Final Flashcards
(248 cards)
1
Q
Where are the kidneys located?
A
Behind the peritoneal cavity
2
Q
What is “parenchymal tissue”?
A
Functional tissue (ie the nephron in the kidneys)
3
Q
What is the outer and inner layer of the kidney called?
A
Outer=cortex. Inner=medulla
4
Q
What is the costovertebral angle tenderness test?
A
It tests for kidney inflammation by percussing on the area of the back that is over the kidneys
5
Q
What are two by-products of metabolism that are excreted by the kidneys?
A
Urea and creatinine
6
Q
What does the glomerulus do?
A
Filters waste products from blood
7
Q
What happens in the urinary system if a man’s prostate is swollen?
A
It becomes difficult to urinate
8
Q
What dietary factor can lead to repeated UTIs in some people?
A
High sodium diet
9
Q
What is isosthenuria? What does it indicate?
A
The secretion of urine that has not been concentrated by the kidneys. It indicates renal tubular damage.
10
Q
What does the BUN test measure?
A
The amount of nitrogen from urea in the body (so if kidneys are not removing urea adequately, this number will rise)
11
Q
Why is the BUN elevated in dehydration?
A
Because there is not adequate fluid in the body to remove waste products
12
Q
What does a serum creatinine test measure?
A
The amount of creatinine in the blood (and how well the kidneys are filtering creatinine out of the blood)
13
Q
What is the creatinine clearance rate?
A
The volume of blood plasma that is cleared of creatinine per unit of time
14
Q
What is creatinine clearance a good indicator of?
A
Glomerular filtration rate
15
Q
What does the uric acid serum test look for?
A
The amount of uric acid in the blood
16
Q
What does a high uric acid level indicate?
A
That the kidneys are not removing uric acid fast enough
17
Q
What do high levels of uric acid cause?
A
Gout
18
Q
How long does urine have to be collected for the urine uric acid test?
A
24 hours
19
Q
Uric acid is a byproduct of the breakdown of what substances?
A
Purines
20
Q
When is it best to take a sample for a urinalysis?
A
First thing in the morning, before the patient pees anywhere else
21
Q
What is the specific gravity of distilled water?
A
1
22
Q
What happens to the specific gravity of urine in dehydration? Why?
A
It increases (greater that one) because the urine becomes more concentrated.
23
Q
What does the urine culture and sensitivity test look for?
A
It tests for the specific microorganisms in urine so that the appropriate antibiotic can be selected for
24
Q
How should the urine be collected for a urine culture and sensitivity test?
A
As a mid-stream sample
25
For how long should urine be collected in the creatinine clearance test?
24 hours
26
What is a pheochromocytoma and what does it do to the body?
An adrenal gland tumor that constantly secretes catecholamines, keeping the body in a constant stress response
27
What test tests for pheochromocytoma?
The VMA test
28
What should the pt avoid before the VMA test and for how long?
They should avoid stimulating drinks/foods/stress for at least 2 days prior to testing
29
What is the uric acid test used to diagnose?
Gout and kidney disease
30
What happens to the joints when high levels of uric acid build up?
Uric acid crystals form in them (this is gout)
31
What is a KUB test and what is it used to detect?
It is an x-ray test that is used to detect urinary calculi
32
What are urinary calculi?
Solid structures in the urinary tract (like kidney stones)
33
What is an intravenous pyelogram?
Dye is injected into the pt to view the urinary structures
34
What is a renal angiography?
A dye is injected into the kidneys via a catheter to view renal artery supply
35
What is a renal scan?
An IV injection of a radioactive substance to view renal blood flow
36
How long is a patient radioactive for after a renal scan?
24 hours
37
What does a voiding cystourethogram monitor for?
Backflow of urine
38
What is a UTI?
An infection anywhere in the urinary system
39
What is cystitis?
A bladder infection
40
What bacteria most commonly causes cystitis?
E. coli
41
What can menopausal women use to decrease the incidence of UTIs?
Estrogen creams
42
What is urosepsis commonly caused by?
An indwelling catheter
43
What can urosepsis lead to if not treated early on?
Septic shock
44
What is urethritis?
Inflammation of the urethra
45
What is urethritis commonly seen in conjunction with?
STDs
46
What is the most common symptom of urethritis in men and women?
Men=discharge. Women=abdominal discomfort.
47
What is ureteritis?
Inflammation of the ureter
48
What is pyelonephritis?
Inflammation of the kidney
49
What are three symptoms of acute pyelonephritis?
Fever, nausea, chills
50
What occurs in chronic pyelonephritis?
The kidney contracts and nephrons become replaced by scar tissue
51
What is azotemia?
Abnormally high levels of nitrogen in the blood, related to insufficient filtering by the kidneys
52
What is nephrolithiasis?
Kidney stones
53
How are kidney stones detected?
By KUB
54
What is urolithiasis?
Urinary tract stones
55
What are three symptoms of kidney stones?
Pain, obstruction, and ischemic change to the nephron (which can result in nephron death)
56
Why does dehydration increase the chances of developing kidney stones?
Because it concentrates the urine
57
Why should you strain the urine if someone has kidney stones?
So that they can be analyzed in the lab
58
What are calcium phosphate kidney stones caused by?
Excess calcium and phosphate in the urine
59
What diet is recommended for calcium phosphate kidney stones?
The acid ash diet
60
What nutrients should be avoided in the acid ash diet?
Calcium and Vitamin D
61
What are calcium oxalate stones caused by?
Excess calcium and oxalate
62
What diet should be used for calcium oxalate stones? What else should they avoid?
Acid ash diet. They should also avoid foods high in oxalate
63
What are three foods high in oxalate?
Chocolate, tea, beans
64
What are struvite stones caused by?
An excess of magnesium and ammonium phosphate
65
What diet is used to treat struvite stones?
Acid ash, and avoiding foods high in phosphate
66
Name three foods high in phosphate.
Red meat, whole grains, and dairy products
67
What are uric acid stones caused by?
Excess dietary purine or gout
68
What is the treatment for uric acid stones?
Alkaline ash diet, and decrease foods with purine
69
What are three purine-rich foods?
Organ meats, red wine, sardines
70
In what kind of urine do cystine stones form?
Acidic urine
71
What are cystine stones caused by?
Cystine crystal formation
72
What does the alkaline ash diet do to urine's pH?
Increases it
73
What are three things that a pt on the alkaline ash diet should eat?
Milk, fruit, and most veggies
74
What three fruits should a pt on the alkaline ash diet avoid?
Plums, cranberries and prunes
75
What are three foods someone on the acid ash diet should eat?
Plums, cheese, fish
76
Carbonated beverages should be avoided by someone on which diet?
Acid ash
77
What is a cytoscopy?
A procedure in which a scope is inserted into the urinary tract to look for and/or dislodge a kidney stone
78
What is extracorporeal shock wave lithotripsy?
A noninvasive procedure that uses sound waves to break kidney stones into tiny pieces so that they can be more easily passed out of the urinary tract
79
What is a percutaneous lithotripsy?
A hollow tube is inserted into the kidney and then ultrasonic waves are used to break up kidney stones; the stone is then removed thru the tube
80
What is a ureterolithotomy?
Surgical removal of kidney stones in the ureter
81
What is a pyelolithotomy?
Surgical removal of kidney stones in the renal pelvis
82
What is a nephrolithotomy?
Surgical removal of kidney stones in the kidney
83
What is a nephroctomy? When is it used?
Removal of all or part of a kidney; used for management of chronic kidney stones
84
What is the main clinical manifestation of renal stones?
Pain
85
What structure produces cerebral spinal fluid in the brain?
The choroid plexus
86
The sympathetic and the parasympathetic nervous systems are two divisions of which nervous system?
The autonomic nervous system
87
What two tracts carry sensory info?
The anterolateral and the posterior tracts
88
Name three types of info carried by the anterolateral system.
Pain, temperature and crude touch
89
Which of the two sensory tracts carries info more slowly and why?
The anterolateral tract, because it is not myelinated
90
Name three types of info carried by the posterior system.
Fine touch, graphesthesia, and position sense
91
What is stereognosis?
The ability to recognize an object by using touch, taste, etc (any sense except visual and auditory)
92
What kind of neurons does the pyramidal tract contain?
Motor neurons
93
What is pyramidal dessucation?
The crossing over of the pyramidal tracts in the medulla oblongata
94
What are excitatory amino acids released in response to?
Injury
95
What is brain herniation?
When brain tissue is pushed away from its normal location within the skull
96
What is hydroecpehalus?
Fluid accumulation in the brain
97
Can the brain participate in anaerobic metabolism?
Yes, but it cannot use the products of it
98
What is hypoxia of the brain?
A condition in which blood flow may be normal, but there is not enough O2 reaching the brain
99
What effect does hypoxia have on the brain?
A depressant effect
100
List three symptoms of hypoxia.
Euphoria, listlessness, and impaired problem solving
101
Name three conditions that can cause hypoxia.
CO poisoning, severe anemia, reduced atmospheric pressure
102
How quickly does brain death occur when the brain is without O2?
4-6 mins
103
What is focal vs global ischemia?
Global ischemia affects the entire brain while focal ischemia affects just a part
104
Is stroke an example of focal or global ischemia?
Focal
105
Is cardiac arrest an example of focal or global ischemia?
Global
106
How long does it take all O2 to be used up in global ischemia?
10 seconds
107
What ions is there an excessive influx of in global ischemia?
Sodium and calcium
108
What does the influx of sodium in global ischemia cause?
Edema
109
What does the influx of calcium in global ischemia cause?
A "calcium cascade" that causes the release of intracellular enzymes that destroy cells
110
Why is there an influx of sodium and calcium in global ischemia?
Because the sodium-potassium pump fails because of a lack of ATP
111
In what artery is a cerebral infarction most common?
In the middle cerebral artery
112
What is a "watershed area" of the brain?
An artery the brain that branches out to reach a greater area of the brain
113
Where are watershed zones located?
The border zones between two major territories of the brain
114
What is the difference between gray matter and white matter?
Gray matter is composed of cell bodies and white matter is composed of axons
115
Where does laminar necrosis ischemic injury occur?
In the grey matter of the brain
116
Where is laminar necrosis most severe?
In the deep tissues of the brain
117
What is post ischemic hypoperfusion?
An ischemic attack causes changes to blood vessels and blood flow that make it difficult to perfuse the brain even after the return of normal circulation.
118
What does it mean to say that blood is desaturated?
That it has reduced O2
119
When does respiratory acidosis occur?
When the body cannot remove all of the CO2 it produces
120
What does treatment for ischemia involve?
Providing oxygen and lowering the brain's metabolic demands
121
What is one method of reducing the metabolic demands of the brain?
By cooling the brain temperature
122
What is excitotoxicity?
Killing of neurons by the overactivity of receptors for amino acids that act as excitatory neurotransmitters
123
What is the primary excitatory neurotransmitter in the brain?
Glutamate
124
What is normal intercranial pressure?
5-15 mmHg
125
What are two ways the body can relieve excess intercranial pressure?
By changing the location of or reabsorbing CSF, or by lowering blood volume
126
Where does the body move CSF to when there is increased intercranial pressure?
To the spinal subarachnoid space
127
What is cerebral compliance?
The ability of the brain to adapt to changes in volume in order to reduce changes in pressure.
128
What does the pressure volume curve show?
Once the brain’s compensatory mechanisms have been exhausted, then small changes in volume will result in dramatic pressure increases.
129
What is a normal cerebral perfusion pressure?
70-100 mmHg
130
What is stage 1 of intercranial hypertension?
Compensation
131
What happens in stage 2 of intercranial hypertension?
Intercranial pressure increases. The brain responds by constricting vessels, but this results in hypoxia
132
What occurs during stage 3 of intercranial hypertension and what is this stage called?
Decompensation. During this stage, brain's arteries dilate, increasing ICP
133
What is stage 4 of intercranial hypertension?
Herniation, due to increased volume and pressure
134
What is the most reliable sign of increased ICP?
A decreased level of consciousness
135
What is Cushing reflex and what are three signs of it?
It is a "last ditch" effort reflex by the body to maintain circulation to the brain; it results in increased MABP, widened pulse pressure, and decreased heart rate
136
What are the three types of cerebral edema?
Interstitial, cytotoxic, or vasogenic
137
What is interstitial cerebral edema?
Increase of sodium and water in the peri-ventricular white matter
138
What is vasogenic edema?
This occurs when there is a brain injury that disrupts the BBB, and a subsequent increase in blood flow to the brain that causes edema
139
What are three signs of vasogenic edema?
Focal neurological deficits, disturbances in consciousness, and intercranial hypertension.
140
What occurs in cytotoxic edema?
Swelling of the brain cells themselves
141
Why do the brain cells swell in cytotoxic edema?
Because there is decreased blood flow leading to a failing sodium-potassium pump (because of insufficient ATP); this causes water to enter the cells
142
In cytotoxic edema, there is an increase in cellular fluid primarily in what type of matter?
Gray matter
143
What are two symptoms of cytotoxic edema?
Coma and stupor
144
What are two things that should be done for cerebral edema?
Stabilize cell membranes and remove metabolic wastes
145
In what two types of edema can osmotic diuretics be given?
Vasogenic and cytotoxic
146
What are the two components of consciousness?
Alertness & wakefulness; and cognition & content
147
What does arousal and wakefulness mean and what is it mediated by?
It is the ability to respond to stimuli, and it is mediated by the RAS
148
What does content and cognition involve and how is it mediated?
It involves moods, cognitive functioning, ect; it is mediated by the cerebral cortex and the RAS
149
What is confusion?
Inability to think clearly and disorientation
150
What is delirium?
Hallucinations and impaired consciousness
151
What is obtundation?
Decreased alertness with psychomotor retardation.
152
What is stupor?
Not unconscious but exhibits little to no spontaneous activity.
153
What is coma?
Not arousable and not responsive to external or internal stimuli.
154
What is decorticate posture?
Upper arms are held tightly the sides with elbows, wrists and fingers flexed. Legs are extended and feet are internally rotated.
155
What is decorticate posture caused by?
A lesion on the corticospinal tracts
156
What is decerebrate posture?
A position in which neck is extended, jaw is clenched, and legs are extended with feet plantar flexed. Arms are adducted.
157
What is decerebrate posture caused by?
A lesion on the pons, midbrain, or diancephalon
158
What is flaccidity?
No motor response exhibited
159
What is purposeful movement?
Unconsciously attempts to remove any pain stimulus.
160
What is complete flexion?
Withdraws completely in response to pain stimulus.
161
Which three focal motor responses may return with brain damage?
Babinski, sucking, and grasping reflex
162
What do unequal or slowly responding pupils indicate?
Compression
163
What do fixed, pinpoint pupils indicate?
Compression of the brainstem
164
What do dilated, fixed pupils indicate?
Compression of cranial nerve III
165
What do unilateral, fixed pupils indicate?
Compression of cranial nerve III
166
What is an oculomotor response an indication of?
Brainstem activity
167
What is an uculocephalic response? What happens if this is abnormal?
When the head is rotated, the eyes rotate to the opposite side. In an abnormal response, the eyes rotate in the same direction.
168
What is the oculovestibular reflex? What happens if this is abnormal?
When the ear canal is irrigated with water, the eyes turn toward the stimulus. If abnormal, there is no rotation of the eyes.
169
What is central neurogenic ventilation?
Unusually rapid or deep breathing
170
What is central neurogenic ventilation seen with?
Increased ICP or damage to the cerebral cortex/upper brain stem
171
What is apneustic ventilation?
Periods of long inspiratory cycles that alternate with long expiratory cycles.
172
What is apneustic ventilation seen with?
With lesions on the pons
173
What is cluster breathing?
Clusters of breath alternating with periods of apnea
174
What is cluster breathing seen with?
Damage to lower pons/high medulla
175
What is ataxic breathing?
Chaotic respiratory effort
176
What is ataxic breathing seen in?
Damage to the respiratory control center
177
What do hypo- and hyperthermia indicate damage to?
To the hypothalamus, pituitary, or general head trauma
178
What three vital sign changes occur in Cushing's triad?
High systolic pressure, low systolic pressure and low HR
179
What three things does the Glasgow Coma Scale measure?
Eye opening, motor response and verbal response
180
What does blood flow to the brain depend on?
Gravity and pressure in the venous sinuses
181
What is superficial cerebral blood flow regulated by?
The sympathetic nervous system
182
How does increased CO2 affect cerebral blood flow?
It increases it
183
How does low oxygen affect blood flow?
Increases it
184
How long must a stroke last be to designated as such?
Over 24 hours -- otherwise, it's a TIA
185
What is a stroke defined as?
A process that occludes a blood vessel or results in disruption in the flow of blood
186
What are the two types of stroke?
Ischemic and hemorrhagic
187
What percent of strokes are ischemic?
80%
188
What is the difference between a thrombus and an embolus?
A thrombus is a blood clot while an embolus is anything that travels thru the blood vessels
189
What is a hemorrhagic stroke caused by?
Bleeding into the brain
190
Which type of stroke is more deadly?
Hemorrhagic
191
What is the most important risk factor for a stroke?
Hypertension
192
What are three warning signs of a stroke?
Numbness, dizziness, weakness
193
How long does a TIA last?
Less than 24 hours
194
What two things could a TIA be caused by?
An embolus or astherosclerotic disease
195
What are two signs of a TIA?
Numbness and weakness on one side of the body, and transient visual disturbances
196
What are three ways to diagnose a TIA?
Via CT scan, cerebrovascular arterial imaging, or cardiac imagery.
197
What are three medications used to treat a TIA?
Aspirin, anticoagulants, and antiplatelet drugs.
198
What two things should be avoided to lower the risk of a TIA?
Dehydration and hypotension
199
What type of stroke can occur at rest?
Thrombotic stroke
200
Where does the clot in a thrombotic stroke usually occur?
At the branches of atherosclerotic vessels.
201
Where do lacunar infarcts occur?
In the smaller branches of large arteries
202
In which arteries do lacunar infarcts usually occur?
Middle or posterior arteries
203
Name three things a lacunar infarct could be caused by.
Embolism, hypertension, vasospasm
204
Where does a cardiogenic embolic stroke most commonly occur?
In the middle artery
205
Where does the embolism commonly originate in cardiogenic embolic stroke?
The left heart or the carotid
206
What are three risk factors for cardiogenic embolic stroke?
a-fib, rheumatic heart disease, recent MI.
207
What is the ischemic 'penumbra'?
A “halo” of barely surviving cells around the area that the stroke has affected. They receive minimal blood flow and have electrical failure but can regenerate if there is good blood flow and minimal edema
208
What is hemorrhagic stroke?
Rupture of a blood vessel and bleeding into the brain
209
What is the most common predisposing factor for hemorrhagic stroke?
Hypertension
210
What are two causes of hemorrhagic stroke?
Aneurysm or spontaneous hemorrhage.
211
Does hemorrhagic stroke occur when the patient is active or passive?
Active
212
Vomiting is a sign of what type of stroke?
Hemorrhagic stroke
213
What kind of paralysis does hemorrhagic stroke cause?
Contralateral
214
What are the s/s of an anterior cerebral artery stroke? Name 3.
Impaired gait, paralysis of contralateral leg/arm, decision making problems
215
What are the s/s of a middle cerebral artery stroke? Name 3.
Aphasia, altered consciousness, inability to turn eyes to paralyzed side
216
A stroke in what part of the brain causes visual disturbances?
In the posterior cerebral artery
217
Name three symptoms of a stroke that affects the thalamus.
Aphasia, intentional tremor, and spontaneous pain.
218
If the vertebral and basilar arteries experience a stroke, which part of the brain is involved?
Cerebellum and brain stem
219
What are three s/s of vertebral/basilar artery stroke?
Vertigo, dysphagia, dysphonia.
220
What is used to pharmacologically treat stroke?
Antithrombolytic agents
221
What is the main long term issue associated with a stroke that affect the corticospinal tract?
Extreme weakness on the contralateral side of the body
222
What is dysarthria?
Difficult articulation of speech
223
What is apraxia?
Inability to perform purposeful actions
224
Aphasia is most common when which artery is affected?
The middle cerebral artery
225
What is receptive/fluent aphasia?
Inability to understand language
226
Receptive/fluent aphasia is caused by damage to which area of the brain?
Posterior temporal or parietal lobe
227
Expressive/nonfluent aphasia is caused by damage to which area?
Broca’s area or the dominant frontal lobe.
228
What is agnosia?
Inability to recognize an object
229
What is alexia?
Word blindness
230
What is anomia?
Difficulty recognizing objects/colors
231
What is conduction aphasia?
Inappropriate word use despite good comprehension
232
What is hemi-attention?
Denial of 1/2 of the body
233
Hemi-attention is more common in a stroke that affects what part of the brain?
The non-dominant half
234
Name 3 symptoms of a right sided stroke.
Inability to think clearly; quick and impulsive behavior, and difficulty drawing or dressing.
235
Name 3 symptoms of a left sided stroke.
Difficulty speaking, writing, calculating numbers; slow, cautious behavior; and forgetting objects on the right side.
236
What are megaloblastic anemias due to?
Most commonly to lack of B12 or folic acid
237
What are three complications of polycythemia?
Hypertension, thromboembolism, viscosity that interferes with blood flow
238
What foods supply vitamin B12?
Meat, eggs, milk and cheese
239
What is inflamed in pneumonia?
Bronchioles and alveoli
240
What does the occipital lobe control?
Vision
241
What does the temporal lobe control?
Hearing
242
What does the thalamus do?
Integrates signals
243
What does a PET scan examine?
Glucose uptake
244
What is the difference between a thrombolytic agent and an anticoagulant?
A thrombolytic agent breaks up a clot and an anticoagulant stops clots from forming
245
What does PROM stand for?
Passive range of motion
246
What does Broca's area control?
The motor part of speech
247
What is affected in receptive aphasia?
Wernicke's area
248
What is affected in expressive aphasia?
Broca's area
