N339 Exam 2 from Fall cohort Flashcards
What do fibroblasts do?
Synthesize collagen and form new connective tissue
What are systemic manifestations of inflammation?
Fever; neutrophilia, lethargy, muscle catabolism
What is the erythrocyte sedimentation rate indicative of?
Presence of inflammation
When does autoimmunity occur?
When the immune system recognizes the own person’s cells as foreign and an immune system response is initiated
What are three factors that are involved in autoimmunity?
Gender
Genetic factors
Environmental factors
What is the mechanism for type 1 reaction?
IgE mediated
What are examples for mechanisms for type 1 reaction?
Hay fever, asthma, anaphylaxis
What is the mechanism for type II reaction?
IgG and IgM
What are examples for mechanisms for type II reaction?
Autoimmune hemolytic anemia; hemolytic disease of newborn; Goodpasture disease
Myasthenia Gravis
What are the mechanisms for type III reaction?
IgG, IgM, IgA
What are examples for mechanisms for type III reaction?
Lupus, arthritis
What are the mechanisms for type IV reaction?
T lymphocytes release cytokines and produce T-cell mediated cytotoxicity
In a type I reaction, what detects the antigens?
CD4-T cells
What occurs during a type I reaction?
Release of histamine
Release of membrane phospholipids
Release cytokines which recruit and activate other inflammatory cells
Is anaphylaxis a systematic or localized response?
Systematic response
What does anaphylaxis cause in relation to blood pressure?
Drop in BP and vasodilatation
What medications can cause human anaphylaxis?
Penicillin, radiographic contrast media, aspirin
What biological agents cause anaphylaxis?
Insulin, vaccines, local anesthetics, insect stings
What foods cause human anaphylaxis?
Nuts, shellfish, eggs, strawberries
In type II (cytotoxic hypersensitivity reaction), describe three mechanisms by which the cell destructs?
Direct cell destruction
Activation of complement can cause membrane lysis OR opsonization and phagocytosis
What is opsonization?
The coating of cells with complement; coating enhances phagocytosis
What does acetylcholine do?
Activates muscle contraction
What occurs in myasthenia gravis?
Acetylcholine cannot be received by muscle due to the antibodies blocking the receptors.
Name three diseases associated with type II hypersensitive.
Type 1 Diabetes
Myasthenia gravis
Graves disease
What occurs in Type III complex mediated hypersensitivy?
Antibodies bind to antigens and then they fall to the cell walls which initiate inflammatory response and cells will migrate to complement and destroy cell wall
What do antigen presenting cells synthesize?
T lymphocytes
In type IV (delayed hypersensitivy), how do the T lymphocytes react?
Either kills cells directly or release cytokines
Examples of type IV reaction?
TB; poison ivy
What are histoplasmosis and coccidiomycosis due to?
Fungal spores
What granulomatous disease is transmitted from animals?
Brucellosi
How is tularemia transmitted?
Rabbits, hares, ticks, flies
What is severe combined immunodeficiency disorder due to?
The failure of white blood cells to develop and there are no B or T lymphocytes
What does the lack of B/T lymphocytes indicate?
No immune response
What is DiGeorge syndrome?
Due to partial or total loss of thymus
What does a protein or general caloric deficiency do to the production of T lymphocytes?
T lymphocytes decreased
What are examples of secondary immunodeficiency disorders?
Severe burns; severe trauma; sickle cell anemia; malignancies and severe infection
What do lymphoid stem cells give rise to?
NK/B/T cells
What do T-cells function as?
Antigen presenting cells
What do Myeloid Stem Cells give rise to?
Neutrophil (Granulocytic Leukemia)
Monocyte (Monocytic Leukemia)
RBC (PV/Erythroid Leukemia)
Megakaryocyte (Essential thombrocythemia/megakaryocytic leukemia)
Where do lymphoid cells begin development?
Bone marrow
What are common manifestations of hematoligic malignancies?
Anemia Thrombocytopenia Leukopenia Pain Infection
What is epistaxis and why does it happen?
Nose bleed
Thrombocytopenia
Acute Leukemia Age Range?
All ages
Chronic Leukemia Age Range?
Adult
What is the clinical onset of acute leukemia?
Sudden
What is the clinical onset of chronic leukemia?
Insidious
What is the course of untreated disease in acute leukemia?
Weeks to month
What is the course of untreated disease in chronic leukemia?
Months to years
What are the predominant cells for acute leukemia?
Blasts, some mature forms
What are the predominant cells for chronic leukemia?
Months to years
How severe is the anemia/thrombocytopenia in acute leukemia?
Mild-severe
How severe is the anemia/thrombocytopenia in chronic leukemia?
Mild
What is the white blood cell count like in acute leukemia?
Variable
What is the white blood cell count like in chronic leukemia?
Increased
What is the age onset and what is exhibited in chronic myeloid leukemia?
Average age onset is 40-50 years
Majority of cases exhibit malignant granulocytes that carry Philadelphia chromosome
What is the age onset and what is exhibited in acute myeloid leukemia?
Median age is 64 years
Causes bone pain, anemia, thrombocytopenia, an increased susceptibility to infection
What is a neoplasm?
Benign or malignant growth
What lymphoid neoplasm is often asymptomatic and has a malignant b-cell precursor?
- Chronic Lymphoid Leukemia
What lymphoid neoplasm is primary a disorder of children? What is the peak age?
- Acute Lymphoblastic Leukemia/Lymphoma
- Peak age is 3-7 years old
What is a rare, chronic type of leukemia?
- Hairy cell leukemia
What is the median age of presentation and gender incidence?
- 55 years old; higher incidence in men
What lymphoid neoplasm is due to a mutation of mature plasma cells that occurs primary in adults?
- Plasma Cell Myeloma (multiple myeloma)
What is the bone breakdown/lysis caused by in plasma cell myeloma?
- osteoclasts cause bone breakdown which causes pain
What are beence-jones proteins?
- large protein molecules that circulate through the blood and become lodged in the kidney
What is the age effected for Hodgkin’s Disease?
50% of individuals effected are between 20 and 40 years old
Is the incidence higher in men or women in Hodgkin’s Disease?
Higher in men than women
Hodgkin’s Disease represents what percent of all malignant lymphomas?
30%
What is found in the blood work of someone with Hodgkin’s Disease?
Reed-Sternberg Cells
What cells give rise to Non-Hodgkin’s Disease?
B/T/NK cells
When does the mutation occur in Non-Hodgkin’s disease?
Earlier in cell development
Are reed-sternberg cells present in non-hodgkin’s disease?
No
Upon diagnosis, which type of Lymphoma (Hodgkin/Non Hodgkin) usually metastasizes by the time of diagnosis?
Non-hodgkins disease
What is the pattern of spread for Hodgkin Disease?
Contiguous spread
What is the pattern of spread for Non-Hodgkin Disease?
Noncontiguous spread
Is extranodal involvement common/uncommon in Hodgkin Disease?
Uncommon
Is extranodal involvement common/uncommon in NonHodgkin disease?
Common
Where is the site of disease in Hodgkin Disease?
Mediastinal involvement common
Where is the site of disease for Non Hodgkin Disease?
Liver involvement common
Bone marrow involvement common
Is the extent of disease localized or unlocalized in Hodgkin Disease?
Often localized
Is the extent of the disease localized or unlocalized in Non Hodgkin Disease?
Rarely localized
What two viruses can cause AIDS?
HIV type 1 and HIV type 2
Which type of HIV is milder and less virulent?
HIV type 2
What is the hallmark of HIV infection?
Defective cell mediated immunity
HIV infects T-cells which causes immunodeficiency
CD4 die off
What are modes of transmission for the HIV virus? (And how?)
Sexual transmission (semen/vaginal/cervical secretions) Parenteral transmission (via blood/blood products) Perinatal transmission (in utero, during delivery, breast milk) Accidental exposure of healthcare workers
What does the cell direct in a retrovirus?
Immune response
What kind of virus is HIV?
Retrovirus
What kind of virus is HIV?
Retrovirus
What cell does HIV infect?
T-Cell (CD4 Lymphocytes)
Once the virus enters the body, what does the t-cell do?
Picks up the virus
Presents virus to other t-cells (to helpt hem focus on antigen)
What solutions carry HIV but don’t transmit the virus?
Urine Saliva Tears Cerebral Spinal Fluid Feces Coughing/Sneezing
Who is at high risk for HIV (population)?
Bisexual / homosexual males Intravenous drug users Sex partners of high risk groups Infants born to HIV infected mothers Accidently exposed health care workers
What is the word for preventive medicine/ “before it happens?
Prophylaxis
What is given to a person after exposure to the HIV virus?
Anti viral medications
How does bi-layer viral envelope bind with CD4 cells?
The viral envelope has protein receptors on its surface
What is binding also referred to as?
Fusion
After HIV fuses to the membrane, what occurs?
Viral RNA is injected into the cytoplasm of the CD4 cell
What does the CD4 transform?
RNA into DNA
What is DNA the roadmap of?
Production of proteins of a cell
What happens when the viral RNA migrates to the membrane?
Protease breaks down viral proteins to form viral RNA
Components of the cell membrane create a new shell which forms HIV Viron
What does viron mean?
Newly formed virus
Why does the host cell die?
The membrane is being punctured by the production of new virons
What is the hallmark of HIV (not infection)?
CD4 die off before infection phase
CD4 die off before infection phase
Why is HIV not initially detected by tests?
Lacks the antibody to the virus that has been formed
When do flu like symptoms occur in HIV patients?
Serconversion
When are antibodies produced?
During seroconversion
Where do the antibodies go once in circulation?
Some go to hypothalamus
Some act as pyrogen (molecules that cause fever)
What happens after the initial symptoms? There is a period of what?
Dormancy
How long does it take for serconversion to HIV+ take place?
Usually occurs between 3 and 6 months
What is an opportunistic infection?
Organisms have a greater chance of multiplying if the immune system is compromised
When are you considered to have AIDS?
When the CD4 cell count is less than 200 cells per microliter
What are systemic manifestations? (basic definition)
Manifestations that occur throughout the body
What is the most common/significant systemic manifestation of AIDS?
Cachexia or malnutrition
What is a gastrointestional manifestation of AIDS?
Chronic diarrhea (opportunistic fungal infection)
What is the most common pulmonary manifestation of AIDS?
pneumocystis carinii pneumonia (PCP) AKA pneumocystis jiroveci pneumonia (new name change)
Tuberculosis (TB)
What are mucocutaneous manifestations of AIDS?
Typically consists of rashes and viral/bacterial infection
What are three gynecoligcal manifestations of AIDS?
Vaginitis (of yeast origin)
Cervical dysplasia (cervical neoplasia)
Pelvic Inflammatory Disease (PID)
What are signs of nueroligcal manifestations of AIDS?
Encephalopathy – increased intracranial pressure can lead to behavioral/personality/cognitive changes (AIDS Dementia)
What are ocular manifestations of AIDS?
Retinitis which is caused by cytomegalovirus
How does AIDS progress in children versus adults (speed)?
Progresses faster
Why is there a rapid progression of AIDS in children?
Children have underdeveloped immune system
What are two major opportunistic infections of AIDS in children?
PCP and Chicken Pox (severe)
What does the central nervous system involvement look like in children with AIDS?
Impaired cognition and impaired motor function
Increased intracranial pressure inhibits proper circuit formations
What neoplastic disease are children with AIDS more suspetible to?
Kaposi Sarcoma: effects children’s skin and mucous membranes and internal organs
What three ‘stages’ are focused in the treatment of HIV?
Fusion Inhibitors
Reverse Transcriptase Inhibitors
Protease Inhibitors
In the fusion inhibitor stage, what two things occur?
Prevents fusion between virus and host cell membrane
Blocks receptors so the virus cannot fuse
What occurs during the reverse transcriptase inhibitor phase of HIV treatment?
Viral RNA will not convert to DNA and then it cannot function in the cell’s nucleus
What occurs in the protease inhibitor stage of HIV treatment?
Interrupts formation of new virus at the end of the cell cycle
Inhibits protease which converts proteins to viral proteins
What is considered a “cocktail” for HIV?
Combination of all three treatment focuses
