Condensed Midterm Study guide
1. What is Forced Vital Capacity (FVC)/normal range 2. What is FEV1/FVC ratio/used to determine what? 3. What is a FEV1/FVC normal ratio? 4. What is Residual volume & Total Lung Capacity used to distinguish?
1. Amount of air forcefully exhaled from the lungs in the first second. Normal 80-120% 2. the ratio of VC (air expired) in the first second divided by the total FVC/ Determines if the pattern is obstructive, restrictive or normal 3. is greater than 70% or greater than the lower limit 4. If the patient has an obstructive disease, RV and TLC results will be elevated-air trapping/hyperinflation In restrictive disease, the TLC will be reduced
1. What is an Immunodeficiency 2. Immunodeficiencies can have either a congenital cause or an acquired cause. Explain the difference btw the two 3. Patients with RA will be treated with drugs to
1. An immune deficiency is the failure of the immune or inflammatory response to function normally, resulting in increased susceptibility to infection. Primary Immunodeficiency Congenital immunodeficiencies are caused by genetic defects that disrupt lymphocyte development. Secondary immunodeficiency This is an acquired immunodeficiency that is caused by another illness (e.g. cancer or viral infection) 3. to reduce inflammation. ie: Disease-Modifying Antirheumatic Drugs (DMARDS), Glucocorticoids and NSAIDS.
Folate Deficiency Anemia 1. causes are 2. The clinical manifestations of folate deficiencies are the same as those of Vitamin B12 deficiency, except 3. Review diagram
1. Insufficient folate intake or decreased absorption from diet, due to Malnutrition, alcoholism, and interactions with medications (especially anticonvulsants) 2. patients with folate deficiency anemia do not have neurological symptoms.
1. What three factors influence SV 2. What two factors influence CO 3. Review Diagram of all factors affecting CO
1. PL, AL and Contractility 2. SV and HR
Review the follow case 1. Step 1 Determine the Pattern: based on a FEV1/FVC ratio of 55 would indicate
1. an Obstructive disease as a restrictive disease would be greater than 70%
Consider the case with a female presenting with: -significant for heavy menstrual cramping and prolonged bleeding OR/AND skipping one or two meals a day, RBC of 4.1, and low Hb -an MCV 67 an MCHC 28 and Ferritin of 12 ng/mL REF 30-300 ng/mL
1. anemia based on RBC and low Hb 2. microcytic hypochromic anemia based on MCV/MCHC, RBC and low Hb 3. IDA based on Ferritin and hx of menstrual bleeding and poor Fe intake
1. What are the two main factors causing L sided HF: 2. Diagram of LV hypertrophy
1. hypertension and aortic valve disorders.
Which of the following is considered a late effect of emphysema? Hypoxemia and Hypercapnia. Hypercapnia. Hypoxemia. Hypocapnia.
Hypoxemia and Hypercapnia.
A lung volume measurement that indicates air trapping in a COPD patient is: Decreased residual volume. Decreased total lung volume. Normal residual volume. Increase residual volume.
Increase residual volume.
What factors bring on the sickling of Hb
Oxidative stress (such as occurs with hypoxia), anxiety, fever, cold, and dehydration further decrease oxygen binding to Hb and increases sickling tendencies
In the healthy heart, the response to an increase in preload is for the stroke volume to a. increase b. decrease c. remain constant d. both increase and decrease
a. increase
Pulmonary function tests will point to restrictive lung disease and include
normal or slightly low FEV1, low FVC, normal or elevated FEV1/FVC ratio reduced lung volumes
Complement-mediated lysis of cells (explain this process)
(IgM or IgG) reacts with an antigen present on the surface of the target cell. The AB-Ag complex fixes with complement MAC attack lyses target cell membrane example, erythrocytes are destroyed by complement-mediated lysis in a delayed hemolytic transfusion reaction
coronary obstruction results in ischemia to the muscle tissue causing these types of angina (Define them) 1. Angina Pectoris 2. Stable Angina 3. Prinzmetal angina
1. Angina pectoris is chest pain caused by myocardial ischemia 2. recurrent predictable chest pain-gradual luminal narrowing/hardening of the arterial walls, that can't dilate in response to increased myocardial O2 demand from physical exertion (relieve w/ rest) 3. unpredictable chest pain (usually at rest), is caused by vasospasm of major coronary arteries with or without associated atherosclerosis
List and ID the areas where you can hear the 4 heart valves
1. Aortic valve is located at the 2nd ICS-R upper SB 2. Pulmonic valve is located at the 2nd ICS-L upper SB 3. Tricuspid valve is located at the 4th ICS-L SB 4. Mitral valve is located at the 5th ICS MidClav Line also known as the Apex of the heart
1. What is a classic localized type 4 reaction Review Diff of Type 1 and Type 4 rashes from review
1. Contact dermatitis seen with poison ivy These are delayed reactions because it may take a day or so for the Ag to evoke a cell-mediated immune response
Macrocytic, hypochromic, megaloblastic anemias 1. cobalamin (vitamin B12) deficiencies cause problems with Hint: decreased DNA precursors 2. Folate deficiencies lead to
1. DNA maturation and condensation. As a result, a deficiency leads to immature RBCs, lack of functional hemoglobin, and decreased nerve cell myelination. 2. abnormal RBC formation and premature death of RBCs. *folate helps with RBC maturation
Aortic Stenosis 1. List the causes of AS 2. List the signs/symptoms of AS hint: SAD
1. Having a Bicuspid Aortic Valve (normal is tricuspid) Age-related calcification, Rheumatic Fever 2. Syncope. Angina (from CAD in aorta or LV hypertrophy), Dyspnea, MAMA-shearing RBCs Systolic Ejection murmur-at upper RSB radiating to carotids
1. Exposure-related ILD includes 2. connective tissue diseases that are the result of 3. Idiopathic is seen in 4. Miscellaneous include
1. Hypersensitivity-allergic (farmer's lung) rxn, Pneumoconioses (asbestos/coal), Radiation or Medication-induced 2. autoimmune conditions-Sclerosis (most common SLE (least likely) 3. Respiratory bronchiolitis-interstitial lung disease-(seen in smokers) 4. Sarcoidosis, Vasculitis, Eosinophilic pneumonia & Pulmonary Langerhans cell histiocytosis
The pathophys of Extrinsic asthma 1. This is mediated by 2. What causes tissue damage 3. What causes air trapping
1. IgE which binds to Mast cells that release histamine, prostaglandins, leukotrienes, and interleukin cause smooth muscle constriction, mucus secretion and vasodilation 2. eosinophils and migratory WBC (neutrophils) 3. histamine, prostaglandins, leukotrienes, and interleukin which cause smooth muscle constriction, mucus secretion that leads to mucous plugs
1. ID location and significance of S3 sounds hint: ventricular gallop 2. What's the difference if you heart this in a young vs an old person
1. It happens in early diastole during the rapid filling phase of due to the tensing of the chordae tendinea and is a sign of fluid overload as in CHF. It is best heard at the apex of the heart. 2. Normal finding in young people but abnormal finding in elderly (a sign of CHF)
interstitial lung diseases (ILD) 1. ILD is not one specific lung condition. 2. ILDs are characterized by a combination of
1. It refers to any disease affecting the pulmonary interstitium and typically excludes infectious and neoplastic diseases. 2. interstitial inflammation, fibrosis, and scarring around the alveoli sacs.
1. ID location and significance of S4 sounds hint: atrial gallop 2. What is this caused by *S3 and S4 sounds are best heard @ the apex
1. It's the sound you hear from the L atrium contracting into a very stiff ventricle heard at the end of diastole just before the next cycle of systole. 2. Its caused by a pressure overload in the aorta from high SVR or an afterload (therefore it is always a pathological finding
ID common CM of R sided HF 1. fluid overload in the RA will cause systemic backup causing 2. Lung problems associated with 3. Valve problems mainly
1. Jugular vein distention, Hepatosplenomegaly, & Peripheral edema, 2. Cor Pulmonale or associated Lung Disease 3. Tricuspid valve damage causing Regurg from a dilated RV caused from pulm HTN
Mitral regurgitation 1. List the causes of MR 2. List the signs/symptoms of MR
1. LV dilation (enlargement), MI, dilated cardiomyopathy (ischemic/nonischemic), Rheumatic fever: early course Endocarditis, Papillary muscle/chordae tendinea rupture 2. Acute sx: flash pulmonary edema -papillary muscle rupture r/t MI, Chronic sx: progressive fatigue, SOB, pulmonary congestion * in MR you can hear a holosystolic murmur at the apex of the heart
What are the WBC that appear in high numbers within 3-6 hrs after invasion What are the WBCs that appear 24 hours after invasion
1. Neutrophils make up 70% of our WBCs; they arrive at site of invasion site within minutes 2. Monocytes arrive with 24 hours after the invasion Once they become involved in the inflammatory response they are known as Macrophages
Mitral stenosis 1. List causes of MS (having a tight MV) 2. List the signs/symptoms of MS
1. Rheumatic fever-late course from by group A streptococcus (strep throat), Endocarditis- acute Staph Aureus, subactue Step Virudans-mouth bacteria 2. sx associated with endocarditis (fever, chills, elev WBC), Fatigue, SOB, exercise intolerance or cough, L atrial enlargement, pulmonary congestion on auscultation, you'll hear a middiastolic rumble and right before this you may hear an opening snap
1. What measurement does the GOLD criteria use to grade the severity of airway disease 2. Indicate the following levels for mild, moderate, severe and very severe-see diagram
1. Severity is graded according to the FEV1 percent predicted, where normal is greater than 80%.
Describe each of the following 1. Preload 2. Contractility 3. Afterload
1. The LVEDV (think of this as the degree of stretch exerted-more stretch in a healthy heart = more power) 2. the LV systolic EF (SV-70ml) 3. The resistance to systolic ejection (think of this like the back pressure also known as systemic vascular resistance (SVR)
The pathophys of Left sided HF 1. It begins with High SVR which increases AL, which increases the LV force of contraction to overcome a higher aortic pressure. This activates 2. Sustained increases in contractility lead to 3. This overcompensation cannot go on which leads to
1. The RAAS which retains circulating fluid further increasing SVR and AL and activating SNS to increase HR and PL and thereby SV 2. LV remodeling and hypertrophy which increases myocardial O2 demand 3. Decreased contractility, reduced CO and under perfusion of tissues
Type 3 hypersensitivity reaction 1. Explain this reaction
1. These are immune-complex mediated where the Ag-Ab complex becomes soluble in the blood and then are deposited in areas of tissue (joints/kidneys)
Type I: Allergic Reaction 1. these reactions are mediated by what Ab 2. characterized by sensitization* which is
1. Type I reactions are IgE-mediated allergic reactions. 2. On subsequent exposure to the allergen, the IgE molecules located on the sensitized cells induce immediate degranulation of Mast cells
1. What is ventilation 2. Perfusion is the actual exchange of 3. What is a shunt low V/Q? 4. What is Dead space ventilation high V/Q
1. Ventilation is the ability to move air in and out of the lung. It is critical to ensure perfusion. 2. oxygen and carbon dioxide in the blood stream that occurs via the alveoli and pulmonary capillaries. 3. poor ventilation (from COPD) but adequate perfusion 4. good ventilation but no perfusion as seen in a pulmonary embolus
Asthma Management 1. The patient receives education on what is
1. a mild, moderate and severe reaction, and depending on where they fit within these categories, they will be provided specific information on its management
1. In High Output Failure the heart cannot keep up with all of the body's demand for oxygen despite causes of HOF (all increase bodies demand of O2) 2. regardless of type it impairs O2 delivery to the tissues 3. vitamin thiamine deficiencies 4. these collectively increase basal metabolic rate
1. a normal blood volume and cardiac contractility. 2. anemia 3. Nutritional deficiencies 4. Hyperthyroidism, fever and sepsis
Restrictive Disorders 1. are characterized by 2. Result in difficulty in 3. Due to stiffness in lung compliance or 4. Include interstitial lung disease (ILD), scoliosis, and
1. a reduction in lung volume (TLC) 2. taking air into the lungs 3. chest wall structural abnormality. 4. neuromuscular (scarring in fibrosis) causes and significant obesity (structural change that prevents expansion).
List three ways the body can compensate for HF
1. activate the SNS to increase SV and HR 2. increase PL to increase SV 3. Muscular hypertrophy to increase SV
Blood Loss Anemia 1. usually associated with 2. begins with blood loss of
1. acute GI bleeding, severe trauma, surgical or labor and delivery complications 2. 1500 mL, causing sx of hypovolemic shock and cardiovascular failure
Diagnosis of COPD 1. On physical exam; hyperresonance will be identified due to 2. Pulmonary function tests will show <70-80% in both what 3. bronchodilator challenge will result in 4. Chest x-ray will typically demonstrate
1. air trapping 2. FEV1/FVC ratio and FEV1 % predicted 3. no change in the obstructive pattern 4. a flattened diaphragm, distended lung fields and increased thoracic diameter
Asthma 1. Asthma is a chronic (obstructive) disease which is characterized by 2. Asthma can be caused by both genetic and environmental factors there are over 3. There are two categories of asthma
1. airway inflammation, bronchial hyperreactivity and smooth muscle spasm that occurs intermittently and is reversible 2. 100 different genetic mutations linked to asthma 3. Extrinsic and Intrinsic
Type II hypersensitivity reaction 1. Type II reactions occur due to 2. There are 5 general mechanisms, each of which begins with antibody binding to tissue-specific antigens or to Ags that have attached to specific tissue List them:
1. an AB-Ag reaction destroying a target cell or altering its function. The Ag is found on the cell's plasma membrane 2. 1. Complement-mediated lysis of cells 2. Phagocytosis by macrophages 3. Neutrophil-mediated damage 4. Antibody-dependent cell-mediated cytotoxicity (ADCC) 5. Receptor blockage
1. Hemoglobinopathies are what? 2. What are the two most common
1. an inherited disorder of the erythrocytes; there are over 300 different Hb gene defects have been documented. 2. sickle-cell anemia and thalassemia.
1. ID the four types of left sided heart murmurs 2. Which are heard during systole? (hint which valves are closed) 3. Which are heard during diastole?
1. aortis stenosis, aortic regurg, mitral stenosis and mitral regurg 2. Aortic stenosis and mitral regurg 3. Aortic regurg and mitral stenosis
Restrictive Lung Disease 1. Restrictive lung disorders can be classified as 2. Extrinsic causes include conditions where 3. Intrinsic causes of restrictive disorders are due to
1. as either intrinsic or extrinsic 2. the problem is from a source outside of the lungs which restricts airflow such as scoliosis, Myasthenia Gravis, Guillain-Bare', Atrophic Lateral Sclerosis, and obesity 3. causes within the lungs or damage to the parenchymal tissue. as such there called interstitial lung diseases (ILD)
the pathophys of atherosclerosis: 1. Atherosclerosis begins with damage to the endothelium which causes 2. As plaque formations build up they can form lesions which
1. attachment of macrophages, phagocytosis; plaque formation and vasoconstriction 2. can dislodge disrupting normal blood flow and causes thrombus formation
B12 Deficiency (Pernicious Anemia) 1. B12 Deficiency results from 2. who* is at high risk for B12 deficiency?
1. autoimmune destruction of the gastric parietal cells which secrete intrinsic factor that aids in the absorption of B12 in the gut 2. those with gastritis, H. pylori infections, and advanced age. and who've had a gastrectomy ALSO vegetarians, b/c foods high in B12 include meats, chicken, Caption, egg, and dairy products.
Sickle-cell anemia 1. is an inherited 2. involves a single amino acid change on the 3. The sickling of millions of hemoglobin molecules causes distortion of RBCs that house those molecules making them weak and causing
1. autosomal recessive genetic disorder; requiring abnormal genes from both parents to be expressed 2. beta-chain which causes sickling of the Hb molecules so they don't not bind oxygen as readily. 3. rupture after only 10-15 days in circulation.
1. The types of asthma are staged as either 2. Persistent is divided into 3. What types of asthma will show abnormal PFTs: FEV1 and FEV1/FEV ratio
1. intermittent (<2 days/week) or persistent (2-6 days/week) 2. mild, moderate and severe. 3. Moderate and severe
1. without adequate intrinsic factor to help with GI absorption, PA is not easily remedied through oral B12 so treatment involves 2. review diagram of PA-B12 defic anemia
1. intramuscular injections, sublingual or intranasal formulations Highlighst of B12 deficiency (pernicious anemia)
Aplastic Anemia the "agent" destroys the blood-cell producing red bone marrow which does not produce blood cells-causing pancytopenia CM of this will include *review the diagram
1. loss of oxygenation capability with signs and symptoms of hypoxia. 2. This is usually followed by problems with blood-clotting, related to the loss of the second most prevalent blood cell type: platelets. 3. Finally, increased development of infections indicates that WBC production is now affected.
Thalassemia is a group of related inherited autosomal recessive 1. unlike sickle cell anemia it can cause varying degrees of distortion and dysfunction of the RBC due to 2. What is the most severe type
1. many different possible genetic mutations on both the alpha- and/or beta-chains on RBCs 2. Colley's thalassemia
1. Spirometry measures what? 2. What are the three important spirometry measurements the NP is concerned with?
1. measures air movement in and out of the lungs during various respiratory maneuvers. 2. Forced Vital Capacity (FVC); Forced Expiratory Volume in 1 second (FEV1) FEV1/FVC ratio
List and describe the 4 stages of HF
1. no structural defects but presence of risk factors such as DM, CAD w/o MI 2. Structural defects (rEF, LV hypertrophy, chamber enlargement) no sx 3. Pt has HF and is now symptomatic 4. Refractory HF and require complex interventions (Bi-V pacemaker, LVAD, or heart transplant
To confirm a diagnosis of asthma two things are needed. 1. First are compatible respiratory symptoms these include *the other key hx your looking for is a trigger for sx 2. In addition, there must be a demonstration of 3. What is the Gold Standard for Asthma Dx
1. non-productive cough, wheezing initially heard on end-expiration & Chest tightness 2. variable (varying PFTs) airflow obstruction to diagnose asthma as well as reversibility- (FEV1 that improves by 12% and 200 mL after the use of a bronchodilator albuterol) 3. the Methacholine Challenge Test
Gas Exchange 1. The high concentration of CO2 creates unfavorable 2. Decreased perfusion of the pulmonary capillaries with oxygenated blood cells results in 3. The term "blue bloater" is used to describe a patient with
1. or gas exchange-this is what causes (V/Q) mismatch and a L/R shunt (deoxygenated blood passing from RV to LV) 2. chronic pulmonary hypoxia and cyanosis. 3. chronic bronchitis, with bloater referring to the expanded thorax that these individuals can develop as a result of alveolar hyperinflation.
List three reasons why this contributes to decompensated HF
1. overactivation of the SNS lead decreased SNS receptors on the heart from overuse 2. O2 deprived muscle cells die off leading to overstretched muscle fibers that can't recoil 3. Bulked up cardiac cells demand more O2 but can't get it so they die off. Also wall thickens so chamber decreases in size lowering PL and SV
1. The most common presenting symptoms of chronic bronchitis are
1. productive and purulent cough, copious sputum production, dyspnea, wheezing, rhonchi, cyanosis of the skin and mucus membranes and peripheral edema
Diastolic HF HFpEF 1. Defined as 2. The main contributing factor is 3. What causes compliance issues and Lusitropy
1. pulmonary congestion despite a normal stroke volume and cardiac output EF >50% 2. decreased compliance of the left ventricle and abnormal diastolic relaxation (lusitropy) 3. Main: myocardial hypertrophy with resultant ventricular remodeling. Other causes include aortic valvular disease, mitral valve disease, pericardial diseases, and cardiomyopathies
List key points of Obstructive Disorders 1. Are characterized by a 2. Result in shortness of breath when 3. Causes air "trapping" in lungs 4. Include chronic obstructive pulmonary disorders (COPD) and 5. In persons with asthma are usually fully reversible, whereas
1. reduction in airflow. 2. exhaling air. 3. after full expiration. 4. asthma. 5. defects in persons with COPD typically are not.
Asthma can take two forms: Extrinsic and intrinsic. The two are compared below: Extrinsic 1. Triggered by an allergic, 2. Elevated IgE 3. More common in children Intrinsic 1. Triggered by a variety of 2. No elevation in 3. More common in
Extrinsic 1. chronic reaction (pollen, dust mites, pet dander) 2. is diagnostic 3. children Intrinsic 1. non-allergic factors (drugs-NSAIDs, chemicals, airborne irritants-smoking, infections-chronic RSV & human resp virus, exercise, stress, anxiety, GERD-acetylcholine causes bronchoconstriction, obesity) 2. IgE 3. adults less than 40 years of age
A subjective finding in interstitial lung disease is rhonchi in the upper posterior airways. True False
False
Cells that contain abnormal types of hemoglobin are more susceptible to infection by the parasite that causes malaria True False
False
Interstitial lung disease (ILD) includes infectious and neoplastic lung diseases. True False
False
Iron Stores When iron stores are depleted, the cell's mitochondria are still able to utilize iron effectively due to compensatory mechanisms. True False
False
Simple spirometry includes a measure of residual capacity. True False
False
The presence of a low number of autoantibodies is an indicator that the individual will develop an autoimmune disease. True False
False
The presenting signs and symptoms of an autoimmune disease is similar across all autoimmune diseases. True False
False
An objective finding in a patient with ILD include productive cough. True False
False (a positive finding is non-productive cough and fine crackles with exertion)
Which of the following is a non-modifiable risk factor for Coronary Artery Disease? Hypertension. Hyperlipidemia. Family history. overweight (BMI 25-29.9) obesity (BMI 30 and above)
Family history.
Clinical Findings in Macrocytic Anemias include:
Fatigue Dyspnea (shortness of breath) Loss of appetite or weight Diarrhea Pallor (pale skin)
Acute Inflammatory Response (Lasts <2 weeks) Histamine causes an immediate vascular response, explain Note: Chronic Inflammatory Response Lasts >2 weeks
Histamine causes constriction of large vessels walls Which increases blood flow to capillaries this causes redness, itching and heat ·Histamine causes dilation of capillaries and endothelial cell retraction Which increases permeability this leads to fluid leakage and swelling
What is a Hypersensitivity reaction?
Hypersensitivity is an inappropriate immune response to an antigen that results in a pathologic response upon re-exposure.
Which types of interstitial lung diseases (ILD) that are commonly associated with smoking: Hypersensitivity pneumonitis Desquamative interstitial pneumonia Sarcoidosis Pneumoconioses Pulmonary Langerhans cell histiocytosis Respiratory bronchiolitis-interstitial lung disease
Hypersensitivity pneumonitis Pulmonary Langerhans cell histiocytosis Respiratory bronchiolitis-interstitial lung disease
The (blank) lab value will be high in post-hemorrhagic anemia. Reticulocyte count MCV
Reticulocyte count
In order to recognize and differentiate the type of anemia what important lab components do we need to know?
Reticulocyte: Immature RBCs. Used to assess bone marrow function. Normal in adults is approximately 3%. Mean Cell Volume (MCV): This measures the average size of the RBC. Normal is 80-100 fL. Mean Corpuscular Hemoglobin Concentration (MCHC): Average concentration of hemoglobin per erythrocyte. Normal is 32-36%.
List some types of Autoimmune diseases and distinguish btw their clinical manifestations? See Diagram
Rheumatoid Arthritis, Systemic Lupus Erythematosus, Multiple Sclerosis, and Sjogren's Syndrome
Clinical Findings that an NP would observe in Rheumatoid Arthritis
Subjective: Painful and tender finger joints Stiffness of fingers upon awakening that improves with movement Fatigue Objective: Swollen metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints PIP joints warm to touch and red Rheumatoid nodule on the proximal ulna Decreased ROM of bilateral wrists and fingers
What sx would you see in a pt with serum sickness Review Scope of damage from SLE a Type 3 reaction
Symptoms: Fever, swollen hands and knees, achy joints, skin rash Signs: nonblancheable rash, bilateral swollen hands and knees
Which of the following is an autoimmune disease? Iron deficiency anemia. ABO incompatibility. Systemic Lupus Erythematosus (SLE). Osteoarthritis.
Systemic Lupus Erythematosus (SLE)
Type 4 hypersensitivity reaction What mediates this reaction
This is a T-cell mediated reaction where no Ag-Ab complex is involved. When the pt comes in contact with the Ag, T-cells are activated leading to epidermal reactions T cells can be Cytotoxic T cells kill target cells directly via toxin (perforin) release. and T helper (TH cells) a. The TH1 cells release cytokines that attract & activate macrophages that induce apoptosis of the target cells via release of lysosomal enzymes
Symptoms common to both intrinsic and extrinsic asthma include: Wheezing. Slowed breathing. Dizziness. Elevated heart rate.
Wheezing.
Aplastic anemia can be caused by: a. Antibiotics. b. Long-standing pulmonary disease. c. Anemia of chronic disease. d. Infections.
a. Antibiotics.
The (blank) test is positive in 90% of patients diagnosed with Systemic Lupus Erythematosus (SLE). a. Antinuclear Antibody (ANA) b. Sedimentation rate c. C-Reactive protein d. Rheumatoid factor
a. Antinuclear Antibody (ANA)
Which of the following would indicate that the patient's iron stores are depleted? a. Ferritin level. b. Vitamin-B-12 level. c. Total iron binding capacity. d. Total RBC count.
a. Ferritin level. This is used to definitively dx IDA
Folic acid is essential to the body because it: a. Plays a major role in the maturing of RBCs. b. Impacts the absorption of vitamin B-12. c. Allows for the production of erythropoietin. d. Prevents cardiovascular disease.
a. Plays a major role in the maturing of RBCs.
Loss of vibratory sense in a patient with Vitamin B-12 deficiency is due to which of the following pathophysiological changes: a. Posterior and lateral column spinal cord changes due to nerve demyelination. b. Cellular atrophy. c. Changes in cerebellar brain function. d. Myelopathy.
a. Posterior and lateral column spinal cord changes due to nerve demyelination.
A patient with human immunodeficiency virus (HIV) was admitted to the acute care facility with difficulty breathing. He is diagnosed with Pneumocytis carinii. Pneumocystis carinii an example of: a. A primary immune disease. b. A secondary immune disease.
b. A secondary immune disease.
The NP notes that a patient's FEV1/FVC ratio is severely reduced. Which of the following conditions is most likely the patient's pulmonary issue? a. Pulmonary hypertension. b. Morbid obesity. c. Chronic asthma. d. Pneumonia.
c. Chronic asthma.
Which of the following findings can be used to diagnose Systemic Lupus Erythematosus (SLE)? a. Headache. b. Low back pain. c. Facial rash confined to the cheeks. d. Fever.
c. Facial rash confined to the cheeks.
Renal Disease A renal disease most often associated with autoimmunity is: a. Urinary Tract Infection. b. Renal lithiasis c. Glomerulonephritis d. Cystitis.
c. Glomerulonephritis
Which of the following indices measures the average size of red blood cells? a. Hemoglobin (Hb). b. Reticulocyte count. c. Mean Corpuscular Volume (MCV). d. Mean Corpuscular Hemoglobin Concentration (MCHC).
c. Mean Corpuscular Volume (MCV).
The patient with aortic stenosis would most likely present with: a. High-pitched murmur. b. Right ventricular hypertrophy. c. Mid-systolic crescendo-decrescendo murmur. d. S3 gallop.
c. Mid-systolic crescendo-decrescendo murmur.
A patient with mitral stenosis would most likely present with: a. Bradycardia. b. High-pitched murmur. c. Rumbling, decrescendo diastolic murmur heard at apex of the heart. d. Holosystolic murmur.
c. Rumbling, decrescendo diastolic murmur heard at apex of the heart.
Which of the following assessment findings would support a diagnosis of Rheumatoid Arthritis (RA)? a. A butterfly rash across the facial cheeks. b. Muscle weakness and ataxia. c. Swollen metacarpophalangeal joints. d. Inflammation in the salivary and lacrimal glands.
c. Swollen metacarpophalangeal joints.
The number one cause of chronic bronchitis is cigarette smoking alpha-antitrypsin deficiency exposure dust exposure to allergens
cigarette smoking
What modifiable risk factors can influence formation of a coronary thrombus?
elevated LDL, cholesterol, Elevated total cholesterol, elevated low-density lipoprotein (LDL), and/or high-density lipoprotein (HDL) smoking and diabetes. overweight (BMI 25-29.9) or obesity (BMI 30 and above). Hypertension
An expected chest x-ray finding for a patient with COPD is a (blank)? flattened diaphragm enlarged heart elongated diaphragm protruding diaphragm
flattened diaphragm
In a patient with pernicious anemia, (blank) lab values can be normal or low? folate reticulocyte count MCV MCHC
folate Retic counts will be low, MCV will be high, MCHC will be low
Foods rich in folic acid include
green, leafy vegetables; citrus fruits; beans, rice and cereal; and folate-fortified foods
Left sided HF can be categorized into two types, id them?
heart failure with reduced ejection fraction, or HFrEF (systolic heart failure), EF<40% or heart failure with preserved ejection fraction, or HFpEF (diastolic heart failure)
The primary difference between type II and type III mechanisms is that
in type II hypersensitivity antibody binds to the antigen on the cell surface, whereas in type III the antibody binds to a soluble antigen that was released into the blood or body fluids, and the complex is then deposited in the tissues
A patient with Chronic Granulomatous Disease of Childhood has a primary immune disease secondary immune disease
primary immune disease
Explain the significance behind a bronchodilator response used in spirometry readings/PFTs?
spirometry may be repeated after the patient receives a bronchodilator. If either the FEV1 increases by at least 12% and by at least 200 mL from the pre-bronchodilator values, then the patient has had a significant bronchodilator response.
Type 3 hypersensitivity reaction Give an example of both a systemic and localized Type 3 reaction
systemic reaction. a. serum sickness (autoimmune disorder) b. Raynaud's phenomenon is a sub-type of serum sickness c. SLE see follow card localized reaction. a. the Arthus reaction (allergic reaction)
Review the follow case Step 2 Determine the Severity: based on a FEV1 percent predicted of 91
the patient is considered to have mild severity based on the FEV1 percent predicted being >80%
Review the follow case Step 2 Determine the Severity; based on FEV1 percent predicted of 47 this would indicate
the severity is severe based on the Gold Criteria
Extrinsic asthma is triggered by an allergic reaction triggered by non-allergic factors characterized by no elevation in IgE typically seen in adults less than 40 years of age
triggered by an allergic reaction
Hyperresonance found on lung percussion with a patient with COPD is primarily due to air trapping consolidation of secretions ruptured alveoli mucus plugs
air trapping
Which of the following is a cause of hemolytic anemia? (Select all that apply.) Drugs. Infection. Transfusion reaction.
all apply
List the three levels or barriers of defense regarding immunity
1st line -the physical, mechanical and biochemical barriers 2nd Line-the inflammatory response 3rd Line-lymphocyte production
Anemia can be caused from which of the following? (Select all that apply.) Increased red blood cell destruction. Impaired red blood cell production. Excessive blood loss.
all of the three
Aortic regurgitation 1. List the causes of AR 2. List the signs/symptoms of AR
1. 1. Widening or aneurysm of Aortic Annulus, Endocarditis, Rheumatic fever (don't focus on 3rd point in diagram) 2. Fatigue, Syncope, SOB, Palpitations, Widened pulse pressure: due to blood going back into LA S3 Signaling, Laterally displaced PMI Early Diastolic murmur @ LSB Don't focus on the third point in diagram heavily convoluted with Aortic stenosis
(systolic heart failure), EF<40% 1. is defined as 2. The main contributing factor is
1. inability of the heart to generate an adequate cardiac output to perfuse vital tissues 2. is decreased contractility due to Myocardial infarction
A patient with chronic bronchitis is at risk for developing pneumonia due to: Inability to cough. Hypoxemia. Overactive cilia in the lungs. Mucus plugs.
Mucus plugs.
List some indications of when to order PFTs 1. signs and symptoms of 2. When disease progression 3. When monitoring the effectiveness 4. When monitoring for potential toxic
1. (cough, dyspnea, cyanosis, wheezing, hypoxemia, hypercapnia and lung hyperinflation). 2. needs to be determined. 3. of drug therapy. 4. effects of certain drugs.
1. What is an Autoimmune Disease? 2. Autoimmune Disease may occur when the immune system overreacts again self-antigens to the extent that tissue damage occurs what mediates this? 3. Review diagram
1. A disease in which the body's immune system attacks healthy cells. 2. The tissues damage is caused by the autoantibodies and T-cells and in some cases, B-cells that overreact against MHCs
Asthma Medications 1. Short-Acting Beta-2 Agonists (SABA) (albuterol)-it will act on the 2. Inhaled Corticosteroids (ICS) are used to 3. Mast-cell stabilizers (cromolyn sodium)-are used in situations where patients have cold or exercise-induced asthma. They Inhibit 4. Leukotriene Receptor Antagonists (LTRA)-(Montelukast) -It binds onto the receptors and blocks 5. Omalizumab-an anti-IgE antibody that binds onto the IgE antibody
1. beta 2 adrenergic receptors to cause bronchodilation. 2. reduce inflammation 3. the release of histamine by the mast cells and inhibit eosinophils 4. the reaction of leukotrienes to inhibit bronchospasms and mucus production 5. It helps to decrease bronchospasms, decrease vascular permeability, inflammation and mucus production. It is indicated in the severe stage of asthma
1. Chronic bronchitis is a disease characterized by 2. What causes airflow obstruction and decreased alveolar ventilation 3. The lung damage from chronic bronchitis is
1. bronchial inflammation, hypersecretion of mucus, and chronic productive cough that persists for at least 3 consecutive months for at least 2 successive years. 2. excess mucus production and accumulation, hypertrophy of bronchial smooth muscles, hypertrophy and hyperplasia of bronchial mucus-producing cells 3. irreversible
Asthma presentation 1. The typical presentation during the onset of an attack is 2. In more severe attacks, the patient will use 3. Signs of status asthmaticus (impending death) may include 4. All asthma symptoms tend to occur
1. chest tightness, expiratory wheezing, dyspnea, non-productive cough, prolonged expiration, tachycardia, and tachypnea. 2. the accessory muscles to breath. 3. The absence of breath sounds and a PaCO2 greater than 70 mmHg 4. at night or in the early morning hours
Chronic blood loss anemia 1. associated with 2. What other concomitant anemia will be seen?
1. chronic GI bleeding. 2. Chronic blood loss will deplete iron stores and also produce iron-deficiency anemia
Iron Deficiency Anemia (most common anemia) 1. Causes of IDA include: 2. review diagram
1. common: Inadequate dietary intake OR Chronic and or occult bleeding: hemorrhage, colitis, cirrhosis, GI ulcers, esophageal lesions, or menorrhagia; less common: Decreased ability to utilize Fe for heme synthesis (e.g. transferrin deficiencies and mitochondrial defect
clinical manifestations of Diastolic HF 1. Individuals will often present with dyspnea especially 2. Late in diastole, atrial contraction with rapid ejection of blood into the noncompliant ventricle may give rise to (you'll hear) 3. chest x-ray shows
1. dyspnea on exertion and fatigue 2. an S4 (atrial) gallop 3. pulmonary congestion without cardiomegaly
clinical manifestations of Systolic HF 1. as result of pulmonary vascular congestion 2. as result of inadequate perfusion of the systemic circulation 3. Physical examination of heart and lungs reveals 4. A CXR shows
1. dyspnea, orthopnea, cough of frothy sputum, fatigue 2. fatigue, decreased urine output, and edema and cyanosis, hypotension or hypertension 3. pulmonary edema, inspiratory crackles, an S3 (ventricular) gallop 4. pleural effusions, pulmonary congestion and cardiomegaly
Diagnosis of ILD 1. Diagnosis of ILD is made based on exposure history ask about 2. A chest-x-ray will reveal 3. There are 4 key tests to definitively diagnose ILD
1. exposure to animals, especially birds; medication history, including the use of illicit drugs (methamphetamines, marijuana, smoking crack cocaine) and radiation treatment 2. a honey-comb pattern 3. High resolution CT Pulmonary function tests Bronchoalveolar lavage Lung biopsy
In Sickle Cell Anemia there is an abnormal shape and high MCHC (Hb concentration) 1. The lysis of large amounts of RBCs put the individual at risk for 2. The abnormal RBCs also occlude
1. for circulatory iron-overload 2. cerebral, splenic and glomerular blood vessels and create a high risk for strokes, splenic and kidney damage. Most are asplenic by adulthood.
Acute Coronary Syndrome 1. ACS develops from 2. ACS is categorized as two events 3. When atherosclerosis reaches a clinically significant level 4. Myocardial infarction (MI) results when
1. sudden coronary obstruction from thrombus OR ruptured plaque 2. unstable angina and myocardial infarction 3. the patient will begin to experience angina. Further progression causes ACS 4. prolonged ischemia causes irreversible damage to the heart muscle usually >20 min
1. Right side HF is defined as 2. Causes of R sided HF include *review the diagram of pathophysiology
1. the inability of the right ventricle to provide adequate blood flow into the pulmonary circulation. 2. pulmonary disease that causes pulmonary HTN. (most common cause) 2) RV (MI), 3) RV hypertrophy (secondary to other causes) 4) tricuspid valve damage -backflow of the blood 5) secondary failure from left heart failure
Review the follow case 1. Step 1 Determine the Pattern: Based on a FEV1/FVC ratio of 88.6 this would indicate
1. the presence of a normal or restrictive disease it can NOT be an obstructive disease would have an FEV1/FVC <70-80%
Type I allergic reaction 1. Skin allergies produce 2. Which of the following assessment findings would be expected in a patient who presents with urticaria?
1. urticaria (hives) which is characterized by a wheal-and flare reaction or hay fever 2. Eosinophilia, because Mast cell degranulation triggers recruitment of eosinophils
1. ILD should be considered in any patient presenting 2. if they have a history of: 2a. exposure to 2b. Connective 2c. Cancer 2d. Taking meds such as
1. with subacute or chronic, progressive shortness of breath and/or a non-productive cough 2a. Occupational or animal exposure, excluding dogs and cats 2b. tissue disease 2c. Chest irradiation 2d. amiodarone, nitrofurantoin, or methotrexate
ILD can be grouped into four general categories based on etiology: List them
Exposure-related Connective tissue disease Idiopathic Miscellaneous or "other"
Review the follow case Step 3 evaluate the post bronchodilator response: Pre-bronchodilator FEV1: 1.38 Post bronchodilator FEV1: 2.61 this would indicate
A good bronchodilator response based on a change of >12% or >200ml *consider based on this the pt likely has asthma over COPD
So what happens in these regulatory genes that cause cancer?
A point-mutation would be like having a faulty accelerator or brake system A chromosomal amplification would be like having two accelerators A chromosomal translocation would be like switching the brake pedal with the accelerator pedal
What is the role of natural adenosine in the body when there is myocardial ischemia?
Adenosine does two things 1. stimulates SNS system to increase HR. 2. SNS stimulation occurs at the upper thoracic dorsal roots of the spinal cord that leads to the arm pain.
Hypertension has its most immediate effect on: Preload. Stroke volume. Afterload. Contractility.
Afterload.
Hypersensitivity can be classified based upon the source of the antigen against which the hypersensitivity response is directed. List the three types Allergy Autoimmunity Alloimmunity
Allergy a. An allergy is an exaggerated response against innocuous environmental antigens. ie: hay fever, hemolysis in drug allergies, gluten, & poison ivy. Autoimmunity a. Autoimmunity is a misdirected immune response against the host's own cells ie: RA, graves disease, T1DM or Systemic lupus Alloimmunity a. Alloimmunity is an immune response that is mounted against antigens from an individual of the same species (directed against beneficial foreign tissues). ie: transfusion reactions, organ rejection or pregnant mom attacking fetus
Choose the drugs that are commonly associated with development of a medication-induced interstitial lung disease (ILD): Nitrofurantoin Lisinopril Amiodarone Warfarin Omeprazole Methotrexate
Amiodarone Methotrexate Nitrofurantoin
In COPD what two factors lead to cardiac hypertrophy and right-sided heart failure or cor pulmonale
An increase in RBCs and pulmonary vasoconstriction 1. RBCs increase from chronic hypoxia triggers kidneys to secrete EPO raising Hb-polycythemia (secondary) 2. Low V/Q ratio causes pulmonary vessel constriction leading to pulmonary HTN
What is Anemia?
Anemia is a hematological disorder characterized by a reduction in the total number of circulating red blood cells (RBCs) and/or a decrease in hemoglobin (Hb) amount or function
List types of anemia associated with normocytic (MCV80-120 fL)
Anemia of inflammation and chronic disease Hereditary spherocytosis G6PD deficiency Paroxysmal nocturnal hemoglobinuria
Cancer cells are defined by 2 heritable properties.
Autonomy a. disregard normal limitations of growth-produce telomerase which makes cell immortal Anaplasia a. Anaplasia is the loss of cell differentiation
List types of anemia associated with Macrocytic (MCV>100 fL)
B12 deficiency (pernicious anemia) Folate deficiency
1. The most common presenting symptoms of emphysema are
Barrel Chest, Dyspnea, Prolonged Expiration
The NP is examining a patient with a longstanding history of chronic bronchitis. Cor pulmonale is expected in the patient that presents with: Hepatomegaly. Venous stasis ulcers. Hypoxia. Hypocapnia.
Hepatomegaly.
Aplastic Anemia 1. means "without 'plasia' or cell growth" can be caused by a variety of factors including
Chemical or radiation exposure (chemotherapy) Viral induced-Hepatitis, Epstein-Barr virus, Cytomegalovirus Tumors-Multiple Myeloma Antibiotics/anti-seizure drugs/other drugs-PCN, Phenytoin, Diuretics, Antidiabetic drugs, Sulfa drugs Congenital defects-Fanconi's anemia
Compare the list symptoms btw Chronic bronchitis and Emphysema Clinical Manifestations Productive cough Dyspnea Wheezing History of Smoking Barrel Chest Prolonged Expiration Cyanosis Chronic Hypoventilation- Polycythemia Cor Pulmonale
Chronic Bronchitis Productive cough-classic Dyspnea Late in course Wheezing-Intermittent Minimal History of Smoking-Common Prolonged Expiration-Always present Barrel Chest-Occasional Cyanosis-Common Chronic Hypoventilation-Common Polycythemia-Common Cor Pulmonale-Common Emphysema Productive cough-Late in course with infection Dyspnea-Common Wheezing-Minimal History of Smoking-Common Barrel Chest-Classic Prolonged Expiration-Always present Cyanosis-uncommon Chronic Hypoventilation-Late in course Polycythemia-Late in course Cor Pulmonale-Late in course
Which of the following pulmonary function test results are expected in a patient with chronic bronchitis? Increased forced expiratory volume in one second. (FEV1) Increased vital capacity. Decreased FEV1/FVC ratio. Decreased residual volume.
Decreased FEV1/FVC ratio.
Asthma results in: Increased alveolar oxygenation. Decreased alveolar ventilation. Increased alveolar ventilation. Scant mucus production.
Decreased alveolar ventilation.
Which of the following pulmonary function test results are consistent with asthma? Increased FVC Increased FEV1 and FEV1/FVC. Decreased peak expiratory flow rate. Decreased total lung capacity and residual volume.
Decreased total lung capacity and residual volume.
Which of the following conditions can decrease preload? Fluid overload. Pain. Fever. Hemorrhage.
Hemorrhage.
The effects of an Alpha-antitrypsin 1 deficiency is: Inhibits the immune cell response. Reduction in elastase production. Inability to block the effects of proteolysis. Deactivates neutrophils.
Inability to block the effects of proteolysis.
Asthma is a chronic disease characterized by: Bronchial scarring. Intermittent, reversible airflow obstruction. Air trapping. Airway infection.
Intermittent, reversible airflow obstruction.
List types of anemia associated with Microcytic (MCV<80 fL)
Iron deficiency Anemia Sideroblastic Thalassemia Anemia of chronic disease
How are Leukotrienes and prostaglandins different than histamine?
Leukotrienes and prostaglandins function similar to histamine; they are capillary vasodilators but have a prolonged effect and occur later in the inflammatory response
List a predominant cause of secondary immune deficiencies worldwide
Malnutrition
Macrocytic Anemias MCV>100 dL Macrocytic anemias are categorized as
Megaloblastic: Folate deficiency and vitamin B12 deficiency Non-megaloblastic: Liver disease*, myelodysplastic syndrome, increased reticulocyte count (hemorrhage)
Microcytic Anemias can also be classified according to their color, or amount of hemoglobin per RBC (MCHC). Identify if each item below is Hypochromic, Normochromic, or Hyperchromic: Iron deficiency Anemia of inflammation and chronic disease Sideroblastic Hereditary spherocytosis Thalassemia
Microcytic Hypochromic Iron deficiency Sideroblastic Thalassemia Microcytic Normochromic Anemia of inflammation and chronic disease Microcytic Hyperchromic Hereditary spherocytosis
Which of the following is a modifiable risk factor for Coronary Artery Disease (CAD)? Obesity. Family history. Age. Menopause. Male gender
Obesity.
Compare the findings of the Spirometry measurements below in Obstructive vs Restrictive Disease Forced vital capacity (FVC) Forced expiratory volume in 1 second (FEV1): Normal is > 80% FEV1/FVC ratio: Normal is 70% or greater than the lower limit Total lung capacity (TLC): Normal range is 80-120% of predicted
Obstructive (FVC)Decreased or normal (FEV1) Decreased FEV1/FVC ratio: Less than 70% Total lung capacity (TLC): >120% (represents hyperinflation) Restrictive (FVC): Decreased (FEV1): Decreased FEV1/FVC ratio: Normal or > 70% Total lung capacity (TLC): <80%
The NP notes that a patient's FEV1/FVC ratio is normal. Which of the following conditions is most likely the patient's pulmonary issue? Pulmonary fibrosis. Pneumonia. Chronic asthma. Emphysema.
Pulmonary fibrosis.
The most common cause of right-sided heart failure is: Pulmonary hypertension. Right ventricular hypertrophy. Myocardial infarction. (MI) Tricuspid valve damage.
Pulmonary hypertension.
Distinguish btw L and R sided HF of the following: Jugular vein distention Increased left ventricular afterload Decreased ejection fraction Hepatosplenomegaly Peripheral edema Increased left ventricular preload Cor Pulmonale Pulmonary edema Dyspnea Tricuspid valve damage
R sided: Jugular vein distention, Hepatosplenomegaly, Peripheral edema, Cor Pulmonale, Tricuspid valve damage L sided: Increased left ventricular afterload, Decreased ejection fraction <40%, Increased left ventricular preload, Pulmonary edema, Dyspnea
Explain what leads to fluid retention, dilute blood that can stress the cardiac system resulting in tachycardia or even heart failure
RBC level decrease in blood volume, activates the renin-angiotensin-aldosterone (RAA) system
Clinical Manifestations of Anemia Decreased tissue oxygenation from anemia can manifest as signs and symptoms of the following:
Severe fatigue Pallor Weakness Dyspnea Dizziness
1. ID the differences btw sickle cell anemia and thalassemia 2. Where is Sickle cell disease common ?
Sickle cell disease is more common in Africa
Receptor blockage (explain this process)
The antibody binds to the target cell and occupies receptors that would normally bind with other molecules required for normal cell function An example of receptor blockage is hyperthyroidism caused by Graves disease
The NYHA Fxnal Classification is based on what?
The impact on the pt's activity caused by the degree of HF symptoms
What is the most important activator of the inflammatory response. Explain.
The mast cell Injury or infection triggers mast cells (located in the skin and RT/GI mucosa) · The degranulate causing the release of histamine which causes an immediate vascular response
Which of the following are iron-rich foods? Spinach. Meat. Lima beans.
They all are
Cancer is a secondary immunodeficiency. True False
True
In Coronary Artery Disease (CAD), pumping ability of the heart can be impaired due to the deprivation of oxygen. True False
True
Sickle Cell Anemia The pathophysiology of sickle cell anemia involves a single amino-acid change on the beta-chain. True False
True
The following immune components can be involved in autoimmune diseases: T-Cells, B-cells and autoantibodies. True False
True
The four key diagnostic tests for interstitial lung disease are pulmonary function tests, high resolution CT scan, bronchoalveolar lavage and lung biopsy. True False
True
The patient with sickle cell anemia is at high risk for stroke. True False
True
The symptoms that are common to all types of interstitial lung disease are shortness of breath and non-productive cough. True False
True
There are four genes involved in encoding synthesis of the alpha protein chains for Hb and are located on chromosome number 16. True False
True
Acute blood loss of anemia is usually associated with acute GI bleeding and labor and delivery complications. True False
True (as well as trauma)
Review the follow case Step 1 Determine the Pattern: Based on a TLC of 67 this would indicate
a restrictive lung disease as the TLC is <80-120% which would indicate a normal TLC
Normocytic anemias are categorized by normal average red blood cell size (MCV 80-99 dL). When a patient presents with a normocytic anemia, what test should be done?
a reticulocyte count should be performed. (to determine the #of premature RBCs in the bone marrow) If >3% the bone marrow is producing many immature RBCs to compensate for a loss from hemolytic or blood loss anemia If <3% bone marrow is not adequately compensation seen in aplastic anemia
The major immune system change associated with Sjogren's Syndrome is: a. Autoantibodies and auto-reactive T-cells against apoptotic cells. b. Autoantibodies and auto-reactive T-cells against brain antigens. c. Autoantibodies and auto-active T-cells against DNA and nucleoprotein antigens. c. Autoantibodies and auto-reactive T-cells and B-cells against joint-associated antigens.
a. Autoantibodies and auto-reactive T-cells against apoptotic cells.
Which of the following spirometry results indicate restrictive lung disease? a. FEV1, FVC, and total lung capacity reduced; FEV1/FVC ratio normal. b. FEV1 reduced, FVC normal, total lung capacity reduced; FEV1/FVC ratio normal. c. FEV1, FEV, and total lung capacity reduced; FEV1/FVC ratio reduced. d. FEV1, FEV, and total lung capacity normal: FEV1/FVC ratio normal.
a. FEV1, FVC, and total lung capacity reduced; FEV1/FVC ratio normal.
Which of the following lab values are normal for the patient with folate deficiency? a. Ferritin. b. Folate. c. MCV. d. Reticulocyte count.
a. Ferritin
The most common type of anemia is a. Iron deficiency anemia b. Anemia of chronic disease c. Pernicious anemia d. Thalassemia
a. Iron deficiency anemia
A non-megaloblastic anemia would be caused by a. Liver disease b. Folate deficiency c. Vitamin B-12 deficiency d. Iron deficiency
a. Liver disease
Coronary artery disease (CAD) is mainly the result of: a. Longstanding atherosclerosis b. Hypertension. c. Hyperlipidemia. d. A history of myocardial infarction.
a. Longstanding atherosclerosis
Which of the following will be elevated in a patient with pernicious anemia? a. MCV. b. Folate. c. Serum B-12. d. Reticulocyte count.
a. MCV.
Rheumatic fever is a common cause for a. Mitral Stenosis b. Mitral Valve Prolapse c. Aortic Regurgitation d. Aortic Stenosis
a. Mitral Stenosis also for Mitral regurg but seen early in the course of the disease
Hemolytic anemia Elaborate on the causes of a. infectious agent b. ones on immune system c. chemicals/drugs *Review the diagram
a. Parasites or hemolytic toxin-producing bacterium, ie: Escherichia coli b. Transfusion Reaction: incompatible blood product (type 2 hypersensitivity OR Hemolytic disease of the newborn (Rh incompatibility issue) c. drugs inducing hydrogen peroxide, a free radicals which causes Fe +2 to oxidize to form Fe +3 which can't bind O2
What are 4 cardinal signs of an acute inflammation:
a. Redness 1) produced by increased oxygenated blood to the area via VD. b. Heat 1) Blood is warmer than surrounding tissue. c. Swelling 1) increased capillary permeability produces edema. d. Pain 1) Injury of nerve fibers/activation of pain receptors by chemicals and swelling elicit pain sensation.
A patient with mitral regurgitation would most likely present with a a. blowing, holosystolic murmur b. high-pitched murmur c. clear lungs d. bradycardia
a. blowing, holosystolic murmur
What happens when acute inflammation can't take care of everything? So what is the beneficial purpose of a fever?
a. increases phagocytic activity. b. inhibits bacterial growth via several mechanisms. c. augments the effects of interferons. d. speeds up body reactions that aid repair.
A deficiency of intrinsic factor will result in a. pernicious anemia b. IDA c. anemia of chronic disease d. aplastic anemia
a. pernicious anemia
Which of the following is not a clinical characteristic of anemia? a. Fatigue b. Bradycardia c. Dyspnea d. Pallor
b. Bradycardia
The NP is seeing a patient with chronic bronchitis that needs spirometry on today's visit. What pulmonary function test (PFT) findings are anticipated based on the diagnosis of chronic bronchitis? a. Decreased total lung capacity (TLC). b. Decreased forced expiratory flow (FEV1). c. Increased lung compliance. d. Decreased diffusing capacity.
b. Decreased forced expiratory flow (FEV1).
Which of the following conditions could result in iron deficiency anemia? a. Increased absorption of iron-containing foods. b. Excessive bleeding. c. Reduced absorption of Vitamin B-12. d. Reduced intake of Vitamin C.
b. Excessive bleeding.
A transferrin deficiency will most likely result in: a. Pernicious anemia. b. Iron-deficiency anemia. c. Aplastic anemia. d. Hemolytic anemia.
b. Iron-deficiency anemia.
Simple spirometry can be used to measure any of the following EXCEPT: a. Vital capacity. b. Residual volume. c. Tidal volume. d. Inspiratory reserve volume.
b. Residual volume.
The NP reviews the results of a patient's pulmonary function tests and notes that the FEV1, FVC, and total lung capacity (TLC) are reduced. The FEV1/FVC ratio is normal. Based on interpretation, this reflects: a. The test is invalid. b. Restrictive lung disease. c. Obstructive lung disease. d. Combined obstructive-restrictive lung disease.
b. Restrictive lung disease.
Which of the following lab values will be low in a patient with folate deficiency? a. MCV. b. Reticulocyte count. c. Ferritin. d. MCHC.
b. Reticulocyte count (were dealing with young RBCs) premature death
A patient with normal lungs should be able to exhale (blank) of the forced vital capacity within the first second. a. 50% b. 70% c. 80% d. 90%
c. 80%
The patient with aortic regurgitation would most likely present with: a. An early, high-pitched diastolic murmur heard at the left lower sternal border b. A diastolic rumbling murmur heart at the apex of the heart c. A systolic crescendo-decrescendo murmur heart at the left upper sternal border d. All of the above
d. All of the above (key sound is high-pitched diastolic murmur heard at the left lower sternal border)
In hemolytic anemia, the destruction of lysis of RBCs is due to: a. Enzymes or toxins produced by an infectious agent. b. Chemical release medication by one's immune system. c. Effects of drugs. d. All of the above will cause lysis of RBCs.
d. All of the above will cause lysis of RBCs.
The MCHC will be normal in which of the following anemias? a. Aplastic anemia b. Post-hemorrhagic anemia c. Hemolytic anemia d. MCHC is normal in all the above anemias
d. MCHC is normal in all the above anemias
Which of the following statements are correct regarding thalassemia? a. Maintains effective erythropoiesis. b. Is characterized by acute and painful episodes. c. Involves a double amino acid change on the beta chain. d. May have many possible genetic mutations.
d. May have many possible genetic mutations.
Cor Pulmonale is: a. Left ventricular failure secondary to systemic hypertension. b. Left ventricular failure due to a pulmonary disease. c. Right ventricular failure due to systemic hypertension. d. Right ventricular failure secondary to pulmonary hypertension.
d. Right ventricular failure secondary to pulmonary hypertension.
