WGU D236 Final Exam V2– Pathophysiology Prep (Latest 2026/ 2027 Update) | 100% Verified Questions & Answers | Grade A

WGU D236 Final Exam V2– Pathophysiology Prep (Latest 2026/ 2027 Update) | 100% Verified Questions & Answers | Grade A Question: What is the primary determinant of oncotic pressure? Albumin Form of osmotic pressure exerted by proteins Oncotic Pressure What is the difference between adult and child immunity? Naive T Cells Fluid and electrolyte levels are regulated by _________________, which regulates actions such as thirst, ADH, the kidneys, and RAAS. Osmoreceptors What are the causes of dehydration? #Excessive loss #Inadequate intake #Both What s/sx are associated with dehydration? #Dry mucous membranes #Decreased skin turgor #Decreased urine output #Low blood pressure #Tachycardia #Weak heart rate #Confusion A patient with a viral illness and severe vomiting has an elevated CO2 level and pH of 7.53. She is breathing slowly. What condition does she have? Metabolic alkalosis The patient's pH and CO2 levels are both elevated (moving in the same direction). This indicates metabolic alkalosis. The CO2 level is high because her respiratory system is attempting to compensate for the high pH by exhaling less and retaining more CO2. Normal CO2 level 35-45 Normal pH level 7.35-7.45 Normal HCO3 level 22-26 Michael's pulmonary edema leads to respiratory acidosis. How does pH impact Michael's basal metabolic panel? Choose 3 answers. His CO2 level is increased because his lungs have difficulty removing it from the bloodstream. His calcium level is reduced because the elevated concentration of H+ makes it easier for Ca+ to bind to albumin. His CO2 level is decreased because his lungs have difficulty adding it into the bloodstream. His sodium level is decreased due to hypervolemia. His K+ is elevated because, as H+ moves inside of cells in an attempt to get it out of the bloodstream, K+ moves from cells into the bloodstream. His CO2 level is increased because his lungs have difficulty removing it from the bloodstream. His sodium level is decreased due to hypervolemia. His K+ is elevated because, as H+ moves inside of cells in an attempt to get it out of the bloodstream, K+ moves from cells into the bloodstream. A hormone panel was done on a patient with congestive heart failure and fluid volume overload. Which elevated hormone on the patient's chart is indicative of the body's attempt to reduce the fluid overload? Antidiuretic hormone (ADH) Brain natriuretic peptide (BNP) Aldosterone Renin BNP BNP is released when fluid volume excess is present. Normal sodium level 135-145 Hyponatremia is indicated by what lab result? S/Sx? Na 135 Loss of energy or fatigue Nausea and vomiting Headache Confusion Muscle spasms Low blood pressure Dark scanty urine Irritability, disorientation and neurological manifestations Seizures Hypernatremia is indicated by what lab result? S/Sx Na 145 Excessive thirst Extreme fatigue Confusion Muscle twitching or spasms Restlessness Seizures Normal potassium level 3.5-5.0 Hypokalemia is indicated by what lab result? S/Sx K 3.5 #Muscle fatigue/cramping #Nausea, vomiting, constipation #Cardiac dysrhythmias #Paresthesia (numbness/tingling) Hyperkalemia is indicated by what lab result? S/Sx? K 5.0 Muscle weakness/paralysis Paresthesia (numbness/tingling) Cardiac dysrhythmias Cardiac arrest/MI Normal calcium level 8.5-10.5 Hypocalcemia is indicated by what lab result? S/Sx? Calcium 8.5 Overexcitability of the muscles Muscle twitching Paresthesia (numbness/tingling) Chvostek and Trousseau sign (twitching on the cheek when touched) Cardiac dysrhythmias Hypercalcemia is indicated by what lab result? S/Sx? Calcium 10.5 Muscle weakness Loss of muscle tone Spontaneous fractures Kidney stones Cardiac dysrhythmias Normal magnesium level 1.6-2.6 Hypomagnesemia is indicated by what lab result? S/Sx? Magnesium level 1.6 Tremors Hyperreflexia Insomnia Muscle cramps Irregular heart beat Hypermagnesemia is indicated by what lab result? S/Sx? Magnesium level 2.6 Hyporeflexia Lethargy Respiratory depression N/V Slow/Irregular heart beat Tay-Sachs Disease An autosomal recessive inherited genetic disorder caused by a recessive allele (chromosome 15) that leads to the accumulation of certain lipids in the brain. Seizures, blindness, and degeneration of motor and mental performance usually become manifest a few months after birth, followed by death within a few years. Marfan Syndrome Inherited autosomal dominant trait (only one abnormal copy of the Marfan gene inherited from one parent) FBN1 gene. Genetic connective tissue disorder that can affect aorta and heart valve structures. **If one parent has Marfan syndrome, each child has a 50% chance of inheriting the abnormal gene and developing the condition. If both parents have the condition, the risk of their child inheriting the abnormal gene and developing Marfan syndrome increases to 75%. Turner Syndrome A chromosomal disorder in females in which either an X chromosome is missing, making the person XO instead of XX, or part of one X chromosome is deleted. Underdeveloped ovaries (sterile) Short stature (under 4' 7") Amenorrhea Webbing of the neck Edema Underdeveloped breasts/wide nipples Respiratory rate increases during exercise. How does this increased respiratory rate allow the body to maintain a homeostatic pH level? The increased exhalation of CO2 helps to increase pH. (The increased respiratory rate allows more CO2 to be exhaled. Since CO2 reacts with water to form carbonic acid, getting rid of more CO2 through increased respiration will raise pH) An ICU patient's arterial blood gas results show low pH and low CO2 levels. The patient's respiratory rate is increased. What is the name of this condition? Metabolic acidosis (Since the pH is low, and the pH and CO2 are trending in the same direction, the condition is metabolic acidosis. The low CO2 indicates that CO2 is not causing the acidosis. The increased respiratory rate lowers blood CO2 in an attempt to compensate for the metabolic acidosis.) Your patient has pulmonary edema, which raises levels of CO2 in the blood. What helps the patient's body to compensate for this increase? The kidneys conserve H+ and conserve HCO3- The kidneys excrete more H+ and conserve HCO3- The kidneys conserve H+ and excrete more HCO3- The kidneys excrete more H+ and excrete more HCO3- The kidneys excrete more H+ and conserve HCO3- (The increased CO2 level will generate more carbonic acid. The body must compensate for the decreased pH. Excreting more H+ and conserving HCO3- will both help to increase pH.) Heberden and Bouchard's nodes are indicative of what disease process? Osteoarthritis You receive a patient who has experienced a burn on the right leg. The burn has small blisters, is markedly pinkish red, and has a shiny and moist appearance. When the patient is asked about pain level, the patient describes it as severe. What level of burn does this patient present? Superficial thickness / Partial or intermediate thickness / Full Thickness / Fourth Degree Second Degree (partial thickness) Second degree: Partial thickness burns can be either superficial partial thickness or deep partial thickness, depending on the degree of tissue necrosis of the dermal layer. These burns can char the epidermis and papillary dermal layer, with resultant edema and formation of epidermal blisters. Burned skin is wet, raw, and pink or cherry red in color that blanches with pressure. Identify degrees of burn, and other s/s to that degree burn First-degree (Superficial) burns affect only the outer layer of the skin. They cause pain, redness, and swelling (no blistering/scarring). Second-degree (Partial or intermediate thickness) burns affect both the outer and underlying layer of skin. They cause pain, redness, swelling, and blistering. Pink/Cherry in color that blanches. Third-degree (Full thickness) burns affect the deep layers of skin. High risk of infection. Fourth-degree burns involve muscle or bone. A 56-year-old female presents with superficial partial-thickness burns to the anterior head and neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg. Calculate the total body surface area percentage that is burned using the Rule of Nines. 63% The Rule of Nines is a rapid method used during the prehospital and emergent phase of care. The body is divided into regions that present 9%, or multiples of 9, with the exception of the perineum, which is 1% of BSA (body surface area). The face and back of the head are 4.5% each, so the entire head is 9%, the anterior and posterior portion of the arm is 9%, and the total for each leg is 18%. Anterior head and neck (4.5%), front and back of the left arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg (18%), back of the left leg (9%) which equals 63%. An adolescent male patient is brought to the emergency department after spending a long day at the beach. The patient's head, neck, and trunk from the waist upwards and legs from the knees downward are bright red and edematous. The patient is crying and reports 8 out of 10 on the pain scale and an inability to find a comfortable position. What is the most likely classification of this burn? Superficial Thickness / Partial or Intermediate Thickness / Full Thickness / Fourth Degree Superficial / First Degree Burn Superficial burns are reddened and painful. Burn that requires surgery, forms more scars and are less painful? Superficial thickness / Partial or Intermediate Thickness / Full Thickness / 4th Degree Deep partial thickness / Second Degree Burn -Blisters/weeps -Risk of infection/scarring increase with depth of burn Describe an intracranial bleed in the epidural space Typically caused by a head injury and usually with a skull fracture. Occurs between the skull bone and the outmost membrane layer, the dura mater. High pressure bleeding is a prominent feature. You may briefly lose consciousness. Describe an intracranial bleed in the subdural space Collection of blood on the surface of your brain. Typically caused by your head moving rapidly forward and stopping, such as a car accident or shaken baby syndrome. More common in older people and people with a history of heavy alcohol use. Describe an intracranial bleed in the subarachnoid space Occurs between the brain and the thin tissues that cover the brain. The most common cause is trauma but it can also be d/t the rupture of a major blood vessel in the brain (intracerebral aneurysm). A sudden, sharp headache usually comes before a subarachnoid hemorrhage. Typical symptoms also include loss of consciousness and vomiting. Describe an intracranial bleed in the intracerebral space Occurs inside the brain. Not usually the result of an injury. Prominent warning sign is the sudden onset of neurological deficits. Symptoms progress over minutes to hours and include headache, difficulty speaking, n/v, decreased consciousness, weakness in one part of the body, and elevated blood pressure. Cerebral Concussion (Mild Traumatic Brain Injury) Individuals with mild TBI can develop postconcussive syndrome (PCS), which includes headaches, lethargy, mental dullness, and other symptoms that can persist for several months after a TBI. Signs and symptoms of cerebral contusion Severe headache, dizziness, vomiting, increased size of one pupil, and sudden weakness in an arm or leg. The person may seem restless, agitated, or irritable. Often, the person has memory loss. These symptoms can last for several hours to several weeks, depending on the severity of the injury. As the brain tissue swells, the person may feel increasingly drowsy or confused. Vitals may show decreased heart rate and respirations and hypertension, which are signs of pressure on the brainstem. What is the cause of Bell's Palsy? Unknown, but thought to be due to virus, or autoimmunity. Doctors believe that the most likely cause of Bell's palsy in pregnant women is the Herpes virus. #Cold sores and genital herpes (herpes simplex) #Chickenpox and shingles (herpes zoster) #Infectious mononucleosis (Epstein-Barr) #Cytomegalovirus infections #Respiratory illnesses (adenovirus) #German measles (rubella) #Mumps (mumps virus) #Flu (influenza B) #Hand-foot-and-mouth disease (coxsackievirus) What are signs/symptoms of cerebral edema? # Headache # Neck pain or stiffness # Nausea or vomiting # Dizziness # Irregular breathing # Vision loss or changes # Memory loss # Inability to walk # Difficulty speaking # Stupor # Seizures # Loss of consciousness What neuro conditions cause flat emotions and sleep disturbances? #Alzheimer's #Schizophrenia #Parkinson's disease What are the s/sx of Parkinson's? #Gait changes #Resting tremor #Increased muscle tone (rigidity) #Slow gait/movements (bradykinesia) What are the s/sx of Amyotrophic Lateral Sclerosis (Lou Gehrig's disease)? Upper motor neurons become sclerotic and die Weakness in upper and lower extremities, head drop, speech changes, dysphagia. Treatment: Riluzole (Rilutek) - works by changing the activity of certain natural substances in the body that affect nerves and muscles. What are the s/sx of Multiple Sclerosis? #Episodes of muscle weakness #Numbness #Blurred vision #Fatigue What is Huntington's and what are s/sx? Autosomal dominant inherited disorder. S/Sx do not develop until adulthood and include movement (spasticity); chorea (lack of control), cognitive function, depression, psychosis, dementia, degeneration of neurons. A provider is providing care for a patient following a hemorrhagic cerebrovascular accident (CVA). The patient asks the provider to explain what happened during the CVA. Which response by the provider is best? "A blood vessel in your brain broke open, causing bleeding in your brain and a lack of blood flow to an area." An older adult patient presents to the emergency department after dropping a pot of boiling water onto their feet. The skin on the patient's left foot is white with profound swelling of the ankle. The patient denies any significant pain. What is the most likely classification of this burn? Superficial thickness / Partial or Intermediate Thickness / Full Thickness / Fourth Degree Full thickness/Third Degree Burn Full thickness burns may be white and the surrounding area is edematous. Due to the damage the nerve endings, pain is minimal or absent. Riluzole (Rilutek) used for what? Medication used to treat amyotrophic lateral sclerosis (ALS; Lou Gehrig's disease). Class of medications called benzothiazoles. It works by changing the activity of certain natural substances in the body that affect nerves and muscles. A provider is working with a patient who is recovering from a subarachnoid hemorrhage caused by a cerebral aneurysm. The patient asks the provider to explain what happened. What is the best response by the provider? "You experienced a spasm of the arteries in your brain, which prevented blood flow to an area." "When you fell and hit your head, a blood vessel broke and you experienced bleeding into your brain." "A clot developed in an artery of your brain, which increased the blood pressure and caused the artery to rupture." "An artery in your brain had a weakened area, which ruptured, causing bleeding into your brain." "An artery in your brain had a weakened area, which ruptured, causing bleeding into your brain." A cerebral aneurysm results when the muscle layer of an artery is weakened and an outpouching occurs. When the weakened area ruptures, bleeding into the brain occurs. The provider is caring for a client who reports experiencing episodes of muscle weakness, accompanied by profound fatigue and blurry vision. Which diagnosis is the most consistent with these signs? Multiple Sclerosis Hypertension causes traumatic damage to the endothelium of the arteries. Which organs have arteries that are at a particular risk for damage? Brain, heart, eyes, and kidneys Which problem causes a myocardial infarction or heart attack? An occlusion of a coronary artery most commonly from a thrombus (blood clot). What are the characteristics of primary/essential hypertension? Idiopathic; common "silent killer" BP consistently 130/80 What are the characteristics of secondary hypertension? Results from other disease or disorder Renal disease; endocrine disorder; pheochromocytoma (adrenal tumor) What are the characteristics of malignant/resistant hypertension? Severe, rapidly progressing; uncontrolled Diastolic pressure extremely high Many complications What are the risk factors, manifestations, and complications of hypertension? Risk Factors: Age, sex, heredity, lifestyle Manifestations: Asymptomatic, vague symptoms (fatigue, malaise, morning headache) Complications: Sclerosis, narrowing of vessels, atheroma formation (fatty build up in arteries) What are the causes of heart failure? MI (left ventricle) CAD HTN Chronic lung disease (R ventricle needs to work harder to push blood through pulmonary circulation if there is an obstructive lung disease) Valve problems What are the compensatory mechanisms of heart failure? #Renin and aldosterone secretion (vasoconstriction and blood volume is increased) #SNS response (increases heart rate/vasoconstriction - epinephrine and norepinephrine) #Cardiac hypertrophy (increased size of the heart) What are complications of heart failure? #Cardiogenic shock #Acute pulmonary edema #Organ failure What lab test is an indication of heart failure? B-Type Natriuretic Peptide (BNP) - a hormone produced by the heart. BNP 500 are considered indicative of heart failure. What are causes of left sided heart failure? #MI #Valve stenosis #HTN (has to push after the afterload) What is the RAAS system? Renin-angiotensin-aldosterone system - a major mechanism in the regulation of arterial blood pressure. It is a compensatory mechanism that raises blood pressure and increases blood volume in response to decreased renal perfusion. What is the patho of left sided heart failure? Decreased cardiac output and pulmonary congestion What are the manifestations of left sided heart failure? Forward Effects (in the body - not getting oxygenated blood) #Fatigue and weakness #Exercise intolerance Backward Effects (in the lungs - blood backing up to the lungs) #Dyspnea #Orthopnea #Pink-frothy sputum #SOB #Rales/Crackles What does the body do to compensate for left sided heart failure? #Tachycardia #Pallor #Daytime oliguria (low urine output) What are the causes of right sided heart failure? #MI (R Ventricle) #Valve stenosis #Pulmonary disease/hypertension (has to push through the lungs) What is the patho of right sided heart failure? Decreased cardiac output and systemic congestion What are the manifestations of right sided heart failure? Forward Effects (to the lungs) #Dyspnea #Fatigue and weakness #Exercise intolerance Backward Effects (systemic congestion/fluid back up - cannot maintain venous return) #Edema (feet, legs, buttocks, ascites, hepato and splenomegaly) #JVD (jugular vein distention) Right sided heart failure compensation? #Tachycardia #Pallor #Daytime oliguria (low urine output) What is endothelial dysfunction and what can it be caused by? A type of non-obstructive CAD in which there are no artery blockages, but the large vessels on the heart's surface constrict (narrow) instead of dilating (opening). Can be caused by several conditions, including diabetes, metabolic syndromes, HTN, smoking and physical inactivity. What is cardiac valve disease? One or more of the valves in your heart don't work properly What is cardiac valve regurgitation? Regurgitation (or leakage of the valve). When the valve(s) do not close completely, it causes blood to flow backward through the valve. This reduces forward blood flow and can lead to volume overload in the heart. What is cardiac valve stenosis? Stenosis (or narrowing of the valve). When the valve(s) opening becomes narrowed, it limits the flow of blood out of the ventricles or atria. The heart is forced to pump blood with increased force to move blood through the narrowed or stiff (stenotic) valve(s). What is the main cause of mitral valve stenosis? Rheumatic fever, which is related to strep infections. What is mitral valve stenosis? Narrowing of the mitral valve, restricting blood flow into the main pumping chamber (left ventricle). **Can cause fatigue and SOB. What is mitral valve regurgitation? A condition in which the heart's mitral valve does not close tightly, which allows blood to flow backward in the heart causing backup of blood and hydrostatic pressure into the left atrium, pulmonary veins, and pulmonary capillaries - resulting in pulmonary edema. What is heart vegetation? Abnormal growths (vegetations) that contain collections of bacteria may form in the heart at the site of the infection and damage the heart valves, which can cause them to leak. **Can lead to endocarditis. What is endocarditis? A life-threatening inflammation of the inner lining of the heart's chambers and valves (endocardium). A patient asks the provider about a new diagnosis of aortic stenosis. What does the provider explain about stenosis? It is caused by calcium deposits forming around the rim of the valve, which reduces the flexibility of the valve. It describes the valve leaflets shifting into the atrium with contraction, due to thickening of the valve leaflets. It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve. It is a failure of the valve to close properly, due to damage to the chordae tendineae that anchor the valve leaflets. It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve. **A narrowing or stricture to the blood flow from the left ventricle to the aorta and may also affect the pressure in the left atrium. Which type of valve defect leads to a diastolic murmur? #Narrowing (stenosis) of the mitral or tricuspid valves #Regurgitation of the aortic or pulmonary valves Which type of valve defect leads to a systolic murmur? Many variations of mitral and tricuspid valve regurgitation and ventricular septal defect. What is a thrombus? An aggregation of platelets and red blood cells (clot) found in the location where it formed. What is an embolus? Can be a thrombus (blood clot), gas bubble, fat globule, mass of bacteria, or other foreign body that has traveled through the bloodstream until becoming lodged in a blood vessel that is too small for it to pass though, blocking the blood flow. **When an embolus occludes a blood vessel, it is called an embolism or embolic event. What are 2 contributing factors to developing an aneurysm? #A weakening of an artery wall that results in bulging or dilation of the artery #Can be caused by arteriosclerosis, degenerative vascular disease, or other causes. What are distinguishing characteristics of endocarditis? #Prosthetic valves and pacemakers are risk factors #Often caused by infection of the endocardium of the heart What are distinguishing characteristics of pericarditis? #Caused by inflammation of the pericardium (thin membrane around the heart), often due to MI #Can result in cardiac tamponade if high levels of fluid accumulate and compress the heart **Sharp/stabbing pain worsens with deep breathing or cough. How does malignant hypertension differ from benign hypertension? Malignant hypertension is high blood pressure that has resulted in multiple complications. Benign hypertension is high blood pressure without evidence of end target organ damage. HTN is never truly benign in that it causes damage to the endothelium that may not be evident for years. A patient presents with a blood pressure of 204/102. The patient complains of chest palpitations, a headache and blurred vision. What is the patient experiencing? Hypertensive crisis The patient's systolic BP 180 combined with symptoms of organ damage indicates hypertensive crisis. A patient who recently underwent a knee replacement suddenly complains of severe SOB and anxiety. What disorder is the most likely cause of the patient's symptoms? Pulmonary embolism Patients are at risk for thrombosis and embolism following a major orthopedic surgery like knee replacement. The patient's sudden onset of symptoms suggests pulmonary embolism. A patient asks the provider about a new diagnosis of aortic stenosis. What does the provider explain about stenosis? It describes the valve leaflets shifting into the atrium with contraction, due to thickening of the valve leaflets. It is caused by calcium deposits forming around the rim of the valve, which reduces the flexibility of the valve. It is a failure of the valve to close properly, due to damage to the chordae tendineae that anchor the valve leaflets. It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve. It is a thickening and narrowing of the valve that decreases the ability of blood to move through the valve. What is the difference between Hodgkin's Lymphoma and Non Hodgkin's Lymphoma? The main difference between the two is the specific lymphocyte each involves. **Hodgkin's is marked by the presence of Reed-Sternberg cells, which are not present in non Hodgkin's lymphoma. Signs and Symptoms of Hodgkins Lymphoma #Painless swelling of lymph nodes in the neck, armpits, or groin. #Persistent fatigue #Fever #Night sweats #Losing weight without trying #Severe itching #Pain in lymph nodes after drinking alcohol #Electrolyte imbalance causing palpitations, diarrhea, muscle weakness What is Non-Hodgkin's Lymphoma? A cancer that starts in white blood cells called lymphocytes, which are part of the body's immune system. Non-Hodgkin lymphomas happen when white blood cells known as lymphocytes mutate or change. Includes any type of lymphoma except Hodgkin's. Lymphomas start in either B or T cells, but B-cell lymphomas are most common. What is lymphedema? Swelling or accumulation of fluid due to blockage Enlargement in one or more lymph nodes, usually due to infection Enlarged lymph nodes that become palpable and tender Cancers of lyphocytes residing in the lymphatic vessels. The swelling or accumulation of the fluid due to a blockage in the lymphatic system caused by scar tissues from damaged lymph vessels or lymph nodes. It is often seen in patients who had their lymph nodes removed and had surgery or radiation to remove cancer. What is lymphadenitis? Swelling or accumulation of fluid due to blockage Enlargement in one or more lymph nodes, usually due to infection Enlarged lymph nodes that become palpable and tender Cancers of lyphocytes residing in the lymphatic vessels. Enlargement in one or more lymph nodes, usually due to infection. Lymph nodes are filled with white blood cells that help the body fight infections. What is lymphadenopathy? Swelling or accumulation of fluid due to blockage Enlargement in one or more lymph nodes, usually due to infection Enlarged lymph nodes that become palpable and tender Cancers of lyphocytes residing in the lymphatic vessels. Enlarged lymph nodes that become palpable and tender. What are lymphomas? Cancers of lymphocytes residing in the lymphatic vessels or nodes. To prevent changes in pH, the body employs what 3 buffer systems? Proteins Phosphates Carbonic acid-bicarbonate system Carbonic acid bicarbonate system first line of defense is ____________, second line of defense is _______________. Respirations; Kidneys HIV causes __________ issues, and targets ______________ cells. Immunity, CD4 What is MRSA (methicillin-resistant staphylococcus aureus)? A mutated strain of the bacterium Staphylococcus that is resistant to antibiotics. What term describes a weakening of the arterial wall resulting in a bulge outward? Aneurysm **Arteriosclerosis is a pathophysiological process in which the walls of the arteries become thick and stiff due to the buildup of plaque (fats) in the artery wall. The provider is reviewing a client's electrocardiogram (ECG) and notes that the client is experiencing cardiac dysrhythmia. Why is a cardiac dysrhythmia a concern? Cardiac dysrhythmias increase the peripheral vascular resistance experienced by the heart. Cardiac dysrhythmias decrease the ability of the heart to pump effectively. Cardiac dysrhythmias increase the risk for aneurysm formation. Cardiac dysrhythmias decrease the serum potassium level. Cardiac dysrhythmias decrease the ability of the heart to pump effectively. **Cardiac dysrhythmias cause a loss of the natural pumping sequence of the heart, resulting in lower cardiac output. What is the term for an infection of the cardiac endothelium (inner lining of the heart chambers/valves)? Endocarditis **Usually caused by bacterial infection A patient presents to the clinic with a blood pressure of 178/92. When repeated 10 minutes later, the patient's blood pressure is 176/96. The patient denies experiencing a headache, chest pain, or visual disturbances. What is the patient experiencing? HTN Stage 2 **The patient's blood pressure meets the criteria for stage 2 (systolic 140, diastolic 90) A patient was recently diagnosed with HIV and asks the provider to explain the concept of immunodeficiency and how it is caused by HIV. What is the providers best response? The virus causes your immune system to produce antibodies that are target some of your own cells. The virus causes your bone marrow to not produce enough white blood cells to fight off infection. The virus targets your CD4 cells. Without these cells, your immune system has a hard time fighting off infection. The virus targets your B cells, which means that you are not able to mount an effective inflammatory response. The virus targets your CD4 cells. Without these cells, your immune system has a hard time fighting off infection. A patient is diagnosed with acute lymphoblastic leukemia. When evaluating the CBC, what does the provider expect to see and why? A normal red blood cell count because leukemia is a cancer of the white blood cells only. A high red blood cell count because the bone marrow is working to compensate for the cancerous cells. A high red blood cell count because the cancer triggers an acute inflammatory reaction. A low red blood cell count because the cancerous lymphoblasts crowd out healthy bone marrow tissue. A low RBC count because the cancerous lymphoblasts crowd out healthy bone marrow tissue. What does the upper respiratory tract do? #Conducts air to the lower airways #Protects lungs from foreign matter #Warms/filters/humidifies air What does the lower respiratory tract do? #Participates in gas exchange by oxygenating blood and excreting carbon dioxide at the alveoli What occurs when the pressure of oxygen in arterial blood is lower than 60mm Hg with normal arterial carbon dioxide? Hypoxemic respiratory failure **Common causes: pulmonary edema, PE, pneumonia or pneumothorax What occurs when carbon dioxide in arterial blood is greater than 50mm Hg? Hypercapnic respiratory failure **Common causes: COPD, asthma What is true about restrictive lung disorders? They impair lung ventilation and inflation. Ex: Pneumothorax How does pneumonia impair gas exchange? The alveoli are filled with purulent material in pneumonia which prevents the exchange of oxygen and carbon dioxide. Aspiration pneumonia is caused by __________________________ swallowed by the oropharynx. Aerobic bacteria - foreign matter that is inhaled into the lungs. Which disorder is a pulmonary embolism most commonly a complication of? DVT (deep vein thrombosis) Melissa is a 46-year-old woman who presents to an urgent care clinic for SOB, chest pain, and a cough that started about four days ago. She reports that the cough is productive of yellow sputum. What are the pathophysiological mechanisms underlying Melissa's SOB and cough? SOB or dyspnea is often caused by diseases that impair gas exchange or oxygenation. A lower blood oxygen level can trigger dyspnea Coughing is triggered by mechanical or chemical irritants to the airways - including excess mucous caused by inflammation. Melissa's temperature is 101.1 F (37 C) and her oxygen saturation is 89% on room air. During auscultation of Melissa's lungs, the provider notes crackles and rhonchi in her RLL. A CXR reveals infiltrates in the RLL of the lung. What disease process is Melissa most likely experiencing? Pneumonia **an inflammatory (and typically infectious) disease. Is pneumonia an upper or lower airway disease? Lower airway, specifically the alveoli. Crackles and rhonchi are suggestive of lower airway inflammation, as fluid and pus from the inflammatory process create these sounds. What could be the causative agent of pneumonia? Bacteria but can also be caused by viruses or fungi. Infections that affect the nose, throat, and sinuses are called ________ ________________ _________ __________________. Examples of this include _______________. Upper respiratory infection (URTIs) #Common cold #Sinue, nose, throat #Epiglottitis #Laryngitis #Pharyngitis (sore throat) #Mono #Rhinitis #Croup Infections that occur in the airways and lungs are called ___________ ___________________ ________ _________________. Examples of this include _______________. Lower respiratory tract infection (LRTIs) #Bronchitis #Pneumonia #Brinchiolitis #Tuberculosis #Asthma A long term lung disease caused by inhaling large amounts of crystalline silica dust is called ______________. Silicosis What are the causes of asthma? #Bronchial obstruction due to hypersensitive or responsive airways #Extrinsic asthma: triggered by type 1 hypersensitivity reactions #Intrinsic asthma: adult onset; due to hyperresponsive airway tissue What are the risk factors of an asthma attack? #Triggers: cold, exercise, stress, inhalant or irritants What are asthma manifestations? #Dyspnea, tachypnea, tachycardia #Wheezing #Coughing #Chest tightness #Thick mucous #Respiratory distress #Conversational dyspnea #Accessory muscle use #Nasal flaring #Tripod position What are complications of asthma? #Respiratory alkalosis/acidosis #Status asthmaticus (ongoing, unrelenting, unresponsive to treatment episode of asthma that can be fatal) #Silent chest #Respiratory failure What is emphysema? A serious disease that destroys lung tissue and causes breathing difficulties. Overdistention of alveoli. What are causes of emphysema? #Cigarette smoking #Genetics (antitrypsin deficiency) What is the disease progression of emphysema? #Fibrosis and thickening of bronchial walls #Narrowed airways #Weaken walls #Interferes with passive expiration #Progressive difficulty with expiration #Air trapping increases residual volume #Over inflation of the lungs #Increased anterior-posterior diameter of chest (barrel-chest) What are emphysema manifestations? #Dyspnea, tachypnea, tachycardia #Clubbed fingers #Barrel chest #Pursed-lip breathing #Fatigue #Anorexia, weight loss What are complications of emphysema? #Pulmonary hypertension #Cor Pulmonale #Respiratory failure What are causes of bronchitis? #Smoking #Pollution #Chronic inhalant of irritants What are manifestations of bronchitis? #Dyspnea, tachypnea, tachycardia #Constant productive cough #Thick, purulent mucus #Rhonchi #Hypercapnia What are complications of bronchitis? #Pulmonary HTN #Cor pulmonale (R sided HF) #Respiratory failure What is bronchitis? Inflammation of the bronchi persisting over a long period of time. What is pulmonary edema? Accumulation of fluid in the lungs. What are causes of pulmonary edema? #L sided HF #Hypoproteinemia #Pulmonary HTN #Inhalation of toxic gases What are manifestations of pulmonary edema? #Orhopnea (difficult breathing while lying) #Rales #Hemoptysis (pink-frothy sputum) What are complications of pulmonary edema? #Hypoxia #ARDS #Respiratory Failure What is pulmonary embolism? A clot that traveled to the pulmonary arterial circulation and causes obstruction of the arterial blood flow through the lungs. What are causes of pulmonary embolism? #Blood clot (Virchow's Triad: stasis of blood, vessel wall damage, hypercoagulation) #Fat emboli #Heart valve vegetation (infective endocarditis) #Amniotic fluid (pregnancy) #Air What are manifestations of pulmonary embolism? #Dyspnea, tachypnea, tachycardia #Chest pain #Hemoptysis What is a complication of pulmonary embolism? Obstructive shock What occurs during gas exchange? Erythropoietin is secreted into the bloodstream. Oxygen moves across the alveolar membrane into the bloodstream. Carbon dioxide moves from the alveoli into the bloodstream. Hemoglobin crosses the alveolar membrane to combine with oxygen. Oxygen moves across the alveolar membrane into the bloodstream. Obstructive disorders, such as ______________ or __________ make it difficult for the individual to fully exhale carbon dioxide and may also make inhalation difficult. asthma, copd ___________________ disorders, such as pneumothorax, make it difficult for the lungs to fully expand for ventilation. Restrictive Disorders of the pulmonary vasculature are often complications from what? #Coagulation disorders #Pulmonary obstructive disorders #Respiratory infections What are causes of aspiration? What other disorders pose a significant risk for aspiration? Anything that interferes with the epiglottis from closing. #Fatigue #Acid reflux #Loss of mental ability (CVA, altered LOC, MS) #Loss of muscle tone or coordination #Pneumonia (bacterial or viral) Risk: PE, ARDS, HF, Lung CA, TB, GERD What is atelectasis? The collapse of a small number of alveoli resulting in reduced gas exchange. The full inflation of bronchioles is inhibited in this process. What is hypoxia? Deficiency in the amount of oxygen reaching the tissues. The gas exchange across the alveolar membrane is impacted. What is the most common cause of gastroenteritis? Viruses (70% of cases) What are s/sx of gastroenteritis? #Diarrhea (watery, usually nonbloody - bloody means you have a different, more severe infection) #N/V or both #Stomach cramps/pain #Occasional muscle aches/headache #Low-grade fever What is cirrhosis and how does it develop? Liver diseases cause liver cells to become damaged and die. Scar tissue replaces liver cells and affects the function of the liver leading to cirrhosis. **In cirrhosis, stellate cells overproduce collagenous fibrous tissue, which takes over the liver. What are common causes of cirrhosis? -ETOH -Viral hepatitis (HEP C) - Autoimmune hepatitis -Drugs and chemicals (aetaminophen or anything else hepatotoxic) Complications of cirrhosis? #Ascites #Edema #Portal hypertension (elevated BP throghout entire portal venous system) #Esophageal varices (engorged varicose veins on the low esophagus weaken/rupture). #Encephalopathy #Respiratory distress #Coagulation defects Hepatocytes do not function properly in cirrhosis, leading to the following: _____________, _________________, ___________________, _______________, _____________, __________________. #Inability to detoxify compound in the blood #Increased toxin exposure #Decreased bile - decreased lipid digestion/absorption #Hyperbilirubinemia - jaundice #Bleeding resulting from portal HTN #Decreased synthesis of clotting factors - excessive bleeding #Hepatic encephalopathy - confusion, impaired cognition What is pancreatitis? Inflammation of the pancreas that causes pancreatic insufficiency, malabsorption, and diabetes. Pancreatitis can be an acute or chronic disorder. What is acute pancreatitis and what are its causes and manifestations? Acute pancreatitis is a sudden, short-term episode of inflammation. Causes: #Gallstones #Excessive alcohol use #High blood triglycerides #Abdominal injury #Certain medications and toxins Manifestations: #Abdominal pain #N/V (following significant alcohol intake) #Cullen sign (blue discoloration around the umbilicus is a hallmark) What is chronic pancreatitis and what are its causes, manifestations, and complications? Chronic pancreatitis is the recurring destruction of the pancreatic tissue that results in atrophy, fibrosis, scarring and the development of calcification within the gland. Causes: #Gallstones (obstruct the flow of bile and pancreatic secretions into the duodenum; backs up into the pancreas and it starts autodigesting itself). #Alcohol (increased secretion of pancreatic enzymes and sphincter of oddi contracts; enzymes pack up into pancreas). Manifestations: #Severe epigastric pain #Vomiting Complications: #Hemorrhage #Hypovolemic shock (massive inflammatory response that causes capillary leak) #Circulatory collapse #Peritonitis (enzymes escape into peritoneal cavity, causing inflammation) What is an ulcer? Open sores in the lining of the digestive system. The constant acid irritation leads to ulceration of the GI cells, also termed peptic ulcer. What is a duodenal ulcer? A type of peptic ulcer that forms in the upper small intestine, most common symptom is pain in the mid to upper abdominal region that intensifies when the stomach is empty or wakes you up in the middle of the night. What is an esophageal ulcer? Results from the reflux of acidic gastric secretions into the esophagus. These can typically be treated with changes to lifestyle and diet, coupled with certain medications and other treatments. What is Crohn's disease and what symptoms might a patient exhibit? Crohn's is a chronic inflammatory bowel disease that affects the lining of the digestive tract. Symptoms: #Perisistent diarrhea #Rectal bleeding #Urgent need to move bowels #Abdominal cramps/pain #Sensation of incomplete bowel evacuation #Constipation, which can lead to bowel obstruction What are causes of RLQ pain? #Crohn's #Appendicitis What is ulcerative colitis (UC) and what symptoms might a patient exhibit? An autoimmune disease of the large intestine, specifically the colon and rectum. It affects the mucosal layer of the large intestine. Symptoms: #Blood and mucus in stool #Predisposes one to colon cancer How could the provider distinguish ulcerative colitis (UC) from Crohn disease? #UC only affects the large intestine, while Crohn's can affect the entire length of the GI tract. #Diarrhea can occur in both, but UC is more likely to present with blood in the stool. #A colonoscopy will show pseudo polyps for UC but will show cobblestone appearance for Crohn's What is an appendicitis? What are the manifestations and complications? Appendicitis is inflammation of the vermiform appendix, usually caused by intraluminal obstruction (gallstones, tumors, parasites, lymphatic tissue). Manifestations: #RLQ pain with rebound tenderness at McBurney's point #N/V #Fever Complications: #Rupture and peritonitis A patient has been diagnosed with pyelonephritis and asks the provider to explain the condition. What is the best response from the provider? "Pyelonephritis is an infection of the kidney that most commonly is caused by a bacterium called E. coli." #Inflammation of the kidneys #Tx: antibiotics, usually hospitalization Clients with acute kidney injury (AKI) may require either continuous renal replacement therapy (CRRT) or hemodialysis. What is a major difference between CRRT and hemodialysis? #CRRT cleanses the blood in a 24-hour cycle, while hemodialysis is performed over 4-6 hours several times a week. What are the 3 different kinds of dialysis? #Hemodialysis #Peritoneal dialysis #Continuous renal replacement therapy (CRRT) A patient reports a family history of renal cancer to the provider and asks how to reduce the risk of experiencing renal cancer. What advice should the provider include in patient teaching? Do not smoke tobacco and avoid exposure to second-hand smoke, maintain a healthy weight, aim for a blood pressure of less than 130/80 and test your urine for blood yearly. Decreased perfusion, medication or toxins, infections, and injuries can result in _______. AKI (acute kidney injury) What is an acute kidney injury (AKI)? What are the manifestations, causes, and complications? AKI refers to kidney dysfunction of short duration or any sudden, severe impairment of kidney function Manifestations: #Elevated creatinine and BUN levels #Fluid overload #Electrolyte imbalances #Metabolic acidosis Causes: #Prerenal: anything in the body that prevents perfusion to the kidneys (hemorrhage, dehydration, shock, HF) #Intrarenal: direct damage to the kidneys (glomerulonephritis, pyelonephritis) #Postrenal: obstruction of urine flow after the kidney (tumor, PBH, kidney stone) Complications: #Chronic renal failure High blood pressure and diabetes often cause ________________________. Chronic renal failure **Results in anemia due to lack of erythropoietin production What is cholestasis? What are the 2 types? Significant reduction of bile secretion and flow from liver to duodenum. 1. Intrahepatic - result of diseased hepatocytes or disease of intrahepatic bile ducts. 2. Extrahepatic - result of a duct obstruction outside the liver (such as gallstones or pancreatic tumor). How can choledocholithiasis lead to acute pancreatitis? Why would this result in damage to pancreatic cells? Occurs when bile flow is obstructed by a gallstone in the common bile duct. This can lead to a backup of digestive enzymes from the pancreas that can perform autodigestion and damage pancreatic cells. What is urolithiasis? What are 3 different types and part of the urinary system do they occur? Calculi (stones) that form in the urinary system. Nephrolithiasis (kidney stones) Ureterolithiasis (Ureter stones) Cystolithiasis (bladder stones) What factors might be responsible for calculi forming and what are the possible ramifications if a stone cannot be passed in the urine? #Factors that can lead to stone formation are urine becomes saturated with stone-forming salts (calcium, struvite, uric acid, cystine); cause can be chemical, metabolic, or genetic #Stasis of urine allows for crystal formation which is commonly caused by urinary obstruction or neurogenic bladder; as the stone is pushed through the ureter it can cause bleeding, buildup of pressure, low urine flow, leading to back flow of toxic urine in the kidney, which could lead to possible damage of the nephrons and kidney failure An ascending lower urinary tract infection (more commonly in women or during pregnancy) often leads to which condition? Glomerulonephritis Pyelonephritis Nephrolithiasis Acute kidney injury Pyelonephritis What are the body's natural defenses against lower UTIs? How are these defenses overcome by various organisms that eventually lead to an infection? Natural Defenses: #Continual free flow of urine #Secreation of IgA (WBCs) #Naturally high osmolarity #Urea and organic acids which inhibit bacterial growth A blockage due to enlarged prostate, kiney stone, or even holding your urine can create stagnant urine which allows bacteria to grow. **Chronic voluntary suppression of urination, sexual intercourse, UT obstruction, catheterization, and vesicoureteral reflux (urine backing up into the kidney) can all lead to UTIs. What are the two likely pathophysiological mechanisms of acute glomerulonephritis? What common infection usually triggers this? Describe the bodily effects of damage to the glomeruli. Antigen-antibody damage to the glomeruli or antibody accidentally targets glomeruli Group A beta-hemolytic streptococcus infection usually precedes by loss of protein due to damaged glomeruli leads to edema and HTN An immune reaction which damages the glomeruli and results in albumin and RBC loss **Glomerulonephritis is an inflammation of the glomeruli in the kidneys. What is a TURBT procedure? Transurethral resection of bladder tumor (TURBT) allows your surgeon to biopsy your tumor, or remove and entire small tumor from the inside of your bladder, while leaving the bladder intact. TURBT is essential to obtain a biopsy to confirm a cancer diagnosis and determine the stage and grade of the cancer. What is the most common type of bladder cancer? Squamous cell carcinoma / Sarcoma / Transitional cell carcinoma / Adenocarcinoma Transitional cell carcinoma (TCC) - 90% Begins in the bladder's interior surface and as it grows it protrudes into bladder lumen and eventually into the bladder muscle where it can metastasize. What is typically the only indication that one might have bladder cancer? Painless hematuria **Can be detected with diagnostic tests such as antigen test, CT or ultrasound. What is the most common type of kidney cancer? And what are some common causes and risk factors? Renal sarcoma / Renal cell carcinoma / Transitional cell carcinoma / Wilms tumor Renal cell carcinoma - 90% Causes/Risk Factors: #Smoking #Long-term use of pain medications #Obesity #High blood pressure #Family history #Hereditary diseases such as Von Hippel-Lindau disease and papillary renal cell carcinoma Stages of Renal Cell Carcinoma I: tumor is 7cm or smaller and no metastasis II: tumor is larger than 7cm and no metastasis III: any size tumor and has spread to lymph nodes, blood vessels in or near kidney, structure in the kidney that collect urine or fatty tissue around kidney. IV: cancer has spread beyond fatty tissue around the kidney and other parts of the body such as adrenal glands, brain, lung, liver, bone, or distant lymph nodes What are the parts of a nephron? Glomerulus, Bowman's capsule, juxtaglomerular apparatus, proximal tubule, Loop of Henle, distal tubule, and collecting duct What is a nephron? It is the structural and functional unit of the kidney. It is responsible for filtering blood and producing urine. What is the glomerulus and where is it located? It is a group of capillaries that use high hydrostatic pressure to push blood through the filtration process and is located in the Bowman's capsule. **The glomerulus allows water, sodium bicarb, acids, and urea out of the blood and into the Bowman's capsule. Large proteins cannot filter out. What are common conditions that are risk factors for developing chronic renal failure? #Diabetes #HTN #Glomerulonephritis #Chronic kidney disease #PKD (polycystic kidney disease) **As many as 75% of nephrons are healthy during initial stages and can compensate stage 5 with GFR below 15mL/min What are chronic renal failure manifestations early vs late? Early #Polyuria (frequent urination) #Elevated BP #Anemia #Fatigue End-Stage #Uremia (abnormally high levels of waste products in the blood due to kidney failure) #Hyperkalemia (unable to secrete potassium) #Azotemia (accumulation of nitrous waste; urea in blood) #Metabolic acidosis #Oliguria (low urine output) #Uremic frost (urea crystals on the skin d/t high level in the body) #Pruritus What is End Stage Renal Disease (ESRD)? And what are 3 problems throughout the body as a result of it? What are 2 treatment options for ESRD? Any type of kidney disease in which there is little or no remaining kidney function. GFR values less than 15 ml/minute are consistent with Stage 5 chronic renal failure, otherwise known as end stage renal disease (ESRD). #Uremic frost - from high urea #HTN - from elevated renin #Anemia - from lack of erythropoietin Tx = Dialysis or kidney transplant What are symptoms of end stage renal disease (ESRD)? #Fatigue #Drowsiness #Decrease in urination #Dry/Itchy skin What is kidney cancer? Occurs when cells in the kidney grow out of control, clump together, and form a malignant tumor. **The most common risk factor for developing kidney cancer is smoking! What is bladder cancer? What are s/sx and treatment options? Common type of cancer that begins in the cells of the bladder. Malignant cells present in the urine. Symptoms: #Painless hematuria is the cardinal feature #UTI symptoms (urgency, frequency, dysuria) #Usually deep within the bladder - rarely presents as a palpable mass Tx: #Transurethral resection of the tumor #Chemotherapy, immunotherapy, radiation #Radical cystectomy with urinary diversion may be necessary for large invasive tumors What is cystitis (UTI)? S/Sx? Inflammation of the urinary bladder. It is often caused by infection and is usually accompanied by frequent, painful urination. #Pelvic pain #Increased urge to urinate #Pain with urination #Blood in the urine What is the most common urological disorder? Urinary tract infection (UTI) What are s/sx of kidney infection (pyelonephritis)? #Back/Flank pain #N/V #Fever Brad is a 42-year-old patient who comes into the emergency department complaining of severe right flank pain. He reports that it started about 24 hours ago. The pain is severe and radiates into his groin. He is also having n/v. What renal disease process would you suspect when a patient presents with flank pain? Are they acute or chronic diseases? Both pyelonephritis and renal calculi can cause flank pain. Typically flank pain is associated with acute infections or inflammation of the kidney, rather than chronic diseases. Most renal calculi (kidney stones) are made up of ___________ ___________________ and are believed to be due to hyperabsorption of ______________ from the digestive tract. calcium oxalate, calcium Brad's creatinine and BUN levels were within normal limits a month ago and now are acutely elevated. Would this be considered acute kidney injury of chronic renal failure? AKI A patient with a history of multiple sclerosis presents with a fever, nausea, and vomiting, that began several days ago. The patient also reports mild flank pain. Which disorder is the patient most likely experiencing? Pyelonephritis **A history of MS (risk for neurogenic bladder) combined with indications of infection suggest pyelonephritis. A patient presents with severe left-sided flank pain. The patient was working extensively outside yesterday on a hot day and did not drink much water. The patient's medication list indicates regular use of a calcium-containing antacid for heartburn. Which disorder is the patient most likely experiencing? Glomerulonephritis Pyelonephritis Polycystic kidney disease Renal calculi Renal calculi **Dehydration combined with a high dietary intake of calcium can cause the formation of renal calculi, which manifests as severe flank pain. What is the strongest risk factor for bladder cancer? Smoking Shelia is a 42 year old female who presents to her health clinic complaining of chronic fatigue, brittle nails, and constipation. She wonders if these are symptoms of menopause because her menstrual cycle has also become very irregular. What endocrine disorder would you suspect? Hypothyroidism **Without adequate thyroid hormone, the body's metabolic processes slow down. When looking at Shelia's (who's been diagnosed with hypothyroidism) bloodwork, would you expect her T3 and T4 levels to be high or low? What about her TSH? #T3 /T4 levels are low due to inadequate production #TSH is high because the pituitary recognizes the low thyroid hormone levels and signals the thyroid gland to produce more Henry is a 12 year old patient with a hx of T1DM who was brought to the ED by his parents. They report that he started having n/v today, his breathing sounded different, and he was very lethargic. They mention that he recently had bronchitis. What would you suspect that Henry is experiencing? Diabetic ketoacidosis (DKA) which is a complication of diabetes. **An infection such as bronchitis can trigger increased glucose levels and increases the risk for DKA. Cerebral edema is a complication of _______ due to increased blood volume and dilutional hyponatremia. This complication can result in papilledema or compression of the optic disc. DKA Early s/sx of cerebral edema include headache, confusion, and lethargy but in severe cases seizures, pupil changes and respiratory arrest may occur. What is diabetes insipidus (DI)? A condition characterized by either a deficiency of antidiuretic hormone (ADH), or an insensitivity to ADH. **Blood glucose levels are normal. Kidneys can't properly concentrate the urine. **Can cause an imbalance of minerals (sodium/potassium) in your blood that maintain the fluid balance in your body. What blood and urine test can help diagnose diabetes insipidus (DI)? #Sodium level - will be high #Osmolality (serum or plasma) - will be high #Osmolality (urine) - will be low #Polydipsia (excessive thirst) What is a goiter and what is it caused by? A goiter is an enlarged thyroid gland and is caused by low iodine in the diet. **The body needs iodine to produce thyroid hormone. What is Addison's disease? And what are s/sx? Adrenal insufficiency; the patient will be low in cortisol and aldosterone but their potassium will be high. #Salt craving #Extreme fatigue #Areas of darkened skin #N/V/D #Muscle/Joint pain What is Cushing's disease? And what are s/sx? When the body has too much of the hormone cortisol. This can result from the body making too much cortisol, or from taking medicines called glucocorticoids, which affect the body the same way as cortisol. #Weight gain in face or trunk (Moon face/Buffalo hump) #Apple shaped fat distribution #Darkening skin under breast, belt line and neck. #Purple stretch marks (striae) #Easy bruising #Poor wound healing #Women develop hirsutism (male pattern hair growth) What is DKA, what is it characterized by, and what s/sx would you expect to see? A condition that develops in persons with no insulin reserves. Diagnosis criteria: #Glucose 250 #Arterial pH 7.3 #Bicarb (HCO3) 15 #Hypokalemia S/Sx: #N/V #Profound dehydration #Possible tachycardia & hypotension **Hyperventilation decreases the CO2 level which in turn lessons the hydrogen concentration of the bloodstream. **More H+ is acidic, less H+ is basic/alkaline What is Grave's disease and how does it manifest? An autoimmune disorder that is caused by hyperthyroidism. Symptoms: #Exophthamos (bulging eyes) #Goiter (enlarged thyroid glands) #Nervousness #Insomnia #Sensitivity to heat #Weight loss #Potential cardiac arrythmia Describe the negative feedback loop utilized by the endocrine system. Occurs when the build up of one molecule leads to the repression of the response that creates the molecule. Why is DKA a more significant problem for T1DM than T2DM? T1DM results form complete lack of insulin where T2DM is insulin resistance **No insulin causes the body to respond as if it is starving, so glucagon will be released from the pancreas, leading to rampant lipid breakdown, resulting in a high level of ketones in the blood- however, in T2DM there is still some insulin, and this concentration will be enough to prevent DKA from occurring A patient presents with a puffy face, acne, elevated BP, and muscle weakness. What disorder is consistent with this patient's symptoms? Hyperthyroidism Adrenal insufficiency Hashimoto thyroiditis Cushing's disease Cushing's What is endometriosis and what are s/sx? A disorder in which endometrial tissue grows outside the uterus. Symptoms: #Dysmenorrhea (painful periods) #Pelvic pain and cramping (may begin before and extend several days into a menstrual period) #Lower back and abdominal pain #Pain with intercourse #Pain with bowel movement or urination #Excessive bleeding #Infertility #Fatigue #Diarrhea, constipation, bloating or nausea (especially during menstrual periods) What is ovarian cancer? What are the causes? What markers indicate ovarian cancer? Pick 2 CEA TP53 PSA AFP HE4 TP53 / HE4 Cancer of the ovaries #Genetic causes, especially TP53 activation #HE4 biomarker: protein that is produced by most epithelial ovarian cancer cells What is pelvic inflammatory disease (PID) and what are s/sx? Inflammation and infection of organs in the pelvic region, most often occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes, or ovaries. (Gonorrhea or chlamydia are the most common) Symptoms: #Can be nonexistent or mild, may not even notice symptoms until trouble getting pregnant #Mild to severe abdominal or pelvic pain #Abnormal or heavy vaginal discharge with odor #Abnormal uterine bleeding, especially during or after intercourse, or between cycles #Pain during intercourse #Fever, sometimes with chills #Painful, frequent, or difficult urination What is polycystic ovarian syndrome (PCOS) and what are s/sx? A disorder of the hypothalamic-pituitary-ovary axis which the hormonal signals are disordered and the patient experiences elevated levels of androgens such as testosterone #Infertility #Irregular menstrual cycles #Hirsutism (facial hair) What is cryoblation and what is it used as a primary treatment for? A procedure in which an extremely cold liquid and an instrument called a cryoprobe is used to freeze and destroy abnormal tissue. Used as a primary treatment for: #Prostate cancer #Bone cancer #Cervical cancer #Eye cancer A female patient presents with irregular menstrual cycles and hirsutism. Lab work reveals elevated androgen levels. Which is the most likely diagnosis for this patient? Pelvic inflammatory disease Adenomyosis Endometriosis Polycystic ovarian syndrome Polycystic ovarian syndrome (PCOS) What is true about Crohn's disease? Choose 3 answers It is an infectious disease. It is an inflammatory disease. It is an autoimmune disease. It is a chronic disease. It is a disease of the large intestine only. #It is an inflammatory disease. #It is an autoimmune disease. #It is a chronic disease. A patient presents with severe abdominal pain, nausea, and vomiting following several days of heavy alcohol intake. The provider notes a dark blue discoloration around the umbilicus (Cullen sign). What is the patient most likely experiencing? Acute pancreatitis A patient has been diagnosed with renal cancer. What manifestations would the provider expect to see? Hematuria A patient has been diagnosed with end stage renal disease (ESRD) and will be undergoing hemodialysis. What is true about hemodialysis? It involves infusing dialysate solution into the abdominal cavity. It slowly filters the blood over a 24-hour cycle. It can cause significant fluid shifts and place the client at risk for hypotension. It can be administered at the bedside via peripheral intravenous access. It can cause significant fluid shifts and place a patient at risk for hypotension. **Hemodialysis is performed over a relatively short period and can cause large fluid shifts, resulting in hypotension. A patient presents with acute pelvic pain and fevers. Testing reveals the presence of N. gonorrhoeae. MRI reveals thickened, inflamed fallopian tubes and uterus. Which d