Exam 5 Final Guide Questions

Question 1

What is the difference between oncotic pressure and hydrostatic pressure and how do they contribute to ascites?

Answer 1

Hydrostatic pressure exceeds oncotic pressure which leads to ascites. Hydrostatic pressure will force fluid out into the intersitial tissue leading to edema and ascites.

Question 2

What happens to PTH in CKD?

Answer 2

In CKD, the kidneys are unable to ‘activate’ vitamin D so less calcium is absorbed and blood calcium levels fall. This triggers the parathyroid glands to overproduce PTH in an attempt to increase the amount of calcium in the blood. This leads to secondary parahyperthyroidism which then leads to osteodystrophy and insulin resistance

Question 3

What are characteristics of struvite renal stones?

Answer 3

They are the second most common type of kidney stone and are made of magnesium, ammonium, and phophate salts.
They tend to result from chronic UTIs with urease producing bacteria such as proteus and pseudomonas. The ureas produced by these bacteria break down the urine to the salts that comprosie the struvite stones

Question 4

What is the end product of protein metabolism?

Answer 4

Amino acids are the end product of protein metabolism in humans. When proteins and amino acids are broken down in the body, ammonium is created as a byproduct. Ammonium is dangerous when it remains free in the human body, so something must be done to get rid of it. The major route of removal of ammonium by the body is via urea synthesis in the liver.

Question 5

What do most testicular cancers secrete?

Answer 5

AFP. Alpha fetoprotein in non-pregnant people is mainly measured as a tumor marker. Tumor markers are substances that are often made by cancer cells or by normal cells in response to cancer. High levels of AFP can be a sign of cancer of the liver, ovaries or testicles.

Question 6

What are causes of hepatic encephalopathy?

Answer 6

1. Accumulation of ammonia
2. GI bleed (breakdown of bleed leats of large protein load–> large ammounts of ammonia)
3. portal vein thrombosis
4. medications with sedating effects
5. hyponatremia
6. diabetes in an individual with Hepatitis C
7. CKD

Question 7

What are causes of acute tubular necrosis?

Answer 7

Any type of ischemia to the renal tubules at the cellular level can cause ATN

Question 8

What are characteristics of ATN seen in a UA?

Answer 8

Muddy brown cast cells are seen in the UA of a patient with ATN

Question 9

How does portal hypertension bleeding most commonly occur?

Answer 9

from esophageal variceal bleeds

Question 10

What is the pathophysiology behind alcholic cirrhosis?

Answer 10

fatty liver occurs due to hepatic fat accumulation
Alcohol -> acetaldehyde -> liver fibrosis
Mitochondrial fx is impaired decreasing oxidation of fatty acids
Acetaldehyde inhibits export of proteins

Question 11

What are signs and symptoms of duodenal ulcers?

Answer 11

melena and hematemesis due to it being an “upper GI bleed” located in the duodenum

Question 12

What is the first sign of small bowel obstruction?

Answer 12

Distention which decreases the intestines ability to absorb water/electrolytes and increased secretions of these things into the lumen which lead to fluid accumulation and gas. This is important to understand because those with SBO need to have their electrolytes/fluids monitored so that they dont become dehydrated

Question 13

What are signs and symptoms of SBO?

Answer 13

1. Hypokalemia due to electrolyte/fluids loss which also causes hypovolemic shock symptoms
2. distention
3. colicky abdominal pain
4. metabolic alkalosis from hydrogen ion loss secondary to vomiting
5. obstruction of the pylorus results in profuse vomiting of clear gastric fluid
6. a partial SBO results in diarrhea while a complete SBO results in constipation

Question 14

Where do peptic ulcers occur?

Answer 14

In the duodenum which includes both gastric and duodenal ulcers

Question 15

What type of pain occurs with gastric ulcers?

Answer 15

The epigastric pain is worse when eating and pain is immediate

Question 16

What is the age group of those get Crohn’s disase?

Answer 16

Crohn’s is usually diagnosed in young adults between the ages of 15-35

Question 17

what are signs and symptoms of chron’s disease?

Answer 17

1. skip lesions
2. malabsorption which causes vitamin deficiencies in B12, vitamin D, calcium, and folic acid
3. fistulas (abnormal tracts that develop in the presence of inflammation) which can cause strictures between the intestines, bladder, and vagina

Question 18

What will screening look like in those with an acute hepatitis B infection?

Answer 18

Acute infection is present when both the hepatitis B core antibody (IgM) and the hepatitis B surface antigen are positive

Question 19

What will screening look like in those with chronic hepatitis B infection?

Answer 19

chronic infections are present when both the total core antibody and the hepatitis B surface antigen are present

Question 20

What are prevention methods for hepatitis A?

Answer 20

Handwashing and Hep A vaccine is available to prevent this

Question 21

How is Hepatitis C transmitted?

Answer 21

transimtted through blood, body fluids, tattoos, and IV drug use

Question 22

What is the pathophysiology of cholelithiasis?

Answer 22

Cholesterol supersaturation: Normally, bile can dissolve the amount of cholesterol excreted by the liver. But if the liver produces more cholesterol than bile can dissolve, the excess cholesterol may precipitate as crystals. Crystals are trapped in gallbladder mucus, producing gallbladder sludge. With time, the crystals may grow to form stones and occlude the ducts which ultimately produce the gallstone disease.
Excess bilirubin: Bilirubin, a yellow pigment derived from the breakdown of red blood cells, is secreted into bile by liver cells. Certain hematologic conditions cause the liver to make too much bilirubin through the processing of breakdown of hemoglobin. This excess bilirubin may also cause gallstone formation.
Gallbladder hypomotility or impaired contractility: If the gallbladder does not empty effectively, bile may become concentrated and form gallstones.

Question 23

What is the pathogenesis of pancreatitis?

Answer 23

premature activation of pancreatic enzymes which cause pancreatic destruction and activation of inflammatory cascade which can cause hemorrhaging

Question 24

Where can pancreatic cancer metastasize to?

Answer 24

metastasizes to the liver

Question 25

what are risk factors of pancreatic cancer?

Answer 25

smoking is the top, then tnon o blood type, diabetes, and chronic pancreatitis

Question 26

what are causes of pylric stenosis?

Answer 26

1. deficiency in nitric oxide synthase containing neurons
2. abnormal innervation of the myenterix plexus
3. infantile hypergastrinemia
4. increased gastric secretion by mom in the third trimester

Question 27

what is the difference between physiologic jaundice vs pathological jaundice?

Answer 27

Physiologic jaundice develops during the 2ND or 3RD day after birth and subsides in 1 – 2 weeks in full term infants. Caused by mild unconjugated (indirect) hyperbilirubinemia
Pathologic hyperbilirubinemia is the development of increased bilirubin after 4-5 weeks of age, this jaundice is high and persistent

Question 28

what is the hallmark sign of endometrial cancer?

Answer 28

postmenopausal bleeding

Question 29

what are risk factors of ovarian cancer?

Answer 29

1. early menarche or late menopause
2. family history of reproductive cancers
3. endometriosis
4. use of fertility drugs
5. genetic factors (BRCA 1, BRCA2, or Tuner’s syndrome). more commonly associated with BRCA 1

Question 30

what are signs of breast cancer?

Answer 30

painless lump, nipple retraction, dimpling of breast tissue, swollen axillary nodes, nipple discharge in non lactating women

Question 31

how can one confirm testicular cancer?

Answer 31

through surgery and biopsy

Question 32

what is the sign of testicular cancer?

Answer 32

a painless testicular mass, they are slow growing. may have testicular heaviness or dull ache in the lower abdomen.

Question 33

Where does testicular cancer spread to?

Answer 33

testis cancer has a very predictable pattern of spread. The first place these cancers typically spread is to the lymph nodes around the kidneys, an area called the retroperitoneum.then the brain, and lungs.

Question 34

what is the genetic risk of prostate cancer?

Answer 34

BRCA 2 increases the risk of prostate cancer more than BRCA 1w

Question 35

where does prostate cancer metastasize to?

Answer 35

the liver, vertebrae, and pelvic bones

Question 36

what type of diet should those with prosate cancer be on?

Answer 36

high fiber diets

Question 37

how does cervical cancer occur?

Answer 37

by HPV virus which cause precancerous dysplasia and cervical carcinoma in situ

Question 38

what is the treatment for ascites?

Answer 38

Ascites is treated with a low-sodium diet, diuretics, removing the fluid, or surgery to reroute blood flow. Reducing sodium is a first line therapy for ascites.

Question 39

what are clinical manifestations of neprholithiasis?

Answer 39

excruciating flank pain that radiates to the groin
anuria and hematuria are also present

Question 40

what is the most common cause of peptic ulcers?

Answer 40

h pylori infection

Question 41

how does hypercalicuria occur?

Answer 41

Hypercalciuria = intestinal hyperabsorption of dietary calcium

Question 42

what occurs in the prodromal phase of hepatitis?

Answer 42

profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain. hyperalgesia

Question 43

what does benign prostatic hyperplasia lead to?

Answer 43

hydronephrosis and increased creatinine

Question 44

how many grams of glucose do the kidneys normally filter?

Answer 44

180 grams

Question 45

how does progressive nephron injury effect angiotensin II?

Answer 45

it will increase/elevate angiotensin II

Question 46

what medications cause acute tubular necrosis?

Answer 46

gentamicin and tobramycin

Question 47

what is the most common clinical manifestation of hypertension induced splenomegaly?

Answer 47

thrombocytopenia

Question 48

when does cleft lip occur in the child?

Answer 48

The incomplete fusion of the nasomedial and intermaxillary process during THE 4TH WEEK of
gestation causes CLEFT LIP

Question 49

what causes BPH?

Answer 49

it is an enlargement of the prostate gland which compresses the urethra where it passes through the prostate resulting in an outlet obstruction

Question 50

what is the treatment for pre renal AKI?

Answer 50

isotonic fluids or 0.9 normal saline. the gold standard is to see a downward trend in creatinine