Total blood volume
How many liters of blood in an adult body?
Blood cells make up what percentage of blood
Plasma makes up what percentage of blood
Plasma is ____ water and ____ plasma proteins
3 types of plasma proteins
Inorgranic constituents of blood
4.2-6.2 mil cells/mm3
Aplastic anemia is a
stem cell disorder
how is aplastic anemia catergorized
-a lack of hematopoietic tissue
-fatty marrow replacement
mean corpuscular volume (MCV)
mean corpuscular hemoglobin concentration (MCHC)
Mean corpuscular hemoglobin (MCH)
RBC, RBC, platelets
Adaptations to anemia include
-preferential blood flor to critical organs
-increased circulatory rate
How does the body compensate for aplastic anemia in the long term?
Symptoms of severe anemia
-night cramps in muscles
Aplastic anemia is anemia related to
decreased RBC production
Aplastic anemia due to decreased functional bone marrow mass is usually the result of
-toxic injury to bone marrow stem cells
-radiant injury to bone marrow stem cells
-immunologic injury to bone marrow stem cells
Two classifications of aplastic anemia
Acquired aplastic anemia can be caused by which viruses?
Pregnancy can cause
What genetic issue can cause aplastic anemia?
putative hereditary uptake of folate
Aplastic anemia usually effects people ages
15-25 and over 60
Signs of clotting disorder can be evidence of _________- anemia
Aplastic anemia is fatal unless
managed with bone marrow transplantation
Why does renal failure lead to aplastic anemia?
primarily--failure of renal endocrine function--erythropoietin
Secondary--failure of excretory function--hemolysis, bone marrow cell depression, blood loss
Renal failure anemia usually involves which labs
low HGB, HCT, RBC
Normal WBC, platelet, leukocyte, corpuscular labs
At what hematocrit do symptoms of anemia usually appear?
Target hemoglobin level
HGB greater than 12 g/dl is associated with
What happens when pts have low B12?
Hemolytic disease of the newborn is anemia related to
extrinsic red cell destruction
ABO incompatability is the most common cause of hemolytic disease of the newborn, but __________-
Rh is more important because of its association with severity
Lab features of hemolytic disease of the newborn
-nucleated RBCs in peripheral blood
-bilirubin reflects severity of disease (ability to excrete)
Clinical manifestations of hemolytic disease of the newborn
-diffuse extravascular coagulation
-extra medullary erythropoietin
newborn condition marked by several neuro symptoms associated with high blood nilirubin
hemolytic disease of the newborn often results in
death before birth
Primary amenorrhea is
failure to begin menstruation by age 16
Secondary amenorrhea is
cessation of established menstruation for 3 or more periods
The initial rise in FSH and LH in the menstrual cycle results from
a decline in progesterone and estrogen
An increase in progesterone and estrogen is caused by
action of gonadotropic hormones (LH/FSH)
Endometrium proliferates again in response to
uterine bleeding outside of menstruation
debilitating increase in the amount or duration of menstrual bleeding
Absent or diminished progesterone levels results in
thick, highly vascular endometrium lacking structural support--Unopposed estrogen
(results in spontaneous superficial bleeding)
Symptoms of dysmenorrhea tend to __________ with age
Childbirth permanently decreases symptoms of dysmenorrhea---T or F?
What causes primary dysmenorrhea?
increased prostaglandins (hormone-like fatty acids) released from the endometrium have profound effects on smooth muscle and vasomotor tone
Ibuprofen, naproxen and celecoxib treat dysmenorrhea because
they are prostaglandin synthetase inhibitors
prostaglandin development in dysmenorrhea requires
high estrogen-low progesterone in proliferative phase
What type of neoplasms can cause amenorrhea?
Infrequent menstruation is called
Light menstruation is called
secondary dysmenorrhea is typically
dull pain that increases with age
Primary dysmenorrhea is
sharp suprapubic pain that limits activity
Two failures required for uterine prolapse
A small supportive device used to hold the uterus in place
5 uterine retrodisplacement positions
protrusion of the bladder into a weak part of the vaginal wall
ANY acute, subacute, recurrent or chronic infection of the oviducts and ovaries with involvement of the adjascent reproductive organs
Infection of the oviducts
When connective tissue between reproductive organs is involved in PID it is called
PID can result in
chronic pelvic pain
In healthy, non-PID women, cervical secretions provide a
PID may result from-
infection during or after pregnancy
Gonorrhea and chlamydia readily break the
cervical barrier--> cause PID
During parturition, the traumatized endometrium favors
multiplication of bacteria
PID generally presents with
Tenderness on palpation
-high WBC (>10,000)
--purulent vaginal discharge
When is PID life threatening?
If a pelvic abscess ruptures
Inflammation of the vulva/vagina
Why does candidiasis vilvovaginitis get worse or show up during the secretory phase of the menstrual cycle and when exogenous estrogen is used?
fungus likes sugar, glycogen levels rise in the vaginal environment
Which viruses can cause vulvovaginitis?
Normal vaginal pH
Uterine leiomyomas are also called
(most common aberrant growths)
Fibroids effect ______ women 3x more than ________-
____ appear to be major factors in the growth of fibroids, but the actual cause is _______-
age, estrogen, and growth hormone
Endometrial tissue outside of the uterus
Oral contraceptives treat ovarian cysts by
Risk factors for endometriosis
30-40 yrs old
never given birth
Infertility rate for women with endometriosis
Theories about endometriosis
-transportation (backwards flow of tissue)
MAIN cause of cervical cancer
Lesser causes of cervical cancer
-sex at a young age or with multiple partners
PAPs for cancer should be started at age ____ and done every _____ after _____ consecutive negative PAPS after age 30
PAPs can be stopped for low risk women after age
Abnormal cells may be present in cervical epithelium for ______ before cancer develops
Early signs of cervical cancer
-pain and bleeding after sex
95% of all cervical cancer is
Squamous cell carcinoma
5% of all cervical cancer is
Cervical precancer treatment
Cervical cancer treatment
Radical surgery for advanced cervical cancer involving removal of all pelvic organs is called
5 year survival for cervical cancer
Gardasil protects against which types of HPV
HPV 6,11, 16 & 18 are responsible for
70% of all cervical cancers
90% of all genital warts
Lesser known HPV vaccine __________- protects against ___ & ____
16 & 18
Which HPV vaccine is suggested for tween girls/boys (9-12, 26 at latest)
Cancer uncommon to young women, but found in equal rates to cervical cancer after menopause--
Related factors to endometrial cancer
-late (>55) menopause
THE most common symptoms of endometrial cancer is
-bleeding between periods
Endometrial cancer 5 year survival rate
Which female cancer has replaced cervical cancer as the leading cause of death and why?
asymptomatic until too late
45% 5 year survival
Symptoms of later stage ovarian cancer
-increased abdominal girth
Which genes put a woman at greater risk of ovarian cancer?
Which med puts baby girls in utero at risk of vaginal cancer?
Vulvar cancer risk factors
-chronic pruritus w/ dryness/swelling
What tissue change may precipitate vulvar cancer?
Leukoplakic changes (whitish plaques or ulcerated lesions)
Once vulvar cancer develops, what may be present
Pregnancy induced HTN is characterized by
increased arterial pressure
salt and water retention by kidneys
HTN complicates _____ of all births
Who is at risk of developing pregnancy induced HTN?
teens and 30s-40s
What happens to the kidneys in pregnancy induced HTN?
thickening of glomerular tufts-- fibrinoid deposits in basement membrane
Arterial spasms occur where in pregnancy induced HTN?
Is it normal for renal blood flow and glomerular filtration to decrease during pregnancy?
No, but it happens in pregnancy induced HTN
Severe cases of pregnancy induced HTN result in
-EXTREME vascular spasticity throughout body
Severe pregnancy induced HTN usually occurs when
shortly before birth
Why is fatality from pregnancy induced HTN less than 1%?
The most common form of cancer in women between 25 and 75
Breast cancer risk factors
-lack of access to health care
-reproductive and hormonal factors
menstruation before 12
menopause after 55
40 years of menstruation or more = 2x risk in 30 yrs or less
--HRT progesterone and estrogen
lower risk if give birth under 18 and/or lots of kids
higher risk if give birth after 35 and/or few kids
unknown, but maybe dietary fat increases risk?
Other than prophylactic surgery, what may be done to prevent
Breast cancer in high risk women?
selective estrogen receptor modulators
25 and older, increasing with age
Sketchy Breast cancer lump?
painless, hard, poorly movable
When are professional breast exams suggested?
half of malignant breast tumors are found where
Other sketch breast cancer signs in breast
dimpling, change in contour
Where are most breast cancers found?
glandular epithelium of ducts
Where does breast cancer commonly metastasize to?
Breast cancer is usually
Breast cancer 5 year survival
no lymph involvement-
Removal of breast and some axillary lymph
modified radical mastectomy
Removal of breast, axillary lymph, and pectorals
Why are SERMS used to help treat breast cancer?
The malignant cells have cytoplasmic hormone receptors that promote division and growth
What is syphilis?
systemic vascular infection
Stages of syphilis
What bacteria causes syphilis?
What does syphilis infect?
abraded skin or mucous membranes
Syphilis spreads to multiple organ system within
How long is the syphilis incubation period?
The primary stage of syphilis manifests with
a chancre, a painless, ulcerative lesion at port of entry
Why does syphilis take until the latent phase to be diagnosed in females?
the primary chance occurs in the vagina or on the cervix
Where can a primary stage syphilis lesion erupt?
What happens in the secondary stage of syphilis?
the chancre resolves within 3-6 weeks and becomes fever, malaise, lymphadenopathy, and a mucosal or cutaneous rash
(it is in the blood and lymph)
What initiates the latent stage of syphilis?
resolution of fever/malaise/rash/lymphadenopathy/rash
How long can latent syphilis last?
What percentage of patients even experience the late (tertiary) stage of syphilis?
What systems are especially vulnerable to late syphilis?
Nervous and cardiovascular
Cardiovascular effects of late syphilis?
Neuro effects of late syphilis?
Why can treatment of syphilitic pregnant women before week 15 prevent damage to the fetus?
an inflammatory response to the pathogen does not occur until then
Syphilis in utero can cause
physical deformities and developmental disabilities
Syphilis is treated with
Benzathine Penicillin G
Treated syphilis is continually assessed for __ months
Gonorrhea infects the ___________ and causes a patchy inflammatory response in the
Gonorrhea is usually asymptomatic in women, but it may present with
Gonorrhea usually effects which parts of women
-Bartholin and skene glands
What age groups (female) have the highest rates of Gonorrhea?
Signs of Gonorrhea in males
-redness and swelling at infection site
Symptoms of Gonorrhea usually occur after a
3-6 day incubation
Gonorrhea MAY cause
inflammation of the
Gonorrhea extends its infection via the
Gonorrhea extension infection occurs in what areas?
oviducts (scarring and fibrosis can result in infertility)
What causes chlamydia
Upper reproductive tract infection with chlamydia is an important cause of
Which is less symptomatic? Chlamydia or gonorrhea
What can happen if a woman has chlamydia during childbirth?
Why is treating chlamydia and gonorrhea difficult
Kidney pain is often referred to as
CVA (costovertebral angle) tenderness
Kidney pain often radiates to
Urine thickness is called
Alterations in structure and function of glomerular capillaries
3 layers of glomerular capillaries --- filtration barrier
podocytes (footlike projections)
When filtrate passes through slit pores between podocytes, it
enters the bowman capsule and then moves into the proximal tubule
__________ tubule to __________ tubule
When there is excessive protein loss over time,
What qualifies as excessive protein loss
3-3.5g in 24 hrs (100 mg is normal)
Nephrotic syndrome requires
leaky and inflamed glomerulus
Common causes of nephrotic syndrome
minimal change disease
focal segmental glomerulosclerosis
any injury to glomerulus to allow protein loss
What exactly is injured in nephrotic syndrome?
basement membrane and slit pores that normally block protein filtration
Pyelonephritis is unlikely to occur unless
Pregnant women are at risk for pyelonephritis because of
anatomical changes to urinary tract
Who is most at risk for pyelonephritis?
ACUTE pyelonephritis usually occurs as a result of
In acute pyelonephritis, what is responsible for tubule damage?
Chronic kidney disease progresses more quickly after
Decreased renal function after acute pyelonephritis occurs in about
3-4% of cases
When organisms in the bloodstream originate from urinary infection
What % of sepsis cases are from UTIs?
What urinalysis finding differentiates pyelonephritis from UTI?
WBC casts because they are formed in the kidney tubules
atrophied, scarred kidneys with blunting of calices secondary to infection
typical cause of chronic pyelonephritis
refluxed infected urine
Findings in chronic pyelonephritis
Risk factors for chronic pyelonephritis
-obstructive (renal calculi)
-underlying intrarenal disease
Diagnosis chronic pyelonephritis requires ultrasound or imaging because
urinalysis results will not be as profound
an assortment of immune mediated conditions that involve inflammation of the glomeruli
Primary glomerulonephritis is
Secondary glomerulonephritis is
Signs of acute glomerulonephritis
-azotemia (nitrogen wastes)
Postinfectious acute glomerulonephritis is usually the result of
skin or throat strep B
Postinfectious glomerulonephritis usually occurs
1-3 wks after initial infection
The key to glomerulonephritis
antibody deposition leading to inflammation
After immune complex deposition in glomerulonephritis, what happens
Mesangial cells proliferate, resulting in proliferative lesions--> complements system and immune cells-->lysosomal enzymes attack glomerular walls
The immune mediated structural changes in glomerulonephritis reduces
surface area for filtration, allowing substances to pass into glomerular space
Why does GFR decrease in glomerulonephritis?
angiotensin II and leukotrienes contract mesangial cells and reduce perfusion to glomerular capillaries
IGA nephropathy (berger syndrome) is
the most common type or primary glomerularnephritis
Rapidly progressive glomerulonephritis is also called,
crescentis, because of crescent shaped lesions
Goodpasture syndrome is
acute glomerulonephritis with pulmonary alveolar hemorrhage and anti-glomerular basement membrane antibodies
Nephrotic syndrome manifestations
-propensity for thrombus formation
Why does hypoalbuminemia cause hyperlipidemia and increased thrombus?
the liver is stimulated to produce lipoproteins and clotting factors
Causes of nephrotic syndrome
How common is nephrolithiasis?
10-15% of americans will have them
(especially white folsk)
High temperatures and sedentary work are associated with
Kidney stones are common in age
Most common type of kidney stone
What causes calcium oxalate stones?
-increased GI absorption
-shitty renal resorption
What causes struvite stones?
UTI with urea splitting bacteria (pseudomonas, proteas, kliebsella)
What causes uric acid stones?
Medication induced kidney stones
associated with stones, intermittent, spasmodic sharp pain
Stone pain is intense, causing __________ until _______
tachycardia, tachypnea, diaphoresis, vomiting
it reaches the bladder
How to diagnoses kidney stones
Stones will pass if they are less than _________-
surgery is needed if they are _________
Dietary changes to avoid kidney stones
avoid fish, poultry, meat
avoid coffee tea colas (<2 per day)
less calcium/more Vit D
limit sodium and oxylate
avoid high purine for uric acid stones
increased fluids (2L plus)
Kidneys that do not work well enough to keep protein will also
spill fluid into tissues
GFR in kidney failure
<60 for 3 months
Signs of kidney failure
What electrolytes are retained in chronic kidney disease?
Which drugs can prevent proteinuria?
angiotensin 2 blockers (preferred)
BP goal in chronic kidney disease
When is metabolic acidosis due to chronic kidney disease not worth treating?
When does hyperkalemia need to be treated?
(admin calcium gluconate, DW5, and insulin)
Calcium loss is a concern with
chronic kidney disease (PTH needs to be suppressed)
Because of protein loss in kidney failure,
fat and carbs have to make up for it
Dietary restrictions for chronic kidney failure
In chronic kidney failure, __________ system is also at risk
Drugs to treat ___________ are a huge concern for pts with kidney failure
What are the biggest reasons for the use of dialysis
Acute tubular necrosis is
intrinsic acute kidney injury
Two types of acute tubular necrosis
the most common cause of acute tubular necrossi
Tubules can repair themselves in 10-20 days IF
the basement membrane is intact
The micturition center is in the
Normal amount of residual urine
Stress incontinence is caused by
cause of overflow incontinence
underactive detrusor muscle
Transient incontinence is typically due to
bowel obstruction, infection, impaction,
Urge incontinence can be treated through
pelvic floor exercises
Primary nocturnal enuresis
after 6 months of dryness
monosymptomatic nocturnal incontinence
child with incontinence and no other urinary symptoms
(should test for diabetes)
nonmonosymptomatic nocturnal incontinence
child has other symptoms, like urgency, frequency
pATHOGENESIS of enuresis
overactivity of detrusor
immature/abnormal arousal mechanisms
Treatments for enuresis
The pons does what for urination
relaxes the internal sphincter
contracts the bladder
Sympathetic innervation of the bladder mostly controls
blood flow and pain
parasympathetic innervation of tha bladder from S2-S4 register
stretch of the bladder
motor nerves stimulate reflex detrusor contraction
vesicouretal reflux is mainly due to incompetence of
the valve at the bladder-ureter junction
(shortened ureteral tunnel)
vesicoureteral reflux can cause
Interstitial cystitis is also called
bladder pain syndrome
to qualify as interstitial cystitis, what must be present
at least 6 months of bladder pain and at least one lower urinary tract symptom
Interstitial cystitis pain is often relieved by:
booze, caffeine, peppers & citrus
"Classic" interstitial cystitis is characterized by ______ but it is only found in ____% of cases
visible, inflammatory lesions of bladder mucosa called hunner ulcers
Interstitial cystitis is found in 5 times more ___________
women than men
Interstitial cystitis pathophysiology is unknown, but it seems to involve
shitty urothelium (maybe abnormal glycosaminoglycan layer leading to lack of protective layer)-->increased permeability, absorption of harmful urine components
Other than shitty epithelium, what may contribute to interstitial cystitis?
sensitive afferent nerves/ silent C-fibers not being silent
maybe cytokines and shit
What is often comorbid in interstitial cystitis?
pain syndromes--> suggestive of neurogenic/autoimmune mechanisms