Pathophysiology Exam Two

A 65 year old male with a significant smoking history and COPD for years presents with symptoms of heart failure. He has JVD, ascites, pleural effusions, hepatosplenomegaly and leg edema up to his thighs that is pitting. His echocardiogram shows a left ventricular ejection fraction of 47 percent. He has no history of MI. What is the most likely diagnosis?

Right sided heart failure due to long term COPD and cor pulmonale

A 45 year old smoker presents with fever, productive green sputum. On exam she has decreased breath sounds on the right side along with increased bronchophony, egophony, and whispered pectoriloquy. What is the diagnosis?

Right sided pneumonia

Place the order of conduction of the heart in the correct order: AV node Purkinje fibers Bundle of His Bundle braches SA node

SA node AV node Bundle of His Bundle branches Purkinje fibers

An asthmatic patient has daily symptoms and an FEV1 less than 60 percent expected. The patient also has had hospitalizations for asthma. What classification is thus asthmatic patient?

Severe Persistent

The primary health care provider prescribes decongestants and nasal steroids for a patient. Which condition is most likely present?

Sinusitis

A patient has blood pressure readings of 142/92 mm Hg and 140/94 mm Hg. Which hypertension category would apply to this patient?

Stage 2 Hypertension

Which muscles of respiration are considered accessory muscles and if used means the patient is in respiratory distress?

Sternocleidomastoids

A 25 year old male was in a car accident resulting in spinal trauma above C4 making him a quadriplegic requiring a ventilator. He has had a chronic Foley catheter for over a year and has had repeated infections with Proteus mirabilis which is a urease splitting microorganism. He has been having issues with repeated urolithiasis that are "staghorn calculi" what type of stone is most likely in this patient?

Struvite

Which of the following is a potential complication of hypertension?

Ventricular hypertrophy

What does the T wave represent in the cardiac cycle?

Ventricular repolarization

Statins

is a medication that lowers cholesterol in the blood and reduce its production in the liver by blocking the enzyme that produces it

Hypertension

high blood pressure

Cardiac output is defined as:

the amount of blood the heart pumps out in 1 minute

Hyperlipidemia (HDL)

the presence of excess lipids/fats in the blood; commonly used interchangeably with simply "high cholesterol"

Which of the following medications work to lower cholesterol?

Bile acid sequestrants Statins

Which finding would be diagnostic with a patient with Goodpasture's Syndrome?

Biopsy of the kidney showing positive anti-GBM antibodies

What is the BEST way to keep track of a patient's daily fluid balance?

Daily weights and 24 hour input and output or I's and O's

Which of the following will cause an increase in stroke volume of the heart?

Decreased afterload

Which pathology is a medical emergency where the pharynx is visibly inflamed and presents with the steeple sign on x-ray?

Epiglottitis

What is the fluid found in capillaries called?

Extracellular fluid or ECF

A patient in asystole must receive defibrillation immediately, just like they do it in TV hospital dramas.

False

What type of cells are unicellular exocrine glands that secrete mucus on to body surfaces?

Goblet Cells

The "good" cholesterol, thought to provide a cardioprotective effect, is known as

HDL

ventricular hypertrophy

Increase in size of cardiac muscle in the heart's ventricles. Left ventricular hypertrophy (LVH) may be a sign that the heart is working harder to pump blood to the rest of the body.

Which of the following is the cause of left ventricular hypertrophy in HTN?

Increased afterload from increased peripheral vascular resistance pushing against the left ventricle cause the muscle to hypertrophy

A 25 year old male patient who is a known IV drug user presents to the hospital with chest pain and the vital signs are 101.5 F body temperature and 125/85 mm Hg blood pressure. The echocardiogram of the patient shows valve perforation with vegetations and a new regurgitant murmur is heard during chest auscultation. Both blood cultures are growing Staphylococcus aureus. What is your diagnosis?

Infective endocarditis

Which fluid is found inside of cells?

Intracellular fluid or ICF

Which patient below would most likely develop hypersensitivity pneumonitis?

A butcher who grinds bones regularly and never uses respiratory protection

Which hormone causes reabsorption of sodium at the kidney and water follows by osmosis, it also helps in excretion of potassium?

Aldosterone

A nurse practitioner is instructing nursing students about a patient who has just been found to have a total cholesterol of 234, a HDL of 32 and an LDL of 137 with a triglyceride level of 140. What is the first line of treatment for this patient?

Low fat diet and cardiovascular exercise at least thirty minutes per day, three time per week

The average heartbeat of a patient is 80 beats per minute. The volume of the blood ejected per contraction from the patient's left ventricle is 72 mL. Which is the cardiac output of the client? Record you answer as a whole number.

5.760 mL per minute

Which statement is TRUE about cardiac output?

"Cardiac output is the amount of blood that the heart pumps out of the left ventricle."

You are a nutritionist teaching a patient who had a recent myocardial infarction about a heart healthy diet. Which of the patient statements below is NOT TRUE about a heart healthy diet to lower cholesterol?

"I should avoid using olive and canola oil"

Which IV fluid is isotonic to red blood cells?

0.9% NaCl or normal saline

What is normal central venous pressure?

1 to 5 mm Hg

75 year old male with a long history of smoking is found to have painless gross hematuria. All of his labs are otherwise normal. What would NOT be a reasonable next step in this patient's evaluation?

24 hour urine collection of protein

A 25 year old Olympic gold medal winning body builder presents to your clinic for a check up. He is found to have elevated serum creatinine and BUN. You are concerned that they may have kidney disease. He admits to protein supplements and has a large body mass above average for his height and mostly muscle with low body fat percentage. What would be the BEST way to determine if this creatinine and BUN elevation is just due to muscle mass and protein supplements?

24 hour urine creatinine to calculate GFC

Which of the following patients would have the lowest risk for developing HTN?

A 25 year old who exercises regularly

You are examining a patient and use the bell side of your stethoscope to listen to the patient's carotid arteries. The right carotid artery has a bruit and the left does not. What is the cause of the bruit in an artery?

A bruit is caused by the narrowing of the lumen to at least 70 percent due to plaque build up resulting in faster blood flow that hits the walls of the artery creating noise

Which would be a presentation of chronic heart failure and NOT acute CHF?

A patient with known left sided heart failure for years present with exacerbation of CHG due to eating at Cracker Barrel

A 65 year old male with known stable angina is brought into the ED with ST elevations on telemetry and now positive troponin indicating an acute MI. What was the most likely pathophysiology causing this man's stable angina to now become unstable and progression to MI?

A plaque ruptured off of the arterial wall and traveled to the known coronary blockage that was causing his stable angina and completely occluded that artery leading to unstable angina and an MI

Which is a risk factor for hypertension?

A strong family history of resistant hypertension

Which of the following is a function of the kidneys?

Acid-base balance of the blood

A patient presents to the ED with left sided chest pain with ST elevations on EKG and an elevated troponin T serum essay. What is the most likely diagnosis?

Acute Myocardial Infarction

Which of the following patients would most likely have infective endocarditis or IE?

An active IV drug user with fever and chills

A 75 year old male comes to the ER with worst chest pains. He has known stable angina. What finding would indicate the patients has a myocardial infarction and not just angina?

An elevated serum troponin level

A 65 year old chronic smoker with hyperlipidemia complains of claudication of the legs. Exams show decreased pulses and increased capillary refill time. What is the BEST screening test to use on this patient initially to look for PAD?

Ankle-branchial index assessment

Which of the following would be a symptom specific to right sided heart failure and NOT left sided heart failure

Ascites

What does the P wave represent on an ECG?

Atrial depolarization

As the telemetry nurse you notice a patient change rhythm to an irregularly irregular rhythm with P waves absent. What is the rhythm?

Atrial fibrillation

You are reviewing a cardiac rhythm in an electrocardiogram and note that the reading shows that the P wave is absent and the rhythm is irregularly irregular. Which cardiac arrhythmia is most likely?

Atrial fibrillation

You have a patient with high cholesterol, what is the BEST initial treatment?

Change in lifestyle with diet and exercise habits

A patient is displaying premature ventricular contractions (PVCs) in a couplet pattern on telemetry on the cardiac floor. Which would be the most important aspect of the patient to monitor because of this pattern?

Changes in electrocardiogram (ECG) pattern as this could lead to ventricular tachycardia

A 68 year old female presents with coughing for three months out of the past year with a productive sputum. She also gets short of breath when she coughs and turns blue. She has smoked for 40 pack years and does not plan on quitting. On exam she has wheezing and clubbing of her fingers. Chest xray is relatively normal. PFTs show decreased FEV1/FVC ratio which did not improve with albuterol. What is the likely diagnosis?

Chronic Bronchitis

What is the major cause of bladder cancer?

Cigarette Smoking

A 65 year old African American female presents with proteinuria by dipstick. She has some increases in creatinine and decreased GFR with 24 hour urine creatinine collection. She has a greater than 200 mg of protein on the same collection. She has diabetes mellitus type 2 for 20 years and has an HbA1c of 8.5% which is not well controlled. What type of kidney disease is most likely in this patient?

Diabetic nephropathy

A patient has a pneumothorax found on chest xray and examination they are having shortness of breath what is the treatment?

Either needle injection to the affect side of chest tube insertion

Patients with this diagnosis are known as "Pink Puffers"

Emphysema

Which of the following statements is TRUE?

Endothelial injury leads to atherosclerosis

when discussing high cholesterol levels with a patient, which of the following is more important?

High HDL, Low LDL

The physician assistant is assessing a patient who has been a butcher for an extensive period making the patient subject to a prolonged and intense exposure to inhale organic dust in the form of animal protein. Which disorder is a probable cause of the patient's respiratory problem?

Hypersensitivity Pneumonitis

What disease is referred to as the "silent killer"?

Hypertension

Which electrolyte imbalance can cause Chvostek's sign and Trousseau's sign?

Hypocalcemia

A 65 year old female presents with muscle tetany and has a positive Chvostek's sign and Trousseau's sign. She is a chronic alcoholic and has had bouts of diarrhea and abuses laxatives often. What is a likely diagnosis?

Hypomagnesemia

An IV drug user is admitted to the hospital with infective endocarditis and develops a lung abscess, which would be the BEST treatment?

IV antibiotics and surgical debridement

A patient with shortness of breath has a 90 percent FEV1/FVC ration. What diagnosis would fit this pattern?

Idiopathic Pulmonary Fibrosis

When viewing the recent CT scans of the thorax of a patient with a restrictive lung disease, the NP finds nodules and honeycomb lung patterns. The health care provider points out the patient's previous chest xray report identifying diffused "ground glass" markings in the lower lung fields. Which condition does the NP conclude from this information?

Idiopathic Pulmonary Fibrosis

A 10 year old girl presents with fever, macular papular rash, and a "strawberry tongue". She just has a viral infection some time ago. The ESR and CRP are significantly elevated. What is the diagnosis?

Kawasaki's Disease

Which of the following vascular pathologies typically affects children and could have a "strawberry tongue"?

Kawasaki's disease

Which of the following urinalysis findings would BEST support the diagnosis of urinary tract infect or UTI?

Leukocyte esterase and nitrites positive

A 25 year old males present with fever and cough with productive sputum. He has decreased breath sounds on the left side. CBC shows mostly neutrophils on his WBC differential. He has been functional with few symptoms but now seeking medical attention as his mother has been worried about him. What type of pneumonia does he likely have?

Mycoplasma Pneumonia

Which of the following patients would be most likely to have nephropathy of the kidneys?

Patient with long standing diabetes mellitus with positive albumin in the urine

Which form of dialysis does not involves the use of an IV access or AV fistula?

Peritoneal dialysis

The NP is assessing a patient who is obese with a short, thick neck circumference. This condition can cause a patient to have obstructive sleep apnea and make them difficult to intubate. What is it?

Pickwickian Syndrome

A 35 year old male with Marfan Syndrome presents with shortness of breath. Exams show aysmmetric chest wall. He has absent breath sounds on the right side and hyperresonance on percussion. What would his treatment be?

Placement of needle or chest tube suction

Which bacterium is responsible for an opportunistic pneumonia in a patient with AIDS?

Pneumocystis jiroveci

What condition results in lung tissue filling up with fluid or pus, inflammatory cells, and fibrin?

Pneumonia

A 55 year old smoker with 30 pack years of smoking history along with HTN presents for a check up. He wants to be screened for an AAA or aortic abdominal aneurysm. What is the BEST screening test for AAA?

Ultrasound of the abdomen

This is also known as a sleep study and is used to screen patients for obstructive sleep apnea?

Polysomnography

A patient is severely dehydrated and now has renal failure with hypotension and tachycardia. What type of renal failure BEST fits this patient?

Prerenal renal failure

If a patient presents with hypertension and no known cause exists, which type of hypertension does the patient have?

Primary hypertension

What device can we use to measure the oxygen saturation of hemoglobin in a patient?

Pulse oximeter

Which of the following is a noninvasive continuous monitoring of a patient's oxygen level by measuring the oxygen saturation of their hemoglobin using a device that clamps over their finger?

Pulse oximetry

What does the U wave represent in the cardiac cycle?

Purkinje fiber repolarization

35 year old female presents with flank pain, fever, and chills. She has dysuria urgency and foul smelling urine. Upon examination you see she has right sided CVA tenderness. Urinalysis reveals no blood, positive leukocyte esterase and nitrates as well as proteins. What is your diagnosis?

Pyelonephritis

Which is the BEST test to determine the cause of urinary incontinence?

Urodynamic studies

Which of the following will NOT cause a raise in blood pressure?

Vasodilation of arteries

Which wave in the electrocardiogram represent ventricular depolarization?

T wave

The nurse practitioner is assessing a patient after cardiac test. One test result indicates a cardiac output of 4,000 mL per minute. Comparing this patient to what is normal cardiac output, which conclusion does the NP draw?

The client's cardiac output is lower than normal

A 68 year old female with emphysema has an SaO2 of 90 percent on room air she occasionally drops to 88 percent with ambulation. Her last ABG had a very high PCO2. How should we order her home oxygen?

The patient should not have oxygen as she needs permissible hypoxia to keep her from having further hypercapnia

A middle aged adult is diagnosed with Class III (moderate) heart failure. In which way is the Class III heart failure different from other classes of heart failure in the patient according to the New York Association of Classification of Heart Failure?

The patient with Class III (moderate) heart failure will have marked symptoms like fatigue, palpitations, or dyspnea while doing less than normal physical activities, but are fine at rest.

Reviewing the medical record of a patient you find that they have been prescribed nasal steroid, antihistamine, antibiotic, and saline nasal spray. What is the likely diagnosis?

The prescription provides medication for rhinitis

What does the R wave represent in the cardiac cycle?

Ventricular depolarization

A patient presents with shortness of breath and is found to have a new pleural effusion. What is the next step?

Thoracentesis to investigate the cause of the pleural effusion

This is the maximum volume of air that the lungs can hold

Total lung capacity or TLC

Which condition means inflammation of the trachea?

Tracheitis

A patient can have both a restrictive and obstructive lung disease at the same time?

True

A homeless man presents with hemoptysis to the ED, he has fever and chills and has been coughing for weeks. What would the next steps be after his exam?

a chest xray and TB skin test (Mantoux test)

LDL (low density lipoprotein)

bad cholesterol