- 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

EITHER: - Increased RBC mass (ABSOLUTE) - Normal RBC mass w/ decreased plasma volume (RELATIVE) >52% in men >48% in women

- 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

Pulm 2 Flashcards by Eooooo m

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

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Normal trancheal pO2 and normal alveolar pO2

Trach:
150 mmHG

Alv:
104 mmHg

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Perfusion-limited?

Think at rest

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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)

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Chronic granuloatous disease is deficient in what?

NADPH oxidase

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

X-linked

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Presentation of pts w/ CGD

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

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Diagnostic tests of CGD

Measure PMN superoxide production

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

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Major virulence factor of S. pneumo

Polysaccharide capsule

Inhibits phagocytosis

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Polycythemia

EITHER:

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

> 52% in men
48% in women

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How do you differentiate between absolute and relative erythrocytosis?

Direct measurement of RBC mass

- Can’t use Hct or Hb levels

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Causes of absolute erythrocytosis?

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

Secondary:

Only RBC increase
Hypoxia
Erythropoietin producing tumors

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Causes of relative erythrocytosis

Dehydration

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

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Hypoxic secondary erythrocytosis indicators?

SaO2

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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

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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)

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What type of channel is the CFTR protein in CF?

ATP-gated chloride channel

AR — ∆F508 on chromosome 7

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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

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

Th2

Products:

IL4 (IgE)
IL5 (eos and IgA)

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

Trapped in upper airways

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

Mucociliary transport

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Dust inhaled

Phagocytosis

Reaches terminal bronchioli and alveoli

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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

Stages of lobal pneumonia

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

Congestion macro and micro appearance

Macro:
- Affected lobe is red, heavy, boggy

Micro:

Vascular dilatation
Alveolar exudate
Alveoli containing bacteria

Red hepatization macro and micro appearance

Macro: - Red, firm lobe - Liver-like Micro: - Alveolar exudate contains erythrocytes, PMNs, fibrin

Gray hepatization macro and micro appearance

Macro: - Gray-brown firm lobe Micro: - RBCs disintegrate - Alveolar exudate contains PMNs & fibrin

Resolution macro and micro appearance

Macro: - Restoration of normal architecture Micro: - 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?

THINK Cryptococcus neoformans Stained w/ mucicarmine

Cryptococcus neoformans complication in immunocompromised individuals

Meningoencephalitis HIV, sarcoidosis, leukemia, high dose steroids

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)

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

OSA

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

Normal CD4+ count?

400-1400

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

S. pneumo

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

Pneumocystis jiroveci

Thick-walled spherules packed w/ endospores Lung organism?

Coccidioides immitis

Pulm TB infection creates caseating granulomas using which cell mediators?

CD4+ T lymphs Macros

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 Loses infectivity

PCWP in ARDS?

Normal 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?

- Bacteroides - Prevotella - Fusobacterium - Peptostreptococcus - S pneumo

Clindamycin MOA

- 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?

Abdominal structures Liver definitely

Microscopic features of chronic bronchitis

- Thickened bronchial walls - Lymphocytic infiltration - Mucus gland enlargement - Patchy squamous metaplasia Cigarettes is leading cause

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