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Exam Biology flashcards > case 5 > Flashcards

case 5 Flashcards

1
Q

Innate immune

A 
Produces non specific immune
response
● Does not use antibodies
● Examples are Skin, Hair, Stomach
Acid, and Inflammatory response
● First line of defense
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2
Q

inflammation response

A 
Inflammation Mechanism
1) Injury occurs
2) Signaling molecules cause
vasodilation
3) Increased diameter allows for
increased permeability of immune
cells
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3
Q

cells of innate 5

A

Leukocytes: white blood cells (Ex. Neutrophils, Lymphocytes, Monocytes, Eosinophils,
and Basophils)
● Dendritic Cells: present antigens and attack pathogens
● Macrophages: present antigens and attack pathogens
● Interferons: secreted by infected cells in order to signal nearby cells of danger
● Natural Killer Cells: activated by interferons and attack cells

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4
Q

adaptive immune system

A 
Uses antibodies
● Initiates specific immune responses
● Uses B cells and T cells
● Uses major histocompatibility
complex I & II to identify cells and
antigens
○ MHC I= all nucleated cells
○ MHC II= antigen presenting cells
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5
Q

B cells adaptive

A

Plasma Cell: Create antibodies

2. Memory B Cell: Stored by body for future immune response

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6
Q

5 types of antibodies

A

● IgM - Made first and is replaced later by IgG
● IgA - Found in secretions (Ex. Breastmilk)
● IgG - Most abundant
● IgE - Cause allergic responses
● IgD - Unknown function and made in small
amounts

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7
Q

antibodies

A 
Antibodies: glycoproteins that recognize a
specific antigen
● Mark pathogen for destruction by other
immune cells
● Are presented to T Cells
● In some cases can lyse cells or neutralize
toxins
● Activates complement system
○ Complement system: enhances
immune response by phagocytizing
pathogens with a group of proteins
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8
Q

adaptive T helper cells

A 
(CD4)
● Stimulate release of antibodies in B
cells
● Increase innate and adaptive
immunity
● Can become T memory cells that are
used for future immune response
● Serve as a precursor to Cytotoxic T
cells
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9
Q

adaptive cytotoxic t cells

A

(CD8)
● Attack specific antigen
● Use perforins and granzymes to cause apoptosis in cells
● Can become T suppressor cells to provide negative feedback on the immune system
● Antigens are presented by macrophages, B cells, and dendritic cells
Require an antigen presenting cell
○ Macrophages, B cells, and
Dendritic cells
● MHC I = CD8 cells
● MHC II = CD4 cells
● After being presented with an antigen, T cell recognizes only that specific antigen

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10
Q

HIV aids`

A

HIV: Human Immunodeficiency Virus that leads to a weakened immune system
● AIDS: Acquired immunodeficiency syndrome that leads to many life-threatening
conditions and illness as a result of HIV
● HIV leads to AIDS

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11
Q

HIV I

A

Common form & easy to transmit
● Develops into AIDS quicker
● 4 groups

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12
Q

4 Groups of HIV I

A
  1. M group
    a. Makes up 90% of cases
    b. 9 strains (A, B, C, D, F, G, H, J, & K)
  2. N group
    a. Rare and only found in Cameroon
  3. O group
    a. Very rare
  4. P group
    a. Newest group
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13
Q

HIV II

A 
Rare
● Harder to transmit
● Takes longer to develop AIDS
● Mostly in West Africa
● Makes up 0.01% of cases in the USA
● No subgroups or strains
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14
Q

HIV structure 6

A

Capsid: holds RNA
● Enzymes: performs steps of the life cycle
● RNA: holds genetic material
● Envelope: outer surface that protects virus
● Glycoproteins: found on surface of virus
● Retrovirus (uses reverse
transcriptase)

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15
Q

conversion from mature to immature HIV

A 
Done by viral proteases cleaving a
long protein chain
● Cleaving of chain makes virus
infectious and mature
● Mature virus is able to continue life
cycle and replicate
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16
Q

life cycle of HIV

A

Binding to CD4 receptor

  1. Fusion through membrane
  2. Reverse Transcription
  3. Integration into cell genome
  4. Replication via cell machinery
  5. Assembly & creation of more HIV
  6. Budding of HIV
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17
Q

Acute infection

A 
(2-4 weeks)
● Virus count is high
● Patient has flu like symptoms
● Life cycle repeats quickly and CD4
cells are being attacked
● Easy to transmit
Fever, rash, sores, fatigue, swelling, and weight loss
● Lasts for a couple weeks
18
Q

c hronic infection

A 
(many years)
● Also called asymptomatic HIV
infection
● HIV continues to repeat life cycle but
at a slower rate
● Can take up to several decades
● Patient may not know they are living
with HIV
Asymptomatic at first, weight loss, prone to infections, fatigue, and swelling (lymph nodes)
● Worsens over time
19
Q

AIDS progression (stage 3)

A 
Immune system is severely
damaged
● Virus is present in large
amounts
● Opportunistic infections
become extremely dangerous
to patients
● CD4 count of less than 200 cells/mm3
Rashes, bumps, persistent fatigue, weight loss, prone to infections, and weakness
● Signs/symptoms are the most severe
20
Q

Virus transmission

A 
Exit - leaving the infected person
2) Survive - withstand temperature,
heat, acidity, and moisture
3) Sufficiency - make enough copies in
new host
4) Entry - enter the bloodstream and
cause further infection
21
Q

HIV transmission

A

Sex
● Sharing Needles
● Bodily fluids (Ex. Blood)
● Pregnancy

RISK
Unprotected Sex
● Having other STIʼs
● Sharing needles
● Lack of sterilizing equipment
● Needle stick injuries
22
Q

Nucleic Acid Tests (NAT):

A

tests blood for presence of virus by looking for nucleic acids
● Expensive and only used in high-risk exposure scenarios (10-33 days after exposure)

23
Q

Platelet levels

A

Platelet levels should be tested for prior to invasive procedures
○ Measured using a platelet count (PC)
○ Platelet count should be above 60,000 cells/mL
■ If below, consult with the patientʼs physician prior to an invasive procedure to
determine the need for a platelet infusion.

24
Q

treatment

A

There is currently no cure for HIV
● Treatment is usually done to control HIV and minimize its presence in the body
● Antiretroviral therapy (ART) is used to treat patients
○ Aimed to reduce the viral load, while keeping CD4 T cell levels high.
○ Can reduce transmissibility
○ Administration of ART does not prevent the transmission of other STDʼs.
● Best protection is offered by a combination of 3 ART medications
● Usually taken daily
○ Inconsistently taking medication may lead to drug resistance.

25
Q

ART

A

To treat HIV/AIDS, patients are often given a class of antiretroviral drugs called reverse
transcriptase inhibitors
● Targets retroviruses
● Prevents conversion of RNA into DNA
● Prevents proliferation of virus
● Not a cure
● 2 types - Nucleoside/nucleotide and non-nucleoside/nucleotide

26
Q

NRTI Nucleoside/nucleotide reverse transcriptase

A 
Stop reverse transcription by incorporating with
the viral DNA
● abacavir (Ziagen)
● lamivudine (Epivir)
● stavudine (Stavudine)
● zidovudine (Retrovir)
○ Effective at stopping transmission in
around 70% of pregnant patients
27
Q

Non-nucleoside reverse transcriptase inhibitors

NNRTIs

A 
Inhibit reverse transcription by binding
directly to the reverse transcriptase
enzyme
● doravirine (Pifeltro)
● efavirenz (Sustiva)
● etravirine (Intelence)
● nevirapine (Viramune)
● rilpivirine (Edurant)
28
Q

Protease inhibnitors + side effects

A 
Bind to the active site of enzymes
needed for the maturation of HIV
● Total of 10 FDA approved protease
inhibitors
○ Examples are Ritonavir,
Nelfinovir, and Amprenavir
Side effects of Protease Inhibitors
● Dyslipidemia: elevated levels of
cholesterol and triglycerides
● Insulin resistance
● Cardiovascular disease
● Can lead to toxicity
29
Q

ART and cd4 and viral load

A

Without ART
● Viral load ultimately exceeds CD4 count
● AIDS can develop much quicker
With ART
● CD4 count remains higher than viral load for
much longer

30
Q

side effects of art

A 
Nausea and vomiting
● Diarrhea
● Difficulty sleeping
● Dry mouth (Xerostomia)
● Headache
● Nausea
● Rash
● Dizziness
● Fatigue
31
Q

Post-Exposure Prophylaxis

A 
Taken after an exposure to HIV in
order to prevent its transmission
● Must be taken within 72 hours of
exposure
● Treatment lasts 28 days
● Prevents transmission in 80% of
cases
● Nausea is a common side effect
32
Q

HIV TREATMENT IS

A

MONEY

33
Q

Dental Patient Management

A

HIV/AIDS patients should be able to tolerate most routine dental procedures
● Perform comprehensive intraoral soft tissue, periodontal, and hard tissue
examination
● If there is a presence of HIV in the oral cavity, first priority is to relieve pain and
treat infections
● Procedures should minimize bleeding
● Consult physician if needed

34
Q

more procedures

A

Invasive procedures (extractions and endodontics) should be cautioned
○ An effort to reduce bleeding during procedures should be made
○ Especially important if patient has low platelet count
○ HIV/AIDS patients are immunocompromised. Antibiotic prophylaxis should be considered to reduce
chances of infection
● Routine procedures like dental restorations (implants, fillings) have not shown to
pose greater risks to HIV/AIDS patients.

35
Q

Dental Setting Precautions

A 
Gloves (should never be reused)
● Protective eyewear
● Mask
● Safe handling/disposal of sharp objects
(needles)
● Disposal of all PPE
● Sterilization
● Administer post-exposure prophylaxis
within 72 hours if exposure occurs
36
Q

dental sterilization

A 
HIV can be transmitted by dental
tools
● Autoclaves are used to sterilize
dental equipment and eliminate
viruses like HIV
● All dental tools must be disinfected,
as well as heat sterilized
37
Q

Antigen Antibody Test:

A

Looks for antigens and antibodies of HIV in the patient
● Most common (18-45 days after exposure)
Antibody Test: Only looks for antibodies in the patient
● Most rapid tests for HIV fall under this category (23-90 days after exposure)

38
Q

CD4 Count test:

A

normal patients have between 500-1200 cells/mm3, less than 200 indicates onset of AIDS

39
Q

Viral Load:

A 
Test for copies of RNA
● Less than 20 is ideal
● Less than 10,000 is low
● Over 100,000 is high
● Patients can have counts of over 1 million
40
Q

CD4 T cell levels

A

CD4 T cell levels should be tested for prior to invasive procedures
○ If less than 50 cell/mm3, consider antibiotic prophylaxis in order to prevent opportunistic disease.
○ Emphasize good oral health care post-procedure to prevent opportunistic disease.
■ Patient should inform dentist immediately if any unusual pain or discomfort
occur post-procedure.
○ Neutrophil count less than 500 cell/mm3 may also warrant antibiotic prophylaxis
■ Measured using absolute neutrophil count (ANC)

Exam Biology flashcards (11 decks)

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