UNMC PATHO EXAM 2 UPDATE ACTUAL EXAM ALL QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY GRADED A+

UNMC PATHO EXAM 2 UPDATE ACTUAL EXAM ALL QUESTIONS AND CORRECT DETAILED ANSWERS |ALREADY GRADED A+ Function of the immune system - Correct Answer 1) to protect the body from invasion by foreign antigens - foreign substances that trigger the immune response 2) to identify and destroy potentially harmful cells 3) to remove cellular debris" "What accomplishes the functions of the immune system? - Correct Answer lymphoid organs & specifically designed lymphocytes through the process of antibody-mediated immune response & cell-mediated immune response." "General types of immune alterations - immune system acts inappropriately - Correct Answer 1) Exaggerated 2) Misdirected against host's own cells 3) Directed against beneficial foreign tissues 4) Deficiency / insufficient" "The type of hypersensitivity where antigen-antibody complexes form and are deposited in tissues is: a) IgE - mediated hypersensitivity b) Type I hypersensitivity c) Type III hypersensitivity d) Isoimmunity - Correct Answer C - Type III hypersensitivity NOTE: IgE-mediated hypersensitivity is Type I hypersensitivity Isoimmunity = Type II - tissue specific reaction" "All of the following are types of hypersensitivity EXCEPT: a) HIV disease b) Systemic Lupus Erythematosus c) Rheumatoid Arthritis d) Allergy - Correct Answer A - HIV disease is virus, NOT hypersensitivity" "What immune alterations are due to hypersensitivity reactions? - Correct Answer 1) Exaggerated 2) Misdirected against host's own cells 3) Directed against beneficial foreign tissues" "Exaggerated - Correct Answer overreaction against environmental antigens Allergic reaction = small Anaphylactic reaction = same as allergic reaction, but bigger" "Misdirected against host's own cells - Correct Answer autoimmunity = sees own cells as being foreign & destroys them." "Directed against beneficial foreign tissues - Correct Answer isoimmunity = body's immune reponse against beneficial foreign tissue - i.e. organ transplants" "Hypersensitivity - Correct Answer A pathologic immune response An exaggerated AND inappropriate immune response 1) Exaggerated 2) Autoimmunity 3) Isoimmunity" "Autoimmunity - Correct Answer Breakdown of that "code of recognition" Body's immune system begins to recognize self as foreign" "Autoimmunity Etiology - Correct Answer Related To: Genetics Exposure to antigens - thought to alter membranes and the expression of self-DNA, and induce this autoimmunity" "Isoimmunity - Correct Answer Body's immune system reacts against tissues of usually other members of the same species i.e. organ transplant" "Types of Hypersensitivity - Correct Answer 1) Type I - Allergy/Anaphylaxis 2) Type II - Tissue-specific reaction 3) Type III - Immune-complex mediated reactions 4) Type IV - Cell-mediated reactions" "Hypersensitivity Type I - Correct Answer Allergy / Anaphylaxis IgE-mediated allergic reactions" "Hypersensitivity Type II - Correct Answer Tissue specific reaction Blood Transfusion reaction" "Hypersensitivity Type III - Correct Answer Immune-complex mediated reactions Antigen-Antibody complexes form & deposit in tissues i.e. Lupus" "Hypersensitivity Type IV - Correct Answer Cell-mediated reactions Involve T cells, macrophages i.e. Rheumatoid Arthritis" "Allergy / Anaphylaxis - Correct Answer A rapid, immediate hypersensitivity reactions upon re-exposure to an antigen *** No reaction with initial exposure" "Allergy / Anaphylaxis Pathophysiology - Correct Answer Primary Exposure: 1) B cells comes in contact with Allergen 2) IgE produced 3) IgE sits on receptor of Mast Cell Secondary Exposure - when exposed to allergen again: 1) Mast cell degranulation 2) Release of histamine & leukotrienes" "Allergy / Anaphylaxis Manifestations - Correct Answer Related to Release of histamine & leukotrienes: Localized: local inflammation Systemic - related to where histamine receptors are located: * Bronchial constriction & laryngeal edema * Skin - itching/pruritis & redness/erythema * GI - abdominal cramping, vomiting, diarrhea * Mucus membranes - increased secretions - nasal, eyes water * Vasculature - increased vascular permeability & vasodilation ***Anaphylactic Shock = Life threatening, dropped BP, not perfusing" "Systemic Lupus Erythematosus - SLE aka Lupus - Correct Answer chronic, autoimmune, multi-system inflammatory disease" "Lupus Incidence - Correct Answer One of the most common Increased frequency in females Onset age 20-40 Genetic predisposition" "What level(s) of hypersensitivity is Lupus? - Correct Answer Level III - mostly Antigen-Antibody complexes form & deposit in vessel walls Body sees self as foreign" "5 components of Lupus * happen at same time - Correct Answer 1) B cells produce IgG - attack what thinks is DNA 2) T helper cells further stimulate B cell production of IgG 3) Macrophages recruited to further attack what is considered foreign DNA 4) IgG attacks RBC because thinks those are foreign too (in addition to DNA) 5) T-suppressor cells are NOT effective to slow down immune response appropriately" "Lupus Manifestations Signs & Symptoms - Correct Answer Exacerbations & Remissions Related to the 5 components: 1) Arthritis of peripheral joints - most common 2) Vasculitis - skin rash & photosensitivity - sensitive to UV light as triggering agent = triggers exacerbation of Lupus 3) Renal disease - due to damage to vascular walls over time & due to destruction of RBC 4) Anemia - due to destruction of RBC 5) CardioVascular disease - pericarditis * over time, problems with perfusion and damage to vessels" "Rheumatoid Arthritis - Correct Answer Autoimmune, inflammatory joint disorder characterized by destruction of the synovial membrane of the joint" "What level(s) of hypersensitivity is Rheumatoid Arthritis? - Correct Answer Type III & Type IV * Type III - Antigen-Antibody complexes * Type IV - Cell-mediated reactions - T cells & macrophage involved" "Rheumatoid Arthritis Pathophysiology - Correct Answer 1) Rheumatoid Factor = Normal ANTIBODIES become "autoantibodies" and attack ANTIGENS on cell membranes that it now views as foreign = Type III 2) Vasodilation & increased permeability of vasculature surrounding synovial space allow WBC to go into space - WBC + more fluid = congestion * WBC include T cells & macrophages = Type IV 3) Synovial space gets clogged up & destroyed 4) Fibrin deposits, collagen deposits, scar tissue" "What is Rheumatoid Factor? - Correct Answer Normal antibodies become "autoantibodies" and attack antigens on cell membranes that it now views as foreign" "Rheumatoid Arthritis Manifestations - EARLY - Correct Answer Peripheral Joints FIRST: 1) Synovitis - inflammation of synovial membrane 2) Minor systemic manifestations of inflammation Feel Stiff & achy, especially in the morning" "Rheumatoid Arthritis Manifestations - Once destruction starts - Correct Answer Tenderness & stiffness of joints" "Rheumatoid Arthritis Manifestations - LATE - Correct Answer * Pain, deformity, loss of function of joint * Rheumatoid Nodules - small pockets of inflammatory cells, not painful * Ulnar drift - wrist starts to deviate toward ulna - out" "Immune Deficiencies - Correct Answer 1) Congenital / Primary - born with 2) Acquired / Secondary" "Congenital Immune Deficiencies - Correct Answer Genetic Immune cells improperly developed Hypogammaglobulinemia Agammaglobulinemia SCID - Severe Combined Immune Deficiencies" "Acquired Immune Deficiencies - Correct Answer 1) Associated physiologic conditions - pregnancy, infancy, elderly, chronic illness, malnutrition 2) Latrogenic - from medical treatment; i.e. chemo, steroids 3) Trauma - i.e. burns 4) Stress" "AIDS Acquired Immune Deficiency Syndrome - Correct Answer Viral disease" "AIDS Caused by - Correct Answer HIV-1 - retrovirus Carries its genetic coding in its RNA * infects/attacks and depletes a portion of the Immune System - cells with CD4 receptors/T-helper cells * then starts to attack macrophages & cytotoxic T-cells" "Steps of HIV infection - Correct Answer 1) HIV surface glycoprotien - gp120 - attaches to CD4 receptor on T-helper cells 2) Chemokine co-receptor aids in binding of gp120 3) Viral RNA converted into DNA with help from 3 enzymes - Reverse Transcriptase, Integrase, & Protease 4) DNA is inserted and integrated into the T-helper cell. Basically takes over cell = cell isn't a T-helper cell anymore, so T-helper cell values drop" "HIV Pathophysiology - Correct Answer 1) HIV-1 carries its genetic code in its RNA 2) HIV surface gp120 glycoprotein, with help from Chemokine, binds to CD4 receptor on T-helper cells 3)Genetic material transformed into DNA 4) Spread to other cells: a) Remain latent = no spread b) New HIV particles bud out c) Lysis of cell with release of particles" "Lab Values for HIV / AIDS - Correct Answer 1) ELISA 2) Western Blot * Both detect antibody to the virus * In 99% of people - the antibody is ineffective 3) T-helper cell count & ratio 4) Viral load" "T-helper cell count & ratio - Correct Answer 1) Overall number of T-helper cells *** NL = 800-1000 for anyone withOUT HIV 2) Ratio of T-helper cells to T-suppressor cells - look at ratio & number! *** NL = 2:1 ; 1,000 T-helper to 500 T-suppressor ; problems as it nears 1:1 & lower numbers overall" "Viral load - Correct Answer amount of "active" virus in the bloodstream the lower the better" "Stages of HIV - Correct Answer 1) Serologically negative 2) Serologically positive 3) Early stages of HIV disease 4) AIDS" "Stage of HIV 1) Serologically negative - Correct Answer have the virus without antibodies produced or detected YET can take 6 weeks to 6 months to form antibodies" "Stage of HIV 2) Serologically positive - Correct Answer Asymptomatic - no real symptoms Detectable antibodies" "Stage of HIV 3) Early stages of HIV disease - Correct Answer Symptoms, but NOT AIDS yet" "Stage of HIV 4) AIDS - Correct Answer serious clinical symptoms and/or malignancies and often T-helper cell count 200" "Time Line of HIV Infection - Correct Answer - Enter body 1) No Antibody production 2) Antibody production 3) Early stages of HIV disease 4) AIDS" "How does HIV enter the body? - Correct Answer Body fluids that contain & can transmit HIV by coming into contact with a MUCOUS MEMBRANE of another person * penis, rectum, vagina, mouth Blood - directly or used needle Semen - pre-seminal fluid Rectal fluids Vaginal fluids Breast milk" "HIV is spread mainly by? - Correct Answer 1) Having anal or vaginal sex with someone who has HIV without using a condom or taking medicines to prevent or treat HIV * Anal sex is highest-risk behavior * Vaginal sex is second-highest risk behavior 2) Sharing needles or syringes, rinse water, or other equipment used to prepare drugs for injection with someone who has HIV. * HIV can live on used needles up to 42 days - depending on temp & other factors" "HIV Manifestations - Signs & Symptoms Serologically Negative - Correct Answer Asymptomatic - No manifestations Ability to unknowingly transmit the virus" "HIV Manifestations - Signs & Symptoms Serologically Positive - Correct Answer Asymptomatic - No manifestations 20% experience a sero-conversion illness - resembles mono or flu that goes away" "HIV Manifestations - Signs & Symptoms Early Stages of HIV disease - Correct Answer * Chronic lymphadenopathy - lymph node enlargement * Night sweats * Recurrent fevers * Flu-like, fatigue * Weight loss, anorexia, diarrhea" "HIV Manifestations - Signs & Symptoms AIDS - Correct Answer * Opportunistic infections * Malignancies - cancers" "HIV Treatment & Prevention - Correct Answer 1) Prolong immune function 2) Restore immune function 3) Prevention of viral replication 4) Vaccine development" "HIV Treatment & Prevention Prolong immune function - Correct Answer everyday healthy lifestyle avoid infections (crowds, salad bars, etc)" "HIV Treatment & Prevention Restore immune function - Correct Answer What has been tried hasn't worked! * Bone marrow transplants and WBC infusions - DIDN'T WORK * Colony stimulating factors - DIDN'T WORK" "HIV Treatment & Prevention Prevention of viral replication - Correct Answer Drugs to block the action of the enzymes or to block fusion" "HIV Treatment & Prevention Vaccine development - Correct Answer Slow HIV is very variable both genetically & antigenically" "Which of the following is FALSE regarding autoimmunity? a) It involves a breakdown of "tolerance" b) The body begins to recognize foreign antigens as "self" c) There can be a genetic predisposition to develop the disorders d) Development of autoimmune disorders can be related to exposure to antigens such as drugs or infections - Correct Answer B - the body begins to recognize SELF as FOREIGN Autoimmunity DOES: involve breakdown of tolerance have genetic predisposition can be related to exposure to antigens" "Clinical manifestations related to the release of histamine include all of the following EXCEPT: a) Vomiting/diarrhea b) Itching/erythema c) Bronchial dilation d) Increased Vascular Permeability - Correct Answer C - Bronchial Constriction is a manifestation related to release of histamine" "Which of the following is FALSE regarding Systemic Lupus Erythematosus (SLE)? a) It consists of a Type III hypersensitivity reaction b) There is increased frequency in females c) The main problem is over-reaction of T cells d) It is an autoimmune disease - Correct Answer C - T cells do not over-react in Lupus NOTE: Type III hypersensitivity = Antigen-Antibody complexes form & deposit in vessel walls; body sees self as foreign" "Which of the following is FALSE regarding Rheumatoid Arthritis? a) It consists of a Type III hypersensitivity reaction b) It consists of a Type IV hypersensitivity reaction c) WBC enter the synovial space causing further inflammation & destruction d) It is progressively chronic, with usually no remissions - Correct Answer D - Rheumatoid Arthritis has exacerbations & remissions NOTE: Type III hypersensitivity = Antigen-Antibody complexes Type IV hypersensitivity = involves T cells & macrophages" "Which of the following is a FALSE statement? a) Primary immune deficiency can be due to a genetic cause b) Burns can be a cause of secondary immune deficiency c) Both primary & secondary immune deficiencies result from cancer or viral infection d) Secondary immune deficiency may result from normal physiologic changes - Correct Answer C - only secondary deficiency results from cancer or viral infection; Primary deficiency = born with improperly developed immune cells" "Which of the following best describes HIV infection? a) It is a bacterial disease in which the individual becomes extremely susceptible to life-threatening infections b) The HIV particles engulf T-helper cells c) The virus can spread through airborne mechanisms d) The HIV particles insert their DNA into the T cell DNA - Correct Answer D - HIV particles insert their DNA into T cell DNA NOTE: viral disease HIV particles infiltrate T helper cells virus spreads through body fluids" "A clinical manifestation that is similar to anaphylaxis, systemic lupus erythematosus, and Rheumatoid arthritis is: a) Bronchial constriction b) General systemic manifestations of inflammation - i.e. fever, fatigue, weakness, achiness c) arthritis of joints d) renal disease - Correct Answer B - anaphylaxis, Lupus, & RA all manifest general systemic inflammation symptoms NOTE: Bronchial constriction = Anaphylaxis Arthritis of joints = Lupus & RA Renal disease = Lupus" "Which disorder is characterized by an over-production of IgG which causes antigen-antibody complexes to be formed and deposited in vessel walls? a) Systemic Lupus Erythematosus b) Rheumatoid Arthritis c) HIV Disease d) Anaphylaxis - Correct Answer A - Lupus NOTE: Antigen-Antibody complexes = Level III hypersensitivity RA is Type III & Type IV - involves T cells & macrophages" "What etiological factors can lead to bronchopulmonary dysphasia - BPD? - Correct Answer Mechanical ventilation Premature birth RDS O2 toxicity" "Which type of croup leads to airway obstruction? - Correct Answer Acute Epiglottitis" "What occurs pathophysiologically with Cystric Fibrosis - specifically in the lungs & pancreas? - Correct Answer * Thick, tenacious mucus obstructs airways - chronic respiratory disease * Deficiency of trypsin, amylase, & lipase - malabsorption - elevated sodium chloride in sweat from ineffective chloride movement out of cell & high reabsorption of sodium into cells * complications affect all organ systems" "Pediatric Respiratory Disorders Incidence - Correct Answer Children have 6-8 respiratory tract infections PER year" "Upper Respiratory Tract Disorders - Correct Answer Aspiration Croup" "Aspiration - Correct Answer inhalation of fluid or solid objects into tracheobronchial system * mostly right mainstem because of straight pathway" "Aspiration Etiology - Causes - Correct Answer * Impaired gag reflex or swallowing, * tubes in the epiglottis, * communication between esophagus & trachea - tracheoesophageal fistula" "Aspiration High risk - Correct Answer * young children who cannot adequately chew * unconscious patients" "Aspiration Pathology - Correct Answer * Normally - epiglottis protects trachea from foreign objects * May be only trauma, irritation, or inflammation - dependent on content aspirated * Chemicals can erode & destroy trachea or lung tissue * Solid object may block blonchi, bronchiole, or some alveoli = decreasing inhalation of air" "Aspiration Prevention & Treatment (She has as "Manifestations" on the print-outs) - Correct Answer * Infants - Prevention best management * Suction baby's airway when head is delivered * control use of baby powder * Avoid overfeeding * Cut toddlers' food into small pieces * Avoid toys with small pieces * Remove object by suction bronchoscopy, or obstructed airway maneuver - Heimlich" "Croup - Correct Answer Syndrome of clinical manifestations in upper airway resulting in narrowing of the airway" "Croup Etiology - causes - Correct Answer Bacterial or viral microorganisms causes inflammation, swelling, & mucus production" "Croup Pathophysiology - Correct Answer 1) Inflammation of larynx, pharynx, or epiglottis 2) Swelling leads to airway narrowing 3) Increased mucus production" "Croup Acute Laryngotracheo-Bronchitis Manifestions - Signs & Symptoms - Correct Answer GRADUAL Onset Rhinitis & Fever Inspiratory STRIDOR Harsh, high crowing noise" "Croup Viral Croup Manifestations - Signs & Symptoms - Correct Answer Sudden onset AT NIGHT Afebrile - NO fever High pitch STRIDOR Muffled voice" "Croup Acute Epiglotitis Manifestations - Signs & Symptoms - Correct Answer Sudden onset - life threatening Fever Inspiratory WHEEZING Restlessness, drooling, difficulty swallowing NOTE: remember the epiglotis is what closes off airway for food = difficult swallowing" "Lower Respiratory Tract Disorders - Correct Answer Respiratory Distress Syndrome - RDS Bronchopulmonary Dysplasia - BPD Asthma Cystic Fibrosis" "RDS - Respiratory Distress Syndrome aka Hyaline Membrane Disease Incidence - Correct Answer 5-10% of premature infants 70% of deaths in premature infants 30-50% of all neonatal deaths" "RDS - Respiratory Distress Syndrome Etiology - Causes - Correct Answer * Decreased surfactant production * Immature lung tissue - underdeveloped and uninflatable alveoli" "At 24 weeks gestation Reason for little chance of survival - Correct Answer * Very small amount of surfactant * Very few developed terminal sacs * Under-developed vascularity" "At 26-28 weeks gestation Reason for higher chance of survival - Correct Answer * Usually sufficient surfactant * Lung development to permit survival" "RDS - Respiratory Distress Syndrome Pathology - Correct Answer 1) Premature infant's lungs immiture = atelectasis - alveioli unable to inflate or opened to exchange O2-CO2 2) Pulmonary blood flow limited by decreased vascular development 3) Decreased surfactant - surfactant acts to reduce surface tension & stabilize alveoli 4) alveoli difficult to expand 5) Need increased respiratory effort to inhale air & prevent collapse of alveoli during expiration 6) CO2 & O2 cannot cross alveolar-capillary membranne = Increased pCO2 & decreased pO2; Hypoxemia - respiratory acidosis 7) Fibrin clots or film - hyaline membrane = decrease gas diffusion in alveolar-capillary interstitium" "RDS - Respiratory Distress Syndrome Manifestations - Signs & Symptoms - Correct Answer Obvious immediately at birth * Increased RR * Intercostal retractions * Labored breathing - expiratory grunting, nasal flaring * Decreased pH & pO2 with Increased pCO2 = respiratory acidosis * Chest x-ray shows atelectasis" "Bronchopulmonary Dysplasia - BPD Associated with - Correct Answer Chronic lung disease in infants & young children" "Bronchopulmonary Dysplasia - BPD Etiology - Causes - Correct Answer Premature birth RDS - Respiratory Distress Syndrome Prolonged mechanical ventilation O2 toxicity" "Bronchopulmonary Dysplasia - BPD Pathology - Correct Answer * Mechanical ventilation with O2 acts as irritant to lung tissue - continuous inflammation * Scarring & stiffening of lung tissue * Alveoli fail to multiply * Chronic inflammation - increased mucus & plugging of alveoli & shunt unit" "Bronchopulmonary Dysplasia - BPD Manifestations - Signs & Symptoms - Correct Answer * Hypoxemia * Chest X-ray - CXR shows atelectasis * Respiratory Acidosis - decreased pH & pO2, increased pCO2 * Respiratory infections" "Asthma in children aka - Correct Answer Reactive Airway Disease" "Asthma - Correct Answer Inflammatory disease characterized by: 1) Increased mucous production 2) Edema 3) Bronchospasms Leading to narrowing of airways" "Asthma Etiology - Causes - Correct Answer Viral respiratory tract infection Allergens Genetics - 30% of cases Irritants in air - i.e. cigarette smoke Exercise Sulfites" "Asthma Prevalence - Correct Answer 5-10% of all children to some degree 80% of affected have symptoms beyond 5 years old" "Asthma Pathophysiology - Correct Answer Large & small airways effected: Allergens trigger release of IgE - mast cell degranulation - * Increased mucous production * Edema of bronchial mucosa * Bronchospams - air trapped in lungs - inadequate ventilation, hypoxemia, hypercapnia, respiratory acidosis, & respiratory failure" "Asthma Manifestations - Signs & Symptoms - Correct Answer Related to narrowed airways & SOB: * Wheezing - mostly on expiration * Cough - sometimes causes vomiting * Irritability, restlessness * Dyspnea, chest tightness * Tachypnea * Nasal flaring * Anxious facial expression * Diaphoresis - sweating" "Cystic Fibrosis - Correct Answer Chronic exocrine gland disorder" "Cystic Fibrosis Etiology - causes - Correct Answer Autosomal recessive gene - Chromosome 7 Results in excessive, thick mucous production - obstruction of respiratory & pancreatic ducts" "Cystic Fibrosis Incidence - Correct Answer 1:2,500 children most common fatal genetic disease" "Cystic Fibrosis Pathology - Correct Answer 1) Production & stasis of thick, tenacious mucus - obstructive pulmonary disease 2) Pancreatic exocrine deficiency of trypsin, amylase, & lipase - malabsorption 3) Chronic respiratory disease 4) Elevated Sodium Chloride in sweat from ineffective chloride movement out of cell & high reabsorption of sodium into cells 5) Complications affect all organ systems" "Cystic Fibrosis Manifestations - Signs & Symptoms - Correct Answer Respiratory: * Thick mucus blocks airways = air trapping, atelectasis * Frequent respiratory infections & inflammatory response * Chronic cough/sputum production * Barrell chest * Chronic rhinitis * Clubbing of fingers - chronic hypoxia GI Tract - R/T not enough trypsin, amylase, & lipase Emaciated - thin, malabsorption of calories Stereatorrhea - fatty, foul smelling BMs" "The lack of what substance in the alveoli leads to RDS? - Correct Answer surfactant" "Proliferation - Correct Answer rapid, abnormal reproduction of cells" "Erythrocytes - Correct Answer RBC doughnut-shaped disc to increase surface area = can carry more O2 Flexible - can flatten to squeeze through capilaries" "Erythrocytes Functions - Correct Answer Transport O2 via Hgb to cells Transport CO2 to lungs" "Leukocytes - WBC Functions - Correct Answer Defend body against infectious organisms Remove debris 1) Granulocytes 2) Agranulocytes" "Granulocytes - Correct Answer Phagocytes = ingest & destroy bacteria & debris 1) Neutrophils - first 2 days of inflammation = MOST important in fighting infection * Segs = mature form of neutrophils * Bands = immature form of neutrophils 2) Basophils - anti-parasitic 3) Eosinophils - control inflammatory/allergic responses" "What does excessive Bands mean? - Correct Answer Trying to pump out new neutrophils really fast Severe infection" "Agranulocytes - Correct Answer 1) Macrophages - powerful phagocytes * Monocyte = immature macrophage 2) Lymphocytes - primary cells of immune response; make antibodies = T & B" "Thrombocytes - Platelets Functions - Correct Answer Blood coagulation / clotting Control of bleeding" "Hematopoiesis - Correct Answer production of RBC, WBC, & Platelets in bone marrow" "Hemostasis - Correct Answer arrest of bleeding" "Hemostasis with Minor injuries - Correct Answer Vasoconstriction formation of platelet plug" "Hemostasis with Major injuries - Correct Answer Clot formation via coagulation cascade" "Physiology of Coagulation Cascade - Correct Answer Intrinsic Pathway from blood vessel injury + Extrinsic Pathway from tissue injury - Aggregation of platelets at site of injury - Simulation of formation of Prothrombin - Prothrombin converts to Thrombin - Forms Fibrinogen - Fibrinogen converts to Fibrin - Factor XII stabilizes clot - Forms Fibrin Clot - When clot isn't needed anymore, Breakdown of Clots via Fibrin Degredation Products - FDPs" "Disorders of Platelet Function - Correct Answer Thrombocytopenia" "Thrombocytopenia - Correct Answer low Platelet count Platelet 100,000" "Thrombocytopenia Etiology - Causes - Correct Answer 1) Autoimmune disorder - immune system destroys platelets 2) Complication of Heparin therapy - Heparin-Induced THrombocytopenia - HIT; Heprin is anticoagulant 3) Blood loss" "Thrombocytopenia Manifestations - Signs & Symptoms - Correct Answer Related to Decreased Platelets - Hemorrhage * Epistaxis - nose bleed - #1 due to digital manipulation - nose picking * Petechiae - micro-hemorrhage in capillaries * Hematuria - blood in urine * Ecchymosis - bruises * Bleeding gums" "Disorders of Coagulation - Correct Answer Disseminated Intravascular Coagulation - DIC" "Disseminated Intravascular Coagulation - DIC - Correct Answer Sequence of events resulting from abnormal, diffuse activation of Coagulation & Fibrinolysis * Fast & overwhelming clotting & clot-breakdown" "Disseminated Intravascular Coagulation - DIC Incidence - Correct Answer Critically ill adults" "Disseminated Intravascular Coagulation - DIC Etiologies - causes - Correct Answer ** Most common - Septicemia - sepsis = overwhelming systemic blood infection * Burns * Trauma * Shock * Terminal Cancers * Emboli - clots in vessels" "How does Septicemia cause DIC? - Correct Answer Bacteria breaks down - Releases endotoxins - Endotoxins act as procoagulant" "Disseminated Intravascular Coagulation - DIC Pathophysiology - Correct Answer Procoagulants stimulate clotting - Overstimulation of coagulation system - Excess Fibrin formation - Systematic/Disseminated Intravascular Clotting - 1) Increased consumption of platelets & clotting factors = decreased platelets & clotting factors = hemorrhage 2) Fibrin deposits in microcirculation/capillaries = Widespread organ ischemia & infarction from poor perfusion = Clotting" "Disseminated Intravascular Coagulation - DIC Manifestations Related to Microvascular/Capillary clotting - Correct Answer CNS: decreased LOC from brain not perfused Skin: Gangrene & necrosis from ischemia Kidney: Oligura & renal failure GI: Acute ulcerations & necrosis from ischemia LUNGS: SOB & Pulmonary Embolis" "Disseminated Intravascular Coagulation - DIC Manifestations Related to Hemorrhage - Correct Answer CNS: Intracranial bleeding Skin: Petechiae & Echymosis Kidney: Hematuria GI: Bleeding in upper & lower GI MUCOUS MEMBRANES: Gingival bleeding" "Disorders of Leukocyte Function - Correct Answer Multiple Myeloma" "Multiple Myeloma - Correct Answer Malignant disorder characterized by proliferation of abnormal plasma - B-lymphocyte - cells in the bone marrow" "Multiple Myeloma Incidence - Correct Answer Peaks in 60s" "Multiple Myeloma Etiology - Causes - Correct Answer Unknown Triggered by viruses, bacteria, chemicals May have genetic component" "Multiple Myeloma Pathophysiology - Correct Answer Excess abnormal plasma cells - B-lymphocytes Infiltrate bone marrow - develop into tumors - destroy bone - invade lymph nodes, liver, spleen & kidneys" "Abnormal Plasma cells - B-lymphocytes Produce - Correct Answer Myeloma - M - protein" "Multiple Myeloma Manifestations - Signs & Symptoms - Correct Answer Onset - slow & insidious 1) Frequent infections 2) Anemia & Bleeding 3) Bone pain & Pathological Fractures 4) Renal insufficiency or Renal Failure *From M proteins trying to get thru nephrons - too big" "Alterations in Lymphoid Function - Correct Answer Lymphoma" "Lymphoma - Correct Answer Malignant disease of the lymphoid tissue Includes Thymus, bone marrow, lymph nodes, spleen * 90% are in lymph nodes" "Thymus - Correct Answer below sternum, in front of heart only active during puberty Produces T-cells" "Lymphoma Etiology - Causes - Correct Answer Unknown Triggered by Virus? May be due to Chromosome abnormality Higher risk in immunosuppressed" "Lymphoma Incidence - Correct Answer Hodgkin's - peak 20-30 y/o Non-Hodgkin's - 50+ y/o" "Lymphoma Pathophysiology - Correct Answer Normal lymph node or tissue lymph structure destroyed by excessive proliferation of lymphocytes * Abnormal, excessive, out-of-control growth of lymphocytes - Destruction of lymph nodes or tissue lymph structure" "Hodgkin's Lymphoma Characterized by - Correct Answer Reed-Sternberg cells in lymph nodes * look like Owl's eyes" "Non-Hodgkin's Lymphoma Characterized by - Correct Answer Detect abnormal cells - 36 different types * bone marrow involvement more often than Hodgkin's" "Lymphoma Manifestations - Signs & Symptoms - Correct Answer Classic - Enlarged, painless Lymph nodes Nondescript - Night sweats, fever, weight loss" "Why is the RBC so efficient in carrying O2? - Correct Answer Shape provides additional surface area Flexibility allows it to squeeze through capillary walls" "What two paradoxical / opposite clinical manifestations occur simultaneously in Disseminated Intravascular Coagulation - DIC? Why - Correct Answer Systemic Clotting and Clot-breakdown 1) Procoagulants stimulate clotting & poor perfusion stimulates more clots 2) Coagulation system is over-stimulated and uses up all the platelets & clotting factors, forcing breakdown of clots" "How is Hodgkin's lymphoma diagnosed microscopically? - Correct Answer Reed-Sternberg cells found in lymph node" "Normocytic - Correct Answer normal RBC size" "Microcytic - Correct Answer small RBC size" "Macrocytic - Correct Answer large RBC size" "Normochromic - Correct Answer normal Hemoglobin" "Hypochromic - Correct Answer low Hemoglobin concentration" "Anemia - Correct Answer Reduced circulating erythrocytes and/or decreased hemoglobin * Low RBCs or Hgb" "Hyperchromic - Correct Answer high Hemoglobin concentration" "Anemia Etiologies - Causes - Correct Answer 1) Altered production 2) Blood loss - hemorrhage 3) Increased destruction 4) Combination of altered production, blood loss, & increased destruction" "Anemia Manifestations - Signs & Symptoms - Correct Answer Related to tissue hypoxia * Weakness * Fatigue * Increased RR * Dizziness * Fainting * Lethargy * Decreased Hemoglobin * Pale earlobes, conjunctiva, & palms * If allowed to continue = Cardiac, renal, & other systemic results" "Normocytic - Normochromic Anemia - Correct Answer Normal sized RBC & Normal concentration of Hemoglobin 1) Aplastic Anemia 2) Post hemorrhagic Anemia 3) Hemolytic Anemia 4) Anemia associated with Chronic Inflammation 5) Sickle-Cell Anemia" "Aplastic Anemia - Correct Answer Normocytic - Normochromic Anemia Insufficient number of RBCs * WBCs & Platelets often also diminished" "Aplastic Anemia Etiologies - Causes - Correct Answer Related to abnormal stem cell production, infiltrative disorders of bone marrow, or altered stem cell environment * Drugs - chloraphenical, benzene * Toxins - radiation, immunologic * Injury to bone marrow" "Post Hemorrhagic Anemia - Correct Answer Normocytic - Normochromic Anemia Loss of RBCs * Severe shock, lactic acidosis * Death * If blood loss is 40-50%" "Hemolytic Anemia - Correct Answer Normocytic - Normochromic Anemia Premature destruction of RBCs 1) Acquired from infections, drugs, toxins, systemic diseases, liver or kidney diseases 2) Hereditary - Hemolytic disease of newborn due to: * ABO incompatibility - mother type O & baby type A, B, or AB * Rh incompatibility - mother Rh negative & baby Rh positive" "Anemia associated with Chronic Inflammation - Correct Answer Normocytic - Normochromic Anemia Increased damand for RBCs * Seen in HIV & inflammatory diseases - Lupus, Rheumatic Fever * Chronic Renal Failure - kidneys do not produce erythropoietin - bone marrow not stimulated to produce RBCs - RBCs not produced - Chronic Anemia" "Sickle-Cell Anemia - Correct Answer Normocytic - Normochromic Anemia Abnormal SHAPED RBCs AND abnormal Hemoglobin synthesis * Autosomal recessive disorder seen in persons from equatorial countries" "Sickle-Cell Anemia Incidence - Correct Answer Mostly African-Americans 7-13% chance of having trait 0.7% chance of having disease" "Sickle-Cell Anemia Pathophysiology - Correct Answer Decreased oxygenation & dehydration from * Hypoxia or infections * High altitude * Exercising * Flying in unpressurized airplanes - Abnormal S-Hemoglobin "sickles" - RBC becomes inflexible & stiff - * occludes blood vessels * increased viscosity of blood * Further sickling of cells from increased de-oxygenation of tissue, infarctions, & pain - When re-oxygenated & rehydrated - cells regain normal shape" "Sickle-Cell Anemia Manifestations - Correct Answer Don't appear until 6 months - decrease of F-Hemoglobin at that time 1) Pallor, fatigue, jaundice, irritability 2) Vaso-occlusive Crisis if extensive sickling" "Vaso-occlusive Crisis Pathophysiology - Correct Answer Begins in Microcirculation - log-jam of sickled RBCs - thrombosis & tissue infarction - severe pain * Lasts 4-6 days - improves with rehydration & reoxygenation" "Vaso-occlusive Crisis Manifestations - Signs & Symptoms - Correct Answer Painful swelling of joints, hands, & feet Abdominal pain Enlarged liver & spleen - due to excessive RBC breakdown" "Sickle-Cell Anemia Prognosis with Disease - Correct Answer Life-expectancy is unpredictable - may die in 20s * Infection is most common cause of death" "Macrocytic - Normochromic Anemia - Correct Answer Large RBC - normal Hemoglobin concentration * Pernicious Anemia" "Pernicious Anemia Etiology - Correct Answer Macrocytic-Normochromic Anemia Decreased Gastric secretion of Intrinsic Factor - Malabsorption of Vit B12 because intrinsic factor is necessary for absorption of Vit B12 - Decreased Vit B12 - Decreased Erythrocyte / RBC production because B12 is necessary for RBC production - RBCs are abnormal & large - RBCs die - Anemia" "Pernicious Anemia Incidence - Correct Answer Usually seen late in adult life May be a congenital form developing before 2 y/o" "Microcytic - Hypochromic Anemia - Correct Answer Small RBC & low Hemoglobin concentration * Iron Deficiency Anemia" "Iron Deficiency Anemia - Correct Answer Microcytic-Hypochromic Anemia Lack of iron for hemoglobin production" "Iron Deficiency Anemia Incidence - Correct Answer Most common type of anemia" "Iron Deficiency Anemia Etiology - causes - Correct Answer * Continual blood loos - menorrhagia, ulcers, ulcerative colitis, GI bleeds from meds * Insufficient dietary intake - Pregnancy = increased need - 6 months to 2 y/o = increased iron needed for growth & cow's milk does NOT contain iron * most common anemia in young children" "Acute Leukemia - Correct Answer * Disorder of accumulation and proliferation of immature WBCs which do not function as normal cells * Crowds the bone marrow, causing reduction in other cellular components of the blood - pancytopenia * Highly undifferentiated, immature blast cells * Abrupt & Rapid Onset * Short survival time" "ALL - Acute Lymphocytic Leukemia - Correct Answer 80% from B cell line 15-20% of all types from T cell line" "Chronic Leukemia - Correct Answer * Cells are well differentiated and can be identified = Mature Cells * but NOT function normally * Gradual Onset * Survival time - Longer" "Iron Deficiency Anemia Pathophysiology - Correct Answer 1) Stage I - body's store of RBCs depleted 2) Stage II - Insufficient iron = altered RBCs produced 3) Stage III - Hypochromic RBCs put into circulation = RBCs are small & contain decreased concentration of Hemoglobin" "Iron Deficiency Anemia Manifestations - Signs & Symptoms - Correct Answer * Develops slowly * Asymptomatic until Stage III * Common manifestations of Anemia - R/T tissue hypoxia * Children may show: - Pica - decreased growth - developmental delays" "Hemophilia - Correct Answer Genetic disease caused by deficiency of blood clotting factors essential for forming a clot * Hemophilia A - deficient Factor VIII * Hemophilia B - deficient Factor IX * Hemophilia C - deficient Factor XI" "Hemophilia A - Correct Answer Deficient Factor VIII Classic Hemophilia Most common type X-linked recessive" "Hemophilia B - Correct Answer Deficient Factor IX "Christmas Disease" X-linked recessive Less severe than Hemophilia A" "Hemophilia C - Correct Answer Deficient Factor XI Autosomal recessive Least severe type" "Hemophilia Manifestations - Signs & Symptoms - Correct Answer Infrequent in 1st year of life Symptoms start showing at 3-4 y/o * Easy bruising & bleeding * Hemarthrosis - bleeding into joint spaces - into elbows, knees, ankles * Pain, limits movement, predisposes degenerative changes in joint * Recurrent bleeding after injury or minor trauma" "Leukemia - Correct Answer Malignant disease of the blood & blood-forming organs causing an accumulation of dysfunctional cells and a loss of cell division regulation" "Leukemia Incidence - Correct Answer Most common malignancy of childhood - 33% of all cancers More common in adults over 50 y/o - chronic form" "Leukemia Classification - Correct Answer According to cell involved & stage of development in which maturation was stopped * Acute Lymphoblastic - ALL - 50% of childhood leukemia * Acute Myelogenous - AML - Common Adult type * Chronic Lymphocytic - CLL - Common Adult type * Chronic Myelogenous - CML" "Leukemia Etiology - Causes - Correct Answer * Exact cause unknown * Tends to run in families - 2-4 times greater chance if sibling has it * Increased incidence in association with other genetic abnormalities - i.e. Down's, Fanconi syndrome * Acquired disorders i.e. myelofibrosis, Hodgkin's, Multiple Myeloma, CLL, CML - may cause Acute * Large doses of ionizing radiation = Myelogenous Leukemia * Drugs which cause bone marrow depression = predispose person to Leukemia * High doses of chemotherapy for Hodgkin's, Myeloma, Ovarian cancer = Acute Myelogenous * Viruses cause Leukemia in animals, but not proven in humans yet" "Leukemia Manifestations - Signs & Symptoms - Correct Answer Related to Bone Marrow Depression: * Anemia - reduced RBCs * Bleeding - reduced Platelets * Fever - reduced WBCs Related to Neurological infiltrates or cerebral bleeding: * Headache, vomiting, blurred vision, papilledema (swollen optic nerve from increased cranial pressure) Other: * Anorexia, weight loss, muscle wasting * Abdominal pain/tenderness" "Leukemia Prognosis - Correct Answer * Longer remission periods & increased survival rates with combined therapy - Bone marrow transplant + chemotherapy + improved blood products + anti-microbial agents * 80% survival rate of 5 years for Acute Lymphocytic Leukemia * 38% survival rate of 5 years for all leukemias * Longer life expectancy for Chronic leukemias" "What conditions in a sickle cell anemia client led to a sickle cell crisis? - Correct Answer Decreased oxygenation Dehydration" "What pathophysiologic effect does sickling of the RBC cause? - Correct Answer Occluded blood vessels increased viscosity of blood further sickling of cells & increased deoxygenation of tissues, infarctions, & pain" "Multiple Myeloma is characterized by: a) Enlarged lymph nodes b) Uncontrolled proliferation of immature leukocytes c) Decreased production of RBCs and platelets d) Proliferation of abnormal B-lymphocytes - Correct Answer D" "Which of the following conditions in a sickle cell anemia client lead to a sickle cell crisis? a) Deficiency of blood clotting factors b) fibrinolysis c) hypoxemia d) iron deficiency - Correct Answer C" "Infection occurs with leukemia. Why? a) decreased production of blood clotting factors b) decreased production of platelets c) decreased production of RBCs d) Leukocytes produced by the bone marrow are immature in form. - Correct Answer D" "Describe what happens pathophysiologically in leukemia that leads to anemia, hemorrhage, and infections. - Correct Answer Accumulation & proliferation of immature WBCs crowd the bone marrow - reduction of other blood cells including: insufficient RBCs = anemia insufficient Platelets = Hemorrhage Immature or non-functioning WBCs = infections" "The blood cells that are responsible for coagulation are the: a) Erythrocytes b) Eosinophils c) Leukocytes d) Thrombocytes - Correct Answer D" "The term used in anemia to describe the RBCs being too small is: a) Hypochromic b) Normocytic c) Microcytic d) Sickle cell - Correct Answer C" "What is the main problem with sickle cell anemia? a) iron deficiency - necessary to form Hemoglobin b) RBCs become inflexible - cannot squeeze out of capillaries c) new sickle cell cannot carry O2 d) Painful swelling from heat and vasodilation - Correct Answer B" "Treatment of sickle cell crisis includes all of the following EXCEPT: a) O2 therapy b) Ice to relieve painful joints c) Transfuse with whole blood d) Hydration - Correct Answer B" "The intrinsic pathway of the coagulation cascade is normally initiated by: a) Injury to blood vessel b) Injury to tissues c) Fibrinogen conversion to Fibrin d) Platelet aggregation at the injured site - Correct Answer A" "In disseminated intravascualr coagulation, the earliest step is: a) Fibrin deposits in the microcirculation b) decreased platelets and clotting factors c) increased consumption of platelets and clotting factors d) overstimulation of the coagulation system by procoagulants - Correct Answer D" "Clinical manifestations of leukemias include all of the following EXCEPT: a) Reed Stemberg cells in the lymph tissue b) Anemia c) Flu-like symptoms, fever d) Enlarged spleen - Correct Answer A"