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[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Asthma ,[object Object]
Pathophysiologic hallmark ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],   Airway resistance    FEV 1 Hyperinflation    Work of breathing Altered resp muscle mechanics Blood gas abnormalities
Stimuli that Incite asthma ,[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],Upper airway obstruction Heart failure TB COPD Recurrent pulmonary emboli
Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Table 236-1 & 236-2
C O P D
COPD ,[object Object],[object Object],[object Object]
COPD ,[object Object],-GOLD, 2006
[object Object],[object Object],[object Object],[object Object]
What are the Risk Factors for Developing COPD?
[object Object]
[object Object],~15% of smokers develop COPD What proportion of smokers develop COPD?
Airway Responsiveness & COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Risk Factors: Respiratory Infections ,[object Object]
Risk Factors: Occupational Exposure ,[object Object],[object Object],[object Object]
Risk Factors: Ambient Air Pollution ,[object Object]
Risk factors: Passive, or 2 nd -hand smoking (ETS)
Genetic Considerations ,[object Object],[object Object],[object Object]
 
MMP Serine  proteinases MMP Cysteine proteinases Proteinase  inhibitors ECM degradation: lung destruction Emphysema  Repair Inflammatory cell recruitment
Transcription of  cytokines Inactivation of  antiproteinases Lipid peroxidation Depletion of  antioxidant defenses Neutrophil  sequestration OXIDATIVE  STRESS I N F L A M M A T I O N I N J U R Y &
What are the Major Categories of COPD?
Chronic Bronchitis ,[object Object]
Emphysema ,[object Object]
- What are the clinical manifestations of COPD? - What is the most common symptom which prompts patients to seek consultation?
Clinical Features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
What are the physiologic abnormalities in COPD?
Physiologic Abnormalities  in COPD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Airway obstruction &  low elastic recoil Expiratory flow limitation Hyperinflation at rest, worsened by exercise Limited inspiratory “space”/”depth of breath” Dyspnea
Hyperinflation
How do you stage the severity of COPD?   What are the recommended therapies?
 
Treatment: Stable COPD ,[object Object],[object Object],[object Object]
Pharmacotherapy:  Bronchodilators ,[object Object],[object Object],[object Object],[object Object]
Pharmacotherapy: Glucocorticoids ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pharmacotherapy: Theophylline ,[object Object],[object Object],[object Object]
Pharmacotherapy: Oxygen ,[object Object],[object Object],[object Object]
Exacerbations of COPD ,[object Object],[object Object],[object Object],[object Object],[object Object]
Exacerbations ,[object Object],[object Object],[object Object]
Patient Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Therapy  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Community-acquired pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object]
Hospital-acquired pneumonia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bronchiectasis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
Etiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PE & Diagnosis ,[object Object],[object Object],[object Object],[object Object]
 
Goals of therapy ,[object Object],[object Object],[object Object],[object Object]
Cystic Fibrosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis ,[object Object],[object Object]
Therapy ,[object Object],[object Object]
 
Disorders of the Pleura ,[object Object],[object Object],[object Object],[object Object]
Pleural Effusion ,[object Object],[object Object],[object Object]
Diagnostic Approach ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exudative Pleural Effusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exudative Pleural Effusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
Exudate Further diagnostic procedure Approach to the Diagnosis of Pleural Effusions  Pleural effusion Perform diagnostic thoracentesis Measure PF CHON & LDH Any of the ff met? PF/serum CHON >0.5 PF/serum:LDH >0.6 PF LDH > 2/3 upper normal serum limit Transudate Treat CHF, cirrhosis, nephrosis
Measure PF glucose, amylase Obtain PF cytology Differential cell count Culture, stain PF PF markers for TB Exudate Further diagnostic procedure
Effusion Due to Heart Failure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hepatic Hydrothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Parapneumonic Pleural Effusion ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Factors indicating the likely need for a procedure more invasive than thoracentesis ,[object Object],[object Object],[object Object],[object Object],[object Object],*increasing order of importance
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effusion Secondary to Malignancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mesothelioma ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effusion Secondary to Pulmonary Embolism ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculous Pleuritis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Effusion Secondary Viral Infection ,[object Object]
AIDS ,[object Object],[object Object]
Chylothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemothorax ,[object Object],[object Object],[object Object],[object Object],[object Object]
Miscellaneous Causes of Pleural Effusion ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Exudative Pleural Effusions
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Spontaneous Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Spontaneous Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Traumatic Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tension Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Disorders of the Mediastinum
Mediastinal Masses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Evaluation of Mediatinal Masses ,[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Mediastinitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chronic Mediastinitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pneumomediastinum ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Acute Respiratory Distress Syndrome ,[object Object],[object Object],[object Object],[object Object],Respiratory  Failure
Clinical Disorders Commonly Associated with ARDS Post-cardiopulmonary bypass Pancreatitis Toxic inhalation injury Drug overdose Near-drowning Multiple transfusions Pulmonary contusion Severe trauma Aspiration of gastric contents Sepsis Pneumonia Indirect Lung Injury Direct Lung Injury
Diagnostic Criteria for ALI & ARDS ARDS: PaO 2 /FIO 2   < 200 PCWP  < 18 mmHg or no clinical evidence of left atrial HPN Bilateral alveolar or interstitial infiltrates Acute ALI: PaO 2 /FIO 2   < 300 Absence of Left Atrial HPN CXR Onset Oxygenation
Acute Lung Injury ,[object Object],[object Object]
Clinical Course & Pathophysiology ,[object Object],[object Object],[object Object],[object Object],Exudative  Proliferative  Fibrotic  Hyaline membranes Interstitial inflammation Interstitial fibrosis Fibrosis 0  2  7  14  21…
Exudative ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Proliferative ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fibrotic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanical Ventilation ,[object Object],[object Object]
Others ,[object Object],[object Object]
Prognosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neoplasms of the Lung ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
Etiology/Risk Factors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Manifestations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Diagnosis & Staging ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Therapy ,[object Object],[object Object],[object Object]
Solitary Pulmonary Nodule (SPN) ,[object Object],[object Object],[object Object],[object Object]
When to Resect SPN? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Reliable radiographic criteria for benignity of lesion ,[object Object],[object Object],For px >35 and all px who smoke – histologic diagnosis mandatory Algorithm (Fig 75-2, p 513)
Benign Lung Neoplasms ,[object Object],[object Object],[object Object],[object Object]
Bronchial Adenomas ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hamartomas ,[object Object],[object Object],[object Object]

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Pulmonology

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  • 17. C O P D
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  • 21. What are the Risk Factors for Developing COPD?
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  • 28. Risk factors: Passive, or 2 nd -hand smoking (ETS)
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  • 31. MMP Serine proteinases MMP Cysteine proteinases Proteinase inhibitors ECM degradation: lung destruction Emphysema Repair Inflammatory cell recruitment
  • 32. Transcription of cytokines Inactivation of antiproteinases Lipid peroxidation Depletion of antioxidant defenses Neutrophil sequestration OXIDATIVE STRESS I N F L A M M A T I O N I N J U R Y &
  • 33. What are the Major Categories of COPD?
  • 34.
  • 35.
  • 36. - What are the clinical manifestations of COPD? - What is the most common symptom which prompts patients to seek consultation?
  • 37.
  • 38.  
  • 39. What are the physiologic abnormalities in COPD?
  • 40.
  • 41.  
  • 42. Airway obstruction & low elastic recoil Expiratory flow limitation Hyperinflation at rest, worsened by exercise Limited inspiratory “space”/”depth of breath” Dyspnea
  • 44. How do you stage the severity of COPD? What are the recommended therapies?
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  • 83. Exudate Further diagnostic procedure Approach to the Diagnosis of Pleural Effusions Pleural effusion Perform diagnostic thoracentesis Measure PF CHON & LDH Any of the ff met? PF/serum CHON >0.5 PF/serum:LDH >0.6 PF LDH > 2/3 upper normal serum limit Transudate Treat CHF, cirrhosis, nephrosis
  • 84. Measure PF glucose, amylase Obtain PF cytology Differential cell count Culture, stain PF PF markers for TB Exudate Further diagnostic procedure
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  • 110. Disorders of the Mediastinum
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  • 117. Clinical Disorders Commonly Associated with ARDS Post-cardiopulmonary bypass Pancreatitis Toxic inhalation injury Drug overdose Near-drowning Multiple transfusions Pulmonary contusion Severe trauma Aspiration of gastric contents Sepsis Pneumonia Indirect Lung Injury Direct Lung Injury
  • 118. Diagnostic Criteria for ALI & ARDS ARDS: PaO 2 /FIO 2 < 200 PCWP < 18 mmHg or no clinical evidence of left atrial HPN Bilateral alveolar or interstitial infiltrates Acute ALI: PaO 2 /FIO 2 < 300 Absence of Left Atrial HPN CXR Onset Oxygenation
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