Anatomy and Physiology Test Bank, Exams of Nursing

Download Anatomy and Physiology Test Bank and more Exams Nursing in PDF only on Docsity! Systemic Signs of Disease Introduction to Pathophysiology Definition of Pathophysiology Pathophysiology involves the study of functional or structural changes resulting from disease processes. It examines the abnormal physiological processes that occur in disease states. Homeostasis Homeostasis refers to the maintenance of a stable internal environment within the body. It is the body's ability to regulate and maintain various physiological parameters, such as temperature, pH, and blood pressure, within a normal range. Causes of Cell Injury or Death Cells can be injured or killed by various factors, including: Excessive pressure on a tissue Lack of oxygen (hypoxia or ischemia) Radiation Chemical toxins Cellular Adaptations Cellular adaptations are changes in the size, shape, and function of cells in response to changes in their environment. These adaptations include: Hypertrophy: Increase in cell size Atrophy: Decrease in cell size Hyperplasia: Increase in the number of cells Metaplasia: Change in the type of cells present in a tissue Dysplasia: Abnormal cell growth and differentiation Manifestations of Disease The manifestations of a disease refer to the signs and symptoms that indicate the presence of a disease. These include: Subjective feelings of discomfort (symptoms) Objective physical findings (signs) Systemic signs, such as fever 1. 2. 3. 4. 1. 2. 3. 4. 5. 1. 2. 3. Etiology and Prognosis Etiology is the study of the causes of a disease. Prognosis is the predicted outcome or likelihood of recovery from a specific disease. Iatrogenic Diseases and Preventive Measures Iatrogenic diseases are unwanted effects of a prescribed drug or medical treatment. Preventive measures, such as the routine application of sunblock, can help reduce the risk of certain diseases. Precipitating Factors and Epidemiology Precipitating factors are circumstances that cause a sudden acute episode of a chronic disease to occur. Epidemiology is the science of tracking the occurrence and distribution of diseases. Conclusion This document provides a comprehensive overview of the key concepts and principles related to the introduction to pathophysiology, as outlined in the original text. It covers the definition of pathophysiology, the role of homeostasis, causes of cell injury or death, cellular adaptations, manifestations of disease, etiology and prognosis, iatrogenic diseases and preventive measures, and the concepts of precipitating factors and epidemiology. Fluid, Electrolyte, and Acid-Base Imbalances Body Water and Fluid Compartments Healthy adult male body contains approximately 60% water by weight. Blood makes up about 4-8% of total body weight. Insensible fluid loss refers to water lost through perspiration and expiration. Increased osmotic pressure in the blood causes water to shift from the interstitial compartment into the blood. Decreased plasma proteins result in decreased osmotic pressure, causing fluid to shift out of the blood. Increased capillary permeability can lead to edema. Elevated hematocrit is associated with fluid deficit. Dehydration is characterized by rough oral mucosa. Third-spacing refers to a combination of decreased circulating blood volume and excess fluid in a body cavity. Sodium is the primary cation in the extracellular fluid. 1. 2. 1. 2. 1. 2. • • • • • • • • • • Generic Drug Names The generic name of a drug is the unique, simple, and official name assigned to a specific drug for worldwide use. Routes of Drug Administration The route of administration by which the largest proportion of the drug dose is likely lost before reaching the site of action is the oral route. Drug Interactions When two drugs interact to produce a result much greater than the sum of their individual effects, this is known as synergism. Drug Metabolism and Excretion Most drugs are metabolized and prepared for excretion primarily in the liver. Acupoints in Traditional Asian Medicine In traditional Asian medicine, acupoints are usually located on designated meridians. Integrative Medicine Osteopaths incorporate traditional drug or surgical therapy with nontraditional methods. Contraindications Contraindications printed on a drug label identify the circumstances under which the drug should probably not be used. Drug Excretion After they are metabolized, most drugs are excreted through the kidneys. Drug-Receptor Interactions A drug that binds with selected specific cell receptors may: Stimulate activity in those cells. Inhibit activity in those cells. Placebo A placebo is a tablet or capsule that does not contain an active drug. 1. 2. Physiotherapy Physiotherapy involves the assessment of physical function and the use of methods such as appropriate exercises and ultrasound to restore any problems and prevent further dysfunction. Medical History A medical history should include all legally prescribed drugs, over-the- counter drugs, herbal/natural products, and any recreational drugs. Antagonistic Drugs Antagonistic drugs may be used to act as an antidote when necessary. Antimicrobial Drug Therapy The full course of a prescribed antimicrobial drug should be completed to prevent the development of resistant microbes. Pain Acute Pain Transmission Impulses related to acute pain are usually transmitted by myelinated A delta fibers. Pain Impulse Ascension Pain impulses ascend the spinal cord through the spinothalamic tract. Gate-Control Theory of Pain According to the gate-control theory, passage of pain impulses may be naturally blocked at the synapse by the entry of other sensory impulses. Pain Tolerance Pain tolerance refers to the degree of pain that is endured before an individual takes action. Pain-Relieving Mechanisms Opiate-like blocking agents in the central nervous system can help relieve pain. Referred Pain Pain perceived in the left arm during a heart attack is an example of referred pain. Headache Types A headache related to changes in cerebral blood flow is classified as a migraine headache. Analgesic Medications Codeine is a common analgesic administered to control a moderate level of pain. Spinal Anesthesia In spinal anesthesia, the drug is injected into the cerebrospinal fluid (CSF) or the epidural space of the spinal cord, blocking the transmission of pain impulses in a small area of the body. Acute vs. Chronic Pain Acute pain is severe but short-term, while chronic pain is associated with depression, debilitation, and lower pain tolerance. Nociceptors Nociceptors are pain receptors that are stimulated by thermal, chemical, or physical means. Intractable Pain Intractable pain is severe pain that cannot be controlled by medication. Infant Pain Response Young infants typically respond to pain with tachycardia and increased blood pressure. NSAID Analgesics Ibuprofen, an NSAID, is particularly useful in treating pain caused by inflammation. Peripheral Analgesic Action Acetaminophen acts to reduce pain at the peripheral site. 3, 2, 5, 1, 4 The correct sequence is 3, 2, 5, 1, 4. Phagocytosis The process of phagocytosis involves the ingestion of foreign material and cell debris by leukocytes, such as macrophages. This helps to clear the area of damaged or infectious material. Systemic Effects of Inflammation Severe inflammation can have systemic effects, including fatigue, anorexia, and mild fever. These symptoms are part of the body's overall response to the inflammatory process. Leukocytosis Leukocytosis refers to an increased number of white blood cells (leukocytes) in the blood. This is a common response to inflammation and infection. Fever Fever results from the release of pyrogens, or fever-inducing substances, into the circulation. This causes the body's temperature regulation mechanisms to be reset to a higher temperature. Mechanisms to Reduce Fever Mechanisms to bring an elevated body temperature down to normal include general cutaneous vasodilation, which increases heat loss from the body. Tissue Repair Replacement of damaged tissue by similar functional cells is termed regeneration. Scar tissue, which consists primarily of collagen fibers, forms where the surrounding cells are incapable of mitosis. Glucocorticoids and Inflammation Glucocorticoids, such as prednisone, are used to treat inflammation because they directly decrease capillary permeability, reducing fluid and protein shift out of the capillaries. 4. Burn Classification A burn area in which the epidermis and part of the dermis is destroyed is classified as a superficial partial-thickness burn. Burn Area Calculation A woman with burns on the anterior surfaces of her right arm, chest, and right leg has approximately 22.5% of her body surface area burned. Burn Wound Infection A typical source of infection in burn areas is microbes surviving in the hair follicles in the burn area. Fluid Shift in Burns Fluid and protein shift out of the blood in large burn areas, leading to decreased blood pressure. Advantages of Biosynthetic Skin Substitutes The advantages of applying a biosynthetic skin substitute to a large area of full-thickness burns include reduced risk of infection, decreased loss of plasma protein and fluid, and more rapid healing. Exudates Purulent exudates usually contain numerous leukocytes, bacteria, and cell debris. A serous exudate is a thin, watery, colorless exudate. Isoenzymes and Inflammation Isoenzymes in the circulating blood can often indicate the precise location of an inflammatory response. Local and Systemic Effects of Inflammation Local effects of a general inflammatory response include redness, warmth, and swelling. Systemic manifestations include fever and malaise. Glucocorticoid Side Effects Prolonged administration of glucocorticoids such as prednisone may cause atrophy of lymphoid tissue and decreased protein synthesis. Ice Application and Edema Application of ice to an injured knee reduces edema by causing local vasoconstriction. Healing of Large Skin Loss Healing of large areas of skin loss (including dermis and epidermis) would be most successful through covering the area with a biosynthetic skin substitute. Inflammatory Mediators Mast cells release mediators such as histamine that cause vasodilation and pain during the inflammatory response. Neutrophils and Inflammation The number of neutrophils in the blood is increased significantly in order to promote phagocytosis during the inflammatory response. Abscess Contents An abscess contains purulent exudate, which is a thick, cloudy secretion containing numerous leukocytes, bacteria, and cell debris. Interferons and Antiviral Protection Interferons are nonspecific agents that protect uninfected cells against viruses during an inflammatory response. Causes of Inflammation Inflammation can be caused by direct physical damage, allergic reactions, and infection. Capillary Exchange and Hydrostatic Pressure In normal capillary exchange, the net hydrostatic pressure is based on the difference between the hydrostatic pressure within the capillary and the hydrostatic pressure in the interstitial fluid. Cardinal Signs of Inflammation The cardinal signs of inflammation include redness, swelling, heat, and pain. Loss of function is also a common sign. Scar Tissue and Obstructions in Tube-like Structures Scar tissue usually causes obstructions to develop in tube-like structures due to the following reason: b. Scar tissue does not stretch, but rather shrinks in time, causing narrowing. As scar tissue forms, it does not have the same elasticity as normal tissue. Over time, the scar tissue contracts and shrinks, leading to a narrowing or obstruction of the affected tube-like structure. Potential Complications of COX-2 Inhibitor Drugs One serious potential complication found only with the anti-inflammatory COX-2 inhibitor drugs is: c. Increased incidence of heart attacks. The use of COX-2 inhibitor drugs has been associated with an increased risk of cardiovascular events, such as heart attacks, compared to other anti- inflammatory medications. Infection Bacterial Morphology and Classification Bacteria that form an irregular cluster of spheres are called staphylococci. A strict anaerobe requires the absence of oxygen. The presence of the bacterial capsule protects the microbe from phagocytosis. Microbial mutation means that genetic information has changed. A bacterial endospore can survive high temperatures and a dry environment. Viral Structure and Replication The structure of a virus includes a protein coat and either DNA or RNA. Viruses use a host cell to produce and assemble their components. A retrovirus such as HIV contains RNA and enzymes for its conversion. Antiviral drugs reduce the rate of viral replication. 1. 2. 3. 4. 5. 1. 2. 3. 4. Fungal and Protozoan Infections Opportunistic fungi are normally not found in large numbers in resident flora. Fungal reproduction involves extension of hyphae and production of spores. Tinea pedis is not classified as a protozoan agent of disease. Rickettsia is a very small gram-negative intracellular microbe. Entamoeba histolytica is transmitted by cysts in feces. Normal Flora and Nosocomial Infections Different species of normal flora inhabit various areas of the body. Urine is normally considered sterile. Nosocomial infection means an infection acquired in a hospital or medical facility. Transmission of microbes by direct contact includes sexual intercourse. An asymptomatic person whose body harbors pathogens and can transmit them to others is considered a carrier. Opportunistic infection may develop when an imbalance occurs in the normal resident flora. Host Resistance and Virulence Factors Chronic respiratory disease would not promote host resistance. Production of interferons would not increase the virulence of a specific microbe. The time when an infected person experiences prodromal symptoms is referred to as the prodromal period. The principle of Universal Precautions is based on assuming that all body fluids from all individuals are possible sources of infection. The incubation period refers to the time period between entry of the pathogen into the body and the first signs of infectious disease. Infection Progression and Diagnosis Microbes present in the blood is referred to as bacteremia. Pain, erythema, and swelling are local signs of infection. 1. 2. 3. 4. 5. 1. 2. 3. 4. 5. 6. 1. 2. 3. 4. 5. 1. 2. Culturing a specimen is done to identify the causative microbe and the effective antimicrobial agent for it. A broad-spectrum bactericidal agent would be expected to destroy many gram-positive and gram-negative bacteria. Penicillin acts as a bactericidal agent by interfering with cell-wall synthesis. Secondary infection may occur with administration of antibacterial drugs because the balance of species in the resident flora is upset. Interference with attachment to host cell is a mechanism of antiviral drug action, but interference with mitosis is not. Secondary bacterial infections occur frequently during influenza epidemics primarily because the viral infection causes extensive tissue inflammation and necrosis. The primary pathological effect of influenza virus is destruction of the upper respiratory epithelium. The presence of bacterial infection can lead to septicemia. Leucopenia often indicates a viral infection. Chlamydia causes a common sexually transmitted disease. Viruses are classified as obligate intracellular parasites. Influenza virus contains RNA, and there are three subtypes: A, B, C. The widespread necrosis of respiratory mucosa caused by an influenza infection often gives rise to secondary infections. Prions cannot be cultured in a Petri plate of media because they are proteinaceous particles, not living organisms. Influenza A H1N1 contains genetic material from avian, swine, and human viruses. The capacity for opportunism does not directly determine the virulence of a microbe. Interferons increase host cell resistance to viral invasion. Inflamed tissue is likely to become infected because the increased fluid and protein in the inflamed area supports microbial growth. When an infectious disease is occurring globally at a higher rate than usual, it may be designated as a pandemic. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. Hypersensitivity Reactions Type I Hypersensitivity (Immediate Hypersensitivity) This type of reaction occurs when an allergen binds to IgE antibodies on mast cells, resulting in the release of chemical mediators like histamine. Type III Hypersensitivity (Immune Complex Hypersensitivity) This type of reaction occurs when immune complexes (antigen-antibody complexes) deposit in various tissues, leading to inflammation and tissue damage. Type IV Hypersensitivity (Cell-Mediated Hypersensitivity) This type of reaction involves the activation of T cells, which can lead to the destruction of target cells or the recruitment of other immune cells. Confirmation of HIV Infection The Western blot test is commonly used for confirmation of a positive HIV antibody test and ELISA test. Incompatible Blood Transfusions Incompatible blood transfusions can result in the hemolysis (destruction) of erythrocytes (red blood cells). Autoimmune Diseases Autoimmune diseases are characterized by the failure of the immune system to distinguish self from non-self, leading to an abnormal immune response against the body's own tissues. Systemic Lupus Erythematosus (SLE) Systemic lupus erythematosus is an autoimmune disease caused by the deposition of immune complexes containing antinuclear antibodies in various tissues. HIV Infection HIV primarily targets CD4+ helper T lymphocytes, impairing both humoral and cell-mediated immunity. • • • • Opportunistic infections are a hallmark of HIV/AIDS, as the impaired immune system is unable to effectively fight off normally harmless microorganisms. Major Histocompatibility Complex (MHC) MHC proteins are essential for the proper functioning of the immune system, as they play a crucial role in the recognition of self and non- self. A close match of MHC proteins is essential for successful tissue transplants to avoid rejection by the recipient's immune system. Cytokines Cytokines are signaling molecules produced by various cells, including lymphocytes, that play a crucial role in the activation and regulation of the immune response. Seroconversion Seroconversion refers to the development of detectable antibodies against a specific pathogen, such as HIV, in the blood. Tolerance Tolerance refers to the ability of the immune system to ignore self-cells, preventing autoimmune reactions. Complement System The complement system is a group of proteins in the blood that must be activated to participate in the immune response, such as the destruction of pathogens. Immunoglobulins Immunoglobulins, or antibodies, are proteins produced by B lymphocytes that have a unique sequence of amino acids, allowing them to recognize and bind to specific antigens. Infants Born to HIV-Infected Mothers Infants born to HIV-infected mothers test positive for HIV due to the presence of maternal antibodies, not necessarily because the infant is infected. • • • Tissue Transplants Allograft: Tissue transferred between genetically different individuals of the same species. Syngraft: Tissue transferred between genetically identical individuals (e.g., identical twins). Autograft: Tissue transferred from one part of the body to another within the same individual. Skin Conditions Erythematous Ring of Vesicles with a Clear Center This condition is characterized by an erythematous (red) ring of vesicles (small fluid-filled blisters) with a clear center. Firm, Red, Painful Nodule or Pustule This condition presents as a firm, red, and painful nodule (small, solid swelling) or pustule (pus-filled blister). Systemic Effects of Acute Necrotizing Fasciitis Acute necrotizing fasciitis can cause the following systemic effects: Low-grade fever and malaise Toxic shock and disorientation Mild nausea and vomiting Identifying the Cause of Contact Dermatitis The cause of contact dermatitis can often be identified by noting the location and size of the lesion. Pathological Change in Scleroderma The pathological change associated with scleroderma is collagen deposits in the small blood vessels of the skin and sometimes the viscera. Typical Lesion of Impetigo The typical lesion of impetigo is small vesicles that rupture to produce a crusty brown pruritic (itchy) mass. Skin Condition and Usual Location Scabies: Fingers, wrists, waist Impetigo: Legs, feet Pediculosis humanus corporis: Scalp • • • • • • • • • Effect of Osteoarthritis on Healthy Joints Affected joints in osteoarthritis can cause the individual to exert stress on the normal joint to protect the damaged one. Typical Joint Involvement in Rheumatoid Arthritis In rheumatoid arthritis, the bilateral small joints are affected, with a symmetrical progression to other joints. Basic Pathology of Rheumatoid Arthritis Rheumatoid arthritis is a systemic inflammatory disorder due to an autoimmune reaction. Articular Cartilage Damage in Rheumatoid Arthritis In rheumatoid arthritis, the articular cartilage is damaged by enzymatic destruction by the pannus. Joint Appearance During Rheumatoid Arthritis Exacerbation During an exacerbation of rheumatoid arthritis, the joint appears red, warm, swollen, and tender to touch. Development of Ankylosis and Deformity in Rheumatoid Arthritis Ankylosis and deformity develop in rheumatoid arthritis because of fibrosis occurring in the joint. Systemic Effects of Rheumatoid Arthritis The systemic effects of rheumatoid arthritis are manifested as nodules in various tissues, severe fatigue, and anorexia. Effect of Long-Term Glucocorticoid Use in Rheumatoid Arthritis A common effect of long-term use of glucocorticoids to treat rheumatoid arthritis is osteoporosis. Difference Between Juvenile and Adult Rheumatoid Arthritis The difference between juvenile rheumatoid arthritis (JRA) and the adult form is that rheumatoid factor is not present in JRA, but systemic effects are more severe. Distinguishing Feature of Septic Arthritis Septic arthritis is distinguished by the presence of purulent synovial fluid in a single, swollen joint. Precipitating Factor for Gout Attack A sudden increase in serum uric acid levels may precipitate an attack of gout. Inflammation Onset in Ankylosing Spondylitis In ankylosing spondylitis, inflammation usually begins in the sacroiliac joints with progression up the spine. Outcome of Fibrosis, Calcification, and Fusion in Ankylosing Spondylitis The common outcome of fibrosis, calcification, and fusion of the spine in ankylosing spondylitis is kyphosis. Function of Ligaments Ligaments prevent excessive movement of joints. Factors Delaying Bone Fracture Healing Prolonged inflammation and ischemia, as well as the presence of osteomyelitis, can delay the healing of bone fractures. Immediate Result of Fat Emboli from Broken Femur The immediate result of fat emboli from a broken femur is pulmonary inflammation and obstruction. Definition of a Sprain A sprain is a tear in a ligament. Therapeutic Measures for Osteoporosis Dietary supplements of calcium and vitamin D are therapeutic measures for osteoporosis. Distinguishing Feature of Primary Fibromyalgia Syndrome The distinguishing feature of primary fibromyalgia syndrome is the presence of specific trigger points for pain and tenderness. Metastasis of Ewing's Sarcoma Ewing's sarcoma metastasizes at an early stage to the lungs. Definition of Immovable Joints Immovable joints are called synarthroses. Cause of Rickets Rickets results from a deficit of vitamin D and phosphates. Outcome of Paget's Disease Paget's disease often leads to cardiovascular disease. Bones Classified as Irregular Irregular bones would include the wrist bones. Definition of a Dislocation A dislocation is the separation of bones in the joint with a loss of contact. Diagnostic Test for Muscle Disorders An electromyogram is a diagnostic test that measures the electrical charge of muscle contraction and can help differentiate muscle disorders from neurological disease. Type of Compound Fracture with Multiple Fracture Lines A comminuted fracture is the type of compound fracture with multiple fracture lines and bone fragments. Fluid-Filled Sacs Between Tendons and Ligaments The fluid-filled sacs composed of synovial membrane located between structures such as tendons and ligaments and act as additional cushions are called bursae. Reduced Erythrocytes in the Blood Decreased Hematocrit A reduced number of erythrocytes (red blood cells) in the blood would result in a decreased hematocrit. The hematocrit is the percentage of the total blood volume that is occupied by erythrocytes. With fewer erythrocytes, the hematocrit value would decrease. Pernicious Anemia Erythrocyte Characteristics Megaloblastic or Macrocytic Nucleated Cells The characteristic erythrocyte associated with pernicious anemia is the megaloblastic or macrocytic nucleated cell. These large, immature red blood cells are a result of the vitamin B12 deficiency in pernicious anemia. Pernicious Anemia and Peripheral Nerve Demyelination Vitamin B12 Deficit Causing Peripheral Nerve Demyelination The numbness and tingling in the fingers of individuals with untreated pernicious anemia is caused by the vitamin B12 deficit, which leads to peripheral nerve demyelination. Jaundice and Anemia Types Sickle Cell Anemia Jaundice is one typical sign of sickle cell anemia. Jaundice is not a common sign of iron deficiency anemia, aplastic anemia, or acute leukemia. Early Signs and Symptoms of Anemia Pallor, Dyspnea, and Fatigue The typical early general signs and symptoms of anemia include pallor, dyspnea (shortness of breath), and fatigue. Chest pain and palpitations, jaundice and stomatitis, and bradycardia and heat intolerance are not the typical early signs of anemia. Oral Ulcerations and Severe Anemia Deficit of Oxygen for Epithelial Cell Mitosis and Metabolism The cause of oral ulcerations and delayed healing occurring with any severe anemia is the deficit of oxygen for epithelial cell mitosis and metabolism. This oxygen deficit impairs the normal functioning of the oral epithelial cells. Pernicious Anemia Characteristics Hypochlorhydria One of the characteristics present with pernicious anemia is hypochlorhydria, which is a decreased production of hydrochloric acid in the stomach. Pernicious Anemia and Vitamin B12 Injections The Ingested Vitamin Would Not Be Absorbed into the Blood Pernicious anemia is treated with injections of vitamin B12 because the ingested vitamin would not be absorbed into the blood due to the lack of intrinsic factor in the stomach. Pernicious Anemia and Hemoglobin Levels Shorter Life Span of Erythrocytes Abnormally low hemoglobin values develop with pernicious anemia due to the shorter life span of erythrocytes. This is a result of the vitamin B12 deficiency, which impairs the normal maturation and function of red blood cells. Early Signs of Aplastic Anemia Excessive Bleeding and Recurrent Infections The common early signs of aplastic anemia include excessive bleeding and recurrent infections. This is due to the decreased production of all blood cell types, including platelets and leukocytes. Sickle Cell Anemia and Vascular Occlusions Erythrocytes Change to Sickle Shape When Hypoxia Occurs Vascular occlusions and infarcts occur frequently with sickle cell anemia because the erythrocytes change to a sickle shape when hypoxia (low oxygen) occurs, leading to obstruction of blood flow. Sickle Cell Trait Characteristics Sickling of Erythrocytes Occurs with Severe Hypoxia In sickle cell trait, sickling of erythrocytes occurs with severe hypoxia, but painful sickling crises and multiple infarctions do not occur frequently. Thalassemia Cause A Defect in One or More Genes for Hemoglobin Thalassemia is caused by a defect in one or more genes responsible for the production of hemoglobin. This leads to an imbalance in the synthesis of the alpha or beta chains of the hemoglobin molecule. Malabsorption and Pernicious Anemia Pernicious Anemia Pernicious anemia can result from a malabsorption problem, specifically the inability to absorb vitamin B12 due to a lack of intrinsic factor. Pernicious Anemia and Antibody Formation Intrinsic Factor or Parietal Cells In individuals with pernicious anemia, antibodies form to intrinsic factor or parietal cells in the stomach, which are responsible for the production of intrinsic factor. Polycythemia Vera and Blood Pressure Increased Blood Volume In cases of polycythemia vera, blood pressure is elevated as a result of the increased blood volume due to the excessive production of erythrocytes. Petechiae, Purpura, and Increased Bleeding Increased Bleeding Petechiae and purpura are common signs of increased bleeding, which can occur in various blood disorders. Thalassemia Cause Defect in One or More Genes for Hemoglobin Thalassemia is caused by a defect in one or more genes responsible for the production of hemoglobin, leading to an imbalance in the synthesis of the alpha or beta chains. Secondary Polycythemia and Chronic Bronchitis Severe Chronic Bronchitis Secondary polycythemia may be associated with severe chronic bronchitis, which can stimulate the production of erythropoietin and lead to an increase in erythrocytes. Vitamin K Characteristics It is Used as an Antidote for Warfarin (Coumadin) Vitamin K is used as an antidote for the anticoagulant drug warfarin (Coumadin). It is a fat-soluble vitamin, but it is not required by the bone marrow for hemoglobin synthesis. Leukemia and Chromosome Abnormalities Presence of Philadelphia Chromosome Translocation in Acute Myelogenous Leukemia (AML) Leukemia is sometimes linked to chromosome abnormalities, as evidenced by the presence of the Philadelphia chromosome translocation in cases of acute myelogenous leukemia (AML). Iron Deficiency Anemia and Diabetes Mellitus Diabetes Mellitus Iron deficiency anemia does not frequently result from diabetes mellitus. The other factors listed, such as certain vegetarian diets, excessive menstrual flow, and malabsorption syndromes, can contribute to the development of iron deficiency anemia. Leukemia Characteristics Chronic Leukemias are More Common in Older People Chronic leukemias are more common in older people, while acute myelogenous leukemia (AML) is the most common childhood leukemia. Blast Cells and Prognosis in Leukemia Acute Myelogenous Leukemia (AML) A high percentage of blast cells in the leukocyte population indicates a poor prognosis for an individual with acute myelogenous leukemia (AML). Erythropoietin Function It Stimulates Production of Red Blood Cells Erythropoietin is a hormone that stimulates the production of red blood cells (erythrocytes) by the red bone marrow. Hemophilia A Diagnostic Test Prothrombin Time For an individual with hemophilia A, the prothrombin time (PT) would be within the normal range, as this test measures the extrinsic clotting pathway, which is not affected in hemophilia A. Disseminated Intravascular Coagulation It is Usually a Secondary Complication Disseminated intravascular coagulation (DIC) is usually a secondary complication, often triggered by an underlying condition such as sepsis or severe trauma. Pancytopenia and Blood Dyscrasias Aplastic Anemia Pancytopenia, the deficit of all blood cell types, develops in the condition of aplastic anemia. Etiology of Aplastic Anemia Idiopathic in Many Cases and Predisposed by Exposure to Myelotoxins Aplastic anemia is idiopathic (of unknown cause) in many cases, but it can also be predisposed by exposure to myelotoxins (substances that are toxic to the bone marrow). Microcytic and Hypochromic Erythrocytes Iron Deficiency Anemia Microcytic and hypochromic erythrocytes are commonly found as a result of iron deficiency anemia, where the red blood cells are smaller and contain less hemoglobin. Cardiovascular System Disorders Atrioventricular (AV) Valves The atrioventricular (AV) valves close due to increased intraventricular pressure. The normal delay in conduction through the AV node is essential for allowing the ventricles to contract before the atria, completing ventricular filling. Cardiac Output When stroke volume decreases, an increased heart rate can maintain cardiac output. Cardiac output refers to the volume of blood ejected by a ventricle in one minute. Cardiac reserve is the ability of the heart to increase cardiac output when needed. Preload refers to the volume of venous return. Cardiovascular Regulation Baroreceptors signal the cardiovascular control center of changes in systemic blood pressure. Increased secretion of epinephrine results in increased heart rate and force of contraction. Stimulation of the sympathetic nervous system causes increased heart rate. Cardiovascular Anatomy The first arteries to branch off the aorta are the coronary arteries. • • • • • • • • • • Signs of Rheumatic Fever Common signs of rheumatic fever include arthritis, erythematous skin rash, subcutaneous nodules, epistaxis, tachycardia, fever, elevated ASO titer, and leukocytosis. Rheumatic Heart Disease Rheumatic heart disease usually manifests in later years as swollen heart valves and heart murmurs. Infective Endocarditis Septic emboli, a common complication of infective endocarditis, are a result of the fact that vegetations are loosely attached and fragile. Subacute Infective Endocarditis Subacute infective endocarditis is characterized by a microbe of low virulence attacking abnormal or damaged heart valves. Pericarditis Pericarditis causes a reduction in cardiac output as a result of excess fluid in the pericardial cavity, which decreases ventricular filling. Causes of Pericarditis Pericarditis may be caused by infection, abnormal immune responses, or other factors. Embolus Causing Brain Obstruction A source of an embolus causing an obstruction in the brain could be the carotid artery. Essential Hypertension The basic pathophysiological change associated with essential hypertension is increased systemic vasoconstriction. Effects of Uncontrolled Hypertension Uncontrolled hypertension is most likely to cause ischemia and loss of function in the kidneys, brain, and retinas of the eye. Diagnosis of Essential Hypertension A diagnosis of essential hypertension is likely to be considered in young or middle-aged individuals when blood pressure remains consistently above 140/90. Peripheral Vascular Disease Atherosclerosis in the iliac or femoral arteries is likely to cause gangrenous ulcers and red, swollen legs. Intermittent Claudication The term intermittent claudication refers to ischemic muscle pain in the legs, particularly with exercise. Amputation in Peripheral Vascular Disease The primary reason for amputation of gangrenous toes or feet in patients with peripheral vascular disease is to prevent the spread of infection and reduce pain. Echocardiogram An echocardiogram is used to demonstrate any abnormal movement of the heart valves. Friction Rub A friction rub is associated with pericarditis. Dissecting Aortic Aneurysm A dissecting aortic aneurysm develops as a tear in the intimal lining, which allows blood flow between layers of the aortic wall. Outcome of Aortic Aneurysms The outcome for many aortic aneurysms is rupture and hemorrhage. Varicose Veins in Pregnancy The factor that predisposes to varicose veins during pregnancy is compressed pelvic veins. Phlebothrombosis and Pulmonary Emboli Phlebothrombosis is more likely to cause pulmonary emboli than is thrombophlebitis because the thrombus forms in a vein and is less firmly attached. Shock Shock is defined as decreased circulating blood and tissue perfusion. Shock Following Myocardial Infarction Shock follows a myocardial infarction when heart valves are damaged. Early Signs of Circulatory Shock The early signs of circulatory shock include loss of consciousness and rapid, strong pulse. Compensation for Shock A compensation for shock would include increased heart rate and oliguria. Anaphylactic Shock and Hypoxia Anaphylactic shock causes severe hypoxia very quickly due to bronchoconstriction and bronchial edema, which reduce airflow. Neurogenic (Vasogenic) Shock Neurogenic (vasogenic) shock results from systemic vasodilation due to increased capacity of the vascular system and reduced venous return. Effects of Prolonged Shock A prolonged period of shock is likely to cause damage to and increased permeability of pulmonary capillaries. Decompensated Acidosis in Shock Decompensated acidosis related to shock would be indicated by a serum pH below the normal range. Metabolic Changes in Shock With shock, anaerobic cell metabolism and decreased renal blood flow cause metabolic acidosis. Shock in Severe Burns Shock develops in patients with severe burns as a result of pain and loss of plasma. a. Reduce renin and aldosterone secretion. b. Slow the heart rate. c. Strengthen myocardial contraction. d. Block arrhythmias. ANS: A REF: 250 Ventricular Septal Defect In a child with ventricular septal defect, the altered blood flow: a. Leads to increased stroke volume from the left ventricle. b. Results in unoxygenated blood in the systemic circulation. c. Is called a right-to-left shunt. d. Is called a left-to-right shunt. ANS: D REF: 252-253 Acute Rheumatic Fever In a child with acute rheumatic fever, arrhythmias may develop due to the presence of: a. Endocarditis. b. Myocarditis. c. Pericarditis. d. Congestive heart failure. ANS: B REF: 256 Prophylactic Antibiotics Prophylactic antibacterial drugs such as amoxicillin are given to patients with certain congenital heart defects or damaged heart valves immediately before invasive procedures to prevent: a. Formation of septic thrombi. b. Infectious endocarditis. c. Abscess formation. d. Myocarditis. ANS: B REF: 257 Varicose Ulcers Varicose ulcers may develop and be slow to heal because: a. Leg muscles are painful, restricting movement. b. Edema reduces arterial blood supply to the area. c. Emboli form in damaged veins, leading to local ischemia. d. Valves in veins restrict blood flow. ANS: B REF: 264 Pericardial Effusion Excessive fluid in the pericardial space causes: a. Increased cardiac output. b. Myocardial infarction. c. Reduced venous return. d. Friction rub. ANS: C REF: 258 Aortic Stenosis Aortic stenosis means the aortic valve: a. Allows blood to leak back into the left ventricle during diastole. b. Cannot fully open during systole. c. Functions to increase stroke volume. d. Does not respond to the cardiac cycle. ANS: B REF: 251 Septic Shock Septic shock is frequently caused by infections involving: a. Gram-negative endotoxin-producing bacteria. b. Spore-forming saprophytic fungi. c. Free-swimming, motile parasitic protozoa. d. Parasitic nematodes. ANS: A REF: 265 Respiratory System Disorders Lung Mechanics What happens in the lungs when the diaphragm and external intercostal muscles relax? a. Air is forced out of the lungs. b. Lung volume increases. c. Intrapulmonic pressure decreases. d. Intrapleural pressure decreases. ANS: A REF: 275 Respiratory Mucosa The respiratory mucosa is continuous through the: Upper and lower respiratory tracts. Nasal cavity and paranasal sinuses. Middle ear cavity and auditory tube. Larynx, trachea, and bronchi. ANS: E REF: 273-274 Respiratory Muscle Contractions Which of the following activities does NOT require muscle contractions and energy? 1. 2. 3. 4. a. Quiet inspiration b. Forced inspiration c. Quiet expiration d. Forced expiration ANS: C REF: 275 Vital Capacity The maximum volume of air a person can exhale after a maximum inspiration is termed the: a. Expiratory reserve volume. b. Inspiratory reserve volume. c. Total lung capacity. d. Vital capacity. ANS: D REF: 276-277 Pulmonary Artery Blood Which of the following applies to the blood in the pulmonary artery? a. PO2 is low. b. Hydrostatic pressure is very high. c. It is flowing into the left atrium. d. It is flowing into the right ventricle. ANS: B REF: 279 Respiratory Control Which of the following can stimulate increased respiratory rate? a. Epinephrine b. Histamine c. Parasympathetic nervous system d. Drugs that block β2-adrenergic receptors ANS: A REF: 302 Central Chemoreceptors The central chemoreceptors in the medulla are normally most sensitive to: a. Low oxygen level. b. Low concentration of hydrogen ions. c. Elevated oxygen level. d. Elevated carbon dioxide level. ANS: D REF: 277 Oxygen Diffusion Oxygen diffuses from the alveoli to the blood because: a. PO2 is higher in the blood. b. PO2 is lower in the blood. c. CO2 is diffusing out of the blood. d. More CO2 is diffusing out of cells into the blood. ANS: B REF: 278 ANS: B REF: 282 Rales Light bubbly or crackling breathing sounds associated with serous secretions are called: a. Rhonchi. b. Stridor. c. Rales. d. Wheezing. ANS: C REF: 282 Laryngotracheobronchitis Choose the correct information applying to laryngotracheobronchitis: a. Viral infection in infant under 12 months b. Viral infection in child, 3 months to 3 years c. Bacterial infection in infant under 6 months d. Bacterial infection in child, 3 to 7 years ANS: B REF: 283 Acute Sinusitis Signs and symptoms of acute sinusitis usually include: a. Serous nasal discharge and chronic cough. b. Copious frothy sputum and dyspnea. c. Severe localized pain in the facial bone and tenderness in the face. d. Fetid breath and sore throat. ANS: C REF: 283 Infectious Rhinitis What are early signs and symptoms of infectious rhinitis? a. Purulent nasal discharge and periorbital pain b. Serous nasal discharge, congestion, and sneezing c. Copious purulent sputum, particularly in the morning d. Harsh barking cough and wheezing ANS: B REF: 285 Influenza Virus Recurrence Why does the influenza virus cause recurrent infection in individuals? a. Elderly patients are predisposed to secondary infections. b. The virus is transmitted by numerous routes. c. Viral mutation reduces immunity from prior infections. d. Antibiotics are ineffective against the virus. ANS: C REF: 285 Epiglottitis What are typical signs and symptoms of epiglottitis? a. Hyperinflation of the chest and stridor b. Hoarse voice and barking cough c. Sudden fever, sore throat, and drooling saliva d. Sneezing, mild cough, and fever ANS: C REF: 289 Viral Pneumonia What is the most common cause of viral pneumonia? a. Rhinovirus b. Influenza virus c. Haemophilus influenzae d. Pneumococcus ANS: B REF: 288 Bacterial Pneumonia Which of the following describes bacterial pneumonia? a. Sudden onset of fever and chills, with rales and rusty sputum b. Insidious onset, diffuse interstitial infection c. Viral infection causing nonproductive cough and pleuritic pain d. Opportunistic bacteria causing low-grade fever with cough and thick greenish sputum ANS: A REF: 288 Hypoxia in Pneumonia How does severe hypoxia develop with pneumonia? a. Acidosis depresses respirations. b. Oxygen diffusion is impaired by the congestion. c. Inflammatory exudate absorbs oxygen from the alveolar air. d. Infection reduces effective compensation by the heart. ANS: B REF: 288 Pneumonia Sputum Rust-colored sputum in a patient with pneumonia usually indicates: a. Secondary hemorrhage in the lungs. b. Streptococcus pneumoniae is the infecting agent. c. Prolonged stasis of mucous secretions in the airways. d. Persistent coughing has damaged the mucosa in the bronchi. ANS: B REF: 289 Legionnaires' Disease What is the cause of Legionnaires' disease? a. Mycoplasma b. A gram-negative bacterium c. Legionella pneumophila d. Pneumococcus ANS: C REF: 290 Tuberculosis Select the statement related to tuberculosis: a. The microbe is present in the sputum of all patients with a positive TB skin test. b. The infection is transmitted primarily by blood from an infected person. c. TB is usually caused by an acid-fast bacillus, resistant to many disinfectants. d. The infection is limited to the lungs and does not spread to other organs. ANS: C REF: 290-291 Tuberculosis Pathogenesis Which of the following describes the pathogenesis of tuberculosis? a. Cavitation in the lungs and spread of the microbe to other organs b. Persistent productive cough, low-grade fever, and fatigue c. Caseation necrosis and formation of a tubercle in the lungs d. Multiple granulomas in the lungs and rapid spread of the microbe ANS: C REF: 291 Active Tuberculosis When does active (secondary) infection by Mycobacterium tuberculosis with tissue destruction occur? a. When host resistance is decreased b. When a hypersensitivity reaction is initiated c. When the BCG vaccine is not administered immediately following exposure to the microbe d. When Ghon complexes form in the lungs ANS: A REF: 290 Tuberculosis Characteristics Which of the following statements does NOT apply to M. tuberculosis? a. Microbes can survive for a long time inside tubercles. b. The bacilli can survive some adverse conditions such as drying and heat. c. Infection is limited to the lungs. d. The bacilli can be destroyed by antibacterial drugs. ANS: C REF: 291 hyperinflation. The destruction of alveolar walls and septae in emphysema leads to a loss of elastic recoil, which results in the lungs becoming overinflated and the thoracic cavity expanding. Progression of Emphysema Increased Residual Lung Volume Typical changes in progressive emphysema include an increase in residual lung volume. As the disease progresses, the destruction of alveolar walls and septae leads to a reduction in the overall surface area available for gas exchange, resulting in an increase in the amount of air that remains in the lungs after exhalation. Chronic Obstructive Pulmonary Disease (COPD) Tissue Degeneration and Respiratory Obstruction A group of common chronic respiratory disorders characterized by tissue degeneration and respiratory obstruction is called Chronic Obstructive Pulmonary Disease (COPD). This umbrella term encompasses conditions such as emphysema and chronic bronchitis, which share the common feature of airflow limitation and respiratory impairment. Chronic Bronchitis Chronic Irritation, Inflammation, and Recurrent Infection of the Larger Airways The cause of chronic bronchitis is chronic irritation, inflammation, and recurrent infection of the larger airways. This leads to the overproduction of mucus and the thickening of the bronchial walls, contributing to the obstruction of airflow. Pathological Changes in Bronchiectasis Airway Obstructions and Weak, Dilated Bronchial Walls The typical pathological changes associated with bronchiectasis include airway obstructions and weak, dilated bronchial walls. These structural alterations in the airways result in the impairment of clearance of secretions, leading to recurrent infections and further damage to the bronchial walls. Significant Signs of Bronchiectasis Chronic Cough, Producing Large Quantities of Purulent Sputum One of the significant signs of bronchiectasis is a chronic cough that produces large quantities of purulent (pus-containing) sputum. This is a result of the weakened and dilated bronchial walls, which impair the clearance of secretions and lead to the accumulation of thick, infected mucus. Cor Pulmonale and Chronic Pulmonary Disease Pulmonary Fibrosis and Vasoconstriction Increase Vascular Resistance Cor pulmonale, the development of right ventricular hypertrophy and failure due to chronic pulmonary disease, is primarily caused by the increased vascular resistance in the pulmonary circulation. This increased resistance is a result of pulmonary fibrosis and vasoconstriction, which place a greater workload on the right ventricle. Restrictive Lung Disorders Anatomical Abnormality and Lung Disease Damage, Impairing Expansion Restrictive lung disorders can be divided into two groups based on the underlying cause: anatomical abnormality and lung disease damage that impairs lung expansion. This distinction is important in understanding the pathophysiology and management of these conditions. Pulmonary Fibrosis and Decreased Compliance Fibrosis and Loss of Compliance Frequent inhalation of irritating particles, such as silica, can lead to pulmonary fibrosis and a loss of compliance. The fibrotic changes in the lung tissue reduce the ability of the lungs to expand and contract, impairing their function. Pulmonary Edema and Hypoxia Interference with Expansion of the Lungs Pulmonary edema causes severe hypoxia primarily due to the interference with the expansion of the lungs. The accumulation of fluid in the alveoli and interstitial spaces impairs the ability of the lungs to effectively exchange gases, leading to a decrease in oxygen diffusion and the development of hypoxia. Causes of Pulmonary Edema Left-Sided Congestive Heart Failure and Excessive Blood Volume (Overload) The common causes of pulmonary edema include left-sided congestive heart failure and excessive blood volume (overload). These conditions lead to an increase in the hydrostatic pressure within the pulmonary vasculature, resulting in the leakage of fluid into the alveoli and interstitial spaces. Sources of Pulmonary Emboli Thrombus Forming in the Femoral Veins A common source of a pulmonary embolus is a thrombus (blood clot) forming in the femoral veins. These deep vein thromboses can dislodge and travel to the pulmonary circulation, causing a pulmonary embolism. Effects of Large Pulmonary Emboli Hypotension and Right-Sided Heart Failure A large-sized pulmonary embolus is likely to cause hypotension and right- sided heart failure. The obstruction of the pulmonary vasculature by the embolus increases the workload on the right ventricle, leading to its failure and a decrease in systemic blood pressure. Manifestations of Atelectasis with Airway Obstruction Decreased Breath Sounds on the Affected Side One of the manifestations of atelectasis associated with airway obstruction is decreased breath sounds on the affected side. The collapse or closure of the alveoli and airways leads to a reduction in the movement of air, resulting in diminished breath sounds. protein in the interstitial spaces and alveoli. This impairs the normal gas exchange function of the lungs. Infant Respiratory Distress Syndrome (IRDS) Insufficient Surfactant Production Infant respiratory distress syndrome (IRDS) results from insufficient surfactant production. Surfactant is a substance that reduces the surface tension within the alveoli, allowing for their proper expansion and gas exchange. The lack of surfactant in preterm infants leads to the collapse of alveoli and impaired respiratory function. Obstruction in the Upper Airway Stridor Obstruction in the upper airway is usually indicated by the presence of stridor, which is a high-pitched, harsh sound heard during breathing, particularly on inspiration. This sound is caused by the turbulent airflow through a narrowed or partially obstructed upper airway. Properties of Carbon Dioxide It Diffuses Across Membranes Much More Easily Than Does Oxygen Carbon dioxide (CO2) has the property of diffusing across membranes much more easily than oxygen. This is due to the smaller size and higher solubility of CO2 compared to oxygen, allowing it to move more readily through biological membranes. Relationship between PO2 and PCO2 Levels PO2 Levels May or May Not Change Whenever PO2 levels decrease below normal, PCO2 levels may or may not change. The relationship between PO2 and PCO2 is not always directly proportional, as the body has various mechanisms to maintain acid-base balance and regulate gas exchange. Manifestations of Laryngotracheobronchitis Hoarse Voice and Barking Cough Laryngotracheobronchitis is typically manifested by a hoarse voice and a barking cough. These symptoms are due to the inflammation and swelling of the larynx, trachea, and bronchi, which can affect the production of sound and the airflow through the upper airways. Cause of Lobar Pneumonia Streptococcus pneumoniae Lobar pneumonia is usually caused by Streptococcus pneumoniae, a common bacterial pathogen that can lead to the consolidation of an entire lobe of the lung. Cause of Severe Acute Respiratory Syndrome (SARS) Coronavirus Severe acute respiratory syndrome (SARS) is caused by a coronavirus, a type of virus that can lead to severe respiratory illness. Progression of Symptoms in SARS Interstitial Lung Congestion, Dyspnea, and Dry Cough SARS typically begins as a flulike syndrome, followed by the development of interstitial lung congestion, dyspnea (difficulty breathing), and a dry cough a few days later. Effects of Cystic Fibrosis High Sodium Chloride Content in Saliva and Sweat In addition to its effects on the lungs and pancreas, cystic fibrosis results in a high sodium chloride content in the saliva and sweat of affected individuals. This electrolyte imbalance is a characteristic feature of the disease. Early Sign of Bronchogenic Carcinoma in a Smoker Hemoptysis and Weight Loss A significant early sign of bronchogenic carcinoma (lung cancer) in a smoker is hemoptysis (coughing up blood) and weight loss. These symptoms can be indicative of the presence of a tumor in the lungs. Causes of Pneumothorax or Hemothorax in Bronchogenic Carcinoma The Tumor Causes Inflammation and Erosion of the Pleural Membranes In patients with bronchogenic carcinoma, the tumor can cause inflammation and erosion of the pleural membranes, leading to the development of a pneumothorax or hemothorax (accumulation of blood in the pleural space). Diagnosis of Primary Tuberculosis Small Areas of Calcification on a Chest X-ray The presence of small areas of calcification on a chest X-ray would confirm a diagnosis of primary tuberculosis. These calcified lesions are indicative of the body's immune response to the tuberculosis infection. Prophylaxis for Tuberculosis Contacts Isoniazid The drug usually prescribed for prophylaxis in persons in close contact with a patient with active tuberculosis is isoniazid. This medication can help prevent the development of active tuberculosis in those who have been exposed to the tuberculosis bacilli. Spread and Treatment of Active Tuberculosis TB Bacilli are Spread by Oral Droplet Tuberculosis bacilli are spread by oral droplet, not by airborne transmission. Active tuberculosis must be treated in the hospital for an extended period, as the disease requires prolonged antibiotic therapy for effective management. Cause of Severe Hypoxia in Pulmonary Edema Diffusion of Oxygen into the Alveoli is Impaired The severe hypoxia occurring with pulmonary edema is primarily due to the impairment of the diffusion of oxygen into the alveoli. The accumulation of fluid in the alveoli and interstitial spaces interferes with the normal gas exchange process, leading to a decrease in the amount of oxygen that can be absorbed into the bloodstream. Vomiting in a patient with increased intracranial pressure is due to pressure on the emetic center in the medulla. Increased intracranial pressure typically results in an increasing pulse pressure. Primary Malignant Brain Tumors The largest category of primary malignant brain tumors that arise from cells in the central nervous system are gliomas. Cerebrospinal Fluid Characteristics Normal cerebrospinal fluid is clear and colorless. Malignant Brain Tumors Most brain tumors do not arise from malignant neurons. Primary brain tumors rarely metastasize outside the central nervous system. Secondary Brain Tumors Secondary brain tumors usually arise from metastasized breast or lung tumors. Seizures and Brain Tumors Focal or generalized seizures can be an early indication of a brain tumor due to the surrounding inflammation stimulating neurons to discharge spontaneously. Transient Ischemic Attacks (TIAs) TIAs can warn of potential cerebrovascular accidents. Cerebrovascular Accident (CVA) Sources The probable source of an embolus causing a cerebrovascular accident is the common carotid artery. Collateral Circulation and CVA Collateral circulation is most likely to be present when a CVA results from atherosclerosis. CVA Characteristics The common cause of CVA is an atheroma with thrombus. Warning signs may appear with partial obstruction of the artery. • • • • • • Increasing neurological deficits usually develop during the first few days. Neurological Function Recovery After CVA The return of some neurological function in the weeks following a CVA can be attributed to the presence of collateral circulation, immediate therapy to dissolve thrombi and maintain perfusion, reduced inflammation in the area, and the development of alternative neuronal pathways. Berry Aneurysms Berry aneurysms usually develop at points of bifurcation in the circle of Willis. They are usually asymptomatic for many years. Following rupture, blood appears in the subarachnoid space. Bacterial Meningitis In bacterial meningitis, swelling and purulent exudate form in the pia mater, arachnoid, and on the surface of the entire brain. Acute Bacterial Meningitis Signs Significant signs of acute bacterial meningitis include severe headache, nuchal rigidity, and photophobia. Encephalitis Transmission Many types of encephalitis, such as St. Louis encephalitis, are transmitted by mosquito and tick bites. Tetanus Infection Tetanus infection is caused by an anaerobic, spore-forming bacillus, and the exotoxin causes strong skeletal muscle spasms, leading to respiratory failure. Guillain-Barré Syndrome In Guillain-Barré syndrome, the pathophysiology includes inflammation and demyelination of peripheral nerves, leading to ascending paralysis. Depressed Skull Fracture A depressed skull fracture causes brain damage when a section of skull bone is displaced below the level of the skull, causing pressure on the brain. • • • • Secondary Brain Injury Following a head injury, the most likely cause of secondary damage to the brain is hematoma or infection. Epidural Hematoma An epidural hematoma is located between the dura mater and the skull. Spinal Injury Signs Following a spinal injury at C5, possible periods of apnea may occur during the period of spinal shock. Following an injury at L2 to L3, spastic paraplegia would indicate recovery from spinal shock. Autonomic Dysreflexia The signs of autonomic dysreflexia in a person with cervical spinal injury include a sudden marked increase in blood pressure with bradycardia. Aphasia Types Expressive aphasia is most likely to result from damage to the left frontal lobe. Intracranial Pressure and Heart Rate As intracranial pressure increases, the heart rate decreases. Herniation from Increased Intracranial Pressure Increased intracranial pressure can result in the displacement of brain tissue downward toward the spinal cord. Cerebrovascular Accident Prognosis Hemorrhagic cerebrovascular accidents have the poorest prognosis. CVA Risk Factors Factors that predispose an individual to a cerebrovascular accident include a history of coronary artery disease, hypertension, and diabetes mellitus. • • typically diagnosed prenatally by ultrasound or detection of alpha- fetoprotein (AFP) in maternal blood or amniotic fluid. Cerebral Palsy The characteristic common to all individuals with cerebral palsy is some degree of motor disability. Cerebral palsy involves nonprogressive brain damage to the fetus or neonate. Seizure Types Generalized seizures are characterized by the uncontrolled discharge of neurons in both hemispheres. The clonic stage of a seizure consists of alternating contractions and relaxation of skeletal muscles. A seizure consisting of bizarre or inappropriate activity would be classified as a focal seizure. Multiple Sclerosis Multiple sclerosis is characterized by remissions and exacerbations, and it affects the brain, spinal cord, and cranial nerves, impacting motor, sensory, and autonomic fibers. Common early signs of multiple sclerosis include areas of numbness, weakness in the legs, and visual problems. Parkinson's Disease Parkinson's disease usually develops in men and women over 60 years of age. The pathophysiological change in Parkinson's disease is degeneration of the basal nuclei with a deficit of dopamine. Common early manifestations of Parkinson's disease include tremors at rest in the hands and repetitive motion of the hands. Amyotrophic Lateral Sclerosis (ALS) In ALS, progressive degeneration is occurring in both upper and lower motor neurons. Myasthenia Gravis In myasthenia gravis, muscle weakness and fatigue occur in the face and neck, but dementia does not develop. Huntington's Disease Huntington's disease presents with choreiform movements in the upper body and decreased ability to concentrate. Alzheimer's Disease In Alzheimer's disease, the characteristic changes in the brain include cortical atrophy with plaques and neurofibrillary tangles, impairing conduction. Schizophrenia Typical characteristics associated with schizophrenia include disorganized thought processes, short attention span, and delusions. Intervertebral Disc Herniation The typical initial effect of a herniated intervertebral disc at the L4 to L5 level is lower back pain radiating down the leg. A herniated intervertebral disc involves a protrusion of the nucleus pulposus through the annulus fibrosis. Spina Bifida Prevention Folic acid supplementation has reduced the incidence of spina bifida in recent years. Cerebral Palsy Causes The most common cause of brain damage in children with cerebral palsy is hypoxia. Seizure Diagnosis and Classification An electroencephalogram is used to confirm the diagnosis of, and classify, seizures. Status Epilepticus In status epilepticus, seizures are recurrent or continuous without full recovery between episodes, leading to severe hypoxia and acidosis, and potentially additional brain damage if the episode persists. Seizure Types in Children The type of seizure that commonly occurs in children is absence seizures. Seizure Precipitants Hypoglycemia, brain abscess, and high fever in a young child may precipitate a seizure, but hypoventilation does not. Parkinson's Disease Progression Typical effects of advanced Parkinson's disease include difficulty chewing and swallowing, urinary retention, and orthostatic hypotension, but not loss of vision. Amyotrophic Lateral Sclerosis (ALS) Early Signs A typical early sign of amyotrophic lateral sclerosis (ALS) is muscle weakness and atrophy. Impaired Ventilation Cognitive Impairment Cognitive impairment can be a symptom of various neurological disorders. Poor Control of Eye Movement Impaired control of eye movements can be a sign of neurological dysfunction. Weakness and Muscle Atrophy in Upper Limbs Weakness and muscle atrophy in the upper limbs can indicate a neuromuscular disorder. Myasthenia Gravis Temporary Improvement with Anticholinesterase Agents Anticholinesterase agents, such as pyridostigmine, can provide temporary improvement in cases of myasthenia gravis by increasing the availability of acetylcholine at the neuromuscular junction. Alzheimer's Disease Early Signs of Alzheimer's Disease Reduced ability to reason and problem solve Decreased verbal responses AIDS Dementia Common Contributing Factors Invasion of the central nervous system by HIV • • • • • • • Goiter Goiter can be caused by lack of iodine in the diet, thyroid gland dysfunction, or pheochromocytoma. Graves' Disease Graves' disease is characterized by exophthalmos (bulging eyes) and tachycardia (rapid heart rate). Cushing's Syndrome Cushing's syndrome is not characterized by staring eyes with infrequent blinking, but rather by a heavy body, round face, and atrophied skeletal muscle in the limbs. Long-term Glucocorticoid Therapy Long-term glucocorticoid therapy can lead to decreased secretion from the adrenal cortex gland. Type 1 Diabetes Mellitus The most common cause of type 1 diabetes mellitus is the destruction of pancreatic cells by an autoimmune reaction. Glucosuria in Diabetes Glucosuria occurs in diabetes when the amount of glucose in the filtrate exceeds the renal tubule transport limit. Pituitary Adenoma Early signs of a pituitary adenoma include persistent headaches and hypertension. Inappropriate ADH Syndrome Inappropriate ADH syndrome is characterized by excess ADH secretion, resulting in severe hyponatremia and fluid retention. Thyrotoxic Crisis Thyrotoxic crisis is characterized by hyperthermia and heart failure. Conditions Affecting Hyperglycemia Hyperthyroidism, but not hypothyroidism, Addison's disease, or growth hormone deficit, may precipitate or exacerbate hyperglycemia. • • • • • • • • • • Immunosuppression in Cushing's Disease Cushing's disease, caused by excess glucocorticoids, can lead to immunosuppression. Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) HHNC more frequently develops in patients with type 2 diabetes. Immediate Treatment of Hypoglycemic Shock If conscious, immediately give sweet fruit juice, honey, candy, or sugar. If unconscious, give intravenous glucose. Glucose Use Without Insulin The brain uses glucose without the aid of insulin. Differences Between Type 1 and Type 2 Diabetes Type 1 diabetes occurs more frequently in children and adolescents, while type 2 diabetes occurs more often in adults. Complications of Diabetes Mellitus Complications of diabetes mellitus include peripheral neuropathy, frequent infections, and cataracts. Causes of Goiter Goiters can be caused by lack of iodine, thyroid gland dysfunction, or radiation involving the thyroid gland and neck area. Dwarfism Dwarfism is caused by a deficit of somatotropin (growth hormone). Diabetes Insipidus Diabetes insipidus is caused by a deficit of antidiuretic hormone (ADH). Goiter Prevalence Goiters occur more frequently in persons living in the Great Lakes or mountainous regions. Graves' Disease Graves' disease causes hypermetabolism. • • • • • • • • • • • Causes of Goiter Goiters can be caused by both hypothyroid and hyperthyroid conditions. Cretinism Cretinism is associated with severe impairment of all aspects of growth and development, including difficulty feeding, mental retardation, and stunted skeletal growth. Pheochromocytoma A pheochromocytoma is a benign tumor of the adrenal medulla that secretes epinephrine and norepinephrine. Anterior Pituitary Hormones The anterior pituitary gland secretes prolactin, adrenocorticotropic hormone (ACTH), and growth hormone, but not glucagon. Functions of Oxytocin Oxytocin stimulates contraction of the uterus after delivery and ejection of breast milk during lactation. Functions of Norepinephrine Norepinephrine causes visceral and cutaneous vasoconstriction. Early Signs of Hyperglycemia Early signs of hyperglycemia include polyphagia (increased hunger). Cortisol and the Stress/Anti-inflammatory Response Cortisol is involved in both the stress response and the anti- inflammatory response. Polydipsia in Diabetes Mellitus Polydipsia (increased thirst) in diabetes mellitus is caused by polyuria (increased urine output) leading to dehydration. Metabolic Syndrome Metabolic syndrome is marked by abnormal lipid and glucose metabolism. • • • • • • • • • • Oral Candidiasis Oral candidiasis is an opportunistic fungal infection of the mouth. It causes white patches in the mucosa that cannot be scraped off. It is not a common bacterial infection in infants and young children. Herpes Simplex Infection Herpes simplex infection tends to recur because the virus persists in latent form in sensory nerve ganglia. Periodontitis Periodontitis refers to bacterial damage to the teeth and surrounding alveolar bone. Oral Cancer Common locations for oral cancer include the floor of the mouth or tongue borders. Hiatal Hernia A common cause of hiatal hernia is stenosis of the hiatus in the diaphragm. Acute Gastritis A common sign of acute gastritis is vomiting and anorexia. Chronic Gastritis The pathophysiology of chronic gastritis includes atrophy of the gastric mucosa with decreased secretions. Gastroenteritis A common cause of gastroenteritis due to Salmonella is raw or undercooked poultry or eggs. Acute Gastritis Risk Factors An individual with an allergy to shellfish is likely to develop acute gastritis. Pyloric Stenosis Acquired pyloric stenosis involves hypertrophy of smooth muscle in the pylorus. • • • • • • • • • • • • Patients with this condition would likely vomit undigested food from previous meals. Peptic Ulcer Disease Prolonged or severe stress predisposes to peptic ulcer disease due to reduced blood flow to the gastric wall and mucous glands. The pathophysiology of peptic ulcer disease does not involve increased stimulation of mucus-producing glands. A perforated gastric ulcer would likely cause chemical peritonitis. Hematemesis is frequently the first manifestation of stress ulcers. Gastric Carcinoma Chronic bleeding from gastric carcinoma would result in occult blood in the stool and anemia. Postgastrectomy Syndrome Nausea, cramps, and dizziness immediately after meals following gastric resection indicate a large volume of chyme has entered the intestines, causing distention. Bilirubin Bilirubin is a product of hemolysis of red blood cells and breakdown of hemoglobin. Mild hyperbilirubinemia in newborns is due to an immature liver that cannot process bilirubin quickly enough. Cholelithiasis Predisposing factors to cholelithiasis include excessive bilirubin or cholesterol concentration in the bile. Obstruction of the cystic duct by a gallstone would cause severe colicky pain in the upper right quadrant. Biliary Tract Obstruction Obstruction of the biliary tract by gallstones is referred to as choledocholithiasis. Hepatitis A Hepatitis A is also called infectious hepatitis and contains a single strand of RNA. • • • • • • • • • • • • • Hepatitis B If the hepatitis B antigen level remains high in the serum, it indicates chronic infection has developed. Hepatitis C Hepatitis C is the most common type of hepatitis transmitted by blood transfusion. Hepatitis B Progression Jaundice occurs in the icteric stage of a hepatitis B infection. Hepatotoxin Exposure Long-term exposure to a hepatotoxin can lead to gradual irreversible damage to the liver and cirrhosis. Alcoholic Hepatitis The presence of third-stage alcohol hepatitis is indicated by decreased production of blood clotting factors. Elevated serum ammonia may precipitate encephalopathy in cirrhosis patients. Bleeding in the digestive tract can increase serum ammonia levels in cirrhosis patients. Esophageal Varices The primary cause of esophageal varices is increased hydrostatic pressure in the veins. Cirrhosis Complications The primary cause of increased bleeding tendencies in cirrhosis is a deficit of vitamin K and prothrombin. Ascites in cirrhosis is contributed to by increased aldosterone and deficit of albumin. Hepatocellular Cancer A major cause of primary hepatocellular cancer is long-term exposure to certain chemicals. Acute Pancreatitis Acute pancreatitis causes massive inflammation and necrosis due to autodigestion of tissue by pancreatic enzymes. • • • • • • • • • • • • Hirschsprung's Disease Hirschsprung's disease is a congenital condition in which there is a lack of parasympathetic innervation (nerve supply) to a section of the colon, impairing its motility. Hypovolemic Shock in Intestinal Obstruction Hypovolemic shock (shock due to fluid loss) can develop with intestinal obstruction due to continued vomiting and fluid shift into the intestine. Rigid Abdomen in Peritonitis The characteristic rigid abdomen found in patients with peritonitis is due to reflex abdominal muscle spasm caused by inflammation of the peritoneum. Outcome of Chemical Peritonitis In the case of a perforated gallbladder leading to chemical peritonitis, the likely outcome is leakage of intestinal bacteria into the blood and peritoneal cavity. Pelvic Inflammatory Disease and Bacterial Peritonitis Pelvic inflammatory disease can lead to bacterial peritonitis when the infection spreads through the fallopian tubes directly into the peritoneal cavity. Acid-Base Changes with Vomiting and Diarrhea Prolonged severe vomiting leads to a decreased bicarbonate ion, decreased PCO2, and a serum pH below 7.35, indicating a metabolic acidosis. Dehydration limits the body's ability to compensate for this acidosis. Gallstone Formation Bile pigment gallstones are more common in individuals with alcoholic cirrhosis. Peptic Ulcer Disease The most frequent location of peptic ulcers is the proximal duodenum. Decreased vagal stimulation does not decrease the resistance of the mucosal barrier in peptic ulcer disease. Complications of Peptic Ulcers Hematemesis (vomiting of blood) in a patient with peptic ulcer disease indicates erosion of a large blood vessel. Gastric Carcinoma Genetic factors and ingestion of foods preserved with nitrates are common predisposing factors for gastric carcinoma, but anti-inflammatory medications like aspirin are not. Post-Gastrectomy Complications A common complication in post-gastrectomy patients is hypoglycemia, which can occur 2-3 hours after meals. Cholangitis Cholangitis refers to an inflammation usually related to infection of the bile ducts. Jaundice in Viral Hepatitis Jaundice is often the first manifestation of viral hepatitis, but individuals with hepatitis are not always jaundiced. Jaundice usually develops with hepatocellular carcinoma. Hepatitis and Hepatocellular Carcinoma Both hepatitis B virus (HBV) and hepatitis C virus (HCV) increase the risk of developing hepatocellular carcinoma. Post-Hepatic Jaundice Post-hepatic jaundice is characterized by pruritic (itchy) skin and light- colored stools, due to increased serum levels of unconjugated bilirubin. Hepatitis B In hepatitis B, blood clotting delays are apparent at onset, and the infection is often self-limiting. Spread of Hepatitis B One major reason making it difficult to prevent the spread of hepatitis B is that the infection is often asymptomatic. Alcoholic Liver Disease The initial pathological change in alcoholic liver disease is the accumulation of fat in hepatocytes, leading to hepatomegaly (enlarged liver). Cirrhosis In cirrhosis, both conjugated and unconjugated bilirubin levels are increased in the serum. Hepatitis D Hepatitis D virus requires the presence of hepatitis B virus in order to replicate. Reversibility of Alcoholic Liver Disease The damage of alcoholic liver disease can be reversed during the alcoholic hepatitis stage, before progressing to end-stage cirrhosis. Causes of Pancreatitis The two major causes of pancreatitis are gallstones and alcohol abuse. Inflammatory Bowel Diseases Genetic and immunological factors appear to play a role in the etiology of inflammatory bowel diseases. Gastroesophageal Reflux Disease Gastroesophageal reflux disease involves the periodic flow of gastric contents into the esophagus. Hiatal Hernia A sliding hiatal hernia occurs when a portion of the proximal stomach and the paraesophageal junction move above the diaphragm. Gastric Cancer Most cases of gastric cancer involve an adenocarcinoma of the mucous glands. Early Diagnosis of Pancreatic Cancer Pancreatic cancer may be diagnosed early if obstruction of bile or pancreatic secretions develops when the tumor is located at the head of the pancreas. Celiac Disease A gluten-free diet is required for individuals with celiac disease, as it involves avoiding products containing certain grains. Indicators of Acute Post-Streptococcal Glomerulonephritis The disease that would cause an increased ASO (antistreptolysin O) titer and elevated serum ASK (antistreptokinase) is acute post-streptococcal glomerulonephritis. Metabolic Acidosis in Bilateral Kidney Disease Metabolic acidosis develops with bilateral kidney disease because the glomerular filtration rate (GFR) is decreased. First Indicator of Acidosis in Glomerulonephritis The first indicator in the arterial blood gases of acidosis caused by glomerulonephritis is decreased bicarbonate ion. Long-Term Effects of Chronic Kidney Infection or Inflammation The long-term effects of chronic infection or inflammation of the kidneys are gradual necrosis, fibrosis, and development of uremia. Factors Contributing to Symptoms in Kidney Disease The factors that contribute to headache, anorexia, and lethargy with kidney disease are: Increased blood pressure Elevated serum urea Anemia Acidosis Significant Signs of Nephrotic Syndrome The significant signs of nephrotic syndrome are hyperlipidemia and lipiduria. Blood Pressure in Nephrotic Syndrome Blood pressure often remains near normal in patients with nephrotic syndrome because hypovolemia results from fluid shift to the interstitial compartment. Causes of Urolithiasis The common causes of urolithiasis (kidney stones) include hypercalcemia, inadequate fluid intake, and hyperuricemia, but not hyperlipidemia. 1. 2. 3. 4. Result of Left Ureter Obstruction by Renal Calculus The result of obstruction of the left ureter by a renal calculus is an attack of renal colic. Effect of Hydronephrosis Hydronephrosis leads to ischemia and necrosis in the compressed area. Predisposing Factor to Bladder Cancer A predisposing factor to bladder cancer is exposure to chemicals and cigarette smoke. Initial Sign of Adenocarcinoma of the Kidney The common initial sign of adenocarcinoma of the kidney is microscopic hematuria. Result of Nephrosclerosis Nephrosclerosis usually results in secondary hypertension and chronic renal failure, but not acute renal failure. Characteristics of Polycystic Kidney Disease Polycystic kidney disease affects both kidneys and results in gradual degeneration and chronic renal failure. Relation to Wilms' Tumor Wilms' tumor is related to a genetic defect. Effects of Hypokalemia or Hyperkalemia in Severe Kidney Disease Severe kidney disease can cause either hypokalemia or hyperkalemia, which may lead to cardiac arrhythmias. Indicator of Early Acute Renal Failure The early stage of acute renal failure is indicated by very low GFR and increased serum urea. Causes of Acute Tubule Necrosis and Acute Renal Failure The causes of acute tubule necrosis and acute renal failure include prolonged circulatory shock, sudden significant exposure to nephrotoxins, and crush injuries or burns. Cause of Chronic Renal Failure Diabetes is a cause of chronic renal failure. Cause of Polyuria in Renal Insufficiency Polyuria during the stage of renal insufficiency is caused by loss of tubule function. Cause of Hypocalcemia in End-Stage Renal Failure The primary reason for hypocalcemia developing during end-stage renal failure or uremia is a deficit of activated vitamin D. Reason for Cystitis Being More Common in Females Cystitis is more common in females because the urethra is short, wide, and adjacent to areas with resident flora. Indicators of Decreased GFR Indicators of decreased GFR include increased serum urea and decreased serum bicarbonate. Condition Not Likely to Lead to Hydronephrosis Nephrosclerosis is not likely to lead to hydronephrosis. Congenital Defect Causing Cystitis in Young Children A common cause of cystitis in young children is vesicoureteral reflux, a congenital defect. Factor Contributing to Anemia in Chronic Renal Failure The factor that contributes to severe anemia in individuals with chronic renal failure is limited protein intake. Indicator of Decompensated Acidosis in Renal Failure When acidosis becomes decompensated in renal failure, a key indicator is serum pH dropping below 7.35. Primary Action of Diuretic Furosemide The primary action of the diuretic furosemide is decreased reabsorption of sodium and water. a. Control of blood flow by the SNS b. The secretion of renin and activation of angiotensin c. Local minor reflex adjustments in the arterioles to maintain normal blood flow d. The control of systemic blood pressure by the kidneys ANS: C REF: 495 Reabsorption of Water and Electrolytes The reabsorption of water and electrolytes by the kidneys is directly controlled by: 1. Atrial natriuretic hormone 2. Antidiuretic hormone 4. The levels of bicarbonate ion a. 2 only b. 3 only c. 1, 2 d. 2, 4 ANS: C REF: 492 Uncontrolled Essential Hypertension and Chronic Renal Failure Uncontrolled essential hypertension may cause chronic renal failure because of: a. Predisposition to recurrent urinary tract infections b. Damage to afferent arterioles and renal ischemia c. Failure of tubules to respond to hormonal controls d. Glomerular congestion causes damaged capillaries ANS: B REF: 508 Urine with Low Specific Gravity Urine with a low specific gravity is usually related to: a. An infection of the gallbladder b. Renal failure due to tubule damage c. Lack of sufficient fluid intake d. Presence of numerous renal calculi ANS: B REF: 510 | 512 Excess Urea and Nitrogen Wastes Excess urea and other nitrogen wastes in the blood is referred to as: a. Dysuria b. Azotemia c. Bacteremia d. Hematuria ANS: B REF: 513 Metastasis Metastasis refers to the spread of malignant cells through blood and lymph to distant sites. Staging Malignant Tumors One reason for staging a malignant tumor at the time of diagnosis is to determine the best treatment and prognosis. Carcinogenesis The process of carcinogenesis usually begins with an irreversible change in the cell DNA. Radiation Therapy Radiation therapy destroys primarily rapidly dividing cells. Adverse Effects of Cancer Treatments The most critical adverse effects of chemotherapy and radiation therapy are thrombocytopenia and leucopenia. Combination Chemotherapy Chemotherapy usually involves a combination of drugs in order to: 1. Reduce the adverse effects. 2. Be effective in more phases of the cell cycle. Ovarian Cancer Ovarian cancer has a poor prognosis because specific signs rarely appear until after secondary tumors have developed. Tumor Markers The correct pair representing a malignant tumor and its marker is colon cancer: carcinoembryonic antigen (CEA). Antiangiogenesis Drugs Antiangiogenesis drugs act on a malignant tumor by reducing blood flow and nutrient supply to tumor cells. Neutropenia During Chemotherapy The development of neutropenia during chemotherapy for cancer means the patient is at high risk for infection. Malignant Brain Tumors Malignant brain tumors spread to other parts of the central nervous system. Dose-Limiting Factor for Chemotherapy The common dose-limiting factor for chemotherapy is bone marrow depression. Glucocorticoids in Cancer Treatment Glucocorticoids are often prescribed during a course of chemotherapy and radiation because inflammation around the tumor may be reduced. Vomiting After Chemotherapy Vomiting frequently follows a chemotherapy treatment because the gastrointestinal tract is irritated.