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96 Cards in this Set
- Front
- Back
What are the three classifications of respiratory diseases? |
(1)Acute vs. chronic, (2)Obstructive vs. restrictive, (3)Infectious vs. non-infectious |
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What are 10 pulmonary s/sx of respiratory diseases. |
(1)Hypoxemia, (2)Atelectasis, (3)Chest pain, (4)Clubbing, (5)Cough, (6)Cyanosis, (7)Dyspnea, (8)Hemothorax, (9)Pneumothorax, (10)Pyothorax |
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Describe hypoxemia. |
Deficient oxygenation of arterial blood. Most common condition caused by lung dz or injury. Not to be confused with hypoxia – diminished oxygen to various body tissues |
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Describe atelectasis. |
Collapsed or airless condition of lung. |
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Describe chest pain. |
Usually localized substernal or across the chest, over involved lungs. Can radiate tp neck, scaps, shoulders, down medial aspect of the arm. May be caused by parietal pleural irritation, made worse with respiration (particularly Inspiration). Better lying on the affected side = autosplinting |
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Describe clubbing. |
Enlarged terminal phalanx of the fingers and toes – loss of the normal angle between the nail and the nail bed. Chronically decreased tissue perfusion (lung CA, CF, bronchiectasis, pulm fibrosis). [Not always respiratory dz - can also be heart dz, PVD, and liver or GI disorders] |
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Describe cough. |
Different cough characteristics can help with dx. Persistent, dry: tumour, congestion, hypersensitivities/allergies, drug side effects. Productive & purulent: infection (viral/bacterial). Productive & non-purulent: irritation. Hemoptysis (coughing up blood): infection, inflammation, abscess, tumour, infarction, trauma |
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Describe cyanosis. |
Bluish colour of skin or mucous membranes in response to low oxygenation saturation of arterial blood, and total amount of circulating hemoglobin. Central -- lips, oral mucous membranes, conjunctivae (R--L shunts, pulm dz). Peripheral -- nail beds, fingers, toes and nose (cold external temperature, anxiety, heart failure, shock). |
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Describe dyspnea. |
Difficult breathing or shortness of breath (SOB). Inadequate ventilation or perfusion. Orthopnea = dyspnea when lying down (dt abdominal pressure, edema). Usually indicates hypoxemia. |
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Describe hemothorax. |
Presence of blood in the plural cavity. eg. TB, pneumonia |
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Describe pneumothorax. |
Presence of air or gas in the pleural cavity |
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Describe pyothorax. |
Accumulation of pus in the thoracic cavity (form of empyema) |
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What are seven altered breathing patterns and sounds? |
(1)Apnea, (2)Hyperventilation, (3)Hypoventilation, (4)Rales, (5)Rubs, (6)Wheezing, (7)Stridor |
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Describe apnea. |
Cessation of breathing. “Apneustic” breathing: episodes of short, shallow expiration, with gasping & prolonged inspiration |
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Describe hyperventilation. |
Abnormally prolonged and deep breathing |
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Describe hypoventilation. |
Reduced ventilation of alveoli -- increased in arterial CO2 |
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Describe rales. |
Crackling sounds usually heard on inspiration (rice krispies) (pneumonia) |
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Describe rubs. |
Grating, tearing or rubbing sound (velcro) (inflammation) |
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Describe wheezing. |
(Rhonchi): breathing w/ a rasp or whistling sound. Constriction or obstruction of throat, pharynx, trachea or bronchi. |
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Describe stridor. |
Shrill, harsh sound heard during inspiration. Generally indicates laryngeal obstruction |
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What are two types of infectious & inflammatory disease of the respiratory system? |
(1)Upper Respiratory Tract (URT), (2)Lower Respiratory Tract (LRT) |
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What are three Upper Respiratory Tract (URT) infections? |
(1)Rhinitis, (2)Sinusitis, (3)Laryngitis |
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What is the etiology of upper respiratory tract infection? |
virus, bacteria, fungus, irritant |
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What are 11 clinical manifestations of upper respiratory tract infections? |
(1)Inflammation, (2)enlarged lymph nodes, (3)loss of voice, (4)sneezing, (5)cough, (6)sore throat, (7)general malaise, (8)fever, (9)chills, (10)lethargy, (11)anorexia |
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Describe acute rhinitis. |
Common cold – MC of all illnesses – viral (esp adeno viruses). Symptoms: runny nose, sneezing, nasal congestion, mild sore throat. Other causes: allergic rhinitis (eg. cats), bacterial infection |
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Describe sinusitis. |
Inflammation of paranasal sinuses. Often due to pre-existing nasal or dental infections. Can be viral, bacterial or fungal. Sx’s mostly from obstructed drainage + systemic. |
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What are three symptoms of sinusitis? |
(1)Sinus headaches/pain, (2)Congestion, (3)Systemic symptoms (fever, malaise etc.) |
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Describe laryngitis. |
Acute inflammation of larynx. Bacteria, viruses, irritants, overuse. Symptoms: Loss of voice/hoarseness, sore/dry throat, cough. |
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What are four lower respiratory tract infections? |
(1)Pneumonia, (2)Pulmonary Tuberculosis, (3)Lung Abscess, (4)Acute Bronchitis |
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What is pneumonia? |
inflammation of lung parenchyma (lobar, bronchopneumonia) |
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What is the etiology of pneumonia? |
Pathogens: virus 50% (often influenza), bacteria 30%, mycobacteria 20%, Pneumoncystis carinii p. opportunistic parasite common w AIDS. Less commonly: inhaled toxins, chemicals, smoke, dust, gas, aspirated food, fluid or vomitus. |
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What is the pathogenesis of pneumonia? |
First and second lines of defense can’t overcome microorganism -- inflammation and infection result. Viral: generally mild and self-limiting. ("walking pneumonia" Bacterial: can be secondary to viral, usually lower lobes, longer to resolve |
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What are eight clinical manifestations of pneumonia? |
(1)sudden and sharp pleuritic pain, (2)purulent / smelly productive hacking cough, (3)dyspnea or tachypnea (rapid respirations), (4)tachycardia (5)fever, (6)chills, (7)maybe hemoptysis, (8)[recall: elderly may not have fever, May have altered mental status or loss of balance] |
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What is pulmonary tuberculosis? |
aka consumption – chronic infection by Mycobacterium tuberculosis. Infectious, inflammatory systemic disease (lungs, lymph nodes, bone, kidneys, skin). Granulomas + caseous necrosis -- abscess. World’s highest infectious mortality |
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What the two types of TB? |
(1)Latent, (2)Active |
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What is latent TB? |
Harbouring the mycobacterium, but no signs/symptoms |
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What is active TB? |
Clinical s/sx’s and lab findings |
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What are eight risk factors for TB? |
(1)HIV, (2)age, (3)overcrowding, (4)drug use, (5)alcohol, (6)infants, (7)immunocompromise, (8)DM |
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What is etiology of TB? |
Primary: inhalation of tubercle bacillus –prolonged and/or repetitive exposure(Mycobacterium tuberculosis) – usually latent, can be dormant for decades. Secondary: usually endogenous activation as a result of debility or lowered immune function; occas. exogenous reinfection |
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What are 8 clinical manifestations of TB? |
(1)No Sx’s for >1 year, then productive cough for >3 weeks (poss blood-streaked), (2)rales, (3)weight loss, (4)fever, (5)night sweats, (6)fatigue, (7)malaise, (8)anorexia |
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How is TB treated? |
Anti-TB drugs for 6-9 months (non-compliance probs -- must restart if missed 2 weeks) – often a combo of 2 or more drugs. |
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What is the pathogenesis of TB? |
Initial infection -- epithelial cells encapsulate the bacilli -- forms a tubercle. 2-10 weeks later: cell-mediated immunity kicks in -- activated T-cells lead to granulomas which limit further multiplication. Organism usually at localized sites. |
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What is the pathogenesis latent and cell-mediated TB? |
While latent, no clinical symptoms, no detection on x- ray -- only a ✚ skin test -- not contagious. Cell-mediated immunity not successful… granulomas become necrotic -- produce fibrosis and calcification |
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What is a lung abscess? |
Localized accumulation of purulent exudate within the lungs. Usually subsequent to pneumonia (esp. Staph) when organisms are aspirated from the oropharynx. Also from aspirated foreign material; alcohol is the most common cause - vomitus |
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What is the etiology of a lung abscess? |
pyogenic bacteria (eg Staph pnemonia) |
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What is pathogenesis of a lung abscess? |
A natural defense mechanism leads to consolidation: fluid, pus, and microorganisms fill the alveoli -- necrosis of consolidated tissue may spread to bronchi. Then spreads to other parts of the lung to form cavities. |
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What are eight clinical manifestations of a lung abscess? |
(1)cough (productive w/ foul smelling sputum), (2)dyspnea, (3)pleuritic chest pain, (4)cyanosis, (5)clubbing, (6)fever, (7)chills, (8)malaise |
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How is a lung abscess treated? |
Antibiotics, Airway clearance – ie. percussion |
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What is acute bronchitis? |
Inflammation of the trachea and bronchi. 1-3 weeks, self-limiting, few pulmonary signs |
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What are the risk factors and etiology of acute bronchitis? |
Second to viral infection or other irritant (smoke, fumes, etc.) |
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What are three clinical manifestations of acute bronchitis? |
(1)cough, initially dry and irritating, later productive/purulent (if bacterial), (2)sore throat, (3)usually chest pain from coughing |
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What is chronic obstructive pulmonary diseases (COPD)? |
A group of airflow obstruction disorders: Chronic bronchitis; Obstructive bronchiolitis; Emphysema. Airflow not fully reversible (Especially small airways. Major cause of disability. Most common cause is smoking. |
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What are the two most common conditions that contribute to COPD? |
(1)Emphysema, (2)Chronic bronchitis |
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What is the etiology of COPD? |
Smoking |
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What is chronic bronchitis? |
Chronic productive cough lasting > 3 months/year for 2 consecutive years. Starts in large bronchi…progresses to bronchioles –all airways eventually obstructed, worse with expiration. Expiration often triggers a cough |
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What are five clinical manifestations of chronic bronchitis? |
(1)persistent cough, (2)sputum, (3)dyspnea, (4)prolonged expiration, (4)recurrent infections (because of impaired ciliary function), (5)cyanosis (“blue bloaters”) |
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What is the pathogenesis of chronic bronchitis? |
Inflammation and scarring of the bronchial lining -- obstructs air flow -- increased mucous production -- hyper secretion in response to triggers + hypertrophy of mucous-producing cells in bronchi -- hypoxemia -- increased RBC production (polycythemia) -- cyanosis, as well as peripheral edema from subsequent ventricular failure (hence blue bloater) |
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What are two possible outcomes of chronic bronchitis? |
(1)Pulmonary HTN over time, (2)Possibly Cor Pulmonale |
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What is emphysema? |
Pathological accumulation of air in tissue – particularly the lungs. Found in most people with COPD. |
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What are the three types of emphysema? |
(1)Centrilobular, (2)Panlobular, (3)Paraseptal |
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What is centrilobular emphysema? |
Most Common, destruction of bronchioles, usually upper lung, alveoli intact |
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What is panlobular emphysema? |
Destroys air spaces of whole acinus, usually lower lung |
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What is paraseptal emphysema? |
Destroys alveoli in lower lungs |
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What are the risk factors and etiology for emphysema? |
smoking, hereditary, prolonged respiratory difficulty (i.e. long-term bronchitis) |
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What is the pathogenesis of emphysema? |
Irreversible destruction of elastin in lungs, which maintains alveolar wall strength -- permanent enlargement of acini -- narrowing/collapse of bronchioles traps air in lungs -- obstruction (from change in tissue, not b/c of mucous) and increased effort to exhale |
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What are six clinical manifestations of emphysema? |
(1)thin (cachexia), (2)Tachypnea, prolonged expiration, (3)increased respiratory effort -- use of secondary respiratory muscles (barrel chested -- “pink puffer”), (4)depression/anxiety, (5)calloused elbows, (6)cough is uncommon |
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What are six possible outcomes of emphysema? |
(1)chronic bronchitis, (2)pneumonia, (3)CHF, (4)pulmonary embolism, (5)cardiac complications, (6)CorPulmonale |
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What is asthma? |
Reversible, obstructive lung disorder with inflammation, and increased smooth muscle reaction to various triggers. Chronic with acute exacerbations. |
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What is the etiology of asthma? |
Often genetic (atopic and non-atopic). Also multifactorial: biochemical; autonomic; immunologic; infectious; endocrine factors; psychological (stress, extreme emotions). |
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What are the two main categories of asthma? |
(1)Extrinsic, (2)Intrinsic |
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Describe extrinsic asthma. |
Allergic/Atopic (IgE). Histamine-mediated (Molds (Aspergillus), Any allergen, Aspirin (or other NSAIDS)).Inorganic chemicals (i.e.coal dust) |
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Describe intrinsic asthma. |
Non-allergic. Usually adult-onset. Cold air. Exercise. Obesity. |
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What are risk factors for asthma? |
Young children, premature babies, C-section babies, and overuse of antibiotics in children under 5, industrialized settings (chemical exposure), cold air, overcrowded living conditions, Airtight homes, especially with forced air or gas heat, smoking, dust, mold, pet hair, other allergens, Wine (sulfites and salicylates), Obesity, “hygiene hypothesis": Lack of exposure to allergen triggers, and/or overexposure to cleaning products (chemical trigger) |
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What is the pathogenesis of asthma? |
Inflammatory response -- inflammatory mediators -- bronchial smooth muscle spasm -- vascular congestion -- increased vascular permeability -- edema -- thick mucous production -- impaired mucociliary function. Also likely involvement of neuroendrocrine system, because of the high prevalence of stress-induced asthma attacks. |
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What are nine clinical manifestations of asthma? |
(1)sensation of chest constriction, (2)wheezing on inspiration and expiration, (3)non-productive cough at first, Then thick tenacious sputum, (4)tachycardia, (5)tachypnea, (6)dyspnea, (7)cyanosis, (8)pale/moist skin, (9)flaring nostrils |
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What is bronchiectasis? |
A progressive form of obstructive lung disease, with irreversible destruction and dilation of the airways. Usually assoc’d with chronic bacterial infections that result in chronic inflammation, which causes tissue changes. Considered to be an extreme form of bronchitis. |
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What is the pathogenesis of bronchiectasis? |
All airways, esp. the small airways – chronic inflammation of the airway walls by mononuclear cells -- result in mucous secretions -- obstruction |
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What is the etiology of bronchiectasis? |
Any condition producing a narrowing of the lumen of the bronchioles. |
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What are 10 clinical manifestations of bronchiectasis? |
(1)persistent cough with copious purulent sputum worse in the morning, (2)rhinosinusitis, (3)dyspnea, (4)fatigue, (5)hemoptysis, (6)low grade fever, (7)clubbing, (8)weight loss, (9)weakness, (10)foul breath |
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What is bronchiolitis? |
‘small airways disease’. Common in young kids (under 2) as a result of a viralURTI. |
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What are four clinical manifestations of bronchiolitis? |
(1)stuff nose and congestion, (2)runny nose, (3)cough, (4)fever. These symptoms last a day or two and are followed by worsening of the cough and wheezing (high-pitched whistling noises when exhaling) |
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What are two clinical manifestations of sleep apnea? |
(1)Significant daytime symptoms (most common is intense fatigue no matter how many hours of sleep), (2)Upper airway obstruction while sleeping |
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What is the etiology/risks of sleep apnea? |
Usually a history of snoring, obesity, < alchohol intake |
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What is the pathogenesis of sleep apnea? |
Partial of complete pharyngeal collapse
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What is restrictive lung disease? |
Any condition that limits lung expansion |
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Pulmonary fxn tests show _________ . |
DECREASE IN TOTAL LUNG CAPACITY
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What are two causes of restrictive lung disease? |
(1)>100 interstitial pulmonary dz’s, (2)extrapulmonary: a)motor nerve pathology (spinal cord injury, ALS, MD, myasthenia gravis, polio), b)musculoskeletal (ankylosing spondylitis, kyphosis, scoliosis, obesity, chest wall injury/deformity), c)Postsurgery complications |
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What are three clinical manifestations of restrictive lung disease? |
(1)Specific CM’s depend on etiology, (2)Rapid (tachypnea), shallow breathing, (3)Exertional dyspnea, then chronic dyspnea with disease progression |
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What is pulmonary fibrosis? |
aka interstitial lung dz. Collective term – any dz where ongoing epithelial damage or chronic inflammation of lung tissue leads to progressive scarring = fibrosis. |
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What is the etiology/risk factors of pulmonary fibrosis? |
(1) idiopathic (most), (2)Second. to TB, systemic sclerosis, adult respiratory distress syndrome, pneumoconiosis, SLE, inhalation of harmful particulates |
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What is the pathogenesis of pulmonary fibrosis? |
replacement of healthy lung tissue with progressive scarring: via fibroblast + blood vessel proliferation in response to chronic inflammation/irritation -- fibrosis + hypoxia |
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What is systemic sclerosis? |
Scleroderma– autoimmune connective tissue dz -- XS collagen deposition in skin and organs (esp esophagus, lungs and kidney); skin changes occur before visceral. |
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What are the risk factors and etiology of systemic sclerosis? |
women of child bearing age; idiopathic (poss mycoplasma or CMV assoc) |
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What is the pathogenesis of systemic sclerosis? |
(1)T-cells and cytokines cause inflammation –alveolitis and fibrois, (2)Severe thickening & obstruction of vessels -- pulm. Htn & renal failure, (3)Cutaneous fibrosis |
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What is the clinical manifestation of systemic sclerosis? |
C - calcinosis around cuticles R - Raynaud’s disease E - esophageal dysfunction S - sclerodactyly T - telangectasia |
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What is the outcome of systemic sclerosis? |
variable course, but ↑ pulm fibrosis --cor pulmonale. Lung disease is the most common cause of death in SS. |