Home > Uncategorized > Pulmonary Pathophysiology: Obstructive Disease 1

Pulmonary Pathophysiology: Obstructive Disease 1

Overview

This is another Dr West lecture on COPD and CB.  It will cost 45 minutes of your time. 

https://www.youtube.com/watch?v=r5B069qliy0&feature=relmfu

Here is a 4 lecture Kaplan series.  I just found an insane number of medical lectures.  Looks like our next year is covered. 

https://www.youtube.com/watch?v=-nnFxnrxnbU&NR=1&feature=endscreen

Details

COPD is common, the third most important cause of death.  Much of it is preventable.  Caused by smoking. 

Symptoms include:

Increase in airway wall thickness

Emphysema and chronic bronchitis. 

Enlargement of the air space distal to the terminal bronchioles. 

Emphysema is most severe in the apex of the lung. 

Bollous emphysema has large balloon like structures. 

Possible Pathogenesis of Emphysema

1) Imbalance of protease/antiprotease system

2) Smoking causes release of neutrophil elastase

3) Type 4 collagen in the BFB are a critical structure

4) Elastase attacks elastin and collagen

Chronic Bronchitis

Too much mucus secreted in the bronchial walls. 

Expectoration of sputum.

Type A is thin, upright, and desperately short of breath.  He is a “fighter”, a pink puffer. 

Type B will be lying in bed, and is sometimes overweight.  Coughing up sputum.  Abnormal blood gas.  Don’t keep pCO2 for the same.  He is a “quitter”, a blue breather. 

Pulmonary Function in COPD

ventilary capacity and mechanics

gas exchange 

TLC FRC RV resting volume are all increased in COPD

Pulmonary Circulation

pulmonary hypertension

destruction of the capillary bed

hypoxic vasoconstriciton

polycythemis increasing blood viscosity

thickening of walls of small arteries

right heart enlargement

For a normal, non COPD subject, increasing ventilation will not increase oxygen uptake. 

CB

 increased R of small airways closing volume, flow volume curve

COPD Treatment

Lung tissue destruction is irreversible

Use bronchodilators in all cases

Portable oxygen to improve mobility

Lung volume reduction surgery

Review

Acetyl COCH3

Thionyl chloride SOCl2

Barchan Dune 35 degrees down, 15 up

R-N=N-R Azo

Ambush – linear, L, V

C=S Thioketone

H2N(C=O)NH2 Urea

cash-futures = basis

+ basis negative carry

– basis positive carry

4 carbons overwhelm hydrogen bonding

Atmosphere: troposphere, stratosphere, mesosphere, thermosphere, ionosphere, exosphere

CTLSC 7 12 554

Sextuple Bond: Mo2, W2

Intermolecular Bonding: electrostatic, h bonding, dipole dipole, van der Waals

Hydrogen Bonding: FON Cl

Mandatory Refusal – when communications are lost, no one is trusted. A breach is assumed.

Gain Band Width Product = Gain x Bandwidth

CARVER is an acronym that stands for Criticality, Accessibility, Recuperability, Vulnerability, Effect and Recognizability.

Wind Speed Beaufort Category How to Judge the Wind
1-3 mph Light Air Smoke drifts. Wind cannot be felt.
4-7 mph Light Breeze Wind felt on face. Leaves rustle. Weather vanes move.
8-12 mph Gentle Breeze Leaves and twigs in motion. Light flags are extended.
13-18 mph Moderate Breeze Wind raises dust and loose papers. Small branches move. Flags flap.
19-24 mph Fresh Breeze Small trees in leaf sway slightly. Wavelets form on ponds and lakes.
25-31 mph Strong Breeze Large branches move. Telephone lines sing.

Visible Light – 400 to 700 nm

adam boy charles david edward frank george henry ida john kevin lincoln mary nora ocean paul queen robert sam tom union victor william xray young zebra
bull spread buy near, sell far
bear spread sell near, buy farcash – futures = basis

spreads are differences between futures contract months
cashpostive carry
cash>futures negative carry (inverted)
Basis: time space quality

Aromatic: planar, cyclic, Huckels Rule – 4n+2 electrons

Fibrous – sclera, cornea

Sensory – retina

Vascular – choroid, iris, pupil, ciliary body

Kingdoms – monera, protista, fungi, plant, animal

HSbF6 pKa = 25

Electrophiles are positive, nucleophiles are negative

EDTA is a tetraprotic acid.

C-C=O-C Ketone

Ketones containing alkene and alkyne units are often called unsaturated ketones.

Ph2CO Benzophenone

Sunflower 8 benzenes fused together

(H3C)(CO)(CO)(CH3) Diacetyl

Butanone MEK

Acetoin (H3C)(CO)(COH)CH3

Tissue: nervous muscular epithelial connective

Epithelial: simple stratified pseudostratifed/ cuboidal columnar squamous

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