Pathology I Review 4

Igor Areinamo
 Case 1
• A 53-year-old patient comes to the ER after experiencing
fever, anorexia, and constant somnolence. A chest
radiograph is performed and it shows lobar consolidation.
The patient is admitted to the hospital with a Dx of lobar
pneumonia. 24 after admission, the patient starts
complaining of leg pain with increased calf size as well as
pain on left arm. It is obvious that this patient is suffering
from DIC which is then confirmed by a high level of tissue
thromboplastin. All these findings are normally induced
by the action of which chemical mediator? What is the
role of platelets in this type of response?
 Case 2
• A patient is suffering from diffuse
vasodilatation due to a bacterial infection. This
type of shock is known as? Explain
mechanism. The doctor orders fluid
replacement, but the blood pressure is not
responsive. This is most characteristic of?
Mention some intrinsic vasoactive and
vasodialator agents.
Case 3
 Case 3
• Platelet Count = 80,000 were 200,000 three
days ago. Explain!!!???
Case 4
 Case 4
• Reasoning behind presentation.
• Explain “Waterhouse-Friderichsen Syndrome”
Case 5
CASE 5
 Case 5
• PaO2 < 60mmHg,
• PaO2/FiO2 <200
• How did we calculate PaO2/FiO2?
• What is the normal value for the previously
calculated figure?
 Case 5
• PaO2 of 75 to 100 mmHg is considered normal. FIO2 is the fraction of inspired oxygen or, simply
percentage of oxygen, in a gas mixture. For example, the atmospheric air has FIO2 of 21
percent. If a patient needs mechanical ventilation, FIO2 is usually in the 30-to-40-percent range.
• Step 1
• Obtain a PaO2 value in mmHg from records or elsewhere. Example PaO2=92 mmHg. Note:
determination of PaO2 requires a sample of the arterial blood and special laboratory
instruments such as blood gas analyzers or spectrofluorometers (see References).
• Step 2
• Convert the FIO2 (%) value into decimal form.
FIO2=FIO2(%)/100%.
Example: FIO2=32%/100%=0.32
• Step 3
• Calculate the PaO2/FIO2 ratio taking numbers from Step 1 and 2 as an example.
PaO2/FIO2=92 mmHg/0.32=287.5 mmHg.
• Step 4
• Compare the PaO2/FIO2 ratio to the hyperemia criterion that is if PaO2/FIO2 < 200 mmHg.
 Case 6
• Identify the following cells: