unit 2 stuff Flashcards
dysplasia
abnormal cells with different shape, size, and organization
metaplasia
abnormal cell changes but are benign and reversible
what is the term for early dysplasia
metaplasia
meta
change, alteration
plasia
cellular multiplication, growth
anaplasia
loss of cell differentiation
hyperplasia
increased number of cells in the tissue
neoplastic hyperplasia
abnormal increase of cell mass from tumor formation
plast
living substance, organelle, cell
carcinoma in situ
preinvasive epithelial tissue that has not penetrated the basement membrane
5 major neoplasm classifications
- epithelial
- connective
- nerve
- lymphoid
- hematopoietic
stage 0
carcinoma in situ (preinvasive)
stage 1
early, local stage cancer
stage 2
increased spread risk due to size
stage 3
spread but not disseminated to distant regions
stage 4
cancer spread and disseminated to other sites
what is “T” in the tumor classification
primary tumor
T(is)
carcinoma in situ
T1-4
progressive tumor size/local involvement
what is “N” in the tumor classification
regional lymph nodes
N(0)
no lymph node metastasis
N(1-3)
increasing lymph node involvement
what is “M” in the tumor classification
distant metastasis
M(0)
no distant metastasis
M(1)
signs of distant metastasis
3 most commonly diagnosed cancers
- lung
- breast
- colorectal
what is the world’s most prevalent cancer that has caused the most deaths
lung
somatic mutation theory
single cell mutation that causes cancer
translocation of genes
nucleotide bases from one chromosomal area go to another location
oncogenes
genes that can cause cancer from virus interaction or independently
tumor-initiating stem cells + why they are dangerous
stem cells that cause cancer
they are not susceptible to chemo and radiation
tumor-specific antigens (TSAs)
only expressed by tumors and recognized by T cells
why are tumor antigens not always spotted by the immune system
because they only slightly vary from self-antigens so they more easily escape the immune system
tumor-associated antigens (TAA)
expressed by tumor cells but also normal cells
3 main cells that fight cancer cells
- NK cells
- macrophages
- CD8+
5 most common cites of cancer metastasis
- lymph nodes
- liver
- lungs
- bone
- brain
is appendicular or axial skeleton more effected by cancer
axial
4 environmentally rich areas for cancer to grow
- pulmonary system
- hepatic system
- skeletal system
- central nervous system
osteolytic cancer
cancer that decreases bone density
stage 4 symptoms
weakness, anemia, prexia
prexia
fever
pryo-
fire, heat, high temp
throbbing pain means
blood supply interference
sharp pain means
nerve pressure or displacement
what cancer is the most painful
bone
referred pain goes to were with pancreas/liver/spleen/gallbladder cancer
shoulder, mid/low back
sympathetic nervous system pain feels like and presents like
mild to moderate pain
tachycardia, hypertension, tachypnea
parasympathetic nervous system pain feels like and presents like
visceral/severe pain
hypotension, bradycardia, nausea, vomiting, weakness
paraneoplastic syndrome
tumor symptoms distant from the tumor itself
what causes paraneoplastic syndrome
typically ectopic hormone production by the tumor
secondary cancer prevention
early detection by screening
primary cancer prevention
epigenetic testing, nutrigenomics, and chemoprevention
curettage biopsy
pap smear
fluid aspiration biopsy
spinal tap
fine-needle aspiration biopsy
breast/thyroid
excisional biopsy
lumpectomy
core needle biopsy
tru-cuts
stereotactic biopsy
mammotome
PSA stands for
prostate specific antigen
CEA biomarker for what cancers
bowl
stomach
pancreas
lung
breast
neoadjuvant treatment
- chemo/radiation
- local control like surgery
adjuvant treatment
- surgery
- chemo/radiation
3 types of irradiation therapy
- external beam
- sealed source (x-ray/gamma)
- unsealed source (systemic therapy)
cell kill hypothesis
chemo reduces tumor to size that immune cells can take over
how can local cancer be cured
surgery
what cancer treatment is most popular for metastasized cancer
chemo
growth fraction
% of proliferating cells to the whole tumor
does growth fraction increase or decrease with tumor size and why
decrease because as the tumor grows, the blood can’t supply all the cells to replicate so some stay “dormant”
what circumstances does chemo work the best
when the tumor is small and a large proportion of the cells are dividing
alkylating chemo agent mechanism
prevents replication of DNA by stopping the untwisting
alkyl group
carbon/hydrogen chains (like methyl CH3)
antimetabolite chemo agent mechanism
interrupts cellular pathways that synthesize DNA/RNA
what are 2 ways antimetabolites interrupt DNA/RNA synthesis
- mimic active ingredients & makes fake, nonfunctional genetic product
- occupying enzymes needed for DNA/RNA synthesis
antibiotic chemo agent mechanism
inserts in between base pairs of DNA to prevent synthesis
antimicrotubular chemo agent mechanism
disrupts spindles and prevents cell division
topoisomerase inhibitor chemo agent mechanism
inhibits the unwinding/winding enzyme in DNA replication
anticancer hormone chemo agent mechanism
blocks hormones that fuel the cancer
platinum coordination complexes chemo agent mechanism
heavy metal compounds bind to DNA to distort the structure and prevent DNA translation/replication
agents that target cell surface receptors (chemo agent mechanism)
binds to receptors and triggers apoptosis (tyrosine kinase inhibitors)
cytokine chemo agent mechanism
stimulates immune system to fight so healthy cells aren’t harmed
alopecia
hair loss
anagen phase
actively growing hair
when does chemo induced nausea and vomiting occur, peak, and how long do effects last
occur: 1-2 hours
peaks: 4-10 hours
lasts: 12-24 hours
myelosuppression
bone marrow inhibition
neutropenia common infections
fungal
gram positive bacteria (most common)
gram negative bacteria (kills most)
tumor lysis syndrome
tumor is destroyed but metabolic byproducts are too much for the kidneys to handle
sinusoidal obstruction syndrome
liver veins are blocked
chemotherapy-induced peripheral neuropathy
less tendon reflexes
- less proprioception
- numbness, tingling, burning
CNS toxicity symptoms
chemo brain
stroke-like symptoms
autonomic neuropathy
hypotension
constipation
dysfunctional sexual organs/bladder
what cells mediate chemo and protect the body when neutrophils are low
granulocyte colony-stimulating factor
granulocyte-macrophage colony-stimulating factor
monoclonal antibodies
pharmacologically designed antibodies used in immunotherapy to attract NK cells which then kill the cell
hematopoietic cell transplantation
type of immunotherapy where bone marrow is transplanted into patient
antiangiogenic therapy
blocks formation of new blood vessels
erol
Bronchodilators
(Adrenergic)
phylline
Bronchodilators
(xanthine derivatives)
fluorouracil
antimetabolite for chemo
cyclophosphamide
alkylating agent for chemo
selective estrogen receptor modifiers
blocks estrogen from stimulating tumor growth
palliative treatment
when cures are no longer possible or available
durable remission
if the response to treatment is maintained for a long period of time
no evidence of disease classification
0-5 years of no detectable disease
cured prognosis classification
5+ years of no disease
how long and how many times a week should a person be exercising mod-vigorously
30-60 min
5x/week
cancer is the 2nd leading cause of death in this age range
1-14 years old
what is the most common pediatric cancer
leukemia
what is the most common soft tissue cancer children get
rhabdomyosarcoma
what cancer is most common in adults
adenocarcinomas
what is the most common form of leukemia in children
acute lymphocytic leukemia (ALL)
what are the 2 age peaks of incidence in childhood cancer
- 2-5
- 15-19
what is the trade name for doxorubicin
Adriamycin
poiesis
making, formation
cells in the innate immune system
monocyctes
neutrophils
eosinophils
basophils
mast cells
NK cells
cells in the adaptive immune system
B cells
T cells
cells in both adaptive and innate immune system
macrophages
dendritic cells
first cells to respond in immune reaction
neutrophils
what cells fight against pus forming bacteria
neutrophils
what cells filter out the neutrophil debris and other dead cells
monocytes/macrophages
what cell helps in allergies and parasitic infection
eosinophils
what are the 3 cells that are elevated with allergic reactions
eosinophils
basophils
mast cells
what is the longest living immune cell type
monocytes
what cell is involved with allergies, anaphylaxis, and wound healing
mast cells
what cells are involved with the movement and removal of antigens, antibodies, and compliment system
erythrocytes
thrombocytes
what cell produces thrombosis and hemostasis
platelets
3 types of T cells
helper
cytotoxic
suppressor
what cell type has mature cells congregate in the blood and spleen
natural killer cells
what cell is a mononuclear granulocyte
neutrophils
what cell is a mononuclear phagocyte
monocytes
what 2 cells ingest pathogens and kills them
neutrophils
monocytes
what 2 cells are limited in cancer patients that make them susceptible to infection
neutrophils
monocytes
what are the 3 antigen presenting cells (APCs)
macrophages
dendritic cells
b cells
what cells to APCs present their antigens to and what class of MHC
CD4+
MHC II
MHC I involves what cell
CD8+
MHC II involves what cell
CD4+
soluble factors of internal defenses include
complement system
cytokines
chemokines
where do B and T cells get trained
the lymphatic system
what is the second line of defense in the immune system
the inflammatory response
what is the first line of defense in the immune system
innate immunity
what is the third line of defense in the immune system
specific immunity
active natural immunity
natural antigen contact from the environment
active artificial immunity
vaccine
passive natural immunity
natural contact through mother/fetus
passive artificial immunity
injection of immune serum globulinhu
what are the 2 parts of adaptive immunity
humoral
cell-mediated
what is the humoral immunity mechanism
antibodies and B cells
what is the cell-mediated immunity mechanism
T cells
what region of the antibody determines the type of immunoglobulin it is
the heavy chain
what region of the antibody binds to antigens
Fab
what region of the immunoglobulin binds to the complement region
Fc
what immunoglobulin is the first secreted
IgM
which immunoglobulin is the main responder for primary immune responses
IgM
which immunoglobulin is the main responder for most secondary immune responses
IgG
which immunoglobulin is antiviral and antibacterial
IgG
which immunoglobulin is involved with allergies
IgE
which immunoglobulin defends the external body surface and is in serum/secretions
IgA
which immunoglobulin has the lowest blood levels and are found on naive B cells
IgD
4 functions of immunoglobulins
- attacks antigens through agglutination
- activates complement system
- activates anaphylaxis through histamine
- stimulates antibody-mediated hypersensitivity
gene rearrangement
DNA rearrangement B cells go through to create millions of antigen receptor types
what cell is responsible for the rejection of donor organs
T cells
what cells present to helper T cells to create an immune response
APCs
what cells present to cytotoxic T cells to create an immune response
infected cells
what t cell prevents inappropriate responses to “self” antigens
regulatory T cells
5 phases of immune system
- recognition
- amplification
- effector
- termination
- memory
what immune system cells are most impacted by strenuous, high-intensity exercise
neutrophils
primary immunodeficiency
involves T cells, B cells, or lymphoid tissue
secondary immunodeficiency
results from underlying disease that stops immune response (AIDS)
HIV life cycle steps
binding
fusion
reverse transcription
integration
replication
assembly
budding
which HIV is most transmittable
HIV-1
4 clinical stages of HIV are based on the cell count of ___ in the body
CD4+
4 clinical stages of HIV
- acute infection
- asymptomatic
- symptomatic
- advanced
how many CD4+ cells are in advanced HIV
200
seroconvergence
HIV antibodies in the blood stream and test positive on HIV tests
what clinical stage of HIV is seroconvergence seen
asymptomatic
what is the hallmark symptom of having AIDS
kaposi sarcoma
Type I IgE-mediated reaction
allergies
Type II tissue-specific reaction
graves disease
myasthenia gravis
insulin-resistant diabetes
Type III immune complex-mediated reaction
lupus
Type IV cell-mediated reaction (T-cells)
contact sensitivity to poison ivy/metals
graft rejection
what is an example of complement-mediated lysis
ABO blood incompatibility: A+ blood cannot receive/give to B- blood
complement-mediated lysis and phagocytosis are both mechanisms of what hypersensitivity disorder
type II tissue specific
T cell mediated diseases
rheumatoid arthritis
multiple sclerosis
hashimoto thyroiditis
type I diabetes
IBS
3 types of autoimmune diseases
- localized tissue damage from specific antibodies
- localized organ lesion but antibodies are NOT organ specific
- non-organ-specific diseases (antibodies and lesions all over)
self tolerance
unresponsiveness to one’s own antigens
central tolerance
immature lymphocytes that recognize self-antigens are killed
discoid lupus
affects only the skin
systemic lupus
affects any organ in the body
presents different from each patient
symptoms of lupus
butterfly rash
lesions
CNS symptoms
Renal symptoms
isoimmune disease
organ/tissue transplant incompatibility of cell surface antigens
HLA matching
used to find donor organs to increase likelihood of host accepting the organ
what defines being at a carrier state for hepatitis
when the pathogen travels from the liver to the bloodstream
biggest external signs of infectious diseases
fever, chills, sweating, malaise, nausea, vomiting
internal physiological sign a patient has an infectious disease
increased # of leukocytes or a change in the types of leukocytes
what is the normal WBC count in the body
5k-10k
leukocytosis
elevated WBC count
leukopenia
decreased WBC count
what could cause leukopenia
bone marrow disease, radiation, or chemo
what could cause leukocytosis
infection or other inflammatory response
what is the most abundant WBC type
neutrophils
decrease in what kind of cell increases heath care-associated infection (HAI)
neutrophils
cytosis
increase in cells
what is the normal body temperature range
96.8-99.5*F
where is the temperature-regulating center of the brain
hypothalamus
pyrogens
protein substances and toxins that cause the hypothalamic thermostat to rise
how does infectious disease present in older adults
change in mental status
subnormal body temperature
brady/tachycardia
fatigue
lethargy
decreased appetite
examples of noninfectious causes of fever
drug reaction
pulmonary emboli
neoplasm
tissue necrosis
autoimmune diseases
intermittent fever
temperature returns to normal at least once every 24 hours
what are intermittent fevers typically associated with
sepsis
abscesses
infective endocarditis
remittent fever
temperature fluctuates but does not return to normal
what are remittent fevers associated with
viral upper respiratory infection
sustained/continuous fever
temperature remains above normal with minimal variations
recurrent/relapsing fever
episodic fevers lasting 1-3 days with 1 or more days of normal temps in between
what temperature threshold should be used for older adults when detecting fever
99-100*F
infectious disease definition
infection that causes obvious injury to the host and is accompanied by one or more clinical symptoms
incubation period
period between pathogen entering the host and the appearance of clinical symptoms
latent infection
after microorganism has replicated but stays inactive in the host (sometimes years)
period of communicability
time period when an organism can be shed
ex: respiratory route, GI
which is larger: fungus or bacteria
fungi are larger than bacteria
pathogenicity
ability of the organism to induce disease
virulence
the potency of the pathogen in producing severe disease
how is virulence measured
the # of people who die of the disease divided by the # of people who have the disease
opportunistic pathogens
they do not cause disease in people with intact host defenses but can cause devastating disease in immunocompromised individuals
an environment in which an organism can live and multiply
reservoir
where the parasite leaves the reservoir is called
portal of exit
what is essential for preventing the transmission of a pathogen
knowledge of the portal of exit
what are the 2 modes of contact transmission
- direct contact
- indirect contact
vector-borne transmission
involves insects and/or animals that act as intermediaries between two or more hosts
how small are airborne-transmitted particles
less than 5 um
how large are droplet-transmitted particles and how far can they travel
5um
3 feet
influenza is spread through what kind of transmission
droplet transmission
tuberculosis and chicken pox are spread through what kind of transmission
airborne transmission
salmonellosis is spread through what kind of transmission
vehicle transmission
vehicle transmission
pathogen is transmitted through a common source to many potential hosts
ex: contaminated food, water, IV
how a pathogen gets into a host
portal of entry
examples of safe waste
feces
urine
vomitus
tears
sweat
snot
health care-associated infection (HAI)
infections that develop in hospitalized person admitted to health care facility that were not present before being admitted
what are the most common HAIs
pneumonia
GI tract infection
surgical site infections (SSIs)
causes of HAI
frequent use of invasive devices
immunosuppressants and antibiotics
multidrug-resistant organisms
lack of hand hygiene
hospital interventions that can cause HAI
- central line associated bloodstream infections
- catheter associated urinary tract infections
- ventilator associated pneumonia
- surgical site infections
what is the #1 way to prevent HAIs
washing hands even when gloves are used
jewelry may sequester what type of pathogen
gram-negative organisms
artificial nails sequester what type of pathogen
coagulase-negative staphylococci
gram-negative rods
what position should the head of the bed be after a tracheostomy to prevent HAI pneumonia
30*
cocci shape
spherical
bacilli shape
rod-shaped
spirilla/spirochetes shape
spiral-shaped
bacteria cell walls contain
peptidoglycan
unicellular microorganisms with a rigid cell wall
bacteria
gram positive bacteria
purple stain
- thicker peptidoglycan wall
gram negative bacteria
pink stain
- small peptidoglycan wall with an additional bilipid membrane
CDI infection is associated with what type of symptoms and how is it transmitted
diarrhea and GI tract symptoms
fecal-oral route from contaminated hands
staphylococcal infection is associated with what type of symptoms and how is it transmitted
integumentary disease that produces skin lesions
streptococcal infections are associated with what type of symptoms and how is it transmitted
strep throat, typically through droplets
group B streptococcal infections
neonatal pneumonia
meningitis
sepsis
clostridial myonecrosis (gas gangrene) is caused by what classification of bacteria
anaerobic bacteria
they produce gas which breaks down tissue
pseudomonas effects which systems
integumentary
circulatory
respiratory
most common hospital and nursing home acquired pathogen
pseudomonas
bactericidal
drugs that typically kill or destroy bacteria
bacteriostatic
drugs that do not actually kill bacteria but limit their growth and proliferation
3 mechanistic steps of antibacterial drugs
- inhibition of cell wall synthesis/function
- inhibition of protein synthesis
- inhibition of RNA/DNA synthesis
what are bacterial cell walls made of
peptidoglycans
what is the enzymatic cofactor in the synthesis of bacterial nucleic acids and EAAs
folic acid
what do drugs target to inhibit RNA/DNA synthesis
folic acid
antibiotic stewardship
being careful to not overuse antibiotics
what is a viruses composition
RNA or DNA
covered with proteins
capsule
3 DNA viruses
hepatitis b
herpes
chickenpox
nucleocapsid
nucleic acid core and the protein shell
4 steps of viral replication
- absorption
- penetration and uncoating
- biosynthesis
- maturation and release
what do antiviral drugs do
they slow down viral replication by interfering with one or more of the steps
75% of hepatitis c goes to…
chronic hepatitis c
approximately 70% of americans older than 12 years old have what virus
HSV-1
what virus is responsible for cold sores
HSV-1
what strain of herpes is most common through sexual contact
HSV-2
what part of the body does HSV1 primarily affect
mouth and oral cavity
what does varicella zoster virus (HHV-3) cause
chickenpox or shingles
what percent of the population gets shingles after chickenpox
10-20%
when is the period of communicability in varicella
first 1-2 days before the rash begins and then first 4-5 days after the lesions form crusts
Herpes virus 4 causes what infection
mononucleosis
Epstein-Barr virus causes what infection
mononucleosis
what % of people in the US between 35-40 have been infected with EBV
0.95
what % of the time do adolescents/young adults contract EBV and develop mononucleosis
35-50%
how is EBV transmitted
oral secretions
blood
transplanted organs
when can someone get back to sport after mono
1 month
what infections does respiratory syncytial virus cause
pneumonia
bronchiolitis
tracheobronchitis
what virus and infection is the main cause of hospitalizations in infants and young children
RSV
tracheobronchitis
how long do infants vs adults shed RSV
infants: 3-4 weeks
adults: 3-8 days
how long does influenza fever last
1-7 days (usually 3-5)
when would secondary bacterial pneumonia develop after influenza
5-10 days after onset of symptoms
endogenous substances that exert nonspecific antiviral activity
interferons
alpha and beta interferon type
type I
gamma interferon type
type II
lambda interferon type
type III