Study Guide for Pathophysiology Exam III

Review of Pulmonary Structure and Function:
Be able to identify the parts of the respiratory system.
What is considered part of the upper respiratory system? What is its function?
What makes up the lower respiratory system? How does a bronchus differ from a bronchiole?
What is the carina and what does this area do?
How do the two lungs differ? What membranes surround them?
What function does the chest wall have here?
What is the function of the respiratory system?
Describe the structure of the alveoli. What three types of cells are found here, and what does each do?
What is the respiratory or alveolocapillary membrane? What makes it and what is its function?
How does the mediastinum assist lung function?
Remember that another name for breathing is (pulmonary) ventilation.
What is external respiration, internal respiration and cellular respiration? Check your A&P book if necessary.
What muscles function in normal inspiration? What muscles do we use if we take a greater than normal inspiration?
How does expiration normally take place? What muscles are used in a forced expiration.
Quickly review respiratory volumes. What is the minute volume of respiration?
Where are the control centers for normal breathing? What is the Hering-Breuer reflex?
What do the central chemoreceptors respond to ? The peripheral chemoreceptors?
How is oxygen transported in the blood? How is carbon dioxide transported? How is MOST of the carbon dioxide transported?
How does the vasculature supplying the lungs differ from blood vessels elsewhere in the body in their response to  hypoxia?

We are seeing increases or decreases in the number of patients with many of  the conditions listed below. An interesting set of questions may be to list some of these and ask if the incidence is increasing or decreasing.

Pulmonary Pathophysiology:
What are the two major factors that reduce pulmonary function?
What is a nosocomial infection? Why is there such a high incidence of pneumonia in hospital patients?
What is dyspnea. Technically, is it a sign or a symptom? What would the signs of dyspnea be? What are some of the general causes of dyspnea?
Why do we cough? What would cause coughing? What is the difference between a productive and nonproductive cough?
What is hemoptysis? Is it dangerous in and of itself? What might it indicate?
What would purulent sputum indicate?
What would cause an acute cough?  A chronic cough?
Why does cyanosis occur? What is peripheral cyanosis? Central cyanosis? What would cause this?
Does a lack of cyanosis mean the blood is oxygenated normally? Does cyanosis always indicate poorly oxygenated blood?
What might you  be able to hear with an infection of the pleura? What kind of pain would you expect, and when would it occur?
Use your text book to be able to differentiate the pain caused by pleural disorders from musculoskeletal strain, bronchial irritation and myocardial pain. What kind of pain would be associated with bronchitis? What kind of pain could occur during exercise, and what might it be mistaken for?
What is clubbing, and when does it occur?
What is pleural effusion? What types of fluid can cause it?
What is respiratory failure? What are the signs and symptoms? The two principal patterns of respiratory failure?
What is ARDS?  What do we see here? What is shunting? What blood cell type plays a central role here? What does it have in common with respiratory distress syndrome of the newborn? What systemic effects can it have?
What is the clinical progression of disease? What are some of the ways we are looking to treat this problem?
What individuals are at risk for postoperative respiratory failure? What can be done to prevent it?
What is obstructive pulmonary disease? Is the problem worse with inspiration or expiration?
What is the major symptom of obstructive pulmonary disease? The major sign?
How does asthma differ from COPD? When does asthma usually develop? We have increased numbers and availability of antiasthmatic medications, so we are seeing a decrease in illness and death - true or false.
What are some of the risk factors for asthma? What are  the major events in an asthma attack? What are we seeing here that should remind you of allergic reactions? What is an asthmatic like during periods of remission? During an attack? What is status asthmaticus?  How is this condition managed?  Why may the regular use of bronchodilators NOT be a good idea? How does asthma differ from COPD?
What two conditions are tied together in COPD? What is the primary cause of COPD? Is the incidence decreasing or increasing? What is the pathophysiology behind chronic bronchitis? What is the best "treatment" for chronic bronchitis? Why? What can be done? What do bronchitis and asthma have in common? How does emphysema differ from these two? What is the major cause of emphysema? What is the cause of primary emphysema? Which is more difficult with emphysema, inspiration or expiration?  What are the clinical manifestations? Treatment?

Renal Structure and Function
Be able to locate your kidneys and their surrounding structures. What are the major functions of the kidneys ? What are the other structures of the urinary system? Be able to identify the macroscopic structures in a longitudinal section of a kidney.
What is the basic functional unit of the kidney? Be able to name and identify the parts of this structure. What processes take place in each part?
What makes up the filtration membrane? What does each part retain within the blood?
What factors would affect the GFR? How does the kidney maintain blood flow on a local and system level?
How is a concentrated urine produced? A dilute urine? Understand the effects of ADH, aldosterone, parathyroid hormone and ANP on the distal convoluted tubules and collecting ducts.
    What conditions affect the pH of urine?
    What conditions would affect specific gravity? How?
    What do casts, cells  or crystals in urine indicate?
    What substances are not normally found in urine? Why? What could cause their presence?
How are BUN and creatinine used to assess the health of the kidneys? Which factor is more stable? Why?

Renal Pathology
What is meant by prerenal, intrarenal and postrenal disorders? Give an example of each.
How do obstructive disorders damage the kidneys? How can a normal kidney compensate for a damaged kidney? What happens after a blockage is removed?
Look in your textbook for the three theories of why and how kidney stones are formed.
What is the most common type of kidney stones? The second most common? Which ones are formed only in an alkaline urine? Which ones can be treated by raising the pH of the urine? Which gender experiences more renal calculi? How can you reduce the risk of stones?
What are the clinical manifestations of renal calculi? How can they be treated?
What is the most common cause of cystitis? Which gender experiences more UTI's? Why?
What groups are at risk for UTI's?  What other organisms in general, and specifically can cause UTI ? How is a UTI treated?
What is nonbacterial cystitis? What can cause it?
What is acute pyelonephritis? What causes it? What could you look for in a urine specimen to distinguish it from cystitis?
What is chronic pyelonephritis? What is damaged, what effect does this have, and what can cause it?
What is glomerulonephritis? What is the most common cause? What else can cause it?
What causes acute GN, how does the damage occur, and what are the clinical manifestations?
What is rapidly progressive GN? Who is affected? What is Goodpasture syndrome? Who is affected? How does the damage occur, and how can it be treated?
What is chronic GN? What two patterns are seen in the cause?  What are the clinical manifestations, and what can we use to distinguish this from bleeding in other areas of the urinary system?
What is the difference between the nephrotic and nephritic syndromes?
What is the most common cause of acute renal failure? What do  we see clinically?
What are the other causes of acute renal failure?
What are the three stages of acute renal failure?
What is chronic renal failure? What causes it?  What is uremia and what are the symptoms?
How do we manage chronic renal failure?

Interesting stuff from chapter 26 (which is not on the exam per se). There is a lot of good information on the structure of the urinary bladder here, and how the bladder is controlled. Even though it has smooth muscle and autonomic nervous system innervation, micturition (urination) can be controlled voluntarily when cortical centers override the micturition control center in the pons. This is probably the only place in the body where we have a degree of control over smooth muscle.