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53 Cards in this Set

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Alveolar-Arterial O2 Difference
**Normal alveolar-arterial O2 difference:

[(A-a)DO2] < 10 mmHg
Obstructive Lung Disease = COPD
**Obstruction of air flow resulting in air trapping in the lungs
PFT's will show:
=DECREASED FEV1/FVC ratio

**HALLMARK**
Types of Obstructive Lung Disease:
1) Chronic Bronchitis
2) Emphysema
3) Asthma
4) Bronchiectasis
Chronic Bronchitis
**"Blue Bloater"**

=productive cough for >3 consecutive months in 2 or more years

**Hypertrophy of mucus-secreting glands in the bronchioles
=Reid index >50%
What is the leading cause of chronic bronchitis?
SMOKING
Findings:
=wheezing
=crackles
=cyanosis
Emphysema
**"Pink Puffer"**

**Enlargement of air spaces and DECREASED recoil resulting from destruction of alveolar walls
Causes:
**Smoking
=centriacinar emphysema

**alpha1-antitrypsin deficiency
=panacinar emphysema and liver cirrosis

**Both lead to an INCREASE in elastase activity
Findings:
1) Dyspnea
2) Decreased breath sounds
3) Tachycardia
4) Decreased I/E ratio
Asthma
**Bronchial hyperresponsiveness causes REVERSIBLE bronchoconstriction.
Triggers?
=viral URIs
=allergens
=stress
Findings:
=cough and wheezing
=dyspnea
=tachypnea
=hypoxemia
=decreased I/E ratio
=pulsus paradoxus
Histological Findings?
=Curschmann's spirals
=SM hypertrophy
=mucous plugging
Bronchiectasis
**Chronic necrotizing infection of bronchi --> leads to:

=dilated airways
=purulent sputum
=reccurent infections
=hemoptysis
Associated with?
1) Bronchial obstruction
2) CF
3) Poor ciliary motility
4) Kartagener's Syndrome
Restrictive Lung Disease
**Restricted lung expansion causes DECREASED lung volumes
=decreased VC and TLC
PFT's:
=FEV1/FVC ratio > 80%
Types:
1) Poor Breathing Mechanics
=EXTRApulmonary
2) Interstial Lung Diseases
=PULMONARY
Poor Breathing Mechanics = EXTRApulmonary
1) Poor muscular effort
=polio, MG

2) Poor structural apparatus
=scoliosis
=morbid obesity
Interstitial Lung Diseases = PULMONARY
1) Adult respiratory distress syndrome (ARDS)
2) Neonatal respiratory distress syndrome
=i.e. hyaline membrane disease
3) Pneumonconioses
=coal miner's silicosis
=asbestosis
4) Sarcoidosis
Continued
5) Idiopathic pulmonary fibrosis
6) Goodpasture's syndrome
7) Wegener's granulomatosis
8) Eosinophilic granuloma
Comparing Obstructive vs. Restrictive Lung Disease
**Obstructive lung volumes are > normal
=increased TLC, FRC, RV

**Restrictive lung volumes < normal

**In BOTH obstructive and restrictive, FEV1 and FVC are reduced, but in OBSTRUCTIVE, FEV1 is more dramatically reduced, resulting in a DECREASED FEV1/FVC ratio
What is Kartagener's Syndrome?
**Immotile cilia due to a dynein arm defect

**Associated w/ sinus inversus
Results in:
1) Male and female infertility
=sperm immotile
2) Bronchiectasis
3) Recurrent sinusitis
=bacteria and particles not pushed out
Asbestosis
**Diffuse pulmonary interstitial fibrosis caused by inhaled asbestos fibers
What does this increase your risk of?
**Pleural MESOTHELIOMA and bronchogenic carcinoma

**Asbestosis and smoking GREATLY increase your risk of bronchogenic cancer
=smoking NOT additive w/ mesothelioma
Who do we see these in?
**Shipbuilders and plumbers

**LONG LATENCY
What do we seen in the lung?
**Ferruginous bodies in the lung
=asbestos fibers coated w/ hemosiderin

**Ivory-white pleural plaques

COLOR IMAGE 42
Neonatal Respiratory Distress Syndrome
**Surfactant deficiency leading to INCREASED surface tension --> resulting in alveolar collapse
More about surfactant:
**Made by type II pneumocytes--in the greatest volume after the 35th week of gestation

**Surfactant = dipalmitoyl phosphatidylcholine
What is the lecithin-to-sphingomyelin ratio?
**The ratio in amniotic fluid can be used as a measure of fetal lung maturity

=it is usually <1.5 in neonatal respiratory distress syndrome
Treatment:
**Maternal steroids before birth

**Artifical surfactant for the infant
Lung Cancer
**LEADING CAUSE OF CANCER DEATH!

1) Bronchogenic Carcinoma
2) Carcinoid Tumor
3) Metastases
Bronchogenic Carcinoma
1) Tumors that arise CENTRALLY:
=Squamous Cell Carcinoma
=Small Cell Carcinoma

2) Tumors that arise PERIPHERALLY:
=Adenocarcinoma
=Bronchioalveolar carcinoma
=Large cell carcinoma
Squamous Cell Carcinoma
**Clear link to SMOKING

=ectopic PTH-related peptide production

COLOR IMAGE 36, Image 118
Small Cell Carcinoma
**Clear link to SMOKING

=associated with ectopic hormone production--ADH, ACTH

**May lead to Lambert-Eaton Syndrome

COLOR IMAGE 37
Adenocarcinoma
MOST common
Bronchioalveolar Carcinoma
Probably NOT related to smoking
Large cell carcinoma
UNDIFFERENTIATED
How does lung cancer typically present?
=Cough
=Hemoptysis
=Bronchial obstruction
=Wheezing
=Pneumonic "coin" lesion on X-ray
Carcinoid Tumor
**Can cause Carcinoid Syndrome
=flushing
=diarrhea
=wheezing
=salivation
Lung cancer has a SPHERE of complications:
**SPHERE**
=Superior vena cava syndrome
=Pancoast's tumor
=Horner's syndrome
=Endocrine (paraneoplastic)
=Reccurent laryngeal symptoms (hoarseness)
=Effusions (pleural or pericardial)
Metastases
VERY COMMON

1) Brain
=epilepsy
2) Bone
=Pathologic fracture
3) Liver
=Jaundice, hepatomeagaly
Pancoast's Tumor
**Carcinoma that occurs in the APEX of the lung --> may thus affect the cervial sympathetic plexus --> causing HORNER'S SYNDROME
Recall the symptoms of Horner's Syndrome:
1) Ptosis
2) Miosis
3) Anhidrosis
Pneumonia
1) Lobar
2) Bronchopneumonia
3) Interstitial (=atypical) pneumonia
Lobar Pneumonia--Organism?
Pneumococcus
Features:
**Intra-alveolar exudate --> consolidation

**May involve the entire lung
Bronchopneumonia--organisms?
**S. aureus
**H. flu
**Klebsiella
**S. pyogenes
Features:
**Acute inflammatory infiltrates from bronchioles into adjacent alveoli

**Pathy distribution involving 1 or more lobes

IMAGE 116
Interstitial (=atypical) Pneumonia--Organisms?
**Viruses
=RSV
=Adenoviruses

**Mycoplasma

**Legionella

**Chlamydia
Features:
**Diffuse patchy inflammation localized to interstitial areas at alveolar walls

**Distribution involving 1 or more lobes

**Image 119