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GCU 631 Final Exam Advanced Pathophysiology Test with Answers Graded A+ Where do we hold the DNA inside of a cell? The nucleus What is cell suicide? apoptosis What are some things we see clinically in a patient pre- senting with carbon monoxide poisoning?
- Normal SpO
- Tissue damage What do we have: ABG w/ pH 7.25, bicarb 28, CO2 is 60? Respiratory acidosis How do we get molecules to between intracellular & extra cellular? If patient has large volume of vomiting, what would we see? Hydrostatic pressure (If it's water: osmotic pressure) Metabolic Alkalosis Why does metabolic alkalosis develop from vomiting? Losing acid, retaining Bicarb What do we look for on an amnio to see neural tube defects? Clinical characteristics of Trisomy 21 Alpha-fetal protein Wide eyes Wide neck Short stature Low IQ Low nasal bridge Low set ears Cardiac defects How could a newborn have type 1 diabetes Autoimmune/ Cannot be prevented We have a certain gene that takes care of maintenance of other cells Patient comes in with chronic wounds that aren't healing. What are you thinking? If a newborn doesn't have enough collectin-like protein what kind of infection might they develop? Housekeeping genes
- Diabetes
- Something else is going on with those patient/other co- morbidities
- Pneumonia
- Anything RESPIRATORY related
Where do B lymphocytes grow up and develop Bone marrow I go over to a friend's house to get chickenpox. What type of immunity is that? What is happening at a cellular level with a type two sensitivity reaction? Active acquired immunity/Body will make antibodies
- Antibodies are attaching to the cellular surface of the antigen.
- release of histamines and IgE
- Stops hemolytic anemia
- Give to Rh - moms with a Rh + baby If we have a patient that went under some organ trans- plant, why would we have tissue damage? Start to see TH1 cells release too many cytokines so we will see the cytotoxic ettects. Cytokines will actually attack the endothelial cells. What is an exotoxin? When bacteria is growing they release exotoxins. What do we have that helps us fight fungal infections?
- Phagocytes
- T-Lymphocytes Why, if I'm really stressed, am I more likely to get sick? Stress releases cortisol, cortisol increases, helper T cells are suppressed.
- Hypoglycemia Stressed patient (long period of time), what can we see develop with lab results? What happens when we have cellular metabolism that just isn't working right? What will develop? What is the least likely IL to cause endothelial cells to go into that proinflammatory state? If you had a patient that developed MODS, what sub- stances stimulate the normal endothelial cells to go into a proinflammatory state?
- Cortisol increase causes hyperglycemia initially, but with chronic stress cortisol levels become depleted causing hypoglycemia. (Adrenal insuflciency) Build up of waste IL Interleukins tumor necrosis factor IL- 6 What does Rhogram do?
- Increase BP What is happening at the cellular level in a sickle cell Valine replaces one of the amino acids (glutamate). That patient? What happens in their DNA? is what will sycle the cells. Where do we make oxytocin? Posterior Pituitary What genetic material will translocate in CML(Chronic Genes 9 and 22 will abnormally fuse and create a protein Myelogenous Leukemia)? called BCR-ABL- 1 Why do we give vasopressors to shock patients?
- Vasoconstriction though ADH What regulates our calcium? Which hormone? PTH (parathyroid hormone) If a patient came in with really high levels of ADH, what type of cancer would I suspect? If you have a patient that comes in saying I haven't gotten my period in 6 months, abnormal hair growth, osteoporo- sis, what tests should you run? Small cell carcinoma of the stomach CT their head to make sure they don't have a tumor looking for a Pituitary Adenoma Why do Diabetics pee so much Tying to get rid ott all that glucose Why do we see so many of those microvascular complica- tions in our diabetic patients, at a cellular level?
- Hyperplasia
- Basement membranes start to thicken Why do our diabetics need to get regular eye exams? We will see retinopathy develop as a result of retinal is- chemia S/S of hypothyroidism (low and slow) Why are obese people at a higher risk for developing high blood pressure. If you did a test where you poked me with the end of a safety pin and I couldn't tell if it was sharp or dull, what part of my brain is attected? Constipation Lethargy Low heart rate Make more angiotensin Pons Cerebellum
What part of my brain controls involuntary muscle control like my posture and balance? If I smile and I only have half a smile which nerve is attected? If I had an injury to my spinal cord and damaged upper motor nerves, what would you see? Ditterentiation between upper and lower motor neuron injury What is it called that separates the cerebellum from its cerebrum? If you had a defect in the arachnoid villi, what would you expect to be wrong with your patient? Facial nerve # Initially full paralysis, then gradual partial recovery LOWER: Permanent paralysis UPPER: Reversible paralysis Tentorium cerebelli Too little absorption of CSF What part of my brain allows me to focus my attention? Pre-Frontal What kind of seizure: altered LOC, dreamlike trans (im- paired). If there is capillary permeability increase in the brain, what type of cerebral edema will we see? If a patient had a CVA and they weren't able to feel the objects and unable to identify objects, what is that called? What is the theory that regulates pain transmission from cns in and out of the spinal cord? Who will need the most amount of pain meds: Rotator cutt injury, gall bladder, or CRUSH injury? Complex focal seizure Vasogenic cerebral permeability Tactile agnosia Gate control theory CRUSH because there is multiple systems involved. What kind of nerve fibers transmit pain? Delta-A fibers Where do those pain neurons live in the spinal cord? Dorsal root ganglia What kind of endogenous opioids do I have in myself Endorphins System is attected from major depressive disorders Hypothalmic Pituitary adrenal system (HPA)
- fat soluble becomes water soluble
- unconjugated bilirubin becomes conjugated bilirubin What do you want to look for if a patient comes in, zero GI complaints but has projectile vomiting all over the place? If I have a lactase deficiency, what kind of diarrhea will I develop?
- Increased intercranial pressure
- Something in the brain CT needed Watery/osmotic How do I document bright red bleeding from the rectum? Hematochezia S/Sx of a small bowel obstruction
- Abdominal distention/fullness (early sign)
- Nausea/vomiting (late signs) What bacteria runs rampant in daycares? Impetigo What disorder do we generally see with hepatic fat accu- mulation in the liver? What are the early s/sx of hepatitis (prodromal) What is it called when we don't have complete fusion of the Nadine dial and the inner maxillary process? Why will we see physiological jaundice in a newborn? Alcoholic cirrhosis
- Fatigue
- Vomiting
- hyper Algeria (overall nerve pain) Cleft lip/palate Immature liver Cannot get rid of the bilirubin Resulting in hyperbilirubinemia What does Surfactant do? Reduces surface tension Keeps Alveoli open Why would you see clubbing with respiratory conditions? Chronic hypoxic state If you had a patient that had long term COPD (chronically hypoxia), what are some physical signs of COPD?
- Barrel chested
- clubbed nails
- SOB on exertion How does conjugation of bilirubin occur?
If a patient has a pleural ettusion and we find that they have transudative exudate but not very many symptoms, what do I want to look for? Bronchiectasis that causes constriction and dilation in the bronchi. If I have a patient that is diagnosed with ARDS (acute respiratory distress syndrome), what am I going to be on high alert for them also developing? What if I diagnose a patient with emphysema but they say they've never smoked?
- Cyanosis
- Frothy cough Protein level (lab draw) Varicose bronchiectasis Pneumonia Check to see if there's a genetic predisposition to emphy- sema What is it called if there is fluid in the pleural space? Pleural Ettusion Working a patient up for Pulmonary HTN, what are some findings? Why do I worry about a young infant that has nasal con- gestion? Why do my cystic Fibrosis patients have all of that mucous plugging? Why do we care about natriuretic peptides? What does it tell us? If we have a patient with heart failure, what's happening to the renin & aldosterone? What do we test if I want to know a patient's renal func- tion? How does potassium (K+) and magnesium (Mg+) attect formation of kidney stones? SOB with activity JVD Peripheral edema They're nose breathers; can't eat if they can't breathe
- Too much defective chloride secretion
- Too much sodium absorption It attects the renin and aldosterone The natriuretic peptides are going to inhibit the renin & aldosterone GFR They attect crystal growth will stop stones from forming
lular reactive oxygen. What do you want to check on a patient that was found by neighbors, saying that she'd been laying on the floor for several hours? CK level (this checks for muscle breakdown) May develop Rhabdomyolysis Why do women develop osteoporosis more than men? Women have a higher oxidative stress and higher intracel- What is not working properly in a person that has Paget's disease? If I saw on an Xray that the radiologist read something sequestrum, what does that mean? Problems with bone resorption and bone formation/too much/too fast Devascularized, devitalized bone on Xray What is ankylosing spondylitis? Chronic inflammation that causes the spine and SI joints to just start fusing and stittening What is it called on a newborn when I go to rotate their hips and the hips are going to stay in contact w/ the acetabulum but it is not going to be seated very well? If I have a patient that their skin when they hurt themselves it becomes very elevated and rounded, what is it called? Tell me 2 things an allergic contact dermatitis and stasis dermatitis have in common: What do I call the skin lesions that are thick, silvery, and scaly? What do I call it if I have a big collection of infected hair follicles? Subluxation Keloid skin
- Inflammation of the skin (redness)
- Itching (Plaque) psoriasis Carbuncle What do I call it if I have one infected hair? Gruncle If you had chicken pox early on in life, what do you need to educate your patient that they can develop later on? Herpes Zoster (shingles) Describe what tinea corporis (ring worm) looks like? Red, circular lesion; scaly What is Kaposi sarcoma Vascular malignancy
nail fungus duced immunosuppression What disorder is kaposi sarcoma associated with? HIV/AIDS Where will we see the kaposi sarcoma be located at usu- ally? In the legs What is kaposi sarcoma associated with? Almost always going to be related to some kind of drug-in- Where would you see an onychomycosis? A nail bed If I have a history of PID and now I come in with right-sided pain, dark red vaginal discharge, I've missed 2 periods, what is going on? What term do we use if we're talking about benign uterine tumors (fibroids)? You have a patient who is in her third trimester of preg- nancy and there is all of a sudden bright red vaginal bleeding, no pain. What are the ditterential diagnosis? If we diagnose a woman with a cervical carcinoma in situ, what does that mean? Tell me how we figure out the GTPAL system Ectopic pregnancy leiomyomas Placenta previa Full epithelial thickness of the cervix G: Gestation- How many pregnancies you've had, includ- ing a current pregnancy T- How many term deliveries P- number of preterm births A- Abortions (including miscarriages) L- Living children Ovarian cancer is related to a mutation of which gene? BRCA- 1 Add 7 days past the first day of your last period, then Be able to figure out due date using Nagel's rule subtract 3 months The test will give us a date, we must be able to figure out the due date
If you had a patient that came in and said that they had this new lesion, it has a depressed center, it's got rolled borders, and its living right on their face, what is your biggest suspicion/ditterential diagnosis? What does Preeclampsia look like?S/S What can happen if we do not treat PID (pelvic inflamma- tory disease)? Basal cell carcinoma Edema(hands/face) Clonus Headache High B/P RUQ Pain from protienuria Scarring of the fallopian tubes due to inflammation
