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Guyton - unit questions EW > Unit VI (33-37) - Blood Cells, Immunity and Coagulation > Flashcards

Unit VI (33-37) - Blood Cells, Immunity and Coagulation Flashcards

1
Q

What organ produces more of the red blood cells during the middle of gestation?

a. Bone marrow
b. Liver
c. Spleen
d. Lymph nodes

A

Answer: B (Guyton 33)

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2
Q

What factors are required for appropriate red blood cell production?

a. Vitamin K and erythropoetin
b. Cyanocobalamin and erythropoetin
c. Iron and vitamin K
d. Cyanocobalamin and carotinids

A

Answer: B (Guyton 33)

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3
Q

Hageman factor deficient cats may have a prolongation of their PTT with no clinical bleeding. What factor are they deficient in?

a. Fibrinogen
b. Factor V
c. Factor VII
d. Factor XII

A

Answer: D (Guyton 37)

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4
Q

What does heparin combine with in order to act as an anticoagulant?

a. Antithrombin III
b. Fibrinogen
c. Prothrombin
d. Tissue factor

A

Answer: A (Guyton 37)

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5
Q

Which of the following vitamins and minerals are required for appropriate red blood cell maturation?

a. Folate and Iron
b. B12 and Iron
c. B6, Cobalamin, and Iron
d. Folate, B12, and Iron

A

Answer d (Guyton 449)

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6
Q

Which of the following is the initiating step in clot formation?

a. Cleavage of fibrinogen to form fibrin
b. Formation of prothrombin activator
c. Formation of fibrinogen activator
d. Conversion of prothrombin to thrombin

A

Answer b (Guyton 487)

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7
Q

Which factor is primarily responsible for adherence of platelets to exposed subendothelium in areas of high shear stress?

a. von Willibrand
b. Hageman factor
c. Factor II (prothrombin)
d. Factor VII (proconvertin)

A

Answer: A

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8
Q

Which factor is responsible for clot lysis by digesting fibrin fibers and other coagulation proteins?

a. Plasmin
b. Plasminogen
c. Fibrin
d. Fibrinogen

A

Answer: A

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9
Q

Which part of the gastrointestinal system absorbs iron?

a. Stomach
b. Small intestine
c. Cecum
d. Large intestine

A

Answer: B; Guyton pg 450

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10
Q 
Which of the following initiates the extrinsic pathway for clotting?
A] Factor XII
B] Tissue factor 
C] Factor XI
D] Collagen
A

Answer: B Guyton and Hall Chapter 37

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11
Q 
The cause of pernicious anemia is deficiency of
A] Vitamin B12
B] Iron
C] Vitamin B6
D] Erythropoietin
A

Answer: A Guyton and Hall Chapter 33

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12
Q

Lack of vitamin B12 and folic acid cause anemia by which mechanism?

a. Failure of division
b. Formational failure of hemoglobin
c. Maturation failure caused by diminished DNA synthesis
d. Production failure due to inhibition of CFU – S

A

Correct Answer: C; Ref: Guyton, pg. 449

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13
Q

Heparin combines with which molecule to results in the removal of free thrombin from the bloodstream to act as an anticoagulant?

a. Antithrombin III
b. Factor V
c. Factor VII
d. Factor X

A

Correct Answer: A; Ref: Guyton, pg. 489

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14
Q

In the first step of hemoglobin synthesis, which molecule combines with glycine to form a pyrrole?

a. citrate
b. oxaloacetate
c. succinyl-CoA
d. acetyl-CoA

A

Answer: C; Guyton 449

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15
Q

Which of the following cytokines promotes growth and reproduction of virtually all the different types of committed stem cells in the bone marrow?

a. IL-3
b. IL-5
c. IL-8
d. IL-11
A

Answer: A. ; Reference: Guyton Ch. 33 Pg. 447

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16
Q

Which of these ions is required for promotion or acceleration of the blood-clotting reactions in both the intrinsic and extrinsic pathways?

a. Potassium
b. Calcium
c. Sodium
d. Chloride
A

Answer: B; Reference: Guyton Ch. 37 Pg. 488

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17
Q

Which mechanism is responsible for increased cardiac output in anemia patients? (Guyton Ch 33)

a. Decreased blood viscosity
b. Peripheral vasodilation
c. Tachycardia
d. All of the above

A

Answer: D Guyton 33

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18
Q

What is the site of fibrinogen formation?

a. Vascular endothelium
b. Liver
c. Platelets
d. Skeletal muscle

A

Answer: B; (Guyton Ch 37)

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19
Q

What is the effect of polycythemia on cardiac output?

a) Greatly decreased due to increased blood viscosity and decreased venous return
b) Greatly increased due to increased blood volume and increased venous return
c) Not far from normal because the changes in viscosity and volume neutralize each other
d) Venous return and cardiac output are not affected by polycythemia

A

Answer : c; Guyton (12th edition), p. 421

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20
Q

Which of the following is the less likely cause of vitamin K deficiency?

a) Liver failure
b) Bile duct obstruction
c) Poor absorption of fats
d) Lack of vitamin K in the diet

A

Answer : d; Guyton (12th edition), p. 458

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21
Q

The majority of the iron in the body is found in:

A. Myoglobin
B. Hemoglobin
C. Liver
D. Plasma

A

Answer: B

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22
Q

Which of the following proteins is responsible for iron transport in plasma?

A. Ferritin
B. Hemosiderin
C. Transferrin
D. Apotransferrin

A

Answer: C

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23
Q

Serum iron is increased with which condition?

a. Renal disease in cats
b. Hypothyroidism in dogs
c. Hyperadrenocorticism in dogs
d. Hypoalbuminemia in dogs

A

Answer: C (Latimer Chp 1)

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24
Q

In a patient that is acutely anemic, when would you expect to see evidence of regeneration?

a. 24 hours
b. 5 days
c. 2 weeks
d. 1 month

A

Answer: B (Latimer Chp 1)

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25
Q

Free hemoglobin in the plasma binds to which protein for transport to the liver?

a. albumin
b. hemopexin
c. haptoglobin
d. alpha-2 macroglobulin

A

Answer: C; Duncan and Prasse p. 12

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26
Q 
Which of the following conditions may be associated with decreased serum iron?
A. Hypothyroidism
B. Hemolytic anemia
C. Hyperadrenocorticism
D. Hemochromatosis
A

ANSWER: A (Latimer)

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27
Q 
Which of the following breeds has been described to have microcytic erythrocytes?
A. Silken windhound
B. Newfoundland
C. Shiba Inu
D. Kooiker
A

Answer: C; Latimer p 14

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28
Q

How does the site of erythropoiesis change through life?

A

Early weeks - yolk sac
Middle trimester - mainly liver (some in spleen and LNs)
Last month of gestation and after birth - bone marrow

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29
Q

How does IL-3 act on the bone marrow?

A

Promotes growth and reproduction of nearly all types of committed stem cells

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30
Q

What is the developmental journey of a RBC?

A

MHSC => CFU-S => CFU-B => CFU-E => pro erythroblast => basophil erythroblast => polychromatophil erythroblast => orthochromatic erythroblast => reticulocyte => erythrocyte

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31
Q

Which RBC precursor is the first to contain haemoglobin?

A

Polychromatophil erythroblast

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32
Q

After release from the marrow, how long does it take a reticulocyte to mature?

A

1-2 days

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33
Q

Where is EPO produced?

A

90% kidneys
10% liver

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34
Q

What are the steps for EPO production?

A

Renal hypoxia => increased tissue HIF-1 - transcription factor for hypoxia-inducible genes
HIF-1 binds hypoxia response element in EPO gene, inducing transcription and EPO synthesis

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35
Q

How can non-renal hypoxia stimulate RBC production?

A

Norepinephrine, epinephrine and several prostaglandins stimulate EPO production

36
Q

How does EPO increase RBC count?

A

Stimulates production of pro erythroblasts from stem cells, and increases rate of maturation

37
Q

What is needed for final maturation of RBCs?

A

Vitamin B12 and folic acid

38
Q

What molecules are needed for haemoglobin formation? Describe the steps

A

2 x succinyl-CoA (from Kreb’s cycle)
2 x glycine
Combine to form pyrrole
4 x pyrrole combine => protoporphyrin IX
Combines with Fe => heme
Heme combines with globin

39
Q

How many oxygen molecules can one haemoglobin molecule bind?

A

4

40
Q

Describe iron transport and metabolism

A

pg 444, F 33-7

41
Q

How and where is iron absorbed?

A

All of small intestine
Liver secretes apotransferrin in bile - combines => transferrin
Complex absorbed by pinocytosis

42
Q

How do the lysosomes of macrophages and neutrophils differ?

A

Macrophage lysosomes contain lipases - capable of digesting thick lipid membranes

43
Q

What cytokines play dominant roles in the control of the macrophage response to inflammation?

A

TNF, IL-1, GM-CSF, C-CSF, M-CSF

44
Q

What are the components of the innate immune system?

A

Phagocytosis
Destruction of swallowed organisms by stomach acid/digestive secretions
The skin
Presence of lysozyme, basic polypeptides, complement and NK lymphocytes in the blood

45
Q

What are the requirements for a substance to be antigenic?

A

Large molecular weight
Must have regularly recurring molecular groups - epitopes

46
Q

Where are lymphocytes processed?

A

T - thymus
B - liver then bone marrow

47
Q

Where is IL-1 produced and what is it’s role?

A

Macrophages
Promotes growth and reproduction of lymphocytes

48
Q

Which antibody class is associated with the primary response to an antigen?

A

IgM

49
Q

What component of the complement cascade activates phagocytosis?

A

C3b

50
Q

What complement factors are responsible for lysis of invading organisms?

A

C5b6789

51
Q

What complement factors are responsible for initiating chemotaxis of neutrophils and macrophages?

A

C5a

52
Q

What complement components activate mast cells and basophils?

A

C3a, C$a abd C5a

53
Q

What are the 7 effects of the compliment cascade?

A

1 - opsonisation and phagocytosis
2 - lysis
3 - agglutination
4 - neutralisation
5 - chemotaxis
6 - mast cell/basophil activation
7 - inflammation

54
Q

What are the 3 major types of antigen presenting cells? Which cells respond to them?

A

Macrophages, B lymphocytes and dendritic cells
T lymphocytes

55
Q

How do APCs present antigen?

A

On MHCs

56
Q

What are the two types of MHC and what id their purpose?

A

MHC I - present to cytotoxic T cells
MHC II - present to T-helper cells

57
Q

What are the most numerous T cells?

A

T helper cells

58
Q

What T cell is CD4+?

A

T helper cell

59
Q

What lymphokine stimulates growth and proliferation of cytotoxic and regulatory T cells?

A

IL-2

60
Q

Which lymphokines stimulate the B-cell response?

A

IL-4, 5 and 6

61
Q

What T cell is CD8+?

A

Cytotoxic T cell

62
Q

How to cytotoxic T cells exert their effect?

A

Secrete hole-forming proteins - perforins
Release cytotoxic substances into the attacked cell

63
Q

What are the mechanisms causing vascular constriction after trauma to a blood vessel?

A

Local myogenic spasm
Local autacoid factors (including thromboxane A2 from platelets
Nervous reflexes

64
Q

What is found in the platelet cytoplasm?

A

1 - actin, myosin and thrombosthenin
2 - ER and Golgi apparatus
3 - mitochondria
4 - enzyme systems for prostaglandin synthesis
5 - fibrin-stabilising factor
6 - growth factor

65
Q

What components make up the platelet surface membrane? What are their function?

A

Glycoproteins - repulse adherence to normal endothelium but adhere to injured areas
Phospholipids - role in activating clotting

66
Q

What is the half life of a circulating platelet?

A

8-12 days

67
Q

What happens to platelets following contact with a damaged vascular surface?

A

Swell and assume irregular form with multiple protruding pseudopods
Contractile proteins contract and release granules
Become ‘sticky’ - adhere to collagen and vWF
Secrete ADP, PAF and thromboxane-A2

68
Q

What are the possible sequelae following blood clot formation?

A

Invasion by fibroblasts and connective tissue formation
Dissolution

69
Q

What are the three essential steps to clotting?

A

Following vessel damage there is a cascade of chemical reactions, resulting in the formation of prothrombin activator
This catalyses the conversion of prothrombin to thrombin
This converts fibrinogen into fibrin

70
Q

What is factor I?

A

Fibrinogen

71
Q

What is factor II?

A

Prothrombin

72
Q

What is factor III?

A

Tissue factor

73
Q

What is factor IV?

A

Calcium

74
Q

Where is prothrombin formed?

A

Liver

75
Q

Where is fibrinogen formed?

A

Liver

76
Q

What activates fibrin stabilising factor?

A

Thrombin

77
Q

Briefly describe the extrinsic pathway

A

Tissue factor (FIII) released from traumatised tissue
Complexes with FVII, in the presence of calcium activated FX
Xa complexes with V to form prothrombin activator

78
Q

Briefly describe the intrinsic pathway

A

Blood trauma causes activation of FXII and release of platelet phospholipids
Activates FXI
Activates FIX
Activates FX (alongside FVIII, FIII and platelet phospholipids)

79
Q

What is needed for the activation of FXI?

A

FXIIa
High-molecular weight kininogen
Accelerated by prekallikrein

80
Q

Which steps of the coagulation cascade are dependent on calcium?

A

All except first 2 steps of intrinsic pathway

81
Q

Which clotting pathway is fastest?

A

Extrinsic

82
Q

What factors prevent blood clotting in the normal vascular system?

A

Endothelial factors
1 - smoothness of endothelial cell surface
2 - layer of glycocalyx on the endothelium
3 - thrombomodulin - binds thrombin
4 - production of prostacyclin and NO by norma intact endothelial cells

Blood-based factors
Fibrin fibres
ATIII
Heparin (not normally significant)

83
Q

What is heparin’s action?

A

Binds to ATIII and increases activity 100-1000x
Removes thrombin and FIX-XIIa

84
Q

What are the vitamin K-dependent factors?

A

II, VII, IX, X, protein C

85
Q

Where is vita normally produced?

A

Intestine

86
Q

How does liver disease cause vit K deficiency?

A

Lack of bile prevents adequate fat digestion and depresses vitK absorption

Guyton - unit questions EW (14 decks)

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