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Nur 6501 Advanced Pathophysiology
Midterm Exam Questions and Answers.
What is the probable cause of cellular swelling in the early stages of cell injury? - Correct answer Na-K pump fails to remove intracellular Na+ The mechanism for liver damage related to chronic alcoholism is:
- Correct answer Oxidative stress. Free radicals cause damage by: - Correct answer Giving up on electron, which cause injury to the chemical bonds of the cell membrane. The loss of adenosine triphosphate (ATP) during ischemia causes cells to: - Correct answer Swell because of the influx of sodium chloride. During cellular injury, when the membrane becomes damaged, what is the mechanism of cell injury? - Correct answer Loss of permeability. When a person experiences a myocardial infarction, how long before anaerobic metabolism ceases? - Correct answer 3- minutes. Left calf being smaller than right calf when a cast is removed is an example of: - Correct answer Atrophy. A young female becomes agitated and apprehensive, and she eventually loses consciousness. At the hospital ER, the following lab values were obtained: -Plasma Sodium 137 -Plasma Potassium 5.
-pH 7. -Serum Co2 22 -Plasma Bicarb 24 What is her immediate diagnosis? - Correct answer Respiratory alkalosis. What would not shift blood toward pH alkalosis? -Hydrogen ion secretion into urine -Exhalation of carbon dioxide -All of the above would -None of the above would - Correct answer All of the above. A 76 y/o man was brought to an urgent care facility when he fell after sitting for prolonged period of time. He is slow to answer questions, has muscle weakness and cramping, and constipated. He had diarrhea for three weeks. On exam: neck veins flat, BP low in supine, HR 110, pulse weak + regular, resps 20 but deep. Labs: Na+ 142, K 2.8. -What fluid imbalance does he have and why? - Correct answer Isotonic fluid deficit. (Diarrhea x 3 weeks, orthostatic hypotension, tachycardia, weak pulse and low BP on supine. A 76 y/o man was brought to an urgent care facility when he fell after sitting for prolonged period of time. He is slow to answer questions, has muscle weakness and cramping, and constipated. He had diarrhea for three weeks. On exam: neck veins flat, BP low in supine, HR 110, pulse weak + regular, resps 20 but deep. Labs: Na+ 142, K 2.8. -What imbalance is indicated based on lab results? What clinical manifestations are noted based on this imbalance? - Correct answer Hypokalemia. (Muscle weakness and constipation).
What tissue type is involved in liquefactive necrosis? - Correct answer Brain. What tissue type is involved with caseous necrosis? - Correct answer Lungs (ex: TB). What tissue type is involved in fatty necrosis? - Correct answer Breasts, pancreas, abdomen. True or false: The human neonate initially has poor production of IgG. - Correct answer True. Type 1 hypersensitivity - Correct answer IgE mediated Type 2 hypersensitivity - Correct answer Tissue-specfic Type 3 hypersensitivty - Correct answer immune-complex mediated. Type 4 hypersensitivity - Correct answer Cell-mediated. True or false: inappropriate immune responses against the host's own tissues is termed alloimmunity. - Correct answer False. Colonization, invasion, multiplication and spread are: - Correct answer the process of infection. Clinical infection stages: - Correct answer Incubation period, prodromal state, invasion period and convalescence. Hallmark of most infectious disease: - Correct answer fever. Polycythemia vera is a chronic condition that occurs when there is a _______________ of RBCs, and causes splenomegaly. - Correct answer Overproduction.
True or false: Hemolytic disease of the fetus and newborn resulting from Rh incompatibility is more sever than that stemming from ABO incompatibility. - Correct answer True. a 62 y/o woman comes into the clinic complaining of being tired. Upon exam, you notice she is pale, has sores in the corners of her mouth accompanied by a red tongue and has concave funerals. Which type of anemia do you suspect? - Correct answer Iron deficiency. Within how many hours should RhoGAM be given to an Rh- negative mother's exposure to Rh-positive fetal blood? - Correct answer 72. What is a lifelong treatment plan for a patient who has had gastric bypass diagnosed with pernicious anemia? - Correct answer Vitamin B12. Your patient has developed hemolytic anemia related to the antibiotic PCN. What is the first line of therapy? - Correct answer Corticosteroid administration. What treatment prevents the development of kernicterius in an infant born with hemolytic newborn disease (HDN)? - Correct answer Replacement transfusion of new Rh-positive blood that is not contaminated with anti-Rh antibodies. What vitamin improves the absorption of oral iron in children and should be recommended as part of the treatment for iron- deficiency anemia? - Correct answer Vitamin C. What is the fundamental physiologic mechanism of anemia? - Correct answer Hypoxia.
What type of anemia is iron-deficiency? - Correct answer microcytic, hypochromic What type of anemia is pernicious anemia? - Correct answer macryocytic normochromic What type of anemia is post-hemorrhagic? - Correct answer normocytic chromocytic What type of anemia is folate-deficiency? - Correct answer microcytic normochromic Anemias associated with impaired erythrocyte function: - Correct answer iron-deficiency, pernicious anemia, folate-deficiency Anemia associated with increased erythrocyte function: - Correct answer sick cell anemia Is chronic ITP (immune thrombocytopenic purpura). more common in men or women? - Correct answer Women The APRN assesses a client with inspiratory and expiratory wheezing, dyspepsia, nonproductive cough, increased use of accessory muscles and tachypnea. The client is afebrile. Which condition should the APRN suspect? - Correct answer Asthma The APRN suspects asthma in a client with a history of significant environmental allergies. When considering the pathophysiology of asthma, which immunoglobulin may contribute to the triggering of asthmatic symptoms in this client? - Correct answer IgE The APRN is assessing an 8 y/o client suspected of asthma. Which criterion should the APRN use to confirm a diagnosis of asthma in this client? - Correct answer Reduced expiratory flow rate confirmed by spirometry testing.
Why is nasal congestion a serious threat to young infants? - Correct answer Infants are obligatory nose breathers. The APRN assesses a 2 y/o child brought to the clinic for a "cold that keeps getting worse". Which clinical manifestations would cause the APRN to suspect croup? - Correct answer -low grade fever -sore throat -barking cough What is the most common predisposing factor for OSA in children? - Correct answer Adenotonsillar hypertrophy The parents of a 2 y/o child are concern because their child has recurrent respiratory infections and "problems with digestion". The child was born at home and did not receive any newborn screenings but has since been caught up on required immunizations. What test should the APRN run to rule out cystic fibrosis? - Correct answer Serum immunoreactive trypsinogen What is the chief predisposing factor for respiratory distress syndrome (RDS) of the newborn? - Correct answer Premature birth. bronchiolitis tends to occur during the first year of life and is most often caused by what type of infection? - Correct answer RSV (respiratory syncytial virus) In chronic bronchitis, goblet cells undergo: - Correct answer hyperplasia and hypertrophy Diminished respiratory flow rates in emphysema are ultimately caused by what? - Correct answer Alveolar wall destruction.
What is true regarding seborrheic dermatitis? - Correct answer - Often involves scale, eyebrows, eyelids, nasolabial folds, axillae, chest and back -In infants it shows up as cradle cap What other condition connect to atopic dermatitis? - Correct answer Asthma What is true regarding scabies? - Correct answer -Transmission occurs through personal contact and infected clothing and bedding -it is a contagious disease caused by the itch mite, sarcoptes scabiei -the rash is marked by burrows, papule and vesicular lesions True or false: allergic contact dermatitis is a common form of t-cell mediated or delayed hypersensitivity type IV - Correct answer true __________ involves high contagious parasites that survive by sucking blood while secreting toxic saliva. - Correct answer pediculosis Tinea capitis: - Correct answer fungal infection of the scalp Tinea pedis: - Correct answer Athlete's foot Tinea corporis: - Correct answer Ringworm Tinea cruris: - Correct answer groin, jock itch Tinea unguium (onychomycosis) - Correct answer fungal infection of the nail True or false: malignant (cutaneous) melanoma is a tumor of the skin originating from keratinocytes: - Correct answer False
What is true regarding herpes zoster (shingles)? - Correct answer - Caused by VSV (varicella zoster virus) -Pain and paresthesia localized to the dermatome -Adults can develop shingles of they've already had chickenpox What form of psoriasis is the most common? - Correct answer Plaque. Complications of psoriasis: - Correct answer -Cardiovascular complications -Chronic inflammation -linked to other autoimmune deficiencies Tick bites cause: - Correct answer -larger rash in bullseye pattern -lyme disease -Rocky Mountain spotted fever What disease can lead to meningitis and inflammation of the cardiac tissue? - Correct answer Lyme disease True or false: erysipelas is a deeper form of cellulitis: - Correct answer False. Erysipelas is a common bacterial infection of the superficial layer of the skin extending to lymphatic vessels. Where is Candida found? - Correct answer -skin -GI tract -vagina What is true regarding yeast infections? - Correct answer - Breastfeeding babies or bottle feeding can get yeast in their mouths -Use of Abx can be a risk factor -Diabetics are prone to yeast infections
Risk factors for osteoporosis: - Correct answer -Decreased estrogen -Reduced dietary intake of vitamin D What increases RANKL expression and inhibits OPG production by osteoblasts and leads to lower bone density? - Correct answer Glucocorticoids What ethnic populations are at highest risk for osteoporosis? - Correct answer Caucasian and Asian. Osteomyelitis causes: - Correct answer -Staph infection -Bloodborne or exogenous source Most common primary malignant bone tumor? - Correct answer Osteosarcoma Which gender is at highest risk for osteoporosis? - Correct answer Women Can osteoporosis be genetic? - Correct answer Yes Other term for osteoarthritis - Correct answer DJD New bone formation: - Correct answer involucrum Bronchitis definition: - Correct answer chronic inflammation of the bronchi that causes airway obstructs. Bronchitis patho: - Correct answer -Results from bronchial smooth muscle hypertrophy -Increased in size and number of epithelial mucous glands and goblet cells -increased production of thick, tenacious mucous
Chronic bronchitis/COPD: - Correct answer -hyper secretion of mucous -chronic productive cough (3 months, two consecutive years) Patho of COPD: - Correct answer -Inspired irritants increase mucous production, size and number of mucous glands, bronchial edema and thicker than normal mucous. -Decreased luminal airways d/t edema/inflammation -Results in impaired airflow -Causes hypertrophied bronchial smooth muscle and hypoxemia/HCAP -Airways collapse early in expiration, traps gas in lungs. COPD clinical manifestations: - Correct answer -Decreased exercise tolerance -Decreased FEV -Polcythemia (increased RBCs = thicker blood) -Productive cough ("smoker's cough") -Wheezing and SOB Acute bronchitis - Correct answer -Infection or inflammation of the large airways or bronchi -usually self limiting, caused by virus Acute bronchitis patho: - Correct answer -Follows viral illness (flu, rhinovirus, adenovirus) -bronchial lining becomes irritated and airways narrow d/t inflammatory process -Edema, capillary dilation, exudates What is the major extracellular cation that plays a pivotal role in the maintenance of extracellular fluid volume and perfusion of vital organs and capillary beds? - Correct answer Sodium.
Most common cause of nephrotic syndrome in adults: - Correct answer glomerulonephritis Renal stone risk factors: - Correct answer -most prevalent is inadequate fluid intake -Geographic location Cystitis urine culture result - Correct answer specific microorganism count of 10,000/mL or more. What type of renal failure is caused by heart failure: - Correct answer Pre Bladder exstrophy - Correct answer characterized by urinary bladder and part of the intestines/GI tract and or spine is outside of the body at the time of birth. Symptoms of nephrotic syndrome in children: - Correct answer - diarrhea -anorexia -poor absorption -HLD -Diminished/frothy/foamy urine output When does the GFR match adult range? - Correct answer Two years When do kidneys reach adult size? - Correct answer Teen years Risk factors for developing Crohn's disease: - Correct answer - Genetic history -NSAID use Smoking
Symptoms associated with colon cancer: - Correct answer -Abd Px -Change in bowel habits -Blood in stool Hallmark of ulcerative colitis: - Correct answer bloody diarrhea True or false: acute pancreatitis is typically caused by viral pathogens: - Correct answer false Hallmark of pyloric stenosis: - Correct answer projectile vomiting Risk factors for peptic ulcer disease: - Correct answer -H.pylori infection -Habitual use of NSAIDs -Excessive ETOH/smoking Appendicitis symptoms: - Correct answer -N/V -Fever and leukocytosis -Sudden pain relief indicates rupture Leading cause of acute liver failure: - Correct answer acetaminophen overdose Gallstone risk factors: - Correct answer -High fat diet -Pregnancy -Female Phase of liver failure marked by patient seeking care after jaundice, hyperbilirubinemia, and pain? - Correct answer icteric phase Diagnostic marker for acute pancreatitis: - Correct answer serum lipase
What upper respiratory infection is similar to PNA without chest infiltrates? - Correct answer Acute bronchitis. Clinical manifestations of acute bronchitis: - Correct answer -non productive cough -aggravated by cold, dry, dusty air -Symptoms generally mild -Cough can linger for weeks -Restrosternal chest pain -intermittent wheeze Cystic fibrosis - Correct answer -Inherited disease caused by dysfunction of CF transmembrane regulator (CFTR) -Autosomal recessive -Causes sever lung damage and nutrient deficits -Defective chloride secretion and excess sodium absorption cause thick, tenacious mucous that plugs airways -Results in chronic pulmonary infections, bronchiectasis r/t airway epithelial Cl and Na+ transport Pathophysio of CF - Correct answer -Pancreatic enzyme deficiency (causes maldigestion) -Overproduction of mucous in respiratory tract, reproductive tract and digestive tract -Changes cells that produce mucous, sweat, saliva and digestive secretions -increases number of goblet cells, causes thick mucous -secretions block airway ducts -Abnormally elevated sodium and chloride concentrations in sweat Major manifestations of CF: - Correct answer -Digestive -Pancreatic insufficiency
Most common cause of CF deaths - Correct answer Respiratory failure Number of Americans with fault CF gene - Correct answer 10 million/1 in 31 Clinical manifestations of CF: - Correct answer -Persistent cough/wheeze -Sputum production -Frequent respiratory infections -Dyspnea -Fatigue -Recurrent/severe PNA -Salty-tasting skin -Activity intolerance -Digital clubbing -Rhonchi -Chronic sinus infections -Nasal polyps -Steatorrhea -Fat soluble vitamin deficiency -Unable to maintain weight -Delayed/impaired growth Evaluation of CF: - Correct answer Newborn screening, IRT blood and sweat test CF treatment - Correct answer -Incurable -Chest PT (oscillation vest) -PEP devices -Aerosol therapies (bronchodilators, nebulizer deoxyribonuclease, inhaled hypertonic saline -IV Abx, azithro, Motrin, corticosteroids -Nutritional support
