miderm study guide Flashcards
MCHC is related to the _____ of RBCs
color
MCV is related to _____ of RBCs
size
RDW is related to the _____ of RBCs
shape
what do we call the percentage of a person’s blood that consists of RBCs
hematocrit
what are the borderline percentages for men and women as diagnostic criteria for anemia
men < 40
women < 37
why is hct count higher for men
because of the higher levels of androgen
how do we diagnose for inflammation
look at ESR rates for C-reactive protein
EPO comes from what organ
KD
if cells are small and pale, we call this
microcytic and hypochromic
what is the most common type of anemia
iron deficiency anemia
what do we suspect is going on inside the body if one has iron deficiency anemia
chronic bleeding (undiagnosed blood loss)
what are typical presentations of iron deficiency anemia
pica, pagophagia, koilonychia, bare tongue
how do we diagnose for iron deficiency anemia
TIBC test
test will come back low - rbcs are pale and small (micrcytic and hypocromic)
which two forms of anemia include macrocytic or megaloblastic cells
folate deficiency anemia & B12 deficiency anemia
which form of anemia will we see neurological difficulties
B12 deficiency
what happens if we mistake B12 deficiency anemia for folate deficiency anemia and treat with folate supplementation?
the anemia itself may improve but the neurological deficits in the patient due to the B12 deficiency will worsen and or become irreversible
when RBCs are large this is what kind of a problem
DNA problem
when RBCs are small, this is what kind of a problem
hemoglobin problem
what type of anemia is pernicious anemia
deficient formation B12 deficiency
what is the pathogenesis for pernicious anemia
auto-immune atrophic gastritis causing poor absorption of B12
if we suspect pernicious anemia, what would we suggest the patient do? what would we ask them?
Ask them about their digestion and send them to a GI specialist for an endoscopy. We can also use a hemogram and immunology exam as a diagnostic tool.
sickle cell anemia results in…
premature hemolysis of cells.
what is the pathogenesis of sickle cell anemia
hemolysis with thrombosis and ischemia
if we see a high level of reticulocytes, what does this indicate
there are not enough RBCs and the person is experiencing hypoxia
we also suspect chronic bleeding
if we see bandemia, what does this indicate
acute bacterial infection unless proven otherwise.
could also be from burns, pregnancy, etc…but have to diagnose
red bone marrow can be found within which type of bones
flat bones of axial skeleton - skull, ribs, sternum, pelvis, spine
what is the #1, 2, & 3 reasons for lymphocytosis
#1 acute viral infection #2 auto immune disorder #3 cancers (will see signs of fatigue, sudden nose bleeds, rashes, bruises...etc)
dehydration, profuse diaphoresis, emesis, diarrhea, heat exhaustion, burns and vomiting are all related to which kind of polycythemia
relative
renal cell carcinoma is related to which kind of polycythemia
absolute - secondary
polycythemia rubra vera is associated with which kind of polycythemia
absolute - primary
bone marrow malignancy is associated with which type of polycythemia
absolute - primary
smoking, chronic CO or CO2 poisoning are associated with which kind of polycythemia
absolute - secondary
what is the most common hemophilia
hemophilia A
hemophilia A is a deficiency of…
factor XIII
hemophilia B is a deficiency of…
factor IX
christmas
how do we diagnose hemophilia or other bleeding disorders
with plasmaelectrophoesis
what is the most common genetic bleeding disorder
von willebrand disease
which type of leukemia is responsible for 80% of all childhood leukemias
Acute lymphocytic leukemia (ALL)
which form of leukemia is associated with the Philadelphia chromosome
chronic myelogenous leukemia (CML)
Reed-Sternberg cells are found in what kind of lymphoma
Hodgkin’s
how do we diagnose for Non-Hogkin’s and Hogkin’s
Non-Hogkins: CBC & Hemogram; this lymphoma is in blood
Hogkins: biopsy of lymph node or bone marrow; can’t do a blood test because this is a solid cancer
what is the most common cause of L CHF
systemic arterial HTN
what is the most common cause of R CHF
1 left CHF, followed by cor pulmonale
what is the pathogenesis of portal HTN
chronic smoking –> COPD –> pulmonary HTN = stagnation in RT HT = cor pulmonale –> LV is compromised –> portal HTN
cor pulmonale
R CHF due to COPD
when there is no medical cause found to explain one’s high blood pressure, we call this:
essential/primary/idiopathic hypertension
when high blood pressure is a result of another condition, we call this:
secondary hypertension
what is the most common cause of secondary hypertension
KD pathology
If we have a young patient with HTN, would we suspect primary or secondary HTN?
We would suspect secondary HTN. We would have to investigate the underlying cause because most of the time young people who develop HTN have an underlying pathology.
what are major risk factors for ischemic heart disease
male age family history htn high LDL smoking diabetes mellitus
if a person feels squeezing, crushing and heavy chest pain, we suspect…
stable angina pectoris
sudden chest pain (spasm-like) is related to which type of ischemic heart diease
prinzmetal angina
what are the 3 diagnostic tools for MI
ECG
cardiac enzymes: troponin, creatine, MB
clinical presentation
what is the most common complication after an MI
reactive preicarditis - due to POST MI; inflammation spills into pericardium
if a patient experiences sharp, stabbing pain worse when lying down, we suspect:
pericardial pathology
a chronic auto-immune disease due to/triggered by streptococcal infection is…
rheumatic fever
what type of shock:
low volume of blood/failure of fluids
hypovolemic
what type of shock:
heart cannot pump due to pericarditis, myocarditis, or MI; failure of the pump
cardiogenic
what type of shock:
blood being redistributed and returned to HT is sluggish; failure of the tubes
distributive
what category of shock are septic and anaphylactic
distributive
what are the causes of atherosclerosis
high levels of LDL and endothelial inflammation
how do we diagnose atherosclerosis
angiogram
how do we remove blood or fluids due to pericardial effusion
pericardiocentesis
pulse pressure =
systolic - diastolic
128/85 vs 140/90
128/85 = prehypertensive 140/90 = beginning of HTN
S1 is sound of…
closure of atrioventricular valves - systole
S2 is sound of…
closure of semilunar valves - diastole
the amount if time it takes for the atria to depolarize
P wave
wave of depolarization going through the ventricles
QRS wave
repolarization of ventricles
T wave
Arrhythmia Blocks:
1st
2nd
3rd
1st: PR interval is extended
2nd: 1 QRS complex will be randomly missed
3rd: several QRS complexes will be missed in a row
serious, chaotic beating of ventricles
ventricular fibrillations
irregularly-irregular rhythm, common in geriatric patients, can lead to stroke and MI
atrial fibrillations
what is the most common type of cardiomyopathy
dilated
is preload increased or decreased in the following types of cardiomyopathy:
dilated
hypertrophic
restrictive
dilated - increased
hypertrophic - decreased
restrictive - decreased
why do people have ectopic arrythmias
because of hypoxia
what are the causes of dilated cardiomyopathy
40% we do not know; the other 60% is familial, increased where there is alcoholism, diabetes, pregnancy, and those on anti-cancer meds
narrowing of the root of the pulmonary artery as it departs from the right ventricle
pulmonary stenosis
the root of the aorta is positioned over the septal inter-ventricular defect
dextra-position of the aorta (aka: overriding aorta)
what are the 4 heart malformations associated with tetralogy of fallot
pulmonary stenosis
hypertrophy of the right ventricle
inter-ventricular foramen (right to left shunt)
dextra-position of the aorta
inter-ventricular foramen (right to left shunt) - what kind of blood is moving in what direction?
deoxygenated blood is moving from the right side of the heart into the left side circulation
what is the major source of pulmonary embolism
DVT (deep venous thrombosis)
what is this disease? recurring inflammation and thrombosis of small and medium arteries and veins of the hands and feet?
strongly associated with smoking
Buerger’s disease AKA thromboangitis obliterans
1,2, 3, 4 site of aneurysms
# 1 circle of willis # 2 abdominal aorta # 3 thoracic aorta # 4 popliteal artery
what conditions are likely to put someone in danger of rupture or infection associated with aneurysms
systemic arterial hypertension & adult polycystic kidney disease
decrease in BP upon changing from supine to upright position
orthostatic hypotension
what is the difference between portal HTN and systemic arterial HTN?
portal - amongst the system of portal veins: GI tract and lower extremities (venous circulation)
systemic - arterial circulation
location of KDs
retroperitoneal and extend anywhere from T12-L3 (L4 on right side bc of liver)
filtering unit of the KD
glomerulus
part of the KD where electrolytes and minerals are reabsorbed
proximal convoluted tubule
REMEMBER ALDOSTERONE HERE
in what part of the KD is urine concentrated and diluted
loop of henle
which parts of the KD reabsorb water
distal convoluted tubule and collecting duct
REMEMBER ADH HERE FOR DCT
what is the best index of GFR
serum creatinine
specific gravity
concentration of urine / concentration of plasma
measures how well the tubules are concentrating urine
what should the normal urinary output be
700mL - 2L per 24 hours
which hormone makes tubules able to absorb more sodium in proximal convoluted tubule by sodium potassium pump
aldosterone
what are normal constituents of urine
bilirubin, electrolytes, ammonia, hormones, creatinine, epithelium
what are abnormal constituents in urine
proteins, glucose, formed elements of blood, albumins
adult polycystic kidney disease is classified as:
an autosomal dominant disorder
what are the most common kinds of KD stones
calcium oxalate stones
what are the #1 and #2 causes of calcium oxalate stones
#1 hypercaliurea --> too much Ca+ in urine (unexplained by bio-med) #2 hypercalcemia --> too much Ca+ in blood - (caused by: hyperfunction of parathyroid gland or cancer)
struvite stones are produced by and contain
urea-splitting bacteria
magnesium, ammonium, phosphate stones
difference in appearance between calcium stones and struvite stones
calcium stones are opaque
struvite stones are translucent and mushy
what is the major cause of UTIs
obstruction of stones in urinary tract
what are the clinical presentations of acute nephrolithiasis
renal colic - colicky pain; “loin to groin”
stones are moving with obstruction to urinary tract
