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Pathophysiology > Case Studies 1-10 > Flashcards

Case Studies 1-10 Flashcards

1
Q

Carol is a 50 year old female diagnosed with Diabetes Mellitus 5 years ago. She is overweight. Carol has smoked half a pack of cigarettes a day for the past 30 years. She states that she is planning to lose weight and confesses that she often cheats and doesn’t adhere to her diabetic, sodium-restricted diet. Her resting blood pressure is 150/96. QUESTION: What is the basic pathology involved with Diabetes?

A

Inadequate production of Insulin (Type 2)

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2
Q

Which of the following statements regarding Type 2 Diabetes is true?

A.It is an autoimmune process resulting in an absolute deficiency of Insulin.
B. This type of Diabetes is an autosomal recessive gene disorder.
C.Insulin is still being produced but the pancreas is not secreting it normally.
D. Diabetes is a complication of Acute Pancreatitis.

A

C

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3
Q

Why has Carol been told to restrict her sodium intake?

A

Dietary salt contributes to water retention and Decreasing sodium intake may help to control hypertension

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4
Q

Which of the following factors placed Carol at an increased risk for developing Diabetes? 1. Her age; 2. Her weight; 3. Her hypertension; 4. Her smoking.

A
  1. Her Age

2. Her Weight

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5
Q

Why is Carol taking Aspirin (ASA) on a daily basis?

A

ASA inhibits platelets and helps decrease the chance of a possible stroke.

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6
Q

What are the four cardinal signs of inflammation?

A

Redness, Heat, Swelling, Pain

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7
Q

Susan, 35 years old, was diagnosed with HIV eight years ago during a pre-operative work-up prior to some elective cosmetic surgery. QUESTION: What type of virus is HIV?

A

Retrovirus

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8
Q

How is a diagnosis of HIV positive usually determined?

A

Presence of HIV in the antibodies

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9
Q

Identify possible routes of HIV transmission. 1. Contaminated food. 2. Inhalation of droplet infection. 3. Sexual intercourse. 4. Blood and other bodily fluids. 5 Breast feeding.

A

3,4,5

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10
Q

What is the usual incubation period for HIV?

A

3-7 weeks

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11
Q

The term seroconversion is often used in reference to HIV infection and AIDS. What does seroconversion mean?

A

HIV antibodies have been identified in the blood and the person is contagious

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12
Q

Which cells are selectively targeted by HIV?

A

Helper T Cells

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13
Q

What therapeutic interventions would have been initiated for Susan?

A

Ziduvudine (AZT), as part of the HAART

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14
Q

Recently, Susan has been informed by her health care provider that she has progressed to AIDS! QUESTION: What typically occurs in the period between a diagnosis of HIV positive and AIDS? 1. There is a decrease in all types of Leukocytes. 2. There is a increase in the number of Macrophages. 3. There is a decrease in the number of T-Helper Cells. 4. The incidence of Opportunistic Infections increases. 5. The individual’s viral load increases.

A

3,4,5

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15
Q

What type of drug interferes with viral replication and is usually included in the “cocktail” prescribed in the treatment of HIV infection?

A

Protease Inhibitors

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16
Q

Susan was admitted to the hospital after she developed a number of respiratory signs and symptoms, including a productive cough with blood-flecked sputum. QUESTION: What organism would be suspected as the causative agent for these signs?

A

Pneumocystis jiroveci

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17
Q

Recently, a new type of Testing Algorithm has been developed for the diagnosis of HIV infection. QUESTION: Which of the following tests would be utilized in the “three-stage testing”? 1. ELISA. 2. EIA (1st generation) 3. EIA (3rd or 4th generation) 4. Western Blot Test. 5. Multispot. 6. RNA NAT.

A

3, 5, and 6 are correct.

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18
Q

Now that Susan does have the diagnosis of AIDS, what types of medications, besides her “cocktail” would likely be prescribed for her, depending on the complications that develop? 1. Broad spectrum antibiotics. 2. Laxatives. 3. Antifungal agents. 4. NSAIDS. 5. Analgesics.

A

1, and 3 are correct.

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19
Q

Mr. Maple, age 80 years, has a history of atherosclerosis and angina. Ten years ago he experienced frequent attacks of angina and underwent angioplasty to repair and open his coronary arteries. This, along with prophylactic drug therapy, has prevented further angina attacks, as well as other complications. His blood pressure remains within normal range, and he considers himself fairly health except for mild osteoporosis and arthritis. QUESTION: Given the information below, what was likely the primary cause of his angina 10 years ago?

A

Reduced blood supply to the myocardium.

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20
Q

Does angina usually cause permanent damage to the heart?

A

NO

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21
Q

Identify the type of angina that is predictable and may be brought on by increased physical activity.

A

Stable/Classic

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22
Q

With athersclerosis, Mr Maple is at risk for a Myocardial Infarction (MI). QUESTION: Which of the following is a distinctive feature of MI, not usually present with angina attacks.

A

The pain of a MI is not relieved by rest and the administration of nitroglycerin

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23
Q

As additional prophylaxis against angina attacks and MyocardiaI Infarction, Mr. Maple was prescribed a beta-adrenergic receptor blocking agent, metoprolol (Lopressor). QUESTION: How would this type of drug prevent further angina attacks?

A

It prevents Sympathetic Nervous System (SNS) stimulation in the heart and slows the heart rate preventing increased cardiac workload.

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24
Q

Mr. Maple does not smoke. This benefits Mr. Maple in all of the following ways, EXCEPT:

A

HDL levels are reduced, reducing the risk of plaque formation.

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25
Q

Mr. Maple is taking a statin drug, simvastatin (Zocor). QUESTION: What is the purpose of this drug. 1. To reduce serum LDL levels. 2. To reduce serum HDL levels. 3. To prevent platelet aggregation. 4. To decrease the formation and growth of atheromas.

A

1 &4

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26
Q

Mr. Maple takes one Aspirin Tablet (enteric-coated acetylsalicylic acid tablet, 325 mg) each day. QUESTION: What is the benefit to Mr. Maple of this medication?

A

Reduces the risk of platelets sticking together and potential thrombus formation

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27
Q

How does an Atheroma cause obstruction in the Coronary Arteries?

A

A thrombus forms over a protruding lipid plaque in the arterial wall as platelets adhere to the rough surface.

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28
Q

As a precaution, Mr. Maple carries nitroglycerin with him. How does nitroglycerin act to relieve the pain of angina?

A

Systemic vasodilation reduces cardiac workload.

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29
Q

What does an elevated antistreptolysin O titer mean?

A

Increased level of streptococcal antibodies in the blood

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30
Q

The irregular heart rate (tachycardia) has probably developed from Rheumatic Fever causing fibrotic tissue in the:

A

Myocardium

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31
Q

What complications may occur following Rheumatic Fever?

A

Stenotic or incompetent hair failure

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32
Q

How is cardiac output likely to change with CHF?

A

Decreased

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33
Q

As Denise develops left-sided CHF, what manifestations is she likely to experience?

A

Dyspnea and rales.

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34
Q

Denise is now scheduled to receive a prosthetic heart valve replacement. Which of the following will likely be recommended following surgery?

A

A daily low dose of aspirin (ASA).

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35
Q

Which tissues are often affected by Rheumatic Fever (RF)? 1. Myocardium; 2. Endocardium; 3. Kidneys; 4. Skin; 5. Basal nuclei; 6. Joints

A

1.2,4,5 & 6

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36
Q

One night, Denise woke up coughing and struggling to breathe, Paroxysmal Nocturnal Dyspnea results from:

A

Increased fluid in the pulmonary capillaries and alveoli

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37
Q

Systemic signs and symptoms of inflammation in RF would be:

A

Increased production of white blood cells and fever

38
Q

Inflammation of the heart may cause what things?
1. Verrucae / vegetations on the heart valves. 2. Interference with the conduction system. 3. Pericardial effusion. 4. Decreased cardiac output.

A

1,2,3,4

39
Q

Mrs. Barrett, 70 has a history of hypertension for over two decades, and is monitored and managed therapeutically with medications by her doctor. Mrs Barrett called her daughter, complaining that she suddenly felt weak and dizzy, and was experiencing blurred vision. When her daughter arrived, Mrs. Barrett’s speech was slurred. Her daughter rushed her to the hospital.

A

A & B (A stroke & TIA)

40
Q

Which of the following statements is most accurate?

A

A stroke results in permanent brain damage; a TIA is temporary ischemia.

41
Q

In regards to the time frame with a TIA, all neurologic signs and symptoms must be resolved within:

A

24 Hours

42
Q

CHALLENGE QUESTION: Mrs. Barrett is seen in the Emergency Department of a local hospital. Her signs and symptoms disappear within an hour. She is sent home with instructions to take Aspirin (ASA) every day. Question: Why was Aspirin added to Mrs. Barrett’s medications?

A

ASA is a platelet inhibitor and will help prevent thrombus formation.

43
Q

What are some of the potential complications that Mrs. Barrett may experience over the next several weeks? 1. Dysphagia and aspiration. 2. Constipation. 3. Increased intracranial pressure. 4. Impaired vision. 5. A second stroke.

A

1,2,5

44
Q

Debbie, age 11, has Cystic Fibrosis (CF) involving her lungs, pancreas, and liver. Debbie was diagnosed shortly after birth when her parents noticed a salty taste on Debbie’s skin. Debbie’s genotype revealed mutation of the gene on Chromosome #7. QUESTION: Which of the following is the inheritance pattern for the CF gene?

A

Autosomal recessive

45
Q

Which of the following best describes the basic pathophysiology of CF?

A

A test for antinuclear antibodies.

46
Q

CF is frequently diagnosed in newborns by:

A

Meconium ileus occurring at birth

47
Q

What has been the primary effect of CF on Debbie’s lungs?

A

Thick mucus obstruction the airways, causing chronic inflammation and infection.

48
Q

What is the primary effect of CF on Debbie’s pancreas?

A

Thick mucus obstruction the airways, causing chronic inflammation and infection.

49
Q

In Debbie, the secretion of the bile was affected; this would occur because?

A

The bile ducts are blocked by mucous plugs.

50
Q

What is the primary reason that Debbie has frequent Respiratory Tract Infections?

A

Chronic inflammation and excessive mucus provide a good medium for microbes

51
Q

The mucous plugs in the small airways are likely to cause patches of atelectasis because:

A

Air diffuses out of the alveoli distal to the obstruction and is not replaced

52
Q

Because of extensive Lung damage, Debbie has developed Cor Pulmonale. Which of the following would be typical signs or symptoms of Cor Pulmonale?

A

Edematous feet and hepatomegaly

53
Q

Which of the following will promote Debbie’s growth and development? 1. Taking replacement pancreatic enzymes. 2. Taking Vitamin supplements. 3. Consuming a high calorie diet. 4. Ensuring there is a high proportion of fat in the diet.

A

1,2,3

54
Q

Peter had a history of asthma as a child. His condition improved for a few years, but now at age 32 he has been having frequent acute asthma attacks. QUESTION: Which of the following are typical of acute asthma attacks? 1. Bronchodilation. 2. Rupture of alveolar capillaries. 3. Edema in the mucosa. 4. Increased amounts of thick mucus.

A

Only 3 and 4 are correct.

55
Q

Peter had an acute attack while waiting for his appointment. Which of the following causes air trapping and hyperinflation in the lungs in the early stage of the attack?

A

Partial obstruction in the small bronchi and bronchioles

56
Q

Why is it more difficult to expire than to inspire air past a partial obstruction?

A

Expiration is a passive process

57
Q

Which of the following is a manifestation noted in the early stage of Acute Asthma?

A

Expiratory wheezing and cough.

58
Q

What is the major problem for Peter during an Asthma Attack?

A

Hypoxia

59
Q

Peter carries a inhaler (Beta2-adrenergic agent) to use when an Acute Asthma Attack begins. How does this medication promote recovery from the attack?

A

Causes bronchodilation.

60
Q

What is the major factor contributing to Peter’s frequent Respiratory Tract Infections?

A

Mucus and secretions provide a medium for bacterial growth

61
Q

According to classification, what type of Asthma is IgE mediated, associated with allergies, described as Classic Childhood Asthma, and acute attacks typically respond well to bronchodilators.

A

Extrinsic Asthma

62
Q

Peter has started a new medication, a glucocorticoid (steroid) to be taken on a daily basis by inhalation. This is expected to reduce the number and severity of exacerbations by:

A

Anti inflammatory effect

63
Q

According to classification, what is the key difference between Acute Asthma versus Chronic Asthma?

A

Acute refers to a single episode; chronic refers to a long-term condition, which may result in lung damage.

64
Q

What causes atelectasis during an Acute Asthma Attack?

A

Total obstruction by mucus plugs

65
Q

Jamie is a 20-year-old “street kid” who goes to an outpatient department complaining of flu-like symptoms and abdominal pain. He has multiple tattoos and body piercings. He admits to both IV drug use and unprotected sexual behavior with multiple partners. Blood tests reveal that Jamie’s liver enzymes are elevated. The doctor suspects some form of hepatitis. Considering Jamie’s lifestyle, what type or types of hepatitis is he most likely to have contracted?

A

Hepatitis B or C

66
Q

How is a differential diagnosis of Hepatitis usually confirmed?

A

Presence of the specific Hepatitis virus in the blood.

67
Q

The tests confirm that Jamie has Hepatitis C. What is the average incubation period for Hepatitis C?

A

6-9 weeks

68
Q

What other diseases are spread by IV drug use?

A

HEP B and HIV

69
Q

What other manifestations, besides jaundice, is Jamie probably experiencing? 1. Dark stool. 2. Dark urine. 3. Hepatomegaly. 4. Peripheral Edema. 5. Hypertension. 6. Mild discomfort in the RUQ

A

2, 3 & 6

70
Q

What is the usual treatment for Hepatitis C?

A

No treatment None

71
Q

How is the amount of liver damage assessed in cases of Chronic Hepatitis? 1. Serum levels of liver enzymes. 2. Presence of jaundice. 3. Liver biopsy. 4. Severity of manifestations.

A

1 & 3

72
Q

Which of the following are potential complications of Chronic Hepatitis? 1. Cirrhosis. 2. Hepatocellular Cancer. 3. Cholelithiasis. 4. Ascites. 5. Intestinal obstruction.

A

1,2,4

73
Q

Several weeks later Jamie returns to the clinic. He now exhibits jaundice. Which of the following statements is true?

A

Jaundice occurs when serum bilirubin levels are elevated.

74
Q

How is a differential diagnosis of Hepatitis usually confirmed?

A

Presence of the specific Hepatitis virus in the blood.

75
Q

What does the elevation of AST and ALT blood levels indicate?

A

Necrosis of Hepatocytes

76
Q

Hank, 35, has been a weekend binge drinker for several years and then increased his social drinking during the week. A routine physical examination revealed an enlarged and tender liver. Blood tests indicated increased blood levels of liver enzymes (AST, ALT). A biopsy confirmed inflammation and necrosis in the liver, with a small amount of fibrosis, leading to a diagnosis of Stage 2, Alcoholic Liver Disease. QUESTION: What are the characteristics of Stage 1 Alcoholic Liver Disease? 1. Irreversible damage. 2. Necrosis and fibrosis. 3. Accumulated lipids in hepatocytes. 4. Asymptomatic

A

3 and 4

77
Q

As cirrhosis progressed, Hank developed gynecomastia and impotence. What caused these changes?

A

Failure of the liver to inactivate hormones

78
Q

Despite the warning, Hank continued drinking alcohol. After experiencing intermittent nausea and abdominal discomfort, as well as a persistent dull, aching right upper quadrant (RUQ) pain, he returned to his physician. What is causing the pain?

A

Stretching of the liver capsule.

79
Q

Hank developed ascites. This is best described as:

A

Excessive fluid in the peritoneal cavity

80
Q

Esophageal varices develop because of:

A

Portal hypertension extending into collateral veins

81
Q

Portal hypertension develops with Advanced Cirrhosis because: 1. Fibrotic tissue causing obstructions in the liver. 2. Splenomegaly. 3. Increased resistance to flow of blood in the Hepatic Portal Vein. 4. Hypoalbuminemia.

A

1 & 3

82
Q

What is a major cause of hepatic encephalopathy?

A

Elevated serum ammonia levels

83
Q

Which of the following is responsible for the osmotic diuresis?

A

Decreased renal tubule function.

84
Q

Peter’s blood test indicated a serum pH of 7.35. This value represents:

A

compensated metabolic acidosis

85
Q

Peter was complaining about flank pain. What is causing this pain?

A

Swelling of the kidneys, stretching the renal capsule.

86
Q

Why is Peter’s serum urea concentration elevated?

A

Decreased GFR

87
Q

Over the next several days, Peter developed generalized edema. Which of the following factors contribute to Peter’s edema?

A

All the above

88
Q

Peter’s urine output continued to decrease. What is the major contributing factor to this change?

A

Glomerular congestion and increased aldosterone secretion decrease urine output.

89
Q

What caused Peter’s urine to become dark and cloudy?

A

Erythrocytes and proteins leaking from the glomerular capillaries

90
Q

Peter’s signs and symptoms subside, but subsequent tests indicated chronic inflammation. Despite medication, permanent kidney damage occurred through the next 3 years and, eventually, Chronic Renal Failure (CRF). Which stage of CRF is marked by osmotic diuresis?

A

Middle Stage

Pathophysiology (7 decks)

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