HESI Pathophysiology Exam
Review Q&A
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,HESI Pathophysiology Exam Review & Practice
1. What is TPA? What are at least 2 conditions where you might see it given
as a medication? Why would we not give it?
tPA: clot busting agent used to reduce the effects of CVA (stroke) in
some individuals. It is contraindicated for anticoagulant drugs.
The release of tissue plasminogen (tPA) from injured blood vessels and
tissues, converts plasminogen to plasmin. Plasmin is a potent enzyme
that digests fibrin strands (this leads to clot dissolution).
2. Know the triad that would lead you to conclude your patient is
experiencing cardiac tamponade
Fluid compresses the heart, prevents stretching & filling, reduces CO
Arterial pressure falls, venous pressures rise, pulse pressure narrows
Beck’s Triad: Distant, muffled heart sounds (like under water, fluid),
JVD, decreased BP
=EMERGENCY
pericardiocentesis with surgical repair as appropriate is needed (16-18
gauge needle inserted into pericardial space to relieve pressure and
analyze fluid)
Manifestations include heavy feelings over the chest, shortness of
breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea,
vomiting, excessive perspiration, decreased level of consciousness,
pulses paradoxes, distant or muted heart sounds, and extreme anxiety,
neck vein distension
3. The 3 Ps of diabetes
Polydipsia: osmolality, polyuria: osmotic diuresis, and polyphagia: cell
starvation
4. What electrolyte is of most concern with kidney failure patients?
Potassium: cardiac
5. Review the signs of hypokalemia and hyperkalemia
Hypokalemia: muscle cramps, weakness, cardiac arrhythmias,
flattening of the T wave, confusion and drowsiness, and irritability
Hyperkalemia: peaked T wave, v-fib, cardiac arrest, muscle weakness,
respiratory distress
6. Right sided heart failure versus left sided heart failure
CHF: Occurs when the heart is unable to pump sufficient blood to meet
the metabolic needs of the body; usually occurs secondary; may present
as an acute episode but usually is a chronic condition; may result from
an infarction or a valve defects may arise from increased demands on
the heart, such as those imposed by hypertension or lung disease;
Left-Sided Heart Failure: Characterized by impaired pumping ability
of left side of heart; Eventually backs blood up into pulmonary
, circulation (crackles)- THIS IS BAD-FLUID IN THE LUNGS MEANS
LESS AIR IN THE
LUNGS; Results in elevated pressure and congestion in pulmonary
veins/capillaries; Symptoms: Fatigue, activity intolerance, shortness of
breath, cough, orthopnea, paroxysmal nocturnal dyspnea
**tripod position (leaning over: usually seen); **Pulmonary congestion:
pink frothy sputum, cough, crackles, wheezes, tachypnea
Right-Sided Heart Failure: Characterized by impairment of pumping
ability on right side of heart; Backup of blood followed by congestion
and elevated pressure in systemic veins and capillaries; Most common
cause is left-sided dysfunction; Symptoms result from volume overload
leading to ascites and edema; Patients may complain of abnormal
bloating and discomfort, with poor appetite and sometimes nausea and
vomiting
7. Can you tell the difference between diabetes insipidus, diabetes mellitus
type 1 & type 2?
DI: lack of ADH action, dehydration
DM1: complete lack of insulin, usually diagnosed young; Absolute
absence of insulin – must have injections or insulin pump for life. NOT
oral meds; Two types: immune mediated (most common, especially in
children; Latent autoimmune diabetes (LADA) in adults
Genetic disposition + trigger (eg infection) + T cell hypersensitivity to
beta cell antigen) and idiopathic (less common, no autoimmune
component)
DM2: lifestyle changes, accounts for 90% of diabetes, strong correlation
with diabetes, genetic component, cellular resistance to insulin,
deranged insulin secretion: beta cells fail, increased glucose production
by liver; diagnosed later d/t insidious onset; frequent infections, slow
wound healing, blurred vision; Usually oral meds as initial
pharmacotherapy but often require insulin therapy later; often require
insulin when acutely ill on temporary basis
8. Can you summarize the difference between multiple sclerosis and ALS?
How about how do they differ from Parkinson's?
MS: (Multiple Sclerosis) involves a progressive demyelination of the
neurons in the brain, spinal cord, and cranial nerves; characterized by
remissions and periods of exacerbations; considered a disease of young
to middle-aged adults with the onset usually being between 20 and 50
years of age; Onset is usually insidious and gradual; course is
unpredictable; debilitating autoimmune disorder; Clinical
manifestations: fatigue, ataxia, muscle spasms, paresthesia or abnormal
sensations, difficulty moving arms or legs, unsteady gait, tremor, bowel
and bladder issues, decreased attention span, difficulty reasoning,
dizziness, hearing loss; Predisposing factors include being between 20-
40 years old, smoking, women, and caucasian ethnicity
ALS: (Amyotrophic Lateral Sclerosis) progressive degenerative disease
affecting both upper motor neurons in the cerebral cortex and lower
Review Q&A
user
,HESI Pathophysiology Exam Review & Practice
1. What is TPA? What are at least 2 conditions where you might see it given
as a medication? Why would we not give it?
tPA: clot busting agent used to reduce the effects of CVA (stroke) in
some individuals. It is contraindicated for anticoagulant drugs.
The release of tissue plasminogen (tPA) from injured blood vessels and
tissues, converts plasminogen to plasmin. Plasmin is a potent enzyme
that digests fibrin strands (this leads to clot dissolution).
2. Know the triad that would lead you to conclude your patient is
experiencing cardiac tamponade
Fluid compresses the heart, prevents stretching & filling, reduces CO
Arterial pressure falls, venous pressures rise, pulse pressure narrows
Beck’s Triad: Distant, muffled heart sounds (like under water, fluid),
JVD, decreased BP
=EMERGENCY
pericardiocentesis with surgical repair as appropriate is needed (16-18
gauge needle inserted into pericardial space to relieve pressure and
analyze fluid)
Manifestations include heavy feelings over the chest, shortness of
breath, tachycardia, cough, dysphagia, hiccups, hoarseness, nausea,
vomiting, excessive perspiration, decreased level of consciousness,
pulses paradoxes, distant or muted heart sounds, and extreme anxiety,
neck vein distension
3. The 3 Ps of diabetes
Polydipsia: osmolality, polyuria: osmotic diuresis, and polyphagia: cell
starvation
4. What electrolyte is of most concern with kidney failure patients?
Potassium: cardiac
5. Review the signs of hypokalemia and hyperkalemia
Hypokalemia: muscle cramps, weakness, cardiac arrhythmias,
flattening of the T wave, confusion and drowsiness, and irritability
Hyperkalemia: peaked T wave, v-fib, cardiac arrest, muscle weakness,
respiratory distress
6. Right sided heart failure versus left sided heart failure
CHF: Occurs when the heart is unable to pump sufficient blood to meet
the metabolic needs of the body; usually occurs secondary; may present
as an acute episode but usually is a chronic condition; may result from
an infarction or a valve defects may arise from increased demands on
the heart, such as those imposed by hypertension or lung disease;
Left-Sided Heart Failure: Characterized by impaired pumping ability
of left side of heart; Eventually backs blood up into pulmonary
, circulation (crackles)- THIS IS BAD-FLUID IN THE LUNGS MEANS
LESS AIR IN THE
LUNGS; Results in elevated pressure and congestion in pulmonary
veins/capillaries; Symptoms: Fatigue, activity intolerance, shortness of
breath, cough, orthopnea, paroxysmal nocturnal dyspnea
**tripod position (leaning over: usually seen); **Pulmonary congestion:
pink frothy sputum, cough, crackles, wheezes, tachypnea
Right-Sided Heart Failure: Characterized by impairment of pumping
ability on right side of heart; Backup of blood followed by congestion
and elevated pressure in systemic veins and capillaries; Most common
cause is left-sided dysfunction; Symptoms result from volume overload
leading to ascites and edema; Patients may complain of abnormal
bloating and discomfort, with poor appetite and sometimes nausea and
vomiting
7. Can you tell the difference between diabetes insipidus, diabetes mellitus
type 1 & type 2?
DI: lack of ADH action, dehydration
DM1: complete lack of insulin, usually diagnosed young; Absolute
absence of insulin – must have injections or insulin pump for life. NOT
oral meds; Two types: immune mediated (most common, especially in
children; Latent autoimmune diabetes (LADA) in adults
Genetic disposition + trigger (eg infection) + T cell hypersensitivity to
beta cell antigen) and idiopathic (less common, no autoimmune
component)
DM2: lifestyle changes, accounts for 90% of diabetes, strong correlation
with diabetes, genetic component, cellular resistance to insulin,
deranged insulin secretion: beta cells fail, increased glucose production
by liver; diagnosed later d/t insidious onset; frequent infections, slow
wound healing, blurred vision; Usually oral meds as initial
pharmacotherapy but often require insulin therapy later; often require
insulin when acutely ill on temporary basis
8. Can you summarize the difference between multiple sclerosis and ALS?
How about how do they differ from Parkinson's?
MS: (Multiple Sclerosis) involves a progressive demyelination of the
neurons in the brain, spinal cord, and cranial nerves; characterized by
remissions and periods of exacerbations; considered a disease of young
to middle-aged adults with the onset usually being between 20 and 50
years of age; Onset is usually insidious and gradual; course is
unpredictable; debilitating autoimmune disorder; Clinical
manifestations: fatigue, ataxia, muscle spasms, paresthesia or abnormal
sensations, difficulty moving arms or legs, unsteady gait, tremor, bowel
and bladder issues, decreased attention span, difficulty reasoning,
dizziness, hearing loss; Predisposing factors include being between 20-
40 years old, smoking, women, and caucasian ethnicity
ALS: (Amyotrophic Lateral Sclerosis) progressive degenerative disease
affecting both upper motor neurons in the cerebral cortex and lower
