Flashcards in Pulm 2 Deck (53):
- 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
Normal trancheal pO2 and normal alveolar pO2
Think at rest
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)
Chronic granuloatous disease is deficient in what?
O2 to O2 (superoxide) within phagolysosomes => intracellular killing of orgs in phagosomes
Presentation of pts w/ CGD
- Recurrent bacterial and fungal infections (catalase positive ones)
- Skin/organ abscesses
- Suppurative adenitis
- Diffuse granuloma formation
Diagnostic tests of CGD
Measure PMN superoxide production
- DHR flow cytometry (preferred --- fluorescent green pigment)
- NBT testing (doesn't turn blue like normal)
Major virulence factor of S. pneumo
- Increased RBC mass (ABSOLUTE)
- Normal RBC mass w/ decreased plasma volume (RELATIVE)
>52% in men
>48% in women
How do you differentiate between absolute and relative erythrocytosis?
- Direct measurement of RBC mass
- Can't use Hct or Hb levels
Causes of absolute erythrocytosis?
- Polycythemia vera (RBC, WBC, plt increase)
- Only RBC increase
- Erythropoietin producing tumors
Causes of relative erythrocytosis
- Excessive diuresis (e.g. CHF emergent tx)
Hypoxic secondary erythrocytosis indicators?
Left HF signs in a person w/ recent MI
- Bibasilar crackles (at the lower lobes)
Due to decreased CO from LV => high end-diastolic pressure
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)
What type of channel is the CFTR protein in CF?
ATP-gated chloride channel
AR --- ∆F508 on chromosome 7
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
Humoral immune response - which type of CD4+ helper T cells?
- IL4 (IgE)
- IL5 (eos and IgA)
Dust inhaled 10-15 microm. How does the body clear it?
Trapped in upper airways
Dust inhaled 2.5-10 microm. How does the body clear it?
Reaches terminal bronchioli and alveoli
Alveolar macros MOA
- Take up dust => activation
- Release GFs (PDGF, IGF)
- Stimulates fibroblasts to proliferate/produce collagen
Pneumoconiosis arises b/c of inflammation and fibrosis of interstitium
Stages of lobal pneumonia
1) Congestion --- 24 hrs
2) Red Hepatization ---2-3 days
3) Gray hepatization --- 4-6 days
Congestion macro and micro appearance
- Affected lobe is red, heavy, boggy
- Vascular dilatation
- Alveolar exudate
- Alveoli containing bacteria
Red hepatization macro and micro appearance
- Red, firm lobe
- Alveolar exudate contains erythrocytes, PMNs, fibrin
Gray hepatization macro and micro appearance
- Gray-brown firm lobe
- RBCs disintegrate
- Alveolar exudate contains PMNs & fibrin
Resolution macro and micro appearance
- Restoration of normal architecture
- Enzymatic digestion of exudate
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
Budding yeasts w/ thick capsules? Immunocompromised?
Stained w/ mucicarmine
Cryptococcus neoformans complication in immunocompromised individuals
HIV, sarcoidosis, leukemia, high dose steroids
Sx of meningoencephalitis b/c of c. neoformans
CSF w/ india ink => budding yeasts w/ halos (peripheral clearings due to thick polysaccharide capsules)
Advantages of PPSV23
Decrease incidence of replacement strains due to lack of mucosal immunity
But only moderate levels of intermediate-affinity ABs
Advantages of PCV13
- Increased efficacy in elderly & children
- Recurrent obstruction of upper airway during sleep
- Each episode => reduced ventilation => transient hypercapnia & hypoxemia
- Systemic and pulm vasoconstriction
What can prolonged, untreated OSA cause?
- Pulm HTN
- a. fib
- ^ed risk of sudden cardiac death
Normal CD4+ count?
PNA organism in a 34y HIV+ w/ CD4+ of 800?
PNA organism in a 34yo HIV+ w/ CD4+
Thick-walled spherules packed w/ endospores
Pulm TB infection creates caseating granulomas using which cell mediators?
CD4+ T lymphs
Normal bronchi are lined with...?
Pseudostratified ciliated columnar cells
Interspersed w/ goblet cells (mucus production)
Smoking changes lining of bronchi to what...?
Stratified squamous metaplasia
Similar to Barrett esophagus
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
Enveloped viruses are inactivated by what?
- Ether and other organic solvents
- Dissolves lipid bilayer that makes up outer viral envelope
PCWP in ARDS?
ARDS is noncardiogenic pulmonary edema
ANOVA measures what?
compares difference of means of 2 or more groups
T-test measures what?
Compares the difference between means of 2 groups
Pulm infections in alcoholics. Common bugs?
- S pneumo
- Binds to 50s ribosomal subunit
- Disrupts protein synthesis
Covers anaerobes and G(+) orgs
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
Thoracentesis at risk for penetrating which structures?
Microscopic features of chronic bronchitis
- Thickened bronchial walls
- Lymphocytic infiltration
- Mucus gland enlargement
- Patchy squamous metaplasia
Cigarettes is leading cause