Pulm 3 Flashcards
When a exon measurement is not divisible by 3, think which type of mutation?
Frameshift mutation
In-frame deletion
One or more complete codons are deleted
Still multiple of 3 bp
Missense mutation
Base substitutions
Still multiple of 3 bp
Nonsense mutation
Stop codon prematurely
Still multiple of 3 bp
Most highly oxygenated blood in fetus
Umbilical vein => empties to IVC via ductus venosus
Fluticasone is a what?
Glucocorticoid
Long term use of glucocorticoids is the cornerstone tx for patients with what?
Persistent asthma
Can reduce number and severity of acute asthma exacerbations
Lungs of pt w/ untreated pesistent asthma
- Hyperinflated
- airway mucus plugging
- Cellular infiltration of bronchial wall
Toxicity associated with ciprofloxacin for UTIs?
Theophylline toxicity
- Inhibitions of metabolism caused by concurrent illness or other drugs (cimetidine, cipro, macrolides, verapamil)
- Toxicity: excessive CNS stimulation (tremor, seizures), GI probs, CV probs (arryhthmias)
Eosinophils release which protein?
Major basic protein
Normal function of protein released by eos?
Kills helminths
Thought to contribute to bronchial epithelial damage in pts w/ atopic (extrinsic allergic) asthma
Weakness associated with OSA?
NeuroMSK of oropharynx
Think tx with hypoglossal nerve stimulation
Calculation for A-a gradient
PAO2 - PaO2
Normal A-a gradient
10-15 mmHg
Increased A-a gradient indicates what?
Hypoxemia
Causes:
- Shunting
- V/Q mismatch
- Fibrosis (impaired diffusion)
Normal A-a gradient w/ low PaO2
Hypoventilation (e.g. opioid use, unresponsiveness)
High altitude
When you read “granules containing parallel stacks of membrane lamellae” what do you think?
Surfactant stored by Type II pneumocytes
Lines alveoli => v surface tension
FRC in obstructive vs restrictive lung disease?
Obstructive:
increased
Restrictive:
decreased
Hypoxia in COPD stimulates increased production of what?
Erythropoietin by cortical cells of kidney
Causes increased RBC production
Poor inhalation technique of daily steroids for asthma can lead to what?
- Medication deposition on oral mucous membranes
- Can lead to oropharyngeal candidiasis
Should use a spacer and rinse mouth after steroid use
“Serpentine cords” — growth in parallel chains
Think what?
TB
Virulence: PMN inhibition, mitochondrial destruction, TNF release
SCID characteristic features
- Severe bacterial and viral infections in infancy
- Chronic diarrhea
- Mucocutaneous candidiasis
T&B cell dysfunction
Labs: absent T cells, & hypogammaglobulinemia & Absent thymic shadow
C5-C9 deficiency
- Recurrent Neisseria infection
Wiskott-Aldrich syndrome
- Recurrent infections that worsen with age
- Easy bleeding
- Eczema
Chedick-Higashi syndrome
- Oculocutaneous albinism
- Pyogenic infections
- Progressive neuro dysfunction
Predominant lymphocyte type found in sarcoidosis
CD4+ T helper cells
Lab findings in sarcoidosis
- Hypercalcemia/calcuria
- Elevated serum ACE levels
Round, dense basophilic (dark-staining) body in nucleu
Nucleolus
Nucleolus is the primary site for what?
rRNA transcription
rRNA (18S, 5.8S & 28 S) synthesizing polymerase I
RNA poly I
mRNA poly?
RNA poly II
snRNA poly?
RNA poly II
microRNA poly?
RNA poly II
tRNA poly?
RNA poly III
5S rRNA poly?
RNA poly III
DNA endonuclease function?
Break phosphodiester bonds w/in the nucleotide chain in DNA & RNA
Important in DNA repair & RNA splicing
DNA polymerase
- Primary enzymes responsible for DNA replication & repair
- Found in the nucleus
Hyper-IgM syndrome
X-linked recessive
- Inability of B-lymphs to undergo isotype switching from IgM to others
- Results from CD-40 ligand absence on T-lymphs OR genetic deficiency in enzymes responsible for DNA modification
Clinical presentation of hyperIgM syndrome
- Recurrent sinopulm infections
- Lymphoid hyperplasia
Example of spore-forming bacteria
Bacillus anthracis
All clostridium species
What is unique about spore-forming bacteria
- Can survive boiling (at 100ºC)
- Found in soil
- Capable of forming spores (duh)
Macconkey agar purpose?
Only grows g(-)
When pink = lactose fermenter
Encapsulated, lactose (+), g(-), appear mucoid in culture
PNA in pts w/ impaired host defense/alcoholics
Klebsiella
- Tissue necrosis
- Early abscess formation with production of thick, mucoid, blood-tinged sputum
Chloramphenicol MOA
Anti-ribosomal 50s
Most feared SE: aplastic anemia
Azithromycin MOA
Inhibits 50s ribosomal subunit
Ciprofloxacin MOA
Inhibit bacterial DNA gyrase => bacterial DNA damage and death
No effect on cell wall
Doxy MOA
Inhibit bacterial 30s ribosomal subunit
Which anti-bacterials disrupt peptidoglycan cell wall of g(+) orgs?
PCNs, cephalosporins, vanco
Can’t survive osmotic stress, ability of bacteria lost after tx
After the oxygenated blood leaves the pulm area, it mixes with deoxygenated blood in the pulm veins. Where is the deoxygenated blood coming from?
- Bronchial arteries/veins
- Thebesian veins
LA/LV have less oxygen in the blood compared to pulm veins
Where are the lung apices in relation to outer anatomy?
Above clavicle and first rib between lateral sternal line and midclavicular line
Tension pneumothorax pathophys
- Due to pleural injury
- Increasing air volume => lungs and mediastinum deviate to opposite side of chest
- Causes increased pressure in chest cavity => decreased systemic venous return to heart => decreased CO
Tension pneumothorax signs/sx
- Tachycardia
- Hypotension
- Tachypnea
- Hypoxemia
- Absence of breath sounds and hyperresonance to percussion
Tx: needle thoracostomy or chest tube
When dust is inhaled into the lungs and stopped in the terminal bronchioles, what clears it? What about distal to these terminal bronchioles?
Terminal:
Ciliated mucosa
Distal to terminal:
Macros
Vitamin A function
Maintains orderly differentiation of specialized epithelium:
- Mucus-secreting columnar epithelia of conjunctive
- respiratory tracts
- Urinary tracts
- Pancreatic ducts
Avitaminosis A
Causes squamous metaplasia => keratinizing epithelium
Alveolar gas equation
PAO2 = 150 - (PaCO2/0.8)
GO REVIEW THE PULM-VOLUME CURVE (time x lung volume)
NOW
Cheyne-Stokes breathing
- Cyclic breathin
- Apnea is followed by increasing, then decreasing tidal volumes until next apneic period
- seen in advanced CHF
GO LOOK AT PRESSURE-VOLUME RELATIONSHIP GRAPHS
NOW
Triple combo ART tx in preggers w/ HIV
- 2 nucleoside/nucleotide reverse transcriptase inhibitors
- 1 protease/NNRT/integrase inhibitor
Clinical findings of vertical transmission of HIV-1
- Oral thrush
- interstitial PNA
- severe lymphopenia
Which pneumocytes are capable of lung cell proliferation in response to injury?
Type II pneumocytes
Also produce surfactant
