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Chelsea's Advan Patho & Pharm 2018 > patho test 4 - GI, pulmonary, renal > Flashcards

patho test 4 - GI, pulmonary, renal Flashcards

1
Q

pulmonry function test used for diagnosis of restrictive disease

A

Forced expiratory volume (FEV)

shows obstruction -> asthma or COPD

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2
Q

if FEV improves with bronchodilator

A

asthma

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3
Q

chronic night time cough may be ____

A

asthma

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4
Q

symptoms of asthma

A

Recurrent and intermittent*

tachycardia
chest tightness
SOB at night and w/ exercise

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5
Q

asthma diagnostic tests

A

Peak Expiratory Function

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6
Q

what drugs may exacerbate asthma attacks?

A

beta blockers

cholinergics

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7
Q

why is early dx of asthma important?

A

inflammatory disease - leukotrienes cause bronchoconstriction and histamine causes mucus production
cell irritation ->changes and adaption leads to bronchial remodeling - which is irreversible

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8
Q

how often should a patient with asthma use their albuterol inhaler?

A

2x week or less

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9
Q

assessment of asthma patient

A

“How often do you use your rescue inhaler?”

percuss - less resonance = less air

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10
Q

Sputum, spasm, and swelling = ____

A

Chronic Bronchitis

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11
Q

Chronic Bronchitis physical exam may look similar to ___

A

CHF*

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12
Q

likely organism indicated in PNA in a smoker?

A

H flu

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13
Q

Chronic Bronchitis hallmark feature

A

Chronic excessive mucus secretion

easily colonized by microorganisms

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14
Q

elastace is responsible for _____

A

Emphysema

inflammation - macrophages release elastatase
breaks down alveoli’s elastic lamina

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15
Q

S3 – heart sound of _____

A

pulmonary edema

- chronic broch, chf

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16
Q

tactile fremitus will be _____ in chronic bronchitis

A

decreased

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17
Q

percussion of thorax results in hyperresonance

A

Emphysema

over inflated lungs

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18
Q

Emphysema signs and diagnostics

A

Prolonged expiration

X Ray shows hyperinflation of lungs

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19
Q

common first signs of respiratory disease

A

CNS symptoms
agitation
anxiety
restlessness

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20
Q

main problem with pulmonary edema arises due to ____

A

increased pressure within the lungs changes CO2 and O2 exchange

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21
Q

pulmonary HTN in COPD patho

A

chronic hypoxia leads to
vasoconstriction increases pressure in the lungs
fluid shift d/t pressure shift - crackles
back up of blood to the lungs in the R side of the heart

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22
Q

pulmonary edema sx

A 
sudden SOB
Orthopnea
paroxysmal nocturnal dyspnea
Cough
Fine crackles at bases, 
CHF/intravascular volume overload
JVD (very late sign)
Cardiac murmurs and gallops (S3) – fluid murmur
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23
Q

causes of pulmonary edema

A

hypoalbumemia

increased permeability d/t inflammation

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24
Q

green sputum in bronchitis means ____

A

nothing!

likely viral no ABX

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25
Q

Cholecystitis

risk factors

A

fat
fertile
forty
female

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26
Q

Most gallstones are formed from ______. Created in the liver and stored in the gallbladder

A

cholesterol

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27
Q

_____ is specific for liver injury

A

ALT

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28
Q

mechanism of action in Lactose Intolerance

A

Diarrhea occurs because nondigested lactose is not absorbed and retains water
which raises volume and also provides a medium for bacterial fermentation

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29
Q

Would you give opiates for diverticulitis pain?

A

no!

Opioids and NSAIDS raise the intraluminal pressure and raise the risk of perforation

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30
Q

what should be given for diverticulitis pain?

A

tylenol

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31
Q

dysfunctional GI motility =

A

Gastroparesis

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32
Q

Crohn’s effects what parts of GI tract?

A

GI tract from mouth to anus, typically in patches

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33
Q

signs of Ulcerative colitis

A 
blood in stool
rarely other GI symptoms
involves colon
almost always involves the rectum
involves whole area vs spots like Crohn's
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34
Q

NSAIDs role in peptic ulcers

A

loss of GI protective prosteglandins

and increase in plt aggregation

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35
Q

peptic ulcers are caused by _____

A

H pylori

excessive acid and ETOH

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36
Q

patient presents with pain after eating and substernal pain what should you suspect?
what should you do first?

A

suspect GERD

but get EKG and always assess cardiac first!

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37
Q

why do we treat GERD?

A

to prevent complications

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38
Q

definitive diagnostic test for celiac

A

Biopsy

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39
Q

initial test for celiac disease

A

Tissue transglutaminase antibody (tTG IgA) and total IgA

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40
Q

why may a patient with celiac test negative on work up?

A

tTG may be negative d/t adhering to a gluten free diet

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41
Q

patho of celiacs

A

Gliadin is produced by acid or enzymatic treatment of gluten. The enzymetissue transglutaminase (tTG)converts some of the glutaminestoglutamic acid.

body produces antibodies against tTG

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42
Q

Tests for hepatocellular damage

A

AST, ALT

Transaminases = Enzymes found in Hepatocytes and released when liver cells damaged (ALT specific)

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43
Q

sx of celiac

A 
Oral ulcers
Anemia
elevated liver enzymes
Osteopenia/Osteoporosis
Fatigue
Neuropathy
Arthralgias
Dermatoses
Malnutrition
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44
Q

Alkaline Phosphatase is high in ______

A

measure of cholestasis
(stretching the biliary canaliculi)
seen in…
Obstruction (stones, neoplasm, biliary cirrhosis)
Hepatitis
Heavy ETOH use
Fatty liver
mono
generally considered clinical significant until 3x normal

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45
Q

An increase in ____ bilirubin indicates a prehepatic cause

A

indirect
prehepatic = newborns lots of RBC lysis
Unconjugated = indirect

46
Q

leukoesterase in urine means..?

A

enzyme produced by leukocytes (white blood cells).

a urine test for the presence of white blood cells and other abnormalities associated with infection.

47
Q

ALT elevated 5x or more may be which diseases?

A 
Chronic Hep B / C
Acute Hep A-E
EBV
Medications / Toxins
Celiac Disease
48
Q

AST >5x elevated could be what diseases?

A

Alcohol-related liver dz

Cirrhosis

49
Q

Severe AST & ALT elevation is …

A

> 15x normal

50
Q

An increased ____ bili indicates _____ cause.

A

direct (conjugated)

hepatic cause.

51
Q

Tests for Liver synthetic Function

A

Albumin

PT/INR

52
Q

Tests for hepatocellular Function

A

ALT and AST

53
Q

Conjugated bili =

A

direct

54
Q

when deciding that elevated INR is r/t liver disease what can you do to check?

A

Before you believe that prolonged INR is due to liver disease just
make sure the patient has adequate Vitamin K by giving 10mg sc

Giving Vitamin K has no effect on INR if patient has impaired synthetic function

55
Q

low albumin also occurs in _____

A

hepatic dysfunction
and
NEPHROTIC syndrome, so always check the urine for protein

56
Q

low albumin think ___ & ____

A

liver and kidney

57
Q

EBV, CMV, Herpes viruses can all cause ____

A

acute hepatitis

58
Q

Hep E dangerous in ____

A

pregnancy

59
Q

pt with autoimmune disease present with lethargy, itching and increased ALP, may have hyperlipidemia

A

Primary Biliary Cirrhosis
- chronic inflammation of bile ducts
unable to excrete bile

60
Q

pt presents with constipation what might we want o rule out?

A 
diabetes
 hyperparathyroidism
hypokalemia
hypothyroidism
pregnancy

calcium channel blockers

61
Q

diarrhea without blood or mucus
Without urgency
Less frequent and larger amount
comes from ____

A

small intestine

62
Q

A touch of blood or mucus
urgency
Stool is frequent with small portions
is caused by _____

A

large intestine

63
Q

Steatorrhea

A

fatty stools, foul smelling, pale, float, hard to flush

d/t fat malabsorption - pancreas, sm bowel disease (celiac, Crohn’s) Cholestatic liver disease, Post gastrectomy

64
Q

The anemia of Chronic Renal Failure is primarily caused by _____

A

impaired erythropoietin production

65
Q

If the BP rises, the afferent arteriole _____

A

constricts

66
Q

If BP drops, afferent arteriole _____

A

dilates

67
Q

Glomerulonephritis causes

A

follows a beta-streptococcal infection
autoimmmune disease
(when immune complexes trapped in glomeruli)

68
Q 
sx = increased BP
       fatigue
       oliguria
       proteinureia
      dysuria 
      lethergy
      low grade temp
     periorbital edema
     HA
A

Glomerulonephritis

69
Q

Arteriolar Nephrosclerosis caused by _____

A

severe HTN

arterioles undergo thickening from carrying blood at a much higher pressure than normal
Glomeruli and tubules undergo secondary degenerative changes causing narrowing of lumen and reduction in blood flow

70
Q

Diabetic Nephropathy

A

d/t poorly managed diabetes

Thickening of glomerular basement membranes (glomerulosclerosis)

Progressive impairment of renal function
Protein loss may lead to nephrotic syndrome
No specific treatment can arrest progression of disease

71
Q

Childhood polycystic kidney disease, ______ form has poorer prognosis

A

Recessive

72
Q

sx of pyelonephritis

A 
WBC and bacteria in urine
malaise
frequency and urgency and dysuria
flank pain* (CVA tenderness)
high fever*
73
Q

cystitis sx

A 
urgency
frequency
dysuria
pain in pubic region
WBC and bacteria in urine
74
Q

Vesicoureteral Reflux predisposes pt to ___ & ____

A

uti
and
pyelonephritis

75
Q

Chronic UTI’s may make you suspicious for _____

A

Obstruction and hydronephrosis

76
Q

Major clinical feature of kidney stones

A

colicky pain

77
Q

UTI’s and obstruction can predispose pt to ___

A

kidney stones

78
Q

Nephrotic Syndrome manifestations

A

edema
Proteinuria and therefore hypoalbuminemia

Causes edema due to low plasma osmotic pressure

79
Q

Renal Cysts are worrisome when they occur ____ rather than _____

A

in multiples

solitarily

80
Q

when is hematuria a red flag finding?

A

painless

- think bladder or kidney cancer

81
Q

Oliguria

A

daily urine output < 400 mL

82
Q

Treat scleroderma renal crisis with _______

A

ACE inhibitor

83
Q

CKD common causes

A

DM
HTN
less frequently - Glomerular diseases

84
Q

CKD manifestations

A

systemic
Weakness, loss of appetite, nausea, vomiting
Anemia
Toxic manifestations from retained waste products
Edema: retention of salt and water
Hypertension ** (causes the problem and then is sx of the problem)

85
Q

CKD stage 1

A

GFR >90

86
Q

CKD stage 5 =

A

Kidney Failure

GFR < 15

87
Q

CKD complications

A 
hyperlipidemia 
HTN
anemia
electrolyte imbalance
acid base imbalance
osteoporosis
cardiac abnormalities 
raises to insulin resistance
88
Q

CKD management

A

renal dosing - d/t decreased filtration
protein restriction
Treatment of Hypertension and Hyperlipidemia
Erythropoietin replacement
Treatment of electrolyte imbalances (Phosphorus and Calcium, K+)

89
Q

brown urine

A 
bili
myoglobin (muscle breakdown)
levodopa
90
Q

green or blue urine

A

pseudoonal UTI

amitriptyline

91
Q

red urine

A

hematuria, hemoglobinuria

beets

92
Q

orange urine

A

bili

dehydration

93
Q

increased specific gravity usually means ____

A

dehydration

94
Q

decreased specific gravity

A

lots of hydration

poorer kidney function

95
Q

increased specific gravity may be due to ____

A

contrast dye
proteins
glucose

96
Q

UTI and alkaline urine may mean

A

gram negative bacteria

97
Q

Hematuria, proteinuria, RBC casts, dysmorphic RBCs will be cause by ____

A

Glomerular dysfunction

98
Q

Hematuria in children usually means ____

A

UTI

99
Q

proteinuria and hematuria likely points to ____ cause

A

renal

100
Q

Positive protein in the urine associated with _____

A

glomerular damage

101
Q

when you have a patient with DM or HTN may want to order a ____

A

micro UA - which will detect smaller amounts of protein

102
Q

what other test may be good to order for pt’s with DM or HTN to check kidney/glomerular function

A

urine microalbumin creatinine ratio

103
Q

trace - +2 Proteinuria what should you do?

A

retest

104
Q

3+ to 4+ Proteinuria follow-up

A 
you have to do something right away
serum testing
creatinine
24 hr urine
Protein electrophoresis
105
Q

glucose in the urine means ____

A

glucose > 160

106
Q

Ketones in urine =

A

Diabetes, starvation, anorexia, prolonged N&V, low carb diets

107
Q

+ Nitrites in urine =

A

Produced by Gram neg bacteria

108
Q

Leukocyte esterase in urine =

A

WBCs have been there

or contaminated with vaginal cells

109
Q

Epithelial casts in urine =

A

inflammatory processes

auto-immune or infection

110
Q

Granular or Waxy casts =

A

ominous sign - advanced renal disease

111
Q

if you see a lot of WBCs and Epithelial cells in the urine think ____

A

contaminated - get another specimen

112
Q

abnormally shaped RBC in UA indicates ….

A

Glomerular disease (shape comes from squeezing through glomerulus)

Chelsea's Advan Patho & Pharm 2018 (7 decks)

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