Path 3366

Respiratory Alkaloidosis

Hyperventiliation which creates less CO2 (acid) in blood and higher pH; fixed by kidneys by decreasing HCO2 (bicarbonate) or increasing excretion

Back Up Plan 1

If you don't eat, a temporary stop-gap to provide energy to cells Glycogenolysis (pulls stored glycogen from liver)

Physiology

Study of functions and processes that occur in the body, usually normal processed

Pathophysiology

Study of underlying changes in the body's condition that results from disease or injury; "Pathos", latin for suffering

Multifactorial Genetic Disorders

Combination of environmental triggers and variations/mutations of genes plus potentially inherited tendencies.

Genotypes

Combination of partner genes (alleles) located on the chromosome. Ex GG, Gg, gg

"Ab"

away from

The parents of a new baby with Down's syndrome ask their nurse what to expect. She bases her answer on her understanding that the child will have a. developmental problems brought on by a sex-linked monosomy. b. developmental problems brought on by the pathologic interaction of 3 chromosomes where there should be only two. c. a phenotype based on defective mitochondrial protein synthesis that created aneuploidy. d. the phenotype of diminished IQ and physical differences that are caused by a single-gene disorder.

b. developmental problems brought on by the pathologic interaction of 3 chromosomes where there should be only two. A - not correct as this is an issue with chromosome 21, not chromosome 23 C - not correct because it is not defective mitochrondial protein synthesis, it's an extra chromosome D - not correct because this was not caused by a single-gene disorder (not genetic)

A family nurse practitioner (FNP) tells a patient that her biopsy shows leiomyosarcoma staged at T2N2M0. a. This patient has a benign tumor of the endometrium. b. smooth muscle malignancy that has spread to the lymph nodes. c. a malignancy of the uterus that has spread to distant sites. d. muscle cell tumor that is a carcinoma.

b. smooth muscle malignancy that has spread to the lymph nodes. (lei = smooth; myo = muscle; sarcoma = malignant cancer A - incorrect as sarcoma is malignant C - incorrect as "myo" means muscle D - incorrect as it is a sarcoma, not a carcinoma, and sarcoma means soft tissue and bone origin

"dys"

bad, difficulty, dysplasia

cancer staging

based on size, lymph node involvement, mets Sarcoma = malign w/ connective tissue (angiosarcoma; blood vessels) Myo + Sarcoma = malign of muscle (leiomyosarcoma; soft muscle) Neuro + blast = malig w/ neuro tissue (neuroblastoma) Exceptions LymphOMA(not benign) MelanOMA (not benign) Leukemia S&S pain, fatigue (angiogenesis), cachexia (weight loss), hemotologic changes

Decreased blood osmolality

causes - excess water due to loss of solutes; too much fluid intake, kidney failure; SIADH caused by cancer, drugs, or brain trauma Sequela - high levels of ADH, decreased output, puffy skin, indentions, wet lungs, hypoosmolar bloodwork Fixed by right atrium and left ventricle secrete ANP/BNP -> stimulate kidney to urinate to remove excess fluid

Hypoxia

cellular metabolism has to recycle through glycolysis; stop-gap that keeps body going through anaerobic glycosis but it temporary Deficiency of ATP as the Na/K pump of each cell cannot mantain normal electrical impulses causing acidosis

Karyotype

chromosome pairs from each parent

Sequela

complication, outcome (positive/negative)

A child with sickle cell anemia presents with pain all over, especially the joints. Which of the following best links the patho with S&S? a. Cyst formation in the kidneys leads to blood spillage from the circulation into the urine, thus causing anemia. b. A single-gene mutation causes malfunction of genetic coding for clotting properties, leading to bleeding and ischemic pain of the joints. c. Chromosomal aberrancy causes malformation of RBCs in the blood supply to the joints and subsequent pain due to lack of oxygen. d. A single-gene mutation causes malfunction in RBC O2-carrying capacity, leading to ischemic pain in the joint tissues.

d. d. A single-gene mutation causes malfunction in RBC O2-carrying capacity, leading to ischemic pain in the joint tissues. A - incorrect because cyst formation in the kidneys with blood spillage doesn't cause sickle-cell anemia. B - incorrect as sickle-cell is not a clotting-properties issues; it can cause clotting C - incorrect as this isn't a chromosomal discrepancy, it's a single-gene mutation

High blood volume/pressure

heart muscle pumps harder(hypertrophy)

Osmality

measure of concentration of compartment

Metabolic Acidosis

metabolism of all chemical reactions; kidneys; excess of H+ (acid); low bicarbonate (base); overexercise ->lactic acid (from pyruvic acid) or diabetic ketoacidosis Fixed in lungs to exhale CO2 (change in RR)

"plasty"

molding, surgical repair (cranialplasty)

"algia"

pain; fibromyalgia

You have two patients whose serum osmolality results are as follows: Albus Dumbledore (Mr. D.) has a serum osmolality of 263. Minerva McGonagall (Ms. M) has a serum osmolality of 326. (normal serum osmo = 280- 295). Based on understanding the links between fluid imbalances, lab results, and S&S, you will expect that a. Ms. M. will have an overall puffy appearance. b. Mr. D will have poor skin turgor and dry mucus membranes. c. Ms. M. will need a hypertonic IV to get her fluid status back to normal. d. Mr. D will have generalized pitting edema.

d. Mr. D will have generalized pitting edema. A - incorrect as Ms. M has high osmolality which means there is a high salt content in blood, which means that fluid would be pulled from T to B B - incorrect as Mr. D has a low osmolality which means he has a low salt content, which means there is extra water being pushed from B to T C - incorrect as a hypotonic IV would be needed to counteract her hypertonicity

An 80-year-old patient is in shock from loss of blood following an accident. His vital signs are: BP 80/50 (normal ~ 120/80), HR 120 (norm = 60-100), RR 20 (norm = 12 to 20), T 98.6 (norm ~ 98.6). In assessing this patient, the nurse understands that the abnormal HR is a. probably the etiology for the patient's low BP. b. due to the patient's heart compensating for low blood volume by pumping faster. c. the normal compensatory response of shunting blood volume to the periphery. d. due to multiple risk factors.

B - due to patient's heart compensating for low blood volume by pumping faster A - not right because nuse is unable to draw that conclusion with just the information in the problem C - not right because blood is shunted centrally, not peripherally to the limbs. D - not right because it is not specific enough as to the specific risk factors.

An RN is taking care of a cocaine addict who has just given birth to a baby with a teratogenic defect. A student nurse asks him what the probable etiology was. The RN shows understanding of genetic disorders when he says a. "It's hard to know the exact cause, but it's likely that fetal chromosomal development was impaired by the mom's intra-pregnancy cocaine ingestion." b. "The baby inherited a structural chromosomal defect that resulted in a problem called aneuploidy." c. "The baby inherited a gene that caused a defect called trisomy 21." d. "Since the little guy was born with the Philadelphia chromosome, he will be a life-long Phillies fan."

A - "It's hard to know the exact cause, but it's likely that fetal chromosomal development was impaired by the mom's intra-pregnancy cocaine ingestion." B - incorrect as this was not caused by too many chromosomes C - incorrect as trisomy 21 as patient doesn't have Down's syndrome D - incorrect, just no

Cell Polarization

More Polarization = shorter gap (hypopolarization) more sensitive (hypercalcemia, hyperkalemia, hypernatremia) Less Polarization = longer gap (hyperpolarization) less sensitive (hypocalcemia, hypokalemia, hyponatremia)

Ischemia

Most common (is hypxia from arterial circulation causing infarct) oxygen deprivation due to decreased arterial circulation (narrow/blocked arteries) acute - clot travels to blood vessel and it becomes hypoxic ex. sickle-cell chronic - better tolerated as it is slow-growing Infarct - necrosis caused by unrelieved pressure on skin preventing oxygenated blood flow and tissue breakdown (bedsores)

Osmosis

Moving water from B to T or T to B; excreted by waste, pores, respiration

Automsomal Dominant Disorder

Mutated dominant gene on one chromosome partners up with mutated dominant gene on the other "PP"; such as polycystic kidney disease (PKD) - symptoms are frequent kidney infections and stones

Compensation for too much CO2

Body increases inhalation

A 55-year-old man with emphysema (a type of chronic lung disease) who has smoked 2 packs of cigarettes per day for 40 years is hospitalized for acute onset of cough productive of bloody sputum (sputum=secretions from deep in the lungs). After a few days of testing and treatment, the patient's nurse reads a physician's note on the chart: "I have told the patient that the etiologies of his hemoptysis are: 1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer. The onsets of both were contributed to by his longstanding smoking." Based on all the information you have on the patient, which statement is most likely correct? a. The patient has a poor prognosis because of the comorbidities of lung cancer and cigarette smoking. b. Lung cancer was a sequela of the bloody sputum. c. A precipitating factor for the acute hospitalization was overexertion when the patient started an exercise class. d. Heavy cigarette smoking was a risk factor in the patient's developing emphysema and lung cancer.

D - Heavy cigarette smoking was a risk factor in the patient's developing emphysema and lung cancer. A - not right, smoking is not a comorbidity B - not right because lung cancer was not the result of bloody sputum (vice-versa) C - not right because over-exercise did not cause the bloody sputum; patient's comorbitities were the cause

Back Up Plan 2

If you still don't eat, body will break down fats and proteins Glyconeogenesis _>creates ketones which are acids (but brain cannot use them

Blood terms

K+ imbalances - hyperKalecemia/hypoKalecemia Na+ imbalances - hyperNatremia/hypoNatremia Ca+ imbalances - hyperCalcemia/hypoCalcemia

Domino Effect

K+ pills taken ->absorbed in blood vessels of stomach and duodenum->K+ enters blood creating electrolyte imbalance ->K+ diffuses back into the tissue (B to T)

Alkaloidosis

Less common; large amounts of vomitting, overinjection of tums or bicarbonate; Fixed by decreasing RR

Example pH 7.28 HCO3 18

Low pH 7.28 (acidosis) Low HCO3 18 (metabolic) Causes - kidney failure, diabetic ketoacidosis Fixed by lungs to increase RR

Tonicity (salinity)

Measure of saltiness (NaCl) isotonic > 0.9% = hypertonic/hyperosmolar -> requires hypotonic saline (0.45% NS) < 0.9% = hypotonic/hypoosmolar -> requires hypertonic saline (3% NS)

"Idio"

private, distinct; idiopathic

Iatrogenic

problem or disease as a result of medical treatment

Nosocomial

problem or disease that occurs as a result of being in a hospital environment; i.e. hospital-acquired

"tachy"

rapid (tachycadia)

Acute S&S

rarely rapid appearance of disease over a short time for a short time

Metaplasia

reversible replacement of mature cells by less specialized cells (smoker's lung)

SOB

shortness of breath

"brady"

slow; bradycardia, slow heart beat

Titany

spasms that are unrelenting

"iasis"

state or condition (psoriasis)

Chronic S&S

symptoms develop more slowly that may last longer

chvosteks sign of hypocalcemia

tap on the side of the face and notice a musle spasm reaction in the cheek

Comorbidities

Other diseases

Alleles

Partner genes that code for the same trait on a pair of chromosomes. Same location of each chomosome. Can be dominant, recessive, or both.

Osmotic/Oncotic Pressure

Pressure from the solutes/proteins in a compartment; high osmality/oncoticity = higher osmotic/oncotic pressure

Sickle-Cell

RBCs clog microcirculation of the joints causing ischemic pain and less oxygen; heterozygus geneotype can pass to overspring

RR

Respiration rate

Respiratory Acidosis

Retention of CO2; fixed in kidney by increasing bicarbonate (base)

Anemia Symptoms

Shortness of breath (SOB), weakness, fatigue due to less hemglobin (which carried O2 to the tissues)

Precipitating factor

a condition or event that triggers an ever or disorder, the "kick-off"

Link CML etiology with its S&S: a. Genes on a defective chromosome malfunction and code for extreme leukocytosis. b. Myelocytic leukocytes attack cells in the blood and cause changes known as The Philadelphia Story. c. A genetic defect causes cancerous changes in the blood vessels, producing hemangiosarcomas. d. Genes on an extra chromosome malfunction and cause defects in leukocyte development, resulting in leukopenia.

a. Genes on a defective chromosome malfunction and code for extreme leukocytosis. B - incorrect because it isn't called Philadelphia story, its the Philadelphia chromosome, or translocation C - Incorrect as hemangiosarcomas occur in the tissue, not in the blood D - incorrect as leukopenia indicates a low white-blood cell count, but cancer is a proliferation of white blood cells

This girl's body needs to compensate for the acid/base imbalance noted above. Knowing that the lungs will compensate when the "metabolic" side is "sick" and the kidneys will compensate when the lungs are "sick," which compensatory response would you expect? a. Hyperventilation --increased respiratory rate (RR)-- to "blow off" CO2; this is the lungs' way to get rid of acids. b. Hypoventilation—decreased RR-- to "hold onto" CO2, since CO2 is an alkali that will counteract the acidosis. c. Kidneys will excrete more HCO3 into the urine to get rid of acidic byproducts. d. By hyperventilating and blowing off CO2, the body will bring the pH down to normal range.

a. Hyperventilation --increased respiratory rate (RR)-- to "blow off" CO2; this is the lungs' way to get rid of acids. B - incorrect because CO2 is not alkali, it's acidic C - incorrect because HCO3 is not acidic D - incorrect because bringing down the pH would make it more acidic, not less

A scene in the ER: A CIA operative who has had no previous medical history presents with initial complaints of nausea, vomiting, severe weakness. Now he is also short of breath. His pH is 7.20 and his HCO3 is 17. What is most likely going on in his body? a. Poisoning (by an enemy spy); cellular hypoxia; cells must repeatedly go through anaerobic glycolysis to gain some ATPS; increases pyruvate; lactic acidosis; metabolic acidosis. b. Poisoning (by an enemy spy); hypoxia; cells must continuously go through aerobic glycolysis instead of continuing down normal metabolic pathway; low ATPS; respiratory acidosis. c. Gastrointestinal flu; can't eat; low blood sugar; glucagon secreted; triggers glycogenolysis; glucose released into blood, but also there are acidotic byproducts that must be countered by more HCO3; increased alkalinity; metabolic alkalosis. d. Job stress; low oxygenation; body compensates by increasing respiratory rate (hyperventilation); too much CO2 blown off; respiratory alkalosis.

a. Poisoning (by an enemy spy); cellular hypoxia; cells must repeatedly go through anaerobic glycolysis to gain some ATPS; increases pyruvate; lactic acidosis; metabolic acidosis. B - incorrect as cells go through anaerobic glycosis C - incorrect as there is nothing in the problem to suggest flu D - incorrect as there is nothing in the problem to suggest stress

A patient has advanced liver disease. Blood tests reveal that his serum albumin (albumin is one of the protein molecules found in the blood) level is very low. What eventually happens in this patient situation? a. Water would shift from blood (B) to tissue (T) because of decreased plasma oncotic pressure. b. There would be an increased intravascular volume due to increased plasma oncotic pressure. c. There would be dehydrated brain cells due to fluid shifting from T to B. d. Water would shift from T to B because of increased osmolality of the vascular space.

a. Water would shift from blood (B) to tissue (T) because of decreased plasma oncotic pressure. B - incorrect because while it would increase intravascular volume, it isn't due to increased plasma oncotic pressure C - incorrect because protein is low, not volume/fluid D - incorrect because the fluid volume is high, which means that water would shift from B to T

A patient says she has read that free radicals might be partly responsible for the development of her disease process. She wants to know more information and if there is anything that can counteract free radicals. The nurse's explanation will be based on understanding that all of the following statements are true EXCEPT a. an example of a free radical is cytochrome oxide. b. free radical molecules initiate harmful reactions such as lipid peroxidation, which damages the lipids of cell membranes. c. the body's way to counteract free radicals include enzymes such as superoxide dismutase. d. free radicals are molecules that are in a highly reactive state and can be calmed by taking certain vitamins.

a. an example of a free radical is cytochrome oxide; is not a free radical B - true C - true D - true

(Normal labs: Na+ = 135 to 145; K+ = 3.5 - 5.0; serum osmolality ("osmo") = 280- 295; HCO3 = 22-28). In the previous question, the edema is most likely due to fluid shifting from the intravascular space into interstitial spaces secondary to all the following EXCEPT: a. hypertonicity of the plasma space. b. hypotonicity of the plasma space. c. hypoosmolality of the blood. d. diminished osmotic pressure of the blood.

a. hypertonicity (higher solute/concentration) of the plasma space would mean that there was no edema as it would pull excess fluid to the blood and not send it to the tissue. B - true because hypotonicity means low solute/concentration in the plasma space C - true because hypoosmolality (low fluid) in the blood would mean that the blood is more concentrated D - true because hypoosmolality (low fluid) in the blood would reduce osmotic pressure in the blood

Remember the patient in Assignment #1, with cancer who can't eat and has lost 80 pounds? Let's add to his assessment findings: let's say he has generalized edema and a serum protein of 4gm/dl (normal = 6.0 to 8.3 gm/dl ). Which is the most accurate mini-concept map linking his blood protein level with edema? a. hypoproteinemia; concentration in blood is now lower than the normal concentration of fluids inside cells; fluid goes from blood to tissue (B to T). b. hypoproteinemia; concentration in blood is now higher than the normal concentration of fluids inside cells; fluid goes from B to T c. hypoproteinemia; blood is now hyperosmolar compared to the cells; fluid goes from T to B d. hyperproteinemiaàblood now has lower oncotic pressure than normal; fluid goes from T to B

a. hypoproteinemia; concentration in blood is now lower than the normal concentration of fluids inside cells; fluid goes from blood to tissue (B to T). B - incorrect because if concentration in blood is higher, than it would be "hyperproteinemia" C - incorrect because if patient has hypoproteinemia, it means that protein is low in the blood, so it would be hypoosmolar, not hyperosmolar D - Hyperproteinemia is an excess of protein in blood which would mean blood would have a higher oncotic pressure

Dysplasia

abnormal changes in size, shape, organization (potentially pre-cancer)

Apoptosis

aging of cells, programmed death (10 billion/day)

"ostomy"

artificial opening (ostomy bag)

A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. As an intervention to return the patient to normal serum osmolality, the nurse is likely to be ordered to hang an IV bag of _______ because once the fluid is distributed in the blood it will __________ and help return fluid compartment status to homeostasis. a. 0.45 NaCl: cause water to shift from tissue (T) to blood (B). b. 3% NaCl : cause water to shift from T to B. c. 0.25 NaCl : shift water from B to T. d. NS : shift water from B to T.

b. 3% NaCl : cause water to shift from T to B. A - incorrect since 0.45 NaCl wouldn't cause water to shift from T to B based on current osmo level C - incorrect as we don't want to shift water from B to T D - incorrect as we don't want to shift water from B to T

You have two patients whose serum osmolality results are as follows: Albus Dumbledore (Mr. D.) has a serum osmolality of 263. Minerva McGonagall (Ms. M) has a serum osmolality of 326. (normal serum osmo = 280- 295). On a more cellular level, which is true regarding the two patients in question 14? a. Mr. D's tissue cells are likely shrunken from fluid being pulled from tissue to blood. b. Ms. M's tissue cells are likely shrunken from fluid being pulled from tissue to blood. c. Ms. M has more dilute blood than Mr. D. d. Mr. D's blood is hyperosmolar compared to normal.

b. Ms. M's tissue cells are likely shrunken from fluid being pulled from tissue to blood. A - incorrect as fluid was being pulled from B to T since osmolality is low, which means there is a high water content to push out to the tissues C - incorrect as Mr. D has more water in his blood which means it is more dilute D - incorrect as Mr. D's blood is actual hypoosmolar as it is low compared to the normal levels

A patient with a serum calcium of 6.0 (norm = 8.5- 10.5) is most likely to ______ because_______. a. be lethargic: the cells are hypopolarized. b. have muscle spasms: more Na+ has entered the cells. c. be weak: more Na+ has left the cells. d. have hyperirritable muscles: the cells are hyperpolarized.

b. have muscle spasms: more Na+ has entered the cells. A - incorrect as it would be hypopolarized but would have hyperirritability in the muscles, not lethargy C - incorrect because more Na+ leaving would cause muscle contraction, not lethargy D - incorrect as the cells are hypopolarized

(Normal labs: Na+ = 135 to 145; K+ = 3.5 - 5.0; serum osmolality ("osmo") = 280- 295; HCO3 = 22-28). A patient is hospitalized in renal failure. Because of her kidneys' inability to excrete water, she has generalized edema & a serum sodium of 129. Because the kidneys have also lost the ability to appropriately regulate potassium, she also has a serum potassium of 5.9. These lab results show: a. hypernatremia & hypokalemia. b. hyperkalemia & hyponatremia. c. hyperosmolality & hypernatremia. d. hypoosmolality & hypocalcemia.

b. hyperkalemia/hyponatremia = high potassium and low sodium A - incorrect hypernatremia/hypokalemia = high sodium and low potassium C - incorrect hyperkalemia/hyponatremia = high potassium and low sodium D - hypoosmolality/hypocalcemia = excess water and low calcium

A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. The nurse taking care of this patient suspects that the _____ is due to _________. a. hyperosmolality: dehydration. b. hypoosmolality: syndrome of inappropriate ADH (SIADH). c. hypertonicity: SIADH. d. high oncotic pressure: a state of hyperpolarization inside the cells.

b. hypoosmolality: syndrome of inappropriate ADH (SIADH). A - incorrect because serum osmo is low, so it's hyperosmolality C - incorrect because osmo is a measure of osmolality, not tonicity D - incorrect because hyperpolarization would indicate hyperosmolality, which would mean that serum osmo would need to be high

A 28-year-old man presents with a low blood pressure due to blood loss from a gunshot wound. The regulatory action that will best compensate for this patient's fluid volume deficit is: a. increased action of the natriuretic peptide system. b. increased action of the RAAS. c. inhibition of renin secretion. d. conversion of aldosterone into angiotensin II.

b. increased action of the RAAS. A - incorrect as increased action of the natriuretic peptide system would decompensate the patient C - incorrect as inhibition of renin secretion would exacerbate the low fluid volume D - Incorrect as the conversion of aldosterone into angiotensin II wouldn't correct the problem

A patient who just came out of general anesthesia has lab work done. The serum osmo is 165. The nurse in the previous question (9) would expect all the following S&S EXCEPT: a. signs of cerebral edema such as irritability. b. signs of cerebral cell dehydration such as headache. c. pitting edema d. crackles in the lungs upon auscultation.

b. signs of cerebral cell dehydration such as headache. low osmolity (salt) means there is more room for water, which shifts volume from B to T, so there wouldn't be cell dehydration A - true because edema suggests volume from B to T C - true because edema suggests volume from B to T D - true because crackles or "wet lung" suggests volume from B to T

A patient that has been recently diagnosed with a neuroma on the sole of his foot is very anxious. Of the following, which information shows that the nurse understands the nomenclature of neoplasms when explaining the situation to the patient? a. "You should have the neuroma removed, as this is a cancer that will spread to other parts of the body." b. "This is most likely a malignancy that will metastasize to your lymph nodes." c. "Neuromas are benign growths that usually will not spread." d. "You will soon have the irresistible urge to put on tap shoes and dance in a Broadway musical."

c. "Neuromas are benign growths that usually will not spread." A - incorrect because "oma" means benign in most cases B - incorrect because "oma" means benigh in most cases, not malignant D - just no

The physiologic process underlying fluid shifts in the patient situation above is that a. "concentration calls" fluid into hypoosmolar compartments from hyperosmolar ones. b. the principle of diffusion results in albumin molecules going from lower to higher concentration. c. "concentration calls" fluid into compartments with higher oncotic pressure from compartments with lower oncotic pressure. d. the proteinemia means that protein molecules will diffuse throughout the blood and tissue.

c. "concentration calls" fluid into compartments with higher oncotic pressure from compartments with lower oncotic pressure. A - incorrect because while concentration calls fluid, the movement is from hyperosmolar to hypoosmolar B - incorrect because the principle of diffusion indicates that molecules move from higher to lower concentration D - incorrect because proteinemia means that there is a protein deficient, which means it wouldn't diffuse as it is not considered a high concentration of protein molecules

If you had a patient whose labwork showed that he was hyperproteinemic, what would you know about that patient? a. He has a low osmotic pressure. b. He has a low blood oncotic pressure. c. His blood is more concentrated than usual. d. You may need to hang an IV bottle of albumin.

c. His blood is more concentrated than usual. A - incorrect because for hyperproteinemic, there would be high pressure B - incorrect because for hyperproteinemic, there would be oncotic pressure D - incorrect because hyperproteinemic means that there is a high level of protein in the blood and since albumin is a protein, this would only exacerbate the problem

If ABGs were done on this patient, you would expect all the following EXCEPT: a. a blood pH of 7.32 because sustained gluconeogenesis causes acidic byproducts to accumulate. b. a HCO3 of 20 because the high numbers of acids in her body "take over" and "overcome" the HCO3, which then diminishes in number. c. a HCO3 of 30 because the low numbers of acids in her body stimulate increase in HCO3. d. this acid/base imbalance to be called metabolic acidosis because it is an acidotic state caused by a metabolic disorder.

c. a HCO3 of 30 because the low numbers of acids in her body stimulate increase in HCO3. A - true B - true D - true

A 59 year old man is diagnosed with CML—chronic myelocytic leukemia. All of the following help to explain the genetic etiology of the CML EXCEPT a. a chromosomal structural defect called translocation occurs. b. pieces of two chromosomes are exchanged. c. a chromosomal aneuploidy defect called translocation occurs. d. a short, defective chromosome called the Philadelphia chromosome develops.

c. a chromosomal aneuploidy defect called translocation occurs. A - true B - true D - true

Remember the patient in Assignment #1, with cancer who can't eat and has lost 80 pounds? Let's add to his assessment findings: let's say he has generalized edema and a serum protein of 4gm/dl (normal = 6.0 to 8.3 gm/dl ). All of the following are accurate possible findings in the patient above EXCEPT that a. he has confusion due swollen brain cells. b. he has crackles in his lungs from fluid in the alveoli (lung tissue). c. his serum osmolality is 302 (norm = 280- 295). d. he will need a hypertonic IV solution to return fluid status to normal.

c. his serum osmolality is 302 (norm = 280- 295). A - true because low protein means high fluid which means edema in the body B - true because excess fluid in the lungs would develop wet-lung "crackles" D - true because hypertonic solution would reverse the hyperproteinemia

A diabetic patient has pathological changes to his arteries that result in narrowing and blockage. He is diagnosed with gangrene of the toes (gangrene is when LOTS of cells die).. Lab work is drawn and shows an elevated CK. Which pathological process accurately explains this type of occurrence? a. necrosis; gangrene; ischemia; creatine kinase spillage into blood. b. infarct; cellular differentiation; release of urea. c. ischemia; cell injury; swelling; spillage of cellular enzymes into blood. d. metastasis; superoxide dismutase; release of free radicals.

c. ischemia; cell injury; swelling; spillage of cellular enzymes into blood. A - incorrect as this process is backwards from what a normal process would be B - incorrect as an infarct doesn't change cell differentiation nor is this process related to urea D - incorrect as free radicals occur due to aging, environmental changes, etc.

A patient who smokes expresses concern to his nurse about the metaplastic changes of the bronchi that were seen during his bronchoscopy. The nurse bases her response on the knowledge that this type of cellular change is a. an irreversible cellular adaptation pattern. b. considered a precancerous cellular change. c. reversible if the change agent is removed. d. due to a physiologic hyperplasia.

c. reversible if the change agent is removed. A - incorrect as the cells are resilient and can adapt making this reversible B - incorrect because this is not precancerous cellular change D - incorrect as this is not a normal stress like enlarged breasts during pregnancy

A patient who is having hyposecretion of ADH (antidiuretic hormone) would MOST LIKELY have the following sign: a. serum osmolality of 270. b. oliguria (low urine output). c. serum osmolality of 300. d. edema.

c. serum osmolality of 300; if there is a high osmolality (salt content), it means that the salts will hold onto the water and disperse it from T to B. "hypo-secretion" means there is low-secretion of an anti-durectic hormone, which means ADH is being inhibited, so there is a high urine output and high osmolality A - incorrect as 270 is within normal range B - incorrect as if the patient were having low urine output, than the ADH would be high, not low D - incorrect because if the antidiuretic hormone isn't working, then the patient is excreting urine which does not leave fluid open to move to the tissues and cause edema

As a result of the action in the previous question, all the following will occur EXCEPT: a. the patient's body will "hang on" to fluids. b. Na+ will be retained by the kidneys. c. water excretion into the urine will increase. d. blood pressure will increase.

c. water excretion into the urine will increase. A - true as the patient's body would hang onto fluid B - true as NA+ would be retained in kidneys to keep from excreting fluid D - true because as fluid increased, blood pressure would also increase

"osis"

condition

"Otomy"

cut open (Appendectomy"

A child accidentally ingests an insecticide with the ingredient cyanide. Knowing that cyanide suppresses the actions of cytochrome oxidase in the electron transport chain, what is a likely sign or symptom you would expect and why? (see page 2 of metabolic pathway concept map and use your critical thinking skills) a. Ketonuria due to increased glycogenesis. b. Confusion due to glycolysis. c. Mild euphoria due to enhanced production of ATP. d. Shortness of breath due to decreased ATP to use for the work of breathing.

d. Shortness of breath due to decreased ATP to use for the work of breathing. A - incorrect because this would not create ketones B - incorrect because glycolysis doesn't cause confusion C - incorrect because ATP would be decreased, not increased

All of the linkages below are correct EXCEPT a. cancer-related angiogenesis leaches nutrition from our cells; cachexia, weakness. b. cancer injures prostate cells; release into blood of high levels of a tumor marker called PSA (prostate-specific antigen) c. ingestion of foods high in preservatives; increase genetic "hits"; increased risk of cancer. d. age-related wear and tear of cells; increased risk of cancerous lesions such as lipomas.

d. age-related wear and tear of cells; increased risk of cancerous lesions such as lipomas.(lipomas are benign and not cancerous) A - true B - true C - true

Which sets of information are correctly linked? a. a patient with decreased RBC production: erythropoietin injections are needed to counteract overproliferation of red blood cells. b. arterial embolus blocks blood flow: decrease in venous circulation to tissue with resultant hypoxia of cells. c. gout: caused by diet high in urea. d. carbon monoxide: binds to Hgb in oxygen's place.

d. carbon monoxide: binds to Hgb in oxygen's place. A - icnorrect as a patient with low RBC wouldn't take a drug to deal with overproliferation since they have low RBC B - incorrect because an arterial embolus wouldn't decrease venous circulation to tissue C - incorrect because gout is cause by high uric acid, not urea

Which mini-concept map has correct linkage in describing cancer genesis? a. angiogenesis; cachexia; lack of nutrition; cellular starvation; cancerous changes b. growth factor signals; increased cellular differentiation; anaplasia; cancer. c. oncogene; clonal proliferation; increased cellular differentiation; cancer. d. oncogene; clonal proliferation; anaplasia; cancer cells.

d. oncogene; clonal proliferation; anaplasia; cancer cells. A - incorrect as angiogenesis is when new blood vessels form from existing ones, which wouldn't happen before cancerous tumor exists; it wouldn't happen without provocation B - incorrect as cancer cells lack cellular differentiation, so cellular differentiation would decrease, not increase. C - incorrect as cancer cells lack cellular differentiation, so cellular differentiation would decrease, not increase.

"itis"

inflammation (tonsilitis)

"Megaly"

large or enlarged (acromegaly)

Autosomal recessive

mutated recessive gene on one chromosome partners with mutated recessive gene on the other chromosome Ex. gg

Hematopoietic System

Birthplace of cells, located in blood marrow

Hypertrophy

Increased cell size (usage)

Dairrhea

K+ leaks into water stool (leaky capillaries) which causes less K+ in blood = hypokalemia

"Ad"

Toward, increase

A 55 year old male is in the ER having a myocardial infarction (heart attack, AKA "M.I."), which is caused by coronary arteries that are clogged with fat and narrowed so that not enough oxygen-rich blood is getting to his heart. He admits that his daily nutrition is poor, consisting mainly of high-fat fast food. He has a family history of cardiac disease-- his father had a heart attack at age 46. The patient is obese and is a heavy cigarette smoker-- 2 PPD (packs per day). The patient said he had decided to take up jogging today and after a few minutes began having chest pain, nausea and shortness of breath. He went to the ER and was noted to have profuse diaphoresis (heavy sweating), tachycardia (rapid heart rate), and significant changes on his electrocardiogram (ECG or EKG). The patient recovers from this acute heart attack but his heart is so damaged that subsequently he has many episodes of congestive heart failure and many hospitalizations. A sequela of the MI was a. having to be hospitalized frequently because of problems associated with the damaged heart. b. having to be hospitalized frequently with repeat heart attacks. c. needing to jog more often. d. continuing to smoke 2 PPD.

A - having to be hospitalized frequently because of problems associated with damaged heart B - not correct as this is not indicated as a sequela in the problem C - not correct because the MI/heart damage has given the patient a condition where he is now unable to jog more often D - not correct because....well duh

After not eating since breakfast 6 hours ago, a student taking a test notices a period of hunger and fatigue. He doesn't have access to food because he is taking the test. About 10 minutes later, though, he begins to feel ok again and finishes the test with flying colors. What has happened in his body? a. A compensatory response called glycogenolysis allowed him to access stored glucose for energy. b. A decompensatory response occurred, in which adrenalin increased and caused more blood flow to the brain. c. Since his blood sugar was likely low, the heart underwent a compensatory response known as hypertrophy in order to increase blood flow to central organs. d. Using a control mechanism known as hyperventilation, the student was able to "blow off" excess CO2 and thus have a clearer thinking process.

A. A compensatory response called glycogenolysis allowed him to access stored glucose for energy. B - not correct as decompensatory responses "decompose" which worsens the condition, doesn't make it better C - Hypertrophy wouldn't replace the blood sugar and might instead use the remaining energy in the blood sugar to overcirculate the blood D - not correct because it still doesn't address the low-blood sugar in the blood that is needed for the body to run

Teratogenic disorders

An environmental influence that can cause defects. Ex. alcohol causing fetal alcohol syndrome

A 55 year old male is in the ER having a myocardial infarction (heart attack, AKA "M.I."), which is caused by coronary arteries that are clogged with fat and narrowed so that not enough oxygen-rich blood is getting to his heart. He admits that his daily nutrition is poor, consisting mainly of high-fat fast food. He has a family history of cardiac disease-- his father had a heart attack at age 46. The patient is obese and is a heavy cigarette smoker-- 2 PPD (packs per day). The patient said he had decided to take up jogging today and after a few minutes began having chest pain, nausea and shortness of breath. He went to the ER and was noted to have profuse diaphoresis (heavy sweating), tachycardia (rapid heart rate), and significant changes on his electrocardiogram (ECG or EKG). The patient recovers from this acute heart attack but his heart is so damaged that subsequently he has many episodes of congestive heart failure and many hospitalizations. In reading the scenario, it is easy to find 4 risk factors—things that "set the stage" for this patient to have a heart attack. They include all the following EXCEPT a. being a heavy cigarette smoker. b. having profuse diaphoresis. c. a parent with heart disease. d. high-fat diet.

B - having profuse diaphoresis (excessive sweating with no apparent cause) ; this is not a risk factor A - heavy smoker is a risk factor C -genetic predisposition or family history is a risk factor D - high-fat diet is a risk factor

An 80-year-old patient is in shock from loss of blood following an accident. His vital signs are: BP 80/50 (normal ~ 120/80), HR 120 (norm = 60-100), RR 20 (norm = 12 to 20), T 98.6 (norm ~ 98.6). A young, otherwise healthy patient is admitted to the hospital with a diagnosis of heart failure of unknown cause. The etiology of the heart failure would be termed a. iatrogenic. b. idiopathic. c. nosocomial. d. acute.

B - idiopathic A - not right because the problem does not indicate it was caused by a medical provider or treatment C - not right because it doesn't indicate that this originated in a hospital setting D - not right because it does not indicate a sudden onset or short duration of symptoms

Glycogenolysis

Breakdown of glycogen from stored glucose in the liver

A 55-year-old man with emphysema (a type of chronic lung disease) who has smoked 2 packs of cigarettes per day for 40 years is hospitalized for acute onset of cough productive of bloody sputum (sputum=secretions from deep in the lungs). After a few days of testing and treatment, the patient's nurse reads a physician's note on the chart: "I have told the patient that the etiologies of his hemoptysis are: 1) exacerbation of his chronic emphysema and 2) the new diagnosis of lung cancer. The onsets of both were contributed to by his longstanding smoking." The patient asks the nurse for more information. Which of the following explanations to the patient best indicates a full understanding of the patient's situation? a. "You have a disease process that was iatrogenically caused by cigarette smoking." b. "You have a sudden onset of a chronic lung disease that was brought on by lung cancer." c. "The coughing up of blood is caused by a worsening of a disease you've had for a long time, plus a new problem-- lung cancer." d. "These diseases have been creeping up on you for probably 20 years; it just goes to show that you should never have taken up smoking."

C - "The coughing up of blood is caused by a worsening of a disease you've had for a long time, plus a new problem-- lung cancer." A - not right because it was not caused by medical professional or therapy B - not right because "chronic" lung disease was not a sudden onset, and it wasn't caused by lung cancer D - not right because you wouldn't talk to a patient like that; unprofessional

A 55 year old male is in the ER having a myocardial infarction (heart attack, AKA "M.I."), which is caused by coronary arteries that are clogged with fat and narrowed so that not enough oxygen-rich blood is getting to his heart. He admits that his daily nutrition is poor, consisting mainly of high-fat fast food. He has a family history of cardiac disease-- his father had a heart attack at age 46. The patient is obese and is a heavy cigarette smoker-- 2 PPD (packs per day). The patient said he had decided to take up jogging today and after a few minutes began having chest pain, nausea and shortness of breath. He went to the ER and was noted to have profuse diaphoresis (heavy sweating), tachycardia (rapid heart rate), and significant changes on his electrocardiogram (ECG or EKG). The patient recovers from this acute heart attack but his heart is so damaged that subsequently he has many episodes of congestive heart failure and many hospitalizations. Which mini-concept map do you think best describes accurate linkage between underlying pathophysiology and signs and symptoms (S&S) described in this scenario? a. Jogging increased heart rate; blood pumped throughout body faster; tissues (including lungs and stomach) receive too much blood; patient complains of shortness of breath and nausea. b. History of heart disease in family; patient worries about it constantly; becomes anxious; smokes too much; nicotine causes narrowing of all arteries in body, including coronaries; heart attack from narrowed coronaries. c. High levels of fat in the blood from high-fat diet; clogs in coronary arteries develop over time; oxygenated blood cannot get to distal tissues of heart; unoxygenated tissues "cry out" (send pain messages to brain) ; patient complains of chest pain. d. Obesity; increased pressure on diaphragm; breathing becomes more difficult; shortness of breath; less oxygen; EKG changes.

C - c. High levels of fat in the blood from high-fat diet; clogs in coronary arteries develop over time; oxygenated blood cannot get to distal tissues of heart; unoxygenated tissues "cry out" (send pain messages to brain) ; patient complains of chest pain. A - incorrect because receiving too much blood did not cause the patient's symptoms (not sure if that's even a thing) B - incorrect because the MI was not stress induced, it was caused by diet; we also don't know how worried the patient is by his family history since he smokes and is obese because of a poor diet D - Increased pressure on diaphragm is not an etiology of chest pain or nausea; therefore this doesn't address all the patient's symptoms

An 80-year-old patient is in shock from loss of blood following an accident. His vital signs are: BP 80/50 (normal ~ 120/80), HR 120 (norm = 60-100), RR 20 (norm = 12 to 20), T 98.6 (norm ~ 98.6). The patient would also most likely have all of the following EXCEPT a. S&S of cool feet and hands from the body's compensatory response to shock. b. S&S of feeling faint and weak from blood loss. c. a risk factor of shock. d. a more guarded (ie, "poorer") prognosis because of his age.

C - risk factor of shock A - true because when in shock, blood is shunted to the core and as a result, the limbs turn cold due to lack of circulation B - true because blood loss results in low blood volume, which results in less oxygen distribution in blood circulation, causing weakness and fatigue D - true because the patient's age may be a factor in their ability to recover

Carbon Monoxide Poisoning

CO has high affinity to hemoglobin (Hgb) 3000X more than oxygen; prevents Hgb from binding with oxygen Treated with oxygen

free radicals

Caused by aging, pollutants, drugs, alcohol, radiation Treated with Vitamin C/E or superoxide dismutase

Lipid accumulation

Caused by alcoholism

Urate accumulation

Caused by gout (hyperuricemia; unable to process uric acids causing crystals, inflammation, swelling, pain treat with low diet of meats, creams, red win

Increased blood osmolaltity

Causes - Inadequate water intake; increased output Fixed by T to B Sequela - dry mucous membranes; loose skin; poor skin tugor; sunken eyes; acute CNS changes (restlessness); hyperosmolar bloodwork Fixed by RAAS = Kidneys increase renin ->stimulates angiotensin I -> creates angiotensin II ->stimulate peripheral vasoconstriction ->pulls blood to central circulation -> kidneys hold Na+ ->water flows back into circulation -> bloodflow increases while urine output decreases

A 55 year old male is in the ER having a myocardial infarction (heart attack, AKA "M.I."), which is caused by coronary arteries that are clogged with fat and narrowed so that not enough oxygen-rich blood is getting to his heart. He admits that his daily nutrition is poor, consisting mainly of high-fat fast food. He has a family history of cardiac disease-- his father had a heart attack at age 46. The patient is obese and is a heavy cigarette smoker-- 2 PPD (packs per day). The patient said he had decided to take up jogging today and after a few minutes began having chest pain, nausea and shortness of breath. He went to the ER and was noted to have profuse diaphoresis (heavy sweating), tachycardia (rapid heart rate), and significant changes on his electrocardiogram (ECG or EKG). The patient recovers from this acute heart attack but his heart is so damaged that subsequently he has many episodes of congestive heart failure and many hospitalizations. Without even having further knowledge of course material related to MI's, you can tell a lot about the scenario from careful reading and knowledge of basic patho verbiage. Example: The paragraph above suggests that the direct pathophysiologic etiology of the heart attack (MI) is most likely related to a. not eating green vegetables. b. congestive heart failure. c. lack of oxygen that narrows the coronary arteries. d. oxygen not reaching tissue that is distal to narrowing of the coronary arteries.

D - oxygen not reaching tissue that is distal to narrowing of the coronary arteries A - not correct because not eating green vegetables does not cause MIs B - not correct because congestive heart failure is a sequela (result) of the MI, not the etiology (cause) C- not correct because lack of oxygen doesn't narrow the coronary arteries; fat clogs arteries

Chromosome

DNA molecule that is made up of a series of genes. We receive 23 from each parents; 22 are autosomal, 1 is a sex chromosome.

Not Eating Process

Don't eat->hypoglycemia->Counterregulatory hormone triggered->stress hormones->Growth hormone from pituitary->glycogon from pancreas

Single-gene disorder

Due to inherited mutated gene; Ex autosomal recessive, autosomal dominant, sex-linked

Normal Consumption Process

Eat->glucose->Temporary hyperglycemia->Pancreate secretes insulin to distribute glucose->cellular energy->if access, is stored as glycogen in the liver (glycogenesis)

Inflammation

First step to healing disruption of metabolic pathway ->cell has less ATP and malfunctions Na/K pump ->Na+ enters cell freely/ K+ leaves cell freely ->water follows Na+ into cell -> cell swells and membrane loses integrity causing cell leakage -> cell shut down

"Ventral"

Front of the body

Acids in body

H+; CO2

Bases in body

HCO3 (kidneys)

Compensation for blood loss

Heart rate increases to circulate volume; arteries in limb restrict to keep blood in central organs

Example pH 7.50 HCO3 30

High pH 7.50 (alkaloidosis) High HCO3 30 (metabolic) Causes - excess vomitting Fixed by lungs to decrease RR

Phenotype

How the disorder looks; signs and symptoms of the disorder

Normal Stats

Normal pH 7.35 - 7.45 Normal HCO3 (bicarbonate) 22-26 Normal pCO2 (pressure carbon dioxide) 35-45 Normal p02 (pressure oxygen ) 80-100 Normal Sa02 (saturated oxygen) 97% - 100% Normal HgCO (carbon monoxide) 3% NS; 7% S Normal BP 60-100/min Normal RR 12-20 breaths/min Normal fluids 2100 mL/day Normal tonicity in blood (0.9%)

Packaging in Chromosomes

Nucleotides -> genes -> DNA molecules -> chromosome

Systemic S&S

Occurs all over the body; fever, hives (urticaria, malaise, systemic rash

Local S&S

Occurs in a particular area with redness, swelling, and warmth to the touch i.e. local rash

"blast"

immature precursor; glioblastoma

Hyperplasia

increased number of cells

Main function of genes

To code synthesis of proteins that form our traits and functional characteristics. Can be permanent or functional in purpose.

Sex-linked disorders

Usually occurs within males where the X will have no partner on the Y gene; ex hemophilia

The parents of a five year old girl complain anxiously to her pediatrician that in the last couple of weeks, no matter how much she eats, she keeps losing weight. She appears quite thin, well below her normal weight. Her blood sugar is 300 (normal range 70-99). She is diagnosed with Type I diabetes mellitus (DM 1). In this scenario, the explanation that bests links pathophysiology with S&S in this child is that in DM1, the pancreas a. quits producing glucagon so that glycogen stores are inaccessible, thus causing weight loss. b. increases insulin production so that glucose stays in the blood, causing hyperglycemia. c. quits producing insulin so that glycogenolysis is stimulated and too much glucose enters the blood. d. quits producing insulin so that glucose cannot be used as energy in the cells, thus causing the body to burn up fat and protein for energy.

d. quits producing insulin so that glucose cannot be used as energy in the cells, thus causing the body to burn up fat and protein for energy. A - incorrect because the pancreas doesn't produce glucagon B - incorrect because DM1 is an inability to make insulin, not an overproduction of it C - incorrect because if there was glucose in the blood, the body would use that as an energy source rather than the body's fat and protein

"lysis"

destruction of cell (hemolysis)

Chromosomal disorder

disorder from alteration to development of structure of a chromosome which alters the genes'' functionality. Ex. Down's syndrome.

"Lipo"

fat; lipoma

interstitial fluid

fluid between cells

intracellular fluid

fluid within cells

angiogenesis

formation of new blood vessels; tumor's blood supply

Cancer Genesis

genetic mutation (oncogene) ->clonal proliferation -> loss of differentiation (anaplasia)

Erythop

growth mediator