Anemia
The most common symptom of anemia.
What is fatigue?
Define anemia according to the podcast material and explain why it is considered a laboratory finding rather than a diagnosis.
Anemia is defined as a hemoglobin level of less than the fifth percentile for age.
It’s a lab finding because it indicates an underlying process rather than being a disease itself.
What is the gold standard invasive test for confirming coronary artery disease?
Coronary angiogram
Name the two main hormones secreted by the pancreas that regulate blood glucose, their cell sources, and their primary effects on glucose levels.
Insulin is from β-cells, lowers blood glucose.
Glucagon is from α-cells, raises blood glucose
What is the main protein that forms the mesh holding a clot together?
Fibrin
What does a high RDW indicate in the context of anemia, and why is it clinically useful?
It indicates anisocytosis (variation in RBC size) which can help differentiate causes of anemia.
List the four pathological processes that can cause anemia.
1. Decreased production
2. Increased destruction
3. Blood loss
4. Sequestration
What are the three criteria used to diagnose Typical Angina due to CAD?
1. Retrosternal chest heaviness/achiness radiating to neck/arms
2. Triggered by exertion or stress
3. Relieved by rest or nitroglycerin
Name the two main types of diabetes and briefly describe their underlying pathophysiology.
Type 1: autoimmune destruction of beta cells → absolute insulin deficiency.
Type 2: insulin resistance plus relative insulin deficiency.
Name all three components of Virchow’s Triad.
Which is the most important?
Stasis, venous endothelial injury, hypercoagulability
In anemia of chronic disease, a certain protein can be falsely elevated. What is this protein, why is it elevated, and how can this mask iron deficiency.
Ferritin. Because it is an acute phase reactant; inflammation raises ferritin even when iron stores are low.
This is the most common cause of macrocytic anemia in alcoholics.
What is folate deficiency?
Define unstable angina and explain how it differs from stable angina at the pathophysiologic level.
Unstable angina: chest pain at rest due to plaque rupture and partial thrombus occlusion.
Stable angina: exertional pain due to plaque narrowing without rupture.
What fasting plasma glucose and HbA1c values confirm a diagnosis of diabetes mellitus?
FPG ≥ 7.0 mmol/L
HbA1c ≥ 6.5%.
What are the two key changes that occur in a platelet after it adheres to von Willebrand factor, and why are they important for clot formation?
1. Shape change: increases surface area for adhesion.
2. Granule secretion: releases factors that recruit and activate additional platelets, promoting aggregation.
A patient with anemia has a low MCV, normal iron studies, and a normal RDW. Which condition should be suspected, and what confirmatory test would you order?
Thalassemia trait. Confirm with hemoglobin electrophoresis to distinguish hemoglobin types.
A patient with mechanical heart valve develops anemia. Which mechanism is most likely, and what characteristic finding might be seen on a blood smear?
Non-immune hemolysis from mechanical trauma
Schistocytes on smear.
How does hypertension act as a risk factor for atherosclerosis?
It causes endothelial damage, making it easier for LDL to enter the vessel wall and trigger the inflammatory cascade.
Name all three microvascular complications and all three macrovascular complications, and link each to the vessel type they affect.
Microvascular: Retinopathy (small retinal vessels), Nephropathy (small renal vessels), Neuropathy (small nerve vessels).
Macrovascular: Coronary artery disease (large heart arteries), Peripheral vascular disease (large limb arteries), Cerebrovascular disease (large brain arteries).
What test is used to measure the extrinsic pathway and the intrinsic pathway, respectively?
What does each acronym stand for?
INR = International Normalized Ratio
PTT = Partial Thromboplastin Time
Compare the MCV, RDW, ferritin, and TIBC in iron deficiency anemia versus thalassemia trait.
Iron deficiency: low MCV, high RDW, low ferritin, high TIBC
Thalassemia: low MCV, normal RDW, normal ferritin, normal TIBC
After food is swallowed, Vitamin B12 absorption requires 4 specific steps. List these steps in order, including where in the GI tract each occurs.
1. B12 is separated from proteins in the stomach via gastric acid.
2. Further separation in duodenum via pancreatic enzymes
3. Binding to intrinsic factor from parietal cells
4. Absorption of B12–intrinsic factor complex in terminal ileum.
What role do smooth muscle cells play in the later stages of plaque development?
They migrate over the lipid core to form a fibrous cap and secrete calcium to stabilize the plaque.
What type of fat is linked to insulin resistance, and what are the 3 harmful substances it releases?
Visceral fat.
1. releases free fatty acids
2. inflammatory cytokines
3. harmful adipokines
List, in correct order, all the coagulation factors involved in the common pathway.
Factor X → Xa with cofactor Va converts prothrombin (Factor II) to thrombin (IIa).
Thrombin converts fibrinogen (Factor I) to fibrin, which is stabilized by Factor XIIIa