exam l study guide

Pathophysiology Tamut

Identify the 8 functions of cells and which cells perform those functions

1. Movement: muscle cells

2. Conductivity: nerve cells

3. Metabolic absorption: all cells

4. Secretion: mucous gland cells

5. Excretion: all cells

6. Respiratory: mitochondria

7. Reproduction

8. Communication: homeostasis

Why is cellular communication so important?

To maintain homeostasis

How do neurons communicate with the cells they innervate?

Synapses

Briefly describe cellular metabolism and what organic compound is needed?

• anabolism and catabolism

  • ATP is needed

What is diffusion?

Greater to lesser concentration

What is filtration

Hydrostatic pressure

What is osmosis

Water goes through selectively permeable membrane

What is active transport

Active transport moves molecules against the concentration gradient, requiring energy (usually ATP) for cellular uptake.

What type of pressure is associated with blood pressure?

Hydrostatic pressure

What is the most common example of aneuploidy and what increases the risk for this to occur?

• down syndrome (trisomy 21)

• Maternal age

Identify two examples of sex chromosome aneuploidy

Turner syndrome and Klinefelter syndrome

what is turner syndrome

• female aneuploidy

• patho: XO

• s/s: webbed neck, short stature, wide spaced nipples

what is klinefelter syndrome?

• male aneuploidy

• patho: XXY

• s/s: small testes, enlarged breats, long arms, sparse body hair, delayed language

List abnormalities of chromosomal structure

Breaks, duplication, inversion, translocation, fragile site

Which autosomal dominant disease has a delayed age of onset? Why is it concerning?

• Huntington disease

• If they had kids, it increases the risk for their children

What is the most common autosomal disease that is fatal in children?

cystic fibrosis

List examples of X-linked recessive disorders

color blindness, DMD, hemophilia A & B

Epigenetic modifications can be caused by numerous factors in the environment. What is the result of DNA methylation?

Inactivation of tumor suppressor geners and activation of oncogenes

List adaptive changes that occur in cells

Atrophy, hypertrophy, hyperplasia, metaplasia, dysplasia

Compare hypoxia and anoxia

• hypoxia: reduced oxygen

• Atrophy: lack of oxygen

What is ischemia?

• Reduced blood flow

• Could cause narrowing/stenosis

• Obstruction r/t clot

List some unintentional injuries

Burns, falls, poisoning, drowning, motor vehicles

What are the hemoprotein pigments and identify which is associated with jaundice

Hemoglobin, hemsosiderin, bilirubin

• jaundice: bilirubin

Compare necrosis and apoptosis

• necrosis: passive cell death

  • Apoptosis is active cell death

Differentiate between 1st line of defense and 2nd line of defense

• 1st: innate immunity (natural; saliva, tears, cough)

• 2nd: inflammation (limits the extent of infection)

What are the clinical manifestation of inflammation

Redness, heat, swelling, pain, loss of function

Compare localized inflammation to systematic inflammation

• localized: Erthyema, warmth, edema, pus, clots, pain

• Systematic: fever, sputum, leukocytosis, plasma proteins

Review the clotting system

Forms a fibrinous mesh work of fibrin strands and platelets at an injured/inflammed site

What are the types of wound exudate

• Serous: watery

• Serosanguineos: combo of water/blood

• Sanguineous: blood

• purulent: pus

• Fibrinous: thick/clotted

What is a natural killer cell?

Lymphocyte that eliminates cells w viruses and cancer

Provide an example of dysfunctional collagen synthesis during wound healing

Keloids and hypertrophic scars

Define cytokines and list some examples

Cell responsible for activating other cells and regulating inflammatory response

Explain the difference between origin of T cells and B cells

• T: thymus derived

• B: bone marrow derived

How does aging affect immunity?

• Decreased antibody response to antigens

• Decreased t-cell activity

• Thymic hormone production drops, as does the organ’s ability to mediate T-cell differentiation

List the classes of antibodies. Which is the most abundant for most of protective activity against infection

IgG (most abundant), IgA, IgM, IgD, IgE

List types of hypersensitivity reactions and examples of each

• Type 1: vomitting

• Type 2: graves

• Type 3: raynaud phenomenon

• Type 4: graft rejection

Compare autoimmunity with alloimmunity

• auto: disturbance in the immunologic tolerance of self antigens

• Allo: immune reaction to tissues of another individual

Compare primary immune deficiency with secondary immune deficiency

• primary immune deficiency: congenital, genetic anomaly

  • Secondary immune deficiency: caused by another illness, more common

Terms associated with communicability

Immunogenicity, infectivity, mechanism of action, pathogenicity, portal of entry, toxigenicity, virulence, endemic, epidemic, pandemic

List the stages of infection

Incubation period, prodromal stage, invasion/acute illness period, convalescence

Flu virus shift and drift

Minor change: antigenic drift

Major change: antigenic shift

List the two most common causes of antibiotic resistance

• Lack of compliance w drug regimen

• Overuse of antibiotics

List stages of general adaptation syndrome and what happens at each stage

• alarm (triggers happen axis); activates sns

  • Inc blood vol, blood glucose

  • Inc epinephrine, norepinephrine

• Resistance

  • Dec hormone levels, blood pressure

  • Dec HR and cardiac output

• Exhaustion (allostatic overload)

  • Body no longer able to defend

Define allostasis and allostatic overload

• stasis: stability through change

• Static: over activation of adaptive system, may lead to disease

List key physiological changes associated with adaptive roles of stress systems

Hypothalamic-pituitary-adrenal axis, sympathetic nervous system, immune system, hormones

Compare benign and malignant tumors

• benign: grow slowly, well-define capsule, not invasive, well differentiated, low miotic index, does not metasize

• Malignant: grow rapidly, not encapsulated, invasive, poorly differentiated, high miotic index, metastasis

Explain how cancers are named and list several

Body part, -oma

• ex: carcinoma, adenocarinoma, sarcoma, lymphoma, lipoma, leukemia

Define angiogenesis

Growth of new blood vessels

Explain tumor suppressor genes

Encode proteins that in their normal state negatively regulate proliferation

What is the difference between protoconcogenes and oncogenes?

Proto: normal

Onco: mutant

Explain WHO method for staging cancer

TNM system

• T (tumor): This category describes the primary tumor's size and extent of invasion into nearby tissues.

• N (node): This category indicates whether the cancer has spread to nearby lymph nodes, and if so, how many nodes are affected.

• M (metastasis): This category indicates whether the cancer metastasized to distant parts of the body beyond the primary tumor and regional lymph nodes.

List 5 methods for treating cancer:

Surgery, radiation, chemotherapy, immunotherapy, targeted therapy

What are common side effects of cancer and cancer therapy?

• Anemia: bleeding, lack of nutrition

• Bone density loss: hormone treatment

• Cachexia: most extreme form of malnutrition due to cancer. Cytokines and metabolites from the tumor may contribute

• Fatigue: chemotherapy

• Alopecia: radiation is more localized on hair follicles

• Infertility, lymphedema, pain

Define tumor marker

Diagnose specific types of tumors, screen high risk ppl, observe clinical course of cancer

List environmental/lifestyle influences on the development of cancer (risk factors)

Tobacco, diet, obesity, alcohol, physical activity, radiation, HPV, pollution

At what age does cancer appear?

• It can occur at any time.

• Most commonly in children under the ages of 5 and in teens 15-19.

• More common in white males

What is leukemia and lymphoma?

Leukemia: cancer in the blood

Lymphoma: cancer in the lymph system

What are osteosarcoma and Ewing’s sarcoma?

Bone tumors

Wilm’s tumor

Kidney cancer

What are neuroblastoma and retinoblastoma

Embryonal tumors that begin during intrauterine life

Define ECF and ICF

• ECF: all the fluid outside the cells and comprises abt one-third of TBW. Includes interstitial fluid, intravascular fluid, and the various transcellular fluids

• ICF: all the fluid within cells and comprises abt two-thirds of TBW(total body water)

Which electrolytes are in each?

1. ECF: sodium, chloride, potassium, calcium

2. ICF: phosphates, magnesium, sodium, chloride, potassium, calcium

Total body water percentages for adults vs infants

1. normal

   1. adult male: 60%

   2. adult female 50%

   3. infant: 70%

What are some key points related to

1. ​Aldosterone: mineralcorticoid synthesized and secreted from the adrenal cortex

2. ​Antidiuretic hormone (ADH): water balancing hormone. Posterior pituitary secretes it. Also called vasopressin and oxytocin

3. Renin/angiotensin:

   1. helps control how much water and salt you have. When your body needs more water or if your blood pressure is too low, it sends a signal (renin) to start a process that ends up making a powerful hormone called angiotensin II. This hormone helps tighten your blood vessels, holds onto water and salt, makes you thirsty, and gives your heart a little extra kick to keep everything running smoothly. So, it's like your body's own superhero team, keeping everything in balance!

4. Natriuretic peptides

   1. Hormones primarily prod by the myocardium

   2. released when the transmural atrial pressure inc

   3. natural antagonists to the renin-angiotensin-aldosterone system.

   4. cause vasodilation and inc sodium and water excretion, decreasing blood pressure

What four major mechanisms cause edema?

1. capillary hydrostatic pressure: venous obstruction or salt and water retention.

   1. excessive salt and water retention

2. decreased plasma oncotic pressure: plasma proteins, especially albumin, is lost or diminished

   1. serous drainage from open wounds

3. Increased capillary membrane permeability: inflammation and immune responses

   1. trauma, especially burns

4. lymphatic channel obstruction: lymphatic channels are blocked

   1. lymphedema

Differentiate between localized and generalized edema.

1. Localized: limited to a single body region, often at the site where trauma has occurred 

2. generalized edema: a more uniform distribution of fluid writhing the interstitial spaces throughout the body

Define pitting edema

An indentation or pit left in the skin indicates the pretense of edema

List clinical manifestations of edema.

Inc BP, weight gain, swelling, puffiness, limited mvmt of affected joints, >145 sodium

Management/nursing interventions for edema.

Diuretics, elevating edematous limbs, applying compression stockings, avoiding prolonged standing, restricting salt intake

Define dehydration

Water deficit

List 4 causes of dehydration

Lack of fluid intake, hemorrhage, sweating, vomiting, diarrhea

List clinical manifestations of dehydration.

thirst, headache, weight loss, dry mouth, sunken eyes, tachycardia

Define isotonic, hypertonic, hypotonic.

1. Isotonic: gain or loss of ECF resulting in concentration equivalent to 0.9% NaCl solution. 

2. Hypertonic: imbalances that result in ECF concentration >0.9% NaCl solution

3. hypotonic: imbalance that results in ECF <0.9% salt solution

   1. ​What happens with the cells?

      1. isotonic: no shrinking or swelling of cells

      2. hypertonic: cell shrinks

      3. hypotonic: cell swells

List normal sodium, potassium, calcium levels.

1. Na: 135-145 mEq/L

2. K: 3.5-5.0 mEq/L

3. Ca: 8.5-10.5 mg/dL

Compare hyper/hyponatremia common causes and clinical manifestations.

1. hypernatremia

   1. common causes: water retention, congestive heart failure, prolonged vomiting, inappropriate IV administration of 5% D5W to replace fluid loss

   2. clinical manifestations: impaired nerve function, edema, weight gain, thirst, lethargy, muscle twitches, coma, tachycardia, dry mouth, high blood pressure

2. hyponatremia

   1. common causes: inadequate water intake, excessive sweating, use of loop diuretics, infusion of hypertonic saline solutions in an effort to replace sodium in cases of salt depletion

   2. clinical manifestations: thirst, weight loss, sunken fontanels in infants, hard stools, low blood pressure, weak pulses, oliguria

Compare hyper/hypokalemia and hyper/hypocalcemia common causes and clinical manifestations.

1. hyperkalemia

   1. common causes: increased intake, decreased renal excretion, drugs that decrease renal potassium excretion

   2. Clinical manifestations: ECG changes, anxiety, vomiting, oliguria, (early:hyperactive muscles), (late: weakness and placid paralysis)

2. hypokalemia

   1. common causes: reduced intake of potassium, increased mvmt of potassium into the cells, and increased losses of potassium

   2. clinical manifestations: ECG changes, cardiac arrest, lethargy, distention, water loss, weakness, constipation, 

3. hypercalcemia

   1. common causes: hyperparathyroidism, bone mentases with calcium resorption from breast, prostate, renal, and cervical cancer, sarcoidosis, excess vitamin D, many tumors that produce PTH

   2. clinical manifestation: fatigue, lethargy, anorexia, constipation, kidney stones, bradycardia, osteoporosis 

4. hypocalcemia

   1. Common causes: Related to inadequate intestinal absorption, deposition of ionized calcium into bone or soft, tissue, blood administration, or decreases in PTH and vitamin D; nutritional deficiencies, occur with inadequate sources of dairy products or green leafy vegetables

   2. clinical manifestations: increased neuromuscular excitability, tingling, muscle spasm, intestinal cramping, hyperactive bowel sounds, cardiac arrest

List the three mechanisms by which the body maintains normal pH. How quickly does each respond?

1. physiological: immediately

2. respiratory system: seconds to minutes

3. renal system: hours to days 

List the four major acid-base imbalances and for each identify two causes. List the clinical manifestations for each.

1. Respiratory acidosis

   1. causes: hypoventilation, chronic obstructive pulmonary disease (COPD)

   2. clinical manifestations: headache, drowsiness, confusion, dysrhythmias, warm and flushed skin

2. respiratory alkalosis

   1. causes: hyperventilation, mechanical ventilation

   2. clinical manifestations: light-headedness, numbness and tingling in extremities, seizures, tachycardia, hyperventilation

3. metabolic acidosis

   1. Causes: diabetic ketoacidosis and renal failure

   2. clinical manifestations: kussmaul respirations, vomiting, abdominal pain, weakness, confusion

4. metabolic alkalosis

   1. causes: prolonged vomiting, excessive intake of antacids

   2. clinical manifestations: muscle twitching, tetany, hypertonic muscles, confusion