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Respiratory Exam 1. Flashcards. felton. microbiology. What is the most common infectious disease of humans?. The common cold Also, the leading cause of acute morbidity and of visits to a physician in the US Major cause of industrial and school absenteeism.

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felton

felton

microbiology

what is the most common infectious disease of humans
What is the most common infectious disease of humans?
  • The common cold
    • Also, the leading cause of acute morbidity and of visits to a physician in the US
    • Major cause of industrial and school absenteeism
what microorganism grows optimally at a temp lower than normal core body temp
What microorganism grows optimally at a temp lower than normal core body temp?
  • RHINOVIRUS
    • In tissue culture grow optimally at 33C, the temperature of the nasal mucosa of humans
where does the rhinovirus multiply
Where does the rhinovirus multiply?
  • In the cytoplasm of host cells
what type of virus is the rhinovirus
What type of virus is the rhinovirus
  • Small, single stranded RNA virus
  • Related to poliovirus
  • Member of the family: picornaviruses
what types of viruses are coronaviruses
What types of viruses are coronaviruses?
  • Single stranded RNA viruses
  • Round or petal shaped projections around the viral capsid resembling a crown
  • Lipid envelopes are labile to ether or chloroform
  • SARS-CoV: caused by coronavirus
respiratory syncytial virus
Respiratory syncytial virus
  • Infects infants and children more
  • Causes colds, bronchopneumonia, or bronchitis
  • Paramyxovirus
    • RNA, enveloped
  • Two antigenic types
orthomyxoviruses
Orthomyxoviruses
  • Influenza viruses
  • 3 antigenic types
paramyxoviruses
Paramyxoviruses
  • Parainfluenza viruses
  • 4 antigenic types
  • Enveloped, SS RNA viruses
  • In kids, can cause severe diseases:
    • Croup, bronchitis, pneumonia
  • In adults: can cause adult respiratory diseases
  • Are one of the major causes of viral laryngitis and pharyngitis in adults
list the possible modes of transmission of a virus
List the possible modes of transmission of a virus:
  • Direct contact with infectious secretions on skin and environmental surfaces
  • Large particles of respiratory secretions that are briefly transported in air
  • Infectious droplet nuclei suspended in air
  • Combination of these methods
what are the symptoms of the common cold
What are the symptoms of the common cold?
  • Nasal discharge
  • Nasal obstruction
  • Sneezing
  • Sore or scratchy throat
  • Cough
  • Anorexia and slight fever may be present
what is sinusitis
What is sinusitis?
  • Acute, inflammatory affliction of one or more of the paranasal sinuses
  • Usually after:
    • Rhinitis
    • Dental extraction
    • Or in pts with predisposing factors such as: nasal polyps, deviation of the nasal septum, tumors, foreign bodies, trauma, abrupt change of pressure in the nasal passages, and conditions such as cystic fibrosis
what bacteria most commonly cause acute sinusitis
What bacteria most commonly cause acute sinusitis?
  • Strep pneumoniae and H. influenzae
things that can predispose you to purulent sinusitis
Things that can predispose you to purulent sinusitis
  • Nasal polyps
  • Deviation fo the nasal septum
  • Tumors
  • Foreign bodies
  • Trauma
  • Abrupt change of pressure in the nasal pasages
  • Cystic fibrosis
type of bacteria more commonly associated with chronic sinusitis
Type of bacteria more commonly associated with chronic sinusitis
  • Anaerobic bacteria
    • Often as a combined infection with aerobes
what is the pathogenesis of sinusitis
What is the pathogenesis of sinusitis?
  • Obstruction of the paranasal sinusal ostia impedes drainage
  • Infections impair the cilliary activity of the sinuses
  • Results in accumulation of mucous secretions
  • Mucus converted to mucopus by bacterial multiplication in the sinus cavities
  • The pus irritates the underlying mucosa causing further edema and aggravating the obstruction
when is sinusitis most prevalent
When is sinusitis most prevalent?
  • Fall, winter, and spring
clinical manifestations of sinusitis
Clinical manifestations of sinusitis:
  • Facial pain
  • Purulent nasal discharge
  • Photophobia and tearing may be present
diagnosis of sinusitis
Diagnosis of sinusitis:
  • Can be made without radiographic exams when there is a hx of upper respiratory tract infection or allergic rhinitis, pain and tenderness over a sinus, and purulent discharge
  • Microbial etiology is determined by culture of an exudate or a rinse obtained by sinus puncture and aspiration
    • Cultures obtained from nasal pus or by rinsing of the nose are unreliable because of contamination with resident bacterial flora
tx of sinusitis
Tx of sinusitis:
  • Responds well to antimicrobial therapy
bacteria that causes mostly asymptomatic pharyngitis
Bacteria that causes mostly asymptomatic pharyngitis:
  • N. gonorrhoea
    • Occasional case of mild pharnygitis
type of pharyngitis most commonly caused by adenoviruses
Type of pharyngitis most commonly caused by adenoviruses
  • Pharyngoconjunctival fever
    • Usually more severe than the common cold
    • Temperature elevations persist for 5-6 days
    • MARKED sore throat
    • Distinguishing feature:
      • CONJUNCTIVITIS which occurs in 1/3 to ½ of cases
        • Follicular type
        • Bilateral
    • Cough, hoarseness, and substernal pain occur in acute respiratory disease [ARD] in military recruits.
symptoms of pharyngitis with influenza
Symptoms of pharyngitis with influenza:
  • Sore throat = major complaint
  • Coryza symptoms may be present
  • Temperature elevations are common in children and adults
  • Edema and erythema of the pharynx is NOT marked
  • NO pharyngeal exudates or painful exudate
  • Recovery in 3-4 days
symptoms of pharyngitis with the common cold
Symptoms of pharyngitis with the common cold:
  • Mild to moderate pharyngitis discomfort, but not the primary complaint
  • Rhinorrhea and post-nasal discharge usually present
  • NO:
    • Severe pharyngeal pain or dysphagia
    • Pharyngeal and tonsillar exudates or painful lymphadenopathy
adenoviruses can cause what 3 types of respiratory diseases
Adenoviruses can cause what 3 types of respiratory diseases?
  • Acute, febrile, self-limiting condition
  • Pharyngoconjunctival fever
  • Pertussis-like syndrome indistinguishable clinically from infection with Bordetella pertussis

Adenoviruses are major etiologic agents of acute respiratory disease [ARD] and pharyngitis. Also indicated in pathogenesis of : epidemic keratoconjunctivitis, hemorrhagic cystitis, gastroenteritis, and rashes.

symptoms of acute herpetic pharyngitis
Symptoms of acute herpetic pharyngitis:
  • Primary infection may present as acute pharyngitis
  • Severe cases: inflammation and exudate may mimic full blown streptococcal pharyngitis
  • Vesicles and ulcers of the palate
  • Vesicles and ulcers on the labial and buccal mucosa when there is an assoc. gigivostomatitis
characteristics of herpes simplex viruses
Characteristics of herpes simplex viruses:
  • Large DNA virus
  • Lipid containing capsids
  • Inactivated by ether
  • Will see:
    • eosinophilic intranuclear inclusion bodies in infected cells
  • Tend to produce latent infection
  • Role in recurrent fever blisters
what type of pharyngitis is caused by coxsackieviruses
What type of pharyngitis is caused by coxsackieviruses?
  • Herpangina
    • Small vesicles on soft palate, uvula, and anterior tonsillar pillars
    • Lesions rupture to become small, white ulcers
    • Mostly in kids: severe, febrile illness with marked sore throat with dysphagia
cocksackieviruses
Cocksackieviruses
  • Picornaviruses
  • Can cause:
    • Aseptic meningitis
    • Myocarditis
    • Upper respiratory tract infections
  • Group A:
    • Types 2,4,5,6,8,10 can cause aherpangina
    • Type 10 is also associated with a summer febrile disease in children called acute lymphonodular pharyngitis
symptoms of infectious mononucleosis
Symptoms of infectious mononucleosis:
  • Exudative tonsillitis or pharyngitis in about ½ the cases
  • Fever and cervical adenopathy usually present
  • Enlargement of spleen in ½ the cases
what does the presence of eosinophilic intranuclear inclusion bodies suggest
What does the presence of eosinophilic intranuclear inclusion bodies suggest?
  • Infection with herpes simplex virus
symptoms of anaerobic pharyngitis
Symptoms of anaerobic pharyngitis:
  • Pharyngeal and tonsillar infection
  • Mix of anaerobic bacteria and spirochetes
  • Purulent exudate coats the membrane
  • May be a foul odor to the breath
  • With development of an abscess, pharyngeal pain is usually severe, dysphagia and low grade fever are common
  • Infection usually limited to one side, but when bilateral, partial obstruction of the pharynx occurs
symptoms of streptococcal pharyngitis
Symptoms of streptococcal pharyngitis:
  • In severe cases: marked pharyngeal pain, dysphagia, and a temperatures of 39.4C or greater
  • Pharyngeal membrane is fiery red
  • A thick exudate covers the posterior pharynx & tonsilar area
  • Edema of uvula is often pronounced
  • Tender, enlarged cervical nodes
  • A leukocyte count of over 12,000/mm3
  • Infection with S. pyogenes that produces erythrogenic toxin results in the characteristic erythemetous rash of scarlet fever.
symptoms of diphtheria
Symptoms of DIPHTHERIA:
  • Low grade temperature elevation
  • Tonsillar or pharyngeal pseudomembrane varies from light to dark gray and is firmly attached to the tonsil and pharyngeal mucosa
mycoplasma pneumoniae
Mycoplasma pneumoniae
  • Pharyngitis is usually mild with no distinguishing clinical features
  • M. pneumoniae characteristically causes bronchitis and primary atyptical pneumonia
what does the presence of exudate suggest
What does the presence of exudate suggest?
  • Streptococcal pharyngitis
  • Vincent’s angina
  • Pharyngoconjunctival fever
  • Herpes simplex virus infection
  • Infectious mononucleosis
what does the presence of small vesicles or ulcers suggest
What does the presence of small vesicles or ulcers suggest?
  • Herpes simplex virus infection
  • Herpangina
what does the presence of exudate and small vesicles or ulcers suggest
What does the presence of exudate and small vesicles or ulcers suggest?
  • Herpes simplex virus infection
    • Will also see: eosinophilic intranuclear inclusion bodies
how is vincent s angina diagnosed
HOW is Vincent’s angina diagnosed?
  • Crystal violet stained smear of the pharyngeal or tonsillar exudate showing the presence of numerous fusobacteria and spirochetes
small pleomorphic gram negative rod that is nonmotile nonsporulating and usually capsulated
Small, pleomorphic, gram negative rod that is nonmotile, nonsporulating, and usually capsulated:
  • H. influenzae
    • Aerobic or facultative
    • Requires
      • Iron protoporphrin compound [X factor]
      • Pyridine nucleotide [V factor]
what is the virulence of h influenzae associated with
What is the virulence of H. influenzae associated with?
  • Capsulation
    • 6 antigenic types [a-f]
    • Type b formerly accounted for almost all serious infection in humans
      • Vaccination has reduced the frequency of this disease in young children
drugs used to treat respiratory airway infections caused by h influenzae
Drugs used to treat respiratory airway infections caused by H. influenzae:
  • Chloramphenicol
  • Ampicillin
  • Penicillin G
  • Tetracycline
  • Sulfonamindes
what microorganism causes whooping cough
What microorganism causes whooping cough?
  • Bordetella pertussis
    • Small, ovoid
    • Nonmotile
    • Nonsporeforming
    • Gram NEGATIVE rod
    • Fastidious requirements for grouth
    • Phase I: virulent, encapsulated, piliated
      • produces several toxins
    • Phase IV: pleomorphic, noncapsulated, avirulent
    • ONLY PHASE I BACILLI ARE SUITABLE FOR THE PREPARATION OF VACCINES
paramyxoviruses with binding sites for erythrocytes
Paramyxoviruses with binding sites for erythrocytes
  • Parainfluenza viruses
    • Contain RNA core enclosed in an ether sensitive envelope
    • Multiply in the cytoplasm of infected cells
    • 4 types that parasitize humans: 1,2,3,4
clinical symptoms associated with parainfluenza viruses
Clinical symptoms associated with parainfluenza viruses:
  • 1,3,4: common cold and pharyngitis
  • 1,2,3: croup
  • 1,3: bronchitis and bronchopneumonia
slide54
Crystal violet stained smear of the pharyngeal or tonsillar exudate showing the presence of numerous fusobacteria and spirochetes suggests:

Vincent’s angina

do influenza viruses normally cause upper or lower respiratory tract infections
Do influenza viruses normally cause upper or lower respiratory tract infections?

lower

respiratory infections caused by rsv
Respiratory infections caused by RSV:
  • Usually bronchiolitis or bronchopneumonia in infants
  • Sometimes croup
what are the symptoms of acute laryngitis
What are the symptoms of acute laryngitis?
  • Barking cough and hoarseness
  • In kids: airway obstruction due to infection of the larynx and tracheobronchial tree

Diagnose by clinical characteristics of the illness and may be confirmed by examination of the larynx

how do you treat acute laryngitis
How do you treat acute laryngitis?
  • Rest the voice until hoarseness and aphonia have subsided
  • Inhalation of moistened air on a regular basis may give relief
what is acute epiglottitis
What is acute epiglottitis?
  • Rapidly progressive cellulitis of the epiglottis and adjacent structures that has the potential of causing abrupt, complete airway obstruction

Frequency has decreased dramatically since the introduction of the H. influenzae vaccine

what are the clinical manifestations of epiglottitis
What are the clinical manifestations of epiglottitis?
  • Typically, a 2-4 year old child with a 6-12 hour hx of fever and dysphagia
  • Sore throat is the most prominent symptom in older children and in adults
  • Varying degrees of respiratory distress may be present
how do diagnose epiglottitis
How do diagnose epiglottitis?
  • By finding an edematous “cherry red” epiglottis
  • Labs
    • Leukocytosis
    • Positive cultures of blood and epiglottis
    • Evidence of pneumonia on CXR
    • H. influenzae type b is isolated from cultures of blood and/or the epiglottis in most pts with acute epiglottitis
    • Others: pneumococci, staphylococci, streptococci
how do you treat acute epiglottitis
How do you treat acute epiglottitis?
  • Establish airway
  • Culture blood & epiglottis
  • IV antibiotic therapy against H. influenzae
is immunity conferred after an episode of h influenzae epiglottitis
Is immunity conferred after an episode of H. influenzae epiglottitis?
  • Yes!
  • High levels of serum antibody to capsular polysaccharide make second cases of epiglottitis very rare.
what is croup
What is CROUP?
  • Acute laryngotracheobronchitis
    • Age specific viral infection of the upper & lower respiratory tracts
    • Produces inflammation in the subglottis
    • Results in dyspnea accompanied on inspiration by the characteristic stridulous notes of croup
what virus most commonly causes croup
What virus most commonly causes CROUP?
  • Parainfluenza type 1

Parainfluenza type 3 is the 2nd most frequently associated agent.

Influenza A produces this disease in a broader age range of children and with a higher frequency of hospitalization and tracheotomy.

epidemiology of croup
Epidemiology of CROUP
  • Mostly in kids 3 months - 3 years
  • Peak occurrence in the 2nd year of life
  • More common in boys than girls
clinical manifestations of croup
Clinical manifestations of CROUP:
  • Hoarseness
  • Deepening, non-productive, brassy-tone cough
  • Most kdis have fever
  • Resp rate is elevated
  • Fluctuating course of infection
what is acute bronchitis
What is ACUTE BRONCHITIS?
  • Inflammatory condition of the tracheobronchial tree
  • Usually associated with a generalized respiratory infection
  • Occurs most commonly during winter months
  • Common during influenza epidemics
  • Rhinoviruses are an important cause of acute bronchitis
  • Among military recruits, adenovirus infections are a major cause of acute bronchitis
  • Mycoplasma pneumoniae & Bordetella pertussis are nonviral causes of severe acute bronchitis
what are the clinical manifestations of acute bronchiitis
What are the clinical manifestations of ACUTE BRONCHIITIS?
  • Cough begins early and tends to become prominent as the illness progresses
  • Frequency and duration of cough is prolonged in cigarette smokers
  • In adults, influenza virus, adenovirus, and M. pneumoniae infections are commonly associated with temperature elevation
how do you diagnose and treat acute bronchitis
How do you diagnose and treat ACUTE BRONCHITIS?
  • Diagnosis of exclusion
  • Tx is symptomatic
what is chronic bronchitis
What is CHRONIC BRONCHITIS?

Condition in which cough

&

a chronic and excessive secretion of mucus

is present in the tracheobronchal tree

& is NOT due to specific diseases such as asthma or TB

Pts who have coughed up sputum on most days during at least 3 consecutive months for more than 2 successive years.

etiologic factors in chronic bronchitis
Etiologic factors in CHRONIC BRONCHITIS:
  • Cigarette smoking
  • Infection
  • Inhalation of dust or fumes in the workplace
clinical manifestations of chronic bronchitis
Clinical manifestations of CHRONIC BRONCHITIS:
  • Incessant cough = advanced bronchitis
  • Emphysema
  • Patients maintain normal body weight and tend to be obese
what is bronchiolitis
What is BRONCHIOLITIS?
  • Acute LOWER respiratory illness of VIRAL etiology occurring within the first 2 years of life
major etiologic agents of bronchiolitis
Major etiologic agents of BRONCHIOLITIS:
  • Viruses
    • RSV
    • Parainfluenzae virus type 1 and 3
    • Adenoviruses
  • M. pneumoniae

These make up 87% of the isolates obtained from children.

In the hospital, RSV involvement is higher.

bronchiolitis is a common illness during what age
BRONCHIOLITIS is a common illness during what age?
  • First year of life
  • Peak rate between 2 and 10 months of age
what are the clinical manifestations of bronchiolitis
What are the clinical manifestations of BRONCHIOLITIS?
  • Coryza and cough = onset
  • Mild fever = Prodromal period
  • Dehydration
    • from paroxysms of coughing that may trigger vomiting
    • Poor oral intake related to respiratory distress and lethargy
  • Acute course lasts 3-7 days
how do you diagnose and treat bronchiolitis
How do you diagnose and treat BRONCHIOLITIS?
  • Diagnosis:
    • Characteristic clinical and epidemiologic findings
    • Viral isolation from nasal wash
  • Therapy
    • Oxygen administration with careful supportive care
    • Aerosolized ribavirin is approved for treatment of infants with more severe bronchiolitis due to RSV.
    • Monoclonal antibody and polyclonal immune globulin are available for passive immunization.
which of the following is least likely to be directly affected by croup
Larynx

Pharynx

Trachea

Bronchi

B.

CROUP is

acute

laryngo-tracheo-bronchitis

which of the following is least likely to be directly affected by CROUP?
what virus has the most number of antigenic types
What virus has the most number of antigenic types?
  • RHINOVIRUS: over 110 different types
    • Parainfluenza: 3
    • RSV: 2
    • Corona: 3 or 4
what virus can cause severe pharyngitis with fever and conjunctivitis
What virus can cause severe pharyngitis with fever and conjunctivitis?
  • Adenovirus
    • Pharyngoconjunctival fever
foley

Foley

physiology

partial pressure of gas equation
Partial pressure of gas equation
  • Pgas = fractional concentration x barometric pressure
equation or inspired pgas
Equation or inspired Pgas

Fractional concentration x [barometric pressure - 47mmHg]

what is the partial pressure of water vapor at body temp 37c
What is the partial pressure of water vapor at body temp [37C]?
  • 47mmHg
    • regardless of the ambient barometric pressure
effect of water vapor pressure
Effect of water vapor pressure:
  • Inspired air is rapidly saturated with water vapor
  • Partial pressure of water vapor at body temp of 37C is 47mmHg regardless of ambient barometric pressure
  • Total pressure of the DRY gases in the airways is reduced by 47mmHg
  • Inspired Pgas = Fractional concentration x [barometric pressure - 47mmHg]
how does altitude affect barometric pressure
How does altitude affect barometric pressure?
  • Increased altitude = decreased barometric pressure
equation for respiratory exchange ratio
Equation for respiratory exchange ratio

R = pulmonary CO2 elimination rate

pulmonary O2 uptake rate

what is the physiological dead space volume
What is the physiological dead space volume?

All portions of the system not available for gas exchange

or

the sum of the anatomic dead space and the alveolar dead space volumes

what is alveolar dead space
What is alveolar dead space?
  • Any ventilated alveoli which are not perfused with pulmonary capillary blood
how is physiological dead space volume measured
How is physiological dead space volume measured?
  • Bohr method
  • VD = VT[(PaCO2 – PECO2)/PaCO2]
  • Dead space volume increases slightly during inspiration as the airways expand. It then decreases again during expiration.
what is alveolar ventilation
What is alveolar ventilation?
  • The rate at which the alveoli are ventilated
  • Alveolar vent = expired volume – dead space volume
  • Alveolar ventilation brings fresh air into the gas exchange areas of the lungs. Dead space ventilation does not.
what happens to alveolar air composition as alveolar ventilation increases
What happens to alveolar air composition as alveolar ventilation increases?
  • Alveolar air composition becomes more similar to inspired air.
  • As alveolar ventilation decreases, gas tensions become similar to those in systemic venous blood.
kuehn

Kuehn

embryology

what does the endoderm form
What does the endoderm form?
  • Lines the inner portions of the embryonic pharynx
what does the ectoderm form
What does the ectoderm form?
  • Lining of the outer and part of the inner oral cavity
what does the stomadeum form
What does the stomadeum form?
  • Embryonic mouth
    • after rupture of oral plate
failure of fusion of the nasolabial grove will result in
Failure of fusion of the nasolabial grove will result in:
  • Cleft palate
  • Cleft lip
  • Agenesis of the nasal septum
  • Agenesis of the nasal concha
the bud that will eventually develop in to the trachea bronchi and lungs arises from the
The bud that will eventually develop in to the trachea, bronchi, and lungs arises from the:
  • Dorsal surface of the esophagus
the new limiting factor for which fetuses slightly below 500g weight still cannot survive is
The new limiting factor for which fetuses slightly below 500g weight still cannot survive is:
  • The kidney is not functioning
what are the divisions of the external nares in the early stages
What are the divisions of the external nares in the early stages?
  • Frontonasal prominence
  • Maxillary division: branchial arch I
  • Buccopharyngeal plate
  • Mandibular division: branchial arch I
what nerve innervates the internal muscles of the larynx
What nerve innervates the internal muscles of the larynx?
  • Recurrent laryngeal nerve
    • Goes inferior to aortic arch 6 to enter the larynx
what nerve innervate the internal mucosa of the larynx
What nerve innervate the internal mucosa of the larynx?
  • Internal br. of superior laryngeal nerve
    • From the vagus n, which travels superior to branchial arch 4
what nerve innervates the cricothyroid
What nerve innervates the cricothyroid?
  • External br of superior laryngeal n
where does the trachea arise from
Where does the trachea arise from?
  • Epithelium and glands from the endoderm of the laryngiotracheal grove
  • Everything else from splanchnic mesoderm
what do the lungs arise from
What do the lungs arise from?
  • Primary bronchial buds
what happens during the canalicular period 16 25 weeks
What happens during the canalicular period [16-25 weeks]?
  • Enlargement of the terminal bronchioles
  • Somewhat increased vasculature
  • Surfactant produced at 20 weeks
  • Only fetuses born at the end of this period have a chance of survival
how far have the lungs developed during the pseudoglandular period 5 17 weeks
How far have the lungs developed during the pseudoglandular period [5-17 weeks]?
  • Broncholes developed
  • No alveoli
  • Poor vascular
  • Birth during this phase results in death of fetus
what happens during the terminal sac period 24 weeks to birth
What happens during the terminal sac period [24 weeks to birth]?
  • Terminal sacs develop
  • Epithelium becomes squamous
  • Improvement of vasculature
  • Surfactant producing cells increase in number
  • Births during this period usually survive
when is the alveolar period
When is the alveolar period?
  • Birth to 8 years
    • Increase in size of lung
    • Formation of mature alveoli [superior parts of lung develop 1st]
what has to happen at birth to establish respiration
What has to happen at birth to establish respiration?
  • Increased surfactant production
  • Lungs go from being primary secretory to being a gas exchange organ
  • Mature pulmonary circulation is established
what does the diaphragm arise from
What does the diaphragm arise from?
  • Cervical region
    • Septum transversum  middle of central tendon
    • Pleuroperitoneal folds seal off edges of central tendon
    • Mesoesophagus crura
    • Cervical body wall [C3,4,5] muscular diaphragm
what does a cleft palate result from
What does a cleft palate result from?
  • Failure of the secondary palate to fuse with the primary palate
walters

Walters

pharmacology

where is histamine found in the periphery
Where is histamine found in the periphery?
  • Mast cells [bronchioles, skin, intestinal mucosa]
  • Basophils
where is histamine found in the brain
Where is histamine found in the brain?
  • Cell bodies of histaminergic neurons are in:

POSTERIOR basal hypothalamus

& RETICULAR FORMATION

what is the consequence of having histaminergic neurons in the reticular formation
What is the consequence of having histaminergic neurons in the reticular formation?
  • The reticular formation plays a role in the level of arousal
  • Histamine pays a role in keeping you alert
  • So… if you take an ANTI-histamine, it could make you drowsy!
what is the main stimulus for histamine release
What is the main stimulus for histamine release?

Ag  IgE crossbridging  degranulation of mast cell  release of histamine

what drugs stimulate the release of histamine
What drugs stimulate the release of histamine?
  • Neuromuscular blockers [for use during surgery]
  • Morphine [TX dyspnea with left ventricular failure]
  • Vancomycin [cell wall inhibitor]
what drug can cause red man syndrome
What drug can cause “red man syndrome”?
  • Vancomycin
    • Typically after rapid IV infusion
    • Characterized by flushing of the upper body and facial area, hypOtension, & tachycardia
why is morphine sometimes used to tx dyspnea with lv failure
Why is morphine sometimes used to tx dyspnea with LV failure?
  • Will allay anxiety
  • Histamine release with cause vasodilation, which decreases preload and afterload
how does vancomycin cause tachycardia
How does vancomycin cause tachycardia?

Histamine  vasodilation  drop in BP  reflex tachy

what are the symptoms of a drug induced anaphylactoid rxn
What are the symptoms of a drug induced anaphylactoid rxn?
  • Burning, itching sensation in the hands face, scalp and ears
  • Followed by a feeling of intense warmth
  • These areas and the whole trunk turn red
  • BP falls  reflex tachy
  • Headache
  • Hives accompanied by nausea
  • Acid secretion
  • Bronchospasms
what does the h3 receptor do
What does the H3 receptor do?
  • Regulates the release of various NTs thru autoreceptor and heteroreceptor mechanisms
mechanism of h1r
Mechanism of H1R
  • Coupled to phospholipase C
  • Hydrolyzes membrane phospholipids to form IP3 and DAG
what does ip3 do
What does IP3 do?
  • Releases Ca from the sarcoplasmic reticulum
    • Ca will activate myosin light chain kinase and phospholipase A2
what does myosin light chain kinase do
What does myosin light chain kinase do?
  • Phosphorylates myosin
    • Causes bronchoCONSTRICTION and increased peristalsis
what does phospholipase a2 do
What does phospholipase A2 do?
  • Produces NO and prostacyclin [PGI2]
    • Vasodilators!
what does dag do
What does DAG do?
  • Activates protein kinase C which facilitates Ca release from the SR
what is the mechanism of h2r
What is the mechanism of H2R?
  • Stimulates adenylyl cyclase  increase in cAMP activates a protein kinase that:
    • Phosphorylates and ACTIVATES a Ca pump that pumps Ca out of the cell and into the SR
    • Phosphorylates and INACTIVATES myosin light chain kinase inhibits contraction, causes vasodilation
what 3 things characterize the allergic response to histamine
What 3 things characterize the allergic response to histamine?
  • bronchoCONSTRICTION
  • vasoDILATION
  • Increased capillary permeability [see edema, swelling]
what is the triple response
What is the TRIPLE RESPONSE?
  • Flare and wheal reaction: seen in bee stings, insect bites
    • Localized red spot
      • Few seconds
      • Few mm
      • Immediate vasodilation
      • Stimulation of H1
    • Bright flare
      • Delayed
      • Few cm
      • Stimulation of H2
    • Wheal
      • 1-2 minutes
      • From edema
what are the inotropic chronotropic effects of histamine
What are the (+) inotropic/chronotropic effects of histamine?
  • Direct:
    • Increased automaticity of SAN, atria, ventricle
  • Indirect:
    • Baroreflex increases heart rate

Due to actions at the H2 site

stimulation of which histamine receptor can cause pain itching
Stimulation of which histamine receptor can cause pain & itching?
  • H1 receptors
    • in the dermis  pain
    • In the epidermis  itching
what are the physiological effects of histamine
What are the physiological effects of histamine?
  • Allergic response
  • Triple response
  • + ino/chrono effects
  • Histamine shock
  • Increased gastric secretion
  • Pain and itching
common effects of 1 st generation h1 antagonists
Common effects of 1st generation H1 antagonists
  • Penetrate CNS- highly sedating
  • Anticholinergic activity
    • antiemetic
    • Can cause cognitive decline in elderly
characteristics of 2 nd generation h1 antagonists
Characteristics of 2nd generation H1 antagonists
  • Poorly penetrate CNS- little or no sedation
  • Little or no anticholinergic or antiemetic activity
list the 1 st generation h1 antagonists
List the 1st generation H1 antagonists
  • Diphenhydramine [benadryl]
  • Doxylamine
  • Dimenhydrinate
  • Meclizine
  • Hydroxyzine
  • Promethazine
  • Chlorpheniramine
  • Prompheniramine [dimatapp]
  • Cyproheptadine
  • Azelastine
  • olopatadine
what are the uses of diphenhydramine
What are the uses of diphenhydramine?
  • Type I IgE mediated hypersensitivity reactions
  • Motion sickness
  • Night time sleep aid
  • Antitussive
  • Topical antipuritic
  • Topical with maalox for canker sores in kids
what is doxylamine used for
What is doxylamine used for?

Night time sleep aid

what is dimenhydrinate used for
What is dimenhydrinate used for?
  • NV
  • Dizziness and vertigo
  • Very sedating!!!
what drugs are used for motion sickness
What drugs are used for motion sickness?
  • Diphenhydramine
  • Meclizine
  • Hydroxyzine
  • Promethazine
1 st generation h1 antagonist that also blocks 1 receptors
1st generation H1 antagonist that also blocks α1 receptors
  • Promethazine
    • Used for:
      • Type I hypersensitivities
      • Sedative
      • Anti anxiety
      • Antiemetic: used preop to prevent NV associated with general anesthetics
      • Motion sickness
what is the mechanism of the antiemetic effect of promethazine
What is the mechanism of the antiemetic effect of promethazine?

Blocks dopamine receptor in the

chemoreceptor trigger zone

[in area postrema, which is not protected by the blood brain barrier]

what is apap
What is APAP?
  • Acetyl para amino phenol
  • Aka: tyelenol
1 st generation h1 antagonist known to cause weight gain and block 5 ht2 receptors
1st generation H1 antagonist known to cause weight gain and block 5-HT2 receptors

Cyproheptadine [periactin]

uses of hydroxyzine
Uses of Hydroxyzine
  • Motion sickness + pruritis
  • Preop and postop sedation
  • antianxiety
what are azelastine and olopatadine used for
What are azelastine and olopatadine used for?

Itching with allergic conjunctivitis

what are the side effects of 1 st generation h1 antagonists
What are the side effects of 1st generation H1 antagonists?
  • CAUTION:
    • Other sedating drugs
    • Narrow angle glaucoma
    • Other anticholinergic drugs
  • Anticholinergic SE:
    • Blurred vision
    • Dry mouth
    • Constipation
  • CNS stimulation
    • Restless, sleeplessness, hallucinations, ataxia
    • CONVULSIONS in kids
list the 2 nd generation h1 antagonists
List the 2nd generation H1 antagonists
  • Fexofenadine
  • Cetirizine
  • Loratadine
  • Desloratadine
which 2 nd generation h1 antagonist is the active metabolite of hydroxyzine
Which 2nd generation H1 antagonist is the active metabolite of hydroxyzine?

CETIRIZINE

  • Hydroxyzine is a 1st generation H1 antagonist
other drugs with antihistaminic activity
Other drugs with antihistaminic activity
  • ß agonists
  • Cromolyn
  • Nedocromyl

All block degranulation of mast cells

what are h2 antagonists used for
What are H2 antagonists used for?
  • Block H2 component of allergic response
    • Which is… inactivation of MLCK which causes vasodilation
  • Inhibit gastric acid secretion by parietal cells in tx duodenal and gastric ulcers
list the h2 antagonists
List the H2 antagonists
  • Cimetidine [tagamet]
  • Ranitidine [zantac]
  • Famotidine [pepsid]
  • Nizatidine [axid]
what are the side effects of h2 antagonists
What are the side effects of H2 antagonists?
  • Headaches
  • Diarrhea/constipation
  • Drowsiness
  • RARE: CNS effects, more in elderly
which h2 antagonist has the worst side effects
Which H2 antagonist has the worst side effects?
  • CIMETIDINE!
    • Only in high doses
    • Binds cytochrome P450 significant inhibition of drug metabolism
what is pepsid complete made of
What is pepsid complete made of?
  • Famotidine
  • Calcium carbonate
  • Magnesium hydroxide
what are the side effects of cimetidine
What are the side effects of Cimetidine?
  • Increased estradiol levels in MEN
    • Mech: inhibits cyt P450, causes failure to hydroxylate
  • Increased prolactin  gynecomastia [high doses]
    • High doeses are used to treat Zollenger-Ellison Syndrome
  • Inhibits conversion of testosterone to dihydrotestosterone [DHT]
    • DHT is the form used by the testes
    • Mech: inhibits 5α reductase
  • Inhibits binding of DHT to receptor
    • Impotence and decreased libido
  • CAUTION: change in acidity can alter drug absorption
    • Weakly acidic reactions: decreased absorption
    • Weakly basic reactions: increased absorption
what is zollinger ellison syndrome
What is Zollinger Ellison Syndrome?
  • A tumor [gastroma] of the pancreatic islets causeing secretion of massive amounts of GASTRIN
    • Too much acid life threatening
what is the consequence of inhibition of dht binding to its receptor
What is the consequence of inhibition of DHT binding to its receptor?

Impotence and decreased libido

what happens to the absorption of weakly acidic reactions when the gastric ph goes up
What happens to the absorption of weakly acidic reactions when the gastric pH goes UP?
  • Acids become ionized
  • Decreased absorption!
what happens to the absorption of weakly basic reactions when the gastric ph goes up
What happens to the absorption of weakly basic reactions when the gastric pH goes UP?
  • Bases become non-ionized
  • Increased absorption!
moa of nasal decongestants
MOA of nasal decongestants:
  • α1 agonists!
  • Constrict vessels.
  • Except… oxymetazolone
    • α2 agonist!!!!!!!
what is phenylephrine used for
What is phenylephrine used for?
  • Nasal decongestant
  • IV for shock or supraventricular tachy
    • Systemic vasoconstriction maintains BP
  • Mydriatic [pupil dilation]
    • Contracts dilator muscle

Sometimes added to local anesthetics to prevent systemic effects.

list the nasal decongestants
List the nasal decongestants
  • Phenylephrine
  • Psedoephedrine [sudafed]
  • Oxymetazoline [afrin]: ocular decongestant
which nasal decongestant is an 2 agonist
Which nasal decongestant is an α2 agonist?
  • Oxymetazoline
    • OCULAR DECONGESTANT
    • SE: hypOtesnsion and pounding HR
      • Why? Centrally acting, decreased sympathetic outflow vasodilation
what is the moa of expectorants
What is the MOA of expectorants?
  • Irritate the lining of the airway
  • increase secretions
  • dilute, break up phlegm, decrease viscosity
  • Decrease surface tension
what is guaifenesin
What is Guaifenesin?
  • Robitussin
  • Expectorant

Robitussin DM= dextromethorphan (antitussive) + guaifenesin

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histology

what is the conducting portion of the respiratory system
What is the conducting portion of the respiratory system?
  • Nasal cavity, nasopharynx, larynx, trachea, bronchi, bronchioles, terminal bronchioles
  • Function:
    • Provides a conduit for the passage of air to and from the lungs
    • “conditions” the inspired air
what is the respiratory portion of the respiratory system
What is the respiratory portion of the respiratory system?
  • Respiratory bronchioles, alveolar ducts, alveoli
  • Function: sites for the exchange of oxygen and carbon dioxide between the inspired air and blood
what are specialized hairs at the entrance to the nasal cavity called
What are specialized hairs at the entrance to the nasal cavity called?
  • Vibrissae
    • Removes coarse particles of dust
what is involved in the conditioning of the air
What is involved in the conditioning of the air?
  • Filtration: vibrissae
  • Moistening: goblet cells and glands in lamina propria
  • Warming: richly vascular lamina propria
what moistens the inhaled air
What moistens the inhaled air?
  • Goblet cells
  • Glands in lamina propria
what is the function of the mucous
What is the function of the mucous?
  • Trap particulate and gaseous impurities
what warms the air
What warms the air?

Lamina propria

  • Richly vascular
what two parts make up the nasal cavity
What two parts make up the nasal cavity?
  • Vestibule
    • Dilated anteroom supported by cartilage of the external nose
    • The keratinized stratified squamous epithelium is continuous with the skin of the face and contains coarse hairs [vibrissae], sebaceaous glands, sweat glands
  • Nasal cavity proper
    • Divided by the nasal septum
    • Septal wall= smooth
    • Lateral wall= superior, middle, inferior conchae which increase the surface area to 160 cm2
    • Epithelium divided into olfactory and respiratory zones
what type of epithelium is found in the vestibule of the nasal cavity
What type of epithelium is found in the vestibule of the nasal cavity?

Keratinized stratified squamous epithelium

olfactory cells
Olfactory cells
  • Modified bipolar neurons
    • Dendrite ends at olfactory knob
    • 6-12 non motile olfactory cilia arise from olfactory knob
    • Axon pierces the basal lamina and joins the other axons to form the olfactory nn [CNI] that penetrate the cribiform plate of the ethmoid bone
    • Synapse in the olfactory bulb
    • While passing thru the lamina propria, the axons acquire a schwann cell sheath
sustentacular cells of olfactory epithelium
Sustentacular cells of olfactory epithelium

Tall, columnar cells with a microvillus border

basal cells of olfactory epithelium
Basal cells of olfactory epithelium
  • Undifferentiated
  • Believed to be able to differentiate into the other cell types
brush cells of olfactory epithelium
Brush cells of olfactory epithelium
  • Long microvilli
  • Synapses with CN V
  • May be involved in the sneeze reflex or in modifying the activity of the olfactory bulb
what is found in the lamina propria of the olfactory zone
What is found in the lamina propria of the olfactory zone?
  • Seromucous olfactory [bowman’s] glands
    • Secretions provide a solvent for the olfactory stimulus nd washes the olfactory receptors to prevent stagnation of the odor
  • Branches of ethmoid arteries
  • Lymphatics that are in communication with the subarachnoid space inside the cranial cavity
secretory cells are found in the epithelial lining of
Secretory cells are found in the epithelial lining of:
  • Alveoli
  • Terminal bronchioles
  • Primary bronchi
  • Trachea
olfactory epithelium lines
Olfactory epithelium lines:
  • Roof and superior concha
clara cells secrete a substance similar in action to the secretory product of
Clara cells secrete a substance similar in action to the secretory product of:
  • Type II pneumocyte
olfactory epithelium is classified as
Olfactory epithelium is classified as:
  • Tall pseudostratified columnar
  • Contains olfactory, sustentacular, basal, and brush cells
the larynx is lined by which type of epithelium
The larynx is lined by which type of epithelium?
  • Respiratory epithelium
  • Except vocal cords: stratified squamous epithelium
what is respiratory epithelium made of
What is respiratory epithelium made of?
  • Pseudostratified, ciliated columnar with goblet cells
5 cell types commonly found in respiratory epithelium
5 cell types commonly found in respiratory epithelium:
  • Goblet cell
  • Ciliated cell
  • Basal cell
  • Granule cell
  • Brush cell
goblet cell of respiratory epithelium
Goblet cell of respiratory epithelium
  • unicellular mucous gland
  • Large membrane-bound mucous droplets in the atypical cytoplasm
ciliated cell of respiratory epithelium
Ciliated cell of respiratory epithelium
  • 300 cilia on its luminal surface
  • Concentration of mitochondria at the apical part of the cell
basal cell of respiratory epithelium
Basal cell of respiratory epithelium
  • lies along the basal lamina
  • Fxn as a reserve cell to repopulate the epithelium
granule cell of respiratory epithelium
Granule cell of respiratory epithelium
  • unicellular endocrine gland
  • Numerous dense-core granules in the basal cytoplasm
  • Granules contain seratonin and dopamine & are released downward into the luminal propria via paracrine secretion
  • Concentrated at bronchial divisions and bronchioalveolar portals
  • Believed to be involved in the local regulation of airway diameter
brush cell of respiratory epithelium
Brush cell of respiratory epithelium
  • Long microvilli and epitheliodendritic synapses
  • Involved in the sampling of the airway environment
what is the respiratory zone composed of
What is the respiratory zone composed of?
  • Nasal septum and lateral wall below the superior concha
what is the plexus cavernosum concharum
What is the plexus cavernosum concharum?
  • AKA: swell bodies
  • Erectile tissue found over the lower turbinates
  • Smooth muscle is found in the walls, not in the speta
  • Supplied by veins, not arteries
  • Swell bodies on each side of the nasal cavity become engorged on an alternating schedule [20-30 mins]
    • Cuts the flow of air so that the epithelium can rehydrate
  • Regulation by the autonomic nervous system
    • Adrenergic fibers from the superior cervical ganglion cause vasoconstriction
    • Cholinergic fibers from the pterygopalatine ganglion cause vasodilation
    • Arterial flow in the branches of the sphenopalatine artery is in the opposite direction to the air flow countercurrent heat exchanger to warm or cool and humidify inspired air
paranasal sinuses
Paranasal sinuses
  • Frontal, Ethmoidal, Sphenoidal, Maxillary
  • Connected to the nasal cavity by ostia or ducts
  • Lined by typical respiratory epithelium
  • Cilia of ciliated cells beat TOWARD the nasal cavity
  • Few goblet cells
  • FXN:
    • lighten the bones in which they are found
    • Warm and humidify the inspired air
    • Act as resonating chambers for the voice
what are the 3 parts of the pharynx
What are the 3 parts of the pharynx?
  • Nasopharynx: continuous with the NASAL cavity at the posterior nares and extends from the base of the skull to the level of the soft palate
  • Oropharynx: continuous with the ORAL cavity at the palatoglossal arch and extends from the level of the soft palate to the hyoid.
  • Laryngopharynx: extends from the level of the hyoid to the lower border of the cricoid cartilage [C6]. Includes the epiglottis and larynx.
what cells line the nasopharynx
What cells line the nasopharynx?
  • Respiratory epithelium
    • Pseudostratified, ciliated columnar with goblet cells
what cells line the oropharynx
What cells line the oropharynx?

Stratified squamous epithelium

what cells line the epiglottis
What cells line the epiglottis?
  • Lingual surface & the apical portion of the laryngeal side:
    • stratified squamous epithelium
  • Toward the base of the epiglottis on the laryngeal side:
    • Transition to respiratory epithelium
      • Pseudostratified, ciliated columnar with goblet cells
what cells line the larynx
What cells line the larynx?
  • Respiratory epithelium
    • Pseudostratified, ciliated columnar with goblet cells
  • Except over the vocal cords
    • stratified squamous epithelium
what connects the pharynx to the trachea
What connects the pharynx to the trachea?
  • Larynx
    • Lamina propria contains several irregularly shaped cartilages that help to maintain an open airway and also to participate in producing sounds for phonation
what parts of the larynx are made of hyaline cartilage
What parts of the larynx are made of hyaline cartilage?
  • Thyroid cartilage
  • Cricoid cartilage
  • Arytenoid cartilage
what parts of the larynx are made of elastic cartilage
What parts of the larynx are made of elastic cartilage?
  • Cuneiform cartilage
  • Corniculate cartilage
at what level does the trachea bifurcate
At what level does the trachea bifurcate?
  • Sternal angle/T4-6
  • Divides into left and right primary bronchi
what are the 4 layers of the tracheal wall
What are the 4 layers of the tracheal wall?
  • Mucosa
    • Respiratory epithelium and elastic fiber rich lamina propria
  • Submucosa
    • Slightly more dense CT
  • Cartilaginous layer
    • C shaped hyaline cartilages
  • Adventitia
    • CT which binds the trachea to the surrounding tissue
trachealis muscle
Trachealis muscle
  • Smooth muscle fibers that bridge the gap between the free ends of the C shaped cartilage at the posterior border of the trachea adjacent to the esophagus
which primary bronchus is shorter
Which primary bronchus is shorter?
  • Right
    • Also, larger diameter, more vertical
secondary lobar bronchi
Secondary [lobar] bronchi
  • AKA: intrapulmonary bronchi
  • Branch from primary bronchi at hilum of lungs
  • Left lung gets 2
  • Right lung gets 3
  • Continually bifurcates for about 7 more generations
  • Lined by respiratory epithelium
  • C shaped cartilages become cartilaginous plates as the bronchi become intrapulmonary
bronchiole
bronchiole
  • Division of intrapulmonary bronchi that have a diameter of about 1mm
  • Supply pulmonary lobules
  • NO cartilage lplates
  • Thick later of smooth muscle
what cells line bronchioles
What cells line bronchioles?
  • Large diameter: pseudostratified ciliated columnar
  • Small diameter: simple ciliated columnar with fewer goblet cells
what cells line the terminal bronchioles
What cells line the terminal bronchioles?
  • Simple, cuboidal epithelium
  • Containing:
    • Cliliated cells
    • Non-ciliated bronchiolar [clara] cells
    • Brush cells
clara cells
Clara cells
  • Have a dome shaped luminal surface projection
  • Secretes a surface active agent, a lipoprotein, that functions to prevent luminal adhesion during expiration
respiratory bronchiole
Respiratory bronchiole
  • Branches of terminal bronchioles
  • Concerned with conduction of air AND gas exchange
  • Initial portion is lines with both ciliated cuboidal and clara cells
  • Clara cells predominate in the distal portion
  • Alveoli extend from the lumen of these bronchioles
alveolar ducts
Alveolar ducts
  • Branches of respiratory bronchioles
  • Walls consisting entirely of alveoli
  • Lined by a thin simple squamous epithelium
  • Lamina propria surrounding the rim of the alveoli is a network of smooth muscle cells
    • Sphincter like bundles of smooth muscles appear as knobs between alveoli
  • Terminate as alveolar sacs: spaces surrounded by clusters of alveoli
alveoli
Alveoli
  • The terminal air spaces of the respiratory system
  • The site of gas exchange between air and the blood
  • 100 million alveoli per lung
  • About 0.2 mm in diameter
  • Separated by a thin CT layer containing numerous blood capillaries
alveolar septum
Alveolar septum
  • Tissue between adjacent alveolar air spaces
  • Composed of:
    • Alveolar epithelial cells
    • Basal lamina of alveolar epithelium
    • Basal lamina of capillary endothelium
    • Capillary endothelium
    • Other CT elements
      • fibroblasts, macrophages, collagen & elastic fibers
interalveolar pores of kohn
Interalveolar pores [of Kohn]
  • Openings in the interalveolar septa that allow circulation of air from one alveolus to another
what types of cells line the alveoli
What types of cells line the alveoli?
  • Type I alveolar cells [type I pneumocytes]
  • Type II alveolar cells [septal cells]
type i alveolar cells
Type I alveolar cells
  • Simple squamous cells
  • Line 95% of the alveolar surface
  • Joined to other epithelial cells by TIGHT JUNCTIONS
type ii alveolar cells
Type II alveolar cells
  • Cuboidal cells
  • Interspersed among type I cells
  • Line about 5% of the alveolar surface
  • Cytoplasm: contains multilamellar bodies
  • Surface active agent: SURFACTANT
  • Lamellar bodies are released into the alveolar space by exocytosis
  • Surfactant forms a monomolecular layer over the alveolar epithelium
    • Reduces surface tension at the air-epithelium interface
role of brush cells in the alveoli
Role of brush cells in the alveoli
  • Receptors that monitor the air quality in the lung
  • Few in numbers
function of alveolar macrophages
Function of alveolar macrophages
  • Found in:
    • Alveolar septum
    • Alveolar air spaces: scavenge the surface to remove inhaled particulate matter such as bacteria, dust and pollen
      • Become known as DUST CELLS
  • Some pass up the bronchial tree in the mucus and are disposed of by swallowing or expectoration
  • Others return to or remain in the septal CT
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