Pathophysiology & Disease Management Flashcards

A patient presents with a 3-day history of high fever, productive cough, and new RUL infiltrate. Blood cultures and sputum culture are sent. The CNS recognizes the clinical and radiographic presentation most consistent with community-acquired pneumonia (CAP). Which scoring tool best guides hospital admission vs. outpatient management decision?

Answer: PSI (Pneumonia Severity Index) or CURB-65 score to stratify mortality risk and guide site-of-care decisions

PSI (PORT score) and CURB-65 are validated CAP risk stratification tools that guide admission decisions — CURB-65 is simpler (5 criteria) and widely used in clinical practice.

A patient with lupus (SLE) develops progressive dyspnea and bilateral pleural effusions. Urinalysis shows 3+ protein and RBC casts. Complement C3 and C4 are markedly low. What pathophysiological process best explains the renal findings?

Answer: Lupus nephritis — immune complex deposition in glomeruli activates complement leading to inflammatory destruction of glomerular architecture

RBC casts indicate glomerulonephritis; low complement levels and active SLE suggest lupus nephritis — immune complex deposition in glomeruli drives complement-mediated glomerular destruction.

A 75-year-old patient with Parkinson's disease is admitted for aspiration pneumonia. The CNS reviews the pathophysiology of aspiration risk in Parkinson's disease. Which mechanism primarily contributes to aspiration risk?

Answer: Impaired pharyngeal and laryngeal motor function due to dopaminergic deficiency and motor fluctuations

Parkinson's disease causes impaired pharyngeal and laryngeal motility through dopaminergic deficiency, directly disrupting the complex motor coordination required for safe swallowing.

A patient develops massive pulmonary embolism with hemodynamic instability (BP 80/50, HR 125, SpO2 82% on 15L NRB). Which pathophysiological cascade accounts for the hemodynamic instability?

Answer: Acute right ventricular pressure overload leading to RV dilation and dysfunction, reduced LV filling, low cardiac output, and systemic hypotension

Massive PE causes acute RV pressure overload — the RV dilates, interventricular septum shifts, LV filling is impaired (reduced preload), causing obstructive shock.

A 50-year-old patient with alcohol use disorder is admitted with jaundice, ascites, and spider angiomata. Laboratory findings: total bilirubin 8.5 mg/dL, albumin 2.1 g/dL, PT/INR 2.8, creatinine 0.9 mg/dL. Which pathophysiological mechanism explains the development of ascites in cirrhosis?

Answer: Portal hypertension plus splanchnic vasodilation plus hypoalbuminemia leading to fluid transudation into the peritoneal cavity via Starling forces

Cirrhotic ascites results from portal hypertension (increased hydrostatic pressure) combined with splanchnic vasodilation and hypoalbuminemia (reduced oncotic pressure) altering Starling forces.

A CNS is reviewing the pathophysiology of type 2 diabetes with a nursing team. Which sequence best describes the progressive pathophysiological mechanisms from normal glucose tolerance to established type 2 diabetes?

Answer: Insulin resistance (muscle, liver, adipose) leading to compensatory hyperinsulinemia leading to progressive beta cell exhaustion leading to relative insulin deficiency and hyperglycemia

Type 2 DM progression: insulin resistance in peripheral tissues leads to compensatory pancreatic insulin overproduction, then gradual beta cell loss, then relative insulin deficiency, and clinical hyperglycemia.