Week 210 - Asthma Flashcards
0
Q
What is Atopy?
A
A genetic predisposition towards the development of immediate hypersensitivity reactions against common ** environmental antigens**.
1
Q
How many people are affected by Asthma?
A
There are 300 million individuals of all ages, ethnic groups and countries that are affected by Asthma worldwide.
2
Q
What are the two general types of Asthma?
A
- Extrinsic (otherwise known as Atopic)
- Intrinsic (otherwise known as Non-atopic)
3
Q
Which sub-type of T-Helper cell is Pro- atopic - Th1 or Th2?
A
Th 2 - pro atopic; pro asthmatic.
Th 1 is non atopic.
4
Q
Are Eosinophils “acid loving” or “base loving”?
A
Eosinophils are “acid loving” white cells. They stain brick red with Eosin staining.
5
Q
What are the main inflammatory cells in the airway??
A
- Mast cells: These are the key cell of the innate immune system. They produce a variety of pre-formed and newly-formed inflamatory mediators.
- B lymphocytes: These produce antigen specific IgE (immunoglobulin E), in response to stimulation by interleukin-4 and interleukin-13 cytokines.
Of less importance….
- Dendritic cells - Antigen presenting cells.
- Epithelial cells - Secrete pro-inflammatory mediators (Thymic stromal lymphopoietin)
- Macrophages - Also express receptors which bind IgE and IgG
6
Q
Antigen specific IgE (immunoglobulin E) is produced by what?
A
B lymphocytes.
7
Q
What are the typical early phase clinical signs of Asthma?
A
Patient develops:
- wheeze
- cough
- SOB
- mucus production.
8
Q
What are the typical late stage signs of Asthma?
A
Patient presents with:
- Initial response, but later symptom recurrence.
- Chest tightness
- Worsening SOB
- Bronchodilators do not fully reverse the airway obstruction.
9
Q
What is the hygiene hypothesis?
A
It is hypothesized that exposure to certain microbes by early infection or from the environment may drive T cell production** towards the non atopic (Th 1)** phenotype, thereby reducing the occurence of Asthma.
10
Q
What is Sodium cromoglycate used for?
A
Sodium Cromoglycate is:
- A mast cell stabiliser
- Used in the treatment of Asthma (usually in children).
11
Q
Which drug should an Asthmatic taking Salbutamol not be taking, and why?
A
- What: Beta-Blockers (i.e. Atenolol)
- Why: Salbutamol is a Beta-Agonist. Beta-blockers are Beta-Antagonists. These drugs will be acting in opposition, rendering them both ineffective.
12
Q
What is Omalizumab used for?
A
- This is a recombinant DNA- derived humanised monoclonal antibody
- Specifically binds to free human IgE (immunoglobulin E)
- ** AKA: Anti IgE antibody that aids atopic (not non-atopic) asthmatics.**
13
Q
Why does Omalizumab not help obese asthmatics?
A
- IgE (immunoglobulin E) is an inflammatory mediator released in atopic asthma.
- Omalizumab blocks production of IgE.
- Asthma caused by obesity does not trigger IgE release as part of an immune cascade.
- This monoclonal antibody anti-IgE treatment will therefore be ineffective.
14
Q
How does Omalizumab work?
A
- Binds to free Ige (Immunoglobulin E), decreasing the amount of cell bound IgE
- Decreases expression of receptors that have a high affinity for IgE (i.e. FceRI receptors)
- Decreases the amount of inflammatory mediators released by cells such as mast cells, Basophils, or Eosinophils.
- These collectively decrease allergic inflammation, and prevent exacerbation of asthma.
15
Q
What is Mepoluzimab?
A
Mepoluzimab is a…
- Humanised monoclonal antibody
- Recognises IL 5 (Interleukin 5 - this is a cytokine of the innate immune response).
- Reduces Eosinophil production and proliferation.
16
Q
For which respiratory conditions are leukotrine receptor antagonists used in treatment?
A
Leukotrine antagonists are Helpful in:
- Cold air induced asthma
- Exercise induced asthma
- Aspirin induced asthma
17
Q
How is** aspirin** thought to induce Asthma?
A
- A very complex question that is still being researched
- One theory suggests pharmacological effect on COX enzymes.
- Inhibition of COX enzymes inhibits synthesis of bronchodilatory prostaglandins
18
Q
What spirometry result is diagnostic of COPD?
A
- Ratio of FEV (Forced expiratory volume)/FVC (forced vital capaciity) = less than 0.7
- This question is covered in MI WEEK in my year 2 library.
19
Q
In which age group do most asthmatics first present to the GP?
A
0-4 years (67.7%).
20
Q
When taking a focussed history from a patient you suspect to have asthma, what are the key points to cover?
A
- Exercise induced?
- Wheeze?
- SOB (shortness of breath) and/or tight chest?
- Nocturnal cough
- “Tummy ache” (Paeds)
- History of URTIs (Upper Respiratory Tract infections)?
- Are there any nasal symptoms?
- Is this Atopic? (i.e., any eczema, hayfever, allergies, smoking history, Family history)
21
Q
What are the (important to remember) differential diagnosis for a presenting wheeze in a child under 1 year?
A
- Viral - Recurrent URTIs - Bronchiolitis - see slide for others (lecture 2 wednesday)
22
Q
What is the commonest Acute lower respiratory tract infection (LRTI) in infancy?
A
Bronchiolitis.
23
Q
What are the clinical signs of Bronchiolitis?
A
- Respiratory distress:
- Tachynopea
- Grunting
- Subcostal and Intercostal recession -
Also:
- Tracheal tug
- Nasal flaring
- Hyperinflation with palpable liver edge.
- Widespread fine crepitations throughout respiratory cycle.
- Hypoxia
- Fever in most (<38.5C)
24
What is Harrison Sulcus?
Harrison's sulcus is a **horizontal groove** along the **lower border of the thorax** corresponding to the costal insertion of the diaphragm; It is **usually caused by chronic asthma** or obstructive respiratory disease.
25
What is the **salute sign** in children with wheeze?
The allergic salute sign is the **upward rubbing of the nose** (often in children), in allergic rhinitis, asthma, or other conditions of the respiratory tract productive of nasal mucus.
26
What are the **side effects** of **steroids** used for the treatment of Asthma?
* **Infections** in and around the mouth (*Candida*)
* **Cushings** syndrome
* **Adrenal Suppression** (high dose exogenous steroids inhibit endogenous production)
* Reduced resistance to **chickenpox**
27
What is a "**PEEP sign**" in a child?
**P**ositive **E**nd **E**xpiratory **P**ressure.
* In a child, this may present as **constant crying** or an **O shaped mouth**, which keeps the airway open a little bit.
28
What is the **definition** of **Asthma**?
"Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role.
The chronic inflammation causes an associated increasein airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning.
These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment."
29
What is the estimated number of people **that die prematurely** each year as a result of **Asthma**?
It is estimated that around **250,000 people die** prematurely each year as a result of asthma.
30
What is the difference between **atopic** and **non-atopic** Asthma?
_Cause:_
* Atopic - **ID'able** inducing agent
* Non-Atopic - **No obvious cause**
_Who gets it:_
* Atopic - Majority in **children and young adults**
* Non-atopic - Often more persistent into **adulthood/later life**, often more severe
31
Which % of Asthma is related to atopy?
It is estimated that approximately **30-60%** of asthma is related to atopy.
32
Which **immunoglubulin** is usually elevated in patients with **atopic asthma**?
**IgE (Immunoglobulin E)**
33
Are **concordance rates** for atopic asthma higher in **monozygotic** twins, or **dizygotic** twins?
Concordance rates for atopic asthma are **higher in monozygotic twins** than dizygotic twins.
34
Name **three** Environmental **risk factors** for developing **Asthma**.
1. Smoking
2. Pollution
3. Occupation
35
Which **Cytokines** do T-Helper-1 cells produce?
* IFN Gamma
* **IL2 (Interleukin 2)**
* IL 10 (Interleukin 10)
* **TNF (Tumour necrosis factor) alpha/beta**
36
Which cytokines to **T-Helper-2 cells** help to produce?
* IL3
* IL4
* IL5
* IL6
* IL13
* GM-CSF
37
38
Week 210. According to epidemiological studies **list 2 environmental factors** that may increase your risk of developing **asthma **
• Childhood antibiotic use
• Childhood use of
paracetamol?
• Exposure allergen
• Sedentary life style
• Obesity
• Maternal smoking
• Pollution
39
Week 210
List **3 pathological features** of asthma that may be found at **post mortem**?
_Any of the following_
**• Inflammation: eosinophilic**
**• Mucus plugging**
• **Airway remodelling:– Airway wall thickening**:
50-300% (Bronchial smooth muscle hypertrophy
+ airway oedema)
– Mucus gland hyperplasia
– Loss of surface epithelium
– Sub-epithelial fibrosis
40
Week 210
List 2 **mediators**, released by **mast cells**, which cause
**bronchoconstriction** clinically.
* **Histamine**
* **Prostaglandin D2**
* Leukotrienes (D4, E4)
41
Week 210
**T-helper 2** lymphocytes release the cytokine **IL-5**
which promotes the differentiation of **which **inflammatory **cell type**?
**Eosinophils**
42
Week 210
In some individuals **Non Steroidal Anti-inflammatory**
Drugs (NSAIDS) may **worsen asthma**. Which **enzyme**
does this class of medication **inhibit**?
**Cycloxygenase (II) **
(Otherwise known as the COX 2 enzyme)
43
Week 210
Mr X is an **34 year old asthmatic** on inhaled **budesonide** (200mcg bd) and PRN **salbutamol**. He attends your surgery as he is **not sleeping** at night due to **cough and wheeze**.What **step** of the **asthma ladder** is he currently on?
**Step 2**: low dose inhaled steroid + PRN B2 agonist
44
Week 210
Mr X is an 34 year old asthmatic on inhaled budesonide (200mcg bd) and PRN salbutamol. He attends your surgery as he is not sleeping at night due to cough and wheeze. If you were **to increase his treatment** name a **class of drugs** that you would **add** to his therapy?
Try **LABA first** and if ineffective consider increasing Inhaled **CorticoSteroid** then **theophylline** or leukotriene receptor antagonist.
45
Week 210
You are the A&E SHO on call. Miss B is a **known
asthmatic**who presents with**cough and SOB**. On arrival the paramedics show you her ambulance card. Observations are as follows.**Pulse 120, RR 26, Sats 94% on air**. When you review her she has**marked expiratory wheeze**and is not able to talk full sentences.**_Grade her asthma severity_**.
**Severe**
46
Week 210
You are the A&E SHO on call. Miss B is a known
asthmatic who presents with cough and SOB. On arrival the paramedics show you her ambulance card.
Observations are as follows. Pulse 120, RR 26, Sats
94% on air. When you review her she has marked
expiratory wheeze and is not able to talk full sentences. **Name 3 meds you would consider starting her on. **
* **Salbutamol** 5mg nebulised
* **Ipratropium** bromide 500mcg nebulised
* **Prednisolone** 40mg od po
47
Week 210
You are the A&E SHO on call. Miss B is a known
asthmatic who presents with cough and SOB. On arrival the paramedics show you her ambulance card.
Observations are as follows. Pulse 120, RR 26, Sats
94% on air. When you review her she has marked
expiratory wheeze and is not able to talk full sentences.You do a blood gas. **what concernes you about this blood gas**?
Normal pCO2 with **worsening hypoxia**
48
Week 210
Mrs A is a 44 year old atopic asthmatic. She currently
taking symbicort tubohaler 400/12 (eformoterol +
budesonide 400). She is also taking uniphyllin
(theophylline). **What step of the Asthma ladder is she on?**
**Step 4:** on high dose inhaled steroids, LABA and
theophylline
49
Week 210
What enzyme do **theophylline** tablets **inhibit**?
**Phosphodiesterase**: inhibiting the breakdown of **cAMP.**
50
Week 210
State the side effects you are most likely to see in a
patient taking a **beclometasone** inhaler?
* Sore throat
* Candidiasis
* Hoarse voice
51
Week 210
For approximately **how long** would you expect to see
the **bronchodilatation** effects of **salmeterol**?
12 hours
52
Week 210
Which of the **inflammatory mediators** does
**montelukast block** from reaching its receptor?
**Leukotriene**
53
Week 210
Name a **drug or condition** which can **increase the half life of theophylline**? And what **symptoms** could this cause?
**_Conditions:_**
* Hepatic cirrhosis
* CHF
* Acute pulmonary oedema
**_Drugs: _**
* Erythromycin
* Fluconazole
* Other drugs also inhibit metabolism of theophylline – check Appendix 1 of BNF for details
**_Side Effects_**
* N&V
* arrhythmias
* restlessness
* convulsions
* coma
54
Week 210
Mary has come to her GP and described **worsening
asthma**symptoms,**what would you discuss** before
making changes to her drug treatment?
Possible **triggers** for worsening symptoms
**Inhaler technique** and compliance.
55
Week 210
Jack, aged 31 years is using a **Seretide** 125 evohaler
(fluticasone and salmeterol) regularly and a **salbutamol** inhaler when required. His asthma has been well controlled for many years, with him **rarely using his salbutamol inhaler and he has come for a review of his treatment**. You decide that stepping down his treatment would be appropriate. **Which of his drugs should be discontinued**?
**Salmeterol**- But patient should remain on fluticasone and when required salbutamol so no reduction in dose count.
56
Week 210
Bronchiolitis only affects children over 2 years of age. True or false?
FALSE
57
Week 210
"Haemoptysis is a common symptom of childhood
asthma." True or false?
False
58
Week 210
"Congenital lung abnormalities can present as old as 5
years age". True or False?
True.
59
Week 210
"Toddlers are the commonest age group for inhaled
foreign bodies ". True or false?
True
60
Week 210
"Nocturnal cough is a sign of asthma". True or False?
True.
61
Week 210
"A child who is not wheezing by 3 years of age will not
develop asthma. " True or False?
False
62
Week 210
"Cross country running is usually more of a problem
than football for children with asthma." True or False?
True
63
Week 210
"A high organic content or insufficient chlorine in a
swimming pool can trigger asthma " True or False?
True
64
Week 210
"Swimming is well tolerated in most children with
asthma" True or False?
True
65
Week 210
"Warming up before exercise can have a ‘protective
effect’ for children with asthma " True or False?
True
66
Week 210
"Professional athletes do not have asthma " True or False?
False.
67
Week 210
"10-12 puffs of salbutamol via a spacer is usually as
effective as the appropriate dose via a nebulizer in
acute asthma in children" True or False?
True
68
Week 210
"Oral steroids are not given in acute asthma preteenage years due to their effect on growth"
True or False?
False
69
Week 210
"Teachers have a legal requirement to give children
their medication in school "
True or False?
False
70
Week 210
"Stress/emotion is not a trigger in primary school
children" True or False?
False
71
Week 210
"Toddlers with a tight chest may complain of ‘tummy
ache’ " True or False?
True
72
Week 210
**True or False?**
A) Washing and air drying a spacer in ‘fairy’ washing
up liquid significantly reduces its static
B) An MDI and spacer is the first choice for inhaled
treatment in children under 5 years
C) A dry powder inhaler is first choice for inhaled
steroid treatment in children aged 6 – 12 years
D) Children 3 years and over are able to give reliable
PEFRs
E) An MDI directly into the mouth should be used for
bronchodilators in Teenagers
F) PEFRs in children are charted against their height
A TRUE
B TRUE
C FALSE
D FALSE
E FALSE
F TRUE
73
WEEK 210
Name some of the differences between **Immunological** and **Non-Immunological** Occupational Asthma.
* Onset - Immunuologcal may have lag, NI may be within minutes or hours of exposure.
* NI is usually irritant asthma or REACTIVE AIRWAY DYSFUNCTION SYNDROME (RADS)
* Immunological improves with time away from work.
74
Week 210
What are the **advantages and disadvantages** of treating Asthma with **inhaled** drugs?
_Advantages:_
* Large surface area
* Good blood flow
* Reduce systemic absorption
* Proteins not degraded by acid
_Disadvantages_
* Small proportion of dose absorbed
* Technically difficult
* Mucus – reduces absorption
* Cough & local effects
75
Week 210
Name the drug class for each of the drugs listed.
1. Salbutamol
2. Beclametasone
3. Salmeterol
4. Montelukast
5. Theophylline
1. Beta-2 Agonists
2. Corticosteroids
3. Long acting Beta 2 agonists
4. Leukotrine receptor antagonists
5. Xanthines
76
*How* do Beta-2 agonists cause smooth muscle relaxation?
**Increases cAMP production to relax bronchial
smooth muscle.**
_ Also:_
• Inhibits release of inflammatory mediators
• Increase mucus clearance
77
Week 210
*How* do corticosteroids aid in the treatment of Asthma?
* Reduction in numbers of immune system cells e.g ***eosinophils, T-lymphocytes***
* Reduction in **inflammatory mediators**
* Reduced vascular permeability
78
Week 210
Describe the inflammatory effects of Mast Cells in as much detail as you can.
79
80
Week 210
Define **Asthma**.
A **chronic inflammatory disorder** of the airways,
characterised by airways **hyper-responsiveness**
with **airflow obstruction** that is **reversible** either
spontaneously or with treatment.
81
Week 210.
What does this slide of an airway **show**? Which **condition** is this associated with?
This slide is from a patient that suffered a **fatal Asthma attack**. Note the **inflammatory plug that is blocking the airway**. There is bronchial wall inflammation, and a denuded epithelium. There is also bronchoconstriction.
The disease is, of course, **Asthma**.
82
Week 210.
What is **Churg-Strauss syndrome**?
Churg–Strauss syndrome (CSS, also known as** eosinophilic granulomatosis with polyangiitis** [EGPA] or **allergic granulomatosis**) is an **autoimmune** condition that causes inflammation of small and medium-sized blood vessels (**vasculitis**) in persons **with a history** of airway allergic hypersensitivity (**atopy**).
83
Week 210
What is **Hyperventilation Syndrome**? How might it present?
Hyperventilation syndrome (HVS); also chronic hyperventilation syndrome (CHVS) and dysfunctional breathing hyperventilation syndrome is a **respiratory disorder**, **psychologically or physiologically based**, involving **breathing too deeply or too rapidly** (hyperventilation). HVS **_may present withchest pain and a tingling sensation in the fingertips and around the mouth (paresthesia) and may accompany a panic attack_**.
84
Week 210
How would **Bronchiectasis** present?
The classic clinical manifestations of bronchiectasis are **cough and daily mucopurulent sputum production**, often lasting **months to years**. Blood-streaked sputum or **hemoptysis** may result from airway damage associated with acute infection. Less specific symptoms include dyspnea, pleuritic chest pain, wheezing, fever, weakness, and weight loss.
85
Week 210
What is **Allergic bronchopulmonary aspergillosis**, and how does it typically **present**?
Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterised by an **exaggerated response of the immune system** (ahypersensitivity response) to the fungus **Aspergillus** (most commonly Aspergillus fumigatus). It occurs most often in patients with **asthma or cystic fibrosis**.
**_Presentation clues:_**
* Predisposing lung disease—most commonly **asthma** or** cystic fibrosis**
* symptoms of recurrent infection such as fever
* **Do not** respond to conventional antibiotic therapy.
* Poorly-controlled asthma
* Wheezing and hemoptysis
86
Week 210
What is the (basic) **difference between Extrinsic and Intrinsic** Asthma?
**Extrinsic Asthma is IgE mediated** (It's an immune response).
**Intrinsic Asthma is non-immune** i.e an infection, cold, stress or excersie induced Asthma.
87
Week 210
What is **Urticaria**?
This is a raised, itchy rash on the skin.
88
Week 210
What is **PEF/FEV1 **ratio in **Intermittent** (step 1) Asthma?
\>80% Predicted.
89
Week 210
What is the **PEF/FEV1 **ratio in **STEP 2** (Mild Persistent) Asthma?
\>80% Predicted, with a **variability of 20-30%**.
90
Week 210
What is the **PEF/FEV1 **ratio in **Moderate persistent** Asthma (Step 3)?
Between 60 and 80% of the predicted value.
91
Week 210
What is the **PEF/FEV1 **ratio in **Severe Persistent** (Step 4) Asthma?
**\< 60%** of the predicted value, with 30% **Variability**.
92
Week 210
Which **Immunoglubulin** do **Omaluzimab/Xolair** work against?
These are **Anti-IgE**.
93
Which **immunoglobulin** does **Mepoluzimab** work against?
This is an **Anti-IL5**.
94
Week 210
Label these parts of the tongue.
* A - LINGUAL SEPTUM
* B - SUPERIOR LONGITUDINAL (INTRINSIC)
* C - TRANSVERSE AND VERTICAL (INTRINSIC)
* D - INFERIOR LONGITUDINAL (INTRINSIC)
* E - STYLOGLOSSUS (EXTRINSIC)
* F - HYOGLOSSUS (EXTRINSIC)
* G - GENIOGLOSSUS (EXTRINSIC)
95
Week 210
Name the Extrinsic muscles of the tongue.
* A - STYLOID PROCESS
* B - STYLOHYOID LIGAMENT
* C - STLOGLOSSUS
* D - HYOPGLOSSUS
* E - HYOID BONE
* F - GENIOGLOSSUS
96
Week 210
Label This image of the tongue.
* A - SUP. LONGITUDINAL
* B - APEX OR TIP OF TONGUE
* C - GENIOGLOSSUS
* D - MENTAL SPINE OF MANDIBLE
* E - GENIOHYOID
* F - MYLOHYOID
* G - DIGASTRIC
* H - HYOID BONE
97
WEEK 210
From which **cranial nerve** does the **lingual nerve** arise?
The Lingual nerve arises from the Third branch (V3) of the Trigeminal nerve.
98
Week 210
Label the sensory and motor nerves of the tongue.
* **A** - INTERNAL LARYNGEAL NERVE (CN X)
* **B -** GLOSSOPHARYNGEAL NERVE (CN IX)
* **C -** VALLATE PAPILLAE
* **D -** OVERLAPPING NERVE SUPPLY
* **E -** LINGUAL NERVE (CN V3), CHORDA TYMPANI (CN VII)
* **F -** ALL OTHER MUSCLES - HYPOGLOSSAL (CN XII)
* **G -** PALATOGLOSSUS (VAGUS NERVE CN X)
99
Week 210
Which nerve supplies the main muscles of **mastication** (Mylohyoid, anterior Digastric, tensor Tympani, tensor veli palatini)?
The 3rd Branch of the **Trigeminal Nerve (CN V3**)
100
Week 210
Which nerve supplies the main muscles of **facial expression** (post. Digastric, Stapedius, Stylohyoid)?
The Facial nerve (CN VII)
101
Week 210
Which nerve supplies the Stylopharyngeas muscle?
CN IX (Glossopharyngeal)
102
Week 210
Which nerve supplies the Pharyngeal constrictors, cricothyroid, levator veli and palatini muscles?
The superior branch of the Vagus nerve (CN X)
103
Week 210
Which nerve supplies the Intrinsic muscles of the Larynx?
The Recurrent laryngeal, and Vagus nerves.
104
Week 210
What does the **Otic Ganglion** innervate?
The **Parotid Gland** - for salivation.
105
Week 210
Where is the **Otic Ganglion** located?
Immediately below the Foramen ovale in the infratemporal fossa.
106
Week 210
Through which nerve do secretomotor fibres reach the parotid gland from the Otic Ganglion?
The Auriculotemporal nerve.
107
Week 210
Why does the tongue deviate after a **Hypoglossal nerve injury**?
Upon protrusion, the tongue will deviate TOWARD the side of the LMN lesion (i.e., same side). This is due to the **unopposed action of the genioglossus muscle on the normally innervated side of the tongue** (the genioglossus **pulls the tongue forward**). Remember, the genioglossus arises laterally in the tongue and inserts on the midline of the mandible.
108
Week 210
In which **gland** do most **salivary stones** form?
80% Form in the Submandibular Gland.
109
Week 210
In **which duct** are 85% of **Submandibular stones** found?
Wharton's Duct.
110
Week 210
Through **which duct** does the **Parotid Gland** secrete Saliva?
The **Stenson Duct**.
111
Week 210
Through **which duct** does the **Sublingual gland** secrete?
**Ducts of Rivinus**
112
Week 210
Secretions from the Parotid gland are rich in \_\_\_\_\_.
Amylase.
113
Week 210
Secretions from the Submandibular Gland are more ____ than those from other glands in the oral cavity.
Mucinous.
114
Week 210
Where does Stensons Duct appear?
Opens upon a small papilla opposite **upper 2nd
molar** tooth
115
Week 210
Which Cranial Nerve supplies the Parotid Gland?
Glossopharyngeal (IX)
116
Week 210
What supplies parasympathetic secretomotor innervation to the Submandibular Gland?
The Chorda Tympani of the **Facial Nerve** (CN VII)
117
Week 210
The "Presulcal" Region of the tongue is the ___ section.
Anterior.
118
Week 210
Label these Papillae regions.
1. Vallate papillae
2. Foliate papillae
3. Filiform papillae
4. Fungiform papillae
119
Week 210
What attaches the tongue to the floor of the mouth?
The Frenulum.
120
Week 210
All muscles of the tongue excluding the palatoglossus receive motor innervation from the \_\_\_\_\_\_\_\_\_nerve. The palatoglossus recieves innervation from the ____ nerve.
All muscles of the tongue excluding the palatoglossus receive motor innervation from the **hypoglossal nerve**.The Palatoglossus is a palatine muscle supplied by the **vagus nerve** (CN X).
121
Week 210
The special taste sense "Umami" drives our appetite for what?
Amino Acids. This is why Bacon tastes so good!
122
Week 210
What happens to **tongue deviation** after an **UMN** Lesion, and a **LMN** Lesion?
UMN - tongue deviates AWAY from the lesion (to the opposite side).
LMN - tongue deviates TOWARDS the lesion (To the same side).
123
