NR 507 ADVANCE PATHO. MIDTERM
EXAM QUESTIONS AND ANSWERS
Alloimmunity - Answer-•General term used to describe when an individual's immune
system reacts against antigens on the tissues of other members of the same species
Examples of Alloimmunity - Answer-Hemolytic disease of the newborn, transplant
rejection, transfusion reaction
Hypersensitivity: Type 4 - Answer-•Delayed response
•Does not involve antigen/antibody complexes like Types I, II and III
•Is T-cell mediated
Example- TB Test
Relationship between Type II and Type IV Hypersensitivity Reactions - Answer-•Organ
rejection involves cytotoxicity (Type II)
•Also, T-cells play a major role in organ rejection (Type IV-completely T-cell mediated)
• Antigens from target cells stimulate T-cells to differentiate into cytotoxic (Type II) T-
cells
•These T-cells have direct cytotoxic activity along with help T-cells involved in delayed
hypersensitivity (type IV).
Differentiating Between the Rash of a Type 1 vs. Type IV Reaction - Answer-•Type I:
Immediate hypersensitivity reactions, termed atopic dermatitis, are usually
characterized by widely distributed lesions,
•Type IV: contact dermatitis (delayed hypersensitivity) consists of lesions only at the site
of contact with the allergen
•The key determinant is the timing of the rash:
-Type I: immediate
-Type IV: delayed-several days following contact-e.g. poison ivy
Treatment of Type IV Rash - Answer-•A non-severe case of contact dermatitis would be
treated with a topical corticosteroid
•Why wouldn't we use epinephrine or antihistamines?
•Epinephrine is for emergent Type 1 anaphylactic reactions
•Antihistamines act on the H1 receptors
•Type IV doesn't involve mast cells and H1 receptors
•Antibiotics aren't appropriate since this is not an infection
Primary Immunodeficiency - Answer-•Most primary immune deficiencies are the result
of single gene defects
•Something is lacking with the immune system itself
•For example, B-lymphocyte deficiency-one of the most severe forms of a primary
immunodeficiency
,Secondary Immunodeficiency - Answer-•Secondary immunodeficiency is a complication
of some other physiologic condition or disease.
•Malnutrition is one of the most common causes worldwide
•For example, a patient who has HIV gets pneumocystis carinii
Hematology - Answer-•Anemias are the focus
•Involves RBCs
•Most of our body's iron stores come from the recycling of iron from old RBCs
iron deficiency anemia LAB VALUES - Answer-TEST
Serum Ferritin Levels- DECREASE
Red Blood Cell Distribution-INCREASE
Serum Iron Levels- DECREASE
Total Iron Binding Capacity-INCREASED
Transferrin Saturation- DECREASED
Thalassemia lab values - Answer-TEST
Serum Ferritin Levels- INCREASE
Red Blood Cell Distribution-NORMAL to INCREASE
Serum Iron Levels-NORMAL to INCREASE
Total Iron Binding Capacity-NORMAL
Transferrin Saturation- NORMAL to INCREASE
Anemia of chronic disease LAB VALUES - Answer-TEST
Serum Ferritin Levels- NORMAL to INCREASED
Red Blood Cell Distribution-NORMAL
Serum Iron Levels-NORMAL TO DECREASE
Total Iron Binding Capacity- SLIGHTLY DECREASE
Transferrin Saturation- NORMAL to SLIGHTLY INCREASE
Siderblastic Anemia Lab Values - Answer-TEST
Serum Ferritin Levels- NORMAL to INCREASE
Red Blood Cell Distribution- INCREASE
Serum Iron Levels-NORMAL to INCREASE
Total Iron Binding Capacity- NORMAL
Transferrin Saturation- Normal to Increase
Mean Corpuscular Hemoglobin Concentration (MCHC) - Answer-The measure of the
average concentration or percentage of hemoglobin within a single RBC
When is the Mean Corpuscular Hemoglobin Concentration (MCHC)
NORMAL - Answer-•May be normal in many types of anemias (normochromic anemias)
-Aplastic anemia
-Post-hemorrhagic anemia
-Hemolytic anemia
, When is the (MCHC) Mean Corpuscular Hemoglobin Concentration LOW - Answer-
•May be low in:
- Iron deficiency anemia
-Sideroblastic anemia
-Thalassemia
When is MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) HIGH -
Answer-•May be high in:
-Hereditary spherocytosis- a result of mild cellular dehydration; MCV is low, because of
membrane loss and cell dehydration
-Liver disease
-Hyperthyroidism
-Sickle cell disease
Iron Deficiency Anemia - Answer-•Is a microcytic/hypochromic anemia
• Is caused by disorders of hemoglobin synthesis, particularly iron deficiency
•Ferritin is an important measurement that reflects the body's total iron stores
•The NP will order a ferritin level to get an idea of the body's total iron stores
•Low ferritin reflects anemia, but does not tell you the type
Major Lab Marker for Anemia - Answer-•Increased RBC distribution width (RDW) is one
of the earliest lab markers in developing microcytic or macrocytic anemia
•In future courses, you will learn how to use lab markers to diagnose the different types
of anemia
•Diagnosing anemia is beyond the scope of this course.
•Important to know what these terms mean and what type of anemias they signify.
Folate Deficiency - Answer-•Can cause a megaloblastic anemia
•Is important to know who is at-risk
•Alcoholics can easily get a folate deficiency
vitamin b 12 deficiency anemia - Answer-•Fatigue
•Dyspnea
•Peripheral neuropathy in BLE (numbness and tingling)•
Risk Factors:
-Older adults
-H-pylori infection
-Affects Vitamin B-12 absorption
Hemolytic Anemia - Answer-•Who is at-risk?
•Refer back to our hypersensitivity reactions
•RBCs are destroyed
Why?
-Mismatched blood types-destroys RBCs (Cytotoxic Type 2)
EXAM QUESTIONS AND ANSWERS
Alloimmunity - Answer-•General term used to describe when an individual's immune
system reacts against antigens on the tissues of other members of the same species
Examples of Alloimmunity - Answer-Hemolytic disease of the newborn, transplant
rejection, transfusion reaction
Hypersensitivity: Type 4 - Answer-•Delayed response
•Does not involve antigen/antibody complexes like Types I, II and III
•Is T-cell mediated
Example- TB Test
Relationship between Type II and Type IV Hypersensitivity Reactions - Answer-•Organ
rejection involves cytotoxicity (Type II)
•Also, T-cells play a major role in organ rejection (Type IV-completely T-cell mediated)
• Antigens from target cells stimulate T-cells to differentiate into cytotoxic (Type II) T-
cells
•These T-cells have direct cytotoxic activity along with help T-cells involved in delayed
hypersensitivity (type IV).
Differentiating Between the Rash of a Type 1 vs. Type IV Reaction - Answer-•Type I:
Immediate hypersensitivity reactions, termed atopic dermatitis, are usually
characterized by widely distributed lesions,
•Type IV: contact dermatitis (delayed hypersensitivity) consists of lesions only at the site
of contact with the allergen
•The key determinant is the timing of the rash:
-Type I: immediate
-Type IV: delayed-several days following contact-e.g. poison ivy
Treatment of Type IV Rash - Answer-•A non-severe case of contact dermatitis would be
treated with a topical corticosteroid
•Why wouldn't we use epinephrine or antihistamines?
•Epinephrine is for emergent Type 1 anaphylactic reactions
•Antihistamines act on the H1 receptors
•Type IV doesn't involve mast cells and H1 receptors
•Antibiotics aren't appropriate since this is not an infection
Primary Immunodeficiency - Answer-•Most primary immune deficiencies are the result
of single gene defects
•Something is lacking with the immune system itself
•For example, B-lymphocyte deficiency-one of the most severe forms of a primary
immunodeficiency
,Secondary Immunodeficiency - Answer-•Secondary immunodeficiency is a complication
of some other physiologic condition or disease.
•Malnutrition is one of the most common causes worldwide
•For example, a patient who has HIV gets pneumocystis carinii
Hematology - Answer-•Anemias are the focus
•Involves RBCs
•Most of our body's iron stores come from the recycling of iron from old RBCs
iron deficiency anemia LAB VALUES - Answer-TEST
Serum Ferritin Levels- DECREASE
Red Blood Cell Distribution-INCREASE
Serum Iron Levels- DECREASE
Total Iron Binding Capacity-INCREASED
Transferrin Saturation- DECREASED
Thalassemia lab values - Answer-TEST
Serum Ferritin Levels- INCREASE
Red Blood Cell Distribution-NORMAL to INCREASE
Serum Iron Levels-NORMAL to INCREASE
Total Iron Binding Capacity-NORMAL
Transferrin Saturation- NORMAL to INCREASE
Anemia of chronic disease LAB VALUES - Answer-TEST
Serum Ferritin Levels- NORMAL to INCREASED
Red Blood Cell Distribution-NORMAL
Serum Iron Levels-NORMAL TO DECREASE
Total Iron Binding Capacity- SLIGHTLY DECREASE
Transferrin Saturation- NORMAL to SLIGHTLY INCREASE
Siderblastic Anemia Lab Values - Answer-TEST
Serum Ferritin Levels- NORMAL to INCREASE
Red Blood Cell Distribution- INCREASE
Serum Iron Levels-NORMAL to INCREASE
Total Iron Binding Capacity- NORMAL
Transferrin Saturation- Normal to Increase
Mean Corpuscular Hemoglobin Concentration (MCHC) - Answer-The measure of the
average concentration or percentage of hemoglobin within a single RBC
When is the Mean Corpuscular Hemoglobin Concentration (MCHC)
NORMAL - Answer-•May be normal in many types of anemias (normochromic anemias)
-Aplastic anemia
-Post-hemorrhagic anemia
-Hemolytic anemia
, When is the (MCHC) Mean Corpuscular Hemoglobin Concentration LOW - Answer-
•May be low in:
- Iron deficiency anemia
-Sideroblastic anemia
-Thalassemia
When is MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION (MCHC) HIGH -
Answer-•May be high in:
-Hereditary spherocytosis- a result of mild cellular dehydration; MCV is low, because of
membrane loss and cell dehydration
-Liver disease
-Hyperthyroidism
-Sickle cell disease
Iron Deficiency Anemia - Answer-•Is a microcytic/hypochromic anemia
• Is caused by disorders of hemoglobin synthesis, particularly iron deficiency
•Ferritin is an important measurement that reflects the body's total iron stores
•The NP will order a ferritin level to get an idea of the body's total iron stores
•Low ferritin reflects anemia, but does not tell you the type
Major Lab Marker for Anemia - Answer-•Increased RBC distribution width (RDW) is one
of the earliest lab markers in developing microcytic or macrocytic anemia
•In future courses, you will learn how to use lab markers to diagnose the different types
of anemia
•Diagnosing anemia is beyond the scope of this course.
•Important to know what these terms mean and what type of anemias they signify.
Folate Deficiency - Answer-•Can cause a megaloblastic anemia
•Is important to know who is at-risk
•Alcoholics can easily get a folate deficiency
vitamin b 12 deficiency anemia - Answer-•Fatigue
•Dyspnea
•Peripheral neuropathy in BLE (numbness and tingling)•
Risk Factors:
-Older adults
-H-pylori infection
-Affects Vitamin B-12 absorption
Hemolytic Anemia - Answer-•Who is at-risk?
•Refer back to our hypersensitivity reactions
•RBCs are destroyed
Why?
-Mismatched blood types-destroys RBCs (Cytotoxic Type 2)
