Patho Study Guide

Lesson 1: Homeostasis
● Pressure that is due to albumin in the bloodstream?
- Oncotic - a form of osmotic pressure exerted by proteins. In the blood,
albumin is the most common plasma protein and is, therefore, a
primary determinant of oncotic pressure.
- Albumin controls osmotic pressure in vascular system, builds volume
- One question was about the difference in children and adult immunity, I believe the
answer was naive T cells.
- Fluid and electrolyte levels are regulated by osmoreceptors, which regulates actions
such as thirst, ADH, the kidneys, and RAAS.
- Fluid Deficit/Dehydration
● Causes:
- Excessive loss
- Inadequate intake
- Or the combination of both
● Risk Factors:
- Vomiting
- Diarrhea
- Excessive sweating
- Insufficient water intake
● Manifestations:
- Dry mucous membranes
- Decreased skin turgor (“tenting”)
- Decreased urine output
- Low blood pressure
- Tachycardia and weak heart rate
- Confusion (brain cells are dehydrated)
-

Quiz
1. A patient with a viral illness and severe vomiting has an elevated CO 2 level and a blood
pH of 7.53. She is breathing slowly. What condition does the patient have?
- Metabolic alkalosis
- The patient's pH and CO2 level are both elevating (moving in the same direction).
This indicates metabolic alkalosis. The CO2 level is high because her respiratory
system is attempting to compensate for the high pH by exhaling less and retaining
more CO2
- If pH and PCO2 are moving in opposite directions, then it is the pCO2 levels that are
causing the imbalance and it is respiratory in nature.
- If PCO2 is normal or is moving in the same direction as the pH, then the imbalance is
metabolic in nature.
● ROME-
● Respiratory opposite, metabolic equal
- Buffers, renal compensation, and respiratory compensation help to maintain a blood
pH of 7.35–7.45.
- To prevent such changes in pH, the body employs buffer systems. The body utilizes
three buffer systems: proteins, phosphates, and the carbonic acid–bicarbonate
system. Although all of these systems are important, the majority of this chapter
focuses on the carbonic acid–bicarbonate buffer system.
- First line of defense is respirations. Second line of defense is kidney's

- The equation moves in both directions.

● When CO2 levels are elevated, the equation moves toward the right,
forming more H+ and HCO3− ions.
● When H+ ion levels are elevated, the equation moves toward the left, as
H+ ions are converted to CO2 and the CO2 is exhaled.
● The carbonic acid–bicarbonate buffering system plays a significant role in the
body, as two organs, the lungs and kidneys, use this buffering system to
compensate for alterations in physiologic pH.
● Because of this system, arterial blood gases (ABGs) values include arterial
carbon dioxide and bicarbonate levels, along with other factors

- Know normal levels of CO2, pH, and HCO3

- .Michael's pulmonary edema leads to respiratory acidosis. How does pH impact
Michael's basal metabolic panel? Choose 3 answers.
● His CO2 level is increased because his lungs have difficulty removing it from
the bloodstream.
● His K+ is elevated because, as H+ moves inside of cells in an attempt to get
it out of the bloodstream, K+ moves from cells into the bloodstream.
● His Na+ is decreased due to hypervolemia.
● His Ca+ is decreased because the elevated concentration of H+ makes it
easier for Ca+ to bind to albumin.
● Michael's lung function is impaired because his lungs have accumulated fluid
as the result of his heart failure.
[Link]
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- I don’t remember the specific question but one was about hypoventilation and
another was hyperventilation.

-
- What is excreted in response to fluid volume overload
●
● Natriuretic peptides are hormonal signals released by the brain and heart in response
to excess fluid in the body. These signals increase urine output and reduce fluid
volume.
- A hormone panel was done on a patient with congestive heart failure and fluid
volume overload. Which elevated hormone on the patient’s chart is indicative of the
body’s attempt to reduce the fluid overload?
● Brain natriuretic peptide (BNP) – its released when fluid volume excess is present

- Compare and contrast hemodialysis and peritoneal dialysis. What are some reasons
for a patient choosing one over the other?
● Hemodialysis uses a machine to pump blood from the body in one tube
while dialysate (made of water, electrolytes and salts) is pumped in the
separate tube in the opposite direction. Waste from the blood diffuses through
the semipermeable membrane separating the blood from the
[Link] provides medical care, but 3 times a week for several
hours sitting at a hospital or clinic. Individuals with acute kidney failure are
recommended to use this.
● Peritoneal Dialysis does not use a machine, but instead injects a solution of
water and glucose into the abdominal cavity. The peritoneum acts as the
membrane instead of dialysis tubing. The waste products diffuse into the
abdominal cavity and the waste solution is then drained from the body.
Peritoneal dialysis offers continuous filtration and is less disruption to the
patient’s daily routines. However, it does require some training of the patient
and is not recommended for individuals who are overweight or have severe
kidney failure.
● Hemodialysis takes blood out of the body via a PIV, and puts blood back into
body through a central line.

Lesson 2: Cellular Response

Notes
- There were several questions about signs and symptoms of different electroltye
imbalances.
- Sodium 135-145mEq/L
● Hyponatremia: <135
- Causes:
● Sodium deficit
● Excess water
- Risk Factors:
● Excessive sweating (sweating out the salt, water stays)
● Vomiting, diarrhea
● Excessive water intake
- Manifestations 🡪 goes with the brain/muscles
● Muscle cramps, weakness, fatigue
● Abdominal cramps
● Lethargy, confusion, seizures
● Hypernatremia: >145
 - Causes:
● Loss of water (concentrating sodium in the extracellular fluid)
● Excessive intake of sodium (overcompensating with sports
drink, etc.)
- Risk Factors:
● Excessive sweating (sweating out the water, salt stays)
● Vomiting, diarrhea
● Decreased water intake
- Manifestations: Signs of fluid deficit
● Thirst
● Headache, agitation
- Potassium 3.5-5mEq/L
● Essential for:
- Nerve impulses
- Muscle contractions (heart)
● Hypokalemia: <3.5
- Causes:
● Diuretics (make you urinate, K+ is mainly excreted through
urine)
● Inadequate K+ intake
● Excessive diarrhea
- Manifestations:
● Muscle fatigue/cramps
● Nausea, vomiting, constipation
● Cardiac dysrhythmias
● Paresthesias (numbness and tingling)
● Hyperkalemia: >5.0
- Causes:
● Renal failures (unable to get rid of K+ efficiently)
● K+ sparing diuretics (make you hang onto K+)
● Burns/crush injuries (is cell is crushes, potassium is released)
- Manifestations:
● Muscle weakness/paralysis
● Paresthesias (numbness and tingling)
● Cardiac dysrhythmias
● How can hyperkalemia lead to cardiac arrest?
- A major function of potassium is to conduct nerve impulses in muscles.
Too low and muscle weakness occurs and too much can cause muscle
spasms. This is especially dangerous in the heart muscle and an
irregular heartbeat can cause a heart attack.

- Calcium 8.5-10.5mEq/L
● Essential for:
- Muscle contractions
- Strength of teeth and bones
- Stability of nerve membranes
● Sources of Calcium: milk and milk products
● Excreted: urine (primarily), feces
● Hypocalcemia: <8.5
- Causes:
● Hypoparathyroidism (if you don’t secrete enough PTH, you
cannot put enough calcium in the blood, causing Hypocalcemia)
● Malabsorption issues
● Vitamin D deficiency
- Manifestations: overexcitability of the muscles
 ●Muscle twitching
●Tetany
●Paresthesias
●Chvostek and Trousseau Sign (twitching on cheek when
touched)
● Cardiac dysrhythmias
● Hypercalcemia: >10.5
- Causes:
● hyperparathyroidism (PTH puts Ca+ into the blood, if done too
much, it will cause hypercalcemia)
● bone cancer (rapid breakdown of bones, where Ca+ is stored)
● immobility (bones grow weaker and lose Ca+)
- Manifestation:
● Muscle weakness
● Loss of muscle tone
● Spontaneous fractures
● Kidney stones
● Cardiac dysrhythmias
- Magnesium 1.6-2.5mg/dL
● Hypomagnesemia: <1.6
- Causes: common in alcoholics
● Malnutrition issues
● Malabsorption issues
● Diuretics (Mg is mainly excreted through urine)
- Manifestations:
● Tremors
● Hyperreflexia
● Insomnia
● Hypermagnesemia: >2.5
- Causes:
● Renal failure (due to decreased urine output)
● Increased Mg intake (i.e. to try to stop premature labor-
depresses muscles/contractions)
- Manifestations:
● Hyporeflexia
● Lethargy
● Respiratory depression

- Tay-Sachs Disease
● Autosomal recessive inherited disorder, results from mutation on
chromosome 15
● It is a lysosomal storage disease.
● Infants born appear normal until approx. 6 mo., usually death by 3 yrs.
● Affects CNS, accumulation of ganglioside causes progressive destruction of
neurons and brain cells.
● Seizures, blindness, and progressive flaccid muscles, and “Cherry Red Spot”
seen on retina usually become manifest a few months after birth, followed by
death within a few years.
- Marfan syndrome
● Inherited as an autosomal dominant trait, meaning that only one abnormal
copy of the Marfan gene inherited from one parent is sufficient to have the
condition.
● Cause: Defects or deletions (pathogenic variants) of the fibrillin-1 (FBN1)
gene.
 ● Connective tissue disorder, affects fibrillin formation.
● Aorta and heart valve structures are commonly affected (heart murmur and
pectus exavatum).
● Individuals often have tall stature, long arms/fingers,
● Hypermobility of joints.
● Sudden dyspnea w/pneumothorax
● Sudden chest pain with aortic dissection
- Turner Syndrome
● A chromosomal disorder in females in which either an X chromosome is
missing, making the person XO instead of XX, or part of one X chromosome is
deleted
● Patients with suspected Turner syndrome require genetic testing and
hormone level evaluation. Echocardiogram, bone density, and bone age
testing are necessary.
● Treatment involves estrogen therapy and growth hormone administration. The
patient should be treated symptomatically for all other effects of the disease.
● Characteristics
- Underdeveloped ovaries (sterile)
- Short stature (~ 4'7")
- Amenorrhea
- Infertility
- Webbing of the neck
- Edema
- Underdeveloped breasts; wide nipples
- High number of aborted fetuses

Section 1: Test

2. Respiratory rate increases during exercise. How does this increased respiratory rate allow
the body to maintain a homeostatic pH level?
- The increased exhalation of CO2 helps to increase pH.
- The increased respiratory rate allows more CO2 to be exhaled. Since CO2 reacts with
water to form carbonic acid, getting rid of more CO2 through increased respiration
will raise pH.

3. An ICU patient's arterial blood gas results show low pH and low CO 2 levels. The patient's
respiratory rate is increased. What is the name of this condition?
- Metabolic acidosis
- Since the pH is low, and the pH and CO2 are trending in the same direction, the
condition is metabolic acidosis. The low CO2 indicates that CO2 is not causing the
acidosis. The increased respiratory rate lowers blood CO2 in an attempt to
compensate for the metabolic acidosis.

5. Your patient has pulmonary edema, which raises levels of CO 2 in the blood. What helps
the patient's body to compensate for this increase?
- The kidneys excrete more H+ and conserve HCO3-.
- The increased CO2 level will generate more carbonic acid. The body must
compensate for the decreased pH. Excreting more H+ and conserving HCO3- will both
help to increase pH.

Lesson 3: Muskuloskeletal
- Arthritis is when inflammation of one or more joints are involved.
● Osteoarthritis is the most common type of degenerative joint disease, most
commonly affected are the cervical, lumbosacral spine, hip, knee and first
metatarsal phalangeal joint.
- Heberden and Bouchard’s nodes: Telltale/classic sign of osteoarthritis. Small
bumps that grow on the joints especially the fingers.
● Osteoporosis: usually more prevalent in wrist, vertebrae and upper femur.
- Bone formation occurs throughout life in the remodeling process, and
requires adequate calcium in diet. Insufficient calcium in diet causes
inadequate calcium blood levels that stimulate parathyroid gland activity.
PTH regulates blood calcium by stimulating bone remodeling, triggering
vitamin D synthesis in the kidney, enhancing GI absorption of calcium and
reabsorbing calcium in the kidney.
- AVN, avascular necrosis- deterioration of bone caused by insufficient blood supply, is
commonly associated with fractures of the femoral head and neck, scaphoid, neck
and body, and proximal humerus.
● Associated with pain and weakness, the examiner will find motor weakness,
abnormal gait and lack of rehab progress.
● MRI is used to detect AVN.
● Treatment involves surgical removal of necrotic bone.
●
- Describe the process of articular degeneration. Which cells are involved in this
process and what is their function?
● The thinning and breakdown of the articular cartilage that covers joints and
acts as a lubricant and cushion.
● This articular cartilage is comprised of chondrocytes in a matrix of collagen
and aggrecan. The chondrocytes produce enzymes and other proteins that
slowly break down and reform the matrix, allowing for regeneration. Stress
caused by being overweight or physical trauma can cause chondrocytes to
speed up the matrix breakdown process relative to the reformation process,
leading to a thinning of the articular cartilage.

Lesson 4: Integumentary
 - You receive a patient who has experienced a burn on the right leg. The burn has
small blisters, is markedly pinkish red and has a shiny and moist appearance. When
the patient is asked about pain level, the patient describes it as severe.
What level of burn does this patient present?
● Second degree (partial thickness)
● Second degree: Partial thickness burns can be either superficial partial
thickness or deep partial thickness, depending on the degree of tissue
necrosis of the dermal layer. These burns can char the epidermis and papillary
dermal layer, with resultant edema and formation of epidermal blisters.
Burned skin is wet, raw, and pink or cherry red in color that blanches with
pressure.

- I don’t remember the exact question, but one was about a burn that was painful and
wanted to know what the other symptom was that was not listed, so just know the
symptoms of each burn category that is painful.

2. An adolescent male patient is brought to the emergency department after spending a

long day at the beach. The patient's head, neck, and trunk from the waist upwards and legs
from the knees downward are bright red and edematous. The patient is crying and reports 8
out of 10 on the pain scale and an inability to find a comfortable position. What is the most
likely classification of this burn?
- Superficial
- Superficial burns are reddened and painful.

Lesson 5: Neuro
- There was I believe 4 questions about ischemic and hemorrhagic strokes, so know
those well.
- What are the main differences between ischemic and hemorrhagic CVAs? What are
the similarities?
● Ischemic stroke (thromboembolism) is caused by an embolus that blocks
the cerebral artery and causes brain tissue death.
 - Ischemic stroke is more common, in 85% of all CVA's.
- Treatment utilizes IV thrombolysis, which dissolves the clot that is
blocking arterial blood flow and allows for reperfusion to occur.
Important to be administered within 3-4.5 hrs of sx onset.
- Predisposing factors: AFIB, cerebral arteriosclerosis and carotid
stenosis
- Because HTN accelerates the formation of atherosclerosis, there is an
increased risk of plaque formation in the cerebral arteries, which leads
to thrombotic or embolic obstruction within the brain. This can be
manifested by a TIA or ischemic stroke.
- Antiplatelet agents, heparin, and warfarin can be used to prevent
ischemic stroke.
- The use of oral contraceptives , sickle cell disease, Carotid
arteriosclerosis, is a risk factor, specifically for ischemic stroke.
● Hemorrhagic stroke is caused by cerebral artery rupture from excessive
pressure; blood floods brain tissue, which causes cell death.
- Goal of treatment is to create a blood clot to stop internal bleeding.
- Specific type: when an arterial branch in the subarachnoid space
ruptures, this is called a subarachnoid hemorrhage, this can happen
due to head trauma or an aneurysm rupture.
- Major factor of this type of stroke is HTN
- Neurologic deficit is apparent
- Although hemorrhagic stroke accounts for about 10% of all strokes, the
mortality is very high.
- What are the four different types of intracranial bleeding? How can you distinguish
between them?

- Cerebral Concussion (Mild Traumatic Brain Injury)

● Individuals with mild TBI can develop postconcussive syndrome (PCS),
which includes headaches, lethargy, mental dullness, and other symptoms
that can persist for several months after a TBI.
- Cerebral contusion
● S/S: severe headache, dizziness, vomiting, increased size of one pupil, and
sudden weakness in an arm or leg.
● The person may seem restless, agitated, or irritable. Often, the person has
memory loss.
● These symptoms can last for several hours to several weeks, depending on
the severity of the injury. As the brain tissue swells, the person may feel
increasingly drowsy or confused.
● Vital signs may show decreased heart rate and decreased respirations and
hypertension, which are signs of pressure on the brain stem.
- One question was about someone coming into the ER with a head injury, know the
S+S of concussion and contusion
- Bell's Palsy- I believe the question was about the two main causes, one was viral, I
think the other was autoimmune
- Cerebral edema S+S
● Headache
● Neck pain or stiffness
● Nausea or vomiting
● Dizziness
● Irregular breathing
● Vision loss or changes
● Memory loss
● Inability to walk
● Difficulty speaking
● Stupor
● Seizures
● Loss of consciousness
- Neuro condition causing flat emotions, sleep disturbances:
● Alzheimer's
● Schizophrenia
● Parkinson's disease
- What are the six neurodegenerative diseases we discussed? Choose one of the
diseases and describe the pathophysiology and symptoms of that disease. I would
know the different signs and symptoms of each of these.
● Parkinson's
- Gait changes, a resting tremor, increased muscle tone (muscle
rigidity), and slowed gait and movements (bradykinesia)
● Amyotrophic Lateral Sclerosis (Lou Gehrig’s disease)
- Upper lower motor neurons become sclerotic and die.
- Symptoms: weakness in upper and lower extremities, head drop,
speech changes, dysphagia
- Treatment: Riluzole (Rilutek)
● In a class of medications called benzothiazoles
● .It works by changing the activity of certain natural substances
in the body that affect nerves and muscles.
● Multiple Sclerosis
 -Characterized by episodes of muscle weakness, numbness, blurred
vision, and fatigue.
● Huntington's
- Autosomal dominant inherited disorder.
- Signs and symptoms do not develop until adulthood.
● Movement (spasticity); chorea(lack of control)
● Cognitive function; depression, psychosis, dementia
● Degeneration of neurons

Lesson 5: Quiz

1. A provider is providing care for a patient following a hemorrhagic cerebrovascular

accident (CVA). The patient asks the provider to explain what happened during the CVA.
Which response by the provider is best?
- "A blood vessel in your brain broke open, causing bleeding in your brain and a lack of
blood flow to an area."

Sections 2 and 3: Test

6. An older adult patient presents to the emergency department after dropping a pot of
boiling water onto their feet. The skin on the patient's left foot is white with profound
swelling of the ankle. The patient denies significant pain. What is the most likely
classification of this burn?
- Full thickness
- Full thickness burns may be white and the surrounding area is edematous. Due to the
damage to nerve endings, pain is minimal or absent.

8. A provider is working with a patient who is recovering from a subarachnoid hemorrhage

caused by a cerebral aneurysm. The patient asks the provider to explain what happened.
What is the best response by the provider?
- "An artery in your brain had a weakened area, which ruptured, causing bleeding into
your brain."
- A cerebral aneurysm results when the muscle layer of an artery is weakened and an
outpouching occurs. When the weakened area ruptures, bleeding into the brain
occurs.

9. The provider is caring for a client who reports experiencing episodes of muscle weakness,
accompanied by profound fatigue and blurry vision. Which diagnosis is most consistent with
these signs?
- Multiple sclerosis
 Lesson 6: Cardiovascular
- Hypertension causes traumatic damage to the endothelium of the arteries. Which
organs have arteries that are at particular risk for damage? Brain, heart, eyes, and
kidneys
- Which problem causes a myocardial infarction or heart attack? An occlusion of a
coronary artery (most commonly from a thrombus)

- Hypertension:
● Primary/Essential:
- Idiopathic; common “silent killer”
- BP consistently >130/80
● Secondary Hypertension:
- Results from other disease or disorder
- Renal disease; endocrine disorder; pheochromocytoma
● Malignant/Resistant Hypertension:
- Severe, rapidly progressing; uncontrolled
- Diastolic pressure extremely high
- Many complications
● Essential Hypertension:
- Risk Factors: Ag, Sex, Heredity, Lifestyle
- Manifestation: Asymptomatic, Vague (Fatigue, Malaise, Morning
headache)
- Complications: Sclerosis, narrowing of vessels, Atheroma formation
- Heart Failure
● Causes:
- Myocardial infarction (L ventricle)
- CAD (Coronary Artery Disease)
- HTN (Hypertension)
- Chronic lung disease (R ventricle needs to work harder to push blood
through pulmonary circulation if there is an obstructive lung disease)
- Valve problems (heart has to maintain CO, if it can’t, it is going to
pump harder to compensate)
● Patho:
- Heart is unable to pump sufficient blood to meet metabolic needs of
the body
● Compensatory Mechanisms:
- Renin and aldosterone secretion (vasoconstriction and blood volume is
increased)
- SNS response (increases heart rate/vasoconstriction 🡪epinephrine and
norepinephrine)
- Cardiac hypertrophy (increased size of the heart)
● Complications:
- Cardiogenic shock
- Acute pulmonary edema
- Organ failure
● Diagnostic Test- Heart Failure
- B-Type Natriuretic Peptide (BNP), a hormone produced by the heart
● Normal: <100
- Left Sided Heart Failure:
● Causes:
- Myocardial infarction
- Valve stenosis
- HTN (has to push after the afterload)
 ● Patho:
- Decreased CO and pulmonary congestion
● Manifestations
- Forward Effects 🡪 in the body (not getting oxygenated blood)
● Fatigue and weakness
● Exercise intolerance
- Backward Effects 🡪 In the lungs (blood backing up to the lungs)
● Dyspnea
● Orthopnea
● Pink-frothy sputum
● Shortness of breath
● Rales/crackles
● Compensation:
- Tachycardia
- Pallor
- Daytime oliguria
- Right Sided Heart Failure:
● Causes:
- Myocardial infarction (R ventricle)
- Valve stenosis
- Pulmonary disease (has to push through the lungs)
● Patho:
- Decreased CO and systemic congestion
● Manifestations:
- Forward Effects 🡪 to the lungs
● Dyspnea
● Fatigue and weakness
● Exercise intolerance
- Backward Effects 🡪 systemic congestion/fluid back up (cannot maintain
venous return)
● Edema
- Feet, legs, buttocks
- Ascites (abdomen)
- Hepatomegaly and splenomegaly
● Jugular vein distention (JVD)
● Compensation:
- Tachycardia
- Pallor
- Daytime oliguria
- Endothelial dysfunction can be caused by several conditions, including diabetes or
metabolic syndrome, hypertension, smoking, and physical inactivity
● A type of non-obstructive coronary artery disease (CAD) in which there are no
heart artery blockages, but the large blood vessels on the heart's surface
constrict (narrow) instead of dilating (opening).
● This condition tends to affect more women than men and causes chronic
chest pain.
- Cardiac Valve Disease Process
● In heart valve disease, one or more of the valves in your heart doesn't work
properly.
● Regurgitation (or leakage of the valve). When the valve(s) do not close
completely, it causes blood to flow backward through the valve. This reduces
forward blood flow and can lead to volume overload in the heart.
● Stenosis (or narrowing of the valve). When the valve(s) opening becomes
narrowed, it limits the flow of blood out of the ventricles or atria. The heart is
 forced to pump blood with increased force to move blood through the
narrowed or stiff (stenotic) valve(s).
● Complications
- Heart failure.
- Stroke.
- Blood clots.
- Heart rhythm abnormalities.
- Death
- Mitral Stenosis
● Mitral valve stenosis occurs when the mitral valve in the heart narrows,
restricting blood flow into the main pumping chamber (left ventricle)
● The main cause of mitral valve stenosis is an infection called rheumatic
fever, which is related to strep infections.
- Mitral Regurgitation
● In the left ventricle, papillary muscle rupture causes the mitral valve to
be unable to close. With each contraction of the left ventricle, blood flows
upward through the loose mitral valve into the left atrium. This causes a
mitral valve regurgitation murmur, also called mitral insufficiency.
● As a consequence, mitral regurgitation often causes backup of blood and
hydrostatic pressure into the left atrium, pulmonary veins, and pulmonary
capillaries, causing pulmonary edema.
- Heart vegetations
● Abnormal growths (vegetations) that contain collections of bacteria may form
in the heart at the site of the infection and damage the heart valves, which
can cause them to leak.
- Endocarditis is a life-threatening inflammation of the inner lining of the heart's chambers
and valves (endocardium).
- Aortic stenosis
● Restricts the blood flow from the left ventricle to the aorta and may also affect
the pressure in the left atrium.
- Which type of valve defect leads to a diastolic murmur?
● Diastolic murmurs are due to a narrowing (stenosis) of the mitral or tricuspid
valves, or regurgitation of the aortic or pulmonary valves.
- Which type of valve defect leads to a systolic murmur?
● Systolic regurgitant murmurs include the many variations of mitral valve
regurgitation, tricuspid valve regurgitation, and ventricular septal defect.
- Describe the difference between thrombus and embolus.
● A thrombus is an aggregation of platelets and red blood cells. A thrombus is
found in the location where it formed.
● An embolus can be a thrombus or other object that has traveled through the
bloodstream until becoming lodged in a blood vessel that is too small for it to
pass through, blocking blood flow.
- Describe two contributing factors to developing an aneurysm.
● An aneurysm is a weakening of an artery wall that results in bulging or dilation
of the artery.
● Aneurysms can be caused by arteriosclerosis, degenerative vascular disease,
and other causes.
- What are some distinguishing characteristics of pericarditis and endocarditis?
● Endocarditis - prosthetic valves and pacemakers are risk factors.
- Often caused by infection of the endocardium of the heart
● Pericarditis- a condition called cardiac tamponade can result if high levels
of fluid accumulate and compress the heart.
- Caused by inflammation of the pericardium, often due to myocardial
infarction.
- How does malignant hypertension differ from benign hypertension? Name a few target
organs that can be damaged. Is hypertension ever considered truly benign? Explain why
or why not.
● Malignant hypertension is high blood pressure that has resulted in multiple
complications
● Benign hypertension is high blood pressure without evidence of end target
organ damage.
● Hypertension is never truly benign, in that it causes damage to the
endothelium that may not be evident for years.

Lesson 6: Quiz
1. A patient presents with a blood pressure of 204/102 mmHg. The patient complains of
chest palpitations, a headache and blurred vision. What is the patient experiencing?
hypertensive crisis
● The patient's systolic blood pressure >180 mmHg combined with symptoms of organ
damage indicates hypertensive crisis.

2. A patient who recently underwent a knee replacement suddenly complains of severe

shortness of breath and anxiety. Which disorder is the most likely cause of the patient's
symptoms? pulmonary embolism
● Patients are at risk for thrombosis and embolism following a major orthopedic
surgery, like a knee replacement. The patient's sudden onset of symptoms suggests
pulmonary embolism.

5. A patient asks the provider about a new diagnosis of aortic stenosis. What does the
provider explain about stenosis?
● It is a thickening and narrowing of the valve that decreases the ability of blood to
move through the valve.

Lesson 7: Lymphatic
-What is the difference between Hodgkin's Lymphoma and Non Hodgkin's Lymphoma?
● These are two types of cancer of the lymphatic system that can block lymphatic
ducts and interfere with the flow of lymph through the node.

-Signs and Symptoms of Hodgkin's Lymphoma

● Painless swelling of lymph nodes in the neck,armpits, or groin.
● Persistent fatigue.
● Fever.
● Night sweats.
● Losing weight without trying.
● Severe itching.
● Pain in lymph nodes after drinking alcohol.
● Electrolyte imbalance causing:palpitations, diarrhea, muscle weakness
● Non-Hodgkin's lymphoma where these abnormal cells are absent.
- There were questions about both Hodkins and Non-Hodskins, the answers
aren’t on here, I would study them a bit more.
-I don’t remember the exact question, but I would know the difference between the different
lymph issues.
-Lymphedema
● This is the swelling or accumulation of the fluid due to a blockage in the lymphatic
system
● Caused by scar tissues from damaged lymph vessels or lymph nodes.
● It is often seen in patients who had their lymph nodes removed and had surgery or
radiation to remove cancer.
-Lymphadenitis
● The medical term for enlargement in one or more lymph nodes, usually due to
infection.
● Lymph nodes are filled with white blood cells that help the body fight infections.
-Lymphadenopathy
● Enlarged lymph nodes that become palpable and tender.
-Lymphomas are cancers of lymphocytes residing in the lymphatic vessels or nodes.
- A patient was recently diagnosed with lymphoma. Which type of cells does the provider
know this is a cancer of? Lymphocytes
-Know influenza symptoms
-HIV causes immunity issues, and targets CD4 cells
●
●
- Methicillin-resistant Staphylococcus aureus (MRSA) infection is caused by a type of staph
bacteria that's become resistant to many of the antibiotics

Section 4: Test
1. Which term describes a weakening of the arterial wall resulting in a bulge outward?
- Aneurysm
- **Arteriosclerosis is a pathophysiological process in which the walls of the arteries

3. The provider is reviewing a client's electrocardiogram (ECG) and notes that the client is
experiencing cardiac dysrhythmia. Why is a cardiac dysrhythmia a concern?
- Cardiac dysrhythmias decrease the ability of the heart to pump effectively.
- Cardiac dysrhythmias cause a loss of the natural pumping sequence of the heart,
resulting in lower cardiac output.

4. What is the term for an infection of the cardiac endothelium?

- Endocarditis

5. A patient presents to the clinic with a blood pressure of 178/92mmHg. When repeated 10
minutes later, the patient's blood pressure is 176/96mmHg. The patient denies experiencing
a headache, chest pain or visual disturbances. What is the patient experiencing?
- Hypertension stage 2
- The client's blood pressure meets the criteria for stage 2 (systolic BP >140mmHg,
diastolic BP >90 mmHg).
 -

9. A patient was recently diagnosed with HIV and asks the provider to explain the concept of
immunodeficiency and how it is caused by HIV. What is the best response by the provider?
- The virus targets your CD4 cells. Without these cells, your immune system has a
hard time fighting off infection.

10. A patient is diagnosed with acute lymphoblastic leukemia. When evaluating the
complete blood cell count, what does the provider expect to see and why?
- A low red blood cell count because the cancerous lymphoblasts crowd out healthy
bone marrow tissue.

Lesson 8: Respiratory
- Respiratory System Pathophysiology:
● Upper Resp tract: conducts air to the lower airways, protects lung from
foreign matter and warms, filters, humidifies air
● Lower resp tract: participated in gas exchange by oxygenating blood and
excreting carbon dioxide at the alveoli.
- Impending Resp failure: Hypoxemic vs Hypercapnic respiratory failure.
● Hypoxemic respiratory failure occurs when the pressure of oxygen in
arterial blood is lower than 60mm Hg with normal arterial carbon dioxide. Ex
that can cause this is pulmonary edema, PE, pneumonia or pneumothorax,
● Hypercapnic respiratory failure occurs when carbon dioxide in arterial
blood is greater than 50mm Hg., Common causes are COPD and asthma.
- What is true about all restrictive lung disorders?
● They impair lung ventilation and they impair lung inflation.
- Pneumonia is an infectious process that impairs gas exchange. How does pneumonia
impair gas exchange?
● The alveoli are filled with purulent material in pneumonia, which prevents the
exchange of oxygen and carbon dioxide.
● Greater in males
● Aspiration pneumonia is caused by anaerobic bacteria swallowed by the
oropharynx.
- Which disorder is a pulmonary embolism most commonly a complication of?
 ● Deep vein thrombosis
- Melissa is a 46-year-old woman who presents to an urgent care clinic for shortness of
breath, chest pain, and a cough that started about four days ago. She reports that
the cough is productive of yellow [Link] are the pathophysiological
mechanisms underlying Melissa's shortness of breath and cough?
● Shortness of breath, known as dyspnea, is often caused by diseases that
impair gas exchange or oxygenation.
● A lower blood oxygen level can trigger dyspnea.
● Coughing is triggered by mechanical or chemical irritants to the airways—
including excess mucus caused by inflammation.
- Melissa's temperature is 101.1° F (37° C) and her oxygen saturation is 89% in room
air. During auscultation of Melissa's lungs, the provider notes crackles and rhonchi in
her right lower lobe. A chest x-ray reveals infiltrates in the right lower lobe of the
lung. What disease process is Melissa most likely experiencing?
● Melissa is experiencing pneumonia, an inflammatory (and typically infectious)
disease.
- Is this a disease of the upper or lower airways?
● Pneumonia is a disease that affects the lower airways, specifically the
alveoli. The crackles and rhonchi are suggestive of lower airway
inflammation, as fluid and pus from the inflammatory process create these
sounds.
- What could be causative agents of this disease?
● Pneumonia is most commonly caused by bacteria but can also be caused by
viruses or fungi.
- Upper respiratory tract infections (URTIs). These infections affect the nose, throat,
and sinuses.
● Common cold.
● Epiglottitis.
● Laryngitis.
● Pharyngitis (sore throat).
● Sinusitis (sinus infection).
● Mono
● Rhinitis
- Lower respiratory tract infections (LRTIs). These infections occur in the airways and
the lungs.
● Bronchitis
● Pneumonia
● Bronchiolitis
● Tuberculosis

- Coal Worker's Pneumoconiosis, the lungs are damaged: Silicosis

● A long term lung disease caused by inhaling large amounts of crystalline
silica dust.
- Asthma
● Causes:
- Bronchial obstruction due to hypersensitive or hyperresponsive airways
- Extrinsic Asthma: triggered by type I hypersensitivity reactions
- Intrinsic Asthma: adult onset; due to hyperresponsive airway tissue
● Risk Factors (asthma attack):
- Triggers: Cold, Exercise, Stress, Inhalant of irritants
● Manifestations:
- Asthma Attack:
- Dyspnea, tachypnea, tachycardia
- Wheezing
- Cough
 - Chest tightness
- Thick mucus
- Respiratory distress
- Conversational dyspnea
- Accessory muscle use
- Nasal flaring
- Tripod position
● Complications:
- Respiratory alkalosis 🡪acidosis
- Status asthmaticus (ongoing, unrelenting, unresponsive to treatment
episode of asthma that can be fatal)
- Silent chest
- Respiratory failure
- EmphysemaOverdistention of alveoli
● Causes:
- Cigarette smoking
- Genetics (antitrypsin deficiency)
● Progression of Disease
- Fibrosis and thickening of bronchial walls
- Narrowed airways
- Weakened walls
- Interferes with passive expiration
- Progressive difficulty with expiration
- Air trapping increases residual volume
- Over-inflation of lungs
- Increased anterior-posterior diameter of chest (barrel-chest)
● Manifestations:
- Dyspnea, tachypnea, tachycardia
- Clubbed fingers
- Barrel chest
- Pursed-lip breathing
- Fatigue
- Anorexia, weight loss
● Complications:
- Pulmonary hypertension
- Cor Pulmonale
- Respiratory failure
- Chronic Bronchitis
● Causes:
- Smoking
- Pollution
- Chronic inhalant irritants
● Manifestations:
- Dyspnea, tachypnea, tachycardia
- Constant productive cough
- Thick, purulent mucus
- Rhonchi
- Hypercapnia
● Complications:
- Pulmonary hypertension
- Cor pulmonale (R side heart failure)
- Respiratory failure
- Pulmonary Edema: too much fluid in the lungs
● Causes:
- L side HF
 - Hypoproteinemia
- Pulmonary hypertension
- Inhalation of toxic gases
● Manifestations:
- Orthopnea
- Rales
- Hemoptysis (pink-frothy)
● Complications:
- Hypoxemia
- ARDS
- Respiratory Failure
- Pulmonary Embolism: a clot that has traveled to the pulmonary arterial circulation
and causes obstruction of the arterial blood flow through the lungs.
● Causes:
- Blood clot (Virchow’s Triad: stasis of blood, vessel wall damage,
hypercoagulability)
- Fat emboli
- Heart valve vegetation (Infective Endocarditis)
- Amniotic fluid (pregnancy)
- Air
● Manifestations:
- Dyspnea, tachypnea, tachycardia
- CP
- Hemoptysis
● Complications
- Obstructive shock
- Gas exchange involves the exchange of oxygen and carbon dioxide between the
alveoli and the alveolar capillaries, which share a membrane.
- Obstructive disorders, such as asthma or COPD, make it difficult for the individual
to fully exhale carbon dioxide and may also make inhalation difficult.
- Restrictive disorders, such as pneumothorax, make it difficult for the lungs to fully
expand for ventilation.
- Disorders of the pulmonary vasculature are often complications from coagulation
disorders, pulmonary obstructive disorders, or respiratory infections.
- Describe a primary cause of aspiration. What other disorders pose a significant
risk associated with aspiration?
● Cause: Fatigue. Acid reflux. A loss of mental ability. Loss of muscle tone or
coordination that interferes with how well you chew or swallow. Pneumonia
(bacterial or viral)
● Risk: Pulmonary embolism, Acute respiratory distress syndrome (ARDS), Heart
failure, Lung cancer, Tuberculosis, Gastroesophageal reflux disease (GERD)
- Differentiate between atelectasis and hypoxia. How are these similar and what
are key differences?
● Atelectasis is the collapse of a small number of alveoli resulting in reduced
gas exchange. The full inflation of bronchioles is inhibited in this process.
● Hypoxia is when the oxygen levels in the blood are insufficient to meet the
needs of tissue. The gas exchange across the alveolar membrane is impacted.
- One question was about two diseases that fall under COPD: asthma and emphysema

Lesson 9 GI
- What is the most common cause of gastroenteritis?
● Viruses (70% of cases)
● Signs and symptoms
- Watery, usually nonbloody diarrhea — bloody diarrhea usually means
you have a different, more severe infection.
- Nausea, vomiting or both.
- Stomach cramps and pain.
- Occasional muscle aches or headache.
- Low-grade fever.
- What is cirrhosis and how does it develop? What are four potential detrimental
effects that can result from cirrhosis? How does each of these affect a patient
systemically?
● Common causes: Hepatitis C and chronic alcohol use
● Liver diseases cause liver cells to become damaged and die. Scar tissue
replaces liver cells and affects the function of the liver leading to cirrhosis.
● Esophageal Varices, which are engorged varicose veins on the low
esophagus caused by congestion and hypertension in the liver. This pressure
causes the veins to weaken and potentially rupture.
● Hepatocytes do not function properly in cases of cirrhosis leading to the
following examples (among others):
- Inability to detoxify compounds in blood
- Increased toxin exposure
- Decreased bile – decreased lipid digestion and absorption
- Hyperbilirubinemia - jaundice
- Bleeding resulting from portal hypertension
- Decreased synthesis of clotting factors – excessive bleeding
- Hepatic encephalopathy - confusion, impaired cognition.
- There was a question about a disease with ascites and jaundice, I believe the answer
was cirrhosis
- Pancreatitis
● Inflammation of the pancreas that causes pancreatic insufficiency,
malabsorption, and diabetes. Pancreatitis can be an acute or chronic disorder.
● With acute pancreatitis, there is a sudden, short-term episode of
inflammation.
- Causes
● Gallstones
● Excessive alcohol consumption
● High blood triglycerides
● Abdominal injury,
 ● Certain medications and toxins.
- Manifestations
● Abdominal pain
● Nausea and vomiting following significant alcohol intake
● Blue discoloration around the umbilicus (Cullen sign) is a
hallmark
● With chronic pancreatitis, the gland undergoes repeated episodes of
inflammation and gradual deterioration.
● Causes:
- Gallstones (obstruct the flow of bile and pancreatic secretions into
duodenum; backs up into pancreas and it starts auto digesting itself
- Alcohol (increased secretion of pancreatic enzymes and sphincter of
oddi contracts 🡪 enzymes back up into pancreas)
● Patho
- Auto digestion of the tissues (inflammation of the pancreas)
● Manifestations:
- Severe epigastric pain
- Vomiting
- Complications:
- Hemorrhage
- Hypovolemic shock (massive inflammatory response that causes
capillary leak)
- Circulatory collapse
- Peritonitis (enzymes escape into peritoneal cavity, causing
inflammation)

- Ulcers
● The constant acid irritation leads to ulceration of the gastrointestinal cells,
also termed peptic ulcer.
● Duodenal ulcers are a type of peptic ulcer that forms in the upper small
intestine.
- The most common symptom of a duodenal ulcer is a pain in the mid to
upper stomach region, especially if this pain intensifies when the
stomach is empty or if the pain wakes you up in the middle of the
night.
● Esophageal ulcers are ulcers that develop inside of the esophagus. These
ulcers can typically be treated with changes to lifestyle and diet, coupled with
certain medications and other treatments.

- Chrons disease
● A chronic inflammatory bowel disease that affects the lining of the digestive
tract.
● Symptoms
- Persistent diarrhea.
- Rectal bleeding.
- Urgent need to move bowels.
- Abdominal cramps and pain.
- Sensation of incomplete bowel evacuation.
- Constipation, which can lead to bowel obstruction.
- RLQ pain causes
● Chrons disease
● Appendicitis
- Ulcerative colitis
● An autoimmune disease of the large intestine, specifically the colon and
rectum. It affects the mucosal layer of the large intestine.
 ● Blood and mucus in stool
● Predisposes one to colon cancer
- How could the provider distinguish ulcerative colitis from Crohn disease?
● Ulcerative colitis only affects the large intestine, while Crohn's disease
can affect the entire length of the GI tract. While diarrhea can occur in
both, ulcerative colitis is more likely to present with blood in the stool.
● A colonoscopy will show pseudopolyps for ulcerative colitis but will show a
cobblestone appearance for Crohn's disease.

- Appendicitis
● Causes:
- Intraluminal obstruction (i.e. gallstones, tumors, parasites, lymphatic
tissue)
● Patho
- Inflammation and infection of the vermiform appendix
● Manifestations:
- RLQ pain with rebound tenderness at McBurney point
- Nausea/vomiting
- Fever
● Complications
- Rupture and peritonitis

Lesson 10
-A patient has been diagnosed with pyelonephritis and asks the provider to explain the
condition. What is the best response from the provider?
● "Pyelonephritis is an infection of the kidney that most commonly is caused by a
bacterium called E. coli."
● Inflammation of the kidneys
● Treatment: ABX, usually hospitalization

-Clients with acute kidney injury (AKI) may require either continuous renal replacement
therapy (CRRT) or hemodialysis. What is a major difference between CRRT and
hemodialysis?
● CRRT cleanses the blood in a 24-hour cycle, while hemodialysis is performed over 4–6
hours several times a week.
● The 3 different kinds of dialysis are: hemo, peritoneal, and CRRT

-A patient reports a family history of renal cancer to the provider and asks how to reduce the
risk of experiencing renal cancer. What advice should the provider include in patient
teaching?
● Do not smoke tobacco and avoid exposure to second-hand smoke, maintain a healthy
weight, aim for a blood pressure of less than 130/80 mmHg, and test your urine for
blood yearly.

-Decreased perfusion, medications or toxins, infections, and injuries can result in Acute
kidney injury.
● Manifestations include: elevated levels of creatinine and urea nitrogen (BUN), fluid
overload, and electrolyte imbalances, metabolic acidosis
 ● Causes:
- Prerenal: Anything in the body that prevents perfusion to the kidneys (i.e.
hemorrhage, dehydration, shock, heart failure)
- Intrarenal: Direct damage to the kidney (i.e. glomerulonephritis, pyelonephritis)
- Postrenal: Obstruction of urine flow after the kidney (i.e. tumor, PBH, kidney
stone)
● Complications: Chronic renal failure
-High blood pressure and diabetes often cause chronic renal failure.
● Results in anemia due to a lack of erythropoietin production.
●
-What is cholestasis? What are the two types of cholestasis and how do they differ?
● Cholestasis is the significant reduction of bile secretion and flow.
● Intrahepatic cholestasis is the result of diseased hepatocytes or disease of
intrahepatic bile ducts.
● Extrahepatic cholestasis is the result of a duct obstruction outside of the liver
(such as gallstones or a pancreatic tumor).
-How can choledocholithiasis lead to acute pancreatitis? Why would this result in damage to
pancreatic cells?
● Occurs when bile flow is obstructed by a gallstone in the common bile duct.
● This can lead to a backup of digestive enzymes from the pancreas that can perform
autodigestion and damage pancreatic cells.
-Urolithiasis is a term used to describe stones (calculi) that form in the urinary system.
What are the three different types and what part of the urinary system do these occur?
What factors might be responsible for calculi forming and what are the possible
ramifications if a stone cannot be passed in the urine?
● Urolithiasis are calculi that form in the urinary system, nephrolithiasis (kidney),
ureterolithiasis (ureter), cystolithiasis (bladder).
● Factors that can lead to stone formation are urine becomes saturated with stone
forming salts (calcium, struvite, uric acid, cystine); cause can be chemical, metabolic
or genetic.
● Stasis of urine allows for crystal formation which is commonly caused by urinary
obstruction or neurogenic bladder. As the stone is pushed through the ureter, it can
cause bleeding, build up of pressure, low urine flow, leading to back flow of toxic
urine in the kidney, which could lead to possible damage of the nephrons and kidney
failure.
-An ascending lower urinary tract infection (more commonly in women or during pregnancy)
often leads to which condition?
● Glomerulonephritis Pyelonephritis Nephrolithiasis Acute Kidney Injury
-What are the body's natural defenses against lower urinary tract infections? How are these
defenses overcome by various organisms that eventually lead to an infection?
● Natural defenses include:
- continual free flow of urine
- secretion of IgA (WBCs)
- naturally high osmolarity
- urea and organic acids which inhibit bacterial growth.
● A blockage due to enlarged prostate, kidney stone or even holding your urine can
create stagnant urine which allows bacterial growth.
● Chronic voluntary suppression of urination, sexual intercourse, UT obstruction,
catheterization and vesicoureteral reflux (urine backed up into the kidney) can all
lead to UTIs.
-What are the two likely pathophysiological mechanisms of acute Glomerulonephritis? What
common infection usually triggers acute glomerulonephritis? Describe the bodily effects
of damage to the glomeruli.
 ● Antigen-antibody damage to the glomeruli or antibody accidentally targets glomeruli
Group A beta-hemolytic streptococcus infection usually precedes by Loss of protein
due to damaged glomeruli leads to edema and hypertension
● An immune reaction which damages the glomeruli and results in albumin and red
blood cell loss,
-One question was about a cancer that you needed a transurethral resection of the tumor, I
believe the answer was bladder.
-What is the most common type of bladder cancer? Where in the bladder does this type of
cancer begin and at what point can it begin to metastasize? What is typically the only
indication that one might have bladder cancer?
● TCC (transitional cell carcinoma)-90%
● Begins on the bladder's interior surface and as it grows it protrudes into bladder
lumen and eventually into the bladder muscle, where it can metastasize.
● Diagnostic tests such as antigen test or CT or ultrasound can detect bladder cancer,
but prior to this painless hematuria is often the only symptom a patient experiences.
-What is the most common type of kidney cancer and what are some common causes and
risk factors? Describe briefly, the differences in the 4 stages of renal cell carcinoma.
● The most common form of kidney cancer is renal cell carcinoma (90%).
● Common causes and risks include smoking, long term use of pain medications,
obesity, high blood pressure, family history of renal cancer and heredity diseases
such as Von Hippel-Lindau disease and hereditary papillary renal cell carcinoma.
● Stages of Renal Cell Cancer I : tumor is 7cm or smaller and no metastasis II : tumor is
larger than 7 cm and no metastasis III : any size tumor and has spread to lymph
nodes, blood vessels in or near kidney, structure in the kidney that collect urine or
fatty tissue around kidney IV : Cancer has spread beyond fatty tissue around the
kidney and other parts of the body such as adrenal glands, brain, lung, liver, bone or
distant lymph nodes
-Describe the function(s) of the following parts of a nephron: glomerulus, Bowman's capsule,
juxtaglomerular apparatus, proximal tubule, Loop of Henle, distal tubule, and collecting
duct.
● A nephron is the structural and functional unit of the kidney.
● The glomerulus, located in the Bowman’s capsule is a group of capillaries that use
high hydrostatic pressure to push blood through the filtration process.
- The glomerulus allows water, sodium, bicarbonate, acids and urea out of the
blood and into the Bowman’s capsule.
- Large proteins cannot filter out.
-What are the common conditions that are risk factors to developing Chronic Renal Failure?
Why do the initial stages of CRF have few problems that manifest in patients? At which
stage does End Stage Renal Disease begin?
● Diabetes, hypertension, glomerulonephritis, and chronic kidney disease or PKD As
many as 75% of nephrons are healthy during initial stages and can compensate
Stage 5 with GFR below 15 mL/min
● Manifestations:
- Early:
■ Polyuria
■ Elevated BP
■ Anemia
■ Fatigue
- End-Stage/Uremia:
■ Hyperkalemia (unable to secrete potassium)
■ Azotemia (accumulation of nitrous waste; urea in blood)
■ Metabolic acidosis
■ Oliguria
■ Uremic Frost🡪 urea crystals on the skin due to high levels in the body
■ Pruritus
 ●
-Describe at least 3 problems observed throughout the body as a result of End Stage Renal
Disease (ESRD) and why this problem is caused by poor kidney function. What are the two
treatments for ESRD?
● Uremic frost from high urea, hypertension from elevated renin, anemia from lack of
EPO, etc. Kidney transplant and dialysis.
● Symptoms
- Fatigue
- Drowsiness
- Decrease in urination or inability to urinate,
- Dry skin, itchy skin,
● Doctors can diagnose the disease with
- Blood tests
- Urine tests
- Kidney ultrasound
- kidney biopsy
- CT scan.
● Treatments for ESRD are kidney transplant and dialysis.
-Bladder Cancer vs Kidney Cancer
● Kidney cancer, also known as renal cancer, occurs when cells in the kidney grow
out of control, clump together, and form a malignant tumor.
- The most common risk factor for developing kidney cancer is smoking.
● Bladder cancer is a common type of cancer that begins in the cells of the bladder.
- Malignant cells present in urine.
- Signs and symptoms
● The cardinal feature of bladder cancer: Painless hematuria
● Some types of bladder cancer present similarly to a UTI with urgency,
frequency, and dysuria. Usually located deep within the bladder, bladder
cancer rarely presents as a palpable mass.
- Surgical treatment involves a transurethral resection of the tumor.
Chemotherapy, immunotherapy, and radiation therapy are also used to eradicate
the tumor or reduce tumor size. Radical cystectomy with urinary diversion may be
necessary for very large invasive tumors.
- Cystitis (UTI)
● Lower urinary tract infection (UTI) is the most common urological disorder.
-A bladder infection may cause
● Pelvic pain
● Increased urge to urinate,
● Pain with urination
● Blood in the urine.
-A kidney infection may cause
● Back pain
● Nausea
● Vomiting
● Fever
-UTI, blood in urine - any bladder cancer correlation
● Unfortunately, the most common symptom of bladder cancer—blood in the urine—is
also a common symptom of a UTI. Other UTI symptoms include irritation or pain when
urinating or a frequent and urgent need to urinate and can also be symptoms of
bladder cancer.
- Brad is a 42-year-old patient who comes to the emergency department complaining of
severe right flank pain. He reports that it started about 24 hours ago. The pain is
severe and radiates into his groin. He is also having nausea and vomiting. What renal
disease processes would you suspect when a patient presents with flank pain? Are they
acute or chronic diseases?
 ● Both pyelonephritis and renal calculi can cause flank pain. Typically flank pain is
associated with acute infections or inflammation of the kidney, rather than chronic
diseases.
● Most renal calculi or kidney stones are made up of calcium oxalate and are
believed to be due to hyperabsorption of calcium from the gastrointestinal tract.
- Would this be considered acute kidney injury or chronic renal failure? If acute, what type
of acute kidney injury is this?
● This is acute kidney injury (AKI)—Brad's creatinine and BUN levels were within normal
limits a month ago and now are acutely elevated. Specifically, this is postrenal AKI
caused by a blockage in the urinary pathway after the kidney.
- Brad was first diagnosed with renal calculi at 42 years of age. Over the next several
years, he experienced several more renal calculi. During a recent physical exam, he
mentions to the provider that he has some blood in his urine, but has not been having
any flank pain. He wonders if he could be experiencing another renal [Link] would
be a concern with the painless appearance of blood in the urine?
● Bladder cancer or kidney cancer.
- Now gather more information: Brad undergoes further testing, which reveals stage II
kidney cancer in the left kidney. His oncologist recommends undergoing a total
nephrectomy. What are risk factors for kidney cancer?
● Risk factors include smoking, being overweight or obese, hypertension, a family
history of renal cancer, and using certain pain medications.
- What does having a total nephrectomy mean for Brad's renal function?
● Patients only need one kidney and Brad's renal function could continue to be normal.
However, he should be careful to maintain a normal blood pressure and avoid
medications that could damage his remaining kidney.
● In addition, with one kidney there is a greater concern that a future renal calculi
could result in acute kidney injury or more chronic kidney damage

Lesson 10: Quiz

1. A patient with a history of multiple sclerosis presents with a fever, nausea, and vomiting
that began several days ago. The patient also reports mild flank pain. Which disorder is the
patient most likely experiencing?
- Pyelonephritis
- A history of multiple sclerosis (risk for neurogenic bladder) combined with indications
of infection suggest pyelonephritis.

2. A patient presents with severe left-sided flank pain. The patient was working extensively
outside yesterday on a hot day and did not drink much water. The patient's medication list
indicates regular use of a calcium-containing antacid for heartburn. Which disorder is the
patient most likely experiencing?
- Renal calculi
- Dehydration combined with a high dietary intake of calcium can cause the formation
of renal calculi, which manifests in severe flank pain.

3. What is the strongest risk factor for bladder cancer?

- Cigarette smoking

Lesson 11: Endocrine

 ●
- Sheila is a 42-year-old female who presents to her health clinic complaining of chronic
fatigue, brittle nails, and constipation. She wonders if these are symptoms of menopause
because her menstrual cycle has also become very irregular. What endocrine disorder
would you suspect that Sheila is experiencing?
● Sheila's symptoms are consistent with hypothyroidism. Without adequate thyroid
hormone, the body's metabolic processes slow down.
● When looking at Sheila's bloodwork, would you expect her T3 and T4 levels to be
high or low? What about her thyroid-stimulating hormone (TSH) level?
- In hypothyroidism, the T3 and T4 levels are low due to inadequate
production.
- In primary hypothyroidism, the TSH level is high—this is because the
pituitary recognizes the low thyroid hormone level and is signaling the thyroid
gland to produce more.
- Henry is a 12-year-old patient with a history of type 1 diabetes who was brought to the
emergency department by his parents. His parents report that he started having nausea
and vomiting today, his breathing sounded different, and he was very lethargic. They
mention that he recently had bronchitis. What would you suspect that Henry is
experiencing?
● Henry is most likely experiencing diabetic ketoacidosis, a complication of type 1
diabetes. An infection, such as bronchitis, triggers increased glucose levels and
increases the risk for diabetic ketoacidosis.
● The provider caring for Henry performs frequent pupil checks. For what complication
is the provider performing this assessment?
- Cerebral edema is a severe complication of diabetic ketoacidosis due to
increased blood volume and dilutional hyponatremia. This complication can
result in papilledema or compression of the optic disc
- Diabetes insipidus can cause an imbalance in minerals in your blood, such as sodium and
potassium (electrolytes), that maintains the fluid balance in your body.
● Specific blood and urine tests can point to a diagnosis of diabetes insipidus, such as
- A high sodium level (hypernatraemia)
- High concentration of the blood (serum or plasma osmolality),
- Low urine concentration (urine osmolality).
 ● Your blood glucose levels are normal, but your kidneys can't properly concentrate
urine.
● Polydipsia
- Goiter / iodine relationship
● Iodine deficiency is the most common cause of a goiter. The body needs iodine to
produce thyroid hormone.

- ADDISON’S disease adrenal insufficiency

● Sx include severe and pain, high fever, weakness, confusion, nausea and vomiting.
● Makes you crave salt
- Cushing's Disease hyperadrenalism
● Sx include weight gain, face and trunk. Moon face, buffalo hump, apple shaped fat
distribution, darkening skin under breast, beltline and neck. Purple stretch marks
called striae, easy bruising and poor wound healing. Women also develop hirsutism,
male pattern hair growth.
- DKA:
● A condition that develops in persons with no insulin reserves.
● Sx include severe nausea, vomiting, profound dehydration
● Dx criteria include BG of greater than 250mg/dl, arterial pH lower than 7.3m serum
bicarbonate HCO2 lower than 15meq/L and HYPOKALEMIA
● Hyperventilation decreases the CO2 content of blood, which in turn lessens the
hydrogen concentration of the bloodstream, pt might also be tachycardic and
hypotensive
● Cerebral edema is a severe complication that can develop in DKA, early sx are
headache, confusion and lethargy but in severe cases, seizures, pupillary changes
and respiratory arrest may occur.
● Grave's Disease is a very common example, and manifests with an enlarged
thyroid, nervousness, insomnia, sensitivity to heat, weight loss, and potentially
cardiac arrhythmia.
- Describe the negative feedback loop utilized by the endocrine system.
● A negative feedback loop occurs when the build up of one molecule leads to the
repression of the response that creates the molecule.
- Why is Diabetic Ketoacidosis (DKA) a more significant problem for Type 1 Diabetes
Mellitus than Type 2 Diabetes Mellitus?
● Type 1 diabetes results from complete lack of insulin whereas type 2 simply involves
insulin resistance.
● In Type 1 Diabetes, there is no insulin, which causes the body to respond as if it is
starving, so glucagon will be released from the pancreas, leading to rampant lipid
breakdown, resulting in a high level of ketones in the blood. However, in Type 2
 Diabetes, there is still some insulin, though maybe less, and this concentration will be
enough to prevent DKA from occurring.

Lesson 11: Quiz

3. A patient presents with a puffy face, acne, elevated blood pressure, and muscle
weakness. What disorder is consistent with this patient’s symptoms?
- Cushings

Lesson 12: Reproductive

- Endometriosis- Painful periods (dysmenorrhea). Pelvic pain and cramping may begin
before and extend several days into a menstrual period.
● A disorder in which endometrial tissue grows outside of the uterus.
● Symptoms
- Lower back and abdominal pain.
- Pain with intercourse.
- Pain with bowel movements or urination
- Excessive bleeding.
- Infertility.
- Fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual
periods.
● Ovarian cancer - genetic causes, especially TP53 inactivation.
- HE4 biomarker: Human epididymis protein 4 (HE4) is a protein that is
produced by most, but not all, epithelial ovarian cancer cells. This makes the
test useful as a tumor marker in specific circumstances.
- What is Pelvic Inflammatory Disease (PID)?
● An infection of the female reproductive organs.
● It most often occurs when sexually transmitted bacteria spread from your vagina to
your uterus, fallopian tubes or ovaries.
● S/S
- The signs and symptoms of pelvic inflammatory disease can be subtle or mild.
Some women don't experience any signs or symptoms. As a result, you might not
realize you have it until you have trouble getting pregnant or you develop chronic
pelvic pain.
● Pain — ranging from mild to severe — in your lower abdomen and pelvis
● Abnormal or heavy vaginal discharge that may have an unpleasant odor
● Abnormal uterine bleeding, especially during or after intercourse, or between
menstrual cycles
● Pain during intercourse
● Fever, sometimes with chills
● Painful, frequent or difficult urination
● Causes
- Many types of bacteria can cause PID, but gonorrhea or chlamydia infections
are the most common.
-
● Infertility, irregular menstrual cycles, and hirsutism are most consistent with
polycystic ovarian syndrome (PCOS).
● What is the pathophysiological cause behind the irregular menstrual cycles,
hirsutism, and infertility?
- PCOS involves a disorder of the hypothalamic-pituitary-ovary axis
- The hormonal signals are disordered, and the patient experiences elevated
levels of androgens such as testosterone.
 - IBS- an acute illness with alternating constipation and diarrhea
- Cryoblation
● A procedure in which an extremely cold liquid or an instrument called a
cryoprobe is used to freeze and destroy abnormal tissue. Cryoablation is
sometimes used as a primary treatment for:
- Prostate cancer
- Bone cancer.
- Cervical cancer.
- Eye cancer.

Lesson 12: Quiz

1. A female patient presents with irregular menstrual cycles and hirsutism. Laboratory work
reveals elevated androgen levels. Which is the most likely diagnosis for this patient?
- Polycystic ovarian syndrome

Sections 6 and 7: Test

1. What is true about Crohn disease? Choose 3 answers. It is an inflammatory disease, a
chronic disease, and an autoimmune disease.
-

3. A patient presents with severe abdominal pain, nausea, and vomiting following several
days of heavy alcohol intake. The provider notes a dark-blue discoloration around the
umbilicus (Cullen sign). What is the patient most likely experiencing?
- Acute appendicitis

5. A patient has been diagnosed with renal cancer. What manifestation would the provider
expect to see?
- Hematuria
- Although renal cancers may be asymptomatic, hematuria is a common sign
associated with renal cancer.

7. A patient has been diagnosed with end-stage renal disease (ESRD) and will be undergoing
hemodialysis. What is true about hemodialysis?
- It can cause significant fluid shifts and place the client at risk for hypotension

9. A patient presents with acute pelvic pain and fevers. Testing reveals the presence of N.
gonorrhoeae. Magnetic resonance imaging (MRI) reveals thickened, inflamed fallopian tubes
and uterus. Which diagnosis is consistent with these manifestations?
- PID
- When an infection, commonly gonorrhea or chlamydia, affects the uterus and
fallopian tubes, this results in pelvic inflammatory disease (PID).