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291 Cards in this Set
- Front
- Back
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What do many diseases result from
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an under-functioning immune system ( immunodeficiency ) or an immune system directed at the host (( auto immune disease)
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Definition of Allergy
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How our immune system responds to antigens
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What is the medical terminology for allergy?
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hypersensitivity
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Immediate Type I hypersensitivity
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- Develops within minutes of exposure to antigen
-Typically what we think of when we think of an allergic reaction -range is from hives to anaphylactic shock |
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Mechanism of Type I (Immediate) Hypersensitivity
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- IgE antibody production
-Mast cell degranulation -release of mediators |
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Type II (Antibody Mediated) Hypersensitivity
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immune reaction due to the binding of antibodies to cell surface antigens
autoimmune Hemolytic Anemia, Goodpasture Syndrome |
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Mechansim of Type II ( Antibody Mediated) Hypersensitivity
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Production of IgM, IgG
-antibody binds to antigen - phagocytosis or cell lysis |
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Type III ( Immune Complex Mediated) Hypersensitivty
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-SLE
Serum Sickness Arthus Reaction |
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Mechanism of Type III ( Immune Complex Mediated)
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Vascular deposition of Ag-Ab complexes activates complement ---> recruits WBC
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Type IV( Cell Mediated) Hypersensitivity
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-initiated by T-cells
-function of T-cell response is to eliminate cells that are infected by intracellular pathogens Contact Dermatitis, TB infection, Transplant Rejection |
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Mechanism of Type IV (Cell Mediated) Hypersensitivity
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Activated T cells ---> Macrophage activation
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What is a mast cell
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a specialized type of white blood cell that are found in tissues near blood vessels
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What do mast cells contain
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many granules in their cytoplasm that are filled with potent biologically active mediators such as histamine
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What is on the surface of the mast cell
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binding sites for the Fc portion (non- antigen binding region) of IgE antibody. Circulating IgE is taken up by mast cells. When an antigen binds to the Fab portion of the IgE, the granules from the mast cells are released.
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IgM
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antibody that usually circulates as a large molecule comprised of 5 individual antibodies joined together as a pentamer
-seen early in the response to infection |
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IgG
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primary antibody in the antibody response to infection and appears soon after IgM
-Unlike IgM, circulates as a monomer |
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IgA
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found in secretions and on mucosal surfaces , in breast milk, and saliva
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IgE
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antibody associated with immediate hypersensitivity.
- can be found on the surface of most mast cells |
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IgD
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found on the surface of developing B-cells as a receptor molecule
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What happens when an antibody binds to the surface of a cell
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the cell has been targeted for destruction
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Immune complexes
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Complexes comprised of antibody bound to circulating proteins that contain the target antigen
-helps immune system neutralize and eliminate foreign antigens |
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Anemia
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a reduction in the tots circulating red cell mass(low hematocrit and hemoglobin )
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Where do most blood cells come from?
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bone marrow
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Three Categories of Leukocytes(White blood cells)
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-Neutrophils
-Monocytes -Lymphocytes |
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Megakaryocytes
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cells that fragment to form platelets
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Stem Cell
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precursor cell that all bone marrow derived cells (myeloid cells) descend from.
- Can differentiate into red cells, neutrophils, or megakaryocyte |
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Erythropoietin
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hormone normally made by the kidney which boosts red blood cell production
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hematologic malignancies
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immature cells are unable to mature or reach full differentiation, so they keep dividing and accumulate in large numbers
Ex. Acute Leukemia |
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Plasma components
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1. Fluid portion containing water, proteins, and nutrients
2. Serum= plasma- clotting proteins |
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Plasma Function
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- maintain homeostasis (fight infection, prevent bleeding)
-Transport nutrients and electrolytes to cells - transport waste products to kidneys, liver, lungs for excretion |
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Erythrocytes Function
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-carry oxygen and CO2.
- occupy 40-45% blood volume |
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Hematocrit
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fraction of blood volume occupied by red cells
* men usually have higher hematocrit level than women |
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hemoglobin
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oxygen carrying protein responsible for red color of blood . Normal blood has about 15 g/ 100 ml
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Leukocytes
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1/1oooth as many as red cells
- fight infection |
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Neutrophil
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phagocyte, eats bacteria
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lymphocyte
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(several subtypes) makes antibodies, recognizes and kills foreign cells (microbes, transplanted tissue, cells infected w/ viruses) regulate the immune system
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Monocyte
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phagocyte, works together w/ lymphocyte to control immune response
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Eosinophil
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involved in allergic reactions , kills certain parasites
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Basophil
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involved in allergic reactions
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Platelets and function of platelets
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-small cell fragments , about 1/10th as many red cells
-helps blood clot / prevents bleeding |
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Function of T lymphocyte (T Cell)
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regulation of immune system; killing foreign or infected cells
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Source of T cells
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bone marrow, thymus, lymph nodes
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Function of B lymphocyte (B cell)
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antibody production
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Source of B cell
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bone marrow, lymph nodes, spleen, lymph, follicles in certain other tissue
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Plasma cell
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when stimulated to make antibodies the B cell differentiates into a plasma cell which is the cell type that makes most antibodies
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Natural Killer Cell (NKC)
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kills certain foreign or infected cells
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Monocyte/ Macrophages
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-phagocytosis(ingestion) of foreign cells, bacteria, etc
-digests foreign molecules and transfers pieces ("antigens") to T cells, which then tells Bcells what antibody to make - produces hormones(cytokines) which mediate inflammation and regulate growth of other cells |
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source of Monocyte/ Macrophages
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Bone marrow : first cousin of neutrophil
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2 forms of Monocytes
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a) circulating in blood= 3- 10% of blood leukocytes
b) In tissues= Macrophage |
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Lymph nodes
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collections of lymphoid cells found scattered throughout the body
- connected by small vessels |
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lymph follicles
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microscopic collections of lymph tissue contained in other organs
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spleen
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largest lymphoid organ in the body (fist sized)
-serves as a "filter" for blood and immune function |
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Lymph node
---->>>B cell location |
in and around follicles
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Lymph node
----->>>T Cell location |
between follicles of node
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Lymph node
----->>>Macrophage location |
scattered throughout
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What circulates through the nodes?
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blood and lymph
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What is anemia?
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reduction in total circulating red cell masses.
- reflected by low hematocrit and/ or hemoglobin levels |
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Possible causes of decreased Red Cell Production- due to stem cells
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1. Not enough stem cells due to generalized bone marrow failure or bone marrow replacement by non hematopoietic cells
2. Stem cells present but don not mature properly due to inherited or acquired mutation, or lack of iron or essential vitamin |
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Rapid Red cell Destruction (Hemolysis)
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- due to inherited or acquired abnormality of the red cell that shortens it's lifespan
- due to abnormality of the blood or blood vessels that causes injury to or direct destruction of the red cell |
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macrocytic
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larger than normal red cells
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normocytic
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normal sized cells
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microcytic
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smaller than normal cells
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aplastic anemia
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- Decreased #'s of stem cells; macrocytic or normocytic anemia
- caused by agents that can damage or destroy stem cells ex> Cytoxic Chemicals, Ionizing radiation in Large doses |
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Anemia of inflammation
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- Iron held in Macrophages and not released to red cell precursors
- normocytuc or microcytic -physiological response to inflammation; when inflammation gets better, so does anemia |
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What is Iron used for in the body
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Needed for hemoglobin synthesis
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Pernicious Anemia
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Caused by vitamin-B 12 deficiency
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Purpose of Vitamin B-12
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needed for DNA synthesis during Red Cell production
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Megaloblastic
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macrocytic w/ abnormal / delayed maturation
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Folic Acid deficiency
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needed for DNA synthesis by red cells
- macrocytic and megablastic |
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Lymphomas
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cancerous proliferation of lymphocytes and their precursors
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Low Grade non Hodgkin Lymphoma
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-slow growing, mature appearing cells
-generally not curable |
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High Grade non Hodgkin Lymphoma
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- Faster growing, less mature appearing cells
- potentially curable with chemotherapy |
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Hodgkin Disease (lymphoma)
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-Large multi-nucleated Reed Sternberg cells
- common in adolescents and young adults |
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Stage 1 of disease
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disease confined to single lymph node or group of nodes
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Stage 2 of disease
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disease in 2 or more lymph node groups on same side of diaphragm
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stage 3 of disease
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Disease in lymph nodes on both sides of diaphragm
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stage 4 of disease
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spread outside lymph nodes
ex....bone marrow, liver, bones, etc |
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multiple myleoma
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-originates from plasma cell
- neoplastic cells often secrete antibody like protein |
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Acute leukemia
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- caused by proliferation of immature leuocyte precursors(blasts) that have lost the ability to differentiate
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Chronic Leukemia
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- caused by proliferation of leukocyte precursors that have retained the ability to differentiate
- cells slow/ stop dividing when they differentiate -progress slower |
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ALL
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Acute Lymphoblastic leukemia
- B or T cells origin - most common in children but also occurs in adults, - often curable |
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Acute Myebgenous Leukemia
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-malignant proliferation of immature granulocyte precursors leading to accumulation in blood, bone marrow and often other tissues
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CML
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chronic myelogenous Leukemia
- malignant proliferation of myeloid stem cell with over production of white cells and often platelets |
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What does CML cause?
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enlarged spleen, fever, fatigue, weight loss
- can transform to fatal acute leukemia |
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CLL
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Chronic lymphocytic leukemia
-originates in B cells and grows slowly - primarily affects older people |
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Thrombocyopenia
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low platelet count
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qualitative platelet disorder
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normal number of platelets bu abnormal function
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neoplastic
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cancerous
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leukemia
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cancerous cells replace normal bone marrow
-spread via blood and to other tissues |
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Causes of Leukemia
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- Alterations in genes that regulate cell growth and division caused by exposure to radiation, mutagenic chemicals, or drugs , or other factors ( oncogenes)
- viral infections - precursor to cancer must overcome cell signals and safe guards first |
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What test can detect antibody coated red cells
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Coombs test
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Treatment for autoimmune hemolytic anemia
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corticosteroids( suppress immune system) or other immunosuppressive drugs
- spleenectomy( removes main site of red cell destruction) |
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Polycythemia
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Too many red cells , blood is too thick
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Disorder of Neutrophils:
Neutropenia |
- decreased neutrophils production
- caused by aplastic anemia or other forms of marrow failure - increased risk of bacterial or fungal infection |
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Diseases of Neutrophils:
Neutrophilia |
increased neutrophils by marrow in response to physiological stimuli
ex. infection |
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Demargination
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treatment of neutrophils with corticosteroids that make neutrophils less sticky so more show up in blood
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Hypersplenism
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Spleen soaks up leukocytes and platelets
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asplenia
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absence of spleen
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Thalassemia
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microcytic
- inherited disorder of hemoglobin production |
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Hemolytic anemia
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anemia due to red cell destruction
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Features of hemolytic Anemia
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- increased rate of red cell production, red cell precursors in marrow, and increased numbers of newly made red cells ("reticulocytes") in blood
- high bilirubin in blood---->>>> indicates breakdown of hemoglobin - Red cells may be taken up by macrophages in spleen and liver and then destroyed |
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Sickle Cell Anemia
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- inherited structural abnormality ( single amino acid changes) of hemoglobin leading to polymerization of hemoglobin , damage to Red Cell membrane, premature destruction of red cells
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How do sickle cells form
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Repeated cycles of hemoglobin polymerization causes red cells to become rigid and clog small blood vessels causing tissue damage (infarction)
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auto immune hemolytic anemia
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production of antibodies against one's own red cells
- antibodies coat red cells , which are then eaten by macrophages in the spleen and destroyed. |
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symbiotic
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when both the host and the parasite benefit from the relationship
Ex Bacteria in bowl that produce vit K |
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Commensalism
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When an organism benefits from a host without causing the host any harm
ex. Bacteria in our mouth |
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Saprophytic
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organisms live off dead and degenerate material material
ex. Vit K producing bacteria are both symbiotic and saprophytic because they help the host and live off degenerating material in the colon |
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What are the barriers to infection?
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-Mechanical: skin and mucous membranes
- secretions - epithelial by exfoliation -Chemical( pH) |
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Parasitism
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- interfere with the hosts integrity and function
- the more they interfere with host, the more pathogenic they are |
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virulence
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quality of being poisonous
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What determines how a host is affected by disease
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virulence of a parasite and ability of host to deal with parasite
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What are the 3 types of granular leukocytes
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- neutrophils, Eosinophils, basophils
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Tuberculosis Infection Process
Step 1 |
1. Usually enters via inhalation into lung
- 1st lesion called "Ghon" complex - disease causing bacteria are ingested by neutrophils, but bacteria continue to multiply and neutrophils die - Monocytes engulf bacteria, but cannot kill myobacteria -monocytes w/ bacteria go to lymph nodes |
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Tuberculosis Infection Process
Step 2 |
- cell mediated immunity starts in 1-2 weeks
- organisms slowly destroyed - granuloma forms |
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Tuberculosis infection process
Step 3 |
eventually most tuberculosis is walled off by a scar
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Primary Tuberculosis
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If cell mediated immunity doesn;t function properly, the bacteria may spread within 10-14 days
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Re- infection of tuberculosis
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- organism may remain dormant
-If CMI remains impaired, bacteria may break out |
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Spirochetes
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long slender helically coiled organisms
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Treponema Palladium
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Spirochete that causes Syphilis
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Borrelia Burgdorferi
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spirochete that causes Lyme Disease
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alpha hemolysis
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incomplete green hemolysis
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Beta hemolysis
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complete clear hemolysis--->>> most dangerous
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Gamma Hemolysis
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no hemolysis
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Group A B-hemolytic Streptoccus
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has only one species : "streptococcus" pyogenes'
major cause of human infection ex. strept throat, impetigo (skin infection) |
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Streptococcus Pneumoniae
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grows in pairs and makes a capsule that protects it from being eaten
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Gram (-) Cocci
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- Gonococcus: gonorrhea
-Meningococcus: meningitis -Nesseria Meningitidis: spinal meningitis |
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Gram (+) bacilli
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-clostridium - botulism, tetanus, gas gangrene
-Coryne Bacterium - diptheria |
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Gram (-) bacilli
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Enterobacteriacea: normal or disease causing inhabitants of the large bowel. Ex...E Coli
Shigella- non motile, cause dysentery |
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Acid Fast Bacilli
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principally myobacteria
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Tuberculosis
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produced by myobacterium tuberculosis
- does not stain with ordinary gram stain, only acid fast and special media |
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What is the difference between prokaryotes and Eukaryotes
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prokaryotes do not have a nucleus
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Bacteriostatic action
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process of regrowing a bacteria in culture with antibiotics to see if growth is suppressed.
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Bactericidal
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Process of regrowing a bacteria in culture of antibiotics to see if bacteria are killed
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immunologically mediated disease
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problems encountered by host are due to reaction host mounts against offending bacteria
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Bacteremia
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presence of viable bacteria within the blood
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septicemia
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presence of various pus forming organisms and other pathogens or their toxins in the blood or tissues
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sepsis
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systemic disease caused by the presence of microorganisms or their toxins in the circulating blood. may be associated with chills, fever, shock, death
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Gram (+) cocci
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Pyogenic or pus forming bacteria
- staphylococcus : grows in grape-like clusters Ex. boils, abscesses - Streptococcus : grows in chains, classified by ability to lyse red blood cells in culture |
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non granular leukocytes
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- lymphocytes
- monocytes |
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which leukocytes perform phagocytosis?
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- neutrophils, eosinophils, monocytes
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What are monocytes also referred to as?
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- macrophages or histocytes
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Humoral Immunity
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- concerned with antibody production
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Cell mediated immunity
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directs specialized cells to recognize and destroy offensive agents.
- T cells mediate response |
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What are antibodies made in response to?
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antigens
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Opportunistic pathogens
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cause disease only if they get into the wrong site or of host defenses are down. Have the ability to cause a disease when given the opportunity
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carrier state
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having a pathogenic organism, not showing clinical disease, but fully able to transmit the disease to others
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Spreading factor
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help break down tissue and allow organism to extend the region of infection
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4 principle processes for the spread of infection
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1. physical contact
- direct or indirect 2. airborne 3. food, H2O, or soil borne 4. insect borne |
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5 F's of infection spread
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1. Food,
2. Fingers 3. Fomites, 4. flies, 5. feces |
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General Structure of Viruses
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- submicroscopic, subcellular agents with a protective coat of protein wrapped around a central core of nucleic acid
- may be a surrounding lipoprotein envelope |
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What type of parasites are viruses
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obligate intracellular
- cannot reproduce outside of host - do not multiply by dividing |
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What kind of nucleic acid to viruses have?
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DNA or RNA but never both
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How are viruses classified
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by type of nucleic acid they contain, size, type of tissues they infect
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ways viruses may be spread
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- lysing the host cell and releasing numerous progeny
-budding off from the host cell in a more controlled manner -viral genomes becoming incorporated into the host genome and remain through mitotic cycles involving the hosts genome. - Some may just enter the cytoplasm of a host cell and remain inactive and reactivate at a later time |
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superinfection
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occurs when bacterial parasites have an opportunity to cause an additional infection to the one already occuring
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Influenza structure
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- 2 antigens: hemaglututinin & neuraminindase
- stimulate immune response -lipid membrane beneath antigens -protein layer surrounding the nucleocapsid -RNA genome made up of 8 separate subunits that can exchange with other viruses-----allows viruses to continuously change |
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Virus attachment process
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- attaches to host cell membrane by antigen spikes
-viral envelope fuses with host cell membrane -virus loses its cover and nuclear material enters the cell and starts to take over the machinery of the host cell |
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Viral synthesis inside host cell
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- synthesis of a new viral RNA
-new nucleocapsids migrate to cell surface where antigen spikes have been made on the surface of the hosts cells membrane by the action of the viral RNA on the host cell's synthetic machinery -nucleocapsid buds from cell surface, taking the changed membrane with it |
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rota virus
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most frequent cause of viral gastroenteritis in the young
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Ways to diagnosis viral infections
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-viral culture, measuring host antibody production, and or clinical picture
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Characteristics of Fungi
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- Do not perform Photosynthesis
-live off dying material or parasitize other organisms to survive |
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yeast
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unicellular fungi that exist in a warm, moist environment.
- reproduce by budding |
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mold
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-Fungi that exists in a colder dryer, climate
- reproduce by apical growth of hyphae |
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mycelium
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mass of intertwining hyphae
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mycoses or mycotic diseases
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fungal infections
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Amebiasis
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- caused by Entamoeba histolytica (protozoan)
- comes from ingestion of contaminated water or food - phagocytes RBC's or cyst |
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Malaria
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caused by Plasmodium
- most widespread of infections -spread by bite of female Anopheles mosquitoes *reproduces sexually in mosquito and asexually in host |
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Worm infestations are often associated with a high count of?
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Eosinophil
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Enterbiasis
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-pinworm, mainly infects children
- transmission by fecal-oral route |
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Bone consists of...
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1. cells
2. Matrix components 3. blood vessels |
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Osteoblasts
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synthesize bone, later become osteocytes
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osteocytes
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mature cells that occupy haversion systems
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Osteoclasts
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multinucleated cells that reabsorb and remodel bone
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chondrocytes
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cartilage cells
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collagen
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matrix component that is mostly Type I collagen in bone and ligaments and Type II collagen in articular cartilage
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proteoglycans
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form the matrix in cartilage
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hydroxyapatite crystals
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mineralized crystals that help to provide strength and structure to bone (matrix component)
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Bone Marrow
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contains fat cells and blood cell precursors ( matrix component)
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Intramembranous ossification
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mesenchymal cells directly become bone
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Endochondral ossification
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cartilage mineralizes to become bone, similar to how a fracture heals
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Growth plate
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where new bone is made for growing in a child
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epiphysis
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a portion of bone at the end of the growth plate next to a joint
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metaphysis
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bone adjacent to growth plate where new bone is mineralized
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diaphysis
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middle of tubular bone
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periosteum
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layer of tissue surrounding bone that provides nutrition and assists in circumferential growth
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medullary cavity
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contains trabecular bone and houses the bone marrow
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cortical bone
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thick, mature bone that gives bone its strength
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woven bone
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immature softer bone
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Osteomalacia
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defect in mineralization of bone due to a deficiency of vitamin D
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Characteristics of Osteomalacia
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- Rickets---> childhood form of disease
-alkaline phosphate activity is elevated in the serum -often requires bone biopsy for diagnosis -can be reversed with vitamin D supplementation |
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Osteoporosis
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absolute decrease in bone mass
-no serological changes - normal mineralization |
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Risk factors for Osteoporosis
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-Post menapouse
-pregnancy -immobilization -steroids -thyroid disease -cigarettes |
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Treatment for Osteoporosis
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Calcium, vitamin D, estrogen, fluorides, exercises
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Fracture: inflammatory phase
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mesenchymal cells turn into chondroblasts which make more cartilage that undergoes endochondral ossification
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Fracture : Reparative Phase
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A large callus is formed at the fracture site
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Fracture: remodeling phase
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mechanical forces on the bone cause it to slowly remodel into a more efficient and stronger structure
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open fractures
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skin over the fracture is torn= open or compound fracture
- often get infected due to contamination |
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Comminuted (high energy) fractures
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-multiple fragments of bone
-blood supply to bone is disrupted so fracture heals slowly |
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Osteomyelitis
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infection of bone
-can occur by hematogenous spread through the blood stream or direct inoculation into a wound |
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Osteosarcoma
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-Children's Disease
- highly malignant tumor that produces bone |
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Ewing Sarcoma
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-Children's Disease
- malignant tumor of primitive mesenchyma cells - often present with systemic systems |
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Multiple Myeloma
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-Adult disease
-most common bone tumor in adults - abnormal plasma cell production in the bone marrow |
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Metastatic Disease in bone
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- Adult Disease
-lesions destroy the bone and replace it with the same tumor cells as the primary lesion - spine and proximal femur are areas most commonly involved |
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3 types of joints
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1. Synarthroses
- suture lines in skull 2. Amphiarthroses -little motion, pubic symphysis and disc space in spine 3. Fibrocartilaginous structure |
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Diarthroses
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- most common, and mobile
contains synovial fluid membrane ex. Hip, knew, ankle |
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Subtypes of diarthroses
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-ball & socket in hip
-hinge in interphalangeal joints |
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Wolff's Law
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In all types of joints, form follows function
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Articular cartilage
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made up of type II collagen
- fibers parallel to axis of motion |
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synovial tissue
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lines all diarthrodial joints
- very vascular, produces variety of enzymes |
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Osteoarthritis
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most common form of arthritis
- usually non inflammatory -increased pain and loss of motion |
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Rheumatoid arthritis
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- systemic autoimmune disease
-IgM directed against IgG |
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Septic Arthritis
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-infected joints more common in children
-usually spread in blood -staphyloccal in children -Gonococcal in young adults |
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Gout
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abnormality in metabolism of uric acid
- cause inflammatory response in joints |
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Intervetebral joints
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amphiarthrodial joints
- no synovial fluid - nucleus adjusts to different loads put on it (shock absorber) -most common in lumbar spine shooting pain --->> sciatica |
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Hyperventilation
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reduced Co2
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Hypoventilation
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increased Co2
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Hypoxemia
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reduction of arterial PO2
ex...Hypoventilation : elevated alveolar PCO2 displaces alveolar O2 and hence, causes arterial hypoxemia |
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Most common mechanism causing hypoxemia
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-low ventilation/ perfusion ratio
-venuous blood remains unoxygenated after contact with poorly ventilated alveoli |
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Right to left Shunt
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venuous blood reaches the systemic circulation without contacting alveolar oxygen
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How are the elastic properties of the lung usually described?
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- plotting change in lung volume versus transpulmonary pressure
-slope= compliance of lung |
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Restrictive Lung disease
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Total lung capacity is decreased ( restriction)
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Restrictive Lung Disease:
Restriction secondary to parenchymal abnormal ex fibrosis |
TLC is reduced along with the rest of lung volumes including RV
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Restrictive Lung Disease:
secondary to respiratory muscle weakness |
TLC reduced with reduced inspiratory capacity, RV is increased because not inhaling or exhaling at a max
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Key determinant of arterial PCO2
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alveolar ventilation
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Mucociliary blanket
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lines airway epithelium
-composed of mucus type material that traps mid sized particles *mucus moved outward by cilia 2-10 microns |
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alveolar macrophages
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-non - specific/ immune defense mechanism
- most important phagocytic cell in the lung and serve to protect the lung from injuries by small particles(1-2 microns) and microorganisms |
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antioxidants
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protect the lung against toxic injuries and pollutants and immunologlobins
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Bronchiolitis
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infections involving the peripheral airways
- mostly caused by viruses - seen mostly in children |
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bronchitis
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infection involving central airway
- mostly seen in adults - caused by viruses and bacteria |
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Bronchial obstruction
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pulmonary segment distal to the area of obstruction is susceptible to pneumonia, abscess formation and bronchic
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otelectasis
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completion of an obstruction that leads to a collapse of a lung tissue distal to the area of obstruction
- diagnosed by chest x ray |
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bronchiectasis
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permanent irreversible dilation of the airway secondary to airway obstruction, infection, or cogenital abnormalities
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pneumonia
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an infection of the pulmonary parenchyma
- can be caused by bacteria , fungi, viruses, etc |
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community acquired pneumonia
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occurs in persons outside the hospital
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nosocomial pneumonia
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occurs in patients who are already hospitalized and caused by organisms prevalent in hospital environments
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opportunistic pneumonia
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represents infections in patients with compromised immune status
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What are most cases of community pneumonia caused by
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streptococcus pneumoniae
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Legionella Pneumonia
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caused by legionella pneumophila
- can occur as a community or noscomial pneumonia |
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viral pneumonia
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can be caused in immuno compromised hosts by varicella, measles, influenza
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Fungal pneumonia
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1. Infections acquired outside
2. Infections by ubiquitous organisms that afflict immune compromised hosts |
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Cause of nosocomial pneumonia
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- gram negative organisms
- S. aureus, which is gram (+) organism |
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Opportunistic Pneumonia:
Pneumorystis Carinii Pneumonia |
occurs in an immune compromised host ex...transplant chemotherapy, AIDS patients
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Opportunistic Pneumonia:
Fungal Pneumonia Invasive aspergillosis |
occurs in patients with severe neutropenia and other immune compromised states
- invades pulmonary blood vessels |
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Cytomegalovirus
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causes interstitial pneumonia in an immune compromised host
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neoplasm/neoplasia
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heritably altered, relatively autonomous growth of tissue
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Implications of replicating fast
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-genetic unstability
-not enough time to repair replicative errors - could lead to more growth advantages of cell |
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Benign
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slowly growing and do not spread to other tissues
- can still cause morbidity, and death |
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Malignant
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- grow rapidly, have ability to spread beyond tissue of origin
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Malignant tumor classification
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- Carcinoma : cells arise from epithelium
-Sarcoma: cells arise from mesenchymal cells |
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Dyplastic
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neoplastic cells stay within the tissues
-have features of malignancy and a high liklihood of behaving malignantly in the future |
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Invasion
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requires that the malignant cells be able to degrade the surrounding tissue or stroma with proteolytic enzymes
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Metalloproteinoses
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attack the basement membrane to which epithelial cells are anchored
-------->>>epithelial layer is 1st layer that must be attacked in order to invade surrounding tissues |
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What proteinases attack extracellular matrix proteins in the tissues through which malignate cells migrate
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Serine and Cysteine
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Metastasis
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non-continuous spread of malignant cells throughout the body
Ex------>>> colon cancer spreading to the brain |
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intravasation
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growth of malignant cells through wall of blood vessel or lymphatic capillary
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extravasation
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tumor embolus adheres to vessel wall at distant site and migrate back out of it
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angiogenesis
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ability to establish own blood supply
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somatic mutations
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genes are altered during the lifetime of the individual and the mutations will affect only a subset of cells of the body
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What leads to a malignant phenotype?
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cummulative effect of genetic alterations
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8 basic functions in cells corrupted in pathway to cancer:
1) Self -Sufficiency in growth cells |
Proto-oncogene codes for growth factors, receptors
- oncogene- mutated and constitutively activated form of the proto-onco gene -when the proteins involved in messaging are constantly in activating state, cells replicates more than normal |
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activating mutations
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cause a proto oncogene to become an oncogene
- only takes mutation in 1 of 2 alleles |
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8 basic functions in cells corrupted in pathway to cancer:
2) Insensitivity to growth-inhibitory stimuli |
tumor suppressor genes normally present in active state
- detect and repair DNA before cell can proliferate -mutations can result in replication w/ altered DNA - Becomes " fixed" in daughter cells - both alleles have to be mutated for the regulatory function of tumor supressor genes to be lost |
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8 basic functions in cells corrupted in pathway to cancer:
3) Evasion of Apoptosis |
prevent cell death
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8 basic functions in cells corrupted in pathway to cancer:
4) defective DNA repair |
-many DNA repair mechanisms in the nucleus that respond to and repair different kinds of damages
-when these cells do not function , the cell accumulates damage throughout the genome |
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8 basic functions in cells corrupted in pathway to cancer:
5) Limitless replicative potential 6) angiogenesis 7) invades and metastasis 8) evasion of immune system |
5)cells / subclones can go through cell cycles indefinitely until host or organism dies
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Iniation: time dependent
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appearance of permanent DNA damage in a cell
------>>incurred by exposure to free radicals in the chemical. ------>>DNA damage done by a chemical carcinogen cannot be repaired ----->>must be induced to divide so damage becomes permanent/ fixed |
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promoters
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agents that stimulate proliferation
- time dependent |
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progression
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occurs when initiation and promoters stage happens in order and in a timely fashion
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Tertiary prevention
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treating diseases in its early stages
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secondary prevention
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management of risk factors
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primary prevention
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educating populations on risk factors
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ARDS
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Adult Respiratory Distress Syndrome
Clinical syndrome of rapidly progressive respiratory failure - characterized by severe hypoxemia, - usually requiring mechanical ventilation and featuring extensive radiologic treatments |
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DAD
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Diffuse alveolardamage
non specific pattern of pulmonary parenchymal reaction to a variety of acute insults --->>>ARDS counterpart |
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endothelial lung damage
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results in a leakage of protein rich fluid from capillaries to alveolar space
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epithelial lung damage
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leads to a loss of epithelial basement membrane and of type I pneumocytes (flat epithelial cells that line the alveolar walls)
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Alveolar Damage:
Exudative phase |
develops over first week following an acute insult
-plasma protein exudation, accumulation of inflammatory cells and formation of hyoline membranes - sloughing of Type I cells |
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Alveolar Damage: Organizing phase
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Begin second week following the injury
-Marked by proliferation of Type II pneumocytes in the alveolar space and fibroblasts in the interstitium |
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Alveolar Damage: Resolution phase
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Survival w resolution of diffuse alveolar damage or pulmonary fibrosis
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COPD
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-patients with a chronic bronchitis or emphysema
- decreased expiratory flows |
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Definition of chronic bronchitis
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presence of chronic productive cough for greater than 3 months per year over a period of 2 years
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pathology of Chronic Bronchitis
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hyperplasia of mucus secreting cells
----thickening of bronchial wall by mucuous gland enlargement and edema ----increase in # of goblet cells ----increase in smooth muscle and excess mucus in airways |
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emphysema
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enlargement of air spaces distal to termnal bronchioles with destruction of bronchial walls without significant fibrosis
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pneumothorax
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accumulations of air in pleural space
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pleural effusion
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accumulation of fluid in the pleural space
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what are the key causes of ARDS
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gastric aspiration, shock, trauma, sepsis
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What is ARDS charcacterized by
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respiratory failure, refractory hypoxemia, decreased pulmonary compliance, bilateral infiltrates on chest x rays
- increased mortality , so specific therapy |
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Causes of pleural effusion
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high hydrostatic pressure ( congestive heart failure) or inflammation of the pleura
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Sarcoidosis
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chronic granulomatous interstitial lung disease of unknown etiology
-formation of non necrotic granulomas |
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Hypersensitiviy pneumonitis
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pulmonary inflamation, secondary to immune reaction to inhaled organic dusts
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pneumoconioses
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group of interstitial pulmonary diseases causes by inhalation of organic dusts
ex. Silica asbestos, beryllium -inhalation causes pulmonary inflamation which can be associated with granulomas and fibrosis |
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4 categories of carcinoma
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-squamous cell
- Adenocarcinoma - Large cell - small cell |
