Bioscience II: Test II

Hemolytic Anemia occurs when there is an incompatibility between the blood types of the donor and the recipient. In this case, Mr. Quoya received type B+ blood, which is incompatible with his A- blood type. This leads to the destruction of the donor red blood cells by the recipient's immune system, causing hemolysis and resulting in Hemolytic Anemia.

To examine the extrinsic pathway, the most helpful labs would be PT (Prothrombin Time) and INR (International Normalized Ratio). PT measures the time it takes for blood to clot, specifically evaluating the extrinsic pathway. INR is a standardized measurement used to interpret PT results, allowing for comparison across different laboratories. Bleeding Time, aPTT (Activated Partial Thromboplastin Time), and ACT (Activated Clotting Time) are not specific to the extrinsic pathway and would not provide the most relevant information in this context.

Transfusion of multiple units of PRBCs (packed red blood cells) can lead to a decrease in platelet levels, fibrinogen levels, and coagulation factors. This is because PRBC transfusions do not contain these components, and repeated transfusions can dilute the existing levels in the recipient's blood. Consequently, this can impair the blood's ability to clot properly and increase the risk of bleeding. Therefore, the statement is true.

Sickle cell anemia is caused by the presence of hemoglobin S, an abnormal form of hemoglobin. This disorder is characterized by the production of crescent-shaped red blood cells that can get stuck in blood vessels, leading to pain, organ damage, and other complications. The other options listed, such as aplastic anemia, Fanconi anemia, and megaloblastic anemia, are not associated with the presence of hemoglobin S.

Parasympathetic stimulation of the liver primarily occurs through the Vagus nerve. The Vagus nerve, also known as the tenth cranial nerve, innervates various organs in the body, including the liver. It plays a crucial role in regulating various bodily functions, including digestion and metabolism. Therefore, the Vagus nerve is responsible for transmitting parasympathetic signals to the liver, promoting activities such as bile production and glucose metabolism.

aPTT (activated partial thromboplastin time) is a laboratory test used to evaluate the effectiveness of heparin, an anticoagulant medication, in inhibiting the intrinsic pathway of blood coagulation. The intrinsic pathway is one of the two main pathways involved in the formation of blood clots. Coumadin, another anticoagulant, primarily affects the extrinsic pathway. Therefore, the correct answer is heparin and intrinsic pathway, as aPTT is specifically used to monitor the effectiveness of heparin in inhibiting the intrinsic pathway of blood coagulation.

Biliary atresia is a condition that affects the outflow of bile from the liver into the digestive tract. Bile acids are responsible for the digestion and absorption of fats and fat-soluble vitamins. Therefore, if the outflow of bile is impaired, it would lead to the malabsorption of fats and fat-soluble vitamins. This explains why children with biliary atresia would most likely suffer from malabsorption of fats and fat-soluble vitamins.

Alcohol consumption is the most common cause of cirrhosis. Excessive and prolonged alcohol intake can lead to liver damage and inflammation, causing the liver to become scarred and hardened. This condition, known as cirrhosis, can impair the liver's ability to function properly and can eventually lead to liver failure. It is important to note that not everyone who consumes alcohol excessively will develop cirrhosis, as individual susceptibility to liver damage can vary. However, alcohol abuse is a significant risk factor for developing this condition.

Coumadin, also known as warfarin, primarily exerts its effects on the extrinsic coagulation pathway. The extrinsic pathway is one of the two main pathways involved in the coagulation cascade. It is initiated by tissue factor, which is released from damaged blood vessels. Coumadin works by inhibiting the production of vitamin K-dependent clotting factors, including factors II, VII, IX, and X, which are all involved in the extrinsic pathway. By inhibiting these factors, Coumadin helps to prevent the formation of blood clots.

The correct answer is "All the Above" because the given statement "Wow, a surprise ending. Is that Scott Baio? No!! Noooo!! Exit Only!!!" suggests that all of the options - "Wow, a surprise ending", "Is that Scott Baio?", and "No!! Noooo!! Exit Only!!!" - are correct.

A patient who is non-compliant with vitamin supplements such as calcium, iron, and B12 after gastric bypass surgery may be at an increased risk for developing anemia. This is because these vitamins are essential for the production of healthy red blood cells, and a deficiency in any of them can lead to decreased red blood cell production and subsequently anemia. Anemia is characterized by a decrease in the number of red blood cells or a decrease in the amount of hemoglobin in the blood, resulting in symptoms such as fatigue, weakness, and shortness of breath.

Fluid overload is not a known precipitating factor of a sickle cell crisis. A sickle cell crisis is typically triggered by factors that cause the red blood cells to become sickle-shaped and block blood flow, leading to pain and other complications. Acidosis, stress, and hypothermia are known precipitating factors as they can cause the red blood cells to sickle. However, fluid overload does not directly affect the shape of the red blood cells and is therefore not a known precipitating factor of a sickle cell crisis.

Chronic alcoholics are most prone to hypomagnesemia, which is a condition characterized by low levels of magnesium in the blood. Alcoholism can lead to decreased intake of magnesium through the diet, increased excretion of magnesium by the kidneys, and impaired absorption of magnesium in the intestines. Magnesium plays a crucial role in various bodily functions, including nerve and muscle function, blood pressure regulation, and bone health. Therefore, chronic alcoholics are at a higher risk of developing hypomagnesemia due to their alcohol consumption and its effects on magnesium levels in the body.

The correct answer is "Opioids cause spasm of Sphincter of Oddi." The surgeon is likely upset because the spasm of the Sphincter of Oddi caused by opioids can interfere with the ERCP procedure. The spasm can make it difficult for the surgeon to access and visualize the common bile duct, potentially leading to complications or the need for additional interventions.

Glucagon is the correct answer because it is known to relax the smooth muscles of the Sphincter of Oddi, which allows for better visualization during a cholangiogram. Rocuronium is a neuromuscular blocking agent used for muscle relaxation during surgery, but it does not specifically target the Sphincter of Oddi. Fentanyl is an opioid analgesic and metoclopramide is a prokinetic agent used for gastric motility, neither of which affect the Sphincter of Oddi. Therefore, glucagon is the most appropriate choice to open up the Sphincter of Oddi in this situation.

The liver is divided into right and left lobes by the falciform ligament. This ligament is a fold of peritoneum that attaches the liver to the anterior abdominal wall and separates the liver into two distinct lobes. It is a thin, flat structure that runs from the diaphragm to the anterior abdominal wall, and its presence helps to maintain the position and stability of the liver within the abdominal cavity.

Volatile anesthetic agents are known to cause vasodilation, which leads to a decrease in systemic vascular resistance. This decrease in resistance can also affect the blood flow to the liver, specifically the portal hepatic blood flow. As a result, the volatile anesthetic agents will cause a decrease in portal hepatic blood flow.

The endothelial lining of the blood vessel wall promotes anticoagulant activity because it releases substances such as nitric oxide and prostacyclin, which inhibit platelet aggregation and prevent blood clot formation. Additionally, the endothelial cells produce antithrombotic molecules like heparin sulfate and tissue factor pathway inhibitor, which further prevent clotting. This anticoagulant activity is crucial for maintaining blood flow and preventing the formation of dangerous blood clots that can lead to conditions like deep vein thrombosis or pulmonary embolism.

The correct answer is T6-T11. The sympathetic stimulation of the liver is provided by the spinal nerves in this region. These nerves originate from the thoracic region of the spinal cord and innervate various organs including the liver. The sympathetic nervous system is responsible for regulating various physiological processes, including liver function, by increasing blood flow and promoting glucose release. Therefore, stimulation of the sympathetic nerves in the T6-T11 region would affect liver function.

not-available-via-ai

Coagulation of blood occurs several minutes after the other two processes in hemostasis. Vascular spasm is the initial response to vessel injury, where the smooth muscles in the blood vessel walls contract to reduce blood flow. Formation of a platelet plug follows, where platelets adhere to the damaged vessel wall and aggregate to form a temporary seal. Finally, coagulation of blood takes place, involving a complex cascade of reactions that result in the formation of a fibrin clot to stabilize the platelet plug and prevent further bleeding.

Heparin affects the intrinsic pathway of the clotting cascade. The intrinsic pathway is activated by contact with negatively charged surfaces, such as collagen or glass, and involves factors XII, XI, IX, and VIII. Heparin enhances the activity of antithrombin III, which inactivates factors XIIa, XIa, IXa, and Xa, thereby inhibiting the intrinsic pathway. This ultimately leads to the prevention of blood clot formation.

Anesthetic management of a patient with sickle cell anemia involves providing generous IV fluids to ensure the patient is well hydrated. This is because sickle cell anemia can cause vaso-occlusive crises, which can be triggered by dehydration. By maintaining good hydration, the risk of vaso-occlusive crises can be reduced. Narcotics should not be avoided due to the risk of respiratory suppression, and maintaining slight hypothermia during surgery is not a true statement regarding anesthetic management of these patients.

Approximately 25-30% of the cardiac output goes to the liver. This means that a significant portion of the blood pumped by the heart is directed towards the liver. The liver plays a crucial role in various metabolic processes, including the detoxification of harmful substances and the production of important proteins. Therefore, it requires a substantial amount of blood supply to perform its functions effectively.

The sphincter of Oddi controls the flow of bile from the common bile duct into the duodenum. It is a muscular valve that regulates the release of bile into the small intestine. When the sphincter of Oddi relaxes, bile is allowed to flow into the duodenum, aiding in the digestion and absorption of fats.

During deamination, proteins are broken down into their constituent amino acids. In the liver, these amino acids undergo deamination, where the amino group (-NH2) is removed. The end product of this process is ammonia (NH3), which is highly toxic to the body. The liver then converts ammonia into urea, a less toxic compound that can be excreted in urine. Therefore, the correct answer is ammonia.

The correct answer is that the surgery cannot be done until the acute hepatitis has resolved for the patient's own safety. Hepatitis is a liver inflammation that can cause complications during surgery, such as impaired liver function and increased risk of bleeding. It is important to wait until the liver has recovered and the patient's overall health has improved before proceeding with any surgical intervention.

Cisatracurium would be the muscle blocking agent of choice for a patient with liver cirrhosis who requires long-term paralysis. Liver cirrhosis can affect the metabolism and clearance of drugs, and cisatracurium is primarily eliminated through non-organ-dependent Hoffman elimination. This makes it a suitable choice for patients with liver dysfunction as it is not dependent on liver metabolism for elimination. Succinylcholine, on the other hand, is metabolized by plasma pseudocholinesterase, which can be reduced in patients with liver cirrhosis. Rocuronium and vecuronium are primarily eliminated by the liver, so they may have prolonged effects in patients with liver dysfunction.

The outermost layer of the blood vessel lining is known as adventitia. This layer is composed of connective tissue and provides support and protection to the blood vessel. It helps to anchor the blood vessel to surrounding tissues and organs. The adventitia also contains blood vessels, nerves, and lymphatic vessels that supply the blood vessel itself.

Hepatitis A is primarily spread through contaminated food or water, and poor hygiene practices, such as not washing hands after using the bathroom, can contribute to its transmission. Therefore, if a Subway employee forgets to wash their hands after going to the bathroom and then handles food or prepares sandwiches, there is a higher risk of transmitting Hepatitis A to customers. Hepatitis B and C are primarily spread through contact with infected blood or body fluids, and the scenario described does not involve direct contact with blood or body fluids.

The endothelial lining is responsible for synthesizing prostaglandins in the blood vessels. Prostaglandins are lipid compounds that have various physiological effects, including regulating inflammation, blood clotting, and blood pressure. The endothelial cells in the lining of blood vessels produce prostaglandins in response to various stimuli, such as injury or inflammation. These prostaglandins play a crucial role in maintaining vascular homeostasis and regulating blood flow.

Kupffer cells are a type of specialized macrophage found in the liver. They are responsible for removing foreign substances, such as bacteria and old red blood cells, from the blood. The sinusoids are blood vessels within the liver that are lined by liver cells, and it is within these sinusoids that Kupffer cells are found. Therefore, the correct answer is "Lining sinusoids between liver cells."

After birth, the breakdown of fetal hemoglobin leads to the production of bilirubin, which is responsible for the mild degree of jaundice commonly seen in many infants. Bilirubin is a yellow pigment that is formed when heme, a component of hemoglobin, is broken down. It is then processed by the liver and excreted in the bile. In infants, the liver may not be fully developed, leading to a buildup of bilirubin in the bloodstream, causing the yellow discoloration of the skin and eyes known as jaundice.

Upon entering the intestines, bilirubin is converted to urobilinogen. This conversion is an important step in the excretory process as urobilinogen is further metabolized and eventually gives urine its yellow color.

A patient is at risk for spontaneous bleeding at any platelet level that is below 20. Platelets are responsible for blood clotting, and a low platelet count can result in difficulty in clotting, leading to spontaneous bleeding. Therefore, a platelet level below 20 indicates a significant risk for bleeding.

A platelet count of less than 50 indicates a low number of platelets in the blood, which can lead to an increased risk of bleeding. Therefore, the statement that at a platelet count

Normal bleeding time refers to the time it takes for bleeding to stop after a small cut or injury. The correct answer, 2-9 minutes, indicates the normal range for bleeding to cease. This range is considered normal as it allows for the body's natural clotting mechanisms to take effect and stop the bleeding. Bleeding times that are significantly shorter or longer than this range may indicate underlying health conditions or disorders affecting the blood's ability to clot.

The most well oxygenated cells in the hepatic lobules are those located closest to the Portal tract. The Portal tract contains branches of the hepatic artery, which supplies oxygenated blood to the liver. As the blood flows through the sinusoids in the lobules, the cells closest to the Portal tract receive the highest concentration of oxygen.

The correct answer is Inferior Vena Cava. The liver receives blood from two sources - the hepatic artery, which carries oxygenated blood, and the portal vein, which carries nutrient-rich blood from the digestive organs. After the blood passes through the liver, it is drained by the hepatic veins into the inferior vena cava, which then carries the deoxygenated blood back to the heart. Therefore, the inferior vena cava is responsible for the venous drainage from the liver.

The liver performs various functions in the body, including detoxification, protein synthesis, and the production of bile. However, it does not store ammonia. Ammonia is a toxic waste product that is produced by the breakdown of proteins in the body. It is converted into urea by the liver and then excreted by the kidneys. Therefore, the liver does not store ammonia but rather helps in its elimination from the body.

The preferred treatment for intrahepatic cholestasis caused by viral hepatitis is medical treatment. This typically involves using antiviral medications to target and eliminate the viral infection. Medical treatment may also include supportive care such as managing symptoms, providing adequate nutrition, and monitoring liver function. Surgical treatment may be considered in some cases, but it is not the preferred or primary treatment option for this condition. Holistic treatment may have some complementary benefits, but it is not the mainstay of treatment. Ignoring the condition will not make it go away and can lead to further complications.

When there is an injury to the muscular layer of the blood vessel, the body's response is to initiate acute vascular contraction. This contraction helps to lessen the blood flow to the injured site, which is beneficial in reducing bleeding and preventing further damage. By constricting the blood vessels, the body is able to limit the amount of blood reaching the injured area, allowing for better clot formation and healing. This response is an important mechanism in the body's overall process of repairing damaged blood vessels.

The correct answer is Factors XII, XI, IX, VIII. The intrinsic pathway is one of the two pathways involved in the process of blood clotting. It is initiated by factors XII and XI, which activate factor IX. Factor IX then combines with factor VIII, calcium ions, and phospholipids to form a complex that activates factor X. This ultimately leads to the formation of a blood clot. Factors III and VII are not involved in the intrinsic pathway, and factors V, X, I, and II are not the correct combination of factors for this pathway.

Secondary hemostasis refers to the process of coagulation, which is the formation of a blood clot to stop bleeding. During this process, a series of enzymatic reactions occur, leading to the conversion of soluble fibrinogen into insoluble fibrin threads. These threads form a mesh-like structure that traps platelets and other blood cells to form a stable blood clot. Therefore, the correct answer is "Coagulation of blood."

The correct answer is Factor XII. The intrinsic pathway of coagulation is initiated with the activation of Factor XII, also known as Hageman factor. Factor XII is activated by binding to negatively charged surfaces, such as collagen or platelets, and undergoes a series of enzymatic reactions leading to the formation of a blood clot. This pathway plays a crucial role in maintaining hemostasis and preventing excessive bleeding.

Drug therapy is the most common cause of platelet abnormalities because certain medications can affect the production, function, or lifespan of platelets. Drugs like aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and certain antibiotics can inhibit platelet aggregation and increase the risk of bleeding. Other medications, such as heparin and certain chemotherapy drugs, can cause a decrease in platelet count, leading to a condition called thrombocytopenia. Therefore, drug therapy is often associated with platelet abnormalities.

Alcohol is the most common cause of drug-induced hepatitis. Prolonged and excessive alcohol consumption can lead to inflammation and damage to the liver, resulting in hepatitis. Alcohol-induced hepatitis can range from mild inflammation to severe liver damage, including cirrhosis. Chronic alcohol abuse can also increase the risk of developing other liver diseases, such as alcoholic fatty liver disease and alcoholic cirrhosis. It is important to note that other substances, such as medications and recreational drugs, can also cause drug-induced hepatitis, but alcohol remains the most common culprit.

The statement is true because the signs and symptoms of cirrhosis, such as fatigue, jaundice, and abdominal pain, do not necessarily indicate the severity of the disease. Some individuals with advanced cirrhosis may not exhibit any symptoms, while others with mild cirrhosis may experience significant symptoms. Therefore, the presence or absence of signs and symptoms cannot be used as a reliable indicator of the severity of cirrhosis.

A plt. count of 62 refers to a platelet count of 62, which is below the normal range. Platelets play a crucial role in blood clotting, and a low platelet count can lead to prolonged bleeding time. Therefore, a plt. count of 62 would have the effect of causing a prolonged bleeding time.

The correct answer states that the patient should be well hydrated with colloids to prevent hypotension following the removal of ascites. This is because removing ascites can lead to a decrease in blood volume, which can cause hypotension. By ensuring that the patient is well hydrated with colloids, which are substances that increase blood volume, the risk of hypotension can be minimized.