Fluid and Electrolytes Past Paper PDF

Module 1 -- Week 1 ================== Module 1 Topics // Fluid and Electrolytes; Acid/Base Balance ------------------------------------------------------------ A. Fluid Regulation: RAAS system, ADH, ANP/BNP 1. Renin-Angiotensin-Aldosterone System: [Key hormones of the RAAS]: - Renin: -...

Module 1 -- Week 1 ================== Module 1 Topics // Fluid and Electrolytes; Acid/Base Balance ------------------------------------------------------------ A. Fluid Regulation: RAAS system, ADH, ANP/BNP 1. Renin-Angiotensin-Aldosterone System: [Key hormones of the RAAS]: - Renin: - Released by: [ Kidneys ] - Angiotensin: - Angiotensin 1 + \_\_ enzymes in the lungs (ACE) Angiotensin-Converting Enzyme\_\_ = Angiotensin 2 - Aldosterone: - Regulates \_\_\_Sodium\_\_\_\_\_\_\_ reabsorption - Remember: Wherever salt/ sodium goes, water follows - Renin-Angiotensin-Aldosterone System - -Kidneys detect drop in BP of blood volume or a drop (aka renal hypotension) -\> - kidneys release renin -\> angiotensinogen - protein released by the liver (comes from liver) activated by renin -\> - becomes angiotensin 1 -\> enzymes in the lungs (ACE) + angiotensin 1 -\> angiotensin 2 (comes from lungs) -\> - angiotensin 2 communicates with blood vessels and has them increase vascular tone/ constrict (= increased BP) -\> - angiotensin 2 also communicates with the adrenal gland -\>releases aldosterone (important in fluid regulation- regulates sodium reabsorption at kidneys- wherever salt/sodium goes, water follows- increase blood volume) - Net effect: - Increased vascular tone -- the contractile activity of vascular smooth muscle cells in the walls of small arteries and arterioles RAAS.png 2. Anti-Diuretic Hormone (ADH) / Vasopressin: - What does ADH tell the kidneys to do? - I[ncrease water reabsorption into the bloodstream.] - [Decrease the amount of water excreted in the urine (antidiuresis).]  "anti-D is anti pee" -activated by low BP/volume OR increased serum osmolality -\> posterior pituitary detects this and releases ADH -\> ADH travels to the kidneys and causes them the increase BP, blood volume, and water reabsorption 3. ANP and BNP: **Overall Net Effect:** Decreased plasma volume, decreased blood pressure Screenshot%202023-03-26%20at%2009.23.52.png B. Edema - **Fluid Dynamics**: A reminder  - Edema: A condition where fluid leaves the blood vessel and enters the interstitial space 1. Due to increased hydrostatic pressure: 2. Increase in vascular permeability 3. Decrease in oncotic pressure 4. Fluid volume overload a. Circle the correct option: Hydrostatic pressure is a [**pushing**] force b. Examples: Heart failure: Increased workload on the heart leads to increased pressure in the blood vessels, pushing fluid out of the vessels. Hypertension: Elevated blood pressure increases hydrostatic pressure, causing fluid to seep into interstitial tissues. 5. Due to decreased colloidal osmotic pressure (oncotic pressure): c. Circle the correct option: Osmotic pressures is a **[pulling]** force d. Examples: [Liver failure (lack of albumin): The liver produces albumin, which has a high oncotic pressure. A decrease in albumin levels reduces oncotic pressure, causing fluid to leak out of blood vessels.] [Kidney failure: Inefficient removal of waste products by the kidneys can lead to a buildup of waste, which increases the osmotic pressure in the blood vessels, but more significantly, in liver and kidney disease we see decreased production of albumin.] 6. Due to increased vascular permeability: e. Examples: [ Inflammation: Increased permeability of blood vessel walls leads to the escape of fluid and cells into tissues.] C. **Causes of Fluid Volume Imbalance** - Excessive water loss: Screenshot%202023-03-26%20at%2009.37.03.png - SIADH: Syndrome of Inappropriate ADH - Elevated blood pressure - Hyponatremia: irritability, confusion, headache, muscle cramps, twitching, pulmonary congestion - Concentrated urine: high specific gravity (dark and concentrated), high urine osmolality - Edema: fluid escapes the blood vessel and enters the tissue - Water intoxication  - DI: Diabetes Insipidus D. **Electrolytes: Na^+^ / K^+^** - Sodium (Na^+^) : 135-145mEq/L - **Hyponatremia**: - Signs and symptoms: [ ] - [Muscle weakness/loss of tone. ] - Causes: - [Volume overload, alcoholism] - **Hypernatremia**: - Signs and symptoms: [ ] - [Thirst, muscle twitching, absence of deep tendon reflexes] - [\* Both will have confusion, seizure, coma] - Causes: - Dehydration, diuretics, kidney disease - Potassium (K^+^) : 3.5-5.0mEq/L - Hypokalemia: - Hypokalemia is characterized by delayed repolarization of cardiac muscle due to a lack of potassium, resulting in a \"low and slow\" effect. - Common signs and symptoms include muscle weakness, confusion, cardiac arrhythmias, hypotension, restlessness, irritability, constipation, and shallow breathing. - Causes of hypokalemia include severe vomiting or diarrhea, diuretics (especially non-potassium-sparing ones), alkalosis, and hyperinsulinemia. - Hyperkalemia: - Hyperkalemia is characterized by a sharper T-wave on the ECG due to K-driven repolarization, leading to a \"tight and contracted\" effect in the cardiac muscle. - Common signs and symptoms include muscle weakness, confusion, cardiac arrhythmias, and hypotension, often accompanied by peaked T waves on the ECG. - Causes of hyperkalemia include kidney disease, certain medications (such as potassium-sparing diuretics), acidosis (e.g., Diabetic Ketoacidosis), ischemia leading to cell death, and sudden reperfusion. - Cardiac Impacts: - In hypokalemia, there is delayed repolarization of cardiac muscle, which may lead to T wave inversion or a prolonged U wave on the ECG. - In hyperkalemia, the ECG shows peaked T waves that reflect potassium-driven repolarization, indicating tighter and more contracted heart muscle. - Electrolyte Role: - Potassium regulates conduction of cardiac muscle. - It assists in balancing the electrochemical gradient across the plasma membrane. - It is also involved in maintaining acid-base balance. Screenshot%202023-03-26%20at%2010.12.19.png E. **Electrolytes: Ca^2+^ / P / Mg^2+^** - **Calcium (Ca²⁺) Reference Range:** - The normal range for calcium is 9.0-10.5 mEq/L. - Calcium is involved in blood coagulation and assists in the neuronal release of neurotransmitters. - A key concept in calcium function is its role in regulating muscle contraction. - **Hypocalcemia:** - Trousseau's Sign is a clinical test used to indicate hypocalcemia, where a spasm of the wrist and fingers occurs when the blood pressure cuff is inflated. - Chvostek's Sign refers to the twitching of facial muscles in response to tapping over the facial nerve, indicating hypocalcemia. - Common signs and symptoms of hypocalcemia include numbness, tingling, muscle spasms, diarrhea, and weak bones. - Causes of hypocalcemia may include diarrhea, malabsorption, end-stage renal disease, and parathyroid removal. - **Hypercalcemia:** - The mnemonic \"moans, bones, stones, and thrones\" summarizes the effects of hypercalcemia: - **Moans** refer to CNS effects such as fatigue, memory loss, psychosis, depression, and lethargy. - **Bones** are associated with painful conditions like osteitis fibrosa cystica. - **Stones** refer to calcium-based kidney stones. - **Thrones** indicate gastrointestinal symptoms, including nausea, vomiting, and abdominal pain. - Common causes of hypercalcemia include excessive parathyroid hormone and excessive vitamin D. - Signs and symptoms associated with hypercalcemia include fatigue, psychosis, depression, painful bones, kidney stones, and gastrointestinal disturbances like nausea and diarrhea. - **Relationship to Phosphate:** - Calcium and phosphate have an inverse relationship. - High calcium levels correspond to low phosphate levels, while low calcium levels coincide with high phosphate levels. - Phosphate (PO~4~) : 2.5-4.5mg/dL - Hypophosphatemia: - Signs/Symptoms: Weakness, fatigue, muscle aches, bone pain, and confusion may occur. - Causes: Common causes include alcoholism, burns, diarrhea, malnutrition, and chronic use of antacids. - Hyperphosphatemia: - Signs/Symptoms: Symptoms can include itching, muscle cramps, numbness, joint pain, and signs of low calcium levels. - Causes: Primary causes are renal failure, excessive dietary phosphate, hypoparathyroidism, and cell catabolism from conditions like rhabdomyolysis. - Magnesium (Mg^2+^) : 1.3-2.1mEq/L Principles: mainly regulated by renal excretion in association with parathyroid hormone (PTH) and Vitamin D Assists in regulating blood pressure Assists in enzymatic reactions Key Concept: acts as a muscle relaxant - Hypermagnesemia: - Signs/Symptoms: Nausea, vomiting, CNS effects, hypotension, flushing, headache. - Causes: Primarily caused by renal disease and the abuse of magnesium laxatives or diuretics. - Hypomagnesemia: - Signs/Symptoms: Hyperactive deep tendon reflexes, hypoactive bowels, constipation, and agitation. - Causes: Often due to celiac disease, Crohn\'s disease, malnutrition, chronic alcoholism, and certain medications (such as aminoglycosides). - Magnesium Functions: - Acts as a muscle relaxant and helps with potassium regulation. - Cardiac Impacts of Magnesium Imbalance: - Hypertension, ST depression, prolonged PR interval, and widened QRS can occur. Part 2: Acid/Base Balance ------------------------- A. **Buffer System** a. **Serum** i. Immediate ii. Bases can combine with acids (form water & CO2) iii. Proteins can combine with H+ iv. K+ can exchange for H+ b. **Respiratory** v. Minutes to hours vi. CO2 levels are tightly regulated vii. Increased CO2  \_increase in breathing rate\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ viii. Decreased CO2 \_\_decrease in breathing rate\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ c. **Renal** ix. 2-3 day delay x. Continuous xi. Produce & recycle HCO3- xii. Filter and excrete excess H+ xiii. Ammonia + H+ = Ammonium B. **Respiratory Imbalances:**  C. **Metabolic Imbalances:** Screenshot%202023-03-26%20at%2011.28.33.png D. **Clinical Features of Acid/Base Imbalances:** - Respiratory: - Normal rate 12-20 breath/min in adults - PaCO~2~ : low in alkalosis, high in acidosis - PaO~2~ : low in hypoxia - Metabolic: - HCO3^-^: high in alkalosis, low in acidosis - Anion gap: high in acidosis, low in alkalosis E. **Anion Gap:** A laboratory test that measures whether electrolytes are imbalanced Equation: (Na^+^ + K^+^) -- (HCO~3~^-^ + Cl^-^) High anion gap = acidosis F. **ABGs:** - Normal values pH: 7.35-7.45 PaCO2: 35-45 mmHg (partial pressure of arterial carbon dioxide) HCO3: 22-26 mEq/L (arterial concentration of bicarbonate) - Steps to interpreting ABG's 1. What is the pH? 2. What is the PaCO2? 3. What is the HCO3? 4. Are they normal? (if yes, stop here) 5. Any compensation? (look at the pH) Below, you will find several practice ABG scenarios. The answers to each scenario are contained in the lecture video by Dr. Hill entitled "ABGs". Please see your week 1 module for the video. Additional ABG practice can be found in the appendix to this outline.  Screenshot%202023-03-26%20at%2013.40.40.png Module 2 -- Week 2 ================== Module 2 Topics // Pathogens; Immune System and WBC Disorders; UTI ------------------------------------------------------------------ Part 1: Pathogens ----------------- A. **Pathogens**: Organisms that cause disease to their host 1. Bacteria (streptococcus pyogenes, streptococcus pneumoniae, E. coli) - Bacteria shapes: - Cocci - Bacilli - Spirilla  2. Viruses (coronavirus, rhinovirus, influenza, herpes simplex - Steps of viral infection: - Attachment -- outside of the virus envelop is going to open up and push the material into the host cell leading to penetration - Penetration -- now have a virus has penetrated the cell - Uncoating -- virus is going to take off his coat "uncoat" and release viral DNA in the cell, DNA can not take over the cell.  - Replication -- nucleic acid (DNA of the virus) is going to take over the host cells and make more - Assembly -- replication of virus comes together to make the new virus that we can send to another cell to make more - Release -- send out to cause infection in a different cell Screenshot%202023-03-26%20at%2013.58.22.png 3. Protozoa (giardia, malaria, scabies, lice) - Key features: single-celled organisms that cause harm - Additional examples: Malaria, Giardia, Trichomoniasis, Toxoplasmosis 4. Fungi (tinea, candida) a. AKA mycotic infection\`  5. Helminths/Worms (pin worm, tape worm) Screenshot%202023-03-26%20at%2014.01.20.png B. **Routes of Transmission and Establishing Infection** Routes of Transmission - Aerosol, Airborne, Droplet Contact - Fomite Contact - Direct Contact - Vector Transmission - Oral Transmission - Zoonotic Transmission **The Steps in Establishing Infection:** 1. **Entrance:**\ a. **Notes:** - **Portal of Entry**: The site where the pathogen enters the host. - **Types of portals of entry**: Skin, mucous membranes, respiratory tract, gastrointestinal tract, etc. - **Factors facilitating entrance**: Wounds, trauma, bites, sexual contact, contaminated food or water, etc. 2. **Adherence:**\ a. **Notes:** - **Type 1 Adherence**: Direct attachment to the host cell membrane. - **Type 2 Adherence**: Attachment to the extracellular matrix. - **Factors facilitating adherence**: Host surface receptors, lectins, proteins, etc. 3. **Colonization:**\ a. **Notes:** - **Colonization**: The establishment of a population of microorganisms on a suitable surface. - **Factors facilitating colonization**: Host immune tolerance, biofilm formation, nutrient availability, etc. 4. **Avoid Host Defenses:**\ a. **Notes:** - **Immune Evasion**: Mechanisms employed by pathogens to avoid host immune responses. - **Mechanisms of evasion**: Molecular mimicry, antigenic variation, suppression of host immune cells, etc. 5. **Create Host Injury:**\ a. **Notes:** - **Pathogenicity**: The ability of a pathogen to cause disease in a host. - **Virulence factors**: Toxins, enzymes, and other molecules produced by pathogens to create injury in the host. - **Examples of virulence factors**: Hemolysins, endotoxins, proteases, lipases, etc. Additional Terms to Know - **Colonization**: An increase in the amount of a microorganism present at a given location (replication / growth) - The presence of microorganisms (flora) **without** infection or harm - **Virulence**: A pathogen's ability to cause disease (influenced by toxins, adherents, evasion) - **Nosocomial Infection**: A hospital-acquired infection that occurred in the hospital/clinical setting - **Opportunistic Infection**: An infection that occurs when microbes that typically do not cause disease take advantage of certain conditions and become pathogenic C. **Stages of Infection** **Stages of Infection:** 1. **Exposure:** - Refers to the initial contact between the host and the infectious agent. - Transmission can occur via various routes such as direct contact, airborne transmission, vector-borne transmission, or through contaminated surfaces and objects (fomites). - Not all exposures lead to infection; host factors (immune status, preexisting conditions) can influence this. 2. **Incubation:** - The time between exposure to the pathogen and the appearance of symptoms. - In this period, the pathogen begins to replicate actively within the host. - Duration may vary widely depending on the pathogen (e.g., influenza might have a short incubation period of 1-4 days, while some viral infections can take weeks). - The host is typically asymptomatic during this stage, making it challenging to identify and contain the infection. 3. **Prodrome:** - Characterized by the onset of non-specific symptoms that indicate the beginning of infection. - Symptoms like fatigue, malaise, headache, low-grade fever, and muscle aches are common. - This stage serves as a warning sign of an upcoming illness, but symptoms may not be severe enough for the host to seek treatment. 4. **Acute:** - This stage represents the peak of the infection, during which the most severe and specific symptoms occur. - Symptoms are at their strongest (e.g., high fever, cough, rash) and the person is typically highly contagious to others. - This stage often requires medical attention and can sometimes lead to complications if not managed properly. 5. **Convalescent:** - This stage involves the containment and gradual elimination of the pathogen from the body. - Symptoms start to resolve, and the host begins to regain strength. - While recovery is underway, some symptoms may linger, and the host may still be susceptible to opportunistic infections due to a transient weakened immune state. 6. **Resolution:** - This final stage is marked by the total elimination of the infection from the body. - The host returns to a state of health and is typically asymptomatic. - In some cases, this stage may involve the development of immunity (e.g., antibodies) to the pathogen, which provides protection against future infections. - Some infections can lead to long-term effects or chronic conditions, where the resolution is not complete. Additional Considerations: - **Chronic Infection:** In some cases, an infection may not follow the typical stages and can lead to a persistent or chronic infection, where the pathogen remains in the host for long periods without causing acute symptoms. - **Latent Infection:** Some infections can also become latent, where the pathogen is present but inactive, with the potential to reactivate later (e.g., herpes simplex virus). - **Host Factors:** Factors such as age, nutritional status, coexisting illnesses, and immune system function significantly impact the progression through these stages.  D. **Testing for Microbes (with a focus on bacteria)** Goal: Identify what type of bacteria we are looking at - Q. Where can samples come from? [ Body fluids, respiratory samples, wound samples, tissue samples, skin, mucosal etc ] - Gram Stain: A way to organize bacteria into one of two groups to understand which type of antibiotic would be best - Culture: A test that tells the identity of bacteria - Sensitivity: A test that tells us which specific antibiotics are best to treat the bacterial infection **Gram Positive Bacteria:** - **Characteristics:** - Thick peptidoglycan layer in cell wall. - Retain crystal violet stain, appear purple. - **Examples:** - Staphylococcus aureus - Streptococcus pneumoniae - Bacillus subtilis - **Diagnostic Features:** - Appear purple under microscopy after gram staining. - Resistant to certain antibiotics due to thick cell wall. **Gram Negative Bacteria:** - **Characteristics:** - Thin peptidoglycan layer and outer membrane containing lipopolysaccharides (LPS). - Do not retain crystal violet stain, appear pink/red. - **Examples:** - Escherichia coli (E. coli) - Pseudomonas aeruginosa - Salmonella typhi - **Diagnostic Features:** - Appear pink/red under microscopy after gram staining. - More susceptible to antibiotics due to outer membrane structure. Screenshot%202023-03-26%20at%2014.21.45.png Culture and Sensitivity: - Culture: **A patient sample that is grown within a laboratory setting to help identify which bacteria is present** - Sensitivity: **Bacterial culture is subjected to variety of antibiotics to determine which are most effective against the pathogen present** Incidence and Prevalence: - Incidence: new cases (Incidents) - Prevalence: all cases (PrevALLence) E. **Tuberculosis (bacteria)** Tuberculosis (TB) **Overview:**\ Tuberculosis is a bacterial infection primarily affecting the lungs, caused by the bacterium *Mycobacterium tuberculosis*. **Pathophysiology:** - **Latent TB:** In individuals with a strong immune system, white blood cells (WBCs) isolate and contain the bacteria, preventing it from spreading. - **Active TB:** If the immune system is weakened, TB bacteria can escape from the containment, leading to active infection and possible dissemination throughout the body. **Risk Factors:** - Living in crowded conditions (e.g., prisons, dormitories) - Overpopulated urban areas with poor sanitation - Weakened immune systems (e.g., due to HIV, malnutrition) **Signs and Symptoms:** - **Hemoptysis:** Coughing up blood - **Weight Loss:** Unintentional weight loss - **Cough:** Persistent cough lasting more than 3 weeks - **Fatigue:** Generalized tiredness or weakness Part 2: Immune System and WBC Disorders --------------------------------------- A. **Primary Lymphoid Organs** 4 Primary Lymphoid Organs: 1. Bone Marrow: A primary lymphoid organ - Site of hematopoiesis - Produces all immune cells - Site of B-cell maturation - Unidirectional exit for cells to enter blood / lymphatics 2. Thymus: A primary lymphoid organ - Site of T-Cell Maturation - Shrinks from puberty onward, but still active 3. Lymph Nodes/Lymphatics - Immune surveillance - Present anywhere that the body bends or regions come together - Filters fluid from the tissue - Removes foreign matter from the tissue - Removes waste from the tissues - Proliferates immune cells (B- and T-cells 4. Spleen - Acts as a massive lymph node - Home to white pulp - Mononuclear phagocyte system - Removes and destroys antibody-coated bacteria / RBC's - Filters blood - Removes dead / damaged RBC's - Filters antigens from the blood - B- and T-cells exist in the spleen B. **Innate and Adaptive Immune System** - Immune system definition: a defense against pathogens and the environment around us - Innate (humoral) vs. Adaptive (compliment) - Red Blood Cells:  - White Blood Cells (Leukocytes) - **Neutrophils** - **Most Abundant:** 60-70% of WBCs. - **Immature Forms:** Called bands; indicates severe bacterial infection when elevated. - **Function:** First responders (1-2 hrs. to infection), perform phagocytosis of bacteria, and can increase scar tissue. - **Eosinophils** - **Function:** Combat parasitic infections and mediate allergic responses. Elevation indicates parasitic worms or allergies. - **Basophils** - **Function:** Release histamine (vasodilation) and fibrinolytics; elevated during allergic responses and parasitic infections. - **Monocytes** - **Largest WBC:** 2-8% of WBCs; differentiate into macrophages in tissues. - **Function:** Phagocytosis, antigen presentation, and recruitment of other immune cells. - **Lymphocytes** - **Function:** Key players in adaptive immunity---B cells produce antibodies, T cells mediate cellular responses, and contribute to long-term immunity. - Summary - White blood cells work collaboratively to protect the body from infections, with specific cell types responding to various threats through phagocytosis, immune regulation, and facilitating adaptive immunity. - Innate vs. Adaptive - - Innate = NONSPECIFIC - Fast response (0-4 hours) - Adaptive = SPECIFIC - Slow response (4-14 days)../Desktop/Screenshot%202023-04-11%20at%2019.31.52.png C. **Humoral Immunity and Hypersensitivity Reactions** - Humoral Immune System:  The 5 Immunoglobulins (GAMED) **IgG** **Function:** Provides long-term immunity. **Transfer:** Can pass from mother to baby through the placenta. **Duration:** Lasts for years, providing protection against past infections. **IgA** **Function:** Protects mucosal surfaces. **Location:** Found in secretions such as saliva, tears, breast milk, and mucous membranes. **Mnemonic:** Think \"Achoo\" for its role in respiratory and gut immunity. **IgM** **Function:** First antibody produced in response to an infection. **Timing:** Indicates immediate or recent infection when elevated. **Utility:** Helps assess acute infections. **IgE** **Function:** Associated with allergic reactions and defense against parasites. **Location:** Present on mast cells in tissues; involved in inflammation and edema. **Mnemonic:** \"E\" for edema and allergy. **IgD** **Function:** Primarily acts as a receptor on B cells that helps initiate the immune response. **Presence:** Found in small amounts in the blood. Summary The five immunoglobulins (IgG, IgA, IgM, IgE, IgD) play distinct yet complementary roles in the immune system, ranging from long-term immunity to immediate responses to infections and allergic reactions. - [ ]../Desktop/Screenshot%202023-04-11%20at%2019.38.33.png - Hypersensitivity Reactions (4 Types) 1. Type I: IgE & Mast Cells a. Allergic responses b. Examples: [ ] 2. Type II: IgM / IgG c. Cytotoxic responses d. Examples: [ ] e. (Compliment) 3. Type III: Antigen-Antibody Complex f. Immune complex g. Examples: [ ] h. (Compliment, IgG, IgM, Neutrophils) 4. Type IV: Cell-Mediated Reactions i. Delayed Type Hypersensitivity Reaction (DTH): 24-48 hours after exposure / contact j. Examples: [ ] k. (Cytotoxic T Cells, Natural Killer Cells, Macrophages) - Allergic Response: - Risk of anaphylaxis: extreme allergic response characterized by involvement of 2 or more bodily systems - Urticaria **and** respiratory involvement - Treat with epinephrine  - Transplant Rejection: - Background: Almost every cell in the body has a "name tag" called a human leukocyte antigen (HLA) - Role of HLA: Lets the immune system know that the cell belongs - During organ transplants it is important to receive donor tissue that matches the recipient's \_\_\_HLA\_\_\_\_\_\_\_\_\_\_\_\_ as closely as possible to prevent the immune system from \_\_\_\_\_\_rejecting\_\_\_\_\_\_\_\_\_\_ the tissue 1. **Autologous Transplant:** - Tissue is transplanted from one part of the body to another in the same individual. 2. **Allogenic Transplant:** - Tissue is transplanted from a donor to a recipient, ideally requiring HLA matching for compatibility. **Types of Rejection** 1. **Hyper-acute Rejection:** - Occurs immediately (within minutes) after transplantation due to pre-existing antibodies against the donor\'s HLA. 2. **Acute Rejection:** - Occurs days to weeks after transplantation, where the immune system mounts a response against the transplanted tissue, often treatable with immunosuppressants. 3. **Chronic Rejection:** - Develops over months to years and involves gradual deterioration of the transplanted organ, often resistant to treatment. D. **Active and Passive Immunity** - Goal: IMMUNITY../Desktop/Screenshot%202023-04-11%20at%2019.48.55.png Active -natural (exposed to pathogen) -artificial (vaccine) Passive -natural (fetal transfer of Ab, breastfeeding transfer) -artificial (receiving Ab via antisera or gamma globulin) "Artificial means you got it from a bottle" E. **Autoimmune Disease** **Background:** The immune system is a complex system of chemicals, cells, signals and other parts. When one or more of these parts "accidentally" targets the body instead of foreign particles, we can develop \_\_\_\_\_autoimmune\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ disease. The signs / symptoms of each autoimmune disease are specific to the parts of the immune system involved and their specific targets. F. **Immunodeficiency and HIV** - Immunodeficiency: A condition that develops as the result of a compromised immune system - May be temporary or permanent - Increases the likelihood of "opportunistic infections" - Common causes of immunodeficiency: [ ] - HIV Infection:  - HIV: A Quick Reference - Definition: a virus that selectively targets CD4 lymphocytes (T-Helper Cells) - Results in a failure of the adaptive immune system - Increases risk of uncommon infections and cancers - Caused by exposure to infected bodily fluids - Causes: [ Cancer and cancer treatment] - [HIV] - [Diabetes] - [Stress] - [Malnutrition] - [Splenectomy ] - Signs and symptoms: [ ]../Desktop/Screenshot%202023-04-11%20at%2020.32.06.png - Stages of HIV Infection (3) - **Acute** - Initial viral infection - Flu-like symptoms - **Latent** - Replication within cells - Gradual decline of CD4 cell count - Minimal symptoms - **AIDS (Acquired Immune Deficiency Syndrome)** - [CD4 \ - Leukemia: Cancer of the bone marrow cells - Myeloid cells: basophils, eosinophils, neutrophils - Lymphoid cells: T cells, B cells../Desktop/Screenshot%202023-04-11%20at%2020.38.53.png Part 3: Urinary Tract Infection (UTI) ------------------------------------- A. Urinary Tract Infection: - E. Coli accounts for 75-95% of UTIs - **Acute Cystitis -** bladder infection - S/Sx - Dysuria, frequency, urgency, cloudy or bloody urine - No systemic symptoms (no fever) - Urinalysis: could show + leukocyte esterase and nitrates - **Acute Pyelonephritis** -- bacteria reaches the kidney - S/Sx - Dsyuria, frequency, urgency - "systemic symptoms" à fever, flank pain, malaise, N/V - Abrupt onset - Urosepsis possible (bloodstream infection) - Risk factors: - Diabetes, HIV/ immunodeficiencies, anatomical abnormalities  Appendix **B: Supplemental Resources (organized by module)** ============================================================ Module 1: ========= Practice Questions: Fluid and Electrolyte Imbalances  **Quizlet:** https://quizlet.com/720565172/patho-ii-week-1-fluids-and-electrolytes-flash-cards/ **Quizlet:** https://quizlet.com/722988532/bio280-week-1-acids-and-bases-flash-cards/ **Acid & Base Practice KEY** **ABG Reference Ranges**    **Normal Reference Range**  -------- ----------------------------- pH  7.35-7.45  PaCO2  35-45mmHg  HCO3  22-26mEq/L  PaO2  80-100mmHg  SaO2  \90%  Note: Reference ranges vary slightly between labs and patient populations.  **Acid/Base Imbalances**  +-------------+-------------+-------------+-------------+-------------+ | **Condition | **Diagnosis | **Causes**  | **Symptoms* | **Compensat | | **  | (Lab | | *  | ion**  | | | Values, | | | | | | Findings)** | | | | | |   | | | | +=============+=============+=============+=============+=============+ | **Respirato | pH below | Opioids, | Tachypnea | Depends on | | ry | 7.35  | anesthesia, | (compensati | cause: | | acidosis**  | | COPD, | on), | reverse | | | PaCO2 above | asthma, | SOB, | opiates | |   | 45mmHg  | pneumonia, | hypoxia, | with | | | | pulmonary | fatigue, | naloxone, | |   | Low | embolism, | dizziness, | give | | | PaO2/SaO2  | hypoventila | weakness, | bronchodila | |   | | tion, | HA, | tors  | | | | respiratory | confusion | | | | | distress  | hyperkalemi | | | | | | a, | | | | | | hypotension | | | | | |   | | +-------------+-------------+-------------+-------------+-------------+ | **Respirato | pH above | Hyperventil | N/V, | Reduce | | ry | 7.45  | ation | confusion, | breathing | | alkalosis** | | (anxiety, | seizures, | rate | |   | PaCO2 below | fear), | lightheaded | (change | | | 35mmHg  | mechanical | ness, | ventilator | |   | | ventilation | tachycardia | rate, use | | | Normal |   | , | meds to | |   | PaO2/SaO2  | | hypokalemia | calm | | | | | , | patient)  | |   | | | numbness/ti | | | | | | ngling | | | | | | in | | | | | | extremities | | | | | |   | | +-------------+-------------+-------------+-------------+-------------+ | **Metabolic | pH below | DKA, severe | Hyperventil | Sodium | | acidosis**  | 7.35  | diarrhea, | ation, | bicarbonate | | | | renal | HA, | , | |   | HCO3 below | failure, | confusion, | IV fluids, | | | 22mEq/L  | shock, | drowsiness, | treat | |   | | dehydration | hyperkalemi | cause  | | | High anion |   | a, | | |   | gap  | | reduced | | | | | | muscle | | | | | | tone, N/V  | | +-------------+-------------+-------------+-------------+-------------+ | **Metabolic | pH above | Severe | Hypoventila | IV fluids | | alkalosis** | 7.45  | vomiting, | tion, | potassium | |   | | GI suction, | tachycardia | supplements | | | HCO3 above | diuretics, | , | , | |   | 26mEq/L  | bicarbonate | confusion, | treat | | | | excess, | N/V/D, | cause  | |   | | hyperaldost | tremors, | | | | | eronism  | muscle | | |   | | | cramps/ting | | | | | | ling, | | | | | | hypokalemia | | | | | |   | | +-------------+-------------+-------------+-------------+-------------+ **Arterial Blood Gas (ABG) Practice Questions** 1\. pH = 7.29, PaCO2 = 47, HCO3 = 24 UNCOMEPNSATED RESPIRATORY ACIDOSIS 2\. pH = 7.31, PaCO2 = 49, HCO3 = 30 PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS 3\. pH = 7.49, PaCO2 = 33, HCO3 = 24 UNCOMPENSATED RESPIRATORY ALKALOSIS 4\. pH = 7.48, PaCO2 = 31, HCO3 = 20 PARTIALLY COMPENSATED RESPIRATORY ALKALOSIS 5\. pH = 7.32, PaCO2 = 40, HCO3 = 16 UNCOMPENSATED METABOLIC ACIDOSIS 6\. pH = 7.31, PaCO2 = 30, HCO3 = 18 PARTIALLY COMPENSATED METABOLIC ACIDOSIS 7\. pH = 7.32, PaCO2 = 38, HCO3 = 19 **UNCOMPENSATED METABOLIC ACIDOSIS** 8.pH = 7.30, PaCO2 = 48, HCO3 = 29 PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS 9.pH = 7.48, PaCO2 = 49, HCO3 = 28 PARTIALLY COMPENSATED METABOLIC ALKALOSIS **\ Arterial Blood Gas (ABG) Practice Questions** 1\. UNCOMPENSATED RESPIRATORY ACIDOSIS. 2\. PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS. 3\. UNCOMPENSATED RESPIRATORY ALKALOSIS. 4\. PARTIALLY COMPENSATED RESPIRATORY ALKALOSIS. 5\. UNCOMPENSATED METABOLIC ACIDOSIS. 6\. PARTIALLY COMPENSATED METABOLIC ACIDOSIS. 7\. UNCOMPENSATED METABOLIC ACIDOSIS. 8\. PARTIALLY COMPENSATED RESPIRATORY ACIDOSIS. 9\. PARTIALLY COMPENSATED METABOLIC ALKALOSIS. **\ ** \\ **Fluids & Electrolytes Practice**  **Reference Ranges**  **Electrolyte**  **Normal Reference Range**  ------------------ ----------------------------- Sodium  135-145mEq/L  Potassium  3.5-5.0mEq/L  Calcium  8-10mg/dL  Phosphate  2.5-4.5mg/dL  Magnesium  1.5-2.5mEq/L  Note: Reference ranges vary slightly between labs and patient populations.  **Fluid/Electrolyte Imbalances**  **Condition**  **Diagnosis (Lab Values, Findings)**  **Causes**  **Symptoms**  **Treatment**  ------------------------ -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------ **Fluid deficit**  I&Os, prolonged capillary refill, poor skin turgor (skin tenting)  N/V/D, blood loss, excessive sweating, fever, burns, diuretics, NG suction, alcohol, reduced fluid intake  Orthostatic hypotension, dizziness, weight loss, tachycardia, concentrated urine, poor skin turgor, HA, muscle cramps  Oral and/or IV fluids  **Fluid overload**  Pitting edema, jugular vein distension, ascites  HTN, CHF, CKD, liver dz, sepsis, lymph obstruction  Swollen legs, pitting edema (skin retains dimple after being touched), weight gain, jugular vein distension, HA  Diuretics, fluid restriction  **Hyponatremia**  Na+ \145mEq/L  Dehydration, NSAIDs, CKD  Muscle twitching, hyperreflexia, confusion lethargy  Isotonic fluids  **Hypokalemia**  K+ \5mEq/L  Acidosis, CKD, cell death (trauma, burns)  Cardiac arrhythmia, weakness, confusion  Avoid foods & supplements high in potassium  **Hypocalcemia**  Ca+ \10mg/dL  Dietary/supplemental excess, thiazide diuretics  Bone pain  Reduce calcium intake  **Hypophosphatemia**  PO4 \ 4.5mg/dL  CKD  Muscle cramps, numbness, tingling  Phosphate binders (e.g. calcium supplements)  **Hypomagnesemia**  Mg2+ \ A. Vaccines allow patients to develop active natural immunity  B. Active natural immunity is developed from mom to baby via placenta   C. Overcoming an infection will result in active natural immunity  D. Immunoglobulins administered will result in passive natural immunity    10. Matching Questions - Pathogens  +-----------------------------------+-----------------------------------+ | 5. Bacteria | I. Need host for survival. 5 | +===================================+===================================+ | 1. Fungus | E. Another name for worms 4 | +-----------------------------------+-----------------------------------+ | 2. Parasites | F. Produce transmittable spores | | | and live in warm, moist | | | places 2 | +-----------------------------------+-----------------------------------+ | 3. Helminths | G. May spread by contaminated | | | vector 3 | +-----------------------------------+-----------------------------------+ | 4. Virus | H. Classified based on shape, | | | size and cell staining. 1 | +-----------------------------------+-----------------------------------+.   11. Select the characteristics of bacteria (Select all that apply)  J. Single celled organisms  K. No organelles  L. No nucleus  M. Can not reproduce without a host  N. Lives in warm, moist places    12. Which of the following are examples of viruses? (Select all that apply)  A. HIV  B. Rabies  C. Hepatitis A  D. E.coli  E. Influenza    13. Vectors are insects that carry disease and transmit it through their bite (ex: deer tick - Lyme disease): True or False    14. With gram staining, a gram positive organism will appear pink under the microscope: True or False    Answer Key: 1\. C; 2. B; 3. A;4. A, C, D, E; 5. A, B, C; 6. D; 7. A; 8. False; 9. C; 10. 1 -- E, 2 -- C, 3 -- D, 4 -- B, 5 -- A ; 11. A, B, C; 12. A, B, C, E; 13. True; 14. False