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T)mo)rs
+#nign 3alignant
/asc)lar Dis#as#s D/T $ ")lmonar #m,olism P)lmonar O#d#ma ARDS 0 Ad)lt R#s"irator Distr#ss S ndrom#
PLE!RA
T)mo)rs Pl#)ral #ff)sion
3 +
SY3PTO3S
-unny nose E.cess sputum production Dyspnoea !ough /hee0ing !hest pain
,
SY3PTO3S
R)nn nos#
Allergy !ommon cold &asal (loc2age
E%c#ss m)c)s
3mo2ing 4 clear #n$ection 4 yellow/green Asthma 4 yellow 'eosinophils* Bronchial carcinoma) 5B) pneumonia 4 (lood 6 haemoptysis
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27/11/2013
SY3PTO3S
1'##4ing
Air$low limitation $rom any cause 4 not necessarily asthma
S m"toms
D s"no#a 'di$$iculty in (reathing* 7ulmonary disease !ardio"ascular disease 8eta(olic disease :thers
C'#st "ain
7leuritic 4 sharp) worse on (reathing -i( pain -etrosternal soreness 4 tracheitis !onstant dull chest wall pain 4 in"asion (y lung carcinoma !entral chest pain with radiation to nec2) arms 4 cardiac 3houlder pain 4 diaphragmatic pleura / 8#
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Co)g'
Ca)s#s of c'ronic co)g' !:7D Asthma astro6oesophageal re$lu. 6 heart(urn 7ost6nasal drip 7ost chest in$ection 8edications
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IN/ESTIGATION OF THE RESPIRATORY SYSTE3 ;ung <unction 5ests Blood as Analysis -adiology Histolog C tolog 8icro(iology :thers
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S")t)m
+ronc'ial as"irat#s 5 *as'ings 5 ,r)s'ings +ronc'oal-#olar la-ag# 0 +AL
Pl#)ral fl)id
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27/11/2013
/asc)lar Dis#as#s
Deep =ein 5hrom(osis
and pulmonary em(olism
/irc'o*8s triad:
P!L3ONARY E3+OL!S
?,@ arise $rom throm(i in large "eins) lower legs usually deep "eins o$ cal$ muscles) D=5) or pel"ic "eins em(oli tra"el to right side o$ heart and pulmonary trun2 and i$ total (loc2age cause death i$ small no symptoms till late pulmonary hypertension pulmonary in$arction i$ increase in "enous pressure in lungs
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R#s"irator Inf#ctions
Inflammations
R#s"irator Inf#ctions
more $reAuent than in$ections o$ any other organ largest num(er o$ wor2days lost in general population ma>ority in"ol"e only the upper respiratory tract and are caused (y "iruses 6 tri"ial or mild diseases
!""#r R#s"irator Tract Inf#ction /iral5,act#rial inf#ction Lo*#r R#s"irator Tract Inf#ction Pn#)monia 7 +act#rial Pn#)monia 7 /iral
P)lmonar T),#rc)losis
H "#rs#nsiti-it r#actions
1, 11
accumulation o$ secretions
cystic $i(rosis) (ronchial o(struction
"irulent in$ections
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Classification 3or"'olog
Bronchopneumonia) ;o(ar 7neumonia
many organisms present with either pattern C con$luent (ronchopneumonia / lo(ar radiologically
+ronc'o"n#)monia
in$lammation starts in (ronchi 6 polymorphs) $i(rin spreads to ad>acent al"eoli patchy $oci coalesce consolidation
3treptococcus pneumoniae %aemophilus in$luen0ae 3taphylococcus pneumonia Dle(siella 7seudomonas aeruginosa !oli$orm (acteria
Lo,ar Pn#)monia
"irulent organism host "ulnera(ility ?06?,@ 3treptococcus
pneumoniae
in$lammation starts
in al"eoli
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Pn#)monia
&osocomial 7neumonia
Gram n#gati-# rods &:l#,si#lla$ E9 coli$ Ps#)domonas($ sta"' lococc)s a)r#)s &)s)all 3RSA(
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27/11/2013
Com"lications
complete resolution i$ correct anti(iotic uncommon complications
pleural adhesions (eing the most common complications commoner with lo(ar pneumonia
(ut E10@ now die
/iral Pn#)monia
interstitial pneumonia misnomer as interstitial in$iltrate
histiocytes) lymphocytes
lung a(scess septicaemia uncommon i$ se"ere pneumonia is not treated death may occur
2,
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P!L3ONARY T!+ERC!LOSIS
8yco(acterium tu(erculosis
droplet in$ection $rom acti"e 5B 7rimary 5u(erculosis in childhood 6 rare now primary lesion 6 hon $ocus (elow pleura) mid lung tu(ercles 6 epithelioid granulomas with caseation (acteria spread to hilar lymph nodes hon $ocus F nodes heal with $i(rosis / calci$ication 5B sur"i"es in $oci and (ecomes source o$ later in$ection cell mediated immunity to antigens o$ tu(ercle (acillus 6 positi"e tu(erculin s2in test 6 increased resistance to su(seAuent in$ection
<ungi
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P!L3ONARY T!+ERC!LOSIS
3econdary 5u(erculosis people pre"iously sensitised (y a primary lesion a new in$ection or (y reacti"ation o$ micro(e in chronic disease) steroid therapy) %#= ape. o$ the upper and lower lo(es $oci heal with $i(rosis and calci$ication haemoptysis with erosion o$ a "essel in the lung coughing up o$ caseous material 'ca"ities in the lung* pro"ides a source o$ in$ection to the other lung spread "ia lymph and (lood spreads tu(erculosis throughout the (ody 'military 5B*
2?
R#s"irator Dis#as#s
O,str)cti-# P)lmonar Dis#as# 0 Air*a s
COPD: C'ronic +ronc'itis . Em"' s#ma +ronc'ial Ast'ma
27/11/2013
R#s"irator Dis#as#s
O,str)cti-# P)lmonar Dis#as# 7 Air*a s
airflo* limitation$ not f)ll r#-#rsi,l# "rogr#ssi-# in most a,normal inflammator r#s"ons# e.piratory $low rate <=! & or <E=1 <E=1 B <=! is low
CHRONIC +RONCHITIS
clinical term persistent cough with sputum production $or at least three months in at least two consecuti"e years middle6aged men especially smo2ers smo2e predisposes to in$ection (y inter$ering with ciliary action and causing direct damage to epithelium 1062,@ o$ ur(an population due to irritation (y inhaled pollutants
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CHRONIC +RONCHITIS
Em"' s#ma
pathological term condition o$ the lung characterised (y a(normal permanent enlargement o$ the air spaces distal to the terminal (ronchiole) with destruction o$ their walls
elastases destroy elastin $ree radicals $rom smo2e
pathhsw,m,+Gucs$Gedu/o"er"iew/te.tGhtml
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Em"' s#ma
proteases 'elastase* or antiproteases 'antielastase) alpha616 antitrypsin* elastin destruction in al"eolar walls
3,
de"elopment o$ emphysema in smo2ers there is lung in$ection with neutrophils and macrophages) which produce elastase lung damage stimulated neutrophils release o.ygen $ree radicals 6 cause damage
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27/11/2013
Em"' s#ma 7rognosis with se"ere emphysema) cor pulmonale 'heart disease secondary to lung disease* and congesti"e heart $ailure de"elop death due to right heart $ailure and respiratory $ailure
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Ast'ma
increased responsi"eness o$ (ronchial tree to "arious stimuli) resulting in paro.ysmal constriction o$ the (ronchial airways triggered (y e.posure to an allergen (ronchospasm triggers se"ere dyspnoea and whee0ing (etween attac2s asymptomatic an unremitting attac2) status asthmaticus) may pro"e $atal
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Ast'ma
lungs are o"er distended (ronchi occluded (y thic2 mucous plugs eosinophils F oedema in (ronchial walls hypertrophy o$ (ronchial smooth muscle
Ast'ma
5ypes o$ Asthma 7recipitating <actors
3peci$ic allergens !hemicals Antigens'spores*
EH5-#&3#!
Atopic 'allergic* :ccupational Allergic aspergillosis
#&5-#&3#!
&onatopic 7harmacologic -espiratory 5ract #n$ection Aspirin Un2nownI hyper reacti"e airways prostaglandins leu2otrines
%yper reacti"e airways) which respond to non6speci$ic irritants 6 cold) e.ercise and stress
+0
3?
Ast'ma
Atopic or Allergic Asthma commonest type triggered (y en"ironmental antigens 6 dusts) pollen) $oods) house dust mite $amily history common 6 allergic rhinitis) urticaria or ec0ema genetic predisposition positi"e s2in tests classic 5ype # #gE hypersensiti"ity reaction
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27/11/2013
!lassi$y the common respiratory diseases ;ist the methods o$ in"estigation o$ the respiratory system Discuss the de$ence mechanisms o$ the respiratory system Discuss the importance o$ U-5 in$ections Discuss the pathogenesis and morphology o$ (ronchopneumonia and lo(ar pneumonia Di$$erentiate (etween "iral and (acterial pneumonia /rite a short note on pulmonary tu(erculosis Distinguish (etween o(structi"e and restricti"e lung diseases) in terms o$ lung $unction and morphological a(normalities De$ine chronic (ronchitis and emphysema Brie$ly discuss the pathogenesis o$ chronic (ronchitis and emphysema :utline the pathogenesis o$ asthma Descri(e the morphological changes that occur in asthma
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