PHLT 304 Exam 3 with correct answers 2024

Functions of kidneys - answer-- Maintenance of body fluids and salt levels - Excretion of wastes and foreign particles - Hormone synthesis Renin - answer-angiotensin system: controls water and salt reabsorption by kidneys; regulates blood pressure (BP) Erythropoietin - answer-produced by kidneys in response to tissue hypoxia; stimulates production of blood cells Kidneys participate in conversion of vitamin D - answer-a prehormone from diet (or skin synthesis) to the active form of vitamin D (calcitriol) needed in the body Hypoxia - answer-oxygen deficiency Nephron - answer-unit of filtration in the kidney Average # of nephrons per kidney - answer-= 900,000 to 1 million; range is approx. 200,000 - 2.5 million per kidney Uremia - answer-accumulation of toxic constituents in the blood; usually occurs with severe kidney disease Chronic Kidney Disease (CKD) - answer-Permanent damage to the kidneys causing them to function at less than normal Potential Complications of CKD - answer-- high blood pressure - heart disease (#1 killer in patients with CKD) - Weak Bones - Anemia - Poor Nutrition Symptoms of chronic kidney disease - answer-- Fatigue, tiredness - Insomnia, sleep apnea - Chronic pain - Encephalopathy, dementia - Anorexia, edema, interdialytic weight gain - Decreased libido, infertility - Cognitive problems Stages of Chronic Kidney Disease (CKD) - answer-- Stage 1: Below normal to mild loss of kidney function - Stage 2: Mild to moderate loss of kidney function - Stage 3: Moderate to severe loss of kidney function - Stage 4: Severe loss of kidney function - Stage 5: Kidney failure - Dialysis Causes of kidney disease - answer-- many commonly used drugs are nephrotoxic (toxic to the kidneys), including certain analgesics, antidepressants, antihistamines, antimicrobials, benzodiazepines, cardiovascular agents, proton pump inhibitors, diuretics, herbal products, and drugs of abuse. - Drugs can be an important cause of acute renal failure, particularly among older adults who have co-morbidities and take multiple medications What are the most important causes of kidney disease? - answer-- Diabetes - High blood pressure Risk factors of kidney disease - answer-- Diabetes - High blood pressure - Heart disease - Obesity - Family history of CKD - Age 60 and older - Overuse of pain medicines (e.g., aspirin, naproxen, ibuprofen) - Overuse of alcohol - Use of street drugs (cocaine, heroin, amphetamines) Dietary protein - answer-- Recommended daily allowance for dietary protein: 0.83 g per kg of ideal body weight per day - High protein diet: more than approx. 1.2 - 1.5 g/kg per day - Current average protein intake in the U.S. (NHANES data) is 1.2-1.4 g/kg per day Effects of a high protein diet on kidney health (currently being studied) - answer-- High dietary protein intake can cause hypertension in the glomerulus - Patients with CKD or high risk for CKD may experience harm to the kidneys from high protein intake - Long-term high protein intake may lead to CKD in previously healthy individuals (currently under study) Prevention of kidney disease - answer-- Manage diabetes - Lower high blood pressure - Stop smoking & minimize exposure to secondhand smoke • Smoking can affect medicines that treat high blood pressure • Smoking slows blood flow to the kidneys and can make kidney disease worse - Stay hydrated • Urine should be light yellow or colorless - Eat a healthy diet, exercise & manage your weight - Reduce salt intake: high sodium increases blood pressure - Don't overuse NSAIDs & drugs that affect the kidneys Blood pressure - answer-the force of blood pushing against blood vessel walls as the heart pumps out blood Blood pressure and your kidneys - answer-- Hypertension is both an important cause and a consequence of chronic kidney disease - Approx. 10% of US has CKD - Over 300,000 end stage renal disease (ESRD) cases in US - Predominantly people in oldest quartile Hypertension - answer-- High blood pressure - Affects 60 million Americans - Blood pressure is related to the amount and size of the blood vessels and resistance within and around the vessels • Hypertension medications decrease pressure and change blood flow and resistance to lower BP Systolic blood pressure - answer-- Top number - Pressure through arteries when heart contracts Diastolic blood pressure - answer-- Bottom number - Pressure through arteries between contractions Normal blood pressure - answer-120/80 mmHg Hypertensive blood pressure - answer-140/90 mmHg Renal failure - answer-loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance What is one of the most common causes of drug-induced renal injury? - answer-widespread use of NSAIDs Kidney stones - answer-- Solid crystalline masses formed in the kidney, resulting from an excess of insoluble salts or uric acid crystallizing in the urine; may become trapped anywhere along the urinary tract. - Form with high levels of certain minerals in urine Kidney stones symptoms - answer-- Sharp pain in back, side, groin or lower abdomen - If stone is very small: may not have symptoms Kidney stones treatment - answer-- medical care to break up and/or remove stones - sonication Types of Kidney stones - answer-- Calcium oxalate - Calcium - Phosphate - Uric Acid - Struvite - Cystine Tips from the national kidney foundation - answer-- Hydrate with plenty of water - To prevent calcium oxalate stones: Pair oxalate-rich foods (e.g., peanuts, spinach, beets, chocolate, sweet potatoes) with calcium-rich foods in the same meal so they bind in stomach and intestines before kidneys - Reduce sodium - To prevent uric acid stones: Limit red meat, shellfish, alcohol, sugar Macronutrients in the body - answer-- Macronutrients from food: protein, carbohydrates, fat - See circulating forms (in blood) - Brain needs continuous supply of glucose Insulin - answer-hormone secreted by beta cells of pancreas Maintenance of normal glucose levels 1 - answer-In a healthy person, insulin helps regulate blood sugar levels and store excess glucose for energy: After you eat, carbohydrates are converted to glucose, and the glucose enters the bloodstream -> pancreas then produces insulin -> insulin allows glucose to enter the body's cells to provide energy Maintenance of normal glucose levels 2 - answer-Insulin is released in response to higher blood glucose levels, and it lowers blood sugar by: - Increasing glucose uptake by muscles - Increases conversion of glucose to glycogen (glycogenesis) - Suppresses glycogenolysis and gluconeogenesis (conversion of glycogen or amino acids to glucose) - Suppresses lipolysis (breaking down stored fat for fuel) Glucagon helps maintain blood glucose levels between meals: - secreted by alpha cells of pancreas in response to low blood sugar - Stimulates glycogenolysis in liver -> causes a rise in blood glucose, keeping blood sugar levels within the appropriate range Maintenance of normal glucose levels 3 - answer-If blood sugar is too high: - Insulin secretion -> glycogenesis in liver converts glucose to glycogen If blood glucose drops too low: - Glucagon secretion -> glycogenolysis in liver breaks down glycogen to glucose and releases glucose to blood - Gluconeogenesis: conversion of amino acids to glucose the brain needs continuous supply of ? - answer-glucose glycogenesis - answer-liver converts glucose to glycogen if blood glucose drops too low .... Glycogenolysis in liver breaks down glycogen to glucose and releases this where ? - answer-into the blood gluconeogenesis - answer-conversion of amino acids to glucose glucagon is secreted by - answer-alpha cells of pancreas glucagon is released in response to - answer-low blood sugar glucagon function - answer-Stimulates glycogenolysis, causing an increase in blood glucose and free fatty acids Type 1 Diabetes - answer-autoimmune disease; deficiency in production and secretion of insulin Insulin is secreted by - answer-beta cells of pancreas insulin is released in response to ? - answer-higher blood glucose levels insulin lowers blood sugar by: - answer-- increasing glucose uptake by muscles - increases conversion of glucose to glycogen(glycogenesis) - suppresses glycogenolysis and gluconeogenesis (conversion of glycogen or amino acids to glucose) -suppresses lipolysis (breaking down stored fat for fuel) hyperglycemic - answer-high blood sugar hypoglycemic - answer-low blood sugar Type 1 Diabetes mellitus (T1DM) - answer-- was called juvenile diabetes - insulin deficiency due to loss of pancreatic islet - Beta cells - loss of beta cells due to autoimmunity in 70-90% of patients - remainder of cases, cause of beta cell destruction not known - idiopathic --> has strong genetic component - generally leads to absolute insulin deficiency - no prevention - no cure what % of people with diabetes have type 1? - answer-~5-10% is the incidence of type 1 diabetes increasing worldwide? - answer-Yes - type 1 diabetes incidence rate varies between countries --> highest in Scandinavia, less common in Europe, North America and Australia; least common in Asia Management of Type 1 Diabetes - answer-- taking insulin - carb, fat, and protein counting - frequent blood sugar monitoring - eating healthy foods - exercising regularly and maintaining a healthy weight without insulin, glucose builds up where? - answer-in the bloodstream Precursor to type 2 diabetes - answer-insulin resistance Type 2 Diabetes - answer-- fasting plasma glucose 126 mg/dl or higher - lifestyle disease, reduced insulin sensitivity in target tissue - mostly muscle, fat, and liver - body doesn't make enough insulin or doesn't use insulin well - Too much glucose stays in the blood and not enough reaches the cells insulin resistance - answer-- muscle, fat, and liver cells don't respond well to insulin & can't easily take up glucose from blood - Pancreas produces more insulin to help glucose enter cells - Blood glucose levels remain healthy as long as there is enough insulin to overcome the cells' weak response to insulin - if liver becomes fatty, it doesn't respond well to insulin signals to shut down glucose production - excess fuel can cause fatty tissue deposits in muscle, interfering with insulin - insulin resistance is NOT a shortage of insulin; instead, cells don't respond properly to insulin pre-diabetes - answer-- fasting plasma glucose between 100 - 125 mg/dl - blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes how many people in the US have pre-diabetes? - answer-88 million (over 1 in 3 people); 84% of people don't know they have it Risk factors for type 2 diabetes: - answer-- age >56 - family history - overweight/obese - low physical activity - hypertension - gestational diabetes - diet - smoking - medication side effects Diet: WHO Recommended limits on sugar intake - answer-- WHO Guideline: reduce daily intake of free sugars to < 10% of total energy intake; says < 5% would provide additional health benefits - GOAL: stop the increase in obesity, diabetes, and chronic disease Free sugars - answer-- sugars added to foods & drinks (e.g., glucose, fructose, table sugar) - Sugars naturally present in honey, syrups, fruit juices, & fruit juice concentrates NOT Free sugars - answer-sugars naturally present in fresh fruits, vegetables, and milk gestational diabetes - answer-- during pregnancy, hormonal changes can decrease the body's sensitivity to the effect of insulin - can lead to type 2 diabetes - more common in overweight mothers - loss of vision - risk to child - Usually goes away after delivery (if doesn't go away, then it is called Type 2 diabetes) - Half of women who had gestational diabetes develop Type 2 diabetes later epinephrine is stimulated by - answer-immediate stress and exercise functions of epinephrine - answer-- suppresses insulin secretion - promotes glucagon secretion increases circulating levels of glucose and fatty acids by: - increasing glycogenolysis - increasing gluconeogenesis - increasing fat mobilization cortisol is stimulated by - answer-chronic stress effects of cortisol are similar to those of? - answer-epinephrine; increases circulating levels of substrates (fuel); ensures the mobilization of fuels for the body stress hormones function as ______________hormones - answer-anti- insulin hormones; buildup of fuel in the cells subsistence efficiency ration (SER) - answer-food intake compared to calories expended in physical activity - paleolithic times: ratio was ~3:1 - now: ratio is ~7:1 - more food + less activity --> more substrate (fuel) in cells --> precursor to metabolic dysregulation in cells consequences of too much fuel in cells - answer-- increased production of reactive oxygen species that is implicated in development of type 2 diabetes - accumulation of visceral (deep abdominal fat) around the organs - this fat is very metabolically active - insulin resistance As of 2015, how many people globally have diabetes? - answer-> 415 million Countries with highest numbers of diabetes - answer-- Highest prevalence: Pacific Islands, Middle East - Largest number: China, India rule of halves - answer-- diagnosis - care - make targets - achieve goals how to reduce risk of type 2 diabetes - answer-- change in eating habits - weight loss - increase physical activity ( makes you more sensitive to insulin) - reduce stress - sleep - healthy diet Infertility - answer-Not able to get pregnant or stay pregnant after 1 year (up to age 35) Risk factors for infertility - answer-- Age - Chemical exposure including tobacco, alcohol, certain medications - Stress - Chronic disease: diabetes, heart disease, obesity, high blood pressure, autoimmune disorders _____% of men and ____% of women of reproductive age in the US have experienced fertility problems - answer-9% of men and 11% of women Rates of involuntary pregnancy loss - answer-Hard to assess approx. what % of conceptions do not result in successful birth (not including intentional abortions) - answer-40-60% what % of known pregnancies end in miscarriage (loss before 20th week of pregnancy) - answer-10-15% approx. what % of pregnancies end in stillbirth - answer-1% miscarriages are also called - answer-spontaneous abortions definition of miscarriage - answer-demise of a pregnancy without medical or mechanical assistance rate of miscarried fetuses that have chromosomal abnormalities - answer-~2/3 in regards to miscarriages, data shows an inverse relationship between increased _______ _____ and the _____________________________________ - answer-gestational age and the relative risk of spontaneous abortion what % of miscarriages occur before 12 weeks' gestation - answer-80% spontaneous abortions in the first 2 weeks are attributed to ______ - answer-unsuccessful embryo implantation or chromosomal abnormalities advanced maternal age - answer-35 being an older pregnant woman increases the chance for a baby to have what disorder? - answer-down syndrome older fathers have several issues including... - answer-- Higher sperm mutation rate - Increased risk of schizophrenia - Increased risk of bipolar disorder why plan ahead during pregnancy? - answer-to help ensure your baby has good health examples of planning ahead during pregnancy - answer-- taking prenatal vitamins - healthy diet why is folic acid good for the baby? - answer-prevents neural tube defects neural tube defects - answer-- failure of neural tube closure by week 4 (day 28 after conception); often occurs before mother knows she is pregnant - ex: of a neural tube defect - spina bifida how long is pregnancy? - answer-- 40 weeks! - begin the count for the first day of your last period - end at the birth How many trimesters are in a pregnancy? - answer-3 trimesters 1st trimester - answer-1-12 weeks 2nd trimester - answer-13-28 weeks 3rd trimester - answer-29-40 weeks prenatal - answer-occurring, existing, or performed before birth Getting prenatal care is ________ - answer-essential 1st doctor's visit during pregnancy - answer-- Review medical history/pre-existing conditions - Screening recommendations - Medications/exposures • Healthy lifestyle --> what would this look like? Prenatal check ups schedule - answer-- weeks 4 to 28: every 4 weeks (once a month) - weeks 28 to 36: every 2 weeks (twice a month) - weeks 36 to birth: every week examples of factors that can complicate pregnancy - answer-- Asthma - Eating disorders - Epilepsy - Migraine - Heart disease - High blood pressure - Kidney problems - Autoimmune disorders - Overweight/obese - Nicotine use - STIs - Thyroid disease - Uterine fibroids - Diabetes - Cancer - Polycystic ovary syndrome - type of hormonal imbalance - HIV TORCHH infections - answer-- Toxoplasmosis - Rubella - Cytomegalovirus - Herpes Simplex - HIV listeriosis - answer-- food borne illness - some cheeses carry listeria (a rare but deadly germ) - listeria infection in pregnant women can cause miscarriage, stillbirth, or death of the newborn the pregnant woman's immune system is weaker so she should avoid - answer-- Recalled foods - Raw sprouts - Raw seafood - Unpasteurized milk, juice, cider - Soft cheeses & raw milk cheeses - Soft-serve ice cream - Pre-made meat or seafood salad, meat spreads - Undercooked or raw eggs - Smoked seafood - Hot dogs, lunch meat Syphilis during pregnancy - answer-- can be fatal to fetus or newborn - Recommendation: test all women during pregnancy; treatment is available - syphilis in newborns is on the rise in the US - mainly in southern states preventable infections during pregnancy: - answer-- Hepatitis B (HBV): get tested; vaccinate - Influenza: vaccinate - Zika virus: can cause severe fetal brain defects - Don't travel to areas with Zika - Use condoms if your partner has lived in or traveled to an area with Zika chemical exposures during pregnancy - answer-- Environmental exposures, e.g.: • Mercury • Lead • Excess Vitamin A (e.g. in skin treatments) - affects molecular signaling --> birth defects exposure to lead can seriously harm a child's health ... - answer-- damage to the brain and nervous system - learning and behavior problems - slowed growth and development - hearing and speech problems - lower IQ - decreased ability to pay attention - underperformance in school a pregnant woman can be exposed to chemicals through ... - answer-- Pharmaceuticals - Lifestyle factors • Alcohol • Nicotine • Illegal drugs • Opioids - Neonatal abstinence syndrome • Born to mothers with drug dependence - Other chemical exposures, e.g., lead dust from sanding lead paint, pesticides, volatile chemicals in paint, etc chemical exposure: alcohol: FASD - answer-- fetal alcohol spectrum disorders (FASD) - 1% of births - no amount of alcohol is safe during pregnancy Alcohol: FASD: physical defects - answer-- Distinctive facial features - Small head circumference and brain size - Heart defects - Vision/hearing problems - Slow physical growth Alcohol: FASD: Brain and CNS problems - answer-- Intellectual disability - Learning disorders - Poor memory - Trouble identifying consequences of choices - Difficulty with problem solving and reasoning - Rapidly changing moods Alcohol: FASD: social/behavioral issues - answer-- Difficulty in school - Poor social skills - Trouble getting along with others - Difficulty planning or working toward a goal - Problems staying on task - Problems with behavior and impulse control chemical exposures: nicotine - answer-- Causes toxicity to the nervous system of the developing fetus - Animal studies suggest nicotine use during pregnancy plays a key role in offspring health effects including • type 2 diabetes • obesity • hypertension • neurobehavioral defects - Juul: what are the implications? - Cigarette smoking: associated in humans with miscarriage/stillbirth, placenta previa, pre-term birth, low birthweight, SIDS Timing of exposure - during pregnancy - answer-- When a body part is forming, it is most sensitive to disruption/ birth defects - Ex: defects in hamster caused by excess retinoic acid (metabolite of vitamin A) Pregnancy complications: gestational hypertension - answer-develops during pregnancy Pregnancy complications: preeclampsia - answer-- High blood pressure with protein in urine &/or edema after week 20 - Signs of damage to other organ(s) - Potentially fatal for mother and child - affects 4% of pregnancies in the US pregnancy complications: eclampsia - answer-- Preeclampsia + seizures/convulsions - More severe - May result in seizures and coma stillbirth - answer-- the birth of a fetus that died before, or during, the delivery - death in the womb after week 20 pregnancy complications: gestational diabetes - answer-- Seen in women who did not have diabetes before pregnancy - Affects 2-10% of pregnancies in US - Test for it at 24-28 weeks pregnancy - Increased risk for: • Large size of baby (more likely to need C-section) • High BP • Preeclampsia • 50% go on to have Type 2 diabetes pregnancy complications: risks, excess weight gain by mother - answer-- Baby too large - Obesity during childhood pregnancy complications: ectopic pregnancy - answer-implantation in the fallopian tube or outside uterus pregnancy complications: placental abruption - answer-placenta separates from uterine wall; fetus without enough oxygen/nutrients pregnancy complications: placenta previa - answer-3rd trimester bleeding, placenta covers the cervix; increases risk to baby & mother pregnancy complications: placenta accreta - answer-- placenta attaches too deeply into wall of uterus - Can cause severe blood loss Risk factors for placenta accreta - answer-- previous C-section - previous surgery on uterus (e.g., fibroids) - mother > 35 years - in vitro fertilization placenta accreta rates have _____ since the 1980s - answer-quadrupled risks of placenta accreta - answer-- severe maternal blood loss - blood transfusions - hysterectomy - death cesarean sections - answer-- Surgical delivery of child - Some C-sections are medically necessary - Approx. 9.6% of C-sections in US not necessary (Zhang et al., 2010 each c-section increases risk of - answer-- placenta previa - placenta accreta - gravid (related to pregnancy) hysterectomy maternal morbidity - answer-conditions that result from or are aggravated by pregnancy proposed contributing factors for increase in severe maternal morbidity - answer-- C-section deliveries - Increases in maternal age - Pre-existing chronic disease - Pre-pregnancy obesity most common severe maternal morbidity procedures - answer-- Blood transfusions - Hysterectomy - Ventilation/temporary tracheostomy leading causes of maternal mortality globally (WHO, deaths up to 42 days after end of pregnancy) - answer-- hemorrhage (27%) - hypertension in pregnancy (14%) - infection (11%) - Unsafe abortion (3%) leading causes of maternal mortality in the US (CDC; up to 1 year after pregnancy) - answer-- Heart conditions - Infection - Bleeding - Blood clots maternal mortality: contributing factors - answer-- Reason for increase is unclear - Contributing factor: Increasing chronic disease, e.g.: • Hypertension • Diabetes • Chronic heart disease maternal emotional health after birth - answer-- baby blues - postpartum depression baby blues - answer-worry, sadness, tiredness that usually resolves on its own within a few days postpartum depression - answer-- about 1 in 9 women in US - More intense and last longer than "baby blues" Risk factors : • Low social support • Difficulties with pregnancy • Mother of multiples (e.g., twins, triplets) pre-term birth - answer-- between 20- 37 completed weeks of gestation • increased risk of life-threatening complications, long-term problems, and developmental delays pregnancy weeks 37-39: - answer-significant lung, liver, and brain development Children born before 39 weeks of pregnancy have a _____ greater chance of death within the first year of life compared to babies born between 39 weeks and 41 weeks - answer-63% low birth weight - answer-- Low birth weight <2500 g - Very low birth weight <1500 g low birth weight causes - answer-- Pre-term birth - Intrauterine growth retardation (babies born full-term) low birth weight risk factors - answer-- Chemical exposures, e.g., smoking, alcohol, lead - Lack of maternal weight gain - Stress - Mother <15 years or >35 years - Hypertension low birth weight effects - answer-Increased risk of infant morbidity & mortality approx: _____ babies in US born with a birth defect - answer-1 in 33 babies most common birth defects - answer-heart defects, cleft lip and palate, Down syndrome, spina bifida Sudden Infancy Death Syndrome (SIDS) - answer-affects babies 1-12 months old potentially fatal childbirths is a problem especially for who? - answer-Black mothers Disparities in maternal health are prevalent for - answer-black women PRMR - answer-pregnancy related mortality ratio is unintentional injury a serious public health issue? - answer-yes what is the leading cause of death in people between the ages of 1 and 44? - answer-unintentional injury --> these are preventable and predictable most common causes of poisoning deaths: - answer-- misuse/abuse of drugs --> opioids, benzodiazepines - opioids, benzodiazepines both sedate users and suppress breathing --> overdose - carbon monoxide --> esp. people >65 and males - pesticides - usually unintentional exposure - esp. children under 6yrs and adults >20 years - child overdose, iron-containing vitamins - acetaminophen - Non-fatal poisonings: include improper exposure to cleaning agents (esp. mixing cleaners) & pesticides - Unintentional poisoning deaths for ages 15-64 benzodiazepines - answer-prescription sedatives, used for anxiety, insomnia; includes alprazolam (Xanax) and clonazepam (Klonopin), diazepam (Valium) what is carbon monoxide produced by? - answer-by incomplete combustion of hydrocarbons (i.e., gas, diesel, etc.) • Colorless, odorless, toxic • Dizziness, headache, nausea, vomiting • Disorientation, collapse, coma, death nearly _____ people died from an opioid overdose from - answer-450,000 natural opioids - answer-extracted from seed pods of certain types of poppy plants synthetic opioids - answer-synthesized in a lab; same mechanism of action in the body as natural opioids (includes fentanyl, which is common & about 100x more potent than morphine) Illicit fetanyl - answer-- llicitly manufactured fentanyl is cheap and potent, and is often mixed with other street drugs without buyers' knowledge (e.g., in counterfeit prescription drug pills, heroin, methamphetamine, cocaine, some reports - marijuana) - 2 mg fentanyl can be fatal - greatly increased risk of overdose - only take prescription drugs prescribed to you and dispensed by legitimate pharmacy Firearm deaths - answer-- 2018: 39,740 firearm deaths in USA • 24,432: suicides • 13,958 homicides • Highest rates of gun deaths: Mississippi, Alabama, Wyoming - 2015 • US deaths from gun violence: 11.2/100,000 population • Other high income countries 1/100,000 population - Dickey amendment, 1996 (federal): "none of the funds...at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control" - 2012: similar language, NIH funding - 2020: funding allocated for gun research what is the overall cause of nonfatal injuries treated in ER departments? - answer-unintentional falls Traumatic Brain Injuries (TBI) - answer-Traumatic brain injuries affect how the brain works; can be caused by: • Bump or blow to head • Penetrating injury (e.g., gunshot) Common causes of TBIs - answer-- Falls (approx. half of TBI-related hospitalizations) - Firearm-related injuries - Motor vehicle crashes - Assaults including domestic violence Willingness to accept risk - answer-- Actual risk vs. perceived risk are often very different - Voluntary vs. involuntary risk Ex: • Wearing masks (COVID) • Anti-vaxxers: why do they accept risk of vaccine-preventable diseases? • Tanning salons - why do people go? Youth safety - answer-- Motor vehicle accidents • distracted driving • unsafe car seat/booster seat use - Drowning - happens quickly and quietly • All kids should learn to swim • Even strong swimmers may drown - Falls - playground equipment, stairs, windows, lack of bike or rollerblading helmet, equipment that isn't age-appropriate - Burns - fires, also from hot water faucet, stove, microwaves, steam - Sports - heat injuries, concussions, etc. healing injuries: bleeding stops - answer-blood clotting healing injuries: inflammation - answer-response to fight potential infection and bring wound scaffolding healing injuries: collagen - answer-protein to build new tissue connections healing injuries: wound closure - answer-scab falls off healing injuries: internally the new tissue continues to heal - answer-- Tissue still molds - Scar changes - Final appearance may take 2 years internal injuries - answer-- more severe - higher mortality - less long term disability - contusion - laceration - necrosis - peritonitis - transection contusion - answer-bruising laceration - answer-cut necrosis - answer-tissue death peritonitis - answer-internal injury leading to infection and potential sepsis transection - answer-laceration that cuts organ into 2 pieces sepsis - answer-- chemicals released into the bloodstream to fight infection trigger inflammatory responses throughout the body - this inflammation can trigger a cascade of changes --> organ damage and failure age <1, what is the major injury? - answer-suffocation injury risk factors: gender - answer-After the age of 9 there is a nearly exponential increase in male injury over female injury - >65 age, females have more injuries, but males have more fatalities from injury injury risk factors: personality - answer-- Any gender can have risky behaviors - Sensation seeking - Refusal to wear protective gear - Aggressive behavior (sports, competition, other) injury risk factors: alcohol - answer-- Neurotoxin and depressant - Slows response times - Lowers cognition and inhibitions - The cause of at least 30% of ER visits - Many fatalities - 1/3 of car crashes - ½ of drownings - Associated with assault (both perpetrator and victim) The Haddon Matrix - answer-helps identify all factors associated with an injury/death • This allows us to think of potential places to control or stop unintentional injuries • This one is for a car crash, but they can be adapted to other incidents according to the CDC, there is no concussion-proof helmet - answer-true heat injuries: heat exhaustion - answer-- Muscle cramping, fatigue - Headache Nausea or vomiting - Dizziness or fainting - Worsens pre-existing conditions - Skin may be cool, moist but pulse fast & weak heat injuries: heat stroke - answer-- Body temp > 103ºF - Red, hot, dry skin (no sweating) - Rapid, strong pulse - Throbbing headache - Dizziness - Nausea - Confusion - Unconsciousness - Damage to brain - Multiple organ system failure - Death the 5E's of injury prevention - answer-Education • How do injuries occur (on the job, in the car, etc)? • How can we prevent these things? Engineering Controls • Seat belts, hand brakes, lights, force plates • Design of work Economic incentives • Fines for non-compliance Enforcement • Jail time, closure, loss of license Empowerment • Change social norms (drinking/driving, buckle seat belts, motorcycle/bicycle helmets) osteoporosis - answer-Osteoporosis is a skeletal disorder characterized by • decrease in bone mass • decrease in bone density • enlarged spaces within bone that produce fragility Diminished bone strength • Quality • Density Increased risk of fracture • Wrist • Spine • Hip Sarcopenia - answer-reduction in skeletal muscle mass as people age bone remodeling - answer-bone removal and replacement bone reabsorption - answer-- removing bone that is damaged or needed for minerals - minerals, esp. calcium, are essential to cell function and are taken from bones as needed Risk factors for osteoporosis - answer-- Age - Injury - Gender - Genetics - Estrogen deficiency or amenorrhea - Low testosterone - Anorexia nervosa - Low calcium or vitamin D - Medications - Chronic intestinal disorders - Diseases affecting mobility or a sedentary lifestyle - Smoking - Alcohol - More common in Caucasians and SE Asians prevention and treatment of osteoporosis - answer-- Calcium and vitamin D (better from food) - Exercise - Weight bearing - Resistance training - No smoking - Low alcohol intake CTE - answer-chronic traumatic encephalopathy Chronic Traumatic Encephalopathy (CTE) - answer-form of dementia caused by repeated head trauma such as concussions - symptoms usually do not begin until years after the injury - can only be diagnosed after death Bubble-wrap effect - answer-Certain animals brains are well protected against concussions due to a phenomenon called the bubble wrap effect. Their brains are naturally protected with mechanisms that slow the return of blood from the hedge to the body increasing blood volume that fills their brains vascular tree. arthritis - answer-- Includes > 100 diseases & conditions that affect joints, tissues surrounding joints, & other connective tissue - Typically involves pain, stiffness around joint(s) - US adults age ≥ 18 (): 22.7% had doctor-diagnosed arthritis • Prevalence, women: 23.5% • Prevalence, men 18.1% • ~43.5% overall had limitations to usual activities osteoarthritis - answer-- Affects > 30 million US adults - Also called degenerative joint disease or "wear and tear" arthritis - Degeneration of cartilage - Leads to bone degeneration - Gradual Symptoms: • pain, inflammation, stiffening, decreased range of motion, swelling osteoarthritis risk factors - answer-- Age (>40) - Gender (female) - Obesity - Trauma • Joint injury/overuse • Infection • Poor alignment • Occupation & repetitive motions - Genetics joint friendly activities - answer-- low risk of injury - don't twist or pound the joints too much - walking - biking - swimming - water aerobics - muscle strengthening with resistance bands osteoarthritis treatments - answer-- Education - Physical activity/muscle strengthening - Exercise therapy including physical therapy - Weight control - Medications • Anti-inflammatory • Pain relief • Cortisone - Supportive devices (canes, crutches) - Surgery, e.g., injections into knee, knee replacement rheumatoid arthritis - answer-- Systemic inflammatory disease - Autoimmune - Mainly attacks joints, usually many joints at once - Inflammation of the synovial membrane (joint lining) - Can affect other organs, e.g., lungs, heart, eyes - Symptoms: pain, inflammation, redness, fatigue, stiffness, same symptoms on both sides of body, weight loss rheumatoid arthritis risk factors and treatments - answer-Risk Factors: • Any age; likelihood increases with age • Female • Smoking • Obesity • Genetic Treatment: • No cure • Stop smoking • Medications • Exercise and weight control • Surgery gout - answer-- Inflammatory arthritis - Usually affects one joint at a time - Bouts of flares (symptoms present) and remission (no symptoms) - Deposition of uric acid crystals in tissues and fluids - Recurring acute flares can lead to gouty arthritis Symptoms of acute flares: • Red, hot swollen joints • extreme pain gout risk factors - answer-- Male - Obesity - Medications including diuretics - Alcohol - Certain health conditions, e.g., hypertension, diabetes, poor kidney function, insulin resistance - Diet high in fructose (type of sugar) & purines (e.g., in red meat, alcohol) 1 in 3 American adults is... - answer-at risk for kidney disease 29 million American adults have... - answer-kidney disease 8.3 million American adults have... - answer-gout The kidney, gout, and uric acid connection - answer-- Kidney disease sometimes leads to high uric acid in the blood. High uric acid may cause gout in some people. - High uric acid may also cause kidney stones in some people - If you have gout, you should be checked for kidney disease Gout symptoms - answer-- Joints that are swollen, tender, warm, or red - Gout usually occurs in the large joint of your big toe, but it can also occur in your feet, ankles, knees, wrists, and hands - Symptoms are important to know because some people have gout even if their uric acid level is normal severe joint pain - answer-when an individual rates his or her pain as 7 or higher out of 10 on a scale of 0 (no pain) to 10 (as bad as it can be) - higher in women - Highest among non-Hispanic blacks (42.3%), then Hispanics (35.8%), and non-Hispanic whites (23.1%) - More common in adults with arthritis who also have other chronic conditions persistent pain - answer-when an individual reports having pain (of any severity) on most or all days in the past 3 months fibromyalgia - answer-- Condition causing pain all over body, sleep problems, fatigue - May have increased sensitivity to pain (abnormal pain perception processing) - Symptoms: • Pain, stiffness • Fatigue • Depression • Sleep problems • Difficult with thinking, memory & concentration • Headaches • Digestive problems Fibromyalgia risk factors and treatment - answer-Risk factors: - Age - Preexisting lupus or rheumatoid arthritis Rheumatoid Arthritis Treatment: • Medications • Aerobic exercise & muscle strengthening • Good sleep hygiene • Stress management • Cognitive behavior therapy for underlying depression chain of infection: causative agent - answer-pathogen chain of infection: reservoir - answer-places in environment where pathogen lives, including people & inanimate objects chain of infection: portal of exit - answer-way that pathogen leaves reservoir, e.g., splatter of body fluids chain of infection: mode of transmission - answer-way the pathogen gets passed on, e.g., airborne chain of infection: portal of entry - answer-way the pathogen enters a new host chain of infection: susceptible host - answer-an individual who is susceptible Henle-Koch Postulates (developed in the late 1800s) - answer-- A germ causing a disease must be discoverable in all cases of the disease - The germ must grow in a pure culture - The germs in the culture must cause the disease in a susceptible host - The germs must be recoverable and transmit the disease to another susceptible host Since then: • Discovery of new classes of disease organisms, e.g., viruses, that can't be propagated in pure culture • Many new types of imaging and culture techniques, assays, etc. - The Henle-Koch postulates help us understand how the pathogen replicates, length of time to symptoms, how transmitted, etc. case - answer-person showing symptoms of illness infection - answer-person with disease organism in their body • Consider polio, which does not cause symptoms in all people who are infected • Implications for surveillance, control, elimination, eradication Endemic - answer-refers to constant or usual presence of a particular disease or infectious agent in a specific population and geographic area Sporadic - answer-for a specific disease, refers to the situation where that disease occurs irregularly and infrequently in a population and geographic area Cluster - answer-situation where the number of cases grouped in place and time is suspected to be greater than the expected number Epidemic - answer-when there is an increase (often sudden) in the number of cases of a specific disease, above the expected number of cases in that area Pandemic - answer-epidemic that has spread across multiple countries or continents, usually affecting a large number of people natural selection - answer-A process in which individuals that have certain inherited traits tend to survive and reproduce at higher rates than other individuals because of those traits. sustainability - answer-don't make your environment uninhabitable Natural History of Infectious Disease - answer-Viable balance in host-pathogen relationship: • Natural selection applies to pathogens too: survival and spread of pathogens is ultimately based on their reproductive success • Best not to kill a high % of hosts, or kill them quickly • Improved pathogen survival and reproductive success if pathogen is less virulent or takes a long time to kill host • Natural selection will favor pathogens that allow both pathogens and hosts to survive and reproduce • Viruses that cause common cold: relatively easy to transmit, infect millions, kill few hosts • Ebola: kills host more quickly & transmits slowly between people --> unlikely to spread worldwide smart microbes - answer-Adapt to host • Cause little or no disease • Maybe even helps host (e.g., gut microbiome) - polio - malaria CFR - answer-case fatality rate dumb microbes - answer-- bubonic plague - ebola What percent of the population needs to be immune to achieve herd immunity? - answer-Depends on how infectious the pathogen is • Measles: min. ~ 94% needs to be immune for herd immunity • NOTE! This assumes the immune people are spread equally throughout population ring vaccination - answer-Based on herd immunity concept • Ring vaccination was used in the eradication of smallpox, and targets: • Vaccination of the contacts of confirmed cases of disease • Vaccination of people who are in close contact with those contacts • Vaccination of health care workers • Ring vaccination requires thorough and rapid surveillance and epidemiologic case investigation. foodborne illness - answer-a disease transmitted to people by food ~48 million cases of foodborne illness annually (~ 1 in 6 Americans each year) • Result in approx. 128,000 hospitalizations and 3,000 deaths per year • The most deaths: caused by nontyphoidal Salmonella , Toxoplasma , Listeria, and Norovirus • The most hospitalizations: caused by nontyphoidal Salmonella, norovirus, Campylobacter, and Toxoplasma • The most illness: caused by norovirus • norovirus illness is usually mild, but is a leading cause of foodborne deaths because it affects so many people • Economic burden of 15 foodborne pathogens: approx. $15.5 billion annually Food safety concerns - answer-- Allergens not listed on label - Extraneous materials (e.g., metal or plastic bits) - Food fraud (e.g., fish improperly labeled as a different species) - Chemical contaminants (e.g., mercury in fish) Adaptive Immune System - answer-- Also called "acquired" or "specific" immunity - Specific to a particular pathogen - Involves development of immunologic memory - Slow the first time a person is exposed to a specific pathogen - Immunologic memory is crucial to the success of a vaccine Antibody - Mediated (Humoral) Immunity - answer-- a component of Adaptive Immunity - primary defense against extracellular organisms Antigen - answer-- substances that provoke an immune response against that substance - antigens are often proteins on the surface of cells, viruses, fungi, bacteria; also includes nonliving substances such as toxins and foreign particles Antibodies - answer-- Antibodies: proteins secreted into plasma to help eliminate foreign organisms - Antibodies are specific for the antigen that initiated their production - Plasma cell can make up to 2000 antibody molecules per second - Antibody functions: • Neutralize bacterial toxins • Neutralize viruses • Attach to bacteria, promoting phagocytosis • Activate components involved in inflammatory response Phagocytosis - answer-Engulfing of smaller cells or particles by a phagocyte (a type of white blood cell) What happens upon first exposure to an antigen... - answer-- When a person is first exposed to antigen: adaptive immune system is activated - A few days to a week after exposure to a new antigen, antibodies specific for that antigen begin to appear in the blood - Antibody levels plateau and eventually decline after organism is cleared from the body - If immune cells encounter the same antigen in the future: memory cells that were formed the first time stimulate a much faster immune response --> basis for vaccine Vaccine types - answer-- Live attenuated vaccines - Inactivated vaccines - Toxoid vaccines - Acellular vaccines - mRNA vaccines - DNA vaccines Live attenuated vaccines - answer-- Attenuated = weakened - live virus is weakened through chemical or physical processes to produce an immune response without causing the disease symptoms - Produce a strong & long-lasting immune response - Must be refrigerated - limiting range and usefulness - Typically can't be given to people with weakened immune systems, e.g., with cancer or AIDS - Used for measles, mumps, rubella, chickenpox Inactivated vaccines - answer-- Heat or chemically killed (no cooling needed to maintain vaccine quality) - Produces weaker response; may need booster shots - Used for flu shots, rabies, etc Toxoid vaccines - answer-- Uses a toxin produced by the pathogen - Toxin is deactivated - Creates immune response targeted to the toxin rather than the pathogen - Used for diphtheria, tetanus Acellular vaccines - answer-- contains partial material from the pathogen - Can be used for almost everyone, e.g., those with weakened immune systems - Used for whooping cough, HPV, hepatitis B, etc. - Booster shots may be needed mRNA vaccines - answer-- Vaccine contains mRNA that codes for just the antigen (not the whole virus) - mRNA that codes for the antigen instructs your own cells to make the antigen - For COVID-19, the antigen produced is the spike protein on the outside of the SARS-CoV-2 virus - Only the spike protein is made, so you can't catch COVID from the vaccine - Your immune system develops an immune response to the antigen (e.g., spike protein) - The mRNA degrades over time - Ex: Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines 1. Vaccine injected 2. mRNA containing lipid nanoparticles transfer mRNA into cells 3. mRNA is translated into COVID spike protein (your own cells do work!) 4. Second dose DNA vaccines - answer-Johnson & Johnson and AstraZeneca COVID-19 DNA vaccines Why is an HIV vaccine so difficult to make? - answer-- HIV mutates rapidly - Outer spike protein conceals itself from the immune system - The evolving number of virus subtypes makes vaccine development hard - Vaccines may have to be adapted to the virus forms that are present in the precise location where their use is intended Who should not receive certain vaccines? - answer-People with: - Severe allergic reactions to previous dose of vaccine or vaccine component - severe immunodeficiency for certain vaccines such as MMR (a live attenuated vaccine) - pregnant or planned pregnancy within a few months - certain vaccines: • e.g., avoid MMR [measles, mumps, rubella] vaccine - Infants before they are due for vaccines according to vaccine schedule Herd immunity - answer-resistance to the spread of an infectious disease within a community because a sufficient percent of individuals have pre-existing immunity (from either previous infection or vaccination). - Herd Immunity works by reducing the risk that vulnerable people will be around people who are infected with the pathogen • Protects people who can't be vaccinated • Only works for diseases that spread directly between people • Would not work for tetanus (tetanus bacteria lives in soil) - Note: immune people may not be evenly distributed in a population --> pockets of unvaccinated people could still get sick Herd Immunity: % coverage needed - answer-- The more infectious the pathogen is, the higher the percent vaccination coverage needed for herd immunity - Basic reproduction number (R0 ): expected number of secondary cases produced by a single (typical) infection in a completely susceptible population • R0 does not relate to how serious the disease is • R0 for a single disease can be different from one location or population to another R0 Values - answer-(R0 - 1/R0) x 100% = % coverage that should be exceeded to stop the outbreak - If R0 = 2, this means that in a fully susceptible population, each infected person will (on average) give the disease to two other people • When R0 = 2, to eliminate the outbreak, need to vaccinate more than 1 out of 2 people in the population (>50%) - R0 helps us figure out what % of the population needs to be protected against infection to stop an outbreak - If R0 = 3, then on average, in a fully susceptible population, need to vaccinate > 67% of the non-sick people around the sick people to eliminate the outbreak - If R0 = 18, then on average, in a fully susceptible population, need to vaccinate over 17 out of every 18 people (> 94.4%) of the non-sick people around the sick people to eliminate the outbreak