Jeopardy Midterm Flashcards
BLANK-type refers to the complete genetic material in an organism, while BLANK-type is observed characteristics and traits of genetic material
Genotype
Phenotype
True or false
The balance of sodium in the nephron is regulated only by baroreceptors located in the afferent arteriole of the kidney
False
It is also regulated by chemoreceptors in the distal convoluted tubule
Parathyroid hormone and activated vitamin D increase calcium absorption resulting in Hypercalcemia, whereas secretion of this regulating hormone will result in hypocalcemnia
What is calcitonin
Decreases osteoclast activity and decreases renal resorption of calcium
Actions of NSAIDS on the kidney
Can cause pre and infra renal damage
COX-2 blocks prostaglandin vasodilation of of the afferent arteriole- constricting and reducing GFR
Causes of hyponatremia according to Jonathan
ADH/vasopressin release
Water intoxication
GI loss…
Hemolytic uremic syndrome
Hemolysis clogs up the kidneys?= intrarenal injury
Mutation in this type of gene affects individuals with XY chromosomes much more often than XX chromosomes
X-linked genes
hemophilia A
Red-green color blindness
Rett syndrome…
Cystic fibrosis is this type of genetic condition, in which two copies of an allele from parents are needed to develop
Autosomal recessive
Toll like receptors are located on cell membranes of innate leukocytes, many epithelial and endothelial cells, plus in intra cellular endosomes and lysosomes
True or false
TRUE
Eicosanoids, like prostaglandins, thromboxane and leukotrienes are paracrine hormones that are released by things inflammatory pathway
Arachadonic acid pathway
With recruitment, rolling and margin actions of leukocytes to an area of inflammation, they bind to cell proteins like selectins and integrins, to facilitate this key step in leukocytes translocation
Adherence
Selectins and integrins location
Selectins- extracellular
Integrins- intracellular
Leukocytes involved in acute inflammation
Neutrophils, macrophages via chemotaxis
Electrolyte imbalances in crush injuries
Hyperkalemia and hypernatremia from massive cellular destruction
These also experience rhabdo- which is intra renal injury and it blocks K excretion
BLANK. Is and ear infection characterized by inflammation to the inner ear and BLANK is an ear infection of the outer ear
Otitis media
Otitis externa
PREMATURE CLOSURE OF FONTANELLES AND these connecting structures may result in infant craniofacial deformities
Sutures
Acute infection of this virus is associated with sore throat, tonsillar hypertrophy, posterior cervical lymphadenopathy and hepatosplenomegaly
Epstein-Barr- aka mononucleosis
This inflammatory eye condition is associated with autoimmune diseases such as rheumatoid arthritis, systemic lupus, and Sjögren’s syndrome and involves the sclera, iris and ciliary body
Uveitis
Deficiency of this element is commonly associated with the development of Microcytic/hypochromic anemia
Iron
This normal physiological factor promotes adhesion of platelets to each other and to collagen and prevents the break down of factor VIII
Von willebrand factor
With time aggregated platelets will release this substance, which converts plasminogen to plasmin, to enzymatically break down fibrin in a clot
tPA
Case study: You are a FNP working in an outpatient setting. You are seeing a 55-year-old female for reports of an insidious onset of dizziness for 1-2 months. She reports symptoms are worse when moving from sitting- or laying-to-standing, and are accompanied by feeling “tired all of the time.” Symptoms are constant and worsening with time. During the patient’s interview, ROS is significant for dyspnea on exertion, numbness of fingers and toes, and tongue soreness.
Medical history: Hashimoto’s thyroiditis, mild persistent asthma, benign essential hypertension, chronic kidney disease, obesity
Surgical history: sleeve gastrectomy (2 years ago)
Medications: fluticasone 88 mcg 2 puff INH BID, losartan 50 mg PO daily
Vitals: BP 125/70 mmHg. HR 110 bpm. RR 18 rpm. SaO2 98% (room air). T 97.9 F.
Labs:
Hemoglobin 10.5 g/dL (ref 13.8-17.2)
Hematocrit 31.5% (ref 41-50)
MCV 110 fl (HIGH)
MCH 40 pg/cell (HIGH)
MCHC 50 g/dL (HIGH)
Discuss potential etiologies of this patient’s anemia and symptoms.
Identify risk factors this patient has for anemia.
Discuss potential etiologies of this patient’s anemia and symptoms:
Macrocytic/megaloblastic anemia from vitamin B-12 deficiency
Identify risk factors this patient has for anemia:
History of gastric surgery -risk of malabsorption from lack of intrinsic factor
History of CKD-risk of anemia of chronic disease
Released from the anterior pituitary (adenohypophysis), these two gonadotropins stimulate sex hormones, like estradiol, progesterone, and testosterone.
Lutenizing hormone and follicle stimulating hormone
In this condition, which can be congenital or acquired, abnormal fluid will collect between the layers of the tunica vaginalis of the scrotum.
Hydrocele
During the late follicular phase, a Graafian follicle will release this hormone to inhibit further release of FSH.
Inhibin B
DAILY DOUBLE
Case study: You are a CNM working in an outpatient setting. You are seeing a 30-year-old female for preconception counseling, as she and her partner desire pregnancy in the near future. She denies health concerns, but reports being “sick and tired” of taking iron supplementation due to constipation – this was prescribed 1 month ago by her former PCP in Lebanon (where she and her partner are from). She is a vegetarian. Her LNMP was 2 weeks ago, and “normal” for her in that it was heavy and lasted ~1.5 weeks.
Medical history: iron deficiency anemia, dysmenorrhea, endometriosis
Medications: ferrous sulfate 325 mg PO daily, prenatal vitamin 1 tab PO daily
Vital signs: BP – 120/60 mmHg. HR – 65 bpm. RR – 16 rpm. SaO2 – 99% (room air). T – 98.1 F.
Labs:
RBC 6.2 million/mcL (HIGH)
Hgb 10.9 g/dL (LOW)
Hct 31% (LOW)
MCV 70 fl (LOW)
MCH 22 pg/cell (LOW)
MCHC 25 g/dL (LOW)
Ferritin 65 mg/L (NORMAL)
Identify what phase of her cycle she is probably in and hormone likely involved.
Discuss possible etiologies of her anemia and risk factors she has for anemia.
Ovulatory phase, peaking of FSH, LH and estrogen
Thalassemia?
Chronic blood loss from menorrhagia
Following injury and destruction of cellular phospholipid membranes and release of phospholipase A2, this pathway becomes activated
Arachidonic pathway
During a normal, physiological inflammatory response, Hageman factor (also known as factor XII) converts prekallikrein to kallikrein, which generates this peptide.
Bradykinin
True – or – False: A genetic frameshift mutation disrupts the sequence of amino acids in DNA that usually leads to a non-functional protein.
TRUE
DAILY DOUBLE
Case study: You are a PNP working in an inpatient setting. You are seeing an 11-year-old who was admitted yesterday for severe dehydration due to Norovirus and thrombocytopenia. The patient is receiving IV fluids and symptomatic therapies for GI symptoms. The parent/guardian is at the bed side and wonders why they didn’t contract Norovirus (parent has B+ blood).
Vital signs – BP 100/50 mmHg. HR 110 bpm. RR 20 rpm. SaO2 100% (room air). T 37.0 C.
Labs (before receiving IV fluids):
Blood type: AB+
BUN: 35 mg/dL (HIGH)
Creatinine: 2.1 mg/dL (HIGH)
Potassium: 2.8 mEq/L (LOW)
Sodium: 129 mEq/L (LOW)
Hgb 13.1 g/dL (NORMAL)
Hct 42% (NORMAL)
Platelets 70,000 uL (VERY LOW)
Describe the sequence of WBC movement towards a site of infection.
Discuss possible etiologies of this patient’s abnormal kidney labs and electrolyte imbalances.
Discuss possible etiologies of this patient’s thrombocytopenia.
Discuss why the patient and parent have different blood types, but similar Rh factors.
- rolling, adherence, diapedesis, migration
-hypokalemia.hyponatremia from GI loss
Prerenal from dehydration
-immune thrombocytopenic purpura
-inheritance of blood type is co-dominant (both alleles for a trait are expressed equally), whereas inheritance of Rh is autosomal dominant
Complete the sentence: Activation of the renin-angiotensin-aldosterone system (RAAS) will result in reabsorption of _______ and excretion of ________.
Sodium
Potassium
Other actions of RAAS
Arteriole vasoconstriction
SNS activation
Vasopressin/ADH release
What stimulated aldosterone release?
Hyperkalemia
Element that becomes neutralized when bound to negatively charged sites on albumin
Calcium
Lithium renal complications
Nephrotoxic
Absorption through Na channels in collecting ducts
Resistance to vasopressin
Drug induced DI
BUN/CR ratio indicating prerenal injury
> 20
Dehydration
Heart failure
Liver failure
BUN/Cr ration intra renal injury
10-20
Hypertensive emergency
Gglomerular disease
ATN
Post renal causes and BUN/cr ratio
10-20
Ureteral obstruction
Neurogenic bladder
UTI
Medications
BPH
Complete the sentence: “Afferent arteriole vasodilation will lead to [increased/decreased] glomerular filtration by [increasing/decreasing] hydrostatic pressure.”
Complete the sentence: “Afferent arteriole vasodilation will lead to INCREASED glomerular filtration by INCREASING hydrostatic pressure.”
As a result of cardiac myocyte stretch, these hormones increase glomerular filtration, and prevent sodium reabsorption in the collecting ducts.
Atrial natriuretic peptide and brain natriuretic peptide
ANP
BNP
This proton exchanger in the proximal convoluted tubule and collecting duct is important for maintaining blood pH and intracellular volume, and becomes dysregulated with hyperglycemia.
Sodium-hydrogen exchanger
DAILY DOUBLE
Case study: You are an AGACNP working in an ED setting. You are seeing Mr. P, a 60-year-old male with reports of abdominal pain, blood diarrhea, discolored urine, fever, and weakness that has been worsening over the past 3-4 days.
He is eating and drinking, but reports being very thirsty and has been mostly drinking water the past 1-2 days. He has been taking ibuprofen 600 mg up to 5x/day with some relief of abdominal pain, but has tried no other treatments.
Mr. P has a history of benign prostatic hyperplasia and reports chronic lower urinary tract symptoms.
Vital signs: BP 80/45 mmHg. HR 130 bpm. RR 20 rpm. SaO2 97% (room air). T 39.2 C.
Labs:
BUN 30 mg/dL (HIGH)
Creatinine 2.5 mg/dL (HIGH)
Na+ 130 mEq/L (LOW)
K+ 2.9 mEq/L (LOW)
Hgb 11 g/dL (LOW) with hemolysis
Hct 30% (LOW) with hemolysis
Stool culture positive for E coli
Discuss possible explanations for Mr. P’s electrolyte abnormalities.
Identify risk factors Mr. P has for prerenal, intrarenal, and postrenal kidney injuries.
Discuss possible explanations for Mr. P’s electrolyte abnormalities.
Hypokalemia from GI loss and inadequate intake
Hyponatremia from ADH/vasopressin release, water intoxication, +/- GI loss
Identify risk factors Mr. P has for prerenal, intrarenal, and postrenal kidney injuries.
Prerenal: Hypotension, overuse of NSAIDs
Intrarenal: Hemolytic uremic syndrome, overuse of NSAIDs
Postrenal: History of BPH
This chromosomal condition, in which there is Monosomy or a partially-missing X chromosome, only affects females, and may result in short stature, webbed neck, and infertility.
Turners
This chromosomal condition from a FMR1 gene mutation on X chromosomes, may result in elongated facial structures, a prominent forehead and jaw, highly-arched oral palate with dental crowding, and intellectual disabilities.
Fragile X
Released from the anterior pituitary (adenohypophysis), these two gonadotropins stimulate sex hormones, like estradiol and progesterone.
LH
FSH
This hormone released by the hypothalamus stimulates secretion of leutinizing and follicle stimulating hormones from the anterior pituitary (adenohypophysis), stimulating spermatogenesis in the testicles.
GnRH
This chronic gynecological condition is characterized by androgen excess, anovulation, and insulin resistance.
Polycystic ovarian syndrome
Identify the phase of the menstrual cycle that JD experiences mood swings, “brain fog,” and difficulty sleeping, etc., and discuss what hormones are potentially involved.
Luteal phase
Sharp decreases in FSH and LH low estrogen.
Corpus luteum secretion of progesterone
Discuss how inhibition of prostaglandins from a NSAID would affect inflammatory pathways during JD’s heavy, painful periods.
Suppression of prostaglandins interrupt the arachidonic acid inflammatory pathway – in this case from apoptosis and shedding of uterine lining
True – or – False: The sequence of the abdominal exam is inspection, auscultation, percussion, and palpation, which is different from exams of other body systems (like pulmonary).
True
In a patient with worsening RUQ abdominal pain after consuming a meal high in fat content, Murphy’s sign may be a physical exam method to help estimate the clinical suspicion of this condition.
Cholecystitis
The presence of cervical motion tenderness (positive “chandelier sign”) in a patient with an acute N gonorrhoeae or C trachomatis infection increases the clinical suspicion for this inflammatory condition.
Pelvic inflammatory disease
Complete the sentence: Celiac disease, ulcerative colitis, and Crohn’s disease are three common auto-immune bowel diseases. Celiac affects the _____ intestines, ulcerative colitis the ______ intestines, and Crohn’s _________________.
Complete the sentence: Celiac disease, ulcerative colitis, and Crohn’s disease are three common auto-immune bowel diseases. Celiac affects the small intestines, ulcerative colitis the large intestines, and Crohn’s the entire GI tract.
