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Advanced Pathophysiology > Unit 3 > Flashcards

Unit 3 Flashcards

1
Q

85% of nephrons- short loops of Henle

A

Cortical nephrons

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2
Q

15% of nephrons- longer loops of Henle

A

Juxtamedullary nephrons- primary site of urine concentration

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3
Q

Where fluid is filtered out of the blood and into the nephron

A

Glomerulus in the renal corpuscle (Bowman’s capsule)

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4
Q

Average UO

A

60ml/hr

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5
Q

The rate at which fluid filters from the blood into the Bowman’s capsule

A

Glomerular Filtration Rate

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6
Q

Major site of reabsorption in the nephron

A

Proximal tubule

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7
Q

Na is mainly reabsorbed in this part of the nephron

A

Proximal tubule

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8
Q

Known as the salt retaining hormone, also increases secretion of K

A

Aldosterone

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9
Q

Acts in the collecting tubules, which transmits urine from the nephron and concentrates urine/absorbs water

A

Antidiuretic hormone (ADH)

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10
Q

ADH is synthesized in the _____ and stored in the _____.

A

Hypothalamus, posterior pituitary

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11
Q

Angiotensin II is a potent ______

A

Vasoconstrictor

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12
Q

Acts in the distal tubule to increase reabsorption of Na and secretion of K

A

Aldosterone

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13
Q

Acts in the collecting tubules to concentrate the urine and reabsorb water

A

ADH

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14
Q

Two effects of ADH:

A
  1. vasoconstrictor blood vessels to increase BP

2. increases reabsorption of water to increase blood volume

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15
Q

Increased ADH causes increase of water in blood, low serum Na, edema, and concentrated urine

A

SIADH

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16
Q

The best way to measure GFR

A

Plasma creatinine

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17
Q

Reflective of renal function

A

GFR

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18
Q

Type of ARF where kidneys are normal but hypo perfusion of the kidney causes failure

A

Prerenal ARF

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19
Q

Type of ARF that occurs due to obstruction of urine

A

Postrenal ARF

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20
Q

Type of ARF that results from loss of renal function due to structural damage to the glomeruli and/or tubules

A

Intrinsic ARF

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21
Q

Increased levels of this denote a decreased renal clearance and decline in GFR

A

Creatinine

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22
Q

CKD-kidney damage with normal/increased GFR (GFR >90)

A

1

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23
Q

CKD-kidney damage with mild disease in GFR (GFR 60-89)

A

2

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24
Q

CKD-moderate decrease in GFR (GFR 30-59)

A

3

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25
Q

CKD-severe decrease in GFR (GFR 15-29)

A

4

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26
Q

CKD-kidney failure (GFR < or equal to 15 or dialysis)

A

5

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27
Q

Blood urea levels _____ with a high-protein diet, excessive tissue breakdown, or GI bleed

A

Rise

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28
Q

Kidneys receive _______ of CO for glomeruli to remove metabolic wastes and regulate body fluids and lytes

A

20-25%

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29
Q

Pushes water out of the capillary into interstitial spaces (30-40mmHg arterial, 10-15mmHg venous)
• Aka capillary hydrostatic pressure
• Rise in arterial or venous pressure increases capillary pressure
• Weight of gravity in dependent parts of the body

A

Capillary filtration pressure

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30
Q

Pulls water back into the capillary (28mmHg)

• Osmotic pressure generated by the plasma proteins that are too large to pass through the pores of the capillary wall

A

Capillary colloidal osmotic pressure

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31
Q

Opposes the movement of water out of the capillary (-3mmHg)

A

Interstitial hydrostatic pressure

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32
Q

Pulls water out of the capillary into the interstitial spaces (8mmHg)
• Reflects the small amount of plasma proteins that normally escape into the interstitial spaces from the capillary also pulls water out of the capillary and into the tissue spaces

A

Tissue colloidal osmotic pressure

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33
Q

Edema throughout the body

A

Anasarca

34
Q

Increased permeability of glomerulus
o Massive proteinuria and lipiduria (fatty casts)
o Also hypoalbuminemia, generalized edema, hyperlipidemia
o Loss of plasma proteins (albumin and globulins- meaning infection is also possible…) in the urine

A

Nephrotic syndrome

35
Q

Proliferative inflammatory response
o Sudden onset of hematuria (red cell casts), proteinuria, diminished GFR, oliguria, signs of impaired renal function
o Caused by damage to the capillary wall in glomerulus- letting RBCs escape into the urine
o Causes extracellular fluid accumulation, HTN, and edema due to decreaed GFR and enhanced tubular reabsorption of salt and water
o Can occur in SLE or other infections…

A

Nephritic syndrome

36
Q

Hereditary defect of glomerular basement membrane that results in hematuria and can progress to chronic renal failure

A

Alport syndrome (type of glomerulonephritis)

37
Q

Edema cause:
 Force of increased volume in capillaries that pushes fluids out
 Hypervolemia that causes pulmonary edema
 Also heart failure, renal failure and pregnancy

A

Increased capillary hydrostatic pressure

38
Q

Edema cause: Decrease in plasma proteins like albumin
 From kidney disease (patient peeing out proteins- nephrotic syndrome)) or lack of synthesis of proteins (malnutrition or liver disease because liver produces proteins)
 Burns or wounds (loss of protein from denuded skin areas)

A

Decreased capillary oncotic pressure

39
Q

Edema cause: Causes localized edema
 Response from an inflammatory issue or infection
• Release of histamine or other chemical mediators from injured cells that allows proteins and fluid movement into interstitium
 Toxins, bacterial infections, vitamin C deficiency, prolonged ischemia, burns

A

Increased capillary permeability

40
Q

Edema cause: Localized edema because excessive fluid and protein are not returned to the general circulation
 Damage to lymph node or removal- cancer, infections, surgery, congenital absence or abnormality of lymph vessels
• Chylothorax

A

Lymph obstruction

41
Q

The amount of blood that the heart ejects in a minute

A

Cardiac output (4.2-8L)

42
Q

Amount of blood ejected with each beat

A

Stroke volume

43
Q

Filling of the ventricles/volume work of the heart before contraction begins/amount of stretch applied to the ventricles as it fills with blood

A

Preload

44
Q

Resistance to ejection of blood from the heart/pressure or tension work of the heart

A

Afterload

45
Q

Determined by the interaction of actin and myosin filaments of cardiac muscles

A

Contractility

46
Q

CO formula

A

SV x HR

47
Q

There is a direct relationship between the volume of blood in the heart and the stretch or length of cardiac fibers at the end of diastole and the force of contraction during the next systole in a normal functioning heart

A

Frank-Starling Law

48
Q

CO x SVR =

A

Blood pressure

49
Q

Most significant factor in causing target organ damage

A

Systolic HTN

50
Q

HTN is caused by:

A

Increases in CO, PVR, or both

51
Q

Average age of onset of HTN is:

A

30

52
Q

Most common predisposing factor in essential HTN is:

A

Increased PVR

53
Q

Two stimuli for secretion of renin:

A
  1. renal hypo perfusion (decrease in renal blood flow)

2. macula densa in distal tubule senses a concentration of Cl

54
Q

Primary mechanism in atherosclerosis development

A

Inflammation with oxidative stress and activation of macrophages

55
Q

What can cause a regression of atherosclerotic lesions and improve endothelial function?

A

A decrease in LDL using statins

56
Q

Occurs secondary to ischemic/toxic injury to the renal tubules, SNS stimulation and angiotensin II causes severe vasoconstriction, leading to hypoxia and cellular damage

A

Acute tubular necrosis

57
Q

A decrease in ability to excrete ______ will result in hyperparathyroidism in CRF

A

Phosphate

58
Q

An early manifestation of CRF…

A

Hypertension

59
Q

Decrease in the ability to activate vitamin D, excrete phosphorous, and form growth factors leads to:

A

Osteodystrophy

60
Q

Significant cause of renal failure, severe HTN is a contributing factor, reflux is the most common cause…

A

Chronic pyelonephritis

61
Q
  • True aneurysm that involves the entire circumference of the vessel with gradual and progressive vessel dilation
  • Vary in diameter and length and may involve ascending and transverse portions of the thoracic aorta or may extend over large segment of the abdominal aorta
A

Fusiform abdominal aortic aneurysm

62
Q

Below level of renal artery and involves bifurcation of the aorta and proximal end of the common iliac arteries

A

Abdominal aortic aneurysm

63
Q

Chronic disease of the arterial system that results in abnormal thickening/hardening of the vessel walls

  • smooth muscle cells and collagen fibers migrate to the tunica media and cause it to stiffen and harden
  • can be from HTN or PVD
A

Arteriosclerosis

64
Q

Inflammation of the heart muscle and condition system without evidence of MI
-from virus, radiation, hypersenstivity reactions, chemical/physical agents (cocaine)

A

Myocarditis

65
Q

Most important cause of myocarditis in US? And clinical features?

A

Coxsackie viruses and enteroviruses/ flu-like symptoms

66
Q

Myocarditis progresses to….?

A

Dilated cardiomyopathy (diagnosed with biopsy- shows inflammation- no CAD)

67
Q

_____ should be suspected whenever a young, previously healthy, normotensive person experiences cardiomegaly and heart failure

A

Cardiomyopathies

68
Q

Heart’s ability to contract = _____ dysfunction

A

Systolic

69
Q

What type of CM? Myofibril disarray- muscle fibers in the heart are not in the typical lattice pattern
 Produces uncoordinated contraction and relaxation and can lead to sudden death

A

Hypertrophic CM (HoCM)

70
Q

What type of CM?

  • Abnormal ventricular hypertrophy and abnormal diastolic filling
  • Wall of septum is thicker than it should be- can obstruct left ventricular outflow tract
A

Hypertrophic CM (HoCM)

71
Q

What type of CM?- Progressive cardiac enlargement (increase in heart size and cardiomegaly) and dilation

  • Grossly impaired systolic function
  • Heart has difficulty contracting
A

Dilated CM

72
Q

What type of CM?
Excessive rigidity of ventricular walls
-From amyloid infiltrations or idiopathic
-Least common type of myopathy
-Symptoms are similar to pericarditis and HF (especially RHF)

A

Restrictive CM

73
Q

Secretion of ADH is stimulated by:

A
  1. ) increased plasma osmolality

2. ) decrease in BP

74
Q

Slowly progressive disease caused by the accumulation of lipid-laden macrophages within the arterial wall which leads to the formation of plaque lesions

A

Atherosclerosis

75
Q

When blood flor through the coronary arteries does not meet the metabolic demands of the heart

A

Myocardial ischemia

76
Q

Associated with fixed coronary obstruction, occurs with increased demands of the heart, subsides with rest, unless it becomes more serious.

A

Stable (classic) angina

77
Q

Myocardial ischemia without anginal pain- reason is unclear

A

Silent angina

78
Q

Abnormal vasospasm of one or more coronary arteries, with or without atherosclerosis, most occurring at rest
(Can be from hyperactive SNS or increased calcium influx in arterial smooth muscle)

A

Prinzmetal (variable) angina

79
Q

Combination of classic and variant angina- seen in ppl with worsening CAD and could be a signal that infarction is near

A

Unstable angina

80
Q

Steps to atherosclerotic plaque formation

A

1) endothelial injury
2) cellular proliferation
3) macrophage migration
4) process of LDL oxidation into foam cells
5) fatty streak formation
6) fibrous plaque development over time

Advanced Pathophysiology (4 decks)

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