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NSG 533 / NSG533 ADVANCED PHARMACOLOGY EXAM 4. QUESTIONS WITH 100% CORRECT ANSWERS. $8.99
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NSG 533 / NSG533 ADVANCED PHARMACOLOGY EXAM 4. QUESTIONS WITH 100% CORRECT ANSWERS.

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MODS: mortality The mortality rate increases with increased number of organ dysfunctions 20% mortality rate if there is 1 organ dysfunction 40-45% mortality rate if there are 2 organs dysfunctions 68-70% mortality rate if there are 3 organ dysfunctions 80-85% mortality rate if there are 4...

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  • January 29, 2025
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NSG 533 EXAM 4
Iron Deficiency: Microcytic anemia risk factors
Heavy menstrual bleeding
Being female of child-bearing age
Gastric surgery


Iron Deficiency: Microcytic anemia clinical manifestations
Fatigue
Irritability
Pagophagia-ice craving
Pica- craving for dirt, paint, or clay
Thinning, flattening, and then spooning of nail bed (koilonychia)
Hair loss
Glossitis and angular stomatitis
Gastritis
Restless leg syndrome


Iron Deficiency: Microcytic anemia diagnosis
Early has normal CBC; Mild hgb 9-12
Low MCH, MCHC and increased RDW (new cells smaller and paler)
Low ferritin <100

,High TIBC (total iron binding capacity)
Low serum Iron <30Zz
Poikilocytosis (abnormally shaped RBC's)
Transferrin <16%
Bone Marrow biopsy - Absence of iron stores *Gold standard*


Iron Deficiency: Microcytic anemia complications
Cardiac & respiratory (impaired oxygen binding capacity)


B12 Deficiency: Macrocytic anemia definition
Related to malabsorption of B12 when it is not released from food proteins due to
impaired gastric acid peptic digestion or lack of parietal cells secreting intrinsic
factor in the gastric fundus to bind in the ileum.
-B12 is a substrate required for RBC production


B12 Deficiency: Macrocytic anemia etiology
Can take years to develop given extensive stores of vitamin B12 in the liver
Levels can be falsely low in folate deficiency, pregnancy, and use of oral
contraception
Levels can be falsely normal in myeloproliferative disorders, liver disease and
bacterial overgrowth syndromes


Most common causes:
-Food cobalamin malabsorption

,-Lack of intrinsic factor
-Dietary deficiency (rare unless strict vegetarian or malnourished): Animal food is
primary source: milk, cheese, eggs, meat


B12 Deficiency: Macrocytic anemia risk factors
Impaired peptic acid digestion
Atrophic gastritis seen in chronic H. pylori infections, gastric surgery, and long-term
acid-suppressing medications (PPI's, metformin, colchicine, ethanol, neomycin)
Malabsorption in the terminal ileum 2/2 ileal resection/bypass or Crohn's disease
Lack of Intrinsic factor 2/2 gastrectomy or Pernicious anemia


B12 Deficiency: Macrocytic anemia clinical manifestations
Paresthesias
Peripheral neuropathies
Ataxia
Cognitive impairment


B12 Deficiency: Macrocytic anemia diagnosis
Low reticulocyte
Elevated MCV
Low B12 (<200 likely deficient, 200-300 equivocal, greater than 300 likely ok)
Intrinsic factor antibody
Methylmalonic acid (MMA)
Homocysteine- less specific than MMA

, May be associated thrombocytopenia and neutropenia
Smear: macro-ovalocytes, Howell Jolly bodies, nucleated RBCs, hypersegmented
neutrophils


B12 Deficiency: Macrocytic anemia complications
Neurological symptoms may be irreversible


Folic acid Deficiency: Macrocytic anemia
Most common cause macrocytic anemia


Folic acid Deficiency: Macrocytic anemia etiology
Inadequate dietary intake (especially in alcoholic patients)
Body stores 4-5 months
Absorption occurs in jejunum, malabsorption is rare except in short bowel
syndrome or bacterial overgrowth syndrome
Increased demand in pregnancy, chronic hemolysis, leukemia
Medications- methotrexate (immunosuppressant/DMARD in breast Ca/ Leukemia/
OS/Ra/Psoriasis), phenytoin, sulfasalazine (DMARD in UC/Crohn/RA)
Alcohol




Folic acid Deficiency: Macrocytic anemia clinical manifestations
Diarrhea
Headache

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