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Patho > exam 2 > Flashcards

exam 2 Flashcards

1
Q

Hematocrit

A

volume of packed RBC expressed as a % of total peripheral blood

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2
Q

hemoglobin chains: types

A

Alpha, beta, gamma, epsilon

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3
Q

hemoglobin chains: factors

A

iron, vitamin b12, vitamin b6, folic acid

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4
Q

hemoglobin: cellular structure

A

porphyrin heme ring produced y mitochondria, iron inserted to form heme, globin chains produced by ribosomes and are joined to heme = hemoglobin

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5
Q

hemoglobin: levels

A

anemia = <13.5 g/dL for men, <12.5 g/dL for women. transfusion needed < 8 g/dL

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6
Q

anemia

A

reduction of hemoglobin in blood to below normal levels

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7
Q

anemia: pathogenesis (actions)

A

iron deficient, breast feeding, vegetarian diet, peptic ulcer, menorrhagia, pregnancy, carcinoma, gastrectomy

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8
Q

anemia: morphology

two ways

A

due to chronic disease: chronic inflammation and malignant condition

microcytic homochromic: decrease production of hemoglobin (iron, Hb, porphyrin ring)

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9
Q

types of anemia: aplastic

3 types
physiological changes
symptoms
what do they crave

A

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

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10
Q

types of anemia: macrocytic (megaloblastic)

A

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)

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11
Q

sickle cell anemia

A

substitution of glutamic acid by valine (point mutation), african americans (7-10%HbAS, 0.4% HbSS)

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12
Q

SHORT ANSWER: pathogenesis of sickle cell anemia

A

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

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13
Q

thalassemia

A

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

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14
Q

polycythemia

A

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

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15
Q

leukemia

A

WBC precursors in bone marrow and peripheral blood

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16
Q

types of leukemia: acute lymphoblastic

A

most common form in children, massive infiltration of bone marrow and peripheral blood with immature lymphoid cells (blasts)

good prognosis with chemo

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17
Q

types of leukemia: acute myelogenous

who does it affect
what physiological changes
prognosis
acid type

A

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

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18
Q

types of leukemia: chronic myelogenous

A

pluripotent hematopoietic stem cells, too many in peripheral blood and bone marrow, Philadelphia chromosome, tyrosine kinase inhibitors, transplant, chemo

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19
Q

types of leukemia: hairy cell

cells affected and how
+ for
sign
treatment

A

neoplastic proliferation of mature B cells, + for tartrate-resistant acid phosphate (TRAP); splenomegaly; good response to 2-CDA (chemo, adenosine deaminase inhibitor)

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20
Q

types of leukemia: chronic lymphocytic

A

lymphoid cells; lymph node involvement leads to generalized lymphadenopathy and is called small lymphocytic lymphoma; 7-9 years after dx

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21
Q

lymphoma

ages
organs affected
malignant or benign?

A

any age, lymph nodes, spleen, thymus, bone marrow, no benign types

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22
Q

types of lymphoma: non-Hodgkins: follicular

A

most common form, older people, slow growing, 7-9 years after dx

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23
Q

types of lymphoma: non-Hodgkins: diffuse-large cell

A

most common aggressive form; tissues infiltrated with large lymphoid cells that have irregular nuclear outlines and prominent nuclei

chemo

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24
Q

types of lymphoma: non-Hodgkins: Burkitt’s

A

malignant tumor of small B cells (EBV); extranodal masses, sub-saharan (jaw), abdominal mass; high mitotic index

“starry sky”

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25
Q

types of lymphoma: Hodgkins

ages
types (4)
special cells
prognosis

A

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%)

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26
Q

lymphoma dx: PET grading

A

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)

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27
Q

multiple myeloma

what is it
symptoms
tests
prognosis

A

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

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28
Q

hemophilia

A

sex-linked congenital clotting factor deficiency; uncontrollable bleeding with trauma and subcutaneous hematoma

A: deficiency of FACTOR VIII
B: deficiency of FACTOR IX

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29
Q

ECG: set up - leads

A

V1-6 and RA LA LL RL

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30
Q

ECG: conduction pathway

A

SA node sends out AP to AV node then to AV bundle (bundle of HIS) then R&L branches then Purkinje fibers

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31
Q

ECG: know graph, and what each section does

A

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

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32
Q

ECG: chronotropic

A

heart rate (- = beta blocker)

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33
Q

ECG: inotropic

A

cardiac contractile force

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34
Q

ECG: dromotropic

A

speed of impulse transmission

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35
Q

Atrial septal defect

cause
blood direction

A

failure of proper closure of foramen ovale or defect in the septum

blood from LA to RA due to pressure difference

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36
Q

Ventricular septal defect

A

failure of fusion of interventricular septum

high pressure, blood shunts

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37
Q

Tetralogy of Fallot

A

stenosis of RV outflow tract, RV hypertrophy, VSD, overriding aorta

R to L shunt: cyanosis

squat during spells (inc. arterial resistance)

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38
Q

Valvular disease: rheumatic fever

cause
pathogenesis
dx

A

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

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39
Q

bacterial endocarditis

A

inflammation of endocardium due to bacterial infections (strep. viridans)

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40
Q

bacterial endocarditis: subacute infective

A

low virulence organisms, do not destroy valves, mild symptoms (low fever)

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41
Q

bacterial endocarditis: acute infective

A

highly virulent organism, infect normal valves (most commonly tricuspid), destroy valves (strep. aureus)

fever with chills, murmurs, need antibiotics

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42
Q

bacterial endocarditis: by staph. epidermidis

A

endocarditis of prosthetic valves

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43
Q

pericarditis

causes
symptoms
ecg changes

A

viruses, travel, bacteria, open heart surgery

chest pain worse with lying supine and with inspiration

concave ST elevation with PR depression, normal CK-MB

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44
Q

myocarditis

what causes it
what is it
physiological changes
treatment

A

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

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45
Q

dilated cardiomyopathy

what is it
causes

A

dilation of all 4 chambers and most common form, systolic dysfunction

causes: idiopathic, genetic mutation, myocarditis, pregnancy, alcohol abuse

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46
Q

hypertrophic cardiomyopathy

A

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

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47
Q

restrictive cardiomyopathy

what is it
causes

A

decreased compliance of ventricular endomyocardium that restricts filling during diastole

cause: amyloidosis, result in CHF with decreased QRS amplitude

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48
Q

nonrheumatic aortic stenosis

cause
area of heart
physiological change
results in…

A

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

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49
Q

cor pulmonale

A

overload of RV from pulmonary hypertension

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50
Q

atherosclerosis

A

plaque build up in arteries

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51
Q

atherosclerosis pathogenesis

A

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

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52
Q

Coronary Artery Disease/CHD/Ischemic HD

what is it
who is at risk
levels

A

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

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53
Q

SHORT ANSWER
manifestations of CAD: angina pectoris - stable angina

what is it
cause
symptoms

A

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

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54
Q

SHORT ANSWER
manifestations of CAD: angina pectoris - unstable angina

A

more frequent, longer, less relieved by nitro, rupture of atherosclerotic plaque with thrombosis and incomplete occlusion of coronary artery

higher chance of MI

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55
Q

SHORT ANSWER
manifestations of CAD: angina pectoris - Prinzmetal’s

A

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

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56
Q

SHORT ANSWER
manifestations of CAD: angina pectoris - TREATMENT

A

oxygen, baby aspirin, nitroglycerine, morphine

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57
Q

aneurysm

A

dilating of artery wall or outpouching portion of wall

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58
Q

arteriosclerotic aneurysm

A

weakens vessel wall (most acquired as a result of arteriosclerosis)

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59
Q

dissecting aneurysm of aorta

A

splitting of aorta media by blood due to degenerative changes that cause layers to lose cohesiveness and separate

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60
Q

abdominal aortic aneurysm

cause
symptoms

A

result of atherosclerosis

abdominal pain, back/flank pain, hypotension, urge to defecate (pressure on large intestine)

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61
Q

atheroma

A

degeneration of artery wall due to atherosclerosis

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62
Q

myocardial infarction

areas involved
percents

A

L&R ventricles: anterior, posterior, and lateral walls

regional (90%), diffuse (10%)

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63
Q

myocardial infarction: L anterior descending artery (LAD)

A

infarction of anterior wall and septum of LV

most commonly involved artery in MI

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64
Q

myocardial infarction: R coronary artery (RCA)

A

infarction of posterior wall and septum, and papillary muscles of RV

2nd most commonly involved artery

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65
Q

myocardial infarction: L circumflex artery

A

infarction of LV lateral wall

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66
Q

SHORT ANSWER
MI ECG zones (3)

A

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

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67
Q

MI dx

A

enzyme tests, leak with proteins from necrotic cells when muscle becomes infarcted

Troponin T & I (protein)
creatine kinase CK-MB (enzyme)
lactic dehydrogenase (enzyme)

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68
Q

MI treatment

A

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)

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69
Q

congestive heart disease (CHD)

what is it

A

cannot pump powerfully or fast enough to empty, blood gets backed up

70
Q

Left sided CHD

area affected
signs
levels
treatment

A

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

71
Q

Right sided CHD

causes
signs
symptoms
medication
surgical treatment

A

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

72
Q

cardiac tamponade

what is it
causes
Beck’s Triad
treatment

A

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

73
Q

varicose veins

A

dilated, torturous (leg) veins

thrombosis: blockage of vein by clot
phlebitis: inflammation of a vein

74
Q

acute upper respiratory infection: chronic sinitus

what is it
causes

A

thickened and inflamed sinus mucosas and persistent fluid accumulation

inflamed sinus, chronic inhalation or irritant, nasal obstruction (deviation septum or polyps)

75
Q

acute upper respiratory infection: acute sinitus

A

rhinitis or bacteria (cold/flu)

76
Q

acute upper respiratory infection: acute laryngitis

causes (3)
what is it

A

acute inflammation of larynx can be infective, allergic, or irritant

sore throat; lasts 2 ish days

77
Q

acute upper respiratory infection: chronic laryngitis

what is it
who gets it

A

chronic inflammation of larynx

heavy cigarette smoker

78
Q

croup

ages
what is it
cause
symptoms
treatment

A

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

79
Q

epiglottis

what is the sickness
cause
signs/symptoms
treatment

A

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

80
Q

pneumonia

what is it
symptoms
tests

A

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)

81
Q

pneumonia that can be seen on x-ray: lobar

what is it
four kinds

A

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

82
Q

pneumonia that can be seen on x-ray: bronchopneumonia

A

bacterial, scattered patchy bronchioles

83
Q

pneumonia that can be seen on x-ray: nosocomial

where
risk

A

in hospital. pts. at risk for aspiration

84
Q

COVID-19

type of illness
spread
vaccine pathogenesis (spike protein)
how are variations created

A

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

85
Q

Tuberculosis

what causes it

A

airborne bacteria (myobacterium tuberculosis)

86
Q

TB: primary

pathogenesis
symptoms

A

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

87
Q

TB: secondary

cause
area
spread

A

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

88
Q

TB: Pott’s disease (skeletal TB)

body parts affected
symptoms

A

osteomyelitis, T&L spine vertebrae, then knee and hip

extensive necrosis, bony destruction, soft tissue extension, “cold” abscess

89
Q

TB: dx

A

skin test (mantoux; recent TB), chest xray (granuloma), sputum culture

90
Q

TB: treatment

A

2-3 types of antibiotics incase of resistance (ex: INH, Rifampin & Ethambutol or Streptomycin)

91
Q

cystic fibrosis

A

production of viscid secretions by exocrine and mucus secreting glands (pancreas/resp. tract)

92
Q

cystic fibrosis: pathogenesis and tests

A

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

93
Q

COPD

2 factors
symptoms

A

emphysema and chronic bronchitis; 2 types

barrel chest, prolonged respiration and rapid rest phase, thin, pink skin (inc. RBC), accessory muscle hypertrophy, “pink puffers”

94
Q

COPD: emphysema - centrilobular

cause
physiological changes

A

cigarette smoking

destruction of cluster of terminal bronchioles at the end of bronchial tree in central pulmonary lobule; upper lobes and superior lower lobes

95
Q

COPD: emphysema - paracinar

what does it destroy

A

acinus (alveoli with ducts)

destruction of alveolar septa from center to acinus periphery; lower lobes

96
Q

COPD: emphysema - localized

aka
physiological change
possible complication

A

“paraseptal”

destruction of alveoli in one or FEW locations, rest of the lung is normal

possible pneumothorax

97
Q

COPD: bronchitis

symptom
signs
treatment

A

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

98
Q

COPD: bronchitis - acute

A

common, self limiting

99
Q

COPD: bronchitis - chronic

cause
criteria

A

secondary to chronic irritation (smoking, air pollution)

cough lasting at least 3 months over at least 2 years

100
Q

bronchiolitis

cause
facts

A

swelling and mucus buildup in bronchioles

viral, kids under 2, peak is 3-6 mo. with RSV, starts as upper respiratory infection, breathing issues

101
Q

respiratory syncytial virus (RSV)

A

mild cold in adults

most common germ to cause lung and airway infections in infants/kids (fall into spring)

102
Q

pulmonary embolism

what is it
whats it made of
risk factors
treatment

A

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

103
Q

asthma

what is it
treatment

A

increased irritability of bronchial tree with paroxysmal narrowing airways (dyspnea and wheezing)

fluticasone and salmeterol

104
Q

asthma: allergic

causes
levels

A

extrinsic, kids, pollens and animal hair and fur and dust mites, skin test reactivity correlation, inc. IgE and type I hypersensitivity

105
Q

asthma: infectious

causes
who is affected
levels

A

intrinsic, viral respiratory tract infection in kids under 2, RSV agent

common: rhinovirus, influenza, para influenza

normal IgE

106
Q

asthma: exercise induced

what is it
physiological cause

A

bronchospasm, rapid breathing rate + cold air = worse

mediator release or vascular congestion secondary to airway rewarming

107
Q

asthma: occupational

examples

A

animal handlers, wood and vegetable dust, metal salts, pharmacutical agents, brown lung in cotton fiber workers and industrial chemicals

108
Q

asthma: emotional

A

stress can cause bronchospasm

109
Q

sarcoidosis

pathogenesis
who is affected
identifying factors
levels
treatment

A

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

110
Q

pulmonary fibrosis

cause

A

pneumoconosis: lung injury by inhalation of injurious dust or other particulate material

111
Q

pulmonary fibrosis: silicosis

type
cause

A

progressive nodular pulmonary fibrosis by inhalation of rock dust

112
Q

pulmonary fibrosis: inhalation of…

A

coal dust (coal-workers lung disease), cotton fibers, certain fungus spores and others from occupations

113
Q

pulmonary fibrosis: asbestosis

cardiac symptoms

A

diffuse pulmonary fibrosis by inhalation of asbestos fibers

pulmonary hypertension and cor pulmonale

114
Q

pulmonary fibrosis: asbestos - serpentine asbestos (white)

A

most common, fibers in lung for limited time

115
Q

pulmonary fibrosis: asbestos - amphibole asbestos (blue and brown)

cause of…

A

fibers in lung for many years and main cause of malignant mesothelioma

116
Q

respiratory distress syndrome: neonatal (NRDS)

cause physiological and prenatal
treatment
symptoms

A

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

117
Q

respiratory distress syndrome: acute

what is it
treatment

A

(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

118
Q

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

A

iron deficiency anemia

119
Q

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

A

megaloblastic anemia

120
Q

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

A

sickle cell anemia

121
Q

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

A

thalassemia

122
Q

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

A

autoimmune hemolytic anemia

123
Q

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

A

aplastic anemia

124
Q

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

A

acute lymphoblastic leukemia

125
Q

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

A

acute myelogenous leukemia

126
Q

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

A

hairy cell leukemia

127
Q

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

A

chronic myelogenous leukemia

128
Q

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

A

Hodgkin lymphoma

129
Q

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

A

Non-Hodgkin lymphoma

130
Q

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

A

multiple myeloma

131
Q

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

A

hemophilias A&B

132
Q

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.

A

disseminated intravascular coagulation

133
Q

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

A

essential and secondary hypertension

134
Q

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

A

atherosclerosis

135
Q

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

A

aortic aneurysm

136
Q

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

A

atrial septal defect

137
Q

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.

A

ventricular septal defect

138
Q

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

A

tetralogy of fallot

139
Q

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

A

angina pectoris

140
Q

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

A

myocardial infarction

141
Q

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

A

mitral stenosis

142
Q

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

A

acute rheumatic fever and rheumatic heart disease

143
Q

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

A

acute and subacute endocarditis

144
Q

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

A

myocarditis

145
Q

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

A

dilated cardiomyopathy

146
Q

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

A

hypertrophic obstructive cardiomyopathy

147
Q

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

A

restrictive cardiomyopathy

148
Q

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

A

cardiac tamponade

149
Q

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

A

congestive heart failure

150
Q

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

A

emphysema

151
Q

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

A

asthma

152
Q

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

A

chronic bronchitis

153
Q

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.

A

cystic fibrosis

154
Q

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

A

acute and neonatal respiratory distress syndrome

155
Q

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

A

pneumoconiosis (Silicosis, Coal worker, anthracosis)

156
Q

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.

A

asbestosis

157
Q

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

A

hypersensitivity pneumonitis

158
Q

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

A

sarcoidosis

159
Q

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

A

pulmonary embolism

160
Q

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

A

acute bacterial pneumonia

161
Q

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

A

atypical pneumonia

162
Q

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

A

tuberculosis

163
Q

SHORT ANSWER: pathogenesis of primary tb

how
what is it

A

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

164
Q

SHORT ANSWER: pathogenesis of secondary tb

A

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

165
Q
A
165
Q
A
165
Q
A
166
Q
A
167
Q
A
168
Q
A
169
Q
A

Patho (3 decks)

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