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1 - ROP > Clinical Pathology > Flashcards

Clinical Pathology Flashcards

1
Q

What is blood pressure?

A

blood pressure is defined as the amount of pressure exerted on the walls of the arteries as the blood moves through them

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2
Q

How is blood pressure measured?

A

systolic pressure
- blood pressure exerted when the heart beats and forces blood around the body

diastolic pressure
- blood pressure when the heart is at rest between beats.

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3
Q

What is the method for taking blood pressure?

A

standardise the environment when measuring blood pressure

  • environment should be relaxed, quiet and warm
  • the patient should be seated with their arm outstretched and supported
  • patient should be seated and not talking for five minutes before taking the blood pressure

discard the initial value if there is a large (>10mmHg) difference between the first and subsequent readings and make further measurements.

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4
Q

How should the blood pressure of a person suspected of having postural hypotension be taken? How should the blood pressure of a person suspected of having hypertension be taken?

A

postural hypotension

  • when blood pressure drops upon standing after sitting or standing for a period of time
  • should measure blood pressure while the patient s standing

hypertension
- should take 2 additional readings at monthly intervals

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5
Q

When should treatment for hypertension be started?

A

treatment should only be initiated if ambulatory monitoring confirms hypertension

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6
Q

What is at risk of hypertension?

A

age
- hypertension os more prevalent as you age

ethnic group
- black people have higher prevalence and incidence of hypertension than white people

gender

  • men are more likely to develop hypertension at an earlier age
  • as age increases hypertension is more prevalent in women
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7
Q

What are the normal measurements of blood pressure?

systole and diastole

A

systolic = 90-120 mmHg

  • optimal is less than 120 mmHg
  • normal is less than 130 mmHg

diastolic = 60-80 mmHg

  • optimal is less than 80 mmHg
  • normal is less than 85 mmHg
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8
Q

What is diabetes mellitus?

A

Diabetes Mellitus is a chronic, progressive, lifelong condition
- characterised by chronic hyperglycaemia (high blood glucose levels) with disturbances of carbohydrate, fat and protein metabolism

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9
Q

What are the types of diabetes?

A

Type 1 diabetes (T1DM)

  • results from destruction of the insulin producing pancreatic beta cells (in the islets of langerhans)
  • generally affects younger non-obese people

Type 2 diabetes (T2DM)

  • is caused by a combination of insulin resistance and defective beta cell function
  • more prevalent as you age
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10
Q

How can diabetes be diagnosed?

A

diagnosis is made by checking blood glucose levels when fasting and at random

fasting (no calorie intake for last 8 hours)
- plasma glucose ≥ 7.0 mmol/L

random (without regard to time since last meal)
- plasma glucose ≥ 11.1 mmol/L

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11
Q

What is the method for testing for diabetes?

A

random pin-prick blood test

a person with a test result ≥ 11.1 mmol/l
- should be referred to their GP practice at the earliest opportunity for further tests

if levels are between 5.6 and 11.0 mmol/l

  • a re-test should be offered using a fasting sample
  • this is probably best done by the GP

a random test result of < 5.6 mmol/l
- indicates a low probability of diabetes.

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12
Q

What is high cholesterol a risk factor of?

A

atherosclerotic cardiovascular disease (CVD)
- plaque builds up inside your arteries
stroke

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13
Q

What transports cholesterol around the body? What are the different forms?

A

lipoproteins transport cholesterol around the body

low-density lipoprotein (LDL) - carries cholesterol from the liver to cells

high-density lipoprotein (HDL) – carries cholesterol from cells to the liver where it is broken down or excreted as waste.

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14
Q

When do problems arise with cholesterol?

A

when the body makes too much low density lipoproteins
- carries too much cholesterol to cells and it builds up

when intake of cholesterol exceeds the body’s ability to excrete/remove it

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15
Q

What are the normal and optimal levels of cholesterol within the body?
total cholesterol
LDL cholesterol
HDL cholesterol

A

total cholesterol

  • optimal is less than 4 mmol/L
  • minimum standard is less than 5 mmo/L

LDL cholesterol

  • optimal is less than 2 mmol/L
  • minimum standard is less than 3 mmo/L

HDL cholesterol
preferred value for men is more than 1 mmol/L
preferred value for men is more than 1.2 mmol/L

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16
Q

What is the method for taking a cholesterol test?

A

two or more cholesterol measurements need to be performed to establish a diagnosis of high blood cholesterol

to ensure a good blood sample you should follow a protocol that reduces contamination by fats from cosmetics, soaps, etc

17
Q

What is the main class of drug used to treat high cholesterol levels?

A

statins

- atorvastatin

18
Q

What is obesity? What are health consequences of obesity?

A

is defined as a body mass index (BMI) of 30Kg/m2 or more
- where a person’s BMI is defined as their weight in kilograms divided by the square of their height in metres

health consequences of obesity
- type 2 diabetes, high blood pressure, asthma, high cholesterol, atherosclerotic cardiovascular disease

19
Q

What classifies as healthy weight, overweight and obese?

A

healthy weight = 18.5 - 24.9
overweight = 25 - 29.9
obese = 30+

20
Q

What makes up the blood?

A

Blood is
Plasma (55%) = water, electrolytes, protein
Cells (45%) = erythrocytes, thrombocytes, leukocytes

21
Q

What causes anaemia?

A

Insufficient Haemoglobin
- blood can’t carry enough oxygen from the lungs to the tissues to meet tissue needs

Inadequate iron absorption
- malabsorption or inadequate iron intake

Increased physiological demand
Blood loss

22
Q

How can red blood cells indices/anaemia be tested for?

A

haemoglobin - Hb

  • check the total amount of Hb in the blood
  • anaemic should be less than 132g/L for M and less than 117 g/L for F

haematocrit - Hct

  • check the volume of RBCs in the blood
  • anaemic should be less than 40% for M and less than 36% for F

mean corpuscular haemoglobin concentration - MHC

  • check the average Hb concentration in a RBC
  • microcytic (smaller than normal so iron deficiency), normocytic, macrocytic (bigger than normal, vitamin B12 and folate deficient)

mean corpuscular volume - MCV
- check the average volume of a single RBC

mean corpuscular haemoglobin - MCH
- check the average mass/weight of each Hb per RBC

23
Q

How can iron indices/anaemia be tested for?

A

serum ferritin = body’s storage of iron

  • low Ferritin – iron deficiency
  • increased serum ferritin – iron overload, alcoholism, inflammatory diseases

transferrin = protein that transports iron
- measured by TIBC (total iron binding capacity)

serum iron
- amount of iron bound to transferrin

transferrin saturation

  • percentage of serum iron to TIBC
  • 20-50%
24
Q

What are indicators of anaemia?

A

microcytic
- decrease MCV = small red cells, MCV < 80 fl)

hypochromic

  • reflects a decreased Hb content within the RBC
  • is associated with decreased MCH and MCHC producing a hypochromic appearance on blood film)

serum iron decreased
serum ferritin decreased
TIBC increased
Transferrin saturation decreased

25
Q

What are the symptoms of anaemia?

A 
fatigue and faintness
dyspnoea on exertion = breathlessness
tachycardia = palpitation, fast heart rate
headache 
confusion
decreased mental acuity
skin pallor
26
Q

What are iron rich foods? What is the treatment for anaemia?

A

iron-rich food
- red meat, fish, eggs, baked beans, pulses (kidney beans and lentils and dried apricots)

oral administration of ferrous sulphate 200mg tds (three times a day)

  • haemoglobin level should rise by about 20g/L every 3 weeks
  • once the Hb level is within the normal range, iron replacement should continue for a further 3 months to replace the body’s iron stores
27
Q

What are other causes of anaemia other than iron deficiency and Hb deficiency?

A

Folate and Vitamin B12 deficiency
- they cause macrocytic anaemia

Anaemia associated with chronic diseases – e.g. Renal failure, chronic infections, etc -normocytic

28
Q

How can cholesterol be treated?

- while waiting for more tests and preventative measures

A

cardioprotective diet

  • healthy diet high in fibre, fruit and vegetables and oily fish
  • nuts, seeds, and legumes daily
  • avoid frying = try to grill, steam, poach or bake instead.

Limit red and processed meat
Limit alcohol and added sugar intake
Limit full fat dairy products

1 - ROP (32 decks)

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