Exam 1 Flashcards
Cellulitis
Bacteria (Streptococcus and staphylococcus most common)
Contact/Vector
Breaks in skin, eczema, Athlete’s foot, shingles, burns, insect bites, IV catheters
No vaccine; antibiotics to treat
Chickenpox (Varicella)
Herpes Virus Type 3; Varicella-Zoster Virus
Direct contact, Droplets in Air
Respiratory tract or eyes
Vaccine available
Clostridium Difficile
Bacteria
Contact or Vehicle (Fecal-Oral)
Oral
No vaccine; stop antibiotics and take oral flagyl
Chlamydia
Bacteria: Chlamydia trachomatis
Contact (sexual; mother-child), body fluids
Mucous membrane (vagina, anus) or oral
No vaccine
Cytomegalovirus
Virus (herpes virus Type 5)
Contact (blood/body fluids); transplanted organs
Oral and Genital cavity, eyes, organs transplant
No vaccine (in development)
Gas Gangrene
Anaerobic Bacteria (Clostridium perfringens)
Contact
Lesions/Open Wounds
No vaccine
Gonorrhea
Bacteria
Contact (Unprotected sex/mother-baby)
Mucous membrane
No vaccine, antibiotics cure
Hepatitis A
Virus
Food/Water
Ingestion, Inhalation
Vaccine available (children starting at age 1, travelers to certain countries)
Hepatitis B
Virus
Contact with body fluids
Sex, needles, mother-child, percutaneous injuries
Vaccine available
Hepatitis C
Virus
Contact (body fluids, injection, needle, mother-child)
Needle, open wounds, sexual contact
No Vaccine, treated with meds
Herpes Simplex Virus
Virus
Sexual contact, mother-child, hand contact
Broken/open mucous membranes (oral cavity, eyes, genitals), minor skin abrasions
No vaccine, can be treated with anti-viral drugs
HIV
Human Immunodeficiency Virus
Contact/Droplet
Percutaneously (needles), sex, child birth, blood transfusion, body fluids
No vaccine, antivirals used for treatment
Human Papillomavirus
Virus
Contact (sexually transmitted)
Cuts/Abrasions/Small tears in skin, mucous membranes (genitals and eyes)
Vaccine, recommended ages 11-12
Impetigo
Bacteria (90% Staph; also Strep)
Skin-to-skin/Droplet
Wound, surgical site, mucous entry point, impacts healthy skin
No vaccine, treated with oral antibiotics
Epstein Barr Infectious Mononucleosis
Herpes Virus 4
Direct contact with saliva or genital secretions, organ transplants
Oral, blood transfusion (possible), transplants, genital contact
No vaccine
Influenza
Virus
Droplet, contact
Mucosal tissues of respiratory tract, direct contact, inhalation
Vaccine, recommended annually (injection or nasal)
Lyme Disease
Bacteria; tick-borne
Vector (deer ticks)
Skin puncture into bloodstream
No vaccine, manufacturer discontinued in 2002 ( lack of demand), treated with antibiotics
Malaria
Micro-organisms from plasmodium; parasite
Vector, water, congenital, blood transfusion
Vector bite, transfusion, mother-child
No vaccines (clinical trials); protective measures
Meningitis
Viral, bacteria (also fungal or protozoa)
Airborne, droplet, contact (depends on organism)
Mucous membranes of upper respiratory tract
Vaccine, antibiotics for treatment
Otitis Media
Secondary to another bacterial/viral disease
Occasionally droplets and fomites
Oral, mucous membrane
Vaccine
Pneumonia
Bacteria, virus, or fungus
Direct contact, inhalation
Mucous membranes, respiratory tract (oral/nasal cavity)
Vaccine (adults 65+, immunocompromised children)
Pseudomonas
Bacteria (Pseudomonas aeruginosa)
Contact
Wounds, Urinary Tract, Blood
No Vaccine; antibiotic resistant for treatment
Respiratory Syncytial Virus (RSV)
Virus
Droplet/Direct Contact
Nose, mouth, eyes
No vaccine, in development; meds available for high-risk children
Rheumatic Fever
Inflammatory disease (inadequately treated bacterial infection [strep/scarlet fever])
Direct contact (mucous, skin lesions); occasionally droplets/fomites
Contact with mucous membrane
No vaccine; treated with antibiotics
Roseola
Herpes Virus Type 6 and 7
Droplet (respiratory secretions) or contact (saliva)
Respiratory tract
No vaccine
Shingles
Varicella Zoster Virus Type 3
Contact (fluid from blisters/rash)
Chapped lips, dry skin, open wounds, respiratory tract/eye
Vaccine; recommended adults over 60
Staphylococcus Aureus
Bacteria
Direct Contact (nose, skin, axilla, perineum); possibly airborne
Broken skin/mucous membranes, recent surgical sites, burns needles, catheters, prosthetics
No vaccine, antibiotics used depending on strain’s resistance
Abscess, osteomyelitis, wound infection, endocarditis, toxic shock, MRSA
Strep Throat
Bacteria (Group A Streptococcal infections)
Droplets or food
Travels from one respiratory system to another (mouth, nose)
No vaccine, treated with antibiotics
Tuberculosis
Bacteria
Airborne
Droplet (Respiratory tract)
Vaccine, BCG (rarely used in US)
Vancomycin-Resistant Enterococci (VRE)
Bacteria (Enterococci)
Fomite
Broken skin or mucous membranes
No vaccine; antibiotics other than Vancomycin may be effective
This test provides a prognosis for critically ill patients
APACHE
What does a Basic Metabolic Panel measure?
Sodium, Potassium, Chloride, Calcium, BUN, Creatinine, Glucose, Carbon Dioxide
____ levels reflect _______ status
Bicarbonate; Acid-Base
What 2 tests test Renal Function?
Creatinine
Blood Urea Nitrogen (BUN)
What aspects are tested with electrolytes?
Sodium, Calcium, Potassium, Chloride, and Bicarbonate
What is a Comprehensive Metabolic Panel composed of?
Basic Metabolic Panel Bilirubin Total Protein Albumin Serum Enzymes
What are the Liver Enzymes?
Transaminases
Bilirubin
Ammonia
What are the Hematological Tests?
Complete Blood Count RBC Function WBC Function WBC Differential Erythrocyte Sedimentation Rate Coagulation Studies Bone Marrow Aspiration
What does a CBC test?
Infection
Anemia
Arthritides
Cancer
What does an RBC Production and Function?
Hematocrit (percentage of whole blood occupied by RBCs)
Hemoglobin (oxygen-carrying capacity)
Reticulocyte (bone marrow production)
What do the Serum Chemistries test?
Iron and Iron Binding
Ferritin
Vitamin B12 and Folic Acid
What does a Bone Marrow Aspiration test?
Infectious Diseases
Leukemia
Lymphoma
Multiple Myeloma
What does an ERS test?
Rate RBCs settle out of unclotted blood in 1 hour
Polymyalgia rheumatica, Giant cell arteriris, RA, SLE, Hodgkin’s disease, TB
What are the 5 types of Leukocytes?
Neutrophils Lymphocytes Monocytes Eosinophils Basophils
What are the 3 types of Lymphocytes?
Helper T Cells (middle man)
Suppressor T Cells
B-Lymphocytes
What does a WBC Function test indicate?
Susceptible to infection
What does a WBC Differential test indicate?
Maturity (left shift of neutrophils during infection/necrosis)
Morphology
Qualitative abnormalities
What tests are used to evaluate hemostasis?
Bleeding Time
Prothrombin Time
International Normalized Ratio
Activated Partial Thromboplastin Time
What are the 2 Regulation of Coagulation tests?
D-Dimer: Neg (low chance of thrombus) Elevated (unfavorable coagulation)
Warfarin Sensitivity: Genotypes associated with abnormal sensitivity to warfarin (coumadin)
What are the Immunologic Tests?
Tumor-Associated Antigens
Rheumatoid Factor
Human Leukocyte Antigen
Antinuclear Antibodies
What all is analyzed in a Urinalysis test?
Color and Appearance (Pale yellow to amber; turbidity: clear to slightly hazy)
Specific Gravity (high if concentrated urine) and Occult Blood (no RBCs seen)
Glucose (spills into urine when renal tubule reabsorption capacity is exceeded)
Ketones (excess when carb metabolism is altered in Type 1 diabetes, fat used as energy)
Electrolytes (sodium, chloride, potassium)
Drug Screening
What are the Microbiologic Study Tests?
Gram Stain (gram-positive [blue] vs gram-negative [pink]) Cultures: detect bacteria in blood, sputum, pleural fluid, throat, urine
What is a Peritoneal Fluid Analysis?
Paracentesis: insertion of a trocar through small surgical incision into abdominal cavity to remove fluid
Diagnoses peritoneal effusion
What happens to your immune system as you age?
Decreased Cell Immunity
Chronic Disease
Increased Likelihood of Exposure to Nosocomial Infections
Subtle Response to Infection
What are the 3 lines of defense?
1st: Normal Flora
2nd: Inflammatory Process
3rd: Immune Response
What are the characteristics of Group B Streptococcal Infections?
Streptococcus Pneumoniae
Leading cause: Neonatal pneumonia, meningitis, sepsis
Direct Contact or Inhalation
Vaccine for children and older adults
What are the blood-borne Viral Diseases?
Hepatitis B
Hepatitis C
HIV
What are the Herpesviruses?
Herpes Simplex (Type 1 and 2) Varicella/Herpes Zoster (Type 3) EBV (Type 4) CMV (Type 5) Roseola (Type 6 and 7) Kaposi's Sarcoma (Type 8)
What are the Viral Respiratory Infections?
Influenza
Respiratory Syncytial Virus
What are the Epithelial Neoplasms?
Benign: Papilloma and Adenoma
Malignant: Carcinoma and Adenocarcinoma
What are the CT/Muscle Neoplasms?
Benign: Fibroma and Osteoma
Malignant: Fibrosarcoma and Osteosarcoma
What are the Nerve Neoplasms?
Benign: Neuroma
Malignant: Glioma and Retinoblastoma
What are the Lymphoid Neoplasms?
Lymphoma
What are the Hematopoietic Neoplasms?
Leukemia and Multiple Myeloma
What are the characteristics of Actinic Keratosis?
Precancerous (10% advance to carcinoma)
Small, dry, crusty
Face, lips, back of hands, arms, shoulders
What is the TNM Staging System?
T: Primary Tumor (Tx, T0, TIS, T1-4
N: Regional Lymph Nodes (Nx, N0, N1-3
M: Distant Metastasis (Mx, M0, M1
What is the tumor angiogenesis?
How cancerous cells invade the body
Cells break away, travel through blood/lymphatic system, trapped in capillaries
What tumors are most likely to metastasize to the brain?
Lungs
Clinical manifestations of Liver metastasis?
Abdominal pain, general malaise, fatigue, anorexia, early satiety, weight loss
What are the clinical manifestations of bone metastasis?
Metastasize to the lung
Osteolytic: lung, kidney, thyroid, breast
Osteoblastic: breast and prostate
What are the clinical manifestations of CNS metastasis?
Brain: life-threatening and debilitating; rarely metastasize
Spinal Cord: compression with osteolytic changes; loss of neuro function
What are the systemic clinical manifestations of tumors?
Nausea, vomiting, retching, cancer-related anorexia/cachexia, pain, fever
What are the different types of childhood cancer?
Acute Lymphocytic Leukemia Lymphomas Primary CNS Tumors Neuroblastoma Wilm's (Kidney) Tumor Rhabdomyosarcoma
What is Dysplasia?
General disorganization of cells
What is Metaplasia?
Reversible and benign change from one cell type to another
What is Hyperplasia?
Increase in the number of cells in the tissue; benign or malignant
What is Anaplasia?
Loss of cellular differentiation; malignant only
Most advanced form of Metaplasia
Innate vs. Acquired Immunity
Innate: natural or native (skin and mucosal barriers; nonspecific inflammatory response)
Acquired: adaptive: either active (body does something) or passive (body doesn’t do anything)
Humoral vs Cell-Mediated Adaptive Immunity
Humoral: relies on antibodies
Cell-Mediated: relies on phagocytes and T lymphocytes
What are the phases of immune response?
Recognition Amplification Effector Termination Memory
What happens to immunity as you age?
Decreased resistance to pathogens
Increased tumor incidence
Increased autoimmune diseases
What are the Diseases of Secondary Immunodeficiency?
Leukemia Hodgkin's Malnutrition Alcoholism Autoimmune Diseases Diabetes Mellitus Cancer Iatrogenic (Immunosuppressive Drugs, Radiation, Splenectomy)
What are the common immunodeficiency disorders you will run into?
HIV/AIDS
CFS and IDS
Hypersensitivity Disorders
What are some of the clinical manifestations of CFS?
Sore throat, fever, muscle pain/weakness
What are the stages of Hypersensitivity Disorders?
Type I: Immediate, allergic, anaphylaxis
Type II: Cytotoxic reactions to self-antigens
Type III: Immune Complex Disease
Type IV: Cell-Mediated Immunity
What is SLE?
Lupus
4 of 11 ARA must be present (butterfly rash, photosensitivity))
Genetics, stress, strep/viral infection, UV light, EBV, drugs
What are the disorders of the Pituitary Gland?
Anterior Lobe:
Hyperpituitarism: Gigantism and Acromegaly (GH)
Hypopituitarism: Panhypopituitarism and Dwarfism
Posterior Lobe:
Diabetes Insipidus and SIADH
What are the results of Hypopituitarism of GH?
Short stature, delayed growth, delayed puberty
What are the results of Hypopituitarism of ACTH?
Hypoglycemia, anorexia, nausea, orthostatic HTN
What are the results of Hypopituitarism of TSH?
Tiredness, lethargy, sensitivity to cold
What are the results of Hypopituitarism of LH and FSH?
Secondary amenorrhea, impotence, infertility, decreased libido, absent secondary sex characterstics
What are the neuro signs of secondary tumor?
Headache, bilateral temporal hemianopsia, loss of visual acuity, blindness
What are the results of Hypopituitarism of ADH?
Diabetes Insipidus (Posterior lobe) Polyuria, polydipsia, dehydration, nocturia, fatigue
What are the results of Hyperpituitarism of ADH?
SIADH
Headache, confusion, lethargy, decreased urine, weight gain, seizures, muscle cramps
What are the functional and anatomic abnormalities of the Thyroid Gland?
Functional:
Hyperthyroidism (Grave’s Disease)
Hypothyroidism (most common)
Anatomic:
Thyroiditis
Goiter
Tumor
What are the signs and symptoms of Grave’s Disease?
Goiter, nervousness, heat intolerance, weight loss, sweating, diarrhea, tremor, palpitations, exophthalmos
Reduced capacity
What are the signs and symptoms of Hypothyroidism?
Bradycardia, Decreased GI motility, slowed neuro function, decreased body heat production, altered lipid metabolism, myxedema, exercise intolerance, edematous skin, chest pain, HTN, CHF
What is Goiter?
Enlargement of thyroid, lack of iodine, inflammation or tumors
What is Thyroiditis?
Inflammation of thyroid, bacterial/viral, autoimmune (Hashimoto’s)
What is Hyperparathyroidism?
Release of bone calcium into blood
Hypercalcemia -> hypergastrinemia -> abdominal pain, peptic ulcer disease, pancreatitis
Kidney damage
What is Hypoparathyroidism?
Decreased bone resorption
Iatrogenic and idiopathic
Acute tetany (tingling, spasms, trousseau’s sign, chvostek’s sign, laryngospasm)
What are the hormones of the Adrenal Glands?
Outer Cortex: Mineralocorticoids (fluid balance), Glucocorticoids (metabolism), and Sex hormones
Inner Medulla: Epinephrine and Norepinephrine
What are the Adrenal Conditions?
Insufficiency: Addison’s (Primary) and Secondary
Hyperfunction: Cushing’s Syndrome, Conn’s Syndrome, and Adrenal Hyperplasia
What is Addison’s Disease?
Decreased cortisol and aldosterone
Dark pigmentation, hypotension, progressive fatigue
hyperkalemia, GI disturbances, Hypoglycemia
What is Secondary Adrenal Insufficiency?
Hypothalamic/pituitary tumors, rapid withdrawal of corticosteroid drugs
ACTH and MSH levels too low
What is Acute Adrenal Insufficiency?
Life-Threatening, abrupt withdrawal
Watch medication adherence
What is Cushing’s Syndrome?
Excess glucocorticoid Moon face, buffalo hump, protruding abdomen, weakness/atrophy, decreased density, DM Other form (oversecretion of ACTH by pituitary tumor, results from oversecretion of adrenocortical hormones)
What is Conn’s Syndrome?
Hyperaldosteronism
Hypervolemia: HTN results in cerebral infarcts/renal damage
Hypokalemia: polyuria, polydipsia, DM
Metabolic alkalosis
Primary: adrenal lesion (benign)
Secondary: renal artery stenosis, renal HTN, cirrhosis with ascites
What is Adipose Tissue Disorder?
Neurotransmitters + glucose -> adipocytes -> adipokines
Systemic low-grade inflammation
What is Phenylketonuria?
Genetic defect in metabolism of phenylalanine
Mental retardation, tremors, poor coordination, perspiration, seizures (untreated)
Screened in newborns, dietary restrictions
What is Wilson’s Disease?
Hepatolenticular Degeneration
Copper metabolism defecit
Kayser-Fleischer rings around iris, cirrhosis of liver, degenerative brain changes
What is Porphyrias?
Hereditary, but sometimes acquired
Enzymatic abnormalities in biosynthesis of heme molecules
