HSC 4551 Exam 1 Study Guide Fall 2024 PDF

Exam 1 Study Guide -- Block 1 exam for HSC 4551 Fall 2024 - Describe how diseases are recognized - Health -- (definition by WHO) - State of mental, social, and physical well-being where the body performs its vital functions normally w/o the mere absence o...

Exam 1 Study Guide -- Block 1 exam for HSC 4551 Fall 2024 - Describe how diseases are recognized - Health -- (definition by WHO) - State of mental, social, and physical well-being where the body performs its vital functions normally w/o the mere absence of disease - These systems are in balance with one another - We recognize diseased based off of: - Signs -- physical manifestations of the disease (physical findings also) - Reported by the physician - Symptoms -- subjective manifestations of the disease such as pain - Reported by the patient - Disease itself is an imbalance within the body - Two types: - Syndrome: a type of disorder that includes a combination of signs and symptoms that are common within the affected population - Best example would be the presence of trisomy 21 within those affected with Down's syndrome - Disorder: an abnormal condition of the mind or body - Describe the ways Diseases can be Diagnosed - Physical Exams - Help with diagnosis of the specific condition - IPAP protocol - Inspection -- observing the chest and the airways for heaving, abnormalities in breathing, SOB - Palpitation -- feeling the areas of the body to test for conditions such as tenderness or soreness - Percussion -- tapping of the areas of the body to check for things such as consolidation in the chest or ascites (fluid within the abdomen that is not supposed to be there) - Auscultation -- listening to the sounds that are produced by the lungs or the breathing of the patient - Vital signs: - BP, pulse, heart rhythm, respiration rate, temperature, pain? - Imaging Technologies and how they work - Cytology - Study of cells that is mainly the work of pathologists - Pathologists are the doctors that examine slides of cells to see whether there are diseases - Clinicians -- the physicians that see and examine the patients while also giving diagnoses to them - Hallmark of cancer is enlarged nuclei, less cytoplasm, and grouping together of the cells - They are also irregular and not circular in shape with a no uniformity - Benign cells retain their shape and normal unformity - Mammography - Form of x-ray that is important because 1/8 women develop breast cancer - Has the ability to predict cancer 2 years before a manual breast exam - Should be done by the age of 40 in women - X-rays - EM radiation that resolves into finding two types of things -- - Radiolucent (black) -- means the organ is full of air - Good example would be the lungs on a chest x-ray - Radiopaque (white) - Ribs, bones, anything that is dense enough to block the passage of the rays through the organ - Sometimes dye can be swallowed which shows white to look for things such as gallstones that are not normal within the gallbladder - CT-Scans - Use of x-rays to produce a detailed 3D image of the area - Usually used for cases of trauma, hemorrhage, and tumors, infection as well (head ct) - Abdominal can look for cancer staging and tumors - Uses ionizing radiation but is more convenient yet not as detailed on the organs - MRI - Magnetic resonance imaging that uses a magnetic field and interaction with the hydrogen atoms that are present in the water that fills our organs to create an image of the body - Used for brain tumors and strokes that located within the brain primarily - May require the use of sedation due to people having claustrophobia - PET Scan - Form of nuclear medicine that uses a tracer that essentially moves towards higher active areas of the body - Cancer is very active and thus the tracer can identify areas of cancer from increased metabolic activity being perceived - FNA - Also known as a fine needle aspiration - Biopsy that samples a lesion, places it on a slide, which is then analyzed for its cancerous Ness - Ultrasound - Use of sound waves and their echoes from the organs to produce a very quick and convenient internal view of the region - Fluid would appear black on this guy whereas solid things such as the bones of a baby appear white alongside gallstones or something similar - Learn the different ways Disease Occurrence is quantified - Mortality -- number of deaths - Morbidity -- burden of the disease as well as existing cases - Incidence -- new cases of the disease - Prevalence -- existing cases of the disease - Epidemiology -- study of the distribution and transmission of a disease across a population - Idiopathic disease -- one of unknown cause - Describe Homeostasis - Term for when the systems of the body are in balance - Monitored via dynamic equilibrium of the body -- ever changing processes of feedback that respond to both internal and external stimuli - - The Causes of Disease and how it occurs - Course/Timeline: - Prognosis -- predicted outcome - Acute -- sudden onset with short duration - Chronic -- late onset with long duration - Remission -- subside of s/sx for a time, does not mean disease is gone - Relapse -- after the disease has supposedly been cured, the re-onset of the s/sx - Exacerbation -- worsening of the disease - Complication -- basically another disease or condition that resulted from the treatment of the initial disease or came from the primary disease, reminder that the initial disease is still present too - Sequela -- different from complication in that the disease has already passed and yet the other condition occurs - Does not deal with treatment - Is also an expected outcome after treating the first disease - Example would be getting shingles from chickenpox - Hereditary -- based on genetic passage (example would be sickle cell anemia) - Congenital -- based on birth (syphilis, fetal alcohol syndrome, cleft lip) - Degenerative -- with age, knee replacements - Inflammatory, Autoimmune, Allergic -- inflammatory response and allergic reactions (lupus) - Neoplastic -- tumors (cancers and also the benign growths) - Metabolic -- metabolism, example would be diabetes mellitus - May be genetically acquired or determined - T1DM is acquired with insulin deficiency - Traumatic -- trauma (CTE example) - Nutritional - Know Risk Factors, how they contribute to disease, and how to decrease them - Environmental, chemical, physiological, psychological, genetic - Way to treat -- physical exercise, well maintained diet, good weight, no smoking, limit alcohol, screening tests and immunos, stress management - Can also be - Palliative - Pharmacologic - Surgical - Psych/psychiatrist - Know the course of disease - Already mentioned above with the chronic, acute, etc. - Pathogenesis -- steps in the progression of disease, also is the way in which the cause of disease leads to bodily changes - Describe the different types of immunity - Immunity - The body's ability fight off infections - These infections are usually caused by antigens - Antigen - Any foreign material or microorganism that elicits an immune response within the body - Nonspecific Immunity - Refers to the 1^st^ line of defense - Cilia -- the hairs that line the respiratory tract to push out foreign bacteria and virus - Saliva -- has enzymes that break down bacteria - Tears - Sweat - Mucous membranes - Skin without any breaks prevent entry - 2^nd^ line of defense - Deals with the inflammatory response - Mobilize body defense, limit tissue injury and destroy the pathogen, repair the harmed tissue - Characterized by redness, swelling, tenderness, heat, sometimes fever and increase in WBCs (leukocytosis) - Biggest cell involved are the neutrophils, known as the polymorphonuclear cells - Phagocytotic cell that engulfs debris from the cell tissue injury - Has lysosomes that degrade debris - Agents of the process: - Histamines -- compounds acting as vasodilators and also increase permeability of blood vessel - Complement system -- plasma proteins that aid in the immune response - Deals with increase in the immune response - Specific Immunity - **Describe protective barriers present in the body** - **Characterize inflammatory response of the body** - **What is a polymorphonuclear leukocyte and what it does** - Describe the different cells that the body uses in its immune response - Leukocytes - Natural Killer Cells - Interferons - Helper T Cells - Memory T Cells - B Cells - Describe Type I allergic reactions - Describe Type II allergic reactions - Describe all types of hypersensitivity - I - II - III - IV - What is the difference between AIDS and HIV? - How is HIV diagnosed? - What is the most common tumor caused by AIDS? - How does cell-mediated immunity become achieved? - How is Lupus diagnosed and what is its etiology? - What is the course of disease for scleroderma? - What is the course of disease for Sjogren's syndrome? - How do CD8 T Effector immune cells fight infection? - What is the course of disease for Hodgkin's Lymphoma? - What is the course of disease for Non-Hodgkin's Lymphoma? Define the following terms - Endemic - Epidemic - Pandemic - Outbreak - Notifiable diseases - Reservoir - Horizontal transmission - Fomites - Vertical transmission - Parenteral Ways of controlling transmission - Immunization - Isolation - Vector control - Primary Syphilis course of disease - Chancre -- know the definition - Know what a Gram Stain is and how it works/how it is used - What is HPV? - Treatments and Prevention for HPV - Course of disease for HPV - Know the microorganisms that can cause disease in humans - Viruses - Bacteria - Protozoa - Fungi - Helminths - Prions Know the different ways infections can be prevented in healthcare settings - What is MRSA and how is it spread/treated? **The assigned article readings have supplemental questions on the exam, review them.** **[Chapter 1]** - **Health:** - From WHO, it is the state of **mental, physical, and social** wellbeing but not merely the absence of disease - Another perspective is when all systems within the body are functioning normally -- coordination between systems to work in sync - **Homeostasis:** - When everything is going fine and the systems are in balance, that is the def of homeostasis - Dynamic equilibrium -- ever changing processes of feedback and then regulation for the external and internal feedback changes. - **Disease** = imbalance that is going on within that system. - *Example:* - Cold room -- shivers for the body to regulate temperature to prevent being overwhelmed from the cold - **Recognizing disease ([pathology - study of suffering or disease])** - **Pathologists** looks at cells in the lab to determine cancers and the morphology of cells, whereas a clinician would be an internal medicine doctor that provides the actual patient care - **Signs** -- physical findings (**objective)** -- ex: swelling/redness, typically what the medical professional sees - **Symptoms** -- **subjective**, what the patient tells you, "I have pain, I feel weak" - Pain is a symptom, but *tenderness* would be a sign to the doctor - Sometimes patient will say 10/10 pain but again that is subjective and relative to what they mean by pain - Practically the same thing but from a different POV - **Disorder** -- abnormal condition of the mind and the body - **Ex:** diabetes mellitus as it affects structure and function - **Larger umbrella** compared to a syndrome (ex: anxiety -- generalized, one to heights, but ultimately all under the same topic) - **Syndrome** -- - Reason why you are able to tell someone has a syndrome, it is a combination of physical findings and symptoms that are common among the people that have the condition - Example is Down syndrome -- trisomy 21 (abnormality -- extra chromosome at position 21) - Common factor can be genetic, biochemical, physiologic, or structural - **Diagnosis of disease (identification of disease or disorder)** - One of the first things is the medical history, family history, social hx - Will then send them to imaging, blood work. - Categorically, this person has this medical condition - **Imaging techniques:** - Electrocardiography -- checking electric activity of the heart with leads, has a strip that shows MI, HA, abnormality with the heart - Radiography -- basically X-ray - Computed tomography **-- CT scan** - Basically like an X-ray but is multiple X-ray images - Place those images together in a 3D way and then project it into a computer - Used for tumors, hemorrhage, bone trauma, infarction - MRI - Use external mag field onto the human body - Body contains lots of water and thus hydrogen atoms - Much better for people with something in the brain, stroke or swelling or tumor in the brain - Contrast (inject or drink it -- helps to outline part of the specific area that they are looking for) - Usually gives white appearance in the body - **Claustrophobia** may require sedation - Ultrasound - Use high frequency sounds waves by a transducer, and when the sound waves meet resistance by tissues, you get Doppler emissions/echos reflected back - Echos go back to the transducer thereby generating electrical signals to the scanner to make an image - Can also use for gallstones - Nuclear med (PET, etc) - Uses a tracer that goes to the body where there is high metabolic activity - Cancers tend to have metabolic activity as they are using lots of resources - Positron emitting tracer - **Physical Exam** - *Inspection* -- looking for any signs or changes in the persons body, looks at chest, abdomen (breathing heavy, flaring) - Palpation -- actually touching the different parts of the body to usually test for tenderness - Auscultation -- use of stethoscope for hearing Boyle, breath, heart sounds (listening) - Percussion -- put hand down and make sound to check for consolidation in the chest, ascites in the body - **Vital signs --** heart rate, pulse rate, BP, temperature, respiratory rate - **Cytology --** study of cells - Work of pathologists - Dark cells are aggressive cervical cancer cells with crowded and large nuclear bodies - Cancer cells have enlarged active nucleus and minimal cytoplasm - **Fine needle aspiration --** - Goal is to obtain cells from suspicious lesion, send to lab, and then microscopely examine the cells and make the dx. - **Mammography --** - Type of X-ray that focuses on the breast tissue - Once you hit the age of 40, you should get a mammogram done - Is able to detect any growth in the breast 2 years before manual breast examination - **1/8 women get invasive breast cancer** - This is why it is Important \^ - **Chest X-ray** - Radiation passes through tissue and check the film for any abnormality - Anything that is dark color is *radiolucent* (most likely contains air) - lungs b/c contain air - White is r*adio-opaque* - White ribs, organs like the heart (it is solid) - Gallbladder would be normally dark and radiolucent because of normal bile, if there are gallstones, the x-ray would be more white and opaque because the solid stones - **Course of disease:** - ***Prognosis*: potential outcome of that disease (expected)** - **Good (lipoma) or bad (cancer)** - ***Acute:* sudden onset with short duration** - **Common cold, flu** - ***Terminal*: Ends in death** - **AIDS,** - ***Chronic*: slow onset with long duration** - **COPD, High BP, DM** - ***Remission:* when the signs and symptoms subside and disappear for short period of time** - **Tends to be seen after chemotherapy** - **Does not mean the disease has gone away** - *Exacerbation*: when s/sx become worse - *Relapse*: return of the s/sx of a person that potentially had a cure - *Complication*: already have existing disease and now they develop another disease because of the existing disease situation - *Ex**:*** **maybe cancer and chemotherapy caused them to get another** - **can be from the disease or treatment** - can also have chronic disease, could get pressure sores from lying on a bed for a long time - *Sequela*: - Disease that Usually develops after a particular disease, Fu to that illness - Ex: somebody has a streptococcal infection (rheumatic fever) in the throat, sequela can be rheumatic heart disease - Common thing that can happen in any person that can have that disease - Shingles from chickenpox - **Can only come from the disease** - **And the disease has already passed really and this new one is expected** - **Mortality: a**ny deaths associated with the disease - **Morbidity**: existing cases of a disease, shows burden of a disease - **Burden:** how it affects the population and the patient - **Incidence:** new cases of the disease - **Prevalence:** existing cases of the disease in a specific population at a certain time - **Epidemiology --** study of distribution and determinant of health realted states and events in populations as well as applications of the study for public health control - **Idiopathic --** disease with no known cause of that disease - May be spontaneous - Diverticulitis (sometimes) - **Etiology --** cause of a disease - Chief causes: - **Hereditary** - Disease passes from parents to offspring - Cystic fibrosis, sickle cell disease - **Congenital** - Any disease that is present at birth that can be due to multiple factors - Could be from env factor, medication, infection, hereditary (potential subset), cigarette, smoking, etc. - Congenital syphilis, fetal alcohol syndrome - Thalamides used to be normal but it can harm children upon birth by loss of an arm - **Degenerative** - Changes as you age, increased deterioration of cells over time - Knee and hip replacements - **Inflammatory** - Uncontrolled inflammation destroying normal tissue - **Autoimmune** - Body attacks its healthy cells by mistake - Systemic lupus erythematosus - **Neoplastic (neoplasm = tumor)** - Basically abnormal growth of cells, malignant or benign - **Metabolic** - Genetic or acquired, anything that affects the metabolism of the body - Good example is diabetes mellitus - **Traumatic** - Physical injury or wound from external force or violence - Example is chronic traumatic encephalopathy (CTE) which harms the brain tissue and can lead to active dementia - **Pathogenesis --** steps in which a disease progress - **Idiopathic --** *disease without a known cause* - **Treatment of Disease:** - **Chapter 2 (9/4):** - **Immunity** -- body ability to fight infection or ID - Each person is born with some level of immunity to fight infection - **Antigen** -- anything foreign that when it goes into the body causes an immune response (**means being able to produce an antibody** to fight that foreign agent) - Can be any type of pathogen - Fungi, bacteria, virus, protozoa - Pollen - Essentially anything that is non-self - Two major types: - **Nonspecific (innate immunity as well)** - Born with that ready to go - Cilia - cause for sneezing, something foreign being pushed back - Intact skin - *Body secretions (tears, saliva, sweat)* - **1^st^ - Skin (physical barrier),** mucous membrane from mouth to anal region provides barrier, tears (chemical), genetics (born with genes that are protective) - **2^nd^ -- inflammatory process** -\> leuks and WBCs types - Inflammation characterized by redness, swelling, heat, tenderness, leukocytosis (higher WBC), and sometimes fever - Polymorphonuclear leukocyte -- also known as neutrophil - Cells with multiple nuclei that phagocytes with lysosomes for destruction - Multiple nuclei, nothing different than that just being a structural thing that comes from differentiation and natural body processes - All cells come from BM and pluripotent cells - Histamines -- cause vasodilation and vascular permeability - That's why you have redness, swelling, and the other features of inflammation - Benadryl is an antihistamine to stop congestion and the other associated effects - Complement system -- group of plasma proteins made by immune system - Helps the IS and fight bacterial infection - System can go and attack the bacteria itself - **Membrane attack complex** -- make pores and flood it with water - **Opsonization -- attach to the cell and make it ready for digestion by the body cells** - Interferons - Normal cells produce these proteins to fight against the virus - Used for hep C for example - Phagocytosis - Swallowing of foreign material - Neutrophils, - **Specific (acquired/adaptive immunity)** - Must be exposed to antigen and becomes familiar with it so that next time a heavy and high immune response is released in the future - Humoral: - [B cells/lymphocytes] - Note: all the cells, both B and T cells are produced in the bone marrow - but B cell mature in BM and T cell mature in the thymus - B cells produce plasma cells (factories for the production of antibodies) - Target bacterial toxins or *extracellular* pathogens - Antibodies = immunoglobulins - Cell-mediated: - [T cells/lymphocytes (can be called plasma cells)] - Tend to target *intracellular* pathogens, viruses, abnormal cells - Types: - Helper T cell (CD4 cells) -- - Coordinate the immune system and response and produce **cytokines (chemical messengers)** - Tend to count CD4 within HIV as it helps to tell us if they have the condition - **Below 200 -- full blow AIDS** - Less likely to fight any type of infection from the low count - normal is 400-800 - Cytotoxic T cell (CD8 cells) -- - Go directly and kill the pathogen - Both B and T cells produce memory cells - Both help with future immune response - Those cells get updated - Cytokines: - Interferon -- protein produced after viral infection that can interfere with viral replication - Interleukin -- sends reg signals bw cells - Tumor necrosis factor -- destroys forgein/abnormal cells and cancer - Immunglobulin: - IgE -- allergic reactions - IgA -- anywhere that is wet, mucous membranes - IgD -- activates B cells - IgG -- most prominent, principal one -- component of primary and secondary response to antigen, crosses placenta - IgM - first antibody made in primary responose to antigens - Diagnostic Testing: - Agglutination reactions, etc. (may not need to know) - Autoimmunity (do not know the cause): - Non-self would be antigen - Body makes autoantibodies to destroy itself - Scleroderma, sjorgens -- body cannot recognize proper self - [Ex: SLE (systemic lupus erythematosus)] - Idiopathic - From other diseases - Infections - Sulfa antibiotics - Genetic factors - **Types of lupus:** - Systemic -- affects entire body (no cure) -- 70% of the cases are of this nature - Cutaneous -- skin (no cure but can be managed) - Drug-induced (can be cured by stopping med) - Neonatal -- child exposed to the mother's antibody (can also be cured) - More common among women - **Signs/symptoms:** - Fatigue, arthritis, fever, butterfly rash, photosensitivity, mouth/nose ulcers, - Raynaud's phenomenon -- vasoconstriction of fingers that makes them look whiter - Scleroderma (idiopathic) - Chronic autoimmune - Hallmarks are being Coarse and tight skin - Localized - Waxy patches, skin streaks - Systemic - S/Sx - Raynaud's, heartburn, pain in two or more joints, diff swallowing, SOB - 4x more common in women than in men, could be linked to an estrogen hormonal dispositions - Skin flaws because of fibroblasts - Sjorgens syndrome - Chronic, slow - Destroys secretory glands, so dry all over (eyes and mouth dryness = hallmark) - 90% are women - Primary -- affecting exocrine glands - Secondary -- have another illnesss and then develop Sjorgens - Idiopathic - Not any current treatment - Stay hydrated - Allergy - Overwhelming allergic response to a normal allergen (name of the antigen) - Allergen is an antigen that elicits an immune response - Four types of hypersensitivity - I,II,III are all antibody-based - IV is due to T cells (delayed) - In I: - Most common, triggered by IgE - Mast cells have histamines which are released - Anaphylaxis -- severe IgE mediated hypersensitivity - In II: - Antibody mediated, IgM and igG cause destruction cells - Happens with complement activation - Blood transfusions and agglutination - In III: - Antibody antigen complex - Immune complexes deposit in the skin - SLE example - In IV: - Delayed cell mediated - T helpers and cytotoxic are generated in the inflammatory reaction - Example would be from poison ivy, TB test - Anything above 10 mm from TB could mean exposure or dormant TB - HIV - Sexually transmitted disease - Know the three different enzymes - Reverse transcriptase makes viral RNA into DNA (so it's the reverse pathway) - Integrase then places the newly coded viral DNA into the host cell's DNA chain - Protease cuts protein chains into units and assembles them into the viral wall - Will test CD4 count - Normally the CD4 count should be between 800 to 1200 when checked - If you have an infection and not on treatment, below 500 has risk of opportunistic infections - **Below 200, you have full blown AIDs** - Pneumocystis jirovecii pneumonia is common infection for people with HIV - Chest x-ray could present as normal, but it is serious - Other oppurtunisitc infeciton include toxoplasmosis - Crypto causes diarrhea - Mycobacterium causes burns - Will likely be a question on what can be a risk for opp infection (3 above) - Gay men are at risk for it, - Hiv-realted malignances - Cancer - Kaposi's sarcoma: connective tissue tumor fo the cells that line the blood vessels - Can be seen on skin, oral cavity and may affect lymphatic system - Examples of opp infections:\ - Oral candidiasis - Primary HIV infection -- - Once exposed, within few days, redness of eye, feel unwell, fever - Seroconversion: HIV getting into the system Clinically asymptomatic: - Can be clinically asymptomatic for many years -- 5,10,15 years without any Symptomatic HIV: - Start to have skin issues and fever Progression from HIV to AIDS: - Much harder to reverse, happens if nothing is done about it - AIDS does not have a cure at this time - Antiretroviral therapy (ART) - Does not cure but is a treatment - HIV prevention - Pre-exposure prophylaxis (PrEP -- reverse transcriptase inhibitor) - Essentially blocks the risk of getting the infection and thus the method of viral infection - **Truvada** is the other name for the medication - Hodgkin's Lymphoma - Cancers that affect lymphatic system of the individuals - Difference between Hodgkins - **Those who have it, look under microscope -- have Reed Sternberg cells** (large, abnormal lymphocytes that have more than one nucleus) - Non-Hodgkins do not have the Rs cells - s/sx: - painless lymph swelling - unexplained fever - night sweats - itchy skin - coughing - dysspnea - chest pain - unexplained weight loss - etiology is idiopathic - treatment is usually chemotherapy, bone marrow or stem cell transplant **Chapter 3 Lecture:** - pathogen - any microorganism that can cause infection - contagious/communicable -- can get infection from direct contact - epidemiology -- study of distribution and transmission of diseases - incidence -- new cases of a disease - prevalence - existing cases of a disease - endemic -- low levels of disease at a particular point in time/ local to an area - ex: sexually transmitted infection - any time of the year, people will have it - always occurs in that area - malaria - epidemic -- [unusual] increase in volume of disease cases - ex: influenza in the U.S. - pandemic -- epidemic when it has gone across country lines or worldwide - ex: COVID-19, went to over 100 countries - outbreak -- sudden increase in an infection but subsides within **limited geographical area** - ex: measles in California in Disneyland - notifiable diseases -- - once you come across the disease - you must report it to the CDC to prevent the occurrence of an outbreak - Fomites: inanimate objects that are capable of transmitting infection - Skin cells, clothing, hair, bedding material - Must common would be our phone - Reservoir -- source of the infection - **Horizontal transmission** - From reservoir to humans - **Direct** -- human contact - STIs - I**ndirect** -- where the infectious agent can survive outside the reservoir and can still be infectious - Respiratory droplets, sneezing - **Vertical Transmission** - From the mother to the child - HIV can be vertically moved, syphilis, gonorrhea - Parenteral -- through direct puncture - Needle injuries, hepatitis/HIV could be moved Controlling Transmission: - Primary prevention - Vaccinations - Isolation -- already have the disease, and so isolating is to stop the spread to other people - Quarantine -- have been exposed but not sure if you will manifest the infection - Incubation period: time between exposure to the time you manifest symptoms **[Sexually transmitted infections:]** - There are six major STIs - HPV (most common STI) - Chlamydia is the most commonly REPORTED - So common - Comes with wart, removoal can be done via laser, freezing, surgery - In 2006, Gardasil was a drug that covered some strains - In 2014, Gardasil then covered more stains - Some can cause cervical cacner - Cannot have this cancer without HPV (strains 16 and 18) - Strains 31, 22, 45, 52, and 48 account for additional 20% of cervical cacners - Syphilis - Bacterial Agent that causes it is treponema pallidum (can be called **spirochetes -- spirally shaped bacteria)** - Primary: - Chancre, painless ulcer forms 2-10 weeks after sex with someone who has syphilis - Persists for 4-6 weeks and then disappears - Direct contact through mucus membrances - Secondary: - After primary resolves - Develops non-specific skin rashs, persists for weeks, spirochete travels in the blood across the body - Tertiary: - Can be dormnant from 1 to 30 years - Can be asymptomatic - Can then affect the nervous system - Dx: - Chancre scarpings - VDRL -- venereal disease research lab - RPR -- rapid plasma regain - FTA -- fluorescent treponemal antibody absorption - Gonorrhea - Neisseria gonorrhea (GC) - Gram-negative diplococci - Pink and have two spheres (always in pairs) - Transmitted via sexual contact - In men: - Dysuria (pain when urinating) - Urethritis -- inflamed urethra - Infects mucous membranes of urethra, pharynx, anus - Can infect prostate, seminal vesicle, epididymis - Area which sperm moves can be blocked, thus reducing fertility - In women: - Dysuria - Vaginal bleeding and discharge - PID (pelvic inflammatory disease) - Affects more of the woman's reproductive tract from the tubes to the womb area - Fever, discharge - Reduced fertility - Adhesion that blocks the fallopian tube - From all of them you can get tubal pregnancy - Tubal pregnancy - Ectopic pregnancy -- fertilization took place but implantation occurred within the tubes rather than the uterus - Could rupture and women bleeds to death - Gonorrhea is thus a risk factor for ectopic pregnancy - Herpes - Herpes simplex virus - HSV-1 causes cold sores - HSV-2 is the genital and sexually transmitted one - Once the virus is in, they can remain latent within the system for life, hide in the nerve cell ganglia - C section would be done if the pregnant women has hx of the virus and may pass it to the baby upon delivery - Chlamydia (most commonly reported) - Most times it is asymptomatic in men - s/sx seen in gonorrhea are the same for this one - can be vertically transmitted - may cause conjunctivitis or pneumonia - - HIV - Peaked in 1980s, started to decrease from antiviral - Gram Stain: - Classifies the negative versus the positive ones - Get sample, place on slide, flood with purple dye, iodine, alcohol to decolorize, apply red dye - Positive -- retains purple - Negative -- retains pink - Shape: - Cocci -- round in shape - Bacilli -- more cylindrical - Color though tells you positive versus negative **Microorganisms:** [Virus:] - Contain DNA/RNA encased within a protein coat called the capsid - May also have an external lipid membrance that deals with cell recognition markers - May be latent in activation [Bacteria:] - Single-celled, small organisms that do not have membrane-bound organelles or a nucleus - Have a cell wall that gives rigid shape - Spirochetes, bacilli, spirilla, cocci, - Some can make endospores [Protozoa] - Single celled but larger than bacteria, eukaryotic as well - Have the nucleus and membranes around the organelles - Flagelliate, cillilate, pseudopodia (cell membrane extensions that amoeboids use), sporozoans are the not motile ones [Helminth:] - Parasitic worms that are eukaryotes and complex - Have developed reproductive rogans and can reproduce well - Cause infestations - Hook worm example [Fungi:] - Mycoses are the name fo the infecitons that are caused by fungi - Single or multicellular in nature with cell walls made of chitin material - Contain reproductive spores - Usually opportunistic in nature - -ringworm [Prions ] - Misfolded proteins that are involved in neural degeneration [Chapters 1-3 supp articles] - Focus on the numbers (statistic information, results section usually) Chapter 1 supplementary file summaries: - Biopsy: what you need to know - Procedure that involves removing a tissue sample and sending it to a pathologist - Based on type of biopsy, results may come **back up to 10 days.** - Biopsy comes from bios = life and opsis=sight - Types: - Scrape: remove cells from surface of target tissue - Ex: cervical cancer pap smears - Punch: round-shaped knife that removes disk of tissue to collect deep tissue samples for skin cancer progression - Needle: wide needle for core and thin one for FNAB - Stereotactic: 3D imaging located cell abnormalities and guides the sample collection - Used mainly breast cancer and brain biopsies - Colposcopic: colposcopy evals after abnormal cervical smear, telescope can see areas of cervix detail - Endoscopic: long,thin, optical instrcument to see deep inside the GI tract, lungs, and other internal pathways - Uses: - See if growth is cancerous - Gastric: reveals cause of stomach pain, from either inflame or bacteria such as H. pylori - Lung: can see if abnormal lung mass is benign or malignant with radiologist - Breast: same thing but for breasts - **Note: straightforward result can be reasdy within 1-2 days but take up to 10 of them.** - **Many people receive their biopsy results within 2 days** - Biopsies are low risk, safe but obv have a risk of infection and excessive hemorrhage in rare cases - Usually same day case unless more intensive on internal organ that requires overnight stay - What is the difference between CT and MRI scans? - Both are imaging techniques that make detailed images of internal body parts like the bones, joints, and the organs - CT uses x-rays while MRI uses strong magnetic fields and radio waves - IN CT, sanncer sends images to computer after taking the X-rays (also called a computerized axial; tomorgraphy scan) - More common, less expensive, SILENT - In MRI, radio waves bounce off of the water and fat cells of the body to make the image - Better image but costs more - More noisy - Uses for CT: - Look for tumors, bone fractures, hemorrhage internally, cancer development - Uses for MRI: - Issues in the ankles, breasts, brain, heart, joint, wrists, blood vesssles - Anything within the head really - BOTH ARE SAFE: - Ct though can deliver small dose of ionizing radiation that could affect biological tisues, not safe for pregnant women - Mri scans are loud and may cause claustrophobia, also cannot be used for someone with metal implants within their bodies - Dye can be used as contrast as well to make images clearer, but allergies to the dyes are possible **Chapter 3:** Part I: Mechanisms of Disease - Infectious diseases remain a major cause of death, disability, and social and economic upheaval for millions around the world. - Illness and death from infectious diseases are particularly tragic because they are largely preventable and treat-able. More than 90% of deaths from infectious diseases worldwide are caused by a handful of diseases (Table 3--1 ). - The World Health Orga-nization reports that in high-income countries, only one of the top 10 causes of death is an infectious disease; - in contrast, among low- and middle-income countries, infectious diseases account for 4 of the 10 leading causes of death. - Poverty, lack of access to health care, antibiotic resistance, evolving human migration patterns, new infectious agents, and changing environ-mental and developmental activities all contribute to the growing impact of infectious diseases. - ID caused by pathogens = disease causing microorganism that grows in or on the body - Damages tissue, induces inflamm, triggers s/sx related to infecitons - Pathogen derived from "to cause suffering" - ID transmitted **directly** through human to human contact = contagious/communicable - Measels and influenza are 2 examples - Contrary -- rabes being from bite of rabid racc or cholera from water - Epidemiology = study of transmission, occurrence, and control of disease - Incidence = number of new cases of disease in pop - Reveals patterns and prevalence (existing cases -- can show impact on a pop) - Endemic -- always occurs at low levels - Ex: sexually transmitted ID - Epidemic -- disease occurs in unusually llarge numbers over a certain area - Influenza example - Pandemic -- when the epidemic has spread to areas worldwide - Outbreak -- disease has suddenly appeared in unexpected numbers in a limited area and then subsides - Notifiable disease are ID that must be rpoted by doctors to CDC - Ex: measela, mumps, polio, tuberculosis, legioonnaries, tetanus, and chlamydia - Leading cause from ID Is lower resp infections at 3.46 - Lowest is measles at 0.15 million - (See table 3-1) - Reservoir = source of the infectious aagent - Humans, animals, insects, soil, water - Measles have human res - Carriers = have the infectious agent but are not showing symptoms of it Tranmission types: - **Horizontal** -- from res to suspectible human, directly or indirectly - [Directly] -- infected by contact with reservoir, sneezing or coughing as well from the expelled droplets - Ex: ringworm, hiv and aids, common cold, flu - Expelled droplets would be for the flu and pneumonia - [Indirectly] -- pathogen withstands env out of host before infecting individual - Survival in airborne droplets and travel - TB and measles go via this method - F[omites] -- inanimate carriers of the infectious agent - **Vertical** - Mother can give it to the newborn if infected with the disease - Ex: syphilis, hiv/aids, opthalmia neonatorum eye infection - Though disease is caused by the microbs entruing the human host - Most common POE is respiratory tract, GI or GU, - direct dispense into the tssiues below skin throug punctrues, injections, bites, surgery = **parenteral route** - **Nosocomial --** hospital acquired or from a healthcare facility - 1.7 mil contract one yearly with 99,000 dying from them - Most common: 32% for urinary tract - 22 are at surgical ste - 15 from llung infections - 14 from blood stream infection or sepsis - Higher nos rates in developing countries - Weaker, older patient is more prone to an opportunistic pathogen - Burns, surgical wounds, injections, invasive diagnostic procedures, ventilators, intravenous therapy, and catheters increase the risk of infection. The principal routes of transmission of - nosocomial infections are contact with health care staff, contact with contaminated instruments, and through the hospital's ventilation system. - Normal flora composed of 100 trillion microbes that may have normal flora becoming opportunistic pathogens or just oppurtunists - Difference between the two is that one causes disease while the opps do not cause disease in healthy person but may if weak immune system or at the site of surgery - Handwashing according to cdc is the most important way to prevent the spread of nosocomial infections - Control of ID: - Control can be done from isolation of infected people in hospitals or at hmoe - Quarantine = sep who may or may not be infected from healthy people until the period for infectious risk has passed - Respiratory etiquette: One should sneeze or cough into a hand-kerchief, a tissue, or upper arm or elbow. - Never sneeze or cough into the hands. After coughing or sneezing, always wash hands and discard tissues. Handwashing prevents foodborne ill-nesses as well as those transmitted by respiratory droplets. One must wash hands before and after preparing meals and after handling raw meat and eggs. - Of all methods, **vaccination** may be the most and only effective way to protect personal and public health. - Helped to completely remove smallpox - OSHA says 5.6 mill workers in healthcare at risk for occ exposure to bloodboardn paths like HIV, hep B, and hep C. - 600 to 800,000 injuries go unnoticed - Rate of HBV trans to sus health care works is 6 to 30% after a single needlestick ecposure from someone who had HBV - Cancer = abnormal and uncontrolled growth of abnormal cells in body - Metastasize -- infriltrate normal body tissue and spread - U.S., ½ of all men and 1/3 of all women will develop cancer in life - Cancer is the second most common cause of death within the U.S. - Number of dx cancer cases will continue to 24 million by 2035 global - Cancer is the leading cause of death worldwide though, killed 8.2 million in 2012 - A tumor is an uncontrolled set of cell that are considered to be abnormal growths (also called a neoplasm) - Benign or malignant in nature - Some tumors are not solid and most are lymphomas, leukemia, and myeloma (bone marrow) - Benign are ok and localized, does not metastasize either - Smooth surface, symmetric, uniform appearance, encapsulated (covered with capsule material), easy to remove, rarely reoccur - Malignant - Life threatening, rapid growth, invade tissue and metastasize, - Crab like appearance with irregular surface, no uniform appearance, not encapsulated (makes removal harder) - Polyp -- bening tumors projecting from the epithelial surface - Naming is done usually by adding -oma to the location fo the tumor - **Malignant are named with the location followed by "carcinoma"** - **Carcinomas are more common and metastasize slowly via lymph** - The supportive tissue cancers are named with the location of the tissue and then adding "sarcoma" to it - These are less common, grow faster, and meta through blood - Ex: osteosarcoma - Found within the bone, muscle, cartilage - - Risk factors for cancer: - Age -- most important is growin older, 77% dx by people 55 years and older - Tobacco use -- CS causes 30 percent of deaths in U,S, - Infections - HPV -- GU - Hep B and C - Epstein barr -- lymphoma and nasopharynx - Human herpesvirus 8 -- Kaposi sarcoma link - Heliobacter pylori -- gastric cancer - Radiation -- known cause - UV is main cause for nonmelanoma skin cancer - Ionizing from medical radiation like x-rays or ct scans and radon gas in the homes can cause leukemi, thyroid and breast cancer - Immunosuppressive medications - NK secrete pore destroying chemicals -\> cell death - Cytotoxic t cells (specific) eliminate the abnormal cells - Use of these meds increase the cancer risk as a result - S/sx of cancer - Depends on location, size, and burden of the tumor - General symptoms: unintentional weight loss (comes from the cells competing from the nutrients that are in the body), fever, fatigue, pain, skin changes - Skin frequently serves as underlying marker for any internal diseases that are usually unnoticed - Etiology - Four main involved cells: oncogenes, mutations, suicide genes, DNA repair - Oncogenes tell when to divide - Supressors tell when not to - Suicide ones control apoptosis - DNA repair - Mutations in either one can be acquired or inherited - Acquired are from 5-10% - BRCA1 or 2 is a common example for breast cancer in women - Majority of cancers come from acquired mutatioons from the environmental or lifestyle - More than 50% of cancers involve the mutated tumor suppressor gene p53 - Mutations can also be caused by carcinogens (cancer-causing substances or agents such as bacteria/virus, certain chemcials, radiation) - Diagnosis of cancer: - No single test that can easily dx cancer within a patient - Blood test: - Tumor markers, can still be elevated in the normal noncancerous conditions - Limits the potential for it - PSA is an example for prostate cancer and cacner antigen 125 for ovarian - Dx imaging: - Radiography -- use of x-rays to make picture of the body - Ex: mammogram - CT -- makes 3D image of the body using combination of cross-sectioonal views - Dye may be inserted for the sake of contrast within the body - MRI -- uses magnetic filds, of which each tissue emits different signals - May also used contrast, similar to the CT scan - US -- sound waves reflect off the tissues to produce an image known as the sonogram - No radiation, easy to use, very inexpensive - Grading and cancer staging - Prostate, breast, and kidney cancer use their own unique grading scales aside from the normal 1-4 scale - Staging -- classification of tumor based on the size and the level of spread - TNM system - T -- tumor (size fo the original tumor) - N -- node (spread to lymph nodes?) - M -- metastasis (spread to distant parts) - 1 -- look almost normal - 2 -- look slightly abnormal - 3 -- look abnormal - 4 -- very abnormal - Treatment of cancer - Ultimate causes of death without treatmtne - Sceondary infection, organ failure, hemorrhage, undetermined factros - Most include surgery, radiation therapy, chemotherapy, ADT, immunio - Surgery -- malignant usually removed alongside surrodungin tissue to prevent recurrence - May also remove LN - RT -- about half usually receive this - High energy rays to damage cell DNA, stopping divison and growth - Normal and cancer cell DNA are harmed - Internal v external - Most SE are temp and resolve once treatment has ended - Chemo -- about half of pts also receive chemo - Systemic treatment (RT and surgery are local tx) - Uses meds that kill rapdialy dividng cells - Also kills cancer and normal cells - Bloos cells, BM, hair follices, digestive tract - SE include anemia, hair loss, nausea, vomting, diarrhea - SE temp and can be treated often - ADT -- some organs and tumors need the hromones to grow - Suppress the synthesis of the hormones in that area can inhibit the cancer development - Immuno -- strengthens the immune ssystem - Monoclonal antibdies -- synthetic nes that bind to an antigen on a cancer cell - Some carry drugs or radioactive isotopes, others signal the immune cells to come and kill the cancer ones - [Cancer prevention strategies: ] - No tobacco - Healthy weight with exercise - Healthy diet - Lmit alcohol conusptiom - UV protection - Imunized - Avoid risky behviaors - Rec cancer secreeenings