Test 2 practice Qs Flashcards
What types of shock are associated w widespread vasodilation?
- Anaphylactic
- Septic
- Neurogenic
Which type of shock might occur after a MI?
Cardiogenic
During which phase of hypovolemic shock would you likely see a rise in vital signs?
Phase II
Which of the following are main treatment methods for anaphylactic shock?
- Antihistamines
- IM adrenaline
Outline the underlying pathophysiology for the following signs/symptoms common to most types of shock:
Hypotension, Change in HR, Oliguria, Change in temp
- Hypotension: drop in CO
- HR: compensatory mechanism, increases as SNS response to fall in CO/BP
- Oliguria: vasocontriction and incr. water retention due to SNS and RAAS.
- Change in temp: vasoconstriction or vasodilation
Which 2 body systems/structures are responsible for regulating acid-base balance?
Renal system (kidneys) and respiratory system(lungs)
T/F?
The lungs can expel both acids and bases?
False
Name the type of pH imbalance for each description:
- Decreased expulsion of CO2
- Too much bicarbonate lost or increased acid production
- Too many acids are lost or incr. bicarb retention
- Increased expulsion of CO2
- Respiratory acidosis
- Metabolic acidosis
- Metabolic alkalosis
- Respiratory alkalosis
Identify which pH imbalances are compensated for by the following mechanisms:
- Renal compensation occurs via changes to acid/base secretion
- Respiratory compensation occurs via alterations to ventilation
- Metabolic acidosis and alkalosis
2. Respiratory acidosis and alkalosis
Identify the causes of the following sodium imbalances:
- Hypernatremia
- Hyponatremia
- Sodium gain, water loss
2. Sodium loss, water gain
T/F:
- Water follows sodium
- Potassium moves in opposite direction to sodium
- Chloride follows sodium
All are true!
Outline why changes in K+ concentration can result in alterations to cardiac function
The movement of K+ across cardiac cell membranes has a role in AP signalling. Changes in conc. affects transmission of electrical signals and subsequently the contraction of the myocardium.
What is another name for kidney stones?
Calculi
Briefly explain the patho of a urinary tract obstruction
An obstruction of the UT that causes the accumulation of urine proximal to the obstruction, resulting in dilation. This affects the nephrons (decr. GFR, reabsorption, secretion, urine conc.) and incr. UTI risk. Can ultimately lead to AKI or CRD
4 Typical signs of cystitis?
- Incr. urinary freq.
- Dysuria (pain w urination)
- Incr. urgency to urinate
- Lower abdominal pain/discomfort
T/F?
Ischemia and toxins are the 2 major causes of acute tubular necrosis
True
In which renal condition associated with bacterial infection do antigen-antibody complexes become trapped within the glomeruli?
Acute glomerulonephritis
Determine whether the following causes of acute kidney injury belong to: prerenal cause, intrinsic cause, or postrenal cause.
- Hypotension
- Glomerulonephritis
- Septic shock
- Polycystic kidney disease
- Kidney stones
- Acute tubular necrosis
- Neurogenic bladder
- Cardiac failure
Prerenal:
Hypotension
Septic shock
Cardiac failure
Instrinsic:
Glomerulonephritis
Polycystic kidney disease
Acute tubular necrosis
Postrenal:
Neurogenic bladder
Kidney stones
Describe chronic kidney disease and its pathophysiology
Progressive loss of renal function.
- Progressive loss of functioning nephron mass, causing surviving nephrons to compensate, maintaining a constant rate of excretion w/in an overall declining GFR
- The hyperfiltration of the functioning nephrons results in further nephron injury leading to end-stage kidney disease
- Process:
1. Glomerular hypertension, hyperfiltration, and hypertrophy
2. Glomerulosclerosis (scarring)
3. Tubulointerstitial inflammation and fibrosis
Describe uremia
Sydrome of chronic kidney disease characterised by azotemia (abnormally high levels of nitrogen-containing compounds, e.g. urea and creatinine) and the accompanying systemic symptoms
Identify some common signs/symptoms of anemia
Fatigue, jaundice, pallor, dizziness, SOB, GI symptoms, feeling cool/cold peripheries, neurological symptoms (numbness, weakness, etc.)
Which 2 types of anaemia does macrocytic anaemia include?
- Vitamin B12 deficiency anaemia
- Folate deficiency anaemia
Why does a lack of intrinsic factor lead to vitamin B12 deficiency?
Because IFis required for intestinal absorption of vitamin B12
Pernicious anemia is related to a decrease in what?
Vitmain B12 absorption
Briefly describe aplastic anaemia
Decreased blood cell production due to bone marrow stem cell destruction
Briefly describe sickle cell anaemia
Abnormal Hb synthesis resulting in sickle shaped RBCs (inherited disorder)
Briefly describe hemolytic anaemia
Accelerated destruction of RBCs
Briefly describe thalassemia
Inherited disorder affecting globin chain synthesis resulting in decreased Hb
What is primary polycythemia?
Excess RBC production caused by a mutation in the bone marrow cells
Which of the following is a risk factor for folate deficiency anaemia?
- Alcoholism
- Neural tube defects
- Chronic atrophic gastritis
- Hemmorhage
Alcoholism
Which type of polycythemia is related to dehydration?
Relative polycythemia
What is leukopenia?
Reduction in WBC numbers
Outline the pathophysiology of leukemia associated w cytopenia and thus anemia, bleeding and infections
Malignancy of un- or partially differentiated cells of hematopoiesis, leading to a build up of malignant cells w/in bone marrow. This crowds out/reduces the number of healthy blood cells produced, therefore reducing numbers of RBCs, WBCs and platelets.
What are some of the “B symptoms” associated w lymphoma?
Unexplained fever
Weight loss
Night sweats
In acute leukemia, genetic abnormalities and malignancy develop within which blood cell stage of development?
Blast cells
Which condition is characterized by the presence of Reed-Sternberg (RS) cells?
Hodgkin lymphoma
Which specific type of cell becomes malignant in myeloma?
Plasma B cells
What are the signs/symptoms used in the diagnosis of myeloma?
Renal failure
Anemia
Hypercalcemia
Osteolytic bone lesions
With lymphoma, where does malignancy of lymphocytes occur?
Within the lymphatic system
Outline the phases of an acute infection
- Incubation period: asymptomatic, pathogen is replicating.
- Prodromal phase: mild/vague symptoms begin to appear, pathogen still replicating
- Illness: period of significant symptoms, specific to infection
- Decline: decline in signs/symptoms as pathogen is eliminated from the body
- Convalescence: signs/symptoms disappear, infection contained/eliminated
Which of the following sexually transmitted infections has a high association with cervical cancer? Gonorrhea HPV Chlamydia HIV
HPV
Which type of infection causes common warts (verrucae)?
HPV
Which infection often presents with productive cough, night sweats and weight loss?
Tuberculosis
Which infections are caused by members of the herpes family of viruses?
- HPV
- Chickenpox
- Viral hepatitis
- Shingles
- Cold sores
- UTIs
- Chickenpox
- Shingles
- Cold sores
What is the defining manifestation of the icertus phase of a viral hepatitis infection?
Jaundice
Identify three (3) common healthcare acquired infections (HAI).
- UTIs
- pneumonia
- Surgical site infections
- Central line acquired blood stream infection
- MRSA infections
- Clostridium difficile infection
Through which of the following body fluids is HIV more readily transmitted?
- Semen
- Sweat
- Breastmilk
- Blood
- Saliva
- Blood
- Semen
- Breastmilk
Which type of influenza most readily mutates, regularly resulting in new strains?
Influenza A
How do penicillins work?
Inhibit the formation of crosslinks in bacterial cell walls which weakens the peptidoglycan structure, causing the bacteria to lyse.
What is the difference between hypovolemia and hypervolemia?
What do you do if someone presents with each of these?
- Hypovolaemia: low ECF vol. Both fluid and sodium are lost together (unlike dehydration which is just water), so implement controlled rehydration using fluid and sodium with isotonic solutions of electrolytes and glucose.
- Hypervolaemia: high ECF vol. (e.g. excess administration of IV saline). Restrict fluid intake to correct the hypervolaemia.
Signs and symptoms of hypernatremia and hyponatremia
- Hypernatraemia: accompanied by hyperchloraemia (bc Cl- follows Na). Causes intracellular dehydration and hypervolaemia. Symptoms incl. thirst, fever, dry mucous membranes and restlessness. Also weight gain, strong pulse and incr. BP.
- Hyponatraemia: accompanied by hypochloraemia. Alters cell’s ability to de- and repolarise normally, hence severe complications for neuronal/muscular APs. Causes lethargy, confusion, apprehension, slow reflexes, seizures and coma. Also muscle twitching and weakness.
Signs and symptoms of hypokalaemia and hyperkalaemia
- Hypokalaemia: mild is usually asymptomatic, severe causes decreased neuron and muscular excitability, causing skeletal muscle weakness, cardiac arrhythmias, glucose intolerance, etc.
- Hyperkalaemia: mild = restlessness, intestinal cramping and diarrhoea. Severe = muscle weakness, loss of muscle tone and parlaysis.
Describe AKI and its pathophysiology
- Sudden decline in kidney function occurring over hours-days.
- Inhibits the ability to regulate fluid, electrolyte and acid-base balance
- associated with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood
Patho:
1. Prerenal AKI - impaired renal blood flow
- GFR decline bc decr. filtration pressure
- poor perfusion
2. acute tubular necrosis
3. postrenal - urinary tract obstruction
- causes incr. intraluminal pressure prior to obstruction w gradual dec. GFR.
Signs/symptoms of anaemia (in general)
Fatigue, feeling cold, and pallor.
However in mild anaemia and where compensation has occurred (e.g. incr. RR/depth, incr. HR, incr. BP) may be asymptomatic.
