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respiratory medicine > Pahtology 2nd Slide Set > Flashcards

Pahtology 2nd Slide Set Flashcards

1
Q

young children with aeroallergen sensitization who develop lower respiratory tract viral infections (rhinovirus type C, RSV) have a 10 - 30 fold increased risk of developing what?

A

persistent and/or severe astham

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2
Q

this result from hypoplasia of bronchial cartilage in infants and is sometimes associated with other congenital cardiac and lung abnormalities

A

congenital lobar overinflation

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3
Q

What locus and chromosome encodes alpha1-antitrypsin?

A

Pi locus on chromosome 14

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4
Q

Death in most patients with emphysema is due to what?

A
  • CAD
  • respiratory failure
  • right-sided heart failure
  • pneumothorax
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5
Q

What inflammatory mediators and leukocytes have been shown to be increased in affected parts of emphysema?

A
  • leukotriene B4
  • IL-8
  • TNF
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6
Q

WHEEZING, breathlessness, chest tightness, and cough particularly at night and/or in early morning

A

Asthma

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7
Q

What genetic variant other than alpha1-antitrypsin deficiency have been linked to risk of emphysema?

A

Nicotinic acetylcholine receptor - influence addictiveness

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8
Q

What people are at most risk for getting interstitial emphysema?

A

Premature children on positive pressure ventilation and adults who are being artificially ventilated

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9
Q

Curschmann spirals in sputum or BAL

A

severe asthma

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10
Q

persistent cough with sputum production for at least 3 months in at least 2 consecutive years in the absence of any other identifiable cause

A

chronic bronchitis

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11
Q

clinical features of chronic bronchitis after persistent productive cough

A

dyspnea on exertion then with passage of time

  • hypercapnia
  • hypoxia
  • mild cyanosis (blue bloater)
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12
Q

Describe the small airway inflammation in emphysema?

A
  • Goblet cell hyperplasia with mucus plugging of lumen
  • inflammatory infiltrates in bronchial wall consisting of neutrophils, macrophages, B and T cells
  • Thickening of bronchiolar wall due to smooth muscle hypertrophy and peribronchial fibrosis
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13
Q

What are the 4 major types of emphysema?

A
  • centriacinar
  • panacinar
  • paraseptal
  • irregular
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14
Q

What are the 4 main processes involved in the pathogenesis of emphysema?

A
  • inflammatory mediators and leukocytes
  • Protease-antiprotease imbalance (elastase)
  • Oxidative stress
  • infection
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15
Q

What factors relaeased from eosinophils in the late reaction of Atoplic asthma caused damage to the epithelium?

A
  • major basic protein

- eosinophil cationic protein

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16
Q

What abnormality is associated with panacinar emphysema

A

Alpha1-antitrypsin deficiency

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17
Q

what people are more susceptible to COPD?

A

Women and African Americans

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18
Q

Irreversible enlargement of the airspaces distal to the terminal bronchiole accompanied by destruction of their walls without obvious fibrosis

A

Emphysema

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19
Q

Cardinal symptom of chronic bronchitis

A

-persistent productive cough

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20
Q

what is the morphology for chronic bronchitis

A
  • edema and swelling often with squamous metaplasia
  • hyperplasia of mucous gands of trachea and larger bronchi
  • increased reid index (normally .4)
  • in most severe, bronchiolitis obliterans
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21
Q
  • severe persistent cough
  • foul smelling sometimes bloody sputum
  • sometimes hemoptysis
  • in severe cases dyspnea and orthopnea
  • EPISODIC
A

bronchiectasis

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22
Q

The idea that microbial exposure during early development reduces the later incidence of allergic diseases

A

hygiene hypothesis

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23
Q

What gene is linked to increased proliferation of bronchial smooth muscle cells and fibroblasts, thus contributing to bronchial hyperreactivity and subepithelial fibrosis in asthma?

A

ADAM33

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24
Q

if long standing asthma becomes fatal

A

Acute severe asthma (status asthmaticus)

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25
Q

If death occurs in chronic bronchitis from further impairment of respiratory function, what was it probably due to

A

superimposed acute infection

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26
Q

in Atopic asthma, what mediators from TH2 and mast cells activates/recuits eosinophils

A

IL-5

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27
Q

in the pathogenesis of chronic bronchitis, describe the inflammatory component

A

cellular DAMAGE, eliciting both acute and chronic inflammatory responses involving neutrophils, lymphocytes, and macrophages. long-standing inflammation and accompanying FIBROSIS of SMALL AIRWAYS

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28
Q

destruction of smooth muscle and elastic tissue by chronic necrotizing infections leads to permanent dilation of bronchi and bronchioles

A

bronchiectasis

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29
Q

What gene is associated with differetial in vivo airway hyper responsiveness in vitro response to beta-agonist stimulation?

A

Beta2-adrenergic receptor gene variants

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30
Q

What precipitate the symptoms of bronchiectasis

A

upper respiratory infection

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31
Q

Test and history or NON atopic asthma

A

skin tests negative

Family history less common

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32
Q

What drug induced asthma occurs in those with recurrent rhinitis and nasal polyps

A

aspirin-sensitive asthma

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33
Q

What proinflammatory mediators are thought to be involved in aspirin sensitive asthma

A

leukotrienes B4, C4, D4, and E4

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34
Q

What are the causes of interstitial emphysema?

A
  • mostly alveolar tears in pulmonary emphysema

- rarely chest wounds or fractured ribs

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35
Q

early onset allergic asthma that responds well to corticosteroids is associated with inflammation by what cells

A

TH2 helper T cells

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36
Q

What lobes are affected in panacinar emphysema?

A

Lower and anterior margins

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37
Q

eosinophils and charcot-leyden crystals in sputum and BAL

A

severe asthma

38
Q

What symptom of asthma overlaps with chronic bronchitis

A

increased mucus secretion

39
Q

Patients with atopic asthma often have a history of what

A

allergic rhinitis or eczema

40
Q

What is the earliest feature of chronic bronchitis?

A

hypersecretion of mucus

41
Q

lung expands because air is trapped within it. common cause is subtotal obstruction of the airways by a tumor or foreign object

A

obstructive overinflation

42
Q

COPD includes what 2 obstructive diseases

A

Emphysema and chronic bronchitis

43
Q

When is the cough of bronchiectasis more frequent

A

when they rise in morning

44
Q

inheritance pattern of primary ciliary dyskinesia

A

autosomal recessive

45
Q

in Atopic Asthma, what mediators from TH2 cells stimulate production of IgE from B cells

A

IL-4 and IL-5

46
Q

What congenital or hereditary conditions can cause bronchiectasis

A
  • CYSTIC FIBROSIS
  • intralobar sequestration
  • immunodeficiency states
  • primary ciliary dyskinesia
  • kartagener syndroms
47
Q

What are the ways that obstructive overinflation can occur?

A
  • something acting as a ball valve

- collaterals (pores of Kohn and canals of Lambert) bring air in behind the block

48
Q

What IL gene has strongest and most consistent associations with asthma?

A

IL13 (but don’t forget about 3, 4, 5, 9 and receptor IL4)

49
Q

What are the major conditions associated with bronchiectasis

A

obstruction and infection

50
Q

What are the 4 obstructive pulmonary diseases?

A
  • emphysema
  • chronic bronchitis
  • asthma
  • bronchiectasis
51
Q

Where does distal acinar (paraseptal) emphysema occur

A
  • more striking adjacent to pleura
  • along lobular connective tissue septa
  • at margins of lobules
  • adjacent to areas of fibrosis, scarring, or atelectasis
  • upper half of lungs
52
Q

what inflammatory mediators are involved in the hypersecretion of chronic bronchitis

A

histamine and IL-13

53
Q

Tell me about tests and history for Atopic asthma

A
  • may have high serum IgE
  • postive family history of asthma
    • skin test: WHEAL and FLARE reaction
  • RAST
54
Q

what happens to smaller bronchiles in bronchiectasis

A

progressively obliterated as a result of fibrosis (bronchiolitis obliterans

55
Q

Atopic asthma is what type of hypersensitivity

A

type 1 (IgE mediated)

56
Q

What cells and what mediator is responsible for recruitment of neutrophils in Atopic ashtma

A

TH17 and IL-17

57
Q

What type of emphysema?

  • Heavy smoker often with chronic bronchitis (COPD)
  • central or proximal part of acini (distal spared)
  • More severe and common in upper lobes
A

Centriacinar

58
Q

in Atopic asthma, the allergens most frequently act in synergy with other proinflammatory environmental cofactors, most notably what?

A

respiratory viral infections

59
Q

There are no symptoms in emphysema until how much of the lung is affected/

A

1/3

60
Q

when does atopic asthma usually begin

A

childhood

61
Q

What leads to stasis and increased risk for infection in chronic bronchitis

A

smoke interferes with ciliary actions of respiratory epithelium

62
Q

What gene associated with asthma responsible for cleaving chitin, a polysaccharide in many human parasites and cell walls of fungi?

-correlated with disease severity, airway remodeling, and decreased pulmonary function

A

YKL-40

63
Q

Severe emphysema symptoms

A
  • weight loss
  • barrel chest
  • prolonged expiration
  • “pink puffer”
  • sits forward in hunched-over position and breathes through pursed lips
64
Q

in Atoplic asthma, what mediator stimulates mucus secretion from bronchial submucosal glands and promotes IgE production

A

IL-13

65
Q

Entrance of air into connective tissue stroma of the lung, mediastinum, or subcutaneous tissue

A

interstitial emphysema

66
Q

What cells release the chemotactic factors in the pathogenesis of emphysema?

A

Lung epithelial cells and macrophages

67
Q

What gene variants are associated with atopy, elevation total serum IgE, and asthma

A

IL-4 receptor gene

68
Q

What is airspace enlargement with fibrosis (irregular emphysema) almost invariably associated with?

A

Scarring

69
Q

Dilation of alveoli in response to loss of lung substance elsewhere. hyperexpansion of residual lung parenchyma following surgical removal of a diseased lung or lobe

A

Compensetory hyperinflation

70
Q

What type of emphysema probably underlies many cases of spontaneous pneumothorax?

A

Distal acinar (paraseptal) emphysema

71
Q

Long standing severe chronic bronchitis commonly leads to what

A

cor pulmonale and cardiac failure

72
Q

The early reaction of atopic asthma is dominated by what features?

A
  • bronchoconstriction
  • increased mucus production
  • variable degrees of vasodilation
  • increased vascular permeability
73
Q

the 3 things involved in pathogenesis of chronic bronchitis?

A
  • mucus hypersecretion
  • inflammation
  • infection
74
Q

What gene is associated with protection of oxidative stress from tobacco smoke and emphysema

A

NFR2

75
Q

Who commonly gets chronic bronchitis

A

smokers and inhabitants of smog-laden cities

76
Q

What is the late phase reaction in Atopic asthma dominated by?

A

recruitment of leukocytes, notably eosinophils, neurtrophils, and more T cells

77
Q

What area of lungs does bronchiectasis usually affect?

A

lower lobes bilaterally

78
Q

occurs in patients with asthma and cystic fibrosis who develop periods of exacerbation and remission that may lead to proximal bronchiectasis and fibrotic lung disease

A

Allergic bronchopulmonary aspergillosis

79
Q

Homozygous for what allele have markedly decreased serum levels of alpha1-antitrypsin?

A

PiZZ

80
Q

Bacterial species that cause infection in CF patients

A
  • S. aureus
  • H. influenzae
  • Berkholderia cepacia
  • Pseudomonas aeruginosa
81
Q

describe the airway remodeling that occurs after repeated allergen exposure and reaction

A
  • bronchial wall smooth muscle hypertrophy and hyperplasia
  • subepithelial fibrosis (collagen 1 and 3)
  • submucosal gland hyperplasia; increased goblet cells
  • increased thickness of the airway wall
82
Q

asthmatic attack with urticaria

A

aspirin sensitive asthma

83
Q

What are charcot-leyden crystals composed of

A

an eosinophil protein called galectin-10

84
Q

The bronchoconstriction in the early phase of an atopic asthmatic reaction is triggered by what?

A
  • direct stimulation of sub epithelial vagal (parasympathetic) receptors
  • Luekotrienes C4, D4, and E4
  • acetylcholine
85
Q

What causes an obstructive overinflation to become life threatening?

A

affected portion distends sufficiently to compress remaining lung

86
Q

What is the major trigger of COPD?

A

Cigarette smoke

87
Q

What gene is linked to production of IgE antibodies against some antigens such as ragweed pollen?

A

class II HLA

88
Q

Common triggers for Non-atopic asthma

A
  • Respiratory infections due to viruses (rhinovirus, parainfluenza, RSV)
  • inhalation of irritants
  • cold
  • exercise
89
Q

Initial symptoms of emphysema

A

Dyspnea, cough, and wheezing

90
Q
  • ciliary dyskinesia
  • sinusitis
  • bronchiectasis
  • situs inversus
A

Kartagener syndrome

respiratory medicine (37 decks)

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