Midterm Flashcards

Question

M (mitosis) Phase

Answer 1

Cell undergoes mitosis (prophase, metaphase, anaphase, & telophase) - Results in the cell splitting into 2 identical cells

Answer 2

Cells multiply through mitosis where one cell divides to make two new daughter cells identical to the parent cell - Allows the body to grow, repair, and replace cells - Tightly regulates to ensure that cells divide only when necessary

Answer 3

Process by which a cell becomes more specialized with distinct functions and characteristics - Ensures cells can perform specialized functions necessary for organisms survival - Stem Cells: are special cells with the ability to develop into various cell types - They receive signals directing them to become a specific type of cell

Answer 4

Labile Stable Permanent

Answer 5

Constantly dividing and replacing cells that are lost Eg. the skin, intestinal epithelial cells

Answer 6

Do not divide under normal conditions but can be stimulated to divide after injury Eg. Hepatocytes and liver regeneration (Zeus vs Prometheus)

Answer 7

Lack regeneration ability Eg, cardiac, neural, and skeletal cells - Cardiac tissues don't heal after MI, causing reduced cardiac capacity

Answer 8

Epithelial Muscular Connective Nervous

Answer 9

Line all internal and external surfaces

Answer 10

Specialized for contraction, allowing movement and force generation in the body

Answer 11

Supports, connects, or separates different types of tissues and organs in the body

Answer 12

Specialized tissues that transmit electrical impulses to coordinate bodily functions by facilitating communication between different body parts

Answer 13

A cells ability to adjust in response to different stimuli and challenging environmental conditions that threaten their structure or function - Stimuli can be Physiological (breast during pregnancy), or pathological (aging) - Cells may change in size, number, or type, to adapt - If stress is too severe or the adaptations are not effective, the cell may become injured or die

Answer 14

Atrophy Hypertrophy Hyperplasia Metaplasia Dysplasia

Answer 15

- Decreases in cell size leading to tissue degeneration - Atrophied cells = decrease in cell content = reduced oxygen consumption - Caused by: Disuse, denervation, loss of endocrine stimulation, inadequate nutrition, ischemia

Answer 16

Enlargement of cells increase in size and functional components Eg. Bigger muscle = more ATP, more actin and myosin filaments - Results from increased functional demands or specific hormonal stimuli - Caused by: Exercise & muscle mass, uterus enlargement in pregnancy (physiological), myocardial hypertrophy from hypertension (pathological)

Answer 17

- "plasia" = Cell formation or growth - Controlled increase in the number of cells in an organ or tissue - Occurs in wound healing with proliferation fibroblasts of connective tissues - Different from hypertrophy BUT may occur TOGETHER (Eg. uterus) - Cause by: Stimulation of endometrium in the follicular stage of menstrual cycle (physio), Benign prostate hyperplasia (patho), endometrial hyperplasia (patho)

Answer 18

Reversible replacement of mature, differentiated cell-type by another cell-type that is better suited to tolerate a particular stimuli or environment - Reprogramming of undifferentiated stem cells present in tissue, but conversion of cell type remains within boundaries of primary tissue (epithelial cells CANNOT be converted to cardiac cell) - Caused by: Barret's Oesophagus (in response to reflux), replacement of ciliated pseudostratified columnar epithelium in bronchi w/ stratified squamous epi (smoking)

Answer 19

When signals cause metaplasia to persist, they frequently lead to the development of neoplasia

Answer 20

Disordered growth in tissue, resulting in cells that vary in size, shape and organization - Caused by irritation (smoke), or inflammation (radiation causes damage to cell DNA) - Mild-moderate cases may regress if underlying cause if alleviated but severe dysplasia can be a precursor to irreversible malignancy

Answer 21

- Describes the build-up of substance that the cells cannot immediately use or eliminate

Answer 22

Substance is produced faster than it can be metabolized or excreted Eg. Obesity = high delivery of free fatty acids from adipose tissues to the liver = accumulation of FFA = Fatty liver

Answer 23

May result from disorders that disrupt metabolism due to abnormal or missing enzyme Eg, Von Gierke disease where a deficiency in Glucose-6-phosphatase leads to accumulation of glycogen in the liver and kidneys

Answer 24

Environmental agents and pigments Eg. Accumulation of carbon dust blackens the lung tissue and may cause serious lung disease

Answer 25

2 Types: Dystrophic & Metastatic Involve abnormal tissue deposition of calcium salts, and other minerals in tissues

Answer 26

Occurs in damaged or necrotic tissues despite normal calcification levels in the blood - Happens in areas of tissue like damaged heart valves, atherosclerotic plaques, or areas of chronic inflammation

Answer 27

Occurs in healthy tissues due to elevated levels of calcium in the blood (hypercalcemia)

Answer 28

Can generally be reversed up to a specific point, after which the damage becomes irreversible, leading to cell death - MECHANICAL FORCE: Trauma due to body's impact w/ external force (split and tear tissues, fracture bones, disrupt blood flow etc) - EXTREMES OF TEMP: Heat (burns) disrupt cell membrane. Cold may lead to hypoxic tissue injury due to vasoconstriction - ELECTRICAL INJURIES: Extensive tissue injury. Disruption of neural and cardiac impulses

Answer 29

ULTRAVIOLET RADIATION: Photon is a particle of electromagnetic radiation energy - UV radiation contain high energy photons that can disrupt release free radicals, damage DNA and damage melanin-producing processes in skin cells IONIZING RADIATION: -Radiation energy above the UV range - L.R. photons cause ionization of molecules and atoms in the cell by knocking off elections from them Eg. Localized irradiation in cancer treatment NONIONIZING RADIATIONS: - Radiation energy BELOW the UV range (Eg. Ultrasound, welding, microwaves) - Uses energy from vibration of atoms and molecules o generate thermal energy - Resulting thermal energy can disrupt the cell depending on duration and extent of exposure

Answer 30

CHEMICAL INJURY: - May injure cells membrane, block enzymatic pathways, disrupt cell metabolism etc - Air and water pollutants. tobacco smoke, drugs and alcohol, CO, Lead toxicity, mercury toxicity BIOLOGIC INJURY: - Viruses incorporate themselves into a cell's DNA machinery - Bacteria may release toxins that increase cardiac permeability, interfere with ATP production or other cellular processes

Answer 31

FREE RADICAL INJURY: - Highly reactive with molecules in their vicinity and can convert other molecules into additional free radicals Reactive Oxygen Species (ROS) = Free radical in the body

Answer 32

When the generation of free radicals exceeds the ability of the body to neutralize it - High blood sugar can cause oxidative stress on blood vessels - In cancer, oxidative stress damages the DNA in healthy cells - Also linked to Aging neurodegenerative disease

Answer 33

Vit A,C,E, Zinc, Beta-carotene

Answer 34

Oxygen Deficiency: lack of O2 in the air, respiratory disease, anemia, ischemia Deprives the cell of O2 thereby interrupting the generation of ATP

Answer 35

Cause cell injury due to deficiency in function proteins or the accumulation of damaged DNA or misfolded proteins (both trigger cell death) EG, sickle cell anemia

Answer 36

Cellular Swelling Fatty Changes

Answer 37

Impairment of the sodium-potassium-ATPasepump leads to accumulation of Na and water inside the cell - Hydropic degeneration. Change is reversible if O2 delivery resumes alongside ATP production

Answer 38

Intracellular accumulation of fat, causing small vacuoles of fat disperse throughout the cell -Increased fat load (obesity) -Impairment of fat metabolism

Answer 39

Highly selective process that controls tissue regeneration by eliminating injured and aged cells. Cellular suicide - Does NOT trigger the inflammatory process - Responsible for several physiologic processes: Programmed destruction of cells during embryonic development (separates webbed-toes and fingers in embryo), Hormone-dependent involution of tissue, Control immune cells

Answer 40

Refers to cell death in an organ or tissue that is still part of a living tissue - Usually due to ischemia or toxic injury - Interferes with cell replacement and tissue regeneration - Triggers inflammatory process**

Answer 41

When a considerable mass of tissue undergo necrosis

Answer 42

Cels regulate growth (proliferation) by turning growth-promoting and growth suppressing genes on and off

Answer 43

Abnormal cell proliferation/tissue growth caused by damage or mutation of regulators

Answer 44

Movement of abnormal cells to other parts of the body, where they populate new tumors

Answer 45

Uncontrolled cell proliferation enclosed in a fibrous capsule and does not infiltrate or affect tissue of origin directly - Slow growing and localized - Does not metastasize and can be removed Eg. Benign prostatic hyperplasia

Answer 46

Rapid and uncontrolled cell proliferation that invades the tissue of origin and can invade other remote tissues via lymph or blood - Always requires treatment

Answer 47

Uncontrolled proliferation - De-differentiation (loss of normal function) - Invasiveness - Metastases: Cancer cells break away, travel through the blood or lymph system, form new tumors, metastatic tumor is the same type of cancer as the primary tumor

Answer 48

Formation of new capillaries out of existing blood vessels - Cancer cells establish their own blood supply to bring nutrients and escape during metastasis

Answer 49

Section of DNA that safeguards the chromosome ends from damage and entanglement - They shorten with each cell division and eventually become too short for proper cell division = cell death

Answer 50

An enzyme that lengthens the telomere chains and allow continued replication - Found in stem cells - Cancer cells produce large amounts = Indefinite replication

Answer 51

Solid - Abnormal tissue mass, difficult to assess in blood at 1st, Eg. Breast, prostate, lung CA Hematological - Formed in the blood or bone marrow, not a mass (liquid), Eg. Leukemia, lymphoma

Answer 52

Chemical: Tobacco smoke & Asbestos = Lung CA Physical: Sun's UV rays = Skin carcinoma, Xrays = Leukemia Biological: Genetic predisposition to damaged growth promoter/suppressor, viruses/HPV = Cervical CA

Answer 53

Blood Test: CBC & Differential (Hb, WBC, blood smears) Imaging: Ultrasound, CT scan, MRI, PET, Mammogram Others: Biopsy, Colonoscopy

Answer 54

Identifies the location and extent of cancer invasion within the body - Assessed at initial diagnosis to help understand the disease's prognosis and the most effective treatment options - CA is assigned values for the tumor (T), node (N), Metastasis (M) and then a stage - Assigned stage does not change even if CA progresses***

Answer 55

Stage 1: Least Invasive, most favourable outlook. No lymph involvement, no metastasis, tumors are less than 2 cm in size Stage 2: Local lymph involvement, no metastasis, tumors are less than 5 cm in size Stage 3: Nodal involvement, no metastasis, tumors over 5 cm Stage 4: (Most aggressive = least favourable outlook), nodal involvement, metastasis tumors greater than 5 cm

Answer 56

Involves examining cancer cells under microscope and comparing their appearance to that of normal, mature cells it came from G1 = differentiated and very similar to the parent cells G4 = Very abnormal and different from normal cells. Aggressive CA cells with worst prognosis Grading can change as the tumor evolves

Answer 57

Obstruction: Anorexia and necrosis of tissue leading to loss of function Hematologic Alterations: Impairs functions of blood cells. Leukemia, GI tumors, Renal cell carconoma Anorexia-cachexia Syndrome: "wasting syndrome" - malnutrition, weight loss, neoplastic cells divert nutrition to own use Paraneoplastic Syndromes: malignant tumor secretes hormones or proteins that affects organ systems away from tumor sites (symptoms occur away from tumor site) Psychological Stress Pain

Answer 58

Alkylating Drugs: Non-cycle specific Anti-metabolites (-ate/purine, bine): Interrupts S-phase Cytotoxic Antibiotics (-mycin/bicin): Block DNA replication enzymes or produce free-radicals Vinca Alkaloids (Vin-): Targets Mitosis-phase

Answer 59

Used to treat cancers that are linked to hormonal stimulation - Prevents cell proliferation by disrupting testosterone/estrogen/progesterone

Answer 60

Immuno-stimulants: Stimulate immune system against certain tumor cells Antibodies

Answer 61

Combination Drugs Dosing Schedule Route of Administration

Answer 62

Growth Fraction: ratio of replicating cells (growth) to resting cells in a tissue - Anti-neoplastic drugs are more toxic to tissues and tumors with high growth fractions

Answer 63

Very sensitive to chemo due to need for constant replacement. short life span 7-12hrs Neutropenia: Diagnosed when neutrophil count is below 1500 cells/mL - Requires reverse iso - Colony Stimulating factors

Answer 64

Lifespan = 7-8 days (needs constant replenish) - Thrombocytopenia: diagnosed when platelet count drops below 100,000/milliletre of blood - Low platelets can cause increased bleeding

Answer 65

Lifespan = 90-120 days (anemia appears later in chemo) - Anemia affects O2 delivery to tissues - RBC infusions and medications like epoetin alfa can be administered

Answer 66

Unintended leakage of blood, lymph, or other fluids (including chemo drugs) from a blood vessel or catheter into the tissue surrounding IV site

Answer 67

Drugs that have the potential to cause blistering, severe tissue injury or necrosis when they infiltrate into surrounding tissue

Answer 68

Agents that may cause inflammation and/or pain at venipuncture site or along the vein - DO NOT cause tissue necrosis

Answer 69

Any physical or psychological stimuli that disrupts homeostasis

Answer 70

Fight or flight

Answer 71

Rest and Digest

Answer 72

- Pre-synaptic neuron initiates signal that is received by the post-synaptic neuron - Pre-synaptic neurons contain neurotransmitters (stored in vesicles) that are released into the synaptic cleft when stimulated by action potential - Binding of neuroT's to receptors on post-synaptic neuron or target tissues at neuroeffector junction induces response (Activate or inhibit AP)

Answer 73

Termination of neurotransmitter action - NeuroT separates from receptor, returning it to baseline activity - NeuroT is removed from synapse through: Reuptake back into pre-synaptic neuron OR Degradation in synaptic cleft by enzymes - Acetylcholine degraded by AchE - Norepinephrine degraded by MAO or COMT in synapse

Answer 74

- Alter synthesis of the neurotransmitter in the preganglionic nerve - Prevent storage of neurotransmitter in vesicles within the preganglionic nerve - Influence release of the neurotransmitter from the preganglionic nerve - Bind to the neurotransmitter receptor site on the postganglionic nerve - Prevent the normal destruction or reuptake of the neurotransmitter

Answer 75

- Cholinergic Receptors (Respond to Ach) - Adrenergic Receptors (Responds to Epin and Norepin)

Answer 76

Nicotinic: - Found on postganglionic neurons in ANS - Promotes sympathetic and parasym. effects - Found at neuromuscular junction of skeletal muscle cells Muscarinic: - Found on parasymp. target tissues - Promotes parasymp. effects

Answer 77

Alpha and Beta Subtypes - Found on target tissues of sympathetic nervous system **Promotes sympathetic effects

Answer 78

Alarm Reaction Resistance/Adaptation Exhaustion

Answer 79

Stressor = activation of Symp NS (fight or flight) - SNS = Norepin and Epin = Increased Symp NS functions and decrease in parasymp innervation

Answer 80

Persistant stress activates the Hypothalamus-pituitary-Adrenal (HPA) axis which promotes the secretion of ACTH (which stimulates adrenal cortex to make Cortisol Cortisol: helps body deal with long-term stress by increasing blood sugar, enhancing metabolism and suppressing non-essential functions like digestion and immune response

Answer 81

HPA axis may become dysregulated - Sustained elevation of BP and HR may lead to cardiovascular diseases - Prolonged inhibition of digestive and urinary functinons = GI and Renal disorders - Decreased muscle mass and fat = weight loss Bad immune system

Answer 82

Helps body deal with stress by increasing energy supply Liver: promotes metabolism Muscle: reduces glucose uptake and promotes breakdown of muscle proteins into amino acids to make energy Fat Cell: promotes lipid breakdown for additional energy Pancreas: decreases insulin and increases glucagon to increase blood glucose Others: Increase BP by upping vasoconstriction and reduces inflammation and suppresses immune system

Answer 83

Physical barriers: skin and mucous membranes Cellular Barriers: phagocytes, cytokines Process barriers: inflammation, opsonins, fever

Answer 84

- Memory (Remembers immune response) - Relies on Lymphocytes (B cells and T cells) to recognize specific antigens presented by pathogens (antigens are the foreign substance that provokes the immune response) - B cells produce the antibodies and T cells directly attack infected cells or help regulate the immune response

Answer 85

55% of whole blood volume - Contains 90% water, blood protein and solutes (electrolytes and nutrients)

Answer 86

45% of whole blood - RBCs, WBCs, platlets - Synthesized via Hemopoiesis

Answer 87

-Synthesized from hematopoietic stem cells - Migrate out of blood vessels into tissues and towards stimulus - 2 Types: Granulocytes and Agranulocytes

Answer 88

Neutrophils: -First order at the site of injury (within 90min) - Make up 50-70% of WBC (short-lived) - Phagocytose and digest pathogens then apop Eosinophils: - Respond to parasites involved in allergic reactions Mast Cells: - Localized in tissue for allergic responses (player in anaphylaxis) Basophils: - Amplifies allergic response

Answer 89

Monocytes: - Inactively circulate bloodstream until chemotaxis signal is received about damage - Move into interstitial space as macrophages - **Macrophages phagocytose invaders and produce signals to prolong immune response Lymphocytes: - Involved in systemic response - T Lymphs = kill infected or damaged cels and stores memory - B Lymphs = secrete antibodies which physically interest with antigens to neutralize or mark them for destruction

Answer 90

Reaction of vascular tissues to harmful stimuli - Eliminate the initial cause of cell injury, remove the damaged tissue, and generate new tissue

Answer 91

Endothelial Cells: for a selective permeable barrier between the circulating blood in vessels and the surrounding tissues Platlets: Release potent inflammatory mediators which increase vascular permeability Neutrophils and Macrophages: Eosinophils, Basophils and Mast Cells

Answer 92

Mostly found in con tissue and blood vessels (skin, mucosa) - Degranulation may be caused by injury, temp, allergens - Primary secretors of histamine (primary mediator associated with inflammation assoc w/ allergies)

Answer 93

Redness (rubor) Swelling (tumor) Heat (colour) Pain (dolor) Loss of function (functio laesa) Signs of Swelling

Answer 94

Neutrophils Lymphocytes Eosinophils C- Reactive Protein

Answer 95

Endothelium, tissues, and mast cells: -release inflammatory mediators (histamine) - Release pro-inflammatory mediators (cytokines etc)

Answer 96

Selective COX Inhibitors: - Target COX-2-MOA - Analgesic, anti-inflam, and anti-pyretic actions typical of older NSAIDS Non-Selective COX Inhibitors: - First gen - block both COX 1&2 - Side effects of bleeding, gastric upset and reduced kidney function from blocking COX-1 - Eg ASA, Ibuprofen etc

Answer 97

Primary mediator of inflammation assoc with allergic reaction - Released upon mast cells' contact with allergen... bind to H1 receptors Histamine + H1 = Smooth muscle contraction, vasodilation & increased permeability, swelling and flare (redness), Increased sensitivity and pain and wakefulness

Answer 98

1st: -block histamine -receptors, very lipid soluble (causes drowsiness) - Benadryl 2nd: - Block H1 - histamine receptor - Less lipophilic = decreased CNS distribution (non drowsy) - Eg. Cetrizine (Reactine), Loratadine (Claritin)

Answer 99

Local Response: -Patient touches something - localized hives, itching, no vital sign changes etc Systemic: Patient comes to a friends house and a cat is present - Watery eye, itchy eyes, runny nose, sneezing Systemic Life-Threatening: - The cat allergy worsens - Itching, diffused urticaria throughout, difficulty breathing, tachy - Anaphylaxis

Answer 100

ACINI: - Secrete digestive juices into the duodenum ISLETS OF LANGERHANS: - Secrete hormones into the cell - Composed of beta cells that secrete insulin, alpha cells that secrete glucagon and delta cells that secrete somatostatin

Answer 101

Islets of Langerhans Scattered in exocrine pancreas Made up of 4 cell types Distribution of cell type varies w/ region of pancreas

Answer 102

Alpha Cell = 10% and 0.5% (Glucagon) In response to low blood glucose and to activity of sympathetic nervous system Beta Cell = 70-80% and 15-20% (Insulin, Amylin), In response to HIGH bl. glucose and activity of the parasymp. nervous system Delta Cell = 3-5% and <1% (Somatostatin) F Cell = <2% and 80-85% (Pancreatic polypeptide)

Answer 103

- Located beneath LIVER and tucked into the curvature of the duodenum - Has ENdocrine AND EXOcrine functions EXOCRINE: - Secretes enzymes into duodenum to support digestion of macromolecules - Secretes bicarbonate into the duodenum to raise pH of chyme ENDOCRINE: - Islets of Langerhans includes Alpha and Beta cells to secrete hormones

Answer 104

1) GLYCOLYSIS = process through which glucose is broken down into water and CO2 w/ the release of energy 2) GLYCOGENOLYSIS = breakdown of stored glycogen (from liver or skeletal muscles) - Controlled by 2 hormones = Epinephrine (Break down glycogen in muscle) and Glucagon (breaks down glycogen in the liver. Can be directly released into blood stream and used by nervous system) 3) GLUCONEOGENESIS = building of glucose from new sources - Hormones that stimulate = Glucagon, Glucocorticoid hormones, Thyroid hormones - Process usually occurs in the liver

Answer 105

Glucose is preferred source of energy to produce ATP by cells of body - Normal range for serum glucose = 3.3-5.5 mmol/L BUT body usually regulates between 4.4-5 Insulin: - Promotes formation of glucose transporters that bring glucose from the blood into cells, lowering glucose - Promotes conversion of monosaccharides, lipids, and amino acids into storage forms of polysaccharides, triglycerides and proteins - Insulin secretion increases during fed state Glucagon: - Promotes conversion of glycogen, proteins and lipids into glucose and release glucose into blood - Glucagon secretion increases during fasted state

Answer 106

- Increases glucose transport into skeletal muscle and adipose tissue - Increases glycogen synthesis - Decreases glyconeogenesis

Answer 107

Promotes glycogen breakdown Increases gluconeogenesis

Answer 108

- Anabolic in nature - Promotes glucose uptake by target cells and provides for glucose storage as glycogen - Prevents fat and glycogen breakdown - Inhibits gluconeogenesis and increases protein synthesis

Answer 109

- Catabolic in nature - Increases transport of amino acids into hepatic cells - Increases breakdown of proteins into amino acids for use in gluconeogenesis - Increases conversion of amino acids into glucose precursers

Answer 110

CATECHOLAMINES: - Epinephrine and norepinephrine - Help to maintain blood glucose levels during periods of STRESS - Inhibiting insulin release and decreasing movement of glucose into cells - Promoting glycogenolysis by converting muscle and liver glycogen to glucose - Increasing lipid activity, conserving energy, Causes mobilization of fatty acids and conserves glucose - Conversion of bl. glucose mediated by these actions is important in the homostatic effect GH: - Increases protein synthesis in all cells of the body - Mobilizes fatty acids from adipose tissue and anatagonizes the effects of insulin GLUCOCORTICOIDS: - Critical to survival during periods of fasting and starvation - Stimulate gluconeo. by the liver

Answer 111

Normally released in small increments when food is ingested - Consists of 2 polypeptide chains - Check amount a person is releasing by testing the C Peptide - Rise in plasma insulin after a meal stimulates storage of glucose as glycogen in the liver and muscle - Also inhibits gluconeo. and enhances fat deposition in adipose tissue - Fall in insulin levels during the night when you're eating facilitates the release of stored glucose from the liver, protein from the muscle and fat

Answer 112

Glucagons Epinephrine GH Cortisol

Answer 113

2nd Beta Cell Hormone Effects: - Amylin and insulin together suppress the secretion of glucagon by the liver - Amylin slows the transfer of nutrients to the intestine

Answer 114

Produced in alpha cells Transported via the portal veins to the liver Acts in opposition to insulin Stimulates breakdown of glycogen and fats to glucose and promotes gluconeo. from fats and proteins

Answer 115

Produced in the pancreas by the delta cells - Inhibits secretion of insulin, glucagon, GH

Answer 116

Major disease affecting pancreas Occurs when there is insufficient secretion of insulin from the pancreas or when target tissues do not respond to circulating insulin in the appropriate manner Hyperglycemia is a symptom of underlying problem Disorder of carb, protein, and fat metabolism (Results from an imbalance between insulin availability and insulin need) Can represent: - Absolute insulin deficiency - Impaired release of insulin by the pancreatic beta cells - Inadequate or defective insulin receptors - Production of inactive insulin or insulin that is destroyed before it can carry out its action

Answer 117

Impaired fasting plasma glucose and impaired glucose tolerance

Answer 118

Family Hx. Obesity esp. abdominal and visceral adiposity BMI >27% Race/ethnicity GDM or babies >9lbs (mom is more at risk of developing if she has big babies) HTN 200mg/dL Prev. impaired glucose tolerance Causes: - Genetics - Autoimmune - Viral - Environmental

Answer 119

Polyuria = Excessive urination Polydipsia = Excessive thirst Polyphagia = Excessive hunger

Answer 120

Type 1 = Loss of Beta cell function, Absolute insulin deficiency Type 2 = Impaired ability of the tissues to use insulin, relative lack of insulin or impaired release in relation to blood glucose levels Gestational Secondary

Answer 121

aka "Insulin-dependent DM (IDDM) - Pancreas cannotproduce insulin - Represents 5-10% of all cases of DM - Usually underweight - Treated w/ insulin replacement therapy - Disease usually appears during childhood through early adulthood - Rapid onset Characteristics: - Little to no C Peptide - Autoimmune process - Weak family history - Obesity uncommon - Diabetic Ketoacidosis (DKA) often present - Insulin mandatory (Exercise and diet help) S&S: - Frequent urinations - Unusual thirst - Extreme hunger - Unusual weight loss - Extreme fatigue - Irritability - Ketoacidosis

Answer 122

Not treating it** DKA: - Extreme hyperglycemia, osmotic diuresis - Body metabolizes lipids to ketone bodies to create source of energy for cells - Ketone bodies reduce pH of blood causing metabolic acidosis - Fruity breath (Due to presence of ketones) - Treated w/ Insulin and fluid replacement

Answer 123

aka "Non-insulin dependent (NIDDM)" Pancreas does not produce enough insulin to meet needs of body or receptors are not sensitive to insulin that is produced Represents 90-95% of DM Clients are usually overweight* - Treated w/ appropriate diet and exercise, then w/ oral hyperglycemic drugs and then insulin if needed - Usually appears in the middle adulthood though children w/ sedentary lifestyles are developing disease - Gradual onset Characteristics: - Strong family history - Obesity common - DKA rare - Insulin resistance - Varying levels of insulin (hyperinsulinemia not uncommon) S&S: - Frequent infections - Blurred vision - Cuts/bruises slow to heal - Tingling/numbness in hands and feet - Recurring skin, gum or bladder infections - Any of the type 1 signs - Often no symptoms occur

Answer 124

Previously identified IFG (Impaired fasting glucose) or IGT (Impaired glucose tolerance) (Aka "Prediabetes") - Hypertension (>/= 140/90) - HDL cholesterol level >/=40 mg/dL - History of GDM or delivery of babies over 9lbs

Answer 125

Type 1A = Immune-mediated diabetes Type 1B = Idiopathic diabetes

Answer 126

No evidence of autoimmunity is present - Only a small number of people - Usually African or Asian decent - Strongly inherited - Have episodic ketoacidosis due to varying degrees of insulin deficiency w/ periods of absolute insulin deficiency that may come and go

Answer 127

Impaired beta cell function and insulin secretion Peripheral insulin resistance Increased hepatic glucose production

Answer 128

- Initial decrease in beta cell mass - Increased beta cell apoptosis/decreased regeneration - Long-standing insulin resistance leading to beta cell exhaustion - Chronic hyperglycemia can induce beta cell desensitization ("glucotoxicity") - Chronic elevation of free fatty acids can cause toxicity to beta cells ("Lipotoxicity") - Amyloid deposition in beta cell can cause dysfunction

Answer 129

Metabolic Syndrome: - Triglycerides - HDL - Hypertension - Systematic inflammation - Fibrinolysis - Abnormal function of the vascular endotheluim - Macrovascular disease - Obesity and insulin resistance - Increased resistance to the action of insulin - Impaired suppression of glucose production by the liver - Hyperglycemia and hyperinsulinemia

Answer 130

Higher risk of C-section Perinatal death Neonatal complications Risk of developing type 2 DM in 5-10yrs increased Any degree of glucose intolerance during pregnancy Hyperglycemia develops during pregnancy - secretion of placental hormones (Which causes insulin resistance) -High risk women should be screened at 24-28weeks of gestation -Need oral glucose tolerance test or glucose challenge - 2hr Fasting level after 100mL glucose load of 155 would indicate GDM

Answer 131

Causes: - Damage/injury/interference or destruction of pancreas Conditions: - Cushing's - Hyperthyroidism - Recurrent pancreatitis - Use of parenteral nutrition Medications: - Corticosteroids - Thiazides - Dilantin - Atypical antipsychotics *Resolves when treatment of underlying condition is treated

Answer 132

Macrovascular disease Microvascular disease Ocular disease Neuropathy Nephropathy

Answer 133

Weight loss Recurrent blurred vision Fatigue Paresthesias Skin infections

Answer 134

- Fasting Blood glucose test - Casual blood glucose test - Capillary blood tests and self-monitoring of cap. blood glucose levels - Glycated hemoglobin testing

Answer 135

Nutrition therapy Exercise Anti-diabetic agents

Answer 136

Diet Exercise Self-monitored blood glucose Medications Other monitoring/tests

Answer 137

Controlling complications and target organ damage: - Bl. glucose/glycosylated hemoglobin - BP - Dyslipidemia - Weight management - Smoking - Dental/foot/eye care - Vaccinations

Answer 138

Sulfonylureas Repaglinide and Nateglinide Biguanides α-Glucosidase Inhibitors Thiazolidinediones

Answer 139

RAPID-ACTING: -Clear in appearance Onset = 10-15min Peak = 1-2hr Duration = 3-5hr Eg) - Lispro (Humalog) - Glulisine (Apidra) - Aspart (NovoRapid) INTERMEDIATE ACTING: - Cloudy in appearance Onset = 1-3hr Peak 3-8hr Duration = up to 18hrs Eg) NPH (Humulin-N, Novolin-NPH) SLOW OR LONG ACTING: - Clear in appearance Onset = 90min Peak = None Duration = up to 24hrs Eg) Glargine (Lantus) Detemir (Levemir) Zinc

Answer 140

Diabetic Ketoacidosis Hyperglycemia Ketosis Metabolic acidosis Hyperosmolar hyperglycemic state Hypoglycemia Hypoglycemia Abnormally low bl. glucose level (<70) Causes: - Too much insulin or oral hypoglycemic agents - Too little food or excessive exercise - Delayed or skipped meals

Answer 141

MILD = sympathetic nervous system is stimulated (Surge of epinephrine and norep.) S&S = sweating, tremor, tachycardia, palpitations, nervousness, and hunger MODERATE = Deprives the brain cells of needed fuel for functioning S&S = inability to concentrate, headache, lightheadedness, confusion, memory lapse, numbness of lips and tongue, slurred speech, impaired coordination, emotional changes, irrational or combative behaviour, double vision and drowsiness EMERGENCY MEASURES = for pts. who are unconsciousness or cannot swallow = Glucagon 1mg injection can be given IM

Answer 142

No warning S&S Increase risk of dangerously low BS Related to autonomic neuropathy

Answer 143

Caused by absence of markedly inadequate amounts of insulin and disorders in the metabolism of fats CHO and proteins 3 Main Clinical Features: - Hyperglycemia - Dehydration nad electrolyte loss - Acidosis, Brunner & Suddath (Insulin deficiency leads to breakdown of fat (Lipolysis) into free fatty acids and glycerol and free fatty acids are converted into ketone bodies by the liver) Diagnosis: - Bl. glucose levels >250mg/dL - Low bicarbonate (<15) - Low pH (<7.3) - Ketonemia (positive at 1:2 diluation) - Moderate ketonuria

Answer 144

S&S = Nausea & vomiting, rapid breathing, extreme tiredness and drowsiness, weakness, acidosis (Fruity breath, tachy, hypotension)

Answer 145

1) Decreased or missed dose of insulin 2) Illness or infection 3) Undiagnosed or untreated diabetes Treatment: - IV fluid and electrolyte replacement - Correct acidosis - Provide adequate insulin - Est. cause - Can be mild or severe

Answer 146

Fluid Overload = administering fluids rapidly to treat DKA or HHNS Hypokalemia = due to treatment of DKA loss of potassium Cerebral Edema = cause unknown, may be rapid correction of hyperglycemia resulting in fluid shift

Answer 147

- Serious condition - Bl. glucose 800-1000 - Ketosis usually minimal or absent - Defect is usually lack of effective insulin (insulin resistance) - Presistent hyperglycemia causes osmotic diuresis which results in losses of water and electrolytes - To maintain osmotic equilibrium, water shifts from intracellular fluid space to extracellular fluid space - With glycosurea and dehydration, hypernatremia and increase osmolarity occurs - Usually occurs in older adults

Answer 148

Bl. Glucose = >600 Plasma osmolarity = >310 Dehydration Absence of ketoacidosis Depression of the senorium

Answer 149

Acute illness Medications that exacerbate hyperglycemia Dialysis treatment S&S: - Hypotension - Profound dehydration - Tachy - Variable neurological signs - Morality rate 10-40% Treatment: - Fluid replacement and correct electrolytes

Answer 150

DKA: - More common in Type 1 DM** - Lower mortality rate - Onset = hours - Treatment = fluid replacement, IV insulin, K replacement HHS: - More common in Type 2 DM** - Higher mortality rate - Onset = Days - Treatment = NO INSULIN**, replace fluid/electrolyte

Answer 151

Disorders of the microvasculature - Neuropathies (impaired sensation or pain, carpal tunnel, slowed digestion), nephropathies (damage to small vessels that supply glomeruli of kidney. Leading cause of end-stage renal disease), retinopathies (leading cause of acquired blindness) - Distal symmetric neuropathy and foot ulceration Macrovascular complications: - Diseases of large and medium sized vessels - Atherosclerosis = from altered lipid met. - Cerebral vascular - Peripheral vascular disease - Adults w/ DM = 2-4x increased risk Heart disease and stroke account for majority of deaths in DM clients Poor circulation

Answer 152

Thickening of the walls of the nutrient vessels that supply the nerve - Leading to the assumption that vessel ischemia plays a major role in the development of neural changes Segmental demyelinization process that affects Schwann Cells Accompanied by slowing of nerve conduction

Answer 153

SOMATIC: - Polyneuropathies (Bilateral sensory) - Mononeuropathies - Amyotrophy AUTONOMIC: - Impaired vasomotor function - Imparied GI function - Impaired GU function - Cranial nerve involvement

Answer 154

Unique to Diabetes Capillary Basement membrane thickening - Surrounds the endothelial cells of the cap - Believed that increased bl. glucose levels react through series of biochemical responses to thicken basement membrane to several times its normal thickness 2 Areas Affected: - Retina - Kidneys

Answer 155

Pro = Most SEVERE form Non = Most COMMON form

Answer 156

Hypertension Control = Lower BP <120/80 Antihypertensive agents: -ACE Inhibitors ("-pril")= CaptoPRIL, EnalaPRIL, lisinopril, benazepril, fosinopril etc - ARB (Angiotension Receptor Blocker) = CandesarTAN, cilexetil, irbesarTAN, losarTAN, potassium, telmisarTAN, - Beta blockers Glycemic control: - Pre-prandial plasma glucose 90-130 - A1C <7.0% - Peak postprandial plasma glucose <180 - Self-monitoring of Bl. Glu. (SMBG) - Medical Nutrition Therapy Restrict dietary protein to RDA of 0.8g/kg body weight per day

Answer 157

1) Hemodialysis 2) Peritoneal Dialysis 3) Kidney Transplant

Answer 158

Metabolic Factors: - High Bl. Glu. - Advanced glycation end products - Abnormal Bl. fat levels Ischemia Nerve fibre repair mechanisms

Answer 159

Affects the autonomic nerves controlling internal organs: - Peripheral - GU - GI - Cardiovascular Is classified as clinical or sub-clinical on the presence or absence of symptoms Hypoglycemic unawareness Sudomotor neuropathy = absence of sweating of the extremities w/ compensatory increase in upper body sweating Sexual dysfunction

Answer 160

Bed Rest Antibiotics Debridement Good control of Bl. Glu. *If pt has PVD, ulcers may not heal due to the decreased ability of O2 nutrients and antibodies to reach injured tissue

Answer 161

Dark, course, thicken skin on the neck

Answer 162

Red-brown flat-topped papules

Answer 163

Type 1 Autoimmune Partial rings of papules often in dorsal surface of hands and feet

Answer 164

Most common drugs promote release of insulin (secretagogues) OR increase receptor sensitivity to insulin SECRETAGOGUES: - Sulfonylureas (also decreases insulin resistance, can cause hypoglycemia, GI disturbances, rash, cross sensitivity w/ sulfa drugs and thiazide diuretics) - Meglitinides (Administer slightly before meals, well tolerated) SENSITIVITY INCREASE: - Biguanides (Decreases production and release of glucose from liver, increase cellular uptake of glucose, lower lipid level, Risk of lactic acidosis, avoid alcohol, low risk of hypoglycemia) - Thiazolidinediones (Increases insulin sensitivity to fat and muscle tissue, can cause fluid retention and worsening heart failure. Therapeutic effects take several days to develop. NO hypoglycemia) ALPHA GLUCOSIDASE INHIBITORS: - Reduce absorption of glucose by preventing digestion of carbs - Hypoglycemia can occur if combined w/ another oral drug, insulin or sulfonylurea (treat w/ glucose NOT sucrose) INCRETIN ENHANCERS: - Reduce met. of insulin - Decreases rate of digestion of carbs - Well tolerated - Minor nausea, vomiting, and diarrhea - Some weight loss - LOW risk hypoglycemia

Answer 165

GLP-1 acts rapidly to produce: - Increased amount of insulin by pancreas - Decreased amount of glucagon secreted by pancreas - Delayed gastric emptying - Decreased food intake 2 CLASSES: - Activating GLP-1 receptor - Inhibiting dipeptidyl peptidase 4 (DPP-4)

Answer 166

- Divided into 1st and 2nd Gen. categories - Stimulate release of insulin from pancreatic islet cells - Increase sensitivity of insulin receptors on target cells

Answer 167

Blood: - Glucose - Hemoglobin A1C - Fructosamine - Lipid Profile - Creatinine - BUN Urine: - Ketones (Type 1) - Glucose - Protein Weight BP

Answer 168

Not easily interpreted (some tests are qualitative instead of quantitative) Potential false positive readings depending on test used Lack of direct correlation between urine glucose and bl. glu. levels Results are technique dependent

Answer 169

Minimum Recommendation: - Diet/exercise or oral meds = 2-3times/day to 2-3times/week Fixed-dose Insulin: - 3-4x/day to 3 days/week Intensive Insulin Therapy: - 3-4x/day everyday - 3am measurement weekly Additional measurements needed when: - sick - Change in exercise habits - Travel - Change in treatment plan - Symptoms of hypo/hyperglycemia

Answer 170

User variability Hematocrit >60% or <25% Defective strips (temp, moisture, time) Very high TG and/or cholesterol Extreme environmental temps Hypoxia Altitude Uric acid Ascorbic acid Improper cleaning and maintenance

Answer 171

Formed when glucose reacts w/ hemoglobin (concentration-dependent reaction) Usually constitutes 4-6% of total hemoglobin Level reflects ave. bl. glu. over 3 months Level canbe drawn any time of day (regardless of meals) Best indicator of overall degree of glycemic control

Answer 172

**Gold Standard for monitoring long term** Should be performed every 3-6months (3 = therapy has changed or goals not met) (6 = if meeting goals)

Answer 173

>8% = always warrants changes in therapy** May experience hyperglycemia for 2-4 weeks before HbA1c will rise

Answer 174

Anything affecting ave. life span of RBC can cause misleading HbA1c results: - Bleeding - Hemolysis - Sickle cell anemia

Answer 175

Type 2 have a 2-4 increase risk of coronary Heart Disease Most common pattern: - Increased TGs + Decreased HDL (While LDL seem to be similar to non diabetics) Weight loss and exercise will DECREASE TGs and INCREASE HDL without need for drugs Also decreased saturated fats in diet

Answer 176

HTN contributes to the development and progression of chronic complications of DM Decreasing BP will slow the rate of progression of neuropathy, reduce CV disease and cerebrovascular complications Goal BP = <140/90 **ACE-1 or ARB first line** = renal protective

Answer 177

All blood cells and their precursers Bone marrow (where blood cells are born) Lymphoid tissues (where some blood cells circulate as they develop and mature)

Answer 178

Fluid/Dissolved Components: - Water - Proteins - Small molecular substances Cellular Elements: - RBCs - Thrombocytes or platelets - WBCs (lymphocytes and leukocytes)

Answer 179

Carry cells that transport gases Aid in body defenses Prevent blood loss

Answer 180

ALBUMIN: - 54% of plasma proteins - Contributes to plasma osmostic pressure and maintenance of blood volume - Serves as a carrier for certain substances GLOBULINS: - 38% - Alpha globulins transport bilirubin and steroids - Beta Globulins transport iron and copper - Gamma " constitute the antibodies of the immune system FIBRINOGEN: - 7% - Converted to fibrin in the clotting process

Answer 181

50-60% of WBCs **Maintaining normal host defenses against invading substances** - 1st cells to arrive at the site of infection (first responder) - Origins in myeloblasts (bone marrow) - Move to the tissue for approx. 1-3 days (die in the tissue discharging phagocytic function OR die of senescence)

Answer 182

1-3% of WBCs **Increase in number during allergic reactions and parasitic infections** - Assoc. w/ allergic reactions** - In parasitic reactions, they use surface markers to attach themselves to the parasite and then release hydrolytic enzymes

Answer 183

0.3-0.5% of total LEUKOCYTES **Involved in allergic reactions and hypersensitivity** - Consist of heparin (anticoagulant), histamine (vasodilator), and other mediators of INFLAMMATION** Similar to mast cells

Answer 184

20-30% of LEUKOCYTES **Defend against microorganisms through IMMUNE RESPONSE** Function in the spleen or lymph nodes 3 Types: 1) B lymphocytes 2) T lymphocytes 3) NK Cells

Answer 185

3-8% total LEUKOCYTE **Important role in CHRONIC inflammation** Involved in IMMUNE RESPONSE: - Activating lymphocytes** - Presenting antigen to T cells Cells survive for months to years in the tissues

Answer 186

Circulating cell fragments of the large megakaryocytes Function to **form platelet PLUG that helps CONTROL BLEEDING** 8-9 days in circulation

Answer 187

Blood cells originate from pluripotent stem cells in the bone marrow Proliferation, differentiation, and functional abilities of various blood cells are controlled by cytokines (hormone-like growth factors)

Answer 188

- Increase peripheral stem cells for transplantation - Accel. cell proliferation after bone marrow engraftment Eg) EPO TPO G-CSF GM-CSF

Answer 189

Bone marrow failure caused by chemotherapy or aplastic anemia Anemia of kidney failure Hemato. neoplasms Infectious diseases such as AIDS Congenital and myeloproliferative disorders Some sold tumors

Answer 190

Provides info regarding the number of blood cells and their structural and functional characteristics White cell differential count is the determination of the relative proportions (%'s) of individual white cell types

Answer 191

Skin puncture (capillary blood) Venipuncture (Vein blood) Arterial puncture (artery blood) Bone marrow aspiration

Answer 192

CBC Erythrocyte sedimentation rate Bone marrow aspiration and biopsy

Answer 193

Anemia = Low RBC Polycythmia = High RBC Leucopenia = Low WBC Leucocytosis = High WBC Thrombocytopenia = Low Platelets Thrombocytosis = High Platelets

Answer 194

Blood loss (hemorrhage) = HEMORRHAGIC Anemia Bone marrow failure (from radiation, toxin, tumor, fibrosis) = APLASTIC Anemia Erythropoietin deficiency (secondary to renal disease, Iron, folic acid, Vit B12 deficiency) = NUTRITIONAL Anemia Hemolysis (RBC destruction) = HEMOLYTIC Anemia

Answer 195

Low O2 tension in blood (CHD, Cor pulmonale, pulmonary fibrosis) Polycythemia rubra vera Dehydration (from severe diarrhea) Renal Disease w/ high erythro. production

Answer 196

Infectious diseases Inflammatory Disease (Eg RA or allergy) Leukemia Severe emotional or physical stress Tissue damage (Eg burns) Low O2 Dehydration Diarrhea

Answer 197

Bone marrow failure (Eg. b/c of infection, tumor or fibrosis) Presence of cytotoxic substance Autoimmune/collagen-vascular diseases (Eg. lupus erythematosus) Diseases of liver or spleen Radiation exposure

Answer 198

Chronic myeloid Leukemia

Answer 199

Aplastic anemia Chemotherapy

Answer 200

Ratio of volume of RBCs to volume of Blood HIGH Hematocrit = Polycythemia LOW Hematocrit = Anemic

Answer 201

1) Vessel Spasm (Vascular Constriction) 2) Formation of platelet Plug 3) Blood coagulation or dev. of an insoluble fibrin dot 4) Clot retraction 5) Clot dissolution

Answer 202

THROMBOSIS: - inappropriate formation of clots within vascular system BLEEDING: - Failure of blood to clot in response to appropriate stimulus

Answer 203

Vessel spasm constricts the vessel and reduces blood flow (transient event lasting min-hr) Vessel spasm is initiated by endothelial injury and caused by local and humoural mechanisms

Answer 204

Adhesion and aggregation 1) Attracted to damaged vessel wall 2) Activation by subendothelial tissue 3) Changes from smooth disks to spiny spheres 4) Exposing glycoprotein receptors on their surfaces

Answer 205

Presence of platelets produced in bone marrow Von Willebrand factor generated by the vessel endothelium Clotting factors synthesized in liver using Vit K

Answer 206

Interaction of substrates, enzymes, protein cofactors, and calcium ions that circulate in the blood or are released from platelet cells in the vessel wall

Answer 207

Terminal steps in both pathways are the same: - Calcium, factors X&V, platelet phospholipids combine to form prothrombin activator - Prothrombin activator converts prothrombin to thrombin - Causes conversion of fibrinogen in fibrin strands that create the insoluble blood clot

Answer 208

*Calcium ions* must be present for the thrombin system to begin Consists of several blood proteins that activate when bleeding occurs Activated clotting proteins engage in a cascade of chemical reactions that finally produce a substance called "fibrin" Fibrin strands stick to the exposed vessel wall, clumping together and forming a web-like complex of strands RBCs become caught up in the web causing a clot

Answer 209

Antithrombin III inactivates coagulation factors and neutralizes thrombin When antithrombin III is complexed w/ naturally occurring heparin, its action is accelerated and provides protection against uncontrolled thrombus formation on the endothelial surface Protein C (plasma protein) acts as an anticoagulant by inactivating factors V and VIII Protein S accelerates the action of Protein C Plasmin breaks down fibrin into fibrin degradation products that act as anticoagulants

Answer 210

Atherosclerosis DM Smoking Elevated blood lipoid and cholesterol levels Increased platelet levels

Answer 211

Pregnancy and the puerperium Use of oral contraceptives Postsurgical state Immobility CHF Malignant diseases

Answer 212

Increase risk of clot or thrombus formation in the arterial or venous circulations Arterial thrombi are assoc. w/ conditions that produce turbulent blood flow and platelet adherence Venous thrombi are assoc. w/ conditions that cause stasis of blood flow w/ increased concentrations of coagulation factors

Answer 213

Decrease in the # of Circulating Platelets: - Depletion of platelets must be relatively severe before hemorrhagic tendencies of spontaneous bleeding occur Impaired Platelet Function: - Bleeding resulting from platelet deficiency commonly occurs in small vessels and is characterized by petechiae and purpura

Answer 214

Hypercoagulability due to increased platelet function results in platelet adhesion, formation of platelet clots and disruption of blood flow Causes of increased platelet function are disturbances in flow, endothelial damage and increased sensitivity of platelets to factors that cause adhesiveness and aggregation

Answer 215

Plaques disturb blood flow, causing endothelial damage and promoting platelet adherence Platelets that adhere to vessel wall release growth factors which cause proliferation of smooth muscle and thereby contribute to the development of atherosclerosi Smoking, elevated blood lipids and cholesterol, hemodynamic stress, and DM predispose vessel damage, platelet adherence and eventual thrombosis

Answer 216

Thrombocytopenia: - Low Platelets, increased sequestration of platelets in spleen or decreased platelet survival Types: - Drug-induced Thrombocytopenia: - Idiopathic Thrombocytopenia purpura - Thrombotic Thrombocytopenia purpura Impaired Platelet Function

Answer 217

Bleeding: - Mucus membranes (nose, mouth, GI tract and uterine cavity) - Commonly occurs in small vessels (Petechiae = pinpoint purplish red dots & Purpura = purple areas of bruising)

Answer 218

**Vit K is an essential cofactor for synthesis of clotting factors** Fat-soluble vitamen synthesized by intestinal bacteria In Vit K deficiency, the liver produces inactive clotting factor resulting in abnormal bleeding

Answer 219

Deficiencies can arise b/c of defective synthesis, inherited disease, or increased consumption of the clotting factors Eg) Hemophilia A Hemophilia B Von Willebrand Disease Any genetic disruption of the production of the clotting factor

Answer 220

HEMORRHAGIC TELANGIECTASIA: - Uncommon autosomal dominant disorder characterized by thin-walled, dilated capillaries and arterioles VIT C DEFICIENCY: - "Scurvy" - Results in poor collagen synthesis and failure of the endothelial cells to be cemented together properly, causing fragile wall CUSHING DISEASE: - Causes protein wasting and loss of vessel tissue support because o the excess cortisol SENILE PURPURA: - Bruising in elderly persons - Caused by the aging process

Answer 221

Obstetric conditions Cancers Infections Shock Trauma or surgery Hematologic conditions

Answer 222

Continuously being formed from the pluripotent stem cells in bone marrow Move through a series of divisions to develop into mature RBCs Normoblast to reticulocyte, the RBC accumulates hemoglobin as the nucleus condenses and is lost Red cell loses its mitochondria and ribosomes

Answer 223

Transportation of O2 to the tissues Hemoglobin bind some CO2 and carry it from the tissues to the lungs Hemoglobin molecule is comprised of two pairs of structurally different polypeptide chains Each of the four polypeptide chains consists of globin (protein) and a heme unit (Which surrounds an atom of iron that binds to O2) Each molecule of hemoglobin can carry 4 molecules of O2 The production of each type of globin chain is controlled by individual structural genes with 5 different gene loci Mutations can occur anywhere in these 5 locations

Answer 224

Red cells are produced in the red bone marrow after birth Until Age 5, almost all bones produce Red cells to meet growth need - After 5, bone marrow activity gradually declines After 20yrs red cell production takes place mainly in the membranous bones of the vertebrae, sternum, ribs and pelvis With this reduction in activity of red bone marrow is replaced with fatty yellow bone marrow

Answer 225

Globin Chains = α & β Heme = Iron & Porphyrin O2 Binding

Answer 226

Lifespan = 120 days - Broken down in the spleen - Degradation products (Iron and amino acids) are recycled Heme molecule is converted to bilirubin and transported to the liver: - It is removed and rendered water soluble for elimination in the bile

Answer 227

Heme unit is converted to bilirubin Insoluble in plasma and attaches to plasma proteins for transport (unconjugated) Removed from blood by liver and conjugated w/ glucuronide to render it water soluble (conjugated) Jaundice

Answer 228

RBC Count: - measures total # of RBC in 1mm3 of blood % of Reticulocytes (normally 1%ish): - Provides an index of the rate of Red cell production Hemoglobin (grams per 100mL of blood): - Measures the hemoglobin content in blood Hemacrit: - Measures volume of red cell mass in 100mL of plasma volume

Answer 229

Provides the means for replacement of RBCs and other blood components 4 Major ABO blood types are determined by the presence or absence of 2 red cell antigens (A & B) The presence of D antigen = Rh-positive type The absence of D antigen = Rh-negative type

Answer 230

Whole blood RBCs Leukocyte-reduced blood cells Washed RBCs Frozen RBCs

Answer 231

Intravascular lysis of transfused RBCs by complement, IgM Causes: - Transfusion of ABO-incompatible blood - Transfusion of ABO-incompatible plasma - Non-ABO antibodies Clinical Manifestations: - Fever (but most febrile reactions not hemolytic) - Back pain - Dark or red urine - Bronchospasm - Shock - DIC - Organ failure - Death S&S of Transfusion Reactions: - Sensation of heat along vein where blood is being infused - Flushing of face - Urticaria (Hives) - Headache, pain in lumbar - Chills, fever, constricting pain in chest - Cramping pain in abdomen - Nausea and vomiting - Tachy, hypotension and dyspnea Treatment: - Stop transfusion - IV crystalloid or colloid - Maintain BP, HR - Maintain airway - Diuresis (fluid, loop diuretic, mannitol may cause volume overload) - Monitor renal and coagulation status

Answer 232

Check blood product/paperwork to ensure correct product given Notify blood bank/transfusion service Obtain blood and urine samples - Plasma and urine hemoglobin - Direct Coombs test - Repeat crossmatch/antibody screen - Repeat ABO/Rh typing

Answer 233

IgG-mediated lysis of transfused red cells (usually extravascular, non-ABO) Usually begins 5-10 days after transfusion Jaundice, falling Hct, positive direct Coombs test, fever Not generally life-threatening

Answer 234

Cause: - Cytokines released by leukocytes during storage, antibodies to HLA antigens on transfused or donor PMNS Incidence: -

Answer 235

Hypoxemia w/ bilateral pulmonary infiltrates No increase in central venous or pulmonary artery pressures Usually begins acutely within 6hrs of transfusion Clinical = acute res distress, fever, chills Pathophysiology: - Underlying lung injury (Eg. sepsis, pneumonia) causes PMNs to adhere to pulmonary caps - Mediators in transfused blood product (neutrophil antibodies, cytokines) activate PMNs w/ resistant cap injury Risk = FFP > Platelets > RBC Treatment: - Stop transfusion - O2 - Ventilatory support - Pulse corticosteroids

Answer 236

Hereditary deficiency of glucose-6-phosphate dehydrogenase predisposes to oxidative denaturation of hemoglobin, w/ resultant red cell injury lysis

Answer 237

Extravascular = When RBCs become LESS DEFORMABLE making it difficult for them to transverse the splenic sinosoids Intravascular = Result of complement fixation in transfusion reactions, mechanical injury or toxic factors

Answer 238

Inherited disorder in which an abnoraml hemoglobin (Hemoglobin S [HbS]) leads to the chronic hemolytic anemia, pain and organ failure

Answer 239

Group of inherited disorders ofhemoglobins synthesis leading to the decreased synthesis of either the α- or β-globin chains of HbA

Answer 240

Common worldwide cause of anemia affecting people of all ages Results from dietary deficiency, loss of iron through bleeding or increased demands B/C iron is a component of heme, a deficiency leads to a decreased hemoglobin synthesis and consequent impairment of O2 delivery

Answer 241

aka Megaloblastic Anemia Red cells are produced abnormally large b/c of excess cytoplasmic growth and structural proteins

Answer 242

Primary = Proliferative disease of the bone marrow w/ an absolute increase in total RBC mass accompanied by elevated white cell and platelet counts Secondary = results from increased erythropoietin levels caused by hypoxic conditions such as chronic heart and lung disease

Answer 243

Hemoglobin concentrations at birth are high, reflecting the high synthetic activity in utero to provide adequate O2 delivery HbF vs HbA = affinity of F vs A Hyperbilirubinemia = Unconjugated vs conjugated, phototherapy Hemolytic disease

Answer 244

Age-Assoc. Decline in the hemto. reserve - Reduction in hemato. progenitors - Reduced production of hemato. growth factors - Inhibition of erythro. - Inflammatory cytokines interfere w/ erythro. interaction w/ its receptors Anemia: - Hb decreases - RBC production decreases w/ age - CBC = peripheral blood smear and reticulocyte count and index - Studies rule out comorbid conditions such as malignancy, GI conditions that cause bleeding and pernicious anemia

Answer 245

"stopping blood flow" Proceeds in a series of steps using clotting factors: - Intrinsic and extrinsic pathways both lead to formation of prothrombinase - Prothrombinase converts to prothrombin to thrombin - Thrombin converts to fibrinogen to fibrin - Fibrin strands trap RBCs forming clots Cofactors = Ca+2 and Vit K are critical for synthesis of clotting factors Fibrinolysis = Plasmin breaks down fibrin network Pharmacotherapy focuses on manipulating these elements

Answer 246

"removal of blood clot, proceeds in cascading steps" Initiated by release of enzyme 'tissue plasminogen activator (tPa)' - Converts inactive plasminogen enzyme in the clot to active form plasmin enzyme Plasmin digests fibrin strands to remove clot

Answer 247

Thromboembolic disorders: - Thrombus = stationary clot - Embolus = clot that moves to another location - Deep Venous Thrombosis (DVT) = venous clots often develop in the legs as a DVT but can migrate to lungs creating pulmonary embolism - Clots migrating from left atrium can cause strokes - Coronary artery clots cause MI Platelet Disorders: - Due to decreased production resulting in low Platelet counts - Bone marrow suppression - Folic acid and B12 deficiency - Decreased thrombopoietin in liver failure Hemophilia and von Willeband's disease: - Genetic conditions resulting in absence of clotting factors = difficulty clotting

Answer 248

Used to prolong bleeding time in order to prevent blood clots from forming Eg) Heparin - Enhances antithrombin III (AT-III) activity - Decreases thrombin activity (active factor IIa) - Decreases prothrombinase (Active factor Xa) Low molecular weight heparin: - Also enhances AT-III activity but more specific to prothrombinase (active factor X) - Fewer adverse effects than heparin (Less risk of thrombocytopenia compared to heparin)

Answer 249

Warfarin has been the drug of choice for the prevention and treatment of arterial and venous thrombotic disorders for more than 40yrs It was initially marketed as a pesticide against rats and mice and is still popular for this purpose