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NYCPM Physiology > Quiz 3 Cases > Flashcards

Quiz 3 Cases Flashcards

1
Q

Case 40 pneumonia: What is his chief complaint?

A

Fever and chills. The patient has an unproductive cough and shortness of breath upon exertion.

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2
Q

Case 40 pneumonia: What significant thing has been happening in the last week? What else in his history might be contributory?

A

Fever and chills that have persisted for one week. He has been working in cold weather and is under stress.

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3
Q

Case 40 pneumonia: What are off in his vital signs?

A

Temperature and respiration are high.

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4
Q

Case 40 pneumonia: What was the problem with deep breaths?

A

There is dyspnea during deep breaths

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5
Q

Case 40 pneumonia: Altered breath sounds: is pneumonia more likely to result in consolidation of distant breath sounds? Explain. What causes the dullness to percussion?

A

Dullness to percussion is caused by fluid accumulation in the lungs.

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6
Q

case 40 pneumonia: Explain the effect on pulse oximetry. By “90% saturation”, what is saturated by what?

A

Oxygen is saturated by hemoglobin.

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7
Q

Case 40 pneumonia What causes the fever and the chills?

A

Fever is caused by inflammatory responses (particularly cytokines) to bacteria crossing into the alveoli

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8
Q

Case 40 pneumonia: Explain what the spirometers results would have been and why for tidal volume, vital capacity, FEV1

A

Spirometers would show low tidal volume and low vital capacity, but the FEV1 would be normal.

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9
Q

case 41 brain injury: What does the decerebrate posture indicate?

A

Damage to the brainstem.

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10
Q

case 41 brain injury: What causes decerebrate posture?

A

Have cut off the inhibitory input from the basal nuclei and the substantia nigra (removal of all inhibitory descending inputs onto the spinal cord alpha motor neurons), which are motor control areas. Exciting basal nuclei causes relaxation of the muscles. If have all the downward anti-gravity extensor rigidity (increased muscle tone), will not be able to move.

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11
Q

case 41 brain injury: What is an epidural hematoma?

A

Bleeding between the inside of the skull and the outside of the dura. It causes pressure on the brainstem and its arterial supply and in damage to the brainstem.

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12
Q

case 41 brain injury: What is the ARAS? What is its function?

A

Ascending reticular activating system (is located in the brainstem), controls arousal and attentiveness

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13
Q

case 41 brain injury: What is the Glasgow coma scale?

A

Associating the function of verbal command and motor function. His was 3, there is no lower score than that.

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14
Q

case 41 brain injury: VS: Where is the most likely damage site causing low T? Low pulse, respiration, BP, pulse pressure?

A

Nuclei in the medulla oblongata regulate autonomic nervous system output to the cardiovascular system and control respiration.

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15
Q

case 41 brain injury: What is decerebrate posture?

A

A posture in which the arms are extended and the fingers flexed. It indicates damage to the brainstem and results from the removal of all inhibitory descending inputs onto the spinal cord alpha motor neurons.

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16
Q

case 41 brain injury: What gives one 3 on the Glasgow Coma scale? That plus pupils fixed and dilated is indicative of what? (Provided it is not a possibly reversible trauma or swelling).

A

A complete lack of function (function of eyes, response to verbal commands, and motor function). The absence of pupillary reaction to light (pupils fixed) and dilation indicate loss of function of the optic nerve, the oculomotor nerve or the brainstem. The combination of Glasgow coma score of 3 and pupils fixed and dilated is indicative of brain death.

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17
Q

case 41 brain injury: Fracture of his temporal bone likely caused what sequence resulting in damage to the brain stem?

A

The fracture of temporal bone produced a tear in the middle meninges artery of the dura. The arterial hemorrhage can produce an epidural hematoma that expands rapidly. This can result in herniation of the temporal lobes, resulting in pressure on the brain stem and its arterial supply and in damage to the brain stem.

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18
Q

case 41 brain injury: What are the neurons that comprise the ascending reticular activating system (ARAS or just RAS)?

A

Interspersed among the tracts and nuclei of the brainstem are neurons that collectively are known as the ascending reticular activating system.

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19
Q

case 41 brain injury: What does decerebrate posture indicate and what does it result from?

A

Decerebrate posture indicates damage to the brain stem and results from the removal of all inhibitory descending inputs onto the spinal cord alpha motor neurons.

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20
Q

case 42 hemianopsia: Which nerves (nasal or temporal) cross to contralateral at the optic tract? Which one remains ipsilateral?

A

Nerve from nasal side cross to contralateral optic tract and the temporal remain ipsilateral optic tract.

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21
Q

case 42 hemianopsia: What would a defect in both nasal and temporal visual fields of one eye indicate and why

A

A defect in both the nasal and temporal visual fiends of one eye indicates that the damage occurred in the optic nerve before the optic chiasm, because that is the only time those fibers travel I nthe same structure.

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22
Q

case 42 hemianopsia: What in the visual defect that people with bitemporal hemianopsia experience? Which part of the optic tract does this indicate a problem in?

A

Loss of vision in temporal side (peripheral vision) of both sides and is indicative of the optic chiasm (between the optic chiasm and the visual cortex).

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23
Q

case 42 hemianopsia: What does the MRI show and how does it explain the patient’s condition?

A

A tumor that compresses the optic chiasm. It was an intervenal tumor. The most common is a prolactin-secreting tumor (pituitary tumor)

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24
Q

case 42 hemianopsia: What is the pathway of visual sensory information to the brain?

A

Retina, optic chiasm, thalamus, lateral geniculate nucleus, primary visual cortex, occipital lobe

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25
Q

case 42 hemianopsia: In what specific way might his visual problem contribute to his having an accident

A

Loss of peripheral vision prevented the patient from noticing another car in the intersection

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26
Q

case 42 hemianopsia: Can you think of possible contributing factors to his accident besides the visual problem?

A

The lunesta may have been taken prior to the accident, making the patient fatigued.

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27
Q

case 42 hemianopsia: What is the Goldman field examination and what does it show in his case?

A

The Goldman field examination involves testing peripheral vision by moving a ray of light from the center to the perimeter.

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28
Q

case 42 hemianopsia: What does the MRI show?

A

The MRI shows a pituitary gland compressing the optic chiasm.

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29
Q

case 42 hemianopsia: Is bitemporal hemianopsia a homologous or heterozygous deficit? Explain

A

It is a heteronymous deficit. The visual fields in each eye are different.

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30
Q

case 42 hemianopsia: A deficit affecting one eye can be a problem where?

A

Localization of the deficit to the visual field of only one eye indicates a problem with the retinal receptors or the optic nerve of that eye.

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31
Q

case 42 hemianopsia: A deficit affecting the chiasm causes what kind of deficit of which fibers?

A

Loss of vision on temporal sides of the visual fields of both eyes is indicative of a problem at the optic chiasm

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32
Q

case 42 hemianopsia: Complete deficits of the right or left visual field indicates damage where?

A

Complete defects in the left or right visual space indicate damage to the nerves between the optic chiasm and the visual cortex. These defects can be in the optic tract, in the lateral geniculate body of the thalamus, in the optic radiation or within the visual cortex

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33
Q

case 45 epilepsy What are the patient’s symptoms tied to?

A

The patient suffered a head injury while playing sports 6 months earlier

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34
Q

case 45 epilepsy What is the slowest brain wave? Which waves are associated with emotional stress?

A

High amplitude delta waves (occur during slow wave sleep). Theta waves are associated with emotional stress

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35
Q

case 45 epilepsy: What does the abnormal neural activity associated with epilepsy cause?

A

Epilepsy results from the excessive activity in clusters of neurons. It causes strange sensations, emotions and behaviors, possibly causing muscle spasms and loss of consciousness

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36
Q

case 45 epilepsy: What is the difference between partial and generalized seizures?

A

Partial seizures are localized to just one area of the brain and rarely result in the loss of consciousness. Generalized seizures involve all areas of the brain, creating large amplitude and often repetitive Bain wave activity.

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37
Q

case 45 epilepsy: What treatments are used for seizures?

A

Anti epileptic drugs, surgery, vagal nerve stimulation, a ketogenic diet.

38
Q

case 45 epilepsy: What causes the EEG measured where?

A

The EEG in the patient is normal because the abnormal brain wave activity only occurs during seizures and not during the interval between seizures.

39
Q

case 45 epilepsy: What is he complaining of?

A

Sporadic loss of memory.

40
Q

case 45 epilepsy: What do his classmates report?

A

He begins smacking his lips and fumbling around, disrupting the class.

41
Q

case 45 epilepsy: What symptoms does he heave after a seizure besides not remembering his seizure?

A

He is confused and disoriented.

42
Q

case 45 epilepsy: What 4 normal brain waves were discussed, at what eps (cycles/sec = Hertz), characterized by what?

A

Delta waves are the slowest, 3.5 cycles/sec, and are during sleep. THe that waves have an amplitude of 4 – 7 cycles/sec and are associated with emotional stress. Alpha waves are 8 – 13 cycles/sec and are due to rhythmic feedback oscillation in the thalamic cortical system, they are associated with a quiet and awake period. Beta waves are 14 – 80 cycles/sec and represent when the brain is alert and processing sensory input

43
Q

case 45 epilepsy: His absence seizures would be characterized as generalized versus partial by what criterion with respect to consciousness?

A

Since the patient looses consciousness during the seizures, he has generalized seizures.

44
Q

case 45 epilepsy: What is his EEG lie at the time of this case and when do the abnormal brain waves occur?

A

His EEG is normal, and the abnormal brain waves occur when he has a seizure.

45
Q

case 47 stroke: What is the patient’s main complaint and relevant history?

A

Difficulty speaking and can only communicate in blocking. He is on beta blockers for hypertension and has type II diabetes

46
Q

case 47 stroke: What did the CT show? What was his diagnosis?

A

Occlusion of the left hemisphere supplying the frontal cortex. Diagnosis was an aphasia of stroke

47
Q

case 47 stroke: What is the difference between ischemic stroke and a hemorrhagic stroke? Why is a stroke bad in a patient?

A

Ischemic stroke is caused by a thrombus or embolus that lodges in a small branch of cerebral blood vessels. Hemorrhagic stroke is caused by a rupture of a blood vessels, usually at the site of aneurysm.

48
Q

case 47 stroke: Where are Broca’s area and Wernicke’s area located?

A

The left hemisphere

49
Q

case 47 stroke: What treatment did the patient receive?

A

Thrombolytics (tissue plasminogen activator)

50
Q

case 47 stroke: What is his difficulty? Does he have equal difficulty with all communication

A

He is unable to speak clearly, but is able to communicate in writing.

51
Q

case 47 stroke: From the physical exam, is his language perception impaired

A

No, he is able to respond to spoken commands

52
Q

case 47 stroke: From the CT scan, a vessel occlusion affected which part of the cortex? Did it affect both hemispheres equally

A

Occlusion of the left hemisphere of a branch of the anterior main division of the middle cerebral artery supplying the frontal cortex. It only affects the left hemisphere

53
Q

case 47 stroke: Strokes or cerebral vascular incidents can be caused by what 2 general conditions

A

Ischemic stroke is caused by a thrombus or embolus that lodges in a small branch of cerebral blood vessels. Hemorrhagic stroke is caused by rupture of a blood vessel, usually at the site of an aneurysm. In both cases, blood supply to the neurons distal to the injury is interrupted.

54
Q

case 47 stroke: In case of a blockage, what can be done to restore blood flow

A

Treatment involves rapid identification of the site of blockage and restoration of blood flow by stunting or treatment with thrombolytics

55
Q

case 47 stroke: What are listed as risk factors for stroke? Can you guess what the problem is with atrial fibrillation?

A

Advanced age, hypertension, diabetes, enhanced coagulation and atrial fibrillation (increased blood flow

56
Q

case 47 stroke: Since most strokes are from thromboembolic conditions, what may be done for the condition? (Hypertension)

A

Prescribe blood thinners, antiplatelet agents and anticoagulants

57
Q

case 47 stroke: What named area is most likely involved in this problem and where is it located

A

Broca’s area and motor areas of the cortex (a region of the posterior lateral prefrontal cortex and the premotor area)

58
Q

case 47 stroke: What named area (often considered to be in the emporia like lobe) is a language comprehension area? Are these language areas usually bilaterally represented? Where are they usually

A

Wernicke’s area, and they are usually only in the left hemisphere.

59
Q

case 47 stroke: How was this patient treated

A

The patient was treated with tissue plasminogen activator and restored flow through the blocked blood vessel. They were also prescribed anticoagulants

60
Q

case 56 pancreatits: How does the patient describe his condition today? What is the immediate cause of his condition

A

An abrupt, severe epigastric pain. He is brought in because of an attack of pain in his epigastric region after an afternoon drinking binge

61
Q

case 56 pancreatitis: Why is his T high? What in his immediate history might contribute to his pulse pressure problem

A

The drinking may have caused a depressant effect on his pulse pressure, and the increased temperature may be due to an inflammation or from strong sympathetic activation, including sweating.

62
Q

case 56 pancreatitis: Why is his stool sample. Fatty? Why is his bilirubin high? Part of it: structuring of common bile duct from edema and fibrosis which can lead to the bilirubin being heigh -> post hepatic jaundice.

A

The pancreas is not secreting digestive enzymes lipase which are responsible for digesting fats due to damage to the pancreatic cells. Bilirubin is high

63
Q

case 56 pancreatitis: Why is his glucose high

A

The pancreas is not functioning correctly and the insulin is not being released

64
Q

case 56 pancreatitis: In acute pancreatitis, what do activation of digestive enzymes while in the pancreatic duct or pancreatic tissues cause? How does duodenal enterokinase normally contribute to proteolytic enzyme activation in the appropriate place?

A

The digestion of the pancreatic tissues results in a severe egastric pain. The pain intensity increases when walking or lying flat and diminishes when sitting upright or leaning forward. Duodenal enterokinase converted to trypsinogen to trypsin.

65
Q

case 56 pancreatitis: What do you think causes vascular volume deprecation here? How can that affect his blood BUN, proteinuria and granular casts in urine?

A

Vascular volume depletion results in a drop in arterial blood pressure. The hypotension can result in acute tubular necrosis. Consequently, BUN are elevated and the urine can show proteins and granular cysts.

66
Q

case 61 diabetes: List 5 of his recent signs/symptoms

A

Loss of weight, increase in appetite, increase in thirst (polydipsia), does not feel well/tired (general malaise), has to pee a lot (polyuria)

67
Q

case 61 diabetes: Why does he have decreased skin turgor

A

Dehydration

68
Q

case 61 diabetes Loss of weight combined with an increase in appetite could be either an increase in metabolic consumption or decrease in metabolic substrate availability. In his case, which is it? (The combo of inactivity and tiredness suggest the interpretation).

A

Decrease in metabolic substrate availability due to feelings of tiredness and inactivity.

69
Q

case 61 diabetes: Correction: p. 165, 1st column, last line, change to “high volume, acidic urine.” Dilute? No! What are listed as consistent with type I diabetes mellitus?

A

Acidic urine, positive glucose, positive ketones

70
Q

case 61 diabetes What is the most powerful stimulus for insulin release

A

An increase in plasma glucose.

71
Q

case 61 diabetes: What are some additional insulin releases that are stimulated by a carbohydrate meal

A

Increase in CCK and GRP.

72
Q

case 61 diabetes: What does insulin do to blood glucose and how? What 2 tissues are mentioned as particularly affected by GLUT-4 transporters?

A

Insulin decreases blood glucose by stimulating glucose uptake by skeletal muscle and adipose tissue by increasing the number of functional GLUT-4 transport proteins on the cell membrane

73
Q

case 61 diabetes: How is autoimmunity considered causal in type I diabetes mellitus? Besides monitoring plasma insulin levels, what can be used as a measure of insulin production?

A

There appears to be an autoimmune destruction specifically of the pancreatic beta cells. Insulin production can be monitored by both plasma insulin levels and by the presence of the C peptide fragment of the pro hormone

74
Q

case 61 diabetes: What can the shift to free fatty acids as fuel lead to in diabetics? What kind of breath order can occur?

A

Mitochondria shift to free fatty acids as a metabolic fuel, generating ketones from the beta oxidation of fatty acids

75
Q

case 61 diabetes: Is the GLUT-3 transporter that most of the brain uses insulin dependent? What does the fact that the brain satiety center uses an insulin-dependent glucose transporter lead to in diabetes mellitus?

A

The GLUT-3 transporter is insulin insensitive. The brain satiety center, however, has an insulin dependent glucose transporter. The lack of insulin is interpreted as a decrease in blood glucose levels, leading to the hunger and polyphagia characteristic of diabetes mellitus

76
Q

case 61 diabetes: How can elevated blood glucose lead to an osmotic dieresis

A

Elevated glucose levels result because the kidney may filter more glucose than can effectively be reabsorbed, and glucose may be lost in the urine. The glucose acts as an osmotic particle in the urine, leading to an osmotic dieresis

77
Q

case 61 diabetes The acid base imbalance has what effect on breathing and urine

A

The metabolic acidosis stimulates ventilation (respiration is elevated) and results in the excretion of a highly acidic urine. The urine also tests positive for ketones, indicating a shift to fatty acids as a metabolic substrate

78
Q

case 75 hyperprolactinemia What does the patient come in for? What is responsible for his vision problems and headaches?

A

The patient comes in for decrease in sexual desire, erectile dysfunction, visual problems and headaches

79
Q

case 75 hyperprolactinemia: What are the names and meanings of the 3 features noted in the physical exam

A

Small amount of growth of the breath (gynecomastia) stimulation of the nipples produces a small amount of milk (galactorrhea), testicular size is small (hypogonadism).

80
Q

case 75 hyperprolactinemia How are his testosterone levels abnormal and why, whereas his prolactin levels are in the opposite direction

A

Testosterone levels are low due a decreased size of the testicles

81
Q

case 75 hyperprolactinemia: What did the pituitary MRI show

A

Macroprolactinoma

82
Q

case 75 hyperprolactinemia: What does decreased libido and hypogonadism suggest and what does galactorrhea indicate

A

It suggests a drop in testosterone levels. Galactorrhea indicates an elevated prolactin level.

83
Q

case 75 hyperprolactinemia: Explain how elevated prolactin has an effect on testosterone and testicular size

A

Prolactin decreases testosterone and testicular size.

84
Q

case 75 hyperprolactinemia: In nursing mothers, what is the correlation between prolactin and ovulation?

A

Elevated prolactin suppresses GnRH, FSH and LH, which contribute to the suppression of ovulation that is seen in nursing mothers.

85
Q

case 75 hyperprolactinemia: What is the name of the visual field defect he has and why?

A

As a pituitary tumor increases in size, it begins to compress the optic chiasm, creative a characteristic visual field defect (bilateral temporal hemianopia).

86
Q

case 75 hyperprolactinemia What class of agents can be used to inhibit prolactin secretion and perhaps reduce tumor size? How is this related to natural prolactin inhibition? What are two other possible treatments if the chemical agents don’t work?

A

Dopamine receptor agonists, such as broom riptide messy slate or cabergoline, may inhibit prolactin secretion and reduce tumor size

87
Q

case 76 panhypopitutarism: Why did they do a pregnancy test on her

A

Due to lactation and gain in weight

88
Q

case 76 panhypopituitarism: In what way are 3 pituitary hormone levels abnormal, as well as thyroid hormones, and why?

A

FSH, LH, Cortisol, T4, T3 and prolactin are abnormal

89
Q

case 76 panhypopituitarism: Explain why prolactin does not follow the pattern of the others.

A

Prolactin is predominantly controlled by an inhibitory hypothalamic peptide, prolactin inhibitory hormone (dopamine). Thyroid hormone is controlled by thyroid hormone releasing hormone. FSH and LH are controlled by gonadotropin releasing hormone. Growth hormone is under ducal control by both growth hormone releasing hormone and a growth hormone and inhibiting hormone (somatostatin).

90
Q

case 76 hypopituitarism: What does the name of the diagnosis mean?

A

Several of the hormones in the pituitary gland are low.

91
Q

case 76 hypopituitarism:

What is the other pituitary hormone besides prolactin that has an inhibiting hormone from the hypothalamus? What would one have to know about normal balance to determine whether hormone levels in this patient are increased or decreased in this patient (no mention is made in the case)?
A

Growth hormone

92
Q

case 76 hypopituitarism: What indication is there that the posterior pituitary is most likely affected? Explain

A

The other hormones are decreased and prolactin production is increased.

NYCPM Physiology (17 decks)

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