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HOSMERIT NR507 Advanced Pathophysiology Midterm Exam Questions & Answers, Exams of Nursing

A comprehensive set of questions and answers covering key concepts in advanced pathophysiology, specifically focusing on immunology and related disorders. It covers topics such as primary and secondary immunodeficiency, hypersensitivity reactions, autoimmune diseases, and hematological conditions. Valuable for students preparing for a midterm exam in advanced pathophysiology.

Typology: Exams

2024/2025

Available from 11/13/2024

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HOSMERIT

NR507 ADVANCED PATHOPHYSIOLOGY MIDTERM

EXAM QUESTIONS & CORRECT ANSWERS GRADED

A+|| 2024 - 2025

Primary immunodeficiency - ANSWER: - less common and occur in result ofsingle gene defects (defect on the development of the immune system)

  • this could involve antibody deficiencies, B- and T- cell deficiencies, defects in thephagocytic cells and deficiency of complement
  • something is lacking with the immune system Ex: B-lymphocyte deficiency is one of the most common forms of primaryimmunodeficiency Examples of primary immunodeficiency - ANSWER: - Chronic GranulomatousDisease of Childhood
  • DiGeorge Syndrome
  • Familial Mediterranean fever
  • Job Syndrome
  • Common Variable Immunodeficiency Secondary Immunodeficiency - ANSWER: - conditions where the immune systembecomes compromised because of a complication of some other physiological condition or disease
  • can be caused by cancer, effect from a drug (chemotherapeutic agents that suppress immune system), and infections that compromise the immune system Ex: Patient with HIV gets pneumocystis carinii What is is a predominant cause of secondary immune deficiencies worldwide? - ANSWER: - malnutrition

Examples of secondary immunodeficiency - ANSWER: - Pneumocystis Carinii

  • HIV
  • PNA
  • Sinus infection
  • Lung cancer Hypersensitivity Type I - ANSWER: - allergic reaction
  • mediated by IgE
  • mast cells are the primary effector cells involved
  • inflammation due to mast cell degranulation Hypersensitivity Type I symptoms - ANSWER: Local: itching, rashSystemic: wheezing Hypersensitivity Type I example - ANSWER: Most dangerous form: anaphylacticreaction - > systemic response - > hypertension - > severe bronchoconstriction Treatment: epinephrine reverses the effects Hypersensitivity Type II - ANSWER: - cytotoxic reaction
  • tissue/organ specific
  • macrophages are primary effector cells involved
  • can cause tissue damage or alter function Mechanism: Tissue-specific destruction or impairment because of:
  • Antibody binding followed by lysis via complement
  • Antibody binding followed by macrophage phagocytosis
  • Antibody binding followed by neutrophil destruction
  • Antibody-dependent cell (NK)-mediated cytotoxicity
  • Antireceptor antibodies Hypersensitivity Type II examples - ANSWER: 1. Grave's disease (hyperthyroidism): altering thyroid function, but does not destroy thyroid tissue Incompatible blood type (ABO incompatibility): cell/tissue damage occurs
  • severe transfusion reaction - > transfused erythrocytes destroyed by agglutinationor complement-mediated lysis
  • Drug allergies
  • Hemolytic anemia Graves disease - ANSWER: - Autoantibodies specific for thyroid tissue impairreceptor for TSH ABO incompatibility - ANSWER: - Complement damages RBC membrane andcells lyse Hypersensitivity Type III - ANSWER: - NOT organ specific
  • antibody binds to soluble antigen outside the cell surface that was released into theblood of body fluids - > complex is then deposited in the tissues
  • organ rejection involved cytotoxicity
  • antigens from target cells stimulate T-cells to differentiate into cytotoxic T-cells
  • neutrophils are the primary effector cells Raynaud's phenomenon - ANSWER: - Complex deposited in small peripheral vessels in cool temperatures leading to vasoconstriction and blocked circulation Hypersensitivity Type III examples - ANSWER: 1. Rheumatoid arthritis:antigen/antibodies are deposited in the joints

Systemic Lupus Erythematosus (SLE): antigen/antibodies deposit in organs thatcause tissue damage

  • Serum sickness
  • Raynaud's phenomenon Systemic Lupus Erythematosus (autoimmune response) - ANSWER: - facial rashconfined to cheeks (malar rash)
  • discoid rash (raised patches, scaling)
  • photosensitivity (rash developed as a result to light exposure)
  • oral or nasopharyngeal ulcers
  • hematologic disorders
  • immunologic disorders
  • non-erosive arthritis of at least 2 peripheral joints
  • serositis (pleurisy, pericarditis)
  • renal disorder
  • neurologic disorder
  • presence of antinuclear antibody (ANA) Autoimmunity - ANSWER: - reaction of immune response to one's own tissues
  • can be familial Autoimmunity examples - ANSWER: - Systemic Lupus Erthyematosus
  • Rheumatoid Arthritis
  • Multiple Sclerosis
  • Sjogren's Syndrome T or F: T-Cells, B-cells, and autoantibodies are immune components involved inautoimmune diseases - ANSWER: True

T or F: The presenting signs and symptoms of an autoimmune disease is similaracross all autoimmune diseases - ANSWER: False T or F: The presence of a low number of autoantibodies is an indicator that theindividual will develop an autoimmune disease - ANSWER: False A renal disease most often associated with autoimmunity is - ANSWER: - Glomerulonephritis What can depress a person's normal immune function? - ANSWER: - psychological stress What test is positive in 90% of patients diagnosed with Systemic LupusErythematosus (SLE)? - ANSWER: - Antinuclear Antibody (ANA) What can be used to diagnose Systemic Lupus Erythematosus (SLE)? - ANSWER:

  • Facial rash confined to the cheeks What are symptoms that best describe Systemic Lupus Erythematosus? - ANSWER: - Tissue inflammation, vasculitis, rash, tissue inflammation Which of the following is an autoimmune disease? - ANSWER: - Systemic LupusErythematosus (SLE) Alloimmunity - ANSWER: Individual's immune system reacting against antigenson the tissues of other members of the same species Loss of vibratory sense in a patient with Vitamin B- 12 deficiency is due to whichof the following pathophysiological changes - ANSWER: - Posterior and lateral column spinal cord changes due to nerve demyelination A deficiency of intrinsic factor will result in - ANSWER: - pernicious anemia

In a patient with pernicious anemia, which lab value could be normal or low? - ANSWER: - folate What lab value will be low in a patient with folate deficiency? - ANSWER: - Reticulocyte count The NP is examining a patient with a longstanding history of chronic bronchitis.Cor pulmonale is expected in the patient that presents with - ANSWER: - Hepatomegaly In normal gas exchange, what is correct? - ANSWER: - After air is breathed in, it diffuses into the pulmonary veins Asthma is a chronic disease characterized by - ANSWER: - Intermittent, reversibleairflow obstruction Alloimmunity examples - ANSWER: - neonatal diseases where the maternalimmune system becomes sensitized against antigens expressed by fetus

  • transplant reaction
  • transfusion reaction NYHA functional classifications - ANSWER: - impact on the patient's activitycaused by the heart failure symptoms
  • Stage I, II, III, IV NYHA Stage I - ANSWER: - mild
  • no limitation on physical activity
  • ordinary physical activity does not cause symptoms NYHA Stage II - ANSWER: - mild
  • slight limitation of physical activity
  • comfortable at rest
  • ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain

NYHA Stage III - ANSWER: - moderate

  • marked decreased in physical activity
  • comfortable at rest
  • less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain NYHA Stage IV - ANSWER: - severe
  • inability to carry on any physical activity without discomfort
  • symptoms of heart failure of the anginal syndrome may be present even at rest
  • if any physical activity, discomfort is increased Hypersensitivity Type IV - ANSWER: - known as cell-mediated responses
  • delayed response
  • lymphocytes and macrophages as primary mediators
  • does not involve antigen/antibody complexes like the other types
  • T-cell mediated (T-cells play a major role in organ rejection)
  • T-cells have direct cytotoxic activity along with helper T-cells involved in delayed hypersensitivity
  • does not involve mast cells of H1 receptors Hypersensitivity Type IV example - ANSWER: 1. Poison ivy
  • T cells attack tissue directly (no antibody) Hypersensitivity Type IV rash - ANSWER: - delayed hypersensitivity reaction
  • contact dermatitis (lesions only at the site of contact with the allergen) Treatment:
  • topical corticosteroid

Aplastic anemia - ANSWER: - diagnosis made by blood tests and bone marrowbiopsy

  • suspected if levels of circulating erythrocytes, leukocytes, and platelets arediminished
  • granulocytes < 500
  • platelets < 20,
  • absolute reticulocyte less than or equal to 40 x 109 Sickle cell anemia - ANSWER: - sickle cell trait
  • autosomal recessive genetic disorder
  • inherited a normal hemoglobin gene from one parent and an abnormal hemoglobingene from the other parent
  • involves a single amino acid change on the beta-chain
  • Increased RBCs, hemoglobin concentration, RBC dehydration, acidosis, andhypoxemia
  • characterized by acute painful episodes Thalassemia - ANSWER: - inherited blood disorder that causes decreasedcirculating hemoglobin
  • may have many possible genetic mutations
  • ineffective erythropoiesis
  • occurs primary in persons from Southeast Asia and China Hypersensitivity Type I rash - ANSWER: - immediate hypersensitivity reaction
  • atopic dermatitis (widely distributed lesions) Which of the following are considered the "first responders" of the innate immunesystem? - ANSWER: - Neutrophils Type 2 (Cytotoxic) hypersensitivity reactions are mediated by - ANSWER: - IgGor IgM What type of hypersensitivity reaction is anaphylaxis? - ANSWER: - Type Ihypersensitivity reaction

Hives (urticaria) are an example of what type of hypersensitivity reaction? - ANSWER: - Type I hypersensitivity reaction What type of hypersensitivity reaction is allergic contact dermatitis? - ANSWER: - Type IV hypersensitivity reaction The diagnosis for an individual who presents to the office with sudden swollen lips and eyes, shortness of breath and throat tightness after a bee sting is - ANSWER: - anaphylaxis Damage occurs with ABO incompatibility because - ANSWER: - Complementdamages RBC membrane causing cell lysis Type IV cytotoxic hypersensitivity reactions are mediated by - ANSWER: - T-cells What is the underlying pathology for hay fever? - ANSWER: - Mast celldegranulation Hematology - ANSWER: - anemias

  • involves RBCs
  • most of the body's iron stores come from the recycling of iron from old RBCs Sustained tachycardia will result in... - ANSWER: - decreased stroke volume Cor Pulmonale is - ANSWER: - Right ventricular failure secondary to pulmonaryhypertension Hypertension has its most immediate effect on - ANSWER: - afterload The most common cause of right-sided heart failure is: - ANSWER: - pulmonaryhypertension What condition can decrease preload? - ANSWER: - hemorrhage

In the healthy heart, the response to an increase in preload is for the stroke volumeto - ANSWER:

  • increase What measures the average size of red blood cells? - ANSWER: - MeanCorpuscular Volume (MCV) What is considered a microcytic anemia? - ANSWER: - Iron deficiency What microcytic anemia is characterized by hyperchromic RBCs? - ANSWER: - Hereditary spherocytosis T or F: Interstitial lung disease (ILD) includes infectious and neoplastic lungdiseases - ANSWER: False T or F: Interstitial lung disease refers to any disease affecting the pulmonary interstitium and typically excludes infectious and neoplastic diseases - ANSWER:True T or F: A subjective finding in interstitial lung disease is rhonchi in the upperposterior airways - ANSWER: False Which of the following pulmonary function test results are consistent with asthma? ANSWER: - decreased peak expiratory flow rate Asthma results in - ANSWER: - Decreased alveolar ventilation Symptoms common to both intrinsic and extrinsic asthma include - ANSWER: - wheezing Hyperresonance found on lung percussion with a patient with COPD is primarilydue to - ANSWER: - air trapping

A patient with chronic bronchitis is at risk for developing pneumonia due to - ANSWER: - mucus plug What is not a clinical characteristic of anemia? - ANSWER: - Bradycardia Iron deficiency anemia labs - ANSWER: - Ferritin level: decreased

  • Red blood cell distribution width: increased
  • Iron level: decreased
  • Total iron-binding capacity: increased
  • Transferrin saturation: decreased Thalassemia labs - ANSWER: - Ferritin level: increased
  • Red blood cell distribution width: normal to increased
  • Iron level: normal to increased
  • Total iron-binding capacity: normal
  • Transferrin saturation: normal to increased Anemia of chronic disease labs - ANSWER: - Ferritin level: normal to increased
  • Red blood cell distribution width: normal
  • Iron level: normal to decreased
  • Total iron-binding capacity: normal
  • Transferrin saturation: normal to slightly decreased Sideroblastic anemia labs - ANSWER: - Ferritin level: normal to increased
  • Red blood cell distribution width: increased
  • Iron level: normal to increased
  • Total iron-binding capacity: normal
  • Transferrin saturation: normal to increased

Mean Corpuscular Hemoglobin Concentration (MCHC) - ANSWER: - measure ofthe average concentration of hemoglobin inside a single RBC Anemias can be classified into 3 categories based on the average size of the RBCs (MCV): - ANSWER: 1. Microcytic anemia (MCV<80 fL) describes RBCs that aresmall.

  • Macrocytic anemia (MCV>100 fL) describes RBCs that are large.
  • Normocytic anemia (MCV 80 - 99 fL) describes RBCs that are normal in size. Microcytic (MCV<80 fL) - ANSWER: - iron deficiency
  • sideroblastic
  • thalassemia
  • anemia of chronic disease Normocytic (MCV 80 - 99 fL) - ANSWER: - anemia of inflammation and chronicdiseases
  • hereditary spherocytosis
  • G6PD deficiency
  • paroxysmal nocturnal hemoglobinuria Macrocytic (MCV>100 fL) - ANSWER: - B12 deficiency (pernicious anemia)
  • folate deficiency Normochromic anemias - ANSWER: 1. Aplastic anemia
  • Post-hemorrhagic anemia
  • Hemolytic anemia What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? - ANSWER: - Decreased forced expiratory flow(FEV1) T or F: Simple spirometry includes a measure of residual capacity - ANSWER: False

Heart failure: Stage A - ANSWER: - patient has risk factors (CAD) but nosymptoms, no structural heart damage Heart failure: Stage B - ANSWER: - patient has structural heart damage (MI), butno symptoms Heart failure: Stage C - ANSWER: - patient is symptomatic with alteration in theirdaily functions due to dyspnea, swelling, etc. Heart failure: Stage D - ANSWER: - end stage heart failure

  • maximized medications
  • may need heart transplant or pacemaker What spirometry results indicate restrictive lung disease? - ANSWER: - FEV1,FVC, and total lung capacity reduced; FEV1/FVC ratio normal Chronic bronchitis will decrease which of the following parameters? - ANSWER:
  • Decreased forced expiratory flow (FEV1). The NP reviews the results of a patient's pulmonary function tests and notes that the FEV1, FVC, and total lung capacity (TLC) are reduced. The FEV1/FVC ratio is normal. Based on interpretation, this reflects: - ANSWER: - Restrictive lung disease. T or F: The characteristic finding of on a chest x-ray of an individual with ILD is ahoney-comb pattern - ANSWER: True T or F: The symptoms that are common to all types of interstitial lung disease areshortness of breath and non-productive cough - ANSWER: True T or F: An objective finding in a patient with ILD include productive cough - ANSWER: False T or F: The four key diagnostic tests for interstitial lung disease are pulmonary function tests, high resolution CT scan, bronchoalveolar lavage and lung biopsy - ANSWER: True

What interstitial lung diseases are the most diagnosed? - ANSWER: - Hypersensitivity pneumonitis

  • Pneumoconioses
  • Radiation pneumonitis The NP notes that a patient's FEV1/FVC ratio is severely reduced. Which of the following conditions is most likely the patient's pulmonary issue? - ANSWER: - chronic asthma A patient with mitral regurgitation would most likely present with - ANSWER: - ablowing holosystolic murmur Rheumatic fever is a common cause for - ANSWER: - mitral stenosis valvedisorder A patient with normal lungs should be able to exhale - ANSWER: - 80% of theforced vital capacity within the first second Simple spirometry can be used to measure any of the following EXCEPT - ANSWER: - residual volume The patient with aortic regurgitation would most likely present with: - ANSWER:
  • An early, high-pitched diastolic murmur heard at the left lower sternal border
  • A diastolic rumbling murmur heart at the apex of the heart
  • A systolic crescendo-decrescendo murmur heart at the left upper sternal border The number one cause of chronic bronchitis is - ANSWER: - cigarette smoking A patient with chronic bronchitis is most likely to experience: - ANSWER: - Respiratory acidosis due to inability to exhale CO Which of the following is considered a late effect of emphysema? - ANSWER: - Hypoxemia and Hypercapnia

The terms normocytic, microcytic, and macrocytic characterizes red blood cells bytheir - ANSWER: size T or F: Identification of the type of anemia involves an examination of size of theRBC only - ANSWER: False What is a type of macrocytic anemia? - ANSWER: - vitamin B- 12 deficiency What would normocytic-normochromic indicate? - ANSWER: - cell is normal in size and normal in hemoglobin level Which anemias can be categorized as microcytic-hypochromic? - ANSWER: - Irondeficiency anemia

  • sideroblastic anemia
  • thalassemia Which anemias can be categorized as microcytic-normochromic? - ANSWER: - anemia of inflammation and chronic disease Which anemias can be categorized as microcytic-hyperchromic? - ANSWER: - hereditary spherocytosis Iron deficiency anemia - ANSWER: - microcytic hypochromic anemia
  • caused by disorders of hemoglobin synthesis, particularly iron deficiency
  • ferritin is an important measurement that reflects the body's total iron stores
  • low ferritin reflects anemia, but does not determine the type A transferrin deficiency will most likely result in - ANSWER: - iron deficiencyanemia

T or F: Although less common, transferrin deficiencies and mitochondrial defectscan lead to iron deficiency anemia. - ANSWER: True T or F: The basic pathophysiology of iron deficiency anemia is that there are insufficient iron levels or the inability of the cell's mitochondria to utilize ironeffectively. - ANSWER: True T or F: When iron stores are depleted, the cell's mitochondria are still able to utilizeiron effectively due to compensatory mechanisms. - ANSWER: False Which of the following pulmonary function test results are expected in a patientwith chronic bronchitis? - ANSWER: - Decreased FEV1/FVC ratio The effects of an Alpha-antitrypsin 1 deficiency is - ANSWER: - Inability to blockthe effects of proteolysis The NP notes that a patient's FEV1/FVC ratio is normal. Which of the following conditions is most likely the patient's pulmonary issue? - ANSWER: - Pulmonaryfibrosis Which of the following would indicate obstructive lung disease? - ANSWER: - chronic asthma What types of interstitial lung diseases (ILD) are commonly associated withsmoking? - ANSWER: - Desquamative interstitial PNA

  • Pulmonary Langerhans histiocytosis
  • Respiratory bronchiolitis-interstitial lung disease What drugs are commonly associated with development of a medication-inducedinterstitial lung disease (ILD)? - ANSWER: - Nitrofurantoin
  • Amiodarone
  • Methotrexate The treatment of iron deficiency anemia includes - ANSWER: - ironsupplementation

What condition could result in iron deficiency anemia? - ANSWER: - excessivebleeding The most common type of anemia is - ANSWER: - iron deficiency anemia Low MCHC in: - ANSWER: 1. Iron deficiency anemia 2 Sideroblastic anemia

  1. Thalassemia Normal MCHC in: - ANSWER: 1. Aplastic anemia
  2. Post-hemorrhagic anemia
  3. Hemolytic anemia High MCHC in: - ANSWER: 1. Hereditary spherocytosis
  4. Liver disease
  5. Hyperthyroidism
  6. Sickle cell disease Hereditary spherocytosis - ANSWER: - result of mild cellular dehydration
  • MCV is low because of membrane loss and cell dehydration Major lab marker for anemia - ANSWER: - increased RBC width (RDW) is one ofthe earliest lab markers in developing microcytic or microcytic anemia Folate deficiency - ANSWER: - can cause megaloblastic anemia
  • common in alcoholics A non-megaloblastic anemia would be caused by - ANSWER: - liver disease Folic acid is essential to the body because it - ANSWER: - Plays a major role in thematuring of RBCs

Extrinsic asthma is - ANSWER: - triggered by an allergic reaction What lab value will be normal in a patient with pernicious anemia? - ANSWER: - MCHC What lab value would be elevated in a patient with pernicious anemia? - ANSWER: - MCV What are causes of hemolytic anemia? - ANSWER: - transfusion reaction

  • drugs
  • infection T or F: Acute blood loss anemia is usually associated with acute GI bleeding andlabor and delivery complications - ANSWER: True In hemolytic anemia, the destruction or lysis of RBCs is due to: - ANSWER: - Enzymes or toxins produced by an infectious agent
  • Chemical release by one's immune system
  • Effects of drugs An individual who has received an incorrect blood transfusion will exhibit signs of ANSWER: - Hemolytic anemia The MCHC will be normal in what anemias? - ANSWER: - Aplastic anemia
  • Post-hemorrhagic anemia
  • Hemolytic anemia What lab value is low in aplastic anemia? - ANSWER: - reticulocyte count What lab value is normal for hemolytic anemia? - ANSWER: - MCV

What lab value will be high in post-hemorrhagic anemia? - ANSWER: - reticulocyte count Vitamin B- 12 deficiency - ANSWER: - fatigue

  • dyspnea
  • peripheral neuropathy in BLE (numbness and tingling) Risk factors:
  • older adults
  • H-pylori infection affects vitamin B- 12 absorption Hemolytic anemia - ANSWER: - RBCs are destroyed Ex. mismatched blood types, autoimmune hemolytic anemia due to autoantibodies against erythrocytes that the immune system perceives as an antigen and attacks it, allergic reaction to a drug causes drug-induced hemolytic anemia Acute blood loss anemia - ANSWER: - trauma victims losing blood Sickle cell anemia and thalassemia are more prevalent in which of the followinggeographic areas? - ANSWER: - Africa Thalassemia is similar to sickle cell anemia in that the individual with thalassemia ANSWER: - Inherits an abnormal Hb gene from one parent T or F: The patient with thalassemia is at high risk for stroke - ANSWER: False T or F: There are four genes involved in encoding synthesis of the alpha proteinchains for Hb and are located on chromosome number 16 - ANSWER: True What is correct regarding thalassemia? - ANSWER: - May have many possiblegenetic mutations

T or F: The patient with sickle cell anemia is at high risk for stroke - ANSWER: True T or F: Cells that contain abnormal types of hemoglobin are more susceptible toinfection by the parasite that causes malaria - ANSWER: False T or F: The pathophysiology of sickle cell anemia involves a single amino-acidchange on the beta-chain - ANSWER: True Heart anatomy - ANSWER: Normal blood flow through the heart - ANSWER: Cardiac output (CO) - ANSWER: - the volume of blood pumped from eachventricle per minute

  • ml/min CO (cardiac output) = SV (stroke volume) x HR (heart rate) Stroke Volume (SV) - ANSWER: - The volume of blood pumped forward witheach ventricular contraction
  • ml/beat Heart rate (HR) - ANSWER: - beats/min Preload - ANSWER: - diastolic filling with venous blood Contractility - ANSWER: - systolic ejection Afterload - ANSWER: - resistance to systolic ejection

What describes the flow of blood between the heart and lungs? - ANSWER: - oxygenated blood is transported from the lungs to the heart via the pulmonary veins What are non-modifiable risk factors for Coronary Artery Disease? - ANSWER: - family history

  • age
  • male
  • menopause T or F: In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen. - ANSWER: True Coronary artery disease (CAD) is mainly the result of - ANSWER: - longstandingatherosclerosis What are modifiable risk factors for Coronary Artery Disease? - ANSWER: - obesity
  • dyslipidemia
  • DM
  • smoking
  • HTN
  • sedentary lifestyle HTN, pulmonary disease, and damage to aortic valve will result in... - ANSWER:
  • increased afterload Ischemia, acidosis, and cardiomyopathy will result in... - ANSWER: - decreasedcontractility Hypertension has its most immediate effect on... - ANSWER: - afterload Hemorrhage and decreased afterload is due to... - ANSWER: - decreased volume

Increased preload increases... - ANSWER: - stroke volume (in a healthy heart)

  • heart is able to compensate to the extra volume Decreased preload can be caused by.... - ANSWER: - hemorrhage
  • dehydration
  • anything that reduces blood volume Heart failure pathophysiology - ANSWER: - less cardiac output to meet the body'soxygen demands
  • decreased contractility, decreased stroke volume, increased left ventricular end-diastolic volume (LVEDV) - > causes dilation of heart and an increase in preload Risk factor:
  • long-standing HTN Right-sided heart failure - ANSWER: - can occur due to left-sided heart failure dueto the back-up of fluid from the left to the right
  • can occur without left-sided heart failure due to long-standing pulmonary issues(COPD) Right sided heart failure symptoms - ANSWER: - JVD
  • Hepatosplenomegaly
  • Peripheral edema
  • Cor Pulmonale
  • Tricuspid valve damage Left sided heart failure symptoms - ANSWER: - Increased left ventricular afterload
  • Decreased ejection fraction
  • Increased left ventricular preload
  • Pulmonary edema
  • Dyspnea The patient with aortic stenosis would most likely present with - ANSWER: - Mid-systolic crescendo-decrescendo murmur. A patient with mitral stenosis would most likely present with: - ANSWER: - Rumbling, decrescendo diastolic murmur heard at apex of the heart. Aortic stenosis - ANSWER: - narrowing of the aorta Symptoms:
  • fainting
  • chest pressure upon exercising
  • sustained, laterally displaced apical pulse
  • mid- systolic crescendo-decrescendo murmur heart loudest at the base andradiating to the neck
  • S4 gallop present Aortic regurgitation - ANSWER: - (aortic insufficiency) incompetent aortic valvethat allows backward flow of blood into left ventricle during diastole Symptoms:
  • shortness of breath that progressively worsens
  • high pitched early diastolic murmur heart loudest at the left lower sternal border
  • diastolic rumbling sound at the heart's apex
  • systolic crescendo-decrescendo murmur heart at the left upper sternal border
  • XR may show signs of pulmonary edema and cardiomegaly

Mitral stenosis - ANSWER: - calcified mitral valve impedes forward flow of bloodinto left ventricle during diastole

  • symptoms of decreased cardiac output especially during exertion Symptoms:
  • shortness of breath on activity
  • pounding/racing heart
  • associated with hx of rheumatic heart disease
  • low pitched murmur auscultated at the heart's apex
  • jugular vein distention and bilateral crackles in the lung bases
  • ECG may demonstrate afib and left ventricular hypertrophy Mitral regurgitation - ANSWER: - mitral insufficiency; incompetent mitral valveallows regurgitation of blood back into left atrium during systole Symptoms:
  • shortness of breath
  • jugular vein distention
  • crackles in bilateral lung bases
  • blowing pansystolic murmur heart beat at the heart's apex and radiates to the backand axilla Obstructive pulmonary disease - ANSWER: - decreased FEV1
  • decreased FEV1 ratio Restrictive pulmonary disease - ANSWER: - FEV1/FVC ratio above 70% Asthma - ANSWER: episodes of breathing difficulty due to narrowed orobstructed airways Intrinsic asthma - ANSWER: - triggered by something internal such as anxiety

Extrinsic asthma - ANSWER: - triggered by something outside environment suchas dust mites or wet dander Treatment for asthma (mild-intermittent) - ANSWER: - short acting beta 2- agonist inhalers COPD - ANSWER: - diagnosis based on history of symptoms, physical exam, testimaging, pulmonary function tests, and blood gas analysis

  • PFT reveals airway obstruction (decreased FEV1) that is progressive andunresponsive to bronchodilators Types of COPD - ANSWER: 1. Emphysema
  1. Chronic bronchitis COPD Staging - ANSWER: - based on the degree of airway limitation GOLD 1 - ANSWER: - Mild COPD
  • FEV1 >/= 80% predicted GOLD 2 - ANSWER: - Moderate COPD
  • 50% </= FEV1 < 80% predicted GOLD 3 - ANSWER: - Severe COPD
  • 30% </= FEV1 < 50% predicted GOLD 4 - ANSWER: - Very severe
  • FEV1 < 30% predicted Emphysema - ANSWER: - damage occurs in the alveoli
  • impairs gas exchange