Download NU 606~Exam 2~Advanced Pathophysiology: Gould's Pathophysiology 6th - Ch 5,6,7,10,11 Quest and more Exams Nursing in PDF only on Docsity!
NU 606~Exam 2~Advanced Pathophysiology:
Gould's Pathophysiology 6th - Ch 5,6,7,10,
Questions With Complete Solutions
What is the body's first line of defense? correct answer: mechanical barrier such as intact skin and mucous membrane Identify the body's second and third lines of defense. correct answer: second: processes of phagocytosis and inflammation; third: the immune system response Which of the three lines of defense are specific? Explain what is meant by "specific defense mechanism." correct answer: The immune system is the specific defense mechanism of the body. It provides protection by stimulating a unique response following exposure to foreign substances. Define phagocytosis. Identify types of cells that are phagocytic. correct answer: process by which neutrophils, monocytes, and macrophages engulf and destroy bacteria, cellular debris, or foreign material What is inflammation, and what is its basic function? Identify some causes of inflammation. correct answer: Inflammation is the body's nonspecific response to injury that involves increased blood flow to the area to localize and remove an injurious agent. Inflam- mation can cause redness, swelling, warmth, and pain; loss of function is also possible. It may be caused by direct physical damage such as cuts or sprains, caustic chemicals such
as acids or drain cleaners, ischemia or infarction, allergic reactions, extremes of heat or cold, foreign bodies such as splinters or glass, and infection. Identify the two main events of the "vascular response" that occur during an inflammatory response. Explain their function as part of the response and the direct effects of each event. correct answer: The two main events are vasodilation, and increased capillary permeability in response to a chemical mediator (e.g., histamine, serotonin) released at the site of injury. This allows for the accumulation in the area of fluid (to dilute any toxic substances) and specific plasma proteins such as globulins or antibodies (to react with specific antigens) and fibrinogen (to form a fibrin mesh to localize the problem). Identify the four cardinal signs of an inflammatory response and the cause of each. correct answer: • Redness (rubor or erythema) Due to increased blood flow to the damaged area
- Heat Also due to increased blood flow
- Swelling (edema) Caused by the shift of protein and fluid into the interstitial space • Pain Due to increased pressure of fluid on the nerves Outline the sequence of events involved in the cellular response of inflammation. correct answer: • chemotaxis
- margination
- emigration (diapedesis)
- phagocytosis and subsequent release of lysosomal enzymes involved in cell-mediated immunity correct answer: neutrophils
What is the four-letter acronym that lists the approach to first aid for injury-related inflammation? correct answer: R = Rest allows time for healing, minimizing further pain and irritation to the injured area. I = Early application of cold causes vasoconstriction, decreasing pain and edema. C = Compression reduces edema and pain by activating alternate sensory pathways. E = Elevation improves fluid flow away from the damaged area. Identify the differences between nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids or steroidal anti- inflammatory drugs. correct answer: NSAIDs are analgesic and antipyretic. They may cause allergic reactions, slow blood clotting, and cause nausea and/or stomach ulceration. Steroids decrease immune responses and increase the risk for infection, hypertension, and edema. They may also cause osteoporosis and skeletal muscle wasting. Identify the differences between NSAIDs and acetaminophen. correct answer: NSAIDs are antiinflammatory. They may cause allergic reactions and slow blood clotting. Acetamino- phen has no antiinflammatory action. Overuse at higher dosages than recommended may cause kidney and liver damage. Identify additional nonpharmacologic therapies/treatment that could be used to treat inflammation, particularly conditions that are chronic, such as arthritis. correct answer: heat, physiotherapy, adequate nutrition and hydration, mild to
moderate exercise, elastic stockings to reduce fluid accumulation Differentiate between the processes of resolution and regeneration. correct answer: Resolution occurs when there is minimal tissue damage, the damage is repaired, and cells recover and resume normal function in a short time. Regeneration is the healing process that occurs in tissues whose cells are capable of mitosis (e.g., epithelial cells of the skin, gastrointestinal tract). The damaged cells are replaced by the proliferation of nearby undamaged cells. Identify potential complications that may occur during the healing process with scar formation. correct answer: loss of function; contractures and obstructions; adhesions; hypertrophic scar tissue; ulceration Explain why full-thickness burns initially may be painless but later become very painful. correct answer: Nerves in the burned area have been destroyed. Other than tissue destruction, what complications may arise from a burn? correct answer: shock, respiratory problems, pain, infection List some of the actions that may be taken to aid in the prevention of infection in the healing of a burn. correct answer: excision/removal of damaged tissue, antibiotics, covering of wound
C: Vibrio, D: spirilla, E: pleiomorphic, F: spirochete, G: diplo-, H: staph(ylo)-, I: strep(to)-, J: palisade, K: tetrad Explain the difference between gram-positive and gram-negative bacteria. correct answer: Gram-positive bacteria have a thick peptidoglycan layer in the cell wall, and they stain purple with the standard Gram stain process. Gram- negative bacteria have a very thin peptidoglycan layer, and they stain red/pink in the Gram stain process. Explain the differences between exotoxins and endotoxins. correct answer: Exotoxins are produced/secreted by gram- positive bacteria. Endotoxins are components of the cell wall of gram-negative organisms. What is an endospore or bacterial spore? Describe the process of spore formation. Identify some genera of bacteria that produce spores. correct answer: Endospores are latent forms of some bacterial species with an outer coat that is resistant to heat and other environmental conditions. Examples of spore-producing bacteria include tetanus (C. tetani) and botulism (C. botulinum). Bacteria reproduce by a process called binary fission. Describe this process. correct answer: Binary fission is simply dividing in
half, forming two daughter cells identical to the parent bacterium. Why are viruses said to be "obligate intracellular parasites"? correct answer: They require a living host cell for replication. Describe the structure of a viral particle or virion. correct answer: The virion consists of a protein coat or capsid and a DNA or RNA nucleic acid core. Outline the basic steps of viral infection/replication. correct answer: Virus attaches to the host cell and penetrates. It uncoats and takes over the host cell DNA. The host cell synthesizes viral components. The components assemble and are released by host cell lysis. Sometimes the virus may remain inactive in the host cell or activate at a later time. Describe the basic structures of the single-cellular and multicellular forms of a fungus. correct answer: Fungi are classified as eukaryotic. They consist of cells or chains of cells and may have long filaments called hyphae that intertwine to form a mass called the mycelium, which is large enough to be visible. chlamydiae correct answer: pelvic inflammatory disease; eye infections in newborn of infected mothers rickettsiae correct answer: rocky mountain spotted fever, typhus fever mycoplasmas correct answer: pneumonia
Immunodeficiency or immunodepression can result in opportunistic infections; relocation of normal flora to another body site can also result in the production of disease. Pneumocystis carinii pneumonia correct answer: fungi candidiasis correct answer: fungi syphilis correct answer: bacteria trichomoniasis correct answer: protozoa tuberculosis correct answer: bacteria pneumonia correct answer: bacteria, viruses, fungi tetanus correct answer: bacteria Rocky Mountain spotted fever correct answer: rickettsiae tinea pedis correct answer: fungi herpes simplex correct answer: viruses influenza correct answer: viruses botulism correct answer: bacteria What is the basic difference between a disinfectant and an antiseptic? correct answer: Disinfectants are designed for use on
nonliving surfaces; antiseptics are designed to be used on living tissue. Identify the components in the infection chain and ways in which the cycle can be broken. correct answer: The components and means to break the cycle include locating and removing the reservoir or sources of infection; blocking the exit from the source; providing or cleaning/sterilizing barriers; maintaining immunizations; and treating or quarantining infection or carrier. Describe the methods for determining the effectiveness of an antimicrobial agent as a possible treatment for a specific infection. correct answer: The disk diffusion method involves plating a small amount of the specimen to produce a bacterial colony and placing paper disks impregnated with an antibiotic on the inoculated plate. After a 24-hour incubation, if there is a clear zone of inhibition surrounding the disk, the zone will be measured to determine the effectiveness of the agent. If there is no zone, the bacteria are resistant to the antibiotic. The Minimum Inhibitory Concentration method uses a series of dilutions of an antimicrobial agent applied against a known pathogen to determine the minimum concentration of a specific agent that is effective against the organism. spectrum correct answer: the range of bacteria for which the drug is effective: narrow, either gram-positive or gram-negative; broad, both gram-positive and gram-negative bacteria bacterial resistance correct answer: bacteria that develop or adapt so as to lose their sensitivity to a drug, such as altering
If an antibacterial drug is bacteriostatic rather than bactericidal, how does the individual ever destroy the infecting microorganism? correct answer: The drug prevents replication of the bacteria, thereby keeping the number of bacteria constant —the body's own defensive cells will destroy the organism. When would the prescription of a bacteriostatic drug not be advisable? correct answer: if the individual was immunosuppressed (e.g., organ transplant recipient) or immunodeficient (e.g., someone with AIDS) Explain how the misuse or overuse of antibacterial agents could lead to the development of bacterial resistance. correct answer: Bacteria adapt and/or mutate to develop various means of losing drug sensitivity; excessive or unnecessary use of drugs provides a stimulus for such adaptation. If antibacterial drugs are not effective in the treatment of viral infections, why are they often prescribed for individuals with chronic viral infections such as hepatitis B, hepatitis C, or HIV? correct answer: because they may reduce the risk for secondary bacterial infection Identify guidelines that an individual should follow to maximize the effects of antibacterial medications. correct answer: The drug should be taken regularly according to the prescription. The drug should be taken until the prescription is completely used. Follow instructions regarding food or fluid intake. Provide a good medical history, including known drug allergies.
Explain why it has been difficult to develop antiviral drugs. correct answer: Because viruses are obligate intracellular parasites, a drug that destroys viruses would also destroy the host cell. Rule of Nines correct answer: method used to calculate the amount of fluid lost as the result of a burn; divides the body into 11 areas, each accounting for 9% of the total body area What is a cell surface antigen? Why is it important? correct answer: A cell surface antigen is a unique protein or glycoprotein configuration that is a distinctive marker for the recognition of a cell by the immune system. It provides the means by which the immune system distinguishes self from nonself. It is important because it provides for the detection and identification of "nonself" by the immune system. This differentiation underlies the host defense against infection and other foreign antigens, and it forms the basis for selection of compatible organs and tissues for transplantation. What is the major histocompatibility complex (MHC), and how is it related to the human leukocyte antigens (HLAs)? correct answer: The major histocompatibility complex (MHC) cell membrane antigens are molecules that are specific for each individual. The HLA is the human MHC on human leukocytes that determine "self" and serve as the basis for identifying histocompatible cells and tissues for transplantation, including blood transfusion. vasodilation: correct answer: histamine, prostaglandins, kinins, leukotrienes
Helper T cells (T4 or CD4 lymphocytes) correct answer: activate B and T cells; limit immune response Memory T cells correct answer: remember antigen and stimulate immune response upon subsequent exposure (secondary response) Suppressor T cells (T8) correct answer: limit immune response B-lymphocytes correct answer: stimulated by particular antigen cloning becoming plasma cells producing antibod- ies. A population of cells remains as memory cells following simulation by the antigen. Plasma cells correct answer: produce specific antibody B memory cells correct answer: secondary antibody response Which cells participate in both cellular and humoral immunity? correct answer: helper T cells Explain how antibodies exert their effects and how the release of complement contributes to these effects. correct answer: Antibodies exert their effects by binding to the specific antigen that elicited their production, usually on a cell or bacterial surface, resulting in antigen destruction, cell membrane damage (especially in the presence of complement), and, in the case of red blood cells, cell lysis. Some antigen-antibody- complement complexes are also chemotactic, attracting phagocytes and other cells to the site.
What is the approximate time frame between exposure to an antigen and the appearance of immunoglobulins in the serum on the first exposure to a specific antigen? On subsequent exposure to the antigen? correct answer: Primary response on initial antigen exposure may range from days to weeks. Secondary response is almost immediate. What is the average length of time required to acquire an effective antibody titer following exposure to an antigen on first exposure and subsequent exposures? correct answer: Primary response is approximately 3 to 4 weeks. Secondary response is quicker, with much higher titer within 1 or 2 weeks. Explain the rationale for boosters. correct answer: to promote a stronger, faster secondary immune response by "reminding" the immune system of the previously encountered antigen Explain why individuals may contract infections such as colds, influenza, and sexually transmitted diseases (STDs) repeatedly. correct answer: There are many strains of a virus or bacteria that cause a disease, and they may mutate readily, causing new strains; then, because the immune response is specific, infection with one strain does not create immunity to subsequent exposures to new, different strains. A serious complication of organ transplantation is organ rejection. Identify measures that are taken in attempt to prevent this from happening. correct answer: A close match of HLAs between donor and host tissues reduces the risk for rejection. The common treatment involves immunosuppressive drugs, such as cyclosporine, azathioprine (Imuran), and prednisone.
State the underlying mechanism responsible for autoimmune disorders. correct answer: when individuals develop antibodies to their own cells or cellular material How is systemic lupus erythematosus diagnosed? correct answer: Systemic lupus erythematosus (SLE) is diagnosed by the presence of numerous antinuclear antibodies (ANAs), especially anti-DNA, as well as other antibodies. Lupus erythematous (LE) cells are mature neutrophils containing nuclear material found in the circulating blood and are a positive sign. What types of medications and therapeutic interventions might be prescribed in the treatment of the autoimmune disorder systemic lupus erythematosus? Explain the rationale for each treatment. correct answer: prednisone (glucocorticoid) to reduce the immune response and subsequent inflammation; hydroxy- chloroquine (antimalarial) may be used to reduce exacerbations; nonsteroidal antiinflammatory drugs skin: correct answer: butterfly rash joints: correct answer: polyarthritis heart: correct answer: carditis and pericarditi blood vessels: correct answer: Raynaud phenomenon blood/bone marrow: correct answer: anemia, leukopenia, thrombocytopenia
kidneys: correct answer: glomerulonephritis, with marked pro- teinuria and progressive damage lungs: correct answer: pleurisy central nervous system: correct answer: psychosis, depression, mood changes, seizures List common causes of immunodeficiency. correct answer: primary: hypogammaglobulinemia; thymic aplasia, DiGeorge syndrome, combined immunodeficiency syndrome (CIDS), inherited deficits in any one or more of the components secondary: kidney disease, Hodgkin disease, AIDS, radiation, immunosuppressive drugs, immunosup- pression, malnutrition, loss or removal of the spleen, liver disease Identify the general effects of immunodeficiency. correct answer: predisposition to opportunistic infections and an increased risk for cancer Identify the types of medications that are often prescribed for the immunodeficient individual or immunocompromised host correct answer: prophylactic antimicrobials to reduce incidence of opportunistic infections; gamma globulin replacement therapy to provide passive immunity (antibodies) What is the causative agent responsible for AIDS? Describe its properties. correct answer: Human immunodeficiency virus (HIV) is the causative agent for AIDS. It is a "slow-acting" ret- rovirus containing two strands of RNA and the enzyme reverse transcriptase. Its envelope is characterized by spikes of
