Study Guide for Pathophysiology - Exam 2
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Hematology -
Alteration of Erythrocyte Function:
How can you estimate a person's blood volume? Normal blood is about 55 %       ?   and 45 %        ?
What are the major plasma proteins? Why do we say "formed elements" instead of cells?
A hemocytoblast gives rise to what blood cells? Remember that hemopoiesis continues throughout life because blood cells all have limited life spans.
Why is the shape of the erythrocyte important? What organelles does it lack? How can you identify a young RBC? What is it called?  What hormone controls RBC production? What organ produces this hormone?
What is the structure of hemoglobin? To what does the oxygen bind? (be specific) Carbon monoxide? A small percentage of carbon dioxide?  What is the average lifespan of an erythrocyte? Where does it go to die? What happens to the globin portion of hemoglobin? To the heme? What happens if there is a great deal of destruction of RBC's or if the liver is not functioning properly? What happens to the iron?
What is the difference in fetal and adult hemoglobin? How does this change the functioning of the hemoglobin in the fetus?
What is the definition of anemia?  What two major (general) conditions cause it?  What are the clinical manifestations? What is the link between oxygen (or lack of ) and fatigue?
 Terms that end with -cytic refer to what? Those that end in -chromic?
What is the cause of macrocytic anemias? If they have the normal amount of hemoglobin, why is being big a problem?  What is one of  the more common megaloblasitic or macrocytic anemias? How did it get its name? It is caused by a lack of  what? Why does type A chronic gastritis cause this? (What type of hypersensitivity reaction would this be? )What substance is needed for the absorption of this vitamin? What other type of signs and symptoms are associated with this type of anemia?  Why are the early symptoms ignored? If it goes untreated, of what does the person die?
Besides anemia, what other signs are seen in folate deficiency? What conditions increase demand for this vitamin? What defects can a maternal lack of this vitamin cause in the developing baby?
Why are small red blood cells a problem?  What are some causes?
What is the most common form of anemia throughout the world? Who is at high risk? What can cause this anemia?
What are some of the more interesting later changes seen in this disease? (in nails, tongue and esophagus). Treatment?
What is sideroblastic anemia? What do the sideroblasts look like? What signs do we see here other than anemia? How can it be treated?
How can we have a normocytic- normochromic anemia? 
What is aplastic anemia? What can cause it? How is it treated?
How do we treat posthemorrhagic anemia?
What is hemolytic anemia?
What is sickle cell anemia? Why is a change in the shape of the cell a problem? Why does the gene for this condition persist if having two bad genes can be fatal? At what age does this condition first show up? Why? What can trigger sickling?
What happens in thalassemia? What populations have a high incidence of this condition ? What other formed elements may be affected besides erythrocytes?
What is polycythemia, and why would it be a problem? (of benefit?) Polycythemia vera is  a condition seen in what population?
Secondary polycythemia is due to an overproduction of        ?  It is seen in what groups of people?
What are the clinical manifestations ?  How is it treated?
What two very different conditions are sometimes treated by phlebotomy?
Why do we put newborn babies under blue lights?

Alteration of Leukocyte Function:
What are the two major groupings of white blood cells, and which white blood cells fall under those headings? Can you give me a function for each of the white blood cells?
What causes increased production of white blood cells in general ?
What is leukocytosis? When is it normal? Name several conditions that would cause this. When is it not?
 Mononucleosis is caused by infection by what virus? What cell type increases here? What type of antibodies are formed? What is the clinical presentation?
What is leukopenia? Is it normal? What do we worry about with this condition? What can cause it ?
What is leukemia? Do the altered white blood cells reproduce faster than the normal cells ? Along with a genetic predisposition to the disease, what are some of the risk factors for developing leukemia?
What is the overall 5 year survival rate for acute leukemias? Is it increasing or decreasing?  What are the clinical manifestations seen here? If we are seeing an increase in the numbers of the cells we use to fight disease, why is infection a problem? Why is early detection a problem? How is it treated?
How does chronic leukemia differ from acute leukemia? (not only duration, but what is going on with the leukocytes)
In what age group do we see chronic leukemia increase? What are the initial symptoms? What type of lymphocyte is seen most often in lymphocytic leukemia? Do these function normally?
How does a lymphoma differ from a  leukemia?
What cell type distinguishes Hodgkin's Lymphoma from other lymphomas? Where does this problem first arise?
What virus is associated with this disease? What other factors?  What are the clinical manifestations?  What other organs can be affected by lymph node swelling?  How is it treated?
What is non-Hodgkin's lymphoma?  What are some of the causes? What bacterium may be involved? This also starts in a single lymph node, but what other organs may be involved? How is it treated?
What is multiple myeloma? What type of cell is over-produced? What organs are affected?
Alteration of platelet function and hemostatis:
What is the life span of a platelet? Where are many stored?
What organ produces many of the proteins needed for blood coagulation? (clotting factors) What vitamin is needed for it to make them?
What is thrombocytopenia, and why is it a problem? What commonly used anticoagulant can cause thrombocytopenia?  How is it caused?
What is thrombocythemia? What is the problem here? What conditions can cause this?
What is hemophilia?
Acquired coagulation disorders are caused by?
What is Disseminated Intravascular coagulation? What causes it? What is happening during this process, and how does it present clinically? How is it treated:?

Vascular and Lymphatic System and pathologies Chapt. 16 & 17):
Trace the blood flow from the heart through the vessels and back to the heart.
What three layers make up the arteries and veins? How do these layers differ in arteries and veins?
What do veins have that arteries do not? What else assists blood flow back to the heart?
Describe the structure of a capillary.
What system supplies the innervation to blood vessels - be specific!
Through which vessels does gas and nutrient exchange take place?
The cardiovascular center receives input from what types of receptors in the vessels?
What is compliance as far as vessels are concerned? What would a decreased compliance indicate?
What factors affect blood pressure?
What is lymph made of? Where does the lymphatic system start? Where does the lymph end up?
What are lymph nodes for?
What is a thrombus? An embolus? What types of substances could form an embolus?
What two conditions would encourage the formation of thrombi? (Think blood flow)
What are the lines of Zahn?
What other factors can influence the formation of thrombi? What do we give a patient to remove them? Prevent them?
What is atherosclerosis and how is it related to arteriosclerosis?
What are VLDL, IDL, LDL and HDL? Which one is the "good" cholesterol?
How much of a blood vessel has to be occluded before symptoms tend to occur?
How does atherosclerosis progress? What is a complicated lesion?
What signs and symptoms would you expect to see with atherosclerosis? How can it be treated?
What is an aneurysm? Where do most occur ? Who has the highest risk? If an aneurysm doesn't rupture is it still a problem?
How does chronic hypertension affect blood vessels?
What causes primary hypertension? What is secondary hypertension? Which is more common? What may cause primary hypertension?  What are some of  the risk factors?
What is complicated hypertension?
What patient factor makes hypertension difficult to treat?
 

Review of cardiac structure and function:
What is the location of the heart?
To what surrounding structures does it attach?
Describe the layers of the pericardium. How does it differ from other serous membrane pairs? Why is this important?
How do cardiac and skeletal muscle cells differ in shape?
What do you find in an intercalated disc? Why are these structures important to the functioning of cardiac muscle?
In what ways do cardiac muscle cells resemble skeletal muscle cells in their cellular structure? How do they differ?
How does much of the calcium necessary for cardiac muscle contraction enter the cell? Why is this significant?
Trace the conduction system through the heart. How do the parasympathetic and the sympathetic nervous systems affect the heart rate?
Review the ECG and what each of the waves represent in a normal electrocardiogram.
Be able to trace the path of blood flow through the heart, the pulmonary and systemic circulatios, and be able to locate the aortic, pulmonary, tricuspid and mitral valves.
What do the chordae tendineae and papillary muscles do in the heart?
What would you expect the central venous pressure to be? Where is it measured?
What is systole? Diastole?
How would you calculate cardiac output? What factors affect it? What is preload? Afterload?
What is Starling's Law? The Bainbridge reflex?

Cardiac pathology:
Pericarditis:
What is pericarditis? What typically causes acute pericarditis?
What are the symptoms of acute pericarditis? What may it be confused with initially? What sign is diagnostic for pericarditis? What ECG changes might you see?
What is pericardial effusion? When is it significant? Why can it be deadly? What clinical manifestation would you see  that would let you know what was going on? How would the heart sound? What  symptoms would the patient have? How would it be treated?
Historically constrictive pericarditis has been associated with what infectious disease?  What are the causes of it today? What happens in the course of this disease?  How rapidly does it develop? What clinical manifestations would you expect? On the ECG?  How would it be treated?
Cardiomyopathies:
What is a cardiomyopathy? What are the three categories? How would the heart look with each?
Why are they a problem?
Disorders of the Endocardium - Valvular Dysfunction:
What is stenosis? Regurgitation? What do both of these disorders cause the heart to do?
What valves are most commonly affected? In I.V. drug users?
What is a heart murmur?
What causes aortic stenosis? How does it affect stroke volume? What would this do to cardiac output (C.O.)?  Systolic blood pressure? What happens to heart rate? What kind of a heart murmur is heard? What symptoms are seen? What do we see happening over time?
What is Mitral Stenosis?  How common is it? What causes it? What happens here over time?
What kind of heart murmur is heard?  How is the heart rate affected? How might this be diagnosed?
What is Aortic Regurgitation? What  conditions can cause it? What happens to the shape of the heart? Why?
What happens to the pulse pressure? What are the other clinical manifestations?
What is Mitral Regurgitation ? What kind of heart murmur is heard here? Why does cardiac output decrease?
What is a Mitral Valve Prolapse? Do we always see regurgitation with this?  Why might it be so common? What kind of hearts sounds might be heard? What symptoms are seen here? Do they make sense as a valve disease? What other problem may be associated with the prolapse that causes the other symptoms? How is this condition managed?
What is meant by Heart Failure ? What is Ischemic Heart Disease ?
What is coronary artery disease? What is the most common cause? What are the risk factors?
How much time do we have from the onset of  myocardial ischemia until permanent damage is done to the heart?
What would you expect to see on ECG? How common is chest pain with a myocardial ischemia?
What is stable angina pectoris?
What is Prinzmetal or variant angina pectoris ? When does it occur?  Why does it occur?
What is unstable angina pectoris ? What does it signify?
Why do may individuals experience Silent Ischemia?
How is myocardial ischemia treated ?
What is a myocardial infarction  or" heart attack"?  How does it change the heart? What are the clinical manifestations ?  What do blood tests show? Which of these is specific for a heart attack?
How is it treated? What should you watch for?
What is Heart Failure ?
What usually causes right heart failure? If it occurs alone, what is the cause?

The signs or conditions below would be associated with which of the conditions we have studied? (may be one or more than one condition.)

Extra, rapid heart sound
rumbling decrescendo heart murmur
Midsystolic click
Distant or muffled heart sounds
Crescendo-decrescendo heart murmur
High pitched or blowing sound during diastole
Pansystolic murmur that radiates into the back and axilla
Friction rub at apex and left sternal border
Widened pulse pressure
Pulsus paradoxus
Prominent carotid pulsations
narrowed pulse pressure
T wave inversion and ST segment depression or elevation
PR segment depression and ST segment elevation
bradycardia
tachycardia
Radiation exposures, rheumatoid arthritis and uremia
Connective Tissue disorders, such as Marfan's syndrome
Years ago, associated with T.B.
Antibiotics before invasive procedures

Chapter 19 Heart failure only: New PowerPoint posted
What is Heart Failure ? Is the incidence of heart failure increasing or decreasing?
What is acute heart failure? What is chronic heart failure?
What are the four broad consequences seen with heart failure?
Do we always see a decreased cardiac output? What can cause a high output failure?
What causes right heart failure? Which is more common, right or left heart failure?
What is systolic heart failure?
What conditions decrease contractility of the ventricle? What increases preload? What causes increased afterload?
What compensatory mechanisms are activated that actually make the condition of systolic left heart failure worse?
What do we see clinically? What does treatment attempt to do?
What is diastolic heart failure? What can cause this?
END OF EXAM 2!!!