Comprehensive Medical Interventions Exam Review

Medical Interventions & Homeostasis

• Medical interventions help maintain health and homeostasis in the body.

• A variety of methods detect/identify infectious agents.

Essential Questions

• What is a medical intervention?

• What are the main categories of medical interventions?

• How do scientists gather evidence during an outbreak?

• What is bioinformatics?

• How are DNA sequences used to identify pathogens?

• What is an antibody?

• How do antibodies identify and inactivate antigens?

• How is the ELISA assay used to detect disease?

• Why is antigen concentration important?

• What steps are taken to diagnose, treat, and prevent disease spread?

Antibiotics & Bacterial Resistance

• Antibiotics disrupt bacterial survival pathways.

• Bacteria use pathways to gain antibiotic resistance.

• Antibiotic overuse promotes resistant bacteria selection.

Essential Questions about Antibiotics

• How do antibiotics fight bacterial infections?

• How do bacteria share resistance genes?

• What human actions contribute to bacterial resistance?

Hearing Loss

• Ear structure problems cause different hearing loss types.

• Various interventions help with hearing loss.

Essential Questions about Hearing

• How do frequency and amplitude affect sound interpretation?

• What causes different types of hearing loss?

• How is hearing loss diagnosed?

• What interventions are available for hearing loss?

• What are the bioethical concerns related to cochlear implants?

Vaccines

• Vaccines activate the immune system to recognize antigens and produce antibodies.

• Vaccines are produced in the lab using methods like recombinant DNA techniques.

• Epidemiologists monitor health, search for patterns, assist in investigations, and design treatment/prevention strategies.

Essential Questions about Vaccines

• What is vaccination?

• How does a vaccine activate the immune system?

• How has vaccination impacted disease trends?

• What methods are used to produce vaccines in the lab?

• What is recombinant DNA technology?

• What molecular tools assemble recombinant DNA?

• How are recombinant DNA and bacterial cells used to produce vaccines?

• How are engineered plasmids inserted into bacterial cells?

• What is epidemiology?

• How do epidemiologists assist with detection, prevention, and treatment of diseases?

Medical Interventions

• A medical intervention is anything used to treat, prevent, cure, or relieve symptoms of human suffering caused by disease, accidents, or hygiene.

• A medical intervention is a measure to improve health or alter an illness's course, used to prevent, diagnose, and treat disease.

• Categories of medical interventions include genetics, pharmacology, diagnostics, surgery, immunology, medical devices, and rehabilitation.

Disease Investigation: The Smith Family

• The focus is on discovering what caused symptoms, diagnosis, tests, and treatments.

• Involves determining if the disease has spread and how to manage it.

Steps in a Medical Investigation

• Linking symptoms to suspected disease-causing agents.

• Signs are measurable client issues (temperature, heart rate, blood pressure, etc.).

• Symptoms are patient-reported problems (tiredness, sore throat, nausea, etc.).

• Determining the infectious agent causing the symptoms.

• Finding "Patient 0" to determine disease origin and spread.

Confirming Diagnosis

• Confirming the diagnosis is crucial to avoid unnecessary treatment, antibiotic resistance development, and misdiagnosis.

Bioinformatics and BLAST

• Bioinformatics involves collecting, classifying, storing, and analyzing biochemical and biological information using computers, to identify pathogens.

• This includes DNA sequencing - scanning DNA to identify it.

Process of Identifying Pathogens

• Isolate the disease-causing agent.

• In the case of meningitis, take a sample of cerebrospinal fluid (CSF) via spinal tap.

• Process the CSF to separate human components from disease-causing agents.

• For bacterial infections, "plate" the CSF to grow bacteria outside the human body.

• If bacteria grow, it indicates a problem.

• Lyse the bacteria and isolate their DNA.

• Amplify the DNA and run it through a DNA sequencing machine.

• The machine produces a string of letters (A, T, C, G), which is compared to a database like BLAST.

BLAST

• A program that compares input DNA sequences to a large database of genes and organisms.

• It identifies the agent the DNA belonged to.

• In the Smith family case, it revealed bacterial meningitis in some and other diseases in others.

ELISA

• Stands for Enzyme-linked Immunosorbent Assay.

• Used to confirm meningitis and reveal how sick patients were.

Antigens

• Proteins on the outside of cells (and viruses).

• Surface markers cells use to identify each other.

• The body identifies cells and viruses that aren't its own.

Antibodies

• Produced by B lymphocytes (white blood cells).

• Attach to foreign antigens, neutralizing them.

• Signal other leukocytes (T lymphocytes) to destroy whatever the antibody is attached to.

ELISA Test

• Based on the principle that color changes mean a positive result, with stronger colors indicating more of the substance being tested for.

• Found in pregnancy tests, rapid strep tests, and drug tests.

• Used to test for antigens from infectious agents.

Steps of ELISA Test

• Tray wells are pre-coated with antibodies for the pathogen.

• Patient serum (CSF in the case of meningitis) is added to the wells.

• If the serum contains the bacteria, antigens will bind to antibodies in the wells.

• Primary antibodies are added to latch onto the antigen, forming a platform.

• Secondary antibodies with an enzyme are added, latching onto the primary antibodies.

• A substrate is added that the enzyme responds to, causing a color change.

• A color change means the antigen (infection) is present, indicating a qualitative result.

Serial Dilution

• A known concentration of antigen is diluted to create a series of colors, from darker to lighter.

• Patient samples are compared to determine the amount of infectious agent, aiding in determining treatment aggressiveness.

• Helps determine antibiotic dosage, care duration, and risk of permanent damage.

Antibiotic Treatment

• Bacterial infections are treated with antibiotics.

Gram-Positive vs. Gram-Negative Bacteria

• Gram-positive bacteria have a thick cell wall made of peptidoglycan.

• Gram-negative bacteria have a thinner cell wall.

• Bacteria are classified into these two main groups based on cell wall structure.

Gram Negative Bacteria Characteristics:

• Cell wall contains multiple layers, including a thin peptidoglycan layer.

• Outer layer is the outer membrane made of a lipid bilayer composed of lipopolysaccharides called endotoxins.

• Outer membrane serves as a barrier, containing porins that allow certain molecules through.

• Periplasm between plasma membrane and outer membrane is filled with gel-like fluid and proteins.

• Gram-stained cell appears pinkish-red.

Gram Positive Bacteria Characteristics:

• Cell wall contains a thick layer of peptidoglycan and teichoic acids.

• Approximately twenty times more peptidoglycan than Gram negative bacteria.

• No outer membrane.

• No porins.

• Gram-stained cell appears purple.

Bacterial Cell Components and Functions:

• Nucleoid: Contains single, circular, double-stranded DNA molecule (chromosomal DNA) with genetic information ($\approx$ 0.1% to 10% of cell vol. )

• Plasmids: Circular double-stranded DNA molecules that contains advantageous DNA to the cell for coding proteins (advantageous but not essential).

• Ribosomes: Structures involved in protein synthesis, facilitating amino acid joining.

• Cell Wall: Rigid barrier providing rigidity with peptidoglycan.

• Plasma Membrane: Semipermeable membrane that acts as barrier between the cytoplasm and the outside environment.

• Capsule: Gelatinous layer enabling adherence to surfaces and protection from human immune systems.

• Flagella: Protein appendages that spin like propellers, moving the bacterial cell.

• Pili: Filamentous appendages for attachment (fimbriae) or DNA transfer (sex pilus).

• Endotoxins: Lipopolysaccharide molecules in Gram-negative bacteria's outer membrane.

Antibiotics Mechanisms

• Antibiotics work by disrupting the pathways that bacteria use to survive.

• Inhibition of cell wall synthesis, protein synthesis, or disrupting the cell wall.

• Different antibiotics act on different bacteria.

Action of Antibiotics

• β-Lactam Antibiotics: Irreversibly inhibit enzymes in cell wall synthesis by mediating peptide bridge formation.

• Tetracyclines: Reversibly bind to the 30S ribosomal subunit, blocking tRNA attachment and protein synthesis.

• Fluoroquinolones: Inhibit topoisomerases, preventing DNA supercoiling and essential cell processes.

• Sulfonamides: Competitive inhibition by binding with PABA, a substrate in folic acid biosynthesis.

Antibiotic Resistance

• Bacteria evolve and become immune to antibiotics.

• Resistance begins with a mutation in one bacterium, which then grows and divides.

• Bacteria share plasmids containing antibiotic-resistant genes through transduction, transformation, and conjugation.

• Conjugation is the most common method, where two bacteria form a bridge and exchange a plasmid.

• Plasmids with resistance genes can be scavenged from dead cells via transformation.

• Resistance can be delivered via vectors through transduction.

Consequences of Antibiotic Resistance

• Treating infections becomes more complicated with unpredictable spread.

• It's standard practice to take antibiotics any time a patient suspected an infection because bacteria are capable of evolving and becoming immune to antibiotics.

• Overprescription and overuse is a growing concern.

• Antibiotics are added to chicken and cow feed to prevent the animals from getting sick before sale.

• Antibiotics can stay in the meat and be passed to us.

Antibiotic Usage Guidelines

• Prescribing antibiotics unnecessarily as we become more educated.

Hearing Loss

• Meningitis can cause permanent damage and hearing loss; audiologists diagnose hearing loss.

• Hearing loss can drastically impact a person’s ability to communicate, causing a lot of time and money to be invested into research to develop interventions.

• Impacts millions in the U.S.

Types of Hearing Loss

• Sensorineural hearing loss

• Conductive hearing loss

• Mixed hearing loss

Sound and Hearing

• Sound must travel through a medium like air, water, or bone.

• Intensity (loudness) is measured in decibels. Loud sounds can cause permanent hearing damage.

• Frequency and amplitude deal with sound waves. Frequency = no. of waves. Higher pitch sounds has higher frequencies.

• Pitch is how we perceive frequency.

• Amplitude determines loudness, and is measured by the height of the waves.

• Human ears detect sounds in a set range of pitches and frequencies

Anatomy of the Ear

• Pinna collects sound.

• Sound travels via the auditory canal to the tympanic membrane (eardrum).

• The tympanic membrane vibrates, causing the ossicles (earbones) to vibrate.

• Malleus vibrates, causing the incus and stapes to vibrate.

• Stapes hits the oval window, pushing on the fluid inside the cochlea.

• The fluid vibration stimulates sensory hair cells, sending a signal via the cochlear nerve to the brain.

Types of Hearing Loss and Causes

• Conductive hearing loss: Damage to wave-carrying portions (pinna, canal, tympanic membrane, ossicles). Can be corrected surgically or medically.

• Sensorineural hearing loss: Damage to the cochlea or auditory nerve. Often cannot be corrected. Can result from loud noises or aging.

• Mixed hearing loss: A combination of both.

Ways to Treat Hearing Loss

• Hearing aids amplify sounds.

• Cochlear implants are surgically inserted devices that stimulate the auditory nerve directly.

Controversy of Cochlear Implants

• Cochlear implants have a high cost, may result in complete hearing loss, and it is considered offensive to the deaf community.

Testing for Hearing Loss

• Rinne test uses a timer and tuning fork to differentiate conductive and sensorineural hearing.

• Speech in noise test determines how well the patient detects speech with background static.

• Audiograms detect both types of hearing loss.

Rinne Test

• Sensorineural hearing is tested by placing a struck tuning fork on the mastoid process.

• Bone conduction determines length of time the patient can hear. Flip tuning fork & place it in front of the ear which checks for air conduction (conductive hearing).

• If hearing is normal, air conduction is heard twice as long as bone conduction. Air conduction is heard as long or less than bone conduction.

Speech in Noise Test

• Speech with a background static of varying types is introduced in this test.

• The test determines how well the patient can detect speech under those conditions.

Audiograms

• Are made during a pure tone test and utilizes an audiogram.

• Detect both sensorineural and conductive hearing loss. The test uses an audiometer to measure hearing sensitivity.

• A series of beeps/tones are played at different frequencies and the patient indicates when the beep in heard. the tone is kept going softer until it's no longer heard- which determines the threshold. Recorded with frequencies on x axis and decibles on y axis.

Hearing loss Levels - ranges for each type.

*Normal Hearing 0-20 dB
*Mild Hearing Loss 21-40 dB
*Moderate Hearing Loss 41-55 dB
*Moderate Severe Hearing Loss 56-70 dB
*Severe Hearing Loss 71-90 dB
*Profound Hearing Loss >90 dB

Conductive Hearing loss

*Air conduction levels are represented as x's and o's and bone conduction levels are represented as < and > and therefore are better than air conduction.

Vaccination.

*Vaccination is a prevention method for infection by convincing the body that the infection has already happened and it works by an injection of dead- weakened or modified pathogens. The body activates the immune system and produces antibodies so it won't get it again.

Vaccines impact.

*Vaccinations reduce the incidence of several diseases and has eliminated small pox and polio in our country.

Methods to create Vaccines.

• Similar-pathogen vaccine: Find a virus similar to the one you want to protect against, isolate it, and inject it live into the person -- used for cowpox, making a vaccination for polio.

• Attenuated virus: Alter the virus enough that it is weakened in the human body -- used for measles.

• Killed vaccine: The virus is killed with heat, radiation, or some other means -- used for polio. Requires boosters.

• Toxoid vaccine: Expose the body to the toxins a pathogen produces, rather than to the pathogen itself -- created for pathogens like tetanus. Requires boosters.

• Subunit vaccine: Consists of nothing more than a portion of a pathogen - a chunk -- made for hepatitis B.

• Naked-DNA vaccine: A single gene (that produces protein) is amplified and put into a vector of double-stranded DNA. This DNA is injected into a bacteria,the bacteria grows, the DNA is extracted and injected into a person. The vaccine is currently in development to use in an HIV vaccine.

Recombinant DNA Technology

*Involves modifying DNA by adding or removing genes, placing this modified DNA into an organism and letting that organism replicate. Begions with the selection of a gene of interest. This gene is removed from the organism and isolating it's DNA.
*Restriction enzymes are used to "cut out" the DNA, which is then amplified (copies are made).
*The genes are then ligated into double-stranded DNA. Remember to ligate in order to seal it in and glue to make permanent to the DNA.
*Once that plasmid inside a bacterium, the bacteria produces more of that plasmid, incorporating that DNA and making copies of it before the cell divides. Soon, colonies of this modified bacteria live, containing the recombinant DNA we wanted.
*This DNA can be extracted from the bacteria after they have been killed, and used for the purpose of vaccination, with the DNA injected into the person who needs the vaccine.

The Jobs of Epidemiologist

*Studying symptoms of disease.
*Detecting disease.
*Making diagnoses.
*Administering treatments.
*Studying the after-effects.
*Finding ways to prevent a disease from happening althogether.They monitor the health of populations and search for patterns in disease.

Genetic Testing

*Genetic testing is the use of molecular methods to determine if someone has a genetic disorder, will develop one, or is a carrier of a genetic illness and involves sampling a person’s DNA and examining the chromosomes or genes for abnormalities.

Essential Questions

*What is genetic testing?
*What are the duties of a genetic counselor?
*What is the goal of PCR?
*What are the steps of the PCR process?
*What is the relationship between phenotype and genotype?
*What are SNPs?
*How can restriction enzymes and electrophoresis be used to identify SNPs and determine genotype?
*What medical interventions and lifestyle modifications can help a pregnant woman have a healthy pregnancy?
*What can amniocentesis and chorionic villus sampling tell a couple about their developing fetus?

More Essential Questions.

*How can genetic diseases be cured if scientist replace faulty genes?
*What vectors can be used to transfer DNA to human cells?
*How might gene therapy open the door to genetic enhancement?
*What medical interventions are available for couples who would choose the gender of their child?
*Should parents design their children?
*What is the difference between reproductive cloning and therapeutic cloning?
*What are some of the ethical dilemmas surrounding current and future reproductive technology?

Judy Smith Story

*Judy Smith is pregnant again but because she is getting old- there are increased chances of inherited diseases. Genetic screening and testing will take place. Importance of pre Natal care.

Understanding Inner Working of DNA.

*Genetic testing can be used to diagnose disease before a child is even born. Test ourselves for diseases and learn the likelihood of passing them on to children.

Genetic Testing.

*Genetic testing is often performed by a genetic counselor. A genetic counselor is a trained professional who helps individuals and families understand and adjust to a genetic diagnosis or the possibility of having a hereditary disorder. Genetic counselors interpret family history information and educate patients and professionals about genetic diseases.
*Genetic counseling can help a family understand the risks of having a child with a genetic disorder, the medical facts about an already diagnosed condition, and other information necessary for a person or couple to make decisions suitable to their cultural, religious, and moral beliefs. They provide information needed to make informed choices.

Types of Genetic Disorders

*Single-gene disorder.
*Multifactorial.
*Chromosomal.
*Mitochondrial.

Types of Genetic Disorders Single Gene traits.

*A single gene trait- mutation in one gene ( sickle cell amenia and cystic fibrosis) A Dominant trait- one copy of a gene causes an effect.
*A Dominant trait is one where one copy of a gene passed to a child causes an effect in the child- like dwarfism or Huntington’s disease.
*A recessive trait is one where a child must inherit the defective gene from both parents in order to express the trait. If the child only gets one copy, he or she is a carrier of the trait, but will not show it.
*A sex-linked trait is one that is passed on the sex chromosomes (the X or the Y). Remember that if a child inherits two x chromosomes, they’re a girl. If a child gets an X and a Y (only dad can give a Y) the child is a boy. Sometimes, these X’s and Y’s contain defects. If a child inherits the defective chromosome, they are likely to express the trait. Sex-linked traits are a little confusing for some people because the rules are different for boys or girls.

*An x-linked trait is passed on the x chromosome. Because girls have two x chromosomes, they must inherit two defective x’s to show an x-linked trait. If they only get 1, it’s no big deal because they have a normal x to perform all the functions of the x chromosome. If a boy gets a defective x chromosome, though, they automatically have whatever bad trait was carried on that chromosome. This is because they only have one x chromosome, so there’s no backup to perform x-related functions. This is why disorders like colorblindness, duchenne muscular dystrophy and hemophilia are much more common in males than females.

Multifactual Disorder

*Caused by multiple bad genes AND the environment in combination.
People are more prone to it if they certain lifestyle choices. Breast Cancer, diabetes, alzheimer's, dementia and high bloodpressure etc are typically multifactorial.

Mitochondrial Disorder

*Mitochondrial disorders are fairly rare and are caused by mutations in the DNA of mitochondria. If the mitochondria are defective, the body have a difficult time making ATP and are only pass from mother to child: Lebers Hereditary Optic.

*Chhromosomal disorders- involve inheriting not enough chromosomes. ( downsyndrome)Downs syndrome and Trisomy 21: Tri means 3! They have this syndrome because it creates them to have distictive characteristic traits and the extra DNA MAKES PROTEINS causing this.
*Chromosomes are revealed with a karyotype that pairs biggest to smallest.

Types of Genetic Screening

*Carrier screening.
*Preimplantation genetic diagnose.
*Fetal scresning.
*Newborn screening.

Carrier Screening

*Test typically done on adult couples who are wanting to have children to determine if the will inherit any diseases.

Preimplantation Genetic Diagnoses(PGD)

*Procedure often used by people with known autosomal dominant or sex-linked conditions that they do not want to pass on to their children. Eggs and sperm are harvested from perspective parents.

Fetal Screening/Prenatal Diagnoses

*Performed on fetuses while they are still in utero.
Amniocentesis or chorionic villus sampling are used to extract cells from the fetus for testing.

PCR Steps.

*Denaturation: heat cranked up to 95 degrees C- Nearly boiling. It unzipps and hydrogen bonds spread through. It unzips so new DNA can be grown

** Step2 is called annealing where the thermal cycler cools to 55 degrees where primars bond to the section of DNA that is wished to be copied Primer is there so DNA is primed( readied) for copying.

Genetic Testing- Geno and Pres.

*Genetic testing is not complete when DNA copies are made. Testing these traits are with a process called gel electrophoresis. This describes The Process With Chelex which forces dna to separate.

Healthy Pregnancy- A healthy Baby

*The fact the baby was genetically normal did not mean than nothing could wrong. The baby had bad inherited disease. (Alcohol and cigarette smoke) Chemical substances can have a nasty effect on the baby so exersise makes both mom and baby stay healthy

Lesson 2.2 Our Genetic Future.

*Current technologies allow parents to make certain selections for their babies. It is possible to choose babies with certain gender or do testing to not carry certain diseases. Choosing all of these could be taken too far

*There is a procedure that sperm sorting which centrifuge samples sperm carrying an x chromosme are heavier but if someone had enough money the baby could be gender selected. PGD can also select them.

*Theraputic cloning involves making a clone of a certian body part, like the kidney or arm.
Xenotransplantation- is the best organ if can happen rather than just clones. But scientists must make sure that they protect and not make things toyable.

Detecting Cancer

*Cancer cells are cells that have the inability to regultate or even devide. Cancer can afect any part of the body but its key to diagnose it early.

MRI scan
CT scan. Xray.

How to keep from getting sick( cancer)

*Scientists have learned the difference between healthy cells and cancer is what is turned on.
Tumor Supressors.
** Proto genes are group of genes that become cancer cells.

Marker

*Anylses in breast cancer determines where there is a bad allele in versions/ people can determine if they need to extra precautions.
Avoid Viral infection vaccines!!!

Treating Cancer:

*Chemotherapy.
*Radiation therapy.
Biofeedback therapy.

How to prevent Cancer- avoid smoking and toxins.

*Prosthetics( occupational and therapy)
*Pharmacogenetics.
*Nanotechnologies

Pharmacogenetics

*When pharmacogenetics is administered it is a personalized medition that studies to find what medications work best.

Nanotectnology

*Nanotechnology is another new technology that can change giving medications ( used tiny particles too big for cells).

Clinical trials

*testing something and experimenting on someone or something.

*Understandings 4.1
*The methods used to diagnose and treat diabetes have changed dramatically over the last 200 years, including the use and production of insulin.
*Recombinant DNA technology allows scientists to custom-design bacteria that can produce a variety of important protein products, including insulin.
*Amino acid interactions affect the structure and function of proteins.
*Proteins in a mixture can be separated by various laboratory techniques.
*Numerous biomedical professionals assist with the production, distribution, and marketing of a new pharmaceutical or bioengineered product.
*Essential Questions

*What role does insulin play in diabetes?
*How has the diagnosis and treatment for diabetes changed in the last 200 years?
*How can bacterial plasmids be used to produce proteins such as insulin?
*What is bacterial transformation?
*How can you gauge the success of a transformation experiment?
*How does amino acid structure relate to the overall shape of a protein?
*What is chromatography?
*How can chromatography be used to separate proteins?
*How can electrophoresis be used to check the purity of a protein sample?
*What is SDS-PAGE?
*How does protein electrophoresis differ from DNA electrophoresis?
*What biomedical professionals are involved in all stages of producing and manufacturing a protein product?

Understanding 4.2

*When the kidneys are not functioning properly, they will not filter adequately. Harmful waste products such as urea, creatinine, and blood urea nitrogen build up in the blood stream, which causes the body to make fewer red blood cells due to the lack of the hormone erythropoietin.
*Dialysis is an artificial process that removes waste products and excess water from the blood when the kidneys can no longer function.
Essential Questions
*What is End Stage Renal Disease (ESRD)?
*How is ESRD diagnosed?
*What are the treatment options or medical interventions for patients with ESRD?
*How does dialysis work?
Understanding 4.3
*Deciding who receives donated organs is not always a clear-cut issue and involves many difficult decisions guided by federal policies.
*In organ transplantation, the organ donor and recipient need to have compatible blood and tissue types.
Organ transplant surgery is a complex procedure involving various surgical techniques and a variety of biomedical science professionals.

Essential Questions

*What (or who) decides who should receive a donated organ?
*How are organ donors and recipient matched?
*What general surgical techniques are necessary for a live donor kidney transplant?
*What are the roles of the various members of the surgical transplant team?
*How does a heart transplant compare to a kidney transplant?
Understanding 4.4
A variety of tissues and organs can be transplanted from one person to another.
*Scientific research is investigating the possibility of replacing damaged organs and tissues using xenotransplantation and tissue engineering.
*Advancing medical knowledge and technology will enable scientists to enhance the human body.
Scientists need to make sure that what they present is accurate and is communicated in a way that keeps interest and focus.

Essential Questions

*What parts of the human body can be replaced?
*What are the benefits and risks of using xenotransplantation and tissue engineering for replacement organs?
*What are the ethical considerations for xenotransplantation and tissue engineering?
*How can the human body be remodeled or enhanced to create a “super” human?
*What role do medical interventions play in the prevention, diagnosis, and treatment of disease?
*Building a better body: Xenotransplantation- transplantation of living issues or organs from one species to another.
*Esrd- is determined by testing the Blood Urea Nitrogen Level at Blood Creatine Level blood potassium level and Glomerular Filtration Rate(GFR).