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198 Cards in this Set

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Parts of the immune system?
thymus, tonsils, blood, bone marrow, liver, lymph nodes, spleen
Nonspecific immunity?
A very general type of immunity that does not target pathogens in particular. Includes inflammation, mechanical barriers, chemical barriers, phagocytosis, fever, natural killer cells.
Specific immunity?
Very precise immunity that targets particular pathogens. Includes specialized lymphocytes.
Lymph system?
treats infections, provides protection against cancer toxin, transports excess fluid back to bloodstream
How many cells in the body?
70 trillion
immune attack more specific against virus or bacteria?
virus
qualities of the immune sytem?
(1) recognizes foreign entities (2) responds to germs to destroy, degrade, neutralize, remove (3) recognizes pathogens it has seen before
thymus?
v. difficult to find in adults, immature lymphocytes become mature t-lymphocytes here
liver?
create proteins of the complement system, large # of phagocytes that remove bacteria from the blood
bone marrow?
produces white blood cells
Parts of the immune system?
thymus, tonsils, blood, bone marrow, liver, lymph nodes, spleen
Nonspecific immunity?
A very general type of immunity that does not target pathogens in particular. Includes inflammation, mechanical barriers, chemical barriers, phagocytosis, fever, natural killer cells.
Specific immunity?
Very precise immunity that targets particular pathogens. Includes specialized lymphocytes.
Lymph system?
treats infections, provides protection against cancer toxin, transports excess fluid back to bloodstream
How many cells in the body?
70 trillion
immune attack more specific against virus or bacteria?
virus
qualities of the immune sytem?
(1) recognizes foreign entities (2) responds to germs to destroy, degrade, neutralize, remove (3) recognizes pathogens it has seen before
thymus?
v. difficult to find in adults, immature lymphocytes become mature t-lymphocytes here
liver?
create proteins of the complement system, large # of phagocytes that remove bacteria from the blood
bone marrow?
produces white blood cells
tonsils?
accumulations of lymphocytes in the throat
lymph nodes?
accumulations of b and t lymphocytes
spleen?
accumulation of b and t lymphocytes and monocytes, removes RBCs (often enlarged in people with diseases that cause deformed RBCs)
pathogen?
disease-causing agent, EX=bacteria, virus, fungi, parasites, often their byproducts make us sick
bacteria?
generally function in intercellular space, need a functioning immune system for antibiotics to work, prokaryotes, have their own metabolism, can replicate outside the human body
viruses?
RNA or DNA, surrounded by capsule, needs CELLS to replicate, do not have their own metabolism, difficult to treat because they use our own cells
fungi?
mostly affect skin or mucosal tissues, like high humidity dark place, replicate inside and outside body, secrete proteolytic enzymes that destroy epithelial tissue
parasites?
organisms that must live within a host, generally do not kill host
nonspecific defenses 1st line?
skin, mucosa
nonspecific defenses 2nd line?
chemical barriers->enzymes (pepsin, lysozyme, salts), interferrons (lymphocytes, fibroblasts), complement system (proteins->inflammation->attraction of phagocytes->phagocytosis)

natural killer cells->lymphocytes, secrete perforins that make holes in other cells, enhance inflammation


Inflammation
Fever
Phagocytosis
inflammation parts?
(1)redness=increased blood flow (2)heat (3)swelling (4) pain
most common cells that phagocytose?
neutrophils (engulf smaller particles) and monocytes (become macrophages when activated)
fever?
causes iron to be sequestered in liver and spleen (bacteria and fungi require iron for metabolism), phagocytic cells stimulated by fever
immune system 3rd line of defense?
resistance to specific antigens, toxins, byproducts
WBCs =
lymphocytes, start in bone marrow, 50% specialized to t-cells in thymus
t-lymphocytes?
antigen-presenting cells activate t-lymphocytes, cell mediated immunity -> helper T-cells are activated by macrophage and activate B cell with cytokines and activate helper t cell with interleukin-2, cytotoxic t cells divides into memory t cell and cytotoxic t cell
b-lymphocytes?
become activated when encounter a fitting antigen or antigen-presenting t-cell, differentiate into memory cells and plasma cells
antibodies?
directly attack pathogen, sign for phagocytic cells to eat, activate protein response (complement system and inflammation)
bactericidal antibiotic?
kills the bacteria by interfering with the formation or the cell or the cell's contents
bacteriostatic antibiotic?
stops the bacteria from multiplying
pneumonia is common in what age patients?
birth to 6 and after 65
strains that cause pneumonia?
streptococcus pneumoniae, mycoplasma (atypical), legionella (epidemics), haemophillus (children)
how does the pathogen that causes pneumonia enter the body?
microscopic aspiration through the nasopharynx, throat, or esophagus, when enough bacteria enter the trachea it can cause an infection
symptoms of pneumonia?
fever, coughing, dyspnea, pleuritic chest pain
how is pneumonia treated?
antibiotics, high concentrations of humidified O2
who might not be able to survive pneumonia?
immunocompromised patients, COPD patients, asthma patients
what pathogens cause meningitis?
neisseria meningitidis, streptococcus pneumoniae, haemophillus influenzae
how does the pathogens that cause meningitis enter the body?
through the nasopharynx then enters the bloodstream then the meninges
what are the symptoms of meningitis?
headache, vomiting, fever, rash, photophobia, stiff neck, impaired consciousness
why is meningitis so dangerous?
it kills quickly, many times patients become unconscious before they realize how sick they are, this is because of the area the bacteria infect (the meninges)
meningitis treatment?
steriods, antibiotics
what do crackles heard in the lungs with a stethoscope mean?
either fluids (which generally affect both sides of the lungs, can be because of heart failure) or infection (typ. affects only one side)
what does wheezing mean?
obstruction of the airways
what does wheezing upon inspiration mean?
foreign body is lodged in the trachea
what does wheezing upon expiration mean?
there is an obstruction in the lower part of the lungs, COPD, asthma
what does a lack of lung sounds mean?
collapsed lung, tumor, pneumonia w/ fluids
what tests would you do for shortness of breath?
stethoscopy, O2sat, CO2 pressure, pH, chest xray, lung function test, blood sample (for infection)
how would you test for O2sat, CO2 pressure, pH?
take blood sample from radial artery (aka arterial puncture/a-puncture)
what would a chest xray show in terms of dyspnea?
collapsed lung, tumor, infections
what is spirometry?
lung function test
what are the parts of the upper respiratory system?
nose, pharynx, epiglottis
what are the parts of the lower respiratory system?
larynx, trachea, bronchi
what are conchae?
increase the surface area of the mucus membrane
what are the 4 paranasal sinuses?
ethmoid, sphenoid, maxillary, frontal
what are the functions of the upper respiratory system?
heats the air, gives the air moisture, clear teh air of foreign particles, speech (tongue)
pharynx?
nasopharynx, oropharynx, laryngealpharynx
epiglottis?
closes the airways while swallowing
larynx?
vocal cords are housed here (produce sound with the air)
bronchus divides into?
bronchi->bronchioles->alveolar ducts->alveolar sacs-> alveoli
forced inspiration?
intercostal mucles, pectoralis muscle
emphysema?
large lungs, alveoli are destroyed, one big sac with decreased surface area
pleura?
one close to lungs, one close to ribs/muscle, pleural cavity, hole can cause collapsed lung
inspiration?
diaphragm moves downward, pressure in alveoli falls, air is forced into the lungs, surfactant=fluid lining the alveoli, create tension to keep alveoli open
expiration
lungs contains elastic fibers that stretch during inspiration, lungs recoil and return to original shape
vital capacity?
amt of air you can maximally have taking out the air that is always left
FEV1?
forced expiratory volume in one second, problem for COPD, asthma
FVC?
forced vital capacity
FEV1/FVC?
if less than 70%, then COPD
breathing control?
brain (pons, medullary respone center), chemoreceptors (central detect CO2, peripheral detect O2), inflation reflex (regulates depth of breathing)
what determines rate of diffusion?
partial pressure
normal blood O2 sat?
above 95%, below or at 90%=v. concerning
O2 binds?
hemoglobin
where is CO2 in the body?
7% plasma, 23% bound to hemoglobin, 70% bicarbonate ion
as O2 is released from hemoglobin?
pressure O2 decreases, CO2 increases, acid increases
Is COPD preventable? Treatable?
yes and yes
what is COPD?
air flow limitation, progressive, 90% caused by smoking, leading cause of death in industrialized world
what are the 2 main symptoms of COPD?
emphysema (loss of alveoli SA), bronchitis (inflamed bronchus, small airway)
COPD and elastic fibers?
there is increased pressure in chest cavity, normally elastic fibers hold the bronchi open, in COPD elastic fibers don't work as well
what are the symptoms of COPD?
breathlessness, coughing, weight loss(high, shallow respiration requires E), hypoxia, cyanotic, edema (because of increased pressure in lungs, swollen legs)
how do you test for COPD?
spirometry (very low FEV1), GOLD guidelines (mild, moderate, severe, v. severe)
how do you treat COPD?
oxygen (not too much because it will go to CO2 and blood will become too acidic), inhaled beta2-agonists (bronchodialator) and anticholinergics, steroids, antibiotics, non-invasive ventilation
why is there edema in COPD?
higher resistance and pressure in the circulation in the lungs, heart has to work against this, R side of heart has to work harder, eventual heart failure
Is asthma reversible?
yes
what causes asthma?
genes, obesity, sex(child-male, adult-female), allergens, infections, occupations
childhood vs. adult asthma?
many children have bronchospasms during viral infection and then grow out of it
histadine causes what?
bronchospasms, antihistamines against allergic rxns
symptoms of asthma?
quick progression of symptoms, breathlessness, blue lips, wheezing, coughing, chest tightens, worse at night and in the morning
symptoms of asthma are initiated by?
irritants, exercise, infections, allergens
how do you diagnose asthma?
based on symptoms, reversability test, peak flow measurements, try to trigger hyperresponsiveness, measure exhaled NO (high levels indicate asthma), allergy status
what is a reversibility test?
test FEV1 normally and then one test w/in 50 minutes after asthma med. (increase in volume by at least 500mL is indicative of asthma
what is the goal for asthma treatment?
to have no symptoms, can't say the same for COPD
what is the treatment for asthma?
O2, bronchodialators, steroids
what are the parts of the gastrointestinal system?
mouth, pharynx (oropharynx, nasopharynx, laryngeal pharynx), esophagus, stomach, liver, gall bladder, duodenum, pancreas, small, intestine, large intestine, rectum, anus ALL VARIATIONS OF THE SAME TUBE
what are the symptoms of the gastrointestinal system?
dyspepsia, nausea, vomiting, abdominal pain, gastrointestinal bleeding, constipation diarrhea
define constipation.
having a bowel movement fewer than 3 times a week, always take into acct what is normal for the patient, stools=hard, dry, small, difficult to eliminate, bowel movement=painful, there is straining, bloating, feeling of fullness
what are the causes of constipation?
not enough fiber in diet***, low fluid intake, medical side effects (narcotic analgesics, psychiatric drugs, diuretics), lack of exercise, colon cancer***(v. scary for MDs), diverticular disease, neurological disease, metabolic diseases
what do you do if a patient comes in complaining of constipation?
pt history, abdominal xray (straight lines show air and fluid and are a sign that not enough air is getting out of the colon, gas from bacteria is dialating the intestines, urgent surgery) barium enema (contrast soln. to xray, can't do in pt with complete obstruction), endoscopy
define diarrhea.
3 or more loose or liquid stools per day or more stools than normal for the patient
types of diarrhea?
inflammatory, infections, cancer
how does a medical history help determine cause of diarrhea?
blood? severe bacterial diarrhea, cancer, inflammatory bowel disease - vomiting? gastroenteritis - family members ill? food poisoning, infection - drugs? cocaine, amphetamines - alcohol intake? a lot of liquids, no food, no glucose
what tests would you do if a patient comes in with diarrhea?
blood test to check iron and hemoglobin, a stool culture is diarrhea lasts more than a week there is a fever and blood to check for toxins virus bacteria parasites
what can cause abdominal pain and where?
RHR=liver, gall bladder ER=stomach, duodenum LHR=stomach RLR+LRL=kidneys UR=small intestine, pancreas RIR=appendix LIR+HR=large intestine
what are the types of gastrointestinal bleeding?
(1)heamatemesis=bloody vomit (2) melaena (3)rectal bleeding
what are the causes of heamatemesis?
ulcer, varices, Mallory Weiss lesion, tumor
how would you treat hematemesis?
treat shock with fluids and blood, pt. history, endosopy
what causes melena?
usually gastrointestinal bleeding from gastric pouch, peptic ulcer, varices, mallory weiss lesion, tumor, iron treatment (not bleeding)
how would you treat melena?
treat shock first with fluids and blood, then pt history then endoscopy
what causes rectal bleeding?
diverticular disease, tumor, hemorrhoids, anal fissures
what is the vomiting relflex?
vomiting center in medulla oblongata (1) nausea, pale, sweating, sallivate (2) retch, contract (3) expulsion of gastric contents, relaxation of lower esophageal sphincter
what are the causes of vomiting?
food poisoning, drugs (chemo), alcohol, systemic disease, inner ear disease
what causes COPD?
smoking, genes, working conditions, pulmonary infections, air pollution, biomass fuel
what is the prevalence of GOLD stage two or higher COPD?
men-11.8% women-8.5%
what is the prognosis for COPD?
3-mo. readmission - 14% 1 yr. readmission - 46%
what are the GOLD COPD guidelines?
mild - FEV1 >80% predicted MODERATE 50<FEV1<80 SEVER 30<FEV1<50 VERY SEVERE <30%
what treatment do you do according to the GOLD guidelines?
MILD-reduction of risk factors (smoking, vaccinations, education), short-acting bronchodialators MODERATE-long-acting brochodialators, rehabilitation SEVERE-inhaled glucocorticosteroids V. SEVERE-long term oxygen, surgery
what airway remodeling happens with asthma?
increased fibrosis, inflammatory cell, muscle thickness, mucus
what are the different types of diagnostic imaging?
FUNCMP-fluoroscopy, ultrasound, nuclear medicine, computed tomography, MRI, plain x-rays
what are xrays used for?
chest, abdominal, skeletal
what are the advantages of xrays?
cheap, fast, accessible, low doses of radiation, quick overview of organs
what is ultrasound?
uses high frequency sound waves and their echos, the sound waves travel into your body until they hit a boundary between tissues, some are reflected back to the probe, the machine displays distances and intensities of the echos on the screen, doppler ultrasound is used for blood
what is ultrasound used for?
brain, thorax, abdomen, pelvis, peripheral, heart
what are the advantages of ultrasound?
low cost, non-ionizing, safe, can be used on anyone, aids in biopsy and drainage procedures, can be repeated, detection of flow, portable
what are the disadvantages of ultrasound?
poor conduction through bone gas and air, operator dependent, scattering of ultrasound through fat
what is CT?
computed tomography is a diagnostic technique that uses a computer and a rotating xray device to give detailed cross-sectional images of the human body, the absorption values are -1000 for air and +1000 for bone (absorbs the most xrays-white)
what are the uses for computed tomography?
widely used, staging primary tumors***, radiotherapy planning, exact anatomical details, cardiac CT***
what are the advantages to CT scans?
painless, noninvasive, accurate, image bone blood vessels and soft tissue at the same time******, fast, simple, cost-effective, less sensitive to movement than MRI, can be performed if you have an implanted medical device, real-time imaging, no radiation remains, no immediate side effects
what are the risks of CT scans?
slight increased risk of cancer from radiation, not recommended for pregnant women, not recommended for children because they are more sensitive to radiation, slight risk of allergic rxn to contrast materials containing iodine
what are the limitations of CT scans?
soft tissue details can be more clearly seen using MRI
how does MRI work?
there are hydrogen protons within the body that will align with a magnetic field, applying short radiowave frequency to a particular part causes the hydrogen protons to flip perpendicular to the magnetic field, as the protons relax back into alignment an RF coil receives a signal
what is a concern with patient safety when using an MRI?
MRIs are incompatible with metal objects
what are the uses for MRIs?
CNS, musculoskeletal, cardiac, thorax, abdomen, pelvis
what are the advantages of MRIs?
images in any plane, non-ionizing, great pictures of soft tissues, allows for visualizaiton of blood vessels without contrast
what are the disadvantages by MRIs?
takes at least 30 minutes, claustrophobic, don't show calcification as well, poor images of lungs
what is nuclear medicine?
radiopharmaceuticals are taken internally, show physiological function, good for showing metabolic things and cancer
what are the disadvantages of myocardial perfusion imaging?
high radiation dose, usually has to occur over 2 days, functional not anatomical
how would you treat rectal bleeding?
treat shock, pt history, colonoscopy
functions of the liver?
Protein synthesis (immune, blood), Glucose processing +storage, Metabolism of proteins and a.a., Toxin breakdown (meds to active form), Bile secretion
what is unique about the liver?
it has a double blood supply->venous blood goes in through hepatic portal vein, arterial blood goes in, venous blood goes out
what is the functional unit of the liver?
a hepatic lobule which forms around a central vein, there are hepatic sinusoids which are lined by Kupffer cells
what is the gall bladder?
a pear shaped sac, bile exits through the cystic duct and joins with the hepatic duct to form the common bile duct which lets bile out into the duodenum via the hepatopancreatic sphincter
what causes gall stones?
an imbalance in the components of bile eg too much cholesterol or electrolytes
what is bile made of?
bile salts, bile pigments, cholesterol, electrolytes
what does bile too?
helps digestive enzymes and aids in digestion of fat-soluble vitamins
what is the anatomy of the pancreas?
there are usually two main ducts gathering pancreatic juice
what is the function of the pancreas?
endocrine function-secretes insulin (lowers blood glucose levels) and glucagon (raises blood glucose levels by converting glycogen to glucose) into the bloodstream

exocrine function-secretes pancreatic juice into the gastric tract
what are the most common liver diseases?
hepatitis, cirrhosis, cancer
what is cirrhosis?
scarring of the liver, fibrotic lobules form, IRREVERSIBLE end stage of liver disease, mostly caused by alcohol
what is hepatitis caused by?
infectious diseases, inflammatory disease
what does liver cancer signify?
end-stage cancer, metastic liver cancer common
what is the definition of liver cirrhosis?
the clinical syndrome of liver dysfunction and portal hypertension histochemically categorized by the presentation of regeneration nodules in the liver
what consequences does portal hypertension have?
blood backs up in the veins and veins in the skin of the abdomen will become visible, when this happens the patient likely already has liver cirrhosis
what is the pathogenesis of liver cirrhosis?
the liver cannot regenerate, normal liver tissue is replace with regeneration nodules, increased pressure in the liver, then portal hypertension and the liver can't function properly
what are the symptoms of liver cirrhosis?
fatigue, decreased appetite, abdominal pain, sexual disorders, pruritus, icterus, ascites, hematemesis, melena, hepatic encephalopathy
what are the clinical findings of liver cirrhosis?
spider naevi, ascites, caput medusae, enlarged liver, palmar erythema, jaundice (liver not breaking down bilirubin), esophageal varices***** (serious indicator of liver disease)
what paraclinical tests can you do for liver cirrhosis?
ultrasound for cirrhosis, endoscopy for esophageal varices, liver biopsy for cirrhosis (usually don't do)
what are the complications of liver cirrhosis?
hemodynamic-portal hypertension (causes ascites, hematemesis, esophageal varices, caput medusae)


infectious-peritonesis, pneumonia, sepsis

cancer-hepatocellular carcinoma




metabolic-hepatic encephalopathy, glucose intolerance, malnutrition, decreased protein production, disturbance of sex hormones
what is the treatment for liver cirrhosis?
stop drinking alcohol, diet to maintain protein and energy intake, diuretics to treat edema and ascites, ligation of varices, infection treatment, liver coma-glucose and lactulose (to decrease ammonia production in stomach), liver transplants
what is the prognosis for liver cirrhosis?
5yr 40%, with complications 50% die w/in months, 10% develop carcinoma
what is hepatitis?
a viral infection of the liver
what are the symptoms of hepatitis?
fatigue, nausea, vomiting, ab pain, anorexia, fever, headache, pruritis, icterus, dark urine, pale feces
what are the clinical findings of hepatitis?
enlarged liver, icterus, tenderness over liver, when chronic there can be signs of cirrhosis
hepatitis A virus?
incubation=2-6 wks
only acute symptoms,never chronic
transmission=feces
vaccination
no treatment
mostly symptoms of gastroenteritis
hepatitis B virus?
incubation=2-6 months
transmission=blood, body fluids, mother to child
asymptomatic
often in Asia
10-15% become chronic
20% increased risk of cirrhosis
increased risk of carcinoma
no acute treatment
chronic cases treated with alfa interferrons
vaccination
Hepatitis C virus?
incubation=weeks
transmission=blood, body fluids, mother to child
often asymptomatic
70-80% chronic
a lot of times have HIV as well
20% develop cirrhosis
increased risk of carcinoma
interferron or ribavirin treatment
Hepatitis D virus?
only affects those w/ HBV
often chronic
hepatitis E virus?
like A, more in central america
incubation=a month
tans=feces
acute symptoms
1-5% develop liver failure v.v. quickly
no vaccine no treatment
treat symptomatically to try and get past infection
what is the most common disease of the gall bladder?
galls stones, 5-30% have gall stones, more in women
what causes gall stones?
imbalance of cholesterol, electrolytes, bile salts, bile pigments
what are the symptoms of gall stones?
most are asymptomatic, extreme pain can result, maximal pain an hour after eating, pain in RHR and radiates to back R scapula, effects of severe pain=nausea, vomiting, restlessness
what are the clinical findings of gall stones?
ultrasound can show gallstones, blood test done to measure liver function, icterus, dark urine + pale feces, endoscopy shows stones, MRCP shows stones (must be repeated to determine if gall stone is obstructive)
what are the complications of gall stones?
pain, cholecystitis, pancreatitis (NEEDS TO BE TREATED IMMEDIATELY BEFORE SEPSIS)
what is the treatment for gall stones?
not removed unless obstructive, ERCP (endoscopic retrograde choangiopancreatography), stop drinking, low-fat diet, surgery to remove gall bladder
what problems of the pancreas did we discuss?
acute and chronic pancreatitis
how is pancreatitis seen on a CT scan?
the pancreas is very diffuse
what is acute pancreatitis?
when the pancreas starts digesting itself
what are the causes of acute pancreatitis?
ALCOHOL, implanted gall stone
what are the symptoms of acute pancreatitis?
pain, tenderness, nausea, vomiting, fever, tachycardia
what are the lab tests for acute pancreatitis?
increased WBC, increased serum amylase, increased serum lipase
what is the differential diagnosis for acute pancreatitis?
ulcer, mesenteric ischemia, intestinal obstruction, salpingitis, ectopic pregnancy
what are the investigations done for acute pancreatitis?
ultrasound for gall stones, CT scan
what is done for a pt with acute pancreatitis?
pain meds, IV fluids, nasogastric tube, no eating or drinking, removal of gall stones (ERCP), oxygen, antibiotics
what is the prognosis for those with acute pancreatitis?
HIGH MORTALITY RATE, MUST BE TREATED RIGHT AWAY
what are the complications of acute pancreatitis?
shock, renal failure, hypoxia, obstruction of intestines, infection
chronic pancreatitis?
main cause=ALCOHOL, seen more in men, inflammation causes necrosis and fibrosis of the pancreas
what are the symptoms of chronic pancreatitis?
abdominal pain, diarrhea, weight loss, diabetes
what are the investigations done for chronic pancreatitis?
xrays, CT=BEST, ERCP, ultrasound
what is the treatment for chronic pancreatitis?
pain relief, STOP DRINKING, pancreatic enzyme replacement, fat-soluble vitamin replacement
what causes expiratory airflow obstruction in COPD?
reduced recoil, reduced tethering, increased airways resistance