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

NR507 / NR 507 Midterm Exam 3 characteristics of bronchitis ANSWER: bronchial inflammation hypersecretion of mucus chronic productive cough for at least 3 consecutive months for at least 2 successive years 3 layers of the bronchioles ANSWER: innermost layer middle layer - lamina propria outermost layer Acute Kidney Injury ANSWER: Sudden decline in kidney function with a decrease in GFR and an increase in plasma creatinine and BUN levels -results in oliguria After air passes through the trachea where does it go? ANSWER: goes into the left or right bronchi Afterload ANSWER: the amount of resistance to open the semilunar valves and eject of blood from the ventricle alveolar hyperinflation ANSWER: When air is unable to move out of the alveolar like it should due to bronchial walls collapsing around possible mucus plug thus trapping air inside anemia risk factors ANSWER: acute or chronic blood loss, increased hemolysis, inadequate dietary intake or malabsorption, bone marrow suppression, age angiotensin converting enzyme (ACE) ANSWER: an enzyme that converts angiotensin I to angiotensin II Ascending infection ANSWER: - urethra to bladder, and then to kidney - due to: bacteria from residual fecal contamination

Asthma ANSWER: Chronic disease due to bronchoconstriction and an excessive inflammatory response in the bronchioles average amount of preload? ANSWER: 120-130 mls Azoetmia ANSWER: presence of elevated plasma creatinine benign prostatic hyperplasia ANSWER: benign growth of cells within the prostate gland Biventricular failure ANSWER: unresolved left sided heart failure will increase pressure on the right side of the heart contributing to right sided heart failure as well Bladder anatomy ANSWER: - ureter - bladder -urethra blood cell formation in adults over 20 ANSWER: red marrow in large bones -illium, vertebrae, cranium, jaw, sternum, ribs, humerus, and femur Blood cell formation in chidren 0-5 years old ANSWER: red marrow of all bones to make blood cells blood hydrostatic pressure ANSWER: the pressure produced by a fluid against a surface BPH (benign prostatic hyperplasia) ANSWER: Age-associated prostate gland enlargement that can cause urination difficulty.

BPH treatment ANSWER: - Alpha-adrenergic antagonists: terazosin, doxazosin - 5-alpha reductase inhibitors: finasteride, dutasteride - Transurethral prostatectomy

- Open prostatectomy Bronchioles ANSWER: smaller passageways that originate from the bronchi that become the alveoli bronchitis ANSWER: inflammation of the bronchial tubes cardiac reserve ANSWER: difference between resting and maximal CO; should be about 4-5x as high but does decrease 1% per year after age 30 causes of anemia ANSWER: - impaired RBC production - excessive blood loss - increased RBC destruction Causes of bronchitis ANSWER: -long term exposure to environmental irritants -repeated episodes of acute infection (RSV infection in early infancy) -Factors affecting gestational childhood lung development (preterm birth) causes of hemolytic anemia ANSWER: infection transfusion reaction hemolytic disease of the newborn (Rh incompatibility) autoimmune reaction drug induced causes of high output failure ANSWER: Severe anemia Nutritional deficiencies Hyperthyroidism Sepsis Extreme febrile state Causes of intrarenal disease ANSWER: ATN Acute glomerulonephritis

causes of kidney stones ANSWER: Family HX, chronic dehydration and infection, dietary factors, medications, imobility. Stoned more common in men than women usually ages 30/50.

Causes of left sided heart failure ANSWER: systemic hypertension left ventricle MI LV hypertrophy Aortic SL valve or bicuspid valve damage Secondary to right heart failure Causes of postrenal disease ANSWER: BPH Calculi Inflammation Tumors Causes of right sided heart failure ANSWER: - pulmonary disease - pulmonary hypertension - RV MI - RV Hypertrophy - pulmonary SLV or tricuspid valve damage - secondary to left heart failure Causes of tubular necrosis ANSWER: - being post operative - severe sepsis - burns - trauma - contrast chemical use in medical imaging procedures Chronic kidney disease ANSWER: progressive, irreversible deterioration in renal function Labs: elevated BUN, Cr Phosphorus.

Rx: meds for hypertension, statins, epoetin, diuretics, calcium, LOW protein, low salt, restrict K, phosphorus (no chicken, milk, legumes, carbonated drinks), dialysis. clinical indicators of glomerulonephritis ANSWER: - proteinuria

- hematuria - edema - azotemia - oliguria - coagulation cascade activation Conditions associated with renal failure ANSWER: - congenital abnormalities in the urethral tract development - kidney and bladder cancer - infections - glomerulonephritis - acute/ tubular necrosis - AKI cor pulmonale ANSWER: right-sided heart failure Descending infection ANSWER: The blood can carry bacteria from a focus of infection in another part of the body to the kidneys. The bacteria then pass with the urine down the ureters to the bladder.

Describe how blood flows to become oxygenated ANSWER: - deoxygenated systemic blood flows from the vena cava to R atrium - Tricuspid valve opens to flow to R ventricle -Pulmonary semilunar valve opens and blood flows to the alveolar capillaries for gas exchange from the pulmonary trunk and L & R pulmonary arteries - blood goes from alveolar capillaries to pulmonary veins to return oxygenated blood to the left atrium - bicuspid valve opens to allow blood to go to left ventricle - aortic semilunar valve opens and blood goes to the aorta - aorta pushes oxygenated blood out to the body development of anemia due to gastrectomy ANSWER: loss of intrinsic factor from surgery results in the loss of protein necessary for vitamin B12 absorption an can lead to anemia Effect of hyperinflation of the alveolar ANSWER: -expanded thorax and hypercapnia (retention of CO2) - respiratory acidosis

ejection fraction ANSWER: measurement of the volume percentage of left ventricular contents ejected with each contraction Erythrocyte function ANSWER: transport oxygen and carbon dioxide Erythrocyte life span ANSWER: 120 days Erythropietin ANSWER: Produce: Kidney (small amount in liver) Released: Kidney Target: Bone Marrow Functions: Stimulates bone marrow to produce more red blood cells filtration (kidney) ANSWER: movement of solutes from blood to filtrate at bowman's capsule 20% of the blood that goes through the glomerulus is passed as filtrate into the bowman's capsule depends on the hydrostatic and oncotic pressures/ starling forces between the glomerulus and bowman's capsule hydrostatic pressure: a lot higher in the glomerulus (move into the nephron/bowman's capsule) oncotic pressure: higher in the blood/glomerulus than in the bowman's capsule (move into the blood/glomerulus) hydrostatic pressure is greater so there will be movement into bowman's capsule usually favors the filtrate to go into the bowman's capsule each persons full body is filtered about every 40 minutes filtration (kidney) ANSWER: movement of solutes from blood to filtrate at bowman's capsule

20% of the blood that goes through the glomerulus is passed as filtrate into the bowman's capsule depends on the hydrostatic and oncotic pressures/ starling forces between the glomerulus and bowman's capsule hydrostatic pressure: a lot higher in the glomerulus (move into the nephron/bowman's capsule) oncotic pressure: higher in the blood/glomerulus than in the bowman's capsule (move into the blood/glomerulus) hydrostatic pressure is greater so there will be movement into bowman's capsule usually favors the filtrate to go into the bowman's capsule each persons full body is filtered about every 40 minutes function of hemoglobin ANSWER: In red blood cells, carries oxygen from the lungs to body's tissues and returns carbon dioxide from tissues back to lungs. It also maintains the shape of red blood cells. glomerulonephritis ANSWER: inflammation of the glomeruli of the kidney heart failure ANSWER: cardiac dysfunction caused by the inability of the heart to provide adequate CO resulting in inadequate tissue perfusion Hematopoiesis ANSWER: formation of blood cells hematopoietic stem cells ANSWER: The stem cells that give rise to RBC WBC and platelets through the process of haematopoiesis. hemolytic anemia ANSWER: premature destruction of RBCs

hemolytic anemia is what kind of anemia ANSWER: normocytic normochromic anemia High output failure ANSWER: inability of the heart to pump sufficient amounts of blood to meet the circulatory needs of the body despite normal blood volume and cardiac contractility How does a hematopoietic stem cell produce a red blood cell ANSWER: hematopoietic stem cells produces an unndifferentiated hemocytoblast - erythropoietin binds to it and createsa a proerythroblast - cell develops into an erythrocyte 7 days later How does Aortic SL valve or bicuspid valve damage lead to heart failure ANSWER: damage leads to back flow into the left atrium or ventricle after ejection how does chronic bronchitis lead to respiratory acidosis? ANSWER: hyperinflation of the alveoli causes CO2 retention How does heart failure progress from hypertension? ANSWER: - high systemic vascular pressure causes high after load requires the left ventricle to increase contraction force to eject the blood - damage causes reduced ejection fraction and left ventricle gets tired and becomes unable to eject normal amount of blood - increased amount of blood remaining in left ventricle and increased left ventricle preload causes the left atrium unable to eject the normal amount of blood into the left ventricle - blood volume and pressure backs up into the pulmonary veins - increased pressure will force fluid from the pulmonary capillaries into the pulmonary tissues how does hyperinflation occur? ANSWER: the ongoing inflammatory process of asthma produces mucus and pus plug that the bronchial walls collapse around

How does LV hypertrophy lead to left sided heart failure ANSWER: The hypertrophy is secondary to cardiac damage resulting in an enlarged by weaker structure that holds more blood How does the lamina propria effect the lungs in regards to asthma ANSWER: the WBCs protective feature goes into overdrive causing an inflammatory response that damages host tissue How does the thickening and rigidity of bronchial basement membranes effect the lungs?

ANSWER: leads to further narrowing of the bronchial passageways Hypertrophy and hyperplasia of goblet cells do what in the bronchials ANSWER: promotes hypersecretion of mucus Intrarenal disease ANSWER: disease or damage within the kidney Kidney Anatomy ANSWER: renal artery renal vein cortex, medulla, renal pelvis ureter renal pyramid nephron kidney stone treatment ANSWER: high fluid intake, decreasing dietary intake of stone-forming substances, stone removal kidney stones ANSWER: Solid crystalline masses formed in the kidney, resulting from an excess of insoluble salts or uric acid crystallizing in the urine; may become trapped anywhere along the urinary tract. lamina propria ANSWER: the middle layer of the bronchioles Left sided heart failure characteristic ANSWER: inability of the left ventricle to provide adequate blood flow into systemic circulation MOA of anticholinergic drugs for asthma ANSWER: the parasympathetic system is stimulated by the vagal nerve to release

acetylcholine which binds to the cholinergic receptors of the respiratory tract to cause bronchial constriction = decreased airflow - blocking the cholinergic receptors prevents acetylcholine binding preventing the bronchial constriction most common irritant with bronchitis is? ANSWER: tobacco product smoke Nephron Anatomy ANSWER: 1. glomerulus 2. bowman's capsule 3. collecting duct 4. tubule 5. capillary normocytic normochromic anemia ANSWER: Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number Pathogenesis of bronchitis ANSWER: -Exposure to airborne irritants - Irritant activates bronchial smooth muscle constriction and mucus secretion - Triggers release of inflammatory mediators from immune cells located in the lamina propria pathogenesis of primary glomerulonephritis ANSWER: - infection triggers of immune response to cause formation of antibodies - antibodies form complexes with the pathogen that should be rapidly phagocytized by WBC - in glomerulonephritis the Ag-Ab complexes are not phagocytized in a timely manner and continue to circulate in the blood stream - the Ag-Ab complexes get trapped in the narrow vasculature of the glomerular capillaries - build up of the Ag-Ab complexes signals that immune system and the complement system and WBC infiltration of the site - Complement protein with enzymes released by phagocytic cells attack the complexes and cause collateral damage to the glomerular area - Damage weakens thee glomerular structure and plasma proteins with blood leak into the tubular system and pass out into the urine

Pathophysiology of asthma (5) ANSWER: -airway inflammation, bronchial hyper-reactivity and smooth muscle spasm -excess mucus production and accumulation -hypertrophy of bronchial smooth muscle -airflow obstruction -decreased alveolar ventilation Pathophysiology of tubular necrosis ANSWER: - ischemia or nephrotoxin exposure occurs to the renal tubules - inflammation and tubular injury occur - cast formation and tubular obstruction occurs - tubular injury, leakage, increased glomerular pressure causes decreased capillary perfusion further decrease in GFR occurs - oliguria results Perfusion ANSWER: The supply of oxygen to and removal of wastes from the cells and tissues of the body as a result of the flow of blood through the capillaries. polycystic kidney disease ANSWER: - Mutant PKD genes cause fluid accumulation in kidney tubules "cysts" - The cysts can be the size of grapes or oranges and compress and destroy nephrons polycythemia vera ANSWER: condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels postrenal disease ANSWER: obstruction in the lower urinary tract that prevents urine flow from the kidneys Potter syndrome ANSWER: Syndrome characterized by bilateral renal agenesis and incompatibility of live birth Prerenal disease ANSWER: decreased blood flow to and through the kidney prerenal disease causes ANSWER: - hypotension

- decreased cardia output - decreased blood volume Process of high output failure ANSWER: - impaired oxygen delivery of excessive tissue oxygen demands cause tissue hypoxia - catecholamines initiation increase HR and stroke volume - increased cardiac output is produced but depletes cardiac muscle reserve overtime and leads to low output failure over time Progression of right sided heart failure ANSWER: - damage causes the right ventricle to increase contraction force to eject/unload the blood - over time EF is reduced and right ventricle us unable to eject the normal amount of blood - the blood remaining in the RV increases and RA preload increases until the RA is unable to eject the normal amount of blood into the RA - the amount of blood remaining in the right atrium increases causing an increase in RA preload - blood volum enad pressure then backs up into the vena cava and systemic veins purpose of the lamina propria ANSWER: white blood cells are present to help protect the airways reabsorption (kidney) ANSWER: movement of solutes from filtrate to blood things taken back that were secreted of filtered by the kidney renal agenesis ANSWER: unilatral or bilateral failure of the kidneys to develop in utero results of chronic bronchitis/ low perfusion ANSWER: cyanosis right to left shunting

chronic hypoxemia right sided heart failure ANSWER: inability of the right ventricle to provide adequate blood flow into the pulmonary circulation Right to left shunting ANSWER: when blood passes from the right ventricle through the lungs and to the left ventricle without perfusion Role of macrophages ANSWER: -In Innate: 1. Phagocytosis PRR or opsonization w/ complement 2. Secrete Cytokines: Recruit more cells, inflammation, fever, etc.

-In Adaptive: 1. Phagocytosis: opsonization with complement or Abs 2. Secrete cytokines: recruit more cells etc.

3. Antigen presentation: peptides from the broken down pathogen are displayed on surface of the cell. secretion (kidney) ANSWER: movement of solutes from blood to filtrate anywhere besides bowman's capsule able to secrete salts, acids, bases and urea directly into the tubule via *active or passive transport* what is secreted into the tubule depends on what the body needs at that time

ex. eating a lot of protein nitrogen waste is a product of protein metabolism (ammonia) liver converts ammonia to urea and the kidneys secreted urea into the tubule for secretion also possible to eliminate products that are in excess in the blood -- potassium, hydrogen, metabolites or medications can secrete things that were too larger to fit through the glomerulus's pore

signs and symptoms of right sided heart failure ANSWER: jugular vein distension hepatosplenomegaly peripheral edema sliding filament theory ANSWER: theory that actin filaments slide toward each other during muscle contraction, while the myosin filaments are still Stenosis of a heart valve, may result in what? ANSWER: Narrowing of the heart valves means that blood moves with difficulty out of the heart. Results may include chest pain, edema in the feet or ankles, and irregular heartbeat. and hypertrophy Stenosis of heart valve ANSWER: A narrowing of the valve opening, causing turbulent flow and enlargement of the emptying chamber Stimulation of what set a resting HR (chronotropic state) ANSWER: parasympathetic system structure of the lamina propria ANSWER: embedded with connective tissue cells and immune cells Troponin-Calcium Binding ANSWER: Calcium binds to troponin on the thin filament tubular necrosis ANSWER: the renal tubules cells are highly sensitive to low oxygen levels or presence of toxins and leads to tubular necrosis vesicoureteral reflux ANSWER: Abnormal ureter-bladder connection allowing retrograde flow of urine from bladder to ureters and/or kidneys What acid-base disorder is seen in chronic bronchitis? ANSWER: respiratory acidosis What are 5 s/s of asthma ANSWER: coughing

wheezing shortness of breath rapid breathing chest tightness What are characteristics of epithelial cell metaplasia? ANSWER: squamous cells become nonciliated and are less protective; allow passage of toxins and WBCs What are most cases of AKI caused by? ANSWER: prerenal issues What are the atrioventricular valves? ANSWER: tricuspid and bicuspid (mitral) valves What are the semilunar valves? ANSWER: pulmonary and aortic valves What are the two parts of the cardiac cycle? ANSWER: diastole and systole What are two anticholinergic drugs used for asthma ANSWER: tiotropium and ipratropium What are two common causes of hypovolemia ANSWER: dehydration and hemorrhage what can cause an increase in afterload ANSWER: systemic hypertension valve disease COPD (pulmonary hypertension) What can cause decreased preload ANSWER: cardiac tamponade and hypovolemia What can cause increased preload ANSWER: CHF and hypervolemia what can decrease afterload ANSWER: hypotension or vasodilation

What can extreme vagal response result in? ANSWER: life threatening bradycardia What can uncontrolled tachycardia lead to? ANSWER: reduced stroke volume and fatigue What causes blood to move from the atria to the ventricles ANSWER: gravity and atriole systole What causes the S1 heart sound? ANSWER: Bicuspid/Mitral and Tricuspid valves closing What causes the S2 heart sound? ANSWER: closing of semilunar (aortic and pulmonary) valves What causes the semilunar valves to close? ANSWER: ventricles relax and intraventricular pressure falls, blood flows back from the arteries, and fill the cusps of the semilunar valves What causes the semilunar valves to open? ANSWER: As ventricles contract and intraventricular pressure rises, blood is pushed up against the SL valves, forcing them to open what decreases cardiac muscle contraction ANSWER: low ATP levels; ischemia hypoxia or acidosis What do anticholinergics do in the lungs? ANSWER: These drugs block the effects of the parasympathetic nervous system - increasing bronchodilation What does angiotensin II do? ANSWER: increases blood pressure by vasoconstriction What does fluid in the pulmonary tissue result in ANSWER: the areas are flooded and results in pulmonary edema and dyspnea what does long term exposure to irritants promote in bronchitis? (5) ANSWER: - smooth muscle hypertrophy - hypertrophy and hyperplasia of goblet cells

- epithelial cell metaplasia - migration of more WBC to site - thickening and rigidity of bronchial basement membrane What does smooth muscle hypertrophy do in lungs? ANSWER: causes increased bronchoconstriction What does the innermost layer of the bronchioles contain ANSWER: columnar epithelial ells and mucus producing goblet cells What does the migration of WBCs to the bronchials do? ANSWER: increases inflammation of the cite and causes fibrosis in the bronchial wall What does the outermost layer of the bronchioles contain ANSWER: smooth muscle cells what does the outermost layer of the bronchioles do ANSWER: control the airways ability to constrict and dilate What does the parasympathetic system do? ANSWER: It releases acetycholine which decreases heart rate and causes vasodilation What does the sympathetic system promote in the cardiac system ANSWER: vasoconstriction and increased HR What effects amount of water and solute reabsorption ANSWER: ADH and aldosterone What electrolytes are used for cardiac muscle contraction? ANSWER: sodium potassium and calcium What happens in renal failure when the coagulation cascade is activated ANSWER: fibrin is deposited in the glomerular structure and decreases capillary perfusion by causing blockages and further decreases GFR further What happens when cardiac fibers overstretch during diastole? ANSWER: decreased contraction due to fibers being unable to snap back What increases cardiac muscle contraction ANSWER: sympathetic stimulation; fear anxiety and increased thyroxine

what influences afterload (3) ANSWER: ventricle wall thickness (muscle strength) arterial pressure (resistance to ejection) ventricle chamber size (blood volume capacity) what influences cardiac contractility (inotropic state) ANSWER: levels of electrolytes High levels of ATP level of oxygen available synchronous muscle contraction What is preload? ANSWER: the degree of stretch on the heart before it contracts/ amount of blood entering the ventricles during diastole What is the formula for cardiac output ANSWER: CO = HR x SV What is the most common cause of right sided heart failure ANSWER: pulmonary hypertension what kind of anemia can result from incorrect blood transfusion ANSWER: hemolytic anemia What mediates the sympathetic system ANSWER: epinephrine and norepinephrine What prevents the backflow into the ventricles ANSWER: semilunar valves what solutes are typically reabsorbed ANSWER: glucose, ions, amino acids and urea what stimulates the parasympathetic system ANSWER: the vagus nerve What type of relationship does heart rate and stroke volume have? ANSWER: inverse low HR = longer fill time = increase stroke volume

high HR = lower fill time = lower stroke volume When fibers stretch during diastole how does that effect contraction? ANSWER: contraction is stronger Where does air enter the body? ANSWER: naso and oropharynx (mouth and nose) Where does air flow after the bronchi? ANSWER: into the smaller bronchioles Where does air flow after the bronchioles? ANSWER: into the alveoli Where does air go after it passes through the nose and mouth? ANSWER: it passes through the trachea Where does blood cell formation occur in a fetus ANSWER: 3 weeks - yolk week 8 - fetal liver and spleen 5th month - bone marrow Where is most of the solute reabsorbed? ANSWER: proximal convoluted tubule Why are kidneys and bladders at high risk for cancer ANSWER: - UT is the route of excretion for many toxins and contains highly mitotic cells Why does hepatosplenomegaly develop in right sided heart failure ANSWER: the large volume of blood flow through the liver and spleen causes these areas to be engorged why does peripheral edema occur in right sided heart failure ANSWER: Increased pressure forces fluid from the systemic capillaries into the peripheral tissues and flood those areas Why is there azoetmia with renal failure? ANSWER: Decreased GFR means waste is remains in the bloodstream and is not excreted

Why is there cyanosis with chronic bronchitis ANSWER: there is hypoxia due to unfavorable conditions for gas exchange Why is there edema with glomerulonephritis ANSWER: the loss of albumin from the bloodstream reduces plasma oncotic pressure and results in edema Why is there oliguria with renal failure? ANSWER: when the glomerual structure has sustained enough damage the nephron structure is no longer functional as a filtration unit Wilms tumor ANSWER: - Embryonal kidney tumor associated with defective tumor (WT) genes - Tumors are typically not clinically diagnosable until age 1-5 even though they are present at birth