20221022072432_63539ab0a281e_wgu_pathophysiology_d236_b

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WGU pathophysiology D236-Exam Questions and Answers What is Starling's Law of Capillary forces? How does this explain why a nutritionally deficient child would have edema? - ANSWER Starling's Law describes how fluids move across the capillary membrane. There are two major opposing forces that act to balance each other, hydrostatic pressure (pushing water out of the capillaries) and osmotic pressure (including oncontic pressure, which pushes fluid into the capillaries). Both electrolytes and proteins (oncontic pressure) in the blood affect osmotic pressure, high electrolyte and protein concentrations in the blood would cause water to leave the cells and interstitial space and enter the blood stream to dilute the high concentrations. On, the other hand, low electrolyte and protein concentrations (as seen in a nutritionally deficient child) would cause water to leave the capillaries and enter the cells and interstitial fluid which can lead to edema. How does the RAAS (Renin-Angiotensin-Aldosterone System) result in increased blood volume and increased blood pressure? - ANSWER A drop in blood pressure is sensed by the kidneys by low perfusion, which in turn begins to secrete renin. Renin then triggers the liver to produce angiotensinogen, which is converted to Angiotensin I in the lungs and then angiotensin II by the enzyme Angiotensin-converting enzyme (ACE). Angiotensin II stimulates peripheral arterial vasoconstriction which raises BP. Angiotensin II is also stimulating the adrenal gland to release aldosterone, which acts to increase sodium and water reabsorption increasing blood volume, while also increased potassium secretion in urine. How can hyperkalemia lead to cardiac arrest? - ANSWER Normal levels of potassium are between 3.5 and 5.2 mEq/dL. Hyperkalemia refers to potassium levels higher that 5.2 mEq/dL. 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

The body uses the Protein Buffering System, Phosphate Buffering System, and Carbonic Acid-Bicarbonate System to regulate and maintain homeostatic pH, what is the consequence of a pH imbalance - ANSWER Proteins contain many acidic and basic group that can be affected by pH changes. Any increase or decrease in blood pH can alter the structure of the protein (denature), thereby affecting its function as well Describe the laboratory findings associated with metabolic acidosis, metabolic alkalosis, respiratory acidosis and respiratory alkalosis. (ie relative pH and CO2 levels). - ANSWER Normal ABGs (Arterial Blood Gases) Blood pH: 7.35-7.45 PCO2: 35-45 mm Hg PO2: 90-100 mm Hg HCO3-: 22-26 mEq/L SaO2: 95-100% Respiratory acidosis and alkalosis are marked by changes in PCO2. Higher = acidosis and lower = alkalosis Metabolic acidosis and alkalosis are caused by something other than abnormal CO2 levels. This could include toxicity, diabetes, renal failure or excessive GI losses. Here are the rules to follow to determine if is respiratory or metabolic in nature. -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. The anion gap is the difference between measured cations (Na+ and K+) and measured anions (Cl- and HCO3-), this calculation can be useful in determining the cause of metabolic acidosis. Why would an increased anion gap be observed in diabetic ketoacidosis or lactic acidosis? - ANSWER The anion gap is the calculation of unmeasured anions in the blood. Lactic acid and ketones both lead to the production of unmeasured anions, which remove HCO3- (a measured anion) due to buffering of the excess H+ and therefore leads to an increase in the AG. Why is it important to maintain a homeostatic balance of glucose in the blood (ie describe the pathogenesis of diabetes)? - ANSWER Insulin is the hormone responsible for initiating the uptake of glucose by the cells. Cells use glucose to produce energy (ATP). In a normal individual, when blood glucose increases, the pancreas is signaled to produced in insulin, which binds to insulin receptors on a cells surface and initiates the uptake of glucose.

Glucose is a very reactive molecule and if left in the blood, it can start to bind to other proteins and lipids, which can lead to loss of function. AGEs are advanced glycation end products that are a result of glucose reacting with the endothelial lining, which can lead to damage in the heart and kidneys. Compare and contrast Type I and Type II Diabetes - ANSWER Type I diabetes is caused by lack of insulin. With out insulin signaling, glucose will not be taken into the cell and leads to high blood glucose (hyperglycemia). Type I is usually treated with insulin injections. Type II diabetes is caused by a desensitization to insulin signaling. The insulin receptors are no longer responding to insulin, which also leads to hyperglycemia. Type II is usually treated with drugs to increase the sensitization to insulin (metformin), dietary and life-style changes or insulin injections. Describe some reasons for a patient needing dialysis - ANSWER AEIOU-acidosis. Electrolytes, Intoxication/Ingestion, overload, uremia. Patients with kidney or heart failure. A build up of phosphates, urea and magnesium are removed from the blood using a semi-permeable membrane and dialysate. AEIOU: A—acidosis; E—electrolytes principally hyperkalemia; I—ingestions or overdose of medications/drugs; O—overload of fluid causing heart failure; U—uremia leading to encephalitis/pericarditis Compare and contrast hemodialysis and peritoneal dialysis. What are some reasons for a patient choosing one over the other? - ANSWER 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 dialysate. 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.

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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 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 hemodialysis. How does homeostasis and maintaining optimal physiological health impact your wellbeing? - ANSWER Homeostasis acts to create a constant and stable environment in the body despite internal and external changes. Proteins and other cellular processes require optimal conditions in order to carry out their functions. Alterations in pH, salt concentration, temperature, glucose levels, etc. can have negative effects on health, so it is vital for mechanisms that regulate homeostasis to function properly for maintaining good health Differentiate between Innate Immunity and Adaptive Immunity ? - ANSWER The innate immune system encompasses physical barriers and chemical and cellular defenses. Physical barriers protect the body from invasion. These include things like the skin and eyelashes. Chemical barriers are defense mechanisms that can destroy harmful agent. Examples include tears, mucous, and stomach acid. Cellular defenses of the innate immune response are non-specific. These cellular defenses identify pathogens and substances that are potentially dangerous and takes steps to neutralize or destroy them. Adaptive immunity is an organism's acquired immunity to a specific pathogen. As such, it's also referred to as acquired immunity. Adaptive immunity is not immediate, nor does it always last throughout an organism's entire lifespan, although it can. The adaptive immune response is marked by clonal expansion of T and B lymphocytes, releasing many antibody copies to neutralize or destroy their target antigen What is a way that Adaptive Immunity can recruit innate immunity? - ANSWER The innate immune response to microbes stimulates adaptive immune responses and influences the nature of the adaptive responses. Conversely, adaptive immune responses often work by enhancing the protective mechanisms of innate immunity, making them more capable of effectively combating pathogenic microbes Why are some infections harder on children while other infections are harder on the elderly? - ANSWER Children have not been exposed to many pathogens yet, so they lack memory cells and have not built-up immunity yet.

The elderly have a depleted naïve T cell population from years of battling infections, so the likelihood of getting a match is less. Describe how and why our injury response results in the signs of redness, swelling, heat, and pain? (Be sure to use chemokines, histamine, and vasodilation in your response.) - ANSWER An injury causes an inflammatory response which is responsible for the redness, swelling, heat and pain. Upon injury, cells on the surface begin to release chemokines which act as messengers that something has happened. Mast cells are also alerted to release histamines which travel to the endothelial cells of capillaries and causes vasodilation, which is related to swelling and redness. Vasodilation also causes the capillaries to become leaky which allows for histamines, chemokines and even pathogen particles to enter the blood stream where they are met by neutrophils (non-specific) which start to adhere to the capillary wall and squeeze through the leaky holes (diapedesis or extravasation) to phagocytose pathogens and damaged cells. Dendritic cells just under the surface of skin are also activated to phagocytose foreign particles. Other B cells, T cells (specific) and the complement system also squeeze through the capillary wall to create an area of congestion. Explain dominant vs recessive genetic diseases. What is a "carrier" in recessive genetic diseases? - ANSWER The human genome contains 23 pairs of chromosome (22 autosomes and 1 pair of sex chromosomes). The pairs are homologous and contain the same genes in the same order. This means that every gene has a copy, one inherited from your mother and the other from your father. Not all versions of a gene (alleles) are treated the same by the cell. Some are expressed over others. A dominant gene is a gene that is expressed, even if you only have one copy. The dominant gene will be expressed over the recessive gene, which must have two copies to be expressed. In a dominant genetic disease, all it takes is one copy of the disease to have the disease. Recessive genetic diseases require that the individual gets two copies of the gene to have the disease. Someone who is a carrier for a recessive genetic disease is healthy, but contains a copy of the disease gene, potentially passing it to their offspring. Describe how to determine the probability of clinical outcomes given information about the parents (eg two heterozygous carriers of sickle cell disease). - ANSWER Punnett Squares can be used to determine the potential probabilities of certain traits being

passed to offspring. If you know the genotypes of each parent (ie homozygous or heterozygous for the trait), you can determine the possible outcomes. Heterozygous means that the parent has one copy of each gene, homozygous means the parent has the same copy for each gene (either both dominant genes or both recessive genes). What are some of the consequences of alcohol exposure in pregnancy? - ANSWER ND-PAE (neurobehavioral disorder-prenatal alcohol exposure) can cause birth defects and developmental disabilities (fetal alcohol spectrum disorders-FASDs). Affects thinking and memory, causes behavioral issues and linked to trouble with everyday functioning What are some of the distinctive features associated with trisomy 21, or Down's Syndrome? Why is increased maternal age a risk factor? - ANSWER Distinct features of Down's syndrome include intellectual disabilities and common physical features that include slanted eyes, flattened bridge of the nose and forehead, short in stature, poor muscle tone, loose joints and single palmar crease. As a woman's eggs age, they can have mistakes in meiosis potentially leading to a nondisjunction event causing trisomy 21 What is Spina Bifida? Why are relative deficiencies in Folic acid or B12 associated with Spina Bifida? - ANSWER Failure to close the neural tube early in gestation due to low folic acid and B- 12. These vitamins help activate DNA synthesis in the developing fetus in the first 4 weeks of pregnancy, that are responsible for closing up the spinal column. Three types of spina bifida. 1) spina bifida occulta (most common, less severe) 2) Meningocele (least common) 3) Myelomeningocele (most severe). Essential Question: How does the body's cellular responses and adaptations react to disruptions? - ANSWER The body uses the RAAS system to regulate blood volume and pressure, the immune response reacts to fight infection, the inflammatory response reacts to injury Describe how calcitonin, parathyroid hormone, and calcitriol (Vitamin D) work together to maintain normal blood calcium levels. - ANSWER Vitamin D: UV light stimulates formation of cholecalciferol, which is hydroxylated in the liver and the kidney into the active form of Vitamin D, calcitriol.

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Calcitriol stimulates absorption of calcium and phosphorus from the GI tract in the intestine and phosphate in the kidney. Calcitriol increases the calcification of osteoid. Calcitriol also stimulates the formation of bone by raising the levels of calcium and phosphorus in the blood. Low vitamin D levels can cause hypocalcemia, which stimulates the parathyroid gland to release parathyroid hormone (PTH). PTH stimulates osteoclasts to resorb bone calcium to increase blood calcium levels. PTH also stimulates osteoblasts to form bone. PTH stimulates kidneys to reabsorb calcium into the blood and to synthesize vitamin D. When blood calcium gets too high, the thyroid is stimulated to release calcitonin (suppresses osteoclast activity and calcium will be used to form bone). Describe the function of osteocytes within lacunae of bone - ANSWER Osteocytes absorb nutrients from the bloodstream and distribute them within the bone structure. Osteocytes absorb waste products from the bone and excrete them into the bloodstream. Describe bone remodeling ? Which cells are involved in this process and what is their function? - ANSWER Osteoclasts breakdown older bone structure and secrete the release calcium into the bloodstream. Osteoblasts absorb calcium from the bloodstream and use it to build new bone structure. Working together, these two cell types allow for regeneration of damaged bone structure. Describe the process of articular degeneration. Which cells are involved in this process and what is their function? - ANSWER Articular Degeneration is 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.

What is rickets? How does it develop? Who usually develops rickets? How can rickets be treated? - ANSWER Rickets is, primarily, due to a deficiency of vitamin D (due to sunlight exposure), which leads to a deficiency of blood calcium. Rickets can lead to bone weakness, deformity, and susceptibility to fracture. Rickets results from a failure to calcify osteoid due to low amounts of blood calcium and low vitamin D (typically). There are many different types of rickets. Children, especially under age 2, are most likely to be diagnosed with rickets. Infants can develop rickets if their mother's diet was low in vitamin D or in calcium, and breastmilk is low in vitamin D, so mother and baby need to supplement vitamin D (and calcium). The best way to treat rickets is to prevent it by taking supplements of vitamin D and calcium, eating food/drink containing vitamin D/calcium, and getting sufficient sunlight. Physical therapy with weight-bearing exercise can help to treat rickets, as well. It is a multi step process to make the active form of Vit D How does Denosumab treat osteoporosis? - ANSWER Denosumab is a monoclonal antibody that binds to osteoclasts and inhibits their Calcium- withdrawing capability. Distinguish between open reduction and internal fixation (ORIF) and hip replacement surgery. - ANSWER Open reduction and internal fixation involves "surgical opening' and insertion of hardware into the patient that assists with maintaining proper bone alignment during the healing process. Hip replacement involves replacement of a fractured hip joint with a prosthesis. What is degenerative disc disease? What are some of the anatomical features of degenerative disc disease? What are some symptoms of lumbar vs. cervical degenerative disc disease? - ANSWER Degenerative disc disease (DDD) is a disorder of the intervertebral discs. When the discs deteriorate, they cause improper alignment of the spinal column. Some anatomical issues that result are thinning discs, herniated discs (nucleus pulposus leaking through annulus fibrosus cartilage), bulging discs, and degenerated discs (possible with the formation of osteophytes).

Lumbar DDD results in pain in the buttock and thighs that gets worse with sitting, bending, lifting or twisting; weakness and numbness in the lower body, such as sciatica. Cervical DDD can result in chronic neck pain that radiates to shoulders and down the arms, weakness of arms/hands, and numbness and tingling in arms/hands. What is sepsis ? What are symptoms of sepsis, and how can sepsis be treated? - ANSWER Sepsis is an infection of the blood. Fever, chills, and increased pressure in the affected area are symptoms, as well as the area of injury will be warm, edematous, and erythematous. If the infection is advanced, a purulent (pus-like) discharge can develop, as well as a foul odor. The patient is treated with IV antibiotics in the hospital. When they are allowed to go home, they are given oral antibiotics. In the context of musculoskeletal injury, as part of treatment, the debridement of the wound and removal of orthopedic hardware will be needed to clean up infected region around injury, if it exists. How does compartment syndrome develop? Which part of our body tends to develop compartment syndrome? How do patients typically recognize they may need to seek medical assistance for rhabdomyolysis? What is the most sensitive laboratory test for rhabdomyolosis? - ANSWER Because the fascia around the muscles, nerves and blood vessels do not stretch, compartments surrounded by fascia cannot tolerate swelling or bleeding internally. When this happens, tissue pressure can exceed perfusion pressure, and compartment syndrome develops. The area can feel very hard due to the pressure. It is common in the lower leg and the forearm, and can be present in several potential body compartments. Several issues develop, and then exacerbate, the compartment syndrome, including constriction of veins, then arteries and compressed nerves. These lead to tissue necrosis, ischemia, leaky capillaries, and edema. This gives even higher pressure and can lead to increase Mb in the blood as muscles break down (rhabdomyolysis). Mb in the kidneys can lead to renal toxicity and tea-colored urine, which is, typically, a patient's first indication that they have rhabdomyolysis. The most sensitive laboratory test is an elevated creatine

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What is a pulmonary embolism? What is a fat embolism? When might a patient develop a pulmonary embolism? When might a patient develop a fat embolism? How are they treated? - ANSWER A pulmonary embolism is a blood clot that has obstructed an artery in the lungs. A fat embolism occurs when fat globules released from marrow of a fractured bone block microvasculature in the lung or other organs, such as the brain. A pulmonary embolism may often develop due to orthopedic surgery and in individuals with low mobility and blood hypercoagulation tendency. Anticoagulant may be administered during orthopedic surgery, and DVT may be treated through thrombolysis or pulmonary thrombectomy. A fat embolism is often related to a deep fracture of a marrow-containing bone, such as the femur. Early stabilization of marrow- containing bone fractures can help prevent fat embolisms, and fat embolisms may be treated by flushing the blood with solutions containing albumin to increase blood vessel volume and to dissolve the fat globules with the aid of the albumin. Choose three of the seven roles (of your choice) of the integumentary system. Describe the vital physiological function that each role serves. Provide at least two examples that illustrate the function for each role you have chosen. - ANSWER 1) Indicator of general health. Changes in the color of skin or nailbeds can indicate diseases of heart, liver, or blood cell synthesis. Examples: see slides provided. Anemia /shock: pallor. Oxygen deficit: blue skin. 2) Barrier protection. Protect body from chemical and environmental hazards. The stratum corneum is a barrier to antigens and is waterproof. 3) Thermoregulation. Maintain a constant body temperature. Temperature sensors in the dermis send signal to thermoregulatory center in hypothalamus. If warm, will sweat and have capillary dilation. If cold, hairs stand up, surface vessels constrict, and body shivers.

4) Immunological surveillance. Non-specific protection from antigens. Keratinocytes secrete keratin and regulate immune response. 5) Excretion/absorption. Regulate composition and volume of sweat, and help to manage total fluid volume. Many substances pass into and out of body through skin. See slides for more. 6) Mirror for internal disease processes. External signs of internal immune response/inflammatory processes, such as wheals, blisters, and bullae. 7) Production of Vitamin D. Regulates calcium and phosphorus metabolism. Role in bone development. Describe Albinism ? What portions of the body are negatively affected by Albinism? - ANSWER Albinism is a genetic disorder in which the body does not produce the skin pigment melanin. Lack of melanin negatively impacts the skin and eyes: The skin of albinos is easily sunburned and these individuals are prone to skin cancers. The eyes of albinos are sensitive to and easily damaged by sunlight and albinos frequently have issues with vision. Describe Eczema and Contact Dermatitis. How can these conditions be mitigated? - ANSWER Eczema is a disorder involving the immune system that leads to crusty, itchy, reddened skin. Eczema can be induced by a variety of factors, including stress, dietary intake of certain foods, and high or low temperatures. Observation and determination of risk factors can allow for avoidance of these risk factors (i.e. stress reduction) to mitigate eczema breakouts. Contact dermatitis is an allergic reaction that is localized at the area of contact that leads to redness and swelling. Certain metals or other chemical compounds can be the culprits of contact dermatitis, and avoidance of exposure will mitigate the symptoms. Describe Urticaria and associated Angioedema. What potentially life- threatening scenario can be associated with these conditions? - ANSWER Urticaria is the formation of red, blotchy, itchy patches (also called hives) associated with a large release of histamines.

Angioedema is the swelling of the eyes, face, lips, and mucous membranes that is often associated with urticaria. Anaphylactic shock is often associated with these conditions. Describe the three most common types of skin cancer. Where in the skin does each occur, and what are risk factors for each? Which are most likely to metastasize? How are skin cancers diagnosed, and what are treatment options? - ANSWER The most common type of skin cancer is basal cell carcinoma. Basal cell carcinoma is a cancer of the basal cells and is most commonly located on the face. Basal cell carcinoma often appears as a shiny, pearly bump. Basal cell carcinoma is usually treated by excision and rarely metastasizes. Squamous cell carcinoma is a cancer of the squamous cells that appears as a red, crusted, or scaly ulcer or bump. Squamous cell carcinoma rarely metastasizes (but can do so through the lymphatic system) and is treated by excision. Melanoma is a cancer of the melanocytes that appears as an irregularly-shaped patch of skin with unusual pigmentation. The coloration of the melanoma is often dark but can appear as other colors such bright-pink or blue. Melanoma has a very high risk of penetrating into blood vessels and the lymphatic system, and early detection and excision can prevent metastasis. Skin cancers are diagnosed through biopsy of the suspected area of skin. Explain the Rule of Nines and the briefly describe the ABA classification system. What are local effects and systemic effects of burns? - ANSWER The Rule of Nines is a method to quickly estimate the effected burn area of a patient that divides the body into regions with multiples of 9% of total body surface area (TBSA). In adults, head is 9%, arms are 9% each, legs are 18% each, and torso is 18% front and back each (groin is 1%). The ABA classification system groups burns into three types based on burn depth, percentage of TBSA, and whether or not certain body areas such as eyes and respiratory tract are affected. Local effects of burns include edema brought on by increased hydrostatic pressure and decreased osmotic pressure, poor perfusion, and hypermetabolism.

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Systemic effects of burns include pulmonary (edema of airways, inhalation injury, CO poisoning), gastrointestinal (decreased perfusion of GI tract and associated complications), Immune system (damage to outer barrier, decreased immune response), and Renal system (decreased kidney perfusion and associated complications). What are potential complications of Albinism? How can these complications be treated or mitigated? - ANSWER Complications of albinism include skin cancer and visual problems. Melanin is involved in eye development and lack of melanin can lead to problems with depth perception and focusing. UV damage to skin and eyes in people with albinism may be mitigated by limiting UV exposure and usage of sunscreen and sunglasses. Frequent checkups for skin abnormalities and vision problems should be conducted. Certain visual motor issues caused by albinism may be treated through surgery. What are potential complications of burns? How would you prevent or lessen these complications? - ANSWER Burns damage the skin's outer barrier to infection and can lead to localized infection and sepsis if not treated. Sterilization of the burn area and use of sterile and antibiotic-containing dressings can prevent burn wound infection. The body undergoes a state of hypermetabolism in order to repair itself after a severe burn, and consumption of nutrients is increased drastically. The loss of fluids through the wound is also common. These nutrients and fluids should be replaced through oral and IV means to prevent loss of perfusion and nutrients to vital organs. Adult respiratory distress syndrome can be caused by damaged lungs and large burn areas, and care should be taken to prevent swelling from blocking airflow. Dead, inelastic tissue can lead to compartment syndrome and said tissue should be excised to prevent loss of blood flow and nerve signals. What are the main differences between ischemic and hemorrhagic CVAs? What are the similarities? - ANSWER Ischemic stroke is caused by an embolus that blocks the cerebral artery and causes brain tissue death.

Hemorrhagic stroke is caused by cerebral artery rupture from excessive pressure; blood floods brain tissue, which causes cell death. Ischemic stroke is more common, in 85% of all CVA's. Goal of treatment of ischemic is to remove blockage and goal of treatment of hemorrhagic is to create blood clot to stop internal bleeding. These types of CVAs are similar in their risk factors (hypertension, age, ethnicity etc) and the symptoms they cause. What are the ways in which the core of ischemic region may spread into the ischemic penumbra region? - ANSWER The ischemic region is the region of the brain deprived of oxygen. The penumbra is the perimeter of that area. Ischemia impairs cell metabolism and causes glutamate accumulation in the ischemic penumbra. The glutamate opens ion channels and causes an influx of sodium and calcium. The persistent elevation of intracellular calcium activates degradative enzymes and results in cell death, which extends the stroke region. How are the bodily locations of CVA symptoms related to location of cerebral damage? - ANSWER The cerebral hemisphere that is damaged is contralateral to the side of the body that displays the symptoms. Why is it so important to have a patient with a suspected CVA to get a CT scan as soon as possible? Explain while describing treatment options. - ANSWER Because the treatment needs to begin asap. For ischemic CVA, thrombolytic therapy can begin within 60 minutes with a goal of beginning within 3.5-4 hrs from event. Hemorrhagic CVA treatment needs to create a blood clot asap to stop internal bleeding. For each of the three types of nerves (sensory, motor and autonomic), describe 1-2 symptoms of neuropathy. - ANSWER Sensory nerves cause numbness, tingling. Motor nerves cause overall weakness, difficulty walking. Autonomic nerves cause GI issues, lightheadedness. Patients with neuropathy often have poor balance that worsens in the dark or when their eyes are closed.

Explain 2-3 ways in which neuropathy causes this reduced balance. - ANSWER Neuropathy causes reduced balance by causing numbness in sensory nerves, by causing lack of feeling in feet and weakness in ankles by affecting motor nerves, and by causing lightheadedness by affecting autonomic nerves What are the four different types of intracranial bleeding? How can you distinguish between them? - ANSWER Epidural Hematoma (EDH)-occurs in the space below the skull and above the dura matter. Subdural Hematoma (SDH)-occurs below dura mater and above arachnoid membrane. Traumatic Subarachnoid Hemorrhage (SAH)-occurs within subarachnoid space Aneurysmal Subarachnoid Hemorrhage (SAH)-occurs within subarachnoid space What are the six neurodegenerative diseases we discussed? Choose one of the diseases and describe the pathophysiology and symptoms of that disease. - ANSWER The six neurodegenerative diseases are *Parkinson's, *Amyotrophic Lateral Sclerosis, *Multiple Sclerosis, *Huntington's, *Guillain-Barre Syndrome, *Myasthenia Gravis. The pathophysiology of ALS is that upper lower motor neurons become sclerotic and die. Symptoms of ALS include weakness in upper and lower extremities, head drop, speech changes, dysphagia Describe the pathophysiology of glaucoma. How does it differ from that of age-related macular degeneration? How is sight affected differently in both diseases? - ANSWER In glaucoma, the ciliary muscle is relaxed which causes a build up of ocular fluid that increases IOP (intraocular pressure). Increased IOP damages the optic nerve and irreversible vision loss ensues. In AMD, drusen builds up and separates the layers of the RPE cells and choroid and/or new vasculature separates these eye layers and as a result retinal detachment ensues. In glaucoma, peripheral sight is affected and central vision is left in-tact.

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In AMD, central vision deteriorates and peripheral vision is left in tact. Retinal detachment is a serious complication of diabetic retionopathy and AMD. Describe how retinal detachment leads to vision loss. - ANSWER In retinal detachment, the inner layers of the retina break away from retinal epithelial cells and the choroid layer, leading to ischemia of the retina and loss of vision. Compare and contrast otitus media and Meniere's disease. In the discussion, include the part of the ear affected, the symptoms, general age of people affected, and treatment strategies. - ANSWER Otitis media occurs most commonly in children, it affects the middle ear space, causes earache, fever, hearing loss, and can be treated by antibiotics. Meniere's disease most commonly occurs in individuals 40-50 years old, it affects the inner ear, causes hearing loss, tinnitus, vertigo, and can be treated by low-salt diet, diuretics, and anti-inflammatory meds. Describe the difference between thrombus and embolus ? - ANSWER 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 travelled through the blood stream until becoming lodged in a blood vessel that is too small for it to pass through, blocking blood flow. Describe two contributing factor to developing an aneurysm - ANSWER 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. They are most prevalent in males over 60 and African Americans. Please briefly explain the series of events that bring about atherosclerosis when cells are injured. - ANSWER After endothelial cells are injured, white blood cells are recruited to the site of injury. These become incorporated into the tunica media. The white blood cells differentiate into macrophages, which engulf LDLs. As the macrophages process the LDLs, they release cholesterol into their cytoplasm, becoming foam cells. As the foam cells go through apoptosis, the release inflammatory signals, resulting in further foam cell formation.

The end result of this is fatty streaks in the blood vessel and reduced capacity for vasodilation. These plaques can rupture and cause occlusion of the vessel What locations might angina symptoms be felt in and list any unique presentations of angina - ANSWER Angina is classically defined as squeezing chest pain as a result of Acute Coronary Syndrome, but some people, especially women, experience angina equivalents, such as dyspnea, diaphoresis, feeling faint, dizziness, extreme fatigue, or heartburn. Name two biomarkers that can be used to confirm a myocardial infaction occured and what types of molecules are they? - ANSWER Two diagnostic markers of myocardial infarction are creatine phosphokinas MB and cardiac troponin. These are proteins found in heart muscle that are released into the bloodstream when the heart is damaged Of the types of dysrythmia presented, which can lead to death within 48hrs and explain why this can result in death? - ANSWER Ventricular fibrillation can lead to death in 48 hours if not treated. Instead of pumping properly, the heart rhythm degenerates into a quivering of the ventricle, resulting in lack of blood flow. What are some distinguishing characteristics of pericarditis and endocarditis? Match the following (select either pericarditis or endocarditis as the correct answer): 1) Pericarditis or endocarditis - prosthetic valves and pacemakers are risk factors. 2) Pericarditis or endocarditis - a condition called cardiac tamponade can result if high levels of fluid accumulate and compress the heart. 3) Pericarditis or endocarditis - commonly occurs after myocardial infarction. * - ANSWER Endocarditis is often caused by infection of the endocardium of the heart, while pericarditis is caused by inflammation of the pericardium, often due to myocardial infarction. Matching: 1)Endocarditis - prosthetic valves and pacemakers are risk factors. 2) Pericarditis - a condition called cardiac tamponade can result if high levels of fluid accumulate and compress the heart. 3) Pericarditis - commonly occurs after myocardial infarction. Does left ventricular failure (LVF) exhibit backward effects, forward effects, or both?

Briefly explain what happens - ANSWER LVF occurs when the weakened left ventricle can not pump blood forward into the aorta and blood flow into the aorta is decreased. This causes backwards effects, in that hydrostatic pressure builds up in the left atrium, pulmonary veins, and pulmonary capillaries. The build up of pressure causes pulmonary edema. LVF causes forward effects in that the decrease of systemic arterial pressure leads to a sense of low blood pressure, decrease circulation to the kidneys, and decreased circulation to the brain Name the two types of heart murmurs and briefly describe characteristics of each. Dysfunctional heart valves can be stenotic or regurgitant. What do these terms mean? - ANSWER Heart murmurs can be physiological or pathological. This means they can innocent or cause by abnormalities of the heart, respectively. A stenotic heart valve is narrowed so it doesn't allow blood to flow freely across it, while a regurgitant valve does not close properly, which allows leakage of blood across it. 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. - ANSWER Malignant hypertension is high blood pressure that has resulted in multiple complications. While 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. What are the four main functions of the Lymphatic System? - ANSWER Lymphatic system can be thought of the highway system. The main functions are to protect the body from foreign invaders, maintain the body fluid levels by returning leaked fluid from bloodstream back to the blood, absorb fats from the digestive system and to remove cellular waste. Name 5 of the 10 main parts of the Lymphatic System - ANSWER • Lymph: • Lymph nodes: • Lymphatic vessels • Collecting ducts: • Spleen:

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• Thymus: • Tonsils and adenoid: • Bone marrow: . • Peyer's patches: • Appendix What is Lymph? - ANSWER Is also known as lymphatic fluid. It contains proteins, minerals, fats, nutrients, damaged cells, cancer cells and foreign invaders such as bacteria, viruses etc. Lymph transports infection-fighting WBCs. What are Lymph Nodes? - ANSWER They are bean shaped glands that monitor and cleanse the lymph during their filtration process. There are about 600 lymph nodes throughout the body. These nodes filter out the damaged cells and cancer cells. What is the purpose of the Spleen? - ANSWER It is the largest lymphatic organ. The spleen filters and stores blood and produces the WBC to fight infection and diseases. What is the purpose of the Tonsils and Adenoid? - ANSWER These are lymphoid organs that trap pathogens from the food we eat and the air we breathe. They are our bodies first line of defense against any foreign invaders. What are Peyer's Patches? - ANSWER These are small masses of lymphatic tissues in the mucous membrane that line the small intestine. These patches monitor and destroy bacteria in the intestines. What is Lymphedema? - ANSWER 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. Often seen in patients who had their lymph nodes removed, had surgery or radiation to remove cancer. What is the difference between Hodgkin's Lymphoma and Non Hodgkin's Lymphoma? - ANSWER These are two types of cancer of the lymphatic system that can block lymphatic ducts or be near lymph nodes and interfere with the flow of lymph through the node.

Hodgkin's lymphoma where you see the presence of specific type of abnormal cell called the Reed-Sternberg cell. Whereas the non-Hodgkin's lymphoma where these abnormal cells are absent. What is the clinical Presentation of infection ? - ANSWER Wounds are hot to touch because the inflammatory response results in vasodilation and increased vasculature. Permeability. Inflammation is a result of increased amount of fluid in the tissues results in heat, swelling and redness. Swelling, redness at the site of infection and yellow discharge are typical characteristics of infection. Describe a primary cause of aspiration. What other disorders pose a significant risk associated with aspiration? - ANSWER A person with dysphagia is much more likely to aspirate. Dysphagia is more common in older adults. Stroke is a very common cause of both dysphagia and aspiration. Risk factors for breathing in (aspiration) of foreign material into the lungs are: Being less alert due to medicines illness surgery or other reasons Differentiate between atelectasis and hypoxia. How are these similar and what are key differences? - ANSWER 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. The term of hypoxemia indicates a lack of sufficient oxygen in the arterial blood. Several respiratory disorders can result in hypoxia including advanced stages of atelectasis. Epiglottitis is serious condition with a significant risk of mortality. Elaborate on why this is the case. - ANSWER Epiglottitis is the infection and inflammation of the epiglottis-which is the flap of tissue that sits atop the trachea to keep food from going down.

When inflamed, the epiglottis can obstruct the trachea. There is a possiility for the sudden closing of the airway which can lead to death. Which of the following is NOT an Upper Respiratory Infection (URI)? A. Rhinitis B. Laryngitis C. Pneumonia D. Tracheitis E. Sinusitis - ANSWER Pneumonia Overdistention of alveoli resulting in the ability to remove CO2 is called? A. Bronchitis B. Emphysema C.Asthma D. Pulmonary Embolism - ANSWER Emphysema The Space between the lung and membrane is called? A. Bronchioles B. Alveoli C. Larynx D. Pleural Cavity - ANSWER Pleural Cavity Pleural effusion caused by increased hydrostatic pressure is called what? A. Exudative B. Pheumonic C. Transudative D. Oxidative - ANSWER Transudative Name at least two pulmonary vasculature related disorders and the main distinguishing characteristics of each disorder you chose. - ANSWER Pulmonary edema is the fluid around the alveoli which inhibits the oxygen transfer oat the alveolar capillary interface. Pulmonary embolism is a clot that has traveled to the pulmonary arterial circulation and causes obstruction of the arterial blood flow through the lungs. Describe the general pathophysiology of the Acute respiratory distress syndrome(ARDS). - ANSWER A damage to the alveolar lining results in diffuse alveolar damage. The damage results in release of the proinflammatory cytokines. The cytokines recruit neutrophils to the lungs. The neutrophils activate and release toxic mediators.

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These mediators damage the alveolar epithelium and capillary endothelium. Inflammation leads to the breakdown of the surfactant that normally helps keep the air sacs open. This results in the impairment of gas exchange, lung expandability and pulmonary arterial pressure. Describe how the lungs and particularly alveoli are affected in COVID- 19 ? - ANSWER As the SarsCoV2 virus travels through the airways, it infiltrates the alveolar pneumocytes. The virus permeates this sac. The cells will eventually experience apoptosis of all the alveolar neighboring cells. Diffused alveolar damage is observed. The damage from DAD combines to produce a form of debris called hyaline membranes. This is a key pathologic feature of the COVID. The thickening of the alveolar wall impedes diffusion of oxygen into the capillaries making it difficult for patients to breathe. An imbalance of secretions can lead to GI issues. Which of these blocks the function of parietal cells? A. Gastrin B. Endoscopy C. Histamine D. PPIs (Proton Pump Inhibitors) - ANSWER Histamine This disease is caused by pathological changes in the wall of the colon and predisposes to colon cancer. A. Esophageal varices B. Dyspepsia C. Crohn's disease D. Ulcerative Colitis - ANSWER Ulcerative Colitis 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? - ANSWER Hepatitis and chronic alcohol use are common causes of Cirrhosis of the liver. 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.

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Cirrhosis can lead to esophageal Varices, which are engorged varicose veins on the low esophagus caused by congestions and hypertension in the liver. This pressure causes the veins to weaken and potentially rupture. Cirrhosis also causes a decrease in bile, which affects lipids digestion and absorption, hyperbilirubinemia, which can lead to jaundice, inability to detoxify the blood, decrease in synthesis of clotting factors, which can lead to excessive bleeding and hepatic encephalopathy causing confusion and impaired cognition.. Cirrhosis is the formation of liver scar tissue as a result of multiple hepatocyte injuries and repair efforts. When hepatocytes are injured, stellate cells are stimulated and create collagenous fibrous tissue in an effort to repair the injury. 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 What are the three types of jaundice that may present as a result of liver dysfunction? Describe the cause of each. - ANSWER • Prehepatic jaundice - excessive hemolysis resulting in bilirubin quantities above what the liver can conjugate • Intrahepatic jaundice- direct injury to hepatocytes resulting in bilirubin not being conjugated • Posthepatic jaundice - bile duct obstruction resulting in conjugated bilirubin building up in the blood What is cholestasis? What are the two types of cholestasis and how do they differ? - ANSWER 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).

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What is biliary sludge and how does its presence lead to the development of gallstones? - ANSWER Biliary sludge is the result of bile stasis. The components of bile become very concentrated in the gallbladder resulting in an increased likelihood of precipitation. Cholesterol is the most common component that precipitates however bilirubin salts precipitate to form black and brown pigment stones How can choledocholithiasis lead to acute pancreatitis? Why would this result in damage to pancreatic cells? - ANSWER Choledocholithiasis 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? - ANSWER 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, and a build up of pressure 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? - ANSWER 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? - ANSWER Natural defenses include, continual free flow of urine, secretion of

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IgA (WBCs), and 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 allows for bacterial growth. Some women are non secretors of IgA and do not have this innate defense. Uropathogenic bacteria defenses include resistant outer capsules and secretion of hemolysins and cytotoxic necrotizing factor, which allow them to colonize the bladder. Proteus mirabilis secretes urease which raises the pH, flagellated and can swarm into the bladder (common with catheterization). 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. - ANSWER 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 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? - ANSWER The most common type of bladder cancer is TCC (transitional cell carcinoma)-90%, begins on the bladders interior surface and as it grows protrudes into bladder lumen and eventually into the bladder muscle, where it can metastasize. Diagnostic tests such as antigen test or CT or ultra sound 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. - ANSWER The most common form of kidney cancer is renal cell carcinoma.

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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. - ANSWER 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. As blood passes through the glomerulus the filtrates travel through the juxtaglomerular apparatus, which responds to levels of sodium and potassium, reabsorbing if needed. It also secretes renin in response to low levels of sodium, initiating the RAAS system. Next the filtrate heads through the proximal tube where approximately 60% of the water is reabsorbed into the blood. The more concentrated filtrate the flows through the loop of Henle, which secretes urea (nitrogenous waste), reabsorption od approximately 25% of electrolytes and 15% of water is also reabsorbed., As this product is pushed through to the distal tubule, aldosterone is secreted which acts to reabsorb more water and sodium into the blood and takes on potassium from the blood, if needed the body will absorb more water to further concentrate the urine. The urine enters the collecting duct, where even more water is absorbed as needed under the control of diuretic hormone. The final product can then be excreted through the urethra 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?

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At which stage does End Stage Renal Disease begin? - ANSWER Diabetes, hypertension, glomerulonephritis, and PKD. As many as 75% of nephrons are healthy during initial stages and can compensate Stage 5 with GFR below 15 mL/min 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? - ANSWER Uremic frost from high urea, hypertension from elevated renin, anemia from lack of EPO, etc.,Kidney transplant and dialysis,Problems that are commonly associated with ESRD are edema, hypertension and uremic frost. Edema and hypertension occur due to kidneys not being able to filter water out of the bloodstream. Swelling and increased blood pressure result. Uremic frost occurs because urea builds up in the body and as one sweats urea is deposited on the skin forming crystals as the sweat evaporates. Treatments for ESRD are kidney transplant and dialysis. What are two differences between hemodialysis and Continuous Renal Replacement Therapy (CRRT)? Why might CRRT be the preferred treatment over hemodialysis? - ANSWER CRRT is slower than hemodialysis and for longer periods of time (24 hours or longer). CRRT patients are typically demonstrating signs of acute renal failure, but also are critically ill or hemodynamically unstable (having trouble maintaining blood pressure) Why is the Pituitary gland considered the Master gland of the endocrine system? Describe any two disorders of your choice that are caused by pituitary gland dysfunction - ANSWER 1. The pituitary is considered the master gland because it either makes and secretes or stores and secretes the majority of the tropic hormones., 2. Diabetes insipidus is a hypopituitarism disorder in which ADH is not secreted from the posterior pituitary. This results in kidney malfunction because the nephron will not reabsorb water, leading to loss of water in the urine and concentration of sodium in the blood. Dehydration and hyperatremia result., 3. Syndrome of Inappropriate ADH (SIADH) is the opposite disorder - hyperpituitarism resulting in excessive secretion of ADH. This can result from brain injury or

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neurosurgery. ADH leads to too much reabsorption in the nephrons of the kidneys, concentrating urine and leading to hypervolemia (fluid overload) and hyponatremia. Compare hormonal vs neural signals. Comment on the need for these differences based on the response time required. Hint: Think about the steroidal vs non-steroidal hormone response to electrochemical signals fired by neurons - ANSWER Both hormonal and neural signals are required for our body to respond to environmental and developmental changes. Neuronal responses are almost immediate, allowing responses such as the ability to move and balance, the 5 senses, and the regulation of autonomic responses. Hormonal responses are more long term, allowing reactions that can occur over several minutes or even over several days! This allows for negative feedback loops to occur to maintain our body's responses over a longer period. Give an example of primary hyperthyroid disease. Describe the pathophysiology and manifestations of this disease. - ANSWER Primary hyperthyroid disease occurs when thyroid-stimulating antibodies activate the thyroid itself to secrete excess T3 and T4. Grave's Disease is a very common example, and manifests with an enlarge thyroid, nervousness, insomnia, sensitivity to heat, weight loss, and potentially cardiac arrhythmia. Exophthalmos may also result due to extraocular deposits that push the eyes forward and can cause edema - this will result in visual impairment if it is prolonged. Describe the negative feedback loop utilized by the endocrine system with an example of a marathon runner - ANSWER A negative feedback loop occurs when the build up of one molecule leads to the repression of the response that creates the molecule. The example of a marathon runner occurs with negative feedback between the hypothalamus and the metabolic muscles and organs of the body. The hypothalamus secretes CRF during the marathon, simulating the release of ACTH from the pituitary. This causes cortisol release from the adrenal gland, ultimately leading to the "fight or flight" response that stimulates metabolism in the muscles and organs. The cortisol feeds back to the pituitary, shutting off the stimulus to the adrenal gland, and thus creating the negative feedback loop.,

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When an individual is running in a marathon, the hypothalamus receives signals from the body that the muscles and organs have extra metabolic needs. The hypothalamus secretes corticotrophin-releasing factor (CRF), which stimulates the pituitary gland. The pituitary gland secretes ACTH (Adrenocorticotropic hormone), which, in turn, stimulates the adrenal gland to secrete the hormone cortisol. As cortisol levels in the bloodstream rise, the pituitary senses the increased level and shuts off the stimulus to the adrenal gland; this is an example of the endocrine negative feedback system Why is Diabetic Ketoacidosis (DKA) a more significant problem for Type 1 Diabetes Mellitus than Type 2 Diabetes Mellitus? - ANSWER Type 1 diabetes results from complete lack of insulin whereas type 2 simply involves insulin resistance. With complete lack of insulin, glucose cannot be absorbed at all by the tissues, leading to a "starvation" response from the body. The starvation response leads to the breakdown of fat and subsequence ketogenesis, resulting in excessive ketone body production. In contract, there is still some glucose absorption,in Type 2 diabetes, which means the starvation response is not initiating to the point of excessive ketogenesis., DKA is a result of increasing ketone concentration in the bloodstream. 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. Explain how treatment of hyperosmolar hyperglycemic syndrome (HHS) with rehydration and insulin can cause serum hypokalemia. - ANSWER HHS is a result of intracellular fluid escaping into the bloodstream in response to high blood glucose levels. Intracellular potassium will follow the fluid such that blood serum levels of K+ will appear normal or even high. Once treatment begins and fluids return to intracellular compartments, K+ will leave the bloodstream creating a hypokalemic response.

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In response to hyperglycemia, Protein Kinase C activates VEGF, which over time can lead to retinopathy and retinal detachment. How does this occur? - ANSWER VEGF signals proliferation of new blood vessels following retinal arteries damaged from persistent hyperglycemia. The new fragile arteries branch and grow between the internal surface of the retina and the vitreous gel. These can rupture, which will pull the retinal layer away, creating visual images like "floaters" and over time can lead to retinal detachment. In FtM (Female to Male) transgender hormone treatment, why is there an increased risk of breast cancer in remaining tissue? - ANSWER In FtM transgender affirming treatment, patients receive testosterone, which will be metabolized into estradiols. Any breast tissue which remains during the course of treatment will have increased risk factor for cancer due to this estrogenic stimulation. Individuals are particularly at risk if they have the BRCA1 or BRCA2 mutation. What is amenorrhea? Describe at least 3 causes, besides pregnancy, including molecular/hormone involvement. - ANSWER Amenorrhea: absence of menstrual periods. Turner's syndrome - molecular cause is genetic loss of second X chromosome, leading to underdevelopment of ovaries. High levels of FSH/LH (hypergonadotropic) but low estrogen (hypogonadism) Eating disorders or chronic disease - lack of gonadotrophic-releasing factor leads to lack of FSH/LH and therefore lack of estrogen/progesterone control. MRKH syndrome - lack of uterine development = lack of progesterone. Asherman's syndrome - scarred or absent endometrium = lack of progesterone. Birth control = disturbance of hypothalamic-pituitary-ovarian axis. Hyperprolactinemia - high prolactin inhibits estrogen release Female reproductive cancers include breast cancer, ovarian cancer, and cervical cancer.

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What are the most common causes of each of these types of cancer? - ANSWER Breast cancer - prolonged estrogen exposure causing overactivation of estrogen receptor. Ovarian cancer - genetic causes, especially TP53 inactivation. Cervical cancer - HPV infection causing TNF mutations or TP53 inactivation. Compare and contrast obstructive vs non-obstructive causes of male infertility. Provide examples of each, including their causes. - ANSWER Obstructive: infections, vasectomy, swelling, blockage. Examples include varicocele (enlargement of blood vessels in testicles), cryptorchidism (undescended testicles), blockages of ducts that deliver semen, and retrograde ejaculation. Non-obstructive: deficiencies in sperm production or function. Examples include antisperm antibodies, microdeletions on chromosome Y or in AR gene that cause insufficient development or hormone delivery, low count, impaired shape or movement, etc. What is the main treatment for prostate cancer, including some side effects of the treatment? - ANSWER Prostate cancer feeds on testosterone, so chemically blocking testosterone is the main treatment. This involves either wiping out testosterone completely by blocking the testes or by blocking testosterone signaling through the androgen receptor. Blocking testosterone has side effects that are metabolic, cognitive, and physical. The physical effects include hot flashes, ED, decreased bone density, and muscle loss. What is Pelvic Inflammatory Disease (PID)? - ANSWER Pelvic inflammatory disease (PID) is 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. What are the signs and symptoms of PID? - ANSWER 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.,

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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 What are the Causes of PID? - ANSWER Many types of bacteria can cause PID, but gonorrhea or chlamydia infections are the most common. These bacteria are usually acquired during unprotected sex. Less commonly, bacteria can enter your reproductive tract anytime the normal barrier created by the cervix is disturbed. This can happen during menstruation and after childbirth, miscarriage or abortion. Rarely, bacteria can also enter the reproductive tract during the insertion of an intrauterine device (IUD) — a form of long-term birth control — or any medical procedure that involves inserting instruments into the uterus. What are the risk factors for PID? - ANSWER Risk factors A number of factors might increase your risk of pelvic inflammatory disease, including: *Being a sexually active woman younger than 25 years old *Having multiple sexual partners *Being in a sexual relationship with a person who has more than one sex partner *Having sex without a condom *Douching regularly, which upsets the balance of good versus harmful bacteria in the vagina and might mask symptoms. *Having a history of pelvic inflammatory disease or a sexually transmitted infection. *There is a small increased risk of PID after the insertion of an intrauterine device (IUD). This risk is generally confined to the first three weeks after insertion.

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20221022072432_63539ab0a281e_wgu_pathophysiology_d236_b

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