Patho Final Study Guide
Immunity
1. Know about signs and symptoms of AIDS
1. Fever, fatigue, rash, headache, lymphadenopathy, night sweats, opportunistic
infections
2. Lab Values, CD4 Counts, and viral loads
1. ELISA (Enzyme-linked Immunosbent Assay) followed by Western Blot if
ELISA is positive
2. CD4 counts less than 200 is considered AIDS
3. Viral Load tests monitor the health of people with HIV, in conjunction with
other markers
4. Higher numbers in the Viral Load tests indicate an increased risk of getting
sick from an opportunistic infection
Inflammatory Response
3. Know about the Inflammatory Response
1. When a bacterial infection is established in the body, it is the function of the
immune system to control or eradicate it. The initial reaction of the immune system
to an infection differs, depending on the site which has been invaded, and on the
nature of the invader. There can be many "triggers", that can kick the immune
system into action
2. Signs and Symptoms of Inflammation
1. Rubor (redness)
2. Tumor (swelling)
3. Color (heat)
4. Dolar (pain)
5. Functio Laeso (loss of function)
4. Asthma
1. Asthma is defined as a chronic inflammatory disorder of the airways in which
several different cells and cellular components take part; among these are mast
cells, eosinophils, T-lymphocytes, neutrophils, macrophages, and epithelial cells.
Activation of these cells, leading to asthma, results in symptoms of wheezing,
shortness of breath, coughing, and chest tightness.
5. Anaphylaxis, including eosinophils
1. It is known that eosinophils appear as an aftermath of anaphylaxis in
sensitized tissues that are reexposed to specific antigens. Circumstantial evidence
that has accumulated in recent years makes it likely that they participate in the
disposal of the antigen-antibody complex.
1. Type One
1. Rapid Antigen-antibody reaction
2. Release of IgE bound to mast cells and basophils which leads to
histamine release which caues.... increased vasodilation and capillary
permeability, swelling of bronchioles and bronchospasm leading to
anaphylactic shock
2. Type Two (Antibody Mediators)
1. Immunoglobulins IgG and IgM are responsible for activation of
compliment
2. Caused by mismatched blood, hemolytic disease of Newborns (“Blue
Babies”), Rh incompatibility
3. Type Three (Immune Complex Mediated)
1. Formation of insoluble antigen-antibody complex- activate compliment
1. Altered blood flow, including vascular permeability, tissue
destruction by inflammatory cells
2. **Immunoglobulins are produced by mediators in many allergic
responses
Infection
6. Know about Macrophage and neutrophils and the relationship to
1. Macrophages and neutrophils circulate in the blood and survey the body for
foreign substances. When they find foreign antigens, such as bacteria, they engulf
and destroy them. Macrophages and neutrophils destroy foreign antigens by
making toxic molecules such as reactive oxygen intermediate molecules. If
production of these toxic molecules continues unchecked, not only are the foreign
antigens destroyed, but tissues surrounding the macrophages and neutrophils are
also destroyed.
7. Know about universal precautions infection
• Avoid touching body fluids, such as blood, vomit, stool and urine.
• Do not share anything that touches blood. This includes razors, needles, any
sharp instruments that cut the skin, and toothbrushes. If you must share such
things, disinfect them before another person uses them.
• Keep wounds covered with a clean bandage or cloth.
• Use gloves or a piece of plastic to handle dirty bandages, cloths, blood, vomit or
stool.
• Wash your hands with soap and water after changing dirty bedding and clothes.
• Keep bedding and clothing clean. This helps keep sick people comfortable and
helps prevent skin problems. Handle clothing or sheets stained with blood,
diarrhoea or other body fluids carefully. Separate from other laundry for washing.
Dry laundry thoroughly in the sun if possible or iron after drying.
Pain and Stress Response
8. Know about stress and the General Adaptation Syndrome
1. Stress- A state manifested by symptoms that arise from coordinated
activation of the neuroendocrine and immune system
2. Physiological and Psychological responses to Stress-
1. Increased heart rate and contractility
2. Increased blood pressure
3. Increased peripheral resistance
4. Bronchioles dilate
5. Pupils dilate
6. Vessels constrict (skin, kidneys, GI tract)
7. Pallor
8. Conservation of body water
9. Immunosuppression (Cortisol)
10. Catecholamines are released (Norepinephrine and Epinephrine)
3. Adaptation- the ability to respond to challenges of physical or psychological
homeostasis and the return to a balanced state
4. General Adaptation Syndrome (GAS) was created by Hans Seyle
1. Three stages= ARE
1. Alarm
2. Resistance
3. Exhaustion or Recovery
5. PTSD= Post Traumatic Stress Disorder
1. Caused by major catastrophic events such as major weather related
disasters, airplane crashes, war, terrorist bombings, or rape/child abuse
9. Know about pain responses acute vs. chronic
1. Chronic Pain
1. Continuous or intermittent (6 months or more)
2. Absence of autonomic response
3. Increase in irritability, depression, somatic preoccupation, withdrawn
4. Decrease in sleep, libido (sexual desire), appetite
2. Acute Pain
1. Recent onset - short duration (less than 6 months consistent with fight or
flight response)
2. Increase in heart rate, stroke volume, blood pressure, pupil dilation,
muscle tension
3. Decrease in gut and salivary
4. Anxiety
Hormones
10. Know about Hypo and Hyper thyroidism
1. Hypothyroidism (Hashimoto’s thyroiditis=Autoimmune disorder and
Myxedema=presence of non-pitting edema and Myxedematous Coma=progession
of hypothyroidism, will kill you)
1. Symptoms
1. Decreased BMR
2. Mental Sluggishness
3. Bradycardia
4. Weight gain
5. Cold Intolerance
6. Coarse dry skin
7. Brittle Hair
8. Hypoventilation
2. Treatment
1. Thyroid Hormone replacement
2. Treat Underlying Cause
2. Hyperthyroidism (Graves Disease=hyperthyroid state, bulging eyes,
autoimmune and thyroid storm=hyperthyroid crisis, body goes out of control, life
threatening)
1. Symptoms
1. Increased BMR
2. Tachycardia
3. Intolerance to heat
4. Increased sweating
5. Thin/silky hair/skin
6. Restlessness
7. Anxiety
8. Goiter in Graves Disease
2. Treatment
1. Reduce Thyroid Level
2. Antithyroid drugs
3. Thyroidectomy
4. Treat underlying cause
11. Antidiuretic hormone - ADH
1. “No Pee Hormone”
2. Regulates the absorption of water by the kidneys
3. Secreted by Posterior Pituitary
4. Regulates Plasma osmolarity, drop in blood pressure, and vomiting
5. Effects on kidney are to conserve body water
6. Hyposecretion of ADH = Diabetes Insipidus (DI)
1. Symptoms
1. Severe dehydration- possible CV collapse
2. Excessive thirst
3. Excessive Urination (greater than 2L a day and up to 20L a day)
4. Fever
2. Diagnostics
1. Document of 24 hour urine output (can not lose ANY urine)
2. Measurement of ADH, urine osmolality, and serum osmolality
3. Treatment
1. Desmopressin acetate (DDAVP)
2. Increase Water intake
3. Treat the underlying cause
7. Hypersecretion of ADH = Syndrome of Inappropriate Antidiuretic
Hormone (SIADH)
1. Symptoms
1. Hypotonic, hyopnatremia (low sodium in blood)
2. Natriuresis (process of excretion of sodium in the urine through the
kidneys)
3. Urine osmolality excess is plasma osmolality
4. Absence of edema and volume depletion
5. Normal renal and adrenal function
2. Diagnosis
1. Medical History
2. Serum osmolality less than 280 mOsm/kg of water and low serum
sodium confirm it
3. Urine osmolality is greater than plasma osmolality.
4. Diagnostic studies show normal renal function and no evidence of
dehydration
3. Treatment
1. Fluid restriction
2. Diuretics such as Mannitol and Lasix
3. If severe water intoxication- hypertonic sodium used 3% Sodium
Chloride
12. Diabetes
1. An imbalance between insulin availability and insulin needed
2. Disorder of the metabolism (Carbohydrates, fats, proteins)
3. Can represent:
1. An absolute insulin deficiency
2. Impaired release of insulin
3. Inadequate or defective insulin receptors
4. Production of inactive insulin or insulin that is destroyed
4. Type One “IDDM”
1. Loss of Beta cell function
2. An absolute insulin deficiency
5. Type Two “NIDDM”
1. Impaired ability of the tissues to use insulin
2. A relative lack of insulin or impaired release of insulin in relation to blood
glucose levels
Shock
13. Know the pathology of shock
1. Shock leads to multi-organ dysfunction syndrome (MODS). The lungs are
usually the first organ to fail, folowed by kidneys, liver, GI tract, and then brain.
14. Know signs and symptoms of each type, relationships to tissue perfusion,
and compensatory mechanisms of the sympathetic nervous system
1. Cardiogenic Shock
1. Damage to the heart from MI
2. Ineffective pumping caused by cardiac arrhythmias
3. Physical/Structural Problems
1. Ventricular Septal Defect
2. Ventricular Aneurysm
3. Acute Disruption of valvular function
4. Problems associated with open heart surgery
2. Circulatory Failure Shock
1. Hypovolemic Shock
1. Loss of whole blood
2. Loss of plasma
3. Loss of extracellular fluid
2. Obstructive Shock
1. Inability of heart to fill properly
2. Obstruction to outflow from heart
3. Distributive Shock
1. Loss of sympathetic vasomotor tone
2. Presence of vasodilating substance in blood
3. Presence of inflammatory mediators
1. Neurogenic Shock
1. loss of or a decrease in sympathetic control of blood vessel tone
2. Cause: a defect in vasomotor center in brain stem (often related
to spinal cord injury)
2. Anaphylactic Shock
1. Severe allergic reaction- Histamine release (vasodilatory effect)
3. Sepsis and Septic Shock
1. Associated with severe infection
2. Systemic response to infection
3. Bacteremia more common (bacteria in blood)
4. Endotoxins and inflammatory response
5. Associated with complications- organ failure, pulmonary
insufficiency
15. Know the classifications of shock also
Fluid and Electrolyte Balance
16. Know about renin angiotensin and ADH
17. Most important lab value for renal function
1. Creatine = 0.6-1.2 mg/DL
2. BUN (blood urea nitrogen) = 8.0-20.0 mg/dL
3. **Both rise with renal failure**
18. Know about signs and symptoms of fluid excess
1. Swelling of the skin (edema)
2. Bloated or enlarged abdomen, a common feature in ascites edema
3. Breathing difficulties, a common feature in pulmonary edema
4. Rapid Weight gain, occurring in a matter of days
5. Fluctuations in body weight
19. Know Trousseau’s and Chvostek’s sign
1. Trousseau’s Sign
1. Ischemia-induced carpal spasm
2. sign of hypocalcemia and hypomagnesmia
3. Neuromuscular irritability
4. Occurs during taking BP
5. Flexion Contractor
2. Chvostek’s Sign
1. Facial Irritability
2. Unilateral spasm induced by tap over the facial nerve CN 7
3. Associated with Hypocalcemia and Hypomagnesmia
20. Know about what laboratory value is most predictive of renal function
1. Creatine
1. 0.6-1.2 mg/dL Respiratory
21. Know about most common area of foreign body obstruction
22. Know about the differences between expiration and inspiration, also what
muscles are used and the most important muscle
1. Expiration: passive process (don’t have to think about it)
2. Inspiration: active process (have to think about it)
3. Diaphragm!! can’t breathe without it!
23. What is the best way to thin/thick respiratory secretions
1. WATER!!
2. Hydrate the patient with water or IV
24. Know where the respiratory control is located in the brain
1. Respiratory control centers are located in the medulla and the pons. In the
medulla the ventral respiratory group contains rhythm generators whose output
drives respiration. Also in the medulla, the neurons of the dorsal respiratory group
integrate peripheral sensory input and modify the rhythms generated by the VRG.
The pons respiratory centers interact with the medulla centers to smooth the
breathing pattern
25. Know the formula for minute ventilation
26. Know about ventilation perfusion mismatch and how to determine if a
patient has an increased ventilation/perfusion ration or a decreased
ventilation/perfusion and associated disorders
1. Perfusion Mismatch= less than normal ratios (4 or 3L/min) and VQ ratio is
higher
2. Ventilation Mismatch = ventilation number is smaller and VQ is smaller than
normal
3. ***Look up in book***
27. Know about respiratory volumes and capacities, values, what is
represented, etc.
1. Tidal Volume (TV) - Inspiration and Expiration in normal breath
2. Inspired Reserve Volume (IRV) - normal breath and sucking in extra
3. Expiratory Reserve Volume (ERV) - normal breath and blowing out as much
as you can
4. Residual Volume (RV) - what is left over in the lungs to keep alveoli open
5. Minute Volume - Tidal Volume x Respiratory Rate
6. Total Lung Capacity (TLC) - TV + RV + IRV
7. Vital Capacity (VC) - TV + IRV + ERV
8. Functional Residual Capacity (FRC) - RV + ERV
9. Inspiratory Capacity (IC) -
28. Know respiratory terms: eupnea, Cheyne strokes, hyperapnea, apnea, and
orthopnea, normal respiratory rate
1. Eupnea - good breathing
2. Cheyne Strokes - (also known as periodic breathing) is an abnormal
pattern of breathing characterized by oscillation of ventilation between apnea and
tachypnea characterized by a crescendo-decrescendo pattern in the depth of
respirations
3. Hyperapnea -
4. Apnea - no breathing
5. Orthopnea - trouble breathing while laying down, but better when sitting up
6. Normal Respiratory Rate - 12 BPM
Cardiovascular
29. Know about cardiac output, know about sinus tachycardia, know about P,
QRS, and T complexes, what do they represent, what is happening in the heart- is
it ventricular or atrial, is it repolarization or depolarization etc
1. P wave - atrial depolarization
2. PR interval - represents the electricity through AV node
3. ORS complex - represents ventricular depolarization and atrial repolrization
hides in the QRS complex
4. T wave - represents electrically ventricular repolarization
30. Know the signs and symptoms of Congestive Heart Failure
1. Shortness of Breath (SOB)
2. Waking up Breathlessness at night
3. Coughing
4. Swelling and Weight gain (Edema)
5. Fatigue
6. Waking many times through the night to urinate
7. Increased abdominal girth
31. Know about Myocardial ischemia and injury, angina, ST elevation, know the
different ST changes with myocardial ischemia and injury
1. ST elevations - ischemia or Myocardial Infarction
2. ST depression - oxygenation tissue with cardiac tissue
32. Know about venous thrombosis-virchow’s triad
33. ***Increased risk of thrombosis
1. stasis of blood
2. increased blood coagubility
3. vessel damage
1. Treatment
1. give blood thinners (anticoagulants)
2. give aspirin (anti-platelet)
3. do something to move the blood around
4. constrict the blood vessels but not all vessels at once
5. patients prone to stasis put TED hose on legs
34. Know about beta blockers- uses, adverse effects on heart rate
1. Beta blockers, also known as beta-adrenergic blocking agents, are drugs that
block norepinephrine and epinephrine (adrenaline) from binding to beta receptors
on nerves. There are three types of beta receptors and they control several
functions based on their location in the body.
2. decrease heart rate
3. should not give beta blockers to patients with heart rate less than 60
4. used to treat:
1. abnormal heart rhythm
2. high blood pressure
3. heart failure
4. angina
5. tremor
6. prevention of migraines
5. Side effects include:
1. diarrhea
2. stomach cramps
3. nausea
4. vomiting
5. rash
6. blurred vision
35. Know about digoxin- action, side effects, precautions, relationship to
potassium
1. It helps make the heart beat stronger and with a more regular rhythm.
2. Used to treat:
1. CHF
2. atrial fibrillation
3. abnormal heart rhythm
3. Side effects include:
1. nausea
2. vomiting
3. headache
4. dizziness
5. skin rash
6. blurred or yellow vision
7. abdominal pain
8. breast enlargement
36. Know about cardiac output
1. amount of blood the heart pumps each minute
1. HR x SV
37. Know about atherosclerosis
1. Atherosclerosis including risk factors
38. formation of fibrofatty plaque in the intima of large and medium sized vessels-
39. risk= hypercholesterolemia and inflammation
40. hypercholesterolemia=
1. Primary= Genetic
2. Secondary= associated with other health problems
41. Types of lesions associated with Atherosclerosis
1. Fatty Streaks
1. Thin, flat, yellow intimal discolorations that progressively enlarge
2. Fibrous atheromatous plaque
1. The accumulation of intracellular and extracellular lipids, proliferation of
vascular smooth muscle cells, and formation of scar tissue
3. Complicated Lesions
1. Contains hemmorhage, ulceration, and scar tissue desposits
42. CLINICAL MANIFESTIONS (what the patient looks like)
1. Narrowing of the vessel - ischemia (decrease of oxygen in tissue)
2. Sudden vessel obstruction (plaque hemmorrhage or rupture) -pain in chest
3. Thrombosis and formation of emboli (from damage to the vessel endothelium)
4. Aneurysm formation (weakening of the vessel wall)
43. MAJOR COMPLICATIONS of Atherosclerosis
1. Ischemic heart disease (Myocardial Infarction)
2. Stroke (brain attack)
3. Peripheral vascular disease (PVD)
Acid/Base
44. Know about the most common causes of hypoxemia, hypoxia
1. hypoxemia: Low oxygen in the blood. Specifically, hypoxemia is
determined by measuring the partial pressure of oxygen in the arterial blood
[PaO2].
1. most common cause = ventilation/perfusion inequality
2. hypoxia: Asthma and Chronic Obstructive Pulmonary Disease (COPD)
45. Know how to interpret Arterial Blood Gases (ABG’s)
1. if pH is low (<7.4) it is acidosis...you are LOW when on ACID
2. if pH is high (>7.4) it is alkalosis
3. CO2 and HCO3 will tell you whether it is a respiratory or metabolic problem.
You breathe off CO2 (respiratory) and you need HCO3 for your stomach
(metabolic)
4. If CO2 is elevated and pH is low...respiratory acidosis.
5. If CO2 is low and pH is elevated...respiratory alkalosis.
6. If HCO3 is elevated and pH is elevated...metabolic alkalosis.
7. If HCO3 is low and pH is low...metabolic acidosis.
8. Respiratory complications - CO2 and pH are in the opposite direction
9. Metabolic complications - HCO3 and pH are in the equal direction
46. Know about PaCO2, PaO2- partial pressures
1. PaCO2 (mmHg)
1. mean = 41
2. range = 35-45
2. PaO2 (mmHg)
1. mean = 90
2. range = 80-100
47. Know the cause of cyanosis
1. abnormal hemoglobin levels
2. bronchospasms
3. congenital heart disease
4. heart failure
5. hypothermia
6. hypoventilation
7. Myocardial Infarction
8. pulmonary embolism
9. COPD
10. asthma
48. Know Arterial Blood Gas values, what they mean, what conditions would
cause the Acid/Base disorder and what to do to correct it
1. PaO2- the amount of dissolved oxygen in the blood
1. Normal Values - 80-100 mmHg
2. PaCO2- the amount of dissolved carbon dioxide in the blood
1. Normal Values - 35-45 mmHg
3. HCO3 - the bicarbonate ion
1. Normal Values - 22-28 mEq/L
4. Respiratory Acidosis- decreased pH/increased PCO2
1. Signs and Symptoms
1. ABG values= pH < 7.35 and PaCO2 > 45
2. Blood Pressure changes (usually increased)
3. Headache
4. Hypoventilation (slow RR)
5. Restlessness/confusion (brain is not getting enough oxygen)
6. Tachycardia
2. Causes?
1. Ventilatory Failure
2. Acute Airway Obstruction (asthma)
3. Severe Pneumonia
4. Pulmonary Edema
5. Neuromuscular disorders
6. CNS depression (drugs, CNS event)
7. Compensated - Chronic Lung Disease
5. Respiratory Alkalosis- Increased pH/decreased PCO2
1. Signs and Symptoms
1. ABG values = pH > 7.45 and PCO2 < 8.5
2. Dizziness
3. Hyperventilation
4. Light-headedness
5. Muscle cramps and spasms
6. Parathesias (tingling)
7. Palpations (irregular HR)
2. Causes?
1. Anxiety
2. Hypoxia
3. Drugs (OD or bicarb base--too much sodium in bicarb)
4. Sepsis
5. Hepatic encephalopathy
6. Patients who take a lot of antacids
6. Metabolic Acidosis- decreased pH/decreased HCO3
1. Signs and Symptoms
1. ABG values = pH < 7.35 and HCO3 < 22
2. Arrythmias
3. Hyperventilation (secondary to compensation)
4. Hypotension
5. Lethargy/coma
6. Signs and Symptoms related to underlying cause
2. Causes?
1. Ketoacidosis (DKA)
2. Renal Failure
3. Lactic acidosis
4. Diarrhea/vomiting
5. Toxins (methanol)--type of alcohol
7. Metabolic Alkalosis-increased pH/increased HCO3
1. Signs and Symptoms
1. ABG values = pH > 7.5 and HCO3 > 28
2. Arrhythmias
3. Confusion
4. Apathy/stupor
5. Hypoventilation (secondary to compensation)
6. Muscle weakness (hypokalemia)
2. Causes?
1. Vomiting/NG suctioning (pulls out the acid in the stomach)
2. Diuretic therapy (makes you pee)
3. Mineral corticoid activity (cushings sydrome)
1. **also aldosterone mains the balance between sodium and water**
49. Know about COPD- causes, respiratory drive, care of these patients
50. Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis
and emphysema, a pair of two commonly co-existing diseases of the lungs in which the
airways become narrowed. This leads to a limitation of the flow of air to and from the
lungs causing shortness of breath. In contrast to asthma, the limitation of airflow is
poorly reversible and usually gets progressively worse over time.
1. Signs and Symptoms
1. Shortness of Breath (SOB)
2. Barrel Chested (increased in anterior/posterior chest diameter)
3. Alveolar wall destruction
4. Destruction of Elastin (loss of elastic recoil)
5. Enlarged mucous glands
6. Over inflated lungs
2. Respiratory Drive
1. COPD patients retain O2
2. Their drive to breathe is NOT high CO2
3. It is low O2
3. Treatment
1. Smoking cessation (STOP SMOKING!)
2. Home O2
3. Bronchodilators
4. Steroids
5. Fluids
51. Oxygen delivery Systems ***Oxygen is FLAMMABLE!***
1. Oxygen tent (babies)
2. Nasal Cannula (1-4L) up to 6L/min
3. Simple Face Mask
4. Venturi Mask
5. Nonbreather Mask (can deliever 100% O2)
6. Trans-tracheal Oxygen (MUST HUMIDIFY)
7. Mechanical Ventilators
