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MSN 570 Advanced Pathophysiology exam with
correct answers
Nephrotic syndrome - CORRECT ANSWERS ✔✔characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay; Associated with glomerulonephritis and with an immune response that is noninflammatory. Glomerular Injury: Diffuse and Focal - CORRECT ANSWERS ✔✔Lesions that involve all or most (> 50%) of the glomeruli (plural) are termed diffuse, and lesions that involve some (< 50%) of the glomeruli are termed focal (e.g., focal segmental glomerulonephritis). Glomerular injury: Global and Segmental - CORRECT ANSWERS ✔✔When a whole glomerulus (singular) is affected, the lesion is termed global, and the lesion is considered segmental if only a portion (< 50%) of the glomerulus is affected. Glomerulonephritis - CORRECT ANSWERS ✔✔An inflammatory disorder of the glomeruli, and most forms occur as a result of activation of immune mechanisms. Nephritic syndrome - CORRECT ANSWERS ✔✔Associated with glomerulonephritis and an immune response that is inflammatory. A key feature is the passage of leukocytes, red blood cells, and plasma proteins which occur as a result of inflammation. 1.) LIMITED proteinuria 2.) Oliguria and Azotemia 3.) Salt retention -- periorbital edema and hypertension(salt/fluid retention) 4.) RBC casts and
dysmorphic RBCs in urine-- Immune Complex deposition activated Complement; C5a attracts neutrophils which mediate the damage Proliferative structural (histologic) descriptor - CORRECT ANSWERS ✔✔refers to an increase in glomerular cells (e.g., mesangial, endothelial, basement membrane). In the extra capillary space, this forms specific lesions that are termed crescents, which are made of macrophages, fibroblasts, and other cells. These crescent cells accumulate in the Bowman space and represent a rupture of the capsule. sclerosing structural (histologic) descriptor - CORRECT ANSWERS ✔✔refers to glomerular scar formation, and when the scarring is between the glomerulus and tubules, it is referred to as interstitial fibrosis. necrotizing structural (histologic) descriptor - CORRECT ANSWERS ✔✔refers to cellular death. Benign prostatic hyperplasia (BPH) Also called benign prostatic hypertrophy - CORRECT ANSWERS ✔✔A common, nonmalignant enlargement of the prostate gland that occurs as men age, usually appearing by age 50. Bladder cancer - CORRECT ANSWERS ✔✔cancerous tumor that arises from the cells lining the bladder; major sign is hematuria Diagnostic procedures for hydronephrosis - CORRECT ANSWERS ✔✔History physical examination urinalysis
intermittent and occurs throughout all of micturition as opposed to just the beginning. Irritative symptoms such as frequency, urgency, and dysuria may be present and occur due to detrusor overactivity, obstruction, or decrease in bladder capacity. Flank or abdominal pain (e.g., suprapubic) are usually signs of more advanced cancer. Other general symptoms such as fatigue, weight loss, or anorexia are also manifestations of more advanced disease. Physical examination findings may reveal the presence of a pelvic or abdominal mass (if advanced) and prostate induration. Treatment for hydronephrosis - CORRECT ANSWERS ✔✔treat underlying cause and facilitating urine flow will be necessary if UTIs develop. Wilms tumor, or nephroblastoma - CORRECT ANSWERS ✔✔a rare cancer of the kidney that occurs in children from residual embryonic or fetal tissue IgE - CORRECT ANSWERS ✔✔Immunoglobulin E. Antibody attached to mast cells and basophils. Responds to parasites and triggers allergic/inflammatory reactions to release histamine and heparin. IgM - CORRECT ANSWERS ✔✔First immunoglobulin formed in response to antigen. Fights blood infections and triggers additional production of IgG. Present in lymphocyte cells and the first antibody made by a developing fetus.
IgA - CORRECT ANSWERS ✔✔Found in membranes of the respiratory and gastrointestinal tract, tears, saliva, mucus, and colostrum. Important in local immunity. IgD - CORRECT ANSWERS ✔✔Present in blood serum in small amounts and on B-cell surfaces. Receptor for antigens and helps anchor cell membranes. IgG - CORRECT ANSWERS ✔✔Second response after IgM. Main defense against bacteria and can cross the placenta to protect the fetus against infections, giving it passive immunity. Eventually replaces IgM. ICF - CORRECT ANSWERS ✔✔IntraCellular Fluid is rich in potassium, magnesium, phosphates, and proteins. Hyperkalemia - CORRECT ANSWERS ✔✔excessive potassium in the blood; manifestations include: Neuromuscular: Paresthesias Muscle cramps Weakness/fatigue Hyperreflexia Flaccid paralysis (later) Anxiety Cardiovascular: Electrocardiogram (EKG) changes and dysrhythmias (delayed conduction—bradyarrhythmias/asystole) Respiratory: Respiratory depression/arrest—diaphragm weakness Gastrointestinal Nausea/vomiting Diarrhea Cramping Hypokalemia - CORRECT ANSWERS ✔✔deficient potassium in the blood; manifestations include:
anxiety/depression/confusion/drowsiness), gastrointestinal (anorexia, constipation and ulcers hypercalcemia causes - CORRECT ANSWERS ✔✔Hyperparathyroidism Malignant bone disease Prolonged immobilization Excess calcium supplementation Hypernatremia - CORRECT ANSWERS ✔✔High serum sodium levels (greater than 145 mEq/L). The excessive sodium levels generally lead to high serum osmolality (greater than 295 mOsm/kg) because of the imbalance between sodium and water. Symptoms: Increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. Give hypotonic solution. Hypocalcemia - CORRECT ANSWERS ✔✔deficient calcium in the blood; symptoms include hypertension, peripheral/perioral paresthesia, abdominal pain, cramps, lethargy, irritability in infants. Lipoedema - CORRECT ANSWERS ✔✔type of edema caused by excess deposition of fat cells in an irregular and disproportional manner and not fluid shifts. The fat deposition is usually in the legs, thighs, and buttocks but can go to the arms. The legs will look like block columns. Lipoedema occurs mostly in women and rarely in men. It can occur with or without obesity. Eventually, lipoedema can cause venous and lymphatic problems. Lymphedema - CORRECT ANSWERS ✔✔type of edema that occurs when there is a blockage in lymphatic channels (e.g., tumor) or removal of lymph nodes (e.g., breast cancer).; swelling of the tissues due to an abnormal accumulation of lymph fluid within the tissues
Myxedema - CORRECT ANSWERS ✔✔A type of edema not related to fluid shifts;refers to a thick nonpitting edema caused by deposits of mucopolysaccharides in the skin; caused by extreme deficiency of thyroid secretion; also known as adult hypothyroidism Normal Serum Values of the Major Electrolytes - CORRECT ANSWERS ✔✔Electrolyte Normal range Sodium (Na+) 135-145 mEq/L Chloride (Cl−) 98-108 mEq/L Potassium (K+) 3.5-5 mEq/L Calcium (Ca++) 8.8-10.3 mg/dL Phosphorus (P) 2.5-4.5 mg/dL Magnesium (Mg++) 1.8-2.4 mEq/L Bicarbonate (HCO3−) 24-31 mEq/L Tonicity - CORRECT ANSWERS ✔✔The ability of a solution surrounding a cell to cause that cell to gain or lose water. "The effect of the osmotic pressure or tension on the cell. It is determined by the osmotic pressure of two solutions (i.e., solvent and solute) separated by a semipermeable membrane and the
protein), leukocytes (white blood cells), erythrocytes (red blood cells), and thrombocytes (platelets). Burkitt Lymphoma - CORRECT ANSWERS ✔✔Type of Non-Hodgkin Lymphoma. Origin: B lymphocytes. Most linked to EBV. Epidemiology, U.S.: 40%; More common in males; Age 5-10 years; peak 4-6 years Common clinical presentation: Abdominal mass, pain, nausea, vomiting, & change in bowel patterns. Rapid growing head and neck lymphadenopathy Special notes: One of the most aggressive fast-growing cancers. Cases in Africa account for almost all NHL. Over 50% of childhood cancers develop in the jaw or other facial bones. Disseminated Intravascular Coagulation (DIC) - CORRECT ANSWERS ✔✔Complex, acquired disorder in which clotting and hemorrhage simultaneously occur Eosinophil - CORRECT ANSWERS ✔✔Granulocyte, polymorphonuclear. white blood cell containing granules that stain red; associated with allergic reactions; Phagocytizes antigen-antibody complex; attacks parasites Epoetin and Darbepoetin - CORRECT ANSWERS ✔✔synthetic versions of erythropoietin (EPO). Synthetic EPO is used in some anemias such as those caused by chronic renal failure or chemotherapy.; 2 ESAs used in tx of anemia in cancer Erythrocytes - CORRECT ANSWERS ✔✔red blood cells; Disk-shaped cells that carry oxygen to tissues and transport carbon dioxide out of the tissues for its subsequent removal from the body. Erythrocytes contain proteins such as hemoglobin, which binds to oxygen, giving blood its red color. The brighter the
shade of red, the more the blood is saturated with oxygen. Hematocrit refers to how much of the blood volume comprises erythrocytes. Erythropoietin (EPO) - CORRECT ANSWERS ✔✔hormone (growth factor) secreted by the kidney to stimulate the production of red blood cells by bone marrow Extrinsic Pathway of Blood Coagulation - CORRECT ANSWERS ✔✔A cascade of enzymatic reactions resulting in blood clotting and is done with the addition of injured tissue cells (outside of body, thus extrinsic). Also called The Tissue Factor Pathway. Ferritin - CORRECT ANSWERS ✔✔iron storage protein Folate - CORRECT ANSWERS ✔✔Requisite for RBC production Low: deficiency; B Folic Acid - CORRECT ANSWERS ✔✔a water-soluble B vitamin is eliminated in urine, and a small quantity (0.5 to 20 mg) is stored in the body. Hematocrit (Hct) - CORRECT ANSWERS ✔✔Percent of intact RBCs in whole blood Low: anemia High: polycythemia Normal levels:
- Females 37-47%
- Males 42-52%; levels slightly increased in elderly
hemoglobin and is characterized by small red blood cells containing low amounts of hemoglobin. It may be caused by decreased iron consumption, decreased iron absorption, or increased loss because of bleeding (e.g., menstruation, gastrointestinal cancer). Most widespread anemia in the world. This type of anemia is most commonly seen in women of childbearing age, children younger than 2 years of age, and the elderly. Large-cell lymphoma - CORRECT ANSWERS ✔✔Non-Hodgkin lymphoma composed of large lymphocytes that infiltrate nodes and tissues diffusely. Not as aggressive as other lymphomas with rare metastasis to brain. Origin: Mature T cells Anaplastic or mature B cell for diffuse large B cell. -Epidemiology US: Older children and teens; Anaplastic: 10% (median age 12); Diffuse large B cell: 15% -Common clinical presentation: Mass anywhere in the body; Diffuse large B cell: mediastinal mass or neck/abdomen lymph nodes; Anaplastic: painless lymphadenopathy, fever, malaise Leukocytes - CORRECT ANSWERS ✔✔white blood cells; key players in the inflammatory response and infectious process; consist of neutrophils, eosinophils, basophils, and mast cells (called granulocytes because of the granules in their cytoplasm); function diminishes with aging. Lymphoblastic lymphoma - CORRECT ANSWERS ✔✔Rare variant of Non- Hodgkin lymphoma, majority is from a T cell origin Mean corpuscular hemoglobin (MCH) - CORRECT ANSWERS ✔✔Amount of Hgb per RBC Alterations same reasons as MCV; normal value: 27 -31 pg/cell
Mean corpuscular hemoglobin concentration (MCHC) - CORRECT ANSWERS ✔✔Average concentration of hemoglobin per RBC (size of RBC taken into account) Low: hypochromic High: hyperchromic Normal: normochromic; regular lab value: 32-36 g/dL Megaloblastic Anemia—Macrocytic - CORRECT ANSWERS ✔✔type of anemia that causes high MCV -- Impaired DNA synthesis, due to vitamin B12 and folic acid deficiency, characterized by delayed nuclear development but normal cytoplasm development (i.e., nuclear-cytoplasmic aysynchrony). The aysynchrony causes large developing cells called megaloblasts and large mature cells that are macrocytic. Cell color is unaffected, and, therefore, the anemia is normochromic. Vitamin B12 and folic acid deficiencies also cause premature precursor cell death through phagocytosis or apoptosis. Monocyte - CORRECT ANSWERS ✔✔an agranulocytic leukocyte that performs phagocytosis to fight infection Multiple myeloma (MM) - CORRECT ANSWERS ✔✔Malignant proliferation of plasma cells Infiltrate bone marrow and aggregate into tumor masses in skeletal system; mostly affects older adults Neutrophil - CORRECT ANSWERS ✔✔a granular leukocyte, named for the neutral stain of its granules, that fights infection by phagocytizing bacteria Plasma - CORRECT ANSWERS ✔✔Liquid part of blood - a transport medium that carries the blood cells as well as antibodies, nutrients, electrolytes,
Red cell distribution width - CORRECT ANSWERS ✔✔Variations in sizes of the RBCs (i.e., anisocytosis) Low: uniformity in size High: large variation in RBC size or shape (i.e., poikilocytosis) Reticulocyte - CORRECT ANSWERS ✔✔immature red blood cell; erythrocyte that has become smaller and has lost its nucleus after most of the hemoglobin has been synthesized. Reticulocyte count - CORRECT ANSWERS ✔✔measurement of the number of circulating reticulocytes, immature erythrocytes in a blood specimen; Low: problems with production of RBCs High: increased need for RBCs Sickle Cell Anemia (SCA) - CORRECT ANSWERS ✔✔a deficiency that results from abnormally shaped hemoglobin; the most common of the sickle cell disease types, and the disease is more severe because almost all of the individual's erythrocytes are abnormal. Sickle Cell Disease - CORRECT ANSWERS ✔✔Genetic disorder in which red blood cells have abnormal hemoglobin molecules and take on an abnormal shape. Thalassemia (microcytic anemia) - CORRECT ANSWERS ✔✔Thalassemia is another hereditary type of hemolytic anemia, which results in abnormal hemoglobin. The abnormal hemoglobin is a result of an abnormal quantity of one of the two protein chains, resulting in α-thalassemia or β-thalassemia. Thalassemia occurs most frequently in persons of Mediterranean descent. Other ethnic groups affected by thalassemia include those of Asian, and Indian descent and Blacks.
Thrombocytes - CORRECT ANSWERS ✔✔platelets - carried passively in the blood, and coated with a sticky material that causes them to adhere to irregular surfaces. Thrombocythemia - CORRECT ANSWERS ✔✔overproduction of platelets, leading to thrombosis or bleeding disorders due to platelet malformations Thrombophilia - CORRECT ANSWERS ✔✔tendency to develop blood clots Thrombotic Thrombocytopenic Purpura (TTP) - CORRECT ANSWERS ✔✔a coagulation disorder resulting from a deficiency of an enzyme, a disintegrin and metalloproteinase with thrombospondin domain 13 enzyme (ADAMTS13), which is necessary for cleaving von Willebrand factor (vWF). Total iron-binding capacity (TIBC) - CORRECT ANSWERS ✔✔Amount of iron capable of binding to transferrin (indirect measure of transferrin availability) Low: excess iron High: deficiency in iron; Normal value: 250-460 mcg/dL Transferrin - CORRECT ANSWERS ✔✔iron transport protein Transferrin saturation - CORRECT ANSWERS ✔✔the saturation of the carrier protein for iron, which is a sensitive indicator of iron status and stages of anemia; normal value is 20-50% Von Willebrand Disease - CORRECT ANSWERS ✔✔most common hereditary bleeding disorder; caused by a deficiency of von Willebrand factor, a "sticky" protein that lines blood vessels and reacts with platelets to form a plug that leads to clot formation
natural active immunity - CORRECT ANSWERS ✔✔production of one's own antibodies or T cells as a result of infection or natural exposure to antigen IgE mediated hypersensitivity - CORRECT ANSWERS ✔✔Interactions between mast cells (or basophils) and involved in allergies (like hay fever) Type II Cytotoxic Hypersensitivity - CORRECT ANSWERS ✔✔Antigen is present on cell membrane May be normal body component or exogenous Circulating IgGs react with antigen Destruction by phagocytosis or cytolytic enzymes Example Response to incompatible blood transfusion Type III immune complex hypersensitivity - CORRECT ANSWERS ✔✔Type of hypersensitivity in which antigen-antibody complexes are deposited in joints, kidney, precipitate and initiate inflammation,organs are damaged. (ex conditions: Post-strep infections, glomerulonephritis, rheumatoid arthritis) Type IV cellular hypersensitivity - CORRECT ANSWERS ✔✔does not involve antibody formation; host tissue cell involvement; cytokines are mediators opportunistic infection - CORRECT ANSWERS ✔✔Infections that occur when the body's defenses are weakened Antigen - CORRECT ANSWERS ✔✔A protein that, when introduced in the blood, triggers the production of an antibody
autoantibody - CORRECT ANSWERS ✔✔Antibodies against self antigen; attacks body's own tissues Helper T cells - CORRECT ANSWERS ✔✔T cells that help the immune system by increasing the activity of killer cells and stimulating the suppressor T cells Killer T cells - CORRECT ANSWERS ✔✔Lymphocytes that use enzymes to destroy the cell membranes of bacteria and other foreign invaders. Macrophages - CORRECT ANSWERS ✔✔phagocytize foreign substances and help activate T cells lympatic tissue - CORRECT ANSWERS ✔✔Connective tissue containing many lymphocytes; transports immune cells, antigen-presenting cells, fatty acids, and fats; filters body fluids. mast cells - CORRECT ANSWERS ✔✔Cells that release chemicals (such as histamine) that promote inflammation. T cells - CORRECT ANSWERS ✔✔Cells created in the thymus that produce substances that attack infected cells in the body.
