HCOM Wellness Exam 3

MCHAT scoring

low risk = 0-2

moderate risk = 3-7

high risk = 8-20

12 month milestones

independent steps

waving

clapping

looking for objects

feeding self

15 month milestones

stoop and step

stack and solve

spoon and self care

say words

say words

18 month milestones

runs well

seats self in small chair; gets onto adult chair unaided

removes garment

moves about house without adult 

points to self, understands “mine”

uses giant words (all gone, stop that)

24 months milestones

2-word sentences

50% intelligibility

parallel play

follow 2-step commands

walk down stairs with a rail, with both feet on each step

3 year milestones

balance on 1 foot for 3 seconds

rides tricycle

3 word sentences 

75% intelligibility 

draws 2 to 3 part person

knows own age

aortic stenosis

blood is ejected from the left ventricle through only a small fibrous opening of the aortic valve

mitral regurgitation

blood flows backward through the mitral valve into the left atrium during systole

aortic regurgitation

blood flows backward from the high-pressure aorta into the left ventricle

mitral stenosis

blood passes with difficulty through the stenosed mitral valve from the left atrium into the left ventricle

murmurs

associated with turbulent blood flow and are intensified with increased cardiac output

thenar muscles

opponens pollicis 

ABductor pollicis brevis 

flexor pollicis brevis

ADductor pollicis 

opponens pollicis attachment

proximal: flexor retinaculum and tubercles of scaphoid and trapezium

distal: lateral side of 1st metacarpal

opponens pollicis innervation

recurrent branch of median nerve

opponens pollicis action

to oppose thumb, it draws 1st metacarpal medially to center of palm and rotates it medially

abductor pollicis brevis attachment 

proximal: flexor retinaculum and tubercles of scaphoid and trapezium

distal: lateral side of base of proximal phalanx of thumb

abductor pollicis brevis innervation

recurrent branch of median nerve

abductor pollivis brevis action

ABducts thumb; helps oppose it

flexor pollicis brevis attachment

proximal: flexor retinaculum and tubercles of scaphoid and trapezium

distal: lateral side of base of proximal phalanx of thumb

flexor pollicis brevis innervation

recurrent branch of median nerve

flexor pollicis brevis action

flexes thumb

adductor pollicis attachment

proximal: bases of 2nd and 3rd metacarpals, capitate, adjacent carpals

distal: medial side of base of proximal phalanx of thumb

adductor pollicis innervation

deep branch of ulnar nerve

adductor pollicis actions

ADducts thumb toward lateral border of palm

hypothenar muscles

adbuctor digiti minimi

flexor digiti minimi brevis

opponens digiti minimi

lumbricals

dorsal interossei

palmar interossei

abductor digiti minimi attachment

proximal: pisiform

distal: medial side of base of proximal phalanx of 5th finger

abductor digiti minimi innervation

deep branch of ulnar nerve

abductor digiti minimi action

ABducts 5th finger

flexor digiti minimi brevis attachment

proximal: hook of hamate and flexor retinaculum

distal: medial border of 5th metacarpal

flexor digiti minimi brevis innervation

deep branch of ulnar nerve

flexor digiti minimi brevis action

flexes proximal phalanx of 5th finger

opponens digiti minimi attachment

proximal: hook of hamate and flexor retinaculum 

distal: medial border of 5th metacarpal

opponens digiti minimi innervation

deep branch of ulnar nerve

opponens digiti minimi action

draws 5th metacarpal anterior and rotates it, bringing 5th finger into opposition with thumb

lumbricals 1 and 2 attachment

proximal: lateral 2 tendons of flexor digitorum profundus

distal: lateral sides of extensor expansions of 2nd-5th finger

lumbricals 1 and 2 innervation

median nerve

lumbricals 1 and 2 action

flex metacarpophalangeal joints; extend interphalangeal joints of 2nd-5th fingers

lumbricals 3 and 4 attachment

proximal: medial 3 tendons of flexor digitorum profundus

distal: lateral sides of extensor expansions of 2nd-5th fingers

lumbricals 3 and 4 innervation

deep branch of ulnar nerve

lumbricals 3 and 4 action

flex metacorpophalangeal joints; extend interphalangeal joints of 2nd-5th fingers

dorsal interossei, 1-4 attachement

proximal: adjacent sides of 2 metacarpals

distal: bases of proximal phalanges; extensor expansions of 2nd-4th fingers

dorsal interossei, 1-4 innervation

deep branch of ulnar nerve

dorsal interossei, 1-4 action

ABduct 2nd-4th fingers from axial line; act with lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints

palmar interossei, 1-3 attachment

proximal: palmar surfaces of 2nd, 4th, and 5th metacarpals

distal: bases of proximal phalanges; extensor expansions of 2nd, 4th and 5th fingers

palmar interossei, 1-3 innervation

deep branch of ulnar nerve

palmar interossei, 1-3 action

ADduct 2nd, 4th, and 5th fingers toward axial line; assist lumbricals in flexing metacarpophalangeal joints and extending interphalangeal joints

effort-dependent

initial part of expiratory limb, controlled by strength of muscle effort

effort-independent

descending part of expiratory limb, controlled by airway mechanics 

forced vital capacity (FVC)

totally volume of air forcibly exhaled after full inspiration; end point of X-axis

timed forced expiratory volumes (FEVs)

volume of air exhaled within specific time interval from start of forced expiration; point on volume axis at certain time

maximal expiratory flow rate (FEF25-75%)

average flow rate during FVC during 25-75% of exhaled volume; slope of expiratory flow curve

conducting portion

nasal cavity

nasopharynx

oropharynx

larynx

trachea

bronchi

bronchioles 

terminal bronchioles

function of conducting portion

conditioning of air: warm, moisten, filter

respiratory portion

respiratory bronchioles

alveolar ducts and sacs

alveoli

function of respiratory portion 

gas exchange

type I pneumocytes

squamous, can’t divide, form tight junction

type II pneumocytes

cuboidal, progenitor cells, make surfactant

dust cells/alveolar macrophages

from blood monocytes, remove inhaled particulate matter via phagocytizing infectious organisms

fibroblasts/interalveolar septum

elastic and reticular fibers, tissue fluid can accumulate here

small bronchioles

lined with simple cuboidal epithelium

terminal bronnchioles

lined with simple cuboidal epithelium

club cells interspersed among ciliated cells

club cells increase as ciliated cells decrease along bronchiole length

club cells

found between brush cells and small granule cells in respiratory epithelium

contain surface-active agent

functions of club cells

secrete surface-active lipoprotein → prevents airway wall adhesion during expiration

produce club cell secretory protein (CC16)

cystic fibrosis transmembrane conductance regulator (CFTR)

pumps Cl- ions into mucus of respiratory system

airway surface liquid (ASL)

thin layer of fluid that covers luminal surface of airway

pleural pressure (Ppl)

pressure in pleural cavity; normally negative

alveolar pressure (PA)

pressure inside alveoli

atmospheric pressure (Patm)

baseline = 0 reference

airflow

movement of air depends on ΔP = Patm – PA

lung volume

tidal volume rises and falls with inspiration/expiration

compliance

ease with which something can stretch

fibrosis

restrictive disease, less compliant

emphysema

obstructive disease, more compliant

surface tension

measure of force acting to pull liquid’s surface molecules together at air-liquid interface

LaPlace’s Law

smaller bubble’s radius, greater pressure needed to keep it inflated

SP-A and SP-D

water soluble, innate immunity, feedback control of surfactant secretion

SP-B and SP-C

intrinsic membrane proteins

increase rate surfactant enters air-water interface and spreads

obstructive disease

trouble getting air out

restrictive disease

trouble getting air in

4 major factors that limit diffusion of gases

1) diffusion coefficient of gas - solubility of gas

2) partial pressure difference of gas = concentration of dissolved gas/solubility coefficient; total pressure = sum of partial pressures

3) thickness of membrane

4) surface area of membrane

rate of gas diffusion

(diffusion coefficient x partial pressure gradient x membrane surface area) / thickness of membrane 

hypoventilation

decrease in alveolar ventilation that increases arterial PCO2 because CO2 elimination decreases

hyperventiliation

increase in alveolar ventilation that decreases arterial PCO2; due to increase in respiratory frequency or increase in tidal volume

hypercapnia

abnormally elevated level of CO2 in arterial blood 

eupnea

normal breathing; ventilation is matched to metabolic demands

hypopnea

decreased ventilation that doesn’t match increased metabolic needs

hyperpnea

increased ventilation that matches increased metabolic needs

restrictive disease

decrease compliance, decrease FRV, increase elasticity

innate immunity

host’s first line of defense against infections

physical innate defense

intact skin, mucous membranes, mucociliary escalator, flushing actions (tears, saliva, sweat), coughing, sneezing

chemical innate defense

acidic pH, enzymes, antimicrobial peptides, bile salts in intestine, lactoferrin, complement proteins

microbiological innate defense

normal microbiota, production of antimicrobial substances, maintain local pH, stimulate immune defenses

phagocytes

neutrophils

monocytes

dendritic cells

neutrophils

nucleus with 3-5 lobes and small, numerous lilac colored granules

each lobe of nucleus connected by thin strand of material to other lobes

monocytes

largest of white blood cells

effective phagocytes

nucleus that lacks granules in cytoplasm

monocytes when in blood stream but migrate out into tissue to become macrophages

dendritic cells

sentinel residing in skin and mucous membranes

higher capacity to present microbial antigens to T cells

bridge between innate and adaptive 

granulocytes

eosinophils

basophils

mast cells

eosinophils

protect against helminths and protozoa and play role in allergic reactions

basophils

ability to absorb basic dye methylene blue

allergic reactions and responses that involve inflammation

chemotactic chemicals like histamine to help open gaps between cells in blood vessels 

mast cells

similar to basophils but leave blood and mostly found residing in tissues

associated with blood vessels and nerves or found close to surfaces that interface with external environment