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ID/LC Step Review > Pulm 2 > Flashcards

Pulm 2 Flashcards

1
Q

Actinomycosis

A
  • Slowly progressive dz due to g(+) anaerobic bacteria
  • Orgs colonize mouth, colon, vagina (think dental caries, poor dentition)
  • Alcoholics ^ed risk
  • Filamentous branching patterns & sulfur granules

TX: PCN

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2
Q

Normal trancheal pO2 and normal alveolar pO2

A

Trach:
150 mmHG

Alv:
104 mmHg

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3
Q

Perfusion-limited?

A

Think at rest

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4
Q

Diffusion-limited?

A

Think exercise, emphysema, and pulm fibrosis (can’t get enough O2 to caps b/c of thickness

O2 does not equilibrate by the time it meets the end of the capillary (20mmHg from alveolus only gives 10mmHg to cap)

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5
Q

Chronic granuloatous disease is deficient in what?

A

NADPH oxidase

O2 to O2 (superoxide) within phagolysosomes => intracellular killing of orgs in phagosomes

X-linked

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6
Q

Presentation of pts w/ CGD

A
  • Recurrent bacterial and fungal infections (catalase positive ones)
  • PNA
  • Skin/organ abscesses
  • Suppurative adenitis
  • Osteomyelitis
  • Diffuse granuloma formation
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7
Q

Diagnostic tests of CGD

A

Measure PMN superoxide production

  • DHR flow cytometry (preferred — fluorescent green pigment)
  • NBT testing (doesn’t turn blue like normal)
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8
Q

Major virulence factor of S. pneumo

A

Polysaccharide capsule

Inhibits phagocytosis

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9
Q

Polycythemia

A

EITHER:

  • Increased RBC mass (ABSOLUTE)
  • Normal RBC mass w/ decreased plasma volume (RELATIVE)

> 52% in men
48% in women

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10
Q

How do you differentiate between absolute and relative erythrocytosis?

A
  • Direct measurement of RBC mass

- Can’t use Hct or Hb levels

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11
Q

Causes of absolute erythrocytosis?

A

Primary:
- Polycythemia vera (RBC, WBC, plt increase)

Secondary:

  • Only RBC increase
  • Hypoxia
  • Erythropoietin producing tumors
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12
Q

Causes of relative erythrocytosis

A
  • Dehydration

- Excessive diuresis (e.g. CHF emergent tx)

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13
Q

Hypoxic secondary erythrocytosis indicators?

A
  • SaO2
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14
Q

Left HF signs in a person w/ recent MI

A
  • Dyspnea
  • Bibasilar crackles (at the lower lobes)
  • S3

Due to decreased CO from LV => high end-diastolic pressure

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15
Q

Why do you get dyspnea from L. HF?

A

high end-diastolic pressure => ^ed hydrostatic pressure in pulm circulation => transudation of fluid into interstitium

Causes decreased lung compliance (can’t stretch b/c fluid distorts lung tissue)

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16
Q

What type of channel is the CFTR protein in CF?

A

ATP-gated chloride channel

AR — ∆F508 on chromosome 7

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17
Q

Sarcoidosis dysregulated immune response

A

Th1 => secretes IL-2, IFN-gamma (aka cell-mediated)

IL-2: autocrine proliferation of Th1

IFN-gamma: activates macros => granuloma formation

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18
Q

Humoral immune response - which type of CD4+ helper T cells?

A

Th2

Products:

  • IL4 (IgE)
  • IL5 (eos and IgA)
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19
Q

Dust inhaled 10-15 microm. How does the body clear it?

A

Trapped in upper airways

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20
Q

Dust inhaled 2.5-10 microm. How does the body clear it?

A

Mucociliary transport

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21
Q

Dust inhaled

A

Phagocytosis

Reaches terminal bronchioli and alveoli

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22
Q

Alveolar macros MOA

A
  • Take up dust => activation
  • Release GFs (PDGF, IGF)
  • Stimulates fibroblasts to proliferate/produce collagen
  • Inflammation

Pneumoconiosis arises b/c of inflammation and fibrosis of interstitium

23
Q

Stages of lobal pneumonia

A

1) Congestion — 24 hrs
2) Red Hepatization —2-3 days
3) Gray hepatization — 4-6 days
4) Resolution

24
Q

Congestion macro and micro appearance

A

Macro:
- Affected lobe is red, heavy, boggy

Micro:

  • Vascular dilatation
  • Alveolar exudate
  • Alveoli containing bacteria
25
Q

Red hepatization macro and micro appearance

A

Macro:

  • Red, firm lobe
  • Liver-like

Micro:
- Alveolar exudate contains erythrocytes, PMNs, fibrin

26
Q

Gray hepatization macro and micro appearance

A

Macro:
- Gray-brown firm lobe

Micro:

  • RBCs disintegrate
  • Alveolar exudate contains PMNs & fibrin
27
Q

Resolution macro and micro appearance

A

Macro:
- Restoration of normal architecture

Micro:
- Enzymatic digestion of exudate

28
Q

How do you treat group B strep in pregnant women?

A

Test at 35-37 wks

INTRApartum antibiotics (PCN or amp)

Prevents neonatal GBS sepsis, PNA, and meningitis

29
Q

Budding yeasts w/ thick capsules? Immunocompromised?

A

THINK

Cryptococcus neoformans

Stained w/ mucicarmine

30
Q

Cryptococcus neoformans complication in immunocompromised individuals

A

Meningoencephalitis

HIV, sarcoidosis, leukemia, high dose steroids

31
Q

Sx of meningoencephalitis b/c of c. neoformans

A
  • HA
  • N/V
  • Confusion

CSF w/ india ink => budding yeasts w/ halos (peripheral clearings due to thick polysaccharide capsules)

32
Q

Advantages of PPSV23

A

Decrease incidence of replacement strains due to lack of mucosal immunity

But only moderate levels of intermediate-affinity ABs

33
Q

Advantages of PCV13

A
  • Increased efficacy in elderly & children
34
Q

OSA

A
  • Recurrent obstruction of upper airway during sleep
  • Each episode => reduced ventilation => transient hypercapnia & hypoxemia
  • Systemic and pulm vasoconstriction
35
Q

What can prolonged, untreated OSA cause?

A
  • Pulm HTN
  • RHF

Also:

  • a. fib
  • arrhythmias
  • CAD
  • ^ed risk of sudden cardiac death
36
Q

Normal CD4+ count?

A

400-1400

37
Q

PNA organism in a 34y HIV+ w/ CD4+ of 800?

A

S. pneumo

38
Q

PNA organism in a 34yo HIV+ w/ CD4+

A

Pneumocystis jiroveci

39
Q

Thick-walled spherules packed w/ endospores

Lung organism?

A

Coccidioides immitis

40
Q

Pulm TB infection creates caseating granulomas using which cell mediators?

A

CD4+ T lymphs

Macros

41
Q

Normal bronchi are lined with…?

A

Pseudostratified ciliated columnar cells

Interspersed w/ goblet cells (mucus production)

42
Q

Smoking changes lining of bronchi to what…?

A

Stratified squamous metaplasia

Similar to Barrett esophagus

43
Q

Exercise’s effect on pCO2

A
  • Increases pCO2 of mixed venous blood
  • Due to increased skeletal muscle CO2 production

Homeostatic => maintains arterial blood gas and arterial pH near resting levels

44
Q

Enveloped viruses are inactivated by what?

A
  • Ether and other organic solvents
  • Dissolves lipid bilayer that makes up outer viral envelope

Loses infectivity

45
Q

PCWP in ARDS?

A

Normal

ARDS is noncardiogenic pulmonary edema

46
Q

ANOVA measures what?

A

compares difference of means of 2 or more groups

47
Q

T-test measures what?

A

Compares the difference between means of 2 groups

48
Q

Pulm infections in alcoholics. Common bugs?

A
  • Bacteroides
  • Prevotella
  • Fusobacterium
  • Peptostreptococcus
  • S pneumo
49
Q

Clindamycin MOA

A
  • Binds to 50s ribosomal subunit
  • Disrupts protein synthesis

Covers anaerobes and G(+) orgs

50
Q

Thoracentesis should be performed where?

A
  • Above 8th in midclavicular line
  • above the 10th rib along the midaxillary line
  • Above 12th rib along the posterior scapular or paravertebral line
51
Q

Thoracentesis at risk for penetrating which structures?

A

Abdominal structures

Liver definitely

52
Q

Microscopic features of chronic bronchitis

A
  • Thickened bronchial walls
  • Lymphocytic infiltration
  • Mucus gland enlargement
  • Patchy squamous metaplasia

Cigarettes is leading cause

53
Q

Complications associated w/ concentrated O2 tx for neonatal respiratory distress syndrome

A

Retinopathy of prematurity/retrolental fibroplasia

  • Abnormal retinal neovascularization => major cause of blindness
  • Due to up-regulation of VEGF when returned to room air

ID/LC Step Review (19 decks)

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