Pulm 3 Flashcards Preview

ID/LC Step Review > Pulm 3 > Flashcards

Flashcards in Pulm 3 Deck (62):
1

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

Frameshift mutation

2

In-frame deletion

One or more complete codons are deleted

Still multiple of 3 bp

3

Missense mutation

Base substitutions

Still multiple of 3 bp

4

Nonsense mutation

Stop codon prematurely

Still multiple of 3 bp

5

Most highly oxygenated blood in fetus

Umbilical vein => empties to IVC via ductus venosus

6

Fluticasone is a what?

Glucocorticoid

7

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

Persistent asthma

Can reduce number and severity of acute asthma exacerbations

8

Lungs of pt w/ untreated pesistent asthma

- Hyperinflated
- airway mucus plugging
- Cellular infiltration of bronchial wall

9

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)

10

Eosinophils release which protein?

Major basic protein

11

Normal function of protein released by eos?

Kills helminths

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

12

Weakness associated with OSA?

NeuroMSK of oropharynx

Think tx with hypoglossal nerve stimulation

13

Calculation for A-a gradient

PAO2 - PaO2

14

Normal A-a gradient

10-15 mmHg

15

Increased A-a gradient indicates what?

Hypoxemia

Causes:
- Shunting
- V/Q mismatch
- Fibrosis (impaired diffusion)

16

Normal A-a gradient w/ low PaO2

Hypoventilation (e.g. opioid use, unresponsiveness)

High altitude

17

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

18

FRC in obstructive vs restrictive lung disease?

Obstructive:
increased

Restrictive:
decreased

19

Hypoxia in COPD stimulates increased production of what?

Erythropoietin by cortical cells of kidney

Causes increased RBC production

20

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

21

"Serpentine cords" --- growth in parallel chains

Think what?

TB

Virulence: PMN inhibition, mitochondrial destruction, TNF release

22

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

23

C5-C9 deficiency

- Recurrent Neisseria infection

24

Wiskott-Aldrich syndrome

- Recurrent infections that worsen with age
- Easy bleeding
- Eczema

25

Chedick-Higashi syndrome

- Oculocutaneous albinism
- Pyogenic infections
- Progressive neuro dysfunction

26

Predominant lymphocyte type found in sarcoidosis

CD4+ T helper cells

27

Lab findings in sarcoidosis

- Hypercalcemia/calcuria
- Elevated serum ACE levels

28

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

Nucleolus

29

Nucleolus is the primary site for what?

rRNA transcription

30

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

RNA poly I

31

mRNA poly?

RNA poly II

32

snRNA poly?

RNA poly II

33

microRNA poly?

RNA poly II

34

tRNA poly?

RNA poly III

35

5S rRNA poly?

RNA poly III

36

DNA endonuclease function?

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

Important in DNA repair & RNA splicing

37

DNA polymerase

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

38

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

39

Clinical presentation of hyperIgM syndrome

- Recurrent sinopulm infections
- Lymphoid hyperplasia

40

Example of spore-forming bacteria

Bacillus anthracis

All clostridium species

41

What is unique about spore-forming bacteria

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

42

Macconkey agar purpose?

Only grows g(-)

When pink = lactose fermenter

43

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

44

Chloramphenicol MOA

Anti-ribosomal 50s

Most feared SE: aplastic anemia

45

Azithromycin MOA

Inhibits 50s ribosomal subunit

46

Ciprofloxacin MOA

Inhibit bacterial DNA gyrase => bacterial DNA damage and death

No effect on cell wall

47

Doxy MOA

Inhibit bacterial 30s ribosomal subunit

48

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

PCNs, cephalosporins, vanco

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

49

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

50

Where are the lung apices in relation to outer anatomy?

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

51

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

52

Tension pneumothorax signs/sx

- Tachycardia
- Hypotension
- Tachypnea
- Hypoxemia
- Absence of breath sounds and hyperresonance to percussion

Tx: needle thoracostomy or chest tube

53

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

54

Vitamin A function

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

55

Avitaminosis A

Causes squamous metaplasia => keratinizing epithelium

56

Alveolar gas equation

PAO2 = 150 - (PaCO2/0.8)

57

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

NOW

58

Cheyne-Stokes breathing

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

59

GO LOOK AT PRESSURE-VOLUME RELATIONSHIP GRAPHS

NOW

60

Triple combo ART tx in preggers w/ HIV

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

61

Clinical findings of vertical transmission of HIV-1

- Oral thrush
- interstitial PNA
- severe lymphopenia

62

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

Type II pneumocytes

Also produce surfactant