NR 507- Advanced Patho Midterm

Afterload - answer-The amount of resistance the ventricle must overcome to pump blood Increased by hypertension, pulmonary disease, and damage to aortic valve Alloimmunity - answer-When an individuals immune system reacts against antigens on tissues of other members of same species i.e. transplant rejection, transfusion reaction, neonatal disease where maternal immune system becomes sensitized against antigens expressed by fetus Alpha-1 antitrypsin - answer-Protects the lungs against proteolysis If deficient--> lung disease such as COPD Anemia of chronic disease/inflammation - answer-Initially normocytic-normochromic but changes to microcytic-hypochromic caused by decreased erythropoiesis and impaired iron utilization in those with chronic disease/inflammation i.e. CHF, CKD, infections Aortic regurgitation murmur - answer-High-pitched early diastolic murmur heard loudest at left lower sternal border Diastolic rumbling at heart's apex and systolic crescendo-decrescendo murmur at left upper sternal border Aortic regurgitation x-ray - answer-signs of pulmonary edema and cardiomegaly Aortic stenosis murmur - answer-S4 gallop Mid-systolic crescendo-decrescendo murmur heard loudest at base and radiating to neck Aplastic anemia - answer-normal MCHC Suspect if levels of circulating erythrocytes, leukocytes, and platelets are also diminished Cardiac output - answer-volume of blood pumped from each ventricle per minute The stroke volume x heart rate Causes of folic acid deficiency - answer-decreased dietary intake, increased requirement, impaired utilization Causes of hemolytic anemia - answer-Acquired (transfusion reaction, hemolytic disease of newborns, drug, infectious, etc.) Genetic (structural defects, plasma protein mutation, enzyme deficiencies) causes of iron deficiency anemia - answer-dietary deficiency, impaired absorption, increased requirement, chronic blood loss Causes of vitamin B12 deficiency - answer-Decreased nutritional intake, impaired absorption COPD Stage 1- Mild - answer-FEV1/FVC ratio <70% FEV1 >80-100% COPD Stage 2- Moderate - answer-FEV1/FVC ratio <70% FEV1 50-80% COPD Stage 3- Severe - answer-FEV1/FVC ratio <70% FEV1 30-50% COPD Stage 4: Very severe - answer-FEV1/FVC ratio <70% FEV1 <30% Extrinsic asthma - answer-Triggered by chronic allergic reaction elevated IgE More common in children and males i.e. mold, pollen, dust, dander Genetics of Autoimmune disease - answer-Often familial but appear as different autoimmune conditions in different family members Heart failure Stage A - answer-Has risk factors but no symptoms Heart failure stage B - answer-Structural heart damage but no symptoms Heart failure stage C - answer-Symptomatic with alteration in daily function d/t dyspnea and swelling Heart failure stage D - answer-end-stage heart failure Maximized all pharmacologic therapies Consider transplant/LVAD/pacemaker Hematocrit - answer-Volume of cells as a percentage of the total volume of cells and plasma in whole blood Normal for men: 42-45% Normal for women: 37-48% Hemoglobin - answer-Oxygen-carrying pigment of red cells Normal for men: 13.5-17.5 Normal for women: 12-15.5 Hemolytic anemia - answer-premature accelerated destruction of erythrocytes Hyperchromic - answer-increased hemoglobin high MCHC dark color Hypochromic - answer-decreased hemoglobin low MCHC RBCs pale color Intermittent Stage Asthma - answer-Day sx: <2 days/week Night sx: <2 days/month Activity level: normal Severe exacerbation: 0-1/year FEV1: >80% FEV1/FEV: normal Intrinsic asthma - answer-Triggered by a non-allergic factor No IgE elevation Typically seen in adults >40 i.e. chemicals, exercise, anxiety, GERD, obesity Iron deficiency anemia - answer-Accompanied by low ferritin and transferrin levels Low MCHC Microcytic, hypochromic Macrocytic anemia - answer-MCV >100fl Large RBCs i.e. B12 deficiency, folate deficiency Mean cell volume (MCV) - answer-Measurement of the average size of the RBC Normal: 80-100 Mean corpuscular hemoglobin (MCH) - answer-Weight of hemoglobin per RBC Normal: 27-33 Mean corpuscular hemoglobin concentration (MCHC) - answer-Average concentration of hemoglobin per erythrocyte Normal: 32-36 Microcytic anemia - answer-MCV <80fL Small RBCs i.e. iron deficiency anemia, sideroblastic, thalassemia Mild Persistent Asthma Stage - answer-Day sx: 2-6 days/week Night sx: 3-4 day/month Activity level: Minor limitation Severe exacerbation: 2/year FEV1: >80% FEV1/FEV: Normal Mitral regurgitation murmur - answer-Blowing pansystolic murmur heart at heart's apex and radiates to back and axilla Mitral stenosis murmur - answer-Low-pitched murmur at heart's apex Moderate persistent asthma stage - answer-Day sx: daily Night sx: >1 night/week Activity level: some limitation Severe exacerbation: 2/year FEV1: 60-80% FEV1/FEV: Decrease by 5% of normal Normochromic - answer-normal amount of hemoglobin normal MCHC Normal color Normocytic anemia - answer-MCV 80-99fl normal size RBCs i.e. hereditary spherocytosis, acute blood loss, paroxysmal nocturnal hemoglobinuria NYHA Stage 1 - answer-Mild, no limitations of physical activity Ordinary activity does not cause symptoms NYHA Stage 2 - answer-Mild, slight limitation of physical activity Comfortable at rest Ordinary physical activity results in fatigue, palpitations, dyspnea, anginal pain NYHA Stage 3 - answer-Moderate, marked decrease in physical activity Marked limitation of physical activity Comfortable at rest Less than ordinary activity causes fatigue, palpitations, dyspnea, or anginal pain NYHA Stage 4 - answer-severe disability, unable to tolerate normal ADLs Obstructive PFTs - answer-Decreased FEV1/FVC <70% Decreased FEV1 No change with bronchodilator challenge