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Pathology
Exam II
420
Physiology
Graduate
02/15/2008

Additional Physiology Flashcards

 


 

Cards

Term
Stem Cell
Definition

They retain the ability to renew themselves through mitotic cell division and can differentiate into a diverse range of specialized cell types.

 

can differentiate into either a red cell, neutrophil or megakaryocyte.

Term
Plasma
Definition

The fluid portion containing water, proteins, and nutrients

 

Term
Function of plasma
Definition

-maintain homeostasis (fight infection, prevent bleeding)

-transport nutrients and electrolytes to cells

-carry waste products to kidneys, liver, lungs for excretion

Term
Serum
Definition
What is left after clotting (essentially plasm mius most clotting proteins)
Term
Hematocrit
Definition

refers to the fraction of blood volume occupied by red cells.

 

low hematocrit = anemia

Term
Leukocytes (white cells)
Definition

Normally about 1/1000th as many in normal blood as red cells

 

Function: fight infection

Term
What are the different kinds of leukocytes
Definition

1. Neutrophil (PMN): phagocyte (eats bacteria)

2. Lyphocyte - makes antibodies, recognizes and kills foreign cells (microbes, transplanted tissue, cells infected with viruses)

3. Monocyte: phagocyte, works together with lymphocyte to control immune response

4. Eosinophil: involved in allergic reactions, kills certain parasites

5. Basophil: involved in allergic reactions

Term

What is the function of erythrocytes?

Definition
Carry oxygen and CO2.
Term
Hemoglobin
Definition
Red cells are essentially small bags of hemoglobin, which is oxygen-carrying protein responsible for the red color of blood.
Term
What nutrients are required for red cell production?
Definition
iron, vitamin B-12, and folic acid
Term

What is the function of T lymphocye (T cell)?

 

And where does it come from?

Definition

regulation of immune system

 

bone marrow, thymus, lymph nodes

Term

What is the function of B lymphoctye (b cell)?

 

and where does it come from?

Definition

antibody production

 

bone marrow, lymph nodes, spleen, lymph follicles in certain other tissue

Term
Plasma cell
Definition
When stimulated to make antibodies, the B-cell differentiates into a  plasma cell, which is the type that makes most antibodies.
Term

What are the functions of monocyte/macrophage?

 

Where does it come from?

Definition

1.phagocytosis (ingestion) of foreign cells, bacteria, etc.

2. Digests foreign molecules and transfers pieces to T cells, which then initiate specific immune response (tell B cells to make antibody)

3. Produces hormones (cytokines) which mediate inflammation and regulate growth of other cells.

 

Bone marrow (a first cousin of the neutrophil)

Term

What is the largest lymphoid organ in the body?

Definition

spleen

Term

anemia

Definition
reduction in total circulating red cell mass - this is usually reflected by low hematocrit and hemoglobin levels in blood
Term
hemolysis
Definition
rapid red cell destruction
Term
macrocytic red cell
Definition
larger than normal RBC
Term
normocytic
Definition
normal sized cells
Term
microcytic
Definition
smaller than normal cells
Term
What is the most common cause of anemia worldwide?
Definition
iron deficiency anemia
Term
what is an example of an inherited disorder of hemoglobin production?
Definition
thalassemia
Term
what is aplastic anemia?
Definition

decreased numbers of stem cells, macrocytic or normocytic anemia

-caused by agents that can damage or destroy stem cells:

1. cytotoxic chemicals

2. ionizing radiation in large doses

3. viral infection (rare)

4.  in most cases, cause cannot be found.

Term
pernicious anemia
Definition

vitamin B-12 deficiency

-vitamin B12 is needed for DNA synthesis during red cell production.

-macrocytic with abnormal/delayed maturation (megaloblastic)

- treatment = B-12 injections

-may cause serious neurologic disease as well as anemia

-often due to stomach disorder causing decreased production of factor needed for B-12 absorption

Term
anemia of inflammation
Definition

"anemia of chronic disease"

-iron held in macrophages and not released to red cell precursors

- can be considered part of physiologic response to inflammation: bone marrow usually appears normal.  when inflammation gets better, so does anemia.

- normocytic or microcytic.

Term
alpha (minor) thalassemia
Definition
decreased or absent production of alpha chain of hemoglobin - mild or moderate anemia.
Term
beta thalassemia (major)
Definition
decreased or absent production of beta chain of hemoglobin- very severe
Term
what is sickle cell anemia caused by?
Definition
inherited structural abnormality (single amino acid change) of hemoglobin leading to polymerization of hemoglobin,damage to red cell membrane, premature destruction of red cell.
Term
what do cells containing polymerized hemoglobin (sickle cells) clog?
Definition
small blood vessels - which causes tissue damage/death (infarction).
Term
recessive inheritance (sickle cell)
Definition

parents of individuals with sickle cell anemia have sickle cell trait- usually asymptomatic but their red cells can be made to sickle in the test tube (8% of African-Americans have sickle trait).

-mainly found in thos of African, Middle Eastern descent.

-have some resistance to malaria, which may account for the prevalence of the condition in this area of the world.

Term
autoimmune hemolytic anemia
Definition

production of antibodies against one's own red cells (a mistake by the immune system)

-antibodies coat red cells, which are then eaten by macrophages in the spleen and destroyed.

-antibody coated red cells can be detected by the coombs test.

treatment- corticosteroids (suppress immune system), spenectomy (removes main site of RBC destruction).

Term
Transfusion reaction
Definition

foreign red cells enter bloodstream via a transfusion

The immune system makes antibodies to antigens on these cells.

 

ex: blood transfusion mismatch = antibodies are already present

blood transfusion match, but with some other foreign antigen = takes awhile for antibodies to appear. 

Term
Symbiotic
Definition

both organisms derive a benefit from the association

 

example: E. coli making vitamin k: needed for clotting

Term

Commensal

Definition

the relationship doesn't help or hurt the host

Term
Saprophytic
Definition
live off dead matter
Term
Parasitic
Definition

harm/hinder the host

 

They are pathogenic

Term

Describe Host Resistance

Definition
  • refers to an organism's ability to fight disease
  • Modified by the general state of health of the host (young/old, nourished)
  • infection and disease are not synonymous: some people can harbor a parasitic organism and not get a disease.
Term

Describe the iceberg concept of infection:

Definition

 

  • of most of the infections occuring in the community, very few will come into awareness (most are subclinical) 

a= cellular response b=host response

 

Starting from the bottom of the pyramid and moving up:

1. Below visible change, subclinical disease

    a) exposure without cellular attachment or microbial proliferation.

    b) exposure without infection

2. Below visible change, subclinical disease

    a) microbe colonization and proliferation without apparent cellular damage

    b) infection without clinical illness (asymptomatic infection)

3. Discernible effect, clinical disease

    a) cell dysfunction with morphologic and biochemical deragements

    b) classical and severe disease, moderate severity, mild illness

4. Discernible effect, clinical illness

    a) lysis of cell

    b) dealth of organism 

Term

What are some ways that cells react to infection?

 

Definition
  • purulence (pus)
  • generage lymphocytes and monocytes--> granuloma
Term
What are the barriers to infection?
Definition
  1. Mechanical: skin, mucus membrane, body orfices, cilia (carry mucus up and out taking microbes away)
2. Secretions: tears, saliva, urine

dilute the number of organisms present in the area and some secretions have anti organism activity

3. Epithelial: skin renews every couple of weeks, carries away bugs with it

4. Chemical: skin secreting compounds that are bacteriocidal, enzymes in the digestive system kill a lot of microbes

5. Microbial: normal flora...crowd out the bad bugs. 

Term
What is the most common source of infection in the industrial world?
Definition
endogenous: normal flora getting into areas it shouldn't.
Term
What is the most common source of disease in areas other than the industrial world?
Definition
exogenous:caused by factors (as food or a traumatic factor) or an agent (as a disease-producing organism) from outside the organism or system
Term
Host cellular factors act to:
Definition
  • limit the spread of the agent
  • destroy the agent
  • prepare the area of damage for later repair
Term
Neutrophil
Definition
  • first reponders among the leukocytes (white blood cells)
  • non-specific
  • react in a stylized manner
  • phagocytize and engulf things
Term
Lymphocytes
Definition
  • innvolved in inflammation and immunity
  • specific
  • responsible for both humoral (antibody)immunity and cellular immunity
Term
What forms antibodies?
Definition
B-lymphocytes
Term
What is the action portion of the humoral immune system?
Definition
antibodies
Term
Describe the antibody-antigen interaction.
Definition
  • antibodies are directed against an organism (antigen)
  • sit on it, opsonization
  • white blood cells recognize the antibodies
  • white blood cells attack
Term
Candida Albicans
Definition
  • present in the mouth, GI tract, skin and vagina of many normal individuals
  • in the impared host it can invade and cause disease (HIV, chemotherapy patients)
  • facultative pathogen (opportunistic)
  • usual cause of yeast infections
  • Conditions it causes: yeast infections, oral candidiasis, thrush (organism grows in the back of the mouth)
Term
What are some ways that microbes get around the host response of phagocytes in marrow?
Definition
inhibit production of phagocytes
Term
Describe how a microbe might get around the host response of an inflammed blood vessel?
Definition
inhibit inflammation
Term
Describe how a microbe might get around the host response of putting microorganisms in tissue?
Definition

inhibit chemotaxis

kill phagocyte 

Term
Describe how microbes might get around the host response of phagocytosis?
Definition

inhibit lysosomal fusion

resist killing and multiply in phagocyte 

Term
What are some ways that an organism can get around host defense mechanisms?
Definition
  • inhibit production of phagocytes
  • inhibit inflammation
  • inhibit chemotaxis
  • kill phagocyte
  • inhibit phagocytosis
  • inhibit lysosomal fusion
  • resist killing and multiply in phagocyte
  • reproduce quickly
    • genetic manipulation
    • exchange DNA: adapt resistance
Term
What are some modes of transmission?
Definition
  1. Direct physical contact: sexual, mother-child, organism has to be present in moist environment
  2. Indirect physical contact: eating utencil
  3. Airborne Infection: sneeze
  4. Food, water or soil-borne infection
  5. Insect borne infection


*****Remember the 5 F's******

1. Fomites (can be coughed out)

2. Food

3. Fingers

4. Flies

5. Feces 

Term
What are the routes of transmission?
Definition

*** Remember 5 F's***

1. Fomites

2. Food

3. Fingers

4. Flies

5. Feces 

Term

two general divisions of the immune system:

 

Definition

1. humoral immunity: concerned with antibody production

2. Cell mediated immunity: directs specialized cells to recognize and destroy offensive agents. 

Term
What are some mechanisms for producing disease?
Definition

toxins: may be made directly by the organism or be liberated when the organism is destroyed by the body's efforts to get rid of it

 

* some organisms are not toxic at all; however, the host's reaction to the invading agent may be very dramatic and normal structures that get in the way of the host's immunologic response end up getting damaged. 

Term

What are some differences that prokaryotes have from eukaryotes along with distinguishing features of bacteria?

 

Definition
  • smaller size
  • absense of a nucleus and many other organelles
  • ribosomes smaller than those present in a human cell
  • a cell wall surrounding the cell membrane, similar to the cell walls of common plants
  • lack many of the organelles found in "higher" eukaryotic organisms, but structures and enzymes are present enabling bacteria to exist as individual cells
  • bacteria= complete organisms
  • some bacteria surround their cells with a mucoid capsule (may augment their pathogenicity)
  •  cell walls and capsules contain antigenic chemical compounds that can be recognized by the host, and the host can activate cells and produce antibodies and cell mediated reactions against these antigens.
Term
What are some ways to classify bacterial pathogens?
Definition
  1. Shape
  • coccal-spheroidal
  • bacillary-cylindrical
  • Spirochetes-spiral shaped

2. Staining reactions

  • gram stain reaction: gram + (purple), gram - (pink)
  • acid fast stain reactions (important for mycobacterial infections)

3. cultural features

  • grow them in large numbers in cultures...require: food, temperature, amount of moisture, amount of oxygen
  • colony formation in culture: bacteria tend to form characteristic groups or colonies (size, shape, color and smell)
  • oxygen tolerance: anaerobic (no oxygen), facultative anaerobic (with or without oxygen), aerobic (oxygen)
  • biochemical properties: growth requirements (what bacteria need to grow), biochemical products (what the bacteria produce)

4. Immunotyping: using lab produced antibodies to join with and identify certain bacteria

 

5. antibiotic sensitivity: suppress growth (bacteriostatic action) or kill (bactericidal action)

 

6. DNA typing 

 

Term
Endogenous
Definition
disease caused by bacteria which normally colonize most humans.  Areas with heavy bacterial colonization include oropharynx, lower GI tract, vagina, and skin
Term
Exogenous
Definition
disease caused by bacteria obtained from the environment.  At times bacteria may be transmitted from infected persons, animals, or insects.
Term
Describe Direct Tissue Invasion as a possible component of Pathogenesis.
Definition
  • majority of bacterial infections are caused by invasion of the host's tissue, often with permanent destruction of at least some of the tissue---> destructed tissue replaced by fibrous tissue (scar)
  • examples: staphylococcus, pseudomonas, tuberculosis (TB)
Term
How does Tuberculosis typically act as a pathogen?
Definition
direct tissue invasion
Term
Explain how toxin production is a mode of pathogenesis and give some examples of organisms that use this method?
Definition

- major problems and symptons are due to the effects of toxins elaborated by the bacteria

- examples: diphtheria, botulism, tetanus, cholera, traveler's diarrhea (turistas) 

Term
Explain how immunologically mediated disease is a mode for pathogenesis.
Definition

problems encountered by the host are due to the sort of reaction the host mounts against the offending bacteria.

-cross antigenicity: rheumatic fever

-immune complex formation: post-streptococcal glomerulonephritis 

Term
Bacteremia=
Definition
the presence of viable bacteria within blood
Term
Septicemia=
Definition
the presence of various pus forming organisms and other pathogens, or their toxins, in the blood or tissues
Term
Sepsis=
Definition

systemic disease caused by the presence of microorganisms or their toxins in the circulating blood.

- may be associated with chills, fever, fall in blood pressure due to vascular dialation, and poor cardiac function

- can ultimately lead to shock and death. 

Term
What are some symptoms of sepsis?
Definition

-sepsis= systemic disease caused by the presence of microogranisms or their toxins in the circulating blood

- chills, fever, fall in blood pressure due to vascular dialation, and poor cardiac function.

-can also lead to shock and death 

Term
Staphlococcus:
Definition

- gram +, cocci

- grows in clusters

-examples: pimples, boils, abscesses,osteomyelitis, endocarditis, wound infections and food poisoning 

- doesn't spread itself 

Term
What bacteria causes pimples, boils, abscesses, osteomyelitis, endocarditis, wound infections and food poisoning?
Definition
staphylococcus
Term
Streptococcus
Definition

-gram +, cocci

-certain streptococci are serious pathogens

-grow in chains

-ability to lyse red blood cells (hemolysis) in culture -

- detected usually by employing sheep red cells mixed with agar 

* alpha hemolysis: incomplete green hemolysis

*beta hemolysis: complete clear hemolysis

*gamma hemolysis: no hemolysis

 

***beta hemolytic group is the most dangerous 

Term
Which bacteria is characterized by its ability to lyse red blood cells (hemolysis)?
Definition
Streptococcus
Term
Streptococcus pneumoniae:
Definition

- grows in pairs

-makes a capsule that protects it from being eaten by phagocytes

-gram +, cocci

- organism commonly lives in the nasopharynx

-may cause otitis media in children

- may be the reason for termial pneumonia in older adults. 

Term
What are some examples of gram negative cocci?
Definition

gonococcus: gonorrhea

meningococcus: meningitis

neisseria meningitidis: cause of spinal meningitis 

Term
Neisseria meningitidis
Definition

- gram negative cocci

- cause of spinal meningitis

- can infect the coverings of the brain and spinal cord with fatal results

- organism can colonize the nasopharynx of normal individuals

- hygiene, quick diagnosis and modern antibiotic therapy have made the difference. 

Term
What are some examples of gram positive baccilli?
Definition

Clostridium: botulism, tetanus, gas gangrene

Corynebacterium: diphtheria 

Term
What are some examples of gram negative bacilli?
Definition

- enterobacteriaceae: normal or disease causing inhabitants of the large bowel (E.coli)

-Shigella: gram negative non motile rods (cause bacillary dysentery) 

 

 

Term

 

Enterobacteriaceae 

Definition
  • enteric gram negative bacteria
  • either normal or disease causing inhabitants of large bowle
  • E.coli
  • cause severe widespread infections in hopitalized and debilitated patients
  • cell walls of these organisms contain endotoxins, when liberated these toxins can cause failure of the cardiovasular system, shock, and dealth
Term
Shigella
Definition
  • gram negative nonmotile rods
  • cause bacillary dysentery: acute infection of the wall of the large bowel and results in blood, pus, and mucus appearing in the stool
  • damages bowel by direct invasion with resultant inflammation, plus the bacterium secretes an exotoxin which further irritates the bowel wall.
  • dysentary is passed on by contaminated food and water, especially where human wastes are put into the source of drinking water.
Term
What are some exaples of acid fast bacilli?
Definition

- principally mycobacteria

- Tuberculosis: Mycobacterium tuberculosis

 

Term
Mycobacterium tuberculosis
Definition

- acid fast bacilli

- thin long rod with a waxy coat 

- coat doesn't stain with ordinary gram stain

- doesn't grow on ordinary culture media

-slow growing organism 

Term
Examples of spirochetes:
Definition
  • long slender helically coiled organisms
  • Treponema palladium: syphilis
  • Borrelia burgdorferi: lymes disease
Term
What are some general characteristics of viruses?
Definition
  • submicroscopic, subcellular agents with a protective coat of protein wrapped around a central core or nucleic acid.  There may be a surrounding lipoprotein envelope.
  • they are obligate intracellular parasites
  • can't reproduce outside of a host
  • they do not multiply by dividing
  • evolved mechanisms for invading a host cell and taking over the cell's synthetic machinery for the sake of viral reproduction
  • nucleic acid may be RNA or DNA, but never both
  • are classified by the type of nucleic acid they contain, their size, and the type of tissues they tend to infect
  • viruses may spread by:

-lysing the host cell and releasing numerous progeny

-budding off from the host cell in a more controlled manner

-viral genomics becoming incorporated into the host genome and remaining dormant through mitotic cycles involving the host's genome.  

  • viruses are implicated in causing certain forms of cancer
  • viruses tend to be antigenic and induce humoral (antibody) and cell mediated immune responses 
Term
What are some general characteristics of fungi?
Definition
  • plant-like but do not have the photosynthetic machinery needed to generate sugar from sunlight, carbon dioxide and water
  • live off of dying material or parasitize other organisms to survive.
  • yeast, mold
Term
6 divisions of Stratification:
Definition

1. Kingdom

2.Phylum

3. Class

4. Order

5. Genus

6. Species 

Term
What are the steps of the gram stain?
Definition
  1. heat fixed bacterial smear
  2. crystal violet and iodine
  3. alcohol rinse
  4. safranin counterstain
  5. final water rinse
Term
What are the steps of a acid fast stain?
Definition
- also called Ziehl-Neilsen stain
  1. heat fixed bacterial smear
  2. carbolfuschin
  3. acid alcohol
  4. loeffer's methylene blue
  5. final water rinse
Term
What are some ways bacteria can access?
Definition
  • natural passages
  • via trauma
  • via circulation

- bacteremia: the presense of viable bacteria within the blood (brush teeth)

- sepsis: the presense of various pus forming organisms or their toxins in the blood. 

Term

Shock

 

Definition
a condition where the supply of the circulation does not meet the demands of the body
Term

Initial event in the development of a Neoplasm

(Benign or Malignant)

Definition
nonlethal genetic alteration (DNA mutation)
Term
Clonal expansion
Definition
When a single cell preferentially proliferates, creating a large collection of cells all derived fro the original cell.
Term
Transformation
Definition

first step in the process of becoming a malignant cell.

 

Autonomous, dysregulated proliferation

Term
Malignant Neoplasm
Definition
the ability to invade locally and/or metastasize
Term
mestastasize
Definition
move to a distant site in the body and form a new tumor
Term
replicative error
Definition

repair mechanisms can become saturated and mutations can become fixed in the genome leading to transformation.

 

Replicative error results in increased mutations in the cells DNA during proliferation

Term
cancer
Definition

an abnormal proliferation of cells that show the life threatening propensities of local invasion and distant spread (metastasis)

 

--malignant neoplasm

 

Cancer is a disease of the GENOME/DNA through mutations in somatic cells and rarely inherited through the germline (germ cells) which would show a mendelian pattern of inheritance

Term
carcinogenesis
Definition
process of developing cancer
Term
Beningn neoplasm
Definition
don't invade or metastasize
Term

Carcinogenesis is a.....

 

Single Step or Multi-Step process???

Definition

Multi-Step

--no single mutation to an oncogene or tumor suppressor gene can fully transform a cell...requires multiple oncogenes and 2+ tumor spressor genes

Term

5 Molecular Features of Cancer

Definition

1. acuisition of self-sufficiency in growth signals

2. insensitivity to growth inhibitory (antigrowth) signals

3. evasion of rogrammed cell death (apoptosis)

4. sustained angiogenesis

5. tissue invasion and/or metastasis

 

--most also show alterations in DNA repair genes and/or genomic instability w/ abnormal # of chromosomes.

Term

Targets of genetic damage

(leading to carcinogenesis)

Definition
proto-oncogenes, tumor suppressor genes, gnees regulating apoptosis, DNA repair genes, genes involved in issue invasion and metastasis
Term
proto-oncogenes
Definition

Normal cellular genes that promote growth and differentiation

Term

Are mutations in proto-oncogenes:

loss of function or gain of function

AND

dominant or recessive?

Definition

gain of function

dominant

--once proto-oncogenes are mutated, they are called cellular oncogenes

Term
cellular oncogenes
Definition
mutations in proto-oncogenes or their promoters(regulatory regions) lead to increased function (activation) or overexpression and the genes are then referred to as cellular oncogenes.
Term

growth factors

what are they and what can mutations cause?

Definition

soluble or cell surface proteins that lead to increased cell proliferation

 

mutations in genes encoding growth factors results in increased cellular proliferation BUT a single growth factor mutation is not enough to result in a malignant neoplasm

Term

Growth factor receptors

 

What are they and what do mutations do?

Definition

membrane bound proteins that have an extracellular domain to bind growth factors

 

mustations can lead to activation without lignand (unregulated growth promoting signal to the cell and increased cell proliferation)

Term

Signal transducing proteins

what do they do?

Definition

mediate signals from the cell surface to the nucleus

example: RAS

Term
What is the single most common abnormality of dominant oncogenes in human tumors?
Definition
mutation of the RAS gene
Term

RAS

what is it's nickname and what does it do?

Definition

It is the signal transducing 'gatekeeper'

It is involved in mediating the growth promoting signals of many growth factor receptors.

 

Activation (by GTP) activates the MAP kinase-signaling pathway

Term

RAS

what is the common mutation?

Definition
Mutation of the GTPase domain -- so GTP is never converted to GDP...so it is continuously active.  This leads to continuous growth-promoting signals to the nucleus...hence abnormal proliferation
Term

Nuclear ranscription factors

What do they do?

Definition
regulate transcription rom specific genes (many do this by binding directly to DNA)
Term

Cell Cycle: Phases and what regulates?

Definition

G1 - pre-DNA synthesis

S - DNA synthesis (cell commits to division

G2 - pre-Mitotic

M - Mitosis

G0 - quiescent cells that are nonproliferating

 

Regulated by: Cyclin-dependent Kinases (CDKs)

 and Cyclin D (major in G1 to S transition)

Term

Proto-oncogene to cellular oncogene mechanisms

(3)

Definition

1. Mutational activation

2. Chromosomal translocations

3. Transcriptional activation

Term

Mutational activation

Definition

converts proto-Onc to Onc

--single mutation results in a change in structure of gene product.

ex: point mutation, frameshift mutation

Term
Chromosomal translocation
Definition

converts proto-Onc to Onc

--a portion of one chromosome can become attached to a portion of another chromosome

Term
Transcriptional activation
Definition

converts proto-Onc to Onc

--can occur through translocations (like in chromosomal translocation) or by gene amplification

Term

Tumor supressor gene

what do they do?

Definition

growth inhibiting gene

they prevent normal cells from proliferating too fast

Term

Mutations in tumor suppressor genes result in:

loss of function OR gain of function

AND are

dominant OR recessive

mutations?

 

Definition

Loss of function

AND

Recessive

Term

APC, Rb (retinoblastoma gene), p53

Definition
examples of tumor suppressor genes
Term

p53

what is it?

mutations: loss or gain of function? dominant or recessive?

Definition

tumor supressor gene

 

***Most common target for genetic alteration in human cancers**

loss of function, recessive

 

"guardian of the genome" "gatekeeper of cell proliferation"

Term
Describe Gonorrhea
Definition

gram negative

gets into tissues through sexual contact

scaring of tissue

males=urination problems

females: infertility

pelvic inflammatory disease 

Term
listeria meningitis
Definition

occurs in crowded conditions (ex: dorms)

rapidly spreading 

coats surface of brain

therapy is needed quickly

immunization availability 

Term
What are some dangerous gram + bacteria?
Definition

clostridia 

dyptheria 

Term
Shigella
Definition
  • gram -
  • nonmotile rods
  • cause bacillary dysentery: acute infection of the wall of the large bowel, results in blood, pus and mucus appearing in the stool
  • microorganism damages the bowel by direct invasion with resultant inflammation, plus the bacterium secretes an exotoxin which further irritates the bowel wall
  • can cause dehydration, anemia
  • disorder is prevalent in the tropics
  • cramping, ulcers 
Term
Is mycobacterium tuberculosis still a big killer in most of the world? What can be done to help prevent it?
Definition

improvement in sanitation

personal hygene 

Term
Mycobacterium tuberculosis
Definition
  • thin, long rod with waxy coat
  • does not stain with gram stain
  • acid stains and special media are needed
  • slow growing
  • can't transmit through blood exchange, only through inhalation
  • aerobic (they love them some oxygen!)
Term
Describe the process of Mycobacterium tuberculosis infecting the body.
Definition
  • organism gets in body, usually through inhalation
  • early neutrophilic response: the bacteria are ingested by neutrophils, but the bacteria multiply and the neutrophils die
  • monocytes then engulf the bacteria, but also cannot kill it
  • the monocytes that contain the bacteria go to regional lymph nodes
  • within 1-2 weeks, cell mediated immunity starts up: testing for delayed hypersensitivity by skin testing will be positive
  • organisms are slowly destroyed
  • monocytes (macrophages) assume an epithelioid appearance and a granuloma (tubercle) forms with general necrosis (caseation)
  • eventually most of the tubercles are walled off by scar
Term

Primary Tuberculosis:

 

Definition
  • If the cell mediated immunity does not function properly the bacteria may spread within 10-14 days
  • may cause severe destructive pneumonia and disseminate throughout the body causing small foci of infection
Term
Reinfection Tuberculosis
Definition
  • in some primary complex lesions the organisms may remain dormant
  • later if the hosts cell mediated immunity becomes impared the bacteria may break out
  • most cases are pulmonary with destructive disease
  • also possible that there is hematogenous spread throughout the body, spread to GI tract by swallowing infected secretions, and spread to lymph distand nodes 
Term
How is Tuberculosis spread?
Definition

VERY CONTAGIOUS

spread via respiratory droplets during coughing, sneezing, talking 

Term
What is the agent of syphilis?
Definition

Treponema palladium

(this is a spirochete) 

Term
What are some examples of spirochetes?
Definition

*long slender helically coiled organisms

*Treponema palladium (syphilis)

*Borrelia burgdorferi (lymes disease) 

Term
What is the general structure of viruses?
Definition

-Nucleic acid core surrounded by a capsid

-the capsid is surrounded by an envelope 

-on the envelope there are envelope antigens 

Term
What are some distinguishing characteristics of viruses?
Definition
  • submicroscopic, subcellular agents with a protective coat of protein wrapped around a central core of nucleic acid
  • there may be a surrounding lipoprotein envelope
  • obligate intracellular parasites
  • cannot reproduce outside a host cell
  • do not multiply by dividing
  • take over the cell's synthetic machinery for the sake of viral reproduction
Term
What is the nucleic acid of viruses?
Definition

may be RNA or DNA

NEVER BOTH! 

Term
How do viruses spread?
Definition
  • lysing the host cell and releasing numerous progeny
  • budding off from the host cell in a more controlled manner
  • viral genomes becoming incorporated into the host genome and remaining dormant through mitotic cycles involving the host's genome. Some may just enter the cytoplasm of a host cell and remain inactive.  They may reactivate and form infectious viral particles at a later time.
Term
Give an example of a virus causing cancer?
Definition

human papilloma virus

- the DNAor products of human papilloma virus, types 16 and 18 (and others) are often found in association with dysplasias and/or carcinomas of the uterine cervix 

Term
What is the order of stratification?
Definition

Kingdom

Phylum

Class

Order

Genus

Species

 

(Kinkie patty classes out green spandex) 

Term
Describe the viral multiplication cycle:
Definition
  • attachment to the cell
  • Penetration of the cell
  • Unwinding of DNA
  • Transcription of mRNA
  • Translation of early proteins
  • Replication of viral DNA
  • Transcription of mRNA
  • Translation of late proteins
  • Assembly of viruses
  • Release from the cell
Term
Describe Viral Influenza
Definition
  • highly contagious infection of the respiratory tract
  • viral proliferation occurs in the upper respiratory tract and trachea
  • in most patients the illness is relatively benign, but may be complicated due to pneumonia
  • influenza virus kills respiratory epithelium and destroys the barrier, giving bacteril parasites an opportunity to cause an additional infection (SUPERINFECTION)
  • spherical
  • has two antigens on its surface: a hemagglutinin and a neuraminidase
  • able to change surface antigens (this is why there are new strains of flu)
Term
Superinfection
Definition

 a secondary infection

- example is in viral influenza when the virus kills respiratory epithilium and destroys the barrier, giving bacterial parasites an opportunity to cause an additional infection. 

Term
Two antigens on the surface of viral influenza:
Definition

- hemagglutinin and a neuraminidase

*able to change surface antigens (this is why there always new strains of the flu) 

Term
Rotavirus
Definition
  • big kid killer
  • most frequent cause of viral gatroenteritis in the young
  • may be the biggest killer of the young (BABY KILLER!)
  • malnourishment
  • GI infection
Term
What are some clinically important viral diseases of the CNS?
Definition

polio

rabies

encephalitis

"aseptic meningitis" 

Term
How can viral infections be diagnosed?
Definition

diagnosis of viral infection can be made by viral culture, measuring host antibody production, and/or clinical picture

Term
What are some characteristics of fungal diseases?
Definition
  • plantlike: but lack pigments to generate sugarfrom sunlight
  • live by saprophytic or parasitic means
  • two forms of fungi: yeast and molds
  • fungi live off of dying material or parasitize other organisms to survive
Term
What are the two types of fungi?
Definition
yeast and mold
Term
Describe yeast
Definition

- a type of fungi found in warm, moist environments

-unicellular

-reproduce by budding 

Term
Describe molds:
Definition

-fungi

- live in colder, dryer environments

-exist as a mass of tubules that tend to form terminal spores or conidia

- long branching tubular hyphae which consist of several cells lying end to end and reproduce by apical growth of hyphae 

Term
mycoses or mycotic diseases
Definition

what fungal infections are known as

Term
What causes the destructive response in fungal infections?
Definition

immune system

- in fungal infections damage to the host is not caused to any great extent by the invasive or toxic properties of the fungus, but rather the overwhelming destructive response of the immune system as the body tries to get rid of the parasite

Term
Cutaneous fungi
Definition

ring worm: cause suerficial infections with a predilection for keratin rich structures such as nails, hair and epidermis

 

athletes foot and jock itch

Term
Candida albicans (monilia)
Definition
  • Fungi 
  • part of the normal mouth and GI flora
  • may involve mucous membranes and cause oral lesions (thrush) or vaginitis (especially in diabetics and pregnant women)
  • In hospitalized or immunosuppressed patients it is an occasional cause of systemic illness leading to septicemia, endoarditis, meningitis, renal infections, and death
Term
Aspergillosis
Definition
  • ubiquitous mold usually associated with decaying vegetation but can be found everywhere
  • has been recovered from air conditioning units
  • can cause pulmonary infections and one of the more common opportunistic infections
  • in severe infections it tends to invade and block blood flow and death of the tissues supplied by the vessel
  • it may colonize and invade wounds or burns
Term
General Characteristics of Protozoa:
Definition
  • protazoa infections are common in less developed areas of the world
  • unicellular, eukaryotic (possess nuclei, mitochondria and other organelles)
  • some have very complicated life cycles, while others reproduce by asexual division (binary fission)
Term
What are the general classifications of protozoa?
Definition

1. Luminal parasites (gastrointestinal and genitourinary): passed either directly from human to human or by contaminated food or water (fecal-oral transmission); related to inadequate hygen and sanitation

2. Blood and tissue parasites: generally transmitted via an arthropod (misquitoes, flies, etc)either a vector or secondary host- and more dependent on ecological factors allowing existence of vectors.

Term
How do protazoa cause disease?
Definition

-tissue invasion

-tissue colonization

-due to host defense responses

Term

How are protozoan infections diagnosed?

Definition
diagnosis based mainly on recovery and morphologic identification of the parasite; some by serologic methods
Term
Amebiasis
Definition

-protazoan disease

- caused by Entamoeba histolytica

-disease caused by ingestion of contaminated food or water

-organism lives in the colon and usually causes diarrheea (amebic dysentery); can spread to other organs including the liver, lung and brain

-organism is identified in stool smears as an amoeba that tends to phagocytize red blood cells or more often as a multinucleated cyst.

Term

What protazoan organism is identified by its tendency to phagocytize red blood cells and often shows up as a multinucleated cyst?

What disease does it cause?

Definition

Organism: Entamoeba histolytica

Disease: Amebiasis

Term
Malaria
Definition

-protazoan disease

-caused by a species of Plasmodium

-one of the most widespread of all infections

-spread by the bite of infected female Anopheles mosquitoes: the organism reproduces asexually in man and sexually in misquito.

- spreads from the bite site to the liver

-spreads from the liver to the red blood cells

-fever, shaking chills, anemia, and plugging of small blood vessels

-has been transmitted by blood transfusions

Term
What are some symptoms of malaria?
Definition

fever

shaking chills

anemia

plugging of small blood vessels

Term
Enamoeba histolytica
Definition

-produces a flask shaped ulcer in the colon wall

-associated with bad sanitation

-protazoan

-causes amebiasis: disease is caused by ingestion of contaminated food or water

-tends to phargocytize red blood cells

-shows up most often as a mutlinucleated cyst

Term
Describe general characteristics of Worms (Helminths).
Definition
  • uncommon in urban industrialized areas
  • large, multicellular organisms including: roundworms, tapeworms, and flukes
  • most have complicated life cycles
  • high association with poor sanitation
  • can cause disease by a variety of mechanisms: tissue invasion, host response, or competition between the worm and the host for nutrients
  • worm infestations are often associated with high eosinophi count
  • diagnosis is usually made by identifying the worm in stool or tissue

 

Term
What are worm infestations often associated with?
Definition
high eosinophil count
Term
What is the diagnosis of worm problems?
Definition
identifying the worm in the stool or tissue
Term
Enterobiasis
Definition

- pinworm

-worldwide distribution

-mainly an infection of children

-lives in the small and large intestines

-transmission by the fecal-oral route

- at night adult females migrate from their normal home in the colon and deposit eggs on the perianal skin

-the eggs cause inflammation and intense itching

-worms are occasionally passed in the stool, appearing as white moving threads

-relatively mild disease

Term
What are the 5 major disease causing deaths in the US?
Definition

1. Heart disease

2. Cancers

3. Cerebrovascular diseases

4. Chronic obstructive lung diseases

5. Accidents

Term

What are the leading cancers in adult women?

Definition

1. breast

2. lung

3. colon and rectum

4. uterus

5. lymphoma/leukemia

Term
What are the 6 leading cancer causes of death in women?
Definition

1. lung

2. breast

3. colon and rectum

4. lymphoma/leukemia

5. pancreas

6.ovary

Term
What are the top 5 cancers in men?
Definition

1. prostate

2. lung

3. colon and rectum

4. lymphoma/leukemia

5. urninary bladder

Term
What are the top 5 cancer types that cause death in men?
Definition

1. lung

2. prostate

3. colon and rectum

4. lymphoma/leukemia

5. pancreas

Term
What are the top five causes of death in children in the US?
Definition

1. accidents

2. cancer

3. congenital abnormalies

4. homicide

5. suicide

 

*cancer types that are common in children are different from those that are common in adults

Term
What's the average length of survival after diagnosis of lung cancer?
Definition
6-9 months
Term
Definition of tumor:
Definition

a swelling

-therefore, the term tumor could be applied to any type of swelling including  purely inflammatory process

-most people use this term to imply a swelling due to a neoplastic process

- the terms tumor and neoplasm are more often used interchangably

Term
Neoplasm=
Definition

a heritably altered, relatively autonomous growth of tissue

- generally means "new growth"

Term
What is the definition of polycythemia?
Definition

too many red cells (the opposite of anemia)

 

the blood is too thick when hematocrit rises above 55%, tendency towards thrombosis. 

Term
erythroblastosis fetalis
Definition
hemolytic disease of the newborn
Term
how do you treat hemolysis in the fetus?
Definition

there is no good way to treat it, so it must be prevented!

-give anti-Rh serum to mother during delivery to prevent sensitization by Rh positive cells.

-Do not ransfuse an Rh negative woman with Rh positive blood 

Term
LiFraumeni syndrome
Definition
inherited mutations of p53, inherited as autosomal dominant.  These patients have a predisposition to the development of cancer
Term
There are two forms of polycythemia, what are they?
Definition

1. Polycythemia vera (primary polycythemia)

- a form of myeloproliferative disorder, a low-grade neoplasm.  Red cell progenitors proliferate independent of normal controls.

-Treatment : phlebotomy (removal of blood), antineoplastic drugs.

2. Secondary Polycythemia

-Red cell progenitors proliferate in response to erythropoietin.

-decreased oxygen delivery to kidney -> increased production of erythropoietin by kidney -> increased red cell production

-usually caused by chronically low blood oxygen level due to lung or cardiac disease, may be correctable by giving oxygen. 

Term
p53 mechanism
Definition

When mutation in DNA occurs, p53 is activated

It binds to DNA and upregulates the transcription of p21, inducing the cell in G1 phase AND it upregulates GADD45 (a DNA repair gene)

If DNA cannot be repaired, p53 can increase transcription of bax (pro-apoptotic gene)

Term
Apoptosis
Definition

programmed cell death that eliminates cell from the organism

involves the breakdown of cytoplasmic and nuclear skeletons, extrusion of cytoplasm, chromosome degradation, and nuclear fragmentation.

Term
Methods of apoptosis (2)
Definition

1. soluble cell surface death signals produced in a response to certain cytokines bind to cell surface receptors

2. intracellular sensor molecules (such as p53) detect one of the following: DNA damage, abnormal oncogene activation, survival factor insufficiency or hypoxia, and this can activate apoptosis

Term
what is a myeloproliferative disorder?
Definition
a disease of the bone marrow where too many cells are produced.
Term
What does the mitochondria release in response to proapoptotic signals??
Definition

Cytochrome-C (a catalyst of apoptosis)

 

Term
Neutropenia
Definition
decreased neutrophils
Term
neutrophilia
Definition
increased neutrophils
Term
angiogenesis
Definition
formation of new blood vessels
Term
How do you get a decrease in neutrophils?
Definition

Aplastic anemia or other forms of marrow failure

 

Temporary drop in production due to bone marrow suppression by cancer chemotherapy.

 

OR you may have INCREASED NEUTROPHIL CONSUMPTION.

- Autoimmune

-Severe infections

- Enlargement of spleen 

Term
Classes of signaling factors that mediate angiogenesis (2)
Definition

1. soluble proteins and their receptors

2. Integrins and adhesion molecules that mediate matrix and cell-cell associations

Term
Angiogenesis promoting soluble molecules
Definition

VEGF - vascular endothelial growth facor

FGF1 and FGF2 - fibroblast growth factor 1 and 2

 

Tumors often give these off to initiate angiogenesis so that the tumor can receive more blood and oxygen

Term
How do you get increased neutrophils?
Definition

in response to physiologic stimuli (infection)

- neutrophils are normally stuck to the wall of blood vessels, ready for entering the surrounding tissue if needed, but with corticosteroid drugs, the neutrophils become less sticky and are involved in "demargination." - blood test says more WBCs but there are actually less to fight infection.

 

-neoplastic conditions that cause unregulated production of neutrophils. 

Term

Steps in invasion of the extracellular matrix

Definition

Detatchment of the tumor cells from each other

Attachment to the extracellular matrix

Degradation of the matrix

Migration of the tumor cells

Term

Classes of molecules involved in invasion and metastasis (2)

Definition

1. cell-cell adhesion molecules (CAMs, cadherins, integrins)

2. extracellular proteases

Term
Agents that lead to mutations in DNA
Definition

chemicals, radiation, some microorganisms (viruses)

**mutations could also be inherited

Term
thrombocytopenia
Definition
low platelet count
Term
asplenia
Definition
absence of spleen
Term
leukemia
Definition
neoplastic (cancerous) proliferation of leukocyte precursors.  Cancerous cells are usually found in bone marrow, blood and often many other tissues.
Term

Acute vs. Chronic leukemia

What is acute leukemia caused by? 

Definition
proliferation of immature leukocyte precursors (blasts) that have lost the ability to differentiate.  Since these immature cells never stop dividing, leukemic cells accumulate rapidl, and the disease is usually fatal within months if untreated.
Term

Acute vs. Chronic leukemia

What is chronic leukemia caused by? 

Definition
proliferation of leukocyte precursors that have retained the ability to differentiate.  Since cells stop dividing as they differentiate, chronic leukemias progress more slowly; some patients can live for many years.
Term
sporadic cancer : hypothesis of how it arises
Definition
contributions from both inherited (somatic cells) and environmental factors that lead to mutations
Term
carcinogen
Definition
any agent that can facilitate the formation of a tumor
Term
What is the most common form of leukemia in children?
Definition

acute lymphoblastic (or lymphocytic) leukemia (ALL)

 

-fatal if not treated, but it's OFTEN CURABLE.

-especially w/ children w/ chemotherapy and or marrow transplant. 

Term
Steps of carcinogenesis (3)
Definition

1. Initiation

2. Promotion

3. Progression

Term
Initiation of carcinogenesis
Definition

-ONCE A MUTATION HAS BEEN FIXED IN THE CELL IT IS SAID TO BE INITIATED

-mutation to single cells

-irreversible

-dose dependent (higher dose of carcinogen is more likely to induse a mutation

-some critical genes that mutation results in initiation include: oncogenes, tumor supressor genes, DNA repair genes, and apoptosis regulating genes

Term
Acute myelogenous leukemia (AML)
Definition

malignant proliferation of immature granulocye (or occasionally erythroid or megakaryocyte) precursors (blasts) leading to accumlation in blood, bone marrow, and often other tissues. 

-Proliferation is more rapid than in CML because blast cells divide faster than stem cells. 

 

-most common adult leukemia 

Term
Promotion of carcinogenesis
Definition

-THE ACCUMULATION OF ADDITIONAL MUTATIONS 

-reversible (since it doesn't involve a DNA mutation)

-involves exogenous signalling to the initiated cell

-dose dependent (more promoting agent = greater proliferation)

Term
Chronic myelogenous leukemia (CML)
Definition

malignant proliferation of myeloid stem cell, with overproduction of white cells and often platelets.

 

- associated with specific chromosome mutation "Philadelphia chromosome" so that parts of the two different chromosomes get studck together and create new (hybrid) gene, which produces a protein that causes uncontrolled growth of myeloid cells. 

Term
progression of carcinogenesis
Definition

-ADDITIONAL DNA DAMAGE BEGINS TO ACCUMULATE MORE RAPIDLY (UNTIL THE MALIGNANT PHENOTYPE APPEARS)

-final, irreversible stage

-involves acquisition of multiple additional mutations and results in genetic instability

Term
Chronic lymphocytic leukemia (CLL)
Definition

primarily affects older people, has slowly growing cells, and is treatable, but NOT CURABLE.

 

-cell of origin: B-cell and slowly growing, mature appearing cells that may take years to accumulate to the point that they cause symptoms. 

Term
procarcinogens
Definition

must be metabolically activated to an electrophile

indirect acting carcinogens

Term
direct acting agents
Definition

weak initiators

include alkylating agents

Term
Lymphomas
Definition
cancerous proliferation of lymphocytes and their precursors
Term

Radiation carcinogenesis

 

What are the divisions of radiation?

Definition

radiation induces DNA damage

 

1. Electromagnetic spectrum (ultraviolet, gamma, X-rays)

2. particulate radiation (alpha nd beta particles, protons and neutrons)

Term
Non-Hodgkin lymphoma
Definition

cause enlargement of lymph nodes, spleen, often infiltrate bone marrow and other tissues.

 

Some types cause leukemia

 

Most are treatable, some can be cured. 

Term
Types of UV radiation
Definition

ultraviolet A (320-400) is very low risk

ultraviolet B (280-320) is very high risk

ultraviolet C (200-280) is very high risk

Term
Low Grade lymphoma (Non-Hodgkin)
Definition
slow growing, mature appearing cells, generally incurable but some patients can survive with disease for many years. 
Term
Intermediate grade lymphoma (non-hodgkin)
Definition

fast growwing, immature appearing cells, curable with chemotherapy in 30-40% but many patients die of disease within 1-3 years. 

Example : diffuse large cell lymphoma. 

Term
High grade lymphoma (non hodgkin)
Definition

VERY fast growing, very immature (blast-like) cells similar to acute lymphoblastic leukemia.

Example: Burkitt lymphoma. 

Term
Hodgkin Disease (Hodgkin lymphoma)
Definition

distinctive microscopic appearance, with characteristic  large multinucleated cells (Reed-Sternberg cells).  Cell of origin not known but thought to be a lymphocyte of some kind.

 

One of the more common types of cancer in adolescents and young adults. 

Term
Stages of disease in Hodgkin Disease
Definition

Stage I - diseaes confined to single lymph node or group of nodes.

Stage II- disease in two or more lymph node groups on same side of diaphragm.

Stage III - disease in lymph nodes on both sides of diaphragm.

Stage IV- spread outside the lymph nodes (eg. bone marrow, liver, bone, etc)

 

Most patients with Hodgkins Disease

CAN BE CURED. 

Term
Risk of developing skin cancer from UV radiation also depends on...
Definition

1. intensity of exposure

2. quantity of radiation absorbed (melanain content of the skin is protective)

3. person's genetic makeup

Term
Xeroderma pigmentosa
Definition
patients have mutations in DNA repair enzymes, they have a 2000 fold increase to developing cancer
Term
Viral carcinogenesis
Definition
DNA and RNA viruses have been associated with some cancers (however the mechanism is unknown)
Term
Multiple myeloma
Definition

a disease of plasma cells secreting monoclonal immunoglobulin, causing destruction of bone (holes in bone) and is NOT CURABLE!

 

happens in individuals over 40 

 

marrow infiltration may cause anemai, etc. 

Term
How are neoplasms heritiably altered?
Definition

1. the major changes that occur in neoplastic cells are genetic changes (i.e. DNA, mutations)

2. These changes are irreversible

3. These changes are transmitted to a cell progeny (daughter cells) 

Term
How are neoplasms relatively autonomous?
Definition

1. neoplastic cells are not under the usual "rules and regulations" of most cells, so they grow with little regard to the rest of the organism (remember that pic of the lady with the f'd up grill)

2. Neoplasms are not completely self-sufficient: they require host blood supply to grow to clinically important sizes.

-most tumors outgrow their blood supply and become negrotic in their centers  

Term
What percent of cells in cancer die?
Definition
90%
Term
Benign tumor
Definition

- less virulent

-not totally free of disease

-slow growing

-do not spread to other tissues

- general suffix "-oma" 

-non-invasive

-encapsulated

-no metastasis

-slow growth

-well-differentiated

-mature-looking cells

-rare mitosis

-localized 

Term
Malignant tumor
Definition

- rapidly growing

-potential to spread throughout the body

-malignant neoplasms are commonly referred to as cancer 

-invasive

-non-encapsulated

-metastases

-rapid growth

-poorly differentiated

-anaplastic

-mitosis common

-invade to other tissues 

Term
Benign neoplasms, while they do not spread throughout the body, still have the capacity to cause significant morbidity and even mortality, by producing:
Definition

- local effects (e.g. erosion of bone leading to pathologic fractures or increased intracranial pressure leading to brain herniation)

-hormones that affect other tissues (e.g. a pituitary adenoma producing prolactin which stimulates the growth of breast tissue)

- pain

-bleeding 

Term
Describe Neoplasms:
Definition

- neoplasm=new growth; a heritably altered, relatively autonomous growth of tissue

 

*heritably altered: an irreversible genetic (DNA) alteration that gives a cell some growth advantage is transmitted to daughter cells during mitosis

 

-transformed cells are:

1.no longer very responsive to their environment (i.e. do not respond to signals to quit growing)

2. Are genetically unstable, so they accumulate more genetic alterations which allow them to further evade the immune system, grow autonomously and spread throughout the body

 

- neoplasms growth with little regard to the rest of the organism: the cells do not respond to signals put out by other cells and by the extracellular matrix to stop growing

 

-relatively autonomous:

-- the transformed cells are dependent on the surrounding tissue, or the "host" for oxygen

-- central necrosis occurs at the neoplasm outgrows the host's blood supply

--some neoplasms acquire a growth advantage by developing the ability to grow their own vessels. (angiogenesis or neovascularizatoin) 

-- the transformed cells may respond to some degree of growth-stimulating influences, such as hormones or growth factors 

Term
angiogenesis=
Definition
the ability of some neoplasms to develop their own vessels (blood supply)
Term
Describe how a neoplasm is relatively autonomous.
Definition

- the transformed cells are dependent on the surrounding tissue, or the "host" for oxygen

- central necrosis occurs as the neoplasm outgrows the host's blood supply

-some neoplasms aquire a growth advantage by devleoping the ability to grow their own vessels (angiogenesis or neovascularization)

-the transformed cells may respond to some degree to growth-inhibiting or growth-stimulating influences (such as hormones or growth factors)

**this property can sometimes be used for therapeutic purposes (some forms of breast cancer are stimulated to grow by circulating estrogen, administration of an anti-estrogen, tamoxifen, blocks the ability of estrogen to promote the growth of the neoplastic cells)

Term
Carcinoma
Definition

a malignancy arising from epithelial cells

(e.g. squamous cell carcinoma or adenocarcinoma)

 

Term
sarcoma
Definition

a malignancy arising from mesenchymal cells

(e.g. osteosarcoma, chondrosarcoma) 

Term
What are some ways to determine whether a tumor is benign or malignant?
Definition

-characteristic on the basis of clinical and histologic features.

- clinical feature used to determine whether a neoplasm is benign or malignant is the potential of the neoplasm to metastisize or move to lymph nodes and other organs.

**in general benign neoplasms stay confined to the tissue of origin, while malignant neoplasms have the potential to move throughout the body

Term
What does invasion of neoplastic cells require:
Definition

that the malignant cells be able to degrade the surrounding tissue, or stroma, with proteolytic enzymes

 

Ex: Metalloproteinases: attack the basement membrane

 

Ex: Serine proteinases and cystine proteinases: attack extracellular matrix proteins 

Term
Invasion=
Definition
neoplastic cells grow contiguously beyond their site of origin
Term
Differentiation=
Definition

the extent to which the malignant cells resemble their mature counterparts

 

- the less the malignancy is identifiable in comparision to a mature prototype, the more "undifferentiated" it is

-the "grade of malignancy" is based on it's degree of differentiation. A well differentiated tumor is "low-grade", a poorly differentiated tumor is "high-grade"

Term
What is the "grade" of malignancy based on?
Definition

it's degree of differentiation

 

- a well-differentiated tumor is "low-grade"

- a poor-differentiated tumor is "high-grade" 

Term
Anaplasia=
Definition

-a complete loss of differentiation of cells

-anaplastic cells vary widely in their size and morphologic appearance and bear no resemblance to their mature counterparts 

Term
What are some cytologic features of malignancies?
Definition

- the nuclei are larger than normal, and the ratio of the nucleus to the cytoplasm is increased (increased N:C ratio)

-there may be more than one nucleus

- the nucleus and/or the cell itself has irregular contours

-nuclei are dark

-nucleoli are prominent

-mitotic figures are increased 

Term
Metastasis=
Definition

-noncontiguous spread of malignancy

-ability to move in a noncontiguous fashion to lymph nodes or other organs 

Term
What are the 6 steps of metastasis?
Definition

1.invasion

2. intravasatuib

3. Intravascular circulation

4. Extravasation

5. Local growth in the metastic location

6. Angiogenesis 

Term
Describe the Invasion step of Metastasis.
Definition

- destruction of and movement through adjacent tissue

-invasion requires that the malignant cells be able to degrade the surrounding tissue, or stroma, with proteolytic enzymes

-metalloproteinases: attack the basement membrane

-serine proteinases and cystine proteinases: attack extracellular matrix proteins.

 

6 Steps of metastasis:

1. invasion

2. intravasation

3. Intravascular circulation

4. Extravasation

5. Local growth in the metastatic location

6. Angiogenesis 

Term
What do Metalloproteinases attack in the invasion step of metastasis?
Definition
attacks the basement membrane
Term
What do serine proteinases and cystine proteinases attack in the invasion step of metastasis?
Definition
- attack the extracellular matrix proteins
Term

 Describe the Intravasation step of metastasis.

Definition

-movement into lymphatic or blood vessels

-this requires the ability to destroy the capillary or lymphatic basement membrane and to bore holes through or between endothelial cells

-enzymes destroy basement membrane or endothelial cells

 

6 steps of metastasis:

1. Invasion

2. Intraversion

3. Intravascular circulation

4. Extravasation

5. Local growth in the metastatic location

6. Angiogenesis 

Term
Describe the Intravascular circulation step of metastasis.
Definition

- circulating lymphocytes destroy most of the tumor cells that gain entry into the blood stream. Single cells are more likely to be eliminated than clusters of cells.

-clumps of tumor cells surrounded by platelets (tumor emboli) are more likely to survive in the blood stream

 

 

6 steps of metastasis:

1. invasion

2. intravasation

3. intravascular circulation

4. extravasation

5. local growth in the metastatic location

6. angiogenesis 

Term
Describe the extravasation step of metastasis.
Definition

- movement out of the lymphatic vessels or blood vessels

-the flow of lymph or blood can carry tumor emboli to organs far removed from the site of the primary malignancy.

-extravasation can occur in lymph nodes, if the tumor emboli intravasated to lymphatics, or into the organs, if they were present in the blood steam

-matastasis most commonly occur in organs that receive a high volume of blood flow, such as the lungs or the liver

 

 

6 steps of metastasis:

1. invasion

2. intravasation

3. intravascular circulation

4. extravasation

5. local growth in the metastatic location

6. angiogenesis 

Term
Examples of human DNA oncogenic viruses
Definition
HPV, EBV, HBV, HHV8
Term
Describe the local growth in the new location phase of metastasis.
Definition

- the malignant cells must be able to avoid growth-inhibiting signals and mechanisms of the host tissue, such as protease inhibitors

 

6 steps of metastasis:

1. invasion

2. intravasation

3. intravascular circulation

4. extravasation

5. local growth in the metastatic location

6. angiogenesis 

Term
Describe the angiogenesis step of metastasis.
Definition

- angiogenesis is the introduction of growth of new blood vessels.  Without a supply of oxygen, the metastatic tumor cannot grow.

 

6 steps of metastasis:

1. invasion

2. intravasation

3. intravascular circulation

4. extravasion

5. local growth in the metastatic location

6. angiogenesis 

Term
Examples of human RNA oncogenic viruses
Definition
Hep C, human T-cell leukemia virus type 1 (HTLV1), HIV
Term
Monogenic heritance
Definition
when the mutation leading to cancer is inherited in a simple mendelian pattern (recessive or dominant)
Term
polygenic inheritance
Definition
when multiple genes are mutated i order to inherit a predisposition to cancer (the initiation event)
Term
Stage of malignancy=
Definition
how widely the malignancy has spread throughout the body
Term
What is the stage of malignancy determined by?
Definition

Determined by assessing:

 

   - the extent of local growth

--size of the neoplasm

--extension to surrounding tissue

 

-lymph node metastases

--number of involved lymph nodes

--size of lymph node metastases

 

-distant organ metastases

 

**stage is correlated with survival

**stage determines treament 

Term
What does an increased stage indicate?
Definition
increased movement through the body
Term
What are the three most common cancers in women?
Definition
breast, lung, and colon
Term
What are the three most common cancers in men?
Definition
prostate, lung and colon
Term
What are the three deadliest cancers in women?
Definition
lung, breast and colon
Term
What are the three most deadliest cancers in men?
Definition
lung, prostate, and colon
Term
What can we do to reduce the incidence and mortality of cancer?
Definition

1. Tertiary prevention: early detection, effective treament (most cancers are treated with a combination of surgery, radiotherapy and chemotherapy...these treatments can cause nausea, fatigue, abdominal pain, infections, hair loss)

-prostate: yearly PSA levels for men beginning at the age of 50

- Breast: screening mammorgraphies for women over 40

-Colorectal: yearly fecal occulut blood testing and colonoscopy every 5 years.

-lung: no effective screening tool

-cervix: PAP smear 

 

2. Secondary Prevention: risk factor management

- smoking is the leading cause of lung cancer

-health care giver advice to patients to stop smoking has declined over the last 2 decades

-colon cancer: linked to diets high in fat, low in vegetables, and to a sedentary lifestyle

-sex, age, family history

-Breast cancer: estrogen exposeure, high socioeconomic status

-Prostate cancer: dietary fat, smoking, african-american.

3. Primary Prevention: avoiding the development of risk factors to begin with 

Term
Cause of Death (COD)
Definition

any injury or disease producing physiological derangement in the body that results in the death of the individual

 

examples: gunshot to the head, drowning, drug overdose, etc.

Term
Mechanism of death (MOD)
Definition

actual hysiological derangement that is produced by he cause of death that results in death

 

Examples: hemorrhage, arrhythmia, asphyxia, etc.

Term
5 Manners of death
Definition

Suicide

Homicide

Accident

Undetermined

Natural

Term
What 2 pieces of info go on the death certificate?
Definition
Cause of death and manner of death
Term
Suicide
Definition
'self murder'
Term
Homicide
Definition
individua is killed by another person.  it is not murder and does not imply intent
Term
Accident
Definition

death occurring under circumstances that neither the victim nor anyone else knowingly brought about and the resulting death was not reasonably foreseeable

Term
Papilloma=
Definition
benign tumor projecting above the surrounding surface
Term
undetermined
Definition
manner of death used when after all death investigative info has been examined there is isufficient info to put death in one of the other manner categories.
Term
natural
Definition

victim dies of natural causes and no non-natural event caused or contriuted to the death

 

** this is most of what forensic pathologist's see

Term
lymphoma=
Definition
malignant tumor of lymph node elements
Term
Contact gunshot wound
Definition

muzzle of the weapon is in contact with the target

 

muzzle imprint or muzzle stamp

Term
What is the largest general classification of cancer?
Definition

- carcinoma=histogenesis is from epithelial cells which, for the most part, are cells that normally come in contact with the environment outside the body

Term
intermediate range gunshot wound
Definition

muzzle of the weapon is not in contact but is close enough that unburned poder leaving the barrel with the bullet retains enough energy to cause microabrasions (stippling) of the skin

 

Term
stippling
Definition

occurs from intermediate range gunshot wound

 

microabrasions

Term
What are the pathophysiologic events necessary for invasion?
Definition

1. attachment

2. Degradation

3. migration 

Term
indeterminant range
Definition
no features of the wound indicate range of fire.  May have been a contact wound over clothing, or shot from several hundred feet away
Term
Three main classes of abused drugs (resulting in death)
Definition
cocaine, opioids, meth
Term
ARDS (Adult Respiratory Distress Syndrome)
Definition
- a clinical syndrome of rapidly progressive respiratory failure characterized by severe hypoxemia usually requiring mechanical ventilation and featuring extensive radiologic opacities in both lungs.
Term
cocaines inactive metabolite
Definition
benzoylecgonine (BE)
Term
Where is ARDS (Adult Respiratory Distress Syndrome) usually seen?
Definition
- typically seen in a previously healthy patient who sustained a severe injury
Term
metabolite of cocaine if ethanol is also injested
Definition
cocaethylene (CE)
Term
2 classes of narcotic analgesics
Definition
opiates and opioids
Term
opiates
Definition

actual alkaloid extracts of opium

 

morphoine and codeine

Term
DAD (diffuse alveolar damage)
Definition

- the pathologic counterpart of ARDS

-non-specific pattern of pulmonary parencymal reaction to a variety of acute insults 

Term
opioids
Definition

any medication inding to opioid receptors found in the brain or GI tract

 

endogenous(produced w/i the body):  endorphins, enkephalins

exogeneous (semisynthetic or fully synthetic): semi:heroin, oxycodone, hydrocodone. fully: methadone, fentanyl, propoxyphene

Term
foam cone
Definition

frothy fluid discharge from the mouth and nose caused from profound pulmonary edema

 

three settings this is seen in: opioid toxicity, drowning, head injuries

Term
heroin is metabolized to:
Definition
6-monoacetylmorphine (6-MAM), then to morphine
Term
antifreeze component that is an alcohol
Definition

ethylene glycol

when injested it can result in severe toxicity and death

 toxic intermediates: oxylate, oxalic acid

Term
calcium oxylate crystals
Definition
seen in the kidney tubules in death due to ethylene glycol toxicity
Term

vitreous humor

 

what is it? where is it collected from??

Definition

fluid collected from the posterior chamber of the eye. 

vitreous ethanol level lags the blood by 2 hours

Term
death while in an absorptive phase
Definition

most likely still drinking around the time of death

 

vitreous ethanol level is lower than the blood ethanol level

Term

death while in the elimination phase

Definition

ethanol levels were falling during death and the individual had not ingested ethanol immediately prior to death

 

vitreous ethanol is higher than the blood ethanol level

Term
carbon monoxide
Definition

200x greater affinity for hemoglobin than oxygen

50% saturation of hemoglobin by CO is enough to say that was the cause of death

 

this is helpful in determining whether someone in a fire died before, or during the fire.

Term
postmortem interval
Definition
time of death
Term
Non-biological clues to determine postmortem interval (time of death)
Definition
witnesses, newspapers/mail, food in fridge
Term
Biological clues to determine postmortem interval (time of death)
Definition
algor mortis (cooling of the body), rigor mortis (stiffening of the muscles), livor mortis (pooling of blood)
Term
algor mortis
Definition

still warm? short postmortem interval (have only been dead a few hours)

Term
rigor mortis
Definition
stiffening of the muscles due to ATP depletion following death
Term
Rule of 12's
Definition

part of rigor mortis

1st 12 hours: rigor strenghtens with muscles becoming stiffer and stiffer

middle 12 hours: rigor remains fixed and firmly established (difficult to 'break')

3rd 12 hours: rigor passes, becoming less stiff

Term
livor mortis
Definition

pooling of the blood

 

when you can't determine whether stiffness is 1st or 3rd 12hour, check this~~

 

bloodsettles in gravity dependent ares of the body due to stasis or lack of circulation.  The blood becomes 'fixed' and will not blanch

Term
vitreous humor to determine postmortem interval (time of death)
Definition

potasium levels can be measured (potassium is usually maintained by pumps, but after death it is able to leak into the extracellular matrix...vitreous fluid...so they will rise linearly after death)

 

glucose levels can also be evaluated (can check for diabetes as a cause of death) glucose levels should fall near to zero within several hours after death

Term
mummification
Definition

desiccation (drying) of the skin and internal organs with reservation of structures.

 

arrid and dry environments

Term
interstitial lung diseases
Definition
large number of pulmonary disorders that are characterized by lung injury, pulmonary inflammation (related to known or unknown causes), and variable degrees of fibrosis
Term
Idiopathic pulmonary fibrosis (IPF)
Definition

classic example of fibrotic interstitial lung disease

 

typically presents with: progressive dyspna and dry cough

 

clinically: exertional dyspnea, restrictive defect (low TLC), hypoxemia on exercise and tachypnea

 

Term
Is there effective therapy for idiopathic pulmonary fibrosis (IPF)?
Definition
No, corticosteroids can be helpful in a minority of patients.  Lung transplants can also be somewhat successful but 50% of patients die w/in 5 years
Term

Stages of idiopathic pulmonary fibrosis

 

Definition

Usual interstitial pneumonia (UIP) aleolar walls are thickened with extensive fibrosis and extreme abnormalities in alveolar architecture

 

Desquamative interstitial pneumonia (DIP) milder type of the disease characterized by minimal fibrosis, alveolar inflammation and fullness of the alveoli with macrophages.  (type 2 pneumocytes have been desquamated)

Term
sarcoidosis
Definition
chronic granulomatous interstitial lung disease
Term
PaCO2
Definition

The partial pressure of CO2 in the arterial blood

 

- it is determined by the relationship between CO2 production (VCO2) and elimination (i.e. alveolar ventilation)

if alveolar ventilation is increased, PaCO2 will decrease proportionately(provided that VCO2 remains stable) 

Term
Several disease states are associated with hyperventilation, they include: 
Definition

fever, sepsis

Medications (aspirin, progesterone, xanthines) 

Metabolic acidosis

Maximum exercise

Hypoxemia

Anxiety 

Term
Alveolar hypoventilation
Definition
increased PaCO2
Term

What's the defintion of hypoxemia?

 

Also, there are several mechanisms of hypoxemia, what are they? 

Definition

Reduction of arterial P02

 

hypoventilation

 

low ventilation/perfusion (V/Q)

 

right-to-left shunt 

 

 

Term
What are affects of low V/Q (ventilation/perfusion)?
Definition
venous blood remains unoxygenated after contact with poorly-ventilated alveoli.  This is the most common mechanism causing hypoxemia.
Term
What is right-to-left shunt?
Definition
venous blood reaches the systemic circulation wiwthout contacting alveolar oxygen.
Term
Residual Volume
Definition
the volume of air remaining at the end of forced exhalation
Term
Expiratory Reserve Volume (ERV)
Definition
the maximal volume of air exhaled by forced expiration after the end of normal exhalation, thus it requires expiratory muscle recruitment
Term
Tidal Volume
Definition
the volume of air inspired with each breath.
Term
Inspiratory Reserve Volume (IRV)
Definition
the maximal volume of air inhaled by forced inspiration after inhaling a normal tidal volume.
Term
Functional residual capacity (FRC)
Definition
the volume of gas remaining in the lung at the end of a normal exhalation.
Term
Inspiratory capacity
Definition
the maximal volume inhaled from normal end-expiration; IC is dependent on inspiratory muscle strength.
Term
Vital Capacity (VC)
Definition
the volume of air inhaled or exhaled between mazimal inspiratory and maximal expiratory effect.
Term
Total Lung Capacity (TLC)
Definition
the amount of air in the lungs at the end of maximal forced inspiration
Term
FEV1
Definition
Forced expiratory volume in one second
Term
Define lung resistance and elasticity.  What is the difference?
Definition

Resistence- the airflow through extrathoracic and intrathoracic airways

 

Elastance - opposing stretching the lung and thorax. 

Term
compare an emphysematous lung and a fibrotic lung
Definition

emphysematous lungs are larger and more compliant

 

fibrotic lungs are smaller and less compliant (elastic recoil is greater) 

Term
What does FEV1/FVC measure and what does it mean?
Definition

it's the measure of how much you force out after a forced inspiration in one second, over the total amount you can force out. 

 

If you have a reduced FEV1/FVC, that's the hallmark of obstructive defect 

Term
Pulmonary Hypertension
Definition
increased pressure in the pulmonary vascular system (can occur at some stage in most cardiopulmonary disorders)
Term
Acute pulmonary hypertension
Definition
seen in pulmonary thromboembolism
Term
chronic pulmonary hypertension
Definition
 occurs most often as a result of chronic lung disease, recurrent pulmonary thromboembolic disease, or congenital heart diease.
Term
What is the key determinant of arterial PCO2
Definition
alveolar ventilation
Term
Hypersensitivity pneumonitis
Definition

extensive allergic alveolitis

pulmonary inflammation secondary to immune reaction to inhaled organic dusts

Term
2 main syndromes for hypersensitivity pneumonitis
Definition

acute: occurs a few hours after exposure to an antigen. 

chronic: slowly progressive, the lung reveals inflammation with multinucleated giant cells forming scattered "loose" granulomas.

Term
Pneumonoconioses
Definition

group of interstitial pulmonary diseases caused by inhalation of inorganic dusts.

 

Examples:

Siliocosis, asbestosis

Term
silicosis
Definition

an example of pneumonoconioses

 

it is caused by the inhalation of silicon dioxide (silica) which occurs in mining, sand blasting, and foundries

 

inhilation causes pulmonary inflammation and fibrosis.

Term
diagnosis of silicosis
Definition
Xray and history of exposure
Term
Patients with silicosis are at an increased risk for developing....
Definition
tuberculosis
Term
asbestosis
Definition

a pneumoconioses

 

fibrotic pulmonary disease secondary to inhalation of asbestos fibers which occurred in mining, insulation, tile production, and ship building.

Term
mechanism of asbestos antigen
Definition

inhaled asbestos fibers deposit in the distal airway and alveoli are injested by macrophages.

 

large fibers penetrate into the interstitial space and become coted w/ iron rich protein and are called the asbestos bodies.

Term
asbestos bodies
Definition
when asbestos' large fibers penetrate into the interstitial space and become coated w/ iron rich protein.
Term
Other conditions associated with asbestos inhalation
Definition

pleural plaques, pleural effusion and mesothelioma

 

also associated with increased risk for bronchogenic carcinoma

Term
mesothelioma
Definition

lethal cancer in the pleural space

 

no effective therapy

Term

Lung cancer is classified into: (4)

Definition

1. squamous cell carcinoma

2. adenocarcinoma

3. large cell carcinoma

4. small cell carcinoma

Term
diagnosis of lung cancer
Definition
chest x-ray and confirmed by tissue examination
Term

small cell carcinoma

 

what is it?

what therapy?

Definition

highly malignant cancer, a majority of patients have metastatic disease at the time of diagnosis

 

chemotherapy

Term
non-small cell carcinoma
Definition

starts off as being more localize and mestasizes over time.

 

surgical resection

Term
What can cause increased air resistance?
Definition

-decreased airway diameter

-increased thickness of airway wall

-loss of parenchymal elastin

Term
Bronchiolitis is most often caused by:
Definition

viruses

-most commonly happens to children

Term
Chest restriction is defined by:
Definition
reduced total lung capacity
Term
Adult Respiratory Distress Syndrome (ARDS)
Definition

clinical syndrome of rapidly progressive respiratory failure, extensive radiologic opacities in both lungs and severe hypoxemia requiring mechanical ventilation

-happens to normal healthy people

Term

What are some possible causes of ARDS?

Definition

-severe infections

-multiple trauma

-aspiration

-pancreatitis

-shock

 

Term

Where does the pathogenesis of ARDS come from:

(Diffuse alveolar damage, DAD)

Definition

-accumulation of inflammatory cells in interstitial space

-release of mediators, oxidants, and enzymes

 

-epithelial damage

--loss of type I pneumocytes

--denudation of basement membrane

 

-endothelial damage

--leakage of protein rich fluid (alveolar edema)

Term
Describe the exudative phase of ARDS.
Definition

-(week one) 

-edema: an abnormal excess accumulation of serous fluid in connective tissue or in a serous cavity

-inflammation

-loss, type I cells

Term
Describe the Organizing phase of ARDS.
Definition

- (week 2)

-proliferation of  type II cells

-fibrosis

Term

Describe the resolution phase of ARDS.

Definition

-(after week 3)

-partial or complete resolution

-varying fibrosis

Term
What are some clinical features of ARDS
Definition

-presents within hours of severe injury

-severe dyspnea, hypoxia

-diffuse infiltrates on chest x-rays

-treatment: supportive

-high mortality

Term
What is the treatment for ARDS?
Definition
there is only supportive treatment
Term
What are the obstructive lung diseases?
Definition

-asthma

-chronic bronchitis

-emphysema

Term
COPD (Chronic Obstructive Pulmonary Disease):
Definition
general term used to desribe patients with chrionic bronchitis, emphysema or a mixture of the two
Term
Describe Chronic Bronchitis.
Definition

-chronic productive cough for 3 months or more per year over a period of two years or longer

-commonly caused by smoking (90% of the cases)

-can also be caused by secondhand smoke or occupational inhalants

Term
What are some pathogenic features of chronic bronchitis?
Definition

-mucus gland hyperplasia

-goblet cell hyperplasia

-thickening of the bronchial wall

-increase in smooth muscles

-excess mucus in airways

-inflammatory cell infiltration

Term
What are some treatments for Chronic Bronchitis?
Definition

-prevention and treatment of infections

-influenza and pneumonia vaccines

-bronchodilator drugs

-oxygen (If PaO2 is low)

- mechanical ventilation

Term
Describe Emphysema
Definition
enlargement of air spaces distal to terminal bronchioles with destruction of bronchial walls
Term
What are some causes of emphysema?
Definition

SMOKING!

- also can have a genetic component: Alpha-1-AT deficiency

Term
What's the pathogenesis of emphysema?
Definition

-cigarette smoke

-accumulation and activation of neutrophils

-release of oxidants and proteases

-damage to the elastic tissue of the lung parenchyma

- anatomic location of emphysematous changes (destruction) varies depending on the cause

- clinical manifestations are similar regardless of the anatomic pattern

Term
What are some clinical manifestations of emphysema?
Definition

-PROGRESSIVE dyspnea

-airway obstruction

-chest hyperinflation

-hypoxia

-weightloss: because it is taking a lot of effort/energy to inhale and exhale

Term
What are some treatments for emphysema?
Definition

-oxygen

-smoking cessation

-bronchodilators

-lung transplant

Term
Describe Asthma.
Definition

an obstructive pulmonary disease with the following characteristics:

1.airway obstruction that is reversible (in most cases)

2. airway inflammation

3. increased airway responsiveness

Term
Describe the pathogenesis of asthma
Definition

-airway inflammation

-- eosinophils

--lymphocytes

--neutrophils

 

-loss of epithelial cells

-allergy is a major contributor

-airway obstruction in response to various stimuli

-role mediator release

-subepethilial fibrosis

Term
What are some clinical features of asthma?
Definition

-episodic symptoms (attacks)

-cough, wheezing and dyspnea

-reversible airway obstruction

-can lead to respiratory failure

Term
What are some treatments for Asthma?
Definition

-Bronchodilators

--beta agonist inhalers (can be short or long lasting)

--theophylline

 

-Anti-inflammatory drugs

--corticosteroids

--cromolyn

 

-Leukotriene modifying drugs

-- Anti IgE

Term
Compare and contrast Asthma and COPD.
Definition

ASTHMA:

-reversible

-young patient

-non-smoking

-allergies

-episodic

 

COPD

-non-reversible

-older patient

-smoker

-no allergies

-progressive

 

**these are general classifications

Term
What are some examples of Pleural Diseases?
Definition

-pleaural effusion

-pneumothorax

Term
Pneumothorax
Definition

-pleural disease

-accumulation of air in the pleural space of the lungs

-spontaneous

-secondary to trauma or lung disease

Term
What are some manifestations of pneumothorax?
Definition

-chest pain

-dyspnea

-decreased breath sounds on the side of pneumothorax

Term
What is the treatment for Pneumothorax?
Definition

-small, asymptomatic: observation

-large, symptomatic: drainage, chest tube

Term
Describe pleural effusion.
Definition

-accumulation of fluidin the pleural space

-serous (heart failure)

-bloody (trauma)

-infection (pneumonia)

 

Term
What are some clinical manifestations of pleural effusion?
Definition

symptoms depend on the size, cause and status of underlying lung

- may cause dyspnea, fever or chest pain

Term
What is the treatment for Pleural Effusion?
Definition

Drainage: large, bloody or infected effusion

-treatment of underlying cause

Term
What are the most important causes of emphysema?
Definition

-air pollution in urban areas

-untreated lung infection

-asthma

-cigarette smoking

-AIDS

Term
What is the most important cause of emphysema?
Definition
-cigarette smoking
Term
What are the two pulmonary defense mechanisms?
Definition

1.Mechanical Barriers (nose, mucociliary blanket and cough)

 

2. Non-specific and immune defense mechansims

( alveolar macrophages, neutrophils, anti-oxidants)

Term

What inhaled/aspirated substances can cause inflammation, irritation or infection in the lungs?

 

Definition

-bacteria

-fungi

- gastic acid

- organic dust

-inorganic dust

- toxic gases 

Term

What are the sizes of particles that are caught by the following?

(mechanical) 

-Nose

-Mucociliary Blanket

(immune)

-Alveolar Macrophage

Definition
-Nose(>5 micron)
-Mucocilliary blanket (3-5microns)
-Alveolar macrophage (<3 microns)
 
these answers were given on Learn@UW/powerpoint.  Note: lecture notes are different and we're supposed to follow these. 
Term
mucociliary blanket: this mucus is moved outward by continuous movement of ________.
Definition
cilia
Term
____________ are the most important phagocytic cell in the lung and serve to protect the lung from injuries by small particles and microorganisms.
Definition
alveolar macrophages
Term
______________ are important in defense against bacteria and fungi.
Definition
Neutrophils
Term
what protects the lung against the harmful injuries of toxic gases and pollutants?
Definition
anti-oxidants
Term

What are congenital anomalies?

 

and what are some examples?

(hint: in lung) 

Definition

these abnormalities involve incomplete or defective development of a part or entire lung.

 

The most common anomalies include bronchial atresia, pulmonary hypoplasia, bronchogenic cyst and pulmonary sequestration. 

Term
what's the difference between acute bronchiolitis and acute bronchitis?
Definition

bronchiolitis - peripheral airways (small airways), typically seen in children, caused mostly by viruses

 

bronchitis - central airways, large airways) more common in adults (and smokers); caused by viruses and bacteria.

 

Main symptoms: cough, sputum production or fever. 

Term
What is pulmonary sequestration?
Definition
it's a medical condition where a piece of tissue that develops into lung tissue is not attached to the pulmonary blood supply and does not communicate with the other lung tissue. (via wikipedia - he had this in the slide, but it wasn't in the lecture notes or explained in the slides)
Term
Describe a bronchogenic cyst
Definition

-Intra-pulmonary or Extra-pulmonary

 

-symptoms are related to size and location

 

- complications include infection and bleeding 

Term
What are the three types of bronchial disease?
Definition

Infection - bronchitis and bronchiolitis

 

Obstruction - tumor, foreign body, secretions

 

Destruction - localized or generalized bronchiectasis

Term
Bronchiectasis
Definition

Permanent dilation of the airway secondary to destruction of the elastic and muscular elements of bronchial wall.

 

-it can be secondary to congenital (cystic fibrosis), or secondary to obstruction (foreign body) or infection (pneumonia). 

Term
Pneumonia
Definition
Infection of the pulmonary parenchyma which can be caused by bacteria, viruses fungi and other organisms.
Term
What are the three types of pneumonia and briefly describe them
Definition

community acquired pneumonia - occurs in persons outside the hospital

 

nosocomial pneumonia- occurs in patients who are already hospitalized and is caused by organsims prevalent in hospital enviornments

 

opportunistic pneumonia  - which represents infections in patients with compromised immune status.

 

Term
What are the 5 sub-types of community aquired pneumonia?
Definition

1. Community aquired bacterial pneumonia

2. Mycoplasma Pneumonia

3. Legionella Pneumonia

4. Viral Pneumonia

5. Fungal Pneumonias 

Term
What are most acquired pneumonias caused by?
Definition

Streptococcus pneumoniae

 

other bacteria include: Klebsiella pneumonia, Staphylocuccus aureus and group A Streptococcus pyogenes. 

Term
Empyema
Definition

pneumonia can be complicated by pleural effusion which can become infected

 

or by bacteremia with secondary infections in the heart, CNS or spleen and by lung abscesses.

Term
further describe nosocomial pneumonia
Definition
occurs in patients who are already hospitalized and typically caused by gram negative organisms (pseudomonas, ecoli, and klebsiella).  Other organsims include Staphylococcus aureus and anaerobic bacteria.
Term
Describe Blastomycosis and what form of pneumonia is it?
Definition

- Community acquired pneumonia (fungal)

 

-Fungal pneumonia seen in Midwest

- Fungi grow in moist vegetation

-Parenchymal and lymph node involvement

-Symptoms range from minimal to severe life threatening illness 

Term
Describe PCP (Pneumocystis carinii Pneumonia)
Definition

occurs in an immune compromised host (transplant, post chemothreapy and AIDs)

-wide range of severity

-leading cause of death in aids patients

- treatments include antibiotics, including sulfa (pentamidine), corticosteroids and supportive care. 

Term
Describe the two types of fungal pneumonia
Definition

Community acquired  - acquired in the outdoors, such as histoplasmosis, blastomycosis, cryptococcus and coccidioidomycosis.

 

Immune compromised host - aspergillosis 

Term
Describe invasive aspergillosis (fungal pneumonia)
Definition
seen in patients with severe neutropenia and other immune compromised states.  It manifests by diffuse nodular lesions which frequently cavitate and invades the pulmonary blood vessels.  Invasive pulmonary aspergillosis is often a fatal condition.
Term
What is a lung abscess?
Definition

localized accumulation of pus in an area of destroyed pulmonary parenchyma.

 

Note: the most common cause of abscess is aspiration which often occurs in a setting of alterned consciousness commonly related to alcholism.   

Term
Hemoptysis
Definition
the expectoration (coughing up) of blood or of blood-stained sputum from the bronchi, larynx, trachea, or lungs (e.g. in tuberculosis or other respiratory infections). (wikipedia)
Term
Describe Sputum (lungs)
Definition
matter that is expectorated from the respiratory tract, such as mucus or phlegm, mixed with saliva, which can then be spat from the mouth (wikipedia)
Term
opportunistic organisms infect immune compromised patients, what about immune competent persons (normal immunity)?
Definition
Persons with normal immunity are usually unaffected by such organsims as Pneumocystic carinii, cytomegalovirus, or Aspergillus fumigatus)
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