RHS1 Flashcards
acute vs chornic CO toxicity
acute: bright red
chronic: hypoxic CNS lesions, basal gangia lesions, globus pallidus necrosis
Colorless, Odorless, nonirritating gas.
Carbon Monoxide
-higher affinity for hemogloibibn(turns to carboxyhemoglobbin)
Attaches to and inactivates metalloenzymes
cyanide
-will inhibit cell respiration
Principal toxicity due to inactivation of cytochrome C oxidase
cyanide
acute vs chronic cyanide toxicity
acute effects largest O2 organ demads: brain and heart
chronic: weakness and visual distrubances
binds to the sulfhydryl groups
lead
inhibition of delta-aminolevulinic acid dehydratase and ferrochelatase.
lead
-impares heme synthesis, Zinc-protoporphyrin (ZPP) is formed instead of heme, causing dec IRON
inhibits sodium- and potassium-dependent ATPases in cell membranes
lead
-will make the RBC more fragile and more suceptible to lyse
Competes with calcium for binding to phosphates in bone
lead
-radiodense deposits on bone
burton line
lead deposits on gingiva
Zinc-protoporphyrin (ZPP)
formed when led is in the body and will inhibit iron
vascular sclerosis and stromal fibrosis
ionizing radiation
heat cramps vs heat exhaustion vs heat stroke
heat cramps: loss of electrolytes. normal core temp maintained, cramping of muscles
heat exhaustion: heart nor able to compensate for hypovolemia from excessive sweating. core temp in within safe range and will be brief until water is replenished
heat stroke: failure of thermoreg mechanisms. core body temp above 104. general vasodialation and **sustained muscle contraction from RYR1 dysfunction
what are respiratoyr tract defense enzymes
lysozyme and lactoferrin
what innate defense is used for virus, bacteria, parasite, fungus
virus: lymphocytes and NK
bacteria: macrophages and PMN(neutrophils)
fungi and parasites: mast and eosinophils
MCHC
words for high and low MCHC
-who has a high MCHC, low?
concentration of Hb in a given volume of RBC
hyper and hypochromic
HIGH: HS, SCD
LOW: Iron def(drastic), thalasemia (slight)
gives an idea about how similar or different the RBCs are in size
-word for high variation
Red cell distribution width (RDW)
-anisocytosis (high RDW)
ovalocyte
B12 and Folate Dec (macrocytic)
thassalemia has what shape RBC
target
tear drop
what shape for myelofibrosis, metastatic marrow, megaloblastic anemia
what shpae immune heamolitic anemia, post spleenectomy, HS, severe burns
sphereocyte
what shape microangipathic and mechanical hemolytic anemia
name the dzs
schistocyte
-TTP(neurologic- VWF multimers), ITP(antibodies Gp 2b 3a, factor 4), HUS(Ecoli), DIC
what kind of anemia is having no space in the bone marrow
hypoprolioferative
hemolytic anemia definition
shortened lifespan of RBC and compensatory INC IN EPO, INC IN bilirubin, INC LDH, DEC haptoglobin
hemolytic anemia lab findings on peripheral blood stain
Normochromic normocytic anemia, with polychromasia ± nucleated RBCs.
genes mutated for HS
ankyrin(most common)
spectrin
band 3
band 4.2
what type of cells come up with a speelectomy
holley jowell
cell types seen in G6PD
intra or extra vascular?
heinz bodies (intravascular lysis)
spherocytes
bite cells (extravascular lysis)
drug for SCD
hydroxyurea(inc HbF-dec sickling)
aspleenic infection risks
encapsulated bacteria
H influenza, S pnemonia
bacterimia, spesis, meningitis
babesiosa(will be more symptomatic)
hand foot syndrom(where else is this seen), leg ulcers, priapasm, papillary necrosis, stroke,seizures, ACS, hemochromotosis. gallstones
cardiomyopathy
pulm htn
SCD -vaso-oculsion
hand and foot syndrom also seen in polycethmia vers and essential thrombocytosis
what does salmonella do to one with SCD
osteomyeolitis
types of cells seen in thasselemia
target(micro hypochromo)
basophilic stippling
teardrop
Microcytic hypochromic anemia
Polychromatic cells ± nucleated RBCs
B thasalemia major(nucleated cells!)
w/ almost absent HbA, inc HbF
PIGA mutation stops the synthesis of ..
genetic inheriance
PNH, invovled in the synthesis of GPI/glycolipid(CD55, CD59, C8) anchor
-X linked and only needs one hit
lab finding for PNH
may find pancytopenia(anemia, leukopenia, thrombocytopenia) and ascend CD55 CD59
names of the capsid proteins for rhinovirus
VP1-4
VP7 binds to ICAM
penton base
adenovirus
-with intranuclear inclusions
casual bacterial and viral agent of acute sinusitus /otitis
chronic?
acute bacterial: Strep Pneumonia, H eamofilus influenza (Hib)
acute viral: rhino, corona, adenovirus
chronic: staph aureus
lanceolate/flame-shaped
strep pneumonia
basis of the strep pneumonis vac
capsule, it is also what allows them to escape macrophage via opsonization
Optochin sensitive
strep pneumonia
Positive Quellung reaction
strep pneumonia
-detects capsule
IgA protease
strep pneumonia - contributes to persisiten mucosal colonization(no IgA)
spleen is essential to make IgM instead
compnent of pneumolysin
strep pnemonia
-Cytotoxic for respiratory epithelial and endothelial cells
-Inhibits ciliated epithelial cell activity
-Decreases PMN and inc inflammation
most common cause of chronic otitis media
staph aureus
s pneumonia 23 vaccine for vs other
+65
2-65 with medical condition like aspleenia
19-65 if smoker, copd, CF
-inactivated vaccine from the capsule
other is s.pnemonia 13- conjugate for less than 2 or older than 65
pathologies assocaited with NTHi vs Hib
NTHi= sinusitis, otitis, bronchopneumonia(same as mcat)
Hib= meningitis, spesis, epliglotitis!
tripod
thumb sign, muffled hot potatoe voice
Hib-epilogittitis
key feature of mumps
swollen parotid gland. parotitis/ bull neck
leukocidin
strep pyrogenes induces pus in pharyngitis
Bacitracin sensitive
strep pyrogenes
PYR positive
strep pyrogenes
detection of pyrolidonyl
arylamidase (hydrolysis of L-
pyrrolidonyl-β-naphthylamide)
sand paper rash and strawberry tounge
scarlet fever
-following a strep pyrogenes infection/ strep throat
club shaped, chinese letters, pleomorphic
diptheria
harboring phage-encoded toxin can cause disease
diptheria
GPCR inactivation
tracheal toxin- direct damage
Pertussis/Adenylyl Cyclase Toxin-alters GCPR signaling pathways)
pertussis is A-B inactivates GPCR vis ADP ribosylation to inhibit immune signalling and chemotaxis.
-adenycle cyclase toxin inc camp and inc mucus
Presidposing factors for PIV
child under 5
Asthma
Vit A Def
lack of breast feeding
(Croup)
Steeple sign
narrowing of the traacheal
Croup
Laryngotracheobronchitis
PIV vs RSV peak
PIV peak in fall
RSV peak in winter
Necrosis of the bronchi and bronchioles leads to the formation of “plugs” of mucus, fibrin, and necrotic material within smaller airways.
RSV
Infection can progress to alveolar sacs (atypical interstitial pneumonia) or trigger bacterial secondary super- infections
HMPV dx
bronchitis, bronchiolitis, pneumonia
-ver similar to RSV
RdRp–antivirals
covid
moderna/pzizer vs johnson johnson
M/P: mRNA subunit vaccines encoding Spike protein
JJ: Adenovirus vectors with subunit DNA Spike protein
typical vs atypical carcinoid
typical variant
* Centrally located
* Polypoid growth
* 40 y/o age range
* Obstruction, cough, hemoptysis, infection
* Localized, but can metastasize to lymph
nodes
* Resectable and good prognosis
atypical variant: necrosis and or elevated mitotic count
recombination vs Drift
recombination is sudden and recombination of two strains
drift is gradual from lots of pt mutations
coin lesion
lung harmatoma
-Nodules of connective tissue (cartilage/ fibrous tissue/ fat) along with epithelial clefts.
pink frothy sputum
pulm edema
clinical presentation of ARDS
abrupt onset of dyspenia, hypoxemia, bipateral pulm edema(bilateral pulmonary infiltrates) and absence of cardiac failure
phases of ARDS
day 1-7 = acute, exudative phase (hyaline membrane and heavy lungs)
day 7-21 = organizing, proliferative phase(type 2 proliferation, granulation tissue)
potential scarring 21+
poor prognostic indicators for ARDS
elderly,
spesis, bacteremia,
multisystem organ failure
pi gene, what chromosome
alpha 1 antitrypsin on chrom 14
fate of alpha 1 antitrysin def
accumulation of defective protein in the liver and leads to chronic liver dx
moth eaten appearence
emphysema
both chronic bronchitis and asthma will have Infiltrate of CD8+ T-cells, macrophages and neutrophils with eventually fibrosis. hyperplasia/ hypertrophy, mucus plugging….what distinguishes them
asthma will have eosinophils present
foul smelling sputum
bronchiectisis
lung abcess
bronchiectisis
bronchiolitis obliterans
bronchiectisis
episodic, Paroxysms of cough particularly frequent when the patient rises in the morning
bronchiectisis…change in position causes collections of pus and secretions to drain into the bronchi
Clubbing of the fingers
bronchiectisis
IPF
complications of bronchiectisis
brain or lung abcess, systemic amyloidosis, pulm htn, cor pulmonal
Primary Ciliary Dyskinesia mutation
dynein (cilia)
leads to recurrent infections and bronchiectisis
Kartagener syndrome triad
bronchiectisis(defective mucus clearance), dextrocardia, sinusitis
-males may have infertility
what causes non-atopic asthma
viral infections of URT or inhaled irritants (So2, NO2, O3)
what type of person gets aspirin asthma
people with recurrent rhinitis and nasal polyps
Curschmann spirals
bronchial asthma
-cleared mucus plugs with swirls of shed epithelium
Charcot-Leyden crystals
bronchial asthma
-made of eosinophils
asthma causes what kind of pH balance in the b ody
respiratory acidosisi
Idiopathic Pulmonary Fibrosis aka
Usual interstitial pneumonia
-progressive
interstitial pulmonary fibrosis and respiratory failure. lots and lots of fibrosis
IPF demographic
older males
-Arises in genetically predisposed individuals who are prone to irregular repair of recurrent alveolar epithelial cell injuries from environmental exposures
Cobble stone
IPF
-with lower lobe fibrotic parenchyma and honeycomb cysts
pathcy interstitial fibrosisi
-Temporal (time) and geographic (spatial) heterogeneity (does not affect all parts of the lung
simultaneously and similarly)
IPF
Nonspecific Interstitial Pneumonia (NSIP) demographic
female non smoker, young
Uniform fibrosing process (chicken-wire)
Nonspecific Interstitial Pneumonia
Bronchiolitis obliterans organizing pneumonia aka
Cryptogenic Organzing Pnemonia
Polypoid plugs of loose organizing connective tissue called…
mason bodied
Cryptogenic Organzing Pnemonia
All lesions are of same age, and underlying lung architecture is normal(no interstitial fibrosis)
COP
-only the areas effected with the mucus pleugs will be fibrosed
what induces collagen vascular dxs,whats a significant feature?
AI: lupus, RA, sclerosis,
-will have resitrictive lung dx with pleural involvement
pleural plaques
absestosis
-do not contain asbestos bodies in the plaques
Increased risk of Pulmonary Tuberculosis
silicosis
eggshell calcification
silicosisi
Anthracosis
Accumulation of carbon pigment mostly in peri lymphatic regions and lymph nodes
-coal workers pneumocosis
noncaseating granulomatous inflammation in young nonsmokers and hypercalcemia
sarcoidosis
Schaumann bodies:
laminated concretions of calcium and protein in sarcoidosis
Asteroid bodies:
stellate inclusion in giant cells in sarcoidosis
Farmers’ lung, Silo fillers’ disease, and Byssinosis all under what umbrella term
Hypersensitivity Pneumonitis
-farmers is mody hay, spores of actinomycetes/granuloma + mild fibrosis
-silo is organics, plant materials
-bysstosisi is textiles(granuloma +severe fibrosis)
Smoking related Interstitial lung Disease
- Desquamative Interstitial pneumonia (DIP).
- Respiratory bronchiolitis associated interstitial lung disease.
Characterized by a large amount of macrophages in the 1st and 2nd respiratory bronchioles of current and former smokers with slight fibrosis
Desquamative interstitial pneumonia
Rare disease caused by defects in pulmonary macrophage function due to deficient (GM- CSF) signalling, which results in ….
Pulmonary Alveolar Proteinosis
granulocyte-macrophage colony-stimulating factor
results in the accumulation of surfactant in the intra-alveolar and bronchiolar spaces
bilateral patchy asymmetric pulmonary opacifications with minimal inflammatory rxn
other sx
tx?
Pulmonary Alveolar Proteinosis
-gellatenous sputum
-pulm lavage and GM-CSF replacement
Cough, abundant gelatinous sputum
Pulmonary Alveolar Proteinosis
BMPR2 function
pulmonary htn(normally inhibits the proliferation of fibroblasts and smooth muscle cells.)
Diffuse Alveolar Haemorrhage Syndrome sx triad
hemoptysis, anemia, diffuse pulm infiltrates
Diffuse Alveolar Haemorrhage Syndrome dxs
good pastures(linear IgG), wegners granulomatosis, hemosiderosis
Kidney and lung injury are caused by circulating autoantibodies against the non-collagenous domain of the α3 chain of collagen IV.
good pastures
Linear deposition of IgG along basement membranes, hemosiderin
good pastured (RPGN1)
the mediastinum shifts toward the
atelectatic lung
Resorption Atelectasis
-absent TF and breathsounds
Most often caused by excessive secretions (e.g., mucus plugs) or exudates within smaller bronchi (bronchial asthma, chronic bronchitis, bronchiectasis, and postoperative states)
* Aspiration of foreign bodies
* Intrabronchial tumors
resporbtion atelectasis
Air or fluid accumulation in pleural cavity
compression Atelectasis
Trachea and mediastinum shift away from the affected lung
compression Atelectasis
Occurs when focal or generalized pulmonary or pleural fibrosis prevents full lung expansion
contraction Atelectasis
lepidic pattern
adenocarcinoma in situ
CAVITATION
squamous cell carcinoma
cavitary lesions in reactivated TB(HIV)
Azzopardi effect and _______cell appearence
small cell carcinoma
salt and pepper(also seen in carcinoid)
basophilic staining
extensive necrosis
collar-button” lesion
carcinoid
Kulchitsky cells
carcinoid
salt-and-pepper and little pleomorphism
carcinoid
acute vs chronic blood loss
-intra or extra
-peripheral smear
acute= intravascular loss, 24 hrs later extravascular loss. recticulocytosis, thrombocytosis, nutrophilia(inc). normocytic normochromic
chronic: PS only anemia. microcytic hypochromic
α2-globulin that binds free hemoglobin and prevents its excretion in the urine
Haptoglobin
is g6pd intra or extravacula HA
both
intravascular from the heinz bodies
extravascular from the bite cells
erythroid hyperplasia/ ineffective erythropiosis
sickle cell disease, thalassemia, megaloblastic anemia
-results in a dec in reticulocytes(causes intramedullary hemolysis-ischemia and jaundice)
blood disorders that cause gallstones
G6PD, SCD
basophilic stippling
beta thalasemia
small cell carinoma
hemochromatosis diseases and complication risks
SCD, B thalasemia major
-risk of cardiomyopathy
anisopoikilocytosis vs poikilocytosis
variance in size and shape of a red blood cell
-thalasemia, megaloblastic anemia
poikilocytosis: just variation in the shapes
-Iron deficiency
PNH risk of developing
AML or MDS
aplastic anemia, iron def, thrombosis
MA TIA
what causes warm AIHA. is it intra or extra
SLE, CLL(B neoplasma)
Drugs-methyldopa and penicillin
-extravascula, positive coombs test
what causes cold AIHA
is it intra or extra vascular
mycoplasma pneumonia, EBV, CBV, HIV, flu
B cell lymphomas
-extravascular
non immune hemolytic anemia
HUS, TTP, DIC, malignent HTN, SLE, disseminated cancer = mechanical damage
-Malaria!
DMT HDS + M
methotrexate dec what nutrient
folic acid
hyper and hypo segmented neutrophils
hyperhsegmented: megaloblastic anemia
hyposegmented: MDS
nuclear cytoplasmic asynchrony
megaloblastic anemia
beefy tounge
megaloblastic anemia
partly degraded aggregates of ferritin
hemosiderrin (one of the two forms that iron is stored as, the second being ferritin)
Plummer Vinson syndrome-
esophageal webs + iron deficiency anemia + atrophic
glossitis
Fanconi anemia;Dyskeratosis congenita; Shwachman Diamond syndrome can lead to what
aplastic anemia
Ferruginous bodies
asbestos bodies
-golden brown rods with translucent centers
bilateral hilar lymphadenopathy
Sarcoidosis, byssinosis, silicosis(just looks like a granuloma)
-noncaseous granuloma
Hypersensitivity pneumonitis will also have granulomas but will also have eosinophils
small and squamous cell carcinoma will effect hilar lymph nodes
damage to type I pneumocytes with the subsequent proliferation of type II pneumocytes and secretion of factors by macrophages that cause fibrosis
IPF
Superior vena cava (SVC) syndrome
pan coast tumor
-venous congestion and edema of the head and arm. head will be red hot
MOST COMMON CAUSE of Community-Acquired Pneumonia CAP
strep pneumonia
Resistance to β-lactams
Hib/NTHi , maxorella
Pneumolysin
strep pneumonia
Klebsiella pneumoniae family
Enterobacteriaeceae
Haemagglutinin (HA) glycoprotein organism and function
Viral attachment and binding to silica acid protein of influenza
Neuraminidase organism and function
Release* and cleavage of new virions from sialic acid. influenza virus
PIV will have (Hemagglutinin-Neuraminidase) for attatchment
M2 protein organism and function
uncoating for influenza
MOST COMMON CAUSE of “Flu-associated” deaths
sinusitis, otitis media (children), typical bacterial pneumonia (elderly
Prominent capsule (mucoid appearance
Klesseba pneumonia
K antigen
what type of pneumonia most likely with k. pneumonia
aspiration(CAP)-Putrid odor to breath & sputum, intubation(HAP)
ventilator
hospital aquired(G-)
-all typical
MDR plasmids
Extended Spectrum β-Lactamase gives K pneumonia penicillin resistance
microbe can progress from pneumonia to Lung Abscess formation
K pneumonia
can create an aerobic core for GNAR bactericides to grow
-more complications include bacteremia, sepsis, and meningitis
Hemoptysis variations in typical pneumonia
s.pneumonia: rust colored or streaked sputum
klebsiella: jelly
Lactose Non-fermenter, Oxidase +
G-bacilli
what another G- with oxidase positive, strict aerobe, gamma hemolysis
Pseudomonas
m.cat
(only other strict aerobe is mycobacterium tb)
Motile, strictly aerobic
Pseudomonas
“fruity”smelling,yellow-greensputum
Pseudomonas
leading cause of mortality in CF patients
pseudomonas aug
what gives mycobacterium resistance
having no cell wall
pyocyanin
pseudomonas
blue pigment
-catalyzes the production of superoxide and hydrogen peroxide
pyoverdin
pseudomonas
yellow-green pigment
- a siderophore that binds iron for use in metabolism
disrupts protein synthesis by blocking peptide chain elongation in eukaryotic cells
exotoxin A
pseudomonas
Elastases
pseudomonas
typical sputum cultures in complicated bronchipneumonia
aka AECB
polymicrobial. biofilm of Pneumococcus, Pseudomonas, NTHi, Moraxella
Pleomorphic, lacking cell wall
mycobacterium pneumonia
-wont gram stain(requires NAAT) there fore causes atypical pneumonia
Cold-agglutinin test
mycobacterium pneumonia
produces molecular mimicry
no cell walls(different from myobacterium tb which will have mycolic acid in cell wall)
number 1 atypical pneumonia CA
mycobacterium pneumonia
asthma is specific high risk for what pneumonia bacterium
mycobacterium pneumonia
-effects 15-25 yrs
Strictaerobe
* Catalase & SOD Positive
mycobacterium tuberculosis
Thick lipid rich/waxy cell wall made of______ and ______________
MycolicAcid&Cord Factor[Trehalose dimycolate]
mycobacterium tuberculosis
-NOT peptidoglycan
- inhibits phago lysosome fusion!!
regions of inflammation for active Pulmonary Tuberculosis(primary, recurrent, military)
- Primary – Mid lung
- Reactivated – Apex * Miliary - Dispersed
Ziehl-Neelsen stain
acid fast TB microscopy
Rhodamine-Auramine
TB microscopy
Löwenstein-Jensen medium
TB culture
Interferon-γ Release Assays IGRA find what
aka?
Mycobacterium TB-specific memory CD4+ T cells
-helps distinguish vaccinated or latent infection
aka QuantiFERON
defect in TGF-β signaling,
Hereditary hemorrhagic telangiectasia
characterized by having dilated, thin-walled blood vessels that bleed easily.
Rituximab
chornic immune thrombocytopenia Purapura tx
These usually present as large posttraumatic ecchymoses or hematomas, continued bleeding after a
laceration or surgery.
platelet factor deficiencies
hereditary: factor 8 and 9 and vwF
acquired: DIC, vit K def
antibodies against platelets membrane glycoproteins IIb-IIIa or Ib-IX factors
chronic immune thrombocytopenia purpura
low ferritin causes what to be released and will do what
hepcidin inhibition of macrophage ferroportin
-will lock iron into storage
Patchy sub-pleural or peri-bronchial areas of airspace consolidation
COP
1 and #2 microbes for typical pneumonia
- strep pneumonia
- klebsiella pneumonia
1 agent for secondary pneumonia
staph aureus
ghon and
primary TB
hilar lymphadenopathy, visible granuloma
Inhibits protein synthesis via ADP ribosylation of EF2
diptheria
this will damage cardiac, epithelial, and nerve cells
ALSO Pseudomonas Aeug’s exotoin A
PIV virulence factors
HN binds to host sialic acid.
F protein then exposed to fuse viron and host membrane(this leads to syncitia formation)
alpha thalassemia mutation
deletion on chromose 16, up to 4 genes to be deleted
3= HbH(Btetramet) 4= hydrofetalis( gamma tetramet)
RSV virulence factors
F protein for fusion (also in pIV and causes syncitia)
G protein is just for attatchment
ranke
latent TB
not RANKL for multi myeloma
TTP sx
mutation?
seizures, fevers renal insufficiency, anemia, schistocytes
VWF metalloprotease mutation
antiemetic tx
5HT-3: ondanserone
NK1: Aprepitant
Corticosteroid: Dexamethasone
Adjunctant: Benzo
G protein
F protein
L protein
H-N
G: attatchment for RSV and HMPV
F: fusion/penetriation for PIV, RSV, HMPV, mumps
L: involves RNA Dep RNA poly ‘Large’ in PIV, RSV, HMPV
H-N: PIV, Mumps
