module 3

Question 1

adrenal cortex and feedback

Answer 1

when the hypothalamus senses stress in any way (infection, emotional, trauma, hypoglycemia) it releases CRH which travels to the anterior pituitary which then releases ACTH adrenocorticotropic hormone. this hormone signals to the adrenal cortex to release cortisol. cortisol is involved in a negative feedback loop with the hypothalamus and the anterior pituitary.

Question 2

cortisol

Answer 2

increases plasma proteins, catabolism and muscle breakdown. it also increases free fatty acids, and blood glucose for energy to “fight or flight”. stimulates the sympathetic nervous system

also suppresses the immune and inflammatory systems by decreasing capillary permeability, decreasing accumulation of neutrophils and macrophages, decreasing cytokines and phagocytosis

Question 3

Cushing syndrome

Answer 3

excess cortisol in the body. leads to red cheeks, rounded face, buffalo hump, excess hair growth, think skin, stretch marks, thin arms and legs, poor wound healing and a loose hanging abdomen

Question 4

sympathetic vs autonomic

Answer 4

sympathetic: the neurotransmitter is norepinephrine. this is the arousing response in which alpa 1 receptors increase blood pressure, beta 1 receptors increase HR, and beta 2 receptors bronchodilate
parasympathetic: the neurotransmitter is acetylcholine. this is the calming response in which muscarinic receptors are on the heart, organs, sweat glands, and smooth muscle and the nicotinic receptors are on the skeletal muscle and the adrenal glands

Question 5

adrenergic

Answer 5

pupils dilate, HR BP and contractility increase, bronchioles dilate, liver releases glucose, gut decreases secretions, motility and digestion, bladder constricts the sphincter, muscles increase in strength and GU ejaculation occurs

Question 6

cholinergic

Answer 6

sweat glands increase water, pupils constrict, saliva and tears increase, HR BP and contractility decrease, bronchioles constrict, gut secretions and motility increase, bladder detrusor muscle tone increases and sphincter relaxes, GU orgasm and errection

Question 7

function of the bronchial smooth muscle

Answer 7

the tone of the smooth muscles surrounding the airways determine the airway radius. the presences or absence of airway secretions influences airway patency. bronchial smooth muscle is innervated by the autonomic nervous system: parasympathetic has vagal control which causes bronchoconstriction and sympathetic innervates beta 2 adrenergic receptors for bronchodilation

Question 8

type I allergic responses

Answer 8

1. first exposure: allergens activate the helper T cells which activate the B cells. the B cells then form IgE which binds to receptors on mast cells.
2. subsequential exposures: antigens or allergens bind to the IgE and create a crosslink which causes the mast cells to degranulate. when this happens, they release histamine. this causes the release of many pro-inflammatory substances such as mediators and cytokines

Question 9

antigen

Answer 9

a substance or molecule that the body recognizes as non-self. it triggers an immune response

Question 10

innate immunity

Answer 10

nonspecific immunity

1. the first line of defense: barriers are skin, mucous membranes, stomach acid, normal intestinal flora
2. the second line of defense: injured or compromised cells release chemokines such as prostaglandins, leukotrienes, kinins, and histamines. these initiate an inflammatory process which increases vascular permeability. neutrophils are the first to arrive at the scene and they phagocytose invaders but they die in the process. macrophages also phagocytize invaders, destroy them with lysosomes, and act as antigen-presenting cells that alert b cells and t cells to recognize the antigen as nonself. dendritic cells break up invader proteins and present a small amount of antigen to other immune cells

Question 11

adaptive immunity

Answer 11

B-cells: engulf antigens and present them on their surface. they are then activated by hylper t cells and differentiate into plasma cells that produce antibodies and memory cells. T-cells will also differential to for memory t cells and activated T cells. Monoclonal antibodies are lab made clones of antibodies that have specific targets.

Question 12

eosinophil

Answer 12

a type of red blood cell. an increase usually means there is a parasitic infection, an allergic reaction, or cancer. can be present in blood and in tissue at the site of inflammation

Question 13

MAST cells

Answer 13

immune cell made in bone marrow. it is found widely distributed where the body come into contact with the environment. contains chemicals such as histamone, heparin and cytokines. responsible for allergic reactions such as itching or flushing

Question 14

asthma

Answer 14

a chronic inflammatory disorder that causes edema of the airway, excessive mucous secresion with plugging, bronchospasm, and airway remodeling

Question 15

symptoms of asthma

Answer 15

wheezing, breathlessness, chest tightness, nighttime or early morning couching, tachypnea, use of accessory muscles, increased HR, and hyper resonant lung fields due to air trapping. *the presence of wheezing or coughing is not a dependable standard for evaluating severity of an attack

Question 16

causes of asthma

Answer 16

IgE mediated allergic respinse to triggers, it is associated with other atopic or allergic conditions. could also be genetic or environmental, or due to viral infection

Question 17

types of asthma

Answer 17

intermittent
mild: recurrent, reversible changes
moderate: recurrent reversible changes
severe: less reversible due to airway remodleing- chronic inflammation results in the process of fibrosis, enlargement of smooth muscle cells and enlargement of mucous glands
Status asthmatics: acute or severe attack that is not responsive to bronchodilators. can lead to respiratory failure
* need to reduce triggers and promote early and effective treatment

Question 18

acute asthma

Answer 18

administering medications by metered dose inhaler or nebulizer is most effective

1. rescue medications are for quick relief and they are short acting
2. maintenance medications are for prevention and long term control

Question 19

peak flow meter

Answer 19

80% of the patients best is a safe range.
50% -80% of the best means there needs to be an increase in controller meds
<50% of the patients best requires urgent intervention

Question 20

metered dose inhaler use

Answer 20

1. an inhaler must be primed if it has not been used in a while and before the first use. to do this spray the inhaler 3-4 times
2. next shake the inhaler for 10-15 seconds and breath out all the way
3. next hold the inhaler with the mouthpiece down and place it in your mouth forming a tight seal with your lips
4. slowly start to breathe in and press the inhaler down once but keep breathing in slowly
5. take the inhaler out and hold breath for 10 seconds
6. pucker lips and breathe out slowly
   7 if the dose is another puff of the same med wait 1 min then repeat. when done place the bap back on the mouthpiece and rinse mouth with water and spit. do not swallow

Question 21

combination of ICS and LABA

Answer 21

• fluticasone(ICS)/ salmeterol (LABA)
• budensonide(ICS) /formoterol (LABA)
  effects: improved lung function and quality of life with reduced dyspnea, exacerbations, and use of unhaler

Question 22

cystic fibrosis

Answer 22

is caused by chloride channel dysfunction that leads to mucus hypersecretion, airway inflammation, recurrent lung infections, gastrointestinal dysfunction, male infertility, and elevated sweat chloride levels.
a new CFTR modulator drug improves production, intracellular processing, and function of the defective CFTR protein in patients with a specific genetic mutation. this drug can cause abdominal pain. diarrhea, rash, increased ALT and ASTs (liver function tests)