N307 - Unit One Study Guide

Major aims of inflammation

1. Wall off area of injury

2. Prevent spread of injurious agent

3. Bring defenses to region under attack

Acute vs chronic inflammation

Acute: occurs rapidly, resolves quickly

Chronic: results in cellular damage / organ dysfunction

Phases of inflammation

1. Vascular (vascular permeability)

2. Cellular (WBCs released into bloodstream)

Effects of Inflammation

1. Local (SHARP acronym)

2. Systemic (fever, lymphadenopathy, anorexia, lethargy)

Outcomes of inflammation

1. Complete resolution

2. Healing by connective tissue

3. Chronic inflammation

Causes of chronic inflammation

1. Persistent infection

2. Hypersensitivity disorders

3. Prolonged exposure to toxic agent

Two levels of defense

1. Innate (nonspecific)

2. Adaptive (specific)

Factors of innate defense

1. Inflammatory response

2. WBCs (phagocytes)

3. Physical barriers and normal flora

Types of phagocytes in innate defense

1. Neutrophils (first to respond)

2. Macrophages (arise from monocytes)

Factors of adaptive defense

B lymphocytes: mature into plasma cells that produce Ig

T lymphocytes: CD4 (helper T cells), CD8

Functions of immunoglobulins

1. Neutralize bacteria toxins

2. Attack viruses

3. Promote phagocytosis

Acquiring Immunoglobulins

1. Passive (premade, fully formed, breastmilk, antibody infusion)

2. Active (exposure through illness or vaccination)

IgM

Earliest to respond

IgG

Most abundant, autoimmune disorders

IgA

Mucosal secretions

IgE

Skin, mucous, respiratory tract, allergies

IgD

Skin, hypersensitivity reactions

Types of vaccines

1. Viral (live, mRNA)

2. Bacterial (dead organisms)

Type 1 hypersensitivity reaction

Immediate (allergens, IgE)

Type 2 hypersensitivity reaction

Cytotoxic (target cells coated with antigens, blood transfusion)

Type 3 hypersensitivity reaction

Immune complex (antigen-antibody complex deposited in tissues, organ dysfunction)

Type 4 hypersensitivity reaction

Delayed (days after exposure, contact dermatitis, organ transplant)

Classification of autoimmune disorders

1. Organ specific

2. Generalized

Systemic lupus erythematosus (SLE)

Autoimmune

Multisystem

Anti-nuclear antibodies (ANAs) form immune complexes that are deposited in tissues

Kidneys most commonly affected

Periods of remission and exacerbation

Butterfly rash across cheeks

Sarcoidosis

Autoimmune

Accumulation of macrophages and T lymphocytes in organs

90% of patients develop lung disease

Sjorgens syndrome

Autoimmune

Lymphocyte infiltration in exocrine glands

Dry eyes and mouth

Human immunodeficiency virus (HIV)

Retrovirus infects CD4 which leads to depletion of CD4 cells

Stages of HIV

1. Acute infection: 28 days, general or asymptomatic

2. Chronic infection: 6mo-10yrs, virus grows, latent

3. AIDS: CD4 <200/mm^3 (normal 800-1200)

Infection

invasion, colonization, and multiplication of pathogens

Incidence

New cases

Prevalence

Present cases

Endemic

Regularly occurring/always present

Pandemic

Global

Epidemic

Regional

Virulence

ability to produce disease

Classification of bacteria

Shape

Aerobic v anaerobic

Gram staining (important for specific antibiotics)

Endotoxins in gram negative bacteria

Released when bacteria die (taking antibiotics)

B lymphocytes

Humoral immunity, immunoglobulin

T lymphocytes

Cell mediated, killers

Portals of entry

Skin

Respiratory tract

GI tract

GU tract

Blood-blood transfusion

Maternal-fetal

Stages of infection

1. Incubation (asymptomatic)

2. Prodromal (general symptoms, highly contagious)

3. Acute (full experience, specific symptoms)

4. Convalescent (body contains and eliminates, symptoms resolve, no longer contagious)

5. Resolution (total elimination of pathogen)

Staphylococcus aureus

Cellulitis, MRSA

Group A hemolytic streptococci

Can affect nearly any body system

P. aeruginosa

Healthcare associated, uti, bacteremia

Neisseria meningitidis

Most common causes of meningitis

Haemophilus influenzae

Meningitis, Upper respiratory infections, aka HIB

Salmonella enterica

Gastroenteritis (food poisoning)

Salmonella typhi

typhoid fever

E. coli 0157:H7

Enterohemorrhagic E. coli, severe bloody diarrhea

Clostridium difficile

Diarrhea, abdominal pain

Long-term antibiotic use

NOT killed by alcoholic hand sanitizer

Pertussis

whooping cough

Tetanus

Soil

Lockjaw, rigid arching of back

Lyme disease

Borrelia burgdorferi

Tick must be embedded for 36-48hr

Erythema migrans (bullseye rash)

Common cold

Rhinovirus, adenovirus

Rhinorrhea

Epstein-Barr virus (EBV)

infectious mononucleosis (cervical lymphadenopathy, debilitating fatigue

Cytomegalovirus (CMV) (birth defects, opportunistic infection)

Measles

Respiratory droplets, conjunctivitis, photophobia, Koplik's spots, head to toe rash

Varicella Zoster

chicken pox

Herpes zoster

Shingles (reactivation of varicella zoster, lesions and postherpectic neuralgia

Herpes simplex virus (HSV)

HSV1: cold soles

HSV2: genital lesions

Oropharyngeal candidiasis

oral thrush

Vulvovaginal candidiasis

vaginal yeast infection

Tumor suppressor genes

A gene whose protein product inhibits cell division, thereby preventing the uncontrolled cell growth that contributes to cancer.

Oncogenes

cancer causing genes

Reactive Oxygen Species (ROS)

Highly reactive molecules causing cellular damage.

Vascular endothelial growth factor (VEGF)

Blood vessel formation (cancer)

Characteristics of cancer cells

No uniform, disorganized, undifferentiated (anaplastic), decreased function, abnormal secretions, unlimited life spans

Anaplastic

characterized by a loss of differentiation of cells and their orientation to one another; a characteristic of malignant tumors

Cancer cells origin

DNA changes - sporadic (smoking) or inherited

Poorly differentiated

malignant, abnormal

Well differentiated

benign, normal/like others

Cancer risk factors

Age (65+)

Viruses/chronic inflammation

Radiation

Chemicals (diet, lifestyle)

Cancer etiology

Decreased immunity

Genetics (TP53)

Viruses

TP53

tumor suppressor gene, 50% of cancer cases linked to mutation of this gene

Proto-oncogene

A normal cellular gene that has the potential to become an oncogene.

Neoplasia

new growth (tumor)

Benign tumor

non-cancerous tumor, doesn't spread

Malignant tumor

Cancerous, can spread

Adenoma tumor

benign tumor of glandular/organ tissue

Carcinoma tumor

Malignant, skin, more superficial than adenocarcinoma

Adenocarcinoma tumor

Malignant, glandular/ductal tissue

Sarcoma tumor

Malignant, connective tissue, bone, cartilage

Leukemia

Malignant leukocytes

Lymphoma tumor

malignant tumor of lymph nodes and lymph tissue

Lung cancer

80-90% caused by smoking

Pack years

Cilia are paralyzed, carcinogens accumulate in lungs

Types of lung cancer

Small cell (aggressive, smoking)

Nonsmall cell

Breast cancer

risk factors (prolonged reproductive life, nulliparity, dense breast tissue)

BRCA 1 and 2 (50% more likely)

Estrogen and progesterone

HER2

Peau d'orange

Upper outer quadrant (MOST COMMON LOCATION)

Ovarian cancer

Epithelial, germ cell, stromal

Epithelial most common

Jewish descent

Can be asymptomatic

Types of ovarian cancer

- Epithelial Tumors (90%)

- Stromal Tumors (7%)

- Germ Cell (3%)

Cervical cancer

Squamous cell, adenocarcinoma

Grows up and out

Can invade bladder and rectum

2+ lifetime sexual partners

Types of cervical cancer

squamous cell and adenocarcinoma

Prostate cancer

Adenocarcinoma

Slow to grow

BRCA 1 and 2

Back pain in late stage

BRCA1 and BRCA2 types of cancer

1. Breast

2. Prostate

3. Ovarian

Colorectal cancer

Cachexia, iron deficiency anemia, hematochezia, melena

Origins of brain cancer

1. Neurons or tissues in brain

2. Metastasis of primary tumors in body

glioblastoma multiforme

Most common and aggressive, ADULTS

Medulloblastoma

Most common and aggressive, CHILDREN

Diplopia

double vision

Ataxia

lack of muscle coordination

papilledema

swelling of the optic disc

Types of bone cancer

1. Osteosarcoma (growing bones)

2. Chrondrosarcoma (cartilage)

3. Ewing syndrome (immature nervous tissue, children)