NR-507 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 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.
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 INFLAMMATORY INNATE IMMUNITY ADAPTIVE
RESPONSE (ACQUIRED) IMMUNI
TY
Level of defense First line of defense Second line of defense; Third line ofdefense;
against infection and occurs as a response to initiated when innate
tissue injury tissue injury or infection immune system signals the
cells ofadaptive immunity
Timing of defen Constant Immediate response Delay between primary
se 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 T lymphocytes, B
(neutrophils, lymphocytes,
eosinophils, basophils), macrophages, dendritic
monocytes/macrophages cells
, natural killer (NK)
cells, platelets,
endothelial cells
Memory No memory involved No memory involved Specific immunologic
memory by T and B
lymphocytes
Peptides Defensins, cathelicidins, Complement, clotting Antibodies, complement
collectins, lactoferrin, factors, kinins
bacterial toxins
Protection Protection includes Protection includes Protection includes
anatomic barriers (i.e., vascular responses, activated T and B
skin and mucous cellular components lymphocytes, cytokines,
membranes), cells and (e.g., mast cells, and antibodies
secretory molecules or neutrophils,
cytokines (e.g., macrophages), secretory
, lysozymes, low molecules or cytokines,
pH of stomach and and activation of plasma
urine), and ciliary protein systems
activity
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
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
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 mechanisms, or morphologic characteristics. They are less frequent than macrocytic-
normochromic 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.
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 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.
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 INFLAMMATORY INNATE IMMUNITY ADAPTIVE
RESPONSE (ACQUIRED) IMMUNI
TY
Level of defense First line of defense Second line of defense; Third line ofdefense;
against infection and occurs as a response to initiated when innate
tissue injury tissue injury or infection immune system signals the
cells ofadaptive immunity
Timing of defen Constant Immediate response Delay between primary
se 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 T lymphocytes, B
(neutrophils, lymphocytes,
eosinophils, basophils), macrophages, dendritic
monocytes/macrophages cells
, natural killer (NK)
cells, platelets,
endothelial cells
Memory No memory involved No memory involved Specific immunologic
memory by T and B
lymphocytes
Peptides Defensins, cathelicidins, Complement, clotting Antibodies, complement
collectins, lactoferrin, factors, kinins
bacterial toxins
Protection Protection includes Protection includes Protection includes
anatomic barriers (i.e., vascular responses, activated T and B
skin and mucous cellular components lymphocytes, cytokines,
membranes), cells and (e.g., mast cells, and antibodies
secretory molecules or neutrophils,
cytokines (e.g., macrophages), secretory
, lysozymes, low molecules or cytokines,
pH of stomach and and activation of plasma
urine), and ciliary protein systems
activity
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
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
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 mechanisms, or morphologic characteristics. They are less frequent than macrocytic-
normochromic 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.
