Test 3 Cases Flashcards
How is emphysema defined?
loss of lung elasticity, abnormal enlargement of airspaces distal to the terminal bronchioles
What are risk factors for pulmonary embolism (6)?
cardiovascular disease, birth control pills, sedentary lifestyle, smoking, alcohol consumption, vascular wall injury
What is Virchow’s triad (risk for pulmonary embolism)
Hypercoagulable state
Circulatory stasis
Vascular wall injury
What happens in a pneumothorax?
Lung collapses until equilibrium is achieved or the rupture is sealed - makes lung become smaller
What is the difference between open vs. closed pneumothorax?
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
How do bronchodilators (anticholinergic) help with asthma?
short and long acting
Relaxes airway
Reduces mucus production
Where are Beta-1 and Beta-2 receptors located?
Beta-2: bronchioles and arteries of skeletal muscles
Beta-1 receptors: the heart
How do corticosteroids help with asthma?
inhibits bronchial inflammation
Patho of pulmonary fibrosis
Micro-injuries to alveolar epithelial cells, leads to inflammatory response - leads to thickened scarred tissue
Is pulmonary fibrosis restrictive or obstructive?
Restrictive respiratory disorder: affect supporting elastin cells in the airway, lung compliance thus decreased
- Difficulty expanding lungs
- Difficulty inhaling
How would pulmonary fibrosis present on PFT?
Total lung capacity decreased
Patho of poststreptococcal GN
Body produces antibodies to fight infection - antibodies can settle in the glomeruli and cause inflammation; presents within 7-12 days
Nephrotic vs. nephritic syndrome
Nephrotic: excess protein, urinary albumin >3, hypoalbuminemia, edema, hyperlipidemia
Nephritic: excess blood, RBC, oliguria, HTN, proteinuria
Common causes of acute tubular necrosis (3)
Ischemia: surgery, severe hypovolemia, sepsis, trauma (crush injuries), burns, blood transfusion reactions
Tubular obstruction
Toxic: antimicrobials, cancer chemotherapeutic agents, radio contrast agents
Distinguish between patho of toxic vs. ischemic acute tubular necrosis
Toxic: renal vasoconstriction, direct tubular damage, intratubular obstruction
Ischemic: tubules receive less O2 than required
Treatment and prognosis of acute tubular necrosis
Treatment: ID and correct cause of injury, provide supportive care
Prognosis: Typically reversible in healthy patients
Sick patients - prognosis is not as good
Risk factors for UTI (9)
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
Types of UTI (3)
Cystitis
Pyelonephritis
Urethritis
Patho of findings on UA of a UTI (4)
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
Define neurogenic diabetes insipidus, distinguish between congenital/acquired causes
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
Patho of acute kidney injury
Basement membrane becomes damaged/injured
Patho of findings due to acute kidney injury - edema, increased creatinine, elevated BUN
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
What are s/s of peripheral vascular disease (7)
- Pain that resolves with rest
- Mottled skin
- Thinning of the skin
- Reduced size of leg muscles
- Weak or absent pedal pulses
- Limb color blanches with elevation, reddens when dependent
- Achiness/tingling with exercise
Define exertional angina
anaerobic metabolism occurs with exertion which leads to production of lactic acid and stimulation of pain nerve endings
What is the latent period of rheumatic fever in causing mitral valve stenosis?
20-40 years
Define the different types of shock
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
What agent can be used once hypovolemia is resolved if hypotension persists after shock?
Inotropic agents
Causes of the different types of shock
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
