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Term 3: Immunology/Pathology > Asthma, COPD, & TB > Flashcards

Asthma, COPD, & TB Flashcards

1
Q

What are the three possible airway obstructions in asthma?

A
  • Airway hyperresponsiveness
  • Mucus hypersecretion
  • Plastic bronchitis
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2
Q

Which antibody is elevated in the serum of asthmatics?

A

IgE

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3
Q

Which kinds of helper T cells are present in the lungs of asthmatics?

A

Th2

Th17

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4
Q

What interleukin does Th17 produce?

A

IL-17 (A and F)

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5
Q

Which interleukin is the most important differentiation factor for Th2 cells and IgE-secreting B cells?

A

-IL-4

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6
Q

Which interleukin favors the development of eosinophils?

A

-IL-5

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7
Q

Which interleukin is the most important mediator of most features of the asthma phenotype?

A

-IL-13

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8
Q

What is the methacholine challenge test for asthma?

A
  • muscarinic agonist
  • triggers smooth muscle contraction
  • asthmatics will have greater sensitivity to lower levels of methacholine compared to normal folks
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9
Q

What cells drive asthma?

A

-Th2

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10
Q

What is the intrinsic cause of asthma?

A

Adaptive immune response involving Th2 cells and secreted cytokines, especially IL-13.

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11
Q

What activates the extrinsic cause of asthma?

A
  • Exogenous proteases activates Th2 cells, which then secrete IL-4, 5, and 13
  • natural sources of proteases from pollen and fungi are linked to asthma
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12
Q

What are the two phenotypes of COPD?

A
  • pink puffer

- blue bloater

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13
Q

What are the radiological findings of emphysema?

A
  • flattening of the diaphragm
  • widening of the retrosternal air space
  • Physical loss of lung seen on CT
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14
Q

What kind of T cells are found in the lungs of those with emphysema?

A
  • Th 1 & Th17
  • no Th2, key difference between COPD and asthma
  • Decreased Treg cells
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15
Q

What keeps the medium sized airways open?

A

Elastin cables

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16
Q

In patients with COPD, how to T cells respond to elastin?

A
  • produce IFN-gamma and IL-10

* shows emphysema is an Autoimmune issue

17
Q

Can emphysema be caused in IL-17 knockout mice?

A

No

18
Q

What is Emphysema?

A

Emphysema is a chronic disease with an anti-elastin, autoimmune component in which the lung structural matrix protein elasin is destroyed by elastases that are induced innately and amplified by adaptiveTh1 and Th17 cell responses

19
Q

What should treatment of COPD be focused on?

A
  • achieving bronchodilation

- Turning off the Th1/Th17 response

20
Q

Compare the Fundamental causes of Asthma Vs. emphysema.

A

Asthma: Proteinases & Fungi

Emphysema: Smoke

21
Q

Compare the physiological findings of Asthma Vs. emphysema.

A

Asthma: Reversible airway obstruction

Emphysema: Irreversible airway obstruction

22
Q

Compare the immune profile of Asthma Vs. emphysema.

A

Asthma: Th2, Th17, IgE. No autimunity

Emphysema: Th1, Th17. Strong Autimmune component

23
Q
  1. Physiologically, asthma is characterized by the following (select the best answer):
    A. Fixed airway obstruction
    B. Hyperresponsiveness to methacholine challenge
    C. Th2 and Th17 cell-driven allergic airway inflammation
    D. Chronic hypoxemia
    E. B and C
A

E. B and C

24
Q
  1. True or false (pick the best answer)
    Allergic inflammation in asthma is maladaptive and a major goal of therapy is to suppress it.

A. True
B. False

A

B. False

25
Q

What happens when TB bacteria is ingested by macrophages?

A
  • they are adapted to live inside macrophage
  • carried to lymph node by macrophage
  • replicate and lyse the cell
  • kinda like a virus
26
Q

When are corticosteroids used to treat pediatric TB?

A
  • when host inflammatory response is contributing to tissue damage or dysfunction
  • meningitis, endobronchial, miliary w/ alveolar block, pericardial w/ constriction, vertebral w/ spinal root irritation
27
Q

What are the two ways to test for asthma?

A
  • spirometry

- methacholine test

28
Q

Physiologically, emphysema is characterized by which of the following?

A.  Fixed airway obstruction 
B.  Preserved lung architecture despite marked hypoxemia 
C.  Predominant Th2 cells in the lung 
D.  Loss of lung volume 
E.  Weight gain
A

A. fIxed airway obstruction

29
Q

Potential future therapies for emphysema might include which of the following?

A.  Beta-2 adrenergic receptor agonists 
B.  Glucocorticosteroids 
C.  Peroxisome proliferator activated receptor gamma (PPAR-g) agonists (e.g., rosiglitazone) 
D.  Insulin 
E.  Smoking cessation intervention
A

C. Peroxisome proliferator activated receptor gamma (PPAR-g) agonists (e.g., rosiglitazone)

30
Q

Which of the following contribute to the pathogenesis of emphysema?

A.  Th2 cells 
B.  Immunoglobulin E (IgE) and mast cells 
C.  Elastases 
D.  Tree pollens 
E.  Obesity
A

C. Elastases

31
Q

Which TB patients are the most infectious?

A
  • those that are sputum AFB smear positive (see TB under microscope)
  • children tend not to manifest like this, and thus are not usually infectious
32
Q

Why do children tend to be less infectious when they have active TB?

A

-don’t have the bacteria in their sputum

33
Q

What are things that can cause a decreased ppd response?

A
  • more sick = less likely to have a positive skin test
  • immunosuppressed states
  • improper storage and dilution of the tuberculin in the skin test
34
Q

Which interleukin is essential for granuloma formation?

A

IL-17

35
Q

Why are TNF-a inhibitors contraindicated in TB patients?

A
  • they will block TNF-a, thus preventing granuloma formation

- will result in widespread damage and death

36
Q

What is Miliary TB?

A
  • hematogenous dissemination of a large number of organisms
  • Negative PPD in 50%
  • Lack of T–cell proliferation, therefore tends to be aggressive
37
Q

What is the difference in immune response between pulmonary TB and pleural, Lymph node, and latent TB

A

-pulmonary TB has a higher ratio of Th2 cells to Th1 cells

Term 3: Immunology/Pathology (17 decks)

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