Pathophysiology Study Guide: Key Terms and Concepts

Normal vitals: O2 sat

>95% O2

Normal vitals: respiration rate

12-18 breaths/minute

Normal vitals: heart rate

60-100 bpm

Normal vitals: blood pressure

<120 mmHg SBP & <80 mmHg DBP

__________ BP: <120 mmHg SBP and <80 mmHg DBP

Normal

__________ BP: 120-129 mmHg SBP and <80 mmHG DBP

Elevated

__________ BP: 130-139 mmHg SBP OR 80-89 mmHg

Stage I Hypertension

__________ BP: >140 mmHg SBP OR >90 mmHg

Stage II Hypertension

List the dermatomes of the upper body.

C2 - suboccipital (behind the ears)

C3 - subclavicular fossa

C4 - upper trapezius (shoulders)

C5 - lateral antecubital fossa

C6 - thumb

C7 - 3rd digit

C8 - 5th digit

T1 - medial antecubital fossa

List the myotomes of the upper body.

C1-C2 - cervical flexion

C3 - cervical lateral flexion

C4 - shoulder elevation

C5 - shoulder abduction

C5/C6 - elbow flexion

C6 - wrist extension

C7 - elbow extension

C8 - thumb abduction or finger flexion

T1 - finger abduction

List the deep tendon reflexes of the upper body.

C5 - biceps (musculocutaneous)

C6 - brachioradialis (radial)

C7 - triceps (radial)

How do you grade deep tendon reflexes?

0 = absent

1+ = slight reflex (hypo-)

2+ = normal

3+ = brisk reflex (hyper-)

4+ = clonus

List the dermatomes of the lower body.

L1 - upper anterior thigh

L2 - mid anterior thigh

L3 - medial femoral condyle

L4 - medial malleolus

L5 - dorsum of great toe

S1 - lateral malleolus

S2 - popliteal fossa

List the myotomes of the lower body.

L1-L2 - hip flexion

L3 - knee extension

L4 - ankle DF

L5 - great toe extension

L5-S1 - ankle PF

S1-S2 - ankle PF and eversion

List the deep tendon reflexes of the lower body.

L2-L4 - patellar (femoral)

S1-S2 - achilles (tibial)

What are the 5 cardinal signs of inflammation?

1. Erythema (redness)

2. Heat

3. Edema (swelling)

4. Pain

5. Decreased function

Overall goal: cellular responses of inflammation

Remove or eliminate injurious $ (by releasing enzymes and toxic substances that kill, inactivate, or degrade microbial agents, foreign antigens, or necrotic tissues)

What is the predominant leukocyte in acute inflammation? Chronic inflammation?

Neutrophils (acute); lymphocytes & macrophages (chronic)

What do leukocytes release to stimulate the healing process?

Growth factors

__________ is a short-lived, potent vasodilator that increases blood vessel permeability to promote vascular leakage

Histamine

___________ are chemical mediators of the inflammatory response that promote systemic inflammation (fever)

Cytokines

Overall goal: vascular changes during inflammation

Increase the movement of plasma proteins and circulating cells out of the intravascular space and into the site of injury

Vascular changes: immediate ____________ to stop blood loss --> _________ + increased capillary permeability --> platelets gather @ vascular injury site

Vasoconstriction -- vasodilation

What is the primary purpose of platelets during an inflammatory response?

Initial hemostatic plug

__________ (enzyme) converts fibrinogen --> fibrin to form the blood clot

Thrombin (component of the blood coagulation system)

What takes place in the fibrinolytic system to lyse the blood clot when it is no longer needed?

Plasminogen --> plasmin

____________: group of plasma proteins that normally lie dormant in the blood until activated by microorganisms or antigen-antibody complexes

Complement system

What are the primary functions of the complement system?

Vasodilation, chemotaxis of leukocytes

_____________ is a process within the complement system by which the surface of microbes are coated to make them vulnerable to phagocytosis

Opsonization

___________ function within the complement system to form channels in invading cells and cause cytolysis by rushing sodium inside to blow it up

Membrane attack complexes (MACs)

___________ (stage of tissue healing & repair): takes place hours after the event

Primary cellular activity: coagulation cascade begins, platelets form the initial hemostatic plug and release chemotaxins to attract inflammatory cells

Hemostasis and degeneration (stage 1 of healing)

___________ (stage of tissue healing & repair): takes place days after the event

Primary cellular activity: granulocytes protect and clean up the injury site + secrete GFs and cytokines; complement system activated

Inflammation (stage 2 of healing)

___________ (stage of tissue healing & repair): takes place weeks after the event

Primary cellular activity: inflammatory cell decline, angiogenesis, ongoing proliferation (fibroblasts and endothelial cells), fibroblasts synthesize collagen to produce the initial scar

Proliferation and migration (stage 3 of healing)

___________ (stage of tissue healing & repair): takes place months after the event

Primary cellular activity: scar tissue reduced and remodeled, fibroblasts and immune cells beginning degradation/apoptosis, myofibroblasts shrink ECM; healing achieved by regeneration and/or repair

Remodeling and maturation (stage 4 of healing)

During rapid vasodilation, endothelial cell shrinkage begins and allows _________ (process) of fluid, protein, and blood --> effusion, heat, and redness (stage 1 of healing)

Exudation

Loss of fluid --> high conc. of RBCs, increased blood viscosity, and slower blood flow (otherwise known as __________) (stage 1 of healing)

Hemostasis

Formation of a blood clot begins ___________ (stage 2 of healing)

Inflammation

Leukocytes and macrophages migrate to injury site through ____________ (stage 2 of healing)

Chemotaxis (via release of chemotaxins by platelets)

Fibroblasts, epithelial, and endothelial cells move into the wounded area to initiate formulation of ___________ (stage 2 of healing)

Granulation tissue

What is the general timeline for skeletal muscle healing?

6-8 weeks

- 1st stage (24-48 hrs) = hemostasis, hematoma, inflammation

- 2nd stage (6-8 weeks) = phagocytosis, satellite cells, and myofiber regeneration

- Final = remodeling of scar tissue and regeneration

What is the general timeline for bone healing?

8-12 weeks

- Blood vessel injury --> hematoma

- Inflammatory response --> vascular response and cellular proliferation

- Reparative phase --> neovascularization, initial fibrosis, and soft callus formation (2 wks)

- Regeneration and remodeling (no scar) --> endochondral ossification (6-12 wks)

What is the general timeline for tendons & ligaments?

3-4 months

- Hemostasis & inflammation (first 3-5 days)

- Proliferative phase (2-3 weeks)

- Maturation (begins week 3, 12-16 weeks until tendon safely able to be stressed)

- Remodeling (40-50 weeks BUT may not regain full tensile strength)

Unrelieved pressure --> ischemia --> __________ (pathology)

Pressure injuries

List several risk factors for pressure injuries.

Decreased sensation, impaired mobility, incontinence, impaired nutrition, altered cognition/consciousness

Excessive plantar pressure in the presence of sensory neuropathy and foot deformity --> __________ (pathology)

Diabetic/neuropathic ulcers

List several risk factors for diabetic/neuropathic ulcers.

Ill-fitting shoes, deformities, previous plantar ulceration, improper cleaning and lubrication of the feet, improper removal of corns or calluses, foot pressure

Muscle type: multi-nucleated w/ a large, cylindrical shape + striations (sarcomeres)

Skeletal

Muscle type: uni-nucleated w/ branching + striations (sarcomeres)

Cardiac

Muscle type: uni-nucleated w/ small, spindle shape + smooth

Smooth

Muscle type: somatic control via Ca2+ (from SR) and troponin -- fibers independent of one another

Skeletal

Muscle type: autonomic control via Ca2+ and calmodulin -- some fibers electrically linked via gap junctions, other independent

Smooth

Muscle type: autonomic control via Ca2+ (from ECF & SR) and troponin -- fibers electrically linked via gap junctions

Cardiac

Sliding filament theory: synaptic vessels in the presynaptic neuron are triggered by Ca2+ influx --> fuse w/ the presynaptic membrane --> release _________ via exocytosis

ACh

Sliding filament theory: _______________ (extensions of the sarcolemma that associate w/ terminal cisternae of the SR) bring AP to interior of cell

T-tubules

Sliding filament theory: Ca2+ released from _________

Sarcoplasmic reticulum

Sliding filament theory: Ca2+ binds to ___________ --> pulls away _________ to expose actin's binding sites

Troponin -- tropomyosin

Sliding filament theory: myosin utilizes _________ to generate power stroke

ATP

Skeletal muscle type: Type I, "red", slowest development of maximal tension BUT longest contraction duration

Slow-twitch oxidative

Skeletal muscle type: Type IIA, intermediate w/ short contraction duration

Fast-twitch oxidative-glycolytic

Skeletal muscle type: Type IIX, "white", fastest development of maximal tension BUT shortest contraction duration

Fast-twitch glycolytic

Skeletal muscle type: fatigue-resistant, most used--posture, first type to be recruited

Slow twitch oxidative (Type I)

Skeletal muscle type: fatigue-resistant, used in standing & walking, second type to be recruited

Fast twitch oxidative glycolytic (Type IIA)

Skeletal muscle type: fatigable, least used--jumping, quick, fine movements, third type to be recruited

Fast twitch glycolytic (Type IIX)

With _________ fibers, you are more likely to run out of oxygen w/ repeated contraction due to larger diameter, less myoglobin, and fewer blood vessels

Glycolytic

____________: contraction that creates force w/o movement due to series elastic elements helping to generate force w/o change in length

Isometric

___________: contraction that creates force WITH movement

Isotonic

The neurotransmitter of the somatic nervous system is ___________

ACh

Termination of neurotransmitter signaling via ACh occurs with which 3 methods?

1. Diffusion out of the synaptic cleft

2. Enzyme deactivation via AChE

3. Transport into adjacent cells or presynaptic cell for recycling

Myelin allows for ____________ (increased/decreased) contact of leaky ion channels w/ ECF, which prevents ion flow out of the cell

Decreased

__________ cells form myelin @ PNS

Schwann cells

___________ cells form myelin @ CNS

Oligodendrocytes

_____________: process that involves APs jumping from Nodes of Ranvier to avoid ion flow out of the cell

Saltatory conduction

What are 3 factors that contribute to faster AP conduction?

1. Larger diameter of the axon

2. *GREATER* resistance of the axon cell membrane to leakage out of the cell

3. Myelination

Neuron synapses of the somatic nervous system involve ______________ that are ALWAYS excitatory

Neuromuscular junctions

What is the most common disease @ NMJ? Hint: this disease involves a loss of ACh receptors.

Myasthenia gravis

Neuron synapses of the autonomic nervous system involve _____________, which include postganglionic axons that end in swollen areas called varicosities

Neuroeffector junctions

What is the hallmark characteristic of the autonomic nervous system?

Dynamic balance b/w the autonomic branches and their contrasting functions

True or false: the somatic and autonomic nervous systems include similar neurotransmitter release, which follows the same patter of depolarization --> Ca2+ influx --> exocytosis

TRUE!!

__________ (branch of the ANS): pre-ganglionic neurotransmitter = ACh @ nicotinic cholinergic receptors, post-ganglionic neurotransmitter = norephinephrine @ adrenergic receptors

Sympathetic

___________ (branch of the ANS): pre-ganglionic neurotransmitter = ACh @ nicotinic cholinergic receptors, post-ganglionic neurotransmitter = ACh @ muscarinic cholinergic receptors

Parasympathetic

PNS vs. SNS: dilates pupils & bronchioles

SNS

PNS vs. SNS: secretory to glands of bronchial tree

PNS

PNS vs. SNS: increases respiration, blood pressure, HR

SNS

PNS vs. SNS: vasodilation

PNS

PNS vs. SNS: inhibits digestion, decreases peristalsis

SNS

_________: proprioceptors that respond to changes in muscle TENSION @ junction of tendon and muscle fibers

Golgi tendon organs (GTOs)

_________: proprioceptors that respond to changes in muscle STRETCH to create a reflexive contraction of the muscle to prevent damage/injury from overstretching

Muscle spindles

_________: proprioceptors that allow for tonic activity -- resistance to stretch in relaxed muscle

Muscle spindles

What is the simplest reflex loop muscle spindles partake in?

Monosynaptic reflex loop

Which reflex type occurs ONLY in the somatic nervous system?

Monosynaptic

Which reflex type occurs in ALL autonomic reflex loops?

Polysynaptic (3+ neurons, 2+ synapses)

__________: simplest reflex in a myotatic unit (ex: patellar-tendon reflex)

Basic muscle stretch reflex

__________: relaxation of an antagonist muscle to allow unopposed contraction of the agonist muscle

Reciprocal inhibition

If all efferent motor neurons are excitatory, how does reciprocal inhibition occur?

Some branches of afferent sensory nerves synapse @ inhibitory interneurons that synapse @ motor neurons to suppress their activity

___________: reflex that results in pulling away from a noxious (painful) $

Flexion withdrawal reflex

____________: reflex that typically accompanies the flexion reflex to allow for rapid transfer of weight-bearing into the opposite leg

Crossed extensor reflex

How many pathways are required to ensure an effective crossed extensor reflex?

4 pathways

- Inhibitory to extensor muscle in limb w/ noxious $

- Inhibitory to flexor muscle in opposite limb

- Excitatory to flexor muscle in limb withdrawing from noxious $

- Excitatory to extensor muscle in contralateral limb to support weight

___________ is the MAIN $ of chemoreceptors in the blood --> increase ventilation, brochodilation

CO2

Diffusion of O2/CO2 in alveolus and capillaries is proportional to __________, _________, and ___________

Surface area, concentration gradient, barrier permeability

Diffusion of O2/CO2 in alveolus and capillaries is INVERSELY proportional to ____________

Diffusion distance^2