PCCN 2024 Exam Questions Marking Scheme

PCCN 2024 Exam Questions Marking Scheme what type of WBC increases with anaphylaxis - ANSWER- basophils what type of WBC increases with allergic reaction or parasite? - ANSWER- eosinophils what are mature neutrophils? - ANSWER- segs what are immature neutrophils? - ANSWER- bands what are types of granulocytes? - ANSWER- neutrophils, eosinophils, and basophils what are types of agranulocytes? - ANSWER- monocytes, lymphocytes (T and B lymphocytes) what type of WBC "starts the war" or triggers an immune response? - ANSWER- monocytes what is a shift to the left with neutrophils? - ANSWER- an increase in immature neutrophils (bands). if bands 10% start thinking infection or inflammation what do basophils become when they leave the vessels and enter tissues for response? - ANSWER- mast cells what are common stress responses? - ANSWER- PE, pneumonia, GI bleed normal platelet count - ANSWER- 150,000-400,000 what is reversal agent for heparin? - ANSWER- protamine sulfate what is reversal agent for coumadin? - ANSWER- vitamin K or FFP what are causes of DIC? - ANSWER- sepsis, blood or immuno disease, if greater than 4 units PRBCs received in 24 hours, solid organ transplant, trauma what is DIC? - ANSWER- unpredictable clotting, some progress to bleeding bc used up all of clotting factors, always secondary diagnosis to something else what are s/s of DIC? - ANSWER- dusky fingers/toes (clotting in capillaries), bleeding (gums, oozing of IV sites), unexplained petechiae/bruising lab changes in DIC - ANSWER- -decreased platelets 100,000 -increased coags (PTT, INR, PT) -decreased fibrinogen levels (protein precursor to fibrin which is essential to make the clot) -increased FSPs (things that make the clot) -increased D dimer how to treat DIC - ANSWER- treat clotting phase with heparin treat bleeding phase with cyroprecipitate - blood product of choice for hemorrhage related to DIC - gives pt back clotting factors AND fibrinogen What is HIT? - ANSWER- Heparin Induced Thrombocytopenia. platelets decrease 5-14 days after receiving heparin. more likely to be caused by low molecular weight heparin (SQ). see unpredictable clotting, more common in venous. what is HIT treatment? - ANSWER- stop all heparin! including heparin flushes. stop coumadin! don't want to give platelets because it will cause more clotting. what is most common reason patients reject an organ/blood? - ANSWER- they develop antibodies what are s/s of hypoglycemia? - ANSWER- pale, sweaty, cool/clammy, shaky, confusion, vision changes (blurred or seeing spots) what do cells start to break down when they dont have glucose for energy? what does this produce? - ANSWER- proteins and fats, ketones what is DKA? - ANSWER- more commonly in type one diabetics who produce little to no insulin. as glucose in blood increases, it causes osmotic diuresis and patient excretes large volumes of urine. patient may become hypovolemic. patient will develop ketoacidosis and lactic acidosis. what s/s of DKA? - ANSWER- blood sugar 250-800 sweet, fruity breath postural hypotension kusmol respirations (deep + labored) to decrease CO2 to attempt to normalize pH nausea/vomiting what are the hallmarks of DKA? - ANSWER- high blood sugars ketones in urine and blood acidosis with low bicarb what is treatment for DKA? - ANSWER- fluid volume resusitation and insulin drip what kills DKA patient? - ANSWER- hypokalemia