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Old 04-12-2012
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Lungs Emphysema. Lets make it straight

Emphysema is a pathologic increase in lung volume and in residual volume.

Can be caused by deficiency of a1-antitrypsin.

I am confused: so if a1-antyripsin is deficient - than the pt has panacinar emphysema. If a pt is smoker - smoke inactivates a1-antitrypsin, so there is no inhibition of neutrophil elastase which leads to tissue destruction and causes a centriacinar emphysema.

Thats what I thought before. Now UsmleConsult qbank says: smoking inhibits α1-antitrypsin by chemical modification of a methionine residue. Neutrophil elastase is uninhibited and destroys alveolar walls, causing panlobular emphysema.


I need some clarification
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Old 04-12-2012
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Alfa 1 antitrypsin def- panacinar seen on lower lobes- no inhibition for elastase
Smoke- centriacinar- upper lobes.
that's all you need to know for step 1 i think.
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Old 04-12-2012
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Originally Posted by LatinGeorge View Post
Alfa 1 antitrypsin def- panacinar seen on lower lobes- no inhibition for elastase
Smoke- centriacinar- upper lobes.
that's all you need to know for step 1 i think.
true dat.
Thats what I was thinking before came across that USmle consult Q [QID: 25422]
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Old 04-12-2012
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I think that's just a mistake in USMLE Consult.
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Old 04-13-2012
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Quote:
Originally Posted by DocSikorski View Post
..
Now UsmleConsult qbank says: smoking inhibits α1-antitrypsin ... causing panlobular emphysema.
...
If so, I think USMLE consult statement is not wrong, but is misleading, because it misses the principal pathological feature- centriacinar emphysema. You can read more inRubin's Pathology: Clinicopathologic Foundations of Medicine.

I would remember that smoking leads to centriacinar emphysema, mainly in upper lobes. It can be associated with panacinar emphysema in lower lobes.
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