How do centriacinar and panacinar emphysema differ?

Centriacinar disease begins centrally and favors upper lungs with smoking. Panacinar disease involves the whole acinus and favors lower lungs with alpha-1 antitrypsin deficiency.

Why can alpha-1 antitrypsin deficiency injure lung and liver?

Too little protein reaches the lung while misfolded protein remains trapped in liver cells.

Which emphysema pattern causes subpleural blebs?

Paraseptal emphysema affects the distal acinus near pleura and septa.

Room 1 of 4

Build the acinus before naming the damage.

Both diseases destroy air-exchange tissue. The useful question is where destruction begins inside one acinus. Commit the airflow order first.

No diagnosis labels unlock until the sequence is correct.

Airflow sequence

What receives air next?

The acinus begins just distal to the terminal bronchiole. Its respiratory bronchioles, alveolar ducts, and alveolar sacs exchange gas.

Room 2 of 4

Place the damage in three dimensions.

Choose acinus region, vertical lung zone, and cause for each patient. The diagnosis, pathology, and comparison remain hidden until commitment.

Mara, 62

Forty pack-years and progressive dyspnea. Commit before the CT pattern appears.

1. Acinus region

2. Lung zone

3. Cause

TOP

MIDDLE

BOTTOM

Abstract zone meter. No anatomical outline.

Pattern	Acinus	Zone and cause
Centriacinar	Center first, distal spaces spared early	Upper lungs, smoke
Panacinar	Whole acinus uniformly	Lower lungs, alpha-1 antitrypsin deficiency
Paraseptal	Distal edge near pleura	Subpleural blebs, pneumothorax

Room 3 of 4

Eli is 34. Predict both organ failures.

Alpha-1 antitrypsin is an antiprotease. It normally keeps neutrophil elastase from chewing through alveolar walls.

What happens in Eli's lung when too little protein reaches blood?

What happens in Eli's liver when the protein misfolds?

Lung problem: loss of protection.

Liver problem: toxic retention.

Room 4 of 4

Thirty different problems. One spatial model.

Right-click or long-press to cross out. Double-click or double-tap to highlight. Clues glow only after answer lock.