PPOM 2 Week 15 LEC 132-141 WORK IN PROGRESS

Just a note: I havent noticed the " osteopathic considerations in..." lectures to be very high yield when it comes to exam content. As a result, I haven't included many flash cards from those lectures.

(132) Right vagus Nerve provides parasympathetic innervation to the:

SA node

(132) Left vagus Nerve provides parasympathetic innervation to the:

AV node

(132) Primary Lymphatic Drainage Path of Endocardium, myocardium, epicardium

Right lymphatic duct → Right subclavian vein

(132) Primary Lymphatic Drainage Path of Pericardium

Thoracic duct → Left subclavian vein

(132) Consequences of Impaired Lymph Flow

Increased central venous pressure, tissue congestion leading to decreased myocardial oxygenation, larger myocardial infarctions

(132) Right pectoralis major trigger point (below rib 5 margin) is associated with:

SVT

(132) Left pectoralis major trigger point is associated with:

mimics cardiac pain; must be distinguished clinically.

(132) Anterior Chapman Point of Heart

Left 2nd intercostal space, close to sternum

(132) Anterior Chapman Point of Adrenals

1″ lateral & 2″ superior to umbilicus

(132) Anterior Chapman Point of Kidneys

1″ superior & 1″ lateral to umbilicus

(132) Posterior Chapman Point of Heart

Between T2–T3 transverse processes

(132) Posterior Chapman Point of Adrenals

Between T11–T12

(132) Posterior Chapman Point of Kidneys

Between T12–L1

(132) Overactivation of right sympathetic fibers leads to:

SA node oversimulation → tachyarrhythmia

(132) Overactivation of Left sympathetic fibers leads to:

AV node ovetstimulation → VF/ectopy

(132) Overactivation of right vagus nerve leads to:

bradycardia

(132) Overactivation of Left vagus nerve leads to:

AV block

(133) Compliance

The ability of the thoracic cage and lungs to expand

(133) Work of Breathing (WOB)

The effort required to move air in and out of the lungs

(133) Diaphragm Atrophy

begins as early as 18 hours of ventilation; Can reduce diaphragm size by up to 57% with prolonged ventilation

(133) Perivascular lymphatics

Pulmonary Lymphatic Drainage System that follows arteries and veins

(133) Peribronchial lymphatics

Pulmonary Lymphatic Drainage System that follows the airways

(133) Lymphatic Drainage Mechanism of Large airways

Mucociliary + lymphatic drainage

(133) Lymphatic Drainage Mechanism of Terminal bronchioles & alveoli

Entirely lymphatic drainage

(133) Pathophysiology of Pneumonia

Marked inflammation of small airways; Increased secretions; Deep lymphatic dependence for clearance; Respiratory excursion becomes limited due to pain, consolidation, or cough

(135) Basic Properties of Fungi

Eukaryotic organisms with 80S ribosomes and membrane-bound organelles

(135) Basic Properties of Fungi Cell wall

contains chitin and glucans

(135) Basic Properties of Fungi Cell membrane

contains ergosterol (not cholesterol)

(135) Examples of dimorphic fungi pathogens

Coccidioides immitis/posadasii, Histoplasma capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei

(135) Endemic Region of Coccidioides (Coccidioidomycosis)

Southwestern U.S., Mexico

(135) Endemic Region of Histoplasma (Histoplasmosis)

Ohio & Mississippi River Valleys

(135) Endemic Region of Blastomyces (Blastomycosis)

Upper Midwest, Great Lakes, riverbanks

(135) Endemic Region of Paracoccidioides (Paracoccidioidomycosis)

Central & South America

(135) Endemic Region of Talaromyces marneffei

Southeast Asia

(135) Endemic Region of Mucorales (Mucormycosis)

Worldwide (opportunistic)

(135) Environmental Sources of Histoplasma (Histoplasmosis)

Bird/bat guano

(135) Environmental Sources of Coccidioides (Coccidioidomycosis)

Desert soil

(135) Environmental Sources of Blastomyces (Blastomycosis)

Moist soil near rivers

(135) Environmental Sources of Paracoccidioides (Paracoccidioidomycosis)

Rural soil

(135) Environmental Sources of Mucorales (Mucormycosis)

Rotting vegetation/soil

(135) Environmental Sources of Talaromyces marneffei

Bamboo rats

(135) Dimorphic fungi transform to pathogenic yeast at:

37°C

(135) Immune Response to fungal agents

Cell-mediated (Th1) immunity critical. IL-2, IFN-γ activation. Activated macrophages kill yeast. Neutrophils important against molds (e.g., Mucor)

(135) KOH preparation

Laboratory techniques used for the identification and diagnosis of fungal pathogens; dissolves tissue; leaves fungal cell wall intact

(135) PAS stain

Laboratory techniques used for the identification and diagnosis of fungal pathogens; highlights polysaccharides

(135) Silver stain (GMS)

Laboratory techniques used for the identification and diagnosis of fungal pathogens; best for fungi

(135) H&E

Laboratory techniques used for the identification and diagnosis of fungal pathogens; general tissue stain

(135) Histopathology of Coccidioides

spherules with endospores

(135) Histopathology of Histoplasma

yeast inside macrophages

(135) Histopathology of Blastomyces

broad-based budding

(135) Histopathology of Mucorales

broad, right-angle branching, non-septate hyphae

(135) Histopathology of Talaromyces

red pigment at room temp

(135) Serology / Antigen Detection of Coccidioides

complement fixation

(135) Serology / Antigen Detection of Histoplasma

urine antigen (>90% sensitivity in HIV)

(135) Serology / Antigen Detection of Blastomyces

limited utility

(135) Serology / Antigen Detection of Talaromyces

serology available

(135) Serology / Antigen Detection of Mucorales

serology not helpful

(135) _____ transmission is uniquely specified: infection occurs through inhalation of a single arthroconidium, which is sufficient to cause disease.

Coccidioides (Coccidioidomycosis)

(135) _____ transmission has environmental condition dependence: cycles of rain → drought promote spore dispersion.

Coccidioides (Coccidioidomycosis)

(135) _____ culture is dangerous, so direct microscopy is preferred.

Coccidioides (Coccidioidomycosis)

(135) _____ produces proteinases that degrade collagen, elastin, Hb, IgG, and IgA.

Coccidioides (Coccidioidomycosis)

(135) _____ granulomas may reactivate years later, causing disease in non-endemic areas.

Histoplasma (Histoplasmosis)

(135) _____ conidia are killed easily by neutrophils but yeast form is too large, requiring T-cell–stimulated neutrophil killing.

Blastomyces (Blastomycosis)

(135) _____ has an evasion strategy in which it sheds surface antigens after infection to escape recognition.

Blastomyces (Blastomycosis)

(135) _____ almost exclusively affects men, due to estrogen blocking transformation to pathogenic yeast.

Paracoccidioides (Paracoccidioidomycosis)

(135) _____ involves mucosal lesions, a unique presentation not shared with the other endemic fungi.

Paracoccidioides (Paracoccidioidomycosis)

(135) _____ causes black necrotic eschar in rhino-orbital-cerebral disease.

Mucorales (Mucormycosis)

(135) _____ has the strongest association with diabetic ketoacidosis of all fungi.

Mucorales (Mucormycosis)

(135) _____ is very common in HIV patients in Southeast Asia (3rd most common opportunistic infection).

Talaromyces marneffei

(135) Organism Type & Morphology of Coccidioides (Coccidioidomycosis)

Dimorphic; spherules in tissue

(135) Organism Type & Morphology of Histoplasma (Histoplasmosis)

Dimorphic; yeast in macrophages

(135) Organism Type & Morphology of Blastomyces (Blastomycosis)

Dimorphic; broad-based budding yeast

(135) Organism Type & Morphology of Paracoccidioides (Paracoccidioidomycosis)

Dimorphic

(135) Organism Type & Morphology of Mucorales (Mucormycosis)

Opportunistic mold; broad, non-septate hyphae

(135) Organism Type & Morphology of Talaromyces marneffei

Dimorphic; red pigment

(135) Primary Host Group of Coccidioides (Coccidioidomycosis)

General population in endemic area

(135) Primary Host Group of Histoplasma (Histoplasmosis)

General population in endemic area; high AIDS risk

(135) Primary Host Group of Blastomyces (Blastomycosis)

Humans & dogs

(135) Primary Host Group of Paracoccidioides (Paracoccidioidomycosis)

Middle-aged/older men (estrogen protective)

(135) Primary Host Group of Mucorales (Mucormycosis)

Immunocompromised; diabetics

(135) Primary Host Group of Talaromyces marneffei

HIV patients (3rd most common opportunistic infection in SE Asia)

(135) Immune Response of Coccidioides (Coccidioidomycosis)

Th1 (IL-2, IFN-γ); high CMI needed

(135) Immune Response of Histoplasma (Histoplasmosis)

CMI; macrophage activation crucial

(135) Immune Response of Blastomyces (Blastomycosis)

Th1; neutrophils kill conidia

(135) Immune Response of Paracoccidioides (Paracoccidioidomycosis)

Standard CMI

(135) Immune Response of Mucorales (Mucormycosis)

Neutrophils critical; defects → severe disease

(135) Immune Response of Talaromyces marneffei

CMI important

(135) Key Pathogenesis Features of Coccidioides (Coccidioidomycosis)

Resistant to phagocytes; proteinases degrade collagen/elastin/IgG/IgA

(135) Key Pathogenesis Features of Histoplasma (Histoplasmosis)

Survives in macrophages; raises phagosome pH

(135) Key Pathogenesis Features of Blastomyces (Blastomycosis)

Sheds Ags to evade phagocytes

(135) Key Pathogenesis Features of Mucorales (Mucormycosis)

Tissue necrosis; invades vessels; needs free iron

(135) Key Pathogenesis Features of Talaromyces marneffei

Mimics TB clinically

(135) Diagnosis of Coccidioides (Coccidioidomycosis)

Spherules in tissue; serology (complement fixation)

(135) Diagnosis of Histoplasma (Histoplasmosis)

Yeast in macrophages; urine antigen

(135) Diagnosis of Blastomyces (Blastomycosis)

Broad-based budding yeast; culture

(135) Diagnosis of Paracoccidioides (Paracoccidioidomycosis)

Clinical + microscopy

(135) Diagnosis of Mucorales (Mucormycosis)

Wide, ribbon-like non-septate hyphae; histopathology

(135) Diagnosis of Talaromyces marneffei

Red pigment; serology

(135) Treatment of Coccidioides (Coccidioidomycosis)

Amphotericin B → azoles; fluconazole for meningitis (lifelong)

(135) Treatment of Histoplasma (Histoplasmosis)

Amphotericin B (severe); itraconazole/ketoconazole (mild)