NR507- Midterm Advanced Patho- cardiac, pulmonary, hematology, renal With 100% correct answers + rationales 2026

Hematopoiesis

blood cell formation

Fetus- liver and spleen

Adult- bone marrow

Anemia

A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.

Erythropoiesis

formation of red blood cells

In kidney in response to hypoxia

macrocytic normochromic anemia

Large RBC's, normal hemoglobin

Folic acid or Vitamin B12 deficiency

microcytic hypochromic anemia

small, abnormally shaped erythrocytes that are not able to carry normal hemoglobin

Thalassemia- mediterranean

normocytic normochromic anemia

Characterized by red cells that are relatively normal in size and normal hemoglobin

Aplastic, hemorrhagic, hemolytic, sickle cell

iron deficiency anemia

anemia resulting when there is not enough iron to build hemoglobin for red blood cells

Affects children, poverty, child bearing age

Erythrocytes

red blood cells

Most abundant cell in the body

Responsible for tissue oxygenation

Mitotic division- 100-120 days

sickle cell anemia

A genetic disorder in which erythroctyes take on an abnormal curved or "sickle" shape (Hb-s)

Thalassemia

Inherited defect in the ability to produce hemoglobin, usually seen in persons of Mediterranean background.

pernicious anemia

Lack of mature erythrocytes caused by inability to absorb vitamin B12 into the bloodstream

hemolytic anemia

Characterized by an inadequate number of circulating red blood cells due to the premature destruction of red blood cells by the spleen

Pancytopenia- reduction in all 3 types of blood cells (RBC, WBC, Plt)

Erythropoietin (EPO)

Hormone secreted by the kidney to stimulate the production of red blood cells by bone marrow

In response to hypoxia

In the fetus the liver produces this

Hemoglobin

Iron-containing protein in red blood cells that carries oxygen for delivery to cells

4 molecules of O2

Made of polypeptide, heme, iron

anemia due to gastrectomy

Iron def anemia is major cause after this

Removal of stomach often leads to marked decrease in production of gastric acid. This acid is necessary to convert dietary iron to a form that is more readily absorbed by the duodenum

hemolytic anemia causes

Sickle cell disease, ABO or Rh incompatibility, drug induced

Role of macrophages

Innate:

1. Phagocytosis

PRR or opsonization w/ complement

2. Secrete Cytokines: Recruit more cells, inflammation, fever, etc.

Adaptive:

1. Phagocytosis: opsonization with complement or Abs

2. Secrete cytokines: recruit more cells etc.

3. Antigen presentation: peptides from the broken down pathogen are displayed on surface of the cell.

Note: macrophages and dendrites are the majoy antigen processing and antigen presenting cells that initiate immune response

- Present antigen to memory (Th) cells in order to initiate a rapid response to antigens (secondary immune response)

Anticholinergic drugs for asthma

Atrovent & Spiriva both prevent the muscle bands around the airways from tightening thus reduce in exacerbation

Albuterol is short acting

Asthma

A chronic allergic disorder characterized by episodes of severe breathing difficulty, coughing, and wheezing.

T2HIGH eosinophilic inflammation

Airway responsiveness

Albuterol

Beta 2 Agonist, Short-Acting

acute bronchitis

infection and inflammation of bronchial tubes (bronchi)

chronic bronchitis

inflammation of the bronchi persisting over a long time

3 or more months atleast 2 years

Acid/ base disturbance- COPD

chronic obstructive pulmonary disorder. Causes air trapping. Increasing CO2 retention and respiratory acidosis.

Perfusion

The passage of fluid to an organ or a tissue, usually referring to the delivery of blood to an area.

Blood flow of heart

Enters the right side inferior/superior vena cava- emptying deoxygenated blood to right atrium- right ventricle, through tricuspid valve, pulmonary valve, pulmonary artery to lungs (where it is oxygenated). Pulmonary vein empties oxygen rich blood to left atrium/ left ventricle, through mitral valve, aortic valve, aorta---->to the body.

bronchioles function

passage of air to alveoli- gas exchange

polycythemia vera

condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels. Blood clots can lead to stroke and heart attack. Gene mutation in the protein janus kinase 2.

stroke volume

The amount of blood ejected from the heart in one contraction.

Determined by: preload/ afterload/ contractility

cor pulmonale

right-sided heart failure arising from chronic lung disease. can be caused by long term pulmonary hypertension

Causes of heart failure

"MI, afib, infection, shock/trauma, thyroid disease, PE, excess salt, medication noncompliance, beta blockers, NSAIDs"

Over time, reduces contractility

right sided heart failure

1. Jungular Vein Distention

2. Ascending Dependent Edema

3. Weight Gain

4. Hepatomegaly (Liver Enlargement)

Left sided heart failure symptoms

-Left = lungs (and heart)

-Crackles, increased HR, SOB, palpitations, dizzy, lightheaded, confused, restless, cough, dyspnea

Hypertension

consistent elevation of systemic arterial blood pressure, increases in cardiac output or total peripheral resistance or both. CO is increased by any condition that increases HR or SV, whereas peripheral resistance is increased by any factor that increases blood viscosity or reduces vessel diameter (vasoconstriction)

primary hypertension

Essential or idiopathic hypertension

Genetic and environmental factors

Affects 92% to 95% of individuals with hypertension

secondary hypertension

high blood pressure caused by the effects of another disease. Example (renal artery stenosis, kidney atrophy, increase in plasma renin)

calcium binding

Binding of calcium to subunit of troponin

Induces conformation change in troponin

Troponin-tropomyosin complex moved

Myosin binding sites of actin exposed

Troponin

regulatory protein that binds to actin, tropomyosin, and calcium. Integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle

Cardiac Output (CO)

volume of blood ejected by each ventricle per minute

CO= HRx SV

factors that affect cardiac output

preload

after-load

heart rate

myocardial contractility

Ejection Fraction (EF)

calculation of how much blood a ventricle can eject with one contraction

SV / EDV

55-70% of ventricular blood ejected/ systole

cardiac contractility (inotropic)

Force generated at any given end diastolic volume

Increased:

sympathetic stimulation (anxiety, increased thyroxine)

Decreased:

low ATP levels (inschemia, hypoxia, acidosis)

preload (venous return)

volume of blood in ventricles at end of diastole

Increased: CHF, hypervolemia

Decreased: cardiac tamponade, hypovolemia

AFTERLOAD (arteries)

resistance to left ventricular ejection (systole)

Increased: COPD, hypertension, valve dx (all r/t pulm htn)

Decreased: hypotension, vasodilation (shock)

Laplace's Law

Wall tension = (pressure x radius)/ (2 x wall thickness)

heart must work harder- increased tension

Systole (OUT)

ventricular contraction that ejects blood out of the ventricules to the pulmonary and systemic circulation.

Diastole (IN)

Relaxation period when blood fills the relaxed ventricles

AV valves

tricuspid- right side/ pulmonary

bicuspid- left side/ aortic side

semilunar valves

pulmonary and aortic

S1

When AV (mitral and tricuspid) valves close

S2

When semilunar close (pulmonic and aortic)

aortic stenosis

calcification/ narrowing of aortic valve cusps that restricts forward flow from left ventricle to aorta (during systole)

crescendo- decrescendo systolic heart murmur

mitral stenosis

narrowing of the mitral (bicuspid) valve, impairs blood from LA to LV.

Most common rheumatic heart disease

Low rumbling diastolic murmur heard at apex and radiating to axilla. Heard during S1

anatomy and physiology of kidney

consists of 3 distinct areas:

*Located in posterior region of the abd cavity behind peritoneum.

cortex (outer)

medulla (middle)

renal pelvis (inner)

hilum

depression in an organ where blood vessels and nerves enter and leave

renal artery

blood vessel that carries blood IN to the kidney

renal vein

blood vessel that carries blood away from the kidney and toward the heart (reabsorption)

renal medulla (of kidney)

inner portion of the kidney, called pyramids

renal columns

Inward extensions of the cortex tissue separating the renal pyramids.

minor calyces

cup-shaped areas that collect urine draining from pyramidal papillae

major calyces

areas that collect urine from minor calyces, empty urine into renal pelvis

renal pelvis

funnel-shaped reservoir that collects the urine and passes it to the bladder

ureter

tube that carries urine from the kidney to the urinary bladder

the lobe

structural unit of the kidney, 14 lobes

nephron

Functional unit of the kidney

filtration

collection

Types of Nephrons:

superficial

midcortical

juxtamedullary (concentration of urine)

glomerulus

A ball of capillaries surrounded by Bowman's capsule in the nephron and serving as the site of filtration in the vertebrate kidney.

Bownman's capsule

cup shaped structure surrounding the glomerulus

mesangial cells

control blood pressure and filtration within glomerulus. they also have phagocytic properties similar to monocytes and release inflammatory cytokines and growth factor.

renal corpuscle

glomerulus and bowman's capsule

glomerular

filtration

proximal convoluted tubule

reabsorption

65% of salt and water and most organic substances are reabsorbed in the PCT

Remainder absorbed throughout tubule system- ADH and aldosterone influence amounts

antidiuretic hormone (ADH)

promotes retention of water by kidneys

Aldosterone

Hormone that stimulates the kidney to retain sodium ions and water

Loop of Henle

The part of a kidney tubule that forms a long loop in the medulla of the kidney, from which water and salts are resorbed into the blood.

distal convoluted tubule

reabsorption and secretion

collecting duct

reabsorption of water/ secretion

Formation of urine steps

1. glomerular filtration

2. tubular reabsorption

3. tubular secretion

function of kidneys

Filter blood and produce urine

maintain homeostasis

PH

BP

Waste (urea)

glomerular filtration

the movement of substances from the blood within the glomerulus into bowman's space

nephron damage

1 thing that causes an increase in creatinine. number of nephrons decrease with age. Change in renal vasculature causing shunt between efferent and afferent arterioles. specific gravity in elderly tends to be low.

renal failure

loss of kidney function resulting in its inability to remove waste products from the body and maintain electrolyte balance

Elevated blood urea and creatinine levels

homeostasis in kidneys

remove waste from blood, leave nutrients alone, maintaining the acid-base, regulating water and electrolyte balance

renal calculi

calcium stones that lodge in the renal pelvis or pass through the ureters

supersaturation of one or more salts in the urine

Struvite stones

Ammonium magnesium phosphate

Uric acid stones

patients who excrete uric acid in the urine (gouty arthritis)

Treatment of renal calculi

-treat pain, eradicate infection if necessary

-Surgery, ultrasound destruction

BPH (benign prostatic hyperplasia)

Age-associated prostate gland enlargement that can cause urination difficulty.

non-cancerous

BPH treatment

-Alpha blockers [relax bladder neck muscles in the prostate making urination easier]; alfuzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and silodosin (Rapaflo),

-5-alpha reductase inhibitors [shrink your prostate by preventing hormonal changes that cause prostate growth]; finasteride (Proscar), dutasteride (Avodart)

prerenal causes

Severe decrease in perfusion to the kidneys

Caused by:

hypovolemia

trauma

n/v/d

shock

massive PE

renal artery/ vein occlusion

Intrarenal causes (intrinsic)

Systemic disease or drug toxicity

DIC

tumor growth

antibiotics

malignant hypertension

*ATN caused by ischemia is the most common cause usually after surgery/ sepsis

Postrenal causes

Obstruction of urine leaving the kidney

Enlarged prostate

Stones

glomerulonephritis

inflammation of the glomeruli within the kidney (immune response)

blood hydrostatic pressure

The pressure exerted by the water in the blood against the inside wall of a capillary of the bowmans capsule. essential for blood pressure in the glomerulus.

role of angiotensin converting enzyme

lower urine protein excretion and control BP

Juxtuglomerular Cells

Secrete RENIN which in turn:

Increases blood volume

increases sodium reabsorption

constricts blood vessels

increases blood pressure