Quiz 4 (test 2) Flashcards
(189 cards)
1
Q
Define atelectasis. Can be due to what three things.
A
AKA collapse
Inadequate expansion or collapse of airspaces. Gives rise to hypoxia
Airway obstruction (aspiration)
Compression (pneumothorax)
Contraction due to lung or pleural fibrosis
2
Q
Acute respiratory distress syndrome is a progression of ___ injury by either __ or __ damage. And damage from activated ____ and fluid accumulation.
A
Acute lung injury
Physical or chemical damage
Activated neutrophils. Their products cause damage of alveolar epithelial and vascular structures
3
Q
Name four types of chronic obstructive pulmonary diseases
A
Emphysema
Chronic bronchitis
Asthma
Bronchiectasis
4
Q
Chronic obstructive pulmonary disease is a very common disease and the main cause is ___
A
Smoking
5
Q
Emphysema is due to destruction of _____ in ____ leading to permanent (enlargement/shrinkage) of airspaces.
A
Elastic fibers
Alveolar walls
Enlargement
(Barrel lung is a result because too much air is in the lungs and it is difficult to get out)
6
Q
What are three common causes of emphysema?
A
Smoking (most cases)
Alpha-1 antitrypsin deficiency (familial type)
Air pollution
7
Q
What is the clinical presentation of emphysema?
A
Hyperinflation of lungs with barrel chest
Long expiration phase with pursing of lips
Clinically apparent after 1/3 of lung is destroyed
Dyspnea w/ cough and wheezing
8
Q
What is the key diagnostic feature in diagnosing emphysema on a radiograph?
A
Flattened diaphragm over liver
9
Q
What is the underlying etiology of emphysema?
A
**Imbalance of protease and anti-protease activity (alpha-1-antitrypsin deficiency)
Neutrophils and macrophages release elastase and oxygen free radicals
Smoking increases inflammation and inhibits alpha-1-antitrypsin
10
Q
Which is worse, centrilobular emphysema or panacinar emphysema? Why?
A
Panacinar emphysema is worse because it is alpha-1-antitrypsin deficiency related
11
Q
What is a pneumothorax?
A
Air pockets into the pleural spaces causing collapse of lungs
12
Q
What is the diagnostic criteria for chronic bronchitis?
A
Persistent cough for over 3 months in 2 consecutive years
13
Q
What are the causes of chronic bronchitis?
A
Smoking and air pollution
14
Q
Patients who are “blue bloaters”? Have what disease?
A
Chronic bronchitis
15
Q
What is the pathology behind chronic bronchitis?
A
Hypersecretion of mucus by airways
Microbial (viral or bacterial) infection is often secondarily present
16
Q
What is bronchiectasis?
A
Obstruction of bronchi and persistent necrotizing infections. This will cause destruction of elastin and muscles in bronchial walls.
17
Q
What are two congenital causes of bronchiectasis?
A
Cystic fibrosis
Kartagener’s syndrome (defective cilia)
18
Q
What are some microbes that may cause bronchiectasis?
A
TB
Staphylococcus
Klebsiella
These cause hypersecrion of mucus in airways
19
Q
Which lung disease is characterized by a persistent productive cough (often foul smelling) (sometimes blood) hemoptysis and if widespread, hypoxemia occurs. Destruction of muscle, cartilage, and elastin of the bronchial walls occurs
A
Bronchiectasis
20
Q
What lung disease is considered a reactive airway disease that leads to narrowing of airways. It is considered a bronchial hyper-reactivity)
A
Asthma
21
Q
True or false… it is difficult for asthma patients to breath in
A
False.. it is difficult for them to breath out (COPD)
22
Q
What are the two types of asthma? Describe them.
A
Atopic: allergic reaction. Hypersensitivity response. Onset occurs with other allergic responses
Non-atopic: non allergy related. May be family related. Causes are not clear.
23
Q
Asthma typically occurs in (younger/older) patients. It is precipitated by ___ stimulation. It causes shortness of breath and chest tightness-wheezing.
A
Younger
Vagal
24
Q
In regards to the pathology of asthma… the lungs are ___-inflated. There are thick mucus plugs in the ___. Smooth muscle ____. ____ infiltration
A
Hyperinflated
Airways
Hypertrophy
Eosinophili (IGE)
25
For restrictive diseases, it is difficult to (inhale/exhale). Chest imaging shows a diffuse _____ appearance. It is (more/less) common than COPD.
Inhale
Ground glass
Less
26
Fibrosing diseases ( a type of restrictive disease) is associated with ___ vascular diseases such as _____.. it can cause ____-sided heart failure
Collagen.
Rheumatoid arthritis
Left
27
Which of the fibrosing diseases is a worse prognosis, usual interstitial pneumonitis, non-specific interstitial pneumonitis, or respiratory bronchioloitis interstial lung disease.
Usual insterstial pneumonitis (fibroblastic foci in histo)
RB-ILD is a good prognosis with smoking cessation and steroids
28
Name three work related restrictive lung diseases. Describe them
Coal workers pneumoconiosis (anthracotic/carbon)
Silicosis (most prevalent. Caused by inhalation of crystalline silica by sand blasters and hard rock miners)
Asbestosis (associated increased risk of both lung carcinoma and mesothelioma - cancer of the pleura)
29
True or false... sarcoidosis causes a restrictive lung disease
True
30
What is a characteristic finding of sarcoidosis in the lung?
Non-caseating granulomas in lung and mediastinal lymph nodes
It is a restrictive disease caused by abnormal CT and reduced elastic properties. Sarcoidosis has multi-organ involvement
31
Sarcoidosis is lethal in __% of the cases. It is an ___-related disease
10%
Immune (abnormally stimulated T cells)
Note that African Americans have a 10X greater risk
32
Hypersensitivity pneumonia is is caused by ___ or ___.
Mold (farmers lung)
Animal products (bird fancier's disease)
Need to remove antigen from environment to allow the pt to heal
May be an acute reaction or result in end stage lung disease
33
What are some iatrogenic causes of pulmonary fibrosis (restrictive)?
Chemotherapy (bleomycin, busulfan)
Radiation
IV contamination
34
What is hemoptosis?
Coughing up blood. Seen with most diseases causing severe coughing
35
Name three vascular disease of the lung.
Pulmonary emboli
Pulmonary HTN
Vasculitis
36
Pulmonary emboli can cause sudden death with occlusion of the ___ artery. Emboli originate from ___. What can cause this?
Main pulmonary artery
Deep veins of the legs
Prolonged bed rest, surgery, congestive heart failure, surgery
37
Small pulmonary emboli can result in ___
Pulmonary HTN
38
What is the difference between primary and secondary pulmonary HTN?
Primary - seen in young patients with SOB
Secondary - more common. Causes heart disease, chronic lung disease, and recurrent thromboemboli
39
Pulmonary HTN can cause ___ ventricular failure. It can also cause what three things.
Right. (Cor pulmonale)
SOB, fatigue, chest pain
40
True or false.. diffuse alveolar hemorrhages can be caused by autoimmune responses
True
41
Name two diffuse alveolar hemorrhage syndromes.
Goodpasture syndrome
Wegener granulmatosis
42
True or false... in restrictive lung diseases gas change is left unimpaired.
False. It is impaired by thickened septal walls
43
What are the two types of vascular lung diseases?
Abrupt (PE)
Insidious (PPH)
44
True or false... in obstructive lung diseases gas exchange through septal walls is left unimpaired
True.
45
Chronic bronchitis is caused by ___ hypersecreiotn and associated with productive coughing. It increases the ___ index, which is defined as...
Mucus
Reid
Increased ratio of mucus gland to bronchial wall
46
What are the symptoms of walking (community) pneumonia?
Low-grade fever
General malaise (although still functioning)
Nonproductive cough and respiratory distress out of proportion to radiologic findings
47
What are the symptoms of community acquired pneumonia? What causes it?
Acute onset fever, chills, hemolysis, productive cough
S. Pneumoniae, H. Inluenzae, M. Catarrhalis, S. aureus
48
True or false... TB only affects the lungs
False. It may affect other organs
49
T or F... TB is non contagious during long periods of dormancy
True
50
What is miliary TB?
Organisms break off and wide-spread TB throughout body
51
What are ghon complexes?
Granulomas of TB that have been walled off and contained and are associated with a lymph node. These are found in primary TB
52
Pulmonary fungal infections are usually by ___ fungi
Dimorphic
Can cause acute pulmonary infection, chronic graulomatous lung infection, or disseminated milliary disease
53
____ is the leading cause of cancer death worldwide
Carcinoma of the lung
54
___% of primary lung cancers are carcinomas. What are the most common types? Which is the most aggressive?
95%
Adeno and squamous cell types are the most common
Most aggressive are the small cell (OAT) carcinoma
55
____ carcinoma of the lung is commonly associated with smokers
Smokers are ___x more likely to develop lung cancer than the general populiation
Squamous cell
55
56
True or false... lung tumors frequently spread to the brain.
True
57
Asthma is most prevalent in __ and ___
Children
Females
58
What are the relievers for asthma? Describe them.
Short-acting. Used for less severe cases
Typically beta2 agonist at minimum dose and frequency such as..
Albuterol (rapid onset 4-6hr effectiveness)
Salmeterol (slower onset, 12 hr effectiveness)
Mechanism: directly relax airway smooth muscle
59
What are the controllers for asthma?
Taken regularly for long-term stable control. Often more side effects
Inhaled: corticosteroids/drug of choic for moderate to severe asthma. Often combined with beta 2 agonists. Chronic management, not for rescue
60
Name one controller for asthma. What are the side effects?
Fluticasone
Nose bleeeds, sores in nose, mouth, and tongue that dont heal
61
What are the add-on controllers for asthma? What is their mechanism?
Methylxanthine drugs; theophylline (tablet or inhaler)
Mechanism: phosphodiesterase inhibtor and increases cAMP and relaxes airway smooth muscle
Monotherapy for mild asthma
combine with corticosteroids to reduce steroid doses and side effects
62
Name one antimuscarinic used to treat asthma. How does it work?
Ipratropium
Reverses contraction of smooth muscle from vagal activity. Usually a backup for beta 2 agonists
63
Name one leukotriene modifier. How does it work?
Montelukast (singulair)
Use is for prophylaxis for patients who have trouble with inhaled therapies. This drug is taken orally
Mechanism: block leukotriene-binding to receptor
64
What is cromolyn?
Used for treating asthma
Inhibits release of inflammatory mediators such as histamine
65
What is omalizumab?
Used for treating asthma.
Inhibits IgE binding to mast cells-very expensive. Only for severe non-responsive asthma
66
What are three things to consider regarding the dental relevance of asthma?
Asthmatics tend to be mouth breathers - dry mouth
Asthma inhalers irritate mucosa of mouth, especially back of roof of mouth
Make sure asthmatics brain inhalers to appointment; avoid asthma attacks
67
In order to treat COPD, you can use longer acting bronchodilators such as ____. Longer acting beta 2 agonists such as ___. ___ with glucocorticoids (because glucocorticoids alone are not very effective). Typically responses are not as good as with asthma
Tiotropium bromide (spireva)
Salmeterol
Theophylline
68
What is oseltamivir (tamiflu) used to treat?
Influenza
It prevents separation of virus particle from cell receptors, stopping viral spread - earlier treatment essential
69
What are the symptoms of allergic reactions?
Itching, hovers, sneezing, and wheezing, difficulty breathing
70
Reaction to allergens causes release of histamine from mast cells and basophils which do what four things?
Contract pulmonary smooth muscles
Dilate blood vessels-lowers BP
Increases permeability of vessels
Increases gastric secretion
71
What drugs should you use to treat allergic reactions?
Antihistamines (H1 blockers have anticholinergic/sedation side effects): diphenhydramine (Benadryl), chlorpheniramine
Epinephrine: potent reversal - vasoconstriction and reduces fluid in lungs so breathing improves and swelling reduces
72
What are diphenhydramine and chlorpheniramine used to treat?
Allergies
73
What is Anuria, polyuria, and bladder distention? Can pts with urinary obstruction be asymptomatic?
Anuria: nonpassage of urine
Polyuria: production of abnormal quantity of dilute urine
Bladder distention: chronic painful bladder
Yes, pts may be asymptomatic. Symptoms vary depending on where their partial obstruction, complete, unilateral, or bilateral.
74
What are the possible symptoms associated with urinary obstruction?
Anuria
Polyuria
Bladder distention
Symptoms vary. May be asymptomatic
75
What are the symptoms associated with kidney stones?
Renal colic - abnormal pain that is referred to the sides and groin area
Hematuria - blood in the urine
Pyelonephritis - inflammation of the kidney, usually as a result of bacterial infection
May be asymptomatic
76
Most kidney stones (75%) are composed of ___. The rest are typically composed of ___
Calcium oxalate/phosphate
Magnesium ammonium phosphate
77
What is pyelonephritis caused by?
Retrograde spread from cystitis or hematogneous spread of infection
Commonly seen with urinary obstruction, stenosis, or reflux
Associated with diabetes. More severe in diabetics. (May cause papillary necrosis)
78
What are the consequences of pyelonephritis?
Flank pain
Fever
10-20% chronic renal failure
Kidney scarring
79
Adenomas in the kidney are identical to papillary renal cell carcinoma but are less than ___cm.
1.5
80
Renal cell carcinoma make up ___% of all renal malignancies
80-90%
81
Renal cell carcinomas are are more common in what population? Also in pts who....
Males over the age of 40 and in smokers
Abuse NSAIDs and/or are obese
82
What are 5 symptoms of renal cell carcinomas?
Often asymptomatic
Hematuria
Dull flank pain
Fever
Fatigue
83
Renal cell carcinomas are most likely to metastasize to what locations?
Lungs or bones
84
What is the most common congenital renal tumor?
Wilms tumor
Most common in first 3 years
It is triphasic (epithelial, mesenchymal, blastemal components)
85
What are 4 contributing factors to bacterial cystitis?
Stones
Catheters
Short femal urethra
Obstructions
86
Bacterial cystitis is usually related to what bacteria?
E. Coli
87
Urothelial carcinoma is most often seen in (females/males) over the age of __. It is associated with ___, and carcinogens.
Males
50
Smoking
88
What is the most common urothelial malignany?
Urothelial carcinomas
89
___ is the most common bladder malignancy in children
Rhabdomyosarcoma
90
What typically causes prostatitis? Prostitis cause enlarged and tender prostate and can cause ___. It is most commonly found in ___ men. It is commonly seen with ___
Bacterial infection (like cystitis)
Obstruction
Older
Benign prostatic hyperplasia
91
__% of men over the age of 75 have benign prostatic hyperplasia. True or false. Serious sequelae are less common. The cause is not well known but it may be associated with androgens or estrogens.
95
True
92
BPH may cause ____. __% require surgery to relieve.
Urinary obstruction.
10%
93
What is the most common non-skin malignancy in older men?
Prostatic adenocarcinoma
94
Prostatic adenocarcinoma most commonly metastases to ___
Bone
95
How is prostatic adenocarcinoma most commonly detected?
Rectal exams
Many are small and not clinically significant, however some can be deadly in some pts.
96
Rapidly increasing PSA (prostate specific antigen) means a higher risk for ___.
Cancer. The more psa bount to alpha-1-antichymotrypsin, the greater the risk
97
___ million American adults have chronic kidney disease. ___ million of these are on dialysis
26
0.5
98
What are the main causes for chronic kidney disease? (3 things)
Diabetes
Hypertensive kidney disease
Chronic glomerulonephritis
99
The most common primary glomerulonephritis is ______. It is triggered by ___
IgA nephropathy
Viral infection
100
CRD (chronic renal disease) pateints commonly have what symptoms?
Platelet dysfunctions
Gingival hyperplasia (particularly in transplant pateints on cyclosporine)
Bone abnormalities (slow bone healing after oral surgery. Osteoporosis)
Infectious complications (due to immunosuppression)
101
What is the dental relevance of CRD?
Causes uremia resulting in halitosis
Can affect bone density in jaws, decreasing cortical plate thickness
Can cause premature bone loss
Can cause gingival hyperplasia
102
True or false... pts with CRD are likely to have less protein in their urine, hematuria, mechanical injury to kidneys, and glomeruli overgrowth.
False.
They have...
Heavy proteinuria
Hematuria
Inflammatory injury to kidneys
Glomeruli scarring
103
What is nephrotic syndrome?
Includes heavy proteinuria
Edema
Hyperlipidemia
Associated with HTN and kidney dysfunctions
104
What is glomerulonephritis?
Inflammatory injury to kidneys
105
What is glomerulosclerosis?
Chronic renal injury and renal scarring
106
What is medullary sponge kidney?
Enlarged
Kidney stones
UTI
Benign
107
What is the leading cause of kidney failure?
Diabetes
Advanced glycosylation products result in mesangial cell injury and production of matrix
108
True or false... amyloidosis is a common cause of nephrotic syndrome and kidney disease
False, it is uncommon. Amyloidosis is the accumulation of abnormal proteins in beta-pleated sheet conformations in multiple organs including the kidney
109
What is hydronephrosis caused by?
Blood clot
Tumor
Pregnancy
110
True or false... nephrotic syndrome includes proteinuria, lipidurea, and edema
True
111
Treatment of kidney stones depends on the size and types of stones present. What is the treatment for small stones (<1cm)?
Drink lots of water (2-3 liters)
Dietary changes
OTC pain relievers (ibuprofen, naprosyn)
Tamusolin (flomax) - Rx drug that relaxes ureter muscle to pass stones (and to decreases spasms due to irritation of stone)
112
What drug is used to help pass small kidney stones by relaxing the ureter muscle and reducing spasms?
Tamusolin
113
What are the treatment options for larger kidney stones (>1cm)
Lithotripsy (shock wave treatment) - breaks up stones
Surgical removal
Opioid analgesics for pain
Parathyroid gland surgery (reduces deposition of calcium)
114
For most kidney stones, you can alkalinity the urine to slow deposition or break up the stones, except for one. What is the exception?
Struvite stones
You must treat infection and must ACIDIFY the urine pH
115
What is the most common type of kidney stone? What is it caused by?
Calcium oxalate (75-80%)
Caused by excess calcium/oxalate in the urine
116
What is the second most common type of kidney stone? What causes it?
Struvite (10-15%)
Composed of magnesium ammonium phosphate crystals which deposit in urine when bacterial urease* enzymes alkaline the urine too much
117
Which type of kidney stone is most often associated with UTIs?
Struvite
118
Uric acid kidney stones (~5%) are formed due to...? About half of pts with these stones also suffer from ___.
Excess Uris acid waste in urine mineralizes into stones when urine is too acidic.
Gout
119
How do cystine kidney stones form? (Least common)
Excess cystine production causes hypercystinuria and deposition when urine is too acidic
120
What are hydrochlorothiazide, sodium bicarbonate, and allopurinol used to treat?
Kidney stones
121
Hydrochlorothiazide is a ___ diuretic. It is very effective in the ____ portion of the nephron, reducing ___ in the urine and preventing ____ kidney stones.
Thiazide
Distal convoluted tubule
Calcium
Calcium oxalate
122
Sodium bicarbonate ___ the urine which decreases the amount of ___ and ___ deposition from the urine. This drug is recommended for __ and ___ stones but is contraindicated for ____ stones
Alkalizes
Uric acid and cystine
Uric acid stones and cystine stones
Contraindicated for structure stones because these stones should be acidifies. Alkalizing them will make it worse
123
Allopurinol reduces the amount of ___ produced in patients with ____ and ___
Uric acid
Uric acid stones
Gout
124
Acetohydroxamic acid is an irreversible inhibitor of ___ used to prevent and slow the growth of ____ stones
Bacterial urease
Struvite
125
UTIs are most commonly in the bladder (___) or urethra (___). UTIs are most often caused by ____. Especially in females due to the anatomy
Cystitis
Urethritis
E. Coli
126
What are three drugs that are commonly used to treat UTIs?
Trimethoprim-sulfamethoxazole (synergistic protein synthesis inhibitor)
Amoxicillin + clavulanic acid (resistant bacteria a problem)
Ciprofloxacin (expensive) (alternative treatment) (may cause seizures)
127
___, ____, ____, and prophylactic ___ are commonly used drugs for people receiving hemodialysis. Describe each of these drugs.
Atenolol/captopril - reduces HTN (use atenolol cautiously in diabetics)
Heparin - anticoagulant to prevent clotting blood passed through dialysis machine
Furosemide - potent diuretic. Reduces fluid retention and the amount of fluid that needs to be removed by the dialysis
Prophylactic antibiotics - these are used because there is a high rate of infection in dialysis pts
128
Why is erythropoietin often given to pts on dialysis?
Because they arent producing suffienct EPO. EPO is a renal hormone that stimulates the bone marrow to make new RBCs
129
What are the dental concerns with pts on dialysis?
Higher incidence of periodontal disease. More likely to have oral infections due to the weakened immune system
Prophylactic antibiotics prior to surgical dental procedures is necessary
Dental procedures should take place on non-dialysis days, since heparin will extend bleeding time
130
What is the difference between primary and secondary hemostasis?
Primary - platelets
Secondary - factors to cause adhesion for platelets (coagulation)
131
Platelets are (nucleated/anucleated), their lifespan is ___ days. Circulating platelets do not adhere normally. They adhere during stasis and sites of injury.
Anucleated
10
132
Primary hemostatis is typically initiated by ___. Platelets adhere to ___ by interacting with ____. ___ are released to attract other platelets. Platelets aggregate with other platelets and form surface for the ___ cascade.
Injury
Sundendothelium
Von willebrand factor (factor 8)
Granules
Coagulation
133
In secondary hemostasis, (coagulation cascade) factors mostly from the ___ are involved. It involves a series of activating enzymatic conversions. It involves the ___ pathway and the ___ pathway
Liver
Intrinsic
Extrinsic
134
What factors unique that are involved in the intrinsic pathway? It is measured by the ___ clotting time.
12
11
9
8
PTT (partial thromboplastin time)
135
What unique factors are involved in the extrinsic pathway? It is measured by the ___ clotting time.
7
PT (prothrombin time)
136
What are the common factors that are involved in both the intrinsic and extrinsic pathways?
10
5
2
And fibrin production
(Measured by both PT and PTT clotting times)
137
In the coagulation pathway, which occurs first, thrombin or fibrin formation?
Thrombin forms first
138
Which factors are vitamin K dependent, necessary for calcium binding sites activating coagulation cascade?
2
7
9
10
139
What are some natural anticoagulants?
Protein C
Protein S
Antithrombin
These prevent growth of clot to keep it under checks and balances
140
What is fibrinolysis?
Breaks down clot and releases fibrin
141
What are three ways to assess hemostasis?
Platelet count (part of CBC)
Coagulation cascade (PT and PTT)
Prolonged coagulation tests may be due to deficiency or inhibitor of coagulation factor
142
What is thrombosis?
Pathologic counterpart of hemostasis that results in abnormal clotting. In involves vessels, platelets, and the coagulation cascade.
143
What is virchows's triad?
The causes of thrombosis...
Endothelial injury
Abnormal blood flow
Hypercoagulability (acquired/inherited factors)
144
What are some acquired hypercoagulable states?
Surgery/trauma
Limb immobilization
Bedridden
Long-distance air travel (stasis)
Pregnancy
Oral contraceptives
145
Factor V ___ is an example of a genetic thrombotic disorder (point mutation, AD). It is the most common inherited ____ - associated with increased ___ formation. It makes factor V resistant to cleavage and inactivation by activated protein __. This will increase clotting but usually does not cause major problems.
Leiden
Thrombophlilia
Fibrin
C
It is found in about 5% of adults (especially in caucasians)
146
What is caisson disease?
Caused by air embolism, blocking blood flow
147
___ venous thrombin in leg rarely embolize (usually caused by ____).
Superficial
Deep vein thrombosis. - can dislodge, especially to the lung
148
Deep vein thrombosis can dislodge and end up especially in the ___
Lung
149
Platelet type bleeding has a ____ bleeding pattern. What are some causes of platelet-type bleeding?
Mucocutaneous (petechiae, ecchymoses, GI bleeding, epistaxis)
Thrombocytopenia (decreased bone marrow production)
Von willebrand disease
Qualitative platelet dysfunction
Vascular abnormalities
150
Von willebrand disease has a mutated ___-related carrier protein
VIII
151
What are three common causes of thrombocytopenia?
Decreased bone marrow production
Hemodilution due to multiple transfusions
Increased peripheral destruction (immune reaction due to platelet autoantibodies directed at platelet surface proteins)
Sequestion in spleen
152
Platelet counts below ___ may result in spontaneous bleeding.
~10,000-20,000
153
What are some symptoms of thrombocytopenia purpura?
Fever
Renal failure
Transient neurological deficits
Microangiopathetic hemolytic anemia
154
What is the most common inherited blood-clotting disorder? Describe this disease.
Von willebrand disease (altered vWF does not bind properly to factor VIII and interferes with platelet adhesion to collagen.
155
True or false.. hemophilia A and B are both inherited blood-clotting disorders. Describe them.
True
```
A = deficient factor VIII
B = deficient factor IX. (More likely in males over 25 cause its X-linked recessive)
```
Both A and B have prolonged PT and PTT
156
What are 2 examples of acquired blood clotting diseases?
Vitamin K deficiency (usually due to malabsorption of fat; increase in both PT and PTT)
Liver disease
157
What is disseminated intravascular coagulation (DIC)?
Generalized secondary activation of clotting due to disseminated factors such as toxins, information, cancer. Can cause both organ ischemia because of increased clotting as well as bleeding due to increased activation of fibrinolysis
158
What are blood typing disorders?
Presence or absence of Ab related to RBC surface antigens.
159
What is a CBC?
Complete blood count
Automated hematological evaluation. Includes red and white blood cells and platelets
160
What are some factors that may alter the CBC?
```
Iron deficiency
Medications
Alcohol
Infections
Gender
Pregnancy
```
161
WBC (white blood counts) include all uncleared hematopoietic cells except RBCs. What is the normal WBC?
3500-10,000 cells/microliter
Neutrophils 1800-6700 (55%)
Eosinophils 0-570 (3%)
Lymphocytes 1400-3900 (35%)
Important to evaluate infections, some drug effects, radiation therapy
(know ranges and percents)*
162
What is leukocytosis? What are things that may cause it?
WBC > 10,000
Causes:
Chronic infection or inflammation
Exercise
Some leukemia
163
What is gaisbock syndrome?
Relative polycythemia due to decreased plasma volume but #RBCs remain the same.
Higher conc. Of RBCs
164
What is polycythemia Vera?
Genetic. Due to increased RBCs
165
What is microcytic anemia?
<80 fl MCV (mean corpuscular volume (RBCs are smaller)
166
What are some things that may cause microcytic anemia?
Iron deficiency (usually by hemorrhaging). Often has glossitis
Cause can include blood loss or poor diet
Lead poisoning
167
What is the size range for normocytic anemia?
80-100 MCV
168
What is macrocytic anemia and what is it caused by? What are some symptoms?
Larger than 100 fl
Caused by...
Liver disease
Drugs
Vitamin B12 (abnormal tongue) or folate deficiency (associated with pregnancy)
Often includes neurological findings (paresthesia, weakness, dementia) - pernicious anemia or autoimmune diseases
169
What is normocytic anemia caused by?
Aplastic anemia
Blood loss
Anemia of chronic diseases
170
What is sickle cell anemia?
The globin of the molecule is abnormal due to an amino acid substitution
171
___ are systemically distributed neoplasms of WBCs.
___ are solid tumors of hematopoietic system/neoplasm of lymphoid tissue - lymphadenopathy
Leukemias
Lymphomas
172
True or false.. lymphomas and leukemias are clonal expansions of cells at certain developmental stages
True
173
In acute myeloid or acute lymphoblastic there is __ evidence of maturation in blood or marrow. ___% are blast cells. Skin and gum infiltration are probable. It is found more frequently in (children/adults). It progresses ___, but more responsive to treatment.
No
20
Children
Rapidly
174
Chronic myeloid or chronic lymphocytic leukemia results in ___% of mature cells. Chronic myeloid has the presence of the ___ chromosome (abnormal ____). Chronic means more pts can function and have better prognosis.
Increased
Philadelphia
Tyrosine kinase
175
True or false... Hodgkin's lymphoma is more prevalent than non-hodgkins lymphoma
False. Non-hodgkins lymphoma represent 90% of lymphomas. It is very aggressive and not likely curable
Hodgkin's lymphoma represents 10% of lymphomas and is curable in most. Presence of Reed-Sternberg cells
176
Multiple myeloma is cancer of ___ cells that arises in bone marrow (often replacing other blood cells) and often has ___ proteins.
Plasma
Bence-jones
177
What is the desired total cholesterol level? What is considered high?
Below 200 mg/dL desirable
>240 is considered high
178
What is the desirable LDL level? What is considered border-line high? What is considered high?
<100 = desirable
130-159 = borderline high
160-189 = high
179
What is considered the desirable levels of triglycerides? What is considered too high?
Below 120 is desirable
Over 200 is high
180
What is the ideal level of HDL?
60
Below 40 is poor
181
What kind of drug is gemfibrozil?
Fibrate
182
What kind of a drug is cholestyramine?
Bile acid binding resin
183
What is the normal PTT?
25-35 seconds
184
The intrinsic pathway is sensitive to ___ as an anticlotting agent. What are some side effects?
Heparin
Hemorrhage, allergic reactions, osteoporosis, and bone fractures
Heparin typically used in hospital setting. Heparin-like drugs frequently used is enoxaparin
185
What heparin-like drug is used to treat deep vein thrombosis?
Enoxaparin
186
What is the normal PT?
What is a normal INR?
PT = 11-13.5 seconds
INR = 0.8-1.1
187
Which, the intrinsic pathway or extrinsic pathway is sensitive to coumadin (warfarin). How does it work? What are some side effects?
Extrinsic pathway
Antagonizes K
Side effects: hemorrhage, numbness, pain, headache, dizziness
Oral warfarin is prescribed for out patient
188
What is an alternative drug to warfarin? Describe this drug.
Dabigatran (pradaxa)
Has fewer side effects and is more popular than heparin or warfarin. Affects PTT sensitive pathway but has unique mechanism that makes it distinct from heparin and warfarin. used on out-patient basis
189
What kind of drug is abciximab and bivalirudin? Describe them.
Abciximab - (glycoproteins inhibitor) - injected and used to prevent clot formation such as in unstable angina.
Bivalirudin - (thrombin inhibitor) it is rapid and short acting and inhibits circulating thrombin
