TEST 1 Flashcards
Identify the WHO definition of health
State of complete physical, mental and social well-being and not merely the absence of disease or infirmity
Definition of Pathophysiology
The study of the abnormalities in physiologic functioning of living beings
Process of clinical reasoning
Steps in the thought process to get to your diagnosis
- *Take a good history
- *Develop DD list using +/- patient presentation
- *Order diagnostics based on DD
- *Prioritize the order of the differentials Possible vs Probable
Process of Differential Diagnosis
- Most likely - prevalence demographics, risk factors, signs and symptoms
- Life-threatening - can’t miss it
- High prevalence - most common diagnosis
Etiology
WHAT CAUSED THE DISEASE
- Idiopathic (unknown) Iatrogenic (treatment cause)
- Risk factor (presence increased the likelihood of the disease)
Pathogenesis
Development or evolution of the disease from initial stimulus to full-blown disease and finish. Initial factors alter normal physiologic fx and lead to the development of clinical manifestations that are observed in a particular disorder/disease
Clinical course of a disease
- Exacerbation - a sudden increase in severity of existing disease
- Remission - decrease in s/s (could be cure)
- Convalescence - stage of recovery after a disease, injury, or surgery
- Sequela - complications resulting from illness (flu recovered but dev pneumonia)
Stages of disease
- Latent period - the time between exposure of pathogen and 1st s/s (asymptomatic)
- Prodromal period - 1st s/s occur indicating disease
- Acute phase -disease at full intensity; usually short-lived
- Exacerbation- sudden increase in severity
- Remission - decrease in severity, signs/symptoms
- Convalescence - stage of recovery after a disease, injury, or surgical procedure (rehab after stroke)
- Sequela - subsequent pathologic condition resulting from illness (pneumonia after flu)
Differentiate between primary, secondary, tertiary prevention
- Primary - (P) Preventing disease: Seasonal flu shot, vaccinations, clean H2O, seatbelts, condoms, safe sex
- Secondary (S) Screening, early detection: screening mammogram, blood tests, screening colonoscopy, year physicals
- Tertiary (T) Medical Treatment (disease is there): medications, rehab, surgery, supportive care
Function of Organelles and its components
Control center containing all genetic information. Nucleus, Endoplasmic Reticulum, Golgi complex, Mitochondria, Lysosomes
Nucleus
- Performs work maintaining the cell’s life
- Largest organelle
- Contains DNA and RNA synthesized in the nucleus
Endoplasmic Reticulum/Golgi Complex
Synthesize enzymes/proteins and packages them
Lysosomes
Digests material - Phagocytosis
Mitochondria
Converts energy for cellular reactions ATP production
Anaerobic vs. Aerobic metabolism in ATP production
Anaerobic no oxygen needed (not as efficient in ATP production) vs aerobic needs oxygen (more efficient)
Differentiate between diffusion, osmosis, passive/active transport
- Diffusion - movement of solutes from higher to lower concentration
- Osmosis - movement of solvent across cellular membrane from low to high solute area
- Passive transport is diffusion and facilitated diffusion and moves fluid from higher concentration to lower concentration without ATP Active transport is movement from lower to higher solute concentration area it involves a carrier molecule (ATP- energy)
Describe active transport in relation to Na/K pump
Energy is required to move sodium out of the cell where the concentrations are high and move potassium into the cell where concentrations are high
Differentiate between function of DNA vs RNA
- DNA replicates and stores genetic information. It is a blueprint for all genetic information in an organism.
- RNA converts the genetic information stored within the DNA to a format used to build proteins and then moves it to the ribosomal protein factories
Identify the four types of cellular tissue
- Epithelial
- Connective
- Muscle
- Neural
Epithelial Tissue
Lines outside and interior areas of the body. Squamous, cuboidal, and columnar cell shapes. Holds together cushions organs
Connective Tissue
Large extracellular and fibroblast cells. Collagen, elastic, and reticular types Holds organs together, cushions organs
Muscle
- Cannot replicate
- Made of contractile fibers consisting of actin and myosin - Myocytes Smooth, cardiac, or skeletal
Neural Tissue
Cannot replicate
- Neurons - conduct impulses
- Neurons cell body, axon, dendrites
- Neuroglial cells - supporting role
- Astrocytes - BBB
- Oligodendrocytes - myelin in CNS
- Schwann cells - myelin in PNS
- Microglia - phagocytic cells
- Ependymal - produce CSF
Proliferation
The process by which cells divide and reproduce. The rate is determining factor. If the rate is abnormal develop neoplasms.
Differentiation
Process by which cells become specialized by:
- Type
- Function
- Structure
- Life cycle
Everything comes from stem cells
Adaptation
Cells attempt to prevent their own death from environmental changes through adaption. Modify size, numbers, and types in an attempt to maintain homeostasis. Adaption ceases once stimuli is remove. Atrophy - shrinks uses less resources Hypertrophy - enlarges Hyperplasia - increase # of cells (epithelial) - menses Metaplasia - adult cells are replaced by less mature cells. Cells still look alike. Initiated by chronic irritation and inflammation. Esophagus cells r/t GERD Dysplasia - mutation into cells of different size, shape, and appearance. Premalignant cell, next stage Ca. Can still be reversed
Describe the process of cellular injury and cellular death
Cellular injury is reversible up to a point. Cell death occurs by apoptosis or necrosis. Hypoxia is the most common cause of cellular injury. Apoptosis is programmed cell death at a certain point of development and there is no inflammatory response Necrosis - cell rupture, spilling of contents cause inflammation. Liquefaction (brain) cauceous (lung, TB), fat (pancreas), and coagulative (heart)
Explain the process of free radical damage and the role of antioxidants
Free radicals are unstable atom unipolar molecules in the body. The most concerning are those derived from oxygen and therefore called ROS. Free radicals attach to molecules and then make them unstable. Antioxidants are marketed as preventing and/or fighting disease and aging. Antioxidants travel through the blood vessels to reach damaged cells and supply the free radical with an electron to repair the free radical without damage to itself.
Differentiate between benign and malignant neoplasms
Neoplasm is cellular growth no longer responding to normal regulator processes (an error in the division of cells) Benign neoplasms are similar to normal cells faster growth than normal, localized, do not cause systemic effects. Malignant neoplasms are undifferentiated (nonspecific cell type), nonfunctioning cells that reproduce rapidly. Differ from normal cells in size, shape, and number. Invade nearby tissue and metastasize to distant tissue. Cause systemic effects. Genetic, epigenetic, and microenvironments factors. Epithelial - carcinoma Connective - sarcoma hematopoietic - leukemia Bone, liver, and lung most common areas of metastasizes
Identify common tumor cell markers
- Alfa fetoprotein - liver, ovarian, testicular germ cell ca
- CA 15-3 - breast, lung, ovarian, prostate
- Carcinoembryonic antigen - bladder, breast, cervical, kidney, liver, lung, lymphoma, melanoma, ovarian, pancreatic, stomach, thyroid
Autosomal Dominant Disorder
Single gene mutation Passed from affected parent to offspring - REGARDLESS OF SEX
Ex. Marfan’s Syndrome - tall, thin, long arms, Aortic & Mitral valve murmurs, aorta abnormalities
Autosomal Recessive Disorder
Single gene mutation Passes from an affected parent - REGARDLESS OF SEX Both parents have to be carriers can skip generations before active disease occurs
Ex. Cystic Fibrosis
Sex-Linked Disorders Recessive or Dominant
Mostly X-linked Very little genetic material on Y chromosome. More males affected with more severe presentation
Ex. Hemophilia
Polyploidy
More than the normal 23 pairs in a cell
Aneuploidy
Abnormal separation during cell division - too many or too few chromosomes
Trisomy 21 Autosomal Aneuploidy
A spontaneous chromosomal mutation resulting in three copies of chromosome 21 Hypotonia Distinctive facial features Congenital heart defects Simian crease
Turner’s Syndrome
Females - deletion of X chromosome Short lymphedema of hands and feet Broad chest wide nipples Low-set ears
Klinefelter’s Syndrome
One or more extra X chromosomes and at least one Y (XXY) MALES
- Small penis. prostate gland, and testes
- Sparse facial and body hair
- Long legs short obese trunk
Identify the components of the immune system
Antigen-Antibody Autoantibody
Primary Lymphoid Organs
Secondary Lymphoid Organs
Antigen
Foreign agents that trigger the body to produce antibodies
Antibody
Proteins in the body that IDs and neutralizes foreign agents (virus/bacteria)
Autoantibody
An antibody that attacks itself
Primary Lymphoid organs
- Bone marrow - red marrow
- Thymus gland
- Lymphoid system Lymphocytes (T cells, B cells, Natural Killer cells)
Secondary Lymphoid organs
- Spleen
- Lymph nodes
- Tonsils
- Peyer patches
Describe the process of innate immunity
What we are born with. Interferons are released from cells that have an infected virus they put out this interferon to protect other cells from the virus. Bind to the plasma membrane to keep the virus from reproducing. Physical and chemical barriers found in the body Skin and mucous membranes (acidic skin and cilia) Natural Killer cells - react immediately Inflammatory response
Explain NK cells
Natural killer cells are not dependant on the thymus for development. Part of innate immunity will kill tumor and viral infected cells WITHOUT previous exposure. Do not need previous exposure to antigen. Will not affect cells with MCH1 protein to protect from autoimmunity
What role does the Thymus play in immunity?
Found in the mediastinum. Mature T lymphocytes that formed in the bone marrow.
Explain the sequence of the inflammatory response and the role of mast cells and mast cell mediators
Inital response is vasospasm to stop bleeding, clot, then vasodilates to get cells to help repair
Describe the complement system and the membrane attack complex
Plasma proteins to enhance and cause inflammation, gives chemotaxis (attracts neutrophils), lysis, and optimization (immediately flags cells for destruction shorter and faster than MAC) MAC creates a hole in a a bacterial cell membrane (mainly gram- bacteria)
Describe Adaptive Immunity and the difference between cellular immunity and humoral immunity
Recognized and destroy foreighn invaders and maintains a memory of it.
Cellular immunity (cell surfaces) T cells (CD4 and CD8) Humoral immunity (body fluids) B cells (memory or plasma cells) - mature in bone marrow and is aquired immunity. Floating around in the body looking for foreign invaders it remembers. Starts allergic rx’s, prevents viral infections, eliminates bacteria and toxins. ABLE TO RESPOND RAPIDLY found mainly in peripheral tissue. Thousands produced die rapidly. Requires activation from T Helper cells (CD4) No thymus prevents this step
CRP and Sed Rate
Labs to show inflammation in the body
Compliment cascade Classical Pathway
Triggered by the antibody-antigen complexes (IgG, IgM) starts at C1 ends with MAC but takes longer than the alternative pathway
Compliment cascade Alternative Pathway
Triggered by bacterial endotoxin. Skips classical pathway goes to C3 and involves opsonization (immediate flag for phagocytosis) its a shortcut
CD4 cells
Type of T cell, Regulator (helper) cell involved in Adaptive Immunity
CD8 cells
Type of T cell, Effector (cytotoxic) cell involved in Adaptive immunity
Major Histocompatibility Complex
Part of adaptive immunity that is Human Leukocyte Antigen (HLA) in humans Marks the body cells as “safe” No one person has the same MHC except identical twins MHC1 is on every cell expect RBC’s
IgM
Produced first! Lasts around 10 days M for immediate Active infection Activates complement system
IgG
Prior exposure to vaccine or virus. Can cross the placenta to provide immunity to the fetus (passive immunity)
IgA
- Skin
- MM
- Saliva
- Tears
- Colostrum
- Breast Milk
- Acts locally
IgD
On B cells works with IgM
IgE
Triggers histamine and cell mediators Allergic reaction or parasitic infection
Passive Immunity
Immediate protection can be temporary Immunoglobulins (serotherapy) - Rabies, Hep A&B - gives immediate immunity Mother to the fetus (IgG, IgA)
Active Immunity
Has had infection or immunization
Explain the different types of vaccines
Live - identical immune response as infection - no for immunocompromised
Inactivated Vaccine - Whole/fraction of virus/bacteria/toxin, humoral immune response (Polio, HepA)
Fractional Vaccine - Modified toxins (Tetanus, Ptosis, Pneumonia)
Recombinant Vaccine - Genetically engineered (HPV)
Type I Hypersensitivity Reaction
Immediate response - Histamine, Leukotrienes, Prostaglandins Histamine (mild hives, eczema seasonal allergies to wheezing, tachycardia to anaphylaxis) IgE, Allergy response, Asthma, Anaphylaxis T Cells bind to mast cells, stimulate B cells
Type II Hypersensitivity Reaction
Transfusion reactions and newborn hemolytic reactions Destruction of antigens on target cells or tissues resulting in lysis B cells, RBCs, WBCs IgM and IgG are principal antibodies
Type III Hypersensitivity Reaction
Autoimmune disorders - accumulation of circulating antigen-antibody complexes - B cells Targets tissues, joints, skin, kidneys, blood vessels causing glomuleronephritis 10-12 days after infection and triggers complement system
Type IV Hypersensitivity Reaction
PPD reaction, Dermatitis
Delayed processing of the antigen by macrophages. Antigen presented to T cells after processing Can take 24-72 hours to develop
NOT ANTIBODY-MEDIATED
ex. Contact dermatitis, TB, poison oak
Immunodeficiency
Increases susceptibility to infections, crucial to prevent infections
- Primary - congenital deficiency, defective CD4s, deficient complement system, deficient and defective adaptive system (sick more than you should be)
- Secondary - loss of spleen, medications
Autoimmunity
Failure to identify self-antigens from foreign antigens Genetic component, exacerbation and remission, previous Epstein Barr infection. Two methods of attack: Autoantibody, T cell mechanism triggered by viral/bacterial infections, environ/occ stress
Opsonization
A pathogen is marked for ingestion and eliminated by a phagocyte, C3b and antibodies are responsible for opsonization
B Cell Disorders
B - Bone Marrow Attack invaders on the outside of the cell and antibody secretion Deficiency in humoral or antibody-mediated immune responses B cells recognize surface antigens of viruses and bacteria and produce and secrete antibodies, activating the immune system to destroy the pathogens. They defend against viruses and bacteria that enter the blood and lymph. IgA deficiency, hyper-IgM syndrome
T Cell Disorders
Deficiency in Cell-Mediated immune responses. Can only recognize viral antigens outside the infected cells T cells defend against pathogens including protists and fungi that enter the cells. DiGeorge Syndrome, Wiskott-Aldrich syndrome
Difference between CD4 and CD8 cells
CD8 (cytotoxic cells) can kill cancer cells recognizes antigens, destroys viral cells, mutant cells CD4 (T-helper cells) leads the fight against infection, , activates macrophages, interacts with antigens; stimulates B Cell proliferation and antibody production.
3 types of HOST / MICROBE RELATIONSHIP
- Transient - food/water pass through without staying
- Commensal - normal flora
- Pathogen - cause disease
Physical barriers to pathogens
Epithelial cells (must be intact)
Sloughing of the skin
High-fat content of skin inhibits growth of bacteria & fungi
Mucous membranes trap
Cilia transport system in lungs sweep out
Frequent urine passes out bacteria
Biochemical barriers to pathogens
- Acidic environment of the skin, urine, vagina inhibits bacterial growth
- HCI in stomach kills organisms
- Saliva, mucous, tears, sweat have enzymes that are antibacterial
- Sebaceous gland secretions are antifungal
Risk factors that promote pathogen proliferation
Nutritional status, Age, Chronic Illness, Immunosuppression, Stress (cortisol)
Differentiate between high and low pathogen virulence
- High virulence can cause disease in a healthy
- individual Low virulence can cause disease in an immunocompromised individual
Routes of transmissions in pathogens
- Direct
- Indirect
Direct transmission (3) routes
- Body fluids: droplet
- Animal bites/soil
- Placenta transfer - vertical transmission
Indirect transmission (3) routes
- Vehicle borne - water, food, clothing, tissue
- Vector-borne - insect carries
- Airborne - droplets, measles, legionnaires (cooling towers)
Four types of pathogenic microorganisms
- Bacteria
- Viruses
- Fungi
- Parasites
Bacteria Characteristics
Various shapes Cocci (spherical) enterococcus
Bacilli (rod-shaped)
Vibrio (comma-shaped rods)
Pseudomonas Spirilla (twisted , spiral rod-shaped
Anaerobic - spirochetes
Viruses
Smallest known infective agents Composed of protein shell; capsid with core of DNA or RNA Some have protective envelope around the capsid Viruses have organelles bacteria don’t which means they can mutate into different strains
DNA Viruses
DNA - Produce messenger RNA in host cell nucleus Viral proteins formed from mRNA Virus DNA replicted by host polymerases Ex. HSV
RNA Viruses Retrovirus
Retrovirus: contains enzyme reverse transcriptase; convert their RNA into DNA; incorporated into the host’s DNA Ex HIV
RNA Viruses Replicating Virus
RNA viruses replicate within the cytoplasm and most produce mRNA which is then translated into proteins and genomic RNA, from which new viruses are created
Fungi
Have organelles Eukaryotic microorganisms with thick rigid cell walls Mycotic Infections caused by yeast Neutrophils, monocytes and eosinophils can destroy fungi Fungi thrive on glucose
Superficial (Fungi)
Superficial, dead, keratinized tissue, cause inflammation DO NOT INVADE TISSUE Ex. Tinea Pedis
Subcutaneous (Fungi)
Introduced during trauma Leads to ulcers and abscesses
Systemic (Fungi)
Inhalation of dust (from soil) More serious Affects immunocompromised hosts
Parasites
Establish themselves with another organism; benefit from the other organism Rarely transmitted by human contact Usually transmitted by a vector (malaria) Protozoal infections trans by food/water (Giardia) Commonly affect skin and GI tract
Protozoa
Single-celled parasite
Nemathelminthes
Roundworm parasite
Platyhelminths
Flatworm parasite
Five types of WBCs (Leukocytes)
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- Neutrophils
- Lymphocytes
- Monocytes
- Eosinophils
- Basophils
