- Recurrent Neisseria infection

Pulm 3 Flashcards by Eooooo m

When a exon measurement is not divisible by 3, think which type of mutation?

Frameshift mutation

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In-frame deletion

One or more complete codons are deleted

Still multiple of 3 bp

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Missense mutation

Base substitutions

Still multiple of 3 bp

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Nonsense mutation

Stop codon prematurely

Still multiple of 3 bp

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Most highly oxygenated blood in fetus

Umbilical vein => empties to IVC via ductus venosus

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Fluticasone is a what?

Glucocorticoid

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Long term use of glucocorticoids is the cornerstone tx for patients with what?

Persistent asthma

Can reduce number and severity of acute asthma exacerbations

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Lungs of pt w/ untreated pesistent asthma

Hyperinflated
airway mucus plugging
Cellular infiltration of bronchial wall

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Toxicity associated with ciprofloxacin for UTIs?

Theophylline toxicity

Inhibitions of metabolism caused by concurrent illness or other drugs (cimetidine, cipro, macrolides, verapamil)
Toxicity: excessive CNS stimulation (tremor, seizures), GI probs, CV probs (arryhthmias)

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Eosinophils release which protein?

Major basic protein

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Normal function of protein released by eos?

Kills helminths

Thought to contribute to bronchial epithelial damage in pts w/ atopic (extrinsic allergic) asthma

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Weakness associated with OSA?

NeuroMSK of oropharynx

Think tx with hypoglossal nerve stimulation

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Calculation for A-a gradient

PAO2 - PaO2

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Normal A-a gradient

10-15 mmHg

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Increased A-a gradient indicates what?

Hypoxemia

Causes:

Shunting
V/Q mismatch
Fibrosis (impaired diffusion)

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Normal A-a gradient w/ low PaO2

Hypoventilation (e.g. opioid use, unresponsiveness)

High altitude

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When you read “granules containing parallel stacks of membrane lamellae” what do you think?

Surfactant stored by Type II pneumocytes

Lines alveoli => v surface tension

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FRC in obstructive vs restrictive lung disease?

Obstructive:
increased

Restrictive:
decreased

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Hypoxia in COPD stimulates increased production of what?

Erythropoietin by cortical cells of kidney

Causes increased RBC production

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Poor inhalation technique of daily steroids for asthma can lead to what?

Medication deposition on oral mucous membranes
Can lead to oropharyngeal candidiasis

Should use a spacer and rinse mouth after steroid use

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“Serpentine cords” — growth in parallel chains

Think what?

Virulence: PMN inhibition, mitochondrial destruction, TNF release

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SCID characteristic features

Severe bacterial and viral infections in infancy
Chronic diarrhea
Mucocutaneous candidiasis

T&B cell dysfunction

Labs: absent T cells, & hypogammaglobulinemia & Absent thymic shadow

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C5-C9 deficiency

Recurrent Neisseria infection

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Wiskott-Aldrich syndrome

Recurrent infections that worsen with age
Easy bleeding
Eczema

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Chedick-Higashi syndrome

- Oculocutaneous albinism - Pyogenic infections - Progressive neuro dysfunction

Predominant lymphocyte type found in sarcoidosis

CD4+ T helper cells

Lab findings in sarcoidosis

- Hypercalcemia/calcuria | - Elevated serum ACE levels

Round, dense basophilic (dark-staining) body in nucleu

Nucleolus

Nucleolus is the primary site for what?

rRNA transcription

rRNA (18S, 5.8S & 28 S) synthesizing polymerase I

RNA poly I

mRNA poly?

RNA poly II

snRNA poly?

RNA poly II

microRNA poly?

RNA poly II

tRNA poly?

RNA poly III

5S rRNA poly?

RNA poly III

DNA endonuclease function?

Break phosphodiester bonds w/in the nucleotide chain in DNA & RNA Important in DNA repair & RNA splicing

DNA polymerase

- Primary enzymes responsible for DNA replication & repair - Found in the nucleus

Hyper-IgM syndrome

X-linked recessive - Inability of B-lymphs to undergo isotype switching from IgM to others - Results from CD-40 ligand absence on T-lymphs OR genetic deficiency in enzymes responsible for DNA modification

Clinical presentation of hyperIgM syndrome

- Recurrent sinopulm infections | - Lymphoid hyperplasia

Example of spore-forming bacteria

Bacillus anthracis All clostridium species

What is unique about spore-forming bacteria

- Can survive boiling (at 100ºC) - Found in soil - Capable of forming spores (duh)

Macconkey agar purpose?

Only grows g(-) When pink = lactose fermenter

Encapsulated, lactose (+), g(-), appear mucoid in culture PNA in pts w/ impaired host defense/alcoholics

Klebsiella - Tissue necrosis - Early abscess formation with production of thick, mucoid, blood-tinged sputum

Chloramphenicol MOA

Anti-ribosomal 50s Most feared SE: aplastic anemia

Azithromycin MOA

Inhibits 50s ribosomal subunit

Ciprofloxacin MOA

Inhibit bacterial DNA gyrase => bacterial DNA damage and death No effect on cell wall

Doxy MOA

Inhibit bacterial 30s ribosomal subunit

Which anti-bacterials disrupt peptidoglycan cell wall of g(+) orgs?

PCNs, cephalosporins, vanco Can't survive osmotic stress, ability of bacteria lost after tx

After the oxygenated blood leaves the pulm area, it mixes with deoxygenated blood in the pulm veins. Where is the deoxygenated blood coming from?

- Bronchial arteries/veins - Thebesian veins LA/LV have less oxygen in the blood compared to pulm veins

Where are the lung apices in relation to outer anatomy?

Above clavicle and first rib between lateral sternal line and midclavicular line

Tension pneumothorax pathophys

- Due to pleural injury - Increasing air volume => lungs and mediastinum deviate to opposite side of chest - Causes increased pressure in chest cavity => decreased systemic venous return to heart => decreased CO

Tension pneumothorax signs/sx

- Tachycardia - Hypotension - Tachypnea - Hypoxemia - Absence of breath sounds and hyperresonance to percussion Tx: needle thoracostomy or chest tube

When dust is inhaled into the lungs and stopped in the terminal bronchioles, what clears it? What about distal to these terminal bronchioles?

Terminal: Ciliated mucosa Distal to terminal: Macros

Vitamin A function

Maintains orderly differentiation of specialized epithelium: - Mucus-secreting columnar epithelia of conjunctive - respiratory tracts - Urinary tracts - Pancreatic ducts

Avitaminosis A

Causes squamous metaplasia => keratinizing epithelium

Alveolar gas equation

PAO2 = 150 - (PaCO2/0.8)

GO REVIEW THE PULM-VOLUME CURVE (time x lung volume)

NOW

Cheyne-Stokes breathing

- Cyclic breathin - Apnea is followed by increasing, then decreasing tidal volumes until next apneic period - seen in advanced CHF

GO LOOK AT PRESSURE-VOLUME RELATIONSHIP GRAPHS

NOW

Triple combo ART tx in preggers w/ HIV

- 2 nucleoside/nucleotide reverse transcriptase inhibitors | - 1 protease/NNRT/integrase inhibitor

Clinical findings of vertical transmission of HIV-1

- Oral thrush - interstitial PNA - severe lymphopenia

Which pneumocytes are capable of lung cell proliferation in response to injury?

Type II pneumocytes Also produce surfactant