2022-2023 WGU D236 Pathophysiology Exam - Study Guide with Answers (108 Solved Questions) - Past Exams | Western Governors University

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WGU D236 pathophysiology Exam-Study Guide-With 100% verifiedanswers-2022-2023

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WGU D236 pathophysiology Exam -StudyGuide-With 100% verified answers-2022-2023Patho OA Study Guide1.Whatis Starling's Law of Capillary forces? How does thisexplain why a nutritionally deficient child would have edema?Starling’s Law describes how fluids move across the capillary membrane. Thereare two major opposing forces that act to balance each other, hydrostatic pressure(pushing water out of the capillaries) and osmotic pressure (including oncontic pressure,which pushes fluid into the capillaries). Both electrolytes and proteins (onconticpressure) in the blood affect osmotic pressure, high electrolyte and proteinconcentrations in the blood would cause water to leave the cells and interstitial spaceand enter the blood stream to dilute the high concentrations. On, the other hand, lowelectrolyte and protein concentrations (as seen in a nutritionally deficient child) wouldcause water to leave the capillaries and enter the cells and interstitial fluid which canlead to edema.2.How does the RAAS (Renin-Angiotensin-Aldosterone System)result in increased blood volume and increased bloodpressure?A drop in blood pressure is sensed by the kidneys by low perfusion, which in turnbegins to secrete renin.Reninthen triggers the liver to produce angiotensinogen, whichis converted to Angiotensin I in the lungs and then angiotensin II by the enzymeAngiotensin-converting enzyme (ACE). Angiotensin II stimulates peripheral arterialvasoconstriction which raises BP. Angiotensin II is also stimulating the adrenal gland torelease aldosterone, which acts to increase sodium and water reabsorption increasingblood volume, while also increased potassium secretion in urine.3.How can hyperkalemia lead to cardiac arrest?Normal levels of potassium are between 3.5 and 5.2 mEq/dL. Hyperkalemia refersto potassium levels higher that 5.2 mEq/dL. A major function of potassium is to conductnerve impulses in muscles. Too low and muscle weakness occurs and too much cancause muscle spasms. This is especially dangerous in the heart muscle and an irregularheartbeat can cause a heart attack.4.The body uses the Protein Buffering System, PhosphateBuffering System, and Carbonic Acid-Bicarbonate System toregulate and maintain homeostatic pH, what is theconsequence of a pH imbalance?Proteins contain many acidic and basic group that can be affected by pHchanges. Any increase or decrease in blood pH can alter the structure of the protein(denature), thereby affecting its function as well.5.Describe the laboratory findings associated with metabolic

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acidosis, metabolic alkalosis, respiratory acidosis andrespiratory alkalosis. (ie relative pH and CO2 levels).

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Normal ABGs (Arterial Blood Gases) Blood pH: 7.35-7.45 PCO2: 35-45 mm HgPO2: 90-100 mm Hg HCO3-: 22-26 mEq/L SaO2: 95-100% Respiratory acidosis andalkalosis are marked by changes in PCO2. Higher=acidosis and lower=alkalosisMetabolic acidosis and alkalosis are caused by something other than abnormal CO2levels. This could include toxicity, diabetes, renal failure or excessive GI losses. Here arethe rules to follow to determine if is respiratory or metabolic in nature. -If pH and PCO2are moving in opposite directions, then it is the pCO2 levels that are causing theimbalance and it is respiratory in nature. -If PCO2 is normal or is moving tin the samedirection as the pH, then the imbalance is metabolic in nature.6.The anion gap is the difference between measured cations(Na+ and K+) and measured anions (Cl-and HCO3-), thiscalculation can be useful in determining the cause of metabolicacidosis. Why would an increased anion gap be observed indiabetic ketoacidosis or lactic acidosis?The anion gap is the calculation of unmeasured anions in the blood. Lactic acidand ketonesboth lead to the production of unmeasured anions, which remove HCO3- (ameasured anion) due to buffering of the excess H+ and therefore leads to an increase inthe AG.7.Whyis it important to maintain a homeostatic balance ofglucose in the blood (ie describe the pathogenesis ofdiabetes)?Insulin is the hormone responsible for initiating the uptake of glucose by thecells. Cells use glucose to produce energy (ATP). In a normal individual, when bloodglucose increases, the pancreas is signaled to produced in insulin, which binds to insulinreceptors on a cells surface and initiates the uptake of glucose. Glucose is a veryreactive molecule and if left in the blood, it can start to bind to other proteins and lipids,which can lead to loss of function. AGEs are advanced glycation end products that are aresult of glucose reacting with the endothelial lining, which can lead to damage in theheart and kidneys.8.Compare and contrast Type I and Type II DiabetesType I diabetes iscaused by lack of insulin. With out insulin signaling, glucose willnot be taken into the cell and leads to high blood glucose (hyperglycemia). Type I isusually treated with insulin injections. Type II diabetes is caused by a desensitization toinsulin signaling. The insulin receptors are no longer responding to insulin, which alsoleads to hyperglycemia. Type II is usually treated with drugs to increase the sensitizationto insulin (metformin), dietary and life-style changes or insulin injections.9.Describe some reasons for a patient needing dialysisAEIOU-acidosis.Electrolytes,Intoxication/Ingestion,overload,uremia.Patientswithkidneyor heart failure. A build up of phosphates, urea and magnesium are removedfrom the blood using a semi-permeable membrane and dialysate. AEIOU: A—acidosis; E—electrolytesprincipallyhyperkalemia;I—ingestionsoroverdoseofmedications/drugs;O—overloadoffluidcausingheartfailure;U—uremialeadingtoencephalitis/pericarditis.10.Compare and contrast hemodialysis and peritoneal dialysis.What are some reasons for a patient choosing one over theother?Hemodialysis usesamachine to pump blood from the body in one tube whiledialysate (made of water, electrolytes and salts) is pumped in the separate tube in the

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opposite direction. Waste from the blood diffuses through the semipermeablemembrane separating the blood from the dialysate. Peritoneal Dialysis does not use amachine, but instead injects a solution of water and glucose into the abdominal cavity.The peritoneum acts as the membrane instead of dialysis tubing. The waste productsdiffuse into the abdominal cavity and the waste solution is then drained from the body.Peritoneal dialysis offers continuous filtration and is less disruption to the patient’s dailyroutines. However, it does require some training of the patient and is not recommendedfor individuals who are overweight or have severe kidney failure. Hemodialysis providesmedical care, but 3 times a week for several hours sitting at a hospital or clinic.Individuals with acute kidney failure are recommended to use hemo11.Essential Question: How does homeostasis and maintainingoptimal physiological health impact your wellbeing?Homeostasis acts to create a constant and stable environment in the bodydespite internal and external changes. Proteins and other cellular processes requireoptimal conditions in order to carry out their functions. Alterations in pH, saltconcentration, temperature, glucose levels, etc. can have negative effects on health, soit is vital for mechanisms that regulate homeostasis to function properly for maintaininggood health.Lesson2:Cellular Response andAdaptation1.Differentiate between Innate Immunity and AdaptiveImmunity.The innate immune system encompasses physical barriers and chemical andcellular defenses. Physical barriers protect the body from invasion. These include thingslike the skin and eyelashes. Chemical barriers are defense mechanisms that can destroyharmful agent. Examples include tears, mucous, and stomach acid. Cellular defenses ofthe innate immune response are non-specific. These cellular defenses identifypathogens and substances that are potentially dangerous and takes steps to neutralizeor destroy them. Adaptive immunity is an organism’s acquired immunity to a specificpathogen. As such, it’s also referred to as acquired immunity. Adaptive immunity is notimmediate, nor does it always last throughout an organism’s entire lifespan, although itcan. The adaptive immune response is marked by clonal expansion of T and Blymphocytes, releasing many antibody copies to neutralize or destroy their targetantigen.2.What is a way that Adaptive Immunity can recruit innateimmunity?The innate immuneresponse to microbes stimulates adaptive immune responsesand influences the natureof the adaptive responses. Conversely, adaptive immune

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responses often work byenhancing the protective mechanisms of innate immunity,making them more capable of effectively combating pathogenic microbes.3.3.Why are some infections harder on children while otherinfections are harder on the elderly?Children have not been exposed to many pathogens yet, so they lack memory cells and have not built-up immunity yet. The elderly have a depleted naïve T cell population from years of battling infections, so thelikelihood of getting a match is less.4.Describe how and why our injury response results in thesigns of redness, swelling, heat, and pain? Be sure to usechemokines, histamine, and vasodilation in your response.An injury causes an inflammatory response which is responsible for the redness,swelling, heat and pain. Upon injury, cells on the surface begin to release chemokineswhich act as messengers that something has happened. Mast cells are also alerted torelease histamines which travel to the endothelial cells of capillaries and causesvasodilation, which is related to swelling and redness. Vasodilation also causes thecapillaries to become leaky which allows for histamines, chemokines and even pathogenparticles to enter the blood stream where they are met by neutrophils (non-specific)which start to adhere to the capillary wall and squeeze through the leaky holes(diapedesis or extravasation) to phagocytose pathogens and damaged cells. Dendriticcells just under the surface of skin are also activated to phagocytose foreign particles.Other B cells, T cells (specific) and the complement system also squeeze through thecapillary wall to create an area of congestion.5.Explain dominant vs recessive genetic diseases. What is a"carrier"inrecessivegeneticdiseases?The human genome contains 23 pairs of chromosome (22 autosomes and 1 pairof sex chromosomes). The pairs are homologous and contain the same genes in thesame order. This means that every gene has a copy, one inherited from your motherand the other from your father. Not all versions of a gene (alleles) are treated the sameby the cell. Some are expressed over others. A dominant gene is a gene that isexpressed, even if you only have one copy. The dominant gene will be expressed overthe recessive gene, which must have two copies to be expressed. In a dominant geneticdisease, all it takes is one copy of the disease to have the disease. Recessive geneticdiseases require that the individual gets two copies of the gene to have the disease.Someone who is a carrier for a recessive genetic disease is healthy, but contains a copyof the disease gene, potentially passing it to their offspring.6.Describe how to determine the probability of clinicaloutcomes given information about the parents (eg twoheterozygous carriers of sickle cell disease)Punnett Squares canbe used to determine the potential probabilities of certaintraits being passed to offspring. If you know the genotypes of each parent (ie

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homozygous or heterozygous for the trait), you can determine the possible outcomes.Heterozygous means that the parent has one copy of each gene, homozygous meansthe parent has the same copy for each gene (either both dominant genes or bothrecessive genes).7.What are some of the consequences of alcohol exposure inpregnancy?ND-PAE (neurobehavioral disorder-prenatal alcohol exposure) can cause birth defects anddevelopmental disabilities (fetal alcohol spectrum disorders-FASDs). Affects thinking and memory, causesbehavioral issues and linked to trouble with everyday functioning8.Whatare some of the distinctive features associated withtrisomy 21, or Down's Syndrome? Why is increased maternalage a risk factor?Distinct features of Down’s syndrome include intellectual disabilities and common physical featuresthat include slanted eyes, flattened bridge of the nose and forehead, short in stature, poor muscle tone, loosejoints and single palmar crease. As a woman’s eggs age, they can have mistakes in meiosis potentially leadingto a nondisjunction event causing trisomy 219.What is Spina Bifida? Why are relative deficiencies in Folicacid or B12 associated with Spina Bifida?Failure to close the neural tube early in gestation due to low folic acid and B-12. These vitamins helpactivate DNA synthesis in the developing fetus in the first 4 weeks of pregnancy, that are responsible forclosing up the spinal column. Three types of spina bifida. 1) spina bifida occulta (most common, less severe)2) Meningocele (least common) 3) Myelomeningocele (most severe).10.Essential Question: How does the body's cellular responsesand adaptations react to disruptions?The body uses theRAASsystemto regulate blood volume and pressure, theimmune response reacts to fight infection, the inflammatory response reacts to injuryLesson3: MusculoskeletalPathophysiology1.Describe how calcitonin, parathyroid hormone, andcalcitriol (Vitamin D) work together to maintain normalblood calcium levels.Pages 926, 968, and 980 of text. Vitamin D: UV light stimulates formation of cholecalciferol, whichis hydroxylated in the liver and the kidney into the active form of Vitamin D, calcitriol. Calcitriolstimulates absorption of calcium and phosphorus from the GI tract in the intestine and phosphate inthe kidney. Calcitriol increases the calcification of osteoid. Calcitriol also stimulates the formation ofbone by raising the levels of calcium and phosphorus in the blood. Low vitamin D levels can causehypocalcemia, which stimulates the parathyroid gland to release parathyroid hormone (PTH). PTHstimulates osteoclasts to resorb bone calcium to increase blood calcium levels. PTH also stimulates

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osteoblasts to form bone. PTH stimulates kidneys to reabsorb calcium into the blood and tosynthesize vitamin D. When blood calcium gets too high, the thyroid is stimulated to releasecalcitonin (suppresses osteoclast activity and calcium will be used to form bone).2.Describe the function of osteocytes within lacunae of boneOsteocytes absorb nutrients from the bloodstream and distribute them within the bone structure.Osteocytes absorb waste products from the bone and excrete them into the bloodstream.3.Describe bone remodeling. Which cells are involved in thisprocess and what is their function?Osteoclasts breakdown older bone structure and secrete the release calcium into the bloodstream.Osteoblasts absorb calcium from the bloodstream and use it to build new bone structure. Working together,these two cell types allow for regeneration of damaged bone structure.4.Describe the process of articular degeneration. Which cellsare involved in this process and what is their function?Articular Degeneration is the thinning and breakdown of the articular cartilagethat covers joints and acts as a lubricant and cushion. This articular cartilage iscomprised of chondrocytes in a matrix of collagen and aggrecan. The chondrocytesproduce enzymes and other proteins that slowly break down and reform the matrix,allowing for regeneration. Stress caused by being overweight or physical trauma cancause chondrocytes to speed up the matrix breakdown process relative to thereformation process, leading to a thinning of the articular cartilage.5.What is rickets? How does it develop? Who usually developsrickets? How can rickets be treated?Pages 979-980 of text. Rickets is, primarily, due to a deficiency of vitamin D (due to sunlightexposure), which leads to a deficiency of blood calcium. Rickets can lead to bone weakness, deformity, andsusceptibility to fracture. Rickets results from a failure to calcify osteoid due to low amounts of blood calciumand low vitamin D (typically). There are many different types of rickets. Children, especially under age 2, aremost likely to be diagnosed with rickets. Infants can develop rickets if their mother's diet was low in vitamin Dor in calcium, and breastmilk is low in vitamin D, so mother and baby need to supplement vitamin D (andcalcium). The best way to treat rickets is to prevent it by taking supplements of vitamin D and calcium, eatingfood/drink containing vitamin D/calcium, and getting sufficient sunlight. Physical therapy with weight-bearingexercise can help to treat rickets, as well. It is a multi step process to make the active form of Vit D6.How does Denosumab treat osteoporosis?Denosumab is a monoclonal antibody that binds to osteoclasts and inhibits their Calcium-withdrawingcapability.7.Distinguish between open reduction and internal fixation(ORIF) and hip replacement surgery.Open reduction and internal fixation involves “surgical opening’ and insertion of hardware into thepatient that assists with maintaining proper bone alignment during the healing process. Hip replacementinvolves replacement of a fractured hip joint with a prosthesis.8.What is degenerative disc disease? What are some of theanatomical features of degenerative disc disease? What aresome symptoms of lumbar vs. cervical degenerative discdisease?

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