Final Exam: NUR631/ NUR 631 (Latest 2023/2024 Update) Advanced Physiology and Pathophysiology Study Guide| Questions and Verified Answers| 100% Correct – GCU
Final Exam: NUR631/ NUR 631 (Latest
2023/2024 Update) Advanced Physiology and
Pathophysiology Study Guide| Questions and
Verified Answers| 100% Correct – GCU
Q: Patient comes in with chronic wounds that aren’t healing. What are you thinking?
Answer:
-Diabetes
-Something else is going on with those patient/other comorbidities
Q: If a newborn doesn’t have enough collectin-like protein what kind of infec- tion might they
develop?
Answer:
-Pneumonia
-Anything RESPIRATORY related
Q: Where do B lymphocytes grow up and develop
Answer:
Bone marrow
Q: I go over to a friend’s house to get chickenpox. What type of immunity is that?
Answer:
Active acquired immunity/Body will make antibodies
Q: What is happening at a cellular level with a type two sensitivity reaction?-
Answer:
-Antibodies are attaching to the cellular surface of the antigen.
-release of histamines and IgE
Q: What does Rhogram do?
Answer:
-Stops hemolytic anemia
-Give to Rh – moms with a Rh + baby
Q: If we have a patient that went under some organ transplant, why would we have tissue
damage?
Answer:
Start to see TH1 cells release too many cytokines so we will see the cytotoxic effects. Cytokines
will actually attack the endothelial cells.
Q: What is an exotoxin?
Answer:
When bacteria is growing they release exotoxins.
Q: What do we have that helps us fight fungal infections?
Answer:
-Phagocytes
-T-Lymphocytes
Q: Why, if I’m really stressed, am I more likely to get sick?
Answer:
Stress releases cortisol, cortisol increases, helper T cells are suppressed.
Q: Stressed patient (long period of time), what can we see develop with lab results?
Answer:
-Hypoglycemia
-Cortisol increase causes hyperglycemia initially, but with chronic stress cortisol levels become
depleted causing hypoglycemia. (Adrenal insufficiency)
Q: What happens when we have cellular metabolism that just isn’t working right? What will
develop?
Answer:
Build up of waste
Q: What is the least likely IL to cause endothelial cells to go into that proin- flammatory state?
Answer:
IL4
Q: If you had a patient that developed MODS, what substances stimulate the normal endothelial
cells to go into a proinflammatory state?
Answer:
Interleukins tumor necrosis factor
IL-6
Q: How dehydrated does a child have to be before we see them have low
BP
Answer:
10%
Q: Why a patient can develop a reperfusion injury.
Answer:
Once we’ve had oxygen cut off for a while we can actually see damage happen from that
reexposure to oxygen
Q: Why do burn patients go into kidney failure?
Answer:
Damaged muscles produce
Myoglobin
Myoglobin is huge and hard for kidneys to filter out. Not meant to filter it.
Q: What type of cancer do we recommend exercise to decrease prevalence?-
Answer:
Colon CA
Q: In children, exposure to what virus develops a carcinogenic relationship?-
Answer:
EBV
Q: Risk factors of kids being exposed to and might develop CA due to (SE- LECT ALL THAT
APPLY)
Answer:
Ionizing radiation
Chemo
Cigarette smoke
EBV
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Where do we hold the DNA inside of a cell?
The nucleus
What is cell suicide?
apoptosis
What are some things we see clinically in a patient presenting with carbon monoxide poisoning?
-Normal SpO2
-Tissue damage
What do we have: ABG w/ pH 7.25, bicarb 28, CO2 is 60?
Respiratory acidosis
How do we get molecules to between intracellular & extra cellular?
Hydrostatic pressure
(If it’s water: osmotic pressure)
If patient has large volume of vomiting, what would we see?
Metabolic Alkalosis
Why does metabolic alkalosis develop from vomiting?
Losing acid, retaining Bicarb
What do we look for on an amnio to see neural tube defects?
Alpha-fetal protein
Clinical characteristics of Trisomy 21
Wide eyes
Wide neck
Short stature
Low IQ
Low nasal bridge
Low set ears
Cardiac defects
How could a newborn have type 1 diabetes
Autoimmune/ Cannot be prevented
We have a certain gene that takes care of maintenance of other cells
Housekeeping genes
Patient comes in with chronic wounds that aren’t healing. What are you thinking?
-Diabetes
-Something else is going on with those patient/other comorbidities
If a newborn doesn’t have enough collectin-like protein what kind of infection might they develop?
-Pneumonia
-Anything RESPIRATORY related
Where do B lymphocytes grow up and develop
Bone marrow
I go over to a friend’s house to get chickenpox. What type of immunity is that?
Active acquired immunity/Body will make antibodies
What is happening at a cellular level with a type two sensitivity reaction?
-Antibodies are attaching to the cellular surface of the antigen.
-release of histamines and IgE
What does Rhogram do?
-Stops hemolytic anemia
-Give to Rh – moms with a Rh + baby
If we have a patient that went under some organ transplant, why would we have tissue damage?
Start to see TH1 cells release too many cytokines so we will see the cytotoxic effects. Cytokines will actually attack the endothelial cells.
What is an exotoxin?
When bacteria is growing they release exotoxins.
What do we have that helps us fight fungal infections?
-Phagocytes
-T-Lymphocytes
Why, if I’m really stressed, am I more likely to get sick?
Stress releases cortisol, cortisol increases, helper T cells are suppressed.
Stressed patient (long period of time), what can we see develop with lab results?
-Hypoglycemia
-Cortisol increase causes hyperglycemia initially, but with chronic stress cortisol levels become depleted causing hypoglycemia. (Adrenal insufficiency)
What happens when we have cellular metabolism that just isn’t working right? What will develop?
Build up of waste
What is the least likely IL to cause endothelial cells to go into that proinflammatory state?
IL4
If you had a patient that developed MODS, what substances stimulate the normal endothelial cells to go into a proinflammatory state?
Interleukins
tumor necrosis factor
IL-6
How dehydrated does a child have to be before we see them have low BP
10%
Why a patient can develop a reperfusion injury.
Once we’ve had oxygen cut off for a while we can actually see damage happen from that reexposure to oxygen
Why do burn patients go into kidney failure?
Damaged muscles produce Myoglobin
Myoglobin is huge and hard for kidneys to filter out. Not meant to filter it.
What type of cancer do we recommend exercise to decrease prevalence?
Colon CA
In children, exposure to what virus develops a carcinogenic relationship?
EBV
Risk factors of kids being exposed to and might develop CA due to (SELECT ALL THAT APPLY):
Ionizing radiation
Chemo
Cigarette smoke
EBV
What are the granulocytes that have those vasoactive amines like histamines, what are those granulocytes called?
Basophils
Why would a patient develop pernicious anemia
can’t absorb Vitamin B-12
What is aplastic anemia, what will develop?
Pancytopenia (low everything)
Low erythrocytes
Low leukocytes
Low thrombocytes
What kind of inherited disorder is Hemophilia A
X linked recessive
Why is Hemophilia A only seen in Men?
Because it is X-linked recessive
Why will we see paresthesia develop in our b12 deficient patients?
-Myelin sheath degeneration/damage
-Happens right in the spinal cord
What is happening at the cellular level in a sickle cell patient? What happens in their DNA?
Valine replaces one of the amino acids (glutamate). That is what will sycle the cells.
Where do we make oxytocin?
Posterior Pituitary
What genetic material will translocate in CML(Chronic Myelogenous Leukemia)?
Genes 9 and 22 will abnormally fuse and create a protein called BCR-ABL-1
Why do we give vasopressors to shock patients?
-Vasoconstriction though ADH
-Increase BP
What regulates our calcium? Which hormone?
PTH (parathyroid hormone)
If a patient came in with really high levels of ADH, what type of cancer would I suspect?
Small cell carcinoma of the stomach
If you have a patient that comes in saying I haven’t gotten my period in 6 months, abnormal hair growth, osteoporosis, what tests should you run?
CT their head to make sure they don’t have a tumor
looking for a Pituitary Adenoma
Why do Diabetics pee so much
Tying to get rid off all that glucose
Why do we see so many of those microvascular complications in our diabetic patients, at a cellular level?
-Hyperplasia
-Basement membranes start to thicken
Why do our diabetics need to get regular eye exams?
We will see retinopathy develop as a result of retinal ischemia
S/S of hypothyroidism (low and slow)
Constipation
Lethargy
Low heart rate
Why are obese people at a higher risk for developing high blood pressure.
Make more angiotensin
If you did a test where you poked me with the end of a safety pin and I couldn’t tell if it was sharp or dull, what part of my brain is affected?
Pons
What part of my brain controls involuntary muscle control like my posture and balance?
Cerebellum
If I smile and I only have half a smile which nerve is affected?
Facial nerve #7
If I had an injury to my spinal cord and damaged upper motor nerves, what would you see?
Initially full paralysis, then gradual partial recovery
Differentiation between upper and lower motor neuron injury
LOWER: Permanent paralysis
UPPER: Reversible paralysis
What is it called that separates the cerebellum from its cerebrum?
Tentorium cerebelli
If you had a defect in the arachnoid villi, what would you expect to be wrong with your patient?
Too little absorption of CSF
What part of my brain allows me to focus my attention?
Pre-Frontal
What kind of seizure: altered LOC, dreamlike trans (impaired).
Complex focal seizure
If there is capillary permeability increase in the brain, what type of cerebral edema will we see?
Vasogenic cerebral permeability
If a patient had a CVA and they weren’t able to feel the objects and unable to identify objects, what is that called?
Tactile agnosia
What is the theory that regulates pain transmission from cns in and out of the spinal cord?
Gate control theory
Who will need the most amount of pain meds: Rotator cuff injury, gall bladder, or CRUSH injury?
CRUSH because there is multiple systems involved.
What kind of nerve fibers transmit pain?
Delta-A fibers
Where do those pain neurons live in the spinal cord?
Dorsal root ganglia
What kind of endogenous opioids do I have in myself
Endorphins
System is affected from major depressive disorders
Hypothalmic Pituitary adrenal system (HPA)
What receptor is impaired in depressed patients
Serotonin
Patient has lithium toxicity, what electrolyte is affected?
Sodium (results in Hyponatremia)
What type of inherited disorder is DMD (duchenne muscular disorder)
X-linked recessive
What is the link between depression and cortisol secretion?
Cortisol increases—Causes inflammation–causes depression
Normal PR interval
<0.2 seconds
What does the Pericardium do?
encloses the heart for protection
Papillary muscles within the heart function as:
-Help close valves
-Prevent backward expulsion of the AV valves
Cardiac cycle, issue in phase 0, what electrolyte imbalance do I expect to see?
Sodium – LOW – hyponatremia
Raynaud’s disease
-Vasospasms, seen mostly in fingers
-lack of blood flow
My patient comes into the ER ℅ chest pain…what labs am I ordering?
Troponin
BNP
Patient c/o chest pain and the troponin is normal…what’s the next step?
Serial troponins due to possible delayed elevation
If I see a pulseless paradoxus, what are some differentials?
Pericardial effusion, because there is low blood volume in all 4 chambers
A patient has COPD and we see increased pulmonary vascular resistance due to what type of heart failure?
Right sided heart failure
Most common cardiac complication of Down syndrome
Ventricle septal defect
What does a crescendo/decrescendo systolic ejection murmur sound like?
It’s going to be specific to the 2nd heart sound.
along the left sternal border/2nd-3rd intercostal space
What defect commonly has crescendo/decrescendo systolic ejection murmur?
Atrial septal defects
How does conjugation of bilirubin occur?
-fat soluble becomes water soluble
-unconjugated bilirubin becomes conjugated bilirubin
What do you want to look for if a patient comes in, zero GI complaints but has projectile vomiting all over the place?
-Increased intercranial pressure
-Something in the brain
CT needed
If I have a lactase deficiency, what kind of diarrhea will I develop?
Watery/osmotic
How do I document bright red bleeding from the rectum?
Hematochezia
S/Sx of a small bowel obstruction
-Abdominal distention/fullness (early sign)
-Nausea/vomiting (late signs)
What bacteria runs rampant in daycares?
Impetigo
What disorder do we generally see with hepatic fat accumulation in the liver?
Alcoholic cirrhosis
What are the early s/sx of hepatitis (prodromal)
-Fatigue
-Vomiting
-hyper Algeria (overall nerve pain)
What is it called when we don’t have complete fusion of the Nadine dial and the inner maxillary process?
Cleft lip/palate
Why will we see physiological jaundice in a newborn?
Immature liver
Cannot get rid of the bilirubin
Resulting in hyperbilirubinemia
What does Surfactant do?
Reduces surface tension
Keeps Alveoli open
Why would you see clubbing with respiratory conditions?
Chronic hypoxic state
If you had a patient that had long term COPD (chronically hypoxia), what are some physical signs of COPD?
-Barrel chested
-clubbed nails
-SOB on exertion
-Cyanosis
-Frothy cough
If a patient has a pleural effusion and we find that they have transudative exudate but not very many symptoms, what do I want to look for?
Protein level (lab draw)
Bronchiectasis that causes constriction and dilation in the bronchi.
Varicose bronchiectasis
If I have a patient that is diagnosed with ARDS (acute respiratory distress syndrome), what am I going to be on high alert for them also developing?
Pneumonia
What if I diagnose a patient with emphysema but they say they’ve never smoked?
Check to see if there’s a genetic predisposition to emphysema
What is it called if there is fluid in the pleural space?
Pleural Effusion
Working a patient up for Pulmonary HTN, what are some findings?
SOB with activity
JVD
Peripheral edema
Why do I worry about a young infant that has nasal congestion?
They’re nose breathers; can’t eat if they can’t breathe
Why do my cystic Fibrosis patients have all of that mucous plugging?
-Too much defective chloride secretion
-Too much sodium absorption
Why do we care about natriuretic peptides? What does it tell us?
It affects the renin and aldosterone
If we have a patient with heart failure, what’s happening to the renin & aldosterone?
The natriuretic peptides are going to inhibit the renin & aldosterone
What do we test if I want to know a patient’s renal function?
GFR
How does potassium (K+) and magnesium (Mg+) affect formation of kidney stones?
They affect crystal growth
will stop stones from forming
What am I looking for on an urinalysis to differentiate between pyelonephritis and cystitis?
White blood cell casts (will be present with pyelo)
What change in the labs for kidneys that is normal for an older person?
UA- Specific gravity is going to be higher in an elderly person. This is normal process.
If I have a patient w/ blood in their urine, + RBC casts, excessive proteinuria…What do I want to do next?
Renal biopsy
Suspecting Glomerular nephritis
Why will patients who have glomerulonephritis get soda-colored urine?
All the RBCs have not broken down
What part of the kidney does the IgG affect when we’ve got certain nephropathies like glomerulonephritis? Your IgG is going to deposit itself where?
Basement membrane
IgG is heavy and sinks to bottom
Why will we see urine reflux in children? Why is it more common?
It’s an anatomy thing; the ureters are shorter in children
If I have a urinary obstruction and it’s due to a spinal cord injury, what do we call that?
Neurogenic bladder
Where is an obstructed bladder coming from?
Any kind of obstruction:
Prerenal
intrarenal
postrenal
If I hurt my shoulder, what’s the part of my shoulder that I want to avoid hurting because it’s going to regenerate the most slowly and heal the least?
Articular cartilage
What glycoprotein do we have that’s going to move around our hormones and other metabolites so that our bone cells can form properly?
Bone Albumin
What cells are going to maintain our bone matrix for us?
Osteocytes
What is a pathological fracture?
Fracture not due to mechanical stress/insult/injury
What do you want to check on a patient that was found by neighbors, saying that she’d been laying on the floor for several hours?
CK level (this checks for muscle breakdown)
May develop Rhabdomyolysis
Why do women develop osteoporosis more than men?
Women have a higher oxidative stress and higher intracellular reactive oxygen.
What is not working properly in a person that has Paget’s disease?
Problems with bone resorption and bone formation/too much/too fast
If I saw on an Xray that the radiologist read something sequestrum, what does that mean?
Devascularized, devitalized bone on Xray
What is ankylosing spondylitis?
Chronic inflammation that causes the spine and SI joints to just start fusing and stiffening
What is it called on a newborn when I go to rotate their hips and the hips are going to stay in contact w/ the acetabulum but it is not going to be seated very well?
Subluxation
If I have a patient that their skin when they hurt themselves it becomes very elevated and rounded, what is it called?
Keloid skin
Tell me 2 things an allergic contact dermatitis and stasis dermatitis have in common:
-Inflammation of the skin (redness)
-Itching
What do I call the skin lesions that are thick, silvery, and scaly?
(Plaque) psoriasis
What do I call it if I have a big collection of infected hair follicles?
Carbuncle
What do I call it if I have one infected hair?
Gruncle
If you had chicken pox early on in life, what do you need to educate your patient that they can develop later on?
Herpes Zoster (shingles)
Describe what tinea corporis (ring worm) looks like?
Red, circular lesion; scaly
What is Kaposi sarcoma
Vascular malignancy
What disorder is kaposi sarcoma associated with?
HIV/AIDS
Where will we see the kaposi sarcoma be located at usually?
In the legs
What is kaposi sarcoma associated with?
Almost always going to be related to some kind of drug-induced immunosuppression
Where would you see an onychomycosis?
A nail bed
nail fungus
If I have a history of PID and now I come in with right-sided pain, dark red vaginal discharge, I’ve missed 2 periods, what is going on?
Ectopic pregnancy
What term do we use if we’re talking about benign uterine tumors (fibroids)?
leiomyomas
You have a patient who is in her third trimester of pregnancy and there is all of a sudden bright red vaginal bleeding, no pain. What are the differential diagnosis?
Placenta previa
If we diagnose a woman with a cervical carcinoma in situ, what does that mean?
Full epithelial thickness of the cervix
Tell me how we figure out the GTPAL system
G: Gestation- How many pregnancies you’ve had, including a current pregnancy
T- How many term deliveries
P- number of preterm births
A- Abortions (including miscarriages)
L- Living children
Ovarian cancer is related to a mutation of which gene?
BRCA-1
Be able to figure out due date using Nagel’s rule
Add 7 days past the first day of your last period, then subtract 3 months
The test will give us a date, we must be able to figure out the due date
If you were doing a breast exam and the woman had squishy feeling, easily palpated and movable areas, what would you diagnose her with?
Breast cysts
If my patient has gonorrhea, they probably also have what?
Chlamydia
what is Balanitis?
Swollen glands on penis and foreskin
If you diagnose a man with balantis, what is the next thing that you would think of?
Diabetes
How do we treat trichomoniasis?
Flagyl
If I were doing a testicular exam and I felt a firm, non-tender testicular mass, give me a differential diagnosis.
Testicular cancer
I have a patient that I am doing an exam on and I see those strawberry spots on her vagina and cervix…what am I diagnosing her with?
Trichomoniasis
If a guy comes in and he’s complaining of fatigue, has diffuse low back pain, fever, urinary retention, what are you going to order?
Urinalysis/UTI
What organism did we say is the culprit for syphilis?
Treponema pallidum
Give me some risks for prostate cancer (select all that apply)
Diet
Over the age of 65 y/o
Family history
African american
If I have syphilis and I already have bone and tissue lesions, what stage am I in?
Tertiary
How do we document if a man can’t retract his foreskin over the glands?
Phimosis
What does gonorrhea look like in a newborn?
Conjunctivitis → Corneal ulcerations
If you had a patient that came in and said that they had this new lesion, it has a depressed center, it’s got rolled borders, and its living right on their face, what is your biggest suspicion/differential diagnosis?
Basal cell carcinoma
What does Preeclampsia look like?S/S
Edema(hands/face)
Clonus
Headache
High B/P
RUQ Pain from protienuria
What can happen if we do not treat PID (pelvic inflammatory disease)?
Scarring of the fallopian tubes due to inflammation
An elevated, firm, rough lesion with flat top surface that is more than 1 cm in diameter is called:
plaque found in psoriasis and seborrheic and actinic keratosis.
Elevated circumscribed, superficial lesion filled with serous fluid, less than 1 cm in diameter
vesicle- varicella and herpes zostrer
Pathogenetic mechanism of POS
anovulation, elevation of levels of androgens, hyperandrogenism, and polycytic ovaries
Hirschprung’s Disease (Megacolon)
congenital ganglionic megacolon- neonatal obstuction
Marasmus
A wasting away of body tissues in the infant’s first year, caused by severe protein-calorie deficiency.
Koplik spots are a diagnostic indicator of
lusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars -rubeola measles
variococele
swelling and distention of veins of the spermatic cord, somewhat resembling varicose veins of the legs #1 cause of sterility
What medical term is used to identify an inflammatory disorder of the skin that is often considered synonymous with dermatitis and characterized by pruritus with lesions that have an indistinct border?
Eczema and Atopic Dermatitits
spermatocele
a cyst that develops in the epididymis and is filled with a milky fluid containing sperm
Type of Necrosis associated with gangrene?
Caseous Liqueactive Necrosis
3 substances that influence calcium regulation in the body
Vit D, calcitonin, and PTH
Risk for autosomal dominant to occur
50%
What cancer does HHV-8 cause
Kaposi’s sarcoma
BRCA1 and BRCA2
breast cancer 1 and 2 – genetic mutations associated with increased risk for breast and ovarian cancer
hypomethylation
Reduced methylation of DNA. This results in the activation of oncogenes genes and the resulting formation of tumors.
Which component of the plasma protein system tags pathogenic microorganisms for destruction by neutrophils and macrophages?
C3b
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cells that fight against parasitic infections
Eosinophills
Which leukocytes are in. and IgE hypersenisitivity
Eosinophills
SLE, MS, IBD, are all what
auto immune diseases
Treponema pallidum
causes syphilis
What does stress-induced sympathetic stimulation of the adrenal medulla cause secretion of?
release cathecholamines
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fluid in the tunica vaginalis
hydrocele
Most commonly reported symptom with any tye of cancer
fatigue
arterial circle of willis
These vessels supply blood to the brain (mostly the cerebrum) without clots in a circle by multiple routes in the middle of the brain
Philadelphia chromosome causes
CML
Where does ADH act?
renal collecting duct
An elevated, firm, circumscribed area; less than 1 cm in diameter
papule
hematopoietic growth factors
correct chronic renal failure
increase peripheral stem cells for transplantation
Accelerate cell proliferation after bone marrow engraftment
Which type of cancer is cause by helicobacter
stomach cancer
patholgical fracture
a break at the site of a preexisting abnormality, usually by force that would not fracture a normal bone
which hormone exerts antiapoptotic effects on osteoblasts but proapoptotic effects on osteoclasts
Estrogen deficiency
ankylosing spondylitis
chronic, progressive arthritis with stiffening of joints, primarily of the spine
People with gout are at high risk for:
renal calculi
Which protein is absent in DMD
dystrophin
The most common childhood bone cancer
Osteosarcoma
3 conditions that jaundice can be contributed to
acute inflammation of the liver, hemolytic anemia, cholestasis.
Bilateral uterteral obstruction is not associated with which type of renal injury
prerenal
x-ray showing punched out lesions
multiple myeloma
silicosis
disease due to silica or glass dust in the lungs; occurs in mining occupations TLC decreased, FEV1 decreased, and v/q decreased
A patient presents with right ventricular hypertrophy seen as a right axis deviation on the EKG and a loud systolic murmur heard at the left sternal border. What valve is the cause?
Mitral Senosis
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