Week 2

Question 1

Defense Mechanisms:

• Innate response in lungs: Relies on? Recruits? What suppresses adaptive immune response? Clear what?
• What patrols the vascular epithelium?
• Sequence of innate receptor signaling? (3)
• Bridge between innate and adaptive response?
• Innate receptor signaling leads to? (5)
• Where does adaptive response occur?

Answer 1

• PAMPS; phagocytes and inflammation; alveolar MACs; junk in the lungs
• Monocytes
• PAMP binds TLR; APC present it and incite inflamm. respinse; Adaptive response later occurs
• TLR’s
• Cytokine produced; PMN recruitment; microbial killing; DC maturation; monocyte recruitment
• Lymph nodes

Question 2

Obstructive Lung Disease:

• Bronchiolitis? Which airways?
• Brhonchiolectasis? Effects what? Due to?
• Types of obstruction? (3) All increase what?
• Obstructive effect on airways? Leads to?
• 5 types of asthma?
• Long term asthma treatments? (6) Short term? (3)

Answer 2

• Inflamm of membranous bronchioles; peripheral airways
• Abnormal dilation of proximal medium sized bronchi; chronic bacterial infection; destruction of elastic components of airway
• Intrinsic airway narrowing, floppy airways, decreased airflow; increased resistance
• allergy (atopic); exercise induced; environmental; non-atopic; cough variant
• Inhaled glucocorticoids; long acting B2 agonists; LT modifiers; omalizumab (anti IgE); Cromolym sodium; Theophylline (PDE inhibitor)
• B2 agonists; anticholinergics; oral gc steroids

Question 3

Obstructive Lung Disease:

• Types of obstructive lung disease? (5)
• 4 classes of COPD and their FEV/FVC and FEV values?
• 4 classes of asthma and day symptoms? Night symptoms?
• 2 parts of COPD? FEV/FVC values? DLCO?
• goals of COPD treatment? (5)

Answer 3

• Asthma, emphysema, chronic bronchitis, bronciolectasis, bronchiolitis
• Mild (FEV/FVC 80); Moderate (FEV/FVC 2/mo); moderate persistant (daily; >1/wk); severe persistant (continual; frequent)
• Emphysema (low; low), chronic bronchititis (low; high)
• Decrease smooth muscle tone; decrease inflamm; treat infections; quit smoking; supplement O2

Question 4

• Imaging:
  1. ) Chest X-Ray: Ad? (3) Dis? (2)
  2. ) Chest CT: Ad? (3) Dis? (3)
  3. ) MRI: Ad? Dis? (2)
  4. ) V-Q scan: Ad? (3) Dis?
  5. ) PET scan: Ad? Dis? (2)

Answer 4

• Cheap, low radiation, portable; nonspecific, insensitive to early disease
• Overlapping densities covered, sensitive to early disease, better diagnostics; radiation, expensive, high false +
• Great for heart and vascular; not great for lung imaging, poor spatial resolution
• Good eval of ventiation/perfusion, great for PE, low radiation; only good for vascular issues
• Metabolic activity; expensive, radiation

Question 5

• Histology:
• 5 compartments? (5)
• Acute Bronchitis: Infection of? Primarily?
• Chronic bronchitis: 3 characteristics?
• Asthma effects what? 3 characteristics?
• Bronchioles don’t contain?
• Types of bronchiolitis? (4) All lead to?
• Types of granulomatous bronchiolitis? Cause? Cells Present? (2)

Answer 5

• Airways, airspaces, alveolar septa, vessels, nodules
• Bronchi; neutrophils in airways
• Chronic inflamm, squamus metaplasia, mucus gland hypertrophy
• Large airways; thickened subbasal lamina, eisino inflamm, mucus hyper secretion
• Cartilage
• Chronic, follicular, constrictive, granulomatous
• Air trapping
• Necrotizing = necrotic material via mycobacteria and fungus; non-necrorizing = sarcoid/beryllium; histiocytes (macs), giant multinucleated cells

Question 6

• Histology:
• Cause of acute pneumonia?
• Other types of pneumonia? (3)
• Cause of organizing pneumonia? Present how?
• Diffuse alveolar damage: What forms? Septa? Present how?
• Emphysema? Common finding? (2) Smoking vs. alpha 1 a trypsin? (2)
• Other smoking related diseases? (2) Cell found?

Answer 6

• Neutrophils in airspace
• Aspiration, eisinophillic, organizing
• Fibroblast pugs; relatively healthy
• hyaline membranes (pink fibrin ribbons); thickened; very sick
• Enlarged airspaces; recoil bodies/ blebs; Smoking = upper lobes, centrilobular; a1 = lower lobes, panlobular
• Respiratory bronchiolitis, desquamitive intersitital pneumonia; black pigmented macrophages

Question 7

• Histology:
• Capillaritis can lead to? Sign?
• Pulm. alveolar proteinosis: Airspaces with?
• UIP effects? Age? Infectious? Patchy? Genous? Foci? Looks like? Worse where? Treatment?
• NSIP: Uniform? Foci? Honeycomb? Treatable? 3 types?
• Hypersensitivity pneumonia: Response to? What is effected? Find what on histology? (2)
• Types of emboli? (2) Causes?

Answer 7

• Diffuse alveolar hemorrhage; blood containing macs
• pink fluid/ macs
• Septa; older; no; yes; hetero; fibro foci; honeycomb; lower lobes; none
• Yes homogenous; none; no; yes; cellular (inflamm.), fibrotic (fibrosis), or mixed
• Foreign antigens (birds, mold, hot tub); septa; airway chronic inflamm., non-necrotizing granulomas
• Thromboembolytic; talc = polarized crystals on histology with multinuc. giant cells from IV drug use

Question 8

• Histology:
• Pulm htx leads to? (2)
• Common causes of vasculitis? (2) Effect?
• Sarcoid/ Beryllium disease: Granulomas? Colloagen is? Distribution?
• Pulm. langherans cell histio.: Type of scar?
• Carcinoid: Salt and pepper around? Prognosis?
• Small Cell carcinoma: Crushed? Stain + for?
• Squamus cell carcinoma: Common? Common histology finding?
• Adenocarcinoma forms?
• Large cell: Appear? (2) Lack features of?

Answer 8

• Muscular hypertrophy; plexiform lesions (airway slits)
• Infection or autoimmune; alveolar hemorrhage
• well-formed non- nec grans; concentric; lymphatic
• Star (stellate) scar
• NE cells; good
• small with little cytoplasm; bad
• most common; keratin pearls
• Glands with lumen
• Large and bizarre; typical cell features of other carcinomas

Question 9

• Restrictive Lung Disease:
• Overall cause of disease? Ex? (3)
• Can also be caused by? (5)
• Interstitial PV slope? Vol? DLCO?
• Chest wall disease effect on PFT’s?
• PFT’s for mixed obstructive and restrictive? (2)
• 4 types of interstital lung disease? 2 treatable one?
• Key physical exam findings? (3)
  1. ) Interstitial pulm. fibrosis: Caused by? Treatment? Ground glass?
  2. ) NSIP: Prognosis? Treatment?

Answer 9

• Increased stiffness: More CT, surface tension, fluid
• Chest wall disease, bony thorax, pleura, resp. muscles, soft tissues
• Slope reduced, low, low
• PV slope is the same; rest is low
• Decreased volume and FEV/FVC

Question 10

Restrictive Lung Disease:

3. ) Respiratory Bronchiolitis: Progress to end stage fibrosis? Related to? Treatment? Don’t treat with? Looks like?
4. ) Desquamative Inter. Pneu: Related to? Treat with? Location?
5. ) Acute Inter. Pneu: Histologically called? Treatment? Symptoms? Alveoli?
6. ) Organizing pneumonia: Called? Histological findings? Airways?
7. ) Acute eisino. pneu: Presents like? DAD with? Treat?

Answer 10

3. ) No; smoking; stop smoking; glucocorticoids; patchy ground glass
4. ) Smoking; corticosteroids; distal airspaces
5. ) Diffuse alveolar damage; none; flu-like; flooded with fluid
6. ) BOOP; uniform granulation in distal airspaces; often neutrophillic alveolar infiltrates
7. ) ARDS; esinophils; steroids

Question 11

• Pathophysiology of sleep apnea? Leads to? (2) Good treatment?
• Most obstructive position?
• Pressure relationships with collapse?
• Best diagnostic tool?
• Most likely definitively sucessful treatment?

Answer 11

• Pharyngeal occlusion; hypoxemia and hypercapnia; Continous Positive Airway Pressure
• Supine; REM sleep
• Pcrit>Pds>Pus
• Overnight polysomnography
• Tracheostomy

Question 12

• Pneumonia:
• Community acquired acute? (3) Atypical? (2)
• Hospital acquired?
• Aspiration?
• Immunocompromised?

Answer 12

• Strep pneu, hameopholis flu, staph aeureus; mycoplasma, chlamydia
• gram - rods, staph aeureus
• Anaeorobic
• CMV