What is the primary cause of neonatal respiratory distress syndrome?
immature type II pneumocytes leads to low surfactant production
Ration of lecithin to sphingomyelin in Neonatal respiratory distress syndrome?
L/S ratio <1.5
COPD includes which disorders
emphysema, bronchiectasis, chronic bronchitis, asthma
Pulmonary changes characterized by enlargement of air spaces distal to terminal bronchiole which results in destruction of alveolar walls
Most common cause of emphysema
Why does cigarette smoke cause emphysema
toxic and free radical damage to respiratory epithelium leads to an inflammatory response in the airways and release of proteases from neutrophils and macrophages
What happens when cigarette smoke alters protease-antiprotease mechanism?
proteases are free to lyse elastin and other structural proteins, leading to loss of alveolar elastic tissue and loss of septal tissue
Hereditary alpha 1 antitrypsin deficiency leads to
mutation in protease inhibitor
Young patient presents with emphysema symptoms but say they have never smoked cigarettes. What is most likely the cause?
hereditary alpha 1 antitrypsin deficiency
Breathing characteristics of emphysema pts
pursed lip breathing, hyperventilation
Emphysema increases resistance in pulmonary artery blood flow, leading to pulmonary hypertension and eventually..
Pathogenesis of bronchiectasis
obstruction -> microbial proliferation (S. aureus, K. pneumoniae) -> inflammation -> necrotizing suppurative infection -> damage to epithelia -> impair mucociliary clearance -> destruction of muscle and elastic tissue secondary to erosive inflammatory pro
Morphology of bronchiectasis
abnormally dilated airways, with mucous plug
Clinical features of bronchiectasis
chronic, productive, mucopurulent cough, foul smelling secretion, hemoptysis likely
Persistent productive cough for at least 3 months per year during a period of 2 consecutive years
Bronchitis is caused by inhaled irritants, which leads to bronchial wall thickening caused by
goblet cell hyperplasia, submucosal glandular hyperplasia, mucus hypersecretion
Bronchitis causes a change from columnar respiratory epithelium to multiple layers of squamous epithelium
bronchial squamous metaplasia
In bronchitis, the inflammation, glandular hyperplasia, and mucous hypersecretion leads to overall
Two types of bronchial asthma
1. intrinsic/non-atopic asthma 2. extrinsic/atopic asthma
Positive family history is common in which asthma?
In extrinsic asthma, IL-4 stimulates which cells to produce IgE that locaizes mast cells?
stimulates B cells
Il-3 and Il-5 in asthma stimulates
Asthma attack that lasts days-weeks and does not respond to therapy; life threatening
Asthma shows up on xray as
hyperinflation, diaphragmatic flattening, increased bronchial cuffing, +/- mucous plugs
Restrictive pulmonary disease is characterized by
reduced expansion of lung parenchyma, reduced total lung capacity, decreased FVC and decreased FEV1
Major causes of restrictive pulmonary disease
chest wall disorders, acute or chronic interstitial diseases
Chronic interstitial disease that would cause restrictive pulmonary disease includes
idiopathic pulmonary interstitial fibrosis, pneumoconiosis, infiltrative disease
Idiopathic pulmonary interstitial fibrosis aka
diffuse interstitial lung disease
Ground glass appearance on chest ray is associated with
idiopathic pulmonary interstitial fibrosis
Lung disease caused by inhalation of dust particles
Rod shaped, ferruginous bodies in sputum and lung interstitium from inhalation of asbestos fibers
Anthracotic deposits caused by inhalation of coal dust
Sarcoidosis of salivary glands. Leads to xerostomia and increased risk for caries
Bilateral lymphadenopathy on chest xray is associated with
Sarcoidosis is associated iwth increased levels of
HLA-A1 and HLA-BB, increased ACE levels, hypercalcemia, polyclonal hypergammaglobulinemia
In sarcoidosis, the exaggerated interstitial and intra-alveolar CD4+ Th1 response to the unknown antigen leads to...
macrophage activation and noncaseating granuloma formation
Sarcoidosis is associated with caseating granuloma or noncaseating granuloma?
sarcoidosis = noncaseating granuloma; tuberculosis = caseating granuloma