Advanced Pathophysiology HESI Exam review
metabolic acidosis
low pH, low HCO3
metabolic alkalosis
high pH, high HCO3
respiratory acidosis
low pH, high CO2
respiratory alkalosis
high pH, low CO2
metabolic acidosis causes
Primary Cause: Addition of large amounts of fixed acids to body fluids; Contributing
Causes: Lactic acidosis (circulatory failure), Ketoacidosis (diabetes, starvation),
Phosphates and sulfates (Renal dz), Acid ingestion (salicylates), Secondary to
respiratory alkalosis, Adrenal insufficiency
metabolic alkalosis causes
Primary Cause: Retention of base or removal of acid from body fluids; Contributing
Causes: Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy),
Burns, Excessive Sodium Bicarb admin
respiratory acidosis causes
Primary Cause: Hypoventilation (causes hypercapnia); Contributing Causes: COPD,
Pulmonary dz, Drugs, Obesity, Mechanical asphyxia, Sleep Apnea
respiratory alkalosis causes
• Primary stimulation of CNS: hyperventilation. Can be due to emotional origin (anxiety,
fear, apprehension), CNS infection (encephalitis), or salicylate poisoning.
• Reflex stimulation of CNS. Hypoxia stimulates hyperventilation (heart failure,
pneumonia, pulmonary emboli).
Can also be stimulated by fever.
• Mechanical hyperventilation, resulting in "over breathing."
Neuro exams include:
-hand strength, limb strength
-ability to follow commands
-ability to move eyes in equal and uniform fashion
-deep pain stimulus response
-symmetrical and coordinated movement
-clear, speech.
Acute Bronchitis patho
infection or inflammation of the bronchi. In more than 90% of individuals, this is a self-
limiting disorder caused by viruses.
will not have high fevers and will have only scattered coarse wheezes on examination
without evidence of pulmonary consolidation.
Chest X-ray examination is usually normal.
Chronic Bronchitis patho sequence
The chronic bronchitis pathophysiologic sequence of events is as follows:
Hypersecretion of bronchial mucus, which leads to
Recurrent respiratory infections, which lead to
, Airway inflammation, which leads to
Bronchospasm and irreversible airway obstruction
chronic bronchitis patho
characterized by chronic inflammation with recruitment of neutrophils, macrophages,
and lymphocytes to the lung, with progressive damage to airways and the lung
parenchyma.
hyperplasia of the mucus-producing goblet cells of the bronchial epithelium occurs,
resulting in the production of large amounts of mucus in the airways.
Mucus accumulation facilitates the colonization and growth of bacteria, which further
contributes to airway inflammation, bronchospasm, and eventual scarring.
Narrowed airways cause v/q mismatching and expiratory airway obstruction with air
trapping, resulting in both hypoxemia and hypercapnia.
CAD risk factors pathological
Major:
Advanced age
Gender (men > women before age 55, women > men after age 55)
Dyslipidemia
Hypertension
Smoking
Diabetes mellitus and insulin resistance
Obesity
Sedentary lifestyle
Metabolic syndrome
Atherogenic diet
Non traditional:
Markers of inflammation
C-reactive protein (CRP)
Fibrinogen
Protein C
Others
Troponin I
Adipokines
Chronic kidney disease
Air pollution & ionizing radiation
Medications
Coronary artery calcification and carotid artery wall thickness
atherosclerosis pathophysiology
-Inflammatory response
-Injury to endothelial lining
-LDL penetrates vessel wall
-inflammation/macrophage adhesion
metabolic acidosis
low pH, low HCO3
metabolic alkalosis
high pH, high HCO3
respiratory acidosis
low pH, high CO2
respiratory alkalosis
high pH, low CO2
metabolic acidosis causes
Primary Cause: Addition of large amounts of fixed acids to body fluids; Contributing
Causes: Lactic acidosis (circulatory failure), Ketoacidosis (diabetes, starvation),
Phosphates and sulfates (Renal dz), Acid ingestion (salicylates), Secondary to
respiratory alkalosis, Adrenal insufficiency
metabolic alkalosis causes
Primary Cause: Retention of base or removal of acid from body fluids; Contributing
Causes: Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy),
Burns, Excessive Sodium Bicarb admin
respiratory acidosis causes
Primary Cause: Hypoventilation (causes hypercapnia); Contributing Causes: COPD,
Pulmonary dz, Drugs, Obesity, Mechanical asphyxia, Sleep Apnea
respiratory alkalosis causes
• Primary stimulation of CNS: hyperventilation. Can be due to emotional origin (anxiety,
fear, apprehension), CNS infection (encephalitis), or salicylate poisoning.
• Reflex stimulation of CNS. Hypoxia stimulates hyperventilation (heart failure,
pneumonia, pulmonary emboli).
Can also be stimulated by fever.
• Mechanical hyperventilation, resulting in "over breathing."
Neuro exams include:
-hand strength, limb strength
-ability to follow commands
-ability to move eyes in equal and uniform fashion
-deep pain stimulus response
-symmetrical and coordinated movement
-clear, speech.
Acute Bronchitis patho
infection or inflammation of the bronchi. In more than 90% of individuals, this is a self-
limiting disorder caused by viruses.
will not have high fevers and will have only scattered coarse wheezes on examination
without evidence of pulmonary consolidation.
Chest X-ray examination is usually normal.
Chronic Bronchitis patho sequence
The chronic bronchitis pathophysiologic sequence of events is as follows:
Hypersecretion of bronchial mucus, which leads to
Recurrent respiratory infections, which lead to
, Airway inflammation, which leads to
Bronchospasm and irreversible airway obstruction
chronic bronchitis patho
characterized by chronic inflammation with recruitment of neutrophils, macrophages,
and lymphocytes to the lung, with progressive damage to airways and the lung
parenchyma.
hyperplasia of the mucus-producing goblet cells of the bronchial epithelium occurs,
resulting in the production of large amounts of mucus in the airways.
Mucus accumulation facilitates the colonization and growth of bacteria, which further
contributes to airway inflammation, bronchospasm, and eventual scarring.
Narrowed airways cause v/q mismatching and expiratory airway obstruction with air
trapping, resulting in both hypoxemia and hypercapnia.
CAD risk factors pathological
Major:
Advanced age
Gender (men > women before age 55, women > men after age 55)
Dyslipidemia
Hypertension
Smoking
Diabetes mellitus and insulin resistance
Obesity
Sedentary lifestyle
Metabolic syndrome
Atherogenic diet
Non traditional:
Markers of inflammation
C-reactive protein (CRP)
Fibrinogen
Protein C
Others
Troponin I
Adipokines
Chronic kidney disease
Air pollution & ionizing radiation
Medications
Coronary artery calcification and carotid artery wall thickness
atherosclerosis pathophysiology
-Inflammatory response
-Injury to endothelial lining
-LDL penetrates vessel wall
-inflammation/macrophage adhesion
