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Understanding Human Disease > Exam 2 (ch. 13 & 15) > Flashcards

Exam 2 (ch. 13 & 15) Flashcards

1
Q

What is the function of the blood?

A
  • Transport (CO2, O2, nutrients, hormones)
  • Immune system response
  • Plasma proteins needed to help maintain BP, temp. -regulation, coagulants and the complement system
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2
Q

Plasma vs. serum

A

Plasma is all the liquid portion of the blood. Serum is all the liquid portion of the blood, but without coagulation proteins

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3
Q

Cells and cell fragments are within what part of the blood?

A

plasma

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4
Q

Why do we say “cellular ELEMENTS of human blood”?

A

Because some are cells, some are parts of cells

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5
Q

Erythrocytes

A

RBC

  • primary job is to transport O2
  • most numerous cells
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6
Q

Erythroblasts

A

Precursor cell of erythrocytes in bone marrow

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7
Q

Hemoglobin

A

Oxygen-carrying protein formed by the developing red cell.

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8
Q

Cellular elements of human blood

A

Erythrocytes (RBC)
Leukocytes (WBC)
Thrombocytes (platelets/fragments)

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9
Q

What are the components of erythrocytes

A

erythroblasts

hemoglobin

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10
Q

Hematopoesis

A

the normal making of cells in the blood

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11
Q

Bone marrow is what type of stem cell?

A

Multipotent stem cell

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12
Q

What are the 2 main lineages of hematopoiesis?

A
  1. Myeloid Lineage
    - makes thrombocytes, PMNS, mast cells, macrophages, RBC
  2. Lymphoid Lineage
    - makes all lymphocytes
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13
Q

What is normal/healthy hemoglobin called?

A

HbA –> hemoglobin A (adult)

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14
Q

What is the structure of hemoglobin?

A
  • alpha globin chain (x2)

- beta globin chain (x2)

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15
Q

Where does synthesis of hemoglobin take place?

A

mitochondria and cytosol of RBC

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16
Q

Heme

A

Structural chemical group in the middle of each heme is iron, which is where the O2 binds

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17
Q

Erythropoiesis

A

The formation and development of RBC

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18
Q

Substances needed for erythropoiesis

A
  • protein
  • vitamin B12
  • folic acid (one of the vitamin B groups)
  • iron
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19
Q

Where is iron in the body stored?

A

75% of iron is found in RBC, the rest is stored in the liver, bone marrow, and spleen

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20
Q

Where does iron uptake take place?

A

Iron uptake is controlled in the gut

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21
Q

What is Hepcidin?

A

It is a protein in the gut that is made by the liver; it affects the GIs uptake of iron

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22
Q

What is RBC production regulated by?

A

RBC production is regulated by oxygen content of the arterial blood

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23
Q

Erythropoietin (EPO)

A

Made by the kidneys; EPO is released by the kidneys and it affects the bone marrow stimulating the production of RBC

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24
Q

Where are RBC removed at?

A

spleen and liver

*when destroyed, we recycle iron and beta-globin as amino acids; heme is eliminated at bilirubin

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25
Q

Anemia

A

Abnormally low hemoglobin

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26
Q

Causes of anemia

A
  1. Low HgB in RBC

2. Low RBC count

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27
Q

How might you diagnose anemia

A
  1. Complete blood count (CBC)
    - RBC indices (color, count, size, volume)
  2. Visual inspection
    - Reticulocyte
  3. Hb< 12 g/dl blood
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28
Q

Reticulocyte

A

An immature RBC characterized by still having organelles

  • body kicks RBC out of bone marrow to soon in order to increase O2
  • RBc do not have organelles; right before a RBC is kicked out of the bone marrow, it loses it’s nucleus/organelles
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29
Q

Anemia: morphologic classification

A

classification is based on red cell appearance which can suggest the etiology of anemia

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30
Q

Normocytic anemia

A

RBC with normal size and appearance

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31
Q

Macrocytic anemia

A

RBC that are larger than normal

  • folic acid deficiency (green leafy)
  • vitamin B12 deficiency (animal products)
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32
Q

Microcytic anemia

A

RBC smaller than normal

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33
Q

Hypochromic anemia

A

reduced hemoglobin content

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34
Q

Hypochromic microcytic anemia

A

RBC smaller than normal and reduced hemoglobin content

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35
Q

Symptoms of anemia

A

fatigue
cyanosis (blue tint)
increased pica (appetite for non-food)
headache

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36
Q

Causes of anemia

A
  • Iron-deficiency Hemorrhage
  • Insufficient RBC production
  • Hemolytic anemia
  • Chronic disease
  • Aplastic anemia
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37
Q

Most common type of anemia

A

Iron-deficiency anemia

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38
Q

When you see Iron-deficiency anemia, what morphologic classification should you think of

A

Hypochromic microcytic anemia

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39
Q

Iron-deficiency anemia: pathogenesis

A
  • Inadequate iron in diet
  • Infants during periods of rapid growth
  • Adolescents with bad diet
  • Inadequate reutilization of iron present in red cells due to chronic blood loss (periods, ulcer/cancer in GI tract) `
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40
Q

Iron-deficiency anemia: treatment

A

Primary focus: learn cause of it

  • direct treatment towards cause than symptoms
  • administer supplementary iron
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41
Q

Macrocytic anemia is a of what what?

A

megaloblastic anemia

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42
Q

Why are the deficiencies of vitamin B12 and folic acid an issue in Macrocytic anemia?

A

They are both required for normal hematopoesis, DNA replication, and the deficiencies may affect other cells as well such as WBC/platelets

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43
Q

What morphological classification of anemia does this statement describe: Mature RBC formed are larger than normal or macrocytes

A

Macrocytic anemia

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44
Q

Pernicious Anemia

A

Lack of intrinsic factors in the stomach which results in Macrocytic anemia
- vitamin B12 combines with intrinsic factors in stomach and is absorbed in ileum

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45
Q

Pernicious Anemia: Causes

A
  1. Gastric resection and bypass: vitamin B12 is not absorbed
  2. Distal bowel resection or disease: impaired absorption of vitamin B12 intrinsic factor complex
  3. May develop among elderly because they produce less hydrochloric acid in stomach
  4. Autoimmune: associated with autoantibodies against gastric mucosal cells and intrinsic factor
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46
Q

Conditions that depress bone marrow function

A
  1. Anemia of chronic disease
    a. mild suppression of bone marrow function
    b. cannot find cause
  2. Aplastic Anemia
    a. marrow injured by radiation, anti-cancer drugs, chemicals or autoantibodies
  3. Cancer
    a. Bone marrow infiltrated by tumor or replaced by fibrous tissue
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47
Q

Hemolytic Anemia

A

Premature destruction of RBC

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48
Q

Characteristics of Hemolytic Anemia

A
  1. Active bone marrow trying to increase RBC count
  2. Increased EPO
  3. Increased reticulocytes
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49
Q

Causes of Hemolytic Anemia

A

genetic and non-genetic defects

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50
Q

Genetic Hemolytic Anemia: Sickle cell disease

A

Pathophysiology = HbS

  • autosomal RECESSIVE (2 copies)
  • missense (misbase) mutation on Beta globin chain
  • RBC sickle
  • Microinfarcts

due to mutation

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51
Q

Non-genetic Hemolytic Anemia: Acquired Hemolytic Anemia

A
  • Normal red cells but are unable to survive due to “hostile environment”
  • attacked and destroyed by antibodies
  • destruction of red cells by mechanical trauma
  • passing through enlarged spleen (splenomegaly)
  • in contract with some part of artificial heart valve
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52
Q

Polycythemia

A

Too many RBC

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53
Q

Polycythemia: types

A
  1. Primary
    a. in bone marrow
    b. bone marrow malignancy
    c. overproduction of RBC, WBC, platelets
  2. Secondary
    a. outside of bone marrow
    b. reduced arterial O2 saturation leads to compensatory increase in RBC
    - lung cancer
    - life at altitude
    - increase in EPO
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54
Q

Polycythemia complications

A

Increase in clots, blood is more viscous which causes heart to work harder leading to heart failure

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55
Q

Polycythemia treatments for each type

A 
Primary = drugs that suppress marrow function
Secondary = periodic removal of excess blood
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56
Q

Hemorrhagic Anemia

A

Loss of iron –> loss of O2 carrying capacity

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57
Q

Hemorrhagic Anemia types

A
  1. Acute
    - due to trauma or wounds
  2. Chronic
    - periods
    - intestinal bleeding
    - presents as iron-deficiency anemia
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58
Q

What is the main threat to acute Hemorrhagic Anemia

A

low BP and low blood volume –> could go into shock

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59
Q

Primary Thrombocytopenia

A
  • associated with platelet antibodies
  • bone marrow produces platelets, but they are rapidly destroyed
  • encountered in children and subsides after short time
  • tends to be chronic in adults
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60
Q

Secondary Thrombocytopenia

A
  • Damage to bone marrow from drugs or chemicals

- Bone marrow infiltrated by leukemic cells or metastatic carcinoma

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61
Q

Thrombocytopenia

A

a low blood platelet count.

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62
Q

Primary function of lymphatic system

A

Provide immunologic defenses against foreign material

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63
Q

lymph nodes

A

Bean-shaped structures consisting of a mass of lymphocytes

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64
Q

Explain how lymph works

A

As lymph flows though the nodes, phagocytic cells filter out and destroy microorganisms and foreign matter

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65
Q

Leukopenia

A

Deficiencies in the quality and quantity of leukocytes.

  • always abnormal
  • low WBC count predisposes people to infections
66
Q

Leukocytosis

A

Increased number of leukocytes.

  • normal protective response to stressors
  • benign or malignant
67
Q

What are some malignancies of leukocyte function

A

lymphoma or leukemia

68
Q

Infectious Mononucleosis (Mono)

A

Infection to leukocytes.

- acute, self limiting infection of B lymphocytes transmitted by saliva through personal contact

69
Q

What causes Infectious Mononucleosis (Mono)

A

Epstein-Barr virus (EBV)

- B cells have an EBV receptor site

70
Q

What is Infectious Mononucleosis (Mono) characterized by?

A

enlarged, tender lymph nodes

71
Q

Hematologic malignancies: Leukemias

A

Malignant disease involving WBC precursors in bone marrow, peripheral blood (acute and chronic)
- can be from either the myeloid or lymphoid lineage

72
Q

Hematologic malignancies: lymphomas

A

Malignant disease involving lymphocytes

  • non-hodgkins lymphoma
  • hodgkins lymphoma
73
Q

Hematologic malignancies: Myeloma

A

Malignant disease of plasma cells.

  • Tumor may be solitary or multifocal
  • most patients over 45 yrs
74
Q

Leukemias (in depth)

A
  1. Malignant disorder of the blood and blood-forming organs

2. Uncontrolled proliferation of malignant leukocytes

75
Q

What hematopoietic cells can give rise to leukemia?

A

Any type of hematopoietic cells can give rise to leukemia, but the most common types are…

a. granulocytic (types of WBCs)
b. lymphocytic
c. monocytic (macrophages)

76
Q

What are the classifications of leukemias

A
  1. maturity

2. cell types

77
Q

Clinical features of leukemia

A

Impairment of bone marrow function.

78
Q

Leukemic cells crowd out normal cells, causing…

A
  1. Anemia: inadequate red cell production
  2. Thrombocytopenia: causes bleeding
  3. Infections from inadequate number of normal WBCs
79
Q

Infiltration of organs by leukemic cells causes…

A
  1. Splenomegaly (enlarged spleen)
  2. Hepatomegaly (enlarged liver)
  3. Lymphadenopathy: enlarged lymph nodes
80
Q

Types of Leukemias

A
  1. Acute lymphocytic leukemia (ALL)
  2. Acute myelogenous leukemia (AML)
  3. Chronic myelogenous leukemia (CML)
  4. Chronic lymphocytic leukemia (CLL)
81
Q

Myeloid Malignancies

A

Arise from myeloid progenitor cells called myeloblast, which are not normally present in the blood

82
Q

Acute myeloid leukemia (AML)

A
  • rapidly progressive
  • age associated
  • leading cause of leukemia deaths in adults
83
Q

Chronic myeloid leukemia (CML)

A
  • slowly progressive

- associated with translocation between chromosomes 9 and 22

84
Q

Acute lymphocytic leukemia (ALL)

A
  1. most common form of leukemia in children
    a. sudden onset
    b. leading cause of cancer deaths in children
85
Q

What is Acute lymphocytic leukemia (ALL) characterized by?

A

Too many immature lymphoid cells that are poorly functioning
- mostly B cells

86
Q

Acute lymphocytic leukemia (ALL): symptoms

A

Recurrent infections, weakness, anemia, bruising, fatigue

87
Q

Acute lymphocytic leukemia (ALL): treatment

A

chemotherapy

88
Q

Chronic lymphocytic leukemia (CLL)

A
  1. Age associated
    - adults
  2. Most common leukemia in the US in prevalence
  3. Slow growing
89
Q

Chronic lymphocytic leukemia (CLL): symptoms

A

Asymptomatic for many years

Predisposed to infections

90
Q

What do malignant cells often infiltrate

A

lymph nodes, spleen, thymus, or bone marrow, but also may involve other organs

91
Q

Non-Hodgkin’s Lymphomas

A
  • risk increases with age
  • 6th most common cancer in US
  • cancer cells can spill over into blood and can present as leukemia (need to distinguish where the cancer is coming from)
92
Q

What organs does Non-Hodgkin’s Lymphomas involve

A

lymph nodes, bone marrow, spleen, thymus, but can be of an extranodal origin

93
Q

Hodgkin’s Lymphoma

A

Most common malignant neoplasm of Americans 10-30 years of age.

94
Q

What is Hodgkin’s Lymphoma characterized by

A

Reed-Sternberg cells

  • B cells gone awry
  • Epstein Barr Virus is a risk factor
95
Q

Non-Hodgkin’s Lymphomas vs Hodgkin’s

A
  1. BOTH present as painless enlargement of lymph nodes
  2. Hodgkin arises in single lymph node or chain or nodes, spreading predictably, rather than spreading widely
  3. Hodgkin rarely involves structures other than lymph nodes (1/3 NHL other organs)
  4. NHL = more aggressive
  5. NHL more common
  6. NHL increasing, while Hodgkin’s decreasing in US
96
Q

Where do malignant plasma cells proliferate?

A

bone marrow

97
Q

Pathophysiology of Myeloma

A

a. functionally useless antibodies
- breakdown of antibodies
- light chains are toxic to kidneys

b. Impaired humoral immunity
- hypogammaglobulinemia (antibodies)

c. anemia
d. most common cause of death infection or renal failure

98
Q

Treatment of Leukemia/Lymphoma

A

Depends on age, severity, and type
a. chemo and radiation are first line of defense, but overtime, cancer may become resistant so you may need to use a different drug

b. HSC stem cell transplantation from bone marrow; need to match HLA. A major concern for this is Graft vs. host disease

99
Q

US leading cause of death

A
  1. heart disease
  2. cancer
  3. chronic lower respiratory disease
100
Q

Leading cause of death worldwide

A
  1. heart disease
  2. stroke
  3. chronic obstructive pulmonary disease
101
Q

Most morbidity and mortality of the lung associated with what lifestyle factor?

A

smoking and pollution

102
Q

What is the structure of the respiratory system?

A

trachea
bronchi
bronchioles
alveoli

103
Q

Alveoli function

A

O2 and CO2 exchange

Production of surfactant

104
Q

Respiration: function

A
  1. Ventilation: the physical movement of air in and out of the lungs
  2. Gas exchange: at lungs; CO2 out, O2 in, gas exchange occurs at the tissues
105
Q

Describe gas exchange

A

Gases diffuse between blood, tissues, and pulmonary alveoli due to differences in their partial pressures

106
Q

Partial pressure

A

the pressure that would be exerted by one of the gases in a mixture if it occupied the same volume on its own.

107
Q

Requirements for efficient gas exchange

A
  1. Large capillary surface area in contact with alveolar membrane
  2. Unimpeded diffusion acros alveolar membrane
  3. Normal pulmonary blood flow
  4. Normal pulmonary alveoli
108
Q

Pleura

A

each of a pair of serous membranes lining the thorax and enveloping the lungs

109
Q

Visceral vs parietal pleura

A 
Visceral = right on lung (inside)
Parietal = line thoracic cavity (outside)
110
Q

Pleural cavity

A

space between lungs and chest wall; in between visceral and parietal pleura

111
Q

Intrapleural pressure

A

The pressure within the pleural cavity

  • normally lesser than intrapulmonary pressure
  • vacuum, no air in or out
  • hold lungs open
112
Q

Dyspnea

A

difficulty breathing; shortness in breath

113
Q

Apnea

A

without breathing

114
Q

Tachypnea

A

increase in breathing rate (ventilation)

115
Q

Hemoptysis

A

coughing up blood

116
Q

Cyanosis

A

blue coloring on body due to lack of O2 in blood

117
Q

Pulmonary function tests

A
  1. Percussion: tapping around lungs (to see if hallow)
  2. Auscultation: listening to lungs with stethoscope
  3. Spirometry: measures lung volumes and capacities (RV, VC, FEV1)
118
Q

Pneumothorax

A

Presence of air in pleural cavity; leads to a collapsed lung

119
Q

Atelectasis

A

Incomplete expansion of the lung

120
Q

Obstructive Atelectasis

A

Obstruction of conducting airway; foreign bodies, mucus plugs

121
Q

Compression Atelectasis

A

Compression of lung by liquid, solid, gas within pleural space; can result in sudden death

122
Q

Diagnosis of Atelectasis

A

X-Ray - the affected lung appears dense

123
Q

Pneumonia

A

Inflammation of the lungs

- leading cause of death in elderly and children

124
Q

Pneumonia may be due to…

A
  • virus
  • bacteria*
  • fungi
  • mycoplasma
125
Q

How might you detect Pneumonia

A
  • auscultation

- chest X ray

126
Q

Predisposing factors of Pneumonia

A

Any condition associated with poor lung ventilation and retention of bronchial secretions

127
Q

Post-op Pneumonia

A

accumulation of mucous secretions in bronchi

128
Q

Aspiration Pneumonia

A

Foreign body, food, vomit

129
Q

Clinical features of pneumonia

A

fever, cough, purulent sputum, pain on respiration, shortness of breath

130
Q

Walking Pneumonia

A

Can still do activities (job, school)

- fever is not as high

131
Q

Walking Pneumonia cause

A

Mycoplasma –> lives inside cells so it can be hard for immune system to see it

132
Q

Walking Pneumonia treatment

A

Need specific type of antibiotic cause it is a specific type of bacteria

133
Q

Bronchiectasis

A

Pathologic dilation of airways due to weakening walls

134
Q

What repeated chronic infections is Bronchiectasis typically associated with

A
  • decrease ability to move mucus
  • distended bronchioles retain more mucus secretions
  • creates an environment for bacterial growth
135
Q

Chronic Obstructive Airway Disorders

A

Group of disorders characterized by reduced airflow and impaired gas exchange

  • progressive
  • poor reversibility
  • increasing prevalence in US
136
Q

What are Chronic Obstructive Airway Disorders often associated with?

A

inflammatory conditions of the lungs

137
Q

Two classifications of Chronic Obstructive Airway Disorders

A

Emphysema

Chronic Bronchitis

138
Q

COPD signs and symptoms

A 
large amount of mucous 
coughing
dyspnea
tight chest
barrel chest
139
Q

Diagnosis of COPD

A

Spirometry: if you see a decrease in FEV1 of VC

140
Q

Chronic Bronchitis

A

Inflammation of medium sized walls (bronchioles)

141
Q

Emphysema

A

Abnormal permanent enlargement of the alveoli, they weaken and eventually rupture

  • enlargement of air spaces
  • loss of lung elasticity
  • irreversibility destruction of alveoli
142
Q

Chronic Bronchitis symptoms

A
  • persistent cough for at least 3 month for 2 consecutive years
  • irritants in lungs
  • excessive mucus
143
Q

Complications of COPD

A
  1. Respiratory failure
    a. acidosis
    b. arrhythmia due to hypoxia
  2. Right side heart failure
  3. more infections such as pneumonia
  4. acute respiratory failure
  5. lung cancer
144
Q

Asthma

A

Bronchospasm (bronchioles get smaller)

  • obstructive disease
  • dyspnea and wheezing on expiration
145
Q

Describe how Asthma is in most cases, an allergic basis

A

Type 1 hypersensitivity

- mast cells release inflammatory mediators –> spasm smooth muscle –> recruit more WBC (eosinophils)

146
Q

Asthma treatment

A
  • avoid the allergen
  • drugs that dilate bronchial walls: epinephrine (beta agonist inhalers)
  • reduce inflammation (corticosteroid inhalers)
  • drugs that block release of mediators from mast calls
147
Q

Neonatal Respiratory Distress Syndrome

A

a. Progressive respiratory distress soon after birth

148
Q

Neonatal Respiratory Distress Syndrome: Pathogenesis

A

Inadequate surfactant in lungs

  • alveoli do not expand normally during inspiration
  • tends to collapse during expiration
149
Q

Neonatal Respiratory Distress Syndrome: at-risk groups

A
  • premature infants
  • infants delivered by C-section
  • infants born to diabetic mothers
150
Q

Neonatal Respiratory Distress Syndrome: treatment

A

Before delivery –> adrenal corticosteroids to mother

After delivery –> oxygen + surfactant to baby

151
Q

Adult Respiratory Distress Syndrome (ARDS)

A

Associated with alveolar damage

  • alveolar epithelium
  • vascular endothelium
152
Q

Types of Adult Respiratory Distress Syndrome (ARDS)

A
  1. Damage due to decrease blood flow to lungs (shock)
  2. Direct damage to pulmonary capillaries
    a. inhalation of irritants
    b. gastric aspiration
153
Q

Result of Adult Respiratory Distress Syndrome (ARDS)

A

Hypoxemia (low O2 in blood) which results in organ failure

154
Q

Treatment of Adult Respiratory Distress Syndrome (ARDS)

A
  1. Treatment of underlying conditions
  2. Supportive care (fluids)
  3. Oxygen therapy (to increase O2 levels in blood)
155
Q

Leading cause of cancer death in both men and women

A

Lung cancer

156
Q

Classifications of Lung Cancer

A
  1. Small Cell (SCLC)
    - only see this in smokers
  2. Non-small Cell (NSCLC)
157
Q

Lung cancer etiology

A

a. Cigarette smoking (80-90%) of lung cancers
- non-smokers = 10-15% of lung cancers

b. Radon gas
c. Asbestos
d. Pollution (second hand smoke)
e. Genetics

158
Q

Why is lung cancer do deadly?

A

Because by the time someone shows symptoms, it already metastasized
- 60% will die within the first year

159
Q

Symptoms of lung cancer

A
  • unexplained cough
  • weight loss
  • coughing up blood
  • loss of appetite
160
Q

What facilitates metastasis in lung cancer?

A

Rich lymphatic and vascular network in lungs facilitates metastasis

161
Q

What are common sites for metastatic cancer

A

breast, prostate, colon

Understanding Human Disease (4 decks)

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