Human Anatomy: Thoracic Structures
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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?

  • Anterior cutaneous branch
  • Lateral cutaneous branch (correct)
  • Pleural branch
  • Collateral branch
  • What is the primary muscle responsible for inspiration?

  • External intercostal muscles
  • Serratus anterior muscle
  • Diaphragm (correct)
  • Internal intercostal muscles
  • Which structure separates the thoracic cavity from the abdominal cavity?

  • Intercostal muscles
  • Central tendon
  • Diaphragm (correct)
  • Pleura
  • What is the general origin of the diaphragm?

    <p>Xiphoid process, lower ribs and lumbar vertebrae</p> Signup and view all the answers

    Which part of the diaphragm is specifically U-shaped?

    <p>Central tendon</p> Signup and view all the answers

    Which of the following is NOT a neuropsychiatric event associated with LTRA?

    <p>Nausea</p> Signup and view all the answers

    What should be considered at Step 5 of asthma treatment according to the stepwise approach?

    <p>Add on LAMA</p> Signup and view all the answers

    What characterizes the eosinophilic phenotype in severe asthma?

    <p>Involves T-helper 2 cell activation</p> Signup and view all the answers

    How does Omalizumab function in the treatment of allergic asthma?

    <p>It blocks IgE from binding to receptors on mast cells</p> Signup and view all the answers

    Which class of drug is used as an add-on for patients with an allergic phenotype of severe asthma?

    <p>Monoclonal antibodies against IgE</p> Signup and view all the answers

    For which symptoms should a patient be categorized into Step 3 of asthma management?

    <p>Daily symptoms and nocturnal awakenings</p> Signup and view all the answers

    What is a potential adverse effect reported with LTRA use?

    <p>Hypoesthesia</p> Signup and view all the answers

    What is the primary purpose of using corticosteroids in the treatment of bronchial asthma?

    <p>To decrease airway hyperresponsiveness</p> Signup and view all the answers

    In the management of an acute severe asthma attack, which medication is NOT typically part of the initial treatment?

    <p>Long-acting beta agonists</p> Signup and view all the answers

    What is the recommended concentration of oxygen saturation to maintain during acute asthma treatment?

    <p>94-98%</p> Signup and view all the answers

    Which treatment option is indicated for patients with persistent symptoms of asthma despite other treatments?

    <p>Azithromycin</p> Signup and view all the answers

    What role does helium play in the treatment of bronchial asthma?

    <p>It reduces airway irritation from pure oxygen</p> Signup and view all the answers

    In a status asthmaticus scenario, which of the following is NOT a recommended management step?

    <p>Oral corticosteroids</p> Signup and view all the answers

    Which of the following treatments can be considered for refractory cases of bronchial asthma?

    <p>Biological therapy</p> Signup and view all the answers

    What is the typical intravenous dose of hydrocortisone for an acute asthma attack if oral administration is not possible?

    <p>100 mg</p> Signup and view all the answers

    What is the main function of the combination of SABA and SAMA in the treatment of acute asthma?

    <p>To enhance bronchodilation</p> Signup and view all the answers

    What is a characteristic sign of diphtheria?

    <p>Sore throat with adherent membrane</p> Signup and view all the answers

    What kind of immunization is primarily used for preventing diphtheria?

    <p>Active immunization with toxoid</p> Signup and view all the answers

    Which of the following is true about the morphology of Corynebacterium diphtheriae?

    <p>Non-motile with a beaded appearance</p> Signup and view all the answers

    What is the main virulence factor contributed by Bordetella pertussis?

    <p>Lethal toxin causing local necrosis</p> Signup and view all the answers

    Which drug is preferred for treating diphtheria?

    <p>Penicillin</p> Signup and view all the answers

    What describes the Gram staining characteristics of Bordetella pertussis?

    <p>Small Gram-negative coccobacillus</p> Signup and view all the answers

    What is the mode of transmission for diphtheria?

    <p>Direct or indirect droplet infection</p> Signup and view all the answers

    Which statement is true regarding the trivalent DPT vaccine?

    <p>It contains diphtheria toxoid, pertussis vaccine, and tetanus toxoid</p> Signup and view all the answers

    What should be administered immediately if diphtheria is suspected?

    <p>Antitoxin treatment</p> Signup and view all the answers

    Which statement about the tracheal cytotoxin produced by Bordetella pertussis is correct?

    <p>It destroys ciliated cells of the trachea</p> Signup and view all the answers

    What classification does Corynebacterium diphtheriae fall under in terms of disease?

    <p>Bacterial infection</p> Signup and view all the answers

    Which of the following is a typical symptom of a diphtheria infection?

    <p>Grayish-white membranous patches in the throat</p> Signup and view all the answers

    What is the typical laboratory diagnosis method for Bordetella pertussis?

    <p>PCR assay</p> Signup and view all the answers

    What is the most common causative organism of upper respiratory tract infections?

    <p>Streptococcus pneumoniae</p> Signup and view all the answers

    Which respiratory condition is characterized by a 'whoop' sound during coughing?

    <p>Whooping cough</p> Signup and view all the answers

    What is a key characteristic of Haemophilus influenzae?

    <p>It requires certain growth factors for culture.</p> Signup and view all the answers

    What is the initial management step for a child exhibiting signs of diphtheria?

    <p>Administration of diphtheria antitoxin</p> Signup and view all the answers

    Which clinical finding may suggest an upper respiratory infection in a child?

    <p>High-grade fever and inspiratory stridor</p> Signup and view all the answers

    What distinguishes acute laryngotracheobronchitis from other respiratory infections?

    <p>Presence of stridor and barky cough</p> Signup and view all the answers

    What immunization status can increase a child's risk for respiratory infections?

    <p>Inappropriate immunization for age</p> Signup and view all the answers

    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.

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