Test 2 practice Qs

Question 1

What types of shock are associated w widespread vasodilation?

Answer 1

• Anaphylactic
• Septic
• Neurogenic

Question 2

Which type of shock might occur after a MI?

Answer 2

Cardiogenic

Question 3

During which phase of hypovolemic shock would you likely see a rise in vital signs?

Answer 3

Phase II

Question 4

Which of the following are main treatment methods for anaphylactic shock?

Answer 4

• Antihistamines

- IM adrenaline

Question 5

Outline the underlying pathophysiology for the following signs/symptoms common to most types of shock:
Hypotension, Change in HR, Oliguria, Change in temp

Answer 5

• Hypotension: drop in CO
• HR: compensatory mechanism, increases as SNS response to fall in CO/BP
• Oliguria: vasocontriction and incr. water retention due to SNS and RAAS.
• Change in temp: vasoconstriction or vasodilation

Question 6

Which 2 body systems/structures are responsible for regulating acid-base balance?

Answer 6

Renal system (kidneys) and respiratory system(lungs)

Question 7

T/F?

The lungs can expel both acids and bases?

Answer 7

False

Question 8

Name the type of pH imbalance for each description:

1. Decreased expulsion of CO2
2. Too much bicarbonate lost or increased acid production
3. Too many acids are lost or incr. bicarb retention
4. Increased expulsion of CO2

Answer 8

1. Respiratory acidosis
2. Metabolic acidosis
3. Metabolic alkalosis
4. Respiratory alkalosis

Question 9

Identify which pH imbalances are compensated for by the following mechanisms:

1. Renal compensation occurs via changes to acid/base secretion
2. Respiratory compensation occurs via alterations to ventilation

Answer 9

1. Metabolic acidosis and alkalosis

2. Respiratory acidosis and alkalosis

Question 10

Identify the causes of the following sodium imbalances:

1. Hypernatremia
2. Hyponatremia

Answer 10

1. Sodium gain, water loss

2. Sodium loss, water gain

Question 11

T/F:

1. Water follows sodium
2. Potassium moves in opposite direction to sodium
3. Chloride follows sodium

Answer 11

All are true!

Question 12

Outline why changes in K+ concentration can result in alterations to cardiac function

Answer 12

The movement of K+ across cardiac cell membranes has a role in AP signalling. Changes in conc. affects transmission of electrical signals and subsequently the contraction of the myocardium.

Question 13

What is another name for kidney stones?

Answer 13

Calculi

Question 14

Briefly explain the patho of a urinary tract obstruction

Answer 14

An obstruction of the UT that causes the accumulation of urine proximal to the obstruction, resulting in dilation. This affects the nephrons (decr. GFR, reabsorption, secretion, urine conc.) and incr. UTI risk. Can ultimately lead to AKI or CRD

Question 15

4 Typical signs of cystitis?

Answer 15

• Incr. urinary freq.
• Dysuria (pain w urination)
• Incr. urgency to urinate
• Lower abdominal pain/discomfort

Question 16

T/F?

Ischemia and toxins are the 2 major causes of acute tubular necrosis

Answer 16

True

Question 17

In which renal condition associated with bacterial infection do antigen-antibody complexes become trapped within the glomeruli?

Answer 17

Acute glomerulonephritis

Question 18

Determine whether the following causes of acute kidney injury belong to: prerenal cause, intrinsic cause, or postrenal cause.

• Hypotension
• Glomerulonephritis
• Septic shock
• Polycystic kidney disease
• Kidney stones
• Acute tubular necrosis
• Neurogenic bladder
• Cardiac failure

Answer 18

Prerenal:
Hypotension
Septic shock
Cardiac failure

Instrinsic:
Glomerulonephritis
Polycystic kidney disease
Acute tubular necrosis

Postrenal:
Neurogenic bladder
Kidney stones

Question 19

Describe chronic kidney disease and its pathophysiology

Answer 19

Progressive loss of renal function.

• Progressive loss of functioning nephron mass, causing surviving nephrons to compensate, maintaining a constant rate of excretion w/in an overall declining GFR
• The hyperfiltration of the functioning nephrons results in further nephron injury leading to end-stage kidney disease
• Process:
  1. Glomerular hypertension, hyperfiltration, and hypertrophy
  2. Glomerulosclerosis (scarring)
  3. Tubulointerstitial inflammation and fibrosis

Question 20

Describe uremia

Answer 20

Sydrome of chronic kidney disease characterised by azotemia (abnormally high levels of nitrogen-containing compounds, e.g. urea and creatinine) and the accompanying systemic symptoms

Question 21

Identify some common signs/symptoms of anemia

Answer 21

Fatigue, jaundice, pallor, dizziness, SOB, GI symptoms, feeling cool/cold peripheries, neurological symptoms (numbness, weakness, etc.)

Question 22

Which 2 types of anaemia does macrocytic anaemia include?

Answer 22

• Vitamin B12 deficiency anaemia

- Folate deficiency anaemia

Question 23

Why does a lack of intrinsic factor lead to vitamin B12 deficiency?

Answer 23

Because IFis required for intestinal absorption of vitamin B12

Question 24

Pernicious anemia is related to a decrease in what?

Answer 24

Vitmain B12 absorption

Question 25

Briefly describe aplastic anaemia

Answer 25

Decreased blood cell production due to bone marrow stem cell destruction

Question 26

Briefly describe sickle cell anaemia

Answer 26

Abnormal Hb synthesis resulting in sickle shaped RBCs (inherited disorder)

Question 27

Briefly describe hemolytic anaemia

Answer 27

Accelerated destruction of RBCs

Question 28

Briefly describe thalassemia

Answer 28

Inherited disorder affecting globin chain synthesis resulting in decreased Hb

Question 29

What is primary polycythemia?

Answer 29

Excess RBC production caused by a mutation in the bone marrow cells

Question 30

Which of the following is a risk factor for folate deficiency anaemia? - Alcoholism - Neural tube defects - Chronic atrophic gastritis - Hemmorhage

Answer 30

Alcoholism

Question 31

Which type of polycythemia is related to dehydration?

Answer 31

Relative polycythemia

Question 32

What is leukopenia?

Answer 32

Reduction in WBC numbers

Question 33

Outline the pathophysiology of leukemia associated w cytopenia and thus anemia, bleeding and infections

Answer 33

Malignancy of un- or partially differentiated cells of hematopoiesis, leading to a build up of malignant cells w/in bone marrow. This crowds out/reduces the number of healthy blood cells produced, therefore reducing numbers of RBCs, WBCs and platelets.

Question 34

What are some of the "B symptoms" associated w lymphoma?

Answer 34

Unexplained fever Weight loss Night sweats

Question 35

In acute leukemia, genetic abnormalities and malignancy develop within which blood cell stage of development?

Answer 35

Blast cells

Question 36

Which condition is characterized by the presence of Reed-Sternberg (RS) cells?

Answer 36

Hodgkin lymphoma

Question 37

Which specific type of cell becomes malignant in myeloma?

Answer 37

Plasma B cells

Question 38

What are the signs/symptoms used in the diagnosis of myeloma?

Answer 38

Renal failure Anemia Hypercalcemia Osteolytic bone lesions

Question 39

With lymphoma, where does malignancy of lymphocytes occur?

Answer 39

Within the lymphatic system

Question 40

Outline the phases of an acute infection

Answer 40

1. Incubation period: asymptomatic, pathogen is replicating. 2. Prodromal phase: mild/vague symptoms begin to appear, pathogen still replicating 3. Illness: period of significant symptoms, specific to infection  4. Decline: decline in signs/symptoms as pathogen is eliminated from the body 5.  Convalescence: signs/symptoms disappear, infection contained/eliminated

Question 41

``` Which of the following sexually transmitted infections has a high association with cervical cancer? Gonorrhea HPV Chlamydia HIV ```

Answer 41

HPV

Question 42

Which type of infection causes common warts (verrucae)?

Answer 42

HPV

Question 43

Which infection often presents with productive cough, night sweats and weight loss?

Answer 43

Tuberculosis

Question 44

Which infections are caused by members of the herpes family of viruses? - HPV - Chickenpox - Viral hepatitis - Shingles - Cold sores - UTIs

Answer 44

- Chickenpox - Shingles - Cold sores

Question 45

What is the defining manifestation of the icertus phase of a viral hepatitis infection?

Answer 45

Jaundice

Question 46

Identify three (3) common healthcare acquired infections (HAI).

Answer 46

- UTIs - pneumonia - Surgical site infections - Central line acquired blood stream infection - MRSA infections - Clostridium difficile infection

Question 47

Through which of the following body fluids is HIV more readily transmitted? - Semen - Sweat - Breastmilk - Blood - Saliva

Answer 47

- Blood - Semen - Breastmilk

Question 48

Which type of influenza most readily mutates, regularly resulting in new strains?

Answer 48

Influenza A

Question 49

How do penicillins work?

Answer 49

Inhibit the formation of crosslinks in bacterial cell walls which weakens the peptidoglycan structure, causing the bacteria to lyse.

Question 50

What is the difference between hypovolemia and hypervolemia? | What do you do if someone presents with each of these?

Answer 50

1. Hypovolaemia: low ECF vol. Both fluid and sodium are lost together (unlike dehydration which is just water), so implement controlled rehydration using fluid and sodium with isotonic solutions of electrolytes and glucose. 2. Hypervolaemia: high ECF vol. (e.g. excess administration of IV saline). Restrict fluid intake to correct the hypervolaemia.

Question 51

Signs and symptoms of hypernatremia and hyponatremia

Answer 51

1. Hypernatraemia: accompanied by hyperchloraemia (bc Cl- follows Na). Causes intracellular dehydration and hypervolaemia. Symptoms incl. thirst, fever, dry mucous membranes and restlessness. Also weight gain, strong pulse and incr. BP. 2. Hyponatraemia: accompanied by hypochloraemia. Alters cell's ability to de- and repolarise normally, hence severe complications for neuronal/muscular APs. Causes lethargy, confusion, apprehension, slow reflexes, seizures and coma. Also muscle twitching and weakness.

Question 52

Signs and symptoms of hypokalaemia and hyperkalaemia

Answer 52

1. Hypokalaemia: mild is usually asymptomatic, severe causes decreased neuron and muscular excitability, causing skeletal muscle weakness, cardiac arrhythmias, glucose intolerance, etc. 2. Hyperkalaemia: mild = restlessness, intestinal cramping and diarrhoea. Severe = muscle weakness, loss of muscle tone and parlaysis.

Question 53

Describe AKI and its pathophysiology

Answer 53

- Sudden decline in kidney function occurring over hours-days. - Inhibits the ability to regulate fluid, electrolyte and acid-base balance - associated with a decrease in glomerular filtration and accumulation of nitrogenous waste products in the blood Patho: 1. Prerenal AKI - impaired renal blood flow - GFR decline bc decr. filtration pressure - poor perfusion 2. acute tubular necrosis 3. postrenal - urinary tract obstruction - causes incr. intraluminal pressure prior to obstruction w gradual dec. GFR.

Question 54

Signs/symptoms of anaemia (in general)

Answer 54

Fatigue, feeling cold, and pallor. However in mild anaemia and where compensation has occurred (e.g. incr. RR/depth, incr. HR, incr. BP) may be asymptomatic.