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Om Sai Ram!!!

Day1: 27th Jan
Uworld 1: Respiratory
1. Surfactant: DPPC, L/S>2 (Fetal lungs are fully matured and will not suffer
from NRDS). Rx: corticosteroids to induce surfactant formation in premature
deliveries.
a. AFP: elevated  Neural tube defect. (spina bifida)
b. Erythroblastosis fetalis: assess fetal hemolysis by measuring amniotic
fluid bilirubin levels.
c. Congenital Adrenal hyperplasia: aminocentesis check 17hydroxyprogesterone, HLA region of CS 6/abnormal genes by molecular
probes.
2. Cystic Fibrosis: mutation of CFTR gene defective post translational
folding and glycosylation Degradation of CFTR integral membrane protein
before it reaches cell surface. 508 mutation :: deletes 3nt that code for
Phenylalanine at 508.
a. Phelyketonuria: mutation in hepatocyte intracellular enzyme
phenylalanine hydroxylase.  protein misfolding.
b. Sickle cell anemia: mutation in beta globin gene of HbS.
c. Marfan Syndrome: defect in extracellular glycoprotein, fibrillin 1.
Abnormal fibrillin 1 monomer disrupts fibrillin 1 polymerization and
prevent normal formation of microfibrils in interstitial connective
tissue.
d. Freidrich’s Ataxia: Frataxin gene. Codes for mitochondrial protein
important in RESPIRATORY function and iron homeostasis, is mutated.
GAA repeat disrupts transcription.
3. Gravity: Supine patients aspirate into Posterior segments of upper lobes and
superior segments of lower lobes. Upright aspirate into BASILAR SEGMENTS
OF LOWER LOBE. Aspirated material goes down right main bronchus.

4. Fetal circulation: Most oxygenated blood in fetus carried by umbilical vein,
empties into IVC via Ductus venosus.

CGD: Nitroblue tetrazlolium. Fibrin is coated on the organism and resistance to phagocytosis. Cystic fibrosis: Autosomal Recessive 6. 7. X linked mutation affecting NADPH oxidase. Beta Lactamase: enzyme produced by bacteria confers Resistance to Beta lactam antibiotics (eg penicillin) Peniclllinase resistant penicillins (eg methicillin. nafcillin) Beta lactamase inhibitors: (eg clavulinic acid. . sulbactam) Coagulase: produced by S aureus (+) prothrombin (fibrinogen to fibrin).Om Sai Ram!!! 5. skin and lymph nodes.  abnormal posttranslational processing of trans-membrane protein. Mutation in NADPH Oxidase: impaired intracellular killing by Neutrophils and macrophages Recurrant bacterial & fungal infections involves lungs. cathepsin G) in phagosomes. oxacillin. Lecithinase (Alpha toxin) w/ phosopholipase C : major virulence factor of C. tazobactam. The enzyme usually functions within activated phagocytes to produce reactive oxygen species and activate granule proteases (eg elastase. Toxin increases Platelet aggreagation & adherence molecule is expressed on leukocytes and endothelial cells  Vasooclusion and ischemic necrosis of affected tissues.. Infections are Catalase Positive organisms that destroy hydrogen peroxide produced by their own metabolic activity. Perfringes. Cystic fibrosis: high chloride content in sweat.

. 7.Om Sai Ram!!!  shunting of CFTR toward proteasome with complete absence of the protein in apical membrane of affected epithelial cells.

At low conc. IFNGAMMA. vasoconstriction. Without Th1 cells  granuloma formation. C3a: anaphylatoxin derived from C3. Thromboxane A2: powerful platelet aggregator and vasoconstriction. IL-4: a. IL-5: Promotes growth and differentiation of B cells and eosinophils and stimulates isotype switching to IgA. Thelpher cell differentiation into Th2 subset. Simulates mast cell histamine release inc vascular permeability and vasodilation.  vasodilation and increases permeability of venules.Om Sai Ram!!! 8. . Macrophage mediated immunity to Mycobacterium tuberculosis is by TH1 cells. b. and increase leukocyte adhesion to endothelium. Platelet activating factor: platelet aggregation. bronchoconstriction. TNF ALPHA : critical in formation & maintenance of granulomas. Host is unable to mount effective response & tuberculous infection would progress freely. stimulates B cell growth and isotype switching to IgE. IL-12.

This crosslinking is accomplished by action of extracellular lysyl hydroxylase. Elastin’s plasticity and ability to recoil upon release of tension  unique of desmosine crosslinking between four different lysine residues on four different elastin fibers. D4. tuberculin skin test and candida extract skin reaction: delayed type hypersensitivity reactions (DTH). Contact dermatitis. Granlumatous inflammation. 12.E4: vasoconstriction. increased vascular permeability and bronchospasm.Om Sai Ram!!! LTC4. Spinal accessory muscle: SCM and Trapezius muscle. 10. . Vagus nerve: 10th cranial nerve: major source of Parasympathetic to viscera of chest wall and foregut. 11. Phrenic nerve (C3-C5) : motor innervation to diaphragm and carries pain fibers from pleura. 9. Parietal pleura: somatic innervation (sensory afferent) nerves—sharp & localized pain. Cells that mediate DTH reactions are TH1 lymphocytes that release IFN-GAMMA  recruitment and stimulation of macrophages.