NR507 Midterm Exam Study Guide
General Study Tips and Recommendations
Topics and content on guides are intended to focus student attention when reading/studying and
some topics may be repeated in multiple chapters.
Multiple test items are derived from the same topic areas to encourage deeper comprehension.
Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
Information contained in the chapters as well as boxes and table within the chapters may
include test items.
Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information. Once you have selected your
answer, read the question one more time to ensure that the best answer has been chosen.
Utilize your time well by not rushing. You will have plenty of time to read each question for
understanding before you select your final answer.
Major Content Topics:
Alterations in Immunity & Inflammation
Hypersensitivity
Immunodeficiency
Autoimmunity
Alterations in Hematologic Function
Anemia
Role of erythropoietin in RBC production
Primary site of RBC production
Anemia
Microcytic anemias
Macrocytic anemias
Normocytic anemias
Hemoglobinopathies
Alterations of Cardiovascular Function
Coronary artery disease
Definition: imbalance between myocardial oxygen demand and supply from coronary arteries
Prolonged O2 demand on the heart leads to Myocardial Infraction
Cause: Atherosclerosis of coronary arteries with myocardial ischemia
,PATHO: LDL in blood overtime starts to stick to artery wall. It grows over time which limits the blood flow
to heart. As people do activity, sob and chest pain with activities. Goes away with rest.-stable angina
Unstable: plaque rupture: artery wall messed up, body sends clotting factors to artery to repair it and
forms a thrombus.
ACS: Thrombus keeps growing and growing which stops blood flow : unstable angina (chest pain
unrelieved by rest and nitroglycerin doesn’t relieve chest pain.
Once thrombus completes blocks blood flow= MI(heart muscle dies)
Non-modifiable: age(men > 45 y/o ; women > 55 y/o), family history
modifiable:: Elevated LDL(BAD) & Decreased HLD(Good), Hypertension, Diabetes, smoking
Present as Stable Angina, Prinzmetal Angia, Acute Coronary Syndrome(unstable angina, Non ST
elevation, MI, NSTEMI, STEMI Chronic Ischemia heart disease, sudden cardiac death)
Less common cause:
Coronary Embolus: A-Fib, Infective endocarditis, left atrial or ventricular thrombus, cardiac cath
Vasculitis(CAD in Children): * Kawasaki disease (medium vessel vasculitis cause coronary artery
aneurysm)
Vasospasm: reduce blood flow
Aortic Valve Stenosis: not enough blood to coronaries leading to myocardial ischemia
Causes of concentric ventricular hypertrophy: HTN, hypertrophic cardiomyopathy d/t more heart
muscle to supply
Stable(Plaque) Angina(hasn’t ruptured)
(Near -total occlusion w/ no infraction of b/c atherosclerotic plaque grows slowly gives heart to develop
**collateral circulationRerouting**)- that supplies the hyperperfused area
Secondary to Myocardial Ischemia(Reversible Cell Injury)
Atherosclerotic plaque occluding > 75% of coronary artery lumen
S/S chest pain with activity, sob, fatigue-goes away with rest
Infraction: Irreversible cell injury or death
Described as :
Deep poorly localized squeezing, crushing, suffocating, retrosternal pain(jaw, neck, arm)
Other symptoms: sob, nausea, vomiting, diaphoresis, fatigue, dizziness
*** Reproducible during: Physical exertion or Emotional Stress***
, Relieved w/in 5 min with : Rest and Sublingual nitroglycerin**
Risk Factors: smoking, obese, overweight, High Cholesterol, Sedentary life style, family history
TEST
ECG: Normal at Rest
Stress Test: Abnormal
Cardiac Markers : Always Normal like TROPONIN why because of ischemia but no infarction
Prinzmetal Angina (variant Angina)
No atherosclerotic plaque instead the coronary artery undergoes vasospasm(narrowing the lumen)
Angina at Rest
Cause: smoking, cocaine, alcohol, triptans(Given with patients with migraines )
24 hour ECG(Holter Monitor)---Transmural Ischemia
***Results: Transient Elevation of ST-Segment ; Troponin Levels Normal**(no infraction)
Diagnosis: Low dose of VASOCONSTRICTIVE meds: ERGONVINE (provoke vasospasm and transient
elevation of ST Segment
Treatment: Calcium channel blockers and nitroglycerin(relax vascular smooth muscle and cessation of
trigger)
Unstable Angina or Acute Coronary Syndrome:
Medical Emergency
Not relieved with rest or nitro
1. Unstable Angina** Near-to (incomplete ) occlusion
ECG: ST Segment Depression, T Waves Inversion, Troponin Levels are Normal(no myocyte necrosis)
2. NSTEMI **infarction beneath endocardium called** subendocardial infarct**
Troponin Levels : Elevated
ECG: ST-Segment Depression and T wave Inversion (Ischemia-reversible)
3. STEMI: Thrombus occludes 100% of the lumen
ECG: ST- Segment Elevation (Acute Transmural Infarction involves the whole wall) (Injury-irreversible)
CM: Sudden new onset angina or increase in severity of existing stable angina
General Study Tips and Recommendations
Topics and content on guides are intended to focus student attention when reading/studying and
some topics may be repeated in multiple chapters.
Multiple test items are derived from the same topic areas to encourage deeper comprehension.
Students must have a broad understanding of content and not simply memorize passages in
textbooks or articles.
Information contained in the chapters as well as boxes and table within the chapters may
include test items.
Exam questions represent various levels of cognitive learning. You are expected to analyze,
synthesis, and evaluate patient scenarios in order to answer the questions.
Read all of the answers BEFORE reading the stem of the question. This will help you focus on the
key content and not get distracted by extraneous information. Once you have selected your
answer, read the question one more time to ensure that the best answer has been chosen.
Utilize your time well by not rushing. You will have plenty of time to read each question for
understanding before you select your final answer.
Major Content Topics:
Alterations in Immunity & Inflammation
Hypersensitivity
Immunodeficiency
Autoimmunity
Alterations in Hematologic Function
Anemia
Role of erythropoietin in RBC production
Primary site of RBC production
Anemia
Microcytic anemias
Macrocytic anemias
Normocytic anemias
Hemoglobinopathies
Alterations of Cardiovascular Function
Coronary artery disease
Definition: imbalance between myocardial oxygen demand and supply from coronary arteries
Prolonged O2 demand on the heart leads to Myocardial Infraction
Cause: Atherosclerosis of coronary arteries with myocardial ischemia
,PATHO: LDL in blood overtime starts to stick to artery wall. It grows over time which limits the blood flow
to heart. As people do activity, sob and chest pain with activities. Goes away with rest.-stable angina
Unstable: plaque rupture: artery wall messed up, body sends clotting factors to artery to repair it and
forms a thrombus.
ACS: Thrombus keeps growing and growing which stops blood flow : unstable angina (chest pain
unrelieved by rest and nitroglycerin doesn’t relieve chest pain.
Once thrombus completes blocks blood flow= MI(heart muscle dies)
Non-modifiable: age(men > 45 y/o ; women > 55 y/o), family history
modifiable:: Elevated LDL(BAD) & Decreased HLD(Good), Hypertension, Diabetes, smoking
Present as Stable Angina, Prinzmetal Angia, Acute Coronary Syndrome(unstable angina, Non ST
elevation, MI, NSTEMI, STEMI Chronic Ischemia heart disease, sudden cardiac death)
Less common cause:
Coronary Embolus: A-Fib, Infective endocarditis, left atrial or ventricular thrombus, cardiac cath
Vasculitis(CAD in Children): * Kawasaki disease (medium vessel vasculitis cause coronary artery
aneurysm)
Vasospasm: reduce blood flow
Aortic Valve Stenosis: not enough blood to coronaries leading to myocardial ischemia
Causes of concentric ventricular hypertrophy: HTN, hypertrophic cardiomyopathy d/t more heart
muscle to supply
Stable(Plaque) Angina(hasn’t ruptured)
(Near -total occlusion w/ no infraction of b/c atherosclerotic plaque grows slowly gives heart to develop
**collateral circulationRerouting**)- that supplies the hyperperfused area
Secondary to Myocardial Ischemia(Reversible Cell Injury)
Atherosclerotic plaque occluding > 75% of coronary artery lumen
S/S chest pain with activity, sob, fatigue-goes away with rest
Infraction: Irreversible cell injury or death
Described as :
Deep poorly localized squeezing, crushing, suffocating, retrosternal pain(jaw, neck, arm)
Other symptoms: sob, nausea, vomiting, diaphoresis, fatigue, dizziness
*** Reproducible during: Physical exertion or Emotional Stress***
, Relieved w/in 5 min with : Rest and Sublingual nitroglycerin**
Risk Factors: smoking, obese, overweight, High Cholesterol, Sedentary life style, family history
TEST
ECG: Normal at Rest
Stress Test: Abnormal
Cardiac Markers : Always Normal like TROPONIN why because of ischemia but no infarction
Prinzmetal Angina (variant Angina)
No atherosclerotic plaque instead the coronary artery undergoes vasospasm(narrowing the lumen)
Angina at Rest
Cause: smoking, cocaine, alcohol, triptans(Given with patients with migraines )
24 hour ECG(Holter Monitor)---Transmural Ischemia
***Results: Transient Elevation of ST-Segment ; Troponin Levels Normal**(no infraction)
Diagnosis: Low dose of VASOCONSTRICTIVE meds: ERGONVINE (provoke vasospasm and transient
elevation of ST Segment
Treatment: Calcium channel blockers and nitroglycerin(relax vascular smooth muscle and cessation of
trigger)
Unstable Angina or Acute Coronary Syndrome:
Medical Emergency
Not relieved with rest or nitro
1. Unstable Angina** Near-to (incomplete ) occlusion
ECG: ST Segment Depression, T Waves Inversion, Troponin Levels are Normal(no myocyte necrosis)
2. NSTEMI **infarction beneath endocardium called** subendocardial infarct**
Troponin Levels : Elevated
ECG: ST-Segment Depression and T wave Inversion (Ischemia-reversible)
3. STEMI: Thrombus occludes 100% of the lumen
ECG: ST- Segment Elevation (Acute Transmural Infarction involves the whole wall) (Injury-irreversible)
CM: Sudden new onset angina or increase in severity of existing stable angina
