exam 2 Flashcards
Hematocrit
volume of packed RBC expressed as a % of total peripheral blood
hemoglobin chains: types
Alpha, beta, gamma, epsilon
hemoglobin chains: factors
iron, vitamin b12, vitamin b6, folic acid
hemoglobin: cellular structure
porphyrin heme ring produced y mitochondria, iron inserted to form heme, globin chains produced by ribosomes and are joined to heme = hemoglobin
hemoglobin: levels
anemia = <13.5 g/dL for men, <12.5 g/dL for women. transfusion needed < 8 g/dL
anemia
reduction of hemoglobin in blood to below normal levels
anemia: pathogenesis (actions)
iron deficient, breast feeding, vegetarian diet, peptic ulcer, menorrhagia, pregnancy, carcinoma, gastrectomy
anemia: morphology
two ways
due to chronic disease: chronic inflammation and malignant condition
microcytic homochromic: decrease production of hemoglobin (iron, Hb, porphyrin ring)
types of anemia: aplastic
3 types
physiological changes
symptoms
what do they crave
idiopathic, secondary, primary (leukemia)
bone marrow depleted of hematopoietic cells and consists only of fibroblasts, fat cells, and scattered lymphocytes
uncontrollable infections, bleeding tendency, chronic fatigue, sleepiness, weakness
crave chewing ice cubes
types of anemia: macrocytic (megaloblastic)
low vitamin B12 or folic acid
folic acid: inadequate intake (green veggies and fruits), absorbed in jejunum, malabsorption caused by disease (alcoholics and elderly) and or increased demand (pregnancy, cancer)
b12: pernicious anemia: autoimmune due to autoantibodies against parietal cells and intrinsic factor, lack of gastric IF = stomach cancer or gastric bypass surgery, dx: Schilling test: oral radioactive b12 and cold b12; fatigue, short of breath, weakness, neurologic symptoms (can be fixed by therapy)
sickle cell anemia
substitution of glutamic acid by valine (point mutation), african americans (7-10%HbAS, 0.4% HbSS)
SHORT ANSWER: pathogenesis of sickle cell anemia
at low O2 partial pressures (venous side of circulatory system), abnormal HbS molecules crystallize into long, insoluble, polymerized rods, distorting shape of RBC, resulting in occlusion of capillaries, compromising O2 delivery to tissues which causes headaches, pain, cardiopulmonary insufficiency, recurrent infections, delayed intellectual development, neurologic deficits in children
thalassemia
genetic defect in the synthesis of HbA (adult hemoglobin) that reduces the rate of globin chain synthesis
alpha thalassemia: reduced synthesis of alpha chain of globin (gene deletion, usually 4 on chromosome 16)
one deletion: asymptomatic
two deletions: mild anemia with inc. RBC count
three deletions: severe anemia
four deletions: lethal in utero, hydrops fetalis
beta thalassemia: reduced synthesis of beta chain of globin
minor: hetero, mild and nonspecific symptoms
major: homo, severe and serious, chronic transfusions necessary
crew cut look
polycythemia
primary (polycythemia vera): clonal proliferation of hematopoietic stem cells, uncontrolled production of RBC (mutation; erythropoietin dec., always linked with blood cancer); symptoms due to blood hyperviscosity: blurry vision, headache, inc. risk of venous thrombosis, flush face due to congestion (plethora) and itching (eg. after bathing, inc. histamine
secondary: inc. RBC volume owing to bone marrow hyperplasia by inc. erythropoietin, caused by prolonged hypoxia; high altitudes, anoxia secondary to chronic lung disease (COPD), congenital heart disease
leukemia
WBC precursors in bone marrow and peripheral blood
types of leukemia: acute lymphoblastic
most common form in children, massive infiltration of bone marrow and peripheral blood with immature lymphoid cells (blasts)
good prognosis with chemo
types of leukemia: acute myelogenous
who does it affect
what physiological changes
prognosis
acid type
most common acute form in adults, clonal proliferation of myeloblasts in bone marrow (20%), fatal in 6 months with no treatment, all trans retinotic vitamin A acid
types of leukemia: chronic myelogenous
pluripotent hematopoietic stem cells, too many in peripheral blood and bone marrow, Philadelphia chromosome, tyrosine kinase inhibitors, transplant, chemo
types of leukemia: hairy cell
cells affected and how
+ for
sign
treatment
neoplastic proliferation of mature B cells, + for tartrate-resistant acid phosphate (TRAP); splenomegaly; good response to 2-CDA (chemo, adenosine deaminase inhibitor)
types of leukemia: chronic lymphocytic
lymphoid cells; lymph node involvement leads to generalized lymphadenopathy and is called small lymphocytic lymphoma; 7-9 years after dx
lymphoma
ages
organs affected
malignant or benign?
any age, lymph nodes, spleen, thymus, bone marrow, no benign types
types of lymphoma: non-Hodgkins: follicular
most common form, older people, slow growing, 7-9 years after dx
types of lymphoma: non-Hodgkins: diffuse-large cell
most common aggressive form; tissues infiltrated with large lymphoid cells that have irregular nuclear outlines and prominent nuclei
chemo
types of lymphoma: non-Hodgkins: Burkitt’s
malignant tumor of small B cells (EBV); extranodal masses, sub-saharan (jaw), abdominal mass; high mitotic index
“starry sky”
types of lymphoma: Hodgkins
ages
types (4)
special cells
prognosis
peaks at 25 & 55
4 types: nodular sclerosis, lymphocyte-rich, mixed cellularity, lymphocyte-depleted
Reed-Steinberg cells: bi or multilobed with a clear halo
Stage I & II have a good prognosis with chemo (90%)
lymphoma dx: PET grading
Stage I: involvement of single lymph node or group of nodes
Stage II: 2+ sites on same side of diaphragm
Stage III: both sides of diaphragm
Stage IV: widespread extralymphatic involvement (liner, bone marrow, skin, lung)
multiple myeloma
what is it
symptoms
tests
prognosis
malignant dx of plasma cells, 45+ years old
in bone marrow, destroys bones; punched out holes in skull, ribs, vertebrae
hypercalcemia, renal failure, proteinuria, infection, roleaux formation of RBC
xray (lytic lesions), urine with Bence Jones Protein (IgG), bone marrow biopsy (inc. plasma cells, fried egg)
fatal in 3-4 years by kidney failure or infection
ninlaro is a reversible proteasome inhibitor
bruised around eyes
hemophilia
sex-linked congenital clotting factor deficiency; uncontrollable bleeding with trauma and subcutaneous hematoma
A: deficiency of FACTOR VIII
B: deficiency of FACTOR IX
ECG: set up - leads
V1-6 and RA LA LL RL
ECG: conduction pathway
SA node sends out AP to AV node then to AV bundle (bundle of HIS) then R&L branches then Purkinje fibers
ECG: know graph, and what each section does
P wave: depolarization of atria
PR interval: depolarization of atria and delay at AV junction
QRS complex: depolarization of ventricles
ST segment: period between ventricular depolarization and beginning of repolarization
T wave: repolarization of ventricles
R-R interval: time between two ventricular depolarizations
ECG: chronotropic
heart rate (- = beta blocker)
ECG: inotropic
cardiac contractile force
ECG: dromotropic
speed of impulse transmission
Atrial septal defect
cause
blood direction
failure of proper closure of foramen ovale or defect in the septum
blood from LA to RA due to pressure difference
Ventricular septal defect
failure of fusion of interventricular septum
high pressure, blood shunts
Tetralogy of Fallot
stenosis of RV outflow tract, RV hypertrophy, VSD, overriding aorta
R to L shunt: cyanosis
squat during spells (inc. arterial resistance)
Valvular disease: rheumatic fever
cause
pathogenesis
dx
systemic complication of pharyngitis due to group A (beta-hemolytic) streptococci, 2-3 weeks after strep
molecular mimicry of bacterial M protein, acts like proteins in human tissue
dx with Jones’ criteria, 1-2 major, 1 minor
major: carditis, previous group A strep, polyarthritis, erythema
minor: fever, ECG changes
bacterial endocarditis
inflammation of endocardium due to bacterial infections (strep. viridans)
bacterial endocarditis: subacute infective
low virulence organisms, do not destroy valves, mild symptoms (low fever)
bacterial endocarditis: acute infective
highly virulent organism, infect normal valves (most commonly tricuspid), destroy valves (strep. aureus)
fever with chills, murmurs, need antibiotics
bacterial endocarditis: by staph. epidermidis
endocarditis of prosthetic valves
pericarditis
causes
symptoms
ecg changes
viruses, travel, bacteria, open heart surgery
chest pain worse with lying supine and with inspiration
concave ST elevation with PR depression, normal CK-MB
myocarditis
what causes it
what is it
physiological changes
treatment
viruses, parasites, and protozoa
inflamed heart muscle, abrupt onset, may lead to acute heart failure
myocardial degeneration and necrosis with mononuclear inflammatory infiltrate
treat underlining cause
dilated cardiomyopathy
what is it
causes
dilation of all 4 chambers and most common form, systolic dysfunction
causes: idiopathic, genetic mutation, myocarditis, pregnancy, alcohol abuse
hypertrophic cardiomyopathy
LV hypertrophy due to genetic mutation in sarcomere proteins (contract/relax)
most common is autosomal dominant
diastolic failure due to decreased cardiac output
death in young athletes, syncope with exercise, ventricular arrhythmias
restrictive cardiomyopathy
what is it
causes
decreased compliance of ventricular endomyocardium that restricts filling during diastole
cause: amyloidosis, result in CHF with decreased QRS amplitude
nonrheumatic aortic stenosis
cause
area of heart
physiological change
results in…
cause: congenital bicuspid aortic valve abnormality, calcified aortic stenosis
strain on LV = heart failure
aortic stenosis caused by degenerative changes in valve leaflet connective tissue and calcification
result in cor pulmonale
cor pulmonale
overload of RV from pulmonary hypertension
atherosclerosis
plaque build up in arteries
atherosclerosis pathogenesis
injury to blood vessel by reactive O2 species (ex: oxidized CDL, free radical, neutrophils/leukocytes/platelets) go to injury site and cause inflammation
macrophages consume oxidized CDL and become foam cells which release growth factors (cytokines) to stimulate movement of smooth muscle cells which proliferate and contribute to plaque
TPA produced endothelial cells dissolve plaque
complications: plaque rupture = thrombus formation
turbulent flow = aneurysm3
Coronary Artery Disease/CHD/Ischemic HD
what is it
who is at risk
levels
lipid deposits in large coronary arteries, accumulate by diffusion
obesity, type A personality, cocaine induced arrhythmias
LDL, HDL, and homocysteine inc., inc. risk of atherosclerosis
dec. blood supply to heart, prolonged= MI
SHORT ANSWER
manifestations of CAD: angina pectoris - stable angina
what is it
cause
symptoms
exertion, gone with rest, relieved by nitroglycerine
due to atherosclerosis of coronary artery with >50-60% stenosis, dec. blood flow
no necrosis of myocytes, <15 mins, arm/jaw pain, diaphoresis, short of breath, ST segment depression
SHORT ANSWER
manifestations of CAD: angina pectoris - unstable angina
more frequent, longer, less relieved by nitro, rupture of atherosclerotic plaque with thrombosis and incomplete occlusion of coronary artery
higher chance of MI
SHORT ANSWER
manifestations of CAD: angina pectoris - Prinzmetal’s
at rest by coronary artery spasm, relieved with nitro or calcium channel blockers
ST segment elevation during chest pain and gone when pain has subsided
SHORT ANSWER
manifestations of CAD: angina pectoris - TREATMENT
oxygen, baby aspirin, nitroglycerine, morphine
aneurysm
dilating of artery wall or outpouching portion of wall
arteriosclerotic aneurysm
weakens vessel wall (most acquired as a result of arteriosclerosis)
dissecting aneurysm of aorta
splitting of aorta media by blood due to degenerative changes that cause layers to lose cohesiveness and separate
abdominal aortic aneurysm
cause
symptoms
result of atherosclerosis
abdominal pain, back/flank pain, hypotension, urge to defecate (pressure on large intestine)
atheroma
degeneration of artery wall due to atherosclerosis
myocardial infarction
areas involved
percents
L&R ventricles: anterior, posterior, and lateral walls
regional (90%), diffuse (10%)
myocardial infarction: L anterior descending artery (LAD)
infarction of anterior wall and septum of LV
most commonly involved artery in MI
myocardial infarction: R coronary artery (RCA)
infarction of posterior wall and septum, and papillary muscles of RV
2nd most commonly involved artery
myocardial infarction: L circumflex artery
infarction of LV lateral wall
SHORT ANSWER
MI ECG zones (3)
zone of ischemia: ST segment depression with or without T wave inversion
zone of injury: ST segment elevation with or without loss of R wave
zone of infarction: deep Q waves due to absence of depolarizing current from dead tissue and receding currents from opposite side of heart
MI dx
enzyme tests, leak with proteins from necrotic cells when muscle becomes infarcted
Troponin T & I (protein)
creatine kinase CK-MB (enzyme)
lactic dehydrogenase (enzyme)
MI treatment
thrombolytic therapy to dissolve clot
coronary angioplasty (balloon pushes plaque into walls)
bypass surgery (bypass obstruction with segments of saphenous vein from leg)
anticoagulant
beta blockers (reduce myo irritability)
aspirin (inhibit platelet function)
antiarrhythmics (reduce myo irritability)
pacemaker (if complete block)
congestive heart disease (CHD)
what is it
cannot pump powerfully or fast enough to empty, blood gets backed up
Left sided CHD
area affected
signs
levels
treatment
LV, cyanosis, wheezing due to bronchiole narrowing, fluid in alveoli = crackling sound, pulmonary edema, HF cells, fluid retention
inc. O2, dec. workload, dec. venous blood, 100% supplemental O2, sit up and dangle feet, IV saline, nitro as vasodilator, Laxis, ACE inhibitor, morphine, bronchodilator
Right sided CHD
causes
signs
symptoms
medication
surgical treatment
due to LCHD or cor pulmonale, cannot keep up with inc. workload, pulmonary embolism or COPD, blood backs up in RV = inc. back pressure to systemic venous circulation
tripod position/lots of pillows, inc. BP, pink sputum, pitting edema
diuretic, digitalis, ACE inhibitors
LVAD: help pump blood out, tube from LV to aorta, machine with battery
cardiac tamponade
what is it
causes
Beck’s Triad
treatment
cardiogenic shock
fluid accumulation between visceral and parietal pericardia, inc. pressure impairs diastolic filling
trauma, MI, pericarditis, renal disease, hypothyroidism, history of dyspnea and orthopnea
Beck’s triad = elevated venous pressure, muffled heart sounds, hypotension/shock
rapid, weak pulse, decreased systolic
give O2, IV access, maintain airway, morphine/Laxis/dopamine, pericardiocentesis
varicose veins
dilated, torturous (leg) veins
thrombosis: blockage of vein by clot
phlebitis: inflammation of a vein
acute upper respiratory infection: chronic sinitus
what is it
causes
thickened and inflamed sinus mucosas and persistent fluid accumulation
inflamed sinus, chronic inhalation or irritant, nasal obstruction (deviation septum or polyps)
acute upper respiratory infection: acute sinitus
rhinitis or bacteria (cold/flu)
acute upper respiratory infection: acute laryngitis
causes (3)
what is it
acute inflammation of larynx can be infective, allergic, or irritant
sore throat; lasts 2 ish days
acute upper respiratory infection: chronic laryngitis
what is it
who gets it
chronic inflammation of larynx
heavy cigarette smoker
croup
ages
what is it
cause
symptoms
treatment
6 months - 6 years
laryngo-tracheobronchitis, upper respiratory infection and larynx edema
viral (para influenza)
stridor, brass cough, hoarseness, laryngeal obstruction
cool humidified air, steroid, epi, endotracheal intubation
epiglottis
what is the sickness
cause
signs/symptoms
treatment
inflammation caused by haemophilus influenzae type B (bacteria); children 6+
edema can obstruct airway, fever, cherry red epiglottis, inspiratory stridor, difficulty breathing/swallowing, cyanosis (tracheostomy)
antibiotics
pneumonia
what is it
symptoms
tests
opportunistic infection of the lung parenchyma
fever, chills, pus or blood sputum, tachypnea with pleuretic angina, dec. breath sounds, inc. WBC
sputum gram stain and culture, blood cultures, chest xray (3 types)
pneumonia that can be seen on x-ray: lobar
what is it
four kinds
consolidation of entire lobe, bacterial, streptococcus pneumoniae (95%) or Klebsiella pneumoniae
congestion: congested vessels and edema
red hepatization: exudate, neutrophil, hemorrhage fill alveolar air spaces, solid lung
grey hepatization: degeneration of red cells and accumulation of fibrin within exudate
resolution: recover normal structure and function
pneumonia that can be seen on x-ray: bronchopneumonia
bacterial, scattered patchy bronchioles
pneumonia that can be seen on x-ray: nosocomial
where
risk
in hospital. pts. at risk for aspiration
COVID-19
type of illness
spread
vaccine pathogenesis (spike protein)
how are variations created
family of viruses causing respiratory illness
air and close contact
produce spike protein from vaccine —> immune system produces antibodies and T cells
mutations cause variations
Tuberculosis
what causes it
airborne bacteria (myobacterium tuberculosis)
TB: primary
pathogenesis
symptoms
first time, lung edema by macrophage, neutrophil, lymphocytes and from granulomatous inflammation, which becomes calcified GHON COMPLEX, contain caseous necrosis and can spread
blood sputum (purulent) with cough, weight loss, fever with night sweat
TB: secondary
cause
area
spread
immune system compromised by another infection, drugs, immunocompromised
granulomatous inflammation: upper lobes, widespread, cavitation
miliary pattern spread: myriad of millet seed sized (1-3 mm) granulomas in lungs or other organs
TB: Pott’s disease (skeletal TB)
body parts affected
symptoms
osteomyelitis, T&L spine vertebrae, then knee and hip
extensive necrosis, bony destruction, soft tissue extension, “cold” abscess
TB: dx
skin test (mantoux; recent TB), chest xray (granuloma), sputum culture
TB: treatment
2-3 types of antibiotics incase of resistance (ex: INH, Rifampin & Ethambutol or Streptomycin)
cystic fibrosis
production of viscid secretions by exocrine and mucus secreting glands (pancreas/resp. tract)
cystic fibrosis: pathogenesis and tests
gene deletion in codon for phenylalanine at position 508 = defect in CF transmembrane conductive regulator (protein) (CFTR) = failure to open chloride channels = prevent release of sodium and water to liquify mucus
sweat chloride test, DNA, fecal fat, upper GI and small bowel, pancreatic function
no cure - use vests, enzymes, gene therapy, lung transplants; short life span
COPD
2 factors
symptoms
emphysema and chronic bronchitis; 2 types
barrel chest, prolonged respiration and rapid rest phase, thin, pink skin (inc. RBC), accessory muscle hypertrophy, “pink puffers”
COPD: emphysema - centrilobular
cause
physiological changes
cigarette smoking
destruction of cluster of terminal bronchioles at the end of bronchial tree in central pulmonary lobule; upper lobes and superior lower lobes
COPD: emphysema - paracinar
what does it destroy
acinus (alveoli with ducts)
destruction of alveolar septa from center to acinus periphery; lower lobes
COPD: emphysema - localized
aka
physiological change
possible complication
“paraseptal”
destruction of alveoli in one or FEW locations, rest of the lung is normal
possible pneumothorax
COPD: bronchitis
symptom
signs
treatment
edema of tracheobronchial mucosa = mucinous gland hypertrophy
overweight, rhonchi on auscultation, distended jugular vein, ankle edema, “blue bloater”, cor pulmonale
treat with inhaled albuterol, umeclidinium and vilanterol
COPD: bronchitis - acute
common, self limiting
COPD: bronchitis - chronic
cause
criteria
secondary to chronic irritation (smoking, air pollution)
cough lasting at least 3 months over at least 2 years
bronchiolitis
cause
facts
swelling and mucus buildup in bronchioles
viral, kids under 2, peak is 3-6 mo. with RSV, starts as upper respiratory infection, breathing issues
respiratory syncytial virus (RSV)
mild cold in adults
most common germ to cause lung and airway infections in infants/kids (fall into spring)
pulmonary embolism
what is it
whats it made of
risk factors
treatment
obstruction of pulmonary artery
emboli can be air, thrombus, fat, or amniotic fluid, or foreign bodies
risks: recent sx, long bone fractures, pregnancy, oral contraceptive, tobacco
treatment: maintain airway (vent, intubation), IV access, watch vitals, TPA or surgery
asthma
what is it
treatment
increased irritability of bronchial tree with paroxysmal narrowing airways (dyspnea and wheezing)
fluticasone and salmeterol
asthma: allergic
causes
levels
extrinsic, kids, pollens and animal hair and fur and dust mites, skin test reactivity correlation, inc. IgE and type I hypersensitivity
asthma: infectious
causes
who is affected
levels
intrinsic, viral respiratory tract infection in kids under 2, RSV agent
common: rhinovirus, influenza, para influenza
normal IgE
asthma: exercise induced
what is it
physiological cause
bronchospasm, rapid breathing rate + cold air = worse
mediator release or vascular congestion secondary to airway rewarming
asthma: occupational
examples
animal handlers, wood and vegetable dust, metal salts, pharmacutical agents, brown lung in cotton fiber workers and industrial chemicals
asthma: emotional
stress can cause bronchospasm
sarcoidosis
pathogenesis
who is affected
identifying factors
levels
treatment
unknown etiology, giant cell granulomatous inflammation reaction affecting lymph nodes and lungs
30-40 years old, black females most affected
may be type IV hypersensitivity, no central necrosis, lung shadowing
inc. BP due to high ACE
treat with steroids
pulmonary fibrosis
cause
pneumoconosis: lung injury by inhalation of injurious dust or other particulate material
pulmonary fibrosis: silicosis
type
cause
progressive nodular pulmonary fibrosis by inhalation of rock dust
pulmonary fibrosis: inhalation of…
coal dust (coal-workers lung disease), cotton fibers, certain fungus spores and others from occupations
pulmonary fibrosis: asbestosis
cardiac symptoms
diffuse pulmonary fibrosis by inhalation of asbestos fibers
pulmonary hypertension and cor pulmonale
pulmonary fibrosis: asbestos - serpentine asbestos (white)
most common, fibers in lung for limited time
pulmonary fibrosis: asbestos - amphibole asbestos (blue and brown)
cause of…
fibers in lung for many years and main cause of malignant mesothelioma
respiratory distress syndrome: neonatal (NRDS)
cause physiological and prenatal
treatment
symptoms
inadequate surfactant (dec. surface tension, preventing alveolar collapse after expiration
preemies, maternal diabetic, c-section (dec. cortisol)
treat with steroids
symptoms: inc. respiratory effort post birth, tachypnea with use of accessory muscles, grunting, hypoxemia with cyanosis, diffuse granular deposition on lung on xray (ground glass like)
treatment: O2 by CPAP, surranta for surfactant production
respiratory distress syndrome: acute
what is it
treatment
(shock lung) trauma or shock damages the alveolar-capillary interface and edema in alveoli and white out on chest xray
treatment: underlying causes from shock/trauma, ventilation with positive end-expiratory pressure (PEEP) and other drugs
26 year old pregnant woman presents for a check up. Smooth pregnancy, more tired than expected. Physical exam good other than marked pallor. Serum studies show dec. hematocrit, dec. ferritin, inc, TIBC. Peripheral blood smear shows RBCs that are both microcytic and hypochromic. Due to pregnancy, normal. Recommend iron supplements
iron deficiency anemia
46 year old man complaining of weakness and pins and needles in extremities. Tongue is red and enlarge. Lab tests show + Schillings test and a macrocytic anemia. Question diet, drinking habits, history of abdominal surgery
megaloblastic anemia
8 year old african american boy presents to ER with severe pain in both legs. Pain began after a pool party and spend most of the day swimming. Had severe bouts of back and chest pain in the past due to a preexisting medical condition. Lab shows severe anemia. Put him on O2, IV fluids, and prep for blood transfusion
sickle cell anemia
10 month old male from Greece presents with pallor and failure to thrive. Splenomegaly and abnormal facial structure. Peripheral blood smear shows microcytic. hypochromic anemia with target cells. Child may need life long blood transfusions
thalassemia
30 year old woman comes to ER complaining of fatigue and dark-colored urine. Recovering from atypical pneumonia, which was treated with antibiotics. Splenomegaly and slight scleral icterus. Blood tests reveal elevated LDH, elevated indirect bilirubin, decreased hematocrit. Use direct Coombs test
autoimmune hemolytic anemia
15 year old girl comes to ER with petechial rash, bleeding of oral mucosa, fatigue, and history of recurrent sinus infections over the past 2 months. Had bad flu-like virus about 3 months ago, had to miss four days of school. No hepatosplenomegaly. Lab tests show anemia, neutropenia, an thrombocytopenia. No abnormal cell types shown on peripheral blood smear. Admit and schedule bone marrow biopsy
aplastic anemia
6 year old boy presents with fatigue, fever, and history of recurrent epistaxis and UTIs. He is pale and has petechial rash over his entire body. Blood tests show pancytopenia with presence of multiple blast forms. Bone marrow biopsy ay show cells that would stain + for TdT and CALLA
acute lymphoblastic leukemia
52 year old woman presents with 2 week history of low grade fever and weakness. Suffered from various infections over the past three months. She is pale with a petechial rash with hepatosplenomegaly. Peripheral blood smear shows pancytopenia with multiple myeloblasts. Refer to hematologist/oncologist
acute myelogenous leukemia
55 year old man complains of a feeling of heaviness in his abdomen. Has had several infections over the last 6 months. Splenomegaly. Peripheral blood smear reveals abnormal cells with filamentous projections. Refer to hematologist/oncologist. Dx very sensitive to treatment
hairy cell leukemia
44 year old man presents with severe fatigue. Splenomegaly. Blood tests show multiple immature granulocytes on peripheral blood smear, a high WBC count, and low LAP activity. Chromosomal abnormality
chronic myelogenous leukemia
22 year old man presents with painless lump in his neck. Low grade fever and drenching night sweats for two months. lost 14 lbs over 8 weeks. Unilateral cervical lymphadenopathy and splenomegaly. Lymph node biopsy reveals large multi-nucleated cells with prominent nucleoli resembling owl’s eyes. Refer to hematologist/oncologist
Hodgkin lymphoma
57 year old man presents with a large painless lump in his neck. Low grade fever for three months. Lost 10 lbs during that time. Painless cervical lymphadenopathy and hepatosplenomegaly. Blood tests show mild anemia and elevated LDH. Send for lymph node biopsy
Non-Hodgkin lymphoma
69 year old man presents to ER with pain in his neck and pack. Extreme fatigue and two UTIs over the last 4 months. Xray shows L2-3 fractures and punched out lytic bone lesions in posterior skull. Lab shows mild anemia and elevated BUN and creatinine. Admit to hematology/oncology
multiple myeloma
8 year old presents to ER with a swollen right knee. Denies history of trauma to knee. Warm, swollen, erythematous joint with significant effusion. Two maternal uncles suffer from a bleeding disorder. Lab shows prolonged PTT, a normal PT, and normal bleeding time. Order clotting factor assay
hemophilias A&B
28 year old woman, 33 weeks pregnant, presents to ER with heavy vaginal bleeding. Ultrasound shows abruptio placentae. Blood seeping from her IV and venipuncture sites and petechial rash. Blood tests show prolonged PT and PTT, prolonged bleeding time, prolonged thrombin time, thrombocytopenia, elevated D-dimer. Transfuse platelets and fresh frozen plasma to stabilize.
disseminated intravascular coagulation
45 year old obese white man presents for annual checkup. Occasional headaches is only complaint. Smoker and family history of heart disease. Mild obesity and BP of 170/100. Suggest lifestyle changes like weight loss, low salt diet, smoking cessation. Prescribe hydrochlorothiazide
essential and secondary hypertension
40 year old white man presents with sharp chest pain radiating to shoulder during strenuous physical activity. Painful muscle cramps in legs when running. All relieved by rest. Father died of MI in early 50s and two paternal uncles experienced the same fate. Yellow nodules under both eyelids. Check cholesterol and exercise stress test of both heart and legs to evaluate for widespread vascular disease
atherosclerosis
55 year old presents to ER with intense back pain, abdomen and groin. Nausea and sudden fainting. Pale, sweating profusely, hypotensive. Mass in mid-abdomen. Give fluids, prepare for imaging, consult for vascular surgery
aortic aneurysm
33 year old man with Down syndrome presents with gradual onset of shortness of breath over the last several months. Systolic flow murmur at left upper sternal border, a widely fixed split S2 sound and an Osat of 93% on room air. Schedule cardiac tests and possible surgery
atrial septal defect
2 year old girl brought to pediatric cardiology clinic for evaluation of murmur heard by PCP. Father says she is healthy and active. Well nourished and appropriately sized. Loud, hard, holosystolic murmur at left lower sternal border with no evidence of right ventricular strain. Order EKG, likely minor and requires no treatment.
ventricular septal defect
newborn boy of diabetic mother is found to be blue. holosystolic murmur, consistent with VSD. CXR shows boot shaped heart. Schedule cardiac tests, will need corrective surgery
tetralogy of fallot
during routine check up, 60 year old man has occasional chest discomfort into left shoulder. “weight on his chest” and tends to happen after he shovels his driveway and goes away with rest. No pain at rest. Stress test, nitro, consult with cardio
angina pectoris
60 year old man comes to ER with 2 hours of crushing substernal chest pain into left shoulder and jaw. Appears fatigued and heavily breathing and sweating profusely. ECG shows ST elevations across the precordium. Go to cath lab, pt. at risk for ventricular rupture in 5-7 days
myocardial infarction
23 year old woman has inc. dyspnea on exertion over 6 months as well as lower extremity sweating. no past history, strep 10 years ago, not treated with antibiotics. late, low frequency, rumbling, mid diastolic murmur following a high pitched opening snap heard best at apex of heart. ECG and cardio referral
mitral stenosis
10 year old girl presents with fever, malaise, migratory polyarthritis, blanching erythematous ring shaped rash on proximal extremities. Severe sore throat 2-3 weeks ago. Serum studies show ESR of 100 mm/h and + anti-streptoysin O (ASO) titer. May suffer from valvular heart disease
acute rheumatic fever and rheumatic heart disease
30 year old presents to ER with sudden high fever and shaking chills. new murmur localized to mitral valve is heard. bilateral nail bed hemorrhages, painful nodules on the tips of his fingers and toes, an erythemateous rash on his palms and soles, and white spots surrounded by hemorrhage in his retina. Begin on broad spectrum antibiotics and order blood cultures and EKG
acute and subacute endocarditis
20 year old man from Panama complains of dyspnea, orthopnea, bilateral leg swelling, bloated belly. no history of congenital heart disease, rheumatic fever, or valvular disease. ECG shows biventricular failure. Possible parasitic endemic
myocarditis
72 year old man presents to ER with difficulty breathing. Visiting from out of town, has been celebrating for the last 5 days, eating out a lot, drinking alcohol, dietary indiscretion, forgets to take meds, two MIs, weak heart, 170/100 BP and HR 100 bpm, crackle lungs, bilateral LE pitting edema, no ECG evidence of acute MI
dilated cardiomyopathy
20 year old college football player suddenly collapses and dies during a practice session, father did same in 30s. autopsy showed hypertrophied heart with enlarged intraventricular septum. disoriented tangled hypertrophied myocardial fibers. related to autosomal dominant condition resulting in mutation of beta myosin heavy chain protein gene
hypertrophic obstructive cardiomyopathy
58 year old woman presents to cardiologist for evaluation of dyspnea. over 6 months has become progressively short of breath with activity. swelling in legs, pitting edema. bilateral crackles in lung. ECG shows thickened heart with dec. ventricular compliance and impaired diastolic filling
restrictive cardiomyopathy
75 year old woman with history of metastatic breast cancer presents in ER with weakness and difficulty breathing. BP 90/50, distant and faint heart sounds. inc. JVP. ECG shows QRS complex height varies each beat. immediate pericardiocentesis
cardiac tamponade
55 year old woman presents with ankle swelling and inc. shortness of breath with exertion, also when lying down. marked hepatosplenomegaly, distended neck veins, pedal edema. CXR shows cardiomegaly. ACE inhibitor, diuretic, and low sodium diet, refer out to cardio
congestive heart failure
63 year old man presents with worsening shortness of breath over the past year. Smoked two packs a day for the last 45 years. Using accessory muscles to breathe, barrel shaped chest, breathing carefully through pursed lips, dec. FEV1/FVC and inc. TLC. Need to stop smoking and prescribe tiotropium inhaler
emphysema
8 year old girl brought into urgent care for shortness of breath. multiple allergies in hx. expiratory wheezes, using accessory muscles for respiration. give inhaled beta two adrenergic agonist for relief
asthma
74 year old man presents with a persistent cough that produces copious sputum. heavy smoker, has had similar cough for years. diffuse wheezing and crackles. pt. will have dec. FEV1/FVC
chronic bronchitis
2 year old girl brought to ER with shortness of breath and a productive cough. hx of pulmonary infections and bulky stools that float. thin girl with barrel shaped chest, crackles over both lungs, digital clubbing. sweat test shows high levels of chloride ions.
cystic fibrosis
63 year old man hospitalized for a severe case of lobular pneumonia with sepsis. first 24 hours in hospital, he develops worsening respiratory failure and requires intubation. CXR shows bilateral patchy opacities. He becomes progressively hypoxemic even with inc. O2 delivery via vent. 30-60% mortality rate
acute and neonatal respiratory distress syndrome
49 year old man presents with mild shortness of breath over a year. not a smoker, worked in a glass manufacturing factory for over 20 years. CXR shows eggshell calcification of hilar lymph nodes. suggest PPD placement due to inc. susceptibility to TB
pneumoconiosis (Silicosis, Coal worker, anthracosis)
59 year old man presents with a productive cough and dyspnea. smoked heavily for many years and worked in construction. CT shows interstitial lung fibrosis and calcified pleural plaques. he is at great risk for both bronchogenic carcinoma and malignant mesothelioma of the pleura.
asbestosis
64 year old woman presents to rural PCP with progressive dyspnea over 6-8 months. lost 12 lbs in the last 3 months. dairy farmer. bibasilar crackles in upper lobes of bilateral lungs. chronic exposure due to livelihood
hypersensitivity pneumonitis
32 year old african american woman presents to urgent care with fever, rash, dyspnea. suffering from arthralgias in both knees and right hip. CXR shows interstitial lung infiltrates and massive bilateral hilar hypercalciuria. predict noncaseating granulomas on biopsy of hilar lymph nodes
sarcoidosis
82 year old woman presents to ER with severe shortness of breath. sore right calf. stroke 6 months ago and has been bedridden since. hypoxic and elevated d-dimer. begin empiric anticoagulant therapy and high-res CT of chest with contrast
pulmonary embolism
68 year old man presents to ER with fever, dyspnea, and cough productive of green sputum. ill appearing, breathing heavily. bronchial breath sounds and dullness to percussion over right lower lung lobe. obtain sputum and blood cultures and admit for antibiotic treatment
acute bacterial pneumonia
21 year old woman presents to university health clinic with general weakness and low grade fever of three days. occasional cough and dyspnea and roommates feel the same. CXR shows patchy infiltrates. prescribe azithromycin and schedule follow up
atypical pneumonia
42 year old HIV + man presents to ER with hemoptysis. lost 15 lbs over last two months. intermittent fever, cough, and chills. not taking HIV meds. CD4 count is 130. CXR shows lesion in apical right lung. cough up green mucous coated with blood, send for staining and culture. sample shows acid-fast bacilli. admit to an isolation room and begin multidrug treatment regimen while drug susceptibility tests are run
tuberculosis
SHORT ANSWER: pathogenesis of primary tb
how
what is it
never exposed to mycobacterium tb and has infection for first time
localized lung inflammation from macrophages, neutrophils, and lymphocytes, to form granuloma
granuloma becomes calcified to turn into Ghon complex, which contains caseous necrosis and may spread to other organs
SHORT ANSWER: pathogenesis of secondary tb
immune system compromised due to reinfection, drugs, or immune compromise
granulomatous inflammation affects upper lung lobes, cavitation can occur
miliary pattern of spread, 1-3 mm sized granulomas in lungs or other organs
