Path Final Module 9

Which of the following provides the best general definition of anemia? A. Decreased amount of circulating plasma volume B. Decreased number of circulating erythrocytes C. Presence of tissue hypoxia D. Bone marrow failure

B. Decreased number of circulating erythrocytes Correct! All types of anemia involve a decreased number of circulating erythrocytes

Which of the following symptoms are you most likely to see in a child who has idiopathic thrombocytopenic purpura (ITP)? A. Multiple infections and erythematous rash B. Epistaxis, easy bruising, and petechiae C. Lower extremity that is warm to touch, edematous, and painful D. Fatigue, weakness, and pale skin

B. Epistaxis, easy bruising, and petechiae Correct! Decreased platelet levels in ITP increase a child's risk of bleeding. Manifestations of bleeding include epistaxis (nosebleeds), easy bruising, and petechiae.

What is the underlying pathophysiology of secondary polycythemia caused by hypoxemia at high altitude? A. Reduced erythropoietin causes severe anemia. B. Erythropoietin stimulates increased erythrocyte production. C. Bone marrow response to hypoxia causes thrombocytopenia. D. Stem cells in bone marrow proliferate, causing neutrophilia.

B. Erythropoietin stimulates increased erythrocyte production. Correct! In response to hypoxia, increased erythropoietin secretion stimulates bone marrow to produce more erythrocytes, causing polycythemia.

An elevation in the serum level of which substance is consistently observed in disseminated intravascular coagulation (DIC)? A. Platelets B. Fibrin degradation products C. Clotting factors D. Activated protein C

B. Fibrin degradation products Correct! In DIC, a sign of fibrinolysis and clot breakdown is the presence of fibrin degradation products

Gino Locatelli has hemophilia. His mother was surfing the Internet and read that hemophilia can cause joint deformities. "How does that happen?" she asks. "How could Gino's bleeding disorder deform his joints?" Choose the best response. A. By impairing balance, causing frequent falls and joint injuries B. From repeated episodes of bleeding into joints C. Through lack of oxygen in joints that causes abnormal cartilage D. That is a rumor you have found on the Internet and it is not true.

B. From repeated episodes of bleeding into joints Good thinking! Hemophilia can cause joint deformities from repeated episodes of bleeding into joints.

What is a thrombocyte? A. A platelet B. An immature blood cell C. A blood clot in a vein D. A phagocytic cell

A. A platelet Correct! A thrombocyte is a platelet.

Which of the following problems occurs in the late stages of disseminated intravascular coagulation (DIC)? A. Active bleeding B. Deep vein thrombosis C. Bone marrow failure D. Aortic rupture

A. Active bleeding Correct! In the late stages of DIC, after platelets and clotting factors have been consumed in widespread formation of microthrombi, the risk of bleeding is increased.

What is a reticulocyte? A. An immature red blood cell B. An abnormal red blood cell C. A kidney cell that secretes erythropoietin D. A spleen cell that destroys erythrocytes

A. An immature red blood cell Correct! A reticulocyte is an immature red blood cell.

Red blood cell lysis in the spleen yields which one of the following products? A. Bilirubin B. Vitamin B12 C. Hematopoietic growth factors D. Fibrin

A. Bilirubin Correct! Bilirubin is formed from degraded hemoglobin that gets released after old or injured red blood cells are phagocytized in the spleen.

Which of the following blood tests allows a clinician to visualize morphological changes in erythrocytes, such as sickle cells or schistocytes? A. Blood smear B. Mean corpuscular volume (MCV) C. Mean corpuscular hemoglobin (MCH) D. Hematocrit

A. Blood smear Correct! With a blood smear, a small amount of blood (or bone marrow) is visualized under the microscope, allowing a clinician to detect structural and shape changes in erythrocytes

You are working on an oncology unit. At change of shift report, you are told that Mrs. Marguson has a functional heart murmur and that you should not worry about it because it is due to her anemia. Another nurse says, "How could anemia cause a heart murmur? That does not make sense to me!" Choose the best response. A. Decreased blood viscosity causes turbulence when blood circulates through heart valves; we hear turbulence as a heart murmur. B. Decreased oxygen content of blood causes tissue hypoxia of the heart valves; the hypoxia causes a heart murmur. C. Increased intravascular volume from anemia causes pressure on heart valves; we hear that pressure as a heart murmur. D. Increased heart rate in anemia causes hypotension in the heart valves; that low pressure causes a heart murmur.

A. Decreased blood viscosity causes turbulence when blood circulates through heart valves; we hear turbulence as a heart murmur. Good thinking! Decreased blood viscosity due to anemia causes turbulence when blood circulates through heart valves; turbulence is heard as a murmur.

What is the underlying pathophysiology of hereditary spherocytosis? A. Erythrocyte membranes have abnormal proteins, targeting them for destruction in the spleen. B. Erythrocytes lack an intracellular enzyme that makes them vulnerable to destruction in the spleen. C. Excess hemoglobin causes erythrocyte deformation, causing erythrocyte destruction in the spleen. D. A genetically overactive spleen destroys normal erythrocytes in excessive numbers, causing anemia.

A. Erythrocyte membranes have abnormal proteins, targeting them for destruction in the spleen. Correct! Defective membrane proteins cause spherocytes to be round instead of biconcave and target them for destruction in the spleen

Which one of the following molecules forms a meshwork that stabilizes the platelet plug during hemostasis? A. Fibrin B. Collagen C. Thrombin D. Fibrinogen

A. Fibrin Correct! Fibrin is the insoluble end product of the clotting cascade that forms the meshwork in a blood clot.

Which of the following is the most important mineral required for erythropoiesis? A. Iron B. Calcium C. Magnesium D. Selenium

A. Iron Correct! Iron is the most important mineral required for erythropoiesis. Iron is necessary for hemoglobin synthesis.

You are working in a prenatal clinic. All of the women today are early in their third trimester. Which of the following women is at highest risk for becoming anemic and therefore needs the most frequent monitoring and careful teaching? A. Mrs. Zernardi, who has rheumatoid arthritis B. Mrs. Harris, who has heartburn after eating C. Mrs. Gluck, who has low blood pressure D. All of these women are at equal risk of anemia.

A. Mrs. Zernardi, who has rheumatoid arthritis Good thinking! Rheumatoid arthritis is associated with anemia of chronic disease, which gives this woman an additional risk for anemia; all of these pregnant women have increased risk of both iron deficiency and folate deficiency anemia because demand for both nutrients is elevated during pregnancy.

Which one of the following symptoms is characteristic of vaso-occlusive crisis in sickle cell anemia? A. Pain B. Pancytopenia C. Splenomegaly D. Hypotension

A. Pain Correct! Ischemia from obstruction of capillaries by malformed erythrocytes causes pain.

Which of the following types of anemia is caused by decreased production of erythrocytes? A. Pernicious anemia B. Sickle cell anemia C. Hereditary spherocytosis D. G6PD deficiency anemia

A. Pernicious anemia Correct! Pernicious anemia is caused by decreased production of erythrocytes.

Why are red blood cells hypochromic in iron deficiency anemia? A. Production of hemoglobin is impaired, so the erythrocytes are more pale than usual. B. Erythrocytes are produced more rapidly, so the erythrocytes are smaller than usual. C. Normal cell growth but slower cell division in the bone marrow makes the erythrocytes larger than usual. D. Lack of erythropoietin causes sluggish activity of bone marrow and makes the erythrocytes darker than usual.

A. Production of hemoglobin is impaired, so the erythrocytes are more pale than usual. Correct! Lack of iron impairs production of hemoglobin, which makes the erythrocytes more pale than usual.

"I am confused by all the different kinds of anemia we see in our clinic," says another nurse. "Please tell me which ones are inherited." From the following list, choose the ones that you should tell her are inherited anemias. Choose all that apply. A. Thalassemia B. Sickle cell C. Aplastic D. Polycythemia vera E. Pernicious F. Spherocytosis G. G6PD deficiency H. Hemolytic .

A. Thalassemia B. Sickle cell F. Spherocytosis G. G6PD deficiency Some hemolytic anemias are inherited but some are acquired. Aplastic and pernicious anemias are acquired. Polycythemia vera is not a type of anemia. Inherited anemias include thalassemia, sickle cell anemia, hereditary spherocytosis, and G6PD deficiency

The pathophysiology of idiopathic thrombocytopenic purpura involves: A. autoimmune platelet lysis. B. an inherited clotting factor deficiency. C. proliferation of megakaryocytes in the bone marrow. D. a stem cell defect in platelet production.

A. autoimmune platelet lysis. Correct! Idiopathic thrombocytopenic purpura involves autoimmune platelet lysis.

Pathophysiological consequences of polycythemia vera include: A. hypercoagulability, leading to tissue ischemia and possible organ infarction. B. decreased oxygen-carrying capacity of erythrocytes, leading to tissue hypoxia. C. malformed platelets, leading to spontaneous bleeding. D. production of deformed erythrocytes that lyse prematurely.

A. hypercoagulability, leading to tissue ischemia and possible organ infarction. Correct! The excess erythrocytes in polycythemia vera cause hyperviscosity of the blood, leading to clot formation, poor tissue perfusion, tissue ischemia, and even organ infarction.

Pica most commonly is associated with: A. iron deficiency anemia. B. folate deficiency anemia. C. thalassemia. D. hemolytic anemias.

A. iron deficiency anemia. Correct! Pica (eating nonfood substances) is associated with iron deficiency anemia.

A unique manifestation of hemolytic anemias (i.e., generally absent in other types of anemia) is: A. jaundice. B. paralysis. C. cerebral edema. D. cyanosis.

A. jaundice. Correct! Hemolysis causes release of bilirubin from degraded hemoglobin molecules. When bilirubin accumulates in the blood, it is deposited in the skin, causing the yellowish discoloration known as jaundice.

When an individual develops heparin-induced thrombocytopenia (HIT), the administration of heparin induces: A. platelet aggregation and thrombus formation. B. pooling of platelets in the spleen. C. lysis of megakaryocytes in bone marrow. D. release of deformed platelets that are unable to form clots.

A. platelet aggregation and thrombus formation. Correct! HIT involves antibodies that activate platelet aggregation and thrombus formation.

Which of the following describes the pathophysiology of sickle cell disease? A. Malformed, sickle-shaped platelets lead to thrombocytopenia and bleeding. B. Hypoxia causes abnormal hemoglobin to make erythrocytes sickle-shaped. C. Sickled erythroblasts are unable to form adequate amounts of hemoglobin. D. Autoantibodies attach to erythrocytes, changing them to a sickled shape.

B. Hypoxia causes abnormal hemoglobin to make erythrocytes sickle-shaped. Correct! Sickle cell disease involves abnormal hemoglobin (Hgb S) that polymerizes in low oxygen tension, changing erythrocytes into sickled shapes.

Why is gastric bypass surgery for morbid obesity a risk factor for development of pernicious anemia? A. Vitamin B12 is absorbed in the stomach. B. Intrinsic factor production by the gastric epithelium is reduced. C. Postoperative antibodies to vitamin B12 are produced. D. Vitamin B12 stores are in the adipose tissue.

B. Intrinsic factor production by the gastric epithelium is reduced. Correct! Pernicious anemia is caused by vitamin B12 deficiency. Vitamin B12 absorption in the distal ileum requires intrinsic factor, which is secreted by parietal cells in the stomach.

Which of the following people are at highest risk for developing a folate deficiency anemia? A. Children born with a congenital intrinsic factor deficiency B. People who abuse alcohol C. Menstruating women D. Vegetarians

B. People who abuse alcohol Correct! People who abuse alcohol are at high risk for folate deficiency anemia.

In anemia, what factor stimulates production of erythropoietin? A. Low blood viscosity B. Renal hypoxia C. Inflammation D. Release of stress hormones

B. Renal hypoxia Correct! Renal hypoxia in anemia stimulates production of erythropoietin.

Hemophilia is caused by: A. autoimmune platelet lysis. B. an inherited clotting factor deficiency. C. proliferation of megakaryocytes in the bone marrow. D. stem cell defect in platelet production.

B. an inherited clotting factor deficiency. Correct! Hemophilia is a genetic bleeding disorder caused by specific clotting factor deficiencies.

The most common cause of acquired hemolytic anemia is: A. viral infection of erythrocytes. B. autoimmune destruction of erythrocytes. C. severe nutritional deficiencies. D. alcoholism.

B. autoimmune destruction of erythrocytes. Correct! The most common cause of acquired hemolytic anemia is autoimmune destruction of erythrocytes

The most common causes of iron deficiency anemia are inadequate diet and: A. acute inflammatory diseases. B. chronic gastrointestinal bleeding. C. genetic autoimmune disease. D. end-stage renal disease.

B. chronic gastrointestinal bleeding. Correct! Inadequate dietary intake of iron and chronic gastrointestinal bleeding are the most common causes of iron deficiency anemia

Causes of anemia include decreased erythropoiesis, hemolysis, and: A. thrombosis. B. hemolysis. C. dehydration. D. splenectomy.

B. hemolysis. Correct! Hemolysis is destruction of erythrocytes and can cause anemia.

The reticulocyte count is elevated in hemorrhage or hemolytic anemias but not in aplastic anemia because reticulocytes are: A. abnormally shaped erythrocytes that change from normal ones to resist hemorrhage or hemolysis, if the bone marrow is functioning. B. immature erythrocytes that are released from bone marrow when circulating erythrocytes are deficient, if the bone marrow is functioning. C. fragile erythrocytes that lyse easily during stress conditions, such as hemorrhage and hemolysis, if the bone marrow is functioning. D. erythrocytes that lack a nucleus and therefore survive longer during hemorrhage and hemolysis, if the bone marrow is functioning.

B. immature erythrocytes that are released from bone marrow when circulating erythrocytes are deficient, if the bone marrow is functioning. Correct! Reticulocytes are immature erythrocytes that are released from bone marrow when circulating erythrocytes are deficient, if the bone marrow is functioning.

In adults, hematopoiesis occurs in the bone marrow of all of the following bones except the: A. vertebrae. B. shaft of the femur. C. ribs. D. pelvic bones.

B. shaft of the femur. Correct! In adults, hematopoiesis does not occur in the bone marrow of the shaft of the femur. It occurs in the bone marrow of the vertebrae, sternum, ribs, cranium, pelvic bones, and very proximal ends of the humerus and femur.

Mr. Yoon developed iron deficiency from repeated episodes of bloody diarrhea associated with ulcerative colitis. "I asked my physician what my red blood cells looked like and he said they are pale and there are not enough of them." Why does iron deficiency make my red blood cells pale? Is that what makes my skin pale too?" Choose the best response. A. Red blood cells get pale whenever a person becomes anemic because the bone marrow makes unusually pale immature cells when it has to make red blood cells in a hurry to make up for anemia. Pale red blood cells circulating in your skin make it look pale. B. Red blood cells get pale whenever a person becomes anemic because the bone marrow makes unusually pale immature cells when it has to make red blood cells in a hurry to make up for anemia. Your skin is pale for a different reason. When you are anemic, your body responds by sending blood from your skin to other parts of your body. Less blood flow to your skin makes you look pale. C. Red blood cells get their color from a substance called hemoglobin that contains iron. When you do not have enough iron, you cannot make enough hemoglobin. Your skin is pale for a different reason. When you are anemic, your body responds by sending blood from your skin to other parts of your body. Less blood flow to your skin makes you look pale. D. Red blood cells get their color from a substance called hemoglobin that contains iron. When you do not have enough iron, you cannot make enough hemoglobin. Pale red blood cells circulating in your skin make it look pale.

C. Red blood cells get their color from a substance called hemoglobin that contains iron. When you do not have enough iron, you cannot make enough hemoglobin. Your skin is pale for a different reason. When you are anemic, your body responds by sending blood from your skin to other parts of your body. Less blood flow to your skin makes you look pale. Good thinking! Erythrocytes are hypochromic in iron deficiency anemia because hemoglobin gives erythrocytes their red color and iron is required for hemoglobin synthesis. Pallor in anemia is due to compensatory cutaneous vasoconstriction.

Which microcytic hemolytic anemia arises from a genetic defect in either the alpha or beta chains of hemoglobin? A. Hereditary spherocytosis B. Iron deficiency anemia C. Thalassemia D. Aplastic anemia

C. Thalassemia Correct! Thalassemia is a genetic disorder that causes impaired synthesis of either the alpha or beta chains of hemoglobin

Clinical manifestations unique to iron deficiency anemia (i.e., usually absent in other types of anemia) include: A. fatigue, dyspnea on exertion, and pale skin. B. symmetrical paresthesias and ataxia. C. dizziness, renal calculi, and skin rash. D. brittle malformed nails and angular stomatitis.

D. brittle malformed nails and angular stomatitis. Correct! Iron deficiency anemia can cause brittle malformed nails and angular stomatitis (erosions at the corners of the mouth).

Erythropoietin is released by the: A. red blood cells. B. bone marrow. C. spleen. D. kidneys.

D. kidneys. Correct! Erythropoietin is released by the kidneys in response to hypoxia.

Erythrocytes in anemia caused by a single recent episode of acute blood loss usually are: A. macrocytic and normochromic. B. microcytic and hypochromic. C. macrocytic and hypochromic. D. normocytic and normochromic.

D. normocytic and normochromic. Correct! Loss of whole blood causes anemia and the remaining erythrocytes are morphologically normal, as they were before the hemorrhage.

Clinical manifestations unique to pernicious anemia (i.e., usually absent in other types of anemia) include: A. fatigue, dyspnea on exertion, and pale skin. B. palpitations, chest pain, and signs of heart failure. C. dizziness, headaches, and nausea. D. symmetrical paresthesias and ataxia.

D. symmetrical paresthesias and ataxia. Correct! Pernicious anemia causes neurological signs and symptoms that may include symmetrical paresthesias and ataxia

What is a megakaryocyte? A. A large phagocytic immune cell in the bone marrow B. A large bone marrow cell that breaks apart into platelets C. A large blood cell that participates in blood clotting D. A large liver cell that produces bilirubin from hemoglobin

B. A large bone marrow cell that breaks apart into platelets Correct! A megakaryocyte is a large bone marrow cell that breaks apart into platelets.

What is the difference between anemia and polycythemia? A. Anemia can be caused by a problem that arises in the bone marrow or in the blood, but polycythemia is caused by a problem that arises in the blood. B. Anemia can be life threatening, but polycythemia does not cause tissue damage. C. Anemia is decreased mass of erythrocytes, but polycythemia is increased mass of erythrocytes. D. Anemia can lead to disseminated intravascular coagulation, but polycythemia can lead to idiopathic thrombocytopenic purpura.

C. Anemia is decreased mass of erythrocytes, but polycythemia is increased mass of erythrocytes. Correct! Anemia is decreased mass of erythrocytes, but polycythemia is increased mass of erythrocytes.

Mr. Than is taking a drug to treat rheumatoid arthritis that can cause thrombocytopenia. You need to teach him the signs and symptoms of thrombocytopenia so that he can report them if they occur. Which of the following should you teach him? A. Deformed fingernails, massive bleeding from cuts B. Weakness, fatigue, pale skin C. Bruising easily, multiple little red skin spots D. Severe bleeding from gums when brushing teeth

C. Bruising easily, multiple little red skin spots Good thinking! Bruising easily and petechiae are signs of thrombocytopenia.

Which of the following proteins is not a normal component of plasma? A. Albumin B. Clotting factors C. Collagen D. Immunoglobulins

C. Collagen Correct! Collagen is a structural component in the wall of arteries and veins but is not normally found in the plasma.

When plasmin degrades fibrin during the fibrinolytic process, what is (are) the by-product(s) called? A. Clotting factors B. Thrombopoietin C. Fibrin degradation products D. Tissue thromboplastin

C. Fibrin degradation products Correct! The degradation of fibrin by plasmin creates fibrin degradation products (FDPs), which also help to dissolve the clot.

In addition to the general manifestations of anemia, which of the following problems also occur(s) with aplastic anemia? A. Elevated bilirubin levels B. Deep vein thrombosis C. Increased risk of infection D. All of the above

C. Increased risk of infection Correct! Bone marrow failure in aplastic anemia causes leukopenia and immunosuppression, which increase susceptibility to infection.

Where in the body are clotting factors synthesized? A. Bone marrow B. Kidneys C. Liver D. Spleen

C. Liver Correct! Clotting factors are proteins synthesized by liver cells.

Why are red blood cells macrocytic in pernicious anemia? A. Production of hemoglobin is impaired, so the erythrocytes are more pale than usual. B. Erythrocytes are produced more rapidly, so the erythrocytes are smaller than usual. C. Normal cell growth but slower cell division in the bone marrow makes the erythrocytes larger than usual. D. Lack of erythropoietin causes sluggish activity of bone marrow and makes the erythrocytes darker than usual.

C. Normal cell growth but slower cell division in the bone marrow makes the erythrocytes larger than usual. Correct! Lack of vitamin B12 causes normal cell growth but slower cell division in the bone marrow, which makes the erythrocytes larger than usual.

Mrs. Jarene has pernicious anemia. "Why do they have to give me those vitamin shots?" she says. "I prefer to take vitamins in a pill." Choose the best response. A. You need large amounts of vitamin B12 right now, because you are anemic, but after your red blood cells return to normal, you can take it in a pill. B. Those shots contain intrinsic factor, as well as vitamin B12; you need the combination of the two in order for them to work effectively in your body. C. You developed pernicious anemia because your body does not absorb vitamin B12 when you take it by mouth, so we need to give it to you in an injection. D. Most people prefer the shots of vitamin B12 because the pill usually causes diarrhea; I can ask for a trial of the pill if you prefer.

C. You developed pernicious anemia because your body does not absorb vitamin B12 when you take it by mouth, so we need to give it to you in an injection. Good thinking! Pernicious anemia arises from lack of intrinsic factor in the stomach, so that vitamin B12 is not absorbed properly and must be given by injection.

Which of the following conditions is (are) associated with development of disseminated intravascular coagulation (DIC)? A. Sepsis B. Major trauma C. Obstetrical accidents D. All of the above

D. All of the above Correct! Any condition that results in significant endothelial injury and activation of the systemic inflammatory response syndrome (SIRS) can lead to DIC.

Causes of aplastic anemia include which of the following? A. Industrial toxins B. Radiation exposure C. Drugs D. All of the above

D. All of the above Correct! Bone marrow failure in aplastic anemia can arise from exposure to industrial toxins, high-dose ionizing radiation, and certain drugs, especially antineoplastics and antibiotics.

Iron is stored in the tissues in what form? A. Myoglobin B. Ferritin C. Hemosiderin D. All of the above

D. All of the above Correct! Iron is stored in muscles as myoglobin but also is stored as ferritin and hemosiderin in the liver and bone marrow.

What is the general cause of aplastic anemia? A. Hemolysis in the spleen B. Severe nutritional deficiencies C. Autoimmune destruction of mature red blood cells D. Bone marrow failure

D. Bone marrow failure Correct! Aplastic anemia is caused by bone marrow failure.

Which of the following is a characteristic of mature erythrocytes? A. Have a spherical shape B. Are produced in the spleen C. Contain the protein transferrin D. Have no nucleus

D. Have no nucleus Correct! During the final stages of erythropoiesis, the nucleus is extruded from the developing red blood cell.

Miss Henderson has used mineral oil for bowel management daily for several years. Now she has developed oozing gums when she brushes her teeth and she bruises very easily. You should teach her that mineral oil prevents absorption of which vitamin that is necessary for synthesis of clotting factors? A. C B. E C. A D. K

D. K Good thinking! Vitamin K is required for normal clotting factor synthesis by the liver. It is fat soluble, so that chronic use of mineral oil can impair its absorption.

Hemolytic disease of the newborn most commonly involves an immune reaction against which of the following antigens on the fetal red blood cells? A. A B. B C. O D. Rh

D. Rh Correct! The most common cause of hemolytic disease of the newborn is maternal-fetal Rh antigen incompatibility.

Which one of the following is a secondary lymphoid organ capable of releasing up to 200 mL of blood into the circulation to restore blood volume in the case of hemorrhage? A. Liver B. Bone marrow C. Pancreas D. Spleen

D. Spleen Correct! The spleen is a secondary lymphoid organ that serves as a blood reservoir and also contains macrophages and lymphocytes.

What is the function of stem cells in the bone marrow? A. They destroy blood cells that are developing abnormally. B. They provide the collagen framework in which blood cells reside while maturing. C. They secrete antibodies that protect immature blood cells. D. They differentiate into blast cells that differentiate into mature blood cells.

D. They differentiate into blast cells that differentiate into mature blood cells. Correct! Stem cells differentiate into blast cells that differentiate into mature blood cells.