RESPIRATORY: 604 - 605 Flashcards Preview

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Flashcards in RESPIRATORY: 604 - 605 Deck (53)
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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?

Methacholine challenge


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?

Both decrease


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. Pneumoconioses

2 hypersensitivity reactions
1. Hypersensitivity pneumonitis
2. Goodpasture syndrome

3 that cause granulomas
1. Sarcoidosis
2. Granulomatosis with polyangiitis (Wegener's)
3. Langerhans cell histiocytosis

1 ???
1. Idiopathic pulmonary fibrosis


What is damaged in neonatal respiratory distress syndrome?

Hyaline membrane


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?

1. Dyspnea
2. Cough
3. Chest tightness
4. Headache
5. Fever


What two groups of people is hypersensitivity pneumonitis often seen in?

1. Farmers
2. Those exposed to birds


How do we treat hypersensitivity pneumonitis?

Remove the exposure


When does hypersensitivity pneumonitis lead to interstitial lung disease?

When it is a chronic exposure (leads to interstitial fibrosis)