AP3 Final Study Guide Flashcards
1
Q
Name the organs of the respiratory system. (upper & lower)
A
The Upper Respiratory System
- Nose,
- nasal cavity,
- pharynx, and associated structures
Lower Respiratory System
- Larynx,
- Trachea,
- Bronchi, and
- lungs
2
Q
What are the conductive and respiratory zones?
Name the organs of each zone
A
Conducting Zone
- Series of interconnecting Cavities whose function is to filter, warm, and moisten air and conduct it into the lungs
- Nose, Nasal Cavity, Pharynx, Larynx ,Trachea, Bronchi, Bronchioles Terminal Bronchioles
Respiratory Zone
- Consists of tubes and tissues within the lungs where gas exchange occurs between the air and blood
- Respiratory Bronchioles, Alveolar Ducts, Alveolar Sacs, Alveoli
3
Q
What are the bones forming the bony framework of the nose?
Name the cartilages of the nose?
What are the bones forming the nasal septum?
A
- The bony framework of the nose is formed by the frontal bone, nasal bones, and maxilla
- The cartilaginous framework consists of:
- septal cartilage
- lateral nasal cartilages
- alar cartilages
- Septum made up of cartilage and bones: vomer, ethmoid, maxilla, palatine
4
Q
Define external nares and internal nares (Choanae).
A
- External Nares – Nostrils that open into the nose
- Internal Nares – Posterior opening of the nasal cavity, communication with the Pharynx
5
Q
Name the paranasal sinuses.
What are the locations and functions of paranasal sinuses?
A
Paranasal sinuses are found in ethmoid, sphenoid, frontal & maxillary
Function is to lighten skull & resonate voice - they are also produce and are lined with mucus that is continuous with the mucus of the nasal cavity
6
Q
What are the functions of nasal cavity?
A
- Warming, moistening, filtering
- Detect olfactory Stimuli
- Speech vibration, Resonance
7
Q
Define conchae and meatuses. What are their functions?
A
Conchae - bony swellings
Meatuses - gaps between them
Increase surface area and prevents dehydration (keep air moist and warm)
8
Q
What are the functions performed by the pharynx?
A
Passageway for food, water, air
9
Q
What are the anatomic extensions of pharynx?
A
Nasopharynx - from choanae to soft palate
Oropharynx - from soft palate to Hyoid Bone
Laryngopharynx - from Hyoid to Cricoid cartilage of Larynx
10
Q
What are the three regions of pharynx? What are the structures and openings related to each region?
A
Nasopharynx -
- Two choanae (internal nares) to soft palate
- Two openings of auditory (Eustachian) tubes) from middle ear that equalizes air pressure
- Opening into the oropharynx
- Posterior wall contains adenoids (aka pharyngeal tonsil)
- Passageway for air only
Oropharynx
- Extends from soft palate to the level of the Hyoid bone
- Fauces is the opening from mouth into oropharynx
- Palatine tonsils found in the side walls, lingual tonsil in the tongue
- Common passageway for food and air
Laryngopharynx
- Begins at the level of the Hyoid bone down to the cricoid cartilage
- Inferior end opens into esophagus posteriorly and larynx anteriorly
- Common passageway for food and air
11
Q
Define larynx. What are the cartilages of the larynx? What are the locations of each cartilage?
A
Larynx aka Voice Box — Short passageway that connects the laryngopharynx with the trachea
9 Cartilages
- Epiglottis
- Thyroid Cartilage
- Cricoid Cartilage
Pairs:
- Arytenoid – most important because they influence changes in position and tension of the vocal folds (true vocal cords for speech)
- Cuneiform
- Corniculate Cartilages
12
Q
What is the function of epiglottis?
A
Leaf like cartilage - Prevents food from entering the Larynx
13
Q
What are the two pairs of vocal folds? What are the names of the spaces between each of them?
A
Ventricular folds or vestibular folds - Superior, aka false vocal cords
- It consists of vestibular ligament covered by mucous membrane
- Function in holding breath against pressure in thoracic cavity
- The space between the ventricular folds is called rima vestibuli
Vocal folds (true vocal cords) - Inferior, which produce sound.
- It consists of vocal ligament covered by mucous membrane
- The space between the vocal folds is called rima glottidis
14
Q
To which cartilage, the true vocal cords are attached?
A
True vocal cords attach to arytenoid cartilages
15
Q
What is the mechanism of voice production? What are the organs involved in speech production?
A
- Deep to the mucosa of vocal folds are bands of elastic ligaments (vocal ligament) stretched between the rigid cartilages of the larynx like the strings of a guitar.
- Intrinsic laryngeal muscles attach to both the rigid cartilages and the vocal folds
- When the laryngeal muscles contract, they move the cartilages which pulls the elastic ligaments tight, and this stretches the vocal folds out into the airways so that rima glottidis is narrowed
- Contraction and relaxation of muscles varies the tension in the vocal folds, much like loosening and tightening a guitar string.
- Air passing through the larynx vibrates the folds and produce sound.
16
Q
What is the difference between male and female vocal folds?
A
The longer & thicker vocal cord in male produces a lower pitch of sound – Androgens make vocal folds thicker and longer causing slower vibration and lower pitch in males.
17
Q
How the pitch of the sound is controlled? What are the other structures which modify the sound and how?
A
- The variation in the pitch of the sound is related to the tension in the vocal folds
- The tighter the folds, the higher is the pitch because the folds vibrate more rapidly.
- Relaxed vocal folds produce low pitches because the folds vibrate more slowly
- Other structures which modify the sound are – Pharynx, mouth, nasal cavity and paranasal sinuses – They all act as resonating chambers that give the voice its individual quality
- Vowel sounds are produced by the constriction and relaxation of muscles in the wall of the pharynx
- Muscles of the face, tongue and lips help enunciate words
18
Q
Which organs are involved during whispering?
A
Whispering is forcing air through almost closed rima glottidis – oral cavity alone forms speech
19
Q
How the trachea is made up of? What are the relations and extensions of trachea with vertebrae and esophagus?
A
Trachea - aka windpipe
16-20 C-shaped Cartilage Rings,
Smooth Muscle,
and pseudostratified ciliated columnar Epithelial Cells
The C-shaped rings allow for the esophogus to expand
20
Q
What is carina? Name the generations of divisions of bronchial tree.
A
The point where the trachea divides into right and left primary bronchi is a ridge called carina
- Right Left Main/Primary Bronchi,
- Secondary/Lobar bronchi,
- Tertiary/Segmental bronchi,
- Bronchioles,
- Terminal Bronchioles
21
Q
What is the difference in the structural component of bronchi and bronchioles?
A
Walls of bronchi contain rings of cartilage.
Walls of bronchioles contain smooth muscle
22
Q
Why aspiration is more likely in the right primary bronchus?
A
Right primary bronchus is more vertical, shorter, and wider than the left.
Aspirated object is more likely to enter in the right than the left primary bronchus
23
Q
What parts of the respiratory system are supplied by the primary, secondary, and tertiary bronchi?
A
- Primary bronchi supply each lung
- Secondary bronchi supply each lobe of the lungs (3 right + 2 left)
- Tertiary bronchi supply each bronchopulmonary segment
24
Q
Name the pleural membranes. What is the location and attachment of each layer?
A
Visceral Pleura - is the inner layer, covering the lungs themselves
Parietal Pleura - is the outer layer which is attached to the wall of the thoracic cavity
25
Define pleural cavity. What is its content and functions?
Pleural cavity is potential space between ribs & lungs - Protects & lubricating fluid secreted by the membranes.
26
What is pneumothorax?
Pneumothorax •
Pleural cavities are sealed cavities not open to the outside
Injuries to the chest wall that let **air** enter the **intrapleural space –** causes a pneumothorax
27
What are the anatomic extensions of the lungs?
What are the fissures and lobes in the two lungs? Define cardiac notch.
Base, an apex (cupula), a costal surface, and a mediastinal surface
**Right Lung (thicker, broader, shorter):** Lobes Superior, Middle, Inferior Horizontal Fissure, Oblique Fissure
**Left Lung (smaller**): Lobes Superior, Inferior Oblique Fissure only
Cardiac Notch - medial left lung where the heart sits
28
What are the parts of the lungs? What are the locations and relations of each part?
* The **apex** lies superior to the medial third of the clavicle
* The a**nterior, posterior and lateral** surfaces lie against the **ribs**
* The **base** extends from the sixth costal cartilage anteriorly to the spinous process of the 10th thoracic vertebra posteriorly
* The pleura extends about 5 cm below the base from the 6th costal cartilage anteriorly to the 12th ribs posteriorly.
* Surface of each lung has a hilum (Bronchi, Pulmonary blood vessels, Lymphatic vessels, Nerves) — These structures constitute the root of lungs
29
Define hilum of the lung. What are the structures passing through the hilum?
Indentation through which the following structures enter and exit being held together by pleura and connective tissue
* The bronchi
* Pulmonary blood vessels
* Lymphatic vessels
* Nerves
30
Define alveolus. What are the names and functions of the three cell types in alveoli? Name the layers of respiratory membranes.
An alveolus is a cup-shaped outpouching lined by simple squamous epithelium and supported by a thin elastic basement membrane
* Type I alveolar cells - simple squamous cells where gas exchange occurs
* Type II alveolar cells (septal cells) - free surface has microvilli Secrete alveolar fluid containing surfactant, keeps the alveolar cells moist
* Alveolar macrophages (dust cells) – Phagocytes that remove debris from alveolar spaces
31
What is the double blood supply to the lung?
Lungs receive blood supply from pulmonary arteries and bronchial arteries
* Deoxygenated from Pulmonary Arteries
* Oxygenated from the Aorta to the tissues
32
What is ventilation perfusion coupling?
A unique feature of pulmonary blood vessels is their constriction in response to low O2 levels thereby diverting pulmonary blood from poorly-ventilated areas of the lungs to well-ventilated regions.
aka: **When there is more air, more blood will go there**
33
What are the three basic steps of respiration? Define each step.
**Pulmonary ventilation** — (breathing) is the inhalation and exhalation of air between the atmosphere and the alveoli of the lungs
**External respiration —** exchange of gases between alveoli of the lungs and the blood in the pulmonary capillaries
**Internal respiration** — exchange of gases between blood in systemic capillaries & tissue cells
34
Describe the mechanism of breathing in relation to pressure changes in the intrapleural and alveolar spaces. Know the pressures of each area in different steps.
When alveolar (intropulmonic) pressure drops below atmospheric pressure (from 760 mm Hg to 758 mm Hg) air moves into the lungs.
Contraction of the diaphragm and external intercostal muscles increases the size of the thorax, thus decreasing the intrapleural (intrathoracic) pressure so that the lungs expand.
Expansion of the lungs decreases alveolar pressure so that air moves along the pressure gradient from the atmosphere into the lungs.
35
Which pressure is always negative and how does it help?
Intrapleural Pressures - Always ~ -4mmHg at rest
Helps keep parietal & visceral pleura stick together
36
What is the function of the surfactant? What are the cause and effects of its absence?
Surfactant lowers the surface tension of alveolar fluid, preventing the collapse of alveoli with each expiration (Produced by Type II Avelolar cells).
The surfactant is a mixture of phospholipids and lipoproteins
A deficiency of surfactant in premature babies causes respiratory distress syndrome, in which many alveoli collapse at the end of each exhalation
37
What are the muscles of inspiration and which one is most important? What are the accessory muscles of both inspiration and expiration?
Diaphragm and external intercostal muscles (Internal intercostal, expiration)
Accessory Muscles: Scalenes, Serratus Posterior Superior / Anterior, Latissimus dorsi, Pec Major/Minor, SCM
38
What muscle activity causes expiration? What are the two forces that contribute to the elastic recoil of the lungs during expiration?
Relaxation of the diaphragm and external intercostal muscles results in elastic recoil of the chest wall and lungs, which increases intrapleural pressure
Two forces contribute to the elastic recoil –
* recoil of elastic fibers that were stretched during inhalation
* inward pull of surface tension due to the film of alveolar fluid.
39
What is Anatomical dead space?
Anatomic dead space is the total volume of the conducting airways from the nose or mouth down to the level of the terminal bronchioles, and is about **150 ml on the average** in humans. (Not participating in the exchange of gases)
40
Define the following Lung volumes and capacities (TV, RV, VC, IRV, FEV1) and normal values of each.
**Tidal volume** (TV) = amount of air inhaled and exhaled during quiet breathing; **500ml**
**Residual volume (RV)** = the amount of air remaining in the lungs after forceful expiration; **1200 mL in males and 1100** ml in females
**Vital capacity (VC)**= the amount of air that can be forcefully exhaled after taking a forceful inspiration; sum of IRV, TV, and ERV; **4800 in males and 3100** in females
**Inspiratory reserve volume** (IRV)= amount of air you can breathe in forcibly above tidal volume; **3100 ml in males and 1900 ml** in females
**FEV1 -** Forced expiratory volume in one second. Normal FEV1 is 3.8 L in males, and 2.8 L in females. Typically, Asthma and COPD greatly reduces FEV1 because COPD increases airway resistance
41
What is spirometer?
The apparatus commonly used to measure the volume of air exchanged during breathing is called spirometer
42
What are the factors on which the gaseous exchanges depend? Explain each.
1. Partial pressure difference of gases; the rate of diffusion is faster when the pp difference is larger and vise versa
2. Surface area available for gas exchange; emphysema reduces the surface area thereby slowing the pulmonary gas exchange
3. Diffusion distance; pulmonary edema increases diffusion distance -- size of the respiratory membrane
4. Molecular weight and solubility of the gases; O2 has a lower molecular weight than CO2; solubility of CO2 is 24 times greater than that of O2; Taking both these factors into account, net outward CO2 diffusion occurs 20 times more rapidly than net O2 diffusion
43
In which forms oxygen is transported in the blood? Know the percentage in each form
* **Dissolved in Plasma** - 1.5% (Only dissolved portion can go to the tissue)
* **Oxyhemoglobin** (Carried by RBC) - 98.5%. (Reserve of oxygen)
44
What are the factors that affect the affinity of hemoglobin for oxygen? What are the effects of pH, temperature, pCO2 and type of hemoglobin on hemoglobin affinity for oxygen?
* PO2 (Partial Pressure of oxygen)
* pH - Right shift, a decrease in pH lowers the affinity, more O2 released (PCO2 increases acidity, lowers affinity)
* Temperature - Higher heat, lower affinity, more O2 released
* BPG - BPG decreases affinity
* Type of Hb - Fetal has a higher affinity because its structure binds BPG less strongly. BPG decreases affinity
45
What is Bohr effect?
As blood flows from the lungs toward the tissues, the increasing acidity (pH decreases) shifts the O2–Hb saturation curve “to the right”, enhancing unloading of O2 (which is just what we want to happen). This is called the Bohr effect.
46
How does carbon monoxide cause poisoning and what is its affinity to hemoglobin as compared to oxygen and carbon dioxide?
Strong attraction of carbon monoxide (CO) to hemoglobin, even small concentrations of CO will reduce the oxygen carrying capacity leading to hypoxia and carbon monoxide poisoning. It is treated by administering pure O2.
200x the affinity
47
In which forms carbon dioxide is transported in the blood? Know the percentage in each form.
* Dissolved CO2 in plasma (7%)
* Combined with the globin part of Hb molecule forming carbaminohemoglobin (23%)
* Bicarbonate ions (70%).
48
Name the respiratory centers with locations.
3 groups of neurons –
* medullary rhythmicity area - medulla oblongota
* pneumotaxic area - Pons
* apneustic area - Pons
49
What are the neurons and groups of the Medullary Rhythmicity area?
Medullary (Rythmicity Area) - basic rhythm of respiration
* **Dorsal Respiratory Group** - DRG, impulses to the diaphram via the Phrnic nerve and Intercostal Nerves
* **Ventral Respiratory Group VRG** - Rhythm generator similar to, and likely communicating with pacemaker cells, activated in forceful breathing sending signals to accessory muscles
50
What are the neurons and groups of Pontine area
* (PRG) Pneumotaxic, Apneustic - Modifies the rhythm by VRG for excercising, sleeping, speaking etc
* The pneumotaxic area and the apneustic area in the pons help coordinate the transition between inspiration and expiration.
* Apneustic area - sends stimulatory impulses to the inspiratory area that activate it and prolong inspiration, inhibiting expiration. This results in a long, deep inhalation
51
How do the cortical influences control the respiratory center?
Voluntary influence - allow the concious control of repsiration that may be needed to avoid inhaling noxious gases or water
52
What are the two groups of chemoreceptors? How does each group control the respiratory center? What are the nerves involved?
* Sensors - Central and Periphereal
* **Central Chemoreceptors** - medulla oblongata, central nervous system, respond to changes in H+ concentration (or PCO2) in cerebrospinal fluid
* **Peripheral Chemoreceptors** - aortic bodies and carotid bodies, sense changes in PO2, H+, and PCO2 in Blood, Aorta - Vagus Nerve, Carotid - Glossopharyngeal nerve
53
What is the effect of increased pCO2 (increase H+) and decreased pCO2 on respiratory rate?
* An increase in pCO2 (**hypercapnia**) will stimulate the DRG - increase the respiratory rate (hyperventilation, rapid and deep breathing, occurs. This allows the inhalation of more O2 and exhalation of more CO2, until pCO2 and H+ are lowered to normal.)
* Decrease in PCO2 (**hypocapnia**) will decrease the respiratory rate until CO2 accumulates
54
How the proprioceptors of joints and muscles influence the respiratory rate?
Monitor movement of joints, nerve impulses stimulate DRC and increases breathing
55
What is Hering-Breuer reflex? What is its function?
The inflation (Hering-Breuer) reflex detects lung expansion with stretch receptors and limits it depending on ventilatory need and prevention of damage. (Breathing then resumes back to normal)
56
What are the other influences on the respiratory rate?
blood pressure, temperature, pain, stretching the anal sphincter, and irritation to the respiratory mucosa.
57
Define hypoxia. What are its types? What are the causes of each?
Hypoxia refers to oxygen deficiency at the tissue level and is classified in several ways
**Hypoxic hypoxia** - low PO2 in arterial blood (high altitude, airway obstruction, fluid in lungs).
**Anemic hypoxia,-** too little functioning hemoglobin in the blood (hemorrhage, anemia, carbon monoxide poisoning). –
**Stagnant hypoxia -**inability of blood to carry oxygen to tissues fast enough to sustain their needs (heart failure, circulatory shock).
**Histotoxic hypoxia-** blood delivers adequate oxygen to the tissues, but the tissues are unable to use it properly (cyanide poisoning).
58
What are the organs and functions of the lymphatic system?
**Organs:**
Thymus, Spleen, Lymph (Vessels, Notes, Fluid), Red Bone Marrow (And more)
**Functions:**
* Drain excess interstitial fluid from tissue spaces and return to the blood
* Transport dietary lipids and lipid-soluble vitamins absorbed by GI tract
* Carry our immune responses against particular microbes or abnormal cells
59
What are the features of lymphatic vessels? What are the features of lymphatic capillaries?
**Lymphatic vessels -**
* Closed at one end, like veins but thinner with more valves
**Lymphatic Capillaries -**
* Allow lymph fluid to flow in but not out, slightly larger than blood capillaries, have anchoring filaments to stretch when fluid accumulates
60
What is chyle? Why its color is creamy-white?
Chyle is lymph with lipids that drains from the small intestines specialized capillaries called Lacteals; Lipids cause its color to be creamy-white
61
What are the five main lymph trunks and two main lymph channels?
**Trunks:**
* Lumbar,
* Intestinal,
* Broncomediastinal,
* Subclavian and
* Jugular
**Channels:**
* Thoracic Duct,
* Right Lymphatic Duct
62
How is thoracic duct formed? From which area and to which vessel does the thoracic duct drain lymph? From which area and to which vessel does the right lymphatic duct drain lymph?
The thoracic duct is formed beginning at the dilation called the Cisterna Chyli
**Thoracic duct**
* receives lymph from: left side of the head, neck, and chest, the left upper extremity, and the entire body below the ribs.
* It drains lymph into venous blood at the junction of the left internal jugular and left subclavian veins
**The right lymphatic duct**
* drains lymph from the upper right side of the body.
* It drains lymph into venous blood at the junction of the right internal jugular and right subclavian veins.
63
What are the primary lymphatic organs? What is their major function?
Primary Organs: **Red Bone Marrow and Thymus**
Sites where stem cells divide and become immunocompetent, capable of mounting an immune response
64
What is the location of the thymus? What are the component cells in outer cortex and inner medulla of the thymus?
The Thymus is located in the mediastinum between the sternum and the aorta
Component Cells of the **Outer Cortex and Inner Medulla:**
* Large number of T Cells
* Dendritic Cells
* Epithelial Cell
* Macrophages
65
Where and how self recognition and self tolerance of T cell happen?
In the Thymus is where the T Cells under go **self recognition (OC) and self tolerance (IM)** but only 2% survive
Immature T Cells migrate to Thymus, specialized epithelial cells educate for self-recognition through positive selection, specialized epithelial cells produce thymic hormones **(Positive and Negative Selection)**
66
What are the component parts of a lymph node? What are the functions of a lymph node?
Stroma - The Connective Parts
Parenchyma - Outer/Inner Cortex, Deep Medulla
Function as a filter Macrophages destroy foreign substances by phagocytosis Lymphocytes destroy foreign substances by immune responses
(double check this)
67
What are the component structures and cells in the outer cortex, inner cortex, and medulla of a lymph node?
* Outer Cortex - Groups of B cells called lymphatic nodules (follicles)
* Inner Cortex - T Cells and Dendritic Cells
* Inner Medulla - B cells, antibody-producing plasma cells from cortex, and macrophages
68
How the lymph flows through the lymph nodes?
Afferent Lymphatic Vessel -\> directs lymph inward Subcapsular Sinus -\> sinus / irregular channels Trabecular Sinus -\> Medullary Sinus -\> Efferent Lymphatic Vessel -\> Conveys lymph antibodies, and activated T cells out of the node
69
Where is the location of the spleen? What are the surface features of spleen?
Located in the left hypochondriac region between the stomach and the diaphragm Superior surface (Ribs) and Visceral surfaces with organs, gastric (stomach), renal (left kidney), and colic (left colic flexure of large intestine)
70
What are the component structures of white pulp and red pulp of spleen?
White pulp – lymphatic tissue consisting mostly of lymphocytes and macrophages around branches of the splenic artery called central arteries
71
What are the functions of red pulp?
Red Pulp - Blood filled venous sinuses, cords of splenic tissues called splenic cords (Or Billroth's Cords) Red blood cells, Macrophages, Lymphocytes, Plasma Cells and Granuloctes
1) Removal of RBC by macrophages (ruptured, worn out, defective)
2) Storage of platelets - up to 1/3 of body's supply
3) Production of blood cells during fetal life
72
What are the Peyer’s patches?
Large aggregations of lymphatic nodules in the ilieum of the small intestine
73
Define lymphatic nodule. What are the locations of lymphatic nodules?
Egg-shaped masses of lymphatic tissue not surrounded by a capsule (and therefore not an organ)
**Scattered throughout the body** in mucous membranes of GI tract, Urinary, Reproductive, and Respiratory. In these areas they are called Mucosa-Associated Lymphatic Tissue (MALT)
74
What are the locations of five tonsils on the pharyngeal walls?
Waldeyer’s tonsillar ring
1 Pharyngeal Tonsil (Adenoid) posterior wall of the nasopharynx
2 Palatine tonsils at the posterior region of the oral cavity
2 Lingual tonsils located at the base of the tongue
75
Define immunity. Classify immunity. What are the differences between them?
Immunity is classifed into Innate Immunity (Non-Specific) and Adaptive Immunity (Specific Immunity - Cell Mediated, Antibody Mediated)
76
What are the external (first line) physical and chemical components of innate immunity?
External (First Line) Mechanical:
* Epidermis of the skin
* Epithelial layer of mucous membranes
* Mucus, cilia and hairs of the nose
* Urine flow
* Vaginal secretions - Acidity of vaginal secretions
* Defecation and vomiting
Chemical:
* Lacrimal apparatus - Lysozymes of tears
* Flow of saliva - Lysozymes of Saliva
* Sebum of sebaceous glands
* Perspiration
* Gastric juice of the stomach (acidic)
77
What are the internal (second line) components of innate immunity?
Internal (Second Line)
* Antimicrobial proteins
* Interferons
* Complement Iron-binding proteins
* Antimicrobial proteins
* Phagocytes
* Natural killer cells
* Inflammation
* Fever
78
What are the component cells in the third line of body defense?
Specific Immune Response from B Cells and T Cells
79
Define Phagocytosis. What are the five steps of phagocytosis?
Phagocytosis is a non-specific process wherein neutrophils and macrophages (from monocytes) migrate to an infected area.
* **Chemotaxis** - chemically stimulated movement of phagocytes to site of damage
* **Adherence** - Attachment to the microb Ingestion - pseudopods engulf the microbe
* **Digestion** - enters cytoplasm and merges with lysosomes which break down
* **Killing** - digestive enzymes quickly kill
80
Define inflammation. What are the four characteristic signs of inflammation?
Inflammation is a nonspecific, defensive response of the body to tissue damage that results in:
* Redness
* Pain
* Heat
* Swelling
81
What are the three basic stages of inflammation?
1. **Vasodilation** and increased permeability of blood vessels
2. **Emigration** of phagocytes from the blood into intersitial fluid
3. **Tissue repair**
82
What are the events occurring in vasodilation and emigration stages of inflammation?
**Vasodilation** allows more blood to flow to the damaged area which helps remove toxins and debris Increased permeability means defensive proteins can enter injured area Histamine released - causes vasodilation/permeability
Local temp rises and increases reactions (heat) Edema results from increased permeability (swelling) Pain - kinins affect nerve endings, chemical reactions
**Emigration -** phagocytes arrive, neutrophils destroy invading microbes, die off quickly and then monocytes arrive (when the phagocytes die, they turn into pus)
83
What are the antimicrobial substances forming the second line of defense? What are the functions of interferons and the complement system?
* **Interferons** - Released by infected cells to induce synthesis of antiviral proteins to slow down replication
* **Complement System** - Enhances immune reaction causes cytolysis of microbes, promotes phagocytosis, contributes to inflammation
* **Iron-Binding Proteins** - inhibit the growth of certain bacteria by reducing avail iron
* **Anti-Microbial Proteins** - kill wide range of microbs, attract dendritic and mast cells
84
What is adaptive immunity? What are the two aspects by which adaptive immunity differs from innate immunity?
Adaptive immunity is the ability of the body to defend itself against SPECIFIC invading agents
1. SPECIFIC
2. MEMORY
85
Define antigen. Define epitope
**Antigens (Ags) –** antibody generators, are substances recognized as foreign that provoke immune responses.
**Epitopes –** Antigenic determinants, small parts of a large antigen molecule act as triggers for immune responses
86
Define antigen presenting cells. Give examples. What are their functions? To which cells each antigen presenting cells present the foreign antigens? Which one is most potent?
Antigen-presenting cell engulfs and destroys a foreign invader and isolates the antigens of those cells to "display" and present to helper T cells (CD4)
Examples:
* **Dendritic cells - Most potent**
* Macrophages
87
What are the functions of activated helper T cells?
Activated helper T cells aid in both types of immune responses and activate other lymphocytes to become:
* T cytotoxic cells (CD8 cells) which directly kill foreign invaders
* B cells (which make antibodies that kill or helps kill foreign invaders).
88
Which cells form the two arms of the adaptive immune response?
ACTIVATED T Cells and B Cells form the two arms of the adaptive immune response
89
Which cells are involved in **cell-mediated** immunity?
Helper T Cells (Effector and Memory)
**Activated Cytotoxic T Cells - primary - Directly attacks**
90
Which cells are involved in antibody-mediated immunity?
Helper T Cells
Activated B Cells
91
Define a clone of cells. What happens to the effector cells and memory cells of a clone after the initial immune response?
**Clone —** a population of identical cells, all recognizing the same antigen as the original cell.
After the initial immune response, effector cells die and memory cells live on to respond to a subsequent exposure
92
Define immunoglobulins. What are the five classes of immunoglobulins? Which class can cross the placenta? What are the features of each type?
* **IgG -** Most abundant, found in blood lymph and intestines, monomer, protects against bacteria and viruses by enhancing phagocytosis, neutralizing toxins and triggering complement system - **only class to cross placenta**
* **IgA -** 10-15%, Mainly in Sweat, Tears, Saliva, Mucus, Breat milk, GI - levels decrease during stress, lowering resistance, Provides localized protection of mucous membrains
* **IgE -** Less than .1%, located on mast cells and basophils, involved in allergic and hypersensitivity reactions, provides protection against parasitic worms
* **IgM -** ~5% of antibodies, It is the first antibody to appear in an immune response, causes agglutinization and lysis, Blood type antigen
* **IgD -** About .2% of all antibodies in blood, Mainly found on surfaces of B cells as antigen receptors
93
Define opsonization. What are the components which can cause opsonization?
Enhancing phagocytosis, Complement System, Antibodies
94
Define MHC molecules. What are the two classes of MHC? What are the locations and uses of each class?
Major Histocompatibility Complex Molecules - the proteins that are used as cell markers to flag self from non-self
* **Class I MHC** - in almost all body cells, present non-self proteins to Cytotoxic T Cells
* **Class II MHC -** only found on APC present to Helper T cells
95
Define active immunity and passive immunity.
**Active immunity** – the body’s response to make antibody after exposure to a pathogen (antigen) - LONG TERM
**Passive immunity** – the body simply receives antibodies that have been preformed - SHORT TERM
96
Give examples of natural active immunity, artificial active immunity, natural passive immunity and artificial passive immunity.
**Natural Active** – contracting hepatitis A and production of anti-hepatitis A antibodies
**Natural passive –** baby receives antibodies from its mother through the placenta and breast milk
**Artificial active –** a person receives a vaccine of an attenuated (changed/weakened) pathogen that stimulates the body to form an antibody
**Artificial passive** – injection of prepared antibody
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Define immunological memory. How does it help in the development of body immunity? What are the primary and secondary immune responses? What happens in each?
Thousands of memory cells exist after initial encounter with an antigen - this is called Immunological Memory.
**Primary immune response –** first exposure to antigen response is steady, slow – memory cells may remain for decades
**Secondary immune response** with 2nd exposure – 1000’s of memory cells proliferate & differentiate into plasma cells & cytotoxic T cells • antibody titer is measure of memory (amount serum antibody) – recognition & removal occurs so quickly not even sick
98
Which cells of the immune system can target and remove cancer cells from the body?
Cytotoxic T cells
Macrophages and
**Natural killer cells.**
99
What are positive and negative selections? Which cells undergo these processes?
T cells undergo both positive and negative selection to ensure that they can recognize self-MHC antigens (self-recognition) and that they do not react to other self-proteins (tolerance).
Negative selection involves both deletion and anergy.
100
How do T and B cells develop self-recognition and immunological tolerance?
T cells must learn to recognize self (its own MHC molecules ) & lack reactivity to own proteins – self-recognition & immunological tolerance
T cells mature in thymus – those can’t recognize self or react to it destroyed by programmed cell death (apoptosis or deletion) • inactivated (anergy) -- alive but unresponsive – only 1 in 100 emerges immunocompetent T cell • B cells similarly develop in bone marrow
101
What are the effects of aging on immune system?
* Increased susceptibility to infections and malignancies Increased production of autoantibodies
* Decreased response to vaccines
* Decreased immune system function
102
What are the effects of aging on T and B cells?
T cells become less responsive
Thymus atrophies as we age, decrease production of thymic hormones – which are needed for functioning of t lymphocytes B cells become less responsive, cannot produce enough antibody, response to antigen
103
What is the cause of assortment of infections in AIDS patient?
The HIV virus bonds to the Helper T Lymphocyte (CD4) and destroys them.
Over time, this reduces the body's immunity and opens up the body to more infections with no ability to fight them off.
104
What are the modes of transmission of HIV virus? How the virus can be killed at hospital and home settings?
blood, semen, vaginal, secretions, and breast milk
The virus can be killed by standard disinfecting, most effective Bleach, but also heat (135 degree) and cloth washing, hydrogen peroxide, rubbing alcohol, or germicidal cleanser such as betadine or hibiclens.
105
What isn't effective at killing the HIV virus (per the quiz)
hand sanitizer - however, the book includes Alcohol as an option, assumption here is that it needs a specific %
106
What are the ways by which transmission of HIV infection can be blocked?
Abstinence and/or condoms
Don't share needles, use only sterile hypodermic needles
Avoid pregnancy and especially breast feeding
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What are the type and structure of HIV virus? What are the three enzymes HIV has? Why is it called retrovirus?
HIV is a Retrovirus - Genetic information is carried by RNA not DNA. RNA genome transcribes/copies back into the DNA in the host cell
Structure: inner core of RNA covered by a protein coat (capsid), envelope composed of a lipid bilayer penetrated by glycoproteins
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Generally how a virus makes its copies?
Outside a living host cell the virus is unable to replicate – in the cell it uses the host cells enzymes and ribosomes to make thousands of copies of the virus
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What are the stages in the life cycle of HIV?
1. Attachment of HIV Virus to CD4 Receptors / bonding
2. Internalization and uncoating of the virus with viral RNA and reverse transcriptase
3. Reverse transcription, which produces a mirror image of the viral RNA and double stranded DNA molecule
4. Integration of viral DNA into host DNA using the integrase enzyme
5. Transcription of the inserted viral DNA to produce viral messenger RNA
6. Translation of viral messenger RNA to create viral polyprotein
7. Cleavage of viral polyproteininto individual viral proteins that make up the new virus (using protease)
8. Assembly and release of the new virus from the host cell
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Why HIV can only attach CD4 T cells?
Gp120 glycoproteinon the HIV virus is specifically able to bond to the receptors on the Helper T Cell (CD4)
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How a HIV infected patient present early after contacting the infection? What are the responses of immune system to IV infection in a few weeks?
Soon after being infected, most people experience a brief flulike illness - common signs are fever, fatigue, rash, headache, joint pain, sore throat, and swollen lymph nodes (about 50% experience night sweats)
3-4 weeks after infection, plasma cells begin secreting antibodes, they are detectible in a blood test, but not able to destroy the HIV virus
112
How the progression of HIV infection to AIDS happen? What measures can help HIV positive patients in addition to drugs?
HIV progresses to AIDS after a period of 2-10 years when it has destroyed enough Helper T cells that they begin to experience immunodeficiency symptoms - the immune system collapse and they become susceptible to ""**opportunistic infections**"" because the immune system is no longer able to hold these diseases in check
113
What is the cause of hypersensitivity reactions in general? Define an allergen.
Overly reactive to a substance that is tolerated by most other peopls
**Antigen**s that induce an allergic reaction are called allergens
114
Name common allergens.
Common allergens:
* Food - milk, peanuts, shellfish, eggs
* Antibiotics - penicillian, tetracycline Vaccines - pertussis, typhoid
* Venoms - honeybee, wasp, snake
* Cosmetics
* Chemicals in plants - poison ivy, pollens, dust, molds, iodine containing dyes
* Even Microbes
115
What are the four types of hypersensitive reactions? Which is most common?
* Type 1: Anaphalactic
* Type II: Cytotoxic
* Type III: Immune-Complex
* Type IV: Cell-Mediated
The first three are antibody mediated, only Type IV is cell-mediated Type I Anaphalactic are most common
116
What is the mechanism of type 1 hypersensitivity? What are the cells and chemicals involved in it? Give examples of type 1 hypersensitivity disorders.
IgE antibodies, Mast Cells, Basophils
In response to the first exposure, B lymphocytes are activated and plasma cells produce antibodies to a antigen/allergen, when they are re-exposed to the allergen there are antibodies present and mast cells and basophils release histomine, prostaglandins, leukotrienes, and kinins.
They cause vasodilation - resulting in inflammatory responses, difficulty breathing
Diseases caused by Type I Reactions **Asthma**, Eczema/Atopic Dermatitis, Allergic Rhinitis/Hay Fever, Anaphylactic Shock – widespread vasodilation, BP low
117
What is the mechanism of type I1 hypersensitivity? What are the cells and chemicals involved in it? Give examples of type 1 hypersensitivity disorders.
**Cytotoxic** reactions are caused by antibodies (IgG or IgM) directed against a person’s blood cells or tissue cells
Mediated by **IgG or IgM** which forms antigen-antibody complexes on cell membrane or basement membrane -\> complexes activates complement lysis of the cells
Diseases
* **Hemolytic anemia** – against RBC Goodpasture’s syndrome – lung, kidney cell – antibodies directed at the basement membrane – bleeding
* **Graves’ disease –** causes hyperthyroidism, produces too much T3, T4 hormone
* **Myasthenia gravis** – joint – muscle fatigue, ACH receptors is decreased, cannot produce enough to contract
118
What is the mechanism of type II1 hypersensitivity? What are the cells and chemicals involved in it? Give examples of type 1 hypersensitivity disorders.
Immune-Complex reactions involve antigens (not part of a host tissue cell) antibodies (IgA or IgM) and complement
Formed in the circulation, precipitated in some organs
Mediated by circulating immune complexes (precipitate) between antigens and appropriate antibodies -\> activate complement -\> Attraction of PMNs -\> Acute inflammation
**Diseases**
* Systemic Lupus erythematosus
* Rheumatoid arthritis
* Poststreptococcal glomerulonephritis – strep throat - kidney and other organs
* Postarterisis Nodosa
119
What is the mechanism of type IV hypersensitivity? What are the cells and chemicals involved in it? Give examples of type 1 hypersensitivity disorders.
Cell-mediated, delayed type hypersensitivity reaction
No antibody (**T Lymphocytes**) Exposure to an allergen and occur when allergens are taken up by antigen=presenting cells to lymph nodes and present the allergen to T cells. Intracellular bacteria, such as the one that causes tuberculosis, trigger this type of cell mediated immune response
Macrophages transform into epithelioid cells -\> formation of giant cells by fusion of Epitheloid cells -\> formation of **granuloma**
**Diseases**
* Caseous necrosis (‘cheese like’ on the center of this giant granuloma)
* Tuberculosis – latent phase, contained by the granuloma, active when the body immunity is lower
* Sarcoidosis Contact Dermatitis
120
What are the causes of autoimmune diseases?
The immune system fails to display self-tolerance and attacks the person's own tissues
121
How self-tolerance can be broken in a susceptible person? What are the results of this?
The influence of unknown environmental triggers and certain genes that maek some people more susecptible, self-tolerance breaks down, leading to activation of self-reactive clones of T cells and B cells . These cells then generate cell-mediated or antibody-mediated immune responses against self-antigens
122
What are the possible mechanisms of different autoimmune diseases? Give examples of each.
**Production of autoantibodies** - antibodies that bind to and stimulate or block self antigens
* Autoantibodies that mimic thyroid stimulating hormone are present in Graves disesase and stimulate secretion of thyroid hormones - producing hypothyroidism
* Autoantibodies bind and block ACH receptors cause muscle weakness in Mysathenia Gravis
**Activation of Cytotoxic T Cells** that desctroy certain body cells
* Type 1 diabetes melltus - t cells attack the insulin-producing pancreatic beta cells - MS - T cells attack myelin sheats around axons of nerons
**Innapropriate activation of Helper T Cells** or excessive produciton of Gamma-interferon occur
123
What are the possible mechanisms of SLE pathogenesis? What are the organs usually affected?
Lupus - Cause is not known - a genetic predisposition to the disease and environmental factors (infections, antibiotics, ultraviolet light, stress, and hormones) may trigger it - Abnormalities in apoptosis, a type of programmed cell death in which aging or damaged cells are neatly disposed of as a part of normal growth or functioning - During an immune reaction to a foreign stimulus, such as bacteria, virus, or allergen, immune cells that would normally be deactivated due to their affinity for self-tissues can be abnormally activated in SLE Organs impacted: Skin (butterfly rash, ulcers, hair loss, Raynauds phenomenon - blue hands), Joint pain, arthritis, brain-CNS symptoms, Kidney - Lupus nephritis, Lymphnode & Spleen, Red blood cells - anemia
124
What is the Rima Vestibulli?
The space between the Ventricular Folds (false vocal cords)
125
What is the Rima Glottidis? When are they used?
The space between the true vocal cords.
When whispering, air is forced through almost closed.
126
Which vessel does the Thoracic Duct drain lymph?
The Junction of the Left Internal jugular and Left Subclavian Veins
Thoracic = LEFT side
127
What are the features of lymphatic capillaries?
Slightly larger diameter than blood caps
Unique one-way structure
Anchoring filaments pull openings wider when interstitial fluid accumulates
128
What are the functions of the lymphatic system?
1. Drain excess interstitial fluid from tissue spaces and return to the blood
2. Carry out our immune responses against particular microbes or abnormal cells
3. Transport dietary lipids and lipid soluable vitamins absorbed by GI tract.
129
Where to T cells mature and become immunocompetent?
Thymus
130
What is the location of the Thymus
Mediastinum
131
The lymph from the RIGHT foot empties into?
The Thoracic Duct
Everything BELOW the waste empties into the Thoracic Duct.
132
What are the primary Lymphatic organs?
Red Bone Marrow and Thymus
133
Which organ is a filter that removes foreign substances by phagocytosis and immune responses
Lymph Node
134
Which of the immune cells is the first responder in the early stages of emigration process of inflammation?
Neutrophil
135
What are the functions of the RED PULPS of the Spleen?
Remove worn out blood cells
Production of red bloods cells IN FETUSES
Storage of up to 1/3 of body's platelet supply
136
What is the location of the pharyngeal tonsils?
In the POSTERIOR wall of the NASOPharynx
Also referred to as ADENOID
137
Lymphatic follicles in the ileu of the small intestine are referred to as what?
Peyer's Patches
138
What is the order of steps in Phagocytosis?
Chemotaxis
Aherence
Ingestion
Digestion
Killing
CAIDK
C A - I Don't Know
139
What are the antimicrobial substances of the second line of body defense?
Iron-binding Proteins
Complement System
Interferons
140
Rheumatoid arthritis is an example of what type of a Hypersensitivity Reaction
Type III hypersensitivity reaction
141
Graves disease is an example of what type of hypersensitivity reaction?
Type II hypersensitivity reaction
142
What is the impact of effector T helper cells producuction of interferon gamma?
Activates the inflammatory response and macrophages
143
Which cell produces Antibodies?
Plasma Cells
144
What are the three types of APCs?
Macrophages
Dendritic Cells - MOST POTENT
B Cells
145
What are the other names for Helper T and Cytotoxic T cells?
Helper - CD4
Cytotoxic - CD8
146
What is the main collecting duct of the Thoracic Trunk and what drains into it?
**Cisterna Chyli**
- Left upper extermity and _entire body below the ribs_
- Drains INTO the venous blood at the junction of Left internal Jugular and Left Subclavian veins
147
What are the processes for T Cell maturation, which is postiive/negative, and which part of the Thymus does it occur?
**Self-Reconition:** Positive Selection, Cortex
**Self Tolerance**: Negative Selection, Junction b/t Cortex and Inner Medula
Reconize - positive, love
Tolerate - negative, meh
148
What % of T Cells survive their training
2%
149
What is the functional part of the Lymph node and what are its components?
**Parenchyma**
* _Outer Cortex_ - B Cells/Lymphatic Nodules
* _Inner Cortex -_ T cells, Dendritic Cells
* _Medulla_ - B cells, Plasma, Macrophages
150
Which organ is the largest mass of lymphatic tissue?
Spleen.
151
In what part of the spleen are the two "pulps" - what are they?
In the **Parenchyma**
* **White Pulp** - mostly lymphocytes and macrophages
* **Red Pulp** - Blood filled venous sinuses and splenic cords (bilroth's)
* RBC, Macrophages, Lymphocytls, Plasma, Granulocytes
152
What is the primary trait that distinguishes a Lymphatic nodule (follicle) from other lymphatic organs?
It is not surrounded by a capsule and exists in mucous membranes
153
What are the three types of immunity?
* First - External: Mechanical Barriers, Chemical Barriers
* Second - Internal: Phagocytosis, Inflammatory, NK
* Third - Specific: Cell Mediated, Antibody Mediated
First and Second are INNATE
Third is ADAPTIVE / ACQUIRED
154
What are the three types of cells involved in Phagocytosis?
Macrophage, Neutrophil, Dendritic Cell
Neutrophils are first to the party
155
What is the role of the **interleukins** secreted by Effector T Helper Cells?
Activate B lymphocytes and cytotoxic T lymphocytes
156
Where does clonal selection of lymphocytes occur?
in the SECONDARY lymphatic organs and tissues (swollen tonsils, lymph nodes etc)
157
What is the result of the activation of a complement cascade?
Membrane attack Complex (MAC) and lysis of the cell
158
Which antibody is the most abundant?
Where is it found?
Hint: It is also the only one able to cross the placenta
IgG, 80% of total antibodies
Found in blood, lymph, intestins and provides LONG term immunity.
159
What type of antibody is the Anti-A and Anti-B in the ABO blood group? Where is it found?
**IgM**
## Footnote
in the blood plasma (and lymph)
First to show up to the party in an immune response
160
Which type of antibody is impacted by stress, therefore lowering resistence to infection? Where is it found?
**IgA**
Sweat, tears, saliva, breast milk, gastro fluids - mucous membrains
161
Which type of antibody is the primary responder in allergic reactions? Where is it located?
**IgE**
Located on mast cells and basophils
162
Which antibody is involved in the ACTIVATION of B Cells and found on surfaces of B Cells as antigen receptors?
**IgD**
163
Which hypersensitivity reaction is the only one to be Cell-Mediated? What cells are involved?
Type IV - sometimes referred to as "Delayed"
T Cells (T Lymphocytes)
164
Tuberculosis, Sarcoidosis and Contact Dermatitis are examples of what type of hypersensitivity reaction?
Type IV - Cell Mediated/Delayed
165
Asthma is an example of what type of hypersensitivity reaction? What is the cause?
Type I - Anaphylactic
## Footnote
Widespread vasodilation due to inflammation resulting from the release of histamines (IgE - Mast / Basophils)
166
Systematic Lupus Erthematosus is an example of what type of hypersensitivity reaction?
Hint: Same as Rheumatoid Arthritis
Type III - Immune Complex
167
What type of hypersensitivity reaction causes Grave's Disease, Hemolytic Anemia, Goodpasture's Syndrom, and Myasthenia Gravis?
What is the result of this type of reaction?
Type II - **Cytotoxic** reactions
The reaction is directed specifically against an antigen on the cell (i.e. ABO blood type) or against the extracellular material such as the basement membrane and the result is cell lysis
168
What are the antibodies associated with the antibody-mediated hypersensitivity reactions:
Type I
Type II
Type III
Type I: IgE
Type II: IgG or IgM
Type III: IgA or IgM
The only antibody not seen in hyper sensitivity is IgD -
169
What is the end of the upper respiratory and star of the lower respiratory?
Pharynx is end of upper respiratory and Larynx starts lower respiratory
170
Which cartilage is the "Adam's Apple"
Thyroid Cartilage
171
