Starred Slides- clinical science exam 2

MHC I

cytotoxic T cells (CD8+)

MHC II

T helper cells (CD4+)

B cells

recognize free floating antigen

T cells

require antigen presentation

CD4: Helper T cells

Help B cells augment production of antibodies• Activate macrophages• Help CD8's to proliferate• Help NK cells to kill infected cells• Neutrophil recruitment

CD8: Cytotoxic T cells

induce apoptosis

What is the ratio of CD4 & CD8 cells?

2:1, shift indicates autoimmune or inflammation

CD25: T regulatory cells

Prevent inappropriate response to "self" (inhibit immune response)• Generate inhibitory cytokines (IL-10, TGF-β)

What factors effect the immune system?

Nutrition/malnutrition, trauma, burns, medications, stress 7 implanted prostheses

Epitope

antigen site that binds with T cell receptor

Adaptive immunity

acquired immunity, specificity & memory

HIV pathogenesis

leads to destruction of CD4+ cells. Then the virus re-enters bloodstream & infects remaining lymphocytes. Progressive loss of immune function leads to AIDS

Symptoms of advanced HIV disease

neurological symptoms, dermatologic conditions, and side effects from medication

What is myalgic encephalomyelitis?

Also known as chronic fatigue syndrome. Unexplained fatigue > 6 months. Nociplastic pain

Lipodystrophic syndrome (LDS)

picture of arm (wife beater lol)

Pathogenesis of CFS

complex interaction among multiple systems. CNS, immune & hormonal regulation

Clinical manifestation of ME/CFS

overwhelming fatigue exacerbated by activity (post-exertional malaise)

What is fibromyalgia?

chronic, widespread musculoskeletal pain

What is fibromyalgia characterized with?

Allodynia & hyperalgesia

Pathogenesis of FM

Top down: brain function

- sleep or memory problems

Bottom up: identifiable nociceptive or neuropathic pain

Pathogen

Any microorganism with the capacity to cause a disease

- commonly mutate

Signs & symptoms of infectious disease

Varied depending on etiologic agent & systems impacted

Systemic symptoms: fever, chills, malaise

Older adults: confusion, memory impairment & down concentration

Initial: confusion, hypotension, and tachypnea (rapid breathing)

What is the substance that causes a fever?

Pyrogen

Immunosenescence

- Reduced function of immune cells

- Reactivation of dormant infections

- Difficulty responding to new pathogens

What are microorganisms present in tissue?

Colonization

Outcomes of Infection

1. Contaminate body & be destroyed

2. Subclinical infection: no apparent symptoms

3. Infectious disease: development of clinically apparent infection

What is bacteria?

single-celled organisms with well-defined cell walls

- Can grow independently on artificial media

- Bacteria shape; cocci, bacilli, and spirilla

Infection sources, Healthcare Associated Infections

- 1/31 for hospitalization

- Hand washing

- Iatrogenic vectors, catheters, needles, and implants

Clostridium difficile

- Most common of health care associated GI symptoms

- About 50% of cases are acquired in community

- Over age of 65

Manifestation of C diff

diarrhea & fever

C diff facts

Anaerobic: Hand sanitizer ineffective

Incidence: Increase incidence & morbidity

Transmission mode: fecal oral

Staph: methicillin & vancomycin resistant

- One of most common agents on skin

- Leading cause is hospital acquired infections

Risk factors of Staph

insulin dependent, immunosuppression, burns, prosthetics

Pathogenesis of Staph

Inoculation: virulent pathogen, local effect which can lead to travel in bloodstream (sepsis & fever)

Streptococcal Pharyngitis- Strep throat

- Fever, absence of cough, tonsillar exudates

- Impetigo

Impetigo

GAS- streptococcal cellulitis

Strep B

Pregnant women and neonate infections (GI & vaginal tracts)

- Transmission through labor

- Decreased over last decade

Common cause of community acquired phenomena

- Transmission is inhalation of droplets

HSV

HSV-1 Cold Sores, 70% Americans over 14

HSV-2 Genital Herpes, 11.9% Americans

Transmission of HSV-1 and HSV-2

Shedding, direct skin to skin

VZV (varicella zoster virus)

chicken pox and shingles

Transmission of VZV

highly contagious & airborne

Symptoms of VZV

pain/tingling, fever, chills, malaise 1-3 days prior to eruption of red papules

MONO manifestations

Swollen lymph nodes, fever, sore throat, headache, abdominal pain, and malaise

Influenza

sub-divided by surface protein

Transmission: inhaled aerosolized virus or direct contact with large droplets

Manifestation of influenza

abrupt onset, high fever, chills, malaise, myalgia, headache and non-productive cough

Lyme disease

infectious multi-systemic disorder

- Hallmark bullseye rash

Manifestations: flu-like onset

Unilateral poly-arthritis of large joints

Stage 1 of Lyme Disease

5-14 days post tick bite

- Red, slowly expanding bullseye

- Flu like symptoms

Stage 2 of Lyme disease

weeks to months

- Skin, nervus system, heart, joints

- Meningitis, facial nerve palsy

Stage 3 of Lyme Disease

months to years

- Joint symptoms, polyneuropathy, cognitive impairment

pruritus

itching

urticaria

hives; an eruption of wheals on the skin accompanied by itching

Rash

eruption on skin

Xeroderma

excessive dryness of skin

Vesicles

< 5mm (blister)

Bulla

> 5mm (blister)

Macule

lesion measuring less than 2 cm in diameters. Not raised nor depressed

Papules

slightly elevated induration of skin, <1 cm

plaque

elevated flat-topped area, > 5 mm across

Scale

dry, platelike sheet of keratin

Folliculitis

papule formed around single central hair follicle

furnucle

focal suppurative infection of central hair shaft and surrounding subcutaneous tissue

Carbuncle

cluster of furuncles with connection through sinuses

Atopic Dermatitis

genetic predisposition

- Early: red, ozzing, crusting rash

- Later: dry, thickened, brownish gray color

- Xerosis and pruitis

What is contact dermatitis?

Acute or chronic skin inflammation caused by exposure to an external agent

- Priutitis, erythema, edema

- Removal of offending agent for management

What is eczema?

superficial itch inflammation of skin

Stages of eczema

- Acute: extensive erosions with serous exudate or erythema

- Subacute: erythematous, excoriated scaling plaques

- Chronic: brownish- grey color & thickened skin

ABCDE of mole

A- asymmetry

B- border

C- color

D- diameter

E- elevation

Verrucae

benign viral infections of skin caused by HPV

Tinea corporis (ringworm)

Red lesions in a circular pattern blanched in the center caused by fungus, NOT a worm

Tinea pedis

Tinea versicolor

Skin cancer

most prevalent form of CA, affects nearly all Caucasian people over 65 years old

- Most rapidly increasing forms of cancer

- Excessive exposure to UV radiation from the sun

Basal Cell carcinoma

slow growing skin tumor from undifferentiated epidermis basal cells

- Can cause local destruction

- Slightly elevated, pearly or ivory color, rolled edges, visible blood vessels

- "Sore that will not heal"

Malignant Melanoma

neoplasm of the skin originating from melanocytes

- Surgical excision

- 100% curable if detected early

Manifestations of Polymyositis & Dermatomyositis

General- fatigue, malaise, weight loss

UE- trouble lifting overhead

LE- squatting, walking & standing from chair

Heliotrope rash

Purple rash over the upper eyelids, often seen in dermatomyositis

Gottron's papules (dermatomyositis)

Lacy, pink, raised areas typically found over IP joints

Diagnosis of Polymyositis & Dermatomyositis

progressive symmetric weakness, elevated CPK & EMG will be abnormal

Systemic effects of burns

Integumentary, CV changes, Renal/GI changes, Pulmonary artery hypertension & immune system suppression

Pressure Injury Stages

TNM staging system

Tumor: refers to size of primary tumor

Tx- cannot be assessed

T0- no evidence of primary tumor

Tis- carcinoma in situ

T1-4 - progressive increase in tumor size & involvement

Nodes: regional lymph nodes involved

Nx- nodes cannot be assessed

N0- no metastasis to regional lymph nodes

N1,2,3- increasing degree of involvement of regional lymph nodes

Metastases (0-1)

Mx- presence of stant metastases not assessed

M0- no metastases

M1- distant metastases

Most prevalent cancer in the world?

Lung cancer

What % of people diagnoses with cancer will be cured or survive 5+ years after treatment?

60%, 3/5

What % of people will be diagnosed with a form of invasive cancer in lifetime?

33.3%, 1/3

endogenous cancer risk factors

Genetics, hormones, immunodeficiency & age

Exogenous cancer risk factors

Lifestyle, viral exposure, chemicals & radiation exposure

Modifiable risk factors of cancer

Lifestyle behaviors, pollution, household fuels, contaminated injections, obesity, sexual behavior & sexual activity

Non-modifiable risk factors of cancer

Age, exposure to viruses, exposure to hormones, sex, ethnicity, socioeconomic status, heredity & stress

General manifestations of cancer

initially asymptomatic, thickening or lump, sore that does not heal & pain

Systemic signs of cancer

unexplained weight loss, change in bowel habits, nagging cough, fatigue, malaise, weakness, and fever

Lung cancer manifestation

Persistent dry, non producing cough

Exertional dyspnea

Colon cancer manifestation

Change in bowel function

Color- blood in stool

Shape- ribbons

Type I Hypersensitivity

Local- urticaria, erythema, priuritis, rhinitis

Type II hypersensitivity

Body's own tissue is recognized as "non-self"

Type III Hypersensitivity

Excessive circulation of antigen-antibody complexes. Systemic Lupus Erythematosus

Type IV Hypersensitivity

cell mediated (no antibodies)