General

Question 1

Septic Shock

Answer 1

=^CO & low SVR (due to inflam mediators)
(initially, maintains CO by ^ing inotropy)
Mech:
Systemic inflam –> leaky BV –>fluid pools
(warmth) –>begins to pool in lungs –>resp. probs
Sx:
-^WBC, fever, shaking chills
-productive cough
-hypotension, tachycardia
Tx: restore hemodynamics + antibiotics
Hemodynamics:
i. ^intravascular vol (fluids)
ii. Vasopressors (NE: a & B agonist ^ CO (B), ^PVR (a))

Question 2

3 types of shock

Answer 2

=inadequate tissue perfusion
–> ischemia –>end organ damage
ALL: Decreased BP
i. Septic shock: ^CO, low SVR (inflam mediators), warm
ii. Cardio shock: ^PCWP, ^SVR
iii. Hypovolemic shock: decreased PCWP, ^SVR

Question 3

Hypovolemic Shock

Answer 3

=decreased PCWP, ^SVR
Cause: hemorrhage, dehydration, burns
Mech: decreased venous return –> decreased preload –> decreased SV –> decreased CO –> So ^HR, contractility, BV constriction
Later stages: hypotension

Question 4

Cardiogenic Shock

Answer 4

=^preload/PCWP, decreased CO, ^afterload
Causes: acute MI, HF, valvular dysfxn, arrhythmia
Tx: 
   -inotropes
   -diuresis

Question 5

Carotid sheath anatomy

Answer 5

Internal jugular v is lateral to common carotid artery & anterior to vagus n.
Outside–>internal jugular –>common carotid a –>esophagus

(Femoral triangle: vein is medial to artery
outside–>artery –>vein)

Question 6

Spur cell (Acanthocyte)

Answer 6

-Liver dz
-Abetalipoproteinemia (states of cholesterol dysregulation)
“Acantho”= spiny

Question 7

Basophilic Stippling

Answer 7

Blue dots in RBC

• Pb poisoning
• Sideroblastic anemia
• Myelodysplastic syndromes

Question 8

Dactocyte (tear drop)

Answer 8

=RBC “sheds a tear” bc it’s mechanically squeezed out of BM
BM infiltration
-myelofibrosis

Question 9

Degmacyte (bite cell)

Answer 9

G6PD def

Question 10

H&E stains

Answer 10

H: basic, +, violet –> binds acidic/ - structures
DNA/RNA
E: acidic, -, red –> binds basic, + structures
protein

Question 11

Echinocyte (burr cell)

Answer 11

Spiny //Acanthocyte BUT projections are more uniform & smaller

• ESRD
• Liver dz
• Pyruvate kinase def

Question 12

Elliptocyte

Answer 12

-Hereditary elliptocytosis (usually asymp)

Question 13

Macro-ovalocyte

Answer 13

No indentation, large, oval

• Megaloblastic anemia (+hypersegmented PMNS)
• BM failure

Question 14

Ringed Sideroblast

Answer 14

Blue, white circular area

• Sideroblastic anemia
• excess Fe in mito

Question 15

Schistocyte

Answer 15

RBC fragments

• DIC
• TTP/HUS
• HELLP syndrome
• Mechanical hemolysis (eg heart valve prothesis)

Question 16

Spherocyte

Answer 16

Sold RBC (no indentation)

• hereditary spherocytosis
• drug & infection induced hemolytic anemia

Question 17

Target cell

Answer 17

"HALT" said the hunter to his Target
-HbC dz
-Asplenia
_liver dz
-Thalassemia