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Review / Wrong Answers > DIT review - Pulmonary 2 > Flashcards

DIT review - Pulmonary 2 Flashcards

1
Q

Will you see an increase or a decrease in the following values in obstructive lung disease:

  • Residual volume (RV)
  • Functional residual capacity (FRC)
  • Total lung capacity (TLC)
  • FEV1
  • FVC
  • FEV1:FVC
A
  • Residual volume (RV) - increased
  • Functional residual capacity (FRC) - increased
  • Total lung capacity (TLC) - increased
  • FEV1 - decreased
  • FVC - decreased
  • FEV1:FVC - decreased (< 80%)
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2
Q

What are the 4 obstructive lung diseases?

A

Asthma, chronic bronchitis, emphysema, bronchiectasis

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3
Q

What will be seen on histology in asthma patients

A
  • Curschmann’s spirals (shed epithelium forms whorled mucus plugs)
  • Charcot-Leyden crystals (eodsinophilic, hexagonal, double-pointed, needle-like crystals)
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4
Q

What is the diagnostic criteria for chronic bronchitis

A
  • Chronic productive cough for > 3 months per year for > 2 consecutive years
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5
Q

Describe characteristic histology of Chronic bronchitis

A
  • Characterized by hyperplasia of mucus-secreting glands in bronchi
    • Reid index (thickness of mucosal gland layer to thickness or wall) > 50%
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6
Q

Classic presentation of chronic bronchitis

A

“Blue bloaters”

  • Productive cough, wheezing, crackles, dyspnea
  • Cyanosis (“blue bloating”) due to shunting
    • Decreased paO2
  • CO2 retention due to mucus plugs trapping CO2
    • Increased paCO2
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7
Q

Describe the basic premise behind emphysema

A
  • Destruction of alveolar air sacs = loss of elastic recoil and collapse of airways during exhalation = obstruction and air trapping
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8
Q

What are the two types of emphysema, and which occurs in what part of the lung

A
  • Centriacinar
    • Associated with smoking
      • Pollutants in smoke = excessive inflammation = protease-mediated damage
    • Worse in upper lobes
  • Panacinar
    • Associated with alpha-1-antitrypsin (A1AT) deficiency
      • No A1AT to neutralize proteases (elastase)
    • Worse in lower lobes
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9
Q

Why is A1AT deficiency also associated with liver cirrhosis

A
  • A1ATD due to misfolding of mutated proteins
  • Misfolded proteins accumulate in the endoplasmic reticulum of hepatocytes
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10
Q

Classic presentation of emphysema

A
  • Dyspnea and cough with minimal sputum
  • Prolonged expiration with pursed lips (“pink puffer”)
  • Barrel-chest
    • Increased AP diameter on CXR
    • Flattened diaphragm
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11
Q

Describe the basic premise behind bronchiectasis

A
  • Chronic infection of the bronchi causes permanent dilation of airways
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12
Q

Common causes of bronchiectasis

A
  • Cystic fibrosis, Karagener sundrome, necrotizing infection, allergic bronchopulmonary aspergillosis
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13
Q

Presentation of bronchiectasis

A
  • Cough, dyspnea, foul-smelling sputum
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14
Q

What type of drug is Chlorpheniramine and Diphenhydramine

A
  • 1st generation H1-blockers
    • Are lipophilic and can cross the BBB
    • Diphenhydramine** and **Dimenhydrinate
      • = dragonfly fairy
    • Chorpheniramine
      • = color fairy
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15
Q

What type of drug are

  • Hydroxysine, Meclizine, Promethazine
A
  • 1st generation H1-blockers
    • Are lipophilic and can cross the BBB
  • Hydroxysine, Meclizine, Promethazine
    • = fairy cuisine
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16
Q

What are the 2nd generation H1-blockers

A
  • 2nd generation H1-blockers:
    • Are less lipophilic and so do NOT cross the BBB (less central effects)
  • Fexofenadine
    • à fox
  • Cetirizine
    • à Satyr
  • Loratidine
    • à rat
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17
Q

What effects do 1st generation H1-blockers have the 2nd generation do not?

A
  • Treats vestibular nausea or motion sickness
    • = seasick fairy sailors in front of the brain tree
    • Only 1st generation H1 blockers because they are lipophilic so can enter the CNS and act of the vestibular system and brainstem
  • Drowsiness (can be used to treat insomnia)
    • = guy sleeping
    • Only 1st generation
  • Antagonize peripheral and central muscarinic receptors (e.g. pupillary dilation, dry mouth, urinary retention, constipation, exacerbation of glaucoma, and delirium)
    • = anti-muscarinic tea party
  • Treat extrapyramidal side effects caused by antipsychotics (e.g. acute dystonia)
    • = falling “extra parking” cone
    • This is because the anti-muscarinic effects re-establish dopaminergic-cholinergic balance
  • Antagonize serotonin receptors in the CNS stimulating appetite and weight gain
    • = cut smiley face cake
    • = stuffed fairy next to cake
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18
Q

What are the main 2 drugs used in mild to moderate asthma

A

Beta-2 blockers

Inhaled cortocosteroids

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19
Q

MOA of Montelukast and Zafilukast

A

Direct inhibitors of leukotriene receptors (CysLT1)

Causes broncodilation

Used for persistent asthma, espcially aspirin-induced asthma

20
Q

MOA of Zileuton

A
  • Zileuton
    • = GodZILla
  • Mechanism:
    • Direct inhibition of LOX, which prevents the production of leukotrienes
      • = Godzilla falling on coach LOX
  • Uses:
    • Alternative therapy for mild persistent asthma
    • Especially goof for aspirin-induced asthma
  • Adverse effects:
    • Risk of hepatotoxicity
      • = liver spot on Godzilla
21
Q

What are the two long-acting Beta-2 agonists (LABA) used for asthma

A
  • Salmeterol** and **Formoterol
    • = Salute
    • = formation
    • = ROL call
  • Used for prophylaxis of asthma
22
Q

What is the muscarinic antagonist that can be used for asthma

A

Ipratropium

23
Q

MOA of Omalizumab

A
  • Omalizumab = limousine
    • Mechanism of action
      • Recall:
        • Mast cell degranulation is important to the pathogenesis of asthma
        • Antigen binding to IgE on mast cells causes degranulation and release of inflammatory mediators (e.g histamine)
      • Is an anti-IgE monoclonal antibody directed against the Fc portion of IgE (part that attaches IgE to mast cell), preventing mast cell sensitization
        • = limo guy grabbing end of IgE gun
24
Q

MOA of Theophyllin

A
  • Increases intracellular cAMP by inhibiting its breakdown by phosphodiesterases
    • = “Don’t PHOSTER disinterest”
    • = “go cAMPing”
  • Increased cAMP can aid in bronchial smooth muscle relaxation and inhibition of cytokine release
25
Q

MOA of Cromolyn

A
  • Mechanism of action:
    • Inhibits mast cell degranulation, preventing the release of histamine
      • = bee sedating smoke
26
Q

Will the following value be high or low in restrictive lung disease:

  • TLC
  • FEV1
  • FVC
  • FEV1:FVC
A
  • Decreased TLC
  • Decreased FEV1 and FVC, but FVC is decreased more
  • FEV1:FVC ratio is increased (> 80%)
27
Q

What are the two main mechanisms that can cause restrictive lung disease

A

(1) Poor breathing mechanics (muscular or structural)
(2) Interstitial lung disease

28
Q

What will you see in idiopathic pulmonary fibrosis

A
  • Repeated cycles of lung injury and wound healing with increased collagen deposition
  • “Honeycomb” lung appearance
29
Q

What are the 2 interstitial lung diseases that also affect the kidney

A

Goodpasture syndrome

Granulomatosis with polyangiitis (Wegener’s)

?? microscopic polyangiitis ??

30
Q

Besides pulmonary issues, what else does Langerhans cell histiocytosis present with?

A
  • Neoplastic proliferation of specialized dendritic cells (especially in skin)
  • Birbeck (“tennis racket”) granules seen on EM
  • S-100 (+) and CD1a (+)
  • Presentation:
    • In children
    • Lytic bone lesions
    • Skin rash
    • Recurrent otitis media
31
Q

What type of HSR is hypersensitivity pneumonitis

A
  • Aka Pigeon breeder or Farmer’s lung
  • Mixed type III/IV HSR to environmental antigen
  • Presents with dyspnea, cough, chest tightness, and headache
32
Q

What pneumoconiosis is caused by aerospace and manufacturing industries

A

Berylliosis

33
Q

What pneumoconiosis is associated with sand blasting

A

Silicosis

34
Q

What pneumoconiosis is associated with shipbuilding and roofing

A

Asbestos

35
Q

What pneumoconiosis is associated with carbon dust exposure

A

Coal worker’s pneumoconiosis

36
Q

Of the 4 pnuemoconioses, which occur in the upper and which occur in the lower lobes:

Asbestos, Coal worker’s, Berylliosis, Silicosis

A

THINK: Asbestos is from the roof but affects the base; Silica and coal are from the bast but affect the roof

Lower lobe = asbestos

Upper lobe = berylliosis, coal worker, silicosis

37
Q

What pneumoconiosis is assoicated with golden-brown fusiform rods resembling dumbbells?

A

Asbestos

38
Q

Complications associated with Asbestos

A
  • Causes fibrosis of lung or pleura; cancer of lung or pleura (mesothelioma)
    • Lung carcinoma more common than mesothelioma
39
Q

What is anthracosis

A

Asymptomatic carbon in lungs

Found in most urban dwellers

40
Q

Describe presentation of Berylliosis

A
  • Noncaseating granulomas in lung, hilar lymph nodes, and systemic organs
    • Looks similar to sarcoidosis
41
Q

Complications associated with silicosis

A
  • “Eggshell” calcifications of hilar lymph nodes
  • Silica impairs phagolysosome formation (increased risk for TB)
42
Q

Characteristic findings of sarcoidosis

A
  • Characterized by noncaseating granulomas in multiple organs
    • Granulomas most commonly involve the hilar lymph nodes and lung
    • Erythema nodosum (nodules on shins), uveitis, salivary and lacrimal glands (mimics Sjogren)
43
Q

Elevated serum levels and histology of sarcoidosis

A
  • Elevated serum levels:
    • ACE
    • Calcium
  • Histology = asteroid bodies
    • THINK: watching shooting stars (asteroids) on the beach with ice cream (hypercalcemia) while playing cards (ACE)
44
Q

Describe the pathogenesis behind acute respiratory distress syndrome (ARDS)

A
  • Due to diffuse damage to alveolar-capillary interface
    • Caused by neutrophil activation inducing protease- and free radical-mediated damage of type I and type II pneumocytes
    • Endothelial damage = increased capillary permeability = protein-rich leakage into alveoli = diffuse alveolar damage and noncardiogenic pulmonary edema
    • Results in intra-alveolar hyaline membrane
45
Q

Causes of ARDS

A
  • Sepsis, Pancreatitis, Pneumonia, Aspiration, Uremia, Trauma, Amniotic fluid embolism, Shock, Infection
46
Q

Describe the defect that causes neonatal respiratory distress syndrome, and associated risk factors

A
  • Respiratory distress due to inadequate surfactant levels
  • Associated with:
    • Prematurity, C-section delivery, maternal diabetes
  • Will show diffuse granularity (“ground glass”) appearance on lung

Review / Wrong Answers (140 decks)

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