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ID/LC Step Review > Pulm 3 > Flashcards

Pulm 3 Flashcards

1
Q

When a exon measurement is not divisible by 3, think which type of mutation?

A

Frameshift mutation

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2
Q

In-frame deletion

A

One or more complete codons are deleted

Still multiple of 3 bp

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3
Q

Missense mutation

A

Base substitutions

Still multiple of 3 bp

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4
Q

Nonsense mutation

A

Stop codon prematurely

Still multiple of 3 bp

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5
Q

Most highly oxygenated blood in fetus

A

Umbilical vein => empties to IVC via ductus venosus

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6
Q

Fluticasone is a what?

A

Glucocorticoid

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7
Q

Long term use of glucocorticoids is the cornerstone tx for patients with what?

A

Persistent asthma

Can reduce number and severity of acute asthma exacerbations

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8
Q

Lungs of pt w/ untreated pesistent asthma

A
  • Hyperinflated
  • airway mucus plugging
  • Cellular infiltration of bronchial wall
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9
Q

Toxicity associated with ciprofloxacin for UTIs?

A

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)
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10
Q

Eosinophils release which protein?

A

Major basic protein

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11
Q

Normal function of protein released by eos?

A

Kills helminths

Thought to contribute to bronchial epithelial damage in pts w/ atopic (extrinsic allergic) asthma

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12
Q

Weakness associated with OSA?

A

NeuroMSK of oropharynx

Think tx with hypoglossal nerve stimulation

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13
Q

Calculation for A-a gradient

A

PAO2 - PaO2

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14
Q

Normal A-a gradient

A

10-15 mmHg

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15
Q

Increased A-a gradient indicates what?

A

Hypoxemia

Causes:

  • Shunting
  • V/Q mismatch
  • Fibrosis (impaired diffusion)
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16
Q

Normal A-a gradient w/ low PaO2

A

Hypoventilation (e.g. opioid use, unresponsiveness)

High altitude

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17
Q

When you read “granules containing parallel stacks of membrane lamellae” what do you think?

A

Surfactant stored by Type II pneumocytes

Lines alveoli => v surface tension

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18
Q

FRC in obstructive vs restrictive lung disease?

A

Obstructive:
increased

Restrictive:
decreased

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19
Q

Hypoxia in COPD stimulates increased production of what?

A

Erythropoietin by cortical cells of kidney

Causes increased RBC production

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20
Q

Poor inhalation technique of daily steroids for asthma can lead to what?

A
  • Medication deposition on oral mucous membranes
  • Can lead to oropharyngeal candidiasis

Should use a spacer and rinse mouth after steroid use

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21
Q

“Serpentine cords” — growth in parallel chains

Think what?

A

TB

Virulence: PMN inhibition, mitochondrial destruction, TNF release

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22
Q

SCID characteristic features

A
  • Severe bacterial and viral infections in infancy
  • Chronic diarrhea
  • Mucocutaneous candidiasis

T&B cell dysfunction

Labs: absent T cells, & hypogammaglobulinemia & Absent thymic shadow

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23
Q

C5-C9 deficiency

A
  • Recurrent Neisseria infection
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24
Q

Wiskott-Aldrich syndrome

A
  • Recurrent infections that worsen with age
  • Easy bleeding
  • Eczema
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25
Q

Chedick-Higashi syndrome

A
  • Oculocutaneous albinism
  • Pyogenic infections
  • Progressive neuro dysfunction
26
Q

Predominant lymphocyte type found in sarcoidosis

A

CD4+ T helper cells

27
Q

Lab findings in sarcoidosis

A
  • Hypercalcemia/calcuria

- Elevated serum ACE levels

28
Q

Round, dense basophilic (dark-staining) body in nucleu

A

Nucleolus

29
Q

Nucleolus is the primary site for what?

A

rRNA transcription

30
Q

rRNA (18S, 5.8S & 28 S) synthesizing polymerase I

A

RNA poly I

31
Q

mRNA poly?

A

RNA poly II

32
Q

snRNA poly?

A

RNA poly II

33
Q

microRNA poly?

A

RNA poly II

34
Q

tRNA poly?

A

RNA poly III

35
Q

5S rRNA poly?

A

RNA poly III

36
Q

DNA endonuclease function?

A

Break phosphodiester bonds w/in the nucleotide chain in DNA & RNA

Important in DNA repair & RNA splicing

37
Q

DNA polymerase

A
  • Primary enzymes responsible for DNA replication & repair
  • Found in the nucleus
38
Q

Hyper-IgM syndrome

A

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
39
Q

Clinical presentation of hyperIgM syndrome

A
  • Recurrent sinopulm infections

- Lymphoid hyperplasia

40
Q

Example of spore-forming bacteria

A

Bacillus anthracis

All clostridium species

41
Q

What is unique about spore-forming bacteria

A
  • Can survive boiling (at 100ºC)
  • Found in soil
  • Capable of forming spores (duh)
42
Q

Macconkey agar purpose?

A

Only grows g(-)

When pink = lactose fermenter

43
Q

Encapsulated, lactose (+), g(-), appear mucoid in culture

PNA in pts w/ impaired host defense/alcoholics

A

Klebsiella

  • Tissue necrosis
  • Early abscess formation with production of thick, mucoid, blood-tinged sputum
44
Q

Chloramphenicol MOA

A

Anti-ribosomal 50s

Most feared SE: aplastic anemia

45
Q

Azithromycin MOA

A

Inhibits 50s ribosomal subunit

46
Q

Ciprofloxacin MOA

A

Inhibit bacterial DNA gyrase => bacterial DNA damage and death

No effect on cell wall

47
Q

Doxy MOA

A

Inhibit bacterial 30s ribosomal subunit

48
Q

Which anti-bacterials disrupt peptidoglycan cell wall of g(+) orgs?

A

PCNs, cephalosporins, vanco

Can’t survive osmotic stress, ability of bacteria lost after tx

49
Q

After the oxygenated blood leaves the pulm area, it mixes with deoxygenated blood in the pulm veins. Where is the deoxygenated blood coming from?

A
  • Bronchial arteries/veins
  • Thebesian veins

LA/LV have less oxygen in the blood compared to pulm veins

50
Q

Where are the lung apices in relation to outer anatomy?

A

Above clavicle and first rib between lateral sternal line and midclavicular line

51
Q

Tension pneumothorax pathophys

A
  • 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
52
Q

Tension pneumothorax signs/sx

A
  • Tachycardia
  • Hypotension
  • Tachypnea
  • Hypoxemia
  • Absence of breath sounds and hyperresonance to percussion

Tx: needle thoracostomy or chest tube

53
Q

When dust is inhaled into the lungs and stopped in the terminal bronchioles, what clears it? What about distal to these terminal bronchioles?

A

Terminal:
Ciliated mucosa

Distal to terminal:
Macros

54
Q

Vitamin A function

A

Maintains orderly differentiation of specialized epithelium:

  • Mucus-secreting columnar epithelia of conjunctive
  • respiratory tracts
  • Urinary tracts
  • Pancreatic ducts
55
Q

Avitaminosis A

A

Causes squamous metaplasia => keratinizing epithelium

56
Q

Alveolar gas equation

A

PAO2 = 150 - (PaCO2/0.8)

57
Q

GO REVIEW THE PULM-VOLUME CURVE (time x lung volume)

A

NOW

58
Q

Cheyne-Stokes breathing

A
  • Cyclic breathin
  • Apnea is followed by increasing, then decreasing tidal volumes until next apneic period
  • seen in advanced CHF
59
Q

GO LOOK AT PRESSURE-VOLUME RELATIONSHIP GRAPHS

A

NOW

60
Q

Triple combo ART tx in preggers w/ HIV

A
  • 2 nucleoside/nucleotide reverse transcriptase inhibitors

- 1 protease/NNRT/integrase inhibitor

61
Q

Clinical findings of vertical transmission of HIV-1

A
  • Oral thrush
  • interstitial PNA
  • severe lymphopenia
62
Q

Which pneumocytes are capable of lung cell proliferation in response to injury?

A

Type II pneumocytes

Also produce surfactant

ID/LC Step Review (19 decks)

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