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Human Disease And Therapeutics > Quiz 4 (test 2) > Flashcards

Quiz 4 (test 2) Flashcards

1
Q

Define atelectasis. Can be due to what three things.

A

AKA collapse

Inadequate expansion or collapse of airspaces. Gives rise to hypoxia

Airway obstruction (aspiration)

Compression (pneumothorax)

Contraction due to lung or pleural fibrosis

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2
Q

Acute respiratory distress syndrome is a progression of ___ injury by either __ or __ damage. And damage from activated ____ and fluid accumulation.

A

Acute lung injury

Physical or chemical damage

Activated neutrophils. Their products cause damage of alveolar epithelial and vascular structures

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3
Q

Name four types of chronic obstructive pulmonary diseases

A

Emphysema

Chronic bronchitis

Asthma

Bronchiectasis

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4
Q

Chronic obstructive pulmonary disease is a very common disease and the main cause is ___

A

Smoking

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5
Q

Emphysema is due to destruction of _____ in ____ leading to permanent (enlargement/shrinkage) of airspaces.

A

Elastic fibers

Alveolar walls

Enlargement

(Barrel lung is a result because too much air is in the lungs and it is difficult to get out)

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6
Q

What are three common causes of emphysema?

A

Smoking (most cases)

Alpha-1 antitrypsin deficiency (familial type)

Air pollution

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7
Q

What is the clinical presentation of emphysema?

A

Hyperinflation of lungs with barrel chest

Long expiration phase with pursing of lips

Clinically apparent after 1/3 of lung is destroyed

Dyspnea w/ cough and wheezing

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8
Q

What is the key diagnostic feature in diagnosing emphysema on a radiograph?

A

Flattened diaphragm over liver

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9
Q

What is the underlying etiology of emphysema?

A

**Imbalance of protease and anti-protease activity (alpha-1-antitrypsin deficiency)

Neutrophils and macrophages release elastase and oxygen free radicals

Smoking increases inflammation and inhibits alpha-1-antitrypsin

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10
Q

Which is worse, centrilobular emphysema or panacinar emphysema? Why?

A

Panacinar emphysema is worse because it is alpha-1-antitrypsin deficiency related

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11
Q

What is a pneumothorax?

A

Air pockets into the pleural spaces causing collapse of lungs

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12
Q

What is the diagnostic criteria for chronic bronchitis?

A

Persistent cough for over 3 months in 2 consecutive years

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13
Q

What are the causes of chronic bronchitis?

A

Smoking and air pollution

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14
Q

Patients who are “blue bloaters”? Have what disease?

A

Chronic bronchitis

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15
Q

What is the pathology behind chronic bronchitis?

A

Hypersecretion of mucus by airways

Microbial (viral or bacterial) infection is often secondarily present

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16
Q

What is bronchiectasis?

A

Obstruction of bronchi and persistent necrotizing infections. This will cause destruction of elastin and muscles in bronchial walls.

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17
Q

What are two congenital causes of bronchiectasis?

A

Cystic fibrosis

Kartagener’s syndrome (defective cilia)

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18
Q

What are some microbes that may cause bronchiectasis?

A

TB

Staphylococcus

Klebsiella

These cause hypersecrion of mucus in airways

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19
Q

Which lung disease is characterized by a persistent productive cough (often foul smelling) (sometimes blood) hemoptysis and if widespread, hypoxemia occurs. Destruction of muscle, cartilage, and elastin of the bronchial walls occurs

A

Bronchiectasis

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20
Q

What lung disease is considered a reactive airway disease that leads to narrowing of airways. It is considered a bronchial hyper-reactivity)

A

Asthma

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21
Q

True or false… it is difficult for asthma patients to breath in

A

False.. it is difficult for them to breath out (COPD)

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22
Q

What are the two types of asthma? Describe them.

A

Atopic: allergic reaction. Hypersensitivity response. Onset occurs with other allergic responses

Non-atopic: non allergy related. May be family related. Causes are not clear.

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23
Q

Asthma typically occurs in (younger/older) patients. It is precipitated by ___ stimulation. It causes shortness of breath and chest tightness-wheezing.

A

Younger

Vagal

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24
Q

In regards to the pathology of asthma… the lungs are ___-inflated. There are thick mucus plugs in the ___. Smooth muscle ____. ____ infiltration

A

Hyperinflated

Airways

Hypertrophy

Eosinophili (IGE)

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25
Q

For restrictive diseases, it is difficult to (inhale/exhale). Chest imaging shows a diffuse _____ appearance. It is (more/less) common than COPD.

A

Inhale

Ground glass

Less

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26
Q

Fibrosing diseases ( a type of restrictive disease) is associated with ___ vascular diseases such as _____.. it can cause ____-sided heart failure

A

Collagen.

Rheumatoid arthritis

Left

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27
Q

Which of the fibrosing diseases is a worse prognosis, usual interstitial pneumonitis, non-specific interstitial pneumonitis, or respiratory bronchioloitis interstial lung disease.

A

Usual insterstial pneumonitis (fibroblastic foci in histo)

RB-ILD is a good prognosis with smoking cessation and steroids

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28
Q

Name three work related restrictive lung diseases. Describe them

A

Coal workers pneumoconiosis (anthracotic/carbon)

Silicosis (most prevalent. Caused by inhalation of crystalline silica by sand blasters and hard rock miners)

Asbestosis (associated increased risk of both lung carcinoma and mesothelioma - cancer of the pleura)

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29
Q

True or false… sarcoidosis causes a restrictive lung disease

A

True

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30
Q

What is a characteristic finding of sarcoidosis in the lung?

A

Non-caseating granulomas in lung and mediastinal lymph nodes

It is a restrictive disease caused by abnormal CT and reduced elastic properties. Sarcoidosis has multi-organ involvement

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31
Q

Sarcoidosis is lethal in __% of the cases. It is an ___-related disease

A

10%

Immune (abnormally stimulated T cells)

Note that African Americans have a 10X greater risk

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32
Q

Hypersensitivity pneumonia is is caused by ___ or ___.

A

Mold (farmers lung)

Animal products (bird fancier’s disease)

Need to remove antigen from environment to allow the pt to heal

May be an acute reaction or result in end stage lung disease

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33
Q

What are some iatrogenic causes of pulmonary fibrosis (restrictive)?

A

Chemotherapy (bleomycin, busulfan)

Radiation

IV contamination

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34
Q

What is hemoptosis?

A

Coughing up blood. Seen with most diseases causing severe coughing

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35
Q

Name three vascular disease of the lung.

A

Pulmonary emboli

Pulmonary HTN

Vasculitis

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36
Q

Pulmonary emboli can cause sudden death with occlusion of the ___ artery. Emboli originate from ___. What can cause this?

A

Main pulmonary artery

Deep veins of the legs

Prolonged bed rest, surgery, congestive heart failure, surgery

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37
Q

Small pulmonary emboli can result in ___

A

Pulmonary HTN

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38
Q

What is the difference between primary and secondary pulmonary HTN?

A

Primary - seen in young patients with SOB

Secondary - more common. Causes heart disease, chronic lung disease, and recurrent thromboemboli

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39
Q

Pulmonary HTN can cause ___ ventricular failure. It can also cause what three things.

A

Right. (Cor pulmonale)

SOB, fatigue, chest pain

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40
Q

True or false.. diffuse alveolar hemorrhages can be caused by autoimmune responses

A

True

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41
Q

Name two diffuse alveolar hemorrhage syndromes.

A

Goodpasture syndrome

Wegener granulmatosis

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42
Q

True or false… in restrictive lung diseases gas change is left unimpaired.

A

False. It is impaired by thickened septal walls

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43
Q

What are the two types of vascular lung diseases?

A

Abrupt (PE)

Insidious (PPH)

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44
Q

True or false… in obstructive lung diseases gas exchange through septal walls is left unimpaired

A

True.

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45
Q

Chronic bronchitis is caused by ___ hypersecreiotn and associated with productive coughing. It increases the ___ index, which is defined as…

A

Mucus

Reid

Increased ratio of mucus gland to bronchial wall

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46
Q

What are the symptoms of walking (community) pneumonia?

A

Low-grade fever

General malaise (although still functioning)

Nonproductive cough and respiratory distress out of proportion to radiologic findings

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47
Q

What are the symptoms of community acquired pneumonia? What causes it?

A

Acute onset fever, chills, hemolysis, productive cough

S. Pneumoniae, H. Inluenzae, M. Catarrhalis, S. aureus

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48
Q

True or false… TB only affects the lungs

A

False. It may affect other organs

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49
Q

T or F… TB is non contagious during long periods of dormancy

A

True

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50
Q

What is miliary TB?

A

Organisms break off and wide-spread TB throughout body

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51
Q

What are ghon complexes?

A

Granulomas of TB that have been walled off and contained and are associated with a lymph node. These are found in primary TB

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52
Q

Pulmonary fungal infections are usually by ___ fungi

A

Dimorphic

Can cause acute pulmonary infection, chronic graulomatous lung infection, or disseminated milliary disease

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53
Q

____ is the leading cause of cancer death worldwide

A

Carcinoma of the lung

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54
Q

___% of primary lung cancers are carcinomas. What are the most common types? Which is the most aggressive?

A

95%

Adeno and squamous cell types are the most common

Most aggressive are the small cell (OAT) carcinoma

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55
Q

____ carcinoma of the lung is commonly associated with smokers

Smokers are ___x more likely to develop lung cancer than the general populiation

A

Squamous cell

55

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56
Q

True or false… lung tumors frequently spread to the brain.

A

True

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57
Q

Asthma is most prevalent in __ and ___

A

Children

Females

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58
Q

What are the relievers for asthma? Describe them.

A

Short-acting. Used for less severe cases

Typically beta2 agonist at minimum dose and frequency such as..

Albuterol (rapid onset 4-6hr effectiveness)

Salmeterol (slower onset, 12 hr effectiveness)

Mechanism: directly relax airway smooth muscle

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59
Q

What are the controllers for asthma?

A

Taken regularly for long-term stable control. Often more side effects

Inhaled: corticosteroids/drug of choic for moderate to severe asthma. Often combined with beta 2 agonists. Chronic management, not for rescue

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60
Q

Name one controller for asthma. What are the side effects?

A

Fluticasone

Nose bleeeds, sores in nose, mouth, and tongue that dont heal

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61
Q

What are the add-on controllers for asthma? What is their mechanism?

A

Methylxanthine drugs; theophylline (tablet or inhaler)

Mechanism: phosphodiesterase inhibtor and increases cAMP and relaxes airway smooth muscle

Monotherapy for mild asthma

combine with corticosteroids to reduce steroid doses and side effects

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62
Q

Name one antimuscarinic used to treat asthma. How does it work?

A

Ipratropium

Reverses contraction of smooth muscle from vagal activity. Usually a backup for beta 2 agonists

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63
Q

Name one leukotriene modifier. How does it work?

A

Montelukast (singulair)

Use is for prophylaxis for patients who have trouble with inhaled therapies. This drug is taken orally

Mechanism: block leukotriene-binding to receptor

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64
Q

What is cromolyn?

A

Used for treating asthma

Inhibits release of inflammatory mediators such as histamine

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65
Q

What is omalizumab?

A

Used for treating asthma.

Inhibits IgE binding to mast cells-very expensive. Only for severe non-responsive asthma

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66
Q

What are three things to consider regarding the dental relevance of asthma?

A

Asthmatics tend to be mouth breathers - dry mouth

Asthma inhalers irritate mucosa of mouth, especially back of roof of mouth

Make sure asthmatics brain inhalers to appointment; avoid asthma attacks

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67
Q

In order to treat COPD, you can use longer acting bronchodilators such as ____. Longer acting beta 2 agonists such as ___. ___ with glucocorticoids (because glucocorticoids alone are not very effective). Typically responses are not as good as with asthma

A

Tiotropium bromide (spireva)

Salmeterol

Theophylline

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68
Q

What is oseltamivir (tamiflu) used to treat?

A

Influenza

It prevents separation of virus particle from cell receptors, stopping viral spread - earlier treatment essential

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69
Q

What are the symptoms of allergic reactions?

A

Itching, hovers, sneezing, and wheezing, difficulty breathing

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70
Q

Reaction to allergens causes release of histamine from mast cells and basophils which do what four things?

A

Contract pulmonary smooth muscles

Dilate blood vessels-lowers BP

Increases permeability of vessels

Increases gastric secretion

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71
Q

What drugs should you use to treat allergic reactions?

A

Antihistamines (H1 blockers have anticholinergic/sedation side effects): diphenhydramine (Benadryl), chlorpheniramine

Epinephrine: potent reversal - vasoconstriction and reduces fluid in lungs so breathing improves and swelling reduces

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72
Q

What are diphenhydramine and chlorpheniramine used to treat?

A

Allergies

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73
Q

What is Anuria, polyuria, and bladder distention? Can pts with urinary obstruction be asymptomatic?

A

Anuria: nonpassage of urine

Polyuria: production of abnormal quantity of dilute urine

Bladder distention: chronic painful bladder

Yes, pts may be asymptomatic. Symptoms vary depending on where their partial obstruction, complete, unilateral, or bilateral.

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74
Q

What are the possible symptoms associated with urinary obstruction?

A

Anuria

Polyuria

Bladder distention

Symptoms vary. May be asymptomatic

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75
Q

What are the symptoms associated with kidney stones?

A

Renal colic - abnormal pain that is referred to the sides and groin area

Hematuria - blood in the urine

Pyelonephritis - inflammation of the kidney, usually as a result of bacterial infection

May be asymptomatic

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76
Q

Most kidney stones (75%) are composed of ___. The rest are typically composed of ___

A

Calcium oxalate/phosphate

Magnesium ammonium phosphate

77
Q

What is pyelonephritis caused by?

A

Retrograde spread from cystitis or hematogneous spread of infection

Commonly seen with urinary obstruction, stenosis, or reflux

Associated with diabetes. More severe in diabetics. (May cause papillary necrosis)

78
Q

What are the consequences of pyelonephritis?

A

Flank pain

Fever

10-20% chronic renal failure

Kidney scarring

79
Q

Adenomas in the kidney are identical to papillary renal cell carcinoma but are less than ___cm.

A

1.5

80
Q

Renal cell carcinoma make up ___% of all renal malignancies

A

80-90%

81
Q

Renal cell carcinomas are are more common in what population? Also in pts who….

A

Males over the age of 40 and in smokers

Abuse NSAIDs and/or are obese

82
Q

What are 5 symptoms of renal cell carcinomas?

A

Often asymptomatic

Hematuria

Dull flank pain

Fever

Fatigue

83
Q

Renal cell carcinomas are most likely to metastasize to what locations?

A

Lungs or bones

84
Q

What is the most common congenital renal tumor?

A

Wilms tumor

Most common in first 3 years

It is triphasic (epithelial, mesenchymal, blastemal components)

85
Q

What are 4 contributing factors to bacterial cystitis?

A

Stones

Catheters

Short femal urethra

Obstructions

86
Q

Bacterial cystitis is usually related to what bacteria?

A

E. Coli

87
Q

Urothelial carcinoma is most often seen in (females/males) over the age of __. It is associated with ___, and carcinogens.

A

Males

50

Smoking

88
Q

What is the most common urothelial malignany?

A

Urothelial carcinomas

89
Q

___ is the most common bladder malignancy in children

A

Rhabdomyosarcoma

90
Q

What typically causes prostatitis? Prostitis cause enlarged and tender prostate and can cause ___. It is most commonly found in ___ men. It is commonly seen with ___

A

Bacterial infection (like cystitis)

Obstruction

Older

Benign prostatic hyperplasia

91
Q

__% of men over the age of 75 have benign prostatic hyperplasia. True or false. Serious sequelae are less common. The cause is not well known but it may be associated with androgens or estrogens.

A

95

True

92
Q

BPH may cause ____. __% require surgery to relieve.

A

Urinary obstruction.

10%

93
Q

What is the most common non-skin malignancy in older men?

A

Prostatic adenocarcinoma

94
Q

Prostatic adenocarcinoma most commonly metastases to ___

A

Bone

95
Q

How is prostatic adenocarcinoma most commonly detected?

A

Rectal exams

Many are small and not clinically significant, however some can be deadly in some pts.

96
Q

Rapidly increasing PSA (prostate specific antigen) means a higher risk for ___.

A

Cancer. The more psa bount to alpha-1-antichymotrypsin, the greater the risk

97
Q

___ million American adults have chronic kidney disease. ___ million of these are on dialysis

A

26

0.5

98
Q

What are the main causes for chronic kidney disease? (3 things)

A

Diabetes

Hypertensive kidney disease

Chronic glomerulonephritis

99
Q

The most common primary glomerulonephritis is ______. It is triggered by ___

A

IgA nephropathy

Viral infection

100
Q

CRD (chronic renal disease) pateints commonly have what symptoms?

A

Platelet dysfunctions

Gingival hyperplasia (particularly in transplant pateints on cyclosporine)

Bone abnormalities (slow bone healing after oral surgery. Osteoporosis)

Infectious complications (due to immunosuppression)

101
Q

What is the dental relevance of CRD?

A

Causes uremia resulting in halitosis

Can affect bone density in jaws, decreasing cortical plate thickness

Can cause premature bone loss

Can cause gingival hyperplasia

102
Q

True or false… pts with CRD are likely to have less protein in their urine, hematuria, mechanical injury to kidneys, and glomeruli overgrowth.

A

False.

They have…

Heavy proteinuria
Hematuria
Inflammatory injury to kidneys
Glomeruli scarring

103
Q

What is nephrotic syndrome?

A

Includes heavy proteinuria

Edema

Hyperlipidemia

Associated with HTN and kidney dysfunctions

104
Q

What is glomerulonephritis?

A

Inflammatory injury to kidneys

105
Q

What is glomerulosclerosis?

A

Chronic renal injury and renal scarring

106
Q

What is medullary sponge kidney?

A

Enlarged

Kidney stones

UTI

Benign

107
Q

What is the leading cause of kidney failure?

A

Diabetes

Advanced glycosylation products result in mesangial cell injury and production of matrix

108
Q

True or false… amyloidosis is a common cause of nephrotic syndrome and kidney disease

A

False, it is uncommon. Amyloidosis is the accumulation of abnormal proteins in beta-pleated sheet conformations in multiple organs including the kidney

109
Q

What is hydronephrosis caused by?

A

Blood clot

Tumor

Pregnancy

110
Q

True or false… nephrotic syndrome includes proteinuria, lipidurea, and edema

A

True

111
Q

Treatment of kidney stones depends on the size and types of stones present. What is the treatment for small stones (<1cm)?

A

Drink lots of water (2-3 liters)

Dietary changes

OTC pain relievers (ibuprofen, naprosyn)

Tamusolin (flomax) - Rx drug that relaxes ureter muscle to pass stones (and to decreases spasms due to irritation of stone)

112
Q

What drug is used to help pass small kidney stones by relaxing the ureter muscle and reducing spasms?

A

Tamusolin

113
Q

What are the treatment options for larger kidney stones (>1cm)

A

Lithotripsy (shock wave treatment) - breaks up stones

Surgical removal

Opioid analgesics for pain

Parathyroid gland surgery (reduces deposition of calcium)

114
Q

For most kidney stones, you can alkalinity the urine to slow deposition or break up the stones, except for one. What is the exception?

A

Struvite stones

You must treat infection and must ACIDIFY the urine pH

115
Q

What is the most common type of kidney stone? What is it caused by?

A

Calcium oxalate (75-80%)

Caused by excess calcium/oxalate in the urine

116
Q

What is the second most common type of kidney stone? What causes it?

A

Struvite (10-15%)
Composed of magnesium ammonium phosphate crystals which deposit in urine when bacterial urease* enzymes alkaline the urine too much

117
Q

Which type of kidney stone is most often associated with UTIs?

A

Struvite

118
Q

Uric acid kidney stones (~5%) are formed due to…? About half of pts with these stones also suffer from ___.

A

Excess Uris acid waste in urine mineralizes into stones when urine is too acidic.

Gout

119
Q

How do cystine kidney stones form? (Least common)

A

Excess cystine production causes hypercystinuria and deposition when urine is too acidic

120
Q

What are hydrochlorothiazide, sodium bicarbonate, and allopurinol used to treat?

A

Kidney stones

121
Q

Hydrochlorothiazide is a ___ diuretic. It is very effective in the ____ portion of the nephron, reducing ___ in the urine and preventing ____ kidney stones.

A

Thiazide

Distal convoluted tubule

Calcium

Calcium oxalate

122
Q

Sodium bicarbonate ___ the urine which decreases the amount of ___ and ___ deposition from the urine. This drug is recommended for __ and ___ stones but is contraindicated for ____ stones

A

Alkalizes

Uric acid and cystine

Uric acid stones and cystine stones

Contraindicated for structure stones because these stones should be acidifies. Alkalizing them will make it worse

123
Q

Allopurinol reduces the amount of ___ produced in patients with ____ and ___

A

Uric acid

Uric acid stones

Gout

124
Q

Acetohydroxamic acid is an irreversible inhibitor of ___ used to prevent and slow the growth of ____ stones

A

Bacterial urease

Struvite

125
Q

UTIs are most commonly in the bladder (___) or urethra (___). UTIs are most often caused by ____. Especially in females due to the anatomy

A

Cystitis

Urethritis

E. Coli

126
Q

What are three drugs that are commonly used to treat UTIs?

A

Trimethoprim-sulfamethoxazole (synergistic protein synthesis inhibitor)

Amoxicillin + clavulanic acid (resistant bacteria a problem)

Ciprofloxacin (expensive) (alternative treatment) (may cause seizures)

127
Q

___, ____, ____, and prophylactic ___ are commonly used drugs for people receiving hemodialysis. Describe each of these drugs.

A

Atenolol/captopril - reduces HTN (use atenolol cautiously in diabetics)

Heparin - anticoagulant to prevent clotting blood passed through dialysis machine

Furosemide - potent diuretic. Reduces fluid retention and the amount of fluid that needs to be removed by the dialysis

Prophylactic antibiotics - these are used because there is a high rate of infection in dialysis pts

128
Q

Why is erythropoietin often given to pts on dialysis?

A

Because they arent producing suffienct EPO. EPO is a renal hormone that stimulates the bone marrow to make new RBCs

129
Q

What are the dental concerns with pts on dialysis?

A

Higher incidence of periodontal disease. More likely to have oral infections due to the weakened immune system

Prophylactic antibiotics prior to surgical dental procedures is necessary

Dental procedures should take place on non-dialysis days, since heparin will extend bleeding time

130
Q

What is the difference between primary and secondary hemostasis?

A

Primary - platelets

Secondary - factors to cause adhesion for platelets (coagulation)

131
Q

Platelets are (nucleated/anucleated), their lifespan is ___ days. Circulating platelets do not adhere normally. They adhere during stasis and sites of injury.

A

Anucleated

10

132
Q

Primary hemostatis is typically initiated by ___. Platelets adhere to ___ by interacting with ____. ___ are released to attract other platelets. Platelets aggregate with other platelets and form surface for the ___ cascade.

A

Injury

Sundendothelium

Von willebrand factor (factor 8)

Granules

Coagulation

133
Q

In secondary hemostasis, (coagulation cascade) factors mostly from the ___ are involved. It involves a series of activating enzymatic conversions. It involves the ___ pathway and the ___ pathway

A

Liver

Intrinsic

Extrinsic

134
Q

What factors unique that are involved in the intrinsic pathway? It is measured by the ___ clotting time.

A

12

11

9

8

PTT (partial thromboplastin time)

135
Q

What unique factors are involved in the extrinsic pathway? It is measured by the ___ clotting time.

A

7

PT (prothrombin time)

136
Q

What are the common factors that are involved in both the intrinsic and extrinsic pathways?

A

10

5

2

And fibrin production

(Measured by both PT and PTT clotting times)

137
Q

In the coagulation pathway, which occurs first, thrombin or fibrin formation?

A

Thrombin forms first

138
Q

Which factors are vitamin K dependent, necessary for calcium binding sites activating coagulation cascade?

A

2

7

9

10

139
Q

What are some natural anticoagulants?

A

Protein C
Protein S
Antithrombin

These prevent growth of clot to keep it under checks and balances

140
Q

What is fibrinolysis?

A

Breaks down clot and releases fibrin

141
Q

What are three ways to assess hemostasis?

A

Platelet count (part of CBC)

Coagulation cascade (PT and PTT)

Prolonged coagulation tests may be due to deficiency or inhibitor of coagulation factor

142
Q

What is thrombosis?

A

Pathologic counterpart of hemostasis that results in abnormal clotting. In involves vessels, platelets, and the coagulation cascade.

143
Q

What is virchows’s triad?

A

The causes of thrombosis…

Endothelial injury

Abnormal blood flow

Hypercoagulability (acquired/inherited factors)

144
Q

What are some acquired hypercoagulable states?

A

Surgery/trauma

Limb immobilization

Bedridden

Long-distance air travel (stasis)

Pregnancy

Oral contraceptives

145
Q

Factor V ___ is an example of a genetic thrombotic disorder (point mutation, AD). It is the most common inherited ____ - associated with increased ___ formation. It makes factor V resistant to cleavage and inactivation by activated protein __. This will increase clotting but usually does not cause major problems.

A

Leiden

Thrombophlilia

Fibrin

C

It is found in about 5% of adults (especially in caucasians)

146
Q

What is caisson disease?

A

Caused by air embolism, blocking blood flow

147
Q

___ venous thrombin in leg rarely embolize (usually caused by ____).

A

Superficial

Deep vein thrombosis. - can dislodge, especially to the lung

148
Q

Deep vein thrombosis can dislodge and end up especially in the ___

A

Lung

149
Q

Platelet type bleeding has a ____ bleeding pattern. What are some causes of platelet-type bleeding?

A

Mucocutaneous (petechiae, ecchymoses, GI bleeding, epistaxis)

Thrombocytopenia (decreased bone marrow production)
Von willebrand disease
Qualitative platelet dysfunction
Vascular abnormalities

150
Q

Von willebrand disease has a mutated ___-related carrier protein

A

VIII

151
Q

What are three common causes of thrombocytopenia?

A

Decreased bone marrow production

Hemodilution due to multiple transfusions

Increased peripheral destruction (immune reaction due to platelet autoantibodies directed at platelet surface proteins)

Sequestion in spleen

152
Q

Platelet counts below ___ may result in spontaneous bleeding.

A

~10,000-20,000

153
Q

What are some symptoms of thrombocytopenia purpura?

A

Fever

Renal failure

Transient neurological deficits

Microangiopathetic hemolytic anemia

154
Q

What is the most common inherited blood-clotting disorder? Describe this disease.

A

Von willebrand disease (altered vWF does not bind properly to factor VIII and interferes with platelet adhesion to collagen.

155
Q

True or false.. hemophilia A and B are both inherited blood-clotting disorders. Describe them.

A

True

A = deficient factor VIII
B = deficient factor IX. (More likely in males over 25 cause its X-linked recessive)

Both A and B have prolonged PT and PTT

156
Q

What are 2 examples of acquired blood clotting diseases?

A

Vitamin K deficiency (usually due to malabsorption of fat; increase in both PT and PTT)

Liver disease

157
Q

What is disseminated intravascular coagulation (DIC)?

A

Generalized secondary activation of clotting due to disseminated factors such as toxins, information, cancer. Can cause both organ ischemia because of increased clotting as well as bleeding due to increased activation of fibrinolysis

158
Q

What are blood typing disorders?

A

Presence or absence of Ab related to RBC surface antigens.

159
Q

What is a CBC?

A

Complete blood count

Automated hematological evaluation. Includes red and white blood cells and platelets

160
Q

What are some factors that may alter the CBC?

A 
Iron deficiency 
Medications
Alcohol
Infections
Gender
Pregnancy
161
Q

WBC (white blood counts) include all uncleared hematopoietic cells except RBCs. What is the normal WBC?

A

3500-10,000 cells/microliter

Neutrophils 1800-6700 (55%)
Eosinophils 0-570 (3%)
Lymphocytes 1400-3900 (35%)

Important to evaluate infections, some drug effects, radiation therapy

(know ranges and percents)*

162
Q

What is leukocytosis? What are things that may cause it?

A

WBC > 10,000

Causes:
Chronic infection or inflammation
Exercise
Some leukemia

163
Q

What is gaisbock syndrome?

A

Relative polycythemia due to decreased plasma volume but #RBCs remain the same.

Higher conc. Of RBCs

164
Q

What is polycythemia Vera?

A

Genetic. Due to increased RBCs

165
Q

What is microcytic anemia?

A

<80 fl MCV (mean corpuscular volume (RBCs are smaller)

166
Q

What are some things that may cause microcytic anemia?

A

Iron deficiency (usually by hemorrhaging). Often has glossitis

Cause can include blood loss or poor diet

Lead poisoning

167
Q

What is the size range for normocytic anemia?

A

80-100 MCV

168
Q

What is macrocytic anemia and what is it caused by? What are some symptoms?

A

Larger than 100 fl

Caused by…
Liver disease
Drugs
Vitamin B12 (abnormal tongue) or folate deficiency (associated with pregnancy)

Often includes neurological findings (paresthesia, weakness, dementia) - pernicious anemia or autoimmune diseases

169
Q

What is normocytic anemia caused by?

A

Aplastic anemia

Blood loss

Anemia of chronic diseases

170
Q

What is sickle cell anemia?

A

The globin of the molecule is abnormal due to an amino acid substitution

171
Q

___ are systemically distributed neoplasms of WBCs.

___ are solid tumors of hematopoietic system/neoplasm of lymphoid tissue - lymphadenopathy

A

Leukemias

Lymphomas

172
Q

True or false.. lymphomas and leukemias are clonal expansions of cells at certain developmental stages

A

True

173
Q

In acute myeloid or acute lymphoblastic there is __ evidence of maturation in blood or marrow. ___% are blast cells. Skin and gum infiltration are probable. It is found more frequently in (children/adults). It progresses ___, but more responsive to treatment.

A

No

20

Children

Rapidly

174
Q

Chronic myeloid or chronic lymphocytic leukemia results in ___% of mature cells. Chronic myeloid has the presence of the ___ chromosome (abnormal ____). Chronic means more pts can function and have better prognosis.

A

Increased

Philadelphia

Tyrosine kinase

175
Q

True or false… Hodgkin’s lymphoma is more prevalent than non-hodgkins lymphoma

A

False. Non-hodgkins lymphoma represent 90% of lymphomas. It is very aggressive and not likely curable

Hodgkin’s lymphoma represents 10% of lymphomas and is curable in most. Presence of Reed-Sternberg cells

176
Q

Multiple myeloma is cancer of ___ cells that arises in bone marrow (often replacing other blood cells) and often has ___ proteins.

A

Plasma

Bence-jones

177
Q

What is the desired total cholesterol level? What is considered high?

A

Below 200 mg/dL desirable

> 240 is considered high

178
Q

What is the desirable LDL level? What is considered border-line high? What is considered high?

A

<100 = desirable

130-159 = borderline high

160-189 = high

179
Q

What is considered the desirable levels of triglycerides? What is considered too high?

A

Below 120 is desirable

Over 200 is high

180
Q

What is the ideal level of HDL?

A

60

Below 40 is poor

181
Q

What kind of drug is gemfibrozil?

A

Fibrate

182
Q

What kind of a drug is cholestyramine?

A

Bile acid binding resin

183
Q

What is the normal PTT?

A

25-35 seconds

184
Q

The intrinsic pathway is sensitive to ___ as an anticlotting agent. What are some side effects?

A

Heparin

Hemorrhage, allergic reactions, osteoporosis, and bone fractures

Heparin typically used in hospital setting. Heparin-like drugs frequently used is enoxaparin

185
Q

What heparin-like drug is used to treat deep vein thrombosis?

A

Enoxaparin

186
Q

What is the normal PT?

What is a normal INR?

A

PT = 11-13.5 seconds

INR = 0.8-1.1

187
Q

Which, the intrinsic pathway or extrinsic pathway is sensitive to coumadin (warfarin). How does it work? What are some side effects?

A

Extrinsic pathway

Antagonizes K

Side effects: hemorrhage, numbness, pain, headache, dizziness

Oral warfarin is prescribed for out patient

188
Q

What is an alternative drug to warfarin? Describe this drug.

A

Dabigatran (pradaxa)

Has fewer side effects and is more popular than heparin or warfarin. Affects PTT sensitive pathway but has unique mechanism that makes it distinct from heparin and warfarin. used on out-patient basis

189
Q

What kind of drug is abciximab and bivalirudin? Describe them.

A

Abciximab - (glycoproteins inhibitor) - injected and used to prevent clot formation such as in unstable angina.

Bivalirudin - (thrombin inhibitor) it is rapid and short acting and inhibits circulating thrombin

Human Disease And Therapeutics (13 decks)

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