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Respiratory Medicine > Pahtology 2nd Slide Set > Flashcards

Pahtology 2nd Slide Set Flashcards

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1
Q

young children with aeroallergen sensitization who develop lower respiratory tract viral infections (rhinovirus type C, RSV) have a 10 - 30 fold increased risk of developing what?

A

persistent and/or severe astham

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2
Q

this result from hypoplasia of bronchial cartilage in infants and is sometimes associated with other congenital cardiac and lung abnormalities

A

congenital lobar overinflation

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3
Q

What locus and chromosome encodes alpha1-antitrypsin?

A

Pi locus on chromosome 14

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4
Q

Death in most patients with emphysema is due to what?

A
  • CAD
  • respiratory failure
  • right-sided heart failure
  • pneumothorax
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5
Q

What inflammatory mediators and leukocytes have been shown to be increased in affected parts of emphysema?

A
  • leukotriene B4
  • IL-8
  • TNF
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6
Q

WHEEZING, breathlessness, chest tightness, and cough particularly at night and/or in early morning

A

Asthma

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7
Q

What genetic variant other than alpha1-antitrypsin deficiency have been linked to risk of emphysema?

A

Nicotinic acetylcholine receptor - influence addictiveness

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8
Q

What people are at most risk for getting interstitial emphysema?

A

Premature children on positive pressure ventilation and adults who are being artificially ventilated

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9
Q

Curschmann spirals in sputum or BAL

A

severe asthma

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10
Q

persistent cough with sputum production for at least 3 months in at least 2 consecutive years in the absence of any other identifiable cause

A

chronic bronchitis

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11
Q

clinical features of chronic bronchitis after persistent productive cough

A

dyspnea on exertion then with passage of time

  • hypercapnia
  • hypoxia
  • mild cyanosis (blue bloater)
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12
Q

Describe the small airway inflammation in emphysema?

A
  • Goblet cell hyperplasia with mucus plugging of lumen
  • inflammatory infiltrates in bronchial wall consisting of neutrophils, macrophages, B and T cells
  • Thickening of bronchiolar wall due to smooth muscle hypertrophy and peribronchial fibrosis
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13
Q

What are the 4 major types of emphysema?

A
  • centriacinar
  • panacinar
  • paraseptal
  • irregular
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14
Q

What are the 4 main processes involved in the pathogenesis of emphysema?

A
  • inflammatory mediators and leukocytes
  • Protease-antiprotease imbalance (elastase)
  • Oxidative stress
  • infection
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15
Q

What factors relaeased from eosinophils in the late reaction of Atoplic asthma caused damage to the epithelium?

A
  • major basic protein

- eosinophil cationic protein

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16
Q

What abnormality is associated with panacinar emphysema

A

Alpha1-antitrypsin deficiency

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17
Q

what people are more susceptible to COPD?

A

Women and African Americans

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18
Q

Irreversible enlargement of the airspaces distal to the terminal bronchiole accompanied by destruction of their walls without obvious fibrosis

A

Emphysema

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19
Q

Cardinal symptom of chronic bronchitis

A

-persistent productive cough

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20
Q

what is the morphology for chronic bronchitis

A
  • edema and swelling often with squamous metaplasia
  • hyperplasia of mucous gands of trachea and larger bronchi
  • increased reid index (normally .4)
  • in most severe, bronchiolitis obliterans
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21
Q
  • severe persistent cough
  • foul smelling sometimes bloody sputum
  • sometimes hemoptysis
  • in severe cases dyspnea and orthopnea
  • EPISODIC
A

bronchiectasis

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22
Q

The idea that microbial exposure during early development reduces the later incidence of allergic diseases

A

hygiene hypothesis

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23
Q

What gene is linked to increased proliferation of bronchial smooth muscle cells and fibroblasts, thus contributing to bronchial hyperreactivity and subepithelial fibrosis in asthma?

A

ADAM33

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24
Q

if long standing asthma becomes fatal

A

Acute severe asthma (status asthmaticus)

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25
If death occurs in chronic bronchitis from further impairment of respiratory function, what was it probably due to
superimposed acute infection
26
in Atopic asthma, what mediators from TH2 and mast cells activates/recuits eosinophils
IL-5
27
in the pathogenesis of chronic bronchitis, describe the inflammatory component
cellular DAMAGE, eliciting both acute and chronic inflammatory responses involving neutrophils, lymphocytes, and macrophages. long-standing inflammation and accompanying FIBROSIS of SMALL AIRWAYS
28
destruction of smooth muscle and elastic tissue by chronic necrotizing infections leads to permanent dilation of bronchi and bronchioles
bronchiectasis
29
What gene is associated with differetial in vivo airway hyper responsiveness in vitro response to beta-agonist stimulation?
Beta2-adrenergic receptor gene variants
30
What precipitate the symptoms of bronchiectasis
upper respiratory infection
31
Test and history or NON atopic asthma
skin tests negative | Family history less common
32
What drug induced asthma occurs in those with recurrent rhinitis and nasal polyps
aspirin-sensitive asthma
33
What proinflammatory mediators are thought to be involved in aspirin sensitive asthma
leukotrienes B4, C4, D4, and E4
34
What are the causes of interstitial emphysema?
- mostly alveolar tears in pulmonary emphysema | - rarely chest wounds or fractured ribs
35
early onset allergic asthma that responds well to corticosteroids is associated with inflammation by what cells
TH2 helper T cells
36
What lobes are affected in panacinar emphysema?
Lower and anterior margins
37
eosinophils and charcot-leyden crystals in sputum and BAL
severe asthma
38
What symptom of asthma overlaps with chronic bronchitis
increased mucus secretion
39
Patients with atopic asthma often have a history of what
allergic rhinitis or eczema
40
What is the earliest feature of chronic bronchitis?
hypersecretion of mucus
41
lung expands because air is trapped within it. common cause is subtotal obstruction of the airways by a tumor or foreign object
obstructive overinflation
42
COPD includes what 2 obstructive diseases
Emphysema and chronic bronchitis
43
When is the cough of bronchiectasis more frequent
when they rise in morning
44
inheritance pattern of primary ciliary dyskinesia
autosomal recessive
45
in Atopic Asthma, what mediators from TH2 cells stimulate production of IgE from B cells
IL-4 and IL-5
46
What congenital or hereditary conditions can cause bronchiectasis
- CYSTIC FIBROSIS - intralobar sequestration - immunodeficiency states - primary ciliary dyskinesia - kartagener syndroms
47
What are the ways that obstructive overinflation can occur?
- something acting as a ball valve | - collaterals (pores of Kohn and canals of Lambert) bring air in behind the block
48
What IL gene has strongest and most consistent associations with asthma?
IL13 (but don't forget about 3, 4, 5, 9 and receptor IL4)
49
What are the major conditions associated with bronchiectasis
obstruction and infection
50
What are the 4 obstructive pulmonary diseases?
- emphysema - chronic bronchitis - asthma - bronchiectasis
51
Where does distal acinar (paraseptal) emphysema occur
- more striking adjacent to pleura - along lobular connective tissue septa - at margins of lobules - adjacent to areas of fibrosis, scarring, or atelectasis - upper half of lungs
52
what inflammatory mediators are involved in the hypersecretion of chronic bronchitis
histamine and IL-13
53
Tell me about tests and history for Atopic asthma
- may have high serum IgE - postive family history of asthma - + skin test: WHEAL and FLARE reaction - RAST
54
what happens to smaller bronchiles in bronchiectasis
progressively obliterated as a result of fibrosis (bronchiolitis obliterans
55
Atopic asthma is what type of hypersensitivity
type 1 (IgE mediated)
56
What cells and what mediator is responsible for recruitment of neutrophils in Atopic ashtma
TH17 and IL-17
57
What type of emphysema? - Heavy smoker often with chronic bronchitis (COPD) - central or proximal part of acini (distal spared) - More severe and common in upper lobes
Centriacinar
58
in Atopic asthma, the allergens most frequently act in synergy with other proinflammatory environmental cofactors, most notably what?
respiratory viral infections
59
There are no symptoms in emphysema until how much of the lung is affected/
1/3
60
when does atopic asthma usually begin
childhood
61
What leads to stasis and increased risk for infection in chronic bronchitis
smoke interferes with ciliary actions of respiratory epithelium
62
What gene associated with asthma responsible for cleaving chitin, a polysaccharide in many human parasites and cell walls of fungi? -correlated with disease severity, airway remodeling, and decreased pulmonary function
YKL-40
63
Severe emphysema symptoms
- weight loss - barrel chest - prolonged expiration - "pink puffer" - sits forward in hunched-over position and breathes through pursed lips
64
in Atoplic asthma, what mediator stimulates mucus secretion from bronchial submucosal glands and promotes IgE production
IL-13
65
Entrance of air into connective tissue stroma of the lung, mediastinum, or subcutaneous tissue
interstitial emphysema
66
What cells release the chemotactic factors in the pathogenesis of emphysema?
Lung epithelial cells and macrophages
67
What gene variants are associated with atopy, elevation total serum IgE, and asthma
IL-4 receptor gene
68
What is airspace enlargement with fibrosis (irregular emphysema) almost invariably associated with?
Scarring
69
Dilation of alveoli in response to loss of lung substance elsewhere. hyperexpansion of residual lung parenchyma following surgical removal of a diseased lung or lobe
Compensetory hyperinflation
70
What type of emphysema probably underlies many cases of spontaneous pneumothorax?
Distal acinar (paraseptal) emphysema
71
Long standing severe chronic bronchitis commonly leads to what
cor pulmonale and cardiac failure
72
The early reaction of atopic asthma is dominated by what features?
- bronchoconstriction - increased mucus production - variable degrees of vasodilation - increased vascular permeability
73
the 3 things involved in pathogenesis of chronic bronchitis?
- mucus hypersecretion - inflammation - infection
74
What gene is associated with protection of oxidative stress from tobacco smoke and emphysema
NFR2
75
Who commonly gets chronic bronchitis
smokers and inhabitants of smog-laden cities
76
What is the late phase reaction in Atopic asthma dominated by?
recruitment of leukocytes, notably eosinophils, neurtrophils, and more T cells
77
What area of lungs does bronchiectasis usually affect?
lower lobes bilaterally
78
occurs in patients with asthma and cystic fibrosis who develop periods of exacerbation and remission that may lead to proximal bronchiectasis and fibrotic lung disease
Allergic bronchopulmonary aspergillosis
79
Homozygous for what allele have markedly decreased serum levels of alpha1-antitrypsin?
PiZZ
80
Bacterial species that cause infection in CF patients
- S. aureus - H. influenzae - Berkholderia cepacia - Pseudomonas aeruginosa
81
describe the airway remodeling that occurs after repeated allergen exposure and reaction
- bronchial wall smooth muscle hypertrophy and hyperplasia - subepithelial fibrosis (collagen 1 and 3) - submucosal gland hyperplasia; increased goblet cells - increased thickness of the airway wall
82
asthmatic attack with urticaria
aspirin sensitive asthma
83
What are charcot-leyden crystals composed of
an eosinophil protein called galectin-10
84
The bronchoconstriction in the early phase of an atopic asthmatic reaction is triggered by what?
- direct stimulation of sub epithelial vagal (parasympathetic) receptors - Luekotrienes C4, D4, and E4 - acetylcholine
85
What causes an obstructive overinflation to become life threatening?
affected portion distends sufficiently to compress remaining lung
86
What is the major trigger of COPD?
Cigarette smoke
87
What gene is linked to production of IgE antibodies against some antigens such as ragweed pollen?
class II HLA
88
Common triggers for Non-atopic asthma
- Respiratory infections due to viruses (rhinovirus, parainfluenza, RSV) - inhalation of irritants - cold - exercise
89
Initial symptoms of emphysema
Dyspnea, cough, and wheezing
90
- ciliary dyskinesia - sinusitis - bronchiectasis - situs inversus
Kartagener syndrome

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