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Flashcards in Respiratory - Stuff Missed Deck (171):
1

Major component of pulmonary surfactant

Phosphatidylcholine (aka lecithin) - it is measured to gauge fetal lung maturity

2

How to assess fetal lung maturity

When lecithin (phosphatidylcholine) to sphingomyelin ratio (L/S ration) in amniotic fluid is =/ > 2
- measured in cases of premature labor or premature of rupture of membranes

3

How to assess fetal neural tube defect

amniotic fluid is sampled to measure alpha fetoprotein (AFP)

4

Anaphylaxis

systemic version of local allergenic response due to cross-linking of surface IgE to signal degranulation
- systemic vasodilation
- increased vascular permeability
- airway constriction
- mediated by histamine, heparin, and vasoactive peptide
-

5

Conducting zone of respiratory tree

Large airways (nose, pharynx, bronchi)
Smaller airways (bronchioles, terminal bronchioles)

- warm, humidifies, and filiters air but NO GAS EXCHANGE

6

Respiratory zone of respiratory tree

Respiratory bronchioles (mostly cuboidal)
Alveolar ducts
Alveoli (simple squamous)
- GAS EXCHANGE HAPPENS HERE
-

7

Which structural components end in bronchi

Cartilage
Goblet cells

8

Which structural components end in terminal bronchioles

Pseudostratified columnar cells - to beat mucous out of lungs
Smooth muscle of airway walls

9

Cystic fibrosis

- phenylalanine removal at base pair 508
- mutation impairs post-translational processing of CFTR transcript and degrades protein before it can transported to cell surface
- aka abnormal transport of protein to cell surface

10

Secondary reactivation tuberculosis

occurs in patients previously infected by tuberculosis
- occurs in immunosuppressed patients
- characterized by apical lesions and hemoptysis

11

Primary tuberculosis

formation of Ghon foci (calcified granulomas) in lower lung fields

12

Common signs of sarcoidosis

- Erythema nodosum
- Hilar lymphadenopathy
- Elevated serum AVCe levels
- liver biopsy usually shows scattered granulomas

13

Discuss peak expiratory flow rates

Decreased in obstructive lung disease
- FEV1 is decreased
- FVC is very decreased
- leads to decreased FEV1/FVC

14

Systemic response to patient with COPD (remember: smoker and chronic cough)

- Patient has hypoxia, thus may have increased erythopoietin production

15

Type I pneumocytes

- line 97% of alveolar surfaces
- line alveoli
- thin for optimal gas diffusion

16

Type II pneumocytes

- secrete surfactant
- cuboidal and clustered
- precursors for type I pneumoncytes
- these cells proliferate during damage

17

Surfactant

secreted by type II pneumocytes
- decrease alveolar surface tension and prevent alveolar collapse

18

Clara cells

non-cilliated
- columnar with secretory granules
- secrete component of surfactant
- degrade toxins
- act as reserve cells

19

When does surfactant synthesis begin?

Week 26 of gestation, but mature levels not reached until week 35

20

Meconium ileus

-commonly caused by Cystic Fibrosis
-abnormalities in Cl, Na, water transport by ductal epithelium causes isotonic dehydration of lumen

21

Signs of small bowel obstruction

bilious vomiting
abdominal distention
air fluid levels
small bowel dilatation

22

Meconium illeus

- signs of small bowel obstruction (bilious vomiting, abdominal distention, air fluid levels, and small bowels)
- INSPISSATED GREEN MASS (distal ileum obstructed by dehydrated meconium)
- associated with CF

23

Common complications of cystic fibrosis

- Treatment resistant pneumonias
- Bronchiectasis
- Bronchitic obstructive disase
- Cor pulmonale

24

What makes the pulmonary vascular bed unique in its response to hypoxia?

In times of hypoxia, pulmonary vascular bed VASOCONSTRICTS to divert blood flow away to more ventilated areas

25

Patients with asbestos risk exposure are at risk for which cancer?

- Bronchogenic carcinoma
- Mesothelioma (is second)

26

Asbestosis

- calcific plaques in parietal pleura
- diffuse pleural thickening of lower lung lobes
- interstitial lung fibrosis and asbestos bodies are seen
- asbestos bodies are coovered in iron
- symptoms appear until 15-20 years after initial exposure

27

Smoking + Asbestos increases risk for what cancer

- Give 55x increased risk for bronchogenic cancers in comparison to non-smokers with asbestos exposure

28

Normal tracheal pO2
Normal alveolar pO2
Normal alveolar pCO2

Tracheal pO2 = 150 mmHg
Alveolar pO2 = 104 mmHg
Alveolar pCO2 = 40 mmHG

29

The equilibration of between venous blood and alveolar air is dependent on what?

The O2 equilibration is perfusion limited

30

Recurrent pulmonary infections
Exocrine gland fibrotic atrophy
Mucus plugs

THINK CF!!!`

31

Vitamin A

- fat soluble
- maintains orderly differentiation of specialized epithelia, which includes mucous secreting epithelia, respiratory tracts, pancreatic tracts

32

Vitamin deficency

- can cause night blindness
- squamous metaplasia of epithelia

33

Risk factors for asthma

- genetic predisposition to have more Th2 cells than Th1 cells
- environmental irritants (e.g. smoking) triffer bronchospasm

34

Ethambutol

antimycobacterial agent that inhibits carbohydrate polymerization, thus preventing peptidoglycan wall sythesis

35

Side effect of ethambutol

Optic neuritis
- presents in conjunction with decreased visual acuity, central scotomas, and color blindness

36

Rifampin

directly inhibits DNA-dependent RNA polymerase
- disrupts transcription of DNA into RNA

associated with hepatotoxivity and red-orange discoloration of bodily secretions

37

Isoniazid

inhibits mycolic acid syntehsis

- associated with liver toxicity and peripheral neuropathy
- may cause Vitamin B6 deficiency

38

Common consequences of left ventricular infarction

- Cardiogenic acute pulmonary edema
- Pulmonary hypertension (due to congestion)
- Transudate of plasma into lung interstitium

39

Hemosiderrin-containing macrophages in alveoli

- suggestive of prior episodes of pulmonary congestion and edema from chronic LHF
- when RBC extravasate into alveoli due increased intravascular pressure, hemosiderin collegct

40

Focal necrosis of alveolar walls

associated with pulmonary hemorrhage syndromes (e.g. Goodpastures, Wegner's and SLE

41

Azoles

inhibit synthesis of ergosterol by fungal cytochrome P450 enzymes
- suppress P450 system resulting in many drug-drug interactions

42

Amphotericin B

polyene antifungal that binds to ergosterol in fungal cell membrane
- leads to pore formation and cell lysis

43

Griseofulvin

enters fungal cells and binds microtubules

44

Theophylline intoxication

Seizures
Abdominal pain
Vomitting
Tachyarrhythmias

45

Treatment of theophylline toxicity

gastric lavage and administering charcoal
- treat cardiac arrhythmias with B-blockers

46

Cystic fibrosis

- autosomal RECESSIVE
- defect in CFTR gene in chromosome 7
- most common defect leads to protein degradation before it gets cell surface

47

Unaffected person with unaffected parents who has a sibling with an autosomal recessive disease (e.g. cystic fibrosis) has what chance of carrying the disease?

2/3

- both parents must be Aa
Aa x Aa will create the following possibilities
1 AA
2 Aa,
aa (affected sibling)

48

Blastomycosis

- dimorphic fungus found in Great Lakes, MS, and OH River basins
- transmitted by respiratory route, entering lungs and transforms into yeast
- causes flu-like illness or productive cough
- may become chronic infection and associated with granulomas

49

Aspergillus fumigatus

- opportunistic pathogen
- causes invasive aspergillosis in immunocompromised patients
- aspergillomas in patients with lung cavities (e.g. TB)
- allergic bronchopulmonary aspergillosus in asthma

50

Cryptococcus neoformans

- only fungus with pathogenic capsule
- inhaled and causes meningitis via hematogenous spread to meninges
- affects immunocompromised patients (e.g transplant patients, AIDS patients, diabetics??)
- stained with methanmine silver and muscarimine (detects polysaccharide)

51

Hemoptysis in elderly smoker

Likely lung cancer

52

Pancoast tumor

- lung cancer tumor found in lung apex in superior sulcus
- Characterized by:
- severe pain in shoulder that radiates towards axilla and scapula
- Horner's syndrome (ptosis, anhydrosis, miosis)
- upper extremity edema (compression of subclavian vessels)
- spinal cord compression/ paraplegia

53

Pancoast syndrome

- ispilateral Horner's syndrome
- rib destruction
- atrophy of hand muscles
- pain in C8, T1, T2 nerves

54

S. pneumoniae

Gram positive diplococci
Lancet shaped
Optochin sensitive
Bile soluble (unable to grow in bile)
Alpha hemolytic

55

Transformation

-ability to uptake and express naked DNA made available when another bacterial cell dies

- SHiN bacteria can do this (S. pneumoniae, H. influenzae, Neisseria)

56

Irritation of mediastinal or diaphragmatic parietal pleura will transmitted by which nerve

Phrenic nerve (C3-C5)
- may cause sharp pain worsened upon inspiration

57

Legionella pneumophila

Gram negative (but difficult to stain)
- use silver stain
- contaminates water sources and air conditioning systems
- grows on charcoal yeast and aerosilized water

58

Cause of green discoloration of pus or sputum during bacterial infections

Associated with release of myeloperoxidase (MPO) from neutrophil azurophilic granules
- MPO contains heme

59

Myeloperoxidase

- heme containing molecules contained with azurophilic granules of neutrophiles that catalyze HOCl from chloride and H2O2 during respiratory burst
- responsible for green color of sputum or pus in bacterial infections

60

Acid fast staining

carried out by applying an aniline dye (e.g. carbolfuchsin) to a smear and then decolorizing with acid alcohol to reveal whether organisms are acid fast

(e.g. Mycobacterium and Nocardia species)

61

Discuss work of breathing and patietns with increased elastic resistance (e.g pulmonary fibrosis)

Work of breathing is MINIMIZED in patients with increased elastic resistance (e.g pulmonary fibrosis) when their respiratory rate is high and tidal volume in low (fast, shallow breaths)

62

Discuss work of breathing and patients with decreased elastic resistance (e.g. asthma, COPD)

Work of breathing is MAXIMIZED in patients with decreased elastic resistance (e.g. asthma or COPD) at lower respiratory rate/higher tidal volume to minimize work of breathing

63

Pathogenecity of H. influenzae

- depends on presence of antiphagocytic polysaccharide capsule
- type b is most invasive and virulent (with ribose capsule instead of the hexose seen in other)
- Unencapsulated H. influenzae are part of normal intenstinal flora

64

Metaplasia

adaptive change that occurs in response to chronic irritation
(e.g. Barrett's esophagus - due to longstanding GERD & Smoking which can cause squamous bronchial metaplasia)

65

Discuss high altitude - in terms of CO, HR, pO2, and pCO2

- Condition of hypoxia so increases CO, HR to improve oxygen delivery
- pO2 and pCO2 would be lower than normal

66

Discuss pulmonary embolism - in terms of CO, HR, pO2, and pCO2

- Causes low blood flow to left side of heart
- Decreased CO thus compensated tachycardia takes place
- Hypoxemia and lung vagal stimulation produces hyperventilation and respiratory alkalosis

67

Discuss carotid sinus massage - in terms of CO, HR, pO2, and pCO2

causes reflex vagal discharge to SA node, atrial myocytes, and AV node
- HR and CO are reduced
- would not affect pO2 and pCO2

68

Discuss panic attack - in terms of CO, HR, pO2, and pCO2

- sympathetic stimulation causes increase in CO and HR
- but hyperventilation causes lowered pCO2 and respiratory alkalosis

69

Discuss exercise - in terms of CO, HR, pO2, and pCO2

- increased heart rate, increased cardiac output, and increased respiratory rate balance the increased oxygen consumption and CO2 production
- arterial blood gases remain the same, BUT VENOUS oxygen is decreased and VENOUS CO2 is increased

70

Tissue destruction caused by M. tuberculosis

- associated with granulomatous inflammation with caseating necrosis
- due to T-lymphocyte mediated delayed type of hypersensitivity
- stems from Th1 lymphocyte simulation of both macrophages and CD8 T lymphocytes

71

Signs of exudation and alveolar hepatization

associated with S. pneumoniae

72

Churg-Strauss Syndrome

- necrotizing GRANULOMATOUS inflammation with EOSINOPHILS
- associated with ASTHMA, palpable purpura, peripheral neuropahty
- p-ANCA

73

Idiopathic pulmonary fibrosis

insiduous onset progressive exertional dyspnia
- restrictive lung disease profile
- biopsy with honeycomb lung (fibrosis with paraseptic and subpleural enlargement

74

Acute Respiratory Distress Syndrome ARDS

diffuse injury to alveolicapillary membraine results in interstitial and intraalveolar edema, acute inflammation, and alveolar hyaline membranes

- acute necrotizing pancreatitis is major risk factors
- commonly caused by:
- gastric aspiration, shock, trauma, or infection

75

Negative Predictive Value

probability of not having a disease when a given a negative test results
- is dependent on prevalence
- inversely dependent on prevalence of disease
-

76

Adenocarcinoma

- most common lung cancer in general population
- common in women and non-smokers
- located peripherally and consists of tumor cells that form glandular structures

77

Squamous cell carcinoma

- found centrally
- necrosis & cavitation are common
- associated with hypercalcemia (due to secretion of PTHrP

78

Large cell carcinoma

- locately peripherally
- associated with gynecomastia and galactorrhea

79

Small cell carcinoma

- located centrally
- may produce ACTH or ADH or cause Lambert-Eaton syndrome (anti-bodies against presynaptic Ca channels, prevents ACh release)

80

Acute epiglottis

associated with rapidly progressive fever, sore throat, progressive airway obstruction
- associated with H. influenzae type b
- vaccine has dropped incidence of this disease

81

Describe Mycobacterial resistance to isonizaid

- Non-expression of catalase-peroxidase enzyme OR
- genetic modification of isoniazid binding site on mycolic acid synthesis enzyme

82

CMV

- interstitial pneumonia in transplant patient
- has cytoplasmic inclusion bodies
- contains double stranded DNA genome

83

Most common side effect of inhaled glucocorticoids (e.g. albuterol)

- Development of oral candidiasis (as result of immunosuppression)

84

Systemic ieffects of inhaled glucocorticoids

- Increased intraoccular pressure
- Cataracts
- Growth retardation in children
- Bone loss
- Suppression of Hypothalamus-Pituitary Axis (HPA Axis)

85

Primary infection of TB

- occurs after inhaling aerosilized secretions of patient infected with TB
- characterized by Ghon complex (lower lung lesion) and ipsilateral hilar adeopathy (calcified hilar lymph node)

86

Hematogenous dessimation of TB

associated with extrapulmonary symptoms
- Pott disease
- tuberculous meningitis
- psoas abcess
- miliary tuberculosis ( small, scattered seed-like foci of infection throughout body)

87

Most effective anti-inflammatory agents for chronic prevention of asthma

Corticosteroids (e.g Fluticasone)
- don't have direct bronchodilatory effect, but minimize airway hyperresponsiveness by reducing inflammation (inducing apoptosis of inflammatory cells)

88

Hamartomas

common benign lung tumors
- present as asymptomatic peripherally located "coin lesion" with "popcorn calcifcaitions" in patients 50-60 years old
- composed of disorganized hyaline cartilage, fibrous tissue, and adipose tissue

89

Fat embolism

- occurs within days of long bone fractures
- associated with
respiratory distress
diffuse neurological impairment (e.g. confusion)
upper body diffuse petichial rash (due to thrombocytopenia)
** multiple fat emboli stain black with osmium tetroxide

90

Virchow's triad

- associated with development of deep vein thrombosis
Endothelial injury
Venous stasis
Hypercoaguable state

91

Major risk factors for deep venous thormbosis

- older age
- major lower extremity surgery (e.g hip surgery)
- subsequent immobility

92

Mycoplasma pneumonia

- causative agent of walking pneumonie
- has no peptipglycan cell wall, only has phospholipid bilaer
- shares antigen with human RBCs so when body immune response mount, it also lyses RBCs which lead to anemia
- associated with COLD AGGLUTININS

93

Pulmonary hypertension and Scleroderma

- pulmonary hypertension in patients with scleroderma caused by damage to pulmonary arterioles
- manifests with accentuated pulmonary component of 2nd heart sound
- signs of right-sided heart failure

94

Scleroderma

associated with increased deposition of collagen in tissues
- affected tissue secrete cytokines (e.g. TGF-beta) that increased collagen production and ECM proteins by fibroblasts

95

Pneumoccocal vacine

- recommended for all adults > 65 years and for patients with COPD, asplenia, or immune suppression
- is an unconjugated polysaccharide vaccine that does not stimulate T-cell response

96

Examples of inactivated toxin vaccines

Diptheria and Tetanus vaccines

97

Bosentan

- competitive antagonist for endothelial receptors used for primary (idiopathic) pulmonary arterial hypertension
- used for treatment of pulmonary hypertension

98

Clopidogrel

- inhibits ADP induced platelet aggregation

99

Blastomyces dermatidis

dimorphic fungus - changes due to temperature
- fungus outside of body
- yeast inside of the body
- in tissue as round yeast with doubly refractive walls and broad based budding
- can cause flu-like illness or pneumonia
- diagnosed by KOH preparation

100

Hyperacute rejection

occurs within minutes of transplantation
- performed antibodies against ABO or HLA are the cause
- can cause blood vessel spasm and intravascular coagulation
- rare and IRREVERSIBLE

101

Acute rejection

occurs 1-2 weeks after receiving transplant
- represents recipient reaction to HLA to graft
- CELL MEDIATED IMMUNE RESPONSE
- causes vascular damage
- microscopy shows lymphocytes
- IMMUNOSUPPRESSANTS CAN TREAT THIS

102

Chronic rejection

occurs months or years after transplant
- associated with fibrosis

103

Chronic reject in lung transplantation

- cuases inflammation of small bronchioles
- inflammation of bronchiolar wall leads to narrowing and obstruction
- patients present with dyspnea, non-productive cough and wheezing

104

In the lung, which cells release elastase?

- Alveolar macrophages (specifically in lysosome)
- Neutrophils (in azurophilic granules)

105

Clara cells

non-cilliated secretory cells which liver in terminal respiratory bronchioles
- secrete protein which inhibits neutrophil recruitment and activation
- associated with surfactant

106

Thoracocenteis should be performed where to avoid hitting abdominal strucures

- above 7th rib in mid-clavicular line
- above 9th rib along midaxillary line
above 11 rib along paravertebral line

** hitting below rib risks hitting subcostal neurovascular bundle

107

Superior vena cava syndrome

- due to compression of SVC that impairs drainage from head, often caused by malignancy (e.g lung cancer) or thrombossis from indwelling catheters

presents with facial swellign, conjunctiva
- JVP
- upper extremity edema
- heart sounds are fine

108

Complications associated with SVC syndrome

- Headaches, dizziness, and increased risk of rupture/aneurysm of cranial arteries

109

Amphotericin B

binds ergosterol of fungal cell membrane to exert antifungal effects

110

Amphotericin B side effects

- binds to cholesterol, which can cause toxicity
- important side effects are nephrotoxicity (dose dependent because it can decrease GFR) , hypokalemia, and hypomagnesmia

111

Which enzymes / cells are responsible for formation of abcesses and tissue damage

Lysosomal enzymes released by neutrophils and macrophages

-

112

IFN-gamma

reponsible for phagolysosome formation
inducible NO synthase relase
- development of granulomas and caseous necrosis

113

IL-12

stimulates natural killer cells and is responsible for T helper cell secretion of IFN-gamma

114

Stages of Lobar pneumonia

1. Congestion (first 24 hours)
2. Red hepatization (day 2-3)
3. Gray hepatization (day 4-6)
4. Resultion

115

Congestion stage of lobar pneumonia

- occurs within first 24 hours
- affected lobe in red, heavy and boggy microscopically
- vascular dilation
- alveolar exudate contains mostly bacteria

116

Red hepatization stage of lobar pneumonia (4)

- occurs within 2-3 days
- lung looks red, firm (liver-like consistency)
- alveolar exudate contains erythrocytes, neutrophils, and fibrin

117

Gray hepatization stage of lobar pneumonia

- occurs within 4-6 days
- gray-brown firm lobe
- RBC disintegrate
- Alveolar exudate filled with neutrophills and fibrin

118

Resolution stage of lobar pneumonia

Restoration of normal architecure
- enzymatic digestion of exudate

119

Culture requirements of H. influenza

- Chocolate agar with factor V (NAD+) and factor X (Hemati)

** can't grow in sheep agar because it lacks the nutrients and has enzymes which inhibit factor V

120

H. influenzae

small gram negative coccobaccilli
EMOP (Esophagitis, Meningitis (in young kids) , Otitis Media, Pneumonia)
- requires chocolate agar with factor V and factor X

121

Discuss S. aureus and H. influenzae sattelite phenomenon

H. influenzae can only grow in sheep agar in the presence of S. aureus because S. aureus produces factors X and factors V

122

Pathogenesis of centriacinar emphysema

associated iwth chronic, heavy smoking predominantly involves intraalveolar release of protease (e.g. elastase) from infiltrating neutrophils

123

Presentation of Bronchoalveolar carcinoma

- patients (non-smoker or woman) presents with cough and dyspnea
- coughs up lots and lots of tan-colored fluid
- biopsy reveals columnar mucin-secreing cells that fill alveoli without invading stroma or vessels

124

Bronchoalveolar carcinoma

- subtype of adenocarcinoma
- occurs in non-smokers and arises from alveolar epithelium
- located in peripheral parts of lung and is multi-focal
- composed of tall, columnar mucin secreting cells that don't invade stroma or vesels

125

Coccidioides immitis

can be asymptomatic
- can cause pulmonary disease ranging from flu-like illness to chronic pneumonia
- can cause disseminated disease in immunocompromised patients
- SPHERULES containing endospores are found in tissue samples

126

Discuss rifampin as monotherapy

best used as prophylaxis for people exposed to Meningitis

- can eliminate carrier state and prevent active infection
*** used alone, bacteria acquire resistance through spontaneous mutations of bacterial DNA dependent RNA polymerase

127

Mycoplasma pneumoniae

- cause of "walking pneumonia" where patients look better than labs present
- lack cell wall, capsule, or cell envelope so require cholesterol in rowth medium

128

Coxiella burnetti

- causes Q fever (mild pneumonia-like illness) that results from inhaling C. burnetti spores found in animal hides

129

Small cell carcinoma

associated with smoking that is usually centrally located
- arises from primitive cells in bronchial epithelium
- stains are positive for neuroendocrine markers: neuron specific endolase, chromogranin, synaptophysin

130

Neuroendocrine markers found in small cell carcinoma

- Neuron specific enolase
- Chromogranin
- Synaptophysin

131

Isoniazid

- similar to pyroxidine
- can increase urinary excretion of pyroxidine and cause deficiency of B6 and competes for binding sites with pyroxidine
- B6 deficiency leads to defective synthesis of NTs like GABA- can induce neuropathy

132

Isoniazid induced neuropathy

- can be cured by pyroxidine supplementation

133

Primary virulence factor of S. pnuemoniae

S. pneumoniae expresses polysaccharide capsule that inhibits phagocytosis by macrophages and PMNs (neutrophils)

134

Diffusion limitation gas-exchange

- caused by hypoxia that caused by pulmonary fibrosis, ARDS, emphysema
- blood pO2 does NOT equilibrate with the alveolar pO2

135

Perfusion limited gas ecxchange

occurs in resting sate
- blood equibrilation with alveolar gas is complete by the time blood crosses 1/3 of pulmonary capillary

136

Apex of lung (Zone 1) in terms of V and Q

- Wasted ventilation
- V/Q =3
- alveolar PO2 > blood pO2 > venous pO2

137

Base of lungs (Zone 3) in terms of V and Q

- Wasted perfusion
- V/Q = .6
- both ventilation and perfusion are higher in the base of the lung, BUT THE V/Q RATIO IS BIGGER IN APEX
- arteriolar pO2 > venous pO2 > Alveolar pO2

138

Middle of lung (Zone 2) in terms of

- arteriolar pO2 > Alveolar pO2 > venous pO2

139

Echinocandins (e.g. caspofungins and micafungin)

inhibit synthesis of polysaccharide glucan in ufngal cell walls
- most active against Candida and Aspergillus
- NOT EFFECTIVE in C. neoforms

140

Terbinafine

accumulates in skin and nails and used to treat dermatophytosis
- inhibits squalene 2,3 epoxidase

141

Griseofulvin

- binds microtubules in fungi and inhibit mutosis
- effective against dermatophyte fungi as it accumulates in keratin containing tissues

142

Allergic Bronchopulmonary Aspergillosis

- caused by Aspergillus fumigatis
- may complicate asthma
- may result in recurrent pulmonary infiltrates

143

Neutrophil chemotactic agents

- Leukotriene B4
- 5-HETE (leukotriene precursor)
- complement component (5a)

144

Side effects associated with ethambutol

causes optic neuritis that results in color blindness, central scotomas, and decreased visual acuity

145

Side effects of aminoglycoside

Nephrotoxicity (dose dependent esp. when used with cephalosporins)
Neuromuscular blockade
Otoxicity (due to direct damage to CN VIII)
Teratogen

146

Colonizing aspergillosis

- occurs in old lung cavities (e.g. TB, emphysema or sarcoidosis)
- does not invade lung tissue, but grows inside cavity to form "fungus ball"
- may be asymptomatic or may present with hemoptysis
- on X-ray, shifts when patient changes position

147

Invasive aspergillosus

- occurs in immunosuppressed patients
- characterized by primary lung involvement, cough, hemoptysis
- necrotizing pneumonia and granuloma formation may appear
- biopsy shows lung invading tissue

148

Hypersensitivity reactions to Aspergillosus

- occurs in patients with asthma
- called allergic bronchopulmonary aspergillogosis (ABPA)

149

ARDS

- interstitial edema and alveolar edema associated with increased pulmonary capillary permeability
- decreased in lung compliance
- increase in work breath
- worsened V/Q mismatch
- CAPILLARY WEDGE PRESSURE STAYS NORMAL BECAUSE NOT HEART CAUSED PROBLEM

150

Peptidoglycan layer in gram positives

- protect them against osmotic stress and provide shape of bacterium

151

Antiobiotics which disrupt cell wall syntheisis in gram-positive organisms

Penicillins
Cephalosportins
Vancomycin

152

Chloramphenicol

- anti-ribosomal antibiotic that inhibits the 50S bacterial ribosomal subunit

153

Illnesses associated with cold agglutinins

- Mycoplasma pneumonia
- EBV infection
- Hematologic infection
** Cold agglutinins are antibodies that are antibodies for RBCs and cause clumping at low temps

154

Pathogens most responsible for secondary bacterial pneumonia

S. pneumoniae
S. aureus
H. influenzae

** elderly are more likely to pick up new infections

155

Ether and organic solvents can inactivated which type of viruses

"Enveloped viruses"
- Ether dissolves lipid bipayer that makes up outer viral envelope
- loss of infectivity is characteristic

156

Nontypable strain of H. influenzae

strains that don't form the antiphagocytic capsule
- part of intestinal flora and cause EMOS
- not conferred by vaccination

157

Sarcoidoisis

- affects young black women and presents with malaise, cough, and varied cutaneous findings
- reveals bilateral hilar lymphadenopathy
- non-caseating granulomas present in biopsy

158

Absolute Risk Reduction

ARR = Event Rate (control) - Event Rate (studied treatment)

159

H. influenzae type b vaccine

- composed of polyribosyl-ribitol-phosphate (PRP)
- conjugated with diptheria and tetanus toxoid
- immune activation with antibody production and memory B-lymphocyte induction

160

Polycythemias

Hct > 52% in men; Hct > 48% in women
may result of:
- true increase in RBC mass (Absolute polycythemia) OR
- decrease in plasma volume (Relative polycythemia)

161

Relative polycythemia

normal RBC mass
- caused by dehydration or excessive diuresis

162

Absolute polycythemia

true increase in RBC mass
- can result of polycythemia vera or secondaary erythrocytosis

163

Primary erythrocytosis

e.g. polycythemia vera
- associated with LOW erythropoietin levels
- commonly caused by myeloproliferative disorders

164

Secondary erythrocytosis

- increased erythropoietin levels
due to chronic hypoxia from high altitudes, smoking, or COPD OR
due to abnormal secretion of erythropoetin

165

Non enveloped RNA virususes

- ENTEROVIRUSES (e.g. polioviruses, coxsackievirus, echovirus, hep A virus)
- REOVIRUSES (e.g rotavirus)
- NORWALK VIRUS

166

Discuss viral protein synthesis for naked RNA viruses

Naked RNA viruses must be able to act directly as mRNA using host's intracellular machinery for translatioj

167

Which naked RNA viruses are more infectious?
Naked negative sense RNA viruses or Naked positive sense RNA viruses?

- Naked viruses containing single stranded POSITIVE sense RNA can be infectious whereas
naked viruses contaning single- or double stranded NEGATIVE SENSE RNA are not infectious

168

Influenza

orthomyxovirus
SS - RNA
- to replicate in host cell, an RNA-dependent RNA polymerase within intact virion mus also gain entry into the host cell.

169

HIV

retrovirus
enveloped and SS+ RNA
-packaged with reverse transcropatase
- RNA dependent DNA polymerase

170

N-acetylcysteine

mucolytic agent used in treatment of CF
-works by cleaving disulfide bonds within mucus glycoproteins, thus loosening thick sputum

171

Histoplasma capsulatum

- can survive as small ovoid bodies intracellularly within macrophages
- causes disseminated mycosis in immunocompromised patients
- includes systemic mycosis (fever and weight loss), painful oral ulcers, HILAR lymphadenopathy, and hepatosplenomegaly