NR-507 FINAL STUDY GUIDE
Chapters 1-5, 11-14, 16-20, 21-25, 27-3-33, 34-39, 40-47
1. Types of immunity-e.g. innate, active, etc (ch 7 ,191)
➢ Innate i... [Show More] mmunity includes two lines of defense: natural barriers and inflammation
Natural barriers are physical, mechanical, and biochemical barriers at the body’s
surfaces and are in place at birth to prevent damage by substances in the environment
and thwart infection by pathogenic microorganisms.
➢ the natural epithelial barrier and inflammation confer innate resistance and protection, commonly
referred
to as innate, native, or natural immunity. Inflammation associated with infection
usually initiates an adaptive process that results in a long-term and very effective
immunity to the infecting microorganism, referred to as adaptive, acquired, or specific
immunity.
➢ Adaptive immunity is relatively slow to develop but has memory and more rapidly
targets and eradicates a second infection with a particular disease-causing
microorganism.
➢ Innate immunity includes two lines of defense: natural barriers and inflammation. Natural barriers
are
physical, mechanical, and biochemical barriers at the body’s surfaces and are in place at
birth to prevent damage by substances in the environment and thwart infection by
pathogenic microorganisms
BARRIERS
INNATE IMMUNITY
INFLAMMATORY
RESPONSE
ADAPTIVE (ACQUIRED) IMMUNITY
Level of
defense
First line of defense against
infection and tissue injury
Second line of defense; occurs as a
response to tissue injury or infection
Third line ofdefense;
initiated when innate
immune system signals the
cells ofadaptive immunity
Timing of
defense
Constant Immediate response Delay between primary
exposure to antigen and
maximum response; immediate
against secondary exposure to
antigen
Specificity Broadly specific Broadly specific Response is very specific
toward “antigen”
Cells Epithelial cells Mast cells, granulocytes
(neutrophils, eosinophils,
basophils),
monocytes/macrophages, natural
killer (NK) cells, platelets,
endothelial cells
T lymphocytes, B
lymphocytes,
macrophages, dendritic
cells
Memory No memory involved No memory involved Specific immunologic memory
by T and B lymphocytes
Peptides Defensins, cathelicidins,
collectins, lactoferrin,
bacterial toxins
Complement, clotting factors, kinins Antibodies, complement
Protection Protection includes anatomic
barriers (i.e., skin and mucous
membranes), cells and secretory
molecules or cytokines (e.g.,
lysozymes, low pH of stomach
and urine), and ciliary activity
Protection includes vascular responses,
cellular components (e.g., mast cells,
neutrophils, macrophages), secretory
molecules or cytokines, and activation
of plasma protein systems
Protection includes activated T
and B lymphocytes, cytokines,
and antibodies
2
2. Alveolar ventilation/perfusion- (ch, 34,pg 1238)
➢ The relationship between arterial perfusion and alveolar gas pressure at the base of the lungs is
best described as: arterial perfusion pressure exceeds alveolar gas pressure.
➢ Effective gas exchange depends on an approximately even distribution of gas (ventilation) and blood
(perfusion) in all
portions of the lungs. The lungs are suspended from the hila in the thoracic cavity. When the
individual is in an upright position (sitting or standing), gravity pulls the lungs down toward the
diaphragm and compresses their lower portions or bases.
3. Dermatologic conditions e.g. pityriasis rosea (ch46, pg 1630/1631)
➢ Psoriasis, pityriasis rosea, and lichen planus are inflammatory disorders characterized by papules,
scales, plaques, and erythema
➢ Psoriasis is a chronic, relapsing, proliferative, inflammatory disorder that involves the skin, scalp, and nails
and can
occur at any age.
➢ Pityriasis rosea is a benign self-limiting inflammatory disorder that occurs more often in young
adults, with seasonal peaks in the spring and fall. The cause is unknown but
➢ thought to be associated with a virus (e.g., human herpesvirus 6 [HHV-6] and HHV-7) because of the timing
and
clustering of the outbreaks
3
➢ Pityriasis rosea begins as a single lesion known as a herald patch that is circular,
demarcated, and salmon-pink; is approximately 3 to 4 cm in diameter; and is usually located
on the trunk
➢ Lichen planus (LP) is a benign, autoimmune inflammatory disorder of the skin and mucous membranes
with multiple
clinical variations. The cause is unknown, but T cells, adhesion molecules, inflammatory
cytokines, perforin, and antigen-presenting cells are involved.The infiltrate of T cells
mediates immunoreactivity against basal layer keratinocytes, which have altered surface
antigens and adhesion molecules
➢ LP is also linked to hepatitis C virus. Some individuals develop lichenoid lesions after
exposure to drugs or film- processing chemicals. The age of onset is usually between 30 and
70 years. The disorder begins with flat purple, polygonal, pruritic, nonscaling papules 2 to 4
mm in size, usually located on the wrists, ankles, lower legs, and genitalia
➢ New lesions are pale pink and evolve into a dark violet. Persistent lesions may be
thickened and red, forming hypertrophic LP. Oral lesions (oral lichen planus) appear as
lacy white rings that must be differentiated from leukoplakia or oral candidiasis and they
may be precancerous lesions
4. Croup (C 36,pg 1294)-
➢ Croup illnesses can be divided into two categories: (1) acute
laryngotracheobronchitis (croup) and (2) spasmodic croup. Diphtheria can be
considered a croup illness but is now rare because of vaccinations. Croup illnesses
are all characterized by infection and obstruction of the upper airways.
➢ Croup is an acute laryngotracheobronchitis and most commonly occurs in children from 6 months to
3 years of
age, with peak incidence at 2 years of age
➢ The incidence of croup is highest in late autumn and winter, corresponding to the
parainfluenza and RSV seasons, respectively. Croup is more common in boys than girls. In a
significant portion of affected children, croup is a recurrent problem during childhood, and
there is a family history of croup in about 15% of cases
➢ Chickenpox (varicella) and herpes zoster (shingles) are produced by the varicella-zoster virus (VZV).
VZV is a
complex herpes group deoxyribonucleic acid (DNA) virus. The incubation period is 10 to 27
days, averaging 14 days. Productive infection occurs within keratinocytes such that the
vesicular lesions occur in the epidermis, and an inflammatory infiltrate is often present
5. Types of anemia (ch 28,pg 987-1002)
➢ anemia is a reduction in the total number of erythrocytes in the circulating blood or a
decrease in the quality or quantity of hemoglobin. Anemias commonly result from (1)
impaired erythrocyte production, (2) blood loss (acute or chronic), (3) increased erythrocyte
destruction, or (4) a combination of these three factors.
➢ Pernicious anemia (PA), the most common type of megaloblastic anemia, is caused by
vitamin B12deficiency, which is often associated with the end stage of type A chronic
atrophic (congenital or autoimmune) gastritis. PA
results from inadequate vitamin B12 absorption because of autoantibodies against the B12transporter IF
➢ Folate (folic acid) is an essential vitamin for RNA and DNA synthesis within the maturing
erythrocyte. Folates are coenzymes required for the synthesis of thymine and purines
(adenine and guanine) and the
conversion of homocysteine to methionine. Deficient production of thymine, in particular,
affects cells undergoing rapid division (e.g., bone marrow cells undergoing erythropoiesis).
Humans are totally dependent on dietary intake to meet the daily requirement of 50 to 200
mcg/day. Folate deficiency anemia is caused by inadequate dietary intake of folate. Both
anemias respond to replacement therapy.
➢ The microcytic-hypochromic anemias are characterized by abnormally small
erythrocytes that contain abnormally reduced amounts of hemoglobin
4
➢ Microcytic-hypochromic anemia can result from (1) disorders of iron metabolism, (2) disorders
ofporphyrin and
heme synthesis, or (3) disorders of globin synthesis. Specific disorders include iron deficiency
anemia, side roblastic anemia, and thalassemia
➢ Iron deficiency anemia (IDA) is the most common type of anemia worldwide, occurring in both
developing and
developed countries and affecting as many as one fifth of the world population. Certain
populations are at high risk for developing hypoferremia and IDA and include individuals
living in poverty, women of childbearing age, and children. Iron deficiency in children is
associated with numerous adverse health-related manifestations, especially cognitive
impairment, which may be irreversible
➢ Sideroblastic anemias (SAs) are a heterogeneous group of disorders characterized by
anemia of varying severity caused by a defect in mitochondrial heme synthesis.SA is
characterized by the presence of ringed side roblasts within the bone marrow. SA results
from defects in mitochondrial metabolism leading to ineffective iron uptake and
dysfunctional heme synthesis. The characteristic cell in the bone marrow, a ringed
sideroblast, is an erythroblast containing iron granules arranged around the nucleus. SAs
may be hereditary or acquired, and treatment varies depending on the cause.
➢ Normocytic-normochromic anemias (NNAs) are characterized by erythrocytes that are relatively
normal in size
and hemoglobin content but insufficient in number. These anemias have no common etiology,
pathologic
5
mechanisms, or morphologic characteristics. They are less frequent than macrocyticnormochromic
and microcytic-hypochromic anemias.
➢ NNAs include five distinct groups: aplastic (damage to bone marrow erythropoiesis);
posthemorrhagic (acute blood loss); acquired hemolytic (immune destruction of
erythrocytes); hereditary hemolytic, such as sickle cell (destruction by eryptosis); and
anemia of chronic inflammation (multiple causes)
➢ Macrocytic-normochromic, or megaloblastic-normochromic, anemias are characterized by larger than
normal
erythrocytes with normal levels of hemoglobin. They most commonly are caused by deficiency
of vitamin B12 (PA) or folate.
➢ Aplastic anemia (AA) is a critical condition characterized by pancytopenia, a reduction or
absence of all three blood cell types, resulting from failure or suppression of bone marrow to
produce adequate amounts of blood cells
➢ Posthemorrhagic anemia is a normocytic-normochromic anemia caused by acute blood loss. Initial
manifestations of this event depend on the severity of blood loss. If blood loss is severe, the
significant manifestations are related to loss of blood volume rather than loss of hemoglobin.
➢ The predominant event in hemolytic anemias is premature accelerated destruction of
erythrocytes, either episodically or continuously. The consequences of the anemia are
elevated levels of erythropoietin to induce accelerated production of erythrocytes and an
increase in the products of hemoglobin catabolism.
➢ Anemia of chronic disease (ACD) is a mild to moderate anemia resulting from decreased
erythropoiesis in
individuals with conditions of chronic systemic disease or inflammation (e.g., infections,
cancer, and chronic inflammatory or autoimmune diseases). These conditions include
acquired immunodeficiency disease (AIDS), malaria (particularly that caused by Plasmodium
falciparum), rheumatoid arthritis, systemic lupus erythematosus (SLE), acute and chronic
hepatitis, and chronic renal failure (a condition in which almost all affected individuals are
anemic)
➢ This form of anemia also is commonly noted in the presence of congestive heart failure (CHF).
The anemia develops after 1 to 2 months of disease activity. The initial severity is related to
that of the underlying disorder but, although persistent, it usually does not progress.
Individuals may be asymptomatic, or
the anemia may be a coincidental clinical finding.
6. The inflammatory process upon injury ( ch 7)
➢ The inflammatory response is initiated upon tissue injury or when PAMPs are recognized by
PRRs on cells of the innate immune system.
➢ There are two types of human defense mechanisms: innate resistance or immunity conferred by natural
barriers and
the inflammatory response; and the adaptive (acquired) immune system.
➢ Many different types of cells are involved in the inflammatory process including mast cells,
granulocytes (neutrophils, eosinophils, basophils), monocytes/macrophages, NK cells and
lymphocytes, and cellular fragments (platelets).
➢ The cells of the innate immune system secrete many biochemical mediators that are responsible for the
vascular
changes associated with inflammation and for modulating the localization and activities of other
inflammatory cells. The mediators include histamine, chemotactic factors, leukotrienes,
prostaglandins, and platelet-activating factor.
7. GI symptoms resulting in heart burn( ch 41, pg 1429- 1466)
➢ The clinical manifestations of (GERD) reflux esophagitis are heartburn from acid regurgitation,
chronic cough, asthma attacks and laryngitis.
➢ Heartburn also may be experienced as chest pain, which requires ruling out cardiac ischemia.
➢ Hiatal hernias are often asymptomatic. Generally, a wide variety of symptoms develop later in life
and are associated with other gastrointestinal disorders, including GERD. Manifestations of the [Show Less]
