ADVANCED PATHOPHYSIOLOGY EXAM 1(220 QUESTIONS WITH 100% PRECISE ANSWERS) 2024 LATEST UPDAT, Exams of Nursing

Download ADVANCED PATHOPHYSIOLOGY EXAM 1(220 QUESTIONS WITH 100% PRECISE ANSWERS) 2024 LATEST UPDAT and more Exams Nursing in PDF only on Docsity! ADVANCED PATHOPHYSIOLOGY EXAM 1(220 QUESTIONS WITH 100% PRECISE ANSWERS) 2024 LATEST UPDATED AND GRADED100% PASS) A certain disease is currently found in 1 of every 10 people in the country and 1,000 people contract the disease yearly. The population of the country is 4,500,000. Which of the following statements is correct? a. The prevalence of the disease is 10% and the incidence is .02%. b. The prevalence of the disease is .02% and the incidence is 10%. c. Neither is correct. d. There is insufficient data - Precise answer A In relation to disease development, the term "etiology" refers to which of the following? a.number of people with the disease b. cause of the disease c. definition of the disease d. outcome of the disease - Precise answer B Which of the following is(are) true about "symptoms"? a. objective and measurable b. the same as "signs" c. both of the above d. neither of the above - Precise answer D In 1992, there were 980 deaths in a Midwestern city with a population of 1,000,000. At the beginning of that year, 900 cases of AIDS existed in this population. During the year, 250 new cases of AIDS were diagnosed, and 75 people died of the disease in 1992. Using the data given above, what was the incidence rate (per 100,000 population) at the end of 1992 for AIDS? a. 6 b. 25 c. 88 d. 116 - Precise answer B What level of prevention is a blood pressure screening program for high school students who are pregnant? a. primary b. secondary c. tertiary - Precise answer B Mr. Forbes complains of "indigestion" and becomes sweaty and pale. His wife takes him to the Emergency Department at Northwestern Memorial Hospital. A cardiac catheterization 2 days later shows partial blockage of his right coronary artery (RCA). Blockage of the right coronary artery can lead to myocardial cell injury because it results in which of the following? a. bilirubin accumulation in myocardial cells b. alteration in the genetic material of myocardial cells c. reduced energy production in myocardial cells d. activation of the complement system - Precise answer C When myocardial cells are injured, the function of the Na-K membrane pump may be impaired. Which of the following may then result? a.intracellular sodium will increase b. extracellular potassium will decrease c. cell volume will decrease d. all of the above - Precise answer A Mr. Forbes is being prepared for open heart surgery when he suffers a myocardial infarction in which a large part of his left ventricle has suffered lethal cell injury. Mr. Forbes' CPK-MB and LDH1, enzymes associated with myocardial cells, are significantly elevated. What is the best explanation for this? a. It is a sign that necrotic myocardial cells have released their cytoplasmic contents into the blood. b. It is a sign of reversible fatty accumulation in the myocardial cells c. It is a sign that the myocardial cells are undergoing hypertrophy. d. None of the above. - Precise answer A c. It results in phagocytosis of the apoptotic cell. d. all of the above. - Precise answer D Insufficient blood flow to a part of the body is defined as: a. hypoxia. b. hypoxemia. c. necrosis. d. ischemia. - Precise answer D A cellular change, which is often precancerous, is called: a. hyperplasia. b. metaplasia. c. dysplasia. d. hypertrophy. - Precise answer C Which of the following changes is indicative of irreversible cell injury? a. sodium influx into the cytoplasm b. glycolysis (anaerobic metabolism) c. detachment of ribosomes from rough endoplasmic reticulum d. release of lysosomal enzymes - Precise answer D Which of the following best describes reperfusion injury? a. The increased blood pressure in the area of reperfusion causes rupture of small arterioles and release of free radicals. b. The return of blood flow to the area results in a burst of free radical production from neutrophils that accumulated in the area. c. Reperfusion injury results from restoration of the function of the sodium- potassium pump. d. Reperfusion of the area results in apoptosis of the previously ischemic cells. - Precise answer B Which of the following best describes free radicals? a. stable molecules not normally found in the body, but introduced exogenously during ischemia b. unstable molecules that are normal products of oxidative metabolism and are removed by endogenous antioxidants c. stable molecules that have an affinity for iron in the cytoplasm of the cell d. none of the above - Precise answer B The usual fate of apoptotic cells is which of the following? a. metaplastic transformation b. calcification c. hypertrophy d. phagocytosis e. neoplastic transformation - Precise answer D Which of the following statements is true regarding the difference between cell necrosis and apoptosis? a. Apoptosis is a more rapid process. b. Apoptosis is usually initiated by ischemia-induced cell injury. c. Apoptosis is genetically controlled. d. Apoptosis characteristically involves rupture of the cell membrane. - Precise answer C You are a nurse practitioner working in an outpatient clinic. Your patient's echocardiogram shows moderate aortic stenosis (narrowing of the aortic valve). You know that the stenotic valve creates an increased resistance against which the left ventricle contracts. The cellular adaptation most likely to occur in the left ventricle is which of the following? a. atrophy b. hypertrophy c. hyperplasia d. metaplasia - Precise answer B Select the condition that is an example of physiologic hyperplasia. a. breast enlargement during puberty b. endometrial hyperplasia from excessive estrogen stimulation c. prostatic hyperplasia occurring as men age d. none of the above are physiologic - Precise answer A Your patient has a long history of mitral stenosis (narrowing of the mitral valve). As the years go by, the left atrium, which contracts against the increased resistance of the stenotic valve, begins to fail--and output from the left ventricle begins to decline. If the left ventricle were to undergo adaptation, what would it most likely be? a. atrophy. b. hypertrophy. c. hyperplasia. d. metaplasia. - Precise answer A Which of the following is not characteristic of cellular dysplasia? a. variation in size and shape of cells b. small, pale nuclei c. disorderly arrangement of cells d. preneoplastic change - Precise answer B If a normal individual began to take cortisol 100 mgs. every day as a medication, which of the following would result? a. hypertrophy of the adrenal gland b. hyperplasia of the adrenal gland c. atrophy of the adrenal gland d. hypertrophy and hyperplasia of the adrenal gland - Precise answer C If a normal individual began to take thyroid hormone 100 mcgs. every day as a medication, which of the following would result? a. hypertrophy of the thyroid gland b. hyperplasia of the thyroid gland c. atrophy of the thyroid gland d. hypertrophy and hyperplasia of the thyroid gland - Precise answer B Chronic alcoholism can result in the development of a fatty liver because it results in which of the following? a. increased production of free fatty acids b. increased conversion of free fatty acids to triglycerides c. decreased oxidation of cholesterol, triglycerides, and phospholipids d. decreased binding of cholesterol, triglycerides, and phospholipids to apoproteins - Precise answer A Which of the following is the primary difference between wet and dry gangrene? a. Infection and inflammation are present in wet gangrene. b. Wet gangrene results from arterial occlusion and dry gangrene from venous stasis. c. Dry gangrene involves the presence of Clostridium perfringens. d. Wet gangrene occurs only in internal organs. - Precise answer E Which of the following components is not involved in apoptosis? a. Bcl-2 b. apaf-1 c. caspase 9 Tertiary prevention - Precise answer -aims to prevent the long-term consequences of a chronic illness or disability and to support optimal functioning -examples: prevention of pressure ulcers as complication of a spinal cord injury; promoting independence for the client who has traumatic brain injury Atrophy - Precise answer Decrease or shrinkage in cellular size.Most common in skeletal muscle, heart, secondary sex organs, and brain. Physiologic atrophy - Precise answer occurs with early development. Ex. Thymus gland gets physiologic atrophy during childhood. pathologic atrophy - Precise answer occurs as a result of decreases in workload, pressure, use, blood supply, nutrition, hormonal stimulation, and nervous stimulation hypertrophy - Precise answer Increase in the size of the cells that increase the size of the affected organ. Heart and kidneys (responsive to enlargement) and skeletal muscle. physiologic hypertrophy - Precise answer occurs with increased demand, stimulation of hormones, and growth factors. Ex. Pregnancy causes hormone induced hypertrophy of the uterus, in skeletal muscle occurs as a response to heavy workload. pathologic hypertrophy - Precise answer results from chronic hemodynamic overload. Ex. Hypertension or heart valve dysfunction. Hypertrophic cells have increased accumulation of ER, plasma membrane, myofilaments, mitochondria (not cellular fluid). Nucleus is also hypertrophic with increased DNA synthesis. Triggers for cardiac hypertrophy include mechanical signals (stretch) and trophic signals (growth factors and vasoactive agents). Hyperplasia - Precise answer increase in number of cells in an organ/tissue as a response to injury that results from an increased rate of cellular division compensatory Physiologic hyperplasia - Precise answer is an adaptive mechanism that enables certain organs to regenerate. Occurs in skin, intestines, hepatocytes, bone marrow, and fibroblasts. Ex. Is when skin gets callus in response to mechanical stimulus. Hormonal physiologic hyperplasia - Precise answer Hormonal occurs mainly from estrogen dependent organs such as uterus and breasts.Ex- after ovulation estrogen stimulates endometrium to grow/thicken for fertilized ovum. Pathologic hyperplasia - Precise answer he abnormal proliferation of normal cells and can occur as a response to excessive hormonal stimulation or the effects of growth factors on target cells. These cells have enlargement of the nucleus, clumping of chromatin (package and protect DNA), and the presence of one or more large nucleoli. Ex. Benign prostatic hyperplasia (BPH) and endometriosis-both the result of hormonal imbalance. Metaplasia - Precise answer reversible replacement of one mature cell type (epithelial or mesenchymal) by another, sometimes less differentiated, cell type. Cause of metaplasia - Precise answer develops from reprogramming of stem cells. Found in association with tissue damage, repair, and regeneration. pathophysiology of metaplasia - Precise answer Adaptive replacement cell may be more suitable to the changed conditions in the surrounding environment. Ex. GERD damages squamous epithelium of the esophagus, cells are replaced by glandular epithelium which may tolerate the acid better. Not always beneficial. Ex. Smoking causes changes in bronchi cells, which don't have cilia or secrete mucus, causing loss of protective mechanism. What is the significance of metaplasia - Precise answer Can be reversed if stimulus is removed. If continues, can cause malignant transformation. Dysplasia - Precise answer abnormal changes in the size, shape, and organization of mature cells. mostly found in epithelia Significance of dysplasia - Precise answer can be reversed if it does not involve the entire epithelium. When dysplastic changes penetrate the basement membrane it is considered a preinvasive neoplasm (carcinoma in situ) mechanisms of cell injury - Precise answer ATP depletion, mitochondrial damage, accumulation of oxygen and oxygen-derived free radicals membrane damage protein folding defects DNA damage defects calcium level alterations reperfusion injury - Precise answer injury to tissue that occurs after blood flow is restored restoration of needed oxygen is accompanied by oxidative stress with the generation of toxic oxygen radicals which damage cellular membranes and mitochndria What helps reperfusion injury? - Precise answer antioxidants and anti- inflammatory drugs examples of cell injury - Precise answer ischemic and hypoxic injury ischemia-reperfusion injury oxidative stress or accumulation of oxygen-derived free radicals induced injury chemical injury Cell injury: ATP depletion - Precise answer loss of mitochondrial ATP and decreased ATP synthesis results include: cellular swelling decreased protein synthesis decreased membrane transport lipogenesis all changes that contribute to loss of integrity of the plasma membrane Cell injury: Oxygen and oxygen-derived free radicals - Precise answer lack of oxygen is key in progression of cell injury in ischemia (reduced blood supply) activated oxygen species (free radicals) cause destruction of cell membranes and cell structure -Failure of metabolic process that converts fatty acids to phospholipids resulting in the preferential conversion of the fatty acids to triglycerides -increased synthesis of triglycerides from fatty acids -decreased synthesis of apoproteins (lipid acceptors) -failure of lipids to bind with apoproteins and form lipoproteins -failure of mechanisms that transport lipoproteins out of the cell -direct damage to the ER by free radicals released by alcohol's toxic effects pathogenesis of bilirubin - Precise answer -released when RBCs break down -released into blood (unconjugated) -fat-soluble, cannot be elimintated through urine -unconjugated is taken up in the liver cells, bound to glucuronic acid, becomes conjugated bilirubin -can now be eliminated through the kidney -some becomes part of bile, some is eliminated in urine and feces giving yellow and brown color (bilirubin is a pigment) What is jaundice caused by - Precise answer excess bilirubin what is excess bilirubin caused by - Precise answer -diseases that cause destruction of RBC (hemolytic jaundice) -Diseases affecting the metabolism and excretion of bilirubin in the liver -diseases that can obstruct the common bile duct (gallstones/pancreatic tumors) Effects of free cytosolic calcium - Precise answer -normally removed by ATP dependent calcium pumps -If abnormal permeability of calcium ion channels, direct damage to membranes, or depletion of ATP (i.e. hypoxic injury) -then calcium level increases -if not buffered or pumped out, uncontrolled enzyme activation takes place -leading to: phosphorylation of protein and chromatin fragmentation, membrane damage, cytoskeletal disassembly (damage), nucleus chromatin damage -often final pathway in many causes of cell death pyknosis - Precise answer in some cells the nucleus shrinks and becomes a small dense (clumped together) mass of genetic material. The pyknotic nucleus eventually dissolves (by karyolysis) karyorrhexias - Precise answer a degenerative cellular process involving fragmentation of the nucleus and the breakup of the chromatin into unstructured granules karyolysis - Precise answer nuclear dissolution and lysis of chromatin from the action of hydrolytic enzymes. Result of the action of hydrolytic lysosomal enzymes on DNA Liquefactive necrosis - Precise answer brain infarct, bacterial infections; wet gangrene type of necrosis which results in a transformation of the tissue into a liquid viscous mass. coagulative necrosis - Precise answer primarily occurs in kidneys, heart, and adrenal glands results from hypoxia caused by severe ischemia or chemical injury most common usually replaced by scar/fibrous tissue caseous necrosis - Precise answer commonly results from tuberculous pulmonary infection combination of coagulative and liquefactive the dead cells disintegrate but the debris is not digest completely by hydrolases tissues appear soft and granular and resemble clumped cheese Fat necrosis - Precise answer occurs in the breast, pancreas, and other abdominal structures cellular dissolution caused by powerful enzymes called lipases break down triglycerides releasing free fatty acids which combine with calcium, magnesium, and sodium ions, creating soaps necrotic tissue appears opaque and chalk white Gangrenous necrosis - Precise answer refers to death of tissue and results from severe hypoxic injury commonly occurring becasuse of arteriosclerosis especially in lower leg with hypoxia and subsequent bacterial invasion, the tissues undergo necrosis dry gangrene - Precise answer an area that is free of infection and in which the line of demarcation between live and dead tissue is apparent tissue becomes dry and shrunken - mummified wet gangrene - Precise answer often malodorous and the line of demarcation between live and dead tissue is unclear until the infection is arrested gas gangrene - Precise answer wet gangrene caused by clostridium perfringes, an organisms that produces gas within the destroyed tissue. This accumulation of gas produces a distinctive sound on palpation of the area called crepitus systemic manifestations of cellular injury - Precise answer fever increased heart rate increase in number of leukocytes pain presence of cellular enzymes in extracellular fluid lactate dehydrogenase CK AST ALT ALP amylase aldolase tropinins cellular processes involved in necrosis - Precise answer -caused by an injurious agent, or -cells are induced to commit suicide -a disorganized sequence of events that stimulates the inflammatory process -cellular changes after cell death and process of cellular autodigestion -membrane integrity is lost and necrotic tissue leaks out causing inflammation in the surrounding tissue apoptosis - Precise answer -event that results in cell death -quiet, organized, programmed process resulting in elimination of individual cells relationship of apoptosis to AIDS - Precise answer -immune response to a foreign invader - proliferation of lymphocytes (T and B cells) -when their job is done they are removed via apoptosis leaving a small population of memory cells define aging and its relationship to cellular function/structure and genetic and environemental factors - Precise answer -aging is the progressive loss of tissues overtime -senescence is a process of permanent proliferative arrest on cells in response to various stressors -senescent cells accumulate - tissue dysfunction -cellular changes of aging include: -atrophy -decreased function -loss of cells (maybe apoptosis) -free radicals damage tissues during aging -DNA is vulnerable to breaks, deletions, and additions -movement of intracellular and Extracellular substances decreases with age causes of hypovolemia - Precise answer - loss of fluids from anywhere (thoracentisis, paracentisis, vomiting, diarrhea, hemorrhage, suction) - Third spacing (burns, ascites) - diseases with polyuria (polyuria > oliguria > anuria > renal failure) clinical manifestations of hypovolemia - Precise answer -Thirst -Dry mucous membranes -Decreased skin turgor/delay return/tenting -Hypotension, tachycardia -Weight loss -Decreased urine output, concentrated urine -Restless, drowsy, confused, dizzy, weak total body water - Precise answer -usually expressed as a percentage of body weight -varies based on body type, sex, and age -female normal build 50% water -male normal build 60% water causes of hypervolemia - Precise answer Heart failure Kidney disease Cirrhosis Overdose of sodium concentrated fluids Fluid shifts in burns Prolonged use of corticosteroids Severe stress Hyperaldosteronism weight gain manifestations of hypervolemia - Precise answer -Edema pitting -pulmonary congestion -circulatory overload( bounding pulses, jugular vein distention, elevated blood pressure - weight gain hypernatremia - Precise answer occurs when serum sodium levels exceed 145 mEq/L and causes hypertonicity hypovolemic hypernatremia - Precise answer occurs where there is loss of body sodium accompanied by a relatively greater loss of body water causes: loop diuretics, osmotic diuresis (ie from hyperglycemia related to uncontrolled diabetes or mannitol), GI losses, failure of kidneys to concentrate urine Euvolemic hypernatremia - Precise answer most common occurs when there is a loss of free water with a near normal sodium concentration causes: inadequate water intake, excessive sweating, fever with hyperventilation and water loss from burns, vomiting, diarrhea, diabetes insipidus hypervolemic hypernatremia - Precise answer rare occurs when there is increased TBW and greater increase in total body sodium level, resulting in hypervolemia causes: infusion of hypertonic saline solutions, over-secretion of ACTH or aldosterone (cushing syndrome) signs of hypernatremia - Precise answer weakness lethargy muscle twitching hyperreflexia due to shrinking of brain cells and alterations in membrane potential labs of hypernatremia - Precise answer hematocrit and plasma protein levels are elevated with water loss sodium >145 hyponatremia - Precise answer develops when the serum sodium concentration decreases to less than 135 mEq/L most common electrolyte disorder in hospitalized individuals occurs when there is a loss of sodium, inadequate intake of sodium, or dilution of sodium by water excess excessive diuretic therapy hyponatremia ECF effects - Precise answer extracellular volume contraction and hypovolemia hyponatremia ICF effects - Precise answer increased intracellular water, edema, brain cell swelling, irritability, depression, confusion, systemic cellular edema (weakness, anorexia, nausea, diarrhea) hypovolemic hyponatremia - Precise answer with pure sodium loss is accompanied by loss of ECF with symptoms of hypotension, tachycardia, decreased urine output hypervolemic hyponatremia - Precise answer weight gain, edema, ascites, jugular vein distention labs of hyponatremia - Precise answer hematocrit and plasma protein level may be elevated with pure sodium deficits Sodium < 135 hyperkalemia - Precise answer greater than 5.0 mEq/L caused by excess dietary or IV intake decreased renal loss renal failure K+ sparing diuretics hypoaldosteronism shift from ICF to ECF metabolic acidosis bone pain osteoporosis fractures calculation of water def - Precise answer the difference between ideal TBW and current TBW = weight in kg x (0.4 F) (0.5 M) (0.6 infants) calculation for ideal TBW - Precise answer (current Na X TBW)/140 calculation for water deficit - Precise answer ((current Na X TBW)/140) - TBW calculation for water excess - Precise answer the difference between current TBW and ideal TBW water excess = weight (kg) x (0.5 F) x (1 - (Na/125)) (0.6 M) (0.7 infants) normal body fluid osmolality - Precise answer 280 - 294 mOsm/Kg osmolality - Precise answer determined by the total solute concentration in a fluid compartment Calculation for serum osmolality - Precise answer OSM = 2 X [sodium concentration] + [glucose concentration/18] + [BUN/2.8] Pseudohyponatremia - Precise answer shift of H2O from ICF to ECF Sosm is hypertonic (>280) due to presence of another effective osmol Mannitol, prostate resection, hyperglycemia artifact of hyperlipidemia/hyperproteinemia (multiple myeloma) (calculated Na will appear low) hyponatremia with hypotonicity - Precise answer "true hyponatremia" most common form usually caused by renal water excretion in the presence of continued water intake calculation for corrected serum sodium - Precise answer G= (pt. glucose - 100)/100 (1.6 mEq/L x G) + (serum sodium) Examples of edema caused by decreased capillary oncotic pressure - Precise answer -cirrhosis, malnutrition (decreased synthesis of plasma proteins) -nephrotic syndrome (increased loss of plasma proteins) -Increased plasma Na and H2O retention (dilution of plasma proteins) examples of edema caused by increased capillary permeability - Precise answer -burns -inflammation -neoplastic disease -allergic reactions -infection loss of plasma proteins to interstitial space leading to increased tissue oncotic pressure examples of edema caused by increased capillary hydrostatic pressure - Precise answer -venous obstruction -salt and water retention -heart failure fluid movement into tissue leading to edema how does lymph obstruction cause edema - Precise answer decreased transport of capillary filtered protein leading to increased tissue oncotic pressure leading to edema how does sodium and water retention contribute to edema - Precise answer if the depletion of the intravascular volume stimulates the renin- angiotensin-aldosterone system, the increase in sodium retention and water also adds to edema by further increasing hydrostatic pressure localized edema - Precise answer limited swelling to site of trauma ex sprained finger, injury, cerebral edema, pulmonary edema, pleural effusion, ascites generalized edema - Precise answer is an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such as cardiac, renal or liver failure dependent edema - Precise answer Swelling in the part of the body closest to the ground, caused by collection of fluid in the tissues; a possible sign of congestive heart failure. problems with edema - Precise answer -accumulation of fluid increases distance for nutrients, oxygen, and wastes to move between capillaries and cells in the tissues -diminishes capillary blood flow leading to ischemia -wounds heal more slowly -risk for pressure ulcers increases -edematous fluid is trapped in third space, dehydration can develop normal ranges of pH, PaCO2, and HCO3 - Precise answer 7.35 - 7.45 35 - 45 22 - 26 etiology of metabolic acidosis - Precise answer -primary loss of bicarbonate from the body (usually GI or renal) -an increase in the production or addition of metabolic acids (not carbonic acid) -decrease in acid excretion causes of metabolic acidosis related to increased non-carbonic acids (elevated anion gap) - Precise answer -overproduction of ketoacidosis (diabetes, alcohol excess, stavation -lactic acidosis (shock) -ingestions -advanced renal failure -distal renal tubule acidosis clinical manifestations of respiratory alkalosis - Precise answer dizziness confusion tingling convulsions coma deep and rapid respirations carpopedal spasm and other symptoms of hypocalcemia diagnostics of respiratory alkalosis - Precise answer PaCO2 < 35 pH > 7.44 what is the anion gap - Precise answer Concentration of anions (Cl and HCO3) to cations (Na and K) in the ECF, by rule, the concentrations should be relatively equal relationship of anion gap and metabolic acidosis - Precise answer - metabolic acidosis is characterized as either normal anion gap metabolic acidosis or elevated anion gap metabolic acidosis -MA elevated gap - we know abnormal anions -MA normal gap - we know that the cause is loss of bicarbonate What are the causes of elevated anion gap in metabolic acidosis - Precise answer P - paraldehyde L - lactic acidosis U - uremia M - Methanol S - Salicylates E - Ethanol E - Ethylene Glycol D - DKA S - Starvation calculate the anion gap - Precise answer AG = (Na + K) - (Cl + HCO3) relationship between metabolic alkalosis and hydrogen - Precise answer - bicarb generation is coupled with hydrogen secretion -increase in bicarb can be due to loss of hydrogen ions - usually from GI losses or shift from ECF to ICF explain buffers in metabolic acidosis - Precise answer -buffer systems compensate for excess acid and attempt to maintain pH. -H+ into cell, K+ out -acidosis severe then buffers depleted cannot compensate and pH continues to decrease -there is also an increase in Ca because acidosis decreases the amount of Ca bound to albumin What is compensation in ABG's - Precise answer -metabolic (renal) and respiratory (pulmonary) counter adjustments to try to fix pH imbalance in ABG's ex. metabolic alkalosis means high bicarb, respiratory will try to compensate by retaining CO2 into blood partial compensation - Precise answer systemic arterial blood pH is still lower than 7.35 example - respiratory acidosis, renal system tries to balance by reabsorbing bicarb (bc high bicarb will raise pH) but is not enough to reach WDL full compensation - Precise answer pH is normal, pCO2 and HCO3 are abnormal 3 pathophysiolgical types of AKI - Precise answer prerenal intrarenal (intrinsic) postrenal nonoliguria vs oliguria vs anuria - Precise answer nonoliguria - daily volume >500 oliguria - daily volume <500 anuria <100 prerenal AKI etiologies - Precise answer -hypovolemia -hemorrhagic blood loss (trauma, GI bleeding, complications of childbirth) -loss of plasma volume (burns, peritonitis) -water and electrolyte losses (severe vomiting, diarrhea, obstruction, diabetes, diuretics) -hypotension or hypoperfusion -septic shock -cardiac failure -massive pulmonary embolism -stenosis -increased intraabdominal pressure intrarenal AKI etiologies - Precise answer -acute tubular necrosis -glomerulopathies -acute interstitial necrosis (tumors or toxins) -vascular damage -malignant HTN, vasculitis -coagulation defects -renal artery/vein occlusion -bilateral acute pyelonephritis postrenal AKI etiologies - Precise answer -obstructive uropathies (usually bilateral - fibrosis) -ureteral destruction (edema, tumors, stones, clots) -bladder neck obstruction (enlarged prostate) -neurogenic bladder how does urinary sediment differentiate prerenal, intrarenal (glomerulonephritis), intrarenal (ATN), and postrenal AKI - Precise answer normal - bland prerenal - bland intrarenal (G) - active (hallmark) intrarenal (ATN) - muddy brown casts, renal tubular epithelial cells postrenal - bland how does urine sodium differentiate prerenal, intrarenal (glomerulonephritis), intrarenal (ATN), and postrenal AKI - Precise answer normal - 20 mEq/L prerenal - <10 mEq/L intrarenal (G) - <20 mEq/L intrarenal (ATN) - >40 mEq/L postrenal - usually low how does urine osmolality differentiate prerenal, intrarenal (glomerulonephritis), intrarenal (ATN) - Precise answer normal - 300 - 900 mOsm prerenal - > 500 mOsm (high) intrarenal (G) - > 500 mOsm macula densa cells of diatal tubule in JGA sense changes in flow rate - intiates signal to compensate changes in afferent arteriolar resistance and GFR identify and rank the major causes of CKD - Precise answer 1 - diabetes mellitus - causing diabetic nephropathy 2 - hypertension 3 - glomerulonephritis 4 - cystic kidney disease CKD - Precise answer Chronic kidney disease (rising BUN and serum creatinine levels affect many body systems) GFR <60 for at least 3 months Stage 1 CKD - Precise answer GFR >90 symptoms - usually none, HTN common stage 2 CKD - Precise answer GFR 60-89 increased PTH, early bone disease, increased plasma creatinine in urea symptoms - subtle HTN stage 3 CKD - Precise answer GFR 30-59 erythropoeitin deficiency, anemia, increased plasma creatinine in urea symptoms - mild HTN stage 4 CKD - Precise answer GFR 15-29 increase in triglycerides, metabolic acidosis, hyperkalemia, salt and water retention, increased plasma creatinine in urea symptoms - moderate HTN, hyperphosphatemia, anemia stage 5 CKD - Precise answer GFR <15 end stage, kidney failure uremia symptoms - severe HTN, hyperphosphatemia, anemia renal osteodystrophy - Precise answer decrease in renal function, decrease in vitamin D, which will decrease serum calcium and increase serum phosphorus - PT gland is stimulated to release PTH and elevated PTH causes bone disease kidneys and anemia - Precise answer the kidneys can sense hypoxia/anemia, and incrase endogenous erythropoietin production, which acts in the bone marrow to produce new RBCs if the kidney is failing, this does not work - anemia - kidneys cannot compensate by producing erythropoietin and cannot make new RBCs signs and symptoms and abnormal labs of nephrotic syndrome - Precise answer proteinuria >3.5g/day hypoalbuminemia <3.5g edema - reatining Na/H20 - causes low albumin hypercholestorlemia lipiduria vit d deficiency hypothyroidism urine sediment contains large amount of proteins