Advanced Patho Exam 1 Review
Questions with Detailed Answers
Define and differentiate the following: physiologic and pathologic atrophy; physiologic
and pathologic hypertrophy; compensatory hyperplasia - ANSWERSPhysiologic atrophy
occurs with early development; for example, the thymus gland involutes and atrophies.
Pathologic atrophy occurs as a result of decreases in workload, use, pressure, blood
supply, nutrition, hormonal stimulation, and nervous stimulation.
Hypertrophy is an increase in the size of cells caused by increased work demands or
hormonal stimulation. Hypertrophy can be physiologic or pathologic. With physiologic
hypertrophy, preservation of myocardial structure characterizes postnatal development,
moderate endurance exercise training, pregnancy, and the early phases of increased
pressure and volume loading on the adult human heart. This physiologic response is
temporary, however, and aging, strenuous exercise, and sustained workload or stress
lead to pathologic hypertrophy with structural and functional manifestations.
Compensatory hyperplasia is an adaptive mechanism that enables certain organs to
regenerate. For example, removal of part of the liver leads to hyperplasia of the
remaining liver cells (hepatocytes) to compensate for the loss.
Explain why excess sodium and water occur intracellularly during hypoxic cell injury -
ANSWERSA reduction in ATP levels causes the plasma membrane's sodium-potassium
(Na+-K+) pump and sodium-calcium exchange to fail, which leads to an intracellular
accumulation of sodium and calcium, resulting in cellular swelling and diffusion of
potassium out of the cell. Because all cells are bathed in a fluid rich in calcium ions, cell
membrane damage allows rapid movement of calcium intracellularly. The movement of
water and ions into the cell causes early dilation of the endoplasmic reticulum. Dilation
causes the ribosomes to detach from the rough endoplasmic reticulum, resulting in
reduced protein synthesis. With continued hypoxia, the entire cell becomes markedly
swollen, with increased concentrations of sodium, water, and chloride and decreased
concentrations of potassium.
Determine what mechanisms occur in the liver after lipid accumulation in liver cells -
ANSWERS1. Increased movement of free fatty acids into the liver (starvation, for
example, increases breakdown of triglycerides in adipose tissue, releasing fatty acids
that subsequently enter liver cells) 2. Failure of the metabolic process that converts fatty
acids to phospholipids, resulting in the preferential conversion of the fatty acids to
triglycerides 3. Increased synthesis of triglycerides from fatty acids (in-creases in
amounts of the enzyme α-glycerophosphatase, which can accelerate triglyceride
synthesis) 4.Decreased synthesis of apoproteins (lipid-acceptor proteins) 5. Failure of
lipids to bind with apoproteins and form lipoproteins 6. Failure of mechanisms that
transport lipoproteins out of the cell 7. Direct damage to the endoplasmic reticulum by
free radicals released by alcohol's toxic effects
, Define and determine purpose of apoptosis - ANSWERSApoptosis has been called "cell
suicide" and can occur in normal and pathologic states. Apoptosis is essential for
removing redundant and senescent (old or dying) cells from the body; this often occurs
when an important growth factor is no longer available to the cell (e.g., breast cells at
menopause no longer have estrogen as a growth factor). It can also result in the
degeneration of vital tissues in response to tissue injury and inflammation.
Describe how the body reestablishes equilibrium when solute is added to extracellular
fluid, making it hypertonic - ANSWERSWhen changes to the extracellular fluid volume
(ECV) osmolality occur, water moves from the compartment with lower osmolality to the
compartment with higher osmolality until osmotic equilibrium is reestablished. In other
words, the distribution of fluid between the ICF and the ECV occurs by osmosis
Delineate those at risk for fluid imbalance - ANSWERSOn average, the body consists of
one-third extracellular and two-thirds intracellular fluid. This proportion can vary as a
function of body age, size, and the proportion of muscle versus fat, as muscle contains
considerably more water than fat contains. Consider the following: Infants: 70-80%
water; kidneys immature; surface area is proportionally larger, more rapid respirations
Elderly: 46-52% water; declining kidney function; heart failure; mental deterioration;
multiple meds, especially diuretics Obese: < 52% water because fat holds less water
than muscle; fat is hydrophobic (water repelling)
Compare and contrast capillary hydrostatic and oncotic pressure; interstitial hydrostatic
and oncotic pressure - ANSWERS1.Capillary hydrostatic pressure (blood pressure)
facilitates the outward movement of water from the capillary to the interstitial space.
2.Capillary (plasma) oncotic pressure osmotically attracts water from the interstitial
space back into the capillary. 3.Interstitial hydrostatic pressure facilitates the inward
movement of water from the interstitial space into the capillary. 4.Interstitial oncotic
pressure osmotically attracts water from the capillary into the interstitial space
Explain the primary factors in regulation of water balance - ANSWERSWater balance is
regulated by: Antidiuretic hormone (ADH)/vasopressin- secreted when plasma
osmolality increases or circulating blood volume decreases & B/P drops Perception of
thirst- symptoms activate hypothalamic osmoreceptors, causing thirst Baroreceptors
(volume/pressure sensitive receptors)- also stimulate release of ADH Aldosterone-
regulates Na+ and K+ conservation and excretion by kidneys Natiuretic hormones-
stimulates kidneys to increase Na+ and water excretion (opposite of ADH)
Correlate the clinical manifestations of hypernatremia to its pathophysiology -
ANSWERSSerum sodium levels > 147 mEq/L Water is redistributed to the extracellular
space, and intracellular dehydration ensues. Thirst, fever, dry mucous membranes,
hypotension, tachycardia, low jugular venous pressure, and restlessness are associated
with hypernatremia as a result of water loss. Pulmonary edema occurs when water
shifts from the ICF to the interstitial space. Central nervous system symptoms are the
most serious and are related to alterations in membrane potentials and shrinking of
Questions with Detailed Answers
Define and differentiate the following: physiologic and pathologic atrophy; physiologic
and pathologic hypertrophy; compensatory hyperplasia - ANSWERSPhysiologic atrophy
occurs with early development; for example, the thymus gland involutes and atrophies.
Pathologic atrophy occurs as a result of decreases in workload, use, pressure, blood
supply, nutrition, hormonal stimulation, and nervous stimulation.
Hypertrophy is an increase in the size of cells caused by increased work demands or
hormonal stimulation. Hypertrophy can be physiologic or pathologic. With physiologic
hypertrophy, preservation of myocardial structure characterizes postnatal development,
moderate endurance exercise training, pregnancy, and the early phases of increased
pressure and volume loading on the adult human heart. This physiologic response is
temporary, however, and aging, strenuous exercise, and sustained workload or stress
lead to pathologic hypertrophy with structural and functional manifestations.
Compensatory hyperplasia is an adaptive mechanism that enables certain organs to
regenerate. For example, removal of part of the liver leads to hyperplasia of the
remaining liver cells (hepatocytes) to compensate for the loss.
Explain why excess sodium and water occur intracellularly during hypoxic cell injury -
ANSWERSA reduction in ATP levels causes the plasma membrane's sodium-potassium
(Na+-K+) pump and sodium-calcium exchange to fail, which leads to an intracellular
accumulation of sodium and calcium, resulting in cellular swelling and diffusion of
potassium out of the cell. Because all cells are bathed in a fluid rich in calcium ions, cell
membrane damage allows rapid movement of calcium intracellularly. The movement of
water and ions into the cell causes early dilation of the endoplasmic reticulum. Dilation
causes the ribosomes to detach from the rough endoplasmic reticulum, resulting in
reduced protein synthesis. With continued hypoxia, the entire cell becomes markedly
swollen, with increased concentrations of sodium, water, and chloride and decreased
concentrations of potassium.
Determine what mechanisms occur in the liver after lipid accumulation in liver cells -
ANSWERS1. Increased movement of free fatty acids into the liver (starvation, for
example, increases breakdown of triglycerides in adipose tissue, releasing fatty acids
that subsequently enter liver cells) 2. Failure of the metabolic process that converts fatty
acids to phospholipids, resulting in the preferential conversion of the fatty acids to
triglycerides 3. Increased synthesis of triglycerides from fatty acids (in-creases in
amounts of the enzyme α-glycerophosphatase, which can accelerate triglyceride
synthesis) 4.Decreased synthesis of apoproteins (lipid-acceptor proteins) 5. Failure of
lipids to bind with apoproteins and form lipoproteins 6. Failure of mechanisms that
transport lipoproteins out of the cell 7. Direct damage to the endoplasmic reticulum by
free radicals released by alcohol's toxic effects
, Define and determine purpose of apoptosis - ANSWERSApoptosis has been called "cell
suicide" and can occur in normal and pathologic states. Apoptosis is essential for
removing redundant and senescent (old or dying) cells from the body; this often occurs
when an important growth factor is no longer available to the cell (e.g., breast cells at
menopause no longer have estrogen as a growth factor). It can also result in the
degeneration of vital tissues in response to tissue injury and inflammation.
Describe how the body reestablishes equilibrium when solute is added to extracellular
fluid, making it hypertonic - ANSWERSWhen changes to the extracellular fluid volume
(ECV) osmolality occur, water moves from the compartment with lower osmolality to the
compartment with higher osmolality until osmotic equilibrium is reestablished. In other
words, the distribution of fluid between the ICF and the ECV occurs by osmosis
Delineate those at risk for fluid imbalance - ANSWERSOn average, the body consists of
one-third extracellular and two-thirds intracellular fluid. This proportion can vary as a
function of body age, size, and the proportion of muscle versus fat, as muscle contains
considerably more water than fat contains. Consider the following: Infants: 70-80%
water; kidneys immature; surface area is proportionally larger, more rapid respirations
Elderly: 46-52% water; declining kidney function; heart failure; mental deterioration;
multiple meds, especially diuretics Obese: < 52% water because fat holds less water
than muscle; fat is hydrophobic (water repelling)
Compare and contrast capillary hydrostatic and oncotic pressure; interstitial hydrostatic
and oncotic pressure - ANSWERS1.Capillary hydrostatic pressure (blood pressure)
facilitates the outward movement of water from the capillary to the interstitial space.
2.Capillary (plasma) oncotic pressure osmotically attracts water from the interstitial
space back into the capillary. 3.Interstitial hydrostatic pressure facilitates the inward
movement of water from the interstitial space into the capillary. 4.Interstitial oncotic
pressure osmotically attracts water from the capillary into the interstitial space
Explain the primary factors in regulation of water balance - ANSWERSWater balance is
regulated by: Antidiuretic hormone (ADH)/vasopressin- secreted when plasma
osmolality increases or circulating blood volume decreases & B/P drops Perception of
thirst- symptoms activate hypothalamic osmoreceptors, causing thirst Baroreceptors
(volume/pressure sensitive receptors)- also stimulate release of ADH Aldosterone-
regulates Na+ and K+ conservation and excretion by kidneys Natiuretic hormones-
stimulates kidneys to increase Na+ and water excretion (opposite of ADH)
Correlate the clinical manifestations of hypernatremia to its pathophysiology -
ANSWERSSerum sodium levels > 147 mEq/L Water is redistributed to the extracellular
space, and intracellular dehydration ensues. Thirst, fever, dry mucous membranes,
hypotension, tachycardia, low jugular venous pressure, and restlessness are associated
with hypernatremia as a result of water loss. Pulmonary edema occurs when water
shifts from the ICF to the interstitial space. Central nervous system symptoms are the
most serious and are related to alterations in membrane potentials and shrinking of
