Pathophysiology of ARDS and Asthma

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Questions and Answers

What is the primary underlying cause of Acute Respiratory Distress Syndrome (ARDS)?

  • Inadequate expansion of air spaces leading to atelectasis.
  • Injury to the epithelial and endothelial linings of the alveolar-capillary membrane. (correct)
  • Release of pro-inflammatory mediators such as IL-1 and TNF.
  • Activation and sequestration of neutrophils in pulmonary capillaries.

What is the primary mechanism by which atelectasis contributes to hypoxemia?

  • Release of pro-inflammatory mediators, causing endothelial dysfunction and reduced gas exchange.
  • Activation of neutrophils leading to inflammation and fluid buildup in the lungs.
  • Obstruction of airways, preventing air from reaching the lungs.
  • Increased ventilation-perfusion imbalance due to perfusion of atelectatic lung. (correct)

What is the role of neutrophils in the pathogenesis of ARDS?

  • Neutrophils release pro-inflammatory mediators that contribute to the inflammatory cascade.
  • Neutrophils cause obstruction of airways by forming clumps in the air sacs.
  • Neutrophils directly damage the epithelial and endothelial linings of the alveolar-capillary membrane.
  • Neutrophils contribute to the inflammatory response and are implicated in the damage observed in ARDS. (correct)

What type of atelectasis occurs when an obstruction prevents air from reaching distal airways?

<p>Obstruction atelectasis (A)</p> Signup and view all the answers

What is the direct effect of pro-inflammatory mediators like IL-1 and TNF on the pathogenesis of ARDS?

<p>They activate neutrophils, leading to a cascade of inflammatory events. (D)</p> Signup and view all the answers

What is the primary function of the goblet cells in a healthy airway?

<p>Produce mucus to trap foreign particles (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic of the late phase of asthma?

<p>Release of histamine from mast cells (A)</p> Signup and view all the answers

In an airway affected by asthma, the subepithelial basement membrane becomes thickened. What is the primary contributor to this thickening??

<p>Inflammation and deposition of collagen (B)</p> Signup and view all the answers

Which cell type is NOT directly involved in triggering the immediate phase of an asthma response?

<p>Neutrophils (A)</p> Signup and view all the answers

What is the role of IgE in asthma?

<p>Binds to allergens and triggers mast cell degranulation (A)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature of asthma?

<p>Reduced airway inflammation (A)</p> Signup and view all the answers

What is the role of dendritic cells in triggering asthma?

<p>Present allergens to T cells (D)</p> Signup and view all the answers

Which of the following is a key mediator released by mast cells in the immediate phase of asthma?

<p>Histamine (C)</p> Signup and view all the answers

Which of the following is the primary driving force for bronchoconstriction in asthma?

<p>Contraction of smooth muscle cells in airway walls (D)</p> Signup and view all the answers

What is a characteristic histological finding in the early stages of IPF?

<p>Exuberant fibroblastic proliferation forming fibroblastic foci (B)</p> Signup and view all the answers

Which of the following clinical presentations is highly suggestive of IPF?

<p>Gradual onset of non-productive cough and progressive dyspnea (D)</p> Signup and view all the answers

What is the underlying mechanism responsible for the reduction in lung compliance in patients with IPF?

<p>Thickening of the alveolar walls due to fibrosis (A)</p> Signup and view all the answers

In the advanced stages of IPF, what characteristic radiographic finding may be observed?

<p>Honeycomb fibrosis with cystic spaces (C)</p> Signup and view all the answers

Which of the following cells is typically involved in the interstitial inflammation associated with IPF?

<p>Lymphocytes (A)</p> Signup and view all the answers

What is the underlying cause of hypoxia in patients with IPF?

<p>Decreased diffusion capacity of the alveoli due to thickened alveolar walls (C)</p> Signup and view all the answers

Which of the following pathological changes is a common consequence of pulmonary hypertension in IPF?

<p>Thickening of the pulmonary artery walls (B)</p> Signup and view all the answers

What is the most characteristic physical examination finding associated with IPF?

<p>Dry, velcro-like crackles during inspiration (C)</p> Signup and view all the answers

What percentage of heavy smokers develop COPD?

<p>35-50% (A)</p> Signup and view all the answers

Which of the following is NOT a risk factor for developing COPD?

<p>Regular exercise (C)</p> Signup and view all the answers

What is the primary cause of COPD in approximately 80% of cases?

<p>Smoking (A)</p> Signup and view all the answers

Which of the following best describes the defining characteristic of emphysema?

<p>Permanent enlargement of air spaces distal to the terminal bronchioles (C)</p> Signup and view all the answers

What is the main distinction between emphysema and chronic bronchitis, as outlined in the text?

<p>Emphysema involves permanent enlargement of air spaces, while chronic bronchitis is characterized by inflammation and mucus production. (C)</p> Signup and view all the answers

What is the significance of understanding the anatomical distribution of emphysema?

<p>It allows for more accurate diagnosis and prognosis. (D)</p> Signup and view all the answers

Why does the text emphasize that emphysema is characterized by destruction of the walls of air spaces "without significant fibrosis"?

<p>Fibrosis indicates a different disease process than emphysema. (A)</p> Signup and view all the answers

Which of the following scenarios is most likely to result in a significant exacerbation of emphysema?

<p>An individual with a history of cigarette smoking develops a severe respiratory infection. (A)</p> Signup and view all the answers

Which of the following statements accurately describes the role of a1-antitrypsin in the pathogenesis of emphysema?

<p>It inhibits the activity of proteases, primarily elastase, which are involved in the breakdown of lung tissue. (D)</p> Signup and view all the answers

Which of the following genetic factors significantly increases the risk of developing emphysema?

<p>Homozygosity for the Z allele of the proteinase inhibitor (Pi) locus, leading to reduced a1-antitrypsin levels. (C)</p> Signup and view all the answers

How does environmental irritant exposure contribute to the development of chronic obstructive pulmonary disease (COPD)?

<p>It triggers a cascade of inflammatory events, including the release of proteases, contributing to lung tissue destruction. (A)</p> Signup and view all the answers

Based on the information provided, which of the following is NOT a major contributing factor to the development of emphysema?

<p>The overproduction of surfactant. (B)</p> Signup and view all the answers

What is the primary mechanism by which the loss of elastic tissue in the alveoli contributes to airway obstruction in emphysema?

<p>It reduces the recoil of the lung parenchyma, leading to decreased radial traction on the small airways. (A)</p> Signup and view all the answers

The statement "About 1% of patients with emphysema have this defect" refers to which defect?

<p>An inherited deficiency of the antiprotease a1-antitrypsin. (B)</p> Signup and view all the answers

Which of the following is NOT a direct consequence of environmental irritant exposure on the airways, according to the provided information?

<p>Destruction of alveolar septa. (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic feature that distinguishes CWP from silica and asbestos exposures?

<p>Presence of coal macules and nodules (D)</p> Signup and view all the answers

Which of the following is the most common crystalline form of silica implicated in silicosis?

<p>Quartz (C)</p> Signup and view all the answers

What is the primary effect of silica particles on alveolar macrophages, leading to the development of silicosis?

<p>Cause lysosomal damage, leading to activation of the inflammasome (B)</p> Signup and view all the answers

Which of the following is NOT a reason why workers involved in sandblasting and hard-rock mining are at a particularly high risk for silicosis?

<p>These occupations involve high-intensity physical exertion, increasing the risk of silica inhalation (A)</p> Signup and view all the answers

Which of the following statements is accurate regarding the difference between Simple CWP and Complicated CWP?

<p>Simple CWP is characterized by coal macules and nodules, while Complicated CWP is characterized by large, dense scars (D)</p> Signup and view all the answers

What is the significance of pulmonary anthracosis being commonly seen in individuals who smoke tobacco?

<p>It highlights the difficulty in distinguishing between CWP and the effects of tobacco smoke (B)</p> Signup and view all the answers

Which of the following is NOT a characteristic of Complicated CWP (PMF)?

<p>Can be caused by prolonged exposure to asbestos fibers (D)</p> Signup and view all the answers

What is the main difference between the pathogenesis of silicosis and CWP?

<p>Silicosis is caused by the inhalation of crystalline silica, while CWP is caused by the inhalation of carbon pigment (D)</p> Signup and view all the answers

Flashcards

ARDS

Acute Respiratory Distress Syndrome caused by injury to the alveolar-capillary membrane.

Atelectasis

Loss of lung volume due to inadequate expansion of air spaces.

Inflammatory mediators

Substances like IL-1 and TNF that initiate inflammatory reactions in ARDS.

Neutrophils

White blood cells that are activated and sequestered during ARDS pathogenesis.

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Ventilation-perfusion imbalance

A condition where ventilated areas of the lung are not matched by perfusion, leading to hypoxemia.

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COPD

Chronic Obstructive Pulmonary Disease, a preventable disease causing persistent respiratory symptoms and airflow limitation.

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Emphysema

A type of COPD characterized by permanent enlargement of air spaces in the lungs and destruction of wall structures.

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Risk factors for COPD

Key factors include smoking, poor lung development, environmental pollutants, and genetic factors.

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Symptoms of COPD

Includes chronic cough, difficulty breathing, and susceptibility to respiratory infections.

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Chronic Bronchitis

Another form of COPD, characterized by inflammation of the bronchi leading to coughing and mucus production.

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Airflow limitation

Reduced air movement during inhalation and exhalation, often due to airway abnormalities in COPD.

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Panacinar emphysema

A type of emphysema where the destruction of alveolar walls affects all areas of the acinus.

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Prevalence of COPD

Affects more than 10% of U.S. adults over 40; increasing due to factors like smoking.

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Reactive Oxygen Species

Molecules that can cause tissue damage and inflammation during immune responses.

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a1-antitrypsin

A major antiprotease that inhibits neutrophil proteases, particularly elastase, to prevent tissue damage.

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Protease

Enzymes that break down proteins, can damage lung tissue during inflammation.

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Chronic Obstructive Pulmonary Disease (COPD)

A progressive disease that causes airflow blockage and breathing-related problems, including emphysema and chronic bronchitis.

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Mucous Gland Hypertrophy

Increase in the size of mucous glands in the airways, often due to environmental irritants.

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Dyspnea

Shortness of breath, usually the first symptom of COPD, starts slowly and progresses over time.

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Goblet cells

Cells that secrete mucus in the airway to trap particles.

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Airway inflammation

Swelling and irritation of the airway due to immune response.

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Eosinophils

White blood cells involved in allergic reactions and asthma.

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Basement membrane thickening

Increased thickness of the membrane under airway epithelial cells, common in asthma.

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Smooth muscle hyperplasia

Increased number of smooth muscle cells around the airway in asthma.

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Th2 cells

A subtype of T-helper cells that release cytokines in asthma response.

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Mucus hyperproduction

Excessive mucus production in the airway due to asthma.

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IgE antibody

Immunoglobulin E produced in response to allergens, promoting allergic reactions.

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Vagal afferent nerve

Nerve that signals response to inhaled irritants, triggering bronchoconstriction.

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Bronchoconstriction

Narrowing of the bronchial tubes during asthma attacks, hindering airflow.

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Coal Workers' Pneumoconiosis (CWP)

A lung disease from coal dust exposure, characterized by two forms: simple and complicated.

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Pulmonary Anthracosis

A coal-induced lung lesion, considered the least harmful among coal miners, and seen in urban smokers.

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Silicosis

A chronic lung disease caused by inhalation of crystalline silica, prevalent in sandblasting and mining workers.

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Coal Macules

Small lesions in simple CWP that consist of dust-laden macrophages and collagen fibers.

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Complicated CWP (PMF)

An advanced stage of CWP marked by large, dark scars due to coalescence of coal nodules.

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Crystalline Silica

A toxic form of silica responsible for the fibrogenic effects in silicosis, including quartz and cristobalite.

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Lesions in Silicosis

Silica particles are ingested by macrophages, causing inflammation and lung damage.

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Centrilobular Emphysema

A condition that may develop in silicosis where air spaces enlarge in the center of lobules due to inhalation damage.

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Desquamative Interstitial Pneumonia

A lung condition characterized by dilated bronchi filled with purulent mucus.

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Respiratory Bronchiolitis

A lung condition featuring bronchi that are dilated and filled with mucus extending to pleural regions.

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Reduced lung compliance

Stiff lungs that require increased effort to breathe, leading to dyspnea.

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Honeycomb Fibrosis

Advanced lung scarring resulting in collapsed alveolar walls and cystic spaces.

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Idiopathic Pulmonary Fibrosis

A chronic lung disorder causing progressive scarring and dyspnea with nonproductive cough.

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Progressive Dyspnea

A gradual increase in trouble breathing, characteristic of lung disorders.

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Pulmonary Hypertension

Increased blood pressure in the pulmonary arteries, often related to lung disease.

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Dry Crackles

A characteristic sound heard during inspiration of patients with lung disorders.

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