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Pathophysiology Exam 1 Study Guide
** Select all means the question is a select all that apply **
Module 1
1. What happens during the alarm phase of Hans Selye’s General Adaptation Syndrome?
Initial reaction-Fight or flight, physiological response to stress. Catecholamines (norepinephrine and epinephrine are released) (The sympathetic nervous system)The adrenal medulla releases epinephrine and some norepinephrine. The adrenal cortex produces glucocorticoids, increase in sympathetic nervous system, reduce resistance to stressors.
2. Remember this is the fight or flight stage. What clinical findings would the patient in the
fight or flight stage present with? (Select All)
Increased heart rates, breathing rate and blood sugar, pupils dilate.
3. The four components of Pathophysiology (Select all)
Etiology, pathogenesis, manifestations and treatment implications.
4. Prevention and treatment of disease- eg. Primary, Secondary, Tertiary
Primary- Does not have the disease and is trying to prevent it, vaccines. Secondary Disease detection- testing, Tertiary- Trying to prevent problems from the disease or problem. Treatment and rehabilitation, medications, reduce the risk for complications.
5. What compounds does the body release during stress?
Catecholamines include neurotransmitters such as dopamine, epinephrine (adrenaline) and norepinephrine (noradrenaline), and cortisol
6. How is fluid between interstitial and intracellular compartments distributed?
Through the cell membrane and mainly by osmosis
7. How fluid is lost or excreted from the body?
sweating, breathing, urination, feces, blood loss. Excess fluid or sodium losses, nephrosis, Diabetes 1 & 2, burns, wounds, ascites, effusions, water pill excess and osmotic diuresis.
8. How do we lose fluid from extracellular compartment?
Through the interstitial fluids (edema), intravascular space (blood) and transcellular space (joints, we removed it) Inadequate fluid intake, output via sweating, urinations, respiration and defecation, dehydration vomiting, diarrhea and hemorrhage.
9. What is potential and fatal complication of hyponatremia?
cerebral edema
10. Priority assessment for a patient with a potassium imbalance? Cardiac, EKG and Labs,
troponin level
11. Symptoms of dehydration?
Absence of urine, decreased skin turgor, hard stools and rapid thread pulse, thirst, altered LOC, hypotension and hypovolemic shock, tachycardia, flat jugular veins, dry mucus membranes, oliguria, weight loss, sunken fontanelles (infants)
12. Cause of edema?
excess fluid trapped within the interstitial compartment. An increase of capillary
hydrostatic pressure, excess sodium or water intake (high sodium diet, psychogenic
polydipsia, hypertonic fluid admin, free water and enteral Fluid builds up in the interstitial
space from sodium imbalance
13. What hormones assist with potassium distribution (I discussed 2 main hormones in the
webex lecture)
Insulin helps move potassium in and out of the cell and Epiepherine(I mentioned 2 but I stressed one main hormone in the webex lecture)
14. Extracellular fluid has higher concentration of which electrolytes/substances.
Sodium, as the primary extracellular electrolyte, controls the osmolarity (either too much
or too little) of the extracellular fluid.
15. The energy currency of a cell and role the mitochondrion plays in this currency.
ATP, mitochondria make ATP with the use of glycogen and oxygen
16. Three electrolytes that impact bone.
Calcium, magnesium and phosphorus and they have a Calcium has an inverse relationship with phosphorus and a synergistic relationship with magnesium. When calcium levels go up, phosphorus goes down, and vice versa. Calcium needs magnesium to fully function as well as
balance its effects.
Module 2
1. Passive Immunity
Receiving antibodies from external sources-maternal breast milk or IV transfer of
Immunoglobulins-short lived.
2. What is active (acquired) immunity?
Immunity from actually having the disease or getting the vaccine. Develop immunity through having the disease. Long lasting. Maturation of memory B cells.
8. What do histamines do? found in mast cells and basophils. Immune system mediator
Cause vasodilation. Bring WBC to cite of injury, blood vessels dilate. Swelling bronchial
constriction, itching. See B cells and Mast cells. Creates hypersensitivity.
9. A lab test that can measure inflammation.
Sed rate (ESR) or CPK and plasma viscosity CRP
10. What is metastasis?
Cancer cells escape their tissue of origin and initiate new colonies of cancer in distant sites. (Spreading to other parts of the body quickly)
11. What is cachexia?
Patient that looks really sick, overall weight loss (skin to bone), generalized weakness, malnutrition (muscle wasting syndrome), loss of appetite, nausea, vomiting, increased metabolic rate.
12. What are the properties of cancer cells? (Select All)
New rapid cellular growth, spreads quickly (metastasis), fatal, highly undifferentiated, abnormal cell growth, decrease in functionality invade local tissues and migrate to distant sites and kill host Risk factors for cancer- family history (genetics), gene mutations, aging, smoking, sun exposure, HPV, chronic inflammation asbestos.
13. The effects of bone marrow suppression in cancer patients (We discussed 3 of these)
Fewer RBC, platelets, and WBC (anemia, leukopenia, thrombocytopenia)
14. Identify examples of types of malignant cells (Select All)
Varied in size and shape, many undifferentiated, Mitosis increased and atypical. New rapid growth spreads quickly (metastasis), fatal, highly undifferentiated, abnormal cell growth, decrease in functionality invade local tissues and migrate to distant sites and kill host Risk factors for cancer- family history (genetics), gene mutations, aging, smoking, sun exposure, HPV, chronic inflammation asbestos.
15. Identity examples of benign cells (Select All)
Similar to normal cells, differentiated, frequently encapsulated, normal mitosis, slow
growing, expands in mass (width) usually doesn’t cause death, found frequently in the
brain. Remains localized, Rare, found only in certain locations.
16. Steps in carcinogenesis
Initiation- involves the exposure of the cell to a substance or event. Promotion- involves the mutated cells’ exposure to factors (e.g., hormones, nitrates, or nicotine) that promote growth. Initiation of uncontrolled growth. Progression- the tumor invades, metastasizes (spreads), and becomes drug resistant. This final phase is permanent or irreversible.
17. What are T lymphocytes and B lymphocytes (T cells and B cells)?
T Lymphocytes are Produced in the bone marrow and mature in the thymus—hence “T” cell;
include two major types that work to destroy antigens—regulator cells and effector cells.
B-Lymphocytes are Cells that mature in the bone marrow, where they differentiate into
memory cells or immunoglobulin-secreting (antibody) cells; eliminate bacteria, neutralize bacterial toxins, prevent viral reinfection, and produce immediate inflammatory response.
Bilateral symmetric polyarthritis involving smaller joints (hands, wrist, knees, feet elbows, and shoulders) Malaise, fatigue, and diffuse musculoskeletal pain Swelling, Swan neck, Boutonniere deformity in joint. Autoimmune disorder.
3. Conditions which result from excessive immune response
Autoimmune disease, RA, Lupus, MS,Psoriasis. Type 3 hypersensitivity.
4. What activity is appropriate for osteoarthritis?
Water therapy (whirlpool, water aerobics), acupuncture, tai chi and yoga (activities that work directly on strengthening your bones and provide cardiovascular benefits)
5. What is atopic dermatitis? IgE reaction type 1, eczema,
Chronic inflammatory condition triggered by an allergen. Inherited tendency may be
accompanied by asthma and allergic rhinitis. Has remissions and flare ups, Usually
resolves by adulthood, Causes skin infections from itching, neurodermatitis, eye
problems, found on arms, knees lower legs Thickened skin
6. What is psoriatic arthritis?
If the patient has both arthritis and psoriasis they get psoriatic arthritis
7. What causes gout?
Disturbance of purine metabolism, excessive build up; acute episodes caused by uric acid crystals in joints. (Hyperuricemia). Common in the big toe or lower extremities. Painful.
8. Osteoporosis etiology
is a condition characterized by a progressive loss of bone calcium that leaves the bones brittle. It occurs with age, decline in bone mass, from hormonal changes, especially in women at menopause age, Deficient intake of protein, vitamin C, and vitamin D as well as excessive intake of phosphorus. Individuals who have had gastrointestinal procedures such as a gastrectomy or gastrointestinal bypass are at particular risk of developing osteoporosis because of the nutritional deficits that often occur as a result of these surgeries.
9. The best prevention for Pressure ulcers/injuries is to perform what intervention?
Turn patient every 2 hrs, get patient out of bed into a chair, keep vulnerable areas clean and dry, avoid over sedating the patient, look for malnutrition with albumin and prealbumin (measures how long nutrition has been bad)
10. Complications of compartment syndrome
Amputation, necrosis, muscle damage, nerve damage, 5 P’s, numbness & tingling
11. The 5 P’s of compartment syndrome
Pain. Pressure. Paresthesia (numbness). Paralysis. Pulselessness.
12. What is muscular dystrophy?
A group of myopathies that cause progressive weakness and loss of muscle mass. Abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle. Mainly in men by 5-6 & most will eventually need to use a wheelchair by 12-14; lifespan is often shortened 20-30s.
13. What is Fibromyalgia?
A disorder characterized by widespread chronic musculoskeletal pain accompanied by fatigue, tenderness, sleep, memory and mood issues.
14. What is osteoarthritis?
Most common; occurs when the protective cartilage that cushions the ends of your bones wears over time. Can damage any joint, but most common in weight bearing joints like knees, hips and spine. Not autoimmune or inflammatory
15. Bones cancers and their properties: properties of cancer are all the same. Usually are
secondary to another cancer. Risk factor is Paget’s disease.
Type 4 cell medicated, involves a delayed processing of the antigen by macrophages. Once
processed, the antigen is presented to the T cells (usually helper or cytotoxic cells), resulting in the release of cytokines that cause inflammation and antigen destruction. These reactions can cause severe tissue injury and fibrosis. Examples of type IV reactions include tuberculin skin testing, transplant reactions, and contact dermatitis. Treatment for type IV reactions is disease specific. No antibodies involved (IgG, IgM, IgE)
22. Types of Bone Breaks:
Complete- Bone is broken into two or more pieces. Incomplete-Bone is partially broken, ex: Greenstick fracture. Open or compound-Skin is broken, and bone sticks out. Damage to skin and infection can occur. Closed -Skin is intact Impacted-When one end of the bone is forced into the adjacent bone. Pathologic-Weakness in the bone from secondary condition, osteoporosis Stress-Repeated excess stress, usually on the tibia, femur and metatarsals Depressed- Piece of skull breaks off and is forced inward toward the brain.
23. Simple fracture-single break in bone with bone ends maintaining their alignment and position.
24. Types of Simple Fractures-
Transverse Fracture-A fracture straight across the bone
Oblique fracture-Fracture at an angle
Spiral fracture- fracture that twists around the bone shaft.
Comminuted fracture-Characterized by multiple fracture lines and bone pieces
Greenstick fracture-Incomplete fracture bone is bent, and only outer curve of the bone is
broken. Common in children due to minimal calcification.
Compression fracture-Bone crushes or collapses into small pieces, vertebrae.
Lecture notes: test review
Hypernatremia-dehydration. Too much salt in extracellular compartment is not enough
water in the intravascular compartment.
Two causes of hyponatremia? Fluid volume excess, Excessive fluid intake, too much salt intake. Occurs in the intravascular compartment. Sodium imbalance primary physical assessment is the heart. Osteomalasia is the adult form of rickets, bone softening from not enough vitamin D calcium or phosphate deficiency. Improper nutrition. Leaves the bones weak and soft. Anaplasia-Lack of differentiated features in a cancer cell
Cells need glucose for energy Negative feedback loop-counteracts changes in the body to regain homeostasis. Pathogenesis- How the disease develops and evolves. Facilitated diffusion uses a carrier molecule. Intracellular fluid-Inside the cell Extracellular fluid-outside the cell Fluid build up in the interstitial compartment causes edema. Intravascular- Fluid in the bloodstream Transcellular fluid- fluid in compartment (joint) Isotonic-equal amounts on both side of the cell Hypertonic- Higher solute concentration, fluid shifts in the cell Hypotonic-Lower solute concentrations, fluid shifts out of the cell Aldosterone-Regulates blood pressure, increases reabsorption of water and sodium in the kidneys. Helps to hold sodium in the kidneys. Atrial Natriuretic Peptide-Releases when there is fluid overload-Triggers the kidneys to release the excess fluid-suppresses Aldosterone. Water intoxication occurs in which part of the cell? Intracellular space, inside the cell Ischemia-Decrease in the amount of blood flow going to tissue. Hypoxia-Decrease in oxygen going to a cell or a tissue/organ. Hypoxemia-Decrease of circulatory oxygen in the blood. Metaplasia- the replacement of one differentiated cell type with another.
. Injury that occurs when blood flow is diminished to tissue is called Ischemic injury. The activities of the cell are directed by which cell structure? The Nucleus A metastatic tumor is one that: has spread to a location away from its site of origin. Eccrine glands , which are also known as merocrine glands, secrete sweat through skin pores in response to the sympathetic nervous system. Apocrine glands open into hair follicles in the axillae, scalp, face, and external genitalia. G.A.S 3 STAGES 1-Alarm stage-initial reaction 2-Resistance- adaptation Limit stressor 3- Exhaustion Adaptation failingdisease develops. Innate defense barriers- Defenses we are born with-skin, (chemicals saliva), has an immediate response. 1-Inflammatory response- Vascular reaction. Triggered by mast cells- Manifestations are erythema, edema, warmth heat and pain. 2-Pyrogens- Fever producing molecules in response to bacteria-produced by macrophages and creates a hostile environment for the bacteria.
