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 (A)</p> Signup and view all the answers

Which part of the diaphragm is specifically U-shaped?

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

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

<p>Nausea (C)</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 (A)</p> Signup and view all the answers

What characterizes the eosinophilic phenotype in severe asthma?

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

What is a potential adverse effect reported with LTRA use?

<p>Hypoesthesia (A)</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 (A)</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 (C)</p> Signup and view all the answers

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

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

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

<p>Azithromycin (B)</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 (A)</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 (B)</p> Signup and view all the answers

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

<p>Biological therapy (A)</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 (D)</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 (A)</p> Signup and view all the answers

What is a characteristic sign of diphtheria?

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

What kind of immunization is primarily used for preventing diphtheria?

<p>Active immunization with toxoid (A)</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 (D)</p> Signup and view all the answers

What is the main virulence factor contributed by Bordetella pertussis?

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

Which drug is preferred for treating diphtheria?

<p>Penicillin (A)</p> Signup and view all the answers

What describes the Gram staining characteristics of Bordetella pertussis?

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

What is the mode of transmission for diphtheria?

<p>Direct or indirect droplet infection (A)</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 (C)</p> Signup and view all the answers

What should be administered immediately if diphtheria is suspected?

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

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

<p>Bacterial infection (A)</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 (B)</p> Signup and view all the answers

What is the typical laboratory diagnosis method for Bordetella pertussis?

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

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

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

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

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

What is a key characteristic of Haemophilus influenzae?

<p>It requires certain growth factors for culture. (C)</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 (D)</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 (B)</p> Signup and view all the answers

What distinguishes acute laryngotracheobronchitis from other respiratory infections?

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

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

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

Flashcards

LTRA Adverse Effects

Leukotriene receptor antagonists (LTRAs) can cause neuropsychiatric events (anxiety, depression, etc.), headaches, fever, fatigue, and increased upper respiratory issues.

Asthma Treatment Stepwise Approach

Bronchial asthma treatment progresses in steps, starting with low-dose inhaled corticosteroids (ICS) and formoterol, potentially escalating in subsequent stages to add-on therapies and biological agents based on patient symptom severity and response.

Asthma Phenotyping

Asthma categorizes based on underlying causes to personalize treatment. Identifying phenotype helps choose the most effective treatment approach.

Severe Asthma Treatment

Severe asthma requires more personalized assessment and therapy. Patients with uncontrolled asthma should get a phenotyping assessment to adjust treatment plans.

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Allergic Asthma Phenotype

An allergic asthma phenotype is associated with IgE-producing B cells. A monoclonal antibody against IgE could be beneficial for some patients.

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Eosinophilic Asthma Phenotype

Characterized by T-helper 2 cell activation and abnormal type 2 cytokine production (IL-4, IL-5, IL-13). Type 2 targeted biological therapies may be appropriate for this asthma type.

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Omalizumab Mechanism

Omalizumab is an anti-IgE monoclonal antibody that blocks IgE from binding to mast cells, reducing allergic mediator release and lowering plasma IgE.

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Heliox

A mixture of 80% helium and 20% oxygen used to treat asthma. Helium's low density helps oxygen reach obstructed airways, reducing breathing effort.

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Status Asthmaticus

A severe asthma attack where bronchodilators are ineffective. Requires immediate medical attention.

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Treatment for Status Asthmaticus

Involves hospitalization, oxygen therapy, inhaled bronchodilators, corticosteroids, and IV magnesium sulfate to relieve severe asthma symptoms.

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Anti-Inflammatory Therapy in Asthma

Essential for managing asthma by reducing airway hyperresponsiveness. Corticosteroids are the primary choice for this purpose.

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Corticosteroids in Asthma

Can be inhaled, oral, or intravenous, depending on the severity and urgency of the asthma attack. Inhaled is the first line of treatment.

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Biological Therapy in Asthma

Targeted medications used for refractory asthma, based on asthma phenotyping and specific triggers. Used when traditional treatment fails.

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Stepwise Approach to Asthma Management

A gradual approach to asthma treatment, starting with low-dose inhaled corticosteroids and stepping up therapy depending on the patient's response.

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GINA

The Global Initiative for Asthma, a worldwide organization that provides updated guidelines and recommendations for asthma management.

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Intercostal Nerves: Postganglionic Branch

This is the non-myelinated branch of the intercostal nerve, also known as the gray ramus. It carries postganglionic sympathetic fibers.

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Intercostal Muscles: Innervation

The intercostal muscles are supplied by the intercostal nerves. These nerves are responsible for controlling the movement of the ribs during breathing.

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Parietal Pleura: Innervation

The parietal pleura, which lines the inner surface of the thoracic cavity, receives innervation from the intercostal nerves.

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Diaphragm: What is it?

The diaphragm is a dome-shaped muscle that separates the thoracic cavity from the abdominal cavity. It plays a crucial role in breathing.

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Diaphragm: Origin

The diaphragm has multiple origins: the sternal (xiphoid process), costal (lower ribs), and vertebral (crura and arcuate ligaments).

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Normal microbiota of the respiratory tract

The collection of microorganisms that normally reside in the respiratory tract, including bacteria, fungi, and viruses.

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Upper respiratory tract infections (URTIs)

Infections affecting the nose, sinuses, throat, and middle ear, often caused by viruses, bacteria, or fungi.

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Corynebacterium diphtheriae

A bacterium responsible for diphtheria, an infectious disease characterized by formation of a thick, grayish membrane in the throat, which can lead to respiratory obstruction.

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Diphtheria toxin

A toxin produced by Corynebacterium diphtheriae that inhibits protein synthesis in cells, leading to cell death and tissue damage.

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Bordetella pertussis

A bacterium responsible for pertussis (whooping cough), a highly contagious respiratory disease characterized by severe coughing spasms.

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Haemophilus influenzae

A bacterium that causes various infections, including otitis media, sinusitis, and pneumonia, but can also cause invasive diseases like meningitis.

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Pertussis transmission

Spread through respiratory droplets released into the air when an infected person coughs, sneezes, or talks.

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Diphtheria transmission

Spread through direct contact with infected individuals or contaminated objects, like infected droplets, toys, or clothing.

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Laboratory diagnosis of pertussis & diphtheria

Identifying the presence of the causative bacteria in respiratory samples using techniques like culture, polymerase chain reaction (PCR), or serological tests.

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Membranous patches in the throat

A characteristic sign of diphtheria, where a thick, grayish membrane forms on the tonsils and pharyngeal wall, potentially obstructing breathing.

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Diphtheria Cause

Diphtheria is caused by Corynebacterium diphtheriae, a bacterium that produces a toxin that damages heart, nerve, kidney, and liver cells.

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Diphtheria Symptoms

Diphtheria presents with a sore throat, low-grade fever, and a thick, gray membrane covering the tonsils, pharynx, or nose.

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Diphtheria Prevention: Active Immunization

Active immunization with diphtheria toxoid (DTaP vaccine) provides long-lasting protection against diphtheria.

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Diphtheria Prevention: Passive Immunization

Passive immunization, using diphtheria antitoxin, provides temporary protection for individuals exposed to diphtheria.

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Diphtheria Treatment: Antitoxin

Antitoxin is the primary treatment for diphtheria, administered immediately if the disease is suspected.

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Diphtheria Treatment: Chemotherapy

Antibiotics like penicillin or erythromycin are used to kill the Corynebacterium diphtheriae bacteria.

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Whooping Cough Cause

Whooping cough, also known as pertussis, is caused by the bacterium Bordetella pertussis.

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Bordetella pertussis Morphology

The Bordetella pertussis bacterium is a small, gram-negative coccobacillus with bipolar staining.

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Bordetella pertussis Adherence

The Bordetella pertussis bacterium attaches to the respiratory epithelium using specialized attachment mechanisms.

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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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Treatment of Bronchial Asthma (Part 2) PDF

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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