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PAS- PATHOPHYSIOLOGY > CHAPTER 29 > Flashcards

CHAPTER 29 Flashcards

Alterations of Leukocyte, Lymphoid, and Hemostatic Function

1
Q

what are leukocytes?

A 
basophils
eosinophils 
neutrophils 
monocytes 
lymphocytes
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2
Q

granulocytes (polymorphonuclear leukocytes)

PMNs

A

basophils
eosinophils
neutrophils

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3
Q

alterations of leukocyte function

  • deficiencies occur in the quality and quantity of leukocytes counts are low (leukopenia)
  • numbers of leukocytes are increased, counts are high (leukocytosis)
  • reasons affecting leukocyte production:
  • -many _____ are _____
  • -many nonhematologic malignancies metastasize to the _____, affecting _____ production
A

hematologic disorders
malignancies
bone marrow
leukocyte production

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4
Q

granulocytosis (neutrophilia)

  • is evident in the first stages of infection or inflammation
  • if the need for neutrophils increases beyond the supply, then immature neutrophils (banded neutrophils) are released into the blood
  • premature release of _____ is termed a _____
  • -_____
A

immature leukocytes
shift-to-the-left
leukemoid reaction

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5
Q

infectious mononucleosis

  • acute, self-limiting viral infection of _____
  • commonly caused by the _____-_____
  • transmission: usually by saliva through personal contact (e.g., kissing, hence the term kissing disease)
A

b lymphocytes

EBV-85%

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6
Q

infectious mononucleosis in _____ is
-an acute viral infection of lymphocytes: infectious mononucleosis is a lymphoproliferative clinical syndrome produced by acute viral infection of B lymphocytes

-causative agents include _____, CMV, adenovirus, hepatitis, HIV, and influenza A and B

A

children

epstein-barr

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7
Q 
infectious mononucleosis 
clinical manifestations- malaise, arthralgia
-classic triad of symptoms 
--\_\_\_\_\_
--\_\_\_\_\_
--\_\_\_\_\_ of the \_\_\_\_\_
  • diagnostic test
  • -_____ test for _____ detects _____
A 
fever
pharyngitis
lymphadenopathy
cervical lymph nodes 
monospot qualitative 
heterophillic antibody
immunoglobulin M (IgM)
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8
Q

leukemias

  • are malignant disorders of the blood and blood-forming organs
  • exhibit uncontrolled proliferation of malignant leukocytes
  • -overcrowding of bone marrow
  • -decreased production and function of normal hematopoietic cells
  • classification:
  • -predominant cell of origin: _____ or _____
  • -rate of progression: _____ or _____
A

myeloid
lymphoid
acute
chronic

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9
Q

leukemia classification
predominant cell of origin: _____ or _____
rate of progression: _____ or _____

  • _____: occurs in both children and adults
  • _____: most common type of leukemia in children. also affects adults
  • _____: mainly affects adults
  • _____: most often in people over age 55
A 
myeloid 
lymphoid
acute 
chronic 
acute myelogenous leukemia (AML)
acute lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)
chronic lymphocytic leukemia (CLL)
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10
Q

leukemias

acute leukemia:

  • presence of undifferentiated or immature cells, usually blast cells
  • disease from the _____

chronic leukemia

  • predominant cell is mature but does not function normally
  • slow progression
  • disease starts _____
A

bone marrow

outside the bone marrow

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11
Q

for acute and chronic leukemias

  • the current classification of leukemia is based on:
    1. the _____ (either _____ or _____)
    2. the _____ which usually reflects the degree at which cell differentiation was arrested when the cell became malignant (_____ or _____)
A 
predominant cell type 
myeloid
lymphoid 
rate of progression
acute
chronic
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12
Q

acute lymphocytic leukemia
disease from the _____!! so…
-is defined as greater than 30% _____ in blood or bone marrow
-ALL is an increase in _____ to more than 30%
-ALL is the most common leukemia in children
-most common childhood leukemia
-ALL is a _____ defined by the presence of _____ in the _____ or _____

A 
bone marrow
lymphoblasts 
lymphoblasts 
progressive neoplasm 
greater than 30% lymphoblasts 
bone marrow
blood
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13
Q

acute myelogenous leukemia (AML)
disease from the _____!! so…
-acute myelogenous leukemia (AML) is caused by an abnormal proliferation of _____

A

bone marrow

myeloid precursor cells

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14
Q

chronic leukemia

-disease starts outside the _____

A

bone marrow

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15
Q

leukemias
chronic myelogenous leukemia (CML)
-is usually diagnosed in adults
-is a myeloproliferative disorder that also includes polycythemia vera, primary thrombocytosis, and idiopathic myelofibrosis

-_____ is often present and _____ causes initiation of CML

A

philadelphia chromosome

BCR-ABL1

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16
Q

chronic myelogenous leukemia (CML)

  • _____ is often present and _____ causes initiation of CML
  • the Philadelphia chromosome is present in more than _____ of those with CML, and the presence of the _____ protein is responsible for the initiation of CML
A

philadelphia chromosome
BCR-ABL1
95%
BCR-ABL1

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17
Q 
leukemias 
clinical manifestations 
CML
-\_\_\_\_\_, \_\_\_\_\_, and \_\_\_\_\_
-\_\_\_\_\_ phase
--lasts \_\_\_\_\_ years 
--symptoms: may not be apparent 
-\_\_\_\_\_ phase
--lasts \_\_\_\_\_ months 
--primary symptoms develop: \_\_\_\_\_ 
-\_\_\_\_\_ phase
--"\_\_\_\_\_ crisis"
--survival: only \_\_\_\_\_ months
A 
infections 
fever
weight loss
chronic 
2 to 5
accelerated
6 to 18
splenomegaly
terminal blast 
blast
3 to 6
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18
Q

CML

  • _____ cure for CML
  • combined _____
  • _____ modifiers
  • _____
A

no
chemotherapy
biologic response
allogenic stem cell transplantation

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19
Q

chronic lymphocytic leukemia (CLL)

  • affects monoclonal B lymphocytes
  • _____ fail to mature into _____ that synthesize _____. CLL is derived from transformation of a _____ that has not yet encountered _____
  • has familial tendency
  • is common in adults older than 50 years
A 
B cells
plasma cells
immunoglobulins 
partially mature B cell
antigen
20
Q

malignant lymphomas

  • two major categories
  • -_____
  • -_____
  • results from genetic mutations or a viral infection
A

hodgkin lymphoma

non-hodgkin lymphoma

21
Q

hodgkin lymphoma

  • _____ in the _____
  • -are necessary for the _____ but not specific to _____
  • -are derived from _____ that usually become _____
  • types
  • -classic Hodgkin lymphoma
  • -nodular lymphocyte-predominant hodgkin
A 
Reed-Sternberg cells 
lymph nodes
diagnosis 
hodgkin lymphoma
malignant B cells
binucleate
22
Q

hodgkin lymphoma

-_____ cells represent _____ and _____ of _____

A

reed-sternberg (RS)
malignant transformation
proliferation
B cells

23
Q

hodgkin lymphoma
clinical manifestations:
-enlarged painless neck lymph nodes
-_____, causing _____ and _____. local symptoms caused by _____ and _____ of the _____ are the result of _____
-mediastinal mass
-fever, weight loss, night sweats, pruritus, fatigue,

tests:
-chest x-rays, lymphangiography, and biopsy (biopsy most indicative of Hodgkin lymphomas)

A 
lymphadenopathy
pressure
obstruction
pressure
obstruction
lymph nodes
lymphadenopathy
24
Q

non-hodgkin lymphoma
treatment
-survival: extended periods but less than the survival rate for Hodgkins lymphoma
-dependent on the type (B cell or T cell), tumor stage histologic status (low, intermediate, high grade), symptoms, age, and any co-morbidities
-_____ or _____
-combination of _____ and _____
-_____

A 
chemotherapy
radiation
chemotherapy 
radiation
monoclonal antibody: rituximab
25
Q

burkitt lymphoma

  • highly aggressive B-cell non-hodgkin lymphoma
  • very fast growing tumor of the jaw and facial bones (Africa); rare in the US
  • _____ in _____ of cases. the Epstein-barr virus, found in _____, is associated with burkitt lymphoma in _____ children
  • in non-african burkitt lymphoma, the most common presentation is _____, _____, _____, and _____
A 
EBV
90%
nasopharyngeal secretions
african
abdominal swelling
night sweats
fever
weight loss
26
Q

alterations of splenic function

  • splenomegaly: may be classified as pathologic
  • hypersplenism: overactive spleen
  • congestive splenomegaly: engorgement by macrophages with indigestible material from various “storage diseases”
  • manifestation: anemia from red blood cells (RBC) destruction
  • treatment: _____
A

removal of the spleen

27
Q

what is a plasma cell?

  • plasma develop from _____, a type of white blood cell that is made in the _____
  • normally when bacteria or viruses enter the body some of the _____ will change into _____
  • the plasma cells make _____ to fight _____ and _____, to stop infection and disease
A 
B lymphocytes (B cells)
bone marrow 
B cells
plasma cells
antibodies 
bacteria
viruses
28
Q

multiple myeloma

  • in multiple myeloma, cells are _____ ( a the of white blood cell) that build up in the bone marrow and form _____ in many bones of the body
  • normal plasma cells make _____ to help the body fight _____ and _____
  • as the number of multiple myeloma cells increases, more antibodies are made
  • this can cause the blood to _____ and keep the bone marrow from making enough healthy blood cells
  • multiple myeloma cells also damage and weaken the _____
A 
abnormal plasma cells 
tumors
antibodies
infection 
disease 
thicken
bone
29
Q

multiple myeloma

  • plasma cell: end-stage cell of the humoral immune response
  • examples:
  • -_____
  • -waldenstrom macroglobulinemia
A

multiple myeloma

30
Q

multiple myeloma
-plasma cells proliferate in the bone marrow
-primary translocation involves immunoglobulin heavy chain on chromosome 14
-malignant plasma cells produce abnormally large amounts of one class of immunoglobulin
–M protein: abnormal antibody molecule
–_____ of the _____
(_____ proteins) can pass through the _____ and damage the _____ cells

A 
unattached light chains
immunoglobulins
bence jones
glomerulus 
renal tubular cells
31
Q 
multiple myeloma
clinical manifestations 
-\_\_\_\_\_, renal failure
-anemia
-lytic lesions (round, "punched out" regions of bone)
-skeletal pain
-hyperviscosity syndrome 
-recurring infections due to loss of the humoral immune response

tests
-radiographic and laboratory studies; bone marrow biopsy

A

hypercalcemia

32
Q

multiple myeloma
the myeloma cells, (the cancer cells), in the bone marrow directly secrete _____ and stick to _____, inducing their production of several cytokines, one of them is _____

A

parathyroid hormone-related peptide
stromal cells
IL6

33
Q

multiple myeloma and hypercalcemia

  • _____ acts on an _____ and stimulates _____ to reabsorb _____
  • this process results in _____ and _____ (high calcium in the blood) result from release calcium from the bone breakdown of bone
A 
IL6 
osteoclastic activating factor 
osteoclasts 
bone
bone lesions
hypercalcemia
34
Q

why does your blood clot a lot?

thromboembolic disease

  • certain conditions within the blood vessels predispose an individual to develop _____ spontaneously
  • _____: a stationary clot attached to the vessel wall (made up of _____ and _____)
  • _____: from under conditions of high blood flow and are composed mostly of platelets aggregates held together by _____
  • _____: form in conditions of low flow and are composed mostly of red cells with larger amounts of fibrin and few platelets
A 
clots
thrombus
fibrin
blood cells
arterial thrombi
fibrin strands
venous thrombi
35
Q

tx of thromboembolic disease

  • therapy consists of _____ or _____ of the _____
  • anticoagulants (heparin, Coumadin) is effective in treating or preventing venous thrombosis, it is not useful in treating or preventing arterial thrombosis
  • thrombolytic (streptokinase, urokinase) is are administered to accelerate the lysis of known thrombi
A

removal
lysis
clot

36
Q

thromboembolic disease

  • the risk of developing spontaneous thrombi is related to several factors below referred as the:
  • _____:
    1. _____ to _____
    2. _____
    3. _____ of the _____
    4. _____
A 
virchow triad
endothelial injury
blood vessels
turbulent arterial blood flow
rapid coagulation
blood
stagnant venous blood flow
37
Q

thromboembolic disease
hypercoagulability (thrombophilia)
-is a condition in which a individual is at risk for thrombosis
-_____ (hereditary):
–results are the defects in proteins that are involved in hemostasis

  • _____ (acquired)
  • -causes include a variety of clinical disorder
A

primary

secondary

38
Q

why does your blood not clot?

disorders of coagulation
causes:
-defects or deficiencies of one or more clotting factors _____
-impaired hemostasis: inability to promote coagulation and the development of a stable fibrin clot. _____ of _____
-consumptive thrombohemorrhagic disorders _____

A

hemophilias
dietary deficiency
vitamin K
disseminated intravascular coagulation

39
Q

why does the blood not clot properly??

  • some clotting factors defects are inherited and usually involve a single factor such as _____ or von willebrand disease
  • other coagulation defects are acquired and rend to result from deficient synthesis of clotting factors by the liver. causes include _____ and _____ of _____
A

hemophilias
liver disease
dietary deficiency
vitamin K

40
Q

vitamin K deficiency

  • impaired _____
  • _____ is required for normal clotting factor synthesis by the _____
  • -necessary for synthesis and regulation of prothrombin, procoagulant factors (VII, IX, X), and proteins C and S (anticoagulants)
  • -deficiency: leads to bleeding
  • -treatment: parenteral administration of vitamin K

most common cause of vitamin K deficiency is _____ with _____

A 
hemostasis 
vitamin K
liver
total parenteral nutrition
antibiotic therapy
41
Q

disseminated intravascular coagulation consumptive thrombohemorrhagic disorders

  • the description of DIC an _____ of _____ with subsequent _____ and accelerated _____
  • DIC is an acquired clinical syndrome characterized by widespread activation of coagulation resulting in the formation of fibrin clots in medium and small vessels throughout the body
A

unregulated release
thrombin
fibrin formation
fibrinolysis

42
Q

disseminated intravascular coagulation
clinical manifestations demonstrate wide variability
-bleeding from venipuncture sites
-bleeding from arterial lines
-bleeding from surgical wounds
-purpura, petechiae, and hematomas
-symmetric cyanosis of the fingers and toes
-diagnosis:
–most reliable and specific test for diagnosing _____- is a molecule produced by _____. the test measures a specific _____ related product

A

D-dimer
fibrin clots
DIC

43
Q 
thrombocytopenia (low platelets)
may cause these signs:
-petechiae
-purpura
-mucosal bleeding 
-gingival bleeding 
-spontaneous bruising

two diseases:

  • _____
  • _____
A

immune thrombocytopenic purpura (ITP)

thrombotic thrombocytopenic purpura (TTP)

44
Q

disorders of platelets

  • immune thrombocytopenia purpura (ITP)
  • -_____ antibody targets _____. antibody-coated platelets are sequestered and removed from _____. (_____ in the spleen remove _____ from circulation
  • -acute form develops after viral infections.
  • –is one of the most common childhood bleeding disorders
  • -chronic form usually is found in adults
  • bottom line point ITP is a
  • -_____ with _____
A 
IgG
platelet glycoproteins 
circulation
mononuclear phagocytes 
antibody-coated platelets 
autoimmune disease
anti-platelet antibodies
45
Q

purpura

-a _____ discoloration caused by _____ into the _____

A

red-purple
diffuse hemorrhage
skin

46
Q

disorders of platelets
thrombotic thrombocytopenic purpura (TTP)
-a thrombotic microangiopathy
–platelets aggregate and cause occlusion of arterioles and capillaries

  • types
  • -familial: is chronic, relapsing, and observed in children.
  • -acquired idiopathic: is more acute and severe; observed mostly in women in their 30s
  • TPP is:
  • -_____ react with _____ to cause _____
A

platelets
endothelial cells
arterial occlusions

47
Q

disorders of platelets

  • IN TTP:
  • _____ of symptoms
    1. extreme _____
    2. intravascular _____
    3. _____ and _____ most often involving the CNS (approximately 65% exhibit memory disturbances, behavioral irregularities, headaches, or coma)
    4. _____
    5. _____
A 
pathognomonic pentad
thrombocytopenia 
hemolytic anemia 
ischemic signs and symptoms 
kidney failure 
fever

PAS- PATHOPHYSIOLOGY (17 decks)

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