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NR 507 midterm LATEST ACTUAL EXAM WITH QUESTIONS AND CORRECT VERIFIED ANSWERS|GRADED A+|GUARANTEED 100% PASS Hypersensitivity: Type 1 - CORRECT ANSWER--Mediated IgE
- inflammation due to mast cell degranultion
- anaphylactic, asthma, hay fever treatment: epinephrine Hypersensitivity: Type 2 - CORRECT ANSWER--Cytotoxic reaction: tissue specific
- binds to the antigen ON THE CELL SURFACE
- macrophages are primary effectors cells involved cause tissue damage or alter function Hypersensitivity 2 - CORRECT ANSWER--Graves Disease (hyperthyroidism) - alters function not destroy
- blood transfusions reaction- transfused erythrocytes are destroyed by agglutination or lysis
- drug allergies
- hemolytic anemia Hypersensitivity: type 3 - CORRECT ANSWER--Not organ specific
- antibody binds to soluble antigen OUTSIDE THE CELL SURFACE that was released into the blood or bodily fluids, and the complex is then deposited in the tissues
Hypersensitivity: Type 3 - CORRECT ANSWER--rheumatoid arthritis
- Systemic Lupus Erythematosus (SLE)
- Raynaud's Hives (urticaria) - CORRECT ANSWER-Hypersensitivity Type 1 First responders to innate the immune system - CORRECT ANSWER-Neutrophils Allergic contact dermatitis - CORRECT ANSWER-Hypersensitivity Type IV Type 2 cytotoxic hypersensitivity mediated by: - CORRECT ANSWER--IgG IgM
- macrophages are primary effort cells
Serum Sickness - CORRECT ANSWER-type 3 hypersensitivity Hypersensitivity IV, - CORRECT ANSWER--is more of a delayed immune response.
- mediated T-cells attack tissue directly (no antibodies) Autoimmune - CORRECT ANSWER--diseases in which the body makes antibodies directed against its own tissues
Primary immunodeficiency - CORRECT ANSWER--Genetic; inherited
- result of single gene defects
- B and T cell deficiencies secondary immunodeficiency - CORRECT ANSWER--acquired
___ measures the average size of RBCs - CORRECT ANSWER-MCV Anemia occur by... - CORRECT ANSWER--impaired RBC production
- excessive blood loss
- increased RBC production microlytic anemia is characterized by hyper chromic RBS: - CORRECT ANSWER-Hereditary spherocytosis Anemia - CORRECT ANSWER--"without blood" 4.7-6.1mcl - CORRECT ANSWER-Normal for men RBC 4.5-5.2mcL - CORRECT ANSWER-Normal for women RBC 13.5-17.5 - CORRECT ANSWER-Normal hemoglobin for men 12.0-15.5 g/dL - CORRECT ANSWER-Normal hemoglobin for women RBC - CORRECT ANSWER-The number of erythrocytes in 1 cubic mm of whole blood Hemoglobin (Hgb) - CORRECT ANSWER-The oxygen-carrying pigment of red cells Hematocrit (Hct) - CORRECT ANSWER-The volume of cells as a % of total volume of cells and plasma in whole blood 42 - 45% - CORRECT ANSWER-Normal for HCT for men
37 - 48% - CORRECT ANSWER-Normal HCT for women Mean Cell Volume (MCV) - CORRECT ANSWER-Measures the average size of the RBC 80 - 100 fL - CORRECT ANSWER-Normal MCV RDW (red cell distribution width) - CORRECT ANSWER-Estimate of the uniformity of individual cell size 11.5- 14.5% - CORRECT ANSWER-Normal RDW Microcytic (MVC <80fL) - CORRECT ANSWER-Iron deficiency Microcytic (MVC <80fL) less than - CORRECT ANSWER-Sideroblastic Microcytic (MVC <80fL) - CORRECT ANSWER-Thalassemia Microcytic (MVC <80fL) - CORRECT ANSWER-Anemia of chronic disease Normocytic (MVC 80-99) - CORRECT ANSWER-Anemia of inflammation and chronic disease Normocytic (MVC 80-99) - CORRECT ANSWER-Hereditary spherocytosis Normocytic (MVC 80-99) - CORRECT ANSWER-G6PD deficiency Normocytic (MVC 80-99) - CORRECT ANSWER-Paroxysmal nocturnal hemglobinuria Macrocytic (MVC >100) greater than - CORRECT ANSWER-B12 deficiency (pernicious anemia)
Lack of intrinsic factor causes - CORRECT ANSWER-pernicious anemia Folic acid is essential for the body because - CORRECT ANSWER-It plays a role in maturing of RBCs Liver disease causes - CORRECT ANSWER-Non-megaloblastic anemia Macrocytic Anemia's - CORRECT ANSWER--MCV larger than 100.
- megaloblastic and non-megaloblastic megaloblastic anemia (macrocytic) - CORRECT ANSWER-Folate deficiency and vitamin b- 12 deficiency Non-megaloblastic anemia (macrocytic) - CORRECT ANSWER--Liver disease, myelodsplastic syndrome, hemorrhage Manifestations of Macrocytic Anemia's - CORRECT ANSWER--fatigue
- dyspnea - loss of appetite and weight
- diarrhea
- pallor B12 definitely (pernicious anemia) - CORRECT ANSWER--Autoimmune destruction of intrinsic factor
- peripheral neuropathy
- treatment: injections risk: vegetarians, elderly, h-pylori infection
Folate deficiency anemia - CORRECT ANSWER--lack of folate leading to premature RBC death... caused by dietary deficiency
- ferritin level normal
- alcoholics, pregnancy, anticonvulsant meds folic acid foods - CORRECT ANSWER-peas beans veggies liver seeds orange juice fortified bread cereal rice pernicious anemia labs - CORRECT ANSWER--Normal or low - folate
- MCHC is normal
- elevated MCV Folate deficiency labs - CORRECT ANSWER-macrocytic. (increased MCV) low RBC count. decreased folate. hemolytic anemia - CORRECT ANSWER--destruction of lysis of RBCs due to enzymes or toxins produced by infectious agent , chemical release medication, effects of drugs Incorrect blood transfusions - type 2 hypersensitivity hemolytic anemia labs - CORRECT ANSWER-RBC normal size, reticulocyte count is high Aplastic anemia labs - CORRECT ANSWER-RBC normal, reticulocyte count low Blood loss anemia - CORRECT ANSWER--Acute: GI bleed, trauma, labor
- Chronic: GI bleed, deplete iron stores can result in iron deficiency anemia aplastic anemia - CORRECT ANSWER-"Without" =plasa of cell growth
- chemical- chemo
- many possible genetic mutations
- single or muitlple amino changes on alpha and beta chains Manifestations of Sickle cell - CORRECT ANSWER--Involves single Amino acid change on the betachai
- Increased RBC hemoglobin S concentration, dehydration, acidosis, hypoxemia
- have a cute painful episodes Manifestation of thalassemia - CORRECT ANSWER--May have possible genetic mutations
- ineffective erythropoiesis
- occurs and people from south east Asia and China Patho of heart failure - CORRECT ANSWER-*less cardiac output
- Heart tries to compensate for not pumping an adequate amt of blood
- Increased heart rate
- Blood vessels dilate
- Heart hypertrophy
- Right side triggered by MI or lung dx
- Vascular resistance
- Greater O2 demand
- Cells become hypoxic Heart failure overtime causes....resulting in increase preload - CORRECT ANSWER--decreased contractility
- decreased stoke volume
- increase left ventricular end-diastolic volume (LVEDV) Long-standing cause of heart failure - CORRECT ANSWER-Hypertension
Flow of the heart: - CORRECT ANSWER-Inferior/Superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi lunar valve, pulmonary arteries, (deox), lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic semi lunar valve, aorta, (oxy) Flow of the heart - CORRECT ANSWER-a. Right Atrium, Right Ventricle, Pulmonary Arteries, Lungs, Pulmonary Veins, Left Atrium, Left Ventricle, Aorta right sided heart failure manifestations - CORRECT ANSWER-1. Jungular Vein Distention
- Ascending Dependent Edema
- Weight Gain
- Hepatomegaly (Liver Enlargement
- cor pulmonale right sided heart failure - CORRECT ANSWER-Right sided heart failure can occur due to left sided heart failure due to the back up of the fluid from the left side of the heart Preload - CORRECT ANSWER--volume of blood in ventricles at end of diastole
- Amount of venous blood returning to the ventricles door and diastole
- The amount of blood in the left Ventricle after systole
- can cause a backflow of blood causing heart failure Afterload - CORRECT ANSWER--the amount of resistance to ejection of blood from the ventricle
- Elevated afterload results in increased ventricular workload and hypertrophy of the myocardium Stroke volume - CORRECT ANSWER--The amount of blood ejected from the heart in one contraction. (Systole)
- super vena cava (preload)
- pulmonary artery afterload Left HF involves - CORRECT ANSWER--Left ventricle
- pulmonary vein (preload)
- aorta (afterload) Stage A HF - CORRECT ANSWER-Patient at risk for heart failure who have not yet developed structural heart changes (those with diabetes, those with coronary disease without prior infarct) Stage B HF - CORRECT ANSWER-Patients with structural heart disease reduce ejection fraction (left ventricular hypertrophy chamber enlargement) who have not yet developed symptoms of heart failure
- structural heart damage, but no damage Stage C HF - CORRECT ANSWER-Patients you have developed clinical heart failure
- symptomatic Stage D HF - CORRECT ANSWER-Patients with refractory heart failure that require advance intervention
- example the need for bio
- ventricular pacemaker left ventricular assist device or a heart transplant Class I HF - CORRECT ANSWER-No limitation of physical activity Class II HF - CORRECT ANSWER--Slight limitation of physical activity
- Patient is comfortable at rest but ordinary physical activity results and symptoms of HF
Class 111 HF - CORRECT ANSWER--There is marked limitation of physical activity
- the patient is comfortable at rest but less than ordinary activity causes symptoms of HF Class IV HF - CORRECT ANSWER-The patient is unable to carry on any physical activity without symptoms of HF or they have symptoms of HF at rest Transition of stages of HF: - CORRECT ANSWER--Once a stage has been reached the person can ever go back to the prior stage
- the damage of the heart cannot be reversed Transition of classes in HF - CORRECT ANSWER-The patient may move between classes one and four as symptoms can be improved through treatment wand medications Manifestations of Right HF - CORRECT ANSWER--Jugular vein distention
- heptatosplenomegal
- peripheral Edema
- cor pulmonale tricuspid valve damage Left HF manifestations - CORRECT ANSWER--Increase left ventricular afterload
- decrease ejection fraction
- increased left ventricular preload
- pulmonary edema
- Dyspnea CAD - CORRECT ANSWER-Long-standing atherosclerosis aortic stenosis murmur - CORRECT ANSWER-Mid-systolic crescendo-decrescendo heard loudest at the base and radiating to the neck
- SOB on activity, tachycardia, JVD, crackles
- EKG shows a-fib and left atrial hypertrophy Obstructive Disease - CORRECT ANSWER-characterized by an increase in resistance to airflow from the trachea and larger bronchi to the terminal and respiratory bronchioles Reduction of FEV1/FVC ratio - CORRECT ANSWER-Chronic asthma OBSTRUCTIVE PFT Diagnosis used for chronic bronchitis - CORRECT ANSWER--FEV1 will be decreased (obstructive)
- increased TLC simple spirometry measures - CORRECT ANSWER--Exhaled flow rates that include: - title volume
- vital capacity
- FEV forced vital capacity - CORRECT ANSWER--the maximum amount of air that can be removed from the lungs during forced expiration
- normal lungs should exhale 80% of the FVC Restrictive Disease spirometry results - CORRECT ANSWER--FEV1, FVC, TLC are reduced
- FEV1/FVC ratio is normal Steps to analyze pulmonary function test - CORRECT ANSWER-1.Determine the pattern 2.Determine the severity 3.Bronchodilator response
FEV1/FVC ratio - CORRECT ANSWER-Determines if it's obstructive of restrictive FEV1/FVC ratio of ___% or less determines obstructive - CORRECT ANSWER--70% FEV1/FVC ratio of greater than ___% determines restrictive - CORRECT ANSWER-70% TLC is greater than __% in restrictive - CORRECT ANSWER--80%
- 80 - 120% represents a normal range Obstructive pattern measurements: - CORRECT ANSWER--FVC- decreased or normal
- FEV1 - decreased
- FEV1/FVC ratio: less than 70%
- TLC: greater than 120 represents hyperinflation Restrictive pattern measurements - CORRECT ANSWER-FVC: decreased
- FEV1: decreased
- FEV1/FVC ratio: normal or greater 70%
- TLC: 80% Determining the severity: mild - CORRECT ANSWER->70% Determining the severity: moderate - CORRECT ANSWER- 60 - 70% Determining the severity: Moderately Severe - CORRECT ANSWER- 50 - 60% Determining the severity: severe - CORRECT ANSWER- 35 - 50% Determining the severity: Very severe - CORRECT ANSWER-<35%
GOLD criteria for COPD: stage 3: severe FEV1 % predicted - CORRECT ANSWER- 30 - 50% GOLD criteria for COPD: stage 4: very severe FEV1 % predicted - CORRECT ANSWER-Less than 30% Emphysema - CORRECT ANSWER--hyperinflation of air sacs with destruction of alveolar walls (damage occurs in the airway, but the aveloi
- air trapping
- purses lip breathing
- barrel chest Chronic Bronchitis definition - CORRECT ANSWER--Bronchial inflammation hypersecretion of mucus and chronic productive cough that persist for at least three consecutive months for at least two successful years Result of chronic bronchitis - CORRECT ANSWER--Excessive mucus production accumulation
- hypertrophy of bronchial smooth muscles
- hypertrophy and hyperplasia of chronic bronchial mucus producing cells
- airflow obstruction
- and decreased alveolar ventilation
- (irreversible) Manifestations of chronic bronchitis - CORRECT ANSWER--Productive and purulent cough
- copious sputum production
- Dyspnea
- wheezing
- rhonchi
- cyanosis of the skin and mucous membranes
- and peripheral edema
Patho of chronic bronchitis - CORRECT ANSWER-Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. chronic low oxygen - CORRECT ANSWER--The kidneys compensate by increasing secretion of a erythropoietin the primary hormone results for simulating red blood cell production
- As a result of increased red blood cells production the patient with chronic bronchitis exhibits in elevated hematocrit can develop secondary polycythemia Vera.
- This increase in red blood cells causes strain on the pulmonary and cardiovascular system causing pulmonary hypertension due to vasoconstriction
- causes right sided heart failure or cor pulmonale Asthma s/s common to both instrinsic and extrinsic: - CORRECT ANSWER-Wheezing Extrinsic asthma is - CORRECT ANSWER--Triggered by an allergic reaction
- elevated IgE
- more common in children Intrinsic asthma is - CORRECT ANSWER--triggered by non-allergic factors
- no elevation in IgE
- more common in adults less than 40 years of age Wheezing occurs at - CORRECT ANSWER--The end of expiration
- improves after bronchodilator use Asthma occurs at __% FEV1/FVC - CORRECT ANSWER- 70 Gold standard test for asthma - CORRECT ANSWER-Methacholine Challenge test
