Pathos: Chapter 2 S1-38

Q1: What is stress?

A: A universal body response to change that can result from positive or negative experiences. It can affect disease states and homeostasis.

Q2: Who developed the stress response theory?

A: Hans Selye – proposed the General Adaptation Syndrome (GAS), which includes Alarm, Resistance, and Exhaustion stages.

Q3: What are the three stages of GAS?

• Alarm: SNS stimulation → release of epinephrine, norepinephrine, cortisol (“fight or flight”).

• Resistance: Adaptation and selection of defenses.

• Exhaustion: Prolonged stress causes disease (hypertension, ulcers, immune suppression).

Q4: What are examples of conditioning factors that affect the stress response?

A: Genetics, age, gender, past experiences, support systems, and coping mechanisms.

A nursing student has frequent infections and poor sleep before exams. Which phase of GAS is she likely in?

Answer: Exhaustion phase – prolonged stress leading to immune suppression.

Q5: What are short-term effects of stress?

A: Increased HR, BP, RR, glucose, and alertness.

Q6: What are long-term effects?

A: Hypertension, diabetes, immunosuppression, digestive disorders, anxiety, depression

Q7: What are the three lines of defense?

• First: Physical/chemical barriers (skin, mucous membranes, normal flora).

• Second: Inflammatory response.

• Third: Immune response (specific/adaptive immunity).

Q8: How do the first and second lines differ from the third?

A: The first two are innate (nonspecific), while the third is adaptive (specific, has memory).

A burn patient loses their skin barrier and quickly develops an infection. Which line of defense failed?

Answer: First line of defense.

Q9: What triggers inflammation?

A: Tissue injury from infection, trauma, ischemia, or toxins.

Q10: What are the cardinal signs of inflammation?

A: Redness, heat, swelling, pain, loss of function.

Q11: What are the main goals of inflammation?

A: Increase blood flow, deliver immune cells, and prepare for repair

Q12: What are the main chemical mediators?

A: Histamine, prostaglandins, leukotrienes, cytokines, TNF

Q13: What is the difference between acute and chronic inflammation?

• Acute: Immediate, short-term, resolves with healing.

• Chronic: Long-lasting, involves macrophages, lymphocytes, and granuloma formation.

A patient with tuberculosis develops a granuloma in the lungs. What type of inflammation is this?

Answer: Chronic inflammation.

Q14: What are the stages of healing?

• Inflammatory phase: Seal wound, remove debris.

• Proliferative phase: Granulation tissue forms.

• Remodeling phase: Tissue matures (scar formation).

Q15: What is the difference between primary and secondary intention healing?

• Primary: Edges approximated (sutures); minimal scarring.

• Secondary: Large wound, fills with granulation tissue; more scarring.

Q16: What complications can interfere with healing?

A: Infection, ulceration, dehiscence, keloids, adhesions

A post-op wound separates and oozes blood. What complication is this?

Answer: Dehiscence.

Q17: What are the major organs of the immune system?

• Central: Bone marrow, thymus.

• Peripheral: Lymph nodes, spleen, tonsils, lymphatic tissue

Q18: What are the two main types of immunity?

• Innate (nonspecific): Immediate, no memory.

• Adaptive (specific): Develops over time, has memory

Cellular (T-Cell) Immunity

• Helper T (CD4): Coordinate immune response.

• Cytotoxic T (CD8): Destroy infected/tumor cells.

• Suppressor T: Regulate balance.

• Memory T: Rapid response on re-exposure

Humoral (B-Cell) Immunity

• Produce antibodies (Ig).

• Memory B: Long-term defense.

• Protect against extracellular pathogens.

A patient with HIV has a low CD4 count. Which immune function is impaired?

Answer: Helper T-cell mediated immunity.

Immunoglobulins (Antibodies)

Immunoglobulin	Function	Location/Example
IgG	Main defense against bacteria; crosses placenta	Blood, extracellular fluid
IgM	First antibody in infection	Blood
IgA	Protects mucous membranes; in breast milk	Respiratory & GI tracts
IgE	Triggers allergic reactions	Skin, lungs
IgD	Helps B cells recognize antigens	B cell surface

A newborn is immune for several months after birth due to maternal antibodies. Which antibody provides this?

Answer: IgG.

Q19: What is passive immunity?

A: Antibodies are transferred (placenta, breast milk, or injection). Short-term protection.

Q20: What is active immunity?

A: Antibodies are developed by the body after infection or vaccination. Long-term protection

A snakebite victim receives antivenom. What type of immunity is provided?

Answer: Artificial passive immunity.

Q21: How does immunity differ by age?

• Infants: Rely on maternal IgG (3–6 months) and IgA from breastfeeding.

• Adolescents: Hormonal changes increase autoimmune risk.

• Older adults: Decreased T & B cells, slower response (immune senescence)

An elderly patient has recurrent pneumonia despite vaccination. Why?

Answer: Age-related immune senescence – decreased immune cell production and function.

1⃣ A nurse caring for ICU patients develops frequent infections and chronic fatigue after months of overtime.
→ Which phase of Selye’s General Adaptation Syndrome is she in?

Answer: Exhaustion phase (prolonged cortisol elevation → immune suppression).

2⃣ A college student feels nervous before a test; heart rate and breathing increase, pupils dilate.
→ Which GAS stage?

Answer: Alarm stage (sympathetic activation).

3⃣ After losing his job, a patient reports chronic headaches, insomnia, and weight loss.
→ Which physiologic change best explains his symptoms?

Answer: Long-term cortisol elevation altering metabolism and immune defense.

4⃣ A patient with severe burns on 30% of their body later develops sepsis.
→ Which line of defense failed first?

Answer: First line – physical barrier (skin).

5⃣ A woman’s cut finger becomes red, swollen, and warm.
→ Which line of defense is responsible for this reaction?

Answer: Second line – inflammatory response.

6⃣ A vaccinated child avoids illness despite exposure to measles.
→ Which line of defense protected the child?

Answer: Third line – adaptive immune response (antibody-mediated).

7⃣ A patient with a sprained ankle experiences swelling, warmth, and pain.
→ What mediators cause these symptoms?

Answer: Histamine (vasodilation), prostaglandins (pain), cytokines (signal inflammation).

8⃣ A patient with rheumatoid arthritis has chronic joint inflammation and scarring.
→ Which type of inflammation is present?

Answer: Chronic inflammation (ongoing immune activation and fibrosis).

9⃣ A person cuts their hand on a can. The wound becomes red and swollen within minutes.
→ What is the purpose of this response?

Answer: Increase blood flow and WBC delivery for repair and defense.

🔟 A surgical incision is closed with sutures and heals with minimal scarring.
→ What type of healing is this?

Answer: Primary intention.

11⃣ A large pressure ulcer heals slowly, forming thick scar tissue.
→ What type of healing is this?

Answer: Secondary intention.

12⃣ A patient’s abdominal incision opens after coughing post-surgery.
→ What complication is this?

Answer: Dehiscence.

13⃣ A patient develops raised, shiny scar tissue after an ear piercing.
→ What complication is this?

Answer: Keloid formation.

14⃣ A patient’s CD4 (helper T-cell) count is critically low due to HIV.
→ Which type of immunity is most impaired?

Answer: Cellular immunity (T-cell mediated).

15⃣ After recovering from chickenpox, a person is protected from future infection.
→ Which type of immune response explains this?

Answer: Humoral (B-cell memory and antibody production).

16⃣ A transplant patient takes immunosuppressive drugs.
→ What is the purpose?

Answer: To prevent T-cell–mediated attack on transplanted tissue.

17⃣ A baby receives antibodies through breast milk.
→ What kind of immunity is this?

Answer: Natural passive immunity (IgA transfer).

18⃣ A traveler receives the Hepatitis A vaccine before flying abroad.
→ What kind of immunity develops?

Answer: Artificial active immunity (antigen exposure → own antibody production).

19⃣ A snake-bite victim is given antivenom serum.
→ What kind of immunity?

Answer: Artificial passive immunity (ready-made antibodies).

20⃣ A newborn has protection from measles for 3–6 months after birth.
→ Why?

Answer: Maternal IgG crossed the placenta (natural passive immunity).

21⃣ A child catches chickenpox from a sibling and later becomes immune.
→ What type of immunity developed?

Answer: Natural active immunity.

22⃣ A nurse accidentally exposed to hepatitis receives immune globulin injection and then the vaccine series.
→ What type of immunity results from each?

• Immune globulin: artificial passive

• Vaccine: artificial active

A premature infant develops pneumonia at two months despite breastfeeding.
→ Why might immunity be limited?

Answer: Maternal IgG protection wanes after 3 months; infant’s own immunity still immature.

A 17-year-old girl develops lupus after puberty.
→ Why is she at higher risk?

Answer: Hormonal influence on immune cell receptors increases autoimmune tendency.

25⃣ A 70-year-old man has poor vaccine response and frequent bronchitis.
→ What explains this?

Answer: Immune senescence (reduced T- and B-cell production with age).

26⃣ A nurse notes a patient’s fever and elevated CRP after appendectomy.
→ Which defense line is active?

Answer: Second line – inflammatory response (systemic).

27⃣ An older adult with chronic stress and malnutrition develops slow-healing ulcers.
→ What two physiologic factors impair their immune response?

Answer: Elevated cortisol (stress) + poor nutrition (protein/vitamin deficiency).

A child with a genetic B-cell disorder can’t produce antibodies but has normal T-cell function.
→ Which type of immunity is deficient?

Answer: Humoral (antibody-mediated).

A patient recovering from influenza produces IgM antibodies first, followed by IgG.
→ What does this pattern indicate

Answer: Normal primary immune response progression.

30⃣ A healthcare worker exposed to COVID-19 receives monoclonal antibody therapy and later the vaccine.
→ What are these types of immunity?

• Monoclonal antibody: Artificial passive

• Vaccine: Artificial active