• What are pores of Kohn? • Perforations in wall of alveoli, permit passage

of bacteria and exudate between adjacent alveoli

Early organization of intra-alveolar exudate, seen in areas to be streaming through the pores of Kohn (arrow).

True or false?

• In atelectasis caused by:– Resorption – there is a decreased in LV

mediastinum shift to atelectactic lung – Compression – mediastinum shifts towards the

atelectactic lung – Contraction – caused by localised or generalized

infection • Atelectasis is irreversible

Qs on pulmonary oedema

• Where in the lung does fluid accumulate first?– Basal regions of lower lobes due to hydrostatic

pressure is greater there• What is brown induration?– In long-standing cases of pulmonary congestion,

such as those seen in mitral stenosis, hemosiderin-laden macrophages are abundant, and fibrosis and thickening of the alveolar walls cause the soggy lungs to become firm and brown.

ARDS, ALI and DAD

• The histological manifestation of ARDS and ALI is ___?

• Abrupt onset of significant hypoxemia and diffuse pulmonary infiltrates in the absence of cardiac failure with no underlying aetiology is called A__ I___ Pn___

What are the black arrows pointing at?Clue: lining

Past exam PSA1.3 Part A Section 1, Summative Examination, First Semester, 2010

Mavis is a 68 year old retiree who presents to you one mid-winter day with worsening of her chronic cough. She smoked 20 cigarettes a day from the age of 18 until her retirement three years ago.

• Question 1. (6 marks) • a) What is the function of the cough reflex,

and by what two (2) basic mechanisms is it triggered? (3 marks)

b) Give one (1) feature of the type of cough you would expect in the following conditions.

(3 marks) • Asthma • Chronic Bronchitis • Vocal cord paralysis • Left heart failure • Gastro-oesophageal reflux • Bronchogenic carcinoma

At the end of the consultation you send Mavis off for a Chest X-Ray. She returns the following morning. The report describes a sub-segmental area of atelectasis in the right upper lobe.

• Question 2. (6 marks) • a) What is atelectasis, and by what

mechanisms is it caused? (3 marks)

• b) Give three (3) other radiological signs which may be associated with an area of atelectasis. (1 ½ marks)

• c) Give three (3) clinical conditions which can cause atelectasis. (1 ½ marks)

Mavis is later found to have a small cell carcinoma in her right upper lobe.

• Question 3. (4 marks) • Briefly outline the key features of small cell

carcinomas that have significance with respect to

• a) symptoms. (1 ½ marks) • b) management. (2 ½ marks)

• Mavis initially refuses to give up smoking after her treatment, saying there is no point, it is “too late”.

• Question 4 (8 marks) • a) Briefly outline the local and two (2)

systemic effects of smoking that make it a risk factor for respiratory disease. ( 3 marks)

• b) You try to persuade her by pointing out the benefits of smoking cessation at this stage. What will you tell her? (3 marks)

• c) List four (4) population-wide strategies to reduce tobacco consumption. (2 marks)

• Question 5. (6 marks) • In Question 4, you were asked to identify

benefits for Mavis from smoking cessation, even at this stage. As a long-term smoker, and particularly in view of her unwillingness to cease following treatment for lung cancer, Mavis would be described by some people as suffering from a self-induced disease.

• a) Briefly outline the two (2) common senses or notions of “self-induced” disease, as illustrated by the case of Mavis. (2 marks)

• b) Briefly explain why one (1) of these senses has potential negative implications for the patient. (2 marks)

• c) What beneficial purpose can the concept of “self-induced disease” serve? (2 marks)

T or F

• ALI/ARDS is a diagnosis of exclusion • True: ALI nor ARDS should be diagnosed until

other causes of acute bilateral infiltrates, severe hypoxemia, and respiratory distress have been excluded

What disease is this disease course?

During the early (or exudative) phase, the lesion is characterized by high permeability pulmonary edema followed by the formation of hyaline membranes. After seven to ten days, a proliferative phase may develop, with marked interstitial inflammation, fibrosis, and disordered healing.

F. Legionella pneumoniaG. Staphylococcus aureus

a. Bronchial asthmab. GORDc. Postnasal dripd. Mycobacterial infection

A. Lung hyperinflationB. Airflow obstruction C. Pulmonary hypertensionD. HypoxemiaE. Occult malignancy

A. Metastatic stomache cancerB. Metastatic colon cancerC. Metastatic pancreatic cancerD. Broncogenic carcinomaE. Peritoneal mesotheliomaF. Pleural mesothelioma

A. Heart failureB. PneumoniaC. Drug induced lupusD. Pulmonary embolismE. Hypoalbunemia