Patho Test 2

Differentiate between bacterial, viral, and fungal infections, their pathogenicity's, treatments etc.

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Hodgkin's vs. non-Hodgkin. Spread, treatments, who get its etc.

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Know your terminology in relation to blood products, blood cells, and all the anemia's.

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Make sure you completely understand the inflammatory process. Why it works. How it works. What mediators are involved? Treatments modalities.

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Systemic and Local effects of cancer, hepatitis, leukemia, anemia, burns (all degrees)

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There are many questions on the different types of anemias. Make sure you can distinguish the signs/symptoms/diagnostic characteristics of all of them. Make sure you understand the physiology of how each of them work. Be able to apply the knowledge in a critical thinking fashion.

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Rule of 9's- Genitalia

1%

What are the three major goals of the inflammatory response?

1) Increase blood flow to the site of an injury, which is referred to as the vascular response. 2) To alert the products of healing to attend to the site of injury, which is referred to as the cellular response 3) To remove the injured tissue and prepare the site for healing

Incubation time, Vaccine, Transmission: Hepatitis A

1-2 Months yes vaccine Fecal--Oral from another infected person: contaminated food and water supplies

Incubation time, Vaccine, Transmission: Hepatitis E

1-2 months no vaccine Fecal--Oral from another infected person

How long does it take for the spleen or liver to remove old or damaged cells?

120 days

Incubation time, Vaccine, Transmission: Hepatitis C

2-3 Months no vaccine Contact with infected blood

Incubation time, Vaccine, Transmission: Hepatitis D

2-3 Months no vaccine Contact with infected blood and body fluids; infected mother to fetus; must have HBsAg to be infected with this (coinfection and super infection)

Incubation time, Vaccine, Transmission: Hepatitis B

2-3 Months yes vaccine Contact with infected blood and body fluids; infected mother to fetus

During the inflammation process, a fever would be an example of:

A systemic response to the inflammation process

The following describes what disease? Increased number of immature, non-functioning lymphocytes in bone marrow Expansion of Bone Marrow Increased pressure Multiple resistant infections

Acute Lymphocytic Leukemia

Describe Secondary Intention

An injury is let open to heal. No coverage (possible sterile dressings/packing). The body is able to push the particulates, such as bacteria and viruses, out. Con: Granulation forms: Larger scaring

All of the following describe what? Non-function of bone marrow- loss of stem cells and pancytopenia Serious complications- infections- bleeding Bone marrow changes and increased fatty tissue present

Aplastic Anemia

Amy is a 3 month old baby who has been hospitalized because of meningitis. Her treatment includes IV antibiotic therapy. After the therapy has started, her health status begins to decline quickly. You understand that the bacteria that causes meningitis is gram negative. Considering this, Amy's decline in health status is most likely due to the fact that: A. The gram negative bacteria react with gram positive bacteria B. The bacteria are not killed by the antibiotic C. As the bacteria were killed, endotoxins within the cell wall were released and they triggered a massive inflammatory response D. The bacteria are causing a hypersensitivity

As the bacteria were killed, endotoxins within the cell wall were released and they triggered a massive inflammatory response

Malignant Cell and Age groups effected by: Chronic Lymphocytic Leukemia

B-Lymphocytes Adults over 50

Malignant Cell and Age groups effected by: Hairy Cell Leukemia

B-Lymphocytes Males over 50

Malignant Cell and Age groups effected by: Acute Lymphocytic Leukemia (ALL)

B-Lymphocytes Young Children

The following describes what disease? Thrombocytopenia- AIDS- drugs-autoimmune Chemotherapy- radiation- cancers Uremia- platelets not working ASA use Vit K-liver DX- malabsorptions- PT measures Extrinsic path - APTT measures Intrinsic path- thrombin for final stage- fibrinogen to fibrin- fibrin split for fibrinolysis

Bleeding Disorders

Deep Partial Thickness Burn

Blistering. Hurts the most. Skin replacement needed

Treatment for Thalassemia

Blood transfusions Bone marrow transplants Cord blood harvesting for stem cells for affected sibling Iron chelation Splenectomy Many severe cases die in childhood

In order for the cellular response to occur, which of the following processes need to take place?

Cellular migration Cellular adherence Chemotaxis

Full Thickness Burn

Charring. Does not hurt (in retrospect) due to nerve damage. Does most damage to body. Skin replacement needed

Treatments for Cancer and the effects

Chemotherapy Radiation Surgery Immunotherapy Hormones Palliative care

Why is Crohn disease more likely to cause intestinal obstruction than ulcerative colitis?

Crohn disease is located in the small intestine

The following describes the treatment for what disease? Excessive Bleeding and Excessive Clotting Overactive platelet adhesion- consumes clotting factors- fibrinolysis then leads to bleeding Treat shock /bleeding first- Blood- Fluids- platelets fast Heparin therapy- oxygen Prayer

DIC

The hospitalized burn patient wants to know why you need to remove his dressings everyday. It is painful and he wants to avoid uncovering his burn injury. You explain that removing the dressings promotes

Debridement

Katelynn asks what she can do to help the abrasions heal faster. All of the following are important factors in wound healing except:

Decreased protein synthesis

Depth of injury is important to determine with burns. You are in the sun too long without sunscreen and develop redness and blistering on your face, chest and back. What depth of burn did you experience

Deep partial thickness burn

Treatment for Pernicious Anemia

Folic Acid and B12 shots

Rule of 9's- Chest

Front and Back- 18% Total- 36%

Rule of 9's- Arms

Front and back (one arm)- 4.5 Total 9% Both arm total- 18%

Rule of 9's-Legs

Front and back (one leg)- 9% Total 18% Both leg total- 36%

Rule of 9's- Head

Front and back- 4.5% Total 9%

A major difference between the acute and chronic inflammatory response is that in chronic inflammation:

Granulation tissue is present

Malignant Cell and Age groups effected by: Chronic Myelogenous Leukemia (CML)

Granulocytic Stem Cells Adults 30-50

Malignant Cell and Age groups effected by: Acute Myelogenous Leukemia (AML)

Granulocytic stem cells Adults

Which is the most common cause of acute gastritis?

H.pylori infection

A patient is diagnosed with achilles tendonitis. What would you expect to be the clinical manifestations of this condition given what you know about acute inflammation.

Heel pain, swelling, limited range of motion

The following describes what disease: Excessive Bleesding after trauma Most common- Factor VIII X linked recessive Gene- Seen in Men- Carried By Women Some Spontaneous gene mutation 400 infants per year Fathers that survive are

Hemophillia A

You are caring for Andrew, a 5 year old boy in the ED. He has a sliver in his index finger that has been present for 2 days. Andrew refused to let his mother remove the sliver, and now the surrounding tissue is red, warm and swollen.What is most likely cause of the warmth and swelling?

Increased blood flow to the area due to vasodialation

You get a paper cut and experience pain at the site. This response is related to?

Increased exudate and chemical mediators at the site

Which of the following best describes the inflammatory process in relation to an acute injury

Increased vascular permeability, dilation of vessels, and leukocyte attraction to the site of the injury

Donna's exposure to the cold virus occurred when she was with Alexia. However, Donna did not experience symptoms of a cold right away. This period of time from the time of exposure until Donna developed symptoms is called the: A. Incubation period B. Exposure period C. Prodromal period D. Convalescence period

Incubation period

You know that the most important roles for chemical mediators are to:

Induce vasodilation and increase capillary permeability

Tissue destruction that is the result of the invasion of microorganisms is called:

Infectious disease

Teri's brother accidentally hooked her arm with a fish hook while they were fishing for sunfish off of their grandparents; dock. Her grandfather removed the hook and cleansed the are with soap and water. One week later, an infection developed and the tissue around the wound was red, painful, swollen, and warm to touch. The redness, pain swelling, and warmth in the tissue are due to the: A. Inflammation process B. Bactercidal process C. Septic shock D. Chronic infection

Inflammation process

Prostaglandins, histamine, leukotrienes,

Inflammatory mediators associated with vasodialation and increased permeability

Signs and symptoms of Aplastic anemia/ Tests/ treatment

Insidious (gradual, subtle, harmful) Anemia/ Leukopenia/multiple infections Thrombocytopenia- petechiae- bleeding gums bleeding Tests Blood counts Bone Marrow biopsy Erythrocytes appear normal Treatment- remove cause if possible Bone marrow transplant

You are presented with a client who, during the assessment complains of brittle names, heart palpitations, menstrual irregularities and you notice she has rigid nails. What is the possible diagnosis?

Iron Defcient Anemia

All of these tests are used to confirm what disease? CBC and differential Serum iron Barium X rays for cause of bleed Gynecological examination Cells appear hypochromic and microcytic

Iron Deficient Anemia?

Partial Thickness Burn (Superficial)

Just through epidermis- Minor sunburn

Ulcerative colitis is found in the:

Large intestine

increase capillary permeability causes what?

Leakage

Which is not a local manifestation of acute inflammation

Leukocytosis

The redness, warmth, and swelling around the site of injury in Teri's arm are considered: A. Systemic signs of infection B. Local signs of infection C. Septicemia D. Chronic infection

Local signs of infection

Alexia has had a cold for the past week. During school she coughs and sneezes. One of her friends also becomes infected with the virus and develops symptoms 1 week later. When considering the chain of infection, the coughing and sneezing was most likely the:

Mode of transmission

A patient diagnosed with ulcerative colitis. She has more than four bowel movements per day but no fever, weakness, fatigue, or other systemic manifestations. Her disease would be classified as

Moderate

Malignant Cell and Age groups effected by: Acute Monocytic Leukemia

Monocytes Adults

Cells that play a role in phagocytosis include

Neutrophils Monocytes Macrophages

The following describes what disease? Increased with AIDS S/S similar Mulitiple nodes at once- mostly in abd and organs Not systematic in advancement Difficult to treat

Non-Hodgkins Lympomas

Causes of iron deficient anemia

Not enough iron intake for needs Ulcer, heavy menses, bowel bleeding, blood loss Duodenal absorption- ileitis- achlorhydia Severe liver DX+ protein deficit impedes hemoglobin synthesis Infections and cancers cause iron not to be used- but good iron storage

Iron Deficient Anemia Effects

Pale- vasoconstriction Fatigue, lethargy, and cold intolerance as cell metabolism decreases Irritability- CNS response to hypoxia Degenerative changes-brittle hair, concave and ridged nails Menstrual irregularities Delayed healing Tachycardia, heart palpations, dyspnea and syncope as anemia becomes severe

Caren is a 22 year old female. She comes into the clinic because she suspects that she has a UTI. Most UTI's are caused by the bacteria E.Coli. When E.Coli moves into another part of the body where it is not normally present and causes problems it is called:

Pathogen

All of the following describe what disease? Large immature nucleated erythrocytes ( megaloblastic) Lack of folic acid (B6) or B12 Lack of B12 - pernicious anemia Gastric mucosa lacks intrinsic factor-formation of autoantibodies attacks IF or cells that produce it Cells destroyed quicker Lack of B12 causes demyelination on nerves-sensory then motor Malabsorption- alcoholics and gastric bypass

Pernicious Anemia

The inflammation process must prepare the site of injury for healing. This includes cleaning up debris (dead and impaired tissue) at the site. The process of engulfing and digesting impaired tissue is called?

Phagocytosis

The following describes what disease? Increased production of erythocytes and other cells Neoplastic disorder Increased blood volume and viscosity Blood vessels distended and sluggish flow Blood pressure is elevated and clots and infarcts common Spleen and liver enlarged Bone marrow can become fibrotic Bone marrow hypercellular Leukemia can develop

Polycythemia

Inflammation is ultimately needed to:

Prepare the site for healing

Teri's mom took her into the clinic to see their health care provider. The provider prescribed an antibacterial medication for Teri to take. Teri doesn;t understand how a pill that she takes is going to help the infection in her arm. Teri is told that an antibacterial medication works because it does all of the following except: A. Inhibits synthesis of the bacteria cell wall B. Damages the cytoplasmic membrane of the bacteria C. Disables nucleic acid metabolism or protein synthesis D. Promotes bacterial cell wall enlargement

Promotes bacterial cell wall enlargement

Influenza is a virus that has the ability to change and adapt to its host. This ability to change genetic composition during replication in the human host cell is called: A. Host adaptation B. Reassortment C. Realignment D. Prodromal communication

Reassortment

A major aspect of treatment for inflammatory condition is:

Removal of the source of injury when possible

Chronic inflammation differs from acute inflammation because it:

Represents a persistent or recurrent state of inflammation lasting several weeks or longer

E. Coli is present within the GI tract and dose not pose any harm to the body. This type of bacteria is an example of:

Resident flora

The portal of entry into the human host for the influenza virus is the: A. Skin B. Mucous membrane C. Gastrointestinal tract D. Respiratory tract

Respiratory Tract

Shana has scheduled a visit with a fertility clinic because she is unable to become pregnant. When taking her history, it is noted that she had been diagnosed with numverous sexually transmitted infections in the past. Shana wonders how those infections in the past could possibly affect her ability to become pregnant now. You know that repeated or chronic infections will: A. Result in scar tissue formation within the fallopian tubes B. Enhance ovulation C. Decrease the risk for future sexually transmitted infection D. Increase the number of eggs released from the fallopian tubes

Result in scar tissue formation within the Fallopian tubes

A wound is 6cm X 6cm X 4cm. A wound with these dimensions needs to heal through:

Secondary intention

Katelynn, a 13 year old female, is accompanied to the ED by her mother. She hit a tree with her four wheeler and has large abrasions on her right knee and forehead. Her mother asks if she will need "stitches". You know that this type of wound will most likely heal by

Secondary intention

Signs and symptoms of Acute Lymphocytic Leukemia

Severe Bone Pain and Tenderness High % of lymphoblasts in cells

All of the following describe what disease? Abnormal HGB- HbS When altered HbS is deoxyginated it crystallizes and forms sickle effect Hemolysis 20 day life span- increased bilirubin r/t cell destruction Some sickling can be reversed but then causes perment damage Obstruction of small blood vessels- infarcts-tissue necrosis Gallstones and jaundice from high bilirubin Common middle east and africa- may have been mutation to prevent malaria 1-12 african americans have trait and 1-600 have Sickle cell anemia

Sickle Cell Anemia

A major difference between Crohn disease and ulcerative colitis is the presence of ____ in Crohn disease

Skip lesions

Besides the antibacterial medication that Teri was given, her health care provider also encouraged her to rest, take in plenty of oral fluids, and use acetaminophen for the pain. These types of treatments are called: A. Fungicidal treatment B. Prodromal treatment C. Symptomatic treatment D. Bactericidal treatment

Symptomatic treatment

All of the following describe what disease? Gene defect in hemoglobin missing or variant Autosomal dominant Mediterranean Usual anemia signs and hemolysis/ impaired growth and development from hypoxia/ fatigue and inactivity Hyperactive bone marrow Heart failure Iron overload

Thalassemia

Ellen, your neighbor, has contracted the influenza virus. She knows that you are taking pathophysiology and asks you how a simple virus can cause her sore throat, cough, and nasal congestion. You explain that the localized clinical manifestations that someone with influenza experiences are caused by: A. A septic response B. The inflammatory response and cell death C. The virus separation mode D. Nucleic acid metabolism

The inflammatory response and cell death

The preferred outcome from the inflammation process is:

Tissue repair or regeneration

Signs and symptoms-Tests Pernicious anemia

Tongue large swollen, red, sore and shiny Gastric discomfort -nausea/ diarrhea Tingling or burning Loss of coordination

The following are all treatment for what disease? Stop cause if able Treatment depends on cause Iron rich foods and iron supplements Iron causes gastric irritation and constipation Liquid Iron stains teeth/ skin on injection

Treatment for Iron Deficient Anemia

Causes/Contributing factors of Polycythemia?

Unknown cause contributing factors include Normal 40-60 yrs Secondary DX from chronic lung/ heart disease/ living at high altitudes Renal erythropoietin secreting tumors

What are the steps in hemostasis

Vascular Spasms Platelet Plug Formation Platelet adhesion to vessel wall Platelet aggregation to form platelet wall Coagulation Activation of intrinsic or extrinsic coagulation pathway Prothrombin is converted into thrombin, fibrinogen converted to firbrin Clot Retraction and Repair Fibrinolyosis

Inflammation is a process that includes the following

Vascular and cellular response The formation of exudates preparation for tissue repair

During the inflammation process, the vascular response triggers the following changes at the site of the injury except:

Vasoconstriction

Describe Primary Intention

a wound is sew or closed in a way. The tissues must align properly to ensure effective healing and minimal scarring. Risk: trap particulates within the wound

What is the one definitive test to diagnose rheumatoid arthritis?

one test is not difinitive

Signs and Symptoms of Polycythemia

plethoric and cyanotic/ hepatomegaly/ splenomegaly Puritis common Increased BP Chf Phlebotomy/ chemo or radiation if severe

The primary signs and symptoms of acute inflammation include all of the following except

redness and heat swelling pain and loss of function

another name for platelets

thrombocyte

Acute inflammation occurs in response to:

tissue injury