NR-507 Study Guide
I I
Chapters I1-5, I11-14, I16-20, I21-25, I27-3-33, I34-39, I40-47
1. Types Iof Iimmunity-e.g. Iinnate, Iactive, Ietc I(ch I7 I,191)
➢ Innate Iimmunity Iincludes Itwo Ilines Iof Idefense: Inatural Ibarriers Iand Iinflammation INatural Ibarriers Iare
Iphysical, Imechanical, Iand Ibiochemical Ibarriers Iat Ithe Ibody’s Isurfaces Iand Iare Iin Iplace Iat Ibirth Ito
IpreventIdamage Iby Isubstances Iin Ithe Ienvironment Iand Ithwart Iinfection Iby Ipathogenic Imicroorganisms.
➢ the Inatural Iepithelial Ibarrier Iand Iinflammation Iconfer Iinnate Iresistance Iand Iprotection, Icommonly Ireferred
to Ias Iinnate, Inative, Ior Inatural Iimmunity. IInflammation Iassociated Iwith Iinfection Iusually Iinitiates Ian
Iadaptive Iprocess Ithat Iresults Iin Ia Ilong-term Iand Ivery Ieffective Iimmunity Ito Ithe Iinfecting Imicroorganism,
Ireferred Ito Ias Iadaptive, Iacquired, Ior Ispecific Iimmunity.
➢ Adaptive Iimmunity Iis Irelatively Islow Ito Idevelop Ibut Ihas Imemory Iand Imore Irapidly Itargets Iand Ieradicates Ia
Isecond Iinfection Iwith Ia Iparticular Idisease-causing Imicroorganism.
➢ Innate Iimmunity Iincludes Itwo Ilines Iof Idefense: Inatural Ibarriers Iand Iinflammation. INatural Ibarriers Iare
physical, Imechanical, Iand Ibiochemical Ibarriers Iat Ithe Ibody’s Isurfaces Iand Iare Iin Iplace Iat Ibirth Ito Iprevent
Idamage Iby Isubstances Iin Ithe Ienvironment Iand Ithwart Iinfection Iby Ipathogenic Imicroorganisms
INNATE IIMMUNITY
BARRIERS INFLAMMATORY IRESPONSE ADAPTIVE I(ACQUIRED) IIMMUNITY
Level Iof Idefense First Iline Iof Idefense Iagainst Iinfection Second Iline Iof Idefense; Ioccurs Ias Ia Iresponse Third Iline Iofdefense; Iinitiated Iwhen
IandItissue Iinjury ItoItissue Iinjury Ior Iinfection Iinnate Iimmune Isystem Isignals Ithe
Icells Iofadaptive Iimmunity
Timing Iof Idefense Constant Immediate Iresponse Delay Ibetween Iprimary Iexposure Ito
Iantigen Iand Imaximum Iresponse;
Iimmediate Iagainst Isecondary
IexposureIto Iantigen
Specificity Broadly Ispecific Broadly Ispecific Response Iis Ivery Ispecific
ItowardI“antigen”
Cells Epithelial Icells Mast Icells, Igranulocytes I(neutrophils, T Ilymphocytes, IB Ilymphocytes,
Ieosinophils, Ibasophils), Imacrophages, Idendritic Icells
Imonocytes/macrophages, Inatural Ikiller
I(NK)Icells, Iplatelets, Iendothelial Icells
Memory No Imemory Iinvolved No Imemory Iinvolved Specific Iimmunologic Imemory Iby IT
IandIB Ilymphocytes
Peptides Defensins, Icathelicidins, Icollectins, Complement, Iclotting Ifactors, Ikinins Antibodies, Icomplement
Ilactoferrin, Ibacterial Itoxins
Protection Protection Iincludes Ianatomic Ibarriers Protection Iincludes Ivascular Iresponses, Icellular Protection Iincludes Iactivated IT Iand IB
I(i.e., Iskin Iand Imucous Imembranes), Icomponents I(e.g., Imast Icells, Ineutrophils, Ilymphocytes, Icytokines, Iand
IcellsIand Isecretory Imolecules Ior Imacrophages), Isecretory Imolecules Ior Iantibodies
Icytokines I(e.g., Ilysozymes, Ilow IpH Iof Icytokines,Iand Iactivation Iof Iplasma Iprotein
Istomach IandIurine), Iand Iciliary Iactivity Isystems
2. Alveolar Iventilation/perfusion- I(ch, I34,pg I1238)
➢ The Irelationship Ibetween Iarterial Iperfusion Iand Ialveolar Igas Ipressure Iat Ithe Ibase Iof Ithe Ilungs Iis Ibest Idescribed
Ias: Iarterial Iperfusion Ipressure Iexceeds Ialveolar Igas Ipressure.
➢ Effective Igas Iexchange Idepends Ion Ian Iapproximately Ieven Idistribution Iof Igas I(ventilation) Iand Iblood I(perfusion) Iin Iall
portions Iof Ithe Ilungs. IThe Ilungs Iare Isuspended Ifrom Ithe Ihila Iin Ithe Ithoracic Icavity. IWhen Ithe Iindividual Iis Iin Ian
Iupright Iposition I(sitting Ior Istanding), Igravity Ipulls Ithe Ilungs Idown Itoward Ithe Idiaphragm Iand Icompresses Itheir
Ilower IportionsIor Ibases.
3. Dermatologic Iconditions Ie.g. Ipityriasis Irosea I(ch46, Ipg I1630/1631)
➢ Psoriasis, Ipityriasis Irosea, Iand Ilichen Iplanus Iare Iinflammatory Idisorders Icharacterized Iby Ipapules, Iscales, Iplaques, Iand
Ierythema
➢ Psoriasis Iis Ia Ichronic, Irelapsing, Iproliferative, Iinflammatory Idisorder Ithat Iinvolves Ithe Iskin, Iscalp, Iand Inails Iand Ican
occur Iat Iany Iage.
➢ Pityriasis Irosea Iis Ia Ibenign Iself-limiting Iinflammatory Idisorder Ithat Ioccurs Imore Ioften Iin Iyoung Iadults, Iwith Iseasonal
Ipeaks Iin Ithe Ispring Iand Ifall. IThe Icause Iis Iunknown Ibut
➢ thought Ito Ibe Iassociated Iwith Ia Ivirus I(e.g., Ihuman Iherpesvirus I6 I[HHV-6] Iand IHHV-7) Ibecause Iof Ithe Itiming Iand
clustering Iof Ithe Ioutbreaks
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, ➢ Pityriasis Irosea Ibegins Ias Ia Isingle Ilesion Iknown Ias Ia Iherald Ipatch Ithat Iis Icircular, Idemarcated, Iand Isalmon-pink; Iis
Iapproximately I3 Ito I4 Icm Iin Idiameter; Iand Iis Iusually Ilocated Ion Ithe Itrunk
➢ Lichen Iplanus I(LP) Iis Ia Ibenign, Iautoimmune Iinflammatory Idisorder Iof Ithe Iskin Iand Imucous Imembranes Iwith Imultiple
clinical Ivariations. IThe Icause Iis Iunknown, Ibut IT Icells, Iadhesion Imolecules, Iinflammatory Icytokines, Iperforin, Iand
Iantigen-presenting Icells Iare Iinvolved.The Iinfiltrate Iof IT Icells Imediates Iimmunoreactivity Iagainst Ibasal Ilayer
Ikeratinocytes, Iwhich Ihave Ialtered Isurface Iantigens Iand Iadhesion Imolecules
➢ LP Iis Ialso Ilinked Ito Ihepatitis IC Ivirus. ISome Iindividuals Idevelop Ilichenoid Ilesions Iafter Iexposure Ito Idrugs Ior
Ifilm- Iprocessing Ichemicals. IThe Iage Iof Ionset Iis Iusually Ibetween I30 Iand I70 Iyears. IThe Idisorder Ibegins Iwith Iflat
Ipurple, Ipolygonal, Ipruritic, Inonscaling Ipapules I2 Ito I4 Imm Iin Isize, Iusually Ilocated Ion Ithe Iwrists, Iankles, Ilower
Ilegs, Iand Igenitalia
➢ New Ilesions Iare Ipale Ipink Iand Ievolve Iinto Ia Idark Iviolet. IPersistent Ilesions Imay Ibe Ithickened Iand Ired,
IformingIhypertrophic ILP. IOral Ilesions I(oral Ilichen Iplanus) Iappear Ias Ilacy Iwhite Irings Ithat Imust Ibe
Idifferentiated IfromIleukoplakia Ior Ioral Icandidiasis Iand Ithey Imay Ibe Iprecancerous Ilesions
4. Croup I(C I36,pg I1294)-
➢ Croup Iillnesses Ican Ibe Idivided Iinto Itwo Icategories: I(1) Iacute Ilaryngotracheobronchitis I(croup) Iand I(2)
Ispasmodic Icroup. IDiphtheria Ican Ibe Iconsidered Ia Icroup Iillness Ibut Iis Inow Irare Ibecause Iof
Ivaccinations. ICroup Iillnesses Iare Iall Icharacterized Iby Iinfection Iand Iobstruction Iof Ithe Iupper Iairways.
➢ Croup Iis Ian Iacute Ilaryngotracheobronchitis Iand Imost Icommonly Ioccurs Iin Ichildren Ifrom I6 Imonths Ito I3 Iyears Iof
age, Iwith Ipeak Iincidence Iat I2 Iyears Iof Iage
➢ The Iincidence Iof Icroup Iis Ihighest Iin Ilate Iautumn Iand Iwinter, Icorresponding Ito Ithe Iparainfluenza Iand IRSV Iseasons,
Irespectively. ICroup Iis Imore Icommon Iin Iboys Ithan Igirls. IIn Ia Isignificant Iportion Iof Iaffected Ichildren, Icroup Iis Ia
Irecurrent Iproblem Iduring Ichildhood, Iand Ithere Iis Ia Ifamily Ihistory Iof I croup Iin Iabout I15% Iof Icases
➢ Chickenpox I(varicella) Iand Iherpes Izoster I(shingles) Iare Iproduced Iby Ithe Ivaricella-zoster Ivirus I(VZV). IVZV Iis Ia
complex Iherpes Igroup Ideoxyribonucleic Iacid I(DNA) Ivirus. IThe Iincubation Iperiod Iis I10 Ito I27 Idays, Iaveraging I14
Idays. IProductive Iinfection Ioccurs Iwithin Ikeratinocytes Isuch Ithat Ithe Ivesicular Ilesions Ioccur Iin Ithe Iepidermis, Iand
Ian Iinflammatory Iinfiltrate Iis Ioften Ipresent
5. Types Iof Ianemia I(ch I28,pg I987-1002)
➢ anemia Iis Ia Ireduction Iin Ithe Itotal Inumber Iof Ierythrocytes Iin Ithe Icirculating Iblood Ior Ia Idecrease Iin Ithe Iquality
Ior Iquantity Iof Ihemoglobin. IAnemias Icommonly Iresult Ifrom I(1) Iimpaired Ierythrocyte Iproduction, I(2) Iblood
Iloss I(acute Ior Ichronic), I(3) Iincreased Ierythrocyte Idestruction, Ior I(4) Ia Icombination I of Ithese Ithree Ifactors.
➢ Pernicious Ianemia I(PA), Ithe Imost Icommon Itype Iof Imegaloblastic Ianemia, Iis Icaused Iby Ivitamin IB12deficiency,
Iwhich Iis Ioften Iassociated Iwith Ithe Iend Istage Iof Itype IA Ichronic Iatrophic I(congenital Ior Iautoimmune) Igastritis.
I PA
results Ifrom Iinadequate Ivitamin IB12 I absorption Ibecause Iof Iautoantibodies Iagainst Ithe IB12transporter IIF
➢ Folate I(folic Iacid) Iis Ian Iessential Ivitamin Ifor IRNA Iand IDNA Isynthesis Iwithin Ithe Imaturing Ierythrocyte. IFolates Iare
Icoenzymes Irequired Ifor Ithe Isynthesis I of Ithymine Iand Ipurines I(adenine Iand Iguanine) Iand Ithe
conversion Iof Ihomocysteine Ito Imethionine. IDeficient Iproduction Iof Ithymine, Iin Iparticular, Iaffects Icells
Iundergoing Irapid Idivision I(e.g., Ibone Imarrow Icells Iundergoing Ierythropoiesis). IHumans Iare Itotally Idependent Ion
Idietary Iintake Ito Imeet Ithe Idaily Irequirement Iof I50 Ito I200 Imcg/day. IFolate Ideficiency Ianemia Iis Icaused Iby
Iinadequate Idietary Iintake I of Ifolate. IBoth Ianemias Irespond Ito Ireplacement Itherapy.
➢ The Imicrocytic-hypochromic Ianemias Iare Icharacterized Iby Iabnormally Ismall Ierythrocytes Ithat Icontain
Iabnormally Ireduced Iamounts I of Ihemoglobin
➢ Microcytic-hypochromic Ianemia Ican Iresult Ifrom I(1) Idisorders Iof Iiron Imetabolism, I(2) Idisorders Iofporphyrin Iand
heme Isynthesis, Ior I(3) Idisorders Iof Iglobin Isynthesis. ISpecific Idisorders Iinclude Iiron Ideficiency Ianemia, Iside
Iroblastic Ianemia, Iand Ithalassemia
➢ IIron Ideficiency Ianemia I(IDA) Iis Ithe Imost Icommon Itype Iof Ianemia Iworldwide, Ioccurring Iin Iboth Ideveloping Iand
developed Icountries Iand Iaffecting Ias Imany Ias Ione Ififth Iof Ithe Iworld Ipopulation. ICertain Ipopulations Iare Iat Ihigh
Irisk Ifor Ideveloping Ihypoferremia Iand IIDA Iand Iinclude Iindividuals Iliving Iin Ipoverty, Iwomen Iof Ichildbearing Iage,
Iand Ichildren. IIron Ideficiency Iin Ichildren Iis Iassociated Iwith Inumerous Iadverse Ihealth-related Imanifestations,
Iespecially Icognitive Iimpairment, Iwhich Imay Ibe Iirreversible
➢ Sideroblastic Ianemias I(SAs) Iare Ia Iheterogeneous Igroup Iof Idisorders Icharacterized Iby Ianemia Iof Ivarying Iseverity
Icaused Iby Ia Idefect Iin Imitochondrial Iheme Isynthesis.SA Iis Icharacterized Iby Ithe Ipresence Iof Iringed Iside
Iroblasts Iwithin Ithe Ibone Imarrow. ISA Iresults Ifrom Idefects Iin Imitochondrial Imetabolism Ileading Ito Iineffective
Iiron Iuptake Iand Idysfunctional Iheme Isynthesis. IThe Icharacteristic Icell Iin Ithe Ibone Imarrow, Ia Iringed
Isideroblast, Iis Ian Ierythroblast Icontaining Iiron Igranules Iarranged Iaround Ithe Inucleus. ISAs Imay Ibe Ihereditary
Ior Iacquired, Iand Itreatment Ivaries Idepending Ion Ithe Icause.
➢ Normocytic-normochromic Ianemias I(NNAs) Iare Icharacterized Iby Ierythrocytes Ithat Iare Irelatively Inormal Iin Isize
and Ihemoglobin Icontent Ibut Iinsufficient Iin Inumber. IThese Ianemias Ihave Ino Icommon Ietiology, Ipathologic
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, mechanisms, Ior Imorphologic Icharacteristics. IThey Iare Iless Ifrequent Ithan Imacrocytic-normochromic Iand
Imicrocytic-hypochromic Ianemias.
➢ NNAs Iinclude Ifive Idistinct Igroups: Iaplastic I(damage Ito Ibone Imarrow Ierythropoiesis); Iposthemorrhagic
I(acute Iblood Iloss); Iacquired Ihemolytic I(immune Idestruction Iof Ierythrocytes); Ihereditary Ihemolytic, Isuch Ias
Isickle IcellI(destruction Iby Ieryptosis); Iand I anemia Iof Ichronic Iinflammation I(multiple Icauses)
➢ Macrocytic-normochromic, Ior Imegaloblastic-normochromic, Ianemias Iare Icharacterized Iby Ilarger Ithan Inormal
erythrocytes Iwith Inormal Ilevels Iof Ihemoglobin. IThey Imost Icommonly Iare Icaused Iby Ideficiency Iof Ivitamin IB12
I (PA)Ior Ifolate.
➢ Aplastic Ianemia I(AA) Iis Ia Icritical Icondition Icharacterized Iby Ipancytopenia, Ia Ireduction Ior Iabsence Iof Iall
IthreeIblood Icell Itypes, Iresulting Ifrom Ifailure Ior Isuppression Iof Ibone Imarrow Ito Iproduce Iadequate Iamounts Iof
IbloodIcells
➢ Posthemorrhagic Ianemia Iis Ia Inormocytic-normochromic Ianemia Icaused Iby Iacute Iblood Iloss. IInitial
manifestations Iof Ithis Ievent Idepend Ion Ithe Iseverity Iof Iblood Iloss. IIf Iblood Iloss Iis Isevere, Ithe Isignificant
Imanifestations Iare Irelated Ito Iloss Iof Iblood Ivolume Irather Ithan Iloss Iof Ihemoglobin.
➢ The Ipredominant Ievent Iin Ihemolytic Ianemias Iis Ipremature Iaccelerated Idestruction Iof Ierythrocytes, Ieither
Iepisodically Ior Icontinuously. IThe Iconsequences Iof Ithe Ianemia Iare Ielevated Ilevels Iof Ierythropoietin Ito
IinduceIaccelerated Iproduction Iof Ierythrocytes Iand Ian Iincrease Iin Ithe Iproducts I of Ihemoglobin Icatabolism.
➢ Anemia Iof Ichronic Idisease I(ACD) Iis Ia Imild Ito Imoderate Ianemia Iresulting Ifrom Idecreased Ierythropoiesis Iin
individuals Iwith Iconditions Iof Ichronic Isystemic Idisease Ior Iinflammation I(e.g., Iinfections, Icancer, Iand Ichronic
Iinflammatory Ior Iautoimmune Idiseases). IThese Iconditions Iinclude Iacquired Iimmunodeficiency Idisease I(AIDS),
Imalaria I(particularly Ithat Icaused Iby IPlasmodium Ifalciparum), Irheumatoid Iarthritis, Isystemic Ilupus Ierythematosus
I(SLE), Iacute Iand Ichronic Ihepatitis, Iand Ichronic Irenal Ifailure I(a Icondition Iin Iwhich Ialmost Iall Iaffected Iindividuals
Iare Ianemic)
➢ This Iform Iof Ianemia Ialso Iis Icommonly Inoted Iin Ithe Ipresence Iof Icongestive Iheart Ifailure I(CHF).
The Ianemia Idevelops Iafter I1 Ito I2 Imonths Iof Idisease Iactivity. IThe Iinitial Iseverity Iis Irelated Ito Ithat Iof Ithe Iunderlying
Idisorder Ibut, Ialthough Ipersistent, Iit Iusually Idoes Inot Iprogress. IIndividuals Imay Ibe Iasymptomatic, Ior
the Ianemia Imay Ibe Ia Icoincidental Iclinical Ifinding.
6. The Iinflammatory Iprocess Iupon Iinjury I( Ich I7)
➢ The Iinflammatory Iresponse Iis Iinitiated Iupon Itissue Iinjury Ior Iwhen IPAMPs Iare Irecognized Iby IPRRs Ion Icells Iof Ithe Iinnate
Iimmune Isystem.
➢ There Iare Itwo Itypes Iof Ihuman Idefense Imechanisms: Iinnate Iresistance Ior Iimmunity Iconferred Iby Inatural Ibarriers Iand
the Iinflammatory Iresponse; Iand Ithe Iadaptive I(acquired) Iimmune Isystem.
➢ Many Idifferent Itypes Iof Icells Iare Iinvolved Iin Ithe Iinflammatory Iprocess Iincluding Imast Icells, Igranulocytes I(neutrophils,
Ieosinophils, Ibasophils), Imonocytes/macrophages, INK Icells Iand Ilymphocytes, Iand Icellular Ifragments I(platelets).
➢ The Icells Iof Ithe Iinnate Iimmune Isystem Isecrete Imany Ibiochemical Imediators Ithat Iare Iresponsible Ifor Ithe Ivascular
changes Iassociated Iwith Iinflammation Iand Ifor Imodulating Ithe Ilocalization Iand Iactivities Iof Iother Iinflammatory Icells.
IThe Imediators Iinclude Ihistamine, Ichemotactic Ifactors, Ileukotrienes, Iprostaglandins, Iand Iplatelet-activating Ifactor.
7. GI Isymptoms Iresulting Iin Iheart Iburn( Ich I41, Ipg I1429- I1466)
➢ The Iclinical Imanifestations Iof I(GERD) Ireflux Iesophagitis Iare Iheartburn Ifrom Iacid Iregurgitation, Ichronic Icough, Iasthma
Iattacks Iand Ilaryngitis.
➢ Heartburn Ialso Imay Ibe Iexperienced Ias Ichest Ipain, Iwhich Irequires Iruling Iout Icardiac Iischemia.
➢ Hiatal Ihernias Iare Ioften Iasymptomatic. IGenerally, Ia Iwide Ivariety Iof Isymptoms Idevelop Ilater Iin Ilife Iand Iare Iassociated
Iwith Iother Igastrointestinal Idisorders, Iincluding IGERD. IManifestations Iof Ithe Ivarious Itypes Iof Ihiatal Ihernia Iare Idifficult
Ito Idistinguish. ISymptoms Iinclude I heartburn, Iregurgitation, Idysphagia, Iand Iepigastric Ipain
➢ Early Istages Iof Iesophageal Icarcinoma Iare Iasymptomatic. IThe Itwo Imain Imanifestations Iof Iesophageal Icarcinoma Iare
chest Ipain Iand Idysphagia. IThe Imost Icommon Itype Iof Ipain Iis Iheartburn I(pyrosis). IIt Iis Iinitiated Iby Ieating Ispicy Ior Ihighly
Iseasoned Ifoods Iand Iby Ilying Idown.
8. Pulmonary Iterminology Isuch Ias Idyspnea, Iorthopnea, Ietc I( Ich I35, Ipg I1249)
➢ Dyspnea Iis Ia Ifeeling Iof Ibreathlessness Iand Iincreased Irespiratory Ieffort.
➢ Orthopnea Iis Idyspnea Iwhen Ia Iperson Ilies Iflat
➢ Paroxysmal Inocturnal Idyspnea Ioccurs Iat Inight Iand Irequires Ithe Iperson Ito Isit Ior Istand Ifor Irelief.
9. Complications Iof Igastric Iresection Isurgery I(c I41, Ipg I1439)
➢ Weight Iloss Ioften Ifollows Igastric Iresection Ibut Istabilizes Iwithin I3 Imonths. IInadequate Ifood Iintake Iis Ia Icommon Icause
Ibecause Imany Iindividuals Icannot Itolerate Ithe Iosmotic Ieffect Iof Icarbohydrates Ior Ia Inormal-size Imeal. IFoods Imay
Ibe Ipoorly Iabsorbed Ibecause Ithe Istomach Iis Iless Iable Ito Imix, Ichurn, Iand Ibreak Idown Ifood Iparticles. IAbdominal
Ipain, Ivomiting, Idiarrhea, Iand Imalabsorption Iof Ifats Ialso Icontribute Ito Iweight Iloss. IIn Ithe Icase Iof Ibariatric Isurgery
Ifor Iextreme Iobesity, Iweight Iloss Iis Ithe Iintended Ioutcome.
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