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Block 11 Week 3 > Stage of Life and Infectious Disease - Hunter > Flashcards

Stage of Life and Infectious Disease - Hunter Flashcards

1
Q

hematopoietic stem cells originate in the (blank) of the embryo

A

yolk sac

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2
Q

Stem cells migrate into the fetal liver and finally into the (blank)

A

bone marrow

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3
Q

t/f: hematopoeisis continues throughout life

A

true

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4
Q

t/f: hematopoiesis decreases with age

A

true

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5
Q

infants are born with a selectively (blank) immune system compared to adults

A

selectively

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6
Q

(blank) results in immunosenescence

A

aging

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7
Q

what the difference between prenatal/antepartum vs. perinatal/intrapartum?

A

prenatal/ante: during fetal dev

perinatal/intra: during labor and passage through the birth canal

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8
Q

What are the TORCH infections?

A 
Toxoplasmosis
Other (syphilis, VZV, parvo)
Rubella
CMV
Herpes simplex
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9
Q

What are some non-torch maternally acquired infx?

A

Strep agalactiae
E. coli
STDs (herpes, chlamydia, Neisseria)

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10
Q

t/f: congenital CMV can result from primary maternal infection during pregnancy or as a reactivation

A

true

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11
Q

primary maternal infection with CMV is the most damaging during which trimester?

A

first

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12
Q

t/f: most women don’t show symptoms with primary CMV infx

A

true

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13
Q

what types of symptoms may show with primary CMV infx?

A

mono-like

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14
Q

t/f: maternal immunity to CMV has no affect on transplacental transmission of CMV

A

false!; decreased transmission!

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15
Q

A newborn showing low birth weight, microcephaly, seizures, petechial rash, and moderate HSM with jaundice most likely has….

A

congenital CMV

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16
Q

What types of samples are taken from the newborn to test for CMV?

A

urine
saliva
blood

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17
Q

what lifelong impariments will an infant have who had congenital CMV?

A

hearing loss
vision loss
mental and physical retardation

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18
Q

preterm birth is birth before how many weeks?

A

37 weeks

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19
Q

what percent of births globally are preterm?

A

11%

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20
Q

preterm birth accounts for what percent of newborn death?

A

35%

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21
Q

Preemies are especially fragile because of an underdeveloped…

A

immune system

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22
Q

Intrauterine (blank) is a major contributor to preterm birth and causes premature immune system activation and cytokine production

A

intrauterine inflammation

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23
Q

25% of all preterm births were caused by (blank, both with and without intact membranes

A

intrauterine infection

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24
Q

The earlier the gestational age at delivery, the higher the frequency of….

A

intra-amniotic infections (chorioamnionitis)

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25
Q

The earlier the gestational age at delivery, the higher the frequency of….

A

intra-amniotic infections (chorioamnionitis)

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26
Q

What are the most common bugs that cause intrauterine infection?

A 
Ureaplasma urealyticum
Mycoplasma hominis
Gardnerella vaginalis
Trichomonas
Neisseria
Chlamydia
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27
Q

What is the dominant bug found bacterial vaginosis?

A

Gardnerella vaginalis

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28
Q

What is the only Ig class that can cross the placenta?

A

IgG

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29
Q

What is the receptor that transports IgG across the placenta?

A

FcRN (fetal receptor)

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30
Q

At what week of gestation does IgG transport begin?

A

22nd week

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31
Q

Describe IgG levels and antigen specficity in a newborn compared to an adult

A

THE SAME!! it’s all comparable to mom and will last for 6 months

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32
Q

Which Ig class is produced at birth?

A

IgM

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33
Q

which ig class is not produced until 6 months after birth?

A

IgG

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34
Q

What is the half life of maternal IgG?

A

2-3 weeks

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35
Q

At what month after birth is there a lowpoint in total serum Ig?

A

4-5months; INCREASED RISK OF INFX

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36
Q

At what age after birth do the humoral immunodef’s appear

A

at 4-5 months( coincides with low total serum Ig)

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37
Q

when is IgA produced?

A

6 months afer birth

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38
Q

IgA is present in what form in breast milk?

A

colostrum

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39
Q

t/f: maternal IgA is capable of entering fetal circulation

A

false

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40
Q

what is the most common cause of meningitis and septicemia in neonates?

A

group B strep

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41
Q

GBS is transferred vertically tot the neonate during birth from the vagina after GBS has already established an infection in the maternal….

A

intestine

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42
Q

neonatal meningitis can be a result of GBS exposure during birth or…

A

in utero!

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43
Q

Why is there no maternal protection against GBS?

A

we don’t normally make Abs to GBS?!?!

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44
Q

A neonate, several days after birth develops an infection. From the mother’s vagina, a gram positive, B-hemolytic, CAMP postive coccus was isolated from the mother’s vagina. What is the bug?

A

GBS

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45
Q

What fluid sample can you take from the baby to determine GBS meningitis?

A

CSF

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46
Q

Adult B cells respond well to thymus (dependent/independent) ags while infant B cells respond well to thymus (dependent/independent) ags

A

adult: independent
infant: dependent

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47
Q

what are thymus independent ags?

A

stuff like LPS

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48
Q

what are thymus dependent ags?

A

protein ags

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49
Q

What is linked recognition?

A

Conjugation of polysaccharide to an immunogenic protein allows B cells to receive help from helper T cells

50
Q

What is linked recognition?

A

Conjugation of polysaccharide to an immunogenic protein allows B cells to receive help from helper T cells

51
Q

what are the cell types affeted by immunosenescence?

A 
hematopoietic stem cells
lymphoid progenitor cells
bone marrow
thymus
mature lymphocytes in the peripheral blood/2ry lymphoid organs
innate immune systems
52
Q

t/f: immunosenescence reduces the effectiveness of vaccines

A

true

53
Q

t/f: immunosenescence reduces the effectiveness of vaccines

A

true

54
Q

what cells arise from the myeloid line?

A 
erythrocytes
platelets
basophils
eosinophils
neutrophils
monocytes
macrophages
mast cells
dendritic cells
55
Q

what cells arise from the lymphoid line?

A

b lymphos
t lymphos
NK cells

56
Q

what cells arise from the lymphoid line?

A

b lymphos
t lymphos
NK cells

57
Q

what happens to the mass of hematopoietic tissue with aging?

A

it decreases

58
Q

What are the changes to the hematopoietic microenvironment that decrease stem cell mass?

A

alteration of hormone production disturbs self-renewal and commitment of HSC

59
Q

Is the myeloid or lymphoid lineage more compromised with age?

A

lymphoid

60
Q

Changes to what parts of the body are the cause of the lympohid degeneration with age?

A

lower bone marrow mass=fewer b cells

fat involution of the thymus=fewer mature t cells

61
Q

Changes to what parts of the body are the cause of the lympohid degeneration with age?

A

lower bone marrow mass=fewer b cells

fat involution of the thymus=fewer mature t cells

62
Q

is complement affected by aging?

A

nope

63
Q

is humoral immunity altered by aging?

A

nope

64
Q

despite neutrophil numbers remaining constant, what changes in them with aging?

A

their function; decreased phagocytic capacity as well as decreased bactericidal activity (oxidative burst)

65
Q

what receptor on macrophages has an altered expression with aging?

A

TLRs

66
Q

what causes a decrease in the ag-presenting function of mac’s and DCs with age?

A

decreased expression of MHC II and defects in activation of CD4 T cells

67
Q

What characteristic of neutrophils INCREASES with age?

A

membrane viscosity

68
Q

Describe the change in the number of NK cells with age

A

they INCREASE, but their cytotoxic activity decreases

69
Q

Which cyotkines increase with age?

A

TNF-a
Il-1b
IL-6

70
Q

elevated plasma concentrations of which cytokines are predictive markers of functional disability and mortality?

A

TNF-a
IL1-b
IL6

71
Q

elevated plasma concentrations of which cytokines are predictive markers of functional disability and mortality?

A

TNF-a
IL1-b
IL6

72
Q

what are some of the major age-related diseases d/t inflammaging?

A

osteoporosis
neurodegeneration
cancer
atherosclerosis

73
Q

when does involution of the thymus begin?

A

40-50

74
Q

What two cell types suffer the greatest changes in thymus involution?

A

T cell precursors

Thymic stromal cells

75
Q

What happens to the number of naive t cells in the thymus with aging?

A

decreased

76
Q

despite decreased naive t cells in oldies, does the size of the mature t cell pool change?

A

nope, stays stable

77
Q

describe the changes in proportion of t cells in elderly pts?

A

increased effector
decreased naive
about the same to fewer memory

78
Q

The loss of (blank) within naive t cells in oldies leads to a reduced ability to cope with bugs

A

diverity of naive t cells

79
Q

Effector and memory t cells have (extended/limited) diversity

A

limited

80
Q

What particular virus tends to get over-protected against in oldies?

A

CMV

81
Q

which co-stimulatory molecules decreased with age?

A

CD28 and CD40L

82
Q

which co-stimulatory molecules decreased with age?

A

CD28 and CD40L

83
Q

What are 6 changes to T cells with aging?

A
  1. dec naive cells
  2. dec diversity
  3. dec. expression of co-stim molecules
  4. dec proliferative capacity
  5. dec t cell signaling
  6. dec. activation of potential naive cells
84
Q

with regard to the thymus, what might reduce immunosenescence?

A

thymic regeneration; cryopreserve T cells in early adulthood then expand the selected populations or deplete the highly differentiated clones

85
Q

what can be done to immunodominant bugs like CMV to prevent the accumulation of highly differentiated clones that replace naive cells?

A

vaccination or treatment

86
Q

what can be done to immunodominant bugs like CMV to prevent the accumulation of highly differentiated clones that replace naive cells?

A

vaccination or treatment

87
Q

Describe the changes in B cells that result in limited b cell receptor diversity

A

fewer B2 cells
more B1 cells (limited diversity)
fewer naive B cells

88
Q

describe the changes to the antibodies themselves with aging

A

Ab response is weaker
Ab levels drop faster
Abs bind with lower affinity
INCREASED autoAbs

89
Q

Aged CD4 cells produce less IL(blank) and less of what CD molecule?

A

IL2 and CD40L

90
Q

What do T helper cells play in the activation of B cells?

A

isotype switching and affinity maturation; decreased in aging leads to diminished high-affinity Ab response

91
Q

what happens to germinal centers with aging?

A

increase in number and size

92
Q

Which costimulatory molecule on B cells decreases with aging?

A

CD40

93
Q

Which costimulatory molecule on B cells decreases with aging?

A

CD40

94
Q

serious infections may be heralded by what systemic changes?

A

declines in function, mental status, or anorexia, or exacerbation of comorbidities (CHF)

95
Q

What is the most common sign that triggers the search for an infx?

A

fever

96
Q

what is the most cost effective method of preventing infection?

A

vaccination

97
Q

how many different bugs can we now protect against using vax?

A

25

98
Q

what are the particular vaccines we give to oldies?

A

influenza
pneumococcus
zoster

99
Q

t/f: the flu vaccine reduces hospitalization and death in the elderly

A

true

100
Q

which particualar pnuemonia vax is recommended for oldies?

A

23-valent polysaccharide strep pneumo

101
Q

by what percent is the incidence of pneumococcal dz decreased oldies who get pneumovax?

A

65%!!

102
Q

what is the effect of underlying comorbidities on vaccine effectiveness?

A

lower protection

103
Q

pneumococal pneumonia in oldies often happens secondary to a….

A

viral infection

104
Q

t/f: high fever is not common in older adults for infection

A

true!

105
Q

t/f: high fever is not common in older adults for infection

A

true!

106
Q

t/f: even with the vaccine, you can still get pneumococcal dz

A

true

107
Q

what particular type of VZV vaccine is given to oldies?

A

attenuated live vaccine; give after 60

108
Q

by what percent is herpes neuralgia reduced with the VZV vaccine?

A

50-67%

109
Q

describe the shingles rash

A

papules, vesicles, crusting scabs and a dermatomal distribution

110
Q

What is the primary source of infection that causes reactivation of shingles?

A

chickenpox

111
Q

where does the VZV stay while it is latent?

A

ganglion cells

112
Q

VZV recurrence is tied with a decreased in what cell type immunity?

A

T cell

113
Q

do CONJUGATE vaccines given to kids enhance adult immune responses?

A

nope

114
Q

What types of vaccines should we give to keep vaccine efficacy high in old age?

A

immungenic live-attenuated in early life followed by booster vaccination with better adjuvants for the elderly and shorter intervals

115
Q

What particular type of malnutrition is present in up to 60% of pts older than 65 who present to the hospital?

A

protein energy malnutrition

116
Q

Protein malnutrition is linked to what problems?

A 
delayed wound healing
pressure ulcer formation
increased risk of nosocomial infx
extended length of stay
inc mortality
117
Q

What is the serum albumin level that reflects PEM?

A

3-3.5g/dL

118
Q

what is the correlation between PEM and vaccine effectiveness?

A

decreased response and diminished responses to immune stimuli

119
Q

higher rates of CAP is associated with what social factor?

A

lower SES

120
Q

what environmental triggers increases the risk to infection?

A

poor nutritional status
frequent air pollution or tobcco exposure
inadequate vaccination

121
Q

Long-term care residents have a high incidence of what type of infection?

A

respiratory infections

Block 11 Week 3 (1 decks)

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