Zaman 9-25-07

Front 1

COPD conditions

Back 1

bronchiolitis (small airways disease),
chronic bronchitis, pulmonary emphysema, chronic asthma
and bronchiectasis.

Front 2

COPD is said to affect ___% of the adult
population.

Back 2

10

Front 3

COPD patients tend to trap air, retain C02 and develop respiratory ______.

Back 3

acidosis

Front 4

The two most common forms of COPD are _________

Back 4

chronic bronchitis and
emphysema.

Front 5

Bronchi
bronchioles
Respiratory bronchioles
Alveolar ducts
Alveoli

Which are in the respiratory zone?

Back 5

Alveolar ducts
Alveoli

Front 6

Bronchi
bronchioles
Respiratory bronchioles
Alveolar ducts
Alveoli

Which are in the transition zone?

Back 6

Respiratory bronchioles

Front 7

Bronchi
bronchioles
Respiratory bronchioles
Alveolar ducts
Alveoli

Which are in the conduction zone?

Back 7

Bronchi
bronchioles

Front 8

What's this?

-abnormal enlargement of air
spaces distal to the terminal bronchiole accompanied by
destruction of their walls

Back 8

Emphysema

Front 9

Classification of Emphysema

Back 9

Centrilobular/Centriacinar

Familial/Panlobular/Panacinar

Front 10

Centrilobular/Centriacinar-affects central portion of
acinus or lobule (area of ______ zone).

Back 10

transition

Front 11

Familial/Panlobular/Panacinar-involves all of _____

Back 11

lobule

Front 12

Centrilobular Emphysema -Is the most common
type and is strongly associated with smoking and
pollution. It is most prominent in the _____ lobes.

Back 12

upper

Front 13

Panlobular is associated with alpha-1-antitrypsin
deficiency and is most prominent in the _____ lobes.

Back 13

lower

Front 14

Familial/Panlobular Emphysema:

Associated with alpha-1-antitrypsin (an alpha-1-
globulin) deficiency.
Amount and type determined by at least 22 pairs of
codominant alleles. Normal is ______

Back 14

PiMM

Front 15

Familial/Panlobular Emphysema:

Emphysema is associated with the ____ codominant
phenotype (0.012% of pop).

Back 15

PiZZ

Front 16

Familial/Panlobular Emphysema:

PiMZ phenotype is common (3-5% of pop) and there
is controversy whether they are predisposed to ____.

Back 16

CAO

Front 17

Which is Worse in upper lobe?

SMOKERS EMPHYSEMA
FAMILIAL EMPHYSEMA

Back 17

SMOKERS EMPHYSEMA

Front 18

Which is Phenotype PiZZ?

SMOKERS EMPHYSEMA
FAMILIAL EMPHYSEMA

Back 18

FAMILIAL EMPHYSEMA

Front 19

Which is Panlobular distribution ?

SMOKERS EMPHYSEMA
FAMILIAL EMPHYSEMA

Back 19

FAMILIAL EMPHYSEMA

Front 20

Which has Increased macrophages?

SMOKERS EMPHYSEMA
FAMILIAL EMPHYSEMA

Back 20

SMOKERS EMPHYSEMA

Front 21

What's this?

-persistent cough with sputum
production for three months in two consecutive years.

Back 21

Chronic Bronchitis

Front 22

Chronic Bronchitis:
-intrabronchial mucous and plugging,
bronchial gland hypertrophy and activity, increased bronchial
smooth muscle, usually associated with ____

Back 22

emphysema

Front 23

When do you get Compensatory emphysema?

Back 23

-following removal of lung or portion of lung

Front 24

What is Senile emphysema?

Back 24

-refers to radiolucency on X-ray with age

Front 25

Septal / Bullous emphysema?

Back 25

-Septal emphysema is along the septa or
pleura. It leads to bullae formation and outpouchings along
the pleura.

Front 26

The underlying reason for airway collapse is thought
to be due to destruction of the surrounding alveolar
______ which in the normal lung exerts traction on the
periphery of the airway, holding it open.

Back 26

septa

Front 27

Serial _____ measurements can help predict which
smokers are at greatest risk for disability and premature
death

Back 27

FEVl

Front 28

With which do you see Cirrhosis/liver disease (any age)?

SMOKERS EMPHYSEMA
FAMILIAL EMPHYSEMA

Back 28

FAMILIAL EMPHYSEMA

Front 29

emphysema: clinical features

Back 29

Severe emphysema (both types)
Over expanded large lungs
Barrel chest, often hunched over
Low diaphragms
Gas trapping, C02 retention, respiratory acidosis,
hypoxia, bronchitis.
Pulmonary hypertension (possible with any chronic lung disease)
Right heart failure (cor pulmonale)

Front 30

Pink Puffers = compensated COPD - non hypoxic

Blue Bloaters = COPD with hypoxia and ___ sided failure -
tend to be seen with severe bronchitis and severe hypoxia

Back 30

right

Front 31

Respiratory bronchiolitis: lesion is found in peripheral airways less than __? mm in
diameter and not associated in its early stages with
emphysema, bronchitis, asthma or bronchiectasis.

Back 31

2

Front 32

Emphysema and its precursor, bronchiolitis, are presently thought
to be due to an imbalance in release of proteases versus levels of
______

Back 32

antiproteases

Front 33

SAD-bronchiolitis:
Clinical disease not apparent until ____ of lung destroyed.

Back 33

1/3

Front 34

severe bronchiolitis is seen in persons with ______
arthritis

Back 34

rheumatoid

Front 35

Permanent dilatation of bronchi.

Back 35

Bronchiectasis

Front 36

Bronchiectasis is more common in lower lobes. This disease
process appears to be decreasing perhaps due to the
introduction of ______.

Back 36

antibiotics

Front 37

Important causes of bronchiectasis

Back 37

Tuberculosis
b. Infection including measles and whooping cough
c. Cystic fibrosis
d. Asthma
e. Kartagener's Syndrome and other ciliary defects
f. Bronchial obstruction

Front 38

End stage of small airway disease

Back 38

emphysema

Front 39

COPD tratment:
_______ improves contractile properties of
the diaphragm and can partially relieve
diaphragmatic fatigue

Back 39

Theophylline

Front 40

Repeated episodes of vaso-_______ secondary to
hypoxemia are thought to underlie the development of fixed pulmonary hypertension and cor pulmonale.

Back 40

vasoconstriction

Front 41

It is generally recommended that patients with resting O2
arterial tensions of less than 55mm Hg as well as patients
with arterial desaturation during exercise receive ____
therapy.

Back 41

oxygen

Front 42

Disease in which filling of the lung (or total lung
capacity) is markedly decreased.

Back 42

RESTRICTIVE LUNG DISEASE

Front 43

Is there acidosis with restrictive lung disease?

Back 43

no

Front 44

RLD

Chest wall or space occupying processes

Back 44

a. Kyphoscoliosis
b. Chest Injury
c. Post Surgery
d. Paralysis
e. Obesity -Pregnancy
f. Ascites
g. Pleural effusion

Front 45

RLD:
There may be a respiratory _____ due to hyperventilation,

Back 45

alkalosis

Front 46

Adult Respiratory Distress Syndrome (ARDS) :
Clinically these patients have rapidly progressive ______

Back 46

dyspnea, hypoxemia, cyanosis, and respiratory failure.

Front 47

Adult Respiratory Distress Syndrome (ARDS) :

There is a ___% mortality, peaking at 1-2 months.

Back 47

50

Front 48

Causes of ARDS

Back 48

Hypovolemic shock, e.g., post-trauma
Septic shock, especially gram negative
Virus -e.g. Hanta virus
Pneumocystis and CMV in AIDS
Toxic gases, near drowning, high altitude (all are diffuse toxic
exposures)
Pancreatitis (systemic release of digestive enzymes)
Cardiopulmonary bypass
Some immunological disorders and other severe, diffuse
conditions (uremia, DIC, etc).

Front 49

three stages of ARDS

Back 49

exudative
proliferative
organizing

Front 50

ARDS: What stage?

There is an initial injury involving all
layers of the alveolar wall: epithelial, interstitial and
endothelial. Edema fluid collects within the interstitium
and the capillaries leak plasma proteins leading to
formation of hyaline membranes.

Back 50

exudative

Front 51

ARDS: what stage?

The type I pneumonocytes are
replaced by type II. Fibroblasts proliferate within the
edematous interstitium and fibrous tissue may be seen
within 10-15 days.

Back 51

proliferative

Front 52

ARDS: Wht stage?

More fibrous tissue is produced,
alveolar spaces enlarge, and with time may form
prominent cystic spaces (honeycomb lung).

Back 52

organizing

Front 53

Chronic Interstitial and infiltrative disorders:

Describe the lungs.

Back 53

The lungs are small, stiff and fibrotic.

Front 54

Chronic Interstitial and infiltrative disorders:

The patients exhibit reduced lung volumes, hypoxemia
and hypocapnia... what's that?

Back 54

respiratory alkalosis

as a result of
hyperventilation perhaps secondary to scarring &
involvement of the stretch receptors.

Front 55

FEV1,/ FVC in Chronic Interstitial and infiltrative disorders:

Back 55

FEV1,/
FVC is often increased.

Front 56

Chronic Interstitial and infiltrative disorders:

hypoxemia at rest in these patients is a disparity in ventilation/perfusion, with functional ______ shunting through fibrotic lung.

Back 56

right to left

Front 57

Interstitial lung disease can clearly be induced by a
what drugs?

Back 57

alkylating agents, nitrosoureas,
antimetabolites and other drugs used in cancer
therapy.

Front 58

Etiologies for chronic interstitial fibrosis

Back 58

Environmental disease (pneumoconioses and chronic
hypersensitivity disorders, etc.) (25%)
Sarcoidosis (20%)
Idiopathic interstitial pneumonias e.g. UIP, (10-15%)
Connective tissue disorders (10%)
Infections (3%)
Drugs (amiodarone, cytotoxic agents)
Radiation
Other immunological disorders (Goodpasture's, Wegener's,
eosinophilic (allergic) pneumonia)

Front 59

interstitial disease/ idiopathic
pulmonary fibrosis :

The disease begins as a chronic inflammatory disorder in
which inflammatory cells collect in the lower respiratory
tract, a process called "alveolitis" even though the
inflammation also involves the walls of _______.

Back 59

bronchioles

Front 60

interstitial disease/ idiopathic
pulmonary fibrosis

While neutrophils damage the lung parenchyma, the
__________ releases both a collagenase and a factor which
stimulates fibroblast activity (collagen synthesis).

Back 60

macrophage

Front 61

interstitial disease/
idiopathic pulmonary fibrosis:


Circulating immune complexes are present in some
of these patients, the patients which respond best to
what treatment?

Back 61

steroids

Front 62

ILD:

One form of these disorders you should know: Usual
______ ______ (UIP).

Back 62

interstitial pneumonitis

Front 63

Stages of UIP

Back 63

"Alveolitis"
Release of fibrogenic mediators
Fibrosis
"Honeycomb" lung at end stage

Front 64

Causes of UIP

Back 64

The cause is unclear.
Both neutrophils and macrophage are thought to be
involved.