Patho Exam 2 Flashcards
which immunoglobulin protects mucous membranes of genitourinary, gastrointestinal & pulmonary systems. Activity not related to infection; has protective & preventative role. (location: breast milk, tears, sweat, saliva)
IgA
which immunoglobulin binds antigens to B cells. Binds to basophils and mast cells in hypersensitivity reactions. Early stage, when antigen has first entered the body. (location: attached to surface of B cells, in skin, digestive, respiratory tracts)
IgD
which immunoglobulin is abundant in skin, mucous membranes, and respiratory tract. active in allergic reactions; binds to mast cells & basophils to release histamine & leukotrienes. Not related to infection, found in persons with allergies. (location: found on mast cells in pulmonary & gastrointestinal tracts) (pollen, dust, animal dander)
IgE
which immunoglobulin initiates complement activity & further immune responses, early infection, RESPONDS FIRST (shows recent/current infection) in infection (location: throughout blood stream) also called macroglobulin due to large size.
IgM
which immunoglobulin activates complement to release inflammatory & bactericidal mediators, confers long-term immunity, active against viruses, bacteria, antitoxins; moves across maternal-fetal barrier. SECONDARY RESPONDER in infection (shows previous exposure)! Late disease, recovery, & long term after, most abundant in bloodstream, most important antipathogenic immunoglobulin in infections & commonly involved in autoimmune disease
IgG
what allows the body to recognize an antigen, target antigen, limit its response to that antigen & develops memory for the antigen for future reference. Its system’s ability to recognize & remember specific antigens is called specificity. Distinguishes self from non self. 2 types of this - humoral and cell mediated
adaptive immunity
type of adaptive immunity that is associated with B cells that mature within bone marrow
humoral adaptive immunity
type of adaptive immunity that is associated with T cells that mature within thymus gland
cell-mediated adaptive immunity
type of immunity that is obtained through exposure to an antigen or through a vaccination that provides immunization. LONGER LASTING.
active acquired immunity
type of immunity where an individual is given premade, fully formed antibodies against an antigen. Pt is a passive recipient of the antibodies, & their body does not have to perform the actions needed to develop immunity. Provides immediate immunity, but short term.
passive acquired immunity
what type of immunity is when an infant is breastfed & receives fully formed maternally produced antibodies in breast milk OR pt has hep B infection so family member gets administration of HBIg against hep b … short term immunity!
passive acquired immunity
what type of immunity is after a child contracts measles infection, the child develops this type of immunity? The child’s body has to process the antigen & develop B cells & plasma cells that secrete Igs while enduring the disease. The child develops all symptoms of disease but at the same time develops significant Igs for life. OR child can develop active acquired immunity by receiving measles vaccine.. long lasting!
Active acquired immunity
bacterium that causes many different infections. Gram positive. Has capsules that resist WBC phagocytosis & secrete substances that degrade tissue membranes. Streptococci can also release an exotoxin that can cause fever and rash.
GABHS (Group A beta hemolytic streptococcus)
these work hand in hand with macrophages to destroy foreign invaders and self
major histocompatibility complexes (MHCs)
every human has these surface antigens which are also called human leukocyte antigens. These give the ability to distinguish self from non-self & come into play for autoimmune disorders to recognize foreign invaders & get rid of them which can also destroy self.
major histocompatibility complexes (MHCs)
these are found in the innate division, the first line of defense against foreign invaders or antigens. They engulf, ingest, & break down foreign matter such as bacteria, pollen, viruses, fungi that enter the body.
macrophages
these consist of either viral or bacterial components. They can be live or or inactivated.
vaccines
what type of vaccine has the potential, although rare, to mutate into disease-causing strain?
live virus vaccines
what type of vaccine should immunocompromised people never get?
live virus vaccines! because could mutate into disease causing strain
an illness caused by a pathogen that takes advantage of the lack of immune defenses within the host
opportunistic infection
3 stages of HIV
acute HIV infection, chronic HIV infection, AIDS
who is at greater risk for HIV?
African Americans, gay/bisexual men, IV drug users
what happens with HIV is left untreated?
it can advance to AIDS
what shows progression in HIV?
depletion of CD4 T cells.
when is AIDS reached?
when CD4 T cells get to 200 or below and they have a presence of an opportunistic infection such as Kaposi’s sarcoma, TB, pneumocystitis pneumonia, candida infection (thrush), toxoplasmosis, cryptococcus
What is the latent stage or latency period?
when you have it but appear healthy, you aren contagious at this time & don’t know. Most dangerous latent stage of HIV is 2 weeks to 6 months after contraction of virus where bloodwork looks normal, asymptomatic.
What is the transition period?
when your tests show positive and will have flu like symptoms
someone who has the infection but is asymptomatic
carrier
what encompasses immune reactions against self antigens that result from the loss of self-tolerance. T cells or Igs cannot make a distinction between nonantigenic cell surface markers and antigenic foreign cell surface markers. Inability of body to recognize self (body starts attacking self so we start on immunosuppressants which makes pt greater risk for infection and then cancer as well bc body doesn’t know how to fight it off)
autoimmune disease
type of autoimmune disease that pt has fever, butterfly rash, joint inflammation, damage to kidney, lungs, serosal membranes. most common in women, African Americans as well as asians and hispanics. presence of Epstein-Barr virus increases risk of this as well.
SLE (systemic lupus erythematous)
this occurs from lupus (SLE) and is an episodic vasospasm of the arteries supplying the fingers. has blue, red, to white color change. can be numb, painful, tingly.
Raynaud’s phenomenon
autoimmune disease that is chronic autoimmune inflammatory disorder that affects the joints bilaterally (joint pain/inflammation)
RA (Rheumatoid Arthritis)
What are the 4 types of hypersensitivity reactions?
- type I: Immediate hypersensitivity
- type II: Cytotoxic hypersensitivity
- type III: Immune complex disorders
- type IV: Delayed hypersensitivity
which type of hypersensitivity is an allergy or atopic disorder, rapidly developing immune reaction that occurs after IgE binds to mast cells and combines with antigen, occurs in individuals previously exposed to antigen, local (hives/rash aka urticaria) or systemic. Allergic rhinitis reactions. Can lead to anaphylactic reaction. Ex: pollen, dust, shellfish, peanuts
Type 1: Immediate hypersensitivity
which type of hypersensitivity is mediated by Igs directed toward antigens present on cell surfaces. Antibody mediated cell destruction & phagocytosis occur in these reactions. Ex: blood transfusion reaction in which cells from an incompatible donor react with host Igs. Or certain drug reactions.
Type II: Cytotoxic Hypersensitivity
what type of hypersensitivity reaction occurs when antigen combines with Ig within circulation & these complexes are then deposited in tissues causing organ dysfunction. Autoimmune disease – failing to recognize self. Ex: systemic lupus erythematosus (SLE) where complexes are deposited in kidney, blood vessels, lung skin. Can also be localized such as joints in RA.
Type III: Immune Complex Disorders
what type of hypersensitivity reaction is initiated by T lymphocytes that have had previous exposure to an antigen. The T lymphocytes are sensitized to the antigen do not attack the antigen until days after initial exposure. Most common is contact dermatitis. Ex: poison ivy but don’t get itchy til days after exposure. PPD skin test as well. Also occurs in transplant rejection (don’t know til days after)
type IV: delayed hypersensitivity
what cells are associated with HIV?
CD4 t cells, monocytes, and macrophages
specific strain of E.Coli that causes severe gastroenteritis and HUS (hemolytic uremic syndrome) aka disorder of acute renal failure. Infants and elderly are most susceptible to this. Can be fatal. Transmitted through fecal/oral route. Contaminated (undercooked meat) food and water.
E. coli O157:H7
Gram negative, rod shaped bacteria that inhabit the human intestine. Can cause cholecystitis, bacteremia, cholangitis, UTI, traveler’s diarrhea, neonatal meningitis, & pneumonia.
E. coli
disorder of acute renal failure, s/s include fever, diarrhea, n/v, stomach cramps, flatulence, stool may have blood/mucus/pus. rare instances kids can have seizures. This can happen from a GI bacterial infection like shigella or E. coli
HUS (hemolytic uremic syndrome)
Collapsed alveoli !!!!!!!! due to pressure placed on it by fluid. Leads to PNA.
atelectasis
Increased AP diameter = good chance they have chronic emphysema …these pts trap air/ have difficulty expelling CO2
barrel chest
coughing up blood , bright red blood in sputum. Can be a sign of 2 things: TB and/or lung cancer
Hemoptysis
a lung condition that causes shortness of breath (dyspnea). The air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken & rupture. Obstruction to expiratory airflow, loss of elastic recoil of the alveoli, & high residual volume of CO2 in lung
Emphysema
immune responses that is our skin, mucus membranes, enzymes
innate immune response
immune response that once it has seen an antigen, it recognizes it & adapts to it to know how to deal with it next time. Ex: immunizations
adaptive immune response
Patients with allergic urticaria(hives) should be monitored for signs of what?
anaphylaxis
ARDS
acute respiratory distress syndrome
pulmonary dysfunction characterized by diffuse alveolar injury, pulmonary capillary damage, bilateral pulmonary infiltrates, & severe hypoxemia. Occurs in critically ill pts. Most common risk factor is sepsis. symptoms include SOB, fatigue, confusion, hypercapnic (too much CO2 in blood), poor O2, high CO2, severe organ dysfunction and muscle weakness
ARDS (acute respiratory distress syndrome)
which type of hypersensitivity reaction is type I?
Immediate hypersensitivity
which type of hypersensitivity reaction is type II?
Cytotoxic Hypersensitivity
which type of hypersensitivity reaction is type III?
Immune Complex Disorders
which type of hypersensitivity reaction is type IV?
Delayed Hypersensitivity
if this malfunctions, you cough when drinking. this allows you to breathe and drink when you want.
Epiglottis
this is produced in utero as a fetus, it reduces surface tension in the lungs, cells in alveoli produce these
Surfactant
where major organs are, space between lungs
Mediastinum
surround lungs
Pleural membranes
intercostal muscles
Thoracic cavity
C shaped, smaller, less likely to get PNA
left lobe lung
larger, straight, higher risk of PNA
right lung
thin walled, balloon like structures that are surrounded by pulmonary capillaries that enables transfer of O2 & CO2
alveoli
hemoglobin plus oxygen
oxyhemoglobin
the % Hgb with oxygen bound. Use a pulsox to measure this (indirect measurement)
Oxygen saturation (SaO2)
optimal saturation of Hgb
PaO2 90-100mmHg
what type of injury will cause motor and sensory conduction to diaphragm to stop and pt will require respiratory support to maintain life?
C4 or above injury
controlled voluntarily and involuntarily
diaphragm separates and from thoracic cavity)
what innervates the diaphragm?
phrenic nerve
the amt of blood reaching alveoli, ideally it should be equal. If unequal then there is an imbalance. AIR TO BLOOD TO AVEOLI that should be matched.
VQ ratio (lung scan)
ventilate with ______, perfuse with _______
ventilate with air, perfuse with blood
the process of inspiration & expiration
ventilation
the movement of blood through the pulmonary circulation, then tissues
perfusion
occurs when oxygen levels of blood are insufficient to meet needs of tissue (at risk for this if O2 is less than 90%)
hypoxia
no perfusion so PE, weak heart, insufficient blood & hemoglobin, recent MI or heart failure … this will lead to what?
VQ mismatch
if VQ is unequal, there is an imbalance and a VQ scan should for ordered for what?
pulmonary embolism
hyperventilation leads to what?
hypocapnia ( getting rid to too much CO2) which can cause alkalosis & CNS excitation
hypoventilation leads to what?
hypercapnia (holding onto too much CO2) which leads to respiratory acidosis (these people are blowers aka trying to blow the CO2 off)
what is the 1st sign of someone in respiratory acidosis?
CNS depression aka change in mental status (remember hypoventilation leads to hypercapnia which leads to respiratory acidosis)
amount of air that moves into & out of the lungs during a normal breath
Tidal volume(TV)
max amount of air that can be inspired in excess of the normal TV
Inspiratory reserve volume (IRV)
max amount that can be exhaled in excess of TV
Expiratory reserve (ERV)
amount of air that remains in lungs after forced expiration; increases w/ age
Residual volume (RV)
IRV + (TV and ERV); is the amt of air that can be exhaled from the point of maximal inspiration
Vital capacity
involves full inspiration to TLC followed by forceful maximal expiration
Forced vital capacity
form of dyspnea and is the sensation of dyspnea when lying flat. It is commonly seen in heart failure but can also be seen in asthma.
orthopnea
Which measure of lung function indicates the total amount of air that the lungs can hold?
Total lung capacity
zero amount of O2 in blood
Anoxia
hypoxia vs hypoxemia
hypoxemia- abnormally low blood oxygen levels
hypoxia- low Oxygen levels in tissues
OLDCART
Onset, location, duration, character, aggravating or relieving factors, treatment
restricted airway
wheezing (doesn’t clear with cough)
bradypnea vs tachypnea
bradypnea - less than 12 breaths
tachypnea - more than 20 breaths
feeling for vibrations aka fluid aka atelectasis (should be equal bilaterally)
tactile fremitus
percussion sounds (dull, resonant, hyper resonance)
dull - solid mass (bone) or fluid
resonant - air
hyperresonance - lungs overinflated (emphysema)
percussion sound for chronic bronchitis, COPD, emphysema
hyperresonance
rhonchi vs crackle
rhonchi - snores
crackles - velcro
what could the pt have if you hear crackles/rales
HF, PNA
wheezing could mean what?
asthma, obstruction (doesn’t clear w/ cough)
Serum blood values obtained through arterial blood. Identified alterations in acid-base balance caused by respiratory issues.
ABG (arterial blood gases)
normal ABG values (pH, PCO2, HCO3-, PO2, % Hgb sat)
pH: 7.35 - 7.45
PCO2: 35 - 45
HCO3-: 22 - 26
PO2: 90 - 100
% Hgb sat: 95 - 100
inflammation & irritation of nasal mucosa
acute rhinitis
during allergies (IgE), these increase
eosinophils
sore throat, always viral, antibiotics don’t help with this.. inflammation of the pharynx
acute pharyngitis
inflammation of the sinuses, almost always viral
acute sinusitis
inflammation of the bronchi/bronchioles, mostly viral but can be bacterial, can occur from cold exposure or smoking in house
acute bronchitis
egophony, bronchophony, whispered pectoriloquy
egophony- pt says “e” but abnormal aka PNA if it sounds like “a”
bronchophony- pt says “99” , should sound muffled or will hear clear as day if abnormal
whispered pectoriloquy- whisper “1,2,3” and will hear it clear as day if abnormal aka possible PNA.. muffled if normal
this is not a type of PNA but puts you at risk for PNA because of decreased immune response when you have this
the flu/ influenza
these treat fevers
antipyretics
this medication opens up airway for more ventilation
bronchodilators
these are heard over peripheral lung fields and may indicate PNA
bronchial breath sounds
these are released by WBCs, bronchoconstrcition
leukotrienes / histamine
if these pts are given high levels of O2, their respiratory drive will be suppressed
COPD or chronic hypercapnia pts
The high pulmonary artery pressure places high resistance against the RV of the heart, which leads to RVH
(right ventricular hypertrophy) and RV failure.. this is known as what?
cor pulmonale
this is a type of CT scan that is used to diagnose pulmonary embolisms
VQ Scan
these are types of obstructive disorders
asthma and COPD
what is the number 1 and 2 symptoms for asthma?
- wheezing
- cough, dyspnea, maybe use of accessory muscles
also known as blue bloater, happens due to hypoxia & cyanosis as well as edema that occurs due to RV failure
chronic bronchitis
also known as pink puffer, well oxygenated until later in disease & exhibit pursed lip breathing
emphysema
this is RV failure caused by pulmonary disease, signs/symptoms include JVD, ascites (fluid collects in abdomen), hepatomegaly, jaundice dyspnea, wheezing, ankle edema, might have 3rd heart sound
cor pulmonale
collapsed lung, air in plural cavity that causes collapse of lung. can be caused by trauma or rupture of alveoli
pneumothorax
Type of pneumothorax that is Closed, penetrating wound allows air into pleural cavity, but not out.
Life-threatening: Cardiac structures compressed
tension pneumothorax
type of pneumothorax where there is air in intrapleural space, No preceding trauma or underlying disease. Most common in tall, young men
primary spontaneous pneumothorax (PSP)
type of pneumothorax where underlying pathological process in the lung, Air enters the pleural space via ruptured blebs, Long-term emphysema most at risk
secondary spontaneous pneumothorax (SSP)
type of pneumothorax caused by penetrating wound of the thoracic cage, Rib fracture that puncture pleural membrane
traumatic pneumothorax
type of pneumothorax that is from a Complication of medical procedure, Transthoracic needle aspiration
latrogenic pneumothorax
Syndrome characterized by severe and rapid onset of dyspnea, tachypnea, hypoxemia, pulmonary edema, and pulmonary infiltrates
ARDS (Acute respiratory distress)
Ig found in bodily secretions
IgA
caused by fluid
rales/rhonchi
lymphocyte plasma cells are triggered by?
humoral immune response
health status of a person with HIV in latent stage
healthy with no symptoms
hormone implicated in creased risk of SLE (lupus)
estrogen
worsening LV HF leads to …
pulmonary edema
immunity via vaccine or disease, long lasting
active acquired immunity
anaphylaxis is which type of hypersensitivity
Type 1 immediate hypersensitivity
virus implicated in development of RA
EBV
Associated with glomerulonephritis, pharyngitis (sore throat), necrotizing fasciitis
GABHS (Group A beta hemolytic streptococcus)
abnormally elevated CO2 levels
hypercapnia
number of new cases
incidence
Right ventricular failure and enlargement, commonly seen in chronic emphysema
cor pulmonale
this is caused by bronchoconstriction
wheezing
Side effect of treatment with immunosuppressant agents for autoimmune diseases
risk of infections
antibody administration confers..
short term immunity
inability to distinguish self from non self
autoimmune disorder
what causes Raynaud’s
capillary vasoconstriction
period of seroconversion (HIV/AIDS)
2 weeks to 6 months
PPD (Mantoux text) or poison ivy is with hypersensitivity rx?
Type IV Delayed hypersensitivity
Fatal toxic effect caused by e.coli 0157
Hemolytic uremic syndrome (HUS)
sign of lung cancer
hemoptysis
Macrophages contain these substances which allow them to recognize self from non self
MHC (major histocompatibility complexes)
immunoglobulins that antibody titers measure
IgM (first responder, shows current infection) and IgG (secondary response, shows previous exposure)
type of PNA that is commonly transmitted through warm moist air, older pts so don’t have high fevers
Legionella pneumophila (Legionaries Disease)
cause of VQ mismatch in PE
decreased blood flow through pulmonary arteries
vector borne infection (through insects!!!!)
malaria
type of PNA that affects ppl <40 y/o, don’t really have symptoms
walking PNA aka mycoplasma PNA
who is at risk for TB
prison, homeless shelters, schools, third world countries, HIV
who is at risk for aspiration
decreased LOC
immunoglobulin involved in hypersensitivity rxs
IgD
cause of absent breath sounds unilaterally
pneumothorax
associated with high fever, productive cough, pleuritic chest pain, rigors
PNA
most prevalent type in US
HIV 1
risk factor for COPD
tobacco use
FEV1
forced expiratory volume
most important system to asses in C spine injury
respiratory
immunoglobulin involved in allergic rx
IgE
most common feature of RA
bilateral joint pain
adequate oxygen range
92-100%
mast cells predominate here (which type)
Type 1 immediate hypersensitivity rx
organ specific autoimmune disease
DM1
blood transfusion rx (which type)
Type II cytotoxic hypersensitivity
cell most affected in HIV
CD4 (WBC)
examples of opportunistic infections
Kaposi sarcoma, TB, pneumocystis carinii pneumonia
what happens when CD4 cells are less than 200
AIDS
reset after recent exposure
HBV antibody titer
antibody mediated cell destruction and phagocytosis occurs here (which type)
type II cytotoxic hypersensitivity
systemic lupus erythematous (SLE = lupus) which type
type III hypersensitivity immune rx
antigen combines with Ig within circulation and the complex are deposited in tissues causing organ dysfunction
type III hypersensitivity immune complex rx
these block entry of environmental antigens
anatomical barriers
type of PNA that is more common in healthcare workers and people with compromised immune systems
Pseudomonas pneumonia
what causes decreased ventilation?
not enough air reaching the alveoli, hypoventilation can cause this. airway obstruction or bronchonconstriction
what should people with decreased immune response be doing?
washing hands, avoid crowds, get vaccines to avoid infectious disease
risk factors for chronic emphysema, bronchitis, COPD
exposure to chemical irritants like tobacco or anything that could damage lungs. bleach, fine particulate matter, asbestos
acute vs chronic bronchitis
acute bronchitis- inflammatory, occurs as a viral illness
chronic bronchitis- tobacco
this is bronchoconstriction/inflammatory response so we give steroids to reduce inflammation
asthma
how to treat acute rhinitis
treat with antihistamine, potential steroid to reduce inflammation, & give leukotriene inhibitor
how to treat type 1 anaphylaxis rx
epinephrine to open airway
protects us against PNA, part of our upper respiratory tracts. Innate. Moves up our inhaled particles that were missed from our nose/oral airway
mucus cilliray clearnace
this leads to pulmonary edema aka backup of blood flow into lungs, s/s include rails, rhonchi, crackles, decreased O2, tachypnea, chronic hypertension, wearing of left ventricular pump, puffy extremities
left ventricular failure
leads to cor pulmonale aka back up of systemic blood flow, s/s include JVD, jaundice, ascites, enlarged liver
right ventricular failure
we do this for early detection of COPD, emphysema, or to monitor asthma. this measures how much O2 you take in/out. (tidal capacity tells us how much you can hold). this tells us how severe your pulmonary disease is. (ex: coal miners are at high risk for pneumoconiosis aka black lung disease)
pulmonary function test
what are the 5 stages of infectious disease?
- incubation stage (microorganisms being replication without symptoms)
- prodromal stage (symptoms start, often vague/general)
- acute stage (full infectious disease, signs/symptoms in full force trying to fight it off)
- convalescent stage (body starts to eliminate the pathogen, no longer infectious)
- resolution stage (pathogen eliminated)
ppl are treated with immunosuppressant drugs for inflammatory disorders are increased risk for what?
developing infections!
measures how quickly an individual can exhale, usually measured at the same time as the FVC (forced vital capacity which measures the amt of air an individual can exhale with force after inhaling as deeply as possible).
peak expiratory flow (PEF)
measures the amount of air an individual can exhale with force in one breath. This is measured at 1 second
forced expiratory volume (FEV1)
this is a combination of chronic bronchitis, emphysema, hyperactive airway disease. smoking is major cause of this.
COPD (chronic obstructive pulmonary disease)
the ability of an individual’s immune system to resist and control infections (ex: antibody titers)
immunocompetence (example of immunocompetence test would be allergy panel)
Tranquilizers, sedatives, and opiates can depress respiratory drive and cause respiratory failure in what kinds of pts?
COPD
this is an extension or sign of severe right ventricular heart failure… goes hand in hand with ppl with chronic emphysema & choric bronchitis. This is a back up of blood into venous systemic system including hepatic vein.
cor pulmonale
this is where the pathogen is living within host, does not necessarily mean it infects it
colonization
Human or animal colonized by pathogen
host
Microorganisms capable of causing infectious disease
pathogen
Invasion, colonization, and multiplication of pathogens
infection
pathogen source
reservoir
Living being that can carry pathogen from reservoir to host
Mosquito, tick, flea
vector
ability to produce disease
virulence
gram positive, damaging enzymes (ex: neurotoxin from tetanus, immunizations for tetanus)
exotoxins
gram negative, cell wall/released with cell destruction (ex: typhoid, fevers)
endotoxins
lesions that are contagious (skin infections, crusty, bumps etc)
impetigo
