Path 2 - Midterm Flashcards

1
Q

T or f

The major function of the kidneys are to regulate the body’s concentration of water and salt.

A

FALSE

Excretion of waste products of metabolism is its major function.

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2
Q

List the 4 main functions of the Kidneys

A

Excretion of waste products of metabolism
Water and Salt concentration
Acid/Base balance of plasma
Secretion of hormones

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3
Q

All of the following are secreted from the Kidneys except:

  • Prostaglandins
  • Angiotensiongen
  • Erythropoietin
  • Renin
A

Angiotensiongen

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4
Q

What cells make renin?

A

Juxtaglomerular cells

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5
Q

What condition will result if there is a failure or defect in the production of erythropoietin?

A

Anemia

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6
Q

T or F

The renal pyramids are the major site of filtration of the blood and primary urine production

A

False

This is describing the Cortex. The pyramids collect urine.

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7
Q

T or F

Almost all diseases of the Glomerulus are caused by immune system pathologies

A

True

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8
Q

Which microscopic compartment of the kidneys are mainly affected by toxins and infections

A

Tubules

Interstitial Tissue

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9
Q

What microscopic compartment of the kidney is mainly affected by pulmonary pathologies?

A

NONE!! TRICK QUESTION

The kidney vessels are mainly affected by Cardiovascular pathologies not just pulmonary.

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10
Q

Where is the Glomerulus located?

A

Within the Bowman’s Capsule

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11
Q

Which layer of the capillaries within the Glomerulus have fenestrations?

A

Endothelial cells

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12
Q

What is the name of the outermost layer of the capillaries within the Glomerulus?

A

Visceral Epithelial cells

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13
Q

Aka for Visceral Epithelial Cells

A

Podocytes

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14
Q

Name the glycoprotein located between the podocyte slits that aids in selective filtration

A

Nephrin

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15
Q

These cells are similar to podocytes but they line the inner surface of the Bowman’s Capsule

A

Parietal Epithelial Cells

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16
Q

List all the functions of the Mesangial Cells

A
Contractile components
Produce chemicals that help for glomeruli function
Proliferations
Secretion of some hormones
Network of arterioles
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17
Q

Which cells of the Glomerulus account for scar tissue in the healing process and contain many monocytes?

A

Mesangial Cells

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18
Q

Where in the Glomerulus are the Juxtaglomerular cells located?

A

In the area where the afferent arteriole enters the Glomerulus

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19
Q

Circulating immune complex deposition is what type of hypersensitivity rxn?

A

Type 3

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20
Q

Where in the glomerulus do the immune complex of circulating immune complex deposition hide?

A

Subintimal layer - space between glomerular basement membrane and endothelial cells

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21
Q

The circulating immune complex deposition glomerulonephritis can result in damage to what structures?

A

Glomerular basement membrane
Endothelial Cells
Podocytes

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22
Q

T or F

Azotemia is a clinical abnormality characterized by increased levels of creatine and blood urea nitrogen in the blood stream.

A

False

Biochemical abnormality

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23
Q

What is the difference between Azotemia and Uremia

A

Azotemia is elevated levels of creatine and BUN but there are no clinical symptoms. When the process becomes advanced it is referred to as Uremia. Essentially uremia has symptoms and clinical manifestations.

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24
Q

T or F

Anti-GBM is a type 3 hypersensitivity

A

False

Type 2 - complement dependent

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25
Q

T or F

Heymann’s Glomerulonephritis is a Type 3 Hypersensitivity rxn

A

False

Not associated with a specific hypersensitivity reaction.

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26
Q

What is the pathogenesis of Heymann’s Glomerulonephritis?

A

Development of autoantibodies against Podocytes as well as some antigens within podocytes.

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27
Q

Describe what Nephritis Syndromes are

A

Basically when damage of glomerular walls leads to dramatic increased permeability for red blood cells = Hematuria

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28
Q

What is Oligouria?

A

Decrease in the amount of urine excreted per day. Results from a decrease in permeability of water in the glomerulus.

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29
Q

If there is a decrease of BP to less than ____ mmHG juxtaglomerular cells will increase pressure

A

50

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30
Q

What are the signs and symptoms of acute glomerulonephritis?

A
A little proteinuria 
Azotemia
Hematuria 
Casts
Hypertension
Oliguria 
Swelling under the eyes.
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31
Q

What tonsils are more susceptible for infection?

A

Palantine

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32
Q

What disease associated with Nephritis syndromes is described as having molecular mimicry?

A

Acute Proliferative (post-streptococcal, post-infectious) Glomerulonephritis

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33
Q

What specific type of Strep is involved with Acute Proliferative (post-strep) Glomerulonephritis.

A

Beta hemolytic Strep A

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34
Q

Pathogenesis of Post Strep Glomerulonephritis

A

Immune system makes antibodies that bind to the antigen of strep. This antigen is very similar to that of Glomerular Tissue. Immune system is not able to tell which is which and will destroy both causing kidney damage!

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35
Q

T or F

Post-strep Glomerulonephritis is considered to be an infectious condition.

A

False!

Disease of immune system. Infection is the catalyst for the immune system to destroy healthy glomeruli tissue.

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36
Q

What are the recovery rates of Post-Strep Glomerulonephritis?

A

Children = 99%
Adults = 50%
* tx = corticosteroids

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37
Q

What type of Glomerulonephritis is clinically characterized by rapid & progressive loss of renal function associated with severe Oliguria & (if untreated) death from renal failure within weeks to months

A

Rapidly Progressive (Crescentric) Glomerulonephritis

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38
Q

T or F

Good Pasture’s Syndrome falls under Type 2 of Rapidly Progressive Glomerulonephritis

A

False

Type 1

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39
Q

Describe the pathogenesis of Crescentric Glomerulonephritis

A

Hyperplasia of Parietal Epithelial cells
- epithelial cells eventually will close the exit to proximal tubules resulting in an accumulation of primary urine in Bowman’s Capsule. This increase in pressure = atrophy of capillary network within the capsule.

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40
Q

Type 1 Rapidly Progressive Glomerulonephritis is what type of Hypersensitivity rxn?

A

Type II

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41
Q

What is Good Pasture’s Syndrome?

A

Characterized by autoimmune aggression against antigens of two types of basement membranes - Alveolar & Glomerular

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42
Q

What is a typical manifestation of Goodpasture’s Syndrome in the lungs?

A

Hemoptysis
- damage of alveolar wall leads to hemorrhage and blood within the alveoli. Patient will literally drown in their own blood.

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43
Q

How is Goodpasture’s Syndrome Treated?

A

Plasmapheresis - blood is taken from patient and spun in a centrifuge, the plasma is thrown again and blood cells given back in glucose solution. Mechanical cleaning of blood to get rid of the antibodies.

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44
Q

T or F

Type II Rapidly Progressive Glomerulonephritis is a Type I hypersensitivity reaction.

A

False

Type III

45
Q

This condition is characterized by the formation of autoantibodies against antigens of cell nuclei and cytoplasm **antinuclear antibodies

A

Systemic Lupus Erythematosus

46
Q

List some symptoms of SLE

A

Butterfly rash on face
Allopecia
Joint involvement * Lupus Arthritis
Hypertension

47
Q

List some factors contributing to SLE

A

Genetic predisposition

Provocative factors = Exposure to UV light *MC, Certain drugs (sulfa drugs), rxn to vaccination.

48
Q

T or F

The kidneys are the only system affected by SLE

A

False

Potentially any system in the body but kidneys are the most involved organ.

49
Q

List the 4 clinical symptoms of Henoch-Schonlein Purpura

A

Cutaneous - purpura
Abnormal - pn in stomach and duodenum
Articular Syndrome - arthralgia
Kidney Syndrome - Type II RPGN

50
Q

T or F

Type III Rapidly Progressive Glomerulonephritis is not associated with a hypersensitivity

A

True

51
Q

What type of antibodies are made in Pauci-immune RPGN

A

Antineutrophils

52
Q

List the 3 important components of Wegener’s Granulomatosis

A
  1. Necrotizing vasculitis of middle and small arteries of URT
  2. Necrotizing vasculitis of middle of small arteries of LRT
  3. RPGN Type III
53
Q

Virtually all organs are affected when a person suffers from Polyarteritis Nodosa except…

A

Lungs

Arch of aorta

54
Q

What is the pathogenesis of Polyarteritis Nodosa

A

Vasculitis of small and middle arteries of the body causes weakening and softening of vascular wall which leads to pouching of the wall. Weakening also leads to rupture under pressure.

55
Q

IgA Nephropathy aka ?

A

Berger’s Disease

56
Q

What is the most common glomerular disease worldwide and the most common cause of hematuria?

A

IgA Nephropathy

57
Q

How does Berger’s disease begin?

A

With/after an acute urinary, GI or respiratory infection.
Sudden development of gross hematuria within 1-2 days of acute infection. Will urinate blood for a few days than disappears.

58
Q

Where does IgA and IgA complexes get deposited in Berger’s disease?

A

Mesangium - the space between capillaries in the glomerulus.

59
Q

Berger’s Disease aka?

A

Thromboangitis Obliterans

60
Q

T or F

Berger’s Disease is a kidney related pathology

A

False

Cardiovascular

61
Q

What are some manifestations caused by Berger’s Disease?

A

Raynaud’s Syndrome
Instep Calaudication
Gangrene
Thrombophlebitis

62
Q

What is the most common hereditary RPGN?

A

Alport Syndrome

63
Q

Increased selective permeability of albumin sized proteins is characteristic of what class of Kidney pathologies?

A

Nephrotic Syndrome

64
Q

List the major groups of blood proteins and their relative percentages in the blood

A

Albumin 55%
Globulins 45%
Fibrinogen 5%

65
Q

What blood protein is responsible for maintaining oncontic pressure?

A

Albumins

66
Q

Why is there generalized edema with Nephrotic conditions?

A

From a decreased oncotic pressure in the blood and a higher pressure in the tissues causes an escape of the fluid portion of the blood into the tissues.

67
Q

Massive proteinuria is how many grams?

A

Greater than 3.5 g/dl

68
Q

T or F

The ratio of albumin to globulins normally should be less than 1

A

False

Normally ratio is 55/45 so greater than 1. When you have the loss of albumin the ratio will drop to below one and essentially reverse. This is a major sign or a Nephrotic syndrome.

69
Q

T or F

Ascites is characterized by accumulation of exudate in the abdomen

A

False

Transudate!
Exudate is in the glomeruli

70
Q

What are the name of the white lines on the nails that can disappear upon pressure commonly seen with Nephrotic conditions.

A

Muehrcke’s Lines

71
Q

What are the primary Glomerular diseases?

A

Minimal change disease (lipid nephrosis)
Membranous Glomerulonephritis
Focal Glomerulosclerosis
Membranoproliferative Glomerulonephritis

72
Q

What kidney pathology is the most common contributor to Chronic Glomerulonephritis? Least common?

A

RPGN = MC

Post Strep = LC

73
Q

What happens to the appearance of the kidney with Chronic Glomerulonephritis?

A

Has a granular appearance due to healing by repair at different rates.

74
Q

This condition will develop suddenly and is characterized by pain in the back, a higher fever with chills

A

Acute Pyelonephritis

75
Q

What bacteria is the most common cause of Acute Cystitis?

A

E.Coli

others = Staphylococcus, Gram - bacillus, Candida Albans

76
Q

T or F

Bacteremia and Lymphogenic is the most common cause of Acute Pyelonephritis

A

False

Rare

77
Q

What is the #1 cause of chronic renal failure in the USA

A

Chronic Pyelonephritis

78
Q

T or F

Healing of erosions takes weeks to months

A

False

Ulcers are weeks to months
Erosions are short 2-5 days

79
Q

Breech in the mucosa of the wall of the alimentary tract organ that extends through muscularis mucosa into the submucousa or deeper is describing…

A

Ulcers

80
Q

T or F

Erosions tend to be multiple

A

True

81
Q

T or F

Erosions are superficial damage to the GI wall

A

True

82
Q

80% of stomach ulcers occur where?

A

Dudodenum (duodenal bulb)

83
Q

What is the Z line?

A

Boundary between esophagus and stomach

84
Q

Name the aggressive forces contributing the ulcers

A

Stomach acidity
Peptic activity
H.Pylori Infection

85
Q

T or F

Approximately 20% of ulcers occur in the esophagus

A

False

Stomach - usually the lesser curvature

86
Q

Where do the H.Pylori bacteria like to hang out in the stomach?

A

Anteropyloric acrea

87
Q

What are the components of the Mucous barrier?

A
Surface mucousal secretion 
Bicarbonate Secretion into the mucosa
Mucosal blood flowApical surface membrane transport
Epithelial regenerative Capacity 
Elaboration of prostaglandins
88
Q

Why do smokers have a hard time healing peptic ulcers?

A

Smokers have an impaired mucosal defensiveness due to the vasoconstriction of the wall of the stomach.

89
Q

How do NSAIDs and corticosteroids contribute to peptic ulcers?

A

They prevent prostaglandins and other mediators of inflammation.

90
Q

T or F

With a decrease in gastrin secretion you get an alternative increase in HCL production

A

False

Decrease gastrin = decrease HCL

91
Q

T or F

The duodenal bulb is the most distal portion

A

False

Most proximal

92
Q

Name the 5 complications of peptic ulcers

A
  1. Hemorrhage
  2. Perforation
  3. Penetration
  4. Hypertrophic Pyloric Stenosis
  5. Transformation of the peptic ulcer to cancer
93
Q

T or F

Perforation is the most common complication of peptic ulcers

A

Fales

Hemorrhage

94
Q

T or F

A major concern with duodenal peptic ulcer is its transformation into cancer

A

False

This will occur in a stomach peptic ulcer but doesn’t occur in the duodenal peptic ulcers.

95
Q

What complication of peptic ulcers would indicate the need for surgery?

A

Perforation
- gas can accumulate just under the diaphragm in the liver, due to perforation of the alimentary tract. These gases can get caught between the liver and the diaphragm and this requires immediate attention.

96
Q

Why is Pyloric stenosis a complication?

A

Due to healing of ulcer by connective tissue causing a narrowing of the lumen of the pyloric canal it does not allow the passage for food to enter the duodenum.

97
Q

T or F

Hypertrophic pyloric stricture is a complication of peptic ulcers

A

False

This is a congenital disorder not a complication of ulcers

98
Q

T or F

Rheumatic Fever causes cardiomyopathy

A

False

Valvular problem not muscular problem

99
Q

Rhematic conditions associated with the heart primarily caused by what microbe?

A

Beta Hemolytic Strep A (Pyogens)

100
Q

What layer of the heart makes the valves?

A

Endocardium

101
Q

What is the fibrous layer of the heart called?

A

Pericardium

102
Q

Rhematic arthritis is characterized by…

A

Migrating arthritis
Erythmia Annulare
Subcutaneous nodules
Sydenham Chorea

103
Q

Where do you see the subcutaneous nodules develop with Rheumatic arthritis?

A

knuckles

104
Q

T or F

Sydenham Chorea is curable

A

True

105
Q

Syndenham’s Chorea usually affects what part of the body?

A

Jerky movements of extremities and facial muscles

106
Q

Aschoff’s Nodes affect what layer of the heart?

A

Myocardium

- Rheumatic Myocarditis

107
Q

Aschoff’s nodes are what type of necrosis?

A

Fibrinoid Necrosis

108
Q

T or F

Involvement of the pericardium occurs in 100% of cases of Rheumatic fever

A

False

MUSCLE layer ALWAYS involved

109
Q

What is the pathopneumonic sign of rheumatic myocarditis?

A

Aschoff’s Nodes