Pathophysiology Rasmussen Questions with 100% Correct Answers 2023

Stages of general adaptation syndrome - Correct answer-1. Alarm Initial reaction Sympathetic nervous system 2. Resistance Adaptation Limit stressor 3. Exhaustion Adaptation failing Disease develops Edema - Correct answer-Excess fluid in the interstitial space Dehydration (ECF volume deficit) - Correct answer-Can occur independently without electrolyte defects Decrease in fluid level leads to increase in level of blood solutes Cell shrinkage Hypotension Hypovolemia or fluid volume deficit - Correct answer-Decreased fluid in the intravascular space Hypotonic Hydration - Correct answer-(fluid overload) Causes of Fluid Deficit - Correct answer-Inadequate fluid intake Poor oral intake Inadequate IV fluid replacement Excessive fluid or sodium losses: Gastrointestinal losses Excessive diaphoresis Prolonged hyperventilation Hemorrhage Nephrosis Diabetes mellitus Diabetes insipidus Burns Open wounds Ascites Effusions Excessive use of diuretics Osmotic diuresis Deydration Manisfestations - Correct answer-thirst, altered level of consciousness, hypotension, tachycardia, weak and thready pulse, flat jugular veins, dry mucous membranes, decreased skin turgor, oliguria, weight loss, and sunken fontanelles Cancer Benign - Correct answer-Slow, progressive, localized, well defined, resembles host (more differentiated), grows by expansion, does not usually cause death Cancer Malignant - Correct answer-Rapid growing, spreads (metastasis) quickly, fatal, highly undifferentiated Sodium - Correct answer-Normal range: 135-145 mEq/L. • Most significant cation and prevalent electrolyte of extracellular fluid. • Controls serum osmolality and water balance. Plays a role in acid-base balance. • Facilitates muscles and nerve impulses. • Main source is dietary intake. • Excreted through the kidneys and gastrointestinal tract. Hypernatremia - Correct answer-Sodium 145 mEq/L Serum osmolarity increases • Results in fluid shifts Causes of Hypernatremia - Correct answer-Excessive sodium ingestion Hypertonic IV saline (3% saline) administration Cushing's syndrome Corticosteroid use Diarrhea Excessive sweating Prolonged episode of hyperventilation Diuretic use Diabetes insipidus Decreased water ingestion Loss of thirst sensation Inability to drink water Third spacing Vomiting Hypernatremia Manifestations: - Correct answer-increased temperature, warm and flushed skin, dry and sticky mucous membranes, dysphagia, increased thirst, irritability, agitation, weakness, headache, seizures, lethargy, coma, blood pressure changes, tachycardia, weak and thready pulse, edema, and decreased urine output Hyponatremia - Correct answer-Sodium 135 mEq/L Serum osmolarity decreases Causes of Hyponatremia - Correct answer-Deficient sodium Diuretic use Gastrointestinal losses Excessive sweating Insufficient aldosterone levels Adrenal insufficiency Dietary sodium restrictions Excessive water Hypotonic intravenous saline (0.45% saline) Hyperglycemia Excessive water ingestion Renal failure Syndrome of inappropriate antidiuretic hormone Heart failure Hyponatremia Manifestations: - Correct answer-anorexia, gastrointestinal upset, poor skin turgor, dry mucous membranes, blood pressure changes, pulse changes, edema, headache, lethargy, confusion, diminished deep tendon reflexes, muscle weakness seizures, and coma Hyponatremia Treatment: - Correct answer-limit fluids and increase dietary sodium Chloride - Correct answer-Normal range: 98-108 mEq/L Mineral electrolyte Major extracellular anion Found in gastric secretions, pancreatic juices, bile, and cerebrospinal fluid Plays a role in acid-base balance Main source is dietary intake Excreted through the kidneys Hyperchloremia - Correct answer-Chloride 108 mEq/L Hyperchloremia Causes - Correct answer-Increased chloride intake or exchange: hypernatremia, hypertonic intravenous solution, metabolic acidosis, and hyperkalemia Decreased chloride excretion: hyperparathyroidism, hyperaldosteronism, and renal failure Hypochloremia - Correct answer-Chloride 98 mEq/L Hypochloremia Causes - Correct answer-Decreased chloride intake or exchange: hyponatremia, administration of 5% dextrose in water intravenous solution, water intoxication, and hypokalemia Increased chloride excretion: diuretics, vomiting, metabolic alkalosis, and other gastrointestinal losses Hypochloremia Treatment: - Correct answer-identify and manage underlying cause, sodium replacement (oral or intravenous), ammonium chloride, and saline irrigation of gastric tubes Potassium - Correct answer-Normal range: 3.5-5 mEq/L. The primary intracellular cation. Plays a role in electrical conduction, acid-base balance, and metabolism. Main source is dietary intake. Excreted through the kidneys and gastrointestinal tract. Serum potassium cannot fluctuate much without causing serious issue. Hyperkalemia - Correct answer-Potassium 5 mEq/L Hyperkalemia Causes - Correct answer-Deficient excretion: renal failure, Addison's disease, certain medications, and Gordon's syndrome Excessive intake: oral potassium supplements, salt substitutes, and rapid intravenous administration of diluted potassium Increased release from cells: acidosis, blood transfusions, and burns or any other cellular injuries Hyperkalemia Manifestions: - Correct answer-paresthesia, muscle weakness, flaccid paralysis, bradycardia, dysrhythmias, electrocardiogram changes, cardiac arrest, respiratory depression, abdominal cramping, nausea, and diarrhea Hyperkalemia Treatment: - Correct answer-Correct acidosis, usually with sodium bicarbonate Calcium gluconate to minimize dysrhythmias Decrease dietary potassium intake Increase excretion by Dialysis Kayexalate Intravenous fluids Potassium-losing diuretics Facilitate cellular exchange Insulin Hypokalemia - Correct answer-Potassium 3.5 mEq/L Hypokalemia Causes - Correct answer-Excessive loss: vomiting, diarrhea, nasogastric suctioning, fistulas, laxatives, potassium-losing diuretics, Cushing's syndrome, and corticosteroids Deficient intake: malnutrition, extreme dieting, and alcoholism Increased shift into the cell: alkalosis and insulin excess Hypokalemia Manifestations: - Correct answer-muscle weakness, paresthesia, hyporeflexia, leg cramps, weak and irregular pulse, hypotension, dysrhythmias, electrocardiogram changes, decreased bowel sounds, abdominal distension, constipation, ileus, and cardiac arrest Hypokalemia Treatment: - Correct answer-identify and manage underlying cause along with potassium replacement (oral or intravenous) Calcium - Correct answer-Normal range: 4-5 mEq/L Mostly found in the bone and teeth Plays a role in blood clotting, hormone secretion, receptor functions, nerve transmission, and muscular contraction Has inverse relationship with phosphorus Has synergistic relationship with magnesium Main source is dietary intake. Vitamin D aids absorption. Regulated by Vitamin K Parathyroid hormone Calcitonin Hypercalcemia - Correct answer-Calcium 5 mEq/L Hypercalcemia Causes: - Correct answer-Increased intake or release: calcium antacids, calcium supplements, cancer, immobilization, corticosteroids, vitamin D deficiency, and hypophosphatemia Deficit excretion: renal failure, thiazide diuretics, and hyperparathyroidism Hypercalcemia Manifestations: - Correct answer-dysrhythmias, electrocardiogram changes, personality changes, confusion, decreased memory, headache, lethargy, stupor, coma, muscle weakness, decreased deep tendon reflexes, anorexia, nausea, vomiting, constipation, abdominal pain, pancreatitis, renal calculi, polyuria, and dehydration Hypercalcemia Treatment: - Correct answer-Identify and manage underlying cause Manage symptoms Phosphate Increase mobility Calcitonin Intravenous fluids Diuretics Hypocalcemia - Correct answer-Calcium 4 mEq/L Hypocalcemia Causes - Correct answer-Excessive losses: hypoparathyroidism, renal failure, hyperphosphatemia, alkalosis, pancreatitis, laxatives, diarrhea, and other medications Deficient intake: decreased dietary intake, alcoholism, absorption disorders, and hypoalbuminemia Hypocalcemia Manifestations: - Correct answer-dysrhythmias, electrocardiogram changes, increased bleeding tendencies, anxiety, confusion, depression, irritability, fatigue, lethargy, paresthesia, increased deep tendon reflexes, tremors, muscle spasms, seizures, laryngeal spasms, increased bowel sounds, abdominal cramping, and positive Trousseau's and Chvostek's signs Нуросalcemia Treatment - Correct answer-Identify and manage underlying cause Calcium replacement (oral or intravenous) Vitamin D Decrease phosphorus Phosphorus - Correct answer-Normal range: 2.5-4.5 mg/dL. Mostly found in the bones; small amounts are in the bloodstream. Plays a role in bone and tooth mineralization, cellular metabolism, acid base balance, and cell membrane formation. Main source is dietary intake. Excreted through the kidneys. Hyperphosphatemia - Correct answer-Phosphorus 4.5 mg/dL Hyperphosphatemia Causes - Correct answer-Deficient excretion: renal failure, hypoparathyroidism, adrenal insufficiency, hypothyroidism, and laxatives Excessive intake or cellular exchange: cellular damage, hypocalcemia, and acidosis Hypophosphatemia - Correct answer-Phosphorus 2.5 mg/dL Hypophosphatemia Causes - Correct answer-Excessive excretion or cellular exchange: renal failure, hyperparathyroidism, and alkalosis Deficient intake: malabsorption, vitamin D deficiency, magnesium and aluminum antacids, alcoholism, and decreased dietary intake Hypophosphatemia Treatment: - Correct answer-Identify and manage the underlying cause Phosphorus replacement (oral or intravenous) Magnesium - Correct answer-Normal range: 1.8-2.5 mEq/L. An intracellular cation. Mostly stored in the bone and muscle. Plays a role in muscle and nerve function, cardiac rhythm, immune function, bone strength, blood glucose management, blood pressure, energy metabolism, and protein synthesis. Main source is dietary intake. Excreted through the kidneys. Hypermagnesemia - Correct answer-Magnesium 2.5 mEq/L Hypomagnesemia - Correct answer-Magnesium 1.8 mEq/L Hypomagnesemia Treatment: - Correct answer-magnesium replacement (oral or intravenous) Signs of Inflammation: - Correct answer-redness, heat, swelling, pain, loss of function Hypersensitivity - Correct answer-Inflated response to antigen Leads to inflammation, which destroys healthy tissue Can be immediate or delayed Hypersensitivity types: - Correct answer-Type I: IgE mediated Type II: cytotoxic hypersensitivity reaction Type III: immune complex-mediated Type IV: delayed hypersensitivity reaction Type I, IgE mediated - Correct answer-Produces an immediate response. Local or systemic. Allergen activates T-helper cells that stimulate B cells to produce IgE. -IgE coats mast cells and basophils, sensitizing them to the allergen. At next exposure, the antigen binds with the surface IgE, releasing mediators and triggering the complement system. Repeated exposure to large doses of allergen is necessary to cause this response. Type I, IgE mediated Examples: - Correct answer-Hay fever, food allergies, and anaphylaxis Type I, IgE mediated Treatment - Correct answer-includes epinephrine, antihistamines, corticosteroids, and desensitizing injections. Type II, cytotoxic hypersensitivity reaction - Correct answer-IgG or IgM type antibodies bind to antigen on individual's own cells. Antigen may be intrinsic or extrinsic. Recognition of these cells by macrophages triggers antibody production. Lysis of cells occurs because of the activation of the complement and by phagocytosis. Usually immediate responses. Type II, cytotoxic hypersensitivity reaction Examples: - Correct answer-Blood transfusion reaction and erythroblastosis Type II, cytotoxic hypersensitivity reaction Treatment - Correct answer-includes ensuring blood compatibility (transfusion) and administering medication to prevent maternal antibody development (Rho[D]). Type III, immune complex-mediated hypersensitivity reaction - Correct answerCirculating antigen antibody complexes accumulate and are deposited in the tissue. Triggers the complement system, causing inflammation. Type III, immune complex-mediated hypersensitivity reaction Example: - Correct answer-Autoimmune conditions (e.g., systemic lupus erythematosus) Type III and Type IV: Treatment - Correct answer-is disease specific. Type IV, delayed hypersensitivity reaction - Correct answer-Cell-mediated rather than antibody-mediated involving the T cells. Antigen presentation results in cytokine release, leading to inflammation. Causes severe tissue injury and fibrosis Type IV, delayed hypersensitivity reaction Examples: - Correct answer-Tuberculin skin testing, transplant reactions, and contact dermatitis Immunodeficiency - Correct answer-Diminished or absent immune response Renders the person susceptible to disease normally prevented Opportunistic infections May be acute or chronic Classifications Primary Secondary HIV - Correct answer-Parasitic retrovirus that infects CD4 and macrophages upon entry In the US, rates rising among women and African Americans Transmission Blood and bodily fluids HIV Type 1 - Correct answer-is the most common strain. HIV Type 2 - Correct answer-is more common in West Africa; progresses to disease more slowly. Verrucae - Correct answer-Warts caused by a number of human papillomaviruses. Can develop at any age and often resolve spontaneously. Transmitted through direct skin contact between people or within the same person. The human papillomavirus replicates in the skin cells, causing irregular thickening. Varying color, shape, and texture depending on type Herpes simplex type 1 - Correct answer-Typically affects the lips, mouth, and face. Usually begins in childhood. Can involve the eyes, leading to conjunctivitis. Can result in meningoencephalitis. Transmitted by contact with infected saliva. The primary infection may be asymptomatic. After the primary infection, the virus remains dormant in the sensory nerve ganglion to the trigeminal nerve until it is reactivated. Reactivation may be a result of an infection, stress, or sun exposure. When reactivated, causes painful blisters or ulcerations that are preceded by a burning or tingling sensation. The lesions resolve spontaneously within 3 weeks, but healing can be accelerated with administration of oral or topical antiviral agents. Herpes zoster (shingles) - Correct answer-Caused by the varicella-zoster virus. Appears in adulthood years after a primary infection of varicella in childhood. The virus lies dormant on a cranial nerve or a spinal nerve dermatome until it is activated years later. The virus affects this nerve only, giving the condition its typical unilateral manifestations. Herpes zoster (shingles) Manifestations: - Correct answer-pain, paresthesia, a red or silvery vesicular rash that develops in a line over the area innervated by the affected nerve (one side of the head or torso), extremely sensitive skin, and pruritis. The rash may persist for weeks to months. Herpes zoster (shingles) Complications: Treatment: - Correct answer-neuralgia and blindness. antivirals, antidepressants, and anticonvulsants. Parasitic Infections Tinea - Correct answer-Causes several types of superficial fungal infections. These fungi typically grow in warm, moist places (e.g., showers). Typically manifests as a circular, erythematous rash accompanied by pruritus and burning. Tinea capitis: - Correct answer-involving the scalp. Common in school-aged children. Hair loss at the site is common. Tinea corporis: - Correct answer-involving the body Tinea pedis: - Correct answer-involving the feet, especially the toes Tinea unguium: - Correct answer-involving the nails, typically the toenails Begins at the tip of one or two nails and then usually spreads to other nails Turns nails white and then brown, causing them to thicken and crack Treatment: topical and systemic antifungal agents Bacterial Infections Impetigo - Correct answer-Common and highly contagious. Can occur without an apparent skin breach, but typically arises from a break in the skin. Lesions usually begin as small vesicles that enlarge and rupture, forming the characteristic honey-colored crust. Can spread throughout the body through selftransfer of the exudate. Typically caused by staphylococci, which produce a toxin that attacks collagen and promotes spread. Other manifestations: pruritus and lymphadenopathy. Psoriasis (1 - Correct answer-Common chronic inflammatory condition that affects skin cell life cycle. Cellular proliferation is significantly increased, causing cells to build up too rapidly on the skin's surface. Normally takes weeks, but occurs over 3-4 days with psoriasis. Buildup leads to thickening of the dermis and epidermis because dead cells cannot shed fast enough. The exact cause is unknown, but it is thought to be multifactorial (environmental, genetic, and immunological factors play a role). It can also be a result of an autoimmune in which T lymphocytes mistake process normal skin cells as foreign. family tendency is observed. Onset is most frequently between 15 and 35 years of age, and may be sudden or gradual. Patient usually experiences remissions and exacerbations. Factors that trigger an exacerbation: bacteria or viral infections in any location, dry air or dry skin, skin injuries, certain medicines (e.g., antimalaria agents, beta-blockers, and lithium), stress, too little or too much sunlight, and excessive alcohol consumption. Severity varies. May also have arthritis-psoriatic arthritis. May be severe in persons who have a weakened immune system. Begins as a small, red papule. Papules most often occur on the elbows, knees, and trunk, but they can appear anywhere. Papules develop into one of the following lesions: Erythrodermic: intense erythema that covers a large area Guttate: small, pink-red spots Inverse: erythema and irritation that occurs in the armpits, groin, and skin folds Plaque: thick, red patches covered by flaky, silver-white scales (the most common type) Pustular: white blisters surrounded by red, irritated skin