clinical med resp

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shmvii
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154758
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clinical med resp
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2012-05-19 15:28:56
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clinical med resp
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clinical med resp
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  1. hypoplasia
    under-development of lungs (one or both) due to impeded dev of thoracic cavity
  2. diaphragmal hernia
    partial or total absence of diaphragm---> herniation of abdominal contents into thoracic cavity
  3. bronchogenic cysts
    • peribronchial cysts, lined by bronchial epithelium
    • may contain air or snot
    • may ---> abscess formation or rupture into bronchi or pleural cavity
  4. bronchopulmonary sequestration
    presence of lung tissue that's not connected to the bronchial system

    can be extralobar or intralobar (outside or within visceral pleura)
  5. what do hypoplasia, diaphragmal hernia, brochogenic cysts, and brochopulmonary sequestration have in common?
    they're all congenital abnormalilites
  6. atelectasis refers to...
    incomplete expansion of alveoli
  7. primary atelectasis
    • results from lungs failing to ventilate at time of birth
    • due to birth trauma, bronchial obstruction, immaturity


    dead baby who never breathed won't float
  8. secondary atelectasis may be due to...?
    • deficiency of surfactant
    • loss of neg intrapleural pressure
    • obstruction of airways
    • direct pressure on lungs w focal, segmental, or massive distribution
  9. bronchiectasis
    def
    due to
    symptoms
    • permanent dilation of bronchi and bronchioles
    • due to destruction of muscle and elastic supporting tissues, often resulting from chronic necrotizing infections or mechanical obstruction of bronchi
    • symptoms: cough and spitting
    • an OLD
  10. pulmonary infections in the form of pneumonia are responsible for __ deaths in the US
    1/6 of all deaths
  11. pneumonia broad def
    the specifics depend on..?
    • any infection in the lung
    • details of the pathological changes depend on the agent and the host's response
  12. viral pneumonia
    where are the lesions?
    peribronchiolar and within the alveolar walls, which are widened by edema
  13. viral pneumonia -- where don't you see much exudate?
    alveolar spaces are generally free of sgnificant cellular exudate
  14. viral pneumonia - hallmark symptom?
    a persistant nonproductive cough,

    also seen: rare chest pain and dyspnea
  15. bacterial pneumonia refers to..?
    inflammation and solidification of pulmonary parenchyma
  16. 2 classes of bacterial pneumonias
    • 1 - bronchopneumonia = patchy inflammatory consolidation
    • 2 = lobar pneumonia - extensive inflam consol in a lobe, usually due to strept pneumonia
  17. pneumococcal pneumonia 4 stages of dev
    • 1 - congestion - bacterial proliferation and inflam response and serous exudation into alveolar space
    • 2 - red hepatization - outpouring of neutrophils and precipitated fibrin into alveolar space ---> look and feel of the liver
    • 3 - grey hepatization - disintigration of neutrophis and erythrocytes w accumulation of fibrin
    • 4 - resolution - digestion and reabsorption of exudate and restoration of pulm parenchyma to normal

    • sooo... 1 - congestion = bacteria and body start to fight
    • 2 - red hepatization = neutrophils & fibrin come along and we start looking liver-y
    • 3 - gray hepatization = the fighters die, the fibrin stays
    • 4 - resolution = eating up the casualties, getting back to normal,
  18. fungi as antigens
    they're weak, so the tissue damage they cause is mostlly due to the hypersensitivity reaction against the fungi proteins
  19. lung abscess
    basic def
    more detailed def
    usually where
    • accumulation of pus in lung tissue
    • localized suppuration and liquefaction necrosis of lung parenhcyma due to inhaling shmutz
    • right side due to shallow angle of R bronchus
  20. 2 categories of diffuse pulmonary disease (think of Amy Hess)
    • 1 - obstructive - increased resistance to airflow due to obstruction
    • 2 - restrictive - reduced expansion of lung parenchyma and decreased total lung capacity
  21. 4 major OLDs
    • asthma
    • emphysema
    • chronic bronchitis
    • bronchiectasis

    (and there's also tumors and inhaling shit)
  22. when does a pulm pt have normal lung capacity but decreased expiratory flow rate?
    OLD
  23. asthma is what type of hypersensitivity reaction
    I (extrinsic

    there's also intrinsic, and he writes "nonimune: viurs infections, cold, stress..."
  24. asthma is characterized by...?
    results from ...?
    • episodic reversible bronchoconstriction
    • increased responsiveness (inflammation) of trachobronchial tree to various stimuli
  25. in OLD which part of breathing is more affected
    exp is more affected than insp
  26. centrilobar emphysema
    changes to bronchioles of upper lobe due to neutrophil elastases -- seen in smokers
  27. panacinar emphysema
    • lower lobe
    • in smokers w alfa-1-antitrypsin deficiency
  28. what's going on w alveoli in emphysema
    alveoli break and what's left merges, so now you have a few big alveoli instead of many small one ---> decreased surface area and gas exchange
  29. what do you have if there's reduced compliance, reduced capacity, normal flow rates?
    RLD!
  30. the extrapulmonary disorder flavor of RLD
    affects the abiliity of chest wall to act as bellows (kypho-skoliosis, neuromuscular disorders)
  31. RLD -- an acute syndrom and 2 chronic
    • acute - adult respiratory distress syndrome
    • chronic - pheumoconiosis, sarcoidosis,

    there's also intersitial lung diseases, but he gives no ex.
  32. sleep apnea is due to...?
    • inspiratory obstruction by walls of pharynx (chest moves, but no airflow)
    • when inspiratory efforts succeed finally, you'll get a loud snore
  33. hypothesis on cause of sudden infant death syndrome
    (happens in US in 2/1000 babies)

    prolonged apnea, followed by cardiac arrhythmia, and the kid's too small and weak to wake himself
  34. adult respiratory distress syndrome is a life-threatening disorder char by:
    acute onset of dyspnea, hypoxemia, cyanosis
  35. etiology of ARDS
    • factors that produce diffuse alveolar damage (DAD)
    • injury of alveolar capillary endothelium

    - this triggers inflam response and alveolar accumulation of fibrinous exudate & dyspnea
  36. bronchogenic carcinoma
    fun facts
    etiology
    begins where
    • 90% of primary malignant lung tumors
    • leading cause of cancer deaths in US
    • smoking, occupation (exposure to bad stuff)
    • begins in hilar regions and then metastesizes
  37. 4 classes of bronchogenic carcinomas
    • a - squamous cell carcinoma
    • b - adenocarcinoma
    • c - bronchoalveolar
    • d - small cell carcinoma
  38. three flavors of emphysema
    • centrilobular - in upper lobes due to neutrophil elastases
    • panacinar - in lower lobes
    • localized

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