronic bronchitis?

Answer 15

It’s reversible.

Question 16

In centriacinar emphysema, there is significant airway obstruction causing damage where, the bronchioles or distal alveoli?

Answer 16

bronchioles

Question 17

What is typically found in the walls of the emphysematous spaces in centriacinar emphysema?

Answer 17

Black pigment

Question 18

Where is panacinar emphysema located in the lung?

Answer 18

The acini from the bronchiole –> alveoli at the lower zones and anterior margins of the lungs.

Question 19

What condition is panacinar emphysema associated with?

Answer 19

a1-antitrypsin deficiency

Question 20

What is centricainar emphysema associated with?

Answer 20

smoking

Question 21

this is the type of emphysema where the proximal portion of the acinus is normal and the distal part is predominantly involved.

Answer 21

Paraseptal (distal acinar) emphysema

Question 22

Where in the lung is paraseptal emphysema located?

Answer 22

Against the pleura along the lobular connective tissue septa in the upper 1/2 of the lungs.

Question 23

This is dilation of alveoli, but no destruction of septal walls in response to loss of lung substance elsewhere. It is best exemplified by hyperexpansion of the residual lung parenchyma that follows removal of a diseased lung or lobe.

Answer 23

Compensatory hyperinflation

Question 24

This is the lung expands because air is trapped within it. A common cause is because of tumor or foreign object obstruction that lets air in, but doesn’t let it out.

Answer 24

Obstructive overinflation

Question 25

This is a large subpleural bullae that occur in any form of emphysema. They represent localized accentuations of emphysema and occur near the apex, sometimes in relation to old tuberculosis scarring

Answer 25

Bullous emphysema

Question 26

This is when alveolar tears in pulmonary emphysema provide the avenue of entrance of air into the stroma of the lung, but rarely, a wound of the chest that allows air to be sucked in or a fractured rib that punctures the lung substance may underlie this disorder

Answer 26

Intersitital emphysema

Question 27

After how much parenchyma is destroyed in emphysema b4 u get Sx?

Answer 27

1/3

Question 28

What causes death in emphysema?

Answer 28

Respiratory acidosis and coma, RHF, an massive collapse of the lungs secondary to pneumothorax.

Question 29

How long must u have a persistent cough with sputum production to have chronic bronchitis?

Answer 29

at least 3 mo within 2 consecutive years

Question 30

What are the 4 hallmarks to asthma?

Answer 30

1. episodic bronchoconstriction 2. inflammation of the bronchial walls 3. increased mucus secretion 4. curshmann spiral, charcot laden

Question 31

This is the most common type of asthma hwere there is a type I IgE-mediated hypersensitivity rxn to environmental allergens.

Answer 31

Atopic asthma

Question 32

This is the type of asthma due to virus-induced inflammation of the respiratory mucosa which lowers the threshold of the subepthelail vagal receptors to irritants.

Answer 32

Non-atopic asthma

Question 33

In drug-induced asthma, which drug causes asthmatic attacks by elabortating bronchoconstrictor leuktotrienes?

Answer 33

ASA

Question 34

Which type of asthma is stimualted by fumes, organic and chemical dusts, gases, and other chemicals?

Answer 34

Occupational asthma

Question 35

What is the severe form of asthma, where there is severe cyanosis and death from airflow obstruction?

Answer 35

Status asthmaticus

Question 36

This condition is when there is severe, persistent cough, expectoration of floul smelling blood sputum, dyspnea and orthopnea in severe cases, and occasiaonally life-treatening hemoptysis.

Answer 36

Bronchiectasis

Question 37

What are the SANS receptors to the lungs?

Answer 37

B2

Question 38

What are the PANS receptors to the lungs?

Answer 38

M3

Question 39

What happens with SANS receptors are activated?

Answer 39

Bronchodilation

Question 40

Which hormone stimulates SANS receptors the best?

Answer 40

Epinephrine

Question 41

What is the first line drug for the Tx of acute asthmatic Sx?

Answer 41

Albuterol

Question 42

What are the 2 indications for anticholinerigic agents?

Answer 42

1. COPD | 2. Acute asthma attacks when B2 agonists are contraindicated

Question 43

What are the 6 bronchoconstricting peptides?

Answer 43

1. ) Neurokinin A 2. ) Calcitonin gene-related peptide 3. ) Substance P 4. ) Bradykinin 5. ) Tachykinin 6. ) Neuropeptide Y

Question 44

What are the 2 bronchodilators released from nonadrenergic noncholinergic (NANC) fibers?

Answer 44

1. NO | 2. Vasoactive

Question 45

Which lymphocytes are the key role in the immune response in asthma?

Answer 45

T cells (CD8 and CD4)

Question 46

Case: your pt has ASTHMA but has cardiac ischemia. what is the DOC?

Answer 46

Ipratropium

Question 47

Why is ipatropium better than atropine for treating asthma?

Answer 47

Less side effects

Question 48

This is the drug for COPD which is a competitive antagonist at muscarinic (M3) receptors --> bronchorelaxation and decreased mucus secretion.

Answer 48

Tiotropium

Question 49

Terbutaline, albuterol, pirbuterol, and bitolterol are good for bronchidilation because they bind almost exclusively to which receptors and activate them?

Answer 49

B2

Question 50

What do you avoid using an albuterol inhaler rather than something oral?

Answer 50

Avoids systemic effects

Question 51

Since B2 receptors are also expressed in peripheral SkM, what can be a side effect of high B2 agonists?

Answer 51

Tremors

Question 52

Why are new drugs like Formoterol and Salmeterol good as prophylactic drugs for asthma?

Answer 52

They have a longer duration of action (12-24hr)

Question 53

Why must u use fomoterol and salmeterol with corticosteroids?

Answer 53

They control the asthma but do not treat the underlying inflammation

Question 54

How does methylxanthines cause bronchodilation?

Answer 54

nonspecific inhibition of PDE isoenzymes III and IV --> prevents cAMP degredation --> smooth muscle relaxation

Question 55

Which receptor does Theophylline block?

Answer 55

Adenosine

Question 56

Why can't u give cimetidine with theophylline?

Answer 56

Cimetidine is a P450 inhibitor and theophylline is metabolized by P450 isoenzyme CYP3A

Question 57

What is the chief preventative agent for the Tx of asthma?

Answer 57

Inhaled corticosteroids

Question 58

Corticosteroids increase the transcription of which receptors, leading to a prophylacitic mechanism for asthma?

Answer 58

B2

Question 59

Corticosteroids decrease the transcription for which proteins?

Answer 59

pro-inflammatory proteins like IL4 and IL5

Question 60

Corticosteroids also decrease which cells in the airways for the Tx of asthma?

Answer 60

inflammatory cells

Question 61

What is the 1 limitation of coticosteroids in the Tx of asthma?

Answer 61

it cannot reverse airway remodeling

Question 62

Where is the substitution to cause corticosteroids to work as inhaled agents?

Answer 62

17-alpha

Question 63

This drug prevents the immediate allergic response in allergic asthma by decreasing the activity of mast cells.

Answer 63

Cromolyn

Question 64

What pathway do montelukast and zafirlukast inhibit for the Tx of asthma?

Answer 64

Leukotriene pathway

Question 65

Which receptor do montelukast and zafirlukast inhibit?

Answer 65

CysLT1 receptor

Question 66

How does omalizumab treat asthma?

Answer 66

It decreases the quantity of circulating IgE and prevents the remaining IgE from binding to mast cells.

Question 67

Which GI condition may exasterbate asthma?

Answer 67

GERD

Question 68

What must be coexisting in the pt to cause allergic bronchopulmonary aspergillosis?

Answer 68

Asthma or CF

Question 69

True or False: to treat allergic bronchopulmonary aspergillosis, you can give corticosteroids or antifungals.

Answer 69

FALSE. Antifungals don't work.

Question 70

How do u treat obstructive sleep apnea?

Answer 70

CPAP or BiPAPmachine