Patho Midterm Exam Blueprint PDF

**Midterm Exam blueprint:** Module 1- 10 questions Module 2- 18 questions Module 3 - 22 questions Module 4 - 25 questions Module 5- 25 questions Every question worth 2 points 2.5 hours **[Module 1: 10 questions Ch 1, 2, 3]** **ABG interpretation** Acids are formed as end products of protei...

**Midterm Exam blueprint:** Module 1- 10 questions Module 2- 18 questions Module 3 - 22 questions Module 4 - 25 questions Module 5- 25 questions Every question worth 2 points 2.5 hours **[Module 1: 10 questions Ch 1, 2, 3]** **ABG interpretation** Acids are formed as end products of protein, carbohydrate, and fat metabolism. To maintain the body's normal pH (7.35--7.45) the H^+^ must be neutralized by the retention of bicarbonate or excreted. Bones, lungs, and kidneys are major organs involved in the regulation of acid-base balance. pH below 6.8 = death. pH above 7.8 = death. Acid-base balance is mainly concerned with two ions 1. 2. Regulated by the Lung Regulated by the Kidney CO2 + H2O ↔ H2CO3 ↔ HCO3− + H+ \* Equation ↑\*\*\* CO2 diffuses into the bloodstream where the following reaction occurs and is a source of H+ Alterations of hydrogen and bicarbonate concentrations in body fluids are common in disease processes. Four categories 1. 2. 3. 4. [Metabolic Acidosis] Causes - - - - - - - - Manifestations: - - - Treatment: - - - - [Metabolic Alkalosis] Causes - - - - - Bicarbonate concentration is increased, usually from excessive loss of metabolic acids (Cl ^−^) - - Treatment: Sodium chloride, potassium, chloride IV (chloride replaces HCO~3~^−^) ~[Respiratory\ Acidosis\ ]~ ~Causes~ - - - - ~Occurs\ with\ alveolar\ hypoventilation~ - - - ~Treatment:\ Restore\ adequate\ ventilation;\ may\ need\ mechanical\ ventilation;\ oxygen\ therapy~ [Respiratory Alkolosis ] Causes - - - - - Occurs with hyperventilation and decreased plasma CO~2~ (hypocapnia). - - Treatment: Paper bag; treat hypoxemia and hypermetabolic states **[ABG Interpretation Practice Examples Site]** [[https://nurseslabs.com/quizzes/arterial-blood-gas-interpretation-practice-quiz-part-1-20-questions/]](https://nurseslabs.com/quizzes/arterial-blood-gas-interpretation-practice-quiz-part-1-20-questions/) **Calcium** Ionized form is 5.5--5.6 mg/dL. Most calcium is located in the bone as hydroxyapatite. - - Is necessary for - - - - - **Phosphate** Serum levels: 2.5--4.5 mg/dL (adults) Similar to calcium, most phosphate (85%) is also located in the bone. Is necessary for high-energy bonds located in creatine phosphate and adenosine triphosphate (ATP) and acts as an anion buffer and needed for muscle contraction energy. Calcium and phosphate concentrations are rigidly controlled. - - **Calcium and Phosphate** **Regulated by three hormones:** 1. - 2\. Vitamin D - 3\. Calcitonin - [Hypocalcemia] Calcium levels \10.5 mg/dL Causes - - - - - - Manifestations - - [Hypophosphatemia] Serum phosphate level \< 2.0 mg/dL Causes: Intestinal malabsorption and renal excretion, vitamin D deficiency, antacid use, alcohol abuse, malabsorption syndromes, refeeding syndromes Manifestations: Diminished release of oxygen, osteomalacia (soft bones), muscle weakness, bleeding disorders (platelet impairment), leukocyte alterations, rickets Treatment: Treat underlying condition such as respiratory alkalosis and hyperparathyroidism. [Hyperphosphatemia ] Serum level \>4.7 mg/dL Causes: Exogenous or endogenous addition of phosphate to ECF, chemotherapy, long-term use of phosphate enemas or laxatives, renal failure High phosphate levels related to low calcium levels Manifestations: Same as hypocalcemia with possible calcification of soft tissue Treatment: Treat underlying condition, aluminum hydroxide, and dialysis. **Buffers**: [pH control Mechanisms]  **[Buffer]**:Chemical that can bind excessive\ H^+^ or OH^−^ without a significant change in pH Located in the ICF and ECF. Consist of a buffering pair: weak acid and its conjugate base. Most important plasma buffering systems: carbonic acid-bicarbonate system and hemoglobin - [Carbonic Acid- Bicarbonate Buffering] Operates in the lung and the kidney. The greater the partial pressure of carbon dioxide (pCO~2~), the more carbonic acid is formed. - - Lungs can decrease carbonic acid. Kidneys can reabsorb or regenerate bicarbonate but do not act as fast as the lungs. If bicarbonate decreases, then the pH decreases and can cause acidosis. pH can be returned to normal if carbonic acid also decreases. - The respiratory system compensates by increasing or decreasing ventilation. The renal system compensates by producing acidic or alkaline urine. [Other Buffering Systems] Protein buffering - Respiratory and renal buffering - - Cellular ion exchange - **Anion gap:** The anion gap measures the difference---or gap---between the negatively charged and positively charged electrolytes in your blood. If the anion gap is too high, your blood is more acidic than normal. If the anion gap is too low, your blood isn\'t acidic enough. **Intracellular versus Extracellular volume (dehydration)** [Alterations in Na+, Cl- and Water Balance] [Isotonic alterations] - - - [Hypertonic alterations] Hypernatremia - - - - - - Water deficit - - - - - - - - - Hyperchloremia - - - [Hypotonic Alterations] Decreased osmolality Hyponatremia or free water excess Hyponatremia decreases the ECF osmotic pressure, and water moves into the cell. Water excess - - - - - - - - - - - Hypochloremia - - - - - - **Intracellular** Cation - - Anions - - - **Extracellular** - - - - - - - Anions - - - - - **Potassium** - - - - - - - - - - [Hypokalemia] - - - - - - - - - - [Hyperkalemia ] - - - - - - - - - - - - - - - **Components of the cell membrane** Plasma membranes - - - - - Membrane composition - - - - - - - - - - - - - - - - - **Why is there a difference in ion composition between intracellular and extracellular compartments?** The ionic compositions of the intra- and extracellular environments are distinct from one another, with K+ being the main cation in the cytosol and Na+ being the most abundant cation outside of the cell. Specific ions can permeate into and out of the cell at different rates, bringing about uneven distribution of charges and development of negative electric potential inside the cell. Like all cells, an excitable cell maintains a different concentration of ions in its cytoplasm than exists in its extracellular environment. Together, these concentration differences create a small electrical potential across the plasma membrane. Then, when conditions are right, specialized channels in the plasma membrane open and allow rapid ion movement into or out of the cell, and this movement creates an electrical signal. Membrane transport, cellular intake and output Solutes---dissolved substances - - - - - - - Passive transport - - - - - - - - - - - - Active transport of Na+ and K+ - - - - - - - - - - - - - - - - - - **Endoplasmic reticulum** - - - **Hypomagnesemia also causes what other electrolyte finding?** ↓calcium and potassium Is an intracellular cation. Is stored most in the muscle and bones. Interacts with calcium. Has a plasma concentration of 1.5--3.0 mg/dL. Is a cofactor in intracellular reactions, protein synthesis, nucleic acid stability, and neuromuscular excitability. [Hypomagnesemia] - - - - - - [Hypermagnesemia] - - - - - - - **[Hypomagnesemia and Hypermagnesemia]** [Hypomagnesemia] - - - - - - **[Hypermagnesemia]** - - - - - - - **[Module 2 (chapters 4,5,6): 18 questions]** Sexual abuse by first degree relative yields - higher risk of recessive diseases - - - - - Nondisjunction: - - - - - - [[https://www.youtube.com/watch?v=0RjSpp4Y87w]](https://www.youtube.com/watch?v=0RjSpp4Y87w) Transcription: - - - - - - - - Note: RNA has uracil and DNA has thymine - - - - - - - - - - Down syndrome - - - - - - - Note: trisome on chromosomes 13, 18, and 21 can survive; most others do not Sex Chromosome Aneuploidies: Trisomy X - - - - - Turner's syndrome - - - - - - - - - - - - A female has one X chromosome. Which diagnosis will the nurse observe documented on the chart? Turner syndrome Klinefelter\'s syndrome - - - - - - - - appearance; abnormalities will increase with each X; can also have an extra Y chromosome. - Fragile X syndrome Second most common (to downs syndrome) Female passes gene to offspring - - - - - - - - - - - - - - Expressivity - - - - - - - - - - - \*\* Praeder-Willi syndrome - - - - - Incidence rate - - - - Colorectal cancer - - - - - - - - - - **Punnett square example** Methylation - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Sickle Cell Anemia  - - - - - - - - - - - - - Autosomal dominant disorders versus Autosomal recessive disorders - what similarity do they have? Similarity? They both occur on the 22 pair of autosomes. Both are rare **Autosomal Dominant:** - - - **Autosomal Recessive** - - - - - - - **DNA polymerase function** - - - - - Familial HLD - - - - - **Breast Cancer** - - - - - - - **[Module 3: (Chapters 7, 8, 9, & 10)] 22 Questions** **IgE vs IgM vs IgG** - - - **Staphylococcus -why is it common in wounds? What is it?** - - - - - - - - - - **Acquired immunodeficiency syndrome (AIDS)** is caused by the virus HIV. - - - - - - - - - - - - - - - - - - - - - - - - - - - - **Benefits of a fever:** - - - - - **Innate immune response** - - - - First Line of Defense: Physical and Biochemical Barriers and the Human Microbiome [Physical and Mechanical Barriers] Physical: protection from tissue damage and infection - - - - - [Biochemical Barriers] - - - - - [The Normal Microbiome] - - - - 1. 2. 3. 4. 5. **Primary lymphoid tissue example** - - **Inflammation - describe definition** - - - - **Type 1-4 hypersensitivity reactions [[Link]](https://www.youtube.com/watch?v=jXTW4F-8jd4)** - - - - - - - - - - - - - - - - - - \*\*\* A-C-I-D\*\*\* to remember hypersensitivity reactions  **Endotoxins & Exotoxins** - - - - - - - - - - **Acute bacterial meningitis - lab findings** - **Severe neutropenia - why isolate the patient?** - **Alloimmunity example** - - **Acute inflammation line of defense** **SLE:** Systemic lupus erythematosus - - - - - - - - - - - - - - - - - - **MHC's facts** - - - - - - - - - **Humoral immunity** - **Adaptive immunity** - - - - -  **Humoral:** - - - **Cell-mediated:** - - - - **Innate Immune system: PAMP's and DAMP's** - - **Dysfunctional wound healing during the inflammatory response** dysfunctional wound healing is usually caused by an infection, this causes prolonged inflammation and failure of re epithelialization. This is seen in autoimmune diseases such as rheumatoid arthritis, lupus, and scleroderma. Must be treated with debridement. A deficiency in zinc can cause poor wound healing. **Innate immunity** - **[Module 4: (Chapters 12, 13, 28 & 29)] 25 questions** **Metastasis features :** hallmark of metastasis is development of any secondary mass that is no longer directly connected to the originating tumor. - - - - - **Reasons for cancerous growth** - - - - **Dysplasia:** Is not cancer but can sometimes become cancer - **Carcinoma in Situ** - - - - **Malignant tumor** - - - - - **Malignant tumors facts** - - - - - - - - - - - - - - **Human carcinogenesis - key genetic mechanisms** - - - **Hallmarks of cancer** - - - - - **Describe oncogene capability** - - - **Where does hematopoiesis occur? -** Red bone marrow - **HIV = patients are more at risk for what?** - - **Macrocytic normochromic anemias are caused by?** - - **Non-Hodgkin\'s lymphoma** (the worst of the two lymphomas) - - - - - **TNM staging** - - - - - - - - - - - **Viruses linked to cancer: what are they?** - - - - - - **Obesity facts** - - **Granulocytes** (**N**ever, **L**et, **M**onkeys, **E**at, **B**ananas- name and order of abundance of granulocyte cells) - - - - - - - - - - - **Anemia of Chronic disease - causes** - - - - - - - - - - **Sign of splenic sequestration after sickle cell crisis** - - - **How do cancer cells use the enzyme telomerase?** - - **Monocytes become what?** Macrophages **ITP** - - - - - - - - - - - - - - **TTP (thrombolytic)** - - - - - - - - - - - - - - - - - - - **Contributors to hemostasis** - - **Iron deficiency anemia: lab findings** - - - - **Glandular Epithelial Malignancy example** - **Cancer cells switch ON telomerase** **Dysplasia - abnormal cell growth - need more testing to determine dx** **Metastasized Cancer traits - Lymphatic spread, monogamous spread (blood) & penetrate surrounding tissues** **[Module 5: (Chapters 15, 16, 17, 18 & 19)] 25 questions** **Calcium ion causes what in the presynaptic membrane?** - **Acute Otitis Media- typical presentation and patho findings** - - - - - - **Cause of global cerebral ischemia** - **Cause of focal cerebral ischemia** - **Temporal arteritis (Giant cell arteritis)** - - - - - **Spinal cord injury with dermatome analysis of findings** A dermatome is an area of skin whose sensory nerves all come from a single spinal nerve root. Loss of sensation in a particular dermatome enables doctors to locate where the spinal cord is damaged.  Example provided what movements patient still had control of and asked what area of the spine was most likely damages **Cranial nerves: III, IV, VI** - Note: cranial nerves III, IV, V, VI are affected by intracranial aneurysms **Cataracts vs Retinal detachment vs Glaucoma processes** - - - - - - - - - - - - **Epidural hematomas** - - - - - - - - - - - - - - - Subdural hematomas - - - - - - - **Multiple Sclerosis presentation - what is a finding in their CSF? (Think Ig's)** - - - - **Anxiety disorders** - - - - - - - - - - - - - **Parkinson disease exam findings** - - - - **Cheyne-Stokes respirations** - - - - **Neurogenic fever -** non-infectious source of fever in the patient with head injury - - - **Pain perception and sensation includes what anatomy?** - - - - - **Older adult temperature management changes in physiology** - - - - - - **Efferent pathways carry...** electrical signals AWAY from the brain/CNS to peripheral nervous system (ex. Motor neurons)  **Neuropathic pain** - - - - - - - - - - - - - - - - - - - - - - - - **NT changes in Depression** - - **Cholinergic NT = ?** - - - - - **Depression facts, etiology - not sure what else we need here...** - - - - - - - - **Paranoid delusion -** Schizophrenia - delusions (false beliefs), hallucinations (seeing or hearing things that don\'t exist), unusual physical behavior, and disorganized thinking and speech. - - - - - - - - - - - - - - - - - **Most common type of stroke - MCA -** Ischemic Stroke - - **Glial cells responsible for myelinating neurons in the PNS =** Schwann Cells (also called neurilemma cell) **Broca's aphasia - which artery is most likely involved?** left middle cerebral artery - MCA superior division - - - **[Notes from midterm review lecture:]** M1- 10 questions: - - - - - - - M2- 18 questions: - - - - - - - - - - - M3 - - - - - - - - - - - - - - - - M4- - - - - - - - - - - - - - - - - - - - M5- - - - - - - - - - - - - - - - - -