Asthma
1. Define asthma. Compare and contrast immune-mediated and nonimmune-mediated forms of asthma in terms of initiating factors and pathogenic mechanisms. Understand the term "bronchial hyperresponsiveness" and its relationship to all types of asthma. Describe the morphologic changes in chronic asthma and discuss the clinical course (Robbins 5th Ed., p. 689-692) or (Robbins 6th Ed., p. 712-716).
Bronchiectasis
2. Define bronchiectasis. Describe the gross anatomic lesion and list the conditions that predispose to this condition (Robbins 5th Ed., p. 692-694) or (Robbins 6th Ed., p. 716-717).
Chronic Obstructive Pulmonary Disease (COPD)
1. Distinguish obstructive vs restrictive lung disease according to functional abnormalities (Robbins 5th Ed., p. 682-683) or (Robbins 6th Ed., p. 706). Understand the use of FEV1/FVC in classifying lung diseases.
1. (Robbins 5th Ed., p. 689-694) or (Robbins 6th Ed., p. 712-717)
2. Images 1 - 3 relate to the case; the rest are related to other objectives
An 18-year-old black male had presented four years previously with difficulty in breathing and wheezing. These attacks occurred intermittently, but were not related to any known circumstances. An x-ray of the chest was unremarkable, but lung function tests performed when he was symptomatic demonstrated a markedly decreased FEV1, which improved significantly after he inhaled a few puffs of b-adrenergic agonist. The patient was prescribed a b-adrenergic inhaler. Although the latter provided some relief, the patient continued to experience episodes of breathlessness and was subsequently prescribed a steroid inhalant. While this provided much greater relief for four years, he had stopped taking all medication for the past several weeks because of financial reasons. He now presented to the ER with severe shortness of breath of 8 hours duration.
On arrival to the ER he was in considerable distress; he could barely talk and was breathing 30 times/minute. Physical exam was remarkable for rare wheezing and markedly diminished breath sounds. Arterial blood gases pH = 6.9, pCO2 = 88, pO2 = 35. While awaiting therapy the patient suffered a cardiac arrest and could not be resuscitated.
At autopsy, gross findings were limited to the respiratory tract. The lungs were overinflated, with focal areas of atelectasis. and many of the bronchi were occluded by thick, tenacious mucous plugs.