Download HOSMERIT NR507 Advanced Pathophysiology Midterm Exam Questions & Answers and more Exams Nursing in PDF only on Docsity!
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
- Thalassemia Normal MCHC in: - ANSWER: 1. Aplastic anemia
- Post-hemorrhagic anemia
- Hemolytic anemia High MCHC in: - ANSWER: 1. Hereditary spherocytosis
- Liver disease
- Hyperthyroidism
- 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
- 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