Final Exam: NR507 / NR 507 (2026–2027 Updated) Advanced Pathophysiology | Complete Q&A | Verified Answers | 100% Accurate | Grade A – Chamberlain

Final Exam: NR507 / NR 507 (2026–2027 Updated) Advanced Pathophysiology | Complete Q&A | Verified Answers | 100% Accurate | Grade A – Chamberlain Q. Which of the following is true regarding a complicated urinary tract infection? ANSWER Can be caused by a structural urinary tract disorder Q. Which of the following is a risk factor for the development of a urinary tract infection (UTI)? ANSWER pregnancy Q. A symptom of a lower urinary tract infection includes: ANSWER urgency Q. Women are at a higher risk for the development of a UTI because of having a shorter urethra. ANSWER true Q. Which of the following can help to prevent a UTI? ANSWER increase water consumption Q. Risk factors for a UTI ANSWER pregnancy sexually active post-menopause estrogen-deficiency women (shorter urethra) catheterization Q. An upper UTI is less common in men due to the longer urethra and ureter structures that make it more difficult for bacteria to reach the kidney. ANSWER true Q. complicated UTI ANSWER -A UTI that extends beyond the bladder -Caused by structural or functional urinary tract abnormalities or untreated UTI -Infants and older adults affected -Associated with:indwelling cathetersrenal calculiDiabetesPregnancy Q. uncomplicated UTI ANSWER -Occurs in the normal urinary tract -Responds well to a short course of antibiotic therapy -Simple cystitis in non-pregnant women without any urologic abnormalities Q. Most common cause of UTI bacteria ANSWER E coli Q. Uncomplicated UTI ANSWER Protein +/_ Leukocyte Esterase + Nitrites +/_ RBCs +/_ WBCs +/ 5000/hpf Casts - None Q. Complicated UTI ANSWER Protein +/_ Leukocyte Esterase + Nitrites +/_ RBCs + WBCs +/ 100,000/hpf Casts + Q. NP education ANSWER -Drink more water. -Although there are differences of opinions, cranberry juice and vitamin C can help to acidify the urine. -Urinate before and after sexual intercourse to remove bacteria from the urethral area.- Encourage the female to avoid holding urine for extended periods of time -Avoid the use of hygiene sprays and spermicides because they alter the normal microbial flora to enhance the risk for infection. -Encourage the female to wipe from the front to the back after a bowel movement to avoid spreading bacteria to the urethra -Encourages showers rather than bathing to avoid the spread of bacteria. Q. A 25 year- old female presents to the primary care office with urinary burning and frequency for the last 3 days. She denies any fever, chills, back pain. Her gynecological history is negative and reports no vaginal discharge. The only new information reported is that she recently had sexual intercourse with a new male partner. ANSWER The NP obtains a urinalysis and determines that the urine contains leukocytes, RBCs, nitrites, and WBCs. No casts are identified. Based on symptom presentation and UA results, the patient can be diagnosed with: cystitis Q. Identify the major risk factor J.S. has that is associated with pyelonephritis: ANSWER indwelling foley catheter Q. The urinalysis of a patient with a complicated UTI will show WBCs and casts ANSWER true Q. Upon examination of a urinalysis, the NP can highly suspect that the causative bacteria are gram negative because of the presence of: ANSWER nitrites Q. A 21-year-old patient reports to the primary care clinic complaining of urinary urgency, frequency and burning. She also reports a small amount of vaginal discharge that contains an odor. It is likely that the NP will perform a vaginal exam at this visit. ANSWER true - NP will want to rule out STD Q. The NP would know that the patient most likely has an uncomplicated UTI because: ANSWER The UTI responds well to a short course of antibiotics Q. A common organism that causes a urinary tract infection include: ANSWER Staphylococcus saprophyticus. Q. The purpose of straining in BPH is to overcome the obstruction encountered during urination. ANSWER true Q. The peripheral zone of the prostate is the largest zone. ANSWER true Q. On a digital rectal exam to assess the quality of the prostate, the NP would be concerned with which of the following findings? ANSWER a hard nodule Q. There is a significant risk for men with benign prostatic hyperplasia (BPH) to develop cellular mutations that lead to prostate cancer. ANSWER false - BPH does not lead to prostate cancer Q. The patient most often develops symptoms of BPH when: ANSWER The prostatic urethra becomes obstructed. Q. The action of a 5-Alpha-reductase inhibitor causes: ANSWER Shrinkage of the prostate gland Q. Men who have BPH are prone to developing a UTI because: ANSWER Stagnated urine in the bladder promotes bacterial growth. Q. The prostate specific antigen (PSA) helps to liquefy semen post-ejaculation. ANSWER true Q. The underlying cause of BPH is that normal prostate cells respond to increases in dihydrotestosterone that causes them to live longer and multiply. ANSWER true Q. The location of the characteristic hyperplastic nodules of BPH is: ANSWER In the periurethral zone. Q. The type of stone that forms due to a urinary tract infection is: ANSWER Struvite stone Q. Renal stones are formed when calcium and oxalate in the urine combine. ANSWER true Q. Renal calculi are typically confined to the bladder. ANSWER false Q. The most common type of stone is: ANSWER calcium stone Q. The gold standard for diagnosing a renal stone is a urinalysis. ANSWER false (CT scan) Q. Lithotripsy is an invasive procedure used to break up the stone ANSWER false Q. The most common stone found in the patient with gout is: ANSWER uric acid stone Hematuria can be seen with kidney stones because: The stone injures the urinary structures as it passes through them. Renal colic is caused by the passing of the stone through the ureter. true At least half of individuals with renal stones will have a reoccurrence within 10 years of the prior stone. Which of the following actions will relax the detrusor muscle of the bladder? Activation of Beta-2 receptors by the sympathetic nervous system. The relay station in the brain that plays a major role in regulating micturition is: Pontine micturition center The location of the internal sphincter is under the urogenital diaphragm. false When the bladder is empty, the detrusor muscle relaxes, and the internal and external sphincters constrict. true The levator ani muscle plays a major role in constriction of the external sphincter. true stress incontinence Leakage of urine with activity Increased intraabdominal pressure causes leaking because there is no resistance to counteract the intraabdominal pressure urge incontinence Leakage of urine with sensation of need to urinate Detrusor muscle hyperactivity leads to urine leakage neurogenic incontinence Unimpeded urine leakage Neurological lesions alter nervous system impulses that innervate the detrusor muscle. The result is decreased bladder compliance and decreased sphincter tone overflow incontinence Leakage of urine is associated with urgency, frequency, dribbling and hesitancy Leakage is due to retained urine in the bladder that leads to overdistention A 54-year-old female reports to the primary care office with complaints of frequent urination. She reports that she is "leaking" urine several times a day, especially when she coughs, sneezes, or lifts a heavy object. She indicates that she has not experienced any dysuria or any urgency. The NP looked at the patient's previous urine culture obtained approximately 1 month ago and determined that it was negative. Other than her urinary complaints, she is in otherwise good health. BP 128/76; HR 78 bpm; T 98.6; Ht. 5'4"; Wt: 180lbs.; BMI 30.9. The NP performs a physical exam and all findings are normal. The urinalysis obtained was negative as well. Based on patient's symptoms and negative physical exam, she has a typical BLANK. The leaking occurs when the abdominal pressure increases during coughing, sneezing, and lifting. We can rule out urge incontinence because the denied urgency with her urination. We could not diagnose an overflow incontinence because there is nothing in her history that points toward any condition that would cause an overextended bladder such as diabetes or a neuropathic issue. The NP can consider her age as a factor in the development of BLANK due to estrogen-deficiency post-menopause. Lack of estrogen results in vaginal atrophy that results in a relaxed external sphincter. Initially, the NP can suggest pelvic strengthening exercises (Kegel exercises). If these are unsuccessful, pessaries that provide pelvic support and surgery may be indicated. 1. stress incontinence 2. stress incontinence A sphincter malfunction that prevents urine from flowing out of the bladder would most likely result in: overflow incontinence The major cause of stress incontinence in women is hypermobility of the external sphincter. true The pathophysiology of neurogenic bladder is: Lesions alter nervous system impulses that innervate the detrusor muscle to decrease bladder compliance and decreased sphincter tone. Involuntary loss of urine caused by dementia or immobility is known as: functional incontinence Which of the following is considered be a transient cause of urinary incontinence? UTI A pre-renal cause of acute renal failure is: hypotension (reduces blood flow to kidneys) One of the first pathophysiological responses to the decreased GFR in acute renal failure is: Activation of the renin-angiotensin-aldosterone system. One of the major markers for glomerular filtration rate is creatinine. true Pre-renal is the most common cause of acute renal failure. true The most common cause of acute renal failure is due to a pre-renal failure. true Acute-renal failure Oliguria ( 30ml/hr). Increased blood urea nitrogen (BUN) and creatinine. Fluid and electrolyte abnormalities. pre-renal sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness Intra-renal direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply post-renal sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury In post-renal failure, the damage occurs in the collecting duct. true In intrinsic renal failure, sodium and water excretion is increased which leads to a dilute urine. true Which of the following is the best indicator of a good prognosis for recovery from acute renal failure? The kidney responds to furosemide Which of the following is true regarding creatinine? Creatinine gets freely filtered from the glomerulus One of the issues that requires management of a patient with acute renal failure is hypokalemia false The result of vitamin D deficiency results in: hypocalcemia The number one cause of end-stage renal disease is diabetes mellitus and hypertension combined. true Stage III kidney disease is signified when the GFR drops below 60. true Which of the following is a complication of decreased GFR? anemia The anemia seen in renal failure is due to the lack or iron. false symptoms of CKD hypocalcemia and hyperphosphatemia anemia electrolyte abnormalities uremia fluid overload Long term management of CKD Dietary management: patients will be on a low potassium, low sodium, and low phosphate diet. Fluid restriction: patients will restrict fluids to 500 mL to 1L/day or an amount that does not cause volume overload. ACE Inhibitor therapy: Lisinopril, enalapril, captopril will be prescribed to provide renal protection for patients in Stage I-III. Medication avoidance: patients will avoid nephrotoxic drugs such as non-steroidal anti-inflammatory drugs (NSAIDS) and aminoglycosides. The decision to begin dialysis is guided by the patient's symptoms rather than GFR. true End-stage renal disease is signified by a GFR of: less than 15 Diuretic therapy is used in Stage IV kidney failures to stimulate kidney function. false The major acid/base disturbance in renal failure is: metabolic acidosis Dietary management of a patient with CKD includes: Low potassium, low sodium, and low phosphate diet. Dermatomes area of the skin that is mainly supplied by branches of a single spinal sensory nerve root. These spinal sensory nerves enter the nerve root at the spinal cord, and their branches reach to the periphery of the body. Substance release at the synapse Acetylcholine- Excitatory or inhibitory- alzheimers Norepi- Excitatory or inhibitory- sleep/wake cycle, SYNS transmission Dopa- Excitatory (h1 and h2 receptors) and inhibitory (H3 receptors). parkinson disease Spondylolysis structural defect (degeneration, fracture, or developmental defect) in the pars interarticularis of the vertebral arch (the joining of the vertebral body to the posterior structures). The lumbar spine at L5 is affected most often. -Heredity -Other congenital spinal defects motor and sensory areas of the brain Parietal lobe- major area for somatic sensory input, located along the postcentral gyrus. which is adjacent to the primary motor area in the precentral gyrus. Primary motor area (Brodmann area 4)- located along the precentral gyrus forming the primary voluntary motor area (homunculus) (little man). Association fibers provide communication between sensory and motor Ischemic penumbra ischemic but not infarcted (salvageable) tissue. Peri-infarct tissue. -no structural damage Cerebral infarction ischemic- white infarct (affected area is pale and soft 6-12 hours after). necrosis appears by 48 to 72 hours. Infiltration of macrophages and phagocytosis of necrotic tissue. necrosis resolves around the 2nd week. glial scarring. excitotoxins Toxins (usually amino acids) that overstimulate glutamate release and cause neuron suicide. Agnosia the inability to recognize familiar objects. -tactile/spatial-parietal lobe -Gerstmann syndrome (loss of spatial orientation of fingers, body, sides and #s)- L angular gyrus (Parieral) -Object- Temporo-occipital area -Associated with CVAs Subarachnoid hemorrhage Bleeding into the subarachnoid space, where the cerebrospinal fluid circulates. -ruptured intracranial aneurysm/trauma -IICP/irritates meningeal tissues/produces inflammation, blood coats nerve roots, impairs CSF circulation -compensatory increase in SBP Meningitis Bacterial- Meningococcus and S. pneumococcus bacteria are most common Viral- Specific pathogen cannot be found in CSF Prostate cancer prevention -Eat a low fat diet - Slow growing cancer so DRE and PSA testing prevents BPH and the urinary system - Chronic inflammation -Bladder outflow obstruction -Urge to pee often -delay in starting stream - Decreased force of stream -Urinary retention/ overflow incontinence (late sign) Complications: Hematuria, infections, bladder calculi, retention, hydronephrosis, renal insufficiency Cause of respiratory Alkalosis - fever -anemia, -anxiety, panic -thyrotoxicosis -hyperventilation buffer molecules -Plasma- Bicarbonate-carbonic acid and HGB. -Intracellular- Phosphate and protein Renal- Ammonia and Phosphate Cushing's disease - Excess endogenous secretion of ACTH (Corticotropin). -from a pituitary adenoma or by an ectopic secreting non pituitary tumor such as small cell carcinoma of the adrenal tumor (rare) - HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia, weight gain, thin hair, moon face, easy bruising, buffalo hump, protein wasting Cause of hypoparathyroidism -decreased PTH -Damage to or removal of the parathyroid gland during thyroid surgery. - genetic syndromes, familial hypoparathyroidism, diGeorge syndrome, and idiopathic, or autoimmune Primary hypothyroidism labs Increased levels of TSH and decreased levels of TH (Total T3 and total and free T4 Autoimmune- Presence of thyroperoxidase and thyroglobulin antibodies Thyroid Storm -occurs in people who have severe hyperthyroidism and are subject to extreme stress (infection, trauma, burns, surgery, emotional). -Sudden release and increased action of thyroxine (T4) and triiodothyronine (T3) exceeding metabolic demands. -Hyperthermia, tachycardia, atrial tachydysrhythmias, high-output heart failure, agitation, n/v, diarrhea -Tx- beta blockers, block TH synthesis, corticosteroids, iodine, plasma exchange Thyrotoxicosis (hyperthyroidism) Increased metabolic rate, heat intolerance, thin hair, bulgy eyes, enlarged thyroid, heart failure, tachycardia, weight loss, diarrhea, warm skin, sweaty palms, pretibial myxedema. Muscle contraction ions Calcium is combined with troponin Long bone growth cartilage cells at the epiphyseal side of the physeal plate multiply and enlarge. Cartilage cells at the metaphyseal side of the plate are destroyed and replaced by bone. appendicular skeleton 126 bones that make up upper and lower extremities, shoulder girdle, pelvic girdle valve problem in women -Mitral valve prolapse -genetic or environmental disruption of valvular development during the fifth or sixth week of gestation Reversible myocardial ischemia Chronic coronary obstruction results in recurrent predictable chest pain called stable angina. Abnormal vasospasm of coronary vessels results in unpredictable chest pain called Prinzmetal angina OR unstable angina (impending infarction) Stable angina transient substernal chest discomfort, ranging from a sensation of heaviness or pressure to moderately severe pain -Feels like indigestion -May radiate to neck, lower jaw, left arm and left shoulder or back or down right arm -Pallor diaphoresis and dyspnea -relieved by rest and nitrates -Women (atypical chest pain, palpitations, sense of unease and severe fatigue) orthostatic hypotension decrease in SBP of at least 20, or decrease in DBP of at least 10 within 3 minutes of standing. -neurogenic, caused by ANS dysfunction -dizziness, blurring of vision, syncope, fainting -Tx: inc. salt intake, raise HOB, thigh-high stockings, erythropoietin, vomune, vasoconstrictors (midodrine) Isolated systolic hypertension High SBP, normal DBP -Associated with cardiovascular and cerebrovascular events, all age groups Insulin resistance in HTN -associated with endothelial injury and affects renal function, causing renal salt and water retention -Insulin resistance is associated with overactivity of the SNS and the RAAS. -BP will decrease when people are given meds to increase insulin sensitivity SNS and HTN Overactivity of the SNS leads to increased production of catecholamines (epi/norepi) or from increased receptor reactivity. - Increase SNS = inc HR, systemic vasoconstriction (inc BP), renin release, inc tubular sodium reabsorption, dec renal blood flow. -vascular remodeling, insulin resistance, inc renin and angiotensin levels, procoagulant effect. - Tx: beta blockers Sustained HTN effects - Inc. workload of myocardium, dec blood flow through coronaries (LV hypertrophy, heart failure) - Accelerated atherosclerosis (CAD) (ischemia, infarction, death) - RAAS/SNS stimulation, inflammation (Glomerulosclerosis, dec GFR, ESRD) - dec. brain blood flow/o2, weak vessel walls (TIAs, CVA, thrombosis, aneurysm, hemorrhage) - hypertensive retinopathy, retinal exudates, hemorrhage -dissecting aortic aneurysm - intermittent claudication, gangrene Unstable coronary artery plaque -Lipid rich core and thin fibrous cap - breaks off by shear force, inflammation, apoptosis, macrophage-derived degradative enzymes - causes inflammation, release of multiple cytokines, platelet activation and adherence, production of thrombin and vasoconstriction, thrombus formation over lesion Atherosclerosis cause: smoking, HTN, DM, aging -injury to endothelial cells that line artery wall (inflammation and cannot make normal amt of antithrombotic and vasodilating cytokines) -LDL penetrates into subintima of arterial wall, and is trapped by proteoglycans. -inflammation, oxidized LDL cause endothelial cells to express adhesion molecules that bind monocytes and immune cells. -monocytes penetrate vessel vall and become macrophages. -fatty streak- NTF, interferons, interleukins and CRP injure vessel wall. -release of growth factors, collagen, migrate over fatty streak and form fibrous plaque. -plaque may calcify and cover vessel lumen Symptoms of inc LAP and Pulm Ven Press in heart failure -Pulmonary edema made worse with tachycardia (exercise) -dyspnea and fatigue R Heart Failure -caused by severe L heart failure, RV MI, cardiomyopathies, and pulmonic valvular disease, PH, COPD, Cystic fibrosis -Sx: RV hypertrophy, JVD, peripheral edema, progressive diastolic and systolic deterioration, hepatosplenomegaly L vs R heart failure L: Blood backs up into pulmonary (inadequate systemic circulation) Sx:pulmonary edema, waking in the middle of the night, SOB, fatigue R: Blood backs up in the body (inadequate pulmonary circulation) Sx:Peripheral edema, HTN, JVD, Dep. edema, hepatosplenomegaly infective endocarditis -Infection and inflammation of the endocardium (esp valves). - Most common cause: Staphylococcus aureus. - Risk fx: prosthetic valve, congenital lesions associated with highly turbulent flow, IV drug use, long-term IV catheter, Pacemaker, heart transplant with defective valve, dental procedures with manipulation of gingiva, - Endocardial damage, Bacterial adherence, and formation of vegetations - Sx: fever, cardiac murmur, petechial lesions of the skin conjunctiva and oral mucosa, night sweats, weight loss, back pain, heart failure, Osler nodes (erythematous nodules on the pads of fingers or toes) Patho of DVT Accumulation of clotting factors leads to thrombus formation (often near a valve). Inflammation leads to further platelet aggregation. Thrombus grows proximally Virchow's Triad 1) Venous stasis (associated with immobility, obesity, age, CHF) 2) Venous intimal damage (related to trauma, venipuncture, IV meds) 3) Hypercoagulable state ( from inherited disorders, smoking, liver disease, pregnancy, oral contraceptives, hormone replacement, malignancy) Physiologic response to anemia - Compensation for reduced blood volume causes interstitial fluid to move intravascularly (inc. plasma volume, dec. viscosity) causing hyperdynamic circulatory state (inc SV/HR/cardiac dilation and heart valve insufficiency). -Inc rate and depth of breathing, dizziness, fatigue, heart failure, Folate Deficiency Anemia People at risk: Pregnant/ lactating, alcoholics, chronic malnourishment, Labs for Iron def. anemia - Low- HGB/Hct/ mcv/plasma iron/ferritin, transferrin - High- Total iron binding capacity/free erythrocyte protoporphyrin -Normal- reticulocyte count/B12, Folate, Bili sickle cell anemia a genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape -Chronic hemolysis, microvascular occlusions, and tissue damage, vaso occlusive crisis -abnormal or absent splenic function Cause of aplastic anemia Failure of bone marrow to produce mature cells causing pancytopenia (reduction of all 3 blood cell types) - Idiopathic, acquired stem cell defects, immune mediated - whole-body irradiation, viral infections, hepatitis, CMV, epstein-barr virus, herpes zoster, inherited -Chemica: alkylating agents, antimetabolites, benzene, chloramphenicol, arsenicals, carbamazepine, gold salts Autoimmune Hemolytic Anemia 1) Warm reactive antibody type- IgG binds optimally to erythrocytes at a normal body temperature. 2) Cold agglutinin type- IgM antibodies optimally bind to erythrocytes at colder temps (lower than 31 deg. Celsius). Recognized by phagocytes in the liver and spleen. Fingers, toes, ears, may have obstructed blood flow 3) Cold hemolysin type- Hemoglobinuria Acquired disorders caused by autoantibodies or complement or both, on RBCs against antigens normally on the surface of erythrocytes. Secondary Polycythemia -physiologic response from increased erythropoietin secretion in response to chronic hypoxia. -Noted in people living in high altitudes, smokers, COPD, CHF -Abnormal hgb Anemia of chronic renal failure - Kidney damage affects secretion of erythropoietin, diminishes bone marrow erythropoiesis. - Uremic toxins that increase in the blood d/t renal failure may suppress bone marrow function and damage erythrocytes - Platelet dysfunction (bleeding) - loss of erythrocytes Hypovolemic shock Loss of whole blood (hemorrhage), plasma (burns), or interstitial fluid (sweat, DM, DI, emesis, diuresis) in large amounts. -When intravascular volume decreases by 15% Glucose regulation in shock glycogenolysis, gluconeogenesis, and lipolysis. -total body stores can fuel metabolism for 10 hours Ovulation - Marks the beginning of the luteal/secretory phase of the cycle. Uterine prolapse descent of cervix or entire uterus into the vaginal canal polycystic ovary syndrome -at least two of these features: irregular ovulation, elevated levels of androgens (testosterone), and appearance of polycystic ovaries on ultrasound. -strong genetic component -Low FSH, high LH (causes high androgens), and high LH bioactivity -s/s: anovulation, hyperandrogenism, insulin resistance, amenorrhea, hirsutism, acne, infertility, dysfunctional bleeding, sleep apnea -60% of women with PCOS are obese - Tx: Oral contraceptives, weight loss, exercise, progesterone therapy, metformin, lifestyle modification Testicular cancer - Complication of cryptorchidism. Tx= giving GnRH or Hgc or surgery - HIV -Aids Breast cancer Lumps, retraction of tissue, palpable notes in the axilla, nipple discharge, ulceration, local pain Premenstrual Dysphoric Disorder (PMDD) Symptoms: Depression, anger, irritability, fatigue, breast tenderness, abdominal bloating, headache, swelling of extremities. aggravation of underlying physical or psychological disease Abnormal Uterine Bleeding - Bleeding that is abnormal in duration, volume, frequency, or regularity 6 months -PALM(structural)-COEIN (nonstructural) -Major cause: lack of ovulation - commonly seen in perimenopausal women and adolescents -Tx: NSAIDs (reduce prostaglandin synthesis within endometrial tissues- cause vasoconstriction and dec. blood loss), regulating cycles, hormone therapy Prostate Cancer - Rely on androgen-dependent signaling for development and progression. -alterations in autocrine/paracrine growth-stimulating and growth-inhibiting factors between the prostate tumor cells and microenvironment influence cancer pathogenesis -Occur in the periphery of the prostate - Risk fx: chronic arsenic exposure, genetic HPV and Cervical CA - Strains 16 and 18 are most cancerous -Transformation zone is susceptible to HPV Deep tissue pressure ulcer healing Bacteria colonize the dead tissue, and infection is usually localized and self-limiting. Proteolytic enzymes from bacteria and macrophages dissolve necrotic tissues and cause a foul-smelling discharge that resembles, but is not, pus. The necrotic tissue initiates an inflammatory response with potential pain, fever, and leukocytosis. Contractures and wound healing - Burn wounds are susceptible to contractures. -Internal contractures= Common in liver cirrhosis - Scar tissue that is contracted constricts blood flow and may contribute to portal hypertension and esophageal varices. -Control myofibroblast contraction by giving colchicine and prevent collagen cross-linking or MMP activity. -Myofibroblast binding to collagen can "lock" contracted cells in position. tactile fremitus palpable vibration- Usually indicative of pneumonia Pneumothorax Primary (Spontaneous)- Occurs unexpectedly in healthy people. Rupture of bleb on visceral pleura.Apex of lung. rx: smoking Secondary (Traumatic)- chest trauma (Stab, rib fx, bullet) Iatrogenic- caused by transthoracic needle aspiration Open (communicating)- Air pressure in pleural space equals barometric pressure b/c air that is drawn into pleural space during inspiration is forced back out during expiration. Tension- One-way valve- air enters during inspiration and cannot exit during expiration. Air pressure exceeds barometric pressure. displaces heart, trachea, and great vessels. Life threatening Alpha-1-antitrypsin deficiency - Primary emphysema - Autosomal recessive inherited - Proteolysis in lung tissues is not inhibited Surfactant in ARDS Becomes inactivated, and production by type 2 alveolar cells is impaired as alveoli and bronchioles fill with fluid and collapse. -Atelectasis and decreased lung compliance Cheyne-Stokes respiration alternating periods of slow, irregular respirations and rapid, shallow respirations, possibly along with periods of apnea - High PaCO2 needed to stimulate ventilation, but leads to tachypnea. When PaCO2 decreases, apnea occurs. How vaccines are formed 1) Characterizing the desired protective immune response (Antibody, t-cell) 2) Identify the antigen to induce that response (immune responses against some agents on an infectious agent are ineffective to increase risk for infection) 3) determine the most effective route (oral, inhaled) 4) Optimize the #/timing of vaccine doses 5) Decide on the most effective form for administration (live, inactivated) Antibiotic resistance -Enzymatic inactivation of antibiotics -Multi-drug-resistance transporters (MDRs) -Resistance genes- Spread by horizontal gene transfer -Decreased uptake of the ATB by the bacteria (ex. thickened cell walls) Normal flora -Compete with pathogens for nutrients and block attachment to the endothelium -Produce chemicals (ammonia, phenols, indoles) and toxic proteins (bacteriocins) that inhibit colonization of pathogenic microorganisms. -Helps develop local and systemic adaptive immune systems. Desensitization therapy Repeated exposure to stimulus which gradually reduces intense reaction. -Works best for routine respiratory tract allergens and biting insect allergies. -Not good for food allergies -Blocks circulating IgG. Allergen is unable to bind with IgE on mast cells "left-shift" in WBC differential -When demand for mature neutrophils exceeds the supply -Premature release of immature WBCs (leukocytes) Immunity -Innate/Natural/Native- Natural barriers (physical, mechanical, and biochemical-in place at birth) and inflammation (2nd line of defense, prevent infection, promote healing) -Passive-preformed antibodies or T lymphocytes are transferred from a donor to the recipient (only temporary) (placenta to fetus) -Active/Specific/adaptive/Acquired- Slow to develop, but has memory and rapidly eradicates the 2nd infection. Produced by the individual after natural exposure to an antigen on immunization MHC Class I antigens -Heterodimers composed of a large alpha chain and a smaller chain (B2-microglobulin). - loci labeled HLA- A,B, or C -Distribution: All nucleated cells and platelets -Presents "endogenous" antigens (8-10 amino acids) derived from intracellular proteins - Reacts with CD8 on Tc cells Anti Inflammatory drugs - NSAIDs Inhibit COX-1 & 2, blocking synthesis of prostaglandins of the E series ? Binds to H2 receptor resulting in the suppression of leukocyte function Acute phase C- reactive protein -Produced in the liver - Most sensitive to acute phase reactants -Levels rise rapidly in inflammation ( non-specific to type of inflammation) Trisomy - 3 copies of one chromosome - 13, 18 or 21st trisomy is survivable - Trisomy 21 = Down syndrome - May be mosaic = some cells are normal, some have trisomy Down Syndrome (Trisomy 21) - 97% caused by nondisjunction during formation of on of the parent's gametes or embryonic development ( mostly on the mother's egg cell) -Low IQ (25-70), low nasal bridge, protruding tongue, flat low set ears, poor muscle tone, short stature, - reduced ability to fight respiratory infections, 1/3 - 1/2 have congenital heart defects -3/4 fetuses spontaneously aborted or stillborn, 10-20% die within 10 years, others live to 60yo. -Alzheimer's symptoms by 40 yo Klinefelter Syndrome (XXY) -Male appearance, usually sterile, female-like breasts, small testes, high voice, moderate degree of mental impairment -High incidence in prison population -nondisjunction of the X chromosomes in the mother (incidence rises with maternal age) Neurofibromatosis -Benign nerve sheath tumors -Autosomal dominant disorder of the nerve system - Sx range from harmless cafe-au-lait spots to malignant tumors, scoliosis, seizures, gliomas, HTN, learning disabilities, and neuromas. -Type 1 most common: inactivation of NF1 gene -Type 2: NF2 gene - Tx: surgery Duchenne Muscular dystrophy - Most common and most severe X-linked recessive disorder -Progressive muscle degeneration (unable to walk by 10-12yo) - Affects heart and resp muscles and death usually before 20yo - dystrophin is absent Multifactorial traits traits that result from the interaction of one or more environmental factors and two or more genes -BP, Height, quantitative traits, , cancers, DM, CAD, Stroke -Follow a normal or bell-shaped distribution in populations -Diseases do not have bell-shaped distribution Transcription The process by which RNA is synthesized from a DNA template. - results in messenger RNA -RNA polymerase binds to a promoter site on DNA -transcription factors bind to transcription factor binding sites (regulate timing of transcription and tissues) -Each transcribed segment corresponds to one gene that makes up our chromosomes Genetic mutations occur when: 1) an existing error in coding is transcribed to the new DNA 2) a transcription error occurs that results in an error in coding 3) mutation in the coding occurs after transcription. Chromosomes Somatic cells -46 chromosomes (23 pairs)- muscles, liver, epithelial, etc-Diploid (2N) Gamete cells- 23 chromosomes (one from each of the 23 pairs)- Egg or sperm-Haploid (1N) Translation involves the actual synthesis of protein DNA and genetics Genotype- individual's chromosomes- the blueprint Phenotype- the physical end results (eye color, hair color, blood type) -Human genome= 20,000 genes -97% of genes are noncoding DNA -3% codes for synthesis of 60,000-80,000 different proteins, enzymes, hormones, ion channels, cell membrane receptors -99.9% of DNA in humans is the same genetic mutations spontaneously or as the result of exposure to external mutagens such as radiation, chemicals, viruses -like typos in our DNA -Base pair substitution- simple typo- may cause problems, may not -Frame shift mutation- gibberish, complex typo, nothing makes sense- very complex