Pathology

Question 1

Aneurysm

Answer 1

• abnormal balloon- like bulge in the wall of a blood vessel (most often the aorta) that occurs when the blood vessel becomes weakened and can no longer handle the pressure of the blood
• symptoms will differ based on the site of the aneurysm (thoracic versus abdominal aorta) and whether the aneurysm has ruptured or not
• symptoms include:
  low back, abdominal or groin pain
  nausea and vomiting
  Lightheadedness and a rapid heart rate
• Symptoms of a thoracic aortic aneurysm:
  jaw, neck, back or chest pain
  Coughing or hoarseness
  Shortness of breath

Question 2

Angina Pectoris

Answer 2

• results from diminished myocardial perfusion, most commonly caused by narrowing of one or more of the coronary arteries (e.g., due to embolism, atherosclerosis, inflammation)
• described as an uncomfortable or painful feeling of tightness, pressure, fullness or squeezing in the center of the chest
• medical management varies greatly with symptom severity and type (i.e., stable vs unstable) focusing primarily on the underlying pathology

Question 3

Atherosclerosis

Answer 3

A slow progressive accumulation of fatty plaques on the inner walls of arteries

• over time the plaque can restrict blood flow, causing a blood clot
• lifestyle changes, medications, and surgery may be recommended

Question 4

Chronic Venous Insufficiency

Answer 4

• typically affects the distal lower extremities and is characterized by venous incompetence and resultant venous hypertension
• symptoms: edema, feelings of heaviness, tingling sensations, and dull, aching pain in the distal lower extremities.
• symptoms generally improve and may resolve fully with elevation, however, reappear once dependent positioning is resumed.

Question 5

Cor Pulmonale

Answer 5

• occurs when the right ventricle is unable to effectively pump blood due to the prolonged presence of pulmonary hypertension and increased right ventricular afterload.
• initially, symptoms are primarily associated with the underlying pulmonary pathology; as the condition advances, symptoms may include peripheral pitting edema and jugular vein distention.
• most commonly diagnose by means of clinical findings, medical history, echocardiogram, laboratory tests, chest x- ray and electrocardiography.

Question 6

Coronary Artery Disease.

Answer 6

• occurs as a result of atherosclerotic plaque buildup within the coronary arteries; develops slowly, often going unnoticed for years before producing symptoms
• risk factors: hypertension, diabetes, obesity, chronic kidney disease, elevated cholesterol and triglyceride levels, and a family history of the condition.
• cardiac rehabilitation is recommended and upon completion, the patient should posses self- management skills associated with symptom recognition and reduction of risk factors

Question 7

Deep Vein Thrombosis.

Answer 7

• condition in which a blood clot forms in one or more of the deep veins, usually in the lower extremities
• considered an emergent condition as the clot can break loose and travel to the lungs, resulting in a pulmonary embolism
• signs and symptoms can include swelling, pain, redness, and warmth in the affected leg.

Question 8

Congestive Heart Failure

Answer 8

• common etiologies: arrhythmia, pulmonary embolism, hypertension, valvular heart disease, myocarditis, unstable angina, renal failure, and severe anemia
• left sided heart failure is generally associated with signs of pulmonary venous congestion
• right sided heart failure is associated with signs of systemic venous congestion
• diminished cardiac output causes compensatory changes including an increase in blood volume, cardiac filling pressure, heart rate, and cardiac muscle mass

Question 9

Hypertension

Answer 9

• a condition in which blood pressure is persistently elevated:
  Stage 1: 130-139/ 80-89 (or)
  Stage 2: at least 140/ 90 (or)
• symptoms may not be recognized until blood pressure becomes dangerously high producing a:
  Headache
  Confusion
  Visual changes
  Fatigue
  Arrhythmia
  Tinnitus
• medical management is largely focused on risk reduction through modifiable risk factors and pharmacological intervention

Question 10

Lymphedema Post- Mastectomy

Answer 10

• caused by an excess load of lymph fluid or inadequate transport capacity within the lymphatic system secondary to the loss of homeostasis
• primary contributing factor in the development of lymphedema following a mastectomy is the damage and/ or removal of the axillary lymph nodes and vessels
• intervention should focus on manual lymph drainage, short stretch compression bandages, retrograde massage, exercise, compression therapy, and use of a mechanical pump

Question 11

Myocardial Infarction

Answer 11

• occurs when there is poor coronary artery perfusion, ischemia, and subsequent necrosis of the cardiac tissue usually due to thrombus, arterial blockage or atherosclerosis
• risk factor: patient or family history of heart disease, smoking, physical inactivity, stress, hypertension, elevated cholesterol, diabetes mellitus, and obesity
• clinical presentation may include deep pain or pressure in the substernal area with or without pain radiating to the jaw or into the left arm or the back

Question 12

Peripheral Arterial Disease

Answer 12

• stenotic, occlusive, and aneurysmal diseases of the aorta and peripheral arteries
• caused primarily by atherosclerosis and thromboembolic processes that alter the structure and function of the aorta and its branches.
• supervised exercise training should be performed for a minimum of 30 to 45 minutes at least 3 times per week, for a minimum of 12 weeks.

Question 13

Peripheral Vascular Disease

Answer 13

• characterized by narrowing of the lumen of blood vessels causing a reduction in circulation usually secondary to atherosclerosis
• risk factors: phlebitis, injury or surgery, autoimmune disease, DM, smoking, hyperlipidemia, inactivity, hypertension, positive family history, increased age, and obesity
• patient education is paramount regarding the disease process, limb protection, foot and skin care, and risk factor reduction (smoking cessation, avoid cold exposure)

Question 14

Valvular Heart Disease

Answer 14

• damage to one or more of the heart’s valves resulting in regurgitation or stenosis of blood flow
• may be caused by congenital defects, calcification degeneration, infective endocarditis, coronary artery disease, myocardial infarction, and rheumatic fever.
• clinical signs: heart palpitations, shortness of breath, chest pain, coughing, ankle swelling and fatigue.

Question 15

Asthma

Answer 15

• chronic inflammation of the airways caused by an increased airway hypersensitivity to various stimuli
• a mild attack presents with wheezing, chest tightness, and slight shortness of breath
• reducing exposure to known triggers is a critical step toward controlling the condition

Question 16

Bronchitis

Answer 16

• characterized by hypertrophy of the mucus secreting glands, increased mucus secretions, and insufficient oxygenation due to mucus blockage.
• acute bronchitis may be caused by cold viruses and exposure to smoke and other air pollutants; chronic bronchitis is most often associated with cigarette smoking
• signs and symptoms include:
  Persistent cough with production of thick sputum
  Increased use of accessory muscles of breathing
  Wheezing
  Dyspnea
  Cyanosis
  Increased pulmonary artery pressure

Question 17

Chronic Obstructive Pulmonary Disease

Answer 17

• group of lung diseases that block air flow due to narrowing of the bronchial tree
• progression of the disease includes alveolar destruction and subsequent air trapping
• patients with chronic obstructive pulmonary disease have an increased total lung capacity with a significant increase in residual volume

Question 18

Cystic Fibrosis

Answer 18

• causes the exocrine glands to overproduce thick mucus which causes subsequent obstruction
• autosomal recessive genetic disorder (both parents are carriers of the defective gene) located on the long arm of chromosome 7
• the most common cause of death is respiratory failure.

Question 19

Emphysema

Answer 19

• results from a long history of chronic bronchitis, recurrent alveolar inflammation or from genetic predisposition of a congenital alpha- 1 antitrypsin deficiency
• clinical presentation: barrel chest appearance, increased subcostal angle, rounded shoulders secondary to tight pectorals, and rosy skin coloring.
• symptoms of emphysema worsen with the progression of the disease and include a persisted cough, wheezing, difficulty breathing especially with expiration, and an increased respiration rate

Question 20

Pneumonia

Answer 20

• inflammation of the lungs
• usually caused by bacterial, viral, fungal or parasitic infection
• common signs and symptoms:
  Fever
  Cough
  SOB
  Sweating
  Shaking chills
  Chest pain that fluctuates with breathing
  Headache
  Muscle pain
  Fatigue

Question 21

Pneumothorax

Answer 21

• occurs when air accumulates in the pleural cavity and causes a collapsed lung
• symptoms vary widely depending on the type and size of the pneumothorax, but may include chest pain, shortness of breath, hypoxemia, cyanosis, hypotension
• tension pneumothorax is a specific type of pneumothorax that results in large increases in pressure in the pleasurable cavity and is considered a medical emergency.

Question 22

Pulmonary Edema

Answer 22

• characterized by excess fluid in the lungs that often occurs when the left ventricle is unable to adequately pump blood to the systemic circulation.
• acute pulmonary edema is considered a medical emergency and is characterized by extreme shortness of breath, wheezing or gasping, anxiety, a cough that produces frothy sputum, chest pain, and palpitations.
• a chest x- ray is the primary imaging study to confirm the presence of fluid in the lungs.

Question 23

Pulmonary Embolism

Answer 23

• occurs most commonly as a result of venous thrombi that have detached and traveled from elsewhere in the body before lodging in a pulmonary artery.
• symptoms: sudden onset of dyspnea, coughing, hypoxia, and chest pain which may mimic MI
• pulmonary angiogram is the most conclusive means of identifying a pulmonary embolism, however, complication risks are high and so it is used only when other diagnostic methods are inconclusive.

Question 24

Respiratory Acidosis

Answer 24

• refers to a state in which the pH of body fluids is abnormally low indicating acidemia.
• hypoventilation prevents adequate removal of CO2 from the body causing Hypercapnea and as a result, bicarbonate levels decrease altering the body’s acid- base balance.
• initial symptoms are often vague and more closely related to the underlying pathology; as the condition worsens, symptoms include:
  Lethargy
  Confusion
  Altered mental status
  Cyanosis

Question 25

Respiratory Alkalosis

Answer 25

• refers to a state in which the pH of body fluids is abnormally high indication alkalemia
• hyperventilation removes more CO2 from the body than can be produced causing hypocapnia and as a result, hydrogen levels decrease altering the body;s acid- base balance
• initial symptoms are often vague and more closely related to the underlying pathology, however, tachypnea, tachycardia, hyperventilation, and dizziness are commonly observed.

Question 26

Restrictive Lung Disease

Answer 26

• classification of disorders caused by a pulmonary or extra pulmonary restriction that produces impairment in lung expansion and an abnormal reduction in pulmonary ventilation.
• pulmonary restriction of the lungs can be caused by tumor, interstitial pulmonary fibrosis, scarring within the lungs, pleural effusion, chest wall stiffness, structural abnormality, and respiratory muscle weakness.
• pathogens is includes a decrease in lung and chest wall compliance, decrease in lung volumes and an increase in the work of breathing.

Question 27

Tuberculosis

Answer 27

• highly contagious infectious disease spread via airborne transmission primarily caused by the Mycobacterium tuberculosis bacteria
• active TB typically presents with generalized symptoms of infection including fever, chills, fatigue, weight loss, decreased appetite, and night sweats; left untreated can be fatal
• diagnosed based on a skin test where a small amount of substance tuberculin is injected at a forearm site with the skin’s reaction then assesses 48 to 72 hours later

Question 28

Venous Thrombosis

Answer 28

• the formation of a blood clot within a vein, most commonly occurring in the deep veins of the lower extremities
• signs and symptoms include swelling, redness, warmth and pain in the affected leg, though it can occur without any noticeable symptoms
• ultrasound imaging is most commonly used to identify the presence of a venous thrombus