Patho Chapter 16 Q's

101) What is jaundice? What substance is present in abnormal levels? What can cause jaundice to occur? What difference may impede a doctor's ability to diagnose jaundice between people of European compared to African ancestry?

: Jaundice simply means yellowing of skin and the whites of the eyes. It results when bilirubin levels in the blood become elevated (hyperbilirubinemia); superficial blood vessels allow the imparting of yellow color to skin and eyes. During erythrocyte breakdown, the heme is converted in the spleen and liver to a colored pigment called bilirubin. Bilirubin is carried by plasma albumin to the liver where it is metabolized and incorporated into bile (see Fig. 16.8 in the chapter). Bile is secreted into the digestive tract, and the bilirubin metabolites leave the body in the feces. Small amounts of other bilirubin metabolites are filtered from the blood into the kidneys, where they contribute to the yellow color of the urine. The accumulation of bilirubin can occur from multiple causes. Newborns, whose fetal hemoglobin is degraded and replaced with adult hemoglobin, are particularly susceptible to jaundice, so doctors closely monitor bilirubin levels in the first weeks of life. Another common cause of jaundice is liver disease, where the liver is unable to process and/or excrete bilirubin. People with darker skin don't display the yellowing to the same extent as lighter-skinned people, but the yellowing in the eyes should be about the same.

94) Give two morphological characteristics of erythrocytes. Why is each advantageous to the cell?

: Lack of a nucleus and the biconcave shape contribute to flexibility for moving through narrow capillaries and disk shape which aides in responding to osmotic changes.

89) A person who goes from sea level to a city that is 5000 feet above sea level will show an increased hematocrit within 2 to 3 days. Draw the reflex pathway that links the hypoxia of high altitude to increased red blood cell production.

: Low atmospheric at high altitude → low arterial → sensed by kidney → erythropoietin synthesized and released → acts on bone marrow to increase production of red blood cells.

96) Name the process of red blood cell production, the hormone that controls it, the source of that hormone, and the stimulus for its production. Why was the hormone so difficult to isolate and identify?

: Production of red blood cells is called erythropoeisis. It is stimulated by the kidney-produced hormone erythropoietin, in response to hypoxia. It was difficult to isolate and identify because it is made on demand rather than stored, and thus is not present all the time.

102) How would the process of red blood cell production be affected by constricting the arteries that supply blood to the kidney? Explain your answer. Name three other situations that would similarly affect the process of red blood cell production.

: Red blood cell production would be increased. Constricting arteries would reduce blood flow; thus, the kidney would experience hypoxia. The kidney produces the hormone erythropoietin, which stimulates red blood cell production, in response to hypoxia. Increased red blood cell production would also result from anemia, extended presence at high altitude, and following hemorrhage.

104) Erythropoietin (EPO) was first isolated from the urine of anemic patients who had high circulating levels of the hormone. Despite the presence of the hormone that stimulates red cell production, however, these patients were unable to produce adequate amounts of hemoglobin or red cells. Give some possible reasons that the patients' own EPO was unable to correct their anemia.

: Some other factor that is essential for red blood cell synthesis must be lacking. These would include iron for hemoglobin production, folic acid, and vitamin B12.

97) List any five nutrients important for blood cell synthesis and briefly explain the role of each.

: Table 16.3 in the chapter lists B12, folic acid, and iron and a brief explanation of each one's role. The student savvy in metabolism will also note the need for the amino acids for the protein chain synthesis, and energy nutrients in order to supply adequate ATP for these synthetic reactions to occur, as well as the vitamins necessary for the TCA cycle and other aspects of metabolism, including niacin, riboflavin, and pantothenic acid.

68) The condition where the skin and the whites of the eyes appear slightly yellow is due to high blood levels of the substance ________.

: bilirubin

58) Plasma consists of blood minus ________ and ________.

: cells, platelets

61) Hormones called ________ are involved in regulation of white blood cell populations.

: colony-stimulating factors

65) The hormone that regulates the production of red blood cells is ________.

: erythropoietin

71) The dissolution of fibrin by plasmin is known as ________.

: fibrinolysis

59) Active bone marrow is red because of the presence of ________ whereas inactive marrow is ________ because of an abundance of adipocytes.

: hemoglobin, yellow

63) The term used for a cytokine that is released by one white blood cell that acts on another is ________.

: interleukin

67) The condition where the skin and the whites of the eyes appear slightly yellow is called ________.

: jaundice

70) In hemostasis, vasoconstriction is rapidly followed by mechanical blockage of the hole by a ________.

: platelet plug

62) In healthy adults, blood cell production occurs only in the ________.

: red bone marrow

64) The growth and maturation of megakaryocytes is regulated by the glycoprotein ________.

: thrombopoietin (TPO)

69) Plasminogen is activated by an enzyme called ________.

: tissue plasminogen activator

66) The carrier protein that transports absorbed iron through the blood is ________.

: transferrin

72) The two main components of plasma are ________ and ________. Name two other components found in plasma.

: water, proteins; other components found in plasma include: dissolved organic molecules, ions, trace elements and vitamins, and dissolved oxygen and carbon dioxide.

87) Name the two mechanisms and the factors involved that limit the extent of blood clotting within a vessel.

: 1. inhibition of platelet adhesion: protacyclin 2. inhibition of coagulation cascade: plasminogen and plasmin and anticoagulants

88) Name the five types of white blood cells. Which type develops into macrophages? Which white blood cells are collectively known as phagocytes and why?

: 1. lymphocytes 2. monocytes 3. neutrophils 4. eosinophils 5. basophils; monocytes develop into macrophages; neutrophils, monocytes, and macrophages are collectively known as phagocytes because they engulf and ingest foreign particles such as bacteria.

77) What are the three major steps of hemostasis?

: 1. vasoconstriction 2. temporary blockage of a break by a platelet plug 3. blood coagulation, or formation of a clot that seals the hole until tissues are repaired

73) Red blood cells in the circulation live for about ________. The short life span is due to ________.

: 120 days; increasing fragility of the older red blood cells, which may rupture as they squeeze through capillaries

60) Blood is approximately ________% plasma by volume.

: 55

18) Diseases that involve the presence of too many white blood cells have been identified as well as diseases that involve too few white blood cells. A) True B) False

: A

2) Plasma is mostly A) water. B) blood cells. C) proteins. D) organic molecules. E) ions.

: A

24) The function of hemoglobin is to A) carry oxygen. B) protect the body against infectious agents. C) aid in the process of blood clotting. D) carry nutrients from the intestine to the body's cells. E) All of the answers are correct.

: A

27) Under normal circumstances, aged and damaged erythrocytes are broken down by the A) spleen. B) yellow bone marrow. C) kidneys. D) digestive tract. E) thymus gland.

: A

42) Tissue factor is released in the A) extrinsic pathway. B) intrinsic pathway. C) common pathway. D) retraction pathway. E) fibrinolytic pathway.

: A

6) The cell that is the progenitor of all the types of blood cells is called the A) pluripotent hematopoietic stem cell. B) committed progenitor cell. C) megakaryocyte. D) reticulocyte. E) progenitor.

: A

80) Persons who suffer from hemophilia A fail to produce a functional factor VIII; as a result, A) they do not have a functional intrinsic pathway. B) they do not have a functional extrinsic pathway. C) they do not have a functional common pathway. D) their clotting times are shorter than normal. E) All answers are correct.

: A

82) Meghan thinks she has an abscessed tooth (a bacterial infection). If she does, what type of white blood cell would you expect to see in elevated numbers in a differential count? A) neutrophils B) eosinophils C) basophils D) lymphocytes E) monocytes

: A

86) neutrophils

: A (50-70%)

Match the following plasma proteins with the correct function. A. albumins B. globulins C. fibrinogen D. transferrin E. antibodies 43) contribute(s) significantly to osmotic pressure of plasma

: A (albumins)

54) a genetic condition where red blood cells have deficient cytoskeletons

: A (hereditary spherocytosis)

52) Often called immunocytes, these cells direct the activities of the immune system.

: A (lymphocytes)

103) In the disease mononucleosis ("mono"), the spleen enlarges because of increased numbers of cells, phagocytic as well as others. Common symptoms of this disease include pale complexion, a tired feeling, and a lack of energy sometimes to the point of not being able to get out of bed. What might cause these symptoms?

: A major function of the spleen is to destroy old, defective, and worn-out red blood cells. As the spleen increases in size, so does its capacity to eliminate red blood cells, and this produces anemia. The decreased number of red blood cells decreases the blood's ability to deliver oxygen to the tissues and thus metabolism is slowed down. This would account for the tired feeling and lack of energy. Because there are fewer red blood cells than normal, the blood circulating through the skin is not as red, and so the person has a pale skin coloration.

99) Define anemia, and explain how it is the same or different from hypoxemia. Give examples of three different types of anemia and a brief synopsis of each kind. Is sickle cell disease a true anemia? Explain your answer. When sickle cell disease is fatal, what is the cause of death?

: Anemia is a condition in which the blood's hemoglobin content is too low. Hypoxemia means low oxygen in blood, which could be due to an impaired respiratory system and can therefore occur independent of anemia. Because oxygen binds to hemoglobin, individuals with anemia cannot transport as much oxygen to the tissues, resulting in fatigue and weakness. This may be especially noticeable with exercise. Some major causes of anemia are summarized in Table 16.3 in the chapter. Sickle cell disease is considered an anemia because the amount of normal hemoglobin is low. Death is related to hypoxia-caused tissue damage.

100) A dead human body has been discovered in the woods near your home. No, you are not a homicide suspect; rather you are an expert hematologist, and the body is still warm. Implausibly, this adult corpse has no gender cues (no sexual organs, and skeletal features that are in between those expected for males or females). How can you assist the detectives in determining the gender of this person, using the hematology lab in your garage?

: Assuming you can collect and centrifuge the blood soon, prior to clotting and decay, a hematocrit may provide clues. While a differential white cell count is independent of gender, hematocrit, hemoglobin concentration, and red cell count are all slightly lower in females.

15) The primary organ where erythropoietin is produced is the A) liver. B) kidney. C) spleen. D) bone marrow. E) endothelial cells throughout the body.

: B

16) A unique aspect of hematopoiesis is that A) white blood cell production always results in the same proportion of leukocytes. B) white blood cell development varies with the specific needs of the body. C) neutrophils direct all development from the lymph nodes. D) lymphocytes never die.

: B

29) Red blood cell production increases when A) oxygen levels in the blood increase. B) oxygen levels in the blood decrease. C) carbon dioxide levels in the blood increase. D) carbon dioxide levels in the blood decrease. E) protein levels in the blood increase.

: B

32) Excess iron in the body is A) stored in bones. B) eliminated in the feces. C) stored in fatty tissues. D) found in white blood cells. E) All of the answers are correct.

: B

33) The carrier protein that transports absorbed iron through the blood is A) hemoglobin. B) transferrin. C) erythropoietin. D) thrombopoietin. E) intrinsic factor.

: B

35) Which of the following are the two anticoagulants produced by the body? A) heparin and plasmin B) antithrombin III and heparin C) antithrombin III and plasmin D) tissue plasminogen activator and plasmin E) protacyclin and heparin

: B

39) The intrinsic pathway of coagulation is activated by the A) sticking of platelets to damaged tissue. B) activation of proenzyme exposed to collagen. C) release of tissue factor by a damaged endothelium. D) release of heparin from the liver. E) conversion of prothrombin to thrombin.

: B

4) Mast cells in tissues are considered to be a type of A) eosinophil. B) basophil. C) lymphocyte. D) monocyte. E) neutrophil.

: B

78) The usual treatment for neonatal jaundice is exposing the infant to certain wavelengths of light. The infant wears only a diaper and undergoes the light treatment continuously for several days, even at night. Why can the infant's treatement then be discontinued? A) because light treatment stimulates liver growth B) because the transition between fetal hemoglobin to adult is complete C) because the light generates additional RBCs D) because the digestive tract is then large enough to secrete bile E) All of the answers are correct.

: B

Match the following terms with the correct descriptions. A. lymphocytes B. erythrocytes C. eosinophils D. platelets E. neutrophils 48) These cells contain hemoglobin and iron.

: B (erythrocytes)

47) a category that includes clotting factors and enzymes

: B (globulins)

56) a stem cell dysfunction that produces too many blood cells

: B (polycythemia)

74) ________, ________, and ________ are called granulocytes because ________.

: Basophils, eosinophils, neutrophils, they contain cytoplasmic inclusions that give them a granular appearance

1) The total volume of blood in the body of a 70-kg man is approximately ________ liters. A) 25-30 B) 10-15 C) 5-6 D) 2-4 E) 1-2

: C

11) ________ regulates the growth and maturation of megakaryocytes. A) Erythropoietin B) Interleukin C) Thrombopoietin D) Colony-stimulating factor E) None of the answers are correct.

: C

12) Red blood cell production is regulated by the hormone A) thymosin. B) angiotensin I. C) erythropoietin. D) M-CSF. E) cobalamin.

: C

14) In normal adults, red blood cells are formed in A) the liver. B) the spleen. C) red bone marrow. D) yellow bone marrow. E) lymph nodes.

: C

19) The average life span of a red blood cell is A) 1 week. B) 1 month. C) 4 months. D) 6 months. E) 1 year.

: C

20) The function of red blood cells is to A) remove carbon dioxide from the lungs. B) remove nitrogenous wastes from active tissues. C) carry oxygen from the lungs to the body's cells. D) carry nutrients from the digestive system to the body's cells. E) defend the body against infectious organisms.

: C

22) The porphyrin ring of heme contains an atom of A) magnesium. B) calcium. C) iron. D) sodium. E) copper.

: C

23) The majority of the protein inside a red blood cell is A) albumin. B) porphyrin. C) hemoglobin. D) immunoglobulin. E) fibrinogen.

: C

3) The most abundant proteins in blood plasma are A) globulins. B) transport proteins. C) albumins. D) lipoproteins. E) fibrinogens.

: C

38) The extrinsic pathway of coagulation is activated by the A) sticking of platelets to damaged tissue. B) activation of a proenzyme exposed to collagen. C) release of tissue factor by a damaged endothelium. D) release of heparin from the liver. E) conversion of prothrombin to thrombin.

: C

41) The process of fibrinolysis A) activates fibrinogen. B) draws torn edges of damaged tissue closer together. C) dissolves clots. D) forms emboli. E) forms thrombi.

: C

9) Which of the following statements about colony-stimulating factors (CSFs) is FALSE? A) CSFs are required to induce both cell division and cell maturation. B) CSFs regulate leukopoiesis. C) CSFs are made by epithelial cells. D) CSFs regulate leukopoiesis and CSFs are made by epithelial cells.

: C

85) monocytes

: C (2-8%)

51) A type of granulocyte, these have red granules.

: C (eosinophils)

45) essential to the process of blood clotting

: C (fibrinogen)

57) Caused by a dietary deficiency, this condition results in red blood cells that are small and pale.

: C (iron-deficiency anemia)

90) Define, compare, and contrast "clot busters" and anticoagulants; describe how each works.

: Clot busters are enzymes that destroy clots that have already formed, while anticoagulants prevent clots from forming in the first place.

10) ________ are a group of diseases characterized by the abnormal growth and development of white blood cells, and ________ are diseases where patients have too few white blood cells. A) Neutropenias, leukemias B) Anemias, leukemias C) Neutropenias, anemias D) Leukemias, neutropenias E) Leukemias, anemias

: D

17) The primary stimulus for the release of erythropoietin is A) hypoxemia only. B) low oxygen levels in the tissues only. C) low blood pressure only. D) hypoxemia and low oxygen levels in the tissues. E) hypoxemia, low oxygen levels in the tissues, and low blood pressure.

: D

21) A hemoglobin molecule is composed of A) just two protein chains. B) just three protein chains. C) just four protein chains and nothing else. D) four protein chains and four heme groups. E) four heme groups but no protein.

: D

25) A hematocrit is used to indicate A) only the ratio of red blood cells to the total blood volume. B) only the packed cell volume. C) only coagulation time. D) the ratio of red blood cells to the total blood volume and the packed cell volume. E) All of the answers are correct.

: D

26) A normal adult hematocrit would be approximately ________%. A) 100 B) 75 C) 66 D) 45 E) 10

: D

28) The percentage of whole blood occupied by red blood cells is the A) viscosity. B) specific gravity. C) pH. D) hematocrit. E) differential cell count.

: D

30) The process of red blood cell production is called A) erythrocytosis. B) erythropenia. C) hemocytosis. D) erythropoiesis. E) hematopenia.

: D

31) Each red blood cell is shaped as a biconcave disk. This allows it to A) change its shape to squeeze through narrow openings. B) shrink or swell slightly in response to osmotic conditions. C) synthesize new proteins and membrane components readily. D) change its shape to squeeze through narrow openings and shrink or swell slightly in response to osmotic conditions. E) change its shape to squeeze through narrow openings, shrink or swell slightly in response to osmotic conditions, and synthesize new proteins and membrane components readily.

: D

40) The common pathway of coagulation begins with the A) sticking of platelets to damaged tissue. B) activation of a proenzyme exposed to collagen. C) release of tissue factor by a damaged endothelium. D) activating of a clotting factor that converts prothrombin to thrombin. E) activation of a clotting factor that converts fibrinogen to fibrin.

: D

5) Monocytes leave the circulation to go to the tissues, where they are called A) eosinophils. B) basophils. C) lymphocytes. D) macrophages. E) neutrophils.

: D

84) eosinophils

: D (1-4%)

55) genetic condition resulting in crescent moon-shaped red blood cells

: D (iron-deficiency anemia)

49) These are fragments of a megakaryocyte.

: D (platelets)

46) bind(s) with iron in the blood

: D (transferrin)

76) What is a differential white cell count and when is it used?

: Differential white cell count estimates the relative numbers of the five types of white blood cells. It is used by clinicians for diagnosis.

13) Thrombopoietin is produced in the A) liver only. B) kidney only. C) spleen only. D) bone marrow only. E) liver and kidney.

: E

34) Which of the following is/are vasoconstrictors? A) platelet-activating factor B) serotonin C) adenosine diphosphate D) thromboxane A2 E) serotonin and thromboxane A2

: E

36) Platelets function in A) transporting chemicals important for clotting. B) forming temporary patches in injured areas. C) contraction after clot formation. D) initiating the clotting process. E) All of the answers are correct.

: E

37) Platelets are A) large cells that lack a nucleus. B) small cells that lack a nucleus. C) large cells with a prominent, indented nucleus. D) small cells with a many-shaped nucleus. E) fragments of large cells.

: E

7) The percentage of cells in blood-producing tissues that become white blood cells is about ________%. A) 90 B) 10 C) 50 D) 25 E) 75

: E

79) How would a decrease in the concentration of iron in the blood affect the process of hemostasis? A) Platelet plugs would fail to form. B) Coagulation would proceed more rapidly. C) Coagulation would proceed more slowly. D) Retraction would occur prematurely. E) There would be no effect.

: E

8) Colony-stimulating factors are cytokines made by A) endothelial cells. B) fibroblasts from bone marrow. C) white blood cells only. D) endothelial cells and fibroblasts from bone marrow. E) endothelial cells, fibroblasts from bone marrow, and white blood cells.

: E

81) Tom suffers from a severe liver disease. Which of the following symptoms would you expect to see as a result of this condition? A) decreased clotting ability B) decreased blood osmotic pressure C) increased levels of bilirubin in the blood D) accumulation of fluid in the tissue spaces of the extremities E) All answers are correct.

: E

Match each leukocyte to its normal percentage in a differential cell count. A. 50-70% B. 20-40% C. 2-8% D. 1-4% E. < 1% 83) basophils

: E (< 1%)

Match the name of the pathological condition with its description. A. hereditary spherocytosis B. polycythemia vera C. iron-deficiency anemia D. sickle cell disease E. anemia 53) general term for the condition of low hemoglobin in the blood

: E (anemia)

44) help(s) defend the body against germs

: E (antibodies)

50) Phagocytic, these cells make up the majority of WBCs.

: E (neutrophils)

98) What is the difference between hemostasis and homeostasis, or are they the same?

: Hemostasis is the process that minimizes blood loss from the body. Homeostasis is the process that maintains normal physiology. Hemostasis is a type of homeostasis.

93) Blood clotting is considered to be an example of a positive feedback situation. Explain why this is so, and demonstrate the appropriate steps or areas of hemostasis as part of your explanation.

: In the blood clotting process, each step triggers a new step(s), by activating enzymes or putting components together that were previously separated. Some of the products formed "feed back" to enhance earlier reactions, sustaining the cascade until some components are completely consumed.