NR-507 IMid-Term IStudy IGuide
Hematology:
hematopoiesis
Ierythropoietin
erythrocyte Ifunction Iand Ilifespan
Ifunctions Iof Ihemoglobin
iron-deficiency Ianemia- I(Microcytic)- Ismall IRBC I*Iron Ideficiency Icommon
IcauseIthalassemia- I(Microcytic)
sickle-cell Ianemia- I(Normocytic)
Ihemolytic Ianemia- I(Normocytic)
pernicious Ianemia- I(Macrocytic)- Ilarge IRBC I*B12 Ior Ifolate Ideficiency
Genitourinary/Renal:
anatomy Iand Iphysiology Iof Ithe Ikidney
Ikidney Ifiltration
nephron Idamage
Itubular Ireabsorption
conditions Iassociated Iwith Irenal Ifailure
Icalculi Iblockage I of I ureter
benign Iprostatic Ihypertrophy
Iprerenal Idisease
intrarenal Idisease
Ipostrenal Idisease
Iglomerulonephritis
Itreatment Iof Irenal
Ifailure
role Iof Iangiotensin Iconverting Ienzyme I(ACE)
Pulmonary:
anticholinergic Idrugs
Itreatment Ifor Iasthma
Iasthma
alveolar Ihyperinflation Iwith Iasthma
chronic Ibronchitis Iand Irelated Iacid/base Idisturbances
Iperfusion
blood Iflow Ibetween Ithe Iheart Iand Ilungs
Ibronchioles
polycythemia Ivera
Cardiovascular:
heart Ivalves
IS1 Iheart
ItoneIS2 Iheart
Itone
cardiac Icontractility
preload- Iventricle Istretch Iduring IDIASTOLE Ifilling I(Franks Ilaw)
afterload-(unload) Iventricle Iexcertion Iduring ISYSTOLE- Ipumping Iblood Iout Iof ISL Ivalves I(Laplace Ilaw)
Idiastole- IEnd I diastolic I volume I (EDV)- I blood Iin Iventricle I before I systole I (120 I mL)
systole- IEnd Isystolic Ivolume I(ESV)- Iblood Ileft Iin Iventricle Iafter Isystole I(50mL)
Istroke Ivolume- Iblood Ivolume Iejected Iby Iventricle Iduring Isystole I(70mL) I*↑HR=↓SV
cardiac Ioutput- Ivolume Iof Iblood Iejected Iby Ieach Iventricle Iper Imin, ISV IX IHR I(70mLx75bpm=5.25 IL/min)
Iheart I failure- I dysfunction=↓CO=↓perfusion
Congestive Iheart Ifailure- ILHF, I*caused Iby IHTN
Cor IPulmonale- IRHF, I* Icaused Iby Ipulmonary Idysfunction
Hypertension- Ileads Ito IHF
, MIDTERM PATHO READINGS
I I
WEEK 1: 1, 2, 7, 8, 9, 10, 11, 12, 13, 14 Cell/Caner/Immunity
I I I I I I I I I I I I
WEEK 2: 3, 34, 35, 36 Acid-Base/F&E/Pulmonary
I I I I I I
WEEK 3: 27, 28, 29, 30, 32, 33 Hematology/Cardiovascular
I I I I I I I I
WEEK 4: 37, 38, 39 Renal
I I I I I
, Hematology
Hematopoiesis I(Hemato=blood IPoiesis= Ito Iform Ior Imake) I(blood I= I7% IBW)
• Process Iof Icreating Inew Iblood Icells. IAll Iblood Icells Iare Imade Iin Ithe Ibone Imarrow. IStimulated Iby
Iandrogens I(testosterone) I& Ierythropoietin Imade Iby Ithe Ikidney I& Iliver Iin Iresponse Ito Itissue
Ihypoxia
• Stimulated Iby Iinfiltration Iof Iyellow I(fatty) Ibone Imarrow Iwith Ired Imarrow Icells
• All Iblood Iis Icreated Ifrom Ihematopoietic Istem Icells I(HSC)-(Hemocytoblast)
o Proliferate I& Idifferentiate Iby Igrowth Ifactors I& Icytokines Ito Iform IRBC, IWBC, I& Iplatelets
o 4 Igroups
▪ Lymphoid: IT-cell I(T-lymphocyte) I& IB-cell I(B-lymphocyte)
▪ Myeloid: IMonocyte I& IGranulocytes I(WBC)
▪ Erythrocyte I(RBC)
▪ Megakaryocyte I(platelets),
• Site Iof Iformation:
o 3rd Iweek Igestation, Iyolk Isac,
o 8th Iweek Igestation, Iliver I& Ispleen
o 5th Imonth Igestation, Ibone Imarrow
o Birth-5yrs, Ired Imarrow
o 20+ Iyears, Ilarger Ibones I(ilium, Ivertebrae, Icranium, Ijaw, Isternum, Iribs, Ifemur, Ihumerus)
• Erythrocyte I(RBC)
o Normal IRBC Ilevel I= I4.2-6.2 Imillion Imm I= I45% Iof Iour Iblood Ivolume
o Contains Ihemoglobin Imolecules: IOxygen Icarrying Imolecule, Iwhich Iregulate Idiffusion
Ithrough Ia Icell’s Iplasma Imembrane, Ito Icells I(Hgb Ican Icarry Iup Ito I4 Imolecules Iof Ioxygen)
▪ Carry Ioxygen Ito Ilungs I& Iexchange Iit Ifor Icarbon Idioxide Iin Ithe Itissues
▪ Responsible Ifor Iblood’s Iruby-red Icolor
▪ As Imany Ias I300 Imillion IHgb Imolecules/RBC I(90% Idry Iweight IRBC)
▪ Hbg= Ipolypeptide Ichains I(2alpha I& I2 Ibeta), I4 Iheme Imolecules, I& I4 Iiron
o Oxyhemoglobin: IOxygen Ibinds Ito Iiron Iin Iheme Imolecule, IRED
o Deoxyhemoglobin: ICO2 Ibinds IHgb, Ireleased Iin Ilungs, IBLUE
o Mature Ierythrocytes Ilack Ia Inucleus I& Iorganelles, Iso Iit Icannot Isynthesize Iprotein Ior Icarry
Iout Ioxidative Ireactions. ICannot Idivide I= Ilimited Ilife Ispan I*Anaerobic Imetabolism Ionly
o Biconcave, Ispherical Idisk, Ireversible
o Lifespan: I100-120 Idays, I1% Icirculating IRBC Ireplenished Ievery I24 Ihours I(2.5million IRBC’s/second)
o Stages: I(7-day Iprocess)
▪ Hemocytoblast I(stem Icell) Ibinds Iwith Ierythropoietin
▪ Proerythroblast- Icommitted Ito Imorph Iinto IRBC
▪ Erythroblast- Iribosome Isynthesis I(2 Iphases)
▪ Normoblast- IHgb Iaccumulation I& Inucleus Iejection
▪ Reticulocyte I– Ireleased Iinto Icirculation, Ino Inucleus, Iribosome, Ior Imitochondria
▪ RBC I(once Iin Ibone Imarrow I1-2 Idays)
o Size: Imicrocytic, Inormocytic, Imacrocytic
o Color: Ihypochromic, Inormorchromic, Ihyperchromic I(due Ito IHgb Ilevel)
, o Variability: IAnisocytosis I(size), Ipoikilocytosis I(shape)
Vitamin IB12 I(Cyanocobalamin)
• Dietary Isources: Imeat, Ifish, Ipoultry, Idairy I*NO IFRUITS IOR IVEGGIES
• Stomach Isecretes Iintrinsic Ifactor Iprotein Iassists Iwith Iabsorption Iof Iileum
• Excess Istored Iin Iliver I(1000X Ireserve, Itakes Iyears Ito Ideplete Istores)
Folic Iacid I(Folate)
• Dietary Isources: Iliver, Igrain, Igreen Ivegies
• Required Ifor IDNA I& IRNA Isynthesis
• Prevents Ineural Itube Idefects Iin Ifetus
• Excess Istored Iin Iliver I(reserve Idepleted I2-3 Imonths)
Iron
• Dietary Isources: Imeat, Idried Ibeans, I& Ieggs
• Absorbed Iin IGI, Icombined Iwith Itransferrin I(plasma Iprotein) I(transporter) I& Icarried Ito Iliver Ifor
Istorage Ias Iferritin, Itransferrin Icarries Ito Ibone Imarrow
• Ferrous Iiron Ican Ibind Ioxygen, IFerric Iiron Icannot
• Vitamin IC I(antioxidant) Iassists Iwith Ikeeping Iiron Iin Iferrous Iform
• Iron/d: I(Female I19-50: I18mg/d)(Female>50, IMale>19: I8mg/d)
Anemia
• ↓total Inumber Icirculating IRBC/ I↓ I(Hgb) Iability Iof Ithe Ierythrocytes Ito Icarry Ioxygen I= Ihypoxemia
o Blood Iloss I(acute Ior Ichronic)
o Defective Ierythrocytes
o Abnormal Idestruction Iof Ierythrocytes
• ↓ Ioxygenation I= Ihypoxia, Idyspnea, Ipallor, Idizzy, Ifatigue
Iron-deficiency Ianemia I(IDA) I(Microlytic Ianemia: Ismall Iabnormal Ishaped IRBC) I*most Icommon
• ↓iron Ilevels Ior Iinability Ifor Imitochondria Ito Iutilize Iiron I= I↓Hgb Isynthesis I= Ismaller Ipaller Icells.
• ↓RBC Iproduction I= ILow IHgb I= I↓ Ioxygen-carrying Icapacity
• Causes: IInadequate Iiron Iintake, Iiron Imalabsorption, Ilead Ipoisoning, Ichronic Iblood Iloss, I↑ Iiron
Idemand I(pregnancy), Ichildhood Igrowth Ispurts, Imenstruation, IGI Ibleed, ICKD, IPPI’s I& IH2 Iblockers
o CKD: Ikidneys Ido Inot Isecrete Ienough Ierythropoietin. IErythropoietin Iand Iiron Iare Ilost
Iduring Idialysis.
• Treatment: IIron Isupplements, Iascorbic Iacid I(vitamin IC) Icontaining Ifoods Ican Ihelp Iwith
absorption.
• Pathophys: IInsufficient IFe Ilevels/inability Iof Imitochondria Ito Iutilize IFe I= I↓ IHgb Isynthesis
• 3 Istages:
o Iron Istore Idepleted Icausing Iiron Ideficiency, Ifew Ito Ino Isymptoms, Ifatigue I(Hgb I<30)
o Iron Ideficiency I& Ianemia I(↓iron Itransportation Ito Ibone Imarrow), Iweak, Ifatigue, IShob
I(Hgb I9-12)
Hematology:
hematopoiesis
Ierythropoietin
erythrocyte Ifunction Iand Ilifespan
Ifunctions Iof Ihemoglobin
iron-deficiency Ianemia- I(Microcytic)- Ismall IRBC I*Iron Ideficiency Icommon
IcauseIthalassemia- I(Microcytic)
sickle-cell Ianemia- I(Normocytic)
Ihemolytic Ianemia- I(Normocytic)
pernicious Ianemia- I(Macrocytic)- Ilarge IRBC I*B12 Ior Ifolate Ideficiency
Genitourinary/Renal:
anatomy Iand Iphysiology Iof Ithe Ikidney
Ikidney Ifiltration
nephron Idamage
Itubular Ireabsorption
conditions Iassociated Iwith Irenal Ifailure
Icalculi Iblockage I of I ureter
benign Iprostatic Ihypertrophy
Iprerenal Idisease
intrarenal Idisease
Ipostrenal Idisease
Iglomerulonephritis
Itreatment Iof Irenal
Ifailure
role Iof Iangiotensin Iconverting Ienzyme I(ACE)
Pulmonary:
anticholinergic Idrugs
Itreatment Ifor Iasthma
Iasthma
alveolar Ihyperinflation Iwith Iasthma
chronic Ibronchitis Iand Irelated Iacid/base Idisturbances
Iperfusion
blood Iflow Ibetween Ithe Iheart Iand Ilungs
Ibronchioles
polycythemia Ivera
Cardiovascular:
heart Ivalves
IS1 Iheart
ItoneIS2 Iheart
Itone
cardiac Icontractility
preload- Iventricle Istretch Iduring IDIASTOLE Ifilling I(Franks Ilaw)
afterload-(unload) Iventricle Iexcertion Iduring ISYSTOLE- Ipumping Iblood Iout Iof ISL Ivalves I(Laplace Ilaw)
Idiastole- IEnd I diastolic I volume I (EDV)- I blood Iin Iventricle I before I systole I (120 I mL)
systole- IEnd Isystolic Ivolume I(ESV)- Iblood Ileft Iin Iventricle Iafter Isystole I(50mL)
Istroke Ivolume- Iblood Ivolume Iejected Iby Iventricle Iduring Isystole I(70mL) I*↑HR=↓SV
cardiac Ioutput- Ivolume Iof Iblood Iejected Iby Ieach Iventricle Iper Imin, ISV IX IHR I(70mLx75bpm=5.25 IL/min)
Iheart I failure- I dysfunction=↓CO=↓perfusion
Congestive Iheart Ifailure- ILHF, I*caused Iby IHTN
Cor IPulmonale- IRHF, I* Icaused Iby Ipulmonary Idysfunction
Hypertension- Ileads Ito IHF
, MIDTERM PATHO READINGS
I I
WEEK 1: 1, 2, 7, 8, 9, 10, 11, 12, 13, 14 Cell/Caner/Immunity
I I I I I I I I I I I I
WEEK 2: 3, 34, 35, 36 Acid-Base/F&E/Pulmonary
I I I I I I
WEEK 3: 27, 28, 29, 30, 32, 33 Hematology/Cardiovascular
I I I I I I I I
WEEK 4: 37, 38, 39 Renal
I I I I I
, Hematology
Hematopoiesis I(Hemato=blood IPoiesis= Ito Iform Ior Imake) I(blood I= I7% IBW)
• Process Iof Icreating Inew Iblood Icells. IAll Iblood Icells Iare Imade Iin Ithe Ibone Imarrow. IStimulated Iby
Iandrogens I(testosterone) I& Ierythropoietin Imade Iby Ithe Ikidney I& Iliver Iin Iresponse Ito Itissue
Ihypoxia
• Stimulated Iby Iinfiltration Iof Iyellow I(fatty) Ibone Imarrow Iwith Ired Imarrow Icells
• All Iblood Iis Icreated Ifrom Ihematopoietic Istem Icells I(HSC)-(Hemocytoblast)
o Proliferate I& Idifferentiate Iby Igrowth Ifactors I& Icytokines Ito Iform IRBC, IWBC, I& Iplatelets
o 4 Igroups
▪ Lymphoid: IT-cell I(T-lymphocyte) I& IB-cell I(B-lymphocyte)
▪ Myeloid: IMonocyte I& IGranulocytes I(WBC)
▪ Erythrocyte I(RBC)
▪ Megakaryocyte I(platelets),
• Site Iof Iformation:
o 3rd Iweek Igestation, Iyolk Isac,
o 8th Iweek Igestation, Iliver I& Ispleen
o 5th Imonth Igestation, Ibone Imarrow
o Birth-5yrs, Ired Imarrow
o 20+ Iyears, Ilarger Ibones I(ilium, Ivertebrae, Icranium, Ijaw, Isternum, Iribs, Ifemur, Ihumerus)
• Erythrocyte I(RBC)
o Normal IRBC Ilevel I= I4.2-6.2 Imillion Imm I= I45% Iof Iour Iblood Ivolume
o Contains Ihemoglobin Imolecules: IOxygen Icarrying Imolecule, Iwhich Iregulate Idiffusion
Ithrough Ia Icell’s Iplasma Imembrane, Ito Icells I(Hgb Ican Icarry Iup Ito I4 Imolecules Iof Ioxygen)
▪ Carry Ioxygen Ito Ilungs I& Iexchange Iit Ifor Icarbon Idioxide Iin Ithe Itissues
▪ Responsible Ifor Iblood’s Iruby-red Icolor
▪ As Imany Ias I300 Imillion IHgb Imolecules/RBC I(90% Idry Iweight IRBC)
▪ Hbg= Ipolypeptide Ichains I(2alpha I& I2 Ibeta), I4 Iheme Imolecules, I& I4 Iiron
o Oxyhemoglobin: IOxygen Ibinds Ito Iiron Iin Iheme Imolecule, IRED
o Deoxyhemoglobin: ICO2 Ibinds IHgb, Ireleased Iin Ilungs, IBLUE
o Mature Ierythrocytes Ilack Ia Inucleus I& Iorganelles, Iso Iit Icannot Isynthesize Iprotein Ior Icarry
Iout Ioxidative Ireactions. ICannot Idivide I= Ilimited Ilife Ispan I*Anaerobic Imetabolism Ionly
o Biconcave, Ispherical Idisk, Ireversible
o Lifespan: I100-120 Idays, I1% Icirculating IRBC Ireplenished Ievery I24 Ihours I(2.5million IRBC’s/second)
o Stages: I(7-day Iprocess)
▪ Hemocytoblast I(stem Icell) Ibinds Iwith Ierythropoietin
▪ Proerythroblast- Icommitted Ito Imorph Iinto IRBC
▪ Erythroblast- Iribosome Isynthesis I(2 Iphases)
▪ Normoblast- IHgb Iaccumulation I& Inucleus Iejection
▪ Reticulocyte I– Ireleased Iinto Icirculation, Ino Inucleus, Iribosome, Ior Imitochondria
▪ RBC I(once Iin Ibone Imarrow I1-2 Idays)
o Size: Imicrocytic, Inormocytic, Imacrocytic
o Color: Ihypochromic, Inormorchromic, Ihyperchromic I(due Ito IHgb Ilevel)
, o Variability: IAnisocytosis I(size), Ipoikilocytosis I(shape)
Vitamin IB12 I(Cyanocobalamin)
• Dietary Isources: Imeat, Ifish, Ipoultry, Idairy I*NO IFRUITS IOR IVEGGIES
• Stomach Isecretes Iintrinsic Ifactor Iprotein Iassists Iwith Iabsorption Iof Iileum
• Excess Istored Iin Iliver I(1000X Ireserve, Itakes Iyears Ito Ideplete Istores)
Folic Iacid I(Folate)
• Dietary Isources: Iliver, Igrain, Igreen Ivegies
• Required Ifor IDNA I& IRNA Isynthesis
• Prevents Ineural Itube Idefects Iin Ifetus
• Excess Istored Iin Iliver I(reserve Idepleted I2-3 Imonths)
Iron
• Dietary Isources: Imeat, Idried Ibeans, I& Ieggs
• Absorbed Iin IGI, Icombined Iwith Itransferrin I(plasma Iprotein) I(transporter) I& Icarried Ito Iliver Ifor
Istorage Ias Iferritin, Itransferrin Icarries Ito Ibone Imarrow
• Ferrous Iiron Ican Ibind Ioxygen, IFerric Iiron Icannot
• Vitamin IC I(antioxidant) Iassists Iwith Ikeeping Iiron Iin Iferrous Iform
• Iron/d: I(Female I19-50: I18mg/d)(Female>50, IMale>19: I8mg/d)
Anemia
• ↓total Inumber Icirculating IRBC/ I↓ I(Hgb) Iability Iof Ithe Ierythrocytes Ito Icarry Ioxygen I= Ihypoxemia
o Blood Iloss I(acute Ior Ichronic)
o Defective Ierythrocytes
o Abnormal Idestruction Iof Ierythrocytes
• ↓ Ioxygenation I= Ihypoxia, Idyspnea, Ipallor, Idizzy, Ifatigue
Iron-deficiency Ianemia I(IDA) I(Microlytic Ianemia: Ismall Iabnormal Ishaped IRBC) I*most Icommon
• ↓iron Ilevels Ior Iinability Ifor Imitochondria Ito Iutilize Iiron I= I↓Hgb Isynthesis I= Ismaller Ipaller Icells.
• ↓RBC Iproduction I= ILow IHgb I= I↓ Ioxygen-carrying Icapacity
• Causes: IInadequate Iiron Iintake, Iiron Imalabsorption, Ilead Ipoisoning, Ichronic Iblood Iloss, I↑ Iiron
Idemand I(pregnancy), Ichildhood Igrowth Ispurts, Imenstruation, IGI Ibleed, ICKD, IPPI’s I& IH2 Iblockers
o CKD: Ikidneys Ido Inot Isecrete Ienough Ierythropoietin. IErythropoietin Iand Iiron Iare Ilost
Iduring Idialysis.
• Treatment: IIron Isupplements, Iascorbic Iacid I(vitamin IC) Icontaining Ifoods Ican Ihelp Iwith
absorption.
• Pathophys: IInsufficient IFe Ilevels/inability Iof Imitochondria Ito Iutilize IFe I= I↓ IHgb Isynthesis
• 3 Istages:
o Iron Istore Idepleted Icausing Iiron Ideficiency, Ifew Ito Ino Isymptoms, Ifatigue I(Hgb I<30)
o Iron Ideficiency I& Ianemia I(↓iron Itransportation Ito Ibone Imarrow), Iweak, Ifatigue, IShob
I(Hgb I9-12)
