Refined Notes Deck Exam 2 Flashcards
here we go
Development pathway of an RBC
Pluripotential hematopoietic stem cell -> CFU-S (committed to the myeloid line) -> CFU-B -> CFU-E -> proerythrocyte -> reticulocyte -> erythrocyte
Ferritin
The storage form of iron in the liver
Apotransferrin and transferrin
The transporter molecule of iron in the blood stream, apotransferrin lacks bound Fe and becomes transferrin upon binding Fe.
RBC metabolism
Free hemoglobin from lysed rbc’s that have become too old are digested by macrophages into porphyrin (able to be broken down) and bilirubin (unable to be broken down, continues to circulate thru the blood stream, liver should remove)
Megaloblastic anemia
Caused by vitamin B9 or B12 deficiency, cannot form proper biconcave disk shape of RBC and thus have large, nonfunctional cells
Microcytic/hypochromatic anemia
Caused by iron deficiency, small pale RBC’s that cannot carry enough hemoglobin
Aplastic anemia
Anemia brought on by death of bone marrow cells that produce RBC’s, often due to toxin or chemo exposure
Pernicious anemia
Anemia brought on by conditions such as gastric bypass which prohibit a patient from being able to absorb enough B12 and thus are deficient
Hemolytic anemia
Anemia brought on by the lysing of RBC’s either by mechanical action or because of underlying disease
Polycthemia vera
Primary polycthemia, unregulated RBC production resulting in high hematocrit and viscous blood
secondary polycthemia
Excess RBC in blood brought on by a secondary condition such as high altitude, COPD, etc.
Inflammation fibrinogen mechanism
Fibrinogen forms clots at the site of infection walling off the area and preventing fluid drainage after vascular leakiness has occurred, resulting in sustained tissue edema for prolonged period of time during infection
D antigen
The most immunogenic antigen on the surface of certain people’s RBC’s, form the basis of the rhesus factor Rh with individuals being Rh positive (they have the D antigen and thus no antibodies against it) or Rh negative (they lack the D antigen and thus have antibodies against it)
Tomograms
3D generated panoramic images from x ray radiation
Radiograph
2D generated image from x ray radiation, used to see bone or foreign objects in body
Ultrasound
Imaging technique using soundwaves and their densities, useful for visualizing vasculature, fluid filled structure
IV enteral contrast dye
Injection of a contrast dye to visualize different aspects of the enteric system, useful for seeing hollow organs
Angiogram
Inserting contrast dye into vessels to pick up occlusion
CT
Fancy computerized radiograph that plots millions of points together simultaneously to create a highly detailed image, used to see bone or organs
MRI
No radiation magnetic imaging technique good for visualizing soft tissue
PET scan
Scan that detects metabolic activity of tissues, often used in cancer screening
The issue with interpreting lab tests
Some people that fall into the sick category of a test are not sick, just have physiological variation. And vise vers
Sensitivity
Measure of a test’s ability to pick up a positive value (regardless of false positives), a sensitive test with a negative diagnosis rules out a condition
Specificity
Measure of a test’s ability to determine negative values (regardless of false negatives), a specific test with a positive diagnosis rules in a condition
Positive predictive value
Proportion of patients with a positve test who truly have the disease
Type 1 error
false positive
Type 2 error
false negative
Negative predictive value
Proportion of patients with a negative test who truly do not have the disease
PPV=
(true positives/(true positives+false positives))
NPV
(True negatives/(true negatives+false negatives))
5 components to be discussed in the patient treatment plan
1) Pending studies (stuff we are waiting results on that we will reach out to the patient about if the results are normal or if we need to discuss)
2) Treatment plans (medications, physical activities, diets, behavioral changes, patient education, preventative issues)
3) Follow ups (both in the event of an emergency what to do and when we need to follow up weeks or months)
4) Referrals (to specialists, PT, nutritionists)
5) Provider notes (notes to self for future reference or things to keep in mind)
Informed consent
Informed consent is the legal and ethical responsibility of the provider to inform the patient of the various risks and benefits associated with a treatment plan in terms that they can understand so they can make educated and informed decisions regarding their course of treatment.
List 4 mandatory questions to ask every time you order a medication
Any prior drug allergies?
Any chance you could be pregnant?
Any other medications?
Any prior reactions to any medications in the past