Patho Exam 2

Signs and symptoms of Hypoxemia

Headache, shortness of breath, fast heartbeat, cough, wheezing, confusion, and bluish color of skin/fingernails/lips

Metabolic acidosis

Low O₂ levels results in aerobic metabolism (< anaerobic metabolism), increasing amount of lactic acid.

Many people with COPD also have what two things?

Emphysema and chronic bronchitis

Unique feature of emphysema

Loss of lung elasticity and abnormal airspace enlargement

Two major causes of CKD

Hypertension and Diabetes

Compare the function of conducting airways and respiratory airways

Conducting airways: transport air to and from the lungs

Respiratory airways: promotes gas exchange between the air and the blood

Three main components of gas exchange

1. Ventilation - movement of air without gas exchange (e.g., inspiration and expiration)

2. Perfusion - blood flow through pulmonary capillaries

3. Diffusion - gas exchange across the alveolar-capillary membrane

Which is more severe, antigenic shift or antigenic drift?

Antigenic shift because it results in great genetic changes, making direct jumps from specie to specie. Viruses from various species can mix genetic information, causing major genetic change with pandemic potential

How does SARS-CoV-2 enter airway epithelial cells?

By binding to ACE2, a receptor on airway epithelial cells (pneumocytes), and quickly colonizes it

Early infection phase of COVID-19

When most patients recover; cold-like symptoms, smell-taste disorders, lymphopenia, viral response phase; occurs one week after onset

Pulmonary phase of COVID-19

Respiratory distress and coughing up phlegm. Characterized by shortness of breath without hypoxia (IIA) or shortness of breath with hypoxia (IIB). Occurs one week to 10 days after onset

Inflammation phase of COVID-19

Cardiac failure, cytokine, and Thrombus formation. Characterized by ARDs, SIRs/shock, host inflammatory response phase. Occurs after 10 days of illness

Which of the following factors can lead to shifts in potassium (K+) levels in the body?

a) Acidosis, where H+ enters cells and K+ exits, causing hyperkalemia

b) B-Adrenergic stimulation, such as with epinephrine or albuterol, moves K+ out of cells

c) Alkalosis, where H+ exits cells and K+ enters, leading to hyperkalemia

d) Insulin, which decreases K+ uptake into cells after meals

a) Acidosis, where H+ enters cells and K+ exits, causing hyperkalemia

Which of the following is correct about hypokalemia?

a) electrocardiographic (ECG) changes such as ST elevation and prominent T waves

b) Plasma concentration < 3.5 mEq/L

c) Metabolic acidosis, leading to K+ retention in cells

d) Lack of aldosterone

b) Plasma concentration < 3.5 mEq/L

Which of the following is a characteristic of hypercalcemia?

a) Increased risk of kidney stones

b) Caused by low PTH

c) Plasma calcium level > 145 mg/dL

d) Positive Trousseau sign

a) Increased risk of kidney stones

JH, a 58-year-old male with a history of narcotic abuse, presents to the emergency department with difficulty breathing and drowsiness. Arterial blood gas analysis reveals pH 7.28, PCO2 60 mmHg, and HCO3 30 mEq/L. Based on the given information, the patient likely exhibits ______________.

a) Respiratory acidosis

b) Respiratory alkalosis

c) Metabolic acidosis

d) Metabolic alkalosis

a) Respiratory acidosis

RA is a 47 year old male with a history of severe COPD and he is admitted to the ICU for respiratory distress and a COPD exacerbation. He has ABGs obtained. What primary acid-base disorder will most likely be evident?

a) metabolic acidosis

b) metabolic alkalosis

c) respiratory acidosis

d) respiratory alkalosis

c) respiratory acidosis

Which of the following correctly describes the compensatory mechanisms for acid-base imbalances?

a) Respiratory alkalosis occurs due to too much CO2 loss, and the kidneys compensate by retaining more HCO3-

b) Respiratory acidosis occurs due to CO2 buildup and the kidneys compensate by excreting more HCO3-

c) Metabolic acidosis leads to a decrease in HC)3- and the body compensates by breathing slower (hypoventilation) to retain CO2

d) Metabolic alkalosis happens when HCO3- increases and the body compensates by breathing slower (hypoventilation) to retain CO2

d) Metabolic alkalosis happens when HCO3- increases and the body compensates by breathing slower (hypoventilation) to retain CO2

Which of the following statements correctly describes the relationship between potassium (K⁺) and proton (H⁺) during acidosis?

a) Excess lactic acid in the blood leads to a decrease in K+ in the ECF

b) In metabolic alkalosis, H+ moves out of the ICF to the ECF in exchange for K+, leading to hypokalemia

c) In metabolic acidosis, excess H+ moves into the ICF, leading to a decrease in extracellular K+ levels

d) Excess K+ in the ECF moves into the ICF in exchange for H+, leading to a decrease in extracellular H+

b) In metabolic alkalosis, H+ moves out of the ICF to the ECF in exchange for K+, leading to hypokalemia

Which of the following correctly describes conditions associated with normal and increased anion gap acidosis?

a) Increased anion gap acidosis is associated with increased chloride ion (Cl-) level

b) Normal anion gap acidosis occurs when bicarbonate loss is replaced by Cl-

c) Both normal anion gap acidosis and increased anion gap acidosis are associated with increased HCO3- level

d) Increased anion gap acidosis is associated with decreased Cl- level

b) Normal anion gap acidosis occurs when bicarbonate loss is replaced by Cl-

Blood flow structures in order through the kidney

1. Renal artery

2. Afferent arteriole

3. Glomerulus

4. Efferent arteriole

5. Peritubular capillaries

What happens when there is increased NaCl levels in the renal tubule, as detected by the macula densa, on RBH and GFR?

Increased NaCl in the filtrate triggers the release of adenosine, leading to vasoconstriction of the afferent arteriole, which decreases RBF and GFR

What is the effect of norepinephrine (NE) on the afferent arteriole in the kidneys?

NE binds to a-1 adrenergic receptors on the smooth muscle of the afferent arterioles, causing vasoconstriction and a decrease in GFR

Characteristic of Angiotensin II

Increases sympathetic nervous system activity, leading to an increase in blood pressure

Primary function of the respiratory system

• Gas exchange

• Host defense by providing a barrier

  • Goblet cell: mucus secretion

  • Ciliated columnar cells: mucociliary clearance

  • Alveolar macrophage: phagocytosis (engulf and kill microbes/particles)

Unique symptom of the common cold

Runny or stuffy nose

Unique symptom of rhinosinusitis

Postnasal drip

Unique sx of pharyngitis

Red/swollen tonsils

Unique sx of flu

High fever

Unique sx of COVID-19

Loss of taste/smell

Unique sx of pneumonia

Difficulty breathing

Unique sx of TB

Coughing up blood (hemoptysis)

Unique sx of pertussis

Long lasting cough >10 weeks accompanied by whooping sound when breathing in

Unique sx of RDS

Cyanosis

Dyspnea

Shortness of breath due to compression of the lungs

Cor Pulmonale

Right-sided heart failure due to underlying pulmonary disorders. Increases pulmonary vasculature resistance, causing hypoxia which increases more due to pulmonary hypertension that occurs. The vasoconstricted pulmonary artery causes the right ventricle to work hard to pump blood into the lungs. The pushing against high pressure in the pulmonary artery can ultimately cause the right ventricle to fail.

Chemical buffer systems - Bicarbonate buffer system

Main ECF buffer; also operates in ICF

Phosphate buffer system

Important buffer in urine and ICF

Protein buffer system

Most important buffer in ICF; also in blood plasma

5 causes of metabolic acidosis

1. Severe diarrhea

2. Carbonic anhydrase inhibitor

3. Lactic acidosis

4. Ketoacidosis

5. Toxic acidosis

Major markers for kidney function with normal ranges

Blood Urea Nitrogen (BUN): 7-20 mg/dL

Serum Creatinine (SCr): 0.6-1.3 mg/dL

What could cause the elevation if BUN to creatinine ratio was greater than 20:1?

• Dehydration

• Congestive heart failure

• GI bleeding

Under/Overestimation → Low muscle mass

Frail elderly patients; A decrease in muscle mass results in low creatinine clearance which would cause overestimation (falsely suggest better kidney function)

Under/Overestimation → Obesity

Increased fat results in muscle decline and high creatinine clearance, which could lead to overestimation.

Under/Overestimation → Liver Disease

This condition causes decreased serum creatinine and increased creatinine clearance, resulting in overestimation.

Under/Overestimation → Pregnancy

Physiological changes that increase GFR such as increased fluid volume, diluted serum creatinine leads to decreased serum creatinine and results in underestimation.

Under/Overestimation → High muscle mass

Increased muscle mass results in increased serum creatinine and decreased creatinine clearance, leading to underestimation.

Two types of renal failure with reversibility

1. Acute Kidney Injury

2. Acute Tubular Injury

Two indicators of acute kidney injury

1. Azotemia: Accumulation of nitrogenous wastes

2. Decreased GFR: Reduced nitrogenous waste excretion, imbalanced fluid and electrolyte

Two assessment criteria to determine CKD

1. GFR

2. Albuminuria

Three symptoms of CKD

1. Anema → lack of Erythropoietin production

2. Hypocalcemia → decreased calcium reabsorption due to lack of active vitamin D

3. Edema → Kidneys unable to filter waste and excess fluid from the blood, leading to buildup of fluid and sodium in body tissues

Characteristics of O2 transport

1. Transfer from alveoli to the pulmonary capillaries

2. Hemoglobin binding and transport

3. Dissociation from hemoglobin in the tissue capillaries

Characteristics of CO2 transport

1. Dissolved CO2

2. Attached to hemoglobin

3. As bicarbonate - acid-base balance

Which bacteria is the most abundant cause of both uncomplicated and complicated urinary tract infections (UTIs)?

E. coli