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Pathophys > Non Neoplastic D/O & Spleen > Flashcards

Non Neoplastic D/O & Spleen Flashcards

1
Q

WBCs (leukocytes) originate from what stem cell?

A

pluripotent stem cell

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2
Q

a pluripotent stem cell divides into what two types of stem cells?

A

myeloid and lymphoid

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3
Q

what three cell types are made from lymphoid stem cells?

A

all progenitors
NK
T cell
B cell

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4
Q

T cell progenitor goes where in the body?

A

thymus (forms a T cell)

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5
Q

B cell progenitor forms into a ______ cell and then a _______ cell

A

progenitor to B cell to plasma cell

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6
Q

myeloid stem cell divides into what four stem cells?

A

monocyte, granulocyte, megakaryocyte and erythrocyte

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7
Q

a monocyte turns into a __________ and then a _________

A

monocyte to monoblast to monocyte

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8
Q

what are the three types of granulocytes?

A

neutrophils, eosinophils, and basophils

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9
Q

a megakaryocyte turns into a __________, which turns into __________

A

megakaryocyte and then platelets

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10
Q

an erythrocyte turns into a _________ and then turns into a ____________

A

erythrocyte to reticulocyte to an erythrocyte

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11
Q

what are the agranulocytes?

A

monocytes and lymphocytes

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12
Q

when is a monocyte called a macrophage?

A

once it goes into the tissues

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13
Q

“Blasts” represent what?

A

committed cells (i.e. lymphoblast will become a lymphocyte)

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14
Q

“Pro” and “Meta” represent what?

A

further differentiation

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15
Q

lymphoid stem cell leads to development of what type of cells?

A

lymphocytes

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16
Q

most WBC are found where?

A

the tissues (connective or lymphatic)

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17
Q

which two types of cells circulate?

A

monocytes and granulocytes

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18
Q

_________ migrate between circulation and lymphatic system

A

lymphocytes

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19
Q

T cells become what two types of cells?

A

CD4 (helper)

CD8 (cytotoxic)

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20
Q

B cells become what type of cells?

A

antibody-producing plasma cells

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21
Q

NK lack what?

A

immunologic specificity

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22
Q

T cells initiate what type of immunity? B cells? what do both of these cells require?

A

T cells: cell mediated
B cells: antibody mediated
**both cells require exposure to antigen (priming)- NK cells don’t

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23
Q

what two organs are part of the lymphatic system?

A

spleen and thymus

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24
Q

what is special about lymphoid tissues? where are they normally located>

A

they lack an external capsule

located near systems with external openings (put lymph near where pathogens can get into the body)

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25
Q

what are four lymphoid tissues?

A

MALT
Waldeyer’s ring
peyer’s patches
appendix

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26
Q

what is waldeyer’s ring?

A

ring of lymphoid tissue that surrounds the larynx

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27
Q

Lymph nodes: concentrated in what three places?

A

neck, axilla, groin

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28
Q

lymph nodes are __________ with inner __________

A

encapsulated with inner trabeculae (divides lymph nodes into areas)

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29
Q

outer cortex of lymph node contains?

A

B cell rich follicles in (germinal center is a secondary follicle and indicates active proliferation)

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30
Q

inner cortex (paracortex) of lymph node contains?

A

mostly T cells

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31
Q

lymph enters via _________ lymphatics and converge to _________ lymphatic in medulla

A

afferent; efferent

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32
Q

what is lymphadenitis?

A

inflammation within a lymph node

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33
Q

what does lymphadenopathy mean?

A

enlarged node

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34
Q

acute generally reactive hyperplasia: does what to the node? what two types can it be?

A

stretches the node (painful)
localized (bacterial infection in one body area, which is drained by that node) vs generalized (systemic viral infection)

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35
Q

Mesenteric adenitis: what type of infection? often confused for what? occurs in what part of the body?

A

Yersinia enterocolitica infection
often confused for appendicitis
occurs in small bowel mesentery

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36
Q

cause of chronic lymphadenitis? may require what test?

A

has many causes

may require biopsy (acute usually doesn’t require one)

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37
Q

disease states that can cause lymphadenitis (12)

A

1) . metastatic CA
2) . lymphoma
3) . Mono
4) . RA
5) . syphilis
6) . AIDS related complex
7) . lupus
8) . toxoplasmosis
9) . whipple’s dz
10) . phenytoin
11) . vaccine reactions
12) . dermatopathic lymphadenitis

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38
Q

what is the most common cause of lymphadenitis?

A

dermatopathic: nodes that drain inflamed skin

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39
Q

total WBC normal range

A

4,000-11,000/ul

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40
Q

_______ WBC count is more informative than _________

A

absolute count > percentages

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41
Q

normal neutrophil count

A

1800-6500/ul

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42
Q

few eosinophil count

A

100/ul

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43
Q

few basophil count

A

300/ul

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44
Q

normal monocyte count

A

100-600/ul

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45
Q

normal lymphocyte count

A

1200-3400/ul

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46
Q

normal CD4 count

A

> or equal to 1000/ul (KNOW in respect to AIDS*)

47
Q

leukocytosis means?

A

WBC> 12,000

48
Q

leukopenia means?

A

any low total WBC (not helpful)

49
Q

severe and life threatening levels of low absolute neutrophil count

A

severe: <500

life threatening: <100

50
Q

low absolute neutrophil count is also called?

A

agranulocytosis

51
Q

what are the three main causes of neutropenia?

A

1) . suppression of granulopoiesis
2) .destruction or sequestration of neutrophils
3) . drugs

52
Q

things that cause suppression of granulopoiesis (4)

A

bone marrow failure, chemo, radiation, bad stuff in the marrow (fibrosis)

53
Q

two things that cause destruction or sequestration of neutrophils?

A

overwhelming infection, hypersplenism

54
Q

drugs that can cause neutropenia (4)

A

carbamazepine, clozapine, PTU/methimazole, ticlopidine

55
Q

what is agranulocytosis?

A

severe neutropenia (ANC< 500)

56
Q

what are two types of ulcers that can provide a portal to the blood stream (and therefore lead to agranulocytosis)?

A

oral ulcers w pseudomembranes or cecal ulcers (typhlitis- inflammation of cecum)

57
Q

what is the usual cause of agranulocytosis? death occurs how quickly?

A

usual cause is meds; death occurs within days

58
Q

what are three dreadful complications of agranulocytosis?

A

bacterial sepsis, deep candidiasis, and deep aspergillosis

59
Q

treat agranulocytosis with what two things?

A

antimicrobials and hematopoietic growth factors

60
Q

what four disease states can cause lymphocytopenia?

A

HIV
protein/calorie malnutrition
Cushing’s
stress

61
Q

which is less common: lymphocytopenia or agranulocytosis?

A

lymphocytopenia

62
Q

what does multi system organ failure induce?

A

lymphocytic apoptosis

63
Q

systemic viral infections does what to T cells?

A

drive them into lymph nodes

64
Q

what is leukocytosis? what are the two main types of causes?

A

elevated WBC count; neoplastic and non neoplastic

65
Q

what is important about marginated neutrophils?

A

half of the circulating neutrophils are stuck along BV walls; certain conditions will cause them to de-marginate and will result in a higher WBC lab count but not a changed # in the body

66
Q

what are some things that can cause granulocytosis?

A

1) . pyogenic bacterial infection
2) . burns
3) . tissue necrosis (remember MI)
4) . late pregnancy
5) . stress/pain/exercise (demarginates)
6) . glucocorticoid therapy
7) . “left shift”

67
Q

what is a left shift?

A

means that there is a severe infection in which bone marrow is producing WBCs and releasing them into the blood before they are fully mature

68
Q

what is a leukemoid reaction?

A

an increase in the white blood cell count usually due to infection or another disease (can mimic leukemia)

69
Q

which type of patients usually get a leukemoid reaction? WBC levels are what?

A

super sick septic patients

WBC > 100K

70
Q

what are four manual differentials results of a leukemoid reaction?

A

1) . toxic granulation
2) . vacuolization- creation of compartments within the cell
3) . low to normal absolute basophil count
4) . high leukocyte alkaline phosphatase

71
Q

why is a manual differential lab run?

A

The manual differential white blood cell count is performed to determine the relative number of each type of white blood cell present in the blood

72
Q

what is eosinophilia? what are the morning and pm values?

A

elevated eosinophil count

am: >350/ul
pm: >650/ul

73
Q

cause of eosinophilia in healthy patients?

A

no cause usually found

74
Q

what type of immune response is eosinophilia?

A

type 1

75
Q

what is the most common type of eosinophilia?

A

chronic eosinophilic leukemia

76
Q

eosinophilia can be caused by what two things?

A

parasitic infection and drug allergy

77
Q

what are two conditions that you can see basophilia in?

A

chronic myelogenous leukemia and polycythemia vera

78
Q

is monocytosis diagnostic?

A

NO never

79
Q

what four disease states could you see monocytosis in?

A

RA, TB, Crohn’s, deep fungal infections

80
Q

adult lymphocytosis range?

A

4,000-10,000/ul

81
Q

what are two disease states that can cause lymphocytosis?

A

stress- “transient stress lymphocytosis”

Mono- atypical lymphocytes

82
Q

Mono mostly results from exposure to what virus? how is it spread?

A

Epstein-barr virus (85%); spread by contact with infected oral secretions

83
Q

mono virus infects what cells? what happens to these cells?

A

B cells; infected B cells are immortalized and eventually bear viral antigens…they stimulate heterophil antibody production

84
Q

what’s the incubation period for mono?

A

long- months

85
Q

what does the mono spot test detect?

A

heterophil antibodies produced by EBV infected B cells

86
Q

what does the immune system produce in response to mono?

A

T cell hyperplasia in lymphoid organs and lymphocytosis

87
Q

what’s the atypical circulating lymphocyte % that is found in mono?

A

at least 20%

88
Q

what two ways are mono infected B cells eventually eliminated?

A

cell mediated and humoral mechanisms

89
Q

mono signs/symptoms (8)

A

1) . fever
2) . fatigue
3) . malaise
4) . pharyngitis (maybe palatal petechiae)
5) . generalized lymphadenopathy (check behind ears)
6) . impressive splenomegaly
7) . mild hepatitis

90
Q

mono rarely infiltrates the ____

A

CNS

91
Q

problem with monospot test?

A

often negative for weeks into illness and often never positive in kids

92
Q

monospot only binds _______ RBCs

A

bovine

93
Q

what is IgG anti-EBV capsid useful at detecting?

A

past or present EBV infection (higher titers indicate present infection)

94
Q

what is IgM anti-EBV capsid useful at detecting?

A

present infection in children

95
Q

what are three “minor mysteries” with mono?

A

1) . half get positive cold agglutinins & hemolytic anemia
2) . mild thrombocytopenia
3) . morbilliform (measles-like rash): those who are tx with ampicillin/amoxicillin

96
Q

treatment for mono?

A

supportive: rest, fluids, pain meds

no contact sports if splenomegaly

97
Q

EBV strongly linked to what type of lymphoma?

A

burkitt’s

98
Q

healthy spleen weighs how many grams? how big does it need to be to be palpable?

A

50-250 g (over 800g before palpable)

99
Q

what two cell centers are in the spleen? macrophages in there remove? what does it do to platelets?

A

T and B cell centers

macrophages remove outdated RBC; sequesters platelets

100
Q

do you biopsy the spleen?

A

almost never due to potential of rupture

101
Q

4 main infections causing splenomegaly?

A

malaria, mono, bacterial endocarditis, most other bad infections

102
Q

two types of WBC disorders that can cause splenomegaly

A

chronic myelogenous leukemia and hairy cell leukemia

103
Q

what are four congestion issues that can cause splenomegaly?

A

cirrhosis, R sided heart failure, splenic vein thrombosis, red cell sludge- sicklers

104
Q

four cases of over destruction of RBC that causes splenomegaly?

A

Hereditary spherocytosis
Hemoglobinopathies
Immune hemolytic anemia
Immune thrombocytopenic purpura

105
Q

3 immunoreactive conditions that can cause splenomegaly

A

Systemic lupus erythematosus
Rheumatoid arthritis
Transplant rejection

106
Q

4 storage diseases that can cause splenomegaly

A

Gaucher’s
Niemann-Pick’s
Hunter’s
Hurler’s

107
Q

enlarged spleen destroys what in blood?

A

formed elements of blood

108
Q

accessory spleens are how common?

A

about 25%

109
Q

what can splenosis result from?

A

spillage of pulp with splenic rupture

110
Q

how does a septic spleen feel?

A

abnormally soft “tomato paste”

111
Q

infarcts in the spleen are _______. three things that can cause splenic infarct

A

common; atheroembolization (splenic artery), sickle cell, mitral valve endocarditis

112
Q

spleen is a common metastasis site of what two types of CA?

A

leukemias and lymphomas

113
Q

what is the most frequently injured organ in blunt abd trauma?

A

spleen (even CPR)

Pathophys (13 decks)

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