Exam 1 Flashcards
Adrenocortical Dysfunction (Addison’s disease/Cushings disease)
Imbalance in adrenal hormones from adrenal cortex (e.g. cortisol, aldosterone)
- examples: Addison’s disease, (insufficiency), Cushing’s Syndrome (excess)
-Key signs: fatigue, hypotension (Addison’s), hypertension, weight gain (Cushing’s), hyperpigmentation/darkening of skin, deficient in androgens, dehydration, hyponatremia or hyperkalemia, nausea, vomiting, dizziness (standing up quickly)
-Treatment: hormone replacement or inhibition therapy
Case study ex: woman complains of persistent fatigue, unexplained weight loss, muscle weakness, frequent dizziness, especially when standing up quickly, darkening of her skin, around elbows and knuckles.
Burns
Tissue damage from heat, chemicals or radiation
-types: superficial (1st degree), partial thickness (2nd degree), full thickness (3rd degree)
-key signs: pain, blistering, eschar formation (dry, dark scab or dead tissue), risk of infection
-treatment: fluid resuscitation, wound care, pain management
Dehydration
Loss of body fluids exceeding intake
-key signs: dry mucous membranes, decreased urine output, hypotension (low blood pressure), tachycardia (abnormally fast heart rate, exceeding 100bpm)
-treatment: rehydration via oral or IV fluids
Fluid overload
Excess fluid in the body
-key signs: edema (swelling via excess fluid), crackles in the lungs, hypertension (high blood pressure), weight gain
-Treatment: diuretics (increase urine production), fluid restriction
Fractures
Break in the bone integrity
-key signs: pain, swelling, deformity, loss of function
-treatment: immobilization, reduction, surgical fixation
HIV/AIDS
Human immunodeficiency virus is a retrovirus that attacks and weakens the immune system by specifically targeting CD4+ T cells, which are crucial for immune response. HIV primarily spreads through blood, semen, vaginal fluids, and breast milk.
Hypercalcemia
High calcium levels
-key signs: bone pain, arrhythmias (abnormal heart rhythms)
Treatment: adjust calcium intake, medications
Hypocalcemia
Blood calcium levels less than 8.5 mg/dL
Medications, heparin and glucagon, can cause decreased blood calcium levels
-key signs: neuromuscular irritability
-treatment: adjust calcium intake, medications
Hyper/Hypokalemia
High/low potassium levels
-key signs: muscle weakness, arrhythmias (both conditions)
-treatment: potassium supplementation (hypo), diuretics/insulin (hyper)
Medication: calcium gluconate or calcium chloride.
Hypersensitivity
Overreaction of the immune system to antigens (which can be a harmless substance or pathogen)
-types: allergies (type I), autoimmune reactions
-key signs: rash, anaphylaxis
Treatment: antihistamines (block histamines, allergies), epinephrine (used to treat severe asthma, cardiac arrest, anaphylaxis)
Immunizations
Vaccines to stimulate immune protection
Key notes: prevent diseases like measles, flu, polio
Management: follow vaccination schedules
Inflammatory Bowel Disease (IBD)
Chronic inflammation of the GI tract (Crohn’s, UC)
Key signs: diarrhea, abdominal pain, weight loss
Treatment: anti-inflammatories, biologics
Intrapartum Care
Care during labor and delivery
Key elements: monitor fetal/maternal visits, manage pain, assist delivery
Leukemia
Cancer of the blood-forming tissues
Key signs: anemia (deficiency in number of RBCs, red blood cells), infections, bruising
Treatment; chemotherapy, stem cell transplant
Liver Diseases
Impaired liver function (cirrhosis, hepatitis)
Key signs: jaundice, ascites (abdominal swelling, fluid buildup), fatigue.
Treatment: lifestyle changes, antivirals, liver transplant
Lymphomas
Cancer of the lymphatic system (part of the body’s immune system; vital for fluid balance)
-Lymph nodes contain B cells, T cells, and macrophages.
Key signs: swollen lymph nodes, fever, night sweats
Treatment: chemotherapy, radiation
Metabolic Acidosis
Excess acid or loss of bicarbonate (HCO3),regulated by the kidneys.
-bicarbonate normal range: 22-26
Key signs: diarrhea, renal failure (too much urine retained), Diabetic KetoAcidosis (DKA),
THINK: Base out the Butt, acidosis!!!
Metabolic Alkalosis
Excess bicarbonate (HCO3) or loss of acid
Key signs: vomiting, NGT suction
Neuromuscular Disorders
Disorders affecting nerve-muscle communication (MS, ALS)
Key signs: weakness, spasticity, coordination loss
Treatment: medications, supportive care
Osteoporosis
Brittle bone disease; loss of bone mass/Bone weakening due to increased density
Factors contributing: loss of estrogen, aging, inadequate calcium and vitamin D intake, cigarette smoking, excessive alcohol, sedentary lifestyle, hormone fluctuations
Manifestations: “silent disease” = asymptomatic; osteoporosis is not manifested until fracture, spinal deformity or loss of height occurs.
Key signs: Fractures, height loss
Treatment: calcium, vitamin D, bisphosphonates
Postoperative care
Care after surgery, Post-Op
Key focus: pain Manegmnt, wound care, monitor for complication
Respiratory Acidosis
Excessive CO2 accumulation in the blood, leading to decrease in pH
LOW AND SLOW
Causes: chronic obstructive pulmonary disease (COPD), severe asthma, hypoventilation, pneumonia, neuromuscular disorders, obesity hypoventialtion syndrome (OHS)
Manifestations: headache, confusion, dyspnea, tachycardia, flushed skin
Compensation mechanism: KIDNEYS attempt to compensate for respiratory acidosis by increasing bicarbonate reabsorption and secreting more hydrogen ions (H+)
Rheumatoid Arthritis
Autoimmune joint inflammation
Key signs: swollen, painful joints
Treatment: DMARDS (Disease-Modifying Anti-Rheumatic Drugs), biologics (medications derived from living organisms used to treat autoimmune disease), NSAIDS (ibuprofen 200 mg , corticosteroids
Autoimmune Disease
When the immune system mistakenly attacks the body’s own healthy cells, tissues, or organs, leading to inflammation, damage, and dysfunction.
Solid Tissue Cancers
Cancer in solid organs (breast, lung)
Key signs: depends on location; fatigue, pain common
Treatment: surgery, chemotherapy, radiation
Perfusion
Passage of oxygenated blood; poor perfusion can lead to ulceration.
Impairments: ischmeia, hypertension, shock
Nursing role: monitor vitals, assess for cyanosis, administer treatments
Hemostasis
Stopping of blood flow to form a clot.
Thrombus
Protective scab/clot formed from dried blood and exudate.
Vascular Response
Increased blood flow to the site of an injury
Cellular Response
Alerting the products of healing to attend to the site of injury
Endothelial Cells
Form a tight junction within the inner lining of the heart, blood vessels, and lymphatic vessels
Basement Membrane
Noncellular sheet that separates the vessel from the tissues of the body; endothelial cells are connected to this.
Exudate
Watery fluid that seeps from the wound
Inflammatory mediators
Facilitate the process of widening and loosening the blood vessels at the site of injury
Located in the blood plasma (fluid part of blood)
Mast cell
Important inflammatory mediator; type of leukocyte (type of WBC) throughout the connective tissues of body and near blood vessels.
They are similar to having emergency first responders trained in all neighborhoods
Degranulation
Process by which mast cells break apart and release inflammatory mediators.
Basophil
Type of WBC; contains granules that function in same manner as mast cells.
Cytokines
More than a hundred distinct cell proteins (in WBCs) that have a vital role in regulating inflammation
Autoimmunity
Self attack against body tissues;
Body is making normal proteins, new WBCs recognize as foreign substance and starts attacking.
Chemotaxis
Process of moving certain cells to the injury site. Chemotatic factors are activated which attract specific types of sells.
Neutrophil chemotactic factor attracts neutrophils, eosinophil chemotactic factor attracts eosinophils and so on
Diapedesis
Cells move between and through endothelial junctions
Lymphadenitis
Enlargement and inflammation of the nearby lymph nodes; occurs as a function of filtering or draining harmful substances at the injury site.
Pyrexia
Fever (elevated core body temp); result of inflammatory mediators acting directly on the hypothalamus (hypo. Is responsible for controlling body temp)
Hemostasis
Stopping of blood flow to form a clot
Thrombus
Protective scab/clot formed from dried blood and exudate
Fibroblasts
Important cells that produce and replace the connective tissue layer, stimulated by macrophages
Extracellular matrix (ECM)
The layers of architectural structures that support the cells
Glycoproteins
Regulate cell movement across the matrix, providing place for attachment of cells to the matrix, and prompt the cells to function
Angiogenesis
Generation of new blood vessels
Ulcer
Circumscribed, open, crater like lesion of the skin or mucous membranes.
They are often resistant to healing because of the lack of perfusion to the site and persistent habitations by microorganisms
Keloids
Hypertrophic scars resulting from excessive collagen production at the injury site.
Occur in those with deeply pigmented skin.
Proteinases
Enzymes that destroy elastin and other tissue components
Granulomas
Modular inflammatory lesions that encase harmful substances; typically form when the injury is too difficult to control by the usual inflammatory and immune mechanisms, such as with foreign bodies or certain microorganisms
Hyposmia
Reduced ability to smell and detect odors
Sepsis
Bacterial infection of the blood
Eschar
Thick coagulated crust; dead tissue
Integumentary system
Protects the body from pathogen invasions, regulates temp, senses environmental changes, maintains water balance; skin, hair, nails, mucous membranes, glands
Alterations primarily result in impaired skin integrity
Alterations may also result in risk for infection
Lines of defense: 1) skin & mucous membranes, 2) inflammatory response, 3) immune response
Intracellular fluid
ICF; fluid inside the cells
Extracellular fluid
ECF; fluid outside the cells
Tonicity
Osmotic pressure of two solutions separated by a semipermeable membrane
Hypervolemia
Fluid volume excess in the intravascular space
Water intoxication
Excess fluid in the intracellular space
Edema
Due to increased capillary hydrostatic pressure; excess fluid in the interstitial space
hypovolemia
Fluid volume deficit in the intravascular space
Sodium
Normal range: 135-145
- regulated by the kidneys and aldosterone hormone
-controls serum osmolality and water balance
-most significant cation and prevalent electrolyte of Extracellular fluid
Depolarization
Increase in membrane potential or excitability of the cell membrane
Repolarization
Restoration of resting potential
Hypernatremia
Sodium > 145 mEq/L
Causes: excessive sodium, deficient water (excessive output, diuretic use)
Manifestations: NEURO ISSUES
Hyponatremia
Sodium < 135 mEq/L
Causes: deficient sodium (diuretic use gastrointestinal loss, diaphoresis), excessive water (water retention)
Manifestations: NEURO (swelling of brain cells = fatal)
Potassium (K+)
Normal range: 3.5-5 mEq/L
The primary intracellular cation
Helps maintain proper muscle and nerve function, heart rhythm, and fluid balance
Hyperkalemia
Potassium > 5 mEq/L
Causes: excessive intake - oral potassium supplements, salt substitutes, rapid intravenous administration of diluted potassium
Manifestations: CARDIAC
Diagnosis: 12-lead EKG
Hypokalemia
Potassium < 3.5 mEq/L
Causes: excessive loss: vomiting, diarrhea, nasogastric suctioning, laxatives, potassium-losing diuretics
Increased shift into the cell: alkalosis and insulin excess
Manifestations: CARDIAC
Calcium
Normal range: 4-5 mEq/L (8-10 mg)
Mostly found in bone and teeth (bone=storage)
-has inverse relationship with phosphorus
-has synergistic relationship with magnesium
Hypercalcemia
Calcium > 5 mEq/L
Blood calcium levels greater than 10.5 mg/dL
Causes: increased intake or release: calcium antacids, calcium supplements, cancer, immobilization, hypophosphatemia
Manifestations: stones (kidney stones), bones (bone pain), groans (GI symptoms), thrones (polyuria, dehydration), psychiatric overtones (confusion, lethargy, depression, psychosis)
Hypocalcemia
Calcium < 4 mEq/L
Causes: deficient intake = decreased dietary intake, alcoholism, absorption disorders
Manifestations: Trousseau’s and Chvostek’s signs
Trousseau Sign
Occlusion of arterial blood flow elicits carpal spasm
Chvostek Sign
Tapping patients facial nerve prompts brief facial spasm
Phosphorus
Normal range: 2.5-4.5 mg/dL
Excreted through the kidneys
Hypermagnesemia
Magnesium > 2.5 mEq/L
Manifestations: similar to hypercalcemia (decreased memory, nausea, vomiting, dehydration, etc.)
Hypomagnesemia
Magnesium < 1.8 mEq/L
Manifestations: similar to hypocalcemia (trousseau’s and Chvostek signs)
Respiratory Regulation
Manages pH by altering carbon dioxide excretion
-speeding up respirations will excrete more carbon dioxide, decreasing acidity
-slowing down respirations will excrete less carbon dioxide, increasing acidity
Interstitial fluid
Fluid between cells
Intravascular fluid
Fluid inside blood vessels
Transcellular fluid
Third space
Hyperphosphatemia
Phosphorus > 4.5 mg/dL
Causes: renal failure, hypoparathyroidism, hypothyroidism, laxatives
Manifestations: similar to hypocalcemia
Hypophosphatemia
Phosphorus < 2.5 mg/dL
Causes: renal failure, hyperparathyroidism, alkalosis
Manifestations: similar to hypercalcemia
Magnesium
Normal range 1.8-2.5 mEq/L
Intracellular cation
Plays role in muscle and nerve function, cardiac rhythm, bone strength.
Hydrogen is an acid!!!
The more hydrogen, the lower the PH
Renal Regulation
Alters the excretion or retention of hydrogen or bicarbonate
More effective because its permanently removing hydrogen
Responds the slowest, but lasts the longest
Respiratory alkalosis
CO2 levels are reduced in the blood
Usually due to hyperventilation, which leads to CO2 elimination, resulting in hypocapnia (low CO2 levels)
Increase in PH (alkalosis)
Causes: hyperventilation, high altitude, central nervous system (CNS) disorders (stroke, head injury, brain tumors), salicylate toxicity (e.g. aspirin overdose), pulmonary embolism
Compensation mechanisms: renal (kidney) compensation, kidneys attempt to excrete bicarbonate and conserve hydrogen ions (H+) to restore pH balance.
Manifestations: lightheadedness or dizziness, tingling or numbness, muscle cramps or tetany, palpitations, confusion or anxiety
PH
7.35-7.45
PaCo2
35-45
HCO3
(Bicarbonate) 22-26
PaO2
95-100 (hypoxemia = <90%)
Active immunity
Development of antibodies to an antigen (Achieved by having a specific disease or vaccine)
Passive immunity
Immunity transfer from host to recipient (achieved via mother - infant transfer (placenta or breast milk) or injection of antibody)
Humoral immunity
B lymphocytes (B Cells)
-(antibodies secreted from plasma cells IgA, IgG, IgM, IgE, IgD)
-memory cells
Primary adaptive immune response
-activation with first recognition of a specific antigen
Secondary adaptive immune response
-reactivation with later recognition of the same antigen
Cell - mediated immunity
-cytotoxic T lymphocytes
-Helper T lymphocytes (TH1, TH2): CD4
Major histocompatability complex (MHC)
Neoplasia
“New growth”, uncontrolled and unregulated
-may originate in one organ or spread from another site
Carcinogenesis
Development of cancer
Initiation
The cell is exposed to a substance or event that causes DNA damage or mutation
Promotion
Initiation of uncontrolled growth
Progression
Permanent malignant changes where metastasis occurs
Metastasis
The process by which cancer cells spread from the original (primary) site to other parts of the body, forming secondary tumors in distant organs or tissues
Apoptosis
Programmed “suicide” of cells
Atrophy
Decrease in size of cells
Hypertrophy
Increase in size of cells
Hyperplasia
Increase in number of cells
Metaplasia
Change in cell type
Dysplasia
Abnormal growth and appearance of cells
Multifactorial
Having more than one cause
Idiopathic
No known cause
Nosocomial
Caused by an infection received in a healthcare environment
Iatrogenic
Caused inadvertently by medical treatment
Diagnosis
Label for a disease, based on diagnostic criteria
Prognosis
Prediction of how one will proceed through the disease process, morbidity vs. mortality
Fluid balance
Total body water
Composes 60% of body weight
-intracellular (40%)
-Extracellular (20%)
Etiology
The study or identification of the cause or origin of a disease or condition
Determining Compensation for ABGs
-uncompensated if the unpaired result is within normal range
-partially compensated if the unpaired result is the opposite letter of the pairs, but pH is still abnormal
-fully compensated if the unpaired result is the opposite letter and the pH has returned to normal range
AIDS
Acquired Immunodeficiency Syndrome
-results form HIV infection
-if HIV infection goes untreated, AIDS results within 8-12 years on average
-disease courses vary, but opportunistic infections can cause death
Human Immunodeficiency Virus (HIV)
-RNA retrovirus that destroys CD4+
-destroys T cells and cell-mediated response
Hematopoesis
Creation of new blood cells, red marrow is the site of hematopoesis
Bones
Site of fat and mineral storage as well as hematopoesis
Osteoclasts
Break down spongy bone
Osteoblasts
Rebuild new compact bone
Osteocytes
Osteoblasts surrounded by calcified Extracellular material
Bone growth
Growth hormone works with thyroid hormones to control normal bone growth
-calcitonin and parathyroid hormone regulate bone remodeling and mineralization of calcium
Estrogen
Inhibits formation of osteoclasts in women
Testosterone
Increases bone length and density in men
Vitamin D
Controls the absorption of calcium from the intestine and increases calcium and phosphate reabsorption in the kidneys
Synovial joints
Most common
-contain cartilage that is lubricated by a transparent viscous fluid (synovial fluid) that contains leukocytes to fight infections and delivers nutrients to the cartilage
Smooth muscles
Involuntary; line walls of hollow organs and tubes (eyes, skin, and glands)
Kyphosis
Increase in curvature of thoracic spine outward
Lordosis
Exaggerated concave of the lumbar spine (oh my lordosis!); pregnant women, obese people
Transverse fracture
Straight across the bone shaft
Oblique fracture
At an angle to the bone shaft
Spiral fracture
Twists around the bone shaft
Comminuted fracture
Multiple fracture lines and bone pieces
Green stick fracture
An incomplete break in which the bone is bent and only the outer curve of the bend is broken
-commonly occurs in children because of minimal calcification and often heals quickly
Compression fracture
Bone is crushed or collapses into small pieces
Dyspnea
Shortness of breath
Ascites
Abnormal accumulation of fluid in the peritoneal cavity, space between the lining of the abdominal wall and abdominal organs, most commonly associated with liver diseases.
Hypertension
High blood pressure
Complications: heart attack, stroke, heart failure, aneurysm, vision loss, chronic kidney disease
Diuretics
Drugs that increase urine production
Hypotension
Low blood pressure
1st Degree Burn
(Superficial partial thickness burn)
Affects only the epidermis (causes pain, erythema [redness], and edema)
-Extracellular matrix generally remains intact.
Healing occurs within a week
Ex: sunburn, touching hot surface
2nd degree burn
(Deep partial thickness burns)
Affects epidermis and dermis
-blisters form
-necrosis results in both epidermal & upper dermal layers
-collagen fills in gaps left after removal of damaged tissues, excess collagen production leads to tissue fibrosis (thickening or scarring) at burn site
-2-4 week healing process
Ex: severe sunburns, chemical burns, scalding with hot liquids.
3rd degree burns
(Full thickness burns)
Damages to the epidermis and dermis and can penetrate subcutaneous layers as well.
Severity depends on temp or type of chemical & length of exposure
Charred white skin, low blood pressure (hypotension), rapid heart rate (tachycardia)
Ex: contact with extremely hot objects, exposure to flames, electrical exposure, and caustic chemicals
Tachycardia
Rapid heart rate
Dosage and calc: BURNS
Adults
4mL x Weight in kg x %TBSA burned = RL (ringers lactate)
Dosage & calc: BURNS
Children
3mL x Weight in kg x %TBSA Burned = RL
Dehydration
Characterized by negative fluid balance; diarrhea is the most common cause of dehydration, although a variety of other conditions can lead to dehydration
Manifestations: decreased level of consciousness, prolonged capillary refill time, dry mucous membranes, decreased or absent tears, change in vital signs (increased respiratory rate, decreased blood pressure, weak pulse), sunken eyes, decreased or absent urine output, depressed fontanelles (areas not enclosed by cranium, or “soft spots” on infant heads)
Isonatremic dehydration
Equal loss of fluid and solutes (like sodium), so the sodium level stays normal
Hyponatremic dehydration
More sodium is lost than fluid, causing the sodium level in the blood to drop; to balance this, fluid moves from the blood vessels to the spaces between cells, making the blood volume decrease even more
Hypernatremic dehydration
More fluid is lost than sodium, causing the sodium level to rise. This pulls fluid into the blood vessels, which helps maintain blood volume and circulation despite the fluid loss
Fractures
Breaks in the rigid structure of the bone
Traumatic = most common cause
Manifestations: swelling or bruising, deformity, limited mobility, numbness or tingling, shock
Complications: compartment syndrome, fat embolism, osteomyelitis, osteonecrosis or a vascular necrosis
Compartment syndrome
Serious condition that results from increased pressure in a compartment, usually muscle fascia in the case of fractures
Pressure impinges on the nerves and blood vessels present within the compartment, potentially compromising the distal extremity (impaired blood flow).
Manifestations: excruciating pain beyond what would be expected given the injury (not relieved with pain medications)
Diagnosis: measuring pressure inside the muscle fascia
Treatment: remove the cast (if present), immediate fasciotomy
5 Ps of Pain
Pain - pallor (pale color) - paresthesia (numbness/tingling) - paralysis - pulselessness
Fat embolism
Fat enters the blood stream, usually after long bone fracture
- outcome can be fatal if the emboli travel to vital organs such as the lungs, brain or heart
- confused, shortness of breath, petechia on head and chest
-prevention: early immobilization
Osteomyelitis
Infection of the bone tissue
-can take months to resolve and result in bone or tissue necrosis
-infection with anaerobic bacteria such as clostridium causes gas gangrene
-treatment: potent antibiotic therapy
Osteonecrosis, or avascular necrosis
Death of bone tissue due to loss of blood supply
-can result from displaced fractures or dislocations
-treatment: surgical replacement of the necrotic bone and/or joint
Open Reduction and Internal Fixation (ORIF)
Procedure used for fractures, realigns the bone and secures it using metal plates and screws to hold the bones in place while they heal
Acute HIV infection (stage 1)
Occurs 2-4 weeks after exposure and is high viral replication and severe drop in CD4+ cells. The body may start to mount an immune response, but the viral load remains high
Chronic HIV infection (stage 2)
The virus replicates at a lower level, and CD4+ counts stabilize. However, the immune system is still compromised, leaving the body vulnerable to opportunistic infections
Acquired immunodeficiency syndrome (AIDS, Stage 3)
If untreated, HIV progresses to AIDS, where the CD4+ count drops below 200 cells/mm^3 , and the body becomes highly susceptible to opportunistic infections (e.g. tuberculosis, pneumonia, candidiasis) and certain cancers (e.g., Kaposi’s sarcoma, non-Hodgkin lymphoma)
Antiretroviral Therapy (ART)
Controls viral replication, prevents disease progression, and manages opportunistic infections. Lifelong treatment with ongoing monitoring is required (used for HIV/AIDS)
Post operative care
Focuses on managing patients recovery after surgery, ensuring proper healing, preventing complications and promoting the restoration of normal physiological functions
Pulmonary embolism (PE)
Life threatening cording where a blood clot (usually from the deep veins of the legs, DVT) travels to the lungs, blocking blood flow
Dyspnea
Shortness of breath due to increased CO2
Palpitations
Sensations of an irregular, rapid or forceful heartbeat, described as fluttering, pounding, skipping, or racing in the chest.
Angiogenesis
Tumor angiogenesis is the process of a tumor inducing the growth of new blood vessels to supply the growing mass with nutrients and oxygen/ supports spread and growth of tumor. Vascular endothelial growth factor (VEGF)
Carcinomas
(Cancers of epithelial tissue)
- most common types of solid tumors and arise from the epithelial cells that line the organs and tissues
- adenocarcinomas = tumors arising from glandular tissue
-squamous cell carcinomas = tumors arising from squamous epithelium (skin, lungs, esophagus)
-basal cell carcinomas (most common form of skin cancer, originating from basal cells in the skin
Sarcomas
(Cancers of connective tissue)
Originate in the connective tissue (muscles, bones, fat or cartilage)
-osteosarcoma = bone cancer
-chondrosarcoma = cartilage cancer
-rhabdomyosarcoma = cancer of the skeletal muscle
Neuroendocrine tumors
Tumors arising from neuroendocrine cells that produce hormones and are found in organs like the pancreas, lungs, and GI tract
-small cell lung cancer (SCLC): type of neuroendocrine carcinoma
-pancreatic neuroendocrine tumors (PNETs)
Germ cell tumors
These tumors originate from the reproductive cells (sperm or eggs) and can occur in the testes, ovaries, or other areas of the body
-testicular cancer: seminomas or non-seminomatous tumors
-ovarian cancer: includes various types like teratomas and embryonal carcinoma
Lymphomas and Leukemias
Hematologic cancers; can involve solid tissues such as lymph nodes (lymphoma) or other organs (leukemia)
Tumor suppressor genes
Work to regulate the cell cycle and promote apoptosis (programmed cell death). Mutations or loss of function in these genes, such as p53 or RB1, prevent the normal control of cell growth, leading to tumor formation
RB
Retinoblastoma RB gene controls the rate of cell growth
type of cancers from suppression of this type of gene:
-retinoblastoma
-osteosarcoma
-breast cancer
-pancreatic cancer
-lung cancer
TP53 (p53)
Tumor protein p53 gene opposes cell division and development when damage is detected. It initiates apoptosis if it cannot repair cell
-mutation on p53 gene is MOST COMMON MUTATION LEADING TO CANCER
-p53 gene located on chromosome 17 associated with three or four types of colorectal cancer and many other malignancies
BCL2
B-cell lymphoma 2 (BCL2) gene apoptosis
Mutation of BCL12 causes one type of leukemia
BRCA1 & BRCA2
-breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) regulate a protein responsible for regulation of transcription and repair DNA damage
-mutation of these genes causes an inherited form of breast cancer
DNA repair defects
Mutations that impair DNA repair mechanisms
Palliative care
Specialized medical care for individuals with serious, chronic, or life-threatening illnesses.
-focuses on relieving symptoms, improving quality of life, providing emotional. Psychological and spiritual support for both patient and their family
Tumor Staging Scale (TNM)
Primary tumor: TX, T0, ‘Tis, T1, T2, T3, T4
TX = primary tumor cannot be measured
T0 = primary tumor cannot be found
Tis = carcinoma situ (early cancer that has not spread to neighboring tissue)
T1,T2,T3,T4 = size or extent of the primary tumor
Regional Lymph Nodes (N)
NX = cancer in nearby lymph nodes cannot be measured
N0 = no cancer in nearby lymph nodes
N1, N2, N3 =1 N³ refers to number and location of lymph nodes with cancer
Distant Metastasis (M)
MX = metastasis cannot be measured
M0 = cancer has not spread to other body parts
M1 = cancer has spread to other body parts
Immediate Hypersensitivity (Type I)
Allergic reactions
Involves IgE antibodies, mast cells, and basophils
Symptoms: uticaria (hives)
Treatment: antihistamines, epinephrine (for anaphylaxis)
Cytoxic Hypersensitivity (Type II)
Involves IgG or IgM antibodies that react with antigens leading to cell destruction
Ex: wrong blood transfusion reactions
Treatment: remodel of offending antigens, blood transfusion management
Immune Complex Hypersensitivity (Type III)
Antibodies bind to antigens and are deposited in tissues, leading to inflammation
Ex: systemic lupus erythematous (SLE), rheumatoid arthritis (RA)
Treatment: immunosuppressive drugs. (Suppresses the immune system but can lead to infection)
Delayed- Type Hypersensitivity (Type IV)
Cell-mediated (immune response where T cells are primary agents in defending body against pathogens); CD4 (enhances macrophages), CD8 (causes apoptosis)
Mechanism: involves T cells rather than antibodies. T cells recognize chemical as an antigen and trigger an inflammatory response
Ex: contact dermatitis (e.g. poison ivy)
Treatment: corticosteroids for inflammation
Corticosteroids
Steroid hormones produced in the adrenal cortex that are used medically to treat a wide variety of inflammatory and autoimmune conditions
Innate Immunity
Present at birth.
-physical barriers: skin, mucous membranes (e.g. in the respiratory tract)
Adaptive immunity
Develops over time in response to exposure to pathogens
-targets specific pathogens through immune cells called lymphocytes
Key components:
-humoral immunity = B cells and the production of antibodies (immunoglobulins) that recognize and neutralize specific antigens
-cell-mediated immunity (T-cells mediated) = involves T cells which recognize and destroy infected cells directly and help regulate the immune response
Necrosis
Uncontrolled death of cells or tissues in body due to injury, infection, lack of blood supply (ischemia), toxins, or trauma.
Unlike apoptosis (programmed cell death), necrosis is PATHOLOGICAL, and often leads to INFLAMMATION and damage to surrounding tissues
ACID (Hypersensitivity types)
A – Anaphylaxis & Allergies (Type I)
C – Cytotoxic (Type II)
I – Immune complex (Type III)
D – Delayed (Type IV)
Immunoglobulins (antibodies)
REMEMBER: Plasma cells are specialized B cells that secrete antibodies (immunoglobulins, Ig) to help fight infections. They do not secrete other immune molecules like cytokines (which are released by T cells and macrophages).
GAMED = order of immunoglobulins
Types of Antibodies Secreted by Plasma Cells
1. IgA – Airway; Protects mucosal surfaces (GI, respiratory, saliva, tears, and breast milk).
2. IgG – greatest; Most abundant; provides long-term immunity and crosses the placenta (blood, extracellular fluid, long term immunity).
3. IgM – massive; first responder, first antibody produced in infections, activates complement, largest; First antibody produced in an infection; strong complement activator.
4. IgE – Eosinophils, allergies; Involved in allergic reactions and defense against parasites (triggers histamine release).
5. IgD – dont know; least undersood; Acts as a receptor on immature B cells, with an unclear role in circulation.
White Blood Cells (Leukocytes): Five Major Types
“Never Let Monkeys Eat Bananas”
• N → Neutrophils (Most abundant, First responders)
• L → Lymphocytes (B cells, T cells, and NK cells – Specific immunity)
• M → Monocytes (Become macrophages and clean up debris)
• E → Eosinophils (Attack parasites and cause allergies)
• B → Basophils (Release histamine, involved in allergic reactions)
Major Histocompatability Complex (MHC) - the body’s ID system
MHC molecules are proteins on the surface of cells that help the immune system recognize what belongs to the body (self) and what is foreign (non-self, like viruses or bacteria). They are crucial for activating immune responses.
How MHCs Work:
1. MHC I – “Kill Me if Infected”
• Found on all cells (except RBCs).
• If a virus infects a cell or cancer develops, the cell puts a “red flag” (MHC I with the foreign antigen) on its surface.
• CD8+ Cytotoxic T cells recognize the infected cell and kill it.
2. MHC II – “Look What I Found!”
• Only found on Antigen-Presenting Cells (APCs) like macrophages, dendritic cells, and B cells.
• These cells engulf bacteria or debris, break them down, and “present” the pieces on MHC II.
• CD4+ Helper T cells recognize the antigen and activate other immune cells (like B cells to make antibodies and killer T cells).
Memory Trick:
• MHC I → One (1) digit = CD8 → Found on all nucleated cells → Triggers killer T cells to destroy infected cells.
• MHC II → Two (2) digits = CD4 → Found on special immune cells → Triggers helper T cells to coordinate an immune response.
Lymphocytes
B cells: produce antibodies against pathogens
T cells: regulate immune responses and attack infected cells
Helper T Cells
CD4 - stimulate B cells and other T cells
Cytotoxic T Cells
CD8 - directly kill infected cells
Macrophages
Ingest and digest pathogens
Help activate the adaptive immune response by presenting antigens to T cells
Neutrophils
First responders to infections, particularly bacterial (first on scene, first to leave)
Dendritic Cells
Present antigens to T cells and initiate the adaptive immune response
Leukemia
Cancer of the blood and bone marrow, leading to abnormal production of white blood cells
Manifestations: fatigue and weakness, frequent infections, fever, bruising, bleeding, petechiae, pain, paleness, enlarged liver, spleen, or lymph nodes, weight loss, and night sweats
Lactated Ringers solution (LR)
Balanced isotonic crystalloid IV fluid that contains electrolytes (sodium, potassium, calcium and chloride) along with lactate, which help suffer acid-base imbalances
Uses: Burn patients, fluid resuscitation, dehydration, maintaining electrolyte balance
Chronic obstructive pulmonary disease (COPD)
Progressive irreversible lung disease that causes airflow obstruction due to chronic inflammation, mucus buildup, and narrowing of the airways.
Caused by smoking or long-term exposure to lung irritants
How to check compensation with ABGs
Uncompensated: the pH is abnormal, and only one system (CO2 or HCO3-) is abnormal. The other is normal
Partially compensated: the pH is still abnormal, but both CO2 and HCO3- are abnormal, meaning the body is trying to fix the issue
Fully Compensated: the pH is normal, but both CO2 and HCO3- are abnormal, showing that the body has successfully balanced the pH.
Normal blood pressure
systolic = less than 120 mmhg
diastolic = less than 80 mmhg
Eosinophils
Eosinophils are a type of white blood cell (WBC), specifically a granulocyte, that plays a major role in:
Allergic reactions (e.g., asthma, hay fever, anaphylaxis)
Parasitic infections (e.g., worms, helminths)
Inflammation & autoimmune diseases
