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Patho > Patho Exam 4 > Flashcards

Patho Exam 4 Flashcards

1
Q

effect of post renal obstruction in kidney

A

Hydronephrosis

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2
Q

main cause of stroke

A

thrombosis (ischemic stroke) is more common than hemorrhagic stroke

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3
Q

rhythmic jerking of major muscle groups

A

clonic seizure (vs tonic clonic seizures aka change from jerking to either full on fixed in position to the jerking aka GRAND MAL)

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4
Q

sign of basilar skull fracture

A

-CSF (clear fluid) leaking from nares or ears
-Raccoon eyes (black eyes bilaterally)

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5
Q

first indication of increased ICP

A

decreased LOC

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6
Q

hypotonic IVs cause water to move…

A

Into the cells

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7
Q

sign of AKI (acute kidney injury)

A

oliguria aka low urine output- less than 30mL per hr

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8
Q

pH 7.50, PCO2 50, PO2 85, HCO3 35, SaO2 95

A

metabolic alkalosis (bc 7.50 is basic & HCO3 is abnormal so always metabolic!)
normal HCO3 = 22 - 26

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9
Q

burns, crush injury, CKD, CHF, ACE, ARB, NSAID use

A

hyperkalemia

(bc kidney injuries impact potassium bc muscles need potassium to function)

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10
Q

signs of cerebellar dysfunction

A

poor coordination & abnormal gait aka ataxia

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11
Q

common cause of metabolic acidosis

A

DKA (Diabetic ketoacidosis)

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12
Q

definition of hyrdonephrosis, kidneys are

A

swollen/edematous & distended

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13
Q

CKD, DKA, burns, diarrhea, vomiting, fever dehydration, DI (diabetes insipidus), increased dietary intake

A

hypernatremia
(bc increased dietary intake & diarrhea are key words)

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14
Q

absent bowel sounds, hypotension, bradycardia, absent or weak DTRs

A

signs of spinal shock

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15
Q

this can cause bone pain, arrhythmia, kidney stones, GI upset

A

hypercalcemia

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16
Q

periorybital edema, proteinuria, oliguria are signs of this

A

glomerulonephritis

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17
Q

this metabolic factor can increase cerebral blood flow causing an increase ICP

A

PCO2 increase

(decrease blood flow to brain will increase ICP)

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18
Q

buildup of nitrogenesis waste in the blood

A

azotemia

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19
Q

neurotransmitter decreased inmysento gravis

A

acetylcholine (ACH)

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20
Q

Most common pre-renal injury to the kidney

A

hemorrhage, hypovolemic shock

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21
Q

how does body respond to acid base balance

A

buffer

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22
Q

difficulty speaking

A

dysphasia (partial loss vs aphasia is full loss)

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23
Q

electrolyte abnormality causes muscle spasms, cramps, paresthesia

A

hypocalcemia

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24
Q

cause of anemia in CKD

A

low level of erythropoietin

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25
Q

problem w/ Guillain Barre Syndrome

A

respiratory is priority due to paralysis

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26
Q

signs of waste build up in the blood stream

A

uremia

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27
Q

pH 7.50 pCO2 55 PO2 55 HCO3 31 SaO2 92

A

metabolic alkalosis

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28
Q

physical signs of compensation for metabolic acidosis

A

hyperventilation - rapid & deep respirations

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29
Q

priority system to assess w/ potassium abnormality

A

cardiovascular system

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30
Q

NSAIDs, CKD, diuretics, CHF, increased water intake can cause abnormalities w/ this electrolyte

A

Hyponatremia

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31
Q

sports & head injury w/ brief LOC but normal near assessment

A

concussion

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32
Q

feet & wrists flexed, elbows extended

A

decerebrate posturing

(deCORticate posturing = pulled into the CORe)

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33
Q

excessive sweating, vomiting, diarrhea, diuretics, poor dietary intake, CKD, alcoholism are risk factors for this electrolyte abnormality

A

hypokalemia

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34
Q

labs used to monitor kidney function

A

BUN, creatinine, GFR

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35
Q

risk factors for respiratory acidosis

A

spinal cord, brain injury, opioids/narcotics bc reduced RR

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36
Q

example of isotonic IV

A

Normal Saline 0.9%

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37
Q

condition of intermittent exacerbation of musculoskeletal weakness and remission

A

MS (Multiple sclerosis)

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38
Q

causes of urinary tract obstruction

A

-BPH
-Renal calculi

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39
Q

hypertonic solution move water…

A

Out of the cell

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40
Q

what provides collateral circulation to the brain

A

Circle of Willis

(good & bad things; bad thing is most common site of aneurism)

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41
Q

if pH is elevated, will there be increased or decreased hydrogen ions present?

A

decreased

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42
Q

what would you call it when a pt is looking at you but nothing else (spells of staring)

A

absence seizure

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43
Q

What important renal enzyme is released in response to decreased blood flow to the kidneys resulting in increased blood pressure and sodium retention?

A

Renin

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44
Q

What hormone is produced by the kidneys that stimulates Red Blood Cell production?

A

Erythropoietin

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45
Q

normal pH level

A

7.35 - 7.45

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46
Q

this is inactive if you have poor renal function which can cause what

A

Vit D
which can cause hypocalcemia

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47
Q

Decreased blood flow and perfusion to the kidney

A

pre renal dysfunction

(occurs bc of reduced CO or severe hypovolemia or shock….not enough fluid pumping to kidneys AKA DECREASED PERFUSION)

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48
Q

Actual injuries to the kidney

A

intra renal dysfunction

(occurs d/t damage to renal tissue. Trauma or toxic injury d/t nephrotoxic medications, kidney infections, systemic illnesses that affect the kidneys such as NSAIDS, post streptococcal glomerulonephritis, HTN, DM (direct damage to kidney due to trauma, infection, disease)

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49
Q

Obstruction of urine outflow from the kidneys

A

post renal dysfunction

(obstructive uropathy, kidney stones, prostate gland enlargement, bladder cancer…obstruction, not allowing the flow out of the kidneys, causes backflow…this can lead to hydronephrosis)

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50
Q

Normal BUN (Blood Urea Nitrogen level)

& what can affect BUN level?

A

5-20 mg/dL

BUN can be high or low based on hydration status (look at gravity – it tells you dehydration)

Can be seen in those with extremely muscular individuals (athletes) and high protein diets bc of high muscle breakdown. Muscle cell proteins break down into amino acids which are nitrogen compounds.

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51
Q

low albumin means low this

A

low protein

52
Q

pre vs intra vs post renal

A

Prerenal (most common): decreased perfusion

Intrinsic: medications, infections

Postrenal: obstruction

53
Q

edema w/ fluid leakage after you move your finger print

A

Anasarca

54
Q

this it the destruction of RBCs

in CRF- it is not regulating RBC production

A

hemolysis

55
Q

this is a complication in CRF that is confusion, coma, death

A

Encephalopathy

56
Q

this is the renal blood filtered per unit of time

A

GFR (glomerular filtration rate)

57
Q

this is combination of clinical findings that occurs when the glomeruli are damaged. When glomeruli are injured, they become hyperpermeable to protein and the substances in the blood stream … the is significant protein loss (proteinunira), hypoalbuminia, hyperlipidemia)

A

nephrotic syndrome

58
Q

this involves the spinal cord and cortex of the brain to control voiding.

A

Micturition reflex

59
Q

Hydronephrosis vs hydroureter

A

Hydroureter - dilation of the ureter caused by obstruction.

Hydronephrosis - distention of the renal calyces and pelvis as a result of obstruction of the outflow of urine distal to the renal pelvis. Can cause kidney tissue damage

(We can reverse hydronephrosis, but usually cant if hydroureter)

60
Q

Force of fluid pressure in bloodstream

A

hydrostatic pressure

61
Q

Pressure by solutes in solution

A

osmotic pressure

62
Q

“colloid pressure”

pressure due to albumin in blood

A

oncotic pressure

63
Q

Concentration of solutes/kg solution

A

osmolality

64
Q

Number of osmoles of solute per liter of solution

A

osmolarity

65
Q

this is an example of isotonic solution

A

Lactated ringers – temporary replacement for blood

NS 0.9% saline

66
Q

this is an example of hypertonic solution

A

3% NaCl

ICF to ECF so cells shrink. This is more rare bc it’s dangerous to use. Used in ICU or surgery sometimes. Used for cerebral edema (swelling in brain)

67
Q

this is an example of hypotonic solution

A

0.45% NaCl

(ECF to ICF to treat dehydration. Causing cells to enlarge)

68
Q

dehydration causes this

A

Decreased circulating blood volume leads to tachycardia and hypotension

69
Q

causes of dehydration

A

-Reduced fluid intake
-Reduced ADH or kidneys not responsive to ADH
-Burns, fever, perspiration
-Osmotic diuresis, as occurs with elevated blood glucose levels
Hypernatremia

70
Q

Na / K pump

A

Sodium = extracellular electrolyte

Potassium = intracellular electrolyte

The Na/K pump is constantly at work trying to retain K in the cell and move Na outside of the cell.

**3 Na out, 2 K in

71
Q

low sodium levels

A

Hyponatremia

(Low sodium is less than 135)

72
Q

s/s of hypovolemic hyponatremia
& treatment?
& cause?

A

thirst, dry mouth, orthostatic hypotension, tachycardia, azotemia (high BUN), oliguria,
h/a, lethargy, apathy, confusion, h/v/d, muscle cramps/spasms

**burns, fistulas, wounds, diarrhea, vomiting cause this

treatment : Slow replacement of sodium with adequate fluid (an isotonic fluid 0.9% normal saline)

73
Q

high levels of sodium

A

hypernatremia

High sodium = greater than 145

74
Q

s/s of hypernatremia
& treatment?

A

Fluid overload: hypertension, edema, weight gain

no fluid overload: Dehydrated, thirst, tachycardia, oliguria

treatment: fix the underlying cause

75
Q

s/s of hypokalemia
& treatment?
cause?

A

s/s = Anorexia, cardiac arrhythmias, leg cramps

cause of it: NPO status, etoh abuse. Bariatric surgery (malabsorption due to decreased stomach size). Eating disorders.

treatment: Replace potassium at acceptable rate, Rapid K+ infusion can cause cardiac arrest

76
Q

s/s of hyperkalemia
& treatment?
& cause?

A

s/s = Numbness/tingling, cramping, diarrhea, apathy, mental confusion.

**cause = decrease in renal perfusion, such as decreased cardiac output, will diminish the kidney’s ability to excrete K. Can also occur d/t major muscle trauma b/c K is released rapidly from muscle cells.

treatment: depends on cause, but possibly diuretic

77
Q

s/s Hypercalcemia
(Greater than 10 mg/dL)

A

-Decreased Neuromuscular excitability
-Constipation
-Renal calculi
-Ventricular arrhythmia
-Hyperreflexia

78
Q

s/s hypocalcemia
(less than 8.7 mg/dL)

A

-neuromuscular excitability
-Paresthesia
-Weakness
-Bone pain/fragility/dry skin/hair
-hypotension
-cardiac arrhythmias
-Chvostek’s Sign (facial twist when touching face)
-Trousseau’s sign (weird hand spasms from bp cuff)

79
Q

how does the buffer system work ?

A

Donating H+ when solution is too basic

Absorbing H+ when solution is too acidic

80
Q

normal pCO2 levels

A

35 - 45 mmHg

81
Q

normal HCO3 levels

A

22 to 26

82
Q

respiratory compensation means what?

A

increased ventilation

83
Q

metabolic (renal) compensation means what?

A

adjust HCO3 and H+

84
Q

metabolic vs respiratory (which is same/different)

A

metabolic - same

respiratory - different

85
Q

elevated CO2
aka hypoventilation

A

respiratory acidosis

86
Q

reduced CO2
aka hyperventilation

A

respiratory alkalosis

87
Q

Elevated acid other than CO2 (i.e., ketones)

A

metabolic acidosis

88
Q

Excess base or loss of H+ ions

A

metabolic alkalosis

89
Q

compression of lower spinal nerves causing bowel/bladder dysfunction and leg weakness

A

cauda equina syndrome

90
Q

Hypoventilation vs hyperventilation

A

Hypoventilation can be caused by CNS depression (sedation, given pain meds etc) can’t get rid of enough CO2 - respiratory acidosis

hyperventilation can be caused by CNS stimulation or excitation…. gets rid of too much CO2 bc you’re blowing it off way too fast - respiratory alkalosis

91
Q

s/s of respiratory alkalosis

A

anxiety
restlessness
pain
CNS excitation
increased VS
normal or decreased BP
cardiac problems
electrolyte imbalances

92
Q

s/s of respiratory acidosis

A

CNS depression
respiratory distress
decreased BP but increased VS

93
Q

Increased respirations, tachycardia, hypotension, confusion

A

metabolic acidosis

94
Q

Confusion, dizziness, weakness, diarrhea

A

metabolic alkalosis

95
Q

pt has severe asthma, what is going on ?

A

respiratory acidosis is occurring … so pt will hyperventilate (respiratory alkalosis will happen!) to compensate

96
Q

signs of increasing ICP?

A

-Decreased level of
-consciousness
-Pupillary dilation
-Headache
-Vomiting
-Papilledema
-Increased BP
-Cushing’s triad: (Hypertension, Widened pulse pressure,
Bradycardia,
Abnormal respiratory pattern)

97
Q

The Glasgow Coma Scale (GCS) is based off what 3 things

A
  1. Eye opening
  2. Verbal response
  3. Motor response

Lowest GCS: 3 (coma!)
Highest GCS: 15 (normal)

98
Q

2 types of posturing

A
  1. Decorticate
    (Flexed arms, clenched fists, rigid legs)
    **Corticospinal tract damage

2.Decerebrate
(Arms held straight outward with toes pointed downward)

**Upper brainstem damage SO WORSE!

99
Q

Bleeding in space below the dura mater,
Usually due to tearing of bridging veins in subdural space,
Most common type of traumatic intracranial hematoma…
Slow bleeding, but blood can accumulate over time
Acute: within 72 hours after head injury
Subacute: take up to 7 days

A

SDH (subdural hematoma)

100
Q

2 types of these:

traumatic one of these: 1 of most common head injuries, Tearing of cerebral & meningeal vessels within subarachnoid space,
Post-traumatic cerebral vasospasm in response to blood

Aneurysmal one of these:
-Weakened area of vessel, may rupture
“Berry aneurysm”
In 50% of cases, symptoms precede rupture
“Thunderclap headache” and has
Rapid decline.
-Rupture of artery causes blood to fill subarachnoid space,
Blood irritates tissues and puts pressure on brain, can cause obstructive hydrocephalus,
Pressure may cause brain herniation

A

Subarachnoid Hemorrhage (SAH)

101
Q

Spinal nerves at end of spinal cord

A

Cauda equina

102
Q

the temporary loss of reflexes

A

areflexia - sign of spinal shock!

103
Q

Results from primary injury,
Flaccid muscles, paralysis, lack of sensation below injury, bowel & bladder dysfunction,
Loss of the anal reflex or bulbocavernosus reflex, (Contraction of the anal sphincter with squeezing of the glans penis or tugging on a Foley catheter),
Autonomic function also disrupted

A

Areflexia which is due to
Spinal shock

104
Q

this type of shock occurs in patients with injuries at T6 and above

A

neurogenic shock

105
Q

affects Speak language,

Expressive aphasia if there is dysfunction of this area

A

Broca’s area

106
Q

Comprehend (understand) language,

Receptive aphasia if there is dysfunction of this area

A

Wernicke’s area

107
Q

this is the base of brain,
Formed by posterior cerebral artery & internal carotid,
Common site for aneurysms (weakness in arterial wall)

A

Circle of Willis

108
Q

2 types of stroke, which is most common?

A

ischemic (most common which is thrombus or embolus) and hemmoraghic stroke (rupture of cerebral artery)

109
Q

mini stroke , no permanent injury but can warn future stroke is coming

A

Transient ischemic attack (TIA)

110
Q

risk factors for ischemic stroke vs risk factors for hemorraghic stroke

A

ischemic:
-Afib
-carotid stenosis
-cerebral arteriosclerosis

hemorrhagic:
-hypertension
-oral anticoagulation
-cerebral aneurism

111
Q

which stroke is more deadly?

A

Hemorrhagic stroke - occurs when a cerebral artery ruptures & can no longer bring blood to the brain tissue (less common than ischemic)

112
Q

hypertension, bradypnea, and bradycardia are signs of what

A

Cushing’s triad aka pressure on brain stem

113
Q

risk factors for stroke

A

Hypertension (HTN)
Hyperlipidemia
Diabetes
Smoking
Obesity
Lack of exercise
Atrial fibrillation
Oral contraceptives
Excess alcohol
Family history
Age 55+
Gender
Male risk is greater than female
Ethnicity
African American risk is greater than Caucasian
Sickle cell disease
Transient ischemic attack (TIA)
Amyloid accumulation

114
Q

This causes a thunderclap headache (comes out of nowhere, most severe headache that causes n/v even seizure, stiff neck, etc)

A

SAH (Subarachnoid hemorrhage) = brain bleed

115
Q

how to know if someone had stroke

A

(FAST)
Facial droop
Arm weakness
Speech difficulty
Time to call 911

116
Q

spinal injuries

A

Higher injuries (e.g., C4) may need ventilatory support, while lower injuries might require mobility aids.

117
Q

this disorder is the degeneration of myelin

A

MS

118
Q

if this is positive, toes flare up and show a upper motor neuron disorder

A

Babinski reflex

119
Q

Orthostatic hypotension, sleep disturbances, GI disturbances and impaired thermoregulation are symptoms of what?

Bradykinesia (slowing muscle movements), resting tremors, muscle rigidity is the classic triad

A

Parkinson’s neurodegeneration disorder

120
Q

Progressive neurodegenerative disorder characterized by loss of upper and lower motor neurons
Symptoms include painless muscle weakness and atrophy

A

ALS (Amyotrophic Lateral Sclerosis)

121
Q

Weakness, numbness, balance problems, blurred vision
Dysphagia, hemiparesis, paraparesis may develop with this disorder

A

MS

122
Q

Postinfectious disease
Acute inflammatory demyelination
Weakness varies from mild weakness to complete paralysis, including respiratory muscles

A

Guillain-Barré Syndrome (GBS)

123
Q

Autoimmune neuromuscular disorder that can occur at any age.

ptosis is the first sign!

Caused by loss of ACH receptors in neuromuscular junction

Muscle weakness and fatigue

A

Myasthenia Gravis (MG)

124
Q

fluid accumulates in cavities without fluid such as pericardial sac, peritoneal cavity, pleural space

A

third spacing

125
Q

what causes anemia in CKD?

A

Low EPO levels cause your red blood cell count to drop and anemia to develop

126
Q

hypovolemeia vs hypervolemia

& causes!

A

hypovolemia = condition that occurs when your body loses fluid, like blood or water. (dehydration is a cause)

hypervolemia = too much fluid in your body
(heart failure, kidney failure, cirrhosis causes this)

127
Q

s/s of brain herniation

A

-Irregular or slow pulse.
-Severe headache.
-Weakness.
-Cardiac arrest (no pulse)
-Loss of consciousness, coma.
-Loss of all brainstem reflexes (blinking, gagging, and pupils reacting to light)
-Respiratory arrest (no breathing)

Patho (4 decks)

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