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NR 507 midterm exam questions with
answers
Hypersensitivity: Type 1 - .......🔷ANSWERS🔷......✔✔ -Mediated IgE -inflammation due to mast cell degranultion -anaphylactic, asthma, hay fever treatment: epinephrine Hypersensitivity: Type 2 - .......🔷ANSWERS🔷......✔✔ -Cytotoxic reaction: tissue specific -binds to the antigen ON THE CELL SURFACE -macrophages are primary effectors cells involved cause tissue damage or alter function Hypersensitivity 2 - .......🔷ANSWERS🔷......✔✔ -Graves Disease (hyperthyroidism) - alters function not destroy -blood transfusions reaction- transfused erythrocytes are destroyed by agglutination or lysis -drug allergies -hemolytic anemia Hypersensitivity: type 3 - .......🔷ANSWERS🔷......✔✔ -Not organ specific -antibody binds to soluble antigen OUTSIDE THE CELL SURFACE that was released into the blood or bodily fluids, and the complex is then deposited in the tissues Hypersensitivity: Type 3 - .......🔷ANSWERS🔷......✔✔ -rheumatoid arthritis -Systemic Lupus Erythematosus (SLE) -Raynaud's
Hives (urticaria) - .......🔷ANSWERS🔷......✔✔ Hypersensitivity Type 1 First responders to innate the immune system - .......🔷ANSWERS🔷......✔✔ Neutrophils Allergic contact dermatitis - .......🔷ANSWERS🔷......✔✔ Hypersensitivity Type IV Type 2 cytotoxic hypersensitivity mediated by: - .......🔷ANSWERS🔷......✔✔ -IgG IgM -macrophages are primary effort cells
Serum Sickness - .......🔷ANSWERS🔷......✔✔ type 3 hypersensitivity Hypersensitivity IV, - .......🔷ANSWERS🔷......✔✔ -is more of a delayed immune response. -mediated T-cells attack tissue directly (no antibodies) Autoimmune - .......🔷ANSWERS🔷......✔✔ -diseases in which the body makes antibodies directed against its own tissues
Primary immunodeficiency - .......🔷ANSWERS🔷......✔✔ -Genetic; inherited -result of single gene defects -B and T cell deficiencies secondary immunodeficiency - .......🔷ANSWERS🔷......✔✔ -acquired Common cause of secondary immunodeficiency - .......🔷ANSWERS🔷......✔✔ Malnutrition
Anemia occur by... - .......🔷ANSWERS🔷......✔✔ -impaired RBC production -excessive blood loss
- increased RBC production microlytic anemia is characterized by hyper chromic RBS:
- .......🔷ANSWERS🔷......✔✔ Hereditary spherocytosis Anemia - .......🔷ANSWERS🔷......✔✔ -"without blood" 4.7-6.1mcl - .......🔷ANSWERS🔷......✔✔ Normal for men RBC 4.5-5.2mcL - .......🔷ANSWERS🔷......✔✔ Normal for women RBC 13.5-17.5 - .......🔷ANSWERS🔷......✔✔ Normal hemoglobin for men 12.0-15.5 g/dL - .......🔷ANSWERS🔷......✔✔ Normal hemoglobin for women RBC - .......🔷ANSWERS🔷......✔✔ The number of erythrocytes in 1 cubic mm of whole blood Hemoglobin (Hgb) - .......🔷ANSWERS🔷......✔✔ The oxygen-carrying pigment of red cells Hematocrit (Hct) - .......🔷ANSWERS🔷......✔✔ The volume of cells as a % of total volume of cells and plasma in whole blood 42-45% - .......🔷ANSWERS🔷......✔✔ Normal for HCT for men 37-48% - .......🔷ANSWERS🔷......✔✔ Normal HCT for women
Mean Cell Volume (MCV) - .......🔷ANSWERS🔷......✔✔ Measures the average size of the RBC 80-100 fL - .......🔷ANSWERS🔷......✔✔ Normal MCV RDW (red cell distribution width) - .......🔷ANSWERS🔷......✔✔ Estimate of the uniformity of individual cell size 11.5- 14.5% - .......🔷ANSWERS🔷......✔✔ Normal RDW Microcytic (MVC <80fL) - .......🔷ANSWERS🔷......✔✔ Iron deficiency Microcytic (MVC <80fL) less than - .......🔷ANSWERS🔷......✔✔ Sideroblastic Microcytic (MVC <80fL) - .......🔷ANSWERS🔷......✔✔ Thalassemia Microcytic (MVC <80fL) - .......🔷ANSWERS🔷......✔✔ Anemia of chronic disease Normocytic (MVC 80-99) - .......🔷ANSWERS🔷......✔✔ Anemia of inflammation and chronic disease Normocytic (MVC 80-99) - .......🔷ANSWERS🔷......✔✔ Hereditary spherocytosis Normocytic (MVC 80-99) - .......🔷ANSWERS🔷......✔✔ G6PD deficiency Normocytic (MVC 80-99) - .......🔷ANSWERS🔷......✔✔ Paroxysmal nocturnal hemglobinuria Macrocytic (MVC >100) greater than - .......🔷ANSWERS🔷......✔✔ B12 deficiency (pernicious anemia)
Microcytic Hyperchromic - .......🔷ANSWERS🔷......✔✔ Hereditary spherocytosis Lack of intrinsic factor causes - .......🔷ANSWERS🔷......✔✔ pernicious anemia Folic acid is essential for the body because - .......🔷ANSWERS🔷......✔✔ It plays a role in maturing of RBCs Liver disease causes - .......🔷ANSWERS🔷......✔✔ Non-megaloblastic anemia Macrocytic Anemia's - .......🔷ANSWERS🔷......✔✔ -MCV larger than 100. -megaloblastic and non-megaloblastic megaloblastic anemia (macrocytic) - .......🔷ANSWERS🔷......✔✔ Folate deficiency and vitamin b-12 deficiency Non-megaloblastic anemia (macrocytic) - .......🔷ANSWERS🔷......✔✔ -Liver disease, myelodsplastic syndrome, hemorrhage Manifestations of Macrocytic Anemia's - .......🔷ANSWERS🔷......✔✔ -fatigue -dyspnea -loss of appetite and weight -diarrhea -pallor B12 definitely (pernicious anemia) - .......🔷ANSWERS🔷......✔✔ -Autoimmune destruction of intrinsic factor -peripheral neuropathy
- treatment: injections risk: vegetarians, elderly, h-pylori infection Folate deficiency anemia - .......🔷ANSWERS🔷......✔✔ -lack of folate leading to premature RBC death... caused by dietary deficiency
-ferritin level normal -alcoholics, pregnancy, anticonvulsant meds folic acid foods - .......🔷ANSWERS🔷......✔✔ peas beans veggies liver seeds orange juice fortified bread cereal rice pernicious anemia labs - .......🔷ANSWERS🔷......✔✔ -Normal or low -folate -MCHC is normal -elevated MCV Folate deficiency labs - .......🔷ANSWERS🔷......✔✔ macrocytic. (increased MCV) low RBC count. decreased folate. hemolytic anemia - .......🔷ANSWERS🔷......✔✔ -destruction of lysis of RBCs due to enzymes or toxins produced by infectious agent , chemical release medication, effects of drugs Incorrect blood transfusions -type 2 hypersensitivity hemolytic anemia labs - .......🔷ANSWERS🔷......✔✔ RBC normal size, reticulocyte count is high Aplastic anemia labs - .......🔷ANSWERS🔷......✔✔ RBC normal, reticulocyte count low Blood loss anemia - .......🔷ANSWERS🔷......✔✔ -Acute: GI bleed, trauma, labor -Chronic: GI bleed, deplete iron stores can result in iron deficiency anemia aplastic anemia - .......🔷ANSWERS🔷......✔✔ "Without" =plasa of cell growth
- chemical- chemo -viral: hepatitis
Manifestations of Sickle cell - .......🔷ANSWERS🔷......✔✔ -Involves single Amino acid change on the betachai -Increased RBC hemoglobin S concentration, dehydration, acidosis, hypoxemia -have a cute painful episodes Manifestation of thalassemia - .......🔷ANSWERS🔷......✔✔ -May have possible genetic mutations
- ineffective erythropoiesis -occurs and people from south east Asia and China Patho of heart failure - .......🔷ANSWERS🔷......✔✔ *less cardiac output -Heart tries to compensate for not pumping an adequate amt of blood -Increased heart rate -Blood vessels dilate -Heart hypertrophy -Right side triggered by MI or lung dx -Vascular resistance -Greater O2 demand -Cells become hypoxic Heart failure overtime causes....resulting in increase preload
- .......🔷ANSWERS🔷......✔✔ -decreased contractility -decreased stoke volume -increase left ventricular end-diastolic volume (LVEDV) Long-standing cause of heart failure - .......🔷ANSWERS🔷......✔✔ Hypertension Flow of the heart: - .......🔷ANSWERS🔷......✔✔ Inferior/Superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi lunar valve, pulmonary
arteries, (deox), lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic semi lunar valve, aorta, (oxy) Flow of the heart - .......🔷ANSWERS🔷......✔✔ a. Right Atrium, Right Ventricle, Pulmonary Arteries, Lungs, Pulmonary Veins, Left Atrium, Left Ventricle, Aorta right sided heart failure manifestations - .......🔷ANSWERS🔷......✔✔ 1. Jungular Vein Distention
- Ascending Dependent Edema
- Weight Gain
- Hepatomegaly (Liver Enlargement
- cor pulmonale right sided heart failure - .......🔷ANSWERS🔷......✔✔ Right sided heart failure can occur due to left sided heart failure due to the back up of the fluid from the left side of the heart Preload - .......🔷ANSWERS🔷......✔✔ -volume of blood in ventricles at end of diastole -determined by:
- Amount of venous blood returning to the ventricles door and diastole
- The amount of blood in the left Ventricle after systole -can cause a backflow of blood causing heart failure Afterload - .......🔷ANSWERS🔷......✔✔ -the amount of resistance to ejection of blood from the ventricle -Elevated afterload results in increased ventricular workload and hypertrophy of the myocardium Stroke volume - .......🔷ANSWERS🔷......✔✔ -The amount of blood ejected from the heart in one contraction. (Systole)
-pulmonary artery afterload Left HF involves - .......🔷ANSWERS🔷......✔✔ -Left ventricle -pulmonary vein (preload) -aorta (afterload) Stage A HF - .......🔷ANSWERS🔷......✔✔ Patient at risk for heart failure who have not yet developed structural heart changes (those with diabetes, those with coronary disease without prior infarct) Stage B HF - .......🔷ANSWERS🔷......✔✔ Patients with structural heart disease reduce ejection fraction (left ventricular hypertrophy chamber enlargement) who have not yet developed symptoms of heart failure -structural heart damage, but no damage Stage C HF - .......🔷ANSWERS🔷......✔✔ Patients you have developed clinical heart failure -symptomatic Stage D HF - .......🔷ANSWERS🔷......✔✔ Patients with refractory heart failure that require advance intervention -example the need for bio -ventricular pacemaker left ventricular assist device or a heart transplant Class I HF - .......🔷ANSWERS🔷......✔✔ No limitation of physical activity Class II HF - .......🔷ANSWERS🔷......✔✔ -Slight limitation of physical activity -Patient is comfortable at rest but ordinary physical activity results and symptoms of HF Class 111 HF - .......🔷ANSWERS🔷......✔✔ -There is marked limitation of physical activity
-the patient is comfortable at rest but less than ordinary activity causes symptoms of HF Class IV HF - .......🔷ANSWERS🔷......✔✔ The patient is unable to carry on any physical activity without symptoms of HF or they have symptoms of HF at rest Transition of stages of HF: - .......🔷ANSWERS🔷......✔✔ -Once a stage has been reached the person can ever go back to the prior stage -the damage of the heart cannot be reversed Transition of classes in HF - .......🔷ANSWERS🔷......✔✔ The patient may move between classes one and four as symptoms can be improved through treatment wand medications Manifestations of Right HF - .......🔷ANSWERS🔷......✔✔ -Jugular vein distention -heptatosplenomegal -peripheral Edema -cor pulmonale tricuspid valve damage Left HF manifestations - .......🔷ANSWERS🔷......✔✔ -Increase left ventricular afterload -decrease ejection fraction -increased left ventricular preload -pulmonary edema -Dyspnea CAD - .......🔷ANSWERS🔷......✔✔ Long-standing atherosclerosis aortic stenosis murmur - .......🔷ANSWERS🔷......✔✔ Mid-systolic crescendo- decrescendo heard loudest at the base and radiating to the neck
-EKG shows a-fib and left atrial hypertrophy Obstructive Disease - .......🔷ANSWERS🔷......✔✔ characterized by an increase in resistance to airflow from the trachea and larger bronchi to the terminal and respiratory bronchioles Reduction of FEV1/FVC ratio - .......🔷ANSWERS🔷......✔✔ Chronic asthma OBSTRUCTIVE PFT Diagnosis used for chronic bronchitis - .......🔷ANSWERS🔷......✔✔ -FEV1 will be decreased (obstructive) -increased TLC simple spirometry measures - .......🔷ANSWERS🔷......✔✔ -Exhaled flow rates that include: -title volume -vital capacity -FEV forced vital capacity - .......🔷ANSWERS🔷......✔✔ -the maximum amount of air that can be removed from the lungs during forced expiration -normal lungs should exhale 80% of the FVC Restrictive Disease spirometry results - .......🔷ANSWERS🔷......✔✔ -FEV1, FVC, TLC are reduced -FEV1/FVC ratio is normal Steps to analyze pulmonary function test - .......🔷ANSWERS🔷......✔✔ 1.Determine the pattern 2.Determine the severity 3.Bronchodilator response
FEV1/FVC ratio - .......🔷ANSWERS🔷......✔✔ Determines if it's obstructive of restrictive FEV1/FVC ratio of ___% or less determines obstructive - .......🔷ANSWERS🔷......✔✔ - 70% FEV1/FVC ratio of greater than ___% determines restrictive
- .......🔷ANSWERS🔷......✔✔ 70% TLC is greater than __% in restrictive - .......🔷ANSWERS🔷......✔✔ -80% -80-120% represents a normal range Obstructive pattern measurements: - .......🔷ANSWERS🔷......✔✔ -FVC- decreased or normal -FEV1 - decreased -FEV1/FVC ratio: less than 70% -TLC: greater than 120 represents hyperinflation Restrictive pattern measurements - .......🔷ANSWERS🔷......✔✔ FVC: decreased -FEV1: decreased -FEV1/FVC ratio: normal or greater 70% -TLC: 80% Determining the severity: mild - .......🔷ANSWERS🔷......✔✔ >70% Determining the severity: moderate - .......🔷ANSWERS🔷......✔✔ 60-70% Determining the severity: Moderately Severe - .......🔷ANSWERS🔷......✔✔ 50-60% Determining the severity: severe - .......🔷ANSWERS🔷......✔✔ 35-50%
GOLD criteria for COPD: stage 2: moderate FEV1 % predicted
- .......🔷ANSWERS🔷......✔✔ 50%-80% GOLD criteria for COPD: stage 3: severe FEV1 % predicted
- .......🔷ANSWERS🔷......✔✔ 30-50% GOLD criteria for COPD: stage 4: very severe FEV1 % predicted
- .......🔷ANSWERS🔷......✔✔ Less than 30% Emphysema - .......🔷ANSWERS🔷......✔✔ -hyperinflation of air sacs with destruction of alveolar walls (damage occurs in the airway, but the aveloi -air trapping -purses lip breathing -barrel chest Chronic Bronchitis definition - .......🔷ANSWERS🔷......✔✔ -Bronchial inflammation hypersecretion of mucus and chronic productive cough that persist for at least three consecutive months for at least two successful years Result of chronic bronchitis - .......🔷ANSWERS🔷......✔✔ -Excessive mucus production accumulation -hypertrophy of bronchial smooth muscles
- hypertrophy and hyperplasia of chronic bronchial mucus producing cells -airflow obstruction -and decreased alveolar ventilation -(irreversible) Manifestations of chronic bronchitis - .......🔷ANSWERS🔷......✔✔ -Productive and purulent cough -copious sputum production -Dyspnea
- wheezing -rhonchi -cyanosis of the skin and mucous membranes -and peripheral edema Patho of chronic bronchitis - .......🔷ANSWERS🔷......✔✔ Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall. chronic low oxygen - .......🔷ANSWERS🔷......✔✔ -The kidneys compensate by increasing secretion of a erythropoietin the primary hormone results for simulating red blood cell production -As a result of increased red blood cells production the patient with chronic bronchitis exhibits in elevated hematocrit can develop secondary polycythemia Vera. -This increase in red blood cells causes strain on the pulmonary and cardiovascular system causing pulmonary hypertension due to vasoconstriction -causes right sided heart failure or cor pulmonale Asthma s/s common to both instrinsic and extrinsic: - .......🔷ANSWERS🔷......✔✔ Wheezing Extrinsic asthma is - .......🔷ANSWERS🔷......✔✔ -Triggered by an allergic reaction -elevated IgE -more common in children Intrinsic asthma is - .......🔷ANSWERS🔷......✔✔ -triggered by non-allergic factors -no elevation in IgE -more common in adults less than 40 years of age Wheezing occurs at - .......🔷ANSWERS🔷......✔✔ -The end of expiration -improves after bronchodilator use
