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First Aid

QuestionAnswer
In which section of the lymph node are T cells housed? Paracortex
Where can the paracortex be found within a lymph node? Between the follicles and medulla
The medulla of a lymph node contains sinuses and medullary cords. Which immune cells make up the cords? Packed lymphocytes and plasma cells
Lymph node follicles can be primary or secondary. Contrast the activity status of B cells in each follicle. Primary follicles are dormant, while secondary follicles are active germinal centers
Do lymph nodes generally have more afferent or efferent lymphatic vessels? Afferent; each lymph node usually has many afferent channels, w/one or more efferent vessels
Lymph nodes are encapsulated immune system organs. Their capsules extend to form what structure within lymph nodes? Trabeculae
A pt presents w/painful cervical lymphadenopathy. He asks you what lymph nodes do. What are their 3 functions? Nonspecific filtration of lymph by macrophages, B-cell & T-cell storage, & activation of immune responses
In which section of the lymph node do B cells localize & proliferate? Follicle
A lymph node has both primary & secondary follicles in its outer cortex. What is the difference between them? Primary: dense, dormant; secondary: pale germinal centers, active
Name the area surrounding a germinal center in a secondary follicle. Mantle zone
The medulla of the lymph node contains medullary cords and sinuses. What is the function of medullary sinuses? Communication w/efferent lymphatics; contain macrophages & reticular cells
The paracortex of a lymph node contains high endothelial venules. Which immune cells enter the lymph node through these vessels? T cells and B cells
A woman presents w/a severe viral upper respiratory infection. Which section of her cervical lymph nodes will be enlarged? Paracortex (enlarges in extreme cellular immune response, such as a viral infection)
A young boy w/DiGeorge syndrome has a viral illness. On physical exam, what size do you expect his lymph nodes to be? Abnormally small; the lymph node paracortex is underdeveloped in pts w/DiGeorge syndrome
Contrast the lymph drainage for the anal canal above and below the pectinate line. Internal iliac nodes drain above the pectinate line; superficial inguinal drain below the pectinate line
A pt is diagnosed with bilateral multilobar pneumonia. To which lymph node cluster would drainage flow? Hilar (lungs)
A 3 yo child is diagnosed w/strep pharyngitis. To which lymph node cluster would drainage flow? Cervical (head and neck)
A child w/Kawasaki disease will probably have significant lymphadenopathy of what area of the body? Cervical (head and neck)
Into which lymph node cluster do the trachea & esophagus drain? Mediastinal
In a granulomatous disease, such as sarcoidosis, what 2 lymph node regions will most likely be pathologically enlarged? Mediastinal and hilar
Into which lymph node cluster do the upper limbs & skin above the umbilicus drain? Axillary
A woman is diagnosed w/breast cancer. In determining the severity, which lymph node cluster should be examined? Axillary
Into which lymph node cluster do the stomach, upper duodenum, liver, spleen, & pancreas drain? Celiac
Into which lymph node cluster do the lower duodenum, jejunum, ileum, & part of the colon drain? Superior mesenteric
What areas of the body are drained by the superficial inguinal nodes? Vulva, anal canal below pectinate line, subumbilical skin, & scrotum
A man is diagnosed w/colon cancer at the transverse colon. To which lymph node cluster would drainage flow? Superior mesenteric (colon to splenic flexure)
A woman is diagnosed w/colon cancer at the sigmoid colon. To which lymph node cluster would drainage flow? Inferior mesenteric (colon from splenic flexure to the upper rectum)
A man is diagnosed w/colorectal carcinoma at the upper rectum. To which lymph node cluster would drainage flow? Inferior mesenteric (colon from splenic flexure to the upper rectum)
A man contracts typhoid fever from contaminated food. What group(s) of lymph nodes might exhibit pathologic involvement from his infection? Celiac, superior mesenteric, & inferior mesenteric
Into which lymph node cluster do the testes, ovaries, & uterus drain? Para-aortic
A young child is diagnosed w/pyelonephritis. To which lymph node cluster would drainage flow? Para-aortic
The bladder, middle 3rd of the vagina, cervix, prostate, & lower rectum drain into which group of lymph nodes? Internal Iliac
A screening CT scan of a man's abdomen & pelvis shows enlarged superficial inguinal lymph nodes. Is a genital exam warranted? Yes, superficial inguinal lymph nodes drain the scrotum; the anal canal & subumbilical skin should also be examined
A diabetic man develops cellulitis w/an abscess at the dorsolateral area of his right foot. Which lymph node cluster will collect drainage? Popliteal (posterior calf & dorsolateral foot)
A young man contracts lymphogranuloma venereum from unprotected sex. Which lymph node regions may exhibit pathologic involvement? Internal iliac & superficial inguinal; lymphogranuloma venereum is a sexually transmitted infection
A man's endoscopy reveals a duodenal tumor. Is screening of >1 lymph node territory required? Yes; because celiac lymph nodes drain upper duodenum & superior mesenteric lymph nodes drain lower duodenum, both should be investigated
A pt has thrombosis at the junction of the left subclavian and internal jugular veins. Where in the body will you see resultant lymphedema? Entire body except for right half above the diaphragm (drained by right lymphatic duct), as flow in the thoracic duct is probably impaired
A lactating mother is diagnosed w/right-sided mastitis. Which major lymphatic duct will carry drainage into venous circulation? Right lymphatic duct (drains the right side of the body above the diaphragm)
Where does the thoracic duct drain? The junction of the left internal jugular vein & the left subclavian vein
A 67 yo smoker presents with a diagnosis of primary lung cancer. What lymph node cluster is most likely to be enlarged? Hilar
After a pt undergoes splenectomy, there is ↓ C3b opsonization. This is caused by ↓ levels of which antibody? IgM
What is the function of the marginal zone in the spleen? Location for antigen-presenting cells (APCs) to capture antigens; antigens will later be recognized by lymphocytes
The white pulp of the spleen is split into 2 histologic sections. In which section can B cells be found? Follicles
A frozen section of the spleen is prepared after splenectomy. In which histologic section of the spleen are T and B cells found? White pulp
The white pulp of the spleen is split into 2 histologic sections. In which section can T cells be found? Peri-arteriolar lymphatic sheath (PALS)
The spleen can be found anterior to the left kidney in the LUQ of the abdomen. What numbered ribs protect the spleen? 9th–11th ribs
A frozen section of the spleen is prepared after splenectomy. In which histologic section of the spleen are long, vascular channels found? Red pulp (w/a fenestrated "barrel hoop" basement membrane)
In the spleen, APCs capture blood-borne antigens for later recognition by lymphocytes. In which histologic section does this occur? Marginal zone, between the red & white pulp; also houses specialized B cells
A pt is diagnosed w/Streptococcus pneumoniae. Which immune cells in the spleen work to remove streptococci? Macrophages near the sinusoids of the spleen eliminate encapsulated bacteria
A pt w/sickle cell disease becomes susceptible to meningococcemia. What is the most likely cause? Splenic dysfunction: ↓ IgM, ↓ complement activation, ↓ C3b opsonization → higher susceptibility to encapsulated organisms
A pt undergoes splenectomy after a motor vehicle accident & subsequent splenic laceration. To which bacteria is the pt most susceptible? Encapsulated organisms (pneumococcus, Hib, meningococcus)
A CBC reveals thrombocytosis & lymphocytosis. Peripheral blood smear reveals nuclear remnants & target cells. Most likely cause? Splenectomy; nuclear remnants are probably Howell-Jolly bodies
What is the mechanism of action underlying the hematologic thrombocytosis & lymphocytosis seen after splenectomy? Loss of sequestration & removal in the spleen
A 35 yo woman has progressive weakness of the ocular muscles and extremities, especially at night. Which mediastinal organ may be enlarged? Thymus (can be enlarged in myasthenia gravis)
An infant has a hypoplastic thymus. Which immunodeficiencies are the most likely causes? DiGeorge syndrome and severe combined immunodeficiency (SCID)
In what region of the mediastinum is the thymus found? Anterior superior mediastinum
What is the function of the thymus? The thymus is the primary site of T-cell differentiation and maturation
Which pharyngeal pouch is the thymus derived from? Third (the thymus)
Which histologic section of the thymus holds immature T cells? Cortex (dense w/immature T cells)
The thymus is the site of T-cell maturation. Which histologic section of the organ holds mature T cells and epithelial reticular cells? Medulla (pale w/Hassall corpuscles containing epithelial reticular cells)
A pt is diagnosed w/a thymoma. What 2 disorders are associated w/this benign tumor? Superior vena cava syndrome and myasthenia gravis
What is the contour of the neonatal thymus on CXR (see image) "Sail-shaped," thymus involutes w/age
What are the 2 primary immune system organs? Bone marrow and thymus
Bone marrow is a primary immune system organ. What is its function? Bone marrow produces immune cells and matures B cells
The thymus is a primary immune system organ. What is its function? Thymus matures T cells
What are the 4 secondary immune system organs? Spleen, lymph nodes, tonsils, & Peyer patches
What is the function of secondary immune system organs (ie, spleen, tonsils, lymph nodes, Peyer patches)? They are the sites of immune cells' interaction w/antigens
How does the adaptive immune response differ during 1st and 2nd exposures to an antigen? Adaptive immunity is slow to develop on 1st exposure but fast on any subsequent exposures
Through which mechanism does the adaptive immune system develop a highly specific defense against pathogens? V(D)J recombination during lymphocyte development results in variation; hence, microbial resistance is not inherited
A girl's innate immune system responds to bacteria. Which receptors are activated, and which molecular patterns do they look for? TLRs are activated and look for bacterial pathogen-associated molecular patterns (PAMPs) such as LPS and flagellin
What is the benefit of germline-encoded target antigen recognition of the innate immune system? It allows innate immunity to be both fast and nonspecific; however, resistance is heritable
What are the 3 components responsible for adaptive immunity? T cells, B cells, & circulating antibodies
On the 1st day of a viral infection, a girl has ↑ neutrophils & fever resulting from what property of this arm of the immune response? The innate immune system is responsible for the initial response to a pathogen; its cell receptors are germline encoded & nonspecific
A pt has elevated lysozymes, complement, CRP, & defensins. Which arm of the immune system is probably involved? Innate immunity
A boy's innate immune system responds to a virus. Which receptors are activated, & which molecular patterns do they look for? TLRs are activated; they look for viral pathogen-associated molecular patterns (PAMPs), such as nucleic acids
Toll-like receptor (TLR) activation via pathogen-associated molecular patterns (PAMPs) leads to activation of what cellular protein complex? NF-κB, which functions as a transcription factor
A man who had childhood measles develops no disease despite repeat exposure. How does this response work? Memory B and T cells are activated in the adaptive immune response & release immunoglobulins targeting the measles virus
Name the various components of the innate immune system. Neutrophils, monocytes, macrophages, dendritic cells, natural killer cells, complement, secreted enzymes, epithelial barriers
A hospital receives a set amount of money per service rendered. The money is then divided among all providers. What payment model is this? Bundled payment; regardless of ultimate cost, the money must be divided among all providers/facilities involved
A pt's physician receives a set payment in 1 yr regardless of how many times the pt visits the hospital. What payment model is this? Capitation, which is generally used by some HMOs
A 42 yo pt pays for each individual healthcare service he receives, albeit at a discounted price. What payment model is this? Discounted fee-for-service
A 65 yo woman pays for every individual service she receives from her PCP. What type of payment model is this? Fee-for-service; the pt pays for each individual service
A 56 yo pt undergoes elective surgery. He pays for all pre- and post-op care expenses through a single payment. What payment model is this? Global payment
A 67 yo pt with Medicare gets all of her health care at a private HMO. What part of Medicare does she have? People with Medicare Part C get hospital care and basic medical treatment from approved private companies
A 45 yo unemployed homeless man with diabetes asks what insurance he can get. What is the most appropriate response? Medicaid is for people with limited income and/or resources; it is funded by the state and federal governments
A 45 yo woman with ESRD has Medicare and is hospitalized for pneumonia. Which part of Medicare covers her hospitalization? Part A: hospitAl/hospice; the others: B: Basic medical bills, C: delivery of parts A+B (Combo) by private Companies, D: prescription Drugs
Which part of Medicare covers prescription drugs? Part D
A 71 yo pt presents for his 3-mo diabetes checkup. What part of Medicare covers this visit? Medicare Part B covers basic medical bills such as doctor's fees and diagnostic testing
An 83 yo man is hospitalized with a COPD exacerbation. What part of Medicare covers his hospitalization? Medicare Part A covers hospitalizations; also covers home hospice care
A 73 yo uninsured man presents with low back pain. For what type of health insurance is he eligible? MedicarE is for the Elderly (over 65), those under 65 with certain disabilities, and those with end-stage renal disease
Name the type of insurance, created from amendments to the Social Security Act, that is available to a 70 yo woman. Medicare
A homeless man with no income presents with swelling of his right foot. For what type of health insurance is he eligible? He is eligible for Medicaid (MedicaiD is for the Destitute)
For which type of government-funded insurance are pts undergoing dialysis eligible? Medicare is for people 65 or older and for people with certain disabilities, such as end-stage renal disease
What are the names of the 2 federal social healthcare programs that originated from amendments to the Social Security Act? Medicare and Medicaid
Which insurance is a joint federal and state health assistance program for people with limited income/resources? Medicaid
A 92 yo terminally ill pt has a life expectancy of <6 mo. What type of care is appropriate for this pt? Hospice care
What is the principle of double effect? In hospice care, the pt's comfort and pain relief supercede adverse side effects of treatment
What health insurance programs are available for pts in hospice care? Medicare, Medicaid, and most private health insurance plans
What is the maximum life expectancy someone may have and still qualify for hospice services? 6 mo
Which type of medical care focuses on providing comfort and palliation instead of a definitive cure? Hospice care
In an effort to improve pt comfort/pain during hospice care, what medications can be administered? Opioids, sedatives, and anxiolytic medications are often used during end-of-life care
What are the top 3 causes of death in children <1 year of age? Congenital malformations, preterm birth, and SIDS
What are the top 3 causes of death in children aged 1 to 14 years? Unintentional injury, cancer, and congenital malformations
What are the top 3 causes of death in people aged 15 to 34 years? Unintentional injury, suicide, and homicide
What are the top 3 causes of death in people aged 35 to 44 years? Unintentional injury, cancer, and heart disease
What are the top 3 causes of death in people aged 45 to 64 years? Cancer, heart disease, and unintentional injury
What are the top 3 causes of death in people 65+ years of age? Heart disease, cancer, and chronic respiratory disease
Which organizations do not require referral from a PCP to see a specialist? Exclusive provider organizations and preferred provider organizations
Which organizations require referral from a PCP to see a specialist? Health maintenance organizations and point of service plans
In which organizations are pts restricted to a limited panel of providers and hospitals? Exclusive provider organizations and health maintenance organizations; except in emergencies
In which organizations are pts not restricted to a limited panel of providers and hospitals? Point of service plans and preferred provider organizations
Give 1 common drawback of point of service and preferred provider organization insurance plans. They both have higher copays and deductibles for services
In a health maintenance organization, describe the limitations (if any) related to seeing providers outside of the network. Except in emergencies, pts are restricted to a limited panel of providers who are in the network
What important criterion must be met for all services rendered within a health maintenance organization? All services must meet established, evidence-based guidelines, or they will be denied
In a point of service medical insurance plan, describe the limitations (if any) related to seeing providers outside of the network. Pts may see providers outside of the network, but will incur higher costs (eg, copays, deductibles, out-of-pocket expenses)
In a preferred provider organization, describe the limitations (if any) related to seeing providers outside of the network. No limitations; all services have equally higher copays and deductibles
In an exclusive provider organization, describe the limitations (if any) related to seeing providers outside of the network. Except in emergencies, pts are restricted to a limited panel of doctors, specialists, and hospitals
A 65-year-old woman pays for every individual service she receives from her primary care provider. What type of payment model is this? Fee-for-service; the patient pays for each service received
A 56-year-old patient undergoes elective surgery. He pays for all pre- and post-op care expenses with a single payment. What payment model is this? Global payment
A patient's physician receives a set payment in 1 year regardless of how many times the patient visits the hospital. What payment model is this? Capitation, which is generally used by some health maintenance organizations (HMOs)
A 42-year-old patient pays for each healthcare service he receives, albeit at a discounted price. What payment model is this? Discounted fee-for-service
A hospital receives a set amount of money per service rendered. The money is then divided among all providers. What payment model is this? Bundled payment; regardless of final cost, the money must be divided among all providers/facilities involved
Generally speaking, how can readmissions to the hospital be reduced? Discharge planning and outpatient follow-up appointments
Mood disorders, alcohol disorders, and diabetes mellitus with complications are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? Uninsured patients
Maintenance of chemo/radiotherapy, mood disorders, and complications of care are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? Private insurance patients
Mood disorders, schizophrenia/psychotic disorders, and diabetes mellitus with complications are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? Medicaid patients
Congestive heart failure, septicemia, and pneumonia are the top 3 diagnoses for readmission in which insured (or uninsured) patient group? Medicare patients
A patient is admitted for wound infection 7 days after discharge following laparoscopic cholecystectomy. Is this considered a readmission? Yes; readmission is rehospitalization for any reason within 30 days of the original admission
Created by: 6stars2019