NR507- Advanced Pathophysiology Final Exam with 100% correct answer, Exams of Pathophysiology

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NR507- Advanced Pathophysiology Final Exam with 100% correct answer Acute renal failure - correct answer Reversible Determining prognosis- kidneys respond to diuretic with good output; this indicates that kidneys are functioning well Acute Pyelonephritis - correct answer Diagnosing by clinical symptoms alone can be difficult; can be similar to cystitis Diagnosis established by: -Urine culture -Urinalysis (WBC casts indicates pyelonephritis, but may not always be present) -Signs/Symptoms -Complicated pyelonephritis requires blood cultures and urinary tract imaging Renal Calculi (Renal Stones) - correct answer Goals of Treatment: Manage acute pain Promote passage of stone Reduce size of stone Prevent new stone formation Chronic Renal Failure - correct answer Chronic Kidney Disease (CKD) is a progressive loss of renal function associated with systemic disease such as hypertension, diabetes mellitus (most significant risk factor), systemic lupus erythematosus or intrinsic kidney disease CKD stage is determined by estimates of GFR and albuminuria Who is a candidate for dialysis? - correct answer End-stage renal disease (ESRD) is the final stage of CKD with the number one cause being diabetes mellitus combined with hypertension. At this point, the patient is completely dependent on dialysis to survive. CKD is classified into five stages and is based on the patient's GFR rather than symptoms. Patients will need dialysis when the following symptoms are present: --Metabolic acidosis. --Hyperkalemia: Hyperkalemia in the presence of EKG changes (peaked T-waves) is an indication for dialysis. --Hyperkalemia by itself is not an indication for dialysis. --Drug toxicity: Drug toxicity due to the following drugs is an indication for dialysis and include salicylates, Lithium, Isopropanol, Methanol and Ethylene glycol). --Fluid volume overload that is not responsive to diuretics. --Uremic symptoms due to nitrogenous wastes in the blood stream. Stage I CKD - correct answer There is kidney damage with normal or elevated GFR 90-120 Stage II CKD - correct answer There is kidney damage with mild decrease in GFR 60-89 Stage III CKD - correct answer There is a moderate decrease in GFR 30-59 Stage IV CKD - correct answer There is a severe decrease in GFR 15-29 Stage V CKD - correct answer Kidney failure- End-stage renal disease <15 (dialysis) Once Stage IV is reached, progression to Stage V is inevitable as well as dialysis or kidney transplant Example: anxious person may feel very uncomfortable having a conversation or interacting with others and very conscious of being scrutinized and humiliated or rejected by others Schizophrenia Diagnosis: - correct answer Advanced neuroimaging techniques have revealed structural brain abnormalities A consistent finding is the enlargement of the lateral and third ventricles and the widening of frontocortical fissures and sulci . Schizophrenia Positive symptoms - correct answer ("More" symptoms): Hallucinations Delusions Formal thought disorder Bizarre behavior Schizophrenia Negative symptoms - correct answer Flattened affect Alogia Anhedonia Attention deficits Apathy Schizophrenia Cognitive symptoms: - correct answer Inability to perform daily tasks requiring attention and planning Hypothyroidism - correct answer Most common thyroid function disorder Affects between 0.1% and 2% of the U.S. population More common in women and elderly Hormone replacement therapy with the hormone levothyroxine is the treatment of choice Thyroid-Stimulating Hormone (TSH) - correct answer TSH released by anterior pituitary Review hypothalamic-pituitary axis (Picture) Thyroid-releasing hormone (hypothalamus) Hyperthyroidism/ Grave's Disease - correct answer Two most distinguishing factors of Grave's disease = pretibial myxedema and exophthalmos Treatment directed at controlling excessive TH production, secretion or action and includes antithyroid drug therapy (methimazole or propylthiouracil), radioactive iodine therapy (absorbed only by thyroid tissue, causing death of cells), and surgery Goal of radioactive iodine ablation for the treatment of Grave's disease is to destroy overactive thyroid tissue Two categories of ophthalmopathy associated with Grave's Disease: - correct answer Functional Abnormalities: resulting from hyperactivity of the sympathetic division of the autonomic nervous system (lag of the globe on upward gaze or a lag of the upper lid on downward gaze) Infiltrative Changes: involving the orbital contents with enlargement of the ocular muscles. These changes affect more than half of individuals with Grave's Disease. Increased secretion of hyaluronic acid, adipogenesis, inflammation and edema of the orbital contents results in exophthalmos (protrusion of the eyeball), periorbital edema and extraocular muscle weakness leading to strabismus and diplopia (double vision) Hyperparathyroidism - correct answer Characterized by stimulation of parathyroid gland in response to hypocalcemia Hypercalcemia - correct answer Hypercalcemia & Hypophosphatemia may be asymptomatic or affected individuals may present with symptoms related to the neuromuscular changes that include paresthesias and muscle cramps Patients with hypercalcemia can have low bone density that is most noted in the distal one-third of the radius Hypoparathyroidism - correct answer Hypomagnesemia inhibits PTH secretion Hypomagnesemia may be related to chronic alcoholism, malnutrition, malabsorption, increased renal clearance of magnesium caused by the use of aminoglycoside antibiotics or certain chemotherapeutic agents, or prolonged magnesium-deficient parenteral nutritional therapy Hypocalcemia - correct answer Symptoms: Dry skin Loss of body and scalp hair Hypoplasia of developing teeth Horizontal ridges on nails Cataracts Basal ganglia calcifications Bone deformities Bowing of the long bones Hypercortisolism - correct answer Glucose intolerance associated with hypercortisolism --Occurs because of cortisol-induced insulin resistance and increased gluconeogenesis and glycogen storage by the liver --Dysarthria --Dysphagia Multiple Sclerosis (MS) - correct answer Risk factors that may be involved in the development of MS include: --Smoking --Vitamin D deficiency --Epstein-Barr Virus Infection Febrile Seizures - correct answer One possibility for the development of a febrile seizure is that neurons are excited by decreased CO2 levels caused by hyperventilation during a febrile state Cluster Headache - correct answer Unilateral trigeminal distribution of severe pain with ipsilateral autonomic manifestations, including tearing on the affected side, ptosis of the ipsilateral eye and congestion of the nasal mucosa Occurs in one side of the head primarily in men between 20 to 50 years of age Pain may alternate sides with each headache episode Severe, stabbing and throbbing Pain often referred to the midface and teeth Migraine Headache - correct answer Episodic neurologic disorder whose marker is headache lasting 4 to 72 hours Diagnosed when any two of the following occur: --Unilateral head pain --Throbbing pain --Pain worsens with activity --Moderate or severe pain intensity And at least one of the following: --Nausea and/or vomiting --Photophobia and phonophobia Migraine with aura with visual, sensory or motor symptoms Migraine without aura (most common) Chronic migraine Tension Headache (Tension Type Headache/TTH) - correct answer Most prevalent type of recurrent headache Not vascular or migrainous Average age of onset is during the second decade of life Usually mild to moderate bilateral headache with sensation of a tight band or pressure around head Bell's Palsy - correct answer Associated with Cranial Nerve VII paralysis and results in facial asymmetry and inability to close eye, smile or frown on the affected side Bacterial Meningitis - correct answer Associated with compression of Cranial nerve V and results in severe and sharp stabbing pain that can worsen with chewing Trigeminal neuralgia - correct answer Characterized by clinical manifestations of systemic infection including Characterized by clinical manifestations of systemic infection including --Fever --Tachycardia --Chills And clinical manifestations of meningeal irritation including --Severe throbbing headache --Severe photophobia --Nuchal rigidity --Positive Kernig and Brudzinski signs --Fever --Tachycardia --Chills And clinical manifestations of meningeal irritation including --Severe throbbing headache --Severe photophobia --Nuchal rigidity --Positive Kernig and Brudzinski signs