Exam 1 - Respiratory packet Flashcards
Two examples of OTC decongestants?
Pseudoephedrine, phenylephrine
How do OTC decongestants work?
sympathomimetics that work by inducing vasoconstriction
What are OTC antihistamines used for?
to relieve allergy symptoms
Primary side effect of first generation antihistamines (Benadryl)?
drowsiness and dryness
General defense mechanisms of respiratory system? (3)
Warming, humidification, filtration
How is normal nasal resistance during inhalation a defense mechanism?
Allows more time for warming and humidification
What does warming and expansion of air inhaled through the nose act as a defense mechanism?
Allows for better air distribution
What type of epithelium is in the nasal vestibule?
Stratified keratinizing squamous epithelium
What bacteria is commonly found in the nasal vestibule?
Staph aureus, especially in neonates
Why is wide-spread inflammation of the mucosal surface of nasal vestibule a problem?
Can compromise immune function
Where does most of the mucus seen in a runny nose originate from?
Anterior-inferior surface of inferior turbinate
What does mild inflammation of anterior aspect of inferior turbinate lead to?
excess serous mucus and nasal dripping
What does inflammation that involves the nasal cavity lead to?
Excess gel mucus, less dripping
How do you determine allergic rhinitis from non-allergic rhinitis?
Allergic = more likely to involve eyes and ears, ITCHY. Non-allergic = less likely to involve eyes and ears, NOT ITCHY
Common symptoms of allergic rhinitis?
nasal congestion, sneezing, itchy/runny nose, itchy/watery eyes, stuffy ears
What causes post-nasal drip?
excess mucus cannot be evacuated through anterior nares
If mucus involved in post-nasal drip is aspirated into upper airways, what can happen?
Trigger asthma attacks or exacerbate cases of COPD
What do particles foreign to nasal mucosa initiate?
increased production and flow of nasal secretions, sneeze reflex
What do particles foreign to bronchi mucosa trigger?
increased production and flow of bronchial secretions, cough reflex
What 2 things do sneeze and cough reflexes require?
Enough air velocity for a forceful sneeze/cough, and the secretions are thin enough to be “cleared” by increased velocity
Deviation of which septum causes slight concern?
Cartilagenous
Deviation of which septum causes bigger concern?
boney
What does deviation of boney septum imply?
developmental anomalies involving turbinates and paranasal sinuses
What are nasal polyps most often associated with?
Chronic allergies
What are nasal polyps?
sac-like growths of inflamed mucosa that most often arise from tissue covering the nasal cavity
When would nasal polyps be seen during examination?
If they are located on very anterior portion of cavity
What type of epithelium lines the nasal cavity and turbinates?
pseudostratified ciliated columnar epithelium with goblet cells and mucous glands
What is the mucociliary escalator?
important defense mechanism - cilia “whip” in one direction, “grab” mucosal layer and any trapped particles and push it in the direction of the beat
What makes up the mucus layer of the nasal cavity?
viscous “gel” mucus from goblet cells
What makes up the serous layer of the nasal cavity?
serous mucus from mucous glands = “ciliary bath”
Why is Nitric oxide (NO) another important defense mechanism in respiratory system?
powerful anti-microbial agent
What happens to NO if mucosa around turbinates swells?
can impede movement of NO out of sinuses
How can you diminish the effectiveness of the muco-ciliary escalator? (7)
- dehydration of ciliary bath 2. over-hydration of ciliary bath 3. increased viscosity of mucus layer 4. sudden/severe temperature change 5. caffeine 6. anti-anxiety meds/tranquilizers 7. cigarettes/alcohol
What do OTC expectorants/mucolytic agents do to help muco-ciliary escalator?
may help with mucus production
What does pure mucus look like?
clear/white, translucent
What does mucopurulent sputum look like?
Not translucent
What does yellow or green sputum indicate?
large number of WBCs
What does red or brown sputum indicate?
presence of RBCs
What should you use for somato-sensory exams of CN I and V?
familiar, mildly aromatic substances such as coffee
What is hyposmia/anosmia?
inability to recognize the presence of an odor
What causes hyposmia/anosmia?
inflammatory swelling compresses the receptors and makes them dysfunctional
What is dysosmia/parosmia?
Can notice presence of odor but have trouble identifying it?
What causes dysosmia/parosmia?
damage to receptors and neuroepithelium
What do most olfactory problems originate from?
disorders of nasopharynx and/or paranasal sinuses that affect the receptors
What is phantosmia/olfactory hallucination?
reporting an odor when no odor is present
What does phantosmia imply?
Disorder of the olfactory cortex
Where is ciliated epithelium most abundant?
paranasal sinuses
What causes “sinus pressure”?
blocked drainage
How is mucus moved out of the nasal cavity?
ciliary action moves mucus to ostium -> infundibulum -> meatus of middle turbinate
How can soft tissue swelling around the ostia/infundibulum prevent adequate drainage?
cilia of two surfaces come together, this impedes ciliary function
Why does tissue in the posterior aspect of the nasal fossae “swell” from side to side in a cyclic manner?
To control air flow between the two sides of the fossa
Which area of the nasal cavity is most sinus drainage involved in?
Middle meatus
What can infections of the lacrimal gland, nasolacrimal sac, or nasolacrimal duct lead to?
discharge of pus from middle meatus
Acute vs chronic sinusitis: painful?
acute = more painful chronic = more uncomfortable than painful
Acute vs chronic sinusitis: discharge?
acute = thick yellow/green mucoid discharge, sometimes tinged with blood. Chronic = clear and thin (serous)
Acute vs chronic sinusitis: fever?
acute = likely chronic = usually none
Sinus exam procedure? (4)
- history 2. inspection of anterior nares 3. palapation of frontal and maxillary sinuses 4. transillumination of frontal and maxillary sinuses
Good independent predictors of sinusitis in adult pts? (5)
- maxillary toothache 2. purulent secretions 3. poor response to decongestants 4. abnormal transillumination 5. history of purulent discharge
Sinusitis red flags? (7)
- high fever 2. persistent fever 3. visual complaints 4. periorbital edema/erythema 5. changes in mental status 6. severe facial or dental pain 7. infraorbital hypesthesia/hypoesthesia
Is use of the nasal specific technique permitted in all jurisdictions?
No
What is choanal atresia?
congenital partial or total obstruction of choana by soft tissue and/or bone
Is the pharyngeal opening of the Eustachian tube normally open or closed?
Normally closed
Why must the pharyngeal opening of the Eustachian tube open?
To allow air into the middle ear cavity
What type of epithelium lines the middle ear cavity?
simple cuboidal epithelium that can resorb oxygen
What type of epithelium surrounds the pharyngeal opening of the Eustachian tube?
ciliated epithelium
What type of epithelium surounds the boney opening of the Eustachian tube?
ciliated epithelium
Why are the goblet cells and viscous mucus clinically important in the boney opening of the Eustachian tube?
Can form “mucus plug”
What does swelling of mucosa and tubal tonsils around the pharyngeal opening of the Eustachian tube lead to?
intermittent occlusion of the opening
When does the pharyngeal opening of the Eustachian tube open?
during talking, chewing, swallowing, etc
What does the opening of pharyngeal portion do?
Equilibrate pressure in middle ear with atmospheric pressure
What does pressure equilibration allow the tympanic membrane to do?
remain in neutral position
When is prolonged obstruction of the pharyngeal opening a concern?
In children
What does obstruction of the Eustachian tube cause?
negative pressure in the middle ear -> retraction of the tympanic membrane
What is mastoiditis?
inflammation of mastoid air cells
What is Libman’s test?
used to assess pt pain tolerance - examiner uses thumbs to apply increasing amts of pressure to mastoid processes
Why is bacterial infection of the middle ear a concern?
Can spread infection to other structures, potentially lethal complications
