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Immune System Outlin
Clinical Medicine II
| Question | Answer |
|---|---|
| Three functions of the immune system | protection from foreign substances, tumor surveillances, self recognition |
| What are tissue components to immune system | bone marrow, thymus, lymph nodes, spleen |
| Cellular components to immune system | leukocytes, marcrophages, antigen presenting cells |
| Proteins involved in the immune system | immunoglobulins , complement proteins |
| Two types of immunity | humoral and cellular |
| Parts of humoral immunity | B cells→ plasma cells→ abs |
| Types of celluar immunity | T cells: cytotoxic, activate phagocytes, direct humoral immune response |
| Types of congenital defects | B,T or combined defects |
| Types of acquired immune def | Human immunodeficiency, malignancy(Cll, lymphoma, myeloma), chemo, radiation |
| 3 functions of the spleen | Hematopoiesis, filtering, immune defense |
| Do we need the spleen | important organ but can live w/o it |
| Major site of hematopoiesis during fetal life | spleen, mostly during the second trimester |
| How does the cell “kill” foreign cells as blood trickles through it | Very acidic, ↓glucose, ↓ o2 |
| What are howell-jolly bodies | w/ removal of spleen, RBC have reminents of its nucleus that the spleen normally removes |
| What are Heinz bodies | insoluble globin proteins within RBC’s d/t no spleen |
| Functions for immune defense of the spleen | 25% lymphoid mass, 50% total ab producing B cells-clear bacteria from circulation |
| What is the spleen especially good at | removing encapsulated bacteria like S. peumo, H.flu, and N. meningitides |
| What type of organ is the spleen | lymphoid organ, largest one being 25% lymphoid material |
| What is a spleen enlarged | when you can feel it |
| What causes splenomegaly | liver dz, hematolgic malignancy, infx, congestion/inflammation, 1 splenic dz |
| Causes massive splenomegaly | CML myelofibrosis, gaucher dz, lymphoma, parasitic infx, thalassemia |
| Indications for splenectomy | clinical infxs, diagnostic, therapeutic |
| Can we biopsy the spleen | not usually good candidate, leaky jelly like supstance, will leak post biopsy |
| Consequences of splenectomy | leukocytosis: 10-15, thrombocytosis, Howell-jolly bodies, infx risk |
| Nuclear remnants in RBC | howell-jolly bodies |
| Huge complication of a splenectomy | splenectomy sepsis w/I 3 years of splenectomy ~5% lifetime risk |
| What is PSS commonly caused by | Strep pneumo, H. flu, N. meningitides |
| How do we prevent PSS | those 3 vaccines for those bugs 2 weeks before, prior to splenectomy, but can get vaccines at any time and an annual influenza vaccine |
| Who do we prophalactically treat to prevent PSS | kids until age 5 (pen or amoxicillin) or 3 years after, highly immunocomprimised adults, adult survivers of pneumococcal PSS |
| When do we give empiric abx | if no spleen, give abx for febrile illnesses 7-10days |
| 5 types of WBCs | neutrophils, lymphocytes, monocytes, eosinophils, basophils |
| Polymorphoncuclear cells (PMNs) | Neutrophils, 45-75% all WBC |
| Fxns of Neutrophils | find, ingest, kill invading microganisms (creates pus) |
| What ↑ neutrophil count | bacterial infx, physiologic stress, corticosteroids |
| What ↓ neutrophil count | viral infx, drugs/toxins, some bacterial infxns: brucella |
| When do we compaire ↑ vs ↓ neutrophil count | CBC w/ diff, look at the percentage |
| ANC, levels that create risk | absolute neutrophil count nl >1500, sig risk 100-500, great risk <100 |
| What cells are primary for generating the immune response | lymphocytes: B, T and NK cells 20-45% all white cells |
| What are signs for most viral infections | lymphocytosis |
| Where are lymphocytes | circulating in blood and in lymphoid tissue: lymph nodes, spleen |
| Where does differentiation of B lymphocytes occur and maturation | D: in bone marrow, M: in llymphoid tissues |
| Functions of B lymphocytes | synthesize immunoglobulins (abs) |
| MC lymphocyte and location of them and types | T lymphocytes, Helper T (CD4) Cytotoxic suppressor (CD8) 60-85% |
| Fxn of Helper T cells | regulators of immune sys, influence production of abs by B cells |
| Fxn of cytotoxic suppressor T cesll | recognize kill virus, ↓ regulate ab production by B cells |
| What are natural killer cells (NK) | large lymphocytes w/ small number of granules important in preventing growth and spread of tumors |
| When do we see monocytosis | chronic infx: TB, lymphomas, granulomatous dz like sarcoid |
| Fxns of monocytes | phagocytize and kill microorganisms |
| What is significant when monocytes are highly fxns | secrete cytokines that induce fever and inflammation |
| What are 4 things that cause ↑ eosinophilic | invasive parasitic dz, chronic inflammatory skin d/o, hypersensitivity states (allergies, vasculitis), certain malignancies (Hodgkins lymphoma) |
| Problem w/ eosinophils | chronic infiltatrion can cause organ damage by release of granular contents |
| When do basophils come into action | in allergic d/o’s and myeloproliferative dz (CML, Polycythemia vera) |
| What do basophils differentiate into | mast cells |
| What signals for basophils | IgE causes histamine release |
| Causes for leukopenia and leukocytosis | know it pg 7 |
| When would we call a hematologist or just recheck it | call 0-2,000 2,000-4,000 usually recheck it |
| What does lymphocytosis signify | viral infx (usually ↓ neutorphils) |
| What is leukemia | cancer of the blood and bone marrow |
| What are the two types of leukemia | acute: block in differentiation of immature WBC: rapid, dead days-wks, Chronic: excess proliferation of more mature WBCm insidious,survive yrs even if untreated |
| Initial presentation of non | specific |
| Abno CBC examples | pancytopenia, marked leukocytosis |
| Leukemia classifications | acute vs. chronic, myeloid vs. lymphoid |
| Excess proliferation of a nl WBC | chornic leukemia, still fxns nl but way more than there should be, ex CLL or CML |
| Block in differenctiation of immature WBC’s | Acute leukemia, can’t make nl RBCs death fast |
| 4 types of leukemia and MC | ALL CLL AML CML MC is CLL hight dealths AML |
| MC types is young kids, and Old ppl | Y: ALL, Old: AML, CML |
| How to tell b/w acute and chronic | acute: sxs fast, chronic slow and often diagnosis is mistaken CBC |
| Tx for leukemia | Chemo, stem cell trx, prognosis varies widely |
| 3 phases of Acute leukemia | chemo, induction, consolidation, maintenance |
| Highly curable in kids w/ chemo | ALL |
| Not curable ~10% in adults need bone marrow trx cure | ALL |
| Seen rarely in kids, mostly young/middle aged adults, tx | CML tx: |
| What is Gleevec | in CML Philidelphia chromosome croses: 9 and 22→BCR protein→rapid proliferation, gleevec stops this BCR protein |
| Common lymph nodes you can feel and nl size | cervical, supraclavicular, axillary, inguinal nl: 1cm |
| Soft, tender mobile lymph node | often infx/inflammation |
| Firm, rubbery, mobile lymph node | lymphoma |
| Hard, fixed, non-tender | carcinoma |
| Cancer of the lymphoid tissues | lymphoma |
| Which is more common HL or NHL | NHL |
| Dx of lymphoma | CBC renal and LFTs, coags, LDH, peripheral blood immunophenotyping, CT< MRI, PET, biopsy |
| Nodes on both sides of diaphragm | stage iii |
| 1 node group | stage I |
| Marrow or other extranodal site | Stabe IV |
| >1node gropu, same side of diaphragm | stage II |
| What does A or B staging of lymphoma | B + for fever, night, sweats, wt loss |
| CT scans for internal lymph nodes | eyes to thighs |
| Tx for lymphoma | chemo, radioation, stem cell tx |
| Excess production of gamma globulin protein by a single clone of B cells/plasma cells | monoclonal gammopathy |
| MGUS | monoclonal gammopathy of underteerminded significance |
| Why is MGUS so important! | 10-20% develop myeloma but can take more than 10 years |
| How dx MGUS | monoclonal paraprotein band less than 30 g/L (< 3g/dL); |
| Malignant proliferation of plasma cells | multiple myeloma |
| Where is MM seen more often | AF’s and rare in Asians |
| What are clinical manifestations of MM | monoclonal protein (causein renal failure, hyperviscosity,amyloidosis, lytic bone lesions causing bone pain, pathologic frx, hypercalcemia, anemia and infections |
| Major criteria for MM | plasmacytoma, >30% plasma cells in bone marrow, serum M-smike, Urine M-smike |
| Minor criteria for MM | 10-29% plasma cells, smaller M-smike, lytic bone lesions, ↓ immunoglobulin levels |
| How do we dx MM | 1 major + 1 minor or 3 minor |
| Tx MM | chemo effective, not dcurative, survival 2.5-3 yrs w/ chemo |
Created by:
becker15
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