Cumulative Patho Final Exam

hyperplasia

increase in # of cells

dysplasia

disordered cell growth and maturation

neoplasia

uncontrolled and abnormal cell growth

basic changes of cell injury

Na/K pump dysfunction, loss of plasma membrane integrity, protein synthesis defects, DNA damage, waste accumulation

how many Na out and how many K in?

3 out and 2 in

loss of plasma membrane

low oxygen → no more ATP → Na/K pump stops = ion imbalance, water influx, membrane swelling

protein synthesis defects example

viral infections, HIV, viruses

intracellular accumulation example

bilirubin if there is liver failure = jaundice

difference between benign and malignant neoplasm

benign = well organized and differentiated, slow growing, do not invade tissues, do not spread

malignant = cancerous, grow rapidly, invade and spread to other part of the body, abnormal and undifferentiated

endogenous vs. exogenous cell injury

endogenous = toxins, infections,

exogenous = metabolic disorders, genetic mutations, oxygen deprivation, hyperglycemia, acidosis

low ATP on protein synthesis

low levels inhibit protein synthesis. it is the primary energy source for it = cell death

where does atheriosclerosis occur?

in the endothelial layer of the arteries

cell injury reversal

restoration, removal, cloning, transplantation, stem cells

apoptosis

cells die at a specific time, natural

cell necrosis

cells die due to injury, may harm surrounding cells

gangrene

body tissue dies with lack of blood supply

therapeutic vs. reproductive cloning

therapeutic = produces embryonic stem cells to create tissues that replace injured/deceased tissues

reproductive = produces copies of whole animals

genetics

study of inherited traits and patterns of inheritance

genomics

study of all the DNA in an organism, both the parts that make proteins and the ones that don’t

T/F most mutations cause disease

false, most do not

polymorphism

common change in DNA sequence

point mutations

mutation occurring at a single point in the DNA sequence

frameshift mutation

removal of a single nucleotide, or addition of an extra nucleotide = shifts in reading frame during translation

karyotype

organized arrangement of all chromosomes in a cell = 23PAIRS

what are the autosomes?

first 22 pairs, sex chromosomes are the 23rd

genotype

set of genes inherited from parents, make a certain trait

transcription vs translation

transcription = copy of a gene/ RNA from the DNA in the nucleus

translation = RNA read in codons/3 bases for specific amino acids

what is a SNP?

single nucleotide polymorphism: ATCGTA → ATTGTA

what is GWAS?

genome wide association study = compares specific genes and traits in groups of people, all DNA at once

epigenetic

study of how behaviors, lifestyle, and environment influence genes and their expression (DO not change DNA, but how it is read)

what is CRISPR-Cas9?

Clustered Regularly Interspaced Short Palindromic Repeats

• scientists cut and edit DNA, ethical concerns

allele, genotype, gene, genome

allele = gene inherited from 1 parent

genotype = genetic code

gene = fundamental unit of DNA

genome = collection of all a person’s genes

intracellular vs interstitial vs extracellular

intra = INSIDE of a cell

inter = BTW cells and capillaries

extra = OUTSIDE of the cell

what is trans cellular fluid?

makes up 1% of fluid, in the third compartment (joints, pleural lining)

osmosis (pull)

movement oof water from LOW too HIGH

hydrostatic pressure (push)

water in the bloodstream pushes through the capillary membrane into interstitial/intracellular compartments

tonicity

ability of a solution to influence water movement across semipermeable membrane

isotonic examples

0.9% saline, lactated ringers, 5% Dextrose

what is hypotonic

IV fluid is lower than outside, 0.45% NaCl/.25% dextrose

hypertonic solution

IV fluid is higher than outside, 3% NaCL, 5% dextrose lactated ringers

osmolality vs osmolarity

osmolality = measure of concentration of solutes per Kg of solvent

osmolarity = # of osmoses of solute per Liter of solution

what is normal osmolality?

282-295 mOsm/kg

fluid excess signs

excessive aldosterone, high BP, lung crackles, weight gain, edema

fluid deficit signs

vomiting and diarrhea, weight loss, weak pulse

hypernatremia / high sodium signs

water loss, cells shrink, edema, dysphagia, dry sticky membranes, weak pulse

hyponatremia / low sodium signs

hypervolemia, anorexia, edema, BP alterations, seizures, GI upset

how fast should correcting Na+ levels go?

6-12 mEq over 24 hours

hyperkalemia / high K+ signs

paralysis, bradycardia, anxiety, cardiac arrest, cramps/weakness

hypokalemia / low K+

muscle weakness, leg cramps, hyporeflexia, cardiac arrest, confusion, hypotension, dysrhythmias

hypercalcemia / high calcium

cardiac (dysrhythmias, EKG changes, high BP)

nervous system (mood changes, confusion, coma)

renal (stones, polyuria)

GI (anorexia, pancreatitis)

musculoskeletal (weakness, decreased reflexes

decreased cell membrane excitability

hypocalcemia / low calcium

cardiac (dysrhythmias, low BP, bleeding)

neuro (anxiety, irritability)

respiratory (laryngeal spasms)

musculoskeletal (tremors, spasms, seizures)

Gi (cramping, diarrhea)

trousseau sign = carpal spasm DUCK

chvostek sign = spasm at corner of mouth or ear or cheek

hyperchloremia and hypochloremia

high chloride intake, low chloride intake

hypermagnesemia and signs

increased magnesium, same manifestations as hypercalcemia

hyperphosphatemia and signs

increased phosphorous, same manifestations as hypocalcemia

hypophosphatemia and signs

decreased phosphorous, same manifestations as hypercalcemia

normal pH levels

7.35-7.45

pH levels that lead to DEATH

6.9 < DEATH > 7.7

what are the three buffer systems?

bicarbonate-carbonic acid system

phosphate system

hemoglobin system

metabolic acidosis and alkalosis

acidosis: low HCO3, pH < 7.35, / high K+, lethargy

alkalosis: high HCO3, pH > 7.45 / confusion

respiratory acidosis and alkalosis

acidosis: high CO2, pH < 7.35 / breathing issues, lethargy

alkalosis: low CO2, pH > 7.45 / anxiety, vertigo

normal PaO2 levels

80-100 mmHg

normal PaCO2 levels

35-45 mmHg

normal PaHO3 levels

22-26 mmHg

normal SaO2 / saturation of hemoglobin with oxygen

95%-100%

how can metabolic acidosis occur? (low pH bc of too little HCO3)

loss of base through diarrhea

how can metabolic alkalosis occur? (high pH bc of excess HCO3)

loss of H+ ions by vomiting

pyrogens

hypothalamus releases molecules to cause fever and an inflammatory response

cytokines

regulates inflammation, messenger btw cells, promote leukocyte recruitment, activate macrophages

what do natural killer cells do?

destroy tumor and virus-infected cells

what are helper T-cells vs suppressor T-cells?

helper T-cells contain CD4 protein, activating B-cells for antibodies, produces cytokines

suppressor T-cells turn off antibody production

what are effector T-cells/ killer T-cells

contain CD8, that destroys infected cells by releasing lymphokines to degrade cell walls

IgE mediated hypersensitivity

IgE deals with allergens, can be severe/life threatening

treat with = steroids, epinephrine, or antihistamines

tissue specific hypersensitivity

IgG/IgM: destruction of target cell by antibody binding to tissue cell surface

• cell lysis or phagocytosis (transfusion incompatibility)

• treat: prevention

immune complex mediated hypersensitivity

IgG: antigen-antibody complexes are not properly removed from blood

• degranulation, permeability (systemic lupus, rheumatoid arthritis

cell mediated hypersensitivity

t-cells, macrophages, etc change immune response

• memory T-helper cells, macrophages increase/phagocytosis (transplant reactions from MHCs, TB skin test)

types of transplants: allogenic, syngeneic, autologous, xenogenic

allogenic = same species

synogenic = identical twin

autologous = host and donor same person

xenogeneic = different species

transplant reaction: hyper acute tissue rejection

host has antibodies against donor tissue

transplant reaction: acute tissue rejection / most common

host recognizes donor tissue as foreign

transplant reaction: chronic tissue rejection

build up of antibodies

transplant reaction: graft vs host

donor’s immune cells attack

autoimmunity general information

immune system attacks own body, not well understood

• old people

• women

• 100 types (lupus, arthritis, Type 1 diabetes, celiac disease)

immunodeficiency general information

diminished immune system

• primary: defect, congenital or genetic

• secondary: disease suppressing it (drugs, stress)

• HIV & AIDS (infect T-cell CD4)

how does AIDS work?

infect CD4 from T-cells, destroying the cells

• bodily fluid transmission

• Retrovirus: needs a host

• antibody/NAT tests and CD4 counts for AIDS

• no cure

3 stages of oncogenesis

initiation, promotion, progression

angiogenesis

new blood vessels from existing ones

autophagy

new cells from recycled cell waste

anaplasia

loss of differentiation, aggressive growth malignancy, revert to primitive state

risk factors for cancer

age, history, overweight, sun exposure, chemicals or carcinogens, diet and behavior, infection

general signs for cancer

tissue damage

pain, anorexia

cachexia (weight and muscle loss)

fatigue, sleep disorders, anemia

infection, swelling, inflammation, pressure

staging for cancer TNM

T / size and extent 0-4

N / number of lymph nodes affected 0-3

M / spread 0-1

cancer grading differentiation I-iV

l = well differentiated

lV = poorly differentiated

NLMEB normal numbers

N = 40-80%

L = 20-40%

M = 2-10%

E = 1-7%

B = 0-2%

iron anemia/pernicious anemia/hemolytic anemia/sickle cell anemia

iron = lack

pernicious = autoimmune

hemolytic = premature RBC destruction

sickle cell = abnormal shaped RBCs

anemia general signs

fatigue, pale, dizzy, cold, chest pain, shortness of breath, headache

what should ventilation/perfusion ratio be?

0.8

ventilation = 4 L/minute

perfusion = 5 L/minute

hypoxia vs hypoxemia

hypoxia = low O2 in TISSUE

hypoxemia = low O2 in BLOOD

cyanosis

bluish skin discoloration due to hypoxemia

atelectasis

collapse of small # of alveoli, reduced gas exchange

• post surgery

• can cause pneumonia

pneumonia general information

fluid in lungs from inflammation (pathogens enter airway and penetrate mucosa)

• where gas exchange occurs = reducing gas exchange

• WBC flood the alveolar walls and lungs stiffen

what can cause pneumonia?

flu, RSV, food, chemicals