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Pulmonology > Obstructive/Restrictive Disease- Lecture > Flashcards

Obstructive/Restrictive Disease- Lecture Flashcards

1
Q

Draw the volume-flow loop in obstructive lung disease

A
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2
Q

Draw the volume-flow loop in restrictive lung disease

A
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3
Q

_ is characterized by airway inflammation, hyperresponsiveness, and reversible airflow obstruction

A

Asthma is characterized by airway inflammation, hyperresponsiveness, and reversible airflow obstruction

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4
Q

What happens during an asthma exacerbation?

A
  • Bronchoconstriction
  • Mucosal inflammation
  • Increased mucus production
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5
Q

Patient has a decreased FEV1/FVC which is normalized after bronchodilation

A

This is characteristic of asthma- it is reversible whereas COPD is not

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6
Q

The asthma phenotypes that are associated with high Th2 include:

A

High Th2:
* Allergic asthma
* Eosinophilic asthma
* Exercise-induced asthma
* Aspirin induced asthma

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7
Q

The asthma phenotypes that are not associated with Th2 (non-Th2) include:

A

Non-Th2:
* Neutrophilic asthma
* Obesity associated
* Infection-induced asthma

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8
Q

IL-4 is a type 2 cytokine that causes _

A

IL-4 is a type 2 cytokine that causes production of IgE

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9
Q

IL-5 is a type 2 cytokine that causes

A

IL-5 is a type 2 cytokine that attracts eosinophils to the bronchial wall

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10
Q

IL-9 is a type 2 cytokine that

A

IL- 9 is a type 2 cytokine that heightens the Th2 response

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11
Q

IL-13 is a type 2 cytokine that causes

A

IL-13 is a type 2 cytokine that promotes mucus production

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12
Q

Two short acting beta agonists used for asthma include _ and _

A

Two short acting beta agonists used for asthma include albuterol and epinephrine

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13
Q

Three long acting beta agonists used for asthma:

A
  1. Salmeterol
  2. Formoterol
  3. Indacaterol
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14
Q

_ is a short acting muscarinic antagonist

A

Ipratropium is a short acting muscarinic antagonist

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15
Q

Three long acting muscarinic antagonists include:

A
  1. Tiotropium
  2. Aclidinium
  3. Umeclidinium
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16
Q

Theophylline is another drug that can be used as a bronchodilator that has _ mechanism

A

Theophylline is another drug that can be used as a bronchodilator that is a phoshodiesterase4 inhibitor

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17
Q

The muscarinic receptor in the lungs that can be antagonized to treat asthma is specifically the _ receptor, which is a _ g protein

A

The muscarinic receptor in the lungs that can be antagonized to treat asthma is specifically the M3 receptor, which is Gq coupled receptor

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18
Q

Both beta receptors (beta1 and beta2) are _ G protein coupled

A

Both beta receptors (beta1 and beta2) are Gs –> adenylyl cyclase –> cAMP

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19
Q

The a2 and M2 receptors are coupled to _ G proteins

A

The a2 and M2 receptors are coupled to Gi –> inhibits adenylyl cyclase

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20
Q

a1, M1, M3 are _ G protein coupled

A

a1, M1, M3 are Gq coupled –> PLC –> Ca2+

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21
Q

cAMP in the bronchiole smooth muscle cell leads to (bronchodilation/ bronchoconstriction)

A

cAMP in the bronchiole smooth muscle cell leads to bronchodilation

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22
Q

Adenosine binds to bronchiole smooth muscle cell and induces _

A

Adenosine binds to bronchiole smooth muscle cell and induces bronchoconstriction

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23
Q

Theophylline is a _ inhibitor (although with poor sensitivity) and it works by _ and _

A

Theophylline is a phophodiesterase4 inhibitor (although with poor sensitivity) and it works by blocking adenosine binding and breaking down PDE4 to increase cAMP levels

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24
Q

PDE4 normally _ cAMP

A

PDE4 normally breaks down cAMP
* Giving a drug that inhibits this therefore rises cAMP levels
* Can induce bronchodilation this way

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25
Name four corticosteroids used in the treatment of asthma
1. Beclomethasone 2. Budesonide 3. Fluticasone 4. Mometasone
26
_ and _ are two biologics that work against IL-5 to treat asthma
**Mepolizumab** and **Reslizumab** are two biologics that work against IL-5 to treat asthma
27
_ is a biologic that blocks the IL-5 receptor
**Benralizumab** is a biologic that blocks the IL-5 receptor
28
# ` Corticosteroids are used in the treatment of asthma because they _ and _
Corticosteroids are used in the treatment of asthma because they **promote anti-inflammatory mediators** and **inhibit inflammatory mediators**
29
Corticosteroids bind hormones and cause changes in _
Corticosteroids bind hormones and cause changes in **transcription and translation** * Increase transcription of anti-inflammatory mRNA * Decrease transcription of inflammatory mediators
30
Corticosteroids (inhibit/ upregulate) NF-kappaB
Corticosteroids **inhibit** NF-kappaB * NFkB mediates the induction of various pro-inflammatory genes
31
Inflammation or tissue injury triggers _ enzyme to convert phospholipids in the cell membrane into arachidonic acid
Inflammation or tissue injury triggers **phospholipase A2** enzyme to convert phospholipids in the cell membrane into *arachidonic acid*
32
Arachidonic acid can then be converted by _ into leukotrienes or converted by cyclooxygenases into _
Arachidonic acid can then be converted by **lipoxygenase** into leukotrienes or converted by cyclooxygenases into **prostaglandins**
33
Corticosteroids can inhibit the production of arachidonic acid by upregulating the production of _
Corticosteroids can inhibit the production of arachidonic acid by upregulating the production of **annexin 1** * Annexin 1 blocks phospholipase A2
34
Montelukast and zafirlukast work via _
Montelukast and zafirlukast work via **binding to the leukotriene receptor**
35
Montelukast and zafirlukast have a target that is located on _ cells
Montelukast and zafirlukast have a target that is located on **bronchial smooth muscle cells**
36
Zilueton has a target found in _ cells
Zilueton's target is found in **mast cells and eosinophils**
37
What is the progression of asthma medications for increasing severity?
1. SABA 2. Add daily corticosteroid 3. Daily CS/ LABA 4. Add LAMA 5. Add oral corticosteroid
38
Dilation of the distal airspaces with septal destruction describes _
Dilation of the distal airspaces with septal destruction describes **emphysema**
39
Hereditary emphysema is caused by a gene mutation that causes A1AT to misfold and remain stuck in the _
Hereditary emphysema is caused by a gene mutation that causes A1AT to misfold and remain stuck in the **hepatocyte ER**
40
Explain how smoking, even in the absense of A1AT def can lead to emphysema
Smoking causes **damage to the resident epithelial cells that normally release A1AT** and also causes **recruitment of neutrophils and macrophages** which are responsible for secreting elastase
41
This pattern of emphysema is most likely associated with _
This pattern of emphysema is most likely associated with **smoking**; this is *centrilobular emphysema*
42
This is a gross view of a lung with _
This is a gross view of a lung with **centrilobular emphysema**
43
An increase in the _ diameter is common in COPD; this is sometimes called a _ chest
An increase in the **AP diameter** is common in COPD; this is sometimes called a **barrel chest**
44
The most important "treatment" for COPD patients is _
The most important "treatment" for COPD patients is **smoking cessation**
45
Our oxygen saturation goal for COPD patients is _
Our oxygen saturation goal for COPD patients is **88-92%**
46
What are the possible complications that this patient may experience?
This patient has **bronchiectasis**- a pathologic dilation of the airways that leads to impaired mucus clearance, obstructive lung disease, and cough, dyspnea, sputum Complications include: * Infection * Hemoptysis * Cor pulmonale * Hypercapnia/hypoxemia
47
Hemoptysis is usually a sign that the _ arteries are being affected
Hemoptysis is usually a sign that the **bronchial arteries** are being affected
48
Sarcoidosis
49
Sarcoidosis is associated with _ electrolyte abnormality
Sarcoidosis is associated with **hypercalcemia** * Granulomas produce calcitrol --> stimulates bone release of calcium
50
Sarcoidosis is a multiorgan inflammatory disease that is associated with _
Sarcoidosis is a multiorgan inflammatory disease that is associated with **thick, well-formed non-necrotizing granulomas**
51
Sarcoidosis granulomas have a focal accumulation of _
Sarcoidosis granulomas have a focal accumulation of **epithelioid histiocytes** (lymphocytes) * Recall that these are non-caseating granulomas * TB, fungi have amorphorous pink debris in the center (necrotizing)
52
Identify the giant cells, macrophages, and T cells
53
Sarcoidosis
54
Pneumoconiosis is caused by an (organic/ inorganic) cause while hypersensitivity pneumonia is caused by an (organic/inorganic) cause
Pneumoconiosis is caused by an **inorganic** cause while hypersensitivity pneumonia is caused by an **organic** cause
55
Explain the pathogenesis of hypersensitivity pneumonia
Inhaled antigen derived from plant/animal protein or microorganism --> lymphocytic inflammation (T cells) --> activation of macrophages --> granulomatous inflammation
56
Hypersensitivity pneumonia can be diagnosed via the presence of _ antibodies or _ cells on bronchoalveolar lavage
Hypersensitivity pneumonia can be diagnosed via the presence of **IgG antibodies against specific antigens** or **lymphocytosis** on bronchoalveolar lavage
57
Treatment of hypersensitivity pneumonia includes _ and _
Treatment of hypersensitivity pneumonia includes **avoidance** and **steroids**
58
Hypersensitivity pneumonitis histology is characterized by _ and _
Hypersensitivity pneumonitis histology is characterized by **pathy peri-bronchiolar and interstitial inflammation** and **loosely formed granulomas**
59
Subpleural fibrosis and pleural plaques are associated with _
Subpleural fibrosis and pleural plaques are associated with **asbestosis**
60
_ is not fibrogenic, but rather inert; it just settles and sits in the lungs
**Coal** is not fibrogenic, but rather inert; it just settles and sits in the lungs
61
Idiopathic pulmonary fibrosis is a fibrosis of the _ of unknown etiology
Idiopathic pulmonary fibrosis is a fibrosis of the **lung parenchyma** of unknown etiology
62
Usual interstitial pneumonia (UIP) is _
**Usual interstitial pneumonia (UIP)** is a pattern of histologic findings that often is synonymous with IPF * Shows honeycombing on CT scan * We see a dilation of the parenchyma surrounded by fibrosis
63
In usual interstitial pneumonia we may see fibroblastic or fibrotic foci with temporal heterogeneity which means _
In usual interstitial pneumonia we may see fibroblastic or fibrotic foci with temporal heterogeneity which means **various timepoints of fibrosis** * Some young fibrosis (fibroblastic foci) * Some mature fibrosis (fibrotic foci)
64
mean pulmonary artery pressure equation
mPAP = LAP + (CO x PVR)
65
Compared to the systemic arterial vasculature, the pulmonary arterial vasculature is _ pressure and _ resistance
Compared to the systemic arterial vasculature, the pulmonary arterial vasculature is **lower** pressure and **lower** resistance * This is important for the right ventricle which can't handle high pressures
66
WHO group 1 of PH includes _
WHO group 1 of PH includes **PAH**
67
WHO group 2 of PH includes
WHO group 2 of PH includes **left heart disease**
68
WHO group 3 of PH includes
WHO group 3 of PH includes **lung disease** * Hypoxic vasoconstriction * Sleep apnea * Destruction of blood vessels (emphysema, fibrosis)
69
WHO group 4 of PH includes
WHO group 4 of PH includes **chronic thromboembolism**
70
"Plexiform lesion" is associated with _
"Plexiform lesion" is associated with **pulmonary arterial hypertension** (Group 1) * Narrowing of the arterial lumen --> increased PVR
71
Pulmonary arterial hypertension is often idiopathic; heritable PAH is often caused by a mutation of the _ gene
Pulmonary arterial hypertension is often idiopathic; heritable PAH is often caused by a mutation of the **BMPR2** gene
72
Secondary causes of PAH
Secondary causes of PAH * Schistosomiasis * HIV * Scleroderma and other connective tissue diseases * Drug/ toxins
73
Pulmonary hypertension patients will often present with _ symptoms
Pulmonary hypertension patients will often present with **exertional dyspnea, lightheadedness, fatigue, peripheral edema, weight gain, sometimes angina and syncope**
74
Exam findings of PH might include:
Loud P2, TR murmur, parasternal heave & sometimes signs of RV failure
75
Right heart catheterization is necessary for PAH diagnosis to determine that mPAP > _
Right heart catheterization is necessary for PAH diagnosis to determine that mPAP > **20 mm Hg**

Pulmonology (16 decks)

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