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MIDTERM EXAM: NR 507
ADVANCED PATHOPHYSIOLOGY,
2025/2026 WITH
CORRECT/ACCURATE ANSWERS
anemia risk factors - CORRECT ANSWERS- acute or chronic blood loss, increased hemolysis, inadequate dietary intake or malabsorption, bone marrow suppression, age function of hemoglobin - CORRECT ANSWERS- 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. causes of anemia - CORRECT ANSWERS- - impaired RBC production
- excessive blood loss
- increased RBC destruction hemolytic anemia - CORRECT ANSWERS- premature destruction of RBCs causes of hemolytic anemia - CORRECT ANSWERS- infection transfusion reaction
hemolytic disease of the newborn (Rh incompatibility) autoimmune reaction drug induced development of anemia due to gastrectomy - CORRECT ANSWERS- loss of intrinsic factor from surgery results in the loss of protein necessary for vitamin B12 absorption an can lead to anemia what kind of anemia can result from incorrect blood transfusion - CORRECT ANSWERS- hemolytic anemia normocytic normochromic anemia - CORRECT ANSWERS- Characterized by red cells that are relatively normal in size and hemoglobin content but insufficient in number hemolytic anemia is what kind of anemia - CORRECT ANSWERS- normocytic normochromic anemia polycythemia vera - CORRECT ANSWERS- condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels Kidney Anatomy - CORRECT ANSWERS- renal artery renal vein cortex, medulla, renal pelvis ureter renal pyramid nephron
secretion (kidney) - CORRECT ANSWERS- 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 filtration (kidney) - CORRECT ANSWERS- 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 Conditions associated with renal failure - CORRECT ANSWERS- - congenital abnormalities in the urethral tract development
- kidney and bladder cancer
- infections
- glomerulonephritis
- acute/ tubular necrosis
- AKI
Descending infection - CORRECT ANSWERS- 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. Ascending infection - CORRECT ANSWERS- - urethra to bladder, and then to kidney
- due to: bacteria from residual fecal contamination glomerulonephritis - CORRECT ANSWERS- inflammation of the glomeruli of the kidney tubular necrosis - CORRECT ANSWERS- the renal tubules cells are highly sensitive to low oxygen levels or presence of toxins and leads to tubular necrosis Causes of tubular necrosis - CORRECT ANSWERS- - being post operative
- severe sepsis
- burns
- trauma
- contrast chemical use in medical imaging procedures Pathophysiology of tubular necrosis - CORRECT ANSWERS- - 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 Acute Kidney Injury - CORRECT ANSWERS- Sudden decline in kidney function with a decrease in GFR and an increase in plasma creatinine and BUN levels -results in oliguria Prerenal disease - CORRECT ANSWERS- decreased blood flow to and through the kidney prerenal disease causes - CORRECT ANSWERS- - hypotension
- decreased cardia output
- decreased blood volume What are most cases of AKI caused by? - CORRECT ANSWERS- prerenal issues Intrarenal disease - CORRECT ANSWERS- disease or damage within the kidney Causes of intrarenal disease - CORRECT ANSWERS- ATN Acute glomerulonephritis
imobility. Stoned more common in men than women usually ages 30/50. benign prostatic hyperplasia - CORRECT ANSWERS- benign growth of cells within the prostate gland BPH (benign prostatic hyperplasia) - CORRECT ANSWERS- Age- associated prostate gland enlargement that can cause urination difficulty. BPH treatment - CORRECT ANSWERS- - Alpha-adrenergic antagonists: terazosin, doxazosin
- 5-alpha reductase inhibitors: finasteride, dutasteride
- Transurethral prostatectomy
- Open prostatectomy pathogenesis of primary glomerulonephritis - CORRECT ANSWERS- - 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 clinical indicators of glomerulonephritis - CORRECT ANSWERS- - proteinuria
- hematuria
- edema
- azotemia
- oliguria
- coagulation cascade activation Why is there edema with glomerulonephritis - CORRECT ANSWERS- the loss of albumin from the bloodstream reduces plasma oncotic pressure and results in edema Azoetmia - CORRECT ANSWERS- presence of elevated plasma creatinine
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 angiotensin converting enzyme (ACE) - CORRECT ANSWERS- an enzyme that converts angiotensin I to angiotensin II What does angiotensin II do? - CORRECT ANSWERS- increases blood pressure by vasoconstriction Role of macrophages - CORRECT ANSWERS- -In Innate:
- Phagocytosis PRR or opsonization w/ complement
- Secrete Cytokines: Recruit more cells, inflammation, fever, etc. -In Adaptive:
- Phagocytosis: opsonization with complement or Abs
- Secrete cytokines: recruit more cells etc.
- Antigen presentation: peptides from the broken down pathogen are displayed on surface of the cell. Asthma - CORRECT ANSWERS- Chronic disease due to bronchoconstriction and an excessive inflammatory response in the bronchioles What are 5 s/s of asthma - CORRECT ANSWERS- coughing wheezing shortness of breath rapid breathing chest tightness Pathophysiology of asthma (5) - CORRECT ANSWERS- -airway inflammation, bronchial hyper-reactivity and smooth muscle spasm -excess mucus production and accumulation -hypertrophy of bronchial smooth muscle -airflow obstruction -decreased alveolar ventilation Bronchioles - CORRECT ANSWERS- smaller passageways that originate from the bronchi that become the alveoli
what does the outermost layer of the bronchioles do - CORRECT ANSWERS- control the airways ability to constrict and dilate alveolar hyperinflation - CORRECT ANSWERS- 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 how does hyperinflation occur? - CORRECT ANSWERS- the ongoing inflammatory process of asthma produces mucus and pus plug that the bronchial walls collapse around Effect of hyperinflation of the alveolar - CORRECT ANSWERS- - expanded thorax and hypercapnia (retention of CO2)
- respiratory acidosis What are two anticholinergic drugs used for asthma - CORRECT ANSWERS- tiotropium and ipratropium What do anticholinergics do in the lungs? - CORRECT ANSWERS- These drugs block the effects of the parasympathetic nervous system
- increasing bronchodilation MOA of anticholinergic drugs for asthma - CORRECT ANSWERS- 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 bronchitis - CORRECT ANSWERS- inflammation of the bronchial tubes 3 characteristics of bronchitis - CORRECT ANSWERS- bronchial inflammation hypersecretion of mucus chronic productive cough for at least 3 consecutive months for at least 2 successive years Perfusion - CORRECT ANSWERS- 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. results of chronic bronchitis/ low perfusion - CORRECT ANSWERS- cyanosis right to left shunting chronic hypoxemia
- 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? - CORRECT ANSWERS- causes increased bronchoconstriction Hypertrophy and hyperplasia of goblet cells do what in the bronchials - CORRECT ANSWERS- promotes hypersecretion of mucus What are characteristics of epithelial cell metaplasia? - CORRECT ANSWERS- squamous cells become nonciliated and are less protective; allow passage of toxins and WBCs What does the migration of WBCs to the bronchials do? - CORRECT ANSWERS- increases inflammation of the cite and causes fibrosis in the bronchial wall How does the thickening and rigidity of bronchial basement membranes effect the lungs? - CORRECT ANSWERS- leads to further narrowing of the bronchial passageways What acid-base disorder is seen in chronic bronchitis? - CORRECT ANSWERS- respiratory acidosis
how does chronic bronchitis lead to respiratory acidosis? - CORRECT ANSWERS- hyperinflation of the alveoli causes CO retention Where does air enter the body? - CORRECT ANSWERS- naso and oropharynx (mouth and nose) Where does air go after it passes through the nose and mouth? - CORRECT ANSWERS- it passes through the trachea After air passes through the trachea where does it go? - CORRECT ANSWERS- goes into the left or right bronchi Where does air flow after the bronchi? - CORRECT ANSWERS- into the smaller bronchioles Where does air flow after the bronchioles? - CORRECT ANSWERS- into the alveoli Describe how blood flows to become oxygenated - CORRECT ANSWERS- - deoxygenated systemic blood flows from the vena cava to R atrium
- Tricuspid valve opens to flow to R ventricle
