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102 Cards in this Set
- Front
- Back
Intra-alveolar accumulation of fluid
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Pulmonary edema
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2 general causes of Pulmonary Edema
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1. Hemodynamic derangements
-congestive heart failure -decreased plasma oncotic pressure 2. Increased capillary permeability due to direct microvascular injury |
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Most common cause of Pulmonary Edema
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Left-sided heart failure
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How much can Lymphatic drainage increase before appreciable pulmonary edema occurs?
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10-fold
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Type of edema associated with alteration in Starling's pressure
-Congestive Heart Failure |
Transudate = low protein content
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Type of edema associated with microvascular or alveolar damage?
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Exudate
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Edema with low protein content and low specific gravity
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Transudate
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What are 4 possible causes of increased Hydrostatic pressure resulting in Hemodynamic edema?
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1. Left heart failure
2. Mitral Stenosis 3. Volume overload 4. Pulmonary Vein obstruction |
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What are 3 diseases that would result in Hypoalbuminemia and therefore Pulmonary Edema
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1. Nephrotic syndrome = losing protein in the urine
2. Liver disease/cirrhosis = not producing albumin 3. Protein-losing enteropathy = albumin is lost via the gut |
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How could Lymphatics be involved in Pulmonary Edema?
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Lymphatic obstruction such as Metastatic Cancer could prevent fluid from being drained off
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Auscultation sound heard with Pulmonary Edema?
Treatment for Pulmonary Edema? |
Wet rales
Diuretic (Lasix = Furosemide) |
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"Diffuse Alveolar Damage" is the same thing as...
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Acute Respiratory Distress Syndrome
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Increase in Alveolar capillary permeability causing leakage of protein-rich fluid into alveoli
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Acute Respiratory Distress Syndrome
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Drug that is used to treat testicular cancer that can cause ARDS
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Bleomycin
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Drug used to treat fungal infections that can cause ARDS
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Amphotericin B
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Drug used to treat Gout that can cause ARDS
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Colchicine
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What is the best way to treat ARDS?
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remove the inciting cause
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2 causes of Edema of Undetermined Origin
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High Altitude Pulmonary Edema
Neurogenic edema -> severe brain trauma |
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Most common cause of ARDS
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sepsis
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Pathognomonic feature of ARDS (5)
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Hyaline Membranes
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Clinical findings of ARDS
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1. accelerated onset of respiratory insufficiency
2. progressive infiltrates on CXR -CXR is normal initially -progresses to diffuse bilateral infiltrates 3. Tachycardia 4. Cyanosis 5. Severe Arterial Hypoxemia which is refractory (unresponsive) to oxygen therapy |
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Cells that line the alveoli
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Type I pneumocytes
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Cells that secrete Surfactant
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Type II Pneumocytes
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Loss of lung volume due to inadequate expansion of the airspaces = lung collapse
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Atelectasis
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When does Surfactant synthesis begin?
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at or after 28th week of gestation
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Major component of surfactant
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Phosphatidylcholine (lecithin)
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What is Surfactant stored in in Type II Pneumocytes
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Lamellar bodies
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Surfactant synthesis is increased by these 2 things
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Cortisol (Glucocorticoids)
Thyroxine |
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What causes decreased synthesis of Surfactant?
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Insulin
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What are 3 possible causes of decreased surfactant in fetal lungs?
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1. Prematurity
2. Maternal diabetes = fetal hyperglycemia increases insulin release = insulin decreases surfactant synthesis 3. C-section = lack of stress-induced increase in Cortisol from a vaginal delivery = Cortisol increases Surfactant synthesis |
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At what week is surfactant made most abundantly during gestation?
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35th week
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What are 4 complications of Hyaline Membrane Disease of the Newborn?
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1. Pulmonary Interstitial Edema
2. Pneumothorax = accumulation of gas/air in pleural cavity 3. Retrolental Fibroplasia = abnormal replacement of the sensory retian by fibrous tissue and blood vessels, mostly due to high-O2 treatment 4. Ventricular Brain Hemorrhage |
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Parts of the Respiratory passages that Obstructive Lung Diseases can affect
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From the Trachea to the Respiratory Bronchioles
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3 Pulmonary Functional Tests decreased in COPD
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1. FEV1 = amount of air expelled from the lungs in 1 second after a maximal inspiration
2. FEV1/FVC = 4L / 5L in a normal person 3. Arterial pressure of O2 (PaO2) *FVC is usually normal or slightly increased in COPD **FVC = total amount of air expelled after a maximal inspiration (normal is 5L) |
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What 2 Pulmonary Functional Tests are increased in Restrictive Lung Disease
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1. FEV1/FVC
2. A-a gradient = increase in the difference in O2 in the Alveoli compared to the Arteries = hypoxemia of pulmonary origin |
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Prognosis of Neonatal Respiratory Distress Syndrome
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30-50% fatality rate
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Prognosis for Acute Respiratory Distress Syndrome
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60% fatality rate
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Enlargement of air spaces and decreased recoil resulting from destruction of alveolar walls
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Emphysema
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Increase in resistance to air flow out of the lungs, resulting in air trapped in the lungs
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Obstructive Lung Disease
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What is the major cause of Emphysema?
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Smoking
*alpha1-antitrypsin is another cause |
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Parts of the Respiratory passages that Obstructive Lung Diseases can affect
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From the Trachea to the Respiratory Bronchioles
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What is the most common type of Emphysema?
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Centriacinar (Centrilobular)
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What are 4 examples of Obstructive Lung Diseases
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1. Asthma
2. Chronic Bronchitis 3. Emphysema 4. Bronchiectasis *BABE* |
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Type of Emphysema caused by Smoking?
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Centriacinar
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Type of Emphysema caused by Alpha-1-antitrypsin deficiency
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Panacinar
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What is Restrictive Lung Disease?
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reduced expansion of the lung parenchyma and decreased total lung capacity
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What is the most common type of Emphysema?
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Centriacinar (Centrilobular)
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Part of the acini that Centriacinar emphysema affects
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central part, sparing the distal alveoli
Respiratory bronchioles are dilated |
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Type of Emphysema with anthracotic pigment
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Centriacinar
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Type of Emphysema that primarily involves the apical segments of the upper lobe
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Centriacinar
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Gender that Centriacinar emphysema is most common in
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Male
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Type of Emphysema in which entire acinus is dilated
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Panacinar
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Emphysema associated with large subpleural bullae
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Paraseptal
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Emphysema associated with risk for spontaneous pneumothorax
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Paraseptal
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Emphysema that affects primarily the lower lobes
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Panacinar
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Emphysema with scarring (fibrosis) of the acinus within the walls of enlarged air spaces usually a complication of various inflammatory processes
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Irregular emphysema
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Enzyme that is at heightened activity in Emphysema
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Neutrophil Elastase
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Where is Alpha-1-antitrypsin synthesized?
What genotype interferes with AAT secretion? |
Liver
piZZ homozygous state *pi = proteinase inhibitor |
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Decent of people who primarily have AAT deficiency emphysema
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Northern European decent
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Explain the age differences in AAT deficiency emphysema and Smoking emphysema
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AAT = patients are classically around 25 yoa
Smoking = classically around 40 yoa |
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Give 2 reasons why smoking causes emphysema
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1. attracts neutrophils and macrophage = sources of Elastase
2. inactivates AAT = usually neutralize Elastase |
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How is diagnosis of AAT deficiency made?
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DNA-based cheek swab test
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Restrictive Lung Disease:
- increase or decrease in compliance? - increase or decrease in elasticity? |
decrease = difficult to take air in
increase = easy to push air out |
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chronic necrotizing infection of bronchi and bronchioles, resulting in abnormal dilation
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Bronchiectasis
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4 diseases that Bronchiectasis is associated with
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1. Bronchial obstruction
2. Cystic Fibrosis 3. Poor ciliary motility 4. Kartagener's syndrome |
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Disease with sinusitis, bronchiectasis, and situs inversus, sometimes with hearing loss and male sterility
*ultimate cause is due to a defect in the motility of respiratory, auditory, and sperm cilia = absent DYNEIN arm in cilia |
Kartagener syndrome
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Most common cause of Bronchiectasis in US?
Worldwide? |
Cystic Fibrosis (P. aeruginosa)
Tuberculosis |
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Bronchiectasis most commonly occurs in which lobes of the lungs?
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Lower lobes
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3 clinical findings with Bronchiectasis
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1. Purulent sputum
2. Recurrent infections 3. Hemoptysis |
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At least 3 months of productive sputum for 2 or more consecutive years
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Chronic Bronchitis
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Hypertrophy of mucus-secreting glands in the bronchioles
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Chronic Bronchitis
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What is the Reid index?
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= gland depth / total thickness of bronchial wall
-used in measuring Chronic Bronchitis |
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What is the Reid index greater than in Chronic Bronchitis?
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>50%
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Type of metaplasia in Chronic Bronchitis
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Squamous metaplasia
*loss of ciliated epithelia |
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Describe Asthma
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Bronchial hyperresponsiveness causes reversible bronchoconstriction resulting in trapping of air in the lungs
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List 3 general causes of Asthma
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1. Extrinsic = allergens = Type I HS = IgE mediated
2. Intrinsic = viral URI's 3. Aspirin sensitive = clinical triad = nonsteroidal drugs, asthma, nasal polyps |
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Mucus plugs containing denuded epithelium found in asthma
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Curschmann spirals
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Collection of crystalloid composed of eosinophil membrane protein in asthma patients
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Charcot-leyden crystals
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Type of hyperplasia found in Asthma
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Goblet cell hyperplasia
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COPD with Eosinophils
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Asthma
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Adult Respiratory Distress Syndrome
- Hyaline membranes - Bilateral infiltrates |
A 60 year old man presented with Dyspnea, tachypnea, and cyanosis.
What is the diagnosis? |
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What is the therapy for Hyaline Membrane Disease of the Newborn?
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- remove the initial insult
- Ventilator -> Positive end-expiratory Pressure |
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What are 4 examples of Chronic Obstructive Lung Disease?
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1. Asthma
2. Chronic bronchitis 3. Emphysema 4. Bronchiectasis |
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Pink Puffer = slowing of forced expiration through pursed lips
What disease? |
Emphysema
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What is the mechanism of obstruction in Emphysema?
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Loss of elastic recoil of the acini = air gets trapped in the acini
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What is the cause of Chronic Bronchitis in 90% of cases?
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Smoking
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Disease that affected are referred to as "Blue Bloaters"
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Chronic Bronchitis
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-Hypertrophy of Bronchial Smooth muscle
-Hyperplasia of bronchial submucosal glands -Mucous plugs |
Asthma
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Asthma
-Bronchial cartilage at right -Mucus plug at left -Submucosa widened by Smooth Muscle Hypertrophy |
What lung pathology?
Explain what you see |
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Hyperreactive airways, resulting in episodic bronchospasm when triggered by certain stimuli
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Asthma
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List some causes of Intrinsic Asthma
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1. Respiratory infections
2. Stress 3. Exercise 4. Cold 5. Aspirin -> Asthma, Nasal Polyps, Chronic pain syndrome |
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Asthma b/c there are Eosinophils present
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What COPD would this be? Why?
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Bronchiectasis = permanent dilation of bronchi and bronchioles
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What COPD is this?
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Asthma
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What is this picture showing?
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Bronchiectasis
- dilated bronchi and bronchioles - P. aeruginosa with |
What do these indicate?
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Bronchiectasis
- Dilated bronchioles with Signet-ring appearance - Due to Cystic Fibrosis |
What is this?
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Panacinar Emphysema
AAT deficiency Lower lobes (but all part can be affected) |
What is this?
What causes it? What part of lung is primarily affects? |
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Panacinar Emphysema
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What are these showing?
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Panacinar Emphysema
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What is this?
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Centriacinar Emphysema
-peripheral alveoli are normal |
What is this?
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Diffuse Alveolar Damage
Hyaline Membranes |
What is this?
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Centriacinar Emphysema
-holes are located around the terminal bronchioles Rupture causing Pneumothorax |
What is this?
What is a potential complication? |