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35 Cards in this Set
- Front
- Back
obstructive lung dz details
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-dec airflow from inc resistance
-secondary to obstruction of airway -anatomic narrowing of airway -dec elastic recoil |
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PFT in obstructive lung dz
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-dec FEV1
-nL of inc TLC -dec FEV1/FVC ratio and TLC not dec |
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what is emphysema
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permanent enlargement of airspaces with destrution of airspace walls
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panacinar emphysema clinical features
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distal acinus (resp bronchioles to terminal alveoli)
-wrose in lower lobes -can cause clinical airflow obstruction -alpha 1 - antitrypsin deficiency |
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centriacinar emphysema clinical features
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-involves central/proximal acini (resp bronchioles) (spares distal alveoli)
-worse in UPPER lobes -can cuase clinical airflow obstruction -smokingdistal acinar |
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distal acinar emphysema clinical features
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-involves distal airspaces (along pleura, along CT septa)
-worse in upper lobes -no clinical airway obstruction -spont pneumo in adults ?? |
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emphysema pathogenesis
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excess protease and/or elastase production unopposed by antiprotease regulation
-neutros release elastase, which destroys elastic tissue -if antiprotease is insufficient, tissue destruction does unchecked |
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smoking and emphysema
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-inc neutrophils/macs in alveoli
-elastase release from neutros -inc elastase actibity in macs (not inhibited by alpha-PI) -oxidants and free radicals in smoke and free radicals from neutros inhibit alpha-PI |
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nL alpha PI phenotype
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PiMM
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most common alpha PI phenotype in alpha AT deficiency
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PiZZ
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clinical features of emphysema
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-no sx until loss of 1/2 functioning parenchyma
-dyspnea -weight loss -obstructive pattern on PFTs -pink puffer/ blue bloater -death (pulm failure, resp acidosis, hypoxia, coma, cor pulmonale, pneumo |
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weird usage of emphysema
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-compensatory
-mediastinal/interstitial/subQ -obstructive overinflation |
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what is chronic bronchitis
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persistent, productive cough for at least 3 consecutive months in at least 2 consecutive years
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types of chronic bronchitis
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simple
chronic asthmatic obstructive chronic |
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pathogenesis of chronic bronchitis
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-cig smoking + air pollutants inhaled (mucous gland hypersecretionhypertrophy + goblet cell metaplasia)
-inflammation + fibrosis -> obstruction -frequent co-existent emphysema -complicated by microbial infection |
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gross morphology of chronic bronchitis
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-large airway edema + hyperemia
-mucosa (large and small airways) covered by mucinous/mucopurulent secretion |
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micro morphology of chronic bronchitis
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-mucous gland hyperplasia (+ goblet cell hyperplasia +/- loss of cilia
-inflamm infiltrate -chronic bronchiolitis (small airway dz) |
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clinical presentation of chronic bronchitis
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-persistent productive cough
-inc CO2, dec O2, cyanosis -recurrent infections -heart failure (cor pulmonale) |
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what is asthma
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episodic, reversible bronchospasm due to exaggerated broncoconstrictor response
-chronic inflamm dz of airways |
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extrinsic asthma information
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-type 1 hypersensitivity to extrinsic Ag
-atopic -occupational -allergic bronchopulmonary aspergillosis |
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instrinsic style of asthma
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non-immune trigger
-aspirin -infection -cold -psych stimuli -stress -exercise -inhaled irritants |
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sensitization in atopic asthma
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-inhaled Ag by dendritic cell to TH2 cell
-TH2 secretes IL4 -> Bcell IgE production -IL3, IL5, GM-CSF -> eosinophil recruitment -IgE binds to Fc receptor on mast cell |
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atopic asthma early phase
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-Ag crosslinks on surface mast cells
-surface mast cells secrete mediators - > open epithelial tight junctions -Ag penetrates epithelium to cross-link IgE on deep mast cells |
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deep mast cells secretion of mediators results in
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-inc vascular perm
-inc mucus production -bronchospasm -recruit more cells |
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late phase of asthma
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-more mediator release from leukos, endos, epis
-accumulating eosinophil release: amplifying/sustaining inflamm response without additional Ag exposure |
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intrinsic asthma triggers also affect
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extrinsic astham sufferers
nL people -nonimmune mediated bronchospasm, mucus secretion, and edema |
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morphology of asthma
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-thicker
-more inflamm cells -hyperplasia of smooth m -more glands |
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status asthmaticus
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prolonged attack, refractory to Tx
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charcot-leyden
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any complication with excess eosinophils
-asthma |
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curschmann's spirals
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injury to epi, slough off and in mucous
asthma |
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bronchiectasis
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permanent dilatation of bronchi and bronchioles due to destruction of muscle and supporting elastic tissue
not primary dz dx based on hx and CXR |
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forms of dilatation seen in bronchiectasis
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cylindrical
fusiform (spindle shaped) saccular |
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predisposing conditions to bronchiectasis
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bronchial obstruction: tumor, foreign body, mucus impaction
necrotizing or suppurative pneumonia congenital or hereditary condition: CF, immunodef, primary ciliary dyskinesia |
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morphology of bronchiectasis
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gorsS:
bronchial dilatation lower lobes micro: -acute and chronic inflamm with exudate -epithelial ulceration -abscess formation |
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clinical features of bronchiestasis
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-severe, persistant cough with mucopurulent sputum +/- blood
-frank hemoptysis -clubbing of fingers -obstructive sequelae( dec O2, PHTN, cor pulm) -mets brain abscess -reactive amyloidosis |