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NR507/ NR 507 Midterm Exam (Latest 2024/
2025 Update) Advanced Pathophysiology |
Complete Guide with Questions and Verified
Answers| 100% Correct |Grade A – Chamberlain
Innate immunity - ANSWER>>>>the immunity we are born with Immune response: 3 levels/lines of protection - ANSWER>>>>1st line: physical, mechanical, & biochemical barriers 2nd line: the inflammatory response 3rd line: lymphocyte production most important immune defense - ANSWER>>>>intact skin and mucous membranes (impermeable barrier) PAMP - ANSWER>>>>pathogen associated molecular pattern surfaces of bacteria, viruses, and other microbes are covered with many foreign proteins foreign DAMP - ANSWER>>>>damage associated molecular pattern many proteins are released from inside our cells when they are damaged foreign PRR - ANSWER>>>>pattern recognition receptors surfaces of WBCs contain these receptor sites
- continuously interact with any material they encounter to ID it as "self" or "non-self" (foreign; PAMP or DAMP) Chemotaxis - ANSWER>>>>Cell movement that occurs in response to chemical stimulus
Phagocytosis - ANSWER>>>>"cell eating"
- opsonization and adherence
- engulfment - WBC surrounds and ingests Ag
- Fusion of phagosome with lysosome
- destruction - phagosome digested by lysozyme, H202, acids, and other toxic chemicals inside the lysosomes
- egestion Hypersensitivity Type 1:_____ - ANSWER>>>>Allergic reaction Hypersensitivity: Type 1 Mediated by ______ - ANSWER>>>>IgE Hypersensitivity: Type 1 Inflammation due to _____________ - ANSWER>>>>mast cell degranulation Hypersensitivity: Type 1 local symptoms - ANSWER>>>>itching, rash Hypersensitivity: Type 1 systemic symptoms - ANSWER>>>>wheezing Hypersensitivity: Type 1 most dangerous form - ANSWER>>>>anaphylactic reaction-systemic response- hypotension, severe bronchoconstriction Hypersensitivity: Type 1 main treatment ___________ - ANSWER>>>>epinephrine Hypersensitivity Type 2: _________________ - ANSWER>>>>Cytotoxic reaction; tissue specific (example: thyroid tissue) hapten causes mediation of IgE or IgM Hypersensitivity: Type 2 Primary effector cells involved - ANSWER>>>>macrophages Hypersensitivity: Type 2 can cause ____________ - ANSWER>>>>tissue damage or alter function Hypersensitivity: Type 2
immune system of one individual produces a reaction against tissues of another individual Alloimmunity examples - ANSWER>>>>-Neonatal disease where the maternal immune system becomes sensitized against antigens expressed by the fetus
- Transplant rejection
- Transfusion reaction Hypersensitivity: Type 4 - ANSWER>>>>T-cell mediated delayed response Does not involve antigen/antibody complexes Hypersensitivity: Type 4 typical reaction - ANSWER>>>>localized contact dermatitis (symptoms usually occur a few days later) Differentiating between type 1 and type 4 rash reactions - ANSWER>>>>Type I: IMMEDIATE hypersensitivity reactions, termed atopic dermatitis, are usually characterized by widely distributed lesions Type 4: contact dermatitis (DELAYED hypersensitivity) consists of lesions only at the site of contact with the allergen - Example: poison ivy How to treat Type 4 hypersensitivity rash - ANSWER>>>>non-severe case of contact dermatitis: tx with topical corticosteroid How to treat emergent Type 1 anaphylactic reactions - ANSWER>>>>epinephrine Antihistamines act on _____________ - ANSWER>>>>H1 receptors Primary immune deficiency - ANSWER>>>>congenital
- caused generally by a genetic abnormality 60% of cases, symptoms within first 2 years of life most primary immune deficiencies are the result of ______________ - ANSWER>>>>single gene defects one of the most severe forms of primary immunodeficiency - ANSWER>>>>B- lymphocyte deficiency
secondary immune deficiency - ANSWER>>>>acquired
- caused by illness, such as cancer or viral infection
- caused by normal physiological changes, such as aging
- more common than congenital most common cause of secondary immunodeficiency worldwide - ANSWER>>>>malnutrition most common symptom of immune deficiencies - ANSWER>>>>recurrent severe infections hematopoiesis - ANSWER>>>>blood cell formation most of our body's iron stores come from ____________________________ - ANSWER>>>>the recycling of iron from old RBCs erythropoiesis - ANSWER>>>>formation of red blood cells (7 day process) lab values for: Iron Deficiency Anemia - ANSWER>>>>Serum ferritin level: Decreased RBC distribution width: Increased Serum iron level: Decreased Total iron-binding capacity: Increased Transferrin saturation: Decreased lab values for: Thalassemia - ANSWER>>>>Serum ferritin level: Increased RBC distribution width: Normal to incrased Serum iron level: Normal to increased Total iron-binding capacity: Normal Transferrin saturation: Normal to increased lab values for: Anemia of Chronic Disease - ANSWER>>>>Serum ferritin level: Normal to increased RBC distribution width: Normal Serum iron level: Normal to decreased Total iron-binding capacity: Slightly decreased Transferrin saturation: Normal to slightly decreased lab values for: Sideroblastic Anemia - ANSWER>>>>Serum ferritin level: Normal to increased
Folate deficiency can cause a _______________ - ANSWER>>>>megaloblastic anemia megaloblastic anemia - ANSWER>>>>a blood disorder characterized by anemia in which the red blood cells are larger than normal who is at risk for folate deficiency - ANSWER>>>>alcoholics Symptoms of Vit B12 deficiency - ANSWER>>>>Fatigue Dyspnea Peripheral neuropathy in BLE Vit B12 deficiency risk factors - ANSWER>>>>older adults H-pylori infection vegan (its in meat, fish, poultry, dairy) Hemolytic anemia - ANSWER>>>>anemia caused by the destruction of red blood cells
- mismatched blood types-destroys RBCs (cytotoxic type 2)
- autoimmune hemolytic anemia due to autoantibodies against erythrocytes the immune system perceives as an antigen and attacks
- Allergic reaction to a drug Trauma victims who are losing blood are at risk for what type of anemia? - ANSWER>>>>Acute blood loss anemia Aplastic anemia is a __________-__________ type of anemia - ANSWER>>>>a normocytic-normochromic type of anemia Aplastic anemia is characterized by: __________ Dx: ___ - ANSWER>>>>failure of bone marrow to produce red blood cells Dx made by blood tests and bone marrow biopsy
- granulocyte count <
- platelet count <20,
- absolute reticulocyte count ≤ 40x109/L Sickle Cell Anemia - ANSWER>>>>Hemoglobinopathy Inherited autosomal recessive genetic disorder Inherit 2 abnormal genes, one from each parent, if only one abnormal Hb gene inherited then person has sickle cell trait
Sickle cell anemia pathophysiology: _______________________ - ANSWER>>>>single amino acid change on beta-chain (valine replaces glutamic acid) Sickle cell anemia increases the risk for: - ANSWER>>>>stroke and splenic damage Thalassemia - ANSWER>>>>Hemoglobinopathy Inherited autosomal recessive genetic disorder that causes decreased circulating hemoglobin
- abnormal gene from both parents Thalassemia has __________genetic mutations - ANSWER>>>>many possible Thalassemia relation to malaria - ANSWER>>>>abnormal RBCs are more resistant to infection by parasite that causes malaria, shortened life span doesn't allow malaria parasite to complete life cycle *more prevalent in Africa Anatomy of Heart: Flow through heart (Valves in order) - ANSWER>>>>1. Tricuspid valve
- Pulmonary valve
- Mitral valve (Bicuspid)
- Aortic valve Blood flow through the heart: - ANSWER>>>>1-Superior & Inferior Vena Cava 2 - Rt Atrium 3 - Tricuspid Valve 4 - Rt Ventricle 5 - Pulmonary Valve 6 - Pulmonary Artery 7 - Lungs-pick up oxygen 8 - Pulmonary Veins 9 - Lt Atrium 10 - Mitral Valve (Bicuspid) 11 - Lt Ventricle 12 - Aortic Valve 13 - Aorta 14 - Body (Systemic) Cardiac output - ANSWER>>>>The volume of blood pumped from each ventricle per minute
__________ preload caused by hemorrhage, dehydration-anything that reduces blood volume - ANSWER>>>>Decreased Types of heart failure - ANSWER>>>>Left heart failure (CHF) Right heart failure (Cor Pulmonale) High-output failure Left heart failure - ANSWER>>>>Inability of left ventricle to provide adequate blood flow into systemic circulation Causes of left heart failure - ANSWER>>>>systemic hypertension (most common) LV MI LV hypertrophy (often secondary to cardiac damage) Aortic semilunar or bicuspid valve damage Secondary to right heart failure Left heart failure process - ANSWER>>>>1. high systemic vasular pressure
- increase LV contraction force (increase afterload)
- LV unable to eject normal amount of blood
- increase LV preload
- LA unable to eject normal amount of blood
- Increase LA preload
- Increase blood volume and pressure in pulmonary veins
- fluid forced out into pulmonary tissues
- pulmonary edema, dyspnea
- right heart failure=biventricular heart failure underlying pathophysiology of heart failure - ANSWER>>>>less cardiac output to meet bodys oxygen demands heart failure: over time there is decreased _________, decreases __________, increased ____________________________. - ANSWER>>>>contractility, stroke volume, left ventricular end-diastolic volume (LVEDV) When contractility is decreased, stroke volume falls, and left ventricular end-diastolic volume (LVEDV) increases. This causes dilation of the heart and an increase in __________ - ANSWER>>>>preload Heart failure: major risk factor in its development - ANSWER>>>>long-standing hypertension
Sometime right-sided heart failure can occur without there being left-sided heart failure; This usually occurs because the person has _________________________________. - ANSWER>>>>long-standing pulmonary issues (COPD) Right heart failure - ANSWER>>>>Inability of RV to provide adequate blood flow into pulmonary circulation Right heart failure causes - ANSWER>>>>pulmonary disease RV MI RV hypertrophy pulmonary semilunar valve or tricuspid valve damage Secondary to left heart failure Characteristic of right heart failure - ANSWER>>>>JVD Right heart failure process - ANSWER>>>>1. high pulmonary vascular pressure
- increase RV contraction force (increase afterload)
- RV unable to empty completely
- increase RV preload
- RA unable to empty completely
- increase RA preload
- increase vena cava and systemic venous volume and pressure
- fluid forced out into peripheral tissues
- jugular distension, hepatosplenomegaly, peripheral edema
- Left heart failure = biventricular heart failure High-Output Failure (HOF) - ANSWER>>>>Inability of heart to pump sufficient amounts of blood to meet the circulatory needs of the body, despite the normal blood volume and cardiac contractility High-output failure causes - ANSWER>>>>severe anemia nutritional deficiencies hyperthyroidism sepsis, extreme febrile state Right heart failure symptoms - ANSWER>>>>JVD Hepatosplenomegaly peripheral edema CorPulmonale
Stage III: moderate - marked decrease in physical activity Stage IV: severe - inability to carry on any physical activity without discomfort Mitral stenosis murmur characteristics - ANSWER>>>>-rumbling, decrescendo diastolic murmur heard at apex of heart
- low-pitched murmur auscultated at apex of heart
- opening snap mitral stenosis s/s - ANSWER>>>>As it progresses, symptoms of decreased CO occur: SOB exercise intolerance JVD crackles in bases pulmonary congestion/edema cough fatigue pounding/racing heart mitral regurgitation murmur characteristic - ANSWER>>>>-blowing, holosystolic murmur
- blowing pansystolic murmur heard best at the hearts apex and radiates to the back and axilla Mitral regurgitation s/s - ANSWER>>>>SOB JVD crackles in bases aortic stenosis murmur characteristic - ANSWER>>>>mid-systolic crescendo- decrescendo murmur heard loudest at the base and radiating to the neck aortic regurgitation presents with - ANSWER>>>>-early, high pitched diastolic decrescendo murmur heard loudest at the left lower sternal border aortic regurgitation s/s - ANSWER>>>>fatigue syncope SOB palpitations wide pulse pressure (SBP-DBP)
LV dilation
- can have extra heart sound (S3) or displaced PMI chest xray may show signs of pulmonary edema and cardiomegaly with what type of heart valve disorder? - ANSWER>>>>aortic regurgitation mitral valve prolapse (MVP) s/s - ANSWER>>>>-many asymptomatic
- atypical chest pain
- palpitations
- SOB
- mid-systolic click mitral valve prolapse increases the risk for: - ANSWER>>>>infective endocarditis certain arrhythmias progression to mitral regurgitation Fainting and chest pressure upon exercising are symptoms of ___________. - ANSWER>>>>aortic stenosis Aortic stenosis has __________, laterally displaced ___________. - ANSWER>>>>sustained, apical pulse what kind of heart valve disorder will have a S4 gallop present - ANSWER>>>>aortic stenosis Spirometry that indicates obstructive pulmonary disease - ANSWER>>>>decreased FEV low FEV1/FEV ratio <70% Spirometry that indicates restrictive pulmonary disease - ANSWER>>>>FEV1/FVC ratio above 70% Asthma - ANSWER>>>>obstructive pulmonary disease airways are constricted two forms: intrinsic or extrinsic asthma characterized by: - ANSWER>>>>airway inflammation bronchial hyperreactivity and smooth muscle spasm intermittent, reversible airflow obstruction
Diagnostic PFT for COPD - ANSWER>>>>reveals airway obstruction (decreased FEV1) that is progressive and unresponsive to bronchodilators COPD consists of _______ and _______ - ANSWER>>>>chronic bronchitis and emphysema risk factors for COPD - ANSWER>>>>smoking airborne irritants
- air pollutants, chemical fumes, dust anything that affects lung growth during gestation
- smoking, antibiotic use, preterm, air pollution inherited mutation of alpha-antitrypsin gene
- genetic cause of COPD COPD has decreased _______ due to expiratory airway obstruction from ______________________ - ANSWER>>>>decreased FVC, mucus, edema, loss of elastic recoil COPD causes air trapping in the lungs which leads to: - ANSWER>>>>chest to hyper expand causing increased work of breathing
- hypoventilation
- hypercapnia COPD chest xray reveal - ANSWER>>>>flattened diaphragm distended lung fields increased thoracic diameter COPD GOLD staging - ANSWER>>>>GOLD guidelines are based on the degree of airway limitation: Gold 1: Mild - FEV1 ≥ 80% predicted Gold 2: Moderate - 50% ≤ FEV1 < 80% predicted Gold 3: Severe - 30% ≤ FEV1 < 50% predicted Gold 4: Very Severe - < 30% predicted perfusion - ANSWER>>>>the actual exchange of O2 and CO2 in the bloodstream
- occurs via the alveoli and pulmonary capillaries ventilation - ANSWER>>>>air movement in/out of the lung
- critical to ensure sufficient perfusion
damage from Emphysema occurs in the ___________ - ANSWER>>>>alveoli emphysema impairs _________ - ANSWER>>>>gas exchange emphysema s/s - ANSWER>>>>air trapping pursed-lip breathing increased A&P diameter barrel chest prolonged expiration dyspnea damage from chronic bronchitis occurs in the __________ - ANSWER>>>>airway chronic bronchitis s/s - ANSWER>>>>Productive cough with copious amount of sputum dyspnea wheezing rhonchi cyanosis of the skin and mucus membranes prolonged expiration chronic bronchitis characterized by: - ANSWER>>>>chronic productive cough:
- persisting for at least 3 consecutive months for at least 2 successive years bronchial inflammation hypersecretion of mucus Chronic Granulomatous Disease (CGD) is what type of immunodificiency? - ANSWER>>>>Primary immunodeficiency what is a predominant cause of secondary immune deficiency worldwide? - ANSWER>>>>malnutrition Pneumocystis Carinii is what type of immunodeficiency? - ANSWER>>>>secondary immunodeficiency
- caused by something external to immune system (yeast-like fungus) contact dermatitis is an example of type ______ hypersensitivity reaction - ANSWER>>>>type 4 "first responders" of the innate immune system - ANSWER>>>>neutrophils
- appear 1st in any immune response
Immune system change associated with Systemic Lupus Erythematosus (SLE)? - ANSWER>>>>Autoantibodies and auto-active T-cells against DNA and nucleoprotein antigens anemia types are classified by: - ANSWER>>>>size
- normocytic, microcytic, macrocytic color
- normochromic, hypochromic, hyperchromic variability
- anisocytosis (size), poikilocytosis (shape) microcytic-hypochromic anemias - ANSWER>>>>iron deficiency sideroblastic thalassemia microcytic-normochromic - ANSWER>>>>anemia of inflammation and chronic disease microcytic-hyperchromic - ANSWER>>>>hereditary spherocytosis causes of hemolytic anemia - ANSWER>>>>RBC's are destroyed: infection transfusion reaction hemolytic disease of newborn (Rh incompatability) Autoimmune reaction drug-induced aplastic anemia - ANSWER>>>>failure of blood cell production in the bone marrow what valve disorder is associated with a hx of rheumatic heart disease - ANSWER>>>>mitral stenosis an ECG may demonstrate atrial fibrillation and left ventricular hypertrophy in _______ - ANSWER>>>>mitral stenosis 4 main categories of interstitial lung diseases (ILD) - ANSWER>>>>Exposure-Related ILD Connective Tissue Disease Idiopathic Interstitial Pneumonias Other ILDs
ILDs observed almost solely in current or past smokers - ANSWER>>>>Respiratory bronchiolitis-interstitial lung disease (RB-ILD) Desquamative interstitial pneumonia (DIP) Pulmonary Langerhans cell histiocytosis Meds that can cause Medication-Induced ILD - ANSWER>>>>Amiodarone Nitrofurantoin Methotrexate ILD s/s - ANSWER>>>>dyspnea non-productive cough hypoxemia fine (velcro-like) crackles fever clubbing extrapulmonary symptoms hemoptysis, chest pain, wheezing
- relatively uncommon but can occur interstitial lung disease (ILD) excludes: - ANSWER>>>>infectious and neoplastic diseases ILD characterized by: - ANSWER>>>>interstitial inflammation and fibrosis alterations of alveolar and airway architecture
- scarring around alveolar sacs ILD 4 diagnostic tests - ANSWER>>>>1. High resolution chest CT
- PFT
- Bronchoalveolar lavage
- lung biopsy What are the most diagnosed ILD's - ANSWER>>>>Radiation pneumonitis Pneumoconioses Hypersensitivity Pneumonitis
