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Flashcards in Test 3 Deck (265):
1

How are screening decisions made by the USPSTF?

burden of suffering
screening test
prevention

2

What are the 6 D's of the burden of suffering?

death
disease
disability
discomfort
dissatisfaction
destitution

3

What factors apply to a screening test's usefulness?

sensitivity/specificity
simplicity
cost
safety
acceptability

4

What factors apply to useful prevention?

effective
safety
cost-effective
early treatment more effective than late

5

What are the harms of screening?

risks associated with test
anxiety
additional diagnostic testing
over-diagnosis
limited benefit with certain comorbidities

6

What grades by the USPSTF are refundable by the government?

A and B guidelines

7

What app can we use to help identify preventative services appropriate for our patients?

electronic preventive services selector (EPSS)

8

What school was the model medical school?

Johns Hopkins

9

Who founded the PA profession and at what school was it started?

Eugene Stead MD
Duke University

10

What is the most common type of health care coverage in the US?

employer based

11

Who qualifies for Medicare?

65+
need of hemodialysis and eligible for social security

12

What does Medicare part A cover?

hospital and skilled nursing care

13

What does Medicare part B cover?

outpatient visits when medically necessary

14

What does Medicare part C cover?

"Medicare Advantage Plans"
-provide A, B, D benefits

15

What does Medicare part D cover?

drug plan
-voluntary, not automatically enrolled

16

Who generally qualifies for Medicaid?

low-income
children
parents of dependent kids
pregnant women
disabled

17

What is a common problem for those on Medicaid?

"churn" move in and out of qualifying due to changes in income, employment, or life

18

Who funds Medicaid?

joint state and federal partnership

19

What is the primary payer for long term services?

medicaid

20

What is CHIP?

children's health insurance program
-for children of low-income families that don't qualify for Medicaid

21

What are the key roles of public health?

assessment
assurance
policy development

22

What are the "core" public health services?

environmental health (regulations)
disease control
health education/promotion

23

What are the top 3 reportable diseases in AZ?

chlamydia
influenza
gonorrhea

24

What are ways we "build walls" in public health?

literally-isolation
treatment
immunization
behavior change
change environment for less transmission
policy that effects transmission

25

Who are the main disseminators of the flu?

children

26

What are the 10 leading causes of death?

heart disease
cancer
chronic lung disease
accidents
stroke
alzheimer's
diabetes
flu/pneumonia
nephritis
suicide

27

Why is policy better than behavioral change in public health?

behavior- you're teaching/telling
policy- is doing and making those things available

28

What type of health care is public health?

it's not health care
it is societal monitoring/education

29

What is the complication of public health?

needs investment in order to prevent

30

What are the components of a wellness exam?

screening
immunizations
behavioral counseling
chemoprevention

31

What is the life expectancy in the US?

79 years

32

What is the infant mortality rate in the US?

6 per 1,000

33

What are the leading causes of death for infants?

congenital malformations
disorders of premature birth
maternal complications

34

What percent of children age 6-11 are obese?

17%

35

What are the leading causes of death in 1-4 year olds?

accidents
congenital malformations
assault/homicide

36

What are the leading causes of death for 5-14 year olds?

accidents
cancer
suicide

37

What are the leading cases of death in 15-19 year olds?

accidents
suicide
homicide

38

What percent of adolescents age 12-19 are obese?

21%

39

What percent of adolescents 12-17 smoked in the past month?

4%

40

What percent of adolescents 12-17 used alcohol in the past month?

10%

41

What are the leading causes of death in age 65+?

heart disease
cancer
chronic lower respiratory disease

42

What is the order of highest to least death rate in US?

elderly
infants
teens
5-14 y/o
1-4 y/o

43

What are the leading causes of death for American Indians/Alaska Natives?

Heart disease
Cancer
Accidents

44

What are the leading causes of death for Asian/Pacific Islanders?

cancer
heart disease
stroke

45

What are the leading causes of death for the black population?

heart disease
cancer
stroke

46

What are the leading causes of death in the Hispanic population?

cancer
heart disease
accidents

47

What are the leading causes of death in the White population?

heart disease
cancer
chronic lower respiratory disease

48

Overall, what are the leading causes of death in men?

heart disease
cancer
accidents

49

Overall, what are the leading causes of death in women?

heart disease
cancer
chronic lower respiratory disease

50

Patients utilize preventative services at what rate compared to recommended use?

half the rate of recommended

51

What is primary prevention?

preventing disease from occurring
(immunizations)

52

What is secondary prevention?

identifying risk of disease early in order to treat (screening)

53

What is tertiary prevention?

already have disease, but controlling it and preventing complications

54

What are the stages of behavioral counseling?

precontemplation
contemplation
preparation
action
maintenance
termination

55

What is healthy people 2020?

10-year national goals and objectives for health

56

How many topic areas, objectives and health indicators are there in healthy people 2020?

42 topics
1,200 objectives
26 health indicators

57

What is the name for anything that causes an immune response?

antigen
-general & specific

58

What is a protein molecule created by our immune system to target an antigen for destruction?

antibody

59

How do antibodies work?

protein binds to antigen disabling it and tagging it for destruction

60

Where are cytokines produced?

by a variety of leukocytes

61

What are cytokines?

proteins that communicate between cells and control development, differentiation and movement

62

What interleukins are responsible for fevers?

1 & 6

63

What interleukins cause the acute phase response?

6

64

What are interleukins?

regulators of immune responses, inflammation and hematopoiesis

65

What activates neutrophils, mediates septic shock and causes tumor necrosis?

tumor necrosis factor

66

What are a type of cytokine released by an infected or injured cell?

chemokines

67

What does a chemokine do?

initiate immune response
signal circulating neutrophils and macrophages
warn neighboring cells of threat

68

What block virus replication?

interferons
(alpha, beta, and gamma)

69

What is the strongest interferon and where is it produced?

gamma
-produced T cells

70

What do gamma interferons do?

activate macrophages, natural killer cells, and neutrophils

71

What type of interferons sometimes suppress the normal activity of the immune response?

Type 1

72

What are type 1 interferons and where are they produced?

alpha and beta
-produced by almost any cell

73

What secretes Type 2 interferons?

natural killer cells and T lymphocytes

74

What are type 2 interferons?

gamma

75

What function to induce viral resistance in cells?

Type 1 interferons

76

What is the main purpose of Type 2 interferons?

signal immune system to respond to infections or cancerous growth

77

What has been shown to suppress T- Cell response and memory T- Cells?

Type 1 interferons

78

Type 1 interferons help limit viral replication but create what?

pathologic inflammation in lungs

79

What may interfere with bactericidal mechanisms?

Type 1 interferons

80

What are other names for innate immunity?

natural
non-specific

81

What are other names for adaptive immunity?

specific
humoral
cell-mediated

82

Where does hematopoiesis occur in the embryo and fetus?

liver
spleen
thymus

83

Where does hematopoiesis occur from birth- adults?

bone marrow
small amount in lymph tissue

84

What bones does hematopoiesis usually occur in children?

long bones

85

What bones does hematopoiesis usually occur in adults?

sternum and pelvis

86

What are the components of innate immunity?

physical barriers
granulocytes
monocytes
macrophages
dendritic cells
natural killer cells
complement cascade

87

Where are complement proteins primarily produced?

liver

88

Is sweat basic or acidic?

acidic

89

What roll does heparin have in inflammation?

decreases clotting

90

What creates leaky capillaries to fit immune cells out?

histamine

91

What is released in the inflammatory response of damaged tissue?

histamine
prostaglandin
leukotriene

92

What plays a major roll in recruitment of neutrophils to the site of inflammation?

adhesion molecules

93

Mutations in genes encoding for adhesion molecules we believe to cause what?

atherosclerosis
alzheimers
autism

94

In chronic inflammation what causes tissue damage?

chronic cytokine release and leukocyte infiltration which then causes release of lysozyme and free radicals

95

What is the second line of defense in innate immunity?

granulocytes

96

Where are basophils made and where do they circulate?

mature in bone marrow
circulate in bloodstream

97

What do basophils release?

histamine and heparin

98

What situations do we have increased basophils?

allergic and worm infections

99

Where are eosinophils made and where do they circulate?

bone marrow
circulate in blood stream and present within organs (esp. GI and respiratory)

100

What is released by eosinophils?

hydrogen peroxide
oxygen radicals
leukotrienes

101

What situations do we have increased eosinophils?

viruses
parasites
allergic reactions
asthma

102

What do leukotrienes do?

cause smooth muscle contraction in airway

103

What type of granulocyte stimulates T-lymphocytes?

eosinophils

104

Are eosinophils weakly or strongly phagocytic?

weak

105

What type of granulocyte act as antigen presenting cells?

eosinophils

106

What type of granulocyte is the most abundant and where does it circulate?

neutrophils
circulate in bloodstream

107

What type of situation are neutrophils usually elevated?

bacterial and fungal infections

108

What are thrown out by neutrophils that are extracellular fibers that bind bacteria together?

neutrophil extracellular traps

109

What do neutrophils respond to through chemotaxis?

chemokines

110

Neutrophils release cytokines to recruit what?

monocytes and macrophages

111

What do mast cells release?

histamine and heparin

112

What type of response do mast cells create?

inflammatory response

113

Where do mast cells mature?

leave bone marrow immature and mature in tissues

114

What will degranulate mast cells?

injury
encounter antigen or allergen
exposed to complement proteins

115

Massive release of histamine by mast cells can cause what?

anaphylaxis

116

What is anaphylaxis?

body-wide vasodilation which leads to edema, decreased BP etc.

117

Where do red blood cells and platelets derive from?

myeloid stem cells

118

What are the granulocytes?

basophil
eosinophil
neutrophil
mast cell

119

What are the 3 primary functions of monocytes, macrophages and dendritic cells?

phagocytosis
antigent presentation
cytokine production

120

What give rise to dendritic cells and macrophages?

monocytes

121

Are monocytes granular cells?

no- agranular

122

Where are monocytes developed and stored?

develop in bone marrow
half stored in spleen
half migrate to tissues and become dendritic cells or macrophages

123

What is the strongest antigen presenting cell and why?

dendritic cells
best at activating helper T- lymphocytes

124

What are antigens captured by?

dendritic cells

125

What do dendritic cells do after they capture an antigen?

go to nearest lymph node and present antigen to T and B cells

126

What is the name for specialized dendritic cells in the skin?

langerhans cells

127

What cells may be the initial target in sexually transmitted HIV?

langerhans cells

128

What are just large phagocytes?

macrophages

129

What do macrophages release?

Tumor necrosis factor and interluekins

130

Besides phagocytosis what else do macrophages do?

act as antigen presenting cell

131

Where are macrophages present?

skin
lungs
GI tract
most tissue

132

What are the 3 phases of macrophage readiness?

resting
primed
hyper-activated

133

After digesting a pathogen a macrophage will present the antigen to what?

helper T cell

134

What does the major histo compatibility molecule do?

tells other white blood cells that macrophage is not a pathogen even with antigen in it

135

What is the resting state of macrophage readiness?

cleaning up cellular debris

136

What is the primed state of macrophage readiness?

active engulfing of bacteria- display fragments to T cells

137

What is the hyper-activated state of macrophage readiness?

rapid destroying of pathogens or cancer cells after being enlarged by cytokines

138

What are Kupffer cells?

specialize macrophages within the liver

139

What do kupffer cells do?

destroy bacteria and old RBCs

140

What happens in chronic activation of kupffer cells?

overproduction of inflammatory cytokines and result in liver damage

141

What are cytotoxic lymphocytes that don't need to recognize a pathogen to kill it?

natural killer cells

142

What are natural killer cells most active against?

viruses and cancer cells

143

What are contained in the granules of natural killer cells?

destructive enzymes

144

Where do natural killer cells mature?

bone marrow
lymph nodes
spleen
tonsils
thymus

145

What enhances the killing activity of natural killer cells?

cytokines secreted by macrophages

146

How do natural killer cells kill?

releasing perforins and proteases that cause lysis or apoptosis
-surface contact can also cause apoptosis

147

Where do natural killer cells circulate?

bloodstream
liver
spleen

148

When can natural killer cells actually kill?

during ANY phase- including resting
best at killing when activated by cytokines

149

Natural killer cells work on containing viral infections until when?

until antigen-specific cytotoxic T cells can clear infection

150

What is another name for the major histocompatibility complex protein?

human leukocyte antigen

151

What do human leukocyte antigens do?

mark the cell surface as self or non-self
-if non-self bind antigen for recognition of T cells

152

What are the subgroups of the major histocompatibilty complex?

I, II, III

153

What determines organ donation compatibility?

major histocompatibility complex

154

A malfunction of the recognition system of the major histocompatibility complex is what?

autoimmune disease

155

The major histocompatibility complex activates what?

T & B cells
-by displaying antigen

156

What are produced by the liver in response to inflammation induced release of IL1 IL6 and TNF?

acute phase proteins

157

What are the acute phase proteins?

c-reactive protein
mannose-binding lectin
lipopolysaccharide-binding protein

158

All acute phase proteins do what?

mark pathogens or injured cells for destruction

159

What is the role of the complement system?

enhances phagocytic cells in destroying pathogens

160

What is the complement system activated by?

antigens

161

Where are complement proteins made?

the liver

162

What is the most abundant complement protein in humans?

C3

163

What are the 3 possible activation pathways of the complement system?

classical- triggering
alternative- continuously activated
lectin- requires special triggering

164

What is the term for enhancing phagocytosis of antigens by marking them for destruction?

opsonization

165

What is chemotaxis?

attracting and activating macrophages and neutrophils
inducing mast cells and basophils to degranulate

166

What are the functions of the complement system?

opsonization
chemotaxis
lysis
membrane attack complex

167

C5,6,7,8,9 form the membrane attack complex and destroy how?

lysis of cell by disrupting osmotic balance

168

How many antigens can one antibody recognize?

only one- bind to specific receptor site

169

How do antibodies work?

block binding of invader cells
inactivate viruses and neutralize toxins
mark pathogen for destruction (opsonization)

170

What makes up an antibody?

2 light chains
2 heavy chains
antigen binding site
Fab region
Fc region

171

What region of the antibody is always constant?

Fc region

172

What region of the antibody is variable/ is antigen specific?

Fab region

173

Where is the antigen binding site in an antibody?

between light and heavy chain

174

What are the 5 classes of antibodies?

IgM
IgG
IgA
IgE
IgD

175

What is the size of IgM?

large!
5 units

176

What is the first antibody produced?

IgM

177

What is the half-life of IgM?

10 days

178

If a test shows increased IgM what does that mean?

recent exposure

179

Where is IgM usually confined and when can this change?

intravascular space
inflammation allows it to enter interstitial space

180

What antibody has the longest half life?

IgG- 23 days

181

Where is IgG predominantly found?

blood
lymph
CSF
peritoneal fluid
even between intra and extravascular space

182

What is the only class of antibody that crosses the placenta?

IgG

183

What type of antibody can be used for passive immunity?

IgG

184

Can IgG be used as an indicator for an infection in a baby?

no

185

What are the functions of IgG?

opsonization
immobilizes bacteria by binding to cilia or flagella
activates complement
neutralizes toxins and some viruses by binding

186

When is IgG formed in the primary immune response?

late

187

What is special about polyclonal AB antibodies?

formed from immunized animals
can bind w/ multiple sites of antigen

188

What is special about monoclonal AB antibodies?

produced in lab
only bind to one site of antigen

189

In a secondary exposure to an antigen what antibody becomes more elevated than on first exposure?

IgG

190

Where is IgA primarily found?

external secretions
(mucus, tears, saliva etc.)

191

What type of antibody is found in breast milk?

IgA

192

What are the functions of IgA?

protect infant
prevents virus from entering cell
prevents pathogens from attaching to epithelial surfaces
respiratory and GI tract

193

What is the half life of IgE?

2 days

194

What does atopic mean?

allergies, asthma, dermatits

195

When is IgE elevated?

presence of parasites

196

Where are IgE antibodies found?

low amounts in serum

197

What are the functions of IgE after it binds to mast cells and basophils?

triggers degranulation
releases histamine leukotrienes & heparine

198

People with syndromes/hyperproduction of IgE are prone to what?

anaphylaxis- overproduction of IgE crowds out other types of antibodies

199

What is the function of IgD?

unknown

200

Where is IgD present?

surface of naive B-cells
low amounts in serum

201

What are the components of adaptive immunity?

T cells
B cells
antibodies
complement system
antigen presenting cells

202

What are the cell-mediated components of the adaptive immune system?

T cells
B cells

203

What are the humoral components of the adaptive immune system?

antibodies

204

Where are the primary lymphoid organs?

thymus
bone marrow

205

What are the secondary lymphoid organs?

spleen
lymph nodes
tonsils & adenoids
appendix

206

What is the difference between primary and secondary lymphoid organs?

primary- where lymphocytes grow
secondary- where antigens are presented to lymphocytes

207

Do B or T cells produce antibodies?

B- in the plasma/effector cells

208

What is the difference in pathogens that B and T cells destroy?

B cells- eliminate extracellular pathogens
T cells- eliminate intracellular pathogens

209

What works in conjunction with an MHC as an APC?

B cells

210

What are the subtypes of T cells?

Killer- CD8
Helper- CD4

211

How do Helper T cells work?

-assist in activating killer T cells
-signal B cells to secrete antibodies
-splits up into effector cells and memory cells

212

What is a Type 1 hypersensitivity reaction linked with?

allergies or anaphylaxis

213

What is a Type 2 hypersensitivity reaction linked with?

antibody dependent
cytotoxic

214

What is a Type 3 hypersensitivity reaction linked with?

immune complex

215

What is a Type 4 hypersensitivity reaction linked with?

cell-mediated/ delayed type

216

What are the antibody mediated hypersensitivity reactions, and which antibody illicits them?

Type 1- IgE
Type 2- IgG
Type 3- IgG

217

What is the main thing produced in a Type 1 hypersensitivity reaction?

histamine

218

What does histamine do?

causes vasodilation
increased capillary permeability
smooth muscle contraction

219

What does the IgE antibody bind to in a Type 1 hypersensitivity reaction?

mast cells and basophils

220

How fast does a Type 1 hypersensitivity reaction occur?

minutes

221

What is the treatment for a Type 1 hypersensitivity reaction?

epinephrine
steroids
antihistamine

222

What does the antibody IgG bind to in a Type 2 hypersensitivity reaction?

antigens on cell surface- leads to complement mediated lysis (cytotoxic)

223

How fast does a Type 2 hypersensitivity reaction occur?

hours to days

224

What is the difference between a Type 2 and Type 3 hypersensitivity reaction?

3 causes chronic inflammation that causes damage over time

225

What type of response occurs in a Type 3 hypersensitivity reaction?

antigen-antibody immune complexes deposited into tissues and compliment is activated
(immune complex)

226

How fast does a Type 3 hypersensitivity reaction occur?

2-3 weeks

227

What antibodies are formed in Lupus?

antinuclear antibody

228

What labs are shown in a patient with rheumatoid arthritis?

high Rh factor
low compliment in serum

229

Lupus and Rheumatoid arthritis are part of which type of hypersensitive response?

Type 3

230

How does a Type 4 hypersensitivity reaction work?

T lymphocytes are activated by an antigen and release lymphokines which cause inflammation and macrophage response

231

How fast does a Type 4 hypersensitivity reaction occur?

2-3 days

232

What causes hereditary angioedema?

deficiency of C1 protease inhibitor
-autosomal dominant

233

What is the area on the antigen that triggers a response called?

epitope

234

What is the criteria for autoimmunity?

autoantibodies
self-reactive T lymphocytes
imbalance between T and B pathogenic factors
imbalance of regulatory factors controlling immune response

235

What is an autoimmune disease that is a reaction to infection of Group A Strep?

Rheumatic fever

236

What is an autoimmune disease that blocks receptors of Ach?

Myasthenia gravis

237

What is an abnormality associated with Myasthenia Gravis?

thymus abnormality

238

What are the antibodies present in Lupus?

Anti-dsDNA
anti-Smith

239

What antibodies are present in myasthenia gravis?

anti-AChR

240

What is the autoantibody stimulation in graves disease?

TSH receptor

241

What is targeted in Lupus?

double-stranded DNA

242

What genes are specifically problematic in people with Type 1 diabetes?

genes that code for MHC class II

243

What antibodies are present in those with Type 1 diabetes?

Insulin antibodies
Islet cell autoantibodies
T cell cytokine production

244

What autoantibodies are present in sombody with Rhematoid arthritis?

rhematoid factor
anti-CCP antibodies
pro-inflammatory cytokines

245

What type of hypersensitivity reaction is multiple sclerosis?

Type 4

246

What is damaged in multiple sclerosis?

CNS myelin

247

What cells are involved in multiple sclerosis?

T and B cells

248

What part of the immune system do immunizations work on?

adaptive immunity

249

What is a passive immunity immunization?

antibody transferred directly

250

What is an active immunity immunization?

artificial antigens administered to elicit immune response

251

What type of vaccine is freeze-dried and which is refrigerated?

freeze-dried- inactivated
refrigerated- live attenuated

252

What type of vaccine has a weaker immune response than live attenuated?

subunit vaccine

253

How is a subunit vaccine made?

use component of the pathogen as vaccine to illicit response

254

What antigens and antibodies are present on O blood?

antigens- none
antibodies- anti-A & anti-B

255

What antigens and antibodies are present on AB blood?

antigens- A & B
antibodies- none

256

Are antibodies to the Rh antigen present on Rh-people?

not unless exposed to Rh+ blood

257

What are the most common and most rare blood types?

common- O+, A+
rare- AB-

258

What does a RAST test do?

detects IgE antibodies to allergen by attracting with an antigen- then marks it with radioactive anti-IgE antibody

259

A higher titer means what?

more of the antibody is present

260

A higher number means of a titer means what?

antibody response at a higher/ more diluted rate (more sensitive)

261

What does the Rapid Plasma Reagin (RPR) test, test for?

not specific syphilis antibodies but general antibodies

262

What is syphilis confirmed with?

FTA-ABS test (specific antibodies)

263

What does an ASO titer indicate?

body's reaction to group A strep

264

What is the primary purpose for using an ASO titer?

determine whether a previous strep infection has caused a post-strep disease

265

When are ASO titers the highest and when do they return back to normal?

highest- 3 weeks after infection
normal- 6 months post infection