Paramedic Pathophysiology Flashcards
When there is a fluid volume deficit, kidneys secrete:
renin
Main function of Renin in fluid volume deficit
stimulation of Angiotensin I secretion
___ converts Angiotensin I to Angiotensin II
Angiotensin converting enzyme
Angiotensin II serves these two purposes purpose
Peripheral vasoconstriction
Increasing secretion of aldosterone from Adrenal glands
Function of Aldosterone:
Stimulating distal convoluted tubule to reabsorb Na+
The compensatory mechanism for fluid volume deficit regulated by the kidneys
Renin-Angiotensin-Aldosterone-system
3 situations when the kidneys secrete renin:
High blood osmolality
Low blood volume
Low BP
Increased systemic hypertonicity triggers the release of ___ to aid in fluid retention
ADH
Pathologic H2O gain or blood protein loss can be referred to as:
Decreased blood osmolality
or
decreased oncotic pressure
SIADH = ___
Syndrome of inappropriate ADH
Explanation of SIADH
Increased/excessive ADH production
SIADH can be a cause of:
Fluid volume overload
SIADH works by:
Abnormally high levels of ADH > decreased urine output > increased vascular fluid volume
Fluid volume overload can also be cause by excessive loss of ___
solutes
Insufficient plasma compartment protein concentration
hypoproteinemia
3 possible otiologies of Hypoproteinemia:
Insufficient protein synthesis (liver cirrhosis) Insufficient protein intake (malnutrition or alcoholism) Kidney disease (glomerulonephritis)
Inflammation of the glomeruli
glomerulonephritis
Concept map of glomerulonephritis:
Inflammation of glomeruli causes diminished protein filtration from blood > protein spills into urine instead of recirculating > reduced blood osmolality/oncotic pressure > fluid shifts from blood to tissues > edema
2 Possible sequela of Hypoproteinemia:
Edema due to fluid shifts into the tissue
Muscular atrophy
A PT with fluid shifts from B>T is in:
fluid volume overload
Primary compensatory mechanism of fluid volume overload:
Natriuretic Pepside system
In the NPS, the __ and __ of the heart secrete __ and __
right atrium, left ventricle; atrial natriuretic peptide, B-type natriuretic peptide
The NPS is triggered by:
stretching of the heart muscle fibers by excess fluid volume
When natriuretic peptides reach the ___ they stimulate ___ to decrease fluid volume
kidneys; increase in urination
Abnormal mass of tissue
Tumor
Another term for abnormal mass of tissue
Neoplasm
“Not cancer”
Benign
“Cancer”
Malignant
Genetic mutation that sets cancer into motion
Oncogene
Cancer stating method
TNM
Benign tumors usually end with this suffix
-oma
Malignant tumors usually have these prefixes/roots
Sarco-, carcino-, blasto-
Malignant tumor of muscle tissue
Myosarcoma
Benign nerve cell tumor
Neuroma
Increase in the size of cells
Hypertrophy
Increase in the number of cells
Hyperplasia
Reversible replacement of cells of one type with another type
Metaplasia
Excessive fluid trapped in body tissues
edema
Most common type of edema
peripheral
Total fluid volume loss of ___% or more can lead to compromised homeostasis
30%
Hypertonic solutions have relatively higher ___ than interstitial fluid
osmotic pressure
Abnormal accumulation of fluid in the peritoneal cavity
ascites
PTs with CHF may present with ___ edema
pulmonary
A decrease in ECF with proportionate losses of NA+ and H2O
isotonic fluid deficit
Decreased urine output
Oliguria
Proportionate gain in both H2O and NA+
isotonic fluid excess
(Increased/Decreased) capillary colloidal osmotic pressure may cause edema
decreased
Normale serum NA+ range:
136-142 mEq/L
___ occurs when there is body water loss without proportionate loss of NA+
hypertonic fluid deficit
Serum NA+ level greater than 143 mEq/L
hypernatremia
NA+ is primarily found __
in blood and ECF
Serum NA+ level less than 135 mEq/L
Hyponatremia
___ fluid deficit occurs when there is NA+ loss in the body without proportionate H2O loss (relative water excess)
hypotonic fluid deficit
The major intracellular cation, crucial to many cellular functions
K+
Normal serum K+ range:
3.5-5.0 mEq/L
Decreased serum K+ level
hypokalemia
Medications that can inhibit K+ excretion:
spironolactone, ACE inhibitors, NSAIDs
Elevated K+ levels can interfere with ___
normal neuromuscular function
Hypoparathyroidism (endocrine disease) can lead to ___
hypocalcemia
Hypocalcemia can lead to ___ of neuromuscular & cardiovascular systems
increased excitation
__ may beg observed in the ECG of a PT with hypocalcemia
prolonged QT interval and dysrhythmias
Decreased serum phosphate
hypophosphatemia
Massive loading of phosphate into the ECF
hyperphosphatemia
Breakdown of muscle fibers that may occur as a result of low serum phosphate level
rhabdomyolysis
Second most abundant intracellular cation:
Magnesium
__ almost always occurs as a result of kidney insufficiency
hypermagnesemia
A ___ imbalance usually manifests itself as a disturbance in excitable tissues (especially the heart)
K+
Disturbances of ___ are associated with disturbances of K+ balance
acid-base imbalance
__ ions shift out of the cell in response to an influx of hydrogen (acidosis)
Ca2+
Ca2+ acts at the ___
neuromuscular junction
Because it works at the neuromuscular junction, __ decreases the rate of neural transmission
hypercalcemia
___ is characterized by hypersensitive neurons & and accelerated rate of neural transmission
hypocalcemia
___ causes increased cell permeability of Na+
hypocalcemia
Signs of hypocalcemia include: (4)
wheezing, stridor, crackles, bradycardia
Fluctuations in the level of bicarbonate cause ___
metabolic alkalosis or acidosis
Low pH caused baby inhibition of normal breathing pattern
respiratory acidosis
ABG findings of respiratory acidosis will usually involve:
low pH & high HCO3
Low pH caused by accumulation of acids
metabolic acidosis
ABG findings of metabolic acidosis will usually involve:
high low pH, low HCO3
State of high pH due to increase in normal breathing pattern
respiratory alkalosis
respiratory alkalosis will usually have ABG findings that reveal:
high pH, normal HCO3
OD of a CNS depressant (i.e. heroin) can cause:
respiratory acidosis
Respiratory acidosis is caused by:
accumulation of acids due to a decrease inn respiratory rate
Respiratory acidosis can cause a release of ___ into blood, which can cause potentially fatal dysrhythmias
K+
Respiratory acidosis is always related to ___
hypoventilation
Respiratory alkalosis is always associated with conditions that result in ___
hyperventilation
___ moves into the ICF to rebalance depleted H+ levels in respiratory alkalosis
Ca2+
Hypocalcemia resulting from respiratory alkalosis causes ___
muscle contractions
Muscle spasms in the fingers and toes causing them to flex in a claylike manner
carpopedal spasms
A classic sign of respiratory alkalosis:
hyperventilation accompanied by carpopedal spasms
___ usually occurs with increased urinary output or decreased gastric acid output
Metabolic alkalosis
Cellular death is followed by:
necrosis
During and after cell death, the cell and its organelles swell and release ___ that destroy intracellular components
enzymes
The earliest and most dangerous mediators produced by cells in response to hypoxia are:
free radicals
Definition of a free radical:
a molecule missing one electron in its outer shell
___ binds to hemoglobin more easily than O2
CO
___ measures the disease-causing ability of a microorganism
Virulence
The ___ of a microorganism is a measure of its ability to reproduce and cause disease within the human body
Pathogenicity
Cells that engulf and consume foreign material
macrophages
Poisonous substances produced inside a cell and released into the surrounding tissues or fluids
exotoxins
Toxins that affect the GI tract
enterotoxins
Toxins that affect the nervous tissue
neurotoxins
Toxins that affect a variety of tissue types:
cytotoxins
Chemicals or proteins released by WBCs that cause fever to develop
pyrogens
The body’s most common reaction to bacterial presence
inflammation
The presence of bacteria in the blood
Bacteremia
Potentially life-threatening systemic disease caused by the proliferation of microorganisms (or their toxins) in the blood
septicemia/sepsis
Intracellular parasites that take over the metabolic processes of host cells to help them replicate
viruses
Protein core of a virus that protects it from phagocytosis
capsid
The protective response that occurs in the presence of cellular injury
inflammation
Local effects of inflammation include
vasodilation & increased vascular permeability
The increase in the number of leukocytes in the blood
leukocytosis
Leukocytes are produced in the ___
bone marrow
The best known protein that helps protect the body from tissue injury caused by inflammation
C-reactive protein/CRP
Proteins released by the liver in response to tissue injury or inflammation
acute phase proteins
When cellular membranes come into contact with cellular/chemical components of inflammatory response, Cellular swelling results from :
K+ leaking out of and H2O leaking into the cell
Normal cell death
apoptosis
Proteins produced by activation of genes as an underlying mechanism for apoptosis
caspases
Product of the immune system being ineffective in destroying abnormal cells
tumor/cancer
Result of morphologic changes that occur following cell death inn living tissues
necrosis
2 categories of necrosis
simple, derived
Necrosis where cells/tissue are recognizable
simple necrosis
Necrosis characterized by Loss of all features of tissues/cells; resembles cheese under microscope
caseation necrosis
Cell death typically caused by ischemia or infarction
coagulation necrosis
Delivery of O2/nutrients and removal of wastes from cells, organs, tissues by the circulatory system
perfusion
Decreased tissue perfusion below the normal level
hypoperfusion
A condition in which the patient’s condition is stabilized by the body’s internal mechanisms in response to tissue hypoperfusion
compensated shock
When hypo perfusion overcomes the body’s normal mechanisms in response to shock and the PTs condition deteriorate
decompensated shock
The body releases ___ in response to hypoperfusion which result in increased vascular resistance
catecholamines
2 catecholamines released by the body
epinephrine, norepinephrine
The overall response of initial compensatory mechanisms is to increase ___
preload, stroke volume
An abnormal state associated with inadequate oxygen & nutrient delivery to cells
shock
Impairment of cellular metabolism prevents the body from properly using ___ at the cellular level
oxygen & glucose
___ shock consists of cardiogenic shock and obstructive shock
Central
___ shock includes hypovolemic and distributive shock
peripheral
___ occurs when the heart cannot circulate enough blood to maintain adequate peripheral O2 delivery
cardiogenic
Most common form of cariogenic shock:
MI
___ occurs when blood flow becomes blocked in the heart or great vessels
obstructive shock
Impairment of ventricular filling due to fluid surrounding the heart
pericardial tamponade
___ occurs when the volume of circulating blood is insufficient to adequately circulate O2 & nutrients to the body
hypovolemic shock
type of Hypovolemic shock due to external bleeding from a wound
exogenic hypovolemia
___ occurs when there is widespread dilation of peripheral vessels
distributive shock
type of Hypovolemic shock due to internal bleeding/fluid loss
endogenous hypovolemia
3 most common types of distributive shock
anaphylactic, septic, neurogenic
___ occurs when vasodilator proteins are released on exposure to an allergen
anaphylactic shock
___ occurs as a result of widespread infection, usually by bacteria, that causes the immune system to be overwhelmed
septic shock
___ usually results from spinal cord injury, causing loss of sympathetic nervous system tone & vasodilation
neurogenic shock
A classic, but late sign of shock, especially in children
hypotension
Peripheral pulse strength is related to ___
stroke volume & pulse pressures
Slow, delayed, or prolonged ___ indicates shock
capillary refil time
___ provides useful information about respiratory & ventilatory status of the PT
ETCO2
Decreasing levels of ___ are Ann early indicator of shock
ETCO2
Treatment of shock should focus on ___
the underlying condition
A progressive condition that occurs in some critically ill patients
MODS | multiple organ dysfunction syndrome
MODS is characterized by:
concurrent failure of 2 or more organs or organ systems initially unharmed by the underlying condition
MODS is the major cause of death following ___
sepsis, trauma, or burn injuries
___ are the body’s protection against foreign substances invading the body
anatomic barriers
___ is the body’s defense reaction to any substance it recognizes as foreign
the immune response
The immune response involves only one type of WBC, namely:
lymphocytes
Components of the complement system that attract WBCs to fight the infection:
Chemotaxins
Chemotaxins attract ___ to fight infection
leukocytes
Set of proteins that insert themselves into bacterial membrane to weaken it
membrane attack complex
Memory cells
B cells/B lymphocytes
WBCs that release histamine
basophils
WBCs that phagocytize bacteria
neutrophils
WBCs that directly attack or produce antibodies
lymphocytes
WBCs that are part of the first line of defense in the inflammatory process
Macrophages
WBCs that develop from B cells and produce specific antibodies
Plasma cells
Memory cells that produce in bone marrow and become either memory or antibody-secreting cells
B lymphocytes
Cells that mature in the thymus and work to destroy antigens
T lymphocytes/T cells
Cells that destroy virus-infected cells
Killer/Cytotoxic T cells
Non-specific immunity that operates as the first-line defense against pathogens
natural immunity
Highly specific, inducible, discriminatory method that allows the body to recognize a foreign substance and produce antibbodies
Acquired immunity
Receipt of pre-formed antibodies to fight or prevent infection
passive acquired immunity
The ___ occurs during the first exposure to an antigen
primary immune response
The ___ occurs on subsequent exposure to a foreign substance
secondary immune response
___ bind specific antigens
antibodies
An antigen capable of generating an immune response
immunogen
A substance that normally does not stimulate immune response but can be combined with an antigen to initiate a specific antibody response on it’s own
hapten
___ immunity is mediated by B cells
humoral immunity
B cells produce ___
Immunoglobulins
Activation of B cells to produce antibodies occurs via ___
helper T cells
__ degranulate and release a variety of substances during an inflammation response
Mast cells
After degranulation, mast cells release ___
vasoactive amines
2 important vasoactive amines released by mast cells
histamine, serotonin
Slow reacting substances of anaphylaxis
leukotrienes
Group of plasma proteins that attract WBCs to sites of inflammation
complement system
___ serves a vital role in blood clot formation in vessels
the coagulation system
The fibrous component of a blood clot
fibrin
The ___ leads to the formation of bradykinin from kallikrein
kinin system
The goal of cellular components of acute inflammation response is for ___ to arrive at the sites they are needed at
polymorphonuclear neutrophils
Movement of WBCs to the sides of blood vessels
marination
Leukocytosis as a result of inflammation is caused by:
production of more WBCs by bone marrow in response to demargination from stress
The appearance of selectins and integrins on the surface of endothelial cells and polymorphonucleic neutrophils
activation
Attachment of polymorphonuclein neutrophils to endothelial cells due to selectins
adhesion
Polymorphonucleic neutrophils permeating the vessel wall into the interstitial space
transmigration/diapedesis
movement of neutrophils toward the site of inflammation
chemotaxis
Products of cells that affect the function of other cells
cytokines
___ attract WBCs to the sites of injury or bacterial invasion
interleukins
Protein produced by cells when invaded by viruses
interferons
Interferon works by:
inducing healthy cells to manufacture enzymes to counter infection
___ stimulate leukocytes
lymphokines
___ keeps WBCs at the site of injury/infection until they can perform their designated task
Migration inhibitory factor
__ cells divide continuously, so organs derived from these cells heal completely
labile
___ cells are replaced by mitosis of remaining cells
stable
___ can’t be replaced
permanent
Damaged permanent cells are replaced bby
scar tissue
The beginning of the process of scab formation
epithelialization
Process during which the size of the wound becomes smaller as part of healing
contraction
Vascular events of chronic inflammation are similar to that of acute inflammation, but also include:
angiogenesis
Type of reaction that occurs in response to a stimulus
type I: immediate hypersensitivity reactions
Disease characterized by autoimmune attack on the neuromuscular junction
myasthenia gravis
Decrease in circulating neutrophils
neutropenia
Blood disorder in which antibodies form to blood platelets that cause their destruction
idiopathic thrombocytopenic purpura
Decrease in blood paltelets
thrombocytopenia
Pertaining to side-effects or complications of medical treatment
iatrogenic
Type I hypersensitivity reactions are most commonly associated with:
IgE
A person who has an allergic tendency is said to be:
atopic
Pathology associated with malignant growths
cancer
One of the most significant endocrine diseases
Diabetes mellitus
___ is characterized by increased RBC destruction
hemolytic anemia
Most sex-linked disorders are ___
X linked
Number of new cases of a disease in a population
incidence
of cases of disease in a population within a particular time frame
prevalence
Presence of a disease
morbidity
Number of deaths from a disease in a population
mortality
In ___ a person needs to inherit only one copy of a particular form of a gene to show that trait
autosomal dominant
In ___ a person needs to inherit 2 copies of a gene to show that trait
autosomal recessive
Inherited disorder characterized by excessive bleeding
hemophilia
Disease in which the body absorbs more iron than it needs
Hemochromatosis
Disease of the myocardium that ultimately progresses to heart failure, MI, or death
cardiomyopathy
___ is caused baby impaired circulation to the heart, usually due to coronary artery atherosclerotic buildup
Coronary heart/artery disease
Good cholesterol
HDL
Bad cholesterol
LDL
___ is associated with increased risk of CAD
HTN
Abnormal accumulation of uric acid in the blood and joints
gout
Small masses of uric acid or calcium salts that form in the urinary tract
Kidney stones
Caused baby defects in the function of the bowel wall, preventing adequate absorption
malabsorption disorders
Defect or deficiency of the lactase enzyme
lactose intolerance
Serious chronic inflammatory disease of the large intestine and rectum
Ulcerative colitis
Chronic inflammatory disease of the colon or terminal portion of the small intestine
Crohn disease
Characterized by circumscribed erosions of the mucus membranes of the GI tract
peptic ulcer disease
Caused by precipitations of substances contained in bile
gallstones
Disease characterized by jerky motions and mental deterioration
Huntington disease
Disease characterized by cortical atrophy and loss of neurons in the frontal and temporal lobes of the brain
Alzheimer’s
Group of mental disorders characterized by gross distortions of reality
Schizophreia
Mental disorder characterized by episodes of mania and depression
bipolar disorder
Medical term for a wide range of external stimuli
stress
In a stress response, the brain to stimulate the ___ to secrete ___
pituitary gland ; adrenocorticotropic hormone
ACTH stimulates the release of ___
glucocorticoids
___ chracterizes a 3 stage reaction to stressors
General adaptation syndrome
The body reacts to stress first by releasing:
catecholamines
The most abundant catecholamines are ___
epinephrine, norepinephrine, dopamine
During a stress response, the brain stimulates the ___ to secrete __
adrenal medulla; catecholamines
Receptors in the SNS that allow certain responses to be activated
alpha and beta receptors
3 stages of general adaptation syndrome
alert, resistance/adaptation, exhaustion
The most significant glucocorticoid in the body
cortisol
Cortisol controls metabolism of:
carbohydrate, fat, and proteins
Predominant mineralocorticoid
aldosterone
ACTH targets the ___ and causes the release of ___
adrenal cortex; cortisol
Cortisol decreases the size of ___
lymphoid tissue
