Partial preview of the text
Download ADVANCED PATHOPHYSIOLOGY EXAM QUESTIONS WITH CORRECT DETAILED ANSWERS VERIFIED ANSWERS A+ and more Exams Pathophysiology in PDF only on Docsity!
Overview of the Blood - correct answers-*Blood ©5000ml *Plasma ©3000m! Hematocrit defined - correct answers-- % of RBCs [higher value = higher viscosity = thicker blood) - Example: Polycythemia may have Hct of 60-70% Types of Blood Cells - Erythrocytes [RBCs) - correct answers-- Transport O2 - Small disc shape - Lifespan = 120 days - Carry Hgb [ferrous oxide, also an acid/base buffer) - Made in the bone marrow - Iliac crest for sample in leukemia [after age 20 in the vertebrae, sternum, ribs, iliac) - Hgb Levels: 14-16g/dL in males / 12-14g/dl females Cytic vs Chromic - correct answers-Cytic = Size of RBCs Chromic = Amount of Hgb MCV and MCHC - correct answers-MCV: Mean corpuscular volume - [average size rbc] MCHC: normal Mean corpuscular Hgb concentration - [average amount of hemoglobin in the RBCs compared to the average size of the RBCs. The amount of hemoglobin that was there Morphology Size or Erythrocyte Volume Cytic Values - correct answers-- Normocytic: Normal RBC size [MCV = 83-99) - Microcytic: Small RBC size [MCV = 50-82) - Macrocytic: Large RBC size [MCV is > 100) Chromic Values [Hgb content) - correct answers-- Normochromic: Normal amount of Hgb [MCHC -Average amount of hemoglobin in the RBCs compared to the average size of the RBCs. [MCHC = 32-36) - Hypochromic: Low amount of Hgb [MCHC is < 32) - Hyperchromic: Increased amount of Hgb [MCHC is > 36) Leukocytes [WBCs) - correct answers-- Defend the body against foreign proteins - Made in the bone marrow - 9,000/mm*3 - CBC w/ Diff shows: Leukocytes broken down into: Neutrophils, Basophils, PMNs [polymorphonulcear), Bands Bands - {Infective process - correct answers--Immature Leukocytes - Indicate an infective process - Increase in bands = 12 to 20 or more = shift to the left indicating a bacterial infection - If bands are not increased it is a shift to the right and a viral infection Alterations of Leukocytes WBC Morphology/Fx - correct answers-- Bands being immature with infection there is an increase in production = shift to the left - Neutrophils = segs or polys = mature polymorphonuclearcytes and segmented WBC's and bands - correct answers-Should tell you right away that when you have an infection and the WEBCs are called on to replicate and attend to this infection, that the faster they do it the more immature cells they have so the more bands produced. How to tell if an infection is viral or bacterial? - If there is a shift to the left [increase in bands) it is bacterial - correct answers-- This is because of the way the differential used to be displayed [Shift to the left then you would see the WECs going up, the bands going up, the neutrophils or segs rising as well and the other percentages going down [lymphocytes and monocytes in particular] Response to infections - correct answers-- Neutrophils are released - Many are immature or "bands" - "Shift to the left" indicating more bands = acute bacterial infection - "Shift to the right" indicates a more viral infection Platelets - correct answers-- Small, round, colorless cells - Made in the bone marrow - Lifespan: 5 - 8 days - Normal level: 150k - 300k - Key substance for blood clotting Pathology of Platelets - correct answers-- Thrombocytopenia Purpura Caused by: Viruses, radiation, and drugs - Example = HELLP Syndrome: [Hemolysis. Elevate Liver enzymes. Low Platelets) Due to Hypertension,spilling proteins Pathology of Platelets and pregnancy - correct answers-- Seen in pregnant women - The liver doesn't make platelets - Delivery of the baby is the treatment - C-section is the best way, To prevent mother from deteriorating into a DIC - risky due to low platelet count Blood Proteins - Albumin - correct answers-- Normal range is 3-5 - Sponge Responsible for blood osmotic pressure aka oncotic [pulling) force - Albumin and its presence in the bloodstream and with it , hydrostatic pressure and oncotic pressure functions and blood returns to the vascular tree. - Assists with wound healing Problems with low albumin levels - correct answers-- Low albumin = low oncotic pressure = leakage of fluids into the interstitial space = ascites and edema of dependent extremities - Albumin Usually <2 is incompatible with life although Reavis has seen people come back low albumin levels - correct answers-- Decreased albumin is usually from decreased liver fx - Reavis says that giving albumin IV does nothing because it doesn't stay in the vessels, it leaks out. Reavis surgeon story about Albumin - correct answers-- Liver CA pt had 19L of paracentesis fluid removed - MD filtered it and put it back into the pt IV which caused a spike in albumin resulting in a spike in oncotic pressure resulting in a crisis and increased CVP - Disorders of hemostasis - Disorders of Leukocytes 5 Classifications of Anemias by etiology - correct answers-- Altered Hgb synthesis - Altered DNA from deficient nutrients - Stem Cell dysfunction - Bone marrow infiltration - RBC Destruction Class of Anemia: - Altered Hgb Synthesis - correct answers-- IDA (Iron deficiency anemia) - Thalassemia - Anemia of chronic disease Class of Anemia: - Altered DNA from deficient nutrients - correct answers— Pernicious anemia [B12) Class of Anemia: - Stem Cell dysfunction - correct answers-- Aplastic anemia [cells not made at all) - Myeloproliferative leukemia Class of Anemia: - Bone marrow infiltration - correct answers-- CA - Lymphoma Class of Anemia: - RBC / Erythrocyte Destruction - correct answers-- Blood loss - Hemolysis INTRAcorpuscular [cell itself) - Hgb S [sickle cell) - G6PD [Oxidation-Glucose-6-phosphate dehydrogenase deficiency) - EXTRAcorpuscular [outside the cell) - Immune mechanisms - Infection Red blood cells / glycolysis / ATP - correct answers-How dependent the red blood cell is on ATP production from glycolysis - The glucose molecule through glycolysis you get this bisphosphoglycerate which is the precursor to the hemoglobin that is necessary for the red blood cell to function correctly. Blood Loss Anemia - correct answers-- Acute hypovolemia and shack usually - Cells are normcytic and normochromic - Low H&H - Hypoxia causes and increase in RBC production [compensatory mechanism - takes a while) - H&H should return to normal in 3-4 weeks Blood Loss Anemia - Causes: - correct answers-- L&D [iron supps and prenatal vits help prevent this - In one month back to normal) - Trauma - Insidious loss due to ulcers or lesions *According to Reavis, all pts of age or that are insidiously bleeding With a drop in hemoglobin are to have a colonoscopy to help prevent colon CA Microcytic Anemia - small cell - correct answers-MCV 52-82, MCHC 24-32 - Do not hold as much hemoglobin = low MCHC Microcytic Anemias: Seen in : - correct answers— IDA = Iron deficiency anemia - Thalassemia Anemia [aplastic and early iron deficiency] - correct answers-- EARLY iron deficiency [transferrin rises [when iron stores in body are low] and ferritin falls[blood cell contains iron] =lron deficiency anemia - Aplastic Anemia - Cancer hypoplastic cell invading the bone marrow where red blood cells are made Macrocytic Values - correct answers-- Big RBCs MCV > 100 MCHC > 36 3 Types of Macrocytic Anemias - B12 deficiency - Folic acid deficiency - Antimetabolites - correct answers-- Low B12: normal folate - Must be used with Intrinsic factor which is missing from the stomach - Low B12 and normal Folate - Tx: B12 injections - Folic acid deficiencies: - Low folate - Causes neural tube deficits - Tx: Oral folic acid Macracytic Anemias - Antimetabolites - correct answers-- Antimetabolites: - Pernicious [destruction of parietal cells /Gastric mucosa = no production of intrinsic factor which absorbs B12) - Tx: B12 Reavis pt story about B12 - correct answers-- Has a pt that comes in for B12 shots because it gives them more energy - Insurance does not pay for this be the pt lacks a dx of pernicious anemia Etiology of B12 Deficiency - correct answers-- Inadequate intake - Decreased absorption - Inadequate utilization - Usually occurs in the Sth or 6th decade of life Forms of B12 deficiency - correct answers-- Pernicious - Autoimmune disease producing autoantibodies to gastric parietal cells and their secretory produce [IF) - necessary for B12 absorption - Crohn's disease - Whipple's disease - Sprue [Increased cases) - Post Gastrectomy (B/c the parietal cells have been removed) -Drugs / Chemotherapy RDA [Recomm. Daily Allowance) of B12 - correct answers-- 2 micrograms/day [avg person gets 3-9/day) - Alcoholics are usually low in B12 because according to Reavis they only buy alcohol and not food so they have low dietary intake S/S of B12 deficiency - correct answers-1.* Smooth/beefy red tongue + atrophy on top [atrophic glossitis) - not tongue rugae 2. - Fatigue 3. - Malabsorption/diarrhea from megaloblastosis of epithelial cells of small intestine 4.- Paresthesia/numbness from peripheral neuropathy / lesions in posterior-lateral columns spinal cord/cerebrum) S/S of B12 deficiency continued - correct answers-5. Loss of vibratory and position sense * a. Loss of Sensory ataxia * b. Positive Romberg - balance test with eyes closed * c, Weakness * d. Spasticity Hereditary Hemachromatosis (HH) - Etiology [cause] - correct answers-- Hereditary: autosomal RECESSIVE - In general population: 0.3% - 0.5%, but 11% are carriers - Most common hematologic genetic disorder [in US) - 1/10 Caucasians are carriers *Body absorbs to much iron* Hereditary Hemachromatosis (HH) - - Etiology continued - correct answers-- Males affected 5-10 times more than females [iron loss during menses prevents it from showing up) - First s/s usually appear after age 40 - Environmental factors may accelerate the process due to: a. Iron rich diet, High intake of Vit C, Alcohol abuse Reavis story about Hereditary Hemachromatosis [HH) - correct answers-- Male pt in for annual check up - ls a recovering alcoholic in rehab and takes megavitamins - CBC showed an elevated Hgb - Skin was sallow and yellow in appearance Hereditary Hemachromatasis [HH) Patho - correct answers-- Disorder of iron metabolism [IRON OVERLOAD) - Increased intestinal iron absorption - Deposited ino the liver, pancreas, heart, joints, pituitary gland and endocrine glands - This causes progressive tissue damage and functional impairment Hereditary Hemachromatosis (HH) Patho continued Not on lecture - correct answers-- Normally crypt cells have HFE protein that facilitates transferrin receptor dependent iron uptake - Disorder in crypt cells of the duodenum - HFE protein malfunctions cause relative iron deficiency = an increase in DMT-1 [Divalent metal iron transporter 1) -Equals increase in intestinal absorption S/S of Hereditary Hemachromatosis [HH) - correct answers-- Fatigue - Abdominal pain - Arthralgia - Weight loss - Change in skin color [marked) - Decreased libido - Palpitations - Menstrual changes - Impotence [of both sexes according to Reavis) - Cirrhosis - Diabetes Diagnosis of Hereditary Hemachromatosis (HH) - Labs - correct answers--CBC with deifferential - Elevated Transferrin saturation - Elevated ferritin levels * Fasting in the AM when levels are the highest - Liver Bx [quantitative hepatic iron) Treatment of Hereditary Hemachromatosis (HH) - correct answers-- Early Dx and Tx prevent long-term complications - Goal is to remove excess iron periodically through: - Diabetes may NOT improve, but disease progression may SLOW - Arthralgia, impotence, menstrual problems may NOT improve Increased Epogen = - correct answers—~ Increased bone pain - Sternal tenderness Causes of Leukocytosis - increased WBC's - correct answers-- Infectious organisms - Exercise - Emotional changes - Temp changes - Anesthesia, surgery - Pregnancy - Drugs - Hormones - Toxins Alterations of Leukocytes - can be quantitative - correct answers-*Quantitative* 1. Bone marrow dysfunction 2.Premature destruction of cells a. May originate in lymphoid organs secondary to infectious process Leukocytosis is a defense mechanism... - correct answers-- Absolute Leukocyte count that is HIGHER than normal - Absolute neutrophil count is greater than 7500 - Neutrophils become so few that they cannot defend your body Leukopenia - correct answers-- Never normal or beneficial - Defined as as an absolute blood cell count less than 4000 cells/mm3 Pathologic Leukocytosis - correct answers-- From Malignancies - Hematologic disorders such as Myelotic leukemia having an absolute neutrophil count greater 100,000/microliters which * Increases the viscosity of the blood and the risk of thrombus formation Neutropenia - correct answers-- Defined as neutrophil count 200/microliter Low count of Neutrophils which destroy bacteria. Causes of Neutropenia - correct answers-- Severe prolonged infection - Aplastic anemia - leukemia - Drug or Toxin induced - Starvation / anorexia nervosa Neutropenia is a classic s/s of what? - correct answers-Anorexia nervosa Severe Neutropenia [Granulocytopenia or Agranulocytosis] - correct answers-Called [Granulocytopenia or Agranulocytosis] which causes: - Interference with hematopoiesis - Increased cell destruction in circulation from: a.Chemotherapeutic agents b.Drugs: NSAIDS and anti-thyroid drugs Agranulocytosis can be a complication of what? - correct answers-Anti-thyroid medications S/S of Severe Neutropenia - correct answers-- Malaise - Septicemia - Fever - Tachycardia - Acute infection - Long-term steroid therapy - Ovulation and pregnancy Lymphocytes and Infectious Mononucleosis [Mono) - correct answers-- Acute - Self-limiting - Neoplastic lymphoproliferative syndrome - Infection of B lymphocytes - From the EBV - Etiology: viral transmission, oral/fecal Lymphocytes and Infectious Mononucleosis - correct answers-- Incubation period is 30-60 days - Diagnosed with blood tests - Monospot may be false positive) - Heterophilic antibody test is the MOST ACCURATE way to dx Mononucleosis - *HAT* test Leukemia - correct answers-- Clonal malignant disorder of blood / blood forming organs - Accumulation of dysfunctional cells - Loss of cell division regulation causing uncontrolled proliferation of leukocytes which: - causes overcrowding of bone marrow - and decreased production and function of normal hematopoietic cell 4 Types of Leukemias - correct answers-- (ALL): Acute Lymphocytic - (AML): Acute Myelogenous - (CLL): Chronic Lymphocytic - (CML): Chronic Myelogenous Classes of Leukemias - correct answers-1. Acute or chronic comes as Undifferentiated or immature [blast) cells 2. *Myeloid or Lymphoid Leukemia arise from: - 80% are from B cells - 15% - 20% are from T cells Acute Leukemias - correct answers-- Usually seen in the neonate period - Onset is abrupt - Survival is short Most common genetic error resulting in Leukemia - correct answers-- Reciprocal translocation between chromosomes 9 and 22 (Philadelphia chromosome) Chronic Leukemias - correct answers-- Have mature cells, but they don't function normally - Onset is gradual - Survival is longer ALL is most commonly seen in... - correct answers-Kids Clinical Manifestations of ALL - acute lymphocytic leukemia - correct answers-Anemia Bleeding DIC Infection Weight loss Bone pain -Elevated uric acid [by product of protein catabolism, urate concentration secondary to dehydration caused by anorixa or fever and drug TX] - TX: Chemotherapy, supportive TX, allopurinol for gout, bone marrow transplants 
