Host Defense Mechanisms of the Lung

Question 1

upper airway and bronchi defense?

Answer 1

anatomic barriers
cough
mucociliary apparatus
airway epithelium
secretory IgA
dendritic cells, lymphocytes, and neutrophils

Question 2

alveolar space defense?

Answer 2

alveolar macrophage
immunoglobulins, opsonins, surfactants
lymphocyte mediated immunity
neutrophils and eosinophils

Question 3

greater than 10 microns?

Answer 3

tonsils and adenoids

Question 4

2-10 microns?

Answer 4

mucokinesis and coughing

Question 5

less than 2 microns?

Answer 5

alveolar macrophages

Question 6

cough reflex?

Answer 6

deep inspired
shut off air (close glottis)
expiratory effort, builds pressure
release high pressure trapped air

Question 7

airway epithelial cells?

Answer 7

barrier function

• release bacterostatic molecules
• regulation of immune response

secrete IgA

**toll like receptors

Question 8

secretory IgA

Answer 8

produced by plasma cells

• heterodimer
• secreted into lumen

**important for defense at mucosal surfaces

Question 9

dendritic cells

Answer 9

trap antigen and present to other cells in lymphoid strictures

Question 10

BALT

Answer 10

bronchial associated lymphoid tissue

Question 11

GALT

Answer 11

gut associated lymphoid tissue

Question 12

mucociliary clearance

Answer 12

2-10 microns deposited on mucus of upper airways

altered in asthma, chronic bronchitis, and cystic fibrosis

Question 13

mucus contains?

Answer 13

IgA, lysozyme, lactoferrin, peroxidase

Question 14

gel-on-brush model

Answer 14

propose model for mucus clearance

Question 15

cystic fibrosis

Answer 15

mutant in CFTR gene
-cystic fibrosis transmembrane conductance regulator

-prevents chloride transport out of cell (Cl- and Na+ abnormalities)

accumulation of thick and viscous mucus - difficult to move it out (it is actually dehydrated)

increased risk of infecton

Question 16

mucus in cystic fibrosis?

Answer 16

dehydrated**

normal - Kmucus less than Kpcl
dehydrated - Kmucus equals Kpcl

Question 17

common pathogens in cystic fibrosis?

Answer 17

pseduomonas aeruginosa
burkholderia cepacia
staphylococcus aureus
haemophilus influenza

Question 18

CFTR gene mutations?

Answer 18

pathogens can embed in mucus and survive in these suitable microenvironments

Question 19

defense in alveoli?

Answer 19

IgA and IgG
surfactant, fibronectin, C reactive protein
lymphocyte antibody production
neutros and eosinos

Question 20

protease/antiprotease in respiratory system?

Answer 20

neutrophil elastase
metalloproteinase
alpha-1 antitrypsin

imbalance can cause problems

Question 21

epithelial cell recognition of pathogens?

Answer 21

ligation of toll like receptors

recognize flagellin, LP5, etc.

Question 22

innate immune response?

Answer 22

dendritic cells
neutrophils
NK cells

Question 23

adaptive immune response?

Answer 23

effector T cells

Question 24

pathology of pneumonia?

Answer 24

lung inflammation associated with alveoli filling in response to lung infection

Question 25

predisposing factors of pneumonia?

Answer 25

age - increases with age
immune status - immuno compromised
presence of lung disease - CF, chronic bronchitis

Question 26

pneumonia?

Answer 26

V/Q mismatch

• vasoconstriction in edematous areas
• will develop hypoxemia
• CO2 levels should be fine
• pain with chest wall movement

Question 27

no change amines?

Answer 27

dopamine
adrenaline
histamine

Question 28

inactivated amines?

Answer 28

5-hydroxytryptamine

noradrenaline

Question 29

activated peptide?

Answer 29

ANG I

-converted to ANG II in lung**

Question 30

no change peptides?

Answer 30

ANG II
oxytocin
vasopresin

Question 31

ANG 1 - 2

Answer 31

in lung**

Question 32

inactivated peptides?

Answer 32

bradykinin
ANP
endothelins

Question 33

activated arachidonic acid derivatives?

Answer 33

arachidonic acid

Question 34

no change arachidonic acid derivative?

Answer 34

PGI2

PGA2

Question 35

Inactivated arachidonic acid derivative?

Answer 35

PGD2, PGE2, PGF2a

Question 36

inactivated purine derivatives

Answer 36

leukotrienes
adenosine
ATP
ADP
AMP