diseases of the blood

Question 1

diseases of the blood

Answer 1

1) big category
- anemias
- leukopenias
- thrombocytopenia
- leukemia
- lymphomas
- bleeding

Question 2

reactive vs neoplastic lymph nodes

Answer 2

1) enlarged are active
- freely movable
- soft to firm
- tender
2) neoplastic
- fixed
- firm to hard
- non tender and non painful
- progressive enlargement
3) chronic specific infections
-tb
- movable, firm, minimal tender, progressive enlargement

Question 3

lymphoid hyperplasia

Answer 3

1) reactive lymph node
- neck
- intraoral
2) reactive lymphoid hyperplasia (non nodal)
- palatine tonsil
- waldeyers ring
- hyperplastic lingual tonsil
3) a related lesion
- lymphoepithelial cyst

Question 4

anemia

Answer 4

1) categorized by how big the cells are and how darkly they stain
2) microcytic
- low or normal RBC
- lead poisoning
- iron deficiency
3) normocytic anemia
- RBC look normal
- autoimmune diseases
- acute blood loss
- less O2 carrying
4) macrocytic
- larger RBC, redder
- vitamin B12 deficiency
- folic acid deficiency

Question 5

clinical anemia

Answer 5

1) weakness, fatigue, pallor

Question 6

result of

Answer 6

1) decreased number, size, or HgB content of RBC
- can be secondary to nutrient deficiency or RBC loss (chronic bleeding)
- failure of RBC formation (leukemia or other marrow space occupying disease)
- HgB malformation

Question 7

anemia definition

Answer 7

1) decreased oxygen carrying capacity of blood
2) evaluate by blood draw
- RBC count
- Hb concentration
- hematocrit
- classified by red cell indices (MCV, MCH, MCHC)
3) size: micro, normo, macro
4) color: hyper, normo, hypo

Question 8

MCV

Answer 8

1) mean corpuscular volume
- Hct/RBC

Question 9

MCH

Answer 9

1) mean corpuscular hemoglobin
- HgB/RBC

Question 10

iron deficiency anemia

Answer 10

1) pummer vinson syndrome
2) more prone to gastric carcinomas
3) get iron!

Question 11

vitamin B 12 or folic acid deficiency

Answer 11

1) pernicious anemia
2) inflammation of the tongue
- enlarged, reddened, smooth

Question 12

RBC destruction

Answer 12

1) autoimmune
2) fetal erythroblastosis

Question 13

herediary

Answer 13

1) sickle cell anemia
2) thalassemia

Question 14

aplasia

Answer 14

1) of the bone marrow
2) radiation

Question 15

oral features of anemia

Answer 15

1) mucosal pallor
2) mucosal atrophy
3) hunters glossitis
4) rare jaw radiolucency
- increase hematopoiesis esp in thalassemia

Question 16

sickle cell anemia

Answer 16

1) autosomal recessive
2) mutation thymine for adenine in B hemoglobin chain
3) weird step ladder trabecular pattern

Question 17

thalaseemia

Answer 17

1) deficiency of alpha or beta Hgb chain
2) major and minor forms
3) enlarged jaws from increased hematopoiesis

Question 18

aplastic anemia

Answer 18

1) total bone marrow aplasia
- etiology unknown but may be environmental toxin
2) clinical
- anemia, infection and bleeding
3) periodontitis, ulcer, bleeding

Question 19

leukopenia

Answer 19

1) aplastic anemia
1) agranulocytosis
- myelodysplastic syndrome
3) neutropenia
- more bacterial infections bc less neutrophils
5) cyclic neutropenia

Question 20

agranulocytosis

Answer 20

1) absence of granulocyte
2) more bacterial infection
3) idiopathic or drug induced
4) oral
- necrotic ulceration and gingivitis
5) histo
- absent or deficient neutrophils in ulcer base

Question 21

generic neutropenia

Answer 21

1) decrease in circulating PMNs
2) increased susceptibility to infection
3) may be
- idiopathic
- drug induced (most common cause)
- secondary to other disease like leukemia, osteopetrosis, gaucher’s disease
- ineffective hematopoiesis (myelodysplasia)

Question 22

cyclic neutropenia

Answer 22

1) associated periodic infections and may have accelerated periodontitis
2) oral
- aphthous like ulcers
- lymphadenopathy, fever
3) typical 21 day cycles
- 3-6 days each
- treated by oncologists

Question 23

neutrophil dysfunction

Answer 23

1) x-linked defects in neutrophil and monocyte
2) opportunistic bacterial and fungal infection
- pneumonia
- lymphadenitis, etc
3) other related conditions

Question 24

leukocytosis

Answer 24

1) inflammatory. infectious
2) more WBC circulating
3) bacterial or neutrophilic
4) viral, lymphocytic
- more lymphocytes
- infectious mononucleosis from EBV
5) neoplastic
- leukemia

Question 25

leukemia definition

Answer 25

1) malignancies of WBC from blood marrow 2) lymphocytic, myelogenous (granulocyte) 3) expression in peripheral blood - elevated WBC with blast atpical looking cells

Question 26

classes of leukemia

Answer 26

1) acute - immature and blast like - fulminant course (rapid) 2) chronic - mature cells - indolent course (slower) --- 1) ALL - children 2) AML 3) CML 4) CLL - elderly

Question 27

leukemia etiology

Answer 27

1) viral, chemical, radiation 2) downs and other syndromes 3) CML- Philadelphic chromosome t(9;22)

Question 28

leukemia lab features

Answer 28

1) elevated WBC with abnormal differential 2) abnormal cells in peripheral blood 3) rare aleukemic form with leukopenia 4) abnormal bone marrow

Question 29

oral manifestation of leukemia

Answer 29

1) bleeding 2) gingival enlargement 3) ulceration 4) infection 5) localized chloroma

Question 30

leukemia treatment

Answer 30

1) induction and maintenance phases - chemo - radiation - bone marrow or stem cell transplant - 2) treatment produces many side effects as the disease progresses

Question 31

leukemia prognosis

Answer 31

1) ALL - fair 2) CLL - best 3) AML - worst 4) CML - bad

Question 32

WHO simple classification of lymphomas

Answer 32

1) precursor B cell neoplasms 2) peripheral B cell neoplasm 3) precursor T cell neoplasms 4) peripheral T cell and NK cell neoplasms 5) hodgkin lymphoma

Question 33

hodgkin lymphoma

Answer 33

1) malignancy of reed-sternberg cells - predominantly nodal disease, almost never orally - early features mimick infection - treatment with chemo and radiation 2) owl's eye appearance of reed-sternberg cells 3) affects one single lymph node chain but can spread to contiguous nodes 4) infects young adults around age 32 5) usually curable with chemo

Question 34

non hodgkin lymphone

Answer 34

1) 5x more common than hodgekin - worse prognosis 2) seen in lymph nodes and extra nodal sites - and seen intraoral and primary jaw tumors 3) most are B cell tumors

Question 35

more indolent lymphomas

Answer 35

1) less treatment options 2) Takes years to kill 3) if you didnt treat them, they will survive quite long before it kills them

Question 36

burkitts lymphoma

Answer 36

1) endemic and sporadic 2) mainly extranodal - rarely with lymph nodes 3) sheets of blue cells with macrophages - dark sea with starry sky 4) associated with AIDs 5) malarial belt of africa (endemic) - associated with EBV 6) sporadic (bowels, and viscera)

Question 37

midline granuloma

Answer 37

1) can have ulcerated lesion of palate 2) pain and necrosis

Question 38

plasma cell lesions

Answer 38

1) multiple myeloma 2) plasmacytoma 3) extramedullary plasmacytoma 4) defective protein (M protein) in blood and urine - histology is always sheets of neoplastic plasma cells

Question 39

multiple myeloma

Answer 39

1) older people 60> 2) little holes in the bone 3) plasma cells in the bone marrow - myeloma 4) lower back pain 5) punched out radiolucencies 6) amyloid deposits in tongue

Question 40

solitary plasmacytoma

Answer 40

1) solitary bone lesion of Ig producing malignant plasma cells 2) might not be detected in blood and urine - no bone marrow involvement 3) often progress to myeloma

Question 41

know the clotting cascade diagram

Answer 41

1) intrinsic and extrinsic pathway

Question 42

blood coagulation in vivo

Answer 42

1) platelets with tissue factor 2) platelet aggregation -also need von willebrand

Question 43

bleeding disorders

Answer 43

1) platelets and clotting factors - need thromboxin A2 and von Willebrand for platelet aggregation - can't take aspirin if you have bleeding problems 2) easy bruising, prolonged bleeding, spontaneous gingival hemorrhage, hematoma, bleeding elsewhere, pupura

Question 44

testing for bleeding disorders

Answer 44

1) prothrombin time - efficacy of extrinsic pathway - mostly factor VII 2) partial thromboplastin time - intrinsic pathway - factor VIII and IX 3) platelet count 4) bleeding time, clotting time 5) platelet aggregation assay

Question 45

platelet deficiency

Answer 45

1) thromobocytopenia - numbers of platelets low 2) defective adhesion - thrombasthenia and thrombocytopathia

Question 46

vascular wall fragility

Answer 46

1) vitamin C deficiency 2) hereditary hemorrhagic telangectasia - microbleeds everywhere

Question 47

coagulation factor deficiency

Answer 47

1) tests for PTT and PT, and INR 2) hereditary / genetic - factor 8, factor 9, von willebrands deficiency, etc. 3) acquired - primary liver disease - biliary obstruction - steatorrhea - anticoagulant drug

Question 48

what does aspirin do

Answer 48

1) block thromboxane A2 2) bleeding issues

Question 49

how does a new clot initiate

Answer 49

1) formation of platelet plug - platelets stick to proteins using von willebrand 2) activation of coagulation cascade - tissue factor, initiate the cascade 3) inhibition of fibrinolysis - disturbed endothelial cells secrete PA1 which limits fibrinolysis

Question 50

primary or secondary deficiency of platelets

Answer 50

1) primary idiopathic thrombocytopenic purpura 2) secondary leukemia, HIV, aplastic anemia

Question 51

thrombocytopenia

Answer 51

1) primary autoimmune 2) secondary due to drug exposure or other disease - clinical hemorrhage, esp petichiae

Question 52

thrombocytopathia

Answer 52

1) aspirin toxicity inhibits for the platelet life 8-10 days 2) vonwillbrands disease - deficient vWF 3) primary hereditary defect - GP-IIIa are required for aggregation

Question 53

wafarin

Answer 53

blocks vitamin K

Question 54

heparin

Answer 54

1) anti thrombin, plasma thromoplastin

Question 55

GI malabsorption

Answer 55

1) sprue or biliary disease 2) deficient vitamin K

Question 56

memorize beautiful diagram

Answer 56

:(

Question 57

important points on clotting cascafe

Answer 57

1) actual initiating event in body is exposure of tissue factor to blood 2) intrinsic arm initiators are not necessary for clotting in vitro