Advanced Pathophysiology Exam 1 Advanced Pathophysiology Exam 1, Exams of Pathophysiology

Download Advanced Pathophysiology Exam 1 Advanced Pathophysiology Exam 1 and more Exams Pathophysiology in PDF only on Docsity! Advanced Pathophysiology Exam 1 What is the primary functional unit of the liver? - Liver lobule True or False? Cirrhosis causes hypoglycemia? - True What is the first stage of Alcoholic Liver Disease? - Fatty liver "Steatosis" (reversible) What is the second stage of Alcoholic Liver Disease? - Alcoholic hepatitis (reversible) What is the third stage of Alcoholic Liver Disease? - Cirrhosis (Irreversible) What are three nutritional deficiencies in Alcoholic Liver Disease? - Thiamine, Folic Acid, and Electrolytes What is end-stage chronic liver disease called? - Cirrhosis What are the 3 top causes of Cirrhosis? - Alcoholism Viral Hepatitis Fatty liver disease (obesity) What is the pathophysicology of Cirrhosis? - Diffuse fibrosis throughout the liver (stellate cells are activated by Kupffer cells), formation of nodules, the fibrous scarring begins to form bands called septae in between nodules, and increased fibrous tissue causes an obstruction of blood flow leading to increased pressure in the portal vein. True or False? Portal hypertension causes collateral vessels? - True What complication of Portal hypertension causes anemia (decreased hemoglobin and hemocrit), thrombocytopenia (decreased platelets), and leukopenia (decreased WBCs)? - Splenomegaly What complication of Portal hypertension causes collateral vessels, dark or bright red stools? - Esophageal Varices True or false? Coagulapathy is due to portal hypertension. - False. What is the pathophysiology of Hepatic encephalopathy? - Build up of ammonia in the brain, since ammonia is not being converted to urea in the liver. What is the collection of excess fluid in the peritoneal cavity called? - Ascites/Edema What is the pathophysiology of Ascites? - Activation of the Renin-Angiotensin Aldosterone system causing sodium and water retention. What occurs in the Renin-Angiotensin Aldosterone system? - -Kidneys produce renin -The liver produces angiotensinogen -Renin converts angiotensiongen into AngI -AngI is converted to AngII by ACE -AngII stimulates the adrenal gland to produce Aldosterone -Aldosterone causes sodium and water retention, leading to increased blood volume What is the pathogenesis of Ascities/Edema? - Hypoalbuminemia causes decrease plasma oncontic pressure. This causes excess fluid to leak into the muscles and tissues. What is Spontaneous Bacterial Peritonitis? - Infection of the peritoneal fluid What does a Serum Albumin Ascites Gradiet (SAAG) reading of >1.1 g/dL indicate? - Portal hypertension/cirrhosis What does a PMNs reading of >250 cells/mm3 indicate? - Antibiotics needed (in the case of spontaneous bacterial peritonitis) What disease is characterized by high WBC count, fever, and Ascites? - Spontaneous Bacterial Peritonitis What disease is characterized by Spider angioma? - Feminization/hypogonadism What disease is presented with clay colored stools, dark urine, high alkaline phosphatase, high AST/ALT, and pruritis? - Jaundice What is inflammation of the liver called? - Hepatitis What are the 3 presentation phases of Hepatitis? - -Prodromal -Icteric -Convalescent What are the 2 mechanisms of liver injury caused by hepatitis? - What is the differences between TTN and RDS? - TTN: Term and Near Term Neonates, immediate onset, primary cause is delayed reabsorption of fetal lung fluid. RDS: Primarily preterm, onset within first 6 hrs of life, primary cause is surfactant deficiency. What is Apnea? - The cessation of breathing for at least 20 seconds or less if associated with bradycardia or desaturation (cyanosis). What are the 3 types of Apnea? - -Central (40%): Immaturity of respiratory center in medulla oblongata. -Obstructive (10%): obstruction of the airway -Mixed (50%) True or False? Apnea is associated with bradycardia? - True What are some key characteristics of newborn hearts? - -Decreased ventricular compliance -Lower ratio of contractile/non-contractile myocardial proteins -Higher resting heart rates -Right ventricle is more muscular than left ventricle What are some key characteristics of infant/child hearts compared to newborns? - -Reversal of ventricular strength -Heart rate slows -Systolic blood pressure rises Do heart rates generally increase or decrease with age (newborns to adolescents)? - Decrease Is blood pressure generally higher or lower in infants/children compared to adults? - Lower True or false? Hypertension in infants/children is usually a sign of kidney disease? - True Highly oxygenated blood bypasses the liver through the __________________ to the inferior vena cava, then crosses the __________________ to the left atrium. - Ductus venosus, foramen ovale Through what anatomical feature in newborns is the majority of oxygenated blood from the right ventricule directed to the descending aorta? - Ductus arteriosus What are the 3 major changes that occur after birth? - -Aeration lungs -Increased arterial oxygen pressure -Umbilical cord clamping True or false? With the first breath and expansion of lungs, the pulmonary vascular resistance (PVR) increases? - False. The PVR decreases. True or false? As the pulmonary venous return increases, the left atrial pressure increases in newborns. - True What is the most common congenital disorder in newborns? - Congenital Heart Disease (CHD) True or false? Many congenital heart lesions are ductus dependent. - True. Affected neonates may not be symptomatic immediately around birth because the ductus arteriosus has not closed yet. At what age is the digestive process mature? - 3 months Where does bilirubin come from? - The breakdown of Hemoglobin What are the 3 types of Jaundice? - -Physiologic jaundice (not pathologic) -Kernicterus (bilirubin in the brain) -Breast milk jaundice What is the Rule of 3 in regards to Irritable Infant Syndrome/Colic? - -Crying for more than 3 hours a day -Crying for more than 3 days a week -Crying for longer than 3 weeks What is the percentile BMI for children of the same age and gender, which is considered overweight/obesity? - BMI at or above the 95th percentile True or false? Premature infants are at high risk of sepsis? - True What are the 3 principal anatomic sections of the kidney? - -Pelvis -Medulla -Cortex What is the function of the Glomerulus? - Filters fluid from blood What is the function of the Proximal Convoluted Tubule? - Reabsorbs water, electrolytes, bicarb, glucose, amino acids, and vitamins. What is the function of the Descending Loop of Henle? - Reabsorbs water. What is the function of the Ascending Loop of Henle? - Actively reabsorbs Na, K, and Cl resulting in high osmolality. What is the function of the Distal Convoluted Tubule? - Reasborbs Na, Cl, water, urea, secretes H and K. What is the function of the Collecting Tubule? - Reabsorbs water under the influence of ADH, secretes H and K. What effect does ADH have in renal function? - ADH increases the re-absorption of water in the collecting tubule (reduces blood osmolality). What effect does Aldosterone, AngII have in renal function? - They both increase sodium and water re-absorption (no effect on blood osmolality). What effect does ANP have in renal function? - ANP decreases sodium and water re-absorption (no effect on blood osmolality). What effect do diuretics have in renal function? - Diuretics opposes water re-absorption. What effect does afferent constriction and efferent dilation have on Glomerular Filtration Rate (GFR)? - Decreases GFR What effect does afferent dilation and efferent constriction have on Glomerular Filtration (GFR)? - Increase GFR What effect does calcium channel blockers (Amlodipine) have on GFR? - Increases GFR (dilates afferent arteriole) What effect does ACE inhibitors have (Lisinopril) have on GFR? - Decreases GFR (dilates efferent arteriole) What effect does Calcineruin inhibitors/Immunosuppressants (Tacrolimus) have on GFR? - Decreases GFR (constricts afferent arteriole) What 3 important hormones does the kidneys release? - -Erythropoietin (RBC production) -Renin (increases blood pressure/volume) -Calcitriol (Vitamin D which maintains calcium for bones) What are 6 tests of Renal structure and function? - -Urinalysis What are the 3 ways Chronic Kidney Disease is classified by? - -Cause -GFR category -Albuminuria category What are the 5 stages of Chronic Kidney Disease? - -Stages 1 and 2: Nephron loss up to 75% (asymptomatic) -Stages 3 and 4: Nephron loss between 75%-90% (mild azotemia, polyuria, nocturia) -Stage 5: ESRD, 90% Nephron loss, elevated BUN and Creatinine concentrations (fluid and electrolyte abnormalities, uremia) What is Azotemia? - Accumulation of nitrogenous waste in blood Name 8 clinical manifestations of Chronic Kidney Disease? - -Accumulation of Nitrogenous waste -Fluid,Electrolyte (increased potassium excretion, decrease sodium excretion), and Acidosis -Calcium and phosphorus metabolism and bone disease -Secondary hyperparathyroidism -Renal Osteodystrophy -Hyperphosphatemia -Anemia -Pharmacokinetic changes in renal failure What is Neoplasia? - Process of altered cell differentiation and growth -Uncoordinated -Lacks normal regulatory control What is a Neoplasm? - New growth -Uncoordinated -"Tumor" (Can be benign or malignant) What is cancer? - Disease resulting from altered cell differentiation and growth What 2 components are involved in normal tissue renewal and repair? - Proliferation-CELL DIVISION Differentiation-SPECIALIZATION What phases are in Interphase? - -G1: Cell is preparing for DNA replication -Synthesis (S): DNA synthesis & replication =10-12 hours -G2: Pre-mitotic phase, enzymes & protein development What phases are in Mitosis? - -Prophase: Chromatin condenses down to form chromosomes, Nuclear envelope breaks down & disappears, Cetromeres appear near the middle of the cell and move toward the poles of the cell, Spindle fibers form. -Metaphase: Chromosomes line the equator of the cell, Spindle forms microtubules attached to each sister chromatid. -Anaphase: Begins when chromosomes begin to move apart, Ends when the chromosomes reach the poles of the cell and stop moving. -Telophase: Chromosomes decondense & unwind back into chromatin, Reformation of nuclear envelope. Which transition between what stages is considered to be the most important? - Transition from G2 to M is considered to be the most important What do cyclins, cyclin dependent kinases and cyclin-dependent inhibitors do in the cell cycle? - Pauses within the cycle if phases not completed, commonly controlled by cyclins, cyclin dependent kinases and cyclin-dependent inhibitors. True or False? Proliferating cells become progressively more specialized. - True True or False? As cells differentiate, their capacity for proliferation increases. - False, as cells differentiate, their capacity for proliferation diminishes. What are 3 genetic basis for cancer? - -Oncogenes (mutated causing over-activity) -Tumor suppressors (mutated causing under-activity) -Mutated Genes that control genomic stability What kind of mutation do oncogenes undergo that leads to new or accelerated biochemical activity? - Point mutation (insertion,deletion, substitution). How many alleles are mutated for oncogenes and tumor-suppressor genes to cause problem? - Oncogenes: only one allele is mutated Tumor suppressor genes: Both alleles must be inactivated ("2 hit model") What is the regarded as the most significant tumor suppressor gene? - TP53 What is Epigenetics? - Changes in gene expression control through molecular and cellular processes that can be passed from one cell to its offspring, that are not changes in DNA sequence. DNA methylation, Histone modification, and Non-coding RNAs are examples of which DNA mutation or epigenetics? - Epigenetics True or false? Single gene mutations do not seem to be sufficient to start this pathway towards cancer, rather multiple independent genes must be activated . - True What are 6 host and environmental factors for cancer? - -Heredity -Hormones -Immunologic mechanisms -Carcinogens -Radiation (ionizing and UV) -Oncogenic viruses What are two types of reactions for carcinogenic activity? - -Direct reacting (Do not require activation in the body to become carcinogenic) -Indirect reacting (Active only after metabolic conversion) True or false? The larger the dose and the longer the exposure to carcinogens, the higher risk. - True What is the difference between group 1 carcinogens and group 2 carcinogens? - Group 1: Carcinogenic to humans Group 2A: Probably carcinogenic to humans What are 5 molecular and cellular pathways that increase the susceptibility to cancer? - -Defects in DNA repair mechanisms (carcinogens) -Defects in growth factor signaling pathways -Evasion of apoptosis -Avoidance of cellular senescence (High levels of telomerase and prevention of telomere shortening) -Develpment of sustained angiogenesis What are 3 stages in Carcinogenesis, and are they reversible or irreversible? - -Initiation (Irreversible): carcinogen causes DNA damage and cell mutation. -Promotion (Reversible): Activation of oncogenes -Progression (Irreversible): Malignant tumor What are the 2 types of Cancer cells? - -Solid Carcinoma: covers external/internal surfaces (lung, colon, etc.) Sarcoma: in supporting tissues (bone, fat, muscle) -Liquid Lymphoma: in lymph nodes and tissues of the body's immune system Leukemia: immature blood cells in bone marrow What is Carcinoma? - Cancer which covers external/internal surfaces (lung, colon, etc.) What is Sarcoma? - Cancer in supporting tissues (bone, fat, muscle) What is Lymphoma? - Cancer in lymph nodes and tissues of the body's immune system What is the key regulator of the process of erythropoiesis? - Erythropoietin What is Mean Corpuscular Volume (MCV)? - Expresses volume or size of a single RBC What is Mean Vorpuscular Hemoglobin (MCH)? - Average mass of Hemoglobin What is Mean Corpuscular Hemoglobin Concentration (MCHC) - Average concentration of hemoglobin in the RBC and the amount of color. What is Red Blood Cell Distribution Width (RDW)? - Indication of variation in red blood cell volume. What is Reticulocyte Count what does it indicate? - Number of young, non-nucleated cells of the erythrocyte system -Increased count: increased production of RBCs -Decreased count: bone marrow suppression What is Anemia? - Abnormally low level of circulating RBCs What are 3 manifestations of anemia? - -Decreased presence of hemoglobin in the blood (pallor) -Tissue hypoxia due to deficient oxygen transport (weekness, angina, headache) -Recruitment of compensatory mechanism (Tachycardia, dyspnea) What are 3 classifications of anema? - -Macrocytic (increased MCV) -Microcytic (decreased MCV) -Normocytic (normal MCV) What are the 2 most common causes of Macrocytic anemia? - -Vitamin B12 deficiency -Folic acid deficiency What is the main differences between anemia caused by Vitamin B12 deficiency and anemia caused by folic acid deficiency? - Vitamin B12 Deficiency: -Neurologic changes due to deranged myelin -Require intrinsic factor to be absorbed Folic Acid Deficiency: -No neurologic changes -Does not require intrinsic factor to be absorbed What are some signs of Iron-Deficiency Anemia? - -Low hemoglobin and hematocrit -Low RBCs -Low MCV -Low serum iron and ferritin What is Hemolytic Anemia? - Premature destruction of red cells. True or False? With hemolytic anemia, there is an increase in erythropoeiesis? - True What are the 5 stages of Hemostasis and what happens in each? - -Vessel spasm (vasoconstriction, reducing blood flow) -Formation of the platelet plug (adhesion and aggregation of platelets, von Willebrand factor adherence, [TxA2, ADP, and 5-HT released], GPIIb/IIIa binds fibrinogen to link platelets) -Blood coagulation (fibrin production by Thrombin, Terminal step of cascade is activation of Factor X) -Clot retraction (join edges of broken vessel) -Clot dissolution (Plasminogen converted to plasmin by t-PAs, Plasmin digests fibrin) What are 2 disorders of Hemostasis? - -Hypocoagulopathies (bleeds) -Hypercoagulopathies (clots) What is Thrombocytopenias? - Reduced platelet number What are some causes of Thrombocytopenias? - -Bone marrow failure -Chemotherapy -Drug/Heparin induced What is the role of von Willebrand factor in forming a clot? - It is the bridge between platelets and endothelium. What are some clinical manifestations of von Willebrand Disease? - -Easy brusing -Skin bleeding -Prolonged bleeding from mucosal surfaces What are 3 causes of Thrombosis? - -Circulatory Stasis -Endothelial Injury -Hypercoagulable State What is Circulatory Stasis? - -Sluggish blood flow -Venous congestion -Causes accumulation of activated clotting factors -Prevents interaction of factors and PLTs with inhibitors -Increased blood viscosity increases resistance What is a Hypercoagulable State? - -Increased procoagulation factors -Decreased anticoagulation factors -Reversible (hormonal contraceptives, pregnancy, smoking, etc) vs irreversible (MI, CHF, Inherited genetic factors, etc.) simulators What is Endothelial Injury? - -Endothelial cells form intima of vessel -Injury exposes sub-endothelium -Trigger platelet adherence -Activation of coagulation cascade What are some clinical presentations of Deep Vein Thrombosis? - -Can be asymptomatic -Edema -Erythema -Calf tenderness -Dorsiflexion causing pain behind the knee Does increase or decreased readings of D-dimer blood test indicates a presence of a clot? - Increased What is Pulmonary Embolism? - Blood born substance lodged in the pulmonary artery. What does a pulmonary embolism cause? - -Obstruction of pulmonary circulation -Reflex bronchoconstriction -Pulmonary infarction is uncommon What percent of pulmonary embolisms result from Deep Vein Thrombosis (DVT)? - 95%