Immune System

Question 1

206 - WHITE BLOOD CELLS
+ Expected ranges
+ Leuokopenia, Leukocytosis, Neutropenia, “Left Shift”

Answer 1

WHITE BLOOD CELLS

NORMAL WBC RANGE = WBC between 5,000-10,000/mm3.

LEUKOPENIA WBC < 4,000/mm3. Can indicate presence of autioimmune disease, bone marrow suppression, drug toxicity.

LEUKOCYTOSIS = WBC > 10,000/mm3. Can indicate presence of infection or inflammation.

NEUTROPENIA = Neutrophil count < 2,000/mm3. Indicates compromised immunity.

“LEFT SHIFT” (BANDED NEUTROPHILS) = Indicates release of immature neutrophils when body is fighting infection.

Question 2

207 - TYPES OF WBCs

Answer 2

TYPES OF WBCs

NEUTROPHILS (55-75%): Increased during acute bacterial infections.

LYMPHOCYTES (20-40%): Increased during chronic bacterial or viral infection.

MONOCYTES (2-8%): Increased ruing protozoal and viral infections, tuberculosis, chronic inflammation.

EOSINOPHILS (1-4%): Increased during allergic reactions or parasite infections.

BASOPHILS (0.5-1%): Increase due to leukemia

Question 3

213 - Lupus:
+ What is it?
+ 2 Main types of Lupus
+ Risk factors, S/S

Answer 3

LUPUS: Autoimmune disorder that causes chronic inflammation in the body. There is no cure. Disease is characterized by periods of exacerbations and remissions.
+ Discoid: Affects skin (butterfly rash)
+ Systemic: Affects the connective tissues in multiple organs

RISK FACTORS: Females, ages 20-40, race (African American, Asian, Native American).

S/S: Fatigue, joint pain, fever, BUTTERFLY RASH ON FACE, Raynaud’s phenomenon, anemia, pericarditis, lymphadenopathy.

Question 4

214 - Lupus:

+ Labs, Medications, Patient teaching, Complications

Answer 4

LUPUS:

LABS: POSITIVE ANA TITER, decreased serum complement (C3/C4), decreased RBC, WBC, platelets. Increased BUN, creatinine w/kidney involvement.

MEDS: NSAIDs, immunosuppressant agents (prednisone, methotrexate), ANTIMALARIAL DRUGS (HYDROXYCHLOROQUINE), topical steroid cream for rash.

PATIENT TEACHING: AVOID UV/SUN EXPOSURE, avoid sick people (due to risk of infection w/immunosuppressants).

COMPLICATIONS: Renal failure.

Question 5

215 - Gout:
+ What is it?
+ Risk factors, S/S, Medications

Answer 5

GOUT: Inflammatory arthritis, resulting in formation of uric acid crystals in joints and body tissues.

RISK FACTORS: Obesity, alcohol consumption, high purine diet (meat), cardiovascular disease, starvation dieting.

S/S: Severe joint pain (most common in metatarsophalangeal joint in great toe). Erythema, swelling, warmth in affected joint. Tophi w/chronic gout.

MEDS:
+ Acute gout: colchicine, NSAIDs, corticosteroids.
+ Chronic gout: allopurinol, probenecid.

Question 6

216 - Rheumatoid Arthritis (RA):
+ What is it?
+ Risk factors, S/S, Labs

Answer 6

RHEUMATOID ARTHRITIS (RA)

RA: Chronic, progressive autoimmune disease that causes inflammation, thickening, and deformation of the joints. Joints are affected BILATERALLY AND SYMMETRICALLY. Characterized by periods of exacerbations and remissions.

RISK FACTORS: Female gender, ages 20-50, genetics

S/S: Joint pain, MORNING STIFFNESS, fatigue, joint swelling w/erythema and warmth, swan neck and boutonniere deformities in fingers, subcutaneous nodules, fever, red sclera, lymphadenopathy.

LABS: POSITIVE RHEUMATOID FACTOR (RF) ANTIBODY, POSITIVE ANA TITER. Elevated WBCs, ESR, CRP.

Question 7

217 - Rheumatoid Arthritis (RA)
+ Diagnosis, Medications
+ Procedures, Patient education, complications

Answer 7

RHEUMATOID ARTHRITIS (RA)

DIAGNOSIS: Arthrocentesis (aspiration of synovial fluid from joint) to test for WBCs, RF.

MEDS: NSAIDs, immunosuppressants (prednisone, methotrexate), antimalarial agents (hydroxychoroquine).

PROCEDURES: Plasmapheresis (to remove antibodies from blood), total joint arthroplasty.

PATIENT EDUCATION: Take hot shower to relieve morning stiffness, physical activity to preserve ROM, use of assistive devices.

COMPLICATIONS: SJOGREN’S SYNDROME (DRY EYES, DRY MOUTH, DRY VAGINA).

Question 8

229 - Prostate Cancer:

+ Risk factors, S/S, Labs, Treatment options

Answer 8

PROSTATE CANCER

RISK FACTORS: older age, high fat diet, race (African Americans at higher risk), family history.

S/S: Urinary retention, hesitancy, frequency. Frequent bladder infections, hematuria (late sign).

LABS: Elevated PSA (> 4 ng/ml). TAKE PSA BEFORE DIGITAL RECTAL EXAM.

TREATMENT: Hormone therapy (leuprolide), chemotherapy, radiation, prostatectomy.