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Respiratory Course

What traps large particles when breathing through the nose? Hairs of the nasal vestibule
What traps smaller particles within the nasal cavity? respiratory epithelium
What are the cartilidges of the Nose? Lateral nasal, Alar, and Septal
Rhinoplasty Smoothing out the bump made between nasal cartilages and nasal bones.
Deviated Septum May be due to development or trauma. May impede airflow and predispose to congestion
Blow-Out Fracture Fracture of the medial orbit (lamina papyracea)
CSF Rhinorrhea Fracture of the ethmoid bone's cribiform plate. Causes CSF to leak out into the nasal cavity.
Type of epithelium covering the nasal vestibule? stratified squamous epithelium. It contains fine hairs that help exclude large particles from the airway.
Respiratory epithelium Covers the nasal cavity, auditory tube, air sinuses, nasopharynx, lacrimal sac, larynx, trachea,and bronchi.
Lamina propria a layer between the epithelium and bone in the nasal cavity containing arteries, distended veins (swell bodies) and mucoserous glands.
Epithelium of respiratory tract? pseudostratified ciliated columnar epithelium
Function of Ciliated Cells? Move mucous
Function of Goblet Cells? Create mucous
Nasal polyps benign overgroths of the nasal mucosa. Require surgical removal when they become too large. May appear in rare parasitic infestations but are typically idopathic. Idiopathic.
Olfactory Epithelium Upper third of the lateral nasal cavity and nasal septum. Extremely thick layer of pseudostratified ciliated columnar epithelium. Tons of olfactory nerves.
Olfactory (Bowman's) Glands located in the olfactory epithelium. In the lamina propria release a serous fluid to dissolve and bind oderant molecules.
Kiesselbach's Area Area located in the nose where all arteries interrelate (anastomosis).
Epistaxis Nose bleed. Typically involving veins. If it involves arteries, it must be packed.
Olfactory Cells Bipolar sensory nerve cells with an apical projection sprouting modified cilia.
Olfactory Cilia Very long, nonmotile cilia that extand over the olfactory epithelium surface. Function as odor receptors
Supporting Cells of Olfactory epithelium most numerous cell type, have apically located nuclei with many microvilli
Brush cells of olfactory epithelium Sensory cells.
Basal Cells of olfactory epithelium stem cells that contact the basal lamina.
Choanae Connect each nasal cavity to the nasopharynx
Sphenoid sinus empties into sphenoethmoidal recess
posterior ethmoid air cells empty into: superior meatus
Anterior ethmoid air cells empty into: Ethmoid bulla which empties into middle meatus
Middle ethmoid air cells empty into: Ethmoid bulla which empties into middle meatus
Frontal sinus empties into: semilunar hiatus which empties into middle meatus
Maxillary sinus empties into: semilunar hiatus which empties into middle meatus
Nasolacrimal duct empties into: inferior meatus
Opening of auditory tube empties into: Nasopharynx
Problems with the Maxillary Sinus This is because the orifice of the maxillary sinus enters the hiatus semilunaris at a superior oblique angle. This makesdrainage particulary difficult and leads to it being a frequent site of infection. (sinusitis)
Innervation of the air sinuses Supraorbital nerve (V1) innervates the mucosa of frontal sinus, sphenoid sinus and ethmoidal air cells.
Innervation of Maxillary sinus infraorbital and superior alveolar nerves (V2). sinusitis can put pressure on these nerves and give a sense of tooth and facial pain. Treatment: supraorbital nerve stimulated at supraorbital notch. Infraorbital nerve at infraorbital foramen.
Torticollis Wry Neck, Birth trauma, tumors, trauma, cranial nerve palsy, muscle spasms, infection, drug ingestion. Contraction of SCM Muscle.
Nuchal Rigidity (Stuff Neck) Stiff Neck, Most commonly associated with meningeal irritation.
Myxedema Skin and tissue disorder usually due to severe prolonged hypothyroidism
Graves Disease Autoimmune, antibodies to thyroid-stimulating hormone receptor, leading to overactive thyroid
Hashimoto disease Autoimmune antibodies against thyroid gland, often causing hypothyroidism
Symptoms of Autoimmune Thyroid Disorder (Graves and Hyperthyroidism) Exophthalmos, Facial flushing, Tachycardia, Muscle Weakness, Thyroid Bruit
Congenital Hypothyroidism Needs immediate attention. Puffy-appearing face, Thick protruding tongue, jaundice, poor feeding, lack of muscle tone (floppy infant)
Hypothyroidism Puffy eyes, Feels cold;sensitive to cold, Weight gain, thick nails.
Hydrocephalus Sunset eyes
Hurler Syndrome Enlarged skull, low forehead, corneal clouding, short neck, Muccopolysaccharide Storage Disease, protrusion of tongue.
Down Syndrome Epicanthal folds, Depressed nasal bridge, mongoloid slant of eyes, low set ears, large tongue.
Systemic Lupus Erythematosus Butterfly Rash, rash across nose and cheeks
Hippocratic Facies sunken eyes, cheeks, and temporal areas; sharp nose; Dry, rough skin; seen in terminal stages of illness. Looks malnourished (holocaust victim)
Cushing Syndrome Rounded or moon shaped face, then erythematous skin, Hirsutism, Association with adrenal cancer, hyper functioning of the adrenal cortex, leading to increased production of glucocorticoids. Seen when using steroids.
Caput Succedaneum Subcutaneous edema cross suture lines. Resolves in a few days. "cone head"
Cephalohematoma Subperiosteal collection of blood. Does not cross suture lines. firm and well defined edges. Does not go away easily.
Fetal Alcohol Syndrome Mental retardation, poorly formed philtrum, widespread eyes, inner epicanthal folds, mild ptosis, short nose, thin upper lip, microcephaly.
When does inner ear develop in infants? First trimester
Eustachian tube in children vs adults. wider, shorter, and more horizontal than adults
Which sinuses are present at birth? maxillary and ethmoid sinuses. Frontal and sphenoid are not fully developed until late adolescence (7 to 8 y.o.)
When do deciduous teeth (baby teeth) appear? between 6 and 24 months
When do permanent teeth appear between 6 and 15 years.
When do third molars appear? about 18 years old.
Changes in Oropharynx in Pregnant Women? Hoarseness and cough, Vocal Changes
Epistaxis Nosebleed
Labyrinthitis Dizziness when moving
Otitis Externa Swimmer's Ear, Infection in outer ear.
Mastoiditis Inflammation of mastoid periosteum
Middle ear effusion Middle ear filled with serous fluid. fluid built up due to closing of eustachian tube.
Cholesteatoma chronic eustachian tube problems. ability to destroy bone and nerve tissue that lie in its path of growth. Harbors infection. Tumors. Permanent, mild-to-moderate hearing loss due to damage to the delicate bones in the middle ear.
Otosclerosis Hardening of the ossicles, especially the stapes. Slow, progressive hearing loss. between ages of 15 and 45, usually around age 20.
Meniere disease Disorder of inner ear. Extreme dizziness, ringing in ears (tinnitus). full feeling in ear with intermittent hearing loss. Caused by a change in fluid volume within the portion of the inner ear known as the labyrinth.
Presbycusis age related hearing loss
Xerostomia dry mouth from decreased salivary land secretion
Presbycusis gradual loss of the ability to hear sounds. Occurs very slowly to the point that many people are not aware that they have hearing loss. High pitched sounds are difficult to hear.
Peritonsillar abscess Complication of tonsillitis. Severe pain radiating to ear. Deviated Uvula**
What is an indicator of why people cough at night? Postnasal drip.
Torus Palatinus Bony protuberance at the midline. Normal variant. A nodule NOT in midline may indicate a tumor.
Oral Cancer Ulcerative, white or pigmented mouth sores that will not heal. Patches on gums, tongue, tonsil, or buccal mucosa. Painless at first, pain with erosion.
Leuokplakia A white premalignant plaque on the tongue or gums. Chronic irritation and from the use of tobacco products.
What would indicate a Niacin or vitamin B12 deficiency on the tongue? smooth red tongue with slick appearance.
Baby bottle syndrome decay due to not switching to sippy cup or transmitted from mother
What are the top Viral Causes of upper respiratory tract infections? Rhinoviruses, Coronaviruses, and Adenoviruses (broader spectrum)
What area do URT viruses travel to? adenoid area
Rhinoviruses over 100 strains, no cross-protective immunity. Acid labile, heat stable. Optimal @ 33C. MOST frequent causes of common colds. Very big problem with misuse of antibiotics.
How are rhinoviruses spread? through respiratory droplets, hands touching face.
Inflammatory mediators responsible for almost all symptoms of URI? histamine, prostaglandins (mucous gland secretion). kinins (stimulation of pain nerve fibers, sore throat), cytokines (headache, fever, chills, shivers, muscle aches).
Which immunoglobulin is responsible for recovery, and immunity of the Rhinovirus? IgA
Coronaviruses ssRNA, enveloped. 30% cause of common cold. SARS.
SARS Sever Acute Respiratory Syndrome. caused by coronaviruses. may have crossed over from wild animal.
AdenoViruses ds DNA, naked, icosahedral. 51 human strains. can develop persistent infections in lymphoid tissues. *Significant contribution to upper (common cold) and lower respiratory tract diseases in children.
Pharyngoconjunctival fever caused by adenovirus strains: 3 and 7. swimming pools
Epidemic Keratoconjunctivitis caused by adenovirus strains: 8,19,37.
Infantile gastroenteritis caused by adenovirus strains: 40 and 41. second most common to rotavirus.
What will the coelom develop into? The thoracic and abdominal cavities
Somatopleuric Mesoderm contributes to the wall of our body cavities
Splanchnopleuric Medsoderm contributes to the lining of our digestive tract (Visceral Pleura)
Gastroschisis Body wall closure fails in the abdominal region. Gut tube ends up in amniotic cavity, and is not surrounded by amnion. Very bad,
Omphalocele Not a body wall closure issue. Rather, a failure of normal herniation process to resolve. Gut tube is in amniotic cavity but surrounded by amnion. Fixable, with little protection.
Primary Bronchial Buds During development, they are the small buds that first form off of the Foregut (endoderm) which eventually make the lobes of the lungs.
Pleuropericardial Membrane During development. Folds to meet and fuse midline to form 3 compartments. A definitive pericardial cavity and two dorsolateral pleural cavities.
What germ layer do the pleuras arise from? mesoderm!!
Septum Transversum Forms the tendenous region of the diaphragm
Pleuroperitoneal Folds/Membrane Membrane that grows to divide the thorax and abdomen. This is the section that grows the most to close off the pericardioperitoneal canals.
When do the lung buds divide into the primary bronchial buds? day 26-28.
Polyhydramnios Pneumonia When there is an esophageal atresia and a Fistula that is still attached to the esophagus.
Polyhydramnios When there are two esophageal atresias.
Pneumonia in development When there is still communication of esophagus with the trachea. Two Fistulas or still connected.
When do the secondary bronchial buds form? and how many on each side? during week 5. 3 on right 2 on left.
When do the secondary buds divide into the tertiary bronchial buds and how many? by week 6. 10 on the right, 8 on the left.
What side do aspirations usually end up in? The right side because the right main bronchus is wider and shorter and runs more vertically than the left main bronchus.
Explain the growth of alveolar cells. 16% are present at birth; the remainer of your respiratory epithelial cells and alveoli will continue to develop for 10 years.
Tracheoesophageal Ridge The crease or segmentation between the trachea and esophagus.
Tracheal anatomy C-shaped hyaline cartilages with smooth muscle. Goblet cells to release mucous and ciliated cells.
Irregular Cartilage Plates found in the bronchi as they progress further into the lungs
Segmentectomy lung surgery of tertiary bronchi to each bronchopulmonary segment.
Lobectomy surgery of secondary bronchi to the lobes of the right and left lungs
Pneumonectomy surgery of Primary bronchi to the right and left lungs.
muscularis spiral smooth muscle bundles found in Bronchi.
Asthma Excessive constriction of bronchiolar smooth muscle. Associated with difficult air expiration, mucous accumulation in airways and inflammation.
Terminal bronchioles lack glands and cartilage plates but contain smooth muscle.
bronchiolar exocrine cells replaces respiratory epithelium gradually towards terminal bronchioles.
Bronchiolar Exocrine Cells (Clara) non ciliated, domed, cuboidal cells that line the bronchioles. Secrete glycosaminoglycans that prevent collapse of the smaller airways and release ions into the lumen.
Cystic Fibrosis disease where mucous in airways is abnormally thick. Caused by a CL- pump mutation which leads to lack of water. increases rate of infections and may asphyxiate patient.
Respiratory Bronchioles have a simple cuboidal lining of bronchiolar exocrine cells.le and elastic fibers are seen in their walls, which are interrupted by alveoli.
Alveolar Ducts Passageway from the respiratory bronchioles. ALined by simple squamous epithelium consisting of type I and II pneumocytes. No more ciliated or bronchiolar exocrine cells. Last portion to contain smooth muscle.
Alveoli gas exchange occurs. THIN walls of elastic and reticular fibers. Lined by type I and II pneumocytes.
Type I Pneumocytes 40% of total pneumocytes but 95% of alveoi surface. Simple squamous and allow gas diffusion to occur.
Type II pneumocytes 60% of total pneumocytes but only 5% of alveolar surface area. Can divide and generate both types of pneumocytes.
Interalveolar Septa contain contiinuous capillaries that exchange oxygen and CO2. Three layers: type I pneumocyte and surfactant layer, basal lamina of pneumocyte, capillary endothelium.
Alveolar Macrophages (Dust Cells) phagocytic and clean up ultra-fine debris from alveolar spaces and elsewhere in airway. Increase during inflammation and heart failure.
Emphysema Destruction of elastic fibers in interalveolar septae causing a loss of elasticity and SA. Two forms genetic deficiency in a1 antitrypsin or from smoking.
Mesothelium simple squamous epithelium on visceral pleura which secretes a serous fluid to lubricate the interface between visceral and parietal pleura.
Safest place for thoracocentisis
Laryngeal Muscles are innervated by? Inferior Laryngeal Nerve, Except the cricothyroid muscle.
Laryngeal muscle ADDuctors Arytenoids (Lowers Volume) and Lateral Cricoid Arytenoids (Lowers volume for whisper).
Laryngeal Muscle ABductors Posterior Cricoarytenoid (Raises volume and allows passage of more air)
Laryngeal Tensors Cricothyroid (Tilts thyroid cartilage anteriorly allowing increased pitch by tightening vocal folds). Only intrinsic laryngeal muscle innervated by external laryngeal nerve.
Laryngeal Muscle Relaxers Thyroarytenoid m. (Shortens and Relaxes, Lowers Pitch) and Vocalis m. (minute adjustments to volume and pitch)
Laryngeal Muscle Sphincters Combination of lateral cricoarytenoid, arytenoid and aryepiglottic mm. to pull arytenoid cartilages toward epiglottis. Important reflex when swallowing.
Two nerves of Larynx Occur from Vagus N. Superior Laryngeal Nerve (internal and external laryngeal nerves)
Internal Laryngeal Nerve Sensory to Vestibule and middle cavity. Travels with superior laryngeal a. into thyrohyoid membrane
External Laryngeal Nerve Motor to cricothyroid. Travels with superior thyroid a.
Inferior Laryngeal Nerve Sensory to Infraglottic Cavity, Motor to almost all.Travels with inferior laryngeal a. inferior to inferior border of inferior pharyngeal constrictor.
Lesions of CN X affecting the larynx sensory loss and motor loss. Can cause dysphoniz or aphonia.
Superior Laryngeal Artery Dives through thyrohyoid membrane to larynx
Superior thyroid artery Gives off cricothyroid artery
Inferior Laryngeal Artery Branch of Inferior thyroid. Travels inferiorly to supply inferior larynx.
Know the Lymph Drainage of Lungs! (and Heart)
What three things pass through the Diaphram Inferior Vena Cava (IVC), Aorta and esophagus.
What do the extrnal intercostals do? They raise the ribs, increasing the volume of the chest cavity.
When are the scalenes and Sternomastoid muscles used in respiration? During heavy respiration
Which muscles are used for inspiration? 1. Diaphram (flattens and pushes ribs out) 2. external intercostals (expand ribcage) 3. scalene and sternomastoid muscle (accessory for heavy breathing)
How does expiration occur? 1. Relaxation of muscles 2. abdominals aids in expiration and increases abdominal pressure. 3. the internal intercostals pulls the ribs down and in.
Intrapleural Fluid This is the fluid that produces the cohesion between the lungs and chest wall. It allows the expansion of the lungs and thus inspiration.
Functional Residual Capacity The equal force between the lungs and the chest cavity in the intrapleural space.
pneumothorax When the chest wall moves outward and the lungs suppress inward. Occurs when air gets into the pleural space, equalizing the pressure in the cavity and allowing the layers to seperate.
What disease goes along with stiff lungs? Lung fibrosis
What disease goes along with stretchy lungs? emphezyma
Which alveolar cells produce surfactant and what is its purpose? Type II alveolar Cells. Surfactant is used to reduce surface tension in the alveolar lining, increasing compliance.
What bacteria causes Epoglotitis? Haemophilus influenza type B (Hib), has a polysaccharide capsule, type b is most invasive, IgA protease which helps break down IgA.
Haemophilus influenzae type b gram neg rods
polysaccharide capsule, IgA proteases, endotoxin (inflammation), Fimbriae for adherence to mucosa, Neuraminidase.
Diseases of H. Influenze type B Meningitis, epiglotitis, wound infection, spesis, arthritis.
Diseases of Nontypable H. Influenze Sinusitis, Otitis media, Bronchitis (elderly), Pneumonia (elderly)
X factor Hemin. Required for H. influenza growth
V factos NAD (nicotinamide adenine dinucleatide). required for H. influenza growth.
Treatment of Epiglotitis Empirically begin ceftriaxone as well as MRSA drug (clindamycin or vancomycin)
H. influenza prevention. Immunization with the conjugated Hib vaccine at same time as DTaP shot.
Conjugated vaccines vs polysaccharide vaccines Polysaccharide vaccines induce T-independent Ab responses while Conjugate vaccines induce T-dependent Ab responses.
T-cell independent antibody production Polysaccharide Ag, IgM Ab, lack of memory response, little boosting achieved. (Polysaccharide vacciines)
T-cell dependent antibody production. Protein Ag, IgG high affinity Ab, Adequate memory, boosting achieved. (Conjugated)
Etiology of Bacterial Tracheitis Staph Aureus (most common), H. influenza, Strept pneumoniae
Bacterial Tracheitis 6m-8y. rare, bacterial infection complicating CROUP (laryngotracheobronchitis-LTB). Ulceration - pseudomembrane formation. "Steeple Sign" on AP radiography
Orthomyxoviruses Influenza. ss RNA. 8 segments (8 genes). requires nucleus for replication. H & N surface proteins. Starts as URTI spreads to LRT. Damages ciliated resp epithelium, systemic effects due to inflammation.
Hemagglutinin (H or HA) Surface protein of orthomyxoviruses. Attachment protein. Target for antibody neutralization, and vaccines. *undergoes antigenic variation* (16 variants)(H1-3, N1-2 for humans)
Neuraminidase (N or NA)(Sialidase) surface protein of orthomyxoviruses. active enzymes that remove sialic acid residues from glycoproteins. Target for current antivirals. undergoes genetic variation. (9 Variants) (H1-3, N1-2 for humans)
What is responsible for typing of influenza viruses into groups A, B, & C? S-Ag. soluble antigen. Also called RNP (ribonucleoprotein). Genetically stable.
Type A influenza Viruses Pandemics and epidemics
Type B influenza Viruses epidemic
Type C Influenza Viruses Rare individual instances.
Diagnosing Influenza Viruses (orthomyxoviruses) hemagglutination inhibition tests ( not used as much nowadays)
Killed and Hemagglutinin subunit vaccines usually have: two type A, one type B. 75% effective.
Preventative Antiviral Treatments for Type A influenza? Amantadine, Rimantadine.
Therapeutic Antiviral Treatments. Zanamavir (inhaled), Oseltamavir (oral).
LRT Infections: Bronchiolitis, Bronchitis, Pneumonia, Alveolitis. (Paramyxoviruses)
Respiratory Syncytial Virus THE MAJOR Severe LRT infection in infants, common cold. Premature infants are especially susceptible because of smaller bronchi/ioles. 40-90% of time.
Metapneumovirus Similar to RSV but accounts for only 15% of LRT infections in infants.
Symptoms of LRTI in infant Persistent coughing, wheezing, rapid breathing, bluish color, trouble breathing, fever.
What are the treatments for LRTI RespiGam and palivizumab are used for preventative treatments. Ribavirin has been used for acute sever RSV.
Hantavirus pulmonary syndrome LRTI. deer mouse cotton rat vector. Primarily out west in desert areas. 50% fatality rate. Not spread person-person. Present with pneumonitis, pulmonary edema.
What is the major cause of Croup/laryngotracheobronchitis? Parainfluenza virus. Voice loss and inspiratory stridor.
What are the two natural sources of shunt in the body? thebesian veins and bronchial circulation.
Created by: 622988909