Patho Exam 4 Flashcards
What effect is a result of inhibiting the parasympathetic nervous system with a drug such as atropine?
Salivation decreases
What does B-Adrenergic stimulation from sympathetic fibers cause?
increased salivation
Which gastric cells secrete hydrochloric acid and intrinsic factor?
Parietal
Which enzyme breaks down protein-forming polypeptides in the stomach?
Pepsin
Which gastric hormone inhibits acid and pepsinogen secretion, as well as decrease the release of gastrin?
Somatostatin
Exposure to which substance protects the mucosal barrier of the stomach?
Prostaglandins
Which statement best describes the gastrointestinal tract?
The gastrointestinal tract is a hollow tube that extends from the mouth to the anus.
Which statement is true regarding the state of the intestinal tract at birth?
The intestinal tract is sterile
What is the role of the normal intestinal bacterial flora?
Metabolizing bile salts, estrogens, and lipids
Which structure synthesizes clotting factors and the vitamin K necessary for hemostasis?
Liver
The process of conjugation of bilirubin in the liver is best described as which transformation?
Unconjugated (fat-soluble) bilirubin into conjugated (water-soluble) bilirubin
What type of diarrhea is a result of lactase deficiency?
Osmotic
A person who has cholera would be expected to have which type of diarrhea?
Secretory
Which statement is false concerning how abdominal pain is produced?
(True:Chemical mediators, such as histamine, bradykinin, and serotonin, produce abdominal pain. Edema and vascular congestion produce abdominal pain by stretching. Ischemia, caused by distention of bowel obstruction or mesenteric vessel thrombosis, produces abdominal pain.)
Low concentrations of anaerobes, such as Streptococci, Lactobacilli, Staphylococci, Enterobacteria, and Bacteroides, produce abdominal pain.
Which statements are true regarding parietal pain? (Select all that apply. 4)
- Parietal pain arises from the parietal peritoneum. 2. It is generally more localized than visceral pain.
- Nerve fibers that travel to the spinal cord are involved in parietal pain.
- Parietal pain corresponds to dermatomes T6 and L1.
How can abdominal pain that is visceral in nature best be described?
Abdominal pain that is visceral in nature is diffused, vague, poorly localized, and dull.
What is the cause of gastroesophageal reflux disease?
Zone of low pressure of the lower esophageal sphincter
What is the cause of reflux esophagitis?
Delayed gastric emptying
By what mechanism does intussusception cause an intestinal obstruction?
Telescoping of part of the intestine into another section of intestine, usually causing strangulation of the blood supply
Protrusion of intestine through weakness in abdominal muscles or inguinal ring
Herniation
Twisting of the intestine on its mesenteric pedicle with occlusion of blood supply; associated w/fibrous adhesion & most common in large intestine of older adults
Torsion (volvulus)
Inflamed saccular herniations (diverticula) of mucosa & submucosa through tunica muscularis of colon; most common in obese people over 60.
Diverticulosis
Growth in the intestinal lumen
Tumor
Loss of peristaltic motor activity in the intestine associated with abdominal surgery, peritonitis, hypokalemia, ischemic bowel, spinal trauma, pneumonia, neuropathies, or myopathies.
Paralytic (adynamic) ileus
Peritoneal irritation from surgery or trauma leading to formation of fibrin & adhesions that attach to intestines.
Fibrous adhesions
What is the most immediate result of a small intestinal obstruction?
Distention
What are the cardinal symptoms of small intestinal obstruction?
Colicky pain caused by distention, followed by vomiting
An intestinal obstruction at the pylorus or high in the small intestine causes metabolic alkalosis by causing which outcome?
Excessive loss of hydrogen ions normally absorbed from gastric juices
What is a cause of chronic antral gastritis?
Helicobacter pylori bacteria
Which statements are true regarding chronic gastritis? (Select all that apply.4)
- Chronic gastritis tends to occur in older adults.
- Results in chronic inflammation and mucosal atrophy.
- Mucosal atrophy is a common outcome.
- Epithelial metaplasia is often observed.
Chronic gastritis treatment: (3)
- Smaller meals; soft, bland diet; avoidance of alcohol and NSAIDs
- Administration of combination antibiotics
- Vitamin B: For pernicious anemia correction
After a partial gastrectomy or pyloroplasty, clinical manifestations that include increased pulse, hypotension, weakness, pallor, sweating, and dizziness are the results of which mechanism?
Rapid gastric emptying and the creation of a high osmotic gradient in the small intestine, causing a sudden shift of fluid from the blood vessels to the intestinal lumen
Which statement is consistent with dumping syndrome?
Dumping syndrome usually responds well to dietary management.
The most common clinical manifestation of portal hypertension is what type of bleeding?
Esophageal
What is the most common manifestation of portal hypertension–induced splenomegaly?
Thrombocytopenia
Which statement is false concerning the pathophysiologic process of alcoholic cirrhosis? (True:Alcohol is transformed to acetaldehyde, which promotes liver fibrosis, mitochondrial function is impaired decreasing oxidation of fatty acids, & acetaldehyde inhibits export of proteins from the liver.)
Inflammation and damage leading to cirrhosis begin in the bile canaliculi.
Hepatic fat accumulation is observed in which form of cirrhosis?
Alcoholic
Which statement is false regarding the pathophysiologic process of acute pancreatitis? (True: Bile duct or pancreatic duct obstruction blocks the outflow of pancreatic digestive enzymes. Acute pancreatitis can also result from direct cellular injury from drugs or viral infection. Acute pancreatitis is usually mild and spontaneously resolves.)
Acute pancreatitis is an autoimmune disease in which immunoglobulin G (IgG) coats the pancreatic acinar cells; consequently, the pancreatic enzymes destroy the cells.
Common systemic disease effecting the liver causing hepatic cell necrosis, scarring, Kupffer cell hyperplasia, and hepatocyte apoptosis
Viral Hepatitis
Phases of Hepatitis:
Prodromal (preicteric), Icteric (jaundice), and Recovery phase (regulation of jaundice or beginning of chronic hepatitis).
Which are the early (prodromal) clinical manifestations of hepatitis? (Select all that apply. 3)
Fatigue, Vomiting, & Hyperalgia.
Increased gastrin secretion by the mother in the last trimester of pregnancy may cause which condition in the infant?
Pyloric stenosis
At 2 or 3 weeks of age, an infant who has been well fed and has gained weight begins to vomit for no apparent reason. The vomiting gradually becomes more forceful. These symptoms may be indicative of which disorder?
Pyloric stenosis
Which situations have been associated with possible causes of the failure to thrive (FTT) in infants? (Select all that apply. 4)
GERD, Pyloric stenosis, Intestinal parasites & Psychosocial isolation.
Meconium Plug Syndrome:
benign bowel obstruction
Meconium Aspiration Syndrome:
gasping respirations that cause meconium aspiration
Meconium Ileus:
abnormally sticky meconium causes intestinal obstruction due to lack of digestive enzymes during fetal life
Which term is used to identify an intestinal obstruction caused by meconium formed in utero that is abnormally sticky and adheres firmly to the mucosa of the small intestine?
Meconium ileus
With which medical diagnosis is meconium ileus often associated?
Cystic fibrosis
Congenital aganglionic megacolon (Hirschsprung disease) involves inadequate motility of the colon caused by neural malformation of which nervous system?
Parasympathetic
What causes a person with cystic fibrosis to experience an exocrine pancreatic insufficiency?
Pancreatic ducts are obstructed with mucus.
What is the cause of faulty digestion of fats in those diagnosed with cystic fibrosis?
Deficiency of pancreatic enzymes
Cystic fibrosis is characterized by which symptom?
Excessive mucus production
Cystic fibrosis is directly responsible for complications to which structures? (Select all that apply. 2)
Cervix & Liver
Which medication compensates for the deficiency that occurs as a result of cystic fibrosis?
Pancreatic enzymes
What factor associated with gluten-sensitive enteropathy (celiac sprue) causes an infant to bruise and bleed easily?
Vitamin K deficiency from fat malabsorption
Which foods should be eliminated from the diet for children who have gluten-sensitive enteropathy (celiac sprue)? (Select all that apply.2)
Red meat & Dairy
Clinical manifestations of Celiac Disease:
: diarrhea, meconium ileus; pale, bulky, greasy, foul smelling stool; FTT; Malabsorption syndromes: Rickets bleeding, anemia, fat-soluble vitamin deficiency; Mag & Cal malabsorption: irritability, tremor, convulsions, tetany, bone pain, dental abnormalities, osteomalacia.
Blood vessels of the kidneys are innervated by the:
Sympathetic nervous system
What part of the kidney controls renal blood flow, glomerular filtration, and renin secretion?
Juxtaglomerular apparatus (JGA)
What effects do exercise and body position have on renal blood flow?
They activate renal sympathetic neurons and cause mild vasoconstriction.
What is the functional unit of the kidney called?
Nephron
The concentration of the final urine is determined by antidiuretic hormone (ADH), which is secreted by which gland?
Posterior pituitary
What effect do natriuretic peptides have during heart failure when the heart dilates?
Inhibits renin and aldosterone.
What is the direct action of atrial natriuretic hormone?
Sodium excretion
What is the action of urodilatin (a natriuretic peptide)? It inhibits salt and water reabsorption
It inhibits salt and water reabsorption
Which statement is true regarding urodilatin?
Urodilatin is stimulated by a rise in blood pressure and an increase in extracellular volume.
Which renal change is found in older adults?
Decrease in the number of nephrons
Compared with a younger individual, how is the specific gravity of urine in older adults affected?
Specific gravity of urine in older adults is considered low normal.
Regarding the formation of renal calculi, what function does pyrophosphate, potassium citrate, and magnesium perform?
They inhibit crystal growth.
Which mineral accounts for the most common type of renal stone? Calcium oxalate
Calcium oxalate
Result in the obstruction and stasis of urine, contributing to bacteriuria and hydronephrosis and causing irritation of epithelial lining with entrapment of bacteria
Kidney stones
Kidney stones in the upper part of the ureter would produce pain referred to which anatomical area?
Umbilicus
Which statements are true concerning struvite stones? (Select all that apply.3)
- They are more common in women than in men
- They grow large and branch into a staghorn configuration in renal pelvis and calyces
- Struvite stones are closely associated with urinary tract infections caused by urease-producing bacteria, such as Pseudomonas.
Overactive Bladder Treatment:
- Lifestyle modifications, Behavioral therapy, neuromodulation, Surgery.
- Pharmacotherapy (antimuscarinic agents) Botulinum Toxin therapy
Bladder cancer is associated with the gene mutation of which gene?
TP53
What are considered risk factors for developing bladder and kidney cancers? (Select all that apply.3)
Cigarette smoking, Hypertension, Exposure to aniline dyes.
Which differentiating sign is required to make the diagnosis of pyelonephritis from that of cystitis?
Urinalysis confirmation of white blood cell casts
Pyelonephritis is usually caused by which type of organism?
Bacteria (Escherichia coli, Proteus, or Pseudomonas)
Which clinical manifestations of a urinary tract infection may be demonstrated in an 85-year-old individual?
Confusion and poorly localized abdominal discomfort
In glomerulonephritis, what damages the epithelial cells resulting in proteinuria? (Select all that apply.2)
Activated complement & Altered membrane permeability
A patient exhibits symptoms including hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin as the major protein. These data suggest the presence of which disorder?
Glomerulonephritis
Which statement is false concerning the skeletal alterations caused by chronic renal failure when the glomerular filtration rate (GFR) declines to 25% of normal?
The parathyroid gland is no longer able to secrete sufficient parathyroid hormone.
(True: Parathyroid hormone is no longer effective in maintaining serum phosphate levels. The synthesis of 1,25-vitamin D3, which reduces intestinal absorption of calcium, is impaired. The synthesis of 1,25-vitamin D3, which impairs the effectiveness of calcium and phosphate resorption from bone by parathyroid hormone, is impaired)
Prerenal AKI:
result of renal hypoperfusion; most common
Intrarenal AKI:
result from may result from ischemic ATN, nephrotoxic ATN, acute glomerulonephritis, vascular disease, allograft rejection, or interstitial disease (drug allergy, infection, tumor growth); ischemic ATN is the most common.
Which renal disorders are considered causes of intrarenal renal failure? (Select all that apply.3)
Acute Glomerulonephritis, Allograft rejection, Tumors, Acute Tubular Necrosis (ATN)
Postrenal AKI:
rare & usually occurs with urinary tract obstruction that effects kidneys bilaterally
Compared with an adult, an infant has a greater content of extracellular fluid, as well as a greater rate of fluid exchange. What effect does this have on the fluid balance of a child compared with that of an adult?
The control of dehydration is more difficult
What initiates inflammation in acute poststreptococcal glomerulonephritis?
Immune complexes
What is the cause of smoky, brown-colored urine resulting from acute poststreptococcal glomerulonephritis? \
Presence of red blood cells
Which cells of the inflammatory process are found in acute poststreptococcal glomerulonephritis? (Select all that apply.4) I
IgG, IgA, Complement C3, Immune complexes
What is the pathophysiologic process responsible for the autoimmune disorder of hemolytic-uremic syndrome (HUS)?
Verotoxin from Escherichia coli is absorbed from the intestines and damages erythrocytes and endothelial cells.
Which statements are true regarding hemolytic uremic syndrome (HUS)? (Select all that apply.)
- Microangiopathic hemolytic anemia characterizes HUS.
- Thrombocytopenia is a comorbid condition.
- HUS is chronic in nature.
What is the first indication of nephrotic syndrome in children?
Periorbital edema
Which symptoms are considered part of the nephrotic syndrome in children? (Select all that apply.4)
Proteinuria, Hyperlipidemia, Edema, and Hypoalbuminemia
Which statement is false about the causes of enuresis?
Excessive nocturnal levels of vasopressin may cause enuresis.
(True: Children who do not have the normal nocturnal elevation of vasopressin produce a higher volume of urine with a lower osmolality. A maturational lag may cause enuresis, it may be related to increased light sleep, and OSA may be a symptom of enuresis. )
Which statement is false about the causes of enuresis?
Excessive nocturnal levels of vasopressin may cause enuresis.
(True: Children who do not have the normal nocturnal elevation of vasopressin produce a higher volume of urine with a lower osmolality. A maturational lag may cause enuresis, it may be related to increased light sleep, and OSA may be a symptom of enuresis.)
Which blood cells are the chief phagocytes involved in the early inflammation process?
Neutrophils
Granulocytes that contain granules of vasoactive amines, such as histamine, are called:
Basophils
Blood cells that differentiate into macrophages are known as:
Monocytes
Active phagocytes that participate in the immune and inflammatory responses. They also ingest dead or defective host cells, particularly blood cells.
Monocytes and macrophages are
Without prior exposure to an antigen, which cells are able to destroy some types of tumor cells and some virus-infected cells?
Natural killer (NK) cells
What is the consequence of a splenectomy?
The number of defective cells in circulation increases.
By which structure are mature erythrocytes removed from the bloodstream?
Spleen
Site of fetal hematopoiesis
Spleen
What is plasmin’s role in the clotting process?
Degrades the fibrin within blood clots.
clot retraction, clot dissolution, limits size of clot and removes clot after bleeding has ceased and repair has begun.
Fibrinolytic system/Fibrinolysis:
What changes to the hematologic system is related to age?
Lymphocyte function decreases.
Which nutrients are necessary for the synthesis of DNA and the maturation of erythrocytes?
Cobalamin (vitamin B12) and folate
Deficiencies in folate and vitamin B12 alter the synthesis of which of the following?
DNA
Which nutrients are necessary for hemoglobin synthesis?
Iron and vitamin B6 (pyridoxine)
Poikilocytosis:
assuming various shapes
Anisocytosis:
assuming various sizes
What term is used to describe the capacity of some erythrocytes to vary in size, especially in relationship to some anemias?
Anisocytosis
Which of the following is classified as a megaloblastic anemia?
Pernicious
A form of macrocytic-normochromic anemia, is caused by vitamin B12 deficiency.
Pernicious anemia,
The absence of parietal cells would prevent the absorption of an essential nutrient necessary to prevent which type of anemia?
Pernicious anemia
The underlying disorder of which anemia is a result of the defective secretion of the intrinsic factor, which is essential for the absorption of vitamin B12?
Pernicious
After a person has a subtotal gastrectomy for chronic gastritis, which type of anemia will result?
Pernicious
What causes the atrophy of gastric mucosal cells that result in pernicious anemia?
Vitamin B12 malabsorption
Which conditions are generally included in the symptoms of pernicious anemia (PA)? (Select all that apply.4)
Weakness, Low hemoglobin, Paresthesia, Low hematocrit
Which condition resulting from untreated pernicious anemia (PA) is fatal?
Heart failure
What is the treatment of choice for pernicious anemia (PA)?
Vitamin B12 injection
Continued therapy of pernicious anemia (PA) generally lasts how long?
The rest of one’s life
Which anemia produces small, pale erythrocytes?
Iron deficiency
What is the most common cause of iron deficiency anemia (IDA)?
Chronic blood loss
Which type of anemia is characterized by fatigue, weakness, and dyspnea, as well as conjunctiva of the eyes and brittle, concave nails?
Iron deficiency
Considering iron replacement therapy prescribed for iron deficiency anemia, who is likely to require long-term daily maintenance dosage?
A woman who has not yet experienced menopause
Normocytic-normochromic anemias, including aplastic anemia, are characterized by erythrocytes that are relatively normal in size but with hemoglobin content that is insufficient in number.
Aplastic Anemia
In aplastic anemia (AA), pancytopenia develops as a result of which of the following?
Suppression of the bone marrow to produce adequate amounts of erythrocytes, leukocytes, and thrombocytes
What is the most common pathophysiologic process that triggers aplastic anemia (AA)?
Autoimmune disease against hematopoiesis by activated cytotoxic T (Tc) cells
An allogenic bone marrow transplantation remains the preferred method for treating which anemia?
Aplastic
Which medications are associated with an intermediate increase in a person’s risk for developing aplastic anemia? (Select all that apply.3)
Chloramphenicol (Chloromycetin), Phenytoin (Dilantin), and Trimethoprim-sulfamethoxazole (Bactrim)
When considering hemolytic anemia, which statement is true regarding the occurrence of jaundice?
Heme destruction exceeds the liver’s ability to conjugate and excrete bilirubin.
Which statement is true regarding warm autoimmune hemolytic anemia?
Erythrocytes are bound to macrophages and sequestered in the spleen.
Erythrocyte life span of less than 120 days, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?
Anemia of chronic disease
Which diseases are commonly associated with anemia of chronic disease? (Select all that apply.4)
Rheumatoid arthritis, AIDS, SLE, and Chronic hepatitis
What is the primary cause of the symptoms of polycythemia vera?
Increased blood viscosity
Which statement best describes heparin-induced thrombocytopenia (HIT)?
Immunoglobulin G immune–mediated adverse drug reaction that reduces circulating platelets
Immune thrombocytopenia (ITP) is a(n) _____ condition in adults and a(n) _____ condition in children.
Chronic; acute
Which statement relates to immune thrombocytopenic purpura (ITP)?
Mononuclear phagocytes in the spleen remove antibody-coated platelets from circulation
What term is used to identify thrombi that occlude arterioles and capillaries and are made up of platelets with minimal fibrin and erythrocytes?
Thrombotic thrombocytopenic purpura (TTP)
Which of the following is characterized by what is referred to as pathognomonic pentad of symptoms?
Acute idiopathic thrombotic thrombocytopenic purpura
Inherited conditions that increase risk for thrombosis
Hereditary Thrombophilia:
Hereditary Thrombophilia:
- most are autosomal dominant; individuals who are homozygous for the mutation are at greatest risk for thrombosis.
Which description is consistent with chronic myelogenous leukemia (CML)?
The translocation of genetic material from genes 9 and 22 creates an abnormal, fused protein identified as BCR-ABL1.
Which electrolyte imbalance accompanies multiple myeloma (MM)?
Hypercalcemia
Hodgkin disease is characterized by the presence of which of the following?
Reed-Sternberg (RS) cells.
Local signs and symptoms of Hodgkin disease–related lymphadenopathy are a result of which of the following?
Pressure and obstruction
The most common etiologic agent in infectious mononucleosis is
Epstein-Barr virus
In infectious mononucleosis (IM), what does the Monospot test detect?
Immunoglobulin M (IgM)
What is the name of the disorder in which levels of bilirubin remain excessively high in the newborn and are deposited in the brain?
Kernicterus
Which disorder results in decreased erythrocytes and platelets with changes in leukocytes and has clinical manifestations of pallor, fatigue, petechiae, purpura, bleeding, and fever?
Acute lymphocytic leukemia (ALL)
When does fetal erythrocyte production shift from the liver to the bone marrow?
Fifth month of gestation
A transient cessation in red blood cell production that results in acute anemia, occurs as a result of a viral infection. The virus causes a temporary shutdown of red blood cell production in the bone marrow, or reticulocytosis
Aplastic crisis
In a full-term infant, the normal erythrocyte life span is _____ days, whereas the adult erythrocyte life span is _____ days.
60 to 80; 120
What is the most common cause of insufficient erythropoiesis in children?
Iron deficiency
During childhood, when is dietary iron deficiency commonly diagnosed?
Between 6 months and 2 years
Which vitamin improves the absorption of oral iron taken to treat iron deficiency anemia in children?
C
Hemolytic disease of the newborn (HDN) can occur if the mother:
Is Rh-negative and the fetus is Rh-positive
What treatment prevents the development of kernicterus in an infant born with hemolytic disease of the newborn (HDN)?
Replacement transfusion of new Rh-positive blood that is not contaminated with anti-Rh antibodies
When diagnosed with hemolytic disease of the newborn (HDN), why does the newborn develop hyperbilirubinemia after birth but not in utero?
Excretion of unconjugated bilirubin through the placenta into the mother’s circulation is no longer possible.
How does hemolytic disease of the newborn (HDN) cause acquired congenital hemolytic anemia?
HDN is an alloimmune disease in which the mother’s immune system produces antibodies against fetal erythrocytes, which are recognized as foreign and removed from circulation.
Erythroblastosis fetalis is defined as an:
Alloimmune disease in which maternal blood and fetal blood are antigenically incompatible
Sickle cell disease is classified as a(an):
Disorder initiated by hypoxemia and acidosis
Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process?
Genetic mutation in which one amino acid (valine) is replaced by another (glutamic acid).
Sickle cell disease (SCD) is what type of inherited disorder?
Autosomal recessive
Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in infants?
Edema of the hands and feet
What is the chance with each pregnancy that a child born to two parents with the sickle trait will have sickle cell disease (SCD)?
25%
Serious bleeding disorders
Hemophilia
Hemophilia A is considered to be what type of inherited disorder?
X-linked recessive
Which type of hemophilia affects only men?
Hemophilia A
Hemophilia B is caused by a deficiency of which clotting factor?
IX
Which type of anemia occurs as a result of thalassemia?
Microcytic; hypochromic
What is the fundamental defect that results in beta-thalassemia major?
A severe uncoupling of A- and B-chain synthesis occurs.
The alpha- and beta-thalassemias are considered what types of inherited disorder?
Autosomal recessive
Thalassemia Treatment:
- genetic counseling, blood transfusion, iron chelation therapy, splenectomy.
- bone marrow, cord blood, and stem cell transplantation is currently the only cure
