5/13 Mixed, Pulm Flashcards
Respiratory papillomatosis (6,11)
HPV infects basal epithelial cells, predilection for stratified squamous epithelium
Found in the TRUE VOCAL CORDS (undergo frequent friction/ abrasion)
Infants acquire respiratory papillomatosis via passage thru the birth canal of mothers infected with the virus
Warty growths on the true vocal cords lead to weak cry, hoarseness and stridor
Immunocompetent patient with a heterophile antibody-negative mononucleosis-like syndrome
CMV infection
Can be acquired during transfuion of leukocyte-laden blood products
Heterophil antibody negative = Monospot test- serum fails to agglutinate horse erythrocytes
Fever, myalgias, malaise, progressive fatigue, splenomegaly
Atypical lymphocytes
Wiskott Aldrich Syndrome
Eczema, recurrent infections, thrombocytopenia
Mutation on X chromosome (combined B and T cell disorder)
Increased risk for infection with capsular organisms
Rx: HLA matched bone marrow
Onset is early
Charcot-Bouchard Aneurysms
Associated with HTN
Location: basal ganglia, cerebrellum, thalamus, pons
Candida Albicans
On light microscopy: budding yeasts with pseudohyphae
Germ tube is diagnostic candida albicans
37 C > true hyphae
Para-aminohippuric acid (PAH) and the kidney
Freely filtered by glomerulus
Majority is secreted by the proximal tubule via carrier mediated active transport
NOT reabsorbed by any portion of the nephron
Elevated pressure in left renal vein
Due to compression where the vein crosses the aorta beneath the superior mesenteric artery
“Nutcracker effect” can cause hematuria and flank pain
Pressure can elevated in left gonadal vein, leading to formation of a varicocele
Where is the majority of water absorbed in the kidney?
Proximal tubules reabsorb >60% of water filtered by the glomeruli
Tricyclic Antidepressant (TCA) Overdose
Delirium, seizures, cardiac abnormalities (arrhythmias, conduction delays, QT prolongation), severe hypotension, anticholinergic toxicity (hyperthermia, flushing, dry mouth, urinary retention
Caused by blockage of cardiac fast Na channels and other receptors
Sodium bicarbonate treats a widened QRS interval or ventricular arrthythmias- increases serum pH and extracelluar sodium (alleviating fast sodium channel blockade)
Hereditary orotic aciduria
Rare AR disorder of de novo pyrimidine synthesis
Physical and mental retardation, megaloblastic anemia, elevated urinary orotic acid
Defect in Uridine 5’-monophosphate (UMP) synthase
Rx: uridine supplementation (Uridine is converted to UMP via nucleoside kinases)
Accessory nipples
Due to failure of involution of the mammary ridge
Usually asymptomatic, may swell or become tender during menses, prenancy, lactation
Hyperpigmentation, epidermal thickening
Most common congenital breast anomaly
Relative erythrocytosis
Normal RBC mass indicates a relative erythrocytosis
Due to a decrease in plasma volume
Can be due to aggressive diuretic therapy for heart failure exacerbation
Overflow incontinence
Due to impaired detrusor contractility or bladder outlet obstruction Involuntary and continuous urinary leakage when bladder is full and incomplete emptying Most likely due to diabetic autonomic neuropathy affecting detrusor muscle innervation (common in T1 DM) Postvoid residual (PVR) testing to confirm
Enterococcus
Important cause of UTIs
Gram positive cocci in pairs and chains
Grown on blood agar, do not cause hemolysis (gamma-hemolytic)
Asthma Dx in a patient with a history consistent with asthma but normal spirometry value
Bronchoprovocation techniques = methacholine
Elicit asthma symptoms and confirm the diagnosis
Causes bronchoconstriction and increased airway secretions
A decrease in FEV1 after a methacholine challenge indicates bronchial asthma
Wernicke-Korsakoff syndrome
Oculomotor dysfunction, ataxia, confusion
Most symptoms resolve after thiamine administration
Korsakoff syndrome is a complication of Wernicke encephalopathy, and involves permanent memory loss and confabulation
Malignant hyperthermia
Due to hypersensitivity of skeletal muscle to inhalation anesthetics (especially halothane) and muscle relaxant succinylcholine
Genetically susceptible: defect on ryanodine receptors of SR
Tachycardia, hypertension, hyperkalemia, myoglobinemia
Rx: Dantrolene (prevents further release of Ca in the cytoplasm of muscle fibers)
Ipratropium
Anticholinergic agent
derivative of atropine
Blocks the action of Ach at muscarinic receptors, preventing bronchocontriction and reducing the parasympathetic stimulation of tracheobronchial submucosal glands in the lungs
Azoles
Antifungal medications
Inhibit demethylation of lanosterol into ergosterol in fungal cells, suppress synthesis of ergosterol (essential component of fungal cell membrane)
Inhibit human P450 cytochrome enzymes, resulting in many drug-drug interactions
Carbamazepine
Used to treat simple partial, complex partial, generalized tonic-clonic seizures
Blocks voltage-gated Ba channels in cortical neurons
SE: bone marrow suppression, hepatotoxic, SIADH
Polymyositis
Symmetrical proximal muscle weakness
Increasing difficulty climbing stairs, getting up from a chair, carrying heavy objects
Elevated muscle enzymes
Autoantibodies (ANA, anti-Jo1
Biopsy: endomysial mononuclear infiltrate, patchy necrosis
Increased expresison of major histocompatibility complex class I antigens on the sarcolemma (with CD8 lymph infiltrate)
Complications: interstitial lung disease, myocarditis
Properties of elastin
Rubber-like properties due to extensive cross linking between elastin monomers, which is facilitated by lysyl oxidase (interchain cross-links involving lysine)
Alveolar hyperventilation
Acute onset dyspnea, hypoxemia, hypocapnia
Arterial PaCO2 is inversely related to and considered the main indicator of total alveolar ventilation (hypocapnia implies alveolar hyperventilation)
Results from V/Q mismatch (pneumonia or PE)
Persistent tachypnea will lead to eventual respiratory muscle fatigue, hypoventilation, hypercapnia
Bosentan
Competitive antagonist of endothelin receptors used for treatment of idiopathic pulmonary arterial hypertension
Sarcoidosis
African Americans, cough, dyspnea, bilateral hilar adenopathy, pulmonary reticular infiltrates, hypercalcemia, elevated ACE, biopsy shows noncaseating granuolmas
CD4+ T helper cells are the predominant type of lymphocyte found in sarcoid granulomas
Lung Abscesses
Due to lysosomal enzyme release by neutrophils and macrophages
Vertical transmission of HIV-1
Oral thrush, interstitial pneumonia, severe lymphopenia during first year of life
All pregnant women with HIV should take ART
2 NRTIs + protease inhibiotr or NNRTIs
Antiretroviral therapy during pregnancy reduces the risk of perinatal transmission of HIV to 1%-2%
Pulmonary tuberculosis
Passed person to person through transmission of aerosolized respiratory secretions that contain M. tuberculosis organisms
Smaller droplets deposit organisms in the alveoli of lower lung fields
These organisms are engulfed by alveolar macrophages that allow for intracellular bacterial proliferation
As the radius of a sphere with constant surface tension decreases, the distending pressure increases
Smaller spheres collapse before larger ones
Surfactant counteracts alveolar collapse by decreasing surface tension as alveolar radius decreases
Cryptococcus neoformans
Only pathogenic fungus that has a polysaccharide capusle
Capsule appears read on mucicarmine stain and as a clear unstained zone with India ink
