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Questions and Answers
Which branch of the intercostal nerves is responsible for supplying the skin of the lateral part of the thoracic wall?
Which branch of the intercostal nerves is responsible for supplying the skin of the lateral part of the thoracic wall?
What is the primary muscle responsible for inspiration?
What is the primary muscle responsible for inspiration?
Which structure separates the thoracic cavity from the abdominal cavity?
Which structure separates the thoracic cavity from the abdominal cavity?
What is the general origin of the diaphragm?
What is the general origin of the diaphragm?
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Which part of the diaphragm is specifically U-shaped?
Which part of the diaphragm is specifically U-shaped?
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Which of the following is NOT a neuropsychiatric event associated with LTRA?
Which of the following is NOT a neuropsychiatric event associated with LTRA?
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What should be considered at Step 5 of asthma treatment according to the stepwise approach?
What should be considered at Step 5 of asthma treatment according to the stepwise approach?
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What characterizes the eosinophilic phenotype in severe asthma?
What characterizes the eosinophilic phenotype in severe asthma?
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How does Omalizumab function in the treatment of allergic asthma?
How does Omalizumab function in the treatment of allergic asthma?
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Which class of drug is used as an add-on for patients with an allergic phenotype of severe asthma?
Which class of drug is used as an add-on for patients with an allergic phenotype of severe asthma?
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For which symptoms should a patient be categorized into Step 3 of asthma management?
For which symptoms should a patient be categorized into Step 3 of asthma management?
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What is a potential adverse effect reported with LTRA use?
What is a potential adverse effect reported with LTRA use?
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What is the primary purpose of using corticosteroids in the treatment of bronchial asthma?
What is the primary purpose of using corticosteroids in the treatment of bronchial asthma?
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In the management of an acute severe asthma attack, which medication is NOT typically part of the initial treatment?
In the management of an acute severe asthma attack, which medication is NOT typically part of the initial treatment?
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What is the recommended concentration of oxygen saturation to maintain during acute asthma treatment?
What is the recommended concentration of oxygen saturation to maintain during acute asthma treatment?
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Which treatment option is indicated for patients with persistent symptoms of asthma despite other treatments?
Which treatment option is indicated for patients with persistent symptoms of asthma despite other treatments?
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What role does helium play in the treatment of bronchial asthma?
What role does helium play in the treatment of bronchial asthma?
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In a status asthmaticus scenario, which of the following is NOT a recommended management step?
In a status asthmaticus scenario, which of the following is NOT a recommended management step?
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Which of the following treatments can be considered for refractory cases of bronchial asthma?
Which of the following treatments can be considered for refractory cases of bronchial asthma?
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What is the typical intravenous dose of hydrocortisone for an acute asthma attack if oral administration is not possible?
What is the typical intravenous dose of hydrocortisone for an acute asthma attack if oral administration is not possible?
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What is the main function of the combination of SABA and SAMA in the treatment of acute asthma?
What is the main function of the combination of SABA and SAMA in the treatment of acute asthma?
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What is a characteristic sign of diphtheria?
What is a characteristic sign of diphtheria?
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What kind of immunization is primarily used for preventing diphtheria?
What kind of immunization is primarily used for preventing diphtheria?
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Which of the following is true about the morphology of Corynebacterium diphtheriae?
Which of the following is true about the morphology of Corynebacterium diphtheriae?
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What is the main virulence factor contributed by Bordetella pertussis?
What is the main virulence factor contributed by Bordetella pertussis?
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Which drug is preferred for treating diphtheria?
Which drug is preferred for treating diphtheria?
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What describes the Gram staining characteristics of Bordetella pertussis?
What describes the Gram staining characteristics of Bordetella pertussis?
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What is the mode of transmission for diphtheria?
What is the mode of transmission for diphtheria?
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Which statement is true regarding the trivalent DPT vaccine?
Which statement is true regarding the trivalent DPT vaccine?
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What should be administered immediately if diphtheria is suspected?
What should be administered immediately if diphtheria is suspected?
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Which statement about the tracheal cytotoxin produced by Bordetella pertussis is correct?
Which statement about the tracheal cytotoxin produced by Bordetella pertussis is correct?
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What classification does Corynebacterium diphtheriae fall under in terms of disease?
What classification does Corynebacterium diphtheriae fall under in terms of disease?
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Which of the following is a typical symptom of a diphtheria infection?
Which of the following is a typical symptom of a diphtheria infection?
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What is the typical laboratory diagnosis method for Bordetella pertussis?
What is the typical laboratory diagnosis method for Bordetella pertussis?
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What is the most common causative organism of upper respiratory tract infections?
What is the most common causative organism of upper respiratory tract infections?
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Which respiratory condition is characterized by a 'whoop' sound during coughing?
Which respiratory condition is characterized by a 'whoop' sound during coughing?
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What is a key characteristic of Haemophilus influenzae?
What is a key characteristic of Haemophilus influenzae?
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What is the initial management step for a child exhibiting signs of diphtheria?
What is the initial management step for a child exhibiting signs of diphtheria?
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Which clinical finding may suggest an upper respiratory infection in a child?
Which clinical finding may suggest an upper respiratory infection in a child?
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What distinguishes acute laryngotracheobronchitis from other respiratory infections?
What distinguishes acute laryngotracheobronchitis from other respiratory infections?
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What immunization status can increase a child's risk for respiratory infections?
What immunization status can increase a child's risk for respiratory infections?
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Study Notes
Treatment of Bronchial Asthma (Part 2)
- Learning Outcomes: Students will be able to describe the mechanism of action, uses, and adverse effects of corticosteroids used in bronchial asthma treatment; identify leukotriene receptor antagonists; identify a stepwise approach for treating different cases of bronchial asthma; describe biological therapy for bronchial asthma; list other drugs used in bronchial asthma treatment; and identify management of acute severe asthma.
Lecture Outline
- Corticosteroids
- Anti-leukotriene
- Biological therapy
- Stepwise approach in BA
- Treatment of acute severe asthma
Anti-inflammatory Drugs (Corticosteroids)
- Action: Corticosteroids are anti-inflammatory and not bronchodilators. They increase airway diameter, decrease frequency of asthmatic attacks, and decrease bronchial hyper-reactivity.
- Inhaled Corticosteroids (ICS): The most effective controllers for bronchial asthma. They effectively suppress inflammation in asthmatic airways, even in low doses, and are first-line therapy for all asthma severities and patients of all ages.
- Examples of ICS: Beclometasone, Budesonide, Combined with LABA in the same inhaler (Beclometasone-formoterol), (Betamethasone-formoterol)
- Mechanism of Action: Inhibit phospholipase A2 enzyme, hence reducing the synthesis of leukotrienes (LTs), prostaglandins (PGs), and platelet-activating factor (PAF). They also inhibit B cell function, decrease inflammatory cytokine production, inhibit mast cells, and upregulate B2 receptors.
Corticosteroids Mechanism of Action (Continued)
- Inhibit B cell function →↓ antigen-antibody reaction.
- Inhibit T cell functions →↓ decrease the production of inflammatory cytokines (e.g., IL, and TNFα leading to inhibition of early phase response to allergen).
- Inhibit macrophage activity.
- Inhibit mast cells → ↓ histamine release and capillary permeability.
- Upregulation of B2 receptors → ↑ increase airway diameter, reverse the shedding of epithelial cells, goblet-cell hyperplasia, and basement-membrane thickening characteristic of the airway mucosa of patients with asthma.
Corticosteroids (Inhaled) - Adverse Effects
- Oropharyngeal candidiasis: Avoided by using a spacer device or nystatin.
- Dysphonia: Leading to a change in voice.
Other Corticosteroids
- Oral corticosteroids: Prednisolone
- IV corticosteroids: Hydrocortisone
Adverse Effects of Systemic Corticosteroids
- Increased susceptibility to infection
- Osteoporosis
- Fluid retention
- Electrolyte imbalances (especially hypokalemia)
- Raised blood pressure
- Elevated blood glucose levels
- Iatrogenic Cushing's syndrome (e.g., moon face, buffalo hump)
Learning Outcomes (Part 2)
- Leukotriene receptor antagonist (LTRA)
- Montelukast: Orally dosed drug(a film-coated tablet). A highly selective leukotriene receptor antagonist that binds with high affinity to leukotriene receptors for leukotrienes D4 and E4 secreted from inflammatory cells. It is involved in the inflammatory process that may cause asthma and allergic rhinitis.
- Adverse effects: Anxiety, depression, aggressiveness, etc.
Asthma Management
- Stepwise approach in treatment of bronchial asthma: different steps are mentioned ( Track 1: Preferred controller and reliever), using data from GINA 2024 guideline for adults and teenagers.
- Biological therapy: Severe asthma is a heterogeneous disease with different phenotypes. Phenotyping is done for patient poor control (Stage 5). If allergic phenotype (type 1), monoclonal antibody against IgE (e.g., Omalizumab) is considered. Eosinophilic phenotype (type 2) → Consider adding on T-helper 2 (Th2) cell-targeted biologic therapy (e.g. Benralizumab)
- Other drugs: Azithromycin; For patients with persistent symptoms despite treatment. Mixture of oxygen (20%) and helium (80%) (Heliox). Helium is inert gas; Its low density makes O2 diffusion through obstructed airways easier; Pure oxygen irritant is mentioned.
- Acute severe asthma (status asthmatics): A severe acute attack poorly responsive to bronchodilators. Management includes: hospital admission; Oxygen to maintain O2 saturation (94-98%); SABA+SAMA (ipratropium bromide) (nebulizer); Prednisolone (40-50mg oral) or hydrocortisone (100 mg IV/ 6 hs) for those unable to take oral Prednisolone; IV magnesium sulfate infusion over 20 minutes; Correction of acidosis and dehydration by IV fluids.
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Description
This quiz covers key concepts in human anatomy related to the thoracic cavity and its components. It includes questions about intercostal nerves, the diaphragm, and the muscles of respiration. Test your understanding of these crucial anatomical structures and their functions.