Monday wk2 Pulm 1 Flashcards
PMN secreted __ is endogenous proteolytic enzyme to hydrolyze elastin in alveolar walls
__ synthesizes A1AT to inhibit this breakdown
elastin is similar in synthesis to _ as it is 1st a large PP precursor
mostly __ AA. proline/lysine are not ___
__ fibers act as scaffold
lysyl oxidase deaminates lysine residues, forming desmosine ___ for the elastic properties
elastase
liver
collagen
nonpolar
hydroxylated
fibrillin
cross links
PAH defined as PA pressure greater than __ mmHg at rest
hereditary is due to inactivating mutation in __ gene transmitted AD w variable penetranc
predisposed to endothelial/smooth muscle __
w second __, dz upregulates endothelin, dec NO/prostacyclin
end result is vasc smooth muscle __, intimal __ and fibrosis, inc pulm vasc __
hypoxic __ seen w COPD/OSA/ILD
25
BMPR2
proliferation
insult
prollif, thickening, resistance
vc
Coccidioides is m_/h_ at low temps, and __ form at high temps
transmitted via __ inhalation
formed via fragmenting __
spherules form and __, releasing endospores to other tissues
5 presentations: acute __, chronc __, pulm /, extrapulm __ dz, and M__
lung dz mostly seen in __ host
__ yeast is present in pigeon droppings
pt w __ at risk for A fumigatas allergic rxn
aka allergic __
cough, dyspnea, migratory _ infiltrates
mold/hyphae, endospore
spherule
hyphae
rupture
PNA, PNA, nodules/cavities, nonmeningeal, meningitis
cyrpto
asthma
pulm
__ aka lecithin is component of surfactant
__ is membrane phospholipid
ratio used in 3rd trimester, which should show rise of __ by type 2 pneumocytes
__ remains unchanged
P__ is another component of surfactant, released at 36 w
chest tubes placed into 4/5th intercostal space at __/__ lines
can cross through S__ muscle, I__ muscles, and __ pleura
phosphatidylcholine
sphingomyelin
Lecithin
sphingo
phosphatidylglycerol
AA, MC
serratus anterior, intercostal, parietal
__ is total volume of air entering resp pathways per minute
TV * RR
__ is new volume entering areas of gas exchange per minute
total volume of dead space is __ dead space, which is anatomic + ___
TV-__ * RR
Each MHC class 1 molecule consists of a heavy chain and assc \_\_ microglobulin heavy chain is highly \_\_ allowing for a large variety of antigens to be presented
MV
alveolar ventilation
physio
alveolar
physio dead space
B2
polymorphic
MHC class 2 molecules consist of __/__ PP chains
respond to antigens digested /in __
activate __ cells for correct immune response
___ stimulates a4b2 nicotinic Ach receptor in the CNS
__ is partial agonist that competes w nicotine
can produce some __ but only mild release of __
used for __ to reduce wdrawal
pt w __ gets transient hyper__ and hypo__ in sleep
reflexive systemic/pulm __
endothelial dysfxn, ab venous return and __ stimulation
A/B
lysosomes
Th
nicotine
Varenicline
activation, DA
cessation
OSA
CO2, O2
VC, SNS
prolonged OSA can lead to __ and RHF
eventually, also get __ HTN due to chronic SNS stimulation and release of __
inc risk of __ comps
right ventricular __ leads to holosystolic murmur at the LLSB
left sided heart failure leads to PAH w pcwp greater than __
__ is VC and promotes smooth muscle prolif
endothelin receptor antags like B/A can be used for PAH to reverse this process
PAH
systemic
NE
cardiac
enlargement
12
endothelin
bosentan/ambrisentan
crytpo is acquired via __
pathogen cleared by __/__ cells in immunocompetent indiv
causes sx in IC indiv, usually M___
pulm form has minimal sx but can be dx as red yeast on __ stain
aspiration in supine indiv usually involves the __ segment of upper lobes or __ segment of lower lobes
upright pt aspirates into the __ segment of RLL
inhalation
Macros, t cells
meningoencephalitis
mucicarmine
posterior, superior
basilar
laplaces law states that smaller spheres will __ as pressure inc, while large spheres will __
surfactant counterracts this, by dec __, to minimize smaller collapse/larger expansion
sx of panic attack caused by dec __
this leads to hypoperfusion to the __ via VC
CO2 is a cerebral __
collapse, hyperexpand
surface tension
CO2
CNS
vasodilator
degree of lung __ affects PVR
inc lung volumes cause __ expansion and stretching of alveolar BV
this inc length and reduces __, leading to inc resistance
dec lung volumes during expiration causes vessels to be __, inc resistance
thus, PVR has __ curve and is lowest at __
__ tract first 10 gen accounts for most airway resistance
remainder of LR tract due to trachea, __ gen of bronchi due to highly turbulent flow
lowest in the __ due to large CSA
distension
alveolar
diameter
compressed
U shape
FRC
UResp (mouth)
2-5
bronchioles
___ synthesized by platelets for __ and platelet __
Leuk C4/D4/E4 cause broncho__ and inc bronchial __ secretion
use low dose \_\_ to prevent PE binds to \_\_\_ to prevent coag large DVT cause \_\_ in PA bifurcation smaller DVT lodge in \_\_ branches, producing \_\_ infarct as bronchial blood hemorrages \_\_ lobes more affected
aspirin blocks __ and platelet agg
used in preventing __ thrombosis and ischemic stroke
thromboxane A2
vasoconstriction, aggregation
spasm, mucus
warfarin AT3 saddle embolus peripheral, hemorrhagic lower
TA2
coronary artery
___ is most common type of lung cancer
arises from __ epithelium and is located peripherally
growth along intact alveolar __ w out invasion
well differentiated, dysplastic __ cells
can produce watery sputum B__
imaging shows __/__
__ is found incidentally on CXR as coin lesion
consists of hyaline __ w CT, SM and fat
Adenocarcinoma in situ alveolar septa bronchorrhea mass/consolidation
hamartoma
cartilage
__ is cx w low absent CD19/CD20 B cells
susceptible to __ bacteria, enterovirus and Girdia
__ is marker of RS for HL
major protease of elastin degredation in the lungs
XLA
encapsulated
CD15
ciliated __ epithelium lines pulmonary airways from trachea to respiratory bronchioles
goes from psuedostratified ciliated columnar to ciliated __ columnar
Ciliated cells present through __ but not alveoli
propels mucus toward __
__ keeps large airways open, but not found in bronchioles
bronchi have Ciliated PS colmnar epithelium w mucin sec __ cells and mucoserous gland
bronchioles lack __/__ and number of goblet cells dec
mucosal
simple
resp bronchioles
pharynx
cartilage
goblet
cartilage/glands
__ is musc agonist inducing bronchoconstriction and inc bronchial mucus prod
detects __ in pt w sx
I__ used for bc in asthma/emphysema
S__ is used for motion sickness
both are muscarinic __
L__ is B2 agonist used in pt w adverse rxn to albuterol
methacholine
asthma
ipratropium bromide
scopolamine
antags
levalvuterol
another test to dx CH is the nasal __ potential diff
CF pt has inc __ absorption and __ retained in lumne
thus, excess Cl causes __ vltage reading
CFTR mutations lower rate of __ excretion in panc ducts, leading to intraductal concretions and duct blockage
__ is mold that forms in old cavities from Tb, COPD, sarcoid
forms septate __ branching at 45 deg
normally cleared, but in IC indiv, it forms a __
radiopaque structure that __ w movement
sx include cough and H
transepithelial
Na, Cl
negative
HCO3
aspergillus hyphae fungal ball shifts hemoptysis
ABPA dx w inc __ immunoglobulun and antibodies to __
invasive aspergillosis seen in severely IC/__ pt
primarily lung involvement w __ PNA and __ formation
fever, HA w ring enhancing lesion, resp sx w pulm nodules and gram positive org is N__
weakly gram postive, Catalase __, __ shaped
partially acid fast __ filaments
affects Lung, __ and skin in IC pt
pulm form mimics ___
tx w ___
IgE
Aspergillus
neutropenic
necrotizing, granuloma
nocardia pos, rod branching brain Tb TMP-SMX
__ is gram positive org causing granuloma formation
may discharge ___
usually cervicofacial __ and __ tracts or __ dz
__ is dimorphic fungus in M/O river valleys
transmitted via __ and becomes yeast
can be asx or acute/chronic __
pulm manifestations characterized by __ formation
can affect Skin, __ and __ systems in IC pt
tx w __
Actinomyces
sulfur granules
abscess, sinus, ab
blasto inhalation PNA granuloma bone, GU itraconazole
ab distension, bilious emesis and air fluid levels consistent w __
finding green dehydrated meconium at the __ is specific for CF
abnorms in __/__/__ transport leads to isotonic dehydration of contents
abnormally __ mucus leads to obs
pt usually dies from __/__/_
pt w hirschprung dz most likely to die from __
bowel obstruction distal ileum Na, Cl, H2O viscus PNA, bronchiectasis, RHF
enterocolitis
alcoholics, esp w poor oral hygiene, likely to get __ PNA
usually __ w anaerobes/aerobes
alcohol may impair __/__ reflex and phagocytic/bacteriocidal action of alveolar __
anaerobics include B/P/F/P
see __ PNA and lung __
tx w C__ which inhibits 50s ribosomal subunit
this covers Strep pneumo and anaerobes, which M__ wont
aspiration
polymicrobial
gag/cough
macros
Bacteroides, Prevotella, Fuso, Peptostrepto
clindamycin
metro
pancoast syndrome affects the superior sulcus, location formed by __ vessels
shoulder pain of __/__ is common sx
involves lower aspect of __
anterior mediastinal masses include T/T/T/terrible __
pulm __ are suppurative collections w in parenchyma resulting in necrosis of surrounding tissue
can create __ cavity if it communicates w air passage
look for __ destxn w/in cavity
due to lysosomal enzyme release by __/__
digest __ and summon __/__ to area
__ stimulates NK to destroy cells and for Th secretion of IFNG
subclavian
axilla/scapula
brachial plexus
thymoma, teratoma, thyroid ca, lymphoma
abscesses air containing suppurative PMN/macros pathogens, PMN/macros
IL12
Legionella stains poorly on \_\_\_ so use silver stain sx include fever w B\_\_ HA/C and \_\_ diarrhea labs show hypo\_\_ culture org on \_\_ w Lcysteine/iron
__ macros and __ cells are predominant cells in granuloma
macros release __ to induce TH1 subtype release
Th1 then produces __ to activates macros and __ to recruit monos/macros
Platelet activating factor used for __ agg, Vaso/broncho__, inc __ adhesion
gram stain bradycardia confusion, watery Na BCYE
epitheliod, giant
IL12
IFNG, TNFA
platelet, constriction, leuk
green pus in bacterial infections due to __ a blue green __ based enzyme released from PMN azurophilic granules
normally produces __ in resp burst
currant jelly/rusty sputum color due to extravasation of __/__ into sputum w extensive inflam/necrosis
hypoNa, dec serum osmolality, and urine osmolality > 100 indicates __
usually seen in SCLC w __ mass
MPO, heme
HOCl
RBC, heme
SIADH
hilar
Adenocarcinoma paraneoplastic syndromes
H__
D/P
Migratory __
CF is __ inheritance
usually due to 3BP deletion of __ at position F508
causes impaired __ processing, which is targeted for __ degredatin
can tx w L__ to correct folding defect
dec prod of normal CFTR can occur via reduced __/__ stability, but less comon
mutations w premature termination of CFTR can occur w complete __ of CFTR
usually seen in the __ pop
CFTR is __ gated Cl activated by cAMP mediated __
hypertrophic osteodystrophy
dermatomyositis, polymyositis
thrombophlebitis
AR phenylalanine posttranslational proteosomal Lumacaftor
mRNA, protein
absence
Ashkenazi jew
ATP, phosphorylation
multiple wedge shaped hemorrhagic lesions in periphery are due to __
in setting of IV DU, think __ PE from TC valve endocarditis
org is __
small airway obstruction is found in __
K__ is gram neg, __ fermenting bacillus
thick __ seen as clear zone
common in __ due to microaspirations into upper lobe
__ is non lactose fermenter and is oxidase Pos
non lactose fermenter, oxidase negH2S prod is __
non lactose ferm, oxidase negH2S prod is __/__
pulm emboli
septic
S aureus
asthma
klebsiella, lactose
capsule
alcoholics
Psuedomonas
shigela
salmonella, proteus
ILD results in progressive __ w thickening/stiffening of pulm interstitium
inc lung __ and airway widening due to radial __ leads to inc expiratory flow rates
outward recoil of chest wall limits __ air
inc in chest recoil would lead to __ exp flow rate, as resp muscles would have to work harder to exhale
wall thickness of aiways is inc in __, dec expiration by reducing radius of __
fibrosis
recoil, traction
expiration
dec
Obstructive lung disease, airways
