NURS 611 EXAM 3 PATHO LATEST TEST BANK 156 REAL EXAM
QUESTIONS AND CORRECT ANSWERS
Explain the pathophysiology associate with Type 1 and Type 2 DM - ANSWER: Is the
result of an autoimmune mediated specific loss of beta cells in the pancreatic islet.
One of the basic patho of type 2 DM is the development of insulin resistant tissue
cells.
Explain what occurs in panhypopituitarism. - ANSWER: Panhypopituitarism is the
term correctly associated with the lack of all anterior pituitary hormones.
List the clinical manifestations of hypothyroidism. - ANSWER: The individual develops
a low basal metabolic rate, cold intolerance, lethargy, tiredness, and slightly lower
basal body temperature.
Differentiate diabetes insipidus, diabetes mellitus and SIADH. - ANSWER: DM: is not
a single disease but a group of clinical heterogeneous disorders that have glucose
intolerance in common.
DI: is an insufficiency of ADH, leading to polyuria and polydipsia.
SIADH: is characterized by high levels of ADH in the absence of normal physiologic
stimuli for its release.
The symptom common to all these conditions is thirst.
What causes the microvascular complications of DM. - ANSWER: Microvascular
complications are a result of capillary basement membranes thickening and
endothelial cell hyperplasia.
What is the cause of diabetes insipidus. - ANSWER: Inability of the kidney to increase
permeability of water. This causes excretions of large volumes of dilute urine,
leading to increase in plasma osmolality.
Describe the pathophysiological changes associated with Addison's Disease. -
ANSWER: Addison disease is a result of hyposecretion of adrenal cortex hormones.
Describe the pathophysiological changes associated with hypoparathyroidism. -
ANSWER: The most common cause of hyperparathyroidism is damage caused during
thyroid surgery. In hypothyroidism a lack of circulating PTH causes a depressed
serum calcium level resulting in the symptomatology mentioned in the stem.
What are the causes and pathophysiological changes associate with ketoacidosis? -
ANSWER: In a state of relative insulin deficiency there is an increase in insulin
counter regulating hormones including catecholamine's, cortisol, glucagon, and GH.
Catecholamine's, cortisol, glucagon and GH antagonize insulin by increasing glucose
,production. In addition, these hormones decrease use of glucose. Profound insulin
deficiency results in decrease glucose uptake, increase fat mobilization with release
if fatty acids, and accelerated gluconeogenesis and ketogenesis. Ordinarily, ketones
are used by tissues as an energy source to regenerate bicarbonate. Hyperkalemia is a
result of a compensatory mechanism directed at eliminating metabolic acidosis.
What is acromegaly? - ANSWER: Acromegaly is a term for adults who have been
exposed to continuously high levels of GH, whereas the term gigantism is reserved
for children and adolescents.
Differentiate hypothyroidism and Graves' disease - ANSWER: One of the cause's
hypothyroidism is a deficiency of endemic iodine. Hypothyroidism are the lower
levels of thyroid hormone, without the negative feedback of TH in the pituitary,
there is an increase secretion of TSH that may lead to goiter. As a result in decreased
energy metabolism resulting in constipation, regulatory mechanisms are overridden
by abnormal immunologic mechanisms that result in the stimulation of excessive TH.
The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia;
the remaining options are not associated with this disorder.
Describe the pathophysiology related to chronic DM - ANSWER: A number of serious
complications are associated with any type of DM and include microvascular
(retinopathy, nephropathy, and neuropathy) and macrovascular (CAD, CVA, PVD)
disease and infection.
What happens during hypoglycemia? - ANSWER: A person with type 1 DM
experiences hunger, lightheadedness, tachycardia, pallor, HA and confusion. The
most likely cause of these symptoms is hypoglycemia, which is often caused by a lack
of systemic glucose resulting from muscular activity.
What is the metabolic syndrome? - ANSWER: It also has been called the insulin
resistance syndrome or syndrome X. It is a clustering of clinical traits occurring
together that increase the risk for accelerated cardiovascular disease and type 2 DM.
Combination of medical disorders that increase the risk of developing cardiovascular
disease and DM.
Describe how DM causes peripheral neuropathy - ANSWER: It is a form of "dying
back" neuropathy, in which the distal portions of the neurons are initially and
eventually more severely affected. The earliest morphologist change in both the
peripheral nerves and CNS is axonal degeneration that preferentially involves
sensory nerve fibers, particularly the smaller polymodal unmyelinated peripheral C
fibers and the larger myelinated A delta fibers.
Trace the electrical activity of the heart. - ANSWER: Normally electrical impulses
arise in the SA nose, which is often called the pacemaker of the heart.
The SA node is located at the junction of the right atrium and superior vena cava,
just above the tricuspid valve.
,Numerous automatic nerve endings are
within the node.
The SA node is heavily innervated by both sympathetic and parasympathetic nerve
fibers.
The SA node P cells, so-called because they are pale and primitive appearance, are
assumed to be the site of impulse formation.
The action potential is transmitted from the atrial to the ventricular myocardium
through fibers of the conduction system, traveling first to the AV node then the
bundle of his and finally through the bundle branches of the interventricular septum
to Purkinje fibers of the heart wall.
Identify the location of the neurotransmitters in the heart. - ANSWER: Sympathetic
neural stimulation of the myocardium and coronary vessels depends on the presence
of adrenergic receptors, which bind specifically with neurotransmitters of the
sympathetic nervous system.
Define adrenergic receptors. - ANSWER: Sympathetic neural stimulation of the
myocardium and coronary vessels depends on the presence of adrenergic receptors,
which bind specifically with neurotransmitters of the sympathetic nervous system.
Discuss left-ventricular end diastolic pressure. - ANSWER: This is a concept expressed
in Frank Starling law, cardiac muscle, like other muscle, increases its strength of
contraction when it's stretched.
Define Frank-Starling law - ANSWER: As stated in Frank-Starling law, the volume of
blood in the heart at the end of diastole (the length of its muscle fibers) is directly
related to the force (strength) of contraction during the next systole.
Discuss the effect of angiotensin II on the heart. - ANSWER: Angiotensin II is a
powerful vasoconstrictor and stimulates the secretion of aldosterone from the
adrenal gland. Angiotensin II is also growth promoter in cardiovascular tissues,
resulting in monocyte and vascular hypertrophy and progression of hypertension.
Neural effects of angiotensin II include stimulation of thirst, release of ADH, and
increases in sympathetic nervous system output. Angiotensin II also causes structural
changes in blood vessels (remodeling) that contribute to permanent increases in
peripheral resistance and make vessels more vulnerable to endothelial dysfunction
and platelet aggregation.
Define pulsus paradoxus. - ANSWER: Pulsus paradoxus means that the arterial blood
pressure during expiration exceeds arterial pressure during inspiration by more than
10 mmHg. This clinical finding reflects impairment of diastolic filling of the left
ventricle plus reduction of blood volume within all 4 cardiac chambers.
, List the indicators for an acute myocardial infarction (AMI). - ANSWER: When
coronary blood flow is interrupted for an extended period, myocyte necrosis occurs,
these results in an MI. In the majority of cases of MI, the decrease in coronary flow is
the result of atherosclerotic CAD, other causes include coronary spasm and coronary
artery embolism. The first s/s of acute MI is usually sudden, severe CP. It's not
possible to distinguish between angina and MI by s/s alone, although pain associated
with MI tends to be more severe and prolonged. It may be described as heavy and
crushing, such as a "truck sitting on my chest," radiation to the neck, jaw, back,
shoulder or left arm is common. Some individuals (especially older adults or those
with DM) experience no pain, thereby having a "silent" infarction. Infarction often
stimulates a sensation of unrelenting indigestion. Nausea and vomiting may occur
because of reflex stimulation of vomiting centers by pain fibers. Vasovagal reflexes
from the area of the infracted myocardium also may affect the GI tract.
Catecholamine release results in sympathetic stimulation, producing diaphoresis and
peripheral vasoconstriction that cause the skin to become cool and clammy.
List the clinic indicator for a coronary thrombus. - ANSWER: These individuals usually
have marked elevations in the ST segments on ECH and are categorized as having a
STEMI.
Define pericarditis - ANSWER: It's an acute inflammation of pericardium. Most
individuals with acute pericarditis describe several days of fever, myalgias, and
malaise followed by the sudden onset of severe CP that worsens with respiratory
movements and with lying down. Although the pain may radiate to the back, it's
generally felt in the anterior chest and may be confused initially with the pain of
acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness,
irritability, anxiety, and weakness. It is also the most common cardiovascular
complication of HIV infection.
List the causes and types of cardiomyopathy - ANSWER: Cardiomyopathies are a
diverse group of disease that primarily affects the myocardium. Most are the result
of underlying cardiovascular disorders, such as ischemic heart disease and HTN.
Cardiomyopathies also can be secondary to infectious disease, exposure to toxins,
systemic connective tissue disease, infiltrative and proliferative disorders, or
nutritional deficiencies. Dilated cardiomyopathy causes decreased ejection fraction,
increased end diastolic and residual volumes, decreased ventricular stroke volume,
and biventricular failure. Dilated cardiomyopathy (congestive cardiomyopathy) is
characterized by ventricular dilation and grossly impaired systolic function, leading
to dilated heart failure. Hypertrophic caridomyopathy is characterized by thickening
of the septal wall, which may cause outflow obstruction to the left ventricular
outflow tract. Restrictive cardiomyopathy may occur idopathically or as a cardiac
manifestation of systemic diseases, such as scleroderma, amylodosis, sarcoidosis,
lymphoma, and hemochromatosis, or a number of inherited storage diseases.
Discuss the effect of HTN on the kidney - ANSWER: In the kidney vasoconstriction
and resultant decreased renal perfusion cause tubular ischemia and preglomerular
arteriopathy.
QUESTIONS AND CORRECT ANSWERS
Explain the pathophysiology associate with Type 1 and Type 2 DM - ANSWER: Is the
result of an autoimmune mediated specific loss of beta cells in the pancreatic islet.
One of the basic patho of type 2 DM is the development of insulin resistant tissue
cells.
Explain what occurs in panhypopituitarism. - ANSWER: Panhypopituitarism is the
term correctly associated with the lack of all anterior pituitary hormones.
List the clinical manifestations of hypothyroidism. - ANSWER: The individual develops
a low basal metabolic rate, cold intolerance, lethargy, tiredness, and slightly lower
basal body temperature.
Differentiate diabetes insipidus, diabetes mellitus and SIADH. - ANSWER: DM: is not
a single disease but a group of clinical heterogeneous disorders that have glucose
intolerance in common.
DI: is an insufficiency of ADH, leading to polyuria and polydipsia.
SIADH: is characterized by high levels of ADH in the absence of normal physiologic
stimuli for its release.
The symptom common to all these conditions is thirst.
What causes the microvascular complications of DM. - ANSWER: Microvascular
complications are a result of capillary basement membranes thickening and
endothelial cell hyperplasia.
What is the cause of diabetes insipidus. - ANSWER: Inability of the kidney to increase
permeability of water. This causes excretions of large volumes of dilute urine,
leading to increase in plasma osmolality.
Describe the pathophysiological changes associated with Addison's Disease. -
ANSWER: Addison disease is a result of hyposecretion of adrenal cortex hormones.
Describe the pathophysiological changes associated with hypoparathyroidism. -
ANSWER: The most common cause of hyperparathyroidism is damage caused during
thyroid surgery. In hypothyroidism a lack of circulating PTH causes a depressed
serum calcium level resulting in the symptomatology mentioned in the stem.
What are the causes and pathophysiological changes associate with ketoacidosis? -
ANSWER: In a state of relative insulin deficiency there is an increase in insulin
counter regulating hormones including catecholamine's, cortisol, glucagon, and GH.
Catecholamine's, cortisol, glucagon and GH antagonize insulin by increasing glucose
,production. In addition, these hormones decrease use of glucose. Profound insulin
deficiency results in decrease glucose uptake, increase fat mobilization with release
if fatty acids, and accelerated gluconeogenesis and ketogenesis. Ordinarily, ketones
are used by tissues as an energy source to regenerate bicarbonate. Hyperkalemia is a
result of a compensatory mechanism directed at eliminating metabolic acidosis.
What is acromegaly? - ANSWER: Acromegaly is a term for adults who have been
exposed to continuously high levels of GH, whereas the term gigantism is reserved
for children and adolescents.
Differentiate hypothyroidism and Graves' disease - ANSWER: One of the cause's
hypothyroidism is a deficiency of endemic iodine. Hypothyroidism are the lower
levels of thyroid hormone, without the negative feedback of TH in the pituitary,
there is an increase secretion of TSH that may lead to goiter. As a result in decreased
energy metabolism resulting in constipation, regulatory mechanisms are overridden
by abnormal immunologic mechanisms that result in the stimulation of excessive TH.
The systemic symptoms of thyrotoxic crisis include hyperthermia and tachycardia;
the remaining options are not associated with this disorder.
Describe the pathophysiology related to chronic DM - ANSWER: A number of serious
complications are associated with any type of DM and include microvascular
(retinopathy, nephropathy, and neuropathy) and macrovascular (CAD, CVA, PVD)
disease and infection.
What happens during hypoglycemia? - ANSWER: A person with type 1 DM
experiences hunger, lightheadedness, tachycardia, pallor, HA and confusion. The
most likely cause of these symptoms is hypoglycemia, which is often caused by a lack
of systemic glucose resulting from muscular activity.
What is the metabolic syndrome? - ANSWER: It also has been called the insulin
resistance syndrome or syndrome X. It is a clustering of clinical traits occurring
together that increase the risk for accelerated cardiovascular disease and type 2 DM.
Combination of medical disorders that increase the risk of developing cardiovascular
disease and DM.
Describe how DM causes peripheral neuropathy - ANSWER: It is a form of "dying
back" neuropathy, in which the distal portions of the neurons are initially and
eventually more severely affected. The earliest morphologist change in both the
peripheral nerves and CNS is axonal degeneration that preferentially involves
sensory nerve fibers, particularly the smaller polymodal unmyelinated peripheral C
fibers and the larger myelinated A delta fibers.
Trace the electrical activity of the heart. - ANSWER: Normally electrical impulses
arise in the SA nose, which is often called the pacemaker of the heart.
The SA node is located at the junction of the right atrium and superior vena cava,
just above the tricuspid valve.
,Numerous automatic nerve endings are
within the node.
The SA node is heavily innervated by both sympathetic and parasympathetic nerve
fibers.
The SA node P cells, so-called because they are pale and primitive appearance, are
assumed to be the site of impulse formation.
The action potential is transmitted from the atrial to the ventricular myocardium
through fibers of the conduction system, traveling first to the AV node then the
bundle of his and finally through the bundle branches of the interventricular septum
to Purkinje fibers of the heart wall.
Identify the location of the neurotransmitters in the heart. - ANSWER: Sympathetic
neural stimulation of the myocardium and coronary vessels depends on the presence
of adrenergic receptors, which bind specifically with neurotransmitters of the
sympathetic nervous system.
Define adrenergic receptors. - ANSWER: Sympathetic neural stimulation of the
myocardium and coronary vessels depends on the presence of adrenergic receptors,
which bind specifically with neurotransmitters of the sympathetic nervous system.
Discuss left-ventricular end diastolic pressure. - ANSWER: This is a concept expressed
in Frank Starling law, cardiac muscle, like other muscle, increases its strength of
contraction when it's stretched.
Define Frank-Starling law - ANSWER: As stated in Frank-Starling law, the volume of
blood in the heart at the end of diastole (the length of its muscle fibers) is directly
related to the force (strength) of contraction during the next systole.
Discuss the effect of angiotensin II on the heart. - ANSWER: Angiotensin II is a
powerful vasoconstrictor and stimulates the secretion of aldosterone from the
adrenal gland. Angiotensin II is also growth promoter in cardiovascular tissues,
resulting in monocyte and vascular hypertrophy and progression of hypertension.
Neural effects of angiotensin II include stimulation of thirst, release of ADH, and
increases in sympathetic nervous system output. Angiotensin II also causes structural
changes in blood vessels (remodeling) that contribute to permanent increases in
peripheral resistance and make vessels more vulnerable to endothelial dysfunction
and platelet aggregation.
Define pulsus paradoxus. - ANSWER: Pulsus paradoxus means that the arterial blood
pressure during expiration exceeds arterial pressure during inspiration by more than
10 mmHg. This clinical finding reflects impairment of diastolic filling of the left
ventricle plus reduction of blood volume within all 4 cardiac chambers.
, List the indicators for an acute myocardial infarction (AMI). - ANSWER: When
coronary blood flow is interrupted for an extended period, myocyte necrosis occurs,
these results in an MI. In the majority of cases of MI, the decrease in coronary flow is
the result of atherosclerotic CAD, other causes include coronary spasm and coronary
artery embolism. The first s/s of acute MI is usually sudden, severe CP. It's not
possible to distinguish between angina and MI by s/s alone, although pain associated
with MI tends to be more severe and prolonged. It may be described as heavy and
crushing, such as a "truck sitting on my chest," radiation to the neck, jaw, back,
shoulder or left arm is common. Some individuals (especially older adults or those
with DM) experience no pain, thereby having a "silent" infarction. Infarction often
stimulates a sensation of unrelenting indigestion. Nausea and vomiting may occur
because of reflex stimulation of vomiting centers by pain fibers. Vasovagal reflexes
from the area of the infracted myocardium also may affect the GI tract.
Catecholamine release results in sympathetic stimulation, producing diaphoresis and
peripheral vasoconstriction that cause the skin to become cool and clammy.
List the clinic indicator for a coronary thrombus. - ANSWER: These individuals usually
have marked elevations in the ST segments on ECH and are categorized as having a
STEMI.
Define pericarditis - ANSWER: It's an acute inflammation of pericardium. Most
individuals with acute pericarditis describe several days of fever, myalgias, and
malaise followed by the sudden onset of severe CP that worsens with respiratory
movements and with lying down. Although the pain may radiate to the back, it's
generally felt in the anterior chest and may be confused initially with the pain of
acute MI. Individuals with acute pericarditis also may report dysphagia, restlessness,
irritability, anxiety, and weakness. It is also the most common cardiovascular
complication of HIV infection.
List the causes and types of cardiomyopathy - ANSWER: Cardiomyopathies are a
diverse group of disease that primarily affects the myocardium. Most are the result
of underlying cardiovascular disorders, such as ischemic heart disease and HTN.
Cardiomyopathies also can be secondary to infectious disease, exposure to toxins,
systemic connective tissue disease, infiltrative and proliferative disorders, or
nutritional deficiencies. Dilated cardiomyopathy causes decreased ejection fraction,
increased end diastolic and residual volumes, decreased ventricular stroke volume,
and biventricular failure. Dilated cardiomyopathy (congestive cardiomyopathy) is
characterized by ventricular dilation and grossly impaired systolic function, leading
to dilated heart failure. Hypertrophic caridomyopathy is characterized by thickening
of the septal wall, which may cause outflow obstruction to the left ventricular
outflow tract. Restrictive cardiomyopathy may occur idopathically or as a cardiac
manifestation of systemic diseases, such as scleroderma, amylodosis, sarcoidosis,
lymphoma, and hemochromatosis, or a number of inherited storage diseases.
Discuss the effect of HTN on the kidney - ANSWER: In the kidney vasoconstriction
and resultant decreased renal perfusion cause tubular ischemia and preglomerular
arteriopathy.
