Download BIOD331 Pathophysiology Final Exam and more Exams Biochemistry in PDF only on Docsity!
BIOD331 Pathophysiology Final Exam
A patient is experiencing a severe reduction in GFR, and their GFR is 15 - 29 mL/min/1.73m2. What stage of kidney disease are they in? - ...ANSWER✓✓✓ 4 A patient is experiencing kidney damage with a mild decrease in GFR, and their GFR is 60-89 mL/min/1.73m². What stage of kidney disease are they in? - ...ANSWER✓✓✓ 2 A patient is said to be in stage 2 kidney disease. What would you expect their GFR to be? - ...ANSWER✓✓✓70 mL/min/1.73m A patient is said to be in stage 4 kidney disease. What would you expect their GFR to be? - ...ANSWER✓✓✓25 mL/min/1.73m A patient presents in the emergency department with severe dehydration secondary to vomiting. The following are the results of their blood work: pH = 8.2, PCO2 = 39 mm, and HCO-3 = 33 mEq/L. Based upon these
results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3- = 22-26 mEq/L. - ...ANSWER✓✓✓The patient is in metabolic alkalosis. The respiratory system is not compensating as PCO2 compensation falls within normal limits. Fluids are replaced with normal saline solution. A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIS. Urinalysis reveals that the pH of their urine is 7.8. A CT scan reveals a renal calculi that is 7 mm in diameter. What is the best treatment plan for this patient? Explain your reasoning for this treatment plan. - ...ANSWER✓✓✓It must be removed through ureteroscopic removal or extracorporeal shockwave lithotripsy, as it is greater than 5 mm in diameter. The patient should be placed on antibiotics to treat the UTI, as well as medication for pain management. is the transfer of gases between the alveoli and the pulmonary capillaries. - ...ANSWER✓✓✓Diffusion is the flow of gases into and out of the alveoli of the lungs.
A 10 - year-old boy who is having an acute asthma attack is brought to the ER. He is observed to be sitting up and struggling to breathe. His breathing is accompanied by use of accessory muscles, a weak cough, and audible wheezing sounds. His pulse is rapid and weak, and both heart and breath sounds are distant on auscultation. His parents relate that his asthma began to worsen after he developed a "cold," and now he doesn't get relief from his albuterol inhaler. Explain the changes in physiologic function underlying his signs and symptoms. - ...ANSWER✓✓✓Recruitment of inflammatory cells from the bloodstream into the bronchial wall, where they directly attack the invading organisms and secrete inflammatory chemicals that are toxic to the organisms causes airway inflammation. Swelling of the bronchial wall, mucus secretion, constriction of the airway; bronchial hyper- responsiveness to stimuli causes airway obstruction or narrowing. They may discuss on a cellular level as well: Upon a trigger, the cascade of neutrophils, eosinophils, lymphocytes, and mast cells cause epithelial injury. This causes airway inflammation, which further increases hyperresponsiveess and decreased airflow. Mast cells release histamine and leukotrienes. These cause major bronchoconstriction, inflammation, and mucus secretion. Mast cells can trigger multiple cytokine release, which causes more airway inflammation. The contraction of the airways and subsequent swelling leads to further airway obstruction.
A 12 - year-old female presents with itchy eyes, nasal congestion and drainage, and sneezing every spring when the pollen count is high. (1) Explain the immunologic mechanisms that are responsible for her symptoms. (2) What type(s) of treatment might be used to relieve her symptoms?
- ...ANSWER✓✓✓(1) Mast cells, basophils, and eosinophils play an important role with type I reactions because they contain histamines. Primary response is vasodilation, vascular leakage, and smooth muscle contraction. Late-phase response is more intense with eosinophils and other acute and chronic inflammatory cells, as well as tissue damage. (2) Antihistamines. A 23 - year-old African-American man with a history of severe lifelong anemia requiring many transfusions has nonhealing leg ulcers and recurrent periods of abdominal and chest pain. These signs and symptoms are most likely to be associated with which one of the following laboratory abnormalities? - ...ANSWER✓✓✓Sickle cells on peripheral blood smear A 45 - year-old woman presents with fatigue, weight gain, and cold intolerance. Lab findings show a low serum T4 and elevated TSH. 1. What diagnosis would her history and lab findings indicate? 2. What type of treatment should be given? - ...ANSWER✓✓✓1. Hypothyroidism
- Synthetic T4 thyroid hormone, thyroxine
history of atrial fibrillation. Given the patient's past medical history and presentation, what is your initial diagnosis? - ...ANSWER✓✓✓Stroke or CVA A 75 - year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband's speech was very unclear. When she asked him what was going on, he said that he didn't know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. What do you suspect this patient is experiencing? Specifically, categorize the disease process based upon his past medical history and his current presentation and explain how you arrived at this specific diagnosis. - ...ANSWER✓✓✓He is more than likely experiencing an ischemic stroke. A past medical history of atrial fibrillation puts him at an increased risk for clots. A 75 - year-old male is brought to the emergency department by his spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband's speech was very unclear. When she asked him what was going on, he said that he didn't know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. You suspect this patient has suffered an ischemic CVA. What diagnostic test would you run to confirm your diagnosis? - ...ANSWER✓✓✓A CT scan and MRI would be needed to determine if a clot is blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke.
A 75 - year-old male is brought to the emergency department via ambulance at 5 pm. The patient's spouse reports that when they woke up (approximately at 6 am) he reported to her that he was having some blurred vision but decided to go about his day. As the day progressed, he started experiencing tingling and feelings of weakness on the entire left side of his body. He has a past medical history of diabetes. Based upon these symptoms and past medical history, what do you suspect this patient is experiencing? How would you confirm this diagnosis? What treatment should be administered? Explain why you chose that treatment. - ...ANSWER✓✓✓This patient is more than likely experiencing an ischemic stroke. A CT scan and MRI would be needed to determine if a clot was blocking blood flow to the brain tissue and to rule out a hemorrhagic stroke. If a clot is found, this patient would need to be re-perfused through catheter-base methods (to break the clot), as they are outside of the 3-4.5 treatment window for the use of tPA drugs. A 9 - year-old boy with a peanut allergy was exposed to peanuts. He presents to the emergency room with an anaphylactic reaction. (1) What symptoms might he present with? (2) Does the quantity of exposure mean he will have a more severe reaction? (3) What is the initial immediate treatment? (4) What are 2 things people with anaphylaxis should always carry? - ...ANSWER✓✓✓(1) Any of the following reactions are accepted. Grade I: erythema and urticaria, with or without angioedema
and flushing. They have experienced which type of seizure? - ...ANSWER✓✓✓Focal seizure without impairment of consciousness or awareness A patient experiences a seizure that manifests with repetitive hand rubbing and reports of hallucinations right before the seizure occurred. They have experienced which type of seizure?
- ...ANSWER✓✓✓Focal seizure with impairment of consciousness or awareness A patient has experienced a seizure affecting the left temporal lobe. The family reports that the patient exhibited repetitive lip smacking and hand rubbing followed by a period of great fear and insecurity. They have experienced which type of seizure? - ...ANSWER✓✓✓Focal seizure with impairment of consciousness or awareness A patient is admitted to the hospital with pneumonia. The following are the results of their blood work: pH = 6.9, PCO2 = 52 mm, and HCO3- = 30 mEq/L. Based upon these results, what type of acid-base disorder are they experiencing? Is compensation occurring? Describe a treatment intervention for this disorder. Normal values are as follows: pH = 7.35-7.45, PCO2 = 35-45 mm, HCO3 - = 22 - 26 mEq/L. - ...ANSWER✓✓✓The patient is in respiratory acidosis. The renal system is attempting to compensate as HCO3- concentration is elevated above normal limits. The goal of treatment for respiratory acidosis is improving ventilation. Supplemental O2 can be administered; in severe cases mechanical ventilation may be indicated.
A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. A CT scan reveals that they have a kidney stone. What type of kidney stone would suspect they have? What about their current presentation leads you to this conclusion? - ...ANSWER✓✓✓The patient has a magnesium ammonium phosphate stone given the elevated pH of their urine. These types of stones are the result of a UTI caused by bacteria that contain urease. A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. Given the patient's past medical history and presentation, what is your initial diagnosis? - ...ANSWER✓✓✓Kidney stones or renal calculi A patient presents to the emergency department with complaints of sharp pain that comes in waves in the upper lateral quadrant of the abdomen. Their skin is clammy, and they have been experiencing nausea and vomiting all day long. They have a history of UTIs. Urinalysis reveals that the pH of their urine is 7.8. You suspect that the patient may have a kidney stone. What diagnostic test would you run to confirm your diagnosis? - ...ANSWER✓✓✓In addition to the urinalysis already run, a
Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. She is given a diagnosis of blood loss or iron deficiency anemia. What is the best treatment plan for this patient? Explain your reasoning. - ...ANSWER✓✓✓If low ferritin, she would need iron supplementation. Also find the cause of the bleeding and try to control. Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. You suspect Anne is anemic. What diagnostic test would you run to confirm your diagnosis? What would her red blood cells look like on the slide? (size and color) - ...ANSWER✓✓✓CBC with peripheral smear and ferritin level. RBCs would appear microcytic and hypochromic. Anne is a 48 y/o female who presents with excessive vaginal bleeding x 6 months. Her skin is pale, she reports feeling fatigued, and often craves a large cup of Sonic crushed ice. A quick in-office H&H shows a hemoglobin of 9 and hematocrit of 30%. You suspect Anne may be anemic. What type of anemia do you think she has, and what about her current presentation leads you to this conclusion? - ...ANSWER✓✓✓Blood loss anemia or iron deficiency anemia. Vaginal bleeding, pale skin, fatigue, and low H&H
Bill and Angela have brought their mom into your office today. They tell you that their mom has experienced dementia for some time now, but they have not been too concerned because, for the most part, she has been able to care for herself, only needing assistance here and there for her daily activities. However, recently things have changed. Her ability to recall recent events has drastically decreased; she is experiencing difficulty with sleep; they've noticed some mood changes, and the most alarming thing is that she has started to wander outside of her home. They are concerned for her safety. Given the patient's presentation, what is your initial diagnosis? - ...ANSWER✓✓✓Alzheimer's Disease Bill and Angela have brought their mom into your office today. They tell you that their mom has experienced dementia for some time now, but they have not been too concerned because, for the most part, she has been able to care for herself, only needing assistance here and there for her daily activities. However, recently things have changed. Her ability to recall recent events has drastically decreased; she is experiencing difficulty with sleep; they've noticed some mood changes, and the most alarming thing is that she has started to wander outside of her home. They are concerned for her safety. You suspect the patient has Alzheimer's. How would you stage the disease process this patient is experiencing? What about her current presentation leads you to this conclusion? - ...ANSWER✓✓✓Moderate Alzheimer's Disease. Changes in sleep, changes in mood, and wandering episodes are all characteristic of moderate Alzheimer's. Bill and Angela have brought their mom into your office today. They tell you that their mom has experienced dementia for some time now, but they have not been too concerned because, for the most part, she has
155/86. Given the patient's past medical history and presentation, what is your initial diagnosis? - ...ANSWER✓✓✓Hypertension Bob is a 55 y/o male here for his annual physical exam. He has no current complaints. His BMI is 31, BP 150/90, HR 72, RR 16. He does not smoke, drinks alcohol occasionally, and has a family history of cardiovascular disease. His BP was retaken in the opposite arm and was 155/86. How would you stage Bob's hypertension? - ...ANSWER✓✓✓Stage 2, > 140/ Briefly explain why autoimmune diseases are difficult to diagnose - ...ANSWER✓✓✓There are over 80 identified autoimmune disorders identified, many with overlapping and/or nonspecific presentations, making an accurate diagnosis can be quite challenging. Cancellous bone receives its blood supply by what means? - ...ANSWER✓✓✓Diffusion through the endosteal surface of the bone and the canaliculi Chad, a 20 y/o male, presents with episodes of diarrhea with mucus and rectal bleeding. A colonoscopy and biopsy are done to confirm ulcerative colitis. How does this disease differ from Crohn disease? - ...ANSWER✓✓✓Crohns disease has granulomatous inflammation, involvement primarily submucosal, extent of involvement- skip lesions, Ulcerative- ulcerative and exudative inflammation, involvement primarily mucosal, extent of involvement- continuous
Compare and contrast the two types of gangrenous necrosis. - ...ANSWER✓✓✓In dry gangrene the affected tissue becomes dry and shrinks, the skin wrinkles, and its color changes to dark brown or black. The spread of dry gangrene is slow. It results from a cut-off in arterial blood supply and is a form of coagulation necrosis. In wet gangrene, the affected area is cold, swollen, and pulseless. The skin is moist, black, and under tension. Blebs form on the surface, liquefaction occurs, and a foul odor is caused by bacterial action. The spread of tissue damage is rapid. Complications of gallstones include each of the following except:
- ...ANSWER✓✓✓Cirrhosis Diagnosis of an autoimmune disease is made by following patient history, physical evidence, and serological findings. Explain why blood tests alone are not enough to diagnose an autoimmune disorder. - ...ANSWER✓✓✓Blood testing can be imprecise, as some tests are more generic and can be elevated in the presence of other diseases. Each of the following are risk factors for secondary hyperlipidemia except? - ...ANSWER✓✓✓Autosomal dominant disorder of LDL receptor YES --> obesity, DM, high cholesterol diet
the glomeruli with a subsequent increase in glomerular pressure and the GFR. When the afferent arteriole constricts, there is a reduction in renal blood flow, glomerular pressure, and the GFR Explain how the skin's physical barrier makes it inhospitable to microorganisms - ...ANSWER✓✓✓Our skin is comprised of closely packed cells in multiple layers. Keratin is what covers the skin and makes it a salty acidic inhospitable environment to microbes with the use of proteins and lysozymes. Explain one reason why obesity puts someone at increased risk for cancer. - ...ANSWER✓✓✓Obesity is associated with insulin resistance and increased production of pancreatic insulin, both of which can have a carcinogenic effect. It is associated with increased levels of sex hormones, androgens, and estrogens. These stimulate cell proliferation, inhibit apoptosis, and increase the chance of malignant cell transformation, especially of the endometrial and breast tissue. Lastly, obesity has been related to chronic inflammation, which can lead to the development of malignancies. Explain the challenges of diagnosing autoimmune disorders - ...ANSWER✓✓✓There are over 80 identified, many with overlapping presentations. Many manifestations are nonspecific and are seen in other non-autoimmune diseases. Blood testing isn't perfect either, as some tests are more generic and can be elevated in the presence of other diseases.
Explain the diagnostic criteria required for an autoimmune disease to be concluded. - ...ANSWER✓✓✓In order for an autoimmune disorder to be concluded, the following criteria must be met: evidence of an autoimmune reaction, the immunologic findings are not secondary to another condition, and no other identifiable causes are found. Fill in the blank: propel chyme along the small intestine toward the large intestine in one direction. - ...ANSWER✓✓✓Peristaltic movements Fill in the blank: occlude small portions of the intestinal lumen to push digestive contents forward and backward - ...ANSWER✓✓✓Segmentation Waves Give a specific example of how our diet can increase our risk for cancer.
- ...ANSWER✓✓✓Any of the following are acceptable answers: While some dietary carcinogens occur naturally in plants (aflatoxins), others are used in the preparation or preservation of food. For instance, when foods are fried in fat that has been reused multiple times, due to the extreme heat, benzo[a] pyrene (and other polycyclic hydrocarbons) are converted to carcinogens. The polycyclic aromatic hydrocarbons are among the most potent and can be found in many common places. They are produced from animal fat when charcoalbroiling meats, are present in smoked meats and fish, and are also present in tobacco smoke. Nitrosamines are formed in foods that are smoked, salted, cured, or pickled using nitrites or nitrates as preservatives. The effects of nitrosamines, however, may be reduced by antioxidants such as vitamin C found in fruits and vegetables. Colon cancer is associated with high
