Exam 2 Flashcards
(218 cards)
1
Q
What percent of blood is water and plasma?
A
55%
2
Q
What percent of blood is formed elements?
A
45%
3
Q
What are the formed elements of blood?
A
Rbc, wbc, and platelets
4
Q
What are the three main plasma proteins?
A
Albumin, fibrinogen, and globulins
5
Q
What is the main function of albumin?
A
It maintains blood osmotic pressure
6
Q
What does low albumin lead to?
A
Extra fluid in interstitial spaces and extra fluid in the cells
7
Q
What are immunoglobulins produced by?
A
Plasma cells (mature B cells)
8
Q
What is hematopoesis?
A
Formation of new blood cells
9
Q
What is a pluripotent stem cell?
A
A stem cell that can differentiate into many different types of cells
10
Q
What are examples of two growth factors that stimulate the differentiation of pluripotent stem cells?
A
Erythropoetin and granulocyte colony-stimulating factor
11
Q
What is a progenitor cell?
A
It is more differentiated than a stem cell but not yet in its “final” form
12
Q
Do RBCs have a nucleus?
A
No
13
Q
What are two reasons that red blood cells have a biconcave disc shape?
A
To make them more flexible for easy passage thru vessels, and for greater surface area for gas exchange
14
Q
What is the average amount of RBC?
A
4 x 10 to the 6/uL of blood
15
Q
What is erythropoesis?
A
The formation of new red blood cells
16
Q
What are the three types of cells in rbc formation?
A
Erythroblast, reticulocyte, erythrocyte
17
Q
What is the lifespan of a reticulocyte?
A
One day
18
Q
What is the lifespan of an erythrocyte?
A
120 days
19
Q
What three nutrients are required for erythropoesis?
A
Iron, folic acid and vitamin B12
20
Q
What three parts of the red blood cell are re-used after it is broken down?
A
Hemoglobin, iron, and globulin
21
Q
What two organs break down old red blood cells?
A
The liver and spleen
22
Q
What is globulin converted to when broken down?
A
Amino acids
23
Q
What happens to the portion of the red blood cell that is not re-used?
A
It is converted to bilirubin and excreted in the stool (as bile) or in the urine
24
Q
At what rate are red blood cells destroyed?
A
At the rate they are created
25
What is hemoglobin composed of?
Heme and the globulin protein
26
What molecule carries iron to the bone marrow for hemoglobin synthesis?
Transferrin
27
How many different types of abnormal hemoglobin are there?
Over 100
28
What is the common, adult type of hemoglobin?
HbA
29
What is the hematocrit?
The percent of the blood that is taken up by RBCs
30
What is the average hematocrit?
45%
31
Is hematocrit alone a good indication of potential anemia?
No - it must be looked at with other lab tests
32
What is dilutional hematocrit and in what two populations does it occur?
It is a normal hematocrit that looks low because of an abnormally large volume of circulating fluid - occurs in pregnant women and in people with too much IV fluid
33
What does Mean Corpuscular Volume describe?
The average size of a patient's red blood cells
34
How is Mean Corpuscular Volume described?
As normocytic, macrocytic, or microcytic
35
What does Mean Corpuscular Hemoglobin Concentration describe?
The average hemoglobin weight in a red blood cell, calculated per given volume of rbc's
36
How is Mean Corpuscular Hemoglobin Concentration described?
As normochromic, hyperchromic, or hypochromic
37
What does Mean Corpuscular Hemoglobin describe?
The average weight of hemoglobin in each individual red blood cell
38
What does Mean Corpuscular Hemoglobin reflect?
Both the size of the RBC and the concentration of hb in the RBC
39
What is the Red Cell Distribution Width?
The RBW is the standard deviation of the Mean Corpuscular Volume
40
What type of anemia produces a normal RBW?
Thalassemia
41
What does the RBW help us understand?
The variation in red blood cell size in a patient
42
What is the reticulocyte count a reliable measure of?
Red blood cell production
43
What is anisocytosis? What is it due to?
Abnormally sized RBCs. Due to severe anemia
44
What is poikilocytosis? What is it due to?
Abnormally shaped RBCs. Due to severe anemia
45
When does basophilic stippling occur?
With lead poisoning
46
What three factors can anemia be due to?
Low red blood cell count, low hemoglobin, or low hematocrit
47
Why are an elevated resp. rate and SOB seen in anemia/hypoxemia?
Because the body is not circulating enough O2, so it is trying to get more O2 into the system
48
What would be an example of something that could cause a production deficit of RBCs?
A lack of dietary folic acid
49
What is destroyed in an anemia due to a 'destruction deficit'?
Either bone marrow or RBCs themselves
50
What are two examples of microcytic, hypochromic anemia?
Thalassemia, iron deficiency
51
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in anemia of chronic disease?
Normocytic and normochromic
52
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in B12 anemia?
Macrocytic and normochromic
53
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in folic acid deficiency anemia?
Macrocytic and normochromic
54
What is aplastic anemia caused by?
By the bone marrow not working correctly -- can be caused by chemo
55
What lab result would you expect to see in aplastic anemia?
Low reticulocyte count
56
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in aplastic anemia?
Macrocytic and normochromic
57
What are the Mean Corpuscular Volume and the Mean Corpuscular Hemoglobin Concentration in iron deficiency anemia?
Microcytic and hypochromic
58
What is the most common type of anemia?
Iron deficiency anemia
59
What is iron deficiency anemia commonly due to?
Chronic blood loss, ie. from heavy menstruation or from a GI bleed
60
What does the serum iron test measure? What important information does it not tell you?
How much iron is in the blood -- but not how much is stored
61
What are two factors that the serum iron test can be affected by?
Time of day and whether or not a woman is menstruating
62
What does the serum ferritin test measure?
How much iron is stored in the body
63
The serum ferritin test is a good marker for what type of anemia?
Iron deficiency anemia
64
How long does it take to completely replenish the body's stores of iron thru iron supplementation?
6 months-1 year
65
What does the transferrin concentration test tell you?
How many binding sites on transferrin are full of iron
66
How is transferrin related to iron stores?
Inversely -- ie, as iron stores increase, transferrin decreases
67
What does TIBC stand for and what does it mean?
It stands for Total Iron Binding Capacity and it reflects how many places there are on the transferrin for iron to bind
68
What does hematochromatosis mean?
That there is an overload of iron in the body
69
What does the transferrin saturation test tell you?
The percent of transferrin that is saturated with iron
70
What is the average amount of iron in the daily diet?
10-20mg
71
What is the average amount of stored iron in the body?
500-1500 mg
72
What are four symptoms of iron deficiency anemia?
Brittle nails, glossitis, pica, and clubbed nails
73
What is glossitis?
Smooth, red tongue
74
How should iron deficiency anemia be treated?
By treating the underlying cause (ie, bleeding)
75
How long after iron deficiency anemia is treated should reticulocytosis begin?
Four to five days after
76
What is megaloblastic anemia caused by?
A deficiency of Vitamin B12 or folic acid
77
What two things could a B12 deficiency be due to?
A dietary deficiency or problems with receptors
78
What type of anemia is megaloblastic anemia?
Macrocytic
79
Where is B12 stored?
In the liver
80
What two things could pernicious anemia be caused by?
A deficiency of intrinsic factor or by blockage of the bonding sites by type 1 and type 2 antibodies
81
What are four symptoms of prolonged B12 deficiency?
Premature gray hair, loss of two-point discrimination, tingling, weakness
82
Is the Schilling test used today?
No
83
What type of anemia is produced by B12 deficiency? (MCV and Mean Corpuscular Hemoglobin Concentration)
Macrocytic and normochromic
84
In what population is folic acid deficiency common?
Pregnant women
85
What is the MCV and Mean Corpuscular Hemoglobin Concentration of anemia produced by a folic acid deficiency?
Macrocytic and normochromic
86
What are two symptoms of acute anemia?
Low blood pressure and high heart rate
87
What is the second most common type of anemia?
Anemia of inflammation and chronic disease
88
What is anemia of inflammation and chronic disease seen with?
Chronic infection, inflammation and cancer
89
What is polycythemia?
An excess of red blood cells
90
How does the blood appear in polycythemia?
Thick and sludgy
91
What occurs in the blood in relative polycythemia?
The hematocrit rises and there is a loss of plasma volume
92
What type of polycythemia is polycythemia vera?
Primary polycythemia
93
What are two factors that secondary polycythemia could be due to?
High altitudes and smoking
94
What is the main function of the respiratory system?
To provide the body with O2 and remove CO2
95
Name three secondary functions of the respiratory system
Facilitating smell, producing speech, and maintaining heat balance
96
Name three structures of the upper resp. tract
Nasal cavity, sinuses, nasopharynx
97
What do the sinuses do?
Produce speech resonance
98
What does acinus mean?
This is the term used for all structures that are distal to the terminal bronchiole
99
How many lobes does the right lung have and how many lungs does the left lung have?
Right has 3; left has 2
100
What three nerves innervate the lungs?
Phrenic nerve, vagus nerve and thoracic nerve
101
What nerve innervating the lung controls parasympathetic activity?
The vagus nerve
102
What happens to the diaphragm during inspiration?
It contracts/flattens
103
Is inspiration active or passive? What about expiration?
Inspiration is active; expiration is passive
104
What is atelectasis?
Collapse of the alveoli in the lungs
105
What does the mucociliary blanket do?
It entraps dust and other foreign particles
106
What is pleural effusion?
The abnormal collection of fluid in the pleural cavity
107
What are three risk factors for respiratory disease?
Smoking, allergies, surgery
108
What is the technical term for an enlarged heart?
Cardiomegaly
109
What physiologic change occurs with chronic respiratory disease?
Flattening of the diaphragm
110
What must you ensure the patient can do before performing a chest xray?
Inhale and hold it
111
What are two ways a sputum sample can be obtained?
Thru expectoration or tracheal suctioning
112
What time of day is it best to obtain a sputum sample?
In the early morning
113
What is the minimum amount that must be obtained for a sputum sample?
3 teaspoons (15 mL)
114
What is a bronchoscopy?
The direct visual examination of the larynx, trachea and bronchi with a scope
115
How long should the patient be NPO before a bronchoscopy?
The patient should be NPO midnight prior
116
When is it safe to give foods by mouth following a bronchoscopy?
When the gag reflex has returned
117
What is one thing that should be done before a bronchoscopy?
Obtain patient's vital signs
118
What are four possible complications of a bronchoscopy?
Bronchospasm, bacteremia, bronchial perforation and fever
119
What is a pulmonary angiography?
An x-ray of the pulmonary vessels taken via catheter inserted via a vein or artery
120
What allergy should be assessed for prior to a pulmonary angiography?
Iodine
121
How long should a patient be NPO for before a pulmonary angiography?
For 8 hours prior
122
What is thoracentesis?
The removal of fluid or air from the pleural space with a needle inserted between the ribs
123
What type of patients is thoracentesis done for?
Cancer patients
124
What two things should a patient be monitored for after thoracentesis?
Signs of pneumothorax and air embolism
125
What is the inspiratory reserve volume?
The amount of air that can be breathed in beyond a normal breath
126
What is the tidal volume?
The amount of air inhaled and exhaled with each resting breath.
127
What is the expiratory reserve volume?
The maximum amount of air that can be exhaled from the resting end-expiratory position
128
What is the total lung capacity for a normal adult?
6 liters
129
How much of the total lung capacity for a normal adult is used in gas exchange?
4 liters
130
What does percutaneous mean?
Under the skin
131
What are two things that a pulmonary function test is used to evaluate?
Lung mechanics and gas exchange
132
What two drugs should not be used before a pulmonary function test? Why?
An analgesic (can depress lung function) or a bronchodilator (will skew results)
133
What does the ventilation-perfusion lung scan measure?
The amount of air that reaches the alveoli, as well as the blood flow to the lungs
134
What is the residual volume?
Amount of air left in the lungs after maximal expiration.
135
What is the forced vital capacity (FVC)?
Max. amount of air that can be forcefully exhaled from lungs after full inspiration.
136
What is the Forced Expiratory Volume in 1 second (FEV1)?
The amount of air that can be forcefully expired in the first second of FVC
137
What happens to the V/Q ratio if there is decreased ventilation?
The ratio decreases
138
What happens to the V/Q ratio if there is a problem with perfusion?
The ratio increases
139
How does a bronchography differ from a broncoscopy?
The bronchography uses dye
140
What does the arterial blood gases test measure?
The O2 and CO2 in arterial blood
141
What test should be done prior to the arterial blood gases test?
The Allen test
142
What is the normal pH of the blood?
7.35-7.45
143
What does the O2 saturation tell you?
The amount of oxygen that is attached to hemoglobin
144
What test is usually done to measure O2 sat?
Pulse ox (pulse oximetry)
145
Below what level are pulse ox results usually life-threatening?
Below 70%
146
What is pneumonia generally defined as?
Acute inflammation of the parenchymal tissues (alveoli and bronchi)
147
What are the nasopharyngeal defenses affected by? (Name two things)
Colds, hay fever
148
What is often a first sign of pneumonia in the elderly?
Uncharacteristic falls
149
What are four possible complications of pneumonia?
Bacteremia, septicemia, abscess in the lungs, and empyema
150
What is empyema?
Pus in the pleural cavity
151
What is the difference between bacteremia and septicemia?
Bacteremia stays localized and septicemia is systemic
152
What is the most common etiology of pneumonia?
Bacteria (both gram positive and gram negative)
153
Are hospital acquired infections usually gram negative or gram positive?
Gram negative
154
What's one example of a gram negative pneumonia?
Legionella pneumonphila
155
What's one example of a fungal pneumonia?
Histoplasmosis
156
What type of pneumonia is either fungal or protozoan and often occurs in AIDs patients?
Pneumocystis carinii
157
Besides microorganisms, what are two other etiologies of pneumonia?
Smoke inhalation and food aspiration
158
What kind of sputum does pneumococcal pneumonia produce?
Purulent & rusty
159
What type of pneumonia produces a red, gelatinous sputum?
Klebsiella
160
When does the congestion stage of pneumonia occur?
In the first 4-24 hours
161
When does the red hepatization stage of pneumonia occur?
At 48 hours
162
What happens in the red hepatization stage of pneumonia?
Red blood cells and granulocytes move into the alveoli
163
When does the grey hepatization stage of pneumonia occur?
72 hours-one week
164
What happens in the grey hepatization stage of pneumonia?
Fibrin accumulates and RBC’s and granulocytes start to disintegrate
165
When does the resolution stage of pneumonia start if the patient is not on antibiotics?
After 1 week to 12 days
166
When does the resolution stage of pneumonia start if the patient is on antibiotics?
After 48 hours
167
If the provider doesn't know the exact cause of a pneumonia, what is their typical course of action?
They will start the patient on either a broad-spectrum anti-b or on the antibiotic that treats what they believe the pneumonia to be caused by
168
What is obstructive pulmonary disease?
When a patient can get air in and but not get it out
169
What are two examples of obstructive disease?
Asthma and chronic bronchitis
170
What is restrictive pulmonary disease?
When the patient can't get air in but can get it out
171
What are three examples of restrictive pulmonary disease?
Pleural effusion, hemothorax, and thoracic cage disorders
172
What does asthma do to the bronchial airways?
Narrows them
173
What is another name for asthma type I?
Extrinsic atopic
174
What is extrinsic atopic asthma mediated by?
IgE
175
What two things increase in asthma type I?
Eosinophils and IgE
176
What is exercise-induced asthma triggered by?
Cool air with less water vapor
177
What is ASA triad asthma triggered by?
A delayed hypersensitivity reaction several hours after taking NSAIDs
178
What are the two broad categories of asthma triggers?
Bronchospastic and inflammatory
179
When does the early response to asthma begin and when does it end?
It begins within about 10 minutes and ends after about 90 mins
180
When does the late response to asthma begin and how long can it last for?
Begins after 3-5 hours and can last for days to weeks
181
What are the two kinds of inhalers used for asthma and how often are each used?
The rescue inhaler (not used daily) and the steroid based inhaler (used daily)
182
Is asthma obstructive or restrictive?
Obstructive
183
A peak expiratory flow reading (PEFR) of below what percent indicates a risk for respiratory failure?
Below 25%
184
What are four symptoms of asthma?
Dyspnea, tachypnea, wheezing and cyanosis
185
Is asthma more common in boys or in girls?
Boys
186
What is paresthesia?
Tingling or prickling sensation of the skin
187
Which type of anemia has paresthesia as a symptom?
B12 deficiency anemia
188
Is tachycardia a symptom of hypoxemia?
Yes
189
Is bradypnea a symptom of hypoxemia?
No
190
What are two symptoms of folic acid deficiency anemia?
Fatigue and dyspnea
191
What is pernicious anemia caused by?
Autoimmune destruction of the gastric parietal cells
192
Does bleeding result in a higher or lower reticulocyte count? Why?
Higher, because the body is trying to compensate for a loss of RBC
193
Is a vegetarian diet likely to result in low folate levels?
No
194
Which of the lab tests provides the least clinically relevant info?
Mean Corpuscular Hemoglobin
195
What are the four categories of drugs used to treat asthma?
B2 adrenergic bronchodilators, anticholinergic bronchodilators, corticosteroids, and mast cell stabilizers
196
What are two examples of B2 adrenergic bronchodilators?
Albuterol and epinephrine
197
What effect does obstructive pulmonary disease have on vital capacity and FEV?
VC is normal but FEV is low
198
What effect does restrictive pulmonary disease have on vital capacity and FEV?
VC is abnormal and FEV is normal
199
What are the requirements for a diagnosis of chronic bronchitis?
Bronchitis present for at least three months out of the year or for 2 months/year for two successive years
200
What happens to the residual lung volume and the vital capacity during an asthma attack?
Residual lung volume increases and vital capacity decreases
201
Why does pursed lip breathing improve ventilation?
It increases pressure in the small airways to prevent their collapse
202
What is a good dietary modification for patients with COPD?
Avoiding foods that require a lot of chewing
203
In a person with normal lung function, the amount of air forcibly exhaled in 1 second (FEV1) is what percentage of the vital capacity (VC)?
75%
204
What is vital capacity?
Maximal amount of air that can be taken in and exhaled with forceful expiration.
205
What is ventilation defined as?
Delivery of air to the alveoli
206
What effect does a decreased pH have on resp. rate?
It increases the resp. rate
207
What is destroyed in emphysema?
The alveolar walls
208
What kind of chest occurs in emphysema?
Barrel chest
209
Does emphysema produce a lot of coughing and/or sputum?
No
210
What are two symptoms of emphysema?
Tachypnea and dyspnea
211
In which disease does weight loss often occur, emphysema or chronic bronchitis?
Emphysema
212
Are ronchi a symptom of emphysema or chronic bronchitis?
Chronic bronchitis
213
Is cyanosis a symptom of emphysema or chronic bronchitis?
Chronic bronchitis
214
What is cor pulmonale?
Enlargement of the right side of the heart due to lung disease
215
Is cor pulmonale more often a symptom of chronic bronchitis or emphysema?
Chronic bronchitis
216
What part of the lungs are affected by chronic bronchitis?
The bronchial walls are inflamed
217
What are two types of COPD?
Emphysema and chronic bronchitis
218
Which type of COPD is characterized by a productive cough?
Chronic bronchitis
