SARHAD UNIVERSITY OF SCIENCE & INFORMATION TECHNOLOGY,

PESHAWAR
Department: Business Administration Program: BBA B

FINAL TERM Examination-Spring 2021

Course Title: General Pathology-II Semester: Summer 2021

Course Code: Time Duration: 12 Hours
Instructor’s Name: Shumaila ijaz Total Marks: 30 (30 % weightage)
Exam Date: ____ /AUG/2021
Student’s Name: Karim Ullah
Registration No: su-17-01-154-012
Student email: [email protected]
WhatsApp Contact No: 03470520389

INSTRUCTIONS:
A) Answer all the Questions in the same Question Paper under each question/section subsequently.
B) Before uploading, save the same file in this format FINAL EXAM_DEPARTMENT_COURSE_Student Name_Reg#.doc
C) Upload it at your SUIT PORTAL before the deadline. Answer Sheet sent through EMAIL will not be accepted.
D) The total size of this file should not exceed 5MB at the time of uploading it at portal.
E) Type the answers under each question, avoid inserting unnecessary images and follow the instructions at SUIT Portal.
Copying, plagiarism, and sharing your answers with other students is strictly prohibited and marks will be deducted.

Attempt All the Questions(with-in 500 - 600 words limit).

Each Question Carries 10 marks.

At the end of each answer mention the references/sources you have used while answering the questions.
Don’t copy/paste the answers from the lecture notes at Portal.

NOTE: Strict action will be taken if two or more students are found to have same answers (copy-pasted).
Students are strictly advised not to share the answer sheets with their class fellows.
For Teacher’s Use
(Marks Obtained and
Comments if any)

Q1: What do you know about Asthma? Explain types of asthma.

Answer: 1
Asthma:

 Asthma is an inflammatory disease of the airways to the lungs. It makes breathing difficult and
can make some physical activities challenging or even impossible.

 To understand asthma, it’s necessary to understand a little about what happens when you breathe.

 Normally, with every breath you take, air goes through your nose or mouth and down into your
throat and into your airways, eventually making it to your lungs.

 There are lots of small air passages in your lungs that help deliver oxygen from the air into your
bloodstream.

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  Asthma symptoms occur when the lining of your airways swell and the muscles around them
tighten. Mucus then fills the airways, further reducing the amount of air that can pass through.

 These conditions can then bring on an asthma “attack,” the coughing and tightness in your chest
that’s typical of asthma.

 Asthma is a chronic condition that affects the airways. It causes wheezing and can make it hard to
breathe. Some triggers include exposure to an allergen or irritant, viruses, exercise, emotional
stress, and other factors.

There are many types of asthma,

Types of asthma:
1: Allergies and Asthma:
Allergies and asthma often go hand-in-hand. Allergic rhinitis (also called hay fever) is inflammation of
the lining of the nose and is the single most common chronic allergic disease. In those with allergic
rhinitis, increased sensitivity (allergy) to a substance causes your body’s immune cells to release
histamines in response to contact with the allergens. Histamines, along with other chemicals, lead to
allergy symptoms. The most common allergens enter the body through the airway.

With allergic rhinitis, you may feel a constant runny nose, ongoing sneezing, swollen nasal passages,
excess mucus, weepy eyes, and a scratchy throat. A cough may result from the constant postnasal drip.
Many times, asthma symptoms are triggered by allergic rhinitis.

2: Exercise-Induced Asthma:
Exercise-induced asthma is triggered by exercise or physical exertion. Many people with asthma have
some symptoms with exercise. But there are many people without asthma, including Olympic athletes,
who get symptoms only during exercise.

With exercise-induced asthma, airway narrowing peaks 5 to 20 minutes after exercise begins, making it
difficult to catch your breath. The symptoms begin within a few minutes of starting exercise and peak or
worsen a few minutes after stopping exercise. You may have symptoms of an asthma attack, with
wheezing and coughing. Your doctor can tell you if you need to use an asthma inhaler (bronchodilator)
before exercise to prevent these uncomfortable asthma symptoms.

3: Seasonal asthma:

This type of asthma occurs in response to allergens that are only in the surrounding environment at
certain times of year. For example, cold air in the winter or pollen in the spring or summer may trigger
symptoms of seasonal asthma.

People with seasonal asthma still have the condition for the rest of the year, but they usually do not
experience symptoms.

4: Cough-Variant Asthma:
In cough-variant asthma, severe coughing is the main symptom. There can be other causes of coughing,
such as postnasal drip, chronic rhinitis, sinusitis, or gastroesophageal reflux disease (GERD or heartburn).
Coughing because of sinusitis with asthma is common.
Cough-variant asthma is vastly underdiagnosed and undertreated. Asthma triggers for cough-variant
asthma are usually respiratory infections and exercise.

For any persistent cough, contact your doctor. They may order specific asthma tests, such as lung
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function tests, to show how well your lungs work. You might need to see a lung specialist for further tests
before an asthma diagnosis is made.

5: Occupational Asthma:
Occupational asthma results from workplace triggers. The list of known triggers is long and varied, but
they are usually things that you breathe in (or inhale). With this type of asthma, you might have trouble
breathing and asthma symptoms just on the days you're on the job.
Many people with this type of asthma have a runny nose and congestion, eye irritation, or a cough instead
of the typical asthma wheezing.
Occupational asthma can happen in almost any line of work or any work environment, including offices,
stores, hospitals, and medical facilities.

6: Chronic asthma:
Also called persistent asthma, this condition is defined by daily symptoms or those which recur several
times a week. The intensity of symptoms may be quite variable, but there are no long periods without
symptoms. Acute exacerbations may supervene at any time upon the chronic course of the disease. These
may be traced in some cases to seasonal increase in air allergens or viral pathogens that provoke airway
inflammation. Chronic asthma must be correctly identified in a patient to ensure proper intervention
strategies.

Q2: (a) What do you know about the ethiology and pathophysiology of renal calculi?

Answer 2A:
Etiology of renal calculi:
Renal stones are crystalline mineral depositions that form from microscopic crystals in the loop of Henle,
distal tubules, or the collecting duct. This is usually in response to elevated levels of urinary solutes, such
as calcium, uric acid, oxalate, and sodium, as well as decreased levels of stone inhibitors, such as citrate
and magnesium. Low urinary volume and abnormally low or high urinary pH also contribute to this
process. All of these can lead to urine supersaturation with stone-forming salts and subsequent stone
formation. Supersaturation depends on urine pH, ionic strength, solute concentration, and solute chemical
interaction. The higher the concentration of two ions, the more likely they are to precipitate out of
solution and form crystals. As ion concentrations increase, their activity product reaches the solubility
product (Ksp). Concentrations above this point can initiate crystal growth. Once crystals are formed, they
either pass out with the urine or become retained in the kidney, where they can grow and stones can form.
In urine, even when the concentration of calcium oxalate exceeds the solubility product, crystallization
may not occur because of prevention from urinary inhibitors. Both urinary calcium and oxalate are
important and equal contributors to calcium oxalate stone formation. Several factors increase calcium
oxalate supersaturation in urine. These include low urine volume and low citrate, and increased calcium,
oxalate, and uric acid.

Pathophysiology of renal calculi:

Most urinary stones start as Randall's plaque at the junction of the nephron's collecting tubule and the
renal pelvis in the papilla. These plaques start suburothelial and then gradually grow until they break
through into the renal pelvis. Once in continuous contact with urine, layers of calcium oxalate typically
start to form on the calcium phosphate nidus (all Randall's plaques are composed of calcium phosphate).
Calcium oxalate stones tend to form when the urinary pH is under 7.2, while calcium phosphate will form
in the more alkaline urine. Hyperparathyroidism and similar metabolic disturbances like renal tubular

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acidosis typically form stones that are primarily or significantly composed of calcium phosphate. Overly
acidic urine is the primary cause of uric acid stones (not hyperuricosuria).

The majority of renal calculi are made of calcium, followed by urare crystals. Supersaturation of the urine
is the common denominator in all cases of renal calculi. In some cases, calcium oxalate stones may
deposit in the renal papilla. Calcium phosphate stones usually precipitate in the basement membrane of
the thin loop of Henle and may erode into the interstitium. The colicky pain s usually due to the dilatation
and spasm of the ureter.

(b) Elaborate the types of renal calculi?

Answer 2B :
There are four types of kidney stones:
1. calcium oxalate,
2. uric acid,
3. struvite, and
4. cystine.

1 : Calcium oxalate,
Calcium stones are the most common. They’re often made of calcium oxalate (though they can consist of
calcium phosphate or maleate). Eating fewer oxalate-rich foods can reduce your risk of developing this
type of stone. High-oxalate foods include:

 potato chips
 peanuts
 chocolate
 beets
 spinach
However, even though some kidney stones are made of calcium, getting enough calcium in your diet can
prevent stones from forming.

2: Uric acid:
This type of kidney stone is more common in men than in women. They can occur in people with gout or
those going through chemotherapy.

This type of stone develops when urine is too acidic. A diet rich in purines can increase urine’s acidic
level. Purine is a colorless substance in animal proteins, such as fish, shellfish, and meats.

3: Struvite:
This type of stone is found mostly in women with urinary tract infections (UTIs). These stones can be
large and cause urinary obstruction. They result from a kidney infection. Treating an underlying infection
can prevent the development of struvite stones.

4: Cystine:
Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria.
With this type of stone, cystine — an acid that occurs naturally in the body — leaks from the kidneys into
the urine.

Q:3 Explain in detail Hypertensive heart disease?

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Answer 3:

What is hypertensive heart disease?

 Hypertensive heart disease refers to heart conditions caused by high blood pressure.
 The heart working under increased pressure causes some different heart disorders. Hypertensive heart
disease includes heart failure, thickening of the heart muscle, coronary artery disease, and other
conditions.
 Hypertensive heart disease can cause serious health problems. It’s the leading cause of death from
high blood pressure.
 Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium, and
coronary arteries as a result of chronic blood pressure elevation. Hypertension increases the workload
on the heart inducing structural and functional changes in the myocardium. These changes include
hypertrophy of the left ventricle, which can progress to heart failure. Patients with left ventricular
hypertrophy have significantly increased morbidity and mortality, but current treatment follows
standard hypertension guidelines as the effects of pharmacotherapy on regression of left ventricular
hypertrophy has unclear benefits.

 Hypertensive heart disease is subclassified by the presence or absence of heart failure as the
management of heart failure requires more intensive goal-directed therapy. Hypertensive heart
disease can lead to either diastolic heart failure, systolic failure, or a combination of the two. Such
patients are at a higher risk for developing acute complications such as decompensated heart failure,
acute coronary syndrome, or sudden cardiac death. Hypertension disrupts the endothelial system
which increases the risk of coronary artery disease and peripheral arterial disease and thus represents
a significant risk factor for the development of atherosclerotic disease. However hypertensive heart
disease ultimately encompasses all of the direct and indirect sequelae of chronic high blood pressure
which include systolic or diastolic heart failure, conduction arrhythmia especially atrial fibrillation,
and increased risk of coronary artery disease.

Types of hypertensive heart disease:

In general, the heart problems associated with high blood pressure relate to the heart’s arteries and
muscles. The types of hypertensive heart disease include:

1 :Narrowing of the arteries:

Coronary arteries transport blood to your heart muscle. When high blood pressure causes the blood
vessels to become narrow, blood flow to the heart can slow or stop. This condition is known as coronary
heart disease (CHD), also called coronary artery disease.

CHD makes it difficult for your heart to function and supply the rest of your organs with blood. It can put
you at risk for heart attack from a blood clot that gets stuck in one of the narrowed arteries and cuts off
blood flow to your heart.

2: Thickening and enlargement of the heart:

High blood pressure makes it difficult for your heart to pump blood. Like other muscles in your body,
regular hard work causes your heart muscles to thicken and grow. This alters the way the heart functions.
These changes usually happen in the main pumping chamber of the heart, the left ventricle. The condition
is known as left ventricular hypertrophy (LVH).
CHD can cause LVH and vice versa. When you have CHD, your heart must work harder. If LVH
enlarges your heart, it can compress the coronary arteries.

Testing and diagnosis:

Your doctor will review your medical history, conduct a physical exam, and run lab tests to check your
kidneys, sodium, potassium, and blood count.
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One or more of the following tests may be used to help determine the cause of your symptoms:

 Electrocardiogram monitors and records your heart’s electrical activity. Your doctor will attach
patches to your chest, legs, and arms. The results will be visible on a screen, and your doctor will
interpret them.
 Echocardiogram takes a detailed picture of your heart using ultrasound.
 Coronary angiography examines the flow of blood through your coronary arteries. A thin tube
called a catheter is inserted through your groin or an artery in your arm and up into the heart.
 Exercise stress test looks at how exercise affects your heart. You may be asked to pedal an
exercise bike or walk on a treadmill.
 Nuclear stress test examines the flow of blood into the heart. The test is usually conducted while
you’re resting and exercising.

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