MSN 570 Advanced Pathophysiology Final Exam Questions and Answers

Nephrotic syndrome - characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay; Associated with glomerulonephritis and with an immune response that is noninflammatory. Glomerular Injury: Diffuse and Focal - Lesions that involve all or most ( 50%) of the glomeruli (plural) are termed diffuse, and lesions that involve some ( 50%) of the glomeruli are termed focal (e.g., focal segmental glomerulonephritis). Glomerular injury: Global and Segmental - When a whole glomerulus (singular) is affected, the lesion is termed global, and the lesion is considered segmental if only a portion ( 50%) of the glomerulus is affected. Glomerulonephritis - An inflammatory disorder of the glomeruli, and most forms occur as a result of activation of immune mechanisms. Nephritic syndrome - Associated with glomerulonephritis and an immune response that is inflammatory. A key feature is the passage of leukocytes, red blood cells, and plasma proteins which occur as a result of inflammation. 1.) LIMITED proteinuria 2.) Oliguria and Azotemia 3.) Salt retention -- periorbital edema and hypertension(salt/fluid retention) 4.) RBC casts and dysmorphic RBCs in urine-- Immune Complex deposition activated Complement; C5a attracts neutrophils which mediate the damage Proliferative structural (histologic) descriptor - refers to an increase in glomerular cells (e.g., mesangial, endothelial, basement membrane). In the extra capillary space, this forms specific lesions that are termed crescents, which are made of macrophages, fibroblasts, and other cells. These crescent cells accumulate in the Bowman space and represent a rupture of the capsule. sclerosing structural (histologic) descriptor - refers to glomerular scar formation, and when the scarring is between the glomerulus and tubules, it is referred to as interstitial fibrosis. necrotizing structural (histologic) descriptor - refers to cellular death. Benign prostatic hyperplasia (BPH) Also called benign prostatic hypertrophy - A common, nonmalignant enlargement of the prostate gland that occurs as men age, usually appearing by age 50. Bladder cancer - cancerous tumor that arises from the cells lining the bladder; major sign is hematuria Diagnostic procedures for hydronephrosis - History physical examination urinalysis renal ultrasound CT intravenous pyelogram MRI. Hydronephrosis - An abnormal dilation of the renal pelvis and the calyces of one or both kidneys that occurs secondary to a disease. Polycystic kidney disease (PKD) - inherited disease in which sacs of fluid called cysts develop in the kidneys Renal cell carcinoma - cancerous tumor that arises from kidney tubule cells; most frequently occurring kidney cancer in adults (most common in those 50-70 years of age). Renal cell carcinoma signs and symptoms - Hematuria An abdominal renal mass that is firm Abdominal flank pain described as dull and achy Unexplained weight loss Other symptoms may include scrotal varicoceles. If the inferior vena cava is affected, then manifestations can include edema, ascites, and hepatic problems. Signs and symptoms of bladder cancer - Painless hematuria that is gross (i.e., visible) or microscopic. The hematuria is intermittent and occurs throughout all of micturition as opposed to just the beginning. Irritative symptoms such as frequency, urgency, and dysuria may be present and occur due to detrusor overactivity, obstruction, or decrease in bladder capacity. Flank or abdominal pain (e.g., suprapubic) are usually signs of more advanced cancer. Other general symptoms such as fatigue, weight loss, or anorexia are also manifestations of more advanced disease. Physical examination findings may reveal the presence of a pelvic or abdominal mass (if advanced) and prostate induration. Treatment for hydronephrosis - treat underlying cause and facilitating urine flow will be necessary if UTIs develop. Wilms tumor, or nephroblastoma - a rare cancer of the kidney that occurs in children from residual embryonic or fetal tissue IgE - Immunoglobulin E. Antibody attached to mast cells and basophils. Responds to parasites and triggers allergic/inflammatory reactions to release histamine and heparin. IgM - First immunoglobulin formed in response to antigen. Fights blood infections and triggers additional production of IgG. Present in lymphocyte cells and the first antibody made by a developing fetus. IgA - Found in membranes of the respiratory and gastrointestinal tract, tears, saliva, mucus, and colostrum. Important in local immunity. IgD - Present in blood serum in small amounts and on B-cell surfaces. Receptor for antigens and helps anchor cell membranes. IgG - Second response after IgM. Main defense against bacteria and can cross the placenta to protect the fetus against infections, giving it passive immunity. Eventually replaces IgM. ICF - IntraCellular Fluid is rich in potassium, magnesium, phosphates, and proteins. Hyperkalemia - excessive potassium in the blood; manifestations include: Neuromuscular: Paresthesias Muscle cramps Weakness/fatigue Hyperreflexia Flaccid paralysis (later) Anxiety Cardiovascular: Electrocardiogram (EKG) changes and dysrhythmias (delayed conduction—bradyarrhythmias/asystole) Respiratory: Respiratory depression/arrest—diaphragm weakness Gastrointestinal Nausea/vomiting Diarrhea Cramping Hypokalemia - deficient potassium in the blood; manifestations include: Neuromuscular: Paresthesias, Muscle cramps, Weakness/fatigue, Hyporeflexia, Flaccid paralysis, Confusion/depression Cardiovascular: Hypotension, Weak, irregular pulse EKG changes and dysrhythmias (Ventricular fibrillation), Cardiac arrest Gastrointestinal: Nausea/vomiting, Constipation, Distention and ileus colloid osmotic pressure (oncotic pressure) - an inward pulling force caused by blood proteins (mainly albumin) that helps move fluid from the interstitial area back into capillaries ECF - extracellular fluid, rich in sodium, chloride, and bicarbonate. The intravascular space is composed of plasma. Electrolytes - Help maintain the body's fluid balance. Minerals with electrical charges found in the blood, urine, and other body fluids. They include sodium, chloride, potassium, calcium, magnesium, and phosphorus. Hydrostatic pressure - created by water, pushes water away Hypercalcemia - Excessive calcium in the blood. Symptoms: 50% asymptomatic - renal (polyuria, thirst, stones, nephrocalcinosis/deposition of calcium crystals in kidney, may lead to renal failure), musculoskeletal (muscle weakness, rarely demineralization and subperiosteal bone resorption with bone cysts - osteitis fibrosa cystica), neurological (psychiatric/neurological symptoms - anxiety/depression/confusion/drowsiness), gastrointestinal (anorexia, constipation and ulcers hypercalcemia causes - Hyperparathyroidism Malignant bone disease Prolonged immobilization Excess calcium supplementation Hypernatremia - High serum sodium levels (greater than 145 mEq/L). The excessive sodium levels generally lead to high serum osmolality (greater than 295 mOsm/kg) because of the imbalance between sodium and water. Symptoms: Increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. Give hypotonic solution. Hypocalcemia - deficient calcium in the blood; symptoms include hypertension, peripheral/perioral paresthesia, abdominal pain, cramps, lethargy, irritability in infants. Lipoedema - type of edema caused by excess deposition of fat cells in an irregular and disproportional manner and not fluid shifts. The fat deposition is usually in the legs, thighs, and buttocks but can go to the arms. The legs will look like block columns. Lipoedema occurs mostly in women and rarely in men. It can occur with or without obesity. Eventually, lipoedema can cause venous and lymphatic problems. Lymphedema - type of edema that occurs when there is a blockage in lymphatic channels (e.g., tumor) or removal of lymph nodes (e.g., breast cancer).; swelling of the tissues due to an abnormal accumulation of lymph fluid within the tissues Myxedema - A type of edema not related to fluid shifts;refers to a thick nonpitting edema caused by deposits of mucopolysaccharides in the skin; caused by extreme deficiency of thyroid secretion; also known as adult hypothyroidism Normal Serum Values of the Major Electrolytes - Electrolyte Normal range Sodium (Na+) 135-145 mEq/L Chloride (Cl−) 98-108 mEq/L Potassium (K+) 3.5-5 mEq/L Calcium (Ca++) 8.8-10.3 mg/dL Phosphorus (P) 2.5-4.5 mg/dL Magnesium (Mg++) 1.8-2.4 mEq/L Bicarbonate (HCO3−) 24-31 mEq/L Tonicity - The ability of a solution surrounding a cell to cause that cell to gain or lose water. "The effect of the osmotic pressure or tension on the cell. It is determined by the osmotic pressure of two solutions (i.e., solvent and solute) separated by a semipermeable membrane and the concentration relative to one and other on each side of the membrane (i.e., intracellular and extracellular)." Anemia of Chronic Disease/Inflammation (ACD) - The second most common anemia, after iron deficiency anemia. The anemia is caused by many different chronic diseases or inflammation (e.g., cancer, chronic kidney disease, congestive heart failure, and infections). Aplastic Anemia - A rare but serious type of anemia that is a result of the bone marrow failing to produce multipotent hematopoietic stem cell precursors. This leads to a lack of erythrocytes, leukocytes, and platelets, which is referred to as pancytopenia. B12 - Requisite for RBC production. Low levels: deficiency. High levels: liver disease; myeloproliferative disorders.