NR507 NR 507 Midterm Exam (Latest 2024/ 2025) Advanced Pathophysiology - Chamberlain...

NR 507 midterm ___ measures the average size of RBCs ANSWER: MCV ___ used to diagnose aplastic anemia ANSWER: -Blood test and bone marrow biopsy -granulocyte count less than 500 -platelet count less than 20,000 -absolute reticulocyte count less than or equal to 40x 109/L 4.5-5.2mcL ANSWER: Normal for women RBC 4.7-6.1mcl ANSWER: Normal for men RBC 11.5- 14.5% ANSWER: Normal RDW 12.0-15.5 g/dL ANSWER: Normal hemoglobin for women 13.5-17.5 ANSWER: Normal hemoglobin for men 37-48% ANSWER: Normal HCT for women 42-45% ANSWER: Normal for HCT for men 80-100 fL ANSWER: Normal MCV A patient with chronic bronchitis is likely to experience__? ANSWER: Respiratory acidosis due to inability to exhale CO2

Afterload ANSWER: -the amount of resistance to ejection of blood from the ventricle -Elevated afterload results in increased ventricular workload and hypertrophy of the myocardium Allergic contact dermatitis ANSWER: Hypersensitivity Type IV Anemia ANSWER: -"without blood" Anemia occur by... ANSWER: -impaired RBC production -excessive blood loss - increased RBC production aortic regurgitation ANSWER: -flow of blood backward from the aorta into the heart; caused by a weak heart valve -severe SOB chest x-ray shows signs of pulmonary edema and cardiomegaly Aortic regurgitation murmur ANSWER: -Diastolic rumbling murmur heard at the apex of the heart -An early high-pitched diastolic murmur hired at the left lower sternal border -A systolic crescendo-descrescendo murmur heard at the left upper sternal border aortic stenosis ANSWER: -calcification of aortic valve cusps that restricts forward flow of blood during systole -narrowing of the aorta -S4 gallop -fainting, chest pressure -left ventricular hypertrophy aortic stenosis murmur ANSWER: Mid-systolic crescendo-decrescendo heard loudest at the base and radiating to the neck

aplastic anemia ANSWER: "Without" =plasa of cell growth - chemical- chemo -viral: hepatitis -tumor -antibiotics and other meds: PCN, phenytoin, diuretics, anti diabetic, sulfa -congenital defects: fanconi's anemia Aplastic anemia labs ANSWER: RBC normal, reticulocyte count low Asthma occurs at __% FEV1/FVC ANSWER: 70 Asthma s/s common to both instrinsic and extrinsic: ANSWER: Wheezing Autoimmune ANSWER: -diseases in which the body makes antibodies directed against its own tissues B12 definitely (pernicious anemia) ANSWER: -Autoimmune destruction of intrinsic factor -peripheral neuropathy - treatment: injections risk: vegetarians, elderly, h-pylori infection Blood loss anemia ANSWER: -Acute: GI bleed, trauma, labor -Chronic: GI bleed, deplete iron stores can result in iron deficiency anemia Breath sounds IlD ANSWER: Fine crackles CAD ANSWER: Long-standing atherosclerosis

Cardiac Output (CO) ANSWER: measurement of the amount of blood ejected per minute from either ventricle of the heart -CO= SV x HR -4-8L/min Causes air trap in the Longs after full expirationobstructive disorders definition COPD and asthma ANSWER: -Characterized by extraction of airflow during expiration -Shortness of breath when exhaling air -Causes air trap in the Longs after full expiration Chronic Bronchitis definition ANSWER: -Bronchial inflammation hypersecretion of mucus and chronic productive cough that persist for at least three consecutive months for at least two successful years Chronic bronchitis will decrease ? ANSWER: FEV1 chronic low oxygen ANSWER: -The kidneys compensate by increasing secretion of a erythropoietin the primary hormone results for simulating red blood cell production -As a result of increased red blood cells production the patient with chronic bronchitis exhibits in elevated hematocrit can develop secondary polycythemia Vera.

-This increase in red blood cells causes strain on the pulmonary and cardiovascular system causing pulmonary hypertension due to vasoconstriction -causes right sided heart failure or cor pulmonale Class 111 HF ANSWER: -There is marked limitation of physical activity -the patient is comfortable at rest but less than ordinary activity causes symptoms of HF Class I HF ANSWER: No limitation of physical activity Class II HF ANSWER: -Slight limitation of physical activity -Patient is comfortable at rest but ordinary physical activity results and symptoms of HF

Class IV HF ANSWER: The patient is unable to carry on any physical activity without symptoms of HF or they have symptoms of HF at rest Classic for asthma ANSWER: Decrease total long capacity and residual volume Common cause of secondary immunodeficiency ANSWER: Malnutrition cor pulomale ANSWER: Right ventricular failure secondary to pulmonary HTN Determining the severity: mild ANSWER: >70% Determining the severity: moderate ANSWER: 60-70% Determining the severity: Moderately Severe ANSWER: 50-60% Determining the severity: severe ANSWER: 35-50% Determining the severity: Very severe ANSWER: <35% ejection fraction ANSWER: -measurement of the volume percentage of left ventricular contents ejected with each contraction -if effected, the blood is unable to pump blood out of the ventricles resulting in increased preload Ejection fraction of ___% can't provide adequate cardiac output ANSWER: 40 Emphysema ANSWER: -hyperinflation of air sacs with destruction of alveolar walls (damage occurs in the airway, but the aveloi

-air trapping -purses lip breathing -barrel chest Emphysema has a late effect of__? ANSWER: Hypoxia and hypercapnia Extrinsic asthma is ANSWER: -Triggered by an allergic reaction -elevated IgE -more common in children Ferritin ANSWER: Measurement that reflects the body's total iron stores FEV1/FVC ratio ANSWER: Determines if it's obstructive of restrictive FEV1/FVC ratio of ___% or less determines obstructive ANSWER: -70% FEV1/FVC ratio of greater than ___% determines restrictive ANSWER: 70% First responders to innate the immune system ANSWER: Neutrophils Flow of the heart ANSWER: a. Right Atrium, Right Ventricle, Pulmonary Arteries, Lungs, Pulmonary Veins, Left Atrium, Left Ventricle, Aorta Flow of the heart: ANSWER: Inferior/Superior vena cava, right atrium, tricuspid valve, right ventricle, pulmonary semi lunar valve, pulmonary arteries, (deox), lungs, pulmonary veins, left atrium, mitral valve, left ventricle, aortic semi lunar valve, aorta, (oxy) Folate deficiency anemia ANSWER: -lack of folate leading to premature RBC death... caused by dietary deficiency -ferritin level normal

-alcoholics, pregnancy, anticonvulsant meds Folate deficiency labs ANSWER: macrocytic. (increased MCV) low RBC count. decreased folate. folic acid foods ANSWER: peas beans veggies liver seeds orange juice fortified bread cereal rice Folic acid is essential for the body because ANSWER: It plays a role in maturing of RBCs forced vital capacity ANSWER: -the maximum amount of air that can be removed from the lungs during forced expiration -normal lungs should exhale 80% of the FVC GOLD criteria for COPD: stage 1: mild FEV1 % predicted ANSWER: 80-100% GOLD criteria for COPD: stage 2: moderate FEV1 % predicted ANSWER: 50%-80% GOLD criteria for COPD: stage 3: severe FEV1 % predicted ANSWER: 30-50% GOLD criteria for COPD: stage 4: very severe FEV1 % predicted ANSWER: Less than 30% Gold standard test for asthma ANSWER: Methacholine Challenge test Heart failure definition ANSWER: The heart is an able to generate an adequate cardiac output such as the inadequate perfusion of tissues or increase diastolic filling pressure of the ventricle or both Heart failure overtime causes....resulting in increase preload ANSWER: -decreased contractility

-decreased stoke volume -increase left ventricular end-diastolic volume (LVEDV) Hematocrit (Hct) ANSWER: The volume of cells as a % of total volume of cells and plasma in whole blood Hemoglobin (Hgb) ANSWER: The oxygen-carrying pigment of red cells Hemoglobinopathies ANSWER: sickle cell and thalassemia hemolytic anemia ANSWER: -destruction of lysis of RBCs due to enzymes or toxins produced by infectious agent , chemical release medication, effects of drugs Incorrect blood transfusions -type 2 hypersensitivity hemolytic anemia labs ANSWER: RBC normal size, reticulocyte count is high Hives (urticaria) ANSWER: Hypersensitivity Type 1 Hyperchromic anemia - (MCHC) more than normal hemoglobin ANSWER: Dark rue or red Hypersensitivity 2 ANSWER: -Graves Disease (hyperthyroidism) -alters function not destroy -blood transfusions reaction- transfused erythrocytes are destroyed by agglutination or lysis -drug allergies -hemolytic anemia Hypersensitivity IV, ANSWER: -is more of a delayed immune response.

-mediated T-cells attack tissue directly (no antibodies) Hypersensitivity: Type 1 ANSWER: -Mediated IgE

-inflammation due to mast cell degranultion -anaphylactic, asthma, hay fever treatment: epinephrine Hypersensitivity: Type 2 ANSWER: -Cytotoxic reaction: tissue specific -binds to the antigen ON THE CELL SURFACE -macrophages are primary effectors cells involved cause tissue damage or alter function Hypersensitivity: type 3 ANSWER: -Not organ specific -antibody binds to soluble antigen OUTSIDE THE CELL SURFACE that was released into the blood or bodily fluids, and the complex is then deposited in the tissues Hypersensitivity: Type 3 ANSWER: -rheumatoid arthritis -Systemic Lupus Erythematosus (SLE) -Raynaud's Hypertension directly effects which load? ANSWER: Afterload Hypochromic anemia -(MCHC) less than normal hemoglobin ANSWER: RBCs pale in color Interstitial Lung Disease... associated with smoking ANSWER: -pulmonary langerhans cell histiocytosis -desquamative interstitial pneumonia -respiratory brochiolitis-interstitial lung disease Intrinsic asthma is ANSWER: -triggered by non-allergic factors -no elevation in IgE -more common in adults less than 40 years of age iron deficiency anemia ANSWER: -microcytic, hypochromic -can cause excessive bleeding -treatment: iron supplements

-insufficient iron levels or the inability of the cells mitochondria to utilize iron effectively Lack of intrinsic factor causes ANSWER: pernicious anemia Left HF involves ANSWER: -Left ventricle -pulmonary vein (preload) -aorta (afterload) Left HF manifestations ANSWER: -Increase left ventricular afterload -decrease ejection fraction -increased left ventricular preload -pulmonary edema -Dyspnea Left side HF (systolic) HFrEF : congestive heart failure ANSWER: -Heart failure with reduced ejection fraction -decreased contractility, increased preload, and increased afterload -S3 gallop left side of heart ANSWER: Aorta, pulmonary vein, left atrium, mitral valve, aortic valve, left ventricle Liver disease causes ANSWER: Non-megaloblastic anemia Long-standing cause of heart failure ANSWER: Hypertension Macrocytic (MVC >100) greater than ANSWER: B12 deficiency (pernicious anemia) Macrocytic (MVC >100) greater than ANSWER: Folate deficiency Macrocytic Anemia's ANSWER: -MCV larger than 100.

-megaloblastic and non-megaloblastic

Manifestation of thalassemia ANSWER: -May have possible genetic mutations - ineffective erythropoiesis -occurs and people from south east Asia and China Manifestations of anemia ANSWER: fatigue, pallor, weakness, dyspnea, dizziness, tachycardia Manifestations of chronic bronchitis ANSWER: -Productive and purulent cough -copious sputum production -Dyspnea - wheezing -rhonchi -cyanosis of the skin and mucous membranes -and peripheral edema Manifestations of Macrocytic Anemia's ANSWER: -fatigue -dyspnea -loss of appetite and weight -diarrhea -pallor Manifestations of Right HF ANSWER: -Jugular vein distention -heptatosplenomegal -peripheral Edema -cor pulmonale tricuspid valve damage Manifestations of Sickle cell ANSWER: -Involves single Amino acid change on the betachai -Increased RBC hemoglobin S concentration, dehydration, acidosis, hypoxemia -have a cute painful episodes Mean Cell Volume (MCV) ANSWER: Measures the average size of the RBC

megaloblastic anemia (macrocytic) ANSWER: Folate deficiency and vitamin b-12 deficiency Microcytic (MVC <80fL) ANSWER: Anemia of chronic disease Microcytic (MVC <80fL) ANSWER: Iron deficiency Microcytic (MVC <80fL) ANSWER: Thalassemia Microcytic (MVC <80fL) less than ANSWER: Sideroblastic Microcytic Hyperchromic ANSWER: Hereditary spherocytosis Microcytic hyperchromic ANSWER: Spherocytosis microcytic hypochromic anemia ANSWER: -iron deficiency anemia -sideroblastic -thalassemia Microcytic normochromic ANSWER: Anemia of inflammation and chronic disease Microcytic Normochromic ANSWER: Anemia of inflammation and chronic disease Microcytic-hypochromic ANSWER: iron deficiency sideroblastic thalassemia microlytic anemia is characterized by hyper chromic RBS: ANSWER: Hereditary spherocytosis

mitral regurgitation ANSWER: -Reflux of blood from left ventricle into left atrium during systole -dyspnea, Jugular vein distention Mitral regurgitation murmur ANSWER: Pansystolic, often loud, blowing, best heard at apex, radiates well to left axilla mitral stenosis ANSWER: -narrowing of the mitral valve opening usually caused by scarring from rheumatic fever -SOB on activity, tachycardia, JVD, crackles -EKG shows a-fib and left atrial hypertrophy Mitral Stenosis murmur ANSWER: Low pitch murmur auscultated at the hearts Apex Most diagnosed interstitial lung disease ANSWER: -radiation pnemonitis -pneumonconioses -hypersensitivity pneumonitis Most patients diagnosed with SLE will have a positive ? ANSWER: antinuclear antibody (ANA) MS immune changes ANSWER: T-cells against brain antigens MS manifestations ANSWER: Formation of sclerotic plaque in the brain, leads to Muscle weakness and ataxia Non-megaloblastic anemia (macrocytic) ANSWER: -Liver disease, myelodsplastic syndrome, hemorrhage Normochromic anemia -(MCHC) normal hemoglobin ANSWER: Neither pale or dark Normocytic (MVC 80-99) ANSWER: Anemia of inflammation and chronic disease

Normocytic (MVC 80-99) ANSWER: G6PD deficiency Normocytic (MVC 80-99) ANSWER: Hereditary spherocytosis Normocytic (MVC 80-99) ANSWER: Paroxysmal nocturnal hemglobinuria Obstructive Disease ANSWER: characterized by an increase in resistance to airflow from the trachea and larger bronchi to the terminal and respiratory bronchioles Obstructive pattern measurements: ANSWER: -FVC- decreased or normal -FEV1 - decreased -FEV1/FVC ratio: less than 70% -TLC: greater than 120 represents hyperinflation Patho of chronic bronchitis ANSWER: Inspired irritants result in airway inflammation with infiltration of neutrophils, macrophages, and lymphocytes into the bronchial wall.

Patho of heart failure ANSWER: *less cardiac output -Heart tries to compensate for not pumping an adequate amt of blood -Increased heart rate -Blood vessels dilate -Heart hypertrophy -Right side triggered by MI or lung dx -Vascular resistance -Greater O2 demand -Cells become hypoxic Patho of sickle cell ANSWER: -Involves a single amino-acid change on the beta-chain -4 genes involved in encoding synthesis of the alpha protein chains for Hb. Genes located on chromosome 16

pernicious anemia labs ANSWER: -Normal or low -folate -MCHC is normal -elevated MCV PFT Diagnosis used for chronic bronchitis ANSWER: -FEV1 will be decreased (obstructive) -increased TLC Post hemorrhage: lab ANSWER: Reticulocyte count is high MCHC normal Preload ANSWER: -volume of blood in ventricles at end of diastole -determined by: 1. Amount of venous blood returning to the ventricles door and diastole 2. The amount of blood in the left Ventricle after systole -can cause a backflow of blood causing heart failure Presentation of COPD on X-ray ANSWER: A flatten diaphragm, distended lung fields, and increased thoracic diameter Primary immunodeficiency ANSWER: -Genetic; inherited -result of single gene defects -B and T cell deficiencies RBC ANSWER: The number of erythrocytes in 1 cubic mm of whole blood RDW (red cell distribution width) ANSWER: Estimate of the uniformity of individual cell size Reduction of FEV1/FVC ratio ANSWER: Chronic asthma OBSTRUCTIVE Renal disease associated with autoimmunity? ANSWER: Glomerulonephritis

Restrictive Disease spirometry results ANSWER: -FEV1, FVC, TLC are reduced -FEV1/FVC ratio is normal Restrictive disorders definition ANSWER: -Characterized by reduction in lung volume -Results in difficulty in taking air into the lungs -Due to stiffness and lung compliance or chest wall structural abnormalities -Includes interstitial lung disease, sclerosis, neuromuscular causes and significant obesity Restrictive pattern measurements ANSWER: FVC: decreased -FEV1: decreased -FEV1/FVC ratio: normal or greater 70% -TLC: 80% Result of chronic bronchitis ANSWER: -Excessive mucus production accumulation -hypertrophy of bronchial smooth muscles - hypertrophy and hyperplasia of chronic bronchial mucus producing cells -airflow obstruction -and decreased alveolar ventilation -(irreversible) Rheumatoid Arthritis immune changes: ANSWER: T-cells and B cells against joint associated antigens rheumatoid arthritis manifestations: ANSWER: Joint inflammation, stiffness, pain, loss of range of motion Right HF involves.. ANSWER: -Right ventricle -super vena cava (preload) -pulmonary artery afterload right sided heart failure ANSWER: Right sided heart failure can occur due to left sided heart failure due to the back up of the fluid from the left side of the heart

Right sided heart failure diastolic caused by: ANSWER: -HTN, myocardial hypertrophy, myocardial infarction -decreased compliance of the left side and abnormal diastolic relaxation -increased afterload will cause an increased right ventricular contraction force and will eventually not be able to move the blood (blood will remain in the right atrium) right sided heart failure manifestations ANSWER: 1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement 5. cor pulmonale Right sided of the heart: ANSWER: Super vena cava (preload), pulmonary artery, right atrium, pulmonary valve, tricuspid valve, inferior vena cava, right ventricle secondary immunodeficiency ANSWER: -acquired Serum Sickness ANSWER: type 3 hypersensitivity sickle cell anemia ANSWER: -a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape sickle cell anemia ANSWER: -autosomal recessive gene disorder -two abnormal genes, one form each parent simple spirometry measures ANSWER: -Exhaled flow rates that include: -title volume -vital capacity -FEV1 Sjogren's syndrome ANSWER: Inflammation in salivary and lacrimal glands

Sjögren's syndrome immune changes: ANSWER: Autoantibodies and auto-reactive t-cells against apoptotic cells SLE ANSWER: Autoantibodies and auto-active t-cells against DNA and nucleoprotein SLE (lupus) ANSWER: -Facial rash -vasculitis - tissue inflammation Stage A HF ANSWER: Patient at risk for heart failure who have not yet developed structural heart changes (those with diabetes, those with coronary disease without prior infarct) Stage B HF ANSWER: Patients with structural heart disease reduce ejection fraction (left ventricular hypertrophy chamber enlargement) who have not yet developed symptoms of heart failure -structural heart damage, but no damage Stage C HF ANSWER: Patients you have developed clinical heart failure -symptomatic Stage D HF ANSWER: Patients with refractory heart failure that require advance intervention -example the need for bio -ventricular pacemaker left ventricular assist device or a heart transplant Steps to analyze pulmonary function test ANSWER: 1.Determine the pattern 2.Determine the severity 3.Bronchodilator response Stroke volume ANSWER: -The amount of blood ejected from the heart in one contraction. (Systole) Thalassemia ANSWER: -Autosomal recessive genetic disorder

-abnormal Hb gene from each parent like sickle cell -many possible genetic mutations -single or muitlple amino changes on alpha and beta chains TLC is greater than __% in restrictive ANSWER: -80% -80-120% represents a normal range Transition of classes in HF ANSWER: The patient may move between classes one and four as symptoms can be improved through treatment wand medications Transition of stages of HF: ANSWER: -Once a stage has been reached the person can ever go back to the prior stage -the damage of the heart cannot be reversed Treatment of asthma ANSWER: *- Avoidance of triggers* - Short-acting ß2-agonists (SABA) - Inhaled corticosteroids (ICS) - Long-acting ß2-agonists (LABA) - Leukotriene antagonists (modifiers) (LTRA) Type 2 cytotoxic hypersensitivity mediated by: ANSWER: -IgG IgM -macrophages are primary effort cells Types of COPD: irreversible ANSWER: chronic bronchitis and emphysema Wheezing occurs at ANSWER: -The end of expiration -improves after bronchodilator use Which condition can lower preload? ANSWER: Hemorrhage