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Flashcards in Pulm 2 Deck (53):
1

Actinomycosis

- Slowly progressive dz due to g(+) anaerobic bacteria
- Orgs colonize mouth, colon, vagina (think dental caries, poor dentition)
- Alcoholics ^ed risk
- Filamentous branching patterns & sulfur granules

TX: PCN

2

Normal trancheal pO2 and normal alveolar pO2

Trach:
150 mmHG

Alv:
104 mmHg

3

Perfusion-limited?

Think at rest

4

Diffusion-limited?

Think exercise, emphysema, and pulm fibrosis (can't get enough O2 to caps b/c of thickness

O2 does not equilibrate by the time it meets the end of the capillary (20mmHg from alveolus only gives 10mmHg to cap)

5

Chronic granuloatous disease is deficient in what?

NADPH oxidase

O2 to O2 (superoxide) within phagolysosomes => intracellular killing of orgs in phagosomes

X-linked

6

Presentation of pts w/ CGD

- Recurrent bacterial and fungal infections (catalase positive ones)
- PNA
- Skin/organ abscesses
- Suppurative adenitis
- Osteomyelitis
- Diffuse granuloma formation

7

Diagnostic tests of CGD

Measure PMN superoxide production

- DHR flow cytometry (preferred --- fluorescent green pigment)
- NBT testing (doesn't turn blue like normal)

8

Major virulence factor of S. pneumo

Polysaccharide capsule

Inhibits phagocytosis

9

Polycythemia

EITHER:

- Increased RBC mass (ABSOLUTE)
- Normal RBC mass w/ decreased plasma volume (RELATIVE)

>52% in men
>48% in women

10

How do you differentiate between absolute and relative erythrocytosis?

- Direct measurement of RBC mass
- Can't use Hct or Hb levels

11

Causes of absolute erythrocytosis?

Primary:
- Polycythemia vera (RBC, WBC, plt increase)

Secondary:
- Only RBC increase
- Hypoxia
- Erythropoietin producing tumors

12

Causes of relative erythrocytosis

- Dehydration
- Excessive diuresis (e.g. CHF emergent tx)

13

Hypoxic secondary erythrocytosis indicators?

- SaO2

14

Left HF signs in a person w/ recent MI

- Dyspnea
- Bibasilar crackles (at the lower lobes)
- S3

Due to decreased CO from LV => high end-diastolic pressure

15

Why do you get dyspnea from L. HF?

high end-diastolic pressure => ^ed hydrostatic pressure in pulm circulation => transudation of fluid into interstitium

Causes decreased lung compliance (can't stretch b/c fluid distorts lung tissue)

16

What type of channel is the CFTR protein in CF?

ATP-gated chloride channel

AR --- ∆F508 on chromosome 7

17

Sarcoidosis dysregulated immune response

Th1 => secretes IL-2, IFN-gamma (aka cell-mediated)

IL-2: autocrine proliferation of Th1

IFN-gamma: activates macros => granuloma formation

18

Humoral immune response - which type of CD4+ helper T cells?

Th2

Products:
- IL4 (IgE)
- IL5 (eos and IgA)

19

Dust inhaled 10-15 microm. How does the body clear it?

Trapped in upper airways

20

Dust inhaled 2.5-10 microm. How does the body clear it?

Mucociliary transport

21

Dust inhaled

Phagocytosis

Reaches terminal bronchioli and alveoli

22

Alveolar macros MOA

- Take up dust => activation
- Release GFs (PDGF, IGF)
- Stimulates fibroblasts to proliferate/produce collagen
- Inflammation

Pneumoconiosis arises b/c of inflammation and fibrosis of interstitium

23

Stages of lobal pneumonia

1) Congestion --- 24 hrs
2) Red Hepatization ---2-3 days
3) Gray hepatization --- 4-6 days
4) Resolution

24

Congestion macro and micro appearance

Macro:
- Affected lobe is red, heavy, boggy

Micro:
- Vascular dilatation
- Alveolar exudate
- Alveoli containing bacteria

25

Red hepatization macro and micro appearance

Macro:
- Red, firm lobe
- Liver-like

Micro:
- Alveolar exudate contains erythrocytes, PMNs, fibrin

26

Gray hepatization macro and micro appearance

Macro:
- Gray-brown firm lobe

Micro:
- RBCs disintegrate
- Alveolar exudate contains PMNs & fibrin

27

Resolution macro and micro appearance

Macro:
- Restoration of normal architecture

Micro:
- Enzymatic digestion of exudate

28

How do you treat group B strep in pregnant women?

Test at 35-37 wks

INTRApartum antibiotics (PCN or amp)

Prevents neonatal GBS sepsis, PNA, and meningitis

29

Budding yeasts w/ thick capsules? Immunocompromised?

THINK

Cryptococcus neoformans

Stained w/ mucicarmine

30

Cryptococcus neoformans complication in immunocompromised individuals

Meningoencephalitis

HIV, sarcoidosis, leukemia, high dose steroids

31

Sx of meningoencephalitis b/c of c. neoformans

- HA
- N/V
- Confusion

CSF w/ india ink => budding yeasts w/ halos (peripheral clearings due to thick polysaccharide capsules)

32

Advantages of PPSV23

Decrease incidence of replacement strains due to lack of mucosal immunity

But only moderate levels of intermediate-affinity ABs

33

Advantages of PCV13

- Increased efficacy in elderly & children

34

OSA

- Recurrent obstruction of upper airway during sleep
- Each episode => reduced ventilation => transient hypercapnia & hypoxemia
- Systemic and pulm vasoconstriction

35

What can prolonged, untreated OSA cause?

- Pulm HTN
- RHF

Also:
- a. fib
- arrhythmias
- CAD
- ^ed risk of sudden cardiac death

36

Normal CD4+ count?

400-1400

37

PNA organism in a 34y HIV+ w/ CD4+ of 800?

S. pneumo

38

PNA organism in a 34yo HIV+ w/ CD4+

Pneumocystis jiroveci

39

Thick-walled spherules packed w/ endospores

Lung organism?

Coccidioides immitis

40

Pulm TB infection creates caseating granulomas using which cell mediators?

CD4+ T lymphs

Macros

41

Normal bronchi are lined with...?

Pseudostratified ciliated columnar cells

Interspersed w/ goblet cells (mucus production)

42

Smoking changes lining of bronchi to what...?

Stratified squamous metaplasia

Similar to Barrett esophagus

43

Exercise's effect on pCO2

- Increases pCO2 of mixed venous blood
- Due to increased skeletal muscle CO2 production

Homeostatic => maintains arterial blood gas and arterial pH near resting levels

44

Enveloped viruses are inactivated by what?

- Ether and other organic solvents
- Dissolves lipid bilayer that makes up outer viral envelope

Loses infectivity

45

PCWP in ARDS?

Normal

ARDS is noncardiogenic pulmonary edema

46

ANOVA measures what?

compares difference of means of 2 or more groups

47

T-test measures what?

Compares the difference between means of 2 groups

48

Pulm infections in alcoholics. Common bugs?

- Bacteroides
- Prevotella
- Fusobacterium
- Peptostreptococcus
- S pneumo

49

Clindamycin MOA

- Binds to 50s ribosomal subunit
- Disrupts protein synthesis

Covers anaerobes and G(+) orgs

50

Thoracentesis should be performed where?

- Above 8th in midclavicular line
- above the 10th rib along the midaxillary line
- Above 12th rib along the posterior scapular or paravertebral line

51

Thoracentesis at risk for penetrating which structures?

Abdominal structures

Liver definitely

52

Microscopic features of chronic bronchitis

- Thickened bronchial walls
- Lymphocytic infiltration
- Mucus gland enlargement
- Patchy squamous metaplasia

Cigarettes is leading cause

53

Complications associated w/ concentrated O2 tx for neonatal respiratory distress syndrome

Retinopathy of prematurity/retrolental fibroplasia

- Abnormal retinal neovascularization => major cause of blindness
- Due to up-regulation of VEGF when returned to room air