Patho assessment 2

In general, the best prognosis for long-term disease-free survival occurs with

ALL (acute lymphoid leukemia). ALL is highly curable in the pediatric population with an 85% survival rate in children. The average age of patients with CLL is 65 to 70 years. Median survival rate is less than 8 years. Patients younger than age 60 have a 4-year survival rate of 30% to 40% in AML. CML does not respond well to chemotherapy and carries a long-term survival rate of 50% to 60%.

Which clinical finding is indicative of compartment syndrome?

Absent peripheral pulses Compartment syndrome creates an effective absence of arterial circulation to an extremity. Swelling within a cast or tight dressing may contribute to the development of compartment syndrome. Compartment syndrome creates pallor in the affected extremity. Acute arterial occlusion is an emergency, and could result in profound ischemia in the involved limb.

A diagnostic laboratory finding in myeloma is

Bence Jones proteins in the urine. Bence Jones protein in the urine is a common clinical manifestation of plasma cell myeloma. It is also known to accumulate in the kidneys and cause kidney damage. Decreased platelet count is not usually a finding in plasma cell myeloma. IgM is not a factor in plasma cell myeloma. Glucose levels are not directly impacted in plasma cell myeloma.

What is the correct definition of complete remission (CR) of leukemia?

CR is less than 5% blasts in marrow and normal CBC values. Complete remission (CR) is a return to normal hematopoiesis. The bone marrow must have less than 5% blasts and must be maintained for at least 4 weeks in order to achieve CR. CR is an absence of leukemic cells, in addition to normal red cell, platelet, and neutrophil counts. CR must include normal hematopoiesis as well as an absence of leukemic cells. CR must include less than 5% blasts in marrow in addition to no detectible neoplastic cells.

Which disorder is considered a primary immunodeficiency disease?

HIV/AIDS HIV/AIDS is a primary immunodeficiency disease involving destruction of T helper cells. Malnutrition immunodeficiency is a secondary immunodeficiency disorder and leads to T-cell destruction and dysfunction. Cancer immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from chemotherapeutic agents. Radiation immunodeficiency is a secondary immunodeficiency disorder caused by the destruction of rapidly proliferating cells from the effects of radiation.

Certain autoimmune diseases are associated with the presence of specific proteins on a person's cells. These proteins are called ________ proteins.

HLA or MHC Human major histocompatibility complex (MHC) genes located on chromosome 6p21 (also called human leukocyte antigen (HLA) genes) are frequently associated with certain autoimmune disorders. Complement, antibody receptors, and TCR or BCR are not factors in development of autoimmune disease.

Which condition is associated with an elevated reticulocyte count?

Hemolytic anemia Hemolytic anemia is associated with an increased number of circulating reticulocytes or reticulocytosis. Anemia of chronic renal failure is not associated with reticulocytosis. Rather, it occurs from failure of the renal endocrine function. Aplastic anemia is a stem cell disorder that is characterized by pancytopenia, a decrease in red cells, white cells, and platelets. Hypertension is not related to reticulocytosis.

Which condition enhances lymphatic flow?

Increased interstitial fluid colloid osmotic pressure Lymphatic flow is controlled by increasing interstitial fluid colloid osmotic pressure and by the stimulation of the contractile fibers (often called lymphatic pumps) as they are stretched. Increasing interstitial fluid colloid osmotic pressure enhances lymphatic flow. Lymphatic flow is not enhanced by decreased capillary hydrostatic pressure. Lymphatic flow is controlled by increases in osmotic pressure, not oncotic pressure.

What is necessary for red blood cell production?

Iron Immature red blood cells produce hemoglobin, which is composed of two pairs of polypeptide chains, the globins. Each globin has an attached heme molecule that contains iron. Dietary iron is transported through the plasma on the RBC membrane. Phosphates are not a necessary component of red blood cell production. Magnesium is not a part of the production of red blood cells. Calcium is not involved in red blood cell production.

Which characteristic is indicative of hemolytic anemia?

Jaundice Jaundice is a classic clinical manifestation of hemolytic anemia. The total iron-binding capacity in hemolytic anemia is not increased. Hemolytic anemia is not generally associated with an increased heart rate unless there is aplastic crisis associated with infection. Hypovolemia is not an indication of hemolytic anemia.

Which causes vasoconstriction?

Norepinephrine The release of norepinephrine results in arterial vasoconstriction via receptors located on the vascular smooth muscle walls. Calcium channel blockers produce vasodilation by interfering with calcium intake into the vascular smooth muscle cells. α-Adrenergic antagonists do not cause vasoconstriction. Acetylcholine does not have an effect on vasoconstriction.

Two of the most serious oncology emergencies associated with non-Hodgkin lymphoma are obstruction of the superior vena cava and compression of the spinal cord. T/F

True Compression of the spinal cord is one of the two most serious oncology emergencies associated with non-Hodgkin lymphoma.

While in the hospital for management of acute lymphoid leukemia (ALL), a patient develops severe thrombocytopenia. The most appropriate action for this condition is

activity restriction. Thrombocytopenia can produce a life-threatening hemorrhage. Patients with this condition should be protected from trauma and placed on activity restriction to reduce the risk of bleeding. Anticoagulant therapy in a patient with thrombocytopenia could actually cause the patient more bleeding. Thrombocytopenia is a complication of leukemia and chemotherapy. Chemotherapy is not an appropriate treatment option for thrombocytopenia. Isolation is not effective in managing the risk of hemorrhage.

A commonly ingested substance associated with prolongation of the bleeding time is

aspirin Many drugs are associated with prolonged bleeding times. Aspirin is known to alter normal platelet function. Acetaminophen is not associated with prolongation of bleeding time. Tobacco does not interfere with bleeding times. Caffeine does not interfere with bleeding times.

Most carbon dioxide is transported in the bloodstream as

bicarbonate ion. Approximately 90% of the CO2 in the arterial blood and 60% of the CO2 in the venous blood are transported as bicarbonate. Carbon dioxide is not transported as carboxyhemoglobin. Some of the remaining carbon dioxide binds with protein to form carbaminohemoglobin for CO2transport, but dissolved carbon dioxide is not the primary means of bloodstream transportation. Carbonic acid is disassociated into hydrogen and bicarbonate ions for elimination by the lungs and kidneys.

Patients with immunodeficiency disorders are usually first identified because they

develop recurrent infections. The first clinical indicators of immunodeficiency disorders are the signs and symptoms of infection, and the disorders are often first suspected when an individual has severe recurrent, unusual, or unmanageable infections. High fevers can occur in patients who have an intact immune system. Because of the immune deficiency, patients with immunodeficiency disorders may not demonstrate expected WBC counts with infection. Infections in patients with immunodeficiency disorders can occur anywhere in the body.

The most effective therapy for anemia associated with kidney failure is

erythropoietin administration. Therapy in anemia of chronic renal failure consists of dialysis and erythropoietin administration. The use of erythropoietin stimulating agents is to increase hemoglobin values to ensure adequate oxygen-carrying capacity. Iron, folate, and vitamin B12 replacement are initiated if necessary. Iron administration is utilized in iron-deficiency anemia. A high-protein diet is not the treatment of choice in the patient with renal failure, and a high-protein diet may be contraindicated. Vitamin B12 and folate are prone to nutritional anemias and receive replacement to adequate levels if necessary. However, dialysis and erythropoietin are more effective.

The prothrombin time (PT) and INR (international normalized ratio) measure the integrity of

extrinsic pathway. The PT and INR assess the extrinsic pathway of coagulation. Platelet function is measured through a CBC. The aPTT assesses the intrinsic pathway of coagulation. The D-dimer assay reflects fibrinolysis.

Treatment for hemophilia A includes

factor VIII replacement. Factor VIII administration is a common treatment choice for hemophilia A, particularly with dental procedures requiring local anesthesia. Heparin administration is typically highly contraindicated in an individual with a bleeding disorder although in some cases it is given to patients with DIC. Factor IX may be available as a treatment option for hemophilia B. A platelet transfusion is not of benefit in the hemophilia A patient.

Red blood cells obtain nearly all their energy from metabolism of

glucose. For RBCs to survive and perform efficiently, they must have a source of energy. Essential for red blood cell viability is the glucose that is used for metabolism. RBC membrane structures are formed from double layer of phospholipids. Fats do not provide energy to red blood cells. A protein network on the surface of the membrane is important for cell structure, but does not provide energy for red blood cell production and maintenance. Acetyl coenzyme A is not a factor in providing energy to the red blood cells.

Red blood cells differ from other cell types in the body, because they

have no cytoplasmic organelles. Red blood cells have no cytoplasmic organelles, nucleus, mitochondria, or ribosomes. Therefore, RBCs cannot synthesize protein or carry out oxidative reactions. Red blood cells are not capable of synthesizing protein because of their lack of organelles. Red blood cells live for 80 to 120 days in the circulation and then die and are replaced. Red blood cells do not contain glycolytic enzymes.

Blood flow is slow through capillaries because capillaries

have the largest total cross-sectional area. The increased cross-sectional area in the capillary bed results in a significant decrease in velocity compared to the arterial and venous networks. Blood flow through the capillaries is not affected by the distance to the heart. Capillaries do have a diameter that is very small, but they have spaces that permit constituents to pass in and out of the capillaries. In some tissues, one or two smooth muscle cells form a precapillary sphincter that controls flow through the vessel.

Risk factors for atherosclerosis include

hyperlipidemia. Hyperlipidemia is a modifiable risk factor associated with atherosclerosis. Men have a higher incidence of atherosclerosis earlier in life than women. A high-protein diet is not associated with atherosclerosis. Dietary fats do play a role as a modifiable risk factor. A low-fiber diet is not a risk factor for atherosclerosis.

Myasthenia gravis is a type II hypersensitivity disorder that involves

impaired muscle function. Myasthenia gravis involves muscle weakness caused by loss of acetylcholine stimulation at the motor end-plate. Symptoms of hyperthyroidism occur in Graves disease. Symptoms of arthritis or polyarthralgia occur in systemic lupus erythematosus, a type II hypersensitivity disorder. Glomerular disease can occur in type III hypersensitivity disorders.

Venous obstruction leads to edema because it ________ pressure.

increases capillary hydrostatic Increased fluid accumulation in the interstitial space also occurs when the lymphatic flow is impaired or when capillaries become more permeable and "leak" fluid. These pressure gradients lead to edema. Interstitial fluid colloid osmotic pressure increases play a role in edema. Arterial blood pressure does not lead to edema. Decreased tissue pressure does not lead to edema in venous obstruction.

The patient is a 12-year-old boy diagnosed with acute lymphoid leukemia (ALL). As part of treatment, the patient must undergo several weeks of chemotherapy. The most serious complication of chemotherapy is

infection. Infection is the most troublesome complication of chemotherapy for the immunosuppressed patient, and infection is a major cause of death in a leukemic patient. Nausea and vomiting are common findings in the treatment phase. While anemia is a common complication of the disease and treatment, it is not as serious as immunosuppression. Alopecia is an unfortunate side effect of chemotherapy, but is not a life-threatening complication.

Disseminated intravascular coagulation may be treated with heparin therapy to

inhibit clotting factor consumption. Although controversial, heparin may be used to minimize further consumption of clotting factors. Fibrinolysis is not enhanced by the use of heparin. The use of heparin does not activate platelets. Heparin is not known to enhance liver synthesis of clotting factors.

Clinical manifestations of chronic arterial obstruction include

intermittent claudication. Arterial thrombosis is usually manifested by intermittent claudication (pain with activity) in the affected limb that improves with rest. Venous obstructions are manifested by edema. Ischemia can occur distal to the point of the occlusion. An increase in blood flow causes hyperemia, which is located in the area proximal to the obstruction.

Dramatic hypotension sometimes accompanies type I hypersensitivity reactions, because

massive histamine release from mast cells leads to vasodilation. Hypotension can occur in type I hypersensitivity resulting from massive histamine release leading to vasodilation. Toxins are not released during type I hypersensitivity reactions. Sweating occurs as a reaction to shock from severe hypotension; the hypotension occurs first and is because of histamine release. Hypoxia occurs in anaphylaxis as a result of shock from severe hypotension; the hypotension occurs first and is because of histamine release.

Thalassemia may be confused with iron-deficiency anemia, because they are both

microcytic. Both thalassemia and iron-deficiency anemia reveal hypochromic, microcytic red cells. Thalassemia and iron-deficiency red cells are hypochromic. Genetics play a role in thalassemia, and are found primarily in Asian individuals. Iron-deficiency anemia is responsive to iron therapy, but thalassemia patients have increased iron absorption.

RhoGAM (an Rh antibody) would be appropriate in an Rh-_____ woman with an _____ Rh-_____ antibody titer carrying an Rh-_____ fetus.

negative; negative; positive If a woman is Rh-negative, RhoGAM is administered for prevention of Rh-positive antibodies. Erythroblastosis fetalis develops during pregnancy when an Rh-negative mother is sensitized to her fetus's Rh-positive red cell group antigens because of exposure during her current or a previous pregnancy. RhoGAM contains antibodies against Rh antigens on fetal blood cells and is given to the mother to destroy fetal cells that may be present in her circulation before her immune system becomes activated and begins to produce anti-Rh antibodies. RhoGAM is not effective if the mother already has a positive antibody titer for fetal Rh antigens. An Rh-positive woman with negative Rh antibody titer carrying Rh-negative fetus does not require RhoGAM because the mother is Rh-positive and the fetus is Rh-negative.

The goal of long term heparin for the management of a deep vein thrombosis is to

prevent further clot formation. Anticoagulation is utilized in deep vein thrombosis to prevent further clot formation. Heparin does not play a role in edema. Prevention of clot dislodgement is not the goal of therapy with the use of heparin. Heparin is not utilized to dissolve a thrombus.

Transfusion reactions involve RBC destruction caused by

recipient antibodies. The recipient of the blood transfusion has antibodies to the donor's red blood cell (RBC) antigens; the antibodies destroy large numbers of RBC. Donor antigens, donor T, and recipient T cells do not cause transfusion reactions.

The movement of blood through the vascular system is opposed by the force of

resistance. The movement of blood through the vascular system is opposed by the force of resistance. Three determinants of resistance are vessel length, vessel radius, and blood viscosity. Viscosity is the thickness of fluid and has an effect on resistance. The length of the vessel does have an effect on the resistance. Vessel radius has an effect on resistance.

Autologous stem cell transplantation is a procedure in which

stem cells are harvested from the patient and then returned to the same patient. In autologous transplantation, the stem cells are collected from the patient's own blood and then stored and reinfused in the same patient after chemotherapy and radiation. The use of autologous transplants eliminates the problem of graft-versus-host disease. Transplant from a closely matched donor is known as allogeneic transplant. In autologous transplant, stem cells are used from the patient's own blood.

A patient is diagnosed with a tortuous blood vessel of the right hand that bleeds spontaneously. This patient presents with

telangiectasia. A telangiectasia is a dilated or tortuous small blood vessel found in the skin or mucous membranes that have a tendency to bleed spontaneously or following minor trauma. Petechiae are pinpoint hemorrhages. Purpura is a collection of petechiae. Thrombocytosis is a platelet count above 400,000/mm3.

Blood flow throughout the periphery is regulated by

the autonomic nervous system Blood flow throughout the periphery is controlled by central mechanisms that are mediated by the autonomic nervous system, the venous and thoracic pumps, and intrinsic autoregulatory mechanisms. Cardiac output does not control peripheral blood flow. Velocity is the measure of distance traveled in a given interval. Hemodynamics is the principle that governs the quantity of blood passing by a given point at a certain period.

The activated partial thromboplastin time (aPTT) is a measure of the integrity of

the intrinsic pathway. The intrinsic pathway is assessed through the aPTT. The extrinsic pathway is assessed through measurements of the PT and INR. An abnormal factor VIII function results in hemophilia A. The deficiency is verified by factor assay. The aPTT is not utilized to assess the integrity of plasminogen.

Activation of the extrinsic pathway of coagulation is initiated by

tissue thromboplastin. The extrinsic pathway of coagulation begins when the vascular wall is traumatized. Tissue factor from injured tissue activates factors which in turn activate and convert into thrombin for clotting. Platelets play a major role in primary hemostasis as well as secondary hemostasis and clot retraction. Platelets accelerate the conversion of prothrombin to thrombin. Platelets adhere to collagen exposed by trauma and initiate degranulation. Factor VII is involved in the extrinsic pathway of coagulation when it is activated by tissue factor following a traumatic injury.

A normal bleeding time in association with normal platelet count, and increased prothrombin time (PT) and INR, is indicative of

vitamin K deficiency. Vitamin K deficiency should be considered as the cause for bleeding when the PT and INR are increased but other coagulation studies are normal. Hemophilia B results from factor deficiency or the abnormal function of factor IX. Hemophilia A results from factor deficiency or the abnormal function of factor VIII. In idiopathic thrombocytopenia, a decreased platelet count is seen in prolonged bleeding times.