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WGU Pathophysiology > Lesson 7 Lymphatic System part 3 > Flashcards

Lesson 7 Lymphatic System part 3 Flashcards

1
Q

This is a multisystem autoimmune disease characterized by autoantibodies particularly antinuclear antibodies (ANAs). It is a chronic disease that can have an acute or insidious onset. It is characterized by remissions and exacerbations with fever; skin rash; joint inflammation; and damage to the kidney, lungs, and serosal membranes

A

Systemic Lupus Erythematosus

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2
Q

Are males or females more likely to be affected by Systemic Lupus E.?

A

Women are 8-10 times more likely

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3
Q

What are the risk factors for Systemic Lupus E?

A

genetic predisposition
environmental
hormonal
immunological
genetic alterations
(presence of Epstein-Barr virus antibodies, meds like hydralazine)

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4
Q

exposure to what exacerbates Systemic Lupus E?

A

UV light

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5
Q

Which hormone is linked to Systemic Lupus E?

A

Estrogen, which can cause exacerbation of disease during menses or pregnancy

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6
Q

Which organ is particularly susceptible in Systemic Lupus E?

A

Kidneys (deposition of immune complexes triggers an inflammation reaction that damages small blood vessels and various organ membranes) Leads to glomerular damage= Lupus nephritis

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7
Q

What is the classic sign of Systemic Lupus E?

A

Classic butterfly rash across bridge of nose and cheeks

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8
Q

What are the other s/s of Systemic Lupus E?

A

Joint inflammation and musculoskeletal symptoms occur in 90% of patients. Other signs include splenic enlargement, pleural effusion, vasculitis, pericarditis, anemia, and thrombocytopenia. Nephrotic syndrome with hypertension and hematuria are common manifestations. Nephrotic syndrome often causes edema; periorbital or peripheral edema is common.

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9
Q

This is an episodic vasospasm of the arteries supplying the fingers, is common; it is observed as a tricolor change in the fingers from cyanosis to pallor to rubor particularly upon exposure to the cold seen with Systemic Lupus E patients

A

Raynaud’s phenomenon

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10
Q

What is the goal for therapy for patients with Systemic Lupus E?

A

to ensure long-term survival, achieve the lowest possible disease activity, prevent organ damage, minimize drug toxicity, improve quality of life, and educate patients about their role in disease management.

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11
Q

What are the 2 unusual diseases contracted by thought to be healthy homosexual males in 1981 that led to the discovery of HIV?

A

Pneumocystis carinii pneumonia and Kaposi’s sarcoma

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11
Q

What are med treatments for Systemic Lupus?

A

Pharmacological treatment includes NSAIDs, antimalarial drugs, corticosteroids, methotrexate (MTX), and immunosuppressive drugs. Combination therapy with NSAIDs and the antimalarial drug hydroxychloroquine provides additive anti-inflammatory effects.

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12
Q

What are the three stages of HIV ?

A

Acute HIV infection
Chronic HIV infection
AIDS

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13
Q

What is the term for the segment of population that is completely resistant to HIV infection, due to gene mutation where they lack a key surface receptor on T cells and macrophages?

A

HIV resistors: they do not have a receptor for HIV on their CD4 cells

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14
Q

What kind of pathogen is HIV?

A

Retrovirus

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15
Q

What are the two major strains of HIV

A

HIV-1: united states
HIV-2: west africa

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16
Q

What does the HIV pathogen target in the body?

A

CD4 receptor and the chemokine receptors which affect T lymphocyte/T helper cells/CD4 T cells, monocytes, and macrophages and dendritic cells

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17
Q

What is the hallmark of HIV due to what it targets and why is so detrimental to the body’s immunity?

A

A progressive depletion of CD4 T cells: it’s integral to BOTH cell mediated and antibody mediated immune responses

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18
Q

What acts as reservoirs of HIV in the body, which allows for viral persistence that can be undetectable in lab tests?

A

macrophages, believed to be vehicles for dissemination, host cell becomes a factory for manufacturing more virusses

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19
Q

What usually causes death in HIV /AIDS patients?

A

opportunistic infections due to decreased immunity caused by the HIV virus

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20
Q

What is the enzyme used by HIV to transform its RNA into DNA?

A

reverse transcriptase

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21
Q

What are the initial symptoms of someone who’s contracted acute HIV

A

mononucleosis-like viral syndrome consisting of fever, headache, fatigue, pharyngitis, GI symptoms, lymphadenopathy, arthralgias, and myalgia. (occurs within 28 days of contracting)

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22
Q

Even though antibodies are not present in acute HIV, patient appears healthy, asymptomatic, can the person transmit HIV?

A

YES, viral particles can be detected in the bloodstream. During this time individuals with the virus can transmit it to others without knowing that they have an infection.

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23
Q

What is the normal range of CD4 cells and when is immunological impairment significant?

A

800 to 1,200 cells/mm3
Immunological impairment becomes significant when the CD4 cell count goes below 500 and an affected individual starts to become susceptible to opportunistic infections

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24
Q

When is the diagnosis of AIDS made?

A

When the CD4 cell count diminishes to 200 and there is existence of an opportunistic infection

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25
Q

This is associated with HIV infection. It is a cancerous condition of the endothelium caused by a type of herpes virus, exhibited by red to purple papular lesions on the skin and mucous membranes.

A

Kaposi’s sarcoma

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26
Q

Other common opportunist infections and diseases associated with HIV

A

Candidiasis (thrush),
Cryptosporidiosis, Cryptococcal meningitis, Cytomegalovirus (CMV), Hepatitis A, B, and C, Herpes simplex (cold sores and genital herpes), Herpes zoster (shingles)
Human papillomavirus (HPV)
Kaposi’s sarcoma (KS)
Molluscum contagiosum
Mycobacterium avium complex (MAC)
Pneumocystis jirovecii pneumonia
Progressive multifocal leukoencephalopathy (PML)
Toxoplasmosis, Tuberculosis (TB)

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27
Q

What is the most accurate measurement of the degree of immune system impairment?

A

CD4 count

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28
Q

This is the most accurate measure of the number of viruses in the bloodstream

A

HIV RNA blood test AKA viral load

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29
Q

What is important to note if the viral load of an HIV patient falls to undetectable levels?

A

the virus is still present in the body in tissue reservoirs and the patient can still transmit the virus to others—it is just not measurable by current blood tests.

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30
Q

What other tests should the provider order for a patient with HIV?

A

STD tests: syphilis, gonorrhea and chlamydia

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31
Q

What treatment is recommended for HIV?

A

Early initiation of ART is recommended. Recent studies have shown that very early initiation of ART can preserve immune function and reduce complications.
Different kinds of ART (antiretroviral therapy) are used to attack virus at various stages in the life cycle

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32
Q

These are solid tumors of lymphoid cells, an example is Hodgkin’s

A

Lymphomas

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33
Q

These cause proliferation of cancerous WBCs. affects 350K people/year and 90% of them are adults. However, it is the 3rd most common cancer in children

A

Leukemias

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34
Q

All blood cells arise from a small number of undeveloped, precursor cells in the bone marrow called

A

pluripotent stem cells

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35
Q

The process of creating blood cells from undeveloped, precursor cells in the bone marrow is called:

A

hematopoiesis

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36
Q

These are the pluripotent stem cells of WBCs in the bone marrow.

A

myeloid and lymphoid stem cells

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37
Q

These WBCs are derived from myeloid stem cells

A

granulocyte and monocyte cells
(Granulocytes= neutrophils, eosinophils and basophils)

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38
Q

These WBCs are known as granulocytes

A

neutrophils, eosinophils, and basophils

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39
Q

These WBCs are without granules and are sometimes called agranulocytes

A

monocytes and lymphocytes

40
Q

These WBCs are derived from lymphoid stem cells

A

lymphocytes

41
Q

What is the name for the immature precursor cells for each WBC cell line

A

Blast cells, from the blast cell stage, each type of WBC begins to differentiate and mature along a committed cell line

42
Q

Percentage of Neutrophils in a WBC differential:

A

40-80%

43
Q

percentage of immature neutrophils (bands)in a WBC differential:

A

0-10%

44
Q

Percentage of lymphocytes in a WBC differential:

A

20-40%

45
Q

Percentage of monocytes in a WBC differential:

A

2-10%

46
Q

percentage of eosinophils in a WBC differential:

A

1-7%

47
Q

Percentage of basophils in a WBC differential:

A

0-2%

48
Q

Where do lymphocytes complete the maturation process?

A

lymphoid tissue:
B lymphocytes develop into plasma cells within lymph nodes
T lymphocytes continue in thymus gland= T helper (CD4) and cytotoxic T (CD8) and then move to lymph nodes for proliferation

49
Q

Which organ is rich in lymphoid tissue?

A

spleen

50
Q

What are the stages of monocyte formation?

A

Pluripotent stem cell–> Myeloid stem cell –> Monoblast –> monocyte

51
Q

what are the stages of neutrophil, basophil and eosinophil formation?

A

Pluripotent stem cell–> Myeloid stem cell –> Meloblasts–> Neutrophil, basophil or eosinophil

52
Q

What are the stages of platelets/thrombocytes formation?

A

Pluripotent stem cell–> Myeloid stem cell –>Megakaryoblasts–> megakaryocytes–> thrombocytes

53
Q

What are the stages of RBC formation?

A

Pluripotent stem cell–> Myeloid stem cell –>Erythroblasts–> Reticulocyte–> Erythrocytes (RBC)

54
Q

What are the stages of B lymphocytes and T lymphocyte formation?

A

Pluripotent stem cell–> Lymphoid stem cell –> Lymphoblasts
-B lymphocytes (processed in bone marrow)
T lymphocytes (processed in thymus)

55
Q

Because of the shape of their nucleus, mature neutrophils are referred to as

A

Segs

56
Q

immature neutrophils are called, these in circulation indicate that the bone marrow is working very hard to manufacture enough WBCs for the infection or inflammatory disorder in the body.

A

bands

57
Q

These are generated and released by the bone marrow in response to many inflammatory reactions, particularly parasitic infection. The mediators histamine and heparin assist in the migration of neutrophils to an inflammatory site.

A

Basophils

58
Q

These leukemias affect the myeloid lineage of WBCs

A

myelocytic leukemia

59
Q

These leukemias affect the lymphoid lineage

A

Lymphoblasic or lymphogenous leukemia

60
Q

This is an aggressive cancer that is more common in children than adults. 75% of all pediatric leukemia cases, with most affected children under age 5. Survival rates are 90% in children but only 20% to 40% in adults.

A

Acute Lymphoblastic Leukemia

61
Q

What are the clinical signs and symptoms of Acute Lymphoblastic Leukemia related to?

A

related to the extent of replacement of the bone marrow with cancerous lymphoblast cells. Because cancerous lymphoblasts do not function and crowd out healthy WBCs in the bone marrow

62
Q

What are the signs and symptoms of Acute Lymphoblastic Leukemia

A

frequent infection, ranging from infected tonsils, canker sores, and diarrhea to life-threatening pneumonia or opportunistic infections.
may present with anemia, which causes fatigue, weakness, dizziness, dyspnea, and pallor. Some patients experience other vague symptoms, such as fevers, chills, night sweats, and other flulike symptoms.

63
Q

Why does a patient with Acute Lymphoblastic Leukemia present with anemia, which causes fatigue, weakness, dizziness, dyspnea, and pallor.

A

because of cancerous lymphoblasts crowding out healthy RBCs in the bone marrow

64
Q

What is often the initial sign of ALL or Acute Lymphoblastic Leukemia?

A

enlarged lymph node or spleen because cancerous lymphoblast cells proliferate within lymph nodes and the spleen and liver, increasing the size of these organs.

65
Q

What causes bone pain in ALL (Acute Lymphoblastic Leukemia) patients?

A

Cancerous lymphoblast cell proliferation within the marrow stretches the interior of bones and leads to persistent bone pain, which is most pronounced at the sternum, tibia, and femur

66
Q

What symptoms are caused by crowding out of healthy platelets by cancerous lymphoblasts in a patient with ALL (Acute Lymphoblastic Leukemia)?

A

unexplained bruising, gingival bleeding, epistaxis (nosebleeds), and extremely heavy bleeding with menstrual periods

67
Q

Diagnostic testing for this disease will show the first sign is unusually high WBC count, a bone marrow biopsy shows hypercellularity with predominantly lymphoblasts. A bone marrow lymphoblast count of over 20% of total WBC is sufficient for a diagnosis of this leukemia.

A

ALL or Acute Lymphoblastic Leukemia

68
Q

What is the common treatment for ALL for children and young adults?

A

Bone marrow transplantation from a tissue-matched sibling or donor and chemotherapy

69
Q

How are older adults treated for ALL?

A

chemotherapy agents: a multidrug regimen that consists of several phases. Induction therapy lasts 4 to 6 weeks and includes a glucocorticoid (prednisone or dexamethasone), vincristine, an asparaginase preparation, optional use of an anthracycline, and intrathecal (intraspinal) chemotherapy.

70
Q

What is common in patients with ALL after they attain remission if they do not receive follow up maintenance treatment?

A

Relapse: Therefore, after remission, treatment includes 6 to 8 months of intensive combination chemotherapy, Repeated courses of methotrexate, administered either through short IV infusion or at high doses over 24 hours followed by administration of folic acid to “rescue” normal tissues from toxic effects, are a critical component of ALL treatment regimens. Patients then receive low-intensity “antimetabolite”-based maintenance therapy for 18 to 30 months.

71
Q

This type of leukemia is the most common type of leukemia in the United States and other Western countries but is rare in China and Japan. It is a B-cell lymphocyte malignancy. found in elderly individuals, with a median age at diagnosis of 70 years. The male-to-female ratio is 2:1

A

Chronic lymphocytic leukemia (CLL)

72
Q

What are the risk factors for Chronic lymphocytic leukemia (CLL)?

A

Male gender, advanced age, Caucasian race, and family history of hematologic cancer, exposure to certain herbicides and insecticides, including Agent Orange

73
Q

What is the fundamental cause of Chronic lymphocytic leukemia (CLL)?

A

Genetic changes: exposure to any agent that can disrupt DNA is an etiologic agent.
80% of patients have some type of chromosomal abnormality, with trisomy 12 being the most common.

74
Q

Over 95% of these cases involve B cells that have failed to differentiate from precursor B cells into mature B cells in the bone marrow and these lymphocytes contain excess proto-oncogene bcl2, which allows constant proliferation of the pre-cursor cells in the bone marrow.

A

Chronic lymphocytic leukemia (CLL)

75
Q

In the blood, CLL (Chronic lymphocytic leukemia) the B-CLL cells resemble mature B cells, but they synthesize and release low levels of what?

A

immunoglobulin (Ig), mutated Igs or no Ig at all

76
Q

How is CLL (Chronic lymphocytic leukemia) often discovered early in the disorder?

A

incidentally after a blood cell count is performed for another reason.

77
Q

What might a patient with CLL (Chronic lymphocytic leukemia) complain of later in the disease?

A

enlarged, but painless, lymph nodes; fatigue; fever; and pain in the upper left portion of the abdomen, which may be caused by an enlarged spleen. Night sweats, weight loss, and frequent infections are common. exposure to certain herbicides and insecticides.

78
Q

How is CLL (Chronic lymphocytic leukemia) staged?

A

According to the Rai staging system in the United states, designates severity of disease according to the extent of lymphocytosis and characteristics of the cancerous lymphocytes

79
Q

What is a procedure that extracts and removes excess WBCs if there is an extremely high number of B-CLL cells in Chronic lymphocytic leukemia?

A

Leukapheresis

80
Q

What is one of the most serious complications of CLL (Chronic lymphocytic leukemia)?

A

a change (transformation) of the leukemia to a high-grade or aggressive type of non-hodgkin’s lymphoma (NHL) called diffuse large B-cell lymphoma or to Hodgkin’s lymphoma

81
Q

This is caused by the proliferation of undifferentiated WBCs (excluding lymphocytes) in the myeloblast stage within the bone marrow

A

Acute Myelogenous Leukemia (AML)

82
Q

Mutations that turn on oncogenes or turn off tumor suppressor genes within the myeloblast cells cause over proliferation of what in Acute Myelogenous Leukemia (AML)?

A

cancer cells

83
Q

What are the risk factors and causes of Acute Myelogenous Leukemia (AML)?

A

previous chemo and radiation for other cancers, male gender, smoking, childhood ALL or myelodysplastic syndrome (MDS), and benzene exposure, Down’s syndrome, exposure to electromagnetic fields (such as living near power lines); workplace exposure to diesel, gasoline, and certain other chemicals and solvents; and exposure to herbicides or pesticides.

84
Q

Signs and symptoms of Acute Myelogenous Leukemia (AML) are similar to the other leukemias, what can sometimes happen that is different than the other ones?

A

the patient’s immune system sometimes synthesizes antibodies against the patient’s own body cells, which is called autoimmunity. Autoimmune hemolytic anemia can occur due to antibodies made against the patient’s RBCs.

85
Q

This disorder is characterized by an overproduction of mature myeloid cells in the bone marrow. The myeloid cells look mature but they do not function. Most affected persons are age 65 or over. It accounts for about 15% to 20% of leukemia in adults, with slightly more males than females diagnosed.

A

Chronic myelogenous leukemia (CML)

86
Q

What are the risk factors and etiology of Chronic myelogenous leukemia (CML)?

A

exposure to ionizing radiation is a known risk. Ninety-five percent of adults with CML have the Ph chromosome, which is a BCR-ABL oncogene mutation in a single pluripotent hematopoietic stem cell. genetic change in myeloid cancer cells causes production of an enzyme called tyrosine kinase.

87
Q

What are the clinical phases of Chronic myelogenous leukemia (CML)?

A

Chronic: have less than 10% immature neutrophils in the bloodstream and bone marrow, symp usually mild, responsive to treatment
Accelerated: have less than 30% immature neutrophils, very low platelet counts, and the Ph chromosome is apparent on genetic testing. Moderate symp: fever,loss of appetite, and weight loss occur. Less responsive to treatment
Blast Crisis: Large clusters of blast cells are present in bone marrow, and the bloodstream has a high percentage of blasts. Blast cells have spread to organs such as the spleen and liver. Patients have severe symptoms due to a decreased number of healthy WBCs, RBCs, and platelets in the bone marrow.

88
Q

These are the most common type of blood cancer in the united states, both have similar symptoms to each other

A

Lymphomas:
1. Hodgkin’s lymphoma (HL), previously called Hodgkin’s disease

  1. non-Hodgkin’s lymphoma (NHL)
89
Q

This lymphoma accounts for 83% of lymphoma cases, is more likely to occur in older people, may derive from either abnormal B or T cells.

A

non-Hodgkin’s lymphoma (NHL)

90
Q

This lymphoma accounts for 17% of lymphoma cases, is most common in two age groups: adults 15 to 20 years of age and people 50 years of age and older, develops from a specific abnormal B lymphocyte line

A

Hodgkin’s lymphoma (HL)

91
Q

How are lymphomas evaluated and classified?

A

according to size, spread, microscopic appearance, and genetic and molecular markers and then assigned a stage

92
Q

Which stage of NHL lymphoma is limited to one lymph node or a single lymphatic tissue region such as the tonsils?

A

Stage I (early disease)

93
Q

Which stage of NHL lymphoma is located within two or more groups of lymph nodes on the same side of (above or below) the diaphragm?

A

Stage II (locally advanced disease)

94
Q

Which stage of NHL lymphoma is in lymph node regions that are located on both sides of (above and below) the diaphragm, or is in lymph nodes above the diaphragm and in the spleen.

A

Stage III (advanced disease)

95
Q

Which stage of NHL lymphoma is spread throughout multiple organs within the body such as lungs, liver, and bone marrow.

A

Stage IV (widespread or disseminated)

96
Q

In patients with NHL or HL, the patient or clinician often notices what?

A

enlarged, painless lymph node

97
Q
A

WGU Pathophysiology (7 decks)

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