Patho Exam 3 Flashcards
1
Q
the production of blood cells
A
hematopoiesis
2
Q
what is the order of hematopoiesis?
A
begins in yolk sac > liver and spleen > then taken to bone marrow
3
Q
blood cell production in the bone marrow
A
medullary hematopoiesis
4
Q
blood cell production in other places (liver, spleen)
A
extramedullary hematopoiesis
5
Q
the hematopoiesis process starts with pluripotent stem cells. what do they develop into?
A
erthrocyte (red cell); myelocyte (monocyte and granulocyte); lymphocyte (T and B cells); and megakaryocyte (thrombocyte)
6
Q
what is the growth of cells controlled by?
A
colony-stimulating factors (CSF) and other cytokines and chemical mediators
7
Q
what do cytokines control the regulation of?
A
hematopoiesis
8
Q
what are the normal lab values for RBCs in males and females?
A
males: 4.7-6.1 million/uL
females: 4.2-5.4 million/uL
9
Q
what are the normal lab values for WBC?
A
5,000-10,000 mm1
10
Q
what are the normal lab values for Hgb in males and females?
A
males: 14-18 g/dL
females: 12-16 g/dL
11
Q
what are the normal lab values for Hct in males and females?
A
males: 42%-52%
females: 39%-47%
12
Q
what are the normal lab values for platelets?
A
150,000-400,000 mm1
13
Q
what is the normal erythrocyte sedimentation rate (ESR)?
A
less than 20 mm/hr
14
Q
the stoppage of blood flow
A
hemostasis
15
Q
what are the three stages of hemostasis?
A
- vascular constriction
- formation of platelet plug
- blood coagulation
16
Q
platelet deficiency
A
thrombocytopenia
17
Q
what are the causes of thrombocytopenia?
A
decreased platelet production; decreased platelet survival; splenic sequestration (pooling); intravascular dilution of circulating platelets
18
Q
what are the lab features of thrombocytopenia?
A
low platelet count; prolonged bleeding time; normal coagulation
19
Q
what are the clinical manifestations of thrombocytopenia?
A
bruising, prolonged bleeding, petechia, purpura; bleeding from mucous membranes; spontaneous bleeding, hemorrhaging
20
Q
what is the treatment of thrombocytopenia?
A
focus in cause
21
Q
blood thickens
A
hypercoagulability (Virchow’s triad)
22
Q
what is Virchow’s triad?
A
venous stasis (sluggish blood flow); hypercoagulability; damage to vessel wall
23
Q
breakdown of the RBC and the release of hemoglobin; generally normocytic and normochromic
A
hemolytic anemia
24
Q
someone has hemolytic anemia. what two things will be increased?
A
reticulocyte count and serum count
25
what are the common causes of hemolytic anemia?
drug reactions and wrong blood received
26
breakdown of RBC and release of hemoglobin
RBC hemolysis
27
genetically determined, most common heritable hematologic disease in the world
sickle cell anemia
28
what are the lab features of sickle cell anemia?
Hgb S presence in blood; hemoglobin electrophoresis (homozygous, heterozygous for hgb S); anemia, decreased survival time of sickled cells; increased reticulocytes (immature RBC); increase of bilirubin (product of RBC breakdown)
29
what are the clinical maifestations of sickle cell anemia?
fatigue; exercise intolerance; hemolysis in spleen; vaso-occlusive events; pain (obstruction of vessels, tissue hypoxia, tissue death); hyperbilirubinemia
30
what does hyperbilirubinemia lead to?
jaundice
31
where do vaso-occlusive events occur? what do they do/cause?
occur in chest, abdomen, long bones, joints; block perfusion (cap stasis, venous thrombosis, arterial emboli (storke)); acute chest syndrome (pain, fever, pulmonary infarction, respiratory failure)
32
loss of iron containing red blood cells
blood loss anemia
33
loss of vascular volume (loosing blood); RBC normal in size and color
acute blood loss anemia
34
what are the clinical manifestations of acute blood loss anemia?
depends on the circumstance but hypovemoia is common
35
does not effect vascular volume due to compensatory mechanisms; often asymptomatic
chronic blood loss anemia
36
what can chronic blood loss anemia lead to?
microcytic hypochromic anemia (low hemoglobin due to depletion of iron stores)
37
common cause of anemia
iron deficiency anemia
38
what are the causes of iron deficiency anemia?
diet (not enough meat); bleeding; increased demand
39
what can lack of iron cause?
decreased hemoglobin synthesis in WBC causes impaired O2 delivery
40
presence of small RBCs in a peripheral blood smear; usually characterized by a MCV
microcytic anemia
41
circulating RBCs are smaller than usual size and have decreased red color
hyochromic anemia
42
what are the clinical manifestations of iron deficiency anemia?
hair loss; glossitis; pica
43
what are the treatments of iron deficiency anemia?
controlling chronic blood loss; increase iron intake (through diet or supplements)
44
size of cell
cytic
45
normal size
normocytic
46
small size
microcytic
47
large size
macrocytic
48
color of the cell
chromic
49
normal color
normochromic
50
decreased color
hypochromic
51
cancerous malignant neoplasms arise from single blood line of precursor hemtopoietic stem cells in bone marrow; immature malignant cells found in large numbers in blood marrow, infiltrate blood stream and organs
leukemia
52
disease if lymphoid stem cell line b and t cells; most common type of leukemia in children and adults
acute lymphocytic (ALL)
53
disease of the myeloid stem cells, blast cells in bone marrow accumulate and result in neutropenia, anemia, and thrombocytopenia
acute myelocytic (AML)
54
what are the clinical manifestations of acute leukemia?
insufficient production of normal WBC, RBC, and platelets (results in low grade fever, night sweats, and weight loss)
55
1/3 of all leukemias, disorder of older adults; malignancy of b lymphocytes; asymptomatic; lymph node enlargement, fever, pain, weight loss; no treatment (chemotherapy with stem cell transplant)
chronic lymphocytic (CLL)
56
excessive proliferation of granulocytes, RBC precursors and megakaryocytes
chronic myelogenous (CML)
57
what are the three phases of chronic myelogenous (CML)?
chronic, accelerated, and acute
58
what are the symptoms of chronic myelogenous (CML)?
fatigue, dyspnea, low grade fever, night sweats, bone pain, and bleeding
59
malignancy of cells in peripheral lymphoid tissues
lymphoma
60
malignant disorder characterized by reed sternberg cells, begin with single lymph one and then spread to other lymph nodes
hodgkin
61
all types of malignant lymphoma that do not have reed sternburg cells, neoplastic lymphoid cells that originate from t and b cells during differentiation in peripheral lymphoid tissues, begins with several enlarged lymph nodes in various locations
non hodgkin
62
what are the symptoms of lymphoma?
painless, progressive lymph node enlargement; fever; night sweats; weight loss; increased infections
63
deficiency in the normal number of neutrophils, a type of leukopenia
neutropenia
64
what is the normal neutropenia level?
3,000-7,000
65
what does the level have to be in order to be diagnosed?
1,500
66
what does the level have to be in order of it to be considered severe?
less than 500
67
born with neutropenia
congenital
68
autoimmune, drug related, infection related
acquired
69
movement of gases from the atmosphere into the airway
ventilation
70
flow of blood
perfusion
71
reduction in arterial oxygen (PaO2), can lead to hypoxia
hypoxemia
72
inadequate supply of O2 to tissues
hypoxia
73
what are the causes of hypoxemia and hypoxia?
inadequate O2; respiratory disease; dysfunction of neurogical; alterations in perfusion
74
what is the normal arterial PaO2 range?
75-100
75
what are the respiratory defense mechanisms?
cilliary mucous membrane; cough reflux; macrophages
76
what are the control centers of the respiratory system?
pons and medulla
77
moves air, warms it, filters, humidifies
trachea
78
smallest unit of lung, gas exchange site, produces surfactant
alveoli
79
membrane lining
pluera
80
what are the three pluera components?
visceral pluera; plueral space; parietal pluera
81
what are the normal lab values for pH?
7.35-7.45
82
what are the normal lab values for PaCO2?
35-45 mm Hgc
83
what are the normal lab values for PaO2?
80-100 mm HgD
84
what are the normal lab values for
HCO3 (bicarbonate)?
21-28 mEq/L
85
what are the normal lab values for SaO2?
95-100%
86
relationship of oxygen to hemoglobin
oxyhemoglobin dissociation curve
87
what does it mean when the oxyhemoglobin dissociation curve shifts to the left?
increased affinity of hemoglobin to O2 (hemoglobin hold onto O2)
88
what does it mean when the oxyhemoglobin dissociation curve shifts to the right?
decreased affinity (hemoglobin gives up O2 to the tissues)
89
viral infection; affects upper and lower rest; three types: A, B, C; transmits through droplet
influenza
90
what are the symptoms of influenza?
fever, chills, malaise, and sore throat
91
entry of food/fluids into airways causing inflammation
aspiration
92
bacterial
typical
93
viral, fungal
atypical
94
infection can be lobar (1 lobe) or bronchopenumionia (several lobes); community or hospital acquired
pneumonia
95
infectious disease; airborne droplets; most commonly affects pulmonary system but can occur anywhere; lives in WBC and can cause scar tissue;
tuberculosis
96
when it comes back out of where it lives in the WBCs and reinfects host
secondary tuberculosis
97
what are the ways to test for tuberculosis?
skin test; chest x-ray; sputum; DNA techniques; genotyping
98
what are the ways to treat tuberculosis?
multiple antibiotics; treatment can be prolonged; drug resistance is a problem
99
leading cause of cancer death for men and women in the US; high mortality; primary tumors arise from lung tissue; aggressive; locally invasive; metastatic; crab protrusions;
lung cancer
100
what are the six classifications of lung cancer?
1. small cell (20-25%)
2. non-small cell (75%)
3. squamous cell (25-40%)
4. adenocarcinoma (20-40%)
5. large cell carcinoma (10-15%)
6. small cell carcinoma (20-25%)
101
strongest association with cigarette smoking; highly malignant; infiltrate early
small cell
102
where does small cell lung cancer originate?
bronchiole epithelium
103
common in men with smoking history
squamous cell
104
where does squamous cell lung cancer originate?
central bronchi
105
most common in north america; women and non smokers; weaker association with cigarette smoking
adenocarcinoma
106
where does adenocarcinoma originate?
bronchioles or alveolar tissues
107
highly anaplastic
large cell
108
where does large cell lung cancer originate?
lung periphery
109
what are the clinical manifestations of lung cancer?
dyspnea; cough; wheezing; chest pain; hemoptysis; increased sputum; hoarseness; anorexia (weight loss); paraneoplastic disorders; superior vena cava syndrome
110
what are the diagnostic tests of lung cancer?
history/physical; pulmonary function; positive cytologic or histologic findings; bronchoscopy; tissue biopsies; pleural fluid samples; CXR; CT; MRI; PET scans
111
inflammation and fibrosis or bronchial wall; hypertrophied mucus glands; loss of alveolar tissue; loss of elastic lung fibers
COPD
112
hypersecretion of mucus and chronic cough, obstructive airflow
hypertrophied mucus glands
113
decreased surface area for gas exchange
loss of alveolar tissue
114
airway collapse, obstructed inhalation, air trapping
loss of elastic lung fibers
115
airway obstruction of major and small airways caused by chronic inflammation and excessive bronchial secretions; bronchial wall fibrosis; mismatch of ventilation/perfusion; can't compensate, hypoxemia and cyanosis; blue bloater
bronchitis
116
what are the symptoms of bronchitis?
chronic productive cough for 3 months in 2 consecutive years
117
hypersecretion of mucus in large airways (why the patient coughs)
hypertrophy of submucosal glands
118
what happens in the small airways?
increase in goblet cells and excess mucus production
119
what does loss of lung elasticity lead to?
CO2 retention
120
enlargement of air sacs distal to the terminal bronchioles
air trapping/barrel chest
121
destruction of alveolar walls and cap beds; smoking is main cause; hyperinflated lungs; bleb; airway collapse; mismatch of ventilation/perfusion; overventilated to maintain blood gas; pink puffer
emphysema
122
what are the ways to diagnose emphysema?
H&P; pulmonary function; chest x-ray; labs
123
what are the ways to treat emphysema?
no more smoking; bronchodilators, anticholinergics expectorants; steroids (anti-inflammatory); nutrition; immunizations
124
blood borne substances lodge in pulmonary artery and obstruct bf; travel toward the heart and lungs; lodge in the pulmonary vasculature; hypotension
pulmonary embolism (PE)
125
blood clots that develop in thighs and legs (MOST COMMON SOURCE OF PE)
thrombus
126
secondary to fx (long bones, pelvis)
fat globules
127
collections of fluid or debris related to a complicated factor
amniotic fluid
128
something that has traveled from one area to another, like a bc/air/fluid, foreign object
embolism
129
increase pulmonary artery pressure
vasoconstriction
130
increase workload for right ventricle
right sided heart failure
131
what are the risk factors of a pulmonary embolism?
development of DVT; immobility; trauma; spinal cord injury; fx; surgery
132
what are the clinical manifestations of a pulmonary embolism?
restlessness; anxiety; tachycardia; tachypnea; sudden dyspnea; chest pain; hemoptysis; heart failure; shock; respiratory arrest
133
what are the diagnostic tests of a pulmonary embolism?
V/Q scan; ABGs; pulmonary arteriography (primary use); D-dimer; lung scans
134
what are the treatments of a pulmonary embolism?
improve respiratory and vascular status; pharmacologic therapy; surgical intervention
135
what is the Virchow's triad of a pulmonary embolism?
venous status: pulling of blood, sluggish blood flow
hypercoagulability: clot easy, dehydration, thick blood
drainage of vessel wall: trauma/surgery
136
obstructive disorder, chronic disease, prevalence for disease has increased, airway obstruction, bronchial hyperresponsiveness, airway inflammation, airway remodeling, narrowing of airway
asthma
137
what are the clinical manifestations of asthma?
cough, wheezing, chest tightness, prolonged expiration, tachycardia, tachypnea, dyspnea, hypoxemia, hypercapnia, anxiety
138
what are the diagnostic tests of asthma?
history/physical, clinical findings, ABGs, pulmonary function test, determination of allergens (skin testing), CBC
139
what is the management of asthma?
stepwise approach: prevent symptoms, reduce triggers, maintain pulmonary function, maintain normal activity, prevent exacerbations
140
what are the 4 classifications of chronic asthma?
intermittent, mild, moderate, severe
141
alveolar collapse; incomplete expansion of the lung or portion of
atelectasis
142
what are the causes of atelectasis?
intra-op high dose supplemental O2; anesthesia; mucus plug; external compression by fluid, mass, exudate
143
what specific population of people are at risk for atelectasis?
post op
144
what is the patho of atelectasis?
decreased ciliary function > secretion retention > airway obstruction > impaired cough reflexes > hypoventilated alveoli > hypoxemia > acute respiratory failure
145
what are the clinical manifestations of atelectasis?
cough; sputum production; low-grade fever; dyspnea; tachypnea; tachycardia; anxious; cyanosis; decreased breath sounds
146
what are the treatments of atelectasis?
prevention (pre-op education, turn, cough, deep breathe, incentive spirometry); improve ventilation and remove secretions; adequate oxygenation; bronchoscopy (to remove mucous plugs)
147
lung collapse, accumulation of air in the pleural cavity, breach in the lung or pleura, allows air to enter the pleura space and the lung or a portion of the lung collapses
pneumothorax
148
what is the normal pressure in the pleural space?
negative
149
why does the pressure need to be negative?
to keep the lungs inflated
150
a subtype and an emergency, air enters and cannot leave, lung collapses, trach shifts to unaffected side
tension pneumothorax
151
what are the clinical manifestations of a pneumothorax?
tachycardia, decreased or absent breath sounds, dyspnea, tachypnea, chest asymmetry, hypoxamia
152
what are the diagnostic tests of a pneumothorax?
chest x-ray, CT scan, ABGs
153
what are the treatments for a pneumothorax?
supplemental O2, evacuation of the air from the pleural space, chest tube insertion
154
placed to chest drainage system that provide water-seal and suction
chest tube insertion
155
abnormal collection of fluid in the pleural cavity as a result of a disease process
pleural effusion
156
what are the 4 types of pleural effusion?
transudates or exudates, empyema (pus), blood; chyle (lymph fluid)
157
what are the clinical manifestations of pleural effusion?
vary based on cause, dullness to percussion, absence of breath sounds over affected area, dyspnea, pleuritic pain, hypoxemia, fever (infections)
158
what are the diagnostics of a pleural effusion?
CXR, CT, ultrasound; thoracentesis; analysis of pleural fluid; elevated WBC (infections)
159
what are the treatments of pleural effusion?
thoracentesis (GOLD STANDARD); chest tube drainage (effusions)
