Haruto Tanaka Well Child
Cell present in both the innate and adaptive immune systems.
Movements of the ribs.
1-5 --> pump handle
5-10 --> bucket handle
11-12 --> caliper movement?
Pt presents to their wellness visit. During the visit, they had imaging done of the chest. Upon review, they noticed that there is still an organ present under the mediastinum. Knowing this, estimate the pt's age and the changes that the organ goes through.
What is the pt has not hit puberty yet since the thymus is still present? Once the pt hits puberty, then the thymus has an increased adipose infiltration and degeneration.
List the different vaccines and one example of each. BONUS! Name a contraindication of live attenuated vaccines and how long between vaccines should be.
What are live attenuated(chickenpox, German measles, Measles, mumps, typhoid fever, yellow fever), inactivated (Cholera, Influenza, Hep A, plague, rabies), subunit (anthrax, Hep B, influenza, meningitis, HPV, pneumococcal pneumonia, whooping cough), toxoid (Tetanus, diphtheria, pertussis, botulism), and conjugate(meningitis)? BONUS! contraindication for live attenuated vaccines would include any immunocompromised patient//on chemotherapy with vaccines being spread for 4 weeks in between if it is not given on the same day.
Define the difference between Morbidity and Mortality rate.
What is that Morbidity rate is an incidence rate for new cases of non-fatal disease over the total population at risk and Mortality rate is an incidence rate of the number of deaths from a disease or all causes over the total population? Incidence is in reference to the about of new cases developing over a period of time (5 cases of Polio from 2013-2019) whereas prevalence is in reference to the amount of current cases of a specific time (6 babies in Cuyahoga County in 2013 where born with birth defects).
Name the Inflammation-eliciting mediators of the innate immune system.
What are leukotrienes, histamine, bradykinin, and prostaglandins?
Pt presents to the clinic for OMM. Upon palpation, the rib that is located at the scapular spine had an inhalation dysfunction. When placed in flexion, it was found to be less prominent but was resistant to movement in rotation right and side bending left. Name the pt's diagnosis.
What is Rib 3 flexion, rotation left, side bending right, and inhalation dysfunction? Diagnoses are ALWAYS in EASE. That means that inhalation dysfunction was ease in inhalation, bind in exhalation. Moreover, since the rib became less prominent flexion, it is the rib's ease whereas extension would be the rib's bind. Lastly, resistance to movement indicates a bind so rotation left and side bending right would be the pt's ease.
List the steps of phagocytosis.
What is pathogen is recognized by the Phagocyte, it gets engulfed and the complex binds with a lysosome, this phagolysosome will release granules which will kill about 2% of pathogens with 98% being killed by the oxidative series? The phagocytes recognize pathogen's PAMPs through their PRRs. These PRRs can either be signaling or phagocytic (think this is the word). If they are signaling PRRs they will secrete cytokines to increase the signal. The most important signaling PRR are the TLRs (know 3,4,5,9)
Pt presents to the clinic for their wellness visit, which they need to get their MMR vaccine. Right before the nurse goes to provide the vaccine, the pt's mother states that the pt has an allergic reaction to gelatin which causes the pt to get explosive diarrhea. The nurse still gives the pt the vaccine. Explain
What is because the MMR vaccine has a contraindication for ANAPLHYLACTIC allergy to gelatin and neomycin? The pt is still allowed and should get the vaccine due to the greater risk of MMR symptoms compared to the allergy.
Other contraindications may include:
HPV --> yeast
Tdap --> latex with Boostrix, (Adacel does not matter)
Influenza --> eggs?
Varicella --> gelatin, neomycin
IPV --> streptomycin, neomycin, polymyxin B
Name the Bradford Hill's Criterias that are used when making causal inferences.
What are Strength of Association, Consistency with Other Studies, Exposure Precedes Disease, Biological Plausibility, and Dose-Response Effect?
4-month-old pt presents to their wellness visit. Name the vaccines that they should receive.
What are Rotavirus, DTaP, Hib, PCV13, and IPV?
Pt presents to the ED after a freak machete accident to where the anterior superior and inferior iliac spines were cut off. Name the anterior muscles that would be affected, main actions, and the nerves that innervate them.
What are the sartorius (anterior superior iliac spine) and the rectus femoris (anterior inferior iliac spine) which are both innervated by the femoral nerve? The sartorius abducts, laterally rotates, flexes the hip, and flexes the knee joint. The rectus femoris extends the knee and stabilizes the hip joint to help flex the hip joint.
Steps of acute inflammation. Describe what will occur if the acute inflammatory response is unsuccessful.
What is initial injury, vasoconstriction, vasodilation, diapedesis, hyperemia, and if the acute inflammatory response does not clear the infection, chronic inflammation occurs? The injury will occur in the individual causing the acute inflammatory response. This will then lead to platelet adhesion, and vasoconstriction of efferent vessels of the injured area. To reverse this, histamine is released from surrounding mast cells and causes the vessel to dilate. Moreover, pathways such as the complement pathway, clotting pathway, fibrinolysis, and kinin system might occur depending on the injury and individual. Due to the increased gaps of the epithelial cell, leukocytes and serum proteins leak into the surrounding area and cause hyperemia. Additionally, IL-6 from macrophages will promote the adhesion and process of diapedesis. The wound might heal on the superficial level, but if the pathogen is still present in the body, chronic inflammation continues. Ongoing lower-level battle.
Pt presents to the clinic for the results of their blood antibody test. The antibody in question can perform neutralization, agglutination, complement activation, and opsonization. Additionally, it is in charge of binding to phagocytes. Name this antibody, special characteristic, binding sites, and percentage in the body. BONUS! List the rest of the antibodies and their special characteristics, if any.
What is IgG which is able to cross the placenta, has 2 binding sites, and is about 80% of the antibodies in the blood? BONUS! the other antibodies are:
IgA --> secretory (breastmilk)
IgM --> "first responder" (10 binding sites)
IgE --> parasites, allergies
IgD --> B-cell receptor
Little Suzy Ann has a cold, but thinking that it was just her allergies, she still went to the large family gathering and talked to everybody (even sneezed on Uncle Netter since she has no manners). Prevalence most likely _____. Explain.
What is increased due to the in-migration of new cases? Due to the increase of new cases, the incidence rate would increase and therefore, the prevalence would increase.
Prevalence = incidence x average duration of disease
This type of vaccine utilizes the immunogenic antigens of a pathogen for an _______ acquired immunity.
What are subunit vaccines for artificially acquired immunity? This vaccine utilizes proteins with multiple epitopes of a peptide with only one epitope to elicit an immune response. Recombinant subunit vaccines are the same as subunit vaccines, except that they utilize fragments not derived from the pathogen (genetic manipulation). This should only cause a humoral response rather than both a humoral and cellular since the vaccine does not allow for "infection" of the cells. On the other hand, vaccines such as the Live Attenuated can because they are able to enter the cell, replicate, and therefore cause a response in both humoral and cellular (also why this causes the strongest immune response). Good article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068582/
Pt presents to the ED with c/o meralgia paresthetica of the left leg. Name the nerve affected including the spinal cord levels and the affected area of the leg.
What is the lateral femoral cutaneous nerve at the levels of L2-L3 affecting the lateral left thigh? This nerve is one of the few cutaneous branches of the lumbosacral plexus. These levels are T12-S5, with the Lumbar plexus being T12-L4, Sacral plexus being S1-S5, and the lumbosacral trunk being L4-L5.
Upon autopsy, it was found that the individual had a mastectomy gone wrong and had some lymph nodes removed. This organ is important to the immune system as they filter ____ after it enters through the _____ vessel. Additionally, it contains _____ cells in the cortex nodules and ____ cells in the paracortex. BONUS! Name the structure in the paracortex that is specific to this region.
What is lymph after it enters through the afferent vessel with the B cells in the cortex and the immature T cells in the paracortex? The medulla is where T cells go through maturation and negative selection occurs. High Endothelial venules are found in the paracortex. All secondary organs, except for the spleen contain these vessels.
Pt presents to the ED with c/o frequent strep throat infections (Streptococcus pyogenes, EXTRACELLULAR BACTERIA) Name the adaptive T helper cell that is most likely absent/reduced in this pt and its main cytokines.
What are Th17 with their cytokines being IL-17, IL-22, IL-6, and TNF-beta? Th17 are mostly in charge of extracellular bacteria and fungi. IL-17 and IL-22 are huge players in mucocutaneous infections.
The attack rate of rotten pumpkins to exposure of a fungus:
Healthy Pumpkins --> 52
Rotten Pumpkins --> 18
Exposed Pumpkins --> 30
Nonexposed Pumpkins --> 40
BONUS! Calculate Relative Rate, and explain what it means in relation to 1.
What is the attack rate of 0.60? This is calculated by dividing the total number of affected individuals by the total number of infected individuals. This compares how likely a person (or pumpkin) is to be affected by a disease ONCE EXPOSED. BONUS! The relative risk is obtained by dividing the affected individuals by the unaffected individuals so the answer here is .35. This means that it is less likely for an exposed individual to get the disease relative to the nonexposed person.
Pt appears to the ED with a cut on their arm. This pt has a breach in their skin which is a ____defense of the ___ immune system. Moreover, since this barrier was destroyed, the chemical enzymes secreted in the ____on the skin cannot provide protection by _____. BONUS! Name the antibody that would be prevalent in dealing with this infection if a creept crawly found its way in the pt's arm.
What is the first defense of the innate immune system with the chemical defenses in the sebum on the skin that cannot provide an oil barrier for hair follicle pores from pathogens? In the innate immune system, there are physical barriers such as the skin and other mechanical means for protection. Additionally, there are chemical barriers seen with the sebum on the skin and its corresponding enzymes such as oleic acid(lowers pH of the skin). Lastly is the body's natural microbiome which can secrete bacteriocins to kill other bacteria or compete for the limited resources. BONUS: It would be the antibody IgE.
Pt presents to the wellness clinic with a bulging disc of the L2-L3. With this in mind, explain the clinical findings in relation to the affected dermatome, myotome, and deep tendon reflex, if any.
What is the pt would present with an affected L3 dermatome located on the lower medial thigh, knee extension, and patella reflex? Look at the dermatome/myotome maps and the need to know areas of minimal overlap. Additionally, keep in mind that knee extension and patella deep tendon reflex are innervated by the L3-L4 spinal levels so they will most likely still be able to occur, but just less than normal.
Describe what happens in a complement system if C5 convertase was missing, and then describe what would happen if C3 convertase was missing.
What is the complement system would not continue past C3b and the MAC would not form since C5 could not be activated, for the C3 convertase missing, the complement system would not get past C3 since it cannot become activated? The complement system has three starting points, Classical (Ag-Ab) Lectin (MBL), and Alternative (C3b Pathogen/injured tissue activated). All of these then funnel into C3 being activated to C3a (inflammation) and C3b (opsonization). Then C5 gets activated into C5a (inflammation and chemoattractant) and C5b (opsonization and, with C9, MAC)
Pt presents to the clinic with c/o frequent infections of the same virus despite having UTD vaccinations. Upon further examination, it was discovered that their T cells are not maturing fully. Explain how this affects vaccination in relation to B cells.
What is that since there are no T cells to activate the B cells, memory B cells are not produced? B cells can be activated in two ways, with T cells T-cell dependent) or without T cells (T-cell independent). If a B-cell is activated without T-cell memory B cells are not produced. T-cell-dependent B cell activation allows for memory B cells to be produced so that the next time the disease is encountered, the Th2 can secrete cytokines to stimulate class switching from IgM to the more specific antibodies.
Determine the Prevalence of Hemispatial neglect
at the end of July with the total population being 1,000,000 (x =1 death):
Jan: 1
Feb: 1 x
March: 1
April: 3
May: x x
June: 2 x
July: 1
What is 0.000005? This is obtained by taking the number of cases present in July and dividing it by the population. So:
5 cases / (1,000,000-4)