PATHO 370 FINAL EXAMS TEST BANK, Exams of Nursing

Download PATHO 370 FINAL EXAMS TEST BANK and more Exams Nursing in PDF only on Docsity! 1 | P a g e PATHO 370 FINAL EXAMS TEST BANK WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWERS LATEST 2024 (NEWEST) ALREADY GRADED A+ A serious complication of deep vein thrombosis is A. stroke. B. hypertensive crisis. C. extremity necrosis. D. pulmonary embolus. D. pulmonary embolus. The first indication of brain compression from increasing intracranial pressure (ICP) may be A. decorticate posturing. B. absence of verbalization. C. sluggish pupil response to light. D. Glasgow Coma Scale score of 13. C. sluggish pupil response to light. Seizures that involve both hemispheres at the outset are termed A. partial. B. complex. C. focal. D. generalized. D. generalized A person who overuses magnesium-aluminum antacids for a long period of time is likely to develop A. hypokalemia. B. hyperkalemia. C. hypophosphatemia. D. hyperphosphatemia. C. hypophosphatemia. Metabolic alkalosis is often accompanied by A. hypernatremia. B. hyponatremia. 2 | P a g e C. hyperkalemia. D. hypokalemia. D. hypokalemia Individuals with end-stage chronic renal disease are at risk for renal osteodystrophy and spontaneous bone fractures, because A. excess potassium leaches calcium from bone. B. erythropoietin secretion is impaired. C. urea causes demineralization of bone. D. they are deficient in active vitamin D. D. they are deficient in active vitamin D. Signs and symptoms of extracellular fluid volume excess include A. tachycardia. B. increased serum sodium concentration. C. bounding pulse. D. increased hematocrit. C. bounding pulse. The displacement of two bones in which the articular surfaces partially lose contact with each other is called A. subluxation. B. subjugation C. sublimation. D. dislocation. A. subluxation. The anemia resulting from a deficiency of either vitamin B12 (cobalamin) or folate is caused by a disruption in DNA synthesis of the blast cells in the bone marrow that produces very large abnormal bone marrow cells called megaloblasts. True False True The goal of long term heparin for the management of a deep vein thrombosis is to A. relieve edema. B. prevent clot dislodgement. C. dissolve the thrombus. D. prevent further clot formation. D. prevent further clot formation. When a parent of a toddler recently diagnosed with pneumococcal pneumonia asks why their child is so much sicker than a classmate was when they were diagnosed with pneumonia, the nurse replies A. "It sounds as if the classmate was just lucky and less exposed at daycare." 5 | P a g e Your patient eats "lots of fat," leads a "stressful" life, and has smoked "about two packs a day for the last 40 years." Her chronic morning cough recently worsened, and she was diagnosed with a lung mass. The most likely contributing factor for development of lung cancer in this patient is A. high-fat diet. B. urban pollutants. C. stressful lifestyle. D. cigarette smoking. D. cigarette smoking. The patient most at risk for postrenal acute kidney injury is a(n) A. elderly patient with hypertrophy of the prostate. B. middle-aged woman with bladder infection. C. young child with reflux at the ureterovesical junction. D. patient who has both hypertension and diabetes. A. elderly patient with hypertrophy of the prostate. A loud pansystolic murmur that radiates to the axilla is most likely a result of A. aortic regurgitation. B. aortic stenosis. C. mitral regurgitation. D. mitral stenosis. C. mitral regurgitation. The principle Ig mediator of type I hypersensitivity reactions is A. IgA. B. IgG. C. IgM. D. IgE. D. IgE. A patient with metastatic lung cancer wants to know her chances for survival. Which response is correct? A. "Lung cancer is always fatal." B. "Lung cancer has about a 15% survival rate." C. "Lung cancer is highly curable when diagnosed early." D. "Lung cancer death rate has decreased significantly, as with all other cancers." B. "Lung cancer has about a 15% survival rate." The dementia of Alzheimer disease is associated with structural changes in the brain, including A. deposition of amyloid plaques in the brain. B. degeneration of basal ganglia. C. hypertrophy of frontal lobe neurons. D. significant aluminum deposits in the brain. 6 | P a g e A. deposition of amyloid plaques in the brain. The most common cause of mechanical bowel obstruction is A. volvulus. B. intussusception. C. adhesions. D. fecal impaction. A. volvulus. Treatment for hemophilia A includes A.heparin administration. B. factor IX replacement. C. factor VIII replacement. D. platelet transfusion. C. factor VIII replacement. ________ edema occurs when ischemic tissue swells because of cellular energy failure. A. Interstitial B. Osmotic C. Vasogenic D. Cytotoxic D. Cytotoxic Widespread activation of the clotting cascade secondary to massive trauma is called A. hemophilia B. B. disseminated intravascular coagulation (DIC). C. Hageman disease. D. idiopathic thrombocytopenia purpura. B. disseminated intravascular coagulation (DIC). What is the effect on resistance if the radius of a vessel is halved? A. Resistance doubles. B. Resistance decreases by a factor of 16. C. Resistance decreases by half. D. Resistance increases by a factor of 16. D. Resistance increases by a factor of 16. What type of fracture generally occurs in children? A. Greenstick B. Stress C. Nightstick D. Colles A. Greenstick 7 | P a g e The condition in which the urethra opens on the dorsal aspect of the penis is known as A. hypospadias. B. urethral fistula. C. epispadias. D. priapism. C. epispadias Referred pain may be perceived at some distance from the area of tissue injury, but generally felt A. on the same side of the body. B. with slightly less intensity. C. within the same dermatome. D. within 10 to 15 cm area. C. within the same dermatome. In addition to E. coli, a risk factor for development of pyelonephritis is A. urinary retention and reflux. B. nephrotic syndrome. C. respiratory disease. D. glomerulonephritis. A. urinary retention and reflux. Proto-oncogenes A. are the same as oncogenes. B. are normal cellular genes that promote growth. C. lead to abnormal tumor-suppressor genes. D. result from severe mutational events. C. lead to abnormal tumor-suppressor genes. In type I diabetes, respiratory compensation may occur through a process of A. respiratory alkalosis. B. respiratory acidosis. C. metabolic acidosis. D. metabolic alkalosis. A. respiratory alkalosis. Which symptom suggests the presence of a hiatal hernia? A. Nausea B. Heartburn C. Diarrhea D. Abdominal cramps B. Heartburn Improvement in a patient with septic shock is indicated by an increase in A. cardiac output. 10 | P a g e A. his glomeruli have been damaged by his own immune system. B. the glomerular membrane has increased permeability. C. his liver is extremely active in synthesizing protein. D. his renal tubules are full of cellular debris. B. the glomerular membrane has increased permeability. Legionnaires disease is characterized by A. presence of systemic illness. B. airborne mechanism of communicability. C. mild symptomatology. D. resolution with or without antimicrobial therapy. A. presence of systemic illness. What is likely to lead to hyponatremia? A. Insufficient ADH secretion B. Excess aldosterone secretion C. Administration of intravenous normal saline D. Frequent nasogastric tube irrigation with water D. Frequent nasogastric tube irrigation with water Pernicious anemia is caused by a lack of A. iron. B. intrinsic factor. C. folate. D. erythropoietin. B. intrinsic factor. Which response to an injection of ACTH indicates a primary adrenal insufficiency? A. No change in serum glucocorticoid level B. An increase in serum glucocorticoid level C. A decrease in serum glucose level D. An increase in serum ACTH level A. No change in serum glucocorticoid level Carbon monoxide injures cells by A. destruction of cellular membranes. B. reducing oxygen level on hemoglobin. C. promotion of free radicals. D. crystallization of cellular organelles. B. reducing oxygen level on hemoglobin "Tell me again the name of that chemical that makes crystals when my gout flares up," asks the client. The nurse's best response is A. calcium phosphate. 11 | P a g e B. urea. C.uric acid. D. Beta-hydroxybutyric acid C. uric acid. If acute tubular necrosis (ATN) does not resolve and continued tubular dysfunction ensues, the patient will then experience A. oliguria and sodium retention. B. infections and sepsis. C. magnesium and phosphorus loss in urine. D.polyuria and sodium wasting. B. infections and sepsis. Infection by ________ accounts for nearly half of all reported cases of vulvovaginitis. A. Chlamydia trachomatis B. Candida albicans C. Neisseria gonorrhoeae D. Pseudomonas B. Candida albicans A patient with heart failure who reports intermittent shortness of breath during the night is experiencing A. orthopnea. B. paroxysmal atrial tachycardia. C. sleep apnea. D. paroxysmal nocturnal dyspnea. D. paroxysmal nocturnal dyspnea The person at highest risk for developing hypernatremia is a person who A. self-administers a daily tap water enema to manage a partial bowel obstruction. B. receives tube feedings because he or she is comatose after a stroke. C.has ectopic production of ADH from small cell carcinoma of the lung. D. is receiving IV 0.9% NaCl at a fast rate. B. receives tube feedings because he or she is comatose after a stroke. A patient has been hospitalized several times in 6 months with severe ECV depletion and hypokalemia resulting from chronic laxative abuse. Which blood gas results should be relayed to the physician? A.pH in high part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal B. pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high C. pH in low part of normal range, PaO2 normal, PaCO2 low, bicarbonate low D. pH in low part of normal range, PaO2 normal, PaCO2 normal, bicarbonate normal B. pH in high part of normal range, PaO2 normal, PaCO2 high, bicarbonate high 12 | P a g e An increase in hemoglobin affinity for oxygen occurs with A. hyperthermia. B. shift to the right. C. elevated PCO2. D. shift to the left. D. shift to the left. Most gallstones are composed of A. bile. B. cholesterol. C. calcium. D. uric acid salts. B. cholesterol. The most commonly ordered diagnostic test for evaluation of the urinary system is A. KUB. B. cystogram. C. ultrasonography. D. cystography. C. ultrasonography The pathology report for a patient with penile cancer has this statement: The tumor involves the shaft of the penis. The cancer is at what stage? A. Stage I B. Stage II C. Stage III D. Stage IV B. Stage II The primary source of erythropoietin is provided by the A. bone marrow. B. kidney. C. lung. D. liver. B. kidney Cystic fibrosis is associated with A. asthma. B. chronic bronchitis. C. bronchiectasis. D. emphysema. C. bronchiectasis 15 | P a g e ________ is the most powerful predictor of developing type 2 diabetes mellitus. A. Aging B. Obesity C. Sedentary lifestyle D. Cardiovascular disease B. Obesity Scrotal pain in males and labial pain in females may accompany renal pain as a result of A. associated infections. B. associated dermatomes. C. muscle tension. D. anxiety. B. associated dermatomes. A person who is diagnosed with nephrotic syndrome is also experiencing hypoalbuminemia. This happens because A.mhepatocyte failure decreases albumin synthesis. B. albumin is excreted in the urine. C. albumin leaks into the interstitial spaces. D. malnutrition is part of nephrotic syndrome. B. albumin is excreted in the urine. Which are clinical findings usually associated with type 1 diabetes mellitus? (Select all that apply.) A. Polyuria B. Polydipsia C. Polyphagia D. Obesity E. Weight gain A,B,C The therapies that would be appropriate for a patient with type 1 diabetes mellitus include (Select all that apply.) A.carbohydrate counting. B.high-protein diet C.daily exercise. D.insulin. E.oral hypoglycemic agents A,B Chronic cholecystitis can lead to (Select all that apply.) A.biliary sepsis. B.calcified gallbladder. C.porcelain gallbladder. 16 | P a g e D.cirrhosis. Ediabetes mellitus. A,B,C Socioeconomic factors influence disease development because of (Select all that apply.) A.genetics. B.environmental toxins. C.overcrowding D.nutrition. E.hygiene. B,C,D,E Events which occur during the alarm stage of the stress response include secretion of (Select all that apply.) A.catecholamines. B. ACTH. C.glucocorticoids. D.immune cytokines. E.TSH. A,C,D Aldosterone may increase during stress, leading to (Select all that apply.) A.decreased urinary output. B.increased blood potassium. C.increased sodium retention. D.increased blood volume. E.decreased blood pressure. A,C,D Chronic activation of stress hormones can lead to (Select all that apply.) A.cardiovascular disease. B.depression. C.impaired cognitive function. D.autoimmune disease E.overactive immune function. B,C,D Tumor markers (Select all that apply.) A.are found only in the blood. B.are always useful for screening. C.help determine cancer origin. D.help identify progression of cancer E.include prostatic-specific antigen 17 | P a g e C,D Which viruses have been implicated as cancer-causing agents? (Select all that apply.) A.Epstein- Barr B.Human T-cell leukemia C.Human immunodeficiency D.Herpes E.Shingles A,B,C Which diseases may be associated with a bleeding problem? (Select all that apply.) A.Urinary retention B.Renal failure C.Cirrhosis D.Systemic lupus erythematosus E.Ovarian cancer B,D,E A male patient involved in a motor vehicle accident is brought to the emergency department with acute flank pain. What additional bleeding may the patient exhibit? (Select all that apply. A.Hematuria B.Melena C.Hematemesis D.Menorrhagia E.Hemoptysis B,C,E Blood pressure is regulated on a short-term basis through which measures? (Select all that apply.) A.Interaction of carotid and aortic baroreceptors B.Vasomotor center in the brainstem C.Activation of SNS D.Inhibition of PSNS E.Activation of RAAS A,B,C,D High blood pressure increases the risk of which conditions? (Select all that apply.) A.Stroke B.Renal disease C.Diabetes D.Ischemic heart disease E.Liver disease A,B,D 20 | P a g e D.bleeding. E.infections： A,B,D,E Deficits in immune system function occur in cancer due to (Select all that apply.) A.chemotherapy. B.cancer cells. C.cancer metastasis to bone marrow D.immunotherapy. E.malnutrition. A,B,C,E Autologous stem cell transplantation is a procedure in which A.there is a high rejection rate. B. stem cells are transferred to the patient from an HLA-matched donor. C. stem cells are transferred to the patient from an identical twin. D. stem cells are harvested from the patient and then returned to the same patient. D. stem cells are harvested from the patient and then returned to the same patient. The liver is responsible for the synthesis of coagulation factors, with the exception of part of VIII. True False True A low mean corpuscular hemoglobin concentration (MCHC) and mean corpuscular volume (MCV) are characteristic of which type of anemia? A. Vitamin B12 deficiency B.Folate deficiency C. Iron deficiency D. Erythropoietin deficiency C. Iron deficiency Individuals diagnosed with systemic lupus erythematosus (SLE) are at risk for developing numerous complications of various organs because of A.excessive production of connective tissue. B. formation of osteophytes in tissues. C. immune injury to basement membranes. D. impaired tissue oxygen transport. C. immune injury to basement membranes. The patient reports persistent pelvic pain and urinary frequency and urgency. She says the pain improves when she empties her bladder. She does not have a fever and her repeated urinalyses over the past months have been normal, although she has a history of frequent bladder infections. She also has a history of fibromyalgia and hypothyroidism. Based on her history and complaints, her symptoms are 21 | P a g e characteristic of A. neuroses. B. ureteral stone. C. neurogenic bladder. D. Interstitial cystitis D. Interstitial cystitis Normal bile is composed of A. water, electrolytes, and organic solutes. B. proteins. C. bile acids. D. phospholipids. A. water, electrolytes, and organic solutes. Parkinson disease is associated with A. demyelination of CNS neurons. B. a pyramidal nerve tract lesion. C. insufficient production of acetylcholine in the basal ganglia D. a deficiency of dopamine in the substantia nigra. D. a deficiency of dopamine in the substantia nigra. Neuromuscular disorders impair lung function primarily because of A. inflammatory events in the lung. B. secondary pneumonia. C. weak muscles of respiration. D. inactivity secondary to the disorder. C. weak muscles of respiration. After evaluation, a child's asthma is characterized as "extrinsic." This means that the asthma is A. of unknown pathogenesis. B. associated with specific allergic triggers. C. associated with respiratory infections. D. induced by psychological factors (stress). B. associated with specific allergic triggers. Glomerular disorders include A. pyelonephritis. B. obstructive uropathy. C. interstitial cystitis. D. nephrotic syndrome. D. nephrotic syndrome. Diabetes insipidus is a condition that A. results from inadequate ADH secretion. 22 | P a g e B. is characterized by oliguria. C. is associated with anterior pituitary dysfunction. D. Leads to glycosuria A. results from inadequate ADH secretion. A patient who experiences early symptoms of muscle twitching, cramping, and stiffness of the hands may be demonstrating signs of A. Guillain-Barré syndrome. B. amyotrophic lateral sclerosis. C. Parkinson disease. D. hydrocephalus. B. amyotrophic lateral sclerosis. The arterial oxygen content (CaO2) for a patient with PaO2 100 mm Hg, SaO2 95%, and hemoglobin 15 g/dL is _____ mL oxygen/dL. A. 19.4 B. 1909.8 C. 210 D. 21.05 A. 19.4 High blood pressure increases the workload of the left ventricle, because it increases A. stroke volume. B. blood volume. C. preload. D. afterload. D. afterload. Cerebral aneurysm is most frequently the result of A. embolic stroke. B. subarachnoid hemorrhage. C. subdural hemorrhage. D. meningitis. B. subarachnoid hemorrhage. Signs and symptoms of ureteral (kidney) stones flank pain, sweating, nausea, vomiting, and hematuria What is the common composition of renal calculi? calcium crystals polycystic kidney disease condition in which the kidney contains many cysts and is enlarged; the cysts will alter kidney function 25 | P a g e What are the causes of cystitis? caused by infection, chemical irritants, stones, or trauma What is chryptorchidism a risk factor for? testicular cancer chryptorchidism failure of the testicles to descend into the scrotum testicular torsion twisting of the spermatic cord causing decreased blood flow to the testis and can lead to ischemia making the patient at risk for necrosis what are the clinical manifestations of testicular torsion? severe sudden pain on the testis, swelling of the scrotum, nausea and vomiting signs and symptoms of prostatic enlargement (BPH) Prostate tissue increases and can compress the urethra and bladder outlet causing urinary retention, obstruction to flow, decreased stream, hesitancy or difficulty initiating stream, interruption of stream, and infection caused by retention amenorrhea absence of menstruation metrorhagia bleeding between periods hypomenorrhea deficient amount of menstrual flow oligomenorrhea infrequent menstruation polymenorrhea increased frequency of menstruation menorrhagia increased amount and duration of flow dysfunctional uterine bleeding Abnormal endometrial bleeding not associated with tumor, inflammation, pregnancy, trauma, or hormonal effects 26 | P a g e dysmenorrhea painful menstruation pregnancy induced hypertension characterized by high blood pressure and edema along with protein in the urine hyperemesis gravidarum severe nausea and vomiting in pregnancy that can cause severe dehydration in the mother and fetus placenta previa placenta implanted abnormally over the internal cervical opening abruptio placentae premature separation of the placenta from the uterine wall spontaneous abortion when the fetus and placenta deliver before the 28th week of pregnancy; commonly called a miscarriage what are clinical manifestations of uterine prolapse? vaginal discomfort, discomfort walking or sitting, difficulty urinating, bleeding, ulceration of the cervix from friction endometriosis endometrial tissue located outside the uterus; ectopic tissue can periodically rupture and bleed; repeated irritation causes the formation of dense tissue adhesions leiomyoma benign uterine tumor composed of muscle and fibrous tissue; growth is enhanced by high estrogen and growth hormone levels vulvovaginitis inflammation of the vulva and vagina caused by candida albicanas What does gastroesophageal varices present with? a history of alcoholism with hematemesis and profound anemia portal hypertension the elevation of blood pressure within the portal venous system esophageal varices is associated with? portal hypertension What is the mortality rate for a patient with ruptured esophageal varices? 27 | P a g e high mortality rate what syndrome is seen after gastric bypass surgery? dumping syndrome what can be a cause of stomatitis? chemotherapy What 3 things does H. pylori cause? chronic gastritis, peptic ulcer disease, gastric carcinoma H. pylori type of bacteria that can cause an infection in the stomach Necrotizing enterocolitis Serious inflammatory condition of the intestines. What age group does necrotizing enterocolitis effect? premature infants What is ulcerative colitis associated with? bloody diarrhea ulcerative colitis chronic inflammation of the colon with presence of ulcers What is a warning sign of colon cancer? change in bowel habits; diarrhea, constipation, black tarry stools Celiac Sprue malabsorptive disorder from a reaction to gluten-containing foods; lack the enzymes to break down gluten and cannot absorb the nutrients Barrett's esophagus preneoplastic condition the results from uncontrolled GERD hiatal hernia protrusion of a part of the stomach upward through the opening in the diaphragm; presents with heartburn What does a patient with gastric ulcers (peptic ulcers) present with? epigastric pain that is relieved by food; can also present with heartburn 30 | P a g e polyuria, polydipsia, polyphagia What is type 1 DM due to? pancreatic b-cell destruction; these patients do not make insulin What does hypoglycemia present with? tremors and faint and weak feelings because of their low glucose levels Nonketotic hyperosmolality associated with type 2 DM What levels are important to evaluate for the long term DM? glycosylated hemoglobin (HbA1C) What does a cerebral aneurysm present with? severe sudden headache What bacteria leads to meningitis? streptococcus pneumoniae What are the signs and symptoms of meningitis? stiff neck and flu-like symptoms What is the best way to diagnose menigitis? spinal tap encephalitis inflammation of the brain caused by a viral infection ischemic stroke a type of stroke that occurs when the flow of blood to the brain is blocked hemorragic stroke a stroke where the blood vessel has ruptured and is hemorrhaging; more deadly and aggressive What is a major risk factor for hemorrhagic stroke? hypertension A stroke of one side of the cerebral hemisphere will affect what side of the body? the contralateral side of the side that the stroke is occuring What does a cerebral aneurysm lead to? subarachnoid hemorrhage 31 | P a g e Parkinson's disease deficiency of dopamine in the substantia nigra What will a patient with Parkinson's disease present with? resting tremors and skeletal rigidity; these patients will also have a shuffling gait while walking Pain subjective experience that is difficult to measure objectively What is a common cause of acute pain? headache What does a migraine present with? severe pounding headache with nausea and photophobia What is a common symptom of multiple myeloma? bone pain What are characteristics of scoliosis? lateral curvature, increased in periods or rapid growth, uneven shoulders, scapular prominence, and respiratory complications What leads to delayed healing of a fracture? smoking, diabetes, and poor diet Paget's disease excessive bone resorption followed by excessive formation of fragile bone What is a common site for Paget's disease lower spine Osteomyelitis inflammation of bone and bone marrow; hematogenous osteosarcoma malignant tumor of the bone osteomalacia bone disorder that comes from insufficient amounts of vitamin D in adults; Rickets in children What is a risk factor for osteoporosis? early menopause 32 | P a g e malunion bone that heals with poor alignment comminuted fracture more than one fracture line and more than two bone fragments impacted fracture telescopes or drives one fragment into another greenstick fracture incomplete break nondisplaced fracture fragments remain in alignment and position displaced fracture end of the fracture fragments are separated depressed fracture fragment displaced below the level of the bone surface complete fracture break through the entire bone incomplete fracture the break only buckles or cracks open (compound) fracture skin is penetrated closed fracture the skin is intact What are muscle strains caused by? abnormal contractions what can osteoporosis lead to? bone fractures What are the phases of bone healing? 1. The cortical bone fracture results in torn blood vessels within the Haversian system 2. Clotting occurs at the fracture site 35 | P a g e activity of the nervous and endocrine system in returning the body to homeostasis Allostatic overload "cost" of body's organs and tissues for an excessive or ineffectively regulated allostatic response Exhaustion stage the point where the body can no longer return to homeostasis What is the sympathetic nervous system mediated by? norepinephrine Catecholamines secreted by the SNS and adrenal medulla norepinephrine and epinephrine Corticosteroids secreted by the adrenal cortex cortisol and aldosterone Cellular Adaptation allows the stressed tissue to survive or maintain function intracellular accumulations buildup of substances that cells cannot immediately use or eliminate; lead to cellular injury hydrophic swelling cellular swelling because of accumulation of water; malfunction of sodium-potassium pump with an accumulation of sodium ions within the cell What are the four examples of intracellular accumulations abnormal metabolism, defect in protein folding or transport, lack of enzymes, and ingestion of indigestible materials Atrophy cells shrink and reduce their differentiated functions in response to normal and injurious factors Hypertrophy increase in cell mass accompanied by an augmented functional capacity in response to physiological and pathophysiological demands Hyperplasia increase in functional capacity related to an increase in cell number because of mitotic division Metaplasia replacement of one differentiated cell type with another 36 | P a g e Dysplasia disorganized appearance of cells because of abnormal variations in size, shape, and arrangement What are the different types of necrosis? coagulative, liquefactive, fat necrosis, and caseous necrosis Coagulative necrosis most common type; process begins with ischemia and ends with degradation of plasma membrane Liquifactive necrosis dissolution of dead cells; formation of abscess or cyst from dissolved dead tissue Fat necrosis death of the adipose tissue that is the result of trauma or pancreatitis; chalky white area of tissue caseous necrosis degeneration and death of tissue with a cheese-like appearance; characteristic of lung damage from TB Apoptosis process of programmed cell death What are some side effects of chemotherapy? anemia, nausea, bleeding, and infection Oma suffix for a benign tumor carcinoma a malignant tumor that occurs in epithelial tissue sarcoma malignant tumor of connective tissue Leukemia malignancy of the white blood cells Grading hitological characterization of tumor cells; the degree of anaplasia; the greater degree of anaplasia = the greater degree of malignant potential Staging 37 | P a g e Location and patterns of spread within the host. Tumor size, extent of local growth, lymph node and organ involvement, distant metastasis; Results of staging determine treatment modality anaplasia loss of differentiation of cells; reversion to a more primitive cell type What are some deficits in immune system function in cancer? chemotherapy, cancer cells, cancer metastasis to bone marrow, and malnutrition Bone marrow suppression in cancer patients contributes to the anemia, leukopenia, and thrombocytopenia Leukopenia decrease in the circulation of white blood cells; reduces the patients ability to fight infection Thrombocytopenia deficiency in the number of circulating platelets, which are needed for clotting What are tumor marker functions? produced by normal cells, help determine cancer origin, help identify progression of cancer, and include prostatic-specific antigen Tumor Supressing Genes Contribute to cancer only when they are not present; can inherit a defective copy of tumor supressor gene or there can be a mutation that causes the gene to not function properly Rb gene normally functions as the master break in the cell cycle and will stop cell division of an unwanted cell; and inactivating mutation will remove the restraints on cell devision and replication will occur p53 gene most common tumor suppressor gene defect; normally it will inhibit cell cycling and damage to this gene will allow mutated or damaged cells to survive and continue replicating BRACA1 and BRACA2 tumor supressor genes commonly associated with breast cancer; family history and inherited defects in these genes increase risk factors for breast cancer Type I Hypersensitivity An immediate allergic or anaphylactic type of reaction that is mediated by sensitized mast cells; signs and symptoms occur within 15 to 30 minutes Type II Hypersensitivity 40 | P a g e excess RBC lysis Where is erythropoietin produced? kidneys; erythropoietin is needed to make RBC What is iron necessary for? red blood cell production What would the serum levels show for Vitamin K deficiency? normal bleeding time, normal platelet count, increase PT, increased INR What does aplastic anemia lead to? pancytopenia aplastic anemia stem cell disorder that is characterized by reduction of hemopoietic tissue in the bone marrow, fatty marry replacement, and pancytopenia pancytopenia deficiency of all types of blood cells; hallmark of aplastic anemia What is pernicious anemia caused by? a lack of intrinsic factors leading to vitamin B12 deficiencies What causes glucose-6-phosphate dehydrogenase deficiency anemia? this anemia occurs when a patient is exposed to certain drugs and the deficiency of the enzyme What are the known functions of the circulatory system? carries oxygen, nutrients, and hormones to cells and removes waste products such as CO2 What are the serum blood levels of a patient with hemophilia? prolonged bleeding time, prolonged aPTT, normal platelet count Hemophilia A Factor VIII deficiency Hemophilia B Factor IX deficiency How do newborns present when they have a vitamin K deficiency? melena, bleeding from the umbilicus, hematuria PT 41 | P a g e prothrombin time; evaluated the extrinsic pathway of coagulation factors of VIII and XII INR International normalized ratio; evaluates extrinsic pathway of coagulation independent of reagents aPTT activated partial thromboplastin time; evaluates intrinsic pathways bleeding time asses platelet and vascular response; normal bleeding time is between 3 and 10 minutes What common medication can prolong bleeding time? aspirin What can chemotherapy cause? thrombocytopenia What is DIC? disseminated intravascular coagulation; clotting and bleeding occur simultaneously; usually happens after some sort of trauma What blood serum values would you see in a patient that is suffering from DIC? increased bleeding time, elevated PT/INR, elevated aPTT, and elevated D-dimer What can the dysfunction of the liver lead to? clotting factor deficiency Venous occlusion A blockage in the vein that will cause a decrease in the venous blood return; leads to peripheral edema Arterial occlusion Blockage in the artery that will cause a decrease in blood flow to the organs/tissues; causes ischemia Thrombosis a stationary clot formed within the vessel or chamber of the heart; composed of aggregating platelets, clotting factors, and fibrin that adhere to a vessel wall Embolism a collection of material that forms a clot within the blood stream; the clot breaks off and is now traveling freely through the vessel until it gets lodged in a different location Venous thrombosis results in... peripheral edema 42 | P a g e Atherosclerosis plaquing that occurs in the artery as a result of poor diet and lifestyle; can lead to blood pooling up causing a blockage in the lumen space of an artery; develops is medium-sized arteries Where is atherosclerosis most commonly found? coronary, cerebral, carotid, and femoral arteries DVT Deep vein thrombosis; acute venous obstruction secondary to a thrombus in a deep vein of the lower extremities vericose veins Superficial, darkened, raised, and tortuous veins that result when there is an impaired venous return which results in capillary pressure, and the involved limb may become edematous; incompetent valves of the superficial veins. What is the primary vein affected by varicose veins? greater saphenous vein Primary hypertension High blood pressure, the cause of which is unknown; also known as essential hypertension; the most common form of hypertension Non-modifiable risk factors of primary HTN? family history, age, and ethnicity Modifiable risk factors of primary HTN dietary factors, sedentary lifestyle, obesity, metabolic syndrome, tobacco use What are some examples of end-organ damage of primary HTN? increased myocardial work results in heart failure, glomerular damage results in kidney failure, affects microcirculation of the eyes, increased pressure in cerebral vasculature cause result in hemorrhage Secondary hypertension high blood pressure caused by the effects of another disease What can be some causes of secondary HTN? renal disease, coarctation of the heart, pregnancy, obesity, endocrine disorders Hypertensive urgency a situation in which blood pressure is severely elevated but there is no evidence of end organ damage hypertensive emergency 45 | P a g e dyspnea on exertion, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackle paroxysmal nocturnal dyspnea Refers to attacks of severe shortness of breath and coughing that generally occur at night What does heart failure cause? reduced cardiac output to meet metabolic demands of tissues and organs What are the complications of dysrhythmias? indicates an underlying disorder and impairs cardiac output What are the signs and symptoms of anaphylactic shock? anxiety, increased HR and respiratory rate, hives, hypotension, itching, and angioedema developing; The patients often has a sense of impending doom and bronchoconstriction can lead to wheezing, cyanosis, and laryngeal edema What are the risk factors of anaphylactic shock? food, medications, animal proteins, and venoms What is the pathogenesis of anaphylactic shock? Type I anaphylactic reactions that involve an antigen/IgE antibody reaction of the surface of mast cells and basophils; vasoactive chemicals are released What is sepsis? results from an inappropriate host response to the presence of pathogens What is septic shock? commonly associated with gram negative infections; gram positive bacteria and fungi are also important causes of septic shock What are the clinical manifestations of septic shock? a hyperdynamic state characterized by high cardiac output and warm extremities; the patient is usually febrile and altered Obstructuve Shock develops when the heart is prevented from pumping because of a mechanical obstruction of blood flow What are the types of obstructive shock? pulmonary embolism, cardiac tamponade, tension pneumothorax, dissecting aortic aneurysm cardiogenic shock primarily a results of severe dysfunction of the left, right, or both ventricles that results in inadequate cardiac pumping 46 | P a g e What are some examples of cardiogenic shock? myocardial infarction, cardiomyopathy, valvular heart disease, ventricular rupture, congenital heart defects, and papillary muscle rupture What is a common sign of viral pneumonia? dry cough What is a risk factor for TB immunosupression What are signs and symptoms of bacterial pneumonia? productive cough and parenchymal infiltrates on an xray What organism causes TB? Mycobacterium tuberculosis What is an x-ray finding of TB? Ghon tubercle What is associated with inhaled allergens in asthma? IgE What is associated with the allergic form of asthma? inflammation, mucosal edema, and bronchoconstriction What leads to alveolar destruction in emphysema? lack of alpha antitrypsin What causes the hypersecretion of mucus in chronic bronchitis? hypersecretion of mucus is a result of recurrent infection What is a characteristic of all obstructive pulmonary disorders? resistance of airflow Extrinsic asthma External factors cause airway inflammation that are often associated with hay fever, a positive family history of the disease, and positive skin test reactions to allergens; most common form of asthma intrinsic asthma Internal triggers that will cause an airway inflammation; exercise or stress-induced asthma; can be more complicated Barrel chest 47 | P a g e COPD leads to barrel chest due to air trapping What causes the destruction of the alveolar walls in emphysema? the release of proteolytic enzymes from immune cells What does chronic bronchitis lead to? Chronic bronchitis leads to cor pulmonale due to increased pulmonary vascular resistance cor pulmonale right ventricular hypertrophy and heart failure due to pulmonary hypertension What are characteristics of an acute asthma attack? bronchoconstriction, bronchial mucosal edema, hypersecretion of mucus, and hypoxemia What are some characteristics of asthma? chronic inflmmatory disorder, airway responsiveness, genetic susceptibility, and airway remodeling What are some clinical manifestations of an acute asthma episode? use of accessory muscles, expiratory wheezing, coughing, feeling of chest tightness status asthmaticus a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. What causes airway obstruction in chronic bronchitis? Thick mucus, fibrosis, and smooth muscle hypertrophy What type of cough is seen in patients with bronchitis? productive cough What is the hallmark for acute respiratory distress syndrome (ARDS)? hypoxemia What are signs for pneumothorax? tracheal shift and respiratory distress What causes hypersensitivity pneumonitis? inhalation of organic substances What are two examples of restrictive respiratory disorders? pneumothroax and ARDS What leads to a tension pneumothorax? 50 | P a g e Efforts to prevent an injury or illness from ever occurring. (vaccinations) secondary prevention Early detection, screening, and management of disease. Allostasis Ability for the body to successfully adapt to challenges. stress response chemicals released Catecholamines, norepinephrine, epinephrine, cortisol, aldosterone, endorphins, enkephalins, cytokines. Selye's General Adaptation Syndrome (GAS) alarm, resistance, exhaustion sympathetic nervous system (SNS) Mediated by norepinephrine intracellular accumulations 1. Normal intracellular substances (fat) 2. abnormal substances 3. accumulation of pigments (bilirubin) Types of necrosis 1. Coagulative (heart) 2. Liquefactive (brain) 3. Caseous (Lung) 4. Fat (pancreas, breast) Apoptosis programmed cell death Chemotherapy side effects Anemia, Nausea, Bleeding, Infections Cancer Terminology "carcinoma & sarcoma" Benign tumor terminology "oma" grading of tumors histologic characterization of tumor cells 51 | P a g e staging of tumors Location and pattern of spread within the host. - Tumor size Deficits in immune system function in cancer chemotherapy, cancer cells, cancer metastasis to bone marrow, and malnutrition Tumor marker functions produced by normal cells, help determine cancer origin, help identify progression of cancer, and include prostatic-specific antigen Hypersensitivity type 1 -Atopic of anaphylactic -Mast Cells -IgE mediated -Released histamine, kinin, prostaglandins, interleukins -Vasodilation, hypotension, urticaria, bronchoconstriction Hypersensitivity type 1 Triggers: Drug reactions, asthma, rhinitis, eczema, bee sting Hypersensitivity type 2 -Cytotoxic or cytolytic -IgM or IgG -antibodies formed against antigens on cell surfaces, resulting in lysis of target cells. (membrane attack) Hypersensitivity type 2 Triggers: Transfusions reactions, erythroblastosis fetalis, myasthenia gravis, hyperacute graft rejection. Hypersensitivity type 3 -Immune Complex/Arthus Reaction -IgG mediated -Antigen-antibody complexes deposited in tissue result in tissue inflammation & destruction Hypersensitivity type 3 Triggers: Low grade infections, inhalation of antigens into alveoli, glomerulonephritis, SLE, farmer's lung arthritis, vasculitis Hypersensitivity type 4 -Delayed hypersensitivity -T cell mediated -Inflammation in the dermal regions 52 | P a g e Hypersensitivity type 4 Triggers: Dermatitis, tuberculin reactions, transplant rejection, graft-versus-host disease, Guillain Barre disease, Multiple Sclerosis transfusion reaction Reactions involve RBC destruction caused by recipient antibodies. (Hypersensitivity type 2) RBC Have no cytoplasmic organelles Iron deficiency Has low MCH, MCHC, and MCV carbon dioxide Is transported in the bloodstream as BICARBONATE ION Bilirubin Can detect excessive red blood cell lysis Erythropoietin A hormone produced by the kidney Iron Is necessary for red blood cell production aplastic anemia Leads to pancytopenia (decrease in all blood cells) pernicious anemia -Lack of intrinsic factor -Vitamin B12 deficiency Glucose-6-phsophate dehydrogenase deficiency Occurs when exposed to certain drugs circulatory system Transports oxygen, waste, nutrients, hormones, heat, etc... around the body PT/INR measures Extrinsic pathway of coagulation Acute Lymphocytic Leukemia (ALL) 55 | P a g e Atherosclerosis Condition in which fatty deposits called plague build up on the walls of the arteries. -Tissue perfusion is diminished -Can lead to CAD, Renal disease, MI, PAD -High LDL deep vein thrombosis (DVT) A blood clot in a deep vein, most often an extremity varicose veins Impaired venous return results in increased capillary pressure causing edema, and superficial, darkened, raised, and tortuous veins. primary hypertension Idiopathic disorder Most common form of hypertension Rare prior to the age of 10 secondary hypertension Hypertension attributed to a specific identifiable pathology or condition. Hypertensive urgency blood pressure is severely elevated but there is no evidence of target organ damage hypertensive emergency sudden increase in either or both systolic or diastolic blood pressure with evidence of end-organ damage hypotension -Dizziness, blurred vision, confusion, syncope, fall risk, increased HR. -Can cause stoke, cognitive impairment, death End organ damage of hypertension 1. Heart (angina, hf) 2. Arteries (aneurysms) 3. Kidney Failure 4. Brain (stroke) 5. Eyes (retinal detachment, hemorrhage) normal blood pressure 120/80 Prehypertension 56 | P a g e 120-139 / 80-89 Stage 1 hypertension 140-159 / 90-99 Stage 2 hypertension >160 / >100 Sodium and Hypertension Increases plasma volume, increasing stroke volume, increased SV increases SBP. Excess sodium consumption causes the body to hold extra water to "wash" the salt from the body. In some people, this may cause blood pressure to rise. The added water puts stress on your heart and blood vessels. ACE inhibitors - prevents production of angiotensin 2 (potent vasoconstrictor) - used for regulating BP by vasodilation - decreases peripheral vascular resistance orthostatic hypotension Is a risk factor for stroke, cognitive impairment, and death Pulmonary stenosis Abnormal fusion of the valvular cusps and can lead to right ventricular hypertrophy. high LDL Atherosclerosis causes narrowing of the arterial lumen. Too many saturated fats can lead to cardiac ischemia by 1. Thrombus formation 2. Coronary vasospasm 3. Endothelial cell dysfunction Stable angina Most common, chronic coronary syndrome, pain is predictable, relived by rest & nitroglycerin unstable angina Acute coronary syndrome, low blood flow, unpredictable attacks, vasospasm, O2 demand, abnormal calcium flu, Responds well to CALCIUM-BLOCKING drugs acute coronary syndrome -Low blood flow in cardiac tissue -Myocardial infarction -Decreased CO which triggers SNS, which increases HR, BP & Contractility 57 | P a g e Myocardial infarction diagnostic tests 1. Signs and Symptoms ( crushing, chest pain, that radiates to arm , shoulder, jaw, back, N &V, sweating) 2. ECC (ST- segment elevation, large Q waves, inverted T waves) 3. Specific markers in blood ( serum changes: Myoglobin, Increased Troponin I &F, lactate, dehydrogenase, creatine kinase) Increase CK-MB rheumatic heart disease - Infection caused by Group A Beta-hemolytic streptococci -Mainly in children -Antibodies attack tissue, joint & heart -Fever, sore throat, involuntary movements, truncal rash, inflammation patent ductus arteriosus A normal channel between the pulmonary artery and the aorta that remains open during intrauterine life. Allows for communication between the aorta and the pulmonary artery. Right sided backward HF symptoms 1. Hepatomegaly 2. Ascites 3. Splenomegaly 4. Anorexia 5. Subcutaneous edema 6. Jugular Vein Distention Left Side backward HF 1. Dyspnea on exertion 2. Orthopnea 3. Cough 4. Paroxysmal nocturnal 5. Cyanosis 6. Basilar Crackles Forward effects of R & L side HF 1. Fatigue 2. Oliguria 3. Increased HR 4. Faint pulses 5. Restlessness 6. Confusion 7. Anxiety Paraxysmal nocturnal dyspnea sudden awakening from sleeping with shortness of breath 60 | P a g e Acute asthma attack Bronchoconstriction, bronchial mucosa edema, hypersecretion of mucus, and hypoxemia. Asthma Chronic inflammatory disorder, airway responsiveness, genetic susceptibility, airway remodeling. Acute asthma attack episode Use of accessory muscles, expiratory wheezing, coughing, chest tightness. status asthmaticus a prolonged, extremely severe, life-threatening asthma attack Chronic bronchitis Thick mucus, fibrosis, and smooth muscle hypertrophy are all parts of airway obstruction in...? Chronic bronchitis Productive cough Hypoxemia Is the hallmark for acute respiratory distress syndrome Pneumothorax Tracheal shift and respiratory distress. air in the pleural cavity Hypersensitivity pneumonitis Inhalation of organic substances are the etiology Restrictive respiratory disorders Pneumothorax and ARDS Tension pneumothorax Air that enters the pleural space during inspiration but is unable to exit during expiration Interstitial lung disease Loss of alveolar walls, immunological nature, honeycomb lung appearance on x-ray. Sarcoidosis Presence of CD4+ cells, nonproductive cough, granulomas, fatigue, weight loss, and fever are signs. pleural effusion dyspnea, diminished breath sounds, tracheal shift 61 | P a g e infant respiratory distress syndrome Is caused by a lack of surfactant Hypophosphatemia A person who over uses magnesium aluminum antacids for a long time can develop...? hyperparathyroidism It's a risk factor for hypercalcemia Neuromuscular excitability Hypocalcemia and hypomagnesemia both increase it Diarrhea Can cause metabolic acidosis Hypernatremia Confusion is a sign Hypokalemia Muscle weakness and cardiac dysrhythmias are CM Hypomagnesemia Chronic alcoholism is the etiology Clinical dehydration Decreased urine output is a symptom Hypernatremia Decrease anti-diuretic hormone can cause it Hyponatremia Confusion, lethargy, coma, and seizure are CM Metabolic alkalosis Hypo ventilation is the compensation Respiratory system compensates for metabolic acidosis/alkalosis Hyperventilation Can cause respiratory alkalosis metabolic acidosis 62 | P a g e Headache is an early sign Respiratory acidosis Includes an increase in carbonic acid Renal compensation For respiratory acidosis is shown by elevated bicarbonate ion concentration Hypoventilation can lead to respiratory acidosis carbonic acid kidneys can NOT excrete it Dysrthymia Can indicate an underlying disorder, can impair cardiac output. Acute coronary syndrome May be present as unstable angina, MI, or sudden cardiac arrest. Barrel chest Loss of elastic tissue in the lungs allows premature airway closure, which traps air, creating a barrel chest. Testicular torsion Sudden severe testicular pain. A twisting of the spermatic cord with subsequent testicular ischemia and infarction. UTI Sexually active women are at higher risk power off Renal calculi The most common sign is pain. prostatic enlargement A progressive decrease in the force of the urinary stream, dribbling of urine, and difficulty initiating the urinary stream. E. coli (Escherichia coli) The microorganism that causes the vast majority of UTI Anemia Insufficient erythropoietin is the most likely cause in a patient with end-stage rent renal disease