3325 Exam #1

Alright — this is the capstone.
What you asked for is not “notes,” it’s a compressed mental model of Exam 1 built from everything you provided:

  • Learning guides (Modules 1A, 1B, 2, 3A, 3B)

  • Student bullet questions

  • Review-session notes

  • Exam 1 concepts list

  • Sherpath emphasis

  • Faculty language patterns

What follows is a true Exam 1 MUST-KNOW MASTER GUIDE.
If a concept is not here, it is either low yield or redundant.
If it is here, you should be able to recognize it instantly in a scenario.

NURS 3325 — EXAM 1 MUST-KNOW MASTER GUIDE

(Cellular Injury, Inflammation, Immunity, Genetics, Cancer, Fluids & Acid-Base)

SECTION I — CELLULAR BIOLOGY & INJURY (FOUNDATION)

Cellular Adaptations (KNOW DEFINITIONS + SCENARIOS)

  • Atrophy → ↓ cell size

    • Disuse, aging, denervation, ischemia

  • Hypertrophy → ↑ cell size (NOT number)

    • Increased workload (heart, skeletal muscle)

  • Hyperplasia → ↑ cell number

    • Hormonal stimulation, wound healing

  • Metaplasia → replacement of one mature cell type with another

    • Chronic irritation (smoking → squamous cells)

  • Dysplasia → abnormal growth, precancerous

  • Anaplasia → loss of differentiation (hallmark of cancer)

👉 Failed adaptation → cell injury → cell death

Cellular Injury

  • MOST COMMON CAUSE: Hypoxia

  • Ischemia = ↓ blood flow → hypoxia

  • ↓ ATP → Na⁺/K⁺ pump failure → cell swelling (early, reversible)

  • Reperfusion injury → ROS damage

Cell Death

Apoptosis

  • Programmed

  • No inflammation

  • Normal or pathologic

Necrosis (ALWAYS inflammatory)

  • Uncontrolled

  • Cell swelling + membrane rupture

Types of Necrosis (MATCH TO ORGAN)

  • Coagulative → ischemia (heart, kidney)

  • Liquefactive → brain, abscess

  • Caseous → TB

  • Fat → pancreatitis, breast trauma

  • Gangrenous → ischemic limb

  • Gas gangrene → Clostridium (medical emergency)

SECTION II — INFLAMMATION (VERY HIGH YIELD)

Purpose of Inflammation

  • Remove injury

  • Neutralize pathogens

  • Prepare for repair

Cardinal Signs

  • Redness (vasodilation)

  • Heat (↑ blood flow)

  • Swelling (↑ permeability)

  • Pain (bradykinin, prostaglandins)

  • Loss of function

Acute vs Chronic Inflammation

Feature

Acute

Chronic

Duration

Short

Long

Cells

Neutrophils

Macrophages, lymphocytes

Outcome

Resolution

Fibrosis, scarring

First responders = NEUTROPHILS

Plasma Protein Systems

  • Complement → opsonization, chemotaxis, cell lysis

  • Clotting → fibrin mesh, localizes injury

  • Kinin → bradykinin = pain + permeability

SECTION III — IMMUNITY (EXAM FAVORITE)

Lines of Defense

  1. Skin, mucosa

  2. Innate immunity

  3. Adaptive immunity

Innate Immunity

  • Immediate, nonspecific

  • Neutrophils, macrophages, NK cells

  • Complement

  • No memory

Adaptive Immunity

  • Specific, memory-based

  • B cells → antibodies

  • T cells → cellular immunity

T Cells

  • CD4 (Helper) → activate immune response

  • CD8 (Cytotoxic) → kill infected cells

  • Regulatory T cells → tolerance

  • Memory T cells → faster re-exposure response

Immunoglobulins (MEMORIZE: “GAMED”)

  • IgG → most abundant

  • IgA → secretions (breast milk, saliva, GI)

  • IgM → first antibody produced

  • IgE → allergies, anaphylaxis

  • IgD → B-cell regulation

Hypersensitivity Reactions

  • Type I (IgE) → anaphylaxis

  • Type II → transfusion reactions

  • Type III → immune complexes (SLE)

  • Type IV → delayed, T-cell (TB skin test)

Anaphylaxis (MUST RECOGNIZE)

  • IgE mediated

  • Hives, airway swelling, hypotension

  • Medical emergency

Immune Deficiencies

  • Primary → congenital

  • Secondary → HIV, chemo, steroids

HIV

  • Destroys CD4 cells

  • AIDS = CD4 < 200

  • Opportunistic infections

SECTION IV — INFECTION & MICROBIOLOGY

  • Virulence = ability to cause disease

  • Endotoxins = Gram-negative (lipid A) → septic shock

  • Exotoxins = proteins, secreted

  • Viruses = require host cell

  • Fungi = budding

  • Parasites = symbiotic

  • Fever = hallmark of infection

SECTION V — GENETICS & EPIGENETICS

Genetics

  • Point mutations

  • Frameshift mutations

  • Silent mutations (no amino acid change)

  • Genotype ≠ phenotype

Epigenetics

  • Changes gene expression, NOT DNA sequence

  • DNA methylation → gene silencing

  • Histone modification

  • Non-coding RNA

Key idea:
Same genes ≠ same disease expression

SECTION VI — CANCER BIOLOGY (HUGE)

Cancer Cell Characteristics

  • Anaplasia

  • Invasion

  • Metastasis

  • Angiogenesis

  • Loss of contact inhibition

Cancer Types

  • Carcinoma → epithelial

  • Sarcoma → connective tissue

  • Lymphoma → lymphatic

  • Leukemia → bone marrow

  • Adenocarcinoma → glandular

Cancer Development

  1. Initiation

  2. Promotion (reversible)

  3. Progression (irreversible)

Metastasis

  • Lymphatic

  • Hematogenous

  • Common sites: lungs, liver, brain, bone

Cancer Staging

  • TNM

  • Stage 0 = carcinoma in situ

  • Stage IV = distant metastasis

Cancer Risk Factors

  • Smoking (complete carcinogen)

  • Obesity

  • Alcohol

  • Age

  • Genetics (5–10%)

BRCA1 / BRCA2

  • Tumor suppressor genes

  • Breast & ovarian cancer risk

SECTION VII — FLUIDS & ELECTROLYTES (3A)

Fluid Compartments

  • ICF → potassium

  • ECF → sodium

    • Plasma

    • Interstitial

Water follows sodium

Edema

  • ↑ hydrostatic pressure

  • ↓ oncotic pressure (albumin)

  • ↑ permeability

  • Lymphatic obstruction

Sodium

  • Hyponatremia → neuro symptoms

  • Hypernatremia → dehydration, thirst

Potassium

  • Hypokalemia → weakness, dysrhythmias

  • Hyperkalemia → peaked T waves, cardiac arrest

SECTION VIII — ACID–BASE (3B)

Normal Values

  • pH: 7.35–7.45

  • PaCO₂: 35–45

  • HCO₃⁻: 22–26

ROME METHOD

  • Respiratory → pH Opposite PaCO₂

  • Metabolic → pH Equal HCO₃⁻

Disorders

  • Respiratory acidosis → hypoventilation

  • Respiratory alkalosis → hyperventilation

  • Metabolic acidosis → DKA, renal failure, diarrhea

  • Metabolic alkalosis → vomiting, NG suction

Compensation

  • Lungs = fast

  • Kidneys = slow

  • Compensation never overcorrects

FINAL EXAM STRATEGY

When you read a question, immediately ask:

  1. Cellular injury or immune?

  2. Acute or chronic?

  3. Innate or adaptive?

  4. Genetic or epigenetic?

  5. Benign or malignant?

  6. Local or systemic?

  7. Acid or base? Lung or kidney?

Bottom Line

If you can:

  • Identify the mechanism

  • Match the organ/system

  • Predict the next physiologic effect

You will score very high on Exam 1.