Patho Test 2

What are antigens?

"non-self" substances, targets of immune system

What are the 5 stages of infection after pathogen enters host, and what happens during each?

--- 1. Incubation period o Microorganism begins active replication without producing identifiable symptoms in host; can be 24 hours or 1-3 months o Some are highly contagious during this phase, and host usually doesn't know --- 2. Prodromal stage o When initial appearance of symptoms are apparent in host o Highly contagious --- 3. Acute stage o Host experiences the full infectious disease with rapid proliferation of the pathogen o Host's defenses are in full force and inflammation reaction is fully engaged o Symptoms are heightened, still contagious --- 4. Convalescent stage o Body is attempting to contain the infection and progressively eliminate the pathogen o Resolution of symptoms begins --- 5. Resolution phase o Total elimination of the pathogen from the body without residual signs or symptoms

What are 2 types of edematous fluid?

--- Purulent exudate: edema fluid that is rich in protein from WBCs, microbial organisms, and cellular debris; also called pus. --- Transudate: edema fluid that contains little protein and is mainly a watery filtrate of blood o Ex.: fluid in blister

What are the portals of entry for microorganisms?

--- Skin o Most vulnerable where there is a break in the surface, decubitis ulcers o Dermatophytes can cause fungal infection without a crack, bc of moist environments that spread from person-person (tinea/ringworm) --- Respiratory tract o Droplets from sneezes/coughs of infected people can spread o Defenses: • after inhalation, large microorganisms are trapped by mucous membranes and swept away by ciliated respiratory tract cells (mucociliary defenses) • Sneezing/coughing is meant to expel agents • Alveolar macrophages are presnt to phagocytose small microorganisms that penetrate beyond the mucociliary defenses • Respiratory epithelial cells secrete interferon, the body's natural antiviral cytokine • Immunoglobulin A is found in B lymphocytes • Cervical lymph nodes within oropharyngeal region store WBCs to defend against inhaled agents --- GI tract o Most are by food or drink contaminated; fecal-oral route o Fecal matter contains a large inoculum of E. coli and Enterococcus faecalis, and may harbor hepatitis A, etc. --- Urogenital tract o Most commonly originate from entry of pathogens into urethra o E. coli and gonococcus are capable of adhering to bladder mucosa epithelium and evade urine protective mechanism

What is Influenza Virus? How does it happen? Transmission? Symptoms?

--- These influenza viruses possess surface antigens known as hemagglutinin and neuraminidase, proteins that facilitate entry into respiratory cells and enhance release of viral particles. • The most extensive and severe outbreaks are caused by influenza A viruses because of their ability to undergo mutation. • From year to year, the hemagglutinin and neuraminidase antigens of influenza A change because of genetic mutations. • Influenza B virus causes outbreaks that are associated with less severe disease because genetic mutation causing variation in their hemagglutinin and neuraminidase antigens is less common. --- Transmission o Occurs through droplet infection and aerosols generated by coughs and sneezes of individuals. o Fomites and hand-to-hand contact also can spread the virus. o Initially, the virus enters the upper respiratory tract and then invades lower respiratory tract mucous gland cells, alveolar cells, and macrophages. --- Symptoms o The infection usually presents as abrupt onset of fever, chills, headache, myalgias, arthralgias, cough, and sore throat.

What is effusion (third space accumulation)? 2 types?

-fluid accumulating in pericardial sac, peritoneal cavity, and pleural space •Transudate - serous filtrate of blood •Exudate - containing material like blood, lymph, proteins, pathogens, inflammatory cells

2 main functions of electrolytes

1. Deliver nutrients and electrolytes to cells 2. Carry away waste products from cellular metabolism

Where is water found concerning cells?

1. Intracellular fluid (ICF) - contains 2/3 of the body's water content • 40% of total body weight; cellular shrinkage/dehydration or edema can occur 2. Extracellular fluid (ECF) - 1/3 of body's water • 20% of total body weight; most is found within intravascular compartment or blood vessels • ECF contains electrolytes, oxygen, glucose for cells; cellular waste products for excretion 3. Interstitial fluid (ISF) - filtrate of the blood • Contains water and electrolytes, mostly Na+ sodium • Lacks proteins because they are too large to diffuse out of the blood vessels into the interstitial spaces • During inflammation, the pores enlarge, allowing proteins like WBC out to the tissues

What is the difference between endemic, epidemic, and pandemic?

A disease is considered endemic if the incidence and prevalence are relatively stable. An epidemic is an abrupt increase in the incidence of disease within a geographic region. A pandemic is a term used for global spread of a specific disease.

In conditions of fluid volume deficit, which of the following would you expect to be elevated? Select all that apply. antidiuretic hormone renin plasma osmolarity natriuretic peptide risk for edema

ADH, renin, plasma osmolarity

What condition may result in "false hyperkalemia"? hypernatremia acidosis hypermagnesemia alkalosis hypercalcemia

Acidosis

How may metabolic acidosis play a role in Frank's condition? Acidosis causes sodium to shift into cells. Acidosis causes calcium to shift out of cells. Acidosis causes potassium to shift out of cells. Acidosis inhibits calcium transporters. Acidosis elevates serum sodium.

Acidosis causes potassium to shift out of cells. - Potassium will move from intracellular fluid (ICF) to extracellular fluid (ECF) based on changes in the hydrogen ion (H+) concentration in the bloodstream. During acidosis, extracellular H+ exchanges with intracellular K+. H+ ions enter the cells, while K+ leaves the cells and enters the plasma. The shift in K+ to the plasma appears as hyperkalemia.

Ethan presents with hypotension, tachycardia, and hyperventilation. You learn that he received a severe wound while using a chain saw. Laboratory results reveal low hematocrit, low hemoglobin, and normocytic normochromic anemia. What condition is consistent with these lab values?

Acute blood loss

Which of the following are associated with inflammation? Select all that apply. Redness Warmth Swelling Increased vascular permeability Increased blood flow

All

Pluripotent Stem Cells:

All blood cells arise from a small # of undeveloped, precursor cells - pluripotent stem cells in the bone marrow during the process of hematopoiesis, called myeloid and lymphoid stem cells • Granulocyte and monocyte cells are derived from myeloid stem cells and lymphocytes from lymphoid stem cells. • All blood cells arise from a small number of undeveloped, precursor cells called pluripotent stem cells in the bone marrow during the process of hematopoieisis. • These precursor cells have the potential to become any type of blood cell.

This measurement assesses the difference between measured cations (sodium and potassium) and anions (chloride and bicarbonate) in the blood.

Anion gap

Because of poor preparation and planning, two individuals are transported to the emergency department with severe dehydration following a hike in a mountainous desert area. Which of the following do you expect to be elevated in these individuals? Body weight Antidiuretic hormone levels Blood pressure Natriuretic peptide Parasympathetic activation

Anti-Diuretic Hormone

Syndrome of Inappropriate ADH (SIADH)

Antidiuretic hormone (ADH) → acts at the nephron → water reabsorption into the bloodstream → dilutes the blood → dilutional hyponatremia

Rosalie reports bruising easily and nose bleeds. Bone marrow biopsy results reveal pancytopenia. Blood values confirm these results, showing reduced red blood cells, white blood cells, platelets, and reticulocytes. What condition is consistent with these findings?

Aplastic anemia

Normal amounts of Ca, Na, K, Mg, PO4?

Ca: 8.5-10.5 Na:135-145 K: 1.5-2.5 Mg: 1.5-2.5 PO4: 2.5-4.5

What is calcium? What does Vitamin D do for calcium? What happens when calcium is low?

Calcium and phosphorus are the major mineral contents of bone. Vitamin D facilitates the absorption of calcium from the gastrointestinal tract into the bloodstream. When the plasma calcium level is low, PTH is stimulated; when the plasma calcium level is high, PTH is inhibited.

What is the term for the twitch noted when you tapped along Louise's jaw? Bell's palsy Kernig sign Trousseau's sign Chvostek's sign Trigeminal neuralgia

Chvostek's sign - Chvostek's sign is elicited by tapping on the patient's face, in front of the ear and below the cheek bone. Facial twitching constitutes a positive sign.

Which organism releases a toxin that causes muscle relaxation

Clostridium Botulinum

Patricia has mild bacterial pneumonia and is being treated with antibiotics. Labored breathing, with increased rate and depth, is noted. Cyanosis is present. Initial values for arterial blood gases reveal elevated pH and below normal carbon dioxide and oxygen levels. With treatment, pH has returned to a normal pH value. Patricia's symptoms, lab findings and history point to ______________________.

Compensated respiratory alkalosis

____ are inflexible shrinkages of wound tissue as the body closes the wound.

Contractures

Which immunoglobulin is primarily responsible for an allergic response?

IgE

If a patient presents with metabolic acidosis, which of the following signs would you expect to observe?

Increased respiratory rate

What does aldosterone do?

Increases sodium and water content

The first stage of an infectious disease in which the microbe is present but symptoms have not appeared.

Incubation

Nina, age 23, has the primary complaint of heavy menstrual periods. Blood laboratory values show low hemoglobin and hematocrit with microcytic and hypochromic cells. Serum ferritin is low with elevated total iron binding capacity. What condition is consistent with these findings?

Iron-deficiency anemia

What is an isotonic solution? % NaCl? What is it used as?

Isotonic solution - same tonicity as blood; when infused in an IV, it does not cause fluid shifts or alter body cell size --- .9% NaCl (normal saline) --- Used often as a bloodstream volume expander; used to keep an open connection to the IV route for med administration or a blood transfusion

Increased epithelial formation may result in scars or _________________.

Keloid formation

What is a WBC differential? What does it measure?

Lab test used in diagnosis of infection and inflammation • Measures total number of WBCs and calculates the % of specific types within the total

As skin cells are _____________, meaning they are mitotically active and continue to transition through the cell cycle, the wound should be healing.

Labile

GI Bacterial Infections: Salmonella Shigella E. coli Campylobacter

Leading causes of gasteroenteritis that cause diarrheal illness --- Salmonella • Can cause typhoid fever or gastroenteritis, usually from food • Can survive for weeks outside the body, heat can kill after 10 minutes --- Shigella • Gram -, nonspore forming, non-motile --- Escherichia coli • Inhabit the intestine • Can cause cholecystitis, bacteremia, cholangitis, UTI, traveler's diarrhea, neonatal meningitis, pneumonia • E. coli 0157:H7 causes severe gastroenteritis, can cause hemolytic-uremic syndrome; This specific bacteria is one of the enterohemorrhagic Escherichia coli (EHEC). • Usually acquired by food or water, live in the intestines of healthy cattle, and can contaminate meat --- Campylobacter • Found in animal feces, especially birds • One of the most common causes of gastroenteritis in the world • Produces diarrheal illness often with blood and is self-limited; causes abdominal pain, fever • Contaminated poultry is common, or cattle infected beef, improper preparation; person-person • Lasts 24 hours-1 week • Treat with antibiotics like erythromycin or ciprofloxacin • Guillain-Barre syndrome can develop 2/3 weeks after the gastroenteritis

What is Reye's Syndrome?

Liver failure • Research has demonstrated a link between salicylate use and Reye's syndrome in children and adolescents who have viral infections.

What is low PO2? What is elevated PCO2? What is diminished PCO2?

Low PO2 is hypoxia or hypoxemia Elevated PCO2 is hypercapnea Diminished PCO2 is hypocapnea

Sara, a 51-year-old woman, was recently diagnosed with an autoimmune disease. She had made an appointment to see her physician because she was experiencing chronic low fever, muscle pain, and joint pain. Her physician noted a butterfly-shaped rash on Sara's face and ordered follow-up tests. Laboratory results revealed a positive anti-nuclear antibodies test, anemia, and thrombocytopenia. Follow-up anti-double-strand DNA and anti-Sm antibody tests were positive.

Lupus

Which is the most devastating protozoal disease worldwide?

Malaria

Which of the following statements is incorrect? Genetic predisposition plays a role in the development of autoimmune diseases. Some autoimmune disorders are systemic. Men are more commonly affected by autoimmune diseases than women. Rheumatoid arthritis may affect tissues other than the joints of the hand. Lupus may result in the appearance of a distinct butterfly-shaped rash on the face.

Men are more commonly affected by autoimmune diseases than women.

A significant loss of acidic gastric fluids via vomiting may cause _______________.

Metabolic alkalosis

IgA deficiency characteristics

Most common primary immunodeficiency Normal IgM and IgG levels Individuals may be asymptomatic Increased susceptibility to autoimmune condition

Characteristics of Hypogammaglobulinemia

Opportunistic infections Defect in B cell development IgG levels below 5th percentile

What are the normal value of PCO2, SaO2, PO2, HCO3-?

PCO2 normal: 35-45 SaO2: 95-100% PO2: 90-100 mmHg HCO3-: 22-26 mEq/L

A characteristic of aplastic anemia is

Pancytopenia

Louise recently had thyroid surgery due to a tumor. You are a nurse working at acute care clinic. She comes in to the office today complaining of tingling around her mouth and fingers and small muscle spasms. She is surprised when you ask if you can tap along her cheekbone. When you do this, you note a slight twitch in her facial muscles. Louise wonders if any of this could be related to her surgery. What tissues do you suspect may have been damaged during Louise's surgery? Parathyroid glands Muscles of the jaw Muscles of the eyes Nerves affecting the lips Diaphragm

Parathyroid glands - The parathyroid glands are small structures located near the posterior aspect of the thyroid gland. Surgery of the thyroid gland may inadvertently damage the parathyroid glands.

Primary immunodeficiencies are_____________.

Present at birth

What are parasites?

Protozoa, helminthes, and insects are single-celled organisms present in environment that can get through skin, GI tract, genitourinary tract

Which chemical resets the hypothalamic thermostat, causing fever?

Pyrogen

John's body temperature is slightly elevated. You know that fevers are a common sign of infection caused by ___________, chemical signals that reset the hypothalamic thermostat.

Pyrogens

What is renin? What does it convert?

Renin - enzyme released from kidney in response to decreased renal perfusion; converts angiotensinogen to angiotensin I; angiotensin-converting enzyme in lungs changes angiotensin I to angiotensin II

What is the most common means of transmission of infectious diseases?

Respiratory

An elderly woman appears in the clinic struggling to catch her breath. She was diagnosed with chronic obstructive pulmonary disease two years prior. Arterial blood gases reveal lower than normal pH and elevated carbon dioxide. What acid-base imbalance is she suffering?

Respiratory acidosis

Abigail decided to seek medical attention after noting a change in her skin's appearance. She says it is strange, but she has noticed the wrinkles on her face seem to be "disappearing." Abigail's skin does appear to be very shiny and smooth. She also reports that recently she has noticed difficulty swallowing, even when she is being cautious about how quickly she is eating. Laboratory work reveals an elevation in antinuclear antibody levels. Abigail's symptoms and lab work point to ___________________.

Scleroderma

Which condition results in the accumulation of fibrous tissue in the skin?

Scleroderma

Prolonged hypoxia, such as occurs with chronic obstructive pulmonary disorder, may result i

Secondary polycythemia

Because of family history, the physician orders hemoglobin electrophoresis tests for Jordan. The results are positive for hemoglobin S. What disorder does the patient have?

Sickle cell anemia

Eleanor tells you that the "weirdest" things have been happening to her. Her eyes feel dry all the time and she can't seem to produce enough saliva. Eleanor reports trying to increase her fluid intake, as well as sucking on candies and lozenges in order to help. She states that her eyes constantly feel "itchy". Laboratory tests reveal elevated antinuclear antibodies and SS-A and SS-B levels. Eleanor's signs and symptoms are likely related to ____________________.

Sjoren's syndrome

What is a reservoir? What other environmental objects can act as reservoirs?

Source of pathogenic organism that may or may not be suffering from the disease caused by the pathogen --- Environmental objects, also called fomites, can also act as reservoirs of microorganisms. An unsanitary bathroom surface is an example of a fomite

Which type of cells, found in the liver and bone, can be induced to replicate with a strong enough stimulus?

Stable

Which symptom is the most common clinical manifestation observed in clients with severe combined immunodeficiency disease?

Susceptibility to opportunistic infections

What is the relationship between calcium and phosphate?

There is a reciprocal relationship between calcium and phosphate; when there is an increase in Ca, there is a decrease in P

A client has fluid volume excess and has gained 2 kg of weight. Which are the symptoms the client might exhibit due to fluid volume excess? Select all that apply. Hypotension Third space accumulation Edema Thirst Elevated heart rate

Third space accumulation, edema

Where is calcitonin produced? What does calcitonin do?

Thyroid Acts at the bone and kidneys to remove calcium from the circulation.

Brad is receiving a blood transfusion. At least two clinicians must verify the patient's blood type and the blood to be infused are the same. The clinicians are avoiding a __________________ reaction.

Type 2

Two days after hiking through the woods with his dogs, Charles noticed a severe rash on his lower legs. He had not been wearing long pants on the hike. Based on the appearance of the rash, he believes he may have contracted poison ivy. Charles is experiencing ___________________________.

Type 4

addy, an 8-year-old girl, is visiting her uncle who has three cats. Maddy is allergic to cats and immediately begins experiencing watery eyes, sneezing, and rhinorrhea. What type of hypersensitivity is Maddy suffering from?

Type I

Which type of hypersensitivity presents as a "delayed" reaction and is used in the Mantoux test for tuberculosis?

Type IV

Meryl, a 72-year-old woman, presents with hyperventilation due to severe anxiety. Respirations are shallow and very rapid. Speaking is difficult for her due to an elevated respiratory rate. Her arterial blood gases reveal an elevated pH value. Meryl's symptoms, lab findings and history point to ______________________.

Uncompensated Respiratory Alkalosis

How may Frank's renal issues play a role in the electrolyte imbalance? Increased sodium reabsorption by the kidneys Decreased potassium excretion by the kidneys Increased calcium reabsorption by the kidneys Increased phosphate excretion by the kidneys Decreased sodium filtration by the kidneys

Decreased potassium excretion by the kidneys - In acidosis, hydrogen ions enter the cells, causing potassium ions to leave the cells and enter into the plasma. The elevation in plasma potassium concentration can be compounded by poorly functioning kidneys, as the kidneys normally filter excess potassium into the urine.

Which factors may contribute to this imbalance? Select all that apply. Being male Digitalis usage Age Diet, perhaps lacking in nutrients Diuretic usage

Diet, perhaps lacking in nutrients Diuretic usage CORRECT. Diuretic therapy is the most common cause of hypokalemia; it is present in 20% to 50% of patients on nonpotassium-sparing diuretics. Thiazide and loop diuretics increase the loss of potassium ions in the urine. Inadequate potassium intake can also be a frequent cause of hypokalemia. Patients who are NPO, alcoholic, who have undergone bariatric surgery, and who suffer eating disorders are at greatest risk, but it can also be due to a poor nutritional diet.

What is virulence? What influences severity of infection?

Different pathogens have varying disease-producing potential --- The severity of infection depends on the virulence of the pathogen and the strength of the host defenses at the time of infection.

In addition, mediators of inflammation, including C-reactive protein (CRP) and _________________, were shown to be elevated.

ESR - ESR, or erythrocyte sedimentation rate, along with CRP are generic markers of inflammation. Although they are not specifically diagnostic, elevation in these factors can be used to assess the presence of inflammation due to infection or autoimmune diseases. PT refers to "prothrombin time" and is used to assess blood clotting. ALT, alanine aminotransferase, is a liver enzyme that may elevate in the blood with liver damage.

Fluid volume excess may cause which of the following signs? Select all that apply. Thirst Edema Dark-colored urine Crackles in the lungs Weight loss

Edema, crackles in the lungs

When you examine the wound, you note the appearance of redness and warmth. Fluid appearing to contain cells and proteins, known as _________, is seeping from the edges of the wound.

Exudate

What is respiratory acidosis? What are symptoms? What are physical findings? What causes it? What is PCO2? What is blood pH?

Failure of the respiratory system to remove or exhale CO2 from body fluids as fast as it is produced by cells. --- Symptoms: oDyspnea oRespiratory Distress oLethargy, comatose --- Physical Findings oDiminished respiratory rate oCyanosis oClubbing if chronic hypoxia •Caused by any interference with breathing (eg, COPD, respiratory muscle weakness, suffocation) •Pco2 is greater than 45 mm Hg. •Blood pH is lower than 7.35.

What are normal flora, and do they cause infection?

Flora constantly on the body do not cause infection unless they invade noncolonized areas of the body

Monica has Crohn's disease and has been experiencing weakness and fatigue. Peripheral blood smear shows megaloblastic cells. Blood laboratory results also show low hemoglobin and hematocrit with high mean corpuscular volume. Homocysteine levels are also high. What condition is consistent with these findings?

Folic acid deficiency anemia

Stephanie has systemic lupus erythematous. Her peripheral blood smear reveals spherocytosis and poikilocytosis. Reticulocyte percentage is elevated. What condition is consistent with these findings?

Hemolytic anemia

What happens in hyperglycemia of uncontrolled diabetes?

Hyperglycemia of Uncontrolled Diabetes glucose increases osmotic pressure; osmotic pressure is greater than hydrostatic pressure Water is pulled from ICF to ECF, cellular dehydration occurs

What other electrolyte imbalance may you also suspect? Hypernatremia Hyperphosphatemia Hyperkalemia Hypernatremia Hypokalemia

Hyperphosphatemia - Hyperphosphatemia is usually accompanied by hypocalcemia, and many of its symptoms are related to low calcium levels.

What is a hypertonic solution? % NaCl? What is commonly used?

Hypertonic: More particles and less water than blood and body fluids; when infused, adds solutes to the blood and causes fluid shifts for ICF to ECF, shrinking body cells --- Also used is less than 3.0% NaCl --- Commonly used is mannitol (diminishes cell swelling like cerebral edema)

Hypercalcemia is often associated with _______________. Hyperphosphatemia Hyponatremia Hypophosphatemia Hypernatremia Hypokalemia

Hypophosphatemia

What is a hypotonic solution? % NaCl?

Hypotonic solution: fewer particles and more water than blood and body fluids; when infused it adds water to the blood and causes a fluid shift from ECF to ICF to treat dehydration --- .45% NaCl (half normal saline)

One sign associated with hypokalemia is __________________. dark-colored urine edema prolonged PR interval on electrocardiogram. weight gain elevated blood pressure

prolonged PR interval on electrocardiogram.

What is a pathogen?

specific microorganism capable of causing infectious disease; categorized as viruses, bacteria, fungi, and parasites

What is dehydration? What does it stimulate in the body?

state of diminished water volume in the body, cells shrink •→ Stimulation of osmoreceptors in blood vessels →stimulation of thirst center in hypothalamus in brain •→ Stimulation of peripheral baroreceptors in blood vessels → sympathetic nervous system increases heart rate and vasoconstriction of blood vessels •→ Stimulation of kidney to secrete renin → RAAS → raises blood volume and blood pressure •→Stimulation of osmoreceptors → stimulation of posterior pituitary gland of brain → ADH, increases water reabsorption at nephron of kidney

What is the late phase?

when leukotrienes and prostaglandins are produced - SRA's or Slow Reacting Anaphylaxis

What is pneumonia?

widespread inflammation and infiltration of exudative fluid in the alveolar regions of the lungs - consolidation

Symptoms of pneumonia/phys. exam/diagnostic tests?

• Acute onset of high fever—often with rigors, productive cough, pleuritic chest pain, dyspnea, tachypnea, tachycardia, sweats, malaise, and fatigue; blood-tinged sputum • On physical examination, crackles can be heard in the lung region affected by the pneumonia. • Diagnostic tests include chest x-ray and sputum culture. Chest x-ray shows consolidation in the region of pneumonia. • Pneumococcal vaccine every 5 to 10 years has been recommended for older adults and has greatly reduced infections. (yep, this is an immunization!)

Symptoms of Fluid Volume Excess?

• Ascites - gastroenterological term for an accumulation of fluid in the peritoneal cavity that exceeds 25 mL • Crackles in lungs • Dyspnea caused by pulmonary fluid accumulation • Edema, either ankle or sacral • Weight gain (2 lbs = 1 liter of fluid)

What is Streptococcus pneumonia? Common precursor?

• Cause of pneumonia • Gram positive diplococcal bacterium • Influenza is a common precursor

What is acidosis and pH value?

• Elevation of H+ concentration of body fluid above normal OR decrease in HCO3- resulting in a pH lower than 7.35.

What is the Cell Cycle and each stage?

• G0: Cells are resting or quiescent and not undergoing mitotic division. • G1: Cells enter the cell cycle, where they make preparations for mitosis and then continue on to the S phase. o First gap phase: synthesis of components needed for DNA • G2: Cells continue to undergo necessary activities before mitosis. o Second gap phase: preparation for mitosis • S: Cells undergo chromosomal duplication in preparation for mitotic division. o Synthesis phase • M: Cell completes mitosis and divides to regenerate itself.

What are lab tests that can be done? How do you use these to classify bacteria?

• Gram stain (bacteria) • Culture • Biopsy • Antibody titer (also called serology) • Polymerase chain reaction (PCR) detects genetic material Bacteria can be classified according to how their cell membrane absorbs a dye such as a Gram stain or acid-fast • A culture can yield info about the organism's antibiotic susceptibility • Culture media can be infused with different antibiotics and growth or suppression of microbes can be observed Infection can also be confirmed in biopsy or serological testing • The level of antibody in the bloodstream is called an antibody titer Or, Polymerase chain reaction technique detecting a microorganism's genetic material

What are the types of Leukemias? (ALL) (CLL) (AML) (CML)

• Leukemias - cause proliferation of cancerous WBCs, 350000 people worldwide per year, 90% in adults o Acute Lymphoblastic Leukemia (ALL) - Aggressive cancer that is most common in children • Stem cell precursors for T or B lymphocytes in the bone marrow do not function and do not mature beyond the lymphoblast stage. • As the lymphoblasts become more numerous, there is less room for healthy WBCs, RBCs, and platelets, leading to anemia, susceptibility to infection, and suppressed clotting. • Lymph nodes also contain large numbers of lymphoblast cells, which crowd out healthy lymphocytes. o Diagnosis • A bone marrow biopsy demonstrates hypercellularity with predominantly lymphoblasts. • A bone marrow lymphoblast count of over 20% of total WBC is sufficient for a diagnosis of ALL o Treatment • Bone marrow transplantation from a tissue-matched sibling and chemotherapy are commonly used treatments. o Chemo Side Effects • Chemotherapy attacks ALL rapidly dividing cells: GI, mucosa, skin, hair, and all blood cells. • Anorexia • Nausea • Vomiting • Hair loss • Infections (immunosuppression) • Fever • Bleeding and bruising o Chronic Lymphocytic Leukemia (CLL) • Most common type of leukemia in the United States and other Western countries; however, it is rare in China and . • B cell lymphocyte malignancy is found in elderly individuals, with a median age at diagnosis of 70 years. • Genetic changes are the fundamental cause of CLL. • Any agent that can disrupt DNA upon exposure is considered an etiologic agent. • Over 80% of patients with CLL have some type of chromosomal abnormality, with trisomy 12 being the most common. • Over 95% of CLL cases involve B cells that have failed to differentiate from precursor B cells into mature B cells in the bone marrow. • In the peripheral blood, these cells resemble mature B cells, but they synthesize and release low levels of immunoglobulin (Ig), mutated Igs, or no Ig at all. • They are referred to as B-CLL lymphocytes. B-CLL lymphocytes contain excess proto-oncogene bcl 2. This proto-oncogene bcl 2 is a suppressor of apoptosis (programmed cell death), resulting in long life for the B-CLL cells. • There is constant proliferation of B-CLL precursor cells in the bone marrow. • The accumulation of B-CLL cells results in crowding of the bone marrow and consequent decreased development of RBCs, WBCs, and platelets. • The proliferation of B-CLL cells also occurs in the lymph nodes and spleen, causing lymphadenopathy and splenomegaly. o Diagnosis • The hallmark of CLL is lymphocytosis with a WBC count of greater than 20,000/uL. The bone marrow is infiltrated with characteristic small lymphocytes. o Acute Myelogenous Leukemia (AML) • AML is caused by the proliferation of undifferentiated (blast) myeloid cells in the bone marrow. • Genetic mutations in the abnormal myeloid cells cause a change in the normal apoptosis. • Symptoms: anemia from lack of RBCs, bleeding disorders from lack of platelets, and infections from neutropenia. o Chronic Myelongenous Leukemia • A disorder characterized by an overproduction of mature myeloid cells in the bone marrow o 3 Phases • 1- chronic phase, where neutrophils begin to lose their differentiation • 2- accelerated phase, where neutrophils are more undifferentiated and unable to function • 3- blast crisis phase, where myeloid blast cells do not differentiate at all o Symptoms • Symptoms of a blast crisis include all the usual symptoms of leukemia: • Decreased number of normal WBCs, RBCs, and platelets • Symptoms = frequent infection, anemia and thrombocytopenia, fever, fatigue, weakness, bleeding, and bone pain o CML is both treatable and curable.

What is MMR? Symptoms and transmission of each?

• Measles, mumps, and rubella (MMR) were common childhood illnesses fewer than 50 years ago, but are now rare because of routine vaccination. • Rubella and measles (also called rubeola) are referred to as viral exanthems, a term indicating rash. • Measles Symptoms o High fever, cough, upper respiratory illness, conjunctivitis with periorbital edema, and photophobia are major symptoms. o There are unique white areas in the oral buccal mucosa called Koplik spots that appear in the prodromal stage. Koplik spots are considered pathognomonic for measles. o After the appearance of Koplik spots, the characteristic tiny maculopapular, mildly pruritic rash appears on the body. The rash develops from head to toe and then fades after 5 to 7 days. • Measles Diagnosis o Specific measles IgM and IgG immunoglobulins can be found in the blood. • Vaccine o All individuals should receive the MMR vaccine at 15 months, and a booster is recommended at age 18. • Rubella Symptoms o Droplet infection from cough or sneeze infects the respiratory epithelium. It has an incubation period of 14 to 19 days, with onset of a rash usually on the 15th day. o Patients are most contagious when the rash is erupting and are noncontagious after 7 days of rash. o The rash may be the first manifestation, followed by fever, sore throat, and rhinitis. After the rash begins, Forchheimer spots, which are pinpoint red macules, and petechiae over the soft palate and the uvula can be seen just before or with the rash. o The hallmark of rubella is generalized, tender lymphadenopathy that involves all nodes, but particularly the cervical nodes. • Congenital Rubella Syndrome o The major complication of rubella is its teratogenic effects when pregnant women contract the disease, especially in the early weeks of gestation. o The virus can be transmitted to the fetus through the placenta and can cause serious congenital defects, spontaneous abortions, and stillbirths. • Mumps o Spread by droplet infection o Inflammation of the parotid salivary gland o Males can develop orchitis.

Blood-blood transmission: how does it happen? Most common transmitted blood borne pathogens?

• Most common method of transmission of bloodborne infections • Through needlestick or lacerating injury contaminated with infected blood, unsterile drug needles, eye, naso-oral mucous membranes, and skin • Most commonly transmitted bloodborne pathogens: hep B, hep C virus, and HIV

What is osmotic pressure? What does it oppose? How is it determined?

• Pressure exerted by the solutes in solution • Exerted by electrolytes in bloodstream, mainly sodium and plasma proteins ---Opposes hydrostatic pressure at all capillary membranes --- Determined by the number of particles or their concentration within the solution; (a solution w/ a greater number of particles has a higher osmotic pressure)

What are hematologic neoplasms?

• The hematologic neoplasms are types of cancer that affect blood, bone marrow, and lymph nodes. • These cancers are malignancies that are either mainly located in the blood (leukemia) or in lymph nodes (lymphomas).

What are the normal values of Pao2, Paco2, HCO3-, SaO2?

• The pressure of the gases in the bloodstream • Pao2: the pressure of oxygen in the arterial blood (90 to 100 mm Hg) • Paco2: the pressure of carbon dioxide in arterial blood (35 to 45 mm Hg) • HCO3-: the amount of bicarbonate ion in the blood (22 to 25 mEq/liter) • Sao2: saturation of Hgb with oxygen: 95% to 100%

CBC with Differential

• The test measures total RBCs, hemoglobin (Hgb), hematocrit (Hct), platelets, total WBCs, and the percentage of each type of WBC present.

What is potassium? How much is needed per day?

•MOST important electrolyte •Main one of ICF •Adults require 40-60 mEq/L/day •When H+ is high in blood, H+ excretion takes precedence over K+ excretion at the kidney

Timothy was recently diagnosed with pernicious anemia presents with complaints of fatigue and dyspnea. He also comments that his tongue "hurts" and feels "strange," and he is experiencing tingling in his hands and fingers. Laboratory values reveal low hemoglobin and hematocrit, with high mean corpuscular volume values. What condition is consistent with these findings?

Vitamin B12 deficiency anemia

Deficiency in which of the following nutrients may result in megaloblastic red blood cells?

Vitamin B12, folic acid

What is hyponatremia? When can the 2 types occur? What are causes? What are symptoms? What is severe hyponatremia?

What? - sodium serum level of less than 135 mEq/L * Can occur in low blood volume; hypovolemic hyponatremia * Can occur in high blood volume; dilutional hyponatremia Causes: • Causes: o Diarrhea o Vomiting o Excess sweating o Burns o Wounds o Gastric lavage Symptoms: o Headache o Lethargy o Apathy o Confusion o Nausea o Vomiting o Diarrhea o Muscle cramps and spasms Severe: fewer than 125 mEq/L

What are cytokines? Examples? What do they do to the effect of inflammation?

What?: --- Inflammatory mediators released by WBCs • Ex.: tumor necrosis factor and interleukins • Amplify or deactivate inflammation • Stimulate liver to released acute phase proteins o Ex.: C-reactive protein (CRP), fibrinogen, and serum amyloid A • Influence the inflammatory process by stimulating, modulating, and deactivating the reaction

What are the 3 phases of wound healing? What factors are involved in healing?

Wound Healing (3 phases) • Inflammation • Proliferation, granulation tissue formation, and epithelialization • Wound contraction and remodeling Factors Involved in Healing • Nutrition • Oxygenation • Circulation • Immune strength • Diabetes; weakens healing • Use of corticosteroids; diminishes healing • Use of immunosuppressant agents • Contamination • Surgically inserted devices • Obesity • Age

Ch. 13 What is the expected hematocrit level in a woman with polycythemia?

above 48%

What are Major Histocompatibility Complexes? (MHC/HLA)

antigens on every human cell surface • The function of MHC is to present antigens to T cells! • So, all processed antigens are presented in the context of the MHC, the Major histocompatibility complex, and come from the human leukocyte antigen genes (HLA). MCH's recognize the body's "self" antigens from foreign "non-self" antigens. • These may be familiar to you from, for example, organ transplants,... HLA antigens have to match a transplant recipient to be successful. • Only identical twins have the exact match. • There are two groups of MHCs: o Type I are the receptors for CD8 o Type II are the receptors for CD4

What is Myasthenia gravis?

autoimmune disorder • Antibodies develop against acetylcholine receptors in muscles • Slowly Ach receptors degenerate • Result: weakening muscle movement

In the bicarbonate buffering system in the body, bicarbonate acts as a(n) _____________ , while carbon dioxide is a(n) _____________.

base, acid

What are cytokines and what do they do?

control amount of inflammation; inflammatory mediators produced by WBS, mainly macrophages and lymphocytes; promote leukocyte recruitment and acute inflammation reactions

What is infection?

describes the invasion, colonization, and multiplication of pathogens within the host; diagnosed when there is isolated of a pathogen or evidence of its presence and pathogen-related host symptoms

What is lymphadenopathy/lymphadenitis? What are lymph nodes and lymphocytes?

enlargement of lymph nodes caused by inflammatory processes. • Lymph nodes are small bean-sized masses of tissue located in various regions of the body, including the neck, axillary regions, central thoracic region, inguinal areas, and gastrointestinal tract. • Lymphocytes mature within a lymph node; during an inflammatory process, lymph nodes become enlarged and tender.

What is a host?

human or animal invaded and colonized by a pathogen

Reduced sodium concentration accompanied by fluid deficit is also known as: hypervolemic hypernatremia. hypervolemic hyponatremia. hypovolemic hypernatremia. hypovolemic hyponatremia. hypernatremia.

hypovolemic hyponatremia

What is colonization?

indicates that a pathogen is living within the host, but does not mean infection exists

What is an opportunistic infection?

infection caused by a microorganism that flourishes because of a host's deficient immune system; can occur with immunosuppression

What is molecular mimicry?

involved in some autoimmune disorders • An infectious agent is composed of antigens that have the same amino acid sequences as some self antigens; Body forms antibodies to an antigen as well as antibodies to body tissue mistaken for an antigen. • Occurs in rheumatic heart disease, body forms antibodies against GABHS and reacts with heart valve tissue

What does serology testing measure?

measures the presence of IgE, which is associated with allergic or hypersensitivity reactions.

What does Starling's Law of Capillary Forces explain?

movement of fluid that occurs at every capillary bed in the body; there are two major opposing forces at every capillary membrane:

Ch. 12 What are leukemias/lymphomas?

neoplastic disorders that affect WBCs --- Nonfunctional, cancerous WBCs proliferate and overwhelm the bone marrow and other lymphoid tissue. The cancerous WBCs increase to excess numbers and they crowd and suppress development of the other blood cells in the bone marrow.

What is passive acquired adaptive immunity?

o This is an injection of premanufactured immunoglobulins. o The body merely passively accepts the immunoglobulins and the body DOES NOT have to manufacture them. o This is short-term immunity. o Example: hepatitis B immunoglobulin (Hbig) and immunoglobulins in breast milk o Administered when the patient needs IMMUNITY NOW because of being with close contacts or a family member who has the virus. o Example: A father has contracted hepatitis B. His wife and children need to get Hbig.

How do kidneys regulate the acid-base balance of blood?

Kidneys can excrete H+ if in excess in the blood. Kidneys can retain HCO3- if needed by blood. Kidneys can retain H+ if needed by blood. Kidneys can excrete HCO3- if blood has excess.

What are the 2 types of inflammation? 3 stages of the first? What does the second type cause?

--- Acute: occurs rapidly in reaction to cell injury, rids the body of the offending agent, enhances healing, and terminates after a short period, either hours or a few days. • 3 stages 1: vascular permeability • Inflammatory mediators such as histamine and bradykinin enable blood vessels to dilate and become more permeable. • This permeability permits fluids, WBCs, and platelets to travel out to the site of injury or infection. • Vasodilation of the arterioles is followed by enhanced capillary permeability, allowing fluid to flow out of the blood vessels to the injured tissues, causing swelling. 2: Cellular chemotaxis • A chemical signal from microbial agents, endothelial cells, and WBCs attracts platelets and other WBCs to the site of injury. • WBCs then line up along the endothelium in the area of inflammation - margination. • WBCs release inflammatory mediators that amplify the inflammatory process; some attract more WBCs to the area of injury, and others dampen the inflammatory process. 3: systemic responses • Fever, pain, swollen lymph nodes, lethargy, anemia, weight loss --- Chronic: when the inflammatory reaction persists, inhibits healing, and causes continual cellular damage and organ dysfunction. • Often causes a granuloma. • Granuloma is an area where macrophages have aggregated and are transformed into epithelial-like cells. The epithelioid cells are surrounded by lymphocytes, fibroblasts, and connective tissue. • Tuberculosis (TB) is the prototypical granulomatous chronic inflammatory disease

What is Systemic Lupus Erythematosus? Symptoms? Diagnosis? Treatment?

--- Autoimmune disease characterized by antinuclear antibodies • 2-5 cases per 100000 people annually; mainly disease of women; women of childbearing age account for 65%; African American women are more likely than Caucasians • Cause is unknown; risk factors: o Genetic predisposition and environmental, hormonal, and immunological elements o EBV antibody presence increases risk • Pathological process involves formation of autoantibodies • Glomerular damage --- Clinical symptoms: o Fever o Mylagias and arthralgias o Butterfly rash across bridge of nose and cheeks o Joint inflammation and musculoskeletal symptoms o Splenic enlargement o Pleural effusion o Vaculitis o Pericarditis o Anemia o Thrombocytopenia o Kidney is worst affected organ: nephrotic syndrome causing edema, hypertension, hematuria o Raynaud's phenomenon • Cold stimulates tricolor change in fingertips; blue-white-red o Accelerated ischemic coronary artery disease --- Diagnosis o History, exam, lab tests o A single test cannot diagnose; immunofluorescent ANA test; anti-dsDNA and anti-Sm antibody levels --- Treatment: o Nonsteroidal anti-inflammatory drugs (NSAIDs), antimalarial drugs, corticosteroids (short term), Methotrexate, immunosuppressive drugs

What is hyperkalemia? Symptoms? What does ECG show? Treatment?

--- Blood K+ level greater than 5.2 mEq/L --- Symptoms: o Numbness or tingling of extremities o Muscle cramping o Diarrhea o Apathy o Mental confusion --- ECG will show wide QRS complexes; tall, peaked T waves; cardiac arrest --- Treatment: o If severe, (greater than 7.0 mEq/L), rapid treatment is needed to move K+ from ECF to ICF o Continuous ECG monitoring necessary o IV 50% dextrose, 10 units of regular insulin, and 75 mEq of sodium bicarbonate o Furosemide (Lasix) o Calcium chloride or calcium gluconate (Kalcinate) o Sodium polystyrene sulfonate (Kayexalate) excretion via feces o If patient is in renal failure, dialysis can reduce K+.

What is hypomagnesemia? Most common cause? Symptoms?

--- Blood level of greater than 2.5 mEq/L --- Most common cause = kidney failure --- Symptoms: o Inhibits acetylcholine release and can cause diminished neuromuscular function o Hyporeflexia o Muscle weakness o Cardiovascular effects (eg, hypotension and arrhythmias) * Severely high Mg++ levels (greater than 10 mEq/L) can cause cardiac arrest.

What is hypophosphatemia? Symptoms?

--- Blood level of phosphate lower than 2.5 mg/dL --- Symptoms: o Tremors o Paresthesias o Hyporeflexia o Anorexia o Dysphagia o Muscle weakness o Joint stiffness o Bone pain o Osteomalacia

What is Hypercalcemia? Causes? Symptoms?

--- Calcium level greater than 10 mg/dL --- Causes: Hyperparathyroidism Cancer --- Symptoms: o Muscle flaccidity o Proximal muscle weakness of the lower extremities o Bone tenderness o Decreased neuromuscular activity of the bowel, causing constipation o High calcium concentrations in the urine, which increase susceptibility to renal calculi o Ventricular arrhythmias o Dulled consciousness o Depression o Anorexia, nausea, vomiting, and ulcers o Hyperreflexia o Tongue fasciculations

What are prions? How do they infect? Which kinds are untreatable and fatal?

--- Capable of causing brain diseases in animals and humans --- Resistant to human proteases and have the ability to confer this resistance to other proteins in human cells --- Believed that they enter neurons in the brain and convert existing proteins into prion-type protein; can cause spongiform encephalopathy, like mad cow disease and scrapie, human Creutzfeldt-Jakob disease through beef --- All spongiform encephalopathies are untreatable and fatal

What is Rheumatoid Arthritis? Symptoms? Diagnosis? Treatment?

--- Chronic autoimmune inflammatory disorder that affects joints and may have systemic effects • .5-1%; more common in females • Cause is unknown • Body's immune system attacks its own synovial tissues, destructing cartilage, bone, tendons, and ligaments • T cells are activated by APCs and secrete cytokines --- Clinical symptoms: o Symmeetrical, tender, swollen joints often after waking or resting --- Diagnosis: o Clinical criteria • Morning stiffness, polyarthritis, symmetrical arthritis, subcutaneous rheumatoid nodules for min. of 6 weeks o Tests • Elevated serum RF, ESR, and CRP; anti-citrullinated protein antibodies --- Treatment • NSAIDs, DMARDs, immunosuppressive drugs

What is Sjoren's Syndrome? Symptoms? Diagnosis? Treatment?

--- Chronic, autoimmune disease characterized by dry eyes, and dry mouth • Most common in women between 50-60; often suffer from RA too • Lymphocytic infiltration of many of the body's exocrine glands, mainly with T cells, B cells, plasma cells, and inflammatory mediators • Excess proliferation of lymphocytes, which interferes with glandular functions; main targets are salivary and lacrimal glands, but respiratory and GI involvement are also seen --- Clinical symptoms o Blurred vision o Burning and itching of eyes o Thickened secretions that can block tear ducts o Dry mouth makes swallowing difficult o Oral mucous membranes become cracked/fissured o Decreased ability to taste o Parotid gland enlargement --- Diagnosis o Autoantibodies are key characteristics o Biopsy of lip tissue to examine salivary glands o Lymph node enlargement with dysplastic B cells --- Treatment o Symptom relief and limitation of effects of xerostomia and keratoconjunctivits sicca o Replace tears

What are common shapes of bacteria? What is the difference between the membranes of Gram + and Gram -? What kind of medication can be used against both types?

--- Common shapes are cocci (found living unattached to each other in environment in clusters; or chains or duos) and bacilli; spirochetes --- Gram + : have a thick peptidoglycan rich cell wall that takes a purple color when stained --- Gram - : thin cell wall that contains fewer peptidoglycan and takes on a pink-colored stain --- A broad-spectrum antibiotic can be used against both types of bacteria

What is hypocalcemia? Symptoms? Key signs?

--- Consists of a blood Ca+ level lower than 8.7 mg/dL in adults --- Symptoms: o Paresthesias around the mouth, hands, and feet o Muscle spasms of the face o Laryngeal spasm o Seizures o Hypotension o Arrhythmias o Chronic hypocalcemia causes bone pain and fragility, dry skin and hair, cataracts, depression, and dementia. --- KEY SIGNS: o Neuromuscular irritability • Chvostek's sign: facial spasm • Trousseau's sign; carpal spasm

What are viruses? How do they infect?

--- Depend on a host cell's metabolic processes for their life cycle, and contain DNA or RNA genome surrounded by a protein coat --- Enter a human cell and reprograms infected cell to synthesize viral particles

What are 5 types of WBCs?

--- Granulocytes - contain cytoplasmic granules that contain important enzymes and inflammation mediators to fight infection oNeutrophils - (polymorphonuclear leukocytes (PMNs)) •in their immature form, they are called bands or stabs. •Neutrophils also have multisegmented nuclei and are sometimes known as segmented neutrophils (segs). o Eosinophils o Basophils Agranulocytes: *Lymphocytes *Monocytes (Macrophages)

What is hyperphosphatemia? Most common cause? It is usually accompanied by ____?

--- Hyperphosphatemia is a Po4- level of 4.5 mg/dL or greater in the blood. --- The most common cause of hyperphosphatemia is kidney failure. --- Hyperphosphatemia is usually accompanied by hypocalcemia, and many of its symptoms are related to low calcium levels.

What is immunization? Booster?

--- Immunization • A vaccine is a weakened virus. • It cannot cause disease; it has the genes for disease removed. • A vaccine is administered to the body and the body "thinks" it is an antigen. • The body then builds specific Igs against it. • Sometimes more than one dose is needed. • Example: hepatitis B vaccine (three doses) --- Booster • This is a repeated vaccine administered some time after the initial vaccine in order to "remind" the body to make immunoglobulins.

What are the two types of immunity?

--- Innate o The innate immune mechanism comes to the defense of the body first and immediately. o It is composed of the body's natural anatomical barriers, normal flora, white blood cells (WBCs), and protective enzymes and chemicals. o Macrophages phagocytize foreign debris and antigens. Interferons, cytokines, and hydrochloric acid are some of the protective enzymes and chemicals. o The Natural or innate mechanisms are protective mechanisms we were born with. o They are non-specific - - meaning they have had NO previous exposure to the antigen. o Inflammation is a critical component of natural immunity. o It represents the response of the microcirculation to all forms of acute tissue injury and does not require prior exposure to a pathogen. o Properidin and lysozyme and examples of proteins that mediate natural immunity. Properidin is a blood protein that can activate the complement system. o Lysozyme is an antibacterial coat protein found in tears and other bodily secretions. o Natural immunity (inflammation) is mediated primarily by segmented neutrophils (polymorphonuclear leukocytes), mast cells, natural killer cells, and macrophages. o Examples of Innate immunity include the protective proteins, the epidermis, phagocytic cells, neutrophils --- Adaptive o The adaptive immune system comes to the body's defense after the innate system. o A more specific form of protection, the adaptive immune line of defense is developed after exposure to antigens. o The adaptive immune mechanisms act rapidly, specifically, destructively, and with memory for every individual antigen it has encountered. • Acquired Immunity o Acquired immunity is based on a specific response elicited by substances that act as antigens. o Acquired Immunity is pathogen specific and requires previous antigen exposure! So, what is an antigen? o An antigen is any substance that elicits an immune response to foreign elements that enters the body. o The body has to be able to differentiate "self" (what is suppose to be present) from "non-self" (what is foreign to the body) o Acquired immunity is based on the reaction of the immune system but also involves other cells (auxiliary [helper] cells), such as macrophages, basophils, and eosinophils. o Acquired immunity is primarily mediated by B and T lymphocytes

What are the body's defenses? (immunity)

--- Innate immunity o Barriers include skin, mucous membranes, phagocytic cells, ciliated cells, mediators of inflammatory reaction. o Nonspecific mechanisms that defends the body against all types of pathogens immediately o First level of defense against invasion by pathogens consisting of anatomical barriers, antipathogenic chemicals, and cellular reactions; intact epithelial surfaces of the skin, respiratory, GI, and Genitourinary tracts o An acute inflammatory reaction is triggered when the innate immune system is stimulated --- Adaptive immunity o Sensitized T lymphocytes and B lymphocytes which have memory for specific antigens o Developed with exposure to antigens and targets precise pathogens o Second line of defense; requires more time to respond o The needed lymphocytes are produced in thymus and bone marrow

3 types of body cells based on ability to regenerate? Examples?

--- Labile o Continually divide and replicate throughout life, replacing cells that are constantly eliminated. o Ex.: skin, hair, nails, oral mucosal cells, gastrointestinal mucosal lining cells, and genitourinary mucous membrane cells; in addition, bone marrow is continuously active as it synthesizes blood cells. o Ex. Cancer cells are considered labile cells because they are constantly dividing. --- Stable o In a resting stage until stimulated, when they then enter the cell cycle. o Ex.: bone cells and hepatocytes. Both kinds of cells require major stimuli to enter the cell cycle, undergo mitosis, and regenerate. --- Permanent o Permanent cells cannot regenerate and therefore do not enter the cell cycle. o Neurons and cardiac myocytes are considered permanent cells that do not undergo mitosis and have lost the ability to proliferate. o Adult "stem cells" can be stimulated to regenerate permanent cells.

What is Lyme disease caused by? How does it happen? Incubation period? Symptoms? Treatment?

--- Lyme disease is caused by a bacterial spirochete called Borrelia burgdorferi (B. burgdorferi), a microorganism found in forest animals such as squirrels, rodents, and the white-tailed deer. --- A tick that feeds off one of these animals can harbor the microorganism. Neither the reservoir (deer) nor vector (tick) becomes ill because of the microorganism. • Deer ticks are no larger than the point of a pencil, and the infected individual frequently cannot remember being bitten. --- Incubation period of 3 to 32 days, a rash known as erythema migrans begins as a painless red macule that expands slowly to form a targetlike lesion. --- Symptoms o Rash followed by headache, mild stiffness of the neck, fever, chills, migratory musculoskeletal pain, arthralgias, and extreme fatigue. o Cranial neuritis; inflammation of the facial nerve causes one side of the face to be paralyzed—a condition called Bell's palsy. o The patient exhibits a one-sided facial droop when smiling and is unable to close the eye on the affected side. o Months later, 60% of patients develop arthritis, usually of the large joints, particularly the knees. --- Treatment o Oral antibiotic regimens may require treatment for 30 to 60 days, whereas intravenous regimens may be needed for only 14 to 28 days.

What are fungi? What are types that infect hair/skin/nails?

--- Moldlike organisms that can live on human tissue and cause infectious disease; fungal infections (mycoses) are classified as superficial or deep infections --- Dermatophytes (ringworm) are fungi that cause superficial infections involving hair, skin, or nails --- Systemic mycoses like candida albicans can cause fatal infection

How does maternal-fetal transmission happen? What is congenital infection?

--- Pathogens invade maternal bloodstream and placenta and pass into fetal circulation --- Maternal infection can be transferred during childbirth o Congenital infections

What is wrong with patients with COPD? What occurs? What can develop from it?

--- Patients with COPD have high CO2 in the lungs; their lungs cannot expel CO2 adequately. •Consequently, COPD patients are Hypercapneic and are susceptible to Acidosis. >CO2 + H2O ---> H2CO3 ---> H+ + HCO3- •H+ accumulates. •Respiratory acidosis can develop.

Healing skin wounds occurs by one of these 3:

--- Primary intention o A clean laceration that requires simple re-epithelialization when edges are approximated o Example: surgical laceration --- Secondary intention o A wound with a large gap in tissue; some of the tissue has been gouged out. o Example: decubitus ulcer --- Tertiary intention o A wound with a large gap of missing tissue that has been contaminated and needs a drainage tube while healing

Characteristics of Severe Combined Immunodeficiency

Both B and T cell lines affected Diagnosis usually occurs by 3 months X-linked is the most common form

What happens in the Acid-base chemical equation? How do lungs increase CO2 in blood? How do they decrease CO2?

CO2 + H2O <---> H2CO3<---> H +HCO3- • H+ ion is VERY STRONG ACID. • HCO3- is a WEAK BASE and cannot counteract H+. • Increasing CO2 pushes the equation toward the right and raises strong acid content of blood. •How do lungs increase CO2 in blood? --- It increases through hypoventilation or slowed breathing. •How do lungs decrease CO2 in blood? --- It decreases through hyperventilation; decreases CO2.

May was diagnosed with COPD 7 years ago. She presents with rapid respirations, cyanosis, and tachycardia. She recently had an upper respiratory infection. Her blood pH is acidic. Medical intervention, including respiratory stimulants and bronchodilators, helps stabilize May's breathing and arterial blood gases. Blood pH returns to the normal range. May's symptoms, lab findings and history point to ______________________.

Compensated Respiratory Acidosis

Mitchell has type 1 diabetes. He arrives in the emergency room with tachycardia, Kussmaul respirations, and a fruity acetone smell to his breath. His body works to adapt to the changes brought on by his current condition, and with medical intervention, arterial blood gases reveal a normal pH value at this time. Mitchell's symptoms, lab findings and history point to ______________________.

Compensated metabolic acidosis

While working in the emergency room, you are called to help a patient named Frank who believes he is having a heart attack. He states that his heart rate "feels different." He states also that his fingers feel as if they are going numb. The results of a preliminary ECG show wide QRS complexes; tall, peaked T waves; and bradycardia. Blood analysis reveals metabolic acidosis, with elevated ketones. This is most likely due to Frank having type 1 diabetes. Frank is also being managed for diabetic nephropathy and shows decreased renal function. What electrolyte abnormality due would account for Frank's ECG results? Hypernatremia Hyperkalemia Hypokalemia Hypercalcemia Hypophosphatemia

Hyperkalemia - Early symptoms of hyperkalemia include numbness or tingling of the extremities, muscle cramping, diarrhea, apathy, and mental confusion. The ECG will show wide QRS complexes and tall, peaked T waves. As the potassium level rises, the ECG will show bradycardia, irregular pulse rate and, ultimately, cardiac arrest.

A young male arrives at the emergency department having suffered a severe traumatic brain injury. To reduce swelling of the brain's cells, a __________________ IV solution is administered.

Hypertonic

Recall Louise complained about tingling around her mouth and in her fingers and muscle spasms. Based on Louise's symptoms, what electrolyte imbalance do you suspect? Hypokalemia Hyperkalemia Hypocalcemia Hyponatremia

Hypocalcemia - The signs and symptoms of hypocalcemia include neuromuscular excitability, which can be demonstrated as paresthesias around the mouth, hands, and feet; muscle spasms of the face, hands, and feet; laryngeal spasm; seizures; and death.

John is a 41-year-old sales manager. A routine ECG on John shows a prolonged PR interval and smaller than normal T waves. When he stands up from bed, he complains of dizziness. His medical history indicates that orthostatic hypotension is a concern. John has been in poor health for some time. He has heart failure and is currently taking digitalis and a diuretic to manage his condition. He admits his diet is poor. He consumes mainly processed, fast foods. Lately, John states he has been experiencing muscle weakness and feels more tired than usual. He is frequently awakened at night with leg cramps. He also complains of difficulty breathing, especially at night. He states that he needs to prop himself up with two to three pillows. What electrolyte imbalance do you suspect? Hypernatremia Hypocalcemia Hyponatremia Hypomagnesemia Hypokalemia

Hypokalemia CORRECT. The two keys pointing to hypokalemia in this case are the abnormalities observed with electrocardiography and the usage of diuretics. Hypokalemia alters the resting membrane potential of cells, causing hyperpolarization. Flattened, smaller T waves appear on ECG's as repolarization is delayed. Hypokalemia may develop with the use of diuretics. For some diuretics, the mechanism of action is a reduction in ion reabsorption, which also reduces water reabsorption, increasing urine output. John's symptoms, such as leg cramps, provide further support that hypokalemia may be present.

Leslie, a 42-year-old woman, was admitted into the emergency room after completing 32 of 50 miles in an ultramarathon. The medical team brought her to ER after noticing her movements were uncoordinated and she was confused about her surroundings. They report that she had difficulty speaking. She complained of nausea but denied vomiting. She was clutching her calf muscle as it contracted in a spasm. ECG results were normal. Blood chemistry values showed a key electrolyte imbalance, and treatment began. After stabilization, she told you that she had been doing "fine" during the race. It had been hotter than she expected, so she had made certain to hydrate and drank a "ton" of water. She did not feel like consuming food or other nutrients during the race. What electrolyte imbalance do you suspect? Hyponatremia Hypercalcemia Hypokalemia Hypermagnesemia Hypophosphatemia

Hyponatremia - One of the concerns with an event such as an ultramarathon is keeping fluid and electrolyte levels within the normal range. In Leslie's situation, the fact she drank a "ton" of water without significant electrolyte replacement through food, beverages, or tablets, would lead you to be concerned about diluting plasma concentrations of electrolytes, particularly sodium. Her symptoms, such as confusion and muscle cramps, point to hyponatremia.

What are immunocompetence and immunosuppression?

Immunocompetence - an individual's ability to protect oneself from infectious agents because of a strong immune system Immunosuppression indicates that there is a defective immune system that is placing a person at risk for infections

What is Digitalis Toxicity?

In hypokalemia, there are open binding sites for K+ in the heart; digitalis binds to these open sites * When a high number of binding sites become occupied by digitalis, there is an increased potential for digitalis toxicity * Diuretics and digitalis are often prescribed together in heart failure - K+ levels and Digitalis level need to be frequently monitored in heart failure!!! * Diuretics commonly cause hypokalemia * Hypokalemia causes increased binding of digitalis in heart, which increases susceptibility of digitalis toxicity * This is demonstrated as arrhythmias

What is the difference between incidence and prevalence?

Incidence: number of new cases of infection within a population Prevalence: number of active ongoing cases of infection at any given time

Which action contributed to this imbalance? Select all that apply. Increased sweating Being above age 40 Running over 20 miles Increased fluid intake Lack of electrolyte intake

Increased sweating, increased fluid intake, lack of electrolyte intake - Leslie is experiencing hyponatremia because she was over-hydrating without taking in enough food or nutrients during the race, including sodium, which she was sweating out due to the physical exertion experienced during the ultramarathon. This resulted in the sodium in Leslie's system diluting to the point that she began to experience dilutional hyponatremia.

Select the signs and symptoms that are associated with this electrolyte imbalance. Select all that apply. Leg cramps Dyspnea Prolonged PR interval Flattened T waves Orthostatic hypotension

Leg cramps, prolonged PR interval, flattened T waves - The major signs and symptoms of hypokalemia include anorexia, nausea, vomiting, sluggish bowel, cardiac arrhythmias, postural hypotension, muscle fatigue, and weakness. Leg cramps are common and, in severe hypokalemia, respiratory muscles can be weakened. On ECG, there is a prolonged PR interval, flattened T wave, and prominent U wave.

What is edema? How do we measure? What can cause it?

Occurs when there is an excess of fluid in the ISF and ICF compartments Measured in mm. •Can occur because of elevated hydrostatic pressure created by excess water in bloodstream or diminished osmotic force created by a low amount of solutes in the bloodstream •Can occur from inflammation which can cause increased capillary permeability •Can occur from hypoalbuminemia - low albumin oLow oncotic pressure is lower than the hydrostatic pressure at the capillary membranes •Can occur because of a low amount of solute in the bloodstream

What is Scleroderma? Symptoms? -- Diagnosis? Treatment?

Powerpoint: • Immune complexes deposit in skin and connective tissues --- Clinical symptoms: o Skin looks stretched and tight o No wrinkles Extra: --- systemic sclerosis; chronic autoimmune disease characterized by abnormal accumulation of fibrous tissue in the skin and various organs • Skin is most noticeably affected, but GI tract, kidneys, muscles, and lungs can be too • 40000-165000 people in US are affected; women between 30-50 are most affected; more often in African Americans • Cause is unclear, but there are numerous gene mutations associated, and exposure to toxic substances • Inflammatory reaction with injury to endothelial lining of blood vessels o Some people develop CREST syndrome, a type of scleroderma o Raynaud's phenomenon - vasoconstrictive disorder of the extremities that causes fingers and toes to become ischemic Symptoms: o Muscle aches, joint pain, swelling with limited ROM o Most noticeable is shiny skin, smooth, and stretched in appearance, particularly on face and hands o Facial masklike appearance with loss of normal wrinkles and nasolabial folds o Skin on hands can become so stiff to cause contractures o Dysphagia is common as disorder continues o Abdominal pain, intestinal obstruction, and malabsorption with weight loss and anemia Diagnosis: o Spirometry, chest x-ray, electrocardiogram, echocardiogram, 24 hour holter monitoring when it is widespread Treatment: o Currently no specific treatment o NSAIDs, corticosteroids, immunosuppressant agents

Ch. 9 John, age 37, appears at your clinic complaining of pain and soreness in his knee. Several days prior, John had undergone shoulder surgery to repair a tear in the medial meniscus. The surgical laceration is considered a _________________ intention.

Primary - In a primary intention, the wound edges are close together and scarring is minimal. In a secondary intention, the wound is allowed to granulate, and wound care is needed daily. The wound may be packed with gauze or allowed to drain. In tertiary intention, delayed wound closure often results in significant scarring.

Peter has been experiencing headache, tinnitus, vertigo and nosebleeds. Blood laboratory results reveal a hemoglobin level of 18 g/dL and a hematocrit level of 55%. White blood cells and platelets are also elevated. Erythropoietin is low. What condition is consistent with these findings?

Primary polycythemia

What are immunoglobulins (antibodies) and the 5 types?

Responsible for neutralizing bacterial toxins, attacking viruses, promoting phagocytosis of bacteria, and activating and reactivating the immune response 2 phases of responding to antigen: • The primary phase occurs when the host cell is exposed to an antigenic invader and proliferation of immunoglobulins to neutralize the invader. The primary immunoglobulin IgM marks the primary response. • A second exposure to the same antigen initiates a secondary immune response, known as an amnestic response, that stimulates a quick increase in levels of IgG immunoglobulins. • 5 major classifications with a particular purpose o A - in secretions including breastmilk, saliva, tears o E - come up with allergic reactions (bee sting, nut allergy) • is secreted by sensitized cells o D - not an allergic reaction but sensitivity to something; hypersensitivity (laundry detergent on skin); binds to basophils and mast cells; 1% of Igs • is cell membrane associated and serves a receptor of early B-cell activation; it regulates B lymphocyte activation and suppression • IgD is found exclusively on B cells. IgD is NOT released into serum (blood stream) or body fluids! o IgM - the largest immunoglobulin whose function is to neutralize microorganisms and dominant a primary responses. IgM antibodies provide a first line of defense against bacterial polysaccharides. IgM is the first immunoglobulin to appear after an immunization! IgM is also a natural antibody against blood group antigens ABO. • IgM are large antibodies that increase in bloodstream after first exposure to an antigen; developed by mother against fetus's blood cells o IgG - is an opsonin! meaning it coats bacteria! It dominates a secondary immune responses in the largest amounts. They are efficient at activating complement and targeting pathogens for phagocytosis. The fact that IgG is an opsonin allows macrophages to phagocytose bacteria efficiently! Even in a newborn who isn't able to produce antibodies because their immune system is not mature!

Ch 12 Characteristics of Non-Hodgkin's Lymphoma

T, B, or NK cells involvement Lymph node enlargement Thrombocytopenia Over 20 different forms

Annie, an older woman who works as an accountant, presents to the clinic with the complaint that her hands "really hurt" while entering data into the computer because of the damage to her joints caused by rheumatoid arthritis. Annie's fingers have a splayed appearance that can understandably make typing difficult. Damage to the joints of the fingers and hand are the result of immune complex deposition in the joint tissues. What type of hypersensitivity that Annie is experiencing?

Type III

Carl has type 1 diabetes and has arrived in the emergency room with tachycardia, Kussmaul respirations, and a fruity acetone smell to his breath. His blood pH measures in the acidic levels. Carl's symptoms, lab findings and history point to ______________________.

Uncompensated metabolic acidosis

Lily is a four-year-old girl, who has been experiencing severe vomiting for the past 3 days. Vital signs reveal a slightly elevated heart rate with slow respirations. Her blood pH is elevated. Lily's symptoms, lab findings and history point to ______________________.

Uncompensated metabolic alkalosis

Ch. 8 Karen presents with rapid respirations, cyanosis, and tachycardia. She recently had an upper respiratory infection and was diagnosed with chronic obstructive pulmonary disorder (COPD) 5 years ago. Her blood pH is acidic. Karen's symptoms, lab findings and history point to ______________________.

Uncompensated respiratory acidosis

What is Varicella Zoster? Herpes Zoster?

Varicella Zoster - Chicken pox • Blisters are transudate, water-filled • Goes to nerve roots after it happens, and can come back as shingles o Typically one-sided and in one area • The triad of rash, malaise, and low-grade fever are typical signs. • The characteristic chickenpox vesicle, surrounded by an erythematous halo, is described as a "dewdrop on a rose petal." • Small, erythematous macules often first appear on the scalp, face, trunk, and proximal limbs, with rapid sequential progression over 12 to 14 hours to papules, clear vesicles, and pustules, with subsequent central umbilication and crust and scab formation. Herpes Zoster (Shingles) • A reactivation of the varicella zoster virus that remains dormant in the sensory spinal neurons • Painful vesicles

Which of the following statements is correct? *Water in the body can only move from intracellular fluid (ICF) to extracellular fluid (ECF), not ECF to ICF. *Water is repelled by albumin. *Water is attracted to sodium. *Water cannot cross the plasma membrane. *Water movement is unaffected by solute concentration.

Water is attracted to sodium.

A nurse is assessing a child with a pollen allergy for allergic rhinitis. Which clinical manifestation would the nurse expect to find?

Watery eyes/rhinorrhea

What is diffusion? What is Osmosis? What is facilitated transport? What is active transport?

What is diffusion? ---o Molecules passively spread from high concentration to low concentration. Water and electrolytes diffuse from high to lower until an equilibrium is reached What is Osmosis? ---o Molecules of a solvent pass through a semipermeable membrane from low to high concentration for an equilibrium o Electrolytes and water move through the cell's semi-permeable plasma membrane, but large proteins like albumin cannot pass through What is facilitated transport? ---o Passing of certain molecules through plasma membrane with help from carrier proteins. o Ex.: Glucose undergoes facilitated transport into the cell by the carrier protein insulin What is active transport? ---o Occurs when a substance requires energy to pass through a membrane against a concentration gradient o Sodium Na+ and Potassium K+ require active transport using the pump, which is within the plasma membrane, to retain K+ as the major intracellular ion and sodium and the extracellular; sodium is a solute that draws water with it

What is metabolic acidosis? When can it occur? Causes? Clinical manifestations? Physical Assessment findings? Body's attempt at compensation? Medical intervention needed? What do arterial pH and blood bicarb decrease to?

What?: --- An abnormal accumulation of acids OR abnormal loss of bases --- It can occur in lactic acidosis, ketoacidosis of diabetes, renal failure causing acid waste buildup, or diarrhea or vomiting with loss of bicarb (pancreatic HCO3- is lost with prolonged, severe vomiting or diarrhea). --- Causes: o Increased Noncarbonic Acids: • Diabetic ketoacidosis • Lactic acidosis • Alcoholic ketoacidosis • Uremic acidosis • Ingestion of toxic substances (antifreeze, aspirin) • Intestinal, biliary, or pancreatic fistulas • Hypocalcemia, hypokalemia, or hypomagnesemia o Bicarbonate Loss • Prolonged diarrhea • Renal tubular acidosis • Interstitial renal disease • Ureterosigmoid loop • Ingestion of acetazolamide or ammonium chloride --- Clinical manifestations: Kussmaul's breathing (deep rapid respirations), disorientation, coma, dysrhythmias, hypotension o Neurological: headache, drowsiness, confusion, seizures, fatigue, twitching, coma o GI: nausea, vomiting, anorexia --- Physical Assessment Findings: o Weak pulse, tachycardia, hypotension, arrhythmia, GI pain/vomiting, dehydration, confusion, lethargy --- The body's attempt at compensation: the lungs will try to blow off CO2; however, the lungs can only increase the ventilatory rate so much. --- MEDICAL INTERVENTION needed: IV bicarb •Arterial pH decreases to lower than 7.35. •Blood bicarb (HCO3-) is decreased to lower than 22.

What is respiratory alkalosis? Causes? Clinical manifestations and clinical presentation? Physical assessment findings? What is the body's attempt at compensation? What medical intervention is needed? What is PCO2? What is blood pH?

What?: Loss of CO2 from lungs faster than is produced by cells; can be caused by breathing too fast (as in anxiety, hyperventilation, pneumonia) --- Causes: o Pulmonary: • Pneumonia • Pulmonary edema • Pulmonary embolus • Asthma • Lung disease with shortness of breath (asthma, pneumonia, ARDS, fibrosis, pulmonary embolism) • Hypoxia with hyperventilation • Overventilation by mechanical ventilation o NonPulmonary: • Anxiety • Pain • Liver disease • Fever/infection/sepsis • Central nervous system disorders (tumors, cerebrovascular accidents) • Salicylate intoxication • Alcohol intoxication --- Clinical manifestations: feeling lightheaded, paresthesias, altered consciousness, muscle spasms --- Clinical Presentation o The CNS and Peripheral nervous systems are stimulated, which causes tingling of extremities o Muscle cramps o Tetany o Dizziness/syncope o Confusion o Anxiety o Seizures o Coma o Cardiac symptoms: palpitation, dysrhythmias, hypotension --- Physical Assessment Findings o May have pulmonary disease and have signs like crackles and rhonchi; cyanosis if hypoxic o Focal neurological signs or depressed level of consciousness o Cardiac rhythm disturbances • The body's attempt at compensation: kidneys attempt to reabsorb maximum H+ and excrete HCO3-. --- MEDICAL INTERVENTION is needed: decrease client's breathing rate, increase CO2 (CO2 rebreathing) •Pco2 < 35 mm Hg •Blood pH > 7.45

What is respiratory acidosis? What are clinical manifestations/what do patients complain of? What are physical exam findings? What are causes? What is the body's attempt at compensation? Because the kidney takes hours to days to do this, what medical intervention is needed?

What?: Occurs when the body accumu- lates too much CO2 or cannot exhale sufficient CO2 (hypercapnea) --- Clinical manifestations: cyanosis, shallow or labored breathing, disorientation, dysrhythmias --- Patients complain of: oAnxiety, restlessness, headache, lethargy, fatigue, shortness of breath, rapid breathing, cough oAdvanced leads to confusion, somnolence, possible coma --- Physical Exam findings: oObstructive lung disease; diffuse wheezing; hyperinflation of lungs; barrel-shaped chest in emphysema; decreased breath sounds; hyperresonance on percussion; prolonged expiration oCyanosis and clubbing may indicate chronic hypoxia --- Causes: o Pulmonary: • Chronic obstructive lung disease (asthma, emphysema, bronchiectasis) • Pulmonary edema • Pneumonia • Airway obstruction • Underventilation by mechanical vent. • Hypoventilation • Excessive fatigue or weakness of rib cage muscles • Cystic Fibrosis o NonPulmonary • Overdosage of anesthetic, sedatives, and narcotics • Neuromuscular disorders, such as Guillain Barré, myasthenia gravis, and advanced multiple sclerosis • Severe spinal deformities • Central nervous system depression related to cerebral infarct, meningitis, or trauma • Cardiopulmonary arrest --- The body's attempt at compensation: kidneys attempt to reabsorb HCO3- and excrete H+. --- MEDICAL INTERVENTION is needed: intubation; mechanical ventilation.

What is metabolic alkalosis? What are causes? Clinical manifestations/presentation? Physical assessment findings? Body's attempt to compensate? What other disease can occur with it? Since the lungs can only slow down breathing so much, what medical intervention? What are plasma bicarb and arterial pH?

What?: Results from a loss of H+ or an addition of base to body fluid •Caused by excess bicarb ingestion, post code excess bicarb IV, or vomiting of excess gastric acid --- Causes: o Bicarbonate ingestion o Excess IV sodium bicarbonate o Potassium wasting diuretics o Loss of gastric fluids from vomiting, gastric suction- ing, diarrhea, or binge-purge syndrome o Cushing's syndrome o Primary hyperaldosteronism o Secondary hyperaldosteronism --- Clinical manifestations: dysrhythmias, paresthesias, lightheaded, muscle weakness --- Clinical Presentation o Confusion o Dizziness o Agitation o Weakness o Vomiting o Diarrhea o Seizures --- Physical Assessment Findings o Can cause changes in K and Ca electrolyte levels • Hypokalemia can cause muscular weakness, myalgia, muscle spasms, and cardiac arrhythmias --- The body's attempt to compensate: the lungs attempt to retain CO2 by decreasing the rate of respiration; breathing is slowed. --- If too much base or not enough acid is in the blood, the kidney attempts to retain as much H+ as possible; the kidney will REABSORB H+ instead of its usual K+. --- Therefore, HYPOKALEMIA occurs with metabolic alkalosis. --- MEDICAL INTERVENTION is needed: administration of IV DIAMOX (enhances kidney excretion of bicarb), administration of KCL, or sometimes a mildly acidic solution is needed IV. •Plasma bicarb is greater than 26. •Arterial pH is greater than 7.45.

What is a nosocomial infection, and why can they be difficult to treat?

infection caused by microorganisms in the hospital; may be difficult to treat because they are often caused by antibiotic-resistant bacteria

What is septicemia?

infection of the bloodstream

What is histamine? What mediators stimulate its release? What are consequences of histamine released in upper respiratory tract?

inflammatory mediator released from basophils, platelets, and mast cells. • Physical injury, immune reactions, cytokines, and other inflammatory mediators stimulate histamine release. • Sneezing, rhinorrhea (runny nose), eye tearing, sinus inflammation, and pharyngeal irritation are consequences of histamine released in the upper respiratory tract.

What is active acquired adaptive immunity?

obtained through exposure to an antigen or through immunization (vaccine). The patient's body has to synthesize specific immunoglobulins against an antigen. • Either the patient contracts a disease and develops Igs and then recovers or the patient is given a vaccine. • Both endow long-term immunity.

Cecilia has a known severe allergic reaction to bee stings. While at a family picnic, a bee stung Cecilia on her right upper extremity. Her husband immediately administered EpiPen injection, while others called for assistance. Cecilia is transported to the emergency department via ambulance. She presents with severe dyspnea, laryngeal swelling, and hypotension. Cecilia is experiencing _____________________.

systemic anaphylaxis - Anaphylaxis is a systemic allergic response, usually occurring within seconds or minutes of exposure to the allergen. In this case, the bee sting precipitated a massive release of chemical mediators that resulted in swelling of the throat and difficulty breathing. The use of the EpiPen counteracts this response, as epinephrine dilates airways and helps to maintain blood pressure.

What is alkalosis and pH value?

• A decrease in the H+ concentration of the body fluids OR an excess of HCO3- resulting in an increase in pH greater than 7.45.

What is a base? Does it give or take a H+?

• A negatively charged particle looking to associate with an H+ • Also known as an alkali • A hydrogen acceptor

Leukocytosis/Leukemoid/Leukopenia

• A rise in WBC count above 11,000/uL is called leukocytosis. • A leukemoid reaction is leukocytosis in excess of 50,000/µL caused by conditions other than leukemia. • A decrease in WBC count below 4,000/uL is leukopenia, which is a general term that describes a decrease in all types of WBCs. o Leukopenia increases the risk of infection, decreases signs of infection, and diminishes healing ability. o Filgrastim (NeupogenR) is a stimulant of the bone marrow that can increase leukocyte synthesis, specifically neutrophils.

What is an acid? Does it give or take a H+?

• A substance that dissociates or ionizes into a H+ ion and an anion (negatively charged particle) • A hydrogen donor

What are Arterial Blood Gases? (ABGs) What is the chemical equation that occurs in the bloodstream?

• ABGs are primarily the concentrations of oxygen and carbon dioxide in the bloodstream. • CARBON DIOXIDE is involved in calculation of blood pH and HCO3- concentration. --- In the bloodstream, the following CHEMICAL EQUATION occurs: --- CO2 + H2O ßà H2CO3 ß-à HCO3- + H+

What is the relationship between calcium and albumin?

• About half of the calcium in the body is bound to albumin. • Hypoalbuminemia can cause the appearance of low calcium levels called pseudohypocalcemia.

What is albumin?

• Albumin is the main colloidal protein in the bloodstream • Is essential for maintain the oncotic pressure in the vascular system • Albumin attracts water and helps keep it inside the blood vessel.

Where do cells/lymphocytes come from?

• All cells of the immune system come from the hematopoietic stem cells found in bone marrow. However, they may mature in different areas! • All lymphocytes come from bone marrow pre-lymphoid stem cells. Some of them stay in the bone marrow to mature, others migrate to the thymus to mature.

What are Amebiasis and Giardiasis?

• Amebiasis and giardiasis are both waterborne protozoan infections contracted by consuming contaminated food or water containing the cyst stage of the parasite. • Amebiasis is caused by the protozoan parasite Entamoeba histolytica. • Giardiasis is caused by Giardia lamblia. • The trophozoite form of the protozoan (motile organism) is responsible for the clinical syndrome referred to as dysentery. • This syndrome is associated with nausea, vomiting, intense abdominal pain, tenderness, and copious diarrhea of watery stool, sometimes with blood

What is tonicity? Definition only.

• Amount of solutes in solution compared with the bloodstream; or, various IV solutions in clinical setting,

What are 6 agents of bioterrorism?

• Anthrax • Plague • Smallpox • Botulism • Tularemia • Ebola hemorrhagic fever, Marburg hemorrhagic fever

What is an antibody titer?

• Antibody screening tests, referred to as antibody titers, are laboratory tests used to confirm adequate immune protection against a particular antigen by measuring IgM and IgG immunoglobulins. • Because IgM is the immunoglobulin that responds first in infection, elevated IgM levels indicate a recent or current infection. • IgG is a secondary responder, which means that levels rise after a second exposure to an antigen. IgG levels indicate prior exposure and immune competence to a particular antigen.

B and T Lymphocytes

• B lymphocytes mature to an extent in bone marrow and then develop into plasma cells, which are antibody-producing cells, within lymphoid tissue. o Produce immunoglobulins • T lymphocytes continue the maturation process mainly within the thymus gland, where they become T helper (CD4) and cytotoxic T cells (CD8) and then move into lymphoid tissue for proliferation.

What 3 lab tests can indicate inflammation?

• C-reactive protein (CRP) • Erythrocyte sedimentation rate (ESR) • Leukocytosis (high WBC count)

What is Clostridium difficile? Most common predisposing factor?

• C. difficile is a spore-forming, toxin-secreting anaerobic bacteria. • The organisms emit toxins that disrupt the intestinal mucosa, erode the intestinal epithelial cells, and form pseudomembranes that contain necrotic tissue, white blood cells (WBCs), and mucus. • The most common predisposing factor is long-term antibiotic use because of consequent alteration of the normal flora in the gut. • Contagion between patients is possible; this is a source of nosocomial infection.

What is Candida albicans? Risk factors?

• Candida fungus: normal flora • Candida albicans: found in the gastrointestinal and vaginal tracts. • Candida becomes pathogenic when an overgrowth of the Candida fungus occurs, commonly causing superficial diseases. • An immunocompromised host can develop widespread dissemination of Candida within the body, which can then progress to overwhelming sepsis. • Risk Factors o Risk factors: antibiotic use, diabetes, HIV, steroids, oral contraceptives o Thrush o Esophageal infection o Vulvovaginitis o Balanitis

What is HIV? Diagnosis? Routes of Transmission? Seroconversion?

• Causes an acute infection syndrome usually followed by a lengthy asymptomatic period • classified as an RNA retrovirus • Can advance to AIDS without treatment • Up to 1.1 million people infected annually in US • Mainly infects CD4 cells (helper T) (involved in both humoral and cell-mediated immune reactions) • Reverse transcriptase enables HIV to utilize CD4 cell machinery for replication • After contraction, it presents like the flu • Diagnosis o HIV RNA assay is earliest and most sensitive test; measures how much virus is in bloodstream o Test for HIV antibody = ELISA/Western Blot Test • Formation of antibody takes a prolonged time, 2 weeks-6 months • Routes of Transmission o Sexual activity, semen/vaginal secretions o Blood o Transplacenta o Breast milk o Organ transplants o Saliva into open mouth wounds • Window period = time from contraction of virus to antibody development; seronegative during this time; ELISA test neg. • Seroconversion o Antibody negative status à antibody positive status o On average, occurs between 2 weeks to 6 months.

T lymphocytes:

• Cell mediated immunity • CD cells come from thymus • Again, T cells have what we call TCR or antigen surface markers. This surface marker expresses the "cluster differentiation" marker known as the CD -antigen marker. o Twice as many 4's as we do 8's o CD 4's - helper T cells • Usually have around 1200, when number hits 200 HIV is diagnosed • The CD4 cell influences all other cells of the immune system, including other T cells, B lymphocytes, macrophages, and NK cells. The CD4 cells are involved in cell-mediated immunity and also assist in antibody-mediated adaptive immunity. • They predominate in peripheral blood and secrete interleukins, which help coordinate immune responses. • secrete cytokines which stimulate B cells to mature into plasma cells, which begin to synthesize and secrete immunoglobulin • o CD 8's - Killer cells (cytotoxic T cells) • Directly attacks an antigen • They participate in immune surveillance and kill foreign and virally infected cells. • There are also Natural Killer (NK) cells. These cells do not have the T-cell receptor. Since they do not have TCR markers, they basically circulate in the blood stream and react against viruses that enter into the body. • CD8 - receptor proteins bind to surface of invading organisms. Release enzymes that disrupt cell membrane cause cell to lyse and die, regulate the immune response. Also suppress unwanted antibody production

How do we sense respiratory demands of the body? 3 ways.

• Chemoreceptors in blood vessels - responsive to CO2 in blood • Respiratory center in MEDULLA stimulated by CO2 accumulation in blood • Major stimulus for inhalation = CO2 concentration in blood

Reed-Sternberg cells in Hodgkin's Lymphoma

• Classic HL is diagnosed by the presence of RS cells in the lymphoid tissue. • The RS cell is a large malignant B cell with two nuclei that give the cell the appearance of owl's eyes. • Remember: HL develops from abnormal B lymphocytes so RS cells are B lymphocytes that are malignant! If RS cells are present, the person has HL!

What is Erythema Infectiosum? (Fifth Disease)

• Common childhood viral exanthem caused by human parvovirus B19. • Erythema infectiosum is spread primarily via droplet infection during this period. • The prodromal phase may include headache, low-grade fever, pharyngitis, and malaise. • Classic skin rash follows within 3 to 7 days. The facial skin develops a classic slapped-cheek appearance that may appear like a sunburn and typically fades over 2 to 4 days.

What is Rheumatic Heart Disease

• Condition involving development of a heart murmur • An immune reaction occurs; antibiodies developed against GABHS mistakenly attack heart valve tissue and cause valvular deformities

How much does a diet low in NaCl consist of? When are low Na+ diets recommended?

• Consists of fewer than 1500 mg per day • Low Na+ diets recommended in hypertension and heart failure

What is DTP/DPT? Vaccination?

• Corynebacterium diptheriae • Bordetella pertussis • Clostridium tetani o Tetanus is a neurological disorder caused by Clostridium tetani (C. tetani), a toxin-producing, spore-forming anaerobic bacteria. o C. tetani is found in soil and its spores can survive for many years. o Tetanus infection can occur after a penetrating injury such as a puncture wound or laceration. o C. tetani toxin blocks inhibitory neurotransmitters, causing hyperactivity of neurons. o Infected persons have muscle spasms (tetany), particularly in masseter muscles and jaw = lockjaw. --- Adults should receive Tdap vaccination every 10 years because it offers the best prevention against pertussis, tetanus, and diphtheria. o Tdap = tetanus and diphtheria toxoids with acellular pertussis

Symptoms of Fluid Volume Deficit?

• Dark urine with high specific gravity • Depressed fon tanelles (infant) • Dry mucous membranes • Low urine output • Orthostatic hypotension • Poor skin turgor • Thirst • Weight loss

What is Epstein Barr Virus (EBV)? What does it infect?

• EBV infection = infectious mononucleosis, a common infection of adolescents and young adults. • By adulthood, more than 90% of individuals have been infected with EBV and have developed antibodies to the virus. • Among adolescents and young adults, the virus is nicknamed "the kissing disease." • The virus infects the cells of the oropharynx. After the virus enters the oropharynx, it invades the bloodstream and the virus incites an immune response that causes proliferation of B lymphocytes within lymphoid tissue, resulting in lymphadenopathy. • The cervical lymph nodes, which are most commonly involved, are tender and symmetrically enlarged. Pharyngitis, fatigue, headache, fever, chills, abdominal pain, nausea, and vomiting are usually presenting symptoms. Pharyngitis is often the most prominent sign with tonsillar enlargement and exudate. Some individuals develop periorbital edema and a papular rash on the trunk and arms. • Warnings o The individual with EBV infection and splenomegaly should not participate in strenuous activities or contact sports for at least 3 weeks or until the spleen returns to its normal size.

What is Immune Complex Deposition?

• Ex. Rheumatoid Arthritis • Body develops antibodies against joint tissues because of an unknown antigenic stimulus. • Immune complexes--à joint inflammation-à deterioration of joint surfaces

What are systemic responses during acute inflammation?

• Fever • Pain • General malaise (a general feeling of poor health) • Lymphadenopathy (swollen lymph nodes) • Anorexia • Sleepiness • Lethargy • Anemia • Weight loss

Disadvantage of fever? Medications to reduce?

• Fever can reach levels high enough to cause seizures and brain damage. • It is recommended to keep fever below 102°F through the use of antipyretic medications such as aspirin, ibuprofen, or acetaminophen. • These medications inhibit prostaglandin formation and, thus, reduce fever.

What is oncotic pressure?

• Force exerted by albumin in the bloodstream • Total albumin in the bloodstream is indicative of the body's protein nutritional status. • Normal level is 3.1-4.3 g/dL • In hypoalbuminemia - reduced oncotic pressure

Types of Staphylococcal infections; resistance

• Gram-positive round bacteria that form clusters • Staphylococcus aureus (S. aureus) colonizes the skin, vagina, nares, and oropharynx as normal flora. • S. aureus: leading cause of nosocomial infection and surgical wound infection!!! • S. aureus has developed resistance to many antibiotics, and strains such as methicillin-resistant S. aureus (MRSA) and vancomycin-resistant S. aureus (VRSA) are commonly encountered in clinical settings.

What is Ebola Virus? Transmission?

• Hemorrhagic fever • Africa • Zoonosis: appearing first in animals, then spread to humans by contact • Transmission is by direct contact with the virus through blood and body fluids. • Humans spread it to each other when in close contact or commonly in unsterile clinical conditions. The incubation period is from 2 to 21 days. • It continues to spread until all the cells have the virus. Bleeding occurs internally and externally. Death ensues within 7 to 14 days. • Health-care providers should isolate the affected patient and use mask, gloves, gown, and goggles when caring for patients. It is also important to prevent close contact with bodies of the deceased.

B Lymphocytes:

• Humoral immunity • B lymphocytes, also called B cells, are naïve or immature until they encounter antigens. • After exposure to an antigen, B cells are stimulated to further mature into plasma cells. • As plasma cells, they have the ability to produce specific proteins called immunoglobulins (Igs), also called antibodies, which attack the antigen. • Plasma cells are terminally differentiated B lymphocytes. Antibodies are produced by Plasma cells! • Plasma cells secrete monospecific (monoclonal) antibodies, known as immunoglobulins (for example, IgG, IgM, or IgA)

Blast cells:

• Immature precursor cells for each cell line are called blast cells. • From the blast cell stage, each type of WBC begins to differentiate and mature along a committed cell line.

What is Active Multiple Myeloma?

• Increase in osteoclast activity (bone macrophages) that causes bone resorption at an accelerated rate. Osteoclastic activity is greater than osteoblastic activity, causing bone destruction and preventing bone formation. • Vertebral bones collapse. Bone destruction causes serum hypercalcemia. • Radiculopathy is a frequent neurological occurrence from compression of a nerve by a paravertebral plasmacytoma (neoplastic plasma cell tumor) in the lumbosacral area.

What is inflammation? What is intensity of it related to? What are the major aims of inflammation?

• Inflammation is a protective, coordinated response of the body to an injurious agent. • The intensity of the inflammatory reaction is usually proportional to the extent of tissue injury. • The major aims of inflammation are to wall-off the area of injury, prevent spread of the injurious agent, and bring the body's defenses to the region under attack.

What is meningitis? What is it caused by? Key signs and diagnosis? Treatment?

• Inflammation of the meningeal layers around the brain and spinal cord • Most commonly caused by viruses or strains of bacteria • Bacterial is very serious, and viral is more mild • Key signs are fever, stiff neck, headache, sometimes rash; sometimes Kernig's and Brudzinski signs • Diagnosis requires lumbar puncture • High dose antibiotic therapy is needed for bacterial; viral usually resolves itself • Complications: seizures, brain damage, ischemia of extremities, visual/hearing loss • Bacterial meningitis can be prevented by immunization • Streptococcus pneumoniae (pneumococcus) • Neisseria meningitidis (meningococcus) (Meningococcal vaccine can prevent Neisseria meningitis.) o Spread by droplet • Haemophilus influenzae (Hib vaccine can prevent H. influenza meningitis.)

What is mycoplasmia pneumonia?

• It is an infection of the lungs from the bacteria Mycoplasma pneumoniae (M. pneumoniae). • It causes an atypical pneumonia that commonly affects people younger than 40 years. • This type of pneumonia is often referred to as "walking pneumonia" because the affected individual does not appear very ill.

Complication of Treatment - Tumor Lysis Syndrome

• It results from rapid cell destruction of a large number of tumor cells all at once. • The lysed cells release their intracellular contents into the surrounding tissues and circulation, causing hyperuricemia (from purine breakdown), hyperkalemia, and hyperphosphatemia with secondary hypocalcemia. • The uric acid crystals can cause damage to the glomeruli and nephron tubules, causing renal failure.

Complications of wound healing?

• Keloid: hyperplasia of scar tissue • Contractures: inflexible shrinkage of wound tissue that pulls the edges toward the center of the wound • Dehiscence: opening of a wound's suture line • Evisceration: opening of wound with extrusion of tissue and organs • Stricture: an abnormal narrowing of a tubular body passage from the formation of scar tissue • Fistula: an abnormal connection between two epithelium-lined organs or vessels • Adhesions: internal scar tissue between tissues or organs

What is a vector?

• Living being that can carry the pathogenic organism from the reservoir to the host • Ex.: insect; it is not infected but can transmit the pathogen to the host

Lymphocytosis/Lymphocytopenia

• Lymphocytosis is an increase in lymphocytes within the bloodstream, most commonly caused by infection. • Lymphocytopenia, a decrease in lymphocytes, is a result of a decreased production in the bone marrow because of an acquired or inherited immunodeficiency.

Tumors in AIDS?

• Lymphoma of lymph nodes or GI tract • Lymphoma of CNS • Kaposi's sarcoma - a malignant disease of vascular endothelial cells).

What are the types of Lymphomas?

• Lymphomas - solid tumors of lymphoid cells and affect approx.. 3% of the US per year • Chromosomal translocations are the genetic hallmark of lymphomas. • A common translocation in Non Hodgkin's Lymphoma is the translocation of genes at 14q32 and 18q21 present in 85% of follicular lymphomas. • Some pathogens that have been associated with the development of NHL include HIV, EBV, Helicobacter pylori, HTLV-I, hepatitis C, and human herpesvirus-8. • Diagnosis o The patient or clinician often notices an enlarged, painless lymph node, which initiates further investigation. o A lymph node biopsy is the mainstay of diagnosis. • Hodgkin's lymphoma (15-20 years, 50-70 years); one of most curable, 1 in 25000 people • Lymphoma is the most common type of blood cancer in the United States. Lymphoma falls into one of two major categories: • Hodgkin's lymphoma (HL, previously called Hodgkin's disease) • Non-Hodgkin's lymphoma (NHL) • Non-Hodgkin's lymphomas account for 83% of lymphoma cases, with HL accounting for the other 17%. o HL develops from a specific abnormal B lymphocyte line. o NHL derives from either abnormal B or T cells.

Myelodysplastic Syndrome (MDS)

• MDS is a term used for disorders of the stem cells in the bone marrow. • All or part of bone marrow hematopoiesis is disorderly and ineffective and differentiation of all or one category of precursor stem cells into committed cell lines is impaired. • The patient suffers deficient numbers of all blood cells or one type of blood cell: WBCs, RBCs, or platelets.

What is osmolality? What is the normal value? What does it evaluate?

• Measurement of the concentration of solutes per kg of solvent • Based on 1 mole of substance dissolved in 1 kg of water --- Normal value is 282-295 --- Can be used to evaluate the body's hydration status

What happens during fever? What substances cause it? What brings fever down? What does a higher body temp. do to WBCs?

• Microbial organisms, bacterial products, and cytokines all act as pyrogens, which are substances that cause fever. • Pyrogens activate prostaglandins to reset the hypothalamic temperature-regulating center in the brain to a higher level. • A higher body temperature increases the efficiency of WBCs in their defense of the body. • An antipyretic agent = drug that brings down fever.

What is multiple myeloma?

• Multiple myeloma (MM) is a hematologic neoplasm that arises in B lymphocytes, causing proliferation of abnormal plasma cells in the bone marrow and consequent synthesis of abnormal Igs or Ig fragments. • A generalized disorder that leads to bone destruction, bone marrow failure, renal failure, neurological complications, and amyloidosis. o Remember: amyloids are proteins. So, amyloidosis is a group of rare diseases. It involves deposits of a protein called amyloid. • When one particular type of plasma cell proliferates abnormally, it causes an excess of its synthesized abnormal immunoglobulin and Ig fragments. • The abnormal Igs and fragments are referred to as monoclonal proteins or M-proteins. • Bone pain, especially in the back, is a common complaint at diagnosis. • It is a result of lytic destruction and the formation of plasmacytomas. • Lytic lesions are rounded, punched-out areas of bone found most commonly in vertebra, the skull, ribs, humerus, and femur.

Cells Within Bone Marrow, 2 Types

• Myeloid cells: Myelocytic leukemias affect these cells. • Lymphoid cells: Lymphocytic leukemias affect these cells.

What is hypernatremia? What happens in the body, and what is the most common cause? Who is at a high risk? What are the symptoms for 2 types?

• NaCl increases osmotic pressure; osmotic pressure is greater than hydrostatic pressure • Water is pulled from ICF to ECF; cell dehydration occurs • Greater than 145 mg/dL • Most common cause: water loss Elderly and infants at highest risk Hypernatremia with water retention o If hypernatremia causes water retention, then the picture is one of an edematous state o Weight gain is often present o Hypertension o If severe, mental changes and pulmonary edema Hypernatremia with water loss o Dehydration o Thirst o Irritability o Tachycardia o Flushed skin o Dry mucous membranes o Oliguria

Neutropenia

• Neutropenia, which is the lack of sufficient number of neutrophils, is the most frequent kind of leukopenia. It is diagnosed in patients with fewer than 1,500 neutrophils/uL. • Increases susceptibility to infection and diminishes the external signs of inflammation.

Neutrophilia

• Neutrophilia is the term used for neutrophil predominance in the WBC count; it is defined as a neutrophil count above 7,700/uL in patients with a total WBC count of fewer than 11,000/uL.

What are emerging infectious diseases?

• Newly appeared in the population and those that are rapidly increasing in incidence or geographic range

What are the categories of WBCs?

• Normal range of total in body is 4100-10900 cells per microliter • Monocytes (3-7% of circulating WBCs) o When they leave circulation and enter tissue, they mature into macrophages and are found in spleen and other organs; can exit and reenter circulation o Main function is phagocytosis o Synthesize and secrete cytokines o Macrophages function within the innate immune system and are the first responders in defense against an antigen • Lymphocytes (20-35% of circulating WBCs) o 2 main types: B lymphocytes (B cells) and T lymphocytes (T cells). o Lymphocytes are part of the adaptive immunity. o After exposure to an antigen, lymphocytes recognize, target, and have memory for specific antigens; They endow the body with long-term immunity. • Granulocytes o Neutrophils, eosinophils (0-7%), basophils (0-2%) o Have powerful digestive enzymes capable of killing microoorganisms and catabolizing debris during phagocytosis o Neutrophils • 60-70% of circulating WBCs; first responders to an infection or stress or inflammation • Antigens, epinephrine, and corticosteroids stimulate generation and release of neutrophils in blood • Mature neutrophils (PMNs) have a life span of 1-2 days (segs) - Mature neutrophils have a segmented, multilobed nucleus, as opposed to immature neutrophils, which have a bandlike nucleus. • Immature are called bands o Eosinophils • Generated by bone marrow and mainly released during allergic reactions and parasitic infection • 1-6% of WBCs • Basophils o Fewer than 1% of circulating WBCs but rise in response to infectors o Generated and released by bone marrow in response to inflammation, especially parasitic infection

What is osmolarity? What are the major solutes in the body?

• Number of osmoles of solute per liter of solution • Dependent on the number of particles suspended in a solution --- In the body, the major solutes are albumin, sodium, potassium, phosphate, magnesium, calcium, bicarbonate, and glucose

What is phosphate? Where is it found?

• Phosphorus is an essential component of bone, red blood cells (RBCs), enzymatic processes, formation of adenosine triphosphate (ATP), acid-base balance, and cellular building blocks. • Phosphorus is found in bone and circulates in the blood as phosphate (Po4-). Phosphates are incorporated into nucleic acids of DNA and RNA and the phospholipids of the cell membrane.

What is poliomyelitis Virus?

• Polio enters the body through the fecal-oral route. • It damages the motor neurons of the central nervous system. • Paralytic poliomyelitis is the classic presentation; also called infantile paralysis. In asymmetrical flaccid paralysis, deep tendon reflexes are decreased or absent and sensation remains intact. • Paralysis of the diaphragm muscle and swallowing mechanisms may be seen in cases called bulbar paralytic poliomyelitis. • The inactivated polio vaccine is an injectable vaccine that can be given at 2 months and 4 months of age. • The oral polio vaccine (not typically given anymore because it is live)is administered early in infancy and again at 4 to 6 years. Boosters are recommended for world travelers.

What is hypokalemia? What is the most common cause? What are symptoms? What is the treatment? What does the ECG look like?

• Potassium below 3.5 mEq/L • Diuretic therapy is most common cause -Diuretics --- Symptoms: o Anorexia o Nausea o Vomiting o Sluggish bowel o Cardiac arrhythmias o Postural hypotension o Muscle fatigue o Weakness o Leg cramps --- Increases Digitalis Toxicity --- Treatment o Rapid administration of K+ can cause cardiac arrest o IV potassium must always be diluted, and never given as an IV bolus o It is excoriating (damaging/removing) to the skin and blood vessels in large doses o Administer 20 mEq in 1 liter of IV fluid ECG: Decreased DTRs on ECG, there is a prolonged PR interval, flattened T wave, and prominent U wave

What is immunization?

• Prevention of infectious disease through administration of vaccines is the most efficient method of controlling contagious disease within a population.

What are 4 inflammatory mediators released from WBCs?

• Prostaglandins • Leukotrienes • Tumor necrosis factor (TNF-alpha) • Interleukins (Ils)

Nutrition in healing?

• Protein needed for cell regeneration and synthesis of connective tissue • Positive N balance - protein is best source • Carbs - used for energy to spare protein for tissue healing • Fats - synthesized during healing • Vitamin A and C - build proteins, fortify epithelial mucous membranes; Increase collagen strength • Vitamin B12 - enable cell replication, support growth of RBCs, maintain nervous system, enable synthesis of nucleic acids • Vitamin D - foster absorption of calcium from GI • Vitamin K - enable synthesis of coagulation factors • Folate - enables synthesis of nucleic acids with B12 • Ca, P, Fe - synthesis of hemoglobin and RBCs; required for mitochondrial functioning • Zn, Copper, Manganese - cell metabolism

What is hydrostatic pressure? Source of the pressure?

• Pushing force exerted by water in the bloodstream • Source of the pressure is the heart's pumping action, which pushes water through the capillary membrane pores into the ISF and ICF • Exerts an outward force that pushes water through the capillary membrane pores into the ISF and ICF compartments • ECF → ICF compartment

When the Lungs and Kidney Cannot Maintain Acid-Base Balance, Any of the Four Acid-Base Imbalances Can Occur:

• Respiratory acidosis • Respiratory alkalosis • Metabolic acidosis • Metabolic alkalosis

Opportunistic Infections: Cryptococcus Histoplasmosis Pneumocystitis Toxoplasmosis

• Risk factor: immunosuppression • Thrush and systemic Candida • Cryptococcus o Encapsulated yeasat that causes meningitis or disseminated disease (C. neoformans) o It is inhaled, infects the lungs and moves to bloodstream; penetrates bloodbrain barrier • Histoplasmosis o Darling's disease; fungal disease caused by Histoplasma capsulatum found in soil; most prevalent mycosis in US o Is inhaled and turned into yeast • Pneumocystis jiroveci o Most common opportunistic infection in patients infected with HIV; fungus • Toxoplasmosis o Caused by a parasite protozoan; primary host is cat o Most at risk are pregnant women and immunosuppressed o Can be transmitted through raw meat

What are 5 signs of inflammation?

• Rubor (redness) • Tumor (swelling) • Calor (Heat) • Dolor (pain) • Loss of function

What is allergy/serology testing?

• Serology testing measures the presence of IgE. • These serology tests are called: • Enzyme-linked immunosorbent assay (ELISA) • Radioallergosorbent test (RAST) • ImmunoCAP IgE test • Evaluate the severity of the allergy by measuring how much IgE reacts with allergen.

What causes chills with fever?

• Set-point of the hypothalamic temperature-control center is changed from normal (98.6°F) to a higher temperature. • Initially, the blood temperature is less than the new higher set-point and the person has a sensation of being cold. • The blood vessels constrict and the body attempts to conserve and generate heat. To reach the new hypothalamic temperature set-point, the muscles shiver to generate body heat.

What do Na+ and K+ each do in the Sodium-Potassium Pump?

• Sodium, the main determinant of osmolarity, is a positive ion, also called a cation; it is found mostly in the extracellular fluid and assists in the maintenance of fluid balance and osmotic pressure. • Potassium is the main intracellular cation; it assists in the maintenance of neuromuscular excitability and acid-base balance. • Both sodium and potassium require the cell's sodium/potassium ATPase pump to maintain Na+ as the extracellular ion and K+ as the intracellular ion.

What are Antigen-Presenting Cells?

• T cells cannot be activated by antigen alone; APCs process the antigen first and induce cell-mediated immunity. • APCs are also referred to as dendritic cells.

Hematologic Cancers? Lab tests?

• The excessive proliferation of cancerous blood cells in bone marrow will suppress the growth of healthy blood cells. Symptoms include: • Anemia (fatigue, weakness, pallor) • Leukopenia (increased susceptibility to infection) • Thrombocytopenia (increased susceptibility to bleeding and bruising) • Bone pain (caused by proliferating cancerous blood cells that put pressure in marrow of bones) • Physical Signs o Physical examination may reveal enlarged lymph nodes, splenomegaly, or both. o An enlarged lymph node is the result of proliferative neoplastic cells. o Splenomegaly is the result of excessive infiltration of neoplastic blood cells or excessive hemolysis performed by an overactive spleen. • Lab Tests o Complete blood count (CBC) with differential is an important initial diagnostic test to identify which specific type of WBC is causing the neoplastic disorder. o Bone marrow aspiration (also known as bone marrow biopsy) o Fluorescence in-situ hybridization (FISH) is used to analyze cells for chromosome defects (such as the Philadelphia chromosome translocation between chromosome 9 and 22.

What are HSV-1 and HSV-2?

• The two viruses are distinctly categorized because they usually infect different parts of the body. • HSV-1 is the common cold sore virus. • HSV-2 is the genital herpes infection. • Both HSV-1 and HSV-2 cause acute and latent infection. • Acute infection: abrupt onset of vesicular lesions within the epidermis and mucous membranes. The fluid-filled vesicles contain active viral particles. • After a few weeks, the acute phase ceases and is followed by a period of dormancy when the virus is inactive. • Herpes viral DNA remains dormant within the neurons and evades immune destruction. • Reactivation of HSV occurs during periods of stress, illness, or immunosuppression.

What is Legionella Pneumophila Bacteria?

• These bacteria are found most often in the warm, moist, air conditioning systems of large buildings, though they have also been found in water delivery systems. The microbe is transmitted via aerosolized mist in the air.

Autologous Stem cell transplants

• This kind of transplant involves extraction of healthy hematopoietic stem cells from the patient and storage of the harvested cells in a freezer. • The patient is then treated with high-dose chemotherapy with or without radiation to destroy the patient's malignant cells. • After complete or partial bone marrow ablation, the patient's own stored healthy stem cells are returned to his or her body, where they replace destroyed tissue and resume the patient's normal blood cell production.

Allogeneic hematologic stem cell transplants

• Treatment for hematologic cancers • Healthy bone marrow cells are harvested from a donor who has a matching tissue type to the recipient. • These are called allogeneic hematologic stem cell transplants. • When successful, the donor's healthy bone marrow cells replace the recipient's cancerous bone marrow. However, bone marrow transplant rejection occurs frequently.

Opportunistic Infections/illnesses that occur with HIV infection? What is Hepatitis A,B,C?

• Tuberculosis • Candida • Pneumocystis pneumonia * key HIV-related disorder (Pneumocystis jiroveci) • Kaposi sarcoma • Toxoplasmosis • Cryptococcus • Histoplasmosis --- Hepatitis A, B, C o Patients with AIDS with advanced stages of immunosuppression are at risk for developing infections including: o Respiratory tract infections, including pneumonia caused by Pneumosystis carinii, Aspergillus fumigatus, or Candid albicans. o Gastrointestinal infections in AIDS patients are commonly caused by Mycobacterium avium intracellulare, and protozoa such as Cryptosporidium. o Skin lesions in AIDS patients are typically caused by chronic infections with herpes viruses, fungi, and Streptococcal folliculitis.

What is hypersensitivity and the 4 types? (And anaphylactic shock)

• Type I immediate hypersensitivity o Occurs after IgE bind to mast cells and combine with antigen; occurs in individuals previously exposed to an antigen o Type I hypersensitivity reflects mast cell degranulation with release of histamine and other vasoactive mediation of acute inflammation. o Mast cell degranulation is normally triggered when an antigen binds and cross-links mast cell surface IgE receptors. o Type I hypersensitivity requires previous exposure to a pathogen (antigen), which results in the generation of IgE antibody. o Lack of the IgE immunoglobulin would make it impossible for the individual to have a type I hypersensitivity reaction! o characterized by excessive production of the IgE antibody, upon re-expose to an antigen, which leads to degranulation of mast cell and basophils, and an increased release of histamine. o Histamine causes bronchial smooth muscle contraction and causes the smooth muscles in the blood vessels to dilate and releases plasma into the tissues leading to edema. In addition, we will see an increased number of eosinophils produced in the blood. After the initial histamine production, a late phase response occurs about 4 -6 hours later. o Exposure to allergens such as mold, animal dander, or pollen leads to development of allergic rhinitis, a type of Type I • Systemic Anaphylaxis is a Type I; hay fever, pollen allergy Anaphylactic Shock Symptoms • Rapid and severe systemic • Degranulation of mast cells, basophils, and SRA's; dilation of vascular smooth muscle, bronchial smooth muscle constriction, increased vascular permeability • Hives, bronchospasm, angioedema, severe hypotension → syncope • Anaphylactic Reaction Clinical Manifestations • Phase 1: difficulty breathing, skin flushing and itching, angioedema • Phase 2: difficulty breathing, severe hypotension, severe edema • Treatment o Emergency treatment needed; epinephrine, antihistamines, corticosteroids o drugs to help relax the bronchial smooth muscles, and drugs to constrict the smooth muscles of the vessels so the blood pressure goes up, and drugs to help limit inflammation, such as Benadryl. o The best treatment we have is when someone knows they are allergic and we can implement prevention. We can help prevent anaphylaxis by giving them allergy shots to desensitize them to the allergen. Or we can have them carry an epi-pen or epinephrine which we can give them at first exposure to the allergen which will help them decrease their allergic response. • Clinical manifestations: mild-severe o Nasal congestion, irritated eyes, hives, diarrhea and abdominal cramping, bronchospasm, desensitization - allergy shots • Type II cytotoxic hypersensitivity o Mediated by Igs directed toward antigens present on cell surfaces; IgM or IgG interact with plasma membranes on only certain cells (causes lysis of the cells); intrinsic or extrinsic; activate complement o Organ specific • Graves disease (affects thyroid; auto-antibodies form against their own tissue), hemolytic anemia (breakdown of RBCs) • Goodpasture's disease (immune system makes antibodies that attack lungs and kidneys • Myasthenia gravis - autoimmune disorder Antibodies develop against acetylcholine receptors in muscles Slowly Ach receptors degenerate Result: weakening muscle movement • Blood Transfusion reactions o cytotoxic antibodies react with antigens in the cells or tissues. This is kind of a result of mistaken identity, if you want to think of it that way, meaning that antigen-antibody complex is formed on cell membranes of specific tissues. Now, the antigen may be extrinsic such as drugs or chemicals or it may be intrinsic such as our own DNA or RNA or proteins that we have in our blood. o • Type III Immune complex disorders o When antigen combines with Ig within circulation and these complexes then deposited in tissues o Immune complex: abnormal or altered IgG antigen-antibody complexes form and deposit in circulation (systemic) or tissues (localized) o Organs involved glomeruli, eye, brain, pleura, pericardium, peritoneal cavity o Antibody excess becomes overwhelming - activate complement resulting in acute inflammation o Localized immune complex formation -vasculitis o arthrus phenomenon- IgG is the antibody involved here, and when it forms in the antibody-antigen complex it does not want to shut off o The antigen-antibody complexes lodge in vessel walls, activate the inflammation-inducing components of complement which results in release of vasoactive substances from mast cells which attract the PMN leukocytes to the site. o So again, The antibody-antigen complex starts out small, but as it becomes overwhelming, they get large enough that they filter through the basement membrane of the organs and through the plasma. o They tend to attract poly-morpho-nuclear neutrophils and result in acute inflammation that occurs throughout the body. • Type IV delayed hypersensitivity o Initiated by T lymphocytes that have had previous exposure to an antigen. They are sensitized to the antigen and do not attack the antigen until days after initial exposure, contact dermatitis occurs • In transplant rejection, poison ivy • Example: contact dermatitis, such as poison ivy rash or reaction caused by chrome jewelry • Example: TB test; reaction develops after 48 hours o It is not an antibody mediated reaction, but it is a cell-mediated reaction. o It is mediated by T-lymphocytes and macrophages, which aggregate at the site of injury to form granulomas. o The CD 8 cytotoxic T cells cause direct damage to the tissues in reaction to antigens. o Then, the CD 4 or helper T cells later secrete cytokines which activate monocytes and macrophages. That is what causes the bulk of the damage to the tissue at the site and causes giant cells to form. o Characteristics of type IV are granuloma formation which is where the macrophages transform into epithelioid cells, which causes even more inflammation. This is very common with tuberculosis. QUICK REVIEW: Now remember back to chapter 1. When what do you remember about Tuberculosis as it relates to necrosis? [Answer: Caseous necrosis is typically found in patients with tuberculosis] o It can also have non-granuloma formation and this is what we see with contact dermatitis or poison ivy, and that's because it causes and infiltration of lymphocytes but there is no granuloma that forms.

Umbilical cord stem cells

• Umbilical cord stem cells are also being used as stem cell transplants for hematologic cancers with varying rates of success. • Cord blood has a higher concentration of hematologic stem cells than is normally found in adult blood.

What is oliguria?

• Urine production lower than 400 mL/day • Urine production is lower than 20 to 30 mL/hour

What are macrophages?

• WBCs that surround and consume the material in a process called phagocytosis • In protein-rich filtrate of blood that leaves the capillaries

What is "shift to the left"?

• When a high number of bands are present, clinicians often use the phrase "shift to the left," indicating an increase in newly formed neutrophils. • An elevated WBC count with a "shift to the left" indicates that an acute inflammatory process is occurring.

What is orthostatic hypotension? When does it occur?

• occurs in dehydration, is a systolic blood pressure decrease of at least 20 mm Hg or a diastolic blood pressure decrease of at least 10 mm Hg within 3 minutes when going from a lying to a standing position.

What are the 3 possible outcomes of acute inflammation?

•1. Complete resolution •2. Or healing by connective tissue •3. Or chronic, persistent inflammation that does not recede

What is dependent edema? What is pitting edema?

•Dependent edema - forms in lower extremities; weakened venous valves, lack of muscle contractions, and gravitational forces can allow venous blood to collect in the lower extremities •Pitting edema - When fluid accumulates under the skin due to edema and pressure is applied to this area, a "pit" or indentation may remain for a few moments after the pressure is removed. The formation of this indentation is known as "pitting edema" and is due to displacement of the fluids by the pressure applied. o The measurement of edema is based on multiples of 2 mm. o Depending on the severity, an individual can have +1, +2, or +3 pitting edema. o 2mm indention = +1 edema o 4 mm indention = +2 edema o 6 mm indention = +3 edema

What is natriuresis? What are 3 natriuretic peptides that promote natriuresis?

•Natriuresis - excretion of a large amount of both sodium and water by the kidneys in response to excess ECF volume oAtrial (ANP) - produced by heart's atria and is secreted in response to excess ECF volume that stretches the heart's atrial chambers oBrain (BNP) - produced in heart's ventricles and, to a lesser extent, in the brain oC-type (CNP) - produced by endothelial cells of the arteries and ventricular cells of the heart

When does Fluid Volume Overload occur? What are causes?

•Occurs when bloodstream has an excessive amount of water •Causes: heart failure cancers that secrete ADH cirrhosis of liver, polycystic kidney disease, hypertension

What 5 things is fluid homeostasis maintained by?

•Osmoreceptors •Sensation of thirst at hypothalamus •Renin-angiotensin-aldosterone system RAAS •Antidiuretic hormone (ADH) •Natriuretic hormones

What is normal blood pH? What is too high and too low called?

•Reflects acidity or alkalinity of the blood. oNORMAL BLOOD pH = 7.35 to 7.45 oAll cells in the body need to have a blood pH in this range for optimal function. oBlood pH is strictly regulated by the lungs and kidneys. oBlood pH < 7.35 = ACIDOSIS oBlood pH > 7.45 = ALKALOSIS

What is thirst and what is it triggered by? What 3 things work together in a healthy person?

•Triggered by response in the thirst center located in the anterior hypothalamus; osmoreceptors respond to changes in both blood osmolarity and blood fluid volume; ICF shifts into ECF and the cells shrink, stimulating thirst center; this center transmits signals to cerebral cortex, promoting sensation of thirst •In a healthy person, osmoreceptors, ADH, and thirst responses work together