Respiration's First Defenses Flashcards

0
Q

When you have a cold and get “congested,” what does that actually mean?

A

The turbinates swell.

this tends to happen one side at a time - a mysterious process called the nasal cycle

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1
Q

Why do you need to be careful placing an NG tube in someone who’s had sinus surgery?

A

The remaining bone is thin… and you could put the tube through the back of a sinus and into the brain.

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2
Q

It’s important to warm and humidify air breathed in.

A

Yes.

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3
Q

Why is turbulence created by the turbinates good?

A

It encourages particulate matter to drop out in the mucus.

It makes it easier to smell, too.

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4
Q

Sniffing directs more air flow toward the olfactory bulbs.

A

That makes sense.

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6
Q

95% of pollen-sized particles are deposited in the anterior nasal cavity.
(but only 60% of 2 micron particles are trapped)

A

Useful.

smaller stuff gets deeper into lungs

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7
Q

Do we know what the paranasal sinuses are actually for?

A

Not really.

They might lighten the skull, add resonance to the voice, and/or provide a crumple zone…

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8
Q

2 layers of mucus?

Is the thickness variable?

A

Gel (mucus) and sol (aqueous).

The thickness of the mucus layer is variable, but the sol layer must be kept constant for cilia beating to work.

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9
Q

Does the cilia beat frequency vary?

A

It sure does. At the faster mucus is moving, the easier it is for it to move.

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10
Q

What’s interesting about the direction in which cilia beat?

Why is this important?

A

They know what direction to beat… in the sinuses, eg. this is toward the opening in a defined pattern.
Making a hole at the bottom of a sinus won’t help it drain. Rather, the existing hole should be enlarged.

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11
Q

Secretory IgA is important.

A

It protects against viruses and bacteria.

If deficient -> recurrent sinusitis.

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12
Q

What kind of defensins are secreted in the airway epithelia?

What do they do?

A

Beta defensins.

Direct antimicrobial activity by forming pores in bacteria.

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13
Q

How is lactoferrin microbicidal?

A

Inhibits microbial growth by sequestering iron.

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14
Q

Lysozyme is particularly good against what kind of bugs?

A

Gram-positive bacteria - as it breaks down peptidoglycan.

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15
Q

Do surfactants have antimicrobial activity?

A

Yes, the hydrophilic ones, SP-A and SP-D help pathogens get cleared.

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16
Q

Toll-like receptors… help bridge the innate -> adaptive response. Is this fast or slow compared to other aspects of innate immunity.

A

It’s slow.

17
Q

A patient has pseudomonas sinusitis, gets ABx, feels better for a while, and then relapses. The culture strain is still sensitive to the ABx. What’s likely going on here?

A

The pseudomonas likely formed a biofilm that is both difficult for ABx to penetrate, and contains bacteria that are less metabolically active, and thus less susceptible to ABx.

(when someone in the ICU has a fever, all the hardware is pulled out for fear of biofilms)

18
Q

What is quorum sensing?

What might this have to do with bitter taste receptors in the airway?

A

Quorum sensing - bacteria secrete molecules allowing them to determine how many of their pals are around, and if they should start making a biofilm.
Quorum sensing molecules may stimulate bitter taste receptors (perhaps most importantly, T2R38, stimulating increased ciliary motion (via Ca++ signaling).

19
Q

What effect does NO (nitrous oxide) have intraceullarly and extracellularly in the airway?

A

Intracellular: promotes cilia beating.
Extracellular: biocidal/biostatic.
(might be a downstream effect of bitter taste receptor T2R38 signaling)

20
Q

Does variance in T2R38 affect outcomes after sinus surgery?

A

Yeah… people with bitter-tasting phenotypes (PAV) seem to be better able to prevent biofilms from forming vs. non-tasting (AVI).

21
Q

Is irrigation with saline a good idea?

A

Probably.

22
Q

If treating with nasal steroids, what are some good tips?

A

Point the tip away from the septum.
Invert the head so that steroids get to the superior turbinates.
(it’s inflammation in the turbinates that you’re trying to reduce).