Midterm Review Quiz

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Questions and Answers

What is a common characteristic of neuroendocrine tumors related to smoking?

They are typically located in the peripheral region of the lungs.

They metastasize very early to the mediastinum and lymph nodes. (correct)

They have a slow progression with minimal early metastasis.

They primarily arise from squamous cells in the bronchi.

Which of the following statements is true about Inflammatory Bowel Disease (IBD)?

Genetic mutations in antibodies are the main risk factor for IBD.

IBD results in a predominantly Th2 immune response.

Th1 T Helper cells primarily mediate the immune response in IBD. (correct)

IBD is primarily caused by a specific type of pathogenic micro-organism.

What role does the NOD2/CARD15 gene play in the context of Crohn's Disease (CD)?

It has no known role in bacterial recognition.

It is associated with increased intestinal permeability.

Loss of function mutations are linked to an increased risk of developing CD. (correct)

It regulates the production of neurotransmitters in the gut.

Which of the following factors may contribute to the pathophysiology of Irritable Bowel Syndrome (IBS)?

Visceral hypersensitivity leading to abnormal pain responses. Signup and view all the answers

What distinguishes Gastroesophageal Reflux Disease (GERD) from normal digestion?

It involves reflux of chyme into the esophagus causing noticeable symptoms. Signup and view all the answers

What is the primary mechanism by which UV radiation contributes to the development of skin cancer?

Damages DNA leading to mutations Signup and view all the answers

What mechanism is primarily thought to be involved in the pathophysiology of IBS?

Altered gut microbiota composition. Signup and view all the answers

In which way does smoking correlate with neuroendocrine tumors?

It accelerates the mutation rate in pulmonary neuroendocrine cells. Signup and view all the answers

Which characteristic is NOT associated with basal cell carcinoma?

Firm, red nodule Signup and view all the answers

Which risk factor has the most significant contribution to skin cancer development?

Excessive sun exposure Signup and view all the answers

What might be considered a prominent psychosocial factor contributing to IBS symptoms?

High levels of stress and anxiety. Signup and view all the answers

What is a hallmark feature of psoriasis regarding skin cell turnover?

Accelerated turnover resulting in thickened plaques Signup and view all the answers

Which of the following statements accurately describes melanoma assessment using the ABCDE rule?

Evolution in size or shape is critical for evaluation Signup and view all the answers

In psoriasis, which immune cells are primarily activated in response to an unknown antigen?

Th1 and Th17 cells Signup and view all the answers

What appearance is typical for squamous cell carcinoma?

Firm, red nodules or scaly, crusted surfaces Signup and view all the answers

Which is NOT a common treatment target in managing psoriasis?

Eliminating all epidermal cells Signup and view all the answers

Which visual characteristic is least likely associated with melanoma?

Symmetrical mole shape Signup and view all the answers

What is the primary cytokine responsible for the rapid growth of skin cells in individuals with psoriasis?

TNF-α Signup and view all the answers

Which genetic factor significantly contributes to the risk of developing psoriasis?

Family history Signup and view all the answers

Which of the following describes the primary characteristic of Atopic Dermatitis?

Relapsing, itchy eczema linked to asthma history Signup and view all the answers

What is a common consequence of chronic lung inflammation due to Alpha-1 antitrypsin deficiency?

Increased risk of pulmonary emphysema Signup and view all the answers

How does chronic bronchitis primarily affect airway structure?

It leads to goblet cell hyperplasia and mucus overproduction Signup and view all the answers

Which medication is known to potentially trigger psoriasis symptoms?

Lithium Signup and view all the answers

What physiological change can occur due to the COPD conditions of hypercapnia and hypoxia?

Structural changes in the pulmonary vasculature Signup and view all the answers

Urticaria (hives) is primarily caused by the release of which substance from mast cells?

Histamine Signup and view all the answers

What causes the thickening of the dermis and epidermis in psoriasis?

Keratinocyte hyperproliferation Signup and view all the answers

Which virus primarily causes chickenpox and shingles?

Varicella-zoster virus Signup and view all the answers

In asthma, which cells play a critical role in presenting allergens and initiating the immune response?

Dendritic cells and macrophages Signup and view all the answers

Which type of dermatitis results from a delayed hypersensitivity reaction?

Allergic Contact Dermatitis Signup and view all the answers

Which cytokines are primarily responsible for increased mucus production in chronic bronchitis?

IL-1β and TNF-α Signup and view all the answers

What type of fungi are dermatophytes primarily associated with?

Superficial skin lesions Signup and view all the answers

What is the most common site affected by shingles?

Thoracic or lumbar areas Signup and view all the answers

Which of the following best describes the lesions associated with dermatitis (eczema)?

Erythema, papules, or scales with indistinct borders Signup and view all the answers

What is often linked to high IgE levels in the context of skin conditions?

Atopic Dermatitis Signup and view all the answers

Which type of herpes simplex virus is most commonly associated with cold sores?

HSV-1 Signup and view all the answers

Stress is known to exacerbate symptoms in which of the following conditions?

Both A and C Signup and view all the answers

What condition is characterized by an itchy, blistering rash and spreads via airborne droplets?

Chickenpox Signup and view all the answers

Which of the following is NOT a risk factor for fungal skin infections?

High carbohydrate diet Signup and view all the answers

What is the primary mode of transmission for the herpes simplex virus?

Direct contact Signup and view all the answers

Candidiasis primarily results from an infection by which organism?

Candida albicans Signup and view all the answers

What type of skin infection is classified as tinea unguium?

Nail infection Signup and view all the answers

What triggers the reactivation of the varicella-zoster virus in the body?

Immunosuppression Signup and view all the answers

What is a characteristic feature of neuroendocrine tumors?

They metastasize very early. Signup and view all the answers

Which immune response is predominantly involved in Inflammatory Bowel Disease?

Th1 T helper cell mediated response Signup and view all the answers

Which factor is associated with altered gut microbiota in Irritable Bowel Syndrome?

Visceral hypersensitivity Signup and view all the answers

What is a common symptom associated with Gastroesophageal reflux disease?

Chronic dry cough Signup and view all the answers

What genetic factor is linked to increased risk of developing Crohn's Disease?

NOD2/CARD15 gene mutations Signup and view all the answers

Which mechanism contributes to the pathophysiology of Irritable Bowel Syndrome?

Visceral hypersensitivity Signup and view all the answers

How is the prevalence of Gastroesophageal reflux disease characterized in North America?

Approximately 18-27% Signup and view all the answers

Which of these is NOT typically involved in the symptoms of Irritable Bowel Syndrome?

Permanent bowel damage Signup and view all the answers

What primarily causes the rapid growth of skin cells in individuals with psoriasis?

Excess production of TNF-α, IL-17, and IL-23 Signup and view all the answers

Which factor is least likely to trigger psoriasis flares?

High environmental humidity Signup and view all the answers

What underlying condition is commonly associated with Atopic Dermatitis?

Allergic rhinitis Signup and view all the answers

What cellular change contributes to the thickening of the dermis and epidermis in psoriasis?

Keratinocyte hyperproliferation Signup and view all the answers

What complication can arise from chronic lung conditions like COPD that is related to the pulmonary vasculature?

Pulmonary hypertension Signup and view all the answers

Which type of dermatitis is characterized by lesions that have indistinct borders?

Atopic Dermatitis Signup and view all the answers

Which autoimmune response mechanism is associated with Allergic Contact Dermatitis?

Type IV hypersensitivity reaction Signup and view all the answers

Which mechanism primarily contributes to the ineffective clearance of mucus in chronic bronchitis?

Reduced ciliary function Signup and view all the answers

In asthma, which cellular mechanism is triggered upon the recognition of inhaled allergens?

Activation of T helper cells and immune response initiation Signup and view all the answers

What is a common trigger for Urticaria?

Chemical exposure Signup and view all the answers

What primary pathological change occurs in the lungs due to Alpha-1 antitrypsin deficiency?

Destruction of alveolar walls and air trapping Signup and view all the answers

Which cytokine is NOT primarily involved in the pathogenesis of psoriasis?

IL-4 Signup and view all the answers

What genetic factor is associated with Atopic Dermatitis and skin barrier function?

Filaggrin gene mutations Signup and view all the answers

Which of the following cytokines is primarily associated with the inflammation seen in chronic bronchitis?

Tumor necrosis factor-alpha (TNF-α) Signup and view all the answers

What characterizes the lesions typically associated with psoriasis?

Scaling and erythema Signup and view all the answers

What is the primary cause of blister formation in non-bullous skin infections?

Bacterial toxins Signup and view all the answers

What mechanism primarily characterizes the pathophysiology of herpes simplex virus infections?

Cell death and inflammation Signup and view all the answers

Which body part is most commonly affected by tinea capitis?

Scalp Signup and view all the answers

What condition arises from the reactivation of the varicella-zoster virus?

Shingles Signup and view all the answers

What is the common transmission mode for varicella-zoster virus?

Inhalation of respiratory droplets Signup and view all the answers

What is the primary infectious agent responsible for candidiasis?

Candida albicans Signup and view all the answers

What symptom is characteristic of chickenpox?

Itchy, blistering rash Signup and view all the answers

Which of these viruses is primarily associated with causing cold sores?

Herpes simplex virus type 1 Signup and view all the answers

Which characteristic is commonly associated with fungal infections like dermatophytes?

Thrive on keratin Signup and view all the answers

Which characteristic best differentiates melanoma from other skin cancers?

Asymmetry of moles Signup and view all the answers

What mechanism leads to the rapid turnover of skin cells in psoriasis?

Activation of immune system and cytokines Signup and view all the answers

Which subtype of skin cancer is most commonly linked to sun exposure?

Basal cell carcinoma Signup and view all the answers

Which cytokine is primarily involved in the inflammatory response seen in psoriasis?

TNF-α Signup and view all the answers

What is a common presentation of squamous cell carcinoma?

Flat, scaly lesions Signup and view all the answers

Which factor contributes most significantly to the risk of developing melanoma?

Multiple sunburns in childhood Signup and view all the answers

The formation of characteristic plaques in psoriasis is primarily due to what process?

Accelerated epidermal cell turnover Signup and view all the answers

What type of skin lesion is most associated with basal cell carcinoma?

Pearly or waxy bumps Signup and view all the answers

Which of the following describes a key risk factor for squamous cell carcinoma?

Development of existing solar keratosis Signup and view all the answers

What is the typical turnover time for epidermal cells in individuals with psoriasis compared to normal?

3-4 days in psoriasis, 21-24 days normal Signup and view all the answers

Study Notes

Inflammatory Response

Inflammation is a crucial component of the innate immune system, triggered by tissue injury.
It's a rapid, non-specific process to contain damage, eliminate pathogens, and initiate healing.
Key features include activation (seconds after injury), vascular changes (increased blood flow, redness, heat, swelling), and cellular events (leukocyte recruitment and destruction).
Cytokines (signaling molecules) regulate the response, with pro-inflammatory cytokines amplifying and anti-inflammatory ones dampening the reaction.

Inflammatory Cell Characteristics

Acute inflammation involves redness, swelling, heat, pain, and function loss.
Processes include vasodilation, increased permeability, and leukocyte recruitment.
Inflammation is protective, neutralising microorganisms and promoting tissue repair.
The process starts within seconds and resolves within days of injury or microbial invasion.

Cytokines and Chemokines

Cytokines are signaling molecules released by the immune system, regulating other cell activity.
Chemokines are released by immune cells, recruiting additional immune cells to specific locations.

Chronic Inflammation

Chronic inflammation results from unresolved acute inflammation or persistent triggers.
It features lymphocyte and macrophage infiltration, fibroblast proliferation, connective tissue formation, and epithelial cell proliferation.
These processes potentially cause scarring or polyp formation.

Cells Involved in Inflammation

Mast cells release histamine and other mediators causing vasodilation.
Macrophages engulf pathogens and debris, releasing pro-inflammatory cytokines, and presenting antigens to T helper cells.
Neutrophils are abundant phagocytes, releasing enzymes and ROS to kill pathogens.
Dendritic cells bridge the innate and adaptive immune systems, capturing antigens and presenting them to T cells.
Eosinophils primarily fight parasites and regulate vascular mediators (released by mast cells).

Innate Immune System

The innate system is the body's initial defense.
It includes physical and biochemical barriers, the microbiome, and immune cells (mast cells, macrophages, dendritic cells).

Adaptive Immune System

The adaptive immune system targets specific pathogens.
T lymphocytes (T cells) mature in the thymus and differentiate into T helper (Th) cells and T cytotoxic (Tc) cells.
B lymphocytes (B cells) mature in the bone marrow and differentiate into plasma cells (producing antibodies) and memory B cells.

Hypersensitivity Reactions

Three major types of hypersensitivity reactions are allergy (environmental antigens), autoimmunity (self-antigens), and alloimmunity (tissues from another individual).
Four major mechanisms (types I - IV) underlie these reactions.
Type I (immediate/humoral) is mediated by IgE antibodies. Type II (tissue-specific) involves IgG or IgM antibodies, type III (immune complex-mediated) is mediated by IgG or IgM, and type IV (cell-mediated) reactions are mediated by T cells.

Antibody-Dependent Cellular Cytotoxicity

Antibodies bind to target cells, marking them for destruction by immune cells (NK cells, macrophages, neutrophils).

Immune Complex-Mediated Hypersensitivity

Immune complexes (antigen-antibody aggregates) activate the complement cascade.
Neutrophils phagocytose complexes, leading to tissue damage, as in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).

Cell-Mediated Hypersensitivity

T cells mediate delayed reactions, taking 24–72 hours to develop.
Antigen presenting cells (APCs) present antigens to T cells.
Activated T cells release cytokines and activate macrophages leading to tissue damage.

Cachexia

Cachexia is a complex metabolic disorder characterized by the wasting of muscle tissue and atrophy of white adipose tissue.
Key characteristics include an abnormal energy balance, where energy input may not meet the body's energy needs.

Human Immunodeficiency Virus (HIV)

HIV is a retrovirus infecting and destroying CD4+ T helper cells of the adaptive immune system.
It also infects macrophages, dendritic cells, NK cells, and cytotoxic T cells.

Infection Concepts

Factors influencing a microorganism's ability to cause infection include communicability (spead from one person to another), infectivity (ability to invade and multiply), pathogenicity (ability to produce disease), mechanism of action (how the microorganism damages tissue), portal of entry (route of infection), toxigenicity, and virulence (capacity to cause severe disease).
The ID50 (Infectious dose 50%) is determined in research models.

Skin Layers

The epidermis is the outermost layer, primarily composed of keratinocytes which produce keratin (a protein giving strength and resilience).
Melanocytes are cells producing melanin.
The dermis lies beneath the epidermis, composed of connective tissue. Fibroblasts create collagen within this layer.
The subcutaneous layer is comprised of fat tissue (adipocytes), and contains blood vessels, nerves, and hair follicles.

Viral Skin Infections

These infections include herpes simplex virus (HSV), varicella zoster virus (VZV), human papillomavirus (HPV), measles virus, and rubella viruses.
These viruses infect skin cells, causing cell death and an inflammatory response.

Fungal Skin Infections

Dermatophytes (e.g., trichophyton, microsporum) are fungi causing superficial skin lesions, feeding on keratin.
Mycoses (e.g., tinea infections) are classified according to location.
Candidiasis (Candida albicans) affects skin and mucous membranes.

Skin Cancer

Various types of skin cancer exist—basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
Risk factors include excessive sun exposure, fair skin, freckles, family history of skin cancer, and weakened immune systems.

Psoriasis

Psoriasis is a chronic immune-mediated inflammatory skin disease.
It involves epidermal cell turnover, causing red, elevated and scaly plaques, often on the scalp, elbows, or knees.
Triggered by an immune response to an unknown antigen.
Associated with Th1 and Th17 cells, activating cytokines such as IL-17, IFN-γ, and TNF-α.

Acute Coronary Syndromes

Sudden blockage in a coronary artery (caused by thrombus formation).
Two conditions exist : Unstable angina (transient ischemia) and myocardial infarction (sustained ischemia leading to cell death).

Chronic Obstructive Pulmonary Disease

COPD is characterized by a progressive, usually irreversible, airflow limitation.
Two major components are emphysema (destruction of alveolar walls) and chronic bronchitis (mucus hypersecretion and airway inflammation).

Asthma

Asthma is an inflammatory disorder causing bronchoconstriction, airway hyperresponsiveness, and airway remodeling.
Triggered by allergens and characterized by airway constriction, mucus hypersecretion, and inflammation mediated by Th2 cells, producing cytokines like IL-4, IL-5, IL-8 and IL-13.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) involves blood clot formation, usually in the deep veins of the leg.
The Virchow's triad of risk factors for DVT include venous stasis, venous endothelial damage, and hypercoagulability.
Venous stasis occurs with immobility; endothelial damage result from trauma; and hypercoagulability can stem from pregnancy, cancer, or medications.

Heart Failure

Systolic heart failure (left-sided) occurs when the heart is unable to pump enough blood to meet the body's needs.
Factors that trigger left-sided heart failure can include reduced contractility, increased preload (volume of blood before contraction), or increased afterload (resistance to blood flow).
Right-sided heart failure is associated less commonly with lung diseases as cause, such as Chronic Obstructive Pulmonary Disease.

Urinary Tract Obstructions

Kidney stones (nephrolithiasis) are a common cause of upper urinary tract obstructions.
These crystals form when urine becomes supersaturated.
Calculi lodge in the calyces, ureteropelvic junction, or ureterovesical junction.

Glomerulonephritis

Inflammation of the glomeruli (kidney's filtering units) can be chronic or acute.
Acute glomerulonephritis commonly arises from infections by bacteria such as Streptococcus.
Chronic glomerulonephritis can stem from systemic conditions, such as diabetes and hypertension

Acute Kidney Injury

Acute kidney injury (AKI) is a sudden decline in kidney function.
It is commonly caused by reduced blood flow to the kidneys, direct damage to the kidneys, or blockage of the urinary tract.
Risk factors include pre-existing kidney disease, diabetes, heart failure, liver failure, older age, and exposure to certain medications or toxins.

Chronic Kidney Disease

Chronic kidney disease (CKD) is a progressive loss of kidney function over time.
Common causes include diabetes, high blood pressure, glomerular diseases, and family history of kidney disease; older age and ethnicity may increase risk.

Hepatitis

Viral hepatitis, typically caused by Hepatitis viruses A, B, C, D, E, G, Epstein Barr virus, varicella virus, alcohol abuse, drugs, and autoimmune disorders.
Transmission varies depending on the hepatitis type (fecal-oral, blood-to-blood, or mother to child).
Risk factors include poor sanitation, unprotected sex, sharing needles, contaminated blood transfusions before 1992, and contact with infected individuals.

Hypercapnia , Hypoxemia and V/Q Ratio

Hypercapnia refers to increased carbon dioxide (CO2) level in blood. Hypoxemia refers to decreased oxygen (O2) level in blood. Both result from ventilation-perfusion (V/Q) mismatches.
V/Q mismatches occur when the amount of air reaching the alveoli does not match the amount of blood flowing through the capillaries.

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Description

Test your knowledge on the characteristics of neuroendocrine tumors, the pathophysiology of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS), as well as risk factors contributing to skin cancer. This quiz covers various aspects of these medical conditions, including genetic factors and psychosocial elements.