Patho Final Exam

etiology: alcohol overuse, poor nutrition

sequela: macrocytic anemia

s&s: paresthesia, glossitis

etiology: alcohol overuse

known as: Wernicke-Korsakoff syndrome, a type of beriberi

s&s: problem with memory, ataxia, nystagmus, paresthesia

lab values: hypocalcemia, hyperkalemia

s&s: muscle spasms, twitching, tetany, positive Chvostek’s sign, tachycardia

lab values: hypercalcemia, hypokalemia

s&s: sluggishness, weakness, mental slowness/confusion, bradycardia

280-295

diarrhea, vomiting, decrease fluid intake

psychogenic water-overdrinking, too much IV fluid, kidney failure & SIADH that cause retention and low urine output

malaise, aches, pain, fever, leukocytosis (neutrophilia), elevated CRP, presence of APR

1. proper clotting

2. stomach lining

3. renal function

4. appropriate vasomotor tone

5. proper immunocyte function

1. altered mental status

2. fever > 100.4

3. increased HR

4. increased RR

5. abnormal WBC count

1. defects in phagocytic function (leukopenia of post-chemotherapy patients)

2. impaired phagocytic function (toxic level of glucose seen in patients with DM affects the immunocyte function)

1. easy bleeding

2. stomach ulcers

3. kidney problems

4. vasoconstriction

5. infection risk

dermatitis, nasal allergic rhinitis, conjunctivitis

itching, urticaria, NVD, wheezing, angioedema, HoTN

antihistamines, steroids, leukotriene inhibitors

patho: autoantibody attacks antigen → immune complex formed → deposited in blood vessel lining of tissues → vasculitis → widespread inflammation

example: lupus

sequela: elevated CRP

clogged blood vessels

1. kidney failure

2. ischemia of distal tissues

3. rash

4. fever

5. HoTN

1. harmless flora: thrush, pneumocystis jiroveci, cytomegalovirus, Kaposi’s sarcoma

2. strange organisms: fungus, helminth

patient has

1. MRSA

2. diarrhea

3. stool incontinence

4. draining wounds

5. sores

1. hand washing

2. gown

3. gloves

1. hand hygiene

2. use of PPE

3. disinfection of surfaces and equipment between each patient use

1. beta-lactamase: enzyme that renders penicillin abx useless. examples: MRSA, resistant strep pneumonia

2. mutation to the pathogen’s cell membrane: vancomycin resistant enterococcus

1. overtreated/overuse of abx

2. inappropriate abx tx (not taking as prescribed/use abx for viral infection)

lab values: low RBCs, low MCV, low Hgb

example: iron deficiency

etiologies: heavy menses, GI bleeding

Tx: iron supplements

lab values: low RBCs, high MCV

etiology: disease causes faulty DNA coding of RBC size → RBC is larger than normal (aging, chronic GI problems, alcohol abuse → decreased intrinsic factors → decreased vit B12 → DNA malfunction)

example: pernicious anemia

s&s: fatigue, paresthesia, glossitis, coordination problems

tx: injection of b12

lab values: low RBCs, normal MCV

causes: low erythropoiesis, rapid blood loss

Tx: erythropoietin injection

etiologies: thrombocytopenia OR clotting factor deficit

s&s: under skin (petechiae, purpura, ecchymosis), occult bleeding, frank bleeding

etiology: thrombocytosis

sequelae: increased risk for venous or arterial thrombosis & emboli

→ hypersplenism → sequestration → pancytopenia

atherosclerosis, overdrive of SNS, overdrive of RAAS

neurologic: stroke, retinal changes from damage arterioles in retina

renal system: hematuria, proteinuria, renal failure

circulatory system: increased heart workload, MI, HF, PAD, ventricular hypertrophy

ACE inhibitors, diuretics, beta-blockers, Na reduction, dietary/lifestyle modifications, smoking cessation, decrease LDL, increase HDL, exercise

1. pain (intermittent claudication)

2. pale

3. poikilothermia

4. prolonged cap refill, diminished pulses

5. paresthesia

6. no hair

7. skin ulcers

1. venous stasis

2. injury to endothelium of vein

   1. hypercoagulability

s&s of thrombophlebitis: pain, erythema, warmth

SOB, chest pain, hemoptysis

encourage mobility and hydration, put up feet, watch for skin stasis ulcers, anticoagulants

diminished CO, arterial thrombi (stroke), venous thrombi (PE)

chest tightness, heaviness, pain, left arm pain radiates to jaw

characteristic: chest pain reduced with rest/NTG

Tx: NTG

compensatory mechanism: collateral circulation

characteristics: plaque rupture which partially occludes the coronary artery, chest pain occurs at rest

s&s: chest pain, diaphoresis, NV

characteristics: plaque rupture which totally occludes the coronary artery, chest pain occurs at rest

s&s: chest pain, diaphoresis, NV

Dx: positive troponin

1. oxygen

2. NTG

3. other vasodilators

4. anti-hypertensive

5. antiplatelet/anti-inflammatory: aspirin

1. pulmonary congestion (lung crackles, dyspnea, orthopnea, PND)

2. poor perfusion

1. peripheral congestion (jugular vein distension, hepatic vein congestion, ascites, peripheral edema)

2. poor perfusion

1. prolonged cap refill

2. pale

3. poikilothermia

4. fatigue

5. weakness

6. mental status change

7. HoTN

8. low urine output

Dx: BNP level (when ventricles are distended, this protein is produced)

Tx: vasodilators, diuretics, positive inotrope

1. elderly patients

2. debilitated

3. unconscious

pt with high risks will have suppressed gag/cough/swallow reflex, can result in aspiration of food/fluid

microorganism inhaled → inflammatory reaction → debris collected in parts of lungs → block bronchioles and/or bronchi → atelectasis (collapse of small portions of lungs) → consolidation (stiffened lungs)

hypoxemia, crackles upon auscultation/area of diminished sound, cough, dyspnea, fever, abnormal chest xray

SOB, chest pain, hemoptysis, HoTN

embolus lodges in smaller pulmonary arterioles → blood does not get to alveoli → can cause infarct of parts of lung tissue + general hypoxemia

elastic recoil of lungs is poor → hard exhalation & often patients must use accessory muscles when exhaling

bronchodilators, steroids, smoking cessation, peak flow assessment

use of accessory muscle in exhalation, hypoxemia because of decreased gas exchange across narrowed bronchi

genetic predisposition to have hyper-responsive airways to environmental allergens → inflammation → edema of bronchial lining + bronchial constriction & spasms → narrowed airways

wheezing upon exhalation, mild R alkalosis, mild hyperventilation

cannot hyperventilate → CO2 retention → hypercapnia → R acidosis

genetic predisposition to have hyper-responsive airways to environmental allergens

irritants in cigarette smoke

irritants in cigarette smoke → inability to expel them due to altered cilia → chronically inflamed airways + elastase (a type of proteolytic enzyme) breaks down the proteins that make lungs elastic → destruction of the alveolocapillary membrane → large, stiff, hyperinflated alveoli with no elastic recoil → air is trapped & becomes harder to exhale it

pink puffers: thin, barrel chest, tripod position, retractions, pursed lip breathing, mild R alkalosis

irritants in cigarette smoke

irritants in cigarette smoke trigger chronic inflammation → can’t expel CO2 → NO hyperventilating

cyanotic, no hyperventilating, overweight, finger clubbing, hypoxemia

cor pulmonale: right ventricle is unable to get blood into the stiff, full-of-mucus areas

main serious sequela of any urinary obstructive disorder

at risk: men > 50

biggest problem: urethra is compressed

s&s: urgency, weak flow, slow to start flow, urinary retention

cystitis and pyelonephritis

women, due to short urethra & proximity of urethral meatus to anus & vaginal os

dysuria, frequency, pyuria, hematuria, costovertebral angle pain, fever

uterine prolapse

acute oliguria, acute jump in SCr

renal artery blockage, decreased CO from a volume deficit (bleeding, dehydration, HF, sepsis)

obstruction causes backup of urine into kidney (hydronephrosis)

acute tubular necrosis

nephrotoxic drugs, hydronephrosis, toxic microbes, toxins, poisons

cast seen in urine

prerenal/postrenal AKI → intrarenal AKI → chronic kidney dz

AKI that is not fixed, post-strep glomerulonephritis

oliguria/anuria with low specific gravity, azotemia, uremia, hyperkalemia, hyperphosphatemia, hypocalcemia, M acidosis

urea nitrogen is a breakdown product of protein, and the kidneys cannot get rid of it. however, only high BUN can’t conclude if the patient is having renal problem.

24-hr urine creatinine clearance to estimate the GFR

uremic encephalopathy, puritis, fatigue, less production of erythropoietin, NV

inability to activate vitamin D → can’t absorb Ca in gut

dialysis, restrict K/Na/H2O, antacids to bind to phosphate and neutralize the acidity, Ca and vit D supplements, erythropoietin, antihypertensive meds, non-K diuretics, reduce dietary protein

intracranial bleeding: head injury, burst aneurysm, HTN, coagulation disorders, intense headache, neck pain, light intolerance, NV

cause: blockage of a cerebral artery which then causes brain cell ischemia

not a true stroke. last from 10 minutes to 24 hours

all s&s are asymmetric & contralateral: paresis below neck & shoulders, facial drooping, homonymous hemianopia (visual deficit in the same side of both eyes), diminished peripheral & central reflexes

aphasia, inability to do math

decrease in spatial understanding, insight into condition, left-sided neglect

symmetrical: vertigo, nystagmus, loss of balance

respiratory problem (Cheyne-Stokes, apnea), CV problems (vital sign abnormalities, decreased HR), cranial nerve problems, loss of central reflexes, decerebrate/decorticate posturing, papilledema, fixed & dilated/constricted pupils bilaterally

clot-busting drugs, anticoagulants (heparin)

surgery to fix rooting problems

increased head of bed, give oxygen, BP management, diuresis

photophobia, headache, irritability, restlessness, confusion, nuchal rigidity, positive Brudzinski’s and Kernig’s signs

worst type of mengitis