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Pathology: Block 1 Flashcards

1
Q

Cell injury depends on what 3 things?

A

Type of injury
Duration/severity
Type of cell

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2
Q

List 4 examples of cell systems that are vulnerable to injuries

A

Membrane- integrity
Mitochondria- ATP supply
RER- protein synthesis
Nucleus- genetics

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3
Q

Define Ischemia, Hypoxia, and Anoxia

Difference between the 2?

A

Ischemia- insufficient blood flow, lacks O2 and nutrients
Hypoxia- reduces O2
Anoxia- complete lack of O2, impedes cell respiration, NaK pump failure= 0 ATP

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4
Q

Of the 3 forms of reduced O2 supply to tissues, which one is fastest?

A

Ischemia causes injury faster than hypoxia

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5
Q

How/why does ischemia-reperfusion injury cause damage?

A

Returning O2 to site activates free radicals which releases MORE radicals and cytotoxic enzymes

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6
Q

What are the 5 types of cellular adaptations that can occur from adverse/prolonged stimuli?

A 
Atrophy
Hypertrophy
Hyperplasia
Metaplasia
Dysplasia
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7
Q

Define Hyperplasia and what causes it

A

Increased size due to an increase in the NUMBER of cells

Hormone / chronic injury

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8
Q

Define Metaplasia

A

Reversible change in TYPE of cell

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9
Q

What is the sequence of changes from metaplasia to cancer if a stimulus is not removed?

A

Metaplasia
Dysplasia
Neoplasia
Cancer

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10
Q

Define Dysplasia

A

Disorderly arrangement/layering of cells

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11
Q

Define Necrosis

A

Premature/unnatural death of organs/tissue which then release inflammatory factors

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12
Q

What are the 3 types of necrosis

A

Coagulative- most common form
Liquefactive
Caseous

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13
Q

What causes coagulative necrosis?

What part of this process allows the superficial tissue to retain it’s shape/structure?

A

Rapid hypoxia or anoxia

Rapid inactivation of hydrolytic enzymes prevents tissue lysis

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14
Q

Where does coagulative necrosis most commonly occur?

A

Solid organs

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15
Q

Where does liquefactive necrosis commonly occur?

A

Brain, lytic enzymes change tissue to pus

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16
Q

What causes casous necrosis?

A

TB/Fungal infections cause cells to fall apart

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17
Q

What is the difference in final events between necrosis and apoptosis?

A

Necrosis- non membrane= inflammation

Apoptosis- membrane= phagocytosis

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18
Q

Define Dystrophic Calcification

Give two examples

A

Pathological calcification that occurs in dead/dying tissue from any type of necrosis
(atheromas of athersclerosis)

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19
Q

Define Metastatic Calcification

Give two examples

A

Pathological calcification that occurs in normal tissue other disease process causes secondary hypercalcemia
(hyperparathyroidism, multiple myeloma, Vitamin D toxicity, renal failure)

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20
Q

What are 4 processes found in the pathogenesis of inflammation/

A

Circulation
Permeability
WBC response/activation
Mediators

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21
Q

What step of the inflammation pathogenesis process does chemotaxis occur?

A

3- WBC response/activation

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22
Q

What step of the pathogenesis process does WBC adhesion get activated?

A

4- by cytokines (mediators)

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23
Q

Acute/immediate inflammation response brings in what WBC?

A

Neutrophils- granulocytic cells in blood circulation

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24
Q

Chronic inflammation includes what physiological changes and what kind of WBCs?

A

Vascular proliferation and tissue changes/scars

Lymphocytes and macrophages- agranulocytic cells in tissues

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25
What are the cardinal signs of inflammation?
Redness- erythema/rubor Heat- calor Pain- dolor Swelling- tumor
26
What are the 3 major steps of acute inflammation?
Dilation Increased permeability Emigration of leukocytes
27
What is the body's first response to injury? | What causes this reaction?
Dilation- induced mostly by histamine
28
What are 3 types of mediators that would be found during the second step of the acute inflammation process?
Histamine Bradykinin Leukotrienes
29
During what step of the acute inflammation process do WBCs accumulate and become active?
#3- emigration of leukocytes
30
What are the sequence of signs/symptoms of the acute inflammation process?
Warmth Erythema Edema
31
What are the 2 classes of inflammation mediators?
Plasma derived- from liver | Cell derived- cells
32
What are the 3 types of plasma-derived mediators?
Acute-phase proteins Factor 7 (Hageman factor) Complement proteins
33
What are the two types of cell-derived mediators?
Preformed (Mast, Platelets, Neutrophil macrophages) Newly synthesized (leukocytes, leukocyte macrophages, endothelial macrophage lymphocytes)
34
Histamine is what type of mediator? | Where does it come from?
Cell derived | Mast, Basophil, Platelet
35
Leukotrienes and prostaglandins are what type of mediators?
Cell-Derived Arachidonic acid derivatives | Arise from membranes to be metabolized through either LOX or COX pathways
36
What does the Lipoxygenase pathway produce?
Leukotrienes- chemotaxis and permeability | Lipoxins- phagocytosis
37
What does the Cyclooxygenase pathway produce?
Prostaglandin Thromboxane Prostacyclin
38
What are the functions of prostaglandins?
Vasodilation Vascular permeability Pain Fever
39
What are the functions of thromboxane?
Platelet aggregation Thrombosis Vasoconstriction
40
What are the functions of prostacyclin?
Counteracts Prostaglandins and Thromboxane so effects don't become too extreme
41
Why are anti-inflammatory drugs taken?
COX inhibitors | Inhibit prostaglandin and thromboxanes
42
What are the functions of bradykinins?
Same as histamine but at slower pace Amplifly/prolong inflammatory response Begins coagulation Creates pain
43
How are bradykinins formed?
Activation of hageman factor (coagulation factor 7)
44
What 2 things comprise the complement system?
Innate and Adaptive immunity
45
What are the 3 functions of the complement system?
Prolongs inflammation Phagocytosis via opsonization Cell lysis- membrane attack complex
46
Define the Complement System
Cascade of proteins acting through separate pathways to end in Membrane Attack Complex to destroy a cell
47
Define the Complement System Alternate Pathway?
Bacterial/fungal endotoxins/snake venom | Does NOT use Ag-Ab complex
48
What sequence of events starts the Complement's Alternate Pathway?
IgA and properdin activate complement B and D to influence C3
49
Define the Complement Lectin pathway
Starts w/ carbohydrate binding on bacterial surface
50
How are Plymorphonuclear Neutrophils visually identified?
Segmented nucleus and cytoplasm w/ granules | "neutrophilic granulocytes"
51
What are 4 unique characteristics of PMNs?
1st to appear in acute inflammation Phagocytic Granules kill w/ O2 radicals Produces cytokines, promotes fever
52
PMNs make up ? % of circulating WBCs? | Eosinophils make up ? %
60-70% | 2-3%
53
Eosinophils are associated with ? activity?
Interact w/ basophils during Allergic reactions | and Parasitic infections
54
What are 2 unique characteristics about eosinophils?
Slower to sites than PMNs but survive longer (seen w/ chronic inflammation) Have mobility, phagocytic and bactericidal actions similar to PMNs
55
Basophils are predominant in allergic reactions mediated by what?
IgE
56
Basophils are precursors of what cells?
Mast cells
57
What is the other 2 names of macrophages?
Tissue mononuclear cells | Histiocytes
58
Where are macrophages derived from?
Blood monocytes
59
How are macrophages visually identifiable?
One large nucleus
60
What two cells are longer living than PMNs and are seen in chronic infectious states?
Eosinophils | Macrophages
61
Platelets contain granules with what 4 substances?
Histamine Coagulation proteins Cytokines Growth factors
62
Acute inflammatory reactions have what 3 outcomes?
Complete resolution Healing by scar/fibrosis Chronic inflammation
63
Chronic inflammation is characterized by what 3 characteristics?
Mononuclear infiltration Tissue destruction Repair
64
What 4 things can cause chronic inflammation?
Resistant microbes Immune responses Toxic substances Foreign bodies
65
Systemic inflammation is AKA ?
Acute phase reaction
66
What are the 3 acute-phase proteins? | What are they indicative from?
CRP Fibrinogen Serum amyloid Acute-Phase Reaction
67
What are the clinical S/Sx of systemic inflammation?
``` Fever from PMN released pyrogens Leukocytosis Inc HR/BP Decreased sweating Anorexia ```
68
Fever during systemic inflammation triggers what reaction to occur in the brain?
Prostaglandin synthesis in hypothalamus
69
Systemic inflammation that presents with anorexia, somnolence and malaise are secondary to what event?
Cytokine impact on brain cells
70
Define Serous Inflammation
Mildest form of inflammation | Caused by physical agents
71
Define Fibrinous Inflammation
Exudate w/ fibrin and cellular debris | Bacterial infection
72
Define Purulent Inflammation
Yellow fluid of dead PMNs/tissue debris | Bacterial infection
73
What is the difference between fibrinous and purulent inflammation locations?
Purulent can be on mucosa, skin or internal organs | Abscesses
74
Define Ulcerative Inflammation
Surface tissues broken down from underlying inflammation
75
Define Pseudomembranous Inflammation
Combined ulcerative inflammation w/ fibrino-purulent exudate
76
C. Diff is an example of what type of inflammation?
Pseudomembranous
77
Define Granulomatous Inflammation
Chronic inflammation, not acute | Macrophage and fibroblasts create barrier
78
TB, histoplasmosis, sarcoidosis and parasites are what type of inflammation?
Granulomatus
79
What starts the wound healing and tissue repair process that is critical to the survival of an organism?
Inflammatory response
80
What are the two types of wound healing/tissue repair reactions?
Regeneration | Scar formation
81
Define the Regeneration Reaction of wound healing
Proliferation of residual/uninjured cells and tissue replacement by stem cells
82
Define the Scar Formation reaction of wound healing
When injured tissues are incapable of regeneration or severe damage has occurred to supporting structures
83
Scar formation occurs from what type of tissue?
Fibrous connective
84
What does scar tissue have and what does it lack?
Structure stability for integrity | Cannot replace function of lost cells
85
What are the 4 steps of the wound healing process?
Hemostasis Inflammatory Proliferative Remodeling
86
Wound resolution and consequences depend on what?
Type of cells injured
87
Define Labile Cells and their wound healing capabilities
Continuously divide and self-replace | Easily regenerate for wound healing
88
What type of cells are most affected by chemo/radiation therapy?
Labile- skin, GI tract, hematopoietic
89
Give 3 examples of Labile Cells
Skin GI tract Hematopoietic
90
Define Stable Cells and their wound healing capabilities
Rarely self-divide but can be stimulated to replicate
91
Where are Stable Cells found?
Kidney proximal renal tubule | Liver
92
Define Permanent Cells and their wound healing capabilities?
Non dividing cells that lack the capacity to replicate | No new cells form, only fibrous scarring
93
Where are Permanent Cells found within the body?
Neurons | Myocardium
94
What cells are least affected by chemo/radiation therapy?
Neurons Myocardium Permanent cells
95
Define Angioblasts and when do they arrive during the wound healing process?
Precursors to blood vessels | Appear 2-3 days after injury
96
When do Fibroblasts arrive during the wound healing process and what is their function?
Several weeks later | Re-establishes the extracellular matrix by producing fibrinoectin and collagen
97
Myofibroblasts are hybrid properties of what two things?
Smooth muscles | Fibroblasts
98
What are myofibroblasts purpose during the wound healing process?
Contract pulling margins inward | Reduces wound size allowing proliferating epithelium to fill in the injured site
99
What events happen during the Hemostasis phase of wound healing?
Vasoconstriction then dilation Platelet activation Coagulation Fibrin + platelet + RBC=clot
100
What events happen during the Inflammation phase of wound healing?
Vessels leak into wound and cause localized swelling | Controls bleeding and prevents infection
101
What events happen during the Proliferation phase of wound healing?
New tissue from collagen and fibronectin Epithelialization Wound contracts and new vessels are formed
102
During epitheliazation, what layer of the skin differentiates?
Deep basal differentiate into layers
103
What events happen during the Tissue Remodeling phase of wound healing?
Maturation phase Begins 21 days after injury Collagen is remodeled and wound fully closes
104
Define Stricture
Tubular structures are narrowed by the healing process
105
Define First/Primary Intention
Clean, uninfected laceration that is healed by epitherlial regeneration as the principal mechanism
106
During what part of wound healing does tensile strength increase with time?
First/Primary intention
107
Define Secondary Intention
Large/complex wound healing for dirty/ulcerated wounds
108
Secondary intention includes what two processes?
Regeneration | Scarring
109
During what phase of wound healing is a large scar and inflammatory reaction more intense?
Secondary intention due to abundant granulation tissue
110
What type of medication/mineral must be avoided during wound healing?
Glucocorticoids- anti-inlfammatory affect weakens scar
111
What are 3 types of wound healing complications?
Dehiscence- separation of margins due to tension or infection Hypertrophic- thicker than expected Keloid- Taller and wider scar than original wound (more common in dark skin individuals)
112
List 4 parts of Inate Immunity
Mechanical Barriers- skin/cilia Phagocytic cells- neutrophil, macrophage NK Cells- special t-lymphocytes Protective Proteins- lysozyme, properdin
113
Where are Lysozyme and Properdin proteins found and what are their purpose?
Lysozyme- body fluid protective protein | Properdin- alternate complement
114
Acquired immunity is the "learned" immunity and is based off of responses to ?
Ags- any chemical/biological substance that induces a specific immune response
115
Acquired Immunity words towards what end goal?
Immunocompetence- body's ability to mount appropriate immune responses now and for future events
116
Difference between Primary and Secondary Lymphoid tissue?
Primary- B/T lymphocytes production | Secondary- B/T colonized in lymph nodes
117
Tonsils, adenoids and spleens are heavily colonized by which lymphocyte? What colonizes GI/Bronchial mucosa?
B Lymphocytes | MALT
118
70% of circulating lymphocytes are ?
T-cells
119
Function of CD4 cells
Part of Ag response | Help B lymphocytes produce Abs
120
What cell secretes cytokines?
CD4- secrete interleukin
121
What does interluekin cause once it's secreted?
Stims macrophages to become phagocytic | Triggers IgE/immunoglobulins to activate eosinophil and basophils
122
Function of CD8 cells?
Suppress unwanted Ab production | Mediates killing of foreign cells
123
CD4 cells are AKA? | CD8 cells are AKA?
4- Helper-T cells | 8- Suppressor/cytotoxic cells
124
Function of NK cells?
Subset of T-cell that lacks an Ag receptor | Recognizes cells infected by viruses
125
What does the CD in CD4 or CD8 cells stand for?
Cluster Differentiation
126
What cell is essential for Ab production?
B Cells
127
Why are B cells essential for Ab production?
Congegrate in nodes/spleen and activate Ab production gene to form Ag receptors on cell surfaces
128
What is triggered when Ag attaches to B cell surfaces?
Plasma Cells
129
Define Plasma Cell
Fully differentiated decendents of B cells w/ numerous ER
130
Function of Plasma Cells
Mass Ab production and release into circulation
131
Abs are AKA and have what two parts?
Immunoglobulins w/ heavy and light chains
132
What are the Heavy and Light Chains of Abs?
``` Heavy- determines Ab property/function that is specific and unique to each class Light- variable for targeted Ag ```
133
RBCs have _____ and serum has _____
``` RBC= Ag Serum= Ab ```
134
What Ag and Abs does Group A blood have?
``` RBC= A Ag Serum= anti-B Abs ```
135
What Ag and Abs does Group B blood have?
``` RBC= B Ag Serum= anti-A Abs ```
136
What Ag and Abs does Group O blood have?
``` RBC= No Ags Serum= anti-A and anti-B Abs ```
137
What Ag and Abs does Group AB blood have?
``` RBC= both A and B Ags Serum= No Abs ```
138
What blood type if the universal RBC donor? | What blood type is the universal RBC recipient?
O- donor | AB- recipient
139
What is the Rh factor?
D antigen on surface of RBCs
140
How/when are Anti-D antibodies formed since they're not naturally occurring?
Rh neg PT exposed to Rh pos | Female birthing Rh pos baby or transfusion of Rh pos blood
141
What happens to Rh factors of a mother during pregnancy?
Rh neg exposed to Rh pos forms IgG Abs that can cross placenta 1st Rh pos baby- not harmed due to lack of Rh Abs in mother 2nd Rh pos baby will be killbed by Anti-D Abs
142
What is the purpose/use of RhoGam?
Given to mother w/ing 12hrs of deliver to destroy fetal Rh pos RBC and prevents her from forming Anti-D Abs
143
Define Cross-Match blood transfusion
Type and Cross Donor serum mixed w/ recipient RBCs Recipient serum mixed with donor RBCs
144
Define Type and Screen blood transfusion
PT blood is typed but not cross-matched
145
What type of blood transfusion locks in donor blood for a specific recipient/PT?
Cross-Match/ Type and Cross
146
What type of blood transfusion identifies a "soft reserve" and allows for greater blood bank flexibility?
Type and Screen
147
During a Emergency Release blood trasnfusion what type of blood is pushed out?
Type O RBCs
148
What are the 3 types of blood transfusions?
Cross-Match Type and Screen Emergency Release
149
What type of transfusion reaction has the highest risk?
Whole blood
150
What is a "minor" transfusion reaction?
Reaction to preservative | Urticaria, fever, bronchospasms
151
Minor transfusion reactions can be reduced by using ?
Leukocyte-poor RBCs
152
What is a "major" transfusion reaction?
ABO mismatch | Fever/chills, back pain, dyspnea, renal failure
153
What steps are take and what things are given to a PT after a "major" transfusion reaction?
Stop transfusion IV fluids IV BiCarb Donor and PT blood to lab
154
Define Hypersensitivity reaction
Abnormal immune response to exogenous Ag or endogenous auto-antigens
155
What are the 4 classifications of hypersensitivity reactions?
1- anaphylactic/atopic 2- cytotoxic Ab-mediated 3- immune complex 4- cell mediated/delayed type
156
Type I hypersensitivity reaction is what type of response?
IgE mediated response | Allergin sensitized B cells->Plasma Cells->IgE
157
Which hypersensitivity reaction requires a prior exposure for the reaction to take place?
Type I
158
What happens during a Type I hypersensitivity reaction if PT is re-exposed?
Ag-Ab complex form on Basophils or Mast Cells | Histamine released and increases permeability->edema->emigration of inflammatory cells
159
What are the inflammatory cells involved in a Type I hypersensitivity?
Eosinophils
160
Give four clinical examples of Type I hypersensitivities?
Anaphylaxis Asthma Atopic dermatitis Allergic Rhinitis
161
What events occur during a Type II hypersensitivity
IgG or IgM mediated Ag-Ab complex | Ab bind to Ag in basement membrane and activates complement system->MAC->Cytotoxicity
162
During what type of hypersensitivity do Abs target a specific tissue or cell of the body?
Type 2
163
What are the intrinsic or extrinsic causes of a Type 2 hypersensitivity?
Intrinsic- autoimmune | Extrinsic- Drug, Virus, Chemical are seen a foreign and mimics an autoimmune response
164
What are 5 clinical examples of Type 2 Hypersensitivities
``` Transfusion Reaction Graves Disease Goodpasture's Syndrome Myasthenia Gravis Hemolytic Anemia ```
165
Define and explain Graves Disease
Hyperthyroidism AKA thyrotoxicosis | Auto-Abs bind to TSH receptor and stims over production of thyroid hormone
166
Define and explain Goodpasture's Syndrome
Auto-Ab attacks collagen in lungs and kidneys | Causes damage to renal glomeruli (blood and protein) and SOB/bloody cough
167
Define and explain Myasthenia Gravis
Auto-Abs attach to Ach receptors on striated muscle cells blocking Ach stimulation leading to severe muscle weakness
168
Define and explain hemolytic anemia
Auto-Abs against RBC Ags Results in clumping/destruction of RBCs w/ the fragments collecting in spleen (splenomegaly), hemolyzed RBCs cause bilirubin and jaundice
169
What is the less common hypersensitivity reaction?
Type 3
170
Define and explain Type 3 hHypersensitivy?
Ag-Ab complex mediation that incorrectly deposit on structure and become trapped on semi-permeable membranes where they accidentally activate complement systems to recruit WBCs leading to cell damage
171
What are 3 clinical examples of Type 3 hypersensitivity?
Systemic Lupus Erythematosus Post Strep Glomerulonephritis Polyarteritis nodos
172
What mediates Type 4 Hypersensitivity?
Previously sensitives T Cells or macrophages | NO Ab involvement
173
Define and explain Type 4 hypersensitivity?
No Ab involvement Macrophages take up Ag and presents to T cells causing cytokine release transforming macrophages to epithelioid cells and formation of granulomas
174
What are 2 clinical examples of Type 4 Hypersensitivity?
Contact dermatitis | Granulomatus reactino from TB, Fungi or sarcoidosis
175
What does contact dermatitis result in?
Wheal formation | Vesicles
176
What type of hypersensitivity is a TB test?
Delayed type
177
Autoimmune diseases can be diagnosed when what 3 situations exist?
Auto-Abs documented Immune mechanism causes pathologic lesion Disorder has an immune origin
178
What are the two forms of autoimmune diseases?
Systemic- multi-organ | Specific- limited to one organ
179
What are examples of systemic autoimmune diseases?
``` Lupus Erythematosus Rheumatic fever RA Systemic sclerosis Polyarteritis nodosa ```
180
What are examples of organ-specific diseases?
``` Brain- MS Thyroid- Hashimotos Blood- AI hemolytic anemia Kidney- glomerulonephritis Muscle- myastenia gravis Skin- pemphigus vulgaris ```
181
What are some characteristics of Systemic Lupus Erythematosus?
Common in women Type 3 hypersensitivity Triggers synthesis of more self cells Anti-Nuclear Abs to nuclear proteins
182
What are the criteria for diagnosing Systemic Lupus Erythmatosus?
``` Arthritis Renal disorder Dermatitis Serositis Neurologic disorder Vasculitis Hematologic disorder ```
183
What are skin S/Sx of Systemic Lupus Erythmatosus?
Malar rash (butterfly rash that spares nasolabial folds) Discoid rash Oral/pharyngeal ulcer Photosensitivity
184
Define Immunodeficiency/Immune Compromise
Inadequate immune response causing reduces resistance to infections
185
What is lymphopenia a disease example of?
Immunodeficiency
186
What are the two types of immunodeficiency diseases?
Primary- congenital: T/B cell differentiation affected | Acquired- more common: immunosuppression, marrow dysfunction, diabetes, AIDS
187
What kind of virus is HIV?
Retrovirus- replicating by reverse transcriptase in T Cells
188
What is the CD4:CD8 ratio in HIV?
``` 4:8= 2:1 AIDS= .5:1 ```
189
Crisis phase symptoms of HIV occur when CD4 counts drop below?
Less than 200
190
What are the opportunistic infections seen in AIDs?
``` Cytomegalovirus Candida Crytpococcus TB Herpes simplex ```
191
What kind of tumors are seen in AIDS PTs?
Kaposi sarcoma | Lymphoma
192
Define Neoplasia
New Growth
193
How are tumors named?
-oma suffix
194
What kind of origin does carcinoma and sarcoma have?
Carcinoma- epithelial | Sarcoma- mesenchymal
195
What are the 3 exceptions to tumor name appearing benign but is not?
Melanoma Lymphoma Leukemia
196
What are the benign types of epithelial tumors?
Pailloma | Adenoma
197
What is the malignant type of epithelial tumor?
Carcinoma
198
What are the benign and malignant mesenchymal tumors?
Benign: oma suffix Malignant: - sarcoma suffix
199
What is the hallmark S/Sx of anaplasia?
Anaplasia- lack of differentiation
200
Due to slow growth, benign tumors retain what characteristic?
Encapsulated- makes tumor mobile, discrete and palpable
201
Due to rapid growth, malignant tumors generally possess what 2 characteristics?
Poorly demarcated from surrounding normal tissue | Locally invasive allowing for metastases
202
What is the most reliable feature that separates malignant from benign tumors?
Locally invasive
203
What characteristic marks a tumor as malignant?
Metastasis
204
Metastasis risk increases with what 4 things?
Non-differentiated Aggressive local invasion Rapid growth Large size
205
What are the three pathways that tumor metastasis spread?
Hematogenous spread Lymphatic spread Seeding of body cavities/surfaces
206
What 2 organs and what part of the organ are most frequently involved in hematogenous spreading?
Liver Lungs Veins penetrated easier
207
Define sentinel lymph node
First node to receive lymphatic drainage from primary tumor site
208
What procedure is often used to detect metastatic cells?
Biopsy of sentinel nodes
209
Where is malignancy seeding often seen?
Peritoneal cavity
210
What is the criteria used to determine the extent a tumor has spread?
Staging- based on clinical exam, radiology, biopsy and surgery offers more prognostic value than grading
211
What procedure/method is better for predicting a PTs outcome
Staging
212
What is the most common method of staging?
TNM System T- Tumor size T1T2T3T4 N- number of lymph nodes w/ cancer NXN0N1 M- metastasis MOM1
213
How is cancer grading conducted?
Histologic exam of tumor
214
What method/procedure is used for treatment planning of certain cancers?
Grading
215
Cancer grading reflects the degree of _______
Differentiation | Less differentiation= aggressive
216
What is the Cancer Grading system?
``` X- unknown I- well differentiated, low grade II- Moderate diff, intermediate III- poor diff, high grade IV- undifferentiated, high grad ```
217
What are examples of chemical carcinogens?
``` Asbestos Nitrosamines Naphthylamine dyes Arsenic Aflatoxin ```
218
What are examples of carcinogen microbes?
H. Pylori | S. Haematobium
219
What are examples of viral carcinogens?
Oncovirus HPV Epstein-Barr Virus Hep B
220
UV light radiation causes what three types of cancer?
SCC BCC Melanoma
221
What types of ionizing radiation are carcinogens?
A, B, G
222
What is the link between skin damage from radiation and treatment?
Tissues easily damaged by radiation can be readily treated by radiation therapy
223
What type of cells are most sensitive by ionizing radiation?
``` Stem Cells Hematopoietic Reproductive Epidermis- skin/intestine 1st trimester fetus ```
224
What tissues are least sensitive to ionizing radiation?
Nerve cells Bone Muscle
225
Define proto-oncogenes?
Normal cellular genes that regulate cell growth and differentiation
226
Define Oncogenes?
Mutated/damaged proto-oncogene leading to uncontrolled cell growth
227
Proto-oncogenes can be changed into oncogenes by what 4 mechanisms?
Point Mutation Gene Amplification- more copies=inc malignancy Translocation- causes over-expression of adjacent gene Insertion of viral genome
228
Define Tumor Suppressor Gene
Anti-oncogene w/in normal cells due to protective action against oncogene activation
229
Name 3 examples of genetic causes of cancer?
Familial adenomatous polyposis coli Neurofibromatosis Type 1 Wilms' tumor (nephroblastoma)
230
What are Cafe Au Lait spots associated with?
Neurofibromatosis Type 1
231
Where can tumor markers be isolated from?
Blood Urine Stool Cancerous tissue
232
What are malignant cell tumor markers?
Retention of functions essential for survival | Regression to fetal/embryonic functions
233
Tumor markers may be used for what 4 things?
Diagnosis Predict response Assess treatment response Monitoring
234
Tumor marker do not generally recommended for routine screening with what exception?
Prostate Specific Antigen
235
What is Alpha-fetoprotein tumor marker used for detecting?
Liver Testicles Ovaries
236
What is CA-125 tumor marker used for detecting?
Ovarian Lung Breast
237
What is Carcinoembryonic Antigen tumor marker used for detecting?
Colon Lung Breast Ovary
238
What is Human Chorionic Gonadotropin tumor marker used for detecting?
Testicular | Breast
239
Most cancer occur during _____ of life and are caused by _____?
Mid-later | Environmental causes
240
What are the dominant risk factors for most cancers?
Environmental influences
241
What are the top two environmental factors of cancer epidemiology?
Smoking | Alcohol
242
What does the CAUTION acronym mean for cancer?
``` Change in bowel/bladder A sore that doesn't heal Unusual bleeding/discharge Thickening lump on breast Indigestion Obvious wart/mole change Nagging cough/hoarseness ```
243
Define Cachexia
Common Sx in cancer PTs Wasting away of body fat/muscle Weak, anorexia, anemia
244
Define Paraneoplastic Syndrome
Earliest sign of occult neoplasm Hypercalcemia Hypercoagulability
245
What is the most common S/Sx in Paraneoplastic Syndrome?
Hypercalcemia
246
Define Hereditary Disorder Define Familial Disorder Define Congenital disorder
``` H= derived from parents F= through generations C= present at birth but are NOT genetic ```
247
__% of pediatric pediatric inpatients have a genetic disorder?
20%
248
Define Morphogenesis
Evolution/development of organ/body part
249
What happens with errors of morphogenesis?
Incompatible w/ life | Spontaneous abortion during 1st trimester
250
Define Agenesis
Absence of organ | Organ contain primordial tissue
251
Define Aplasia
Entire organ mass is comprised of primordial tissue
252
Define Atresia
Absence/closure of a body opening
253
Define Hypoplasia
Underdevelopment of tissue/organ/body
254
Define Involution Failure
Persistence of embryonic structures long into development
255
What types of morphogenesis errors usually result in non-viable births?
Agenesis | Aplasia
256
__% of congenital defects are idiopathic
75%
257
Define Teratogens
Agents known to cause fetal malformations
258
What are the 3 types of teratogens
Physical- radiation Chemical- ETOH (most preventable teratogen) Microbial- TORCH
259
Define TORCH syndrome
``` Toxoplasmosis Other Rubella- german measles Cytomegalovirus Herpes ```
260
Define Genome
Complete set of chromosomes
261
Define Keryotype | What can it be AKA?
Full chormosome set contained w/in a nucleus | AKA- chromosomal count/code
262
Define Genotype
Genetic form | Set of instructions that may/not be expressed
263
Define Phenotype
Physical form | Unique appearance that can be effected by environment
264
What two parts make up the observed phenotype?
Expressed genotype | Environmental influence
265
What are the 3 types of chromosome structural abnormalities?
Deletion Inversion/breakage Translocation
266
Define Numerical Abnormality
Loss/gain of chromosome
267
Define Aneuploid
Cells possessing abnormal numbers of chromosomes
268
Define Euploid
Normal number of chromosomes
269
Define 47XXY | Define 45XO
``` Klinefelters syndrome (male) Turners syndrome (female) ```
270
What are the odds of females delivering a baby w/ Downs?
Over 45y/o= 1:25
271
Prenatal counseling is required for women older than __y/o
35
272
What are the clinical characteristics of Down's Sydrome?
``` Retardation Epicanthal folds Macroglossia Simian Crease Internal organ defects Hematologic disorders ```
273
What is the incidence reate of Klinefelters Syndrome?
1:700 Little/no sperm production Rarely passed/inherited
274
What are the clinical characteristics of Klinefelters?
2* characteristics not fully developed at puberty Body habitus Learning disability
275
What are the incidence rates of Turner's Syndrome?
1:3000 | Ovaries don't mature or atrophy
276
What are the clinical characteristics of Turner's Syndrome?
2* characteristics not developed at puberty Body habitus Heart defects
277
What are the 3 main patterns of single gene disorders?
Autosomal dominant Autosomal recessive Sex-linked
278
Define Autosomal Dominant
Homozygous AA or heterozygous Aa Dominant traits expressed A will over ride a in heterzygous pairing
279
Define Autosomal Recessive
Homozygous aa | Recessive trait might be expressed in phenotype
280
Define Sex-Linked Disorder
Primarily recessive disorders w/ X-linked chromosomes | X and Y are not direct alleles of each other
281
What are examples of autosomal dominant disorders?
``` Marfans Familial hyperchoesterolemia Polycystic kidney disease Huntingtons Osteogenesis imperfecta ```
282
What is the incidence rate and characteristics of Marfan's Sydrome?
1:5000 | CT issue of fibrillin
283
Why is the lack of fibrillin in Marfan's Syndrome important? What happens without it?
Glue for CT structure | Heart failure/Aortic rupture
284
What are the clinical characteristics of Marfan's Syndrome?
Tall/slender habitus w/ elongated head Elongated fingers, loose joints Aortic aneurysms Cataracts/lens detachments
285
What is the most important and frequently encountered autosomal disorder in the US?
Familial Hypercholesterolemia | Mutated gene the encodes LDL
286
What are the clinical characteristics of Familial Hypercholesterolemia?
Atherosclerosis/heart disease Xanthomas- lipid rich nodules Eyelid deposits
287
What are the characteristics of Polycystic Kidney Disease?
Abnormal flank pain PAINLESS hematuria UTI Hypertension
288
When do Huntington's Disease symptoms start? | What is the life expectancy after diagnosis?
30-40 | 10-15yrs after due to pneumonia, fall, suicide
289
What is the pathogenesis of Huntington's Disease?
Progressive neurological disorder of involuntary movements leading to premature brain death and atrophy
290
What are the clinical characteristics of Huntington's Disease?
Chloreiform movements- gyrating movement of trunk and limb | Grimacing face
291
What is Osteogenesis Imperfects AKA and what is the cause of the disease?
Brittle Bone Disease | Defected Type I Collagen
292
What are the clinical characteristics of Osteogenesis Imperfecta
Multiple, easy Fx Can be confused w/ abuse Blue sclera
293
What is the largest group/variety of genetic disorders?
Autosomal recessive
294
Why are autosomal recessive disorders so large/common?
Encoded by genes on on eo f 22 autosomes and NOT the 23rd sex-linked gene
295
What are the basic features of autosomal recessive disorders?
Only in homozygous w/ both recessive genes present and usually w/ unaffected heterozygous parents
296
What are the common Autosomal Recessive Disorders?
``` CF SCA Phenylketonuria Wilson's Disease Hemochromatosis ```
297
What PT population is CF most common in?
Caucasian/Norther European
298
What autosomal recessive disorder is the most lethal?
CF
299
What is the pathogenesis for CF?
Abnormally thick mucus blocks airway and pancreatic ducts
300
What are the clinical characteristics of CF?
Pulmonary infections | Pancreatic insufficiency
301
How is CF diagnosed?
Pilocarpine test- sweat test for excess NaCl in sweat
302
What is the pathogenesis of SCA?
Hgb defect causes sickling when O2 is low
303
Define a Sickle Cell Crisis?
Fever Respiratory disease Hemolysis of RBCs causing anemia and jaundice
304
Define Splenic Sequestrian Crisis?
Spleen over removes sickling RBCs causing acute anemia and spleen damage
305
PKU is the lack of what enzyme?
Phenyalanine hydroxylase- metabolizes phenylalanine into tyrosine
306
What are the clinical characteristics of PKU?
Excess phylalanine causes melanin synthesis inhibition, PT have fair skin/hair and blue eyes Continued build up leads to retardation and seizure
307
What kind of diet do PKU PTs have to follow?
Avoid- meat, fish, nuts, legumes, dairy products and aspartame
308
What are the X-linked recessive diseases?
``` Hemophilia Duchenne Muscular Dyst. Fragile X Syndrome Color blindness G6PD Deficiency ```
309
How are X-linked recessive diseases passed along?
Mother->son | Only fertile male-> daughters
310
What form of hemophilia is more rare?
B- 1:30K
311
What is the pathogenesis for Hemophilia?
Coagulation factor 8 (A) or 9 (B)
312
What are the clinical characteristics of hemophilia?
B s/sx always severe | Easy nose/oral bleeding
313
How is hemophilia treated?
Infusion of man-made recombinant clotting factors
314
Who does Duchenne Musc. Dystrophy effect?
1:3300 males
315
What is the pathogenesis of Duchenne Muscular dystorphy?
Defected dystophin protein which normally interacts w/ contractile proteins to maintain shape
316
What are the clinical characteristics of Duchenne Muscular Dystrophy
Affects skeletal muscle | Progressive muscle weakness/wasting
317
What is the difference between male and females inheritting Fragile X Disease?
Males= mental deficiency
318
What is the pathogenesis of Fragile X Syndrome?
Amplification of fragile portion of X-chromosome
319
What are the clinical characteristics of Fragile X Syndrome?
Mental retardation | Macro-orchidism in 90% of prepubertal males
320
Define Multifactorial Inheritance
Familial disorders don't follow Mendelian genetic rules
321
What are the traits/disease features of multifactorial inheritance?
Product of several genes Ex/endogenous influences Genes encoding error exhibit dose effect Sibling risk determined from familial data
322
What are examples of multifactorial inheritance?
Dwarfism Hypertenstion Diabetes Gout
323
What are increased/decreased levels of Alpha-Fetoprotein indicative of?
``` Inc= brain/kidney abnormalities Dec= Down's ```
324
What is Chorionic Villus Biopsy used for?
Tissue sample of placenta for chromosomal and enzyme analysis
325
When is an amniocentesis performed?
12 - 18wks for chemical/chromosomal analysis
326
Extracellular fluid is a combination of what two liquids and what majority ions?
Interstitial and plasma | High Na, Low K
327
Intracellular fluid is made up of what ions?
Low Na, High K
328
How much liquid is required per day to clear byproducts of metabolism?
500-800ml/day
329
Define Edema
Excess fluid collection in interstitial spaces and body cavities
330
Interstitial space is AKA ?
Third space
331
Edema results form an imbalance between what things?
Permeability Oncotic pressure Venous pressure- obstruction or overload Lymphatic obstruction- or inadequate drainage
332
High permeability causes leakage to where?
Interstitial space
333
What helps maintain oncotic pressure?
Albumin holds fluid inside of blood vessels
334
What happens to bodily fluids if there is an increase in hydrostatic pressure?
Pushes fluid outside of vessels
335
Define Localized Edema
Excess fluid in tissue, organs or body cavities
336
What is the difference in naming tissue/organ edma and body cavity edema?
``` Tissue/organ= location + edema Body= hydro + location ```
337
Define Generalized Edema
Excess fluid accumulation through out the body
338
Generalized edema is generally due to one of three things
Heart, liver, kidney failure
339
Generalized edema is AKA ?
Anasarca
340
Define Pleural Effusion
Hydrothorax | Fluid in chest
341
What is the difference between pleural effusion and pulmonary edema?
Pulmonary edema is inside of lung tissue | Pleural effusion is in thoracic cavity/pleural space outside of lung tissue
342
What are the specific gravities of transudates and exudates?
Trans- low, clear | Ex- high, pus
343
Transudate can arise from what three things?
Increased hydrostatic pressure- DVT Decreased oncotic pressure- hypoalbuminemia Decreased lymph drainage- lymph obstruction
344
Exudates tend to arise from what process?
Increased permeability, usually from inflammatory process
345
Pitting edema is usually caused by one of three things?
Hypoalbuminemia- nephrotic syndrome, malnutrition CHF Fluid overload- renal disease
346
How does CHF lead to pitting edema/pulmonary edema?
Insufficient blood from heart Hyp-perfused kidneys Renin->aldosterone Inc Na/water retention from tubules Inc intravascular press increases hydrostatic press in lungs Fluid pushed from pulmonary capillaries to lung tissue
347
Define Hemothorax
Blood between lung and chest wall
348
Define Hemopericardium
Blood in pericardial sac
349
Define Hematoma
Blood collection in tissue
350
Define Hemoptysis
Coughing up blood
351
Define Hemodynamically Stable
Maintaining adequate blood flow to vital organs
352
Whats the difference between hematochezia and melena?
Melena- dark blood | Hematochezia- bright red blood in stool
353
What are 3 superficial skin signs of bleeding?
Petechiae Purpura- nonblanching bruises Ecchymosis
354
Thrombi are made up of what three things?
Platelet Fibrin RBCs
355
Why are thrombi created?
Prevent extravascular blood loss
356
In normal homeostasis, what balances clotting factors and platelets?
Endothelial cells | Plasmin
357
Define Virchows Triad
Injury to endothelium Hemodynamic change Hypercoagulate state
358
Where do DVTs usually form?
Leg Pelvis Axillary vein Mesenteric vein
359
What are risk factors for developing DVTs?
``` Inactivity Smokers Pregnancy Oral contraceptives Cancer DVT history Aging ```
360
What are 4 forms of embolus
Thromboemboli- most common Liquid Gas Solid particle- marrow/fat
361
What is the most significant result of venous emboli?
PE
362
Most PEs develop from what/where?
DVTs in leg or pelvis
363
What are the S/Sx os large emboli?
Sudden chest pain Sudden SOB Hemopytsis
364
Where do arterial emboli usually originate?
Heart | Large arteries
365
Aortic aneurysms release clots to what 3 locations?
Intestine Kidney Leg
366
What happens if an embolus stops in the brain or intestined?
Brain- ischemic stroke/infarct | Intestine- bowel ischemia/infarct
367
What happens if an embolus stops in a kidney?
Infarct w/ hematuria
368
What happens if an embolus stops in a lower extremity?
Small emboli- blue toe necrosis | Large- ischemia, cold pulseless leg
369
What is the first symptom of ischemia?
Pain
370
Define White Infarct
Arterial inflow obstruction causing paleness | Necrosis occurs downstream of blockage
371
Where are White Infarcts usually found?
Solid organs
372
Define Red Infarct
Venous outflow obstruction causing necrosis upstream of blockage
373
Where do Red Infarcts normally occur?
Intestine | Testes
374
Define Shock
Decreased tissue perfusion by blood
375
What are the 3 mechanisms of shock?
Pump failure- cardiogenic Fluid Loss- hypovolemic Loss of tone- Hypotonic/distributive shock
376
What are the 3 types of Distributive Shock?
Neurogenic Anaphylactic Septic
377
What are 4 causes of cardiogenic shock?
MI C-fib Pericardial tamponade Tension pneumo
378
What is Beck's Triad
Hypotension Muffled heart sounds JVD
379
What are symptoms of a pneumothorax?
Inc respiration/air hunger Dec breath sound on affected side JVD Tracheal deviation (late)
380
What are 3 causes of JVD?
Heart Failure Cardiac tamponade Tension Pneumo
381
What are 2 causes of hypovolemic shock?
Hemorrhage | Water loss
382
What are the symptoms of hypvolemic shock?
``` Tachycardia Tachypnea Cold and clammy Increased thirst Light headedness Hypotension Confusion/Altered ```
383
What does a decrease in body fluids do to Hct levels?
Hemotoconcentration | Hemodilution if fluids added
384
Neurogenic shock is due to loss of what part of the NS?
Sympathetic
385
What are the 3 stages of shock?
Early/compensated Decompensated Irreversible
386
What are the S/Sx of early/compensated stages of shock?
Tachcardia Vasoconstriction Reduced urine output Normal BP
387
What are the S/Sx of decompensated stage of shock?
``` Compensation begins to fail Hypotension Tachy and SOB Oliguria Acidosis ```
388
What are the S/Sx of irreversible stage of shock?
Circulatory collapse
389
What kind of response is a vasovagal syncope?
Neurocardogenic response | Mild form of neurogenic/cardiogenic shock
390
What causes a vasovagal syncope?
``` Tigger stimuli Enhanced PNS vagal tone, bradycardia Dec sympathetic tone, dilation Brain is under perfused and faints ```
391
What are the clinical characteristics of a vasovagal syncope?
Prodrome- light head, N/V, tunnel vision, pale Brief LOC Supine-restoration Immediate regain of consciousness w/out amnesia or post-ictal symptoms
392
What are the two progenitor cells that give rise to blood cell lines?
Myeloid cells | Lymphoid cells
393
Define Myeloid Cells
Granyles w/ complex nucleus Neutrophils Eosinophils Basophils
394
Define Lymphoid Cells
Lack granules w/ large, dense nucleus T/B-Cells NKCs
395
Why do RBCs have a biconcave shape?
Increased SA for O2/CO2
396
What is the structural make up of Hgb?
4 heme groups 4 globins Arranged in 4 pyrrole rings w/ central Fe molecule
397
How are the 4 globin chains of Hgb designated?
A B G D
398
Normally adult heme is Hgb __
A | 2A, 2B
399
What are the 4 RBC indices?
MCV- avg volume/size per RBC MCH- avg Hgb per RBC MCHC- avg Hgb concentration per RBC RDW- variation of RBC volume
400
What measurement is not a part of RBC indices?
Reticulocyte Count (Retic)- number of immature RBCs in sample
401
What is the Reticulocyte Count a measurement of?
Reflection of bone marrow production of new RBCs | Distinguishes between inadequate production vs anemic RBC destruction
402
How to tell between marrow or anemic cause for Reticulocyte Counts?
Marrow responds to anemic state by increasing production (inc Retic count), anemia is not from inadequate production
403
What are the two anemia classifications?
Etiological/pathogenesis- decreased/abnormal production, inc loss/destruction of RBCs Morphological- looks or content
404
What are the clinical features of anemia?
Dec O2 causes hypoxic symptoms Palesness SOB Drowsiness
405
What are anemia levels for M/W?
M- less than 13g | F- less than 11.5g
406
Define Decreased Hematopoiesis
Bone marrow failure- aplastic anemia/myelophthisic anemia | Nutrient Deficiency- Fe, B12, protein
407
Define Aplastic Anemia
Loss of stem cells from bone marrow causing pancytopenia
408
Define Myelophthisic Anemia
Replacement of bone marrow by cancers/fibrosis/granulomas | Leukemia, multiple myeloma
409
What are the two causes of Aplastic Anemia?
Idiopathic | Secondary- marrow suppressed by drugs/virus
410
What is the pathogenesis of Aplastic Anemia?
Marrow becomes hypocellular | Stem cells replaced by fat
411
What are the clinical features of Aplastic Anemia?
Uncontrolled infections/bleeding | Insidious fatigue/pallor/weakness
412
What is the treatment for Aplastic Anemia?
Bone marrow transplant
413
Most PTs that die from Aplastic Anemia die from what?
Sepsis
414
What is the most common form of anemia?
Fe defficiency
415
What is the etiology of Iron Deficiency Anemia
Inc Fe loss Inadequate Fe uptake Increased Fe requirements
416
What is the pathology of Iron Deficiency Anemia?
Microctyic/hypchromic | Target cells- abnormal heme distribution
417
What are the clinical features of Iron Deficiency Anemia
More common in females | Males- secondary to occult bleeding (GI ulcer, cancer)
418
How is Iron Deficient Anemia treated?
Fe supplements but with investigation to underlying cause
419
Define Megaloblastic Anemia
B12/Folic acid deficiency
420
What is the pathology for Megaloblastic Anemia?
Large/hyperchromic RBCs | Hypersegmentation of WBCs
421
Lack of B12 leads to what specific anemia and caused by what?
Pernicious Anemia Bowel disease Stomach surgery
422
What causes folic acid anemia?
Pregnancy Lactation ETOH abuse
423
What are the clinical features of megaloblastic anemia?
Fatigue Palor SOB Weak
424
Pernicious anemia has what unique clinical features?
``` Dec vibratory sense Dec reflexes (permanent) ```
425
How is megaloblastic anemia treated?
B12 shots | Folate supplements
426
What is usually the cause of abnormal hepatopoiesis? | What are 3 examples?
Genetics Sickle Cell Thalassemia Hereditary Spherocytosis
427
What causes Thalassemia?
Defect in Hgb A, A or B chain
428
What causes Hereditary Spherocytosis?
RBC structural protein error
429
What causes Sickle Cell?
Defect during AbA Synthesis causing HbS production
430
What kind of genetic disorder is Sickle Cell?
Autosomal Recessive
431
People with HbS below __ % are asymptomatic
40%
432
What is the pathology of Sickle Cell?
Multiple Organ infarcts
433
What are the clinical features of Sickle Cell?
Fetal HgF -> adult HbA Abnormal cell lysis->jaundice Splenic sequestration crisis
434
Sickle Cells affects what part of the Hgb chain?
Beta
435
Sickle Cell affects ? population? | Thalassemia affects ? population?
African/Mid-Eastern | Mediterranean/SE Asia
436
Define Alpha Thalassemia and Beta Thalassemia
A- A chain defect, less severe | B- B chain defect, severe/lethal
437
What is the pathology of thalassemia?
RBCs are microcytic and hypochromic with target cells | Hbg electrophoresis IDs subtype HbA2
438
Thalassemia pathology is similar to what other blood disorder?
Iron deficiency
439
Define Hereditary Spherocytosis
Structural protein defect of RBC cytoskeleton | Causes dec in RBC flexibility, leading to RBCs lyses and capture in spleen
440
What is the pathology of Hereditary Spherocytosis?
RBCs are small spherical, not biconcave | Microcytic and hyperchromic (normal Hgb on smaller RBC)
441
What are the clinical characteristics of Hereditary Spherocytosis
Hemolytic/aplastic crisis if RBC destruction exceeds production
442
What is the treatment method for Hereditary Spherocytosis?
Splenectomy
443
Destruction of RBCs usually occur from ?
Hemolytic anemia
444
What are some common causes of destruction of RBC leading to hemolytic anemia?
``` Malaria Autoimmune hemolytic anemia Mismatched transfusion Hemolytic disease in newborn Drugs: anti-malarial, sulfa trigger lysing event in PTs w/ G6PD ```
445
Define Lymphadenopathy | What is a red flag here?
Enlarged lymph node w/out not specific cause | Slowly enlarging, persistent and non-tender- early cancer
446
Define Lymphadenitis
Infected lymph node | Enlarged and tender w/ possible abscess
447
Define Lymphangitis | What are some S/Sx that would be seen
Infection of lymph vessels Red streaking- blood poisoning Fever, chills, leukocytosis
448
What are the two forms of plycythemia?
Primary- vera, myeloproliferative disorder considered neoplastic. Hematopoietic stem cell proliferation w/out external stimuli Secondary- over production of RBCs w/ increase stimulation by increased erythropoietin
449
Secondary polycythemia is usually caused by what event?
Prolonged hypoxia
450
What are the clinical features of polycythemia?
Splenomegaly Red/flushed skin Hyperviscous blood w/ easy clotting Headache, hypertension
451
What is the treatment for polycythemia?
``` Cytotoxic drugs Therapeutic phlebotomy (blood letting) ```
452
What are some causes of leukopenia? | What are these PTs at risk for?
Cytotoxins- chem/rad PTs | Overwhelming infections
453
Define Leukocytosis
Normal response to inflammation/infection
454
Prolonged leukocytosis may represent what other disease?
Malignancy
455
Neutrophilia is indicative of ? Eosinophilia is indicative of ? Lymphocytosis is indicative of ?
Bacterial Allergy, parasitic Viral, chronic TB
456
What are 3 malignant disease of WBCs?
Leukemia Lymphoma Multiple Myeloma
457
What are the 4 types of leukemia
ALL/CLL | AML/CML
458
What are the two types of lymphomas?
Non-Hodgkins | Hodgkins
459
What is the most common form of leukemia in children, especially under the age of five?
Acute lymphoblastic leukemia
460
What is the pathogenesis of Acute Lymphoblastic Leukemia
Bone marrow w/ immature blast (lymphoid) cells | Malignant lymphoid cells in peripheral blood
461
What are the clinical features of Acute Lymphoblastic Leukemia?
Enlarged lymph nodes Splenomegaly Rapid- recurrent infections, malaise, bleeding into skin
462
How is Acute Lymphoblastic Leukemia treated?
Chemo | W/out chemo= fatal in 3-6mon
463
What PT population is Acute Myelogenous Leukemia common in?
Most common acute leukemia in +65y/o
464
Acute Myelogenous Leukemia is linked to what environmental factors?
Radiation | Benzene
465
What is the pathogenesis of Acute Myelogenous Leukemia?
Proliferation of myeloblasts | Blast cells take over marrow and smother normal stem cells
466
What are the clinical features of Acute Myelogenous Leukemia?
Enlarged spleen/nodes
467
What is the treatment for Acute Myelogenous Leukemia
Chemo/radiation/BMT | High recurrence rate
468
Chronic Meylogenous Leukemia usually infects what PTs?
Adults over 30y/o
469
What is the pathogenesis of Chronic Myelogenous Leukemia?
Bone marrow over run by malignant cells
470
Chronic Myelogenous Leukemia PTs usually have what genetic abnormality?
Philadelphia chromosome abnormality on #22
471
What are the clinical features for Chronic Myelogenous Leukemia?
Slow onset fatigue, infections, splenomegaly
472
What are the 3 phases of progression of Chronic Myelogenous Leukemia
Chronic- 2/3yrs w/ leuko/thrombocytosis Accelerated- inc blast production in marrow Blast Crisis- death
473
What is the treatment method for Chronic Myelogenous Leukemia?
Radiation w/ chemo
474
What is the PT population for Chronic Lymphocytic Leukemia
Older adults above 50y/o
475
Why is Chronic Lymphocytic Leukemia hard to diagnose?
Lymphocytes are indistinguishable from normal lymphocytes
476
What are the clinical features of Chronic Lymphocytic Leukemia
Slow progression of increase infections
477
What is the treatment method for Chronic Lymphocytic Leukemia?
No chemo
478
What is the pathogenesis of lymphoma?
B-cell phenotypes
479
What are the clinical features of lymphoma?
Painless lymph nodule Extra nodule tumor spread Fatigue/malaise/fever
480
What are the 3 subtypes of lymphoma?
Follicular- older population has slow growing tumor, least response to treatment Diffus large B cell- most aggressive but most responsive to treatment Burkitts- Common in Africa, endemic in kids w/ EBV
481
What part of the body does Burkitt's Lymphoma effect?
Mandible, face
482
What is the incidence of Hodgkin's Lymphoa?
Bi-modal peaks at 25 and 55
483
What are the clinical features of Hodgkin's Lymphoma?
Large nodes- neck, mediastinum | Reed-Sternberg cells
484
What is the pathogenesis of Multiple Myeloma?
Malignant plasma cells proliferate in bone marrow casuing punched-out look
485
What are the clinical features of Multiple Myeloma?
Serum protein electrophoresis | Bence-Jones proteins
486
How is Multiple Myeloma treated?
Ineffective to chemo, death from renal failure
487
Characteristics of Idiopathic Thrombocytopenic Purpura?
Auto-Abs to platelets destroy them in spleen Acute to children post-viral infection Easy bleeding from gums/nose Chronic ITP needs splenectomy
488
Characteristics of Thrombotic Thrombocytopenic Purpura
Abnormal clotting in small cells Primary- Abx breaks up Von Willebrand clotting factor Secondary- from cancer, pregnancy, HIV Easy bleeding gums, nose, hemolytic anemia
489
How is TTP treated?
Plasmapheresis to remove Abs
490
What are the inherited Bleeding Disorders?
A- 8 disorder B- 9 disorder Von Willebrands Disease- autosomal dominant Easy/ecess bleeding Tx w/ infusion of concentrated blood-clotting factors
491
What medication is contraindicated in PTs with Von Willebrand's?
Aspirin- due to inhibitory affect on platelets

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