CEN 1 Hematology

Question 1

Decreased cellular perfusion secondary to lack of circulating volume

Answer 1

Hypovolemic shock

Question 2

Decreased cellular perfusion secondary to failure of the central pump

Answer 2

Cardiogenic shock

Question 3

Decreased cellular perfusion secondary to maldistribution of the oxygen to the periphery

Answer 3

Distributive shock

Question 4

Decreased cellular perfusion secondary to obstruction of blood into or out of the ventricles (e.g.
pulmonary embolism, pericardial tamponade, tension pneumothorax)

Answer 4

Obstructive shock

Question 5

name 7 different types of obstructive shock

Answer 5

Pregnancy, tension pneumothorax, cardiac tamponade, pulmonary embolism, aortic aneurysm, aortic stenosis, excessive positive end expiratory pressure or PEEP

Question 6

what is the mnemonic for remembering what receptors affect what part of the body

Answer 6

• We have ONE heart and Beta-ONE receptors mainly affect the heart
  (contractility, automaticity, heart rate, etc.). We have TWO lungs and Beta-TWO receptors
  affect mainly the lungs (bronchodilation, respiratory rate, etc.)

Question 7

this Stimulates a system

Answer 7

agonist

Question 8

this Diminishes the response of a system

Answer 8

antagonist

Question 9

How would an alpha-adrenergic agonist affect the blood pressure?

Answer 9

answer needed

Question 10

How would an anticholinergic affect the pulse rate?

Answer 10

answer needed

Question 11

How would a beta-blocker affect the respiratory rate?

Answer 11

answer needed

Question 12

Inflammatory mediators are released in response to either foreign invasion of tissue or tissue damage. They
have three main courses of action: what are they

Answer 12

Vasodilation, Increased capillary permeability, Increased coagulation

Question 13

name two isotonic solutions used to treat hypovolemic shock

Answer 13

normal saline, lactated ringer solution

Question 14

what blood type is considered the universal donor?

Answer 14

O negative

Question 15

what blood product does not have to be ABO compatible

Answer 15

platelets

Question 16

Give three examples of distributive shock

Answer 16

Neurogenic shock, septic shock, anaphylactic shock

Question 17

name 7 causes of neurogenic shock

Answer 17

Spinal cord injuries above T4 - T6, Brain injury, Spinal or general anesthesia, CNS depressants, Hypoxia, Lack of glucose or excessive insulin (insulin shock), Vasovagal syncope

Question 18

name 7 symptoms of neurogenic shock

Answer 18

Vasodilation, Gluconeogenesis, Dry skin, Bradycardia, Decreased contractility, Decreased, automaticity, Bradypnea, Bronchoconstriction

Question 19

what are some treatments of neurogenic shock

Answer 19

1 - 2 Liter fluid bolus for hypovolemia, consider, vasoconstrictor such as phenylephrine if boluses ineffective, Atropine for low heart rate, Assist respirations as needed

Question 20

what is the difference between hyperdynamic and hypodynamic sepsis

Answer 20

answer needed

Question 21

what are 7 symptoms of hyperdynamic shock

Answer 21

1. Malaise, not feeling well, tiredness, restlessness.
2. Warm, flushed, dry skin
3. Tachycardia, full bounding pulses
4. RR of more then 20
5. decreased urine output
6. respiratory alkalosis
7. fever/ chills

Question 22

what are 7 symptoms of hypodynamic sepsis

Answer 22

1. decreased LOC, stupor and coma
2. cold, clammy, pale, mottled skin
3. Tachycardia, weak, thread pulse
4. fast, shallow respirations
5. combined metabolic and respiratory acidosis
6. decreased urine output or anuria
7. hypothermia and mottled

Question 23

A patient sustaining multiple traumatic injuries presents with a BP of 50/32 mm Hg, a pulse of 146/minute, a capillary refill of 4 seconds, and no urinary output. Appropriate volume resuscitation is:

a) D5W at a rate of 3 mL for every 1 mL of blood loss
b) Hetastarch at a rate of 3 mL for every 1 mL of blood loss
c) Blood replacement at a rate of 1 mL for every 1 mL of blood loss
d) Lactated Ringers solution at a rate of 1 mL for every 1 mL of blood loss

Answer 23

C

Question 24

An overdose which results in profound central nervous system depression may result in:

a. Distributive shock
b. Obstructive shock
c. Cardiogenic shock
d. Hypovolemic shock

Answer 24

a. Distributive shock

Question 25

Which of the following assessment parameters is most consistent with early compensated hypovolemic shock? a) Respiratory alkalosis and cool clammy skin b) Hypoglycemia and decreased urinary output c) Deep, rapid respirations and hyperactive bowel sounds d) Near-normal systolic blood pressure and abnormally low diastolic blood pressure

Answer 25

a) Respiratory alkalosis and cool clammy skin

Question 26

Which of the following parameters indicates that fluid resuscitation for hypovolemia has been effective in a 200 (90 kg) pound patient? a) A declining serum pH b) A narrowing pulse pressure c) A declining serum lactate level d) A urinary output of 30 milliliters per hour

Answer 26

c) A declining serum lactate level

Question 27

what is Polycythemia and what are the causes

Answer 27

Living or visiting a high altitude Prolonged physical activity associated with hypoxia (e.g. - running a marathon) Erythrocytosis - polycythemia secondary to hypoxic diseases such as COPD

Question 28

what is polycynthemia vera

Answer 28

A condition with an overactive bone marrow resulting in high red blood cell, high white blood cell and high platelet counts. Is a genetic disease which typically affects middle-aged Jewish men. May cause heart failure and hypoxia.

Question 29

what are some factors that may precipitate the sickling of red blood cells

Answer 29

``` Low oxygen concentrations Infection Acidosis Dehydration Exposure to cold ```

Question 30

what are some clinical manifestations of sickle cell anemia

Answer 30

Sudden explosive abdominal, chest, back and joint pain Splenic ischemia can lead to increased susceptibility to infection Heart ischemia can lead to acute coronary syndromes Priapism Ulcers of the lower extremities and long thin extremities

Question 31

what are some treatments for sickle cell anemia

Answer 31

Treat the underlying cause (IV fluids for dehydration, sodium bicarbonate for acidosis, antibiotics for infection, etc.) High flow oxygen (may reverse as many as 80% of sickled cells) Pain control Support extremities on pillows Oral hydroxyurea

Question 32

what is neutropenia

Answer 32

A decrease in the white blood cells responsible for protecting the body from bacteria

Question 33

what are some common causes of neutropenia

Answer 33

Cancer treatment such as chemotherapy or radiation Immunosuppressive therapy after organ transplantation Immunosuppressive diseases such as acquired immune deficiency syndrome (AIDS) Nutritional deficits

Question 34

what are some clinical manifestations of neutropenia

Answer 34

Increased susceptibility to infection especially gram-negative bacteria Blunted responses to infection, decreased redness, swelling, edema and pus formation.

Question 35

what are some treatment considerations for neutropenia

Answer 35

Reverse Isolation Avoid the use of indwelling catheters Dilute IV medications, administer slowly Culture all potentially infected sites Early initiation of antibiotics Acetaminophen (Tylenol) alternated with ibuprofen (Motrin, Advil) every 2 - 3 hours to decrease fever and drug toxicity. Administer drugs to stimulate neutrophil production: Granulocyte colony-stimulating factor (Neupogen) Granulocyte-macrophage colony-stimulating factor (Leukine, Prokine)

Question 36

what are the tests used to diagnose HIV

Answer 36

ELISA test, Western Blot test

Question 37

what is Leukemia

Answer 37

Excessive production of abnormal, immature white blood cells. Although the number of white blood cells increases, they do not function normally and protection from infection diminishes.

Question 38

what are some signs and symptoms of leukemia

Answer 38

``` Fatigue Fever Weight loss Bone pain Elevated uric acid levels Lymph node enlargement Hepatomegaly, and splenomegaly The same precautions that were introduced for neutropenia should be maintained for leukemia. ```

Question 39

what is Idiopathic thrombocytopenia purpura, ITP

Answer 39

An autoimmune disorder that occurs most commonly in children between the ages of 2 to 4 resulting in a decreased platelet count. The disease often occurs several weeks after a viral infection or immunizations.)

Question 40

what are some signs and symptoms of ITP

Answer 40

Signs and symptoms: Indications of bleeding such as bruising, petechiae, purpura, epistaxis, bleeding gums, gastrointestinal bleeding, and hematuria.

Question 41

what is Thrombocytosis

Answer 41

abnormally elevated platelet count which leads to an increased risk of spontaneous clot formation

Question 42

what is Disseminated intravascular coagulation (DIC)

Answer 42

DIC is not a disease, but rather an abnormal activation of the body's clotting system that signals severe underlying problems. It involves both abnormal clotting and abnormal bleeding.

Question 43

Which of the following patients is at highest risk for developing idiopathic thrombocytopenia purpura (ITP)? a) A 3-year-old whose last chicken pox has just disappeared b) A 52-year-old patient who is on daily aspirin for heart disease c) A 17-year-old with an infected laceration to the dorsum of the right hand d) An 80-year-old with a fractured humerus after falling down a flight of stairs

Answer 43

a) A 3-year-old whose last chicken pox has just disappeared

Question 44

Which of the following statements, made by a patient being discharged home with leukemia, indicates they have understood their discharge instructions? a) "I will avoid exercising to decrease stress on my body." b) "I will change my tampons at least hourly to prevent infection." c) "I will call the doctor if my temperature exceeds 100°F (38°C)." d) "I will avoid taking aspirin or nonsteroidal anti-inflammatory drugs to decrease the risk of bleeding."

Answer 44

c) "I will call the doctor if my temperature exceeds 100°F (38°C)."