Pneumonia
Name the three patterns of infectious pneumonia
Lobar, bronchopneumonia, interstitial (atypical)
What is the mainstay of treatment of exudative effusions?
Thoracentesis
Hypoxemia is characterized by a low ____?
Pao2
What is the normal range for pH in the body?
7.35-7.45
Name three adverse effects associated with furosemide use.
Hypokalemia, metabolic alkalosis, nephritis, gout, hypomagnesemia, dehydration, ototoxicity, allergy (sulfa)
What is the most common cause of lobar pneumonia? Name three features of this microbe
Streptococcus pneumoniae.
Gram positive, a-hemolytic, lancelet-shaped diplococci, encapsulated, IgA protease, optochin sensitive, and bile-soluble
Which type of pleural effusion will have a cloudy gross appearance?
Exudate
Hypoxemia causes what change in pulmonary arteries?
Vasoconstriction
Hyperventilation will result in a respiratory _____?
Alkalosis
What is the mechanism of action of furosemide?
Inhibits cotransport system (Na+/K+/2Cl−) of thick ascending limb of loop of Henle.
List 4 or more aspects/methods used in the diagnosis of pneumonia.
History, physical, chest x-ray, sputum culture, bronchoalveolar lavage, CBC, blood culture, urine antigen test
List the Light's criteria for classification of pleural effusions
1. Pleural protein/serum protein greater than 0.5
2. Pleural LDH/Serum LDH greater than 0.6
3. Pleural LDH greater than 2/3 upper limits normal LDH
Hypercapnia causes a _____ shift in the oxygen-hemoglobin dissociation curve?
Right
The physiological response to respiratory acidosis by the kidney is to?
Increase renal HCO3- reabsorption
Virus-infected cells release ____ to prime nearby cells for viral defense by downregulating protein synthesis to prevent viral replication and upregulating MHC for recognition of virus-infected cells.
interferons
This gram-negative, aerobic, oxidase positive organism is associated with nosocomial pneumonia.
Pseudomonas
Transudate can be caused by increased ______ pressure or decreased _______ pressure.
Hydrostatic, oncotic
What are the three major ways CO2 is transported through the blood (in order of highest percentage to lowest)?
1) As bicarbonate
2) Bound to Hb
3)Dissolved in blood
Explain why hypoventilation will result in respiratory acidosis.
Decreased excretion of CO2-->more CO2 converted to carbonic acid by carbonic anhydrase-->Carbonic acid dissociates into a hydrogen ion and bicarbonate-->increased H+ causes decreased pH
What is the equation for alveolar gas exchange? What is the equation for A-a gradient?
PAo2 = PIo2 – (Paco2/R)
PAo2 - Pao2
List the three antibiotics prescribed to our patient in the case and their mechanism of action.
Ceftriaxone - β-lactam drugs that inhibit cell wall synthesis
Amoxicillin - β-lactam drugs that inhibit cell wall synthesis
Azithromycin - Inhibit protein synthesis by blocking translocation; bind to the 23S rRNA of the 50S ribosomal subunit.
Name three pathological states that can result in a transudative pleural effusion?
Heart failure, cirrhosis, nephrotic syndrome, pulmonary embolism, hypoproteinemia
Name 4 causes of hypoxemia
High altitude, hypoventilation, diffusion defects, V/Q mismatch, right-to-left shunt
Name three causes of hypoventilation.
COPD, opiate abuse, obesity, and brain injury
Viruses often downregulate the expression of MHC-I of infected cells to evade attack by cytotoxic T-cells. Which immune cells are responsible for inducing apoptosis in these virally infected cells?
Natural killer cells