Infectious Disease Flashcards
1
Q
What are the 3 types of microorganisms?
A
1) bacteria
2) viruses
3) fungi
2
Q
What is the broad name/category for most bacteria in the body? What does this mean?
A
commensal bacteria
It lives symbiotically with you and causes no harm, its your own natural flora in gut, skin, vagina, etc.
3
Q
Specifically, what type of bacteria is in our flora?
A
lactobacillus “good” bacteria
4
Q
What do commensal bacteria secrete?
A
commensal bacteria secretes toll-like receptor (TLR) ligands which bind to TLR on the surface of normal intestinal tissue
5
Q
Where does commensal bacteria bind to and what does this allow?
A
binds to the epithelium of the gut and allows signaling for repair, protection of injury, etc.
6
Q
What does it mean for the body if TLR signaling is intact?
A
TLR ligands will bind to TLR and cause basal signaling
this leads to homeostasis of the intestinal surface and robust repair in response to injury
7
Q
Describe what happens if TLR signaling is disrupted
A
TLR ligands will bind to TLR, but no signaling will occur/no activation of signaling
this will cause enhanced sensitivity to injury and diminished capacity to induce repair
8
Q
What does it mean if there is no TLR signaling in the gut?
A
There are no ligands binding to TLR, so basal signaling is inactive and does not occur
this will lead to enhanced sensitivity to injury and diminished capacity to induce repair
9
Q
What does basal signaling do in simplest terms?
A
protects against cellular injury
10
Q
What is an example that may disrupt TLR signaling?
A
antibiotics can eradicate commensal bacteria which results in compromised ability of the intestinal epithelium to withstand injury and repair cell damage
11
Q
What happens to the body if antibiotics disrupt your natural flora?
A
body will be more susceptible to bacterial infections, such as C. diff
12
Q
What does C. diff cause?
Hint: think in terms of when the natural flora is disrupted through antibiotics
A
pseudomembranous colitis and candida overgrowth
13
Q
Where in the body is it sterile (no commensal bacteria)?
A
blood, CSF, kidneys, bladder, female fallopian tubes/ovaries
14
Q
How is infection typically transmitted?
A
through direct contact, such as touch or sex
or through fomites (inanimate objects such as medical instruments, bed linens, etc.
15
Q
List at least 3 ways infections are spread
A
in no specific order:
1) needle or injury (direct access to blood)
2) bites, stings or worms (direct access to blood)
3) animals (vector-borne)
4) sexual intercourse
5) ingestion (contaminated soil/water, poultry, eggs, oral/nasal secretions, etc)
6) inhalation (oral/nasal secretions)
16
Q
What is an example of infection that inhales microbes through nasal/oral secretions?
A
TB
17
Q
What is an example of infection that uses a vector, or in other words animal/insect intermediate?
A
malaria
18
Q
What is an example of a microorganism that can cross the placenta? What infection does it cause?
A
Treponema pallidum causes Syphilis
this can really infect the fetus and cause neuro damage or fetus can even die in utero
19
Q
What are nosocomial infections?
A
any infection acquired within a hospital or medical facility
20
Q
What is the most common nosocomial infection? What are the secondary infections that are also fairly common?
A
most common= staph causes UTIs
secondary= wound infections, pneumonia, or diarrhea
21
Q
What is the most common serious nosocomial infection? Secondary infection?
A
most common= MRSA (Methicillin-resistant staphylococcus aureus)
second most common= C. diff
22
Q
How easy is it for C. diff to enter the body? What happens once a pt has C. diff?
A
once the bacteria gets in the body, it’s very easy to get through the stomach (entrance is easy if pt is susceptible to infection)
C. diff causes pseudomembranous colitis, which results in diarrhea, abdominal pain, and high fever
23
Q
What are the 3 ways bacteria can infect you?
A
1) secrete toxins
2) secrete enzymes
3) become spores
some bacteria can do more than 1 of these options
24
Q
What are the toxins that bacteria secrete?
A
exotoxins or endotoxins
25
What type of bacteria typically secretes exotoxins?
Hint: it is either gram pos or neg
gram positive bacteria
26
How are exotoxins released/distributed into body?
they diffuse through tissues and in body fluids
27
What is an example of an exotoxin?
neurotoxins
28
What is an example of a neurotoxic bacteria?
Clostridium tetani (C. tetani)
29
What does C. tetani cause?
causes tetanus
it does not kill any cells, but rather enters the cells and disrupts metabolism
It inhibits neurons (this is called opposed neurons), where one neuron is fired off and the opposite neuron is inhibited
30
What is a classic sign of tetanus?
lock jaw which is caused from muscular rigidity because neurons are being inhibited and this impacts the muscles
31
What type of bacteria typically secretes endotoxins?
Hint: it is either gram pos or neg
gram negative bacteria
32
How are endotoxins released into body?
they are only released once/if the bacteria dies
33
What can release of endotoxins lead to?
minor symptoms such as fever, weakness, etc.
huge inflammatory response (release of lots of cytokines)
34
What happens if the body doesn't take care of endotoxins right away?
the endotoxins will make it to the bloodstream and due to its huge inflammatory response, this can lead to septic shock
35
What are 2 examples of an enzyme that some bacteria can secrete?
collagenases (which break down collagen in the body)
hemolysins (break down RBCs)
36
What is a bacteria we learned in class that can secrete collagenases?
C. histolytieum
collagenases break down collagen, so in this case it will cause gas gangrene
37
Are bacteria spores hard to destroy?
YES!!!!! unfortunately
38
What are 2 examples of bacteria that can become spores?
C. tetani and C. botulinum
39
What bacteria did we learn in class that has multiple infectious routes?
C. tetani can secrete exotoxins (specifically neurotoxins) or become a spore, depends on the environment
40
Where does C. tetani typically form spores?
the soil
we can get infected by this through ingestion
41
What does C. botulinum cause? Where does it typically form spores?
causes botulism which can occur from eating expired canned foods or damaged/seal broken canned foods
Clostridium is just sitting there and eventually will cause illness because it can protect itself since it is a spore and it's hard to destroy
42
What are viruses?
Hint: think in terms of microbiology
obligate intracellular parasites (have to get into your cells to infect you, viruses are not alive)
43
What are two types of infections viruses can cause?
chronic and latent infections
44
What is an example of a chronic viral infection?
Hep B
45
What is an example of a latent viral infection?
Varicella zoster (causes chicken pox and the latent infection you can get afterwards is shingles)
This is because it sits in the dorsal root ganglia and something must trigger the inactive virus to become active again after having chicken pox, and so this trigger can cause shingles
46
What is an example of a viral infection that has multiple strains?
the flu
47
T/F:
In some cases, viruses can change the DNA of cells in order to become malignant
True!
48
What is an example of a viral infection that can lead to change in DNA and malignancy? List a few cancers that it causes
HPV (human papillomavirus) most often leads to cervical cancer
It can also cause throat or oral cancer and this is common in both genders
49
What are the stages of infection?
1) incubation period
1A) prodromal period (only some pt)
2) acute phase
3 outcomes:
3A) full recovery or short convalescent period
3B) chronic infection
3C) death
50
What is the incubation period of infection?
it is the time from the pathogen entering the body to first sign/symptom onset
this is when the pathogen enters the body, colonizes, and multiplies
51
What is the prodromal phase of infection?
this is the stage after incubation period where SOME patients (not all) will experience mild symptoms of "not feeling well" or "coming down with something" but cannot actually pinpoint symptoms
52
What is the acute phase of infection?
this is when all signs and symptoms have manifested and its becoming evident that the pt has some type of infection
53
What are the 3 possible outcomes after the acute phase of infection?
3A) total recovery or a short convalescent period
3B) develops into chronic infection
3C) pt dies from infection
54
How long is the incubation period of infection?
anywhere from a couple days to weeks
55
How long is the prodromal phase of infection?
typically lasts only a few days
56
What does the acute phase of infection duration depend on?
pt immune system and/or medical intervention
acute phase length varies among each pt
57
What is the medical term for death from infection?
septicemia
58
If a pt has an acute infection and they begin to show signs of recovery what does this mean for the pathogen?
decreased reproduction and death of pathogen
host defenses take effect
nutrient supply decreases
wastes and cell debris increase
antibacterial drug
59
If a pt comes into your office with an infection, how are you going to correctly diagnose this?
Ex: you suspect pt has a wound infection, throat, or oral infection
options:
1) C&S (culture and sensitivity)
2) send pt home w/ broad spectrum antibiotics while C&S is being processed (or guess and give them something more specific)
3) blood culture
4) blood test (CBC w/ diff)
5) X-ray
60
What is a C&S?
take culture in office and send it to lab so they can test sensitivity
this will tell you what infection the pt has, what microorganism it is and what medication it is susceptible to
depending on microorganism it may take a few days to grow- (what should you do in this case? Send pt home with broad spectrum antibiotics or guess on microorganism if you have enough experience)
61
When should you do a blood culture if you suspect a pt has an infection?
only do a blood culture if you think the microorganism has entered the bloodstream
62
What blood tests should you be doing if your suspect a pt has an infection? What should you be looking out for?
do a full CBC panel w/ diff (this means WBCs, RBCs, and platelet count, as well as differential for each WBC type)
look out for:
- leukocytosis
-elevated neutrophils, lymphocytes, monocytes, CRP and SED rate, etc.
-leukopenia
-Abs
63
What is leukocytosis?
increase in WBCs, so if its elevated = infection
64
What do elevated neutrophil count mean?
acute infection
65
What do elevated lymphocytes/monocytes mean?
chronic infection
66
What is leukopenia?
decrease in WBCs/ WBC deficiency
67
What does CRP stand for?
C- reactive protein
68
What is another name for SED rate?
ESR- erythrocyte sedimentation rate
69
What does elevated CRP and SED rate mean?
some kind of inflammatory process
70
What are X-rays typically used for in terms of infection diagnosis?
pneumonia or TB
71
T/F:
only some microbes can infect the GI tract
FALSE
any microbe can infect GI tract
72
How long do most infectious diarrhea cases last? Does anything help it?
most last 2-3 days, OTC meds should help w/ N/V and diarrhea
73
What happens if you have infectious diarrhea for over a week? What is a major complication that can arise if left untreated?
leads to dehydration and electrolyte imbalance
complication: cardiac failure
74
Who is most vulnerable to infectious diarrhea?
elderly, young children, or immunocompromised
75
What are the 4 broad categories for GI tract infections?
1) environment
2) agent
3) host
4) site
76
What are the 3 environmental categories for GI tract infections (mode of transmission)?
1) water-borne
2) food borne
3) person to person (fecal oral spread)
77
What are the 3 agent categories for GI tract infections?
1) bacterial
2) viral
3) parasitic
78
What are the 3 sites for GI tract infections?
stomach, small intestine, large intestine
79
What type of diarrhea is produced through the small intestine if it is infected?
very copious amounts of watery diarrhea
ex bacteria that would cause this: V. cholerae
80
What type of diarrhea is produced through the large intestine if it is infected?
inflammatory or hemorrhagic diarrhea
81
Give an example on a bacteria that will cause diarrheal disease
Escherichia coli (E. coli)
82
name this bacteria:
a part of your bacterial flora, and if it overgrows it can cause diarrhea
Escherichia coli (E. coli)
83
How does gastroenteritis differ from E. coli diarrheal disease?
gastroenteritis also causes diarrhea but it is an infection of the stomach and upper portion of the small intestine
w/ gastroenteritis you will still have nausea and abdominal pain, but it can be treated quicker than infections in the lower GI tract
84
What is the most common cause of diarrheal disease in the world?
Escherichia coli (E. coli)
85
What is the most common cause of gastroenteritis in the US?
norovirus or rotavirus on cruise ships
86
What are the 3 types of infectious diarrhea? Where is this infection?
infection in small or large intestine
1) hemorrhagic diarrhea
2) secretory diarrhea
3) inflammatory diarrhea
87
T/F:
hemorrhagic diarrhea is actually a subcategory of inflammatory diarrhea
true
88
Hemorrhagic diarrhea is usually from an infection where?
large intestine
89
What bacteria usually causes hemorrhagic diarrhea?
Escherichia coli (E. coli)
90
How many toxins does E. coli produce? What do these toxins do?
E. coli produces 2 different types of toxins
these toxins can cleave your RNA and disrupt protein synthesis which ultimately kills the cells
91
What is the primary function of large intestine?
to absorb water
92
What happens to the toxins secreted from E. coli?
they will get into bloodstream and will undergo phagocytosis by neutrophils
for some unknown reason, neutrophils will also undergo endocytosis by the endothelial cells in the blood vessels
93
What happens once the toxins secreted from E. coli get into the walls of blood vessels?
it will start to destroy the walls of blood vessels
this will cause an inflammatory process called vasculitis
this is where bleeding comes from and why its called hemorrhagic diarrhea
94
Secretory diarrhea can be caused by....
1) bacteria (ex: V. cholerae)
2) viruses (ex: norovirus)
3) protozoa (ex: giardia)
95
What is giardia?
tiny parasite (germ) that causes the diarrheal disease giardiasis
96
If you drink/ingest contaminated water, you will most likely develop a _______ infection
hint: bacterial, viral, or protozoan
protozoan
if you drink/ingest contaminated water, you will most likely develop a protozoan infection
97
Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) toxins have how many subunits? What are they called?
2 subunits: A and B
98
What two bacterias share a similar pathogenetic mechanism in causing diarrheal illness?
Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC)
99
How does Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria gain entry into the body? How do they attack?
through ingestion of contaminated food and moves down the GI tract where it "attacks" in the small intestinal lumen
they release an enterotoxin that is composed of one A subunit and 5 B subunits
100
Describe process of A/B subunits in Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria releasing enterotoxins?
The B subunits bind to the intestinal cell membrane and facilitate entry of part of the A subunit
this results in a prolonged activation of adenylyl cyclase and the formation of cyclic adenosine monophosphate (cAMP), which stimulates water and electrolyte secretion by intestinal endothelial cells
101
Where are GPCR typically found?
gut tissue
102
List the 5 textbook steps for GPCR-adenylyl cyclase signal transduction and amplification
1) signal molecule binds to GPCR, which activates the G protein
2) G protein turns on adenylyl cyclase, an amplifier enzyme
3) adenylyl cyclase converts ATP to cyclic AMP
4) cAMP activates protein kinase A
5) protein kinase A phosphorylates other proteins, leading ultimately to a cellular response
103
What does Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria do to GPCR?
normal cell process (last step of normal GPCR)= once you activate the G protein, the A subunit is released and binds to something else
in bacteria= the toxin will signal to the subunit to bind to GPCR, GDP falls off and the subunit binds to adenylyl cyclase, but never leaves (it stays on continuously)
the toxin never releases itself from receptor, so then adenylyl cyclase converts ATP to cAMP
cAMP activates protein kinase A and carries out cell response, which in this case would be continuous activation of adenylyl cyclase, breakdown of ATP to cAMP, production of kinases and phosphorylations
this all keeps cystic fibrosis transmembrane regulator (CFTR) protein channels open continuously (obviously not good)
104
What is NKCC2?
its a normal pump within the body, stands for sodium potassium 2 chloride pumps
105
What are the 4 textbook steps for NKCC2 system in the lumen/intestinal cells?
1) Na+, K+, and Cl- enter by cotransport
2) Cl- enters lumen through CFTR channel
3) Na+ is reabsorbed
4) Negative Cl- in lumen attracts Na+ by paracellular pathway, water follows
106
How did we discuss NKCC2 system in class? Normal process only
chloride travels from interstitial fluid through the cell and out to the lumen, potassium enters cell from interstitial fluid and then back out to fluid
sodium pumps from fluid into cell, back out to fluid and then between cells (paracellular method=between)
there are so many anions leaving that Na+ follows, so water does too (because water always follows sodium)
107
What happens once the NKCC2 system is done?
hint: all chloride that was needed to be removed was a removed, now what?
the channels close and stop
108
How does Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria affect the NKCC2 system? What does this lead to?
they keep the CFTR channels open continuously (Cl- always leaving, Na+ leaving and water always following)
copious amounts of water leads to an incredible amount of secretory diarrhea which destroys the cells and does not allow them to absorb water (hijacks the system)
this leads to volume/electrolyte depletion and dehydration, additionally, blood is primarily water, so when water is being depleted, blood is too and this causes a decrease in BP, in severe cases a pt can die from this
109
What is it called when there is lots of water loss with Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria
hint: SECRETORY DIARRHEA
this is known as rice water stools because the diarrhea is so watery and white
110
What is the easiest treatment for secretory diarrhea caused from Vibrio cholerae (V. cholerae) and enterotoxigenic E. coli (ETEC) bacteria?
saline solution (IV bag)
111
List some S&S for inflammatory diarrhea
water loss & diarrhea (obviously)
FEVER (only one of the 3 types of diarrhea has fever)
usually the stool has mucus in inflammatory diarrhea
blood present = dysentery
112
What is dysentery most commonly caused from?
shigella and salmonella
113
What is dysentery? Talk about the process of infection
enterocytes enter the GI system, multiply, release toxins, and the cells die, which causes minimal water absorption & severe bloody diarrhea
114
Do cells die only from toxins (in the case of inflammatory diarrhea)?
NO- some cells die as part of inflammatory response, not just from the toxins!!!!
115
what type of infection is influenza?
viral infection
116
What antigenic shift type strain is most well known for the flu? Why? What is it? Talk about its significance
Type A H1N1
this flu strain had the largest number of recorded deaths in 2009
Type A H1N1 is one of the subtypes of type A
It was found to have genetic material from humans, pigs, and birds
117
Who is most susceptible to the flu?
children, elderly, and immunocompromised
118
RNA viruses are a part of what family of viruses?
hint: big umbrella term
myxovirus
119
What are the 3 subgroups for the flu?
type A, B, and C
120
Which subgroup of the flu is most prevalent?
type A
121
List some characteristics for type A influenza (flu)
most prevalent type
mutates a lot
can jump from species to species (this is called antigenic shift)
122
What does it mean for us if the flu virus can mutate so often?
we cannot develop a good immunity to it
we also end up playing catch up with the vaccine every time it mutates
123
How is influenza transmitted?
through droplets or indirect methods
124
What is the lifespan of RBCs?
approx 120 days
125
What is the lifespan of WBCs?
approx 1-3 days
126
What is the lifespan of neurons?
years
127
Cells have an elaborate system that detects changes in DNA. What are the 2 options in this case for once those changes are detected?
1) repair DNA
2) undergo apoptosis
128
When does neoplasia happen?
when the system for detecting changes in DNA fails and does not repair or force cells into apoptosis
129
What is apoptosis activated by?
intrinsic pathways in response to stressful or catastrophic cellular events or by the extrinsic pathway in response to a signaling instruction to cell death receptors
130
How do cancer cells suppress the apoptotic response?
by upregulating the anti-apoptotic proteins or downregulating the pro-apoptotic proteins
131
Epithelial cells are constantly undergoing turnover. What happens as you age?
with time, function will decrease and cells will die
132
What are benign tumors?
growth doesn't affect organism overall or health, "normal" encapsulated cells
133
What are malignant tumors?
abnormal cells reproducing faster than normal cells, abnormal mitotic figures (under microscope), can invade tissues, metastasis or spread, can invade other tissues/organs, unorganized/abnormal cell shape
134
What are neoplasms (tumor)?
abnormal cell growth with abnormal architecture and sometimes loss of homeostasis
135
How does a benign tumor differ from a malignant tumor in terms of borders?
benign tumors are encapsulated with clear borders and are typically just an overgrowth of tissues, whereas malignant tumors are invading surrounding tissue and looks somewhat chaotic
136
What is the pre-clinical phase of neoplasia?
genetic abnormalities with proliferation of abn cells
pt cannot detect any issues (not sick, no S&S)
medical screening MIGHT catch something, but not always
137
What is the clinical phase of neoplasia?
symptomatic phase
138
What do ECM proteins do? What happens if they're hijacked?
allow normal cells to adhere to something (most often cell-to-cell adhesion)
if they're hijacked then this is how cells are invaded with cancer
139
What are non-neoplastic cell changes? Give an example
cell growth or changes that are not necessarily cancerous
ex: growing children, pregnant mama, ulcers, etc.
140
What may cause neoplastic cell changes?
stochastic events (random)
age
environment
OR DNA might mutate, but show no effect on the body (unknown cause)
141
What are the 5 deviations from a normal cell?
1) atrophy
2) hyperplasia
3) hypertrophy
4) metaplasia
5) dysplasia
142
Define molecular profiling
study of DNA/RNA changes in cells
143
What is the primary precursor for cancer?
hint: its a type of deviation from normal cell
dysplasia
144
Define atrophy of the cells
decrease in size of cells
145
Define hyperplasia of cells
increase in the number of cells
146
Define hypertrophy of cells
increase in size of cells
147
Define metaplasia of cells
converts to other cell types (this process is reversible)
148
Define dysplasia of cells
cells return to immature cell state (lack of differentiation)
149
What part of the immune system will respond to cancer first?
the innate immune system
150
Inflammation of normal cells, if prolonged, can promote....
tumorigenesis
151
T/F:
The inflammatory response can also contribute to tumorigenic growth once a tumor has developed
true!!!!
152
Chronic inflammation can cause/trigger cancer. What is the example we went over in class? Talk about it
IBD (inflammatory/irritable bowel disease) may cause ulcerative colitis long term, which can lead to colon cancer
153
The inflammatory response usually causes ______ of some enzymes
hint: upregulation or downregulation
upregulation
The inflammatory response usually causes upregulation of some enzymes
154
What are the 2 most common enzymes that are upregulated in inflammatory response?
COX1 and COX2
155
What is the function of COX1/2?
they catalyze the synthesis of prostaglandins (which also participate in inflammation)
156
What is the most common COX1/2 inhibitor?
celebrex, it's an NSAID
157
Can the immune system detect cancer?
Yes, the immune system can recognize foreign peptides such as mutated residues from cancer cells
158
What immune system cell detects cancer?
activated cytotoxic T cells can identify some tumor cells expressing the mutated residue and kill them
159
Does the immune system have checkpoints like the cell cycle?
yes, these checkpoints are built in to restrain the immune system from over aggressive targeting
160
What interactions are involved in immune system checkpoints for detecting cancer cells? What is an example?
both stimulatory and inhibitory interactions
ex: PD-L1 by many tumor cells is a mechanism that enables them to suppress the cytotoxic actions of activated T cells and escape the immune system
161
What do cancer cells (and normal cells) need to grow?
nutrition! This comes from our food
162
What happens with cancer cells when they want to grow? What is the most common example?
They will release angiogenic growth factors that cause blood vessels to grow and give them more nutrients faster
the most common of these growth factors is VEGF (vascular endothelial growth factor)
163
What is normal cell metabolism with abundant oxygen? Does this generate a lot of ATP?
normal cells metabolize glucose using glycolysis followed by oxidative phosphorylation in the mitochondria when oxygen is abundant
this method generates plenty of ATP molecules compared to other methods and is more efficient
164
Describe (normal) cell metabolism with low oxygen
If the oxygen is limited, cells instead convert the pyruvate to lactate and increase the rate of glycolysis to generate ATP, although this is a far less efficient mode of generating ATP
165
Describe tumor cell metabolism
tumor cells convert pyruvate to lactate even when oxygen is abundant and thus have higher glycolytic rates to meet their energy demands. This observation is called the Warburg effect
166
What is an additional step tumor cells can do to make sure they have enough nutrients and grow?
use up amino acids in the body!
ex: serine and glutamine
167
What are the 3 different types of embryonic tissue?
ectoderm, mesoderm, and endoderm
168
Where are sarcomas derived from? What tissue is it? Give a few cancer examples
sarcomas are derived from mesoderms
this is connective tissue types of cancer
ex: bone, blood, muscle, cartilage cancer, etc.
169
Where are carcinomas derived from? What tissue is it? Give a few cancer examples
carcinomas are derived from ectoderms and endoderms
this is the most common type of cancer
this tissue type forms all of the epithelial tissues in body
ex of carcinomas: prostate cancer, breast, lung, colon, etc.
170
What is the best example of hyperplasia in normal cases?
pregnant mamas
171
What does carcinoma in situ/pre-invasive mean?
the tumor cells have not broken through the basement membrane yet
172
What does invasive carcinoma mean?
tumor cells have breached the basement membrane, goes into tissues underneath the membrane, can release collagenases (breaks down connective tissue so they can move through tissue more easily)
173
What does metastatic focus mean?
cancer cells have entered the circulatory system
174
T/F:
metaplasia is irreversible
FALSE
175
T/F:
dysplasia is irreversible, and once the cells multiply in this state it is considered neoplasia
TRUE
176
In breast cancer, what is the most common secondary cancers after the tumor cells metastasis?
breast cancer + liver or lung cancer
177
What cancer commonly spreads through seeding? What is seeding?
ovarian cancer
seeding happens primarily in body cavities and its when cells just break off and can move through the empty space
another method of seeding is when it is inadvertently done in a medical procedure (ex: attempting to remove tumor and cells are left behind that spread further)
178
What are the 8 stages of phenotypic changes in the progression of neoplasia?
1) genomic instability
2) enhanced proliferation
3) evasion of immune system
4) invasion of tissue and stroma
5) ability to gain access to and egress from lymphatics and bloodstream
6) establishment of metastatic foci
7) ability to recruit vascularization to support growth of primary or metastatic tumor
8) drug resistance
179
What are the characteristics of genomic instability in the progression of neoplasia?
impaired DNA repair and aberrant cell cycle checkpoint
180
What are the characteristics of enhanced proliferation in the progression of neoplasia?
-autonomous growth
-abnormalities of cell cycle control
-exaggerated response to hormonal or growth factor stimuli
-lack of response to growth inhibitors or cell contact inhibition
181
What are the characteristics of evasion of immune system in the progression of neoplasia?
-antigen modulation and masking
-elaboration of immune response antagonistic molecules
182
What are the characteristics of invasion of tissue and stroma in the progression of neoplasia?
-attachment of ECM
-secretion of proteolytic enzymes
-recruitment of stromal cells to produce proteolytic enzymes
-loss of cell cohesion
183
What are the characteristics of the ability to gain access to and egress from lymphatics and bloodstream in the progression of neoplasia?
-enhanced cell motility
-recognition of endothelial protein sequences
-cytoskeletal modifications
184
What are the characteristics of establishment of metastatic foci in the progression of neoplasia?
-cell adhesion and attachment
-tissue-specific tropism
185
What are the characteristics of drug resistance in the progression of neoplasia?
-altered drug metabolism and drug inactivation
-increased synthesis of targeted enzymes
-enhanced drug efflux
-enhanced DNA damage repair
186
What is the grading scale for tumors? What is 1 and 4?
1-4
1= differentiated cells
4= undifferentiated cells, anaplastic (different sizes/shapes), highly malignant
187
Pain is one of the stages of inflammation and can also be from growing tumors. What can this lead to?
obstructions (primarily in tubular organs such as respiratory airways and digestive tract)
188
Tissue necrosis is most common in which cancer?
oral cancers (ulcers + necrotic tissue)
189
What is cachexia?
severe weight loss/severe muscle wasting during cancer/treatment
190
If cancer/treatment affects the bone marrow, then the pt will develop.....
anemia
191
What is the most common initial sign of anemia?
fatigue
192
List some issues that may arise from cancer/treatment
-vasculitis
-thrombocytopenia (complication = hemorrhaging)
-anemia
-paraneoplastic syndrome (indirect systemic effects of neoplasms)
-hormonal changes
-cachexia (severe weight loss)
193
List some direct systemic effects of neoplasms
-vessel compression
-vessel invasion and erosion
-lymphatic invasion
-nerve invasion
-brain metastases
-spinal cord compression
-bone invasion and destruction
-bowel obstruction and perforation
-airway obstruction
-ureteral obstruction
-liver invasion and metastases
-lung and pleural metastases
-bone marrow infiltration
194
What is a cancer we learned in class that can produce 2 different hormones? What are the hormones and what will the patient present with on top of their cancer symptoms?
bronchogenic cancer can produce ACTH, which will lead to S&S of Cushing's syndrome
can also produce ADH (antidiuretic hormone) which leads pt to manifest S&S of SIADH (syndrome of inappropriate ADH)
195
What is the pathologic tumor-node-metastasis (TNM) staging system for breast cancer? What does each letter stand for and list each stage
T= size of tumor
N= node involvement
M= metastasis
Stages:
1) when tumor is less than 2cm in diameter and is very localized
2) less than 5cm and nodes are involved
3) greater than 5cm and nodes are involved
4) tumor is LARGE, metastasis, and nodes are involved
196
What is the most common cancer based on lifestyle choices?
lung cancer from cig smoking
197
What are the treatment options for cancer?
chemo, radiation, surgery, immunotherapy, etc.
most cancer treatments are prophylactic methods (preventative)
198
Before you start any type of cancer treatment, what should you do?
handle all other medical procedures/problems, especially dental procedures
199
What are some additional sources cancer patients need on top of family and their regular treatment?
mental health therapy, nutrition counseling, physical therapy, etc.
200
What is a lumpectomy?
a lump is removed from the breast, typically when cancer is present but has not spread
201
What is a partial mastectomy?
removal of cancer/abnormal tissue from the breast and some normal tissue around it, but not the whole breast
202
What is a total mastectomy?
a surgical procedure to treat breast cancer by removing an entire breast
203
What is a modified radical mastectomy?
surgical removal of the entire breast including the breast tissue, skin, and nipple, and most of the underarm (axillary) lymph nodes
204
What is radiofrequency ablation (RFA)? What tumor is it typically used for?
it's a procedure that utilizes CT scans and an ultrasound probe on the skin with electrodes that magnifies an ultrasound beam to the tumor area and destroys the tumors cells/surrounding tissue with heat/radio waves
this is most commonly done with liver cancer
205
What is a common complication with a modified radical mastectomy?
lymphedema!!!!
206
This is a motivational flashcard:
We have made it so far. We will do amazing on Exam 1! I love you! You got this
+ one point/gold star for good effort
207
What is the purpose of using radiation before surgery for cancer?
to attempt to reduce the tumor size and margins
208
What are the 3 types of radiation?
1) external beam radiation
2) brachytherapy (internal radiation)
3) proton beam therapy
209
What is the most common radiation protocol?
everyday for 6 weeks
210
What is the purpose of radiation after surgery for cancer?
to try to destroy any remaining cancerous tissues (this unfortunately also destroys regular cells and blood vessels - which decreases nutrients to tumor/healthy cells)
211
What is brachytherapy (internal radiation) therapy?
a procedure that takes little devices known as seeds that have radioactivity and are placed into the tumor region
this is used to treat cervical, prostate, and some types of breast cancer
212
List some side effects of radiation therapy
-fatigue
-lethargy
-depression
-anemia
-susceptible to infections such as pneumonia or septicemia
-susceptible to heavy bleeding (if this is severe reaction then radiation will need to be stopped)
213
Radiation of pelvic region w/ people of reproductive age will be told to....
store their eggs/sperm
214
Radiation can cause damage to epithelial cells. We talked about damage to the skin, blood vessels, GI tract, and hair follicles- what are the complications of this damage?
skin: may look like pt has sunburn
blood vessels: may result in vasculitis
GI tract: may result in nausea and vomiting
hair follicles: may develop alopecia
215
head and neck radiation may cause....
oral ulcers or xerostomia (dry mouth- which will lead to difficulty chewing and swallowing and this decreases nutritional intake)
216
Chemotherapy is a combination of drugs. What are they?
classified as antimitotics, antimetabolites, alkylating agents, and antibiotics
217
What is the most common therapy for Hodgkin's disease?
chemotherapy, specifically ABVD therapy
218
What is the ABVD therapy frequency?
given to pt on day 1 and day 15, and then after that once a month until theres a decrease in tumor cells (will be adjusted as needed)
219
Why is ABVD given in sporadic measurements?
it's such a high conc. of drugs that there will need to be a rest period so that the normal cells can have a little time to heal
220
What does the A stand for in ABVD therapy? What type of drug is it and how does it work?
A= adriamycin
it is an antimitotic and antitumor antibiotic drug
it works in the S phase of cell cycle where it will disrupt DNA synthesis/replication
221
What does the B stand for in ABVD therapy? What type of drug is it and how does it work?
B= bleomycin (also known as blenoxane)
it is an antitumor antibiotic and it works in the S phase of the cell cycle
222
Why are A and B of ABVD therapy called antibiotics?
Ex: penicillin is derived from fungus, same goes for antitumor antibiotics (it comes from a natural source)
For A/B of ABVD therapy, they come from streptomyces which is derived from soil fungus
223
What does the V stand for in ABVD therapy? What type of drug is it and how does it work? What is it derived from?
V= vinblastine (also known as velban)
it is a plant alkaloid drug and is derived from vinca (look at periwinkle flowers!)
it works in mitosis phase of the cell cycle by disrupting mitosis
224
What does the D stand for in ABVD therapy? What type of drug is it and how does it work?
D= dacarbazine
it is an alkylating agent and is nonspecific, which means it works in all phases of the cell cycle
225
How are side effects similar/different between chemo and radiation?
chemo has the same side effects of radiation BUT, nausea and vomiting is heavily increased in chemotherapy compared to radiation
226
What are the 2 hormonal drugs we talked about for cancer?
estrogen to slow down the progress of prostate cancer
hormone blocking agents such as estrogen blockers for breast cancer that is estrogen dependent
227
What is prednisone used for in cancer?
to decrease inflammatory processes
228
What is a drug ex with immune action for cancer? What is it/how does it work?
Herceptin binds to receptors on breast cancer cells and prevents them from dividing
this is considered an immunotherapy bc it binds to the cancer cells and triggers the body's immune system for phagocytic cells to come in and take tumor cells through phagocytosis
229
What are antiangiogenic drugs for in cancer? What is the most common example?
prevent angiogenesis (won't allow the blood vessels to increase in size and number)
most common ex: avastin inhibits VEGF
230
Where is basal cell carcinoma most commonly found?
on head/neck region due to sun exposure
231
What is the most common skin malignancy?
basal cell carcinoma
232
What is the typical age range for people diagnosed with basal cell carcinoma?
most common in people 40+ years old and fair complexion
233
How does a basal cell carcinoma lesion look like?
starts off as a papular lesion with raised margins and center will become ulcerated (this is called a "rodent ulcer")
234
T/F:
ovarian cancer is considered a multifactorial disease
TRUE
235
What is one of the silent tumors we talked about in class?
ovarian cancer
236
What are the first signs of ovarian cancer?
abdominal area is increasing in size
changes in bladder/bowel function (this is because the increasing tumor size infringes on the organs)
237
What is the biomarker used for a number of cancers? What is it used for?
CA125 is used to gauge the response to treatment (look at the levels of CA125 and hopefully in time they decrease with treatment and treatment can be adjusted)
238
Do brain tumors in general affect all age groups equally?
yes, adults and children are affected equally
239
Are benign and malignant brain tumors equally damaging, or no? Why, or why not?
both are equally damaging because there is no space for the tumor to push out/grow because of the skull, so this will lead to lots of pressure in the brain
240
What are some of the first signs of brain tumors?
headache
drowsiness
impaired motor function
visual disturbances
241
Brain cancers rarely metastasis. Why?
because it's already fatal
however, other cancers can metastasize to the brain easily (ex: lung, breast, liver cancer metastasis to the brain the easiest/most often)
242
If the tumor is on the cerebellum or brainstem....
then it is usually fatal bc of all the important centers in that region
243
What are the characteristics of glioblastoma multiforme?
necrotic tissue and hemorrhaging (eating the normal tissue away)
244
Where do lymphoid neoplasms originate from?
immature/mature T cells, B cells, and NK cells
245
What are the 3 types of hematologic cancers we talked about in class?
leukemia, lymphoma, and multiple myeloma
246
Where is leukemia derived from?
immature leukocytes
247
Where is lymphoma derived from?
mature lymphocytes
248
What is another name for multiple myeloma? What is it derived from?
plasma cells myeloma, derived from plasma cells
249
Where is Hodgkin's lymphoma derived from?
lymph nodes, bone marrow, and other lymphoid organs
250
What are the characteristics of Hodgkin's lymphoma?
characterized histologically by Reed-Sternberg cells
usually started in one lymph node and then progresses in an orderly fashion throughout body
occurs equally in men/women and between the ages of 20-40
251
What is the first lymph node that is most commonly infected with Hodgkin's lymphoma?
cervical lymph node, it becomes enlarged but initially painless
252
What is the staging system called for Hodgkin's lymphoma? What are the stages?
Cotswold staging system
1) 1 lymph node/area showing cancerous region
2) 2+ lymph nodes/regions involved, but all on one side of diaphragm
3) nodes on both sides of the diaphragm and the spleen is most commonly infected
4) metastasis (most commonly to liver and/or lungs)
253
S&S of Hodgkin's lymphoma:
-infections become common
-pain throughout body
-pruritis throughout body
-weight loss
-fatigue
-anemia
-low grade fever
254
What is the best treatment option for Hodgkin's lymphoma?
ABVD therapy (chemo)
255
What is non-Hodgkin's lymphoma?
any lymphoma that is not Hodgkin's lymphoma is considered non-Hodgkin's lymphoma
256
Where does non-Hodgkin's lymphoma most commonly develop?
in immunocompromised patients (ex: HIV pt)
257
What is non-Hodgkin's lymphoma associated with?
viruses such as EBV and areas of chronic immune stimulation
ex: gastritis caused from Helicobacter pylori (H. pylori) can affect MALT (mucosa associated lymphoid tissue) and eventually develop into non-Hodgkin's lymphoma
258
80% of non-Hodgkin's lymphoma originates from.....
B cells thats express CD20
this lymphoma involves multiple lymph nodes throughout body and usually genetically predisposed (translocation of chromosome 14)
259
What is more difficult to treat non-Hodgkin's lymphoma or Hodgkin's lymphoma?
non-Hodgkin's lymphoma is more difficult to treat
260
What are the 2 subgroups for non-Hodgkin's lymphoma?
indolent non-Hodgkin's lymphoma and aggressive non-Hodgkin's lymphoma
261
What is indolent non-Hodgkin's lymphoma?
slow growing, painless initially
262
What are the 2 examples for indolent non-Hodgkin's lymphoma?
1) follicular lymphoma is caused from a translocation that results in overexpression of an oncogene that is going to inhibit apoptosis and this is very difficult to cure, however it is non-aggressive. Within 10 years of having follicular lymphoma, 50% of pt will go on to develop a more aggressive type
2) marginal zone lymphoma (MZL) is one subtype of the MALT type of lymphomas and it grows slowly but is treatable and lots of pt can undergo remission
263
Aggressive non-Hodgkin's lymphomas are most often.....
incurable
264
What are the 3 examples for aggressive non-Hodgkin's lymphoma?
1) mantle cell lymphoma is caused from a translocation that overexpression cyclin D1 (cyclin D1 activates cyclin dependent kinases that keep on G1 phase of mitosis), so mitosis is basically always on, however it is unknown why this is more prevalent in men specifically older men
2) diffuse large cell lymphoma is the most common subtype and has the worst prognosis (1/3 of pt go on to metastasis to bone or stomach cancer typically)
3) Burkitt lymphoma is associated with EBV
265
What does it mean if apoptosis is inhibited in cancer?
cells will keep multiplying and growing
266
What are the characteristics of multiple myeloma?
-punched out lesions
-primarily occurs in adults age 50+
-pt produce huge numbers of abnormal plasma cells/Abs
-multiple mutations in multiple genes
-the abnormal plasma cells accumulate in the bone, bone marrow, and soft tissue
-not producing normal Abs= more susceptible to infection
-anemia
-Abs are in bloodstream and kidneys filter through this- so, abnormal Abs can damage the kidneys and pt may go into renal failure
-Abs accumulating in bone = pressure buildup/pain
-osteoclasts break down bone so bones become weak and fracture easily
-as bones are broken down they release lots of calcium, so pt may suffer from hypercalcemia
-even with treatment. average survival rate is approx 3 years
MNEMONIC= CRAB
C= hypercalcemia
R= renal failure
A= anemia
B= bone fractures/lesions
267
Sepsis is a clinical syndrome characterized by....
a dysregulated inflammatory response to infection
268
What is the leading cause of morbidity and mortality in the US?
sepsis
269
What is systemic inflammatory response syndrome (SIRS)?
clinical syndrome that is a form of dysregulated inflammation and may be seen with infection as well as with noninfectious states such as pancreatitis, pulmonary embolism, and myocardial infarction
270
Sepsis generally starts with....
a localized infection
271
Define endotoxin
lipopolysaccharide (LPS) moiety contained in the outer membrane of gram-neg bacteria
it is composed of an outer polysaccharide chain the O side chain, which is a highly conserved lipid portion (lipid A) which is embedded in the outer bacterial membrane
272
Myocardial depression is a common finding in.....
early septic shock
273
Most patients who die of septic shock have either.....
refractory hypotension or multiple-organ failure
274
What are the 6 types of cellular DNA repairs?
1) base excision repair
2) mismatch repair
3) nucleotide excision repair
4) homologous recombination repair
5) non-homologous end joining
6) microhomology-mediated end joining
275
Loss of epigenetic control of chromatin is commonly seen in cancer cells, leading to....
abnormal expression of many genes, increased susceptibility to DNA damage, and errors in mitotic separation
276
What is aneuploidy regarding tumor cells?
tumor cells frequently have many more than the 46 chromosomes of normal cells
