Exam 2 Flashcards
(380 cards)
1
Q
Four Classification of Immune Disease
A
- hypersensitivity
- immunodeficiency
- autoimmune disease
- malignancy
2
Q
Hypersensitivity
A
too much immune response
3
Q
Immunodeficiency
A
too little immune response
4
Q
Autoimmune Disease
A
inappropriate immune response
5
Q
Malignancy
A
aggressive and harmful immune response
6
Q
Hypersensitivity Reactions
A
an inappropriate immune response to a ‘foreign’ particle
7
Q
How many types of hypersensitivities are there?
A
Type 1-4
8
Q
Type 1-3 reactions are all mediated by….
A
B cells
9
Q
Type 4 reactions are mediated by…
A
T cells
10
Q
Type 1 Hypersensitivity catch phrase.
A
“immediate, rapid responses”
11
Q
Main class of antibodies in Type 1 Hypersensitivity?
A
IgE
12
Q
T/F: A person has already encountered antigen when having a Type 1 Hypersensitivty reaction.
A
TRUE – preformed antibodies already exist in the body due to sensitization
13
Q
What are the main cells involved in a Type 1 Hypersensitivity?
A
- mast cells
- basophils
14
Q
T/F: Mast cells are the main cell type to cause anaphylaxis.
A
TRUE – mast cells release granules the cause anaphylactic symptoms
15
Q
T/F: IgE antibodies are attached to mast cells surfaces.
A
TRUE
16
Q
What do mast cells do in an allergic reaction?
A
- a rapid and intense release of various inflammatory substances
17
Q
What inflammatory substances do mast cells release?
A
histamine, leukotrienes, and serotonin
18
Q
What 3 major effects do granules have on surrounding areas?
A
- vasodilation
- increased capillary permeability
- accumulation of edema
19
Q
Describe the components of the 1st and 2nd wave of mast cell reactions.
A
1st: histamines and serotonin
2nd: derivatives of arachidonic acid
20
Q
What is arachodonic acid made from?
A
part of the plasma membrane
21
Q
What are the phases of Type 1 Hypersensitivty?
A
- immediate and late
22
Q
What are characteristics of the immediate phase of a Type 1 reaction?
A
- “wheal and flare”
- wheal: raised, red itchy skin lesion
- flare: surrounding redness and increased warmth
23
Q
What are characteristics of the late phase of a Type 1 reaction?
A
inflammation caused by eosinophils
- attached to flare
- release of cytokines causes edema
24
Q
Allergens
A
particles triggering an immune response
25
Atopy
genetic predisposition that increases an individual's susceptibility to develop allergic reactions, often characterized by a heightened immune response to common environmental allergens.
26
What is the most common allergen?
dust mites
27
Give examples of Allergic Diseases?
- Hay Fever
- Urticaria (hives)
- Atopic dematitis (eczema)
- Systemic Anaphylaxis
28
Describe the Hygiene Hypothesis.
the immune system is untrained and reacts to the wrong things more often
- IgE is typically meant to fight off parasites
29
Characteristics of places with higher rates of allergic disorders.
- westernized countries
- small family size
- affluent, urban homes
- stable intestinal microflora
- high antibiotic use
- low or absent helminth burden
- good sanitation
places with low rates = opposite of list above
30
How are Type 1 Hypersensitivities treated?
- avoidance
- pharmacological management
31
List some Pharmacologic managements.
- anti-histamines
- corticosteroids
- anti-IgE therapy
- beta adrenergics
- desensitization
32
Type 2 Hypersensitivity catch phrase.
- "cytotoxic hypersensitivity"
- tissue specific antibody directly attaches to antigen in target tissue
- B cells
33
Main class of antibodies in Type 2 Hypersensitivity?
IgG, IgM
34
T/F: Type 2 Reactions target host cells rather than foreign antigen.
TRUE
35
Types of interaction for a Type 2 Reaction.
- death of target cell
- antibodies block receptor function
36
What does 'death of target cell' mean?
a cell being killed by other components of immune system
- phagocytes
- macrophages
- neutrophils
37
What does 'antibodies block receptor function' mean?
blocking of the normal interaction between the receptor and its intended ligand, preventing the receptor from carrying out its usual signaling or regulatory function
38
T/F: Myasthenia Gravis is an example of 'antibodies block receptor function'.
TRUE -- antibodies against acetyl-choline receptor (NMJ)
- causes weakness, atrophy
- autoimmune disease
39
Examples of Type 2 Hypersensitivities.
- transfusion reaction
- hemolytic disease of the newborn
- autoimmune reactions
40
Type 3 Hypersensitivity catch phrase.
immune complex hypersensitivity
- B cells
41
Main class of antibodies in Type 3 Hypersensitivity?
IgG, IgM
42
Immune complex
antigen and antibody combine to form immune complex
43
Describe the normal clearance of immune complexes.
- RBCs drop off immune complex
- kupfer cells (macrophages) in the liver removes immune complex
44
What locations are typically affected by failure to clear complexes?
- blood vessels
- kidney
- joints
45
Failure to clear immune complexes results in...
a deposition-induced inflammatory response
46
T/F: Immune complex deposition can be distant from initial site.
TRUE -- immune complexes can circulate to different site from formation
47
T/F: Immune complexes deposition can be local.
TRUE -- complexes can remain at the site
Ex. farmers lung
48
T/F: Type 3 Reaction tend to be ongoing, with variations in symptoms based on antibody to antigen ratios.
TRUE -- Type 3 Reactions are influenced by...
- size of complexes
- vascular permeability
49
Small immune complexes tend to....
circulate for longer, increasing length of immune response
50
Increased vascular permeability allows...
immune complexes to leak out into tissues to be deposited
51
Type 4 Hypersensitivity catch phrase.
- cell mediated
- delayed response
52
Main class of antibodies in Type 4 Hypersensitivity.
- NONE; does not depend on antibodies
- T cell mediated
53
What are the reaction steps of a Type 4 Hypersensitivity?
1. Antigen uptake (hapten); presentation by APC
2. Presentation to Helper T cell
3. Memory T cells migrate to site
4. Second Exposure = release mediators, attract other cells
54
Hapten
particle that is a partial antigen by itself
55
Examples of Type 4 Hypersensitivity.
- Poison Ivy
- Metallic injury (jewelry)
- Tb test
56
Autoimmune Disease catch phrase.
- "we have the enemy, and he is us"
- self becomes foreign
57
Examples of Autoimmune Diseases.
- Systemic Lupus Erythematosus
- Rheumatoid Arthritis
- Myasthenia Gravis
- Type 1 Diabetes
- Multiple Sclerosis
58
What are the 7 reasons the body turns on itself?
(be able to explain each one)
- imperfect B and T cell programming
- Inaccessible self-antigens
- altered antigen
- molecular mimicry
- infection or inflammation
- decrease suppressor T cell function
- Genetic susceptibility (MHC protiens)
59
molecular mimicry
- resemblance of pathogen and host antigen
- immune response initiated by microbe becomes directed at self cells
60
Give a clinical example of molecular mimicry.
rheumatic fever = streptococci bacteria infection
61
Give 2 systemic Autoimmune Disease examples.
- SLE
- Rheumatoid Arthritis
62
Give 3 organ specific Autoimmune Disease examples.
- Multiple Sclerosis
- Hashimoto Thyroiditis
- Myastenia gravis
63
What are the symptoms of SLE?
- butterfly rash
- women (20 - 40 yrs)
- fever
- weakness
- photosensitivity
- arthritis
- kidney dysfunction
64
What type of Hypersensitivity if SLE?
Type 3
- binding of antibodies forms soluble immune complexes
65
Which organ is attacked most by SLE?
kidneys
66
What is the pathology of SLE?
- Circulating antibodies specific for constituents of nucleus
- Antinuclear Antibodies (ANA) in blood
Deposition:
- initiate further inflammation (arteries = vasculitis)
- chronic inflammatory disease (affects all tissues of the body)
67
How is SLE diagnosed?
- blood work
- presence of ANA
- High ESR (cell count) and CRP (inflammation)
68
Most common clinical findings of SLE?
- cytopenia
- vasculitis
- skin lesions
- myocarditis
- glomerunephritis
- arthritis
- brain (microinfarcts, psychosis, dementia)
69
What is the typicaly clinical outcome of SLE?
variable and unpredictable
70
T/F: SLE has a 30% mortality rate in the first 10 years.
TRUE -- eventual death is due to organ failure of kidneys and brain
71
Treatment of both mild and severe SLE?
mild = NSAIDS
- inhibits arachadonic acid derivatives to stop inflammation
severe = corticosteroids, antineoplastic
- inhibits t cell division
72
T/F: Autoimmune disease inducing Lupus-like symptoms following exposure to certain drugs.
TRUE -- only about 10% of lupus cases
73
What are common symptoms of Rheumatoid Arthritis?
- immune system attacking synovial joints
- 20- 40 yrs
- episodic
- 1- 3% of population
74
What type of Hypersensitivity is Rheumatoid Arthitis?
Type III Hypersensitivity
75
What does systemic Rheumatoid Arthitis attack?
- lungs
- bone
- cartilage
- pericardium
76
Rheumatoid Factor
autoantibody
77
Sjorgren Syndrome
autoimmune disease of lacrimal and salivary glands
78
What are symptoms of Sjogren Syndrome?
- dry irritated red eyes
- dry mouth
- difficulty swallowing
- extraglandular (vasculitis, neuropathy, lymphoma)
79
Amyloidosis
group of diseases in which amyloid proteins are abnormally deposited
80
Amyloid
extracellular, insoluble protein aggregates
81
Primary Amyloidosis
- no cause is known
- antibodies form amyloid (light chain)
82
Secondary Amyloidosis
secondary to some other condition (SLE, RA)
- signs and symptoms depends on the tissue/organ
83
Types of transplantation
- autograft
- homograft
- allograft
- xenograft
84
T/F: transplantation rejection is mediated by immune system.
TRUE -- caused by mismatch of MHC
85
Types of Rejection
- hyperacute organ rejection
- acute organ rejection
- chronic transplant rejection
86
Hyperacute Organ Rejection
preformed antibodies react with graft endothelial cells; people affected include...
- past transplant recipient
- pregnant woman
- blood transfusion recipient
timeframe = immediate
87
Acute Organ Rejection
- within weeks
- T cell mediated
88
Chronic Transplant Rejection
- months to years
- T cell mediated
- ischemia and hypoperfusion of organ
89
Graft vs Host Reaction (GVH): Mechanism
- immune cells in graft recognize host as foreign
- transplanted graft lymphocytes attack host cells
90
Graft vs. Host Reaction (GVH): Tissues Affected
- liver, skin, GI tract
- tissues under most attack bc dividing frequently
91
Graft vs. Host Reaction (GVH): Minimization
- matching graft as best as possible
- immune suppression
92
T/F: GVH is commonly found with bone marrow transplantation.
TRUE -- recipient must undergo pretransplant treatment
93
T/F: Bone marrow transplants are the most common type of transplantation.
FALSE -- blood transfusions are the most common
blood typing is done to match donors and recipients
94
What antigens do Type A people have?
What antibodies do they produce?
- A antigens
- B antibodies
95
What antigens do Type B people have?
What antibodies do they produce?
- B antigens
- A antibodies
96
What antigens do Type O people have?
What antibodies do the produce?
- no antigens
- A and B antibodies
97
What antigens do Type AB peple have?
What antibodies do they produce?
- A and B antigens
- no antibodies
98
Major Transfusion Reaction
- hemolysis
- thrombosis
- life threatening
99
Minor Transfusion Reaction
- not life threatening
- fever, chills
- not due to ABO mismatch
100
Rh Incompataility
- D/d antigens
- Hemolytic Disease of the Newborn
101
Crossmatch
donor blood is compatible with recipient blood
102
Major Crossmatch
- Donor RBC to recipient serum (paslma w/ clotting factor)
- checking for preformed antibodies in recipient serum against donor RBC
103
Minor Crossmatch
- donor serum to recipient RBC
- checking fo rpreformed antibodies in donor serum that could hemolyse recipient
104
Severe Combined Immundeficiency Disease
deficiency of T cells
- caused by mutations
- prone to infections and cancer
105
# Primary Immunodeficiency
X-Linked Agammaglobulin (XLA)
- deficiency in tyrosine kinase
- prevents development of mature B cells
106
# Primary Immunodeficiency
XLA Clinical Presentation
- males more often affected
- bacterial infections more frequently
- blood tests show no B cells
107
# Primary Immunodeficiency
DiGeorge Syndrome
- 22 q deletion
- TBX1 is important for thymus formation
- no thymus = no T cells SCID
108
Secondary (Acquired) Deficiency
Secondary to something else:
- nutrition
- infection
- radiation
- age
109
# Secondary Deficiency
HIV
human immunodeficienct virus
110
# Secondary Deficiency
AIDs
autoimmunedeficiency disorder
111
# Secondary Deficiency
How are AIDs and HIV related?
HIV causes AIDS
- not exactly the same
112
# Secondary Deficiency
Characteristics of AIDS
- low Helper T cell count
- recurrent infections that are not normally observed
- certain kinds of neoplasms
- cachexia (wasting away; skinny)
113
T/F: AIDs transmission is transmitted through skin to skin contact.
FALSE -- transmission is through blood and bodily fluids
114
What groups are at higher risk of AIDs in the US?
- gay and bisexual males
- IV drug user
- patients with hemophilia
- recipients of transfusion of human blood
- heterosexual contacts of the above
115
Retrovirus
a virus that uses RNA as its genetic material
116
HIV Pathogenesis
1. HIV contributes its RNA to helper T
2. Reverse transcriptase: RNA makes DNA
3. Abnormal DNA becomes part to T cell DNA
4. Synthesis of new HIV RNA
5. New HIV virus buds from infected T cell
6. Death of infected T cell
117
HIV entry depends on....
- CD4 receptor
- CCR5 (CXCR4) co-receptor
118
What are the 3 stage progressions of HIV?
- Acute
- Latent
- Crisis
119
Acute HIV Syndrome
- primary infection
- sore throat, fever, rash
- wide spread dissemination of virus
- seeding of lymphoid organs
120
Latent HIV
infections still present but lack of symptoms
- can still be transmitted
121
Crisis HIV
- AIDs
- opportunistic diseases
- low helper T cell count
122
What are the clinical features of the crisis period (AIDs) of HIV infection?
- opportunistic infections
- neoplasms
- neurological symptoms
123
Examples of opportunistic infections during AIDs.
- candidasis
- tuberculosis
- salmonella
- herpes
124
Examples of neoplasms during AIDs.
- kaposi sarcoma
- lymphoma brain
125
Examples of neurological symptoms during AIDs.
- dementia
- seizures
- mood swings
126
HIV resistant mutation?
Homo- vs Heterozygous?
Ethnicity?
- mutation in CCR5 (co-receptor w/ CD4)
- homo won't be infected; hetero will cause infection to move slower
- caucasian population
127
Diagnosis of HIV and AIDS
- Anti-HIV antibodies
- HIV antigens in blood
- Saliva
128
# Clinical Diagnosis AIDS
Definitive w/out confirming lab data.
kaposis's sarcoma < 60 yrs old
129
# Clinical Diagnosis AIDS
Definitive w/ confirming lab data.
CD4+ < 200 cells/ml
130
# Clinical Diagnosis AIDS
Presumptive w/ confirming lab data.
recurrent pneumonia
131
T/F: The goals of HIV treatment is complete clearance of infection.
FALSE -- HIV cannot be cured; goals include:
- control virus
- control other infections
132
HAART
Highly Active Antiretroviral Therapy
133
HAART Effects on HIV
- suppress virus repilcation
- act on different stages of life cycle of HIV
- increases latency period, may be indefinitely
134
What different stages of HIV life cycle does HAART act on?
- entry inhibitors
- nucleotide reverse transriptase inhibitors
- protease inhibitors
- chemokine receptor
135
microflora
microorganisms normally living in or on your body
136
T/F: All microflora are beneficial.
FALSE -- some are useful; many have no effect
137
pathogens
cause disease
138
T/F: Only pathogens are capable of causing disease if your health and immunity are weakend.
FALSE -- both microflora and pathogens are capable of causing disease when normal health is weakend.
139
opportunistic pathogens
normally does not cause disease but could in a weakend immune system
140
T/F: Pathogens vary in where they live and replicate.
TRUE
141
T/F: Pathogens vary in how they damage host cells.
TRUE
142
T/F: All pathogens have the same ability to persist outside the body.
FALSE -- pathogens vary in ability to live outside the body
143
Virulence
- ability to cause damage and disease in host
- "how much harm can it cause?"
144
Why are some pathogens more virulent than others?
- secrete toxins
- adhesion factors
- evasive factors
- host factors
145
Virulence variability: secrete toxins
exotoxins and endotoxins
146
Virulence variability: adhesion factors
help infective organism colonize
147
Virulence variability: evasive factors
help keep immune system from killing infective agent
148
Virulence variability: host factors
- genetics
- malnutrition
- age
149
Contagion
- how easily spread from one organism to another
150
Indirect contagion
- sickness passed fomite before passing to another person
151
Direct contagion
- from one person to another person
152
Mode of transmission
- direct contact
- ingestion
- indirect contact (fomite)
- droplets
- vectors
153
Fomite
inanimate objects carrying pathogen
154
Vectors
diverse modes of transmission through which infectious agents spread from one host to another
- encompassing direct contact
- airborne particles
- contaminated surfaces
- mosquitoes
155
Agents of Infectious Disease
- prions
- virus
- bacteria
- fungus
- parasites
156
T/F: Prions are small infectious abnormally folded proteins.
TRUE -- infection induces normal proteins to convert to abnormal prion form
- 'scrapie'
157
Prions primarily affect...
the nervous system
158
Transmission of Prions
- genetics (creutzfeldt jakob disease)
- eating infected tissue (mad cow disease)
159
T/F: Viruses have a protein coat surrounding nucleic acid core.
TRUE
160
T/F: Viruses have metabolic enzymes of their own.
FALSE -- viruses lack metabolic enzymes and depend on host
161
T/F: Viruses insert their genome into a host cell's DNA.
TRUE
162
T/F: Viruses use host cell's metabolic machinery to make new virsues.
TRUE
163
How does a virus effect cells?
- alter cell physiology
- inhibit synthesis of host cell macromolecules
- genotoxic
- alter cell's antigenic properties
164
What cell physiology could a virus alter?
- ion movement
- second messengers
165
Genotoxic
alteration of DNA
166
Types of viral infections
- acute
- latent
167
Acute Viral Infection
Examples?
- transient
- rhinovirus, norovirus, measles, influenza
168
Latent Viral Infections
some viruses cause persistent infection
169
T/F: Anti-viral inhibits some stage of viral replication cycle without toxicity to cell.
TRUE
170
Antiviral Agents kill viruses by...
- blocking viral RNA or DNA synthesis
- blocking viral binding to cells (entry inhibitors)
- blocking production of the protein coats (capsids) of new viruses
171
Describe bacteria
- prokaryotes
- can live independently
- use infected organism for food and shelter
172
T/F: Bacterial infections are typically latent infections.
FALSE -- typically acute infections
173
Bacterial infections are typically characterized by....
- shape
- gram stain
174
Examples of bacteria shape
- cocci
- baccili
- spirochetes
175
Gram Positive
- staphylococci and streptococci
- commonly found on skin
176
Gram Negative
- cause intestinal and respiraotory infections (pneumonia)
177
Sepsis
- blood is infected, typically bacteria
- whole body inflammation
- leads to septic shock
178
Septic Shock
- high mortality
- wide spread organ damage
- low BP
179
Antibiotics kill bacteria by targeting...
- cell wall synthesis
- protein synthesis
- nucleic acid synthesis
- bacterial metabolism
180
Bacteria fight antibiotics by...
- inactivating antibiotics
- changing antibiotic binding sites
- using different metabolic pathways
- changing their walls to keep antibiotics out
181
Describe fungi
- most require cooler temp than human core body temp
- most infections are on body surfaces (skin, hair)
182
Examples of fungus infections
- candidiasis (yeast infection)
- tinea pedis (athletes foot)
183
Vector-borne infections: Malaria
mosquito
184
Vector-borne infections: Rocky Mountain spotted fever
ticks, lice, chiggers
185
Vector-borne infections: Lyme disease
deer ticks
186
Vector-borne infections: Plague
rodent fleas
187
T/F: Emerging diseases are/were previously unknown or undetected.
TRUE -- infections that have recently appeared
188
Examples of emerging diseases
- SARS
- Zika
- Swine Flu
- COVID
189
Why is China a common place of origin for these diseases?
- highly populated areas
- daily wildlife trade with close human contact
190
Zoonosis
disease transfer from animal to human
191
Describe coronavirus
- large group of viruses that cause disease in humans and animals
- enters via ACE2 receptor
- genomic sequence similar to bat coronavirus
192
T/F: Infection causes injury.
TRUE
193
T/F: Inflammation is the usual response to infection.
TRUE
194
T/F: Infectious agents spread in a certain way.
TRUE
195
T/F: Infection runs a natural course.
**TRUE**
- incubation
- prodromal
- illness
- convalescence
- recovery
196
Incubation period
no symptoms; infectious cells are multiplying
197
Prodromal period
nonspecific symptoms; feeling 'under the weather'
198
# [](http://)
Illness period
specific signs and symptoms
199
convalescence period
symptoms fading away
200
Recovery period
no symptoms
201
What immune cells respond to bacteria?
neutrophils
202
What immune cells respond to viruses?
lymphocytes, macrophages
203
What immune cells respond to mycobacteria and fungi?
lymphocytes, macrophages
204
What immune cells respond to parasitic worms?
eosinophils
205
What immune cells respond to protozoa?
lymphocytes, macrophages
206
Tuberculosis is caused by...
mycobacterium
- typically infects lungs but can also affect any part of the body
207
Transmission of Tuberculosis
airborne droplets
208
Common Symptoms of Tuberculosis
- cough
- coughing up blood
- chest pains
- fever
- night sweats
- feeling weak and tired
- losing weight without trying
- decreased or no appetite
209
T/F: 98% of Tuberculosis related deaths occur in developing countries.
TRUE -- most common in southeast asia and africa
210
T/F: Most of the US tuberculosis cases occurred in Florida, Texas, California, and New York.
TRUE -- more populated areas
211
Explain the respiratory route of TB spread.
- Causitive agent (mycobacterium tuberculosis)
- reservoir (infected patient)
- Portal of exit (infected lungs)
- Mode of transmission (sneeze/cough)
- portal of entry (healthy lungs)
- susceptible host (person not immune to TB)
212
What does it mean when TB is described as 'hardy'?
can exist outside of hosts for months
213
TB infection begins with...
phagocytosis into macrophage
214
T/F: TB can remain inside the host in a dormant form and reactivate later.
TRUE
215
T/F: In response to TB infection, immune system forms tubercules.
TRUE -- granuloma formation
216
Granuloma
Type of necrosis?
bacteria trapped in tissues, surrounded by immune cells
- causeous
217
Tuberculosis diagnosis is based on...
- symptoms
- medical history
- TB tests
- Chest X-rays
- diagnositc microbiology
218
What are the 2 types of TB tests?
- TB skin test
- blood tests
219
What is diagnostic microbiology for TB?
sputum smear -- look for acid-fast bacteria
220
Latent Tuberculosis Infection (LTBI)
individuals harbor the tuberculosis bacteria without active symptoms or spreading the disease, but there is a risk of it reactivating into active tuberculosis in the future.
221
What are the predisposing factors of activating LTBI?
- HIV infection
- Other illnesses
- Weak immune system
- Stress
- Being homeless
222
Latent TB Treatment
- not symptomatic or contagious
- positive skin test
- usually treated with isoniazid for 6-12 months
- chest x-ray is negative
223
Infectious TB Treatment
- treatment is very expensive
- treated in phases
224
T/F: A person with infectious TB is allowed to be around everyone.
FALSE -- person must be isolated until non-infectious
225
T/F: Directly observed therapy to assure adherence/completion recommended for TB treatment.
TRUE
226
STI acronym
sexually transmitted infection
227
# definition
STI
general term for any disease that can be spread by intimate or sexual contact
228
Common signs and symptoms of STIs
- hematuria, urinary frequency, incontinence, purulent discharge, burning, itching on urination
- pelvic or genital pain
- any skin ulcerations, especially in genital areas
- fever, malaise
229
Hematuria
blood in urine
230
Incontinence
peeing on accident
231
What are the types of STIs?
- bacterial
- viral
- protozoal
- parasitic
- fungal
232
What type of STI is Gonorrhea?
caused by bacteria
233
T/F: 1 in every 20 college aged females is infected with gonorrhea.
TRUE
234
Gonorrhea transmission generally requires...
contact of epithelial surfaces
235
T/F: Humans are the only natural hosts of gonorrhea.
TRUE
236
Symptoms of gonorrhea
- pain
- discharge (not bloody)
- asymptomatic
237
T/F: Gonorrhea bacteria can only grow in the genital region.
FALSE -- can grow in the mouth, throat, eyes and anus
238
T/F: A gonorrhea infected mother can infect an infant during vaginal delivery.
TRUE
239
T/F: Gonorrhea can lead to infertility.
TRUE
240
Gonorrhea Treatment
antibiotics
241
What type of STI is syphilis?
caused by bacteria
242
T/F: Syphilis can infect any body tissue.
TRUE
243
T/F: Syphilis is less common but more deadly.
TRUE -- syphilis becomes a systemic disease shortly after infection
244
Congenital Syphilis
maternal-fetal transmission can occur as early as 9 weeks gestation
245
What are the stages of syphilis infection?
- primary
- secondary
- latent
- tertiary
246
Describe the primary stage of syphilis
local manifestations
- chancre
- painless, can go unnoticed
- resolves spontaneously
- highly contagious
247
Describe the secondary stages of syphilis
systemic manifestations
- fever, malaise, sore throat, hoarseness, anorexia, joint pain, skin rash, and lesions
- highly contagious
248
Describe the latent stage of syphilis
- medical evidence of the infection, but patient is asymptomatic
- unlikely contagious
249
Describe the tertiary stage of syphilis
- may emerge 5-20 yrs following latency
- most severe stage
- formation of gummas
- destructive systemic manifestations
- neurosyphilis
250
Gummas
destructive skin, bone, and soft tissue lesions
251
Syphilis treatment
antibiotics
252
T/F: The immune system has memory when it comes to STIs.
FALSE -- the immune system does not have memory bc STIs typically affect a limited range of immune cells
253
What type of STI is chlamydia?
caused by bacteria
254
T/F: Chlamydia is rare.
FALSE -- chlamydia is extremely prevalent
255
T/F: Chlamydia is one of the most potentially damaging STDs in the US.
TRUE
256
Chlamydia hallmarks
- urinary frequency
- abdominal pelvic discomfort
- discharge
257
Chlamydia signs and symptoms
- silent STD; asymptomatic; transmission occurs unknowingly
- burning, itching in genitalia
- mucopurulent vaginal discharge
- discharge from penis
- burning on urination
- swollen scrotum
258
Chlamydia prognosis
- good with early treatment
If untreated, such complications as:
1. Pelvic Inflammatory DIsease
2. infertility in females
3. epididymitis in males
4. sterility in both
259
What type of STI is herpes?
caused by virus
260
T/F: Genital herpes is a highly contagious viral infection of genitalia.
TRUE
261
T/F: Genital herpes recurs spontaneously.
TRUE
262
T/F: Genital herpes is life-threatening in infants during vaginal birth.
TRUE
263
What are the two stages of genital herpes?
- active with skin lesions
- latent without symptoms
264
What are the two types of herpes?
- HSV-1 (cold sores)
- HSV-2 (genitalia)
265
T/F: 98% of initial herpes infections are type 2.
FALSE -- only 80% of initial infections are type 2; but 98% of recurrent infections are type 2
266
T/F: Herpes is transmitted through contact with a person who is shedding the virus.
TRUE -- the skin can look normal, but virus is still being shed
267
Genital herpes signs and symptoms
- multiple shallow ulcerations, pustules, on genitales, mouth, and anus
- vesicles rupture causing pain, itching
268
Genital herpes treatment
- managed not cured
- anti-viral medication
269
T/F: 80% with primary genital herpes have recurrence within 12 months
TRUE
270
HPV acronym
human papillomavirus
271
T/F: HPV is the most common STI.
TRUE -- HPV can spread without actually seeing them
272
HPV (genital warts) signs and symptoms
- soft skin-colored, whitish pink to reddish brown bengn growths
- found on genitals, including vagina, cervix and anus
- very contagious
- may not be visible to naked eye
273
HPV (genital warts) treatment
may go away without treatment
- sometimes immune system fights and can resolve
274
HPV etiology
- spread by intimate contact
- pregnant women can pass the virus to the fetus during childbirth
- has an incubation of 1 to 6 months
275
What is HPV a risk factor for?
- cervical cancer (women)
- oral/throat cancer (everyone)
276
How do you prevent HPV?
HPV vaccination
277
Genital herpes physical description
blistery sores causing pain, itching
278
Genital warts physical description
small, painless, do not open and pus
279
T/F: Genital herpes come and go without treatment, but genital warts come but do not always go away without treatment.
TRUE
280
How to prevent STIs?
- vaccines (HPV)
- safe sex
281
Cancer is a name given...
too a group of more than 100 related diseases
282
Cancer is characterized by...
uncontrolled cell growth
283
Lifetime probability of developing cancer for women?
For men?
- 1 in 2 women
- 1 in 3 men
284
Most diagnosed cancers for women?
For men?
- breast
- prostate
285
Most cancers caused deaths for women?
For men?
- lung and bronchus
286
There has been an overall negative trend in cancer mortality, this can most likely be accredited to...
an increase in screening tests
287
Hyperplasia
increase in number
288
Hypertrophy
increase in size
289
neoplasm
uncontrolled growth of cells, benign or malignant
290
tumor
a non-specific term meaning lump or swelling
291
T/F: Neoplasm and tumor are synonymous.
TRUE
292
Metastasis
discontinous spread of a malignant neoplasm to distant sites
293
Malignant
capable of metastasis
294
cancer
any malignant neoplasm or tumor
295
T/F: Metastasis, malignant and cancer can be considered synonymous.
TRUE
296
What is the difference between neoplasia and hyperplasia?
neoplasia is cell proliferation in the absence of a stimulus
297
T/F: Neoplasia and hyperplasia can be differentiated from eachother by just looking at the mass as a whole.
FALSE -- can only be distinguished from eachother by histological examination (cell and tissue structure)
- biopsy
- fine needle aspiration
298
Hyperplasia treatment
- remove stimulus
- removal of hyperplastic tissue
299
Neoplasm treatment
- depends on benign (will not metasize) or malignant
- depends on site of neoplasm
malignant neoplasm:
- curative therapy
- pallitative therapy
300
What are examples of curative therapy?
- chemotherapy
- radiation
- surgery
301
Benign Neoplasms
- grow slowly
- capsule
- do not metastasize
- well differentiated
302
Malignant neoplasms
- grow rapidly
- can metastasize
- less differentiated
303
What does it mean is cancer cells are dedifferentiated?
the most cancerous cells are less differentiated
304
T/F: "-oma" does not distinguish between benign or metastatic.
TRUE -- more often used in conjunction with malignant neoplasms
305
Carcinoma
malignancy of epithelial cells
306
sarcoma
malignancy of connective tissue
307
melanoma
malignancy of connective tissue
308
lymphoma
malignancy of lymphoid tissue
309
Etiology of Cancer
loss of genetic integrity
- large or small scale
- damaged DNA due to mutations
- occur in germline or somatic cells
310
How are mutations acquired?
- carcinogens
- inherited
- spontaneous
311
Environmental Carcinogens
- ionizing radiation
- virus
- UV
- dietary carcinogens
- chronic inflammation
- environment (smoking, pollution, diet)
312
Hallmarks of Cancer
- self sufficiency in growth signals
- insensitivity to growth-inhibitory signals
- evasion of apoptosis
- limitless replicative capacity
- sustained angiogenesis
- tissue invasion and metastasis
- evade immune surveillance
313
Driving mutations
- oncogenes
- tumor suppressor genes
- DNA repair genes
314
Proto-oncogene
usually involved in normal cell growth and cell division
315
Oncogene
proto-oncogene that has been activated by mutation
- growth factors, growth factor receptors, kinases, G-proteins
- gene amplification
316
What are two examples of oncogenes?
- HER2
- Ras
317
HER2 acronym
human epithelial growth factor receptor 2
318
HER2 gene
encodes for growth factor receptors
319
T/F: HER2 overexpression and amplification occur frequently in breast and ovarian cancer.
TRUE
320
Ras function
- relays signals from cell surface
- active when GTP bound
- inactive and GDP bound
321
What type of mutation causes Ras to always be on?
point mutation
322
Tumor Suppressor Genes function?
Example?
- halt cell cycle
- p53
323
Describe p53 activity during cell cycle
- active at G1/S checkpoint
- levels are normally low
324
p53 nickname
Gaurdian of the Genome
325
What state is p53 found in more than 50% of all cancers?
mutated (inactivated)
326
p53 regulates (activates or inhibits) ?? of more than 50 different genes.
transcription
327
When do activated p53 levels rise?
- DNA becomes damaged
- repair intermediates accumulate
328
How are cancers resistant to apoptosis?
- inactivate pro-apoptotic proteins
- activate anti-apoptotic proteins
- upregulate telomerase
329
What is the significance of Bcl-2 anti-apoptosis genes?
overexpression prevents cells from undergoing apoptosis
330
DNA repair genes function?
Examples?
correct errors that arise during DNA replication
- BRCA1 and BRCA2
331
What is a common characterisitic of many cancers?
(60-80%)
chromosomal instability (CIN)
332
CIN typically has...
poor prognosis
333
CIN imbalance
instead of two copies, cancer cells had 1- 6
334
CIN imbalances...
1. ?? number of chromsomes that have oncogenes
2. ?? chromosomes that bear TSG
3. ?? inflammation
1. increase
2. minimize
3. increase
335
T/F: Inflammation is a hallmark of cancer.
TRUE -- Role of Immune System in Tumorigenesis
- chronic inflammation contributes to cancer development
- paradox
336
How does chronic inflammation contribute to cancer development?
creates a microenvironment promoting genomic lesions and tumor initiation
337
How is the immune system a paradox during tumorigenesis?
immune system protects host against tumor growth AND promotes tumor growth
338
T/F: One mutation in DNA can cause cancer.
FALSE -- one mutation is not enough to cause cancer
- if one mutation caused cancer then the rate would be constant independent of age
- percentage of people with cancer increases with age
339
# Biology of Neoplastic Growth
Dysplasia
- premalignant state
- tissue is atypical
- usually epithelium
- does not necessarily progress to malignancy
340
# Biology of neoplastic growth
Carcinoma in situ (CIS)
- cancer in place
- not invasive = basement membrane intact
- curable by complete excision
341
# Biology of neoplastic growth
progression to invasion
invasion of blood vessels or lymphatics with metastasis
342
# Biology of neoplastic growth
What makes cancer so difficult to treat?
- cells start as monoclonal
- end result is tumor cell heterogeneity
- tumor cells all have different number of mutations
- becomes "survival of the fittest"
343
# biology of neoplastic growth
T/F: Not all tumor cells are actively dividing.
TRUE --
- tumor growth ratio
344
# biology of neoplastic growth
Tumor Growth Fraction =
ratio of proliferating cells to total cells
- those with highest tumor growth fractions are most affected by chemotherapy
345
T/F: People with high tumor growth fractions have better success rates with chemotherapy.
TRUE -- large number of highly proliferative cells are easier to attack
346
Paraneoplastic tumor
effects of cancer mediated by humoral factors
347
Examples of paraneoplastic tumor
- hormones released by a cancer cell (cushing syndrome = too much cortisol)
- cross-reacting antibodies
348
Paraneoplastic tumors are more common in
- lung
- breast
- ovaries
- lymphatics
349
What is immune surveillance?
what cells are involved?
- destruction of altered host cells
- natural killer cells
- cytotoxic T cells
350
In regards to immune surveillance, immunodeficient patients...
are more likely to get cancer
351
T/F: Cells need to be studied to confirm cancer.
TRUE
352
cytology
study of cells
353
How are cells obtained for cytology?
- biopsy (piece of tissue)
- resection (larger piece of tissue)
- fine needle aspiration (suction of some cells)
354
What does cancer treatment depend on?
grading and staging
355
cell grading
microscopic assessment
- how abnormal do they look?
- undifferentiated?
356
cell staging
behavioral assessment
- size and extent of metastasis
- help plan the treatment
357
Tumor Staging (TNM) system
- Tumor: level 0-3
- Nodes: level 0-2
- Metastasis: level 0-2
358
Gleason Grading system
levels 1-5
- 1 = differentiated
- 5 = completely undifferentiated
359
# Tumor Grading
Stage 0:
CIS
360
# Tumor grading
Stage 1:
not spread into surrounding tissues, but larger than stage 0
361
# tumor grading
Stage 2:
may extend into nearby tissue
362
# tumor grading
Stage 3:
spread to nearby lymph nodes, but not other parts of the body
363
# tumor grading
stage 4:
spread to distant tissues and organs
364
Tumor markers
substances that appear in blood that can be used as a marker of neoplasm
365
Are tumor markers used for cancer diagnosis?
no, need to look at cells for diagnosis
366
What are tumor markers useful for?
- confirmation of diagnosis
- monitor therapy
367
What are examples of Tumor markers?
- prostate specific antigen; PSA
- breast cancer-CA-15-3
368
Lung cancer screening
chest radiographs (low sensitivity)
369
Prostate cancer screening
PSA (controversial)
370
breast cancer screening
mammogram at age 40
371
cervical cancer screening
pap smear
372
colorectal cancer screening
fecal occult blood test, colonoscopy at 45 yrs
373
Does early detection translate to decrease in deaths?
yes, otherwise whats the point in screening
374
Cancer treatment
- surgery
- radiation
- chemotherapy
- hormone therapy
- immunotherapy
- angiogenesis therapy
375
# cancer treatment
surgery
- to prevent cancer
- removal of abnormal tissue
- biopsy for diagnosis and staging
- lymph node sampling
- debulking surgery
- palliative surgery
376
# cancer treatment
hormone therapy
- receptor activation or blockage
- interferes with cellular growth and signaling
- doesn't cure but works to prolong life
377
# cancer treatment
ionizing radiation
goals:
- eradicate cancer without excessive toxicity
- avoid damage to normal structures
- ionizing radiation damages that cancer cell's DNA
378
# cancer treatment
chemotherapy
- use of nonselective cytoxic drugs that target vital cellular machinery or metabolic pathways critical to both malignant and normal cell growth replication
side effects:
- hair loss
- GI issues
- loss of appetite
- anemia
- frequent infections
379
# cancer treatment
immunotherapy
- stimulating own immune system to work harder or smarted to attack cancer cell
- giving immune system components to attack cancer (antibodies)
380
What life style choices reduce risk of cancer?
- don't use tobacco products
- sun safety
- diet
- drink alcohol in moderation
- exercise regularly
- vaccination (HPV)
- safe sex practices
- self-examination
