Pathophysiology Quiz 2 (Cancer, Inflammation, Immunity, Diabetes)

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All death rates for cancers have _____________ except __________ __________.
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All death rates for cancers have DECREASED except LIVER CANCER.
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_____% of men and _____% of women will be affected by cancer.
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43% of men and 38% of women will be affected by cancer.
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Neoplasia
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Abnormal growth and proliferation (rapid reproduction) of genetically altered cells that are unresponsive or independent of growth control mechanisms.
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What is cancer?
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A group of diseases that shares common features.
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What are the common characteristics of cancer?
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abnormal cell growth, poor differentiation of cells, invasion of cells
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Neoplasm
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tumor/new growth
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What is metastasis? (general description)
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metastasis is secondary growth of a tumor that occurs away from the original site of the tumor due to transportation provided by the blood and lymph.
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Cancer is the ___________ leading cause of death in the US behind ___________ ___________.
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Cancer is the SECOND leading cause of death in the US behind HEART DISEASE.
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What are the environmental risk factors for cancer?
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chemical carcinogens, pollution, radiation, diet, sexual behavior, pharmaceutical agents, obesity, chronic inflammation
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What are some examples of chemical carcinogens?
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tobacco, alcohol, drugs
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What are some examples of radiation?
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UV rays, radiographs
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What are some examples of pollution?
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asbestos, soil, radon, H2O
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What about diet can cause cancer?
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food additives, high fat and low fiber
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How can sexual behavior increase risk for cancer?
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STDs and increased sexual partners
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What chronic inflammatory conditions can increase risk for cancer?
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HIV, hepatitis, h-pylori, bronchitis, pancreatitis
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Differentiated
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cells that are recognizably the same as the original tissue that remain localized and provide a certain function for the body
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Benign
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slow growing, differentiated cells that are not fatal or cancerous
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Malignant
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rapidly growing, poorly differentiated cells that can spread to surrounding tissues and cause death
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What are the two hallmark signs of a tumor under a microscope?
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anaplasia and pleomorphic
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Anaplasia
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Cells that are not differentiated and are therefore not recognizable to the mature cells that are around it because they cannot carry out the same function as the cell they replaced.
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Pleomorphic
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varied size and shape of cell
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Carcinoma in Situ (CIS)
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a non-malignant, non-invasive tumor that can either go away on its own or develop into cancer
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Carcinogenesis
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production of cancer
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What are the four steps of carcinogenesis?
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1) initiation 2) promotion 3) progression 4) metastasis
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Initiation
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genetic mutation or exposure to something that causes the cell to change
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Promotion
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continuing change of the cell after the genetic mutation or exposure (follows initiation)
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Progression
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When the cells have become cancerous and deposit somewhere in the body to form a tumor that continues to grow
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Metastasis
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cells break off original site and move to other places in the body
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What are the five phases of metastasis?
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primary site invasion –> cell detachment into the blood or lymph (can be stopped by immune system @ this point) –> dissemination (spreading) –> secondary site attachment –> proliferation (growth) at new site
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Oncogene
Oncogene
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the mutated form of normal genes that promote proliferation and survival; cheerleader for cancer
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Tumor suppressor genes
Tumor suppressor genes
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inhibit cell proliferation and promote cell death or DNA repair; grim reaper of cancer
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Angiogenesis
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growth of new BVs to provide advanced cancerous cells greater than 1mm with oxygen and nutrients for continued growth
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What are the different neoplasms of epithelial origin?
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papillomas, adenomas, polyps, carcinomas, adenocarcinomas
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Papillomas
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benign finger-like growths on the squamous and basal cells of the skin, BVs, and vocal cords
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Adenomas
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benign growth in glandular tissue particularly breast tissue, prostate, and pituitary glands
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Polyps
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papillomas or adenomas that grow at the end of a stem in a mucous membrane and are usually benign but can be pre-cancerous
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Carcinomas
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malignant and invasive
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adenocarcinoma
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glandular and malignant
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What are the two types of neoplasms with connective tissue origin?
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sarcoma and osteoma
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sarcoma
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malignant and occurring in the muscle cells
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osteoma
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benign and occurring in the bone
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What two types of neoplasms have a neural tissue origin?
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glioma, glioblastoma (astrocytoma)
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Glioma
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a benign encapsulated tumor
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Glioblastoma/astrocytoma
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malignant
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What is a neoplasm called that forms in the lymphatic tissue?
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lymphoma
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What is a neoplasm that forms in the blood?
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leukemia
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What are two examples of cancer named after someone?
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Ewing sarcoma and hodgkin’s lymphoma
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Biopsy
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taking some of the tissue out of the body for testing, can be done by needle aspiration or punch biopsy
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What are tumor markers?
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substances released from the tumor that can be detected in the tumor itself, the blood, bodily fluid or urine
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What are the different types of tumor markers?
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hormones, enzymes, genes, antigens, antibodies
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What are the purposes for grading and classifying cancer?
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1) so it can be described easily to the pt. 2) determine treatment aggression 3) determine survival rate 4) quality and method of treatment 5) exchange info b/w treatment centers
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What does TMN stand for when determining the staging of cancer?
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T = tumor (size or extent of invasion rated 1-4) M = metastasis (yes or no? rated 0-1) N = nodes (extent of lymph node involvement; rated 0-3)
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What are the clinical manifestations of cancer?
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pain, fatigue, cachexia, anemia, leukopenia, thrombocytopenia, oral ulcers, malabsorption, diarrhea, GI obstruction, alopecia, skin breakdown and dryness from lack of epithelial renewal
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What causes cancer to be painful?
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The cancer itself is not painful, it is the invasion and compression of the healthy tissue or any nerve irritation that occurs from the abnormal cell growth.
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What is the most common sign of cancer and treatment?
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fatigue
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Cachexia
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loss of appetite due to early satiety (feeling full) that causes weakness, weight loss, changes in metabolism and changes in taste due to treatment
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Anemia
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low hemoglobin and hematocrit caused by malnutrition, chronic bleeding and/or iron deficiency
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Leukopenia
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low WBC count
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Thrombocytopenia
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low platelet count which decreases clotting ability
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alopecia
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hair loss from chemo
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What are your body’s lines of defense?
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skin and mucous membranes, inflammation, specific immune responses
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Inflammatory Response
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beneficial response to invasion of microorganism or injury
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What are the two phases of tissue reaction to injury?
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cellular phase and vascular phase
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Vascular phase
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involves chemical mediators from the plasma or cells that are released into the tissue when it is damaged
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What is a “compliment” during the vascular phase?
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a system of proteins that acts as the major mediator and enhances chemotaxis, increases vascular permeability and causes cell lysis
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What do ‘kinins’ do?
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contribute to pain and fever and specifically bradykinin causes vasodilation
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Histamine
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mast cells and basophils release this for potent vasodilation and increased capillary permeability
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What do serotonin and leukotrienes do?
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they are similar to histamines in the fact that they are vasodilators, but they are also bronchoconstrictors and react more slowly than histamines
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Prostaglandins
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increase the effects of histamine and pain response to injury while also promoting platelet aggregation so a clot can be formed
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Hemostatic-fibrinolytic system
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This is the end point and the first step in putting returning the BVs back to normal and getting rid of the clot when it is no longer needed.
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What vascular changes result from these chemical mediators?
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vasoconstriction –> vasodilation –> increased capillary permeability –> fluid leaks from intravascular to interstitial space –> edema –> stimulation of pain receptors
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cytokines
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regulators that enhance the vascular phase
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interleukins
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stimulate the liver to produce plasma proteins because a lot are being lost through leakage
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interferon
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blocks receptor site from virus so it can’t bind and invade the cell; does not kill the virus
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Tissue Necrosis Factor (TNF)
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increases the body’s fever response because neutrophils work better at higher temperatures (to a point)
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Cellular phase
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a WBC response causing phagocytosis
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What are the steps of the cellular phase?
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margination –> emigration of leukocytes–> phagocytosis –> formation of exudate –> fibrin barrier formation
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What happens during margination?
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the granulocytes come in and fight off the infection and the phagocytes move to the periphery of the BVs and “eat up” the foreign bodies that the granulocytes were fighting; note: monocytes are used more in chronic inflammation and granulocytes are for acute
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What are the three types of granulocytes?
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neutrophils, basophils, eosinophils
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Neutrophils
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primary responder that will elevate to the greatest extent
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What happens when the leukocytes emigrate?
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WBCs migrate to the area of infection (chemotaxis)
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What happens during phagocytosis?
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the target is recognized and neutrophils and macrophages start to engulf the pathogen which is then ingested through fusion with the lysosomes in the phagocyte. The lysosomal enzymes then destroy the foreign substance.
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What are the local responses to inflammation?
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increased tissue temp, redness, swelling, pain, formation and removal of exudate
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What are the systemic effects of inflammation?
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fever, increase in circulating plasma proteins, leukocytosis, lymphadenopathy
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Fever
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initiated by the release of pyrogens that act on the hypothalamus to raise the body’s thermostat
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Leukocytosis
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elevation in WBC count
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lymphadenopathy
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enlarged lymph nodes
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Adaptive immunity
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endogenous chemicals in cellular system that enhances specific activity/materials present w/in an environment
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immune deficiency
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too little or nonresistant response to a foreign antigen with infections being the most common foreign antigen
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hypersensitivity
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too much of a response to an antigen
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immunodeficiency
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impairment of the immune system
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What are primary immunodeficiencies?
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people are born with them

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