Test 3 Cases

Question 1

How is emphysema defined?

Answer 1

loss of lung elasticity, abnormal enlargement of airspaces distal to the terminal bronchioles

Question 2

What are risk factors for pulmonary embolism (6)?

Answer 2

cardiovascular disease, birth control pills, sedentary lifestyle, smoking, alcohol consumption, vascular wall injury

Question 3

What is Virchow’s triad (risk for pulmonary embolism)

Answer 3

Hypercoagulable state
Circulatory stasis
Vascular wall injury

Question 4

What happens in a pneumothorax?

Answer 4

Lung collapses until equilibrium is achieved or the rupture is sealed - makes lung become smaller

Question 5

What is the difference between open vs. closed pneumothorax?

Answer 5

Open: pleural cavity exposed to outside air (through an open wound in the chest wall)
Closed: air enters through a hole in the lung - can occur in primary and secondary spontaneous pneumothorax

Question 6

How do bronchodilators (anticholinergic) help with asthma?

Answer 6

short and long acting
Relaxes airway
Reduces mucus production

Question 7

Where are Beta-1 and Beta-2 receptors located?

Answer 7

Beta-2: bronchioles and arteries of skeletal muscles

Beta-1 receptors: the heart

Question 8

How do corticosteroids help with asthma?

Answer 8

inhibits bronchial inflammation

Question 9

Patho of pulmonary fibrosis

Answer 9

Micro-injuries to alveolar epithelial cells, leads to inflammatory response - leads to thickened scarred tissue

Question 10

Is pulmonary fibrosis restrictive or obstructive?

Answer 10

Restrictive respiratory disorder: affect supporting elastin cells in the airway, lung compliance thus decreased

• Difficulty expanding lungs
• Difficulty inhaling

Question 11

How would pulmonary fibrosis present on PFT?

Answer 11

Total lung capacity decreased

Question 12

Patho of poststreptococcal GN

Answer 12

Body produces antibodies to fight infection - antibodies can settle in the glomeruli and cause inflammation; presents within 7-12 days

Question 13

Nephrotic vs. nephritic syndrome

Answer 13

Nephrotic: excess protein, urinary albumin >3, hypoalbuminemia, edema, hyperlipidemia
Nephritic: excess blood, RBC, oliguria, HTN, proteinuria

Question 14

Common causes of acute tubular necrosis (3)

Answer 14

Ischemia: surgery, severe hypovolemia, sepsis, trauma (crush injuries), burns, blood transfusion reactions

Tubular obstruction

Toxic: antimicrobials, cancer chemotherapeutic agents, radio contrast agents

Question 15

Distinguish between patho of toxic vs. ischemic acute tubular necrosis

Answer 15

Toxic: renal vasoconstriction, direct tubular damage, intratubular obstruction

Ischemic: tubules receive less O2 than required

Question 16

Treatment and prognosis of acute tubular necrosis

Answer 16

Treatment: ID and correct cause of injury, provide supportive care
Prognosis: Typically reversible in healthy patients
Sick patients - prognosis is not as good

Question 17

Risk factors for UTI (9)

Answer 17

Female anatomy: shorter urethra
Sexual activity
Birth control: diaphragms, spermicidal agents
Menopause: decline in circulating estrogen causing changes in urinary tract
Urinary blockages: kidney stones or enlarged prostate
Catheter use: introduces bacteria directly into bladder, increased risk with extended use
Urinary procedures
Suppressed immune system
Urinary tract abnormalities

Question 18

Types of UTI (3)

Answer 18

Cystitis
Pyelonephritis
Urethritis

Question 19

Patho of findings on UA of a UTI (4)

Answer 19

Leukocyte esterase: indicates WBCs in urinary tract
Blood: pathogen causes inflammation and damage to cells in urinary tract, releasing blood into urine
WBC: immune response to pathogen
Bacteria: indicates pathogen is present in the urinary tract

Question 20

Define neurogenic diabetes insipidus, distinguish between congenital/acquired causes

Answer 20

Neurogenic: due to lack of ADH production in the brain (case study patient has this)

Congenital: structural malformation affecting hypothalamus or pituitary

Acquired: primary tumors or metastases, infection, trauma, surgery, idiopathic

Question 21

Patho of acute kidney injury

Answer 21

Basement membrane becomes damaged/injured

Question 22

Patho of findings due to acute kidney injury - edema, increased creatinine, elevated BUN

Answer 22

Edema: due to loss of albumin
Increased creatinine: waste product from muscle metabolism, not reabsorbed, high levels indicate kidneys are not filtering as they should
Elevated BUN: urea is made when protein is broken down, if kidneys not filtering urea, the BUN will rise

Question 23

What are s/s of peripheral vascular disease (7)

Answer 23

1. Pain that resolves with rest
2. Mottled skin
3. Thinning of the skin
4. Reduced size of leg muscles
5. Weak or absent pedal pulses
6. Limb color blanches with elevation, reddens when dependent
7. Achiness/tingling with exercise

Question 24

Define exertional angina

Answer 24

anaerobic metabolism occurs with exertion which leads to production of lactic acid and stimulation of pain nerve endings

Question 25

What is the latent period of rheumatic fever in causing mitral valve stenosis?

Answer 25

20-40 years

Question 26

Define the different types of shock

Answer 26

Hypovolemic shock: circulatory volume depleted from blood or fluid loses
Distributive shock: due to inappropriate vasodilation of the peripheral blood vessels from sepsis, anaphylaxis, drug rxns, endocrine and neurogenic abnormalities
Obstructive: obstructive of the heart or the great vessels
Cardiogenic shock: failure of the pump

Question 27

What agent can be used once hypovolemia is resolved if hypotension persists after shock?

Answer 27

Inotropic agents

Question 28

Causes of the different types of shock

Answer 28

hypovolemic shock: external loss of whole blood, plasma or ECF; internal hemorrhage or third-space losses
Distributive: depends on type
Obstructive: dissecting aortic aneurysm, cardiac tamponade, pneumo, atrial myxoma, evisceration of abdominal contents
Cardiogenic: MI, myocardial contusion, sustained arrhythmias, cardiac surgery