Flashcards in RESPIRATORY: 604 - 605 Deck (53)
Name 3 key interleukins (and what they do) involved in asthma.
Th2 induces the release of:
1. IL-4 - induces class switching from IgG to IgE
2. IL-5 - recruits eosinophils
3. IL-10 - promotes the Th2 response and inhibits the Th1 response
How do we test for asthma?
What are the clinical findings in asthma?
Cough, wheezing, tachypnea, dyspnea, hypoxemia, pulsus paradoxus, mucus plugging, decreased I/E ratio
Describe the pathophysiology in bronchiectasis.
Chronic necrotizing infection of bronchi leads to permanently dilated airways which leads to loss of tone allowing for air to be trapped since it has trouble accelerating and be expelled
What are 5 things associated with bronchiectasis?
1. Bronchial obstruction
2. Poor ciliary motility (smoking)
3. Kartagener syndrome (defect in dynein arm of cilia)
4. Cystic fibrosis
5. Allergic bronchopulmonary aspergillosis
What are some clinical findings in bronchiectasis?
Purulent sputum, recurrent infections, hemoptysis
What is the main problem in restrictive lung disease?
Problem with filling the lung (restricted expansion)
What happens to FVC and TLC in restrictive lung disease?
What is the signature PFT's in restrictive lung disease?
FEV1/FVC ratio > 80%
What are the two types of restrictive lung disease and how do you characterize each?
1. Poor breathing mechanics - extrapulmonary, peripheral hypoventilation, normal A-a gradient
2. Interstitial lung diseases - decreased pulmonary diffusing capacity, increased A-a gradient
In terms of restrictive lung disease caused by poor breathing mechanics, what are two subcategories of deficits?
1. Problem with the muscles - e.g. polio, myasthenia gravis
2. Problem with the physical structure - e.g. scoliosis, morbid obesity
What are 10 interstitial lung diseases that can lead to restrictive lung disease?
2 respiratory distress syndromes:
1. Acute respiratory distress syndrome
2. Neonatal respiratory distress syndrome
2 from outside toxins
1. Drug toxicity (bleomycin, busulfan, amiodarone, methotrexate)
2 hypersensitivity reactions
1. Hypersensitivity pneumonitis
2. Goodpasture syndrome
3 that cause granulomas
2. Granulomatosis with polyangiitis (Wegener's)
3. Langerhans cell histiocytosis
1. Idiopathic pulmonary fibrosis
What is damaged in neonatal respiratory distress syndrome?
What is sarcoidosis?
Systemic disease involving non-caseating granulomas in multiple organs
What are some of the findings in sarcoidosis?
Bilateral hilar lymphadenopathy, increased ACE, hypercalcemia, dyspnea or cough
Why is there hypercalcemia in sarcoidosis?
Granulomas have 1 alpha hydroxylase so they upregulate vitamin D activity leading to increased serum calcium levels
Describe what happens in idiopathic pulmonary fibrosis.
Repeated cycles of lung injury and wound healing with increased collagen deposition - TGF beta from injured pneumocytes induces fibrosis
What are some of the drugs that can cause interstitial lung disease?
Bleomycin, busulfan, amiodarone, methotrexate
What is hypersensitivity pneumonitis?
Mixed type III/IV hypersensitivity reaction to organic environmental antigen
What are 5 clinical findings in hypersensitivity pneumonitis?
3. Chest tightness
What two groups of people is hypersensitivity pneumonitis often seen in?
2. Those exposed to birds
How do we treat hypersensitivity pneumonitis?
Remove the exposure