Exam 3: NU 606/ NU606 (Latest 2026/ 2027 Update) Advanced Pathophysiology | Questions & Answers | Grade A | 100% Correct (Verified Solutions)- Regis

GRADED A++ Exam 3: NU 606/ NU606 (Latest 2026/ 2027 Update) Advanced Pathophysiology | Questions & Answers | Grade A | 100% Correct (Verified Solutions)- Regis Q: What are the two layers of the pericardial sac Answer outer fibrous pericardium anchors the heart to diaphragm visceral pericardium (epicardium) has a serous membrane Q: What is unique about cardiac muscle (myocardial fibers) Answer - no nerves are present intercalated discs at the junctions between fibers (they contain desmosomes, connections to prevent muscle cells from separating during contraction, and gap junctions, which permit ions to pass from cell to cell which facilitates rapid transmission of impulses Q: What ensures that all muscle fibers of the two atria followed by the two ventricles contract Answer together or shortly after as it were GRADED A++ gap junctions and desmosomes Q: Where does a conduction impulse start Answer all muscle cells can start it, but it usually originates in the sinoatrial node - the pacemaker Q: What can alter the SA node impulses Answer autonomic nervous system fibers and circulating hormones such as epinephrine Q: What is the only anatomical connection between atrial and ventricle conduction in the heart Answer AV node Q: Where does the cardiac electrical impulse go after the AV node Answer av bundle/ bundle of His, the right and left bundle branches, and the terminal purkinje network of fibers GRADED A++ Q: What stimulates ventricular contraction Answer terminal purkinje fibers? Q: What does the P wave represent in an ECG Answer atrial depolarization Q: what does the QRS wave represent in an ECG Answer depolarization of the ventricles - during that time it masks the effect of atrial repolarziation Q: what does the T wave represent on an ECG Answer ventricular repolarization GRADED A++ Q: where is the cardiac control center and what does it do Answer medulla of the brain. responds to changes from the baroreceptors (which detect BP and are located in the aorta and carotid) . activate sympathetic nervous system or parasympathetic nervous system to alter the rate and force of cardiac contractions Q: What does activation of the sympathetic nervous system (SNS) do? Answer tachycardia and contractility Q: What does activation of the parasympathetic nervous system do? Answer bradycardia through Vegas nerve Q: How do beta blockers work? Answer block normal SNS activation in an otherwise damaged heart, so that it does not need to increase force or rate after the heart has been damaged. GRADED A++ Q: What are sulcus (sulci)? Answer shallow grooves where the vessels of the coronary arteries lie Q: when is blood flow greater through the myocardium Answer diastole (relaxation) Q: how does routine aerobic physical exercise help coronary circulation Answer development of collateral circulation Q: what does a blockage of the right coronary artery impact? Answer AV node (resulting in dysrhythmias), supplies right side of the heart and inferior portion of the left ventricle as well as posterior interventriucular septum. Q: what does blockage of the left coronary artery impair? Answer GRADED A++ pumping capability of the left ventricle - congestive heart failure- brings blood to anterior wall of ventricles, anterior septum, and bundle branches Q: cardiac cycle step 1 atria relaxed and filling - the pulmonary veins filling the left atrium, the inferior and superior venue cave fill the right atrium Q: cardiac cycle step 2 the av valves open as the pressure of the blood in the atria increases and ventricles are relaxed Q: cardiac cycle step 3 blood flows into ventricles - almost emptying atria Q: cardiac cycle step 4 conduction system stimulates the atrial muscle to contract, forcing any remaining blood into the ventricles Q: cardiac cycle step 5 the atria relax GRADED A++ Q: cardiac cycle step 6 the two ventricles begin to contract, and pressure increases in the ventricles Q: cardiac cycle step 7 the av valves close Q: cardiac cycle step 8 all valves are closed, and the ventricular myocardium continues to contract which builds pressure Q: cardiac cycle step 9 increase pressure opens the semilunar valves, blood is forced into the pulmonary artery and aorta. right ventricle doesn't need as much pressure because the pulmonary circulation is not as high pressure and systemic circulation. Q: cardiac cycle step 10 atria have begun to fill, ventricles relax, the aortic and pulmonary valves close to prevent back flow. GRADED A++ Q: what causes cardiac heart sounds valves closing - lubb is AV valves at systole, and dubbings is semilunar valves closing with diastole Q: why is there a pause after AV node conduction allow ventricular filling Q: what impacts stroke volume sympathetic stimulation and venous return Q: Cardiac reserve is: the ability of the heart to increase cardiac output when needed Q: Preload volume of blood in ventricles at end of diastole - ventricles are at their maximum volume GRADED A++ Afterload The force or resistance against which the heart pumps to eject blood from the ventricles, deterred by peripheral resistance to the opening of semilunar valves - for example impacted by high diastolic pressure :) what does the circumflex artery nourish? left atrium and the lateral and posterior walls of the left ventricle systolic pressure is: highest pressure, pressure exerted by the blood when ejected from the left ventricle diastolic pressure lower pressure, pressure that is sustained when the ventricles are relaxed what impacts blood pressure cardiac output (impacted by heart rate, which is sympathetic nervous system and epinephrine) and stroke volume which is venous return (preload) blood volume, sympathetic nervous system - contractility only, and peripheral resistance (after load) GRADED A++ what system causes widespread vasoconstriction sympathetic nervous system what causes widespread vasodilation lack of SNS stimulation - there is no PNS innervation in blood vessels. how does blood pressure increase from SNS stimulation SNS and epic act at the beta adrenergic receptors in the heart to increase rate and force of contraction or sis epi and norepi increase vasoconstriction by stimulating the alpha receptors in the arterioles of the skin and viscera, this reduces the capacity of the system and increases venous return hormones which contribute to control of blood pressure ADH: increases water retention and causes vasoconstriction aldosterone: increases blood volume through sodium and water reabsorption renin-angiotensin-aldosterone system: triggered when kidney perfusion is decreased, results angiotensin (vasoconstrictor) and aldosterone what does the troponin blood test tell us proteins which are leased when cardiac muscles are damaged. very high levels indicate MI GRADED A++ Common vasodilators nitro, isosoribide (long acting), reduce peripheral resistance systemically, also coronary vasodilators beta blockers metoprolol or atenolol , create dysrhythmias and hypertension, block beta adrenergic receptors which prevents SNS from increase heart activity Calcium Channel Blockers block movement of calcium ions into the cardiac and smooth muscle fiber, - thus decreasing cardiac contractility, antidysrhythmic in atrial activity, vasodilator. diltiazem, verapamil, nifedipine, amlodipine digoxin cardiac glycoside treated atrial dysrhythmias, slows conduction impulses and heart rate, but also increases the contractility so it is more efficient, effective dose is close to toxic dose antihypertensive drugs GRADED A++ adrenergic or sympathetic blockers (block brain or arteriole SNS alpha adrenergic receptors, or direct vasodilators, calcium blockers, diuretics (remove sodium and water), ACE inhibitors (for CHF, block the renin cascade thing - end in April, reduce peripheral resistance and aldosterone), angiotensin 2 receptor blockers (end in tartan and prevent angiotensin from acting on blood vessels which lowers BP..) anticoagulants ASA decreases platelet adhesion, Coumadin blocks coagulation. cholesterol or lipid lowering drugs statins, simvastatin, atorvastatin, reduce LDL and cholesterol content within the blood by blocking synthesis in the liver. lower CRP? what is the leading cause of death in men and women in the US coronary artery disease arteriosclerosis general term for arterial changes, loss of elasticity of the arteries, walls thicken and harden, and lumen gradually narrows and may obstruct. atherosclerosis GRADED A++ differentiated by the presence of atheroma: plaque consisting of lipids, cells, fibrin and cell debris often with thrombi LDL transports cholesterol from diet and liver to all cells HDLd transport cholesterols away from peripheral cells to the liver where it gets stabilized and excreted angina pectoris chest pain, which may radiate to the left arm and jaw, that occurs when there is an insufficient supply of blood/oxygen to the heart muscle what is the most common cause of an MI coronary artery obstruction due to atherosclerosis with thrombus attached and usually evolve the left ventricle. how long does it take a scar to form on the heart 6-8 weeks, beginning on the 7th day. GRADED A++ heart enzyme markers ck-mb peaks in first 25 hours AST peaks at 48 hours LDH peaks at just before 72 hours (lactic dehydrogenase) myosin and troponin are elevated a few hours after MI for early confirmation what is considered most specific for myocardial tissue damage troponin congestive heart failure (CHF) the failure of the heart to pump efficiently, leading to excessive blood or fluids in the lungs, the body, or both. can occur immediately after or much later as activity is resumed necrotic heart tissue rupture less common. usually develops 3-7 days after MI when necrotic tissues is breaking down where will a left heart thrombus travel brain or elsewhere GRADED A++ where will a right heart thrombus travel pulmonary embolism sinus node abnormalities bradycardia, tachycardia, sick sinus syndrome (alternating Brady and tacky and requires a mechanical pacemaker) Atrial Conduction Abnormalities most common PAC: extra contractions of the atria (palpitations) atrial flutter: atrial HR over 160-350, ventricular rate is slower atrial fibrillation: over 350 heart blocks: conduction excessively delayed, type one is PR increased, type 2 is increase PR length until one contraction is missed, and total is no conduction in AV node, ventricles slowly contract independent of atrial contraction (significantly reduced cardiac output). ventricular conduction abnormalities bundle branch block: does not alter cardiac output but is a wide QRS wave ventricular tachycardia: reduces CO ventricular fibrillation PVCs: v fit can develop from these, mostly they are occasional no big deal GRADED A++ what requires a pacemaker sinoatrial nodal problems or total heart block Left sided congestive heart failure Left ventricle does not empty Blood backs up in pulmonary circulation Pulmonary congestion right sided heart failure 1. Jungular Vein Distention 2. Ascending Dependent Edema 3. Weight Gain 4. Hepatomegaly (Liver Enlargement) what causes congestive heart failure infarction, valvular changes, congenital heart defects, coronary artery disease (leading cause) right sided heart failure due to pulmonary disease GRADED A++ Cor pulmonale why do you have oliguria in both right and left sided congestive heart failure because the decreased cardiac output stimulates the renin angiotensin and aldosterone secretions for vasoconstriction and discarding water and sodium VSD opening in intraventricular septum, small ones do not affect cardiac function but may increase risk of infective endocarditis. large openings permit a left to right shunt (because left is high pressure). overloads pulmonary circulation causing pulmonary hypertension. pulmonary hypertension can eventually reverse the shunt to right to left which would cause cyanosis valvular defects most often on aortic and pulmonary classified as stenosis or incompetent valves Tetrology of Fallot pulmonary valve stenosis, VSD, destroposition of the aorta , rightt ventricular hypertrophy rheumatic fever (rheumatic heart disease) an inflammatory disease that occurs mainly in children and affects the heart valves and joints (it can follow after diseases such as strep throat and scarlet fever) GRADED A++ two phases: inflammation of pericardium causing effusion, myocarditis as localized lesions in the heart muscle called Aschoff bodies interfere with conduction, endocarditis, most common problem, effects the valves, form verrucae (wartlike) infective endocarditis inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis three predisposing factors to bacterial endocarditis decreased host defenses, presence of microbes in the blood, abnormal tissue in the heart. drug of choice is amoxocyllin what are the most common sites of atherosclerosis/atheromas in the peripheral circulation abdominal aorta and the femoral and iliac arteries what sound is accompanied by abdominal aortic aneurysm bruits GRADED A++ varicose veins defect or weakness in the vein walls. predispose to thrombus thrombophlebitis inflammation of a vein associated with a clot formation - inflammation occurs first phlebothrombosis thrombus in a vein without inflammation initially, clot is less firmly intact and develops silently what is the critical problem of venous thrombosis pulmonary embolism cariogenic shock results when an inefficient heart cannot sustain adequate circulation common in left ventricular MI vasogenic shock (neurogenic or distributive) vasodilation owing to loss of sympatheticc and vasomotor tone (such as in spinal cord injury) or hypoglycemia, or acidosis GRADED A++ anaphylactic shock system vasodilation and increased permeability septic shock Shock caused by severe infection, usually a bacterial infection - endotoxic, causes vasodilation owing to severe infection with gram negative bacteria shock eventually causes acidosis which causes vasodilation and relaxed precapillary sphincters what is one of the earliest signs of shock cns stimulation 0 anxiety and restlessness, basically hypotension stimulates the SNS causing anxiety and restlessness definition of a stressor any factor that creates a significant change the body or environment. physical, psychological, or a combo. definition of stress GRADED A++ occurs when an individual's status is altered by his or her reaction to a stressors three stages in stress response the GAS (general adaptation syndrome) - Seyle. alarm stage: body defenses mobilize in the hypothalamus, SNS, and adrenal glands resistance stage: hormonal levels are elevated and essential body systems operate at peak performance stage of exhaustion: body is unable to respond further or is damaged by the increased demands what is the first hormonal increase in response to stress immediate increase in adrenocorticotropic (ACTH) hormone secretion then followed by cortisol. process of stress response in the body stressor activates the CNS and thus the hypothalamus. The hypothalamus activates the SNS (norepinephrine) and adrenal medulla (norepinephrine and epi) as well as the central nervous system through the pituitary to release ACTH and subsequently the adrenal cortex releases cortisol and aldosterone. the posterior pituitary releases ADH physiologic effects of chronic stress renal failure, perforating stomach ulcers (intense vasoconstriction in the gastric mucosa decreases mucosal regeneration and mucus production, decrease motility, and cortisol delays tissue regeneration, also do to gastric secretion encouraged through cortisol release). GRADED A++ why does cancer frequently metastasize to the lungs because the venous return and lymphatics bring tumor cells from distant sites in the body to the heart and then into the pulmonary circulation what are three common sites of metastasis from the lung brain, bone, liver what are pleural effusion, hemothorax, and pneumothorax common secondary to lung tumors when they are located on the lung peripheral they cause inflammation or erosion of the pleural membrane what does smoking do on a cellular level? causes metaplasia, ciliated columnar epithelium is changed to squamous cell epithelium. what causes hemoptysis in lung cancer tumor errodes tissue name three potential complications to aspiration GRADED A++ aspiration/chemical pneumonia - alveoli are involved in the inflammation due to liquids (predisposes to infection) respiratory distress syndrome: if inflammation is widespread Pulmonary abscess: if microbes are in the aspirate solvents may be dissolved into blood for systemic effects what is the incidence of lung cancer third most common cancer in the US, more in men, esp black men. what is sleep apnea thin pharyngeal tissues collapse during sleep leading to repeated and momentary cessation of breathing complications of sleep apnea type 2 diabetes pulmonary hypertension right sided CHF, CVA, erectile dysfunction, depression, daytime sleepiness What is extrinsic asthma? Asthma that is caused by substances outside the body, such as pollen, dust, food additives. - called a type one hypersensitivity to inhaled antigen GRADED A++ what is intrinsic asthma Nonimmune Causes - virus, air pollutants, aspirin or nonsteroidal drug sensitivity, stress, exercise, cigarette smoke how do the bronchi and bronchioles respond to in asthma inflammation of mucosa with edema contraction of smooth muscle (bronchoconstriction increased secretion of thick mucus what is COPD characterized by progressive tissue degeneration and obstruction in the airways of the lungs what are three examples of COPD emphysema, chronic bronchitis, chronic asthma what is restrictive lung disease occupational lung disease, asbestosis, farmers lung - cause interstitial inflammation and fibrosis resulting in loss of compliance or stiff lung GRADED A++ what is for pulmonale right sided heart failure due to lung disease what is the significant change in emphysema destruction of alveolar walls and septa which leads to large permanently inflated alveolar air spaces why is expiration difficult in emphysema loss of elastic fibers causes inability of the lung to recoil on expiration and interference with passive expiratory airflow (often r/t to the narrowed airways and weekend walls) Why does barrel chest occur? more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity). what position is the diaphragm in on X-ray of a person with emphysema flattened GRADED A++ why does c0r pulmonale happen in emphysema pulmonary blood vessels are destroyed and hypoxia causes pulmonary vascoconstriction, this results in increased pressure in the pulmonary circulation and increased resistance to the right ventricle what can cause chronic bronchitis inflammation, obstruction, repeated infections, chronic coughing what characterizes chronic bronchitis mucosa inflamed and swollen resulting in hypertrophy and hyperplasia of the mucous glands, ultimately leading to fibrosis and thickening of bronchial wall and distal pooling of secretions what does blue bloater mean related to chronic bronchitis, used to describe the clinical presentation of low oxygen levels, cyanosis with coughing and sputum production, and edema what does pink puffer mean related to emphysema, relates to the dyspnea, hyperventilation, overinflation, lack of coughing which essentially maintains oxygen levels in emphysema what is bronchiectasis GRADED A++ irreversible abnormal dilation or widening primarily of the medium-sized bronchi, usually due to secondary problems. what are two categories of restrictive lung disease and two examples of each restrictive disorders involving abnormality of the best wall: scoliosis, muscular dystrophy restrictive disorders involve disease affecting the tissues providing the supportive framework of the lungs: pulmonary edema, idiopathic pulmonary fibrosis, "stiff lung". what is pneumoconiosis chronic restrictive diseases resulting from long-term inhalation of irritating particles (asbestos) -fibrosis develops with destruction of connective tissue, irreversible what is pulmonary edema fluid collecting in the alveoli and interstitial area, reduces oxygen diffusion into blood what can cause pulmonary edema -inflammation in the lungs which increases capillary permeability -plasma protein levels are low, decreasing plasma osmotic pressure -pulmonary hypertension (left sided heart failure GRADED A++ what is a pulmonary embolus A blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body (most often from leg veins) through the bloodstream. S/S include SOB, CP on inspiration, palpitations, Cyanosis above the nipple line, low O2 sats. What is atelactasis & who is at high risk for it? non aeration or collapse of a lung or part of a lung leading to decreased gas exchange and hypoxia - can be caused by surgery, external pressure, or blockage what is a pleural effusion excessive fluid in the pleural cavity what is some differences between atelactesis and pleural effusion in atalactesis - often the shift will happen toward the affected side as the unaffected side attempts to compensate, in pleural effusion the shift is toward the unaffected side as the affected side gets bigger due to fluid build up. what is a pneumothorax air in the pleural space - this prevents expansion of the lung GRADED A++ When is surfactant produced? 28-36 weeks, promotes alveoli expansion and reduces surface tension what is the pathophysiology of acute respiratory distress syndrom injury to the lung results in injury to alveolar wall and capillary membrane leading to release of chemical mediators, increased permeability of alveolar capillary membranes, increased fluid and protein in the interstitial area and alveoli, and damage to the surfactant-producing cells - can be caused fro severe of prolonged hypoxia which damages lung tissue acute respiratory failure pa02 less than 50 and / or paC02 50 and decreasing ph 7.3 at what rate does muscular loss occur in immobility 12% each week. at 3-5 weeks half of mass is lost how long does it take tendons and ligaments to be effected by immobility 4-6 days, the connective tissue begin to shorten and the density increases which limits flexibility and range of motion GRADED A++ Why is Legionella Pneumophili hard to identify it resides inside pulmonary macrophages what characterizes primary atypical pneumonia causative organism is viral or mycoplasma and involves interstitial inflammation what is a primary difference between interstitial pneumonia and others: nonproductive cough what mycobacterium is characterized by a type four hypersensitivity reaction and a tubercle formation tuberculosis what is affected cellularly in CF protein involved in chloride ion transport in the cell membrane How does CF affect the exocrine glands abnormally thick secretions all over GRADED A++ what does carbon dioxide result from waste material from cell metabolism what makes up the upper respiratory tract and the lower respiratory tract 1- the passageways which conduct air between atmosphere and lungs, includes the larynx, and trachea 2- bronchial tree, and lungs where does gas exchange take place lower respiratory system what filters out foreign material in the air mucous secretions and hairs what are respiratory mucosa made of psuedostratificed ciliated columnar epithelium which include goblet cells in the presence of smoke what happens to psuedostratified ciliated columnar epithelium? change into squamous cells GRADED A++ what are the lymphoid structures in the upper respiratory system tonsils, or palatine tonsil - the one we see and typically talk about, and adenoids, or pharyngeal tonsil name four upper respiratory infections scarlet fever colds flu HIB name four lower respiratory infections TB flu pneumonia what are areas of hyperinflation indicitive of partial obstruction ex. bronchiolitis What are areas of atelactesis indicative of: GRADED A++ complete obstruction what are some trademarks of bronchiolitis necrosis and inflammation in small bronchi and bronchioles with edema, increased secretions and reflex bronchospasm leading to obstruction of the small airways where does pneumococcal pneumonia sometimes naturally reside nasopharynx what occurs as a diffuse pattern of infection in both lungs most often in the lower lobes bronchopneumonia where does legionella pneumophila reside warm moist environment like air conditioners and spas what can impact the rate and depth set by the medulla ANYTHING DEPRESSING CNS hypothalamus stretch receptors in the lungs hearing Breuer reflex (prevents excessive expansion) GRADED A++ voluntary control (singing) what is voluntary control limited to? CO2 levels what do the central chemoreceptors in the medulla respond to elevations in c02 (normal 40-43) decrease ph of csf what do the peripheral chemoreceptors in carotid bodies and aortic arch respond to decreased arterial oxygen low ph when does the body respond to hypoxemia it takes a while, 105 to 60, watch out though, in CLD individuals breathing is responsive to oxygen low, not co2, so small level of hypoxemia is important what does hypercapnia cause respiratory acidosis GRADED A++ how does acidosis affect the central nervous system depresses the nervous system what is stimulated to breath by a hypoxic drive to breath peripheral chemoreceptors what brings oxygenated blood to the left atrium pulmonary viens what affects gas exchange pressure thickness of respiratory membrane total surface area available for diffusion what happens when there is a ventilation perfusion mismatcb autorefulatory mechanisms in the lungs adjust ventilation and blood flow so if some alveoli aren't working right , they vasoconstriction and dilate where they are working to compensate what does compliance of the lung rely on elasticity of tissues, alveolar surface , slope size and flexibility of the sternum GRADED A++ residual volume volume of air remaining in the lungs after maximum expirations vital capacity maximal amount of air that can be moved in and out of the lung dead space areas where gas exchange cannot take place such as bronchi and bronchioles where are the primary control centers for breathing medulla and pons what does the inspiratory center in the medulla do control basic breathing rhythm by stimulating phrenic nerves to the diaphragm and intercostal nerves to the external intercostal muscles 0 this occurs spontaneously every 2 seconds expiratory center is only activated when forced expiration is needed GRADED A++ pons coordination inspiration, expiration, and intervals for each what is daltons law gases based on their own pressure gradient independent of other gases which gas is most affected by thickened respiratory membrane oxygen what controls the cough reflex medulla what does cerebral hypoxia initially stimulate sympathetic nervous system what does excessive intake of aspirin cause respiratory alkalosis GRADED A++ what are four differences symptomatically between flu and cold sudden onset with fever, marked fatigue, body aches what is scarlet fever upper respiratory infection caused by b hemolytic strep with an incubation of 1-2 days