Monday Wk 2 Pulm 3 Flashcards
fever, hemodynamic instability, tachypnea, evidence of infection has ___
_ and pulm infections are main RF
cytokines like __, __, __, __ released, activating the pulm epithelium
inc recruitment/extravasation of __ to lungs, leading to damage
protein/fluid leaks into __, worsening condition
ARDS
sepsis
TNF, IL1/6/8
PMN
alveoli
CFTR is normally present on the __ of exocrine ductal epithelial cells
L/I are CFTR modulating meds that can restore CFTR to membrane and enhance protein function
parietal pleura is found __ ribs below the visceral pleura and therefore lung
thoracentesis should be performed bw 6- __ ribs on MC line, 8-__ ribs on midaxillary line, and 10-__ rib on paravertebral line
if lower/higher, risk for __ goes up
intercostal VAN lie on the __ portion of the rib
apical membrane
Lumacaftor, ivacaftor
2
8, 10, 12
injury
underneath
mothers should be evaluated at __-__ wks gestation for infections
if positive, tx GBS/meningitis/PNA w __/__ intrapartum
__ granulomas distinguish sarcoid from Tb/Mycobacterium avium
___would present w constitutional sx and palpble LN w nodular growth pattern and fibrous bands/RS cells
35-37
Ampicillin, PenG
noncaseating
HL
small, oxidase pos gram neg coccobacillus is __
strains that dont produce a capsule are called ___
Hib vaccine directed against type _
capsular vaccine conjugated to _ protein for a better response
pt w recurrent sinopulm/GI infections, and autoimmune dz has ___
can have severe __ during blood transfusion due to __ directed against IgA
Haemophilus influenza
nontypeable
B
tetanus
IgA def
analphyactic rxn
IgE
Pt w COPD and supplemental O2 can lead to O2 induced __ resulting in confusion and dec conciousness
major cause is __ mismatch
hypoxia causes __ in pulm arterioles, shunting blood towards well ventilated arterioles minimizing dead space
w high amounts of O2, lung regions are __ and vasodilate
blood goes from well to poorly ventilated alveoli and inc __
Hyperoxia can cause prodxn of __ species
injures airways/lung __
pt presents w __ heaviness, __ pain, and cough w in 24hrs
hypercapnia
VQ
vasoconstriction
reversed
physio dead space
ROS
parenchyma
substernal, pleuritic
fibrotic focus in lower lobe and calcified ipsi LN indicates __ Tb
known as the __ complex
secondary Tb present w __ cavitary lesion
excessive daytime sleepiness, morning HA, cog impairment, depression all indicate __ as dx
upper airway blocked via relaxation of __ muscle tone
PO2 dec, PCO2 inc until __ trigger arousal
look for additional finding of __
primary
Ghon
apical
OSA
pharyngeal
brain
HTN
__ is sleep apnea due to dec resp drive from a neuro do
usually have sig illness like __ and __ dz
Pt w COPD has hypoxia sensed by __ cells, leading to inc EPO prodxn
in severe PHTN, lesions can form interlacing small vasc channels called _ lesions
C__ inhibits ADP induced platelet agg in atherosclerotic iscemic dz to prevent stent thrombosis
CSA
CHF, CV
renal cortical
plexiform
clopidigrel
airflow restriction in COPD results in compensatory lung __ to improve airflow
this reduces __, limiting max TV
esp during __ when expiration time is dec
process is known as __ hyperinflation and main cause of SOB
__ is common cause of pnuemonitis in lung transplant pt
enveloped __ virus part of __ family
biopsy shows large cells w __/__ inclusions surrounded by a halo
hyperinflation
IRV
exercise
dynamic
CMV
dsDNA, herpeviridae
intranuclear/intracytoplasmic
I__ virus is enveloped, ssRNA
R__ is a naked, ssRNA virus
A__ is naked dsDNA virus causing resp illness
__ is pos for modified AFB, while __ is not
__ and __ and __ cells are responsible for path of COPD
release enzymes/proteases to cause __ damage, red __ motion, and inc __ secretion
influenza
rhinovuirus
adenovirus
Nocardia, Actinomyces
PMN, macros, CD8
alveolar, ciliary, mucus
blood in PA is __ in O2 content than blood in the LA
due to mixing of __
comes from __ arteries, which empty in the pulm veins
and small cardiac __ veins
very high, deoxygenated
bronchial
thebesian
CFTR channel opens after binding 2 __ molecules, allowing Cl to move down gradient
this potential draws __/__ across as well
mutations lead to intracellular protein degredation and prodxn of __
__ is OLD w inc DLCO due to high pulm cap blood volumes
sarcoid/pneumoconosis may produce a mixture of __/__ spiro
extrinsic restrictive dz ie / has normal DLCO
ATP
Na, water
thick mucus
Asthma
restrictive/obstructive
obesity, NM
chronic SOB, obstructive findings, fibrotic destruction of small airways posttransplant indicates __ rejection
__ limitation as small brochioles are affected, producing BO__
__ inflam and destrxn of epithelium
fibropurulent exudete/granulation tissue is present in ___
leads to fibrosis, scarring, and __ of small airways
B__/D__ are CS administered to premature infants to prevent NRDS
accelerates maturation of __
chronic
airflow, bronchiollitis obliterans
lymphocytic
bronchioli
obliteration
Betamethasone/dexamethasone
T2 pneumocytes
upon initial exposure, allergic response produces __ to the allergen
w exposure, allergen induces IgE to cross link to __/__ causing release of mediators
__ HS rxn
complement mediated cytotoxicity is seen w __/__ HS Rxn
__ is antibody best at activating the classical complement pathway
IgE
basophils/mast cells
type 1
type 2/3
IgM
primary spontaneous PTX presents w sudden onset __/__
large change in __/__ pressure causes break in visceral pleura
superficial alveoli in the __ experience greatest pressure change, leading to formation of sublpleural blebs
spontaneous __ usually occurs in tall thin __ male
SOB, chest pain
alveolar/IP
apex
rupture, smoking
large particles in trachea/bronchi/bronchioles are __ in mucus and swept to pharynx
medium sized particles are carried away via __ elevator
small particles reach resp bronchioles/alveoli and are cleared via __ via macros
engulfment activates macros, leading to the release of __ to induce inflammation
w inhalation of dust like coal, __ are stimulated to produce collagen
results in progressive __ like CWP
trapped
mucociliary
phagocytosis
cytokines
fibroblasts
ILD
CGD caused by lack of NADPH oxidase, impairing killing of __ by PMN/macros
cannot transfer electron from NADPH to oxygen to form __
lack of granule __ cannot destroy pathogens
most bacteria are __ neg, this producing H2O2 allowing phagocytes to fxn
thus, CGD is susceptible to catalase pos orgs S, B, S, N, A
intracellular orgs
superoxide
proteases
catalase
Staph aureus, B cepacia, serratia, Nocardia, Actinomyces
inhaled __are controlling meds used for pt w asthma not controlled w B agonist
use __ and __ to prevent cadida/irritation
Haemophilus influenza req factors X h__ and __ NAD to grow
thus, use __ blood agar
main virulence factor is antiphagocytic polysaccharide __
this allows spread, resulting in septic __/___
GC
spacer, mouth rinse
hematin, V
chocolate
capsule
arthritis/meningitis
Candida is only a __ form
present in __, __ and __ flora
typically infects __ indiv
does not cause lung disease, so presence in sputum indicates that the __ is colonized
Trachea/large-small bronchi are usually ___
yeast
mouth, vaginal, skin
IC
oral cavity
sterile
thickened bronchial walls, neutro/lymph infiltrates, mucus gland enlargement w inc goblet cells and squamous METAPLASIA indicates ___
similar process except w submucosal gland enlargement and eosinphils/mast cells makes __ more likely
nickel exposure can lead to __ pneumoconiosis
COPD
allergic asthma
silica
acute onset neuro abnorms, hypoxemia and petechial rash in pt w severe long bone/pelvic fracture indicates __ syndrome
esp w __ fractures
trauma dislodges __ in BM, allowing them to occlude pulm microvessels
impairs __ w hypoxia
fat globules that escape lungs via precapillary AV shunt can lead to confusion and __ impairment
extravasation in dermal capillaries can lead to __
platelets may be consumed in the __
fat embolism
bilateral
fat globules
gas exchange
neurologic
microglobules
septic shock results in high AGAP MA due to end organ __ leading to dec ox phos
NADH accumulates, and pyruvate is shunted to __
LA causes
enhanced met rate via S/E
reduced O2 delivery via C/P failure or I___
dec latate breakdown via __ failure
dec O2 utilization via __ poison
enzyme defects like M_ myopathy or __ storage do
hypoperfusion
lactate
seizure, exercise
cardio/pulm, ischemia
hepatic
cyanide
mitochondrial, glycogen
High AGAP MA > 14
M U D P I L E S
methanol uremia DKA Propylene glycol/paraldehyde isoniazid/Iron LA ethylene glycol salicylates
PaO2 normal, SaO2 dec, dec O2 content dx is __ poison
PaO2, SaO2, O2 content normal has __ poison
Normal PaO2/SaO2 but dec O2 content has ___
total O2 content in blood is dependent on __ conc, SaO2 and PaO2
CO
cyanide
HB
__ inc from apex to base bc gravity stretches lung downward from the apex
alveoli at the apex are more __ and less compliant
zone 1 blood does not occur in _ indiv
alveolar pressure > __ > Venous
pulm capillaries are __ and there is no blood flow
can form w low pulm __ pressure or high __ pressure
zone 2 found in __ of lung
arterial > __ > Venous
pulm capillaries obstructed at __ end of capillary bed
as arterial pressure rises, capillary pressure __ and overcomes alveolar pressure
blood flow is __
Zone 3 is __ lung
arterial > __ > alveolar
blood flows __
when person lies supine, blood flow is entirely __
ventilation
distended
normal
arterial
collapsed
artery, alveolar
alveolar
upper region
venous, inc
pulsatile
lower
venous
continuously
__ greatly inc from apex to base
__ inc slightly from apex to base
thus, VQ ratio __ from apex to base
intermittent resp sx in pt w normal CXR, sputum w eosinophils, reduced FEV1 suggetsts __ as dx
allergens include E, __ air, __ infection, exposure to allergen like D__, C_, pet dander, mold/__
ABPA presents w fever, malaise and expectoration of __ plgus
Perfusion
ventilation
dec
asthma
exercise, cold, respiratory, dust mite, cockroach, pollen
brown
Langerhans giant cells in caseating granuloma have multiple __ organized periphrally in shape of __
__ is assc w fever, wl, intraluminal plugs of granulation tissue/inflam debris in distal airways
IPF aka \_\_ patchy involvement w dense \_\_ \_\_ cystic changes and fibroblastic foci present in \_\_/\_\_ regions lined by hyperplastic \_\_
nuclei, horshoe
COP
UIP fibrosis honeycomb paraseptal/subplerual Type 2 pneumos
severe asthma w obstructive fts w necrotizing vasculitis and granulomatous inflamm w eosinophilic infiltration of vessels/tissues is __dx
__ presents w gradual SOB, productive cough
bilateral patchy pulm opacification w accumulation of amorphous __ and __ material
Eosinophilic Granulomatosis w Polyangiitis
Pulm aveolar proteinosis
protein, phospholipid
