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ClinMed > Pathologies Related to the Immune System: Test 2 > Flashcards

Pathologies Related to the Immune System: Test 2 Flashcards

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1
Q

What are the 3 broad groups of cells

A

innate
adaptive
macrophages

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2
Q

describe innate cells. Examples?

A

non specifics from birth

i.e. monocytes, neutrophils, eosinophils, basophils, mast cells, natural killer cells

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3
Q

describe adaptive cells

A

acquired following exposure
remember foreign invaders
i.e. B and T cells or lymphocytes
how MOST vaccines work

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4
Q

describe macrophages and dendritic cells

A

innate AND adaptive

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5
Q

where do stem cells occur? What do they do?

A

in bone marrow and blood

they generate immune cells

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6
Q

what are neutrophils

A

predominately leukocyte or white blood cells

1st cells to arrive

take part in phagocytosis

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7
Q

describe the process of phagocytosis

A

ingest and kill pathogens and debris

short lived; when they die it forms pus along with the bacteria

a decrease in phagocytosis is the principal cause of susceptibility to infection

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8
Q

describe monocytes and macrophages

A

long lived cells

monocytes mature into macrophages

filter the pus/bacteria from neutrophils and kill larger pathogens

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9
Q

what are eosinophils

A

next cells to participate after neutrophils and monocytes/macrophages

handle even larger invading pathogens

release histamines (vasodilator; cause of Redening); basophils and mast cells also release histamines

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10
Q

describe lymphocytes

A

B lymphocytes- produce antibodies in reaction to antigens or foreign substances

T lymphocytes- stimulate B lymphocytes that directly kill infected host cells

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11
Q

describe natural killer cells

A

large lymphocytes (distinct from B and T cells)

function is to directly kill cells infected with pathogens (avoiding any prior steps)

NK cells can also activate macrophages

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12
Q

describe the key components of the first line of defense in terms of innate cells (x5)

A

natural and preventative
they are capable of resolving most threats
have pattern recognition of some pathogens
limited specificity so they may not remember all future invaders
both external and internal defenses

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13
Q

describe the external defenses of innate cells

A

physical, chemical, and mechanical barriers that limit host penetration- non specific

i.e. skin, mucus, peristalsis, coughing, sneezing, stomach acid, ear wax, tears, saliva

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14
Q

describe internal defenses of innate cells

A

soluble factors- modify cell behavior and enhance inflammatory response

innate cells and components from birth mentioned earlier

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15
Q

what is the second line of defense

A

the inflammatory response

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16
Q

describe the vascular response of the second line of defense or “inflammatory response”

A

activated at time of injury or exposure
series of vascular and cellular activities
possibly start a fever
natural killer cells are released

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17
Q

describe the plasma protein systems of the second line of defense or “inflammatory phase”

A

clotting to control bleeding

kinin that:
-produces bradykinin for vasodilation and vascular permeability
-activates fibrinolytic system, producing plasmin to lyse clots
-makes debris/pathogen vulnerable to phagocytosis

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18
Q

what is the third line of defense

A

specific immune system

adaptive immunity

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19
Q

describe the adaptive immunity of the specific immune system

A

acquired and relative (memory of immune system)

characterized by specificity and memory of a pathogen, B and T cells

days to weeks for a full response

develops throughout the life

responds more efficiently on subsequent exposure (reps/recognition)

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20
Q

describe active immunity

A

concept of mist vaccinations using a harmless virus to produce a secondary immune response with antibodies and memory cells

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21
Q

describe passive immunity

A

passing of antibodies through birth/breast feeding but is only temporary due to lack of memory cells

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22
Q

describe cell mediated immunity

A

not involving antibodies but instead cells like WBCs, B, and T cells that can kill antigens

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23
Q

what are the phases of the immune response

A

1- recognition phase: pathogen marking
2- amplification phase: producing of army of cells
3- effector phase: antigen removal
4- termination phase: “pull troops” as pathogen is cleared; important to avoid excessive/prolonged immune response
5- memory: generation of long lived B and T lymphocytes that involve both innate and adaptive immune responses

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24
Q

what factors affect immunity

A

aging
hormonal imbalance
environmental pollution
trauma/illness
inadequate sleep
lack of exercise
stress (excess cortisol)
diet

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25
describe key characteristics that make gut health important for the immune system
all categories of immune cells in the gut (70-80% of all immune cells) good bacteria/immune response is diminished by SAD, medications (analgesics, antihistamines, and antibiotics), and infections leaky and porous gut from these factors contributes to many physical/mental conditions (i.e. good things leak out and bad things leak in)
26
describe how exercise affects age immune system
immune system = enhanced/supressed by ex. depending on intensity moderate = beneficial overtraining without adequate recovery can impair immunity (proper diet and sleep are other conclusive factors)
27
describe what happens with immunodeficiency diseases
absent/depressed immune response due to primary or secondary immunodeficiency primary = genetic DEFECT involving T cells, B cells or lymphatic tissue secondary = results from underlying disease or factor that depresses or blocks the immune response (MOST COMMON)
28
what is AIDS
secondary immunodeficiency "acquired immunodeficiency syndrome" massive destruction of the immune system by Human Immunodeficiency Virus (HIV)
29
incidence/prevalence of AIDS
nearly 40 million worldwide with HIV/AIDS greatest impact in US with male to male sex and IV drug use
30
pathogenesis of aids
HIV depletes T lymphocytes along with other immunity cells HIV has a very high mutation rate
31
clinical manifestations of AIDS
constitutional S&S NeuroMSK conditions -distal peripheral neuropathy -balance and gain deficits -myalgia and arthralgia -bone degradation -weakness integumentary breakdown cardiopulmonary conditions lipodystrophic syndrome (central fat accumulation in neck and trunk but decrease in extremities)
32
PT implications for AIDS
exercise unrestricted with usual benefits for initial asymptomatic HIV more limited with symptomatic and advanced HIV and less beneficial
33
what is chronic fatigue syndrome
immune dysfunction characterized by unexplained fatigue of more than 4 months that significantly limits ADLs
34
incidence/risk factors of chronic fatigue syndrome
most common in minority females with lower socioeconomic status
35
etiology and pathogenesis of chronic fatigue syndrome
immune deficits and or traumatic event may be a trigger poorly managed stress abnormal neuroendocrine function inward focused and introversion personalities inactivity
36
clinical signs and symptoms fo chronic fatigue syndrome
varied and often cyclical constitutional signs and symptoms overwhelming fatigue muscle pain/weakness forgetfulness hypotension that worsens throughout the day
37
chronic fatigue syndrome PT implications
lifestyle management for stress, sleep, diet, and activity levels gentle/graded exercise but gauge physiological distress by vital sign monitoring to mitigate fatigue
38
what are hypersensitivity disorders
no response on 1st exposure hypersensitivity occurs on 2nd exposure to antigens formed from 1st exposure type I or Type II, or type III, or type IV
39
describe type I hypersensitivity
immediate type seasonal or food allergy; i.e. bee sting possible anaphylactic or severe potentially life threatening response that requires immediate action associated with bronchoconstriction
40
describe type II hypersensitivity
tissue or organ specific autoimmune condition; tissue and its cell function are diminished antibody binds to antigen on tissue or cell surface
41
describe type III hypersensitivity
immune complex mediated named because antibody binds to antigen and then released into circulation to reach the tissue systemic lupus erythematosus (SLE) attacks immune tissue throighout the body tissue but not organ specific so there are potentially wider spread affects
42
describe type IV hypersensitivity
cell mediated immunity only hypersensitivity not involving antibodies T lymphocytes are present and kill target cells it does not recognize examples: -graft rejection -contact allergen like latex -also includes diseases and cells like Rheumatoid arthritis with all connective tissue, MS with myelin, and diabetes with pancreas cells
43
overview of autoimmune diseases
body fails to distinguish self from non self over 60 identified
44
etiology and risk factors of autoimmune diseases
genetic (single gene not identified; clusters present; gene expression caused by epigenetic) hormonal (women affected more than men) environmental (physical or mental) infections
45
pathogenesis of autoimmune diseases
immune mechanism attacks self antigens systemically
46
common signs/symptoms of autoimmune diseases
GI S&S consittutional S&S gradual onset inflammation (persistent with possible acute bouts; local or systemic) myalgia/arthalgia swollen lymph nodes typically affects more than 1 part of body emotional changes
47
general PT implications for autoimmune conditions
infection control exercise prescription nutritional guidance sleep health
48
what implications might be present for PT if a pt is using corticosteroid medications for an autoimmune condition
usually used over prolonged time to suppress immune system response side effects include: -sleep/mood changes -GI irritation -hyperglycemia -BONE LOSS -Fluid retention: can contribute to electrolyte imbalance -decreased healing potential: can't expect normal results/timeline -MOST SERIOUS = increase susceptibility to infection
49
what are the PT implications of the bone loss symptom of using a corticosteroid
more susceptible to fx, osteoporosis, avascular necrosis, etc offset ideally with weight bearing and resistance exercise avoid joint mobilizations
50
10 most observed autoimmune diseases observed in the US and the area of the body they most affect
1-type I diabetes- foot/ankle 2-Rheumatoid arthritis-hand 3- chrons disease-lumbopelvic 4-systemic lupus erythematosus (SLE) 5-multiple sclerosis- head and neck 6- ulcerative colitis- lumbopelvic 7- Addison's disease- lumbopelvic 8- celiac disease- lumbopelvic 9- immune thrombocytopenia purport- head and neck 10- sjogre's syndrome
51
incidence of lupus and clinical manifestation
primarily young women more common in minorities all systems may be involved
52
possible skin/joint symptoms of lupus
skin lesions = particularly butterfly rash across nose arthralgia = most common S&S; typically targets the hand, wrist, and knee
53
other possible signs and symptoms aside form skin/joint symptoms
cardiopulmonary abnormalities neurological symptoms including headache, irritability and depression as well as cognitive deficits, seizures, neuropathies, and even strokes urinary with renal disease circulatory with anemia and amenorrhea hepatistis may develop
54
what are the PT implications with lupus
don't want to add anymore inflammation on top of whats already there protect w/ bracing or assistive devices monitor symptoms to maximize movement gentle/regular exercise (land and aquatic based) identify triggers and allow self monitoring to watch for exacerbations ** follow fibromyalgia interventions
55
what is sjogre syndrome
type of spondyloarthropathy or spindyloarthritide
56
what are spondyloarthropathies or spondyloarthritides
group of diverse auto inflammatory conditions that affect the spine more than the extremity joints
57
types of spondyloarthropathies and spondyloarthritides
ankylosing spondylitis reactive arthritis inflammatory bowel disease (Crohns) psoriatic arthritis sjogrens syndrome
58
common features/S&S of spondyloarthropathies and spondyloarthritides
gradual onset constitutional S&S multi joint inflammation and pain familial predisposition extraarticular involvement of eyes, skin, GI tract, and renal and cardiac systems
59
how might the multi joint inflammation and pain of spondyloarthropathies and spondyloarthritides present
over 30 minutes of pain after prolonged positions (doesn't go away after a few steps/seconds) improved pain with easy/regular movement chronic inflammation/P! of axial skeleton most often asymmetric or unilateral extremity involvement to a lesser degree (typically smaller joints)
60
why might those with spondyloarthropathies and spondyloarthritides have a predisposition to tendinitis
inflammation is often localized to enthuses (insertion points of connective tissue) so lots of -itises preferential tissue
61
how might some describe spondyloarthropathies and spondyloarthritides
"hurts to see, pee, and bend my knees"
62
incidence/risk factors of sjogren syndrome
2nd most common rheumatic disease but no Rh factor present in blood most often in postmenopausal women
63
etiology and pathogenesis of sjogre syndrome
gland destruction of exocrine glands (mainly lacrimal and salivary) additional pituitary and adrenal gland dysfunction
64
functions of the pituitary and adrenal glands
pituitary helps regular growth, BP, and reproduction adrenal helps regulate metabolism, immune system, BP, and stress response
65
unique clinical manifestations of sjogre syndrome
spondyloarthritide S&S peripheral neuropathy due to vasculitis hallmark symptoms = dry eyes/mouth but potential effect on all systems fatigue is dominating and disabling sleep disturbances
66
what is fibromyalgia syndrome
similar to other conditions but there are distinct differences systemic and NOT the same as a more localized myofascial pain syndrome not the fatigue level of chronic fatigue syndrome chronic/widespread myalgia
67
incidence/prevalence of fibromyalgia syndrome
most common MSK disorder in US more common in women than men 20-55 years of age minimal fitness level
68
risk factors for fibromyalgia (also pain triggers)
prolonged anxiety/emotional stress trauma rapid steroid withdrawal thyroid disorders infections
69
etiology of fibromyalgia
often unknown but risk factors are possibilities genetic possibility may be triggered by inflammatory conditions psychological and cognitive behavioral factors occur
70
pathogenesis of fibromyalgia
not entirely understood misprocessing of pain with sensitization and nociplastic pain micro spasms of muscles contribute to hypo vascularity and fatigue hypothalamic pituitary adrenal (HPA) axis dysfunction
71
functions of the hypothalamic-pituitary-adrenal gland axis dysfunction
interactive neuroendocrine unit plays large role in body's response to stress pituitary helps regulate growth, BP, and reproduction adrenal helps regulate metabolism, immune system, BP, and stress response
72
73
how does the ANS contribute to the pathogenesis of fibromyalgia
ANS is hyperactive sympathetic (flight or fight) branch and underachieve parasympathetic (rest) branch
74
how does the ANS contribute to the pathogenesis of fibromyalgia
ANS is hyperactive sympathetic (flight or fight) branch and underachieve parasympathetic (rest) branch
75
how does the immune system play a role in the pathogenesis of fibromyalgia
increased pain activated glial cells in spinal cord to release pain facilitating cells also releases pain neurotransmitters
76
top 6 signs and symptoms of fibromyalgia
visual problems mental and physical fatigue sleep disturbances/morning fatigue morning stiffness that persists >30 min global anxiety cognitive problems
77
describe what might be found in tests/measures for fibromyalgia dx
all imaging/blood tests are neg dx by exclusion partly greater than or equal to 11/18 points tender to palpation found by pressure until your nail bed blanches
78
PT implications for the initial approach to treating fibromyalgia
initial = strong support pt education exercise prescription = low/mod global exercises with aerobic/resistance activity 1-1.5 hr sessions, 2-3x/wk, for more than 13 wks *monitor vital signs to avoid hyperactive sympathetic response
79
hat options for fibromyalgia treatments are weakly supported
cognitive behavioral therapy pharmacological for pain, anxiety, and sleep disturbances sleep study
80
general PT implications for fibromyalgia syndrome
nutritional guidance stress management often minimal benefits over long term management

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